Neonatal 2 Flashcards
1
Q
What is choanal atresia?
Tx?
A
- blockage at the back of the nasal passage by bone or soft tissue
- Usually associated with other congenital issues
- Unilateral or bilateral diagnosed based on the inability to pass a small catheter through each nare
- Surgical tx required during neonatal period
- Oral airway may be necessary until surgery
2
Q
What is a congenital diaphragmatic hernia?
Sx
initial tx
A
- Herniation of the abdominal viscera through a defect in the diaphragm
- usually on the left via foramen Bochdalek
- Sx:
- severe resp distress at birth
- cyanosis
- scaphoid abdomen (guts are up in lungs)
- can be seen on x-Ray
- Initial treatment in delivery room:
- avoid aggressive mask ventilation
- urgent intubation
- decompress stomach
- maintain PaCO2 < 40 and optimal oxygenation
3
Q
What must be avoided in a pt with a congenital diaphragmatic hernia?
Plan of care?
A
- Must avoid iatrogenic volutrauma (over ventilating)!
- high risk pneumothorax on side opposite of hernia if attempts are made to expand the ipsilateral lung
- hypoxemia secondary to pulmonary hypoplasia and pulmonary hypertension
- hypotension d/t overdistention of stomack and mechanical kinking of great vessels
- Trend is supportive care instead of immediate surgery
- ECMO
- HFOV
- Nitric oxide
4
Q
Anesthetic management of diaphragmatic hernia
A
- Awake intubation without positive pressure ventilation
- adequate IV access
- a-line
- opioids
- muscle relaxation
- maintain optimal oxygenation PaO2 >100 and ventilation
- avoid nitrous
- anticipate ICU postop
5
Q
What causes apnea of prematurity?
How is it diagnosed?
treatment?
A
- Immaturity of the respiratory control centers of the brainstem
- decreased sensitivity to elevations in CO2
- both central apnea and obstructive apnea
- inversely proportional to gestational age
- Dx
- apneic periods >15-20 seconds
- apnea with HR <80-100
- apnea with desaturation
- Methylxanthines are primary treatment
- aminophylline
- caffeine
6
Q
Neonatal hypoglycemia:
Sx
Who is at highest risk?
A
- Sx- can be masked by anesthesia
- hypotension
- tremors
- sz
- resp distress/apnea, cyanosis
- high pitched cry
- irritability
- limpness
- lethargy
- eye rolling
- poor feeding
- temp instability
- sweating
- Highest risk:
- infants with intrauterine growth restriction*
- diabetic mothers*
- severe intrauterine fetal distress*
- excessively fasted full-term infants
- SGA
- infants of diabetic mothers
7
Q
What is considered hypoglycemia?
Full term neonates?
Premature infants?
A
- Full term neonates: <40 mg/dL during first 24 hours after birth
- <60 mg/dL at 36 hours
- Premature infants: <45 mg/dL during first 24 hour
- later than 24 hrs <50 mg/dL
8
Q
How is neonatal hypoglycemia prevented?
A
- 1st 48 hours IV maintenace fluid should contain 10% glucose in 0.2% saline with 22 mmol/L K
- After 48 hrs: 5% glucose
- pre-terms will have increased requiremnt
9
Q
How is hypoglycemia treated?
A
- bolus of 0.25 to 0.6 g/kg
- 1-2 ml/kg of D25 W
- 2.5-5 ml/kg of D10 W
- After bolus start infusion
- bolus will stimulate insulin production and pt will return to hypoglycemic state
- glucose should be in MAINTENANCE FLUID ONLY
- check bs frequently
10
Q
Hypocalcemia:
Who is affected?
Causes
A
- At birth there is abrupt loss of maternal Ca
- by third day of life Ca levels return to normal in full-term neonate
- premies don’t benefit from the transfer of maternal calcium
- Hypocalcemia in nearly 40% of critically ill neonates
- Causes:
- PTH insufficiency
- inadequate Ca supplementation
- altered calcium metabolism caused by citrated products
- bicarb administration
- diuretics (furosemide)
11
Q
Hypocalcemia symptoms
A
- may be asymptomatic
- neuromuscular irritability (myoclonic jerks, exaggerated startle, sz)
- tachycardia
- prolonged QT interval
- decreased cardiac contractility
12
Q
Hypocalcemia treatment
A
- 90 mg/kg calcium gluconate or 30 mg/kg calcium chloride by slow IV infusion over 5-10 min
- while monitoring for bradycardia
- Calcium gluconate is vesicant, can go through IV but watch closely!
- causes necrosis and subcutaneous calcification
- Calcium chloride must go through central line
- Consider need for Mg supplementation as well!
13
Q
Which CHD present as CHF?
What are CHF symptoms in newborn?
A
- CHDs
- VSD
- PDA
- critical aortic stenosis
- coarctation of the aorta
- Newborn CHF symptoms
- poor feeding
- irritability
- sweating
- tachycardia
- tachypnea
- decreased peripheral pulses
- poor cutaneous perfusion
- hepatomegaly
14
Q
Which CHDs present as cyanotic?
A
- Tetralogy of Fallot
- transposition of the great arteries
- hypoplastic left heart syndrome
15
Q
What is meningomyelocele?
Anesthesia considerations?
A
- hernial protrusion of a part of the meninges and spinal cord through a defect in the vertebral column
- These pts often have chiary malformation (caudal displacement of medulla)
- Anesthesia considerations:
- protect defect with positioning (difficult during intubation)
- anticipate larger insensible losses
- high possibility of hydrocephalus, esp after surgical repair
- possibility of CN palsy affecting vocal cord and causing resp distress/stridor
- potential for brainstem herniation
- higher incidence of latex allergy
- No NMB d/t neuromonitoring
18
Q
What are the different types of TEFs?
(pic)
A
24
Q
What is different between omphalocele and gastroschisis?
(table)
A
