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Principles III, Test One, Neonatal Slides 2-8
Seriously, I gotta find me some motivation!
25
Nursing
Graduate
02/01/2010

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Term

By the 16th week of gestation, how far are the lungs developed?

 

How many alveoli do full term kiddos have?

Definition

To the terminal bronchioles

 

20 million--compared to the 300 million in an adult!

Term
So if kids are born with a decreased number of alveoli, how long does it take for them to develop a full set?  What happens to the alveoli as the chest grows?
Definition
The alveoli increase in number till the age of 8.  As the chest wall grows, the alveoli get bigger.
Term
As the alveoli grow, what happens to the pulmonary vessles?  What about the smooth muscle?
Definition
The number of pulmonary vessels increases, but the smooth muscle lags.  Children do not have full smooth muscle tone in the pulmonary vasculature until adolescence.
Term
What conditions can inhibit growth of the pulmonary vascular bed?
Definition
While there are many, lung hypoplasia associated with diaphragmatic hernia is the one listed.
Term
What is the normal position of ribs in kids, and what effect does this have on breathing?
Definition

The ribs are horizontal, which produces little movement with inspiration.  In fact, the chest wall may move in during inspiration d/t the compliant chestwall.

 

 

Term

What muscle do kids need to breathe?

 

Definition
The diaphragm.  So you better believe those kids better be reversed at the end of the case, cuz muscle relaxants will paralyze the diaphragm.
Term
When do the ribs begin to change position?
Definition
When kids begin to assume an upright position
Term
What type of fibers are predominantly in the pediatric diaphragm?
Definition

Type II--at birth, they only have 10% type I fibers at 37 weeks, 25% at term, and 50% as adults.

 

Type I gets breathing done.

Type II tires.

Term

How does FRC of kids and adults compare on a kg basis?

 

What about total lung capacity?

Definition

FRC is similar.

 

Adults have a larger total lung capacity, mostly due to inspiration--adults can generate 100 cm H2O of negative inspiratory pressure

Term
What happens to closing capacity?  How does the newborn closing capacity compare to the tidal volume?
Definition
Closing capacity declines through adolescence, then increases with age.  In infants, the tidal volume is well within the closing capacity range.
Term
When does the airway resistance change for kids?  Does it increase or decrease?
Definition
By age 5.  It decreases, which is why little kids with high resistance do not tolerate bronchiolar infections well, developing severe oxygen and ventilation impairment.
Term
In newborns and premies, their tracheal rings are compliant.  What does this mean?
Definition
The trachea can collapse on inspiration.
Term
When does surfactant production begin, and when is it adequate?
Definition
Begins at 24 weeks, adequate at 36
Term
Compare the alveolar-arterial oxygen difference between an adult, premie, and newborn (most to least)
Definition
Preterm >full term > adult
Term

Why do babies have a bigger difference in oxygen in the alveoli and the arteries?  Why does this change with age?

 

Definition
They have less surface area for diffusion to occur.  Diffusion capacity increases with linear height, which is associated with lung growth and age.
Term
How does venous admixture compare in an infant to an adult?  How would a patent foramen ovale impact this?
Definition
Newborn venous admixture is 10-20% of cardiac output, compared to 2% in an adult.  If baby has a patent foramen ovale, the amount of venous admixture increases!
Term
What is the oxygen consumption rate of a newborn?  What is an adult's?
Definition

5-8 ml/kg/min

2-3 ml/kg/min

Term
How do tidal volumes compare in a newborn to an adult?
Definition
Nearly the same, about 6 ml/kg
Term

How does the newborn ventilatory gas exchange compare to an adults?

 

How do babies change oxygenation and CO2 elimination rates?

Definition

The adult has nearly 10X greater exchange than infants, with a similar TV.

 

Since infants can't vary TV much, they change their ventilatory rate.

Term

What is the normal PaO2 in utero?

What about the PaO2 of a newborn on room air?

Definition

30 mmHg

60-100 mmHg

Term
Are chemoreceptors fully developed at birth?
Definition
No, they are somewhat immature
Term
How do infants respond to an increase in PaCO2?
Definition
They increase alveolar ventilation, just as an adult, however, the strength of the response is directly related to gestational age, as the central chemoreceptors are not fully developed.
Term
Newborns are a little like COPD-ers.  What does this tell you about their response to oxygen concentrations?
Definition
Exposure to high concentration of oxygen depresses their respirations, while low concentration stimulate it.
Term
How do micro-premies respond to hypoxia?
Definition
First, they increase respiration for several minutes, then they develop apnea.
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