Neonate anat and phys Flashcards
How long is the neonate vs infant period?
Neonate - First month
Infant - First month to one year
Normal O2 consumption adult vs neonate?
Adult - 6mL/kg/min
Neonate - 3.5mL/kg/min
Normal alveolar ventilation adult vs neonate?
Adult - 130mL/kg/min
Neonate - 60mL/kg/min
Why do neonates desat faster than adults?
Increased VO2
Increased VA
Decreased FRC
pH, PaO2, and PaCO2 of mother at term?
pH - 7.40
PaO2 - 90
PaCO2 - 30
pH, PaO2, and PaCO2 of umbilical vein?
pH - 7.35
PaO2 - 30
PaCO2 - 40
pH, PaO2, and PaCO2 of umbilical arteries?
pH - 7.30
PaO2 - 20
PaCO2 - 50
How does pH, PaO2, and PaCO2 of the newborn change during the first 24 hours?
10 min - very acidotic (7.20) and hypoxic (PaO2 50)
1 hour- Trending up but PaO2 still 60
24 hours - Stabilizing with PaO2 at 70
How does hypoxemia effect ventilation before maturation? After?
What age is respiratory maturation?
Before - depresses ventilation
After - Stimulates ventilation
44 weeks post conception
Partial pressure of O2 on the P50 curve for adult? For neonate?
Neonate - 19
Adult - 26.5
What age is a decline in Hgb seen?
2 months (Hgb 10)
What age is Hgb F completely replaced?
6 months
Hgb at birth ?
17
Neonates receiving blood are at risk for what with potassium and calcium levels?
Risk for hyperkalemia from old blood
Hypocalcemia from citrate
Neonates receiving blood are at risk for what with glucose levels?
Hyperglycemia from dextrose in blood
Hgb level for blood being indicated vs needed?
<6 almost always transfusion
6-10 dependent on situation
NO UNIVERSAL TRIGGER
A blood volume loss of what percentage indicates a transfusion
> 15%
Dose for FFP?
10-20mL/kg
Dose for Plt?
1pack/10kg
From apheresis 5mL/kg
One pooled Plt will increase Plt by how much?
50,000
What is the transfusion trigger for a 2-month-old with severe cardiopulmonary disease
<13
What age should guidelines be followed for Plt transfusion?
4 months and older
How to calculate Hct?
Hgb X 3
EBL for premature neonate?
100 mL/kg
EBL for neonate?
90mL/kg
EBL for infant?
80mL/kg
EBL for premature for 1 year old?
70mL/kg
When compared to an adult, Kidney perfusion pressure of a neonate is?
Decreased
When compared to an adult, GFR of a neonate is?
Decreased
When compared to an adult, Diluting and concentrating ability of a neonate is?
Decreased
Are neonates good at conserving water? What about excreting water?
Bad at both
Sensitive to fluid status
Neonates’ insensible loss?
Very high. Loss through evaporation 4x higher than adults
Do neonates retain or excrete Na and glucose?
Excrete both
When does GFR and renal tubular function mature?
2 years old
Total body water of a premature neonate? Neonate? Child ? Adult?
85%
75%
60%
60%
Increased Hct tells you what about fluid status?
Dehyrdation
What age groups is ECF higher than ICF?
Premature neonates and neonates
How should fluid be replaced?
1st hour - 50%
2nd hour - 25%
3rd hour - 25%
Should glucose containing solutions be used for fluid replacement?
No
Use .9, albumin, plasmalyte
What serum glucose level do babies under 72 hours show hypoglycemia? Over 72 hours?
<72 hours ; level less than 30
> 72 hours ; level less than 40
Does GA mask hypoglycemia ?
Yes
Treatment for hypoglycemia? What if seizures are present?
10% dextrose at 2mL/kg
Double if seizures are present
Titrate glucose to maintain above 40
Third space loss and evaporation calculation?
Minimal surgery 3-4ml/kg/hr
Moderate 5-6
Major 7-10
Do not include in the first hour of anesthesia
Why are neonates sensitive to sedative hypnotics?
Immature BBB
Is more or less succ needed?
more
Black box warning for succ?
Hyperkalemia associated with undiagnosed muscular dystrophy
First line treatment for hyperkalemia ?
Calcium
Best sign of NMB recovery in neonates? Is a head life?
They are unable to life their heads or follow commands
- TOF > 90%
- Max inspiratory force less then -25cm H2)
Why do neonates need more succ?
Larger ECF - this offsets immature NMJ
Duration of succ in neonate and adult?
Same
What age has the highest MAC requirement?
2-3 months
about 3.2% sevo
