Neonatal

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Author:
felizdiaz
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65681
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Neonatal
Updated:
2011-02-11 14:32:08
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neonatal
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neonatal
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  1. Four main shuts in fetus
    • placenta
    • foramen ovale
    • ductus arteriosus
    • ductus venosus
  2. Fetus PVR
    70/45
  3. HOW DOES FLUILD LEAVE LUNGS OF FETUS
    • COMPRESSION OF VAG BIRTH
    • FIRST BREATH ( CREATE 40-60 CM OF PRESSURE)
    • REMAINDER OF FLUID IS REMOVED BY LYMPATHICS OVER NEXT 24 HOURS.
  4. FIRST BREATH
    • 5-10 MIN
    • NORMAL VENT VOL AND TV
    • 10-20 MIN
    • FRC
    • BLOOD GAS
  5. CIRCULATIORY CHANGES AT BIRTH
    • PVR DECREASE 75-80 % DT PO2 AND CONTINUE TO DECREASE OVER NEXT 6-8 WEEKS TILL NORMAL LEVEL
    • PUL ART SIZE DECREASE
  6. PERSISTENT PUL HTN (PPH)
    BYPASS THE LUNG VIA DUCTOUS ARTERIOSUS AND FORAMEN OVALE
  7. ETIOLOGY OF PPH
    • SECONDARY
    • MECONIUM ASPIRATION, SEPSIS, PNEUMO, CDH, RESP DISTRES, COLD, ACIDOSIS, STREE
  8. TREATMENT OF PPH
    • SURFACTANT, NO, ECMO (BYPASS)
    • GOAL PAO2 OF 50-70
    • PACO2 OF 40-60
  9. DUCTUS ARTERIOSUS
    • CLOSE IN 48-72HOURS BY INCREASED PO2 AND HIGHER PH AND NO PROSTAGLANDINS
    • THEN 95% CLOSE THEN PERMENENT CLOSURE IS 2-3 WEEKS
    • FUNCTIONAL CLOSEURE 12HOURS
    • PHYSICOLOGICALLY CLOSED IS 2ND DAY
    • PERMANENT FIRST 2 MONTHS
  10. S/S OF PDA
    • CHF
    • TACHY
    • POOR FEEDING AND WEIGHT GAIN
  11. TREATMENT OF PDA
    • BLOCK PROSTOGLANDIN (INDOMETHACIN)
    • SURGICAL-LIGATION
    • CATH LAB (HARD TO DO)
  12. HOW TO KEEP PDA
    • S/S OF NEED IN 2-3 DAYS AS DUCTUS CLOSE
    • BLOCK FLOW TO PUL ART AND AORTA
    • GIVE PROSTAGLANDIN
  13. FORAMEN OVALE
    • CLOSE DT INCREASE PRESSURE OF LEFT ATRUIM AND INCREASE BLOOD FLOW
    • MAY STAY OPEN FOR WEEKS
    • 20% OF ADULTS HAVE PATENT FO
  14. SHUNTS TO WHAT
    • FO- FOSSA OVALIS
    • UMBILICAL VEIN- LIGAMENTUM TERES
    • DUCTUS VENOSUS0 LIGAMENTUM VENOSUM
    • DUCTUS ART- LIGMENTUM ARTERIOSUM
  15. NEONATAL AIRWAY DIFFERENCES
    • 1. OBLIGATE NOSE BREATHERS
    • 2. LARGE TONGUE
    • 3. HIGH GLOTTIS
    • 4.ANTERIOR SLANTING VOCAL CORDS
    • 5. NARROW CRICOID RING
    • 6. LARGE OCCIPUT
    • 7. RING NOT RIGID
    • 8 ABUNDANT LYMPHOID TISSUE
  16. WHAT IS THE MOST COMMON CAUSE OF AIRWAY OBSTRUCTION
    TONGUE
  17. NEONATAL AIRWAY
    • PREMEE- C3
    • FULL TERM-C4
    • ADULT-C5
  18. WHAT IS THE NARROWEST PART OF THE NEONATE
    CRICOID RINGS TILL ABOUT 10 YO
  19. WHERE IS THE EPIGLOTTIS
    BASE OF TONGUE AND MIDLINE
  20. SNIFFED
    FOR BABY PLACE TOWEL UNDER SHOULDERS TILL 2 YO
  21. 4 DIFFERENCES FROM ADULT FOR PUL SYSTEM
    • 1. HIGH O2 CONSUMPTION
    • 2. HIGH CLOSING PRESSURE
    • 3. HIGH MIN VENT TO FRC RATIO
    • 4. ANATOMIC ISSUES
  22. O2 CONSUMPTION
    • INFANT 7-9ML/KG/MIN
    • ADULTS 3ML/KG/MIN
    • 3X
    • DUE THIS BY BREATHING FASTER
  23. HIGH CLOSING VOL
    JUSTED NUMBER NORMAL TV
  24. MIN VOL TO FRC RATIO
    • ADULT 1.5:1
    • NEONATE 5:1
    • 3X
    • HAS HIGHER VESSEL RICH GROUPS
  25. FRC OF NEONATE
    27-30
  26. TYPE ONE MUSCLE
    • SLOW TWICH
    • HIGH O2 NEED
    • SUSTAINED MUSCLE
    • DIAPHRAGM ACHIEVE T1 AT 8 MONTHS
    • INTERCOSTAL T1 AT 2 MONTHS
  27. TYPE TWO MUSCLE
    • FAST TWITCH
    • LOW O2 NEED
    • SHORT ACTIVITY
  28. CARDIO DIFFERENCE
    • CO MAX DT FIXED SV
    • LOW SVR (MAP 35-40)
    • IMMATURE SNS
    • ONLY WAY TO CHANGE CO IS INCREASE HR
    • CAN ONLY INCREASE CO BY 30-40% VS 300% WITH ADULTS
  29. NEONATE HYPOXIA CAUSED
    • NUMBER ONE BRADYCARDIA
    • NOT TOLERATED
  30. FETAL KIDNEY
    • LOW RENAL BLOOD FLOW
    • LOW GFR
    • MAKE URINE THAT FORM AMNIOTIC FLUID
  31. WHY HAVE LOW RBF AND GFR
    • LOW SYSTEMIC ARTERIAL PRESSURE
    • HIGH RENAL VASCULAR RESISTANCE
    • LOE PERMEABLIITY OF GLOMERULAR
    • SMALL SIZE AND NUMBER OF GLOMERULI

    • LIKE OF IT LIKE THE LUNGS
    • 70% MAURE AT 1 MONTH OF LIFE
  32. OBLIGATE NA LOSER
    • NEONATE URINE NA IS HIGH 20-25
    • VS 5-10 IN ADULT
  33. NEONATE HEMOTOLOGY
    • EBV 90 ML/KG
    • HGB-19
    • 80% IS HGB F
    • HBG F HAS HIGHER AFFINITY FOR O2
  34. FALL OF BLOOD LEVELS
    • FALLS FIRST 6-8 WEEKS
    • RARELY DROPS BELOW 9
    • PREMEE FALL FASTER AND LOWER (7)
  35. RBC MADE IN
    • FETAL IN LIVER
    • SHIFT TO BONE BY 6TH WEEK
  36. 4-2-1 IV RULE
    • 4 ML 10 KG
    • 2 ML 11-20KG
    • 1 ML >20KG
  37. WHAT IS THE MAINTENANCE IV NA
    • 3-5 mEq/kg PER DAY
    • HENCE 2% NS
  38. REPLACING NPO FLUID
    • 1/2 FIRST HOUR
    • 1/4 2ND HOUR
    • 1/4 3RD HOUR

    • 50 CC/HR 10 HOURS NPO= 500CC
    • 250 1ST
    • 125 FOR 2ND AND 3RD HOUR
  39. EBV
    • PREEME 90-100
    • NEWBORN 80-90
    • 3MO-1YO-70
    • 1 YO-70
    • ADULT 55-60ML/KG
    • THINK DROP 10
  40. ACCEPTABLE BLOOD LOSS
    • HEALTH
    • LESS THAN 25-30% BL
    • FINAL HGB 8-9
  41. KEEP GLUCOSE
    IF NEONATE ON D5 IV CONTINUE
  42. WHAT IS BROWN FAT
    • THERMOGENESIS
    • FROMS IN 26-30 WKS
    • 2-6% WIEGHT
    • 6 AREAS
    • USE FATTY ACID META
    • WHY?
    • BABY DON'T SHIEVER
  43. WHY JAUNDICE
    • CHANGE FROM HGB F TO HGB A
    • AND LIVER UDP-GLUCRONLY TRANSFERASE (WHICH CHANGE TO WATER SOL) IS NOT FULLY DEVELOPLED
  44. COMMON PROBLEMS OF PREMEEIES
    • RESP DISTRESS
    • MECONIUM ASPIRATION
    • APNEA
    • BRONCHOPUL DYSPLASIA
    • PDA
    • CONGENITAL HD
    • NEC (DIED GUT)
    • JAUNDICE
    • ANEMIA
    • HIGH AND LOW BS
    • INFECTION
    • INTRAVENT HEMORRHAGE
    • SIEZURE
  45. IVA
    • 500-750 GM
    • 60-70%

    • 1000-1500 GM
    • 10-20%
  46. WHEN IS IT SAFE FOR OR
    • FOR PREMIE 60 WEEKS PCA
    • FULLTERM 44-46 WKS PCA

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