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Repro and Sexual Health > Adaptation at birth > Flashcards

Adaptation at birth Flashcards

1
Q

What is the placental function?

A 
Foetal homeostasis
Gas exchange
Nutrient transport to foetus
Waste product transport from foetus
Acid base balance
Hormone production; baby ready for labour
Transport of IgG
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2
Q

What is the role of the foetal liver and kidney?

A

Liver; albumin, clotting factor, RBC

Kidney; excretes urine, contributes to amniotic fluid

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3
Q

What is the role of the foetal endocrine system?

A 
Thyroid hormones
Corticosteroids 
Mineralocorticoids 
PTH 
Insulin
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4
Q

What are the 3 shunts present in the foetal circulation?

A

Ductus venosus
Foramen ovale
Ductus arteriosus

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5
Q

What % of the foetal circulation goes to the lungs?

A

7%

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6
Q

What occurs in the 3rd trimester to prepare the foetus for birth?

A

Surfactant production
Accumulation of glycogen at liver, muscle and heart
Accumulation of brown fat; scapulae and internal organs
Accumulation of subcutaneous fat
Swallowing of amniotic fluid

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7
Q

What produces surfactant?

A

Type 2 pneumocytes

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8
Q

What is the role of surfactant?

A

Reduced surface tension

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9
Q

How much fluid is present in foetal lungs?

A

100ml

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10
Q

What is the benefit of vaginal delivery in terms of lung fluid?

A

Squeezes out 30%, this can be a reason for transient tachypnoea of the newborn in c/s babies (no squeezing)

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11
Q

How does the circulation transition as the baby is born?

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

How does the arterial pO2 change as the baby is born?

A

Rises from 2-3.5 to 9-13 kPa

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13
Q

What factors allows for the duct closure in babies post birth?

A

Decreased flow due to decreased pulmonary vascular resistance
Increased pO2 (oxygen sensitive muscular layer)
Decreased circulating PGE2 due to increased lung metabolism
Shut becomes bidirectional then left-right

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14
Q

When is the physiological and anatomical closure of the ductus venous?

A

Physiological; few hours

Anatomic; 7-10 days

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15
Q

What is the fate of the foramen ovale?

A

Closes or persists as PFO (10%)

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16
Q

What is the fate of the ductus arteriosus?

A

Becomes ligamentum arteriosus

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17
Q

What is the fate of the ductus venosus?

A

Becomes ligamentum teres

18
Q

What can result in failure of cardiopulmonary adaptation?

A 
Asphxia; hypoxia/ acidosis 
Prematurity 
Sepsis
Hypoxia - meconium aspiration 
Cold stress 
Chorioamnionitis 
Hypothermia
19
Q

What is PPHN?

A

Lung vascular resistance fails to fall
Shunts remain; right to left at PFO, right to left at PDA
High pressure in the pulmonary vascular system

20
Q

What is a good test to assess PPHN?

A

Pre and post ductal o2 sats

21
Q

How is PPHN managed?

A 
Ventilation 
Oxygen 
NO - vasodilator 
Sedation 
Inotropes 
ECLS/ ECMO
22
Q

What adaptations occur within the first couple of hours?

A

Thermoregulation
Glucose homeostasis
Nutrition

23
Q

Why is thermoregulation a problem for babies?

A

Large surface area

Wet when born

24
Q

What are the 4 methods of heat loss?

A

Radiation
Convection
Conduction
Evaporation

25
Q

Can babies shiver?

A

No; therefore main source of heat is non shivering thermogenesis

26
Q

How do babies produce heat?

A

Breakdown of stored brown adipose tissue in response to catecholamines

27
Q

Can babies breakdown brown adipose tissue in the first 12 hours of life?

A

No; peripheral vasoconstriction occurs

Newborns need help with maintaining temp; between 36.5-37.5

28
Q

Who do small for dates/ preterms need help maintaining temp?

A

Low stores of brown fat
Little subcutaneous fat
Larger surface area:vol

29
Q

How can hypothermia be prevented in newborns?

A 
Dry
Hat
Skin to skin 
Blanket/ clothes
Heated mattress
Incubator
30
Q

How does glucose homeostasis change in the first couple hours of life?

A

Interruption of glucose supply from placenta
Very little oral intake of milk
Drop in insulin, increase in glycogen
Mobilisation of hepatic glycogen stores for gluconeogenesis
Ability to use ketones for brain

31
Q

What can predispose to hypoglycemia in a newborn?

A

Increased demands; unwell, hypothermia
Low glycogen stores; small/ prem
Inappropriate insulin/ glucagon ratio; maternal diabetes, hyperinsulinism
Beta blockers

32
Q

How can hypoglycemia be avoided in newborns?

A

Identify those at risk
Feed effectively
Keep warm
Monitor

33
Q

What are the different forms of breastmilk?

A

Colostrum
Foremilk
Hindmilk

34
Q

What is a normal weight loss in the first week following birth?

A

10%

35
Q

What can occur if more than 10% of weight is lost?

A

Hypernatremic

36
Q

What chemical will result in the changes of foetal Hb?

A

2,3 BPG

Shifts curve to the right

37
Q

Where will haematopoiesis move to/from after birth?

A

From liver to bone marrow

38
Q

Why will there be a physiological anaemia at 8-10 weeks post birth?

A

Adult Hb is synthesised more slowly than foetal Hb is broken down

39
Q

What type of bilirubin results in physiological jaundice?

A

Unconjugated as conjugating pathways are immature

40
Q

What are the 2 methods of treating jaundice in babies?

A

Phototherapy

Exchange transfusion

41
Q

What is a bad side effect of prolonged and high jaundice in a baby?

A

Kernicterus; bilirubin deposits in basal ganglia resulting in athetoid CP and deafness

42
Q

What babies are at risk to maladaptation?

A 
Hypoxia/ asphyxia during delivery
SGA or LFD
Prematures
Maternal illness
Ill babies; sepsis or congenital anomalies

Repro and Sexual Health (77 decks)

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