Neonatal Pathophysiology Flashcards
(88 cards)
1
Q
Respiratory Dysfunction
A
conditions that interfere with normal O2 and lung airation/expansion
2
Q
Neonatal asphyxia (chemical)
A
Dec O2 and inc CO2 = accumulation of H+ = respiratory acidosis
3
Q
Respiratory Acidosis
A
Accumulation of H+ caused by dec O2 and inc CO2
4
Q
Neonatal asphyxia (anatomical)
A
Pulmonary blood vessels don’t open maintaining high PVR > persistant foetal circulation
5
Q
Metabolic Acidosis
A
Body cells do not receive O2 > anaerobic metabolism occurs > increased lactic acid production > metabolic acidosis
6
Q
Neonatal asphyxia steps (8)
A
- Respiratory Acidosis
- Persistant foetal circulation
- Metabolic acidosis
- Stress Response
- Hypoglycaemia
- Dec CO and Sufactant (Acidosis)
- Shock
- Cardiac Failure
7
Q
neonatal asphyxia causes (5)
A
- Intrauterine asphyxia
- Respiratory distress syndrom/prematurity
- Maternal medicines that inhibit respiration
- Cardiorespiratory malformations/dysfunctions
- Airway obstruction
8
Q
Respiratory distress syndrome process
A
- Small alveolar = reduced surface area + harder to inflate
- Lack of surfactant = inc surface tension = harder to breath
- Poor ventilation > ventilation/perfusion mismatch = body responds by maintaining high PVR
9
Q
Transient Tachypnoea
A
- Retained fluid in lungs > insufficient clearance
10
Q
Transient tachypnoea aetology (5)
A
- Sufactant immaturity
- Cesarean section
- Breech Delivery
- Birth Asphyxia
- Heavy maternal analgesia
11
Q
Pneumothorax
A
Injury to pleural membranes allowing air to leak in to pleural space
Affected lung collapes: displaces position (and therefore functioning) of heart
12
Q
Meconium Aspiration
A
- Passed before birth and inhaled in first gasping breaths
- Obstructed airway > no lung airation > pneumothorax or pneumonia possible
- Increased in 40+ neonates, breech, foetal stress
13
Q
Pneumonia
A
Infection of respiratory system at before/during birth
14
Q
Pneumonia risk factors
A
PROM
Chorioamnionitis
Low birth weight
15
Q
Respiratory distress manifestations
A
Tachypnoea Dyspnoea ( Recession of chest wall, nasal flaring) Grunting Cyanosis Bradycardia
16
Q
Congenital heart defects
A
- Anatomical anomaly > abnormal blood flow
17
Q
Patent ductus areteriosos physiology
A
- May remain open for days/weeks
- Allows L>R shunting > inc pulmonary blood flow > pulmonary hypertension > cardiac failure
- in some cases bacterial endocarditis
18
Q
Patent ductus arteriosis manifestations
A
- Tachypnoea
- Dysapnoea
- lethargy
- failure-to-thrive
- murmurs
19
Q
Ventricular septal defects definition
A
Defect within interventricular septum causing incomplete separation (smaller defects asymptomatic and likely to close)
20
Q
Ventricular septal defects effects
A
L > R shunting > inc pulmonary blood flow > pulmonary hypertension
Hypertrophy of ventricles
21
Q
Ventricular septal defects manifestations
A
- Tachypnoea
- Dyspnoea
- FTT tachycardia
22
Q
Atrial septal defects definition
A
incomplete septum of atria, may extend to ventricular septum and/or cuspoid valves
23
Q
atrial septal effects physiology
A
L>R shunt that may:
inc pulmonary blood flow > inc pulmonarly hypertension > hypertophy/dilation of R ventricle
Cardiac failure
24
Q
Atrial septal defect manifestations
A
Tachypnoea
Murmors
Mild cyanosis
25
Transposition of great arteries definition
Aorta arises from R ventricle and pulmonary trunk from L ventricle = 2 closed system that dont feed in to each other. initial survival dependant on foetal circulation
26
Transposition of great arteries manifestations
Cyanosis that is not relived by O2 therapy
27
Total anomalous pulmonary veins definition
pulmonary veins not connected to LA
O2 blood returned to RA
initial survival dependant on foetal cirulations
28
total anomalous pulmonary veins manifestations
cyanosis
dyspnoea
tachypnoea
29
Teratology of fallot (4)
- Large ventricular septal defect
- Overriding aorta (opens at ventricular defect and overrides RV)
- pulmonary stenosis
- RV hypertrophy
30
tetralogy of fallot implications
decreased O2 sats
- dec blood flow to pulmonary trunk (R>L shunt)
- dec return to LA
31
tetralogy of fallot manifestations
cyanosis
polycythaemia (inc haematocrit)
dyspnoea
hypoxic spells
32
Vitamin K deficiency definition
Normal in healthy neonate. decreased bacteria in gut that synthesise VitK. Intensifies in days following birth
33
Haemorrhagic disease of newborn
- Early: within 24h. association with maternal medicines
- Classic: 2-6d when VitK at lowest levels. decreased prothrombin activity and prolonged clotting times
- Late 2-12w. associated with hepatobiliary and GI disorders
34
Polycynthaemia definition
- Haematocrit >65%
- Inc erythropoises stimulated by:
- Intrauterine hypoxia
- Maternal hypertension/diabetes
- Genetic abnormalities
- Increased BV = Twin-twin transfusion
35
Polycynthaemia manifestations
- Asymptomatic
- Hypoglycaemia
- Hyperbilirubinaemia
- Lethargy
- Respiratory Distress
36
Anaemia definition
"Physiological Anaemia" normal after birht Hbf destruction.
37
"anaemia of prematurity"
lower levels of Hbf at birth
38
Pathological anaemia
- not associated with physiological/prem anaemia
- Rhesus or ABO incompatibility ("haematolotic anaemia")
- Blood loss
- needs iron supplementation
39
Body fliud imbalances
Immaturity of renal system = neonate is suseptable to over-hydration and dehydration and hyponatraemia
40
Overhydration
- Low GFR > inc risk of overhydration
| - risk highest in first 5 days
41
Dehydration
- limited ability to concentrate urine
- vomiting
- diarrhoea
- oedema
42
Hyponatremia definition
- Sodium deficiency (dilutional hyponatremia = water gain diluting Na+)
- Extracellular fluid becomes hypotonic > water movement (ECF >ICF) > increase in cell size
- brain cells effected most
43
Talipes definition
Congenital deformity in foot: developed at unusual angle
44
Talipes causes
- Chromosomal
| - Positional
45
Developmental dysplasia of the hip
hip joint is dislocated or dislocatable or subluxed
46
developmental dysplasia of the hip causes
- Chromosomal
- hormonal
- positional
47
Neural tube defect clasifications
- Aencephaly
- Encephalocele
- Spina bifida
48
Anencephaly definition
no development of cranium and brain. failure of cranial and end of NT to close
49
Encephalocele definition
Extrusion of brain and meninges through scull, canual or facial bones fail to form
50
Spina Bifida definition
possible extrusion of meninges and spinal cord through vertebral column. Failure of vertebral arch to form/fuse usually in lumbar
51
Spina bifida occulta
failure of vertebral arch to form but no protusion of neurological structures.
52
Spina bifida Meningocele
protrusion of meninges only through vertebral column
53
Spina bifida myelomeningocele
protrusion of menenges and spinal cord through vertebral column
54
Hydrocephalus physiology
- blockage of CSF flow or defect in reabsorption of CSF in cranial cavity > Excess cranial volume of cerebrospinal fluid > expansion of the head > decreas in blood volume
55
hydrocephalus manifestation
expansion of head
56
increased crandial pressure implications
- Obstruct cerebra blood flow
- destroy brain cells
- displace brain cells
- damage brain structures
57
Dysfunctio of metabolism
Abnormal metabolism of any substance absorbed from the diet and/or excreted
58
Jaundice
Yellow discouloration of skin, sclera and mucous membranes due to deposition of bilurubin
59
Physiological jaundice causes
immaturity of neonatal liver and GI system (inc breastmilk and premature jaundice)
60
Pathological jaundice
- RBC incompatibility
- Bruising and Haematomas
- Polycynthaemia
- Infections
- Congenital hypothyroidism
- G6PD deficiency
61
Metabolism of bilirubin
heme pigment of haemoglobin > biliverdin > unconjugated bilirubin (lipid soluble) > conjugated in liver > gut > excretion
62
Hyperbilirubinaemia
Excess of bilirubin in blood > deposited in fatty tissue Unconjigated bilirubin bassess BBB
63
Hyperbilirubinaemia causes (3)
- Saturation of molecules that transport bilirubin
- Decreased excretion/inc reabsorption
- Increased production
64
physiological jaundice
- day 2-5
| - sufficient feeding and bowel movements and hydration it will pass (liver catches up)
65
Breastmilk jaundice
factors in breastmilk that increase reabsorption of bilirubin
66
Pathological jaundice causes
- Haemolytic jaundice: ABO incompatibility and Rhesus immunisation
- Devoping in first 24h
- Potentially dangerous > inc risk of neurotoxicity
67
Hypoglycaemia
BGL <2.6mmol/L
Common problem in transition to neonate
Stored as glycogen and lipids, used readily for energy following removal of maternal supply
68
Hypoglycaemic manifestations
- Jittery
- irratibility
- high pitched cry
- lethargy
- Apnoea
- Seizures
69
Hypoglycaemia risk factors
- Poor feeding
- SGA/IUGR
- Maternal obesity
- Maternal diabetes
- Hypothermia
- Asphyxia
70
Hypoglycaemia treatment
FEEDING ASAP & REGULARLY
BGL measurements
Consultation
71
Phenylketonuria (PKU)
PKU present from incomplete breakdown of phenylalanine - RARE METABOLIC DISORDER
phenylalanine accumulates and is deposited in tissues by blood and can lead to mental retardation , microcephaly and delayed neural development
72
Hypospadias
Proximal opening of urethra on penis
73
undecended testes
usually occurs in 3rd trimester.
willeventually affect sperm production
surgery req'd
74
Hyperthyroidism
thyroid gland enlarged > may make NVB difficult. usually transient
75
hyperthyroidism manifestations
increased BMR =
- tachycardia
- irritability
- low birth weight
- hunger
- advanced bone age
76
Hypothyroidism
most commonly caused by dysgenesis of thyroid gland
| maternal production will compensate to a degree in utero, symptoms presenting later
77
Congenital adrenal hyperplasia
Defect in cortisol synthesis > inc levels of ACTH > adrenal hyperplasia > overproducion of cortisoid precursers
78
Cleft lip/palete
occur due to failure of fusion during early embryological development due to
nasomedial processes withmaxillary process
palatal shelves
chromosomal and teratogenic link
79
Oesophageal atresia
proximal and distal of oesophagus are not connected (piece missing)
80
Exomphalos
protrusion of abdominal contents within sac of amniotic membrane/pentoneum through umbilicus.
Associated with heart and kidney problems
81
Gastroschisis
protrusion of abdominal contents without any sac thruogh abdominal wall
82
Caput
oedema and bruising of soft tissue of presenting part resolves in a few days
83
Chignon
oedema, bruising and skin damage following vacuum extraction resolves in a few days
84
Cephalohaematoma
bleeding below periosteum confined within margins of sutures. worse at day 2, resolves over several weeks. may exacerbate jaundice
85
Forcep marks
heal rapidly
86
Skull fracture
usually perietal bone. may req surgery
87
fractured clavical
SD and breech. surgery may be req'd
88
Facial palsy
damage to nerves of brachial plexus due to traction on neck or arm. Erbs palsy (arm) and Klumpke's palsy (wrist)
