10. The adaptation syndrome of a newborn to extaruterine life. Flashcards
what re the factors affecting adaptation to extrauterine life ?
prenatal -
mother’s health , nutritional status , complications in pregnancy
intrapartum - dystocia , medications given
type of delivery - forceps used, c section etc
what are the neonatal physiological adaptation in respiratory
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
what are the ways the baby takes their first breath ?
chemical stimulation
mechanical
sensory
pulmonary blood flow
what is the chemical stimulation in respiration ?
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
what is the mechanical stimulation for respiration
compression of chest during labour releases 1/3 of lung fluid
crying creates a positive intrathroacic pressure keeping the alveoli open
what are the sensory stimulation ?
tactile
casual
auditory
thermal stimuli - cold - thermal receptors picks it ip
trigger the respiratory centre in the medulla = contraction of the diaphragm
what changes in pulmonary blood flor
pulmonary vasodilation occurs as oxygen enters the lungs
pulmonary vessels decrease their resistance giving the gas exchange
respiratory adaptations are stablished how quick
within minute of birth and the respirations are quite
what are the signs fr respiratory distress
nasal flaring
grunting
costal retraction
respiratory rate less than 30-60 per min
what is the vascular system before birth ?
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
wy is there complex circulation in a baby ?
no blood flowing to lungs
what is the cardiovascular adaptation after birth
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
in neonatal circulation how long should the capillary refill be ?
3 sec
why should the femoral and brachial pulses be palpated ?
for symmetry in both arms and legs
and for the strength
what is the systolic and diastolic pressure in neonates ?
60-80 = systolic
diastolic = 40-50
what are the things to consider in dental circulation
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
what is the thermogenic adaptation that neonates go through
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
what are the signs of cold stress/ hypothermia innovate
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
what are the signs for cold stress / hypothermia through a neonates skin ?
skin cool to touch
mottling of skin
central cyanosis
not very responsive
tachypnea
how many ml of urine is passes at birth ? and how many voids happen in the first 2 days
40 ml
2-6 vids per day for the first 2 days
after 48 hours how many voids does a neonate make per day and how much urine loss ?
5-25
15-60 ml of urine per kg/day
what should be the physical chareterictics of the child’s urine
odourless and straw colour
uric crystals cause pink stains i diapers
how long does it take for the renal system to mature
one year
describe the difference in neonates in the renal organ ?
glomeruli same number but small and immature function
unable to concentrate urine
limited tubular reabsorption
limited excretion via tubules
limited dilution capabilities
audible bowel sound should be heard within how many hours after birth
1 hour
describe the difference in the gastrointestinal system in neonates
30-90 ml
uncoordinated peristaltic activity for the first few days
immature cardiac sphincter
when is the first meconium tased in neonates
12-24hrs
when is the first transitional stool to be passed in neonates
1-2 days
what is the hepatic adaptation ?
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
hypoglycaemia is defined in neonates as ?
30mg/dl first 24 hours then glucose levels are below 45mg/dl
normal glucose level in neonates are ?
24 hours the glucose level will be between 50 to 60 mg/dl
what is the desired blood glucose level in the third day with normal feeding ?
60-70 mg/dl
why does neonates have low levels of vitamin k
lack of intestinal flora
what is the neonatal adpation in fluid and electrolytes
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
physiological jaundice appears when
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
what is icterus praecox
icterus present first day of birth
dur to about blood compatibility
cephalhematoma
what is icterus gravid
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
what is kernicterus
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
what is prolonged icterus ?
when jaundice lasts more than 14 days
blood analysis for jaundice is regulated how ?
jaundice children have blood analysis of bilirubin every 8-12 hours during the firt2 days
what is the treatment for jaundice ?
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
jaundice is pathological in infants if?
peak bilirubin is greater than 13mg/dl
if hepatosplenomegaly and anemia are present
what re the three immunoglobulins that neonates depend on for survival ?
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
what is the first immunoglobulin to respond to infection
IgM = found n blood and lymph nodes
and its production starts at birth
if there is increased IgM at birth what does this signify ?
exposure to intrauterine infections
how does the baby receive its IgA?and what is it clinical significant for
through colostrum
limits bacterial growth in gastrointestinal tract
what is the heart rate during birth for a neonate ?
160-180 bo=om
return to 11-160bpm after 30 mins
skin temperature in the baby stabilises after how many hors of birth ?
4-6 hours
what is the progression of stools ?
meconium - thick black and tarry
transitional stools - thin - brown to green
breastfed infants - yellow gold , soft and mushy
formula fed - pale yellow , pasty
