NSPN 7100- MODULE 6 THE NEONATE
QUESTIONS WITH COMPLETE
ANSWERS
Why ffare ffall ffinfants ffconsidered ffto ffbe ffvulnerable? ff- ffAnswer ffthey ffare ffdependent
ffon ffothers ffto ffrecognize ffand ffmeet fftheir ffneeds fffor ffgas ffexchange, fffluid, ffnutrition,
ffthermoregulation, ffand ffprotection fffrom ffharmful ffmicroorganisms
Fill ffin ffthe ffblank: ffCatecholamine ffrelease ffat ffbirth ffcan ffbe ffviewed ffas ffthe ff______
ffthat ffdrives ffthe ffadaptive ffresponses ff- ffAnswer ff'gas'
Why ffare ffchatecholamines ffimportant fffor fftransition ffto fftransition ffoutside ffof ffthe
ffwomb? ff- ffAnswer ffShortly ffbefore ffthe ffonset ffof fflabour ffthere ffis ffa ffcatecholamine
ffsurge ffthat ffseems ffto ffpromote fffluid ffclearance fffrom ffthe fflungs, ffwhich ffcontinues
ffduring fflabour. ffThey ffare ffresponsible fffor ffincreased ffblood ffpressure ffafter ffbirth,
ffadaptation ffof ffenergy ffmetabolism, ffand fffor ffinitiation ffof ffthermogenesis fffrom ffbrown
fffat.
Cortisol ffis ffa ffkey ffregulatory ffhormone ffthat ffaids ffin ffthe ffneonate's fftransition ffto
ffextrauterine fflife. ffWhat ffdoes ffcortisol ffaid ffin? ff- ffAnswer ff- ffLung ffmaturation
ff(anatomy ffand ffsurfactant)
- ffClearance ffof fflung fffluid
- ffGut ffmaturation
- ffMaturation ffof ffglucose ffmetabolic ffpathways ffin ffthe ffliver
- ffMaturation ffof ffthe ffthyroid ffaxis
When ffdo ffcortisol fflevels ffstart ffto ffincrease ffin ffthe fffetus? ff- ffAnswer ffCortisol fflevels
ffstart ffto ffincrease ffaround ff30 ffweeks ffgestation, ffincrease fffurther ffduring fflabour, ffand
ffpeak ffseveral ffhours ffafter ffbirth
When ffdo ffthe ffmajor ffadaptations ffassociated ffwith fftransition ffoccur? ff- ffAnswer
ffduring ffthe fffirst ff6-8 ffhours ffof fflife
What ffis ffthe ffmost ffcritical ffadaptation ffrequired fffor fftransition ffto ffextrauterine fflife? ff-
ffAnswer ffestablishment ffof ffeffective ffrespirations.
, The ffinitiation ffof ffrespirations ffis fftriggered ffby ffa ffcombination ffof ffchemical,
ffmechanical, ffthermal, ffand ffsensory fffactors. ffDescribe ffexamples ffeach ffof ffthese
fffactors ff- ffAnswer ffChemical: fffactors ffin ffa ffnewborn's ffblood ff(low ffoxygen, ffhigh
ffcarbon ffdioxide, ffand fflow ffpH) ffwhich ffstimulate ffrespiratory ffcenter ffin ffbrain.
Thermal: ffchange ffin fftemperature fffrom ffintrauterine ffenvironment ffto ffextrauterine
ffenvironment ffstimulate ffskin ffreceptors ffwhich ffstimulate ffrespiratory ffcenter.
Mechanical: ffrelease ffof ffpressure ffon ffa ffbaby's ffchest, ffas ffthe ffchest ffis ffborn, ffmay
ffstimulate ffbreathing ffand ffchest ffexpansion.
Sensory: ffstimulation fffrom ffdrying, fflights, ffsounds, ffsmells ffall ffinvolved ffin ffstimulation
ffof ffrespiratory ffcenter.
What ffare ffkey ffphysiological ffchanges ffthat ffoccur ffduring fftransition? ff- ffAnswer ff-
ffexpansion ffof fflungs ffwith ffair
- ffrapid ffdecrease ffin ffpulmonary ffvascular ffresistance ffand ffincrease ffin ffpulmonary
ffblood ffflow
- ffinitiation ffof ffgas ffexchange ffacross ffthe ffalveolar ffmembrane
- ffpressure ffgradient ffchanges ff(decreased ffright ffside ffpressure/increased ffleft ffside
ffpressure ffin ffheart)
- ffclosure ffof ffcirculatory ffshunts ff(foramen ffovale, ffductus ffarteriosus)
- ffrise ffin ffarterial ffpO2
What ffleads ffto ffpersistent ffpulmonary ffhypertension ffof ffthe ffnewborn? ff- ffAnswer ffany
fffactor ffthat ffinterferes ffwith ffthe ffphysiological ffprocesses ffrequired fffor fftransition ff(i.e.
ffprolonged fffetal ffhypoxia) ffmay ffresult ffin ffthe ffmaintenance ffof fffetal ffcirculation ff(high
ffpulmonary ffvascular ffresistance ffand ffpatent ffshunts). ffDuring ffthe ffstabilization ffperiod,
ffwhich ffoccurs ffover ffseveral ffhours, ffthe ffpulmonary ffvessels ffremain ffvery ffresponsive
ffto ffthe ffeffects ffof ffhypoxia. ffHypo-expansion ffof ffthe fflungs, ffhypoxemia, ffand
ffpersistent ffacidosis ffresult ffin ffhigh ffpulmonary ffvascular ffresistance, ffdelayed
ffclearance ffof fflung fffluid, ffand ffpersistent ffright ffto ffleft ffshunting. ffThis ffis ffknown ffas
ffpersistent ffpulmonary ffhypertension ffof ffthe ffnewborn
What ffare ffthe ffmajor ffchanges ffthat fftake ffplace ffin ffa ffnewborn's ffcardiopulmonary
ffsystem ffduring ffthe fftransition ffto ffextrauterine fflife? ff- ffAnswer ff- ffthe fflungs ffbecome
ffthe ffprimary fforgan ffof ffgas ffexchange ff(instead ffof ffthe ffplacenta); ffthe fflungs ffinflate,
fffluid ffis ffcleared fffrom ffthe ffalveoli, ffpulmonary ffvascular ffresistance ffdecreases ffrapidly
ffand ffthere ffis ffincreased ffpulmonary ffblood ffflow.
- ffThe ffpressure ffgradient ffin ffthe ffnewborn's ffheart ffshifts. ffRight ffsided ffpressure
ffwhich ffwas ffhigh ffin fffetal ffcirculation ffdecreases, ffand ffleft ffsided ffpressures ffwhich
ffwere fflow ffnow ffincreases. ffAs ffa ffresult ffthe ffforamen ffovale ffcloses.
- ffRising ffpO2 ffcauses ffsmooth ffmuscle ffcells ffin ffthe ffductus ffarteriosus ffto ffconstrict
ffthereby ffclosing ffthe ffshunt.
QUESTIONS WITH COMPLETE
ANSWERS
Why ffare ffall ffinfants ffconsidered ffto ffbe ffvulnerable? ff- ffAnswer ffthey ffare ffdependent
ffon ffothers ffto ffrecognize ffand ffmeet fftheir ffneeds fffor ffgas ffexchange, fffluid, ffnutrition,
ffthermoregulation, ffand ffprotection fffrom ffharmful ffmicroorganisms
Fill ffin ffthe ffblank: ffCatecholamine ffrelease ffat ffbirth ffcan ffbe ffviewed ffas ffthe ff______
ffthat ffdrives ffthe ffadaptive ffresponses ff- ffAnswer ff'gas'
Why ffare ffchatecholamines ffimportant fffor fftransition ffto fftransition ffoutside ffof ffthe
ffwomb? ff- ffAnswer ffShortly ffbefore ffthe ffonset ffof fflabour ffthere ffis ffa ffcatecholamine
ffsurge ffthat ffseems ffto ffpromote fffluid ffclearance fffrom ffthe fflungs, ffwhich ffcontinues
ffduring fflabour. ffThey ffare ffresponsible fffor ffincreased ffblood ffpressure ffafter ffbirth,
ffadaptation ffof ffenergy ffmetabolism, ffand fffor ffinitiation ffof ffthermogenesis fffrom ffbrown
fffat.
Cortisol ffis ffa ffkey ffregulatory ffhormone ffthat ffaids ffin ffthe ffneonate's fftransition ffto
ffextrauterine fflife. ffWhat ffdoes ffcortisol ffaid ffin? ff- ffAnswer ff- ffLung ffmaturation
ff(anatomy ffand ffsurfactant)
- ffClearance ffof fflung fffluid
- ffGut ffmaturation
- ffMaturation ffof ffglucose ffmetabolic ffpathways ffin ffthe ffliver
- ffMaturation ffof ffthe ffthyroid ffaxis
When ffdo ffcortisol fflevels ffstart ffto ffincrease ffin ffthe fffetus? ff- ffAnswer ffCortisol fflevels
ffstart ffto ffincrease ffaround ff30 ffweeks ffgestation, ffincrease fffurther ffduring fflabour, ffand
ffpeak ffseveral ffhours ffafter ffbirth
When ffdo ffthe ffmajor ffadaptations ffassociated ffwith fftransition ffoccur? ff- ffAnswer
ffduring ffthe fffirst ff6-8 ffhours ffof fflife
What ffis ffthe ffmost ffcritical ffadaptation ffrequired fffor fftransition ffto ffextrauterine fflife? ff-
ffAnswer ffestablishment ffof ffeffective ffrespirations.
, The ffinitiation ffof ffrespirations ffis fftriggered ffby ffa ffcombination ffof ffchemical,
ffmechanical, ffthermal, ffand ffsensory fffactors. ffDescribe ffexamples ffeach ffof ffthese
fffactors ff- ffAnswer ffChemical: fffactors ffin ffa ffnewborn's ffblood ff(low ffoxygen, ffhigh
ffcarbon ffdioxide, ffand fflow ffpH) ffwhich ffstimulate ffrespiratory ffcenter ffin ffbrain.
Thermal: ffchange ffin fftemperature fffrom ffintrauterine ffenvironment ffto ffextrauterine
ffenvironment ffstimulate ffskin ffreceptors ffwhich ffstimulate ffrespiratory ffcenter.
Mechanical: ffrelease ffof ffpressure ffon ffa ffbaby's ffchest, ffas ffthe ffchest ffis ffborn, ffmay
ffstimulate ffbreathing ffand ffchest ffexpansion.
Sensory: ffstimulation fffrom ffdrying, fflights, ffsounds, ffsmells ffall ffinvolved ffin ffstimulation
ffof ffrespiratory ffcenter.
What ffare ffkey ffphysiological ffchanges ffthat ffoccur ffduring fftransition? ff- ffAnswer ff-
ffexpansion ffof fflungs ffwith ffair
- ffrapid ffdecrease ffin ffpulmonary ffvascular ffresistance ffand ffincrease ffin ffpulmonary
ffblood ffflow
- ffinitiation ffof ffgas ffexchange ffacross ffthe ffalveolar ffmembrane
- ffpressure ffgradient ffchanges ff(decreased ffright ffside ffpressure/increased ffleft ffside
ffpressure ffin ffheart)
- ffclosure ffof ffcirculatory ffshunts ff(foramen ffovale, ffductus ffarteriosus)
- ffrise ffin ffarterial ffpO2
What ffleads ffto ffpersistent ffpulmonary ffhypertension ffof ffthe ffnewborn? ff- ffAnswer ffany
fffactor ffthat ffinterferes ffwith ffthe ffphysiological ffprocesses ffrequired fffor fftransition ff(i.e.
ffprolonged fffetal ffhypoxia) ffmay ffresult ffin ffthe ffmaintenance ffof fffetal ffcirculation ff(high
ffpulmonary ffvascular ffresistance ffand ffpatent ffshunts). ffDuring ffthe ffstabilization ffperiod,
ffwhich ffoccurs ffover ffseveral ffhours, ffthe ffpulmonary ffvessels ffremain ffvery ffresponsive
ffto ffthe ffeffects ffof ffhypoxia. ffHypo-expansion ffof ffthe fflungs, ffhypoxemia, ffand
ffpersistent ffacidosis ffresult ffin ffhigh ffpulmonary ffvascular ffresistance, ffdelayed
ffclearance ffof fflung fffluid, ffand ffpersistent ffright ffto ffleft ffshunting. ffThis ffis ffknown ffas
ffpersistent ffpulmonary ffhypertension ffof ffthe ffnewborn
What ffare ffthe ffmajor ffchanges ffthat fftake ffplace ffin ffa ffnewborn's ffcardiopulmonary
ffsystem ffduring ffthe fftransition ffto ffextrauterine fflife? ff- ffAnswer ff- ffthe fflungs ffbecome
ffthe ffprimary fforgan ffof ffgas ffexchange ff(instead ffof ffthe ffplacenta); ffthe fflungs ffinflate,
fffluid ffis ffcleared fffrom ffthe ffalveoli, ffpulmonary ffvascular ffresistance ffdecreases ffrapidly
ffand ffthere ffis ffincreased ffpulmonary ffblood ffflow.
- ffThe ffpressure ffgradient ffin ffthe ffnewborn's ffheart ffshifts. ffRight ffsided ffpressure
ffwhich ffwas ffhigh ffin fffetal ffcirculation ffdecreases, ffand ffleft ffsided ffpressures ffwhich
ffwere fflow ffnow ffincreases. ffAs ffa ffresult ffthe ffforamen ffovale ffcloses.
- ffRising ffpO2 ffcauses ffsmooth ffmuscle ffcells ffin ffthe ffductus ffarteriosus ffto ffconstrict
ffthereby ffclosing ffthe ffshunt.
