Neonatal Flashcards
Each VS is consistent with the term newborn EXCEPT:
A. HR 140
B. RR 40
C. SBP 90
D. DBP 40
C - SBP 90
What is the neonatal period?
The 1st 28 days of life
What is the infant period?
29 days - 1 year
The VS of a kid older than ____ bear a closer resemblance to the adult than a neonate.
1 year
While neonates are resilient, they have a reduced _________.
Physiologic reserve
What is normal SBP for newborn?
70
What is normal DBP for newborn?
40
What is normal HR for newborn?
140
What is normal RR for newborn?
40-60
What is normal SBP for 1 year old?
95
What is normal DBP for 1 year old?
60
What is normal HR for 1 year old?
120
What is normal RR for 1 year old?
40
What is normal SBP for 3 year old?
100
What is normal DBP for 3 year old?
65
What is normal HR for 3 year old?
100
What is normal RR for 3 year old?
30
What is normal SBP for 12 year old?
110
What is normal DBP for 12 year old?
70
What is normal HR for 12 year old?
80
What is normal RR for 12 year old?
20
Select the statements that MOST accurately reflect the CV system in the newborn. (Select 2).
A. HR is the primary determinant of BP
B. Neo is a 1st line treatment for hypotension
C. Stress is more likely to activate the parasympathetic nervous system
D. Hypotension is defined as SBP <70
A & C
Neonates consume _____ as much O2 and produce ____ as much CO2 than the adult on a weight adjusted basis.
twice; twice
What is the primary determinant of CO and SBP in the neonate?
HR
T/F: Stroke volume fluctuates in the neonate.
False - it is relatively fixed
What is the best way to support BP for the neonate and why?
Increasing HR; the non-compliant LV is sensitive to increased afterload
_______ of the heart is immature at birth, w/ the SNS being less mature than the PNS.
Autonomic regulation
How does the neonate respond to the stress of DL?
With bradycardia
Why does the neonate respond to DL by bradycardia?
Autonomic regulation of the heart is immature at birth, with SNS being less mature than PNS
Why is the neonate predisposed to intracerebral hemorrhage?
HTN, immature cerebral auto-regulatory response, and fragile cerebral vasculature
Neonates have higher or lower oxygen consumption and carbon dioxide production.
Higher
Since O2 consumption and C2O production are twice that of the adult, neonates must increase ___________ accordingly.
alveolar ventilation
Why do neonates have such a high RR?
B/c it is more metabolically efficient ot increase RR than TV to increase alveolar ventilation for increased O2 consumption and C2O production
What is the TV of neonates?
6 mL/kg
The ventricle of the neonate is ______
non-compliant
What CV relationship is underdeveloped in the newborn?
Frank-Starling
What is the formula for BP?
BP = HR x SV x SVR
What is considered hypotension in the newborn?
SBP <60
What is considered hypotension in the 1 year old?
SBP <70
What is considered hypotension for the kid older than 1 year old?
<[70 + (kids age x 2)]
In the setting of hypovolemia and bradycardia, what medication should you administer?
Epinephrine (it is preferred over atropine)
What can you administer prior to induction in the neonates to prevent complication from DL?
Atropine
What reflex normally occurring with hypovolemia is poorly developed in the neonate?
The baroreceptor reflex, this reflex fails to increase HR in the setting of hypovolemia
What is the primary determinant of SBP in the neonate?
HR
What is hypotension for a 5 year old?
<80
What is hypotension for a 2 year old?
<74
Which statement MOST accurately describes the infants airway? (Select 3).
A. Glottic opening is positioned more cephalad
B. Vocal cord position at C1-C2
C. C shaped epiglottis
D. Epiglottis is floppy
E. Right and left mainstem bronchi take off at same angle
F. Vocal cords have anterior slant
A - glottic opening more cephalad
E - R & L mainstem bronchi take off at same angle
F. Vocal cords have anterior slant
Neonates have preferential _____ breathing.
nose
Neonates have preferential nose breathing up to what age?
5 months
Neonates have a ____tongue relative to the volume of the mouth.
larger
Neonates have a shorter or longer neck?
shorter
What shape epiglottis do neonates have?
U or omega shaped
Neonates epiglottis is ____ and ____
longer and stiffer
Neonates vocal cords taken on an ____ slant
anterior
Where is the laryngeal position in neonates?
C3-C4
Where is the narrowest fixed region of the neonate’s airway?
cricoid ring
Where is the narrowest dynamic region of the neonate’s airway?
vocal cords
The shape of the subglottic airway of the neonate is what?
A funnel
The right mainstem bronchus position of the neonate is ____ vertical.
less
The right mainstem bronchus of the neonate takes off at a ____ degree from midline.
55
T/F: The sniffing position is used for the neonate.
False
Where does the glottis reside in the adult?
C5
In the full-term newborn where is the glottis?
C4
A cephalad larynx + larger tongue = _________
acute OA/LA angle
What limits the size of the ETT in the neonate?
Cricoid ring diameter
What may require emergency airway management of the neonate if they are unable to convert to mouth breathing?
Bilateral choanal atreasia
What is the breathing pattern of adults?
Mouth or nose
The tongue of the neonate is closer to the _______. What does this mean?
soft palate; more likely to obstruct upper airway and more difficult to displace during DL
What is the consequence of the infant having a shorter neck when it comes to DL?
More acute angle is required to visualize the glottis
What is the shape of the adult’s epiglottis?
Leaf or C
Does an adult or infant have a floppy epiglottis?
Adult
Where are the vocal cord’s postioned in the adult?
Perpendicular to trachea
Why is it sometimes more difficult to pass the ETT in the infant?
The anterior slant of the vocal cords
The larynx of the infant is more ____,____, ___ BUT NOT ____.
superior, cephalad, rostral
NOT anterior
When is the only time the infant’s airway is more anterior?
during neck flexion
What blade is preferred in the neonate?
Miller
The larynx is located at C____ for the neonate.
C3-C4
The larynx descends to C4 at _____ and achieves the adult position by _____ .
@1 year; 5-6 years old
How can the neonate feed and have spontaneous ventilation?
The larynx is positioned higher in the neck placing the epiglottis in contact with the soft palate
What is Poiseulle’s Law?
Small changes in radius can significantly increase resistance to airflow (radius to the 4th power for laminar flow)
The subglottic airway shape in the adult is ______
cylinder
The subglottic ariway shape in the neonate is _______
funnel
The right mainstem bronchus is more ____ in the adult.
vertical
In the adult, the right bronchus takes off at a _____ degrees and the left at ____ degrees off midline.
25; 45
What is the ideal position for intubation in the neonate?
head on bed with shoulder roll
What are situations that would increase the risk of cricoid edema?
ETT that is too large, multiple ETT attempts, prolonged intubation, frequent head positioning while intubated
During an inhalation induction, a neonate begins to desaturate shortly after the removal of the facemask. Which statement BEST explains why the neonate desaturated so quickly?
A. Decreased TV to dead space ration
B. Oxygen consumption is 3 mL/kg/min
C. Increased alveolar ventilation to FRC ratio
D. Patient has MH
C - increased alveolar ventilation to FRC ratio
Who has the increased oxygen consumption, neonates or adults?
Neonates
Who has the increased alveolar ventilation, neonates or adults?
Neonates
Who has the greater FRC, neonates or adults?
Adults
Why do neonates desat so rapidly?
During hypoventilation or apnea, the neonate’s relatively higher O2 consumption will quickly exhaust the O2 reserve contained in the FRC
Why do neonates have a faster inhalation induction?
There is faster turnover of the FRC allowing for speedier development of anesthetic partial pressure inside the alveoli
The distal saccules of the lung begin to develop alveoli between ________ of gestation.
24-28 weeks
The number of alveoli continue to rise thorughout childhood until ______
8-10 years of age
The neonatal alveolar surface area is only _____ of the adult
1/3
Basal O2 consumption of the neonate is _____ of teh adult
2-3x
What is the O2 consumption of the neonate?
6-9 mL/kg/min
What is the alveolar ventilation rate of the neonate?
130 mL/kg/min
What is teh O2 consumption rate for the adult?
3.5 mL/kg/min
What is the alveolar ventilation rate for the adult?
60 mL/kg/min
What is the FRC of the neonate?
30 mL/kg
What is the FRC of teh adult?
34 mL/kg
T/F: There is an increased turnover of gases in the FRC of the neonate.
True
Why do neonates experience O2 desaturation much faster than adults?
- Increased VO2
- Increased Va to increase O2 supply
- Decreased FRC
When compared to the adult, select the true statements regarding the pulmonary system in the newborn. (Select 2).
A. the diaphragm has more type 1 than type 2 muscle fibers
B. the diaphragm has more type 2 than type 1 muscle fibers.
C. the newborn has a higher TV on a per weight basis
D. neonates have the same amount of dead space on a per weight basis
B & D
What is the primary muscle of inspiration?
diaphragm
Why does the neonate have an increased risk for respiratory fatigue?
A smaller # of type 1, slow-twitch endurance muscle fibers within the diaphragm
Patients <60 weeks post-conceptual age should be admitted for _____ observation with an apnea monitor.
24-hour
In the neonate, what muscles are inadequately developed and contribute very little to ventilation?
intercostal muscles
The ribs of the neonate are more _____. Why is this significant?
horizontal ; they are less able to significantly augment thoracic volume
The diaphragm and intercostal muscles are composed of ___ types of muscle fibers.
2
What are type 1 muscle fibers of respiratory muscles?
Slow-twitch muscle fibers that are built for endurance
Which type muscle fiber is resistant to fatigue?
Type 1
What are type 2 muscle fibers of respiratory muscles?
Fast-twitch msucle fibers that are built for short bursts of heavy work
Which type of muscle fiber tires easliy?
Type 2
The nenoatal diaphragm only has ___% type 1 fibers compared to ____% in the adult.
25%; 55%
What explains the reduction in neonatal ventilatory reserve?
Fewer type 1 fibers
How many type 1 fibers do preterm babies have?
10%
Neonates are at risk of _____ following surgery and anesthesia.
apnea
The risk of apnea in the neonate is inversely related to what?
gestational and post-conceptual age (PCA)
What medication may reduce the risk of post-op apnea after GA in the neonate?
Prophylactic caffeine 10 mg /kg IV
What is the dose of prophylactic caffeine?
10 mg/kg IV
______ is an alternative to caffeine, but has a higher risk of toxicity.
Theophylline
Which muscle fibers are slow tiwtch?
Type1
Which muscle fibers are fast twtich?
type 2
After surgery, pateints less than what post-conceptual age should be admitted for 24-hour observation with an apnea monitor?
60 weeks
When compared to the adult, which statement presents the MOST accurate understanding of neonatal pulmonary mechanics? (Select 2.)
A. Airflow resistance during tidal breathing is decreased
B. Residual volume is decreased
C. Closing capacity is increased
D. Chest wall compliance is increased
C & D
Compared to the adult, the newborn has higher or lower lung compliance?
LOWER
Compared to the adult, the newborn has higher or lower chest wall compliance?
HIGHER
What is paradoxical breathing?
Chest wall collapse during inspiration
Neonates compared to adults:
______ FRC
_______ Vital capacity
______ total lung capcity
_____ residual volume
____ closing capcity
______ tidal volume
Neonates have a
smaller FRC, VC, and TLC
Greater RV and CC
similar TV
When the neonate inspires, it must overcome the ______ and the _____.
resistance to airflow; elastic properties of the chest wall and lungs
The lung volume at end-expiration (where the opposing forces are equal) is called _____.
FRC
What creates the negative pressure in the pleural space of adults?
The chest wall tends to expand and the lungs tend to collapse
Why does the newborn have lower lung compliance?
B/c they have fewer alveoli
WHy does the newborn have higher chest wall compliance?
D/t cartilaginous ribcage that gives less structural supports (it is flimsy)
Why is the newborn predisposed to hypoxemia?
CC overlaps with TV during normal breathing –> V/Q mismatch –> ↑A-a gradient
What 3 processes support the newborn’s effort to dynamically increase the FRC?
- sustained tonic activity of inspiratory muscles
- Narrowing of glottis during expiration
- Shorter expiratory time w/ faster RR creates end-expiratory pressure
What is the FRC of the neonate in mL/kg?
30 mL/kg
What is the VC of the neonate in mL/kg?
35 mL/kg
What is the TLC of the neonate in mL/kg?
63
What is the RV of the neonate in mL/kg?
23 mL/kg
What is the CC of the neonate in mL/kg?
35 mL/kg
CC is ____ in the neonate.
Increased or decreased?
Increased
RV is ____ in the neonate.
Increased or decreased?
Increased
TLC is ____ in the neonate.
Increased or decreased?
decreased
VC is ____ in the neonate.
Increased or decreased?
decreased
FRC is ____ in the neonate.
Increased or decreased?
decreased
Resistance is inversely proportional to _______
the radius⁴
Select the data set that MOST accurately depicts a normal umbilical ABG?
A. pH 7.2; PaO2 50; PaCO2 50
B. pH 7.3; PaO2 20; PaCO2 50
C. pH 7.35; PaO2 30; PaCO2 40
D. pH 7.4; PaO2 90; PaCO2 30
B - pH 7.30; PaO2 20; PaCO2 50
What supplies oxygen to the fetus?
The umbilical vein
What returns CO2 rich blood to the placenta?
Umbilical arteries
How many umbilical veins are there?
1
How many umbilical arteries are there?
2
What does clamping of the umbilical cord stimulate?
The newborn to breathe rhythmically
(An acute rise in PaO2 promotes continous breathing, hypoxemia causes apnea)
The newborn comes into the world with what kind of pH?
Acidotic
What is the pH of a newborn upon delivry?
pH 7.2
How long does it take a newborn’s pH to stablize?
1 hour
1 hour after devliery, a newborn’s pH stabilizes at what?
7.35
Respiratory control doesn’t mature until ______ post-conceptional age.
42-44 weeks
Before th 42-44 weeks post-conceptional age mark, ______ inhibits ventilation.
Hypoxemia
Blood Gas of Mother at term:
pH ______
PaO2 ______
PaCO2 ______-
pH 7.40
PaO2 90 mHg
PaCO2 30 mmHg
pH of the umbilical vein (placenta fetus)?
7.35
pH of the umbilical arteries (fetus placenta)?
7.30
PaO2 mmHg of the umbilical vein (placenta fetus)?
30
PaO2 mmHg of the umbilical arteries (fetus placenta)?
20
PaCO2 mmHg of the umbilical vein (placenta fetus)?
40
PaCO2 mmHg of the umbilical arteries (fetus placenta)?
50
Newborn’s pH 10 minutes after delivery is _______
7.20
Newborn’s pH 1 hour after delivery is _______
7.35
Newborn’s pH 24 hours after delivery is _______
7.35
Newborn’s PaO2 10 minutes after delivery is _______
50
Newborn’s PaO2 1 hour after delivery is _______
60
Newborn’s PaO2 24 hours after delivery is _______
70
Newborn’s PaCO2 10 minutes after delivery is _______
50
Newborn’s PaCO2 1 hour after delivery is _______
30
Newborn’s PaCO2 24 hours after delivery is _______
30
The umbilical ____ supplies oxygen to the fetus
vein
Why is the pH higher in the umbilical vein than in the umbilical arteries?
B/c the umbilical vein supplies O2 to the fetus
The newborn comes into the world _____, ____, and retains ______l
hypoxic, acidotic, and retains CO2
The neonate takes deep breaths to replace ____ with ____ in the alveoli.
fluid with air
(its alveoli contains fluid)
The neonate generates a relatively normal FRC in the first ________
20 minutes
During the 1st hour of extrauterine life, what is the newborn hyperventilates, hypoventilates, or breathes normally?
Hyperventilation
After respiratory control matures at 42-44 weeks post-conceptual age, _____ stimulates ventilation.
Hypoxemia stimulates ventialtion
How does hypoxemia impact ventilation in the newborn?
It depresses ventilation
Compare the PaO2 of the umbilical vein and artery.
Vein: 30
Artery: 20
Compare the pH of the umbilical vein and artery.
Vein: 7.35
Artery: 7.3
What statement regarding fetal hemoglobin is TRUE?
a. it has a higher P50 than the adult
b. it is replaced by Hgb A at 9 months of age
c. it has an increased affinity for 2,3-DPG
d. erythrocytes contain Hgb F have a shorter lifespan
D - erythrocytes containing hemoglobin F have a shorter lifespan
Fetal hemoglobin shifts the curve to the left or right?
Left
Fetal hemoglobin shifts the curve to the left (P50 = ______ mmHg)
19.5
HgbA begins to replace HgbF at ____ of life.
2 months
HgbA has been completely replaced by HgbF by ______ of life
6 months
When does P50 achieve the adult value? And what is this value?
by 6 months; 26.5 mmHg
Fetal hemoglobin (Hgb F) has a P50 of ____
19 mmhg
Hgb F shifts the curve to the _____-
left (love or locked in)
Why does Hgb F benefit the fetus?
It creates an oxygen partial pressure gradient across the uteroplacental membrane that facilitates the passage of O2 from mom to fetus
Adult hemoglobin (Hgb A) consists of ____ and _____ chains
2 alpha; 2 beta
Hgb F consists of 2 ______ and 2 ___ chains.
2 alpha and 2 gamma
Where is the binding site for 2,3- DPG?
Only on the beta chain of Hgb
Since Hgb has 2 gamma chains instead of 2 beta chains, it does not bind ______
2,3-DPG
2,3-DPG causes a ______ shift in the oxyhemoglobin dissociation curve
right
Why is the Hgb F shifts the curve to the left?
It does not bind 2,3-DPG
What is the Hgb of neonate at birth?
17 g/dL
At month 2-3 of the neonate, what is the Hgb?
10 g/dL - physiologic anemia
(RBC w/ Hgb F is being replaced by RBC w/ Hgb A)
At month 4 of life, _____ increases and Hgb concentrations begin to rise.
erythorpoiesis
What is P50 of Hgb A?
26.5 mmHg
What is the purpose of fetal Hgb?
it facilitates the passage of O2 from the mom to fetus
Hgb F is completely replaced by Hgb A by what age?
6 months
Potential complications of mass transfusion in the neonate include all of the following EXCEPT:
a. metabolic acidosis
b. metabolic alkalosis
c. hypocalcemia
d. hypokalemia
D - hypokalemia
FFP is indicated for _____, _____, or ____. It is not indicated for _______.
FFP is indicated for coagulopathy, massive transfusion, or emergent warfarin reversal. It is not indicated for expansion of intravascular volume.
PLT transfusion is recommended for invasive procedures to maintain the PLT count above __________.
50,000 mm
What are complications associated with mass transfusion of neonate?
Alkalosis, hypothermia, hyperglycemia, hypocalcemia, and hyperkalemia
Why can administering RBCs to neonates cause hyperkalemia and cardiac arrest?
When RBCs are stored, the cell membrane becomes dysfunctional, which allows K+ to leak into the supernatant
Why do neonates (<4 months) have a higher RBC transfusion trigger?
They have a high demand for O2 and Hgb F has an increased affinity for O2 (O2 is locked in and is less likely to be released to metabolically active tissues)
Transfusion trigger of <_____ in the neonate <4 months with severe cardiopulmonary disease
13 g/dL
Transfusion trigger of <______ in the neonate <4 months presenting for major surgery or with moderate cardiopulmonary disease
10 g/dL
What is the dose for RBC administration in the neonate <4 months?
10-15 mL/kg
10 mL/kg of RBC will raise Hgb by ______
1-2 g/dL
Hgb A has a ____ affinity for oxygen than Hgb F.
lower
For neonates >4 months of age, RBC transfusion is rarely indicated if Hgb is > _____.
10 g/dL
For neonates > 4 month sof age, RBC is almost always indicated if Hgb < _______ g/dL.
6
In neonates > 4months of age, RBC transfusion should be considered on a need’s basis for Hgb ____ to ____.
6-10
RBC is indicated for neonates >4 months of age if intraoperative blood loss is > _____% blood volume.
15%
What are the 3 indications for FFP transfusion in the neonate?
- Emergency reversal of warfarin
- Correction of coagulopathic bleeding with increased PT or PTT
- Correction of coagulopathic bleeding if >1 blood volume has been replaced and coagulation studies are not easily obtained
What is the dose for FFP for the neonate?
10-20 mL/kg
When is PLT transfusion recommended for the neonate?
For invasive procedures to maintain PLT count above 50,000
What is the PLT dose for neonates if obtained from apheresis?
5 mL/kg
What is the PLT dose for neonates if obtained from pooled PLT concentrate?
1 pack/10 kg
A single apheresis unit of PLT equals _____ pooled PLT concentrates.
6-8
One pooled PLT concentrate will increase serum PLT by _______.
50 x 10^9/L
Why can alkalosis occur with mass transfusion?
d/t citrate metabolism to bicarb in the liver
Why can hypothermia occur w/ mass transfusion?
d/t transfusion of cold blood
Why can hyperglycemia occur w/ mass transfusion?
d/t dextrose additive to stored blood
Why can hypocalcemia occur w/ mass transfusion?
D/t the binding of calcium by citrate
Why can hyperkalemia occur w/ mass transfusion?
d/t administration of older blood
How can you reduce the risk of hyperkalemia and cardiac arrest w/ RBC administration in the neonates?
Administering washed or fresh cells that are less than 7 days old
Why can hyperkalemia occur with the administration of older blood?
When RBC are stored, the cell membrane becomes dysfunctional, which allows K+ to leak into the supernatant
What causes graft-vs-host disease with the administration of RBC? What are the S/S?
Donor leukocytes attack recipient bone marrow; pancytopenia, fever, hepatitis, and diarrhea
How can you prevent graft-vs-host disease?
administer irratdiated blood b/c gamma radiation destroys donor leukocytes
T/F: The ASA Task Force on Blood Component Therapy has universal trigger for RBC transfusion for neonates of Hgb of 7.
False - there is no universal transfusion trigger recommended
What is the transfusion trigger for a 2 month old kid with severe cardiopulmonary disease?
Hgb <13 g/dL
At what age should you follow Transfusion Practice Guidelines of the ASA Task Force on Blood Component Therapy in a healthy child?
4 months and older
What is the dose range of FFP in a 20-kg patient?
200 - 400 mL
(10-20 mL/kg)
What is the dose for pooled pLT in a 7 year old?
1 pack/10 kg
A 3 kg term neonate requires emergency ex-lap for necrotizing enterocolitis. Her pre-op Hct is 50%. What is the max allowable blood loss to maintain a Hct of 40%?
A. 40 mL
B. 55 mL
C. 70 mL
D. 85 mL
B - 55 mL
What is the normal Hgb of a newborn?
14-20
What is the normal Hgb of a 3 month old?
10-14
What is the normal Hgb of a 6-12 month old?
11-15
What is the normal Hgb of an adult female?
12-16
What is the normal Hgb of an adult male?
14-18
What is the normal Hct of a newborn?
45-65%
What is the normal Hct of a 3 month old?
31-41%
What is the normal Hct of a 6-12 month old?
33-42
What is the normal Hct of an adult female?
37-47%
What is the normal Hct of an adult male?
42-50%
What is the estimated blood volume of a premature neonate in mL/kg?
90-100 mL/kg
What is the estimated blood volume of a term neonate in mL/kg?
80-90 mL/kg
What is the estimated blood volume of a infant in mL/kg?
75-80 mL/kg
What is the estimated blood volume of a 1 year old in mL/kg?
70-75 mL/kg
What is the. formula for max allowable blood loss for a neonate?
EBV x (Hct starting - Hct target)/ Hct starting
The newborn’s kidney tends to:
A. excrete sodium
B. reabsorb sodium
C. reabsorb water
D. reabsorb glucose
A - excrete sodium
Compared to the adult, the neonate’s perfusion pressure is increased or decreased?
decreased
Compared to the adult, the neonate’s glomerular filtration rate is increased or decreased?
decreased
Compared to the adult, the neonate’s diluting and concentrating ability is increased or decreased?
decreased
T/F: At birth, the neonatal kidney is mature.
False - it is immature
Why are neonates intolerant of fluid restriction?
They do a poor job conserving water
Neonates do a poor job ______, so they are intolerant of fluid restriction.
conserving water
Why do neonates not do well with fluid overload?
They are unable to excrete large volumes of water
Neonates have high ____ water losses.
insensible
What is the most significant insensible loss for neonates?
Evaporation
The neonate is an oblidate ____ loser in teh first few days of life.
sodium
GFR improves substantially in the first few weeks of life but does not reach adult levels until _______.
8-24 months of age
Renal tubular function continues to improve after birth, but it does not achieve full concentrating ability until ______.
@2 years of age
Why do neonates lose most of their body water through evaporation?
As a direct result of a surface area to body weight ratio that is 4x that of an adult
How does neonate’s skin contribute to evaporation?
It is immature, thinner, and more permeable to water
Besides sodium, the neonate tends to lose _____ in urine.
glucose
Compared ot the adult, what 3 kidney functions are lower in the neonate?
- Renal perfusion pressure
- GFR
- Diluting and concentrating ability
The total body water for a premature neonate is approximately:
A. 65%
B. 75%
C. 85%
D. 95%
C - 85%
Total body water is _______ in the premature newborn and _______ as the child ages.
highest; decreases
TBW is ______- at birth and _____with age.
highest; decreases
ECF is _______- at birth and ________ with age.
highest; decreases
ICF is _______ at birth and ______ with age.
lowest; increases
(neonates are tiny water balloons)
What are signs of dehydration in the neonate?
sunken anterior fontanel, weight loss, lethargy, dry mucus membrans, increased Hct
ECF is made. up of what 2 things?
Plasma volume and interstitial fluid
TBW% of premature = _________
85%
TBW% of neonate = _________
75%
TBW% of child = _________
60%
TBW% of adult = _________
60%
ECF % of premature = _______
60%
ECF % of neonate= _______
40%
ECF % of child = _______
20%
ECF % of adult = _______
20%
ICF% of premature = _______
25%
ICF % of neonate = _______
35%
ICF % of child = _______
40%
ICF % of adult = _______
40%
In the premature and term neonate, is ECF larger or smaller than ICF?
Larger (ECF > ICF)
TBW as a function of weight approximates adult values by ______ age.
1 year
What does a higher ICF (as the child ages) provide?
A volume reserve in times of intravascular volume loss (feer, fasting, diarrhea)
A ____ reduction of weight in the 1st week is normal.
10%
List the 7 signs of dehydration in the newborn.
- sunken anterior fontanel
- weight loss
- irritability or lethargy
- dry mucus membranes
- absence of tears
- decreased skin turgor
- increased Hct
In what age groups is ECF greater than ICF?
Premature and term neonates
Calculate the hourly maintenance rate for a kid who weights 15 - kg.
50 mL (421 rule)
What are the 4 parts of fluid management?
- hourly maintenance
- NPO deficit
- 3rd space loss
- blood loss
Routine use of _______ solutions is not recommended in the neonate.
glucose-containing solutions (unless at risk for hypoglycemia)
The lower limit of normal serum glucose changes _________ after birth.
a few days
If less than 72 hours old, signs of hypoglycemia develop if the serum glucose is _______.
<30-40 mg/dL
If older than 72 hours, signs of hypoglycemia develop if the serum glucose is _______.
<40 mg/dL
What is the 421 rule?
0-10 kg –> 4 mL/kg/hr
10-20 kg –> 2 mL/kg/hr
>20 kg –> 1 mL/kg/hr
What is the shortcut for the 421 rule if the patient is >20 kg?
Patient’s weight in kg + 40
How should you replace the NPO deficit?
1st hour - 50%
2nd hour - 25%
3rd hour - 25%
3rd space loss calculation for minimal surgical trauma = _______- mL/kg/hr
3-4
3rd space loss calculation for moderate surgical trauma = _______- mL/kg/hr
5-6
3rd space loss calculation for major surgical trauma = _______- mL/kg/hr
7-10
As a general rule, 3rd space loss should not be included when?
in the 1st hour of anesthesia
For blood loss, replace with crystalloid at a ______ ratio
3:1
For blood loss, replace with colloids at a _______ ratio
1:1
For blood loss, replace with blood at a _______ ratio
1:1
What are common choices of fluid for neonates?
NS, LR, PLasma-lyte, 5% albumin
What type of infants are at risk for hypoglycemia?
- premature
- <48 hours old
- small for gestational age
- diabetic motehrs
- kids w/ diabetes who receive insulin on the day of surgery
- kids who receive glucose-based parenteral nutrition
T/F: GA masks the signs of hypoglycemia.
True
What is tx for hypoglycemia for kid?
IV 10% dextrose
IF _______ are present, IV 10% dextrose dose should be double for hypoglycemia.
seizures
What is the dose of IV 10% dextrose for hypoglycemia?
2 mL/kg
