Week 1: Characteristics of Pediatrics/Behavioral Flashcards
Definitions
Newborn:
Neonates:
Infants:
Children:
Newborn: 0- 24 hours old
Neonates: 1-28 days of age
Infants: Between 28 days - 1 y/o
Children: >1 y/o - puberty
Definitions
Gestational age:
Post-conceptual age: & what does it indicate?
Gestational age: the actual # of weeks the baby was in utero
Post-conceptual age = gestational age + chronologic age of the neonate
- indicates the functioning of the various organ systems.
Definition
Prematurity:
Preterm infant:
- neonates who weight <2500 g at birth
- born before 37 weeks of gestation\
Term newborn
born after 37 weeks and before 42 weeks gestation
Post-term newborn
born after 42 weeks gestation
SGA
AGA
LGA
Small for gestational age
Appropiate for gestational age
Large for gestational age
Definitions
- Low birth weight (LBW)
- Very low birth weight (VLBW)
- Extremely low birth weight
- Micropremies
- <2500 grams
- <1500 g
- <1000 g
- <750 g
T/F Infants <1 generally suffer from separation anxiety
False- they do NOT
In healthy children, routine lab work is not required unless the surgical procedure requires it examples:
- Craniosynostosis
- Spine or
- Pelvic/femoral surgery
Preop
In african american or mixed-race ancentry consider neonatal __________ screening results or consider a _________ screen.
ENT may consider a HCT prior to:
- Sickle; sickle cell
- Tonsillectomy or adenoidectomy
- The child with seasonal or viral rhinitis, who does not have a _______ or _________ , may proceed with surgery on a case-by-case basis. Inquire about fever, cough, wheezing, antipyretics.
- The risk of perioperative respiratory complications is increased; however, it may be difficult to find a disease-free window.
- fever or lower respiratory symptoms
- Information available on anesthesia adverse outcomes suggests _______ are at higher risk than are _________.
- __________ are at greater risk than pediatric patients older than 2 years of age.
- neonates, older infants
- Older infants
Anatomy
- Anterior fontanelle
- Posterior fontanelle
- closes between 9-18 months
- closes by 2-4 months
* cranial molding occurs in LBW and is usually of no clinical importance
- Cranial vault increases rapidly in size and after ______ y/o it increases marginally in size.
- Face and base of skull develop at a _______ rate:
- at birth mandible is ________. Forward growth occurs with developing
- failure to do so can represent which congenital defects?
- facial configuration substantive changes after 2 y/o
- Maxilla grows quick to accomodate growing teeth
- 2
- slower
- small
- Pierre Robin Sequence
- Treacher collins
- Goldenhar Syndromes
- Cranial base = rapid growth completed by ___ y/o
- Skull base= grows quick until _______ and slower growth after.
- 2 y/o
- 6 y/o
- Frontal sinuses develop ___-___ year old.
- maxillary, ethmoidal, and sphenoidal after _______ y/o
- 2 - 6;
- 6
Respiratory system
- begins during _______ of gestation.
- Bronchial tree to terminal bronchial it is formed by _______.
- Alveoli grow mainly after birth until ______ y/o in number # and in size until growth of chest wall stops.
- Pulmonary vessels until ___________
- 4th week
- 16 weeks
- 8
- late adolescence
Chest wall and respiratory muscles in infancy
- Accessory muscles of inspiration are ______.
- Ribs extend _________. Moving little with inspiration - which depends on descent of the diaphragm.
- Neonate chest wall is __________ due to noncalcified cartilage and ribs.
This increase workload on diaphragm = risk for fatigue and respiratory failure - * in preterm infant
- ineffective
- horizontally
- floppy
Muscle strength depends on the presence of type I (slow twitch) muscle fibers to respond to an increased workload.
Preterm infants have limited number type I
FRC
- Neonate in supine = small FRC due to ________ elastic lung recoil and ________ outward forces of the complaint chest wall.
- Large abdomen pushes the diaphragm up.
- increased; weak
Closing capacity: (air trapping)
- Related to ____ and _____.
- Closely related to _______
- ________ throughout childhood and adolescence; and _______ throughout adult life.
- Not possible to measure closing volume in children <_____ y/o. But because the elastic recoild pressure is _______ in infancy some airways likely remain close through tidal breathing.
- Infants have a large “trapped gas volume” not free.
- elastic tissue and recoil pressure.
- age
- Decreasing; increasing
- 5 y/o; small
Heart rate:
- Anatomic control in utero mainly by the _____.
- Only shortly after bitrh SNS beings to appear; but PNS continues to dominate until _______.
- PNS
- adolescense
Age and HR
Premature:
0 - 3 months:
3 - 6 months :
6 - 12 months:
1- 3 years:
3 - 6 yers:
6 - 12 years:
> 12 years:
Premature: 120 - 170
0 - 3 months: 100 - 150
3 - 6 months : 90 - 120
6 - 12 months: 80 - 120
1- 3 years::70 -110
3 - 6 yers: 65 - 110
6 - 12 years: 60 - 95
> 12 years: 55-85
Bloop pressure:
- Less in lower extremeties vs. upper in children.
(Mean systolic/diastolic)
Premature :
0 - 3 months:
3 - 6 months :
6 - 12 months:
1- 3 years:
3 - 6 yers:
6 - 12 years:
> 12 years:
(Mean systolic/ diastolic)
Premature : 55-75/ 35-45
0 - 3 months: 65 - 85/ 45 - 55
3 - 6 months : 70-90/ 50-65
6 - 12 months: 80-100/ 55-65
1- 3 years: 90-105 / 55-70
3 - 6 yers: 95- 110 / 60-75.
6 - 12 years: 100-120/ 60-75
> 12 years: 110-135/ 65-85
Renal system
- Development begins in week 4 gestation until adulthood
- Fetus maintain metabolic homeostasis throguh the placenta until bith when kidneys take ove.
Tubular function
- The #/function threshold for resorption of Na+/K+-ATPase are _______ at bith.
- The renal tubular threshold for resorption of Na+, glucose, and bicarb are decreased in neonatal
- Putting babies at risk of:
- reduced
explains why babies become acidotic quickly
- hyponatremia
- osmotic polyuria
- metabolic acidosis
Endogenous acid production in small children (50-100% greater than in adults) d/t deposition of _______ in bone. (0.5-1 mEq/L acid per day)
Explains tendency of infants to become profoundly acidotic when suffering from ___________.
Neonates/Infant are living near its limit of acid compensation making them prone to acidosis when sick/starving.
- calcium
- gastroenteritis
Neonates/ preterm infants are obligate salt loosers.
- They cannot ____________ a large salt load or ___________ urine effectively.
- due to immature distal tubular function and relative _______________.
This increases the risk for:
- excrete; concentrate
- hypoaldosteronism
Hyperkalemia
LES pressures are _______ at birth but _______ steadily. Reaches adult by ____ - ______ weeks postnatal.
Daily vomititng or “spitting up”: 50% of infants 0-3 months of age and 2/3 of infants 4-6 months of age.
Reduced; increase
3-6
**mostly normal “happy spitters”
Hemoglobin
- Neonate normal hemoglobin range
- In term neonates, the hemoglobin concentration decreases during the ________ to ________ week to a nadir of __________ to ____________ (Hematocrit _____ to _______) but increases thereafter.
- Infants weighing <800-1000g may reach _________.
- after 3 months until 2 hemoglobin: _____ - _________
- Gradual increase until puberty (14 F) - 15.5 (M)
- 14-20g/dl
- 9th-12th; 10-11g/dL (30-33%)
- 8 g/dL
- 11.5 - 12
oxygen delivery is not compromised
At birth, vit.K-dependent factor (i.e., II,VII,IX, and X) are 20% to 60% of adult values (preterm even less). The result is prolonged __________.
All neonates hould receive prophylactic vit.K soon after birth to prevent ___________ of the neonate.
Bone marrow is immature
- prothrombin time
- hemorraghic disease
Most common etiologies of cerebral palsy
- ischemic stroke
- white matter disorder
- intrauterine inflammation
- <5% d/t perinatal asphysia
Strongest predictors of cerebral palsy (6)
- congenital anomaly (**congenital heart disease)
- low birth weight
- multiple fetuses
- preterm delivery
- intrauterine infection
- abnormal fetal position before L&D
Two growth spurs
Neuronal cell multiply between ____-_____ wks gestation
Glial cell multiply starting ______ wks gestation until ______ year of life.
- Myelination continue into the 3rd year.
- Myelination usually completed by _______
- malnutrition in this phase = ____________ effects.
- 15-20
- 25; 2
- 7y/o
- handicapping
Growth spurs in brain affected by stress and nutrition
In preterm neonates stressed by hypoxia, the BBB may become permeable to the water-soluble _____ ______, with possible damage to the brain.
unbound bilirubin
Immature pancres
Neonates who are SGA are frequently hypoglycemic possibly due to:
- Malnutrition in utero
- Hepatic glycogen stores are inadequate
- Deficient gluconeogenesis exists
Emergence delirium
- First maladaptive behavioral change in children
- S/S: (6)
- Nonpurposeful restlessness
- Agitation
- Trashing
- Crying
- Moaning
- Disorientation
Emergence delirium
Risk factors
- young age: 2-6 y/o
- preop anxiety
- type of anesthetic (VAs>TIVA; Halothane)
- type of sx. (painful vs. nonpainful)
- previous sx.
**rapid emergence and depth of ANE do not predict delirium
