Adaptation of the Newborn Flashcards

1
Q

What are the 3 shunts in the foetus circulation?

A
ductus venosus (through liver)
ductus arteriosus (from pulmonary vein to aorta)
foramen ovale (between the atria)
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2
Q

What happens to these shunts when born?

A

Ductus venosis = ligamentum teres
Ductus arteriosus = ligamentum arteriosum
Foramen ovale closes

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3
Q

What occurs during the third trimester to prepare for delivery?

A

surfactant production, accumulation of glycogen, brown fat stores, subcutaneous fat and swallowing of amniotic fluid

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4
Q

What occurs in labour?

A

Increase in catecholamines and cortisol

squeezing of lungs

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5
Q

What is the cardiac change that occurs during labour?

A

There is the forcing of air into the lung (when cry) and this results in the opening of pulmonary vessels and an overall lowering of pressure in the pulmonary circulation

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6
Q

What is PPHN? Explain

A

persistent pulmonary hypertension of the newborn
this occurs when there is insufficient opening of the blood vessels within the lungs so pulmonary resistance remains high

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7
Q

How is PPHN diagnosed?

A

O2 sats will be low and the baby will be pale/blue/having difficulty breathing

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8
Q

How is PPHN treated?

A

ventilation, oxygen, nitric oxide, inotropics, ECMO.

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9
Q

How is heat lost from a newborn?

A

radiation, convection, conduction, evaporation

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10
Q

How do newborns thermoregulate?

A

no shiver reflex so need to produce heat via the breakdown of brown fat stores (this is inefficient in the first 12 hrs so require help)

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11
Q

What are risk factors for impaired thermoregulations?

A

SFD or preterm

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12
Q

What are ways to improve thermoregulation?

A

hat, skin to skin, dry, blanket, heated mattress, incubator

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13
Q

How is glucose homeostasis maintained?

A

requires the mobilisation of glycogen from hepatic stores and ketones for brain metabolism

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14
Q

What increases glucose demand?

A

if hypothermia or ill

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15
Q

What decreases glycogen storage?

A

SFD or preterm

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16
Q

Letting down reflex or the root and suck reflex describes what process?

A

The baby learning to suckle and stimulate milk production

17
Q

What do oxytocin and prolactin do respectively?

A
O = triggers milk release
P = triggers milk production
18
Q

What is colostrum?

A

This is the first milk produced by the breast and it is rich in protein and fat (very concentrated)

19
Q

What is foremilk and hindmilk?

A

Foremilk - released at start of feed

Hindmilk - released at end of feed

20
Q

What are the haematological adaptations made?

A

Foetal Hb becomes less efficient so adult Hb production is increased. Haematopoeisis will move to the bone marrow

21
Q

What is ‘physiological anaemia’?

A

This is due to adult Hb made slower than the breakdown of foetal Hb (faster) resulting in anaemia

22
Q

Why is there ‘physiological jaundice’?

A

due to the breakdown of foetal Hb. The conjugating systems in the liver are immature so there is a higher concentration of unconjugated billirubin in the blood = jaundice 2-14 days

23
Q

When is jaundice considered pathological?

A

Early < 2 days old

Prolonged > 2 weeks old

24
Q

How is jaundice treated?

A

Phototherapy (blue lamp)

exchange transfusion

25
Q

What are some risk factors for impaired adaption?

A

hypoxia/asphyxiation at delivery
small for dates or preterm
sick baby
congenital abnormalities

26
Q

What are some causes of PPHN?

A

Meconium aspiration
Infection
Congenital abnormalities