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Perinatology Division Dept. of Child Health Medical School University of Sumatera Utara 1
PERINATOLOGY
Pediatrics
Obstetrics
Perinatology
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Perinatology Coverage
22 weeks Born 1 Month (GA 5 month) Obstetric Pediatric (pregnancy monitor) Neonatologist (intensif care)
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Normal newborn :
Term infants Birth weight : 37 42 weeks GA : 2500 4000 g
: 44 53 cm : 7 10
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Fetus
* Fetal circulation
* O2 depend to Utero placental circulation
Neonates
* Neonatal circulation
* O2 own produce by breathing
* Nutrition depend on
maternal status
NEONATAL ADAPTATION
Birth
Fetus
Neonate
Resuscitation
Adaptation
NEONATAL ADAPTATION
Adaptation :
the process by which one adjusts and becomes more attuned to the environment.
Neonatal adaptation
Functional adjustment from intrauterine to extrauterine life Ability to adjust --- HOMEOSTASIS Maladaptation --- Morbidity
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NEONATAL ADAPTATION
ADAPTATION depend on :
NEONATAL ADAPTATION
ADAPTATION depend on :
MATURATION
Related to gestational age
NEONATAL ADAPTATION
ADAPTATION depend on :
ADAPTATION
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NEONATAL ADAPTATION
ADAPTATION depend on :
MATURATION NUTRITIONAL STATUS TOLARANCE
The ability to overcome the new environment Tolerability to hypoxia, hypoglycemia, caloric intake, etc.
ADAPTATION
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NEONATAL ADAPTATION
ADAPTATION depend on :
MATURATION NUTRITIONAL STATUS TOLARANCE ADAPTIVE CAPACITY
NEONATAL ADAPTATION
Adaptation involved multiorgan function,include:
Cardio-circulatory system Respiratory system Intestinal tract Metabolism Central nervous system
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Circulatory Adaptation
Fetus from 8 weeks until birth organs mature to support external life
Fetal circulation
umbilical-placental circuit via umbilical cord circulatory shunts to bypass
Liver ductus venosus to inferior vena cava Lungs @ foramen ovale between right & left atria @ ductus arteriosus connects pulmonary artery to aorta
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CIRCULATORY ADAPTATION
Umbilical vein
Ductus venosus Foramen Ovale
Ductus arteriosus
Pulmonary circ. Systemic circ. Umbilical artery
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CIRCULATORY ADAPTATION
DUCTUS VENOSUS
BY PASS I
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CIRCULATORY ADAPTATION
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CIRCULATORY ADAPTATION
BY PASS III
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CIRCULATORY ADAPTATION
FETAL CIRCULATION
High pulmonary resistance Low resistance in systemic blood flow
Ductus arteriosus
(High pulmonary resistance, Low fetal systemic blood and prostaglandin function)
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CIRCULATORY ADAPTATION
NEONATAL CIRCULATION
Profound changes of circulation at birth Increased pulmonary blood flow due to the drops of pulmonary resistance - lung expansions. Venous return from lung increase. Left arterial press. is raised; Right art.press.decrease foramen ovale closed. Systemic resistance higher than pulmonary resistance (24 hours) Prostaglandin function Ductus close Constrict umbilical arteries and placental blood stops.
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NEONATAL ADAPTATION
NEONATAL ADAPTATION
CIRCULATORY ADAPTATION
Fetus
Pulmonary circulation Foramen ovale Ductus arteriosus Botali Ductus Venosus Arantii Systemic circulation
Active, less develop.
Newborn
Active, increased development
Open
Close
Open
Open
Active with low resistance
Close
Close
Active with increase resistance
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Circulatory Adaptation
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Lung developments
Control of breathing Fetus : gas exchange placenta
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NEONATAL ADAPTATION
Temperature Touch
Proprioceptive
Pain
FIRST BREATH
Mechanical
Diafragm
Neonatal Respiration Irregular Abdominal respiration
Chemoreceptor
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PULMONARY ADAPTATION
CHAIN OF EVENTS AFTER FIRST BREATH :
Converts fetal to adult circulation
PULMONARY ADAPTATION
FETUS
Alveolus Pulmonary vessels Pulmonary resistance Pulmonary blood Oxygen needs CO2 excretion Colaps Non active High Low Placenta Placenta
NEWBORN
Develops Active Decrease Increase Lung Lung
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Gest.Age 4 wk
Gest.Age 6 wk
Duodenum : occluded - reformation of lumen X atresia Liver & biliary : Begin at 6 and 12 weeks failure to canalization X biliary atresia Pancreas : Insulin secretion and glucagon - 10 and 15 weeks
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NEONATAL ADAPTATION
GASTROINTESTINAL ADAPTATION
Fetus
Nutritional absorption Bacterial colonization Feces Enzyme Non active
Newborn
Active
Negative
Meconium Non function
Positive
Meconium Feces Active
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UROGENITAL ADAPTATION
Renal organogenesis a continuous process 6 till 36 weeks gestation
The developments of urogenital funtion continuous after birth Fetal urine production maintaining amniotic fluid volume More than 90% newborn void in the first 24 hours. Newborn urine production : 1-2 ml/kg BW/hour.
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UROGENITAL ADAPTATION
ALLERTNESS
OLIGOHYDRAMNIOS
May suggest renal agenesis; hypoplasia; dysplasia; urinary tract obstruction.
POLYHYDRAMNIOS
Gastrointestinal anomalies; transplacental transfusion syndr.; congenital DM
NEWBORN : Immune system even in term - lower than adults. Between 3-12 mo transient immunodeficiency. The risk enhance by : Prematurity Traumatic delivery Neonatal stress, etc.
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37.5 C
Normal range
36.5 C Cold stress ---------- Cause for concern Moderate hypothermia --- WARM BABY 32.0 C Severe hypothermia / outlook grave Skilled care urgently needed
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36.0 C
TEMPERATURE ADAPTATION
FETUS : Body temperature intrauterine environment NEWBORN :
Expose to extra uterine condition homeothermy capabilities is limited due to : large surface area; poor thermal insulation; low ability to conserve heat.
PREVENT OF HEAT LOSS
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