Fetal Transition and circulation changes

  1. What are the changes needed for shunts to close properly? 3
    • Increase in blood oxygen levels
    • Shift in pressure in the heart and lungs
    • Closing of the umbilical vessels
  2. When the baby's lungs inflate to cause pressure decrease in the pulmonary artery, it causes this shunt to close.
    Ductus arteriosus
  3. Pressure increase in the left side of the heart causes this shunt to close
    Foramen ovale
  4. What are the hazards of cold stress?
    Increased oxygen need leads to respiratory distress, leading to metabolic acidosis
  5. What happens during metabolism of brown fat
    • When brown fats are metabolized in the presence of insufficient O2 supply, increased acid production will result.
    • Acidosis can be life threatening, and can interfere with transport of bilirubin to the liver, increasing risk of jaundice
  6. Fill in Normal Vital statistics:
    1. Weight
    2. Length
    3. Head
    4. Chest
    • 1. Weight: 5.5 lbs to 8 lbs (1 lb = 454 grams)
    • 2. Length: 19-21 inches (1 inch = 2.54 cm)
    • 3. Head: 13-14 inches
    • 4. Chest: 1 inch less than head
  7. T or F: a newborn baby's heart rate could be irregular
    True d/t immaturity
  8. What is normal BP of newborn?
    80/46 (not routinely measured; may be inaccurate)
  9. T or F: Bilirubin will be low in the first week of being born
    False: will be high in first week (12mg/dl) from destruction of unneeded RBCs
  10. What is RDS in newborns? What causes it?
    Neonatal respiratory distres syndrome, often seen in premature babies.

    • Causes: occurs in infants whose lungs have not yet fully developed. 
    • Lack of substance in lungs called surfactant, which helps lungs fill with air and keep the air sacs from deflating.
  11. What are some tx options for RDS?
    • cpap
    • warm, moist O2, blow-by
  12. How much urine should you see the first 2 days? first week?
    • First two days: 30-60 ml/day
    • First Week: 300 ml/day by first week
  13. T or F: Uric acid crystals in newborn urine is common
  14. What is another name for the startle reflex?
  15. What is normal physiologic range of jaundice?
    What is a higher amount that would need phototherapy? How much that could cause Kernicterus (brain damage d/t Jaundice)?
    • Normal: >7mg/100mL
    • Phototherapy needed: 10-12mg/dl, sometimes 15-17
    • Kernicterus: 20mg/dl
  16. What is vernix caseosa? (hint: appears as a white/ cheese-like substance)
    Protective layer on the baby's skin. Developed on the baby's skin while in the womb.
  17. Match term with definition:

    1.  an edema of the scalp at the neonate’s presenting part of the head. It often appears over the vertex of the newborn’s head as a result of pressure against the mother’s cervix during labor. 

    2. a collection of blood between the periosteum of a skull bone and the bone itself. It occurs in one or both sides of the head. It occasionally forms over the occipital bone.

    a. Cephalehematoma
    b. Caput Succedaneum
    • 1. b
    • 2. a
  18. What is choanal atresia? (Hint: choana = back of the nasal passage)
    a congenital disorder where the back of the nasal passage (choana) is blocked, usually by abnormal bony or sift tissue.
  19. How can choanal atresia be temporarily treated?
    Inserting an NPA. Surgery might be needed.
  20. What keeps the foramen ovale open?
    As long as the placenta is doing oxygenation of the fetus blood
  21. Fill in what each value of apgar (0, 1, 2)
    Reflex irritability
    Muscle tone
    • Color: blue, acryanotic, completely pink
    • HR: absent, <100, >100
    • Reflex: no response, grimace, active cry
    • Muscle tone: Limp, some flexion, active motion
    • Respiration: absent, hypoventilation / weak cry, good ventilation, crying
  22. If APGAR score is less than ___, you want to recheck again at 10 minutes.
    Less than 7. 

    Initially check at first minute, then 5, then 10 or 15 depending on low scores.
  23. Preterm babies (24-36 weeks gestation) will lack this kind of fat, and what important factor for their lungs
    Brown fat and surfactant
  24. What is normal vital statistics for each:
    Normal weight loss
    • Weight 5.5-8 lbs
    • Length: 19-21 inches
    • Head: 13-14 inches
    • Chest: 1 inch less than head
    • Normal weight loss 5-7%
    • - >10% is concerning
  25. What is a normal Hct for newborns?
  26. The first stool of a newborn is called what?
  27. Fill in: Infants should void within the first __a__ hours.
    __b__mL/day for the first two days
    __c__mL/day by the first week
    • a. 24 hours
    • b. 30-60mL
    • c. 300mL
  28. T or F: IgG comes from the mom, which is passed through breast milk
    False: it passes through the placenta
  29. T or F: IgA comes from the mom which is passed through breast milk
  30. Which reflex is the startle reflex?
  31. How do you perform the rooting reflex?
    Stimulate the side of the baby's cheek or lip, this is for the baby to look for the nipple
  32. What is dangerous bilirubin level (kernicterus) of jaundice? __mg/dl.

    When do you start doing phototherapy?
    • 20mg/dl 
    • When levels get too high, bilirubin will get into the CNS, called kernicterus

    Start doing phototherapy around 12-13mg/dl
  33. Vernix is to protect against what?
    • Contact with amniotic fluid in the uterus
    • Premies are covered with it, and can be difficult to completely remove
  34. A baby without enough vernix caseaso can have this happen to their skin
    Desquamation: lines and peeling of the skin, which can cause rashes
  35. What is difference between caput succedaneum vs. cephalohematoma?
    A caput succedaneum is an edema of the scalp at the neonate’s presenting part of the head. It often appears over the vertex of the newborn’s head as a result of pressure against the mother’s cervix during labor. The edema in caput succedaneum crosses the suture lines. It may involve wide areas of the head or it may just be a size of a large egg.

    Cephalhematoma is a collection of blood between the periosteum of a skull bone and the bone itself. It occurs in one or both sides of the head. It occasionally forms over the occipital bone. The swelling with cephalhematoma is not present at birth rather it develops within the first 24 to 48 hours after birth.
  36. What is subconjunctival hemorrhage and when can it occur?
    A subconjunctival hemorrhage is a medical condition that happens when the small blood vessels located just beneath the eye ruptures. Although it can happen at any age, it typically happens to newborn infants when trauma occurs during a stressful delivery.
  37. What is the dubowitz exam?
    An examination called the Dubowitz / Ballard Examination for Gestational Age is often used. A baby's gestational age often can be closely estimated using this examination. The Dubowitz  /Ballard Examination evaluates a baby's appearance, skin texture, motor function, and reflexes.
  38. What will you apply to the baby's penis after circumcision to prevent the diaper from sticking?
  39. What are the 6 states of "being" by Brazelton?
    • crying
    • actively alert
    • quietly alert
    • between awake and sleep
    • actively asleep: where we see feeding cues 
    • quietly asleep
  40. What does STABLE stand for?
    • Sugars
    • Temperature
    • Airway
    • BP
    • Labs
    • Emotional care
Card Set
Fetal Transition and circulation changes
Lecture notes