HEALTH PROMOTION ACROSS LIFESPAN

• Intrauterine


  The embryo or fetus relies on the maternal blood flow through the placenta to meet its basic survival needs
• Maternal health


  Essential for proper fetal growth and development
• Oxygen supply


  1. Pregnant mother gradually increases normal blood flow by 1/3 peaking at 8 months

  2. Respiratory rate and cardiac output increase
• Fetal circulation


  Travels from placenta through two umbilical arteries carrying deoxygenated blood away from fetus
• Fetal heart tone


  Audible through fetoscope by 20 weeks, or as early as 10th week with Doppler stethoscope
• Fetal nutrition and fluids

  Fetus obtains nourishment from placental circulation and by swallowing amniotic fluid
• Fetal nutritional needs


  Met when mother eats a well-balanced diet, sufficient calories and nutrients to prevent neural tube defect
• Fetal rest and activity


  • Fetus sleeps most of the time and develops a pattern of sleep and wakefulness that usually persists after birth
  • Fetal activity can be felt by mother at about 5th lunar month
• Fetal elimination


  • Fetal feces formed in intestines from swallowed amniotic fluid but not excreted until after birth
  • Inadequate oxygenation in 3rd trimester can result in relaxation of anal sphincter and passage of feces into amniotic fluid
  • Urine normally excreted into amniotic fluid when kidneys mature (16-20 weeks)
• Fetal temperature maintenance


  • Amniotic fluid provides safe and comfortable temperature for fetus
  • Changes in maternal temperature can alter amniotic fluid temperature
• Fetal safety


  Embryo vulnerable to damage from teratogens (anything that adversely affects normal cellular development)
• Teratogens


  • Teratogenic drugs (antibiotics), x-ray, smoking, alcohol
• Smoking during pregnancy


  Associated with preterm labor, spontaneous abortion, low birth weights, sudden infant death syndrome and learning disorders
• Alcohol during pregnancy


  • Increases maternal/neonatal mortality
  • Fetal Alcohol Syndrome - impaired mitochondrial development leads to microcephaly, mental retardation, learning disorders and other central nervous system defects
• Health teachings - abstain from alcohol, especially adolescents who engage in risky behaviors (drinking alcohol, unprotected sex)
• Maternal factors contributing to higher risk of low birth weight

  • Underweight before pregnancy
  • Less than 21 lbs gained during pregnancy
  • Inadequate prenatal checkup
  • Age 16 years or younger or 35 years or older
  • Low socioeconomic level
  • Poor nutrition during pregnancy
  • Smoking
  • Use of addictive drugs or alcohol
  • History of abortion
  • Complications during pregnancy, poor health status, exposure to infections
  • High stress levels, including physical and emotional abuse
• Neonate


  From birth to 1 month
• Infant


  1 month to 1 year
• Newborn physical characteristics


  • Weight: 2.7-3.8 kg or 6.0-8.5 lbs
  • Length: Average 50 cm/20 inches, varies by ethnicity and nutrition
  • Head and chest circumference: Average 35 cm/14 inches, chest less than head by 2.5 cm/1 inch, equal by 9-10 months, chest larger after 1 year
  • Head molding: Usually misshapen due to vaginal delivery, occurs due to fontanels and sutures in skull
• Fontanels


  Unossified membranous gaps in the bone structure of the skull
• Sutures


  Junction lines of the skull bones that override to provide flexibility for molding of the head
• Anterior fontanel


  • Larger at 4-6 cm in diameter and diamond shape, increases for several months after birth, gradually decreases at 6 months, closes at 9-18 months
• Posterior fontanel


  • Between parietal and occipital bones, closes between 2-3 months after birth
• Newborn vision


  Can follow large moving objects, blinks in response to bright light and sound, pupils respond slowly, eyes cannot focus on close objects
• Infant vision development


  1. By 1 month - can focus gaze on objects and follow moving ones

  2. By 4 months - has complete color vision and follows objects through 180 degree arc

  3. By 5 months - reaches for objects

  4. By 6-10 months - can fix on and follow objects in all directions

  5. By 12 months - depth perception fully developed, can recognize changes in level
• Newborn hearing


  Reacts with startle to loud noises (Moro reflex), distinguishes mother's voice from others within days
• Infant hearing development


  1. By 2-3 months - actively coos, smiles, or gurgles to sounds and voices

  2. By 3-6 months - looks for sounds, pauses activities to listen, responds with distress or pleasure to happy/angry voices

  3. By 6-9 months - individual words begin to take on meaning, may look at named objects or people

  4. By 9-12 months - understands many words, uses gestures, may articulate 1-2 words, responds to simple commands
• Newborn smell and taste

  Functional shortly after birth, prefer sweet tastes, able to recognize mother's milk smell
• Newborn touch


  Well developed at birth, skin-to-skin touching important for development, sensitive to temperature extremes
• Newborn reflexes


  Present at birth, disappear during first year of life
• Infant motor development


  1. 1 month - can lift head momentarily when prone, turns head when prone, has head lag during sitting

  2. 4 months - head lag should be minimal

  3. 6 months - can sit without support

  4. 9 months - can reach, grasp, transfer objects

  5. 12 months - can turn pages of book, put objects in containers, walk with assistance, help dress
• Denver Developmental Screening Test (DDST)


  Widely used assessment to examine children 0-6 years for developmental progress, estimates child's abilities compared to average group
• APGAR scoring system


  • Heart rate
  • Respirations
  • Muscle tone
  • Reflex irritability
  • Color
• Newborn screening


  Simple procedure to detect congenital metabolic disorders that may lead to mental retardation or death if untreated
• Newborn screening is ideally done immediately after 24 hours from birth
• Newborn screening process


  A few drops of blood taken from baby's heel, blotted on filter card and sent to Newborn Screening Center
• Disorders tested in newborn screening

  • Congenital Hypothyroidism (CH)
  • Congenital Adrenal Hyperplasia (CAH)
  • Galactosemia (GAL)
  • Phenylketonuria (PKU)
  • Glucose-6-Phosphate-Dehydrogenase Deficiency (G6PD Def.)
  • Maple Syrup Urine Disease (MSUD)
• Congenital Hypothyroidism (CH)


  Lack or absence of thyroid hormone essential for physical and mental development, if untreated can lead to growth and mental retardation
• Phenylketonuria (PKU)


  Rare condition where baby cannot properly use the protein building block phenylalanine, excessive accumulation causes brain damage
• Galactosemia


  Condition where baby is unable to process galactose (milk sugar), accumulation causes liver, brain damage and cataracts