Neonatal Flashcards
(80 cards)
1
Q
Organogenesis time frame?
A
1-8 wks
2
Q
Organ function time frame?
A
2nd trimester
3
Q
Body mass time frame?
A
3rd trimester
4
Q
APGAR is based on infant’s condition at what times after birth?
A
1 and 5 min
5
Q
Does APGAR score make long term prediction on child’s health?
A
NO
6
Q
APGAR stands for?
A
Appearance Pulse Grimace Activity Respiration
7
Q
APGAR score of 2 for each category?
A
A: no cyanosis P: >100 G: cry or pull away when stimulated A: flexed arms and legs that resist extension R: strong, lusty cry
8
Q
APGAR score above 7?
A
Normal
9
Q
Is transient cyanosis common?
A
Yes
10
Q
What is the purpose of the APGAR test?
A
To determine quickly whether a newborn needs immediate medical care
11
Q
VC compared to adult?
A
Half
12
Q
Respiratory rate compared to adult?
A
2x
13
Q
Metabolic rate compared to adult?
A
Higher
14
Q
Lung compliance compared to adult?
A
Decreased
15
Q
Chest wall compliance compared to adult?
A
Greater
16
Q
FRC compared to adult?
A
Decreased
17
Q
Oxygenation, ventilation more effected by what 3 things?
A
- Opioids
- Barbs
- Gas
18
Q
Alveoli compared to adults?
A
Not anatomically mature; reduce cross section area for gas exchange
19
Q
What kind of breathers are neonates?
A
Diaphragmatic because poorly developed intercostal muscles
20
Q
Do neonates desat quick?
A
YES
21
Q
What does diaphragm look like compared to adults?
A
Flat, not domed
22
Q
New born negative inspiratory pressures?
A
40-60 H2O (increased surface tension)
23
Q
What 2 things are neonates prone to during anesthesia?
A
- Atelectasis
2. Hypoxemia
24
Q
Use how much O2 compared to adults?
A
3x
25
Neonates have what percent increase in CO?
30-60%
26
Hemoglobin levels due to what?
High (about 17) due to fetal hemoglobin
27
CO2 response curve shift to what?
Right
28
Babies are those who are smaller in size than normal for the baby’s sex and gestational age, most commonly defined as a wt below the 10th percentile for the gestational age?
Small for gestational age (SGA)
29
When are alveolar sacs finally formed?
7 years of age
30
Apnea for more than how long lead to cyanosis?
15-20 secs
31
What bpm is considered bradycardia?
<80
32
When do A&B’s of prematurity markedly improves or goes away?
Time the baby nears his/her due date
33
CO is what dependent?
HR
34
Ventricles of neonates?
Stiff and close to max contractility
35
HR compared to adults?
Faster, can’t tolerate bradycardia
36
BP compared to adults?
Lower BP
37
3 cardiac abnormalities?
1. Patent foramen ovale
2. Patent ductus arteriosis
3. Tetralogy of fallot
38
Patent foramen ovale % close in 1st few months?
75%
39
What % of patent foramen ovale remains open as adult?
25%
40
Fetal hemoglobin comprises what % of infants hemoglobin?
50-95%
41
Adult hemoglobin predominant after what age?
6 months
42
Which has greater affinity for O2? Fetal or adult hemoglobin?
Fetal
43
O2 saturation curve is what kind of shift?
Left
44
Leftward shift decreases and increase what?
Decrease: P50
Increase: hemoglobin’s affinity for O2
45
Overall leftward shirt causes what?
Reduce availability to the tissues
46
Hepatic BF compared to adult?
Decreased
47
Duration type with roc and what affects it?
Prolonged duration and P450
48
Duration type of midazolam and what affects that?
Prolonged and CYP3A4, CYP3A5cytochromes
49
PT and PTT times in healthy premature infant?
Prolonged
50
Jaundice occurs in what % of infants?
60
51
What therapy is used to treat newborn jaundice?
Phototherapy
52
What 4 things does phototherapy cause?
1. Brain damage (kernicterus) leading to cerebral palsy
2. Auditory neuropathy
3. Gaze abnormalities
4. Dental enamel hypoplasia
53
Bili lights have blue light of what nm?
420-470 nm
54
Should infants eyes be protected when under bili lights?
Yes
55
Glycemic levels in neonates?
Hypoglycemia quickly
56
Why do they get hypoglycemic quickly? (2)
Glycogen stores are small
| Gluconeogenesis is immature
57
GFR compared to adults?
25% of adult values
58
Lower esophageal sphincter formation?
Incompetent so increase risk of reflux; always considered full stomach
59
Heat is lost when the surface dries
Evaporation
60
Placed on a cooler surface or touching them with a cool object or hands
Conduction
61
Heat is transferred to the air surround the infant heat loss
Convection
62
Transfer of heat to cool objects that are no in direct contact with neonate
Radiation
63
Heat gain/loss controlled by?
Hypothalamus and limbic system
64
Temp sensors on what and stimulate what?
On posterior hypothalamus stimulate pituitary to produce T4 and adrenals to produce NoE
65
Blood vessels are what to the surface?
Close
66
Can neonates vasoconstrict?
No
67
As infant gets cold, what happens?
Activates NorE release (controlled by hypothalamus) that leads to pulmonary and peripheral vasoconstriction (increased pulmonary vascular resistance)
68
Non shivering thermogenesis uses what to produce heat?
Brown fat
69
What does brown fat contain?
Small lipid droplets and much high number of iron containing mitochondria
70
Non shivering thermogenesis is rich capillary network densely innervate by what?
Sympathetic nerve endings
71
Non shivering thermogenesis generally disappears when after brith?
3-6 months
72
Infant respiratory distress syndrome has a deficiency in what?
Surfactant
73
What 4 things are used to treat respiratory distress syndrome?
1. Surfactant
2. O2
3. CPAP
4. PEEP
74
Respiratory distress syndrome can have the chronic complication of what?
Broncho-pulmonary dysplasia (BPD)
75
4 things to look for in volume assessment?
1. Sunken (top of head and eyes)
2. Skin turgor
3. Cries with no tears
4. Capillary refill
76
During the 1st week reduced fluid requirements: day 1, day 3, day 5, day 7
Day 1: 70 ml/kg/24hr
Day 3: 80 ml/kg/24hr
Day 5: 90 ml/kg/24hr
Day 7: 120 ml/kg/24hr
77
Volume of ECF is small or large?
Large
78
7 pharmacological differences btn neonate and adults:
1. Immature hepatic biotransformation
2. Decreased protein binding
3. Repaid rise in ET volatile agent levels
4. Rapid induction and recovery
5. Decreased MAC
6. Larger volume of distribution for drugs
7. Immature neuromuscular junction
79
Maternal DM may predispose infants to what glycemic level?
Hypoglycemia
80
Airway of neonates (5)
1. Large tongue and occiput
2. Small mouth
3. Short neck
4. Floppy epiglottis
5. Weak respiratory muscles
