ITT Definitions & Treatments Flashcards
HIE criteria A and B and inclusion age
Age >35 for cooling within 6 hours of delivery
Criteria A:
-pH < 7.0 and BE -10
Criteria B:
-pH <7.01 - 7.15 and BE -10 to -16 within 1 hour PLUS APGAR <5 at 10 or 10 min of PPV and sentinel event, evidence of NE
HIE Treatments
- Therapeutic hypothermia for 72 hours at 33 (+/- 5) rectal temp
- Morphine for sedation/analgesia .1mg/kg loading then 20mcg/kg/h IV
- Neutral head alinement, allow for venous drainage
- 50ml/kg/d to decrease complications associated with dysfunctional autoregulation
- micro-repositioning (fat necrosis)
- watch for autonomic dysfunction and complications of cooling
Neonatal seizures
- Phenobarbital 20mg/kg IV over 20 minutes
- Phenobarbital 10mg/kg IV x 2 q 5 minutes
- consider phenobarbital 5mg/kg/d (check levels)
- Phenytoin 20mg/kg IV over 20 minutes
- Keppra 40-60 mg/kg IV
- Midazolam 0.15mg-0.2mg/kg IV loading
- Ativan 0.05-0.1mg/kg
IVH mgmt
- Neuroprotection (corticosteroids, mag for mom)
- normotension, normocapnia, normoxia, normal pH, appropriate TFI, correct coagulopathies
- seizure mgmt to reduced demand
- midline to allow venous drainage
Undifferentiated neonatal encephalopathy mgmt
Essentially treat like a undifferentiated head in for adults. Normal everything with ICP bundle. Consultation for risk/benefit of cooling
consider:
- HIE
- Perinatal stroke
- IVH
- Hypoglycemia
- Inborn errors of metabolism
- structural anomalies
- infection (GBS, TORCH)
- maternal toxins
Prematurity Mgmt
- Bag if <28 weeks n set incubator appropriately
- TFI
- Small baby care
Subgaleal Hemorrhage
- supportive care for hemorrhagic shock and coag profile
- monitor fontanelles
- investigate sodium, cbc/coags, head size
Undifferentiated congenital heart disease
- Pre/Post ductal saturations
- Hyperoxia test
- CXR
- Prostaglandin E1 0.05-0.1 mcg/kg/min
- consider the need for intubation
Hypoplastic left heart syndrome mgmt and goals of care
initial mgmt is aimed ensuring sufficient mixing of oxygenated and deoxygenated blood and optimizing ventricular function via PDA
- prostaglandin E1 0.01-0.05mcg/kg/min
- avoid supplemental oxygen if able
- Consider dobutamine/milirone to reduce SVR
- allow a mild resp acidosis and avoid supplemental oxygenation in order to allow SVR BF. Acidosis and hypoxia causes pulmonary vasoconstriction.
- the initial goal of therapy is to balance PVR and SVR as BF will always take the course of least resistance.
Tet Spell Mgmt
- legs to chest
(to increase SVR by occluding femoral artery) - supplemental oxygen (to reduced PVR)
- Morphine (to decrease PVR)
- vasopressors (to increase SVR) dopamine,phenlyphrine
Coracation of the aorta mgmt
- prostaglandin 0.01-0.05mcg/kg/min
2. balloon angioplasty
How to close a PDA
- PEEP to reduced BF across the duct
- alkalosis
- ibuprofen, indomethacin, Tylenol, surgical closure
How to keep a PDA open
Prostaglandin
- 01-0.05mcg/kg/min if its already open
- 1mcg/kg/min is large dose for those we need to re-open
PPHN mgmt
- HYPEROXIA - (decrease PVR). Initially FiO2 1 then target PREDUCTAL spo2 90-95%, PaO2 50-70
- NORMOCAPNIA - (decrease PVR) PCO2 40-45 since hypercarbia increases PVR
- SEDATION - (decrease PVR and vent synchrony)
- HD SUPPORT (Dobuatmine, milirone, or vasopressin)
- Correct pH
(acidosis increase PVR) - SURFACTANT (Should be considered in patients with associated parenchymal lung disease)
- iNO (decrease PVR - initiate if OI >25 initate at 20 PPM, wean to maintain SaO2 >90 then wean Ino when FiO2
SVT mgmt
- 20 sec ice on face
- .1mg/kg, .2mg/kg Adenosine
- electrical cardio version
High Flow mgmt in neonates
1) setting: flow 2LPM/kg. begin at 2
2) max capacity of the ANAPOD is 25LPM
3) temperature ideally 35-37 degrees
4) Prongs should be 50% of then are diameter
nCPAP mgmt in neonates
nCPAP generally 5-7cmH20 with Fio2
TTN mgmt
- neutral thermal environment
- consider high flow (1-2LPM/kg)
- nCPAP 5-7cmH20
- intubation if failing nCPAP
RDS mgmt
surfactant therapy is indicated for FiO2 > 30 and nCPAP >7cmH20, significant WOB, CXR consistent with RDS, BLES 2.5mg/kg x 2 doses
Congenital Diaphgramatic Hernia mgmt
- intubation (immediately to prevent dilation of abdominal content by increase ITP)
- NG tube placement (reduce pressures)
- fluid resus and inotropes
- surfactant prn
- echo
- surgical intervention
- iNO, sildenafil, prostaglandin, vasopressin, miliron, etc for PPHn
Hyperbilirubinema pathophysiology and treatments
Unconjugated bilirubin is a waste product of hemoglobin breakdown that is taken up by the liver, where its converted to conjugated bilirubin.
Conjugated bilirubin is water-soluble and is excreted into the bile to be cleared from the body.
Bilirubin is a product of heme catabolism. The enzyme heme oxygenase located in all nucleated cells, catalyze the breakdown of heme, resulting in the formation biliverdin. Biliverdin then rapidly converts to Hb.
primary concern would be BIND/karnectus.
- use the bilitool to gage treatment threshold
- phototherapy
- go up on TFI by 20%
- exchange transfusion, IVIG.
Hyperbilirubinema pathophysiology and treatments
Bilirubin is a product of heme catabolism. The enzyme heme oxygenase located in all nucleated cells, catalyze the breakdown of heme, resulting in the formation biliverdin. Biliverdin then rapidly converts to Hb.
primary concern would be BIND/karnectus.
- use the bilitool to gage treatment threshold
- phototherapy
- go up on TFI by 20%
- exchange transfusion, IVIG.
Hyponatremia treatment and goals of therapy
tx: hts 3% 3ml/kg
goals:
1. relieve hyponatremia symptoms
2. avoid rapid correction to prevent osmotic demylinationation
3. prevent further decline in sodium concentration
Approach to gestational HTN
- steroids if predicted risk of PTL
- deliver between 38 and 39+6 if otherwise uncomplicated
post-partrum HTN mgmt
PO/IV antihypertensives like non-pregnant patients
Gestational HTN and severe G.HTN definition
≥140/90, ≥160/110
Preeclampsia criteria dx
140/90 with proteinuria, end organ dysfunction markers, +? fetal effect
Preeclampsia Treatment package
- Acute BP <160/110 (~25% reduction 2 hours)
- reduce with:
a) Nifedipine 5-10mg q 30minutes (XL dose not appropriate for acute HTN)
b) Labetalol 200mg PO - Mag 4g/20 minutes then 1g/hr
- Betamethasone 12mg q 24 hours
- 80ml/hr of fluid maximum