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DEV + ageing > postnatal development lecture and tutorial > Flashcards

postnatal development lecture and tutorial Flashcards

1
Q

at what stage is adult heigh+ growth influenced the most by genetics? prenatal or postnatal?

A

prenatally genetics of the baby have a minor effect overall on adult height/ growth
vs postnatally genetics Largely determine final adult height
Sex chromosomes have an effect:
XY boys are taller than XX girls

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2
Q

since we saw the babies genes dont influence prenatal growth much, what does influence the babies growth prenatally?

A

maternal size - birth size
maternal factors oVERRIDE fetal genetic factors in determining prenatal growth

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3
Q

what is the effect of paternal genetic factors on prenatal growth?

A

little effect

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4
Q

what are the main endocrine factors influencing prenatal growth?

A

Insulin and insulin-like growth factors (IGFs) are major prenatal hormones influencing growth:

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5
Q

at what stage is GH responsible for growth?

A

ONLY POSTNATALLY -MAJOR HORMONE controlling growth but prenatally it doesn’t influence growth AT ALL

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6
Q

what is the role of IGF-2 in growth?

A

MOST important growth factor for EMBRYONIC growth

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7
Q

what is the role of IGF-1

A

MOST important growth factor for later fetal and infant growth

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8
Q

what two things are very relevant/ influential to prenatal nutrition?

A

placental health
maternal diet (influences nutritional availability)

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9
Q

why is the placenta so important in prenatal growth?

A

Placenta provides all NUTRIENTS to growing fetus, therefore essential for growth

Placenta also controls HORMONES necessary for fetal growth

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10
Q

most common cause of intrauterine growth restriction?

A

Placental insufficiency most common cause of intrauterine growth restriction

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11
Q

a fact that highlights the key role of placenta in growth? (abnormality related)

A

Placental insufficiency most common cause of intrauterine growth restriction

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12
Q

what fact illustrates that adequate nutrition is essential for growth postnatally?

A

Starvation due to lack of substrate availability as a can limit growth POTENTIAL

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13
Q

as a result of what does obesity MOSTLY occur postnatally?

A

excessive intake of food

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14
Q

what may poor nutrition lead to in terms of growth postanatlly?

A

DELAY the ONSET of puberty

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15
Q

what may malabsorption of nutrients cause postnatally?

A

reduced growth

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16
Q

what two environmental factors are important for fetal growth prenatally? and which is most important?

A

uterine capacity and placental sufficiency.
placental function is MORE INFLUENTIAL

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17
Q

WHAT environmental factors are important to growth postnatally?

A

Socioeconomic status
Chronic disease
Emotional status
Altitude (mediated by lower oxygen saturation levels)

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18
Q

comment on the size of the head at birth.

A

Head disproportionately large for the body (1/3rd vs 1/7th in adulthood) at birth

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19
Q

how long does the most rapid postnatal growth stage last and when does it occur?

A

infantile stage, for approx 2 years

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20
Q

what is the state of the cranial sutures at birth? what happens to them during early years and by what month exactly?

A

Cranial sutures open at birth, close by 18months

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21
Q

four recognised phases of growth in order + their length ?

A

Fetal (prenatal)
Infantile 0-18 months
Childhood 18 months- 12 yrs
Pubertal 12 yrs+

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22
Q

rank the growth phases for % contribution to adult height

A

1) childhood 40%
2) fetal (in uterine environmetn) 30%
3) infantile and pubertal both 15)

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23
Q

outline some important factors influencing growth in infantile and then childhood stages

A

good health and happiness
,thyroid hormones, nutrition,
but for childhood endocrine regulation is increasing, moving from this largely nutrition based to more GH and genetic and thyroid horm…

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24
Q

factors influencing pubertal growth

A

rising levels of testosterone and oestrogen ( sex hormones)
also boost hGH production

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25
Q

what is the fastest growth phase over whole life course?

A

fetal phase

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26
Q

what are 2 important differences about growth rate in infantile vs fetal growth phases?

A

1) fetal is higher rate
2) Fetal is ACCELERATING vs infantile is DECELERATING

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27
Q

compare how much growth occurs during fetal vs infantile phase

A

fetal: Fetus repeatedly doubles in size over gestation

infantile: Length increases by 50%, head circumference by 30% and weight triples from birth

28
Q

compare the growth happening in fetal (prenatal) vs postnatal phases on a CELLULAR level

A

Growth mainly driven by HYPERPLASIA (number of cells) during fetal life:

~42 cycles of cell division before birth,

~only further five cycles of cell division occur from birth to adulthood.
so more cell SIZE growth

  • this also adds up with growth being largely NUTRITION dependent at infantile phase
29
Q

what happens to the growth rate during childhood and puberty

A

childhood theres a steady prolongued growth and then puberty a sudden growth spurt

30
Q

compare how much growth happens in childhood and puberty.

A

childhood:
5-6 cm annual increase in height, and 3-3.5kg annual increase in weight

pubertal
25cm (XY boys) ~20cm (XX girls) increase in height over 3-4 years

childhood slower but more overall growth bc it lasts longer - more years

but puberty more growth per year- greater rate

31
Q

what physiological mechanism ensures that puberty is only a TEMPORARY growth spurt?

A

although they boost GH, sex hormones also eventually cause fusion of growth plates

32
Q

what are the 6 different phases of reproductive hormones over life and what happens in each

A

fetal- development of sexual organs and the GnRH network- the actual physical brainparts - rise in HPG activity

then HPG activity drops

neonatal- priming of HPG axis called MINI- puberty (lasts around first 6 months of life)

childhood- low/ no HPG activity linear growth and developmental milestones,

adolescence- increasing HPG activity: sexual maturation

adult: HPG activity stabilizes - straight line

33
Q

2 phases where we see greatest increase in HPG axis activity

A

neonatal (Mini puberty) and puberty

34
Q

two phases where HPG axis activity is linear, not changing

A

childhood ( constant no activity )
adulthood (constant activity)

35
Q

what is the pattern of gonadotrophin secretion throughout prenatal and postnatal development

A

prenatal:
1) GONADOTROPHIN (LH +FSH) secretion starts towards the END of the 1st TRIMESTER, peaks MID PREGNANCY then declines

postnatal
2) HPG axis transiently activated after birth (MINI PUBERTY) due to release form restraint by placental hormones
continues for around 6 months after birth before declining

36
Q

what is different about the pattern of oestorgen compared to testosterone and at what stage?

A

after birth, testosterone increases (peaks around 2 months) then decreases while oestrogen keeps fluctuating around every months

37
Q

role of elevated sex steroids during mini puberty in males

A

important for normal gonadal development (WITHOUT spermatogenesis)

38
Q

role of minipuberty in females

A

less clear,
there is follicular development occuring in the ovary at that time so could be that
maybe important for patterning and development of mammary tissue?

39
Q

other than gonadal development and sex- related development, what other thing can the sex steroids in minipuberty also influence later in life?

A

programming of body composition and linear (height) growth.
ex. High testosterone levels in boys during minipuberty, may partly explain the higher growth velocity observed in boys compared to girls.

40
Q

what triggers puberty and what influences its onset

A

Control of puberty onset remains unclear, but influenced by metabolic status.

41
Q

what is one possible amechanism triggering puberty and what is the evidence for it

A

1) KNDy neurons (Kisspeptin/Neurokinin B/Dynorphin)
2) release neurokinin,
3) regulating release of KISSPEPTIN peptides,
4) which act on GnRH neurons to promote pulsatile GnRH release

proof:
Mutations in KISS1R affect puberty timing, implicating Kisspeptin-KISS1R signalling in regulation of this process.
(ex a silencing mutation leads to no pubertyect)

42
Q

what is consonance

A

COMPLIANCE with a PREDICTABLE PATTERN of developmental events during PUBERTY

43
Q

has consonance changed in the past?

A

yes,
age of menarche decreased by 4 yrs 1850s - 1960s then by 3 more months per decade form 1977-2013

44
Q

when do pubertal processes typically start and end for girls and boys

A

8- 16.5 GIrls

10.5-18 boys

44
Q

what is the consonance for female pubertal developmental events

A

breast budding
pubic hair
(the first two start together ish)
growth spur
menarche
armpit hair
body shape
adult breast size

45
Q

what is the consonance for male pubertal developmental events

A

scrotal and testicular growth
change in voice
(first two start together ish)
penile lengthening
pubic hair
growth spur
body shape changes
facial and armpit hair

46
Q

what are the developmental domains

A

gross motor skills
fine motor skills
social behaviour and play skills
speech, language and hearing skills

47
Q

developmental milestones by median age

A
48
Q

what are the aims of the NHS healthy child programme

A

PREVENT disease,
PROMOTE good health

aims to be
universal in order to reduce health inequalities

49
Q

just some epidimiological stats illustrating why theres need for NHS healthy child programme

A

1 in 25 children are born with a genetic disorder,

1 in 45 children with a congenital birth defect,

1 in 10 experience some kind of developmental delay in childhood.

50
Q

what specific processes does healthy child programme carry out?

A

Health Promotion (Obesity prevention is a key aspect)

Supporting care giving and care givers

(in my head these match thematically)
immunisation
Screening
Identification of high-risk families/ individuals for additional support

Signposting for
accident prevention
dental hygiene

51
Q

Fundamentals of a Good Screening Test…

A

relating to the disease its screening for:
1) able to be identified early
2) treatable
3) able to prevent mortality/ reduce morbidity

acceptable and easy to administer
cost effective
reproducible and accurate results

52
Q

Examples of Important Early Childhood Screening:

A

newborn check
newborn hearing screen
blood spot check (the blood analysis from heel prick - collection method)

53
Q

NHS health and development baby reviews, which are they, when do they hapena dn what do they include?

A

Newborn physical exam (within 72h) – weight, eyes, heart, hips and testes

Blood spot test (within 7d, ideally d5) – CF, Sickle Cell, congenital hypothyroidism, inherited metabolic diseases (eg PKU)

Newborn hearing test (3-5 weeks) – sometimes done in hospital before discharge, can be done up to 3 months

Infant physical exam (6-8 weeks) – with GP, as newborn physical, with length and head circumference – opportunity to discuss vaccinations.

54
Q

what is sure start?

A

programme trying to prevent for stuff, has succeded in reducing accidents in older kids (10-11) even though intervention is in earlier years

has also reduced inequalities

invests a lot in childrens community centres (day care schools ect)

aims to help support families with under 5s in LOW INCOME HOUSEHOLDS

PARENT AND CHILD EDUCATION

55
Q

what is global developmental delay

A

SIGNIFICANT delay in reaching 2 or more developmental milestones

56
Q

what is specific developmental disorder

A

refers to delays in developmental domains
in the absence of sensory deficits, suboptimal intelligence
or poor educational environment.

  • learning disorders
  • motor skill disorders
  • communication disorders
57
Q

causes of global developmental delays

A

Chromosomal abnormalities
e.g. Down’s syndrome, Fragile X

Metabolic
e.g. hypothyroidism, inborn errors of metabolism

Antenatal and perinatal factors
Infections, drugs, toxins, anoxia, trauma, folate deficiency

Environmental-social issues

Chronic illness

58
Q

Causes of motor skill developmental delay

A

As an aspect of global developmental delay

Cerebral palsy

Congenital dislocation of the hip

Muscular dystrophies

Neural tube defects

Social deprivation

59
Q

Causes of language skill developmental delay

A

Hearing loss

Autism spectrum disorders

Lack of stimulation

Impaired comprehension of language – e.g. developmental dysphasia

Impaired speech production – e.g. stammer, dysarthria

60
Q

what are some tests testing for language skill development and what age is each appropriate for

A

Schedule of growing skills (0-5y)

Griffiths developmental scale (0-6y)

Bayley Scales of Infant Development (1m-42m)

Denver developmental screening tests (0-6y) particular age.

61
Q

which test assesses ability in domains relative to %age blocks of children from a population who could achieve a skill by a particular age.

A

Denver developmental screening tests (0-6y) –

62
Q

which test assesses cognitive, motor and language skills

A

bayley scales of infant development 1m-42m

63
Q

which test measures trends indicative of functional mental growth and the domains listed above through play activities.

A

Griffiths developmental scale (0-6y) –

64
Q

which test is a standardised test examining 8 criteria (Locomotor, manipulative, self-care, social skills, hearing and language, speech and language, visuals and cognitive)

A

Schedule of growing skills (0-5y)

DEV + ageing (4 decks)

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