neonatal a&p Flashcards
newborn BP, HR, RR
BP 70/40
HR 140
RR 40-60
1 year BP, HR, RR
BP 95/60
HR 120
RR 40
3 year BP, HR, RR
BP 100/65
HR 100
RR 30
12 year BP, HR, RR
BP 110/70
HR 80
RR 20
in the newborn, HoTN is defined as SBP <
60mmHg
explain why neonate RR is higher
they have twice the O2 consumption and CO2 production than adults (infants 6mL/kg/min, adults 3mL/kg/min). its metabolically more efficient to increase RR rather than Vt so thats why RR is increased but Vt is 6mL/kg
HoTN in <1yr is defined as
<70mmHg
HoTN in patients older than 1 year
(70 + (childs age in years x 2))
in the setting of hypovolemia and bradycardia, which drug is preferred
epinephrine since it augments contractility (if only little bit)
why does the child become less dependent on HR
as SVR rises, LV creates more contractile filaments and frank starling starts to be a conversation. therefore the patient becomes less dependent on HR over time to support CO
infant vocal cord position
C1-2
describe the infant epiglottis
long and stiff
vocal cord position: adult versus infant
adult: perpendicular to trachea
infant: anterior slant
alveolar ventilation: adult versus infant
adult: 60mL/kg/min
infant: 130mL/kg/min
infants have a ___________ alveolar ventilation relative to FRC size
increased
do adults and neonates have the same amount of dead space on a per weight basis
yes
what type of muscle fibers do infants have in their diaphragm
more type 2 (fast twitch) muscle fibers and less type 1 (slow twitch) muscle fibers (25% type 1 as compared to 55% in adults)
children less than ______ are at risk for apnea and should be admitted for 24h post surgery
60w PCA
what can you do to be prophylactic about postoperative apnea
caffeine 10mg/kg IV
describe lung compliance in the newborn
lower lung compliance due to fewer alveoli
describe chest wall compliance in newborn
higher compliance due to cartilaginous (flimsy) ribcage
describe the issue with closing capacity in the newborn
overlaps with Vt during normal breathing
lung capacities that are decreased relative to adults
FRC, VC, TLC
lung capacities that are increased relative to adults
closing capacity, RV
mother at term pH, PaO2, PaCO2
pH 7.4
PaO2 90
PaCO2 30
umbilical vein: placenta to fetus pH, PaO2, PaCO2
pH 7.35
PaO2 30
PaCO2 40
umbilical artery: fetus to placenta pH, PaO2, PaCO2
pH 7.3
PaO2 20
PaCO2 50
newborn at time after delivery pH, PaO2, PaCO2:
10 minutes
pH 7.2
PaO2 50
PaCO2 50
newborn at time after delivery pH, PaO2, PaCO2: 1 hour
pH 7.35
PaO2 60
PaCO2 30
newborn at time after delivery pH, PaO2, PaCO2: 24h
pH 7.35
PaO2 70
PaCO2 30
during the first hour of extrauterine life, what does the newborn do and why (think respiratory)
hyperventilates. likely due to poor buffering capacity and compensation for non volatile acids in the blood.
when does respiratory control mature and what is the response to hypoxia before versus after this time
42-44w PCA
<44w, hypoxia depresses ventilation
>44w, hypoxia stimulates ventilation
life span of fetal HGB
70-90 days
HgbF P50
19mmHg (adult 26.5mmHg)
HgbA begins to replace HgbF at ____________ and is complete by _____________
2 months and is complete by 6 months
why does the HgbF left shift benefit fetus
creates o2 partial pressure gradient that facilitates passage from mother to fetus
during which months can you expect physiologic anemia
months 2-3 (~hgb 10)- remember shift from HgbF to HgbA is starting
transfusion trigger for children less than 4 months with severe cardiopulmonary disease
<13mg/dL
transfusion trigger for children less than 4 months with moderate cardiopulmonary disease
<10mg/dL
PRBC dose for kid <4mo of age
10-15mL/kg
(10mL/kg will increase HGB by 1-2g/dL)
for children with no issues and less than 4 months, transfuse when?
<6
6-10, go by sx
3 indications for FFP transfusion
- emergency reversal of warfarin
- correction of coagulopathic bleeding with increased PT or PTT
- correction of coagulopathic bleeding if >1 BV has been replaced and coagulation studies are not easily obtained
FFP dose
10-20mL/kg
when is platelet transfusion recommended
maintain platelet count above 50,000
platelet dose if obtained from apharesis
5mL/kg
platelet dose if pooled platelet concentrate
1pack/10kg
one pooled platelet concentrate will increase serum platelets by
50 x 10^9
massive transfusion is associated with (5, think electrolytes and pH)
alkalosis (due to citrate metabolism to bicarb in the liver)
hypothermia
hyperglycemia (dextrose additive in stored blood)
hypocalcemia (binding of calcium via citrate)
hyperkalemia (administration of older blood)
newborn normal Hgb and Hct
Hgb 14-20
Hct 45-65
3 months normal Hgb and Hct
Hgb 10-14
Hct 31-41
6-12 months normal Hgb and Hct
hgb 11-15
hct 33-42
adult female normal Hgb and Hct
12-16
37-47
adult male normal Hgb and Hct
14-18
42-50
premature neonate EBV
90-100
term neonate EBV
80-90
infant EBV
75-80
1 year EBV
70-75
max allowable blood loss equation
EBV* (starting HCT- target HCT)/starting HCT
compared to adult, the newborn kidney has decreased
perfusion pressure, GFR, and dilution/concentration ability
when does GFR mature
improves substantially over first few weeks of life but does not mature until 8-24 months of age
when does renal tubular function mature
improves after birth but does not have full concentrating ability until ~2 years
premature TBW %, ECF %, ICF %
TBW 85%
ECF 60%
ICF 25%
neonate TBW %, ECF %, ICF %
TBW 75
ECF 40
ICF 35
child and adult TBW %, ECF %, ICF %
TBW 60
ECF 20
ICF 40
signs of dehydration
sunken anterior fontanel
weight loss (10% reduction in first week is normal)
irritability or lethargy
dry mucous membranes
absence of tears
decreased skin turgor
increased Hct (concentration)
hourly maintenance 4:2:1 rule
0-10kg–>4mL/kg/h
10-20kg–> add 2mL/kg/h to previous total
>20kg–> add 1mL/kg/h to previous total
third space loss calculation: minimal surgical trauma
3-4mL/kg/h
third space loss calculation: moderate surgical trauma
5-6mL/kg/h
third space loss calculation: major surgical trauma
7-10mL/kg/h
ratio of replacement for:
crystalloid
colloid
blood
crystalloid 3:1
colloid 1:1
blood 1:1
use of glucose containing fluids should be reserved for the following populations
premature
less than 48h
small GA
newborns of diabetic mothers
children with DM who received insulin the day of surgery
children who receive glucose based parenteral nutrition
less than 72h old, signs of hypoglycemia can manifest if BG is <
30-40mg/dL
older than 72h old, signs of hypoglycemia can manifest if BG is <
40mg/dL
tx of hypoglycemia
10% dextrose 2mL/kg
if seizures are present, dose is doubled
after bolus, D10 infusion at 8mL/kg/min is titrated to maintain serum glucose >40mg/dL
newborn CO
200mL/kg/min
water soluble drugs and neonate dosage
neonates have higher TBW so need higher dose of water soluble drugs
before _____ months, infants have less albumin and alpha 1 glycoprotein
6
lipid soluble drugs and infant dosage
infants have lower percentage of fat and muscle mass and therefore lipid soluble drugs take longer to cleart
drug biotransformation is under developed in the first
month of life
hepatic values are not reached until how old?
one year
what do infants lack for bilirubin conjugation
glucoronyl transferase
when does MAC peak at its highest level
2-3 months
IM succ dose neonates versus children
neonates 5mg/kg
children 4mg/kg
IM roc dose children <1 year and > 1 year
<1 year 1mg/kg
>1 year 1.8mg/kg
onset IM 3-4 min
what conditions contribute to failure from fetal to adult circulation in the newborn?
acidosis, hypothermia
citrate most often occurs in neonates and infants following the administration of what
FFP
