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Human Development > Physiological adaptation from foetus to neonate > Flashcards

Physiological adaptation from foetus to neonate Flashcards

1
Q

describe the in utero environment

A
  • Foetus surrounded by amniotic fluid
  • Warm cushioned quiet
  • Fluid filled lungs
  • Foetal circulation
  • Relative hypoxia – oxygen and carbon dioxide exchange via placenta
  • Nutrient acquisition and waste elimination via placenta
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2
Q

what are the lungs like before brith

A
  • Lungs are fluid filled – mediated by active chloride secretion
  • Increasing secretion of surfactant with increasing gestation – starts at 24 weeks gestation, increased by glucocorticoids, cortisol and thyroid hormones
  • The distending pressure of the fluid in the lung is important for lung exansopn and the development of the airways
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3
Q

what does the foetus make breathing efforts

A
  • Foetus makes breathing efforts primarily during sleep
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4
Q

what happens to the foetus lungs at birth

A
  • Physical pressure of labour squeezes some fluid out of the lung the rest goes into the lymphatic system
  • Initial breath causes negative thoracic pressure – the hardest breath of your life, may cause small pneumothoraces from the initial breath
  • Active absorption of alveolar fluid via sodium transport – stimulated by cortisol, catecholamines and thyroid hormone – switches from chloride to sodium absopriton
  • Establishes a functional residual volume, onset of regular respriations
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5
Q

what can the first breath produce

A

small pneumothraces from the initial breath

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6
Q

what happens if you do not have surfactant

A
  • get respiratory distress syndrome
  • in order to treat them you have to give them surfactant and incubate them
  • if you know they are gunna be born pre term then you give high doses of steroids to the mum as cortisol stimulate surfactant production
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7
Q

describe the cardiovascular system of the foetus

A
  • placenta leads to umbilical vein which leads to the ductus venous which pumps the blood into the IVC
  • the IVC goes to the right atrium
  • it can then go to the right ventricle, into the pulmonary artery pulomyar vein and into the left atrium
  • or it can go to the right ventricle pulmonary artery and ductus arteries into the aorta
  • or it can go into the the foramen oval to the left atrium then left ventricle then aorta then internal lilacs and umbilical artery
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8
Q

where does most of the oxygenated blood supply go

A

supply the brain, and the coronary vessels from the heart

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9
Q

the diameter of the ductus arterioles can equal that of the …

A

aorta

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10
Q

what happens when the umbilical cord is clamped

A
  • Umbilical cord is clamped
  • And someone will cut it
  • So the blood through the umbilical vessels are stop
  • All that is left is the artery and body so the systemic vascular resistance rises
  • The lungs have opened up the pulmonary blood flow has increased and pulmonary vascular resistance drops due to more oxygen, this reduces the blood pressure in the lungs
  • RA pressure drops, LA pressure rises, reducing flow through foramen ovale
  • Flow preferentially goes to RV and pulmonary artery
  • Flow through ductus arteriosus changes
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11
Q

what can the umbilical arteries and veins be used for

A
  • the umbiclia arteries can be used for quick access therefore they can give richly concentrated infusions via candlers
  • umbilical arterial catheter - gives access to do blood tests and so you can work out the babies blood pressure
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12
Q

what happens in persistent pulmonary hypertension

A
  • this is when the switch does not occur

- all the oxygenated blood is still pumping to the peripheral circulation

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13
Q

what happens once the foetus is born to the cardiovascular system

A
  • ductus arteriosus clsoes
  • foramen ovale closes
  • umbilical vein forms the round ligament of the liver
  • the umbilical arteries either becomes the medial umbilical ligament or the branch of the anterior division of the internal iliac artery
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14
Q

how does the ductus arterioles close

A
  • Closure aided by increased oxygen and decreased prostaglandins (PGE2)
  • Functionally closes within a few days
  • Anatomically changes within a couple of weeks – forming ligamentum arteriosum
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15
Q

how does foramen oval close

A

Fuses in the majority but significant minority have a PFO – this usually doesn’t cause any problems but this can cause stroke in young people,
• Umbilical vein forms the round ligament of the liver

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16
Q

what happens to the umbilical artery after birth

A
  • Partly obliterates and become the medial umbilical ligament
  • Whereas A part remains open as a branch of the anterior division of the internal iliac artery.
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17
Q

when to foetal cortisol levels increase

A

Foetal cortisol levels increase during the third trimester and at birth

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18
Q

what does foetal cortisol levels do

A
  • Stimulates surfactant production
  • Activates thyroid hormone
  • Matures hepatic glucose and gut digestive enzymes
  • Increase in beta-adrenergic receptors
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19
Q

when is there a surge of catecholamines

A

during delivery

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20
Q

what do catecholamines do

A

• Raises blood pressure
• Supports energy metabolism
• Aids thermogenesis via brown fat - releasing energy as heat rather than ATP
- thyroid hormone surge has similar effects

21
Q

how do babies maintain heat

A
  • chest contact

- thermaingoen in brown adipose tissue

22
Q

what is the main supply of food for the baby in utero and after birth

A
  • glucose in utero

- after birth it is free fatty acids

23
Q

describe metabolic changes that the baby undergoes

A
  • in babies nutritional supply from placenta stops at brith and blood glucose levels fall
  • Reduction in insulin rise in glucagon and catecholamines
  • Newborns tolerate lower blood sugar levels (normal low 2-2.6mmol/L)
  • The use alternative energy soruces such as ketone bodies, free fatty acids
  • Term neonates have laid down fat and glycogen reseveres
24
Q

what are babies more suspectible to in gestational diabetes

A
  • more likely to get hypoglycaemia
  • pancreas is using a lot of insulin in the womb to get rid of glucose but then there is a sugar drop and no sugar for the baby to use insulin in so they are more likely to get hypoglycaemia
25
Q

what is the rooting reflex

A

stroke their bottom lip or cheek they will think it is the breast and they will settle down

26
Q

when should babies pass meconium

A

within 48 hours

  • transition to milk stools within the first few days this is yellow and grey poo
  • If they don’t pass within 48 hours have ot thing about diseases such as blockages or cystic fibrosis
27
Q

what happens if the baby is stressed in utero

A

if the baby is stress.in utero they poo inside, this can go into the lungs and cause damage which reduces surfactant

28
Q

what happens to haematological changes during pregnancy

A
  • Low oxygen levels in-utero. To overcome this:
    * Foetus and neonate have higher red blood cell levels (160-220 g/L)
    • Foetal haemoglobin has higher affinity for O2
  • Hemopoiesis transitions from extra-medullary sites (liver) to bone marrow
  • Postnatally, HbF decreases by ~6 months
  • Clotting is variable – don’t really cross the placenta
  • Clotting factors don’t cross the placenta and neonates will have lower values than adults
  • Neonates are deficient in vitamin K so receive supplementation at birth – inejctoin or oral supplement – some are at risk of having haemorrhoid
29
Q

what is foetal haemoglobin made out of

A

Foetal haemoglobin – 2 alpha 2 gamma

30
Q

what is adult haemoglobin made out of

A

Adult haemoglobin – 2 alpha and 2 beta

31
Q

why is the baby anaemic at 2 months

A

baby seen anaemic at 2 months due to the switch in haemoglobin

32
Q

what causes neonatal jaundice

A
  • The breakdown of foetal red cells results in high levels of bilirubin
  • Poor activity of hepatic glucuronyl transferase leads low levels of conjugation and excretion
  • Therefore, neonatal jaundice is common
  • Red cells start breaking down as soon as the baby is out and haemoglobin is breaking down and bilirubin is being formed
  • Goes to the liver to get conjgualted by glucuronyl transverase so it can be excreted but glucuronyl transferase is not up to the job so bilirubin is not conjgulated
  • Therefore jaundice develops
33
Q

what is the worry with jaucine

A
  • Worry if the bilirubin goes very high, can start depositing itself in the brain and cause cerberoplasy –
34
Q

how do you treat jaundice

A

use blue phototerhapy lights to treat it, it swtiches the chemical formation of the bilirubin molecule so the kidneys can excrete it without conjugulation

35
Q

what time is urine produced from

A
  • it is produced from around 16 weeks gestation
36
Q

where is urine produced form

A
  • it is produced from the kidney
37
Q

what does the placenta do for the kidney

A

it maintains many of the kidneys functions such as

  • excretion
  • acid base balance
38
Q

what does nephrogensis completed by

A

approximately 34 weeks gestation

39
Q

what are babies full of in utero

A
  • 80-90% water in utero
40
Q

why do babies have a natural weight loss when they are born

A
  • because they loose some of there water that they had in Vitor
41
Q

what happens to babys and renal blood flow

A
  • there is an increase in renal blood flow this further increases GFR which continues till mature until 1 month of age
42
Q

how does urine output in a newborn baby work

A
  • Urine output is low on day 1, but all babies should pass urine within 24 hours – if they haven’t do they have an infection, are they dehydrated
43
Q

when does diuresis establish itself

A
  • it establishes itself within the first few days with increase in urine output and loss of water
44
Q

can babys produce concentrated urine

A

– the baby is less able concentrate urine and excrete molecules – in healthy term baby don’t have to worry about this, issue in preterm babies and unwell term babies, if you give then tons of salt the kidney cannot regulate this

45
Q

does the baby have a immune system in utero

A

In-utero, the foetus is relatively immunosuppressed given its dependence on mother

46
Q

what does the immune system primarily rely on postnatally

A
  • innate immune system - although has less capability to mount neutrophil response
  • maternally-derived IgG
47
Q

describe the other parts of the immune system of the baby

A

Cell-mediated immunity favours T-helper cell response, increasing vulnerability to certain infections
Limited humoral response – low IgA, IgM levels
Gains immune benefit from breastmilk
IgA found in mucosal surfaces, complement, lactoferrin, lysozyme

48
Q

what are the disruption to normal transition

A
  • Prematurity
  • Other disease states in baby, e.g. congenital abnormalities, infection, asphyxia
  • Non-labour deliveries, e.g. elective caesareans – baby hasn’t had a chance to do all hormone, it can go into respiratory distress
  • Complicated deliveries
  • Maternal health and medications (including anaesthesia) – baby can be anaesthetised when it comes outs

Human Development (28 decks)

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