NICU

Question 1

CA

Answer 1

chronological age

Question 2

AA

Answer 2

age adjusted - count from baby’s due date

Question 3

Viability

Answer 3

23-24 weeks

Question 4

SGA/AGA/LGA

Answer 4

small/average/larger for gestational age

Question 5

Low birth weight (LBW)

Answer 5

3.5-5.5 lbs

Question 6

Very low birth weight (VLBW)

Answer 6

2.2-3.5 lbs

Question 7

Extra low birth weight (ELBW)

Answer 7

<2.2 lbs

Question 8

Micropreemie

Answer 8

<800g

Question 9

Apgar - HR

Answer 9

0 = absent
1 = 100

Question 10

Apgar - RR

Answer 10

0 = absent
1 = slow and irregular
2 = good, crying

Question 11

Apgar - muscle tone

Answer 11

0 = limp
1 = some flexion/extension
2 = active movement

Question 12

Apgar - Reflex irritability

Answer 12

0 = no response
1 = grimace
2 = cough or sneeze

Question 13

Apgar - color

Answer 13

0 = blue
1 = pink, blue extremities
2 = pink

Question 14

Neonatal care: main principles

Answer 14

support body temp, control infection, special care nursing

Question 15

Increase in survival 1988-2002 for VLBW/ELBW due to _____

Answer 15

antenatal steroids, aggressive resuscitation, surfactant therapy

Question 16

Nursery Level 1

Answer 16

basic care: 35-37 weeks GA

Question 17

Nursery Level 2

Answer 17

Specialty Care:

2a: >32 weeks
2b: mechanical ventilation for brief period

Question 18

Nursery Level 3

Answer 18

Subspecialty Care

3a: >28 weeks, minor procedures
3b: <28 weeks, high frequency ventilation
3c: ECMO and complex cardiac surgery

Question 19

Characteristics of Preemie

Answer 19

• extremities / and ABD
• decreased midline/flexor activity
• decreased spontaneous movements
• reflexes absent, decreased, or variable

Question 20

Medical Categories Associated with Motor Risk

Answer 20

• BW <1000g (2.2lb)
• more severe IVH
• BPD
• other prenatal events: ETOH, drugs, smoking, decreased SES

Question 21

Hypoxic Ischemic Encephalopathy (HIE)

Answer 21

• episode of asphyxia on neonate brain
• cerebral ischemia
• hypoxemia

Question 22

Periventricular leukomalacia

Answer 22

• symmetrical, non-hemorrhagic, bilateral lesion
• spastic diplegia
• most common

Question 23

Hemorrhagic infarct necrosis (PVHI)

Answer 23

• spastic/hemi/asymmetrical quad

- key: prevent fluctuating BP

Question 24

Intraventricular Hemorrhage (IVH)

Answer 24

• most common brain lesion <32 weeks

- occurs in ~40% preemies

Question 25

IVH Grades (I-IV)

Answer 25

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

Question 26

Respiratory Distress Syndrome (RDS)

Answer 26

- most common cause of distress in neonates - chest wall retraction, cyanosis, expiratory grunt, nasal flaring, tachypnea - <37 weeks - leading cause of death in preemies

Question 27

Bronchopulmonary Dysplasia (BPD)

Answer 27

- chronic lung disease of infancy - iatrogenic factors: trauma from vent, elevated 02, intubation - recovery from damage takes >1 year

Question 28

Meconium Aspiration

Answer 28

- with initial breath, causes airway obstruction that can cause resp. distress (RDS) - greater risk FT or post-term (5-15%)

Question 29

Metabolic Acidosis

Answer 29

- reduced body pH | - increased production/inadequate secretion of H+ or loss of bicarbonate in stool

Question 30

Hyperbilirubinemia

Answer 30

- increased bilirubin = blood incompatibility, physiological jaundice, blood reabsorption, infection - Kernicterus = yellow staining of brain -- high incidence mortality/LT neuro prob

Question 31

Patent Ductus Arteriosus (PDA)

Answer 31

- shunts blood from pulmonary artery to descending aorta | - normal in utero, closes shortly after birth

Question 32

Atrial Septal Defect (ASD)

Answer 32

- L to R shunting of blood | - majority close in first 3 years

Question 33

Tetralogy of Fallot

Answer 33

-VSD, pulm artery stenosis, R ventricular hypertrophy, and an aorta that overrides the interventricular septum

Question 34

ToRCH

Answer 34

toxoplasmosis, rubella, cytomegalovirus, herpes/HIV (O = other)

Question 35

Retinopathy of prematurity (ROP)

Answer 35

- high levels O2 | - heals in 1 year - left with nearsightedness/strabismus, or continue with abnormal growth

Question 36

Clubfoot

Answer 36

plantarflexion, inversion, supination

Question 37

Metatarsus varus

Answer 37

- adduction of forefoot - flexible PROM - rigid serial casting

Question 38

Tibial torsion

Answer 38

- usu. self corrects by age 8 - night brace - medial improves with time, lateral usu. worsens

Question 39

Congenital Hip Dysplasia

Answer 39

- dynamic splinting | - Barlow test