Cote Chapter 2

Growth and Development

Normal and Abnormal Growth and Maturation

-preterm neonates = <2500g (low birth) or <37 weeks
-at term = 37-42 weeks
-postterm neonate > 42 weeks
-Double weight at 6 months and triple by 1 year. Length double by age 4.

Gestational Age Assessment

-gestational wt more sensitive to fetus well being than head circumference or length
-return to birth wt at 7-10 postnatal days.
-TBW decreases during infancy reaching adult proportions at 1yo. Males have greater percentage water and females
greater percentage fat. Percent decrease in extracellular water is greater than dec in TBW b/c of simultaneous inc in
intracellular water.
-failure development mandible a/w congenital defects – pierre robins, treacher collins, Goldenhar syndromes

Airway and Respiratory System

-larger relative tongue in neonate, long, omega shaped epiglottis and white vocal cords
-Bronchial tree and terminal bronchioles form by week 16 gestation. Gas exchanging apparatus distal to terminal
bronchiole develop throughout remainder of gestation.
-alveoli mostly inc after birth until 8 years of life
-Pulm vessels accompany bronchial tree by week 16 of gestation. Vessels in acinus follow development of alveoli.
-critical event in change from placenta to pulm gas exchange is first inspiration  pulm ventilation  clearance of
lung fluid  fetal to neonatal pattern of circulation
 Pulm blood flow increases, dec PVR, inc peripheral SVR (loss umbilical circulation).
 Increase in systemic afterload causes immediate closure of flap valve mechanism of foramen ovale and
reverses shunt through ductus arteriosus.
 Increase in PVR 2/2 hypoxia and acidosis can cause reversal right-to-left shunt.
-Fatigability of diaphragm in infants. Chest wall inc compliance. Inc workload. Limited type I (slow twitch, high
oxidative capacity) muscle fibers.
-Specific lung compliance constant throughout childhood and compliance of chest wall declines in
childhood/adolescence (calcification of ribs, inc bulk of thoracic muscles).
-TLC greater in adults > infants
-FRC (total lung volume at end of expiration) same in infants and adults.
-CC dec in childhood and then inc again in adult life / elderly. Related to development and deterioration of lung elastic
tissue and effect on recoil pressure.
-Airway resistance greater in preterm than full term infants. Distribution of airway resistance constant in central
airways and decreases with age in child in peripheral airways.
-Tracheal compliance in neonates =2x that of adults. Can see dynamic compliance of trachea with inspiration and
expiration.
-Periodic breathing commonly occurs in neonates, which is different than clinical apnea (25% of preterm infants). Risk
of postanesthetic resp depression inversely related to gestational age and postconception age at time of anesthesia
(risk up to 60 weeks after conception).
-Reduced PaO2 of neonates compensated by inc Hb (o2 carrying capacity), left shift hb-oxy curve 2/2 fetal Hb.

Cardiovascular System
-PNS dominates until adolescence.
-SBP increases with age. BP in LE less than UE.
-CO measurement can be used by fick method (o2 extraction) or thermodilution with PA catheter (Rare in infants b/c
shunt at atrial and ductal level can introduce error). Pulsed doppler measurement of CO is good noninvasive
estimate. Between birth and 1yo, CO relatively constant at 205 ml/kg. Greater metabolic rate and O2 consumption in
neonates compared to adults.

Renal System
-Kidney development in week 4 gestation, urine production week 10-12 weeks gestation (excreted in amniotic cavity).
-Tubular fxn develops after 34 weeks gestation and reaches adult levels by 2 yo. Number and fxn of Na/K/ATPase
transporters inc activity in postnatal period. Nephrogenesis complete by 36 weeks gestation.
-RBF and GFR reduced and correlate w/gestational age. Inc rapidly in postnatal period as result of inc CO and dec
renal vascular resistance. Reduced GFR decreases ability to excrete saline, water, drugs at birth.
-neonates at high risk for hyperK (salt losers, immature distal tubular function), prone to acidosis, reduced plasma
bicarb and PaCO2 in infants.

Digestive and Endocrine System

-