Neonatology Flashcards
describe the changes in pulmonary vascular resistance after birth
this decreases as baby takes its first breath
describe circulatory changes after birth
pulmonary vascular resistance drops systemic vascular resistance rises oxygen tension rises circulating prostaglandins drop duct constricts foramen ovale closes
what is persistent pulmonary hypertension
resistance in the lungs remains high and so blood bypasses the lungs and you get lower oxygen levels-ducts remain open and get shunting
significantly differnet pre and post right arm and right head and neck vessels
how is PPH managed
ventilation, O2, nitric oxide, sedation, ionotropes, ECLS (extracorporeal life support)
how is heat produced
breakdown of stored brown adipose tissue in response to catecholamines, not efficient in the first 12 hours
peripheral vasoconstriction
describe glucose homeostasis in newborns
very little oral intake of milk
drop in insulin increase in glucagon
mobilisation of hepatic glycogen stores for gluconeogenesis
ability to use ketones as brain fuel
describe haematological changes
fetal haemoglobin becomes disadvantageous
increase in 2,3 DPG shifts curve to the right
haematopoiesis moves to bone marrow
adult Hb synthesised more slowly than fetal hb is broken down
can get physiological anaemia
if baby is jaundice day 10 this is likely to be what type of bilirubin
unconjugated bilirubin
how does blue light help with increased unconjugated bilirubin
it makes it water soluble
what is HbH disease
excess B chains form tetramers, there is only one working alpha gene (–, -a)
what is raised HbA2 diagnostic of
B thal trait
what are the three stages of CML
chronic phase, accelerated phase, blast crisis
what are the mutation in polycythaemia
JAK2 mutation
what does the JAK2 muscle do
loss of auto-inhibition
activation of erythropoeis in absence of ligand
treatment of PRV
venesect to <0.45, aspirin, cytotoxic chemo-hydroxycarbamide
