EMRG 1305 - Neonatology

Question 1

What are the ages for Neonate and Newborn

Answer 1

neonate is <30 days
newborn is < 24 hours

Question 2

What is different about fetal circulation vs adult circulation

Answer 2

No gas exchange (lungs are not mature)
Babies are not breathing, they rely on the placenta.
- babies lungs are fluid filled & collapsed

Question 3

Preferential Streaming, what is it?

Answer 3

cardiovascular system, is adapted to ensure the most highly oxygenated blood is delivered to the myocardium and brain

Question 4

how does the oxygen work with the umbilical cord?

Answer 4

Oxygenated blood passes via 1 umbilical vein
Deoxygenated blood is carried out via 2 umbilical arteries

Question 5

Ductus Venosus, what is it?

Answer 5

continuation of the umbilical vein which bypasses most of the blood from the liver and connects the umbilical vein to the inferior vena cava

Question 6

Foreman Ovale, what is it?

Answer 6

shunt allows blood to travel from the right atrium to the left atrium

Question 7

Ductus Arteriosus, what is it?

Answer 7

artery that joins pulmonary system directly to aorta

Question 8

what are the 3 major systems involved in post delivery?

Answer 8

Ventilation
Hemodynamics
Temperature Regulation

Question 9

Ventilations, how do they change post delivery?

Answer 9

once delivery occurs, the lungs are inflated with the first breath, which establishes function residual capacity within the lungs, this allows gas exchange

Question 10

How does hemodynamics change post delivery?

Answer 10

as the pulmonary vascular resistance decreases as the lungs are now functioning blood floe increases and is able to carry oxygen throughout the body

Question 11

How does temperature regulation change post delivery?

Answer 11

immature regulation and little fat neonates are at risk of hypothermia and compensate with vasoconstriction and an increase metabolism

Question 12

What are some simple heart defects that neonates can have

Answer 12

arterial and ventricular septal defects
patent ductus arteriosus
pulmonary stenosis

Question 13

Atrial septal defect, what is it?

Answer 13

Hole in the wall of the heart between the L and R atria
Blood to flow from the left atrium and mix with the R atrium instead of going to the rest of the body

Question 14

Ventricular Septal Defect (VSD), what is it?

Answer 14

Hole in the wall of the heart between the L and R ventricle
Blood will flow from the L ventricle and mix with the blood in the R ventricle

Question 15

Patent Ductus Arteriosus, what is it?

Answer 15

the aorta and pulmonary artery does not properly close after birth. This leaves an opening through which blood can flow when it should not
In many cases, small openings may close on their own

Question 16

what is pulmonary stenosis?

Answer 16

heart valve disease in which the pulmonary valve is too narrow or stiff
this affects how well the blood can move from the heart to the pulmonary artery (blood vessel that connects the heart to the lungs

Question 17

What is Tetralogy fallout

Answer 17

birth defect that affects normal blood flow through the heart

Question 18

what are all the different parts of a Tetralogy of Fallot

Answer 18

• pulmonary stenosis
• a large ventricular septal defect
• an overriding aorta (the major blood vessel that carries blood to the body (aorta) is out of place. It is located between the two ventricles.)
• right ventricular hypertrophy (heart has to work harder than normal which makes the muscle of the R ventricle thicker than normal)

Question 19

What are the signs and symptoms for a congenial heart defect?

Answer 19

rapid breathing
cyanosis
fatigue
poor blood circulation (check on forehead)

Question 20

do neonates breath with their mouths?

Answer 20

neonates are nasal breathers, their airway anatomy is small relative to head size

Question 21

Meconium aspiration

Answer 21

when a baby is stressed and gasps while still in the womb and aspire meconium and amniotic fluid

Question 22

How do you manage Meconium Aspiration ?

Answer 22

wipe away whatever is present around the nose or mouth with cloth
if needed, gently suction with a bulb syringe from oro or nasophrynx
nose breathers, so suction from the mouth first then the nose if you can’t get it
rigorous suction can cause apnea/bradycardia

Question 23

How do you use a bulb syringe?

Answer 23

squeeze the bulb
insert tip into baby’s nostril
release the bulb

Question 24

Primary apnea

Answer 24

absence of spontaneous respiration after birth. Often self limiting and reversed with minimal resuscitation

Question 25

Secondary apnea

Answer 25

apnea that exceeds 20 seconds and can occur because of:
- difficult labour
- airway obstruction
- hypoglycemia
- respiratory myself weakness (pre-mature baby)
- narcotics or CNS depressants (no Narcan, jut ventilate)

Question 25

how do you indicate Hypovolemia in a child?

Answer 25

mottled, pale, cool skin, lethargic, poor tone
sunken fontanelles (they don’t close till 18 months)
bulging and indicate increase ICP

Question 26

what does APGAR stand for?

Answer 26

Appearance (skin colour)
Pulse
Grimace (reflex irritability)
Activity (muscle tone)
Respiration

Question 27

what is Vernix

Answer 27

coating on neonates skin in utero