Perinatal Period

Question 1

What are the placental functions?

Answer 1

• Gas exchange
• nutrient delivery
• waste removal
• immune system

Question 2

what is the fetal circulatory flow?

Answer 2

1. placenta
2. umbilical vein
3. ductus venosus
4. inferior vena cava
5. right atrium
6. patent foramen ovale
7. left atrium
8. left ventricle
9. aorta
10. umbilical arteries
11. placenta

Question 3

• blood flow increases to lungs
• blood flow increases from lungs to LA
• UV flow ceases, and DV constricts
• decreased IVC & RA pressures
• when PLA > PRA = closure

Answer 3

PFO closure

Question 4

• separate the pulmonary & systemic blood supply
• delayed closure w/ prematurity
• medical closure w/ ibuprofen or acetaminophen (decreases certain prostaglandins and closes it)
• severe cases need ligation or device closure
• avoid use of tylenol
• if not closure, pt will get pulmonary edema as blood fills lung

Answer 4

PDA closure

Question 5

most important aspect neonatal resuscitation?

Answer 5

Effective ventilation

• Chest compressions are not indicated until effective ventilation is established

Question 6

Disrupted blood supply from placenta to fetus

• placental abruption
• umbilical cord compression

Severe cases lead to hypoxic ischemic encephalopathy (HIE)

• similar to ischemic stroke

Treatment

• Therapeutic hypothermia

Answer 6

asphyxia

Question 7

• delayed resorption of fetal lung fluid by the pulmonary lymphatic system
• may require mild oxygenation/ventilation support
• quick resolution in 24 hours confirms diagnosis

Answer 7

Transient tachypnea of the Newborn

Question 8

• Qualitative or qauntitative surfactant deficiency (born before surfactant is available)

risk factors include

• prematurity
• male gender
• caucasian
• c-section
• gestational diabetes
• multiple gestation pregnancy
• family history of RDS

Answer 8

Respiratory Distress Syndrome (RDS)

Question 9

treatment of RDS?

Answer 9

• Maternal corticosteroids decrease risk
• respiratory support
• surfactant

Question 10

• first intestinal discharge of newborn: contains epithelial cells, fetal hair, mucus, bile
• intrauterine stress may cause passage into amniotic fluid before delivery
• may be aspirated by fetus during gasping in response to hypoxia or hypercapnia

Answer 10

meconium aspiration syndrome

respiratory support as necessary, maybe surfactant

Question 11

Meconium aspiration syndrome pathophysiology?

Answer 11

• airway obstruction
• air trapping
• hyperinflation (increases risk of pneumothorax)
• chemical pneumonitis
• inactivation of surfactant production and activity

Question 12

• failure to achieve or sustain the normal decrease in pulmonary vascular resistance at birth (profound cyanosis)
• in conjunction with lung parenchymal disease (e.g, MAS, RDS, CDH, Pneumonia) or systemic illness (e.g, sepsis, asphyxia)
• idiopathic, aka “persistent fetal circulation”

Answer 12

persistent pulmonary hypertension of the newborn (PPHN)

Question 13

• below the 10th percentile for weight
• issues: Thermoregulation, hypoglycemia

Answer 13

Small for gestational Age

Question 14

• Not the same as SGA (though baby may be both)
• symmetric: Weight, length, and HC are all proportionately reduced for gestational age (infectious, genetic)
• assymetric: brain sparing (placental abnormalities)

Answer 14

Intrauterine Growth Restriction (IUGR)

Question 15

• Above the 90th percentile
• most commonly seen in infants of diabetic mothers

Answer 15

Large for gestational age

Question 16

• abruption, previa, traumatic amniocentesis
• cord abnormalaties: sheering, entanglement
• placental vessels: velamentous insertion
• cesarean delivery: 3% incidence
• obstetric trauma: occult visceral, intracranial

Answer 16

hemorrhagic anemia

Question 17

• immune hemolysis
• sepsis
• congenital erythrocyte defect: metabolic enzyme deficiency, thalassemia, hemoglobinopathies
• systemic diseases: galactosemia

Answer 17

hemolytic anemia

Question 18

• Definition: Venous Hgb > 20g/dL (hct > 68%)
• rarely occurs in premature newborns
• assoicated with IDM
• increased incidence of jaundice
• treat only if symptomatic and only on central Hgb results; partial to double volume exchange transfusion
• sx:lethargy, hypotonia, irritability, jitteriness, weak suck, vomiting, seizures, tremulousness, apnea, desaturation

Answer 18

Polycythemia

Question 19

• yellowing of skin and eyes due to elevated bilirubin levels
• in utero enviornment is relatively hypoxic, so higher levels of erythropoietin lead to increased RBC production
• immature liver has reduced ability to conjugate and excrete bilirubin
• mother’s milk takes a couple days to come in, leaving infant relatively dehydrated
• infant makes less stools

Answer 19

Jaundice

Question 20

• initially reversible neurologic sequelae of untreated indirect hyperbilirubinemia
• precedes the development of the most devastating complication: kernicterus
• initial phase: lethargy, hypotonia, poor suck
• progresses: moderate stupor, irritability, increased tone, arching fever
• next stage: deep stupor, coma, increased one, inability to feed, seizures

Answer 20

Acute Bilirubin Encephalopathy

Question 21

• choreoathetoid cerebral palsy
• high-frequency sensorineural hearing loss
• palsy of vertical gaze
• dental enamel hypoplasia
• cognitive deficits can be severe
• mortality as high as 10%

Answer 21

Kernicterus

Question 22

Jaundice in first 24 hours of life
Anemia, usually mild

Treatment:

• phototherapy
• exchange transfusion is rare
• IVIG use is rare

Prognosis:

• excellent
• in rare cases anemia may need to be monitored over several weeks

Answer 22

ABO incompatibility

(O mom with A or B baby)

Question 23

Jaundice (unconjugated) in first 24 hours of life
anemia
Hydrops Fetalis

Treatment

• RhoGAM for prevention
• intrauterine transfusion
• IVIG for mother prior to delivery

Treatment of baby (postpartum depends on severity)

• phototherapy
• exhange transfusion
• IVIG

Answer 23

Rh Incompatibility

Question 24

• Abnormal fetal fluid collection in at least 2 distinct compartments
• hypoalbuminemia
• generalized edema
• ascites
• pleural effusion
• chronic anemia secondary hypoxia
• high-output cardiac failure
• increased risk of fetal death, stillbirth

Answer 24

hydrops fetalis

Question 25

* prolonged indirect hyperbilirubinemia (can last up to 3 weeks to months) * no evidence for hemolysis or incompatibility * may require phototherapy * cause unknown, speculation- breast milk components

Answer 25

breast milk jaundice

Question 26

* removes placental blood supply * increases systemic vascular resistance * leads to constriction of the ductus venosus

Answer 26

umbilical cord clamping