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
Hyperglycemia
Fluids and Electrolytes
Calcium
Placental Diffusion
75% third trimester
Limited Stores
Renal Immaturity
Hypoparathyroidism
Citrate can bind and decrease Ca
Fluids and Electrolytes
Magnesium
Associated with Calcium
Growth Retardation
Maternal Diabetes
Exchange Transfusions
Fluids and Electrolytes
Blood Volume
Highest Delivery
Cord Clamping
Polycythemia
Hct>65
Diabetes
Toxemia
SGA
Partial Exchange
Fluids and Electrolytes
Hemolytic Anemia
Maternal Antibodies
Direct Coombs
Rh most common
Congenital Infections
SS Dz
Fluids and Electrolytes
Anemia
Premature Infants
Erythropoeitin
Fluids and Electrolytes
Hemoglobin
80% Fetal
Erythropoeisis 2-3 months
P50 Adult Hgb 27 mmHg
P50 Fetal Hgb 8 mmHg

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

Jaundice
Non Physiologic
Breast Feeding
Hemolytic Disease
Hypothyroid
Pyloric Stenosis
Crigler-Najar
Extravascular Blood
Biliary Atresia
Hepatitis
Jaundice
Non-Physiologic
Conjugated > 2mg/dl
Rises > 5mg/dl/day
Born Jaundiced
Doesnt Resolve
Temperature Regulation
Evaporation
Conduction
Convection
Radiation
Temperature Regulation
Humidified Environments
Incubator
Ventilator Circuits
Radiant Warmers
Dry Heat
Increased insensible losses
Clothes/Blankets

Temperature Regulation
Hypothermia
Hypoglycemia
Vasoconstriction
Coagulopathy
Emergence from Anesthesia
Renal Function
Low GFR
Better at 2 weeks
Normal at 1-2 years
Decreased Concentrating Ability
600mOsm
Insensitive to ADH
Cardiopulmonary
Fetal Circulation
Right to Left Shunts
Foramen Ovale
Ductus Arteriosus
Hypoxemia
Hypercarbia
Acidosis
Cardiopulmonary
Persistent Fetal Circulation
Sepsis
Meconium Aspiration
Congenital Diaphragmatic Hernia
Idiopathic
Treatment
Ventilation
Pharmacology
ECMO
Cardiopulmonary
Surfactant Deficiency
Premature
Alveolar Stability
Exogenous Administration
Host Defenses
Cellular Immunity
WBCs
Phagocytosis
Adherence
Killing
Decreased Stores
Poor Stem Cell Production
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
Surgical Stress Response
Initially Poorly Understood
Crude Monitoring
Few Outcome Studies
Myths
Anesthetics Unsafe/Not Approved
Pain
Could Anesthesia Blunt Surgical Stress
Response?
Surgical Stress Response
Measured Catecholamines, Insulin, Cortisol.
Adult Physiology
Levels Decreased when Anesthesia
Administered