ITE Peds 1 Flashcards
Preterm Infants who ingest cow milk (not formula or breast) before the age of ____ are at increased risk of _____.
12 months
Iron deficiency anemia
*infants age 6 mo - 3 yrs have high iron requirements d/t increased growth
Progress for treatment of iron deficiency can be tracked with ______
reticulocyte count
If a pt has a patent ductus arteriosus (PDA) and low pulmonary vascular resistance, blood will preferentially travel to the ____, and overtime, result in ______
lungs
- large diastolic run off from aorta to pulmonary artery
Congestive heart failure
Blood enters the fetus via the ______, then passes ____, unless it bypasses it via the _____ to the IVC
single umbilical vein
through the liver
ductus venosus
In the fetus, pulmonary vascular resistance is (higher/lower) than systemic vascular resistance.
higher
- very small fraction of blood flow enters the pulmonary tree, and majority enters the aorta via ductus arteriosus
Both the ________ and _______ are present in the fetus to shunt blood systemically away from the pulmonary bed since the lungs serve no major function.
Ductus arteriosus (PDA) and foramen ovale
_____% of adults have a patent foramen ovale
25-30%
- Decrease in PVR
- Increase in SVR
- Increase in PaO2 > 50 mmHg
- Normocarbia
All result in (Opening/Closure) of the ductus arteriosus
Closure
- PaO2 >50 mmHg causes arterial sm of the ductus to contract)
Indomethacin is a ______ inhibitor and therefore inhibit prostaglandin synthesis.
nonselective cyclooxygenase (COX) inhibitor
In certain cyanotic heart lesions, ________ can help keep PDA open for survival and prevent hypoxemia
PGE1, alprostadil
Examples of cyanotic heart lesions leading to impaired pulmonary blood flow
- Pulmonary atresia
- Critical pulmonary stenosis
- Transposition of the great arteries
- Severe subpulmonic stenosis with VSD
- TOF
These are special and require__________
keep PDA open with PGE1 for survival and prevent hypoxemia
Congenital heart disease pearl:
What does not see flow, will not grow
- inadequate or absent blood flow = impaired growth of heart structures
Physiological anemia of the newborn typically occurs at age ____ at a value of ___ g/dL.
8-12 weeks of age
11 g/dL
Does not require treatment!
Anemia occuring at 4-8 weeks of age is most likely d/t _______
anemia of prematurity or hemolytic anemias
Anemia occuring at 12-16 weeks of age is most likely _______
not physiologic and needs to be further evaluated.
Spinal anesthesia (subsarachnoid space) in infants. - How is the onset of action and duration of action different?
More rapid onset
Shorter duration of action
d/t higher Cardiac output, highly vascular pia matter, and loose myelination that provides little barrier for drug diffusion across spinal cord
How does the intrathecal space and CSF pressure differ in infants vs adults?
narrower intrathecal space
decreased CSF pressure
Spinal cord infants terminate at ____ until 2 years of age
L3
How common is hypotension and bradycardia infants during spinal?
Rare
- d/t compensatory vagal responses
- Immature SNS
CSF volume in:
- Neonates
- Infants
- Children
- Adults
- Neonates: 10 mL/kg
- Infants: 4 mL/kg
- Children: 3 mL/kg
- Adults: 2 mL/kg
How does a high spinal manifest in infants?
Apnea
- lack of thoracic kyphosis leads to increased cephalad spread of LA
*NOT CV collapse
Estimated blood volume: Premature infant Full term newborn Infant (3-12mo) Child (1-12 yrs) Adult male Adult female
Premature infant: 100 ml/kg Full term newborn: 90 mL/kg Infant (3-12mo): 80 mL/kg Child (1-12 yrs): 75 mL/kg Adult male: 70 mL/kg Adult female: 65 mL/kg
Which congenital heart disorder is common in pts with pectus excavatum?
Mitral valve prolapse
- RV outflow tract obstruction
Most common side effect of succinylcholine in pediatric pt that it should be expected?
Bradycardia
- succ is 2 ACh molecules chemically linked, and can activate muscarinic receptors in sinus node
- pretreat with atropine (muscarinic antagonist) if pt < 1 y.o