Pediatrics Flashcards
What are the types of TEF and which is the most common
A - esophageal atresia, no fistula
B - esophageal atresia w/ communication in upper part with trachea
C***- atresia blind upper pouch, lower segment tracheal fistula
D - esophageal atresia with proximal and distal fistula communicating with trachea
E - H type fistula, pure TEF with no esophageal atresia
what concerns you about baby’s prematurity?
respiratory distress syndrome decreased pulm compliance persistent pulm HTN (PPHN) apneic spells bronchopulmonary dysplasia nec enterocolitis retinopathy of prematurity intravascular hemorrhage
What is VACTERL association?
Vertebral defects Anal atresia Cardiac abn TracheoEsophageal fistula Radial and Renal dysplasia Limb abn
what makes PDA close?
- increased arterial oxygen levels, PVR is reduced
- reversal of flow in ductus arteriosis –> exposes it to systemic blood with higher oxygen concentration –> increased O2and lower PDE –> closure within 2 - 4 days of birth
how long for PDA to close
functional closure in 2- 4 days permanent closure (ductal fibrosis) over several weeks --> ligamentum arteriosum
what is RDS?
respiratory distress syndrome
2/2 insufficient surfactant production (adequate production at 35wks)
- causes atelectasis –> intrapulm shunting –> hypoxemia and metabolic acidosis
- S/S: tachypnea, tachycardia, nasal flaring, intercostal and subcostal retractions, bilateral rales, cyanosis
- “ground glass” b/l infiltrates
- ABG: hypoxemia, metabolic acidosis, resp alkalosis
long term has potential development of bronchopulmonary dysplasia
when should moms get steroids?
any woman after 24wks GA who is at risk of delivery before 34wks
- between 24 and 34 wks
what are risk factors for RDS?
low GA
low birth weight
surgical delivery (C/S not labor)
what is the dose of atropine for bradycardia?
0.01 - 0.02 mg/kg
when are you concerned about glycosuria?
if infant >34wks GA, concerned about hyperglycemia
infants under 34wks GA have reduced tubular absorption of glucose –> often see glucosuria –> not concerning
what are complications of PDA surgery closure?
- recurrent LN injury (hoarseness)
- L phrenic nerve injury
- thoracic duct injury
- massive EBL (2/2 accidental ligation or laceration of ductus arteriosus, aorta, or PA)
- hypertension (common post-op)
what monitoring do you want for PDA closure
- R arm BP cuff (pre-ductal, may need to clamp L subclavian for bleeding)
- pulse ox in R hand (pre-ductal) and foot pulse ox (post-ductal) –> gives info about shunting
what is ideal PaO2 for premature PDA repair baby?
PaO2 50 - 80
O2 sat 87 - 94%
high PaO2 –> increased retinopathy of prematurity (ROP)
more likely if GA < 32wks GA
You’re doing closure of PDA surgery for premature infant, how do you maintain anesthesia?
fentanyl
nitrous
ketamine
avoid volatile agents (they decrease SVR which helps prevent shunting), but cause CV depression which sick infants can’t tolerate
provide estimated blood volume for
- premature neonate
- pregnant woman
- full-term neonate
- child > 1yr
- adult men
- adult women
- premature neonate 90 - 100 cc/kg
- pregnant woman 90 cc/kg
- full-term neonate 80 - 90 cc/kg
- child > 1yr 70 - 75 cc/kg
- adult men 75cc/kg
- adult women 65cc/kg
