Aylotts Triangle Flashcards
Where is vitamin K produced within neonates and why do we give vitamin K?
Vitamin K is produced in the gut through bacteria, but the gut is not mature enough by term to start producing vitamin K, so vitamin K is prescribed at birth. Vitamin K is produced within the Neonate but takes two weeks to produce.
What are the 3 conditions within Aylotts triangle?
Hypothermia, hypoglycaemia, hypoxia
What are the 4 main modes of heat loss?
- Conduction - loss of heat to cold surface e.g cold scales
- Convection - loss of heat to air current e.g open window
- Evaporation - loss of heat to evaporation of fluid e.g wet skin
- Radiation - loss of heat to cold surroundings e.g cold towels
What babies are at higher risk of hypoxia?
Pre term babies - less brown adipose tissue - hypothermia
Babies who’s mothers are on beta blockers - low blood sugars due to beta blockers passing through placenta - hypoglycaemia
SGA - larger surface area to volume - hypothermia
Traumatic birth - used all brown adipose Tissue, more sensitive to hypothermia
Babies born wet with the inability to shiver - hypothermia
10 steps of the warm chain?
Warm delivery room,
warm resus,
immediate drying,
skin to skin contact,
breastfeeding,
bathing/weighting postponed,
appropriate clothing/wrapping,
mom and baby together,
warm transport,
training and awareness.
What provides the newborn with unlimited glucose in utero?
Umbilical cord
Why does the newborn experience mild hypoglycaemia after birth?
To stimulate an endocrine response to break down glycogen and fat
What tissue is breaks down during labour for energy?
Brown adipose tissue
What metabolic/endocrine responses occur after birth to maintain glucose levels?
Adrenaline levels rise due to fall in environmental temperature and loss of placental glucose, leading to lipolysis that release of fatty acids for energy.
Glycogen levels facilitate the release and conversion of glycogen to glucose via glycogenolysis for energy.
Cortisol levels rise during labor, stimulating an increase in hepatic glucose release.
What triggers the rise in adrenaline levels in the newborn after birth?
A fall In environment temperatures and loss of placental glucose
Why is the role of lipolysis in the newborn after birth?
It releases fatty acid for energy
What process converts glycogen to glucose?
Glycogenolysis
How does cortisol affect glucose within the neonate during labour?
It stimulates an increases in hepatic glucose release
Explain the process of hypoglycaemia after birth
-In utero, baby has unlimited access to glucose from umbilical cord.
-newborn goes into mild hypoglycaemic state to make body have a endocrine response
- the pancreas stimulates alpha cells to produce glucagon
-glucagon breaks down glycogen and fat to make glucose and ketones
- after this, endocrine and metabolic systems work to maintain glucose levels
Minimum glucose level of preterm babies in mmol/L
2.5mmol/L
Minimum glucose level of term babies in mmol/L
2mmol/L
Why are preterm babies at higher risk of hypoxia only?
Lungs will develop mostly after 28 weeks - reduced amount of surfactant which prevents lungs collapsing during exhalation
Why are preterm babies at Risk of hypoglycaemia?
Decreased glycogen or glucose stores
Increased glucose utilisation due to growth and development
Why is the signs of hypoxia within the newborn?
Respiratory distress
Increased RR
Grunting
Chest suppression
Cyanosis (blue lips)
What are the signs of hypothermia within the newborn?
Sleepy
Lethargic
Poor feeding
Cold to tough
What are the signs of hypoglycaemia within the newborn?
Jittering
Pale
Poor feeding
What can potentially cause poor feeding in newborns?
Birth trauma
Hypoxia
Cardiac problems
Poor GI tract function
Metabolic problems
Premature
SGA/LGA
Jaundice
Congenital abnormalities
Medication e.g Pethadine, GA
Position and attachment
Why are preterm or SGA babies more at risk of hypoglycaemia?
Glycogen storage is produced within the 3rd trimester, but may be incomplete due to preterm or SGA babies have used all stores before birth for growth
What do we do if we suspect hypoglycaemia within the newborn?
Take venous blood sample to assess true blood glucose level. If sample is below 2 or 2.5 (preterm), contact neonatal doctor and alert mom and midwife in charge. Also check temp and keep baby warm to prevent hypothermia and ultimately hypoxia.
Why are preterm babies at higher risk of hypothermia?
Less brown adipose tissue so it cannot be used for heat production.
Skin is immature so increased evaporation of liquid
Poorly developed metabolic response
