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Quick Review > NICU Quick Review > Flashcards

NICU Quick Review Flashcards

1
Q

What is the presentation time for “classic” hemorrhagic disease of the newborn?

A

2-7 days

  • Early- within the first 24 hours after birth
  • Late: 2-12 weeks post birth
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2
Q

What is thought to be the etiology of early HDNB?

A

Maternal medication use such as antiepileptics

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3
Q

What is the dose of IM Vitamin K?

A

Less than 1500 g- 0.5 mg

Greater than 1500 g - 1 mg

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4
Q

How is oral Vitamin K dosed?

A

Need 3 TOTAL doses
2 mg at first feed
2 mg at 2-4 weeks
2 mg at 6-8 weeks

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5
Q

What is the association between breasting feeding and HDNB?

A

Late disease more commonly seen in breast fed babies

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6
Q

When should pulse oximetry screening be done and why? Who should be screened?

A

Should be done between 24-36 hours and not before because of rate of false positives being higher
- All term and late preterm infants

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7
Q

When should prophylactic antibiotics be given to an infant?

A

All infants born <33 weeks born to mothers with chorioamnionitis or PPROm should recieve abx for 36-48 hours until culture were negative

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8
Q

When should prophylactic antibiotics be given to a mother?

A

PPROM and expecting to delivered before 33 weeks

Consider it in GBS unknown mothers with preterm delivery

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9
Q

When should a mother receive a course of antenatal steroids?

A

If <35 weeks and imminent delivery within 7 days

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10
Q

When should a mother receive MgSO4?

A

If <34 weeks GA

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11
Q

When should baby be put in a bag to prevent hypothermia?

A

If <32 weeks

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12
Q

What are targets for PCO2 when ventilating a neonate? Why?

A

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

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13
Q

What are indications to start iNO?

A 
GA>35 weeks
OI >20-25
PaO2<100 when on 100% FiO2
ECHO has rule out congenital heart disease
Conventional therapies are failing
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14
Q

What are indications for surfactant therapy?

A

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

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15
Q

What babies would qualify for a screening ultrasound?

A

Less than 1500 g

Less than <31+6 weeks

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16
Q

What is the prognosis with PVL?

A

Poor

Cerebral Palsy

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17
Q

What are risk factors for development of PVL?

A 
Twin to twin transfusion syndrome
Postnatal dexamethasone
Chorioamnionitis 
Asphyxia
Severe lung disease
Hypocarbia 
NEC
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18
Q

What are long term vision risks for preterm infants?

A
  • Refractive error
  • Strabismus
  • Amblyopia
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19
Q

What are risk factors for developing ROP?

A
  • Prolonged ventilation
  • Oxygen therapy
  • Hypotension
  • Slow postnatal growth
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20
Q

For which infants has cooling benefit been established?

A

Only established for those with moderate HIE

- Not established for severe HIE

21
Q

What are the standard criteria for cooling?

A

Greater or equal to 36 weeks
<6 hours of age

*May decide to cool up to 35+0 but very situation dependent

22
Q

What are criteria for cooling?

A

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

23
Q

What is the most common pattern of injury seen on imaging?

A

Basal ganglia and thalamus

Ischemia to watershed areas

24
Q

What is the incidence of neonatal encephalopathy?

A

1/1000 to 6/1000 live births

25
Q

What are side effects of cooling?

A

Bradycardia
Coagulopathy
Hypothermia and hypotension
Electrolyte abnormalities/fat necrosis- rare SE

26
Q

When is the highest risk time for seizures?

A

During rewarming

27
Q

How is the baby rewarmed? And when?

A

Cooled for 48-72 hours with target temp of 33.5 degrees

Rewards by 0.5 degrees q3h

28
Q

What are contraindications to cooling?

A 
Chromosomal abnormality
Severe head trauma or bleeding 
Severe encephalopathy* end of life care
Congenital anomaly 
Chromosomal anomaly
29
Q

What type of CP is commonly seen in preterm infants?

A

Spastic diplegia* associated with PVL

Injury to corticospinal tracts

30
Q

What is the definition of transitional hypoglycemia?

A

BG <2.6 within the first 72 hours of life

31
Q

What is the definition of persistent hypoglycemia?

A

BG <3.3 after the first 72 hours of life

32
Q

List three RF for hypoglycemia

A 
SGA
LGA 
IDM
Preterm (<37 weeks)
Maternal labetalol use
late exposure to prenatal steroids, metabolic conditions, genetic syndromes, perinatal asphyxia
33
Q

What is the most common cause of hypoglycemia?

A

Impaired gluconeogenesis

34
Q

When should you screen at risk infants?

A

IDM- for the first 12 hours; stop if normal
SGA/prem- for the first 24 hours; stop if normal after 24 hours
- Always check if asymptomatic

35
Q

At what GIR should medication and subspecialty evaluation be considered?

A

GIR of 10-12

36
Q

Which fluid and and at what rate would you start IVF?

A

D10W at TFI of 80 gives GIR of 5.5

37
Q

What is the target sugar range for a neonate less than 72 hours old?

A

2.6 to 5.0

38
Q

What is the target sugar rate for a neonate over 72 hours old?

A

3.3 to 5.0

39
Q

At what GIR should a central line be considered?

A

GIR 8-10

40
Q

When should a critical sample be drawn? What does it include?

A

Persistent hypoglycemia when over 72 hours of life for BG <2.8
- confirmatory plasma glucose, beta-hydroxybutyrate, bicarbonate, lactate, free fatty acids, insulin, growth hormone, cortisol, carnitine, and acylcarnitine profiling.

41
Q

Chronic bilirubin encephalopathy is associated with what type of CP?

A

Athetoid CP

42
Q

What is the definition of severe hyperbilirubinemia?

A

TSB >340 micromol/L

43
Q

What is the definition of critical hyperbilirubinemia?

A

TSB >400 micromol/L

44
Q

What are the values for bilirubin at which phototherapy threshold plateaus?

A

Low risk- 360
Med risk - 310
High risk - 260

45
Q

How long is an infant at risk for perinatal transmission of HSV after being born?

A

6 weeks

46
Q

For babies that DO get late HDN, what is the % that get intracranial bleed?

A

50%

47
Q

Name 3 hypoglycemic conditions in which the glucose requirement is expected to be normal for a term baby.

A

GH deficiency, cortisol deficiency, prematurity, SGA, fatty acid oxidation defect, galactosemia

48
Q

Name 3 hypoglycemic conditions in which the glucose requirement is expected to be greater than for a term baby

A

Hyperinsulinism, Beckwith-Weidman, IDM, sepsis

Quick Review (2 decks)

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