10. The adaptation syndrome of a newborn to extaruterine life.

Question 1

what re the factors affecting adaptation to extrauterine life ?

Answer 1

prenatal -
mother’s health , nutritional status , complications in pregnancy

intrapartum - dystocia , medications given
type of delivery - forceps used, c section etc

Question 2

what are the neonatal physiological adaptation in respiratory

Answer 2

breathing - 11 weeks

fetal lung fluid necessary for lung development

fully functioning lung - 26 weeks

surfactant suffieicnty produced - 36 weeks

after birth chest wall recoils - negative intrathrjcaic pressure - air sucked back into the lung replacing fluid

exhalation creates positive intrathoracic pressure

lungs continue to expand with each breath

positive pressure distributes the air throughout the alveoli

remaining lung fluid moves into interstitial fluid

Question 3

what are the ways the baby takes their first breath ?

Answer 3

chemical stimulation

mechanical

sensory

pulmonary blood flow

Question 4

what is the chemical stimulation in respiration ?

Answer 4

catecholamines surge prior to labour - giving rapid drop in lung fluid
also increase the amount of surfactant produced

surfactant promotes lung expansion and so the lavoli do not collapse

decreased oxygen and increased oxygen causes the carotid and aortic chemoreceptors to trigger the medulla to contract the diaphragm respiration

Question 5

what is the mechanical stimulation for respiration

Answer 5

compression of chest during labour releases 1/3 of lung fluid

crying creates a positive intrathroacic pressure keeping the alveoli open

Question 6

what are the sensory stimulation ?

Answer 6

tactile

casual

auditory

thermal stimuli - cold - thermal receptors picks it ip

trigger the respiratory centre in the medulla = contraction of the diaphragm

Question 7

what changes in pulmonary blood flor

Answer 7

pulmonary vasodilation occurs as oxygen enters the lungs

pulmonary vessels decrease their resistance giving the gas exchange

Question 8

respiratory adaptations are stablished how quick

Answer 8

within minute of birth and the respirations are quite

Question 9

what are the signs fr respiratory distress

Answer 9

nasal flaring
grunting
costal retraction
respiratory rate less than 30-60 per min

Question 10

what is the vascular system before birth ?

Answer 10

blood from placenta from the umbilical vein passes rapidly through the liver and into inferior vena cava

a portion bypasses the liver through ductus venous

flows through frames oral into he left atrium to aorta and arteries of the head

the venous blood in the baby from lower extremities and head passes predominantly into the right atrium , then ventricle and then into descending pulmonary artery and ductus arteriosus

Question 11

wy is there complex circulation in a baby ?

Answer 11

no blood flowing to lungs

Question 12

what is the cardiovascular adaptation after birth

Answer 12

the cessation of blood through the umbilical veins and vessels causes the change from fetal to neonatal circulation

decrease in pulmonary vascular resistance

decline in right atrium pressure

increased pulmonary flow to the left side of the heart increase in pressure inthe left atrium

causing functional closure of frame ovale

increase in oxygenation causes the muscles walls of ductus arteriousus to close

increase in oxygenation

increase in PVR

systemic resistance greater than pulmonary

closure of ductus venous is in 12 hours

increase in oxygenation causes increase in systemic vascular resistance

decreases systemic venous return

cessation of umbilical venous return

close of ducts venous

Question 13

in neonatal circulation how long should the capillary refill be ?

Answer 13

3 sec

Question 14

why should the femoral and brachial pulses be palpated ?

Answer 14

for symmetry in both arms and legs

and for the strength

Question 15

what is the systolic and diastolic pressure in neonates ?

Answer 15

60-80 = systolic

diastolic = 40-50

Question 16

what are the things to consider in dental circulation

Answer 16

300ml blood vol

late clamping of cord - ploycetmia vera

hemoglobin = 14-24 d/dl

hematocrit = 44-64 percet

factors 2 ,7, 9 , 10 are low due to low in potassium

Question 17

what is the thermogenic adaptation that neonates go through

Answer 17

newborns have limited ability to shiver and generate heat

head is produced through the metabolism of brown fat
voluntary muscle activity such as flexion and restessness and crying

Question 18

what are the signs of cold stress/ hypothermia innovate

Answer 18

increased oxygen consumption by increase in respiratory rate

this causes increase in peripheral vascular constriction

less oxygen in tissues

leading to increase in anaerobic glycolysis and which then leads to metabolic acidosis

PO2 and PH increase

Question 19

what are the signs for cold stress / hypothermia through a neonates skin ?

Answer 19

skin cool to touch

mottling of skin

central cyanosis

not very responsive
tachypnea

Question 20

how many ml of urine is passes at birth ? and how many voids happen in the first 2 days

Answer 20

40 ml

2-6 vids per day for the first 2 days

Question 21

after 48 hours how many voids does a neonate make per day and how much urine loss ?

Answer 21

5-25

15-60 ml of urine per kg/day

Question 22

what should be the physical chareterictics of the child’s urine

Answer 22

odourless and straw colour

uric crystals cause pink stains i diapers

Question 23

how long does it take for the renal system to mature

Answer 23

one year

Question 24

describe the difference in neonates in the renal organ ?

Answer 24

glomeruli same number but small and immature function

unable to concentrate urine

limited tubular reabsorption

limited excretion via tubules

limited dilution capabilities

Question 25

audible bowel sound should be heard within how many hours after birth

Answer 25

1 hour

Question 26

describe the difference in the gastrointestinal system in neonates

Answer 26

30-90 ml

uncoordinated peristaltic activity for the first few days

immature cardiac sphincter

Question 27

when is the first meconium tased in neonates

Answer 27

12-24hrs

Question 28

when is the first transitional stool to be passed in neonates

Answer 28

1-2 days

Question 29

what is the hepatic adaptation ?

Answer 29

in utero iron stores in the liver if stored correctly no need for supplements for 5 moths and will be able to produce haemoglobin

glucose is transferred from the mothers placenta but not insulin , during last trimester glucose is stores in liver , heart and skeletal muscles.
the continuous glucose supply stops and serum glucose declines 2-3 hours after birth then maintained through regular feedings

glycogen stores for metabolic needs

Question 30

hypoglycaemia is defined in neonates as ?

Answer 30

30mg/dl first 24 hours then glucose levels are below 45mg/dl

Question 31

normal glucose level in neonates are ?

Answer 31

24 hours the glucose level will be between 50 to 60 mg/dl

Question 32

what is the desired blood glucose level in the third day with normal feeding ?

Answer 32

60-70 mg/dl

Question 33

why does neonates have low levels of vitamin k

Answer 33

lack of intestinal flora

Question 34

what is the neonatal adpation in fluid and electrolytes

Answer 34

before birth water is 90 percent of the body mass

after birth it is 70 percent of the total body mass
and ECF is two fold compares to adults

Question 35

physiological jaundice appears when

Answer 35

hyperbilirubinemia can start no before than 24 hrs and no more than 12MG/DL in the 3rd day of life

in preterm = 15mg/dl in the fifth day of life

Question 36

what is icterus praecox

Answer 36

icterus present first day of birth
dur to about blood compatibility
cephalhematoma

Question 37

what is icterus gravid

Answer 37

bilirubin is higher than 16 mg/dl

cause is erythroblastis fetalis most of the time = haemolytic anemia fetus has RHd antigen which is the mother is negative to and attacks

Question 38

what is kernicterus

Answer 38

higher than 25mg/dl - starts to deposit in the basal ganglia = retardation
erythroblastis fetalis , fetal liver enzyme not present or not fully functioning , administration of drugs such as aspirin displacing albumin

= asymmetrical moro reflex

Question 39

what is prolonged icterus ?

Answer 39

when jaundice lasts more than 14 days

Question 40

blood analysis for jaundice is regulated how ?

Answer 40

jaundice children have blood analysis of bilirubin every 8-12 hours during the firt2 days

Question 41

what is the treatment for jaundice ?

Answer 41

when it is above 16mg/dl in the 3rd day of birth = blue light phototherapy = convert the unconjugated bilirubin into conjugated bilirubin to be excreted out

Question 42

jaundice is pathological in infants if?

Answer 42

peak bilirubin is greater than 13mg/dl

if hepatosplenomegaly and anemia are present

Question 43

what re the three immunoglobulins that neonates depend on for survival ?

Answer 43

IgG , a,m

IgG crosses the placenta in the third trimester from the mother and protects the fetus from virus and bacteria they mother has developed

Question 44

what is the first immunoglobulin to respond to infection

Answer 44

IgM = found n blood and lymph nodes

and its production starts at birth

Question 45

if there is increased IgM at birth what does this signify ?

Answer 45

exposure to intrauterine infections

Question 46

how does the baby receive its IgA?and what is it clinical significant for

Answer 46

through colostrum

limits bacterial growth in gastrointestinal tract

Question 47

what is the heart rate during birth for a neonate ?

Answer 47

160-180 bo=om

return to 11-160bpm after 30 mins

Question 48

skin temperature in the baby stabilises after how many hors of birth ?

Answer 48

4-6 hours

Question 49

what is the progression of stools ?

Answer 49

meconium - thick black and tarry

transitional stools - thin - brown to green

breastfed infants - yellow gold , soft and mushy

formula fed - pale yellow , pasty