Neonatal Flashcards
The neonatal period encompasses:
The first 28 days
The infant period encompasses:
29 days to 1 year
In the newborn, hypotension is defined as an SBP < _____
60
In neonates, which branch of the Autonomic Nervous System is dominant?
The Parasympathetic, which is why stress tends to cause bradycardia
What is the best way of increasing blood pressure in the neonate?
Increasing heart rate.
The LV has very poor compliance and can’t tolerate increased afterload from Neo or other alpha agonists
How does the Vt of a neonate compare to that of an adult?
It’s the same (6ml/kg), but their O2 consumption and CO2 production are DOUBLE
That’s why their RR is so much higher
In the setting of hypovolemia and bradycardia, which medication is favored?
Epinephrine, since it will add a tiny increase in contractility
What is the formula for defining hypotension in a child > 1 yr?
Hypotension is an SBP that is less than:
70 + (Age/2) mmHg
How long are infants preferential nose breathers?
Up to 5 mos
Compared to the adult, the epiglottis is:
Longer
Stiffer
Omega shaped
What is the oxygen consumption of an adult and a neonate?
Adult 3 ml/kg/min
Neonate 6 ml/kg/min
Is an inhalation anesthetic faster or slower in neonates?
Faster, because the FRC is turned over so quickly due to increased alveolar ventilation
Children’s alveolar count continues to rise until:
8-10 years of age
What are type 2 diaphragm fibers?
Fast twitch
What are type 1 diaphragm fibers?
Slow twitch
Do neonates have more type 1 or type 2 fibers?
Type 2, that’s why they are easily exhausted by respiratory effort
Compare dead space in the neonate and the adult
They are the same (2ml/kg)
Patients less than _______ should be admitted for monitoring post op
60 weeks post conceptual age
What lung volumes and capacities are smaller in neonates?
FRC, VC, TLC
What lung volumes and capacities are larger in neonates?
Residual volume and closing capacity
Lung compliance in the neonate is ________
lower, due to fewer alveoli
Resistance is inversely proportional to:
the radius of the airway. Even minor reductions in airway radius cause a major increase in resistance!
Is respiratory resistance higher or lower in neonates?
Way higher, because it has to overcome the highly elastic chest wall and lung
What is a normal umbilical VEIN ABG?
pH 7.35
PaO2 30
PaCO2 40
What is a normal umbilical ARTERY ABG?
pH 7.30
PaO2 20
PaCO2 50
What is a normal Neonatal ABG in the first ten minutes of life?
pH 7.2
PaO2 50
PaCO2 50
The umbilical vein carries ________
oxygenated blood to the fetus
The umbilical arteries carry________
deoxygenated blood to the placenta
When does arterial pH stabilize in the neonate?
At about 1 hour
Respiratory control doesn’t mature until ________
42-44 weeks post conceptual age
In the neonate, hypoxia causes:
apnea
Hgb F has a P50 of:
19
Structurally, how does Hgb F differ from Hgb A?
Hgb F has 2 alpha and two gamma chains
Hgb A has 2 Alpha and 2 Beta
After ____ months, Hgb A has completely replaced Hgb F
6 months
What is the P50 of Hgb A?
26.5
What is the transfusion trigger in a healthy neonate?
< 10
What is the transfusion trigger in a neonate with severe cardiopulmonary disease?
< 13
Giving a 10 ml/kg PRBC bolus to a neonate will result in a _________ increase in Hgb
1-2 g/dl
What is the transfusion trigger on a child >4 months?
Same as for adults
What is the platelet dose?
What is the EBV for a neonate?
90 - 100 ml/kg
What is the EBV in a term neonate?
80-90 ml/kg
What is the EBV in an infant?
80 ml/kg
What is the EBV in a one year old?
70 -75 ml/kg
Neonatal kidneys tend to excrete:
Sodium
Neonatal kidneys lack the ability to reabsorb:
glucose and water
GFR reaches adult levels at:
8 - 24 months
The renal tubule doesn’t achieve full concentrating ability until age:
2
Total body water is highest in:
the premature neonate
It decreases with age
Which type of Tracheoesophageal Fistula is the most common?
50-70% of patients with TEF also suffer from:
20% of neonates with TEF also have:
a significant cardiac defect
All neonates undergoing surgery for a TEF should undergo:
An ECHO, to check for cardiac involvement
What is the best induction method for a neonate with TEF?
Awake or inhalation
Management of TEF neonates includes the avoidance of:
PPV
In TEF, the ETT should be placed:
Below the fistula but above the carina
Type 2 pneumocytes begin producing surfactant at:
22-26 WGA
Peak surfactant production occurs at:
35-36 WGA
What is Lethicin?
Another word for surfactant
What is sphingomyelin?
The precursor to surfactant
How does an amniocentesis tell us about lung maturity?
Measures the ratio between Lethicin and Sphingomyelin, which should be > 2
D, Foramen of Bochdalek on the L side
When repairing a diaphragmatic hernia, which bronchial blocker should be used for neonates?
None. There aren’t any. Just have to go for mainstem intubation of the “good lung”
After diagnosis, when is a diaphragmatic hernia usually repaired?
5-15 days
In patients with diaphragmatic hernias, it is imperative to avoid:
Anything that increases PVR:
Hypoxia, Acidosis, Hypothermia
Which genetic syndromes are associated with gastroschesis?
None. it’s due to prematurity
Which genetic syndromes are associated with omphalocele?
Downs
Cardiac Defects
Beckwith-Wiedmann
Omphalocele is caused by:
failure of the gut to migrate from the yolk sac into the abdomen
Gastroschisis is caused by:
Occlusion of the omphalomesenteric artery during gestation
What is the biggest difference between omphalocele and gastroschisis
Gastroschisis is a true emergency
Omphalocele has a covering
Neonates with pyloric stenosis usually present with:
Metabolic Alkalosis
Hyponatremia
Hypokalemia
Alkaline Urine
Is pyloric stenosis more common in males or females?
Males
Is pyloric stenosis a surgical emergency?
No, but it is a medical emergency
Maintenance fluids for a neonate with pyloric stenosis should be:
D5 1/2NS @ 1.5x the normal rate
What is the most common post op complication from pyloric stenosis repair?
Apnea
The CSF remains alkalotic
what are risk factors for NEC?
< 32 weeks
< 1500 g
When is retinal maturation complete?
44 weeks after conception
