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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
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1
Q

how long is fresh whole bld good for?

A

42 d

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2
Q

what are the risks of transfusion?

A
  1. infection
  2. Adverse effects of leukocytes - immunomodulation,GVHD, alloimmunization
  3. Volume and electrolytes disturbances
  4. bld group incompatibilities
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4
Q

when do you check a BG in an at risk baby?

A

at 2 hours

SGA, LGA,IDM or < 37 weeks

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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
  1. if BG 1.8-2 at 2 hrs or
  2. 2.0-2.5 for other feeds

treat with IV if <2.6

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5
Q

when do you consider treating hypoglycemia with IV in at risk baby

A
  1. if 2 hr BG is < 1.8
  2. if BG on subsequent checks are less than 2
  3. if baby is unwell and BG < 2.6 after refeeding + glucose check at
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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

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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

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8
Q

WHEN do we screen for ROP?

A

GA of 30 6/7 weeks or less or BW

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9
Q

what is the pathophysiology of HIE? phase 1

A
  1. dec blood flow and O2 -> decrease ATP
  2. failure of Na/K pump
  3. depolarization of cells
  4. Lactic acidosis
  5. +/_ cell necrosis
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10
Q

who do we screen for ROP?

A
  1. gestation of 30+6 or less OR???

2. BW < 1250g or less

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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

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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!!!!
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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
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14
Q

what are the maternal syphilis transmission rates?

A

untreated primary or secondary - 70-100%
early latent syphilis - 40%
late latent - 10%

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15
Q

what is the follow up BW for congenital syphilis?

A

need to show loss of trponemal antibodies by 18 mo

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16
Q

what is the treatment of choice for congenital syphilis

A

pen G q 12 h x 10d

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17
Q

what are risk factors for SNHL?

A
  1. Family history of permanent hearing loss
  2. Craniofacial abnormalities
  3. Congenital infections including bacterial meningitis, CMV, toxo, rubella, HSV and syphilis
  4. ? syndrome associated with hearing loss
  5. 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
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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

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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

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20
Q

what is the suggested rate of RBC transfusion

A

5 ml/kg/hr

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21
Q

what is the major risk of rapid or massive tranfusion

A

hyperkalemia

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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

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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
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24
Q

how long can apnea of prematurity last

A

up to 44 weeks PMA

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25
Q

How do you define apnea of prematurity?

A

apnea for >= 20 sec OR

Apnea for 10-20 sec + bradycardia ( HR< 8 or stas less than 80% in infant < 37 wks

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26
Q

what are appropriate sats for pt with BPD getting DC not on O2

A

90-95%

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27
Q

What can feeding action can shorten the length of stay and facilitate the transition form tube to oral feeds

A

non nutritive sucking during gavage feeds

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28
Q

prems are safe for discharge when:

A
  • 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
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29
Q

what investigations should occur prior to DC for a prem

A
  • 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
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30
Q

Why do we not give postnatal steroids in the first week of life?

A

increase risk of CP

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31
Q

when should a DC prem see their family Dr

A

within 48- 72 hrs of DC

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32
Q

What is the definition of Chronic lung disease?

A

O2 need at 36 weeks PMA + resp symptoms + CXR changes

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33
Q

T or F

CLD is a risk factor for poor neurodev outcome?

A

True

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35
Q

what are short term adverse effects of corticosteroids in prem

A 
hyperglycemia
HTN
GI bleed and perforation
hypertrophic cardiomyopathy
inc ROP but no inc blindness
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35
Q

who should get postnatal steroids

A

babies at risk or with severe CLD

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36
Q

what are the benefits of postnatal steroids?

A 
DART study
earlier extubation
reduced risk for O2 need at 36 weeks
decreased mortality at 28 days
decreased # of babies DC on O2
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37
Q

which steroid and at what dose should we use if considering post natal steroid for severe CLD

A

dexamethasone low dose

0.15 mg/kg/day to 0.2mg/kg/day and taper over 7 to 10 days

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38
Q

How long should a baby be observed in hospital after later pregnancy SSRI exposure

A

48 hrs

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39
Q

what factors effect prognosis when it comes to extreme prems?

A 
GA
birth at tertiary center
antenatal steroids
females ? do better 
multiplicity
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40
Q

what are possible complications of maternal depression?

A 
risk of miscarriage
preterm
low birth wgt
resp distress
inc length of hospital stay
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41
Q

what is the most worrisome possible effect of prenatal SSRI exposure?

A

PPHN

risk < 1% if exposed in 2nd half of pregnancy

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42
Q

what is SSRI neonatal behavioural syndrome?

A 
10-30 % of exposed
onset - hours and resolves in few weeks
inc RR
cyanosis
jitteriness/tremors
inc tone
Sz
feeding difficulties
43
Q

what are physiological changes caused by intubation

A

inc systemic and pulmonary HTN
bradycardia
increased ICP
hypoxia

44
Q

what steps/meds can decrease the physio response to intubation

A

vagolytics
muscle relaxant
analgesia
pre oxygenation

45
Q

what gives chest wall rigidity and how do you treat it?

A

fentanyl

give muscle relaxant of reverse with Naloxone or coadmin with mscl relaxant

46
Q

what are side effects of succinylcholine?

A

it is a muscle relaxant:
hyperkalemia
malignant hyperthermia
inc BP

47
Q

what is the recommended protocol for intubation meds

A

vagolytic- Atropine 20 Micrgram/kg
Analgesia - 3-5 microgram/kg
muscle relax - succ 2mg/kg

48
Q

late prems should have 3 initial evaluations

A

temp
BG at 2 hours
vitals

(bath only once able to keep tem >36.5)

49
Q

how is hyperbili different in the late prem

A

peak at d 7 (not 5)
stays elevated longer
reach higher mean values
need to be checked in first 48 hours

50
Q

what is limited diagnostic evaluation when talking about neonatal sepsis

A

CBC and vital q4h for 24 hrs

CBC value < 5x 10 9/L is worrisome

51
Q

what are the Abx choices for GN rods

A

CEFOTAXIME + gent

E.Coli, Klebsiella, pseudomonas

52
Q

well baby > 35 week, mom appropriately treated for GBS . Plan?

A

nothing

53
Q

what are maternal risk factors that increases risk of neonatal sepsis

A 
ROM > 18 h
mat fever > 38
premature labour < 36 w
GBS bactiuria at anytime during the pregnancy
previous child with invasive GBS disease
54
Q

well baby < 35 week, mom treated other Abx for GBS. Plan?

A

invasive disease risk of 1%
Do CBC:
- if WBC < 5 - do full diagnostic + treat
- if normal CBC - monitor

55
Q

what is the probability of sepsis in term baby with WBC < 5 if mom not appropriately treated?

A

10-20%

56
Q

how do you manage a term baby with GBS neg mom but risk factors for sepsis

A

CBC, if less than 5 need FSWU + Abx

vital q 4 for 24 hrs

57
Q

what do you do if unknown GBS status and well term baby

A

are there any risk factors?
if no - do nothing
if yes - mom needs Abx + routine care

58
Q

if GBS unknown and < late prem

A

CBC+d

monitor for 48 hours

59
Q

what is severe hyperbili

A

> 340 in first 28 d

60
Q

when do you stop screening for ROP

A

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
Q

What is critical bili

A

> 425 in first 28 D

62
Q

what are clinic features of acute bilirubin encephalopathy?

A 
lethargy, poor feeding, low tone 
progress to:
high tone - opisthotonos and retrocollis
high pitched cry
fever
coma
63
Q

What are clinical features of Chronic bili encephalopathy

A 
athetoid CP
GDD
\+/- Sz
hearing deficit
oculomotor disturbance
ID
64
Q

what can increase the risk of acute bili encephalopathy

A 
dehydration
hyperosm state
prem
acidosis
hypoxia
Sz
low albumin
65
Q

in a hyperbili baby, what level of conjugated bili would worry you and make you consider investigating

A

conjugated bili >18 micromol/L or > 20% of total bili

66
Q

what is the most accurate method for establishing GA?

A

US at 8-14 weeks

67
Q

what is survival rate of 24 week?

A

62%

68
Q

23 weeker survival rate

A

36%

69
Q

25 weeker survival rate

A

78%

70
Q

Is prematurity a risk for SIDS

A

yes

71
Q

What is the risk of CP in late prem

A

3 fold increase

72
Q

what is the room temp for a lightly dressed baby in a cot?

A

18 C

73
Q

how do Dx Chorio

A

fever
left shift
lower uterine tenderness

74
Q

when do you do a DAT

A

if mom O and clinically jaundice and baby in low intermediate or high intermediate

75
Q

can you detect G6PD during hemolysis?

A

No, high retic

76
Q

when can you not use transcutaneous

A

dark skin

edema

77
Q

what are the benefit of surfactant

A

reduced mortality
dec pneumo and emphysema
dec hypoxia
dec intubation length

78
Q

Side effects of phototherapy

A

low temp
bronzing of skin
affects bonding
Diarrhea

79
Q

3 short term complication of surfactant

A

hemorrhage
brady and asphyxia
tube block

80
Q

what are 4 clinical scenario for surfactant

A

MEC asp on 50%
intubated infants with RDS
sick newborn with pneumo and OI > 15
Intub with pulm hemorrhage

81
Q

what is the max # of surfactant doses

A

3

82
Q

when can you give second dose

A

2h and more commonly 4-6 hours, for sure within 72 hours

83
Q

which babies need car seat testing?

A

if less than 37 week or cardioresp issues

84
Q

what is a failed car seat test

A

2 or more desats less than 88% for longer 10 sec in 90 min

85
Q

what % of SNHL is genetic?

A

50%

86
Q

What is profound hearing loss?

A

> 80 dB threshold

87
Q

what are the 2 screening methods for hearing?

A 
Otoacoustic emission (OAE)
automated auditory brain-stem response (AABR)
88
Q

when can you do hearing screen

A

older than 24 hrs +

min 34 wk CGA

89
Q

how are OAE and AABR different?

A

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
Q

who gets the AABR right away?

A

is fail OAE or

if have one or more of the RF

91
Q

what do you call a palsy from C7-T1

A

Klumpke - Claw hand

92
Q

What do you call a palsy from C5-C7?

A

Erb - waiter’s tip

93
Q

what % of babies recover from brachial plexus injury in the first month?

A

75%

94
Q

when do you refer to brachial palsy team

A

incomplete recovery at end of first month

95
Q

what % of babies with brachial plexus injury have permanent damage?

A

25%

96
Q

what are the Vit K administration recommendations

A

BW < 1500 g = 0.5 mg IM
BW > 1500 g = 1mg IM

within 6 hours of life

97
Q

what o you do if family refuses IM vit K

A

Oral dose (2mg Vit K1 at first feed) at birth + at 2-4 weeks + at 6-8 week

98
Q

when is late hemorrhagic disease of the newborn?

A

3 - 8 weeks

99
Q

what is the normal hearing range

A

0-20 dB

100
Q

if confirmed hearing loss, what is the management

A
  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
Q

how do you decrease neonatal pain

A
  1. care protocols should include pain mgnt
  2. oral sucrose
  3. sucking/swaddle/cuddle
  4. Topica anaesthetic
  5. infuison of morphine or fentanyl
102
Q

who can receive iNO

A

> = 35 wks
+ hypoxemia
+ failure to respond to treatment

103
Q

what are SE of iNO

A 
NO2
methemoglobin
decreased plt aggregation
inc risk of bleeding
surfactant dysfunction
104
Q

how is iNO beneficial

A

improves oxygenation

decreases outcome of death and ECMO need

105
Q

glucose infusion rate

A

TFI x % glucose/144

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