Perinatal Adaptation and Breast Feeding Flashcards
what are the three shunts in foetal circulation?
ductus venosus
foramen ovale
ductus arteriosus
what are the embryological remnants of the three foetal cardiac shunts?
ductus venosus → ligamentum teres
foramen ovale → closes
ductus arterioses → ligamentum arteriosus
if foramen ovale persists this is known as?
PFO- patent foramen ovale
if the ductus arteriosus persists this is known as?
ductus arteriosus
what happens to the foetal lungs during third trimester?
surfactant produced
accumulation of glycogen in liver, muscle, heart
accumulation of brown/subcut fat
what happens to the foetal lungs during labour and delivery?
inc catecholamies / cortisol
synthesis of lung fluid stops
vaginal delivery squeezes the lungs
what is seen during the first seconds of life following delivery?
baby is blue
start to breathe
cries
turns pink
cord is cut
what happens to pulmonary vascular resistnace and systemic vascular resistance following birth?
pulmonary vascular resistance drops
systemic vascular resistance rises
why does pulmonary vascular resistance drop following birth?
to allow more blood flow into lungs and oxygen exchange to occur
what circulatory transition changes occur following birth?
circulating prostaglandins drop
duct constricts
formamen ovale closes
failure of foramen ovale and ductus arteriosus to close can result in what?
Persistent Pulmonary Hypertension of the Newborn
what are the four methods heat loss occurs when baby is born?
convection
conduction
radiation
evaporation
how does baby produce heat?
breakdown of stored brown fat in response to catecholamines
when are babies at most risk of developing hypothermia?
first 12 hours as breakdown of brown fat not sufficient enough at maintaining temperature
which babies have the highest risk of developing hypothermia?
small for dates/ preterms
(have lower fat stores and larger surface area:vol)
how can you keep baby warm to prevent hypothermia?
keep baby dry
skin to skin
blankets/hat/clothes
incubator
hypothermia will lead to what other complications?
hypoglycaemia and hypoxia
what babies are at risk of developign hypoglycaemia?
inc in energy demands if unwell/hypothermic
small/premy as lower glycogen stores
innapropriate insulin/glucagon ratio due to maternal diabetes or some drugs
how are the anterior and posterior pituitary involved in breast feeding?
ant pituitary → prolactin → milk production
post pituitary → oxytocin → milk ejection
how does the composition of breast milk change?
colustum to foremilk to hindmilk
what is colustrum?
yellowish milk produced in first few days after baby is born
contains antibodies and white blood cells
what is foremilk and hindmilk?
foremlik is the milk at the beginning of a feeding
hindmilk follows it
which is richer in fat and higher in calories, foremilk or hindmilk?
hindmilk
why does foetal haemoglobin become disadvantageous following birth?
2,3,DPG shifts curve to the right
haemopoesis move to bone marrow
why do newborn babies experience physiological jaundice?
due to rapid breakdown of foetal haemoglobin
(liver enzyme pathways present but immature)
when does physiological jaundice present?
2-3 days following birth
usually resolves around 2 weeks
what would be pathological jaundice?
early or prolonged jaundice
what is prolonged jaundice?
jaundice lasting:
>2 weeks in neonates
>3 weeks in preterm neonates
how is jaundice treated in neonates?
phototherapy (fibre optic blanket) if serum bilirubin >50
what are the two main reasons for babies becoming ill?
prematurity
congenital malformity
how are dilated bowels diagnosed?
diameter of bowel is bigger than the diameter of the vertebral column
what is pneuoperitoneum?
free air in the abdomen
what is NEC (baby sick gut)?
necrotising enterocolitis
inflammation and necrosis (death) of inestines
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
what is seen on X-ray in bowel obstruction?
laddering
what is meconium?
baby’s first poo- really dark, almost black
what is meconium ileus?
obstruction means baby cannot pass meconium
will present w no meconium passed in forst couple days and vomiting
meconium ileus is strongly assoc w what condition?
cystic fibrosis
what is atresia?
obstruction due to narrowing of bowel
baby will feed well initially then vomit
how is atresia managed?
surgical reconstruction to anastomose bowel
(disregard really extended bowel as will not regain tone to join further down)
what serious condition presents with green vomiting?
malrotation
what imaging can be done for malrotation?
water soluble contrast
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
when would pyloric stenosis present?
>6 weeks
what is the neonatal period?
birth to 4 weeks
what is the treatment for mastitis?
flucloxacillin
(can continue to breast feed)
what is Sheehans Syndrome?
complication of severe PPH → pituitary gland undergoes necrosis leading to inadequate production of prolactin (can prevent milk production)
