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SUM'20 - Advanced Principles > Week 2 Fetal and Neurologic Injury (everything) > Flashcards

Week 2 Fetal and Neurologic Injury (everything) Flashcards

1
Q

The brain continuously evolves during development (egg to death) but it is susceptible to subtle changes in the

A

internal and external milieu

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2
Q

Neurologic injury is most dynamic during what period of fetal life/growth?

A

Perinatal period

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3
Q

detection and diagnosis of fetal and neonatal brain injury have been advanced by:

A

functional imaging and the identification of potential biochemical markers

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4
Q

What mediators play an important role in the pathophysiology of fetal brain injury?

A

inflammatory mediators

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5
Q

maternal administration of ___ before preterm birth reduces the risk of what?

A
  • magnesium sulfate

- cerebral palsy

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6
Q

Induced hypothermia is beneficial for the treatment of (neonatal)

A

hypoxic-ischemic encephalopathy

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7
Q

rodent and primate data suggest that fetal exposure to anesthetic agents may have harmful effects on

A

neurogenesis and synapse development in the developing brain.

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8
Q

**What are the three major events that appear critical to the establishment of functional synapses:

A
  • *
    1. Neuronal proliferation
    2. migration
    3. cellular differentiation
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9
Q

**Neurogenesis beings with

A

neural stem/progenitor cells in neurogenic niches such as:

-subventricular and the subgranular zone of the dentate gyrus

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10
Q

**Neurogenesis is a term that encompasses both

A

Neuronal proliferation and subsequent survival

(begins w/neural stem/progenitor cells in neurogenic niches such as the subventricular zone and the subgranular zone of the dentate gyrus.

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11
Q

Neural progenitor cells undergo ____ to generate immature neurons to “laminate the cortex”

A

Mitosis

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12
Q

Immature neurons are generated during :

A

Mitosis

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13
Q

**Interneurons compose what % of the total neuronal cells in the brain?

A

10-15%

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14
Q

Interneurons originate from the

A

ganglionic eminences in the developing brain

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15
Q

**The two Neurotransmitters important for fetal brain development:

A

GABA and Glutamate

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16
Q

*Neurogenesis starts at ____ weeks gestation

A

5 weeks

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17
Q

*Neurogenesis peaks at ___ weeks gestation

A

25 weeks

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18
Q

*Neuronal migration is completed between how many weeks gestation:

A

30-36 weeks

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19
Q

Synapse formation begins as early as

A

10 wks and continues to increase gradually at a rate of ~ 4%/week until the end of second trimester

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20
Q

A robust increase in synapse formation (40,000 synapses/min) occurs bw :

A

28wks and term gestation

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21
Q

Neurogenesis and synapse formation occur in conjunction w/the onset of

A

myelination

– result in a 5-fold increase in brain volume and appearance of mature brain features such as sulci and gyri

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22
Q

***By 24 wks the fetus has all the neural machinery necessary to

A

perceive pain **

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23
Q

B/c at 24 wks the fetus can perceive pain, many clinicians recommend

A

appropriate measures should be taken to provide fetal analgesia during fetal surgical procedures from this pt onward

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24
Q

Among the NT’s, which remains the most widely studied?

A

GABA

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25
Q

How does GABA action compare in the mature brain vs the developing fetal brain?

A

GABA has an inhibitory action in the mature brain.

GABA serves an EXCITATORY role during fetal brain development.

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26
Q

The major mechanism for the GABA role reversal (mature vs fetal brain) is differential expression of

A

Chloride ion transporters (NKCC1 and KCC2)

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27
Q

the chloride ion transporters increase

A

intracellular concentration of Chloride in developing neurons.

28
Q

Stimulated GABA receptors in neural progenitor cells and immature neurons, chloride ions cause

A

membrane DEPOLARIZATION rather than the HYPERPOLARIZATION seen in mature neurons.

29
Q

** The depolarizing effect of GABA decreases

A

DNA synthesis

30
Q

** The depolarizing effect of GABA inhibits

A

proliferation of neural progenitor cells

31
Q

** The depolarizing effect of GABA and it’s affects play a major role in

A

activity-dependent synapse formation

32
Q

fetal brain is encoded by genetic programming- such programs remain highly susceptible to what

A

environmentally induced epigenetic modifications and appear closely intertwined with maternal immune and endocrine systems

33
Q

maternal infection and inflammation in early pregnancy can cause an array of neurodevelopment abnormalities- name two

A

schizophrenia and autism

34
Q

among maternal infections _____ is best characterized and thoroughly investigated model of perinatal neuroinflammation

A

chorioamnionitis

35
Q

the exact mechanism by which maternal inflammation triggers a fetal immune response is likely

A

multifactoral

36
Q

Review Box 10.4

10-4 Fetal Cerebral Responses to Asphyxia

A 
FETAL CEREBRAL METABOLISM
• Increased oxygen extraction
• Use of alternative energy sources
• Decreased growth
• Altered behavioral state
FETAL CEREBRAL O2 TRANSPORT
• Redistribution of cerebral blood flow
37
Q

*** the fetus can conserve additional energy by what two ways?

A

decreasing breathing and gross body movements***

38
Q

** during chronic hypoxemia the fetus may also restrict the use of energy from oxidative metabolism to maintain essential cellular process- this leads to

A

decreased somatic growth and fetal growth restrictions ***

39
Q

*** unlike the adult brain what can the fetal brain use as alternate energy sources

A

ketone bodies and lactate **

40
Q

the fetus takes advantage of several adaptive responses for survival and growth- what is this due to

A

the relatively hypoxemia intrauterine environment

41
Q

what is a useful tool in the diagnosis of neonatal brain injury

A

MRI

42
Q

MRI can assist the diagnosis of these 4 things

A

hypoxic- ischemic encephalopathy

determine volume of gray matter

extent of white matter myelination

estimates timing of the brain injury for cerebral palsy.

43
Q

in VIVO MRI can be used to identify structural abnormalities - quantify brain growth beginning at what week gestation

A

18th week gestation

44
Q

neuraxial techniques- used in labor focus on

A

analgesic quality

and obstetric and short-term neonatal outcomes

45
Q

True or false

epidrually administered local anesthetics cross the placenta and enter fetal circulation

A

True- whatever we give to the mother we give to the baby.

46
Q

True or false
the long term effects of peripartum opioid exposure on the infants neurodevelopment shows a decrease in their development

A

false- the infant exposure to opioids remains unclear of any harm to their neurodevelopment

47
Q

what systemic opioid used for labor analgesia is the most widely studied

A

meperidine

48
Q

What receptors in the fetal brain play a limited role during early brain development, they remain functionally silent because of magnesium ion- induced channel blockade? (they originate later than GABA receptors)

A

NMDA-subtype glutamate receptors. (bold in ppt)

49
Q

what three NT systems develop concomitantly and appear fully functional by the 2nd trimester?

A

Dopaminergic, cholinergic, and serotonergic systems.

50
Q

Pharmacologic interventions (e.g., ethanol, antiepileptic drugs) that act directly or indirectly on these powerful neuromodulator systems (dopaminergic, cholinergic, and seotenergic) induce what? (bold in ppt)

(basically saying if a system in the brain is developed and you use drugs that mess with it then what can happen long term to the fetus).

A

long-lasting impairment of fetal brain development, mainly owing to impaired neurogenesis and/or altered neuronal migration.

Alteration of this excitation-inhibition balance is purported to be responsible for an array of childhood neurodevelopmental disorders.

51
Q

Experimental studies have revealed what about the fetal blood-brain barrier at term?

A

morphologically well developed and functionally competent at term.

52
Q

Is Cerebral palsy a progressive or non progressive disorder of the CNS?

A

NON-progressive

53
Q

What is Cerebral Palsy?

A

Present since birth that include impairment of motor function or posture.

Intellectual disability may or may not be present.

54
Q

**The only types of cerebral palsy associated with intrapartum hypoxia, what are they?

A

spastic quadriplegia and, less commonly, dyskinesia**

55
Q

what three disorders should not be ascribed to birth asphyxia unless accompanied by spastic quadriplegia.

A

Intellectual disability,
learning disorders, and
epilepsy.

56
Q

What age should a child be before statements about the severity of Cerebral Palsy be made?

A

3 to 4 years of age, , because mild cases may improve and dyskinesia may not be evident until then.

57
Q

*** Intrapartum hypoxia sufficient to cause cerebral palsy is always accompanied by WHAT?

A

neonatal encephalopathy and seizures. ***

58
Q

An association between cerebral palsy and chorioamnionitis has been demonstrated in preterm and term infants. But it is hard say which moms have chorioaminionitis. until which tests are confirmed?

A

placental culture or histologist examination

59
Q

What is chorioamnionitis?

A

Chorioamnionitis also known as intra-amniotic infection (IAI) is an inflammation of the fetal membranes (amnion and chorion) due to a bacterial infection. It typically results from bacteria ascending from the vagina into the uterus and is most often associated with prolonged labor.

60
Q

what are some signs of chorioamnionitis?

A
  • elevated maternal temperature alone is insufficient for the diagnosis.

Other signs include:

  • maternal and fetal tachycardia,
  • foul-smelling amniotic fluid,
  • uterine tenderness, and
  • maternal leukocytosis.

**Diagnosis remains unproven until confirmed by placental culture or histologic exam

61
Q

What provides the fetus with oxygen and nutrients?

A

Placenta

62
Q

If the Placenta or umbilical cord is not delivering oxygen or nutrients to the fetus what happens?

A

the baby is negatively affected depending on how long the deprivation is, both hypoxemic and inflammatory pathways interact and augment fetal brain damage.

63
Q

True or False

Chronic placental insufficiency relatively spares the fetal brain compared with other organ systems?

A

True, (although it does result in reduced fetal brain weight)

64
Q

It can not be pin pointed that chronic hypoxemia is the sole cause for an array of brain issues the fetus may have. what else could be responsible? (think lack of other things to the fetus not just oxygen?)

A

chronic reduction of fetal nutrient supply or altered maternal-fetal endocrine status could also be to blame, not just hypoxemia.

65
Q

the mechanism for epidural analgesia associated maternal pyrexia is

A

appears to be inflammatory in nature

66
Q

hypoxemic and inflammatory pathways interact and augment:

A

fetal brain damage

SUM'20 - Advanced Principles (16 decks)

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