neonates Flashcards
Inhaled nitric oxide reduces the need for ECMO by how much?
40%
what is suggestive of PPHN
pre and post ductal difference >20%
pre-ductal sats <90%
Nitric oxide has a short half life because??
bind to Hb
HFOV is indicated in which circumstances
rescue for failed conventional ventilation
improved gas exchange in air leak syndromes
decrease ventilator related injury
What are the pitfalls of Newborn screening
1) doesn’t pick up high TSH (hyperthyroidism and panhypopit)
2) In CF doesn’t test all genes - will miss 5%
3) doesn’t test all metabolic disease will miss lysosomal storage disorders
what are the target saturation at what minutes after birth in neonatal resus?
1 min 60-70% 2min 65-85% 3min 70-90% 4min 75 -90% 5min 80-90% 10min 85-90%
what is the dose of adrenaline in neonatal resus IV and ETT?
IV 0.1-0.3mL/kg 1:10,000
ETT 0.5-1mL/kg 1:10,000
what is the ratio of compressions to breaths in neonatal resus?
3:1
90 compressions to 30 breaths per min
how can you measure UAC and UVC position
UAC = (weight x 3) +9
ideal position T6-9
UVC = (weight x 1.5) + 5.5
ideal T9-10, junction ductus venous & IVC
what is the definition of ELBW, VLBW, LBW, SGA
ELBW = <10th centile
What is the most important complication of BPD
pulmonary hypertension
what is surfactant produced and by which cells?
produced 24/40, type 2 alveolar cells
how does steroids increase surfactant production?
binding to intra-cytoplasmic receptor and increasing DNA transcription
what is artificial surfactant made of?
DPPC + SPB and SPC
what Long term outcome doesn’t surfactant and antenatal steroids influence?
development of BPD
what are the pro’s of caffeine
increases central drive increases contractility diaphragm decreases BPD decreases ROP Less toxic that aminophylline
term baby born by traumatic delivery and develops apnoea at 24hrs of age. ?diagnosis
subdural most common
indications of HIE and classification
mild - hypertonia, dilated pupils, tacchycardic
mod - hypotonia, constricted pupils, seizures
severe - comatose, no reflexes
indications for cooling
acidosis pH 35/40
within 6hrs of birth
Cool 33.5 degrees 72hrs
contraindications to cooling
80%
congenital abnormalities
coagulopathy
outcomes of HIE
mild - nil
mod - 5% mortality, 20% morbidity
severe - 75% mortality, 90+% morbidity
what CP is associated with IVH
athetoid CP
Neuro sequelae for IVH
Only grade 3-4
Survival stats for pre-terms
23/40 25% survival, 90% disability
24/40 65% survival, 75% disability
25/40 85% survival ~50% no disability
28/40 95% survival
Premature babies are at risk of osteopenia prematurity because?
transplacental passage of Calcium and Phosphate >24/40
Vitamin D supplementation is associated with which outcomes?
lower pneumonia
lower T2DM
lower rates infleunza
lower asthma exaccerbations
Probiotics decrease NEC but they have no impact on?
Rates of sepsis
how do you calculate mean airway pressure?
(Pip x i-time) + (PeeP x e-time) / i-time + e-time
what is a normal I;E ratio
1:2
How can you calculate GIR
(dextrose % x IV rate) / (6 x weight)
formula has dextose concentration of 7%
what is the biggest risk factor for hospitalisation in RSV
chronological age
what is the duration of sleep for babies
16hrs, mostly REM sleep
indications for Palavizumab
BPD infants
congenital heart disease with sign left to right shunts especially pulmonary hypertension
what are the results for Palavizumab
reduced hospitalisation by 50% (10% to 5%)
DOES NOT reduce need for ventilation or mortality
what are there TORCH infections and specific differentiating signs for each
Toxo - hydrocephalus CMV - periventricular calcification Rubella - cardiac lesions PDA, PS Syphilis - rhinitis and desquamation VZV - Cicatricial skin lesions, hypoplastic limbs
treatment congenital CMV
valganciclovir 6months = better outcomes
Management of bay to Hep B + mother
HBIG and HB vaccine within 12 hrs of birth
plus 2,4, 6 months
management of baby born to mother with chickenpox
give ZIG 7 days prior and 2 days post
if preterm give 2-28 days post birth
