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Clerkship > ACoRN Course > Flashcards

ACoRN Course Flashcards

1
Q

A glucose infusion rate of greater than ?? mg/kg/min indicates a need for higher level care?

A

> 8 mg/kg/min
more intensive or invasive management may be required, consider transferring to a higher level of care

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2
Q

In a well baby, term or late preterm, with risk factors for hypoglycemia, when should BG first be measured routinely?

A

At 2 hrs. Absolutely allowed to breastfeed prior to this routine measurement.

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3
Q

Meconium should be passed within what hour timeframe?

A

48 hours

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4
Q

Total post-natal weight loss should not exceed what percentage of body weight?

A

10%

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5
Q

Fluid requirements for most infants on day1 of life… in ml/kg/hr?

A

3 ml/kg/hr

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6
Q

Fluid requirements for an extremely preterm infant under the radiant warmer… in ml/kg/hr?

A

up to 4 ml/kg/hr
Fluid volumes exceeding this should not be administered before an infant is 24-48 hours old because free water excretion is limited during this normal ‘prediuretic’ phase

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7
Q

Choice of fluid to treat an unwell infant you suspect needs volume?

A

Normal saline (regular, 0.9% NS)

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8
Q

What 3 signs might tip you off that a newborn needs a trial of volume expansion?

A

Hypotension
hypoperfusion
or shock

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9
Q

You determine baby needs fluid, what bolus dose do you administer over what time frame?

A

bolus 10 ml/kg NS over 10-20 minute

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10
Q

Normal glucose utilization rate in a newborn? mg/kg/min

rate in a premature or stressed newborn?

A

4-6mg/kg/min
5-7mg/kg/min

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11
Q

Signs of hypoglycemia - 8+

A

Movement - Jittery, tremor, seizures
Colour - cyanosis, sudden pallor
Poor tone, sweating
Lethargic - Decreased LOC/alertness
Feeding - difficulty feeding
Breathing - apneic spells or tachypnea
Temperature - hypothermia
Crying - weak cry or high pitched

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12
Q

Blood glucose below ? mmol/L should alert you to administer fluid/glucose?

A

<2.6 mmol/L

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13
Q

Symptommatic or persistent hypoglycemia required immediate treatment with ?

A

IV dextrose solution

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14
Q

What conditions put an newborn AT RISK for hypoglycemia? 5+

A

IDM (infants of diabetic mothers)
SGA
LGA
IUGR
GA <37 weeks
perinatal stress or hypoxemia
… asphyxia, maternal exposure to labetalol, late preterm antenatal steroids

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15
Q

If delay in starting IV, give what?
(%, ?ml/kg)

A

40% dextrose gel
0.5ml/kg

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16
Q

GIR - glucose infusion rate calculation
D%W x infusion rate / 6
What is the GIR for D10W at 3ml/kg/min?

A

10 x 3 /6 = 5 mg/ml/min
10 x 4 /6 = 6.7 mg/ml/min
10 x 5 /6 = 8.3 central access and higher level of care!

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17
Q

Target BG range if infant is <72 hours old?
Target range if infant is >72 hours old?

A

<72 h = 2.6 - 5 mmol/L
>72 h = 3.3 - 5 mmol/L

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18
Q

If actively managing a newborns with IV fluids, when should you do labs (what hour) and what labs?

A

at 12h of age
Cr, lytes (Na, K, Ca)

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19
Q

Three options/interventions to increase an infants blood glucose?

A

dextrose gel
supplemental feeds (expressed breast milk, formula, donor milk)
IV dextrose

20
Q

8 systems to consider in a newborn according to ACoRN, in order…

A

Respiratory
Cardiovascular
Neurological
Surgical
Fluid and Glucose
Jaundice
Thermoregulation
Infection

21
Q

Three key signs that trigger resuscitation?

A
  1. apnea, gasping, ineffective breathing
  2. heart rate <100
  3. central cyanosis
22
Q

During what window (days x-y) does jaundice often present?

A

days 3-8 post-birth

23
Q

Risk factors for severe hyperbilirubinemia

A
  • late preterm 34-36 (who are discharged within 48 hrs of birth)
  • significant bruising or cephalohematoma
  • mothers with known RBC antibodies
  • asian, middle eastern, mediterranean backgrounds
  • siblings that had severe hyperbili
24
Q

Timeframe for breast milk jaundice?

A

5-7 days

25
Q

Difference between breast-milk and breast-feeding jaundice?

A

breast milk jaundice - due to beta-glucuronidase in milk causing increased reabsorption of bili

breast feeding jaundice - early in the course of establishing feed, due to lower milk intake and dehydration

26
Q

There are seperate bili normograms for two possible treatments, what are those?

A

phototherapy thersholds
exchange transfusion thresholds

27
Q

When should you get a DAT? direct antiglobulin test

bonus: two most common causes of a + DAT

A

Jaundiced infant who falls within high to intermediate risk zone on the normogram
Jaundiced infant of mother who is type O

Two most common causes of + DAT?
Rh incompatibility
Severe ABO incompatibility

28
Q

bili above phototherapy threshold, three next steps are:

A

initiate phototherapy
order DAT
repeat serum bili in 8-12 hours

and keep breastfeeding (IV fluids only in infants approaching the exchange transfusion threshold)

29
Q

You plot an infants bili and they are above the exchange transfusion threshold, as you consult, what can you do in the meantime to help? 4… ish things

A
  • IV bolus of 10mL/kg NS, followed by continuous dextrose infusion to supplement feeding
  • start intensive phototherapy
  • get DAT
  • BIND score
  • plot repeat TSB in 4h

(fluids replace volume, provide energy, and reduce the enterohepatic reuptake of bili)

30
Q

What respiratory rate in a newborn should alert you?

A

> 60/min

31
Q

What is the normal temperature range in a newborn?

A

36.5-37.5 (axillary)

32
Q

Is a newborn with an infection more likely to be hyperthermic or hypothermic?

A

hypothermic!

33
Q

Overheated infant vs febrile infant - two potentially differentiating observations?

A

warm hands and feet, flushed appearance (vasodilation, overheating)

cool hands and feet, mottled appearance (vasoconstricted, febrile)

34
Q

Early onset sepsis is what timeframe?

A

72 hours postpartum

35
Q

Does intrapartum antibiotic prophylaxis significantly decrease the risk of late onset GBS diseasE?

A

No, just early onset GBS infection (ie. first 72 hours)

36
Q

Risk factors for neonatal sepsis? 6

A
  • positive GBS swab
  • GBS bacteriuria anytime during preg
  • previous infant with invasive GBS
  • PROM >18h/prelabour ROM
  • maternal fever/chorio
  • prematurity <37 weeks
37
Q

Chorioamnionitis diagnosis? 1+ 3

A

maternal fever
plus one of
- maternal WBC >15
- FHR >160 for 10min
- purulent fluid from os

38
Q

Infant born by c-section, fairly significant respiratory distress at birth, no risk factors for sepsis, appears stable… how long is it appropriate to observe this infant for resolution before investigating and starting abx for sepsis? x hours?

A

6 hours

often resolves within several hours, especially with c-section babies

39
Q

How old (in hours) should a newborn be for a urine culture to be part of a septic work up?

A

> 72 hours, less than UTIs are exceedingly rare

40
Q

antibiotics for a <72 hour old newborn with suspected sepsis?

Bonus: abx for >72 hours old?

A

ampicillin + gentamicin or tobramycin

cloxacillin or vancomycin + gent or tobra or cefotaxime

41
Q

Signs of “laboured respirations” - 4

A
  • nasal flaring (see on inspiration)
  • grunting (sounds produced as infant exhales, physiologic method to maintain end-expiratory pressure)
  • intercostal and subcostal retractions (subcostal worse)
  • sternal retractions (paradoxical backwards movement of the sternum on inspiration… severe!)
  • fyi GASPING - ominous, alerting sign for RESCUSITATION, not just respiratory support, go to NRP
42
Q

Normal RR range for newborn?

A

40-60 resp/min
>60 often the earliest most subtle sign of resp difficulty or distress

43
Q

O2 sat target range in infants?

A

90-95, above 95 oxygen toxicity concerns

44
Q

SpO2 monitor should be applied to which hand/arm? Right or left?

A

Right - because it measures preductal O2 sats, the O2 content of blood from the lungs going to the brain

45
Q

how to confirm dx of PPHN (Persistent Pulmonary Htn of the Newborn)

A

echo!

46
Q

Think of PPHN with what other newborn respiratory diagnosis?

A

meconium aspiration syndrome

Clerkship (21 decks)

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