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King Faisal University

College of Applied Medical Sciences


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).

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