Structural Defects: Microcephaly (Nursing)

00:01 Hello. This is the structural defects lecture on pediatric microcephaly.

00:06 We're going to start by reviewing the definition, go over the causes, the manifestations and any treatment available.

00:16 Let's start with a definition.

00:19 Microcephaly, if you breakdown the word which I like to do, is small head, microcephaly.

00:28 Basically, the definition is typically considered to be a head circumference at birth that's less than about a third percentile for the infant's age and gender.

00:40 It's an unusually small head circumference.

00:43 Because an infant's head is usually growing because its brain is growing, a small head usually indicates the brain is also very small.

00:55 All right. Let's discuss some of the known causes of microcephaly.

00:59 Primary or genetic microcephaly is due to either a chromosomal abnormality such as Down syndrome or an autosomal recessive or autosomal dominant disorder.

01:12 Secondary microcephaly or the non-genetic type can be caused by problems during birth such as trauma to the mother or anything that results in anoxia or lack of oxygen to the infant inside her.

01:30 It can result from an insult or trauma, or even an infection during the third trimester of pregnancy.

01:35 The prenatal period or early infancy that causes stunted or decreased growth.

01:42 Secondary or non-genetic microcephaly can result from internal infections such as rubella, toxoplasmosis and cytomegalie virus.

01:53 It can also result from Zika virus exposure.

02:01 In addition, irradiation of the mother during pregnancy can cause microcephaly in some cases as well as alcohol exposure to the fetus.

02:13 Excessive alcohol use can increase the chance of microcephaly more than two-fold.

02:20 All right. Let's talk about how microcephaly presents in a newborn.

02:25 It presents with a wide range of manifestations or signs and symptoms based on the severity of the microcephaly which is usually lifelong.

02:34 It ranges from mild signs and symptoms or presentations, normal cognitive function, to mild hearing or vision problems or deficits, to seizures and much more pronounced deficits.

02:49 An infant with microcephaly may be totally unresponsive and not able to function or they may just have very mild impairments.

03:00 It really varies quite a bit.

03:03 Developmental delays such as speech and motor delays are very common.

03:08 All right. Is there any treatment for microcephaly? Unfortunately, there's no cure for this.

03:14 There's only symptomatic and supportive treatment.

03:19 This is the NCSBN Clinical Judgement Measurement Model.

03:24 This is a framework being used now for many NCLEX Next Generation exam items and case studies.

03:30 You may hear about it in nursing school if you haven't already and you may see it or see test questions framed using it on some of your exams.

03:38 So we're going to talk about it a bit right now.

03:40 Let's relate the content from this lecture to the first two steps recognizing cues and analyzing cues.

03:46 In order to recognize cues and analyze cues in a newborn infant who may potentially have microcephaly, you have to first understand what a normal infant head should look like and how it should measure.

03:59 For more detail on that, please review the normal newborn head lecture.

04:05 Then, you have to understand microcephaly and how that typically presents.

04:09 Microcephaly is typically considered a head circumference that measures less than about a third percentile for the newborn's age and gender.

04:23 It also should be fairly obvious even to the - just to the eye.

04:28 It's not something that's super challenging usually to identify.

04:32 You can usually tell that it's a smaller head than typical newborns have because what happens, typically, the brain stops growing in utero and then, the head stops growing as well.

04:44 The reason why newborn heads, why fetal heads grow in utero is because the brain is growing.