Premature peds

Question 1

What are the types of TEF and which is the most common

Answer 1

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

Question 2

what concerns you about baby’s prematurity?

Answer 2

respiratory distress syndrome 
decreased pulm compliance 
persistent pulm HTN (PPHN)
apneic spells
bronchopulmonary dysplasia 
nec enterocolitis 
retinopathy of prematurity 
intravascular hemorrhage

Question 3

What is VACTERL association?

Answer 3

Vertebral defects
Anal atresia 
Cardiac abn 
TracheoEsophageal fistula 
Radial and Renal dysplasia
Limb abn

Question 4

what makes PDA close?

Answer 4

• 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

Question 5

how long for PDA to close

Answer 5

functional closure in 2- 4 days
permanent closure (ductal fibrosis) over several weeks --> ligamentum arteriosum

Question 6

what is RDS?

Answer 6

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

Question 7

when should moms get steroids?

Answer 7

any woman after 24wks GA who is at risk of delivery before 34wks
- between 24 and 34 wks

Question 8

what are risk factors for RDS?

Answer 8

low GA
low birth weight
surgical delivery (C/S not labor)

Question 9

what is the dose of atropine for bradycardia?

Answer 9

0.01 - 0.02 mg/kg

Question 10

when are you concerned about glycosuria?

Answer 10

if infant >34wks GA, concerned about hyperglycemia

infants under 34wks GA have reduced tubular absorption of glucose –> often see glucosuria –> not concerning

Question 11

what are complications of PDA surgery closure?

Answer 11

• 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)

Question 12

what monitoring do you want for PDA closure

Answer 12

• 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

Question 13

what is ideal PaO2 for premature PDA repair baby?

Answer 13

PaO2 50 - 80
O2 sat 87 - 94%
high PaO2 –> increased retinopathy of prematurity (ROP)

more likely if GA < 32wks GA

Question 14

You’re doing closure of PDA surgery for premature infant, how do you maintain anesthesia?

Answer 14

fentanyl
nitrous
ketamine

avoid volatile agents (they decrease SVR which helps prevent shunting), but cause CV depression which sick infants can’t tolerate

Question 15

provide estimated blood volume for

• premature neonate
• pregnant woman
• full-term neonate
• child > 1yr
• adult men
• adult women

Answer 15

• 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

Question 16

what is equation for estimated allowable blood loss?

Answer 16

EBV * (Hct initial - Hct final) / Hct initial