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Neonatology Flashcards

1
Q

placental functions

A 
foetal homeostasis
gas exchange
nutrient transport
waste removal
acid-base balance
hormone production
transport of IgG
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2
Q

three shunts in the foetal circulation

A
  1. ductus venosus
  2. foramen ovale
  3. ductus arteriosus
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3
Q

role of the ductus venosus

A

passes blood from the placenta to the IVC through the liver

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4
Q

role of the foramen ovale

A

passes blood through atria from right to left (some blood does still enter the right ventricle)

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5
Q

role of the ductus arteriosus

A

right ventricle into the aorta

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6
Q

how does waste go back to the placenta?

A

via the umbilical arteries

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7
Q

resistance in lungs and placenta

A

high pulmonary resistance

low placental resistance

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8
Q

preparation for birth in the 3rd trimester

A 
surfactant production
accumulation of glycogen
accumulation of brown fat (between scapulae and internal organs)
accumulation of subcutaneous fat
swallowing amniotic fluid
this is a period of rapid weight gain
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9
Q

preparations for birth during labour and delivery

A

increased catecholamines/cortisol (stress)
lung fluid synthesis halted and crying absorbs fluid into the lymphatic system
vaginal delivery squeezes the lungs

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10
Q

normal appearance of a baby on delivery

A

blue (gradually pinkness)
breathing
crying
cord is cut (delayed if premature)

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11
Q

circulatory transitions at birth

A

pulmonary resistance drops
systemic vascular resistance drops and oxygen tension rises
prostaglandins drop closing ducts

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12
Q

fate of the ductus venosus

A

ligamentum teres

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13
Q

fate of the foramen ovale

A

closes (can persist as PFO)

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14
Q

fate of the ductus arteriosus

A

ligamentum arteriosus (can persist as PDA)

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15
Q

examples of conditions if there is failure of cardiorespiratory adaptation

A

persistent pulmonary hypertension of the newborn (PPHN)
transient tachypnoea of the new-born (TTPN)
RDS
pneumothorax
meconium aspiration
diaphragmatic hernia
trachea-oesophageal fistula (curled nasogastric tube and no stomach bubble)

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16
Q

causes of PPHN

A

solid lungs filled with fluid or lack of surfactant
PDA
PFO

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17
Q

diagnosis of PPHN

A

pre-ductal and post-ductal saturation (positive if more than 3% difference)

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18
Q

management of PPHN

A 
ventilation
oxygen
nitric oxide (given through ventilator)
sedation
inotropes
ECLS (hypo-coagulable)
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19
Q

cause of transient tachypnoea of the new-born (TTPN)

A

C-section causes no squeezing of the lungs so fluid is not absorbed fully into the lymphatics

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20
Q

presentation of TTPN

A

tachypnoea
grunting
first 6 hours of life

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21
Q

management of TTPN

A

always screen for infection (just in case)

may need respiratory support but often self-limiting

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22
Q

who does RDS occur in and why?

A

pre-terms due to lack of surfactant and structural immaturity

23
Q

management of RDS

A

maternal steroids
surfactant
ventilation

24
Q

cardiac problems

A

heart failure (hydrops foetal is e.g. Rhesus disease)
PPHN
congenital

25
congenital cardiac problems
``` teratology of Fallot transposition of great arteries coarctation of the aorta TADVD hypoplastic heart ```
26
other congenital abnormalities
``` microcephaly (CMV) spina bifida Potter's syndrome (renal agenesis so no urine so amniotic fluid not swallowed) myotonic dystrophy hypoglycaemia acidosis ```
27
three adaptions within the first few hours of life?
thermogenesis glucose homeostasis nutrition
28
ways heat is lost
radiation (large SA to volume ratio, especially head) convection conduction evaporation
29
how to reduce heat loss
``` hat dry protect from drafts clothing mother's chest incubator ```
30
can babies shiver
no so they breakdown stored adipose tissue in response to catecholamines other adaptions include peripheral vasoconstriction
31
can babies use ketones as brain fuel?
yes
32
hypoglycaemia causes in new-born
increased energy demands e.g. unwell or hypothermic low glycogen stores due to being small or premature inappropriate insulin/glucagon (maternal diabetes or hyperinsulinaemia- mother on beta blockers)
33
role of oxytocin
milk ejection
34
role of prolactin
milk production
35
why is foetal Hb disadvantageous when the baby is born?
adapted to a hypoxic state (curve shifted left) so does not release oxygen as easily
36
cause of physiological jaundice
foetal Hb is broken down faster than adult Hb is made and conjugating pathways are immature leading to rise in unconjugated bilirubin
37
when does physiological jaundice happen?
2-5 days, outside of this is pathological
38
risk factors for adaption
``` hypoxia/asphyxia during delivery small large premature maternal illness medications ```
39
define term
37 weeks gestation
40
post-term
beyond 41 weeks
41
normal birth weight
2.5-4.0kg
42
pre-term
before 37 weeks gestation very pre-term= under 31 weeks extreme pre-term= under 27 weeks foetal loss= under 22 weeks
43
what score is used to asses the new-born's progression?
APGAR score | appearance, pulse, grimace, activity and respiration
44
other things to look out for outside the APGAR score?
``` jaundice low tone (floppy) seizures (eye rolling) poor feeding bilious vomit ```
45
management in cerebral palsy
therapeutic cooling
46
antenatal infection cause
group B strep
47
perinatal infection cause
herpes
48
bacterial causes of infection in neonates
``` group B strep E. coli listeria monocytogenes staph aureus epidermidis ```
49
viral causes of infection in neonates
``` CMV parvovirus herpes enteroviruses toxoplasma gondii HIV syphilis TORCH ```
50
management of haemorrhage disease of the new-born
vitamin K IM | oral K
51
factors that increase the chance of a pre-term birth
``` multiple pregnancy rupture of membranes hypertension intrauterine growth restrictions smoking alcohol illicit drugs poor nutrition less than 6 month interval IVF ```
52
what do premature babies need help with?
- staying warm (reduced brown fat- risk of hypoglycaemia) - fragile lungs (ribcage not develop) - breathing (before 34 weeks immature respiratory centres so can forget) - systemic immaturity (RDS, PDA, IVH, NEC) - ROP - nutritional compromise
53
common problems in pre-terms
``` RDS PDA IVH NEC ROP hypoglycaemia (immature liver and pancreas) hyponatraemia (immature kidneys) cerebral palsy risk increased ```

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