OTA 108: Exam 3

37

less than __ weeks is identified as preterm

37-38.6

between what weeks gestation is considered early term?

39-40.6

between what weeks gestation is considered full term?

41-41.6

between what weeks gestation is considered late term?

42

what week gestation is considered post-term?

4

first _ weeks after birth is the neonatal period

neurogenesis

Neurologic development:

* creation of neurons (nerve cells in brain)
* created in utero when we’re developing as an embryo and fetus
* continues after birth and throughout life

myelination

Neurologic development

* protection and insulation
* myelin forms around axons
* purpose = more effective communication
* starts around birth and happens rapidly until 2 y/o
* continues after 2, just at a slower rate

synaptogenesis

Neurologic development:

* forming of synapses
* information is transmitted; brain activity
* creating a network between neurons in the brain
* can start in utero, occurs more after birth
* lots of pruning when younger, starts to slow down as we age

APGAR test

* test that is not an indicator of overall health
* test to see if baby needs additional support when born
* usually respiratory support
* scale of 0-10
* taken at 1 minute and 5 minutes after birth

activity/mm tone

what does the first A stand for in the APGAR test?

pulse

what does the P stand for in the APGAR test?

grimace/reflex response

what does the G stand for in the APGAR test?

appearance (color)

what does the second A stand for in the APGAR test?

respiration

what does the R stand for in the APGAR test?

prenatal circulation

* bypasses fetal lungs
* foramen ovale
* ductus arteriosus
* placenta is the source of oxygen

placenta, liver, heart, foramen oval, aorta, ductus arteriosus, descending aorta, bladder, placenta

route of prenatal circulation

first 2 weeks

when does the foramen vale close in newborn circulation?

newborn circulation

* loss of umbilical arteries and vein, which become ligaments
* not needed since we don’t have the placenta
* foramen ovale closes within first two weeks

persistent fetal circulation

newborn cardiopulmonary issue:

* failure to switch to standard circulation
* failure of foramen oval and ductus arteriosus closure
* if both remain open, we don’t get blood to lungs
* insufficient perfusion of lungs
* results in pulmonary hypertension = high vasomotor tone in pulmonary vasculature
* prenatal circulation outside of womb instead of newborn circulation

patent ductus arteriosus (PDA)

newborn cardiopulmonary issue:

* ductus arteriosus hasn’t closed
* seen in premature babies
* if not closed
* wait to and give baby increased oxygen; give it time to close
* ibuprofen can be given to close
* baby works very hard to breathe when this isn’t closed

ibuprofen

* what can be given to baby to close ductus arteriosus?
* mom can’t take when pregnant

patent foramen oval (PFO)

newborn cardiopulmonary issue:

* may be asymptomatic for a very long time, prove for CVA if not closed
* may not be necessary to address
* affects later in childhood or early adulthood
* may present as asthma or exercise induced asthma
* not as common as PDA
* if severe, surgery can address it
* supplemental oxygen and medication may help

hematopoietic changes

liver takes on function of RBC production after birth

jaundice

* increase of bilirubin in blood
* breakdown of RBCs in first 24-72 hours after birth
* seen especially if mom and baby have a different blood type
* seen more currently

cord clamping

* practiced in hospitals
* not clamping blood supply from umbilical cord for 1 min so baby can get extra blood flow
* reduced risk of anemia in baby
* can increase risk of jaundice

sunlight

most conservative way to treat jaundice in newborns

kericterus

* excessive bilirubin
* crossing blood-brain barrier = possible damage to the basal ganglia = choreoathnetoid cerebral palsy
* not very common now

cerebral palsy

* most common congenital childhood disorder
* affect mm tone, coordination, breathing bladder and bowel control

colostrum

* first breastmilk for the first 48-72 hours
* liquid gold
* full on antibodies, full fat, growth factors, vitamin-a rich
* great for brain development
* protects against infection and allergy

benefits of breastfeeding

* decreases risk of infection (decrease in mortality)
* decrease risk for high cholesterol and obesity
* increases intellectual development
* decrease in cortisol when breastfeeding for mom and baby
* breast milk changes based on what the baby needs

gastroesophageal reflux

* allergies
* small stomach pouch
* immature lower esophageal sphincter

complications:

* uncoordinated swallowing
* aversion to feeding
* arching

interventions:

* positioning
* feeding interventions
* very rarely proton pump inhibitors and Nissen Procedure

physiologic immaturity

complications of preterm infants:

* low, very low, extremely low BW
* sensory system challenges
* musculoskeletal system
* generalized weakness
* deformities
* high bilirubin
* liver isn’t working as it should

raltinopahty of prematurity 

complications of preterm infants:

* results in decreased vision or blindness
* too high oxygenation or pressure = blows out blood vessels in eye
* can result from the way blood vessels develop
* laser surgery may help but can affect peripheral vision

respiratory distress syndrome (RDS)

complication of preterm infants:

* cardiopulmonary
* secondary to lack of surfactant
* surfactant coats lungs so they can expand and contract prenatally
* surfactant can be administered to preterm babies
* complication is bronchopulmonary dysplasia (BPD)
* scarring of the lungs
* patent ductus ateriosus (PDA)

intraventricular hemorrhage (IVH)

neuro complication of preterm infants:

* brain bleed
* similar to stroke
* different grades

periventricular leukomalacia (PVL)

neuro complication of preterm infants:

* breakdown of white matter in the brain

hypoxic ischemic encephalopathy (HIE)

neuro complication of preterm infants:

* lack of oxygen to the brain
* usually post-term babies
* baby might sit on cord in utero
* increase in HIE during covid
* treatment = total body cooling protocol

necrotizing enterocolitis (NEC)

GI complication of preterm infants:

* bowel death
* can be fatal if not caught
* no formula for babies born before 36 weeks
* bowel isn’t developed enough to process formula
* donated breastmilk is given to baby
* breastmilk is the only thing to reduce this in premature babies

gravity

what does movement depends on at brith?

reflex

a stereotypic obligatory response given to a stimulus

typical neonate

* prone: able to lift head and turn side to side, flex of extremities
* supine: head to one side, reciprocal kicking, hand to mouth
* pull to sit: total head lag
* supported sitting: head bobs to neutral
* supported standing: poor ability to bear wt in LE

prenatal 28th week of gestation

onset of suck-swallow-breathe reflex

rhythmic suckling movements; down and forward then up and back

response to suck-swallow-breathe reflex

absence indicative CNS depression

significance of suck-swallow-breathe reflex

prenatal 34th week of gestation

onset of gag reflex

touch to posterior half to 1/3 of tongue

procedure for gag reflex

gagging

response to gag reflex

oral feeding is avoided until preemies have reached 34th week of gestation

significant of gag reflex

prenatal

onset for rooting reflex

stroke either side of cheek

procedure for rooting reflex 

head rotation toward stimulus

response to rooting reflex 

feeding, seeking stimuli with eyes closed

significance of rooting reflex 

prenatal

onset for tonic labyrinthine reflex

porne and supine

position for tonic labyrinthine reflex

observe tone changes in supine and prone

procedure for tonic labyrinthine reflex

flexor tone dominates

prone response for tonic labyrinthine reflex

extensor tone dominates

supine response for tonic labyrinthine reflex

persistence will interfere with ability to roll over and anti gravity behaviors

significance for tonic labyrinthine reflex

birth - 2 months

onset for labyrinthine righting reaction

hold child vertically under arms, tilting child in space

position for labyrinthine righting reaction 

tilt child in all directions

procedure for labyrinthine righting reaction 

head orient to vertical position is is steady

response to labyrinthine righting reaction 

supports development of antigravity behaviors, starting point for Landau reflex

significant for labyrinthine righting reaction

birth - 2 months

onset for palmar grasp reflex

child in supine with hands free

position for palmar grasp reflex

place index finger into infant’s hands with pressure over metacarpal heads

procedure for palmar grasp reflex

finger flexion

response to palmar grasp reflex

inhibits voluntary reach and grasp until integrated

significance of palmar grasp reflex

prenatal

onset for plantar grasp

firm pressure against volar aspect of foot directly below toes

procedure for plantar grasp 

plantar flexion of toes

response to plantar grasp 

persistence may result in balance deficits

significance of plantar grasp 

prenatal

onset of moro reflex

child supine with head in midline

position for moro reflex 

sudden 20-30 degree neck flexion

procedure for moro reflex 

ABD, ADD extremities, inhalation

response of moro reflex 

part of standard neuro exam, neurologic abnormality if to present

significance of moro reflex 

prenatal

onset for galant’s response

prone

position for galant’s response 

stroke with moderate pressure along paravertebral line

procedure for galant’s response 

trunk flexes on stimulated side

response of galant’s response 

ADHD, bed wetting, scoliosis

significance of galant’s response 

prenatal

onset for asymmetrical tonic neck reflex (ATNR)

supine

position for asymmetrical tonic neck reflex (ATNR)

extension of UE and LE to side face is turned, flexion of UE and LE to side where face is turned away

response to asymmetrical tonic neck reflex (ATNR)

early connection between hands and eyes, can impair mouth for feeding, scoliosis

significance for asymmetrical tonic neck reflex (ATNR)

prenatal

onset for traction response

supine

position for traction response 

pull to sit from wrists

procedure for traction response 

flexion of shoulders, elbows, wrists, fingers

response to traction response 

persistence will inhibit voluntary use of arms

significance for traction response 

prenatal

onset for neonatal neck righting reaction

supine

position for neonatal neck righting reaction 

head rotation towards one side

procedure for neonatal neck righting reaction 

child’s body follows “like a log” and not segmentally

respones to neonatal neck righting reaction 

persists with spasticity, prohibits segmental rolling, necessary to learn to change from one position to another

significance of neonatal neck righting reaction 

prenatal

onset for neonatal positive supporting

help upright with feet on surface

position for neonatal positive supporting

allow feet to make contact with surface

procedure for neonatal positive supporting