Fetal/Pregnancy Stuff - TEST 1 Flashcards
What completes fetal circulation and transitions it to newborn circulation?
Closure of PFO, PDA, and ductus venosus
Fetal breaths start around what week?
11th week
First breath occurs around what time and establishes what?
9 seconds; FRC
What is the major physiological stimulus for the release of lung surfactant into the alveoli?
Lung inflation
When is surfactant produced and sufficient?
Produced: 20 weeks
Sufficient: 34-38 weeks
What important role does catecholamine release have?
1) production and release of surfactant
2) transition to active Na+ transport for absorption of lung fluid
3) mediates blood flow to organs during stressful times
4) thermoregulation in neonate
How do neonates thermoregulate?
Raise metabolic rate and release NE in the cold - oxidization of brown fat
Oxidation of brown fat results in…
Non-shivering thermogenesis - major mechanism for neonate heat regulation (increased O2 consumption)
Preterm babies less than 28 weeks need to be wrapped in what?
Polythene wraps and place under warmer to minimize heat loss
What increases chances of needing resuscitation of the newborn?
Neonatal insults, congenital anomalies (diaphragmatic hernia, TE fistula, CNS/cardiac malformations), and preterm deliveries
What does APGAR stand for and what is a normal score?
Appearance Pulse Grimace Activity Respirations (Normal score is 9-10)
Normal neonatal respiratory rate?
30-60 breaths per minute and should begin within 30 seconds and be regular by 90 seconds
When is aggressive tactile stimulation needed?
In the apneic neonate if tactile stimulation does not result in the initiation of spontaneous breathing
Does suctioning amniotic fluid decrease the chances of MAS?
No
What is an EXIT procedure?
Delivering head of baby and keeping body in uterus. This allows the fetus to receive oxygenation and nutrients while establishing an airway.
What is CHAOS?
Congenital High Airway Obstruction Syndrome
What three major events appear critical to the establishment of functional synapses?
Neuronal proliferation, migration, and cellular differentiation - these occur in a pre-ordained fashion to establish early neural circuitry.
Maternal administration of ______ before early preterm birth reduces the risk of _______ in surviving infants.
Magnesium sulfate; cerebral palsy
Main brain mediators in fetal brain development are?
GABA and Glutamate
When does neurogenesis start and peak?
5 weeks; 25 weeks
Neuronal migration is completed between _____ and _____ weeks gestation.
30; 36
When does baby have all neuronal pathways to perceive pain?
24 weeks gestation
GABA has an ______ action in the mature brain and an ______ role in the fetal brain.
Inhibitory; Excitatory
NMDA receptors originate ____ than GABA receptors and remain functionally ____ .
Later; silent
They play a limited role in early brain development due to magnesium ion-induced channel blockade.
Is BBB morphologically well developed and functionally complete at term? When is the BBB fully established?
Yes; unknown exact time, but approximately the late second and early third trimesters
What are the only types of cerebral palsy associated with intrapartum hypoxia?
Spastic quadriplegia and dyskinesia (less common)
What is always accompanied by neonatal encephalopathy and seizures?
Intrapartum hypoxia that is sufficient enough to cause cerebral palsy
What is “likely” associated with chorioamnionitis?
Fever, maternal/fetal tachycardia, foul-smelling amniotic fluid, uterine tenderness, and maternal leukocytosis - diagnosis remains unproven until confirmed by placental culture or histologic examination
Epidural associated pyrexia remains unclear but appears to be _____ in nature?
Inflammatory
Unlike the adult brain, the fetal brain can use _______ and _____ as alternative energy sources.
Ketone bodies; lactate
What would be a reason a baby would want to conserve energy?
To restrict the use of energy during chronic hypoxemia to maintain essential cellular processes. This can lead to decreased somatic growth and fetal growth restriction.
How does the fetus conserve additional energy?
Decreased breathing and gross body movements
Fetal cerebral responses to asphyxia include?
- increased O2 extraction
- use of additional energy sources
- decreased growth
- altered behavioral state
- redistribution of cerebral blood flow
Whats the difference in opioid administration in OB vs standard surgery?
OB = lower concentration for longer duration
- long term effects of opioids on neurodevelopment are unclear
Direct effect example of medications with pregnancy?
Fetus
Indirect effect example of medications with pregnancy?
Placenta/uterine function - eventually effects fetus
Most common medications taken during pregnancy?
Antiemetics, antibiotics, and analgesics
Medications taken by 10% of pregnant women that have long-term effects on CNS?
Antipsychotics, antidepressants, and anticonvulsants
What are some common concerns with medications during pregnancy?
TERATOGENICITY, fetal loss, growth restrictions, congenital malformations, and preterm labor
What medication is metabolized rapidly by mothers and can cause CNS depression and death to fetus?
Codeine - converts to morphine and can be transferred to newborn via breast milk
