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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
What parts of the brain are developed at birth?
all major structures of the brain and cranial nerves - blood brain barrier - myelination
25
Myelination
- CNS continues to myelinate during 1st year of life - at 1 year, all major nerve tracts are myelinated
26
Describe brain growth from birth.
- 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)
27
Describe the head.
large and weighs more than body
28
What happens to cranial sutures?
use at 16-18 months
29
What are the developmental milestones of neurological function?
- 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
30
Pulmonary
- 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)
30
How do alveoli and airways change after 8 years old?
- 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
31
How does oxygen consumption change from neonates to adults?
neonate oxygen consumption is 2x greater than adults
32
Airway
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
33
Respiration
- 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
Describe the work of breathing of neonates vs. adults.
neonate 3x greater than adult
35
What type of breathers are infants?
obligate nasal breathers - breathe and eat
36
What does a small reduction in airway radius (mucus, edema, inflammation) result in?
increased resistance to airflow, therefore increased respiratory distress
37
What is cardiac output?
CO = HR x SV
38
Describe cardiac output in neonates and infants.
- ↑ 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
Cardiovascular Parasympathetic System
fully formed shortly after birth
40
Cardiovascular Sympathetic System
incomplete - increased vagal responses
41
Cardiovascular Cardiac Dysrhythmias
- SVT - bradycardia - same causes as in adults, except also: congenital heart disease, asphyxia (resulting in hypoxic injury)
42
Cardiovascular Cardiac Contraction
- neonates have immature sarcomeres - are calcium dependent for contractility
43
Cardiovascular Calcium Chloride
used as a vasopressor
44
Cardiovascular What do we need to be cautious about?
calcium channel blockers in neonates
45
Physiological Differences in Myocardium of Neonate vs. Adult CO
- neonate: HR dependent - adult: SV and HR dependent
46
Physiological Differences in Myocardium of Neonate vs. Adult Contractility
- neonate: reduced - adult: normal
47
Physiological Differences in Myocardium of Neonate vs. Adult Starling Response
- neonate: limited - adult: normal
48
Physiological Differences in Myocardium of Neonate vs. Adult Compliance
- neonate: reduced - adult: normal
49
Physiological Differences in Myocardium of Neonate vs. Adult Afterload Compensation
- neonate: limited - adult: effective
50
Physiological Differences in Myocardium of Neonate vs. Adult Ventricular Interdependence
- neonate: high - adult: relatively low
51
Blood Volume of Infants vs. Adults
- infants: 80-90 mL/kg - adults: 65-70 mL/kg
52
Circulation
- blood volume relatively larger - absolute volume smaller - relatively small volumes of blood – significant blood loss (laboratory testing, bleeding)
53
Describe gastric acid production in infancy.
- decreased in infancy - adult levels by approximately 2 years of age
54
Describe gastric pH at birth and after.
- at birth: 6-8 - 24 hours after birth: 1-2 - after: increases 4-7
55
Describe motility compared to adults.
- irregular, different peristaltic pattern than adults - gastric emptying irregular & erratic until 6-8 months old
56
Gastrointestinal
- 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
Kidney
- 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
Renal Function
- 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
Urine Output
- neonates: 2-4 mL/kg/h - infants and children: 1-2 mL/kg/h - adolescents and adults: 0.5-1 mL/kg/h
60
What is normal creatinine (SCr) and urea in newborns?
- SCr: 26-90 - urea: 1-9
61
What is normal creatinine (SCr) and urea in infants?
- SCr: 17-35 - urea: 1.4-4
62
What is normal creatinine (SCr) and urea in children?
- SCr: 25-62 - urea: 1.8-6
63
What is normal creatinine (SCr) and urea in adolescent males?
- SCr: 50-106 - urea: 2.5-6.5
64
What is normal creatinine (SCr) and urea in adolescent females?
- SCr: 44-97 - urea: 2.8-7.5
65
How GFR estimated under 2 years old?
Schwartz Equation
66
How GFR estimated at 2 years old or greater?
modified Schwartz Equation
67
What is normal creatinine clearance (GFR) for age 2-8 days?
17-60
68
What is normal creatinine clearance (GFR) for age 4-28 days?
26-68
69
What is normal creatinine clearance (GFR) for age 30-90 days?
30-86
70
What is normal creatinine clearance (GFR) for age 1-6 months?
39-114
71
What is normal creatinine clearance (GFR) for age 6-12 months?
49-157
72
What is normal creatinine clearance (GFR) for age 12-24 months?
62-191
73
What is normal creatinine clearance (GFR) for age 2-12 years?
89-165
74
Metabolic: Thermoregulation
- ↑ body surface area (BSA) - ↓ fat stores - poor ability to thermoregulate - infant cannot shiver to generate heat – need warmers, bundling
75
Metabolic: Blood Glucose
- hypoglycemia - neonates: decreased glycogen stores, decreased body fat, high metabolic needs
76
Neonatal and Pediatric Pharmacodynamics What can development affect?
can alter the response to a drug - effectiveness - toxicity
77
Neonatal and Pediatric Pharmacodynamics
less well understood than pharmacokinetics
78
Pediatric Pharmacodynamics Morphine
- pre-term neonates may have less analgesia - neonates more sensitive to respiratory depression
79
Pediatric Pharmacodynamics Midazolam
neonates may be more sensitive
80
Pediatric Pharmacodynamics Valproic Acid
risk of liver toxicity higher in < 2 years old
81
Why should acetylsalicylic acid (ASA) be avoided in children?
- 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
What factors place pediatric patients at increased risk of medication errors?
watch lecture
83
What are some factors to consider in selecting a medication for a child?
watch lecture

PHRM 100 – IMM (22 decks)

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