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Child Health > Perinatal Adaptation > Flashcards

Perinatal Adaptation Flashcards

1
Q

What are the functions of the placenta?

A 
Foetal homeostasis
Gas exchange
Nutrition transport
Waste product transport
Acid-base balance
Hormone production
Transport of IgG
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2
Q

What does the placenta ultimately prepare the baby for?

A

Delivery

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3
Q

What are the three shunts present in the foetal circulation?

A

Ductus venosus, foramen ovale, ductus arteriosus

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4
Q

What should happen to all three shunts in the foetal circulation after the baby is born?

A

They should close

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5
Q

How much of the foetal output goes to the lungs?

A

Only 7%

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6
Q

What shunt does oxygenated blood pass through when it is passing from the liver to the heart?

A

Ductus venosus

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7
Q

What does the foramen ovale allow?

A

Allows blood to pass from the right ventricle to the left ventricle

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8
Q

Why does very little blood go to the right ventricle in the foetal circulation?

A

The lungs are not fully developed yet so blood is not oxygenated there

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9
Q

What shunt does blood pass through when going to the foetal lungs?

A

The ductus arteriosus

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10
Q

Why is the foetus in a more hypoxic state than the delivered baby?

A

Oxygenated and deoxygenated blood is mixed in the foetal circulation

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11
Q

How does the baby prepare for being born during the third trimester?

A

Produces surfactant
Accumulates subcutaneous fat, glycogen and brown fat
Swallowing amniotic fluid

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12
Q

Where does brown fat accumulate in a baby?

A

Between the scapulae and around the internal organs

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13
Q

What purpose does swallowing the amniotic fluid serve?

A

Helps to grow and expand the lungs

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14
Q

What occurs in the foetus during the onset of labour?

A

There are increased catecholamines and cortisol

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15
Q

When does synthesis of fluid stop in the foetus?

A

Once labour has commenced and the baby is being delivered

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16
Q

How does vaginal delivery help the lungs adapt?

A

Squeezes the lungs = gets rid of 30% of 100ml lung content

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17
Q

How does the baby get rid of 70% of the fluid in its lungs after it is born?

A

By crying

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18
Q

What does a baby do in the first seconds after it is born?

A

Baby is blue, starts to breathe, begins to cry, gradually turns pink, cord is cut (usually delayed for 1 min)

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19
Q

What happens to vascular resistance once the baby is born?

A

Pulmonary vascular resistance drops and systemic vascular resistance rises

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20
Q

What circulatory changes occur once a baby is born?

A

Circulating prostaglandins drop

Duct constricts and foramen ovale closes

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21
Q

What causes the foetal ducts to closes after birth?

A

pO2 increases

Flow and prostaglandins decrease

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22
Q

What happens to the foetal shunts after birth?

A

Foramen ovale = closes or persists (10%)
Ductus arteriosus = become ligamentum arteriosus (rarely persists)
Ductus venosus = becomes ligamentum teres

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23
Q

What can cause the failure of cardiopulmonary adaption?

A

Non-functioning placenta = alters acid-base balance
Prematurity
Sepsis
Prolonged hypoxic state

24
Q

What is the underlying reason for persistent pulmonary hypertension of the newborn?

A

Failure of the cardiopulmonary adaption

25
Q

Why can persistent pulmonary hypertension of the newborn be life-threatening?

A

Lungs are unable to inflate so have high pressure which prevents the oxygenation of blood

26
Q

Why does mixing of deoxygenated and oxygenated blood occur in persistent pulmonary hypertension of the newborn?

A

Foetal shunts don’t close as systemic vascular pressure is lower than pulmonary vascular pressure

27
Q

What is used to diagnose persistent pulmonary hypertension of the newborn?

A

Pre-imposed ductal saturation monitoring = difference of more than 3% is diagnostic

28
Q

How is pre-imposed ductal saturation monitoring carried out?

A

Probe put on right hand (measures pre-ductal saturation) and another put on left foot (measures post-ductal saturation)

29
Q

How is persistent pulmonary hypertension of the newborn treated?

A

Ventilation, oxygen, nitric oxide (must be careful not to over-correct), sedation, inotropes, ECLS

30
Q

What are some features of transient tachypnoea?

A

Common, usually diagnosis of exclusion, resolves quickly, baby may grunt and usually gets infection screening

31
Q

What causes transient tachypnoea?

A

Usually occurs in big healthy babies born by section = no vaginal squeeze to empty fluid from lungs

32
Q

What are some factors that contribute to a baby’s ability to thermoregulate?

A

Large surface area = babies proportionally have large head
Wet when born
Unable to shiver
Peripheral vasoconstriction

33
Q

What are the four ways heat can be lost?

A

Evaporation, conduction, convection, radiation

34
Q

What is the main way babies produce heat?

A

Non-shivering thermogenesis = heat produced by breakdown of brown fat in response to catecholamines

35
Q

What is the main issue with using non-shivering thermogenesis as main way to produce heat?

A

Process isn’t effective in first 12hrs of life

36
Q

What temperature should babies be kept between?

A

36.5-37.5 degrees

37
Q

Why is hypothermia common in premature and small full term babies?

A

They have low stores of brown fat, little subcutaneous fat and a larger surface area:volume ratio

38
Q

How may hypothermia be prevented?

A

Dry the baby, put on a hat, skin to skin contact (best option), blanket/clothes, heated mattress, incubator

39
Q

What happens to the baby’s glucose homeostasis once it is born?

A

Interruption to glucose supply from placenta and very little oral intake of milk = drop in insulin and increase in glycogen

40
Q

How do babies control their glucose homeostasis?

A

Mobilisation of hepatic glycogen stores for gluconeogenesis

Able to use ketones as brain fuel

41
Q

How may hypoglycaemia arise in a baby?

A

Increased energy demands = unwell, hypothermia
Low glycogen stores = small baby, premature
Inappropriate insulin:glucagon ratio = maternal diabetes, hyperinsulinaemia (usually transient)
Some drugs = beta blockers

42
Q

What is the aim of the UNICEF Baby Friendly Initiative?

A

Help promote and support breastfeeding

43
Q

What occurs during breastfeeding?

A

Baby starts to suckle = rooting and suck reflex
Feedback loop causes increase in supply
Composition changes = colostrum, foremilk, hindmilk

44
Q

What are some benefits of breastfeeding?

A

Prevents cancer and post-natal depression
Cheaper and easier than bottle feeding
Helps with bonding

45
Q

How much weight are babies expected to lose after their are born?

A

About 10% of their birth weight

46
Q

Why does foetal haemoglobin become disadvantageous?

A

Has high affinity for oxygen but doesn’t release it easily to tissues

47
Q

What shifts the oxygen dissociation curve to the right in babies once they are born?

A

Increase in 2,3 BPG

48
Q

What impact does the slower synthesis of adult haemoglobin have?

A

Causes physiological anaemia in babies between 8-10 weeks (reticulocyte count should be checked to ensure this isn’t any underlying pathology)

49
Q

Where does haematopoiesis move to once the baby is born?

A

From the liver to the bone marrow

50
Q

What causes physiological jaundice in babies?

A

Liver enzymes present but immature = only harmful if high levels of unconjugated bilirubin

51
Q

How does jaundice arise in babies?

A

Foetal haemoglobin is broken down but conjugation pathways are immature = rise in unconjugated bilirubin

52
Q

When may jaundice in babies be pathological?

A

If it is prolonged or has an early onset

53
Q

How is jaundice treated in babies?

A

Phototherapy or exchange transfusion (only if severe)

54
Q

Why is unconjugated bilirubin harmful in babies?

A

May cross BBB and settle in basal ganglia = causes cerebral palsy in later life

55
Q

How is phototherapy used to treat jaundice in babies

A

Blue light used to change unconjugated bilirubin to excretable form and babies then pee it out

56
Q

What are the risk factors for adaption problems in a foetus?

A 
Hypoxia or asphyxia during delivery
Very small/large babies
Prematurity
Maternal illness or medications
Ill babies (sepsis, congenital abnormalities)

Child Health (27 decks)

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