Volume 2 Flashcards
Which of the following is not a side effect of intubation/laryngoscopy of the newborn infant?
a) systemic and pulmonary hypertension
b) tachycardia
c) hypoxia
d) intracranial hypertension
b) false - bradycardia is the side effect
bradycardia and hypoxia does not appear to be related
some of the side effects from laryngoscopy itself, it is thought to be vagal, pre oxygenation does not help with it.
the others are effects of laryngoscopy/intubation
systemic HTN - increased SVR from catecholamines
IC hypertension - coughing and struggling
Which of the following is not an effect of using premedication for intubation?
a) increased hypoxia when paralytics are used
b) reduce hypertension with analgesia
c) reduce intracranial hypertension with muscle relaxants
d) quicker intubation with paralytics
a) fase - quicker intubation with paralytics which leads to less hypoxia
2 recent studies - used muscle relaxants, additional benefits more than analgesia alone
Which of the following statements is false ?
a) a recent study showed that propofal leads to faster intubation with better maintaining of O2 sats and quicker recovery in neonates
b) thiopental is very slowly cleared by the neonate
c) midazolam has potent analgesic properties and is a good choice for neonatal intubation
d) fentanyl is faster acting than morphine
c)false - does not have analgesic properties, associated with serious adverse effects, doesn’t reduce physiological changes of intubation, should NOT be used for intubation in the newborn
the rest are true
a) true - a recent study shows this, concern that it doesn’t have analgesic properties (is a hypnotic agent ) and would need to be combined with an opiod
need more investigation, limited PK data
can cause hypotension in older people
b) one study does show it reduces pain, but big concern is very slow clearance (half life 14.9 hours)
d) is true, fentanyl is faster acting, morphine does not seem to reduce hypoxia because it is too slow
remifentanyl even quicker, onset within seconds and lasts minutes, limited PK and PD data
meperidine in one study - reduced endocrine responses to intubation, very limited data
Which of the following is not an adverse effect of midazolam?
a) hypotension
b) infusion results in adverse neurological outcomes
c) decreased cerebral flow velocity
d) increased cardiac output
e) long half life (22 hours)
d) in fact decreased cardiac output
the rest are adverse effects/reasons not to use midazolam
After giving fentanyl for intubation to give surfactant, how soon after can a baby be extubated?
a) <1 hour
b) 4 hoursh
c) 6 hours
d) 10 hours
a)half life of fentanyl is 10 hours in newborn) but can be safely extubated t want to give meds that will prolong resp depression when intubating for this reason
remifentanyl super short acting, even better from this perspective (only few minutes)
complications are a reason given to not give pre -meds
RCTs have not shown that pre-meds increase the complication rate
chest freeze - infrequent complication, can avoid by giving slowly and treating with muscle relaxant or opioid antagonist
after giving fentanyl
Which of the following patients is not an acceptable patient to intubate without pre medication?
a) severely abnormal airway
b) crashing patient
c) baby resuscitated by face mask who needs ongoing resp support
d) resuscitation
c) all other newborn babies should be offered pre med
the others are cases where you don’t need pre med
should NOT use pre med if severe abnormal airway and will take time to intubate, and want the patient to be able to breathe on their own; may need special techniques, if not trained, consider transfer with bagging to tertiary care centre
if can’t get IV, consider inhaled (i.e. sevoflurane) or intranasal (i.e. fentanyl) ; or consider awake intubation (clarify what they mean here)
Which of the following statements is true?
a) atropine is the most effective vagolytic
b) fentanyl has been compared to other analgesics and shown to be more effective as a pre med for intubation
c) succinylcholine can cause hypokalemia
d) chest freeze can be treated and potentially prevented with co-administration of muscle relaxing
d) true - muscle relaxants (i.e. succ) can be co administered, also, should administer the fentanyl slowly to prevent this effect, could also give naloxone for this; also remember that fentanyl can reduce the respiratory drive so need to be prepared to support respiratory whenever you give this drug
a) false - both atropine and glycopyrrolate are effective, have not been directly compared
atropine 10-20 ug/kg - no adverse effect at correct dosage, there is potential for CNS complications with overdose
b) false - has not been directly compared to others, morphine NOT ideal, takes too long, remifentanyl is appealing (quicker action) needs more study, thiopental and methohexital only studied in larger preterm and term infants
c) opposite - can cause hyperkalemia and malignant hyperthermia, can also cause rhabdomyolysis
**see table for details on all the studies
Which of the following statements is false?
a) succinylcholine should not be used in babies with hyperkalemia
b) succinylcholine should not be used in babies with family history of malignant hyperthermia
c) succinylcholine causes significant increase in blood pressure
d) succinylcholine is a non depolarizing agent
d) false - it is a depolarizing agent
the rest are true
rare series side effects
hyperkalemia - major elevations are uncommon, usually associated with significant tissue injury
malignant hyperthermia is autosomal dominant - symptoms include increased temperature, muscle rigidity, rhabdomyolysis etc, high HR etc, treatment is dantrolene
rocuronium - not a good choice of relaxant because lasts 1 hour
if intubating with opioid but no muscle relaxant, should have it available in case of chest freeze
Which of the following is not true?
a) fentanyl is the best choice of analgesic at a dose of 3-5 ug/kg (slow infusion over at least 1 minute)
b) full cardiorespiratory monitoring is required for intubation
c) succinylcholine is the best choice of muscle relaxant, at a dose of 2mg/kg
d) atropine is a suggested choice of vagolytic, at a dose of 20 ug/kg (may work at 10 ug/kg)
b) false - O2 sat monitoring is the minimum
Preoxygenation to reduce hypoxia, limiting the duration of attempts to a reasonable maximum duration (such as 30 s), careful observation and monitoring during the procedure (in particular with pulse oximetry), and confirmation of appropriate tube placement with exhaled carbon dioxide detection are required.
should always have muscle relaxant (i.e. succ) when giving fentanyl to non intubated infant
Which of the following is not a radiographic feature of respiratory distress syndrome?
a) increased lung volumes
b) air bronchograms
c) ground glass appearance
a) the opposite, reduced air volume
RDS - surfactant deficiency and poorly functioning surfactant in preterm infants
Which of the following is false about surfactant treatment ?
a) reduces mortality from RDS and increases survival
b) reduces morbidity from RDS
c) reduces the incidence of BPD
d) reduces duration of respiratory support and hospitalization
e) reduces pneumothorax in babies with RDS
c) false- increases the likelihood of survival without BPD (by increasing survival rather than incidence of BPD)
surfactant normally lines the surface of alveoli, reducing surface tension, and prevents atelectasis treatment either as rescue or propylaxis no cost of neurodevelopment outcome the rest are benefits also shorter and cheaper hospital stays
Which of the following infants does not meet criteria for surfactant therapy?
a) baby with meconium aspiration syndrome on 40% FiO2
b) intubated babies with RDS
c) sick newborns with pneumonia and OI>15
d) intubated infants with pulmonary hemorrhage leading to clinical deterioration
a) does not meet - criteria is : babies with MAS on >50% FiO2 should receive surfactant (grade A recommendation)
the other babies do meet criteria
albumin, meconium and blood inhibit surfactant function
for pneumonia, not adequately studied so is a grade C recommendation (one study showed in sepsis helped reduce ECMO, another said might be beneficial in pneumonia)
pulmonary hemorrhage - surfactant has been shown to INCREASE the risk of pulmonary hemorrhage, however because blood adversely affects surfactant function, has been tried, some studies showing that it helps (grade C recommendation)
lung hypoplasia and CDH - only small studies, no conclusions can be made
Which of the following is not a significant risk of surfactant treatment?
a) tube blockage
b) increased mortality from pulmonary haemorrhage
c) bradycardia
d) hypoxemia
b) there is an increased risk of pulmonary hemorrhage but not increased mortality from pulmonary hemorrhage or overall mortality (in fact overall mortality is decreased after surfactant treatment)
tube blockage, bradycardia and hypoxemia are short term risks during instillation
OVERALL, physiology of what all surfactant does
improvement in static compliance only, dynamic stays unchanged
large improvement in FRC (due to improvement in lung volume with recruitment)
get normalizing pressure volume loops, need to decrease administered pressures to avoid over distension
can also get accidental hyperventilation with low pCO2 (bad for brain)
immunological - babies treated with surfactant may have antibodies to surfactant proteins, but no evidence that this is increased compared to other babies with RDS
Which of the following statements is false?
a) natural surfactants lead to lower mortality than synthetic
b) natural surfactants decrease the O2 needs and ventilatory support more than synthetic surfactants
c) pulmonary air leak syndromes are lower with natural surfactant compared to synthetic surfactant
d) incidence of BPD is reduced with natural surfactant (vs synthetic)
d) false - not a difference in the incidence of BPD, but because there is less death, combined outcome of Bpd AND death is reduced (mortality is reduced with natural, but the amount of BPD is the same)
Therefore, natural surfactants improve survival without BPD and with a lower incidence of airleak, and they are to be preferred over synthetic surfactants (evidence level 1a). However, it must be noted that all studies comparing natural with synthetic surfactants have been done using synthetic preparations that did not contain surfactant protein analogues. New synthetic surfactants have been developed which may have enhanced efficacy and they are presently being investigated in clinical trials.
better survival with less pneumos says michelley
Which groups should one consider prophylactic surfactant therapy for in a peripheral hospital ?
all babies who are considered high risk of RDS should get prophylactic surfactant therapy as soon as they are stable (one study found there wasn’t a huge difference between giving ASAP vs giving as soon as stable) :
<29 weeks in a peripheral hospital, then should intubate immediately then give prophylactic surfactant
Which is true of surfactant treatment for babies with RDS?
a) > 3 doses can be of benefit
b) should be considered for babies with persistent O2 and ventilatory needs at 72 hours
c) increase in complications with repeated doses
d) retreatment should not be considered until 8 hours after initial dose
b) true
the rest are false
a) no benefit to more than 3 doses
c) no increased complications from repeated doses
d) can consider retreatment when there is persistent or recurrent FiO2 need of 30% or more as early as 2 hours after, more commonly 4-6 hours after
can consider early extubation to CPAP within 1 hour of surfactant
surfactant for babies on CPAP - should be considered if FiO2 >50% (greater risk of pneumothorax at this point if not)
if babies are initially managed with CPAP then need to make sure that we give them surfactant as soon as they show signs of worsening
Which of the following is false of steroid treatment for mothers with threatened pre term labour?
a) has been shown to reduce severe IVH
b) better outcomes when combined with surfactant that surfactant alone
c) should be considered for all moms GA
c)should be considered for women
Which of the following is false?
a) intrapartum antibiotic prophylaxis reduces the chance of sepsis by other organisms
b) currently in Canada, most babies with invasive GBS infection are born to women who tested GBS -ve
c) invasive GBS disease is possible, although rare, in women who received prophylaxis
d) any infant with signs of sepsis only needs to have cultures done before starting therapy
a) false - doesn’t reduce the chance of sepsis by other organisms
the rest
b) true - can still get GBS if cultures at 35-37 weeks are negative, because of IAP, most babies now who present with invasive GBS infection are born to mom’s who tested negative and got colonized between the test and birth
d) true - the predictive value of no other tests will allow you to prevent therapy, i.e.) normal CBC or diff should not prevent therapy, negative likelihood ratio is 0.7
most common organisms in early sepsis: GBS (strep agalactiae), other strep, E. coli, other gram negative, Listeria
Which of the following is not well covered by the empiric treatment of a neonate by ampicillin and gentamycin?
a) GBS meningitis
b) Listeria meningitis
c) E. coli meningitis
d) Staphylococcus meningitis
c) should treat with cefotax and gent
amp and gent is the usual empiric choice
if +ve CSF, then should target the organism and ensure that the antibiotic can cross the BBB (although I think that neonates have a pretty chill BBB from what I remember)
Gram positive cocci (GBS, staph, enterococci)- amp and gent
Gram positive rod (Listeria )- amp and gent
Gram negative rods (E. coli, less common Klebsiella, Pseudomonas, Citrobacter) - cefotaxime and gentamycin
gram negative cocci - uncommon -
if signs of meningitis but no organisms, or too unstable for LP- amp and gent
which of the following is a gram positive rod?
a) E. coli
b) Klebsiella
c) Citrobacter
d) Listeria
d) listeria is a gram positive rod
gram positive - dark purple
gram negative - red or pink
A healthy and well-looking baby baby is born at 36 weeks to a GBS +ve mom who received penicillin 6 hours prior to delivery, what is the appropriate management?
a) CBC and vitals x 24 hours
b) full septic work up but no antibiotics
c) full septic work up and antibiotics
d) routine care and can discharge as early as 24 hours after
d) if antibiotics >4 hours before, newborn healthy and >35 weeks gestational age, no therapy needed
if baby looks well at 24 hours and parents know how to get to hospital, can d/c home at this time
if did not get penicillin but got different antibiotic, treat as inadequate prophylaxis
if adequately treated 1% chance of GBS in kids
A baby is born at 38 weeks to a mom with GBS +ve who did not receive appropriate antibiotics, which is the appropriate management?
a) CBC and vitals x 24 hours
b) full septic work up but no antibiotics
c) full septic work up and antibiotics
d) routine care and can discharge as early as 24 hours after
a) is the answer
Which is the most predictive finding on a CBC for risk of sepsis (highest positive predictive value)?
a) WBC 30 x 109
b) WBC count <5.0 x 109
c) left shift
d) low platelets
b) <5.0, should move onto full septic work up and empiric antibiotics (flowchart in statement says up to 36 hours, i think it should be 48)
risk of kid with GBS in this case is 10-20%
Which of the following is an appropriate management for a well appearing baby born to a GBS -ve mother who had prolonged rupture of membranes of 20 hours?
a) routine neonatal care
b) CBC at birth and vitals q4 hours (limited diagnostic investigation)
c) full septic work up but no antibiotics
d) full septic work up and antibiotics
b)
GBS-ve ->still have risk of GBS but risk is low, even with prolonged ROM or intrapartum pyrexia
should do a limited diagnostic investigation - CBC and observation with vitals q4 hours
before, they used to say that even GBS -ve mom’s with any one of these risk factors should get IAP prophylaxis
**although in the recommendations they say that if a mother with GBS -ve and risk factors delivers a baby who remains well, don’t need further evaluation for GBS, clarify this
Which of the following is not one of the risk factors for GBS sepsis?
a) intrapartum pyrexia
b) ROM > 18 hours
c) prematurity
d) is not, GBS bacteria at any point in the pregnancy
the risk factors are present in 50% of babies with invasive GBS disease, and happen in about 20% of babies born at term
Which of the following is the appropriate management of a mom who is GBS unknown with intrapartum pyrexia?
a) routine care
b) should have a C/section
c) should receive antibiotic prophylaxis
d) none of the above
c) if GBS unknown with any of the risk factors, should get intrapartum antibiotics (vs if GBS unknown with no risk factors then no special care needed)
GBS unknown should then be treated same as GBS +ve ->if receive prophylaxis routine care and d/c in 24 hours, if no prophylaxis then do CBC at birth and vitals x 24 hours q4hour
Which of the following is the appropriate management for a 35 week baby who looks well and GBS has not yet been done?
a) routine neonatal care
b) CBC at birth and vitals q4 hours (limited diagnostic investigation) with discharge as early as 24 hours
c) CBC at birth and vitals q4 hours (limited diagnostic investigation) with discharge as early as 48 hours
d) full septic work up and antibiotics
c) is the answer, **same as above, has a risk factor (prematurity) so should have CBC and limited diagnostic evaluation (vitals q4 hour)
should NOT discharge prior to 48 hours
for babies
Which of the following is not one of the diagnostic criteria for chorioamnionitis?
a) fever
b) foul smelling discharge
c) lower uterine tenderness
d) left shift
b) is not
the other 3 are the criteria to diagnose definite chorioamnionitis
a lot of the time, it is classified as possible when the main sign is fever
Which of the following is the risk of sepsis in a baby born to a mother with definite chorioamnionitis?
a) 4%
b) 8%
c) 25%
d) 60%
b) 8% is the risk of sepsis (from all organisms) in a mother with definite chorio; when possible and definite are considered together it is 3-4 %
among all mothers with fever, 2-6% (depending on “height” of the fever)
babies who don’t have signs of sepsis at birth are unlikely to develop sepsis (odds ratio for those who are well at birth is 0.26)
therefore, should do a limited diagnostic evaluation (CBC and q4 hour vitals) for these babies, only do more if CBC is suggestive of infection
Which of the following statements is false?
a) babies born at <88% while sitting in car seat for 90 minutes
c) false - should repeat the test in recumbent car seat (i.e. reduced angle, from 45-30 degrees in many cases) and if they pass this can go home with that. this type of car seat might not provide as much protection in a crash
if they still desat in recumbent position may need to do further testing
the rest are true
O2 sat monitoring along should detect 99% of episodes
monitors don’t prevent SIDS
should test all prems (including late perms) and babies with abnormalities
use caution with slings etc until 1 month corrected age, and for neuro abnormalities kids, until they can sit independently
Which of the following statements is false?
a) Last menstrual period is the most accurate way to measure gestational age
b) early ultrasounds are more accurate with dating than later ultrasounds
c) estimated fetal weight cannot be used to date pregnancy at 22-25 weeks
d) most babies at 25 weeks onward should have active care unless there are any special risk factors for a worse outcome
a)false - early U/S is the most accurate, between 8-14 weeks with crown rump length
should figure out dates most accurate way (ultrasound) to help with decisions
the rest are true
early ultrasound +/-5 days, 16-22 week U/S is +/- 10 days
increasing imprecision with advancing gestational age
fetal weight estimates have accuracy of +/- 10% and tend to be underestimates
need to determine the estimated birth date as early as possible and tell the pregnant woman
25 weeks have decent neurodevelopment outcomes so should do active care (weak recommendation)
extremely preterm - 22 weeks-25 weeks and 6 days
154-181 days inclusive
Which of the following is not a recommended management option?
a) consider active care for babies of gestational age 22 weeks and over depending on wishes of the family
b) women with threatened birth at 22-25+6 weeks should be transferred to a tertiary care centre with a level 3 NICU
c) all women where active care is being considered should get antenatal corticosteroids
d) C section should not be done at
a) false - for 22 weekers (22+0 to 22+6) a non interventional approach should be considered with a focus on comfort care, any mothers in threatened preterm labour at 22-25+6 weeks should talk to neonatology and MFM
the rest are true
c) there is some debate about whether babies
Which country has the highest reported survival of 22 week baby?
a) Canada
b) U.K.
c) Sweden
d) Japan
d) Japan - 34%
these data are sometimes skewed cause some countries just won’t resuscitate super perms
Sweden is second at 10%
What is the survival of 24 weeker in Canada?
a) 8%
b) 36%
c) 62%
d) 78%
c) survival in Canada 62% of 24 weaker
<5% survival, also that overall 25 week onwards have good survival
more variability between studies with lower GA
also differences in different countries
Which of the following statements is false?
a) extremely preterm babies (23-25 weeks gestation) have worse neurodevelopment outcomes than more mature preterm babies
b) survival free of neurodevelopment consequences for extreme perms has range of estimates from roughly 18-60% in different studies
c) male sex leads to better outcomes for extreme perms
d) when plan of care is uncertain, should ensure that the birth is attended by people who are capable of caring for an extremely preterm infant
c) false female does better, other things which influence include steroids, tertiary care centre, twins (discuss if they generally do better or worse), so these factors can also affect decision making
when decision not made, have people around that can resuscitate the baby if needed
should do ongoing counselling and document as well as possible
some report that even within this group worse outcomes with decreasing GA, whereas others don’t find this
A large UK-wide study (EPICURE) showed that of the 283 survivors born at ≤ 25 completed weeks’ GA, 23% had a severe disability at 30 months corrected age [51] and 22% had a severe disability at age six years [56]. At 11 years of age [57], this cohort had serious cognitive impairment (score
What is the first step of grief and mourning?
a) avoidance
b) confrontation
c) disorganization
d) accommodation
a)avoidance or protestation is the first step
covers the period of time where the news is delivered and the period immediately after
usually lasts a few hours to days
often anger in this stage
2nd stage: grief is experienced most intensely, reactions to loss are most acute, awareness of finality , involves preoccupation with thoughts of the deceased, most intense phase
accommodation and reorganization - gradual decline in the feelings of acute grief, beginning of social and emotional reinvestment in the world
person learns to live with the death - typically lasts 1-2 years
grief - reaction to loss
absence of grief may be abnormal
perinatal death - multiple losses
Which of the following statements is false?
a) parents have difficulty recognizing loss, particularly of neonates
b) many secondary losses related to the self also occur when faced with the loss of a child
c) complicated grief is more likely to occur with the loss of an older child than a newborn
d) incongruence between spouses coping with the death of a child increases significantly between 2-4 years after the loss
c) false- the age of the child is irrelevant, similar process regardless of whether the child is new or older
loss of a child high risk for complicated grieving
the rest are true
incongruity increases 2-4 years after, decreases after year 5
each person copes with grief differently, and the ups and downs mean that couples may be at different stages of their grief
when a child dies, one must also struggle with the loss of their identify as a parent, harder to hold on to than other roles since parenting is a very active role
hard to readjust and reinvest in relationships, especially with another child
Which of the following does not help parents with critically ill children in the NICU?
a) parents should be encouraged to bring mementos to their infants in the NICU
b) heath care providers should use the child’s first name and sex when talking about a baby
c) limiting visiting hours for parents to avoid crowding and overwhelming parents with information and compromising confidentiality
d) bad news should be given in a timely manner by the attending staff physician
c) false - should not limit visiting hours for parents, including when there are rounds, 80%parents enjoyed attending bedside rounds, helped them learn about their baby and feel more confident in the heath care team
using name, mementos help parents form attachment during the time in the NICU and may help them mourn later on
should give news to the parents and an additional support person (i.e. social worker ) who will stick around afterwards
should give repeated offers to hold the baby, warn about gasping and muscle contractions
reassure parents, support them, allow family to see if the parents want, explain the process/need for autopsy if relevant, explain options for memorials
Which of the following is not part of the management of a perinatal loss ?
a) spiritual support, including baptism if it is wanted, should be offered
b) organ donation should only be mentioned when it is an option for the particular baby/family
c) health care providers should create a partnership with parents early in critical care setting, and withdrawal decisions should be taken with the parents and the team, to help relieve the parents of guilt regarding this
d) an attending should state that the team recommends withdrawal to the parents, rather than asking the parents what they want
b)patients who don’t get the discussion of organ donation are often upset it didn’t happen, should do it even when it is not an option
try to keep the burden of decision to withdraw away from the parents, emphasize the role to he team
attending should state that the team recommends withdrawal
may help for attending to talk to a second attending to say that the team recommends withdrawal
stillbirth - may lead to lower self esteem
Which of the following is false
a) grieving for the loss of a twin can be harder than a singleton
b) separation occurred in 12% of couples after a prenatal loss in one study
c) bereavement counselling should be part of training for health care providers
d) babies who are malformed/macerated should not be held by their mothers because it will disturb them
d) the opposite, mothers who were given the option to hold their babies say it helped, also parents will focus on the good features rather than the malformed ones, should get to hold the baby
pregnancy termination - also results in grieving, even when it is terminated for medical reasons
True or false - circumcision lowers the risk of UTI in boys <1 year old
true - it does lower the risk of UTI in first year of life
it also lowers the risk of penile cancer
AAP says that overall the benefits outweigh the risks but that ultimately the decision should be left up to parents since there are other cultural/religius factors that matter
Canadian ancient statement (1996) say that risks and benefits are equal - so no recommendation
True or false - some research suggests that circumcision lowers the risk of cervical cancer in partners of circumsized men
true -
also some evidence that it lowers the risk of heterosexual acquisition of STI and HIV rates
Name 3 risks of circumcision:
bleeding
infection
swelling
amputation of the glans
renal failure (???) in the old CPS statement
rarely death
very low risk of these complications (0.2-0.6% in the old statement)
should be done under sterile conditions with appropriate pain management
**this is not from the statement, this is from my brain)
Please name 3 conditions where you wouldn’t circumsize a boy immediately
- hypospadias
- prematurity
- bleeding disorders
- congenital abnormalities
circumcision should only be performed on stable, heathy babies
True or false - complication rates of circumcision done in the newborn period are similar to those done later in life
false - much lower complications when done in the newborn period
True or false - male circumcision adversely affects sexual function
false - does not appear to negatively affect sexual function
True or false - sucrose alone is appropriate analgesia for circumcision
false - non pharmacological interventions (i.e. sucrose, positioning, pacifiers) are not enough for pain control, therefore need to use analgesia , these (i.e. non pharm methods) should be adjuncts only
What is the best method of analgesia to use for the circumcision of low birth weight infants?
penile nerve blocks are the best; topical creams in this group may cause more skin irritation
What percentage of term newborns develop jaundice?
60%
What percentage of term newborns have a bilirubin level >340 umol/L
2%
jaundice very common, kernicterus very rare
kernicterus in term infants doesn’t occur until 340, and very rare until over 425 umol/L
most with kernicterus in the US registry had bili>500
also, milder bill levels (but not in the kernicterus range) may cause some impact on neuro outcome, although we aren’t sure of the details - therefore we should treat all hyperbili
Please name 9 factors that can increase the risk of acute encephalopathy in the presence of hyperbilirubinemia
- dehydration
- prematurity
- acidosis
- hypoxia
- seizures
- hyperosmolarity
- hydrops
- resp distress
- hypoalbuminemia
* *however not great evidence for this
on the nomogram, the risk factors for kernicterus are
low risk is :>38 weeks and well
medium risk is: >38 weeks and risk factors or 35-376/7 weeks and well
high risk: 35-376/7 weeks and risk factors
risk factors: 1. isoimmune hemolytic disease 2. G6PD deficiency 3. asphyxia 4. respiratory distress 5. significant lethargy 6. temperature instability 7. sepsis 8. acidosis
True or false - sepsis is common in the well appearing infant with severe hyperbilirubinemia
false - some infants with severe hyperbili are found to have sepsis, however, sepsis is uncommon in the well appearing infant with severe hyperbili
What is the estimated incidence of acute bilirubin encepalopathy in Canada? of chronic bilirubin encephalopathy
based on study - 1/10 000
2002-2004 258 Canadian babies with severe bill (excluding those with Rh disease)
5% hearing loss or severe neuro outcome at discharge, 20% at least one sign
chronic bili encephalopathy 1/100000 (similar as danish study)
acute bili encephalopathy 1st in Rh disase - now this is rare
occurs in children with other risk factors
