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Neonatal Physiology > Test 2 - Skin, Renal, Lungs, Heart > Flashcards

Test 2 - Skin, Renal, Lungs, Heart Flashcards

1
Q

When is the first structure of the skin developed?

A

60 days of fetal life

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2
Q

By what trimester is the skin similar to that of an adult?

A

3rd

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3
Q

What is the earliest organ system to develop?

A

the skin

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4
Q

At what part of the skin is where tape can disrupt the junction? it is critical for skin integrity

A

The epidermis and the dermis

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5
Q

What layer developes at 5-8 wks from ectoderm. It consists of the stratum corneum and basal layer (brick and mortar.)

A

Epidermis

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6
Q

What layer is not mature until the first week of life or 21-33 days in the preterm infant. And not fully functional until 2-3 years

A

Dermis

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7
Q

What is under the dermis and is where the BAT develops?

A

Hypodermis

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8
Q

When are fingernails and toenails formed?

A

10wks gest.

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9
Q

What are two major functions of the skin?

A
  1. Balances F&E between the fetus and the A.F.

2. Contributes to the vernix which provides insulation and minimizes friction at delivery**

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10
Q

The amount of vernix is associated with…

A

gest age and birth weight - more of vernix leads to more hydrated skin

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11
Q

What are some events that can harm the skin in utero/birthing? Some external skin issues may indicate something inside

A
  • scalp monitoring
  • vacuum extraction
  • forceps
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12
Q

When is the epidermal layer (stratum corneum) present?

A

> 24 weeks. Before then, no real barrier protection

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13
Q

What is the pH of the skin?

A

< 5 - bacteriostatic - bacteria can’t grow well

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14
Q

What can reduce TEWL?

higher humidity = lower H2O losses

A

thermal blankets, plastic covers with humidity, aquaphor

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15
Q

Why is the dermosepidermal cohesion not anchored well in preterm infants?

A

The collagen fibers are widely spaced. As the collagen gets closer the binding increases

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16
Q

What is responsible for the stretch of the skin?

A

elastin

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17
Q

When there is a loss in collagen, what are some connective issues in the preterm infant?

A
  • trauma
  • edema
  • fluid loss
  • no insulation (temp instability)
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18
Q

What are the two major mechanism that protects the infant against pathogens?

A
  • acid mantle

- skin colonization

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19
Q

What two systems develop together? And have the highest %of anomalies?

A

GU and genital systems

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20
Q

What two systems develop together? they have the highest % of anomalies

A

GU and gental systems with GU having the highest %

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21
Q

When is urine production established in the fetus?

A

9-10wks

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22
Q

What are the three phases of the kidney’s maturation? and what are the weeks that they occur?

A

Pronephrons - 3-4 wks
Mesonephrons - 5-12 weeks
metanephrons - 5-34 weeks - THE KIDNEY

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23
Q

When do the nephrons stop increasing in number and start their function?

A

34-36 wks

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24
Q

When does the vasculature to the kidneys mature?

A

14-15 wks

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25
Q

Why is the BF to the kidneys decreased in fetal life and what is the major way the fetus gets rid of waste?

A
  1. increase in vasculature resistance
  2. low systemic BF

The placenta*

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26
Q

what system is in charge of keeping a balance with Blood pressure, Na, K, and blood flow

A

Renin-angiotensin-aldosterone system

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27
Q

When is the bladder formed?

A

6wks

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28
Q

GFR doubles in the 1 week of life d/t

A

increased MAP, renal BF, and permeability of glomerular surface area = increase U/O

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29
Q

decrease in Na++ excretion and vascular resistance and

increase in concentration of urine and BF are all

A

postnatal changes

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30
Q

explain the route of how urine is created

A
  1. blood passes through capillaries
  2. plasma is filtered thru glomerular
  3. filtrate is collected in Bowman’s space and enters tubules
  4. excreted as urine
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31
Q

What is the main controller of GFR. If low _____ then there is none or very low GFR?

A

Hydrostatic pressure

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32
Q

What are two major impacts on neonates with a low GFR

A
  1. Hard to excrete water = edema, overhydration

2. Longer to excrete drugs = toxicity

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33
Q

At what age is the tubular function mature which helps increase U/O and is more easy to balance the neonates F&E?

A

34Weeks

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34
Q

What can a preterm and term infant do better?
1. dilute
2. concentrate
and why?

A

they can dilute better bc the renal medulla is still immature (loop of henle and Collecting duct) is where the kidneys concentrate urine.

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35
Q

What does specific gravity measure? normal values? and it is highly dependent on the nephron integrity and antidiuretic hormone (vasopressin)

A

it measures the concentrating ability; 1.001-1.020 term; less than that for preterm.

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36
Q

The preterm infant is also at risk for hyperglycemia. we like to start the VLBW infant on what?

A

Starter D5 so they get less sugar and more water because IWL

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37
Q

When does the the AF vol. peak? and how much vol?

A

34 wks—-500-1500ml

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38
Q

What defines oligohydramnios?

Polyhydramnios

A

< 50% at any gest. age

> 2000ml

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39
Q

What is a normal u/o?

oliguria?

A

1-3cc/kg/hr

<0.5cc/kg/hr

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40
Q

What is the pH of urine?

A

> 6 in NB; 4.5-8 in preterm

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41
Q

Creatinine level? and what is the level used to measure?

A

0.4 in term; GFR - when GFR is high, creatinine is low = good u/o

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42
Q 
What is the normal value for:
Na++
K+
BUN
Creatine
A

130-145
3.5-5.5
10-26
0.4

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43
Q

What is is always normal at birth d/t the placental function. Even with infants born w/out kidneys?

A

BUN

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44
Q

What is BUN affected by? and the value decreases when?

A
  • Protein and postnatal age

- the infant can concentrate urine better

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45
Q

When WBC or bacteria is seen in urine?

A

UTI

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46
Q

What drugs are almost cleared exclusively by GF?

A

Aminoglycosides (amikacin and gentamycin)

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47
Q

When is GFR significantly reduced after this tx?

A

NSAIDS - watch U/O!!

indomethacin and ibuprofen - reduces clearance of vanco by 50%

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48
Q

What drug is processed through the GF and tubules? and with high levels it may lead to tubular necrosis.

A

Gentamicin

49
Q

At what age is the lung bud beginning to form?
then the main bronchus
then the 3 branches on (R) and 2 on (L)

A

4 wks
5 wks
6wks

50
Q

What phase of lung development is from 3-6wks gest. The lung buds arise from foregut - this is where the Trachea and esophagus forms from one primary structure into 2

A

Embyronic phase

51
Q

What phase of lung development is from 6-16wks. 20 divisions develop and by the end all major elements including vasculature is developed.
This is where CDH can be seen bc of the diaphragm also developing

A

Pseudograndular

52
Q

What phase of lung development is from 16-26wks? the bronchioles are larger (Canals forming) and at 24wks gas exchange is occurring. (BF is getting closer)

A

Canalicular Phase

53
Q

What phase of lung development is from 26wks to birth? The caps are very close to alveoli, type 2 pnemocytes (surfactant) develop, and steadily increase closer to term.

A

Terminal - walking to the terminal, waiting to be delivered)

54
Q

What phase of the lung development is from 32 wks to 8 years old? 95% develop postnatally.
from 50 million at birth to 300 million at 8years

A

Alveolar

55
Q

Airway # does not increase at ____wks postnatally but growth in length and size thru childhood. focus on nutrition!!

A

16 postnatal

56
Q

At what age is the lung bud beginning to form?
then the main bronchus
then the 3 branches on (R) and 2 on (L)

A

4 wks
5 wks
6wks

57
Q

What phase of lung development is from 3-6wks gest. The lung buds arise from foregut - this is where the Trachea and esophagus forms from one primary structure into 2

A

Embyronic phase

58
Q

What phase of lung development is from 6-16wks. 20 divisions develop and by the end all major elements including vasculature is developed.
This is where CDH can be seen bc of the diaphragm also developing

A

Pseudograndular

59
Q

What phase of lung development is from 16-26wks? the bronchioles are larger (Canals forming) and at 24wks gas exchange is occurring. (BF is getting closer)

A

Canalicular Phase

60
Q

What phase of lung development is from 26wks to birth? The caps are very close to alveoli, type 2 pnemocytes (surfactant) develop, and steadily increase closer to term.

A

Terminal - walking to the terminal, waiting to be delivered)

61
Q

What phase of the lung development is from 32 wks to 8 years old? 95% develop postnatally.
from 50 million at birth to 300 million at 8years

A

Alveolar

62
Q

Airway # does not increase at ____wks postnatally but growth in length and size thru childhood. focus on nutrition!!

A

16 postnatal

63
Q

At what age does a TE fistula or esophageal atresia happen? the foregut doesn’t partition correctly

A

4-5 wks gest

64
Q

What is produced by the lung tissue as early as 20 weeks. traces found in A.F.

A

Surfactant

65
Q

What is the main mechanism of surfactant?

A

helps decrease surface tension to keep terminal sacs open.

it also prevents atelectasis and maintains FRC

66
Q

When are fetal breathing mvmts seen?

it helps with chest wall and diaphragm development

A

10wks gest

67
Q

What are three things that help accelerate lung maturity?

A

glucocorticoids, thyroid hormones, and catecholamines (stress hormones)

68
Q

What is given to reduce: IVH, NEC, mortality, and RDS. but at risk for delivery within 7days

A

antenatal steroids - betamethasone and dexamethosone

69
Q

What is the major marker for surfactant? - shows little risk for RDS

A

PG

70
Q

What ratio measure is the lungs are mature.

if its 2:1 = mature lungs, 1:1 = immature

A

L/S ratio (lecithin to sphingomyelin)

71
Q

When is fluid present?
how much does a term infant produce?
and it is mostly secreted by what type of cells?

A

6wks gest
10-30ml/kg/day
type 1 and 2

72
Q

What is the mechanism of fetal lung fluid removal?

A

a surge of epi, active Na absorption, a rise in O2, and increased pul BF all help to remove fluid in a NB’s lungs

73
Q

What is the natural tendency for stretched objects to return to their resting state?

A

Elastic recoil

74
Q

What detects the needs (CO2/O2 levels) and alters ventilation to help regulate breathing

A

Chemoreceptors

75
Q

What reflex is when the lung is inflated and the breath is terminated which prolongs the expiratory time?

A

Hering-Breuer reflex

76
Q

What is the measure of how elastic the lung tissue is?

A

Lung compliance

-if the curve is lying down (lots of pressure but to change in lung volume) = RDS (low lung vol)

77
Q

If the Lung compliance curve is very high (lots of volume and high pressure) =

A

Obstructive lungs
MAS (ball-valve effect)
Barotrauma (BPD)
Hyperventilation

78
Q

What time constants are 1/2 as long as _____ time constants? 1:2 (I:E ratio)

A

inspiration; expiration - so you have time to empty the entire lung before the next breath

79
Q

Resistance is inversely related to_____.

A

lung volume

80
Q

What is the natural tendency for stretched objects to return to their resting state?

A

Elastic recoil

81
Q

What is the point at which opposing forces balance at the end of expiration? and what is the level?

A

FRC - Functional residual capacity

20-30ml/kg

82
Q

What is the earliest sign of respiratory distress? and if it persists = increase O2 demand, caloric demand, work or breathing

A

tachypnea - >60 Breaths/min

83
Q

Approx. 50% of airway resistance is due to ______.

A

Nasal resistance

84
Q

What causes the Oxyhemoglobin curve to be shifted to the right? think ADULTS, hgb releases O2 to tissues easily

A

up right, except pH

Acidemia, hypercarbia, and hyperthermia

85
Q

What causes the Oxyhemoglobin curve to be shifted to the left? think FETUS, hgb holds onto O2

A

Alkalemia, hypocarbia, and hypothermia

86
Q

A mismatch between ventilation and perfusion causes ______.

A

Hypoxemia - inadequate amt of O2 in blood

87
Q

What is when there is perfusion but no ventilation/oxygenation?

A

Atelectasis

88
Q

What is when there is ventilation but no perfusion?

A

Pulmonary emboli - the O2 is not getting to the vaculature

89
Q

When the sprouting of 2 new blood vessels from existing ones.

A

Angiogenesis

90
Q

What is the first major system to Fx in the embryo?

A

The fetal heart

91
Q

When does the heart begin to beat?

A

22-23 days

92
Q

When does the partitioning of the heart begin?

A

4th-5th week

93
Q

When is the most critical period for heart development?

A

20-50 days (3-7 wks) post fertilization

94
Q

When does the SA node develop

A

5th week

95
Q

When endothelial cells are recruited and differentiated into mature endothelial cells to form new BV

A

Vasculogenesis

96
Q

When the sprouting of 2 new blood vessels from existing ones.

A

Angiogenesis

97
Q

What veins are the main drainage system in the embryo. From the head and feet back to the heart

A

Cardinal veins

98
Q

What % of Congenital heart disease is caused by chromosomal abnormalities?

A

8%

  • trisomy 21, 18, 13
  • Turner’s
  • Down’s
99
Q

Only 2% of CHD is caused by environments factors which include…

A
  • maternal diseases: diabetes, lupus, rubella
  • drugs
  • toxins
100
Q

The EFFICIENCY of the ventricular contraction - how well the vent can empty vol

A

Contractility

101
Q

When the vents contract, 70mmHg, AO and OA valves open, blood is ejected, valves close =

A

systole

102
Q

When mitral/tricuspid valves open, 70% of blood flows in vents (some into aorta & coronary arteries), atrias contract, valves close =

A

Diastole

103
Q

SV X HR; vol. of blood ejected by the LV in 1 minute

A

Cardiac Output

104
Q

What mechanism helps to increase CO?

A

increase in HR and not SV like in adults

105
Q

What law is defined by the hearts pumps what it receives. Balanced out/in; no pooling

A

Frank-Starling Law

increase in EDP will = increase in SV!

106
Q

What is the vol of blood in vents immediately before a contraction?

A

Preload - End Diastolic pressure

107
Q

The EFFICIENCY of the ventricular contraction - how well the vent can empty vol

A

Contractility

108
Q

What is the pressure/resistance the heart must pump against to empty its contents?

A

Afterload

109
Q

What is the difference between PVR and SVR?

A

PVR - RV afterload

SVR - LV afterload

110
Q

When a baby has very high pressures and can’t get blood to lungs - PVR is very high

A

PPHN

111
Q

What is when the CO is decreased and can’t meet metabolic demands = myocardial dysfunction

A

Congestive heart failure

112
Q

When does PVR start to fall in the postnatal life?

A

2-8weeks

113
Q

Explain the patho of CHF

A
  • Peripheral vasoconstriction - decreased BF to renal system
  • Hyperaldosteronism
  • Na + H2O retension=edema
114
Q

What is the first sign of pulmonary edema?

What rhythm is heard d/t abnormal filling bc of dilated vent

A

Tachypnea

Gallop

115
Q

What is the earliest signs of CHF in children? also seen is

A

Hepatomegaly
periorbital edema
Diaphoresis

116
Q

What is the difference in Heart block and bradycardia?

A

The p wave is not related to QRS. In bradycardia, a QRS follows every P wave

117
Q

If the BPs are >15mmHg in the upper compared to the lower, this usually =

A

Coarctation

118
Q

If the infant continues to have acrocyanosis >24hrs old think…

A

The Heart

119
Q

What is when desaturated blood is leaving the heart, tongue and mucousa are bluish?

A

Central cyanosis

Neonatal Physiology (3 decks)

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