NB 1 - Exam 4

a.) First 28 days of life

b.) 6 hours of life
- Respiratory and Circulation system
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a.) First 28 days of life

b.) 6 hours of life
- Respiratory and Circulation system
a.) Neonatal Period is first ..... days of life.
b.) The Transition period is within the first .... hour of life and includes the stabilising of ..... and ...... functions.
(other systems stabilize over a longer time)
a.) limited differentiation of vascular/lymph.
b.) Alveoli Ductus
c.) Primitive Alveoli (type 1 gas exchange, type 2 synth/store surfactant)
d.) Type 2 increases.
e.) Surfactant peaks
Respiratory Adaptations: Weeks
a.) < 20 weeks = ........
b.) 20-24 weeks =
c.) 24-28 weeks =
d.) 28-32 weeks =
e.) > 35 weeks =
a.) Respiratory movement of muscles

b.) Expansion of lungs

c.) Ability to keep the lungs open and have some retention of air (residual capacity) - Alveoli must remain open

e.) Increased blood flow to the lungs

Changes in cardiac output
Respiratory Adaptations: Events
a.) movements of ........
b.) ..... of the
c.) ....... Capacity (alveoli must remain ......)
d.) Inc blood flow to the .......
e.) Changes in ........
a.) Practices Breathing Movements and develops Chest Wall and Diaphragm.

b.) Surfactant: produced by Amniocentesis, by Lecithicin and Sphingomyelin and has a ratio of L/S: 2:1
- 2:1 Indicates Alveloar expansion and Stability
Respiratory Adaptations:
Utero/Ready for birth
a.) The fetus practices ........ movements and develops ..... and ......
b.) How is surfactant produced? and by what 2 components and ratio of those components?
- What doe these levels/ratio indicate?
a.) Goal: less pressure in the lungs for lungs to expand (low surf = High pressure)
Respiratory Adaptations: Surfactant

a.) Goal of Surfactant?
Image: a.) Goal: less pressure in the lungs for lungs to expand (low surf = High pressure)
a.) Mech/Chem (MAIN)
b.) Thermal
c.) Sensory (sound/light)
Respiratory Adaptations: Triggers of Breathing
a.)
b.)
c.)
1.) Labor:
- Removal of fluid from lungs (via birth canal)

2.) Birth:
Passive: - Chest Wall recoils (causes negative thoracic pressure) = lungs fill up air.
- Newborn exhales, and creates positive thoracic pressure/dries out lungs.
- Lungs continue to expand = increase alveolar volume.
Respiratory Adaptations: Mechanical Events in Initiation of Breathing

1.) Labor
2.) Birth
a.) low Oxygen
- Low O2 = High CO2 = low pH.
- Stimulates respiratory impulse in Medulla.
- Respirations occur.
Respiratory Adaptations: Chemical Stimulation of Breathing

a.) Oxygen
a.) Change in temp = Skin Stimuli = RR Stimuli (Medulla)
Respiratory Adaptations: Thermal Stimuli
Flicking soles of feet
RUbbing back
Skin to Skin w. mom
Respiratory Adaptations:
Sensory stimuli
a.) Examples of: Tactile, Auditory and Visual
- Air enters lungs - PO2 rises in alveoli (alveoli expand) - Blood Vessel tissue relax = inc blood flow. - Blood Flow increases to lungs.Respiratory Adaptations: First Breath a.) What happens within the lungs on first breath? - - - -a.) 30-60 breaths min. - Diaphragmatic, Shallow and Irregular b.) Pauses for 20 seconds between breaths w/ Symmetrical Chest Movements. (Apnea > 20 seconds)Respiratory Adaptations: NB Respirations a.) Expected rate is ..... per minute? (Check for full min.) This could be ....,..... and ...... b.) Periodic breathing is when and with? Apnea is when? (If suctioning = Do mouth then nose.a.) Lungs received NO O2 to inc. O2, Heart pumps sufficiently, and clamping of cord inc. curculation. b.) Epi/Norepinephrine: - cause: Inc. Cardiac Output/Contraction - increased by: - Contractions - Cord Compression (Asphyxia) - ICP - Cold StressCardio Adaptations: a.) How did labor help fetus in cicurlation? b.) what are Cateochalmines? - they Cause? - Increased by?FO - RA/LA DA - Aorta/Pulmonary Artery DV: Umbilical vein and Inferior Vena CavaCardio Adaptations: Structures a.) Fetal structures that carry O2 in uterus: -Foreman Ovale - Ductus A - Ductus Va.) Pulmonary: - High pressure/Low Blood Flow - Lungs not expanded. b.) Systemic - Dilated/Low Resistance - Placenta carries most of blood. c.) DA - Large/ No Tone - Pulmonary Artery -> Aorta d.) FO - Patent w/ Large Blood Flow - Right Atrium -> Left Atrium.Cardio Adaptations: 4 Systems: fetal a.) Pulmonary b.) Systemic c.) Ductus Arteriosus d.) Foramen Ovalea.) Pulmonary: - Low Pressure/ Inc. Blood Flow - Lungs Expand/ Inc. O2 - Vasodilation. - Lungs Oxygenate Blood b.) Systemic - Arterial Pressure and resistance rises/ Loss of Placenta - Inc. Volume/ Blood Return via. Inferior Vena Cava dec. - Clamping UC/ Inc. B/P - Lungs receive O2 c.) Ductus A - CHEMICAL - Reverse: Aorta -> Pulmonary - "Prostalglandin" levels drop/ DA closing. - Functionally Closes d.) Foramen O - MECHANICAL - due to 1st breath: L.A pressure inc./ FO closes at birth. - R. vent blood goes to Lungs. - O2 blood/No O2 blood seperate e.) Ductus Venous - Closes within few days (unsure how) - Liver gets blood to filterCardio Adaptations: 5 Systems: Neonatal a.) Pulmonary b.) Systemic c.) Ductus Arteriosus d.) Foramen Ovale e.) Ductus Venousa.) Inc. Systemic Pressure/dec. Pulmonary and Loss of Placenta Bed. (less blood through venous system) b.) FO - closes - DA = Ligamentaus Arteriousm - DV = Ligamentum StenosusCardio Adaptations: summary a.) Inc A Pressure/dec V Pressure = inc of ......../dec.......pressure and loss of ........ b.) Closure the shunts that become what?a.) 110-160 - Crying = > 160 - Sleeping = < 110 b.) Tachy - Volume Depletion - Cardiorespiratory Disease - Drug Withdrawal - Hyperthryoidism. c.) Brady - Apnea - Hypoxia d.) Murmurs - 90% of murmurs are Transient. - (few days long, associated w/ anomalies.) - Due to: Incomplete Closure of DA/FOCardio Adaptation: Basics a.) Heart Rate = sleep vs awake? Apical Pulse b.) Tachycardia due to? c.) BradyCardia due to? d.) Explain heart Murmurs in NBs. - Always check upper/Lower extremities - Echocardiogram??a.) 80-100 mls/kg (wt) - Delayed Cord Clamping: (can add up to 100 mls extra BV.) - Early (30-40 sec.) = less - Late (> 3 minutes) = more - Gestation Age - Prenatal HemorrhageHema Adaptations: a.) Blood Volume is ....mls/kg. And can be affected by what 3 things?a.) - Cap Refill - Delayed Cord Clamp - Longer GA - Plasma Movement (intra -> extravascular space) b.) - Large and live up to 60-70 days. c.) - Leuko: Stress of Labor d.)- Platelet Count: Same as adult.Hema Adaptations: Blood Components a.) Hgb and Hct - ........ has a higher Hgb/Hct level than Venous. - 3 things increase HGb/Hct? b.) RBCs - Fetal's RBC are ....., they only live up to ..... (less than adults) c.) Leukocytosis: - comes from where? d.) Platelet Count: - is low/high/same as adults?a.) Amniotic Sac b.) Inc. O2 consumption, depletion of Glycogen, and metabolizing Brown Fat. 1.) Conduction: cold scale 2.) Convection: Drafts 3.) Evaporation: Wet Skin 4.) Radiation: surrounding space (keep hat/blanket on)Thermo Adaptations: a.) What creates constant temperature in Utero for baby? b.) Heat Loss is accomplished how? What 4 ways?- inc. Basal Metabolism rate - Hyper Movements (cant shiver) - Chemical Thermogenesis - Brown Fat MetabolismThermo Adaptations: Thermogenesis a.) What ways can a baby produce heat for itself?a.) Chemical Thermogenesis - <97.6: Skin feels Environment temp/ SNS stimulated/ Inc. metabolism and O2. - Brown fat = Dense Adipose Tissue that cant be replenished. (SGA and IUGR babies have less. due to development in 2/3 trimester) - Depletion = Cold Stress b.) Brown Fat: - Promotes: (Metabolism, Heat produce/transfer to Peripheral System) - Found: (Neck, Thoracic, Axillary, Intrascapular, Adrenal Glands.) c.) Metabolic Acidosis = Low Surfactant = RD in NBs.Thermo Adaptations: Brown Fat and Chemical Thermogenesis a.) Chemical Thermogenesis is activated how? Uses Brown Fat to supply heat which is a ........ tissue. This Brown Fat can be depleted rapidly during what? b.) Brown Fat promotes what 3 things? And can be found where? c.) Hypoxia can lead to ...... which will lead to low ...... levels which leads to .... in NB.sa.) Excessive Heat Loss = Hypothermia - Use of Compensatory mechanisms. b.) Risks: - Preemie - SGA (also hypoglycemic) - Sepsis bb.) S/S: - axillary temp = <97.6 - Cool skin - Lethargy/Pallor - tachypnea - grunting - Hypoglycemia - Hypotonia - Jittery - Suck is weak bruhhhhThermo Adaptations: Cold Stress a.) What is it? What does it lead to? and what does it use to maintain body temp? b.) Risks that lead to CS? and S/S?- dry infant after bath - remove wet blankets - cap on head - Skin-Skin/Radiant warmer - Swaddle - Early Feedings - Delay Bath - Radiant Heater when bathing - when using warmer, make sure probe isnt over brown fat (over liver area is best)Thermo Adaptations: Cold Stress - Interventionsoccurs due to large body surface/limited sweating (sweat is limited till 2-3 years old) Leads to Brain Damage Set Limits under warmers.Thermo Adaptations: Overheating Why does this occur? Leads to? Prevention?- Iron Storage - Carbs, Lipid metabolism - Blood clot - Storage of fat vitamins (A,D,E,K) - Detox - Bilirubin conjugation - Three causes of Jaundice (via Bilirubin) : a.) Overproduction b.) Dec. Conjugation c.) Impaired ExcretionHepatic Adaptations: Liver Functions? a.) Functions b.) 3 causes of Jaundicea.) for production of new cells b.) enough for 4-6 months.Hepatic Adaptations: Liver - Iron Storage a.) Many RBCs are destroyed at birth and Iron is stored in the liver for? (inc. in RBC turnover. b.) How much Iron is stored? - wont have to ingest Fe at first - Mom needs adequate H/H and Fe levels.a.) Independent of Mother's Metabolism - Glycogen stored during 3d trimester. b.) HypoglycemiaHepatic Adaptations: Liver - Carbo Metabolism a.) After birth, neonate becomes independent of mother's ....... and must balance amount of insulin production with glucose. These glycogen stored are completed in the ..... trimester. b.) What is common during the transitional period, especially in Newborns of diabetic mothers>a.) Factors 2, 7, 9 and 10 - activated by: Vitamin K - Intestine Flora (since mother stops providing this at birth = delayed clotting and haemorrhaging issues if not taken care of.) b.) s/s: erythema, pain and swelling. - Route and Dose: IM; 0.5-1mg (1 hour of birth)Hepatic Adaptations: Liver - Blood Clotting a.) What coag factors are synthesised in the Liver? What vitamin influences activation of these factors and where is synthesized? b.) Common side effects of V-K shot? Route? Dose?a.) Yellow Bile pigment (by breakdown of RBC/Fat Soluble) ** Unconjugated = no excreted b.) Up by Liver cells - changed in Conjugated cells. ** Conjugated cellsHepatic Adaptations: Liver - Bilirubin Conjugation What is Bilirubin? and how is it produced? How are bilirubin changed into water soluble pigmented cells?a.) Types: - Breastmilk vs Breastfeeding - Pathologic - Physiologic: * NB= 60% of Term/80% of Preterm * Peak at 3-5 days * Appears after 24 hours. 1.) Increase Bilirubin - Large numbers of RBCs (fetal > needs newborn) - Short life span of RBC - Inc. Circulation to liver. *** ABO incompatibility, Delayed Cord Clamping, Trauma. 2.) Decreased Conjugation - Physiological - Breastfeeding 3.) Impaired Excretion - decreased motility - delay in dev of bacteria - delay meconium - not enough protein *** (Drugs, biliary obstructionds, sepsis, chromosomal abnpormality)Hepatic Adaptations: Liver - Jaundice 1 a.) What are the types of Jaundice? b.) Causes of Jaundice? - Increase Bilirubin - Decreased Conjugation - Impaired Excretiona.) Cephalocaudal b.) Treatment: - Inc feeds (they will excrete/poop more after every feed.) - Phototherapy - Untreated = Kernicterus (Bilirubin EncephalopathyHepatic Adaptations: Liver - Jaundice 2 a.) What direction does Jaundice develop? b.) Treatment? If left untreated?a.) Gut is Sterile at birth, due to Oral bacteria. b.) 2-3 months. c.) < 6 days = 5-10 mls. cc.) > 7 days = 60mls. d.) Emptying = 2-4 hours e.) Frequent Regurgitation: (cardiac sphincter and nervous stomach control) f.) Amylase and Lipase (no solid foods for 6 months) g.) 120kcal/kg/day.Gastric Adaptations: Basics a.) Gut is .... at birth, due to taking in bacteria ...... b.) Salivary Gland's dont secrete until ...... months (drooling is frequent.) c.) Stomach can hold ..... mls (1-6 days), then ...... mls (7 day) d.) Empyting time is ...... hours. e.) frequent regurg is due to what 2 things? f.) what digestive enzymes are low at birth? No solids for ..... months? g.) To gain weight a newborn must take in (equation.)a.) term = 8-24 hours - Sticky, thick, black/Dark Green, NO ODOR b.) Days 3-6 - More greenish yellow after 6th day.Gastric Adaptations: Stools a.) Meconium Stools - Term baby's stool ...... hours of birth (standard is 48 hours.) - Stool appearance? b.) transitional Stools (picure) - days ....-..... - Appearance?c.) Yellow/mild (semi) formed - becomes golden, sour, paste later on - Occurs after every feeding d.) Dry/Moderate formed - pale/yellow w/ unpleasant odor. - Not as much as Breastfed. e.) Loose and GreenGastric Adaptations: Stools c.) Breastfed Stools - appearance - frequency? d.) Formula Fed Stools - appearance - frequency e.) Diarrhea - appearance ** Frequency due to active Peristalsis/Small Colon ** Fatty due to Low Lipase.a.) IgG, IgA, IgM (AMG, its a baby!!!) b.) Against Bacteria - IgG: antibodies *crosses placenta = passive immunity (disappears over 6-8 mos) - IgA: Protects Mucus Membranes * found in Breast milk (otherwise not until, 4 weeks of delivery) - IgM: Blood/Lymph ( 1st responder) * Low at birth, but increases over time. * Forms are exposed to agents * Adult level = 1 year of life.Immune Adaptations: a.) newborns are dependent on 3 (of 5) immunglobulins? b.) Functions of each immunoglobulin against bacteria? Found? Appear/Dissappear?a.) Protective barrier between body and environment . - Fully formed = 32 weeks GA (Not Matured at birth) b.) 2-3 years old c.) Functions: - limits loss of H2O - Prevents harmful agents - Thermoregulates/fat storage - Protects traumaIntegumentary Adaptations: a.) what is it? and when is it fully formed? b.) Sweat glands are present, but not Fully Functional until ...... years old. c.) Functions include:a.) within 24 hours = Void - CU = 3 mos of age. b.) excretion/conservation capacity c.) Pink Stain = Brick Dust - lose 5-10% of body weight.Renal Adaptations: a.) should void within .... hours of birth. Can't concentrate Urine until ..... of age. (easily dehydrate) b.) Low Glomerular Rate - limited ...... and ....... capability c.) Pink Staining of the urine is called? and they lose ....% of wt after delivery?a.) Hormones cause: - Hypertrophied Labia - Breast Engorged - secrete "Witches Milk" from first day until 2 mos. - Withdrawl = Pseudomenstruation.Sex Hormones Adaptations: a.) 3 things seen at birth due to mom's hormones effect on child?1st period - (birth to 30 post birth) - alert, moving, hungry - may have: (myoclonic eyes, Moro reflex, sucking/chewing/rooting reflex, tremors.) - Allows time for breastfeed interaction. Unresponsive Period - (30-120 post birth) - sleeping, dec activity - V/S decline - bowel Sounds present - Difficult to arouse 2nd period - (2-8 hours) - Newborn awakens/shows an interest in stimuli. - Meconium BM - interest in feeding b.) Sleep State - Deep/Quiet sleep - Active/Light sleep bb.) Alert State - Drowsy - Quiet Alert - Active Alert - CryingBehavioral Adaptations: a.) 1st period Unresponsive 2nd period b.) 2 States: Sleep/Alert - sleep = 2 - Alert = 4a.) Myleination (gross motor before fine motor) b.) Examples at birth: - Hearing - developed at birth - Taste - sweet/sour difference at 72 hours old - Smell - mother's/other's breast milk difference - Touch - sensitive to pain - Vision - 7-12 inches away is clear (least mature sense at birth) **** Tear Glands = 2-4 weeks - Reflexes - Neuro development indication. (absent or abnormal may indicate Neurologic Pathology)Neuro Adaptations: Senses a.) follows Cephalocoudal and Proximal-Distal patterns ..... why? b.) Examples at birth: - Hearing - Taste - Smell - Touch - Vision - relfexes