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NICU Flashcards

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1
Q

Elevated AFP

Hint RAIN

A

R. Renal (nephrosis, agenesis, pckd)
A. Abdominal wall defects
I. Incorrect dates/ multiple pregnancies
N. Neuro (ancephaly or spins bifida)

RAIN elevates the level of AFP reservoirs

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2
Q

Low AFP

A

Trisomy 21- downs

Trisomy 18- Edwards

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3
Q

The most common cause of fetal bradycardia is…….

A

Heart block

May be seen in maternal lupus

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4
Q

What is the difference in fetal medicine between a non stress test and a contraction stress test?

A

Non stress test- measures spontaneous fetal movements and HR
Measures fetal autonomic nervous system integrity

Contraction stress test- measures fetal HR in response to contractions
Measures uteroplacental insufficiency and tolerance of labor
Positive= late deceleration after 50% of contractions

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5
Q

What are the 2 components of a BPP (biophysical profile)

A

Non stress test

US

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6
Q

What are the 5 things and US measures in a BPP

A 
Fetal movement
Reactive HR
Breathing
Tone
Volume of fluid
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7
Q

What’s the difference between apnea and periodic breathing

A

Apnea lasts for longer than 20s

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8
Q

2 treatments for apnea of prematurity

A

Caffeine

Theophylline

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9
Q

What is primary apnea and how do you treat it?

A

See this post delivery
Gasping with increased depth and RR followed by apnea

Treat with stimulation
Also blow by o2

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10
Q

What is secondary apnea and how do you treat?

A

Occurs if primary apnea does not resolve

Rule of thumb is greater than 30s of apnea after delivery

More gasping apnea

Oxygen and stimulation do not help

Treat with PPV

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11
Q

How much pressure is needed to inflate the lungs with the first breath?

A

60 mmHg

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12
Q

Definition of TTN

A

Tachypnea in otherwise health infants caused by retained fetal fluid

See with CS babies

Diagnosis of exclusion
Presents in first few hours of life
Tachypnea >60
Retractions, nasal flaring, grunting

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13
Q

What does the X-ray of TTN look like

A

Fluid in the inter lobar fissures

Increased pulmonary markings

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14
Q

How long does TTN last?

A

72hrs

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15
Q

TTN treatments

A

NPO

Close monitoring

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16
Q

HIE definition/head cooling requirement

A

Apgar <5 at 10 min
Apgar <3 for longer than 5 min
pH <7
Base deficit >16

> 36 wks
< 6 HOL

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17
Q

Metabolic disturbances seen in HIE

A 
NORMAL anion gap
Elevated ammonia
Lactic acidosis
Hypoglycemia
Hypocalcemia
Hyponatremia
pH <7
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18
Q

At what weeks of development does surfactant surge?

A

33-36 wks

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19
Q

CXR in RDS

A

GROUND GLASS
granular opacifications
air bronchograms
obscure heart and diaphragm borders

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20
Q

Think of this when there is temperature instability in an infant

A

INFECTION!

GBS pna

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21
Q

what happens in children with RDS & hyperbilirubinemia

A

higher risk of kernicterus!

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22
Q

increased risk of RDS with…. (5)

A 
1- premies
2- IDM---> can interfere with the accuracy to L:S
3- CS deliver
4- birth asphyxia
5- surfactant B deficiency
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23
Q

decreased risk of RDS with…. (3)

A

1- PROM
2- antenatal steroids
3- L:S >2

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24
Q

start on vent if pH…. and PCO2…..

A

<7.2

>60

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25
what do you want your PO2 to be with RDS babies on vents/ECMO/HFOV
50-70 mmHg
26
what is the difference between prophylactic and rescue surfactant
1- prophylactic- given in first 2 HOL to babies <30 wks | 2- rescue- given later after dx RDS made
27
what does surfactant do to the following.... ____ O2 requirement ____ inspiratory pressure ____ lung compliance
decrease decrease improve/increase
28
ECMO criteria
reversible lung dz <10-14 day duration failure of other methods * no systemic or intracranial bleeding * no CHD
29
PIE definition
pulmonary interstitial emphysema cause of deterioration of babies with RDS on vents air leaks into the interstitium can end up as pneumothorax
30
what is the cause of BPD
bronchopulmonary dysplasia/chronic lung disease | arrest of nl lung development in premature infants
31
when does bilirubin peak in term infants? in premies?
3-5 DOL | 5-7 DOL
32
CXR findings with BPD
GROUNG GLASS diffuse opacities cystic areas with streaky infiltrates
33
when are mothers screened for GBS?
35-37 weeks GA
34
when do you see... early onset GBS? late onset GBS? late, late onset GBS?
first 7 days after birth ~4 weeks after birth (but up to 90d) up to 6 mos after birth (premies)
35
the difference between mothers with babies with GBS vs listeria
GBS mom often asymptomatic | Listeria mom often with flu-like illness
36
when it's OK not to tx babies with GBS+ mothers
mom adequately tx OR CS prior to ROM *if mother not adequately tx, but asym and baby asym, monitor baby for 48HOL
37
Erb's palsy
C5-7 waiter's tip- adducted, internally rotated, wrist and fingers flexed grasp intact
38
with a baby with Erb's palsy and respiratory distress- think of this
Phrenic nerve palsy | C3-5 keeps the diaphragm alive
39
klumpke palsy
C8-T1 claw hand can be associated with Horners syndrome
40
cord that stays attached >1 month... think of this (2)
1- LAD - leukocyte adhesion deficiency | 2- low WBC
41
further work up for infant with single umbilical artery
Renal US | can have associated renal dz
42
definition of SGA
<10th percentile weight for GA | < 2500 g
43
definition of LGA
>90th percentile weight for GA | >3900 g
44
Term baby
38-42wks
45
normal scalp pH
>7.25
46
hint for knowing MAP (mean arterial pressure) in premies
MAP should not be lower than corrected GA
47
definition of VLBW
<1500g
48
What does CXR look like with meconium aspiration
areas of atelectasis and areas of hyperinflation | can lead to pneumothorax (10-20%)
49
PE findings of baby with meconium aspiration
barrel chest | crackles and coarse breath sounds
50
xray findings with NEC
pneumatosis intestinalis air in the biliar tree pneumoperitoneum
51
long term complication of NEC
intestinal stricture --> obstruction
52
how long should you keep a baby NPO after NEC
~3 wks
53
treatment of NEC
``` NG tube to suction NPO IVF antibiotics CBC (low plt), lyte, coags serial AXR surgery consult ```
54
this can be a nl bili within the first 24h for FT babies
<12.4
55
when is phototherapy contraindicated
1- elevated direct/conjugated bili | 2- family hx of light sensitive porphyria
56
causes of increased enterohepatic circulation leading to jaundice (5)
``` hirschsprungs obstruction ileus pyloric stenosis meconium ileus ```
57
medications that worsen jaundice
anything that binds to albumin and displaces bilirubin -sulfonamides, ceftriaxone increased risk of kernicterus
58
causes of hyperbilirubinemia LIE and GLOW
L- lysed RBC- hemolytic dz, defects of red cell metabolism, isoimminization I- increased E- entterohepatic circulation (obstruction, ileus, pyloric stenosis, hirschsprung, meconium ileus) & Endo (hypotheyroid, hypopit) G- gilberts L- Lucy Driscoll syndrome bOth direct & indirect- galactosemia, tyrosinosis, hypermethioninemia, CF W- wasted blood- caput, bruising, petechiae, cephalohematoma, swallowed maternal blood
59
Exchange transfusion complications
``` imPaCT NO! Potassium high Calcium low Thrombocytopenia Volume NO! (hypovolemia) ```
60
treatment for hypoglycemia
2-3 cc/kg D10 | or glucocorticoids- hydrocortisone, prednisone
61
what labor drugs can cause hypoglycemia
tocolytics- stimulate fetal insulin
62
signs of hypoglycemia in an infant (6)
``` tachypnea jitteriness lethargy apnea cyanosis seizures ```
63
risks for IDMs (5)
``` RDS (decreased surfactant) hypoglycemia (high insulin) LGA (insulin promotes growth) polycythemia (d/t increased erythropoietin) hypoplastic L colon ``` Large body, small Left colon, Lots of RBCs
64
definition of hypocalcemiain infant
ionized ca <4.5 | ca <8.5
65
ekg change in hypocalcemia
prolonged qt
66
what do you do in an infant with hypocalcemia who has been receiving calcium replacement and continues to show signs of hypocalcemia?
give magnesium Mg and Ca are directly correlated hypoMg can cause intractable hypocalcemia that will not respond to calcium replacement until you correct magnesium
67
definition of polycythemia
>65 | tx if >70
68
yellow bananas are not sweet
jandiced kiddos are hypoglycemic
69
when does physiologic nadir for anemia occur
2-3 mos in FT kids | 1-2 mos in premies
70
what is the Apt test
test gastric aspirate for maternal blood
71
what is the cause of hemorrhagic dx of the newborn
vitK deficiency
72
what maternal drugs cause hemorrhagic dz
anticoagulants anticonvulsants antibiotics- quinolones, cephalosporins, TB meds
73
cause of neonatal seizure in first 24HOL
neonatal asphyxia
74
antiepileptic to use in neonatal seizure
phenobarbital
75
omphalocele vs gastroschisis
omphalocele is protrusion of the bowel through the umbilicus covered with a membrane! gastroschisis- bowel is not covered and protrudes through NEAR the umbilicus, not THROUGH!
76
genetic condition seen with omphalocele
beckwidth wiedmann | - also hypoglycemia, big tongue, macrosomia, ear pits, hepatoblastoma
77
caput succedaneum vs cephalohematoma
caput succedaneum- CROSSES SUTURES, boggy, soft pitting | cephalohematoma- confined, firm and tense
78
grading IVH
1- germinal matrix 2- IVH without dilitation 3- IVH + dilitation 4- parenchyma involvement
79
mother given tertbutaline for tocolysis... what is the effect on baby?
hyperinsulin & hypoglycemia
80
antenatal steroids reduce the risk of.... (3)
1- RDS 2- IVH 3- NEC
81
phenobarb and bili
decreases risk of hyperbili
82
signs of EtOH withdrawal in babies (2)
hyperactivity/irritability | hypoglycemia
83
signs of cocaine withdrawal in babies
no official withdrawal sx
84
teratogenic affects of cocaine (4)
cause vasoconstriction of placenta - cerebral infarct - limb anomalies - urogenital defects - abruption
85
babies exposed to amphetamines
irritable and agitated IUGR developmental/cognitive delays
86
babies exposed to barbituates (3)
hyperactivity/irritable hyperphagia poor suck-swallow coordination
87
opioid withdrawal in babies (7)
``` hyperirritability tremors/jitters hypertonia loose stools emesis feeding problems seizures ```
88
definition of LBW
<2500g
89
definition of VLBW
<2000g
90
definition of ELBW
<1500g
91
what is the most common cause of a single umbillical a
trisomy 18 | also need to worry about congenital anomalies, renal problems, cardiac problems
92
what is an early deceleration
decel that mirrors contractions | 2/2 head compression
93
what is a late deceleration
recovery after contraction subsides | ?uteroplacental insufficiency or acidosis
94
what does a variable decel indicate
cord compression
95
what should be the temperature in the DR
73-76 deg F (23-24 C)
96
at was GA do you have lanugo over your entire body
<32 wks
97
at was GA do you have facial clearing of lanugo
33-37 wks
98
at was GA do you have lanugo over your shoulders only
38-41 wks
99
at was GA do you have NO lanugo
>42 wks
100
at was GA are testes in canal, few rugae
28-35 wks
101
at was GA are testes in upper scrotum, anterior rugar
36-39 wks
102
at was GA are testes in lower scrotum, rugae complete
40-41 wks
103
at was GA pendulous scrotum
>42 wks
104
at was GA clitoris prominent, small labia majora
30-35 wks
105
at was GA labia majora covers clitoris
36-39 wks
106
at was GA labia majora covers minora
40 wks
107
at was GA no foot sole creases
24-31 wks
108
at was GA 1-2 foot sole creases
32-33 wks
109
at was GA 2-3 foot sole creases
34-35 wks
110
at was GA 2/3 foot with sole creases
36-37 wks
111
at was GA foot sole creases to heel
>38 wks
112
what is the dx? newborn with subcutaneous fat necrosis
hypercalcemia
113
what is the dx? newborn with cutis congenita aplasia
trisomy 13
114
findings on path with etox?
eosinophils
115
findings on path with pustular melanosis?
neutrophils
116
what is the dx? newborn with cyanosis that resolves with crying
choanal atresia think CHARGE babies are obligate nose breathers
117
what is the dx? newborn with single upper middle tooth
GH deficiency | midline defect
118
what is the most common congenital cyanotic heart disease
Transposition
119
what is the dx? and infant with a "doughy" distended abdomen, bilious emesis, and intraabdominal calcifications on KUB
meconium peritonitis complication of meconium ileus
120
at what wavelength of light is most effective for phototherapy
450 nm | want 460-490

NICU (1 decks)

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