Introduction to Neonatology Flashcards

1
Q

The development of CVS:

Begins to develop toward the end of the _____ week

Heart starts to beat at the beginning of the ______ week

The critical period of heart development is from day 20 to day 50 after fertilization

—

A

third

fourth

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2
Q

describe foetal circulation?

A
  • Oxygenated blood via umbilical vein – Ductus Venosus
  • Some blood via Foramen Ovale to Left Atrium – Left Ventricle – Aorta (Ao)
  • Some of blood to Right Ventricle – Pulmonary Artery (PA) - Patent Ductus Arteriosus (PDA) from PA to Ao
  • Saturation SaO2 in foetal body is 60-70%
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3
Q

what is the function of Ductus Arteriosus?

A

Protects lungs against circulatory overload

Allows the right ventricle to strengthen

Carries low oxygen saturated blood

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4
Q

Ductus Venosus:

  • Foetal blood vessel connecting the umbilical vein to the ___
  • Blood flow regulated via sphincter
  • Carries mostly _________ blood
A

IVC

oxygenated

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5
Q

what happens after the first breath of a baby is taken?

A

Fluid leaves lungs

Oxygen most potent vasodilator

Drop of pulmonary pressure

Circulation of heart significantly changes

Duct doesn’t necessary close immediately

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6
Q

what are the Normal vital signs of Full Term newborn?

A

Breathing/respiratory rate:

  • 30-60 /min
  • Periodical breathing

Heart rate:

Normal Heart rate - 120-160 b/min

—Tachycardia - >160 b/min

—Bardycardia - < 100 b/min

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7
Q

how is thermoregulation done in newborns?

A

Maternal thermoregulation in the womb.

Newborn babies lack shivering thermo genesis thus need a metabolic production of the heat.

Brown fat well innervated by sympathetic neurons.

Cold stress leads to lipolysis and heat production.

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8
Q

how is heat lost in newborns?

A

—Radiation: Heat dissipated to colder objects

—Convection: Heat loss by moving air

—Evaporation: We are born in the water

—Conduction: Heat loss to surface on which baby lies

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9
Q

who gets Physiological jaundice?

A

Appears on Day of life (DOL) 2-3

Disappears within 7-10 DOL in term infants and up to 21 DOL in premature infants

Up to 60% terms and 80% premature babies develop visible jaundice

6% terms up to 220 mcmol/L

10% breast fed jaundice at 30 DOL

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10
Q

Physiological jaundice:

75% bilirubin comes from haemoglobin

Metabolised, conjugated in liver

Bilirubin is lipid soluble thus crosses haemato-encephalic barrier

At high concentrations it cause an irreversible changes in the brain - what is this called?

how is physiological jaundice treated?

A

kernicterus

Blue light converts bilirubin to water soluble form and increases oxidation of bilirubin.

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11
Q

what is Fluid balance like in term newborn?

A

Full term infant is able to maintain fluid / electrolyte balance

Weight loss up to 10% is normal

—Loss is due to: Shift of interstitial fluid to intravascular, Diuresis

It is normal not to pass urine for the first 24 hrs!

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12
Q

what is Fluid balance like in premature infants?

A

Less fat in body composition

Increased loss through kidney: Slower GFR, Reduced Na reabsorption, Decreased ability to concentrate or dilute urine

Increased Insensible Water Loss (IWL): Via immature skin and breathing, Physiological IWL is 20-40 ml/kg/day but could be up to 82 ml/kg/day in 750-1000 g, (IWL can lead to sever dehydration of the babies)

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13
Q

what causes Anaemia of prematurity?

A

Reduced erythropoesis

Infection

Blood letting – most important cause!

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14
Q

Summary:

Full term newborn is prepared for extra-uterine life

Premature infants require lots of help and support (trying to mimic conditions they have in the womb and not always easy to do)

A
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