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Four main shuts in fetus
- placenta
- foramen ovale
- ductus arteriosus
- ductus venosus
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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.
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FIRST BREATH
- 5-10 MIN
- NORMAL VENT VOL AND TV
- 10-20 MIN
- FRC
- BLOOD GAS
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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
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PERSISTENT PUL HTN (PPH)
BYPASS THE LUNG VIA DUCTOUS ARTERIOSUS AND FORAMEN OVALE
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ETIOLOGY OF PPH
- SECONDARY
- MECONIUM ASPIRATION, SEPSIS, PNEUMO, CDH, RESP DISTRES, COLD, ACIDOSIS, STREE
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TREATMENT OF PPH
- SURFACTANT, NO, ECMO (BYPASS)
- GOAL PAO2 OF 50-70
- PACO2 OF 40-60
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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
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S/S OF PDA
- CHF
- TACHY
- POOR FEEDING AND WEIGHT GAIN
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TREATMENT OF PDA
- BLOCK PROSTOGLANDIN (INDOMETHACIN)
- SURGICAL-LIGATION
- CATH LAB (HARD TO DO)
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HOW TO KEEP PDA
- S/S OF NEED IN 2-3 DAYS AS DUCTUS CLOSE
- BLOCK FLOW TO PUL ART AND AORTA
- GIVE PROSTAGLANDIN
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FORAMEN OVALE
- CLOSE DT INCREASE PRESSURE OF LEFT ATRUIM AND INCREASE BLOOD FLOW
- MAY STAY OPEN FOR WEEKS
- 20% OF ADULTS HAVE PATENT FO
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SHUNTS TO WHAT
- FO- FOSSA OVALIS
- UMBILICAL VEIN- LIGAMENTUM TERES
- DUCTUS VENOSUS0 LIGAMENTUM VENOSUM
- DUCTUS ART- LIGMENTUM ARTERIOSUM
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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
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WHAT IS THE MOST COMMON CAUSE OF AIRWAY OBSTRUCTION
TONGUE
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NEONATAL AIRWAY
- PREMEE- C3
- FULL TERM-C4
- ADULT-C5
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WHAT IS THE NARROWEST PART OF THE NEONATE
CRICOID RINGS TILL ABOUT 10 YO
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WHERE IS THE EPIGLOTTIS
BASE OF TONGUE AND MIDLINE
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SNIFFED
FOR BABY PLACE TOWEL UNDER SHOULDERS TILL 2 YO
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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
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O2 CONSUMPTION
- INFANT 7-9ML/KG/MIN
- ADULTS 3ML/KG/MIN
- 3X
- DUE THIS BY BREATHING FASTER
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HIGH CLOSING VOL
JUSTED NUMBER NORMAL TV
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MIN VOL TO FRC RATIO
- ADULT 1.5:1
- NEONATE 5:1
- 3X
- HAS HIGHER VESSEL RICH GROUPS
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TYPE ONE MUSCLE
- SLOW TWICH
- HIGH O2 NEED
- SUSTAINED MUSCLE
- DIAPHRAGM ACHIEVE T1 AT 8 MONTHS
- INTERCOSTAL T1 AT 2 MONTHS
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TYPE TWO MUSCLE
- FAST TWITCH
- LOW O2 NEED
- SHORT ACTIVITY
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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
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NEONATE HYPOXIA CAUSED
- NUMBER ONE BRADYCARDIA
- NOT TOLERATED
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FETAL KIDNEY
- LOW RENAL BLOOD FLOW
- LOW GFR
- MAKE URINE THAT FORM AMNIOTIC FLUID
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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
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OBLIGATE NA LOSER
- NEONATE URINE NA IS HIGH 20-25
- VS 5-10 IN ADULT
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NEONATE HEMOTOLOGY
- EBV 90 ML/KG
- HGB-19
- 80% IS HGB F
- HBG F HAS HIGHER AFFINITY FOR O2
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FALL OF BLOOD LEVELS
- FALLS FIRST 6-8 WEEKS
- RARELY DROPS BELOW 9
- PREMEE FALL FASTER AND LOWER (7)
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RBC MADE IN
- FETAL IN LIVER
- SHIFT TO BONE BY 6TH WEEK
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4-2-1 IV RULE
- 4 ML 10 KG
- 2 ML 11-20KG
- 1 ML >20KG
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WHAT IS THE MAINTENANCE IV NA
- 3-5 mEq/kg PER DAY
- HENCE 2% NS
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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
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EBV
- PREEME 90-100
- NEWBORN 80-90
- 3MO-1YO-70
- 1 YO-70
- ADULT 55-60ML/KG
- THINK DROP 10
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ACCEPTABLE BLOOD LOSS
- HEALTH
- LESS THAN 25-30% BL
- FINAL HGB 8-9
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KEEP GLUCOSE
IF NEONATE ON D5 IV CONTINUE
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WHAT IS BROWN FAT
- THERMOGENESIS
- FROMS IN 26-30 WKS
- 2-6% WIEGHT
- 6 AREAS
- USE FATTY ACID META
- WHY?
- BABY DON'T SHIEVER
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WHY JAUNDICE
- CHANGE FROM HGB F TO HGB A
- AND LIVER UDP-GLUCRONLY TRANSFERASE (WHICH CHANGE TO WATER SOL) IS NOT FULLY DEVELOPLED
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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
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WHEN IS IT SAFE FOR OR
- FOR PREMIE 60 WEEKS PCA
- FULLTERM 44-46 WKS PCA
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