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Review of Peds/Neos
| Question | Answer |
|---|---|
| Fetal shunts, purpose and location? | The Ductus Venosus is at the liver and shunts 50% of blood from liver to inferior vena cava. The Foramen ovale is a shunt from R atrium to L atrium so only 10% of blood goes to lungs. The Ductus arteriosus goes from pulmonary artery to aorta bypass lungs |
| stages of fetal lung development | Stage 1: embryonal phase, stage 2: pseudoglandular phase, stage 3: canalivular phase, stage 4: saccular phase, stage 5: Alveolar stage |
| Embryonal phase | lung bud out of pharynx, bronchial buds, trachea starts to branch |
| Pseudoglandular Phase | 3.5 - 16th week, lungs have glandlike appearance, subdividing of airways acinus may appear, development of airway catilage |
| Canalicular Phase | 17-26 weeks, Growth of vascular bed, gas exchange happens!, extrauterine viability! 22-24 wks, surfactant production begins |
| saccular phase | 26-35/36 weeks, development of mature alveoli |
| Alveolar Stage | 36-18 months postnatal, not easily distinguishalbe from saccular phase |
| Postnatal lung development | 80% of alveopli develop after birth, factors affecting lung development hypoxia or hyperoxia, nutrition or maternal smoking |
| Pulmonary Hypoplasia | causes of decreased lung development, compression via diaphragmatic hernia, oligohydrmanios if baby has kidney issures, polyhydramnios if mom is diabetic, decreased ventilation, metablolic disorders ie diabetes |
| pulmonary surfactant development | Type 1- gas exchange Type 2- pneumocytes, production, secretion, storage reuse surfactant, prevents alveolar collapse Early stimulation of surfactnat: beta agonists, prostaglandins, MV, steriods, heroin |
| Fetal Lung Liquid | secretes 250-330 ml/day, swallowed or expelled into amniotic fluid, essential for normal lung development, stops at 14 weeks bc of skin hardening, removed after birth via blood and lymphatic vessels |
| maternal-fetal gas exchange | umbilical cord, 2 small ateries and one large vein, chorion (chorionic villi) exchange stuff for mom's side and babys side, keeps placenta attached to wall. |
| transition to extrauterine life | increase pulmonary blood flow, pulmonary vasodilation decreaed co2 and increased pao2, stretching pulmonary units more surface area for more gas exvhange |
| Maternal History you would want to know | any preterm delivery, cervical insufficiency, toxic habits of pregnancy, hypertension, diabetes mellitus, infectious disease, any previous miscarriages or following risk factors: placenta or umbilical abnormalities |
| placenta previa | occurs when the placenta covers the cervical os. C-section usually required |
| Normal ABG | PaO2 40-60, Co2 45-55, Bicarb 18 - 21/22, BE -5 |
| Quick assessment for need of resuscitation | gestational age (26 wks or less) clear amniotic fluid, respiratory effort, muscle tone |
| Basic resuscitation goals | warmth and stimulation, oxygenation and ventilation, circulation, volume expanders, cardiotonic medications |
| What will Terbutaline and magnesium do to the baby? | they are both smooth muscle dilators that are labor stopping but depress CNS with effects of bradycardia and some respiratory issues. |
| Normal respirations and heart rate? | RR 40-60 minute, heart rate more than 100/beats min |
| Baby weight, tube size? | Baby: <1,000g 2.5 Tube size 1,000-2,000g 3.0 tube size 2,000-3,000g 3.5 tube size >3g 4.0 tube size |
| gestational age and size estimation? | GA is estimated before baby is 12 hours old, maternal menstrual cycle, prenatal ultrasound, postnatal assessment (physical and neurological examination..aka ballard score) |
| Vernix caseosa and Lanugo? | Vernix caseosa is like thick white lotion on baby after birth, Lanugo are little hairs, usually when premie that will go away |
| Silverman score? | Respiratory Distress Score, Grade 0-2 nares, chest and grunt |
| Signs of respiratory distress | grunting, retractions, accessory muscle use, abdominal/chest wall synchrony |
| Circulating blood volume of neonate and peds? | for a neonate 85-90 ml/kg, for a pediatric about 70-75ml/kg |
| Pain Control | Anesthetic cream, lidocaine injection (must be 4months or older for either of those) or sucrose, good on binkies |
| CBG's how different from ABG? | Less invasive, correlates best with PH and PaCo2, babies need to be minimum 24 hours old, puncture sites are fingertips or heal, assessment of ventilation |
| Arterial catheters | The umbilical arteries are considered "central" and peripheral arteries are radial, posterior tibial or dorsalis pedis |
| Transcutaneous monitoring | pulse ox, transcutaneous Co2, heated to a temperature to increase perfusion to that area, moved every couple of hours to avoid burn |
| Normal SPo2 for children and neonate? | Children: 80 mmhg Pao2 and up, spo2 95% or greater Neonate: premie 40-60 mmhg and Spo2 high 80's% Term baby 60 mmhg and higher, Spo2 90% or higher |
| High-flow Nasal Cannula | warmed and humidified, needed for AOP, 0.25 - 2.0 LPM if flow is too high (4lpm) can be like cpap on baby, ng tube almost always in baby. Hazards: excessive pressure, air in esophagus |
| L:S ratio, what is it and what it means? | how mature the surfactant is, tested from the amniotic fluid, 2:1 ratio is what we want! a 1:1 ratio is likely to develop ARDS |
| TTN | transient tachypnea of the newborn, up to 150 breaths per minute, grunting noise to increase FRC |
| MAS | Meconium aspiration syndrome, ball-valve effect on air-trapping(auto-peep) hyperinflation leads to pneumonia, suctioning right away, do not stimulate baby to breathe! |
| PPHN | Persistent pulmonary hypertension of the newborn - icreased PVR that isn't going away preduct on right side, post duct anywhere else, more than 20 points you have a patent DA, baby looks cyanotic, tx HFV, nitric oxide, ECMO |
| diaphragmatic hernia | PIP <25 cmh2o, hypoplastic lung, can move mediastinal and heart if severe. |
| CF | Genetics CFTR screening, autosomal recessive, chloride test 60 ml or higher it's present |
| PDA, managament? | below 28 wks, 50-60% chance that baby will have a PDA, maintain hematocrit at the high end, administer indomethacin (best when given within the first 24 hrs of life) |
Created by:
phxgrl
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