Neonatal emergencies Flashcards
The most common congenital defect of the esophagus is
esophageal atresia
A key diagnostic indicator tor tracheoesophageal fistula is
maternal polyhydramnios
The most common type of tracheoesophageal fistula is
type C (90%)
Tracheoesophageal fistula may occur as part of
the VACTERL association
Approximately 20% of neonates with esophageal atresia have
a significant cardiac defect
Anesthetic considerations for esophageal atresia & tracheoesophageal fistula include
head up position and frequent suctioning minimizes the risk of gastric aspiration
maintain spontaneous ventilation during induction (PPV can cause gastric distension)
a precordial stethoscope placed on the left chest will immediately detect a right mainstem intubation
Where should the ETT be placed for a tracheoesophageal fistula?
place it below the fistula but above the carina
Most kids with esophageal atresia will have
a tracheoesophageal fistula
Diagnosis of esophageal atresia is confirmed by
the inability to pass a gastric tube into the stomach
Other symptoms of esophageal atresia include
choking
coughing
cyanosis during oral feeding
What is VACTERL association?
vertebral defects
imperforated anus
cardiac anomalies
tracheoesophageal fistula
esophageal atresia
renal dysplasia
limb anomalies
If an ETT is placed too high with tracheoesophageal fistula then
respiratory gas is delivered to the stomach
If an ETT is placed too low with tracheoesophageal fistula then
endobronchial intubation is likely
Placement of a g-tube with tracheoesophageal fistula allows for
gastric decompression with induction
Which lecithin/sphingomyelin ratio suggests fetal lung maturity?
a. 0.5
b. 1.0
c. 1.5
d. 2.0
d. 2.0
Type 2 pneumocytes begin producing surfactant between ___________ with peak production occurring at _______________
22-26 weeks; 35-36 weeks
Neonates who do not produce enough surfactant are at risk for
respiratory distress syndrome
Patients with respiratory distress syndrome are at high risk for
hypoxemia
hypercarbia
mixed acidosis
hemodynamic instability
death
Positive pressure ventilation in the patient with poor lung compliance
increases the risk of pneumothorax
Before delivery, treatment for respiratory distress syndrome includes
maternal corticosteroids to hasten fetal lung maturity
After delivery, treatment for respiratory distress syndrome includes
CPAP
mechanical ventilation
exogenous surfactant
Preductal and postductal oxygen saturation monitoring should be used to assess for
pulmonary hypertension
a right-to-left cardiac shunt and the return to fetal circulation via the PDA
The tendency of an alveolus to collapse is directly proportional to
surface tension
The tendency of an alveolus to collapse is inversely proportional to
alveolar radius (smaller radius= more likely to collapse)
The steroid used to hasten lung maturity is
betamethasone
Risk factors for respiratory distress syndrome include
low birth weight
low gestational age
barotrauma from positive pressure ventilation
oxygen toxicity
endotracheal intubation
maternal diabetes
Anesthetic considerations for respiratory distress syndrome include that SpO2 should be
maintained while keeping in mind that hyperoxia can contribute to retinopathy of prematurity and poor lung development
Where should an arterial line be placed in the neonate with RDS?
preductal artery preferred
Where should the preductal and postductal pulse oximetry be placed?
preductal: right upper extremity
postductal: lower extremity
What cells produce surfactant?
type 2 pneumocytes
________________ allows the abdominal contents to enter the thoracic cavity
Congenital diaphragmatic hernia
The most common site of herniation is
the foramen of Bochdalek (usually on the left)
The mass effect of the abdominal contents within the chest
impairs lung development leading to pulmonary hypoplasia
Consequences of poor lung development related to CDH include
poor pulmonary vascular development
increased pulmonary vascular resistance
pulmonary hypertension
impaired airway development
airway reactivity
What should be avoided in terms of anesthetic management for the patient with congenital diaphragmatic hernia?
keep PIP <25-30 cm H2O to minimize barotrauma and the risk of pneumothorax in the “good” lung
avoid conditions that increase PVR (hypoxia, acidosis, hypothermia)
When is surgery performed for congenital diaphragmatic hernia?
delayed 5-15 days to allow for stabilization of pulmonary, cardiac, and metabolic status
What is necessary for anesthetic management of the patient with a congenital diaphragmatic hernia?
monitor preductal oxygen saturation
one-lung ventilation with a single lumen ETT advanced into the good lung may be required
Other sites of herniation for a congenital diaphragmatic hernia include
foramen of Morgagni and around the esophagus
CDH is usually diagnosed
at birth
The newborn with CDH will experience
respiratory distress
scaphoid abdomen (sunken in)
barrel chest
cardiac displacement
fluid-filled GI segments in the thorax
With CDH, a pulse oximeter placed on a lower extremity can
warn of increased intra-abdominal pressure
With CDH, preductal SpO2 should be
> 90%
