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Lindsey's LC Unit 3 > Physiologic Adaptions of the Newborn > Flashcards

Physiologic Adaptions of the Newborn Flashcards

1
Q

What is the purpose of the ductus arteriosus?

A

it shunts blood from the pulmonary artery directly into the descending aorta

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2
Q

What is primary apnea in an infant?

A
  • baby isn’t breathing at delivery, but stimulation easily initiates a cry
  • HR and BP are relatively maintained
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3
Q

At birth, the infant takes a breath, causing decreased resistance in the pulmonary vasculature, which causes LA pressure to _____, thereby closing the foramen ovale.

A

increase

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4
Q

Deoxygenated blood entering the RA from the SVC goes into the RV, then thru the main pulmonary artery, through the ______, and down the descending aorta because of high fetal pulmonary artery resistance.

A

patent ductus arteriosus

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5
Q

What is the purpose of the ductus venosus?

A

passes oxygenated blood from the umbilical vein around the liver to the IVC

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6
Q

_____ is a phospholipid-protein complex that lowers surface tension within air spaces, preventing alveolar collapse at end-expiration and allowing easy ventilation (compliant lungs).

A

Surfactant

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7
Q

Most highly oxygenated blood reaching the heart via the IVC is diverted through the _____ and pumped out the aorta to the head and body.

A

foramen ovale

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8
Q

What response to suction would earn the baby an APGAR category score of 2?

A

coughing, sneezing, or crying

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9
Q

How can you tell if an infant has a persistent R to L shunt?

A
  • differential saturation in pre-ductal (R arm) and post-ductal (leg, umbilical arterial catheter) circulation
  • oxygen saturation higher in the right arm than in the descending aorta (leg)
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10
Q

Name the phase of lung development:

  • 26-36 weeks’ gestation
  • thinning of interstitial space
  • closer association of capillaries to air spaces and type I cells
A

Saccular Phase

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11
Q

Prior to 22-24 weeks gestation, the capacity for ventilation is limited by ______ and _____.

A
  • a lack of air spaces
  • the distance of capillaries from rudimentary air space
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12
Q

Name the factors that maintain pulmonary vasoconstriction and increase PVR (5).

A
  1. low pO2
  2. low pH
  3. high pCO2
  4. leukotrienes
  5. endothelin
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13
Q

What is the Alveolar Phase of lung development?

A
  • 36 weeks’ gestation to 3 or more years
  • presence of true alveoli
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14
Q

______ and decreased prostaglandins cause the ductus arteriosus to close.

A

Increased oxygen

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15
Q

What heart rate would earn the baby an APGAR category score of 2?

A

greater than 100

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16
Q

What creates the functional residual capacity (FRC)?

A

surfactant allowing the airspace to remain partially inflated at end expiration

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17
Q

Surfactant is stored within Type II cells as _____,

A

lamellar bodies

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18
Q

At birth, the infant takes a breath, causing decreased resistance in the ______, which causes LA pressure to increase, thereby closing the foramen ovale.

A

pulmonary vasculature

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19
Q

Deoxygenated blood entering the RA from the SVC goes into the RV, then thru the main pulmonary artery, through the patent ductus arteriosus, and down the descending aorta because of _______.

A

high fetal pulmonary artery resistance

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20
Q

What is Persistent Pulmonary Hypertension of the Newborn (PPHN)?

A
  • increased pulmonary vascular resistance
  • decreased systemic vascular resistance (hypotension, shock) –> R to L shunting recurs or continues
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21
Q

Surfactant is produced by _____.

A

Type II cells

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22
Q

________ blood entering the RA from the SVC goes into the RV, then thru the main pulmonary artery, through the patent ductus arteriosus, and down the descending aorta because of high fetal pulmonary artery resistance.

A

Deoxygenated

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23
Q

What is the Canalicular Phase of lung development?

A
  • 17-27 weeks’ gestation
  • type II cells begin to differentiate
  • capillary network begins to form
24
Q

Name the factors that promote pulmonary vasodilation and lower PVR (6).

A
  1. alveolar distension
  2. high pO2
  3. high pH
  4. low pCO2
  5. nitric oxide
  6. prostacyclin
25
Q

What tone would earn the baby an APGAR category score of 2?

A

active motion

26
Q

Why do babies with surfactant deficiency grunt?

A

Grunting provides a positive end expiratory pressure, or PEEP

27
Q

Blood entering the fetus through the umbilical vein is conducted via the ductus venosus to the ____ to bypass the hepatic circulation.

A

IVC

28
Q

What is secondary apnea in an infant?

A
  • baby isn’t breathing at delivery and requires positive pressure ventilation to establish lung inflation and to begin regular respirations
  • HR and BP fall quickly
  • death will occur without rescue ventilation
29
Q

What does the ductus venosus become?

A

the ligamentum venosum

30
Q

What keeps the PDA open?

A

prostaglandins E1 and E2

“PGE kEEEEEps it open”

31
Q

At birth, the infant takes a breath, causing _____ in the pulmonary vasculature, which causes LA pressure to increase, thereby closing the foramen ovale.

A

decreased resistance

32
Q

What helps close a PDA?

A

indomethacin

“ENDOmethacin ENDS patency”

33
Q

Blood entering the fetus through the umbilical vein is conducted via the ductus venosus to the IVC to bypass the _______.

A

hepatic circulation

34
Q

Increased oxygen and decreased prostaglandins cause the _______ to close.

A

ductus arteriosus

35
Q

What is surfactant comprised of?

A
  • 90% lipid (phosphatidylcholine, phosphatidylglycerol)
  • 10% protein (proteins A,B,C,D)
36
Q

In the fetus, the pulmonary epithelium secretes fluid by ______.

A

active Cl secretion

37
Q

What color would earn the baby an APGAR category score of 2?

A

completely pink

38
Q

Name 5 requirements for normal cardiopulmonary adaptation at birth.

A
  1. Fetal lung fluid absorption
  2. Expansion of the lungs with establishment of functional residual capacity
  3. Increased systemic vascular resistance
  4. Decreased pulmonary vascular resistance
  5. Closure of fetal R to L shunts
39
Q

What is the Saccular Phase of lung development?

A
  • 26-36 weeks’ gestation
  • thinning of interstitial space
  • closer association of capillaries to air spaces and type I cells
40
Q

What respirations would earn the baby an APGAR category score of 2?

A

regular, crying

41
Q

What do infant lungs with surfactant deficiency look like on CXR?

A
  • diffuse microatelectasis (“reticulogranular pattern” or “ground glass” appearance)
  • air bronchograms – very poorly aerated lungs, so called “white-out”
42
Q

What is the purpose of the foramen ovale?

A

diverts oxygenated blood from the RA to the LA

43
Q

Increased oxygen and ______ cause the ductus arteriosus to close.

A

decreased prostaglandins

44
Q

Most highly oxygenated blood reaching the heart via the ____ is diverted through the foramen ovale and pumped out the aorta to the head and body.

A

IVC

45
Q

At birth, the infant takes a breath, causing decreased resistance in the pulmonary vasculature, which causes LA pressure to increase, thereby causing _______.

A

the foramen ovale to close

46
Q

Surfactant is extruded as ______ into the airspace after the lamellar bodies fuse with the cell membrane.

A

tubular myelin

47
Q

Name the phase of lung development:

  • 36 weeks’ gestation to 3 or more years
  • presence of true alveoli
A

Alveolar Phase

48
Q

What is a sign that the newborn has hypoglycemia?

A

they’re jittery

49
Q

Blood entering the fetus through the umbilical vein is conducted via the ______ to the IVC to bypass the hepatic circulation.

A

ductus venosus

50
Q

Name the phase of lung development:

  • 17-27 weeks’ gestation
  • type II cells begin to differentiate
  • capillary network begins to form
A

Canalicular Phase

51
Q

Approaching labor signals the absorption of lung fluid: switch to _______ rather than Cl secretion.

A

active Na absorption

52
Q

What does the foramen ovale become?

A

the fossa ovalis

53
Q

What does the ductus arteriosis become?

A

the ligamentum arteriosum

54
Q

Approximately ___% of infants will require some assistance in breathing at delivery.

A

10%

55
Q

Failure of fluid absorption leads to retained fetal lung fluid or _____.

A

TTN (Transient Tachypnea of the Newborn)

Lindsey's LC Unit 3 (18 decks)

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