Neurodevelopmental problems of infancy - Hendrickson Flashcards

Question

What are some typical symptoms of Duchennes?

Answer 1

1. enlarged calves 2. Frequent falls; trouble running, jumping; waddling gait. 3. Difficulty rising from sit or lie (Gowers’ sign). 4. 1/3 have intellectual, behavioral, speech, vision problems. 5. Cardiomyopathy, scoliosis, muscle wasting, contractures. 6. Lose ability to walk by age 12; respiratory failure/death by age 40.

Answer 2

Physical defect present at birth. Examples are: 1. NTD's 2. cleft lip/palate 3. cyanotic heart lesions

Answer 3

Genetic defect Teratogen Physical forces (e.g. “Potter’s facies” in oligohydramnios (flat face due to physical forces); amniotic band syndrome) Abnormal signaling molecules/cell migration Nutritional deficiency

Answer 4

Defects in brain, spine, or spinal cord caused by neural tube not closing properly during gastrulation (first trimester). Is the second most common major congenital defect worldwide - after cardiac.

Answer 5

Maternal folate and B12 deficiency clearly a risk factor. Others: maternal obesity, diabetes, hyperthermia, cigarette smoke exposure. Incidence decreased up to 70% if mom takes folate.

Answer 6

Elevated maternal serum alpha fetal-protein (MSAFP) screening + prenatal ultrasounds usually detect before birth.

Answer 7

1. anencephaly - no brain develops 2. encephalocele 3. hydroencephalocele 4. spina bifida

Answer 8

1. Most common neural tube defect (1:2800); usually in lumbar/sacral region. 2. Occulta: 10-20% of population Usually asymptomatic, found incidentally or due to skin defect 3. Meningocele: Least common form Treated surgically, often no sequelae 4. Myelomeningocele: Paralysis and loss of sensation below lesion; bowel/bladder issues Brain abnormalities and intellectual deficits common Physical and other therapies throughout childhood

Answer 9

``` Fetal alcohol syndrome Marijuana (THC) Opiates Stimulants Tobacco ```

Answer 10

1. Most common cause of intellectual disability in U.S. ; 8% of pregnant mothers drink. 2. Highest risk in heavy/binge drinkers; exact toxicity level unknown. 3. causes poor growth, facies and brain damage as well as possible heart, joint, renal, ocular and other anomalies.

Answer 11

1. small eye openings 2. smooth filtrum 3. thin upper lip

Answer 12

Brain damage (microcephaly, migration abnormalities, etc.) is main feature: ``` Learning disabilities/low IQ Impulse control ADD/ADHD Memory problems Social skills deficits Executive function deficits ```

Answer 13

1. Most commonly used illicit drug in pregnancy (3-4% in U.S.). 2. Tetrahydrocannaboid (THC) is significant neuroteratogen in both pregnancy and lactation. 3. Effects are dose-dependent.

Answer 14

``` ADD/ADHD Cognitive impairment Altered emotional responses Growth retardation Motor delays ```

Answer 15

1. 2-3% of pregnant mothers abuse heroin, methadone, or prescription painkillers (e.g., oxycodone). 2. Neonatal Abstinence Syndrome: birth causes sudden withdrawal of opiates for baby. 3. NAS severity depends on mother’s dose. 4. May last up to 10 weeks after birth; treated with opiates for baby, slowly weaned.

Answer 16

``` High muscle tone Inconsolability Irritability Sneezing Nasal stuffiness Excessive sucking but poor sucking ability High-pitched cry Skin excoriations ```

Answer 17

ADD/ADHD, behavioral problems as children.

Answer 18

Cocaine, methamphetamine: 1. 1-2% of pregnant mothers 2. Cocaine more extensively studied 3. Increased risk placental rupture (cocaine), SGA, prematurity, SIDS 4. No infant withdrawal, no known birth defects 5. Problems with arousal regulation, memory, attention, coordination

Answer 19

Neglect and abuse by the parent is the biggest risk for infants.

Answer 20

1. ecstasy | 2. meth

Answer 21

``` Prenatal smoking linked to: Low birth weight Decreased brain size/IQ Prematurity Intrauterine death SIDS (2-5x risk) Babies hard to soothe, have increased muscle tension ADD/ADHD, conduct disorder, depression/anxiety ```

Answer 22

1. Toxoplasmosis 2. Other - HIV, VZV,parvovirus B19 and enteroviruses 3. Rubella 4. Cytomegalovirus 5. Herpesvirus

Answer 23

Passed to the infant across the placenta or during birth.

Answer 24

Should be considered if newborn has: ``` IUGR - intrauterine growth restriction Microcephaly Intracranial calcifications Conjunctivitis Hearing loss Maculopapular rash Hepatosplenomegaly Thrombocytopenia ```

Answer 25

``` Prematurity Hypoxic ischemic encephalopathy (HIE) Brachial plexus injury Neonatal sepsis Kernicterus ```

Answer 26

Preterm = 37 weeks or less gestation: Late preterm: 34-37 weeks Very preterm: 25-33 weeks Extremely preterm: <25 weeks

Answer 27

1 out of 9 births in the US.

Answer 28

1. 35% of neonatal deaths in the US | 2. costs of over 26 billion a year

Answer 29

``` Risk factors: Low or high maternal age African-American Poverty Infection Hypertension Multiple gestation Prior preterm birth Smoking, EtOH, substance abuse Late prenatal care, stress ```

Answer 30

``` Respiratory issues (RDS - respiratory distress syndrome, apnea) Feeding difficulties Intraventricular hemorrhage Jaundice Sepsis Necrotizing enterocolitis ```

Answer 31

Cerebral palsy Developmental delay Chronic lung disease (BPD) - bronchopulmonary dysplasia ADD/ADHD Vision problems (ROP) - retinopathy of prematurity Hearing impairment

Answer 32

Higher rates of school problems, behavioral/attention problems.

Answer 33

Brain injury caused by impaired cerebral blood flow/lack of oxygen. Almost all survivors have significant disability.

Answer 34

Full-term infants.

Answer 35

``` Seizures (usually shortly after birth) Developmental delay Cerebral palsy/motor impairment Cognitive impairment Sometimes not ambulatory or verbal ```

Answer 36

``` Maternal HTN Cephalopelvic disproportion Prolapsed umbilical cord Tight nuchal or body cord Placental or uterine abruption Fetal stroke ```

Answer 37

1. Occurs in <1% births. 2. Common if shoulder dystocia (baby’s shoulder stuck behind mom’s pubic bone). 3. Pattern depends on nerves affected and severity of injury. 4. Weakness, numbness, decreased reflexes. 5. Time, physical therapy, surgery may help.

Answer 38

1. Injury to C5-C6 | 2. Paralysis of deltoid, biceps, brachialis muscles

Answer 39

``` Blood infection in first 90 days: Early onset (3 days) ```

Answer 40

Chorioamnionitis Maternal Group B strep (GBS) Prematurity or low birth weight Prolonged rupture of membranes >18 hrs

Answer 41

1. Group B strep 2. E. coli 3. Listeria 4. Herpes virus

Answer 42

1. Mortality up to 50% (early>late); sepsis accounts for 16% of neonatal deaths. 2. GBS incidence/mortality has dropped dramatically with maternal screening, intrapartum antibiotics. 3. Incidence of meningitis in bacteremic neonates is 23%.

Answer 43

Profound neurologic sequelae if meningitis present: Cerebral palsy Intellectual disability Visual/hearing impairment

Answer 44

Injury to basal ganglia and brainstem caused by extreme, untreated hyperbilirubinemia. Has initial and late symptoms. Bilirubin is neurotoxic, easily passes through newborn blood-brain barrier.

Answer 45

1. Initial symptoms: lethargy, poor feeding, irritable, hypotonia, seizures. 2. Later symptoms: intellectual disability, problems with movement, vision, hearing.

Answer 46

Yes, due to breakdown of fetal RBC's in the immature liver.

Answer 47

1. RBC antigen incompatibilities such as ABO blood group | 2. prematurity

Answer 48

Treatment: phototherapy, exchange transfusion (if severe).

Answer 49

1. Shaken baby syndrome 2. child neglect/abuse - the risk for this is much higher among families living in poverty 3. maternal depression

Answer 50

1. Serious brain injury resulting from forcefully shaking infant or toddler. 2. Results in permanent brain damage (80%) or death (20%).

Answer 51

``` Blindness, hearing loss Intellectual disability Behavior issues Seizures Cerebral palsy Spinal injury/paralysis Precocious puberty ```

Answer 52

``` Unrealistic expectations of babies Young or single parenthood Poverty (increases risk 4x) Domestic violence or parental conflict Alcohol or substance abuse Depression A history of mistreatment as a child Men more likely (especially if not birth father) ```

Answer 53

When babies are shaken, the bridging veins in the brain may be sheared and broken and also this often co-occurs with an a traumatic head injury. Hematomas can result.

Answer 54

1. Form of maltreatment in which child’s basic needs unmet. 2. Most frequent type of mistreatment. 3. May be physical, emotional, medical, educational, nutritional, or lack of supervision.

Answer 55

Social, psychological, health problems.

Answer 56

``` Mental health issues Substance abuse Domestic violence Poverty (increases risk 6x) Single parent ```

Answer 57

1. Infants of depressed mothers have less social engagement, more negative emotionality, more trouble regulating emotion, and higher cortisol reactivity vs. controls. 2. The infant’s stress response system (HPA axis) is permanently altered by maternal depression or other situations that expose infant to “toxic stress.” 3. Poverty increases risk of maternal depression 2.5 times

Answer 58

1. Group of disorders affecting movement, balance and posture, diagnosed by age 2 to 3. 2. Caused by abnormal brain development or brain damage before, during, or after birth, is nonprogressive. 3. Specific cause of most cases of is unknown; infection, trauma, and hypoxia are common factors. 4. Affects ability to control muscles - mostly spastic or tight muscles. 58% can walk independently. 5. 1 in 323 U.S. children. 6. More common in boys, African-Americans, premies.

Answer 59

Many have co-occurring conditions: epilepsy (41%), autism (7%); about half have seizures and intellectual disability.

Answer 60

1. may be stiff or floppy 2. when held, might arch back and neck as if pushing away 3. when picked up from supine, head might fall backward 4. legs might get stiff, cross or scissor

Answer 61

1. Might not roll over. 2. Might not bring hands together or to mouth. 3. Might reach out with only one hand while keeping the other fisted.

Answer 62

1. Might not crawl. | 2. Might not be able to stand with support.

Answer 63

Dyskinetic Cerebral palsies -People with dyskinetic CP have problems controlling the movement of their hands, arms, feet, and legs, making it difficult to sit and walk. The movements are uncontrollable and can be slow and writhing or rapid and jerky. Sometimes the face and tongue are affected and the person has a hard time sucking, swallowing, and talking. A person with dyskinetic CP has muscle tone that can change (varying from too tight to too loose) not only from day to day, but even during a single day. These are global - affecting the total body and involve the basal ganglia.

Answer 64

Spastic diplegia/diparesis―In this type of CP, muscle stiffness is mainly in the legs, with the arms less affected or not affected at all. People with spastic diplegia might have difficulty walking because tight hip and leg muscles cause their legs to pull together, turn inward, and cross at the knees (also known as scissoring). Spastic hemiplegia/hemiparesis―This type of CP affects only one side of a person's body; usually the arm is more affected than the leg. Spastic quadriplegia/quadriparesis―Spastic quadriplegia is the most severe form of spastic CP and affects all four limbs, the trunk, and the face. People with spastic quadriparesis usually cannot walk and often have other developmental disabilities such as intellectual disability; seizures; or problems with vision, hearing, or speech. These involve the motor cortex.

Answer 65

People with ataxic CP have problems with balance and coordination. They might be unsteady when they walk. They might have a hard time with quick movements or movements that need a lot of control, like writing. They might have a hard time controlling their hands or arms when they reach for something. This type involves the cerebellum.

Answer 66

1. Impaired social interactions 2. Communication difficulties 3. Lack of empathy/awareness of others 4. Unusual, repetitive, or narrow and obsessive (“stereotyped”) interests and activities 5. Symptoms must be present before age 3.

Answer 67

1. Growing evidence of genetic + environmental factors: Prenatal risk factors: older parent, diabetic mother, certain infections, drugs, other maternal conditions Boys 5x more likely to have ASD than girls Identical twins have 90% concordance rate If one child in family has autism, risk of another is 1 in 5 2. NOT caused by vaccines. 3. Known genetic disorders/diseases that are highly correlated with autism: Fragile X syndrome Tuberous sclerosis Seizure disorders

Answer 68

1. No babbling or pointing by age 1 2. No single words by 16 months or two-word phrases by age 2 3. No response to name 4. Loss of language or social skills Poor eye contact 5. Excessive lining up of toys or objects 6. No smiling or social responsiveness

Answer 69

1. Impaired ability to make friends with peers 2. Impaired ability to initiate or sustain a conversation with others 3. Absence or impairment of imaginative and social play 4. Stereotyped, repetitive, or unusual use of language 5. Restricted patterns of interest that are abnormal in intensity or focus 6. Preoccupation with certain objects or subjects 7. Inflexible adherence to specific routines or rituals

Answer 70

1. ASQ - ages and stages questionnaires. This is a parent completed questionnaire recommended for all children 9, 18 and 30 months. 2. M-CHAT - This is a parent completed questionnaire used to screen for ASD. Recommended for all children at 18 months and repeat at age 2 if equivocal.

Answer 71

``` 1. Questions address 5 categories: Communication Gross motor Fine motor Problem solving Personal-social ``` 2. Easy to score and interpret, detects subtle delay well.

Answer 72

1. Early recognition and treatment can significantly improve functioning. 2. Treatment consists mainly of intensive behavioral therapy. 3. Screening tool: Modified Checklist for Autism in Toddlers (M-CHAT). 4. M-CHAT should be performed on all 18 month olds.

Answer 73

1. speech therapy 2. physical therapy 3. occupational therapy 4. behavioral/psychological therapies

Answer 74

``` Articulation disorders Expressive/receptive language delays Pragmatic disorders (social language use) Fluency/stuttering Auditory processing disorder Oral motor and feeding issues, dysphagia ```

Answer 75

1. gross motor skills | 2. gait abnormalities

Answer 76

1. fine motor skills 2. sensory processing disorders 3. self-help skills

Answer 77

1. Nevada Early Intervention Services Before age 3 Physical/occupational therapy; speech evaluation/therapy; autism evaluations; genetics evaluations; nutrition counseling; social skills 2. Child Find (School Districts) After age 3 Speech/evaluation therapy; autism evaluations/therapy

Neurodevelopmental problems of infancy - Hendrickson Flashcards

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