PEDIATRICS: Normal Fetal Growth and Development;

Overview of Infant Mortality and Morbidity

NORMAL FETAL GROWTH AND DEVELOPMENT NEUROLOGIC DEVELOPMENT
Somatic Development 3rd week
Neurologic Development - Neural plate appears on the ECTODERMAL surface of the
Behavioral Development trilaminar embryo
Threat to Fetal Development - Neural tube – CNS
- Neural crest – PNS
SOMATIC DEVELOPMENT
EMBRYONIC PERIOD Neuroectodermal cells Mesoderm
6th day - Neurons - microglial cells
- Implantation begins - Astrocytes
- Embryo will have a blastocyst - Oligodendrocytes
- Ependymal cells
2nd week
- Implantation is complete 5th week
- Uteroplacental circulation has begun - Forebrain, midbrain, hindbrain are evident
- 2 distinct layers - Dorsal and ventral horns of the spinal cord have begun to
o Endoderm form, along with peripheral motor and sensory nerves
o Ectoderm
- Start forming amnion MYELINIZATION
- Begins MIDGESTATION and continues for YEARS
3rd week
- Gastrulation = 3rd layer, the mesoderm End of 8th week
- Neural tube and blood vessels - Gross structure of the nervous system has been established
- Paired heart tubes begin to pump - Cellular level
o Neurons migrate outward to form the 6 cortical
4th-8th week layers
- Lateral folding of embryonic plate o Migration is complete by 6 th month but
- Growth at cranial and caudal ends differentiation continues
- budding of arms and legs = human-like shape
- precursors of skeletal muscles and vertebrae appear Axons and dendrites form synaptic connections at a rapid pace, making
(SOMITES) the central nervous system vulnerable to teratogenic or hypoxic
- lens placode appear (future eyes) influences throughout gestation.
- Brain grows rapidly
- DNA – marker of cell number
End of 8th week - Cholesterol – marker of myelination
- Embryonic period closes - Peals
- Rudiments of all major organ systems have developed o Prenatal – represent growth of neurons
- Crown-rump length = 3 cm o Postnatal – represent rapid growth of glia

FETAL PERIOD - Glial cells

9th week onwards
- Rapid body growth
- Differentiation of tissues, organs, organ systems
10th week
- Face looks human
- Midgut returns to the abdomen from the umbilical cord,
rotating counterclockwise to bring the stomach, small
intestine, and large intestine into their normal position
o Important in shaping the brain and in neuronal circuits
o For the formation of axonal myelin sheath
o Maintenance of neural pathways
o Removal of waste because the brain has no lymphoid
system for this task
- By the time of birth
o Structure of brain is complete
o Many cells undergo APOPTOSIS

12th week - Functional Connectivity of the Brain

- Gender of external genitals clearly distinguishable o Disruptions – psychiatric and behavioral disorders
- Lung development proceeds o Begin in fetal life

20th-24th week
- Primitive alveoli formed
- Surfactant production has begun

Third trimester
- Weight triples and length doubles
- Protein, fat, iron, calcium stores increase

YEAR LEVEL 2 NOTES 1

PEDIATRICS: Normal Fetal Growth and Development;
Overview of Infant Mortality and Morbidity
BEHAVIORAL DEVELOPMENT SOMATIC DEVELOPMENT
First neural function seen at 3 rd month Infant Mortality
Major Causes of Infant Death
13-14 weeks – breathing and swallowing Infant Mortality Reduction
17 weeks – grasp reflex, well developed at 27 weeks INFANT MORTALITY
26-28 weeks – eyes opening Infant mortality – number of infant deaths per 1000 live births
MIDGESTATION – full range of neonatal movements can be observed
Live birth
THIRD TRIMESTER - Based on the complete expulsion of the production of
- Fetuses respond to external stimuli with HEART RATE conception from the uterus and 1 of 3 criteria
ELEVATIONS and BODY MOVEMENTS (observed by o Detection of cardiac activity – by auscultation or
ultrasound) palpitation of the umbilical cord stump
o Definite movement generated by voluntary muscle
Behavioral states: contraction
- Quiet sleep o Any respiratory efforts
- Active sleep
- Awake Perinatal period – 28th week of pregnancy through the 7 th postpartum
day
Habituation
- A basic form of learning in which repeated stimulation results Neonatal period – first 28 days of life of a newborn
in a response decrement - Early – 1-7 days
- Late – 8-28 days
PSYCHOLOGICAL CHANGES IN PARENTS
Quickening Primary cause of mortality: Preterm birth and Congenital
- Tangible evidence that a fetus exists as a separate being malformations
- 16-20 weeks - Whereas unsafe sleep practices accounts for the majority of
- Often heightens a woman’s feelings deaths during the remainder of infancy

TERATOGENIC EFFECTS MAJOR CAUSE OF INFANT DEATH

- Decrease growth and cognitive or behavioral deficits US and Europe
- Majority: Preterm birth, congenital malformation, sleep-
SMOKING related
Cigarettes contain NICOTONE - Infections, trauma, birth asphyxia, injuries
- Vasoconstrictor
- Disrupt dopaminergic and serotonergic pathways Developing world
- Low birthweight, stunting, and smaller head circumference - Infection and asphyxia
- Increased risk for learning problems, attention and behavioral
disorders, and long-term health effects In the era of modern neonatal intensive care, most preterm birth
deaths occur among earliest gestational ages (<28 wk), and
ALCOHOL within the 1st few days of life, because of profound respiratory
- Affecting physical development immaturity and insufficiency.
- Affects cognition
- Affects behavior Leading cause of infant death after premature birth
1. Congenital Malformations
COCAINE a. Congenital Heart Disease
- Alterations in placental blood flow and in direct toxic effects 2. Sleep-related deaths
to the developing brain a. SUID b. SIDS
- Exposed adolescents
o Show small but significant effects in behavior and Congenital Malformations
functioning but may not show cognitive impairment - 2nd leading cause of infant death after premature birth
- Prevention
From the book o Folic acid supplementation
- 50% of all pregnancies end in spontaneous abortion, majority o Rubella vaccine
occur in 1st trimester SUID and SIDS
o Chromosomal or other abnormalities SUID (Sudden Unexpected Infant Death)
- Sudden and unexpected
- During infancy
- Suffocation caused by soft objects or excessive bleeding

SIDS (Sudden Infant Death Syndrome)

- Subcategory of SUID
- Sleep-related deaths

Unsafe infant sleep practices – leading cause of death beyond neonatal

period

YEAR LEVEL 2 NOTES 2

PEDIATRICS: Normal Fetal Growth and Development;
Overview of Infant Mortality and Morbidity
Infant Mortality Reduction MODERATE AND EARLY PRETERM NEONATE
- Improving our understanding of the biologic factors that Major morbidities
control gestational duration and initiation of labor and - Bronchopulmonary dysplasia
delivery is key - Intraventricular hemorrhage
- Necrotizing enterocolitis
- Intramuscular progesterone treatment during pregnancy - Patent ductus arteriosus
- Improving understanding of social determinants of health
and health behavior Intraventricular Hemorrhage
- Smoking during pregnancy - Ruptured capillaries of periventricular white matter and
- Folate supplementation choroid plexus
- Accumulate blood in the lateral ventricles
Folate supplementation - Obstruction of CSF circulation
- Reduced enzyme activity of the folate methylation pathway, - Hydrocephalus
particularly the formation of 5-methyltetrahydrofolate, may be
responsible for NTDs or other birth defects Bronchopulmonary Dysplasia
- Reactive airway disease
Recommended Folate Supplementation - Alveolar insufficiency
- No prior history of NTD - Pulmonary hypertension
o 400 micrograms/day; reproductive years - Death
- Mothers with positive history of NTD in previous child/1st - Most common morbidity among NICU survivors
degree relative with NTD - O2 exposure + pressure treatment increase the risk of
o 4 mg/day at least 1 month before conception developing BPD at gestational age
- Women taking Valproate, CBZ - Indicator: Gestational age
o 1-5 mg/day, preconception period o Decreased GA = higher risk of BPD

Necrotizing Enterocolitis
PRETERM BIRTH - Inflammatory in lower GIT most often at distal ilium and
Live birth occurring before 37 th week of gestation ascending colon
- Butod ni sila
Late preterm – 35-36 weeks - 40% of patients – surgical exploration and resection of
Moderate preterm – 32-34 weeks necrotic bowel
Early preterm - <32 weeks
Extreme preterm - <28 weeks Patent Ductus Arteriosus
- Common before 28 weeks
Three approaches used - Normally, ductus arteriosus closes minutes after parturition,
1. Last menstrual period (LMP) but will not close if there is no sufficient O2 that will contract
2. Obstetric estimate (OE) the muscles of ductus
3. Combined estimate - Persists: pulmonary overcirculation, complicating respiratory
disease
Genetic variables
- Pregnancy length variants Low Birth Weight – any live birth <2,500 grams
o EBF1 Very Low Birth Weight - <1,500 grams
o EEFSEC
o AGTR2 Intrauterine Growth Restrictions (IUGR)
o WNT4 - Deficiency of fetal growth and abnormal growth trajectory
o ADCY5
o RAP2C Small for Gestational Age (SGA)
- Preterm birth variants - Constitutionally normal, no known genetic abnormalities or
o EBF1 pathologic conditions
o EEFSEC
o AGTR2

LATE PRETERM
- Apneic disorders
- Disorders of thermoregulation
- Hypoglycemia
- Respiratory distress
- Feeding difficulties
- Dehydration
- Suspected sepsis
- Require NICU admission
- Higher risk of longer-term neurologic problems
o ADHD and Learning disorders
- Result from complication of pregnancy or maternal
conditions

YEAR LEVEL 2 NOTES 3