nicu Flashcards
0
Q
What are the post discharge problems if the late prem?
A
Hyperbilirubinemia Feeding issues Apnea ALTE Suspected sepsis Resp issues Hypothermia
1
Q
how long is fresh whole bld good for?
A
42 d
2
Q
what are the risks of transfusion?
A
- infection
- Adverse effects of leukocytes - immunomodulation,GVHD, alloimmunization
- Volume and electrolytes disturbances
- bld group incompatibilities
4
Q
when do you check a BG in an at risk baby?
A
at 2 hours
SGA, LGA,IDM or < 37 weeks
4
Q
in an at risk baby for hypoglycemia, what values at 2hrs or subsequent feed would make you refeed and check BG in 1 hour?
below what value would you consider IV treatment in this senario
A
- if BG 1.8-2 at 2 hrs or
- 2.0-2.5 for other feeds
treat with IV if <2.6
5
Q
when do you consider treating hypoglycemia with IV in at risk baby
A
- if 2 hr BG is < 1.8
- if BG on subsequent checks are less than 2
- if baby is unwell and BG < 2.6 after refeeding + glucose check at
6
Q
when do you stop testing BG in IDM and LGA if all have been >_ 2.6
and for SGA/prem?
A
after 12 hours
36 hours for SGA and prem if otherwise well
7
Q
how do you treat ROP?
A
laser photocoagulation - directed t the avascular part of the retina with goal to decrease production of angiogenic growth factor
8
Q
WHEN do we screen for ROP?
A
GA of 30 6/7 weeks or less or BW
9
Q
what is the pathophysiology of HIE? phase 1
A
- dec blood flow and O2 -> decrease ATP
- failure of Na/K pump
- depolarization of cells
- Lactic acidosis
- +/_ cell necrosis
10
Q
who do we screen for ROP?
A
- gestation of 30+6 or less OR???
2. BW < 1250g or less
11
Q
who should get treatment for ROP?
A
Zone I - any stage with +disease
Zone I - stage 3 with or without +disease
zone II - stage 2 or 3 with +disease
12
Q
what is the pathophysiology of HIE? phase 2-reperfusion
A
normalization of oxidative metabolism from 6-12 hrs followed by energy failure 12-36 hours and up to 14 d apoptosis mitochondrial failure cytotoxic edema accumulation of excitatory amino acids release of free radicals PHASE 2 is BAD!!!!
13
Q
what is rapid plasma reagin test for syphilis and what can it be used for?
A
looks at non specific Ab against substances released by cells when damaged by T. Pallidum Used for: -staging/progress of disease - response to treatment - confirm re-infection
14
Q
what are the maternal syphilis transmission rates?
A
untreated primary or secondary - 70-100%
early latent syphilis - 40%
late latent - 10%
15
Q
what is the follow up BW for congenital syphilis?
A
need to show loss of trponemal antibodies by 18 mo
16
Q
what is the treatment of choice for congenital syphilis
A
pen G q 12 h x 10d
17
Q
what are risk factors for SNHL?
A
- Family history of permanent hearing loss
- Craniofacial abnormalities
- Congenital infections including bacterial meningitis, CMV, toxo, rubella, HSV and syphilis
- ? syndrome associated with hearing loss
- NICU stay >2 days OR with any of the following regardless of the duration of stay:
• ECMO
• Assisted ventilation
• Ototoxic drug use
• Hyperbilirubinemia requiring exchange transfusion
18
Q
For babies requiring resp support, what is the HB thresholds at 1,2, >3 week
A
week 1 - 115
week 2 - 100
week 3 - 85
19
Q
For babies who do not require resp support, what is the HB thresholds at 1,2, >3 week
A
week 1 - 100
week 2 - 85
week 3 - 75
20
Q
what is the suggested rate of RBC transfusion
A
5 ml/kg/hr
21
Q
what is the major risk of rapid or massive tranfusion
A
hyperkalemia
22
Q
how do you figure out how much blood they need?
A
Dr. Lawrence
wgt x bld volume (80ml/kg) x (desired - obs Hct) / 0.6
23
Q
what are possible complications of a prolonged NICU stay?
A
poor parent child relationship FTT nosocomial infections abuse parental feelings of inadequacy Financial burden of family and system
24
how long can apnea of prematurity last
up to 44 weeks PMA
25
How do you define apnea of prematurity?
apnea for >= 20 sec OR
| Apnea for 10-20 sec + bradycardia ( HR< 8 or stas less than 80% in infant < 37 wks
26
what are appropriate sats for pt with BPD getting DC not on O2
90-95%
27
What can feeding action can shorten the length of stay and facilitate the transition form tube to oral feeds
non nutritive sucking during gavage feeds
28
prems are safe for discharge when:
- temp when closed and in open cot - 37
- no apnea for 5-7 days (8 for late prem)
- Sat > 90-95 on RA
- sustained wgt gain
- feeding without cardioresp issues
29
what investigations should occur prior to DC for a prem
- NBS
- RSV if meet criteria
- HUS in needed
- ROP if indicated
- hearing screen
- Car seat test
- vacc according to chronological age
- full Hx and physical
30
Why do we not give postnatal steroids in the first week of life?
increase risk of CP
31
when should a DC prem see their family Dr
within 48- 72 hrs of DC
32
What is the definition of Chronic lung disease?
O2 need at 36 weeks PMA + resp symptoms + CXR changes
33
T or F
| CLD is a risk factor for poor neurodev outcome?
True
35
what are short term adverse effects of corticosteroids in prem
```
hyperglycemia
HTN
GI bleed and perforation
hypertrophic cardiomyopathy
inc ROP but no inc blindness
```
35
who should get postnatal steroids
babies at risk or with severe CLD
36
what are the benefits of postnatal steroids?
```
DART study
earlier extubation
reduced risk for O2 need at 36 weeks
decreased mortality at 28 days
decreased # of babies DC on O2
```
37
which steroid and at what dose should we use if considering post natal steroid for severe CLD
dexamethasone low dose
| 0.15 mg/kg/day to 0.2mg/kg/day and taper over 7 to 10 days
38
How long should a baby be observed in hospital after later pregnancy SSRI exposure
48 hrs
39
what factors effect prognosis when it comes to extreme prems?
```
GA
birth at tertiary center
antenatal steroids
females ? do better
multiplicity
```
40
what are possible complications of maternal depression?
```
risk of miscarriage
preterm
low birth wgt
resp distress
inc length of hospital stay
```
41
what is the most worrisome possible effect of prenatal SSRI exposure?
PPHN
| risk < 1% if exposed in 2nd half of pregnancy
42
what is SSRI neonatal behavioural syndrome?
```
10-30 % of exposed
onset - hours and resolves in few weeks
inc RR
cyanosis
jitteriness/tremors
inc tone
Sz
feeding difficulties
```
43
what are physiological changes caused by intubation
inc systemic and pulmonary HTN
bradycardia
increased ICP
hypoxia
44
what steps/meds can decrease the physio response to intubation
vagolytics
muscle relaxant
analgesia
pre oxygenation
45
what gives chest wall rigidity and how do you treat it?
fentanyl
| give muscle relaxant of reverse with Naloxone or coadmin with mscl relaxant
46
what are side effects of succinylcholine?
it is a muscle relaxant:
hyperkalemia
malignant hyperthermia
inc BP
47
what is the recommended protocol for intubation meds
vagolytic- Atropine 20 Micrgram/kg
Analgesia - 3-5 microgram/kg
muscle relax - succ 2mg/kg
48
late prems should have 3 initial evaluations
temp
BG at 2 hours
vitals
(bath only once able to keep tem >36.5)
49
how is hyperbili different in the late prem
peak at d 7 (not 5)
stays elevated longer
reach higher mean values
need to be checked in first 48 hours
50
what is limited diagnostic evaluation when talking about neonatal sepsis
CBC and vital q4h for 24 hrs
CBC value < 5x 10 9/L is worrisome
51
what are the Abx choices for GN rods
CEFOTAXIME + gent
E.Coli, Klebsiella, pseudomonas
52
well baby > 35 week, mom appropriately treated for GBS . Plan?
nothing
53
what are maternal risk factors that increases risk of neonatal sepsis
```
ROM > 18 h
mat fever > 38
premature labour < 36 w
GBS bactiuria at anytime during the pregnancy
previous child with invasive GBS disease
```
54
well baby < 35 week, mom treated other Abx for GBS. Plan?
invasive disease risk of 1%
Do CBC:
- if WBC < 5 - do full diagnostic + treat
- if normal CBC - monitor
55
what is the probability of sepsis in term baby with WBC < 5 if mom not appropriately treated?
10-20%
56
how do you manage a term baby with GBS neg mom but risk factors for sepsis
CBC, if less than 5 need FSWU + Abx
| vital q 4 for 24 hrs
57
what do you do if unknown GBS status and well term baby
are there any risk factors?
if no - do nothing
if yes - mom needs Abx + routine care
58
if GBS unknown and < late prem
CBC+d
| monitor for 48 hours
59
what is severe hyperbili
> 340 in first 28 d
60
when do you stop screening for ROP
if complete vascularization
if Zone III vascularization without previous zone I or II
If CGA 45 week with no disease
if regression on ROP
61
What is critical bili
> 425 in first 28 D
62
what are clinic features of acute bilirubin encephalopathy?
```
lethargy, poor feeding, low tone
progress to:
high tone - opisthotonos and retrocollis
high pitched cry
fever
coma
```
63
What are clinical features of Chronic bili encephalopathy
```
athetoid CP
GDD
+/- Sz
hearing deficit
oculomotor disturbance
ID
```
64
what can increase the risk of acute bili encephalopathy
```
dehydration
hyperosm state
prem
acidosis
hypoxia
Sz
low albumin
```
65
in a hyperbili baby, what level of conjugated bili would worry you and make you consider investigating
conjugated bili >18 micromol/L or > 20% of total bili
66
what is the most accurate method for establishing GA?
US at 8-14 weeks
67
what is survival rate of 24 week?
62%
68
23 weeker survival rate
36%
69
25 weeker survival rate
78%
70
Is prematurity a risk for SIDS
yes
71
What is the risk of CP in late prem
3 fold increase
72
what is the room temp for a lightly dressed baby in a cot?
18 C
73
how do Dx Chorio
fever
left shift
lower uterine tenderness
74
when do you do a DAT
if mom O and clinically jaundice and baby in low intermediate or high intermediate
75
can you detect G6PD during hemolysis?
No, high retic
76
when can you not use transcutaneous
dark skin
| edema
77
what are the benefit of surfactant
reduced mortality
dec pneumo and emphysema
dec hypoxia
dec intubation length
78
Side effects of phototherapy
low temp
bronzing of skin
affects bonding
Diarrhea
79
3 short term complication of surfactant
hemorrhage
brady and asphyxia
tube block
80
what are 4 clinical scenario for surfactant
MEC asp on 50%
intubated infants with RDS
sick newborn with pneumo and OI > 15
Intub with pulm hemorrhage
81
what is the max # of surfactant doses
3
82
when can you give second dose
2h and more commonly 4-6 hours, for sure within 72 hours
83
which babies need car seat testing?
if less than 37 week or cardioresp issues
84
what is a failed car seat test
2 or more desats less than 88% for longer 10 sec in 90 min
85
what % of SNHL is genetic?
50%
86
What is profound hearing loss?
>80 dB threshold
87
what are the 2 screening methods for hearing?
```
Otoacoustic emission (OAE)
automated auditory brain-stem response (AABR)
```
88
when can you do hearing screen
older than 24 hrs +
| min 34 wk CGA
89
how are OAE and AABR different?
AABR take 15-20 vs OAE takes 10-15 mi
AARB has head electrodes too
AABR can ID more types of hearing loss (conductive, cochlear, neural from external ear to brainstem inc CN VIII
90
who gets the AABR right away?
is fail OAE or
| if have one or more of the RF
91
what do you call a palsy from C7-T1
Klumpke - Claw hand
92
What do you call a palsy from C5-C7?
Erb - waiter's tip
93
what % of babies recover from brachial plexus injury in the first month?
75%
94
when do you refer to brachial palsy team
incomplete recovery at end of first month
95
what % of babies with brachial plexus injury have permanent damage?
25%
96
what are the Vit K administration recommendations
BW < 1500 g = 0.5 mg IM
BW > 1500 g = 1mg IM
within 6 hours of life
97
what o you do if family refuses IM vit K
Oral dose (2mg Vit K1 at first feed) at birth + at 2-4 weeks + at 6-8 week
98
when is late hemorrhagic disease of the newborn?
3 - 8 weeks
99
what is the normal hearing range
0-20 dB
100
if confirmed hearing loss, what is the management
1. ENT, Optho and genetics consults
2. full Hx and physical to ensure no other issues
3. SLP
4. Hearing aids
5. Consider imaging - case by case
101
how do you decrease neonatal pain
1. care protocols should include pain mgnt
2. oral sucrose
3. sucking/swaddle/cuddle
4. Topica anaesthetic
5. infuison of morphine or fentanyl
102
who can receive iNO
>= 35 wks
+ hypoxemia
+ failure to respond to treatment
103
what are SE of iNO
```
NO2
methemoglobin
decreased plt aggregation
inc risk of bleeding
surfactant dysfunction
```
104
how is iNO beneficial
improves oxygenation
| decreases outcome of death and ECMO need
105
glucose infusion rate
TFI x % glucose/144
