NEONATE Others

Question 1

TRANSFUSION TRIGGERS

Answer 1

Hemoglobin <10 g/dL - major surgery or newborn with moderate cardiopulmonary disease

Hemoglobin <13 g/dL - newborn with severe cardiopulmonary disease

Question 2

PLATELETS should be kept above ___ /uL for invasive procedures

Answer 2

> 50,000/uL

Question 3

Hemoglobin in transfused blood is

Hemoglobin A or Hemoglobin F?

Answer 3

HEMOGLOBIN A

Better release of oxygen at tissue level

Question 4

Rare but potentially deadly complication of RBC transfusion where transfused lymphocytes in the donor blood attack the recepient none marrow

Answer 4

TRANSFUSION-ASSOCIATED GRAFT VERSUS HOST DISEASE

Causes: 
Fever
Pancytopenia 
Diarrhea 
Hepatitis 

Prevention:
GAMMA IRRADIATION OF CELLULAR BLOOD

Question 5

This is used for transfusion in premature neonates to

1. Reduce cytomegalic virus transmission
2. Decrease risk of alloimmunization
3. Decrease febrile hemolytic transfusion reactions

There are also decrease in retinopathy of prematurity, bronchopulmonary dysplasia and length of hospital stay

Answer 5

LEUKOCYTE REDUCTION by FILTRATION

Question 6

Most frequent surgical procedures in the FIRST MONTH of life (6)

Answer 6

1. Exlap for necrotizing enterocolitis
2. Correction of pyloric stenosis
3. Patent ductus arteriosus ligation
4. Shunt procedure for hydrocephalus
5. Central venous catheter placement
6. Inguinal hernia repair

Question 7

Newborns have ______ hemoglobin levels than infant or child

Answer 7

HIGHER - 15-18 g/dL

> 20 g/dL polycythemia

Question 8

At risk for hypoglycemia

Answer 8

1. Stressed preterm or SGA or VLBW
2. With diabetic mothers
3. Who have not been receiving either enteral or parenteral feeds
4. Septic

Question 9

Glucose level

1. Full term
2. Preterm

Answer 9

1. Full term 60-80 mg/dL

2. Preterm 10 mg/dL below the full term glucose level (50-70 mg/dL

Question 10

Hypoglycemia or gloves levels less than ___ warrant therapy with additional dextrose

Answer 10

< 45 mg/dL

Question 11

Unexplained thrombocytopenia can be an early sign of _____

Answer 11

Sepsis

Question 12

PT and PTT are ______ in newborns

Answer 12

10% longer

PT approach adult levels in the 1st week
PTT approach adult levels within the 1st month of life

Question 13

Prevention of early vitamin K deficiency bleeding of the newborn

Answer 13

IM vitamin K administration after birth

Question 14

NIBP

1. Cuff size
2. Cycle

Answer 14

1. Size 1/2 or 2/3 of the length of the upper arm

2. Should not be routinely cycled excessively more than every 3 mins - at risk for venous stasis

Question 15

Lipid emulsion dose for LAST

Answer 15

1.5 ml/kg bolus which may be repeated followed by continuous infusion of 0.25 ml/kg/min

Question 16

EMLA

Answer 16

Mixture of lidocaine 2.5% and prilocaine 2.5%

Applied under an occlusive bandage for 45-60 mins

Question 17

High or total spinal anesthesia in infants will present as _________

Answer 17

APNEA or falling oxygen saturation instead of hypotension due to lack of sympathetic tone in infants

Question 18

Landmarks for caudal epidural block

Answer 18

1. Coccyx
2. Two safral cornua
3. Posterior superior iliac spines

Question 19

Evidence of intravascular injection during caudal block

Answer 19

1. Peak T waves
2. Increase in HR
3. Increase in BP

Question 20

Primary mechanism the newborn has to respond to heat loss

Answer 20

NONSHIVERING THERMOGENESIS

Question 21

Administering _______ at dose ________ prophylactically to infants at risk of postoperative apnea to ensure adequate serum levels may prevent the need for prolonged periods of postoperative ventilatory support

Answer 21

CAFFEINE 10 mg/kg

Caffeine and theophylline - increase central respiratory drive and lowering the threshold of response to hypercarbis and stimulating contractility in the diaphragm

Question 22

The most common cited cause of ROP (retinopathy of prematurity)

Answer 22

HYPEROXIA

Other causes: hypoxemia, hypotension, sepsis, intraventricular hemorrhage and other stresses

Question 23

Surgical procedures performed in the FIRST WEEK of life (6)

Answer 23

1. CDH
2. Omphalocele
3. Gastroschisis
4. TEF
5. Intestinal obstruction
6. Myelomeningocele

Question 24

Multimodal treatment of pulmonary HPN as preoperative preparation for patients with CDH (congenital diaphragmatic hernia) include:

Answer 24

1. Nitric oxide
2. Sildenafil - PDE-5 inhibitor
3. Milrinone - PDE-3 inhibitor
4. Epoprostenol or iloprost - PGI2 inhibitor
5. Bosentan - endothelin inhibitor
6. Imantibin - PDGF inhibitor

Question 25

Anesthetic technique for repair of CDH

Answer 25

1. Infants who will remain intubated: Inhalation agents and narcotics 2. Small defect with little to no respiratory distress: Regional or neuraxial analgesia in anticipation of extubation 3. Muscle relaxant to facilitate abdominal closure 4. Avoid nitric oxide if abdominal closure could be difficult

Question 26

During ___ to ___ week of fetal life, the abdominal contents are extruded into na extraembryonic coelem and gutnreturns to the abdominal cavity at 10th week

Answer 26

5th to 10th week

Question 27

Omphalocele or Gastroschisis Failure of part of or all the intestinal contents to return to abdominal cavity Covered with a membrane called amnion Umbilical cord is found at the APEX of the sac

Answer 27

OMPHALOCELE Amnion - protects the abdominal contents from infection and loss of ECF

Question 28

Omphalocele or Gastroschisis Develops later in life, after intestinal contents have returned to the abd cavity Results from interruption of the omphalomesenteric artery which results in ischemia and atrophy of the various layers of abd wall No sac; abd viscera may be found outside the periotoneal cavity Umbilical cord is found at one side of the intestinal contents

Answer 28

GASTROSCHISIS

Question 29

Omphalocele or gastroschisis High incidence of associated congenital anomalies

Answer 29

OMPHALOCELE

Question 30

Beckwith-Wiedemann syndrome (5)

Answer 30

1. Mental retardation 2. Hypoglycemia 3. Congenital heart disease 4. Large tongue 5. Omphalocele

Question 31

The most common upper gastrointestinal obstruction in the newborn is ________

Answer 31

PYLORIC STENOSIS

Question 32

Most common congenital primary neural tube defect

Answer 32

MYELOMENINGOCELE Failure of neural tube closure during 4th week of gestation

Question 33

Most common airway problem in infants and young children is ________

Answer 33

Upper airway obstruction due to LARYNGOMALACIA Supraglottic structures converge on the glortic opening during inspiration preventing air entry Characterized by 1. Suprasternal and supraclavicular retractions 2. Paradoxical collapse of chest wall or sternum 3. Exaggerated diaphragmatic excursions Treatment: POSITIVE AIRWAY PRESSURE Resolve with age and without treatment

Question 34

Single most effective strategy available to minimize heat loss in children who undergo surgery lasting for 1 hour

Answer 34

Forced air warmers

Question 35

In children, heat loss follows the order:

Answer 35

1. Radiation 39% 2. Evaporation 24% 3. Conduction 3%

Question 36

Core temperature

Answer 36

Mid-esophagus usinh esophageal temp probe