Pediatrics I Flashcards

Question

RDS Complications

Answer 1

``` Treatment → BPD Anemia Apnea history Residual chronic respiratory disease Impaired gas exchange Prolonged ventilation history Residual subglottic stenosis d/t long-term ETT ```

Answer 2

> 15 seconds | → bradycardia & desaturations

Answer 3

Failure to breath

Answer 4

Failure to maintain patent airway

Answer 5

``` Low birth weight Anemia Hypothermia Sepsis* Neurological abnormalities Surgical procedure (even w/ regional) ```

Answer 6

After 44 weeks corrected Neonates < 2,500g 25% risk < 1,000g 85% risk

Answer 7

Common up to 48 hours postop Admit all premature infants < 60wks Continuous apnea & bradycardia monitoring IV caffeine 5-10mg/kg Nasal CPAP or tracheal intubation w/ mechanical ventilation Defer elective surgery until > 44-50 weeks corrected

Answer 8

Immaturity & ↓myofibrils # ↓contractility ↓relaxation ↑risk CV collapse during anesthesia & surgery Fetal heart ↑connective tissues, less organized contractile elements, & ↑dependence on extracellular Ca2+ Less compliant tissues ↓catecholamine sensitivity Autoregulation not well-developed HR unable to compensate hypovolemia → impaired blood flow & cerebral oxygen delivery R & L ventricle are equal size

Answer 9

``` POORLY ↓contractility & relaxation ↑afterload poorly tolerated ↓preload poorly tolerated Dependent on serum ionized Ca2+ Immature Frank-Starling curve ↓volume load response ```

Answer 10

Parasympathetic Vagus → bradycardia Sympathetic innervation = poorly developed

Answer 11

↑CV collapse risk during major surgery | PDA promotes pulmonary HTN & CHF

Answer 12

Blue or cyanotic lesions Occurs w/ ↑PVR Venous blood ejected systemically ↓pulmonary blood flow → hypoxia, hypercarbia, & acidosis ASD or VSD w/ pulmonary HTN Tetralogy of Fallot during Tet spell

Answer 13

Pink or acyanotic lesions Occurs w/ ↑SVR ↑pulmonary blood flow → hypotension & pulmonary volume overload PDA, ASD, & VSD

Answer 14

AVA Umbilical arteries x2 originate from fetal internal iliac arteries & deliver fetal blood to the placenta Umbilical vein x1 carries oxygenated blood from the placenta to the fetus 1° umbilical vein blood supply bypasses the liver via the ductus venous & empties into the IVC where mixes w/ less oxygenated blood from LE IVC blood enters R atrium via Eustachian valve across foramen ovale into the L atrium L ventricle pumps blood to UE via aortic arch great vessels Deoxygenated SVC blood enter R atrium & crosses tricuspid valve into R ventricle ↑PVR → R ventricular output → systemic circulation via ductus arteriosus

Answer 15

Originates from pulmonary artery & inserts into the aorta at point distal to L subclavian artery origin

Answer 16

↑PVR ↓SVR Oxygenated blood from umbilical vein → perfuse brain & heart via ductus venosus shunt across the liver Foramen ovale connects R & L atrium

Answer 17

LEFT SHIFT P50 = 19mmHg ↑Hgb (polycythemia) levels in utero ↑CaO2

Answer 18

Umbilical cord clamping & lung inflation

Answer 19

↑PaO2 ↓PVR Vasomotor tone relaxation ↑pulmonary blood flow ↑L atrium blood flow via the pulmonary vein ↑L atrium pressure > R atrium → closes atrial septum over the foramen ovale

Answer 20

Removes the low resistance placenta ↑SVR ↓IVC blood flow & R atrium pressure Reverse flow via ductus arteriosus ↑O2 concentration ↓PGEs → ductus arteriosus closure Closures prevent blood from bypassing pulmonary circulation Neonatal blood able to become oxygenation in newly operational lungs

Answer 21

Functional closure quick | Anatomic closure usually requires weeks

Answer 22

Remains open d/t hypoxia, mild acidosis, & placental PGEs Functional closure when these factors are removed Reverse flow pressure & ↑PaO2 >50-60mmHg causes muscular wall to constrict

Answer 23

5-7 days | Potential to persist until 3 weeks

Answer 24

``` Hypothermia Hypercarbia Acidosis Hypoxia Sepsis ↑PVR ``` Delayed PDA closure common in premature infants < 34wks

Answer 25

Low diastolic pressure Congestive heart failure Pulmonary edema → pulmonary HTN

Answer 26

Incomplete myelination Cerebral cortex less developed Immature blood-brain barrier (more vulnerable to drugs or toxins) Neural pathways present Impaired cerebral autoregulation → blood flow = pressure dependent

Answer 27

Fragile cerebral vessels susceptible to rupture → intra-cerebral hemorrhage & intraventricular hemorrhage Spontaneous bleeding into & around lateral ventricles

Answer 28

Small birth weight & preterm (1/3 micropreemies) ``` RDS - hypoxia, hypercarbia Acute BP fluctuations Acidosis Hypernatremia ↓Hct Over transfusion Stress/trauma Rapid admin hypertonic fluids (NaHCO3 or dextrose) ```

Answer 29

``` Hypotonia Apnea Seizures Loss sucking reflex Bulging anterior fontanelle ```

Answer 30

Retinopathy of prematurity Normal retinal vascular development stops Neovascularization & fibrous tissue formation in the retina → retinal detachment, fibrosis, & blindness

Answer 31

``` Low birth weight < 1,000g Prematurity Oxygen exposure Apnea Blood transfusions Sepsis CO2 ``` *Fluctuating oxygen levels or rapid swings

Answer 32

90-94% | Titrate based on pre-ductal saturation

Answer 33

↑surface are per kg Thin skin ↓fat content ↑heat loss risk Radiation > convection > evaporation > conduction

Answer 34

``` Non-shivering thermogenesis (up to 3mos) Brown fat metabolism Volatile anesthetics inhibit thermogenesis Crying Movement Stress → poor weight gain ```

Answer 35

Depress the hypothalamus - Reduction in already impaired ability to maintain body temperature Cutaneous vasodilation

Answer 36

``` Delayed awakening from volatile anesthetics Cardiac instability Respiratory depression ↑PVR Altered drug response ```

Answer 37

``` Transport isolette and/or heating pad Room temp 70-80°F Fluid warmer Limit skin exposure Cover infant head Forced air warmer Heat lamps ```

Answer 38

↓ability to compensate volume swings Glomeruli continue to develop until 40 days postnatal Prolonged duration/half-life drugs dependent on GFR excretion ↓proximal tubular Na+/H2O reabsorption Monitor Na+ & electrolytes Impaired glucose production

Answer 39

Immature CYP450 phase 1 metabolism 50% adult values at birth Phase 2 impaired until 1yo Limited glycogen stores & ability to handle large protein loads ↓albumin synthesis ↑unbound drug available Bilirubin & ABO incompatibility

Answer 40

Infant dependent on extracellular Ca2+ & reserves Parathyroid function not fully established Vitamin D stores inadequate Anticipate hypocalcemia especially in preterm, severe neonatal illness, & after blood transfusions Calcium gluconate or chloride infusions to treat symptomatic hypocalcemia Central line preferred