Week 3- Neonatology Flashcards
What is a neonate considered?
<30 days of age
What is a newborn considered??
<24 hrs
Are babies breathing inside of the utero??
NOPE
Where does the gas exchange happen for a neonate?
in the placenta!!
Where does the oxygenated blood pass through to the fetus?
1 umbilical vein
Where is the deoxygenated blood carries out of the fetus?
2 umbilical arteries
What are the 3 addition adaptions involved in fetal circulation??
- Ductus venosus
- Foramen ovale
- Ductus arteriosus
What is the ductus venosus?
continuation of umbilical vein, which bypasses most of the blood from the liver and connects the umbilical vein to the inferior vena cava
What is the foramen ovale?
it is a shunt (opening in septum) allows the blood to travel from the right atrium to the left atrium!!!
What is ductus arteriosus?
artery that joins pulmonary system directly to aorta
When the cord is cut after birth, what happens when the baby takes its first breath??
the surface tension that collapsed the alveoli in utero is now broken allowing the opening of the alveoli and spontaneous oxygenation/respirations
What happens to the pulmonary resistance when the blood flow STOPS from the placenta?
it decreases!!!
Where is the pressure greater in the heart of the fetus AFTER birth??
after placental detachement the left side of the heart has more pressure !!!
What are three physiological changes in the fetus POST delivery??
Ventilation
Hemodynamics
Temp Regulation
Explain how the changes in ventilation occurs in post delivery?
due to compression in the neonate during vaginal delivery, fluid is forced from the lungs into the nose/mouth.
with first breath, functional residual capacity is increased and allows gas exchange to occur, if NOT BVM!!
Explain how hemodynamics changes in the fetus post delivery:
as the pulmonary vascular resistance decreases as the lungs are now functioning blood flow increases, and is able to carry oxygen throughout the body
Explain how the temp regulation changes:
due to large surface area, immature regulation and little fat, neonates are at risk of hypothermia and compensate with vasoconstriction and an increase metabolism
What are congenital heart defects?
they range from simple to complex and critical
How do simple defects possibly resolve themselves?
on their own without surgery
Will a baby born with a simple defect have symptoms?
not always
What are examples of simple heart defects??
atrial and ventricular septal defects
patent ductus arteriosus
pulmonary stenosis
Complex and critical defects may cause life threatening symptoms that require immediate treatment, T or F?
TRUE
What is an example of a critical heart condition?
the tetralogy of Fallot
What is an atrial septal defect?
an atrial septal defect , a hole in the wall of the heart between the left and right atria
***basically a hole in the septum!!!
What is a ventricular septal defect??
a hole in the septum between the left and right ventricles
What would the pt present as with VSD?
CHF presentation (crackles in the lungs)
What is a patent ductus arteriosus?
this common type of simple congenital heart defect
when the aorta and the pulmonary artery does not close properly after birth!!!!
What is pulmonary stenosis?
a type of heart valve disease, when the pulmonary valve is too narrow or stiff!!
this affects how well the blood can move from the heart to the pulmonary artery, the blood vessels that connects the heart to the lungs!!!
Many children with pulmonary stenosis do not need treatment!! T or F??
True!!
What is tetralogy of fallot?
A mixture of simple defects:
1. pulmonary stenosis
- a large ventricular septal defect
- an overriding aorta (place in the middle of both ventricles, creating oxygen poor blood!!)
- right ventricular hypertrophy (when the heart has to work harder than normal which makes the muscle of the right ventricle thicker than normal)
What are s/s of a baby with congenital heart defect?
rapid breathing
cyanosis
fatigue
poor blood circulation
puffy face and hands
pale or blue
sweating!!
sleeps a lot (not playful or curious)
tires easily during feeding
What do we do for patients with CHD?
oxygenate them!!
What are four common emergent conditions post delivery in the baby?
meconium staining
apnea
hypovolemia
hypoglycemia
What is meconium aspiration??
when the baby is stressed during labour and gasps while still in the womb, or soon after delivery (when the baby tries to breath on the inside!!!!)
How do we manage meconium aspiration??
wipe around the mouth with a cloth
BULB suction gently (oro to nasal)
What is primary apnea in newborns?
absense of spontaneous resps. after birth, often limiting and reversed with minimal resusciation efforts!
What is secondary apnea?
apnea that exceeds 20 secs
What are causes of hypovolemia in newborns?
dehydration, hemorrhage, sepsis or trauma
How will a baby with hypovolemia present?
mottled, pale, cool skin, lethargic, poor tone
sunken fontanelles!
What are some risk factors for hypoglycemia in new borns??
apnea
preeclampsia, eclampsia
gestational diabetes
How would a baby with hypoglycemia present?
seizure
pale skin
poor tone
lethargy
apnea
Will glucagon work on a newborn?
No, because the mechanism of action is to trigger your liver to convert already stored glucose into a useable form and release it into the blood stream, so babies do not have that storage yet, therefore making it ineffective in the newborn!!
What are the three things we should be assessing post delivery?
term gestation
good muscle tone
breathing or crying
What is vernix???
baby goo lol
protective coating on neonates skin in the utero, dont be alarmed, its normal!!
What are the two stations we need to set up when delivering a baby?
delivery area (OBS kit)
neonatal resus area
- BVM, blanket, towels, oxygen kit, suction and other ALS equipement if present
During a NORMAL delivery- first 30 secs of baby being born…. what do you do??
note time of delivery
note term gestation, good muscle tone and breathing or crying
provide warmth, position or clear airway, dry and stimulate to generate activity and crying
wipe nose and mouth as needed
promote breastfeeding for oxytocin release to prepare for placenta delivery
If patient is NOT term gestation, with good muscle tone or feeble cry… what do we evaluate:
respirations
pulse
consider cardiac monitor (SPO2)
if baby is flaccid, CUT cord and begin neonate resus
Where should the sp02 go on a neonate?
right hand!!
why right? best blood flow
If central cyanosis is present on the neonate BUT respirations are adequate and the HR is greater than 100bpm should we give O2?
no
If HR is less than 100bpm… what do we do???
being PPV with room air for 30 seconds and reevaluate
if after 3o seconds HR
…. ≥ 60bpm but <100 bpm continues with PPV with 100% 02, as indicated.
If HR is <60 bpm after ventilating with room air begin CPR + BVM with 100% 02
Why do we limit oxygen administration in a neonate?
during initial PPV o2 administration is not required due to hyperoxemia which neonates are sensitive to
What is the MR SOPA pneumonic?
Adjust MASK to ensure good seal
Reposition airway to mouth using manual maneoveurs
Suction mouth and nose
Open mouth using manual maneuveurs
Increase Pressure to achieve adequate chest rise
Alternate Airwayyyyy
How is CPR performed on a neonate?
3:1 using your thumbs!! depress chest by 1/3
What can we do to keep in the warmth of a preterm baby?? ( <32 weeks!!)
dried, placed in a plastic bag, freezer bag or foil blanket to retain moisture and avoid hypothermia
As per the BLS standard what circumstances are we to transport very early after the 1st analysis (and defib is indicated)…..
pregnancy presumed to be ≥20 weeks gestation (fundus above umbilicus, ensure manual displacement of uterus to left),
hypothermia,
airway obstruction,
suspected pulmonary embolism,
medication overdose/toxicology, or
other known reversible cause of arrest not addressed”
What is the most common cause of pediatric cardiac arrest?
respiratory arrest!!
