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Pediatric and Neonatal Respiratory Care Embryologic Development. Mary P. Martinasek, BS, RRT. Overview. Introduction Development of the Pulmonary System Development of the Cardiovascular System Fetal Circulation Development of Other Intrauterine Structures. Introduction.

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pediatric and neonatal respiratory care embryologic development

Pediatric and NeonatalRespiratory CareEmbryologic Development

Mary P. Martinasek, BS, RRT

overview
Overview
  • Introduction
  • Development of the Pulmonary System
  • Development of the Cardiovascular System
  • Fetal Circulation
  • Development of Other Intrauterine Structures
introduction
Introduction
  • General Fetal Development
  • Ovum
  • Embryo
  • Fetus
  • Cellular Development
germ layers of the embryo
Germ Layers of the Embryo
  • Endoderm
  • Respiratory Tract
  • Mesoderm
  • Ectoderm
development of the pulmonary system

Development of the Pulmonary System

Embryonic Period

Pseudoglandular Period

Canalicular Period

Saccular and Alveolar Period

embryonic period
Embryonic Period
  • From Conception to 4-6 weeks gestation
  • Development of proximal airways
  • 0-24 days one central tube
  • 24 days - primitive lung bud appears
embryonic period continued
Embryonic Period (continued)
  • 26-28 days form right and left lung buds
  • Primitive airways progress in dividing
  • Lobar bronchi - day 31
  • diaphragm starts and is completely developed by 8th week
pseudoglandular period
Pseudoglandular Period
  • 7-16 week gestation
  • development of conducting airways
  • 7th week - epiglottis formation starts
  • 7th week - choana disintegrates and palates development begins
pseudoglandular period cont
Pseudoglandular Period (cont.)
  • 8th week - vocal cord development begins
  • Lung resembles gland
  • Dichotomy results
  • 11th week - cartilage in airways appears
  • 12th week - major lobes identifiable
pseudoglandular period cont1
Pseudoglandular Period (cont.)
  • 13th week - goblet cells form
  • 13th-24th week bronchial glands develop
  • 10 week - ciliated cells start to appear
canalicular period
Canalicular Period
  • 17-24 weeks gestation
  • Development of acinus
  • Tremendous amount of vasularization
  • Outpouchings appear on wall of bronchioles
canalicular period continued
Canalicular Period (continued)
  • Two types of cells start to differentiate
  • Capillaries present but too far away from alveolar cavity
saccular alveolar period
Saccular (Alveolar) Period
  • 24th week - birth
  • Development of gas exchange units
  • 25th-26th week alveolar-capillary membrane able to sustain extrauterine life
saccular period continued
Saccular Period (continued)
  • 28-29th week terminal sacs line with mature Type II cells - surfactant appears
  • 34-36th week mature alveolar structure evident
  • approximately 55 million alveoli (10 m2)
surfactant
Surfactant
  • Composition
    • Phospholipids and Protein

Phosphoatidylcholine (Lecithin) – Major surfactant appears at 18 weeks and peaks at 38 weeks

Sphingomyelin – Surfactant found in the amniotic fluid (decreases after 30 weeks)

  • Production
    • Secreted by Type II Alveolar Cells
fetal lung fluid
Fetal Lung Fluid
  • Composition
    • Different than amniotic fluid
    • Decreased levels of bicarbonate and protein
    • Increased levels of Sodium and Chloride
fetal lung fluid cont
Fetal Lung Fluid cont.
  • Function: Maintain patency

Term = 20-30 ml/kg in lungs

Production decreases days prior to clinical detection of labor

hazards of retention
Hazards of Retention
  • TTN – Transient tachypnea of the newborn
  • May present as RDS
    • Grunting, flaring and retracting (GFR)
determination of lung maturity
Determination of Lung Maturity
  • Shake (Foam) Test
  • LS ratio (Lecithin to sphingomyelin ratio)
    • Lungs mature when 2:1 (35 weeks)
  • PG detection (Phosphatidylglycerol)
    • Lipid
      • Absent until about 35 weeks gestation
lung maturity cont
Lung Maturity Cont.
  • FLM or FP Assay – Fluorescence Polarization
    • Surfactant to Albumin
    • Quick and Reliable
  • Lung Profile
    • L:S and PG detection
conditions that delays surfactant production
Acidemia

Hypoxia

Shock

Overinflation

Underinflation

Pulmonary Edema

Mechanical Ventilation

Hypercapnia

Maternal Diabetes (A,B,C)

Smaller of Twins

Conditions that DelaysSurfactant Production
conditions that accelerate surfactant production
Maternal diabetes (D, F, and R)

Maternal heroin addiction

Premature rupture of membranes

Maternal hypertension

Maternal infection

Placental insufficiency

Betamethasone or thyroid hormone

Abruptio placentae

Conditions that AccelerateSurfactant Production
development of cardiovascular system
Development of Cardiovascular System
  • 3rd week - two tubes surrounded by myocardial tissue
  • Tubes fuse form single chamber
development of cardiovascular system continued
Development of Cardiovascular System(continued)
  • 4th week - heart begins to beat
  • Heart begins to twist and fold
  • Eventually will form four chambers
development of cardiovascular system continued1
Development of Cardiovascular System(continued)
  • Sinus venosus - horns at bottom of embryonic heart - will become vena cava’s and portion of right atrium
  • Truncus arteriosus - will form pulmonary artery and aorta
development of cardiovascular system continued2
Development of Cardiovascular System(continued)
  • Bends in middle - S shape
  • Rapid growth
  • Development of chambers
  • Blood flow begins - one way flow
development of cardiovascular system continued3
Development of Cardiovascular System(continued)
  • 5th week - heart takes on shape of adult heart
  • Developing veins and arteries couple the heart to circulatory system
  • Separate blood paths created
development of cardiovascular system continued4
Development of Cardiovascular System(continued)
  • Four chambers formed with openings between the atria and the ventricles
  • Truncus arteriosus allows blood to exit right ventricle
fetal circulation
Fetal Circulation
  • Pressure in the fetal vasculature
    • Systemic – Low resistance
    • Placental – Low resistance
    • Pulmonary – High resistance
characteristics of fetal circulation
Characteristics of Fetal Circulation
  • Normal shunts in the fetus
    • Foramen ovale – bypasses lung
    • Ductus arteriosus – bypasses lung
    • Ductus venosus – bypasses liver
fetal circulation1
Fetal Circulation
  • Flow chart of the most oxygenated fetal blood
  • Bypasses liver - ductus venosus
  • Bypasses lungs - foramen ovale
fetal circulation continued
Fetal Circulation (continued)
  • Flowchart of least oxygenated fetal blood
  • Small amount feed lungs (high resistance)
  • Most bypasses lungs - ductus arteriosus
development of intrauterine structures
Development of Intrauterine Structures
  • Placenta
  • Umbilical cord
  • Amnion
  • Amniotic fluid
placental development
Placental Development
  • Placenta organ of respiration for fetus
  • Umbilical arteries carry unoxygenated blood from fetus
  • Intervillous space acts as alveolar-capillary membrane
  • Umbilical vein carries oxygenated blood to fetus
umbilical cord
Umbilical Cord
  • Life line
  • Wharton’s Jelly
  • 2 arteries and 1 vein
amnion
Amnion
  • Sac surrounding fetus containing amniotic fluid
  • Possible rupture can occur in utero
amniotic fluid
Amniotic Fluid
  • 1 liter at term
  • Constantly recirculated and replenished through lung fluid and urination
    • Amount of fluid depends on recirculation
function of amniotic fluid
Function of Amniotic Fluid
  • Thermoregulation
  • Facilitation of movement
amniotic fluid abnormalities
Amniotic Fluid Abnormalities
  • Polyhydramnios – large amount of amniotic fluid ( greater than 200cc’s)
    • Causes:
      • CNS malformation
      • Orogastric malformation
        • Esophageal atresia
        • Pyloric stenosis
abnormalities cont
Abnormalities Cont.
  • Causes of polyhydramnios cont.
    • Down’s syndrome, CHD, IDM, and prematurity
amniotic fluid abnormalities cont
Amniotic Fluid Abnormalities Cont.
  • Oligohydramnios – decreased amount of amniotic fluid
    • Usually defect in urinary system
      • Renal agenesis (Potter’s syndrome)
      • Urethral stenosis
    • Risk of asphyxia due to cord compression
    • Possible skeletal deformities