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REPRO > Adaptation at Birth > Flashcards

Adaptation at Birth Flashcards

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1
Q

How does the meconium aspiration syndrome present as?

A
  • streaky lung fields

- —not black as it should be

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2
Q

PLacental fxn?

A 
Fetal homeostasis
Gas exchange
Nutrient transport to fetus
Waste product transport from fetus
Acid base balance
Hormone production
Transport of IgG
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3
Q

Name the 3 major shunts in fetal circulation.

A
  • Ductus arteriosus
  • Foramen Ovale
  • Ductus venosus
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4
Q

What % of maternal blood goes to the fetal lungs and why?

A

7%

—-because the lungs is not yet filled with oxygen

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5
Q

How is the baby prepped for birth in the 3rd trimester?

A
  • Surfactant production (allows gas exchange)
  • Accumulation of glycogen – liver, muscle, heart
  • Accumulation of brown fat – between scapulae and around internal organs; Insulation
  • Accumulation of subcutaneous fat
  • Swallowing amniotic fluid
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6
Q

What produces surfacant? What is the role of surfacant?

A
  • by type 2 Pneumocytes

- reduces the surface tension; allows the lungs to fill up easily with air (no collapse of alveoli)

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7
Q

What occurs with reduced amniotic fluid around the baby?

A

Small Hypoplastic lungs

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8
Q

What occurs to the fetus during delivery and labour?

A

Onset of labour – increased catecholamines / cortisol
Synthesis of lung fluid stops
Vaginal delivery – uterine contractions help squeeze out liquid
from lungs

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9
Q

What is the appearance of the baby in the first few secs?

A 
Blue
Starts to breathe
Cries---helps oxygen get into the lungs? 
Gradually goes pink
Cord cut
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10
Q

What affects fetal circulation?

A
  • cord clamped (INCR. placental resistance) and first breath ( decr. resistance)
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11
Q

What occurs with circulatory transition? –search up

A 
Pulmonary vascular resistance drops
Systemic vascular resistance rises
Oxygen tension rises
Circulating prostaglandins drop
Duct constricts
Foramen ovale closes
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12
Q

What occurs to the ductus arteriosus ?

A
  • ductus arteriosus becomes ligamentum arteriosus
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13
Q

Ductus venosus becomes_______

A

Ligamentum teres

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14
Q

What may occur to the foramen ovale?

A
  • may persist as Patent Foramen Ovale (10%)
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15
Q

What may occur to the foramen ovale?

A
  • may persist as Patent Foramen Ovale (10%)
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16
Q

WHat occurs with persistent pulmonary hypertension?

A
  • FAILURE of normal circulatory transition d.t Lung vascular resistance failing to fall; SHUNTS remain
    (surfacant deplete; lungs full of fluid)
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17
Q

What is a sig. finding for PPH?

A
  • anything more than 3% difference between the pre and post ductal saturation
    = PPH
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18
Q

What is the management of PPHN?

A
  • dialyate given direct to the fetal lungs
  • ventilation
  • oxygen
  • nitric oxide
  • sedation
  • inotropes
  • ECLS
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19
Q

What does Transient Tachypnea present as? And Why?

Study These Flashcards
A
  • in big healthy bbies
  • —grunt and breathe faster
  • born by C-section
  • no lung squeeze!
  • —-recovers quickly
20
Q

What should be done in the first few hrs, post delivery?

Study These Flashcards
A

Thermoregulation
Glucose homeostasis
Nutrition

21
Q

How to keep bbies warm?

Study These Flashcards
A
  • cover the HEAD and BODY to stop radiation of body

as bbies have a LARGE surface area and they are wet post-delivery

22
Q

How do bbies attempt to keep warm?

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A
  • non shivering thermogenesis
    Heat produced by breakdown of stored brown adipose tissue in response to catecholamines
  • Not efficient in the first 12 hours of life
    Peripheral vasoconstriction
    —why Newborn babies need help with maintaining temperature
23
Q

Which particular bby has to be kept warm?

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A
  • SGA bbies and preterm bbies
  • Low stores of brown fat
  • Little subcutaneous fat
  • Larger surface area:vol
24
Q

How to keep warm?

Study These Flashcards
A 
Dry
Hat
Skin to skin
Blanket / clothes
Heated Mattress
Incubator
25
How does glucose homeostasis occur?
- Interruption of glucose supply from placenta - Very little oral intake of milk (~5 days for breast milk to set in) - Drop in insulin, increase in glycogen - Mobilisation of hepatic glycogen stores for gluconeogenesis - Ability to use ketones as brain fuel
26
Why may hypoglycemia occur in bbie?
1. incr. energy demands (unwell, hypothermia) 2. low glycogen levels (preterm, small bby) 3. Inappr. insulin/glucagon ratio (hyperinsulinism/ maternal diabetes) 4. Some drugs
27
How to avoid hypoglycemia
Identify those at risk Feed effectively Keep warm Monitor
28
Expectant wgt loss that is normal in bbies?
10% wgt loss | ----some may lose more that 10% ---RISK of HYPERNATREMIC dehydration > usually d/t delayed lactation
29
Why is it important to change the fetal Hb to change to adult Hb?
- to high O2 affinitt (hard to oxygenate fetal tissues) | - fetal Hb break quickly
30
What helps shift the curve to the right?
Incr. in 2,3 BPG helps move the curve to the right
31
What form of JAUNDICE is seen in the first few days of the bby?
- Unconjugated Jaundice; V. high level is DANGEROUS
32
Why does fetal jaundice occur?
Breakdown of fetal haemoglobin Conjugating pathways immature Rise in circulating unconjugated bilirubin early or prolonged jaundice = pathologocical
33
Which bbies are at risk?
``` Hypoxia / asphyxia during delivery Particularly small or large babies Premature babies – a whole other lecture Some maternal illnesses and medications Ill babies – sepsis, congenital anomalies ```
34
What shunts oxygenated blood from the RA to the LA in the fetal circulation?
``` Foramen Ovale (bypasses pulmonary circulation; which is fine as the RA of the fetal heart recieves oxygenated blood) ```
35
What does Ductus Arteriosus shunt blood to and from?
- it shunts blood from the Pulmonary artery to the aorta
36
How is it possible for blood to BYPASS the lungs?
- d.t high pulmonary resistance
37
Name 2 right-to-left shunts in fetal circulation.
- Patent FO and Patent D.A
38
What does blood is shunted to and from in the Ductus Venosus?
-shunts blood from the Umbilical vein to the IVC
39
Does the percentage of blood directed to the lungs increase with gestational age?
YES | becomes 80% of blood redirected to the liver by week 32
40
In utero the patency of Ductus Arteriosus depends on what?
- maintained by HIGH levels of Prostaglandins ----METABOLIZED by the lung (level drops with incr. blood flow to lungs) - low fetal pO2
41
Explain how the ductus arteriosus closes?
- physiological closure in first few hrs/ days - (anatomical closure in 7-10 days) - reduced PVR = Reduced flow - decr. PGE2 circulation d.t INCR. lung metabolism - rising arterial concentrations in blood
42
What occurs with failure of hte cardiorespiratory adaptation?
- Asphyxia - Prematurity - sepsis - hypoxia - cold stress
43
What are the signs of PPHN?
- asphyxia - tachypnea - Respiratory acidosis - Loud, single second heart sound (S2) or a harsh systolic murmur (secondary to tricuspid regurgitation) - Low Apgar scores - Meconium staining - Cyanosis; poor cardiac function and perfusion - Systemic hypotension - Symptoms of shock
44
Where are the pre and post ductal sats taken from and what is a concerning finding?
- Pre-ductal= right hand - Post- ductal= Left foot ----diff. of >10% indicative of Pulmonary hypertension !
45
What are the 3 methods of heat loss in a baby?
- radiation - convection - conduction - evaporation
46
What does suckling of the mother's nipple stimulate?
- the HYPOTHALAMUS >then stimulates Posterior Pituitary> Oxytocin release> milk ejection - Hypothalamus also stimulates the anterior pituitary gland> stimulates PROLACTIN release and MILK prodn
47
Does breast milk have diff. forms of composition?
- Colostrum (lots of IgA, cellular immunity and growth factors) - foremilk - hindmilk

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