Perinatal Period Flashcards
connects umbilical vein to inferior vena cava
ductus venosus
channel of communication between the main pulmonary artery and the aorta
ductus arteriosus
opening between the two atria of the fetal heart
foramen ovale
What causes foramen ovale to close at birth?
decreased pulmonary vascular resistance causes increased left atrial pressure and eliminates right to left shunting
What causes ductus arteriosus to close at birth?
increased oxygen initiates constriction and subsequent closure
What is the last system to form in utero?
pulmonary system
When is surfactant production sufficient?
by 34 weeks of gestation
Normal weight loss in first week after birth
5-10%
When do disorders usually develop in newborns?
after baby has been feeding for 2-3 days
Commonly screened conditions
PKU, galactosemia, hemoglobinopathies, hypothyroidism, hearing
Type of growth restriction that implies event in EARLY pregnancy such as chromosomal abnormalities, drug or alcohol use, or congenital viral infections
symmetric
type of growth restriction that implies problem LATE in pregnancy such as pregnancy-induced hypertension, pre-eclampsia or placental insufficiency
asymmetric
What should all LGA infants be screened for?
hypoglycemia (40-45 mg/dL)
Chance of RDS at 28-30 weeks gestation
70%
Signs within 6 hrs of birth that include: tachypnea, retractions, nasal flaring, grunting, cyanosis
RDS
CXR findings of RDS
reticulogranular (ground glass) pattern and air bronchograms
Managment of RDS
oxygen, CPAP, vent if needed, artifical surfactant replacement
Syndrome that is common with postmaturity and fetal distress
Meconium Aspiration Syndrome(MAS)
Chest xray reveals fluffy infiltrates with alternating areas of lucency. Pneumothorax or pneumomediastinum and hyperinflation with flattening of diaphragm
Meconium Aspiration Syndrome(MAS)
Management of Meconium Aspiration Syndrome(MAS)
gentle suctioning, chest physiotherapy, oxygen, CPAP/vent, abx
Caused by sustained elevation in pulmonary vascular resistance
Can be idiopathic or secondary to MAS, RDS, congenital diaphragmatic hernia, hyperviscosity, sepsis, or other causes
Persistent Pulmonary HTN of Newborn (PPHN). aka- persistent fetal circulation
Retained fetal lung fluid that often occurs in term or near-term infants and resolves within 24 hrs
Transient Tachypnea of the Newborn
CXR shows perihilar streaking and fluid in interlobar fissures
Transient Tachypnea of the Newborn
Type of jaundice that begins after 24 hrs of life, peaks around 3 days, and progresses cephalocaudally
physiologic
Three mechanisms of physiologic jaundice
bilirubin production is higher, bilirubin clearance is decreased in liver, increased enterohepatic circulation
At what serum bilirubin level does jaundice appear?
3-5
Tests for presence of blood type antibodies in serum. A positive test results in agglutination of the RBCs
Indirect Coomb’s Test
Use of a blue light that converts bilirubin to lumirubin to treat jaundice
phototherapy
Used when phototherapy fails or an infant shows signs of bilirubin-induced signs of neurologic-dysfunction (BIND), including “acute-bilirubin encephalopathy” (reversible) and kernicterus (irreversible)
exchange transfusion
Type of jaundice that is exaggerated when the milk takes longer to come in
Or when there is mild dehydration
Exaggerated physiologic hyperbilirubinemia or breast milk jaundice
How often should a newborn feed?
every 2-3 hrs
How many wet diapers should a newborn produce?
6-8 per day
Can occur when unconjugated bilirubin reaches high levels and subsequently crosses the blood-brain barrier to damage cells of the brain
kernicterus
level that kernicterus can occur in full term newborns
unconjugated bilirubin levels are above 20-25mg/dL
How do you distinguish between pre-liver and post-liver problem?
Indirect bilirubin usually indicates a pre-liver problem while direct usually indicates a post-liver problem
Peak age of SIDS
2-4 months of age.
Risk factors for SIDS
sleeping position, bottle feeding, maternal smoking, infant overheating
Treatment for breast milk failure jaundice
Nursing is interrupted for 24-48 hours
Administered to any Rh-negative woman after any invasive procedure during pregnancy as well as after any miscarriage, abortion, or delivery of an Rh-positive infant
Rhogam
Occurs in Rh-negative women who have NOT received appropriate care with Rhogam. Often results in fetal or neonatal death without appropriate prenatal intervention
Erythroblastosis fetalis (hydrops fetalis)
antibodies directed against Rh protein. Can accompany any pregnancy where mom has Rh negative blood
Rh hemolytic disease
Occurs in context of mom having type O blood and baby having type A or B. Disease usually is not severe
ABO hemolytic disease
