Neonatal emergencies 2 Flashcards

1
Q

Which condition is MOST closely associated with gastroschisis?
a. prematurity
b. congenital heart disease
c. Beckwith-Weidemann syndrome
d. trisomy 21

A

a. prematurity

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2
Q

Defects in the abdominal wall of the infant include

A

omphalocele and gastroschisis

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3
Q

Which is more common omphalocele or gastroschisis?

A

ompalocele

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4
Q

Omphalocele is associated with

A

trisomy 21, cardiac defects, & Beckwith Wiedemann syndrome

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5
Q

Ompalocele includes ____________________–whereas gastroschisis does not

A

a covering over the abdominal viscera; does not include a covering over the abdominal viscera

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6
Q

The patient with gastroschisis is

A

sicker and at a higher risk of fluid and heat loss

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7
Q

Anesthetic considerations for omphalocele and gastroschisis include

A

monitoring thoracic and abdominal pressure along with meticulous attention to fluid balance and body temperature

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8
Q

Omphalocele is caused by

A

failure of gut migration from the yolk sac into the abdomen

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9
Q

Gastroschisis is caused by

A

occlusion of the omphalomesenteric artery during gestation

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10
Q

With gastroschisis, abdominal contents are

A

placed in a bag after delivery to minimize water and heat loss

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11
Q

Where should SpO2 be measured with gastroschisis and omphalocele?

A

lower extremity to monitor for impaired venous return

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12
Q

One should expect ____________ with anesthetic management of gastroschisis and omphalocele.

A

significant fluid and electrolyte shifts

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13
Q

What is a late finding in the patient with untreated pyloric stenosis?
a. hyponatremia
b. hyperkalemia
c. metabolic acidosis
d. alkaline urine

A

c. metabolic acidosis

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14
Q

Pyloric stenosis occurs when

A

hypertrophy of the pyloric muscle creates a mechanical obstruction at the gastric outlet

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15
Q

With pyloric stenosis, one can palpate

A

an olive-shaped mass just below the xiphoid process

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16
Q

The infant with pyloric stenosis presents with

A

non-bilious projectile vomiting leading to dehydration with hyponatremia, hypokalemia, hypochloremia, and metabolic alkalosis + compensatory respiratory acidosis

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17
Q

Pyloric stenosis is a ________________________ so pyloromyotomy should be

A

medical (not surgical) emergency; postponed until the fluid, electrolyte, and acid-base status are optimized

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18
Q

With pyloric stenosis, one should anticipate a

A

full stomach; empty the stomach before induction, intubate either awake or with RSI, and extubate awake

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19
Q

With pyloric stenosis, if dehydration is not correct,

A

impaired tissue perfusion increases lactic acid production (metabolic acidosis) this is a late complication

20
Q

Severe hydration with pyloric stenosis

A

should be corrected BEFORE surgery with 20 mL/kg of 0.9% NaCl

21
Q

Maintenance fluids for pyloric stenosis consists of

A

D5 0.45% NaCl at 1.5 x the calculated maintenance rate

22
Q

What is common postoperatively with pyloric stenosis?

A

apnea; possibly due to CSF pH remaining alkalotic even after serum acid-base status is normalized

23
Q

Placing an oro- or nasogastric tube after induction with pyloric stenosis

A

can be used to assess for an air leak following surgical repair which suggests a mucosal perforation

24
Q

When is pyloric stenosis most commonly diagnosed?

A

first 2 to 12 weeks of life

25
Q

How does pyloric stenosis impact urinary pH?

A

early-stage= alkalotic urine secondary to bicarb excretion
late stage- acidic urine secondary to hydrogen excretion

26
Q

What is the MOST appropriate gas mixture for the neonate with necrotizing enterocolitis?
a. 30% oxygen + 70% nitrous oxide
b. 50% oxygen + 50% nitrous oxide
c. 50% oxygen + 50% air
d. 100% oxygen

A

c. 50% oxygen + 50% air

27
Q

Risk factors for necrotizing enterocolitis include

A

prematurity (<32 weeks)
low birth weight (<1,500 g)

28
Q

Necrotizing enterocolitis is likely the result of

A

early feeding

29
Q

With necrotizing enterocolitis, impaired absorption by the gut leads to

A

stasis, bacterial overgrowth, and infection

30
Q

Necrotizing enterocolitis increases the risk of

A

bowel perforation

31
Q

How are babies with necrotizing enterocolitis managed?

A

medically; but bowel perforation necessitates bowel resection and usually colostomy

32
Q

Patients with necrotizing enterocolitis often have

A

metabolic acidosis and require substantial fluid replacement

33
Q

_________ should be avoided with necrotizing enterocolitis.

A

Nitrous oxide

34
Q

Diagnosis of necrotizing enterocolitis includes

A

fixed dilated intestinal loops
pneumatosis intestinalis (gas cysts in the bowel), portal vein air, ascites, and free air in the abdomen

35
Q

Bowel resection early in life can lead to

A

short gut syndrome (nutrient malabsorption)

36
Q

Necrotizing enterocolitis affects what region of the bowel?

A

terminal ileum and proximal colon

37
Q

Select the MOST significant risk factor for retinopathy of prematurity.
a. sepsis
b. prematurity
c. hypoxemia
d. intraventricular hemorrhage

A

b. prematurity

38
Q

The most important risk factors for retinopathy of prematurity include

A

prematurity and hyperoxia

39
Q

Retinopathy of prematurity causes

A

abnormal vascular development in the retina

40
Q

The immature retinal blood vessels with retinopathy of prematurity are at risk of

A

vasoconstriction and hemorrhage which can create scars

41
Q

When scars retract with ROP, they

A

pull on the retina, causing retinal detachment and blindness

42
Q

When is retinal maturation complete?

A

up to 44 weeks after conception

43
Q

Until retinal maturation is complete, supplemental oxygen should be

A

minimized to maintain SpO2 between 89-94%

44
Q

Where should SpO2 be monitored for ROP?

A

preductal location (RUE)

45
Q

ROP is defined by

A

two phases

46
Q

What is phase 1 of ROP?

A

inhibited growth of retinal vessels

47
Q

What is phase 2 of ROP?

A

overgrowth of abnormal vessels with fibrous bands that extend to the vitreous gel which can precipitate retinal detachment