adaptations at birth

Question 1

placental function

Answer 1

• fetal homeostasis
• gas exchange
• nutrient transport to fetus
• excretion of waste products
• acid base balance
• hormone production
• transport igG

Question 2

shunts in fetal circulation

Answer 2

ductus venosus (umbelical vein to ivc)
foramen ovale(right to left atria)
ductus arteriosus(pul. artery to aorta)

Question 3

Preparation for birth

Answer 3

• production of surfactant(by type 2 pnumocytes)
• accumulation of glycogen for starvation
• brown and subcutaneous fat accumulation for insulation
• swallowing of amniotic fluid for lung expansion

Question 4

during labour and delivery

Answer 4

increased catecholamines/ cortisol for stress of labour

• stops production of lung fluids
• vaginal delivery squeezes 30% of lung fluids out and rest is absorbed by babies lymphatics

Question 5

steps in circulation transition

Answer 5

pul. vasc resist drops-> systemic vasc resis rises-> oxygen tension rises ->decrease in circulating prostaglandins-> duct constricts-> closure of foramen ovale

Question 6

fate of ligaments

Answer 6

foramen ovale(FO)-> closes/persists as PFO
ductus arteriosus-> ligamentum arteriosus /PDA
ductus venosus-> ligamentum teres

Question 7

persistent pulmonary hypertension(PPH) measurement

Answer 7

preductal and postductal(right hand always preductal and otherlimbs postductal ) difference greater than 3% high suspicion

Question 8

management of PPH

Answer 8

• ventilation
• oxygen
• nitric oxide- dilates pulmonary vasculature
• sedation- if baby not fully sedated can cause hyperventilation leading to pnuemothorax
• ionotropes
• ECLS(membranous oxygenation )

Question 9

important functions in the first few hours

Answer 9

• thermoregulation
• glucose homestatsis
• nutrition

Question 10

heat loss through

Answer 10

conduction
convection
radiation
evaporation

Question 11

babies need help with thermo regulation

Answer 11

low stores of brown fat
low subcutenous fat
large surface area:vol ratio

Question 12

glucose homeostasis in neonate

Answer 12

placental glucose supply cutoff
very less oral intake 
drop in insulin peak in glycogen 
hepatic glycogen stores used in gluconeogenesis 
ability to use ketones as brain fuel

Question 13

breast feeding

Answer 13

ideal source of baby nutrition

colostrum contains IgA,cellular immunity and growth factors

Question 14

fetal haemoglobin(hb)

Answer 14

adult hemoglobin synthesized slower than fetal hb brokendown leads to physiological anemia

Question 15

neonatal jaundice

Answer 15

Liver enzyme pathways present but immature
Physiological Jaundice
Breakdown of fetal haemoglobin
Conjugating pathways immature
Rise in circulating unconjugated bilirubin
Generally not harmful unless very high levels
Early or prolonged jaundice may be pathological

Question 16

treatment of neonatal jaundice

Answer 16

blue light therapy converts bilirubin into