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Neonate > Fetal and Neonatal Concerns Transitions > Flashcards

Fetal and Neonatal Concerns Transitions Flashcards

1
Q

Describe the path of oxygenated blood from the placenta to the neonate.

A
  • Aorta
  • Uterine artery and ovarian artery
  • Arcuate artery
  • Arcuate vessel
  • Basal and spiral artery
  • Intervillous space
  • Chorionic Villi
  • Umbilical vein
  • Fetus
  • Umbilical arteries
  • Uterine veins
  • IVC
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2
Q

When does fetal resuscitation start?

A
  • During labor
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3
Q

What is the most common cause of neonatal depression?

A
  • Intrauterine asphyxia
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4
Q

How long can the fetus compensate fetal hypoxia and what is this termed?

A
  • 45 minutes

- Fetal stress

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5
Q

When is fetal heart rate monitoring of the neonate?

A
  • 24 weeks or above
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6
Q

What is the most useful technique in monitoring fetal heart well being?

A
  • Fetal heart rate monitoring 35-50%
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7
Q

What are the three parameters that need to be monitored with fetal heart rate monitoring?

A
  • Baseline heart rate
  • Baseline variability
  • Relationship to uterine contractions (Deceleration patterns)
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8
Q

What is the normal heart rate range in the fetus and newborn?

A
  • 110-160
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9
Q
  • Prematurity
  • Mild fetal hypoxia
  • Chorioamnionitis
  • Maternal fever
  • Maternally administered drugs (anticholinergics, B-agaonists)
  • Maternal HYPOTHYROID
    All have what effect on fetal heart rate?
A
  • Increase fetal heart rate
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10
Q
  • Post-term pregnancy
  • Fetal heart block
  • Fetal asphyxia
    All have what effect on fetal heart rate?
A
  • Decrease fetal heart rate
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11
Q

What are two causes of prolonged decelerations in the fetus?

A
  • Neuraxial anesthesia and precipitous BP drop of the mother

- Cord prolapse

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12
Q

What is a measure of an intact neurological system, indicates optimal fetal oxygenation, and is a measure of fetal oxygen reserve?

A
  • Variability

- THE SINGLE MOST IMPORTANT CHARACTERISTIC OF FHR

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13
Q

What is indicated by FHR variability of <5bpm?

A
  • Minimal variability
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14
Q

What is indicated by FHR variability of 6-25 bpm?

A
  • Moderate variability
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15
Q

What is indicated by FHR variability > 25 bpm?

A
  • Marked variability
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16
Q

What may be occurring when there is sustained decreased baseline variability?

A
  • Fetal asphyxia
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17
Q

What is the best way to assess fetal heart rate variability?

A
  • Fetal scalp electrodes
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18
Q
  • CNS depressants (opioids, barbiturates, Mg+, benzos)
  • Parasympatholytics (glyco, atropine)
  • Prematurity
  • Fetal dysrrhythmias
  • Anencephaly
    May all present with what significant finding in FHR?
A
  • Decreased variability
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19
Q

What is indicative of a sinusoidal pattern in FHR?

A
  • FETAL DEPRESSION
  • Hypoxia
  • Drugs
  • Anemia
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20
Q

This FHR finding is defined as increases of 15 beats/min or more lasting than 15 seconds

A
  • Accelerations

- Reflect normal oxygenation and usually r/t to fetal movement and uterine pressure

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21
Q
  • Fetal sleep
  • Drugs (opioids, Mg+, Atropine)
  • Hypoxia
  • Are all factors that have what effect on FHR?
A
  • Decrease accelerations

- Normal fetuses have 15-40 accelerations per hour

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22
Q

The absence of baseline variability AND accelerations indicates what?

A
  • NONREASSURING FETAL HEART PATTERNS AND MAY BE A SIGN OF FETAL COMPROMISE
  • VERY IMPORTANT!
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23
Q

What may be an absence of variability indicate?

A
  • Neurological deficit
24
Q

What deceleration pattern is thought to be a response to fetal head compression or stretching of the neck during uterine contractions and is generally not associated with distress

A
  • Early decelerations
25
Q

What deceleration pattern occurs at the peak or following a uterine contraction and is associated with fetal compromise and uteroplacental insufficiency?

A
  • Late Decelerations
26
Q

What deceleration pattern is thought to be from chord compression and intermittent decreases in uterine blood flow and is the most common type of deceleration?

A
  • Variable decelerations
27
Q

What deceleration pattern is associated with fetal asphyxia when above 60 bpm, lasts longer than 60 sec. or occurs in a pattern that lasts longer than 30 min.?

A
  • Prolonged decelerations
  • EMERGENCY
  • May indicate a chord prolapse
28
Q

With a fetal scalp pH what does a pH of <7.20 indicate? >7.20?

A
  • Depressed neonate (more acidotic)

- Vigorous neonate

29
Q
  • What is the normal breathing rate of the newborn?
  • What is the normal heart rate of the newborn?
  • BP’s?
A
  • 30-60 breaths/minute (begins 30 sec. after birth and is sustained within 90 sec.)
  • 120-160
  • 50/25 for neonates 1-2 kg.
  • 70/40 for neonates >3 kg
30
Q

What does APGAR stand for and what is it measuring?

A
  • Appearance (blue, pink, acrocyanotic)
  • Pulse (absent, <100, >100)
  • Grimace (floppy, minimal stimulation response, prompt stimulation response)
  • Activity (absent, flexed arms, active)
  • Respiration (none, slow and irregular, vigorous cry)
31
Q

What are the four factors that put the neonate at risk for persistent fetal circulation? What do these factors effect that makes the neonate revert to persistent fetal circulation?

A
  • Acidosis
  • Hypoxia
  • Hypovolemia
  • Hypothermia
  • Increased PVR
32
Q

What are the factors that make the neonate born by C/S at risk for persistent fetal circulation?

A
  • 2/3 of fetal lung fluid is expelled during vaginal delivery
  • Increased residual lung fluid
33
Q
  • Release of surfactant
  • Flow to vital organs
  • Thermoregulation
  • Are all important for what important process to fetal transition?
A
  • Catecholamine surge
34
Q

What are the ways in which a wet baby can lose heat?

A
  • Conduction
  • Convection
  • Evaporation (most heat loss AT birth)
  • Radiation (most heat loss AFTER birth)
35
Q

When are APGAR scores taken?

A
  • 1 and 5 minutes after birth
36
Q

What does an APGAR score of 5-7 indicate?

A
  • Mild asphyxiation (100% 02 blow across the face)
37
Q

What does an APGAR score of 3-4 indicate?

A
  • Moderate asphyxiation (temporary assisted positive pressure ventilation w/ bag/mask)
38
Q

What does an APGAR score of 0-2 indicate?

A
  • Severe depression (immediate intubation and chest compressions may be required)
39
Q

When analyzing umbilical cord gas and pH, what is worse, metabolic or respiratory acidosis?

A
  • Metabolic acidosis is a more ominous sign than respiratory acidosis
40
Q

What interventions are necessary if the infant is having respiratory depression caused by opioids administered to mom?

A
  • Nalaxone 0.1mg/kg, IV, ET, IO, SQ

- Caution for acute withdrawal in infants of addicted mothers

41
Q

When neonatal resuscitation is necessary, bag/mask PPV is attempted unsuccessfully, what is important to perform after intubation w/ and ETT?

A
  • Resume PPV w/ 100% 02 until infant is stable

- REDUCE FI02 AS SOON AS POSSIBLE

42
Q

When are chest compressions indicated during neonatal resuscitation?

A
  • When HR < 60 bpm
  • Ventilation ratio is 3:1, the rate is 90 per minute
  • Stop compressions when HR > 60 bpm
  • Continue ventilations until HR > 100 bpm
43
Q

How is fluid resuscitation of the neonate done?

A
  • With NS or LR at 10 mL/kg over 5-10 min.
44
Q

What are the two drugs that need to be available during neonatal resuscitation?

A
  • Epinephrine

- Sodium bicarbonate

45
Q

What is the neonatal drug of choice for treating bradycardia?

A
  • Epinephrine
  • 0.01-0.03 mg/kg (0.1mg-0.3 mL/kg of 1:10,000 solution)
  • Used if HR < 60 bpm after ventilation and chest compressions
  • q 3-5 minutes
46
Q

What medication is given after prolonged neonatal resuscitation, after it is determined the neonate is acidotic, 1-2mEQ/kg of a 0.5 mEQ/mL solution

A
  • Sodium bicarbonate
47
Q

What is associated with a release of thick meconium into the amniotic fluid, especially after 42 weeks of gestation?

A
  • Fetal distress
  • Happens in 10-12% of deliveries
  • Neonatal gasping can cause meconium to enter the lungs (can develop into severe respiratory distress in 15% of cases, and/or persistent fetal circulation)
48
Q
  • Amnioinfusion prior to delivery
  • Bulb suctioning of thin, watery contents
  • Intubation and tracheal suctioning
  • Are all treatments for what complication of delivery of the fetus?
A
  • Meconium stained neonates
49
Q
  • Hypotension (w/ persistent fetal circulation)
  • Hypotonicity
  • Peripheral dilation
  • Are all S/S of what postpartum complication
A
  • Magnesium toxicity
  • Consider intubation and mechanical ventilation
  • Occurs when mothers have been administered high doses of Mg+
  • Mg+ will decrease over 24-72 hours
  • Antidote: Ca++
50
Q

What is the most common metabolic problem in neonates?

A
  • Hypoglycemia

- Will cause neurologic damage if not treated

51
Q

After 3 days of life, what are the normal blood glucose levels?

A
  • 75-90 mg/dL

- < 45 mg/dL considered hypoglycemic in first 3 days of life

52
Q
  • Lethargy
  • Apnea
  • Cyanosis
  • Seizures
  • Hypotonia
  • Are all S/S of what metabolic disorder of the neonate?
A
  • Hypoglycemia
53
Q

What are the common causes of hypoglycemia in the neonate?

A
  • Hypoxemia
  • Sepsis
  • High levels of circulating insulin
54
Q

What is a unique consideration in blood cell product administration of the neonate?

A
  • Products need to be irradiated to reduce the risk of transfusion-associated GVHD
55
Q

What is a consequence of neonates having more type II (fast twitch) and less type I (slow twitch) in the first 28 days of life?

A
  • Neonates experience respiratory distress faster

Neonate (3 decks)

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