INTRODUCTION TO

NEONATAL AND PEDIATRIC

RESPIRATORY CARE
JAMES ASTROLOGO LAMUSAO, RTRP
.
OBJECTIVES:
Discuss the development of Respiratory system
List the five stages of fetal lung development and the gestational age at which
they occur
Explain the key steps of each stage of fetal development
Describe the placenta and discuss its role in fetal blood flow and gas
exchange
Describe surfactant, including source, appearance in the developmental stage,
composition and significance to respiration
Name the three fetal shunts and discuss their role during fetal circulation
Discuss the fetal blood flow and vascular pressures
Describe the cardiac and pulmonary sequences of events that occur when
transitioning from fetal to extrauterine life, including the changes in fetal shunt.
Discuss maternal influences on the developing cardiopulmonary system
What is Respiratory System?
it is the continuous absorption of oxygen and the excretion of carbon dioxide

Two types:
1. External Respiration - exchange between the gas of the atmosphere and
blood
2. Internal Respiration - exchanges of gases between blood and tissues

this system humidifies and warms inspired air while removing inhaled
contaminants and filtering out chemicals and small blood clots deposited
or formed in the blood.
Development of the Respiratory Sysrtem
Two Periods:
1. EMBRYONIC - first 8 weeks
2. FETAL - remaining 32 weeks
FERTILIZATION TO IMPLANTATION:
The fertilized egg or zygote, travels to the uterus and undergoes numerous
iterations of cell division
Blastocyst is the ball of the developing cells and must attach itself and
implant in the uterine lining for nourishment
Trophoblast is the outer surrounding layer of the blastocyst which combines
with tissues from the endometrium to form chorionic membrane around the
blastocyst.
Embryonic Disk is known as the central point which forms the 3 embryonic
germ layers ; Endoderm, Mesoderm and Ectoderm.
FERTILIZATION TO IMPLANTATION:
Development of the Respiratory System
The embryo is made up of three distinct germinal tissue layers that
ultimately forms all tissue organs

GERM LAYERS:

a. Endoderm
b. Mesoderm
c. Ectoderm
Development of the Respiratory System
Birth does not signal the end of lung development
A Full-term infant has an estimated alveoli of 50 million
Has the potential to add another 250 million of alveoli and increases its total
alveolar surface area from approximately 3 to 70 meter squared at maturity
After birth, the alveoli develop in increasing numbers until the age of 8 years
and increase in size until growth of the chest wall is finished
PHASES OF LUNG
DEVELOPMENT
PHASES OF LUNG DEVELOPMENT
1. EMBRYONIC
2. PSEUDOGLANDULAR
3. CANALICULAR
4. TERMINAL SACCULAR
5. ALVEOLAR
 the primitive lung development ( first 5 weeks of
PHASES OF LUNG gestation )
generally regarded to encompass the first 2
DEVELOPMENT
months of gestation
1. EMBRYONIC lung begins to emerge as a bud from the pharynx
(endoderm) 26 days after conception
2. PSEUDOGLANDULAR
Lung bud elongates and forms two bronchial
3. CANALICULAR
buds and the trachea, which then separate from
4. TERMINAL SACCULAR the esophagus through the development of the
5. ALVEOLAR tracheosophageal septum - divides into two

1. Dorsal Portion - primordium of the oropharynx

and esophagus
2. Ventral Portion - primordium of larynx,
trachea, bronchi and lungs
 PHASES OF LUNG
DEVELOPMENT
1. EMBRYONIC
2. PSEUDOGLANDULAR

3. CANALICULAR

4. TERMINAL SACCULAR

5. ALVEOLAR
 By this time, major airways have developed ( 10
PHASES OF LUNG
on the Right and 9 on the Left)
DEVELOPMENT
The endoderm lining of the laryngotracheal
1. EMBRYONIC diverticulum gives rise to the Epithelium and
Glands of respiratory tract
2. PSEUDOGLANDULAR
Left and Right Pulmonary veins start to develop
3. CANALICULAR
at about week 5 as a single evangination in the
4. TERMINAL SACCULAR sinoatrial portion of the heart and so as the
5. ALVEOLAR bifurcation of the left and right primary
bronchial buds
The Foregut bud interacts with the bronchial
mesoderm which eventually gives rise to the
pulmonary interstitium, smooth muscle, blood
vessels and cartilages.
 Injury to the embryo or genetic dysregulation
PHASES OF LUNG
during this crucial phase of development can
DEVELOPMENT
lead to many congenital anomalies including,
1. EMBRYONIC
Tracheoesophageal fistulas
2. PSEUDOGLANDULAR
Esophageal atresia
3. CANALICULAR
Choanal atresia
4. TERMINAL SACCULAR Pulmonary Hypoplasia
5. ALVEOLAR Complex heart and vascular anomalies
 PHASES OF LUNG 6- 16 weeks gestation
named after the distinct glandular appearance of
DEVELOPMENT
the developing lung
1. EMBRYONIC at 7th week, ciliated cells appear early in the
upper airway, smooth mucle cells appear and
2. PSEUDOGLANDULAR
diaphragm is complete
3. CANALICULAR
at 10th week, mucous and submucosal glands
4. TERMINAL SACCULAR and goblet cells begin to appear.
5. ALVEOLAR for the next 10 weeks, the growth and branching
of the tracheobronchial tree and pulmonary
vasculature continue and culminate with
formation of ther terminal and respiratory
bronchioles.
 at 12th weeks, Fetal breathing movement begins
PHASES OF LUNG which serves as a conditioning exercises for
DEVELOPMENT respiratory muscles.
the epithelial lining of the airways begins to
1. EMBRYONIC differentiate into columnar epithelia (proximal
2. PSEUDOGLANDULAR airways) and cuboidal epithelia (distal airways)
3. CANALICULAR
at 16th weeks, about 4-25 generations of
branches formed
4. TERMINAL SACCULAR
Respiration is NOT possible
5. ALVEOLAR Fetuses born during this period are unable to
survive.
 PHASES OF LUNG 16-26 weeks gestation
this phase is so named because of the
DEVELOPMENT appearance of vascular channels or capillaries,
1. EMBRYONIC
that begin to grow by forming a capillary network
around the air passages.
2. PSEUDOGLANDULAR
at 16th week, Respiratory Acinus (Lung
3. CANALICULAR Parenchyma) begin to identify
4. TERMINAL SACCULAR Acinus - the basic gas exchange unit of the lungs.
5. ALVEOLAR
at 20th to 24th week, Type I and Type II
pneumocytes begin to appear and replicate.

TYPE I CELLS - it forms the shape of alveoli

TYPE II CELLS- are rounder and larger than type I
cells and aids in surfactant production
 Surfactant is essential in reducing surface
PHASES OF LUNG tension present in the liquid-air interface within
the lungs. Stored in the Lamellar Bodies.
DEVELOPMENT Composition:
Phospholipids (85%)
1. EMBRYONIC
Proteins (10%)
2. PSEUDOGLANDULAR
Small amount of carbohydrates
3. CANALICULAR Approximately 24th weeks, Dipalmitoyl
4. TERMINAL SACCULAR Phosphatidyl Choline (DPPC) - begins to rise and
makes up the majority of the weight of surfactant
5. ALVEOLAR
at 24th to 26th week (end of canalicular stage),
Respiration is POSSIBLE.
Fetus born at this stage is capable of sufficient
gas exchange and viable if supported with
supplemental O2, ventilatory support and
surfactant administration.
 Terminal Stage (26 - 40 weeks gestation)
PHASES OF LUNG Saccular Stage (27-36 weeks gestation)
at 26th week, more terminal bronchioles and
DEVELOPMENT associated acini formed and developed.
the cuboidal epithelia that line the blind tubules
1. EMBRYONIC
of the acinus continue to differentiate into
2. PSEUDOGLANDULAR
rounded secretory cells (Type II) and flatter
3. CANALICULAR squamous epithelia (Type I).
4. TERMINAL SACCULAR at 28th week, carotid chemoreceptors are likely
5. ALVEOLAR mature enough.
at 30th week, true alveoli developed to the
terminal bronchioles forming short, shaloow, sacs
known as saccules.
at 35th week, mature surfactant begins to appear
at 34th - 36th week, alveoli developed and cause
lung size to increase rapidly.
 PHASES OF LUNG
DEVELOPMENT
1. EMBRYONIC

2. PSEUDOGLANDULAR

3. CANALICULAR

4. TERMINAL SACCULAR

5. ALVEOLAR
 PHASES OF LUNG 36 weeks to 40 weeks (Term)
marks the final phase of lung development
DEVELOPMENT mature alveoli developed accompanied by
1. EMBRYONIC
capillary proliferation within the walls.
this period begins at approximately 32 weeks of
2. PSEUDOGLANDULAR
gestation and continues for years after birth.
3. CANALICULAR Premature infants younger than 32 weeks are at
4. TERMINAL SACCULAR greater risk for developing respiratory distress.
5. ALVEOLAR Full-term newborn infant has approximately 50
million alveoli and continue to increase
approximately 2 to 3 years after birth until the
age of 8 years ( 300 million alveoli ).
SURFACTANT
Pulmonary surfactant promotes lung inflation by reducing alveolar surface tension and
protects the alveolar surface.
Composition:
Phospholipids (85%)
main components: Phosphatidylcholine (Lecithin), Sphingomyelin (S) and
Phosphatidylglycerol (PG)
Proteins (10%)
SP-A, SP-B and SP-C
Small amount of carbohydrates
Production:
by type II pneumocytes
Begins to produced around 24-26th weeks of development
SURFACTANT
L/S ratio and PG concentration provides a predictive index of lung maturity
in a fetus before birth and the risk for the development of respiratory
distress.
FETAL LUNG FLUID
Different than amniotic fluid
Decreased level of bicarbonate and protein
Increased levels of Sodium and Chloride
essential for normal lung development
maintains patency of the developing airways
Term infants= 20-30 ml/kg in lungs
FETAL LUNG FLUID
Removed through:
Absorption - Lymphatic system
Clearance - Pulmonary capillaries
Contraction - Birth canal, Birth squeeze
HAZARDS OF RETENTION
Transient Tachypnea of Newborn (TTNB)
may present as RDS:
Grunting
Flaring
Retractions
ASSESSMENT OF FETAL
LUNG MATURITY
Profile Test
1. L/S Ratio
most long standing and well known fetal lung maturity test
test the ratio of Lecithin to Sphingomyelin
Lecithin increases in late gestation by 35 weeks gestation
Sphingomyelin remain constant
a ratio of 2:1 (mature lungs)
a ratio of <2:1 ( RDS is likely )
ASSESSMENT OF FETAL
LUNG MATURITY
Profile Test
2. PG Concentration
appears at the amniotic fluid around 35 weeks and increases at weeks 37
to 40.
good predictor of mature lungs but poor predictor of occurence of RDS
when result is “absent”
only test that is not affected by sample contamination by blood or
meconium
ASSESSMENT OF FETAL
LUNG MATURITY
Shake Test
also known as Foam Test
sample of amniotic fluid is mixed with ethanol and shaken for 15 seconds
and left to sit for 15 minutes
presence of ring bubbles (positive), enough lecithin is present
no foam is present (negative), L/S ratio should be performed
ASSESSMENT OF FETAL
LUNG MATURITY
S/A (Surfactant-Albumin) Ratio
widely known by its brand name, TDx Fetal Lung Maturity Test
test operates on principle of fluorosence polarization
measures relative concentration of surfactant and albumin
>55 mg of surfactant/ 1g of albumin (mature)
40-55mg of surfactant/ 1g of albumin (indeterminate)
<40mg of surfactant/ 1g of albumin (immature)
AMNIOTIC FLUID
Normal amount: 1 liter ( 1,000 ml)
Functions:
Protection of uterus
Thermoregulation
Facilitation of fetal movement
Aids in metabolism of fetus
Helps dilate cervix on delivery
AMNIOTIC FLUID
Abnormalities:
1. Polyhydramnios
2. Oligohydramnios
AMNIOTIC FLUID
Polyhydramnios
large amount of amniotic fluid (>200 ml)
causes:
CNS malformation
Orogastric malformation
Esophageal atresia
Pyloric Stenosis
Down syndrome
Congenital Heart Disease
Infant of Diabetic mother
prematurity
AMNIOTIC FLUID
Oligohydramnios
decreased amount of amniotic fluid
causes:
Renal agenesis
Urethral stenosis
risk of asphyxia due to cord compression
possible skeletal deformities
Fetal Gas Exchange and
Circulation
MATERNAL - FETAL GAS EXCHANGE
Placenta
disc-like structure that is approximately 6-8 inches in diameter and 1 inch
thick and weighs approximately 1 pound
low-resistance circulatory system
Functions:
the primary center for gas exchange in the fetal state.
provides gas exchange and waste removal
supplies nutrients to the fetus
Parts:
Intervillous spaces- acts as the AC membrane
Chorionic Villi- finger like tissue projection which contains fetal
capillaries.
MATERNAL - FETAL GAS EXCHANGE
Umbilical Cord
enters placenta from the fetus
Parts:
2 Fetal Arteries - which carry deoxygenated blood to the placenta
from the fetus
1 Fetal Vein - which carry oxygenated blood from the placenta to the
fetus
Wharton’s Jelly- a gelatinous substance inside the umbilical cord that
helps protect the vessels and may prevent the cord from kinking.
MATERNAL - FETAL GAS EXCHANGE
In the placenta, the deoxygenated blood will enter the chorionic villi, a
structure that contains fetal capillaries.
Fetal capillaries enables Oxygen availability for the fetus
From the chorionic villi, gas exchange will now take place in the intervillous
space
Fetal Hemoglobin (fHb) has greater affinity than maternal Hb, oxygen will
diffuse from the intervillous space to the chorionic villi and in return, Carbon
dioxide (CO2), the Fetal waste product will be released to the intervillous
spaces.
The oxygenated blood will now pass through the umbilical vein and into the
fetus.
MATERNAL - FETAL GAS EXCHANGE
CARDIOVASCULAR DEVELOPMENT
Heart
at 3rd week of gestation, heart is fully formed
considered to be the first complete organ formed
at 8th week of gestation, fetal heart is fully functional, complete with all
chambers, valves and major vessels.
CARDIOVASCULAR DEVELOPMENT
Early Development
Week 3
Day 16 - Angiogenic clusters ( blood islands ) appear
Day 18 - Heart tube forms
Day 21 - Heart tubes fuse
Chamber Development
Week 4
Day 22 - Fusion of heart tubes complete; Heart begins to beat;
Bidirectional bloodflow begins
Day 23 - Folding, looping, ballooning begin
Day 25 - Atrial septation begins with growth of septum primum
Day 28 - Ventricular Septation starts; Endocardial cushions form;
Unidirectional blood flow begins
CARDIOVASCULAR DEVELOPMENT
Chamber Development
Week 5
Day 32 - Septum secundum starts
Week 6
Day 37 - Foramen Ovale complete
Maturation
Day 46 - Ventricle formation complete
Day 49 - Four chambers complete
Week 8
Day 52 - Aorta/Pulmonary artery complete separation
Day 56 - Valve formation complete
CARDIOVASCULAR DEVELOPMENT:
Early Development
Angiogenic Clusters (Blood Islands)
supply nutrition to the growing embryo
these clusters coalesce to form two heart tubes lined with specialized
myocardial tissue
Day 18 - heart tubes fold
Day 21 - they grow into a complete single-chamber tubular structure
Day 22 - cardiac contractions are detectable ( begin to beat )
CARDIOVASCULAR DEVELOPMENT:
Chamber Development
Dramatic changes occur at the 4th week of
gestation
Heart tube continue to to merge into three
identifiable structures called:
Bulbus Cordis
Ventricular Bulge
Atrial Bulge
these structures contine to bend, fold and
dilate by Truncus arteriosus (which connect
the heart to the future arterial system)
CARDIOVASCULAR DEVELOPMENT:
Chamber Development
Dextral looping occurs between Day 23
and 28 - whereby the ventricular bulge
balloons into C-shaped loop that
pushes the atrial bulge into superior
direction
Subsequently the embryonic heart
appears as a twisted S-shaped
Ventricular structure merges with the
bulbus cordis to form a one- ventricle
structure known as the
Bulboventricular loop.
CARDIOVASCULAR DEVELOPMENT:
Chamber Development
Septum Primum begins the separation of the primitive atrium followed by
shortly growth of the Endocardial cushions, which will separate the atria from
the ventricles.
Right horn of the sinus venosus grows in dominance and merges into the
future right atrium from the inferior and superior vena cavae.
By the end of 4th week, dilating ventricular spaces fold into each other and force the
ventricular septal bud upward at the base of the bulboventricular loop.
CARDIOVASCULAR DEVELOPMENT:
Chamber Development
During week 5 and week 6, the
internal and external structures
continue to mature rapidly.
Septum secundum begin to
appear
Foramen Ovale form through the
presence of septum secundum
and a flap from the septum
primum
Atrioventricular Canal (AV)
continues to mature
Endocardial Cushions separate the
ventricular spaces from the atrium
CARDIOVASCULAR DEVELOPMENT:
Maturation Development
Week 8 - continuing maturation of the internal and
external structures characterized.
Ventricles finish forcing the ventricular septum up
from its base
Tricuspid and Mitral valves form from specialized
tissue surrounding the two atrioventricular openings
Aorticopulmonary septum divides the bulbus cordis
and truncus into an aortic and pulmonary trunk
Early in the 8th week, the outflow tracts and valves
are completely developed
Development of the cardiac structures at this stage is
complete and blood flows through the fetal
circulation pathway.
Fetal Circulation
Fetal Shunt
3 Fetal shunt
Ductus Venosus
Foramen Ovale
Ductus Arteriosus
Fetal Shunt
1. Ductus Venosus
first fetal shunt
appears continuous with the umbilical vein
shunting approximately 30-50% of the oxygen rich blood directly to the
inferior vena cava
bypasses liver
Fetal Shunt
2. Foramen Ovale
second fetal shunt
formed during separation of the atria
most of the blood flow in the right atrium from the inferior vena cava
crosses through a hole within the atrial septum into the left atrium
septum primum act as a one-way valve over the ostium secundum
Even though some admixture occurs, the blood entering the right atrium
contains the highest oxygen saturations available to the fetus.
bypasses the lung
Fetal Shunt
3. Ductus Arteriosus
third fetal shunt
the high PVR causes most of the blood flowing through the pulmonary
artery from the right ventricle to pass through the less resistant ductus
arteriosus directly into the aorta.
bypasses the lung and left heart
FETAL CIRCULATION
Oxygenated blood from the placenta is carried in the umbilical vein back to the
fetal circulation via the hepatic circulatory system
Approximately one-third of this blood flows to the lower trunk and extremities.
The other two-thirds flows through the ductus venosus, bypassing the liver’s
circulation, and flows to the inferior vena cava.
Approximately 50% of this blood is shunted from the right atrium into the left
atrium through an opening in the interatrial septum called the foramen ovale.
Left atrial blood flows to the left ventricle and then to the ascending aorta,
where it continues on to the brain, brachiocephalic trunk, and descending
aorta.
FETAL CIRCULATION
Venous blood from the superior vena cava is directed downward through the
right atrium into the right ventricle and then into the main pulmonary artery.
The relatively low PO2 and various prostaglandins in fetal blood cause the ductus
arteriosus (a muscular vessel attached to the trunk of the pulmonary artery and
the aorta) to dilate and the pulmonary arteries to constrict.
As a result, 90% of the blood flow entering the pulmonary artery takes the path of
least resistance by shunting through the ductus arteriosus and flowing to the
aorta.
Only 10% flows into the lungs.
Blood flowing through the ductus arteriosus mixes with blood flowing through the
aorta, routing into the systemic circulation. Some of this blood flows to the gut,
lower extremities, and placenta.
FETAL CIRCULATION
Two umbilical arteries carry blood from the fetal aorta to the placenta,
carrying out fetal-maternal gas and nutrient exchange.

Pressures in the fetal vasculature:

SYSTEMIC - Low resistance
PLACENTAL - Low resistance
PULMONARY - High resistance
TRANSITION TO EXTRAUTERINE LIFE
Clamping the umbilical vessels removes the low-pressure system of the placenta from fetal
circulation.
During the first breath, several factors drastically reduce the PVR and increase pulmonary
blood flow
Inflation of the lungs initiates gas exchange, which in turn dilates the pulmonary arterioles.
Rising systemic arterial oxygen pressure (PaO2) also stimulates the release of endogenous
pulmonary vasodilating cytokines that act locally to increase the diameter of the pulmonary
arterial vasculature
Once the cord is clamped and the PVR decreases, pressures in the right side of the heart
decrease and pressures in the left side increase.
Because the foramen ovale flap allows blood to flow only from right to left, it closes when the
pressures in the left atrium become greater than those in the right atrium
Closing the foramen ovale further facilitates the increase of blood flow to the lungs during the
transitional period and is necessary to maintain normal extrauterine circulation.
TRANSITION TO EXTRAUTERINE LIFE
Because the pressure in the aorta also increases and becomes greater than the
pressure in the pulmonary artery, the amount of shunting through the ductus
arteriosus decreases.
The functional closure of the ductus arteriosus occurs as a result of being exposed
to an increase in PaO2, a decrease in PVR leading to the reduction in blood
pressure within the ductal lumen, a decrease in the local production of
prostaglandins, and a reduction in the number of prostaglandin receptors within
the tissue of the ductus arteriosus.
Constriction of the ductus arteriosus starts to occur at birth, and 20% of the
ductus closes within 24 hours, with 80% closed in 48 hours and 100% by 96 hours
after birth
By 2 to 4 weeks of age, the anatomical closure is complete and blood flow
normalizes to the adult pattern of circulation
TRANSITION PERIOD: PULMONARY CIRCULATION
INTRAUTERINE EXTRAUTERINE

Lungs are filled with fluid Lungs are filled with air

Pulmonary arterioles are constricted Pulmonary arterioles are dilates

Pulmonary blood flow diminished Pulmonary blood flow increases

Blood flow diverted across ductus Blood flow through lungs to pick-up
arteriosus and foramen ovale oxygen

Decreased PO2 Increased PO2

LUNG INFLATION AT BIRTH
After 30 minutes of birth, lung is aerated.

FRC is 95% of that found of 1 week of age.

Initial pressures to inflate the lung is as high as to cmH2O in the esophagus.

Initial inspiratory volume: (20 to 70 mL) with RV of (20 to 30 mL)

 Stimulus to Breathe:
1. Cutaneous stimuli

2. Decreasing O2 & increasing CO2 (major stimulus)

 VASCULAR RESISTANCE
INTRAUTERINE EXTRAUTERINE

Decreased systemic vascular Increased systemic vascular

resistance resistance

Increased pulmonary vascular Decreased pulmonary vascular

resistance resistance

Low placental resistance Removes when umbilical vessels are

clamped
 HEART PRESSURES
INTRAUTERINE EXTRAUTERINE

Increased right side pressure Decreased right side pressure

Decreased left side pressure Increased left side pressure

Aortic pressure increases and becomes greater than the

pressure in the pulmonary artery.
 CLOSING FETAL SHUNTS

A. FORAMEN OVALE
closes when the pressure in left atrium becomes greater than those in the
right atrium

B. DUCTUS ARTERIOSUS
functional clossure occurs as a result of:
1. Exposure to increased PaO2.
2. Reduction in the PVR leading to reduction in blood pressure within the
ductal lumen
3. Decrease in local production of prostaglandins
4. Reduction in prostaglandin receptors within the tissue of the Ductus
arteriosus
 CLOSING FETAL SHUNTS
B. DUCTUS ARTERIOSUS
normally, constriction of the DA starts to occur at birth:
24 hrs (20% closes)
48 hrs (80% closes)
96 hrs after birth (100% closes)
failure to close can lead to disease called Patent Ductus Arteriosus
can be chemically manipulated:
1. Indomethacin (closes the ductus)
2. Prostaglandin E1 (opens the ductus)

C. DUCTUS VENOSUS
after clamping the umbilical cord ductus venosus vasoconstricts because of
lack of blood flow.
 STRUCTURAL REMNANTS
FETAL STRUCTURE ADULT STRUCTURE

Foramen Ovale Fossa Ovalis

Umbilical vein Ligamentum Teres
Ductus Venosus Ligamentum Venosum
Umbilical arteries & abdominal Medial umbilical ligaments, superior
ligaments vesicular artery (supplies bladder)
Ductus Arteriosus Ligamentum arteriosum
TERATOGENESIS
development of abnormal structures in an embryo, resulting in a deformed
(dysmorphic) fetus.
Maternal Influences:
Cigarette
has a profound effects on the developing fetus
the carbon monoxide in cigarette smoke causes vasoconstriction of the
uterine blood vessels and leads to hypoxia
has been associated with decreased birth weight and stillbirth.
Marijuana
has been associated with decreased birth weight because it disrupts
placental function.
the incidence of prematurity is increased markedly with maternal
marijuana use.
TERATOGENESIS
Cocaine
it causes intrauterine vascular disruption
has led to decreased birth weight, prematurity, and congenital heart
disease
it induces rapid constriction, which causes a major increase in fetal mean
atrial pressure and heart rate and produces large drops in fetal PO2 levels
Alcohol
it produced a characteristic pattern known as Fetal Alcohol Syndrome
(FAS)
infants exposed to alcohol in utero have been noted to have a 10-fold
greater incidence of being small for gestational age.
more likely to have microcephaly, usually with some degree of mental
retardation and facial deformities.
now, the question is,

ARE YOU READY?

CHAROT LUNG!
 1. The respiratory therapist is evaluating a newborn with mild respiratory distress due to tracheal
stenosis. During which period of lung development did this problem develop?

a. Embryonal
b. Saccular
c. Canalicular
d. Alveolar
2.What is the purpose of the substance secreted by the type II pneumocyte?

a. To increase the gas exchange surface area

b. To reduce surface tension
c. To maintain lung elasticity
d. To preserve the volume of the amniotic fluid
3.Which of the following tests of the amniotic fluid have been shown to be sensitive
indicators
of lung maturity?

a. Levels of prednisone
b. Levels of epidermal growth factor
c. Levels of prostaglandins
d. Levels of phosphatidylglycerol and phosphatidylcholine
4.Which of the following phases of human lung development is characterized by the
formation of a capillary network around airway passages?

a. Pseudoglandular
b. Saccular
c. Alveolar
d. Canalicular
5.Which of the following embryonic germ layers gives formation to the respiratory
system?

a. Endoderm
b. Mesoderm
c. Ectoderm
d. Periderm
6.Which of the following organs is considered to be the first to form?

a. Heart
b. Brain
c. Lungs
d. Kidneys
7.What is the function of Wharton’s jelly inside the umbilical cord?

a. To help provide nutrition to the fetus

b. To prevent the vessels inside the cord from kinking
c. To help protect the fetus
d. To regulate the temperature between the fetus and the mother
8.A pregnant woman is coming for an early prenatal evaluation and wants to know if
she can listen to the baby’s heartbeat. How early can the fetal heartbeat be
detected?

a. Day 8
b. Day 22
c. Day 45
d. Day 60
9.How long after birth should it take for the ductus arteriosus to close completely?

a. 24 hours
b. 48 hours
c. 96 hours
d. 1 week
10.Which of the following anatomic structures is a (are) fetal shunt(s)?
I. Foramen ovale
II. Sinus venosus
III. Ductus venosus
IV. Ductus arteriosus

a. III only
b. I, III, and IV only
c. I, II, and IV only
d. II, III, and IV only
End of Slide. THANK YOU future RTRP’s!