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Special Population-RCM > Neonates Part II > Flashcards

Neonates Part II Flashcards

1
Q

Most common congenital defect of esophagus?

A

Esophageal atresia.

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2
Q

Key diagnostic indicator for TEF?

TEF: Transesophageal Fistula

A

Maternal polyhydramnios.

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3
Q

Most common type of TEF?

A

Type C.

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4
Q

TEF may occur in what association?

A

VACTERL association.

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5
Q

Percentage of neonates with Esophageal Atresia & cardiac defect?

A

~20%.

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6
Q

How to minimize risk of gastric aspiration during anesthesia?

A
  • Head-up position
  • Frequent suctioning
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7
Q

Why maintain spontaneous ventilation during induction?

A
  • Positive-pressure ventilation can cause gastric distension
  • G-tube placement minimizes this risk
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8
Q

Where place endotracheal tube in relation to fistula?

A

Below the fistula but above the carina.

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9
Q

How to detect right mainstem intubation?

A

Use a precordial stethoscope placed on the left chest.

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10
Q

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

A
  • 22 - 26 weeks
  • Peaking at 35 - 36 weeks
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11
Q

What risks are neonates without enough surfactant production exposed to?

A
  • Respiratory distress syndrome (RDS)
  • Hypoxemia
  • Hypercarbia
  • Acidosis
  • Hemodynamic instability
  • Death
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12
Q

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

A

Maternal corticosteroids.

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13
Q

What are the post-delivery treatments for RDS?

A
  • CPAP
  • Mechanical ventilation
  • Exogenous surfactant
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14
Q

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

A
  • Monitor preductal and postductal oxygen saturation
  • For pulmonary hypertension, shunting, and fetal circulation.
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15
Q

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

A
  • Increased pressure can cause lung overdistension
  • Leading to air leakage into the pleural space
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16
Q

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

A

Abdominal contents.

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17
Q

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

A
  • Foramen of Bochdalek
  • Typically on the left side
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18
Q

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

A
  • Pulmonary hypoplasia
  • Poor pulmonary vascular development
  • Increased pulmonary vascular resistance
  • Pulmonary hypertension
  • Impaired airway development
  • Airway reactivity.
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19
Q

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

A
  • Keep PIP < 25 - 30 cm H2O
  • To prevent barotrauma
  • To prevent pneumothorax in the “good” lung
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20
Q

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

A
  • Hypoxia
  • Acidosis
  • Hypothermia
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21
Q

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

A

Monitor preductal oxygen saturation (Right Upper Extremity).

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22
Q

Why is surgery delayed in congenital diaphragmatic hernia cases?

A
  • Surgery is delayed 5 - 15 days
  • To stabilize pulmonary, cardiac, and metabolic status
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23
Q

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

A
  • When one lung needs isolation
  • Such as, in congenital diaphragmatic hernia.
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24
Q

What are omphalocele and gastroschisis?

A

Defects in abdominal wall development.

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25
Q

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

A
  • Omphalocele has a covering over the viscera
  • While gastroschisis does not.
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26
Q

What are some associations of omphalocele?

A
  • Trisomy 21
  • Cardiac defects
  • Beckwith-Wiedemann syndrome
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27
Q

What are some associations of gastroschisis?

A

Prematurity.

28
Q

Which condition is more common, omphalocele or gastroschisis?

A

Omphalocele.

29
Q

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

A

Gastroschisis.

30
Q

What are important anesthetic considerations for omphalocele and gastroschisis?

A
  • Monitor thoracic and abdominal pressures
  • Pay attention to fluid balance
  • Body temperature.
31
Q

What is pyloric stenosis?

A
  • Hypertrophy of the pyloric muscle
  • Causing mechanical obstruction at the gastric outlet
32
Q

How is pyloric stenosis characterized clinically?

A
  • Non-bilious projectile vomiting
  • Dehydration with hyponatremia
  • Hypokalemia
  • Hypochloremia
  • Metabolic alkalosis
  • Compensatory respiratory acidosis
33
Q

What is the emergency management approach for pyloric stenosis?

A
  • Optimize fluid
  • Electrolyte, and acid-base status
  • Before performing pyloromyotomy
34
Q

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

A

A full stomach.

35
Q

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

A
  • Empty stomach before induction
  • Intubate either awake or with rapid sequence induction (RSI)
  • Extubate awake
36
Q

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

A
  • Prematurity (< 32 weeks)
  • Low birth weight (< 1,500 g)
37
Q

What is a likely cause of NEC?

A
  • Early feeding leading to impaired gut absorption
  • Stasis
  • Bacterial overgrowth
  • Infection
38
Q

How is NEC managed in babies?

A
  • Medically
  • Bowel perforation may necessitate bowel resection and colostomy.
39
Q

What are common complications seen in NEC patients?

A
  • Metabolic acidosis
  • Bowel perforation
  • Requiring substantial fluid replacement.
40
Q

Why should nitrous oxide be avoided in NEC cases?

A

It can increase the risk of bowel perforation.

41
Q

What is myelomeningocele?

A
  • A form of spina bifida
  • The most common CNS defect
  • occurring during the first month of gestation
42
Q

Why is repair of myelomeningocele considered urgent?

A
  • To avoid increasing the risk of bacterial contamination of the spinal cord
  • Further deterioration of neural and motor function
43
Q

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

A

Lateral position.

44
Q

How can anesthesia be induced for myelomeningocele repair?

A

Inhalation or intravenous technique.

45
Q

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

A
  • Prone position
  • With appropriate protection of all body parts.
46
Q

Body Water Distribution Table

A
47
Q
A
48
Q
A
49
Q
A
50
Q

Omphalocele vs Gastroschisis

A
51
Q
A
52
Q
A
53
Q

Fetal Circulation Diagram

A
54
Q

Fetal Circulation Diagram 2

A
55
Q
  1. Foramen Ovale
  2. Ductus Venous
  3. Ductus Arteriousus
A
56
Q

PVR and SVR

A
57
Q

Blue Baby Pathophysiology

A
58
Q

Pink Baby Pathophysiology

A
59
Q
  • CV changes by Age
  • Estimated blood volume by Age
A
60
Q

Vocal Cords: Neonates vs Adult

A
61
Q
  • Breathing patterns
  • Tongue
  • Neck
  • Epiglottis
A
62
Q
  • Vocal cords
  • Laryngeal position
  • Narrowest point
A
63
Q
  • Subglottic shape
  • Right mainstay bronchus
  • Intubation position
A
64
Q

Oxygen Demand, Supply and Reserve

A
65
Q

Mean Values for Normal Pulmonary Function

A
66
Q

Spinal Column

A

Special Population-RCM (8 decks)

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