Pre-, Per-, and Post-Natal Issues and Prematurity Flashcards
1
Q
What is a preterm infant?
A
- Infant born before 38 weeks of gestation or less
- Low birth weight: 2500 grams (8.17%)
- Very low birth weight: 1500 grams (1.14%)
- 9.8% of births occur preterm
- Postconceptual age (PCA) survival rate
- 23 weeks PCA = 5-25%
- 27 weeks PCA = > 90%
- A high percentage of infants and children seen later in therapy have spent time in the NICU
2
Q
What are pre-natal concerns to take into account?
A
- Pre-natal care of mother
- Length of gestation impacts health of baby
- Complications during pregnancy
- Gestational diabetes (can lead to brachial plexus injuries if the baby is too large)
- Placenta previa (placenta ruptures and can happen peri-natal)
- Pre-eclampsia (high BP, protein in urine)
- Neural tube disorders
- Amniotic Band Syndrome
- Stress
3
Q
What are pre-natal genetic disorders?
A
- Autosomal dominant: abnormal gene passed on from one of the non-sex chromosomes (ex: neurofibromytosis)
- Autosomal recessive: gene must be carried from by parents (1/4 chance of getting disease) (ex: cystic fibrosis)
- Sex linked: abnormal gene is passed on sex-linked chromosome by the mother (ex: hemophilia, muscular dystrophy)
- Polygenetic or multifactorial: many genes passed on from both parents (ex: corpus callosum deficits, cleft pallet)
4
Q
What are pre-natal concerns?
A
- Maternal health
- STORCH Viruses
- – Syphilis: caused by hepatitis and can lead to death, feeding problems, and neurological deficits
- – Toxoplasmosis: can contract it from changing cat litter and sand boxes or from eating raw meat. Can cause death, hydrocephaly, liver damage, and chorioretinitis (blindness)
- – Rubella: used to be more common prior to vaccination, although may become more of an issue since some parents are not vaccinating children. Can lead to deafness, blindness, MR (mitral regurgitation), and heart defects
- – Cytomeglovirus (CMV): type of herpes spread through body fluids. Multiple system involvement passed onto baby. Can cause multiple neurological conditions and deafness, very severe for organ transplants, AIDS patients, and developing fetuses
- – HIV/AIDS: can result in neurological deficits and motor impairment
- Nutrition
- Exposure to toxins
5
Q
What are peri-natal complications?
A
- Diabetes
- Structural abnormalities of the pelvis
- Placenta Previa
- Present birth defects (could worsen with birth)
- Multiple births
6
Q
What are post-natal complications?
A
- Prematurity and post-maturity
- Accidents
- Anoxia
- Exposure to lead from paint chips
- Shaken Baby Syndrome (non-accidental TBI)
- Infection
- Acquired childhood illness/diseases
- Cancer
- Juvenile diseases
7
Q
What are some possible complications if a baby is premature?
A
- Babies born prematurely can have an array of problems
- Respiratory
- Cardiovascular
- Neurological
- Metabolic
- Gastrointestinal
- Vision
- General medical problems due to prematurity
8
Q
What are respiratory issues related to prematurity?
A
- Bronchopulmonary disease (BPD): acute respiratory problem that requires prolonged use of ventilator
- Extracorporeal Membrane Oxygenation (ECMO): life support using a cardiopulmonary bypass
- Meconium Aspiration Syndrome (MAS): aspiration of meconium (stool) into trachea and bronchi
- Apnea: prolonged pause in respiration, accompanied by slowing of heart rate
- Respiratory Distress Syndrome (RDS): air sacs of term babies are kept open by a chemical coating called surfactant for exchange to occur. In premature babies, if surfactant is not produced then the lungs will collapse
9
Q
What is Patent Ductus Arteriosis?
A
- A cardiovascular problem related to prematurity
- While in utero, fetal circulation bypasses lungs via ductus arteriosis and normally closes at birth. In some preterm infants it may remain open, leading to enlargement of heart and cause backup of blood into the lungs
10
Q
What are neurological problems related to prematurity?
A
- Hypoxic-ischemic Encephalopathy: lack of oxygen due to many factors (perinatal) and seizures are common
- Intraventricular or intracranial hemorrhage (IVH): bleeding into cerebral ventricles and surrounding brain tissue
- Grade 1 and 2 brain bleeds: can be reversible
- Grade 3 brain bleed: can cause motor problems, can cause CP. If half the tract are affected it can cause spastic diplegia
- Grade 4 brain bleed: most severe, involves bleeding into ventricles, can cause more severe CP, resulting in quadriplegia
- Periventricular Leukomalacia (PVL): necrosis of white matter below the cortex around the ventricles
- Hydrocephalus: inflammation from blood in ventricles impedes circulation and reabsorption of CSF. Build-up of CSF in the ventricles of the brain
11
Q
What are metabolic problems related to prematurity?
A
- Hyperbilirubemia: excess of bilirubin, referred to as jaundice/yellow
- Hypo and Hyperglycemia: blood sugar imbalance. Can lead to problems with controlling temperature and regulation of breathing
12
Q
What are some GI and nutritional problems related to prematurity?
A
- Necrotizing Entercolitis (NEC): necrosis of the mucosa of the small intestine and colon
- Malnutrition: referred to as failure to thrive if not maintaining adequate calories or if there is inadequate absorption of nutrients
13
Q
What are medical problems related to prematurity?
A
- Temperature regulation: incubator may be necessary
- Sepsis: decreased immunity leads to increased susceptibility to infection
14
Q
What are opthamalogical problems associated with prematurity?
A
- Retinopathy of Prematurity (ROP)
- Grade 1 and 2: minor, no long-term effects
- Grade 3: results in high levels of nearsightedness
- Grade 4: involves the retina being partly attached, causes significant vision problems
- Grade 5: completely detached retina, leads to blindness
- Myopia
- High risk of developing cortical visual impairment (visual association areas are not interpreting what eyes are seeing)
- 35% greater risk for strabismus
15
Q
What are sensory and behavioral problems related to prematurity?
A
- Hearing loss
- 30% higher chance of ADHD
