Neonatal path.

Question 1

def. birth

Answer 1

complete expulsion or removal of fetus that at any time did breath or show signs of life

Question 2

def. premature

Question 3

def. postmature

Answer 3

> 42 weeks GA

Question 4

what is small and large for GA

Answer 4

90th

Question 5

def. neonatal period

Answer 5

birth to one month

Question 6

how does mortality compare to premature

Answer 6

inverse relationship - big jump between 24 and 23 weels

Question 7

2 main causes of neonatal death

Answer 7

1. premature

2. congential/chromo anomalies

Question 8

5 parts of apgar

Answer 8

1. heart rarte
2. resp. effort
3. muscle tone
4. response to cath. in nostril
5. color

Question 9

how does apgar compare to mortality

Answer 9

high score = less death

Question 10

3 fetal circ. bipass systems

Answer 10

1. ductus venosus - liver
2. foramen ovale - lungs
3. ductus areteriosus - lungs

Question 11

what happens to circ at birth

Answer 11

1. pulm art. dilate and reduce pressure
2. high LA pressure and low placental flow close foramen ovale
3. duct arteriosus and venosus close

Question 12

what happens to lung as age

Answer 12

get more alveoli - can survive at 36 weks

Question 13

what happens to lungs at birth

Answer 13

1. vag pressure squeezes fluids from lungs
2. alveoli inflate with first few breaths
3. alveoli don’t collapse b/c of surfactant

Question 14

where does sufactant come from

Answer 14

type 2 pneumocytes

Question 15

when do we have enough surfactant

Answer 15

35 wks

Question 16

what is sufactant made of and what is important ratio

Answer 16

lecitin and shynogmyelin - need > 2:1 L:S

Question 17

3 general causes of failed adaptation

Answer 17

1. immaute physiological systems
2. congenital malformations
3. supression of central controls and reflexes - no practice breathing

Question 18

2 causes of pulm. hypoplasia

Answer 18

1. ogliohydramnos - too little fluid

2. fetal hydrops - too much fluid

Question 19

2 types of congenital heart malformations

Answer 19

1. obstructions to circulation

2. persistence of fetal shunts

Question 20

def. congenital cardiomyopathy

Answer 20

thickening of LV so can’t contract and relax

Question 21

5 birth factors

Answer 21

1. breech
2. forceps/vacuum assisst
3. large bb
4. cephalopelvic
5. prolonged labor

Question 22

3 traumas caused by birth

Answer 22

1. head injuries
2. fractures
3. rupture/laceration of organs

Question 23

most common cause of neonate mortality

Answer 23

prematurity

Question 24

3 placental causes of prematurity

Answer 24

1. premature rupture of placental membranes
2. chorioamnionitis
3. other - twins, placenta previa

Question 25

2 important complications of prematurity

Answer 25

1. hyaline membrane disease | 2. necrotizing enterocolitis

Question 26

def. hyaline membrane dissease

Answer 26

acute injury to alveoli and term. bronchioles with epithelial necrosis, exudation of fluid and formation of membranes in distal airspaces

Question 27

signs of HMD

Answer 27

tachypnea, hypoxia, increased work brething | - ground glass CXR

Question 28

how does HMD compare to age

Answer 28

inverse relat.

Question 29

main cause of HMD

Answer 29

lack of suractant

Question 30

2 main complications of treatment of HMD

Answer 30

1. pulmonary barotrauma - high pressures used - reparative proliferation and metaplasia of stroma 2. oxygen toxicity - bronchopulm. dysplasia - pulmonary fibrosis, arrest in dev. of acini, decrease cap. bed

Question 31

clinical def. of pulmonary dysplasia

Answer 31

persistence of Sx of resp, disease beyond the neonatal period

Question 32

HMD prophylaxis (3)

Answer 32

1. delay birth 2. give steroids 3. exogenous surfactant

Question 33

what does HMD prog. depend on

Answer 33

GA and birth weight - better now with surfactant

Question 34

what is necrotizing enterocolitis (NEC)

Answer 34

acute iscemic necrosis of the intestines of a newborn

Question 35

3 poss. causes of NEC

Answer 35

1. dev. after feeding starts 2. assoc. with poor perf. of intestines 3. assoc. with bact. invasion through damaged mucosa

Question 36

NEC path.

Answer 36

1. necrosis begins at bowel mucosa and progresses full thickness 2. mucosa blees 3. bubbles of gas form in bowel wall 4. necrosis leads to bowel perf.

Question 37

NEC treatment and prog.

Answer 37

- early treat with ABs and bowel rest (TPN) | - 40% require resection