Asphyxia and Its Classifications

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Questions and Answers

What effect can long-term corticosteroid use have on children?

Enhance growth and development

Stabilize hormonal levels

Promote cognitive advancement

Interfere with growth and development (correct)

Which stage of adolescence occurs between the ages of 15 and 17 years?

Middle adolescence (correct)

Pre-adolescence

Late adolescence

Early adolescence

According to Erikson's theory, what consequence does failing to achieve a sense of industry in childhood lead to?

Developing a sense of independence

Developing a sense of inferiority (correct)

Establishing a strong identity

Achieving better cognitive skills

What is a common cognitive change associated with aging?

Decline in short-term memory Signup and view all the answers

What characterizes the formal operational stage in Jean Piaget's theory?

Ability to think abstractly and reason logically Signup and view all the answers

What characterizes primary apnea in a newborn?

Transient rapid breathing followed by cessation. Signup and view all the answers

Which of the following are identified risk factors for birth asphyxia during labor?

Prolonged or obstructed labor. Signup and view all the answers

What is a primary consequence of asphyxia?

Hypoxic Ischaemic Encephalopathy. Signup and view all the answers

Which intervention helps to minimize fetal heart deceleration during labor?

Maternal positioning to left lateral. Signup and view all the answers

What immediate action is included in the resuscitation protocol for a newborn?

Routine gastric aspiration. Signup and view all the answers

What is a significant physiologic change during chronic fetal hypoxia?

Development of placental insufficiency. Signup and view all the answers

During uterine contractions, what happens to blood flow to the fetus?

It is momentarily interrupted. Signup and view all the answers

What is the primary method to assess the newborn's condition at 30 seconds of life?

Checking for heart rate < 100 bpm. Signup and view all the answers

What is the predominant hemoglobin type found in adults?

Hb A (α2β2) Signup and view all the answers

Which variant of hemoglobin is associated with sickle cell disease?

Hb S (α2βS2) Signup and view all the answers

What does an Apgar score of 3 or lower at 5 minutes indicate?

Poor correlation with adverse future neurological outcomes Signup and view all the answers

What type of red blood cell variation is caused by iron-deficiency anemia?

Microcytes Signup and view all the answers

What is the primary cause of Respiratory Distress Syndrome (RDS) in preterm infants?

Deficiency of surfactant Signup and view all the answers

Which stage of labor involves the most rapid cervical dilation?

First stage - Dilatational division Signup and view all the answers

At what gestational age should corticosteroids be administered to mothers at risk of preterm delivery to aid fetal lung maturity?

Before 32–34 weeks gestation Signup and view all the answers

Which condition is characterized by β-chain abnormalities and can lead to mild hemolytic anemia?

Hemoglobin C Signup and view all the answers

What could potentially cause delayed physical milestones such as walking?

Growth Hormone Deficiency Signup and view all the answers

What physiological change indicates adequate ventilation in a neonate?

Improved heart rate Signup and view all the answers

Which type of leukocytosis is characterized by an increase in neutrophils?

Neutrophilia Signup and view all the answers

In the context of hemopoiesis, which stage occurs during the first two months of intrauterine life?

Mesoblastic stage Signup and view all the answers

What type of red blood cell variation is typically seen in megaloblastic anemia?

Macrocytes Signup and view all the answers

What is the main organ responsible for producing red blood cells during the hepatic stage of hemopoiesis?

Liver Signup and view all the answers

What component is the iron-containing pigment in hemoglobin?

Heme Signup and view all the answers

After the age of 20 years, which bones primarily contribute to the production of red blood cells?

Flat bones such as the pelvis and skull Signup and view all the answers

Study Notes

Asphyxia

Impaired respiratory gas exchange (hypoxia and hypercapnia), accompanied by metabolic acidosis
Birth asphyxia: failure to initiate and sustain breathing at birth
Consequences/etiology/causes of asphyxia: hypoxic-ischemic encephalopathy, organ failure, and neonatal death

Classifications of Asphyxia

Acute: caused by intranatal factors only
Chronic: background of prolonged fetal hypoxia and placental insufficiency

Intranatal Risk Factors for Birth Asphyxia

Fetal arterial blood oxygen tension: 25 ± 5 mm Hg
Oxygen consumption is twice that of the adult per unit weight
Fetal oxygen reserve: 1-2 minutes
Uterine contractions: momentarily interrupt blood flow
Cord compression: during contractions
Failure to progress/dystocia: prolonged or obstructed labor exhausts the fetus

Causes of Fetal Hypoxia

Acute:
- Maternal hypotension
- Placental abruption
- Cord prolapse
- Maternal infection
- Maternal respiratory disease
Chronic:
- Any maternal infection
- Maternal respiratory disease

Intrapartum Resuscitation

Maternal positioning to left lateral: reduces fetal heart deceleration risk
Stopping contractions (tocolytics or uterine relaxation): restores maternal blood flow to placenta
Intravenous fluids: corrects maternal hypovolemia and hypotension
Oxygen

Primary Apnea

Transient period of rapid breathing with oxygen deprivation
If prolonged, breathing stops (primary apnea)
Further oxygen deprivation leads to gasping respirations, then secondary apnea
Decline in heart rate and blood pressure, and loss of neuromuscular tone

Management of Fetal Distress (Resuscitation Protocol)

Basic measures:
- Warm the newborn to minimize heat loss
- Clear the airway
- Dry the infant
- Routine gastric aspiration
Assessment at 30 seconds of life:
- Apnea, gasping respirations, or heart rate < 100 bpm beyond 30 seconds after delivery: perform positive-pressure ventilation with room air
- Monitor oxygen saturation with pulse oximetry

Additional Information (Page 2)

Assessment at 60 seconds of life:
- Persistent heart rate below 100 bpm beyond 60 seconds warrants tracheal intubation and head position correction
- Clear secretions and increase inflation pressure
Clinical findings in fetal distress:
- Acidaemia (pH < 7 in umbilical artery blood sample)
- Apgar score of 0-3 persisting 10 minutes or longer
Apgar Score: Used to identify neonates needing resuscitation and evaluate resuscitative measures
- 7+ at 1 minute: Normal
- 9-10 at 5 minutes: Normal
- 5-minute Apgar score of 3 correlates poorly with adverse neurological outcomes
Respiratory distress syndrome (RDS): Hyline membrane disease in preterm infants due to surfactant deficiency, reducing alveolar surface tension
Corticosteroids: Given to mothers at risk of delivery before 32-34 weeks to hasten fetal organ maturation

Hemopoiesis (Haematopoiesis)

Process of origin, development, and maturation of all blood cells
Sites of hematopoiesis:
- Mesoblastic (first two months of intrauterine life, yolk sac)
- Hepatic (third month, liver)
- Myeloid (last three months, red bone marrow, and liver; exclusively from red bone marrow after birth in newborns, children, and adults)(except from flat bones to 20 years and bones ends of long bones after 20 years old)

Hemoglobin Variations

Abnormal hemoglobin variations that result in diseases like:
- Sickle cell disease (Hb S)
- Mild chronic hemolytic anemia (Hb C)

Leukocytes Variation

Pathological leukocytosis occurs when one type of leukocyte increases at the expense of others,
Possible causes include infections (e.g., neutrophilia, eosinophilia, basophilia, lymphocytosis, monocytosis) or allergic conditions

Labor Stages

First Stage: Preparatory and dilatational divisions, cervix dilation
Second Stage: Fetal delivery
Third Stage: Placental delivery
Pelvic Division: Deceleration and final phase of cervical dilatation

Other Information (Page 4)

Causes of growth failure and delayed milestones:
- Genetic and chromosomal conditions
- Nutritional deficiencies
- Hormonal imbalances (growth hormone deficiency and corticosteroid use)
- Thyroid disorders
Eriksson's Theory: Child development sense of industry and inferiority
Adolescence: transition from childhood to adulthood (early, middle, late)
Physical Growth: Growth spurt in adolescence (earlier in girls than boys)
Jean Piaget's Cognitive Development Theory: formal operational stage in adolescence
Erik Erikson's Psychosocial Development Theory: Identity vs. role confusion in adolescence
Aging: Biological process of growing older; gerontology; geriatrics (health care of older adults)
Common diseases of old age: cardiovascular, arthritis, osteoporosis, cognitive changes

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Description

This quiz explores the critical concepts surrounding asphyxia, including its definitions, classifications, and the intranatal risk factors that contribute to birth asphyxia. Delve into the causes of fetal hypoxia and understand the implications of impaired respiratory gas exchange. Test your knowledge on this vital subject in neonatal health.