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NICU Flashcards

1
Q

What tests are in first trimester screening?

A

Nuchal Translucency
PAPP-A
Beta-HCG

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2
Q

What tests are in second trimester screening?

A

MSAFP
Beta-HCG
Unconjugated estriol
Inhibin-A

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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)

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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
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5
Q

What is NIPT?

A

Measures cell free fetal DNA in maternal blood

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6
Q

What does NIPT screen for?

A

Aneuploidy ONLY

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7
Q

When can chorionic villous sampling be performed?

A

10-13 weeks GA

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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
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9
Q

What disease cannot be ruled in CVS?

A

ONTDs

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10
Q

When can amniocentesis be performed?

A

15-20 weeks

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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
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12
Q

Name 4 neonatal/postnatal effects of cigarette smoking

A 
Growth restriction
Preterm labour
Premature ROM
Placental abruption
SIDS
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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
  1. 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).
  2. Neurological abnormalities:
    Developmental delay, behavioural, LD, brain malformations
  3. Confirmed or unconfirmed prenatal alcohol exposure
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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

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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

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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
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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

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18
Q

Name 6 features of maternal lithium use during pregnancy

A 
Ebstein anomaly
Fetal goitre
Hypotonia
Arrhythmia
Seizures
Diabetes insipidus
Preterm birth
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19
Q

Name 3 features of maternal phenobarbital use during pregnancy

A

Cleft lip/palate

Cardiac anomalies

Hemorrhagic disease of the newborn

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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

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21
Q

Name 3 features of maternal warfarin use during pregnancy

A

Optic nerve atrophy

Nasal hypoplasia

Stippled bone epiphyses

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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
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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
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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

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25
Q

Name 8 fetal and neonatal affects of maternal diabetes

A

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)

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26
Q

Do the majority of babies born to mothers have neonatal lupus?

A

NO, only 1-2%

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27
Q

Is it possible for healthy mothers to give birth to a baby with neonatal lupus?

A

YES, 50% of affected babies have healthy mothers

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28
Q

Name 5 features of neonatal lupus

A

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)

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29
Q

What is the only permanent sequel of neonatal lupus?

A

Heart block

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30
Q

Name 10 aetiologies of IUGR

A

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

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31
Q

List 5 neonatal effects of SGA

A 
Hypoglycemia
Hyperglycemia
Hypocalcemia
Depressed immune function
Hypothermia
Risk of perinatal asphyxia
Polycythemia (with concomitant neutropenia and thrombocytopenia)
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32
Q

What is the definition of twin twin transfusion?

A

Discrepancy in amniotic fluid volume (NOT weight discordance or Hb)

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33
Q

Does twin twin transfusion happen more commonly in MC/DA or MC/MA pregnancies?

A

MC/DA

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34
Q

List 5 management options for TTTS?

A
  • Expectant management
  • Amnioreduction
  • Septostomy
  • Selective feticide
  • Fetoscopic laser ablation of vascular anastomoses-inc risk of preterm labour
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35
Q

What non-invasive prenatal screening results are suggestive of trisomy 21?

A

Low AFP
High BHCG
Low estradiol
High inhibin

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36
Q

What non-invasive prenatal screening results are suggestive of trisomy 18?

A 
Everything low!
Low AFP
Low BHCG
Low estradiol
Low inhibin
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37
Q

What non-invasive prenatal screening results are suggestive of trisomy 13?

A

Quad screen not sensitive

Antenatal ultrasounds more helpful

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38
Q

When can NIPT be done?

A

After 10 weeks GA

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39
Q

What is the advantage of umbilical artery sampling as an invasive prenatal test?

A

Quick results (within 24-48 hours)

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40
Q

With maternal history of methadone use, how long do you have to watch baby?

A

10 days

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41
Q

In TTTS, what does the recipient twin have?

A

Cardiac hypertrophy/myocardial dysfunction/tricuspid regurg/RVOTO
Polycythemia
Polyhdramnios
Increased risk of hydrops

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42
Q

In TTTS, what does the donor twin have?

A 
High output failure
Anemia
Oligohydramnios
Hypovolemia
Hypoglycemia
Increased risk of hydrops
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43
Q

How do you treat seizures in NAS?

A

Phenobarbitol

Use AED before morphine

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44
Q

What are two features of a non reassuring fetal heart rate tracing?

A 
Minimal variability (<5 bpm variation around baseline)
Late decelerations (uteroplacental insufficiency)
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45
Q

Name 7 causes of fetal tachycardia

A 
Fever (maternal)
Arrhythmia
Thyrotoxicosis
Infection (chorioamnionitis)
Medications (e.g. beta-agonists, parasympathetic blockers)
Anemia
Hypoxia/Fetal distress
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46
Q

What does a sinusoidal FHR tracing indicate?

A

Anemia

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47
Q

After how many seconds should PPV be initiated for an apneic newborn?

A

30s

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48
Q

If after initiating PPV HR still <100 after 15 seconds of effective PPV, what is the next step?

A 
M= mask readjustment
R= Reposition airway
S= suction mouth and nose
O= open mouth
P= increase pressure
A= consider alternate airway
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49
Q

If HR<60 despite 30s of effective PPV what is the next step?

A

Intubate (recommended before chest compressions in 7th ed NRP)
Chest compressions

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50
Q

What is the IV dose of epinephrine?

A

0.1-0.3 mL/kg

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51
Q

What is the ETT dose of epinephrine?

A

0.5 ml/kg

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52
Q

What are the target SO2 recommendations?

A 
1 min 60-65%
2 min 65-70%
3 min 70-75%
4 min 75-80%
5 min 80-85%
10 mins 85-95%
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53
Q

Name the 3 determinants of the need for resuscitation

A

Term, breathing/crying, good tone

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54
Q

What is the most sensitive indicator of the efficacy of resuscitation?

A

Increase in HR

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55
Q

At what FiO2 should you start resuscitation in newborns <35 weeks?

A

21-30%

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56
Q

Name 4 factors other than gestational age that result in favourable outcomes

A

Female sex
Antenatal steroids
Appropriate EFW
Singleton pregnancy

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57
Q

What are the survival rates for 23, 24 and 25 weeks GA?

A
  • 23 weeks: 36%
  • 24 weeks 62%
  • 25 weeks 78%
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58
Q

Name 5 risk factors for birth injury

A 
Macrosomia
Maternal obesity
Abnormal fetal presentation
Operative vaginal delivery (Vacuum/Forceps)
Cesareandelivery
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59
Q

What is appropriate monitoring for a neonate with subgaleal hemorrhage?

A

Vitals
Serial HC
Serial Hb

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60
Q

What percentage of patients with brachial plexus injury have residual defects?

A

20-30% with residual deficits, especially if incomplete recovery by 3-4 weeks

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61
Q

Name 4 situations where non-initiation of resuscitation is appropriate

A

Confirmed GA <23 weeks
BW <400g
Anencephaly
Confirmed T13 or T18

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62
Q

Above what gestational age is resuscitation nearly always indicated

A

GA>25 weeks

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63
Q

When should you consider stopping resuscitation?

A

After 10 minutes if no HR remains detectable

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64
Q

What are the CPS counselling recommendations for 22, 23-24 and 25 weeks GA?

A

22 week-non-interventional approach
23-24 week-individualized
25-active treatment, except with significant risk factors

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65
Q

Below what gestational age is C/S discouraged UNLESS for maternal indications?

A

<25 weeks

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66
Q

For what gestational ages should antenatal steroids be given?

A

All pregnant women between 22 and 34 weeks’ gestation who are at risk of preterm delivery within 7 days (NEW CPS)

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67
Q

What do antenatal steroids reduce the risk of?

A

↓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

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68
Q

Name two appropriate antenatal steroid regimens

A
  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

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69
Q

What is the difference between caput succudenum, cephalohematoma and sugaleal hemorrhage on exam?

A

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

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70
Q

What percentage of neonates blood can be lost in the subgaleal space?

A

20-40%

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71
Q

If there is no recovery by 3 mo or persistent weakness by 5 mo from brachial plexus injury, what intervention is needed?

A

Suspect rupture of nerve root

Surgical exploration and grafting
MRI may be ordered pre-op to rule out structural anomalies

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72
Q

Name 4 injuries associated with brachial plexus injury

A

Clavicular fracture
Humeral fracture
Subluxation of c-spine
Facial palsy

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73
Q

In a neonate with brachial plexus injury and no improvement after 4 weeks, what should you do?

A

Refer to multidisciplinary team ( (neurologists and/orphysiatrists, rehabilitation therapists and plastic surgeons)

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74
Q

In baby born with hornet’s syndrome, what nerves are likely to have be injured at birth?

A

T1

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75
Q

What nerves are affected in Erb’s palsy and what is the clinical presentation?

A 
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***
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76
Q

What nerves are affected in Klumpkes palsy and what is the clinical presentation?

A

C7, C8, T1

Isolated hand paralysis and Horner Syndrome

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77
Q

Which brachial plexus injury is most likely associated with horner’s syndrome

A

Klumpkes

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78
Q

Which type of brachial palsy is most commonly associated with phrenic nerve injury?

A

Erb’s palsy

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79
Q

What is the treatment for phrenic nerve injury?

A
  • 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
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80
Q

What is the prognosis for total brachial plexus injury (C5-T1) with phrenic nerve involvement?

A

Symptoms may be chronic and require surgery

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81
Q

What is the goal temperature in therapeutic hypothermia?

A

A rectal temperature of 34±0.5°C

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82
Q

When do you start and stop therapeutic hypothermia

A

Start at age 6 hours

Continue x 72 hours

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83
Q

Name 4 mechanisms by which therapeutic hypothermia works

A

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

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84
Q

List the criteria for therapeutic hypothermia:

A

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

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85
Q

Review Sarnat staging

A

http://www.cps.ca/documents/position/hypothermia-for-newborns-with-hypoxic-ischemic-encephalopathy

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86
Q

What benefit has therapeutic hypothermia been shown to have?

A

Reduce risk of death/neurodevelopmental impairment at 18-24 months disability

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87
Q

Name 2 complications of therapeutic hypothermia

A 
Bradycardia
Hypotension
Arrhythmias
Thrombocytopenia
Edema
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88
Q

Name 4 contraindications to cooling

A 
Severe head trauma
Intracranial bleeding
>6 hours of age
<36 weeks GA
Lethal congenital anomalies
PHTN/Oxygenation failure (should fix first)
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89
Q

Name 3 pathophysiologic mechanisms that contribute to IVH

A

Immature capillaries in sub-ependymal germinal matrix
Hemodynamic instability in first few days of life
Inability to auto-regulate cerebral blood flow

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90
Q

Name 3 preventive measures that have been shown to reduce IVH

A

Antenatal steroids

Post-natal prophylactic indomethacin

Delayed cord clamping

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91
Q

When are the majority of IVHs apparent?

A

90% within the first week (80% within 3 days)

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92
Q

Name 3 complications of IVH

A

Post-hemorrhagic hydrocephalus

Periventricular hemorrhagic infarction

Periventricular leukomalacia

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93
Q

What type of cerebral palsy does PVL cause?

A

Spastic diplegia

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94
Q

Name 10 aetiologies for neonatal seziures

A 
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
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95
Q

What investigations would you order for neonatal seizures?

A

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

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96
Q

Name 6 differentials for neonatal hypotonia

A

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)
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97
Q

Name 3 risk factors for neural tube defects

A

Lack of maternal folate
Diabetes
Medications (e.g. VPA)

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98
Q

Name 4 external signs of spinal dysraphism

A
  • Dimple
  • Sinus tract
  • Hemangiomas/Lipomas
  • Hair tuft
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99
Q

Name 10 conditions that cause hydrocephalus in a neonate

A

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)

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100
Q

In acquired perinatal HIE, when does the secondary injury occur?

A

6-72 hours post insult

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101
Q

What are the 4 inclusion criteria for cooling protocol?

A
  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
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102
Q

Name 5 complications of HIE

A 
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

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103
Q

What is the neurodevelopmental outcome in mild, moderate, severe HIE?

A

Mild-usually none
Moderate-30-50%
Severe-80%

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104
Q

Between what gestational ages are premature babies at most risk for IVH?

A

23-32 weeks GA

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105
Q

When should the first head ultrasound be done?

A

Within first 72 hours

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106
Q

Most cases of CP are related to event that occured before labour. T or F?

A

TRUE

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107
Q

What is the most specific indication?

A

Abnormal eye movements

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108
Q

Patient with CHF, seizures and hydrocephalus?

A

Vein of Galen

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109
Q

Child with brachial plexus injury. How long before if no change in exam is prognosis poor?

A

If incomplete recovery by 3-4 weeks, full recovery unlikely

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110
Q

What is the best way to assess neonatal heart rate?

A

Ausculatation NOT palpation of umbilicus

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111
Q

How much pressure should be given for PPV of term and preterms?

A

20-25 cm H20 in preterm

30-40 cm H2O in term

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112
Q

Under what gestational age should babies be placed under a polyethylene wrap + radiant heater?

A

< 28 weeks

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113
Q

If no resuscitation is required, how many minutes of delayed cord clamping should be done?

A

1 minute

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114
Q

Tube sizes

A

<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

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115
Q

List one advantage and one disadvantage of T piece resuscitators

A

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
Q

List one advantage and one disadvantage of self inflating bag

A

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
Q

List 5 signs of hypoglycemia

A
  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
Q

List 3 groups at high risk of neonatal hypoglycemia

A 
SGA (weight <10th percentile)
LGA infants (weight >90th percentile)
IDMs
Preterm infants
Perinatal asphyxia
119
Q

When is the physiologic nadir of blood glucose in neonates?

A

1-2 hours after birth

120
Q

When should asymptomatic at-risk neonates have their first blood glucose check?

A

2 hours of age AFTER 1 effective feed

breastfeed or 5-10 ml/kg formula

121
Q

List 3 indications for IV D10W at TFI 80ml/kg/day as per CPS hypoglycemia protocol

A

<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
Q

How many minutes after feeding should blood glucose be checked?

A

60 mins

Unless <1.8, then check in 30 mins

123
Q

At what GIR should you start considering endocrine/metabolic causes of hypoglycemia

A

If BG <2.6 at TFI 120 mL/kg/day of 12.5% = GIR 10.4 mg/kg/min

124
Q

When should you stop screening in LGA?

A

12 hours of age

125
Q

When should you stop screening in SGA?

A

Screen once or twice on the second day of life

Stop by 36 hours of age

126
Q

List 3 causes of transient neonatal hyperinsulinism

A 
Asphyxia
SGA
Prematurity
Maternal toxemia
Infant of diabetic mother
127
Q

When does congenital hyperinsulinism typically present?

A

Birth to 18 months of age

128
Q

What labs are consistent with hyperinsulinism?

A 
Insulin > 2uU/mL
Low ketones (< 2.0mmol/L)
Low FFA (<1.5 mmol/L)
129
Q

List 10 components in a critical blood sample during hypoglycemia

A 
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
Q

What is the incidence of invasive infection in an initially well-appearing infant with a maternal history of fever or chorioamnionitis?

131
Q

How long should you keep a baby with septic risk factors in hospital for observation?

132
Q

What is the cut off weight for LBW and VLBW?

A

LBW-2500g

VLBW-1500g

133
Q

List 5 causes of IUGR

A

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
Q

List 5 complications of IUGR in the neonate

A

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
Q

By what age do patients who are small for gestational age usually show catch up growth?

A

Most have postnatal catch-up growth to normalize their stature by 2 years of age

136
Q

List 5 causes of polyhydramnios

A 
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
Q

List 5 causes of oligohydramnios

A 
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
Q

List 5 risk factors for RDS

A 
Maternal DM
Multiple gestation
Asphyxia
C/S delivery without labor
Precipitous delivery
Male
Europenea
LBW
139
Q

List 3 protective factors for RDS

A

Heroin use
PIH
PROM
Antenatal steroids

140
Q

List 2 interventions to prevent RDS

A
  1. Avoid unnecessary early delivery

2. Give antenatal corticosteroids to moms between 24 and 34 wk GA likely to deliver within 1 wk

141
Q

List 4 contraindications to indomethacin

A 
Thrombocytopenia
Bleeding d/o
Oliguria <1 mL/kg/hr
↑ Cr
NEC
Isolated intestinal perforation
142
Q

List 3 characteristics of RDS on CXR

A

Diffuse reticulogranular appearance
Air bronchograms
Reduced lung volume/low FRC

143
Q

List 3 causes of secondary surfactant deficiency

A

MAS
Pneumonia
Pulmonary hemorrhage (albumin, meconium and blood inhibit surfactant function)

144
Q

List 3 benefits of surfactant administration

A

↓ 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
Q

List 3 risks of surfactant therapy

A
  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
Q

What is better: natural or synethetic surfacant? And why?

A

Natural surfactant!

↓ mortality
↓ oxygen needs
↓ need for ventilator support
↓ air leak
↑ survival without BPD
147
Q

What is the dose of surfactant?

A

120 mg phospholipids/kg

148
Q

If infants with RDS have persistent or recurrent O2 (FiO2 > 30%) and ventilator requirements in 72 hours what should you do?

A

Should have repeated dose as early as 2 hrs but usually 4-6hrs after initial dose of BLES

NO BENEFIT OF >3 doses

149
Q

After giving surfactant, when should you try to wean from ventilator?

A

Try to RAPIDLY weanfrom ventilator to CPAP within 1 hour

150
Q

List 3 indications for surfactant

A

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
Q

List 3 pathophysiologic causes of BPD

A

Alveolar collapse (atelectotrauma) due to surfactant deficiency

Ventilator-induced overdistention (volutrauma)

Oxygen free radicals; cannot be metabolized by immature antioxidant systems of VLBW

152
Q

Name 2 groups at high risk of developing BPD

A

BW <1,000 g

<28 wk GA

153
Q

When can you make the diagnosis of BPD?

A

Oxygen requirement at 36
weeks postmenstrual
age (PMA)+ respiratory symptoms + CXR abnormalities

154
Q

What are the benefits of postnatal steroids for BPD?

A

May ↓ time to extubation

May ↓ risk of BPD

155
Q

List 3 risks of postnatal steroids for BPD

A 
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
Q

List 3 long term complications of BPD

A
  1. Frequent hospitalization
  2. Increased risk of RAD, PHTN, more severe infections
  3. Poorer neurodevelopment
157
Q

List 3 risk factors for esophageal atresia

A 
Advanced maternal age
European ethnicity
Obesity
Low SES
Smoking
158
Q

What % of patients with esophageal atresia have an associated syndrome?

A

50% syndromic (usually VACTERL)

159
Q

How does EA present in neonates?

A

With ++ secretions/bubbling at the mouth and nose after birth
Coughing, cyanosis, and respiratory distress, exacerbated by feeding

160
Q

How do you diagnose TEF/EA?

A

contrast esophagram

161
Q

List 3 complications of repaired TEF/EA

A

Anastomotic leak
Stricture
GERD (from intrinsic abN of esophageal function)
RAD (often exacerbated by GER)

162
Q

List 3 risk factors for TTN

A 
Elective CS without labor
Prematurity or early term (37-38wk)
LGA
IDM
Twin
Male infant
Maternal asthma
163
Q

Describe 3 CXR findings in TTN

A

Prominent pulmonary vascular markings

Fluid in the intralobar fissures

164
Q

List 3 risk factors for MAS in patients with meconium-staineed amniotic fluid

A 
Thick MSAF
NRFHR
Low apgar at 5 min
Instrumental delivery
Emergent C/S
Planned home delivery
165
Q

List 3 CXR findings consistent with MAS

A

Patchy infiltrates
Coarse streaking of lung fields
Hyperinflation +/- air leaks

166
Q

List 4 risk factors for PPHN in a neonate

A 
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
Q

What is a significant pre/post ductal sat difference?

A

Gradient between preductal and a postductal ABG >20 mmHg
OR
Oxygenation saturation gradient >5% suggests R–L shunting through the PDA

168
Q

List 4 interventions to treat PPHN

A
  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
Q

Should you give narcan to an apneic neonate if mother is a heroin addict?

A

NO

Do not give Narcan to infants of mothers on methadone/heroin-will induce seizures

170
Q

List 4 ways how meconium aspiration affects lungs

A
  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
Q

When does apnea of prematurity typically resolve?

A

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
Q

List 5 clinical features of SSRI neonatal behavioural syndrome

A

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
Q

What is the timeframe of SSRI neonatal behavioural syndrome?

A

Most infants present within several hours, have mild symptoms that resolve within 2 wk

174
Q

What percentage of SSRI exposed infants get SSRI neonatal behavioural syndrome?

175
Q

What would you recommend to a mother taking paroxetine during pregnancy?

A

Consider switching them to another antidepressant or ↓ing dose

176
Q

How long should you observe SSRI-exposed infants?

A

Babies with late-trimester SSRI exposure should be observed minimum of 48 h

177
Q

List 3 effects of maternal depression on the infant

A

Insecure attachment
Negative affect
Dysregulated attention and arousal.

178
Q

What areas of the brain are typically affected in kernicterus?

A

Basal ganglia

Brainstem

179
Q

Describe the clinical features of Chronic Bilirubin Encephalopathy

A

Athetoid CP +/- Seizures
Upward gaze paresis
SNHL
Dental enamel dysplasia

180
Q

List 5 risk factors for severe hyperbilirubinemia

A
  • Prematurity
  • Infection
  • Infant of Diabetic Mother
  • ABO Incompatability
  • Hemolytic Disease (e.g. G6PD)
  • Hx of sibling receiving phototherapy
  • Exclusive breastfeeding
  • East-Asian
  • Male
181
Q

What is the cutoff for severe hyperbilirubinemia?

A

TSB > 340 micromol/L during first 28 days of life

182
Q

Which infants with hyperbilirubinemia should get G6PD screens?

A

In at-risk infants (Mediterranean, Middle Eastern, African, Southeast Asian)

In all infants with severe hyperbili

183
Q

Which infants with hyperbilirubinemia should get intensive phototherapy?

A
  1. Infants with severe hyperbili

2. Those at greatly elevated risk of developing severe hyperbili

184
Q

Which infants with hyperbilirubinemia should get conventional phototherapy?

A

TSB concentrations 35-50 µmol/L lower than threshold

185
Q

Which infants with hyperbilirubinemia should get IVIg?

A

Infants who are DAT+ who have predicted severe disease based on antenatal investigation or high risk of needing exchange

186
Q

Which infants with hyperbilirubinemia should get supplemental fluids (po or IV)?

A

Infants receiving phototherapy who are at an elevated risk of progressing to exchange transfusion

187
Q

List 2 indications for exchange transfusion in hyperbilirubinemia

A
  1. TSB above exchange threshold

2. Acute bilirubin encephalopathy

188
Q

List 5 causes of unconjugated hyperbilirubinemia in the neonate

A

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
Q

How long does breastmilk jaundice last?

A

4-12 weeks

190
Q

After phototherapy, when should you typically recheck bili?

191
Q

4 important questions to ask on history in a neonate with jaundice

A
  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
Q

When does physiologic anemia happen in preterms and term babies?

A

8-12 wk in term infants

4-8 wk in premature infants (as low as Hb 80)

193
Q

What is the Kleihauer-Betke test?

A

Detects fetal Hb and RBCs in maternal blood

Main diagnostic test used for detection and quantitation of fetomaternal hemorrhage

194
Q

List the 2 most common causes of hemolytic disease (erythroblastosis fetalis)

A
  1. ABO incompatibility (most common, mild, usually only jaundice)
  2. RhD incompatibility
195
Q

Explain the physiology of RhD hemolytic disease

A

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
Q

List 3 indicators of significant Rh hemolytic disease based on titers during pregnancy

A
  1. Elevated antibody titers at the beginning of pregnancy
  2. A rapid rise in titer
  3. Titer > 1:64
197
Q

Describe the clinical features of Rh hemolytic disease

A 
Pallor 
HSM
Cardiomegaly
Hydrops fetalis
Petechiae, purpura, DIC
Hypoglycemia
Death in utero
198
Q

What test is the best indicator of the severity of Rh hemolytic disease?

A

Cord hemoglobin

199
Q

List the steps in the management of Rh hemolytic disease

A
  • 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
Q

When is Rhogam given?

A

28-32 weeks GA and at birth

201
Q

List 3 complications of exchange transfusion

A

NEC
Thrombosis
Bradycardia
Infection (CMV, HIV, hepatitis)

202
Q

Why do neonates receive leukoreduced, irradiated blood?

A

Irradiated-reduce risk of GVHD

Leukoreduced-reduce risk of CMV

203
Q

When does classic HDNB typically present and what is it caused by?

A

Within 1st week

  • No vitamin K prophylaxis
  • Exclusive breastfed
204
Q

When does early-onset HDNB typically present and what is it caused by?

A

<24 hours

-Maternal medications (eg, warfarin, antibiotics; cephalosporins, anticonvulsants: phenobarb and phenytoin)

205
Q

When does late onset HDNB typically present and what is it caused by?

A

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
Q

Which types of HDNB typically present with ICH?

A

Early onset
Late onset

Classic-usually GI bleedig, skin bruising, bleeding post circumcision

207
Q

What is the dose of vit K prophylaxis?

A
  1. 5 mg (BW < 1500 g)
  2. 0 mg (BW> 1500 g)

WITHIN FIRST 6 hours!

208
Q

What is the dose and schedule of po vitamin K prophylaxis?

A

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
Q

What tests can you order in HDNB?

A

INR/PTT (both elevated in severe vit K deficeincy)

210
Q

What is the difference between maternal ITP and NAIT?

A

NAIT-mom normal platelets, higher risk of hemorrhage

211
Q

How do you treat NAIT?

A

If plt <20 in term or <50 in preterm

  1. Washed maternal platelets
  2. PLA-1 negative platelet transfusion
212
Q

How do you treat maternal ITP?

213
Q

What is the definition of polycythemia?

A

Central Hct >65%

214
Q

List 3 risk factors for polycythemia

A 
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
Q

List 5 severe complications of polycythemia

A 
Seizures
Stroke
Pulmonary hypertension
Necrotizing enterocolitis
Renal vein thrombosis
Renal failure
216
Q

When should you consider partial exchange transfusion for polycythemia?

A

Hct >0.70
OR
Symptomatic and Hct>0.65

217
Q

What pain management techniques are recommended for minor procedures? (CPS)

A

Sucrose + non pharmacologic (nonnutritive sucking, kangaroo care, facilitated tuck, swaddling and developmental care)

218
Q

When should topical anesthetics be used in neonates? (CPS)

A

Venipuncture
Lumbar puncture
IV insertion

219
Q

What type of pain medication should be used for post-op analgesia? (CPS)

A

Opioids

Tylenol as adjunct (>28 weeks)

220
Q

What pain management for chest drain insertion/removal? (CPS)

A

Local anesthetic

Fentanyl

221
Q

What pain management for eye exams? (CPS)

A

Oral sucrose

Local anesthetic eye drops

222
Q

List 4 pain management strategies for neonate getting an IV (CPS)

A

Oral sucrose
Non-nutritive sucking
Swaddling
Topical anesthetic

223
Q

When should immunizations be given to prems?

A

According to chronologic age

224
Q

When should rotavirus be given to prems?

A

After discharge from NICU

At least 6 weeks of age (less than 15 weeks)

225
Q

What is fetal PaO2?

226
Q

List 4 risk factors for brachial plexus injury

A

Shoulder dystocia
LGA
IDM
Instrumental delivery

227
Q

Brachial plexus injury counseling

A

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
Q

What investigation do you need to do for a patient with suspected Klumpke’s (with Horner’s)?

A

MRI spine

NCS

229
Q

Who to screen for ROP and when?

A

≤ 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
Q

What is newborn visual acuity?

231
Q

Risk factors for NEC in term babies

A 
Birth asphyxia
T21
CHD
Rotavirus infx
Hirschprungs
232
Q

What is the biggest risk factor for NEC?

A

Prematurity

233
Q

When does NEC typically present?

A

Usually week 2-3 of life, but can be up until 3mo in VLBW

234
Q

Management of NEC

A

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
Q

List 3 surgical indications for NEC

A
  • Perforation
  • Failure of medical management
  • Single fixed bowel loop on Xray
236
Q

List 3 post op complications of NEC

A

Intestinal strictures
Short bowel syndrome
Cholestatic jaundice (TPN related)
Neurodevelopmental impairment

237
Q

List 3 ways of preventing NEC

A

Exclusive breast feeding

Slow increase in feeding volumes in VLBW infants

Probiotics (need more evidence if <1000g)

238
Q

What % of choanal atresia patients have CHARGE?

239
Q

What is a diagnostic clue to choanal atresia?

A

Cyanosis worse with feeding

Better with crying

240
Q

How do you diagnose choanal atresia?

A

Inability to pass a firm catheter through each nostril 3-4 cm into the nasopharynx

241
Q

How do you treat choanal atresia?

A

Feed with McGovern nipple

NG feeds if unilateral until airway established

If bilateral- intubation or tracheotomy may be indicated

Surgical correction

242
Q

Risk factors for subcutaneous fat necrosis

A

Preeclampsia
Birth trauma
Prolonged hypothermia

243
Q

When does subcutaneous fat necrosis first appear?

A

More likely in first 4weeks in full term/post term infants

244
Q

What is the natural history of subcutaneous fat necrosis?

A

Weeks to months

245
Q

What is one blood test you should check for in subcutaneous fat necrosis?

246
Q

What is the most accurate assessment of GA?

A

U/S at 8 and 14 weeks’ GA

EFWs tend to underestimate

247
Q

When should short term tocolysis be used?

A

To facilitate In-utero transfer to Level 3 and time for ANCS

248
Q

What is the purpose of MgSO4?

A

Fetal neuroprotection. Give until 32 weeks

249
Q

List 4 adverse neurodevelopmental outcomes in preterms

A

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
Q

List 5 factors that effect preterm outcome

A

GA***strongest effect

Birth at a tertiary perinatal centre

ANCS therapy

Female sex

Multiplicity

251
Q

Can patients with anancephaly donate their organs?

A

NO
Because of uncetainty surrounding establishment of brain death
CAN donate tissue/stem cells

252
Q

How do you neonatal seizures typically present?

A

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
Q

List 10 causes of neonatal seziures

A 
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
Q

What etiology should you consider in neonate where GTCs began in utero?

A

Pyridoxine dependent seizures

255
Q

List 5 poor prognostic signs in HIE

A

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
Q

List 4 risk factors for IVH

A 
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
Q

List 3 preventative interventions for IVH

A

Antenatal steroids
Post-natal prophylactic indomethacin
Delayed cord clamping
Judicious use of operative delivery (minimize traumatic IVH)

258
Q

What % of IVH is diagnosed within 1st day of life? 3rd day of life?

A

1st day-50%

3rd day-75%

259
Q

When does PVL first appear on imaging?

A

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
Q

Who should be screened for IVH and when?

A

<32 weeks GA

1st HUS at DOL 3-7

261
Q

If initial HUS is normal, when should there be a repeat HUS?

A

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
Q

Ddx of neonatal hydrocephalus

A

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
Q

List 3 alternative diagnoses other than hydrocephalus for large heads

A

Thickened cranium from chronic anemia, rickets, osteogenesis imperfecta, epiphyseal dysplasia
Chronic subdural collections
Metabolic and degenerative disorders of the CNS
Neurofibromatosis
Familial megalencephaly

264
Q

List 4 steps in the initial management of CDH

A 
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
Q

How do you calculate GIR?

A

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
Q

List 3 reasons for physiologic jaundice

A

Immaturity of liver enzymes

Increased bilirubin load
(shorter half-life of RBCs,
relative polycythemia)

Increased entero-hepatic
circulation

267
Q

List 10 differentials for neonatal thrombocytopenia

A

Unwell

  • NEC
  • Sepsis
  • DIC
  • HIE

Dysmorphic

  • IUGR
  • TORCH
  • Trisomy
  • TAR

Nondysmorphic

  • NAIT
  • Maternal ITP
  • PIH
  • Thrombus
  • Viral infection
  • Polycythemia
  • Vascular (Kasabach Merrit)
268
Q

Listt 5 causes of anemia in neonates

A 
Anemia of prematurity
Parvovirus B19
Diamond Blackfan
Hypothyroidism
Adrenal insufficiency
Hemolysis
Abruption
Feto-maternal hemorrhage
Intracranial hemorrhage
TTTS
Phlebetomy
269
Q

List 5 signs of a bleeding disorder in a neonate

A

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
Q

List 5 risk factors for invasive GBS early onset sepsis

A
  • 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
Q

List 5 features of prune belly syndrome (Eagle Barrett Syndrome)

A

Cryptoorchidism
Deficiency of abdominal wall musculature
Genitourinary abnormalities

272
Q

When do you stop ROP screening?

A

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
Q

Discharage criteria for late preterm

A

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
Q

List 3 benefits of delayed cord clamping in preterms

A

Decreased need for transfusions

Lower risk of IVH

Lower risk of NEC

275
Q

List 3 benefits of delayed cord clamping in term infants

A

Higher Hgb concentrations in early (but not subsequent assessments)

Improved iron stores

Disadvantage: Higher need for phototherapy for Jaundice

276
Q

When does erythema toxicum resolve?

277
Q

How fast should you rewarm in therapeutic hypothermia?

A

0.5°C every 2 -4 h

If worsening of encephalopathy or seizures occurs, infants may require recooling

278
Q

List 2 ways of achieving brain hypothermia in HIE

A

(A) Selective head cooling with mild systemic hypothermia

(B)Total body cooling ***used more frequently

279
Q

What initial PIP and PEEP should be provided in NRP?

A

PIP 20-25

PEEP 5 for preterms

280
Q

List 3 causes of sudden deterioration after intubation of neonate

A 
DOPE
D-displaced tube
O-Obstructed tube
P-PTX
E-equipment failure
281
Q

After how many seconds of chest compressions using 100% O2 should you reassess HR?

A

60 s

If still <60, give epi

282
Q

3 ways to keep a preterm warm in a resuscitation

A
  • Room temperature 23-25 degrees Celsius
    • Plastic wrap or bag
    • Thermal mattress and hat
283
Q

What does the CPS recommend re: postnatal steroids for BPD?

A

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
Q

What is appropriate premedication for intubation for neonates (CPS)?

A
  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
Q

How do you treat chest wall rigidity from fentanyl?

A

Prevention: give it slowly
Treatment: muscle relaxant or naloxone

FRCPC (27 decks)

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