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what does the fetal lung do in utero

produce lung fluid which contributes to amniotic fluid


how mania veins and arteries does the placenta heave coming baby

1 umbilical vein
2 arteries


how many shunts are there in the fetus and what are they

ductus arteriosis
ductus venousus
foramen ovale


what does DV do

allows oxygenated blood from the placenta to bypass the liver
leads blood into IVC


what does DA do

allows most of the blood from the right ventricle to bypass the fetus's fluid-filled non-functioning lungs
most of the blood goes into the systemic circulation


what does the foramen ovale do
and what is it

flat opening in the left ventricle
shunts highly oxygenated blood from right atrium to left atrium


what happens to DA after birth

ligamentum arteriorsis


what happens to DV after birth

ligamentum teres


what happens to the foramen ovale after birth

usually closes


what happens in preparation of birth in terms of lungs

surfactant production
in preterm babies mums are given IV dexa to promote surfactant production to reduce the chances of neonatal respiratory distress syndrome


what happens in preparation of birth in terms of glucose

accumulation of glycogen to prepare for he disconnection from the placenta
this is in the heart, muscle, liver
also allows them to deal with the stress of labour


what happens in preparation of birth in terms of fat

accumulation of brown fat between scapulae and around internal organs to keep them warm

accumulation of subcut fat as well


what hormones are increased in labour and delivery

catecholamines and cortisol


colour of the baby when it first comes out - and what happens after it

comes out blue
takes a deep breath
goes pinker
cord gets cut


lung aeration when the baby first comes out - steps

cold when baby comes out
baby becomes more hypoxic because placenta disconnected
CO2 levels rise allowing them to breathe by crying
breathing pushes the pulmonary fluid out of the lungs into the lymphatic tissue


what happens during circulatory transition
what resistance drops and why
which leads to what
what resistant rises
which leads to the closing of what

pulmonary resistance drops because baby starts to breathe

blood starts to circulate through the lungs and needs all of the circulation to go through and not just 7%

systemic vascular resistance rises because the cord is cut leading to oxygen tension rising

left sided pressure increases leading to the closure of FO


what things lead to the cut constricting (FO closing)

pressure imbalance
increased oxygen
decrease prostaglandins due to disconnected placenta


when might the duct tissue not constrict
what can this lead to
what is the treatment

in preterm babies as the tissue is not mature enough to close properly

patent ductus arteriosis

NSAIDs as this decreases the level of prostaglandins


what is persistent pulmonary tension of the newborn

if the pulmonary vascular resistance fails to drop
blood will still cross from right to left via the foramen ovale
baby will stay blue


what are the causes of persistent pulmonary tension of the newborn

sick, septic, asphyxiated, unwell, idiopathic


dx of persistent pulmonary hypertension

sats probe on pre ductal such as the right arm and on post ductal feet
usually 20% difference


treatment of persistent pulmonary hypertension of the newborn

ventilation with a tube
inotropes if theres any myocardial dysfunction
nitric acid - if the above does work - vasodilator for the lungs
ECLS - last line - take the blood out of the baby and oxygenate it then put it back in


how long does transient tachypnoea last
who does it occur in and why

benign, self limiting, resolves in around 24 hours
C section babies - they take longer to reabsorb all the lung fluid


why do babies lose a lot of heat when they are born and through which ways do they lose heat

large surface area
wet when born
conduction, convection, evaporation, radiation


how to keep the baby warm

hat, blanket, skin-to-skin with the mum, heated mattress, incubator


which babies get hypothermia and what can this lead to

babies that are small
predisposes to other problems


what does little oral intake of milk in the first few hours of life lead to in the baby

a drop in insulin and an increase in glycogen and use of hepatic glycogen stores


how are babies adapted to dealing with hypoglycaemia

use ketones as brain fuel


which babies get hypos

babies who are unwell due to increased energy demands
maternal DM/hyperinsulinaemia
small/premature babies have low glycogen stores
drugs in the mother such as labetalol


what does breast feeding reduce the risk of in the mum
why is breast feeding good for the baby

reduced risk of ovarian and breast cancer
transfer of immunoglobulins to the baby[colesterum]