Neonatal Adaptation Flashcards

(50 cards)

1
Q

what is meconium?

A

dark green substance forming the first faeces of a newborn infant

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2
Q

what happens in meconium aspiration?

A

blocks with airway passages and causes an inflammatory response

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3
Q

name the functions of the placenta

A
fetal homeostasis 
gas exchange 
nutrient transport to fetus 
waste transport from the foetus 
acid base balance 
hormone production 
transport of IgG
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4
Q

3 shunts in the fatal circulation

A

ductus venosus
foramen ovale
ductus arteriolus

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5
Q

how much of the blood goes to the lungs?

A

7%

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6
Q

why does the blood need to be oxygenated by the mother?

A

lungs haven’t expanded yet and are full of fluid

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7
Q

where is the ductus venous and what does it do?

A

before the liver and transports oxygenated blood to the foetus

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8
Q

where is the foramen ovale?

A

between the right and left atrium so that blood can pass through

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9
Q

what is the role of the ductus arteriosus?

A

takes the blood from the ventricles into the aorta so that it doesn’t all go to the lungs

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10
Q

what is more hypoxic foetus or baby?

A

foetus

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11
Q

what is the role of the blood going to the lungs?

A

perfusion rather than oxygenation

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12
Q

what is produced in the 3rd trimester?

A

surfactant

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13
Q

what accumulates before birth?

A

glycogen in liver, muscle and the heart

brown fat between scapulae and around internal organs

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14
Q

what is swallowed and inhaled before birth?

A

amniotic fluid to fill the lungs and help them grow

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15
Q

which hormone is increased in the onset of labour?

A

catecholamines

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16
Q

what stops being synthesised on the onset of labour?

A

lung fluid

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17
Q

what does vaginal delivery do to help the lungs?

A

squeezes lungs to remove some fluid but the rest is removed by crying

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18
Q

is cord clamping delayed or immediate?

A

delayed

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19
Q

what happens to the pulmonary and systemic vascular resistances in transition?

A

pulmonary drops

systemic rises

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20
Q

what happens to the oxygen tension in transition?

A

rises

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21
Q

circulating prostaglandins increase in transition. T/F

A

false they drop

22
Q

what happens to the ducts and foramen ovale in transition?

A

ducts constrict

foramen ovale closes

23
Q

what contributes to the duct constriction?

A

increase in o2 sats
decrease in blood flow
decrease in prostaglandins

24
Q

fate of the foramen ovale

A

closes or persists

25
fate of the foramen ovale
closes or persists as PFO in 10%
26
fate of the ductus arteriosus
becomes ligamentum arteriosus | can remain persistent but uncommon
27
fate of the ductus venosus
becomes ligamentum teres
28
what causes PPH?
poor transition eg solid lungs, no surfactant
29
what is the result of PPH?
shunts from foetal life remain so can be life threatening
30
how is PPH diagnosed?
pre and post ductal sat monitoring right hand and left foot - more than 3% difference
31
management of PPH
``` ventilate O2 nitric oxide sedation inotropes ECMO (ECLS) ```
32
how is transient tachypnoea diagnosed?
diagnosis of exclusion | baby is breathing faster, can be grunty and can develop an infection
33
what causes transient tachypnoea?
lack of lung squeezing and baby is taking longer to absorb fluid
34
treatment of transient tachypnoea
generally resolves itself
35
3 most important factors in the first few hours
thermoregulation glucose homeostasis nutrition
36
what causes babies to get cold easier?
large surface area wet when born no shivering
37
what is the main source of heat production?
non-shivering thermogenesis | - heat produced by breakdown of brown adipose tissue in response to catecholamines
38
issue with non-shivering thermogenesis
not effective in first 12 hours
39
main ways to keep newborn babies warm
``` dry hat skin to skin blanket/clothes heated mattress incubator ```
40
how is glucose homeostasis maintained after supply from placenta stops?
drop in insulin, increase in glycogen mobilisation of hepatic glycogen stores for gluconeogensis ability to use ketones as brain fuel
41
what reflex does breastfeeding stimulate?
rooting and suck which causes a feedback loop to increase the supply
42
composition changes in breast milk
colostrum -> fore milk and hind milk
43
how much weight do babies lose from their birth weight/?
10%
44
key with weight in babies
as long as they are following a centile and not crossing
45
where does haematopoiesis move to?
bone marrow
46
why do babies have physiological anaemia?
adult Hb synthesised more slowly than fetal Hb broken down
47
what causes physiological jaundice in babies?
breakdown of fetal haemoglobin conjugating pathways immature risk in circulating unconjugated haemoglobin
48
why is prolonged jaundice dangerous?
unconjugated bilirubin can cross the BBB
49
how is prolonged jaundice treated?
phototherapy or blood transfusion
50
babies at risk
``` hypoxia/asphyxia particularly small or large babies premature babies some maternal illnesses and medications ill babies ```