Neonates Flashcards
(28 cards)
Describe the appropriate setting for a T piece device in neonatal resuscitation
PIP 30 cm H20
PIP 20 - 25 cm if <32 weeks
PEEP 5-8 cm H20
Describe the rules for calculating ETT size and depth
Rough guide to size = gestation divided by 10
Depth at lips = weight + 5.5 - 6
Describe the appropriate dosing of adrenaline during neonatal resuscitation
Intravenous: 0.1 - 0.3 mls/kg of 1/10,000 adrenaline
= 10 - 30 mcg / kg
If via ETT 0.5 - 1 ml /kg of 1/10,000
= 50 - 100 mcg/kg
What is the formula for calculating tidal volume in a newborn infant?
4-6 ml/kg in a newborn
In what scenarios might a pedicap remain yellow in both inspiration and expiration?
Contamination with adrenaline
Contamination with gastric juices
Contamination with surfactant
Exposure to high humidity
An ex 27/40 infant at day 9 of life develops fresh blood PR, abdominal distension and bilious aspirates associated with temperature instability.
You suspect NEC
Using Bell Grading, what rating would you ascribe
Answer = 1B
See table attached
Essentially - suspected, proven, advanced
Fresh blood PR gets you from 1A to 1B
Pneumatosis/other radiological signs gets you to II
Ascites/mass/abdominal cellulitis gets you to 2B
Hypotension/bradycardia gets you to 3
Pneumoperitoneum gets you to 3B
Which of the following factors is NOT associated with NEC?
a. absent or reversed end-diastolic flow on antenatal ultrasound
b. early introduction of enteral feeds
c. PDA
d. intestinal dysbiosis
e. assisted ventilation
Answer = B. Early introduction of enteral feeds not associated with NEC in trial discussed in Auckland Neonatal lecture 1
Which of the following is a risk factor for short gut syndrome in neonates with surgically managed intestinal conditions?
a. pre-term at time of surgery
b. NEC as cause
c. Low plasma citrulline level
d. retained ileocaecal valve
answer = C (low plasma citrulline) - linear association with bowel retained
NEC protective vs congenital (likely to have had normal bowel at birth vs congenital)
Pre term protective - more growth potential
IC valve good - slows transit time
SB 258 cm +/- 40 cm at term
What factor provides the greatest impetus for closure of the PDA
a. systemic O2 saturations
b. decreased prostaglandin
c. increased pulmonary blood flow
d. sympathetic stimulation
A = O2 saturations is correct
Which of the following conditions does pre term administration of caffeine NOT protect against?
a. CLD
b. cerebral palsy
c. retinopathy of prematurity
d. NEC
Answer = D
Doesn’t protect against NEC
See image re CAP trial
What is the most serious potential complication of oligohydramnios?
Pulmonary hypoplasia
In a intubated and ventilated baby, what 2 factors will determine oxygenation?
Mean airway pressure and FiO2
What are the 3 modifications it is possible to make to a ventilator to increase mean airway pressure?
- Increase PEEP (higher baseline)
- Increase PIP (higher peak)
- Increase Ti (increased proportion spent at peak)
Rate does not increase total AUC
What physiological factor determines CO2 clearance?
Minute ventilation
ie: tidal volume
When using high frequency oscillatory ventilation, what setting will most influence ventilation (and therefore CO2)
Amplitude
AKA delta P or difference between PIP and PEEP
This is the equivalent of tidal volume and determines ventilation and is the setting you would alter if CO2 is too high or low
When using high frequency oscillatory ventilation, what setting will most influence oxygenation?
Mean airway pressure (MAP)
Aim 7-9 ribs expanded
If less V/Q mismatch
If more volutrauma/decreased venous return
What type of ventilation is described below?
When used alone provides only mandatory breaths (ie: spontaneous breaths above the set rate are not supported)
SIMV
What type of ventilation is described below?
Mandatory breaths at a set rate (control breaths)
Supports spontaneous breaths above the set rate (assist breaths)
Breath limitation (ie: support) is the same regardless of whether it is a assist or control breath
PC-AC / SIPPV
What is the ANZCOR recommendation regarding delayed cord clamping for infant born at less than 34 weeks?
From the ANZCOR guideline:
For infants born at less than 34 weeks’ gestational age who do not require immediate
resuscitation after birth, ANZCOR suggests deferring clamping the cord for at least 30 seconds.
42 [Weak recommendation, low certainty of evidence]
What is the ANZCOR recommendation for delayed cord clamping in neonates born at 34 weeks gestation or later?
For term and late preterm infants born at ≥34 weeks’ gestation who are vigorous or deemed
not to require immediate resuscitation at birth, ANZCOR suggests later (delayed or deferred)
clamping of the cord at ≥ 60 seconds. 41 [Weak recommendation, very low certainty of evidence]
Which of the following summaries regarding HFOV vs conventional ventilation are correct?
a. HFOV is associated with decreased air leak, but increased CLD
b. HFOV is associated with decreased CLD, but increased air leak
c. HFOV is associated in a reduction of both air leak and CLD
d. CMV is associated with a reduction in both air leak and CLD
Correct answer is B
Answer is very general
Cochrane review suggested that there may be decreased CLD, but that evidence across studies is inconsistent
Possibly offset by an increase in air leak
Which of the following is NOT a potential adverse effect of iNO?
a. hypotension
b. methemoglobinaemia
c. impaired platelet function
d. airway irritation
A - hypotension should not occur
What form of cerebral palsy is periventricular leukomalacia most commonly associated with?
Spastic diplegia
What grade is this IVH?
1 - haemorrhage confined to the germinal matrix/subependymal area
