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Paediatrics > Physiology of Neonates > Flashcards

Physiology of Neonates Flashcards

1
Q

What carries oxygenated blood to the baby

What carried deoxygenated blood

A

Umbilical vein
Carries O2 blood from placenta to foetus

Umbilical artery x2 - from bifurcation of aorta - placenta

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2
Q

What is the ductus venous and what type of blood

A

Foetal blood vessel connecting umbilical vein from placenta to IVC of baby
Mostly oxygenated
Liver gets most oxygenated blood as first organ where umbilical vein goes

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3
Q

What is the foramen ovale

A

Hole connecting RA-LA

Bypass immature lungs which have a very high pressure

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4
Q

What is the ductus arteriosus

A

Allows blood flow from Pulmonary artery to aorta without travelling through foetal inadequate lungs
If it doesn’t close blood flows from aorta -> Pa

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5
Q

What does ductus arteriosus allow

A

RV to strengthen

Protect lungs from circulatory overload

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6
Q

What does ductus arteriosus carry

A

Low oxygen saturated blood

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7
Q

What is the saturation in a foetus

A

60-70%

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8
Q

When does CVS start to develop

A

End of third week

Heart beats at 4th week

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9
Q

What happens at first breath

A

Move fluids out of lungs and arteries / alveoli in lungs open
Decreases pulmonary vascular resistance
LA pressure > RA pressure which squishes atrial septum closing foramen oval
Foramen ovale closes - hard top open after 14 days
PDA stays open 1-2 days
Others all become ligaments

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10
Q

What are vital signs of newborn

A 
BP 70/40ish 
RR - 30-60
HR- 120-160
Tachy >160
Brady <100
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11
Q

How do new born babies thermoregulate

A

Lack shivering thermogenesis
Rely on metabolic heat
Brown fat innervated by sympathetic
If premature lack brown fat

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12
Q

What are the 4 ways to lose heat

A

Radiation - to colder
Convection - moving air
Evaporation - to water
Conduction - to surface you touch

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13
Q

How do you assess newborn breathing non-invasively

A

Clinical - RR
Blood gas determination - take capillary blood + analyser
Trans-cutaneous PCO2,O2

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14
Q

What should the PaCo2 and PaO2 be in a newborn

A

PaCO2 - 5-6

PaO2 - 8-12

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15
Q

How do you assess breathing invasively

A

Capnography - monitors PaCO2 in intubation

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16
Q

What is TV average and minute volume

A

TV = 4-6ml / kg

Minute ventilaiton = TV x RR

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17
Q

Physiological jaundice

A

Day 2-3 and disappears in 7-10 days or three weeks in prem

Breast feed increases duration

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18
Q

Fluid balance in newborn term

A

Should be able to maintain fluid and electrolyte balance
U+E may be of first 24 hours as mother may have had IV fluids
Normal not to pass urine for 24 hours
Weight loss up to 10% is normal

19
Q

Fluid balance in premature ?

A

Less fat
Increased loss through kidney
Increased insensible water loss

20
Q

Why is there increased loss through kidney in premature

A

Slower GFR
Reduced Na reabsorption
Decreased ability to concentrate or dilute urine

21
Q

Physiological anaemia

A

Reduced RBC production when born then increases

22
Q

What is physiological of anaemia in prematurity

A

Reduced erythropoiesis when first born
Can’t keep up with rapid growth
Blood letting / tests remove blood volume
Infections

23
Q

How do you treat

A

Give iron at 28 days if premature

24
Q

What should happen to Hb when born

A

Should go up to provide O2

25
Q

What do you do if low

A

Look at reticulocyte count to see if haemolytic

26
Q

Why are bloods not accurate 1st 24 hours

A

Affected by mother e.g. if had IV fluid

Repeat

27
Q

What happens if ductus arteriosus doesn’t close

A

Blood goes from aorta to lungs as higher pressure

28
Q

When is surfactant produced

A

24-34 weeks gestation

29
Q

Role of surfactant

A

Reduces force needed to expand the alveoli which reduces lung compliance

30
Q

Why is hypoxia in baby common

A

Normal labour and birth cause hypoxia as contractions stop gas exchange with placenta

31
Q

What does extended hypoxia lead too

A 
Anaerobic respiration
Bradycardia 
Reduced consciousness 
Drop in RR
Eventually HIE
32
Q

Other issues in neonatal resus

A

Large S/A to weight = cold easily
Born wet so lose heat
May have meconium in airway

33
Q

What do you do if baby comes out not crying

A

Dry baby and stimulate
Keep warm under heat lamp or plastic bag if <28 weeks
Stimulate
Calculate APGAR - tone, RR, HR, colour, activity
Given a score for each 0-2

34
Q

When is APGAR carried out

A

1,5 and 10 minutes

35
Q

If not breathing what do you do or HR low

A

5 inflation breaths
- First breath to open up lungs so want large pressure
- Put pressure on mask
Aim is to sustain pressure to get fluid out

36
Q

If this doesn’t work what do you do

A

Continuous pressure

37
Q

What do you do if not improving or HR <60

A 
CPR 
Ratio 3:1 with ventilation breaths 
IV access and drugs
Intubation 
May benefit from hypothermia to prevent HIE
38
Q

How often do you assess

A

30 seconds

39
Q

What does APGAR look at

A 
Appearance
0 =pale / blue 
1 = pink with blue 
Pulse
0 =absent
1 = <100
Grimmace / activity - response to stimulation
0 = floppy 
1 = minimal
Tone
0 = absent
1 = flexed 
Respiration
0 = absent
1 = irregular

Given a score 0-2

40
Q

Delayed cord clamping ?

A

If uncompromised wait 1 minute
Allows blood from placenta to enter baby
Reduce IVH, NEC and improve BP, iron and Hb

41
Q

What are other causes of anaemia

A

Prematurity
Haemolysis
Blood loss
Twin-twin transfusion

42
Q

What causes haemolytic

A

ABO or Rhesus
G6PD
Heriditary spherocytosis

43
Q

What do you do if low blood sugar after birth

A 
Encourage feeding
Observe
Trnasient hypo = common 
If DM mother start hypoglycaemic protocol
- Dextrogel
- IV dextrose 
- IV fluid

Paediatrics (35 decks)

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