Adaptation at Birth

Question 1

name the 3 shunts of the fetal circulation

Answer 1

ductus venosus
foramen ovale
ductus arteriosus

Question 2

where is brown fat located in the fetus?

Answer 2

between scapulae

around internal organs

Question 3

where does glycogen accumulate in a fetus preparing for birth?

Answer 3

liver
muscle
heart

Question 4

what colour is baby when they are born?

Answer 4

blue

Question 5

____ vascular resistance is higher than ___ vascular resistance in a fetus

Answer 5

pulmonary

systemic

Question 6

what happens to the ductus arteriosus and foramen ovale in a fetus?

Answer 6

duct constricts

foramen ovale closes

Question 7

what makes the ductus arteriosus constrict?

Answer 7

increased pO2
decreased flow
decreased prostaglandins

Question 8

the ductus arteriosus becomes what after birth?

Answer 8

ligamentum arteriosus

Question 9

the ductus venosus becomes what after birth?

Answer 9

ligamentum teres

Question 10

the foramen ovale is located between what 2 chambers?

Answer 10

right and left atria

Question 11

persistant pulmonary hypertension of then newborn is caused by? what is the consequence

Answer 11

patent ductus arteriosus and foramen ovale

causes hypoxemia secondary to right-to-left shunting of blood at the foramen ovale and ductus arteriosus.

Question 12

Tx PPHN

Answer 12

ventilation
oxygen
nitric oxide
sedation
inotropes
ECLS

Question 13

how does the baby lose heat after birth

Answer 13

convection
evaporation
conduction
radiation

Question 14

main source of heat production in a newborn?

Answer 14

non-shivering thermogenesis

Question 15

how is heat produced in non-shivering thermogenesis

Answer 15

breakdown of stored brown adipose tissue in response to catecholamines

Question 16

what happens to blood vessels in non-shivering thermogenesis?

Answer 16

peripheral vasoconstriction

Question 17

why are preterm babies at particular risk of hypothermia?

Answer 17

low stores of brown and SC fat

larger surface area to volume

Question 18

how is hypothermia managed in babies?

Answer 18

keep dry
hat
skin to skin
blanket/clothes
heated mattress
incubator

Question 19

there is a/an __ in insulin and a/an ____ in glucose at birth

Answer 19

drop

increase

Question 20

why do small/premature babies get hypoglycaemia?

Answer 20

have low glycogen stores

Question 21

why might a term baby be hypoglycaemic?

Answer 21

increased energy demands eg if unwell/hypothermic

inappropriate insulin/glucagon ratio eg maternal diabetes

Question 22

management of hypoglycaemia at birth?

Answer 22

identify at-risk babies
feed effectively
keep warm
monitor

Question 23

the hypothalamus acts on the __ pituitary to produce ___ which causes milk ejection

Answer 23

posterior

oxytocin

Question 24

the hypothalamus acts on the ___ pituitary to produce ___ which causes milk production

Answer 24

anterior

prolactin

Question 25

increase in 2.3 DPG shifts the O2Hb curve to the ___

Answer 25

right

Question 26

why do babies become slightly anaemic at birth?

Answer 26

fetal Hb breaks down rapidly but adult Hb is slow to make so cant keep up

Question 27

why do babies get jaundice at birth? is this normal?

Answer 27

breakdown of fetal Hb but liver enzyme pathways are still quite immature so there is a rise in circulating bilirubin as they arent that effective yet; NORMAL but in high quantities abnormal

Question 28

who is at risk of adaptation problems?

Answer 28

hypoxia/asphyxia during delivery

Question 29

what is neonatal absence syndrome?

Answer 29

a condition in babies who have been exposed to drugs

Question 30

what happens to a hypoglycaemic baby's pancreas

Answer 30

baby's pancreas gets hypoplastic because its trying to control its mothers blood glucose

Question 31

risk factors for neonatal infection?

Answer 31

if mum got IV antibiotics for a confirmed bacterial infection during labour or in the 24hrs after rupture of membranes >24hrs in term infant preterm baby mum has infection signs

Question 32

causes of unconjugated jaundice in newborns?

Answer 32

``` Physiological Breast Milk Haemolysis Infection Inherited causes Intestinal obstruction ```

Question 33

causes of conjugated jaundice in newborns?

Answer 33

``` Biliary atresia TPN Hypothyroidism α1 Antitrypsin Galactosaemia Cystic Fibrosis Trisomy 21 ```

Question 34

Ix newborn jaundice?

Answer 34

``` serum bilirubin (SBR) FBC Coombs test (DAT) ```