CARDIOPULMONARY

DEVELOPMENTAL MILESTONES
COURSE:
CARDIOPULMONARY PHYSIOLOGY (PHS402)
PRESENTED BY GROUP 1
LECTURER IN CHARGE: DR. A.O. OYABAMBI
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OUTLINE
• Introduction
• Fetal Development
• Prenatal Cardiopulmonary Development
• Birth and Transition
• Postnatal Cardiopulmonary Development
• Early Childhood
• Pathophysiology
• Conclusion
• Reference
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INTRODUCTION
• Cardiovascular and respiratory systems undergo extensive changes during fetal through
neonatal life and infancy until early childhood( Saikia et al., 2019).
• Cardiopulmonary developmental milestones represent important physiological changes that
occur during prenatal, neonatal and early childhood stages.
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FETAL DEVELOPMENT.
.

FORMATION OF THE HEART AND MAJOR BLOOD VESSELS

• Heart Development: The heart starts developing early in embryogenesis. By the end of the
third week of gestation, the heart begins to form as a tube-like structure, which eventually
differentiates into the four chambers of the heart: two atria and two ventricles.(Sadler, 2012)
• Formation of Major Blood Vessels: The major blood vessels, such as the aorta, pulmonary
artery, superior vena cava, and inferior vena cava, begin to form and connect to the
developing heart. These vessels facilitate the proper distribution of oxygenated and
deoxygenated blood. (O'Rahilly and Müller, 2007)
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FETAL DEVELOPMENT
.

BASIC HEART CONTRACTIONS AND BLOOD CIRCULATION

• Initiation of Heart Contractions: Around the fourth week of gestation, specialized cardiac cells
called pacemaker cells in the embryonic heart start generating electrical impulses. These
impulses initiate rhythmic contractions of the heart, leading to the development of a basic
cardiac cycle. (Miquerol and Kelly, 2013)

• Early Blood Circulation: As the heart starts to contract, blood begins to circulate within the
developing embryo. At this stage, the circulatory system is simple, with blood vessels forming
networks throughout the embryo. Oxygen and nutrients are exchanged between the
developing fetus and the mother through the placenta.(Sadler, 2012)
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FETAL DEVELOPMENT
.

DEVELOPMENT OF THE RESPIRATORY SYSTEM

• Lung bud formation: During early embryogenesis, the respiratory diverticulum or lung bud emerges
as an outpouching from the foregut. It grows and divides into primary bronchial buds, which
subsequently branch to form the bronchial tree. (Kardos and Gaspar, 2021)
• Trachea and esophagus separation: A structure called the tracheoesophageal septum develops,
dividing the foregut into the trachea and esophagus, allowing independent development of the
respiratory and digestive systems.
• Lung lobes formation: The bronchial tree continues to branch, giving rise to secondary and tertiary
bronchial buds, which differentiate into bronchioles. These structures form the basis of the lung
lobes.
• Alveolar development: Respiratory bronchioles develop into alveolar ducts, which further branch
into alveoli, the site of gas exchange. The maturation of alveoli continues after birth.(Hall, 2002)
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PRENATAL CARDIOPULMONARY DEVELOPMENT.
DEVELOPMENT OF THE HEART

• The development of the embryonic heart is a complex and intricate process that involves precise
genetic and molecular interactions. Throughout embryogenesis, the heart undergoes several stages
of development, ultimately forming a fully functional organ that can support the circulatory system
of the developing organism. The stages are:
• Formation of the heart tube
• Looping and chamber formation
• Septation
• Valve formation
• Development of coronary vessels
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PRENATAL CARDIOPULMONARY DEVELOPMENT

Human embryonic development. (Marchianò, 2019).

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PRENATAL CARDIOPULMONARY DEVELOPMENT
DEVELOPMENT OF THE LUNGS

• Development of the lower respiratory tract begins on day 22 and continues

to form the trachea, lungs, bronchi, and alveoli. The process divides into
stages:
i. Embryonic stage 3-6 weeks
ii. Pseudoglandular Stage 5-17 weeks
iii. Canalicular Stage – 16-25 weeks
iv. Saccular Stage – 24 weeks-birth
v. Alveolar Stage – 36 weeks – 8 years
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PRENATAL CARDIOPULMONARY DEVELOPMENT.

The 5 major phases of fetal lung development (Johannes, 2017).

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PRENATAL CARDIOPULMONARY DEVELOPMENT
.

ROLE OF FETAL SHUNTS IN DIRECTING BLOOD FLOW

• Ductus Venosus: This connects the umbilical vein to the inferior vena cava, bypassing the liver
and directing oxygenated blood from the placenta to the fetal heart (Rudolph, 2020).
• Foramen Ovale: This is an opening between the atria of the fetal heart that allows oxygenated
blood from the right atrium to flow directly into the left atrium, bypassing the non-functional
fetal lungs (Clyman, 2018).
• Ductus Arteriosus; This is a blood vessel connecting the pulmonary artery to the aorta, allowing a
portion of oxygenated blood to bypass the lungs and flow directly into the systemic circulation
(Rudolph, 2020).
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BIRTH AND TRANSITION
• Birth Process: During labor and delivery, various physiological changes occur to facilitate the transition
from the intrauterine environment to independent postnatal life. These changes include increased
pressure on the fetal chest, compression of the umbilical cord, and hormonal and chemical signals
triggered by the stress of labor (Gleasin and Juul,2018).
• Initiation of Breathing: The first breath taken by the newborn initiates a series of changes in the
cardiopulmonary system. As the infant inhales air into the lungs, the lungs expand, and alveoli are filled
with air for the first time. This expansion helps establish proper gas exchange (Gleasin and Juul, 2018).
• Closure of Fetal Shunts
• Pulmonary Circulation Changes in Cardiac Function
• Development of Respiratory Drive
Additional adaptations include the establishment of functional gas exchange in the lungs, increased blood
flow to the lungs, and adjustments in systemic vascular resistance and blood pressure regulation.
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POSTNATAL CARDIOPULMONARY
•
DEVELOPMENT
Surfactant Production
• Development of Respiratory Control
• Surfactant Production
• Pulmonary Circulation Changes: With the onset of breathing, pulmonary blood vessels dilate,
increasing pulmonary blood flow. This, coupled with the closure of fetal shunts, redirects blood
flow to the lungs for oxygenation (Stocker and Dehner,2015).
• Lung Expansion: After birth, the newborn takes the first breath, initiating lung expansion. This
allows the alveoli to fill with air, facilitating efficient gas exchange (Gleason and Juul,2018).
• Cardiac Adaptations: The cardiovascular system undergoes adjustments to meet the increased
oxygen demands of the body. The left and right sides of the heart function in series, with the left
side pumping oxygenated blood to the body's tissues, while the right side receives
deoxygenated blood and sends it to the lungs for oxygenation (Bancalari and Claure, 2018).
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POSTNATAL CARDIOPULMONARY DEVELOPMENT
CONT’D
• Immunological Maturation: The postnatal period is characterized by the maturation of the
immune system.This maturation protects the respiratory system from infections and
establishes effective immune responses. (Stocker, and Dehner,2015)
• These postnatal changes collectively establish an efficient and functional cardiopulmonary
system, enabling the newborn to adapt to the extrauterine environment and meet the body's
oxygenation needs
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EARLY CHILDHOOD
During early childhood, the cardiopulmonary system continues to develop, resulting in improved
lung function, increased exercise tolerance, and better respiratory control.
• Lung Growth: The lungs continue to grow in size, and the number of air sacs called alveoli
increases, improving respiratory efficiency. (Zelt et al., 2019)
• Respiratory Rate and Lung Capacity: Children have a lower respiratory rate and increased lung
capacity, allowing for more efficient breathing.
• Muscle Strength and Respiratory Mechanics: Stronger respiratory muscles lead to improved
respiratory mechanics and better airway clearance. (Stocks, and Sonnappa,2013)
• Immune System Development: The immune system matures, providing better respiratory
defenses against infections.
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EARLY CHILDHOOD (CONT’D)
• Cardiovascular Adaptations: The heart grows in size and efficiency, improving oxygen
delivery to the body's tissues.(Stick, 2016)
• Oxygenation and Exercise Tolerance: Children have enhanced oxygenation and exercise
tolerance, enabling them to engage in physical activities more easily. (Stocks and Sonnappa,
2013)
• Respiratory Control: The respiratory centers in the brain develop, resulting in better control
and regulation of breathing.
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PATHOPHYSIOLOGY
• The pathophysiology of the cardiopulmonary system involves the study of abnormal
physiological processes that occur in the heart and lungs, leading to various disorders and
diseases. It focuses on understanding the underlying mechanisms, disruptions, and their impact
on respiratory and cardiovascular functions. Some of these pathophysiology are;
 Respiratory Distress Syndrome
 Reduced pulmonary segments or terminal sacs, commonly known as pulmonary hypoplasia
 Esophageal atresia
 Congenital heart disease
 Tetralogy of Fallot (TOF)
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PATHOPHYSIOLOGY CONT’D

Tetralogy of Fallot (Lehn, 2016).

.
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CONCLUSION
• Throughout fetal development, various factors such as genetic, environmental, and maternal
health can influence the growth and well-being of the fetus
• It's important to note that each child develops at their own pace, and these milestones may
vary slightly from child to child. "Regular check-ups with pediatricians can help monitor a
child's cardiopulmonary development and ensure that they are progressing normally."
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REFERENCES
• Bancalari, E., & Claure, N. (2018). Respiratory physiology and pathophysiology. In Avery's Diseases of the
Newborn (10th ed., pp. 189-208). Elsevier.
• Clyman, R. I. (2018). The role of patent ductus arteriosus and its treatments in the development of
bronchopulmonary dysplasia. Seminars in Perinatology, 42(6), 390-397. doi: 10.1053/j.semperi.2018.09.011
• Davis RP, Mychaliska GB. Neonatal pulmonary physiology. Semin Pediatr Surg. 2013 Nov;22(4):179-84
• Gleason, C. A., & Juul, S. E. (2018). The cardiopulmonary system in the newborn. In Avery's Diseases of the
Newborn (10th ed., pp. 258-283). Elsevier.
• Hall, J. G. (2002). Respiratory System. In Human Embryology and Developmental Biology (3rd ed., pp. 227-
240). Elsevier Saunders
• Johannes C. Schittny; (2017); Development of the lung.
• Kardos, M., & Gaspar, H. A. (2021). Lung Development. In StatPearls [Internet]. StatPearls Publishing.
• Marchianò, Silvia & Bertero, Alessandro & Murry, Charles. (2019). Learn from Your Elders: Developmental
Biology Lessons to Guide Maturation of Stem Cell-Derived Cardiomyocytes. Pediatric Cardiology. 40.
10.1007/s00246-019-02165-5.
• Miquerol, L., & Kelly, R. G. (2013). Organogenesis of the vertebrate heart. Wiley Interdisciplinary Reviews:
Developmental Biology, 2(1), 17-29. doi: 10.1002/wdev.78
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REFERENCES
• O'Rahilly, R., & Müller, F. (2007). The development of the heart. In Human embryology & teratology
(3rd ed., pp. 275-303). Wiley-Liss.
• Rudolph, A. M. (2010). The fetal circulation and its response to stress. The Journal of Clinical
Investigation, 120(3), 1062-1068. doi: 10.1172/JCI41330
• Sadler, T. W. (2012). Langman's Medical Embryology (12th ed.). Lippincott Williams & Wilkins.
• Saikia D, Mahanta B. Cardiovascular and respiratory physiology in children. Indian J Anaesth. 2019
Sep;63(9):690-697
• Sathananthan, A. H., Zaw-Tun, H. A., & Bellairs, R. (2012). Human development of the heart: A
primer. Ian G. Miura, A. Peyvandi, & K. Rekha (Eds.), Developmental Anatomy and Physiology of
Children: A Practical Approach (pp. 221-242). Springer
• Stick, S. M. (2016). The young lung: development, injury
• Stocks, J., & Sonnappa, S. (2013). Early Life Origins of Lung Health and Disease. American Journal
of Respiratory and Critical Care Medicine, 187(9), 938-942. doi: 10.1164/rccm.201211-2088PP
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