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What gestational ages are considered prematurity and post-maturity?
- Prematurity = <37 weeks
- Postmaturity = >42 weeks
What periods of gestation are important for organogenesis and organ function?
- Organogenesis = first 8 weeks of conception
- Organ function develops during 2nd trimester
What is the threshold for low birth weight?
<2500g = LBW
What formula is used to estimate average pediatric weight?
2 x age (years) + 9 = weight (kg)
What is the average weight of the newborn and infant 1-6 months of age?
- Newborn = 3.5 kg
- 1-6 months = 4 kg
What are the risk factors for resorting to transitional (fetal) circulation?
- pulmonary disease resulting in hypercarbia or hypoxia
- aspiration of meconium
- congenital heart disease
What is different about the pediatric heart compared to the adult?
- Less contractile mass
- Less compliant ventricles
- Poor tolerance of increased after load
- HR dependent CO
- Reduced endogenous Ca stores
- Faster HR and lower BP
- Fixed SV
- Underdeveloped compensatory mechanisms
- Hypotension WITHOUT tachycardia
- Increased metabolic rate
What is the normal O2 consumption of a newborn, child, and adult?
- newborn = 5-8cc/kg/min
- children = 4-6cc/kg/min
- adult = 3-5cc/kg/min
What is different about the pulmonary system of the pediatric patient?
- Increased airflow resistance
- Highly compliant airways
- Poorly supported surrounding structures
- Highly compliant chest wall
- Poorly maintained negative intrathoracic pressure
- Faster RR
- Lower FRC in neonates and infants
- Higher minute ventilation:FRC
- Poorly developed hypoxic and hypercapnic ventilatory drives
What is different about the pediatric airway?
- Prominent occiput
- Disproportionately large tongue
- Larynx higher in neck (C3-C4) vs. adults (C4-C5)
- Narrowest part of airway is at cricoid ring
What is important about Type 1 muscle fibers in the intercostal muscles of pediatric patients?
Number of Type 1 muscle fibers inversely proportional to age - results in faster fatigue R/T tachypnea. By age 2, intercostal muscle development similar to adult.
What is important about the renal anatomy of neonates?
- Neonates have limited ability to conserve Na and concentrate/dilute urine
- Increased risk for hyponatremia, hypocalcemia, and hypoglycemia
- Risk for large evaporative water losses
- Higher total body water
- Half life of renal excreted meds prolonged
- GFR < normal until age 1 yr
- Tubular function < normal until age 3 yrs