Perinatal period Flashcards
What do you need to do for determing a newborn assessment
Growth and gestiational age
within the first 24 hours
Difference between preterm, late preterm (near-term), term, post term
preterm = before completion of 36 weeks and 7 days (gestational age)
late preterm = between 34 weeks 0 days and 36 weeks and 6 days
term infants = 37 weeks to 41 weeks
might not be accurate
What is a risk factor for most conditions in neonates
premature
almost ALL of these conditions
what is early discharge?
Discharge before 24 hours
late preterm and preterm should be there for at least 48 hours
What is a carseat challenge
put in carseat for an hour and check pulse ox for apnea or hypoxia
parents should get CPR certified if positive
What can hypoxemia lead to in late term babies
meconium aspiration
Define small for gestational age large for gestational age appropriate for gestational age
SGA < 10 %
LGA > 90%
AGA = 10-90% is what you want!
A = approprioate
L = large
FGR = fetal growth
What is the order of delayed growth/
Weight
height
head circumference (poor prognosis, because it has been going on for a while)
why is symmetrical IUGR a worry?
Congenital oftentimes d/t 1st trimester insult that effects weight, height, and head circumfrence
will remain small
assymetric = more likely to grow out of it because it likely did not effect the head circumference
Intrauterine o2 to after birth conversion
through placenta
after birth - adaptation to new environment (respiratory and CV system)
Intrauterine lungs
Low O2 environment causes constriction of smooth muscle and increased vascular resistance not enough for gas exchange. Alveoli is filled with fluid
Placenta is the source of o2 and nutrition
What is the blood flow of fetal atrial circulation
Right atrium is the oxygenated blood
IVC
Right atrium
significant increase in pulmonary pressure makes it to where there is no BF from atrium to lung, and the shunt allows blood to move from RA to LA
Ductus arteriorsus allows it to bypass the lungs
Left is deoxygenated, goes to the placenta for exchange
What is the respiratory adaptation neonates go through
increase production of surfactant to prevent pulmonary collapse (liquid and protein)
increase production of fetal lung fluid (lungs start removing fluid out of alveoli and into the interstitial space)
Baby cries, the lungs fill with fluid, and then
What stimulates the cry of a baby?
- thermal stimulation because of major drop of temperature which triggers respiratory center of the medulla
- light and sound = sitimulates medulla
- tactile from contractions
What are the CV adaptations
O2 content in blood increases (vasodilates)
decreases pulmonary pressure to help circulation
blood can now flow from right ventricle to the lungs
ductus arteriorsus now closes d/t no longer having a right to left shunt
What is a common respiratory response for an hour or so after birth
hyperventilation - common physiologic reasons
what two things are needed for normal breathing of a newborn?
Surfactant
Muscle tone of respiratory muscles
What percentage of babies need resuscitation?
<1%
even if the baby is not crying (not vigorous) you do not intubate
What is the preferred vascular access for IV access in babies?
umbilical vein
As soon as a baby is delivered, what three things should you ask
is baby term
is the baby have muscle term
crying
if no, do tactile stim, clear secretion, keep patient warm
What is the golden hour of a babies life
First hour should be with skin to skin of mother
If cyanosis persists, what is the step ladder approach
reposition the baby to open airway
then pulse ox on right extremity (because it is preductal)
provide O2 with PPV (bagging the baby)
CPAP
If apnea/gasping and HR 100 BPM after PPV
MRSOPA
Mask adjustment
Reposition
Suction
Open the mouth
Pressure increase
Airway change (meaning you might need to intubate)
When do you do chest compression ALWAYS
<60 BPM right away (also less than 100 should still be performed)
3:1 compressions per breath (instead of 30:1 in adults)
