Neonatal Disorders

Question 1

Apnea of prematurity assessment

Answer 1

Recurrent episodes for 20 seconds OR less than 20 second w cyanosis/4% fall in SpO2
<28 wks

Question 2

Apnea of prematurity information gathering

Answer 2

Rule out: hypoxemia, anemia, sepsis, unstable thermal environment, opiates, IVH,
Electrolytes
ABG

Question 3

Apnea of prematurity treatment/DM

Answer 3

Continuous apnea monitoring/pulse oxE
Caffeine
NO 100%
Frequent episodes? Nasal CPAP

Question 4

Apnea of prematurity no self correction after 10 seconds?

Answer 4

Stimulate
Suction
Extend neck
Bag mask (not w 100%)

Question 5

IRDS/hyaline membrane disease assessment

Answer 5

Prematurity (<27 wks)
Refractory hypoxemia
RD

Question 6

IRDS/hyaline membrane disease IG

Answer 6

L/S (<2)
CXR (diffuse reticulogranular/air bronchograms)
ABG (respiratory acidosis/severe hypoxemia)
Differential dx: cultures, hyperoxia test, echo

Question 7

IRDS treatment/DM

Answer 7

Give mom steroids
Prophylactic surfactant (intubate-surf-extubate to nasal CPAP)
Neutral thermal environment
PaO2: 50-70
Permissive hypercapnia

Question 8

IRDS intubate when

Answer 8

<27 weeks w no steroid tx
Apnea
Inadequate aw protection
Increased WOB/pH <7.25 on CPAP

Question 9

IRDS early extubation to nasal CPAP

Answer 9

Adequate respiratory drive
MAP <= 7
Adequate oxygenation on FiO2 <35%

Question 10

BPD assessment

Answer 10

Prolonged O2 treatment and PPV (28 DAYS POST BIRTH)
at 36 weeks: moderate - <= 30%
Risk factors: low birth weight, preemie, IRDS, etc
Tachypnea
Retractions
Crackles/wheeze

Question 11

BPD IG

Answer 11

CXR (decreased lung volume, diffuse atelectasis and hyperinflation)
ABG (respiratory acidosis w hypoxemia)
Echo

Question 12

BPD treatment/DM

Answer 12

Prevention!
SpO2 88-92%
Prophylactic surfactant/vit A/caffeine
Adequate caloric intake
Restrict fluid/lasix
SABA

Question 13

BPD treatment/DM already intubated

Answer 13

Optimize PEEP
permissive hypercapnia
Nasal CPAP asap (pH 7.3)

Question 14

Meconium aspiration syndrome assessment

Answer 14

Fetal stress/overcooked
Brown stained fluid

Question 15

MAS IG

Answer 15

Hx/RD
BS
Continuous monitoring
CXR
Echo
ABG
CBC w differential
Electrolytes

Question 16

MAS care at birth

Answer 16

SUCTION FIRST
BVM
HR <100? INTUBATE, suction
Prophylactic surfactant

Question 17

MAS DM

Answer 17

Continuous monitoring
Neutral thermal environment
Correct Electrolyte/ABG
Normal blood glucose
Normal Hb
MAP > 45-50 (give inotropes)
Minimize stimulation
Adequate sedation
PaO2 55-80
Intubate By 50/50 rule

Question 18

MAS w PPHN

Answer 18

Give INO

Question 19

OI of 20?

Answer 19

HFOV

Question 20

Surfactant tx when

Answer 20

FiO2 50% and MAP >7

Question 21

ECMO criteria

Answer 21

> 34 wks
No coagulation issues
Reversible lung disease
Birthweight 2000g
No IVH