Fetal and Neonatal Physio Cobine Flashcards
1
Q
HOw big is the baby during the first few weeks of life?
A
microscopic
2
Q
How long does the babies weight remain minuscule?
A
for 12 weeks (then begins to grow)
3
Q
When do we have the most weight gain in the growth of the baby?
A
last 2 months (2lbs pre month)
4
Q
How do embryos grow in length?
A
steadily throughout gestation
5
Q
What is considered the critical period of embryonic development?
A
the first trimester
6
Q
When do organ systems form?
A
within the 2nd and 3rd month and are complete at 4th month (organs will looks the same as they will at birth from this point on)
7
Q
How does cellular development progress?
A
continues during rest of gestational period
8
Q
What systems are not fully developed at birth?
A
nervous system, kidneys, and liver
9
Q
During the first 2 weeks of fetal development, what should you be worried about?
A
abortion
10
Q
During the embryonic period (week 3 - week 8), what should you be worried about?
A
severe morphological anomalies
11
Q
During the fetal period, week 9 and on, what should you be worried about?
A
functional defects and minor morphological anomalies
12
Q
When does the heart start beating and how fast does the heart beat?
A
26 days (65 beast/minute) heart rate increase with growth to 140 beats/minutes just before delivery
13
Q
When and how does the fetus create NUCLEATED RBCs?
A
yolk sac and mesothelial layer of the placenta make these at the 3rd week of development
14
Q
When and how does the fetus create NON-Nucleated RBCs?
A
form in liver and spleen at 4-6 weeks
15
Q
When and how does the fetus create red and white blood cells?
A
from bone marrow in the 3rd or 4th month
16
Q
After birth where does the fetus get its blood cells?
A
just from the bone marrrow
17
Q
Overall, explain how the progression of fetal blood
A
Yolk sac-> liver-> spleen-> bone marrow
young liver synthesizes blood
18
Q
When do respiratory movement take place in embryonic development?
A
during 1st trimester
19
Q
What is inhibited during the last three months of embryonic development?
A
respiratory movements
20
Q
What is the point of the suppression of respiratory movements in the fetus in the last 3 to 4 months of embryonic development?
A
to prevent debris from meconium (the dark green substance forming the first feces of a newborn infant) from entering the lungs
21
Q
Why are their fluids secreted by the alveolar epithelium in embryological development?
A
to keep airways clean
22
Q
Explain the development of the nervous system
A
3-4 months skin reflexes develop
1 yr -> myelinization of major tract of nervous system
Increasing brain mass -> 26% at birth-> 55% 1 year-> 80% at 2 years
23
Q
Most of the higher function of the (blank) are underdeveloped at birth.
A
cerebral cortex
24
Q
After (blank) months of gestation, fetus ingests and absorbs large quantities of amniotic fluid
A
4.5 months
25
During the last (blank), GI function approximates that of a newborn infant.
2-3 months of gestation
26
What is excreted by the fetus after 2-3 months of gestation?
meconium (feces)
27
When do fetal kidneys start developing?
at the 5th week
28
Kidneys begin excreting urine during what period of time?
1st and 2nd trimesters
29
Extracellular fluid electrolyte regulation and acid-base balance only begins after blank) months and isn't fully developed until (blank).
4.5 months
| months after birth
30
Is there a lot of calcium and phosphorous absorption in the fetus?
yes about 23g of Ca and 14g of phosphorus which is mostly absorbed in the last month of gestation.
(i.e calcium total is about 1/50th of the maternal bone content)
31
What does the fetus have the highest and lowest levels of, out of the following three:
phosphorous, iron, calcium?
iron> calcium> phosphorus
32
(blank) accumulates faster than calcium and phophorous
iron
33
Where does most of the fetal iron go?
into hemoglobin (which begins to form at 3 weeks of fetal growth)
34
1/3rd of the iron in a full term fetus is stored in the (blank) for future formation of hemoglobin
liver
35
What vitamins does the fetus utilize and store?
```
B vitamins (B12 and folic acid)
Vitamin C
Vitamin D
Vitamin E
Vitamin K
```
36
What vitamin helps with RBC formation?
B12 and folic acid
37
What vitamin helps with bone matrix and CT fiber formation
Vit C
38
What vitamin helps with bone growth?
Vit D
39
What vitamin helps with maintaining normal development in early embryo?
Vit E (if you dont have this you may have spontaneous abortions)
40
What vitamin helps with the formation of factor VII, prothrombin, an other blood coagulation factors in the liver?
Vitamin K
41
Where does the fetus get vit K and what is the overall function of Vit K?
from the mother (cuz its formed by bacteria in the gut)
| prevents hemorrhage
42
When a baby is born, what is its respiratory rhythm like?
it takes a second for body to recognize the lack of O2 and Low temperature due to the cooled skin and then it is normal
43
What happens if there is not breathing after a few seconds?
the body will have further lack of O2 and increased levels of CO2 which will ususally trigger respiration
44
What do you call delayed or abnormal breathing?
hypoxia
45
What can cause hypoxia of the neonate?
umbilical cord compression, premature placental separation, excessive contraction of the uterus or excessive anesthesia
46
What can hypoxia case?
depression of respiratory center
| lesion development in thalamus, inferior colliculi and other brain stem area which will affect motor function
47
How long can a neonate last without respiration?
10-15 minutes (markedly longer than adults ~4 min)
48
How long does there have to be a lack of oxygen for permanent brain impairment development of the neonate?
8-10 minutes
49
At least (blank) mm Hg negative pressure is required to open the lungs for the first time.
25
50
The first inspirations of a neonate can produce up to (blank) mm Hg negative pressure in the intrapleural space.
60
51
Is the second breath easier or harder than the first breath and when does normal breathing start?
easier
| 40 minutes
52
Describe fetal circulation
lung and liver dont need much blood
placenta needs a lot of blood
umbilical vein carries O2 to ductus venosus (so blood is shunted past liver) into IVC which enters right atrium jumps through foramen ovale into left atrium to left ventricle to the vssels of the head and forelimbs.
The SVC will take blood into right atrium to tricuspid valve to right ventricle into pulomnary artery into ductus arteriosus to descending aorta to umbilical arteries and placenta
53
So explain the path the IVC takes in fetal circulation.
umbilical vein (O2 rich)-> ductus venosus-> right atrium-> formane ovale-> left atrium-> left ventricle-> vessels of head and forelimbs
54
So explain the path the SVC takes in fetal circulation
SVC-> right atrium-> right ventricle-> pulmonary artery-> ductus arteriosus-> descending aorta-> umbilical arteries-> placenta
55
What are the primary changes in pulmonary and systemic vascular resistance at birth?
loss of blood flow to placenta-> increased systemic vascular resistace
increased aortic pressure and increased pressures within left ventricle and left atrium (closes foramen ovale)
pulmonary vascular resistance decreases with expansion of lung
Right ventricular and arterial pressure are also reduced
56
How do you get closure of the ductus arteriosus?
elevated aortic pressure and reduced pulmonary arteries pressure which allows for constriction 1-8 days after brith with complete fibrou closure at 1-4 months
57
How do you get closure of the ductus venosus?
umbilical blood vein flow ceases and you get constriction of ductus venosus w/in 1-3 hours and portal venous pressure increase (0 to 10 mm Hg) enought to force blood through the liver sinuses.
58
What is the total minutre respiration volume and functional residual capacity of a newborn?
2x that of an adult
| 1/2 that of an adult (in relation to body weight)
59
What is the CO of a new born in comparison to an adult?
2x that of an adult
60
What is the average arterial pressure of a new born immediately after birth and over several months after birth?
What are adolescent values?
70/50
90/60
gradullay gets to adolescent values of 115/70
61
What is the RBC count of an infant?
3 X 10^6 /ul
| can increase if umbilical cord blood is stripped into the infant
62
Why does the RBC count decrease after birth?
because the hypoxic stimulus of RBC formation disappeared
63
The white blood cell counts are 45,000/ul at birth, about (blank) that of adult values
5X
64
How is bilirubin excreted by the fetus?
through the placenta
65
SInce the liver is only marginally functional during fetal development, what happens to your bilirubin levels after birth?
they increase from less than 1 to greater than 5 after 3 days of life
66
If your baby has too much bilirubin then what will happen?
it will get milk jaundice due to hyperbilirubinemia
67
How do you get erythroblastosis fetalis?
when RH incompatibility occurs between mother and fetus (i.e fetus is Rh + and fetus is Rh -)
68
Explain how erythrblastosis fetalis causes jaundice in a baby
maternal system recognizes infants RBCs as non self and destroys them with antibodies which releases large quantities of bilirubin into the plasma
69
What three things are newborns are susceptible for?
dehydration, overhydration, acidosis
70
The newborn fluid intake and excretions (blank) that of an adult.
7X
71
T or F
| Slight changes in fluid balance can cause large abnormalities in infants
T
72
Can infants concentrate urine well?
not as well as adults (only 1.5X,, whereas adults 3-4X)
73
Can infants metabolize well?
yes, 2X that of an adult
| so they have 2X the acid formation as well
74
Is the liver functional at birth?
| What are the effects of this?
```
only marginally
Bilrubin levels increase after birth
Reduced plasma protein formation
hypoglycemia
poor formation of blood coagulation factors
```
75
How long do glycogen stores last after birth?
a few hours
76
Do babies have a good amount of gluconeogenesis?
nope, remember their liver isnt functioning fullyy
77
Since babies glycogen stores dont last long, and they arent utilizing gluconeogenesis, what does this mean about their glucose levels? How do they compensate for this?
They fall to about one half of normal
| utilize stored fat and proteins for 2-3 days until mothers milk can be provided
78
Since babies arent making glucose and are utilizing fats and proteins before moms milk comes in AND they are having high body fluid turnover what does this mean for the baby?
they will lose 5-10% of weight after birth until mothers milk supply becomes sufficient
79
```
Relative to older children, newborns have:
low levels of (blank)
Reduced (blank) absorption
Unstable (blank) levels
Good (blank) utilization
```
pancreatic amylase
reduced fat absorption
blood glucose levels
amino acid utilization
80
Since babies have low levels of pancreatic amylase, what does this tell us about their starch utilization?
reduced starch utilization
81
Since babies have reduced fat aborsorption, what does this tell us about high fat milks?
they wont be able to utilize them
82
Since babies have good amino acid utilization, what does this tell us about what they do with protein?
they utilize 90% of AAs to make protein
83
Babies need calcium and Vit D, if they have decreased levels of both of these, this can result in (blank)
sever rickets
84
Babies need iron, if mother has enough iron to provide baby with adequate levels for 3-4 months then good blood cells will form. If not then (blank) will occur.
anemia
85
What happens if babies dont have vit C or enough of it from cows milk?
they need some juice
86
The metabolic rate of the neonate in relation to body weight is (blank) that of the adult (2x CO, 2X respiratory volume)
2X
87
Why is there a rapid drop in body temperature after birth?
More surface area than body mass so therefore more heat escape. This adjusts after a couple of days
88
How does the 6 month old infant have immunity?
from mom, this immunity the mom gives lasts for only 6 months of babies life (protects against diptheria, measles, and polio)
89
So do newborn babies up to 6 months of age need shots for measles, polio, diptheria?
nope!
90
When do infant allergies appear?
when babies start making their own antibodies
91
If females have excess androgenic hormone, what happens?
female children develop with masculinization of the sex organs (hermaphrodism)
92
Excess (blank) or (blank) may cause neonatal breast development and/or milk formation
sex hormone
| prolactin
93
Hyperglycemia in diabetic women will cause (blank) and (Blank) of the islets of langerhans in the fetus.
hypertrophy and hyperfunction
94
What will happen to the adrenal glands of fetuses when their mothers have excess/inadequate hormone levels?
hypo/hyper secretion of adrenal/thyroid glands
95
(blank) in the fetus results in poor bone growth and mental retardation (cretin dwarfism; congenital hypothyroidism)
hypothyroidism
96
What can happen to premies organs?
immature development
97
What will happen to premies lungs?
they may be underdeveloped and result in RDS
98
What will happen to premies GI tract?
poor absorption so cant absorb fat and require high amounts of calcium and vit D
99
Why do premies need to be in an incubator?
they cant regulate body temp so they need to be kept warm
100
How come some premies get hypoproteinemic edema?
cuz they arent getting the nutrition they need
101
Explain why there is a danger of blindness (retinopathy) caused by oxygen therapy in the premature infant
increased O2 results in decreaed amounts new blood vessels. when the O2 stops, the blood vessels grow rapidly and block the vitreous humor which blocks light from the pupil to the retina
102
(blank) occurs in premature infants or those born to diabetic mothers - large quantities of proteinaceous fluid resembling plasma in the alveoli.
RDS (hyaline membrane disease)
103
(blank) is caused by a lack of surfactant secretion
hyaline membrane disease (respiratory distress syndrom)
104
When do type II alveolar epithelial cells begin secreting surfactant?
last 1-3 months of gestation
105
In RDS, (blank) and (blank) often results in these infants.
collapsed alveoli, pulmonary edema
106
What are the risk factors for RDS (hyaline membrane disease) ?
```
male
premature birth
second born twin
perinatal asphyxia
maternal diabetes
L/S ration < 2 (lecthin/sphingomyelin amniotic fluid)
```
107
What are the clinical features of RDS (hyaline membrane disease)?
```
tachypnea (rapid breathing)
nasal flaring
grunting
cyanosis
"ground glass" appearance on chest x ray
```
108
What are the complication of RDS (hyaline membrane disease)?
intrinsic:
pneumothorax, pulmonary emphysema
Oxygen therapy:
bronchopulmonary dysplasia, retinopathy
109
What is the APGAR scoring for Newborns?
assessment of infant's health immediately after birth
110
What are the five criteria that the APGAR score assesses?
```
Activity
Pulse
Grimace
Appearance
Respiration
(APGAR)
```
111
The APGAR score has 5 criteria, and each is evaluated on what kind of scale?
How is the APGAR score assessed?
0-2
then the 5 values are summed to give a score out of 10
A score is given at one minutes and five minutes after birth, if there is a problem an additional score is given at 10 minutes
112
What is considered a normal score?
A score that merits resuscitative measures?
A score that merits immediate resuscitation ?
7-10
4-7
3 and below
113
What is a normal pulse for a neonate?
| What is a pulse that is not very good?
above 100 bpm
| below 100 bpm
114
What is considered a normal grimace?
What is considered not very good grimace?
What is considered bad grimace?
sneeze, cough, pulls away
grimace
grimace (reflex irritability)
115
Tell me what happens each month of life starting at zero?
```
0-> suckles
1-> smiles
2-> vocalizes
3-> head control
4-> hand control
5-> rolls over
6-> sits briefly
7-> crawls
8-> gasps
9-> pulls up
10-> walks w/ support
11-> stands alone
12-> walks alone
```
