NICU Quick Review Flashcards
What is the presentation time for “classic” hemorrhagic disease of the newborn?
2-7 days
- Early- within the first 24 hours after birth
- Late: 2-12 weeks post birth
What is thought to be the etiology of early HDNB?
Maternal medication use such as antiepileptics
What is the dose of IM Vitamin K?
Less than 1500 g- 0.5 mg
Greater than 1500 g - 1 mg
How is oral Vitamin K dosed?
Need 3 TOTAL doses
2 mg at first feed
2 mg at 2-4 weeks
2 mg at 6-8 weeks
What is the association between breasting feeding and HDNB?
Late disease more commonly seen in breast fed babies
When should pulse oximetry screening be done and why? Who should be screened?
Should be done between 24-36 hours and not before because of rate of false positives being higher
- All term and late preterm infants
When should prophylactic antibiotics be given to an infant?
All infants born <33 weeks born to mothers with chorioamnionitis or PPROm should recieve abx for 36-48 hours until culture were negative
When should prophylactic antibiotics be given to a mother?
PPROM and expecting to delivered before 33 weeks
Consider it in GBS unknown mothers with preterm delivery
When should a mother receive a course of antenatal steroids?
If <35 weeks and imminent delivery within 7 days
When should a mother receive MgSO4?
If <34 weeks GA
When should baby be put in a bag to prevent hypothermia?
If <32 weeks
What are targets for PCO2 when ventilating a neonate? Why?
Target between 45-55 with a max of 60
To help prevent periventricular leukomalacia (PCO2 below 35 mmHg) and intraventricular hemorrhage (PCO2 above 60 mmHg
What are indications to start iNO?
GA>35 weeks OI >20-25 PaO2<100 when on 100% FiO2 ECHO has rule out congenital heart disease Conventional therapies are failing
What are indications for surfactant therapy?
Intubated with RDS* may not meet high risk criteria yet
Severe pneumonia or pulmonary hemorrhage
MAS with FiO2 >50%
<29 weeks at an outborn center
What babies would qualify for a screening ultrasound?
Less than 1500 g
Less than <31+6 weeks
What is the prognosis with PVL?
Poor
Cerebral Palsy
What are risk factors for development of PVL?
Twin to twin transfusion syndrome Postnatal dexamethasone Chorioamnionitis Asphyxia Severe lung disease Hypocarbia NEC
What are long term vision risks for preterm infants?
- Refractive error
- Strabismus
- Amblyopia
What are risk factors for developing ROP?
- Prolonged ventilation
- Oxygen therapy
- Hypotension
- Slow postnatal growth
For which infants has cooling benefit been established?
Only established for those with moderate HIE
- Not established for severe HIE
What are the standard criteria for cooling?
Greater or equal to 36 weeks
<6 hours of age
*May decide to cool up to 35+0 but very situation dependent
What are criteria for cooling?
Need A or B +C
Criteria A:
APGAR <5 at 10 mins
pH <7.0 or BE >16
Criteria B:
pH between 7.01 to 7.15 with BE between 10-15.9
* History of acute perinatal event (such as but not limited to cord prolapse, placental abruption or uterine rupture) AND
* Apgar score ≤5 at 10 minutes or at least 10 minutes of
positive-pressure ventilation
Criteria C: Evidence of moderate-to-severe encephalopathy, demonstrated by the presence of seizures OR at least one sign in three or more of the six categories
What is the most common pattern of injury seen on imaging?
Basal ganglia and thalamus
Ischemia to watershed areas
What is the incidence of neonatal encephalopathy?
1/1000 to 6/1000 live births
