Transcript Prenatal and Neonatal Assessment

Prenatal and Neonatal
Assessment
PSY 417
Prenatal Diagnostic Tests
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98% of all tests indicate an unaffected
fetus
Alpha-fetoprotein (AFP) test
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Maternal blood test to assess level of AFP
– substance produced only by fetus
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In typical pregnancy, some AFP found in
mom’s 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)
Ultrasound/Sonogram
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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
Ultrasound/Sonogram
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Early in pregnancy
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Viable Pregnancy?
Ectopic Pregnancy?
Multiple Pregnancy?
After 16-18 weeks
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To detect large birth defects
Sex of baby
10 Weeks
16 weeks
25 Weeks
33 Weeks
Chorionic Villi Sampling (CVS)
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Obtain biopsies of chorion: outermost
membrane surrounding embryo
Transabdominal needle or transcervical
catheter
Genetic testing of embryonic cells – fetal
karotype
Amniocentesis
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14-18 weeks
Withdraw 1-2 ounces of fluid
Karotype
Slight risk of miscarriage
Amniocentesis
Apgar test
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Virginia Apgar (1909-1974)
Studied anesthesia in childbirth
At the time, doctors focused on mother,
not baby
Do new drugs depress infant respiration?
Apgar test
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Developed new test to be given in first minute of
life
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Appearance
Pulse
Grimace (reflex irritability_
Activity
Respiration
Scoring 0-10 (2 points per subscale)
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“Nobody, but nobody stops breathing on me!”
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Virginia Apgar
Nuchal Translucency
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Between 11 and 14 weeks
Accumulation of fluid behind fetal neck
Size can indicate chromosomal
abnormality
80% effective for detecting DS
If combined with blood test, 90% effective
for detecting DS
Neonatal Behavioral Assessment
Scale
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Infants 3 days to 4 weeks of age
Neonatal Competence
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28 behavioral items
18 reflexes
Assumptions of NBAS
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Infants are highly capable when born
Infants communicate through behavior
Infants are social organisms
NBAS
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Widely used as research tool
Used a tool to help parents understand their
infants
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Prematurity, substance-exposure
Drawbacks as assessment tool
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No norms
No real “scores”
No predictive validity
Neurobehavioral Assessment of the
Preterm Infant (NAPI)
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Measures the maturity of preterm infants
between 32 weeks post-conceptional age
and term.