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Clin 3 > NICU > Flashcards

NICU Flashcards

1
Q

What are the 5 possible causes of prematurity?

A
  1. socio-economic factors
  2. gynaecological
  3. fetal
  4. multiple pregnancies
  5. complications during pregnancy
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2
Q

What are the 2 main classifications?

A
  1. Weeks
    Extreme preterm: <29 weeks
    Late preterm: 34-37 weeks
2. Birthweight
extremely low birth weight: <1000g
very low birth weight: <1001-1500g
low birth weight: 1501-2500g
normal: >2500g
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3
Q

What are the 3 subclasses of birth weight classification?

A

SGA: small for gestational age (under 10% percentile)
AGA: appropriate for gestational age (between 10% and 90%)
LGA: large for gestational age (over 90%)

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4
Q

What are the 2 types of IUGR (another type of classification)?

A
  1. Symmetrical (everything is less than 10% percentile)

2. Asymmetrical (better - only weight is below the 10%percentile)

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5
Q

What are 3 facts about the fenton curve?

A
  1. Gender specific chart
  2. Starts at 22 weeks gestation until 50 weeks corrected gestational age
  3. Equivalent to the WHO curve at 50 weeks CGA
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6
Q

How do you calculate CGA?

A

GA + (chronological age/7) = CGA

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7
Q

What are the nutritional screening criteria to identify infants at a highest nutritional risk at <1 week, 1-2 weeks, >2 weeks, >2 months?

A

<1 week

  • > 15% weight loss from birth weight
  • <1kg at birth

1-2 weeks
- <70kcal/kg/d or any continued weight loss

> 2 weeks

  • intake <80%
  • <15 g/kg/d weight gain
  • <1/2 expected weight gain
  • prealbumin < 8mg/dl
  • BUN < 7mg/dl
  • serum phosphorus <4mg/dl and alk phos >600

> 2 months
- same as prvious + no sourcce of iron - continued TPN

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8
Q

What are the 7 factors that affect nutritional status?

A
  1. gastrointestinal immaturity
  2. thermoregulation
  3. GI and respiration
  4. respiration
  5. medical issues
  6. decreased absorption of nutrients
  7. decreased reserves
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9
Q

What are the 7 things to look for at the initial nutritional assessment?

A
  1. Maternal history
  2. Infant (apgar score, gender, levels of prematurity, CGA, days of life, etc)
  3. Medications (caffeine, antibiotics)
  4. Physical
  5. GI
  6. Biochemical
  7. Clinical signs
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10
Q

What are the indications for PN?

A
  1. Congenital GI anomalies requiring surgical repair
  2. Impaired GI motility
  3. Malabsorption syndromes
  4. Delayed initiation or advancement of enteral feeds
  5. Functional immaturity of GI tract or gestational age at birth <30-32 weeks
  6. NEC
  7. Impaired GI perfusion that decreases GI motility
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11
Q

What are the requirements for PN?

A

Fluids: 60-90 to 120-150 ml/kg/d
Trophamine: 1.5-2 to 3.5-4 g/kg/d
Dextrose: 5-10 to 10-18 g/kg/d
Lipids: 0.5-1 to 3 g/kg/d

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12
Q

What are the indications for EN?

A

All infants unable to met nutritional requirements orally

  • premature infants <34 weeks
  • transition from PN towards oral intake
  • poor suck/swallow breathe coordination
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13
Q

What are the contraindications for EN?

A

Severe respiratory distress/syndrome
GI anomalies
NEC

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14
Q

Which delivery method is better for EN?

A

Bolus -> mimics the actual feeding better

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15
Q

What are the 7 benefits of breast milk?

A
  1. optimal distribution of calories
  2. immune factors, hormones, enzymes
  3. decreased gastric transit time
  4. better absorption of nutrients
  5. lower renal solute load
  6. protection from NEC
  7. long term effects
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16
Q

What is OIT and what is it used for?

A

Oral immune therapy: oral care with colostrum, it is used to stimulate the immune system - put VERY little amount of formula in the baby’s mouth (0.1ml every 4h)

17
Q

What is the usual volume of trophic feeds?

A

10-24 ml/kg/d

18
Q

Is the fluid intake restricted or not at first?

A

Yes, it is restricted at first to allow for post natal diuresis of the extra fluids, but it is then increased to 135-200 ml/kg/d

Use 150ml/kg/d

19
Q

What is the energy requirements for premmies?

A

120 kcal/kg/d

20
Q

What are the 4 common supplementation given to premmies?

A
  • iron
  • calcium
  • phosphorus
  • vit D
21
Q

What are the indications for the fortification of breastmilk?

A 
infants < 34w
<1500g
on TPN for > 2w
>1500g at birth with suboptimal growth
>1500 at birth with limited ability to tolerate increased volume
22
Q

What is the safe volume to start fortifying beast milk?

A

80-120ml/lg/d

23
Q

What is the desirable growth velocity? (weight, length and HC)

A

weight: 15-20 g/kg/d
length: 0.9-1cm/week
HC: 0.5-0.9cm/week

24
Q

What is the order of things that catch up first?

A

Weight, HC and then length

Clin 3 (12 decks)

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