Perinatal Adaptation and Breast Feeding Flashcards

1
Q

what are the three shunts in foetal circulation?

A

ductus venosus

foramen ovale

ductus arteriosus

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2
Q

what are the embryological remnants of the three foetal cardiac shunts?

A

ductus venosus → ligamentum teres

foramen ovale → closes

ductus arterioses → ligamentum arteriosus

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3
Q

if foramen ovale persists this is known as?

A

PFO- patent foramen ovale

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4
Q

if the ductus arteriosus persists this is known as?

A

ductus arteriosus

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5
Q

what happens to the foetal lungs during third trimester?

A

surfactant produced

accumulation of glycogen in liver, muscle, heart

accumulation of brown/subcut fat

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6
Q

what happens to the foetal lungs during labour and delivery?

A

inc catecholamies / cortisol

synthesis of lung fluid stops

vaginal delivery squeezes the lungs

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7
Q

what is seen during the first seconds of life following delivery?

A

baby is blue

start to breathe

cries

turns pink

cord is cut

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8
Q

what happens to pulmonary vascular resistnace and systemic vascular resistance following birth?

A

pulmonary vascular resistance drops

systemic vascular resistance rises

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9
Q

why does pulmonary vascular resistance drop following birth?

A

to allow more blood flow into lungs and oxygen exchange to occur

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10
Q

what circulatory transition changes occur following birth?

A

circulating prostaglandins drop

duct constricts

formamen ovale closes

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11
Q

failure of foramen ovale and ductus arteriosus to close can result in what?

A

Persistent Pulmonary Hypertension of the Newborn

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12
Q

what are the four methods heat loss occurs when baby is born?

A

convection

conduction

radiation

evaporation

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13
Q

how does baby produce heat?

A

breakdown of stored brown fat in response to catecholamines

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14
Q

when are babies at most risk of developing hypothermia?

A

first 12 hours as breakdown of brown fat not sufficient enough at maintaining temperature

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15
Q

which babies have the highest risk of developing hypothermia?

A

small for dates/ preterms

(have lower fat stores and larger surface area:vol)

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16
Q

how can you keep baby warm to prevent hypothermia?

A

keep baby dry

skin to skin

blankets/hat/clothes

incubator

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17
Q

hypothermia will lead to what other complications?

A

hypoglycaemia and hypoxia

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18
Q

what babies are at risk of developign hypoglycaemia?

A

inc in energy demands if unwell/hypothermic

small/premy as lower glycogen stores

innapropriate insulin/glucagon ratio due to maternal diabetes or some drugs

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19
Q

how are the anterior and posterior pituitary involved in breast feeding?

A

ant pituitary → prolactin → milk production

post pituitary → oxytocin → milk ejection

20
Q

how does the composition of breast milk change?

A

colustum to foremilk to hindmilk

21
Q

what is colustrum?

A

yellowish milk produced in first few days after baby is born

contains antibodies and white blood cells

22
Q

what is foremilk and hindmilk?

A

foremlik is the milk at the beginning of a feeding

hindmilk follows it

23
Q

which is richer in fat and higher in calories, foremilk or hindmilk?

24
Q

why does foetal haemoglobin become disadvantageous following birth?

A

2,3,DPG shifts curve to the right

haemopoesis move to bone marrow

25
why do newborn babies experience physiological jaundice?
due to rapid breakdown of foetal haemoglobin (liver enzyme pathways present but immature)
26
when does physiological jaundice present?
2-3 days following birth usually resolves around 2 weeks
27
what would be pathological jaundice?
early or prolonged jaundice
28
what is prolonged jaundice?
jaundice lasting: \>2 weeks in neonates \>3 weeks in preterm neonates
29
how is jaundice treated in neonates?
phototherapy (fibre optic blanket) if serum bilirubin \>50
30
what are the two main reasons for babies becoming ill?
prematurity congenital malformity
31
how are dilated bowels diagnosed?
diameter of bowel is bigger than the diameter of the vertebral column
32
what is pneuoperitoneum?
free air in the abdomen
33
what is NEC (baby sick gut)?
necrotising enterocolitis inflammation and necrosis (death) of inestines
34
what can cause bowel obstruction in the newborn?
something inside the lumen somethign pressing on the outside of the lumen something within the lumen wall
35
what is seen on X-ray in bowel obstruction?
laddering
36
what is meconium?
baby's first poo- really dark, almost black
37
what is meconium ileus?
obstruction means baby cannot pass meconium will present w no meconium passed in forst couple days and vomiting
38
meconium ileus is strongly assoc w what condition?
cystic fibrosis
39
what is atresia?
obstruction due to narrowing of bowel baby will feed well initially then vomit
40
how is atresia managed?
surgical reconstruction to anastomose bowel (disregard really extended bowel as will not regain tone to join further down)
41
what serious condition presents with green vomiting?
malrotation
42
what imaging can be done for malrotation?
water soluble contrast
43
why is it important to infrom radiologists that you are investigating malrotation when performing water soluble contrast?
will only look as far as stomach: we are interested in duodenum and jejunum
44
when would pyloric stenosis present?
\>6 weeks
45
what is the neonatal period?
birth to 4 weeks
46
what is the treatment for mastitis?
flucloxacillin | (can continue to breast feed)
47
what is Sheehans Syndrome?
complication of severe PPH → pituitary gland undergoes necrosis leading to inadequate production of prolactin (can prevent milk production)