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CCP - Semester 2 > Neonates > Flashcards

Neonates Flashcards

1
Q

Definition of neonate

A

≤28 days

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2
Q

Late preterm

A

35-36.6

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3
Q

Preterm

A

<37 weeks

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4
Q

extreme preterm

A

<30 weeks

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5
Q

Neonate cardiac output

A

Preload in the neonates is fixed with less stretch/frankstarlings law. heart is underdeveloped and won’t stretch
A decreased ability to manipulate contractility and very afterload dependant. (milironone/dobutamine)

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6
Q

Name the three ducts for fetal transition

A
  1. ductus venous
  2. formamen ovale
  3. ductus arteriosus
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7
Q

Describe cardiovascular transitional changes during delivery

A
  1. Ductus venous functionally closes soon after clamping, and structurally over days to weeks.
  2. Fluid in the lungs need to be absorbed to allow air into the lungs, oxygen dilates the pulmonary vasculature, decreasing PVR. Which then increases pulmonary blood flow which will increase the left atrial pressures and causes the FO to close.
  3. During transition the PVR decreases to or below SVR and the Right to Left shunt decreases
  4. The FO closes and DA beings to constrict but can remain as a bidirectional shunt for days.
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8
Q

8 step process for acorn

A
  1. ID neonates who are unwell
  2. Is immediate intervention required
  3. ACoRN Primary
  4. Infection
  5. Problem list
  6. Address problem list
  7. early consultation
  8. support family
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9
Q

The unwell baby

A

Poor tone/reflexes. Increased WOB. Poor perfusion, poor temperature, hypoglycaemia.

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10
Q

At risk baby

A

Preterm <37 weeks/SGA. Mom of DM, substance using mom, PPROM, abnormal warm/cold environment.

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11
Q

Central Cyanosis ethology

A

Respiratory in nature, CHD, increasing PVR and shunt physiology

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12
Q

Tx of ineffective breathing

A

HR < 100 effective IPPV and reassess HR. If HR 60-100 continue IPPV. If HR <60, begin CPR.

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13
Q

Respiratory sequence for acorn

A
  • recheck patients airway/breathing
  • administered o2 as need to maintain spo2 88-95%
  • establish/continue monitors: sat, bp, cardiorespiratory, oxygen analyzer
  • calculate ACoRN score if spontaneously breathing.
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14
Q

Resp score values (mild/mod/severe)

A

mild: <5
Moderate: 5-8
Severe: >8

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15
Q

Mild resp distress

A

focused hx, physical exam, review dx gets, establish working dx

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16
Q

Moderate resp distress

A

consider/adjust resp support (CPAP/PPV)

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17
Q

Severe resp distress

A

intubate, optimize ventilation. vascular access, cxr, blood gases, consider immediate consult

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18
Q

Define TTN

A

is a parnchymeal lung disorder characterized by pulmonary edema resulting from delayed resorption and clearance of fetal alveolar fluid

19
Q

Define RDS

A

Defined primarily by deficiency of pulmonary surfactant in an immature lung.

In the premature lung, inadequate surfactant activity results in high surface tension leading to instability of the lung at end-expiration, low lung volume and decreased compliance.

20
Q

Altering signs

A

laboured breathing (nasal flaring, grunting, intercostal retractions, sternal retractions, gasping)

  • RR >60
  • receiving resp support
21
Q

Neonatal CVS key concepts

A
  1. Shock, cyanosis, o2 therapy or tachycardia are indictors of CVS instability
  2. Prostaglandin E1 is the life saving tx for ductus dependant lesions
  3. SVT >220
  4. Shock may be the initial presentation of sepsis
  5. The classic presentation of a ductus dependent lesion is cyanosis and/or shock
22
Q

cardiovascular sequence clues

A

pale, mottled, or grey.
weak pulses or low bp
cyanosis unresponsive to o2
heart rate >220

23
Q

cardiovascular sequence

A
  • pale/mottled = consider IV/volume expansion
  • cyanosis unresponsive to o2= perform hyperoxia test
  • HR >220 = record ECG
24
Q

Neonate shock tx

A 
Hypovolemic = volume expansion
Distributive = volume/inotropes/vasoconstrictors
Cardiogenic= inotropes/prostaglandin
25
Q

Hyperoxia Test

A

Ideal 15-20 minutes FiO2 of 1.0 then check PaO2 to see if there is an increase. Modifiable for spo2 >10%

26
Q

Assuming a normal Hb level and adequate cardiac output, how are various degrees of desaturation (hypoxemia) tolerate?

A

SpO2 >75 = mild - moderate defat = well tolerated
SpO2 65-75% =marked= may be less well tolerated if baby otherwise sick
Spo2 <65= severe= poorly tolerate

27
Q

Neonate severe cardiac instability

A

listless, or lethargic and/or distressed, decreased tone
cap refill >3s
pulses weak
gallop
edema or signs of other third space fluid
congested lungs or pleural effusions and/or enlarged heart on cxr

28
Q

Neonate neurology alerting signs

A

abnormal tone, jitteriness, seizures

29
Q

Neonate glucose <2.6

A

D10W bolus 2ml/kg

initiate D10W infusion at 4ml/kg/hr

30
Q

Front line seizure med for neonates

A

phenobarbital 20mg/kg

31
Q

Hx and focused investigations for Neo neuro

A

CBC with diff, glucose, sodium, calcium, potassium, and magnesium, blood gases, blood cultures

32
Q

Perinatal brain injury

A

HIE
stroke
ICH

33
Q

Neonate Abx

A

ampicillin, gentamycin, acyclovir for neonates

34
Q

Neonate seizure clock

A 
Phenobarb 20mg/kg then 10mg/kg x 2
phenytoin 20mg/kg
keppra 40-60mg/kg
midaz
midaz infusion
pyridoxine
35
Q

Neonate BGL <1.8 tx

A

2ml/kg bolus then 4ml/kg/hr of D10w

36
Q

Neonate <2.6 BGL

A

4ml/kg/hr of D10w

37
Q

Neonate hypothermia

38
Q

neonate normothermia

39
Q

Fluid required for 0 days

A

60-80ml/kg/d

40
Q

fluid required for 1 day

A

80-100ml/kg/d

41
Q

fluid required for 2 day

A

100-120ml/kg/d

42
Q

fluid required for 3 day

A

120-140ml/kg/d

43
Q

fluid required for 4 day

A

150ml/kg/d

44
Q

Closure of Fontanelles

A

posterior 2-3m after birth
sphenoid close at 6 months
mastoid 6-18mon
anterior 12-18 months

CCP - Semester 2 (14 decks)

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