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Pediatrics > Neonatology > Flashcards

Neonatology Flashcards

1
Q

What is the definition of Apnea of prematurity

A

Cessation of breathing for at least 20 minutes or a briefer episode with one of the following:

  • Bradycardia
  • Cyanosis
  • Pallor
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2
Q

What is apnea od prematurity related to?

A

Underdevelopment of the brainstem

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3
Q

What other causes must be ruled out before diagnosing with apnea of prematurity?

A 
CNS disorders
Decreased oxygen delivery to brain
Infection
Metabolic disorders
Thermal instability
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4
Q

What are the nonpharm tx for apnea of prematurity?

A 
Supplemental O2 (O2 sat b/n 85-95%)
RBC transfusion (increases O2 carry capacity)
Positions (opens upper airways)
Tube removal (Removed airflow impedance)
Environment (maintain temp)
Ventilation (assists O2 delivery and airway maintenance)
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5
Q

What are methylxanthines?

A

Caffeine
Theophylline
Aminophylline

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6
Q

What are the hypothesized MOAs of methylxanthines?

A 
Stimulates CNS
Increases CO sensitivity
Enhances diaphragmatic contraction force
Increases CO
Increases HR
Decreases vascular resistance
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7
Q

What are the known MOAs of methylxanthines?

A

Inhibits:
Adenosine which normally depresses central respiratory drive
Phosphodiesterases which normally decrease number of cyclic monophosphates

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8
Q

What are the ADRs of Methylxanthines?

A

Increased UO
Jitteriness
Dose limiting effect of coffeine is tachycardia
Hypotension (less common)

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9
Q

What is the half-life of caffeine citrate?

A

52-96 hours

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10
Q

What is the therapeutic concentrations for caffeine citrate?

A

8-20

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11
Q

What is the toxic concentrations for caffeine citrate?

A

> 50

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12
Q

What are the loading doses for caffeine citrate?

A

20-25 mg/kg/dose

10-12.5 mg/kg/dose (base)

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13
Q

What are the maintenance doses for caffeine citrate?

A

5-15 mg/kg/dose

2-2.5 mg/kg/dose (base)

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14
Q

What is the dosing interval for caffeine citrate?

A

Q24h

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15
Q

What is the half-life of theophylline/aminophylline?

A

17-43 h

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16
Q

What is the therapeutic concentrations for theophylline/aminophylline?

A

6-12

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17
Q

What is the toxic concentration for theophylline/aminophylline?

A

> 15

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18
Q

What is the loading dose for theophylline/aminophylline?

A

5-6 mg/kg/dose

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19
Q

What is the maintenance dose of theophylline/aminophylline?

A

2-6 mg/kg/dose

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20
Q

What is the dosing interval of theophylline/aminophylline?

A

Q8-12h

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21
Q

What is the definition of respiratory distress syndrome?

A

Surfactant deficiency in lungs of premature neonates

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22
Q

What is surfactant

A

Provides surface tension at alveoli level in lungs

“Holds” alveoli open for gas exchange

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23
Q

What are the signs of surfactant deficiency?

A 
Delay in normal respirations
Grunting during expirations
Flaring of the nares
Cyanosis in room air
Retraction of intercostal and sternal muscles
Tachypnea
Radiographic findings:
-Reticulograndular, ground-glass pattern
-Air bronchograms
24
Q

What are the treatment outcomes for RDS?

A

Improved lung compliance
Improved oxygenation
Lower O2 requirement

25
Q

What are the components of surfactant?

A

Phospholipids

Proteins (A-D)

26
Q

What is protein A?

A

Hydrophilic protein regulating pulmonary surfactant turnover

27
Q

What is Protein B?

A

Hydrophobic protein improving surfactant surface activity

28
Q

What is Protein C?

A

Protein improving surfactant surface activity and fluidity

29
Q

What is Protein D?

A

Protein involving bacterial opsonization

30
Q

What are the animal derived surfactants?

A

Beractant (Bovine)
Calfactant (Bovine)
Poractant (Pork)

31
Q

What are the synthetic surfactants?

A

Colfosceril (does not contain protein)

Lucinactant

32
Q

How do we prevent RDS?

A 
Antenatal steroids (to mother)
Early surfactant administration (to baby)
33
Q

How do antenatal steroids work in RDS?

A

Increases rate of fetal lung maturation

34
Q

When do we treat with antenatal steroids in RDS?

A

24-34 week gestation with risk of delivery within 7 days

Under 32 weeks gestation with premature rupture of membranes

35
Q

When do we prophylax with early surfactant administration?

A

High risk patients:

Patients less than or equal to 30 week gestation and/or patients that are NOT exposed to antenatal steroids

36
Q

What is PDA?

A

Patent ductus arteriosus

Ductus arteriosus remaining open after birth

37
Q

What can untreated PDA lead to?

A

CHF (Edema, hepatomegaly, tachycardia, tachypnea)

Hypoperfusion (Brain, intestines, kidneys)

38
Q

What is used to clinical diagnosis of PDA?

A 
Systolic murmur:
Bounding palmer pulses
Hyperdynamic precordium
Increased pulse pressures
Pulmonary hemorrhage
Refractory hypotension
Signs of CHF
39
Q

What is a definitive diagnosis for PDA?

A

Echocardiogram with left-to-right flow

40
Q

What are the causes of PDA?

A 
Decreased prostaglandin (from the placenta) metabolism (pre-term)
Decreased arterial oxygen concentration (pre-term)
41
Q

What are the treatments for PDA?

A

Medical
Surgical (uncommon)
Pharmacologic

42
Q

How do we medically treat PDA?

A

Manage CHF:
Fluid restriction
Diuretics (Lasix can increase prostaglandin synthesis. If PDA is not closing fast enough, lasix may be the problem)

43
Q

When is surgical treatment of PDA recommended?

A

Pharmacologic treatment failure

Pharmacologic treatment contraindication

44
Q

What medications are used for treatment of PDA?

A

Indomethacin

Ibuprofen

45
Q

What are indomethacin/ibuprofens MOA?

A

Decrease prostaglandin synthesis resulting in vasoconstriction

46
Q

What are indomethacin/ibuprofens ADRs?

A

Acute kidney damage
Bleeding
Necrotizing enterocolitis

47
Q

How do NSIADs cause bleeding problems?

A

NSAIDs cause platelet inhibition

48
Q

How do NSAIDs cause necrotizing enterocolitis?

A

Vasoconstriction does not allow growing gut to be supplied with nutrients, gut becomes necrotic and becomes colitis

49
Q

How is indomethacin typically dosed?

A

3 dose course
0.2 mg/kg IV x1
Next dose depends on age
Every 12-24 hours

50
Q

What are specific ADRs for indomethacin alone?

A

Decreased UO

Increased SCr

51
Q

How is ibuprofen typically dosed?

A

3 dose course
10 mg/kg IV x 1
5 mg/kg IV x 2
Every 24-48 hours

52
Q

Why would we maintain PDAs?

A

Some congenital heart defects require/need a PDA for patient survival

53
Q

What medication is used for maintaining PDAs?

A

Prostin VR

54
Q

What is the Loading dose for Prostin VR?

A

0.05-0.1 mcg/kg/minute continuous infusion

55
Q

What is the maintenance dose for Prostin VR?

A

Titrate between 0.1-0.4 mcg/kg/minute

56
Q

What are the ADRs for Prostin VR?

A

Apnea
Fever
Flushing

Pediatrics (9 decks)

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