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Apex > Neonatal Emergencies > Flashcards

Neonatal Emergencies Flashcards

1
Q

What is the most common congenital defect of the esophagus?

A

Esophageal atresia

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2
Q

What is a key indicator of TEF (tracheoesophageal fistula)?

A

Polyhydraminos (baby is unable to swallow amniotic fluid ~ it builds up!)

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3
Q

Which type of TEF (tracheoesophageal fistula) accounts for 90% of all TEFs?

A

Class C

Blind upper pouch
Lower half is connected to trachea

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4
Q

What is the VACTERL association?

A

V: vertebral defects
A: imperforated ANUS
C: cardiac anomalies
T: tracheoesophageal fistula
E: esophageal atresia
R: renal dysplasia
L: limb anomalies

Vera the viper who was a snake (long curvy vertebrae with no limbs) couldn’t poop. She also couldn’t drink or eat because her throat!! This made her anxious and her heart rate would go increase! And Because she couldn’t eat or drink, her little bean (kidneys) dried up!

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5
Q

What % of patients with esophageal atresia have cardiac defects?

A

20%

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6
Q

How should you provide anesthesia to a TEF child?

A

> Head up position with freq suctioning
awake intubation or inhalation induction with spontaneous vent
lower positive pressure vent ~ if not ~ increases in gastric pressure ~ decreased compliance
ETT BELOW fistula, but above carina

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7
Q

What lecithin/sphingomyelin suggest lung maturity?

A

> 2

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8
Q

When do type 2 pneumocytes begin producing surfactant?

A

22-26 weeks

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9
Q

When does PEAK production of surfactant take place?

A

35 wks ~ ish

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10
Q

What can be administered to hasten lung maturity?

A

Betamethasone

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11
Q

alveolar collapse is directly proportional to what?

A

Surface tension (^ surface tension ~ ^ likelihood of collapse)

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12
Q

Alveolar collapse is inversely related to what?

A

Radius

Bigger radius ~ less likely to collapse
Smaller radius ~ more likely to collapse

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13
Q

What is lecithin and what is sphingomyelin?

A

Lecithin: surfactant
Sphingomyelin: surfactant precursor

Ratio of these two will aid providers in determining the state of fetal lung

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14
Q

Where should a PREDUCTAL pulse oximetry be placed?

A

Right upper extremity

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15
Q

Where should the POSTDUCTAL pulse oximeter be placed?

A

Lower extremity

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16
Q

What are the 6 risk factors to resp distress syndrome in the neonate?

A

Low birth weight
Prematurity
Hyperoxia
Babies of DM mommas
Barotrauma
Endobronchial intubation

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17
Q

Where is a congenital diaphragmatic hernia most likely to occur?

A

Foramen of Bochdalek (usually left side)

***POSTEROLATERAL

Remember when looking at these pics, they look up!! (Stomach looking up)

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18
Q

What are some finding with congenital diaphragmatic hernia?

A

Resp distress
SCAPHOID abdomen (sunken in)
BARREL chest
Gastric sounds in chest

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19
Q

What is the mass affect in congenital diaphragmatic hernia?

A

Mass affect of abd organs impair lung development leading to pulmonary HYPOPLASIA

20
Q

How does poor lung development in congeniti diaphragmatic hernia affect the neonate?

A

Increase PVR
Pulmonary HTN
Impaired airway development
Airway reactivity

21
Q

What are the anesthetic goals during a case with a congenital diaphragmatic hernia?

A

> PIP < 25-30
may need permissive hypercapnia
avoid conditions that ^ PVR
one lung vent may be required
abd closure ^ PIP ~ may need temp ventral hernia

22
Q

What should preductal SpO2 be?

A

> 90%

23
Q

After diagnosis of CDH, how long is repair delayed?

A

5-15 days

24
Q

What are the two most common congenital abdominal wall defects?

A

Omphalocele
Gastroschisis

25
Q

What are the main traits of Omphalocele?

A

Location: midline *umbilicus
Organ: bowel and Liver (sometimes)
Covering: yes
Incidence: 1:5,000
Co-existing dx: yes (trisomy 21, beckwith-wiedemann, cardiac defects)
Surgery: less urgent (require ❤️ work up)
Primary closure: prosthetic silo (may be staged)

26
Q

What are the main traits of Gastroschisis?

A

Location: off midline (usually rt of umbilicus)
Organ: bowel
Covering: no
Incidence: 1:2,000
Co-existing dx: JUST prematurity
Surgery: more urgent (w/ in 24 hrs) ~ higher risk of fluid and heat loss
Primary closure: prosthetic silo (may be staged)

27
Q

What is the anesthetic management for Gastroschisis?

A

> peak pressure < 25-30
closure may increase intra-abdominal pressure
^ abd pressure ~ decreased venous return ~ decreased CO
NO NITROUS OXIDE
expect SIGNIFICANT fluid and electrolyte shifts (IVF 150-300 mL/kg/day)

28
Q

What is pyloric stenosis?

A

Hypertrophy if the pyloric muscle creates a mechanical obstruction at the gastric outlet (b/t stomach and duodenum)

29
Q

Because patients with pyloric stenosis vomit (a bunch), the patient will present with?

A

Metabolic alkalosis
Hyponatremia
Hypokalemia
Alkaline urine

30
Q

What happens if vomiting persists/dehydration is not corrected in a patient with pyloric stenosis?

A

Impaired tissue perfusion > latic acid production > METABOLIC ACIDOSIS

31
Q

Is pyloric stenosis a medical or surgical emergency?

A

MEDICAL!

These children should NOT proceed to the OR until patient is adequately volume resuscitated ~ electrolytes and renal fx tests should be normal

32
Q

What should the anesthetic provider anticipate during a pyloromyotomy?

A

Full stomach! ~ empty stomach BEFORE induction ~ sucks but necessary

Intubate awake or RSI and extirpate Awake

33
Q

What babies are at risk for NEC (necrotizing enterocolitis)?

A

Prematurity < 32 weeks
Low birth weight < 1500g

34
Q

Which anesthetic gas is avoided in NEC?

A

Nitrous

35
Q

What part of the bowel does NEC affect?

A

Terminal ileum and proximal colon

36
Q

What action (if taken toooo early) can cause NEC in a premature baby?

A

Early feeding

Early feeding > decreased absorption > stasis > bacteria > infection

37
Q

What is the MOST significant risk factor for retinopathy of prematurity?

A

Prematurity

38
Q

What does retinopathy of prematurity cause?

A

Abnormal vascular development in the retina ~ these vessels are at risk of vasoconstriction and hemorrhage.

Dysfunctional healing causes scarring ~ when scar contract they pull on the retina leading to detachment and blindness.

39
Q

When does vasculogenesis occur?

A

16-44 weeks post conception

40
Q

What two phases is ROP defined by?

A

Phase one: inhibited growth of retinal vessels

Phase 2: overgrowth of abnormal vessels with fibrous bands that precipitate retinal detachment

41
Q

Until retinal maturation is complete (up to 44 weeks) what should the SpO2 be?

A

89-94%

42
Q

Based on experimental animal data, what anesthetic agent is LEAST likely to cause apoptosis?

A

Precedex!!!

43
Q

What type of drugs tend to cause apoptosis?

A

Drugs that antagonize the NMDA (ketamine) or stimulate the GABA (propofol, benzos, nitrous, volatile agents, etomidate, barbs)

44
Q

What is kernicterus?

A

Fetal encephalopathy

(Condition of increased bilirubin)

45
Q

What is the treatment for kernicterus?

A

Phototherapy
Exchange transfusion

Apex (47 decks)

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