OB exam 4- birth related stressors

what is neonatal asphyxia

condition resulting from hypoxia from birth

what are the 3 factors of asphyxia

circulatory, respiratory, biochemical

what happens with circulation during asphyxia

inability to transition to extrauterine circulation (late decelerations)

what happens with respiration during asphyxia

not enough surfactant, so failure of lung expansion, rapid RR, pulmonary vasoconstriction, increased pulmonary vascular resistance, respiratory acidosis

what happens biochemically during asphyxia

hypoxemia during labor, so metabolic acidosis, hypercarbia, anaerobic metabolism, brain damage, and death

risk factors of neonatal asphyxia

nonreassuring FHR, sustained bradycardia, anything affecting blood flow through placenta, difficult birth, prolonged labor

what can diagnose neonatal asphyxia

fetal scalp blood sample shows pH < 7.2

what rules out fetal acidemia

moderate variability

other risks for neonatal asphyxia

meconium in amniotic fluid, significant intrapartum bleeding, prematurity, SGA, unexpected congenital anomalies, oligohydramnios, polyhydramnios, narcotics, DM, anemia

what questions are asked to assess the need for resuscitation during the 1st minute

full term, breathing, crying, good muscle tone

what do you do during resuscitation

stimulate, suction, administer 21% oxygen, evaluate vitals, positive pressure ventilation, admin 100% oxygen when giving compressions, epinephrine

what causes respiratory distress syndrome

inadequate production of surfactant in preemies or babies with surfactant deficiency disease

how to care for baby with respiratory distress syndrome

give surfactant through ET tube on each side

what is surfactant required for

alveolar stability

what does alveolar instability cause

atelectasis and eventually hypoxemia, hypercarbia, and acidemia

how to treat respiratory distress syndrome before birth

prevent preterm birth and administer betamethasone to mom

describe betamethasone

2 shots 24 hours apart, IM, usually 12 mg

what is transient tachypnea of the newborn

progressive respiratory distress that resembles RDS, but because of delayed fluid absorption instead of surfactant deficiency

risk factors for TTN

maternal DM, asthma, male baby, macrosomia, C section

how to care for TTN

diagnose with x rays, admin oxygen, IV fluids and electrolytes, abstain from oral feedings

meconium aspiration is a physiologic response to ________

asphyxia

how is meconium aspiration a physiological response to asphyxia

it causes peristalsis and anal sphincter relaxation, which allows meconium to be released

symptoms of meconium aspiration distress

pallor, cyanosis, apnea, decreased HR, respiratory distress, barrel chest, decreased air movement, displaced liver, yellow or green stained

how to care for a baby who aspirated meconium

tracheal suction, umbilical arterial line and IV, increase oxygen, exogenous surfactant, prophylactic antibiotics, ECMO

what is cold stress

excessive heat loss that leads to increased RR and nonshivering thermogenesis

why is the baby’s ability to compensate impaired with cold stress

hypoxemia, CNS abnormalities, hypoglycemia

consequences of cold stress

increase in oxygen requirements, increase in glucose utilization, acids released into bloodstream, surfactant production decreases

process of cold stress

cold, increased oxygen consumed, increased RR, vasoconstriction, decreased oxygen uptake in lungs and tissues, anaerobic glycolysis, decreased PO2 and pH, metabolic acidosis

how to care for a baby with cold stress

warm slowly by raising room temperature to 72-74, remove plastic wrap, cap, shields, and do skin to skin; monitor temperature every 15-30 minutes, warm IV fluids, treat hypoglycemia, assess for anaerobic metabolism and acidosis

definition of baby hypoglycemia

blood glucose < 40 mg/dL

risk factors for baby hypoglycemia

preterm, DM, SGA, stressed baby (low Apgar and nonreassuring FHR)

symptoms of hypoglycemia

lethargy, poor sucking and feeding, pallor, cyanosis, hypothermia, respiratory distress, tremors, seizure activity, high pitched cry

how to care for baby with hypoglycemia

routine screening, early feeding, 5-10% dextrose by IV <20mg

what causes physiologic jaundice

shortened RBC lifespan, slower uptake of bilirubin by liver, lack of intestinal bacteria, poorly established hydration

when do total bilirubin levels peak in baby

4-5 days after birth

pathophysiology of pathologic jaundice

decrease in the number or affinity of bilirubin building sites of albumin

causes of pathologic jaundice

ABO or Rh incompatibility, asphyxia, drugs, hypothermia, hypoglycemia, preemie

when does pathologic jaundice appear

within the first 24 hours

bilirubin concentration rises by more than _______ and exceeds _______ during pathologic jaundice

0.2 mg/dL/hr

what does jaundice lead to

damage of brainstem, causing retardation and cerebral palsy (kernicterus)

symptoms of Kernicterus

cerebral palsy, mental retardation, hearing loss, perceptual impairment, delayed speech development

treatment of pathologic jaundice

measuring transcutaneous bilirubin then total serum levels every 12-24 hours

treatment of pathologic jaundice (not screening)

resolving anemia, removing maternal antibodies, increasing serum albumin, reducing serum bilirubin, drug therapy, phototherapy, exchange therapy

when does hemolytic disease of the newborn occur

when mom is Rh- or blood type O

another name for hemolytic disease of the newborn

erythroblastosis fetalis

pathophysiology of hemolytic disease of the newborn

maternal antibodies cross placenta and destroy fetal RBCs

what is hydrops fetalis

hemolytic disease causes severe anemia, which causes heart failure and fluid build up

what is the most severe form of Rh incompatibility

hydrops fetalis

what does the direct Coombs test determine

whether jaundice is from Rh or ABO

what does the indirect Coombs test detect

the presence of Rh and Ab in mother’s blood

what Coombs result would Rh incompatibility have

positive direct Coombs test

what Coombs result would ABO have

positive indirect Coombs test

what happens during an exchange transfusion

newborn’s blood is removed and replaced with donor blood to treat anemia related to mother infant blood incompatibility; it removes RBCs marked for lysis and serum bilirubin, and increases albumin binding sites for bilirubin

what does phototherapy do

decreases bilirubin by increasing biliary excretion of unconjugated bilirubin

physiology of phototherapy

photobilirubin is transported to liver, incorporated into bile, and excreted in stool and urine

full term hemoglobin

13-16 g/dL (slightly higher in preemies)

causes of anemia in baby

blood loss, hemolysis, impaired RBC production

when does physiologic anemia occur

when HgF levels drop in the first 8-12 weeks

during physiologic anemia, HgF drops to less than _____ in term babies and ______ in preemies

11 g/dL; 8-11 g/d:

how is physiologic anemia fixed

bone marrow begins to make RBCs and it disappears

risk factors of polycythemia

IUGR, full or late term, placental transfusion, maternal-fetal or twin-to-twin transfusion, intrauterine hypoxia, smoking mothers, asphyxia, DM, HTN, or took PROPRANOLOL