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Review of Peds/Neos

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