Neo/Paeds vs Adults

Question 1

gestational age

Answer 1

term: 37-42 weeks
early term: 37-39 weeks
late term: 41-42 weeks
post term: >42 weeks
extreme preterm: 22-25 weeks
very preterm: 26-33 weeks
late preterm: 34-37 weeks

Question 1

normal vitals at birth (term)

Answer 1

RR: 30-60
BP: 75/50 (MAP 60)
HR: 120-170

Question 2

thoracic anatomy & impact

Answer 2

neonate
- circular chest with horizontal ribs leading to decreased bucket handle effect; weak intercostals/more compliant chest wall so rely more on diaphragm, but diaphragm more flattened leading to decreased diaphragmatic excursion

Question 3

upper airway anatomy

Answer 3

neonate
- smaller mouth/mandible/nose, narrow nostrils, large tongue, long uvula, large omega shaped epiglottis
- all structures narrower making obstruction (i.e. edema) more profound
- thinner mucosa
- larynx higher in neck and cone shaped, cricoid ring narrowest portion
- vocal chords higher at C3-C4

Question 4

lower airway anatomy

Answer 4

• shorter, narrower, softer/collapsible, incomplete trachea
• less number of airways and alveoli = lower FRC/alveolar surface area
• risk of mucous plugging in narrow airways
• angle of mainstem bronchi more equal

Question 5

implications for intubation of neonate

Answer 5

1. short neck and large head/occiput
   - do shoulder roll
2. high larynx at C3
   - be mindful about depth of insertion
3. cricoid ring is narrowest part
   - use cuff less ETT
4. large tongue, large/wide/omega shaped epiglottis
   - use miller blade
5. vocal chords slant anteriorly
   - use BURP
6. mainstem angles more equal
   - careful of endobronchial intubation or aspiration

Question 6

reasons why babies get hypoxic easier than adults

Answer 6

1. metabolic rate/o2 consumption
   - very high (2x adults)
2. lungs
   - smaller lungs
   - frequency and duration of apnea spells
   - fewer alveoli
   - higher airway resistance
   - minute ventilation compensation relies more on RR
   - deadspace is high in the infant
3. nervous system
   - hypoxia causes bradycardia as first response
   - brain is easily sedated
4. cardiac
   - CO rate dependent vs stroke volume
   - bradycardia produces hypotension
   - hypovolemia easily produces shock, decreased perfusion, and hypoxia

Question 7

signs of respiratory distress