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APEX > Unit 11 - Neonatal A&P > Flashcards

Unit 11 - Neonatal A&P Flashcards

1
Q

normal VS for a newborn

A

SBP = 70
DBP = 40
HR = 140
RR = 40-60

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2
Q

normal VS for a 1year old

A

SBP = 95
DBP = 60
HR = 120
RR = 40

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3
Q

normal VS for a 3 year old

A

SBP = 100
DBP = 65
HR = 100
RR = 30

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4
Q

normal VS for a 12 year old

A

SBP = 110
DBP = 70
HR = 80
RR = 20

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5
Q

why do neonates have a higher RR than adults

A
  • much higher O2 consumption & CO2 production vs adults
  • Neonate must increase alveolar ventilation accordingly - metabolically more efficient to increase RR
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6
Q

primary determinant of cardiac output and systolic blood pressure in neonates

A

HR

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7
Q

Vt in neonates vs. adults

A

same on a per weight basis (6 mL/kg)

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8
Q

why do neonates rely on HR to maintain CO

A

The neonatal myocardium lacks the contractile elements to significantly adjust contractility or stroke volume

Non-compliant LV is sensitive to increased afterload

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9
Q

what defines hypotension in a newborn

A

SBP < 60 mmHg

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10
Q

what defines hypotension in a 1 yr old

A

SBP < 70 mmHg

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11
Q

what defines hypotension in a child > 1 yr

A

SBP < [70 + (child’s age in years x2)] mmHg

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12
Q

neonatal period

A

first 28 days of life

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13
Q

infant period

A

29 days to one year

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14
Q

what explains why a child becomes relatively less dependent on HR to support CO with age

A

SVR increases over time
* As the left ventricle pumps against a higher SVR, the contractile elements multiply and mature, giving the LV the ability to better adjust contractility

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15
Q

why do newborns respond to stressful situations (DL, suctioning) with bradycardia

A

ANS regulation of the heart is immature at birth - SNS is less mature than the PNS

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16
Q

preferred med in treating hypovolemia and bradycardia in neonates

A

epinephrine over atropine
epi has added benefit of augmenting contractility

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17
Q

why are neonates generally unable to increase HR in the setting of hypovolemia

A

baroreceptor reflex is poorly developed

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18
Q

how do s/s pain manifest in the neonate

A

activates SNS - tachycardia, HTN

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19
Q

why is neo generally a poor choice for treating hypotension in a neonate

A

neonates can’t significantly increase contractility to overcome increased afterload

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20
Q

factors that predispose neonates to intracranial hemorrhage with pain

A

pain = SNS response = tachycardia and HTN
combination of hypertension, an immature cerebral autoregulatory response, and a fragile cerebral vasculature

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21
Q

babies are preferential nose breathers until what age

A

5 months

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22
Q

how is an infant’s epiglottis different from an adult’s

A

infant’s is stiffer and longer
U-shaped or omega shaped

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23
Q

why is a more acute angle required to visualize the glottis in infants

A

shorter neck
cephalad larynx
larger tonge

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24
Q

why is sniffing position avoided in infants

A

tends to move laryngeal opening further from line of sight in DL

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25
Q

positioning an infant for DL

A
  • Larger occiput flexes the neck when placed supine on a flat surface
  • A shoulder roll helps align oral, pharyngeal, and laryngeal axes
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26
Q

why is it more difficult to displace the epiglottis of an infant during DL (vs. adult)

A

epiglottis is stiffer and longer

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27
Q

why is a miller blade preferred in infants

A

infant’s tongues occupy a relatively large area of mouth
helps to lift the tongue to better expose the pediatric larynx

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28
Q

level of newborn’s glottis

A

full term: ~C4
premature: ~C3

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29
Q

glottic opening in newborns vs. adults

A

adult glottis is at ~C5
newborn glottis is at ~C3-C4
higher glottic opening = more superior, cephalad, or rostral (not more anterior)

the only time an infant’s airway is more “anterior” is w neck flexion

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30
Q

why are infants at higher risk of upper airway obstruction vs. adults

A

tongue is closer to soft palate and more likely to obstruct

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31
Q

position of pediatric larynx

A

C3-C5

adult = C5-C6

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31
Q

position of pediatric larynx

A

C3-C5

adult = C5-C6

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32
Q

at what point does the pediatric larynx descend to C4

A

~1 year old

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33
Q

age pediatric larynx achieves adult position

A

by 5-6 yrs old

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34
Q

narrowest region of pediatric airway

A

dynamic = vocal cords
fixed = cricoid ring

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35
Q

changes in bronchi in children

A

up to 3 years of age, both bronchi take off at 55 degrees off the midline

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36
Q

situations that increase risk of cricoid edema in pediatric airways

A
  • an ETT that is too large
  • multiple intubation attempts
  • prolonged intubation
  • frequent head positioning while intubated
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37
Q

why do neonates require a comparatively higher alveolar ventilation to sustain normal arterial gas tensions vs. adults

A

Because the neonatal alveolar surface area is only 1/3 of the adult and basal oxygen consumption is 2 - 3 times that of the adult

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38
Q

when do distal saccules of the lung start to develop

A

24-28 wga

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39
Q

O2 consumption of neonate vs adult

A

neonate = 6-9 mL/kg/min
adult = 3.5 mL/kg/min

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40
Q

alveolar ventilation of a neonate vs adult

A

neonates = 130 mL/kg/min
adult = 60 mL/kg/min

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41
Q

FRC in neonates

A

slightly reduced

30 mL/kg vs. 34 mL/kg in adults

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42
Q

FRC in neonates

A

slightly reduced

30 mL/kg vs. 34 mL/kg in adults

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43
Q

why do neonates rapidly desaturate during hypoventilation or apnea

A

neonate’s relatively higher oxygen consumption will quickly exhaust the oxygen reserve contained in the FRC

also decreased FRC

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44
Q

why do neonates rapidly desaturate during hypoventilation or apnea

A

neonate’s relatively higher oxygen consumption will quickly exhaust the oxygen reserve contained in the FRC

also decreased FRC

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45
Q

why do neonates experience a faster inhalation induction vs. adults

A

Increased ratio of alveolar ventilation relative to the size of the FRC

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46
Q

primary muscle of inspiration

A

diaphragm

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47
Q

types of muscle fibers in diaphragm and intercostals

A

type 1 = slow-twitch, endurance
type 2 = fast-twitch, bursts of heavy work (tire easily)

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48
Q

predominant type of diaphragm muscle fibers in neonates

A

25% type 1
75% type 2

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49
Q

why are neonates at risk for resp fatigue and failure

A

The neonatal diaphragm only has 25% type 1 fibers (adults have 55%)

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50
Q

age that should be admitted for apnea monitoring after surgery

A

< 60 weeks PCA

post conceptual age

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51
Q

age that should be admitted for apnea monitoring after surgery

A

< 60 weeks PCA

post conceptual age

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52
Q

meds to reduce risk of postop apnea

A

caffeine 10 mg/kg
theophylline (higher risk toxicity)

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53
Q

lung and chest wall compliance in neonates vs adults

A
  • decreased lung compliance d/t fewer alveoli
  • increased chest wall compliance d/t cartilaginous ribcage
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54
Q

lung volumes that are decreased in neonates

A

FRC
VC
TLC

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55
Q

lung volumes that are increased in neonates

A

RV
CC

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56
Q

3 processes that support a neonate’s FRC

A
  • Sustained tonic activity of inspiratory muscles
  • Narrowing of glottis during expiration
  • Shorter expiratory time with a faster respiratory rate creates end-expiratory
pressure
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57
Q

why do neonates have increased WOB

A

a function of increased airway resistance (particularly in small airways)

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58
Q

ABG from umbilical vein

A

pH = 7.35
PaO2 = 30
PaCO2 = 40

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59
Q

ABG from umbilical artery

A

pH = 7.3
PaO2 = 20
PaCO2 = 50

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60
Q

ABG of mother at term

A

pH = 7.4
PaO2 = 90
PaCO2 = 30

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61
Q

ABG of newborn 10 min after delivery

A

pH = 7.2
PaO2 = 50
PaCO2 = 50

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62
Q

ABG of a newborn 1 hr after delivery

A

pH = 7.35
PaO2 = 60
PaCO2 = 30

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63
Q

ABG of a newborn 24 hrs after delivery

A

pH = 7.35
PaO2 = 70
PaCO2 = 30

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64
Q

supplies oxygen to fetus in utero

A

umbilical vein

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65
Q

what causes a newborn to breathe rhythmically after birth

A

Clamping of the umbilical cord
acute rise in PaO2 promotes continuous breathing

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66
Q

when do neonates develop a relatively normal FRC

A

in the first 20 minutes of life

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67
Q

why do neonates hyperventilate during the first hour of extrauterine life

A

likely due to its poor buffering capacity and compensation for nonvolatile acids in the blood

After this time, the pH and PaCO2 stabilize

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68
Q

why do neonates hyperventilate during the first hour of extrauterine life

A

likely due to its poor buffering capacity and compensation for nonvolatile acids in the blood

After this time, the pH and PaCO2 stabilize

69
Q

when does neonatal respiratory control mature

A

42 - 44 weeks post-conceptional age

70
Q

when does neonatal respiratory control mature

A

42 - 44 weeks post-conceptional age

71
Q

how does hypoxemia affect neonates before and after respiratory control matures

A
  • Before maturation: hypoxemia depresses ventilation
  • After maturation: hypoxemia stimulates ventilation
72
Q

P50 of fetal Hgb

A

19 mmHg

73
Q

how does fetal Hgb affect the oxyhgb dissociation curve

A

shifts to the left

74
Q

how does the low P50 of fetal Hgb benefit the fetus

A

creating an oxygen partial pressure gradient across the uteroplacental membrane that facilitates the passage of O2 from mother to fetus

75
Q

composition of Hgb A vs Hgb F

A

Hgb A = 2 alpha and 2 beta chains
Hgb F = 2 alpha and 2 gamma chains

76
Q

explains why Hgb F has a higher affinity for oxygen

A

does not bind 2,3-DPG since it has 2 gamma chains instead of 2 beta

the binding site fo 2,3-DPG is only on the beta chain

77
Q

how does 2,3-DPG affect oxyhgb dissociation curve

A

right shift

78
Q

lifespan of fetal RBCs

A

70-90 days

79
Q

hgb at birth

A

17 g/dL

80
Q

how long does it take for Hgb A to replace Hgb F

A

6 months - P50 at this time same as adult (26.5)

in 1st 2 months, erythrocytes containing Hgb F are replaced by those that produce Hgb A

81
Q

what age is assoc with physiologic anemia in newborns

A

2-3 months
Hgb ~ 10 g/dL

82
Q

age Hct begins to rise

A

4 months

erythropoesis increases, hgb concentrtation rises

83
Q

age Hct begins to rise

A

4 months

erythropoesis increases, hgb concentrtation rises

84
Q

when does P50 reach adult level

A

4-6 months old

85
Q

RBC transfusion trigger < 4 mo

A

< 13 g/dL with severe cardiopulmonary disease
< 10 mg/dL in child presenting for major surgery or moderate cardiopulmonary disease

86
Q

10 mL/kg of PRBCs will increase Hgb by ___

A

1-2 g/dL

87
Q

PRCB transfusion practice guidelines for > 4 mo

A
  • Transfusion is rarely indicated if Hgb > 10 g/dL
  • Transfusion is almost always indicated if Hgb < 6 g/dL
  • Transfusion should be considered on a need’s basis if Hgb is 6 - 10 g/dL
  • The use of a universal transfusion trigger is not recommended
88
Q

indications for neonatal FFP admin

A
  • Emergency reversal of warfarin
  • Correction of coagulopathic bleeding with increased PT or PTT
  • Correction of coagulopathic bleeding if > 1 blood volume has been replaced and coagulation studies are not easily obtained
89
Q

indications for plt admin in neonates

A

Recommended for invasive procedures to maintain the platelet count above 50,000

90
Q

indications for plt admin in neonates

A

Recommended for invasive procedures to maintain the platelet count above 50,000

91
Q

platelet transfusion dose if obtained from apheresis

A

5 mL/kg

92
Q

neonatal platelet transfusion dose from pooled plt concentrate

A

1 pack/10 kg

93
Q

single aphresis plt unit = ____ pooled concentrations

A

6-8

94
Q

5 complications of massive transfusion in the neonate

A
  1. metabolic alkalosis or acidosis
  2. hypothermia
  3. hyperglycemia
  4. hypocalcemia
  5. hyperkalemia
95
Q

P50 of hgb A

A

26.5 mmHg

96
Q

purpose of fetal Hgb

A

facilitates passage of O2 from mother to fetus

97
Q

Hgb F is compeltely replaced by Hgb A by what age

A

6 months old

98
Q

why can giving neonates PRBCs cause hyperkalemia and cardiac arrest

A

When RBCs are stored, the cell membrane becomes dysfunctional, which allows potassium to leak into the supernatant

99
Q

cause of graft vs host disease from PRBC transfusion in neonate

A

donor leukocytes attack recipient bone marrow
leads to pancytopenia, fever, hepatitis, diarrhea

100
Q

prevention of graft v host disease from PRBC transfusion in neonates

A

irradiated blood

101
Q

hgb & hct in newborn

A

Hgb 14-20 g/dL
Hcg 45-65%

102
Q

Hgb & Hct in 3 month old

A

Hgb 10-14 g/dL
Hct 31-41 %

103
Q

hgb & hct in 6-12 month old

A

Hgb 11-15 g/dL
Hct 33-42%

104
Q

hgb & hct in 6-12 month old

A

Hgb 11-15 g/dL
Hct 33-42%

105
Q

Hgb & Hct in adult female

A

hgb 12-16 g/dL
hct 37-47%

106
Q

hgb & hct in adult male

A

hgb 14-18 g/dL
hct 42-50%

107
Q

dose range for FFP

A

10-20 mL/kg

108
Q

EBV of premature neonate

A

90-100 mL/kg

109
Q

EBV of term neonate

A

80-90 mL/kg

110
Q

EBV of infant

A

75-80 mL/kg

111
Q

EBV of 1 year old

A

70-75 mL/kg

112
Q

kidneys at birth vs. adult

A

immature at birth
* decreased perfusion pressure
* decreased GFR
* decreased diluting and concentrating ability

113
Q

why are neonates intolerant of fluid swings

A

poor job conserving water - intolerant of fluid restriction
unable to excrete large volumes of water - don’t do well with overload

114
Q

how do neonates lose most of their water

A

through evaporation

surface area to body weight ratio that is four times higher than the adu

115
Q

how do neonates lose most of their water

A

through evaporation

surface area to body weight ratio that is four times higher than the adu

116
Q

why do neonates lose most of their body water through evaporation (via skin)

A
  • surface area to body weight ratio that is four times higher than the adult
  • immature skin is thinner and more permeable to water
117
Q

how long does it take for GFR to reach adult levels

A

8-24 months old

118
Q

when does renal tubular function achieve full concentrating ability

A

~ 2 years of age

119
Q

TBW in a premature neonate vs term neonate

A

preterm = 85%
term = 75%

120
Q

why are neonates oligate sodium losers at birth

A

kidneys have an immature concentrating mechanism

121
Q

when is TBW highest

A

at birth

decreases with age

122
Q

when is TBW highest

A

at birth

decreases with age

123
Q

when is ECF highest

A

at birth

decreases with age

124
Q

when is ECF highest

A

at birth

decreases with age

125
Q

when is ICF highest

A

lowest at birth and increases with age

126
Q

in what age groups is ECF > ICF

A

neonates (premature and term)

127
Q

when does TBW approximate adult values

A

by 1 yr old

128
Q

4:2:1 rule for fluid replacement

A

first 0-10 kg = 4 mL/kg/hr
next 10-20 mg add 2 mL/kg/hr
> 20 kg add 1 mL/kg/hr to previous total

129
Q

fluid replacement for third space losses

A
  • Minimal surgical trauma = 3 - 4 mL/kg/hr
  • Moderate surgical trauma = 5 - 6 mL/kg/hr
  • Major surgical trauma = 7 - 10 mL/kg/hr

As a general rule, third-space loss is not included in the first hour of

129
Q

fluid replacement for third space losses

A
  • Minimal surgical trauma = 3 - 4 mL/kg/hr
  • Moderate surgical trauma = 5 - 6 mL/kg/hr
  • Major surgical trauma = 7 - 10 mL/kg/hr

As a general rule, third-space loss is not included in the first hour

130
Q

when should glucose-containing fluids be used in neonates

A

reserved for infants and children at risk of developing hypoglycemia
* Prematurity
* < 48 hours of age
* Small for gestational age
* Newborns of diabetic mothers
* DM & received insulin on the day of surgery
* TPN dependent

131
Q

at what glucose level do s/s hypoglycemia develop when < 72 hours old

A

30-40 mg/dL

132
Q

at what glucose level do s/s hypoglycemia develop when > 72 hours old

A

< 40 mg/dL

133
Q

treating neonatal hypoglycemia

A

IV 10% dextrose (2 mL/kg)
4 mL/kg if seizures present
after bolus, D10 gtt at 8 mg/kg/hr to maintain serum glucose > 40

134
Q

CO in the newborn

A

200 mL/kg/min

135
Q

why do neonates have a faster circulation time vs adults

A

increased CO (200 mL/kg/min)

136
Q

MAC of sevo in a 3 month old

A

3.2%

137
Q

why are neonates more sensitive to sedative-hypnotics

A

An immature BBB allows passage of drugs that would otherwise not be able to enter the brain

138
Q

when do babies reach adult values of drug biotransformation

A

by 1 yr old

139
Q

when is normal GFR achieved

A

8-24 months of age

140
Q

when is normal tubular function achieved

A

age 2

141
Q

dosing highly-protein bound drugs in infants

A

Before 6 mo, there are lower concentrations of albumin and alpha-1 acid glycoprotein, so for drugs that are usually highly protein-bound, the neonate will experience increased free drug levels and have a higher risk of toxicity

142
Q

dosing water solube drugs in neonates

A

Neonates have a higher percentage of total body water, (higher Vd) so they require higher doses of water-soluble drugs to achieve a given plasma concentration

143
Q

dosing drugs that require fat for redistribution in neonates

A

Neonates have a higher percentage of TBW and a lower percentage of fat and muscle mass. Drugs that require fat for redistribution and termination of effect have a longer duration of action

144
Q

MAC changes in infancy

A
  • Neonate (0 - 30 days): MAC is lower than the infant
  • Premature: MAC is lower than the neonate
  • Infant 1 - 6 months: MAC is higher than the adult
  • Infant 2 - 3 months: MAC peaks at its highest level
145
Q

MAC changes with age in infancy

A
  • Neonate (0 - 30 days): MAC is lower than the infant
  • Premature: MAC is lower than the neonate
  • Infant 1 - 6 months: MAC is higher than the adult
  • Infant 2 - 3 months: MAC peaks at its highest level
146
Q

MAC of sevo in 6mo-12 yr old

A

2.5%

147
Q

dosing succinylcholine in neonates

A

2 mg/kg

combination of an increased ECF and normal sensitivity to succinylcholine necessitates a higher dose

148
Q

dosing succinylcholine in neonates

A

2 mg/kg

combination of an increased ECF and normal sensitivity to succinylcholine necessitates a higher dose

149
Q

NMB that can cause HTN in neonates

A

pancuronium

150
Q

black box warning on succinylcholine

A

warns of hyperkalemia (risk of cardiac arrest) associated with undiagnosed muscular dystrophy in children under 8 years old

151
Q

first line treatment when child experiences cardiac arrest following succs admin

A

IV calcium is the first-line treatment

anytime a child experiences cardiac arrest following succinylcholine, hyperkalemia should be assumed until proven otherwise

152
Q

dosing IM succinylcholine

A
  • The dose for neonates and infants is 5 mg/kg
  • Older children should receive 4 mg/kg
153
Q

dosing neostigmine in neonates

A

0.05-0.07 mg/kg

154
Q

dosing edrophonium in neonates

A

1 mg/kg

155
Q

maximum inspiratory force (MIF) that predicts adequate NMB recovery in peds

A

less than -25 cm HO (e.g., - 30)

156
Q

most common metabolic disturbance in newborns

A

hypoglycemia

157
Q

children at risk of developing hypoglycemia

A
  1. premature
  2. SGA
  3. < 48 hours old
  4. newborns of diabetic mothers
  5. diabetics who received insulin DOS
  6. TPN dependent
158
Q

neonate’s UOP in the first week of life

A

< 1 mL/kg/day

159
Q

Compared to the adult, what 3 kidney functions are lower in the neonate?

A
  1. Renal perfusion pressure
  2. Glomerular fitration rate
  3. Diluting & concentrating ability
160
Q

how do neonates lose most body water

A

evaporation

161
Q

Why is so much body fluid lost through the skin of neonates?

A
  • Surface area to body weight ratio is four times higher than the adult.
  • Immature skin is thinner and more permeable to water.
162
Q

why are neonates intolerant of both fluid restriction and overload

A

restriction: poor job of conserving water
overload: unable to excrete large volumes of water

163
Q

neonates are obligate ____ losers in the first few days of life

A

sodium

164
Q

consequences of glycosuria in the neonate

A

osmotic diuresis
dehydration
increased serum osmolarity (can cause ICH)

165
Q

why does the erythrocyte transfusion trigger vary with age

A

depends on how much Hgb F the child has

166
Q
A
167
Q

In what age groups is ECF greater than ICF?

A
  • premature neonates
  • term neonates
168
Q

What is the PO2 When fetal hemoglobin is 50% saturated by oxygen?

A

19 mmHg

169
Q

10 mL/kg PRBCs estimated to increase Hgb by ___

A

1-2 g/dL

APEX (54 decks)

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