- Antenatal corticosteroids to infants 24-32 weeks GA - Intrapartum fetal monitoring (to reduce risk of asphyxia – associated with worse RDS)

NICU Flashcards by Carol Lam

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

How well did you know this?

Not at all

Perfectly

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

How well did you know this?

Not at all

Perfectly

Initial fluids for pre-term infant

D10W at 80 cc/kg/day

How well did you know this?

Not at all

Perfectly

Prevention of RDS

Antenatal corticosteroids to infants 24-32 weeks GA

- Intrapartum fetal monitoring (to reduce risk of asphyxia – associated with worse RDS)

How well did you know this?

Not at all

Perfectly

Prevention of ROP

Minimize exposure to inspired O2

How well did you know this?

Not at all

Perfectly

Retinal angiogenesis begins..and ends…

begins at 16 weeks GA and ends by 40 weeks

How well did you know this?

Not at all

Perfectly

Most common type of craniosynostosis

Scaphocephaly - sagittal suture fusing prematurely (80% of cases in males)

How well did you know this?

Not at all

Perfectly

Complications of being post-dates (3)

(1) Fetal macrosomia
(2) Meconium aspiration
(3) Shoulder dystocia

How well did you know this?

Not at all

Perfectly

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)

How well did you know this?

Not at all

Perfectly

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

How well did you know this?

Not at all

Perfectly

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

How well did you know this?

Not at all

Perfectly

Appearance of erythema toxicum

Multiple erythematous macules and papules (1 to 3 mm in diameter) that rapidly progress to pustules on an erythematous base

How well did you know this?

Not at all

Perfectly

Marijuana use and breastfeeding?

Not enough evidence. Existing evidence suggest THC excreted into breast milk in moderate amounts.

How well did you know this?

Not at all

Perfectly

Effects of twin-twin transfusion syndrome

Recipient twin: CHF, hydrops, polycythemia, respiratory issues
Donor: hypovolemic, hypoglycemic

How well did you know this?

Not at all

Perfectly

Nerves involved in Erb’s palsy

Brachial plexus: C5-T1

Erb’s palsy: C5,C6 +/- C7

How well did you know this?

Not at all

Perfectly

Features of Erb’s palsy

Asymmetric Moro
Absent biceps reflex
Intact grasp
No wrist extension

How well did you know this?

Not at all

Perfectly

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

How well did you know this?

Not at all

Perfectly

Duration of risk for hypoglycaemia in neonates

LGA, IDM = 12 hours

SGA = 36 hours

How well did you know this?

Not at all

Perfectly

Period of time after which you can stop resuscitating neonate with no heart rate

10 minutes

How well did you know this?

Not at all

Perfectly

Most common cause of hypertension in a newborn

Renovascular - accounts for 50% of cases of hypertension in neonates, including thrombi related to UV lines

How well did you know this?

Not at all

Perfectly

Indications for LP in newborn

Unwell baby

WBC <5

How well did you know this?

Not at all

Perfectly

GBS prophylaxis with penicillin allergy

History of anaphylaxis - clindamycin or erythromycin
No history of anaphylaxis - cefazolin
(cefazolin preferred)

How well did you know this?

Not at all

Perfectly

Components of Sarnat staging

Level of consciousness, tone, reflexes, seizures (yes/no)

How well did you know this?

Not at all

Perfectly

Reason for giving babies irradiated blood?

To prevent GVHD

How well did you know this?

Not at all

Perfectly

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