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EMRG 1305 > Week 3- Neonatology > Flashcards

Week 3- Neonatology Flashcards

1
Q

what is a neonate considered?

A

<30 days

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2
Q

What is newborn considered?

A

<24 hrs

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3
Q

Why is fetal circulation different?

A
  • The lungs are not mature enough to enable gas exchange
  • Babies are not breathing in utero, therefore the neonate relies on placenta, which connects maternal/ fetal circulation
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4
Q

Where does the gas exchange happen in fetal circulation?

A
  • Gas exchange occurs in the placenta
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5
Q

What is preferential streaming?

A
  • Cardiovascular system is adapted to ensure the most highly oxygenated blood is delivered to the myocardium and brain
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6
Q

Oxygenated blood passes thru…

A
  • via 1 umbilical vein to the fetus
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7
Q

Deoxygenated blood is carried…

A
  • via 2 umbilical arteries
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8
Q

Ductus Venosus

A
  • continuation of umbilical vein, which by passes most of the blood from the liver and connects the umbilical vein to the inferior vena cava
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9
Q

Foramen Ovale

A
  • shunt (opening in septum) allows blood to travel from the right atrium to the left atrium
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10
Q

Ductus Arteriosus

A
  • artery that joins pulmonary system directly to aorta
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11
Q

What is fetal circulation before birth?

A
  1. O2 and nutrients from maternal blood transferred from placenta thru umbilical vein and most of the blood bypasses immature live via the ductus venous into inferior vena cava
  2. Oxygen rich blood travel into RA (greater pressure between atrias) of the heart thru the foramen ovale to the left atrium (approx 2/3 of O2 rich blood)
  3. Superior vena cava brings deoxygenated blood also into RA, therefore there is mixing of oxygenated & deoxygenated blood in the RA of the fetal heart
  4. From the LA, blood is transferred to the LV into coronary arteries and aorta where oxygenated blood is delivered to the brain as well as kidneys, lungs
  5. Some blood in the RA will pass into the RV where it will transfer into pulmonary artery, but bc alveoli are fluid filled most of the blood is shunted away from the lungs via the ductus arteriosus, into aorta due to the pressure imbalance.
  6. Deoxygenated blood enters systemic circulation and is then carried back to placenta via the umbilical arteries where the blood can be oxygenated and the cycle can occur again
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12
Q

What is the fetal circulation after birth?

A
  • After birth, and cord cutting, the neonate will support itself under normal circumstances

When the baby takes it first breath:
- The surface tension that collapses the alveoli in uteri is now broken allowing the opening of the alveoli, and spontaneous oxygenation/ respiration

Pulmonary resistance decreases and the blood flow from the placenta stops
- The pressure in left side of heart becomes greater than the right when the fetus was in utero

Pressure in aorta; left side of the heart increase systemic vascular resistance
- Pressure changes the fetal shunts close within the first few hours of birth

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13
Q

What are the 3 major physiological changes involved post delivery?

A
  • Ventilation
  • Hemodynamics
  • Temperature regulation
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14
Q

Physiological changes- ventilation

A
  • Due to the compression of neonate during vaginal delivery fluid is forced from the lungs into the nose/ mouth. Once delivery has occured to lungs are inflated with the first breath; which establishes function residual capacity within the lungs; this allows gas exchange to occur. If it doesn’t in can be reproduced with artificial ventilation (BVM)
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15
Q

Physiological changes- hemodynamics

A
  • as the pulmonary vascular resistance decreases as the lungs are not functioning blood flow increases, and is able to carry oxygen throughout the body
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16
Q

Physiological changes- temperature regulation

A
  • Due to large surface area, immature regulation and little fat, neonates are at risk of hypothermia and compensate with vasoconstriction and an increase metabolism
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17
Q

What are some examples of simple heart defects?

A
  • Atrial and ventricular, septal defects
  • Patent ductus arteriosus
  • Pulmonary stenosis
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18
Q

What is an example of critical condition heart defects?

A
  • The tetralogy of fallot

Babies born with this or another critical congenital heart defect typically have low levels of oxygen soon after birth and need surgery within the first year of life

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19
Q

What is atrial septal defect?

A
  • A hole in the wall between the left and right atria
  • The hole causes blood flow from the LA and mix the RA, instead of going to the rest of the body
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20
Q

Why is atrial septal defect considered a simple congenital heart defect?

A
  • b/c the hole may close on its own as the heart grows during childhood
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21
Q

What is ventricular septal defect?

A
  • Is a hole in the wall between the left and right ventricles
  • Blood may flow from the LV and mix with blood in the RV, instead of going to the rest of the body
  • If the hole is large, the heart and lungs may need to work harder to pump blood. In addition, it may cause fluid to build up in the lunhs
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22
Q

What is patent ductus arteriosus?

A
  • Occurs when a connection between the heart’s two major arteries, the aorta and the pulmonary artery, does not close after birth
  • This leaves an opening through which blood can flow when it shouldn’t
23
Q

What is pulmonary stenosis?

A
  • Heart valve disease in which the pulmonary valve is too narrow or stiff
  • This affects how well blood can move from the heart to the pulmonary artery, the blood vessel that connects the heart to the lungs
24
Q

What is tetralogy of fallot?

A
  1. pulmonary stenosis
  2. A large ventricular septal defect
  3. An overriding aorta
  4. Right ventricular hypertrophy
25
Q

What is an overriding aorta?

A
  • With this defect, major blood vessel that carries blood to the body (aorta) is out of place.
  • Instead of it being above the left ventricles. It is located between the two ventricles.
  • As a result, oxygen-poor blood from the RV can flow directly into the aorta instead of into the blood vessel that carries blood to the lungs (pulmonary artery)
26
Q

What is Right Ventricular Hypertrophy?

A
  • When the heart has to work harder than normal which makes the muscle of the right ventricle thicker than normal which
27
Q

What are some other critical congenital heart defects?

A
  • Coarctation of the aorta
  • Double-outlet right ventricle
  • D-transposition of the great arteries
  • Ebstein’s anomaly
  • Interrupted aortic arch
  • Pulmonary atresia with intact ventricular septum
  • Single ventricle
  • Total anomalous pulmonary venous return
  • Tricuspid atresia
  • Truncus arteriosus
28
Q

What are some s/s of CHD?

A
  • Poor weight gain
  • Pale or bluish skin colour
  • Puffy face, hands, and/or feet
  • often irritable, difficult to console
  • Fast breathing when at rest or sleeping
  • Sweating around the head, especially during feeding
  • Sleeps a lot- not playful or curious for any length of time
  • Tires easily during feeding (ex. falls asleep before feeding finishes)
29
Q

What are some s/s of severe defects in newborns?

A
  • Rapid breathing
  • Cyanosis (a bluish tint to the skin, lips, and fingernails)
  • Fatigue (tiredness)
  • Poor blood circulation
30
Q

What does the heart have to do if a newborn has CHD?

A
  • The heart has to work harder than it should.
  • With severe defects, this can lead to heart failure
31
Q

What is heart failure?

A

Heart failure is a condition in which the heart can’t pump enough blood to meet the body’s needs

32
Q

What are symptoms of heart failure?

A
  • SOB or trouble breathing (accessory muscle use, nasal flaring, abdomen)
  • Fatigue with physical activity
  • A buildup of blood and fluid in the lungs
  • Swelling in the ankles, feet, legs, abdomen, and veins in the neck
33
Q

What are some common emergent conditions after delivery?

A
  • Meconium staining
  • Apnea
  • Hypovolemia
  • Hypoglycemia
34
Q

What is meconium aspiration?

A
  • Meconium aspiration happens when a baby is stressed and gasps while still in the womb, or soon after delivery when taking those first breaths of air
  • A baby may inhale amniotic fluid and any meconium in it
  • Block small airways and prevent a baby from breathing properly, causing respiratory distress
  • This typically occurs when the fetus is stressed during labor, especially when the baby is past its due date (breech, trauma, prolonged delivery)
35
Q

What is the management of meconium aspiration?

A

*suctioning can stress a baby out
- wipe away with cloth if present around nose or mouth
- If required, gentle suctioning with a bulb syringe can be used to remove from oro to nasopharynx
- If copious turn head to side to allow gravity to assist
- Neonates are nose breathers, so suction the mouth before the nose to limit possibility of aspiration
- Rigorous suction can cause apnea/ bradycardia

36
Q

What is primary apnea?

A
  • absence of spontaneous respirations after birth; often self limiting an reversed with minimal resuscitation efforts
37
Q

What is secondary apnea?

A

Defined as apnea that exceeds 20 secs and occur for the following reasons:

  • Difficult labor
  • Airway obstruction
  • Hypoglycemia (gestational diabetes or immature liver)
  • Respiratory muscle weakness (preterm babies)
  • Narcotics or CNS depressants (due not reverse with Narcan if drug abuse suspected, due to withdrawals)
38
Q

What is hypovolemia?

A
  • Can occur from dehydration, hemorrhage, sepsis or trauma
  • They will fail the “look test” appearing obviously hypoperfused: (mottled, pale, cool skin, lethargic, poor tone)
  • Sunken fontanelles can indicate hypovolemia
  • Bulging fontanelles can indicate increase ICP
39
Q

Hypoglycemia

A
  • Risk factors include: apnea, preeclampsia/ eclampsia or smaller babies/ twins
  • Can present with: (seizure, pale skin, poor tone, lethargy, apnea)
40
Q

What should you be assessing in a newborn?

A
  • Term gestation
  • Good muscle tone
  • Breathing or crying

If these are present with no abnormalities only supportive care is required

41
Q

Assessment and Management of newborn

A
  • Initial management consists of tactile stimulation to initiate breathing, if not present
  • Clearing airway/ suctioning; if needed, not routine
  • Avoiding hypothermia
  • Delayed cord clamping/ cutting

DRY, WARM, STIMULATE

42
Q

What is vernix?

A
  • Protective coating on neonates skin in utero; don’t be alarmed,
  • Wipe some of it off if needed, it will be gone in 24 hrs
43
Q

Neonatal Resuscitation- what 2 stations do we set up?

A
  1. Delivery area with pad in place, clamps, scissors, pads, sterile gloves, bulb suction
  2. Neonatal resuscitation area BVM, blanket or towels for drying & warmth, oxygen kit, suction. If with ALS other equipment will be present
44
Q

Normal Delivery First 30 secs

A
  • Note time of delivery
  • Term gestation (37-40 wks) & good muscle tone & breathing or crying (note APGAR @ 1 and 5 min)
  • Provide warmth/ position clear airway/ Dry & stimulate to generate activity & crying
  • In crying/ active baby this might be done on mom’s chest where baby is lying- give supportive care/ allow & encourage “nursing” for release of oxytocin
  • Wipe nose/ mouth as need
  • Prepare for delivery of placenta
45
Q

End of 1st 30 secs beginning of next 30 secs

A
  • If pt is not term gestation, with good muscle toner feeble cry
  • Evaluate: resps, pulse, consider use of cardiac monitor & SPO2
  • If baby is floppy cut cord and move to neonatal resus area
46
Q

Preductal SPO2

A
  • Heart & brain receive blood from aorta before ductus arteriosus, and this artery also supplies the right arm of the neonate (pre ductal)
47
Q

Where should SPO2 be placed?

A
  • On the right hand, bc it will give you an accurate reading
48
Q

If neonate HR is above 100…

A
  • Consider blow by O2 near mouth and nose if not hitting the preductal targets
  • If central cyanosis is present but resps appear adequate and the HR is greater than 100 bpm, oxygen not required
49
Q

If neonate HR less than 100 bpm…

A
  • Begin PPV with room air only for 30 secs and reevaluate
  • If after 30 secs HR is >60 bpm but <100 bpm cont with PPV with 100% O2
  • If HR <60 bpm after ventilating with room air begin CPR + BVM with 100% O2
50
Q

Why are we limiting oxygen administration in neonates?

A
  • During initial PPV oxygen admin is not required due to hypoxemia, which neonates are sensitive to
  • Neonates exposed to O2 have changes in cerebral flow and higher risk of chronic lung disease
51
Q

What is the MR SOPA Mnemonic?

A
  • adjusting MASK to assure good seal
  • REPOSITION AIRWAY to mouth using manual maneuvers, “sniffing” position
  • SUCTION mouth and nose secretions, if necessary
  • OPEN MOUTH using manual maneuvers
  • Increase PRESSURE to achieve adequate chest rise
  • ALTERNATE AIRWAY
52
Q

What is the one exception for CPR on Newborns <24 hrs?

A
  • If the pt’s HR is 0. Then DO NOT delay treatment for stimulation, drying, or ventilations only.
  • Move straight to CPR
  • This being stated, if HR is >0 but <60 bpm you must still ventilate with room air before moving to CPR with 100% O2
53
Q

What to do with preterm babies <32 weeks?

A
  • Due to large body surface poor thermoregulation and difficulty retaining moisture preterm babies should not be dried and instead placed in a plastic bag, freezer bag or foil blanket to retain moisture and avoid hypothermia
54
Q

What is the most common cause of arrest in ped’s?

A
  • Respiratory arrest
  • This needs to be identified and managed early or it will lead to poor prognosis

EMRG 1305 (12 decks)

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