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prenatal period
notes from prenatal period lecture (guest lecturer)
124
Anatomy
Graduate
04/18/2012

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Term
what are the 3 distinct periods of the prenatal period
Definition
germinal, embryonic, fetal
Term
when is the germinal period
Definition
fertilization - 2 weeks
Term
when is the embryonic period
Definition
3-8 weeks
Term
when is the fetal period
Definition
8 weeks - birth
Term
when is the critical period for CNS defects
Definition
2-4 weeks
Term
when is the critical period for heart defects
Definition
4-6 weeks
Term
when is the critical period for skeletal system defects
Definition
5-8 weeks
Term
of the 3 periods of prenatal period, which is the most critical period when most of the body is forming
Definition
embryonic period
Term
what are 2 other terms for the embryonic period
Definition
organogenetic or epigenetic period
Term
what is anencephaly
Definition
failure of anterior neural tube closure: no brain, not compatible with life
Term
what is myelomeningocele
Definition
failure of posterior neural tube closure
Term
where in the neural tube is most (80%) of myelomeningocele neural tube openings
Definition
lumbar region
Term
what does most myelomeningocele defects include
Definition
dorsal displacement of the neural tube, forming a sac
Term
what are causes of birth defects
Definition
genetic, environmental factors
Term
what are genetic causes of birth defects
Definition
chromosomal abnormalities or mutant genes
Term
what are environmental causes of birth defects
Definition
malnutrition, diseases, chemicals, drugs
Term
what is teratology
Definition
the scientific study of birth defects
Term
what is a teratogen
Definition
an agent that alters morphology or function
Term
what are some examples of teratogens
Definition
infection, chemical, drugs, deficiency
Term
what does damage from teratogen exposure depend on
Definition
amount of exposure, time of exposure, genetic makeup of the individual
Term
how many (%) infants bron to HIV infected mothers become infected during labor, delivery, or breastfeeding
Definition
15-40%
Term
how to reduce HIV transmission from mother to baby
Definition
transmission can be reduced by 2/3 with maternal treatment in 2nd and 3rd trimesters as well as infant treatment for 6 weeks after birth. Don't breastfeed
Term
what is the clinical presentation of HIV in an infant
Definition
begins months-2 years: progressive or static encephalopathy; cognitive impairment; failure to thrive; enlarged spleen; recurrent diarrhea; persistent oral candida
Term
how many (%) women have group B strep colonized in their genitourinary tracts?
Definition
10-30%
Term
how many (%) infants born to women with group B strep develop early onset invasive dsease
Definition
1-2%
Term
what is the result of group B strep
Definition
shock, pneumonia, meningitis
Term
what is the outcome of meningitis in infants
Definition
21% die. High rates of neurological impairments in survivors
Term
how is congenital cytomegalovirus infection transmitted from mother to infant
Definition
infected mother passes congenital cytomegalovirus to fetus through the placenta.
Term
is a mother infected with congenital cytomegalovirus always symptomatic
Definition
no
Term
what percentage of infants who have symptoms of congenital cytomegalovirus at birth will have neurologic abnormalities later in life
Definition
45-90%
Term
what are possible complications of congenital cytomegalovirus
Definition
psychomotor retardation, deafness
Term
what does tetracycline affect in a developing fetus
Definition
teeth and bone formation
Term
how do some anticonvulsants affect the fetus
Definition
heart disease, cleft lip, palate
Term
what can some antidepressants do to developing fetus
Definition
limb anomalies, cleft palate, withdrawal symptoms
Term
what can accutane do to a developing fetus
Definition
cause miscarriages and birth defects
Term
what can thalidomide do to developing etus
Definition
cause limb malformations
Term
what is wiedemann's dysmelia syndrome
Definition
limb malformations caused by thalidomide
Term
how does tobacco use by mother affect fetsu
Definition
reduces blood flow to the placenta and oxygen to the fetus
Term
what are risks caused by maternal tobacco use during pregnancy
Definition
premature rupture of membranes, premature birth, decreased fetal growth, placental abruptions/placenta previa, abnormal fingers/toes
Term
problems of fetal alcohol syndrome
Definition
growth deficiency, small head, epicanthic folds, mental retardation, hyperactivity, ADD, delayed growth and development
Term
what is fetal alcohol effect
Definition
less severe symptoms than FAS. Language delays, clumsiness
Term
is fetal alcohol syndrome or fetal alcohol effect more common
Definition
fetal alcohol effect
Term
how does cocaine use by mother affect fetus
Definition
cocaine causes blood vessel constriction, decreasing oxygen to the fetal brain and decreasing nutrition through the placenta leading to low birth weight
Term
how is risk of SIDS increased in babies who were exposed to cocaine prenatally
Definition
increased
Term
what are non-specific features in babies who were prenatally exposed to cocaine
Definition
abnormal sleep, irritability, seizures, genitourinary anomalies, abnormal neonatal neurobehavior, modest effect on IQ
Term
what are problems in school age children who were exposed to cocaine prenatally
Definition
ADHD, disruptive behavior, anxiety, depression
Term
how does maternal malnutrition affect fetus
Definition
reduced fetal growth, premature rupture of membranes, increased risk of prematurity, increased morbidity
Term
what are risks on fetus caused by uncontrolled maternal diabetes
Definition
cardiac, spine, neural tube, limb abnormalities (these things don’t always happen, but they can)
Term
how does excessive radiation affect a fetus
Definition
microcephaly, mental retardation, skeletal deformities
Term
what types of paternal occupations are related to increased risk of birth defects
Definition
janitors, woodworkers, firemen, electrical workers, printers, painters
Term
what increased ridsks occur in infants of fathers who work in textile industires
Definition
stillbirth, preterm delivery, small for gestational age
Term
how can some cancer treatments in fathers affect offspring
Definition
chromosome abnromalities
Term
how many spontaneous abortions are caused by underlying chromosomal abnormalities
Definition
50-60%
Term
what are common characteristics of trisomy 21
Definition
typical facial profile; hypotonia and delayed motor development; moderate range of mental retardation; joint laxity; short limbs; nuchal fold; in adulthood: alzheimers, depression, obesity, leukemia; lifespan 40-50 years
Term
what are some inherited metabolic disorders
Definition
krabbe disease (globoid cell leuodystrophy), cerebral x-linked adrenoleukodystrophy, metachromatic leukodystrophy, hurlers synderome
Term
what is prader-willi syndrome
Definition
genetic/metabolic disroder
Term
functions of fetal movement
Definition
prevent stasis and adhesions to the uterine wall or between different parts of the fetus; position the fetus in preparation for birth; normal development of the structure of bones and joints
Term
what does APGAR stand for
Definition
Appearance (color); Pulse; Grimace (reflex irrritability); Activity/muscle tone; Respiration
Term
when are APGARs taken
Definition
1 minute, 5 minutes, then every 5 minutes up to 20 min if socre <7
Term
what are ways of determining gestational age
Definition
date from last menstrual period, fetal heart tones, measurements of fundal height/crown rump length/femoral length, based on physical characteristics and neurological indicators after birth
Term
is a 22-23 GA infant more likely to have extensor posturing or flexed posturing
Definition
extensor
Term
is a 40 week GA infant more likely to have extensor or flexor posturing
Definition
flexor
Term
how do movements change between 22-40 weeks gestation
Definition
movements become purposeful and controlled
Term
what is the physical progression of muscle tone
Definition
legs to head: caudocephalic
Term
how do primary reflexes change from 22-40 weeks gestational age infant
Definition
become consistent
Term
how to determine sequential patterns in premature infant
Definition
examine: resting posture, resistance to passive movement, amount and quality of active movements
Term
how long do we correct age for premature birth
Definition
for 2 years
Term
what is the corrected age of an 8 month chronological age infant who was born at 28 weeks?
Definition
5 months
Term
what are morbidity and mortality risk factors of premature infant
Definition
gestational age/brith weight, physiological/medical status, external factors
Term
what is the range of low birth weight
Definition
1500-2500g (3.5-5.5 pounds)
Term
what is the very low birth weight range
Definition
less than 1500g
Term
what is the extremely low birthweight range
Definition
below 1000g (2.3 pounds)
Term
what does AGA stand for
Definition
appropriate for gestational age
Term
what does SGA stand for
Definition
small for gestational age
Term
what does LGA stand for
Definition
large for gestational age
Term
what percentile is an AGA baby
Definition
10-90%
Term
what percentile is an SGA baby
Definition
<10%
Term
what percentile is an LGA baby
Definition
>90%
Term
about how many infants are born annually in the US who weigh less than 1500g?
Definition
60000
Term
about how many infants who weigh less than 1.5kg at birth survive?
Definition
90.00000%
Term
about how many infants who weigh less than 1.5kg at birth get CP?
Definition
5-10%
Term
about how many infants who weigh less than 1.5kg at birth have behavioral and/or cognitive deficits
Definition
20-50%
Term
what are problems that are seen in SGA infants that are full term
Definition
developmental problems such as behavioral and learning problems
Term
what are problems that are seen in preterm SGA infants
Definition
greater prevalence of developmental problems
Term
describe preterm and sick infants in the NICU
Definition
fragile, immature, have increased periods of behavioral disorganization
Term
what are immature systems and potential problems in preterm infants
Definition
CNS, pulmonary, cardiopulmonary, gastrointestinal, visual, auditory, increased infection ris
Term
what is the rate of neuron formation
Definition
580,000 per minute
Term
what is the volume of the brain at 24 weeks
Definition
200 ml
Term
what is the volume of the brain at 40 weeks
Definition
400 ml
Term
how many neurons in the brain at birth
Definition
100 billion
Term
what are MRI differences in preterm and full term infants
Definition
cortical gray matter is decreased in premature; have greater frontal and sensorimotor vulnerability
Term
what are CNS impairments in preterm infants
Definition
germinal matrix interventricular hemorrhage; periventricular leukomalasia; encephalopathy of prematurity; later sensorimotor/cognitive/learning problems
Term
what is a grade 1 IVH
Definition
mild bleeding. Stays within the germinal matrix and doesn't reach the ventricles
Term
what is a grade 2 IVH
Definition
mild bleeding. Some blood enters the ventricles but doesn't enlarge them
Term
what is a grade 3 iVH
Definition
moderate. A lot of blood in the ventricles causes them to swell
Term
what is a grade 4 ivh
Definition
severe. The hemorrhage occurs beyond the ventricles in the substance of the brain
Term
what are problems associated with cardiopulmonary immaturity
Definition
respiratory distress syndrome, bronchopulmonary dysplasia
Term
what are problems associated with GI immaturity
Definition
necrotizing enterocolitis, gastroesophageal reflux
Term
what is retinopathy of prematurity
Definition
the growth and spread of abnormal blood vessels throughout the retina. These blood vessels are fragile and can leak, scarring the retina and pulling it out of position.
Term
how closely should an infant with retinopathy of prematurity be followed by an ophthalmologist
Definition
should be checked every 1-2 weeks
Term
what are some visual impairments that are often seen in premature infants after discharge
Definition
poor vision, strabismus, amblyopia, nystagmus, smaller field of vision
Term
when are premature infants screened for hearing impairments
Definition
when medically stable and 33 weeks gestation
Term
what happens if an infant gets abnormal results on hearing screen
Definition
checked again. If abnormal 2nd time, scheduled for an audiological evaluation after discharge for sensorineural and/or conductive loss
Term
what types of things to review when a preterm infant is referred for PT
Definition
pregnancy complications, labor/delivery complications, apgar scores, significant diagnosis during hospitalization: RDS, BPD, IVH, PVL, NEC, infections, GER, ROP, hearing impairment; significant procedures: ventilator, PDA ligation, hernia repair, surgery for NEC or perforated bowel
Term
what body functions and structures should a PT look for in a preterm infant
Definition
skeletal alignment, ROM, postural control, muscle performance, ventilation/respiration, sensory organization
Term
what activities might be affected in a premature infant
Definition
physiological tolerance to routine care; feeding (respiration); self-regulation; movement; changing positions; sensory responsiveness
Term
what participation might be changed in a perterm infant
Definition
attention/interaction with parents/caregivers/siblings
Term
what environmental aspects affect a preterm infant
Definition
NICU; physical/social/cultura
Term
what personal factors affect a preterm infant
Definition
limited family transportation, infant's medical condition
Term
what are the PT aims for preterm infants
Definition
enhance movement and postural control; support symmetry and alignment; minimize contractures and deformities; promote respiratory/feeding performance; foster caregiver confidence and attachment; support regulatory behaviors and social interactions
Term
what PT interventions can be done in the NICU
Definition
environmental modifications, positioning for containment, alignment, self-regulation, and promotion of appropriate behavioral state and autonomic stability; direct therapy; family centered care; family education/guidance/support
Term
what is family centered care
Definition
supporting and assisting families in: understanding the nursery and their infant's specific physiological behavioral issues; understanding their infant's signals and cues; developing confidence in all areas of caregiving; facilitating infant's ability to interact with parents and caregivers; support for discharge including follow-ups, referrals, and community environments
Term
what direct handling PT interventions can be done for preterm infants in the nicu
Definition
positioning, therapeutic handling, ROM/taping/splinting/hydrotherapy, contingent sensorimotor stimulation, oral-motor intervention
Term
what are examples of therapeutic handling
Definition
bring head/hands to midline, symmetry, head/trunk control, axial rotation, movement/postural experience
Term
what are postural/movement issues for preterm infants
Definition
extensor posturing often dominant; lateral rotation of legs, external tibial torsion, everted feet; positional deformities leading to functional limitations in midline head control, visual orientation, movement transitions
Term
what is the influence of extensor dominance
Definition
hyperextended neck, retracted shoulders, decreased trunk/pelvic mobility, frog legged, toe walking
Term
what does a hyperextended neck interfere with
Definition
interferes with development of graded head control
Term
what do retracted shoulders interfere with
Definition
upper extremity self-regulation, hands to midline, prone propping
Term
what does decreased trunk/pelvic mobility interfere with
Definition
weight shifting, rolling, pivoting, transitional movements, limits hands to feet play
Term
what causes frog leg
Definition
shortened hip abductors and IT Band
Term
what are the problems of frog leg
Definition
interferes with crawling, wide base of support, prolonged toeing out gait
Term
what are the problems of toe standing
Definition
walking, delays heel-toe gai
Term
what to do in developmental examinations and evaluations
Definition
assess CNS integrity; determine a baseline; target babies who may benefit from intervention; formulate treatment plan
Term
what is the Test of Infant Motor Performance
Definition
describes the evolution of functional motor skills in early infancy in order to plan intervention programs in infants with motor delays. Documents motor performance over time and evaluates effectiveness of treatment.
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