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Bioscience Complications > Neonatal Pathophysiology > Flashcards

Neonatal Pathophysiology Flashcards

1
Q

Respiratory Dysfunction

A

conditions that interfere with normal O2 and lung airation/expansion

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2
Q

Neonatal asphyxia (chemical)

A

Dec O2 and inc CO2 = accumulation of H+ = respiratory acidosis

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3
Q

Respiratory Acidosis

A

Accumulation of H+ caused by dec O2 and inc CO2

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4
Q

Neonatal asphyxia (anatomical)

A

Pulmonary blood vessels don’t open maintaining high PVR > persistant foetal circulation

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5
Q

Metabolic Acidosis

A

Body cells do not receive O2 > anaerobic metabolism occurs > increased lactic acid production > metabolic acidosis

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6
Q

Neonatal asphyxia steps (8)

A
  • Respiratory Acidosis
  • Persistant foetal circulation
  • Metabolic acidosis
  • Stress Response
  • Hypoglycaemia
  • Dec CO and Sufactant (Acidosis)
  • Shock
  • Cardiac Failure
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7
Q

neonatal asphyxia causes (5)

A
  • Intrauterine asphyxia
  • Respiratory distress syndrom/prematurity
  • Maternal medicines that inhibit respiration
  • Cardiorespiratory malformations/dysfunctions
  • Airway obstruction
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8
Q

Respiratory distress syndrome process

A
  • Small alveolar = reduced surface area + harder to inflate
  • Lack of surfactant = inc surface tension = harder to breath
  • Poor ventilation > ventilation/perfusion mismatch = body responds by maintaining high PVR
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9
Q

Transient Tachypnoea

A
  • Retained fluid in lungs > insufficient clearance
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10
Q

Transient tachypnoea aetology (5)

A
  • Sufactant immaturity
  • Cesarean section
  • Breech Delivery
  • Birth Asphyxia
  • Heavy maternal analgesia
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11
Q

Pneumothorax

A

Injury to pleural membranes allowing air to leak in to pleural space
Affected lung collapes: displaces position (and therefore functioning) of heart

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12
Q

Meconium Aspiration

A
  • Passed before birth and inhaled in first gasping breaths
  • Obstructed airway > no lung airation > pneumothorax or pneumonia possible
  • Increased in 40+ neonates, breech, foetal stress
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13
Q

Pneumonia

A

Infection of respiratory system at before/during birth

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14
Q

Pneumonia risk factors

A

PROM
Chorioamnionitis
Low birth weight

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15
Q

Respiratory distress manifestations

A 
Tachypnoea
Dyspnoea ( Recession of chest wall, nasal flaring)
Grunting
Cyanosis
Bradycardia
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16
Q

Congenital heart defects

A
  • Anatomical anomaly > abnormal blood flow
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17
Q

Patent ductus areteriosos physiology

A
  • May remain open for days/weeks
  • Allows L>R shunting > inc pulmonary blood flow > pulmonary hypertension > cardiac failure
  • in some cases bacterial endocarditis
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18
Q

Patent ductus arteriosis manifestations

A
  • Tachypnoea
  • Dysapnoea
  • lethargy
  • failure-to-thrive
  • murmurs
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19
Q

Ventricular septal defects definition

A

Defect within interventricular septum causing incomplete separation (smaller defects asymptomatic and likely to close)

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20
Q

Ventricular septal defects effects

A

L > R shunting > inc pulmonary blood flow > pulmonary hypertension
Hypertrophy of ventricles

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21
Q

Ventricular septal defects manifestations

A
  • Tachypnoea
  • Dyspnoea
  • FTT tachycardia
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22
Q

Atrial septal defects definition

A

incomplete septum of atria, may extend to ventricular septum and/or cuspoid valves

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23
Q

atrial septal effects physiology

A

L>R shunt that may:
inc pulmonary blood flow > inc pulmonarly hypertension > hypertophy/dilation of R ventricle
Cardiac failure

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24
Q

Atrial septal defect manifestations

A

Tachypnoea
Murmors
Mild cyanosis

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25
Q

Transposition of great arteries definition

A

Aorta arises from R ventricle and pulmonary trunk from L ventricle = 2 closed system that dont feed in to each other. initial survival dependant on foetal circulation

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26
Q

Transposition of great arteries manifestations

A

Cyanosis that is not relived by O2 therapy

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27
Q

Total anomalous pulmonary veins definition

A

pulmonary veins not connected to LA
O2 blood returned to RA
initial survival dependant on foetal cirulations

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28
Q

total anomalous pulmonary veins manifestations

A

cyanosis
dyspnoea
tachypnoea

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29
Q

Teratology of fallot (4)

A
  • Large ventricular septal defect
  • Overriding aorta (opens at ventricular defect and overrides RV)
  • pulmonary stenosis
  • RV hypertrophy
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30
Q

tetralogy of fallot implications

A

decreased O2 sats

  • dec blood flow to pulmonary trunk (R>L shunt)
  • dec return to LA
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31
Q

tetralogy of fallot manifestations

A

cyanosis
polycythaemia (inc haematocrit)
dyspnoea
hypoxic spells

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32
Q

Vitamin K deficiency definition

A

Normal in healthy neonate. decreased bacteria in gut that synthesise VitK. Intensifies in days following birth

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33
Q

Haemorrhagic disease of newborn

A
  • Early: within 24h. association with maternal medicines
  • Classic: 2-6d when VitK at lowest levels. decreased prothrombin activity and prolonged clotting times
  • Late 2-12w. associated with hepatobiliary and GI disorders
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34
Q

Polycynthaemia definition

A
  • Haematocrit >65%
  • Inc erythropoises stimulated by:
    • Intrauterine hypoxia
    • Maternal hypertension/diabetes
    • Genetic abnormalities
    • Increased BV = Twin-twin transfusion
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35
Q

Polycynthaemia manifestations

A
  • Asymptomatic
  • Hypoglycaemia
  • Hyperbilirubinaemia
  • Lethargy
  • Respiratory Distress
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36
Q

Anaemia definition

A

“Physiological Anaemia” normal after birht Hbf destruction.

37
Q

“anaemia of prematurity”

A

lower levels of Hbf at birth

38
Q

Pathological anaemia

A
  • not associated with physiological/prem anaemia
  • Rhesus or ABO incompatibility (“haematolotic anaemia”)
  • Blood loss
  • needs iron supplementation
39
Q

Body fliud imbalances

A

Immaturity of renal system = neonate is suseptable to over-hydration and dehydration and hyponatraemia

40
Q

Overhydration

A
  • Low GFR > inc risk of overhydration

- risk highest in first 5 days

41
Q

Dehydration

A
  • limited ability to concentrate urine
  • vomiting
  • diarrhoea
  • oedema
42
Q

Hyponatremia definition

A
  • Sodium deficiency (dilutional hyponatremia = water gain diluting Na+)
  • Extracellular fluid becomes hypotonic > water movement (ECF >ICF) > increase in cell size
  • brain cells effected most
43
Q

Talipes definition

A

Congenital deformity in foot: developed at unusual angle

44
Q

Talipes causes

A
  • Chromosomal

- Positional

45
Q

Developmental dysplasia of the hip

A

hip joint is dislocated or dislocatable or subluxed

46
Q

developmental dysplasia of the hip causes

A
  • Chromosomal
  • hormonal
  • positional
47
Q

Neural tube defect clasifications

A
  • Aencephaly
  • Encephalocele
  • Spina bifida
48
Q

Anencephaly definition

A

no development of cranium and brain. failure of cranial and end of NT to close

49
Q

Encephalocele definition

A

Extrusion of brain and meninges through scull, canual or facial bones fail to form

50
Q

Spina Bifida definition

A

possible extrusion of meninges and spinal cord through vertebral column. Failure of vertebral arch to form/fuse usually in lumbar

51
Q

Spina bifida occulta

A

failure of vertebral arch to form but no protusion of neurological structures.

52
Q

Spina bifida Meningocele

A

protrusion of meninges only through vertebral column

53
Q

Spina bifida myelomeningocele

A

protrusion of menenges and spinal cord through vertebral column

54
Q

Hydrocephalus physiology

A
  • blockage of CSF flow or defect in reabsorption of CSF in cranial cavity > Excess cranial volume of cerebrospinal fluid > expansion of the head > decreas in blood volume
55
Q

hydrocephalus manifestation

A

expansion of head

56
Q

increased crandial pressure implications

A
  • Obstruct cerebra blood flow
  • destroy brain cells
  • displace brain cells
  • damage brain structures
57
Q

Dysfunctio of metabolism

A

Abnormal metabolism of any substance absorbed from the diet and/or excreted

58
Q

Jaundice

A

Yellow discouloration of skin, sclera and mucous membranes due to deposition of bilurubin

59
Q

Physiological jaundice causes

A

immaturity of neonatal liver and GI system (inc breastmilk and premature jaundice)

60
Q

Pathological jaundice

A
  • RBC incompatibility
  • Bruising and Haematomas
  • Polycynthaemia
  • Infections
  • Congenital hypothyroidism
  • G6PD deficiency
61
Q

Metabolism of bilirubin

A

heme pigment of haemoglobin > biliverdin > unconjugated bilirubin (lipid soluble) > conjugated in liver > gut > excretion

62
Q

Hyperbilirubinaemia

A

Excess of bilirubin in blood > deposited in fatty tissue Unconjigated bilirubin bassess BBB

63
Q

Hyperbilirubinaemia causes (3)

A
  • Saturation of molecules that transport bilirubin
  • Decreased excretion/inc reabsorption
  • Increased production
64
Q

physiological jaundice

A
  • day 2-5

- sufficient feeding and bowel movements and hydration it will pass (liver catches up)

65
Q

Breastmilk jaundice

A

factors in breastmilk that increase reabsorption of bilirubin

66
Q

Pathological jaundice causes

A
  • Haemolytic jaundice: ABO incompatibility and Rhesus immunisation
  • Devoping in first 24h
  • Potentially dangerous > inc risk of neurotoxicity
67
Q

Hypoglycaemia

A

BGL <2.6mmol/L
Common problem in transition to neonate
Stored as glycogen and lipids, used readily for energy following removal of maternal supply

68
Q

Hypoglycaemic manifestations

A
  • Jittery
  • irratibility
  • high pitched cry
  • lethargy
  • Apnoea
  • Seizures
69
Q

Hypoglycaemia risk factors

A
  • Poor feeding
  • SGA/IUGR
  • Maternal obesity
  • Maternal diabetes
  • Hypothermia
  • Asphyxia
70
Q

Hypoglycaemia treatment

A

FEEDING ASAP & REGULARLY
BGL measurements
Consultation

71
Q

Phenylketonuria (PKU)

A

PKU present from incomplete breakdown of phenylalanine - RARE METABOLIC DISORDER
phenylalanine accumulates and is deposited in tissues by blood and can lead to mental retardation , microcephaly and delayed neural development

72
Q

Hypospadias

A

Proximal opening of urethra on penis

73
Q

undecended testes

A

usually occurs in 3rd trimester.
willeventually affect sperm production
surgery req’d

74
Q

Hyperthyroidism

A

thyroid gland enlarged > may make NVB difficult. usually transient

75
Q

hyperthyroidism manifestations

A

increased BMR =

  • tachycardia
  • irritability
  • low birth weight
  • hunger
  • advanced bone age
76
Q

Hypothyroidism

A

most commonly caused by dysgenesis of thyroid gland

maternal production will compensate to a degree in utero, symptoms presenting later

77
Q

Congenital adrenal hyperplasia

A

Defect in cortisol synthesis > inc levels of ACTH > adrenal hyperplasia > overproducion of cortisoid precursers

78
Q

Cleft lip/palete

A

occur due to failure of fusion during early embryological development due to
nasomedial processes withmaxillary process
palatal shelves
chromosomal and teratogenic link

79
Q

Oesophageal atresia

A

proximal and distal of oesophagus are not connected (piece missing)

80
Q

Exomphalos

A

protrusion of abdominal contents within sac of amniotic membrane/pentoneum through umbilicus.
Associated with heart and kidney problems

81
Q

Gastroschisis

A

protrusion of abdominal contents without any sac thruogh abdominal wall

82
Q

Caput

A

oedema and bruising of soft tissue of presenting part resolves in a few days

83
Q

Chignon

A

oedema, bruising and skin damage following vacuum extraction resolves in a few days

84
Q

Cephalohaematoma

A

bleeding below periosteum confined within margins of sutures. worse at day 2, resolves over several weeks. may exacerbate jaundice

85
Q

Forcep marks

A

heal rapidly

86
Q

Skull fracture

A

usually perietal bone. may req surgery

87
Q

fractured clavical

A

SD and breech. surgery may be req’d

88
Q

Facial palsy

A

damage to nerves of brachial plexus due to traction on neck or arm. Erbs palsy (arm) and Klumpke’s palsy (wrist)

Bioscience Complications (6 decks)

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