Neonatal A&P 3

Question 1

Potential complications of massive transfusion in the neonate include all of the following EXCEPT:
a. metabolic acidosis
b. metabolic alkalosis
c. hypocalcemia
d. hypokalemia

Answer 1

d. hypokalemia

Question 2

Erythrocyte transfusion triggers vary on

Answer 2

the patient’s age (how much Hgb F they have) & underlying cardiopulmonary disease

Question 3

FFP is indicated for

Answer 3

coagulopathy
massive transfusion
emergent warfarin reversal

Question 4

FFP is not indicated for

Answer 4

expansion of intravascular volume

Question 5

Platelet transfusion is recommended for

Answer 5

invasive procedures to maintain the platelet count above 50,000 mm3

Question 6

Complications associated with massive transfusion include

Answer 6

alkalosis
hypothermia
hyperglycemia
hypocalcemia
hyperkalemia

Question 7

When RBCs are stored, the cell membrane becomes

Answer 7

dysfunctional, which allows potassium to leak

Question 8

Transfusion should be guided by

Answer 8

ongoing blood loss
anticipated blood loss
baseline Hgb/Hct
signs of inadequate oxygenation and end-organ dysfunction

Question 9

For children less than 4 months of age with severe cardiopulmonary disease, the transfusion trigger would be

Answer 9

<13 g/dL

Question 10

For the child less than 4 months of age presenting for major surgery or with moderate cardiopulmonary disease, the transfusion trigger would be

Answer 10

<10 g/dL

Question 11

Dose of erythrocytes for children less than 4 months of age is

Answer 11

10-15 mL/kg

Question 12

10 mL/kg will raise hgb by

Answer 12

1-2 g/dL

Question 13

Dose of FFP is

Answer 13

10-20 mL/kg

Question 14

Dose of platelets is obtained from apheresis is

Answer 14

5 mL/kg

Question 15

Dose of platelets if pool platelet concentrate is

Answer 15

1 pack/10 kg

Question 16

The risk of hyperkalemia during blood transfusion is reduced by

Answer 16

administering washed or fresh cells that are less than 7 days old

Question 17

What type of blood should be given to immunocompromised patients?

Answer 17

irradiated blood (prevents graft vs. host)

Question 18

At what age should you follow transfusion practice guidelines of the ASA task force on blood component therapy in a healthy child?

Answer 18

4 months and older

Question 19

A 3 kg term neonate requires emergency exlap for necrotizing enterocolitis. her preoperative hematocrit is 50%. What is the maximum allowable blood loss to maintain a hematocrit of 40%?
a. 40 mL
b. 55 mL
c. 70 mL
d. 85 mL

Answer 19

b. 55 mL

Question 20

What is the maximum allowable blood loss equation?

Answer 20

MABL= EBV x (Hct starting- Hct target)/ Hct starting

Question 21

Normal newborn Hgb is

Answer 21

14-20 g/dL

Question 22

Hemoglobin of a 3 month old is

Answer 22

10-14 g/dL

Question 23

normal hemoglobin for a 6-12 month old is

Answer 23

11-15 g/dL

Question 24

Normal hemoglobin for an adult female is

Answer 24

12-16 g/dL

Question 25

Normal hemoglobin for an adult male is

Answer 25

14-18 g/dL

Question 26

Estimated blood volume of a premature neonate is

Answer 26

90-100

Question 27

EBV of a term neonate is

Answer 27

90-100

Question 28

EBV of an infant is

Answer 28

75-80

Question 29

EBV of a year old is

Answer 29

70-75

Question 30

The newborn's kidney tends to: a. excrete sodium b. reabsorb sodium c. reabsorb water d. reabsorb glucose

Answer 30

a. excrete sodium

Question 31

Compared to the adult, the neonatal kidney has

Answer 31

a decreased perfusion pressure a decreased GFR & a decreased diluting and concentrating ability

Question 32

GFR improves substantially in the__________________ but does not reach adult levels until

Answer 32

first few weeks of life but does not reach adult levels until 8-24 months of age

Question 33

The neonate is an obligate __________________-- in the first few days of life

Answer 33

sodium loser

Question 34

Renal tubular function continues to improve after birth, but it does not achieve full concentrating ability until

Answer 34

~2 years of age

Question 35

Describe fluid balance in neonates.

Answer 35

do a poor job conserving water so they're intolerant of fluid restriction but they're unable to excrete large volumes of water so they don't do well with fluid overload either

Question 36

Neonates have a high degree of

Answer 36

insensible fluid loss

Question 37

The most significant source of water loss for neonates is

Answer 37

evaporation

Question 38

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

Answer 38

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

Question 39

The total body water for a premature neonate is approximately: a. 65% b. 75% c. 85% d. 95%

Answer 39

c. 85%

Question 40

Total body water is highest in _________________ and decreases _____________

Answer 40

premature newborns and decreases as the child ages

Question 41

The following are highest at birth and decrease with age

Answer 41

total body water extracellular fluid

Question 42

The following are lowest at birth and increase with age

Answer 42

intracellular fluid

Question 43

Signs of dehydration in the neonate include

Answer 43

sunken anterior fontanel weight loss lethargy dry mucus membranes increased hematocrit

Question 44

The premature neonate total body water is

Answer 44

85%

Question 45

The neonate total body water is

Answer 45

75%

Question 46

A higher ICF as the child ages provides a

Answer 46

volume reserve in times of intravascular volume loss making them more capable of adjusting to theses conditions when compared to the neonate

Question 47

Calculate the hourly maintenance rate for a child who weighs 15 kg.

Answer 47

50 mLs

Question 48

Routine use of _____________- is not recommended unless the neonate is at risk for __________-

Answer 48

glucose-containing solutions; hypoglycemia

Question 49

If less than 72 hours old, signs of hypoglycemia develop if the serum glucose is

Answer 49

<30-40 mg/dL

Question 50

If older than 72 hours, signs of hypoglycemia develop if serum glucose is

Answer 50

<40 mg/dL