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Reproduction Week 5 2018/19 > 1: Perinatal Adaptation I > Flashcards

1: Perinatal Adaptation I Flashcards

1
Q

What colour are babies when they’re born?

Why?

A

Blue (cyanotic)

Hypoxic, deflated lungs

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2
Q

Swallowing amniotic fluid is a normal part of foetal homeostasis.

What condition can be caused by swallowing amniotic fluid following or during foetal distress?

A

Meconium aspiration syndrome

causes ARDS - meconium clogs up air spaces and neonate will become hypoxic

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3
Q

At what point in gestation do the alveoli develop?

A

36 weeks

So prematurity requires steroids to speed up lung development

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4
Q

What is produced from 26 weeks and is required for lung development?

A

Pulmonary surfactant

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5
Q

What is the purpose of pulmonary surfactant?

Which cells produce it?

A

Reduce alveolar surface tension, allowing them to resist collapse

Type II pneumocytes

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6
Q

What does amniotic fluid consist of

a) early in the pregnancy
b) later in the pregnancy?

A

a) Maternal fluid
b) Foetal urine

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7
Q

A lack of amniotic fluid in the womb is related to a problem with which organs?

A

Kidneys

involved in amniotic fluid recycling

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8
Q

Which organs allow a baby to swallow and then filter amniotic fluid?

A

Kidneys

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9
Q

Why do babies cry when they are born?

A

Forcing air against a closed glottis pushes fluid from the air spaces to the interstitium

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10
Q

Which maternal antibody is passed across the placenta to the foetus?

A

IgG

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11
Q

In the first 10 - 20 minutes of life, is oxygen used to resuscitate babies?

A

No

Does more harm than good

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12
Q

How long should you wait before clamping a newborn’s umbilical cord?

Why?

A

3 - 5 minutes

Allows adequate transfer of blood - clamping too early can lead to hypovolaemia and anaemia

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13
Q

What are the three shunts in the foetal circulation?

A

Ductus venosus (bypassing the liver)

Foramen ovale (right to left shunt in the heart)

Ductus arteriosus (bypassing pulmonary circulation)

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14
Q

In the foetus, the pulmonary circulation has a (high / low) resistance.

A

high resistance

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15
Q

Does blood travel to the lungs in the foetus?

A

Yes

But a v small amount (around 7%), most of it is shunted from R heart to L heart

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16
Q

How many umbilical arteries and veins does a foetus have?

Which type of blood travels in each?

A

1x umbilical vein - OXYGENATED BLOOD FROM MOTHER

2x umbilical arteries - DEOXYGENATED BLOOD FROM FOETUS

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17
Q

Describe the pulmonary vascular resistance before birth.

A

High

Allows very little blood to travel to the lungs

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18
Q

Describe the systemic vascular resistance before birth.

A

Low

Especially compared to the pulmonary resistance

Addition of placenta adds a massive ‘length’ to vasculature, reducing the resistance

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19
Q

What remnants of the

a) ductus venosus
b) foramen ovale
c) ductus arteriosus

can be found in adults?

A

a) Ligamentum teres of the liver

b) Oval fossa

c) Ligamentum arteriosum

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20
Q

Why does the foramen ovale close after birth?

A

Pulmonary vascular resistance drops, so blood goes to the lungs avoiding the shunt

Systemic vascular resistance increases, so it’s harder to shunt blood from right heart to left heart

L pressure holds the valve shut and over time it fuses with the septum

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21
Q

What three factors contribute to the closing of the ductus arteriosus?

A

1. Reduced blood flow

2. Reduced Prostaglandin E2 produced by placenta

3. Smooth muscle CONTRACTS (unique response not found anywhere else)

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22
Q

After birth, the smooth muscle of the ductus arteriosus (relaxes / constricts).

A

constricts to reduce blood flow through shunt

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23
Q

Which chemical maintains the patency of the ductus arteriosus?

Which organ produces it?

A

Prostaglandin E2

Placenta

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24
Q

Why does systemic vascular resistance decrease following birth?

A

Widespread vasodilation caused by oxygen

Loss of the ‘length’ of the placental circulation

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25
Q

Why does pulmonary vascular resistance drop following birth?

A

Lungs inflate

Oxygen is a vasodilator –> widespread vasodilation of the pulmonary vasculature

26
Q

Which form of glucose is stored by the foetus before birth?

What is the advantage of this?

A

Glycogen

Loads of sugar stored for first few days post-natally

27
Q

Which type of fat can be rapidly oxidised to produce energy?

A

Brown fat

28
Q

Which process is brown fat useful for?

A

Thermogeneration

making heat

29
Q

What is the function of

a) white fat
b) brown fat?

A

a) Energy storage

b) Thermogeneration

30
Q

Where is brown fat found in the foetus?

A

Between scapulae

Around viscera

31
Q

What diseases, relating to foetal shunts, can cause congenital heart disease in newborns?

A

Patent foramen ovale

Patent ductus arteriosus

Persistence of foetal circulation

32
Q

What happens to the levels of Prostaglandin E2 on birth?

A

Levels decrease

Because it’s produced by the placenta, which is clamped after bith

Decreases in levels of Prostaglandin E2 cause the ductus arteriosus to close

33
Q

Being born too (early / late) can cause hypoxia - why?

A

Too early

No time for foetal adapations (e.g pulmonary surfactant) to occur

34
Q

What metabolic disorder is caused by foetal distress?

A

Metabolic acidosis

Foetal distress is hypoxia; switch to anaerobic respiration; production of excess lactic acid

35
Q

Newborns need to be protected from (heat / cold).

Why?

A

cold

‘cold stress’ - newborns need careful thermoregulation as they easily become hypothermic

36
Q

What condition can persistence of foetal shunts cause?

A

Persistent pulmonary hypertension

37
Q

Which investigation can be used to diagnose persistent pulmonary hypertension?

A

Hand / foot saturations

Right hand - sats will be normal-ish

Left foot - sats will be abnormally low (deoxygenated blood shunting from R to L, bypassing pulmonary circulation, shunting through ductus venosus and tracking to left foot)

38
Q

How is persistent pulmonary hypertension managed?

A

Ventilate with O2 and NO - nitric oxide is a vasodilator and will help bring pulmonary pressure down

Inotropes - e.g adrenaline, to raise systemic pressure above pulmonary pressure

Sedation - to reduce the infant’s distress

39
Q

The key in managing persistent pulmonary hypertension is raising the ___ pressure above the ___ pressure.

A

raise systemic/peripheral pressure ABOVE pulmonary pressure

to abolish R>L shunt and let the ductus arteriosus close

use oxygen, nitric oxide, inotropes

40
Q

Which respiratory illness is seen in many newborns and resolves with time?

A

Transient tachypnoea

41
Q

What causes transient tachypnoea in newborns?

A

Impaired clearance of fluid from the lungs

42
Q

Why might a newborn develop transient tachypnoea?

A

Pre-mature delivery - inadequate time to produce pulmonary surfactant

43
Q

How do we generate heat when we’re cold?

A

Shivering primarily

Some heat energy from metabolism as well

44
Q

By which process do newborns produce heat?

A

Non-shivering thermogenesis

45
Q

What tissue do newborns use to produce heat?

A

Brown fat

46
Q

Why are small-for-dates or pre-term newborns more likely to suffer cold stress?

A

Less brown fat to produce heat with

They need wrapped up / heated / incubated

47
Q

In the first few days after birth, mature newborns require a small volume of colostrum and can regulate their own blood glucose levels.

Why?

A

Large stores of glycogen built up during pregnancy

48
Q

Why may newborns become hypoglycaemic?

A

Increased energy demands: illness, cold stress

Inadequate glycogen stores: small-for-dates or pre-term

Maternal diabetes

Maternal medication

49
Q

What is the rooting reflex?

A

When something touches baby’s mouth or lips, it reflexively tries to open its mouth and attach to it

50
Q

What is the sucking reflex?

A

When something touches the baby’s palette, the baby will reflexively try to suck on it

51
Q

How is the growth of a baby measured after birth?

A

Growth chart

52
Q

What are the differences between foetal Hb and adult Hb?

A

Foetal Hb - greater affinity for oxygen, less 2,3-DPG, more concentrated in foetal circulation

Adult Hb - more 2,3-DPG, less concentrated in foetal circulation

53
Q

Where is foetal Hb produced?

A

Liver

54
Q

Where is adult Hb produced?

A

Bone marrow

55
Q

What happens to the ratio of foetal Hb : adult Hb after birth?

A

Foetal Hb is broken down

Adult Hb is produced

56
Q

Why can newborns become anaemic?

A

Foetal Hb is broken down FASTER than Adult Hb is produced

57
Q

Just after birth, foetal Hb is broken down while adult Hb is produced in the bone marrow.

What is produced by Hb breakdown?

A

Bilirubin

58
Q

What signs does the accumulation of bilirubin cause?

A

Yellow skin and conjunctiva

Dark, yellow urine

Pale stools

59
Q

The accumulation of ___ bilirubin causes jaundice in newborns.

Why?

A

unconjugated bilirubin

foetus doesn’t have enough enzymes to conjugate bilirubin at an adequate rate, so unconjugated bilirubin accumulates as the result of foetal Hb breakdown

60
Q

Which reflexes are described by

a) newborn turns head and opens mouth towards any stimulus to the mouth or lips
b) newborn sucks in response to any stimulus touching the palette?

A

a) Rooting reflex

b) Sucking reflex

Reproduction Week 5 2018/19 (9 decks)

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