NEONATOLOGY Flashcards
Week 3
What is the age requirement to be considered a neonate?
> 24 hours to <30 days of age
What is the age requirement to be considered a newborn?
< 24 hours of age
Where does gas exchange occur?
In the placenta
What is the anatomical structure that connect maternal/fetal circulation?
The placenta
What is Preferential Streaming?
When the cardiovascular system is adapted to ensure the most highly oxygenated blood is delivered to the myocardium and brain
Fill in the blanks:
Oxygenated blood passes via 1 umbilical ____ to the fetus and deoxygenated blood is carried out via 2 umbilical ____ arteries
- vein
- arteries
What is the Ductus Venosus?
A continuation of umbilical vein, which bypasses most of the blood from the liver and connects the umbilical vein to the inferior vena cava
Fill in the blank:
Fetal circulation is described as _____ dependent and location dependent
duct
What is the Foramen Ovale?
A shunt (opening in septum) that allows blood to travel from the right atrium to the left atrium
What is the Ductus Arteriosus?
The artery that joins the pulmonary system directly to the aorta
Fill in the blank:
Most of the fetal blood bypasses the immature liver via the _____ _____ into the inferior vena cava
ductus venosus
Fill in the blank:
Oxygen-rich blood travels into the heart’s right atrium through the _____ _____ to the left atrium
foramen ovale
True or false:
From the left atrium, blood is transferred to the left ventricle into coronary arteries and aorta where oxygenated blood is delivered to the brain as well as some to the kidneys, lungs, etc.
true
True or false:
The superior vena cava brings in deoxygenated blood also into the right atrium, therefore there is a mixing of oxygenated and deoxygenated blood in the right atrium of the fetal heart
true
Fill in the blank:
Some blood in the right atrium will pass into the right ventricle where it will be transferred into the pulmonary artery, but because the alveoli are fluid-filled most of the blood is shunted away from the lungs via the ______ ______ due to the pressure imbalance
ductus arteriosus
Fill in the blank:
Deoxygenated blood enters systemic circulation and is then carried back to the placenta via the ______ ______ where the blood can be oxygenated and the cycle can occur again
umbilical arteries
What are 4 things that occur when a baby takes it’s 1st breath?
- The surface tension that collapsed the alveoli in utero is now broken allowing the opening of the alveoli, and spontaneous oxygenation/respiration
- Pulmonary resistance decreases and the blood flow from the placenta stops
- The pressure on the left side of the heart becomes greater than the right when the fetus is in utero
- Pressure in the aorta, the left side of the heart, increases systemic vascular resistance and pressure changes causes the fetal shunt to close within the 1st few hours of birth
With regards to ventilation, what happens to the baby’s lungs once delivery has happened?
The lungs are filled with the 1st breath, this establishes functional residual capacity within the lungs
What are the 3 major (physiological) systems involved post-delivery?
- Ventilation
- Hemodynamics
- Temperature Regulation
If gas exchange does not occur immediately after birth, (functional residual capacity does is not established), how can it artificially be reproduced?
Through BVM ventilations
True or false: regarding hemodynamics…..
as the pulmonary vascular resistance decreases as the lungs are now functioning blood flow increases, and is able to carry oxygen throughout the body
True
True or false: regarding temperature regulation……
due to large surface area, immature regulation and little fat, neonates are at risk of hypothermia and compensate with vasoconstriction and an increased metabolism
True
When does Meconium Aspiration occur?
When a baby is stressed and gasps while still in the womb, or soon after delivery when taking their first breaths of air
What does Meconium Aspiration cause? What does it lead to?
It causes small airways to become blocked which leads to a baby improperly breathing….this causes respiratory distress to develop
What syndrome is a leading cause of severe illness and death in newborns?
Meconium Aspiration Syndrome
What is Primary Apnea?
The absence of spontaneous respirations after birth; often self-limiting and reversed with minimal resuscitation
What are 3 steps you can take to manage Meconium Aspiration?
- Wipe away excess with a cloth if present around nose or mouth
- If required, gently suction the nose first and then the mouth using a bulb syringe
- If there is copious amounts then turn their head to the side to allow gravity to assist
What complications are important to remember when suctioning?
That rigorous suctioning can cause apnea/bradycardia
What is Secondary Apnea?
Apnea that exceeds 20s
What are 5 possible causes of Secondary Apnea?
- Difficult labor
- Airway obstruction
- Hypoglycemia
- Respiratory muscle weakness
- Narcotics or CNS depressants (DO NOT reverse with Narcan if drug abuse is suspected)
Within the baby, what 4 things can cause hypovolemia?
- Dehydration
- Sepsis
- Hemorrhage
- Trauma
What physical signs would a newborn who is hypo perfused (hypovolemic) present with?
- Mottled, pale, and/or cool skin
- Lethargic
- Poor tone
What can sunken fontanelles indicate? What can bulging fontanelles indicate?
- hypovolemia
- increased ICP
What are 3 risk factors for hypoglycemia within a newborn?
- Apnea
- Preeclampsia/eclampsia
- Smaller babies/twins
What are 5 things newborns experiencing hypoglycemia can present with?
- Seizure(s)
- Pale skin
- Poor tone
- Lethargy
- Apnea
How do you check blood glucose levels in a newborn?
Take blood sugar from their heel
True or false:
Simple Congenital Heart Defects may get better on their own, without surgery
True
How much, and at what rate/interval, glucagon can you administer to a newborn?
You can give 0.5 mg of glucagon every 20 minutes for a maximum of 2 times
What are 3 examples of Simple Congenital Heart Defects
- Atrial and ventricular septal defects
- Patent ductus arteriosus
- Pulmonary stenosis
True or false:
Complex and Critical Congenital Heart Defects may cause life-threatening symptoms that require immediate treatment
True
What is 1 example of a Complex/Critical Congenital Heart Defect
The Tetralogy of Fallot
What is an Atrial Septal Defect?
It is a hole in the wall of the heart between the left and right atria
What does an Atrial Septal Defect cause?
It causes blood to flow from the left atrium and mix with the right atrium, instead of going to the rest of the body
Why is an Atrial Septal Defect considered a simple congenital heart defect?
Because the hole may close on its own as the heart grows during childhood
What is Patent Ductus Arteriosus? What does it cause?
A simple congenital heart defect that occurs when a connection between the heart’s 2 major arteries, the aorta and the pulmonary artery, does not close properly after birth CAUSING an opening through which blood can flow when it should not
What can a Ventricular Septal Defect (VSD) cause?
It may cause blood to flow from the left ventricle and mix with blood in the right ventricle, instead of going to the rest of the body
What is a Ventricular Septal Defect (VSD)?
It is a hole in the wall between the left and right ventricles
True or false:
A Ventricular Septal Defect (VSD) can cause fluid to build up in the lungs?
True
What is Pulmonary Stenosis?
A type of heart valve disease in which the pulmonary valve is too narrow or stiff
What does Pulmonary Stenosis affect?
It affects how well blood can move from the heart to the pulmonary artery, the blood vessel that connects the heart to the lungs
How do you as a Paramedic treat complex heart defects?
By treating symptoms
What are the 4 components of The Tetralogy of Fallot?
- Pulmonary Stenosis
- A large ventricular septal defect
- An overriding aorta
- Right ventricular hypertrophy
How does the location of the aorta change when it becomes an overriding aorta?
Instead of being ABOVE the left ventricle, it is located BETWEEN the 2 ventricles
What is Right Ventricular Hypertrophy?
When the heart has to work harder then normal making the muscle of the right ventricle thicker than normal
What are 4 signs/symptoms of severe heart defects that can be seen in a newborn/neonate?
- Rapid breathing
- Cyanosis
- Fatigue
- Poor blood circulation
Why are neonatal hearts dependent on heart rate for cardiac output as they have decreased vascular compliance?
Because a neonate is unable to generate increases in stroke volumes due to their non-compliant ventricles
What are 4 signs/symptoms of heart failure within a neonate?
- SOB or trouble breathing
- Fatigue with physical activity
- A buildup of fluid in the lungs
- Swelling in the ankles, feet, legs, abdomen, and veins in the neck
Fill in the blank:
Neonates possess a ______ parasympathetic tone placing them at risk for bradycardic episodes under stressful circumstances
dominant
True or false:
Neonates lack cerebral autoregulation and have a mature blood-brain barrier?
False;
Neonates lack cerebral autoregulation and have IMMATURE blood brain barrier
What are the 14 things you should have in your OB kit?
- Alcohol wipes
- A blanket
- Forceps
- Gauze pads
- Gloves
- Incontinent pad
- Obstetrical pad
- Obstetrical towelettes
- Plastic Bags
- Scissors
- Suction device (typically a bulb)
- Towels
- Twist ties
- Umbilical cord clamps
What should you do when you’re initially assessing a newborn and breathing is not present?
Attempt to Dry, Warm, and Stimulate the newborn
When should you perform an APGAR assessment on a newborn?
At 1 minute and 5 minutes post-birth
Only supportive care is required if what 3 things are present upon your initial assessment of a newborn?
- Term gestation
- Good muscle tone
- Breathing/crying
What is vernix?
A protective coating on newborns skin in utero
What 2 stations should you set up when preparing to deliver a baby?
- A delivery area
- A newborn resuscitation area
What would you do if you deliver a baby and notice the baby is flaccid?
IMMEDIATELY cut the cord and move the newborn to the resuscitation area
What is the main cause of cardiac arrest in newborns?
Respiratory failure
Where should the SPO2 probe be placed on a newborn?
On the right hand
True or false:
If a neonate’s HR is above 100 bpm, you should consider bow by O2 near their mouth and nose if not hitting the pre-ductal targets?
true
True or false:
If central cyanosis is present, but respirations appear adequate and the HR is greater than 100 bpm, oxygen administration is not required
true
Provide the Targeted Pre-Ductal SPO2 After Birth values for the following:
- 1 minute
- 2 minutes
- 3 minutes
- 4 minutes
- 5 minutes
- 10 minutes
1 minute: 60-65%
2 minutes: 65-70%
3 minutes: 70-75%
4 minutes: 75-80%
5 minutes: 80-85%
10 minutes: 85-95%
Why is it that during initial Positive Pressure Ventilation oxygen administration is not required?
Due to the risk of hyperoxemia, which neonates are sensitive to
What does the mnemonic MR. SOPA stand for?
M: Mask
R: Reposition airway
.
S: Suction
O: Open mouth
P: increase Pressure
A: Alternate Airway
What position should be used in the P phase of MR.SOPA?
The “sniffing position” … the “sniffing position” is when you placed a folded blanket under the newborn’s shoulder
True or False:
Due to large body surface, poor thermoregulation and difficulty retaining moisture preterm babies <32 weeks should not be dried and placed in a plastic bag (below the neck), freezer bag (below the neck) or foil blanket to retain moisture and avoid hypothermia
true
True or false:
Unless you cannot correct a reversible cause of cardiac arrest you should resuscitate on scene, and do it well within current guidelines
true
As per the BLS in what 6 situations should you consider very early transport after the 1st analysis (and defibrillation is indicated)?
- Pregnancy is presumed >or= 20 weeks
- Hypothermia
- Airway obstruction
- Suspected pulmonary embolus
- Medication overdose/toxicology
- Other known reversible cause of arrest not addressed
