Neonatal Adaptation

Question 1

what is meconium?

Answer 1

dark green substance forming the first faeces of a newborn infant

Question 2

what happens in meconium aspiration?

Answer 2

blocks with airway passages and causes an inflammatory response

Question 3

name the functions of the placenta

Answer 3

fetal homeostasis 
gas exchange 
nutrient transport to fetus 
waste transport from the foetus 
acid base balance 
hormone production 
transport of IgG

Question 4

3 shunts in the fatal circulation

Answer 4

ductus venosus
foramen ovale
ductus arteriolus

Question 5

how much of the blood goes to the lungs?

Answer 5

7%

Question 6

why does the blood need to be oxygenated by the mother?

Answer 6

lungs haven’t expanded yet and are full of fluid

Question 7

where is the ductus venous and what does it do?

Answer 7

before the liver and transports oxygenated blood to the foetus

Question 8

where is the foramen ovale?

Answer 8

between the right and left atrium so that blood can pass through

Question 9

what is the role of the ductus arteriosus?

Answer 9

takes the blood from the ventricles into the aorta so that it doesn’t all go to the lungs

Question 10

what is more hypoxic foetus or baby?

Answer 10

foetus

Question 11

what is the role of the blood going to the lungs?

Answer 11

perfusion rather than oxygenation

Question 12

what is produced in the 3rd trimester?

Answer 12

surfactant

Question 13

what accumulates before birth?

Answer 13

glycogen in liver, muscle and the heart

brown fat between scapulae and around internal organs

Question 14

what is swallowed and inhaled before birth?

Answer 14

amniotic fluid to fill the lungs and help them grow

Question 15

which hormone is increased in the onset of labour?

Answer 15

catecholamines

Question 16

what stops being synthesised on the onset of labour?

Answer 16

lung fluid

Question 17

what does vaginal delivery do to help the lungs?

Answer 17

squeezes lungs to remove some fluid but the rest is removed by crying

Question 18

is cord clamping delayed or immediate?

Answer 18

delayed

Question 19

what happens to the pulmonary and systemic vascular resistances in transition?

Answer 19

pulmonary drops

systemic rises

Question 20

what happens to the oxygen tension in transition?

Answer 20

rises

Question 21

circulating prostaglandins increase in transition. T/F

Answer 21

false they drop

Question 22

what happens to the ducts and foramen ovale in transition?

Answer 22

ducts constrict

foramen ovale closes

Question 23

what contributes to the duct constriction?

Answer 23

increase in o2 sats
decrease in blood flow
decrease in prostaglandins

Question 24

fate of the foramen ovale

Answer 24

closes or persists

Question 25

fate of the foramen ovale

Answer 25

closes or persists as PFO in 10%

Question 26

fate of the ductus arteriosus

Answer 26

becomes ligamentum arteriosus

can remain persistent but uncommon

Question 27

fate of the ductus venosus

Answer 27

becomes ligamentum teres

Question 28

what causes PPH?

Answer 28

poor transition eg solid lungs, no surfactant

Question 29

what is the result of PPH?

Answer 29

shunts from foetal life remain so can be life threatening

Question 30

how is PPH diagnosed?

Answer 30

pre and post ductal sat monitoring right hand and left foot - more than 3% difference

Question 31

management of PPH

Answer 31

ventilate 
O2
nitric oxide 
sedation 
inotropes 
ECMO (ECLS)

Question 32

how is transient tachypnoea diagnosed?

Answer 32

diagnosis of exclusion

baby is breathing faster, can be grunty and can develop an infection

Question 33

what causes transient tachypnoea?

Answer 33

lack of lung squeezing and baby is taking longer to absorb fluid

Question 34

treatment of transient tachypnoea

Answer 34

generally resolves itself

Question 35

3 most important factors in the first few hours

Answer 35

thermoregulation
glucose homeostasis
nutrition

Question 36

what causes babies to get cold easier?

Answer 36

large surface area
wet when born
no shivering

Question 37

what is the main source of heat production?

Answer 37

non-shivering thermogenesis

- heat produced by breakdown of brown adipose tissue in response to catecholamines

Question 38

issue with non-shivering thermogenesis

Answer 38

not effective in first 12 hours

Question 39

main ways to keep newborn babies warm

Answer 39

dry 
hat
skin to skin 
blanket/clothes 
heated mattress 
incubator

Question 40

how is glucose homeostasis maintained after supply from placenta stops?

Answer 40

drop in insulin, increase in glycogen
mobilisation of hepatic glycogen stores for gluconeogensis
ability to use ketones as brain fuel

Question 41

what reflex does breastfeeding stimulate?

Answer 41

rooting and suck which causes a feedback loop to increase the supply

Question 42

composition changes in breast milk

Answer 42

colostrum -> fore milk and hind milk

Question 43

how much weight do babies lose from their birth weight/?

Answer 43

10%

Question 44

key with weight in babies

Answer 44

as long as they are following a centile and not crossing

Question 45

where does haematopoiesis move to?

Answer 45

bone marrow

Question 46

why do babies have physiological anaemia?

Answer 46

adult Hb synthesised more slowly than fetal Hb broken down

Question 47

what causes physiological jaundice in babies?

Answer 47

breakdown of fetal haemoglobin
conjugating pathways immature
risk in circulating unconjugated haemoglobin

Question 48

why is prolonged jaundice dangerous?

Answer 48

unconjugated bilirubin can cross the BBB

Question 49

how is prolonged jaundice treated?

Answer 49

phototherapy or blood transfusion

Question 50

babies at risk

Answer 50

hypoxia/asphyxia
particularly small or large babies 
premature babies 
some maternal illnesses and medications 
ill babies