HOSA!! Ch 6 Prenatal period to year 1

Factors that have the most effect on a developing baby

Heredity and environment

Zygote; chromosomes and sex.

Each sperm and ovum contributes 23 chromosomes to the new entity, a single celled zygote

Sex of zygote is determined by combination of X and Y chromosomes. The ovum has X chromosome, sperm has X or Y. If the ovum is fertilized by an X chromosome sperm, female. If a Y chromosome sperm fertilizes the ovum, a male

Chromosomes carry ___?

Genes

Genes

transmit all the genetic information or hereditary characteristics from the parents to the child

Found on strands of deoxyribonucleic acid (DNA) in the nucleus of a cell

Dominant vs recessive genes

Dominant: capable of expressing their traits over other genes.

Recessive: can transmit their traits only if they exist in like pairs.

What are the results of defects carried on recessive genes?

More than 700 diseases

Sickle cell disease, Tay-Sachs disease, and hemophilia are examples.

MUST be inherited from both parents

Karyotype

chromosomal structure of an entity

Karyotyping

Mapping the chromosomal structure

Helps predict the transmission of certain genetic disorders and is useful in counseling prospective parents.

genetic counseling

Suggested to individuals and couples so they understand hereditary disorders, their risks, and treatments.

Long process including the whole family, blood sampling

Specific cultural descents should screen for certain diseases. Sickle-Cell in African Americans and Tay-Sachs in European jews.

Prenatal testing

part of routine pregnancy care that provides information about the health of the fetus before birth

Includes chorionic villus sampling (sample of placental tissue), umbilical cord sampling, carrier detection, and ultrasonography. Amniocentesis (small sample of amniotic fluid from sac surrounding fetus) only done if further testing is needed.

Postnatal Diagnostic

Medical and genetical screening after birth for mother or baby using physical examination, chromosomal and DNA analysis, and other testing.

Environment and health practices

environment plays a role from birth

Good practices contribute to the development of a healthy baby. Mother’s diet affects her and baby’s health. Balance of rest and exercise is needed. As a rule, a woman can continue any exercise that she has regularly participated in before her pregnancy. Walking is the best exercise, women should walk daily. Before beginning any new form of sport or exercise, the pregnant woman should check with her physician.

Placenta

How harmful and life-sustaining substances are transmitted from mother to baby.

teratogens

Chemical or physical substances that can adversely affect an unborn baby

Tobacco, alcohol, drugs

As soon as women TRIES to become pregnant eliminate ALL such substances

Things (apart from the main 3 teratogens) that can damage the fetus.

Bacteria, protozoan, and viral infections. Pesticides, chemicals, radiation, and other environmental hazards.

3 specific examples of diseases contracted in pregnancy that harms fetus

Rubella virus poses risk to baby - fetal abnormalities

HIV may also be transmitted to unborn

Toxoplasmosis, a common parasite found in many animals. Avoid by eating well-cooked meats and avoiding contact with cat litter.

Why should alcohol be restricted for pregnant women? Symptoms? Stoppage

Alcohol by-products can cross the placental membrane and fetal blood–brain barrier. Alcohol during the first trimester has the greatest risk for developing fetal alcohol syndrome (FAS).

Miscarriages, stillbirths, prenatal and post-natal growth restriction, and CNS abnormalities are causes by FAS

Prevention and education are key to stopping abnormalities. Early detection of FAS and proper intervention helps the child reach full potential.

Cigarette smoking causes…?

Low birth rate and growth restriction

Prenatal period

The period from fertilization to birth

Pre pregnancy processes (every-day)

From the time of menarche in puberty to menopause in middle age, the female ovaries produce ova (female sex cells). Every 28-ish days the ovum matures and is released in a process called ovulation.

From puberty on, the male testes produce sperm, or male sex cells, which are released at the moment of ejaculation.

Pregnancy begins with…? Name, definition, location

the union of female ovum and male sperm cell.

known as conception or fertilization; all inherited characteristics are determined at this moment.

Location: Womens fallopian tube

What happens after fertilization? And the process + duration.

The zygote undergoes a series of cell divisions and forms a cell mass known as a morula.

The morula continues to divide and change as it travels down the fallopian tube to the uterus, where it implants itself in the uterine wall.

At the point of implantation the entity is called a blastocyst.

The total process, from fertilization to implantation, takes about 7 days

What happens after implantation?

After implantation, the multicelled structure, now an embryo, continues to develop. By the end of the 8th week of development, all essential structures are formed and the embryo is now a fetus.

prenatal development breakdown

Length of pregnancy is approximately 40 weeks.

Divided into 3 stages: pre-embryonic, embryonic, and fetal.

The pre-embryonic stage begins with fertilization and lasts about 2 weeks.

The embryonic stage begins 2 weeks after fertilization and ends after the eighth week.

The fetal stage begins with the ninth week and ends with the birth of the baby.

Approximately 280 days after conception, labor begins

Hormones (3) involved in the process of labor and their definitions:

Progesterone, oxytocin, and prostaglandins.

Progesterone is produced by the ovaries (female sex glands). It is the hormone that maintains pregnancy and helps stimulate uterine contractions at the end

Oxytocin is produced by the hypophysis (the posterior lobe of the pituitary gland). It stimulates uterine contractions and prepares the breasts for breastfeeding.

Prostaglandins are produced in various tissues throughout the body. Uterine prostaglandins help stimulate contractions.

Stage one of labor and delivery

The stage of dilation

Usually the longest, lasting an average of 12 to 24 hours.

Begins with the onset of regular rhythmic uterine contractions and ends with the complete dilation (widening) of the cervix (the lower portion of the uterus). During this stage, effacement, or a shortening and thinning of the cervix, occurs.

Stage two of labor and delivery

the expulsion stage

lasts about 1 ½ hours, but it is the most difficult stage.

It begins with the complete dilation of the cervix and ends with the birth of the baby.

Stage three of labor and delivery

Shortest stage, lasting 5 to 30 minutes

begins with the birth of the baby and ends with the delivery of the placenta.

How does the culture and society of individuals help influence childbirth practices and beliefs?

Childbirth in Western civilization has changed.

Before the mid-19th century, childbirth was a family event that took place at home.

After the Industrial Revolution, childbirth shifted from the home to hospital-centered care. Physicians were the primary caregivers. Gradually, the natural childbirth movement evolved and became popular. This resulted in a decreased use of medications and instruments and a shift to family centered care.

Today many hospitals have birthing centers, which attempt to provide comfort in an “at home” atmosphere. Some individuals have selected to give birth at home, often with a midwife, & their family playing an active part.

Education, preparation, and support needed

What surrounds the fetus?

During pregnancy, a protective sac of fetal membranes surrounds the developing fetus.

Amniotic fluid fills the sac. Amniotic fluid acts as a protective cushion, maintains even body temperature, allows for movement of the fetus, and provides a fluid source for the fetus.

Placenta (specific functions)

Mother and fetus are linked through this organ.

Serves many functions, including producing hormones, transporting nutrients and wastes, and protecting the baby from harmful substances.

Umbilical cord and defects with it.

Link between the fetus and the placenta.

At birth it’s to be whitish blue and is covered by a glistening membrane.

In the delivery room the cord must be assessed for the presence of three vessels—two arteries and one vein. Any deviation from this usually indicates some serious cardiac abnormality.

Fetal Circulation

In fetal circulation, oxygen and nutrients reach the fetus by way of the umbilical vein, and waste and deoxygenated blood return to the placenta for oxygenation by way of the umbilical arteries.

Fetal circulation ends at birth, when the umbilical cord is tied off and the neonate, takes its first breath.

Apgar score (and 5 things it tests)

At 1 minute after birth, and again 5 minutes later, the neonate is assessed and given an Apgar score.

Five essential categories of functioning are assessed, including color, reflex irritability, heart rate, respiratory rate, and muscle tone.

The Apgar score gives an immediate clinical picture of the newborn’s overall status.

Newborns head at birth

At birth the newborn’s head is large in proportion to the rest of its body, about one-fourth of the total body length.

A newborn’s average head circumference is 13 to 14 inches (33 to 35.5 cm) about 1 inch larger than the chest.

The head circumference increases by about 3 inches during the first 8 months of life.

the skull bones (number, name, and structures in between)

The skull consists of six soft bones: one occipital, one frontal, two parietal, and two temporal bones.

The skull bones are separated by bands of cartilage, called sutures.

fontanels and their necessity

Located at the anterior and posterior of the infant’s skull, two spaces or soft spots

Very visible and even appears to pulsate when the infant cries. The skull should be palpated for the presence of sutures and fontanels.

The small triangular-shaped posterior fontanel closes by the infant’s fourth month. The larger, diamond-shaped anterior fontanel closes when the child is 12 to 18 months old. These spaces allow the skull to accommodate the rapid brain growth that takes place in this period.

Molding

newborn’s skull may appear misshapen or elongated as a result of molding, which occurs as the head passes through the narrow birth canal.

Temporary and disappears in a few days naturally.

Length of newborn’s body & rate of growth

Average length of newborn measured from head to heel is 20 inches (50 cm).

Usually, infants grow 1 inch per month for the first year. At 12 months the child’s brain is approximately 2.5 times as big as it was at birth, the head and chest are equal in circumference, and the child is 1.5 times longer than at birth.

Weight of a newborn

At birth, the newborn weighs an average of 7.5 pounds; the normal range is from 5.5 to 10 pounds. Boys are generally slightly larger than girls at birth.

normal physiological weight loss

The newborn loses 5% to 10% of its birth weight in the first few days of life.

This occurs because the infant is given nothing by mouth for the first few hours and, therefore, the infant’s output exceeds its intake.

Neonate regains initial weight loss in 10 days after drinking milk (any kind)

Infants weight gain

Newborn will gain 5 to 6 ounces per week for the first month. Infants will double birth weight by 5 to 6 months of age and triple it by year 1.

Most of an infants body is what? That means?

75% is water, making them highly susceptible to a rapid loss of total body fluid and possible dehydration from vomiting and diarrhea.

Newborns skin at birth and 2 specific traits that occur

The newborn’s skin at birth is thin and appears pale.

Some temporary acrocyanosis (blueness of the hands and feet) may be present as a result of poor peripheral circulation; this usually disappears a few hours after birth.

Pigmentation may be more pronounced in certain areas of the body, such as the earlobes, scrotum, and back of the neck; full pigmentation develops several days later.

How does melanin affect neonates color (specific by race)

northern European descent vary from pink to red

African descent vary from pink to dark red

Asian descent vary from rosy red to yellowish tan

Hispanic and Mediterranean descent may be yellowish brown

Native American infants vary from light pink to reddish brown.

lanugo

newborns have a covering of fine hair over the body. vanishes a few days after birth

vernix caseosa

newborn’s skin creases have this white, cheeselike, oily covering, protects the fetus’s skin during pregnancy.

Milia

Small clusters of pearly white spots mostly on the infant’s nose, chin, and forehead, may be present at birth.

These spots are caused by the retention of sebaceous material (sebum) within the sebaceous glands and disappear spontaneously without treatment.

Physiological Jaundice. Definition, process, and other types.

a yellow tinge to their skin also known as icterus neonatorum

frequently occurs in newborns within 48 to 72 hours after birth. At birth the neonate’s red blood cell (RBC) count is higher than that of the normal adult—usually 6 million per mm3 of blood. A few days after birth the RBC count begins to decrease as the body destroys these unnecessary excess cells. This releases a high amount of bilirubin (a component of RBC), producing the jaundiced appearance in the infant.

Different from jaundice related to blood incompatibilities, usually present immediately at birth and requires prompt help.

How do maternal hormones affect newborns

Maternal hormones of pregnancy present in the neonate’s bloodstream may cause certain physiological anomalies.

Maternal hormones may cause these conditions in females

The breasts of neonates of both sexes may be swollen.

The labia in the newborn female may appear swollen. A blood-tinged mucous vaginal discharge known as pseudomenstruation may be noted.

These conditions will disappear without intervention.

Maternal hormones may cause this condition in males. treatment?

Scrotum of males may appear large and edematous.

The scrotum should be palpated for the presence of testicles, which usually descend from the abdominal cavity into the scrotal sac during the seventh month of fetal life. If the testicles have not descended, the infant will be observed to see if descent occurs over the next few months.

Undescended testicles can be treated with a short course of drug therapy or surgery. The newborn’s penis is inspected for the location of the urethral opening. Normally this opening is just at the tip of the head of the penis under the foreskin.

Circumcision, the surgical removal of the foreskin, may be performed after birth for hygienic or religious reasons. Any deviation should be noted and reported to the physician for follow-up treatment.

Urine in newborns

Urine is normally present in the bladder at the time of birth. The newborn should void within 24 hours after birth and 8 to 10 times a day thereafter.

The initial voiding may appear rust-colored because of the presence of uric acid crystals. This condition generally disappears without treatment.

Eyes, their looks, treatments applied, and tear ducts.

The newborn’s face is small, and the eyes may appear swollen.

The eyes are treated after birth with antibiotic application of erythromycin or silver nitrate as a preventive against blindness caused by gonorrhea.

Eye color varies from slate gray to dark blue. Permanent eye color is not determined until 3 to 6 months of age. No tears are produced until 4 weeks of age, when the lacrimal ducts (tear ducts) are developed.

Nose, chin, mouth (examined for..?), and gums look like what in a neonate

The neonate usually has a flat nose and a receding chin.

The neonate’s mouth is usually examined closely for any defects or abnormalities, particularly cleft palate, the incomplete formation and nonunion of the hard palate. This condition can be corrected through surgical repair.

The gums should be pink and moist.

What are the first teeth called, time frame of teeth development, and names of main teeth?

The first teeth, called deciduous teeth or primary teeth, begin to erupt when the infant is about 6 or 7 months old. Usually the first teeth to appear are the two lower central incisors; they are followed by the two upper central incisors.

By age 12 months the baby will have about six or eight teeth.

After birth care for umbilical cord

Immediately after birth the umbilical cord is tied and cut. After a few days the blood vessels of the cord become dry or thrombosed. This is accompanied by a change in color from dull yellowish brown to black. By the tenth day the dried cord falls off and the navel is completely healed. Tub bathing is avoided until the navel is fully healed.

What can and can’t the newborn’s stomach do/ metabolize?

At the time of birth the newborn can swallow, digest, metabolize, and absorb nutrients. The newborn can metabolize only simple carbohydrates. For this reason, whole milk, which contains complex sugars, is not given to the newborn.

How much fluid can newborns stomach hold?

The newborn’s stomach can hold 1 to 3 ounces of fluid; by 10 months, it can hold about 10 ounces.

What is underdeveloped in a newborn? That means what for feeding?

The neonate’s cardiac sphincter is underdeveloped; therefore, it is important to allow the infant short periods of feeding, followed by “bubbling” or burping for the release of swallowed air.

How and why do newborn bowel movements vary?

Bowel movements of healthy infants vary in number, color, consistency, and general appearance.

The mother’s diet or the type of formula given will also influence the infant’s stools

meconium?

Within 10 hours after birth the newborn should pass his or her first stool, known as meconium. Meconium is thick, green–black, tarry, and odorless.

Specifics of how the stool differs in appearance

Breastfed infants have stools that resemble light, seeded mustard.

Stools of formula-fed infants are commonly semi-solid and tan or yellowish in color.

Rate of stools and constipation.

Some infants have four to six bowel movements a day.

An infant is constipated if stools are very hard and can be passed only with much effort. Adding some additional water or strained fruits to the diet may prevent constipation.

Appearance of newborn extremities. Feet differs how depending on maturity?

The newborn’s extremities are short in proportion to the rest of the body and are kept in a tightly flexed position.

In full-term infants the soles of the feet and palms of the hands are deeply creased. Preterm infants have only very fine lines on their palms and soles.

Abnormalities in extremities

They should be examined for range of motion, symmetry, and reflexes.

The lower extremities are examined closely to determine if there is an extra gluteal fold, which usually indicates a congenital hip dysplasia.

The toes and fingers are counted and inspected for abnormalities.

A neurological assessment in the newborn focuses on…?

reflexes, posture, movement, and muscle tone.

purpose of reflexes of a newborn

At birth the nervous system is immature, and the newborn responds to his or her environment through a series of reflexes. The presence of certain reflexes indicates a normal neurological system and also helps estimate gestational age.

Specific types of reflexes

Several reflexes are protective; these include blinking, sneezing, swallowing, and the gag reflex.

Other reflexes present include Moro (brace itself when startled); rooting; grasp; Babinski (toes curl down and in when provoked); and tonic neck reflex (turn head when face down).

Rooting and sucking help the infant secure food.

Newborns spinal column is inspected…?

The newborn’s spinal column is inspected to make certain that there are no masses, cysts, or openings. The presence of any spinal defect necessitates immediate medical intervention.

Vision and how it continuously improves

Neonates can track objects at birth; they appear to prefer bright lights and yellow, green, and pink objects and large geometric shapes. The neonate’s pupils react to light by dilating and contracting.

The newborn’s vision is 10 to 30 times less acute than normal adult vision of 20/20. By the time the infant is 6 months old, vision should be 20/100 or better.

Nystagmus

an eye condition involving rapid, repetitive, and involuntary eye movements

Movement of the eyes is usually unequal because of immature cilliary muscles; it is not uncommon for a neonate’s eyes to cross or for one eye to drift when focusing on an object.

These deviations are temporary and should disappear without treatment.

Eye traits (2 specific things infant vision should have)

By 4 months of age infants have binocular vision: They can focus both eyes simultaneously to produce one image.

Depth perception at first is limited to grasping for items out of reach and becomes more precise at about age 7 to 9 months. At this point the infant is able to reach for items more accurately and purposefully.

Birth the newborns ears are filled with..?

At birth the newborn’s ears are generally filled with either vernix or birth fluid, which dissolves within a few days.

infant reaction to sound? How does it progress?

The infant hears and responds to loud, low frequency sounds. A sudden loud sound will produce a startle response.

By the age of 6 to 8 weeks, infants recognize their mother’s voice and turn their heads in response to it.

A 1-year-old child can discriminate between different sounds and often recognize the source.

Newborn sense of taste

Newborn infants can discriminate different tastes.

Sweet solution = sucking movements.

Sour = grimace or pout.

Infant sense of taste

The 1-year-old child has developed a capacity to taste and has preferences for certain flavors. The sweet taste appears to be universally pleasing. The young child should be introduced to a wide variety of tastes and textures. This exposure helps to mature the child’s sense of taste.

What parts of newborn body are especially sensitive to touch? Why do infants like touch?

The sense of touch is keenly present at birth.

The face is most sensitive, especially around the mouth. The hands and soles of the feet are also sensitive.

Infants like to be touched and rocked because of the calming effect.

Pain perception

Pain perception is present in the newborn can be seen through injections.

The typical reaction to pain is loud crying and thrusting the whole body and extremities.

The 1-year-old child demonstrates withdrawal from pain but may not be able to recognize the source of the pain or the cause and effect (repeat the same harmful experience)

newborns sense of smell and differentiating powers?

Newborns have been tested and found to react to strong odors by turning away. It has also been documented that newborns can recognize the smell of breast milk. One study showed that infants can even distinguish their own mother’s breast milk from that of others.

Newborns temperature

The newborn’s temperature immediately after birth may be slightly below normal.

Result of an immature temperature regulating mechanism and heat loss because outside of mom’s body is colder.

Once stabilized, the neonate’s normal axillary temperature ranges from 97.7°F to 99.5°F.

Steps to make newborns body temperature stable (3)

Newborn should be dried off and placed under a radiant warmer to help raise his or her body temperature.

The neonate’s head should be covered to prevent further heat loss from evaporation.

The newborn’s temperature should be measured using the axillary route to prevent possible rectal perforation (tearing the rectum).

heart rate variation and average (taken how, rate, and variation)

Pulse should be taken by listening to the chest for an apical pulse (directly over heart) for 1 minute. The apical heart rate ranges from 120 to 160 beats per minute.

Slight variations in the heart rate are common. During periods of rest the rate may slow down to 100 beats per minute; during crying periods the rate may increase to 180 beats per minute.

Blood pressure (why needed, rate, and eventual rate)

Readings provide a baseline and can be used to assess the infant for cardiac abnormalities.

Average BP using oscillometry (Dinamap) is 65/40 mm Hg. Blood pressure will increase and heart and respiratory rate will decrease as the child gets older.

Newborn respiration (duration, type, and rate)

Respirations should be counted for 1 minute.

The respirations of the newborn are normally irregular, shallow, and diaphragmatic, with brief periods of apnea (absence of breathing). Infant respirations can be counted by watching the abdomen rise and fall.

The normal respiratory rate is 30 to 60 breaths per minute. Marked deviations in these normal ranges may indicate congenital abnormalities and warrant further investigation.

How to assess motor develoopment and why

all newborns have distinct behavioral characteristics and physical traits. Every infant has their own growth timetable. Growth and development should be assessed based on the infant’s own individual progress.

Gross motors skills develop in a __

cephalocaudal pattern because it develops head to toe

Head control

head control develops by 2 months; by 3 months the infant can briefly hold its head up. At 4 months the infant can raise the head to a 90-degree angle from the prone position.

Rolling over

Rolling over from the abdomen to the back occurs at 4 months. By 6 months old, the baby can roll both ways, sit with support, and hold the head erect.

Sitting alone

Sitting alone occurs at the seventh month. The 10-month-old infant can change position from the prone (facedown) to the sitting position.

Crawling

Crawling, a primitive movement in which the infant’s abdomen is on the floor, is usually achieved by infants at about 9 months.

Creeping and standing

Creeping is a more advanced form of movement that requires the infant to rise up on all four limbs. Some by 10 to 11 months. At about 8 months babies can pull themselves up to a standing position.

Cruising and walking

Standing is followed by cruising, which is a form of stepping while holding on to some object or surface for support. Walking unassisted is achieved between the ages of 12 to 15 months

palmar grasp reflex initial and defintion

Initially, grasp is actually a reflex action involving the whole arm in a swiping movement. The neonate exhibits the palmar grasp reflex, grabbing any object that is placed in the hands.

Proximodsital development

Development spreads outwards from center to extremities

What purposeful hand movements develop by 5 months?

Reaching and grasping using the whole hand.

Why must small objects be kept away from infants?

Infants bring grasped objects to their mouths, risking accidental aspiration.

What can a 6-month-old hold and bring to their mouth?

A bottle, cracker, or dry toast. Biting hard food objects may soothe swollen gums.

When does hand preference usually appear, and what ability develops?

7–8 months; transferring objects between hands.

What is the pincer grasp, and when does it develop?

Opposition of thumb and forefinger; develops around 7 months.