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Flashcards in NICU Deck (75):
1

Management of temperature instability in a newborn

- Plastic wrap
- Radiant heat source
- Incubator with heat and humidity (40-60%)
- Continuous monitoring of the infant’s temperature to avoid hypothermia

2

Prevention of IVH in newborn

- Avoid operative delivery (forceps/vacuum)
- Avoid clinical instability (acidosis, hypoxia, hypotension) – fluctuations in BP or Pco2 can impact development of IVH
- Antenatal corticosteroids (decrease risk of death, grade II and IV IVH and PVL)
- Prophylactic administration of low-dose indomethacin (0.1 mg/kg/d x 3 ds) for VLBW preterm infants – reduces severe IVH
- “Neuroprotection” – head midline, cluster handling

3

Initial fluids for pre-term infant

D10W at 80 cc/kg/day

4

Prevention of RDS

- Antenatal corticosteroids to infants 24-32 weeks GA
- Intrapartum fetal monitoring (to reduce risk of asphyxia – associated with worse RDS)

5

Prevention of ROP

Minimize exposure to inspired O2

6

Retinal angiogenesis begins..and ends...

begins at 16 weeks GA and ends by 40 weeks

7

Most common type of craniosynostosis

Scaphocephaly - sagittal suture fusing prematurely (80% of cases in males)

8

Complications of being post-dates (3)

(1) Fetal macrosomia
(2) Meconium aspiration
(3) Shoulder dystocia

9

Most common cause of sensorineural hearing loss

Genetic causes (50%) - usually bilaterally (others include infections [e.g., CMV, toxoplasmosis, congenital rubella, congenital syphillis] and anatomic)

10

Features of Noonan syndrome

Common findings include a short webbed neck, chest deformity (pectus excavatum), cryptorchidism, intellectual disability (mental retardation), bleeding diathesis, and lymphedema (puffy hands and feet); cardiac defects: pulmonic stenosis and hypertrophic cardiomyopathy
ALSO: Hypotonia in neonatal period

11

Presenting features of PUV

Abdominal distension due to enlarged overdistended bladder or urinary ascites, difficulty with voiding, or a poor urinary stream, failure to thrive, urosepsis, poor urinary stream, and straining or grunting while voiding

12

Appearance of erythema toxicum

Multiple erythematous macules and papules (1 to 3 mm in diameter) that rapidly progress to pustules on an erythematous base

13

Marijuana use and breastfeeding?

Not enough evidence. Existing evidence suggest THC excreted into breast milk in moderate amounts.

14

Effects of twin-twin transfusion syndrome

Recipient twin: CHF, hydrops, polycythemia, respiratory issues
Donor: hypovolemic, hypoglycemic

15

Nerves involved in Erb's palsy

Brachial plexus: C5-T1
Erb's palsy: C5,C6 +/- C7

16

Features of Erb's palsy

Asymmetric Moro
Absent biceps reflex
Intact grasp
No wrist extension

17

Red flags for sacral dimple

>0.5cm
Above gluteal crease (>2.5cm from anus)
Multiple dimples
Associated with patch of hair, hemangioma
(looking for spina bifida occult)
Neurological findings

18

Duration of risk for hypoglycaemia in neonates

LGA, IDM = 12 hours
SGA = 36 hours

19

Period of time after which you can stop resuscitating neonate with no heart rate

10 minutes

20

Most common cause of hypertension in a newborn

Renovascular - accounts for 50% of cases of hypertension in neonates, including thrombi related to UV lines

21

Indications for LP in newborn

Unwell baby
WBC <5

22

GBS prophylaxis with penicillin allergy

History of anaphylaxis - clindamycin or erythromycin
No history of anaphylaxis - cefazolin
(cefazolin preferred)

23

Components of Sarnat staging

Level of consciousness, tone, reflexes, seizures (yes/no)

24

Reason for giving babies irradiated blood?

To prevent GVHD

25

In preterm babies, are vaccines given based on corrected or chronological age?

Chronological age

26

What are the criteria for cooling in HIE?

TWO of the following:
1. Apgars 16 within first hour
*and*
Sarnat stage II or III (moderate or severe) encephalopathy

27

Who are antenatal steroids indicated for?

< 34 weeks, improve lung development, decrease IVH/NEC/mortality

28

Indication for MgSO4

< 32 weeks - neuroprotection, decrease rates of CP

29

CNS finding in congenital CMV

periventricular calcifications

30

Electrolyte abnormalities in IDM

hypocalcemia, hypoglycemia

31

Vit K recommendations

< 1500 g = 0.5 mg
> 1500 g = 1 mg
can give oral alternative (2mg at first feed, repeat at 2-4 weeks and 6-8 weeks)

32

When does apnea of prematurity resolve?

Can last up to 44 weeks, up to 20% of preterm infants can still have apnea/bradycardias at corrected term GA

33

What is kernicterus?

Pathologic yellow staining of basal ganglia

34

Syndromes that affect the bilirubin conjugation enyzme (UGT1A1)

Crigler-Najjar

Gilberts

35

Recommended time and method to do a bilirubin check in a newborn infant?

within 72 hrs, serum or transcutaneous level

36

What is VACTERL

Vertebral anomalies
Anorectal
Cardiac
Trachoesophageal fistula
Renal
Limb anomalies

37

Most common type of TEF

Distal fistula, esophageal atresia

38

TEF is associated with what risk factors

advanced maternal age
obesity
low SES
smoking

39

Most common anomaly associated with omphalocele

cardiac! (TOF)

40

Most common anomaly associated with gastroschesis

intestinal atresia

41

Neonatal hypocalcemia. What other electrolyte abnormality should you look for and treat?

Hypomagnesemia

42

Risk factors for neonatal hypoglycemia

SGA < 10%
LGA > 90%
IDM
preterm < 37 wks
Perinatal asphyxia

43

LGA infant. Blood glucose 2.0 at 2 hrs of age. What do you do?

Feed, recheck in 1 hr

If > =2.6, continue usual care
If < 2.6, consider IV tx

44

GIR of TFI 80 cc/kg/day of D10W

5.5 mg glucose/kg/min

45

SGA infant. blood glucose 2.3 before their 3rd feed. What do you do?

refeed, check glucose in 1 hr

If >= 2.6, continue usual care
If < 2.6 consider IV tx

46

LGA infant. blood glucose 1.6 at 2 hrs of life. What do you do?

Consider IV treatment!

47

At what GIR should you think of hyperinsulinism?

GIR >10

48

Three medications used to manage hyperinsulinism?

Diazoxide
Octreotide
Glucagon

49

Most common cause of CAH? What is the lab test to confirm this?

21-hydroxylase deficiency

Test: 17-OH-progesterone

50

Side effects of inhaled nitric oxide?

NO2 and methemoglobin production

51

Bronchopulmonary sequestration typically occurs in what lobe

LLL

52

Congenital lobar emphysema typically occurs in what lobe

LUL

53

Syndromes associated with CDH

T13, T 18, T21, Turners

54

Common cause of elevated TSH after birth?

Measurement of sample < 24 hrs of life (all babies have peak in TSH)

55

Most common cause of hemolytic disease of the newborn

ABO incompatibility

56

Definition of polycythemia

Hct > 0.65

57

When would you consider an exchange transfusion for polycythemia?

Hct > 0.7 (asymptomatic)
Hct > 0.65 (symptomatic - signs of hyperviscosity)

58

Baby with hirschprungs failed hearing screen. What syndrome do you suspect?

Waardenburg

59

Definition of ophthalmia neonatorum

conjunctivitis occurring in first 4 weeks of life, regardless of bug

60

Metabolic abnormalities associated with subcutaneous fat necrosis

hypercalcemia
hypoglycemia
thrombocytopenia

61

Overlapping fingers, microcephaly, rocker-bottom feet

Edwards syndrome T18

62

Midline cleft lip, polydactyly, scalp abnormalities, microcephaly, hypoplastic/absent ribs

Patau syndrome T13

63

Role of MgSO4 for mom of preterm infant

Should give to mom if < 32 wks GA

Neuroprotection, decreases risk of CP

64

What is an illegal substance that protects against RDS?

Heroin!

65

Two medications you would give a 3 week old baby presenting with ICH (hemorrhagic disease of the newborn)

FFP
Vit K

66

FiO2 for PPV in baby 36 weeks GA

21% (>=35 wks)

67

FiO2 for PPV in baby 34 wks GA

21-30% (< 35 wks)

68

FiO2 when doing chest compressions

100%

69

Best way to assess HR during compressions

ECG monitoring

70

You are providing PPV to a newborn. When do you assess the HR?

after 15 s of PPV

71

Estimate of depth of ETT?

nare to tragus length

72

When you are doing compressions, when do you reassess HR?

after 60 seconds

73

Most common type of craniosynostosis

Scaphoscephaly

74

What measurements constitute an atypical sacral dimple?

> 5mm in size, > 2.5cm from anal verge

75

When do you screen for ROP?

at 31 weeks CGA or 4 weeks GA, whichever is LATER