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Block 3 Week 8 Meg > Cobine: Fetal and Neonatal Physiology > Flashcards

Cobine: Fetal and Neonatal Physiology Flashcards

1
Q

How does weight develop in the fetus? During what weeks does the fetus remain miniscule? When does tremendous weight gain occur?

A

first 2-3 weeks –> microscopic
first 12 weeks –> remains miniscule
then begins to grow
tremendous weight gain during last two months

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2
Q

How does length develop in the fetus?

A

steady growth throughout the gestational period

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3
Q

Organ systems are blocked out within the first month, and systems form within 2nd-3rd month. Cellular development continues until term. What systems are not fully developed at birth?

A

nervous system
kidney
liver

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4
Q

When does the heart start beating? What happens to HR just before delivery?

A

at 26 days; heart rate increases from 65 tp 140 beats before delivery

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5
Q

Where is formation of blood cells seen first? Then where?

A

yolk sac –> liver –> spleen –> bone marrow

young liver synthesizes blood

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6
Q

Respiratory movements take place during the 1st trimester, but is inhibited during the last 3-4 mo’s. What does this prevent?

A

prevents debris from meconium entering the lungs

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7
Q

Skin reflexes develop in the fetus between 3-4mo’s. Most of the higher function of the cerebral cortex are (blank) at birth. How long does it take after birth for myelinization of the major tracts to occur?

A

underdeveloped; 1 year

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8
Q

After ~4.5 months gestation, the fetus ingests and absorbs large quantities of amniotic fluid.
During the last 2‑3 months, gastrointestinal function approximates that of a newborn infant.
What is excreted by the fetus?

A

meconium

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9
Q

Fetal kidneys start to develop at the 5th week. When do they begin secreting urine? Fluid and electrolyte regulation and acid-base balance is not fully developed until months after birth.

A

1st/2nd trimesters

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10
Q

Does the fetus accumulate more calcium or phosphorus?

A

calcium

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11
Q

Why is half of the totals of Ca+ and phosphorus accumulated during the last 4 weeks of gestation?

A

rapid formation of bone

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12
Q

What accumulates faster - iron, calcium, or phosphorus?

A

Iron (most incorporated in hemoglobin)

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13
Q

essential vitamins:

  1. RBC formation
  2. Bone matrix and CT formation
  3. Bone growth
  4. Maintains normal development in early embryo
  5. Formation of blood coagulation factors - provided by the mother
A
  1. vitamin B12 and folic acid
  2. Vit C
  3. Vit D
  4. Vit E
  5. Vit K
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14
Q

Onset of breathing occurs within seconds. What is delayed and abnormal breathing referred to as? What are some causes? Dangers?

A

hypoxia; umbilical cord compression, premature placental separation, excessive contraction of uterus, excessive anesthesia; depression of respiratory center, lesions of hypothalamus, or other parts of the brain leading to permanent brain impairment

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15
Q

How long can a baby survive without respiration? How long until perma brain damage?

A

10-15mins

8-10mins

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16
Q

T/F: Requires 25mmHg to open lungs initially. The first inspirations can produce up to 60mmHg of negative pressure in the intrapleural space. The second breath is much easier.

A

True

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17
Q

Discuss blood flow from umbilical vein to systemic circulation

A

oxygenated blood from umbilical vein –> ductus venosus –> IVC –> R atrium –> foramen ovale –> left atrium –> left ventricle –> vessels of head and forelimbs

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18
Q

Discuss blood flow from superior vena cava to placenta

A

deoxygenated blood from SVC –> right atrium –> tricuspid valve –> right ventricle –> pulmonary artery –> ductus arteriosus –> descending aorta –> umbilical artery –> placenta

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19
Q

Primary changes in pulmonary/systemic vascular resistance at birth

A

Loss of tremendous blood flow to the placenta, systemic vascular resistance doubles.

Increased aortic pressure and increased pressures within the left ventricle and left atrium.

Pulmonary vascular resistance greatly decreases with expansion of the lungs.

Right ventricular and arterial pressure are also reduced.

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20
Q

What three things close after birth in regards to fetal circulation?

A

forament ovale
ductus arteriosus
ductus venosus

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21
Q

What happens to RBC count and bilirubin across age in weeks?

A

RBCs decline a bit (hypoxic stimulus for RBC formation disappears) and bilirubin (which spikes at birth) declines pretty quickly

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22
Q

T/F: WBC counts in infants are about 5 times that of adult values.

A

true

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23
Q

Produced by Rh incompatibility between the mother and fetus.

Maternal system recognizes the infants’ RBCs as non‑self, and destroys them with antibodies.

Large quantities of bilirubin released into the plasma.

A

erythroblastosis fatalis

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24
Q

At birth, the liver is only marginally functional which can lead to (blank).

A

physiologic hyperbilirubinemia

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25
Q

Newborns are susceptible to these three conditions due to underdeveloped fluid and acid-base balance

A

dehydration
overhydration
acidosis

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26
Q

The liver is only marginally functional at birth. What happens to bilirubin excretion? What happens to plasma protein formation? What can occur due to non-existant gluconeogenesis? What happens to formation of blood coagulation factors?

A

reduced; reduced; hypoglycemia; poor formation of blood clotting factors

27
Q

In newborns, glycogen stores rapidly depleted. Can’t do gluconeogenesis. What do they utilize for the first 2-3 days until mothers milk can be provided? As body fluid turnover is 7x that of an adult, often 5‑10% weight loss after birth until mothers milk supply becomes sufficient.

A

stored fats and proteins

28
Q 
Compared to other children, how are newborn levels of the following?
pancreatic amylase
fat absorption
blood glucose levels
amino acid utilization
A

low
reduced
unstable
good

29
Q

Infants need calcium and Vit D because rapid ossification is occuring. What can occur if there is a deficiency?

A

rickets

30
Q

If mother does not have adequate iron in her diet - what can occur?

A

anemia

31
Q

What can lead to Vit C deficiency in infants?

A

low content of vit C in cow’s milk - need juice

32
Q

What happens to body temp after birth?

How is the metabolic rate compared to adults?

A

rapid drop over first few hrs – then adjusts after a couple days
metabolic rate is 2x that of the adult

33
Q

Maternally inherited immunity protects the infant for (blank) months against major childhood infectious diseases including diphtheria, measles, and polio. Therefore, immunization against these diseases before 6 months is unnecessary.

(blank) begin to appear once the infant begins to form its own antibodies.

A

6; allergies

34
Q

With excess androgenic hormone, female children develop with (blank) of the sex organs (hermaphrodism).

Excess sex hormones or prolactin may cause neonatal breast development and/or milk formation.

Hypertrophy and hyperfunction of the islets of Langerhans, caused by (blank) in diabetic women.

Hypo-/hyper- secretion of adrenal/thyroid glands with excess/inadequate hormone levels in the mother.

Hypothyroidism in the fetus results in poor (blank) growth and mental retardation (Cretin Dwarfism; congenital hypothyroidism).

A

masculinization; hyperglycemia; bone

35
Q

Immature respiratory development

A

RDS

36
Q

What can cause immature GI development?

A

low-fat, high calcium and vit D diet

37
Q

Oxygen therapy can cause (blank) in the premature infant

A

blindness

38
Q

Occurs in premature infants or those born to diabetic mothers - large quantities of proteinaceous fluid resembling plasma in the alveoli - also called hyaline membrane disease - lack of surfactant secretion - collapsed alveoli and pulmonary edema

A

RDS

39
Q

Risk factors for RDS

A

male, premature, second born twin, maternal diabetes, perinatal asphyxia, lecithin/sphingomyelin <2

40
Q

Clinical features of RDS

A 
tachypnea (rapid breathing)
nasal flaring 
grunting
cyanosis
"ground glass" appearance on CXR
41
Q

Complications of RDS

A

pneumothorax

pulmonary emphysema

42
Q

5 criteria for APGAR scoring for newborn

A 
Activity
Pulse
Grimace
Appearance
Respiration
43
Q

What is considered a normal APGAR score?

What score is ok? What score requires immediate resuscitation?

A

7-10; 4-7; below 3

44
Q

When is the “critical period” of neonatal development? When are body systems formed? By what month are they the same as in the newborn?

A

1st trimester; 2nd and third months; 4th month

45
Q

After birth, what is the only place where RBCs are produced?

A

bone marrow

46
Q

Brain mass is (blank)% of adult brain by 2 years

A

80%

47
Q

T/F: 1/3 of the iron in a full term fetus is stored in the liver for future formation of Hb

A

True

48
Q

Normal respiratory rhythm within seconds of birth is likely due to what? If no breathing, what will usually start respirations?

A

low O2 and low temp-cooled skin; further decrease in O2 and build up of CO2

49
Q

In the fetal circulation, is blood flow to the fetus from the umbilical vein oxygenated or deoxygenated? Is blood from the superior vena cava to the placenta oxygenated or deoxygenated?

A

oxygenated; deoxygenated

50
Q

T/F: Prior to birth, the lungs and liver do not need much blood, but the placenta does.

A

True

51
Q

When does the functional closure of the ductus arteriosus occur? When does the anatomical closure occur?

A

within day(s); month(s)

52
Q

Low right atrial pressure and high left atrial pressure.

Blood attempts to flow backward through the foramen ovale.

Valve on the left side of the atrial septum closes after birth–> fossa ovalis.

A

Closure of foramen ovale

53
Q

Elevated aortic pressure and reduced pulmonary arterial pressure.

Blood begins to flow backward through the ductus arteriosus.

Constricts within 1‑8 days, producing a functional closure.

During the next 1‑4 months, complete occlusion with fibrous tissue.

A

Closure of the ductus arteriosus

54
Q

Portal blood from the fetus’ abdomen bypasses the liver by joining blood from the umbilical vein and passing through the ductus venosus directly into the vena cava.

At birth, the umbilical vein blood flow ceases, but the portal blood flow continues into the ductus venosus.

Constriction of the ductus venosus within 1-3 hours.

The portal venous pressure increases (from 0 to 10 mm Hg), enough to force blood through the liver sinuses.

A

closure of the ductus venosus

55
Q

Total minute respiratory volume about (blank) that of an adult.

This is compensated for with a functional residual capacity of (blank) that of an adult in relation to body weight.

A

twice; less than half

56
Q

Cardiac output in the infant is about (blank) that of an adult.

A

twice

57
Q

Arterial pressure is about (blank) at birth and then increases over the next few months after birth to (blank) and slowly increases to adolescent values of (blank).

A

70/50; 90/60; 115/70

58
Q

How is bilirubin excreted by the fetus?

A

through the placenta

59
Q

Fluid intake in a newborn is (blank) times that of an adult.
Urine concentration is decreased.
Metabolism is (blank) that of an adult.
Acid formation is increased.

A

7 times; twice

60
Q

Why is there a rapid drop in body temp after birth?

A

body surface area > body mass

61
Q

Premature infants may need to use an (blank) to regulate body temperature and may experience hypoproteinemic edema

A

incubator

62
Q

APGAR scoring:
Active movement, pulse above 100bpm, sneezing coughing or pulling away, appearance over entire body normal, good and crying - score of (blank)

Arms and legs flex, pulse below 100bpm, grimace, normal appearance except for extremeties, slow irregular respiration - score of (blank)

A

10;5

63
Q

What Vitamin deficiency can cause spontaneous abortions?

A

Vit E - maintains normal development in the growing embryo

64
Q

In a fetus, Ca+ levels represent (blank) of the maternal bone content

A

1/50th

Block 3 Week 8 Meg (8 decks)

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