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REPRO > Adaptation at Birth > Flashcards

Adaptation at Birth Flashcards

1
Q

How does the meconium aspiration syndrome present as?

A
  • streaky lung fields

- —not black as it should be

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2
Q

PLacental fxn?

A 
Fetal homeostasis
Gas exchange
Nutrient transport to fetus
Waste product transport from fetus
Acid base balance
Hormone production
Transport of IgG
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3
Q

Name the 3 major shunts in fetal circulation.

A
  • Ductus arteriosus
  • Foramen Ovale
  • Ductus venosus
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4
Q

What % of maternal blood goes to the fetal lungs and why?

A

7%

—-because the lungs is not yet filled with oxygen

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5
Q

How is the baby prepped for birth in the 3rd trimester?

A
  • Surfactant production (allows gas exchange)
  • Accumulation of glycogen – liver, muscle, heart
  • Accumulation of brown fat – between scapulae and around internal organs; Insulation
  • Accumulation of subcutaneous fat
  • Swallowing amniotic fluid
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6
Q

What produces surfacant? What is the role of surfacant?

A
  • by type 2 Pneumocytes

- reduces the surface tension; allows the lungs to fill up easily with air (no collapse of alveoli)

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7
Q

What occurs with reduced amniotic fluid around the baby?

A

Small Hypoplastic lungs

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8
Q

What occurs to the fetus during delivery and labour?

A

Onset of labour – increased catecholamines / cortisol
Synthesis of lung fluid stops
Vaginal delivery – uterine contractions help squeeze out liquid
from lungs

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9
Q

What is the appearance of the baby in the first few secs?

A 
Blue
Starts to breathe
Cries---helps oxygen get into the lungs? 
Gradually goes pink
Cord cut
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10
Q

What affects fetal circulation?

A
  • cord clamped (INCR. placental resistance) and first breath ( decr. resistance)
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11
Q

What occurs with circulatory transition? –search up

A 
Pulmonary vascular resistance drops
Systemic vascular resistance rises
Oxygen tension rises
Circulating prostaglandins drop
Duct constricts
Foramen ovale closes
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12
Q

What occurs to the ductus arteriosus ?

A
  • ductus arteriosus becomes ligamentum arteriosus
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13
Q

Ductus venosus becomes_______

A

Ligamentum teres

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14
Q

What may occur to the foramen ovale?

A
  • may persist as Patent Foramen Ovale (10%)
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15
Q

What may occur to the foramen ovale?

A
  • may persist as Patent Foramen Ovale (10%)
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16
Q

WHat occurs with persistent pulmonary hypertension?

A
  • FAILURE of normal circulatory transition d.t Lung vascular resistance failing to fall; SHUNTS remain
    (surfacant deplete; lungs full of fluid)
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17
Q

What is a sig. finding for PPH?

A
  • anything more than 3% difference between the pre and post ductal saturation
    = PPH
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18
Q

What is the management of PPHN?

A
  • dialyate given direct to the fetal lungs
  • ventilation
  • oxygen
  • nitric oxide
  • sedation
  • inotropes
  • ECLS
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19
Q

What does Transient Tachypnea present as? And Why?

A
  • in big healthy bbies
  • —grunt and breathe faster
  • born by C-section
  • no lung squeeze!
  • —-recovers quickly
20
Q

What should be done in the first few hrs, post delivery?

A

Thermoregulation
Glucose homeostasis
Nutrition

21
Q

How to keep bbies warm?

A
  • cover the HEAD and BODY to stop radiation of body

as bbies have a LARGE surface area and they are wet post-delivery

22
Q

How do bbies attempt to keep warm?

A
  • non shivering thermogenesis
    Heat produced by breakdown of stored brown adipose tissue in response to catecholamines
  • Not efficient in the first 12 hours of life
    Peripheral vasoconstriction
    —why Newborn babies need help with maintaining temperature
23
Q

Which particular bby has to be kept warm?

A
  • SGA bbies and preterm bbies
  • Low stores of brown fat
  • Little subcutaneous fat
  • Larger surface area:vol
24
Q

How to keep warm?

A 
Dry
Hat
Skin to skin
Blanket / clothes
Heated Mattress
Incubator
25
Q

How does glucose homeostasis occur?

A
  • Interruption of glucose supply from placenta
  • Very little oral intake of milk (~5 days for breast milk to set in)
  • Drop in insulin, increase in glycogen
  • Mobilisation of hepatic glycogen stores for gluconeogenesis
  • Ability to use ketones as brain fuel
26
Q

Why may hypoglycemia occur in bbie?

A
  1. incr. energy demands (unwell, hypothermia)
  2. low glycogen levels (preterm, small bby)
  3. Inappr. insulin/glucagon ratio (hyperinsulinism/ maternal diabetes)
  4. Some drugs
27
Q

How to avoid hypoglycemia

A

Identify those at risk
Feed effectively
Keep warm
Monitor

28
Q

Expectant wgt loss that is normal in bbies?

A

10% wgt loss

—-some may lose more that 10% —RISK of HYPERNATREMIC dehydration > usually d/t delayed lactation

29
Q

Why is it important to change the fetal Hb to change to adult Hb?

A
  • to high O2 affinitt (hard to oxygenate fetal tissues)

- fetal Hb break quickly

30
Q

What helps shift the curve to the right?

A

Incr. in 2,3 BPG helps move the curve to the right

31
Q

What form of JAUNDICE is seen in the first few days of the bby?

A
  • Unconjugated Jaundice; V. high level is DANGEROUS
32
Q

Why does fetal jaundice occur?

A

Breakdown of fetal haemoglobin
Conjugating pathways immature
Rise in circulating unconjugated bilirubin

early or prolonged jaundice = pathologocical

33
Q

Which bbies are at risk?

A 
Hypoxia / asphyxia during delivery
Particularly small or large babies
Premature babies – a whole other lecture
Some maternal illnesses and medications
Ill babies – sepsis, congenital anomalies
34
Q

What shunts oxygenated blood from the RA to the LA in the fetal circulation?

A 
Foramen Ovale 
(bypasses pulmonary circulation; which is fine as the RA of the fetal heart recieves oxygenated blood)
35
Q

What does Ductus Arteriosus shunt blood to and from?

A
  • it shunts blood from the Pulmonary artery to the aorta
36
Q

How is it possible for blood to BYPASS the lungs?

A
  • d.t high pulmonary resistance
37
Q

Name 2 right-to-left shunts in fetal circulation.

A
  • Patent FO and Patent D.A
38
Q

What does blood is shunted to and from in the Ductus Venosus?

A

-shunts blood from the Umbilical vein to the IVC

39
Q

Does the percentage of blood directed to the lungs increase with gestational age?

A

YES

becomes 80% of blood redirected to the liver by week 32

40
Q

In utero the patency of Ductus Arteriosus depends on what?

A
  • maintained by HIGH levels of Prostaglandins —-METABOLIZED by the lung (level drops with incr. blood flow to lungs)
  • low fetal pO2
41
Q

Explain how the ductus arteriosus closes?

A
  • physiological closure in first few hrs/ days
  • (anatomical closure in 7-10 days)
  • reduced PVR = Reduced flow
  • decr. PGE2 circulation d.t INCR. lung metabolism
  • rising arterial concentrations in blood
42
Q

What occurs with failure of hte cardiorespiratory adaptation?

A
  • Asphyxia
  • Prematurity
  • sepsis
  • hypoxia
  • cold stress
43
Q

What are the signs of PPHN?

A
  • asphyxia
  • tachypnea
  • Respiratory acidosis
  • Loud, single second heart sound (S2) or a harsh systolic murmur (secondary to tricuspid regurgitation)
  • Low Apgar scores
  • Meconium staining
  • Cyanosis; poor cardiac function and perfusion
  • Systemic hypotension
  • Symptoms of shock
44
Q

Where are the pre and post ductal sats taken from and what is a concerning finding?

A
  • Pre-ductal= right hand
  • Post- ductal= Left foot

—-diff. of >10% indicative of Pulmonary hypertension !

45
Q

What are the 3 methods of heat loss in a baby?

A
  • radiation
  • convection
  • conduction
  • evaporation
46
Q

What does suckling of the mother’s nipple stimulate?

A
  • the HYPOTHALAMUS
    >then stimulates Posterior Pituitary> Oxytocin release> milk ejection
  • Hypothalamus also stimulates the anterior pituitary gland> stimulates PROLACTIN release and MILK prodn
47
Q

Does breast milk have diff. forms of composition?

A
  • Colostrum (lots of IgA, cellular immunity and growth factors)
  • foremilk
  • hindmilk

REPRO (55 decks)

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