Neonates Part II

Question 1

Most common congenital defect of esophagus?

Answer 1

Esophageal atresia.

Question 2

Key diagnostic indicator for TEF?

TEF: Transesophageal Fistula

Answer 2

Maternal polyhydramnios.

Question 3

Most common type of TEF?

Answer 3

Type C.

Question 4

TEF may occur in what association?

Answer 4

VACTERL association.

Question 5

Percentage of neonates with Esophageal Atresia & cardiac defect?

Answer 5

~20%.

Question 6

How to minimize risk of gastric aspiration during anesthesia?

Answer 6

• Head-up position
• Frequent suctioning

Question 7

Why maintain spontaneous ventilation during induction?

Answer 7

• Positive-pressure ventilation can cause gastric distension
• G-tube placement minimizes this risk

Question 8

Where place endotracheal tube in relation to fistula?

Answer 8

Below the fistula but above the carina.

Question 9

How to detect right mainstem intubation?

Answer 9

Use a precordial stethoscope placed on the left chest.

Question 10

When do type 2 pneumocytes start producing surfactant, and when is peak production?

Answer 10

• 22 - 26 weeks
• Peaking at 35 - 36 weeks

Question 11

What risks are neonates without enough surfactant production exposed to?

Answer 11

• Respiratory distress syndrome (RDS)
• Hypoxemia
• Hypercarbia
• Acidosis
• Hemodynamic instability
• Death

Question 12

What treatment is given pre-delivery to accelerate fetal lung maturity in RDS?

Answer 12

Maternal corticosteroids.

Question 13

What are the post-delivery treatments for RDS?

Answer 13

• CPAP
• Mechanical ventilation
• Exogenous surfactant

Question 14

How should oxygen saturation be monitored post-delivery in RDS cases?

Answer 14

• Monitor preductal and postductal oxygen saturation
• For pulmonary hypertension, shunting, and fetal circulation.

Question 15

Why does positive pressure ventilation in poor lung compliance increase pneumothorax risk?

Answer 15

• Increased pressure can cause lung overdistension
• Leading to air leakage into the pleural space

Question 16

What does congenital diaphragmatic hernia allow to enter the thoracic cavity?

Answer 16

Abdominal contents.

Question 17

Which is the most common site of herniation in congenital diaphragmatic hernia?

Answer 17

• Foramen of Bochdalek
• Typically on the left side

Question 18

What consequences arise due to the mass effect of abdominal contents in the chest?

Answer 18

• Pulmonary hypoplasia
• Poor pulmonary vascular development
• Increased pulmonary vascular resistance
• Pulmonary hypertension
• Impaired airway development
• Airway reactivity.

Question 19

How should peak inspiratory pressure (PIP) be managed during anesthesia to minimize risks?

Answer 19

• Keep PIP < 25 - 30 cm H2O
• To prevent barotrauma
• To prevent pneumothorax in the “good” lung

Question 20

What conditions should be avoided during anesthesia to prevent exacerbating pulmonary vascular resistance (PVR)?

Answer 20

• Hypoxia
• Acidosis
• Hypothermia

Question 21

How should oxygen saturation be monitored during anesthesia for congenital diaphragmatic hernia?

Answer 21

Monitor preductal oxygen saturation (Right Upper Extremity).

Question 22

Why is surgery delayed in congenital diaphragmatic hernia cases?

Answer 22

• Surgery is delayed 5 - 15 days
• To stabilize pulmonary, cardiac, and metabolic status

Question 23

In what situations might one-lung ventilation with a single lumen endotracheal tube be necessary?

Answer 23

• When one lung needs isolation
• Such as, in congenital diaphragmatic hernia.

Question 24

What are omphalocele and gastroschisis?

Answer 24

Defects in abdominal wall development.

Question 25

How do omphalocele and gastroschisis differ in terms of abdominal viscera covering?

Answer 25

* Omphalocele has a covering over the viscera * While gastroschisis does not.

Question 26

What are some associations of omphalocele?

Answer 26

* Trisomy 21 * Cardiac defects * Beckwith-Wiedemann syndrome

Question 27

What are some associations of gastroschisis?

Answer 27

Prematurity.

Question 28

Which condition is more common, omphalocele or gastroschisis?

Answer 28

Omphalocele.

Question 29

Which condition is associated with a sicker patient and higher risk of fluid and heat loss?

Answer 29

Gastroschisis.

Question 30

What are important anesthetic considerations for omphalocele and gastroschisis?

Answer 30

* Monitor thoracic and abdominal pressures * Pay attention to fluid balance * Body temperature.

Question 31

What is pyloric stenosis?

Answer 31

* Hypertrophy of the pyloric muscle * Causing mechanical obstruction at the gastric outlet

Question 32

How is pyloric stenosis characterized clinically?

Answer 32

* Non-bilious projectile vomiting * Dehydration with hyponatremia * Hypokalemia * Hypochloremia * Metabolic alkalosis * Compensatory respiratory acidosis

Question 33

What is the emergency management approach for pyloric stenosis?

Answer 33

* Optimize fluid * Electrolyte, and acid-base status * Before performing pyloromyotomy

Question 34

What should be anticipated regarding stomach contents during anesthesia for pyloric stenosis?

Answer 34

A full stomach.

Question 35

How should induction and intubation be approached in a patient with pyloric stenosis?

Answer 35

* Empty stomach before induction * Intubate either awake or with rapid sequence induction (RSI) * Extubate awake

Question 36

What are the risk factors for necrotizing enterocolitis (NEC)?

Answer 36

* Prematurity (< 32 weeks) * Low birth weight (< 1,500 g)

Question 37

What is a likely cause of NEC?

Answer 37

* Early feeding leading to impaired gut absorption * Stasis * Bacterial overgrowth * Infection

Question 38

How is NEC managed in babies?

Answer 38

* Medically * Bowel perforation may necessitate bowel resection and colostomy.

Question 39

What are common complications seen in NEC patients?

Answer 39

* Metabolic acidosis * Bowel perforation * Requiring substantial fluid replacement.

Question 40

Why should nitrous oxide be avoided in NEC cases?

Answer 40

It can increase the risk of bowel perforation.

Question 41

What is myelomeningocele?

Answer 41

* A form of spina bifida * The most common CNS defect * occurring during the first month of gestation

Question 42

Why is repair of myelomeningocele considered urgent?

Answer 42

* To avoid increasing the risk of bacterial contamination of the spinal cord * Further deterioration of neural and motor function

Question 43

In what position may neonates with large defects or severe hydrocephalus be placed for induction and intubation?

Answer 43

Lateral position.

Question 44

How can anesthesia be induced for myelomeningocele repair?

Answer 44

Inhalation or intravenous technique.

Question 45

During myelomeningocele repair, in what position is the procedure typically performed?

Answer 45

* Prone position * With appropriate protection of all body parts.

Question 46

Body Water Distribution Table

Answer 46

Question 47

Answer 47

Question 48

Answer 48

Question 49

Answer 49

Question 50

Omphalocele vs Gastroschisis

Answer 50

Question 51

Answer 51

Question 52

Answer 52

Question 53

Fetal Circulation Diagram

Answer 53

Question 54

Fetal Circulation Diagram 2

Answer 54

Question 55

1. Foramen Ovale 1. Ductus Venous 1. Ductus Arteriousus

Answer 55

Question 56

PVR and SVR

Answer 56

Question 57

Blue Baby Pathophysiology

Answer 57

Question 58

Pink Baby Pathophysiology

Answer 58

Question 59

* CV changes by Age * Estimated blood volume by Age

Answer 59

Question 60

Vocal Cords: Neonates vs Adult

Answer 60

Question 61

* Breathing patterns * Tongue * Neck * Epiglottis

Answer 61

Question 62

* Vocal cords * Laryngeal position * Narrowest point

Answer 62

Question 63

* Subglottic shape * Right mainstay bronchus * Intubation position

Answer 63

Question 64

Oxygen Demand, Supply and Reserve

Answer 64

Question 65

Mean Values for Normal Pulmonary Function

Answer 65

Question 66

Spinal Column

Answer 66