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SEE Stuff > Neonate 1 - Anatomy & Physiology > Flashcards

Neonate 1 - Anatomy & Physiology Flashcards

1
Q

Normal vital signs for newborn

A

HR 140
RR 40-60
SBP 70
DBP 40

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2
Q

Normal vital signs for 1yr old

A

HR 130
RR 40
SBP 95
DBP 60

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3
Q

Normal vital signs for 3 yr old

A

HR 100
RR 30
SBP 100
DBP 65

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4
Q

Normal vital signs for 12 yr old

A

HR 80
RR 20
SBP 110
DBP 70

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5
Q

Why is the neonates minute ventilation higher than the adult?

A

Oxygen consumption and CO2 production is 2x that of adults - neonate must increase alveolar ventilation accordingly.

Metobolically more efficient to increase RR than TV

newborns have a higher RR but SAME TV as an adult on a per weight basis (6ml/kg)

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6
Q

What is primary determinant of BP in neonate?

A

HR is primary determinant of CO and SBP

BP=HR X SV X SVR

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7
Q

Describe autonomic influence of newborns heart

A

Autonomic innervation of heart is immature at birth.

SNS LESS mature than PNS

Stressful situations (laryngoscopy, suctioning) may cause bradycardia) - admin atropine prior

Additionally, baroreceptor reflex is poorly developed - so reflex fails to increase HR in periods of hypovolemia

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8
Q

Contrast breathing pattern of adults vs infants

A

adults - mouth or nose breathers

Infants - preferential nose breather until 5 months

(BL Choanal atresia may require emergency airway management is infant unable to breath)

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9
Q

Contrast size of tongue in adults vs infants

A

Adult - small relative to oral volume

Infant - large relative to oral volume
(tongue closer to soft palate = more likely to obstruct upper airway) & (more difficult to displace)

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10
Q

Contrast neck length

A

Adult - longer

Infant - shorter
more acute angle required to visualize glottis

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11
Q

Contrast epiglottis shape

A

Adult - leaf (C-shaped), floppier, shorter

Infant - U (omega shaped), stiffer, longer

stiff epiglottis makes it more difficult to displace

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12
Q

Contrast vocal cord position

A

Adult - perpendicular to trachea

Infant - anterior slant

visualization and passage of ETT may be more difficult

ETT may get stuck in anterior commissure

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13
Q

Contrast laryngeal postion in regards to C-spine

A

Adult - C5-C6

Infant - C3-C4

Larynx is more superior/cephalad/rosteral but NOT more anterior (only time its more ‘anterior” is during neck flexion)

same as adult at 5-6 yrs old

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14
Q

Contrast narrowest points of airway

A

Adult - glottis (vocal cords)

Infant - cricoid OR glottis

resistance to ETT beyond VC is likely at cricoid ring

Cricoid prone to inflammation –> stridor/obstruction

poiseuilles law = small changes in radius can significantly increase resistance to airflow (R^4th)

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15
Q

Contrast subglottic airway shape

A

Adult - cylinder

Infant - funnel

resistance to ETT beyond VC is likely at cricoid ring

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16
Q

Contrast orientation of R mainstream bronchus

A

Adult - more vertical (right 25, left 45)

Infant - less vertical

up to age 3, both bronchi take off at 55 degrees

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17
Q

Contrast optimal intubation postion

A

Adult - sniffing position

Infant - head on bed with shoulder roll

in infant - sniffing postion will place glottic opening more anterior - bad

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18
Q

Compare O2 consumption, alveolar ventilation, RR, TV

A 
ADULT
O2 consumption: 3.5 ml/kg/min
Alveolar vent: 60 ml/kg/min
RR: 15
TV: 6 ml/kg
INFANT:
O2 consumption: 6 ml/kg/min
Alveolar vent: 130 ml/kg/min
RR: 35
TV: 6 ml/kg
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19
Q

Why do neonates desat faster than adults

A

Neonates have:
Increased O2 consumption
Increased alveolar ventilation
Slightly decreased FRC

Net result = increased ratio of alveolar ventilation relative to size of FRC = faster gas turnover = O2 supply in FRC is quirky exhausted during apnea

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20
Q

Why is inflation induction faster with neonate compared to adult?

A

Increased alveolar ventilation compared to FRC = faster turnover gas turnover of FRC = faster inhalation induction

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21
Q

What is the difference between fast and slow muscle twitch fibers? How does this relate to neonatal pulmonary mechanics?

A

Type 1: slow twitch muscle fibers built for endurance - resistant to fatigue

Type 2: fast twitch muscle fibers built for shirt bursts of energy - tire easily

Neonate diaphragm has 25% type 1 fibers while the adult has 55% (why neonates fatigue more easily)

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22
Q

Compare and contrast FRC, VC, TLC, RV, CC, TV

A 
ADULT:
FRC - 34 ml/kg
VC - 70 ml/kg
TLC - 86 ml/kg
RV - 16 ml/kg
CC - 23 ml/kg
TV - 6 ml/kg
INFANT:
FRC - 30 ml/kg (less)
VC - 35 ml/kg (less)
TLC - 63 ml/kg (less)
RV - 23 ml/kg (more)
CC - 35ml/kg (more)
TV - 6 ml/kg (same)
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23
Q

Mothers ABG at term

A

pH: 7.40
PaO2: 90
PCO2: 30

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24
Q

ABG umbilical vein (placenta to fetus)

A

pH: 7.35
PaO2: 30
PCO2: 40

placenta to fetus explains why O2 is higher - delivering O2 rich blood

25
Q

ABG umbilical arteries (fetus to placenta)

A

pH: 7.30
PaO2: 20
PCO2: 50

O2 has been used (so its lower) and it carries more CO2

26
Q

ABG of newborn at 10min, 1hr, 24 hr

A

10 min
pH: 7.20
PaO2: 50
PCO2: 50

(newborns come into the world hypoxic, acidotic, and retaining CO2)

1hr
pH: 7.35
PaO2: 60
PCO2: 30

24hr
pH: 7.35
PaO2: 70
PCO2: 30

27
Q

How does hypoxemia affect ventilation in newborn?

A

respiratory control does not mature until 42-44 weeks post conceptual age

BEFORE maturation - hypoxemia depresses ventilation

AFTER maturation - hypoxemia stimulates ventilation

28
Q

What is the P50 of fetal HBG? why is this important?

A

P50 is 19mmHg

shift to the left

HGBF benefits fetus by creating an oxygen partial pressure gradient across the utter-placental membrane that facilitates passage of O2 from mother to fetus

29
Q

Why does fetal HGB have a higher affinity for O2?

A

Adult HGB consist of 2 alpha & 2 beta chains

Fetal HGB consist of 2 alpha & 2 gamma chains

2,3 DPG causes a right shift in oxyhgb curve BUT binding site for 2,3 DPG is only on the beta chain (adult). Since HGBF has gamma instead of beta, it does night bind 2,3 DPG. This shifts the curve to the left and explains why fetal HGB has a higher affinity for O2.

30
Q

Discuss physiologic anemia of the infant

A

In the first 2 months of life, erythrocytes containing HGB Fare replaced by those that produce HGBA. After 6 months, HGB F is completely replaced by HGB A. At this time - P50 same as adult.

At birth HGB is 17. At 2-3 months there is physiologic anemia and HGB declines to 10. Should normal out at 4-6 most.

31
Q

What is the dose for PRBC transfusion in the neonate? how much will this increase HBG?

A

Dose = 10-15ml/kg

10ml/kg will increase HGB by 1-2 g/dL

32
Q

Indications for FFP transfusion in neonate

A

Emergency reversal of warfarin

Correction of coagulopathic bleeding with increased PT >1.5 to increased PTT

Correction of coagulopathic bleeding if > 1 blood volume and been replaced and coagulopathic studies not easily obtained

(FFP is NOT for expansion of intravascular volume)

33
Q

What is the dose of FFP transfusion in neonate?

A

Dose = 10-20ml/kg

34
Q

When is platelet transfusion indicated in the neonate? what is the dose?

A

Platelet transfusion recommend for invasive procedures to maintain platelet wound about 50,000

Dose = 10-20ml/kg

35
Q

Describe physiologic changes that occur with massive transfusion

A
  • Acidosis from inadequate O2 and serum lactate
  • Alkalosis from citrate metabolism into bicarb in the liver
  • hypothermia from cold blood
  • hyperglycemia from glucose in stored blood
  • hypocalcemia from citrate
  • hyperkalemia from admin of older blood (admin of PRBCs to neonate can lead to hyperK and cardiac arrest. Risk reduced by admin washed or fresh cells < 7 days old)
36
Q

normal H&H at birth, 3 months, 6-12 mos

A

Birth: 14-20 / 45-65

3 mos: 10-14 / 31-41

6-12 mos: 11-15 / 33-42

37
Q 
EBL for 
preterm neonate
term neonate
infant
child <1
A

Preterm neonate: 90-100 ml/kg
Term neonate: 80-90
Infant: 75-80
Child <1: 70-75

38
Q

A 3kg term neonate requires emergency ex lap for nec. Her starting HCT is 50. What is the MABL to maintain an HCT of 40?

A

3 X 80-100 = 240-300

50-40 = 10

240-300 X (10/50) = 48-60 ml

39
Q

When does GFR and renal tubular function achieve full maturation?

A

Normal GFR 8-24 mos

Normal tubular function ~ 2 years
(in first few days of life, neonate is obligate sodium loser. After that, Peter to retain sodium than to lose it. Also has tendency to lose glucose in urine)

40
Q 
Water distribution in
Preterm:
Neonate:
Child:
Adult:
A

Preterm:
TBW% 85 (little water sacs)
ECF% 60
ICF% 25

Neonate:
TBW% 75
ECF% 40
ICF% 35

Child (1yr) & Adult are SAME
TBW% 60
ECF% 20
ICF% 40

** there is MORE ECF in preterm and neonate

** there is MORE ICF in children and adults

41
Q

What signs suggest dehydration in neonate?

A 
Sunken anterior fontanel
Weight loss (10% reduction in 1st wk normal)
Irritability or lethargy
Dry mucus membranes
Absence of tears
Decreased skin turgor
Increased HCT in absence of transfusion
42
Q

What is the 4:2:1 rules of fluid management

A

Step 1: 0-10kg -> 4 ml/kg/hr
Step 2: 10-20 kg -> 2 ml/kg/hr
Step 3: >20 kg -> 1 ml/kg/hr

43
Q

How should NPO fluid deficit be replaced?

A

multiply its hourly fluid maintenance X hours NPO

1st hour: 50%
2nd hour: 25%
3rd hour: 25%

44
Q

How should 3rd space loss be replaced?

A

minimal surgical trauma: 3-4 ml/kg/hr
moderate surgical trauma: 5-6 ml/kg/hr
major surgical trauma: 7-8 ml/kg/hr

45
Q

Ratio to replace blood loss with:
Crystalloids
Colloids
Blood

A

Crystalloids: 3:1 ratio
Colloids: 1:1 ratio
Blood: 1:1 ratio

46
Q

Which pediatric population should receive IVF that contain glucose

A

routine use of glucose containing products NOT recommended

Reserved for infants/children at risk for developing hypoglycemia:
Prematurity
Newborns of diabetic mothers
Children w/ diabetes who received insulin that day
Children who receive glucose based parenteral nutrition

47
Q

What is the CO of newborns and how does this affect pharmacokinetics?

A

In newborn, CO is 200ml/kg/min, which means drugs are delivered to and removed from circulation at a faster rate than adults

48
Q

Discuss plasma protein binding in neonate

A

Plasma proteins are though of a “sink” for drugs. A drug bound to plasma protein can not exert a physiologic effect.

Before 6 mos of age = lower concentrations of albumin and A1AG
Drugs that are usually highly protein bound will display a higher free level =. increased risk of toxicity

49
Q

Discuss MAC in children

A

MAC varies with age
Infant 1-6 months = MAC higher than adult
Infant 2-3 months = HIGHEST MAC
Neonate 0-30 days = MAC lower than infant
Premature = MAC lower than neonate

MAC for Sevo is different
0 days - 6 mos = MAC higher (3.2%)
6-12 mos = MAC is lower but still higher than adults (2.5%)

50
Q

Volume of distribution of water soluble drugs in neonate

A

neonates have a greater % if TBW, so they require HIGHER doses of water soluble drugs to achieve a given plasma concentration

(NMBs are highly water soluble)

51
Q

Adipose content in neonate in regards to drugs that require fat for redistribution

A

Neonates have a lower % of fat and muscle mass = Drugs that require fat for redistribution and termination have a LONGER DOA

52
Q

Discuss BBB in neonates

A

Immature BBB allows for passage of drugs that would otherwise not be able to enter the brain

Partially explains sensitivity to sedative hypnotics

53
Q

What BG level is considered hypoglycemia in newborns?

A

just remember <40!

54
Q

How do you dose SUCCS in the neonate?

A

2mg/kg

d/t relatively higher ECF (Vd is larger)

55
Q

How do you dose NDNMBs in the neonate?

A

SAME as adult on mg/kg bases

although ECF is higher, the NMJ is highly sensitive to effects of NDNMBs. These cancel each other out

56
Q

What is the IM dose for SUCCS and which IM site has the fastest inset of action

A

Neonates - 5 mg/kg

Children 4 mg/kg

intralingual approach via the submittal approach has the fastest onset

57
Q

What is the primary hemodynamic concern for the small child who receives a second dose of SUCCS?

A

In children <5, succs may cause bradycardia or asystole. This may occur after the first dose but is more likely after repeat admin.

IV atropine (0.02 mg/kg) can mitigate this response

58
Q

An infant that is susceptible to MH developed laryngospasm during induction. There is no IV in place. What is the best drug to give at this time?

A

ROC is the only NDNMB that can be given via IM route

<1 = 1 mg/kg
>1 = 1.8 mg/kg

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