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Foetal-to-neonatal transition during labour and just after birth is an intricate phenomenon in which many processes are involved. It is a vulnerable period for the newborn and perinatal mortality remains an important contributor to overall mortality and morbidity, despite improvements in foetal and neonatal care. In this chapter, the physiology of transition and potential diseases of the neonate are discussed. Important hallmarks of cardiopulmonary transition are the switch from foetal to postnatal circulation and aeration of the lungs, which also interact with each other. As perinatal asphyxia is an important risk factor for perinatal mortality and morbidity, neonatal resuscitation and pathophysiology of perinatal asphyxia are extensively discussed. The preterm born infant can encounter problems as a consequence of immaturity, such as respiratory distress syndrome and intraventricular haemorrhage. Insight into the physiology of transition at birth and the pathophysiology of common neonatal diseases is essential to improve neonatal and long-term outcome.
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Mortality in the first 28 days after birth
Indicates the direction of a shunt in blood flow from the right side of the heart or pulmonary circulation to the left side of the heart or systemic circulation, or vice versa. Effects mostly differ in foetal and postnatal life
Hypothermia is defined as a temperature of < 36.5 oC. Neonates have a high risk of developing hypothermia. It is important to be aware of the causes and consequences of hypothermia; preventing hypothermia is essential for neonatal transition
The aim of neonatal resuscitation is to support foetal to neonatal transition
Asphyxia literally means ‘pulseless’ and indicates a poor clinical condition at birth. Perinatal asphyxia is defined as a condition including disturbed gas exchange which leads to progressive hypoxia, hypercapnia and acidosis
Pulmonary hypertension of the neonate
Increased pulmonary vascular resistance which supersedes systemic vascular resistance leading to right-to-left shunt of blood flow. As a consequence, oxygenation of peripheral tissues can be compromised
Bluish discolouration of the skin can be seen when a certain concentration of deoxygenated haemoglobin level is reached ( ~ 2 g/dl). Patients with anaemia have a lower arterial oxygen saturation when cyanosis manifests, as compared with patients with high total haemoglobin levels
Neonates born small for gestational age might not always be growth restricted during intrauterine growth. Measuring the length and head circumference is important to differentiate between proportional and disproportional growth restriction
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- Birth and the neonatal period
Dr Rob (H. R.) Taal
Professor Irwin K. M. Reiss
Professor Enrico Lopriore
MD, PhD Professor Vincent W. V. Jaddoe
- Bohn Stafleu van Loghum