Neonatal emergencies 2

Question 1

Which condition is MOST closely associated with gastroschisis?
a. prematurity
b. congenital heart disease
c. Beckwith-Weidemann syndrome
d. trisomy 21

Answer 1

a. prematurity

Question 2

Defects in the abdominal wall of the infant include

Answer 2

omphalocele and gastroschisis

Question 3

Which is more common omphalocele or gastroschisis?

Answer 3

ompalocele

Question 4

Omphalocele is associated with

Answer 4

trisomy 21, cardiac defects, & Beckwith Wiedemann syndrome

Question 5

Ompalocele includes ____________________–whereas gastroschisis does not

Answer 5

a covering over the abdominal viscera; does not include a covering over the abdominal viscera

Question 6

The patient with gastroschisis is

Answer 6

sicker and at a higher risk of fluid and heat loss

Question 7

Anesthetic considerations for omphalocele and gastroschisis include

Answer 7

monitoring thoracic and abdominal pressure along with meticulous attention to fluid balance and body temperature

Question 8

Omphalocele is caused by

Answer 8

failure of gut migration from the yolk sac into the abdomen

Question 9

Gastroschisis is caused by

Answer 9

occlusion of the omphalomesenteric artery during gestation

Question 10

With gastroschisis, abdominal contents are

Answer 10

placed in a bag after delivery to minimize water and heat loss

Question 11

Where should SpO2 be measured with gastroschisis and omphalocele?

Answer 11

lower extremity to monitor for impaired venous return

Question 12

One should expect ____________ with anesthetic management of gastroschisis and omphalocele.

Answer 12

significant fluid and electrolyte shifts

Question 13

What is a late finding in the patient with untreated pyloric stenosis?
a. hyponatremia
b. hyperkalemia
c. metabolic acidosis
d. alkaline urine

Answer 13

c. metabolic acidosis

Question 14

Pyloric stenosis occurs when

Answer 14

hypertrophy of the pyloric muscle creates a mechanical obstruction at the gastric outlet

Question 15

With pyloric stenosis, one can palpate

Answer 15

an olive-shaped mass just below the xiphoid process

Question 16

The infant with pyloric stenosis presents with

Answer 16

non-bilious projectile vomiting leading to dehydration with hyponatremia, hypokalemia, hypochloremia, and metabolic alkalosis + compensatory respiratory acidosis

Question 17

Pyloric stenosis is a ________________________ so pyloromyotomy should be

Answer 17

medical (not surgical) emergency; postponed until the fluid, electrolyte, and acid-base status are optimized

Question 18

With pyloric stenosis, one should anticipate a

Answer 18

full stomach; empty the stomach before induction, intubate either awake or with RSI, and extubate awake

Question 19

With pyloric stenosis, if dehydration is not correct,

Answer 19

impaired tissue perfusion increases lactic acid production (metabolic acidosis) this is a late complication

Question 20

Severe hydration with pyloric stenosis

Answer 20

should be corrected BEFORE surgery with 20 mL/kg of 0.9% NaCl

Question 21

Maintenance fluids for pyloric stenosis consists of

Answer 21

D5 0.45% NaCl at 1.5 x the calculated maintenance rate

Question 22

What is common postoperatively with pyloric stenosis?

Answer 22

apnea; possibly due to CSF pH remaining alkalotic even after serum acid-base status is normalized

Question 23

Placing an oro- or nasogastric tube after induction with pyloric stenosis

Answer 23

can be used to assess for an air leak following surgical repair which suggests a mucosal perforation

Question 24

When is pyloric stenosis most commonly diagnosed?

Answer 24

first 2 to 12 weeks of life

Question 25

How does pyloric stenosis impact urinary pH?

Answer 25

early-stage= alkalotic urine secondary to bicarb excretion late stage- acidic urine secondary to hydrogen excretion

Question 26

What is the MOST appropriate gas mixture for the neonate with necrotizing enterocolitis? a. 30% oxygen + 70% nitrous oxide b. 50% oxygen + 50% nitrous oxide c. 50% oxygen + 50% air d. 100% oxygen

Answer 26

c. 50% oxygen + 50% air

Question 27

Risk factors for necrotizing enterocolitis include

Answer 27

prematurity (<32 weeks) low birth weight (<1,500 g)

Question 28

Necrotizing enterocolitis is likely the result of

Answer 28

early feeding

Question 29

With necrotizing enterocolitis, impaired absorption by the gut leads to

Answer 29

stasis, bacterial overgrowth, and infection

Question 30

Necrotizing enterocolitis increases the risk of

Answer 30

bowel perforation

Question 31

How are babies with necrotizing enterocolitis managed?

Answer 31

medically; but bowel perforation necessitates bowel resection and usually colostomy

Question 32

Patients with necrotizing enterocolitis often have

Answer 32

metabolic acidosis and require substantial fluid replacement

Question 33

_________ should be avoided with necrotizing enterocolitis.

Answer 33

Nitrous oxide

Question 34

Diagnosis of necrotizing enterocolitis includes

Answer 34

fixed dilated intestinal loops pneumatosis intestinalis (gas cysts in the bowel), portal vein air, ascites, and free air in the abdomen

Question 35

Bowel resection early in life can lead to

Answer 35

short gut syndrome (nutrient malabsorption)

Question 36

Necrotizing enterocolitis affects what region of the bowel?

Answer 36

terminal ileum and proximal colon

Question 37

Select the MOST significant risk factor for retinopathy of prematurity. a. sepsis b. prematurity c. hypoxemia d. intraventricular hemorrhage

Answer 37

b. prematurity

Question 38

The most important risk factors for retinopathy of prematurity include

Answer 38

prematurity and hyperoxia

Question 39

Retinopathy of prematurity causes

Answer 39

abnormal vascular development in the retina

Question 40

The immature retinal blood vessels with retinopathy of prematurity are at risk of

Answer 40

vasoconstriction and hemorrhage which can create scars

Question 41

When scars retract with ROP, they

Answer 41

pull on the retina, causing retinal detachment and blindness

Question 42

When is retinal maturation complete?

Answer 42

up to 44 weeks after conception

Question 43

Until retinal maturation is complete, supplemental oxygen should be

Answer 43

minimized to maintain SpO2 between 89-94%

Question 44

Where should SpO2 be monitored for ROP?

Answer 44

preductal location (RUE)

Question 45

ROP is defined by

Answer 45

two phases

Question 46

What is phase 1 of ROP?

Answer 46

inhibited growth of retinal vessels

Question 47

What is phase 2 of ROP?

Answer 47

overgrowth of abnormal vessels with fibrous bands that extend to the vitreous gel which can precipitate retinal detachment