transition
Successful:
-alveolar fluid clearance
-lung expansion
-circulatory -> closure of R-to-L shunts
alveolar clearance
3 Parts
Labor:
-hormones cause lung epithelium to switch from active secretion to active resorption (catecholamines) -> sodium and liquid
-inc O2 tension at birth -> inc epithelium Na transport capacity, inc gene expression of epithelial Na channel
Thorac
lung expansion
First effective breath -> air movement begins as intrathoracic pressure falls
-inc inspiratory pressure expands the alveolar air spaces -> establishes functional residual capacity (FRC)
Stimulates surfactant release -> reduces alveolar surface tensions
-i
circulatory changes
Umbilical cord clamping -> rise in neonatal systemic BP
Lung expansion -> reduces pulm vascular resistance and pulm artery pressure
Dec fetal R-to-L shunt at ductus arteriosus -> inc L-to-R shunt at ductus arteriosus
Inc blood flow through pulm arteries a
cephalohematoma
Subperiosteal collection that does not cross suture lines
-more common when forceps or vacuum delivery performed
-resolve after several weeks
Complications: sepsis, hyperbili, calcification
caput succedaneum
Collection of fluid above periosteum
-may cross suture lines
-generally benign
-resolves after few days
Usually on posterior scalp
-mild swelling
subgaleal hemorrhage
Blood accumulates in space between periosteum and aponeurosis
-veins between scalp and dural sinuses are sheared or severed as a result of traction on scalp during delivery
Presents as diffuse, fluctuant swelling
-may shift with movement -> fluid wave (!!
red reflex
Normal is seen if lens and underlying structures are clear
Abnormalities: white pupil (leukocoria)
-lens -> cataract
-vitreous -> persistent fetal vasculature
-retina -> retinoblastoma
cleft lip/palate
Many types
Speech/feeding issues
-often require special nipple to feed
Management: most repaired between 3-6m
-goal -> improve feeding so big enough to handle surgery
-must be cautious of post op inf -> children will pick at it
prune belly syndrome
Abdominal muscle deficiency
-severe urinary tract abnormalities
-bilateral cryptorchidism in males
-renal dysplasia, urinary tract abnormalities, and pulmonary hypoplasia
CM: difficulty breathing
-no resistance when palpating
-won't bulge out when crying
cord vessels
Normally 3
2 -> diaphragmatic hernia, renal problems, or other anatomical issues
-cannot bag mask infant w/ diaphragmatic hernia -> pt will worsen
developmental dysplasia of the hip (DDH)
Hip easily dislocates
High risk:
-breech (female > male)
-females need US at 6w while males it is optional (!!!)
-FMH
Ortolani:
-abduct and pull up, feel hip move back into place
Barlow:
-adduct and push posteriorly -> feel clunk (very different from norm
neonatal reflexes
Moro -> gone by 3-4m
-pull up both hands and drop, look for both hands flaring out
Rooting -> gone by 4m
-stroke cheek -> head turn and opens mouth
Babinski -> gone by 12m
-stroke foot -> toes curl out
Palmar grasp -> gone by 6m
-place something in hand -
APGAR
Appearance -> blue or pink
-0 = blue everywhere
-1 = blue hands and feet
-2 = pink everywhere
Pulse -> above or below 100
-0 = none
-1 = less than 100
-2 = over 100
Grimace -> response to stim
-0 = none
-1 = feeble cry or grimace
-2 = sneezing, coughing,
hepatitis B vaccine
given to all kids
Mom is HBsAg + -> kid gets vaccine and HBIG within 12h
erythromycin
Used to prevent conjunctivitis
-leading cause of blindness in neonates
-gonorrhea
-not useful to prevent chlamydia -> screen and treat mother before birth
vitamin D
Common sources: milk, sunlight
-infant cant have either
-unlikely to get enough through feeding alone
iron
Infants get this from mom during 3rd trimester
-build up stores for 4m
-premature infants often need more than what is in typical formula
sudden infant death syndrome (SIDS)
Sudden death of infant w/o identifiable cause
-3rd leading cause of mortality of infants in US (8%)
Unclear etiology
-majority have hypoxia on autopsy
Prevention:
-Always place your baby on his or her back for every sleep time.
-Always use a firm sleep su