Flashcards in Physiological Adaptation from Foetus to Neonate Deck (42):
Describe how the foetus obtains nutrition pre-partum (in utero)
Amniotic fluid cushions and protects foetus from trauma and infection, placenta supplies site for exchange between maternal and foetal blood and umbilical arteries and veins supply the foetus (in umbilical cord)
How does a foetus prepare for birth?
Accumulates fat and glycogen stores, increased production of surfactant by type II pneumocytes , inhibition of foetal breathing in labour, switch from secretion to absorption of fluid in the lungs
What stimulates the increased production of surfactant near the end of gestation?
Increase in glucocorticoid and thyroxine production
What causes the switch from secretion to absorption of fluid in the lungs?
Stimulated by a stress response during normal vaginal labour which causes the production of catecholamines (adrenaline and noradrenaline)
What fluid(s) supplement the amniotic fluid later on in foetal development?
Urine from the foetal kidneys and secretions from the foetal lungs
List the changes that take place in the cardiorespiratory system of the foetus at birth
Lungs inflate, amniotic fluid is replaced, pulmonary vascular resistance drops, umbilical arteries close, umbilical vein and ductus venosus closes and ductus arteriosus closes
What substances are actively transported across the placenta from the maternal to foetal circulation?
Amino acids, fatty acids, calcium, phosphate, iron
What is the main metabolic energy source for the baby in utero?
What is the main metabolic energy source for the baby post-delivery?
What is the role of umbilical arteries?
Carry waste-laden blood away from the foetus to the placenta
What is the role of umbilical vein?
Carries oxygen and nutrient-rich blood from the placenta to the foetus
What is the role of the placenta?
Responsible for gaseous exchange of CO2 and O2, provides nutrients to the foetus (glucose, amino acids, calcium and electrolytes), acts to excrete waste products from the foetus, detoxifies drugs and metabolites, produces molecules such as hCG, progesterone and oestrogens (metabolically active) and is responsible for production of long-chain fatty acids which are essential for brain development
Describe the changes that occur to the infant's environment at birth
Baby moves from near weight-lessness to being in gravity and from being in a warm environment to a cold one
What is the 'first gasp' at birth?
Where a very negative intra-thoracic pressure is generated and air fills the lungs
Describe the respiratory changes that occur after birth
Very negative intrathoracic pressure generated by the first gasp --> and within the first 2-3 breaths much of the foetal lung fluid is expelled and remainder is absorbed into pulmonary lymphatic and capillaries over the first 6-12 hours and surfactant secretion is initiated
What is surfactant?
Substance of phospholipids and proteins that is secreted by type II pneumocytes and reduces the surface tension of the alveoli to reduce the likelihood of collapse
Describe the circulatory changes that occur at birth
PO2 increases from 2-3.5kPa in foetus to 9-13kPa in the first few breaths, and this hyperoxia causes the ductus arteriosus to close
When does the ductus arteriosus functionally close?
Within 12-15 hours of birth
When does the ductus arteriosus anatomically close?
4-7 days after birth
How is the ductus arteriosus kept open in utero?
Under the influence of prostaglandin E1, but this influence declines as term approaches and bradykinins are released from the distended alveoli and cause the smooth muscle of the ductus arteriosus to constrict
When do the umbilical vessels functionally close?
Within 5 minutes of birth (cord is clamped and cut)
When do the umbilical vessels anatomically close?
Within 10 days after birth
When does the ductus venosus functionally and anatomically close?
Between 1-3 weeks after birth
When does the foramen ovale functionally and anatomically close?
Functionally is variable, and anatomically will take 6 months or never, but due to pressure changes very little shunting occurs post-birth
What causes the ductus arteriosus to close?
Decline in prostaglandin E1 nearing the end of term and production of bradykinins which are released due to distention of alveoli cause the smooth muscle of the ductus arteriosus to constrict
What causes the functional closure of the foramen ovale?
Marked fall in pulmonary vascular resistance shortly after birth --> pulmonary blood flow increases --> drop in pressure on right side of the heart --> no longer an shunting from the right to the left atrium across the foramen ovale
What causes the functional closure of the ductus venosus?
Decrease in blood flow to the inferior vena cava due to greater pulmonary blood flow and this causes the ductus venosus to become the ligamentum teres
What does the ductus venosus become in an adult?
Describe the importance of lipid and carbohydrate stores in a newborn baby
Baby born with plentiful supply of fat and glycogen stores, and in the first few days of life, lipid metabolism to free fatty acids supplies most of the structures of the body (glucose for the brain) whilst breastfeeding isn't occurring due to the baby mostly sleeping
What is the cause of physiological jaundice in newborns?
Common between 2-5 days and this is due to an increased breakdown of RBCs --> more bilirubin in circulation --> immaturity of the enzyme glucuronyl transferase in the liver so the bilirubin cannot be conjugated and excreted into the biliary system --> unconjugated bilirubin levels rise
Describe the treatment of physiological jaundice (if necessary)
If there is any doubt that there may be an underlying pathology, phototherapy is used as a precautionary measure which is a bright light at the blue end of the spectrum (400-450nm) and it breaks down the bilirubin into harmless, 2-pyrrol ring (water-soluble) which can then be excreted in the urine
Describe the transitional neonatal circulation
Flow across the foramen ovale is reversed, now flow is from the left atrium to the right (increased pressure due to increased flow to systemic circulation) and blood flows upward in the ductus arteriosus, from the descending aorta into the pulmonary artery to provide greater blood flow to the pulmonary circuit in the first days of life
How is functional residual capacity established in infants?
First gasp produces a very negative pleural pressure --> draws a large amount of air into the lungs, and this is followed by a very high expiratory pressure (with crying) which helps to establish a functional residual capacity
What must the baby be able to do in order to establish breastfeeding?
Root for the nipple, suckle, swallow, have intestinal motility, digest (have pulsatile increases in intestinal blood flow) and pass meconium )first bowel movement which is sterile)
Describe how there is renal function adaptation after birth
First day of life there is low urine output due to low GFR, but renal blood flow increases during the first week of life, encouraging improvement of renal function and efficacy
Outline how the immune system develops after birth
At birth, immune system is naïve and every response is primary despite IgG transferred by placenta, there are low IgM and IgA levels, and ineffective neutrophils; use of breastfeeding stimulates immune system development
Outline the neurological abilities of a newborn
Focus to a distance of 1.5m, 6/60 visual acuity, normal hearing, distinguish rapid phonetic divisions in human speech, innate reflexes
What is the ductus arteriosus?
Connects the descending aorta to the pulmonary artery
What is the ductus venosus?
Bypasses the liver (umbilical vein) to join IVC
What is the foramen ovale?
Hole in the inter-atrial septum
What is the umbilical cord?
Cord which carries 1 umbilical vein and 2 umbilical arteries and is encased in Wharton's jelly