Perinatal Period Flashcards
Gestational Period: How many weeks is each:
- preterm
- term
- post term
Preterm gestation less than 37wks
Term gestation 37-42wks
Post term gestation greater than 42wks
Neonatal period and Perinatal period definition?
Neonatal is first 28 days of life + preterm time period.
Perinatal period: from 20 weeks gestation to one month after birth
Describe Neonatal circulation
How many arteries and veins?
oxygenated blood from umbilical vein (through the placenta) feeds into the right atrium which supplies the right ventricle and the left atrium and ventricle through the foramen ovale. Blood is pushed from the right ventricle to the pulmonary trunk which feeds the lungs and the ductus arteriosus. Blood from the left ventricle is pushed into the aorta where the blood from the ductus arteriosus mixes with it and supplies the rest of the body. Deoxygenated blood returns to the placenta via the umbillical arteries.
2 arteries, 1 vein
Describe each:
- ductus venosus
- ductus arteriosus
- foramen ovale
WHat happens to all of these shunts at birth?
Ductus venosus: connects the umbilical vein to IVC, allows oxygenated blood directly from mom to enter circulation in baby.
Ductus arteriosus: communication between main pulmonary artery and the aorta. allows majority of blood to bypass the lungs and go directly to the aorta.
Foramen Ovale: opening between the two atria of the fetal heart, allows oxygenated blood from mom to be channeled directly to left atrium and then onto left ventricle, aorta, and system.
-At birth the systemic vascular resistance switches from low to high and pulmonary vascular resistance switches from high to low thereby closing those shunts.
WHat system is the last to fully develop in utero?
when does surfactant start being produced?
function of surfactant?
respiratory system is the last to fully develop.
Surfactant starts being produced in the 3rd trimester, 28-40wks. usually sufficient by 34wks.
function: reduces surface tension and stabilizes alveoli
Can newborns regulate their temperature well?
No, not really. sensitive to excess heat loss an heat retention.
How does an infants body weight fluctuate in the first few weeks of life?
In first few postnatal days they have 5-10% weight loss, predominantly loss of extracellular water.
Most newborns are back to birth weight by 2weeks of age.
Apgar Scoring system
performed at 1 minute and 5minutes.
Activity: 0 = absent, 1 = arms and legs flexed, 2 = active movement
Pulse: 0 = absent, 1 = below 100 bpm, 2 = over 100BPM
Grimace: 0 = flaccid, 1 = some flexion of extremities, 2 = active motion (sneeze, cough, pull away)
Appearance (skin color): 0 = blue, pale, 1 = body pink, extremities blue, 2 = completely pink
Respiration: 0 = absent, 1 = slow, irregular, 2 = vigorous cry
0-3 = severely depressed
4-6 moderately depressed
7-10 excellent condition
Neonatal Resuscitation
-what is the key feature in this?
-oxygen!!!!!!
Newborn screening:
- what are commonly screen conditions?
- when do these disorders usually develop?
Commonly screened conditions?
- phenylketonuria
- galactosemia
- hemoglobinopathies
- hypothyroidsm
- hearing screening
Disorders usually develop 2-3days after baby has been feeding.
Gestastion age–Size
- small for gestational age
- appropriate for gestational age
- large for gestational age
- Describe where these fall on a growth chart.
SGA: less than 10th percentile
AGA: between 10th and 90th percentile
LGA: above 90th percentile.
Intrauterine Growth Retardation (IUGR), may be symmetric of asymmetric, describe each.
Symmetric: small all over, implies event EARLY in pregnancy such as chromosomal abnormalities, drug or alcohol use, or congenital viral infections*
Asymmetric: head is normal size, body is smaller (only the weight is at or below 10%) implies problem LATE in pregnancy such as pregnancy induced HTN, pre-eclampsia, placental insufficiency*
**Asymmetric is associated with better prognosis.
Causes of LGA?
- infant of DM mother**
- erythroblastosis fetalis (hydrops) (Rh+ baby born to Rh - mother…big bloated tummy)
Normal causes:
- genetics
- male
- post-dates gestation
- multiparty (mother who has had many kids, the more you have, the bigger they get.)
What is normal glucose of newborn baby?
-What are some signs of hypoglycemia in newborn?
Normal glucose of newborn baby is 50-80mg/dL, concentrations below 40-45 should be considered abnormal.
Signs:
- lethargy, poor feeding
- irritability, jitteriness
- apnea, seizures
Tx of newborn hypoglycemia
-IV gluose, continued surveillence until full enteral feedings without supplementation for 24hrs.
Normal respiratory rate of newborn?
____ and ____ contribute to pulmonary vasoconstriction in the newborn!
30-60BPM
hypoxemia and acidosis
Respiratory Distress Syndrome:
- who does this most commonly occur in? Why?
- what can we give the mother to help with lung development in premature delivery?
Commonly in premature babies, 28-30wks gestation b/c their lungs are not fully developed and they do not have sufficient surfactant until 34wks.
-STEROIDS!!!!!!!!!!!!!!!!!!
