Fetus and Newborn Committee Flashcards
When should you not give steroids to infants?
You should not give within the first 7 days.
Do not use hydrocortisone.
DART trial - low dose dex with taper.
Medications used for intubation
Fentanyl - 1-2 mcg/kg
Atropine - 0.2 mcg/kg
S(R) - Succ
Note: Fentanyl has been associated with an increased risk of chest wall rigidity.
Indications for surfactant in newborns
- Severe RDS
- Meconium aspiration syndrome FiO2 >50%
- Pneumonia and OI >15
- Intubated and Pulonary hemorrage
Side Effects of Surfactant
Bradycardia, Hypoxemia and pulmonary hemorrhage.
Which mom’s should get steroids?
If at risk of delivery <34 weeks, mom should get steroids
Hypoglycemia Protocol Risk Factors
Risk Factors: IDM, LGA, SGA, Preterm
Who do you screen for hypoglycemia
Infants with risk factors at 2 hours of age (all children will normally have lows within the first 2 hours and this is not to be a concern - no problems with brain after) OR any symptomatic infant
Hypoglycemia Treatment Algorithm
A. IV Fluids and bolus
- Symptomatic and <2.6
- 2 hour check: <1.8
- Recheck after feed: <2.0
- Multiple Re-checks: <2.6
B. Feed and Recheck
- 2 hour check: 1.8-2.0
- Recheck: 2.0-2.6
Stop Checking:
LGA: >2.6 for 12 hours
SGA: >2.6 for 36 hours
Vitamin K - dose, and risk factors for bleeds
1 mg IM x 1 >1500 g; 0.5 mg <1500 g
Early: occurs within the first 24 hour and is usually due to medications (anticonvulsants, anti TB meds, anticoagulatnts)
Classic: Presents within the first week: GI, ICH, Skin burising
iii. Late: Will present as ICH and is secondary to CF and gut issues. Only will occur in breastfed babies (not formula fed).
2 mg at birth, 2-4 weeks and 4-6 weeks.
Pulse Oximetry in Newborns
Who do you screen?
When do you screen? Where do you Screen?
Term and Late Preterm (34-36 weeks).
Need to use the right arm and lower limb - can not use the left arm because of its proximity to the duct.
Screen 24-36 hours after delivery.
Pulse Oximetry Failure Criteria and follow up
Failure Criteria:
1. <90%
2. 90-94% in either right arm or lower limb OR
>3% difference in upper and low extremities. Then re check in 1 hour.
Follow up:
4 limb bp
CXR
ECG
Retinopathy of Prematurity: What is it? What are the stages and what are the zones?
An abnormal proliferation of the retinal blood vessels.
There are 5 stages: Stage 5 is retinal detachment.
There are 3 zones: Zone 1 is the closest to retina and zone 3 is the furthest out.
Who do you screen? Who do you treat?
Screening occurs for any child born <31 weeks or <1250 g. Screening occurs at 31 weeks (or 4 weeks after if born at 28-31 weeks).
Plus disease = Torturous dilated vessels
Zone 1: Plus disease
Zone 2: Stage III disease +/- Plus Disease
Zone 3: Stage II and III + Plus Disease
Treatment options: laser, cryo and anti veg F
Inhaled Nitric Oxide: When do you use it and what do you monitor for?
Inhaled nitric oxide is a arterial dilator to decrease vascular resistance in the lungs. It does not work with CDH (usually).
Uses:
OI = (FIO2 * MAP)/PaO2
OI = 20-25 OR when 100% oxygen but the PaO2 is <100 mgHg
Starting dose: 20 ppm can increase to 40 ppm. Should see a result in 30 minutes and should be able to decrease
Monitoring: methhemoglobin, thrombocytopenia, surfactant dysfunction.
HIE: What is the criteria for cooling and what are the Sarnet Scores?
Sarnet Scores -
Mild: sympathetic System
Moderate: Parasympathetic System
Severe: Coma
Criteria for Cooling: Age: >36 weeks Hours of Life: < 6 hours Criteria A: Any two of the following: APGAR < 5 10 minutes Vent and Resus at 10 minutes pH <7.0 or B.E. >16
Criteria B:
Moderate or severe encephalopathy with seizures or other symptoms
