Week 2 Fetal and Neurologic Injury (everything) Flashcards Preview

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31

** The depolarizing effect of GABA and it's affects play a major role in

activity-dependent synapse formation

32

fetal brain is encoded by genetic programming- such programs remain highly susceptible to what

environmentally induced epigenetic modifications and appear closely intertwined with maternal immune and endocrine systems

33

maternal infection and inflammation in early pregnancy can cause an array of neurodevelopment abnormalities- name two

schizophrenia and autism

34

among maternal infections _____ is best characterized and thoroughly investigated model of perinatal neuroinflammation

chorioamnionitis

35

the exact mechanism by which maternal inflammation triggers a fetal immune response is likely

multifactoral

36

Review Box 10.4
10-4 Fetal Cerebral Responses to Asphyxia

FETAL CEREBRAL METABOLISM
• Increased oxygen extraction
• Use of alternative energy sources
• Decreased growth
• Altered behavioral state
FETAL CEREBRAL O2 TRANSPORT
• Redistribution of cerebral blood flow

37

*** the fetus can conserve additional energy by what two ways?

decreasing breathing and gross body movements***

38

** during chronic hypoxemia the fetus may also restrict the use of energy from oxidative metabolism to maintain essential cellular process- this leads to

decreased somatic growth and fetal growth restrictions ***

39

*** unlike the adult brain what can the fetal brain use as alternate energy sources

ketone bodies and lactate ****

40

the fetus takes advantage of several adaptive responses for survival and growth- what is this due to

the relatively hypoxemia intrauterine environment

41

what is a useful tool in the diagnosis of neonatal brain injury

MRI

42

MRI can assist the diagnosis of these 4 things

hypoxic- ischemic encephalopathy

determine volume of gray matter

extent of white matter myelination

estimates timing of the brain injury for cerebral palsy.

43

in VIVO MRI can be used to identify structural abnormalities - quantify brain growth beginning at what week gestation

18th week gestation

44

neuraxial techniques- used in labor focus on

analgesic quality

and obstetric and short-term neonatal outcomes

45

True or false
epidrually administered local anesthetics cross the placenta and enter fetal circulation

True- whatever we give to the mother we give to the baby.

46

True or false
the long term effects of peripartum opioid exposure on the infants neurodevelopment shows a decrease in their development

false- the infant exposure to opioids remains unclear of any harm to their neurodevelopment

47

what systemic opioid used for labor analgesia is the most widely studied

meperidine

48

What receptors in the fetal brain play a limited role during early brain development, they remain functionally silent because of magnesium ion- induced channel blockade? (they originate later than GABA receptors)

NMDA-subtype glutamate receptors. (bold in ppt)

49

what three NT systems develop concomitantly and appear fully functional by the 2nd trimester?

Dopaminergic, cholinergic, and serotonergic systems.

50

Pharmacologic interventions (e.g., ethanol, antiepileptic drugs) that act directly or indirectly on these powerful neuromodulator systems (dopaminergic, cholinergic, and seotenergic) induce what? (bold in ppt)

(basically saying if a system in the brain is developed and you use drugs that mess with it then what can happen long term to the fetus).

long-lasting impairment of fetal brain development, mainly owing to impaired neurogenesis and/or altered neuronal migration.

Alteration of this excitation-inhibition balance is purported to be responsible for an array of childhood neurodevelopmental disorders.

51

Experimental studies have revealed what about the fetal blood-brain barrier at term?

morphologically well developed and functionally competent at term.

52

Is Cerebral palsy a progressive or non progressive disorder of the CNS?

NON-progressive

53

What is Cerebral Palsy?

Present since birth that include impairment of motor function or posture.

Intellectual disability may or may not be present.

54

****The only types of cerebral palsy associated with intrapartum hypoxia, what are they?

spastic quadriplegia and, less commonly, dyskinesia****

55

what three disorders should not be ascribed to birth asphyxia unless accompanied by spastic quadriplegia.

Intellectual disability,
learning disorders, and
epilepsy.

56

What age should a child be before statements about the severity of Cerebral Palsy be made?

3 to 4 years of age, , because mild cases may improve and dyskinesia may not be evident until then.

57

*** Intrapartum hypoxia sufficient to cause cerebral palsy is always accompanied by WHAT?

neonatal encephalopathy and seizures. ***

58

An association between cerebral palsy and chorioamnionitis has been demonstrated in preterm and term infants. But it is hard say which moms have chorioaminionitis. until which tests are confirmed?

placental culture or histologist examination

59

What is chorioamnionitis?

Chorioamnionitis also known as intra-amniotic infection (IAI) is an inflammation of the fetal membranes (amnion and chorion) due to a bacterial infection. It typically results from bacteria ascending from the vagina into the uterus and is most often associated with prolonged labor.

60

what are some signs of chorioamnionitis?

- elevated maternal temperature alone is insufficient for the diagnosis.

Other signs include:
-maternal and fetal tachycardia,
-foul-smelling amniotic fluid,
-uterine tenderness, and
-maternal leukocytosis.

**Diagnosis remains unproven until confirmed by placental culture or histologic exam