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neonatal a&p Flashcards

(86 cards)

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1
Q

newborn BP, HR, RR

A

BP 70/40
HR 140
RR 40-60

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2
Q

1 year BP, HR, RR

A

BP 95/60
HR 120
RR 40

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3
Q

3 year BP, HR, RR

A

BP 100/65
HR 100
RR 30

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4
Q

12 year BP, HR, RR

A

BP 110/70
HR 80
RR 20

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5
Q

in the newborn, HoTN is defined as SBP <

A

60mmHg

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6
Q

explain why neonate RR is higher

A

they have twice the O2 consumption and CO2 production than adults (infants 6mL/kg/min, adults 3mL/kg/min). its metabolically more efficient to increase RR rather than Vt so thats why RR is increased but Vt is 6mL/kg

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7
Q

HoTN in <1yr is defined as

A

<70mmHg

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8
Q

HoTN in patients older than 1 year

A

(70 + (childs age in years x 2))

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9
Q

in the setting of hypovolemia and bradycardia, which drug is preferred

A

epinephrine since it augments contractility (if only little bit)

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10
Q

why does the child become less dependent on HR

A

as SVR rises, LV creates more contractile filaments and frank starling starts to be a conversation. therefore the patient becomes less dependent on HR over time to support CO

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11
Q

infant vocal cord position

A

C1-2

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12
Q

describe the infant epiglottis

A

long and stiff

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13
Q

vocal cord position: adult versus infant

A

adult: perpendicular to trachea
infant: anterior slant

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14
Q

alveolar ventilation: adult versus infant

A

adult: 60mL/kg/min
infant: 130mL/kg/min

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15
Q

infants have a ___________ alveolar ventilation relative to FRC size

A

increased

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16
Q

do adults and neonates have the same amount of dead space on a per weight basis

A

yes

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17
Q

what type of muscle fibers do infants have in their diaphragm

A

more type 2 (fast twitch) muscle fibers and less type 1 (slow twitch) muscle fibers (25% type 1 as compared to 55% in adults)

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18
Q

children less than ______ are at risk for apnea and should be admitted for 24h post surgery

A

60w PCA

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19
Q

what can you do to be prophylactic about postoperative apnea

A

caffeine 10mg/kg IV

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20
Q

describe lung compliance in the newborn

A

lower lung compliance due to fewer alveoli

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21
Q

describe chest wall compliance in newborn

A

higher compliance due to cartilaginous (flimsy) ribcage

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22
Q

describe the issue with closing capacity in the newborn

A

overlaps with Vt during normal breathing

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23
Q

lung capacities that are decreased relative to adults

A

FRC, VC, TLC

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24
Q

lung capacities that are increased relative to adults

A

closing capacity, RV

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25
mother at term pH, PaO2, PaCO2
pH 7.4 PaO2 90 PaCO2 30
26
umbilical vein: placenta to fetus pH, PaO2, PaCO2
pH 7.35 PaO2 30 PaCO2 40
27
umbilical artery: fetus to placenta pH, PaO2, PaCO2
pH 7.3 PaO2 20 PaCO2 50
28
newborn at time after delivery pH, PaO2, PaCO2: 10 minutes
pH 7.2 PaO2 50 PaCO2 50
29
newborn at time after delivery pH, PaO2, PaCO2: 1 hour
pH 7.35 PaO2 60 PaCO2 30
30
newborn at time after delivery pH, PaO2, PaCO2: 24h
pH 7.35 PaO2 70 PaCO2 30
31
during the first hour of extrauterine life, what does the newborn do and why (think respiratory)
hyperventilates. likely due to poor buffering capacity and compensation for non volatile acids in the blood.
32
when does respiratory control mature and what is the response to hypoxia before versus after this time
42-44w PCA <44w, hypoxia depresses ventilation >44w, hypoxia stimulates ventilation
33
life span of fetal HGB
70-90 days
34
HgbF P50
19mmHg (adult 26.5mmHg)
35
HgbA begins to replace HgbF at ____________ and is complete by _____________
2 months and is complete by 6 months
36
why does the HgbF left shift benefit fetus
creates o2 partial pressure gradient that facilitates passage from mother to fetus
37
during which months can you expect physiologic anemia
months 2-3 (~hgb 10)- remember shift from HgbF to HgbA is starting
38
transfusion trigger for children less than 4 months with severe cardiopulmonary disease
<13mg/dL
39
transfusion trigger for children less than 4 months with moderate cardiopulmonary disease
<10mg/dL
40
PRBC dose for kid <4mo of age
10-15mL/kg (10mL/kg will increase HGB by 1-2g/dL)
41
for children with no issues and less than 4 months, transfuse when?
<6 6-10, go by sx
42
3 indications for FFP transfusion
1. emergency reversal of warfarin 2. correction of coagulopathic bleeding with increased PT or PTT 3. correction of coagulopathic bleeding if >1 BV has been replaced and coagulation studies are not easily obtained
43
FFP dose
10-20mL/kg
44
when is platelet transfusion recommended
maintain platelet count above 50,000
45
platelet dose if obtained from apharesis
5mL/kg
46
platelet dose if pooled platelet concentrate
1pack/10kg
47
one pooled platelet concentrate will increase serum platelets by
50 x 10^9
48
massive transfusion is associated with (5, think electrolytes and pH)
alkalosis (due to citrate metabolism to bicarb in the liver) hypothermia hyperglycemia (dextrose additive in stored blood) hypocalcemia (binding of calcium via citrate) hyperkalemia (administration of older blood)
49
newborn normal Hgb and Hct
Hgb 14-20 Hct 45-65
50
3 months normal Hgb and Hct
Hgb 10-14 Hct 31-41
51
6-12 months normal Hgb and Hct
hgb 11-15 hct 33-42
52
adult female normal Hgb and Hct
12-16 37-47
53
adult male normal Hgb and Hct
14-18 42-50
54
premature neonate EBV
90-100
55
term neonate EBV
80-90
56
infant EBV
75-80
57
1 year EBV
70-75
58
max allowable blood loss equation
EBV* (starting HCT- target HCT)/starting HCT
59
compared to adult, the newborn kidney has decreased
perfusion pressure, GFR, and dilution/concentration ability
60
when does GFR mature
improves substantially over first few weeks of life but does not mature until 8-24 months of age
61
when does renal tubular function mature
improves after birth but does not have full concentrating ability until ~2 years
62
premature TBW %, ECF %, ICF %
TBW 85% ECF 60% ICF 25%
63
neonate TBW %, ECF %, ICF %
TBW 75 ECF 40 ICF 35
64
child and adult TBW %, ECF %, ICF %
TBW 60 ECF 20 ICF 40
65
signs of dehydration
sunken anterior fontanel weight loss (10% reduction in first week is normal) irritability or lethargy dry mucous membranes absence of tears decreased skin turgor increased Hct (concentration)
66
hourly maintenance 4:2:1 rule
0-10kg-->4mL/kg/h 10-20kg--> add 2mL/kg/h to previous total >20kg--> add 1mL/kg/h to previous total
67
third space loss calculation: minimal surgical trauma
3-4mL/kg/h
68
third space loss calculation: moderate surgical trauma
5-6mL/kg/h
69
third space loss calculation: major surgical trauma
7-10mL/kg/h
70
ratio of replacement for: crystalloid colloid blood
crystalloid 3:1 colloid 1:1 blood 1:1
71
use of glucose containing fluids should be reserved for the following populations
premature less than 48h small GA newborns of diabetic mothers children with DM who received insulin the day of surgery children who receive glucose based parenteral nutrition
72
less than 72h old, signs of hypoglycemia can manifest if BG is <
30-40mg/dL
73
older than 72h old, signs of hypoglycemia can manifest if BG is <
40mg/dL
74
tx of hypoglycemia
10% dextrose 2mL/kg if seizures are present, dose is doubled after bolus, D10 infusion at 8mL/kg/min is titrated to maintain serum glucose >40mg/dL
75
newborn CO
200mL/kg/min
76
water soluble drugs and neonate dosage
neonates have higher TBW so need higher dose of water soluble drugs
77
before _____ months, infants have less albumin and alpha 1 glycoprotein
6
78
lipid soluble drugs and infant dosage
infants have lower percentage of fat and muscle mass and therefore lipid soluble drugs take longer to cleart
79
drug biotransformation is under developed in the first
month of life
80
hepatic values are not reached until how old?
one year
81
what do infants lack for bilirubin conjugation
glucoronyl transferase
82
when does MAC peak at its highest level
2-3 months
83
IM succ dose neonates versus children
neonates 5mg/kg children 4mg/kg
84
IM roc dose children <1 year and > 1 year
<1 year 1mg/kg >1 year 1.8mg/kg onset IM 3-4 min
85
what conditions contribute to failure from fetal to adult circulation in the newborn?
acidosis, hypothermia
86
citrate most often occurs in neonates and infants following the administration of what
FFP

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