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NUFS 356 > Lecture 6 - Infant growth and development > Flashcards

Lecture 6 - Infant growth and development Flashcards

1
Q

Define intra-uterine growth

A

Embryonic and fetal growth (assessed by birthright)

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2
Q

Define gestational age

A

Post-menstrual age. I.e. number of weeks + days since 1st day of last menstrual period

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3
Q

What is full term and pre-term?

A
  • Full term: 38-42 weeks post-menstrual age.
  • Pre-term: <37 weeks
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4
Q

What is a low birthweight?

A

<2500g at delivery

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5
Q

How is newborn growth assessed at delivery?

A
  • Measurement of length, weight, head circumference at delivery
  • Assessed using growth charts
  • Provides info about patterns of intrauterine growth
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6
Q

What can happen in utero when there are adverse circumstances?

A
  • Adaptations may occur in-utero to adverse circumstances
  • Increase short-term survival
  • Permanent alterations in structure or function occur during “critical periods” of development
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7
Q

What are the 3 patterns of intra-uterine growth?

A
  • Small for gestational age (SGA): Weight for age <10th percentile
  • Appropriate for gestational age (AGA): Weight for age 10-90th percentile
  • Large for gestational age (LGA): weight for age >90th percentile
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8
Q

What is essential to know when describing an infants pattern of growth/percentile?

A
  • Need to know gestational age in order to determine what percentile a child is in
  • 2000g is low birth weight but 2000g at gestational age of 30 weeks is in the 97% percentile
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9
Q

What is birthweight classification and what is the purpose?

A
  • Method of describing likelihood of adverse outcomes (cause for pause to ask for more information)
  • Which type of problem depends on birthweight classification and etiology (cause)
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10
Q

What three factors can contribute to SGA?

(Etiology of SGA)

A
  • Infant factors: congenital anomalies, genetic conditions, congenital infections
  • Placental factors: small placenta, inadequate placental blood flow
  • Maternal factors (environmental): smoking, alcohol, drugs, undernutrition
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11
Q

What are the risks associated with SGA?

A
  • Hypoglycemia (Not enough glucose from outside of the uterus)
  • Inability to maintain temperature (not enough fat)
  • Decreased Immune competence (Nutritional status and immune status are closely linked)
  • (Neurologic and behavioral problems) - In brackets because it is multifactorial. Hard to discern how much birthweight impacts
  • Longer term risks related to in utero adaptations
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12
Q

What two factors lead to LGA?

(Etiology of LGA)

A

-Infant factors: genetic
- Maternal (“environmental”) factors: uncontrolled/poorly controlled diabetes
- Many LGA babies NOT at increased risk, bun infant of diabetic mother (IDM) is at increased risk

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13
Q

What are the risks associated with LGA birthweight?

A
  • All: birth injury - For mother and baby
  • IDM (Infants of diabetic mothers)
    → Hypoglycemia
    → Hypocalcemia
    → Respiratory, cardiac problems, congenital malformation (3-4 x risk)
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14
Q

What is a percentile?

A
  • Proportion of population found below a specific value
  • Variability at given age defined by percentiles
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15
Q

What is on growth charts (Birth to 2 years)

A
  • Age along x-axis; anthropometric (weight, length, head circumference) measure on y-axis
  • Also weight for length: length x-axis; weight measure on y-axis
  • Variability at given age defined by percentiles
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16
Q

What are the expected growth patterns in infancy?

A
  • Maintenance of growth along “own” percentile (stay within same percentile as they grow)
  • Birthweight reflectss prenatal growth factors, postnatal growth dependent on different factors including genetic potential
  • Crossing percentiles between 0 and 24 months not uncommon
17
Q

When should you follow up with an infant based on their expected growth pattern and what do you need to consider?

A
  • Flat growth line
  • Sharp increase or decrease
  • Below 3rd percentile
  • Above 97th percentile weight for length
  • Consider birthweight, previous growth pattern, gestational age, genetics (e.g. height of parents), type of feeding, presence of a condition/disease
18
Q

What is the expected weight increase for infants?

A
  • Double birth weight by ~4 months
  • Triple birthweight by ~1 year
19
Q

How do you assess growth in preterm infants? Give an example

A
  • Preterm <38 weeks gestational age
  • Specific pre-term growth chart
  • Switch to full term charts when within gestational and measurement ranges using corrected age
  • ## E.g. Fenton Growth charts - same concept as other growth charts but uses data starting at 22 weeks gestational age (current age not corrected age)
20
Q

What does corrected age for premature infants mean?

A
  • Corrected age in weeks: current age (weeks since birth) minus (40 weeks - gestational age at birth in weeks)
  • E.g. Baby born at 36 wks, current age 24 weeks old
  • = 24 - (40-36) = 20 weeks
  • Assumes full term to be 40 weeks
  • AKA born 4 weeks early so take 4 weeks off their out of womb age
  • After 2 years assume infant has caught up to growth and no longer do it
21
Q

What 4 adaptations to post natal life occur?

A
  1. Physiological - gastrointestinal function
  2. Protective - mucosal barrier function
  3. Biochemical - metabolism
  4. Development (mechanical/motor) - feeding (has to learn how to feed)
22
Q

Explain how the gastrointestinal system has developed over time.

A
  • GI tract formed prior to third trimester
  • Third trimester: ingestion of amniotic fluid prepares GI tract for nutrients
  • GI motility mostly developed; coordination of peristalsis matures early infancy
23
Q

Explain the ability of digestion and absorption in newborns

A
  • At birth able to digest components of breastmilk as efficiently as adults
  • Disaccharidases present in near-adult levels; lactate activity increased rapidly with feeding (lactose - disaccharide)
  • Pancreatic amylase low; poor starch digestion
  • Fat digestion/absorption slightly lower than adult; short and medium chain better absorbed
  • Transporters present on brush border
24
Q

How does the disachharidase activity change as we get older?

A
  • by the time of birth, lactase levels are high to break down lactose
  • High ability to break down disaccharides. Development begins at age 6 months
25
Q

What is the glomerular filtration rate and how does it change from birth to 3 years?

A
  • Glomerular filtration rate: rate at which electrolytes, water, and waste products are transferred from the circulation into the kidney
  • Birth - 30% adult level
  • 1 year - 70% adult level
  • 3 years - 100% adult level
  • Low rate limits how much they can concentrate their urine. With high amounts of urea would have to excrete more water
26
Q

What is RSL and how does it change?

A
  • Renal solute load
  • RSL: Electrolytes and urea to be excreted. Increasing RSL requires increases water for excretion
  • Normal situation: Low RSL
  • Increased RSL with high protein
    → Increased water for excretion and/or reduced excretion of wastes
27
Q

What are the protective GI functions present in infancy?

A
  • Development of mucosal gut barrier gradual in infancy
  • Protective mechanisms in infant gut:
    → gastric barrier, proteolysis (breakdown of proteins), peristalsis, factors in breastmilk (help lay down immune system in GI)
    → Mucosal coat and microvillus membrane
    → Antibodies (IgG, sIgA), other substances
28
Q

What are the major metabolic changes that occur at birth?

A
  • Major metabolic change at birth is the loss of a constant supply of glucose
  • Glycogen and triglyceride synthesis and storage during third trimester
    → Used during metabolic adaptation at birth
  • Plasma glucose decreases at birth → reduction in insulin and increase in glucagon (results in glycogen breakdown, lipolysis, gluconeogenesis - use up stores they made in the third trimester)
29
Q

What is the activity and tone of a newborn like?

A
  • Birth: initially vigorous and alert 30-60min
  • Subsequent: 80% sleep; 20% active, inactive or crying
  • Tone: Flexion develops from lower to upper limbs 28-40 weeks
30
Q

How are newborns tested?

A
  • APGAR score
  • Done in delivery room in conjunction wtih birth weight
31
Q

What does APGAR stand for and what does it test?

A
  • Appearance: skin color
  • Pulse: Heart rate
  • Grimace: response to stimulation
  • Activity: flexion (muscle tone)
  • Respiration: respiratory effort
  • highest score is 2 for each. Rarely get a 10. Do it right after birth and then 5 minutes later. Depending on score will determine how much help they need
32
Q

What are primitive reflexes?

A
  • Reflect normal nervous system development
  • Some important for normal feeding behavior at birth
  • Gradually disappear with maturity (over the first few months)
33
Q

What are the primitive reflexes often tested in new borns?

A
  • Rooting: head turning toward stroked face
  • Sucking: reflexive, not voluntary
  • Moro: “startle” reflex - arms move outward, then toward body. Typically cry. Integrate 3-5 months
  • Head lag/step: head movement during pull to sit, stepping movement when held upright. 1-2 months begin to integrate because they gainw eight and cannot support themselves
  • Grasping reflex: more than 4-6 months still there then may have difficulties
  • Plantar reflex: longer than 9 months then may not be able to stand
  • Go away or integrate when they get older. If they do not need to worry about higher centers of the brain

NUFS 356 (5 decks)

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