Which type of antibody can pass via the placenta?
Is this done via active or passive transport?
What contributes to the formation of amniotic fluid?
The baby swallows the amniotic fluid for what purpose?
What can be a sign of kidney failure in the baby?
Fluid produced by the baby's lungs, and urine produced by the baby's kidneys
To develop the GI system
The foetal circulation differs from the adult circulation mainly due to the presence of 3 shunts. What are these?
Only 7% of cardiac output in a foetus goes to the lungs - why is this?
What is the function of the 7% that does go to the lungs?
Because all gas exchange and nutrition takes place in the placenta (the lungs are not in use)
To allow them to grow
In a foetus, the vascular resistance in the lungs is very what? What would it be in adults?
In a foetus, the vascular resistance in the placenta is very what?
High / Low
Complete the sentence:
Oxygenated blood from the placenta travels to the foetus in the ?
This blood then travels into the ?, bypassing the liver via the ?
IVC / Ductus venosus
In an adult, blood from the IVC would travel into which heart chamber?
Due to the presence of the foramen ovale in the foetus, where does this blood go?
In the foetal circulation, the blood from the IVC passes straight into the left atrium. Where does it go from here?
The small majority of blood that does pass into the right atrium goes to where?
The majority goes to supply the brain and systemic circulation
What is the role of the ductus arteriosus?
To allow blood from the pulmonary artery to pass into the aorta to join the systemic circulation
Deoxygenated blood from the foetal body returns to the placenta via which vessels?
The umbilical arteries
What happens to foetal blood which enters the right ventricle?
It passes into the pulmonary trunk and then is diverted into the aorta via the ductus arteriosus
Why does blood pass through the foramen ovale?
What does this allow?
Because the pressure in the right atrium is higher than the pressure in the left atrium
Foetal blood to bypass the pulmonary circulation
In terms of circulation, what happens when a baby takes its first breath?
The resistance in the pulmonary circulation drops which causes blood from the RA to enter the RV, redistributing blood flow across the pulmonary arteries
What happens to each of the following things following delivery:
Pulmonary vascular resistance?
Systemic vascular resistance?
As the placenta disappears, and the umbilical vein flow disappears, which duct will be lost?
The ductus venosus
The foramen ovale closes for 3 reasons, what are these?
Which one of these 3 factors is also responsible for the closure of the ductus arteriosus?
Left sided pressure increases
Circulating oxygen increases
Prostaglandins decrease - also responsible for DA
If necessary, what medication can be given to help duct closure in newborns?
How soon should the foramen ovale and ductus arteriosus close functionally?
How long will it take for them to close by fibrosis?
Indomethacin (prostaglandin inhibitor)
First few hours of life
What is the fate of the foramen ovale?
What is the fate of the ductus arteriosus?
What is the fate of the ductus venosus?
Closes, or in 10% of people it persists as patent foramen ovale
Becomes ligamentum arteriosus, can also fail to close and be PDA
Becomes ligamentum venosus
The process of labour is relatively hypoxic, and so if the labour is prolonged or something goes wrong then what is likely to happen?
What makes this more likely to happen?
What will this be associated with and why?
The baby will become hypoxic
If the baby was unwell to start with
Acidosis, due to the production of lactic acid from anaerobic respiration
If the baby is acidotic at birth and has low oxygen, then this means that what won't happen?
What are some factors which can cause this to happen?
The pulmonary resistance won't drop and the vasculature will not develop in the right way
Sepsis, lung disease, cold stress
What happens when the pulmonary resistance fails to drop after delivery and the foetal circulation continues to exist?
Which foetal ducts are still working?
Unoxygenated blood gets sent where?
Oxygenated blood gets passed where?
Persistent pulmonary hypertension
Foramen ovale and ductus arteriosus
To the systemic circulation
To the pulmonary circulation
How can persistent pulmonary hypertension be diagnosed?
Pre and post ductal saturations
Right hand = high saturations
Left foot = low saturations
How is persistent pulmonary hypertension managed?
Ventilation (with inhaled nitric oxide)
What is ECLS/ECMO?
What do you need to do before giving this?
What is the significance of persistent pulmonary hypertension caused by abnormal lung development?
A type of heart lung bypass which is used if the baby is too sick for other management
Lots of anticoagulation
No typical management options will work as this is irreversible
The lung bud comes out of where?
At what stage of lung development do the different types of epithelium start to develop?
As pregnancy continues, air sacs start to develop and only form alveoli when?
Nearing term, babies start to produce what to help prepare for life outside the womb? What is the role of this? Who are deficient in this?
The GI tract
The pseudoglandular stage
Surfactant - they reduce surface tension to prevent the lungs from collapsing when the baby breathes out
Premature babies- they need supplemented
What happens to cause transient tachypnoea of the newborn?
How is this managed?
What is the outcome of this?
There is retained foetal lung fluid due to impaired clearance methods
Go to NICU for supplementary oxygen
Generally good, but have to separate from mum which is not ideal
In the 3rd trimester, babies accumulate brown fat where?
What is the purpose of this?
Between the scapulae and around internal organs
Helps to maintain body temperature and to keep baby warm once it has been born
At the onset of labour, there is increased secretion of what by the foetus?
What happens to the synthesis of lung fluid?
Where does lung fluid get absorbed into?
What is the advantage of vaginal delivery with regards to the lungs?
Catecholamines and cortisol
It stops, and the baby gets ready to start reabsorbing it
Into the lung interstitium, then lymph and then systemic circulation
Squeezes fluid out of the lungs
In the first few seconds following delivery, the baby is blue and then starts to breathe.
What should the pO2 be?
What will the sats be initially?
What will the sats be at around 10 minutes?
Between 3 and 5
The cord should only be clamped and cut immediately when?
How long should this ideally be delayed by?
What is the purpose in delaying this?
If the baby needs immediate resuscitation
30 secs - 1 min
It causes CO2 to go up, and the bbay will feel cold which will help it start to breathe
Why are babies so prone to getting cold when they are born?
Babies cannot shiver, but what can they do?
What are the downsides to the above method?
They have a large surface area and are also wet
Non-shivering thermogenesis: heat production as a result of breakdown of stored brown adipose tissue in response to catecholamines
It can only occur from 12 hours, and if the baby is premature, they may not have enough brown or subcutaneous fat
What happens to levels of insulin and glycogen after birth?
There is mobilisation of what for gluconeogenesis?
Babies can use what as brain fuel?
How long will it take for a baby's insulin level to go back to normal after delivery?
Insulin drops and glycogen increases
Hepatic glycogen stores
After the first few days
What are some reasons for neonatal hypoglycaemia?
Increased energy demands e.g. unwell, hypothermia
Low glycogen stores e.g. small, premature
Inappropriate insulin/glucagon ratio e.g. maternal diabetes
Some drugs e.g. labetalol
What are the changes in the composition of breastmilk that take place?
It is normal for babies to lose what amount of weight and when following delivery?
Colostrum, foremilk, hindmilk
Lose up to 10% of their birth weight in the first few days and then they start to gain weight again
After birth, foetal haemoglobin becomes disadvantageous why?
Haematopoiesis moves to where?
Adult Hb is synthesised more slowly than foetal Hb is broken down which causes what? When does this peak?
Because there is an increase in 2,3-DPG which shifts the curve to the right
Physiological anaemia - 8-10 weeks
When does physiological jaundice occur?
Why does this occur?
When may jaundice be pathological?
How can it be treated if necessary?
Usually around 2-4 days
Foetal Hb is broken down which causes a rise in circulating unconjugated bilirubin
If very early or prolonged
Exchange transfusion or phototherapy