Chapter 14 - Neonates

Question 1

Based on weight, list the suggested ETT tube diameters.

What formula can be used to estimate correct depth?

Answer 1

<1kg - 2.5mm

1-2kg - 3mm

2-3kg - 3.5mm

>3kg - 4.0mm

Wt (kg) + 6cm, OR

Tube size (mm) x 3

Question 2

What are the five broad categories of processes than can results in neonatal hypoxia?

How does the breathing pattern change between these groups?

Answer 2

Upper Airway Malformation

Congenital Heart Disease

Lung Disease

CNS Pathology

Other

Cardiac disease generally causes tachypnea without grunting or retractions.

CNS and Other groups with often present with slow, shallow resps.

Pulmonary/Airway should appear to be more ‘typical’ respiratory distress.

Question 3

List 4 congenital upper airway malformations.

Answer 3

Choanal atresia (nassage passage blocked by bony or soft tissue)

Laryngeal web

Tracheal stenosis

Pierre-Robin syndrome (cleft palate, retrognathia (abnormal positioning of the jaw or maxilla) and glossoptosis (airway obstruction caused by backwards displacement of the tongue base)

Question 4

List congenital heart diseases causing hypoxia

Answer 4

Total anomolous pumlonary venous return

Truncus arteriosus

Transposition of the great vessels

Tricuspid atresia

Aortic coarctation

Pulmonary atresia

Hypoplastic left heart syndrome

Primary pulmonary hypertension

Question 5

What are congential pulmonary diseases that manifest in neonatal hypoxia?

Answer 5

Diaphragmatic hernia

Lobar emphysema

Pulmonary hypoplasia

*Also acquired causes*

Question 6

What are metabolic/other causes of neonatal hypoxia?

Answer 6

Sepsis

Hypoglycemia

Polycythemia

Met-hemoglobinemia

Question 7

Describe the hyperoxia test.

Answer 7

Set FiO2 to 1.0

Wait 5 minutes.

If PaO2 increases to >100 or by 20mmHg suggests pulmonary problem.

If <100/no increase suggests right to left shunting is occuring.

Question 8

What is the preferred type and rate of maintenance fluids in the neonate?

Answer 8

D10W @ 3.3 mL/kg/hr

Question 9

What is the dose of PGE1?

When should it be given?

Answer 9

Give if suspicous of CHD.

Dose is 0.05-0.1 mcg/kg/min infusion.

Question 10

What are the treatment options for a neonatal pneumothorax?

Answer 10

1. Observe with FiO2 1.0 (small, nontension)
2. Aspirate with 18-20Ga angiocatheter in 4th intercostal space of mid axillary line, a three way stopcock, and a 10-20mL syringle.
3. Placement of a 10-12F chest tube or 8.5F pigtail catheter.

Question 11

What is the dose for dextrose for a symptomatic hypoglycemic neonate?

Answer 11

2mL/kg D10W IV

Question 12

How does a congenital diaphragmatic hernia present?

Answer 12

Respiratory distress

Seesaw respirations

Scaphoid abdomen

Bowel sounds in thorax

Question 13

What is a gastroschisis?

What is an oomphalocele?

How should these be acutely managed?

Answer 13

Gastroschisis - extrusion of uncovered intestine to left of umbilicus

Oophmalocele - extrusion that is covered by mesentary.

Treat with warm saline gauze and wrap in plastic.

Give D10W @ 3-4mL/kg/hr (ooph) or 6-7ml/kg/hr (gast) due to increased insensible losses.

Cover with abx (amp/gent)

Question 14

What anomalies are TEF associated with?

Answer 14

VACTERL

Vertebral

Anal

Cardiac

TEF

radial/renal

limb

Question 15

How does a TEF present?

Describe acute management.

Answer 15

Excessive oral secretions, unable to pass NG tube.

Treat with reverse trendellenburg, suction esophogeal pouch, NPO, D10W infusion