NICU Medical Complications (Except for RDS)

Question 1

What is BPD and what is the cause?

Answer 1

Bronchopulmonary Dysplasia; results from abnormal healing of lung disease during neonatal period.

Question 2

Prolonged mechanical ventilation can cause what from a baby after 28 days?

Answer 2

Thickened, hyper-reactive airways, decreased lung compliance and increased airway resistance– Increases correlation with developmental delay

Question 3

Give the name of the syndrome where there is meconium in the amniotic fluid that the baby breathes in perinatally.

Answer 3

Meconium Aspiration Syndrome

Question 4

What is the result of MAS?

Answer 4

Because meconium is toxic to the lungs is causes a decrease in 02 to the brain and compromised lung function.

Question 5

What is the cause of periventricular Leukomalacia (PVL)?

Answer 5

Symmetrical non-hemorrhagic ischemic lesion to brain near the lateral ventricles caused by decreased 02 to the brain perinatally

Question 6

What is the cause of PVL and how would you treat it?

Answer 6

Cause: Decreased O2 to brain perinatally
Treatment: Address primary cause to minimize damage

Question 7

How would you identify and diagnose a child with PVL?

Answer 7

Early Signs: poor suckling hypertonicity of Bilat. LE

Diagnosed: Cranial US/MRI

Question 8

What is the result of PVL?

Answer 8

Spastic diplegia CP

Question 9

Give the name of the complication that begins with hemorrhage occurring in the germinal matrix and extends the intraventricular space and results in brain damage due to decreased 02.

Answer 9

Germinal Matrix- IVH

Question 10

Where is the matrix in GMIVH located? How common is it for a preemie to have this?

Answer 10

Matrix is located near branches of ant. and middle cerebral artery and internal carotid
This is the most common lesion for a preemie

Question 11

Explain the 4 grades of germinal matrix- IVH.

Answer 11

I: isolated germinal matrix hemorrhage
II: IVH with normal ventricular size
III: IVH with ventricular dilation
IV: IV dilation with parenchymal hemorrhage

Question 12

What are the risk factors and complications of germinal matrix- IVH?

Answer 12

Risks: <1500 g, Pneumothorax, tracheal suctioning, poor breathing
Complications: Neurological disabilities (CP), vision deficits, learning disabilities, and seizures.

Question 13

What is the cause and result of Patent Ductus Arteriosis (PDA)?

Answer 13

Failure of the ductus arteriosus to close after birth

Results in blood flow between aorta and pulmonary artery

Question 14

Explain the process of fetal circulation.

Answer 14

Blood enters RA-> RV-> Pulmonary artery-> ductus arteriosus-> descending aorta-> perfuses LE

Blood enters RA-> LA via foramen ovale-> LV-> aorta-> brain and UE

Question 15

T/F A patent foramen oval is always dangerous and should be immediately addressed.

Answer 15

False; a patent foramen ovale may not ever be an issue

Question 16

Give the steps for a normal first breath

Answer 16

1. Lungs open & pulmonary vascular resistance decreases
2. Lungs release bradykinin to constrict smooth mm of DA
3. Withdrawal of maternal prostaglandins also contributes to DA closing
4. DA should close 12 hrs- 1 week of life

Question 17

What is the result of PDA?

Answer 17

Blood from the aorta is shunted through the DA to the pulmonary artery to the lungs (lungs have to work extra)

Question 18

Give the signs and treatment for PDA.

Answer 18

Signs: difficulty breathing and failure to thrive/gain weight
Treatment: Sx to close after 2 weeks

Question 19

In a preemie what else can delay the closure of the DA?

Answer 19

Hypoxia

Question 20

Give the other name and cause of jaundice in babies.

Answer 20

Hyperbilirubinemia (physiological jaundice due to excessive amounts of bilirubin)
-Caused by immature hepatic function or increased hemoglobin through bruising

Question 21

What are the results and treatment of Hyperbilirubinemia?

Answer 21

Results: decreased activity and arousal
Treatment: Phototherapy and biliblanket

Question 22

If jaundice goes untreated it is called what?

Answer 22

Kernicterus: deposits of unconjugated bilirubin in brain that leads to neuronal injury (highly associated with athetoid CP)

Question 23

Describe GERD.

Answer 23

Gastroesophageal reflux disease- movement of gastric contents in a retrograde fashion into the esophagus

Question 24

GERD is attributed to what causes and is diagnosed with what symptoms?

Answer 24

Causes: Lower esophageal sphincter relaxed

S/S: Poor feeding, excessive crying, oral aversion, apnea, and spit up

Question 25

What are some of the risk factors associated with GERD?

Answer 25

Preemie, perinatal stress, delayed gastric emptying, diaphragmatic defects, NG tube

Question 26

Motor patterns associated with GERD include what?

Answer 26

Increased cervical and trunk extension and not happy in prone (can lead to torticollis)

Question 27

Treatment of GERD includes?

Answer 27

Elevating head of bed and meds

Question 28

What is the most common cause of death to infants during and after surgery?

Answer 28

Necrotizing Enterocolitis (acute inflammatory disease of the immature intestines resulting in acute intestinal necrosis)

Question 29

What is the cause of NEC and what symptoms are associated with it?

Answer 29

Cause: Mucosal injury to the intestinal tract (often post sx)
Symptoms: Respiratory distress, bradycardia, distention and tenderness in the abdomen

Question 30

How would you treat NEC?

Answer 30

NPO, gastric suction, antibiotics, and surgery

Question 31

What is ROP and what does it stand for?

Answer 31

Retinopathy of Prematurity; abnormal blood vessel development in the retina of the eye (in a preemie)

Question 32

Risk factors for ROP include?

Answer 32

Supplemental O2 (#1), <30 weeks GA, hypoxia, IVH, RDS, PDA, and vitamin E deficiency

Question 33

What are the symptoms for ROP? How many stages are associated with ROP?

Answer 33

Symptoms: Abnormal movements of the eye, cross eyed, white looking pupils
Stages: There are 5, I - mild and V-Total bilat. retinal detachment

Question 34

How would you prevent or treat ROP?

Answer 34

Prevent by keeping O2 between 50-70 mm Hg

Treatment with surgery

Question 35

Prenatal cocaine Exposure increases a babys risk for?

Answer 35

Premature labor, spontaneous abortion, placental abruption, fetal distress, cardiac problems, low APGAR scores, cerebral damage

Question 36

Symptoms of withdrawal cause problems after birth and later in life. Describe those problems.

Answer 36

After birth: difficulty sleeping, tremors, irritability, inconsolable crying, poor motor skills
Later in Life: Behavior problems, language delay, poor information processing, impaired motor planning, attention deficits, and sensory integration dysfunction