|What is conduction?||direct heat loss to a cooler surface with body surfaces|
|What is convection?||heat loss to cooler surrounding air|
|What is radiation?||loss of heat to a cooler solid surface that are not in contact with the body such as a wall|
|What is evaporation?||loss of heat when a liquid such as body fluid becomes a gas|
|5 things assessed for APGAR score||HR, Respiratory effort, muscle tone, reflex response, and color|
|APGAR score for HR||Absent-0, Slow(below 100)-1, Over 100-2|
|APGAR scoring for Respiratory effort||Absent-0, Weak cry/hypoventilation-1, Good strong cry-2|
|APGAR scoring for muscle tone||limp-0, some flexion of extremeties-1, well flexed-2|
|APGAR scoring for reflex response cath in nose or footslap||no respone- 0, grimace-1, cough/sneeze/cry/foot withdrawl-2|
|APGAR scoring for color||blue/pale-0, body pink extremities blue-1, completely pink-2|
|6 criteria assessed for neuromuscular maturity on Ballard scoring system||posture, square window wrist, arm recoil, Popliteal angle, Scarf sign, and heel to ear|
|6 areas assessed for physical maturity on Ballard scoring||skin, lanugo, plantar surface, breast, eye/ear, genitals|
|When is APGAR scored?||at 1 minute and 5 minutes|
|What is the maximum APGAR score?||10|
|APGAR ___-__ = severe asphyxia||0-3|
|APGAR __-__= moderate asphyxia||4-6|
|APGAR __-__= no asphyxia||7-10|
|What are the 2 scoring systems for gestational assessment?||Duobowitz(11/10 signs) and Ballard (6/6 signs)|
|The Dubowitz can be performed within __ days and is accurate up to __ weeks; The higher the score then ____ the gestational age||2;2;greater|
|Once the gestational age is determined, what 3 things do you plot on graph to determine size for gestational age||weight, length, and head circumference|
|SGA indicates what?||intrauterine malnutrition|
|6 major reasons for SGA||placenta, infection, maternal htn, toxemia, multiple births, and smoking|
|A newborns anatomy is different. Tongue is proportionally ______ and larynx is more ___||larger; anterior|
|Why is there no need for cuffed ET tubes?||cricoid ring is limiting diameter|
|Tubes are cuffles to what size?||4.0|
|If a leak is heard what do you need?||a bigger ET tube|
|D/t their large tongue, babies are what?||obligate nose breathers, plugging can cause resp distress|
|3 additional differences in neonatal anatomy?||breathing is diaphragmatic, compliant/non calcified rib cage(retractions readily seen), and immature resp muscles(fatigue faster)|
|Clinical color: Acrocyanosis means||decreased perfusion|
|Clinical color:Pale= ___, Mottled= ____, Ruddy= ___||anemia; septic; reddish/blue (high Hct)|
|Where to you check for meconium staining?||nail beds and cord|
|Neonates often appear _____ after the first day||jaundice|
|Normal neonate RR||40-60 breaths per minute|
|First sign of respiratory distress in neonate?||tachypnea|
|What causes tachypnea in a neonate?||decreased PaO2 or increased CO2|
|What causes bradypnea in a neonate?||fatigue|
|What is primary apnea?||around 20 seconds long and you can stimulate them to make them breathe|
|What is secondary apnea?||30-40 seconds long, HR and BP decrease, cannot stimulate to breathe, must bag them|
|Periodic breathing =||normal|
|4 signs of abnormal respiratory function||retractions, grunting, nasal flaring, Seesaw effect|
|What is the scoring system that quantifies degree of respiratory distress called||Silverman Anderson|
|Retractions are commonly seen in diseases that||reduce alveolar ventilation, usually from atelectasis|
|Where do retractions occur?||in any muscle group of or attached to thorax|
|Common site of retractions in neonates||intercostal (most common) and substernal|
|What is grunting and what neonate population is it commonly seen in?||a physiologic response to increase lung volume to improve alveolar gas exchange (mimic natural CPAP), common in babies with RDS|
|What causes grunting and when is it heard?||caused by infant breathing against a closed or partially closed glottis heard at the end of a breath|
|What is the Seesaw effect?||asynchronous breathing during increased RR d/t soft cartilage of rib cage|
|The expansion or rising abdomwn pushing up on the diaphragm during seesaw effect causes what?||reduced volume bc diaphragm is unable to descend effectively|
|4 possible causes of Diminished BS||ET tube problem, RDS, PIE, atelectasis|
|What is PIE?||Pulmonary interstitial edema|
|Asymetrical chest rise could be d/t||ET too low, unilateral disease such as pneumonia or aspiration, pneumothorax|
|Rhonchi are ____ and heard where?||coarse from lg bronchi|
|Rales are ___ and heard where?||fine, in smaller airways|
|What is pectus caritnatum?||malformation of chest with protruding xyphoid process|
|What is pectus excavatum?||funnel chaped chest malformation|
|What can cause asymmetry of the chest?||enlarged heart, Diaphragmatic hernia, pneumothorax|
|PMI: Why seen and what is it?||easily seen d/t thin, compliant chest wall close to sternal border (prominent fetal R ventricle)|
|Tachycardia= >160 and caused by ___, ____||activity, meds|
|Bradycardia: <100 caused by ___, _____||vagal stim, hypoxemia|
|If a neonate is bradycardic what do you do?||start bagging!|
|What do weak pulses suggest?||low CO states such as shock or hypoplastic left heart|
|Bounding pulses are seen with||PDA- Patent Ductus Arteriosus|
|Brachial and Femoral pulses should be ____, if not suspect Coarctation of Aorta||equal|
|Abdominal abnormalities associated with Respiratory distress||Scaphoid( caused by DH), Distended(sepsis, obstruction, tumors, ascites NEC), Omphalocele (bowel into cord), Gastrochisis (bowel outside abd wall)|
|Abnormalited of the head, lips, oral cavity are usually associated with what?||syndromes|
|A cleft palate is associated with what syndrome?||Pierre Robin (small chin, large tongue)|
|What is Choanal atresia?||blockage of 1 or both nares|
|Normal Temperature of Neonate?||36.5 degrees celcius|
|2 things thermoregulation is important for?||minimal oxygen consumption and metabolic demands|
|Lower weights require __ thermal temp||higher|
|Neonates cant _____ and have limited fat for energy||shiver|
|4 responses to cold stress||increased RR, signs of resp distress, Hypoglycemia, Metabolic acidosis|
|6 ways to minimize heat loss||dry with warm blankets, avoid cold surfaces, keep under warmer, use double walled isolettes, heat inspired gases, keep head covered|
1. 1.)When is the heart fully formed?
2.)When is the heart fully functional?: 1. 3rd week of gestation 2. 8th week of gestation
2.Besides vasodilation, what else does lung inflation result in?: inhabition of vasoconstricting agents produced by the lung to facilitate fetal circulation.
3.How does oxygenated blood travel to the fetus ?: From the placenta through the umbilical vein.
4.How is the baby connected to the placenta? how many arteries? how many veins?: The umbilical cord connects the two. Its has 2 small arteries and 1 big vein.
5.Most of the fetal blood entering via the right atrium is shunted to the left atrium through the _____ _____.: Foramen oval
6.Name the 3 recognizable structures during the development of the heart after the heart tubes fuse.: 1. Bulbus cordis
2. Atrial bulge
3. Ventricular bulge
7.What are the percents of ductus arterious closure when the baby is born?: 20% – 24 hours
80% – 48 hours
100% – 96 hours
8.What causes the ductus arteriosus to close? (4): 1. Being exposed to an increased PaO2
2. A decrease in PVR leading to a decrease in blood pressure w/in the ductal lumen
3. A decrease in production of prostaglandins
4. And a decrease in # of prostiglandin receptors in the tissue of the ductus arterious
9.What diffuses through the chorion villi?: O2, carbon dioxide, and nutrients from the mother to the fetus
10.What do “angiogenic clusters” do?: They supply nutrition in the earliest stages of the growing embryo.
11.What do the endocardial cushions do?: Seperates the atria from the ventricles
12.What does the ductus arterious change to in a adult?: In a adult it is becomes known as the ligamentum arteriousum.
13.What does the high pulmonary vascular resistance (PVR) in utero help wth?: It causes most of the blood flowing through the pulmonary artery from the right ventricle to pass through the less resistant “ductus arterious”, directly to the aorta.
14.What does the umbilical stalk eventually turn into?: the umbilical cord
15.What happens when the cord is clamped? what causes the foramen oval flap to close?: The PVR decreases, pressure on the right side of the heart decreases and pressure on the left side of the heart increases.
Because the foramen oval flap allows blood to flow only from the right to the left, it closes when the pressures in the left atrium are greater than the pressures in the right atrium.
16.What happens when the foramen oval closes?: it further facilitates the increase of blood flow to the lungs during the transitional period and is needed to mantain normal extrauterine circulation.
17.What initiates gas exchange (extrauterine) ?: inflation of the lung, which in turn dilates the pulmonary arterioles.
18.What is “wharton’s Jelly” ?: a gelatinous substance inside the umbilical cord that helps protect the vessles and may help the cord from kinking.
19.What is the 1st complete organ formed organ ?: The heart
20.What is the fetal circulation pathway?: Blood is shunted around the lungs and liver, and takes blood to the heart and placenta.
21.What is the first fetal shunt?: Ductus venousus. Shunts 30-50% of O2 rich blood past the liver to the IVC.
22.What is the foramen oval?: A hole in the atrial septum, formed during the seperation of the atria.
23.What is the second fetal shunt ?: Foramen oval – between the right and left atria.
24.What is the third fetal shunt?: Ductus arteriosus – shunts blood from the pulmonary artery to the aorta.
25.When does blood have the highest O2 saturations available to the fetus?: When blood enters the right atrium (coming from the IVC).
26.When does the babys blood flow normalize to the adults pattern of circulation?: 2 – 4 weeks of age the anatomical closure is complete, and blood flow normalizes.
27.When the baby is born do these things increse or decrease: PVR? Pulm artery pressure? left ventricular pressure? pulmonary blood?: 1. PVR decreases
2. PAP decreases
3. Left vent press increases
4. Pulm blood increases
28.When the baby is born what 3 things increase pulmonary blood flow? (vasodilation): 1.initiation of gas exchange
3.stretching pulmonary parenchyma
29.Where is the site of gas exchange for the baby in utero?: The placenta
30.Which shunt allows blood w/in the pulmonary artery to bypass the lungs and left heart?: 3rd shunt – Ductus arteriousus
1.Describe embryo formation: Is shaped like a folded tube.
2.Describe fetal circulation.: Venous and arterial pressures and O2 saturation are opposite as to what is seen in an adult.
3.Describe fetal lung fluid composition.: FLF has a high concentration of sodium and chloride. Has a low pH, low protein count, and low bicarb.
4.Describe fetal lung fluid function and elimination at birth.: It maintains patency of developing airways. Guides the formation, size, and shape of airways and alveoli. It is important to eliminate FLF at birth because it dilutes surfactant. It is eliminated by vaginal delivery squeezing the thorax and being absorbed by the lymphatic system.
5.Describe how the cardiac chambers develop?: The heart starts out with an “S” shape. Atria develop upward, ventricles divide. One way flow begins when valve develops. In the 6th week, the truncus arteriosis divides into the aorta and pulmonary artery.
6.Describe the anatomy of the umbilical cord.: 1 vein, 2 arteries surrounded by Wharton’s jelly. Veins carry O2 to fetus. Arteries return blood to the placenta.
7.Describe what happens in the pseudoglandular period of lung development.: Occurs between 7-16 weeks after conception.
Forms the diaphragm, soft and hard palate, larynx, cartilages along the airway, choana, terminal bronchioles, goblet cells, and bronchial glands/cilia.
8.Describes what happens during the canalicular period of development.: Occurs between 17 to 26 weeks post conception. The respiratory bronchioles multiply in this period. Other airways increase in length and number. Appearance of type I and II alveoli occur. Surfactant is not yet mature. Gas exchange does not yet occur in the lungs.
9.Describes what happens during the saccular and alveolar periods in fetal development.: Occurs between 27 weeks until delivery. Alveio appear between 32-34 weeks. Alveoli increase in size and number. Merging of alveoli and cappilaries occur. Surfactant occurs at 35 weeks post conception.
10.Fertilization occurs where?: Usually in the first 1/3rd of the fallopian tube
11.How does one determine if surfactant is mature in a fetus?: Must do an amniocentesis. The amniotic fluid is analyzed for Lecithin and Sphingomyelin. The ratio must be 2:1 for the surfactant to be considered mature. A positive foam test is also used to determine surfactant maturity.
12.How does the implantation phase work?: It begins by the trophoblast imbedding into the uterus endometrium lining.
13.How does the morula change over time?: A morula changes shape/formation. It has a cavity in the center of it and different layers. An outer layer called a trophoblast and an inner layer called a blastocyst.
14.A lack of surfactant causes what?: Stiff lungs, decreased compliance, hypoventilation, increased WOB, hypoxemia, ventilatory failure.
15.List the fetal blood flow path: Placenta
50% to the liver
50% to the inferior vena cavae
16.Surfactant can be damaged or decreased by what?: Hypoxia, hyperoxia, hypothermia, acidosis, underinflation and overinflation, infants of diabetic mothers, small neonates, mechanical ventilation, and pulmonary edema.
17.What are abnormal amniotic fluid levels?: Polyhydramnios – fluid over 2 L. Indicates swallowing problems, CNS problems, oral or gastric problems, downs syndrome, or congenital heart disease.
18.What are complications of polyhydramnios?: Premature rupture of membranes, umbilical cord prolapse, premature delivery.
19.What are functions of the placenta?: Respiration for the fetus. Provides O2 from the mother’s vessels. Also provides nutrients to the fetus.
20.What are hazards of excessive lung fluid retention?: Makes surfactant less effective. FLF should be aborbed within 24 hours of birth.
21.What are some functions of fetal lung fluid?: Keeps the airways open. It increases as gestational age progresses. It totals 20 to 30 ml/kg at birth.
22.What are the 3 stages of gestational development?: Ovum
23.What are the 5 stages of lung development?: Embryonic, pseudoglandular, canalicular. saccular, and alveolar
24.What are the three layers of the blastomere/embryonic disc?: Ectoderm (outer layer)
Mesoderm (middle layer)
Endoderm (inner layer)
25.What are things a doctor can do prior to delivery to help immature surfactant?: Administer glucocorticoid steroids. Must be administered between 2 and 7 days before delivery.
26.What does the ectoderm layer form?: Nervous systems, nasal canals, skin glands, sweat glands, hair, nasal and lens of the eyes.
27.What does the endoderm layer form?: Epithelium of the digestive tract, bladder, thyroid, liver, pancreas, respiratory system.
28.What does the mesoderm layer form?: Dermis, muscles, bone, connective tissues, lymph network, reproductive organs, cardiovascular systems.
29.What happens if a baby is born before 35 weeks?: Immature surfactant
30.What is a morula?: A ball of cells
31.What is an insufficient amount of amniotic fluid called?: Olihydramnios. Indicates urinary system defects, renal dysplasia, urethral stenosis, or small lungs.
32.What is each new egg cell called?: Blastomere
33.What is surfactant composed of?: Phospolipids (phosphatidlycholine [PC] aka Lecithin & Phosphatidylglycerol [PG])
34.What is the amnion?: The sac around the fetus.
35.What is the gestation time for a normal birth?: 40 Weeks
10 Lunar Months
9 Calender Months
36.What is the membrane called that surrounds the blastomere?: Zona Pellucida
37.What lung volume does surfactant effect?: FRC
38.What other factors can hinder surfactant development in a fetus?: Heroin. Ruptured membranes.
Maternal infection. Placental insufficiency. Abruptio placentae.
39.When does the heart appear during gestation?: Usually around 21 days of gestational age from the mesoderm.
40.Where is surfactant stores?: Lamellar inclusion bodies
1.1.How many ml/day do the fetal lungs secret?
2.And where does that fluid go?
3.What is it essential for?
4.When does it get removed?
5.What removes the displaced liquid?: 1. 250 – 330 ml/day
2. swallowed or expelled into amniotic fluid
3. essential for normal lung development
4. removed after birth.
5. small blood vessels and lymphatics remove the displaced liquid
2.At which stage is the bronchial tree formed ?: Embryonal stage
3.Explain “chest wall compression”: “diaphragmatic hernia” abnormal opening in diaphragm all organs to move into the chest and exert pressure on developing lungs; chest wall abnormalities, and possibly hydropsfetalis, which is fluid accumulation in the fetus, often resulting in hydrothorax and ascites.
4.Explain “Oligohydraminos”: a reduced quantity of amniotic fluid present for an extended period, with or without renal anomalies. Could mean that the babys kidneys haven’t developed or they weren’t “breathing” enough (=small lungs, not stretched enough) (stretching = surfactant production)
5.Explain why decreased respiration can be a cause of pulmonary hypoplasia (decreased lung development).: lack of stretch of developing lung parenchyma.
6.How do Type I & Type II pneumocytes differ?: Type I
* Account for 97% of alveolar surface area
* Flat squamous shaped
* Gas – permeable membrane for gas diffusion
* Cube shaped
* Can differentiate into type I cells
* Responsible for surfactant production, and storage
* release surfactant by exocytosis
7.Name 3 factors that affect lung development: 1. Hypoxia or hyperoxia
3. Maternal smoking
8.Name 4 things that cause early stimulation of surfactant: 1. Beta agonist
3. Epidermal growth factor
4. Mechanical ventilation
9.Name the 5 stages of fetal lung development: Embryonal, Pseudoglandular, Canalicular, Saccular, Alveolar
10.What 2 things happens in the canalicular phase?: 1.growth of vascular bed
*capillaries has sufficient surface area
*proximity to alvoli.
2.extrauterine viability – 22-24 weeks (this is when fetal survival is possible)
11.What are causes of decreased lung development? (4): 1. Chest wall compression
3. Decreased respiration
4. Hormonal or metabolic disorders
12.What are the 3 minimal developmental features required for a fetus to survive outside the uterus?: 1. Sufficient alveolar and vascular surface area for gas exchange
2. 22-24 weeks of gestation
3.Near completion of the canalicular stage of lung development
13.What can happen if Oligohydramnios occurs in early gestation?: It can cause lung hypoplasia and limb deformities.
14.What do the babies liver and lungs do in utero?: Nothing, the placenta takes care of it.
15.What does surfactant do? what would happen w/o it?: It decreases the surface tension at the air- liquid interface. Allows alveolus to expand when filled with air. w/o it the alveolus would remain collapsed due to high surface tension of the moist alveolar surface.
16.What happens if you dont have enough MAP (mean arterial pressure) ?: If you dont have enought pressure to purfuse your tissue you wont oxygenate = ischimia
17.What is “Polyhydramnios” ? What 3 things can this lead to?: Too much amniotic fluid or a amnAFI greater than 24 cm. It is associated with fetal malformations that may effect swallowing of amniotic fluid. It over distends the uterus and can lead to premature rupture of membranes, preterm labor and cord prolapse.
18.What is inside of the Type II cell that stores the surfactant?: Lamellar bodies
19.What is pulmonary hypoplasia?: Incomplete development of the lungs
20.What is the babys PaO2 in utero ?: 20 mm Hg
21.What is the term for the combination of renal agenesis with oligohydramnios?: Potters syndrome (its always fatal)
22.What is the timing and significance of the alveolar phase?: (36- term) Development of alveoli
23.What is the timing and significance of the canalicular phase?: (17-26 wks) Development of vascular bed and framework of respiratory acini
24.What is the timing and significance of the embryonal phase?: (26 – 52 days) Development of trachea and major bronchi
25.What is the timing and significance of the pseudoglandular phase?: (52 days – 16 wks) Development of remaining conducting airways
26.What is the timing and significance of the saccular phase?: (26-36 wks) Increased complexity of saccules
27.What is the Type II pneumocyt cell involved in?: Surfactant production, secretion, storage, and reuse.
28.What lung development stage formally thought to be the last stage before birth, and characterized by
relatively smooth-walled, cylindrical structures subdivided by ridges known as secondary crests?: Saccular phase
29.What percent of Alveoli develop after birth?: 80%
30.What phase does this occur in: subdividing of conducting airways, acinus may appear, cilia are seen on the epithelium, development of goblet, submucosal glands and airway cartilage?: The Pseudoglandular phase
31.What phase shows development of mature alveoli?: Saccular phase
32.What two phases are hard to distinguish from one another ?: Saccular phase and the alveolar phase
33.When are the lungs completly formed?: 1 1/2 years old
34.When is the diaphragm completly formed?: 7 weeks
35.When is the heart completly formed?: 8 weeks
36.Where does the initial lung bud develop from?: The pharynx
37.Where does the lung bud emerge from ? During what phase does this happen?: 1.)The pharynx after 26 days of conception.
38.Why is it that some pregnant women feel short of breath?: Because their blood volumes double w
1.Application of positive pressure ventilation: What is the most effective maneuver to establish normal breathing in a baby with secondary apnea?
2.Assist ventilations: You are at the resuscitation of a newborn who is gasping and has a heart rate of 90 bpm. What is the most important action you can take?
3.Babies may take as long as 10 minutes after birth to increase their oxygen saturation to greater than 90%.: Which best describes normal transitional physiology at the time of birth?
4.The baby has poor tone and respiratory effort: You are at the delivery of a baby born through meconium stained amniotic fluid. What is the correct indication for intubating and suctioning the trachea at birth?
5.Clearance of secretions from the mouth and nose with a bulb syringe: A baby is born with meconium stained amniotic fluid. The baby has normal muscle tone and respiratory effort, and a heart rate of 120 eats per minute. What is the next appropriate action?
6.The combination of an appropriately placed pulse oximeter and knowledge of minute-by-minute normal oxygen targets should guide resuscitation.: Which statement describes best practice when using a pulse oximeter?
7.Determine the color of the baby’s chest and abdomen, and monitor for central cyanosis: What is the best way to determine if a baby requires supplemental oxygen in the delivery room?
8.Free flow oxygen may be administered using an oxygen mask held close to the baby’s face: Which statement accurately describes the role of oxygen in newborn resuscitation?
9.Mask attached to self inflating bag: A baby requires positive pressure ventialation due to apnea, but soon establishes spontaneous respirations and a heart rate over 100 bpm. Her oxygen saturation levels are lower than the target levels when in room air, so you wish to provide free flow supplemental oxygen. Free flow oxygen is not reliable delivered with which device?
10.The neck should be mildly extended: During resuscitation, what is the ideal head position?
11.Slapping or flicking the soles of the feet: What is the appropriate technique to stimulate a baby to breathe?
12.Suction the mouth before the nose.: What is the best technique for removing secretions from the mouth and nose of a newborn who requires resuscitation?
1. The lungs become the source for what between the external environment and the blood?
2. What through the lungs becomes essential to the survival of the newborn?
3. At birth lungs have only reached what degree meaning what?
4. when is fetal lung development complete?
5. Where does information about the normal lung development originate from?
6. How long does it take for the bronchial tree to develop?
7. How long does it take for alveoli to develop and grow along with the chest wall?
8. When are preacinar arteries and veins developed?
9. When are intra acinar vessels developed?
10. How many alveoli does a full term infant have and how many can be added at maturity?
11. how many phases of lung development are there?
12. How long does the embryonal stage last?
13. What happens in the embryonal stage?
14. What is the endoderm?
15. how long does the pseudoglandular stage last?
16. What happens in the pseudoglandular stage?
17. When do cilia and mainstem bronchi appear in the pseudoglandular stage?
18. When do goblet cells appear?
19. when can smooth muscle cells be seen?
20. When is cartilage developed?
21. when does lymphatics appear?
22. Why is the pseudoglandular stage named so?
23. how long does the canalicular phase last?
24. Why is the canalicual stage named so?
25. When do capillaries develop?
26. satisfactory gas exchange cannot occur until the capillaries have what?
27. What is surfactant?
28. when does the survival of the fetus become possible during the canalicular stage?
29. When are pulmonary acinar units formed and what does each unit consist of?
30. What happens in canalicular stage by week 20 to 22?
31. What is happening at the end of the canalicular stage?
32. How long does the saccular phase last?
33. What are saccules?
34. What happens in the saccular phase?
35. how long does the alveolar phase last?
Read page 6 paragraphs 1 and 2 for alveolar phase
36. by 6 months a human infant what in body weight and what by 1 year causing oxygen uptake to what?
37. most of the postnatal formation of alveoli in the infant occurs over the first what of life?
38. after two years of age do males or females have more alveoli?
39. Where may errors occur in the embryonal stage?
40. what might occur during the pseudoglandular stage?
41. What problem might occur if the fetus is born during the cannicular phase?
42. What developmental abnormalities can affect lung development?
43. What are clinical factors causing diminished lung growth?
44. What is leprchaunism?
45. What is an example of altered lung development ?
46. What does growth retardation affect?
47. What does malnutrition affect?
48. What are abnormalities occurring in embryonic period associated with?
49. when might diaphragmatic hernia occur?
50. if abnormalities occur during the second trimester what happens?
51. problems occurring in the perinatal period such as premature birth and bronchopulmonary dysplasia may alter what?
52. What is pulmonary hypoplasia?
53. When is pulmonary hypoplasia considered to be present?
54. What is the ratio of diaphragmatic hernias?
55. What causes incomplete branching of the conducting airways, terminal airways, or both?
56. what is oligohydramnios?
57. What is the role of type 1 cells?
58. What is the role of Type 11 cells?
59. What is an additional function of type 11 cells?
60. What is the primary role of mammalian surfactant?
61. What is surfactant composed of?
62. What are fetal lungs?
63. how much liquid is secreted per day by fetal lungs?
64. What is essential for normal lung development?
65. What does the fetus depend on for nutrient and gas exchange?
66. What happens by day 22?
67. what happens as the zygote travels to the uterus?
68. What is a blastocyst?
69. What is the trophoblast?
70. What is the umbilical cord connected to the placenta to the fetus by?
71. What is Wharton’s jelly?
72. What is the first organ formed?
73. when is the heart fully formed?
74. What are angiogenic clusters?
75. When do the heart tubes fold into what becomes the thoracic cavity?
76. When are cardiac contractions detectable and bidirectional tidal blood flow begin?
77. What happens during weeks 5 and 6?
78. how does oxygenated blood travel from placenta to fetus?
79. what is the ductus venosus?
80. what is the foramen ovale?
81. What is the ductus arteriosus ?
1. gas exchange
2. external respiration
3. morphological, physiological, and biochemical maturity meaning lungs aren’t complete at birth
4. When the alveoli possess an adequate surface area for gas exchange
5. Reid’s anatomical description of the developing human lung
6. 16 weeks
7. until age 8 so 8 years basically
8. after the airway has been established
9. after alveoli are generated
10. they have 50 million and have the potential to add 250 million increasing alveolar surface
from 3 to 70
11. There are 5 embryonal, pseudoglandular, canalicular, saccular, and alveolar
12. Day 26 – day 52 encompasses the first 2 months of gestation
13. the lung emerges as a bud 26 days after conception from the pharynx, it then forms two bronchial buds and the trachea then separates from esophagus development of tracheoesophageal septum, further divisions occur until the end of this stage and major airways have developed. Airway branching occurs 10 on right 9 on left , left and right pulmonary arteries form plexuses before heart descends to thorax left and right pulmonary veins start to develop week 5 and the diaphragm is completed by week 7
14. it is a part of the embryonal phase where the respiratory epithelium develops it is referred to as the foregut bud it is aqlso the innermost layer of the three primary germ layers
15. day 52 to week 16
16. conducting airways continue to develop with extensive subdivision of conducting airway system, the most distal structures are terminal bronchioles which differentiate into respiratory bronchioles and alveolar ducts, branching pattern determines pattern in adult lung, once pattern is laid growth is in size only, gas exchange in pulmonary acini or terminal respiratory units may be laid completely, growth factors and chemical mediators begin to transdifferentiate the primordial tracheal epithelium into respiratory type 11 cells required for development by the end airways, arteries, and veins have developed in the pattern corresponding to that found in the adult
17. 10 weeks of gestation and are present on the epithelial cells of peripheral airways by 13 weeks
18. in the bronchial epithelium at 13 to 14 weeks then submucosal glands arise as solid buds from basal layers of surface epithelium 15 to 16 weeks
19. week 7 and week 12 from posterior wall
20. development at week 24 but present in about 10 to 14 airway generations at 24 weeks of gestation
21. in hilar region week 8 in lung itself week 10
22. because random histologic sections show the appearance of multiple round structures resembling glands
23. Week 17 to week 26
24. because of the appearance of vascular channel, or capillaries, which begin to grow by forming a capillary network around the air passages
25. week 20 and by week 22 they have increased in number
26. sufficient surface area and are close enough to the airspaces for efficient gas transfer
27. a surface active phospholipoprotein formed by alveolar type 11 cells important for reducing alveolar surface tension and reducing work required for breathing in newborn
28. 22 to 24 weeks
29. They are formed during the canalicular period each unit consist of respiratory bronchiole, alveolar ducts, and alveolar sacs
30. two types of cells can be identified type 1 and type 11, type 11 retain their cytoplasmic shape of their precursors and contain concentric layers of lipid and protein important for the production of surfactant called lamellar bodies. Type 1 will provide the structural apparatus that will become the alveoli and begin this process by flattening and elongating during this phase of development
31. the developing air blood barrier is thin enough to support gas exchange, blood vessels grow along side conducting airways, the epithelial cells are capable of producing fetal lung liquid
32. Week 26 to week 36
33. at the beginning of the saccular phase terminal structures are called saccules they are smooth walled cylindrical structures and become subdivided by ridges known as secondary crests
34. as the crests protrude into saccules part of capillary net is drawn in with them forming double capillary layer further septation between crests makes smaller spaces called subscaccules alveoli can then be seen as early as 32 weeks and are present 36 weeks in all fetuses during this phase there is a marked increase in potential gas exchanging surface area
35. Week 36 to term
36. doubles, triples, increases
37. 1.5 years and the lung continues to grow in proportion to the body growth
39. in the laryngeal, tracheal, or esophageal atresia also stenosis may develop
40. pulmonary hypoplasia which is an incomplete development of the lungs by an abnormally low number and or size of bronchopulmonary segments and or alveoli
41. severe respiratory distress as a result of inadequately developed airways and insufficient immature surfactant production by type 11 cells
42. chest wall abnormalities and renal hypoplasia can result in pulmonary hypoplasia aka potter’s syndrome
43. diaphragmatic hernia – an abnormal opening in prenatal diaphragm allows some abdominal organs to move into chest and exert pressure on the developing lungs
Hydrops fetalis – abnormal fluid accumulation in the fetus resulting in hydrothorax and ascites
Oligohydramnios – reduced quantity of amniotic fluid present for an extended period with or without renal anomalies associate with lung hypoplasia
44. it is associated with abnormal carbohydrate metabolism resulting in dysmorphic lungs with decreased number of terminal bronchioles, dilated alveolar ducts and saccules, and enlarged airspaces
45. down syndrome, fetal lung growth is normal postnatal lung growth has larger and fewer alveoli than normal
46. size and weight but not maturation of airways and alveoli
47. it slows functional maturation instead of structural
48. renal agenesis or dysplastic kidneys branching of the lungs may also be affected
49. this might occur during the pseudoglandular period or before 16 weeks of gestation also decreasing airway branching
50. completion of pulmonary vascularization and acinar development may not proceed and pyoplasia in the gas exchanging area may result
51. subsequent alveolar growth and differentiation leading to decrease in alveolar number
52. failure of the lungs to develop in utero, it is common abnormality of lung development
53. when there are too few cells, too few alveoli, or too few airways 10% to 25% of all autopsy cases is diagnosed as incidence of pulmonary hypoplasia
54. 1 in 4000 births
55. compression of the lung before 16 weeks of gestation
56. pulmonary hypoplasia as a result of leakage of amniotic fluid
57. they serve as a thin gas permeable membrane for the diffusion of gases and as a barrier against water and solute leakage they account for more than 97% of the alveolar surface area as a result of their size, shape, and large cellular surface
58. it is a principal cell involved in surfactant production, storage, secretion and reuse. Storage occurs in the lamellar bodies inside type 11 pneumocytes
59. they have the ability to differentiate into type 1 pneumocytes
60. to lower the surface tension within the alveolus specifically at air liquid interface allowing alveolus to expand when filled with air
61. phospholipids, neutral lipids, and proteins
62. secretory organs that make breathing like movement but serve no respiratory function before birth
63. 250 to 300ml
64. fetal lung fluid
65. the mother’s circulation
66. primitive fetal heart begins to beat and myocardial pump function to support circulation on day 27 to 29
67. it undergoes numerous iterations of cell division but has no nutrient source
68. the ball of developing cells
69. the outer layer of blastocyst and combines with tissues from endometrium to form the