Introduction to Developmental Disabilities: The High Risk Infant   <ul><li>Clinical Sciences III </li></ul><ul><li>Karen R...
Definitions <ul><li>Gestation/gestational age </li></ul><ul><ul><li>Gestation-Period between conception and birth </li></u...
DEFINITION The high risk infant is associated with increased hazard of death or disability of the fetus/neonate because of...
Factors may be associated with: <ul><li>Mother </li></ul><ul><li>Infant </li></ul>
MATERNAL FACTORS <ul><li>Maternal Age: </li></ul><ul><ul><li>Gravida less than 16 (18) </li></ul></ul><ul><ul><li>Primagra...
Pregnancy Complications <ul><li>Preeclampsia </li></ul><ul><li>Eclampsia </li></ul><ul><li>maternal infection (STORCH) </l...
MATERNAL FACTORS CONTINUED <ul><li>Malnutrition </li></ul><ul><li>Prepartum bleeding </li></ul><ul><li>Prolonged labor, or...
MATERNAL FACTORS CONTINUED <ul><li>Drug Addiction, Smoking or Alcoholism </li></ul><ul><li>Previous child with CP, or othe...
STORCH:  Group of maternal infections that can cause birth defects and developmental delay <ul><li>S  yphilis </li></ul><u...
STORCH Infections
FETAL ALCOHOL SYNDROME <ul><li>Group of abnormalities directly related to the ingestion of alcohol during pregnancy </li><...
Facial Features in FAS
Major Characteristics <ul><li>congenital malformations: </li></ul><ul><ul><li>Facial, genital, joint abnormalities </li></...
MAJOR CHARACTERISTICS <ul><li>prenatal and postnatal growth deficiency </li></ul><ul><li>Cardiac defects </li></ul><ul><li...
FAS and FAE <ul><li>Fetal alcohol effects: more subtle effects. </li></ul><ul><li>May not have dysmorphic features </li></...
<ul><li>Alcohol intake exceeding 2-3 oz / day considered toxic by some sources </li></ul><ul><li>Alcohol rapidly crosses t...
DRUG ADDICTION <ul><li>Withdrawal symptoms in newborn </li></ul><ul><ul><li>Neonatal Abstinence Syndrome </li></ul></ul><u...
Drug Addiction <ul><li>Prognosis:  reasonably good - mortality rate still present in most severe cases </li></ul><ul><li>L...
Drug Addicted Premature Infant
SMOKING <ul><li>Significant impact on the growth of the fetus </li></ul><ul><ul><li>only well - established complication <...
TERATOGENS <ul><li>Any agent or factor that increases the chance of a congenital anomaly. </li></ul><ul><li>Agents in the ...
TERATOGENS <ul><li>Factors affecting the occurrence and severity of a tetarogenic effect: </li></ul><ul><ul><li>Timing of ...
TERATOGENS <ul><li>Exposure timing </li></ul><ul><ul><li>First  2 weeks of pregnancy - results in spontaneous abortion or ...
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Odu%20 clinical%20sciences%20iii%20high%20risk%20infant%202011[1]

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Odu%20 clinical%20sciences%20iii%20high%20risk%20infant%202011[1]

  1. 1. Introduction to Developmental Disabilities: The High Risk Infant <ul><li>Clinical Sciences III </li></ul><ul><li>Karen R. Voogt </li></ul><ul><li>Fall 2011 </li></ul>
  2. 2. Definitions <ul><li>Gestation/gestational age </li></ul><ul><ul><li>Gestation-Period between conception and birth </li></ul></ul><ul><ul><li>Gestational Age-1 st day of last menstrual cycle to date </li></ul></ul><ul><li>Gravida </li></ul><ul><ul><li>Total number of pregnancies </li></ul></ul><ul><li>Para </li></ul><ul><ul><li>Total number of viable births </li></ul></ul>
  3. 3. DEFINITION The high risk infant is associated with increased hazard of death or disability of the fetus/neonate because of maternal factors, fetal disease or some abnormality
  4. 4. Factors may be associated with: <ul><li>Mother </li></ul><ul><li>Infant </li></ul>
  5. 5. MATERNAL FACTORS <ul><li>Maternal Age: </li></ul><ul><ul><li>Gravida less than 16 (18) </li></ul></ul><ul><ul><li>Primagravida over 35 years </li></ul></ul><ul><ul><li>Gravida over 40 years </li></ul></ul>
  6. 6. Pregnancy Complications <ul><li>Preeclampsia </li></ul><ul><li>Eclampsia </li></ul><ul><li>maternal infection (STORCH) </li></ul><ul><li>Diabetes </li></ul><ul><li>Hypertension </li></ul><ul><li>Trauma/Abuse </li></ul>MATERNAL FACTORS CONTINUED
  7. 7. MATERNAL FACTORS CONTINUED <ul><li>Malnutrition </li></ul><ul><li>Prepartum bleeding </li></ul><ul><li>Prolonged labor, or PROM (premature rupture of membranes) </li></ul><ul><li>Breech presentation </li></ul><ul><li>Multiple births </li></ul>
  8. 8. MATERNAL FACTORS CONTINUED <ul><li>Drug Addiction, Smoking or Alcoholism </li></ul><ul><li>Previous child with CP, or other CNS disorder </li></ul><ul><li>Exposure to teratogen </li></ul>
  9. 9. STORCH: Group of maternal infections that can cause birth defects and developmental delay <ul><li>S yphilis </li></ul><ul><li>T oxoplasmosis </li></ul><ul><li>O ther </li></ul><ul><li>R ubella </li></ul><ul><li>C ytomegalic Inclusion Disease (CID) </li></ul><ul><li>H erpes </li></ul>
  10. 10. STORCH Infections
  11. 11. FETAL ALCOHOL SYNDROME <ul><li>Group of abnormalities directly related to the ingestion of alcohol during pregnancy </li></ul><ul><li>One of the most common causes of mental retardation </li></ul>
  12. 12. Facial Features in FAS
  13. 13. Major Characteristics <ul><li>congenital malformations: </li></ul><ul><ul><li>Facial, genital, joint abnormalities </li></ul></ul>
  14. 14. MAJOR CHARACTERISTICS <ul><li>prenatal and postnatal growth deficiency </li></ul><ul><li>Cardiac defects </li></ul><ul><li>CNS disturbances: </li></ul><ul><li>Microcephaly, mental retardation, </li></ul><ul><li>delay of gross and fine motor development </li></ul>
  15. 15. FAS and FAE <ul><li>Fetal alcohol effects: more subtle effects. </li></ul><ul><li>May not have dysmorphic features </li></ul><ul><li>May include hyperactivity, delayed language development, slow reaction time, problems with judgment and comprehension </li></ul>
  16. 16. <ul><li>Alcohol intake exceeding 2-3 oz / day considered toxic by some sources </li></ul><ul><li>Alcohol rapidly crosses the placenta and blood-brain barrier of fetus </li></ul><ul><li>Timing important </li></ul><ul><ul><li>First trimester - organ formation </li></ul></ul><ul><li>neurological abnormalities may be decreased if stop drinking by 16-20 weeks gestation </li></ul><ul><li>Approx. 2/3 of pregnancies in active alcoholics will have significant complications </li></ul>
  17. 17. DRUG ADDICTION <ul><li>Withdrawal symptoms in newborn </li></ul><ul><ul><li>Neonatal Abstinence Syndrome </li></ul></ul><ul><ul><ul><li>Onset of withdrawal symptoms within the first 72 hours of birth </li></ul></ul></ul><ul><ul><ul><ul><li>Neurologic-CNS excitability </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Gastrointestinal-Poor coordinated suck/swallow </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Respitory-Tachypnea, apnea </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Autonomic dysfunction </li></ul></ul></ul></ul><ul><li>Treatment: observation, drugs, swaddling </li></ul>
  18. 18. Drug Addiction <ul><li>Prognosis: reasonably good - mortality rate still present in most severe cases </li></ul><ul><li>Long term outcome often not encouraging </li></ul><ul><ul><li>Growth retardation </li></ul></ul><ul><ul><li>Intellectual impairment </li></ul></ul><ul><ul><li>Learning difficulties </li></ul></ul><ul><ul><li>Bonding and attachment difficulties </li></ul></ul>
  19. 19. Drug Addicted Premature Infant
  20. 20. SMOKING <ul><li>Significant impact on the growth of the fetus </li></ul><ul><ul><li>only well - established complication </li></ul></ul><ul><li>May be multiple drug use </li></ul>
  21. 21. TERATOGENS <ul><li>Any agent or factor that increases the chance of a congenital anomaly. </li></ul><ul><li>Agents in the environment of the developing embryo and fetus that cause structural or functional abnormalities (Blackman) </li></ul><ul><ul><li>Thalidomide: Well known teratogen leading to limb defects in exposed babies. This medication to prevent morning sickness is not used anymore. </li></ul></ul><ul><ul><li>STORCH, Varicella, HIV </li></ul></ul><ul><ul><li>Chemicals-Mercury, herbicides, solvents </li></ul></ul><ul><ul><li>Prescription and non prescription drugs </li></ul></ul>
  22. 22. TERATOGENS <ul><li>Factors affecting the occurrence and severity of a tetarogenic effect: </li></ul><ul><ul><li>Timing of exposure </li></ul></ul><ul><ul><li>genetic makeup of the fertilized egg </li></ul></ul><ul><ul><li>type and dosage of the teratogen </li></ul></ul><ul><ul><li>genetic and environmental factors in the mother </li></ul></ul>
  23. 23. TERATOGENS <ul><li>Exposure timing </li></ul><ul><ul><li>First 2 weeks of pregnancy - results in spontaneous abortion or no effect at all </li></ul></ul><ul><ul><li>week 3-7 - abnormal growth and development of a body part </li></ul></ul><ul><ul><li>later exposures - disturbances in the functioning of certain organs </li></ul></ul>
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