Neonatal Thermoregulation and Cold Stress Effects
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Neonatal Thermoregulation and Cold Stress Effects

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Questions and Answers

What is the primary function of vernix produced from 18 weeks gestation?

  • To provide lubrication during birth
  • To protect against infections postpartum
  • To assist in the development of skin layers
  • To prevent transdermal water loss in preterm infants (correct)

    • At what week of gestation does IgG reach its maximum level in the fetus?

  • 20 weeks
  • 15 weeks
  • 32 weeks (correct)
  • 36 weeks

    • Which hormone is released by the kidneys to facilitate urine production?

  • Insulin
  • Renin (correct)
  • Cortisol
  • Adrenaline

    • What best describes the Neutral Thermal Environment (NTE) for infants?

    <p>An ideal environment to maintain normal body temperature with minimal oxygen consumption</p> Signup and view all the answers

    What effect does hyperthermia have on the body's metabolic processes?

    <p>Increases metabolic rate</p> Signup and view all the answers

    What is the normal temperature range for neonates?

    <p>36.5°C to 37.4°C</p> Signup and view all the answers

    Which of the following describes the relationship between hypothermia and core temperature in neonates?

    <p>Hypothermia occurs when the core temperature falls below 36.5°C.</p> Signup and view all the answers

    What environmental temperature factors contribute to rapid heat loss in neonates immediately after birth?

    <p>Birth room temperature typically between 21-25°C</p> Signup and view all the answers

    When maintaining neonatal thermoregulation, where should the temperature probe be placed?

    <p>In soft tissue areas such as the abdomen</p> Signup and view all the answers

    What physiological mechanism is triggered by hypothalamic stimulation in response to cold temperatures in neonates?

    <p>Release of noradrenaline in brown adipose tissue</p> Signup and view all the answers

    What sequence occurs after blood enters the right ventricle in a newborn?

    <p>It flows through the pulmonary trunk and bypasses the lungs.</p> Signup and view all the answers

    What is the first event that occurs when a newborn takes its first breath?

    <p>Surfactant is released and lungs expand with air.</p> Signup and view all the answers

    Where should pre-ductal oxygen saturations be collected in a newborn?

    <p>On the right hand.</p> Signup and view all the answers

    How soon can a patent ductus arteriosus take to close in a newborn?

    <p>1-2 days after birth.</p> Signup and view all the answers

    What condition can oxygen saturation screening help detect in newborns?

    <p>Critical congenital heart disease.</p> Signup and view all the answers

    What is the primary organ of gas exchange for the fetus before birth?

    <p>Placenta</p> Signup and view all the answers

    Which clinical sign indicates a compromised newborn with depressed respiratory effort?

    <p>Gasping or apnoea</p> Signup and view all the answers

    What effect can using 100% oxygen for resuscitation on newborns have?

    <p>Increased mortality rates</p> Signup and view all the answers

    At what percentage of oxygen should ventilation begin for preterm infants under 35 weeks?

    <p>30% Oxygen</p> Signup and view all the answers

    How does the blood flow from the fetal heart primarily bypass the lungs before birth?

    <p>By the foramen ovale</p> Signup and view all the answers

    What could be a consequence of an imbalance between reactive oxygen species and antioxidant defenses in newborns?

    <p>Impaired organ function</p> Signup and view all the answers

    What is the composition of blood entering the placenta from the fetus?

    <p>Deoxygenated and nutrient-poor</p> Signup and view all the answers

    Which of the following is NOT a typical sign of a compromised newborn?

    <p>Normal respiratory effort</p> Signup and view all the answers

    What is the primary benefit of non-shivering thermogenesis in neonates during cold stress?

    <p>To metabolize brown fat</p> Signup and view all the answers

    Which condition is likely to result from increased glucose utilization due to cold stress in neonates?

    <p>Hypoglycemia</p> Signup and view all the answers

    Which practice can help with thermoregulation in a newborn?

    <p>Employing flexed positioning to decrease surface area exposure</p> Signup and view all the answers

    What effect does prolonged vasoconstriction during hypothermia have on blood flow?

    <p>Decreased perfusion leading to anaerobic metabolism</p> Signup and view all the answers

    Which of the following describes the immediate changes in fetal circulation after birth?

    <p>Closure of the foramen ovale</p> Signup and view all the answers

    What is a potential consequence of acidosis in a neonate's physiology?

    <p>Worsening hypoxia due to atelectasis</p> Signup and view all the answers

    What change occurs in the lungs of a neonate that is crucial for transition to breathing air?

    <p>Reduction of fetal lung fluid</p> Signup and view all the answers

    What physiological response is expected in neonates due to hypothermia?

    <p>Increased respiratory rate</p> Signup and view all the answers

    How should a neonate be rewarmed after exposure to cold stress?

    <p>Slowly at 0.5°C per hour</p> Signup and view all the answers

    Which factor contributes to the development of hyperoxia in a neonate?

    <p>Enhanced oxygenation of tissues</p> Signup and view all the answers

    What is the role of surfactant in the lungs of a neonate?

    <p>To decrease alveolar collapse during breathing</p> Signup and view all the answers

    What may indicate the need to monitor blood glucose levels in a neonate?

    <p>Signs of hypoglycemia due to increased glucose uptake</p> Signup and view all the answers

    What change occurs in the digestive system during the transition from fetal to neonatal life?

    <p>Release of digestive enzymes</p> Signup and view all the answers

    What significant circulatory change occurs shortly after birth related to the ductus arteriosus?

    <p>It closes, preventing blood flow from the pulmonary artery to the aorta</p> Signup and view all the answers

    Study Notes

    Neonatal Thermoregulation

    • Normal neonatal core temperature: 36.5°C to 37.4°C
    • Homeostasis is the balance between the body’s ability to produce and lose heat.
    • Sensors/receptors send messages to the control center (hypothalamus) if required, effectors make changes to maintain stability.
    • Hypothermia: core temperature < 36.5°C
    • Hyperthermia: core temperature > 37.4°C
    • Brown adipose tissue (BAT) is found around the scapulae, kidneys, adrenals, neck, axillae, and aorta.
    • BAT is important for non-shivering thermogenesis.

    Effects of Cold Stress in the Neonate

    • Cold stress activates non-shivering thermogenesis (metabolism of brown fat)
    • Increased oxygen consumption and glucose use can lead to hypoglycemia, tissue hypoxia, and metabolic acidosis
    • Rewarming should be done slowly, ideally 0.5°C per hour or setting the cot temperature 1-1.5°C above the core temperature.

    Fetal Circulation

    • Intrauterine circulation: fetal circulation with the placenta as the organ of gas exchange.
    • Extrauterine circulation: normal circulation with the lungs as the organ of gas exchange.
    • Patent foramen ovale (PFO): closes with the first breath.
    • Patent ductus arteriosus (PDA): closes within 1-2 days once pulmonary vascular resistance (PVR) reduces.

    Fetal Breathing Movements

    • Intrauterine: alveoli filled with clear fluid, dependent on placenta for gas exchange, high PVR, blood flow diverted across the PFO and PDA.
    • Birth: lungs expand with air, surfactant released, fetal lung fluid leaves the alveoli, PVR reduces, pulmonary blood flow increases, blood flows through the lungs to pick up oxygen.

    Clinical Signs of the Compromised Newborn

    • Apnoea
    • Cyanosis
    • Poor muscle tone
    • Depressed respiratory effort
    • Bradycardia

    Oxygen Saturations

    • Pre-ductal oxygen saturations are collected on the right hand.
    • Post-ductal oxygen saturations are collected on the left or right foot.
    • Infant should be settled and not crying or feeding.
    • Waiting for at least 30 seconds for a good trace before reading the oximeter.

    Medications

    • Adrenaline: given if heart rate is low.
    • Normal Saline: given for fluid resuscitation.

    Neutral Thermal Environment (NTE) & Neutral Thermal Zone (NTZ)

    • NTE: ideal environment where the infant can maintain normal body temperature with minimal metabolic rate, oxygen and glucose consumption.
    • NTZ: environment created to manage the infant's temperature and minimize oxygen consumption and calorie expenditure.
    • Hyperthermia can lead to:
      • Increased metabolic rate and oxygen consumption
      • Dehydration
      • Peripheral vasodilation/ hypotension
      • Fluid/electrolyte abnormalities
      • Seizures

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    Description

    This quiz covers crucial concepts in neonatal thermoregulation, including normal temperature ranges, homeostasis, hypothermia, and hyperthermia. It also highlights the effects of cold stress on neonates, such as non-shivering thermogenesis and metabolic responses. Explore how fetal circulation impacts these processes.

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