Pediatric surgical patients are not merely small adults. The
surgical care of children differs markedly from that of adults in
many respects, including unique physiologic demands that vary according
to age and development. The neonate’s physiologic development
is closer to that of a fetus, while adolescents’ physiology
is similar to that of adults, and infants and children have problems unique
to their chronologic and developmental age. Infants and children
also suffer from congenital abnormalities and diseases not seen
in adults, and their management requires an intimate understanding
of the relevant embryology and pathogenesis.
The newborn infant with a surgically correctable lesion often
has other disorders that threaten survival. The care of these babies,
particularly for premature and small-for-gestational-age (SGA) babies,
has improved with the emergence of the intensive care nursery. Dramatic
advances have been made in the technology of infant monitoring and
respiratory support. Low-birth-weight infants can now receive ventilatory
support from sophisticated infant respirators for prolonged periods
in a precisely controlled microenvironment. Surfactant therapy and
high-frequency ventilation has allowed a population of extremely
premature infants to survive. Temperature is controlled by servoregulation,
while pulse and blood pressure are continuously recorded. Ventilation
is monitored by transcutaneous O2 and CO2 electrodes
or by indwelling arterial catheters. The metabolic consequences
of prematurity and intrauterine growth retardation are monitored
by frequent measurement of glucose, calcium, electrolytes, and bilirubin
in microliter quantities of blood. Nutritional requirements for
growth and development can be provided by enteral or parenteral routes.
This kind of specialized care of critically ill newborns requires
trained personnel and specialized equipment. The care of such babies
is best accomplished in designated regional centers capable of providing
pediatric surgical and neonatal intensive care.
Phibbs CS et al: The effects of patient volume
and level of care at the hospital of birth on neonatal mortality.
Newborn infants can be classified according to their level of
maturation (weight) and development (gestational age). A normal
full-term infant has a gestational age of 37–42 weeks and
a body weight greater than 2500 g. The gestational age of the infant
is calculated from the date of the last normal menstrual period.
However, clinical assessment of gestational age by morphologic and
neurologic examination of the small infant can be more accurate
than calculation from the menstrual history.
Four signs may be useful in assessing gestational age. Infants
less than 37 weeks’ gestational age have (1) fine fuzzy
hair with thin, semitransparent skin, (2) ears that lack cartilaginous
support, (3) a breast nodule less than 3 mm in diameter, and (4)
few transverse creases on the balls of the feet anteriorly. In males,
the testicles are incompletely descended and reside in the inguinal canal,
and the scrotum is small with few rugae. In females, the labia minora
are relatively enlarged and the labia majora are ...