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

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