NICU Flashcards
1
Q
What tests are in first trimester screening?
A
Nuchal Translucency
PAPP-A
Beta-HCG
2
Q
What tests are in second trimester screening?
A
MSAFP
Beta-HCG
Unconjugated estriol
Inhibin-A
3
Q
What tests are in 2 step integrated prenatal screen?
A
PAPP-A and NT at 11-14 weeks
Second trimester quad screen (MSAFP, beta-HCG, unconjugated estriol, Inhibin-A)
4
Q
Name 10 signs on anatomy scan of aneuoploidy
A
- Thickened nuchal fold
- Echogenic bowel
- Mild ventriculomegaly
- Echogenic intracardiac focus
- Choroid plexus cyst
- Single umbilical artery
- Enlarged cisterna magna
- Mild pyelectasis(≥ 5 & ≤ 10 mm)
- Short nasal bone
5
Q
What is NIPT?
A
Measures cell free fetal DNA in maternal blood
6
Q
What does NIPT screen for?
A
Aneuploidy ONLY
7
Q
When can chorionic villous sampling be performed?
A
10-13 weeks GA
8
Q
Name 3 complications of CVS
A
Higher rate of fetal loss Risk of infection PROM Limb anomalies AMNIO HAS SAME RISKS BUT LESS
9
Q
What disease cannot be ruled in CVS?
A
ONTDs
10
Q
When can amniocentesis be performed?
A
15-20 weeks
11
Q
What diseases can be assessed on amniocentesis?
A
Aneuoploidy (chromosomal analysis) ONTDs (AFP levels Assess fetal lung maturity (L:S ratio>2) Measure bilirubin and acetylcholinesterase TORCH
12
Q
Name 4 neonatal/postnatal effects of cigarette smoking
A
Growth restriction Preterm labour Premature ROM Placental abruption SIDS
13
Q
Name 4 diagnostic criteria of fetal alcohol syndrome
A
1. 3 Characteristic facial features: A) Short palpebral fissures B) Flat philtrum C) Thin upper lip Others: hypertelorism, flattened face with short nose, bow shaped mouth
- Growth retardation
A) Birth weight or birth length at or below the 10th percentile for gestational age.
B) Height or weight at or below the 10th percentile for age.
C) Disproportionately low weight-to-height ratio (= 10th percentile). - Neurological abnormalities:
Developmental delay, behavioural, LD, brain malformations - Confirmed or unconfirmed prenatal alcohol exposure
14
Q
Name two infant outcomes in maternal SSRI use
A
Small increase in cardiac malformations (with paroxetine)
SSRI neonatal behavioural syndrome
PPHN-associated with exposure in 2nd half of pregnancy
15
Q
Name 3 neonatal effects of maternal cocaine use
A
Spontaneous abortion
Placental abruption
Prematurity
IUGR
Withdrawal uncommon
Hearing deficits (Abnormal auditory brainstem response)***
Transient abnormal EEG changes
Later-DD, regulation, info processing, LD
16
Q
Name 10 features of neonatal abstinence syndrome
A
High pitched cry Irritability Sleep and wake disturbances Hyperactive primitive reflexes Hypertonicity Tremors with resultant skin excoriation Feeding difficulties Vomiting Loose stools Sweating Sneezing Mottling Fever Nasal stuffiness Yawning Failure to thrive
17
Q
Name 6 features of fetal hydantoin syndrome (phenytoin or carbamezipine use)
A
Facial: Cleft lip/palate*** Short nose Depressed bridge Mild hypertelorism
Extremities:
Digit and nail hypoplasia***
Other:
IUGR
NOTE: Carbamezipine-increased NTDs
18
Q
Name 6 features of maternal lithium use during pregnancy
A
Ebstein anomaly Fetal goitre Hypotonia Arrhythmia Seizures Diabetes insipidus Preterm birth
19
Q
Name 3 features of maternal phenobarbital use during pregnancy
A
Cleft lip/palate
Cardiac anomalies
Hemorrhagic disease of the newborn
20
Q
Name 3 features of maternal valproic acid use during pregnancy
A
Neural tube defects
Face narrow bi-frontal diameter, elecanthus, anteverted nostrils
Cardiac defects
Long thin fingers/toes
21
Q
Name 3 features of maternal warfarin use during pregnancy
A
Optic nerve atrophy
Nasal hypoplasia
Stippled bone epiphyses
22
Q
What are the neonatal effects of PIH?
A
Increased risk of mortality IUGR RDS (mixed evidence) BPD Thrombocytopenia Neutropenia NEC Behaviouralproblems Adult-onset cardiovascular disease
23
Q
What is the definition of hydrops fetalis?
A
Abnormal fluid accumulation in ≥ 2 fetal compartments •Skin thickening •Fetal ascites •Pleural effusion •Pericardial effusion •(±)Polyhydramnios
24
Q
Name 10 conditions that can cause with hydrops fetalis
A
Immune: due to Rh(D) incompatibility (uncommon)
Non-immune:
Hematological
•Feto-maternal hemorrhage, thalassemia, RBC enzyme deficiencies/membrane defects, TTTS
Cardiac
•Congenital heart disease, cardiomyopathy, arrhythmia
Vascular malformation
•AVM, lymphatic obstruction (congenital chylothorax, cystic hygroma)
Infection
•TORCH, Parvovirus B19, congenital syphylis
Genetic
•Aneuploidies, Turner syndrome, Noonan syndrome
Metabolic
•Lysosomal storage disorders, Glycogen storage diseases
Pulmonary
•CCAM, pulmonary sequestration
25
Name 8 fetal and neonatal affects of maternal diabetes
Still birth
Polyhydramnios
Preterm delivery
LGA/Birth trauma (may be SGA if significant vascular disease)
Transient hyperinsulinism and hypoglycemia
RDS
Congenital heart disease
Transient hypertrophic cardiomyopathy
Polycythemia
Hyperbilirubinemia
Early neonatal hypocalcemia (hypoparathyroidism)
Hydrocephalus
NTDs
Arthrogryposis
Lumbosacral agenesis
Situs inversus
Small left colon syndrome
Renal anomalies (RVT, hydronephrosis, renal agenesis)
26
Do the majority of babies born to mothers have neonatal lupus?
NO, only 1-2%
27
Is it possible for healthy mothers to give birth to a baby with neonatal lupus?
YES, 50% of affected babies have healthy mothers
28
Name 5 features of neonatal lupus
Photosensitive rash
-Disappears (generally without scarring) by 4 months age
Cardiac (heart block, cardiomyopathies)
-At risk almost only when mother Anti-Ro/Anti-La positive
Hepatitis/transaminitis
Cytopenias (anemia, thrombocytopenia)
29
What is the only permanent sequel of neonatal lupus?
Heart block
30
Name 10 aetiologies of IUGR
1) Fetal factors
- Genetic/chromosomal abnormalities
- Infection (TORCH)
- Multiple gestation
2) Placental factors
- Uretero-placental insufficiency
- Placental infarcts
- PIH
- Chronic abruption
3) Maternal factors
- Chronic illness
- Drugs/Smoking
- Poor nutrition
31
List 5 neonatal effects of SGA
```
Hypoglycemia
Hyperglycemia
Hypocalcemia
Depressed immune function
Hypothermia
Risk of perinatal asphyxia
Polycythemia (with concomitant neutropenia and thrombocytopenia)
```
32
What is the definition of twin twin transfusion?
Discrepancy in amniotic fluid volume (NOT weight discordance or Hb)
33
Does twin twin transfusion happen more commonly in MC/DA or MC/MA pregnancies?
MC/DA
34
List 5 management options for TTTS?
* Expectant management
* Amnioreduction
* Septostomy
* Selective feticide
* Fetoscopic laser ablation of vascular anastomoses-inc risk of preterm labour
35
What non-invasive prenatal screening results are suggestive of trisomy 21?
Low AFP
High BHCG
Low estradiol
High inhibin
36
What non-invasive prenatal screening results are suggestive of trisomy 18?
```
Everything low!
Low AFP
Low BHCG
Low estradiol
Low inhibin
```
37
What non-invasive prenatal screening results are suggestive of trisomy 13?
Quad screen not sensitive
| Antenatal ultrasounds more helpful
38
When can NIPT be done?
After 10 weeks GA
39
What is the advantage of umbilical artery sampling as an invasive prenatal test?
Quick results (within 24-48 hours)
40
With maternal history of methadone use, how long do you have to watch baby?
10 days
41
In TTTS, what does the recipient twin have?
Cardiac hypertrophy/myocardial dysfunction/tricuspid regurg/RVOTO
Polycythemia
Polyhdramnios
Increased risk of hydrops
42
In TTTS, what does the donor twin have?
```
High output failure
Anemia
Oligohydramnios
Hypovolemia
Hypoglycemia
Increased risk of hydrops
```
43
How do you treat seizures in NAS?
Phenobarbitol
Use AED before morphine
44
What are two features of a non reassuring fetal heart rate tracing?
```
Minimal variability (<5 bpm variation around baseline)
Late decelerations (uteroplacental insufficiency)
```
45
Name 7 causes of fetal tachycardia
```
Fever (maternal)
Arrhythmia
Thyrotoxicosis
Infection (chorioamnionitis)
Medications (e.g. beta-agonists, parasympathetic blockers)
Anemia
Hypoxia/Fetal distress
```
46
What does a sinusoidal FHR tracing indicate?
Anemia
47
After how many seconds should PPV be initiated for an apneic newborn?
30s
48
If after initiating PPV HR still <100 after 15 seconds of effective PPV, what is the next step?
```
M= mask readjustment
R= Reposition airway
S= suction mouth and nose
O= open mouth
P= increase pressure
A= consider alternate airway
```
49
If HR<60 despite 30s of effective PPV what is the next step?
Intubate (recommended before chest compressions in 7th ed NRP)
Chest compressions
50
What is the IV dose of epinephrine?
0.1-0.3 mL/kg
51
What is the ETT dose of epinephrine?
0.5 ml/kg
52
What are the target SO2 recommendations?
```
1 min 60-65%
2 min 65-70%
3 min 70-75%
4 min 75-80%
5 min 80-85%
10 mins 85-95%
```
53
Name the 3 determinants of the need for resuscitation
Term, breathing/crying, good tone
54
What is the most sensitive indicator of the efficacy of resuscitation?
Increase in HR
55
At what FiO2 should you start resuscitation in newborns <35 weeks?
21-30%
56
Name 4 factors other than gestational age that result in favourable outcomes
Female sex
Antenatal steroids
Appropriate EFW
Singleton pregnancy
57
What are the survival rates for 23, 24 and 25 weeks GA?
* 23 weeks: 36%
* 24 weeks 62%
* 25 weeks 78%
58
Name 5 risk factors for birth injury
```
Macrosomia
Maternal obesity
Abnormal fetal presentation
Operative vaginal delivery (Vacuum/Forceps)
Cesareandelivery
```
59
What is appropriate monitoring for a neonate with subgaleal hemorrhage?
Vitals
Serial HC
Serial Hb
60
What percentage of patients with brachial plexus injury have residual defects?
20-30% with residual deficits, especially if incomplete recovery by 3-4 weeks
61
Name 4 situations where non-initiation of resuscitation is appropriate
Confirmed GA <23 weeks
BW <400g
Anencephaly
Confirmed T13 or T18
62
Above what gestational age is resuscitation nearly always indicated
GA>25 weeks
63
When should you consider stopping resuscitation?
After 10 minutes if no HR remains detectable
64
What are the CPS counselling recommendations for 22, 23-24 and 25 weeks GA?
22 week-non-interventional approach
23-24 week-individualized
25-active treatment, except with significant risk factors
65
Below what gestational age is C/S discouraged UNLESS for maternal indications?
<25 weeks
66
For what gestational ages should antenatal steroids be given?
All pregnant women between 22 and 34 weeks’ gestation who are at risk of preterm delivery within 7 days (NEW CPS)
67
What do antenatal steroids reduce the risk of?
↓s mortality from RDS
↓s overall neonatal mortality
↓s need and duration of ventilatory support
↓s need for admission to NICU
↓s incidence of severe IVH, NEC, early-onset sepsis, and developmental delay
68
Name two appropriate antenatal steroid regimens
1. Two 12 mg doses of betamethasone given IM 24 hours apart
| 2. Four 6 mg doses of dexa- methasone given IM 12 hours apart
69
What is the difference between caput succudenum, cephalohematoma and sugaleal hemorrhage on exam?
Caput succundum-above periosteum, crosses suture lines, most superficial
Cephalohematoma-subperisoteal, asymmetric, does not cross suture lines
Subgaleal-between perisoteum and aponeurosis, extends from the orbital ridges anteriorly to the nape of the neck posteriorly and to the level of the ears laterally, pallor
70
What percentage of neonates blood can be lost in the subgaleal space?
20-40%
71
If there is no recovery by 3 mo or persistent weakness by 5 mo from brachial plexus injury, what intervention is needed?
Suspect rupture of nerve root
Surgical exploration and grafting
MRI may be ordered pre-op to rule out structural anomalies
72
Name 4 injuries associated with brachial plexus injury
Clavicular fracture
Humeral fracture
Subluxation of c-spine
Facial palsy
73
In a neonate with brachial plexus injury and no improvement after 4 weeks, what should you do?
Refer to multidisciplinary team ( (neurologists and/orphysiatrists, rehabilitation therapists and plastic surgeons)
74
In baby born with hornet's syndrome, what nerves are likely to have be injured at birth?
T1
75
What nerves are affected in Erb's palsy and what is the clinical presentation?
```
C5, C6
Waiter’s tip position (Adduction, internally rotated, pronated)
No arm abduction (from shoulder)
Can’t externally rotate the arm
Can’t supinate forearm
Asymmetric moro
Absent biceps reflex
Preserved arm extension
Hand grasp preserved***
```
76
What nerves are affected in Klumpkes palsy and what is the clinical presentation?
C7, C8, T1
| Isolated hand paralysis and Horner Syndrome
77
Which brachial plexus injury is most likely associated with horner's syndrome
Klumpkes
78
Which type of brachial palsy is most commonly associated with phrenic nerve injury?
Erb's palsy
79
What is the treatment for phrenic nerve injury?
- Place on affected side
- Give O2 as needed
- Support feeding (initially IV, then gavage)
- Recover spontaneous in 1-3 months
- RARELY require surgical plication of diaphragm
80
What is the prognosis for total brachial plexus injury (C5-T1) with phrenic nerve involvement?
Symptoms may be chronic and require surgery
81
What is the goal temperature in therapeutic hypothermia?
A rectal temperature of 34±0.5°C
82
When do you start and stop therapeutic hypothermia
Start at age 6 hours
| Continue x 72 hours
83
Name 4 mechanisms by which therapeutic hypothermia works
Decreased loss of high-energy phosphates
Reduced oxygen consumption
Reduction of free oxygen radicals, excitatory NTMs
Reduction in expression of genes causing neuronal cell death
84
List the criteria for therapeutic hypothermia:
MUST BE Term or late preterm infants ≥36 weeks’ gestation with HIE who are ≤6 h of age and who meet both treatment criteria A and B:
Criteria A evidence of hypoxia: 2 of the following:
1. APGAR score < 5 at 10 min
2. Continued need for ventilation and resuscitation at 10 min of age
3. Metabolic acidosis (pH < 7 or BD > 16 in cord or ABG within 1 hour
Criteria B evidence of encephalopathy
Moderate (Sarnat stage II) or severe (Sarnat stage III) encephalopathy demonstrated by the presence of seizures or at least one sign in at least three of the six categories
85
Review Sarnat staging
http://www.cps.ca/documents/position/hypothermia-for-newborns-with-hypoxic-ischemic-encephalopathy
86
What benefit has therapeutic hypothermia been shown to have?
Reduce risk of death/neurodevelopmental impairment at 18-24 months disability
87
Name 2 complications of therapeutic hypothermia
```
Bradycardia
Hypotension
Arrhythmias
Thrombocytopenia
Edema
```
88
Name 4 contraindications to cooling
```
Severe head trauma
Intracranial bleeding
>6 hours of age
<36 weeks GA
Lethal congenital anomalies
PHTN/Oxygenation failure (should fix first)
```
89
Name 3 pathophysiologic mechanisms that contribute to IVH
Immature capillaries in sub-ependymal germinal matrix
Hemodynamic instability in first few days of life
Inability to auto-regulate cerebral blood flow
90
Name 3 preventive measures that have been shown to reduce IVH
Antenatal steroids
Post-natal prophylactic indomethacin
Delayed cord clamping
91
When are the majority of IVHs apparent?
90% within the first week (80% within 3 days)
92
Name 3 complications of IVH
Post-hemorrhagic hydrocephalus
Periventricular hemorrhagic infarction
Periventricular leukomalacia
93
What type of cerebral palsy does PVL cause?
Spastic diplegia
94
Name 10 aetiologies for neonatal seziures
```
Birth asphyxia/HIE
IVH/ICH
Infection
Stroke
CSVT
Hypoglycemia
Electrolyte imbalances (hypoNa, hypoMg, hypoCa, alkalosis)
IEM (present 48-72 hours)
Congenital brain malformations
Benign neonatal/familial seizures
```
95
What investigations would you order for neonatal seizures?
Infection
- CBC, blood culture
- Urine culture
- CSF (inc coxscakie, HSV, entero, CMV, echovirus PCR)
Metabolic
- Glucose
- Na, K, Ca, Mg
- VBG, lactate
- AST/ALT
- Urea
- Ammonia
Neuroimaging
EEG
96
Name 6 differentials for neonatal hypotonia
Central
- Congenital (e.g. structural brain anomalies, chromosomal defects)
- Acquired/Acute (e.g. infection, HIE)
Peripheral
- Anterior horn cell (e.g. SMA)
- Peripheral nerve (e.g. Charcot-Marie-Tooth)
- Neuromuscular junction (e.g. Myasthenia)
- Muscular (Myopathies, Muscular dystrophies)
97
Name 3 risk factors for neural tube defects
Lack of maternal folate
Diabetes
Medications (e.g. VPA)
98
Name 4 external signs of spinal dysraphism
* Dimple
* Sinus tract
* Hemangiomas/Lipomas
* Hair tuft
99
Name 10 conditions that cause hydrocephalus in a neonate
Non-communicating (obstructive)
1) IVH-Post-hemorrhagic hydrocephalus
2) Aqueductal stenosis (X-linked with adducted thumbs, auto recessive associated with VACTERL)
3) Arnold Chiari/Dandy-Walker Malformations
4) Congenital hydrocephalus
- Infection (TORCH)
- Vein of Galen malformation
5) Intracranial mass
Communicating
1) IVH-->Injury to subarachnoid granulation
2) Meningitis
3) Congenital absence of arachnoid granulation
4) Choroid plexus papilloma (over-production of CSF)
100
In acquired perinatal HIE, when does the secondary injury occur?
6-72 hours post insult
101
What are the 4 inclusion criteria for cooling protocol?
1. Infants >= 36 weeks GA
2. Within first 6 hours of age
3. Evidence of intrapartum hypoxia (CPS criteria for cooling)
4. Moderate or severe encephalopathy
102
Name 5 complications of HIE
```
PPHN
Seizures
Secondary surfactant deficiency
Hypoglycemia
ICH
ATN
```
CNS: ICH, Seizures, Stroke, Cerebral Edema, Hypotonia/Hypertonia
CVS: Myocardial ischemia, Poor Contractility, Cardiac Stunning, Tricuspid Insufficiency, Hypotension, Bradycardia, Cyanosis/Pallor
RESP: PTHN, Pulmonary Hemorrhage, RDS
RENAL: ATN, Cortical Necrosis
ADRENAL: Hemorrhage
GI: Perforation, Ulceration with Hemorrhage, Necrosis
METABOLIC: SIADH, Hyponatremia, Hypoglycemia, Hypocalcemia, Myoglobinuria
SKIN: Subcutaneous Fat Necrosis
HEME: DIC
103
What is the neurodevelopmental outcome in mild, moderate, severe HIE?
Mild-usually none
Moderate-30-50%
Severe-80%
104
Between what gestational ages are premature babies at most risk for IVH?
23-32 weeks GA
105
When should the first head ultrasound be done?
Within first 72 hours
106
Most cases of CP are related to event that occured before labour. T or F?
TRUE
107
What is the most specific indication?
Abnormal eye movements
108
Patient with CHF, seizures and hydrocephalus?
Vein of Galen
109
Child with brachial plexus injury. How long before if no change in exam is prognosis poor?
If incomplete recovery by 3-4 weeks, full recovery unlikely
110
What is the best way to assess neonatal heart rate?
Ausculatation NOT palpation of umbilicus
111
How much pressure should be given for PPV of term and preterms?
20-25 cm H20 in preterm
| 30-40 cm H2O in term
112
Under what gestational age should babies be placed under a polyethylene wrap + radiant heater?
< 28 weeks
113
If no resuscitation is required, how many minutes of delayed cord clamping should be done?
1 minute
114
Tube sizes
<1,000g, <28 weeks-2.5
1000-2000g, 28-34 weeks-3.0
2,000-3,000g, 34-38 weeks-3.0/3.5
Term-3.5/4.0
115
List one advantage and one disadvantage of T piece resuscitators
Advantage:
1. More consistent inflation pressures and PEEP than self-inflating bags or flow-inflating bags
2. Can deliver free flow
3. Can deliver 100% O2
Disadvantage:
Requires a compressed gas source
116
List one advantage and one disadvantage of self inflating bag
Advantage:
1. Does not need a compressed gas source
Disadvantage:
1. Concentration of oxygen is not consistent unless a reservoir is attached
2. Cannot deliver free flow oxygen
3. Cannot reliable deliver CPAP
117
List 5 signs of hypoglycemia
1. Jitteriness or tremors
2. Apathy
3. Episodes of cyanosis, convulsions, intermittent apneic spells or tachypnea
3 Weak or high-pitched cry
4. Limpness or lethargy
5. Difficulty in feeding
118
List 3 groups at high risk of neonatal hypoglycemia
```
SGA (weight <10th percentile)
LGA infants (weight >90th percentile)
IDMs
Preterm infants
Perinatal asphyxia
```
119
When is the physiologic nadir of blood glucose in neonates?
1-2 hours after birth
120
When should asymptomatic at-risk neonates have their first blood glucose check?
2 hours of age AFTER 1 effective feed
| breastfeed or 5-10 ml/kg formula
121
List 3 indications for IV D10W at TFI 80ml/kg/day as per CPS hypoglycemia protocol
<1.8 mmol/L at 2 h of age
<2.0 mmol/L after subsequent feeding
<2.6 mmol/L repeatedly despite subsequnt feeding
122
How many minutes after feeding should blood glucose be checked?
60 mins
| Unless <1.8, then check in 30 mins
123
At what GIR should you start considering endocrine/metabolic causes of hypoglycemia
If BG <2.6 at TFI 120 mL/kg/day of 12.5% = GIR 10.4 mg/kg/min
124
When should you stop screening in LGA?
12 hours of age
125
When should you stop screening in SGA?
Screen once or twice on the second day of life
Stop by 36 hours of age
126
List 3 causes of transient neonatal hyperinsulinism
```
Asphyxia
SGA
Prematurity
Maternal toxemia
Infant of diabetic mother
```
127
When does congenital hyperinsulinism typically present?
Birth to 18 months of age
128
What labs are consistent with hyperinsulinism?
```
Insulin > 2uU/mL
Low ketones (< 2.0mmol/L)
Low FFA (<1.5 mmol/L)
```
129
List 10 components in a critical blood sample during hypoglycemia
```
Blood glucose
Insulin
C-peptide
Cortisol
Growth hormone
Lactate
Venous blood gas
Free fatty acids
Total and free carnitine
Beta hydroxybutyrate
Ammonia
Pyruvate
Urine reducing susbtances and ketones
T4, TSH
IGFBP-1
```
130
What is the incidence of invasive infection in an initially well-appearing infant with a maternal history of fever or chorioamnionitis?
<2%
131
How long should you keep a baby with septic risk factors in hospital for observation?
24 hours
132
What is the cut off weight for LBW and VLBW?
LBW-2500g
| VLBW-1500g
133
List 5 causes of IUGR
Fetal-genetic, congenital infection, fetal strctural anomaly, multiple gestation
Placental-ischemic placental disease, gross placental abnormalities
Maternal-medical conditions, malnutrition, teratogens, assistive reproductive technologies
134
List 5 complications of IUGR in the neonate
Premature delivery
Perinatal asphyxia, which may be accompanied by meconium aspiration or persistent pulmonary hypertension
Impaired thermoregulation
Hypoglycemia
Polycythemia and hyperviscosity
Impaired immune function-neutropenia
Hypocalcemia
135
By what age do patients who are small for gestational age usually show catch up growth?
Most have postnatal catch-up growth to normalize their stature by 2 years of age
136
List 5 causes of polyhydramnios
```
Anencephaly, Hydrocephalus
TEF
Duodenal Atresia
Spina Bifida
Cleft Lip/Palate
CCAM, CDH
Neuromuscular diseases
Achondroplasia
KlipelFeil
Trisomy 18, 21
TORCH
Diabetes mellitus
Twin-twin transfusion (recipient)
Fetal hydrops - anemia, heart failure, non immune
Polyuric renal disease
Chylothorax
Teratoma
```
137
List 5 causes of oligohydramnios
```
AFV leak, ROM
IUGR
Fetal Anomalies
Twin to Twin Transfusion
Renal Agenesis (Potter)
Urethral Agenesis
Prune Belly Syndrome
Pulmonary hypoplasia
Amnion Nodosum
ACE-I
Intestinal pseudo-obstruction
```
138
List 5 risk factors for RDS
```
Maternal DM
Multiple gestation
Asphyxia
C/S delivery without labor
Precipitous delivery
Male
Europenea
LBW
```
139
List 3 protective factors for RDS
Heroin use
PIH
PROM
Antenatal steroids
140
List 2 interventions to prevent RDS
1. Avoid unnecessary early delivery
| 2. Give antenatal corticosteroids to moms between 24 and 34 wk GA likely to deliver within 1 wk
141
List 4 contraindications to indomethacin
```
Thrombocytopenia
Bleeding d/o
Oliguria <1 mL/kg/hr
↑ Cr
NEC
Isolated intestinal perforation
```
142
List 3 characteristics of RDS on CXR
Diffuse reticulogranular appearance
Air bronchograms
Reduced lung volume/low FRC
143
List 3 causes of secondary surfactant deficiency
MAS
Pneumonia
Pulmonary hemorrhage (albumin, meconium and blood inhibit surfactant function)
144
List 3 benefits of surfactant administration
↓ MORTALITY
↓ morbidity of RDS
↓pulmonary air leaks
↓ length of ventilatory support
↓ hospital stay
↓ cost of ICU treatment
↑likelihood of surviving WITHOUT BPD
Improving survival rather than incidence of BPD
↑ survival WITHOUT ADVERSE NEURO outcomes
145
List 3 risks of surfactant therapy
1. Short-term risks → bradycardia and hypoxemia (during instillation)/ blockage of ETT)
2. Risk of pulmonary hemorrhage (RR = 1.47) – BUT reduces mortality from pulm hemorrhage
3. Over-distention/hyperventilation with low C02 can occur (d/t ↑ compliance) if ventilation pressures/settings aren’t weaned within minutes (as volume increases you must decrease the pressure)
146
What is better: natural or synethetic surfacant? And why?
Natural surfactant!
```
↓ mortality
↓ oxygen needs
↓ need for ventilator support
↓ air leak
↑ survival without BPD
```
147
What is the dose of surfactant?
120 mg phospholipids/kg
148
If infants with RDS have persistent or recurrent O2 (FiO2 > 30%) and ventilator requirements in 72 hours what should you do?
Should have repeated dose as early as 2 hrs but usually 4-6hrs after initial dose of BLES
NO BENEFIT OF >3 doses
149
After giving surfactant, when should you try to wean from ventilator?
Try to RAPIDLY weanfrom ventilator to CPAP within 1 hour
150
List 3 indications for surfactant
Preterm:
Intubated infants with RDS
Intubated with RDS before transport
Preterms on non-invasive with FiO2>50%
Term:
MAS requiring >50% 02
If sick newborn with pneumonia and OI >15 (= FiO2*MAP / PaO2)
Intubated with pulmonary hemorrhage leading to clinical deterioration
151
List 3 pathophysiologic causes of BPD
Alveolar collapse (atelectotrauma) due to surfactant deficiency
Ventilator-induced overdistention (volutrauma)
Oxygen free radicals; cannot be metabolized by immature antioxidant systems of VLBW
152
Name 2 groups at high risk of developing BPD
BW <1,000 g
| <28 wk GA
153
When can you make the diagnosis of BPD?
Oxygen requirement at 36
weeks postmenstrual
age (PMA)+ respiratory symptoms + CXR abnormalities
154
What are the benefits of postnatal steroids for BPD?
May ↓ time to extubation
| May ↓ risk of BPD
155
List 3 risks of postnatal steroids for BPD
```
HTN
Hyperglycemia
GI bleeding and perforation
Hypertrophic cardiomyopathy
Sepsis
Poor weight gain and head growth
Adrenal insufficiency
↑ risk DD and CP (but BPD itself is associated with these as well)
```
156
List 3 long term complications of BPD
1. Frequent hospitalization
2. Increased risk of RAD, PHTN, more severe infections
3. Poorer neurodevelopment
157
List 3 risk factors for esophageal atresia
```
Advanced maternal age
European ethnicity
Obesity
Low SES
Smoking
```
158
What % of patients with esophageal atresia have an associated syndrome?
50% syndromic (usually VACTERL)
159
How does EA present in neonates?
With ++ secretions/bubbling at the mouth and nose after birth
Coughing, cyanosis, and respiratory distress, exacerbated by feeding
160
How do you diagnose TEF/EA?
contrast esophagram
161
List 3 complications of repaired TEF/EA
Anastomotic leak
Stricture
GERD (from intrinsic abN of esophageal function)
RAD (often exacerbated by GER)
162
List 3 risk factors for TTN
```
Elective CS without labor
Prematurity or early term (37-38wk)
LGA
IDM
Twin
Male infant
Maternal asthma
```
163
Describe 3 CXR findings in TTN
Prominent pulmonary vascular markings
| Fluid in the intralobar fissures
164
List 3 risk factors for MAS in patients with meconium-staineed amniotic fluid
```
Thick MSAF
NRFHR
Low apgar at 5 min
Instrumental delivery
Emergent C/S
Planned home delivery
```
165
List 3 CXR findings consistent with MAS
Patchy infiltrates
Coarse streaking of lung fields
Hyperinflation +/- air leaks
166
List 4 risk factors for PPHN in a neonate
```
Birth asphyxia
MAS
Pneumonia
Pulmonary hypoplasia
RDS
Polycythemia
Maternal use of NSAIDS with in utero constriction of DA
Maternal late trimester use of SSRI
```
167
What is a significant pre/post ductal sat difference?
Gradient between preductal and a postductal ABG >20 mmHg
OR
Oxygenation saturation gradient >5% suggests R--L shunting through the PDA
168
List 4 interventions to treat PPHN
1. Optimizing oxygenation (PaO2) and ventilation
- Intubate ventilate
2. Sedate if desats with handling/stimulation
3. Correct acidosis
4. Optimize cardiac function and maintain systemic perfusion with inotropes PRN
5. Reduce PVR (iNO if available)
169
Should you give narcan to an apneic neonate if mother is a heroin addict?
NO
| Do not give Narcan to infants of mothers on methadone/heroin-will induce seizures
170
List 4 ways how meconium aspiration affects lungs
1. Mechanical obstruction of airways (ball-valve effect)
2. Chemical pneumonitis and inflammation
3. Risk of secondary Infection (e.g. GN)
4. Inactivation & decreased endogenous production of surfactant
5. Ventilation-perfusion mismatch
6. Pulmonary vasoconstriction/PPHN
171
When does apnea of prematurity typically resolve?
36 weeks
Some infants, especially those born ≤28 wks GA, may have persistent apneas at 37-40 wks GA - control of breathing matures in almost all infants by 44 weeks
172
List 5 clinical features of SSRI neonatal behavioural syndrome
CNS dysregulation (irritability, excess or restless sleep)
Motor dysregulation (agitation, tremor, hyperreflexia, rigidity, hypotonia or hypertonia)
Autonomic dysregulation (hypothermia or hyperthermia, hypoglycemia)
Respiratory symptoms (nasal congestion, respiratory distress, tachypnea)
GI symptoms (diarrhea, emesis, poor feeding)
173
What is the timeframe of SSRI neonatal behavioural syndrome?
Most infants present within several hours, have mild symptoms that resolve within 2 wk
174
What percentage of SSRI exposed infants get SSRI neonatal behavioural syndrome?
10-30%
175
What would you recommend to a mother taking paroxetine during pregnancy?
Consider switching them to another antidepressant or ↓ing dose
176
How long should you observe SSRI-exposed infants?
Babies with late-trimester SSRI exposure should be observed minimum of 48 h
177
List 3 effects of maternal depression on the infant
Insecure attachment
Negative affect
Dysregulated attention and arousal.
178
What areas of the brain are typically affected in kernicterus?
Basal ganglia
| Brainstem
179
Describe the clinical features of Chronic Bilirubin Encephalopathy
Athetoid CP +/- Seizures
Upward gaze paresis
SNHL
Dental enamel dysplasia
180
List 5 risk factors for severe hyperbilirubinemia
* Prematurity
* Infection
* Infant of Diabetic Mother
* ABO Incompatability
* Hemolytic Disease (e.g. G6PD)
* Hx of sibling receiving phototherapy
* Exclusive breastfeeding
* East-Asian
* Male
181
What is the cutoff for severe hyperbilirubinemia?
TSB > 340 micromol/L during first 28 days of life
182
Which infants with hyperbilirubinemia should get G6PD screens?
In at-risk infants (Mediterranean, Middle Eastern, African, Southeast Asian)
In all infants with severe hyperbili
183
Which infants with hyperbilirubinemia should get intensive phototherapy?
1. Infants with severe hyperbili
| 2. Those at greatly elevated risk of developing severe hyperbili
184
Which infants with hyperbilirubinemia should get conventional phototherapy?
TSB concentrations 35-50 µmol/L lower than threshold
185
Which infants with hyperbilirubinemia should get IVIg?
Infants who are DAT+ who have predicted severe disease based on antenatal investigation or high risk of needing exchange
186
Which infants with hyperbilirubinemia should get supplemental fluids (po or IV)?
Infants receiving phototherapy who are at an elevated risk of progressing to exchange transfusion
187
List 2 indications for exchange transfusion in hyperbilirubinemia
1. TSB above exchange threshold
| 2. Acute bilirubin encephalopathy
188
List 5 causes of unconjugated hyperbilirubinemia in the neonate
Isoimmune Hemolytic:
• ABO incompatibility
• Rh incompatibility
• Other group
```
Non-immune Hemolytic:
• Hereditary spherocytosis/elliptocytosis
• G6PD
• PK Deficiency
• Thalassemia
```
Polycythemia
Hypothyroidism
Cephalohematoma
Crigler Najjar or Gilbert Syndrome
Breastfeeding Jaundice
Breast milk Jaundice
189
How long does breastmilk jaundice last?
4-12 weeks
190
After phototherapy, when should you typically recheck bili?
6 hours
191
4 important questions to ask on history in a neonate with jaundice
1. ABO Incompatibility/ Was DAT done?
2. Did jaundice start in first 24 hrs?
3. Assess for hydration status: What’s their weight (% weight loss from birth weight) and method of feeding?
4. Previous sib with severe hyperbili??
192
When does physiologic anemia happen in preterms and term babies?
8-12 wk in term infants
| 4-8 wk in premature infants (as low as Hb 80)
193
What is the Kleihauer-Betke test?
Detects fetal Hb and RBCs in maternal blood
| Main diagnostic test used for detection and quantitation of fetomaternal hemorrhage
194
List the 2 most common causes of hemolytic disease (erythroblastosis fetalis)
1. ABO incompatibility (most common, mild, usually only jaundice)
2. RhD incompatibility
195
Explain the physiology of RhD hemolytic disease
When Rh-negative woman are exposed to Rh-positive fetal blood (abruption, trauma during pregnancy, spontaneous or induced abortion or at delivery) antibody formation against D antigen may be induced
196
List 3 indicators of significant Rh hemolytic disease based on titers during pregnancy
1. Elevated antibody titers at the beginning of pregnancy
2. A rapid rise in titer
3. Titer > 1:64
197
Describe the clinical features of Rh hemolytic disease
```
Pallor
HSM
Cardiomegaly
Hydrops fetalis
Petechiae, purpura, DIC
Hypoglycemia
Death in utero
```
198
What test is the best indicator of the severity of Rh hemolytic disease?
Cord hemoglobin
199
List the steps in the management of Rh hemolytic disease
- Intrauterine transfusions
- pRBCs ready at delivery (O -ve, leukoreduced, and irradiated blood)
-IVIG → given early, can reduce hemolysis, peak MBR and need for exchange Tx
-
-Measure Hb, Hct, and serum bilirubin q 4-6 hr intervals
- Photherapy
- Exchange Transfusion → if at risk of severe anemia or jaundice
200
When is Rhogam given?
28-32 weeks GA and at birth
201
List 3 complications of exchange transfusion
NEC
Thrombosis
Bradycardia
Infection (CMV, HIV, hepatitis)
202
Why do neonates receive leukoreduced, irradiated blood?
Irradiated-reduce risk of GVHD
| Leukoreduced-reduce risk of CMV
203
When does classic HDNB typically present and what is it caused by?
Within 1st week
- No vitamin K prophylaxis
- Exclusive breastfed
204
When does early-onset HDNB typically present and what is it caused by?
<24 hours
-Maternal medications (eg, warfarin, antibiotics; cephalosporins, anticonvulsants: phenobarb and phenytoin)
205
When does late onset HDNB typically present and what is it caused by?
3 weeks and 8 months of age
- No vitamin K prophylaxis/only one oral dose
- Exclusive breast feeding
- Malabsorption vit K (CF, liver disease)
206
Which types of HDNB typically present with ICH?
Early onset
Late onset
Classic-usually GI bleedig, skin bruising, bleeding post circumcision
207
What is the dose of vit K prophylaxis?
0. 5 mg (BW < 1500 g)
1. 0 mg (BW> 1500 g)
WITHIN FIRST 6 hours!
208
What is the dose and schedule of po vitamin K prophylaxis?
2.0 mg vitamin K1 at the time of the first feeding
Repeat at 2-4 weeks and 6-8 weeks of age
Still have increased risk of HDNB
209
What tests can you order in HDNB?
INR/PTT (both elevated in severe vit K deficeincy)
210
What is the difference between maternal ITP and NAIT?
NAIT-mom normal platelets, higher risk of hemorrhage
211
How do you treat NAIT?
If plt <20 in term or <50 in preterm
1. Washed maternal platelets
2. PLA-1 negative platelet transfusion
212
How do you treat maternal ITP?
IVIg
213
What is the definition of polycythemia?
Central Hct >65%
214
List 3 risk factors for polycythemia
```
High altitudes
Post-dates
SGA
Recipient infant of TTTS
Delayed cord clamping
Infants of diabetic mothers
Trisomy 13, 18, or 21
Neonatal Graves disease or hypothyroidism
Beckwith-Wiedemann syndrome
```
215
List 5 severe complications of polycythemia
```
Seizures
Stroke
Pulmonary hypertension
Necrotizing enterocolitis
Renal vein thrombosis
Renal failure
```
216
When should you consider partial exchange transfusion for polycythemia?
Hct >0.70
OR
Symptomatic and Hct>0.65
217
What pain management techniques are recommended for minor procedures? (CPS)
Sucrose + non pharmacologic (nonnutritive sucking, kangaroo care, facilitated tuck, swaddling and developmental care)
218
When should topical anesthetics be used in neonates? (CPS)
Venipuncture
Lumbar puncture
IV insertion
219
What type of pain medication should be used for post-op analgesia? (CPS)
Opioids
| Tylenol as adjunct (>28 weeks)
220
What pain management for chest drain insertion/removal? (CPS)
Local anesthetic
| Fentanyl
221
What pain management for eye exams? (CPS)
Oral sucrose
| Local anesthetic eye drops
222
List 4 pain management strategies for neonate getting an IV (CPS)
Oral sucrose
Non-nutritive sucking
Swaddling
Topical anesthetic
223
When should immunizations be given to prems?
According to chronologic age
224
When should rotavirus be given to prems?
After discharge from NICU
| At least 6 weeks of age (less than 15 weeks)
225
What is fetal PaO2?
25-30
226
List 4 risk factors for brachial plexus injury
Shoulder dystocia
LGA
IDM
Instrumental delivery
227
Brachial plexus injury counseling
PBPP is not always preventable.
75% of infants recover completely within the first month of life.
25% experience permanent impairment and disability.
If persistent deficits at 1month old →refer to multi-D brachial plexus team (neurologists and/or physiatrists, rehabilitation therapists and plastic surgeons)
Decisions re: conservative vs. surgical correction and prediction of prognosis based on history, electrodiagnostic procedures, diagnostic imaging and physical examination by the multidisciplinary team. (since no RCTs)
228
What investigation do you need to do for a patient with suspected Klumpke's (with Horner's)?
MRI spine
| NCS
229
Who to screen for ROP and when?
≤ 30+6 wks (regardless of BW) OR
BW of ≤ 1250g
Screen at 31 weeks PMA or 9 weeks CA if GA ≤ 26+6; screen at 4 weeks CA if GA ≥ 27 wks
230
What is newborn visual acuity?
20/400
231
Risk factors for NEC in term babies
```
Birth asphyxia
T21
CHD
Rotavirus infx
Hirschprungs
```
232
What is the biggest risk factor for NEC?
Prematurity
233
When does NEC typically present?
Usually week 2-3 of life, but can be up until 3mo in VLBW
234
Management of NEC
NPO, NG insertion for decompression, IV fluids
Triple Abx (Amp+gent+flagyl) (after culture drawn)
Monitor resp status and for electrolyte, acid/base balance, DIC
Remove UV/UA if present
Serial AXR to detect perf
235
List 3 surgical indications for NEC
- Perforation
- Failure of medical management
- Single fixed bowel loop on Xray
236
List 3 post op complications of NEC
Intestinal strictures
Short bowel syndrome
Cholestatic jaundice (TPN related)
Neurodevelopmental impairment
237
List 3 ways of preventing NEC
Exclusive breast feeding
Slow increase in feeding volumes in VLBW infants
Probiotics (need more evidence if <1000g)
238
What % of choanal atresia patients have CHARGE?
10-20%
239
What is a diagnostic clue to choanal atresia?
Cyanosis worse with feeding
| Better with crying
240
How do you diagnose choanal atresia?
Inability to pass a firm catheter through each nostril 3-4 cm into the nasopharynx
241
How do you treat choanal atresia?
Feed with McGovern nipple
NG feeds if unilateral until airway established
If bilateral- intubation or tracheotomy may be indicated
Surgical correction
242
Risk factors for subcutaneous fat necrosis
Preeclampsia
Birth trauma
Prolonged hypothermia
243
When does subcutaneous fat necrosis first appear?
More likely in first 4weeks in full term/post term infants
244
What is the natural history of subcutaneous fat necrosis?
Weeks to months
245
What is one blood test you should check for in subcutaneous fat necrosis?
Calcium
246
What is the most accurate assessment of GA?
U/S at 8 and 14 weeks’ GA
| EFWs tend to underestimate
247
When should short term tocolysis be used?
To facilitate In-utero transfer to Level 3 and time for ANCS
248
What is the purpose of MgSO4?
Fetal neuroprotection. Give until 32 weeks
249
List 4 adverse neurodevelopmental outcomes in preterms
Cerebral palsy
Cognitive impairment (test score ≥ 2SD below mean)
Seizures
Blindness and/or deafness
Behavioural difficulties (e.g. ADHD), language delays, health issues and hospital readmissions
250
List 5 factors that effect preterm outcome
GA***strongest effect
Birth at a tertiary perinatal centre
ANCS therapy
Female sex
Multiplicity
251
Can patients with anancephaly donate their organs?
NO
Because of uncetainty surrounding establishment of brain death
CAN donate tissue/stem cells
252
How do you neonatal seizures typically present?
Transient eye deviations, nystagmus, blinking
Mouthing
Abnormal extremity movements (rowing, swimming, bicycling, pedaling, stepping)
Fluctuations in HR, HTN episodes, and apnea
Clonic, tonic, myoclonic, spasms
253
List 10 causes of neonatal seziures
```
HIE
ICH
Ischemic stroke
Intracranial infections (e.g. HSV)
Brain malformations
Metabolic disturbances (hypoCa, hypoNa, pyridoxine)
Drug withdrawal
Epilepsy syndromes (benign idioatphic neonatal seizures, benign familial neonatal seizures)
```
254
What etiology should you consider in neonate where GTCs began in utero?
Pyridoxine dependent seizures
255
List 5 poor prognostic signs in HIE
Initial pH <6.7
Apgars of 0-3 at 5 min, low Apgar at 20 min
High base deficit (>20-25 mmol/L)
Decerebrate posture
Lack of spontaneous activity
Absence of spontaneous respirations at 20 min
Persistence of abnormal neurologic signs at 2 weeks of age
• Severe MRI and EEG abnormalities
256
List 4 risk factors for IVH
```
Prematurity
RDS
HIE
Hypotension/Hypertension
Reperfusion injury of damaged vessels
Increased or decreased cerebral blood flow
Reduced vascular integrity
Increased venous pressure
Pneumothorax
Thrombocytopenia
Hypervolemia
```
257
List 3 preventative interventions for IVH
Antenatal steroids
Post-natal prophylactic indomethacin
Delayed cord clamping
Judicious use of operative delivery (minimize traumatic IVH)
258
What % of IVH is diagnosed within 1st day of life? 3rd day of life?
1st day-50%
| 3rd day-75%
259
When does PVL first appear on imaging?
May be present at birth but usually occurs later as an early echodense phase (DOL 3-10), followed by echolucent (cystic) phase (DOL 14-20)
260
Who should be screened for IVH and when?
<32 weeks GA
| 1st HUS at DOL 3-7
261
If initial HUS is normal, when should there be a repeat HUS?
36-40 weeks to evaluate for PVL, because cystic changes related to perinatal injury may not be visible for at least 2-4 weeks
262
Ddx of neonatal hydrocephalus
Non-communicating
- Syndromic (trisomies 13, 18, 9, and 9p, as well as triploidy )
- Vein of Galen malformation
- Posterior fossa lesions → Chiari, Dandy-Walker, tumours
- X-linked hydrocephalus (mostly aqueductal stenosis)
- Chiari 2
- Tumour
- Arachnoid cyst
- Neurofibromatosis
- Metabolic disease (e.g. Hurlers, achondroplasia)
Communicating
- IVH
- SAH
- Meningitis
- Intrauterine infection
- Choroid plexus papilloma
263
List 3 alternative diagnoses other than hydrocephalus for large heads
Thickened cranium from chronic anemia, rickets, osteogenesis imperfecta, epiphyseal dysplasia
Chronic subdural collections
Metabolic and degenerative disorders of the CNS
Neurofibromatosis
Familial megalencephaly
264
List 4 steps in the initial management of CDH
```
Avoid bag mask ventilation
Intubate
Insert large bore NG
Minimize ventilation pressures: PIP <25 cm
Pre-ductal sat >85%
Sedation: minimize risk of pneumothorax
```
265
How do you calculate GIR?
E.g. Glucose intake for D10W at 60 mL/kg/day
•To calculate in mg/kg/min convert time units
•100 mg/mL x 60 mL/kg/d ÷ 24 h per day ÷ 60 min per
hour
=4.2 mg/kg/min
266
List 3 reasons for physiologic jaundice
Immaturity of liver enzymes
Increased bilirubin load
(shorter half-life of RBCs,
relative polycythemia)
Increased entero-hepatic
circulation
267
List 10 differentials for neonatal thrombocytopenia
Unwell
- NEC
- Sepsis
- DIC
- HIE
Dysmorphic
- IUGR
- TORCH
- Trisomy
- TAR
Nondysmorphic
- NAIT
- Maternal ITP
- PIH
- Thrombus
- Viral infection
- Polycythemia
- Vascular (Kasabach Merrit)
268
Listt 5 causes of anemia in neonates
```
Anemia of prematurity
Parvovirus B19
Diamond Blackfan
Hypothyroidism
Adrenal insufficiency
Hemolysis
Abruption
Feto-maternal hemorrhage
Intracranial hemorrhage
TTTS
Phlebetomy
```
269
List 5 signs of a bleeding disorder in a neonate
Oozing from umbilical stump
Excessive bleeding from PIV/heel stick sites
Large caput succedaneum and cephalohematomas without significant trauma
Prolonged bleeding following circumcision
Intracranial hemorrhage in a late
preterm/term infant
270
List 5 risk factors for invasive GBS early onset sepsis
* Over 18 h rupture of membranes
* Maternal fever > 38°C
* Premature labour at less than 36 weeks
* GBS bacteriuria at anytime during pregnancy
* Previous child with invasive GBS disease
271
List 5 features of prune belly syndrome (Eagle Barrett Syndrome)
Cryptoorchidism
Deficiency of abdominal wall musculature
Genitourinary abnormalities
272
When do you stop ROP screening?
Complete vascularization
Zone III vascularization without previous Zone I or Zone II ROP
PMA of 45 weeks and no pre-threshold disease
Regression of ROP
273
Discharage criteria for late preterm
Discharge no earlier than 48 hours
Stable vitals: respiratory rate < 60 and heart rate between 100-160
Maintain temperature 36.5 C to 37.4 C in open crib
Demonstrate coordinated suck, swallow, and breathing while feeding
If infant is breast fed, trained health care professionals should observe and document the position, latch and milk transfer
Weight loss should not exceed >10% of birth weight
Absence of medical illness
At least one stool passed spontaneously
274
List 3 benefits of delayed cord clamping in preterms
Decreased need for transfusions
Lower risk of IVH
Lower risk of NEC
275
List 3 benefits of delayed cord clamping in term infants
Higher Hgb concentrations in early (but not subsequent assessments)
Improved iron stores
Disadvantage: Higher need for phototherapy for Jaundice
276
When does erythema toxicum resolve?
5-7 days
277
How fast should you rewarm in therapeutic hypothermia?
0.5°C every 2 -4 h
| If worsening of encephalopathy or seizures occurs, infants may require recooling
278
List 2 ways of achieving brain hypothermia in HIE
(A) Selective head cooling with mild systemic hypothermia
(B)Total body cooling ***used more frequently
279
What initial PIP and PEEP should be provided in NRP?
PIP 20-25
| PEEP 5 for preterms
280
List 3 causes of sudden deterioration after intubation of neonate
```
DOPE
D-displaced tube
O-Obstructed tube
P-PTX
E-equipment failure
```
281
After how many seconds of chest compressions using 100% O2 should you reassess HR?
60 s
| If still <60, give epi
282
3 ways to keep a preterm warm in a resuscitation
- Room temperature 23-25 degrees Celsius
- Plastic wrap or bag
- Thermal mattress and hat
283
What does the CPS recommend re: postnatal steroids for BPD?
For patients at high risk of developing CLD, clinicians can consider low dose dex tapered over 7-10 days
DO NOT recommend high dose dex, steroids within first 7 days, low dose dex on assisted ventilation after 7 days
284
What is appropriate premedication for intubation for neonates (CPS)?
1. Vagolytic
- Atropine or glycopyrrolate
2. Analgesia
- Fentanyl (rapid onset, no effect on respiratory mechanics, short duration of action, good sedation, reliable PK)
3. Muscle relaxant
- Succinylcholine (rapid onset, short duration of action)
285
How do you treat chest wall rigidity from fentanyl?
Prevention: give it slowly
Treatment: muscle relaxant or naloxone
