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2019 RC Specialties > NICU > Flashcards

NICU Flashcards

1
Q

Which require surfactant:

  • any newborn being transferred
  • 29 infant with no symp being transferred
  • critically ill w/ 3 doses in first 18 h
  • infant w/ RDS intubated and need 50% after 72hr
A

Intubated infant with RDS before transplant (not well infant)

More than 3 doses= no benefit

No evidence for use after > 72 hr

THUS: 29 infant transfer

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2
Q

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

  • 1 mo.
  • 3 mo.
  • 9 mo.
  • 1 year
A

3 month

Erb’s: C5-C7= waiter’s tip

Klumpke’s: C8-T1= forearm and hand flexed

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3
Q

Term baby. Born via forceps. 1 month vomit, lethargic, red plaque on back of hand. Check:

  • Glucose
  • Ca
  • K
  • Alk-Phos
  • Cr
A

Calcium

Due to Subcutaneous fat necrosis

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4
Q

Child with meningomyelocele. What do you say for next preg:

  • folic acid prior and till 12 wk GA
  • US at 16 wk
  • amnio at 16 wk
  • alpha-fetoprotein at 16wk
A

Folic acid prior to conception and then till 12 week GA.

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5
Q

List three Back P/E findings that indicate you must US:

A
  1. Subcutaneous mass or lipoma
  2. Hairy patch
  3. Dermal sinus
  4. Vascular lesion (hemangioma, telangiectasia)
  5. Skin appendage (skin tag, tail-like)
  6. Atypical dimple (deep, > 5mm, > 25mm from anal verge)
  7. Scar-like lesion
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6
Q

T or F: VPA causes NTD in 1-2 % of pregnancies.

A

True

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7
Q

TORCH. cataract. HSM. bony change. Dx?

A

Rubella… blue!

  • IUGR
  • microcephaly
  • cataract
  • congenital glaucoma
  • PDA, PPS
  • hearing loss
  • HSM
  • radiolucent bone dx
  • dermal erythropoiesis (blueberry muffin)
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8
Q

Mom with early latent syphilis. RPR titter dropped 8 X. What do you do with BB now born?

A

Adequate response to tx = 4X drop (1:32 to 1:8)
= still check BB serology at 0, 3,6, 18 month
If BB 4X drop or < mom then can just watch and no other W/U.

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9
Q

T or F: child at any age if absent Hep C antibodies= no need to re-test to R/O vertical transmission.

A

True.

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10
Q

Hep B (+) mom. BB born. What do you do?

A
  • HBIG asap (<12h)
  • Vaccine at birth, 1 mo, 6 mo.
  • post immunization testing (HBsAG and anti-HBS) after last vaccine to ensure not affected.
    @ 9 month + 18 mo. if positive.
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11
Q

What is the Klehauer betke test?

A

(+) if fetal blood in maternal circulation

i.e. fetomaternal hemorrhage

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12
Q

Complete heart block. Thrombocytopenia. Mildly elevated liver enzyme. Dx in bb?

A

Neonatal Lupus

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13
Q

Mass on scalp of newborn that crosses suture lines. Mother took phenytoin and child delivered via vacuum. What is it? 2 reasons this kid has it?

A

R/O caput versus subgaleal

Caput Succedaneum
= cross suture line versus cephalohematoma over one area of bone
Reason: instrumentation during delivery

In utero Phenytoin
- link to coag defect
= Subgaleal Hemm

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14
Q

TORCH:

  • snuffles + skeletal + rash
  • chorio, hydrocephalus, Ca
  • Blueberry + Cataracts + Hearing + Radiolucent bone dx
  • Periventricular ca + low plt + HSM
A

Snuffles + Skeletal = Syphilis= The S’s

Toxo= Big Cat/ C’s

Rubella= Blue Eyes, Ear, Heart, Bones

CMV= Draw the Face with Crown

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15
Q

T or F: Cr at birth= Mother Cr.

A

True.

  • decline in first 1-2 wk to nadir and then stable throughout 1st year of life
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16
Q

Fetal pO2 usually:

A

30-35 mmHg

Umbilical venous pO2

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17
Q

Incidence of asymptomatic PFO in adults:

A

10-25%

Exam: 10%

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18
Q

1 month old with vesicle on upper lip:

  • sucking blister
  • HSV
  • varicela
  • epidermolysis bullosa
A

**Sucking Blister

Sucking Blister= superficial bulallae at birth on upper limb from sucking in utero

  • usually forearm, thumb, index finger
  • resolve without sequelae

Sucking Pad= callus on lip on first few month. Confirmed via observed neo sucking affected area. Lead to vesicle or bull that rupture.

Versus Neonatal HSV SEM (skin, eye, mouth)

  • discrete vesicles, multiple
  • usually near 1-2 wk of life
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19
Q

Recent extubation after course of systemic steroids. Likely AE:

  • low BP
  • low BG
  • leukopenia
  • hypertrophic cardiomyopathy
A

Hypertrophic Cardiomyopathy

Other AE:

  • high BG
  • HTN
  • GI bleed and perf (dex)
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20
Q

All normal in BB except:

  • transient cyanosis w/ feed
  • hypotonic after feed
  • irreg resp in sleep
A

Transient cyanosis w/ feed

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21
Q

What is our NRP rule with mec now?

A

Insufficient evidence to suggest routine intubation + suction in non-big infant born through mec.

Normal resus.
If mec obstructing airway intubation + suction identified.

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22
Q

List APGAR criteria:

A

Appearance

  • blue/ pale
  • body pink
  • all pink

Pulse

  • absent
  • <100
  • > 100

Grimace/ Irritability

  • flaccid
  • some flexion of limb
  • active (cough, pull away)

Activity/Tone

  • absent
  • arm + leg flex
  • active movement

Resp

  • absent
  • slow irregular
  • vigorous cry
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23
Q

Polyhydraminos. Resp distress. Lots of oral secretions. Likely? Test? Work up?

A

TEF/ Esophageal Atresia

Can’t pass NG tube

VACTERL (vertebral, anal atresia, cardiac, TEF, renal, limb)
- Echo, XR (hemivertebrae), AUS

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24
Q

What is the most common abnormality noted with TEF or EA?

A

Cardiac= 25%

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25
Q

List 2 things child is at risk for is neonatal persistent bradycardia?

A
  • Syncope
  • Very tired, irritable, dizzy
  • Cardiac arrest/death
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26
Q

T or F: esophageal atresia is associated with polyhydraminos.

A

True

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27
Q

List 3 aetiologies for polyhydraminos.

A

Syndromes

  • achondroplasia
  • klippel-feil
  • T18
  • T21
  • TORCH

Poor swallowing due to GI obstruction

  • esophageal, duodenal, intestinal atresia
  • TEF

Poor swallow due to neuromuscular

  • ancephaly
  • hydrocephaly
  • spina bifida

Poor swallow due to secondary obstruction
- obstruction to GI from massive dysplastic kidney

Increased urine production

  • high fetal CO (fetal anemia, fetal HF, hemolysis)
  • Bartter syndrome (polyuria, met alkalosis, low K)

Other

  • cystic adenomatoid lung malformation
  • diaphragmatic hernia
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28
Q

Expected survival for 25 wk?

A

75%

24 wk GA- 60%
23 wk GA- 40%
22 wk GA- 20%

Note: < 1% mortality if > 30 weeks.

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29
Q

T or F: palliative care is the accepted standard approach when < 23 wk GA.

A

False.

Accepted as standard if = or < 21 wk GA.

If 22-25+6 consult maternal fetal medicine specialist + transfer to tertiary HC centre.

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30
Q

Outcome in neo since surfactant started:

  • decreased mortality
  • decreased BPD
  • increased air leak
  • increased IVH
  • decreased PDA
A

Decreased mortality

EBM:

  • reduced air leak (pneumo) and mortality from RDS
  • reduces morbidity (oxygenation, pneumothorax, pul interstitial emphysema/ PIE, duration on vent support)
  • increases likelihood of surviving without BPD largely by improving survival rather than BPD incidence
    • Does NOT reduce INCIDENCE of CLD
    • NO effect on IVH, BPD, NEC, ROP
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31
Q

Newborn with copious oral secretion and resp distress. What is the most appropriate next test?

  • insert OG cath
  • CXR
  • abdo US
  • barium swallow
A

Insertion of orogastric catheter

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32
Q

When do you give surfactant to newborns?

A
  • Intubated w/ RDS
  • intubated w/ RDS should get it before transport
  • RDS + persistent vent in first 72h= repeated doses (as soon as 2h after)
  • Intubated + MAS + FiO2 > 50%
  • Intubated w/ pul hemm
  • Sick + OI > 15

** < 29 wk GA outside tertiary care consider immediate intubation and surfactant after stabilization.

** if significant risk RDS should get propyl. within few min. of intubation

**no benefit to giving more than 3 doses.

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33
Q

T or F: there is benefit in giving surfactant > 3 doses.

A

False.

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34
Q

T or F: neo intubated w/ RDS should get surfactant before transport.

A

True

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35
Q

T or F: babies born < 30 week should get prophylactic surfactant even if not intubated.

A

False.

Used to be. Now immediate CPAP is alternative.

Some in NRP recommend < 26 wk GA even if they’re well on CPAP.

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36
Q

PPHN post and pre-duct show what?

A

Right radial= Pre
Umbilical artery or other= Post
Difference min. 10%= signif.

PPHN= high PVR= extra pulmonary right to left shunting= hypoxemia

Pre duct > Post
DDX: PPHN, left heart (aortic arch hypoplasia, critical aor. stenosis, interrupted aor. arch)

If Post> Pre = DDX
- TGA with coA, TGA with super systemic pul vascular resistance

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37
Q

List 3 RF for PPHN:

A
  • Birth asphyxia
  • MAS
  • early onset sepsis
  • RDS
  • pulmonary hypoplasia (hernia, oligohydraminos, pleural effusion)
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38
Q

Provide 3 Tx options for PPHN:

A
  • Correct abN (low BG, high Hgb, low BP)
  • Improve O2
  • Intubate + Vent
  • Gentle Vent (normo or permissive hypercapnia)
  • Sedate
  • Inotrope (dopamine, milrinone)
  • iNO (vasodilator)
  • ECMO
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39
Q

Newborn. thin mec. Good APGAR. 12 hr increased WOB. Hyper inflated RUL with mediastinal shift. Likely dx?

  • MAS
  • Neonatal pneumonia
  • Cystic pul airway malformation (CPAM)
  • Congenital lobar emphysema
A

Congenital lobar emphysema

CPAM= WOB, large cyst, pneumo
Lobar emphysema= hyperinflation of one or more pul lobes.

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40
Q

List 4 ways meconium aspiration causes respiratory problems?

A
  1. Airway obstruction
    - complete or partial
  2. Surfactant
    - inactivation
    - decreased amount
  3. Inflam/ Irritation of lung parenchyma
  4. Infection
    - MSAF RF for bacterial infection of amniotic cavity
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41
Q

T or F: you can use ribavirin for routine use in RSV cases.

A

False.

  • May consider in potentially life-threatening RSV infection.
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42
Q

Newborn. 12 h. Sat increase bit with 100% O2. Mild tachypnea. Next initial management?

  • I+V
  • Prostaglandin
  • Abx
A

Prostaglandin

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43
Q

3 DOL. tachypnea. Cyanosis despite 100%. B/L crackles. Weak pulses. No murmur.

  1. HLHS
  2. Sepsis
  3. AV fistula
A

HLHS

  • cyanosis w/in 1st 48hr of life
  • as PDA close signs of poor perfusion
  • typically no murmur
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44
Q

3d infant cyanosis with crying. W/U:

  • ECG
  • CXR
  • ABG
  • BCX
  • Echo
A

Echo

Crying= increase R side pressure
= More R -> L shunt
= Cyanosis

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45
Q

Why are RF for unconjugated hyperbili?

A 
< 38 wk
Male
Asian or european
Bruising
Cephalohematoma
- visible < 24h
- visible pre d/c
- dehydration
- BF

Adv Mom > 35 y.o.
Sibling w/ severe hyperbili

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46
Q

Baby with direct bill. E coli. sepsis. Hepatomegaly. Which test:

  • RBC GALT f’n
  • G6PD
  • Osmotic fragility
  • RBC glucose-phosphate-1 deficiency
A

RBC GALT F’n

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47
Q

What is most common cause of conjugated hyperbili based on incidence?

  • BF
  • hemolysis ABO
  • neo hepatitis
  • galactosemia
A

Neonatal Hepatitis

Top common causes:

  • Biliary atresia
  • Metabolic
  • Neonatal Hepatitis
  • Inherited
  • Alpha 1 Antitrypsin
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48
Q

4 RF for kernicterus

A
  • prem
  • sepsis
  • bili leel
  • hemolytic dx, ABO
  • G6PD
  • asphyxia
  • lethargy
  • temp instable
  • resp distress
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49
Q

32 wk with 5 exchange transfusion. Now vomit, diarrhea, abdo distension. Likely:

  • sepsis
  • actue gastro
  • protein vein thrombosis
  • NEC
A

NEC

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50
Q

BB. Jittery. High T, HR, BP, RR. Flushed and eyes open. Normal tone. Jaundiced. DTR low. HSM. Dx?

A

Dx: congenital hyperthyroidism

Most common cause: trans-placental passage of TRS (thyroid stimulating hormone receptor antibody) Ab from mom w/ Graves dx

Classic: IUGR, restless, goitre, eye exophthalmic, high VS, HSM, jaundice

Tests: T4 + TSH

Tx: propanolol + methimazole

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51
Q

BW to see with IUGR baby:

A
  • low BG

- polycythemia

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52
Q

List two symmetric versus asymmetric causes of IUGR:

A

Symmetric

  • chromosomal
  • genetic
  • infectious/ TORCH
  • teratogenic

Asymmetric

  • pre-eclampsia
  • placental insuff
  • renal dx, DM, antiphospholipid syn
  • maternal malnutrition (severe)
  • if signif smoking T3 (if quit by T3 then similar BW as non-smoker)
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53
Q

Most likely cause of symmetric microcephalic IUGR.

  • maternal malnutrition
  • maternal smoking
  • maternal PIH
  • maternal infection
A

Maternal infection

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54
Q

What complications of asphyxia?

A

**Neuro: Sz, HIE, ischemic brain injury
Pul: RDS, PPHN
Cardiac: dysf’n
**GI: feeding intolerance, increased risk of NEC
**Renal: AKI
Metabolic: mito dysf’n
**Heme: low plt, high Hgb, coagulopathies

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55
Q

When do you offer Intrapartum Abx for unknown GBS:

A
  • preterm w/ imminent risk of delivery
  • preterm pre labour ROM
  • ROM > 18h
  • intrapartum fever 38+
56
Q

Newborn with axillary temp 37.8. Normal P/E. What to do?

  • full septic W/U
  • rectal temp
  • talk all clothes off x 20 min and recheck
  • CBC + diff
A

Rectal temp

Axillary: 36.5-37.4
Definitive= Rectal

57
Q

DOL9. Born 32 wk GA. Born to GBS (+) mom. BCX show gram (+) cocci in clusters. Likely:

  • GBS
  • Strep viridian’s
  • S. aureus
  • Coag. neg. staph
A

Coag. Neg Staph (Clusters)

Late onset = CONS

Gram positive cocci
> clusters= Staph (either coag. + like staph aureus versus (-) epidermis)

> pairs + Chains= Strep

  • group A beta lytic= s. pyogenes
  • group B beta lytic= s. agalactiae
  • Alpha= s. pneumoniae
  • Gamma= Enterococcus or non-enterococcus
58
Q

Galactosemia Dx?

A
  1. RBC galactose phosphate uradyl transferase deficiency
  2. DNA mutation in GALT gene

Other test: reducing substance in urine (+)

59
Q

What are maternal RF for early onset sepsis?

A
  • Intrapartum GBS colonization
  • GBS bacteriuria during current preg
  • Previous infant w/ invasive GBS dx
  • ROM min. 18h
  • Maternal fever (min. 38+)
60
Q

If BB at risk for sepsis and unwell. Next?

A
  • Investigate: CBC, BCX, LP, CXR

- IV ABX (amp + amino glycoside)

61
Q

If mother NOT GBS colonized or unknown but only 1 RF. Next step?

A

If adequate IAP: Routine care. D/c after 24h

If inadequate IAP: Observe with VS q 3-4h min. 24h

62
Q

If GBS unknown BUT multiple RF or maternal chorioamnionitis in BB who looks well? OR GBS (+) with RF (irregardless of Abx):

A
  • Individualize and tx
  • Observe min. VS q3-4h for min. 24h
  • Consider CBC after 4h
  • R/A and counsel after d/c
63
Q

List 3 signs off XR that suggest NEC

A

**- pneumatosis intestinalis
**- pneumoperitoneum
> Rigler sign (air on both sides of bowel)
> Football sign (air outlining the falciform ligament)
**- portal venous gas
- dilated bowel loops

64
Q

Late onset sepsis. 3 Bacteria responsible? Initial Abx tx?

A

Bugs:

  • coag. negative staphylococci
  • staph aureus (this is coag. (+))
  • E. coli
  • Group B Strep (GBS)

ABX: vanco (anti-staph/MRSA) + aminoglycoside

65
Q

How do you tx NEC?

A
  1. NPO
  2. NG to low intermittent suction
  3. IVF
  4. BCX
  5. Amp, Gent, Flagyl
  6. Serial XR
  7. +/- Gen Sx consult
66
Q

Neonate. Serum glucose 1.4 Next?

A

D10 W
TFI 80 cc/kg/day
= 5.5 mg glucose/kg/min

Indication: < 1.8 at 2h old or < 2 at subsequent checks

FINE IF: BG: > 2 @2h old or > 2.6 at subsequent check

67
Q

3 wk old with hypocalcemia. Most likely dx?

A

Transient hypoparathyroidism

  • natural fall last 3 wk in PTH
68
Q

Baby 6 day old. Shock. Low Glucose. Cardiomegaly on XR. Likely etiology:

  • cardiac
  • sepsis
  • endocrine
  • metabolic
A

Metabolic

  • *low BG w/ ++ heart key
    • if febrile think sepsis
69
Q
  1. 2 kg BB. seen at 2h= 1.9. Asymptomatic. Best initial management?
    - feed and recheck BS in 1 hr
    - IV Dextrose 4-6 mg/kg/h
    - IV D10W 2cc/kg then dextrose 4-6 mg/kg/h
    - Supplement BF w/ bottle and recheck BS
A

Feed and recheck in 1hr

At 2 hr= 1.8-2
OR later check 2-2.5

= Refeed and recheck glucose in 1 hour

If remains < 2.6 despite feed= IVF

70
Q

Infantile cystinosis. You get?

  • cataracts
  • ESRD
  • nephrocalcinosis
A

Nephrocalcinosis

Renal fanconi by 6 mo.
Usually corneal cysteine NOT glaucoma.
ESRD later ppt

71
Q

T or F: Infantile cardiomyopathy: muscle cell hypertrophy or deposition of lipid or glycogen.

A

True

72
Q

Rocker bottom think. Think of what dx?

A

Tri 18 (Eight= Edward’s)

  • Elongated skull
  • Digit overlap (clenched)
  • Warrior chest (shield)
  • Apnea
  • Rocker bottom feet
  • Dysplastic feet + IQ disability

Tri 13= Patau= All midline

  • cleft palate
  • dysplastic ear
  • polydactyly
  • undescended testes
73
Q

BB. jittery with BG 1.3. Repeat 0.8. IV order? Glucose requirement?

A

Order: 2-3cc/kg of D10W over 5 min.
Then D10W at TFI 80

GIR= 5.5 mg glucose/kg/minute

GIR= dextrose % x TFI/144

74
Q

CP etiology patterns:

  • spastic diplegia
  • hemiplegia
  • extrapyramidal
A

Spastic diplegia
= PVL

Hemiplegia
= periventricular venous infarct (stroke, cortical malformations)

Extrapyramidal
= birth asphyxia

75
Q

34 wk prem. Now 8 week of age. Occasional bradycardia. Likely cause?

  • apnea of prematurity
  • sz
  • RSV
  • IEM
A

Apnea of prematurity

76
Q

For the first 6 month how and where should BB sleep?

A
  • Sleep on Back
  • IN CRIB
  • IN PRENT ROOM

When can turn over don’t need to return them to back position

Do not use rolled up blanket, soft material (quilt, comforter, pillows)

77
Q

T or F: baby should sleep in parents room till 2 month old.

A

False.

sleep IN room till 6 month of age min.

78
Q

2 month old. Ex 32 weaker. Vent with UA/UV lines. Now HSM. Normal P/E otherwise. Likely cause:

  • hepatic hemangioma
  • portal vein thrombosis
  • hereditary spherocytosis
  • congenital CMV
  • fungal infection
A

Portal Vein Thrombosis

79
Q

BB w/ BPD tx with furosemide. List AE:

A
  • low K
  • low Na
  • low Cl
  • AKI

NICU AE w/ prem:

  • severe hypercalciuria
  • nephrocalcinosis
  • ototoxicity
  • biliary stone (cholelithiasis)
80
Q

Who gets screening for ROP:

A

< 31 week GA

or 1250g or less

81
Q

When is initial ROP screening done?

A

31 week GA

unless born at

  • 28 GA =32 check
  • 29 GA = 33 check
  • 30 GA =34 check

** Perform at 4 weeks of age or 31 weeks corrected.

82
Q

T or F: abnormal eye movement may suggest neo sz

A

True

New tx: lorazepam
Prior Stnd: Phenobarb

83
Q

TEF or EA Tx?

A
  • ABC
  • no bag mask; intubate if need to
  • OG/NG to suction proximal pouch
  • elevate head
  • prone
  • empiric Abx
  • Look for other anomalies (PE, XR abdo, Echo, Renal US)
84
Q

Can’t pass NG through nare of BB. List three other physical exam findings you look for?

A

R/O CHARGE

> Coloboma
> Heart (TOF)
> Atresia Choanae
> Retarded Growth
> GU
> Ear
85
Q

Barium enema of BB shows rectal ampulla narrow with dilated proximal bowel. Two investigation for dx and result seen?

A

Hirschsprung’s Dx

Two Investigation:

  1. Rectal manometry
    - failure of internal anal sphincter to relax w/ rectal distension of balloon
  2. Rectal Biopsy
    - aganglionic cells
86
Q

Neonate has low plt. Mom’s plt normal. Like dx? Management?

A

Neonatal Alloimmune Thrombocytopenia

Tx::

  • prenatal IVIG in T2
  • C/S
  • After delivery + severe transfuse maternal washed platelet (PLA-1 negative or HPA-1)
  • IVIG less effective than transfusion; may help
87
Q

Newborn w/ petechiae. WBC + Hgb normal. Plt 9. List three causes aside from sepsis:

A
  • Neonatal alloimmune thrombocytopenia (NAIT)
  • Congenital CMV
  • Neonatal Autoimmune Thrombocytopenia (usually ITP)

Other:

  • Preclampasia (Hgb up)
  • Thrombus (dehydration, IDM)
  • Kasabach-Merritt Syn
88
Q

Which predisposes to LATE hemorrhagic dx of newborn?

  • BF
  • prem
  • CF
  • maternal phenytoin
  • oral Abx
A

Breastfeeding

Early onset (within 24h):

  • maternal med that block Vit K (like anticonvulsant)
  • prevent via Vit K IM at birth

Late onset (1-3 mo):

  • parental refusal of Vitamin K + exclusive BF
  • fat malabsorption
  • associated with intracranial hemm
89
Q

Most likely cause of late hemorrhagic dx of newborn?

  • maternal phenytoin
  • no vitamin K prophylaxis
  • Po Abx
  • CF
A

No Vitamin K prophylaxis

or CF.

90
Q

Plethoric BB. Lethargic. Poor feed. Hob 170. Hug 0.72. Glucose 3.4. Next?

  • bolus D10W
  • partial exchange transfusion
  • Abx
A

Exchange Transfusion

if asymp and 60-70= hydrate
If symp= exchange transfusion (w/ NS)

91
Q

What fluid do you use as diluent for exchange transfusion?

A

NS

92
Q

BB born at home via midwife. Present with melena, Hgb 70, plt normal. Likely cause?

A

Vitamin K deficiency causing hemorrhagic dx of newborn

Prevention: Vit K IM
Tx: Vit K or FFP

93
Q

Jittery 2 day old. At birth has cleft palate. Murmur. Feeding well despite this.
Dx?
Jittery b/c?

A

Di George

Hypocalcemia

94
Q

Tachypnea, Jittery, myoclonus, normal BG. Tx?

  • amp/gent
  • vitamin D
  • morphine
A

Morphine

NAS:

  • tremor, jittery
  • hyperreflexic
  • hypertonicity
  • myoclonic jerk
  • V/D
  • cry, fist sucking
  • poor feed, sneeze
95
Q

Abstinence from methadone. Neonatal sx?

  • low DTR
  • constipation
  • sneezing
  • lethargy
A

Sneezing

Note: higher incidence of seizures and later onset of withdrawal w/ methadone.

96
Q

In utero exposure to cocaine results in:

  • hearing deficit
  • microcephaly
  • low BP
  • spinal dysraphism
A

Microcephaly

97
Q

HIE Criteria

A

HIE

  1. > 36 wk GA
  2. max 6 hour age
  3. mod-severe encephalopathy
  4. Two of:
    - APGAR < 5 at 10 min
    - vent or resus at 10 min
    - acid < 7 or BE > 16 in gas measured 1h of birth
98
Q

What two tests at BB d/c would suggest good neuro outcome for child w/ HIE?

A

Combo of=

Early EEG
+ MRI

Useful to predict outcome.
Normal= associated w/ good recovery.

99
Q

Intestinal atresia associated defect?

A
  • Gastroschisis
  • Pyloric Web
  • Malrotation
  • Duodenal atresia (T21)
  • Hirschsprung’s
  • Meconium Ileus (CF)
100
Q

Newborn w/ Erb’s palsy. Which is true?

  • extension at wrist
  • preserved grasp
  • symmetric moro
A

Preserved Grasp

“Waiter’s Tip”

  • shoulder adduct
  • internal rotation
  • forearm pronated
  • elbow extended
  • finger and wrist flex
101
Q

BB. Renal mass. Hematuria:

  • IDM
  • polycythemia
  • dehydration
  • UVC
A

Sounds Like= Renal Vein Thrombosis

highest RF=

  1. asphyxia
  2. IDM
  3. Dehydration
  4. Polycythemia

PPT:

  • hematuria
  • flank mass
  • HTN
  • oliguria
102
Q

LP theoretical risk to preterm infants and systemic absorption. Potential risk related to:

  • pain ++
  • shortened PR
  • metabolic alkalosis
  • methemoglobinemia
A

Methemglobinemia

103
Q

Name two maternal intervention to prevent birth defect:

A
  1. Folic acid

2. Control BG if DM

104
Q

What does antenatal steroid and antenatal MGSo4- help with?

A

Mg Sulfate < 32 GA
- neuroprotect (CP)

Steroid <34 week
- lung development, IVH, NEC, mortality

105
Q

List effects of maternal gestational DM

A
  • low BG
  • macrosomia
  • polycythemia
  • RDS
  • cardiomyopathy
  • small left colon (poor IDM with distended BB abdo = contrast show small colon)
  • jaundice
  • low Ca2+
106
Q

T or F: babies born to mom’s with SSRI should be observed for 48h?

A

True

107
Q

Lithium associated with anomaly?

A

Ebstein’s

108
Q

List RF that put you at risk of preterm delivery

A 
multiple pregnancy
low SES
preterm delivery hx
uterine anomaly hx
pyelonephritis
>10cig/day
109
Q

T or F: single PO dose of vitamin K prevent hemorrhagic dx of newborn.

A

False. Inadequate for late hemorrhagic dx.

110
Q

What are rules for weight loss and gain for newborn BB?

A

<10% in 1st week
Regain BW by DOL10-14

Wt gain: 1 ounce/day except Sunday

111
Q

pulse ox screening:

A

Check 24h (R hand and either foot)

= < 90= abN
= min. 95 and less than 3% diff= Normal

90-94 or > 3% diff= 
= repeat screen in 1h
= still border
= repeat again
= still borderline= W/U

Failed = Peds consult, +/- cardio

112
Q

Pale pink. HR 88. Active gasping. Good tone. Respond to nasal catheter. APGAR?

A 
= Appearance= Pink= 1
= Pulse < 100= 1
= Grimace= respond to catheter= 2
= Activity/Tone= 2
= Resp= Slow= 1
113
Q

The 3 questions in NRP at start?

A

Term
Tone
Breathing/Crying?

114
Q

T or F: you must intubate prior to chest compressions in NRP

A

True

115
Q

NRP. How do you decide tube size and depth?

A

Tube size: GA divided by 10.
i.e. 35 wk += 3.5-4
>1 kg= 3
< 1 kg= 2.5

Oral Depth: wt + 6cm

116
Q

What O2 should you be on when doing compressions in NRP?

A

100%

117
Q

List 3 harmful effects of O2 in resus

A

ROP
HIE
CP

118
Q

When do you stop resus in NRP?

A

no HR after 10 min.

119
Q

As per our latest NRP when do you place BB under plastic bag?

A

< 32 weeks

Goal: avoid hypothermia (less surfactant, more O1 used, lower BG)

120
Q

How do we treat pulmonary HTN?

A

iNO
Start when OI
(FiO2 x MAP/ PaO2) = 20-25

Dose: 20 ppm

Other: Oxygen, correct acidosis, high Co2, temperature
Volume, pressor

121
Q

T or F: you should transfer all < 32wk to tertiary centre?

A

True

122
Q

What are risks of surfactant?

A

Pneumothorax
Bradycardia
Blocked tube
Rarely: hemorrhage

123
Q

T or F: post natal steroids decrease vent time but not overall mortality.

A

True.

Risk for neurodevelopment sequelae.
So NOT recommended in 1st week of life for prevention but can consider if vent dependent, severe CLD etc.

124
Q

What is a late preterm? What are they at risk of?

A

34-36 GA

  • resp distres
  • temp instability
  • low BG
  • kernicterus
  • apnea
  • sz
  • feeding problem
125
Q

Findings of open PDA in BB

A 
bounding pulses
hyper dynamic precordium
loud S2
initial SEM then diastolic
cardiac decompensation= HF

Tx: fluid management, indomethacin, ibuprofen, tylenol, Sx

126
Q

NEC RF

A

prematurity
ischemia (asphyxia, CHD, PDA, severe IUGR, exchange transfusion)
infection
formula (BF protective)

127
Q

What must each BB meet to go home?

A

Thermoregulation
Control breathing (spell free off caffeine)
Resp stable (Sat min. 90%)
Feeding and wt gain

128
Q

T or F: car seat challenge still recommended.

A

False. No routine for SGA or late prem.

If want to screen (i.e. hypotonic, low BW) up to individual MD.

129
Q

Sarnat Staging

A

Stage 1= Mild

  • ++ alert
  • normal tone
  • mydriasis
  • tachy
  • no sz
  • last 1-3 d

Stage 2= Mod

  • lethargic
  • mild low tone
  • weak moro
  • miosis
  • bradycardia
  • sz common
  • last 2-14d

Stage 3= Severe

  • flaccid, stupor
  • absent primitive reflexes
  • variable pupil
  • sz uncommon
  • ispotential EEG
  • last hrs-weeks
130
Q

What do you do for HIE?

A

Passive cooling in community

Active cooling in tertiary centre! (method or head cooling only)
KEY: w/in 6 hour
Complication: low BP, brady, coagulopathy, fat necrosis

NNT 11 to prevent 1 mortality. Risk reduction of 25%

131
Q

Causes of neonatal sz

A 
HIE
IVH
Metabolic (low BG, Ca, Mg)
IEM (intractable)
Stroke
Infection
Brain malformation
Drugs (SSRI, NAS)
132
Q

What are severe and critical levels of TSB to know?

A

> 340 = severe

> 425= critical.

133
Q

What are RF on CPS nomogram for hyperbili?

A
  • Asphyxia
  • Resp distress
  • Temp instability
  • Sepsis
  • Acidosis
  • Isoimm hemolytic dx
  • G6PD dx

Low risk > 38 well
Med > 38 + RF or late term but well.
High= 35-38 RF

134
Q

All are associated with congenital hypothyroidism except?

  • prolonged jaundice
  • umbilical hernia
  • large tongue
  • small AF
  • hypotonia
A

Small AF= actually large!

135
Q

Hct partial exchange calculation:

A

Partial exchange
consider if > 75% or symptoms.

Vol= (actual-desired Hct) x wt x 90
= divided by actual hct

2019 RC Specialties (31 decks)

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