4) Neonate Flashcards
dif/ from a PEDI vs adult airway) PEDI:
Adult:
= Large tongue, Floppy omega epiglottis, cricoid narrowest point
= glottis narrowest point, firm epiglottis
Causes of Neonatal Bradycardia
Hypoxia, acidosis, hypothermia; primary treatment is ventilation before considering meds
Causes of Neonatal Hypoglycemia
Prematurity, diabetic mother, sepsis, hypothermia, birth stress
Choanal Atresia
Congenital blockage of nasal passage, causes respiratory distress when mouth is closed
Cleft Palate & Lip
Failure of structures to close during fetal development, can cause feeding & airway issues
Common Causes of Neonatal Seizures
Hypoxia, hypoglycemia, infection, intracranial hemorrhage, congenital abnormalities
Decrease pulmonic defects:
= Tetralogy of Fallot (TOF), dextro-Transposition of the Great Arteries (d-TGA), Levo-Transposition of the Great Arteries (l-TGA)
Diaphragmatic Hernia Considerations
Do not bag-mask ventilate, intubate early, position baby with head elevated
fluid replacement after perfusion rule:
4 2 1rule/ formula :
=back to normovolemia Used for every hr after to maintain
= [A] 4ml/kg 1st 10 [B]2m/Kg 2nd 10kg [C]1ml/kG after per hour Used for every hour after to maintain
From what time is a baby classified as an ‘infant’?
From time of birth until 1 year.
Heart defect categories
1 Increase pulmonary blood flow
2 Decrease pulmonary blood flow
3 Obstruct blood flow
Heart defect categories:
dextro-Transposition of the Great Arteries (d-TGA)
= Decrease pulmonary blood flow
= 1st trimester: TPMA now TAMP
Systems flip flopped
Block Blood flow defects:
= Coarctation of the Aorta,
Pulmonary & Aortic Stenosis
Truncus Arteriosus,
Hypoplastic Left Heart Syndrome
Heart defect categories”
Levo-Transposition of the Great Arteries (l-TGA)
= Decrease pulmonary blood flow
L&RV on wrong side
Heart defect categories
Coarctation of the Aorta:
= Block blood flow
= Narrowinfg of aorta Commonly ductus arterioous most common site, Increased after load & LVF,
Heart defect categories
Pulmonary Stenosis
= Block blood flow
Pulmonary Stenosis: less oxygenation & bad compliance
Heart defect categories
Aortic Stenosis
= Block blood flow
Aortic Stenosis: Less perfusion
Heart defect categories:
Truncus Arteriosus :
=Block blood flow
= Aorta & pulmonic artery become one
< blood to aourta >pulmonic
Heart defect categories
Hypoplastic Left Heart Syndrome:
=Block blood flow
= No area for Preload from too much tissue
Heart defect categories
=Block blood flow, Decreased & Increased Pulmonic Flow,
Heart defect category:
VSD:
=Increase pulmonic blood flow (decreased peripheral systemic flow)
= amino acids got wrong blueprint, L>R shunt, increases vol to RV & hypertrophy, Less in LV & CO b/c shunt, 2nd most common
Heart defect category:
Patent Ductus Arteriosus (PDA)
=Increase pulmonic blood flow (decreased peripheral systemic flow)
= DOESNT CLOSE, back into lungs hyperperfuse, <peripherial, Rales
Heart defect category:
ASD:
= Increase pulmonic blood flow (decreased peripheral systemic flow)
= Patent forman ovale L>R shunt, increases vol to RV & hypertrophy, Less in LV & CO b/c shunt, most common
How do you properly immobilize a pediatric trauma patient?
Place a folded towel or padding under the shoulders to align the head with the body due to larger occiput.
Pedi Uncuffed ETT form:
Pedi Cuffed ETT form:
= (Age in years ÷ 4) + 4.
= (Age in years ÷ 4) + 3.5
hypervent/ for Child w/ brainstem herniation
hypervent/ for Infant w/ brainstem herniation
ETCO2 target:
= 30 breathes a min (>1yr)
= 35 breathes a min (1mth to 1yr)
= ETCO2 target should be 35 mmHg
hypoglycemic with PEDIs trick:
hypoglycemia Rx for neonate:
hypoglycemia Rx for infant:
= Lots of sick kids hypoglycemic so use bone marrow for BGL
= <45BGL neonate
= <60BGL infant
Hypoplastic Left Heart Syndrome (HLHS)
Underdeveloped left heart structures, requires early surgical intervention
Increase pulmonic blood flow (decreased peripheral systemic flow)
=ASD Patent forman ovale, VSD, Patent Ductus Arteriosus (PDA)
Maternal Narcotic Use & Neonates
Causes neonatal abstinence syndrome (NAS) with tremors, irritability, poor feeding
Meconium-Stained Amniotic Fluid
Can cause aspiration syndrome; suctioning indicated if neonate is non-vigorous
Most Common Congenital Heart Defect
Atriam Septal Defect (VSD)
Neonatal Airway Management
Position airway, suction only if obstruction present, intubate if necessary
Neonatal Bag-Valve-Mask (BVM) Considerations
Use appropriately sized mask, ensure good seal, avoid excessive pressure to prevent barotrauma
Neonatal CPR Indications
HR < 60 bpm despite ventilation & oxygenation
Neonatal CPR Reassessment Timing
Every 30 seconds, check HR, color, respiratory effort
Neonatal Diarrhea Risks
Can cause severe dehydration & electrolyte imbalances, especially in breastfed infants
Neonatal Fever Considerations
> 100.4°F (38.0°C) is concerning; workup for sepsis if present
Neonatal Heart Rate (HR) Ranges
At birth: 150-180 bpm, stabilizes to 130-140 bpm, HR <100 bpm = distress
Neonatal Hypoglycemia Treatment
Dextrose 10% (D10) at 5-10 mL/kg IV bolus
Neonatal Hypotension Causes
Sepsis, blood loss, adrenal insufficiency, heart defects
Neonatal Hypothermia Treatment
Skin-to-skin contact, radiant warmer, warm IV fluids, prevent heat loss
Neonatal Inverted Resuscitation Pyramid
Focuses on simple interventions first (warm, dry, position, stimulate), then escalate if needed
Neonatal IO Access Indications
Needed if IV access is not possible & urgent meds/fluids required
Neonatal Jaundice
Common due to immature liver; treat severe cases with phototherapy or exchange transfusion
Neonatal Respiratory Rate (RR)
Normal 40-60 breaths/min, abnormal if <30 or >60
Neonatal Resuscitation Medications
Epinephrine (for severe bradycardia/asystole), Dextrose (for hypoglycemia), Volume expanders (for shock/hypovolemia)
Neonatal Sepsis Signs
Lethargy, poor feeding, hypothermia, tachypnea, jaundice, bradycardia or tachycardia
Neonatal Shock Signs
Pale, cool skin, poor capillary refill, weak pulses, lethargy
Neonatal Shock Treatment
Fluid resuscitation (10 mL/kg bolus NS or LR), treat underlying cause
Neonatal Transport Priorities
Maintain airway, control temperature, provide oxygen, monitor glucose, rapid transport to NICU
Neonatal Vomiting Red Flags
Bilious (green) emesis suggests obstruction, dark blood indicates possible GI bleed
Newborn APGAR Score Components
Appearance, Pulse, Grimace, Activity, Respiration (scored 0-2 each, total 10)
Newborn Care Priorities Post-Delivery
Maintain warmth, clear airway, stimulate breathing, assess APGAR, early breastfeeding
Newborn Oxygenation Guidelines
Start with room air for resuscitation unless preterm or persistent cyanosis
PEDI tension pneumo decompression
2nd ICS above 3rd rib midclavicular to decompress
Might have to decompress again
Febrile seizure:
when pyrogen production stops:
Fever hard to differentiate from heatstroke; neuro symptoms may present w/ either Treat:
= fever seizure with kid & cool down
= Hypothalamic thermostat will reset to normal
= for heatstroke if you are unsure which it is * If child history of febrile seizures, treat for fever.
Signs of Neonatal Hypoxia
Cyanosis, nasal flaring, grunting, tachypnea, bradycardia
Signs of Respiratory Distress in Newborns
Nasal flaring, grunting, retractions, cyanosis, tachypnea
Stages of Labor & Delivery
1st (contractions to full dilation), 2nd (delivery of baby), 3rd (delivery of placenta)
Suction form:
How to estimate weight:
= 2 x ETT
= (Age x 3) + 7 = Approximate weight in kg
Heart defect categories
Tetralogy of Fallot (TOF):
=Decrease pulmonary blood flow
= 4 dif/ defects, also commonly have other defects
4: pulmonic valve stenosis, VSD, overriding aorta (over VSD), RV hypertrophy
Blue membranes/babies “Tet Spell” & pump legs into ABDMN or kid squat to increase after load pressure (hang NORepi to increase pulmonic afterload pressure)
Thermoregulation in Newborns
Prevent cold stress (hypothermia leads to hypoxia & acidosis), use skin-to-skin, warm blankets, radiant warmer
Umbilical Cord Clamping Timing
Clamp & cut 30-45 seconds after birth, inspect for continued bleeding
Umbilical Vein Cannulation Indications
Emergency venous access in neonatal resuscitation, fluid resuscitation
Until what age is a pediatric patient classified as a ‘neonate’?
1 month.
What 3 shunts are involved in the fetal circulation?
Ductus Venosus (later lig terez), Foramen Ovale (septum prinium), Ductus Arteriosus
pediatric spine w/ head/neack trauma)
Positive:
Negative:
= no hard aduld discs
Positive: no intervertebral discs so more room for m-nt
Negative: More prone to invisible disc injuries (SCIWORA)
What are the causes of neonatal seizures?
Causes include hypoxia, hypoglycemia, sepsis, meningitis, drug withdrawal.
What are the characteristics of Pierre Robin Syndrome?
Small jaw, large tongue, cleft palate, leading to airway obstruction
What are the components of Tetralogy of Fallot (TOF)?
Pulmonary stenosis, Right ventricular hypertrophy, Overriding aorta, VSD.
What are the definitions of Newborn, Neonate, and Infant?
Newborn: birth till a few hours old; Neonate: few hours till 1 month; Infant: 1 month till 1 year
Newborn def
birth till a few hours old
Neonate def
few hours till 1 month
Infant def
1 month till 1 year)
What are the effects of maternal narcotic use?
Causes low birth weight, neonatal withdrawal symptoms, risk of respiratory depression.
What are the fetal circulatory shunts?
Ductus Venosus, Foramen Ovale, Ductus Arteriosus
What are the guidelines for neonatal transport?
Position newborn on side to prevent aspiration, maintain temperature, control O2, ventilate if needed.
What are the mechanisms of heat loss in newborns?
Evaporation (fluid loss), Convection (air currents), Conduction (contact with cold surface), Radiation (heat transfer to surroundings).
What are the mechanisms of heat loss in newborns?
Evaporation (fluid loss), Convection (air currents), Conduction (contact w/ cold surface), Radiation (heat transfer to surroundings)
What are the normal newborn vitals?
RR: 40-60 bpm,
HR birth: 150-180 bpm & after birth: 130-140 bpm
HR < 100 bpm = distress
What are the stages of delivery?
1st: labor onset to full dilation; 2nd: delivery of neonate; 3rd: delivery of placenta.
What are the stages of delivery?
1st (labor onset to full dilation), 2nd (delivery of neonate), 3rd (delivery of placenta)
What are the steps in newborn resuscitation?
Dry, warm, position, stimulate; if HR < 100, positive pressure ventilation (PPV); if HR < 60, CPR (3:1 compressions-to-ventilation ratio)
What are the types of Congenital Heart Defects?
Increased pulmonary blood flow, Decreased pulmonary blood flow, Obstructed blood flow
What blood glucose level in a newborn is considered hypoglycemia?
Less than 45 mg/dL.
What does the APGAR score assess?
Appearance (color), Pulse (HR), Grimace (reflex), Activity (muscle tone), Respiration (effort); scored at 1 & 5 minutes
What does the term ‘newborn’ or ‘newly born infant’ refer to?
A baby during the first few hours of life.
What illustrates the correct fluid replacement therapy for a newborn suspected of being in hypovolemic shock?
10 mL’s/kg of normal saline or lactated ringers.
What is a Diaphragmatic Hernia?
Abnormal opening in diaphragm, requires proper positioning and respiratory support.
Diaphragmatic Hernia happens where
Bochdalek (weak spot on LL of diaphragm)
What is a Ventricular Septal Defect (VSD)?
Hole in ventricular septum, leading to left-to-right shunt, common congenital defect.
What is a Ventricular Septal Defect (VSD)?
Hole in ventricular septum, leading to left-to-right shunt, common congenital defect
What is an Atrial Septal Defect (ASD)?
Hole in atrial septum, causing left-to-right shunt, increasing pulmonary blood flow.
What is an Atrial Septal Defect (ASD)?
Hole in atrial septum, causing left-to-right shunt, increasing pulmonary blood flow
What is Coarctation of Aorta?
Narrowing of aorta, leading to high BP before constriction and low BP after.
What is Coarctation of Aorta?
Narrowing of aorta, leading to high BP before constriction & low BP after
What is common in the newborn’s skin color immediately after birth?
Cyanosis of the extremities is common, but central cyanosis is abnormal.
What is hypoglycemia in newborns?
BG < 40 mg/dL, treated with D10 (5-10 mL/kg).
What is hypoglycemia in newborns?
BG < 40 mg/dL, treated w/ D10 (5-10 mL/kg)
What is hypovolemia in newborns?
Leading cause of neonatal shock; results from dehydration, hemorrhage, third-spacing.
What is hypovolemia in newborns?
Leading cause of neonatal shock; results from dehydration, hemorrhage, third-spacing
What is Patent Ductus Arteriosus (PDA)?
Ductus arteriosus fails to close, leading to abnormal blood flow between aorta and pulmonary artery.
What is Patent Ductus Arteriosus (PDA)?
Ductus arteriosus fails to close, leading to abnormal blood flow between aorta & pulmonary artery
What is Pierre Robin Syndrome?
Small jaw, large tongue, cleft palate, leading to airway obstruction.
What is the APGAR score for an infant with the following: Appearance = completely cyanotic, Pulse = below 100, Grimace = frowns when stimulated, Activity = limp, Respiration = slow, irregular?
3.
What is the APGAR score for an infant with the following: Appearance = completely pink, Pulse = over 100, Grimace = crying, Activity = some flexion, Respiration = strong cry?
9.
What is the APGAR Score?
Appearance (color), Pulse (HR), Grimace (reflex), Activity (muscle tone), Respiration (effort); scored at 1 & 5 minutes.
What is the breathing assistance needed for neonates?
Most neonates breathe spontaneously; some need assistance, few require extensive resuscitation, and meds are rarely indicated.
What is the definition of a premature newborn?
An infant born before 38 weeks gestation.
Omphalocele
abdominal contents protrude through umbilicus, covered by sac;
Gastroschisis?
“Hole for gas” (intestines protrude w/o covering)
What is the difference between Primary and Secondary Apnea?
Primary: brief apnea with bradycardia, responds to stimulation; Secondary: prolonged apnea requiring resuscitation.
What is the leading type of shock in newborns and all pediatric patients?
Hypovolemia.
What is the most common cause of bradycardia in the newborn?
Hypoxia.
What is the most common factor causing respiratory distress and cyanosis in the newborn?
Prematurity.
What is the most effective initial treatment for bradycardia in the newborn?
Oxygen.
What is the neonatal CPR technique?
3:1 compression-ventilation ratio, 120 bpm rate, Two-thumb technique, Depth: 1/3 AP diameter.
What is the neonatal CPR technique?
3:1 compression-ventilation ratio, 120 bpm rate, Two-thumb technique, Depth: 1/3 AP diameter
What is the procedure for Umbilical Vein Cannulation?
Trim cord to 1 cm, insert 5-Fr catheter into umbilical vein, secure with umbilical tape.
What is the procedure for umbilical vein cannulation?
Trim cord to 1 cm, insert 5-Fr catheter into umbilical vein, secure w/ umbilical tape
fluid replacement for PEDI trauma PT form:
Best way to rapidly admin fluids:
hypoglycemic with PEDIs trick:
hypoglycemia Rx for neonate:
hypoglycemia Rx for infant:
= give 20 cc/kg NS/LR even if BP norm, repeat bolus if HR, LOC, CR & other signs of systemic perfusion fail to improve.
= 20mL/kG push pull push pull 3way stop cock
What is the typical breathing assistance needed for neonates?
Most neonates breathe spontaneously, some need assistance, few require extensive resuscitation, and meds are rarely indicated.
What is Transposition of the Great Arteries (TGA)?
Aorta and pulmonary artery switched, requiring immediate intervention.
What is Transposition of the Great Arteries (TGA)?
Aorta & pulmonary artery switched, requiring immediate intervention
leg pumping
What problem is suspected in an infant with severe respiratory distress and central cyanosis unresponsive to bag-valve-mask ventilation?
Diaphragmatic hernia.
What should a newborn’s heart rate normally be at birth?
150–180 at birth, slowing to 130–140 thereafter.
What should a normal newborn’s respiratory rate average?
40–60 breaths per minute.
What should the presence of a fever in a neonate be considered?
A sign of meningitis or another life-threatening infection until proven otherwise.
What should you do if a newborn is very limp with central cyanosis and no apparent respiratory effort?
Begin resuscitation immediately.
Where do most spinal injuries occur at for pediatric patients?
C2 (phrenic nerve)
Which congenital defect is considered the most common?
Atrial Septal Defect (ASD).
posterior fontanelle usually closes
anterior fontanelle closes
= in 2 or 3 months
= between 9 and 18 months
Moro reflex/“startle reflex,” reflex
When startled, babies throw their arms wide, spreading their fingers and then grabbing instinctively with the arms and fingers. The reflex should be brisk and symmetrical. An asymmetric Moro reflex (in which one arm does not respond exactly like the other) can imply a paralysis or weakness on one side of the body.
Newborn Tidal volume & Dead Space
Tidal volume is 5 to 7 mL/kg w/ 3mL/kg dead Space
Premature infant) ETT Size:
Type:
Depth of ETT Insertion:
Laryngoscope Blade Size:
2.5–3.0
Uncuffed
8.0 cm
0 straight
Full-term Newborn)ETT Size:
Type:
Depth of ETT Insertion:
Laryngoscope Blade Size:
3.0–3.5
Uncuffed
8.0–9.5 cm
1 straight
Infant to 1 year)ETT Size:
Type:
Depth of ETT Insertion:
Laryngoscope Blade Size:
3.5–4.0
Uncuffed
9.5–11.0 cm
1 straight
Diagphram herniation takes place most often in
he posterolateral segments of the diaphragm, and most commonly (90 percent) on the left side. The defect is caused by the failure of the pleuroperitoneal canal (foramen of Bochdalek) to close completely
