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PHRM 100 – IMM > IMM 27 and 28: Pediatrics > Flashcards

IMM 27 and 28: Pediatrics Flashcards

1
Q

What is gestational age (GA)?

A

time from the first day of the mother’s last menstrual period to the day of birth

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2
Q

What is post-natal age (PNA)?

A

chronological age – time from birth

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3
Q

What is post-menstrual age (PMA)?

A

gestational age (GA) + post-natal age (PNA)

  • usually used up to 44 weeks
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4
Q

What is corrected age (CA) or corrected gestational age (CGA)?

A

chronological age - number of weeks born before 40 weeks of gestation

  • used only for children up to 3 years old who were born pre-term
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5
Q

How old are premature newborns?

A

< 38 weeks GA

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6
Q

How old are term newborns?

A

> or equal to 38 weeks GA

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7
Q

How old are neonates?

A

0-28 days PNA

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8
Q

How old are infants?

A

1-24 months

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9
Q

How old are young children?

A

2-6 years

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10
Q

How old are children?

A

6-12 years

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10
Q

How old are adolescents?

A

12-19 years

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11
Q

What is the weight at 10 days?

A

lose 5-10% of birth weight

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12
Q

What is the weight at 14 days?

A

back to birth weight, then gain 25-30 g/day

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13
Q

What is the weight at 3 months?

A

gain ~500 g/month (15 g/day

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14
Q

What is the weight at 4-6 months?

A

2x birth weight

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15
Q

What is the weight at 12 months?

A

3x birth weight

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16
Q

What is the weight at > 2 years?

A

gain ~2.25 kg per year

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17
Q

What children are included in WHO Growth Charts?

A
  • healthy, term, singleton
  • no health, environmental, economic constraints on growth
  • willing to follow health and feeding recommendations
  • non-smoking mother
  • breastfed: (a) exclusive or predominant breastfeeding for ≥ 4 months, (b) introduction of complementary foods between 4-6 months, (c) partial breastfeeding to be continued ≥ 12 months
  • routine pediatric health care visits & immunization
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18
Q

What are the strengths of WHO Growth Charts?

A

growth standard vs. growth reference

  • prescriptive, based on healthy children
  • best portrayal of physiological growth (growth standard)
  • consistent with current nutrition recommendations
  • establish breastfed child as model for growth: CDC charts (50% breastfed at all; ~30% breastfed ≥ 3 mo), WHO charts (75% breastfed ≥ 4 mo; 68% partially breastfed ≥ 12 mo)
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19
Q

What is the HR, SBP, and RR of newborns?

A
  • HR: 120-150
  • SBP: 60-70
  • RR: 30-60
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20
Q

What is the HR, SBP, and RR of 6 month olds?

A
  • HR: 120-140
  • SBP: 65-120
  • RR: 25-35
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21
Q

What is the HR, SBP, and RR of 1 year olds?

A
  • HR: 120-140
  • SBP: 70-120
  • RR: 20-30
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22
Q

What is the HR, SBP, and RR of 5 year olds?

A
  • HR: 90-110
  • SBP: 80-125
  • RR: 20-25
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23
Q

What is the HR, SBP, and RR of 15 year olds?

A
  • HR: 60-90
  • SBP: 110-130
  • RR: 12-16
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24
Q

What parts of the brain are developed at birth?

A

all major structures of the brain and cranial nerves

  • blood brain barrier
  • myelination
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25
Q

Myelination

A
  • CNS continues to myelinate during 1st year of life
  • at 1 year, all major nerve tracts are myelinated
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26
Q

Describe brain growth from birth.

A
  • birth brain weighs: 350-450 g
  • adult brain weighs:1.3-1.4 kg
  • 1st year of life brain triples in size
  • 2.5 years brain weighs 0.9-1 kg (75% of adult)
  • 6 years brain weighs 1.2-1.3 kg (90% of adult)
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27
Q

Describe the head.

A

large and weighs more than body

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28
Q

What happens to cranial sutures?

A

use at 16-18 months

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29
Q

What are the developmental milestones of neurological function?

A
  • motor function – gross motor skills, fine motor skills
  • language/speech
  • cognitive – following commands, learning, problem solving, remembering
  • social – connecting and having relationships with others, cooperating, responding to feelings of others
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30
Q

Pulmonary

A
  • limited capacity to increase tidal volume – rib position, rib movement on inspiration (up vs. up and out)
  • chest compliance
  • respiratory muscles – fewer type 1 fibres, small airway muscles not completely developed (response to beta-2 agonists)
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30
Q

How do alveoli and airways change after 8 years old?

A
  • up to 8 years old: alveoli increase in number and size
  • after 8 years: growth in size of alveoli and airways
  • alveolar epithelium and endothelium continue to develop until 10-12 years of life
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31
Q

How does oxygen consumption change from neonates to adults?

A

neonate oxygen consumption is 2x greater than adults

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32
Q

Airway

A

all conducting airways are present at birth

  • number does not change
  • branching pattern does not change
  • airways increase in size and length as growth occurs
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33
Q

Respiration

A
  • diaphragm is chief muscle of respiration until around 6 years old
  • abdominal distension or decreased compliance results in decreased ventilation
  • limited capacity to increase tidal volume, rib position, rib movement on inspiration (up vs. up and out)
34
Q

Describe the work of breathing of neonates vs. adults.

A

neonate 3x greater than adult

35
Q

What type of breathers are infants?

A

obligate nasal breathers

  • breathe and eat
36
Q

What does a small reduction in airway radius (mucus, edema, inflammation) result in?

A

increased resistance to airflow, therefore increased respiratory distress

37
Q

What is cardiac output?

A

CO = HR x SV

38
Q

Describe cardiac output in neonates and infants.

A
  • ↑ heart rate is the most efficient means of ↑ CO
  • less preload reserve
  • relatively fixed SV – limited ability to stretch ventricle, noncompliant and poorly developed left ventricle
39
Q

Cardiovascular

Parasympathetic System

A

fully formed shortly after birth

40
Q

Cardiovascular

Sympathetic System

A

incomplete

  • increased vagal responses
41
Q

Cardiovascular

Cardiac Dysrhythmias

A
  • SVT
  • bradycardia
  • same causes as in adults, except also: congenital heart disease, asphyxia (resulting in hypoxic injury)
42
Q

Cardiovascular

Cardiac Contraction

A
  • neonates have immature sarcomeres
  • are calcium dependent for contractility
43
Q

Cardiovascular

Calcium Chloride

A

used as a vasopressor

44
Q

Cardiovascular

What do we need to be cautious about?

A

calcium channel blockers in neonates

45
Q

Physiological Differences in Myocardium of Neonate vs. Adult

CO

A
  • neonate: HR dependent
  • adult: SV and HR dependent
46
Q

Physiological Differences in Myocardium of Neonate vs. Adult

Contractility

A
  • neonate: reduced
  • adult: normal
47
Q

Physiological Differences in Myocardium of Neonate vs. Adult

Starling Response

A
  • neonate: limited
  • adult: normal
48
Q

Physiological Differences in Myocardium of Neonate vs. Adult

Compliance

A
  • neonate: reduced
  • adult: normal
49
Q

Physiological Differences in Myocardium of Neonate vs. Adult

Afterload Compensation

A
  • neonate: limited
  • adult: effective
50
Q

Physiological Differences in Myocardium of Neonate vs. Adult

Ventricular Interdependence

A
  • neonate: high
  • adult: relatively low
51
Q

Blood Volume of Infants vs. Adults

A
  • infants: 80-90 mL/kg
  • adults: 65-70 mL/kg
52
Q

Circulation

A
  • blood volume relatively larger
  • absolute volume smaller
  • relatively small volumes of blood – significant blood loss (laboratory testing, bleeding)
53
Q

Describe gastric acid production in infancy.

A
  • decreased in infancy
  • adult levels by approximately 2 years of age
54
Q

Describe gastric pH at birth and after.

A
  • at birth: 6-8
  • 24 hours after birth: 1-2
  • after: increases 4-7
55
Q

Describe motility compared to adults.

A
  • irregular, different peristaltic pattern than adults
  • gastric emptying irregular & erratic until 6-8 months old
56
Q

Gastrointestinal

A
  • infants feed frequently
  • infant diet consists of breast milk and/or formula for first 6 months
  • infants have delayed gastric emptying
  • nutrients in stomach majority of time between feedings
  • increased rates of gastroesophageal reflux disease
  • by school age, no difference between adult and child
57
Q

Kidney

A
  • at birth, adult complement of nephrons
  • at birth, 50% of renal cortex
  • tubular length and glomerular size increase with age
  • renal blood flow is 5-10% CO at birth, and 25% CO by 2-4 years of age
58
Q

Renal Function

A
  • decreased at birth – linear development after > 34 weeks PMA
  • GFR increases in first 2 weeks of life
  • tubular secretion: 6-8 months
  • tubular reabsorption matures by 1-2 years
  • decreased ability to concentrate urine – decrease urea, increase tubular length, insensitivity to ADH
59
Q

Urine Output

A
  • neonates: 2-4 mL/kg/h
  • infants and children: 1-2 mL/kg/h
  • adolescents and adults: 0.5-1 mL/kg/h
60
Q

What is normal creatinine (SCr) and urea in newborns?

A
  • SCr: 26-90
  • urea: 1-9
61
Q

What is normal creatinine (SCr) and urea in infants?

A
  • SCr: 17-35
  • urea: 1.4-4
62
Q

What is normal creatinine (SCr) and urea in children?

A
  • SCr: 25-62
  • urea: 1.8-6
63
Q

What is normal creatinine (SCr) and urea in adolescent males?

A
  • SCr: 50-106
  • urea: 2.5-6.5
64
Q

What is normal creatinine (SCr) and urea in adolescent females?

A
  • SCr: 44-97
  • urea: 2.8-7.5
65
Q

How GFR estimated under 2 years old?

A

Schwartz Equation

66
Q

How GFR estimated at 2 years old or greater?

A

modified Schwartz Equation

67
Q

What is normal creatinine clearance (GFR) for age 2-8 days?

A

17-60

68
Q

What is normal creatinine clearance (GFR) for age 4-28 days?

A

26-68

69
Q

What is normal creatinine clearance (GFR) for age 30-90 days?

A

30-86

70
Q

What is normal creatinine clearance (GFR) for age 1-6 months?

A

39-114

71
Q

What is normal creatinine clearance (GFR) for age 6-12 months?

A

49-157

72
Q

What is normal creatinine clearance (GFR) for age 12-24 months?

A

62-191

73
Q

What is normal creatinine clearance (GFR) for age 2-12 years?

A

89-165

74
Q

Metabolic: Thermoregulation

A
  • ↑ body surface area (BSA)
  • ↓ fat stores
  • poor ability to thermoregulate
  • infant cannot shiver to generate heat – need warmers, bundling
75
Q

Metabolic: Blood Glucose

A
  • hypoglycemia
  • neonates: decreased glycogen stores, decreased body fat, high metabolic needs
76
Q

Neonatal and Pediatric Pharmacodynamics

What can development affect?

A

can alter the response to a drug

  • effectiveness
  • toxicity
77
Q

Neonatal and Pediatric Pharmacodynamics

A

less well understood than pharmacokinetics

78
Q

Pediatric Pharmacodynamics

Morphine

A
  • pre-term neonates may have less analgesia
  • neonates more sensitive to respiratory depression
79
Q

Pediatric Pharmacodynamics

Midazolam

A

neonates may be more sensitive

80
Q

Pediatric Pharmacodynamics

Valproic Acid

A

risk of liver toxicity higher in < 2 years old

81
Q

Why should acetylsalicylic acid (ASA) be avoided in children?

A
  • risk of Reye’s Syndrome in children and
    adolescents taking ASA while having a
    viral infection
  • acute non-inflammatory encephalopathy
    with fatty liver failure – serious condition: swelling in liver and brain, resulting in behaviour changes, seizures, death
82
Q

What factors place pediatric patients at increased risk of medication errors?

A

watch lecture

83
Q

What are some factors to consider in selecting a medication for a child?

A

watch lecture

PHRM 100 – IMM (22 decks)

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