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OB > Newborn Adaptation > Flashcards

Newborn Adaptation Flashcards

1
Q

What are some considerations r/t fetal lung fluid?

A
  • Fulid produced in utero
  • Fluids move to interstitial space during labor
  • Epi and norepi (stress of labor) increase rate of absorption
  • Absorption is delayed with a C-section
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2
Q

Describe fetal lung surfactant

A
  • Detergent like lipoprotein
  • Detectable by 24-25 weeks
  • Reduces surface tension in alveoli so they remain partially open
  • sUFFICIENT amount needs to be produced by 34-35 weeks to prevent alviolar collapse (different for mother with DM)
  • Secretion increases during and after birth
  • Steriods given in preterm labor help
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3
Q

Describe the mechanism that causes respiration in a newborn

A

INternal- Chemoreceptors are triggered and diaphragm is stimulated

  • Externally: Skin sensors, responces to sounds and light all act on respiratory center
  • -Cold air stimulates skin receptors
  • -Compression during birth causes air to enter lungs
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4
Q

Why do the lungs of neonates sound moist?

A

-Fetal lung fluid is still moving

-

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5
Q

What are the three fetal cardiac shunts?

A
  • Foramen ovale
  • Ductus venosus
  • Ductus arteriosus
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6
Q

What happens that stimulates the cardiac shunts to close at birth?

A

-The infants response to O2 causes a shift in pressure

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7
Q

Describe the flow of fetal blood.

A

From the placent into the inferior vena cave

  • into right A
  • through Foramen Ovale into left A
  • INto left Ven
  • Through aorta
  • Some blood goes into Pulm veins but remixes at the ductus arteriosis
  • Circulates and exits back to plencent
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8
Q

How does the clamping of the umbilical cord help close cardiac shunts

A

It decreases the pressure in the Right A and increases systemic resistance

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9
Q

What is the function of the ductus venous?

A

Shunts 1/3 of blood from UV to inferior cava and away from immature liver

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10
Q

How is the ductus venousus affected at clamping

A

Occlusion of cord stops flow of blood from placenta through UV to ductus venosus
-allows blood to flow through the liver

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11
Q

What is the function of the foramen Ovale?

A

Valve allows flow of blood between the RA and LA so that the blood bypasses the lungs and goes directly into the LV and aorta
-R to L shunt

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12
Q

How is the Foramen ovale affected at clamping

A
  • Cord occlusion elevates systemic resistance; blood returns from PV to LA, both increases L heart pressure
  • Decreased pulmonary resistance allows free flow of blood into lungs and decreased pressure in RA
  • Closes at birth d/t pressure changes
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13
Q

What is the function of the fetal pulmonary blood vessels?

A

Narrowed vessels increase resistance to blood flow to lungs

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14
Q

How are the fetal pulmonary vessels affect at clamping?

A
  • Elevated blood oxygen and removal of fetal lung fluid
  • Decreased pulmonary resistance allows blood to enter freely to be oxygenated
  • Transition occurs with first breath
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15
Q

What is the function of the Ductus Arteriosus?

A

Widely dilated to carry blood from PA to aorta and avoid nonfunctioning lungs

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16
Q

How is the ductus arteriosus affected by clamping?

A
  • Increase of oxygen level in blood
  • Blood in PA is directed to lungs for oxygenation
  • Functional within minutes after birth, complete constriction 1-6 days
  • Permanent 1-4 mos
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17
Q

How do low levels of O2 at birth affect Cardiac shunts?

A

Low levels of oxygen in the blood (asphyxia at birth, becomes hypoxic, or is preterm) may cause the DA to dilate and the PV to constrict increases resistance to blood flow to the lungs
-This results in the opening of the foramen ovale to allow a right-to-left shunt of blood and flow from the pulmonary artery through the DA and into the aorta

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18
Q

How fast can a newborn lose heat?

A

0.5 degrees F to 1.7 degrees F per minute if infant is not kept warm at birth

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19
Q

What are some characteristics that lead to heat loss?

A
  • Thin skin close to blood vesses and with very little SQ fat
  • 3x more surface area
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20
Q

A healthy, term infant requires a position of ____ what does this help reduce

A

Flexion

-Reduces heat loss

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21
Q

How do neonates produce heat

A
  • nonshivering Thermogenesis*
  • They burn brown fat as fuel the heat is transfered to the blood passing through the fat and is distributed throughout the body
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22
Q

What are the three concequences of reduced neonat body temp?

A
  • Increased metabolic rate
  • Brown fat metabolism
  • Vasoconstriction
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23
Q

How does hypothermic induced increased metabolism affect the infant?

A

-increased glucose demand =hypoglycemia
-Increased O2 use
=reduced surfacant and hypoxemia

This leads to respiratory distress and can even cause the return to fetal circulation

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24
Q

How does the burning of brown fat affect the infant?

A
  • Acids are produced
  • Metabolic acidosis
  • Displaced bilirubin

Causes Jaundice

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25
Q

How does hypothermic induced Vasoconstriction affect the infant?

A
  • Peripheral vascular constriction = Pale, cold, mottled skin
  • Pulmondar vessel constriction

Leads to return of fetal circulation and Respiratory distress

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26
Q

What is a neutral thermal environment?

A

An environment that allows the newborn to have stable temp control

27
Q

WHat is the neutral environmental temp for a naked healthy full term neoate
-Cothed?

A 
32-33.5
89.6-93.3
-Clothed
24-27
(75.2 to 80.6)
28
Q

WHat is the HCT for the first month of life?

A

44-65%

29
Q

Polycythemia in an infant increases the risk of ____ and ___

A

Jaundice and Brain injury

30
Q

How do WBC’s present in infants with an infection?

A

They may decrease

31
Q

Signs of an infant infection in blood values are ____ and ___

A

increase of immature leukocytes and a decrease in platelets

32
Q

Why are newborns at risk of clotting deficiency?

How is this treated?

A
  • They do not have the Vit K needed from gut flora

- Vit K is given to infants to reduce the risk of a hemmoragic disease

33
Q

Describe the GI tract of an infant

A
  • 6ml stomach cap.
  • Gastric emptying delayed until first sip of milk. then it is doubled
  • Gastrocolic reflex is stimulated with full stomach. Increasing parastal. and producing a BM
  • Cardiac sphinctor is more relaxed = reflux
34
Q

Describe an infants digestive enzymes

A
  • Panc. Amalase= deficient for the first 4-6 months (in breatsmilk)
  • Amylase: In breast milk, limited production until 3rd month
  • Pancriatic Lipase: deficient (in breast milk)
35
Q

What is the first stool called? what does it look like?

A

Myconium

  • Greenish/black
  • Thick
  • Passess in first 12-48 hours
36
Q

Describe the transitional stool

A
  • Greenish-brown
  • Breastmilk=Seedy and mustard like
  • Formula: Pale yellow to light frown and mor firm
37
Q

What are the major hepatic functions after birth?

A
  • Glucose matainance
  • CONGIGATON OF BILIRUBIN
  • Production of clotting factors
  • Stores iron
  • Metabolized drugs
38
Q

When does the fetus begin to store glucose? How fast is it used up?

A
  • 3rd tri

- 12 hours

39
Q

Newborn blood glucose and fall around ___ after birth and stabilized at around ___

A

60-90 minutes

2-3 hours

40
Q

Newborn Blood glucose should be ___ on the first day and ___ thereafter

A

40-60

50-90

41
Q

What are some factors that increase the risk of hypoglycemia in newborns?

A
  • preterm/late-term
  • Post-term=stores used before birth
  • LGA and those with DM mothers produce extra insulin
  • Stressed infants
  • Cold infants
42
Q

Preterm infants have the reduced ability to conjugate bilirubin. Why

A

Immature livers

43
Q

What is the source of bilirubin?

A

Hemolysis of erythrocytes

Fetal blood has a shorter halflife + there is extra to be broken down at birth

44
Q

Describe Unconjugated bilirubin

A

aka indirect bilirubin

  • Soluble in fat
  • Needs to be water soluble to be excreted
45
Q

Describe conjugated bilirubin

A

aka direct bilirubin

  • water soluble
  • picked up by bile
  • excreted in poop
46
Q

What occurs if there is too much unconjugated bilirubin>

A

staning of the subcutaneous fat and Brain

jaundice

47
Q

ONce unconjugated biliribin enters the blood stream, what is its target location?

A

-Serum albumin binding sites

48
Q

What is Breastfeeding jaunduce?

A

An elevated bilirubin of more than 12mg/dl
caused by insuficcent intake
-affects 13% by the first week

49
Q

What is True Brest milk jaunduce?

A

(late onset BM jaundice)

  • first 3-5 days of life can last 3 weeks to 3 months
  • TSB peaks at 5-10mg/dl and falls
  • Unknown cause
50
Q

Describe the NB Urinary system

A
  • Fully developed but not fully functonal kidneys
  • Kidney perfusion improves as vascular resistance decreases
  • GFR 2x to 3x in first weeks but not fully developed until 1-2
  • 50% void in 12 hours
  • 92% in 24
  • 99 in 48
51
Q

What is Oligohydraminos and what does it indicate?

A

Low amniotic fluid

-Indicates renal problems

52
Q

An infant should be voiding ____or the first few days and _____ or more by the 4th

A

1-2

6

53
Q

Describe newborn fluid balance.

A

-Lower tolorence in fluid changes
-need 60-100 ml/kg in first 3-5 days
150-175ml/kg at day 7

54
Q

What should the newborn urine output and specific gravity be?

A

1-2ml/kg/hr for first day and 2-5 after

-1.002 to 1.010

55
Q

Why are newborns at higher risk for Acid base imbalance?

A

-Lose bicarb at lower levels than adults

56
Q

Describe the immune system of the newborn

A
  • No fever or or leukpcytosis with a infection
  • Immature immune responses
  • Recieves antibodies in last trimester
57
Q

Describe IgG

A
  • Crosses the plecenta begining in first T

- Passive immunity dissapears at 2-4 months

58
Q

Describe infant IgM

A

-Protects against gram neg bacteria
-Produced rapidly after few days after birth
-Cant cross placenta
(too big)

59
Q

Describe infant IgA

A

-Does not cross placenta
-Protects GI and Resp
Present in Colostrum and Breast Milk

60
Q

What are the 3 psychosocial periods of rnewborn reactivity?

A

First period of reactivity
Period of sleep
Second period of reactivity

61
Q

Describe the first period of reactivity

A
  • birth to 30 minutes
  • Active awake alery
  • possible elevated VS
62
Q

Describe the Period of sleep

A

Becomes quite and sleeps

-VS return to normal

63
Q

Describe the second stage of reactivity

A

lasts 4-6 hours

  • Alert and interested in feeding
  • Secretions increase (possible gaging or vomiting

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