NICU Flashcards
Management of temperature instability in a newborn
- Plastic wrap
- Radiant heat source
- Incubator with heat and humidity (40-60%)
- Continuous monitoring of the infant’s temperature to avoid hypothermia
Prevention of IVH in newborn
- Avoid operative delivery (forceps/vacuum)
- Avoid clinical instability (acidosis, hypoxia, hypotension) – fluctuations in BP or Pco2 can impact development of IVH
- Antenatal corticosteroids (decrease risk of death, grade II and IV IVH and PVL)
- Prophylactic administration of low-dose indomethacin (0.1 mg/kg/d x 3 ds) for VLBW preterm infants – reduces severe IVH
- “Neuroprotection” – head midline, cluster handling
Initial fluids for pre-term infant
D10W at 80 cc/kg/day
Prevention of RDS
- Antenatal corticosteroids to infants 24-32 weeks GA
- Intrapartum fetal monitoring (to reduce risk of asphyxia – associated with worse RDS)
Prevention of ROP
Minimize exposure to inspired O2
Retinal angiogenesis begins..and ends…
begins at 16 weeks GA and ends by 40 weeks
Most common type of craniosynostosis
Scaphocephaly - sagittal suture fusing prematurely (80% of cases in males)
Complications of being post-dates (3)
(1) Fetal macrosomia
(2) Meconium aspiration
(3) Shoulder dystocia
Most common cause of sensorineural hearing loss
Genetic causes (50%) - usually bilaterally (others include infections [e.g., CMV, toxoplasmosis, congenital rubella, congenital syphillis] and anatomic)
Features of Noonan syndrome
Common findings include a short webbed neck, chest deformity (pectus excavatum), cryptorchidism, intellectual disability (mental retardation), bleeding diathesis, and lymphedema (puffy hands and feet); cardiac defects: pulmonic stenosis and hypertrophic cardiomyopathy
ALSO: Hypotonia in neonatal period
Presenting features of PUV
Abdominal distension due to enlarged overdistended bladder or urinary ascites, difficulty with voiding, or a poor urinary stream, failure to thrive, urosepsis, poor urinary stream, and straining or grunting while voiding
Appearance of erythema toxicum
Multiple erythematous macules and papules (1 to 3 mm in diameter) that rapidly progress to pustules on an erythematous base
Marijuana use and breastfeeding?
Not enough evidence. Existing evidence suggest THC excreted into breast milk in moderate amounts.
Effects of twin-twin transfusion syndrome
Recipient twin: CHF, hydrops, polycythemia, respiratory issues
Donor: hypovolemic, hypoglycemic
Nerves involved in Erb’s palsy
Brachial plexus: C5-T1
Erb’s palsy: C5,C6 +/- C7
Features of Erb’s palsy
Asymmetric Moro
Absent biceps reflex
Intact grasp
No wrist extension
Red flags for sacral dimple
>0.5cm Above gluteal crease (>2.5cm from anus) Multiple dimples Associated with patch of hair, hemangioma (looking for spina bifida occult) Neurological findings
Duration of risk for hypoglycaemia in neonates
LGA, IDM = 12 hours
SGA = 36 hours
Period of time after which you can stop resuscitating neonate with no heart rate
10 minutes
Most common cause of hypertension in a newborn
Renovascular - accounts for 50% of cases of hypertension in neonates, including thrombi related to UV lines
Indications for LP in newborn
Unwell baby
WBC <5
GBS prophylaxis with penicillin allergy
History of anaphylaxis - clindamycin or erythromycin
No history of anaphylaxis - cefazolin
(cefazolin preferred)
Components of Sarnat staging
Level of consciousness, tone, reflexes, seizures (yes/no)
Reason for giving babies irradiated blood?
To prevent GVHD
In preterm babies, are vaccines given based on corrected or chronological age?
Chronological age
What are the criteria for cooling in HIE?
TWO of the following:
1. Apgars 16 within first hour
and
Sarnat stage II or III (moderate or severe) encephalopathy
Who are antenatal steroids indicated for?
< 34 weeks, improve lung development, decrease IVH/NEC/mortality
Indication for MgSO4
< 32 weeks - neuroprotection, decrease rates of CP
CNS finding in congenital CMV
periventricular calcifications
Electrolyte abnormalities in IDM
hypocalcemia, hypoglycemia
Vit K recommendations
< 1500 g = 0.5 mg
> 1500 g = 1 mg
can give oral alternative (2mg at first feed, repeat at 2-4 weeks and 6-8 weeks)
When does apnea of prematurity resolve?
Can last up to 44 weeks, up to 20% of preterm infants can still have apnea/bradycardias at corrected term GA
What is kernicterus?
Pathologic yellow staining of basal ganglia
Syndromes that affect the bilirubin conjugation enyzme (UGT1A1)
Crigler-Najjar
Gilberts
Recommended time and method to do a bilirubin check in a newborn infant?
within 72 hrs, serum or transcutaneous level
What is VACTERL
Vertebral anomalies Anorectal Cardiac Trachoesophageal fistula Renal Limb anomalies
Most common type of TEF
Distal fistula, esophageal atresia
TEF is associated with what risk factors
advanced maternal age
obesity
low SES
smoking
Most common anomaly associated with omphalocele
cardiac! (TOF)
Most common anomaly associated with gastroschesis
intestinal atresia
Neonatal hypocalcemia. What other electrolyte abnormality should you look for and treat?
Hypomagnesemia
Risk factors for neonatal hypoglycemia
SGA < 10% LGA > 90% IDM preterm < 37 wks Perinatal asphyxia
LGA infant. Blood glucose 2.0 at 2 hrs of age. What do you do?
Feed, recheck in 1 hr
If > =2.6, continue usual care
If < 2.6, consider IV tx
GIR of TFI 80 cc/kg/day of D10W
5.5 mg glucose/kg/min
SGA infant. blood glucose 2.3 before their 3rd feed. What do you do?
refeed, check glucose in 1 hr
If >= 2.6, continue usual care
If < 2.6 consider IV tx
LGA infant. blood glucose 1.6 at 2 hrs of life. What do you do?
Consider IV treatment!
At what GIR should you think of hyperinsulinism?
GIR >10
Three medications used to manage hyperinsulinism?
Diazoxide
Octreotide
Glucagon
Most common cause of CAH? What is the lab test to confirm this?
21-hydroxylase deficiency
Test: 17-OH-progesterone
Side effects of inhaled nitric oxide?
NO2 and methemoglobin production
Bronchopulmonary sequestration typically occurs in what lobe
LLL
Congenital lobar emphysema typically occurs in what lobe
LUL
Syndromes associated with CDH
T13, T 18, T21, Turners
Common cause of elevated TSH after birth?
Measurement of sample < 24 hrs of life (all babies have peak in TSH)
Most common cause of hemolytic disease of the newborn
ABO incompatibility
Definition of polycythemia
Hct > 0.65
When would you consider an exchange transfusion for polycythemia?
Hct > 0.7 (asymptomatic)
Hct > 0.65 (symptomatic - signs of hyperviscosity)
Baby with hirschprungs failed hearing screen. What syndrome do you suspect?
Waardenburg
Definition of ophthalmia neonatorum
conjunctivitis occurring in first 4 weeks of life, regardless of bug
Metabolic abnormalities associated with subcutaneous fat necrosis
hypercalcemia
hypoglycemia
thrombocytopenia
Overlapping fingers, microcephaly, rocker-bottom feet
Edwards syndrome T18
Midline cleft lip, polydactyly, scalp abnormalities, microcephaly, hypoplastic/absent ribs
Patau syndrome T13
Role of MgSO4 for mom of preterm infant
Should give to mom if < 32 wks GA
Neuroprotection, decreases risk of CP
What is an illegal substance that protects against RDS?
Heroin!
Two medications you would give a 3 week old baby presenting with ICH (hemorrhagic disease of the newborn)
FFP
Vit K
FiO2 for PPV in baby 36 weeks GA
21% (>=35 wks)
FiO2 for PPV in baby 34 wks GA
21-30% (< 35 wks)
FiO2 when doing chest compressions
100%
Best way to assess HR during compressions
ECG monitoring
You are providing PPV to a newborn. When do you assess the HR?
after 15 s of PPV
Estimate of depth of ETT?
nare to tragus length
When you are doing compressions, when do you reassess HR?
after 60 seconds
Most common type of craniosynostosis
Scaphoscephaly
What measurements constitute an atypical sacral dimple?
> 5mm in size, > 2.5cm from anal verge
When do you screen for ROP?
at 31 weeks CGA or 4 weeks GA, whichever is LATER
