Neonatal emergencies 2 Flashcards
Which condition is MOST closely associated with gastroschisis?
a. prematurity
b. congenital heart disease
c. Beckwith-Weidemann syndrome
d. trisomy 21
a. prematurity
Defects in the abdominal wall of the infant include
omphalocele and gastroschisis
Which is more common omphalocele or gastroschisis?
ompalocele
Omphalocele is associated with
trisomy 21, cardiac defects, & Beckwith Wiedemann syndrome
Ompalocele includes ____________________–whereas gastroschisis does not
a covering over the abdominal viscera; does not include a covering over the abdominal viscera
The patient with gastroschisis is
sicker and at a higher risk of fluid and heat loss
Anesthetic considerations for omphalocele and gastroschisis include
monitoring thoracic and abdominal pressure along with meticulous attention to fluid balance and body temperature
Omphalocele is caused by
failure of gut migration from the yolk sac into the abdomen
Gastroschisis is caused by
occlusion of the omphalomesenteric artery during gestation
With gastroschisis, abdominal contents are
placed in a bag after delivery to minimize water and heat loss
Where should SpO2 be measured with gastroschisis and omphalocele?
lower extremity to monitor for impaired venous return
One should expect ____________ with anesthetic management of gastroschisis and omphalocele.
significant fluid and electrolyte shifts
What is a late finding in the patient with untreated pyloric stenosis?
a. hyponatremia
b. hyperkalemia
c. metabolic acidosis
d. alkaline urine
c. metabolic acidosis
Pyloric stenosis occurs when
hypertrophy of the pyloric muscle creates a mechanical obstruction at the gastric outlet
With pyloric stenosis, one can palpate
an olive-shaped mass just below the xiphoid process
The infant with pyloric stenosis presents with
non-bilious projectile vomiting leading to dehydration with hyponatremia, hypokalemia, hypochloremia, and metabolic alkalosis + compensatory respiratory acidosis
Pyloric stenosis is a ________________________ so pyloromyotomy should be
medical (not surgical) emergency; postponed until the fluid, electrolyte, and acid-base status are optimized
With pyloric stenosis, one should anticipate a
full stomach; empty the stomach before induction, intubate either awake or with RSI, and extubate awake
With pyloric stenosis, if dehydration is not correct,
impaired tissue perfusion increases lactic acid production (metabolic acidosis) this is a late complication
Severe hydration with pyloric stenosis
should be corrected BEFORE surgery with 20 mL/kg of 0.9% NaCl
Maintenance fluids for pyloric stenosis consists of
D5 0.45% NaCl at 1.5 x the calculated maintenance rate
What is common postoperatively with pyloric stenosis?
apnea; possibly due to CSF pH remaining alkalotic even after serum acid-base status is normalized
Placing an oro- or nasogastric tube after induction with pyloric stenosis
can be used to assess for an air leak following surgical repair which suggests a mucosal perforation
When is pyloric stenosis most commonly diagnosed?
first 2 to 12 weeks of life
How does pyloric stenosis impact urinary pH?
early-stage= alkalotic urine secondary to bicarb excretion
late stage- acidic urine secondary to hydrogen excretion
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
c. 50% oxygen + 50% air
Risk factors for necrotizing enterocolitis include
prematurity (<32 weeks)
low birth weight (<1,500 g)
Necrotizing enterocolitis is likely the result of
early feeding
With necrotizing enterocolitis, impaired absorption by the gut leads to
stasis, bacterial overgrowth, and infection
Necrotizing enterocolitis increases the risk of
bowel perforation
How are babies with necrotizing enterocolitis managed?
medically; but bowel perforation necessitates bowel resection and usually colostomy
Patients with necrotizing enterocolitis often have
metabolic acidosis and require substantial fluid replacement
_________ should be avoided with necrotizing enterocolitis.
Nitrous oxide
Diagnosis of necrotizing enterocolitis includes
fixed dilated intestinal loops
pneumatosis intestinalis (gas cysts in the bowel), portal vein air, ascites, and free air in the abdomen
Bowel resection early in life can lead to
short gut syndrome (nutrient malabsorption)
Necrotizing enterocolitis affects what region of the bowel?
terminal ileum and proximal colon
Select the MOST significant risk factor for retinopathy of prematurity.
a. sepsis
b. prematurity
c. hypoxemia
d. intraventricular hemorrhage
b. prematurity
The most important risk factors for retinopathy of prematurity include
prematurity and hyperoxia
Retinopathy of prematurity causes
abnormal vascular development in the retina
The immature retinal blood vessels with retinopathy of prematurity are at risk of
vasoconstriction and hemorrhage which can create scars
When scars retract with ROP, they
pull on the retina, causing retinal detachment and blindness
When is retinal maturation complete?
up to 44 weeks after conception
Until retinal maturation is complete, supplemental oxygen should be
minimized to maintain SpO2 between 89-94%
Where should SpO2 be monitored for ROP?
preductal location (RUE)
ROP is defined by
two phases
What is phase 1 of ROP?
inhibited growth of retinal vessels
What is phase 2 of ROP?
overgrowth of abnormal vessels with fibrous bands that extend to the vitreous gel which can precipitate retinal detachment
