Prenatal and Neonatal Assessment

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Prenatal and Neonatal Assessment

• PSY 417

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Prenatal Diagnostic Tests

• 98 of all tests indicate an unaffected fetus

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Alpha-fetoprotein (AFP) test

• Maternal blood test to assess level of AFP
  substance produced only by fetus
• In typical pregnancy, some AFP found in moms
  blood.
• If fetus has open abdominal wall or neural tube
  defect, AFP leaks into amniotic fluid and then
  maternal bloodstream
• Elevated AFP levels risk of neural tube defects
• Lower levels higher risk of Down Syndrome (20
  of DS can be detected this way)

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Ultrasound/Sonogram

• Uses sound waves to produce moving image of fetus
• Sound waves penetrate body and are reflected back
  as echoes
• Allows visualization of placenta, fetal body
  parts, movement
• Can diagnose major malformations

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Ultrasound/Sonogram

• Early in pregnancy
• Viable Pregnancy?
• Ectopic Pregnancy?
• Multiple Pregnancy?
• After 16-18 weeks
• To detect large birth defects
• Sex of baby

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10 Weeks
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16 weeks
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25 Weeks
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33 Weeks
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Chorionic Villi Sampling (CVS)

• Obtain biopsies of chorion outermost membrane
  surrounding embryo
• Transabdominal needle or transcervical catheter
• Genetic testing of embryonic cells fetal
  karotype

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Amniocentesis

• 14-18 weeks
• Withdraw 1-2 ounces of fluid
• Karotype
• Slight risk of miscarriage

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Amniocentesis
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Apgar test

• Virginia Apgar (1909-1974)
• Studied anesthesia in childbirth
• At the time, doctors focused on mother, not baby
• Do new drugs depress infant respiration?

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Apgar test

• Developed new test to be given in first minute of
  life
• Appearance
• Pulse
• Grimace (reflex irritability_
• Activity
• Respiration
• Scoring 0-10 (2 points per subscale)
• Nobody, but nobody stops breathing on me!
• Virginia Apgar

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Nuchal Translucency

• Between 11 and 14 weeks
• Accumulation of fluid behind fetal neck
• Size can indicate chromosomal abnormality80
  effective for detecting DS
• If combined with blood test, 90 effective for
  detecting DS

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Neonatal Behavioral Assessment Scale

• Infants 3 days to 4 weeks of age
• Neonatal Competence
• 28 behavioral items
• 18 reflexes
• Assumptions of NBAS
• Infants are highly capable when born
• Infants communicate through behavior
• Infants are social organisms

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NBAS

• Widely used as research tool
• Used a tool to help parents understand their
  infants
• Prematurity, substance-exposure
• Drawbacks as assessment tool
• No norms
• No real scores
• No predictive validity

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Neurobehavioral Assessment of the Preterm Infant
(NAPI)

• Measures the maturity of preterm infants between
  32 weeks post-conceptional age and term.