Adaption at birth**

Question 1

what does the fetal lung do in utero

Answer 1

produce lung fluid which contributes to amniotic fluid

Question 2

how mania veins and arteries does the placenta heave coming baby

Answer 2

1 umbilical vein

2 arteries

Question 3

how many shunts are there in the fetus and what are they

Answer 3

3
ductus arteriosis
ductus venousus
foramen ovale

Question 4

what does DV do

Answer 4

allows oxygenated blood from the placenta to bypass the liver
leads blood into IVC

Question 5

what does DA do

Answer 5

allows most of the blood from the right ventricle to bypass the fetus’s fluid-filled non-functioning lungs
most of the blood goes into the systemic circulation

Question 6

what does the foramen ovale do

and what is it

Answer 6

flat opening in the left ventricle

shunts highly oxygenated blood from right atrium to left atrium

Question 7

what happens to DA after birth

Answer 7

ligamentum arteriorsis

Question 8

what happens to DV after birth

Answer 8

ligamentum teres

Question 9

what happens to the foramen ovale after birth

Answer 9

usually closes

Question 10

what happens in preparation of birth in terms of lungs

Answer 10

surfactant production
in preterm babies mums are given IV dexa to promote surfactant production to reduce the chances of neonatal respiratory distress syndrome

Question 11

what happens in preparation of birth in terms of glucose

Answer 11

accumulation of glycogen to prepare for he disconnection from the placenta
this is in the heart, muscle, liver
also allows them to deal with the stress of labour

Question 12

what happens in preparation of birth in terms of fat

Answer 12

accumulation of brown fat between scapulae and around internal organs to keep them warm

accumulation of subcut fat as well

Question 13

what hormones are increased in labour and delivery

Answer 13

catecholamines and cortisol

Question 14

colour of the baby when it first comes out - and what happens after it

Answer 14

comes out blue
takes a deep breath
cries
goes pinker
cord gets cut

Question 15

lung aeration when the baby first comes out - steps

Answer 15

cold when baby comes out
baby becomes more hypoxic because placenta disconnected
CO2 levels rise allowing them to breathe by crying
breathing pushes the pulmonary fluid out of the lungs into the lymphatic tissue

Question 16

what happens during circulatory transition
what resistance drops and why
which leads to what
what resistant rises
which leads to the closing of what

Answer 16

pulmonary resistance drops because baby starts to breathe

blood starts to circulate through the lungs and needs all of the circulation to go through and not just 7%

systemic vascular resistance rises because the cord is cut leading to oxygen tension rising

left sided pressure increases leading to the closure of FO

Question 17

what things lead to the cut constricting (FO closing)

Answer 17

pressure imbalance
increased oxygen
decrease prostaglandins due to disconnected placenta

Question 18

when might the duct tissue not constrict
what can this lead to
what is the treatment

Answer 18

in preterm babies as the tissue is not mature enough to close properly

patent ductus arteriosis

NSAIDs as this decreases the level of prostaglandins

Question 19

what is persistent pulmonary tension of the newborn

Answer 19

if the pulmonary vascular resistance fails to drop
blood will still cross from right to left via the foramen ovale
baby will stay blue

Question 20

what are the causes of persistent pulmonary tension of the newborn

Answer 20

sick, septic, asphyxiated, unwell, idiopathic

Question 21

dx of persistent pulmonary hypertension

Answer 21

sats probe on pre ductal such as the right arm and on post ductal feet
usually 20% difference

Question 22

treatment of persistent pulmonary hypertension of the newborn

Answer 22

ventilation with a tube
oxygen
sedation
warm
inotropes if theres any myocardial dysfunction
nitric acid - if the above does work - vasodilator for the lungs
ECLS - last line - take the blood out of the baby and oxygenate it then put it back in

Question 23

how long does transient tachypnoea last

who does it occur in and why

Answer 23

benign, self limiting, resolves in around 24 hours

C section babies - they take longer to reabsorb all the lung fluid

Question 24

why do babies lose a lot of heat when they are born and through which ways do they lose heat

Answer 24

large surface area
wet when born
conduction, convection, evaporation, radiation

Question 25

how to keep the baby warm

Answer 25

hat, blanket, skin-to-skin with the mum, heated mattress, incubator

Question 26

which babies get hypothermia and what can this lead to

Answer 26

premature
babies that are small
predisposes to other problems

Question 27

what does little oral intake of milk in the first few hours of life lead to in the baby

Answer 27

a drop in insulin and an increase in glycogen and use of hepatic glycogen stores

Question 28

how are babies adapted to dealing with hypoglycaemia

Answer 28

use ketones as brain fuel

Question 29

which babies get hypos

Answer 29

babies who are unwell due to increased energy demands
maternal DM/hyperinsulinaemia
small/premature babies have low glycogen stores
drugs in the mother such as labetalol

Question 30

what does breast feeding reduce the risk of in the mum

why is breast feeding good for the baby

Answer 30

reduced risk of ovarian and breast cancer

transfer of immunoglobulins to the baby[colesterum]

Question 31

what % weight loss does a baby have to lose to be at risk

and at risk of what

Answer 31

10%

risk of dehydration and become hypernatraemic

Question 32

what is the difference between fetal haemoglobin and adult haemoglobin

Answer 32

fetal Hb has a higher affinity for oxygen

Question 33

what happens to fetal hb when the baby is born

Answer 33

it is broken down and replaced by adult haemoglobin

Question 34

how long is it normal to be anaemic in babies and why

Answer 34

8-10 weeks

as adult hb production catches up

Question 35

why can unconjugated jaundice occur in babies

Answer 35

due to breakdown of RBCs

Question 36

very high levels of bilirubin can lead to what

Answer 36

bilirubin encephalopathy

Question 37

when is jaundice bad

Answer 37

<24 hours

prolonged - longer than 14 days in term and longer than 21 days in preterm