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NICU Flashcards

1
Q

Elevated AFP

Hint RAIN

A

R. Renal (nephrosis, agenesis, pckd)
A. Abdominal wall defects
I. Incorrect dates/ multiple pregnancies
N. Neuro (ancephaly or spins bifida)

RAIN elevates the level of AFP reservoirs

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2
Q

Low AFP

A

Trisomy 21- downs

Trisomy 18- Edwards

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3
Q

The most common cause of fetal bradycardia is…….

A

Heart block

May be seen in maternal lupus

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4
Q

What is the difference in fetal medicine between a non stress test and a contraction stress test?

A

Non stress test- measures spontaneous fetal movements and HR
Measures fetal autonomic nervous system integrity

Contraction stress test- measures fetal HR in response to contractions
Measures uteroplacental insufficiency and tolerance of labor
Positive= late deceleration after 50% of contractions

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5
Q

What are the 2 components of a BPP (biophysical profile)

A

Non stress test

US

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6
Q

What are the 5 things and US measures in a BPP

A 
Fetal movement
Reactive HR
Breathing
Tone
Volume of fluid
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7
Q

What’s the difference between apnea and periodic breathing

A

Apnea lasts for longer than 20s

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8
Q

2 treatments for apnea of prematurity

A

Caffeine

Theophylline

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9
Q

What is primary apnea and how do you treat it?

A

See this post delivery
Gasping with increased depth and RR followed by apnea

Treat with stimulation
Also blow by o2

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10
Q

What is secondary apnea and how do you treat?

A

Occurs if primary apnea does not resolve

Rule of thumb is greater than 30s of apnea after delivery

More gasping apnea

Oxygen and stimulation do not help

Treat with PPV

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11
Q

How much pressure is needed to inflate the lungs with the first breath?

A

60 mmHg

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12
Q

Definition of TTN

A

Tachypnea in otherwise health infants caused by retained fetal fluid

See with CS babies

Diagnosis of exclusion
Presents in first few hours of life
Tachypnea >60
Retractions, nasal flaring, grunting

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13
Q

What does the X-ray of TTN look like

A

Fluid in the inter lobar fissures

Increased pulmonary markings

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14
Q

How long does TTN last?

A

72hrs

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15
Q

TTN treatments

A

NPO

Close monitoring

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16
Q

HIE definition/head cooling requirement

A

Apgar <5 at 10 min
Apgar <3 for longer than 5 min
pH <7
Base deficit >16

> 36 wks
< 6 HOL

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17
Q

Metabolic disturbances seen in HIE

A 
NORMAL anion gap
Elevated ammonia
Lactic acidosis
Hypoglycemia
Hypocalcemia
Hyponatremia
pH <7
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18
Q

At what weeks of development does surfactant surge?

A

33-36 wks

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19
Q

CXR in RDS

A

GROUND GLASS
granular opacifications
air bronchograms
obscure heart and diaphragm borders

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20
Q

Think of this when there is temperature instability in an infant

A

INFECTION!

GBS pna

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21
Q

what happens in children with RDS & hyperbilirubinemia

A

higher risk of kernicterus!

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22
Q

increased risk of RDS with…. (5)

A 
1- premies
2- IDM---> can interfere with the accuracy to L:S
3- CS deliver
4- birth asphyxia
5- surfactant B deficiency
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23
Q

decreased risk of RDS with…. (3)

A

1- PROM
2- antenatal steroids
3- L:S >2

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24
Q

start on vent if pH…. and PCO2…..

A

<7.2

>60

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25
Q

what do you want your PO2 to be with RDS babies on vents/ECMO/HFOV

A

50-70 mmHg

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26
Q

what is the difference between prophylactic and rescue surfactant

A

1- prophylactic- given in first 2 HOL to babies <30 wks

2- rescue- given later after dx RDS made

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27
Q

what does surfactant do to the following….
____ O2 requirement
____ inspiratory pressure
____ lung compliance

A

decrease
decrease
improve/increase

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28
Q

ECMO criteria

A

reversible lung dz <10-14 day duration
failure of other methods

  • no systemic or intracranial bleeding
  • no CHD
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29
Q

PIE definition

A

pulmonary interstitial emphysema
cause of deterioration of babies with RDS on vents
air leaks into the interstitium
can end up as pneumothorax

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30
Q

what is the cause of BPD

A

bronchopulmonary dysplasia/chronic lung disease

arrest of nl lung development in premature infants

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31
Q

when does bilirubin peak in term infants? in premies?

A

3-5 DOL

5-7 DOL

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32
Q

CXR findings with BPD

A

GROUNG GLASS
diffuse opacities
cystic areas with streaky infiltrates

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33
Q

when are mothers screened for GBS?

A

35-37 weeks GA

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34
Q

when do you see…
early onset GBS?
late onset GBS?
late, late onset GBS?

A

first 7 days after birth
~4 weeks after birth (but up to 90d)
up to 6 mos after birth (premies)

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35
Q

the difference between mothers with babies with GBS vs listeria

A

GBS mom often asymptomatic

Listeria mom often with flu-like illness

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36
Q

when it’s OK not to tx babies with GBS+ mothers

A

mom adequately tx
OR
CS prior to ROM

*if mother not adequately tx, but asym and baby asym, monitor baby for 48HOL

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37
Q

Erb’s palsy

A

C5-7
waiter’s tip- adducted, internally rotated, wrist and fingers flexed
grasp intact

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38
Q

with a baby with Erb’s palsy and respiratory distress- think of this

A

Phrenic nerve palsy

C3-5 keeps the diaphragm alive

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39
Q

klumpke palsy

A

C8-T1
claw hand
can be associated with Horners syndrome

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40
Q

cord that stays attached >1 month… think of this (2)

A

1- LAD - leukocyte adhesion deficiency

2- low WBC

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41
Q

further work up for infant with single umbilical artery

A

Renal US

can have associated renal dz

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42
Q

definition of SGA

A

<10th percentile weight for GA

< 2500 g

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43
Q

definition of LGA

A

> 90th percentile weight for GA

>3900 g

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44
Q

Term baby

A

38-42wks

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45
Q

normal scalp pH

A

> 7.25

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46
Q

hint for knowing MAP (mean arterial pressure) in premies

A

MAP should not be lower than corrected GA

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47
Q

definition of VLBW

A

<1500g

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48
Q

What does CXR look like with meconium aspiration

A

areas of atelectasis and areas of hyperinflation

can lead to pneumothorax (10-20%)

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49
Q

PE findings of baby with meconium aspiration

A

barrel chest

crackles and coarse breath sounds

50
Q

xray findings with NEC

A

pneumatosis intestinalis
air in the biliar tree
pneumoperitoneum

51
Q

long term complication of NEC

A

intestinal stricture –> obstruction

52
Q

how long should you keep a baby NPO after NEC

53
Q

treatment of NEC

A 
NG tube to suction
NPO
IVF
antibiotics
CBC (low plt), lyte, coags
serial AXR
surgery consult
54
Q

this can be a nl bili within the first 24h for FT babies

55
Q

when is phototherapy contraindicated

A

1- elevated direct/conjugated bili

2- family hx of light sensitive porphyria

56
Q

causes of increased enterohepatic circulation leading to jaundice (5)

A 
hirschsprungs
obstruction
ileus
pyloric stenosis
meconium ileus
57
Q

medications that worsen jaundice

A

anything that binds to albumin and displaces bilirubin
-sulfonamides, ceftriaxone

increased risk of kernicterus

58
Q

causes of hyperbilirubinemia

LIE and GLOW

A

L- lysed RBC- hemolytic dz, defects of red cell metabolism, isoimminization
I- increased
E- entterohepatic circulation (obstruction, ileus, pyloric stenosis, hirschsprung, meconium ileus) & Endo (hypotheyroid, hypopit)

G- gilberts
L- Lucy Driscoll syndrome
bOth direct & indirect- galactosemia, tyrosinosis, hypermethioninemia, CF
W- wasted blood- caput, bruising, petechiae, cephalohematoma, swallowed maternal blood

59
Q

Exchange transfusion complications

A 
imPaCT NO!
Potassium high
Calcium low
Thrombocytopenia 
Volume NO! (hypovolemia)
60
Q

treatment for hypoglycemia

A

2-3 cc/kg D10

or glucocorticoids- hydrocortisone, prednisone

61
Q

what labor drugs can cause hypoglycemia

A

tocolytics- stimulate fetal insulin

62
Q

signs of hypoglycemia in an infant (6)

A 
tachypnea
jitteriness
lethargy
apnea
cyanosis
seizures
63
Q

risks for IDMs (5)

A 
RDS (decreased surfactant)
hypoglycemia (high insulin)
LGA (insulin promotes growth)
polycythemia (d/t increased erythropoietin)
hypoplastic L colon

Large body, small Left colon, Lots of RBCs

64
Q

definition of hypocalcemiain infant

A

ionized ca <4.5

ca <8.5

65
Q

ekg change in hypocalcemia

A

prolonged qt

66
Q

what do you do in an infant with hypocalcemia who has been receiving calcium replacement and continues to show signs of hypocalcemia?

A

give magnesium
Mg and Ca are directly correlated
hypoMg can cause intractable hypocalcemia that will not respond to calcium replacement until you correct magnesium

67
Q

definition of polycythemia

A

> 65

tx if >70

68
Q

yellow bananas are not sweet

A

jandiced kiddos are hypoglycemic

69
Q

when does physiologic nadir for anemia occur

A

2-3 mos in FT kids

1-2 mos in premies

70
Q

what is the Apt test

A

test gastric aspirate for maternal blood

71
Q

what is the cause of hemorrhagic dx of the newborn

A

vitK deficiency

72
Q

what maternal drugs cause hemorrhagic dz

A

anticoagulants
anticonvulsants
antibiotics- quinolones, cephalosporins, TB meds

73
Q

cause of neonatal seizure in first 24HOL

A

neonatal asphyxia

74
Q

antiepileptic to use in neonatal seizure

A

phenobarbital

75
Q

omphalocele vs gastroschisis

A

omphalocele is protrusion of the bowel through the umbilicus covered with a membrane!
gastroschisis- bowel is not covered and protrudes through NEAR the umbilicus, not THROUGH!

76
Q

genetic condition seen with omphalocele

A

beckwidth wiedmann

- also hypoglycemia, big tongue, macrosomia, ear pits, hepatoblastoma

77
Q

caput succedaneum vs cephalohematoma

A

caput succedaneum- CROSSES SUTURES, boggy, soft pitting

cephalohematoma- confined, firm and tense

78
Q

grading IVH

A

1- germinal matrix
2- IVH without dilitation
3- IVH + dilitation
4- parenchyma involvement

79
Q

mother given tertbutaline for tocolysis… what is the effect on baby?

A

hyperinsulin & hypoglycemia

80
Q

antenatal steroids reduce the risk of…. (3)

A

1- RDS
2- IVH
3- NEC

81
Q

phenobarb and bili

A

decreases risk of hyperbili

82
Q

signs of EtOH withdrawal in babies (2)

A

hyperactivity/irritability

hypoglycemia

83
Q

signs of cocaine withdrawal in babies

A

no official withdrawal sx

84
Q

teratogenic affects of cocaine (4)

A

cause vasoconstriction of placenta

  • cerebral infarct
  • limb anomalies
  • urogenital defects
  • abruption
85
Q

babies exposed to amphetamines

A

irritable and agitated
IUGR
developmental/cognitive delays

86
Q

babies exposed to barbituates (3)

A

hyperactivity/irritable
hyperphagia
poor suck-swallow coordination

87
Q

opioid withdrawal in babies (7)

A 
hyperirritability
tremors/jitters
hypertonia
loose stools
emesis
feeding problems
seizures
88
Q

definition of LBW

89
Q

definition of VLBW

90
Q

definition of ELBW

91
Q

what is the most common cause of a single umbillical a

A

trisomy 18

also need to worry about congenital anomalies, renal problems, cardiac problems

92
Q

what is an early deceleration

A

decel that mirrors contractions

2/2 head compression

93
Q

what is a late deceleration

A

recovery after contraction subsides

?uteroplacental insufficiency or acidosis

94
Q

what does a variable decel indicate

A

cord compression

95
Q

what should be the temperature in the DR

A

73-76 deg F (23-24 C)

96
Q

at was GA do you have lanugo over your entire body

97
Q

at was GA do you have facial clearing of lanugo

98
Q

at was GA do you have lanugo over your shoulders only

99
Q

at was GA do you have NO lanugo

100
Q

at was GA are testes in canal, few rugae

101
Q

at was GA are testes in upper scrotum, anterior rugar

102
Q

at was GA are testes in lower scrotum, rugae complete

103
Q

at was GA pendulous scrotum

104
Q

at was GA clitoris prominent, small labia majora

105
Q

at was GA labia majora covers clitoris

106
Q

at was GA labia majora covers minora

107
Q

at was GA no foot sole creases

108
Q

at was GA 1-2 foot sole creases

109
Q

at was GA 2-3 foot sole creases

110
Q

at was GA 2/3 foot with sole creases

111
Q

at was GA foot sole creases to heel

112
Q

what is the dx?

newborn with subcutaneous fat necrosis

A

hypercalcemia

113
Q

what is the dx?

newborn with cutis congenita aplasia

A

trisomy 13

114
Q

findings on path with etox?

A

eosinophils

115
Q

findings on path with pustular melanosis?

A

neutrophils

116
Q

what is the dx?

newborn with cyanosis that resolves with crying

A

choanal atresia

think CHARGE
babies are obligate nose breathers

117
Q

what is the dx?

newborn with single upper middle tooth

A

GH deficiency

midline defect

118
Q

what is the most common congenital cyanotic heart disease

A

Transposition

119
Q

what is the dx?

and infant with a “doughy” distended abdomen, bilious emesis, and intraabdominal calcifications on KUB

A

meconium peritonitis

complication of meconium ileus

120
Q

at what wavelength of light is most effective for phototherapy

A

450 nm

want 460-490

NICU (1 decks)

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