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The epiglottis of the infant is proportionally _______, ____ flexible, and ____-shaped.
larger; less; omega
The infant epiglottis also lies more horizontally or vetrically than the adult?
What is PARA?
- The past pregnancy history of the mother and is a representation of the number of total prior pregnancies, premature deliveries, abortions/miscarriages, and living children.
- Example: If a women was in her fourth pregnancy, has had one miscarriage, one premature delivery and two living children, it would be written as PARA 3-1-1-2
What is Dubowitz Gestational Age Assessment?
system uses 11 physical signs and 10 neurologic signs, each sign evaluated is assigned a score from 1 to as many as 5 points. The points are added up and the total corresponds to the gestational age. The Dubowitz system is accurate within 2 weeks and has consistent results when used in the first five days of life
When is the Dubowitz Gestational Age Assessment accurate?
within 2 weeks and has consistent results when used in the first five days of life
What is usually used to determine a baby's gestational age?
What replaced Dubowitz Gestational Age Assessment?
Ballard score in 1979
What is the Ballard score and when is it most reliable?
system assesses six neurologic signs and six physical signs; 1st 40 hours of life with ideal time between 30 and 42 hours after delivery
What is the purpose for the neonatal physical exam?
- help to determine if the neonate has made a successful transition to extrauterine life and the effects of labor and delivery
- can also help determine the need for resuscitation (especially for exam observed within 1 min of life)
What is usually observed within the first minute of life?
- - Vernix is white cream cheese-like substance that covers the fetus
- - It appears around 20 to 24 weeks and remains on the fetus until week 36, at which point it starts to disappear
- - It is usually gone by week 41 to 42
- Skin Maturity:
- - At 25 - 26 weeks, the skin is gelatinous and transparent and the blood vessels are visible
- - As gestation advances, the skin becomes pink and less transparent and the vessels become less visible
- - Lanugo is the fine, downy hair that covers the neonates body
- - It appears around week 26, beings to thin by week 28 and disappears around week 32
- - The term neonate may have Lanugo on the shoulders and forehead. This is a more common sign with dark complexioned neonates
- - Lanugo most of the time will disappear around week 40
- Ear recoil:
- - The external portion of the ear (pinna) at week 25 to 26 will remain folded if doubled over
- - Cartilage starts to form at around weeks 27 to 28 and will recoil slowly at this age
- - As the weeks pass the pinna looks more adult-like and will recoil faster
- Breast tissue:
- - At 25 to 26 weeks, the breasts are barely perceptible, if at all
- - At week 27, the breast becomes a red circle, the areola, but there is no palpable tissue behind it
- - Around week 30, a 1 to 2 mm diameter breast bud forms
- - The breast bud is a firm tissue that forms behind the areola and is easily felt during palpation
- - At term the breast bud is approximately 5 to 10 mm in diameter, raised, and the areola is fully developed
- - At weeks 25 to 26 the male scrotum is hardly recognizable. It has no wrinkles (rugae) and the testicles have not descended
- - In females at weeks 25 to 26 the inner portion of the external genitalia, the labia minora and the clitoris, are very pronounced
- - Around weeks 30 to 32 the outer portion, the labia majora, becomes equal in prominence
- - The labia majora continue to grow until, at term, the clitoris and labia minora are completely covered
- Sole creases:
- - At week 26 creases appear as faint red lines on the upper sole (near the toes) of the feet
- - At week 30 the creases have covered the upper portion of the feet
- - By week 34 two thirds of the sole are covered with creases
- - By term the entire sole is covered by deep creases
The term neonate has ______-looking skin, with many wrinkles and no visible vessels
What would be important to identify during the �quiet� exam?
- skin color:
- - Light complexed neonates should be pinkish
- - In darker complexed neonates it may be difficult to assess cyanosis. Assessment of the color of the mucus membranes would be helpful in these cases
- - The healthy neonate will usually be in the fetal position, with the legs drawn to the abdomen, arms flexed, tight to the body and will move extremities symmetrically
- Head to toe inspection:
- - Note any malformations or anomalies
- - Compare head size to body size
- - Look for abnormal bumps or bulges
- - 30 to 60 is normal
What index is used to determine the respiratory status of a neonate?
What are the major mechanisms by which drugs cross the placenta?
- Simple diffusion
- Facilitated diffusion
- Active transport
- Breaks in the placental villi
What are teratogens?
drugs that have been known to cause physical and/or mental developmental abnormalities in the embryo or fetus.
What can teratogens cause?
- Spontaneous abortion
- congenital malformations
- intrauterine growth retardation
- mental retardation
What factors are teratogens dependent on?
- Dose the fetus is exposed to
- The length of exposure
- Age of the fetus
- Other drug interactions
Although drugs can effect the fetus at anytime during development and adversely effect labor, the most critical time is the _____ trimester.
What does Pharmacokinetics mean?
- Used to describe the absorption, distribution, metabolism, and excretion of drugs
- "What the body does to drugs"
What are some drugs used in respiratory care for neonatal and pediatric patients?
- Palivizumab (Synagis
- Terbutaline sulfate (Brethine, Bricanyl, Brethaire)
What do we use to calculate proper drug dose for infants under 1 year?
- Fried�s rule:
- Infant dose = infant age (months) x (adult dose)
- 150 months
What do we use to calculate proper drug dose for pediatrics 1-12 years old?
- Young�s rule:
- Child dose = child age (years) x (adult dose)
- child age + 12 years
What do we use to calculate proper drug dose for a child?
- Clark�s rule:
- Child dose = child weight (lbs.) x (adult dose)
- 150 lbs.
What is Ribavirin used for?
broad spectrum antiviral drug that is specifically used in the neonatal and pediatric population for the treatment of bronchiolitis caused by the respiratory syncytial virus (RSV).
How did we deliver Ribavirin?
What is Respiratory Syncytial Virus Immune Globulin Intravenous (RespiGam)?
a sterile liquid formulation of immunoglobulin G (IgG) containing neutralizing antibody to RSV.
______ offers a prophylactic alternative to the treatment of acute RSV infection with aerosolized ribavirin.
Respiratory Syncytial Virus Immune Globulin Intravenous (RespiGam) comes in what measured doses?
50ml vials, containing 2500 mg of RSV immunoglobulin. It is administered as a monthly intravenous infusion of 750 mg/kg
_________ _______ represents the new class of therapeutic monoclonal antibodies. The drug was approved for the prevention and treatment of RSV in premature infants and those with bronchopulmonary dysplasia (BPD).
Palivizumab (Synagis) comes in what measured doses, and what is the recommended dosage?
- 50 and 100 mg/ml solutions for injection
- recommended doseage is: 15 mg/kg, given IM once a month throughout the season
What are Steroids used for?
decrease inflammation of the airways
What are some other drugs used in Respiratory Care for Neonates and Pediatrics?
- Alburterol = 20 ml at 5mg/ml or .5%, 3 ml at 0.083% or 2.5 mg in 2.5 ml NSS
- Metaproteronol = 5%, normal dosage 0.3ml of 5% diluted w/ 2.5 NSS
- Terbutaline sulfate = 1 mg/ml or a 0.1% solution, subcutaneously at a dosage of 0.01 mg/Kg, metered dose inhaler, giving a dose of 0.2 mg/puff
- Racemic Epinephrine = 2.25%, normal dosage .5 ml diluted w/ 2.5 to 3 ml NSS
- Atropine = 1 mg/0.5ml or 0.2%, also 2.5mg/0.5ml or 0.5%, dosage .05ml/kg 3-4 times per day
- Ipratropim bromide (Atrovent) = 2.5ml of 0.025% 3-4 times a day for adults
- Glycopyrrolate (Robinul)
- Beclomethasone (Vanceril,Steroid) = Dosage 1 to 2 puffs MDI 3-4 times per day. 1 puff is 42 micrograms
- Flunisolide (Aerobid, Steroid) = Dosage 1 to 2 puffs MDI BID
- Dexamethasone (Respihaler, Steroid) = Dosage 2 to 3 inhalations MDI 3-4 times per day
- Triamcinolone (Azmacort, Steroid) = Dosage 1 to 2 inhalations MDI 3-4 times per day
- Cromolyn Sodium (Intal) = Cap 20mg, Neb 20mg in 2ml
- Pentamidine Isethonate (Nebupent, Pentam 300) = Prevent PCP, used w/ Respigard II, 300 mg Q4 weeks
What is administered for TX of colonization in pulmonary tree?