Neonatal

Question 1

The neonatal period encompasses:

Answer 1

The first 28 days

Question 2

The infant period encompasses:

Answer 2

29 days to 1 year

Question 3

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

Answer 3

60

Question 4

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

Answer 4

The Parasympathetic, which is why stress tends to cause bradycardia

Question 5

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

Answer 5

Increasing heart rate.

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

Question 6

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

Answer 6

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

That’s why their RR is so much higher

Question 7

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

Answer 7

Epinephrine, since it will add a tiny increase in contractility

Question 8

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

Answer 8

Hypotension is an SBP that is less than:

70 + (Age/2) mmHg

Question 9

How long are infants preferential nose breathers?

Answer 9

Up to 5 mos

Question 10

Compared to the adult, the epiglottis is:

Answer 10

Longer
Stiffer
Omega shaped

Question 11

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

Answer 11

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

Question 12

Is an inhalation anesthetic faster or slower in neonates?

Answer 12

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

Question 13

Children’s alveolar count continues to rise until:

Answer 13

8-10 years of age

Question 14

What are type 2 diaphragm fibers?

Answer 14

Fast twitch

Question 15

What are type 1 diaphragm fibers?

Answer 15

Slow twitch

Question 16

Do neonates have more type 1 or type 2 fibers?

Answer 16

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

Question 17

Compare dead space in the neonate and the adult

Answer 17

They are the same (2ml/kg)

Question 18

Patients less than _______ should be admitted for monitoring post op

Answer 18

60 weeks post conceptual age

Question 19

What lung volumes and capacities are smaller in neonates?

Answer 19

FRC, VC, TLC

Question 20

What lung volumes and capacities are larger in neonates?

Answer 20

Residual volume and closing capacity

Question 21

Lung compliance in the neonate is ________

Answer 21

lower, due to fewer alveoli

Question 22

Resistance is inversely proportional to:

Answer 22

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

Question 23

Is respiratory resistance higher or lower in neonates?

Answer 23

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

Question 24

What is a normal umbilical VEIN ABG?

Answer 24

pH 7.35
PaO2 30
PaCO2 40

Question 25

What is a normal umbilical ARTERY ABG?

Answer 25

pH 7.30 PaO2 20 PaCO2 50

Question 26

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

Answer 26

pH 7.2 PaO2 50 PaCO2 50

Question 27

The umbilical vein carries ________

Answer 27

oxygenated blood to the fetus

Question 28

The umbilical arteries carry________

Answer 28

deoxygenated blood to the placenta

Question 29

When does arterial pH stabilize in the neonate?

Answer 29

At about 1 hour

Question 30

Respiratory control doesn't mature until ________

Answer 30

42-44 weeks post conceptual age

Question 31

In the neonate, hypoxia causes:

Answer 31

apnea

Question 32

Hgb F has a P50 of:

Answer 32

19

Question 33

Structurally, how does Hgb F differ from Hgb A?

Answer 33

Hgb F has 2 alpha and two gamma chains Hgb A has 2 Alpha and 2 Beta

Question 34

After ____ months, Hgb A has completely replaced Hgb F

Answer 34

6 months

Question 35

What is the P50 of Hgb A?

Answer 35

26.5

Question 36

What is the transfusion trigger in a healthy neonate?

Answer 36

< 10

Question 37

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

Answer 37

< 13

Question 38

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

Answer 38

1-2 g/dl

Question 39

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

Answer 39

Same as for adults

Question 40

What is the platelet dose?

Answer 40

Question 41

What is the EBV for a neonate?

Answer 41

90 - 100 ml/kg

Question 42

What is the EBV in a term neonate?

Answer 42

80-90 ml/kg

Question 43

What is the EBV in an infant?

Answer 43

80 ml/kg

Question 44

What is the EBV in a one year old?

Answer 44

70 -75 ml/kg

Question 45

Neonatal kidneys tend to excrete:

Answer 45

Sodium

Question 46

Neonatal kidneys lack the ability to reabsorb:

Answer 46

glucose and water

Question 47

GFR reaches adult levels at:

Answer 47

8 - 24 months

Question 48

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

Answer 48

2

Question 49

Total body water is highest in:

Answer 49

the premature neonate It decreases with age

Question 50

Which type of Tracheoesophageal Fistula is the most common?

Answer 50

Question 51

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

Answer 51

Question 52

20% of neonates with TEF also have:

Answer 52

a significant cardiac defect

Question 53

All neonates undergoing surgery for a TEF should undergo:

Answer 53

An ECHO, to check for cardiac involvement

Question 54

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

Answer 54

Awake or inhalation

Question 55

Management of TEF neonates includes the avoidance of:

Answer 55

PPV

Question 56

In TEF, the ETT should be placed:

Answer 56

Below the fistula but above the carina

Question 57

Type 2 pneumocytes begin producing surfactant at:

Answer 57

22-26 WGA

Question 58

Peak surfactant production occurs at:

Answer 58

35-36 WGA

Question 59

What is Lethicin?

Answer 59

Another word for surfactant

Question 60

What is sphingomyelin?

Answer 60

The precursor to surfactant

Question 61

How does an amniocentesis tell us about lung maturity?

Answer 61

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

Question 62

Answer 62

D, Foramen of Bochdalek on the L side

Question 63

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

Answer 63

None. There aren't any. Just have to go for mainstem intubation of the "good lung"

Question 64

After diagnosis, when is a diaphragmatic hernia usually repaired?

Answer 64

5-15 days

Question 65

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

Answer 65

Anything that increases PVR: Hypoxia, Acidosis, Hypothermia

Question 66

Which genetic syndromes are associated with gastroschesis?

Answer 66

None. it's due to prematurity

Question 67

Which genetic syndromes are associated with omphalocele?

Answer 67

Downs Cardiac Defects Beckwith-Wiedmann

Question 68

Omphalocele is caused by:

Answer 68

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

Question 69

Gastroschisis is caused by:

Answer 69

Occlusion of the omphalomesenteric artery during gestation

Question 70

What is the biggest difference between omphalocele and gastroschisis

Answer 70

Gastroschisis is a true emergency Omphalocele has a covering

Question 71

Neonates with pyloric stenosis usually present with:

Answer 71

Metabolic Alkalosis Hyponatremia Hypokalemia Alkaline Urine

Question 72

Is pyloric stenosis more common in males or females?

Answer 72

Males

Question 73

Is pyloric stenosis a surgical emergency?

Answer 73

No, but it is a medical emergency

Question 74

Maintenance fluids for a neonate with pyloric stenosis should be:

Answer 74

D5 1/2NS @ 1.5x the normal rate

Question 75

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

Answer 75

Apnea The CSF remains alkalotic

Question 76

what are risk factors for NEC?

Answer 76

< 32 weeks < 1500 g

Question 77

When is retinal maturation complete?

Answer 77

44 weeks after conception