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Advanced Principles II > Neonatal II > Flashcards

Neonatal II Flashcards

1
Q

Most neonates with esophageal atresia also have:

A

Tracheoesophageal Fistula

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2
Q

What is the most common type of TEF?

A

C

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3
Q

What percentage of neonates with TEF suffer from other congenital anomalies?

A

50-70%

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4
Q

What congenital anomalies are associated with tracheoesophageal fistulas?

A

VACTERL

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5
Q

What percentage of neonates with esophageal atresia also have a cardiac defect?

A

20%

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6
Q

What type of induction is ideal for neonates with TEF?

A

An induction that maintains spontaneous breathing and avoids positive pressure

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7
Q

Where should an ETT be placed if the neonate has TEF?

A

Below the fistula but above the carina

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8
Q

What are risk factors for neonatal RDS?

A

Maternal Diabetes
Intubation
Oxygen toxicity
Prematurity
SGA
Barotrauma

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9
Q

How is an amniocentesis used to assess fetal lung maturity?

A

Allows comparison between Lecithin (surfactant) to Sphingomyelin (the precursor to surfactant)

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10
Q

What L/S ratio is reassuring?

A

> 2 suggests adequate lung development

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11
Q

Where is a preductal SpO2 measured?

A

RUE

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12
Q

Where is a postductal SpO2 measured?

A

Lower extremity

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13
Q

If an arterial line is required for a neonate, what artery is preferred?

A

A preductal one

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14
Q

A wide gradient between pre and post ductal SpO2 suggests:

A

pHTN
R-to-L shunt
Return to fetal circulation via the PDA

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15
Q

Where do diaphragmatic hernias usually occur?

A

Foramen of Bochdalek (usually left)

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16
Q

What are the three possible sites for diaphragmatic hernia?

A

Foramen of Bochdalek (posterolateral)
Foramen of Morgagni (Parasternal)
Around the esophagus (paraesophageal)

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17
Q

In a neonate with a diaphragmatic hernia, PIP should be kept less than:

A

25-30

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18
Q

After diagnosis, how long is surgical repair of a diaphragmatic hernia delayed?

A

5-15 days to optimize

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19
Q

What are three things that must be avoided in the neonate with a diaphragmatic hernia?

A

Hypoxia
Acidosis
Hypothermia

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20
Q

What’s the difference between gastroschisis and omphalocele?

A
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21
Q

How does pyloric stenosis present?

A

Palpable olive-shaped mass just below the xiphoid
Non-bilious projectile vomiting

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22
Q

When does pyloric stenosis occur?

A

the first 2-12 weeks of life

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23
Q

Is pyloric stenosis more common in males or females?

A

Males

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24
Q

What bolus and maintenance fluid should be used in a neonate with pyloric stenosis?

A

Bolus: 20ml/kg NS
Maintenance: D5 1/2 NS at 1.5x the normal maintenance rate

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25
Q

What is the most common complication after surgical repair of a pyloric stenosis?

A

Postop apnea, because the CSF remains alkalotic longer than serum, so their respiratory drive is suppressed

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26
Q

How does pyloric stenosis impact neonatal urine?

A

Initially, alkalotic because it’s wasting bicarb
Late stage, acidotic, because dehydration is so bad it’s excreting H to retain Na

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27
Q

What are the two biggest risk factors for NEC?

A

Low birthweight
Prematurity

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28
Q

What is the most likely cause of NEC?

A

Early feeding

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29
Q

Which regions of the bowel are affected by NEC?

A

Terminal Ileum
Proximal Colon

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30
Q

When is retinal maturation complete?

A

Up to 44 WGA

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31
Q

Which anesthetics have been shown to cause apoptosis in animal models?

A

Any drug that:
1. Antagonizes NMDA
2. Agonizes GABA

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32
Q

Which anesthetic does not seem to cause apoptosis?

A

Precedex, Opioids, Xenon

33
Q

Bilirubin is a byproduct of:

A

RBC breakdown

34
Q

How is bilirubin metabolized?

A

Glucuronyl Transferase. This pathway isn’t mature until a week or so

35
Q

What is kernicterus?

A

Fetal encephalopathy from bilirubin

36
Q

The umbilical vein carries:

A

oxygenated blood TOWARD the fetus

37
Q

The umbilical arteries carry:

A

Deoxygenated blood AWAY from the fetus

38
Q

The Ductus Venosus shunts blood from:

A

The umbilical vein to the IVC, bypassing the liver

39
Q

The Ductus Arteriosus shunts blood from:

A

The pulmonary artery to the aorta, bypassing the lungs

40
Q

In the fetus, SVR is (low/high) and PVR is (low/high)

A

SVR is low
PVR is high

41
Q

What causes the ductus arteriosus to close?

A

a decrease in PGE1, which is produced by the placenta

42
Q

A PDA causes what kind of murmur?

A

Continuous murmur, throughout systole and diastole

43
Q

When does the ductus venosus anatomically close?

A

Cord clamping

44
Q

When does the foramen ovale anatomically close?

A

About three days

45
Q

What does the DA become in adults?

A

Ligamentum Arteriosum

46
Q

What is the calculation for PVR?

A
47
Q

What is the calculation for SVR?

A
48
Q

Does light anesthesia increase or decrease PVR?

A

Increases

49
Q

Does hypothermia increase or decrease PVR?

A

Increase

50
Q

Does anemia increase or decrease PVR?

A

Decrease, because hemodilution reduces viscosity

51
Q

Does atelectasis increase or decrease PVR?

A

Increase

52
Q

What are the cyanotic defects?

A
53
Q

What are the acyanotic defects?

A
54
Q

Will a neonate with Tetralogy of Fallot have a faster or slower inhalation induction?

A

Slower
Any cyanotic defect decreases flow through the lungs, which will slow down induction

55
Q

Which inhalational induction agents will be MOST effected by a cyanotic heart defect?

A

The more insoluble, the more they’ll be delayed
Nitrous and Des will be most effected, Iso will be least

56
Q

Will a neonate with truncus arteriosus have a faster or slower IV induction?

A

Faster, because the anesthetic is bypassing the lungs (cyanotic) and entering the VRG group faster

57
Q

What are the hemodynamic goals with cyanotic defects?

A
58
Q

What are the hemodynamic goals with acyanotic heart defects?

A
59
Q

Will an acyanotic heart defect prolong or shorten an inhalation induction?

A

Shouldn’t have any effect

60
Q

Will an acyanotic heart defect prolong or shorten an IV induction?

A

Maybe prolong, but not by a whole lot

61
Q

What is Eisenmenger’s Syndrome?

A

A patient with a L-to-R (acyanotic) shunt develops pulmonary HTN, and the defect converts to a R-to-L shunt (cyanotic)

62
Q

What is Ebstein’s Anomaly?

A

The tricuspid leaflets are further down toward the apex, resulting in a tiny RV and a massive RA

63
Q

What is Ebstein’s Anomaly a cyanotic heart defect?

A

Because it occurs with an ASD about 50% of the time, and since the pressure is higher than normal because of the TV abnormality, blood shunts from R to L

64
Q

Trisomy 21 is associated with what heart defects?

A

ASD, VSD, PDA

65
Q

Turner syndrome is associated with what heart defects?

A

Coarctation of the Aorta

66
Q

Maternal infection with Rubella is associated with what defect?

A

PDA and VSD

67
Q

Maternal diabetes increases the risk of what defect?

A

VSD

68
Q

How does a PFO differ from an ASD?

A

An ASD is a straight up hole, and it allows blood to flow from L to R according to pressure
A PFO allows is a channel that allows clots to flow from R to L when a clot blocks flow from the RA to the RV

69
Q

What is the most common sign of R sided heart failure in infants?

A

It’s usually JUST hepatomegaly. They rarely have pedal edema or JVD

70
Q

What is the most common cyanotic heart defect?

A

Tetralogy of Fallot

71
Q

What are the four defects of ToF?

A
  1. RVOT obstruction
  2. RV Hypertrophy
  3. VSD
  4. Overriding Aorta (receives blood from both ventricles)
72
Q

What precipitates a Tet Spell?

A

SNS activation: pooping, crying, pain, agitation etc.
Just like with HOCM, any increase in contractility increases RVOT obstruction

73
Q

What do children squat when they’re having a tet spell?

A

It increases preload -> increases RV pressure -> decreases RVOT obstruction

74
Q

What is the treatment for a perioperative Tet Spell?

A

100% FiO2
IVF to increase preload
Increase SVR (pressors)
Reduce contractility (deepen anesthesia or give esmolol)
Avoid inotropes
Avoid high airway pressures
Put the child in knee-chest position

75
Q

What are the hemodynamic goals for a patient with ToF?

A
76
Q

What is the best induction agent for a ToF patient?

A

Ketamine (the increase in contractility is lower than the increase in SVR)

77
Q

Which narcotics should be avoided in patients with ToF?

A

Any drug that releases histamine should be avoided, because histamine reduces SVR:
Morphine and meperidine, atracurium

78
Q

Do babies with ToF tend to be anemic or polycythemic?

A

Polycythemic, because of chronic hypoxia

79
Q

Would you expect to see a R or L axis deviation on the ECG of a neonate with ToF?

A

R, because of RV hypertrophy

Advanced Principles II (5 decks)

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