Respiratory Care Department MSRT411: Perinatal and Pediatric Respiratory Care
Anatomical and Physiological
Differences in Neonates
Ghazi Alotaibi, PhD, RRT
Lec06-Oct03 Are they just a small version of adult? Why is it important to know the differences??
• To correctly assess the infants (physical
assessment). • To correctly administer therapeutic intervention. 2 Types of Differences • Anatomical Differences: • Head • Nares • Tongue • Airways • Chest • Abdomen • Physiological Differences: • Number of Alveoli • Ventilatory Reserve • Metabolic Demand Anatomical Differences HEAD • Larger than adult (in proportion). • Head can easily fall and block the airways. • End result: Desaturation • What is the corrective action? Implication: • If the infant’s respiratory status appears to be compromised - first - reposition the head of the infant before trying more aggressive types of therapy. Surface area of the Head: • Since the infant’s head is proportionally larger than adult: • Surface Area is larger: • More heat loss can occur through the head. NARES • Infants are mostly obligate nose breather (breathe nasally under normal circumstances). • Due to small diameter of nasal passages, secretions and inflammation dramatically increase resistance and WOB. • What changes are observed in Nares with increased respiratory distress?? TONGUE • Proportionally larger than adult (What for?) • The tongue can fall to the back of the pharynx and cause an airway obstruction. • Infants also have a large amount of lymphoid tissue in the area of the pharynx. increase the risk for upper airway obstruction • Implications: • During insertion of oropharyngeal airways. • Can affect stability of ET tube (strong suck reflex of the tongue). AIRWAYS • Epiglottis: proportionally larger, less flexible, more horizontally. • More subjected to trauma. • Larynx: • The narrowest point in the infant airway is the cricoid ring (What is the narrowest point in adult?). • More subjected to upper airway occlusion than adult. • Use uncuffed ETT. • Trachea: • Infant: Length 60 mm, diameter 4 mm. • Adult: Length 120 mm, diameter 20 mm. • Implications: Infants are more severely affected by changes in airway diameter than adults. • More susceptible to increase in WOB. CHEST • At birth, AP diameter is almost equal lateral diameter • Little chest stability b/c ribs and sternum are mostly cartilage. • To increase minute ventilation: Infant tend to increase respiratory rate not VT Tachypnea • Heart is large in proportion to chest diameter, reducing lung capacity. ABDOMEN • Proportionally larger than adult. • So what?? • Pushes diaphragm, limiting lung expansion. • Implication: during CPAP therapy. Physiological Differences ALVEOLI • 50 million at birth (15-20% of adult). • Bad: if part of lung is affected (infection, collapse), gas exchange is significantly impaired. • Good: if damaged (MV), can grow out of the dysfunction. VENTILATORY RESERVE: • Infants have poor ventilatory reserve: a. Difficult to increase VT. b. Decreased number of alveoli. c. Proportionally large heart. d. Proportionally large abdomen. METABOLIC DEMAND • Higher metabolic demand (100 cal/kg as compared to 50 cal/kg in adult). greater oxygen need. • Infants responds to cold stress by shivering, increasing metabolic demand and oxygen consumption. • So, keep infants WARM. Reading Assignment • Kent, p 112-113 • Article by: Fiona Macfarlane (electronic copy will be provided).