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2023 RC Blue's Clues > NICU > Flashcards

NICU Flashcards

1
Q

What is an IT ratio

A

Immature to total neutrophil ratio
Ratio >= 0.2 is positive for sepsis

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2
Q

Early onset sepsis definition and risk factors

A

Neonatal sepsis in first 7 days of life
-maternal gbs status inadequately treated with antibiotics (history infant with severe gbs infection, gbs bacteriuria during pregnancy)
- chorioamnionitis
- ROM >18 hr
- preterm
-

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3
Q

Most common presenting sign/symptom of neonatal early onset sepsis

A

Respiratory distress

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4
Q

Most common organisms for early onset sepsis

A
  • GBS (36%)
  • E. coli (25%)
  • viridans Strep (19%)
  • listeria
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5
Q

Empiric antibiotics for early onset sepsis

A

Amp
Gent

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6
Q

NAS CPS Pearls

A

Treat if >/= 12 x 2 or >/= 8 x 3
first line: non pharm
first Rx: morphine or methadone

methadone typically onset of symptpoms later

moms who are HIV negative on buprenorphine or methadone should breast feed

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7
Q

NAS scoring duration

A

minimum 72 hr observation
(up to 120 hr if baby is exposed to long acting such as methadone)

scoring q3-4hr

for discharge, scores must be consistently <8 with stable treatment plan

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8
Q

what is the leading cause of neonatal brain injury, morbidity and mortality worldwide?

A

HIE

20-30% die
30-50% will have permanent neurodevelopmental sequelae

more significant morbidity if acidosis <6.7 or base deficit >25

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9
Q

best imaging in HIE

A

MRI done at 3-5 days of life

  • loss of gray white differentiation
    basal ganglia/thalamus is severe

US has little utilitiy for HIE unless trying to exclude hemorrhage but can be used to evaluate a preterm infant

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10
Q

therapeutic hypothermia

A

cool to 33.5 degrees within first 6 hours of life maintained for 72 hours

> /= 36 weeks (consider if 35-35+6)

whole body cooling preferred

adjuncts:
- low dose morphine infusion <10mcg/kg/h
- trophic feeds
- eppoietin (not recommended in CPS, mentioned in nelsons_
- phenobarb if seizures (target level 20-40)

complications
- coagulopathy
- subcutaneous fat necrosis +/- hypercalcemia
bradycardia and arrhythmia

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11
Q

brain death criteria after HIE

A
  1. coma unresponsive to pain/auditory/visual stim
  2. apnea with CO2 rising from 40 to >60 without ventilatory support
  3. absent brainstem reflexes (pupil, oculocephalic, oculovestibular, corneal, gag, suck)

*no universal agreement for clear definition or when to withrawal life support

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12
Q

criteria for therapeutic hypothermia

A

age >/= 36 weeks who are </= 6 hours old and meet crtiera A or B and C

A: cord pH </= 7 or base deficit >/= -16
B: pH 7.01-7.15 or base deficit -10 to -15 (cord or blood within 1 hr) AND history of perinatal event or apgar <5 at ten minutes or 10 mins PPV

C: evidence moderate to severe encephalopathy with presence of seizures OR at least one sign in three or more of the 6 categories (LOC, spontaneous activity, posture, tone, reflxes, autonomic)

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13
Q

indications to stop cooling

A

-hypotension despite inotropic support
- persistent pulmonary hypertension with hypoxemia, despite adequate treatment
- clinically significant coagulopathy, despite treatment.

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14
Q

SSRI counselling during pregnancy and breastfeeding

A

continue use - bad depression/anxiety is worse
risk of congenital malformations or PPHN is low
no clear increased risk of ADHD or ASD
encourage breast feeding
no specific monitoring required

Risk of PNAS - poor neonatal adaptation syndrome
- mild symptoms
- responds to supportive care measures
- resolves within days to 2 weeks

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15
Q

Blood transfusion hemoglobin cut offs for infants with anemia of prematurity

A

Hemoglobin (hematocrit)

Post natal Week 1
- respiratory support: 115 (35)
- no resp support: 100 (30)

Postnatal week 2
- respiratory support 100: (30)
- no resp support: 85 (25)

Postnatal week 3 and older
- respiratory support: 85 (25)
- no resp support: 75 (23)

*start at 115 (35)
* the no respiratory support is the same as the previous week with resp support
*the next step down is - 15 (-5) except for the last step down which is -10 (-2)

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16
Q

CPS ROP screening indications

A

≤ 30+6 weeks (regardless of weight)
≤ 1250 g
More mature infants thought to be at high risk for ROP

Start at 31 weeks OR at 4 weeks postnatal age, whichever is later

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17
Q

Maternal gonorrhea

A

mom should be treated with IM ceftriaxone or oral cefixime

Chlamydia: If baby is born and asymptomatic, don’t do anything and watch/wait.

Gonorrhea: treat empirically even if baby is asymptomatic

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18
Q

treatment for NAIT

A

HPA1a platelets preferred if bleeding or plt <30 (or <50 if unwell or sibling with NAIT)
- consider IVIG if giving unmatched or normal plt

HUS if plt <50

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19
Q

NAIT is similar to Rh incompatibility - can it occur in first pregnancy or only subsequent?

A

can occur in first whereas RH incompatibility only occurs in subsequent

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20
Q

xray findings in NEC

A

pneumoatosis (confirms diagnosis)
portal vein gas
pneumoperiotenum
sentinel loops (large bowel loops)

21
Q

Bell staging criteria for NEC

A

Stage 1 = suspected NEC (sentinel loop)
*make NPO and start TPN, may not need to do abx immediately

Stage 2 = confirmed with radiographic findings (pneumatosis)

Stage 3 = shock, perforation, bleeding

22
Q

A 3-day old term infant presents with irritability and poor feeding. The infant’s HR is 200, BP 90/60mmHg, and is very irritable with handling. Antenatal history is unremarkable except for long-standing maternal hypothyroidism on synthroid. Mom denies and any other medication or substance use in pregnancy. What is the most likely diagnosis?

A

neonatal thyrotoxicosis

Maternal Grave’s disease

23
Q

adequate GBS prophylaxis

A

one dose of IV penicillin G (or amp or cefazolin) at least 4 hr before delivery

24
Q

GBS + mom with inadequate prophylactic antibiotics

A

monitor infant in hospital for at least 24 hr with vitals q3-4hr
don’t need a CBC before discharge if well

25
Q

condition with reversal of pre-post sats

A

TGA with PPHN

25
Q

if mom has chorioamnionitis

A

consider CBC at 4 hr but not mandatory

25
Q

Abnormal pulse ox testing

A

preductal is right limb

abnormal is
<90% in any limb
90-94$ is borderline
>3% difference between limbs is abnoral

95% or higher in any limb with 3% or less difference between limbs is normal

26
Q

twin-twin transfusion syndrome

A

Recipient: Hypervolemia, polyuria, polyhydramnios, cardiac hypertrophy, cardiomegaly, cardiac dysfunction, R sided Heart failure, pulmonary venous HTN and hydrops

Donor: Hypovolemia and anemia, oliguria, and anhydramnios

27
Q

antenatal steroids

A

<35 weeks

28
Q

benefits of surfactant for RDS

A

Decr mortality, vent, and BPD/Death @28d

29
Q

indications for surfactant

A

FiO2 > 50% or if needing to transfer to tertiary care center

LISA/MIST if not needing intubation

30
Q

complication post surfactant

A

pneumothorax

31
Q

corticosteroids for BPD

A
  • risk of CP if given within first 7 days
  • if needing it in first 48 hr of life, do low dose hydrocort (consider if <28 weeks and exposure to chorio)
  • if >7 days, can use dex

dont give steroids

32
Q

nitric oxide

A

selective pulmonary vasodilator
short half life (seconds)
inhaled only

33
Q

hemodynamically significant PDA

A

Precordial murmur
And one or more of:
Hyperdynamic precordial impulse
Tachycardia
Bounding pulses
Wide PP
Worsening resp status

Typically >1.5mm

34
Q

PDA management

A

conservative for 1-2 weeks
- do not aggressively fluid restrict but can use lasix if pulm
- PEEP

Meds
- ibuprofen if symptomatic PDA (high dose)
- second line: second course of ibuprofen ir indomethacin
- third line: enteral acetaminophen
- procedural if persistent after 2 courses pharmacotherapy

*PDA must be shunting L to R to consider treatment

35
Q

IVH grading

A

Grade 1- just in GM
Grade 2- bleeding also inside ventricles but they are not enlarge
Grade 3 -ventricles are enlarged by accumulation of blood
Grade 4 - bleeding extends into the brain tissue around ventricles

36
Q

gestational age at risk for IVH

A

under 32 weeks because the germinal matrix involutes

HUS screening is due for those <32 weeks (due 4-7 days post birth and repeat at 4-6 weeks)

HUS not routinely recommended for 32-36 weeks unless risk factors (ex. IUGR, septic, unwell)

37
Q

common perinatal injuries resulting in CP

A

Spastic diplegia - PVL (associated with prematurity)

Spastic hemiplegia - MCA stroke or IVH

Spastic quadriplegia- Grade 4 IVH, PVL

Dyskenetic- kernicterus, asphyxia

38
Q

Vitamin K in neonates

A

single IM vit K at birth (0.5 mg if <1500g, 1 mg if >1500 g)
within 6 hr of life
oral is less effective

if declines IM, then give 2mg PO at birth, repeat at 2-4 weeks and again at 6-8 weeks

giving mom vitamin K doesn’t help baby - poorly transferred across placenta

39
Q

risk factors for early onset hemorrhagic disease newborn (within 24hr)

A

maternal oral anticoagulants, anticonvulsants, or anti TB meds

*presents with intracranial hemorrhage

40
Q

Who should you not give soy formula to because of phytoestrogens?

A

congenital hypothyroidism on thyroixine (makes it hard to monitor levels)

41
Q

apnea prematurity definition

A

<37 weeks
Apnea x 20 seconds
Apnea < 20 secs PLUS bradycardia (<80) or cyanosis (SpO2 <80)

42
Q

what is complication of maternal magnesium sulphate

A

neonatal apnea

43
Q

dosing caffeine for AoP

A

caffeine 10-20mg/kg IV loading dose then 5-10mg/kg/day

can trial off sometime between 32-37 weeks
if discharged home on caffeine, continue until 44 weeks CGA

44
Q

ROP zones and stages

A

Zone 1 is worst, zone 3 is best

stages 0 is best, 5 is worst (total retinal detachment)

45
Q

cut offs for severe and critical hyperbili

A

severe >340 anytime in first mo of life
critical > 425 in first mo of life

just remeber as 340 & 430

46
Q
A

2023 RC Blue's Clues (20 decks)

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