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Apex > Neonatal > Flashcards

Neonatal Flashcards

1
Q

The neonatal period encompasses:

A

The first 28 days

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2
Q

The infant period encompasses:

A

29 days to 1 year

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3
Q

In the newborn, hypotension is defined as an SBP < _____

A

60

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4
Q

In neonates, which branch of the Autonomic Nervous System is dominant?

A

The Parasympathetic, which is why stress tends to cause bradycardia

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5
Q

What is the best way of increasing blood pressure in the neonate?

A

Increasing heart rate.

The LV has very poor compliance and can’t tolerate increased afterload from Neo or other alpha agonists

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6
Q

How does the Vt of a neonate compare to that of an adult?

A

It’s the same (6ml/kg), but their O2 consumption and CO2 production are DOUBLE

That’s why their RR is so much higher

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7
Q

In the setting of hypovolemia and bradycardia, which medication is favored?

A

Epinephrine, since it will add a tiny increase in contractility

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8
Q

What is the formula for defining hypotension in a child > 1 yr?

A

Hypotension is an SBP that is less than:

70 + (Age/2) mmHg

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9
Q

How long are infants preferential nose breathers?

A

Up to 5 mos

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10
Q

Compared to the adult, the epiglottis is:

A

Longer
Stiffer
Omega shaped

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11
Q

What is the oxygen consumption of an adult and a neonate?

A

Adult 3 ml/kg/min
Neonate 6 ml/kg/min

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12
Q

Is an inhalation anesthetic faster or slower in neonates?

A

Faster, because the FRC is turned over so quickly due to increased alveolar ventilation

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13
Q

Children’s alveolar count continues to rise until:

A

8-10 years of age

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14
Q

What are type 2 diaphragm fibers?

A

Fast twitch

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15
Q

What are type 1 diaphragm fibers?

A

Slow twitch

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16
Q

Do neonates have more type 1 or type 2 fibers?

A

Type 2, that’s why they are easily exhausted by respiratory effort

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17
Q

Compare dead space in the neonate and the adult

A

They are the same (2ml/kg)

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18
Q

Patients less than _______ should be admitted for monitoring post op

A

60 weeks post conceptual age

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19
Q

What lung volumes and capacities are smaller in neonates?

A

FRC, VC, TLC

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20
Q

What lung volumes and capacities are larger in neonates?

A

Residual volume and closing capacity

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21
Q

Lung compliance in the neonate is ________

A

lower, due to fewer alveoli

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22
Q

Resistance is inversely proportional to:

A

the radius of the airway. Even minor reductions in airway radius cause a major increase in resistance!

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23
Q

Is respiratory resistance higher or lower in neonates?

A

Way higher, because it has to overcome the highly elastic chest wall and lung

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24
Q

What is a normal umbilical VEIN ABG?

A

pH 7.35
PaO2 30
PaCO2 40

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25
Q

What is a normal umbilical ARTERY ABG?

A

pH 7.30
PaO2 20
PaCO2 50

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26
Q

What is a normal Neonatal ABG in the first ten minutes of life?

A

pH 7.2
PaO2 50
PaCO2 50

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27
Q

The umbilical vein carries ________

A

oxygenated blood to the fetus

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28
Q

The umbilical arteries carry________

A

deoxygenated blood to the placenta

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29
Q

When does arterial pH stabilize in the neonate?

A

At about 1 hour

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30
Q

Respiratory control doesn’t mature until ________

A

42-44 weeks post conceptual age

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31
Q

In the neonate, hypoxia causes:

A

apnea

32
Q

Hgb F has a P50 of:

A

19

33
Q

Structurally, how does Hgb F differ from Hgb A?

A

Hgb F has 2 alpha and two gamma chains

Hgb A has 2 Alpha and 2 Beta

34
Q

After ____ months, Hgb A has completely replaced Hgb F

A

6 months

35
Q

What is the P50 of Hgb A?

A

26.5

36
Q

What is the transfusion trigger in a healthy neonate?

A

< 10

37
Q

What is the transfusion trigger in a neonate with severe cardiopulmonary disease?

A

< 13

38
Q

Giving a 10 ml/kg PRBC bolus to a neonate will result in a _________ increase in Hgb

A

1-2 g/dl

39
Q

What is the transfusion trigger on a child >4 months?

A

Same as for adults

40
Q

What is the platelet dose?

A
41
Q

What is the EBV for a neonate?

A

90 - 100 ml/kg

42
Q

What is the EBV in a term neonate?

A

80-90 ml/kg

43
Q

What is the EBV in an infant?

A

80 ml/kg

44
Q

What is the EBV in a one year old?

A

70 -75 ml/kg

45
Q

Neonatal kidneys tend to excrete:

A

Sodium

46
Q

Neonatal kidneys lack the ability to reabsorb:

A

glucose and water

47
Q

GFR reaches adult levels at:

A

8 - 24 months

48
Q

The renal tubule doesn’t achieve full concentrating ability until age:

A

2

49
Q

Total body water is highest in:

A

the premature neonate

It decreases with age

50
Q

Which type of Tracheoesophageal Fistula is the most common?

A
51
Q

50-70% of patients with TEF also suffer from:

A
52
Q

20% of neonates with TEF also have:

A

a significant cardiac defect

53
Q

All neonates undergoing surgery for a TEF should undergo:

A

An ECHO, to check for cardiac involvement

54
Q

What is the best induction method for a neonate with TEF?

A

Awake or inhalation

55
Q

Management of TEF neonates includes the avoidance of:

A

PPV

56
Q

In TEF, the ETT should be placed:

A

Below the fistula but above the carina

57
Q

Type 2 pneumocytes begin producing surfactant at:

A

22-26 WGA

58
Q

Peak surfactant production occurs at:

A

35-36 WGA

59
Q

What is Lethicin?

A

Another word for surfactant

60
Q

What is sphingomyelin?

A

The precursor to surfactant

61
Q

How does an amniocentesis tell us about lung maturity?

A

Measures the ratio between Lethicin and Sphingomyelin, which should be > 2

62
Q
A

D, Foramen of Bochdalek on the L side

63
Q

When repairing a diaphragmatic hernia, which bronchial blocker should be used for neonates?

A

None. There aren’t any. Just have to go for mainstem intubation of the “good lung”

64
Q

After diagnosis, when is a diaphragmatic hernia usually repaired?

A

5-15 days

65
Q

In patients with diaphragmatic hernias, it is imperative to avoid:

A

Anything that increases PVR:

Hypoxia, Acidosis, Hypothermia

66
Q

Which genetic syndromes are associated with gastroschesis?

A

None. it’s due to prematurity

67
Q

Which genetic syndromes are associated with omphalocele?

A

Downs
Cardiac Defects
Beckwith-Wiedmann

68
Q

Omphalocele is caused by:

A

failure of the gut to migrate from the yolk sac into the abdomen

69
Q

Gastroschisis is caused by:

A

Occlusion of the omphalomesenteric artery during gestation

70
Q

What is the biggest difference between omphalocele and gastroschisis

A

Gastroschisis is a true emergency

Omphalocele has a covering

71
Q

Neonates with pyloric stenosis usually present with:

A

Metabolic Alkalosis
Hyponatremia
Hypokalemia
Alkaline Urine

72
Q

Is pyloric stenosis more common in males or females?

A

Males

73
Q

Is pyloric stenosis a surgical emergency?

A

No, but it is a medical emergency

74
Q

Maintenance fluids for a neonate with pyloric stenosis should be:

A

D5 1/2NS @ 1.5x the normal rate

75
Q

What is the most common post op complication from pyloric stenosis repair?

A

Apnea

The CSF remains alkalotic

76
Q

what are risk factors for NEC?

A

< 32 weeks
< 1500 g

77
Q

When is retinal maturation complete?

A

44 weeks after conception

Apex (46 decks)

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