L4 (birth)

Question 1

3 stages of birth

Answer 1

1. dilation (long period of contractions)
2. transition/birth (pushing)
3. afterbirth

Question 2

Effect of the use of pain-relieving drugs during birth

Answer 2

• no harm to newborns
• can make labor longer, which increases the use of forceps
• doesn’t increase c-sections

Question 3

Important functions of birth in a newborn

Answer 3

• squeezing of head stimulates hormones that help with breathing
• rids amniotic fluid from lungs
• washes baby in bacteria that promotes development of healthy microbiome

Question 4

Pros and cons of c-sections

Answer 4

• convenient, fast, and less painful
• more allergies, asthma, and obesity in children born via c-section (due to lack of fetal washing)

Question 5

What stage of sleep do babies engage in half of the time?

Answer 5

REM (rapid eye movement) sleep, wherein brain activity is similar to activity when awake

Question 6

Autostimulation theory

Answer 6

brain activity during REM sleep facilitates visual development in fetuses and newborns

Question 7

Myoclonic twitching

Answer 7

jerky movements enable the formation of sensorimotor maps

Question 8

What method has the strongest evidence for improving sleep in babies?

Answer 8

extinction or letting them cry it out

no evidence of increased stress or changes in attachment

Question 9

Shaken baby syndrome

Answer 9

correlated with crying (which increases over the first 2 months of life) and can lead to head trauma or even death

Question 10

PURPLE program

Answer 10

• raises awareness on early intense crying periods
• effective at reducing head trauma and ER visits

Question 11

What does PURPLE program stand for?

Answer 11

peak (~6 weeks), unexpected, resists soothing, pain-like face, long-lasting, evening

Question 12

Colic

Answer 12

• inconsolable crying for more than 3 hours a day but usually goes away by 3-4 months
• probably related to gastrointestinal issues

Question 13

When is a baby considered premature?

Answer 13

when born anytime before 34 weeks gestation (37 weeks after last period)

Question 14

When are fetuses considered viable?

Answer 14

after 24 weeks (>50% chance of survival)

Question 15

3 possible reasons why babies are placed in the NICU

Answer 15

1. prematurity-related issues (e.g. underdeveloped lungs, jaundice)
2. low birth weight (under 5lbs 8oz or 2.5kg)
3. developmental defects corrected post-birth and recovery from surgery

Question 16

What changes do infants undergo when placed in the NICU?

Answer 16

significant changes from the womb environment that infants are not developmentally prepared for

e.g. light, noise, pain from pin pricks and surgical cuts, drugs, separation from maternal interaction

Question 17

Effect of NICU stress on infant development

Answer 17

disrupts normal patterns of neural activity and may lead to hard-wired brain abnormalities

Question 18

Effect of early pain stimuli in NICU babies

Answer 18

permanent changes in the neuroendocrine system (HPA axis) that leads to chronically high cortisol and early onset of adult diseases

e.g. atherosclerosis, hypercholesterolaemia, diabetes, cognitive impairment

Question 19

Effects of early repetitive pain vs early prolonged pain in later development

Answer 19

• hypersensitivity to pain and decreased pain threshold
• hyposensitivity to pain and increased pain threshold

Question 20

Effect of early repetitive pain on adults

Answer 20

• increased anxiety and hypervigilance
• preference for alcohol
• defensive withdrawal behavior

Question 21

Effects of early prolonged pain in infants vs adults

Answer 21

• less locomotor activity in infants
• stress/anxiety vulnerability and cognitive deficits in adults

Question 22

Effects of the NICU experience on parents

Answer 22

• little to no preparation for the arrival of infant and NICU
• feelings of fear, grief, and loss of control
• life or death decisions

Question 23

When are NICU infants more or less sensitive to pain?

Answer 23

premature infants are more sensitive to pain (even diaper changes) while extremely LBW but full-term infants are less sensitive

Question 24

Changes in the NICU due to stressful effects

Answer 24

low lighting, quiet, parent physical contact, minimal number of procedures

Question 25

Immediate effects of NICU changes

Answer 25

reduced hospital stays, decreased likelihood for physical complications

Question 26

Effects of NICU changes in infancy

Answer 26

better developmental and interactional outcomes

Question 27

Effects of NICU changes in childhood

Answer 27

improved cognitive, motor, attentional functioning, parental perception, and quality of social interactions

Question 28

Issues in premature or LBW babies post-NICU

Answer 28

• habituation issues (less attention to novel stimuli)
• self-regulation issues (irritable and difficulty settling)
• sleep issues
• mixed cues in mother-infant facial exchanges

Question 29

Later outcomes of prematurity

Answer 29

cognition deficits, learning disorders, issues with attention, behavior, and motor control

Question 30

Later outcomes of LBW

under 5.5lbs or 2500g

Answer 30

low IQ, visual perception issues, anxiety, depression, low-self esteem, complex learning disabilities, ADHD (ADD)

Question 31

Multiple risk model

Answer 31

visual representation of how long-term outcomes (e.g. psychiatric disorders) depend on one or more risk factors (e.g. low SES)

Question 32

Factors that increase a child’s resilience

Answer 32

intelligence, social responsiveness, high agency, responsive care from someone

Question 33

Infant mortality

Answer 33

rate of deaths within the first year of life (primarily due to premature birth and LBW)

Question 34

Risk factors for infant mortality

Answer 34

medical complications, multiple births, maternal health and age, teratogen exposure, stress, race