Pediatrics

Pregnancy-Induced Leukocytosis

WBC can increase to 15,000+

causes during pregnancy: hormonal and heighted immune response and stress

Physiologica Anemia of Pregnancy

Plasma volume increases more than the increase in RBC

Pregnancy h/h

11-13 g/dl 28-40%

Non-pregnant females 

<12-16 g/dl  37-47%

Anemia during H/H levels

1st Tri

2nd Tri

3rd Tri

<11g/dl <33%

<10.5 g/dl <32%

<11g/dl <33%

Anemia post partum levels

<10g/dl <30%

Prothrombotic state 

mild thrombocytopenia with a slighly lower platelet count 

• Procoagulant factors increase 

• natural anticoagulants 

  • Reduced Fibrinolysis

Procoagulant

makes blood clot

Natural anticoagulants

keeps body from making clots

Reduced fibrinolysis 

breaking down clots 

infant heart size

RV slighly bigger and same thickness as LV until about 6 months

Since the ventricles are the same size, the infant BNP are

higher after birth becuase the ventricles have to work more and stretch more

Infant lungs 

large tongue compared to mouth size therefore they are obligatory nose breathers 

short neck so their structures closwer together 

infant breathing immature 2nd to

immature neurological function and immage diaphragm

Respiratory Muscle use 0-3 month

diaphragm primarily

Respiratory Muscle use 3-6 months

disphragm and accessory muscles 

Respiratory Muscle use 6-12 months

more used of intercostals muscles with diagphram

Pediatric X ray you will see

a triangle shape

horizontal directions of ribs

diagphram is more horizontal vs dome shaped

6-12 months ribs angle downward

What are does a childs chest shapes more like an adult

10 year

Infant chest wall is more compliant

therefore more flexible, so more distortion of ribs =less efficient

infants have decreased lung compliance (stiffer) when does their elatic recoil increases

as they age

Infants have much less alveoli therefore

gas exchange not as efficient as adults, they continue to grow until age 8 so babies have to breath faster to move air in and out of the lungs to have enough O2 available 

HR for newborn/infant

100-180+ (<60 is an emergency)

2-3 years heart rate

95-140

preschool HR

80-120

10 years to adult

60-100 (55-90)

infant RR

30-50

2-3 years RR

22-37

Preschool RR

20-28

School age (10 years) RR

18-25

Teenage/Adult RR

12-20

Blood pressure in children which arm to use

Right

Blood Pressure for children is based on 

age, height and gener, therefore you need to use growth chart for children who fall outside of the normal ranges 

Newborn BP

50-52/25-30

3 years BP

78-114/46-78

10 years blood pressure 

90-<120/56-<80

teenager BP

104-<120/<80

S/S of respiratory Distress in pediatric

nasal flaring, retractions, grunting and head bobbing

Nasal flaring occurs because

reduce airway resistance in nasal passages

retractions occurs because

extra compliant rib cage and poorly developed intercostals (especially external)

Grunting occurs because

baby expires thru partially closed glottis to produce auto peep

reflects hypoxia and poor gas exchange

head bobbing occurs because

infant is trying to use accessory muschle but have poor head control

Respiratory distress sydrome in premature infants reasons

most common: hyaline membrane disease

decreaed pulomnary surfactant alveoli collapse during axhalation increase work of breathing and impaired gas exchange

Hemaglobin infant

14-24 g/dl

0-2 weeks Hemaglobin

12-20g/dl

 Hemaglobin 2-6 months

10-17 g.dl

 Hemaglobin 1-6 years

9.5-12g/dl

6-18 years  Hemaglobin

10-15.5 g/dl

newborn WBC

9,000-30,000

Child less than two years WBC 

6,200-17,000

Child greater than 2 years WBC

5,000-10,000

Bilirubin in children

higher becuase immature liver

1.0-12.0

Why do children have higher WBC 

high level indicated their devleoping immune system is actively working to protect them

Hgb is higher in children because

increase bone marrow activity