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Neonatal vs Adult Cardiac Physiology

Neonatal vs Adult Cardiac Physiology. Melissa Aromin Anesthesia Clerkship. Adult Circulation. Fetal Circulation. RA  LA RA  PA  Aorta. First breath  decrease pulm vascular resistance  increase pulm blood flow  functional FO closure

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Neonatal vs Adult Cardiac Physiology

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  1. Neonatal vs Adult Cardiac Physiology Melissa Aromin Anesthesia Clerkship

  2. AdultCirculation Fetal Circulation • RA  LA • RA  PA  Aorta

  3. First breath  decrease pulm vascular resistance  increase pulm blood flow  functional FO closure • Increase arterial oxygen  functional DA closure • Anatomic Closure • FO: months • DA: 2-3 weeks • Reversal of closures: • hypoxia, hypercarbia, acidosis • Increase pulm vascular resistance  open DA • Increase right heart pressure  open FO

  4. Fetal Hemoglobin • Fetal  Adult hemoglobin at 2-3 months  physiological anemia • Fetal hemoglobin  left shift  decrease oxygen delivery to tissues • Increase oxygen delivery by: • Higher hemoglobin concentration • Increase CO

  5. Cardiac Output • Neonatal myocardium: immature contractile elements and less compliant • Affect on Cardiac Output • CO = SV x HR • Fluids  little change in SV • Must increase HR to increase CO

  6. Neonatal sympathetic NS and baroreceptor reflexes: immature • Hypovolemia with decreased vasoconstriction -> hypovolemia without tachycardia • Reduced concentration of neurotransmitter, but mature adrenergic receptors  respond better to direct-acting inotropes • 10% reduction in blood volume will cause a 15-30% decrease in MAP

  7. Physiological differences between neonatal and adult myocardium

  8. References • Swamy et al. Applied aspects of anatomy and physiology of relevance to pediatric anesthesia. Indian J. Anaesth. 2004;48(5):333-339. • BrasoveanuE. Neonatal physiology and anesthesia. www.bu.edu/.../05sprgmedanesthesiology/.../Neonatal%20Physiology/Neonatal%20Physiology%20and%20Anesthesia.doc • Burd et al. Neonatal and childhood perioperative considerations. SurgClin North Am. 2006;86(2):227-247.

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