NICU HR Flashcards
Which infants to screen for ROP? When to screen?
- GA <30+6 OR BW < 1250g
- For >26+6: At 4 weeks
- For <26+6: At 31 weeks
Broadly, what is ROP?
Proliferative disorder of developing retinal blood vessels
Risk factors for ROP?
- Hypotension
- Prolonged ventilation
- Oxygen therapy
- Slow postnatal growth
Which patients to treat for ROP?
- Type 1 ROP:
- -Zone I - any stage ROP with plus disease as well as stage 3 ROP without plus disease
- -Zone II - stage 2 or 3 ROP with plus disease
Which patients to monitor closely for ROP?
- Type 2 ROP:
- -Zone 1 - stage 1 or 2 ROP without plus disease
- -Zone 2 - stage 3 ROP without plus diseaase
Treatment for ROP?
- Laser photocoagulation
- -within 72h of Type I ROP
- Antivascular endothelial growth factor
- -Proven in Zone 1
- -Possible risk of delayed ROP
- -Informed consent
Most common locations for NEC?
Terminal ileum, sigmoid colon
Diagnosis? Clinical features?
- Gold standard - pathology
- Clinical features: Lethargy, apnea, temp instability, bile-stained aspirates, abdominal distension, blood/mucous per rectum, shock
Risk factors for NEC?
- Prematurity
- Ischemia (asphyxia, CHD, PDA, severe IUGR, exchange transfusions)
- Complication Hirshsprungs
- Infectioin
- Feeding (breast milk is protective)
Treatment for NEC?
- Supportive
- NPO
- NG decompression
- Antibiotics
- +/- Surgery
Longterm complications of NEC?
-Short gut (surgical), stenosis/obstruction, recurrence
Criteria for safe discharge prem?
- Physiologic maturity
- -Thermoregulation (around 1700g to cot)
- -Control of breathing (Spell free period off caffeine: 5-7days at least)
- -Respiratory stability (25% of <1500g inifants on O2 at 36weeks cGA; Targe sats 90-95%)
- -Feeding skills and weight gain
- –Cue based feeding: earlier to full feeds, decreased length of stay
- –Iron 2mg/kg/day, Vitamin D 400-1000 IU supplements
- –GERD: little evidence of association with pathology
Considerations for investigations/treatment prior to discharge from NICU?
- Assessment for RSV prophylaxis
- Cranial imaging at near-term, if indicated by GA
- ROP screening, if indicated
- Immunizations according to chronological age
- Pre discharge P/E: Weight, length and HC
Indications for therapeutic hypothermia?
Indications: (≥35-36 weeks)
Criteria A or B AND C
A. Cord pH≤7 or BD≥ -16or
B. pH 7.01 – 7.15 of -10 to -16 (cord
or 1 hour gas) AND Hx of acute perinatal event AND APGAR ≤ 5 at 10m or at least 10m of PPV
C. Signs of moderate to severe encephalopathy
Timing for therapeutic hypothermia?
ASAP, within 1st 6 hours
Complications of therapeutic hypothermia?
- Hypotension
- Bradycardia
- Coagulopathy
- PPHN
- Fat necrosis
DDx for neonatal seizures?
- HIE (term)
- IVH (preterm)
- Metabolic/IEM (intractable)
- Stroke
- Drugs (SSRIs)
- NAS (opiates, benzos)
- Infection
- Brain malformations
- Benign neonatal seizures (family hx, dx of exclusion)