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Perinatology Division
Dept. of Child Health Medical School
1
University of Sumatera Utara
PERINATOLOGY
Pediatrics
Obstetrics
Perinatology
2
Perinatology Coverage
22 weeks
(GA 5 month)
Obstetric
(pregnancy monitor)
Born
1 Mon
Pediatric
Neonatologist
(intensif care)
3
Normal newborn :
Term infants
: 37 42 weeks GA
Birth weight
: 2500 4000 g
Birth Length
: 44 53 cm
: 7 10
Fetus
*
Neonates
* Fetal circulation
* Neonatal circulation
* O2 depend to Utero
* O2 own produce
placental circulation
* Nutrition depend on
by breathing
* Feed ---- Breast feeding
maternal status
NEONATAL ADAPTATION
Birth
Fetus
Resuscitation
Neonate
Adaptatio
n
NEONATAL ADAPTATION
Adaptation :
the process by which one
adjusts
and becomes more
attuned to the environment.
Neonatal adaptation
NEONATAL ADAPTATION
ADAPTATION depend
on :
MATURATION
NUTRITIONAL STATUS
TOLARANCE
ADAPTIVE CAPACITY
8
NEONATAL ADAPTATION
ADAPTATION depend on :
MATURATION
Related to gestational
age
NUTRITIONAL STATUS
TOLARANCE
ADAPTATION
9
NEONATAL ADAPTATION
ADAPTATION depend on :
MATURATION
NUTRITIONAL STATUS
Related to birth
weight
TOLARANCE
ADAPTATION
10
NEONATAL ADAPTATION
ADAPTATION depend on :
MATURATION
NUTRITIONAL STATUS
TOLARANCE
The ability to overcome
the new environment
Tolerability to hypoxia,
hypoglycemia, caloric intake,
etc.
ADAPTATION
11
NEONATAL ADAPTATION
ADAPTATION depend on :
MATURATION
NUTRITIONAL STATUS
TOLARANCE
ADAPTIVE CAPACITY
the potential or ability
of a system to adapt to
the effects of change
12
NEONATAL ADAPTATION
Adaptation involved
multiorgan
function,include:
Cardio-circulatory system
Respiratory system
Intestinal tract
Metabolism
Central nervous system
13
Circulatory Adaptation
Fetus -
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
14
CIRCULATORY ADAPTATION
Umbilical vein
Ductus venosus
Foramen Ovale
Ductus arteriosus
Pulmonary circ.
Systemic circ.
Umbilical artery
15
CIRCULATORY ADAPTATION
DUCTUS
VENOSU
S
BY PASS
16
CIRCULATORY ADAPTATION
BY PASS
II
FORAMEN
OVALE
17
CIRCULATORY ADAPTATION
BY PASS
PATENT
DUCTUS
ARTERIOSUS
III
18
CIRCULATORY ADAPTATION
FETAL CIRCULATION
High pulmonary resistance
Low resistance in systemic blood flow
RIGHT to LEFT
shunt
Foramen Ovale
(Left artrial pressure low because returned lung blood is low
and right atrial pressure high due to large volume of blood
from placenta)
Ductus arteriosus
(High pulmonary resistance, Low fetal systemic blood and
19
prostaglandin function)
CIRCULATORY ADAPTATION
NEONATAL CIRCULATION
20
NEONATAL ADAPTATION
NEONATAL
FETAL
CIRCULATION
CIRCULATION
21
NEONATAL ADAPTATION
CIRCULATORY ADAPTATION
Fetus
Pulmonary
circulation
Newborn
Active, less
develop.
Active, increased
development
Foramen ovale
Open
Close
Ductus arteriosus
Botali
Open
Close
Ductus Venosus
Arantii
Open
Close
Active with
increase
resistance
Systemic
circulation
22
Circulatory
Adaptation
23
FETAL PULMONARY
DEVELOPMENT
Alveoli present : 25
weeks fill with lung fluids
Breathing movements:
Intermittently
Lung developments
Control of
breathing
Fetus : gas exchange
placenta
24
NEONATAL ADAPTATION
Temperature
Touch
Pain
Proprioceptive
FIRST
BREATH
Diafragm
Mechanical
Chemoreceptor
Neonatal Respiration
Irregular
Abdominal respiration
25
PULMONARY ADAPTATION
CHAIN OF EVENTS AFTER FIRST
BREATH :
THE
NEWBORN
RESPIRATION
BEGIN
26
PULMONARY ADAPTATION
FETUS
NEWBORN
Alveolus
Colaps
Develops
Pulmonary vessels
Non active
Active
Pulmonary
resistance
High
Decrease
Pulmonary blood
Low
Increase
Oxygen needs
Placenta
Lung
CO2 excretion
Placenta
Lung
27
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
28
GASTRO INTESTINAL
ADAPTATION
FETUS :
Caloric and nutritional needs derived from
mother
placenta.
Intestinal motility non active
No need for enzyme metabolism.
NEWBORN
Intestinal motility begin in function.
Increase needs of calori/nutritional and
enzyme metabolism
29
NEONATAL ADAPTATION
GASTROINTESTINAL
ADAPTATION
Fetus
Nutritional
absorption
Bacterial
colonization
Feces
Enzyme
Newborn
Non active
Active
Negative
Positive
Meconium
Meconium
Feces
Non function
Active
30
UROGENITAL ADAPTATION
Renal organogenesis a continuous process
31
UROGENITAL ADAPTATION
ALLERTNESS
OLIGOHYDRAMNIOS
May suggest renal agenesis; hypoplasia; dysplasia;
urinary tract obstruction.
POLYHYDRAMNIOS
Gastrointestinal anomalies; transplacental transfusion
syndr.; congenital DM
IMMUNOLOGIC STATUS of
the FETUS and
NEWBORN
FETUS :
Phagocytic cells
Granulocytes cells
Monocytes cells
Identified at 4
mo gestation.
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.
33
Body
Body Temperature
Temperature in
in the
the NB
NB
37.5 C
Normal range
36.5 C
36.0 C
32.0 C
Severe hypothermia / outlook grave
Skilled care urgently needed
34
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
35
36