Perinatal Period Flashcards
Pertern gestation
< 37 weeks
Term gestation
37 - 42 wks
Post-term gestation
> 42 wks
Neonatal period
First 28 days of life.
Perinatal period
from 20 wks gestation to one month after birth.
Ductus Venosus
Connects umbilical vein to inferior vena cava.
Ductus arteriosus
Channel of communication btw main pulm artery and aorta.
Foramen Ovale
Opening btw two atria or fetal heart.
What is the last system to develop in utero?
Respiratory system. Surfactant production in 3rd trimester.
What does it mean if a neonate loses weight after birth?
It is a normal loss of water weight. baby should return to birth weight by 2 wks of age.
Symmetric SGA
Early pregnancy complications
Asymmetric SGA
Implies late pregnancy complications.
Causes of LGA
Infant of diabetic mother (IDM)
Erythroblastosis fetalis
IDM
Infant of Diabetic Mother.
Need to be screened for hypoglycemia.
At 3 hrs, normal-term babies BG normalizes at 50-80
IUGR
Intrauterine Growth Restriction
RDS
Respiratory Distress Syndrome.
Results form inadequate surfactant production.
70% chance of RDS at 28-30 wks gestation
RDS Mgmt
O2 therapy, ABG’s
CPAP
Mech ventilation if needed
Artificial surfactant
Meconium aspiration syndrome (MAS)
Meconium enters amniotic fluid and is aspirated.
Common in post-maturity and fetal distress.
MAS CXR findings
Fluffy infiltrates.
Pneumothorax.
Flattened diaphragm.
MAS Mgmt
Suctioning.
Chest phyisiotherapy.
CPAP.
Abx.
Persistent Pulmonary HTN of Newborn (PPHN)
AKA persistent fetal circulation.
Pulm HTN and R to L shunting.
Sustained elevation in Pulm vascular resistance.
Transient tachypnea of the newborn (TTN)
Retained fetal lung fluid. typically happens in term infants.
CHR of perihilar streaking
Resolution occurs in 12-24 hrs
What can cause jaundice?
Any process that increases excess destruction of RBC’s or interferes with bile excretion.
Physiologic Jaundice
Neonates have increased RBC’s and increased destruction, inadequate liver clearance resulting in jaundice. Occurs in first wk of life.
How does physiologic jaundice progress?
Head to toe. Clears in 10-12 days. Starts after 24 hrs of life.
At what serum bilirubin level does jaundice appear?
Total bili levels of 3-5
Do jaundiced infants have high levels of direct or indirect bilirubin?
Indirect, it has not been conjugated by the liver.
Physiologic Jaundice Tx
Feed every 2-3 hrs.
Stay properly hydrated (6-8 wet diapers/day).
Consider phototherapy.
Indirect coombs tests for?
ABO compatability
Kernicterus
Can occur when unconjugated bilirubin reaches high levels.
Neurotoxicity in the brain.
Dangerous levels of bili = ?
20 - 25 mg/dl
Factors suggesting pathologic jaundice?
Levels above 17mg/dl.
Onset in first 24 hrs.
Conjugated bili levels rise.
ABO hemolytic dz
Common, not severe.
Can occur in 10% of pregnancies.
Rh Hemolytic Dz
Much less common, but more severe.
Can accompany any pregnancy where mom has Rh negative blood.
SYmptoms in first 24 hrs
Rhogam
Immunoglobulin that will prevent Rh hemolytic dz.
Breast milk jaundice
Uncommon dz that occurs in healthy thriving newborns and lasts 3 wks to 3 months.
Peaks at 10-15 days of age.
Treat by not nursing for 1-2 days.
BIlirubin level estimation.
Face: 5
Upper chest: 10
Abdomen: 12
Palms and soles > 15
Sudden Infant Death Syndrome (SIDS)
Unexplained death <1 yr of age.
Peak at 2-4 minths of age
Risks: sleeping position, bottle feeding, smoking, overheating.
