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Neonatal Physiology

Neonatal Physiology . Tulane Pediatric Surgery. Topics. Fluids and Electrolytes Cardiopulmonary Temperature Regulation Jaundice Host Defenses Surgical Stress Response. Fluids and Electrolytes. Glucose Placental Glycogen Storage Gluconeogenesis Hypoglycemia SGA Surgical Pts

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Neonatal Physiology

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  1. Neonatal Physiology Tulane Pediatric Surgery

  2. Topics • Fluids and Electrolytes • Cardiopulmonary • Temperature Regulation • Jaundice • Host Defenses • Surgical Stress Response

  3. Fluids and Electrolytes • Glucose • Placental • Glycogen Storage • Gluconeogenesis • Hypoglycemia • SGA • Surgical Pts • Hyperglycemia

  4. Fluids and Electrolytes • Calcium • Placental Diffusion • 75% third trimester • Limited Stores • Renal Immaturity • Hypoparathyroidism • Citrate can bind and decrease Ca

  5. Fluids and Electrolytes • Magnesium • Associated with Calcium • Growth Retardation • Maternal Diabetes • Exchange Transfusions

  6. Fluids and Electrolytes • Blood Volume • Highest – Delivery • Cord Clamping • Polycythemia • Hct>65 • Diabetes • Toxemia • SGA • Partial Exchange

  7. Fluids and Electrolytes • Hemolytic Anemia • Maternal Antibodies • Direct Coombs • Rh most common • Congenital Infections • SS Dz

  8. Fluids and Electrolytes • Anemia • Premature Infants • Erythropoeitin

  9. Fluids and Electrolytes • Hemoglobin • 80% Fetal • Erythropoeisis 2-3 months • P50 Adult Hgb – 27 mmHg • P50 Fetal Hgb – 8 mmHg

  10. Jaundice • Hemolysis • Glucoronyl Transferase • Unconjugated Hyperbilirubinemia • Peaks 3rd Day – 6-7mg/dl • Resolves Day 10

  11. Jaundice • Non Physiologic • Breast Feeding • Hemolytic Disease • Hypothyroid • Pyloric Stenosis • Crigler-Najar • Extravascular Blood • Biliary Atresia • Hepatitis

  12. Jaundice • Non-Physiologic • Conjugated > 2mg/dl • Rises > 5mg/dl/day • Born Jaundiced • Doesn’t Resolve

  13. Temperature Regulation • Evaporation • Conduction • Convection • Radiation

  14. Temperature Regulation • Humidified Environments • Incubator • Ventilator Circuits • Radiant Warmers • Dry Heat • Increased insensible losses • Clothes/Blankets

  15. Temperature Regulation • Hypothermia • Hypoglycemia • Vasoconstriction • Coagulopathy • Emergence from Anesthesia

  16. Renal Function • Low GFR • Better at 2 weeks • Normal at 1-2 years • Decreased Concentrating Ability • 600mOsm • Insensitive to ADH

  17. Cardiopulmonary • Fetal Circulation • Right to Left Shunts • Foramen Ovale • Ductus Arteriosus • Hypoxemia • Hypercarbia • Acidosis

  18. Cardiopulmonary • Persistent Fetal Circulation • Sepsis • Meconium Aspiration • Congenital Diaphragmatic Hernia • Idiopathic • Treatment • Ventilation • Pharmacology • ECMO

  19. Cardiopulmonary • Surfactant Deficiency • Premature • Alveolar Stability • Exogenous Administration

  20. Host Defenses • Cellular Immunity • WBCs • Phagocytosis • Adherence • Killing • Decreased Stores • Poor Stem Cell Production

  21. Host Defenses • Immunoglobulins • IgG crosses the placenta • Poor Response to Antigen Challenge • IgA and IgM • No type specific Antibodies • Decreased Complement System Function • Increased Mortality with Pyogenic Bacterial Infections

  22. Surgical Stress Response • Initially Poorly Understood • Crude Monitoring • Few Outcome Studies • Myths • Anesthetics – Unsafe/Not Approved • Pain • Could Anesthesia Blunt Surgical Stress Response?

  23. Surgical Stress Response • Measured Catecholamines, Insulin, Cortisol. • Adult Physiology • Levels Decreased when Anesthesia Administered

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