Neonatal coomplications

Question 1

Which type of tracheoesophageal fistula (TEF) is the most common?

Answer 1

Type C

Blind pouch upper, esophagus connects with trachea lower

Question 2

What is a key diagnostic indicator of TEF?

Answer 2

Maternal polyhydraminos

Question 3

50-70% patients with TEF have another complication (VACTERL)

Answer 3

Verterbral defects
imperforated ANUS
Cardiac anomolies
Tef
Esophageal atresia
Renal dysplasia
Limb anomolies

Question 4

Anesthesia management of TEF?

Answer 4

Head up, awake, spontaneous breathing (positive pressure distends the stomach). ETT below the fistula but ABOVE the carina

Question 5

Type 2 pneumocytes begin making surfactant at _____ weeks, with peak production at ____ week

Answer 5

22-26

35-36

Question 6

______ can be given to hasten lung maturity

Answer 6

betamethasone

Question 7

L/S ratio over ____ suggests lung maturity, and under ____ could lead to respiratory distress syndrome

Answer 7

2, and under 2

Question 8

Where do you place the pulse oximeter probe to obtain a pre-ductal spo2 value?

Answer 8

right arm

Question 9

Where do you place the pulse oximeter probe to obtain a post-ductal spo2 value?

Answer 9

leg

Question 10

Where is the most common site of herniation with congenital diaphragmatic hernia?

Answer 10

The foramen of Bochdalek (left upper abdomen)

Question 11

Does omphalocele have a covering over the abdominal contents?

Answer 11

YES.. is midline

Question 12

Does gastrochiosis have a covering over the abdominal contents?

Answer 12

NO..is off midline (right of umbilicus)

Question 13

Whats worse, omphalocele or gastrochiosis?

Answer 13

gastrochiosis..more urgent and needs repair within 24 hours

Question 14

With pyloric stenosis, the infant presents with _____, leading to _____ with _____ ______. _____. ____. ______

Answer 14

non-bilious projectile vomiting, dehydration, hyponatremia, hypokalemia, hypochloremia, metabolic alkolosis with compensatory respiratory acidosis

Question 15

Pyloric stenosis is more/less common in males and typically presents in the first ____ of life.

Answer 15

More common in males, it presents in the first 2-12 weeks of life.

Question 16

Is pyloric stenosis a medical or surgical emergency?

Answer 16

MEDICAL

DO NOT proceed to the OR until volume replacement has occurred (use 20ml/kg of 0.9% NS).

Question 17

What is the best gas mixture for necrotizing enterocolitis?

Answer 17

50% fio2, 50% air

Question 18

What are the risk factors for necrotizing enterocolitis?

Answer 18

prematurity (under 32 weeks) and low birth weight (under 1500 grams)

Question 19

What is necrotizing enterocolitis the result of?

Answer 19

Early feeding

Question 20

What can cause retinopathy or prematurity?

Answer 20

prematurity and hyperoxia (so keep spo2 between 89-94% until retinal maturity at 44 weeks). Monitoring preductal at RUE is best

Question 21

Where do you place the pulse ox on a child with retinopathy of prematurity?

Answer 21

RUE (preductal)

Question 22

Drugs that antagonize NDMA and/or stimulate GABA may cause ___

Answer 22

Apoptosis

So what has no effect on this? Precedex, opioids, xenon

Question 23

Which congenital anomalies are associated with cardiac defects?

Answer 23

omphalocele and TEF

Question 24

Which congenital defect is associated with pulmonary hypertension?

Answer 24

congenital diaphragmatic hernia
(abdominal contents enter the thoracic cavity)