Mod IV: Pediatric Hematologic - Renal - Endocrine - Hepatobiliary - GI - Thermoregulation - Central Nervous System

Question 1

_{Hematologic System}

What’s normal Hemoglobin in a healthy newborn?

Answer 1

19g/dl

Question 2

_{Hematologic System}

What’s normal Hemoglobin in premature infant?

Answer 2

13-15g/dl

Question 3

_{Hematologic System}

What percentage of Hemoglobin in newborn and infant is fetal hemoglobin (HgbF)?

Answer 3

70-80%

Question 4

_{Hematologic System}

Why is Neonatal oxyhemoglobin curve shifted to the left?

Answer 4

To increase hemoglobin affinity for O2

Question 5

_{Hematologic System}

Neonatal oxyhemoglobin curve shifted to the left. This increases hemoglobin affinity for O2. What are advantages of this?

Answer 5

Increase ability to uptake O2 from the mother a the placental interface

Question 6

_{Hematologic System}

Neonatal oxyhemoglobin curve is shifted to the left. This increases hemoglobin affinity for O2. What are disadvantages of this?

Answer 6

Decreases the release of O2 to the tissues,

which makes them prone to hypoxemia

Question 7

_{Hematologic System}

The neonatal oxyhemoglobin curve is shifted to the left. This increases hemoglobin affinity for O2. A disadvantage of this is a decrease in the release of O2 to the tissues, which makes them prone to hypoxemia. What is this compensated by?

Answer 7

Increase in CO

Higher Hgb levels

Increase in blood volume per kg, as compared to an adult

Question 8

_{Hematologic System}

What is the P50 of HgbF?

Answer 8

18-20

_{<em>(What’s P50?)!!!!</em>}

Question 9

_{Hematologic System}

What’s P50 of hemoglobin? What’s normal P50?

Answer 9

The P50 of hgb is the oxygen tension at which hemoglobin is 50% saturated

The normal P50 is 26.7 mm Hg

Question 10

_{Hematologic System}

What’s the mormal P50 for adult Hgb?

Answer 10

27 mmHg

Question 11

_{Hematologic System}

When does the fetal hemoglobin phenomenom disappear?

Answer 11

In first few weeks

with physiologic anemia occurring at 2-3 months

Question 12

_{Hematologic System}

When does Physiologic anemia occur?

Answer 12

Physiologic anemia occurring at 2-3 months

Question 13

_{Hematologic System}

How does Physiologic anemia (@ 2-3 mo) manifest?

Answer 13

Hgb falls to normal levels of 10-11 g/dl

Hgb remains at physiologic anemia levels until early teens

Question 14

_{Oxygen-Hemoglobin Equilibrium}

Newborn have a high concentration of HgbF (70-80%). How does newborn Hgb affinity to O2 compare to adult Hgb affinity to O2?

Answer 14

New born Hgb affinity to O2 (P50 of 18-20) is higher than adult Hgb affinity to O2 (P50 of 27)

Question 15

_{Oxygen-Hemoglobin Equilibrium}

How does higher Hgb affinity to O2 affect the Oxygen-Hemoglobin dissociation curve?

Answer 15

Shifts the Oxygen-Hemoglobin dissociation curve to the left

Question 16

_{Oxygen-Hemoglobin Equilibrium}

At what age is HgbF replaced by adult Hgb?

Answer 16

During the first 3 months of life, and

the P50 then equals that of adults

Question 17

_{Oxygen-Hemoglobin Equilibrium}

At what age does the P50 reaches its peak? What’s peak values of P50? How long does P50 remains at peak?

Answer 17

By 9 months of age,

the P50 reaches its peak of 29-30mmHg

where it remains until puberty

Question 18

_{Oxygen-Hemoglobin Equilibrium}

During which developmental period is O2 delivery enhanced?

Answer 18

During the busiest growth period of the pediatric pt’s life

Question 19

_{Renal Function}

T/F: The concentrating capacity of an infant’s kidney is less than that of an adult

Answer 19

True

Question 20

_{Renal Function}

In response to water depravation, what can the kidneys of a term infant do?

Answer 20

Increase the osmolarity of urine to a maximum of

600-700 mOsm/kg

Question 21

_{Renal Function}

In response to water depravation, the kidneys of a term infant can increase the osmolarity of urine to a maximum of

Answer 21

600-700 mOsm/kg

Question 22

_{Renal Function}

In response to water depravation, the kidneys of a term infant can increase the osmolarity of urine to a maximum of 600-700 mOsm/kg. In contrast, maximum urine osmolality in adults is:

Answer 22

1200 mOsm/kg

Question 23

_{Renal Function}

Variations in the release of which hormone regulates the osmolality of the extracellular fluid?

Answer 23

Variations in the release of AntiDiuretic Hormone (ADH) regulates the osmolality of the extracellular fluid

Question 24

_{Renal Function}

T/F: Although dehydrated newborns cannot concentrate urine as efficicently as adults can, free water clearance is greater in infants than adults

Answer 24

True

Question 25

_{Renal Function} After a free water load, infants can excrete a markedly diluted urine of up to

Answer 25

**50** mOsm/kg

Question 26

_{Renal Function} After a free water load, infants can excrete a markedly diluted urine of up to 50 mOsm/kg. In contrast the maximally diluted urine an adult can produce is:

Answer 26

**70-100** mOsm/kg This leads to impaired ability to handle a water load and clear drugs

Question 27

_{Renal Function} Overall, how is GFR?

Answer 27

Overall, there is a ↓ GFR GFR is 15-30% of normal adult value

Question 28

_{Renal Function} By 1 month, how is GFR changed? At what age is the adult GFR reached?

Answer 28

GFR becomes **70% of mature GFR** by 1mos And the Adult GFR value is reached by **1yr**

Question 29

_{Renal Function} Why is there ineffective concentrating ability until 6-12 mos

Answer 29

**Limited renal tubular function** Resulting in ineffective concentrating ability until 6-12 mos

Question 30

_{Renal Function} What's the cause of the Limited renal tubular function that results in ineffective concentrating ability until 6-12 mos?

Answer 30

**Hypotonicity** of the _adrenal medulla_

Question 31

_{Renal Function} Why do they have normal “acidosis”?

Answer 31

**Decreased reabsorptive function** **Loss HCO3** = which leads them to having a *normal “acidosis”*

Question 32

_{Renal Function} Why are they prone to hyponatremia/hypovolemia?

Answer 32

**Decreased reabsorptive function** Makes them **Obligated Na+ losers** = which makes them prone to hyponatremia/hypovolemia This is why **IVF should contain Na+**

Question 33

_{Renal Function} What's the Net renal function effect?

Answer 33

Impaired ability to handle (hold on to) a saline & water load ^{(They will not reabsorb it! or they will just loose it!!!)} This affects the **Renal clearance** of drugs This also affects how **drug metabolites** are diminished

Question 34

_{Endocrine System} With the endocrine system, what do we monitor?

Answer 34

Hypoglycemia

Question 35

_{Endocrine System} How is Hypoglycemia defined for older children?

Answer 35

BG \< 40 mg/dl

Question 36

_{Endocrine System} How is Hypoglycemia defined for neonates?

Answer 36

BG \< 30 mg/dl

Question 37

_{Endocrine System} Why are Premature infants at greatest risk for Hypoglycemia?

Answer 37

**Small** for gestational age Infants of **diabetic mothers**

Question 38

_{Endocrine System} Why are Infants of diabetic mothers at greatest risk for Hypoglycemia?

Answer 38

B/c they have been **Exposed** to ↑ levels maternal glucose throughout the pregnacy With that, they have an **automatic response** which is to **↑** their levels of **insulin**

Question 39

_{Endocrine System} T/F: **Hypocalcemia** is common in premature neonates and small for gestational age infants

Answer 39

True

Question 40

_{Endocrine System} Hypocalcemia is common in premature neonates and small for gestational age infants. What are the causes of this phenomenom?

Answer 40

Decreased stores Lack of exogenous supply Parathyroid immaturity Inadequate vitamin D stores Asphyxiation Offspring DM Transfused with citrated blood

Question 41

_{Endocrine System} Why are infants predisposed to **hypocalcemic hypotension**?

Answer 41

Myocardial contractility more dependent on **extracellular Ca²⁺** due to **immature myocardial sarcoplasmic reticulum**

Question 42

_{Hepatobiliary System} Why may drugs metabolized by P-450 system have a prolonged half-lives?

Answer 42

**Liver enzyme systems** are **immature** in the infant Particularly those involved in phase II (conjugation) reactions

Question 43

_{Hepatobiliary System} Why do you need to know which drugs you are administering that are highly protein bound?

Answer 43

Infants also have ↓plasma albumin levels at birth This results in ↓ protein binding of some drugs You must know the Pharmacologicals effect of ↓ protein binding of some drugs

Question 44

_{Gastrointestinal System} Why is there a higher incidence gastric reflux?

Answer 44

Incompetent LES Prolonged gastric emptying Uncoordinated swallowing/respiration until 4-5mos Upper abdominal disorders, which causes vomiting Lower abdominal disorders, which causes abdominal distention (failure to pass meconium)

Question 45

_{Gastrointestinal System} Uncoordinated swallowing/respiration until how old?

Answer 45

4-5mos

Question 46

_{Gastrointestinal System} Upper abdominal disorders, which causes

Answer 46

Vomiting

Question 47

_{Gastrointestinal System} Lower abdominal disorders, which causes

Answer 47

Abdominal distention (failure to pass meconium)

Question 48

_{Gastrointestinal System} What's infant Gastric pH immediately after birth?

Answer 48

Alkalotic

Question 49

_{Gastrointestinal System} When does infant Gastric pH reaches Normal adult range?

Answer 49

by **2nd day** life

Question 50

_{Thermoregulation} Infants are Highly susceptible to hypothermia, why?

Answer 50

Large **BSA** to weight ratio Thin layers of **insulating fat** Increased **metabolic rate** Limited stores of **brown fat** Poor central **thermoregulation**

Question 51

_{Thermoregulation} Why can't infants compensate for cold by shivering?

Answer 51

**Central thermoregulation is** poor

Question 52

_{Thermoregulation} What's the Principle method of heat production for infants/newborns

Answer 52

**Nonshivering thermogenesis** or **Brown fat** metabolism

Question 53

_{Thermoregulation} T/F: The metabolism of Brown fat is severely limited in the premature infant and sick neonate

Answer 53

True

Question 54

_{Thermoregulation} T/F: (Inaudible) anesthetic inhibits thermogenesis and brown adipocytes

Answer 54

True

Question 55

_{Thermoregulation} Where is Brown fat is stored?

Answer 55

Intrascapulary space Around large vessels In the neck Around the sternum Around the kidneys and the adrenals

Question 56

_{Thermoregulation} T/F: Cool temperatures and anesthetic agents can convert newborns/infants to poikilotherm

Answer 56

True...

Question 57

_{Thermoregulation} What's a poikilotherm?

Answer 57

An organism that cannot regulate its body temperature except by behavioral means such as basking or burrowing

Question 58

_{Thermoregulation} How we can reduce heat loss in these pts?

Answer 58

By limiting temperature gradient between patient & environment

Question 59

_{Thermoregulation} What are the routes of heat loss?

Answer 59

Radiation Conduction Evaporation

Question 60

_{Thermoregulation} Via which route do infants lose most of their heat?

Answer 60

Radiation

Question 61

_{Thermoregulation} How do you reduce heat loss via radiation (route infants lose most of their heat)?

Answer 61

Warm OR to 28-30 C Double-shelled Isolette for transport Radiant warmer

Question 62

_{Thermoregulation} How do you reduce heat loss via Conduction?

Answer 62

Place infant on warming mattress

Question 63

_{Thermoregulation} How do you reduce heat loss via Evaporation?

Answer 63

Humidified gases Warm fluids Warm-air blankets

Question 64

_{Central Nervous System} The Brain represents what proportion of the body weight?

Answer 64

Brain is **1/10th** of the body weight

Question 65

_{Central Nervous System - Spinal cord development} In the Embryo, the spinal cord occupies:

Answer 65

Entire spinal canal

Question 66

_{Central Nervous System - Spinal cord development} At birth where is the lower end of cord?

Answer 66

At L3 level

Question 67

_{Central Nervous System - Spinal cord development} By 1 year of age, where is the end of the cord?

Answer 67

At the level of L1 (adult level)

Question 68

_{Central Nervous System - Spinal cord development} As vertebral column grows, spinal nerve roots are drawn into spinal canal. Which structure emerges from this?

Answer 68

**Cauda equina**

Question 69

_{Central Nervous System - Spinal cord development} Why is testing primitive reflexes (Moro, grasp, Babinski) a useful tool when assessing neuronal development?

Answer 69

Primitive reflexes (Moro, grasp, Babinski) **should disappea**r as _myelination_ occurs

Question 70

_{Central Nervous System - Spinal cord development} When do Primitive reflexes (Moro, grasp, Babinski) disappear? Why?

Answer 70

Primitive reflexes (Moro, grasp, Babinski) disappear as myelination occurs Myelination is not complete until **3rd year** of life