Neonates Part II Flashcards
Most common congenital defect of esophagus?
Esophageal atresia.
Key diagnostic indicator for TEF?
TEF: Transesophageal Fistula
Maternal polyhydramnios.
Most common type of TEF?
Type C.
TEF may occur in what association?
VACTERL association.
Percentage of neonates with Esophageal Atresia & cardiac defect?
~20%.
How to minimize risk of gastric aspiration during anesthesia?
- Head-up position
- Frequent suctioning
Why maintain spontaneous ventilation during induction?
- Positive-pressure ventilation can cause gastric distension
- G-tube placement minimizes this risk
Where place endotracheal tube in relation to fistula?
Below the fistula but above the carina.
How to detect right mainstem intubation?
Use a precordial stethoscope placed on the left chest.
When do type 2 pneumocytes start producing surfactant, and when is peak production?
- 22 - 26 weeks
- Peaking at 35 - 36 weeks
What risks are neonates without enough surfactant production exposed to?
- Respiratory distress syndrome (RDS)
- Hypoxemia
- Hypercarbia
- Acidosis
- Hemodynamic instability
- Death
What treatment is given pre-delivery to accelerate fetal lung maturity in RDS?
Maternal corticosteroids.
What are the post-delivery treatments for RDS?
- CPAP
- Mechanical ventilation
- Exogenous surfactant
How should oxygen saturation be monitored post-delivery in RDS cases?
- Monitor preductal and postductal oxygen saturation
- For pulmonary hypertension, shunting, and fetal circulation.
Why does positive pressure ventilation in poor lung compliance increase pneumothorax risk?
- Increased pressure can cause lung overdistension
- Leading to air leakage into the pleural space
What does congenital diaphragmatic hernia allow to enter the thoracic cavity?
Abdominal contents.
Which is the most common site of herniation in congenital diaphragmatic hernia?
- Foramen of Bochdalek
- Typically on the left side
What consequences arise due to the mass effect of abdominal contents in the chest?
- Pulmonary hypoplasia
- Poor pulmonary vascular development
- Increased pulmonary vascular resistance
- Pulmonary hypertension
- Impaired airway development
- Airway reactivity.
How should peak inspiratory pressure (PIP) be managed during anesthesia to minimize risks?
- Keep PIP < 25 - 30 cm H2O
- To prevent barotrauma
- To prevent pneumothorax in the “good” lung
What conditions should be avoided during anesthesia to prevent exacerbating pulmonary vascular resistance (PVR)?
- Hypoxia
- Acidosis
- Hypothermia
How should oxygen saturation be monitored during anesthesia for congenital diaphragmatic hernia?
Monitor preductal oxygen saturation (Right Upper Extremity).
Why is surgery delayed in congenital diaphragmatic hernia cases?
- Surgery is delayed 5 - 15 days
- To stabilize pulmonary, cardiac, and metabolic status
In what situations might one-lung ventilation with a single lumen endotracheal tube be necessary?
- When one lung needs isolation
- Such as, in congenital diaphragmatic hernia.
What are omphalocele and gastroschisis?
Defects in abdominal wall development.
How do omphalocele and gastroschisis differ in terms of abdominal viscera covering?
- Omphalocele has a covering over the viscera
- While gastroschisis does not.
What are some associations of omphalocele?
- Trisomy 21
- Cardiac defects
- Beckwith-Wiedemann syndrome
What are some associations of gastroschisis?
Prematurity.
Which condition is more common, omphalocele or gastroschisis?
Omphalocele.
Which condition is associated with a sicker patient and higher risk of fluid and heat loss?
Gastroschisis.
What are important anesthetic considerations for omphalocele and gastroschisis?
- Monitor thoracic and abdominal pressures
- Pay attention to fluid balance
- Body temperature.
What is pyloric stenosis?
- Hypertrophy of the pyloric muscle
- Causing mechanical obstruction at the gastric outlet
How is pyloric stenosis characterized clinically?
- Non-bilious projectile vomiting
- Dehydration with hyponatremia
- Hypokalemia
- Hypochloremia
- Metabolic alkalosis
- Compensatory respiratory acidosis
What is the emergency management approach for pyloric stenosis?
- Optimize fluid
- Electrolyte, and acid-base status
- Before performing pyloromyotomy
What should be anticipated regarding stomach contents during anesthesia for pyloric stenosis?
A full stomach.
How should induction and intubation be approached in a patient with pyloric stenosis?
- Empty stomach before induction
- Intubate either awake or with rapid sequence induction (RSI)
- Extubate awake
What are the risk factors for necrotizing enterocolitis (NEC)?
- Prematurity (< 32 weeks)
- Low birth weight (< 1,500 g)
What is a likely cause of NEC?
- Early feeding leading to impaired gut absorption
- Stasis
- Bacterial overgrowth
- Infection
How is NEC managed in babies?
- Medically
- Bowel perforation may necessitate bowel resection and colostomy.
What are common complications seen in NEC patients?
- Metabolic acidosis
- Bowel perforation
- Requiring substantial fluid replacement.
Why should nitrous oxide be avoided in NEC cases?
It can increase the risk of bowel perforation.
What is myelomeningocele?
- A form of spina bifida
- The most common CNS defect
- occurring during the first month of gestation
Why is repair of myelomeningocele considered urgent?
- To avoid increasing the risk of bacterial contamination of the spinal cord
- Further deterioration of neural and motor function
In what position may neonates with large defects or severe hydrocephalus be placed for induction and intubation?
Lateral position.
How can anesthesia be induced for myelomeningocele repair?
Inhalation or intravenous technique.
During myelomeningocele repair, in what position is the procedure typically performed?
- Prone position
- With appropriate protection of all body parts.
Body Water Distribution Table
Omphalocele vs Gastroschisis
Fetal Circulation Diagram
Fetal Circulation Diagram 2
- Foramen Ovale
- Ductus Venous
- Ductus Arteriousus
PVR and SVR
Blue Baby Pathophysiology
Pink Baby Pathophysiology
- CV changes by Age
- Estimated blood volume by Age
Vocal Cords: Neonates vs Adult
- Breathing patterns
- Tongue
- Neck
- Epiglottis
- Vocal cords
- Laryngeal position
- Narrowest point
- Subglottic shape
- Right mainstay bronchus
- Intubation position
Oxygen Demand, Supply and Reserve
Mean Values for Normal Pulmonary Function
Spinal Column
