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199 Cards in this Set
- Front
- Back
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what are premature babies? what are very premie, and extremely
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premature: < 37 weeks
very: <32 extremely: < 28 weeks |
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define the birth weight classification of babies
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<2500g: LBW
<1500g: VLBW < 1000g: ELBW <750g before 26 weeks: micro |
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what is chronological/postnatal age?
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time elapsed since birth
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what is postemstural age?
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gestational age + chronological age
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what is the corrected age?
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chronological age reduced by the number of weeks born before 40 weeks of gestation (weeks, months)
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which groups have the highest rates of premature births?
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under 18 and advanced maternal age
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what is the age of viability?
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hovers around 23/24 weeks
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which of the premies is the least and most likely to survive?
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The least likely to survive are the wimpy white males
most are black females |
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gastric pH approaches netruality at ___
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birth
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highest gastric pH is within ___ days
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first 1-10
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lowest gastric pH within the first ___days
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10-30
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gastric secretion approaches lower limit of adult values by __
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3 months
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ToF: Neonates have better absorption of weak acids
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false: poor: better absorption of weak bases
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what are the weak acid and weak base drugs?
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acid: phenytoin, phenobar
base: penicillin, amp, erythromycin |
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The lack of intestinal flora decreases the bioavailbilty of ___
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digoxin
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what are the enteral absorption issues in neonates?>
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-pH differences
-lack of flora -decreased intestinal motility -pancreatic enzyme activity (decreased at birth) -must receive 1/2 of total fluid intake enterally before PO meds introduced |
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the majority of neonate drugs are absorbed in the __
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small intestine
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what are the issue due to decreased intestinal motility?
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-increase in absorption of drugs in the stomach
-delayed absorption of drugs absorbed in small intestine -gastric emptying normalizes quickly but intestinal empying lags behing until 4-6 months of age |
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what is needed for infant meds in terms of pancreatic insufficiency?
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they need the enzymes to cleave the salt form prior to absorption
-absorption highly variable in first 3 months of life |
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what are the typical trophic feeds? if babies can tolerate, what does this mean?
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1cc per hour. their gut is working and it will prevent hyperosmolarity
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what are the issues of intramuscular absorption in neonates?
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-pain
-low blood flow/supply (slower absorption) -decreased muscle mass (premies) -immobility |
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what is the volume of IM administration that can be given to small infants? older infants? and older children?
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small: 0.5ml
older infants: 1mL older children: 2.5mL |
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when is IM routes reserved for in neonate?
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for emergencies or situations in which slower absorption is desired and or safer (Vit K)
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what are the skin absorptions issues in neonates?
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-increase skin hydration
-low fat stores -immature epidermis (thinner stratum corneum) -increased risk of toxicity (rubbing alcohol, benadryl, etc) -sensitive to environmental changes |
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what are the issues of rectal absorption in neonates?
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-useful for NV, status epilepticus, induction of anesthesia
-avoids first pass effect |
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the 1st 2/3 of the rectum empty into on part of the vasculature and the 2nd 1/3 goes to the __-
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liver
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what are the Vd issues for neonates?
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-hydrophilic drugs (vanc, gent) are confined to extracellular fluid or total body water
-lipophilic drug (dig)widely distribute to all tissues (large Vd) However in neonates: --increase TBW and increase extracellular water may need higher doses to achieve same outcome |
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ToF: neonates have decreased fat and therefore lipophilic drugs may have lover Vd
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true
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what is the % of fat in 29 week neonate; a full term and a 1 year old?
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1%
12-16% and 20-25% |
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Bili competes for binding sites with ___ and therefore protein bound drug overdose in neonates can cause ___
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albumin; kernicterus
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__% of phenytoin is protein bound
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90
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what are the albumin bound meds?
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-phenytoin
-phenobarb -chloramphenicol -PCNs -sulfas -morphine -salicylates |
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what are the alpha 1 glycoprotein bound meds?
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-lidocaine
-propranolol -diazepam |
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what is kernicterus?
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bilirubin deposits in the brain leading to brain damage
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due to decreased protein binding, there are increased concentrations of ___ and ___
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free fatty acids and unconjugated (indirect) bilirubin
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what is phase I of metabolism?
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-change drug into active compound
--oxidative -prolonged elimination for dilatin, phenobarb and diazepam --Reduction --hydrolysis --hydroxylation --working at 50-75% of full capacity in neonates --reaches max maturity at 6 months |
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what is phase II metabolism?
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synthesize a more water soluble compound to augment elimination
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what are the ways in which phase II is accomplished?
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-glucoronidation
-acetylation -sulfation |
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ToF; acteylation and glucuronidation mature very early
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false: glucuronidatioins takes up to 1 year to develop and matures by 3-4 years
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ToF: different metabolic pathways occur in neonates than in adullts
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true
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what are examples of drugs being affected by different metabolic pathways in neonates>
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-theophylline --> caffeine
-acetaminophen goes to the sulfation pathway |
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infants born before __ weeks have more pronounced decreased renal function
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34
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how are drugs dosed in terms of renal immaturity in neonates?
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dosed according to post conceptional age and postnatal age
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Elimination reaches 50% of adult GFR by __ of age
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1 month
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ToF; neonates have a higher ability to concentrate urine than adults
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false
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ToF: elimination is profundly impaired in neonates
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true
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full term infants have decreased renal function that approaches adult values by ___
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3-5 months
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what is the best way to assess renal function?
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calculation of creatinine clearance-schwartz method
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what urine output is considered renal insufficiency?
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< 1cc/kg/hr
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what is an example of age-related drug reactions?
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-aspirin: reyes during a viral illness
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what is an idiosyncratic ADR?
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SxS of the reaction are unrelated to the pharmacologoic properties
ie hemolytic anemia after bactrim |
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what are the dose-related ADRs in neonates?
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-SxS of the reaction are related to the pharmacologic properties
phenytoin > 20 = nystagmus |
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what are examples of administration related ADRs?
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hypotention from rapid infusion of phyentoin
or tinnitus from lasix |
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list the factors related to increase in ADRs in neonates
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-decrease plasma proteins = increase free (unbound) drug
-immature renal function decrease elimination of renally excreted meds -alterations in number or affinity of drug receptor sites -immature hepatic metab -increase permeability of skin |
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what are the drugs that are contraindicated in neonates?
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-sufonamides: kernicterus
-ceftriaxone: kernicterus -benzyl alcohol: gasping baby -chloremphenicol: gray baby -antihistamines |
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what are the drugs contraindicated in CHILDREN?
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-tetracyclines: teeth
-promethazine: EPS and fatal resp depression -propofol: fatal metabolic acidosis, brady, hypoxemia, rhabdomyolosis |
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what do antihistamines possibly do in children?
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paradoxical excitation
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what are the problematic drugs in children?
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-antihistamines
-phenothiazines -valproic acid -cefaclor: serum sickness |
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why is benzoyl alcohol strongly discouraged in neonates?
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they cannot conjugate the biproduct and end up in metabolic acidosis
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What products have benzoyl alcohol?
what is the maximum amount to be given in a day? |
-preservative in aqeous solutions (parenteral)
-Normal Saline -any multidose vial -no more than 25mg/kg/day |
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what is propylene glycol?
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solubilizer in many injectables that is metabolized to lactate (risk of lactic acidosis) and pyruvate
|
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what are the ADR to propylene glycol? what is the MDD?
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cardiovascular collapse, arrythmias, hemolytsis, respiratory instability, CNS depression, seizures, and lactic acidosis
MDD: 25mg/kg/day |
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what is sodium benzoate? what does it do? what is the MDD?
|
-preservative in diazepam and caffeine benzoate inj (use preserve free caffeine citrate as alternative)
-displaces billirubin from albumin putting neonates at risk for kernicterus -MDD: 5mg/kg/24 hours |
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why is the inactive ingrediant alcohol dangerous in the neonate?
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can cause acute intoxication with accidental overdose
-chronic tox associated with use for chronic medical conditions |
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what type of metab does alcohol undergo? why is this bad in kids
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first pass metabolism by alcohol dehydrogenase that is not mature in kids 5 and under
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what is the recommendation for alcohol contents for children <6; 6-12; and >12
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< 6: (<0.5%)
6-12: 5% >12: 10% |
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what can the active ingredient aluminum cause in young children?
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-small infants may be susceptible to skeletal and neurologic tox
-high concens in human albumin and Ca and phosphate salts |
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what is a teratogen?
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a substance which has the potential to cause abnormal development of a fetus
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what does in utero exposure to thalidomide do to the fetus?
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causes phocomelia: short limbs
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what is the leading preventable cause of birth defects, mental retardation and neurodevelopmental problems
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fetal alcohol syndrome
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what are the neonatal alcohol withdrawal signs?
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jitteriness, irritability and poor feeding in the first 12 hours of life
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what are the 4 criteria of fetal alcohol syndrome?
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1. prenatal alcohol exposure (confirmed or unconfirmed)
2. growth restriction (prenatal and postnatal) 3. facial malformations 4. neurodevelopmental disorder |
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what are the facial abnormalities of fetal alcohol syndrome?
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short palprebral fissure, a thin upper lip, and abnormal philtrum, a hypoplastic midface, dental malalignment, malocclusion, myopia, and eustachian tube dysfunction
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what are the characteristics that increase the likelihood of drugs passing into the milk?
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-nonionized Pka of the drug
-nonprotein bound -low molecular weight of the drug -high lipid solubility -high pH drug excretion in breast milk can only be approximated to a certain extent |
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the overall risk of the infant for having a drug passed through the breast milk are based on what?
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-amount of drug bioavailable to the mother
-amount of drug reaching the breast milk -actual amount of the drug ingested and bioavailable to nursing infant |
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weak bases have a M/P ___ and therefore have __ concentration in milk than plasma
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>1; higher
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ToF: drugs with high pH will be ionized in the more acidic milk environment and therefore sequestered in the milk
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true
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what occurs after 72 hours that decreases the amount of drugs that pass into the breast milk?
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tight junctions mature and therefore higher molecular wieght compounds are less likely to pass through
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Milk is approx __ pH untils LOWER than plasma
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0.2
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what is the most clinically useful measure in determining the medication use during lactation?
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the relative infant dose
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what is the relative infant dose?
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percentage of maternal dose, in milligrams per kilogram, received by the infant during a 24 hour period
-a relative infant dose of < 10 % is considered to be safe!!!!! |
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why is the relative infant dose still not perfect at determining the effect of a drug passed to the infant from the breast milk?
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it does not take into consideration the pharmacodynamics of the drug in the infant
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what index accounts best for the true risk of the infant being exposed to a drug from breast milk?
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the exposure index
looks at the M/P ratio in terms of the infant clearance a child may have a high M/P ratio, but rapid clearance meaning limited exposure |
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what are the drugs contraindicated during breastfeeding?
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-amphetamines
-bromocriptine -cocaine -cyclophosphamide -cyclosporine -doxorubicin -ergotamine -godl salts -heroin -lithium -marijuana -methotrexate -nicotine -phencyclidine -phenindione -radio-pharmaceuticals |
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at what age do neonates have the highest mean HR?
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1wk to 2 months
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what are the common conditions affecting neonates?
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-sepsis
-RDS and BPD -PDA -apnea of prematurity -intraven hemorrhage (IVH) -retinopathy of prematurity (ROP) -necrotizing enterocolitis (NEC) -seizures hyperbilirubinemia |
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what are the two types of sepsis?
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early onset: maternal: withint the 1st week of life
late onset: nosocomial: after the 1st week of life |
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what is the presentation of sepsis?
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-apnea, tachypnea, inc O2 need, worsening RDS
-temp instability -VD, abd distention, ileus, poor feeding -dec activity, seizures -hypotension, metabolic acidosis, hyperglycemia, petichiae, purpura |
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what are the risk factors for early onset sepsis?
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-maternal
--PROM > 18 hours --Preterm labor (< 37 weeks) --infection --multiple birth --GBS colonized -Neonatal --low birth weight |
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what are the risk factors for late onset sepsis?
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-length of nursery stay
-LBW -skin breaks: iv lines, chest tubes -crowded nsy -surgery -broad spec abx |
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what are the 3 categories for sources of infections of sepsis?
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-transplacental acquisistion
-perinatal acquisition during labor and delivery -hospital acquisition in the neonatal prior from the mother, hospital, environment |
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what are the pathogens in early onset sepsis?
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-GBS
-E. coli -listeria -enterococci -H flu |
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what are the pathogens for late onset sepsis?
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nosocomial
-s. aureus (MSSA, MRSA) -S. epidermidis -GBS -enterococci -other gran negs |
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what are the adverse effects of GBS perinatally?
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-hearing loss
-impaired vision -delveopmental problems -death |
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what groups have higher proportion of GBS?
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-African americans
-nonsmokers |
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where does GBS live?
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in the GI tract but can spread to the genital tract
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ToF: GBS is a sexually transmitted disease
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false
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GBS present in the mother's urine is a marker for ___ colonization
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heavy
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how do you prevent early onset GBS?
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-intrapartum Abx
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when are GBS cultures obtained in pregnancy?
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35-37 weeks gestation
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what are the recommended meds for GBS?
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-Pen G (recommended)
-Ampicillin (alternative) -if penicillin allergic: use cefazolin if at high risk for anaphylaxis: vancomycin can also give clinda. do not give erythromycin |
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what are the management for early onset sepsis?
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-GBS and Ecoli most likely
-Amp and Gent or Amp and Cefotaxime - do not recommend gent levels if plan to DC abx after 48-72 hours of - cultures |
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what is the management for late onset sepsis?
|
in hospitalized: probably s aureus or s. epidermidis
-DOC: oxacillin or vancomycin (reserved for MRSA or MRSE) -Vanc and gent -or Vanc and cefotaxime use narrow coverage after organism is ID'ed |
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Describe ampicillin profile for sepsis?
|
B lactam abx that is bacteriocidal
-ADR rare: CNS excitation/seziures with high doses Poor CNS penetration with severe GBS give 100mg/kg/dose |
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what is cefotaxime?
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3rd gen bacterocidal
-GOOD CNS pen |
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Describe gentamicin
|
aminoglycoside
-active against GNR -synergistic with B lactam -ADR: nephrotoxic, loss of Na, Ca, Mg; ototoxic; neuromuscl block -concentration depend -dont need levels if only on it for 72 hours |
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whta are the trough levels for van with meningitis, pneumonia, and endocarditis?
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15-20; higher than normal
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what is the presentation of neonatal meninigitis?
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-temp low, normal or elevated
-irritability, lethargy, poor feeding -bulging fontanelle |
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what is the empiric therapy for meningitis in neonates?
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-amp and gent are DOC
-amp and cefotaxime are alternatives |
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how long must abx therapy continue after csf sterilization?
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14 days
minimum 21 days for gram neg 14 days min for gram positive |
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what are the TORCH titers?
|
congenital infections
T-toxoplasmosis O-other: syphillis, gonorrhea, hep B, listeria R- Rubella C- CMV H-HSV |
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what is the clinical presentation of toxoplasmosis?
|
chorioretinitis, ventriculomegaly, micorcephaly, hydrocephaly, intracranial calcifications, ascitis, HSM, Lymphadenop, jaundice, anemia, mental retardation
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what is the treatment for toxoplamsosis?
|
sulfadiazine for 1 year AND pyrimethamine for 2-6 months
also folinic acid 3 times a week to decrease effects of pyrmethamine |
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what are the affects of syphilis?
|
40% of mothers with untreated early syphilis have spontaneous abortion, still birth, nonimmune dydrops, premature delivery and perinatal death
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what are the classic presenation of syphilis before age 2
|
-early: bone lesions, HSM, red maculopapular rash (hands and feet), rhinitis, IUGR, jaundice, anemia, thrombocytopenia, chorioretinitis
-late: after 2 years old hutchinson's triad: (intestinal keratitis, 8th nerve deafness, hutchinsons teeth), mental retardation, hydrocephalus, saddle nose, mulberrry molars |
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what is the treamtent for syphilis?
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Pen G for 10-14 days IV preferred OR
IM or Procaine Pen G IM for 10-14 days |
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Can you give IM for syphilis tx in neonates
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NO!
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ToF: the rate of Hep B transmission is as high as 60% if infection occured in the 2nd trimester>?
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false: in the 3rd
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what do infants who get Hep B develop?
|
long term sequelae such as chronic hep, cirrhosis, and hepatocellular carcinoma
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what is the Tx for Hep B?
|
HBIG IM and Hep B vaccine within 12 hours after birth
repeat Hep B vaccine at 1 and 6 months give Immunoglobulin for premies < 2.2 kg and they need total of 4 doses of Hep B |
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what are the issue with congenital rubella?
|
-virus crosses placefnta and infects fetus, resulting in spontaneous abortion, stillbirth, or birth defects known as congenital rubella syndrome
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what are the symptoms of congenital rubella syndrome?
|
CRS: hearing loss, IUGR and congenital heart disease (PDA and pulmonary artery stenosis
|
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what is the most common cause of congenital infection?
|
CMV
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when can transmission of CMV occur>?
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transplacentally at any stage of pregnancy
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what are the symptoms of CMV if present?
|
-petechiae, HSM, jaundice, prematurity
-90% risk of CNS infection, audiologic and ophthalamic sequelae |
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what is the treatment for congenital CMV?
|
gancyclovir IV 10-12mg/kg/day in 2 doses
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what are the 3 patterns of neonatal herpes?
|
1. disseminiated infection with(out) encephalitis
--irritability, resp distress, skin vesicles, seizures, coagulopathy, jaundice, shock (57% mortaliity) 2. localized CNS infection --temp instability, hypotonia, lethargy or seizures (15 % mortality 3. locatliexzed infection of the skin, eyes or mouth SEM |
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what is the treatment for neonatal Herpes?
|
acyclovir 20mg/kg IV q8 (increase dosing interval in premies < 34 weeks
SEM: 14 days 21 days for disseminated |
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why is the risk of HIV spread to infant less thant 2 % now>?
|
-effective antiretroviral therapy
-elective Csection as appropriate -formula feeding |
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what antiretroviral has been found to lower the incidence of transmission of HIV to newborns?
|
ZDV
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what antiretroviral drug is used in premature infants < 35 weeks?
|
AZT 1.5 mg IV
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what is the most important cause of serious lower resp tract disease in infants and young children world wide?
|
RSV
|
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when is RSV most common?
|
in the winter months and occurs most in children under age 2
spread by respiratory droplets |
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describe the mild, severe, and life threatening cases of RSV
|
Mild: rhinorrhea, cough, low grade fever, rhonchi, fine rales and wheezes
Severe: increased cough and wheezing, air hunger, apnea, apnea, cyanosis, and death Life threatening: central cyanosis, tachypnea (>70), listlessness, apneic spells |
|
|
what is the treatment for RSV?
|
SUPPORTIVE CARE!!
-humidified O2 -fluids -bronchodilators (not great, but maybe in wheezers) -corticosteroids: not indicated, last resort -riboviran: not really used, not that good and tetratogenic |
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how do you prevent RSV?
|
-handwashing
-passive immunization --synagis given during the season |
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what are the risk factors for necrotizing enterocolitis?
|
-premature
-VLBW |
|
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what are the common bacteria of necrotizing entero?
|
colonic flora (clostridia, gram - bacilli, coag - staph, S/aureaus)
|
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what meds are used for necrotizing entero?
|
-early use of indomethacin and dexamethasone
-H2 blockers |
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what are the diet changes for necrotizing entero>?
|
enteral feedingss (too fast, too early?)
-hyperosmolar formula -breast milk may be protective |
|
|
ToF: the mortality of necrotizing enterocolitis is > 1/4 without supportive care and surgery
|
false: that high even with those interventions
|
|
|
what are the abx treatment for NE?
|
Amp and gent +/- metronidazole or clindamycin (add anareobic coverage if bowel is perforated)
|
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|
what are the characteristics of RDS?
|
atelectasis and resp failure
|
|
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what is the cause of RDS?
|
due to insufficient formation /differentiation of type II pneumocytes (32 weeks gestation)
--decreased production of surfactants -->atelectasis |
|
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what are the risk factors for RDS?
|
premature < 28 weeks = 80% vs > 32 weeks 5%
-other: male, caucasian, maternal diabetes, perinatal asphyxia, c section without labor |
|
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what is the presentation of RDS?
|
-grunting/whining
-sternal intracostal retractions -nasal flare -cyanosis -tachypnea -edema -fluid retention -xray: GROUND GLASS APPEARANCE!! |
|
|
how do you prevent RDS?
|
delay delivery: give mom steroids
betamethasone or dexamethasone |
|
|
how do you manage RDS?
|
-supportive care
-surfactant: reduces surface tension in lungs --improves gas exchange and vent 85-90% human composition phospholipid |
|
|
How are the surfactants administered for RDS?
|
via the ETT
each 1/4 of the dose is administered with the infant in a diff position -head and body inclind 5-10 down, head to the right -same but the head to the left -head and body inclined 5-10 up, head to the right -head and body inclined 5-10 up and head to the left |
|
|
what are the natural surfactants?
|
-beractant
-calfactant -poractant |
|
|
what are the synthetic surfactants?
|
-colfosceril (discontinued)
-lucinactant |
|
|
ToF: you must wait 1 hour to suction the infant after administereing surfactant down the ETT
|
true
|
|
|
what are the guidlines for use of surfactant in infants?
|
-prophylactic: all infants born < 1350g or >1350 g with pulmonary immaturity or GA < 29 weeks; L/S ration <2, incomplete maternal steroid course
-rescue: established RDS by xray/ mechanical vent required with FiO2 > 30% |
|
|
why are the natural surfactants better?
|
quicker onset of action, decreased mortality and decreased pneumothorax
|
|
|
what is the def of bronchopulmonary dysplasia?
|
-resp failure during 1st week of life, requiring mechanical vent for > or= 3 days
-persistent resp symptoms -O2 dependence after 28 days PNA -consistent xray findings aka chronic lung disease |
|
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what are the risk factors for BPD?
|
GA, birth weight, high FiO2, aggressive mech vent
|
|
|
what are the disease manifestations of BPD?
|
-airway hyperreactivity
-pulmonary edema -fibrosis -shifting atelectasis -airway hyperinflation |
|
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what are the long term complications of BPD?
|
-pulmonary complications
-growth impairment -cardivascular sequealae -neurodevelopmental problems |
|
|
what are the prevention methods for BPD?
|
-surfactant
-corticosteroids (antenatal) -antioxidants (vit A, and E: not routine) |
|
|
what are the benefits of treatment of BPD with corticosteroids?
|
-short term improvements in oxygenation
-earlier extubation -decreased risks of BPD -decreased the combined risk of death or BPD at 36 weeks No difference in -mortality at discharge -duration of hospitalization -duration of O2 |
|
|
what have been found to be the long term adverse effects of dexamethosone use in BPD?
|
-abnormal neurologic exam: diplegia and hypotonia
-higher proportion of CP and neurologic abnormalities -increase risk of adverse CNS development (decrease brain growth, periventricular leukomalacia, CP) |
|
|
Describe the use of diuretics with BPD.
|
diuresis and decrease pulmonary cap leak, cdec fluid filtration into the lungs
|
|
|
what are the diuretics often used for BPD?
|
-Furosemide (IV or PO) dosing very different between PO and IV
-thiazide -chlorothiazide -spronolactone |
|
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why are bronchodilators used in BPD and what is the goal?
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increase pulmonary compliance
-Goal: improve airway resistance, lung compliance, gas exchange, and decrease airway hyperactivity -management of acute bronchoconstriction episodes |
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what are the ADR of bronchodilators for BPD?
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-tachycardia
-hyperglycemia -HTN -Cardiac arrythmia -Tremor |
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what is a PDA?
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vascular connection between pulmonary artery and aorta
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describe the effects of GA on PDAs?
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Term:
-50% will close within 72 hours -almost all in 72 hours Preterm: -30 weeks: functionally closed by day 4 <30 weeks: 65% still have PDA on DOL4 < 27 weeks: majority with PDA, risk of reopening is high |
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How do PDAs present>
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-murmur
-bounding pulses -widening pulse pressure -decline in resp status -tachypnea -CO2 retention -inc need for mech vent -hypoperfusion |
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what are the problems related to PDA?
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Low systemic perfusion
-organ dysfunction -hypotension hyperpefusion to lungs -pulmonary edema -pulmonary hemorrhage -BPD -CHF |
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how do you manage a PDA?
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Closure:
-indomethacin -ibuprofen -surgery Maintain patency: ductal dependent flow (ie coarct) -give prostaglandins E |
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what does indomethacin do?
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inhibitis prostaglandin synthesis by decreasing activity of COX 1 and 2 enzymes
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when is indomethacin contraindicated?
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-SCr >1.7
-Plt < 60K NEC |
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what are the ADR of indomethacin? what are the other management options for PDA
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decrease renal, cerebral, GI blood flow
hold enteral feeds Monitor Follow up with EKG |
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what are the general findings for ibuprofen use to close PDA?
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-effective and comparable to indomethacin
-may have more favorable cerebral hemodynamics and may provide some neuroprotection -no evidence of sign progression of IVH with either drug -incidence of GI per and NEC are similar -renal effects of ibuprofen remain to be determined |
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when is ibuprofen contraindicated?
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-untreated proven or suspected infection
-heart defect that needs pda open -bleeding -thrombocytopenia -coag defects -NEC -sig renal impairment |
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How should alprostadil (PGE1) be administered?
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continuous infusion that you START HIGH AND TITRATE DOWN!!!
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what does alprostadil PGE do?
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keeps pda open to maintain CO, Systemic perfusion, provides pul blood flow and systemic oxygenation
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how does persistent pulmonary HTN of the newborn (PPHN) present?
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severe hypoxemia and acidosis, R->L shunting, tachypnea, grunting, flaring, retractions
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what are the causes of PPHN?
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-pulmonary vasoconstricion: bacterial spesis and pneumonia, or mec aspiration
-pulmonary hypoplasia: congential diaphragmatic hernia or potters -abnormal pulmonary vascular development: chronic intraueterine asphyxia or premature closure of PDA |
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how do you diagnose PPHN?
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echo: shows elevated pulmonary artery pressure and stie of right to left shunting
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how do you treat PPHN?
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-Supportive care
-NO gas -sildenafil -extracorporeal membrane oxygenation |
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what are the ADRs of NO gas in PPHN?
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methemoglobinemia (brown blood), inhibit platelet aggregations and withdrawal
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what is sildenafil and what are the characteristics of it?
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Viagra!
-used for pulmonary HTN follow cardiac repair -increase cGMP concentrations and allows weaning of iNO in postsurg infants -can cause sig systemic hypotension, (if given with nitrates) |
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What is ECMO?
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extracorporeal cardiopulmonary bypass is essentially dialysis of the lung used in severe PPHN
-used in patients with acute REVERSIBLE resp or cardiac failure -allows lung to rest and oxygenates the blood outside of the body |
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what are the indications for ECMO?
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Neonatal cardiopulmonary failure
-meconium aspiration -primary pulmonary HTN -RDS -pneumonia -massive air leak -congenital diaphragmatic hernia -sepsis |
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What can ECMO do to drugs?
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may alter serum concentration of drugs due to increased volume of distribution
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what is apnea?
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a pause in breathing pattern > 20 seconds in duration OR
a pause in breathing pattern < 20with -pallor -cyanosis -hypotonia -bradycardia |
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a __to __ second pause in breathing is considered normal in the pre-term infant
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5-10
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Apnea is a diagnosis of __
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exclusion
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what must be ruled out for apnea diagnosis?
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-sepsis
-anemia -fluid or electrolyte imbalance -RDS -hypoglycemia -temp fluctuations -seizure |
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what are the types of cyanosis?
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-central: lack of chest wall movement and lac of nasal air movement
-obstructive: chest movement is present, but there is no nasal air flow |
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what are the (non)pharmacologic managements for apnea?
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Non: continuous monitoring, gentle stimulation, nasal CPAP
Pharm: methylxanthines (theophylline and caffeine) and doxapram |
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what are the MOA of methylxanthines for apnea?
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-stimulate medullary resp center
-antagonism of adenosine receptor -more effecient contraction of diaphragm and improve resp muscle contraction |
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what must be checked with giving caffeine for apnea?>
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if the base is purely caffeine or caffeine citrate
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what are the SE of theophylline? of Caffeine?
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Theophy: NV, epigastric pain, cramps, anorexia, CNS excitation, seizures, palpitations, tachy, hypoten, circulatory failure, vent arrhythmias
caffeine: NV, gastric irritation, CNS excitation, minimal CV effects |
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which has a wider therapeutic range, caffeine or theoph?
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caffeine
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What are the caffeine considerations?
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-decrease intracranial blood flow
-decrease GI blood flow -increase metabolic rate -decreased rate of BPD -improved survival rate without neurodevelopmental disability at 18 and 21 months |
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describe doxapram in use for apnea.
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-MOA: produces resp stimulation by activating peripheral carotid chemoreceptors
-increase in tidal volume -stimulate medullary resp center |
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list the uses of doxapram.
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mainly: postanesthesia, drug induced CNS depression, chronic pulmonary disease associated with hypercapnia
unlabelled use: failed treatment with methylxanthines for apnea used very rarely: sig ADR-HTN, arrythmias seizures |
