NICU

Question 1

Choanal Atresia

Answer 1

Pink when crying, cyanotic when quite

Inability to pass ng tube one or both sides

Question 2

meconium/mucus blockage

Answer 2

meconium stained amniontic fliud
poor aeration
deep suction, intubation prn if persitent poor ventilation despite suctioning

Question 3

pharyngeal airway malformation

Answer 3

persistent retraction; poor aeration

prone positioning; posterior nasopharyngeal tube

Question 4

congenital diaphragmatic hernia

Answer 4

asymmetric lung sounds; persistent cyanosis/bradycardia; scaphoid abdomen
CXR; intubation; place orogastric tube

Question 5

pleural effusion/ascites

Answer 5

diminished aeration; poor oxygenation and ventilation
immediate intubation; needle thoracentesis/paracentesis; chest tube (posterior); possible volume expansion; pleural fluid analysis

Question 6

pneumothorax

Answer 6

asymmetric lung sounds. persistent cyanosis/bradycardia

cxr if stable; transillumination; needle thoracentesis, chest tube if recurrent (anterior)

Question 7

congenital heart disease

Answer 7

persistent cyanosis; comfortable tachypnea, murmur
cxr; ekg; 4ext bps, pre/post-ductal sats, hyperoxia test
consider prostaglandins
echo, cards consult

Question 8

fetal/maternal hemorrhage

Answer 8

pallor; poor response to resuscitation; history of delivery

volume resuscitation, transfusion

Question 9

UAC

Answer 9

indication: hypotension; frequent lab draws (extreme prematurity, pphn, sepsis)
length: t6-t10; length/3 or [bw(kg) x 3]+9cm
Catheter size: 3.5 or 5F single lumen
precautions: monitor feet discoloration; monitor for RBC in the urine or HTN; NO dopamine, platelets or blood products
Fluids for UAC: Must contain 0.5 Unites heparin/ml
Must run at 1ml/hr minimum
Duration: 7days (max of 10 days)
Misc: Remove when starting feeds. may give trophic feeds with UAC in place

Question 10

UVC

Answer 10

Indication: hypotension requiring pressors; tpn or fluids requiring high dextrose or calcium
Length: at diaphragm on KUB; length/5; ([bw(kg) x 3]+9cm)/2 + (1-2 cm)
Catheter size: 3.5 or 5.0F double lumen
Precautions: if line is dislodged, check a babygram to confirm central placement
fluids for uvc: at least one carrier fluid must contain 0.5 units heparin
duration: 7 days (max of 10 to 14 days)

Question 11

apnea of prematurity

Answer 11

prematurity <34 weeks
periods of 10 to 20 seconds of apnea followed by bradycardia and desaturations
manage with caffeine

Question 12

BPD

Answer 12

prematurity. diagnose at 36 weeks pma. consider echo at that time. look up criteria

Question 13

pphn

Answer 13

hypoxia, hypotension, cxr w/ meconium aspiration or black lungs, echo with r-> left shunting

Question 14

RDS

Answer 14

surfactant deficiency, cxr: ground glass, low lung volumes; and air bronchograms
cpap vs intubation, surfactant administration

Question 15

TTN

Answer 15

Delayed resorption of fluid, usually term infants, birth by c-section
CXR: Prominent vasculature, fluid in fissures

Question 16

PDA

Answer 16

Continuous machinery-like murmur; hypotension, widened pulse pressure, palmar/axillary pulses, hyperactive precordium; metabolic acidosis, worsening oxygenation and ventilation, pulmonary edema due to over circulation
Diagnosis - echocardiogram,
Treatment: symptomatic support, medical therapy (indomethacin, ibuprofen, tylenol), surgical ligation, wait and see