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Cardiorespiratory Changes After Birth Dr. Harold Helbock Generic Heart The Cardiac Tube The Adult Heart Cardiac Outflow Anomalies Abnormal conditions compatible with fetal life are often Incompatible, or incapacitating to some degree, with postnatal life, including the adult. Chief among the hazards induced by cardiac anomalies is the distribution of inadequately oxygenated blood to the body. Examples of Cardiac Anomalies • • • • Tetralogy of Fallot Stenosis of pulmonary artery Displacement of aortic opening to the right. Intraventricular opening Hypertrophy of right ventricle. Examples of Cardiac Anomalies Patent Ductus Arteriosus • Blood regurgitates from the aorta to the pulmonary artery and is taken back to the lungs. Heart Rate in Labor Characteristics of the Adult Pulmonary Respiratory System Functions of the Lungs • Gas Exchange Oxygen absorption Carbon Dioxide removal • • • • Immunologic Defense Metabolic Function Endocrine Function Peptide Activators Pulmonary capillary Transition Period from Prenatal To Postnatal Life • The newborn must switch rapidly from intrauterine mechanisms to adult physiology. • This process is referred to as transition and involves changes in both pulmonary and circulatory physiology. closed expand Normal Transition of Circulation from Pre- to Post- natal closed open Differences in oxygenation system of the fetus to the newborn Bronchi/airways uterine artery Air sacks/alveoli placental sinusoids Pulmonary vein umbilical vein Oxygenated blood to the heart Pulmonary artery umbilical artery Venous blood to gas exchange organ Diaphragm maternal myocardium Move the gas to be exchanged Events Happening at Birth • First breath 30-100 mm Hg vs. 5-10 mm Hg for normal breathing • Closure of ductus arteriosus Functional and later anatomic closure Initially systemic and pulmonary pressures are equal • Removal of fluid from the lungs Chloride Protein molecules Major steps described in next slide Removal of Lung Fluid at Birth 1. 2. 3. 4. 5. 6. 7. Fetus = Cl- pumps move fluid into potential air space. Very little protein in potential air space liquid. Result = osmotic pressure draws liquid from the alveolar space to the interstitium = circulation. Newborn = Cl- pumping stops and Na+ pump moves fluid out of alveoli. Air pressure in the alveoli drives liquid out and into interstitium. Expansion of the lung stretches open the pulmonary vessels and thereby reducing pulmonary vessel pressure and hydrostatic pressure. Net result = liquid leaves air spaces and exits the interstitial space via the lymph and microcirculation. The Apgar Score Assessment of transition Score 0 1 2 Heart rate Absent Less than 100/min More than 100/min Respiratory effort Absent Slow, irregular Good, crying Muscle tone Limp Some flexion of extremities Active motion Reflex irritability Absent Grimace Grimace and cough or sneeze Color Blue, pale Body pink/extremities blue (acrocyanosis) Completely pink The First Hours of Life The First Week of Life • The infant is given vitamin K. – Eye drops are instilled to prevent blindness from bacterial infection. – Hepatitis B (a major cause of hepatic cancer) immunization. • Feedings – Infant slowly increased volume of milk taken at each feeding until intake is about 1 fluid oz. per hour, on average. – Parents get a little more sleep, but not much!! The First Week of Life • Jaundice is a common problem on days 2-4 and longer if blood group incompatibilities exist. – Principle: post birth adaptation must take place in multiple systems, not just lungs and heart • A good baby is a sick baby! • BW ~ IQ and 1/CV disease risk, mom’s diet