Boston Children's Questions Flashcards
What are the oxygenation goals for prevention of ROP in neonates?
Maintain SaO2 89 - 94% (paO2 50 - 70 mmHg)
At what age is the nadir of physiologic anemia of infancy in a term infant and what Hgb levels would you expect?
8 - 12 weeks of age (most books say 3 months) with levels Hgb = 9 - 11 g/dL
At what age is the nadir of physiologic anemia of infancy in a premature infant?
3 - 6 weeks of age with levels 6 - 8 g/dL
How does a fetus maintain temperature in utero?
The fetus is dependent on maternal thermoregulation to maintain normal temperature!
What is the blood volume of a fetus in terms of cc/kg?
120 - 160 cc/kg at mid-gestation then decreases as the fetus approaches term
How does fetal myocardium primarily differ from adult myocardium?
Fetal myocardium has a greater proportion of non-contractile elements relying on heart rate to maintain cardiac output.
What physiologic evidence is consistent with the claim that fetuses experience pain?
Fetuses have a physiologic response to painful stimuli resulting in increased cortisol and endorphin levels.
What is a normal fetal heart rate?
120 - 160 bpm
What is the parkland formula?
A formula for calculating fluid resuscitation in burn victims. Specifically: (4cc)*(patient_weight_in_kg)*(percent_BSA_burned) = cc_to_be_given_over_24_hours First 8 hours = 1/2 total fluid Next 16 hours = the other 1/2 of fluid
How does the “rule of nines” for calculating burn BSA differ between children and adults?
The primary differences are 1) that an adults face = 9% while a child’s face = 18% 2) each adult leg counts for 18% while a child’s leg counts for 14%
How will a left to right shunt affect the kinetics of inhaled induciton?
Left to right shunts tend NOT to have appreciable effects on the kinetics of inhaled induction.
How many liters of oxygen and what psi correspond to a full E cylinder of oxygen?
660L at 1900 psi
How are ester group local anesthetics metabolized?
By plasma cholinesterases
How do plasma cholinesterase levels differ in infants as compared to adults?
Under 6 months of age, plasma cholinesterases are half of adult values.
How are amide group local anesthetics metabolized?
By the liver.
Why are neonates and infants at greater risk of local anesthetic systemic toxicity with amide local anesthetics?
Lower levels of albumin and alpha 1 glycoprotein result in higher levels of free local anesthetic and it is this free level that contributes to toxicity.
What is the initial dose of intralipid after starting PALS for local anesthetic systemic toxicity?
1.5cc/kg of 20% intralipid
How and when might hypocalcemia present after thyroidectomy?
12 to 18 hours after surgery as any of the following: 1) inspiratory stridor 2) laryngospasm 3) perioral numbness 4) hypotension
What are the two main causes of stridor after thyroidectomy and when would you expect each to cause stridor?
1) Bilateral recurrent laryngeal nerve paralysis with stridor in the immediate extubation/PACU period 2) Hypocalcemia due to hypoparathyroidism presenting 12 to 18 hours after surgery
What is treacher-collins syndrome and what are the primary anesthetic concerns?
aka Mandibulofacial dysostosis with bilateral 6, 7, 8 craniofacial clefts, hearing loss 1) difficult or impossible BMV 2) High risk for orbital compression in the prone position 3) associated CHD (uncommon) 4) OSA
Name the likely syndrome.
Treacher Collins
What anomalies characterize Pierre Robin sequence?
1) retrognathia
2) glossoptosis (tongue falling to back of throat)
3) Airway obstruction
Pierre Robin sequence is most commonly associated with what syndromes?
Most commonly with Stickler syndrome, characterized by micrognathia, poor vision, and a collagen disorder with hyperflexible joints.
Also associated with velocardiofacial syndrome, fetal alcohol syndrome, and bilateral hemifacial microsomia.
Name the likely syndrome.
Apert syndrome
What is another name for Apert syndrome?
Acrocephalosyndactyly
What are the clinical features of Apert syndrome?
1) Orbital hypertelorism
2) Turribrachycephaly
3) midface hypoplasia
4) CHD in 10% (common e.g., VSD, pulmonary stenosis)
5) fusion of digits 2 to 4
6) fusion of cervical vertebrae
7) MR is common
Name the likely syndrome.
Crouzon syndrome
What are the clinical features of Beckwith-Wiedemann Syndrome?
1) Macrosomia (birthweight > 90%, easily 4kg)
2) macroglossia
3) midline abdominal wall defects (omphalocele, umbilical hernia)
4) visceromegally
5) ear creases or ear pits
6) high risk neonatal hypoglycemia
7) association with Wilm’s tumor
What is Shprintzen syndrome?
Velocardiofacial syndrome with 22q deletion
What is a normal neonatal Hgb?
18 - 19 g/dL
What is neonatal blood volume at birth a function of?
1) Gestational age
2) Timing of umbilical clamping at birth
Immediate clamping = 80cc/kg
Delayed clamping (2 - 3 minutes) increases blood volume by 20 - 40 cc/kg
What are possible benefits of delayed clamping of umbilical cord?
Increased Hct
Increased iron stores
decreased risk of severe anemia
