NICU 1 Flashcards
why is caffeine good
- Improves apnea
- Less need for ventilation, CPAP and oxygen.
- Reduces rates of BPD
- Improves the rate of survival without neurodevelopmental disability at 18 to 21 months in infants with very low birth weight … but barely makes a difference at 5 yrs of age
when should we do HUS
7-14 days
4-6 weeks
term corrected
What are the issues with twin-twin transfusion for the donor
oligohydramniosanemia anemia poor growth microcardia hypoglycemia hypovolemia *arterial side
What are the issues with twin-twin transfusion for the recipient
polyhydramnios hydrops hypertrophic cardio plethoric myocardial dysfunction * venous side
when does TTTS occur?
monozygotic twins
share a common placenta
have an AV connection between their circulation
baby born at term, presents with inc WOB. CXR shows hyperinflation and tracheal deviation but still see lung markings. DDX
congenital lobar emphysema usually present in newborn (max 5 mo) resp distress ball valve effect hyperinflation tracheal deviation
what prenatal lab values might indicate a T21
HIGH BHCG and inhibin
LOW estradial and alpha feto
what disorders are associated with large anterior fontanelle
prematurity/IUGR hydrocephalus achondroplasia T13, 18, 21 congenital rubella OI Russel silver
what % of cephalohematoma will have a underlying skull fracture?
10-25%
what are causes of leukoria in a newborn?
cataracts
chorioretinitis
ROP
retinoblastoma
baby has hematuria and new onset of HTN and low PLT. You feel an abdo mass. Dx
renal vein thrombosis
if i have a pt with ambigious genitalia and I find gonads. WHat lab analysis will help differentiate?
Testosterone and DHT
- if Normal T and low DHT = 5 alpha reductase
- if Normal T and HIGH DHT = androgen insensitivity
- If both LOW = error in steroid met/testosterone synthesis defect or absent or defective testes
what metabolite is elevated in 21 hydroxylase def?
17 - OHP
how do you manage an acute adrenal crisis?
NS bolu
mainetnance at 1.5
hydrocortisone at 100mg/m2/day
treat hyperkalemia if too high
what side does CDH tend to occur on and why is CDH bad?
left
- parenchymal insuff - no enough alveoli
- pulm HTN - blood shunted away from lungs causing worsening acidosis and vasoconstriction
How do you manage CDH?
- ABC
- intubate immediate
- BLES
- NG
- close monitoring of acid base balance
- Sx when stable
what are the 6 MC features of baby with suspected galactosemia?
Cataracts - galactose accumulation vomiting/poor feeding Liver failure - hepatomegaly, Jaundice - unconjugated progressing to conjugated, coag issues renal tubular dysfunction hypotonia E.Coli sepsis
what are indications for surfactant?
Intubated prem with RDS MAS on 50% FIO2 Pneumonia or pulm hemorrhage OI > 15 if < 29 weeks and need transport
what are complications of surfactant admin
blocked tube
bradycardia
pneumothorax
pulm hemorrhage
what are early and late signs of kernicterus?
early: poor suck, hypotonia, Sz
late: Hypertonia, high pitched cry, opisthotonus, retrocollis , fever
what maternal drugs will lead to early hemorrhagic disease of the newborn?
Carbamazepine phenytoin INH Warfarin Rifampin cephalosporins barbiturates
what are lab abn in Vit K def bleeding
INR > 4
PT > 4x
rest normal
if a baby has congenital heart block second to maternal SLE, is the permanent or not
permanent
when does neonatal lupus present
can be at birth or within 6 week
typical malar rash is present and last 3-4 mo