Perinatal adaptation

Question 1

what are the 3 shunts in foetal circulation

Answer 1

ductus venosus (liver - portal vein)
foramen ovale (IVC - RA)
ductus arteriosus (pulmonary vein - aortic arch)

Question 2

what substance is produced in foetal lungs in 3rd trimester

Answer 2

pulmonary surfactant

Question 3

what substance is accumulated in liver, muscle and heart prior to birth

Answer 3

glycogen

Question 4

what increases in baby with onset of labour

Answer 4

catecholamines

cortisol

Question 5

what causes transition of foetal circulation to neonatal circulation

Answer 5

pulmonary vascular resistance drops and systemic vascular resistance increases
increased PO2, decreased prostaglandins

Question 6

what does ductus arteriosus become

Answer 6

ligamentum arteriosus (or persistent ductus arteriosus)

Question 7

what does ductus venosus become

Answer 7

ligamentum teres

Question 8

what happens if foramen ovale doesn’t shut

Answer 8

persistent pulmonary hypertension of newborn

Question 9

management of PPHN

Answer 9

ventilation
oxygen
nitric oxide sedation
inotropes

Question 10

what is important in first few hours of life

Answer 10

thermoregulation
glucose homeostasis
nutrition

Question 11

what is main source of heat production on newborn

Answer 11

breakdown of stored adipose tissue in response to catecholamines (this is not efficient in first 12 hours)

Question 12

risk factors for hypothermia in new born

Answer 12

pre-term/small for dates babies:
low stores of brown/subcutaneous fat
larger surface area:volume

Question 13

management of hypothermia of new born

Answer 13

dry 
hat 
skin-skin
blanket/clothes 
heated mattress
incubator

Question 14

new borns have large/little intake of milk in first hours

Answer 14

little

Question 15

insulin increases/decreases in first few hours

Answer 15

decreases (increased glycogen)

Question 16

risk factors for hypoglycaemia

Answer 16

hypothermia (increased energy demands)
small/premature (lower glycogen stores)
maternal diabetes/hyperinsulinism

Question 17

what hormone produces milk

Answer 17

prolactin

Question 18

where produces prolactin

Answer 18

anterior pituitary

Question 19

what hormone causes milk ejection

Answer 19

oxytocin

Question 20

where produces oxytocin

Answer 20

posterior pituitary

Question 21

why does oxygen dissociation curve shift to right

Answer 21

increase in 2,3 DPG

Question 22

why do new borns get physiological anaemia

Answer 22

foetal Hb broken down quicker than adult Hb synthesised

Question 23

why do babies get physiological jaundice

Answer 23

breakdown of foetal Hb

bilirubin conjugating pathways are immature - increase in unconjugated bilirubin