Perinatal Adaptation and Breast Feeding

Question 1

what are the three shunts in foetal circulation?

Answer 1

ductus venosus

foramen ovale

ductus arteriosus

Question 2

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

Answer 2

ductus venosus → ligamentum teres

foramen ovale → closes

ductus arterioses → ligamentum arteriosus

Question 3

if foramen ovale persists this is known as?

Answer 3

PFO- patent foramen ovale

Question 4

if the ductus arteriosus persists this is known as?

Answer 4

ductus arteriosus

Question 5

what happens to the foetal lungs during third trimester?

Answer 5

surfactant produced

accumulation of glycogen in liver, muscle, heart

accumulation of brown/subcut fat

Question 6

what happens to the foetal lungs during labour and delivery?

Answer 6

inc catecholamies / cortisol

synthesis of lung fluid stops

vaginal delivery squeezes the lungs

Question 7

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

Answer 7

baby is blue

start to breathe

cries

turns pink

cord is cut

Question 8

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

Answer 8

pulmonary vascular resistance drops

systemic vascular resistance rises

Question 9

why does pulmonary vascular resistance drop following birth?

Answer 9

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

Question 10

what circulatory transition changes occur following birth?

Answer 10

circulating prostaglandins drop

duct constricts

formamen ovale closes

Question 11

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

Answer 11

Persistent Pulmonary Hypertension of the Newborn

Question 12

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

Answer 12

convection

conduction

radiation

evaporation

Question 13

how does baby produce heat?

Answer 13

breakdown of stored brown fat in response to catecholamines

Question 14

when are babies at most risk of developing hypothermia?

Answer 14

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

Question 15

which babies have the highest risk of developing hypothermia?

Answer 15

small for dates/ preterms

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

Question 16

how can you keep baby warm to prevent hypothermia?

Answer 16

keep baby dry

skin to skin

blankets/hat/clothes

incubator

Question 17

hypothermia will lead to what other complications?

Answer 17

hypoglycaemia and hypoxia

Question 18

what babies are at risk of developign hypoglycaemia?

Answer 18

inc in energy demands if unwell/hypothermic

small/premy as lower glycogen stores

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

Question 19

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

Answer 19

ant pituitary → prolactin → milk production

post pituitary → oxytocin → milk ejection

Question 20

how does the composition of breast milk change?

Answer 20

colustum to foremilk to hindmilk

Question 21

what is colustrum?

Answer 21

yellowish milk produced in first few days after baby is born

contains antibodies and white blood cells

Question 22

what is foremilk and hindmilk?

Answer 22

foremlik is the milk at the beginning of a feeding

hindmilk follows it

Question 23

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

Answer 23

hindmilk

Question 24

why does foetal haemoglobin become disadvantageous following birth?

Answer 24

2,3,DPG shifts curve to the right

haemopoesis move to bone marrow

Question 25

why do newborn babies experience physiological jaundice?

Answer 25

due to rapid breakdown of foetal haemoglobin (liver enzyme pathways present but immature)

Question 26

when does physiological jaundice present?

Answer 26

2-3 days following birth usually resolves around 2 weeks

Question 27

what would be pathological jaundice?

Answer 27

early or prolonged jaundice

Question 28

what is prolonged jaundice?

Answer 28

jaundice lasting: \>2 weeks in neonates \>3 weeks in preterm neonates

Question 29

how is jaundice treated in neonates?

Answer 29

phototherapy (fibre optic blanket) if serum bilirubin \>50

Question 30

what are the two main reasons for babies becoming ill?

Answer 30

prematurity congenital malformity

Question 31

how are dilated bowels diagnosed?

Answer 31

diameter of bowel is bigger than the diameter of the vertebral column

Question 32

what is pneuoperitoneum?

Answer 32

free air in the abdomen

Question 33

what is NEC (baby sick gut)?

Answer 33

necrotising enterocolitis inflammation and necrosis (death) of inestines

Question 34

what can cause bowel obstruction in the newborn?

Answer 34

something inside the lumen somethign pressing on the outside of the lumen something within the lumen wall

Question 35

what is seen on X-ray in bowel obstruction?

Answer 35

laddering

Question 36

what is meconium?

Answer 36

baby's first poo- really dark, almost black

Question 37

what is meconium ileus?

Answer 37

obstruction means baby cannot pass meconium will present w no meconium passed in forst couple days and vomiting

Question 38

meconium ileus is strongly assoc w what condition?

Answer 38

cystic fibrosis

Question 39

what is atresia?

Answer 39

obstruction due to narrowing of bowel baby will feed well initially then vomit

Question 40

how is atresia managed?

Answer 40

surgical reconstruction to anastomose bowel (disregard really extended bowel as will not regain tone to join further down)

Question 41

what serious condition presents with green vomiting?

Answer 41

malrotation

Question 42

what imaging can be done for malrotation?

Answer 42

water soluble contrast

Question 43

why is it important to infrom radiologists that you are investigating malrotation when performing water soluble contrast?

Answer 43

will only look as far as stomach: we are interested in duodenum and jejunum

Question 44

when would pyloric stenosis present?

Answer 44

\>6 weeks

Question 45

what is the neonatal period?

Answer 45

birth to 4 weeks

Question 46

what is the treatment for mastitis?

Answer 46

flucloxacillin | (can continue to breast feed)

Question 47

what is Sheehans Syndrome?

Answer 47

complication of severe PPH → pituitary gland undergoes necrosis leading to inadequate production of prolactin (can prevent milk production)