Unit 2 Flashcards
What should you ask about an infants delivery?
- how they were born (vaginal or c-section)?
- Can indicate complications– neuro impairments
What do pediatric brachial plexus injuries normally occur due to?
-complications with vaginal birth
What 4 risk factors associated with birth can lead to brachial plexus injuries?
-Should dystocia (shoulder get stuck in birth canal), large for gestational age babies, prolonged labor, and breech deliveries
Nerve regrowth typically occurs at what rate in infants?
-1 mm per day
How long does a nerve injury in the upper arm take?
-4 months
How long does a nerve injury in the lower arm take?
-9 months
Approximately what percent of infants recover from nerve injuries?
-70%
What is the most common brachial plexus injury?
-Erb’s Palsy
Erbs palsy is casued by damage to what nerve roots?
-c5 and c6
What posture of the arm will be assumed with Erb’s Palsy?
-Waiters Tip
How does Erb’s Palsy compare to Klumpke’s Palsy?
-Klumpkes Palsy doesnt involve the shoulder or elbow
What type of posture will the arm assume with klumpkes palsy?
-supinated wrist, and will cause weakness of the wrist flexors, extensors and intrinsics
What nerve roots are involved with kulmpke’s palsy?
-c8 and t1
What is global palsy?
-damage to the entire brachial plexus
What can be caused with global palsy with a t1 avulsion?
-Horner’s Syndrome
When does surgery to repair brachial plexus injuries normally occur?
-between 3 and 8 months
What are the indications for surgery to repair a brachial plexus injury?
-lack of shoulder ER, no biceps or supination strength
When does surgery to repair brachial plexus injuries occur before 3 months?
-if complete paralysis or horners syndrome is present
What does TORCH stand for?
-Toxoplasmosis, Other, Rubella, Cytomegalovirus, Herpes
What is considered “other” in TORCH?
-syphillis, varicella-zoster, parvovirus b19, lyme disease, HIV
TORCH infections are responsible for what percent of birth defects?
-2 to 3%
What can indicate a torch infection that is now mandated to screen for in new borns?
-hearing loss
What can toxoplasmosis be acquired from?
-cat shit, undercooked meals, contaminated water/soil, unpasturized goat milk
What 4 things can toxoplasmosis cause?
-hydrocephalus, intracranial calcification, seizures, developmental and motor delay, intellectual disability, and blindness
What is syphilis not as common in infants anymore?
-prenatal testing is mandatory
What physical abnormalities are indicative of syphilis in an infant?
-Rash, damage to teeth and eyes
Where does varicella zoster lay dormant?
-in the dorsal root ganglion
What can Varicella zoster cause in infants?
-eye damage, CNS damage and ANS dysfunction
What are the signs and symptoms of an infant that is infected with HIV?
-Failure to thrive, yeast infection, and developmental delay
Will when will an infant that is actually infected with HIV test positive for it?
-18 months
An infant with a greater than average chance of morbitity or mortality is considered what?
-High Risk
What is developmental delay?
-The failure to acheive a skill expected of a typical infant or child
What is preeclampsia?
-a maternal condition during 20-40 weeks of gestation and 1 week post partum that results in maternal hypertension or edema
What is ecplamsia?
-results from preeclampsia and results in stroke, coma or convulsion
Premature birth occurs before what week of gestation?
-at or befroe 37 weeks
How is gestational age counted?
-time since last menstral cycle
An infant less than 5.5 lbs is considered what?
-Small for Gestational Age (SGA)
What is considered low birth weight?
-1501 to 2500 g (3.3 to 5.5 lbs)
What is considered very low birth weight?
-1000 to 1500 g (2.2 to 3.3 lbs)
What is considered extremely low birth weight?
-<1000 g (<2.2 lbs)
50% of ELBW babies have what?
-moderate to severe neuro disabilities
What is a babies PCA?
-Post conceptual age: Number of weeks since conception + chronological age if not reached full term yet
What is a level I neotnatal care unit?
-well-baby nursery: stable infants; feed and grow babies
What is a level II neotnatal care unit?
-Special Care Nursery: infants 32+ weeks, 1500+ grams or to stabilize infants prior to more specialized care– on tube feed or supplemental oxygen
What is a level III neotnatal care unit?
- infants <32 we, or <1500 grams; on ventliators
What is a level IV neotnatal care unit?
-Regional NICU: most specialized medical services for complex infants
How should you position an infant in the NICU?
-Head in midline, elevated to 32 degrees
In what position is oxygenation the highest?
-prone
How should you educate an infants parents to position the infant for sleep after leaving the NICU to reduce the risk of SIDS?
-supine
What is the Synactive Theory?
-looks at babies ability to self regulate, and the babies behavior indicating the amount of stress they are in
What is Resipratory Distress Syndomre (Aka hyaline membrane disease)?
-when the infants lungs do not produce enough surfactant and the alveoli collapse
Respiratory Distress syndrome mainly occurs in infants born before what gestational age?
-29 weeks
When does surfactant develop?
-32 weeks
When do sufficient levels of surfactant develop?
-37 to 38 weeks
What are the signs of respiratory distress syndrome?
- grunting, soft tissue retractions, syanosis
What does bronchopulmonary dysplasia result from?
-supplemental oxygen or ventilator use, especially longer than 11 days
Bronchopulmonary dysplasia is more common in what babies?
-LBW or ELBW
What is Meconium Aspiration Disorder?
-When the infants 1st poop occurs in the womb or delivery and is inhaled through amneotic fluid
IVH is most common in infants born below what?
-32 weeks
What increases the risk for IVH?
-Low Birth Rate
What grades of IVH have a low risk for long term neurological deficits?
-Grades I and II
What is a grade I IVH?
-Isolated Germinal Hemorrhage
What is a grade II IVH?
-IVH with normal size ventricles
What is a grade III IVH?
-IVH with Dilated ventricles
What is a Grade IV IVH?
-IVH into periventricular white matter
What is periventricular Leukomalacia cause by?
-Too little Cerebral blood flow
What is the leading cause of CP?
-Periventricular Leukomalacia
Periventricular leukomalacia is likely to cause diplegia or quadraplegia in the presence of what?
-bilateral cysts
What is hypoxic encephalopathy caused by?
-decreased oxygenation and glucose due to hypoxemia
What does mild HIE require?
-resuscitation
What will the infant present like with mild HIE?
-May be irritable and jittery but have normal muscle tone
What will an infant with moderate HIE recquire?
-resuscitation and short term assistance with respiration
What are the signs of moderate HIE?
-Possible hypotonia and seizures
What will severe HIE recquire?
-resuscitation and prolonged ventilation
How will an infant with severe HIE present?
-severe hyotonia,decreased movement, seizures, cognitive impairments
GERD is more common in infants with what?
-neurological impairments
What is neonatal abstinence syndrome?
-withdrawal symptoms and neurobehaviors in infants that occurs in response to mothers taking drugs during pregnancy
What are the symptoms of neonatal abstinence syndrome?
-irritability, tremors, failure to thrive, increased muscle tone
What is necrotizing entercolitis?
-acute inflammation of the bowel that results in intestinal mucosal ulceration and hemorhhage
In what infants does necrotizing entercolitis occur most common in?
-Preemies less than 2000G
What does retinopathy of prematurity come from?
-abnormal blood vessel growth in the immature retina due to high levels of supplemental oxygen
What can hyerbilirubinemia cause if untreated?
-damage to the basal ganglia and cause athetosis
What is the normal HR of a newborn infant?
-120-180 BPM
What is the normal RR of a newborn?
-40 to 60 BPM
What is the most common test performed in the NICU?
-Test of Infant Motor Performance
