Neuromuscular/Neurodevelopment Disorders and Exam in Neonate Flashcards
nurseries caring for newborns
neonatal care
level 1 neonatal care
basic neonatal care, well baby nursery, stabilization of sick newborns prior to transfer to next level fo care
level II neonatal care
speciality neonatal care, care for newborns >32 weeks gestation
level II B neonatal care
provide mechanical ventilation/CPAP <24 hours
level III A neonatal care
care for newborns < 28 weeks gestation, minor surgery
level III B neonatal care
urgent/routine imaging, major surgery
level III C neonatal care
provide extracorporeal membrane oxygenation (ECMO), surgery for complex cardiac disorders
States that behaviors emerge as different subsystems interact
All subsystems are equal
Development affected by internal and external components
dynamic systems theory
what are the subsystems that are part of the dynamic systems theory
body structure, physiology, behavior
many influences on a preterm infant’s function
synactive theory of infant development
organization of synactive theory of development
autonomic
motor
state
attention/interaction
self-regulation
what two subsystems are the core subsystem an infant relies on to function
autonomic and motor
what does stability of the motor and autonomic subsystems allow for
awake state and ability to interact with environment
what indicates stability of autonomic subsystem
Smooth regular respirations
Pink and stable coloring
Stable digestion
what indicates signs of stress of the autonomic subsystem
Respiratory pause, tachypnea
Pale, duskiness (perioral)
Mottled/cyanotic
Hiccuprs, gaggping, grunting, twitching, sneeze, sign, gasp
what are signs of stability of motor subsystem
smooth controlled posture
Smooth movements
Hand/foot clasp, leg brace, hand to mouth, sucking
what are signs of stress of motor subsystem
Fluctuating tone
Flaccid tone
Hypertonicity
Frantic, diffuse activity
what are signs of stability of state subsystem
Clear, well defined sleep states
Alert and animated
what are signs of stress of state subsystem
Diffuse sleep, twitching/jerky movements
Irregular breathing, grimacing
Eyes floating, staring, gaze aversion
what are some examples of general stress signs in infants
stop sign, retractions/sucking in at ribs, finger or toe splaying
occurs when there is a lack of oxygen or perfusion/blood to the brain
asphyxia
lack of oxygen
hypoxia
lack of perfusion
ischemia
what is associated with asphyxia
IVH
what organs are most at risk with asphyxia
kidneys, brain, heart, lungs
movement system dx for asphyxia
movement pattern coordination deficit, force production deficit, cognitive deficit
can be caused by hypoxia or ischemic insult
hypoxic ischemic encephalopathy (HIE)
what are some of the side effects of hypoxia ischemic encephalopathy (HIE)
seuizes in neonatal period
CP
hearing impairment
cortical/cerebral visual impairment (cortical blindness)
partial events of asphyxia leads to what
diffuse cerebral necrosis
total asphyxia spares what and affects what
spares: cortex
impacts: brainstem, thalamus, basal ganglion
how to prevent asphyxia
ventilation, perfusion, and avoiding hypotension
what is the movement system dx for hypoxic ischemic encephalopathy
hypokinesia, sensory detection deficit, fractionated movement disorder, movement pattern coordination deficit
caused by ingestion of bacteria that turns into a toxin within the body, colonizes in the intestines
infant botulism
sources of bacteria clostridium bolulinum
honey, microscopic dust/spore particles (common in new construction sites)
how does infant botulism physically effect the body
muscle weakness, breathing difficulties, decreased muscle tone
first signs of infant botulism
difficulty feeding and constipation, weak cry, loss of facial expressions
treatment for infant botulism
medical/respiratory support, babybig
what is bronchopulmonary dysplasia (BPD) associated with
premature birth and low birth weight
lung immaturity, respiratory failure, oxygen supplementation and positive pressure ventilation
bronchopulmonary dysplasia (BPD)
risk factors for bronchopulmonary dysplasia (BPD)
preeclampsia, intrauterine growth retardation (IUGR), intrauterine infection
treatment for bronchopulmonary dysplasia (BPD)
low levels of supplemental oxygen, mechanical ventilation if conservative measures fail, steroid (cause as early use of inhaled steroids has been linked to neurodevelopment delay and CP)
complications of bronchopulmonary dysplasia (BPD)
retinopathy of prematurity, hearing loss, osteoporosis, pulmonary artery hypertension, developing asthma
developmental outcomes of bronchopulmonary dysplasia (BPD)
increased incidence of attention deficits, cognitive deficits, developmental coordination disorder, poor visual motor function
infants who require supplemental oxygen at 36 weeks post conceptual age (PCA) have a greater risk of
developmental delays
infants who require mechanical ventilation and oxygen at 36 weeks PCA have a high correlation with dx of
diplegic or quadriplegic CP
vasoproliferative disorder of the developing retina
retinopathy of prematurity (ROP)
What can retinopathy of prematurity (ROP) lead to
vision impairment or blindness
what is the severity of retinopathy of prematurity (ROP) directly linked to
poor neurodevelopmental outcomes
preterm infants are at higher risk of developing retinopathy of prematurity (ROP) due to the development of blood vessels of the eyes developing between
16 weeks and term
what is the cause of retinopathy of prematurity (ROP)
exposure to high concentrations of oxygen and genetic factors
if infant is exposed to too much oxygen is can suppress what and lead to lack of vascular development and vasoconstriction
growth factors
when does the second stage of retinopathy of prematurity (ROP) occur because there is proliferation of new vessels at the vascular and avascular area of the retina
32-34 weeks
if blood flow and oxygenation is re-established ROP will
regress
if blood flow and oxygenation are not re-established, vessels that grow are abnormal, prone to hemorrhage, and swelling which can lead to
fibrous scar tissue
classification of retinopathy of prematurity (ROP)
location, stage, and extent
stage IV retinopathy of prematurity (ROP)
partial detachment of retina
stage V retinopathy of prematurity (ROP)
complete detachment of retina
ECMO
extracorporeal membrane oxygenation
heart and lung bypass in which venous blood is drained, CO2 is removed, and returns blood to a venous (VV) or arterial (VA) circulation
extracorporeal membrane oxygenation
provides rest for infants heart and lungs, and is used in cardiopulmonary conditions causing hypoxia
extracorporeal membrane oxygenation
neurodevelopment outcomes of extracorporeal membrane oxygenation
may have changes in tone, movement patterns, hyperactivity, behavioral problems, developmental delays
injury occurs during birthing process and leads to stretch of shoulder/neck which damages the nerves in the brachial plexus
brachial plexus injury
what are the different types of brachial plexus injuries
erb-duchenne palsy
dejerine-klumpke palsy
avulsion
rupture
neuroma
neuropraxia/stretch
paralysis to the upper brachial plexus
erb-duchenne palsy
what nerves does erbs palsy affect
C5, C6, C7
presentation of erbs palsy
arm straight, wrist fully bent (“waiters tip”)
what type of brachial plexus injury leads to shoulder instability and weak biceps and deltoids
erbs palsy
paralysis to the lower brachial plexus
dejerine-klumpke palsy
what nerves does klumpkes palsy affect
C8-T1
affects the intrinsics of the hand, flexors of the wrist and fingers, and ulnar half of flexor digitorum profundus
klumpkes palsy
classic presentation of klumpkes palsy
claw hand with forearm supination and wrist/finger flexion
nerve is torn from the spine
avulsion
nerve is torn but not at the spinal attachment
rupture
nerve has torn and healed, scar tissue puts pressure on the nerve causing dysfunction
neuroma
nerve is damaged but not torn
neuropraxia/stretch
what is the most common brachial plexus injury
neuropraxia/stretch
symptoms of brachial plexus injury
Limp/paralyzed arm
Lack of muscle control t/o affected UE
Decreased sensation
movement system diagnosis for brachial plexus injury
force production deficit
at what age is microsurgery completed for brachial plexus injuries
3-6 m/o
at what age are nerve transfer surgeries performed for brachial plexus injuries
12-18 m/o
internal organs protrude through a hole in abdomen
omphalocele and gastroschisis
what is the cause of omphalocele and gastroschisis
unknown
intestines through a hole in the belly button, covered by a protective sac
omphalocele
omphalocele can occur commonly up till when but then should retreat
11th week of pregnancy
intestines through a hole next to the belly button, not covered by a sac
gastroschisis
examples of protecting intestines during omphalocele and gastroschisis
protections of intestines, wrapping of intestines (compression to slowly encourage retreat into abdomen, surgical closure)
what scales can be used to assess pain in infants
behavioral rating scales
FLACC (face, legs, activity, cry, consolability)
CRIES (crying, requiring oxygen, increased vital signs, expressions, sleeplessness)
Neontal Infant Pain Scale (NIPS - facial expression, cry, breathing pattern, legs, state of arousal)
muscle tone presentation in preterm neonates
Hypotonia
Decreased ratio of type I (slow twitch) to type II( fast twitch), leading to muscular fatigue
Lig laxity
Limited physiologic flexion
Decreased balance of flexe/ext
Can be influenced by state of arousal
how do tone, DTRs and primitive reflexes. develop in preterm infants
develop LE to UE and distal to proximal
