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Introduction to Introduction to Developmental Developmental

Disabilities: The High Disabilities: The High

Risk InfantRisk Infant

Clinical Sciences IIIClinical Sciences III

Karen R. VoogtKaren R. Voogt

Fall 2011Fall 2011

DefinitionsDefinitions

Gestation/gestational ageGestation/gestational age Gestation-Period between conception Gestation-Period between conception

and birthand birth Gestational Age-1Gestational Age-1stst day of last menstrual day of last menstrual

cycle to datecycle to date GravidaGravida

Total number of pregnanciesTotal number of pregnancies ParaPara

Total number of viable birthsTotal number of viable births

DEFINITIONDEFINITION

The high risk infant is The high risk infant is associated with increased associated with increased

hazard of death or disability hazard of death or disability of the fetus/neonate because of the fetus/neonate because

of maternal factors, fetal of maternal factors, fetal disease or some abnormalitydisease or some abnormality

Factors may be Factors may be associated with:associated with:

MotherMother InfantInfant

MATERNAL FACTORSMATERNAL FACTORS Maternal Age:Maternal Age:

Gravida less than 16 (18)Gravida less than 16 (18) Primagravida over 35 yearsPrimagravida over 35 years Gravida over 40 yearsGravida over 40 years

Pregnancy ComplicationsPregnancy Complications PreeclampsiaPreeclampsia EclampsiaEclampsia maternal infection (STORCH)maternal infection (STORCH) DiabetesDiabetes HypertensionHypertension Trauma/AbuseTrauma/Abuse

MATERNAL FACTORS CONTINUEDMATERNAL FACTORS CONTINUED

MATERNAL FACTORS MATERNAL FACTORS CONTINUEDCONTINUED

MalnutritionMalnutrition Prepartum bleedingPrepartum bleeding Prolonged labor, or PROM (premature Prolonged labor, or PROM (premature

rupture of membranes)rupture of membranes) Breech presentationBreech presentation Multiple birthsMultiple births

MATERNAL FACTORS MATERNAL FACTORS CONTINUEDCONTINUED

Drug Addiction, Smoking or Drug Addiction, Smoking or AlcoholismAlcoholism

Previous child with CP, or other CNS Previous child with CP, or other CNS disorderdisorder

Exposure to teratogenExposure to teratogen

STORCH: STORCH: Group of maternal Group of maternal infections that can cause birth infections that can cause birth

defects and developmental delaydefects and developmental delay

SS yphilis yphilis T T oxoplasmosisoxoplasmosis O O therther R R ubellaubella CC ytomegalic Inclusion Disease (CID) ytomegalic Inclusion Disease (CID) H H erpeserpes

STORCH InfectionsSTORCH Infections

FETAL ALCOHOL FETAL ALCOHOL SYNDROMESYNDROME

Group of abnormalities directly Group of abnormalities directly related to the ingestion of alcohol related to the ingestion of alcohol during pregnancyduring pregnancy

One of the most common causes of One of the most common causes of mental retardationmental retardation

Facial Features in FASFacial Features in FAS

Major CharacteristicsMajor Characteristics

congenital malformations:congenital malformations: Facial, genital, joint abnormalitiesFacial, genital, joint abnormalities

MAJOR CHARACTERISTICSMAJOR CHARACTERISTICS prenatal and postnatal growth prenatal and postnatal growth

deficiencydeficiency Cardiac defectsCardiac defects CNS disturbances:CNS disturbances:

Microcephaly, mental retardation,Microcephaly, mental retardation,

delay of gross and fine motor delay of gross and fine motor developmentdevelopment

FAS and FAEFAS and FAE

Fetal alcohol effects: more subtle Fetal alcohol effects: more subtle effects.effects.

May not have dysmorphic featuresMay not have dysmorphic features May include hyperactivity, delayed May include hyperactivity, delayed

language development, slow reaction language development, slow reaction time, problems with judgment and time, problems with judgment and comprehensioncomprehension

Alcohol intake exceeding 2-3 oz / day Alcohol intake exceeding 2-3 oz / day considered toxic by some sourcesconsidered toxic by some sources

Alcohol rapidly crosses the placenta and Alcohol rapidly crosses the placenta and blood-brain barrier of fetusblood-brain barrier of fetus

Timing importantTiming important First trimester - organ formationFirst trimester - organ formation

neurological abnormalities may be neurological abnormalities may be decreased if stop drinking by 16-20 decreased if stop drinking by 16-20 weeks gestationweeks gestation

Approx. 2/3 of pregnancies in active Approx. 2/3 of pregnancies in active alcoholics will have significant alcoholics will have significant complicationscomplications

DRUG ADDICTIONDRUG ADDICTION Withdrawal symptoms in newbornWithdrawal symptoms in newborn

Neonatal Abstinence SyndromeNeonatal Abstinence Syndrome Onset of withdrawal symptoms within the Onset of withdrawal symptoms within the

first 72 hours of birthfirst 72 hours of birth Neurologic-CNS excitabilityNeurologic-CNS excitability Gastrointestinal-Poor coordinated suck/swallowGastrointestinal-Poor coordinated suck/swallow Respitory-Tachypnea, apneaRespitory-Tachypnea, apnea Autonomic dysfunctionAutonomic dysfunction

Treatment: observation, drugs, Treatment: observation, drugs, swaddlingswaddling

Drug AddictionDrug Addiction

Prognosis: reasonably good - Prognosis: reasonably good - mortality rate still present in most mortality rate still present in most severe casessevere cases

Long term outcome often not Long term outcome often not encouragingencouraging Growth retardationGrowth retardation Intellectual impairmentIntellectual impairment Learning difficultiesLearning difficulties Bonding and attachment difficultiesBonding and attachment difficulties

Drug Addicted Premature Drug Addicted Premature InfantInfant

SMOKINGSMOKING Significant impact on the growth of Significant impact on the growth of

the fetusthe fetus only well - established complicationonly well - established complication

May be multiple drug useMay be multiple drug use

TERATOGENSTERATOGENS Any agent or factor that increases the Any agent or factor that increases the

chance of a congenital anomaly.chance of a congenital anomaly. Agents in the environment of the Agents in the environment of the

developing embryo and fetus that cause developing embryo and fetus that cause structural or functional abnormalities structural or functional abnormalities (Blackman)(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

TERATOGENSTERATOGENS

Factors affecting the occurrence Factors affecting the occurrence and severity of a tetarogenic and severity of a tetarogenic effect:effect: Timing of exposureTiming of exposure genetic makeup of the fertilized egggenetic makeup of the fertilized egg type and dosage of the teratogentype and dosage of the teratogen genetic and environmental factors in genetic and environmental factors in

the motherthe mother

TERATOGENSTERATOGENS Exposure timingExposure timing

First 2 weeks of pregnancy - results in First 2 weeks of pregnancy - results in spontaneous abortion or no effect at allspontaneous abortion or no effect at all

week 3-7 - abnormal growth and week 3-7 - abnormal growth and development of a body partdevelopment of a body part

later exposures - disturbances in the later exposures - disturbances in the functioning of certain organs functioning of certain organs