Peds (Part 1) Flashcards
Differentiate the different pediatric “life stages” based on these ages:
Birth - 1 month:
1 month - 12 months:
12 months - 3 years:
4 - 6 years:
6 - 13 years:
13 - 18 years:
Birth - 1 month: Neonate
1 month - 12 months: Infants
12 months - 3 years: Toddlers
4 - 6 years: Preschool
6 - 13 years: School age
13 - 18 years: Adolescents
What would make a baby “ post term”?
Delivered at > 42 weeks
What are the corresponding birth weights for the following terms:
LBW:
VLBW:
ELBW:
Micropremie:
LBW: < 2500 gm
VLBW: < 1500 gm
ELBW: < 1000 gm
Micropremie: < 750 gm
Where should we measure an infant’s pulse ox with a PDA?
“Pre ductal” extremity = The right hand
If a patien’t PDA needs to stay open, what can be given?
Prostaglandins
The fetus relies on the ___ for gas exchange, not the ___.
Placenta
Not Lungs
Why is the neonates heart thought to be significantly less developed compared to an adult Heart?
- Fewer myofibrils
- Sarcoplasmic reticulum and T-Tubules are much more immature
- Cellular disorganization
Is tachycardia or bradycardia more poorly tolerated in neotaes?
What do we use to treat the issue?
Bradycardia!
Epi/Atropine = increases CO
Why is the neonates SV relatively fixed, making the CO heavily reliant on HR?
The neonates heart is very dependent on exogenous calcium.
Autonomic innervation is predominately ___.
Parasympathetic
With increased stimulus to a neonate (suctioning/laryngoscopy), we would likely see ___.
Bradycardia
Normal HR for a Neonate, 12 month old, 3 year old, 12 year old:
Basedon the lecture notes, which of the following patients would be considered hypotensive?
A. 11 year old w/ SBP of 94 mmHg
B. 7 month old w/ SBP of 77 mmHg
C. 2 month old w/ SBP of 62 mmHg
D. 8 year old w/ SBP of 72 mmHg
E. 22 day old w/ SBP of 65 mmHg
C. 2 month old w/ SBP of 62 mmHg
D. 8 year old w/ SBP of 72 mmHg
Normal Hgb at birth:
18-20 g/dL
Why do infants experience a physiological anemia at around 3-4 months?
Decrease in erythropoietin activity
Describe the structural differences between Hgb F and Hgb A:
Hgb F: 2 alpha and 2 gamma chains
Hgb A: 2 alpha and 2 beta chains
Where does 2,3 - DPG bind to?
The beta chains only
Alveolar Ductal development begins around ___ weeks gestation.
24 wks
The neonatal alveolar surface area is roughly how big compared to an adult?
About 1/3rd the size
When does surfactant start to get produced?
22-26 wks gestation
Describe anatomical things that may alter a neontates breathing mechanics:
- Horizontal Ribs: Collapse inward causing a paradoxical breathing pattern
- Less Type 1 mucle fibers: tire out quicker
- Pliable Chest wall
- Flat diapragm
Is the metabolic rate and consumption of oxygen different for a neonate than an adult?
YES!
2x greater than adults
Is Minute ventilation for a neonate more dependent on RR or TV?
Respiratory Rate!
Anatomical components of a neonate’s airway:
- Large tongue
- Superior Larynx
- Omega-Shaped epiglottis
- Vocal cords are angled
- Short, funnel shaped trachea
Most narrow portion of the neonates airway is the:
Cricoid “Ring”/ Cricoid cartilage
We can use uncuffed tubes
Angle in which each bronchi takes off from the trachea?
55 degrees
Neonates have a short neck and large occiput, this can lead to what issue?
Obstruction when they lie flat (for intubation)
Where are the vocal cords positioned in a neonate in terms of vertebrae level?
C3-C4
How is the CNS mentioned to be different in neonates?
- Incomplete myelination (until 3 yrs)
- Immature NMJ (greater affinity for NDMB)
- Immature BBB (until 1 yr)
When do the 2 main fontanels close?
Anterior: closes by 2 years
Posterior: closes by 4 months
True or False:
There is no CBF/Autoregulation in neonates:
FALSE:
Just isnt fully developed yet
The cerebral vessels are more ___, especially in ___ infants. Making them more prone to ___.
Fragile
LBW infants
intracerebral hemorrhage
What may precipitate an intracerebral hemmorrhage?
- Hypercarbia
- Hypoxemia
- Hyperglycemia
- Hypoglycemia
- Hypernatremia
- Wide swings in BP
Termination of spinal cord, dural sac, and conus medullaris in neonates:
Spinal Cord: L1
Dural Sac: S2-S3
Conus Medullaris: L2-L3
When does GFR reach normal adult level?
6-12 months
GFR for preterm:
GFR for Full term:
0.55 ml/kg/min
1.6 ml/kg/min
An immature renal medulla can lead to diminished…
ADH
Fluid requirements per day:
150 ml/kg per day
Hepatic System Alterations in neonates:
- Immature glycogen stores (hypoglycemia)
- Decreased liver function
- Low Albumin/AAG = more free drug floating –> toxicity
- Decreased clotting factors (Need Vit. K)
Gastric pH is more ___ at birth.
Alkalotic
(comes back to normal by day 2)
How will upper and lower intestinal anomalies manifest?
Upper: Vomiting
Lower: Abd distention/failure to pass meconium
Why do neonates have such a difficult time with thermoregulation?
They don’t have the ability to shiver
How do neonates stimulate heat production?
NST: Non-shivering thermogenesis
1. SNS stimulation releases Norepi
2. The norepi acts on brown fat, increases body tmep
3. Metabolic acidosis can also occur here
Hypothermia in a neonate can lead to:
- Bradycardia
- Acidosis
- Coagulopathies
Examples of sensible and insensible evaporative heat loss:
Sensible: Sweating
Insensible: Water through the skin
Which method is responsible for the majority of heat loss?
Radiant (environment)
What type of heat loss occurs through direct contact?
Conductive
Increasing the OR temp will help decrease this method of heat loss
Convective
Pharmacokinetics for infant/neonate:
- Increased absorption and Distribution (higher CO)
- Decreased elimination
- Decreased metabolism (Underdeveloped CYP-450)
What is the average CO for the following age ranges:
Neonate:
Infant:
Adolescent:
Neonate: 440 ml/kg/min
Infant: 200 ml/kg/min
Adolescent: 100 ml/kg/min
Pharmacodynamic differences for infants/neonates:
- Nicotinic Ach Receptors (open for longer)
- More opioid receptors (mu/kappa = more resp. depression)
- 1/3rd the normal amount of GABA recetors (higher benzo binding though)
Are there usually more or less CV side effects for inhalation agents in infants/neonates?
What about emergence delirium?
- MORE for BOTH!
With which shunt would it take much longer to induce?
Right to left = decrease in uptake
Besides sevo, when is MAC the highest?
2-3 months specifically is the peak
(Sevo is birth to 1 month)
MAC of Sevo for:
Neonates:
Infants 1-6 months:
Children > 6 months:
Neonates: 3.3%
Infants 1-6 months: 3.2%
Children > 6 months: 2.5%
Benefit of using Nitrous Oxide along with Sevo for inhalational induction?
2nd gas effect –> may decrease stage II time
Propofol drug profile for infants/neonates:
- Requires larger dose becasue of increased metabolic rate
- Reduced clearance in preterm
- Monitor for propofol infusion syndrome
ED-50 for Propofol (loss of eyelid reflex) in 1-6 month old:
3mg/kg
Do we need more or less Ketamine in children?
Dose?
MORE
1-3mg/kg
Neonates might need smaller dose
Precedex drug profile:
- 1-2 mcg/kg
- Takes 30-40 min for peak effect
- Decreased incidence of emergence delirium
Morphine dose:
0.05 - 0.1 mg/kg
(might need to decrease in neonates)
What surgery specifically is codeine contraindicated in?
Tonsillectomy
Fentanyl dose:
0.5 - 2 mg/kg
Most frequently used opioid intraop:
Fentanyl
Traditionally neonates do not clear drugs faster than older children, with the exception of this drug:
Remifentanil
Remi can cause ___ in peds.
Bradycardia
Is succs more water or lipid soluble?
Water = rapid redistribution to ECF
IV Dose and IM Dose of Succs for Children and for neonates/infants
Neonate/Infant:
- 2mg/kg IV
- 5mg/kg IM
Children:
- 1 mg/kg IV
- 4 mg/kg IM
___ is common with succs administration in children < 5yrs. Therefore we give ___.
Bradycardia
Atropine/glyco
Only NDMR that can be given IM:
Roc
Dose for Neostigmine and Edrophonium:
Neostigmine: 0.04 - 0.07 mg/kg
Edrophonium: 0.5 - 1 mg/kg
Sugammadex is FDA approved for patients aged…
2 years or older
