RT134 Circulation, Growth Periods

> 0-7 Weeks
Appearance of Lung Buds
Division into Major Bronchi

> 7-17 Weeks
Rapid Branching
Airways lined by Columnar Epithelium
After 10 Weeks, appearance of Cartilage, Lymphatics, Mucous Glands, and Muscle Cells
At 17 weeks, Terminal Bronchioles present

> 17-27 Weeks
Development of Terminal Bronchioles, Respiratory Bronchioles, and Small Alveolar Sacs (Acinus)
Differntiation for type1 (Gas Excange) & type2 (Surfactant)
Beginning stage of gas exchange

> 27-36 Weeks
Enlargement of Peripheral Airways
Further differentiation of pnemocytes
Has better Gas Exchange

> 36 weeks - 2 years post natal
Alveoli increase until 2-4 years and continue to increase in size until adolescence
Increase in Cartilage, Glands, and Muscles
300-400 million alveoli in Adults

tests for surfactant production in fetus

amniotic fluid

fetal stress in utero

diabetic mother

Parity—prima para, grandmulti para; Multiple Births; 40 years of age; No prenatal Care; Maternal Diabetes; Smoking/Drugs/Alcohol; Ethnicity; Delivery History—dystocia, prom; Position of fetus; Hyperthyroidism; Eclampsia/Pre-eclampsia; Toxemia of Pregnancy; Protenuria; HELLP; Isoimmunization; rH factor; Hydrops Fetalis/Hemolytic Anemia

too much: polyhydraminos

too little: oligohydraminos

fetal butt facing vaginal opening and both feet are pointing up.

fetal butt facing vaginal opening. both legs and feet are crossed.

fetal butt facing vaginal opening. one leg is facing up and one foot is facing down

a woman who has already delivered 5 or more babies at 24 weeks or more.

Responds to stimulation

deprivation of oxygen but is breathing is stimulated by giving oxygen.

unresponsive to stimulation/intervention
Deep irregular gasping
HR and BP decrease
If continues, HR & RR cease, O2 falls, death occurs
NEEDS positive pressure vent with appropriate FiO2

Placental Abruption (partial or complete)

Placenta Previa

Placental abruption is the separating of the placenta from the uterine wall and pool blood.

partial abruption, has no indication while complete abruption will show spotting and bleeding from the mother.

Placenta Previa is a situation where the placenta is blocking the vaginal opening preventing normal birth.
Placenta should not be delivered first as you dont wan to remove the fetus’ unit of respiration before it has a chance to come out. C-section needed

cord prolapse - cord is delivered before baby (breech births)

Nuchal Cord - cord wraps around neck

Cord Knots

DE-oxygenated blood

Oxygenated blood from the umbilical cord

increase in o2
decrease in C02
normalization of pH
Decrease in prostaglandins

This causes the ductus arterosus to contract

after birth, the cord is cut and clamped

| This creates a back pressure to shut it.

Ductus Arteriosus
Ductus Venousus
Foramen ovale

you collect an ABG from the right radial and unbilicus.

If there is a difference of >15 torr you have a patient ductus arteriosus and still have a Right to Left shunt

It leads blood that is coming from the pulmonary artery directly to the Aorta.

Increased pressure from pulmonary arteries to right ventricles due to increased pulmonary vasculature.

After birth, decreased resistance into pulmonary vasculature decreases pressure in the right artrium and increases pressure in left atrium closing it.

It tests physical condition of the baby.

A = Appearance / Color

P = Pulse

G = Grimace / reflex

A = Activity / muscle tone

R = Respiration / respiratory effort

Appearance / color
0 = Blue all over or Pale
1 = Acrocyanosis
2 = Pink all over

Pulse
0 = absent
1 = below 100
2= above 100

Grimace / reflex
0 = no response
1 = grimace or weak cry
2 = Good Cry

Activity / muscle tone
0 = Flacid
1 = some reflex of extremities
2 = Well flexed or active movements

Respiratory Effort
0 = absent
1 = weak irregular or gasping
2 = good / crying

7 - 10 normal and no interventions needed

| 4 - 7 = Needs resusitation

at 1 min and 5 mins after birth.

You may have to test more if baby is

This evals degree of respi distress.

| It subjective, it allows you to focus on respiratory effort

It tests gestational age.

| Premature 42 weeks

Date and Dubowitz/Ballard Scale are 2 ways to test it

HR = 120-170 brady = (=170)

RR = 30 - 60

BP = 75/50

MAP = 60

Conduction (object to object directly)(Cold hands or Cold Stethoscope)

Convection (object to air)(Cold Air draws away heat)

Radiation (object to object indirectly)(Isolate walls coldness draw heat away from baby)

Evaporation (liquid to vapor) (liquid on baby from amniotic sac)

babies cant maintain heat, cant shiver, no brown fat to metabolize, increase surface area to weight

Pulmonary funct / Respi failure

Provide Airway (upper airway obstruction issues)

Protect Airway (Loss of protective airway reflexes)

Pulmonary Hygene (unable to clear secretion)

pH

1000g and 2.5 size

Increase by .5 for every increase in 1000g

you use cuffless et tubes until the age of 8

Miller straight blade

Surfactant deficiency of the lung causing decreased lung compliance and atelectasis

Plasma leaks out of lung tissue and forms hyline membrane and prevent gas exchange

Premature infants

Only over the large airways

Failure of shunts to close during transition from fetal circulation due to lack of O2

High PVR causing Right to Left shunt

Hypoxemia and acidemia causes further increase in ­PVR and perpetuates the cycle

Compare pre and post ductal blood gas samples for R-L shunt

O2 hyperoxia test

hyperventillation test

Contrast echocardiography used to confirm shunting