Neonatal / Pediatric Resuscitation

Question 1

Neonatal/pediatric anatomical differences

Answer 1

Rib cage is more elastic/flexible
“Baby” lungs
Mediastinum is more mobile
Bones of skull are soft
Liver/spleen are larger and more vascular
Bones are softer
Anterior fontanelle closes at 12-18 months
Posterior fontanelle closes by 2 months

Question 2

Peds BP

Answer 2

Infants <44 weeks post-conceptual age
…age (weeks) = neonate MAP
…40 weeks = minimum MAP of 40

Infants >44 weeks post-conceptual age
[age (years) x2] +90 = normal SBP
[age (years) x2] +70 = minimum SBP

Question 3

ETT sizing

Answer 3

Weeks gestation, move decimal

25 weeker = 2.5
35 weeker = 3.5

2.5mm <1kg
3.0mm <1-3kg
3.5-4.0mm >3kg
>1yr: (age +16)/4

Double for NGT, foley, suction
Quadruple for chest tube

Question 4

Peds hypovolemic shock

Answer 4

hemorrhage
free water loss
plasma loss

Kids have circulating blood volume of 75-80 ml/kg

ie 5kg baby = 500mL circulating volume.

25% volume loss can have a significant impact (for a 5kg baby that’s only 100mL blood loss to cause compensation)

Question 5

peds cariogenic shock

Answer 5

left ventricular dysfunction
…diastolic failure
…systolic failure
…apical ballooning
…myocarditis

Question 6

peds obstructive shock

Answer 6

obstruction of circulation/blood flow

cardiac tamponade
pulmonary emboli
tension pneumothorax
congenital disease

Question 7

peds distributive shock

Answer 7

container failure - leak
sepsis
anaphylaxis
neurogenic shock

reduced systemic vascular resistance

Question 8

peds tachycardia

Answer 8

Hypoxic?
Hypovolemic?
Hypotensive?

Don’t automatically assume SVT just because HR >150

Question 9

peds cardiac rhythms - SVT?

Answer 9

SVT vs ST?
220-age?
…rate = 280-290

Stable?
alert
normotensive

unstable?
decreased LOC
respiratory failure
hypotension

Question 10

peds bradycardia

Answer 10

Always bad

Need to maintain HR >100
Start compressions at <60bpm
PP ventilation
Increase FiO2
Begin compressions
Volume resuscitation
up to 30 days: 10mL/kg
>30 days: 20mL/kg

Question 11

peds pericarditis

Answer 11

viral (more common) or bacterial
…often recent viral illness

Sharp chest pain
Pain easily localized by patient
radiates to base of neck
patients unable to lay supine

EKG changes:
Global ST elevation, or isolated
Possibly no reciprocal changes
Downsloping P-R intervals

Question 12

STABLE

Answer 12

Sugar
Temperature
Airway
Blood pressure
Lab values
Emotional support

Question 13

NRP

Answer 13

HR > 100 is the goal
Resuscitate withPPV
Compressions if needed

All O2 treatments stop once minimum goal is achieved

Lowest amount of O2 based on ductal SpO2 after birth (right wrist SpO2)
1 min = 60-65% (treat if <60%)
2 min = 65-70% (treat if <65%)
3 min = 70-75% (treat if <70%)
4 min = 75-80% (treat if <75%)
5 min = 80-85% (treat if <80%)
10 min = 85-90% (treat if <85%)

After 24 hours, if pre-ductal oxygenation is <90%, it is likely a congenital heart defect

Question 14

peds fluid maintenance

Answer 14

Fluid Calculation Formula

4mL/kg up to 10kg PLUS
2mL/kg for 11-12kg PLUS
1mL/kg for 21kg and up

D5 1/2 NS

ie 8kg baby = 4mL x 8kg = 32mL/hr

ie 26kg baby = 4mL x 10 kg =40mL/hr PLUS
2mL x 10 kg =20mL/hr PLUS
1mL x 6 kg = 6mL/hr
Total maintenance fluid = 66mL/hr

Question 15

Neonate fluid maintenance

Answer 15

60-80 mL/kg/day - D10 <28 weeks
100m mL/kg/day - D10 >28 weeks

Glucose infusion rate
6-8mg/kg/day - D10 <28 weeks
Do not exceed D12
Goal is to increase rate and/or adjust % of dextrose

Question 16

Standard fetal circulation

Answer 16

Oxygen comes through inferior vena cava from placenta

High pressure right heart
Most blood classes the foramen ovale
RV blood moves from PA to the aorta through ducts arteriosis

Only 5% of blood flow that moves from placenta through this pathway moves into lungs/pulmonary circuit.