EMRG 1305 - Neonatology Flashcards
What are the ages for Neonate and Newborn
neonate is <30 days
newborn is < 24 hours
What is different about fetal circulation vs adult circulation
No gas exchange (lungs are not mature)
Babies are not breathing, they rely on the placenta.
- babies lungs are fluid filled & collapsed
Preferential Streaming, what is it?
cardiovascular system, is adapted to ensure the most highly oxygenated blood is delivered to the myocardium and brain
how does the oxygen work with the umbilical cord?
Oxygenated blood passes via 1 umbilical vein
Deoxygenated blood is carried out via 2 umbilical arteries
Ductus Venosus, what is it?
continuation of the umbilical vein which bypasses most of the blood from the liver and connects the umbilical vein to the inferior vena cava
Foreman Ovale, what is it?
shunt allows blood to travel from the right atrium to the left atrium
Ductus Arteriosus, what is it?
artery that joins pulmonary system directly to aorta
what are the 3 major systems involved in post delivery?
Ventilation
Hemodynamics
Temperature Regulation
Ventilations, how do they change post delivery?
once delivery occurs, the lungs are inflated with the first breath, which establishes function residual capacity within the lungs, this allows gas exchange
How does hemodynamics change post delivery?
as the pulmonary vascular resistance decreases as the lungs are now functioning blood floe increases and is able to carry oxygen throughout the body
How does temperature regulation change post delivery?
immature regulation and little fat neonates are at risk of hypothermia and compensate with vasoconstriction and an increase metabolism
What are some simple heart defects that neonates can have
arterial and ventricular septal defects
patent ductus arteriosus
pulmonary stenosis
Atrial septal defect, what is it?
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
Ventricular Septal Defect (VSD), what is it?
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
Patent Ductus Arteriosus, what is it?
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
what is pulmonary stenosis?
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
What is Tetralogy fallout
birth defect that affects normal blood flow through the heart
what are all the different parts of a Tetralogy of Fallot
- 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)
What are the signs and symptoms for a congenial heart defect?
rapid breathing
cyanosis
fatigue
poor blood circulation (check on forehead)
do neonates breath with their mouths?
neonates are nasal breathers, their airway anatomy is small relative to head size
Meconium aspiration
when a baby is stressed and gasps while still in the womb and aspire meconium and amniotic fluid
How do you manage Meconium Aspiration ?
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
How do you use a bulb syringe?
squeeze the bulb
insert tip into baby’s nostril
release the bulb
Primary apnea
absence of spontaneous respiration after birth. Often self limiting and reversed with minimal resuscitation
Secondary apnea
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)
how do you indicate Hypovolemia in a child?
mottled, pale, cool skin, lethargic, poor tone
sunken fontanelles (they don’t close till 18 months)
bulging and indicate increase ICP
what does APGAR stand for?
Appearance (skin colour)
Pulse
Grimace (reflex irritability)
Activity (muscle tone)
Respiration
what is Vernix
coating on neonates skin in utero
