Neonatal A&P 3 Flashcards
Potential complications of massive transfusion in the neonate include all of the following EXCEPT:
a. metabolic acidosis
b. metabolic alkalosis
c. hypocalcemia
d. hypokalemia
d. hypokalemia
Erythrocyte transfusion triggers vary on
the patient’s age (how much Hgb F they have) & underlying cardiopulmonary disease
FFP is indicated for
coagulopathy
massive transfusion
emergent warfarin reversal
FFP is not indicated for
expansion of intravascular volume
Platelet transfusion is recommended for
invasive procedures to maintain the platelet count above 50,000 mm3
Complications associated with massive transfusion include
alkalosis
hypothermia
hyperglycemia
hypocalcemia
hyperkalemia
When RBCs are stored, the cell membrane becomes
dysfunctional, which allows potassium to leak
Transfusion should be guided by
ongoing blood loss
anticipated blood loss
baseline Hgb/Hct
signs of inadequate oxygenation and end-organ dysfunction
For children less than 4 months of age with severe cardiopulmonary disease, the transfusion trigger would be
<13 g/dL
For the child less than 4 months of age presenting for major surgery or with moderate cardiopulmonary disease, the transfusion trigger would be
<10 g/dL
Dose of erythrocytes for children less than 4 months of age is
10-15 mL/kg
10 mL/kg will raise hgb by
1-2 g/dL
Dose of FFP is
10-20 mL/kg
Dose of platelets is obtained from apheresis is
5 mL/kg
Dose of platelets if pool platelet concentrate is
1 pack/10 kg
The risk of hyperkalemia during blood transfusion is reduced by
administering washed or fresh cells that are less than 7 days old
What type of blood should be given to immunocompromised patients?
irradiated blood (prevents graft vs. host)
At what age should you follow transfusion practice guidelines of the ASA task force on blood component therapy in a healthy child?
4 months and older
A 3 kg term neonate requires emergency exlap for necrotizing enterocolitis. her preoperative hematocrit is 50%. What is the maximum allowable blood loss to maintain a hematocrit of 40%?
a. 40 mL
b. 55 mL
c. 70 mL
d. 85 mL
b. 55 mL
What is the maximum allowable blood loss equation?
MABL= EBV x (Hct starting- Hct target)/ Hct starting
Normal newborn Hgb is
14-20 g/dL
Hemoglobin of a 3 month old is
10-14 g/dL
normal hemoglobin for a 6-12 month old is
11-15 g/dL
Normal hemoglobin for an adult female is
12-16 g/dL
Normal hemoglobin for an adult male is
14-18 g/dL
Estimated blood volume of a premature neonate is
90-100
EBV of a term neonate is
90-100
EBV of an infant is
75-80
EBV of a year old is
70-75
The newborn’s kidney tends to:
a. excrete sodium
b. reabsorb sodium
c. reabsorb water
d. reabsorb glucose
a. excrete sodium
Compared to the adult, the neonatal kidney has
a decreased perfusion pressure
a decreased GFR
& a decreased diluting and concentrating ability
GFR improves substantially in the__________________ but does not reach adult levels until
first few weeks of life but does not reach adult levels until 8-24 months of age
The neonate is an obligate __________________– in the first few days of life
sodium loser
Renal tubular function continues to improve after birth, but it does not achieve full concentrating ability until
~2 years of age
Describe fluid balance in neonates.
do a poor job conserving water so they’re intolerant of fluid restriction but they’re unable to excrete large volumes of water so they don’t do well with fluid overload either
Neonates have a high degree of
insensible fluid loss
The most significant source of water loss for neonates is
evaporation
Why is so much body fluid lost through the skin of neonates?
surface area to body weight ratio is four times higher than the adult
immature skin is thinner and more permeable to water
The total body water for a premature neonate is approximately:
a. 65%
b. 75%
c. 85%
d. 95%
c. 85%
Total body water is highest in _________________ and decreases _____________
premature newborns and decreases as the child ages
The following are highest at birth and decrease with age
total body water
extracellular fluid
The following are lowest at birth and increase with age
intracellular fluid
Signs of dehydration in the neonate include
sunken anterior fontanel
weight loss
lethargy
dry mucus membranes
increased hematocrit
The premature neonate total body water is
85%
The neonate total body water is
75%
A higher ICF as the child ages provides a
volume reserve in times of intravascular volume loss making them more capable of adjusting to theses conditions when compared to the neonate
Calculate the hourly maintenance rate for a child who weighs 15 kg.
50 mLs
Routine use of _____________- is not recommended unless the neonate is at risk for __________-
glucose-containing solutions; hypoglycemia
If less than 72 hours old, signs of hypoglycemia develop if the serum glucose is
<30-40 mg/dL
If older than 72 hours, signs of hypoglycemia develop if serum glucose is
<40 mg/dL
