NICU Flashcards

Question

Breastfeeding jaundice @ 3 weeks. Mom A+, baby O+. Gaining weight. a) Breastmilk jaundice b) ABO incompatibility

Answer 1

ABO incompatible

Answer 2

) Decreases mortality from RDS a) Increases the risk of IVH (no, antenatal corticosteroids decreases risk of IVH)

Answer 3

a) 5 days According to lecture, long half-life of methadone means onset of symptoms can be delayed to 4-5 days

Answer 4

a) Start PGE | Failed repsonse to 100% O2 makes this more likely cardiac; age of presentation also makes sense

Answer 5

3lb = 1.36 kg - therefore (assuming term) symmetric SGA with microcephaly Pre-eclampsia Fetal effects if placental insufficiency issues - has to be severe and usually get head sparing Maternal infection Likely TORCH infection Smoking: Increases risk miscarriage, stillbirth, preterm birth, low birth weight, placental abruption/previa

Answer 6

GA Who should not be cooled? Evidence of severe head trauma or intracranial bleeding Currently no published studies showing that cooling infants >6 h of age or <36 weeks’ gestational age is beneficial Initiation of cooling for infants with very severe encephalopathy, congenital anomalies or abnormal chromosomes is best performed in consultation with a tertiary centre

Answer 7

a) Neural tube defect Some folic acid antagonists that have been linked to an increased risk of NTDs include valproic acid, carbamazepine, and methotrexate

Answer 8

b) Respect their decisions for resuc Given the lack of moral authority on the suggested level of care, parents may choose a nonrecommended option. Health care professionals (HCPs) should engage with them to determine their infant’s management plan.

Answer 9

Start intensive photo and recheck bili in 6 hours IVIG may reduce the need for exchange transfusion in infants with hemolytic disease caused by Rhesus (Rh) or ABO incompatibility

Answer 10

3,4 APGARS activity, pulse, grimace, appearance, resp

Answer 11

partial exchange Defined as central hematocrit 65% or higher in peripheral venous sample Higher in capillary samples therefore confirm with venous Some also define Hgb >220, but Hct more clinically relevant Causes: DCC, intrauterine hypoxia, TTTS, placental insufficiency, LGA babies, IDDM, endocrinopathies Exaggerated by dehydration Asymptomatic (UTD) Hct 0.6 - 0.7: monitor, adequate hydration (supplement if needed), blood glucose monitoring, bilirubin check, repeat CBC in 12-24 hours Hct >0.7: consider IV hydration Hct >0.75: partial exchange transfusion *Nelson’s says PET should be considered if the Hct is >0.7-0.75, or lower if symptomatic Symptomatic IV hydration PET if worsening symptoms or Hct >0.7-0.75 Infants that get PET are at increased risk of NEC

Answer 12

10min An Apgar score of 0 at 10 minutes is a strong predictor of mortality and morbidity in late preterm and term infants. We suggest that, in infants with an Apgar score of 0 after 10 minutes of resuscitation, if the heart rate remains undetectable, it may be reasonable to stop assisted ventilation; however, the decision to continue or discontinue resuscitative efforts must be individualized.

Answer 13

Hypercalcemia, a potentially life-threatening complication of SCFN, occurs in approximately 36 to 56 percent of affected neonates. Hypercalcemia may be asymptomatic or may present with irritability, hypotonia, anorexia, or vomiting Google subcutaneous fat necrosis - this picture comes up! CFN most often develops in full-term (>37 weeks gestational age) neonates who have experienced hypoxia or other perinatal stress. Therapeutic hypothermia with cooling of the body or head for neonatal asphyxia is an additional risk factor serum calcium levels must be monitored for several months after the diagnosis.

Answer 14

gluteal cleft deep and large (greater than 0.5 cm), fall within the superior portion or above the gluteal crease (>2.5 cm from the anal verge), or are associated with other cutaneous markers for NTDs (eg, hypertrichosis, and discoloration), are more likely to be associated with an underlying NTD

Answer 15

OBSERVE Well infant, GBS negative/unknown with no other risk factors Routine newborn care One other risk factor (ROM > 18 hours or maternal fever Adequate IAP - routine newborn care Inadequate IAP - VS q3-4h for min 24 hours Multiple risk factors or chorio (no matter what the IAP) Individualized care, minimum VS q3-4h x24 hours CBC at 4 hours of life may be helpful

Answer 16

renovascular

Answer 17

do it if <31w or <1250g at birth ANSWER-33 weeks 31 weeks or 4 weeks PNA, which ever is later

Answer 18

d) Continue to monitor glucose every 3-4 hours for the next 12 hours. @2 hours if BG > 2.0 can continue checking. If 1.8-2.0 then feed and recheck in 1 hour. If <1.8 then initiate IV dextrose. Since baby is LGA, checking should continue for 12 hours; if SGA 36 hours.

Answer 19

breastfeeding

Answer 20

GA need to be >36w or <6h Criteria A Any two of the following: Apgar score <5 at 10 min of age. Continued need for ventilation and resuscitation at 10 min of age. Metabolic acidosis with pH <7 or base deficit >16 mmol/L in cord or arterial blood gases measured within 1 h of birth. + SARNAT 2 or 3 wiht seizures, OR at least one sign out of 3 categories/6 cateogries

Answer 21

No further intervention and it will resolve spontaneously in 2-12

Answer 22

counsel to stop mariguana as risk unknown for baby

Answer 23

CHF recipeint, polyhydramios, hydrop,s plethoric, LGA, polycythemic, hypervolemic, cardiac hypertrophy, myocardial dysfunction, RVOT, artertial thick walls

Answer 24

intact grasp reflex adduction and internal rotation of the arm with pronation of the forearm. In erb’s palsy C5+ C6 - there is assymetric Moro, and absent biceps reflex they can still extend forearm and have hand grasp When C7 is additionally involved in upper palsy, there is also flexion of the wrists and fingers (C7 controls finger extension). - cant extend wrist

Answer 25

85 week 1-resp support 115/no resp support 100 week 2 100/85 week 4 85/75

Answer 26

sarnat 1 alertness, muscle tone, seizures, pupils, resp, duration (<24h)

Answer 27

prevent gvhd

Answer 28

needle the chest

Answer 29

weight PLUS bili check 24 hours

Answer 30

Bag-mask ventilation in 100%O2

Answer 31

Hypernatremia due to breastfeeding dehydration

Answer 32

neonatal hepatitis neonatal hepatitis, which can occur in either a sporadic or a familial form, is a disease of unknown cause. Patients with the sporadic form presumably have a specific yet undefined metabolic or viral disease. Familial forms, on the other hand, presumably reflect a genetic or metabolic aberration.

Answer 33

a. ABO incompatibility

Answer 34

c) Decreases mortality from RDS

Answer 35

5 days heroin exposure causes earlier and shorter withdrawal, whereas methadone and buprenorphine exposure lead to later onset and longer withdrawal. Of the nonopioids, methamphetamines cause immediate withdrawal, psychotropic medications usually induce transitional and self-limiting

Answer 36

maternal infxn symmetric (head circumference, length, and weight equally affected) or asymmetric (with relative sparing of head growth) Symmetric IUGR often has an earlier onset and is associated with diseases that seriously affect fetal cell number, such as conditions with chromosomal, genetic, malformation, teratogenic, infectious, or severe maternal hypertensive etiologies.

Answer 37

Asymmetric IUGR is often of late onset, demonstrates preservation of Doppler waveform velocity to the carotid vessels, and is associated with poor maternal nutrition or with late onset or exacerbation of maternal vascular disease (preeclampsia, chronic hypertension).

Answer 38

b) Respect their decisions for resuc At 23, 24 or 25 weeks’ GA, counselling about outcomes and decision making around whether to institute active treatment should be individualized for each infant and family. (Strong Recommendation) At 23 and 24 weeks’ GA, active treatment is appropriate for some infants. (Weak Recommendation)

Answer 39

symptoms will be chronic and require surgery

Answer 40

within first week CLASSIC

Answer 41

O2 as required (as per Nelson’s oxygen is first line, CPAP if ongoing/increasing WOB; Danielle’s group chose this) b. CPAP (as per lecture, pathophysiology of TTN would need distending pressure)

Answer 42

broad spectrum abx cessation of feeding, nasogastric decompression, and administration of intravenous fluids.

Answer 43

continous suction and surgery Prone positioning minimizes movement of gastric secretions into a distal fistula, and esophageal suctioning minimizes aspiration from a blind pouch. Endotracheal intubation with mechanical ventilation is to be avoided if possible because it can worsen distention of abdominal viscera. Surgical ligation of the TEF and primary end-to-end anastomosis of the esophagus are performed when feasible

Answer 44

Bilateral choanal atresia neonates are obligate nasal breathers Classic finding is pink when crying (because breathing through mouth) and blue when settled

Answer 45

g6pd All mothers should be tested for ABO and Rh(D) blood types and be screened for red cell antibodies during pregnancy. If the mother was not tested, cord blood from the infant should be sent for evaluation of the blood group and a DAT (Coombs test) Blood group evaluation and a DAT should be performed in infants with early jaundice of mothers of blood group O Selected at-risk infants (Mediterranean, Middle Eastern, African or Southeast Asian origin) should be screened for G6PD deficiency A test for G6PD deficiency should be considered in all infants with severe hyperbilirubinemia

Answer 46

f/u in 24h for rep bili & wt check

Answer 47

6w In most cases, the initial symptoms of NHSV infection present within the first four weeks of life. Occasionally, disease presents for the first time between four and six weeks after birth.

Answer 48

washed maternal plt Neonatal alloimmune thrombocytopenia is caused by the transplacental transfer of maternal autoantibodies directed against antigens present on the fetal platelets (antigens shared with father). · Consider NAIT in an apparently well child who within the first few days after delivery has generalized petechiae and purpura. · Lab: normal maternal platelet count

Answer 49

CBC and observe 24 hours

Answer 50

start therapy TSH> 17 is elevated If TSH 17-40, then repeat TSH with free T4 If TSH >40 repeat the labs first to confirm the diagnosis start thyroxine immediately and organize imaging.

Answer 51

refer · Brachial plexus injuries present as flaccid paralysis of the arm at birth, can arise from injuries from C5-T1 · 75% of infants will demonstrate full recover within first month, while 25% will have residual effects · incomplete recovery by 4 weeks of life suggests that full recovery in unlikely · incomplete recovery by 4 weeks of life warrants referral to a multidisciplinary brachial plexus team including neurologists, plastic surgeons, physio, rehabilitation therapists.

Answer 52

?CXR - Brachial plexus injuries are clinical diagnoses. · Not moving arm: total paralysis therefore all nerve roots from C5-T1 involved · Can be associated with phrenic nerve palsy: if newborn with brachial palsy has tachypnea and requires oxygen, possibility of phrenic nerve involvement increases and US of hemidiaphragmatic movement can be indicated. Diagnosis made with chest radiograph

Answer 53

Heart failure (as per lecture, donor twin has high output heart failure)

Answer 54

c. Hyperinsulinism Risk factors for hyperinsulinism are SGA, HIE, premature newborns, IUGR, pre-eclampsia. Most common cause of persistent hypoglycemia in early infancy

Answer 55

cf Late (2-8 weeks of life) · Disorders that result from the malabsorption of vitamin K (biliary atresia) · Cystic fibrosis, primary cholangitis, BA, celiac disease contribute to fat malabsorption, since Vit K is a fat soluble vitamin, pts with these conditions can become vitamin K deficient.

Answer 56

Congenital lobar emphysema Distention of the affected lobe, mediastinal shift, compression and atelectasis of the contralateral lung. Diaphragm often flattened because of hyperinflation. · Congenital lobar emphysema usually arises from progressive lobar hyperinflation secondary to obstruction of the developing airway.

Answer 57

``` C5,C6,C7,C8, T1 horners syndrome (miosis and ptosis). ```

Answer 58

a. Insertion of orogastric catheter Espophageal atresia presents with frothing and bubbling at the mouth and nose after birth as well as episodes of coughing cyanosis and respiratory distress. inability to pass an orogastric tube or nasogastric tube suggests esophageal atresia.

Answer 59

furosemide nephrocalcinosis: calcium salt formation and aggregation within the renal tubules · Loop diuretics à increased PO4 excretion + decreased calcium resorption à increased RF of nephrocalcinosis. · Acetazolamide can be used to improve calcium and phosphate excretion in babies receiving loop diuretics. · Thiazide (reduces Na resorption in the distal loop of Henle but also increases Ca resorption)

Answer 60

run d10 IV 80cc/kg/d Natural trough in BG at 1-2 hours post delivery, infants at risk should be screened at 4-6 hours of age · IDMs experience asymptomatic hypoglycemia at 1 hour of age – this population should be screened earlier · LGA and IDMs do not require further screening if BG > 2.6 mmol · Preterm and SGA infants may be vulnerable up to 36 h of age. Screening for preterm infants and SGA infants can be discontinued after 36 hours of age (if BG maintained > 2.6 mmol)

Answer 61

Start D10W at 80cc/kg/day

Answer 62

Phototherapy and repeat bili in 6 hours – this question does not specify that there is significant lethargy, isoimmune hemolytic disease, G6PD, asphyxia, resp distress, sepsis, acidosis which would warrant using the high risk curve (high risk cut off for exchange transfusion is 270)

Answer 63

IV fluids and prepare for exchange transfusion healthy newborns, exchange transfusion should be considered when TSF concentration 375-425 Risk factors: isoimmune hemolytic disease, G6PD deficiency, asphyxia, respiratory distress, significant lethargy, temperature instability, sepsis, acidosis · Exchange transfusion level for medium risk (35-37+6 and well) is 290 · Exchange transfusion level for high risk (35-37+6 and risk factors) is 270.

Answer 64

exchange 400 for low risk 300 high risk photo 250 low risk 350 high risk

Answer 65

. Mom’s blood for fetal hemoglobin

Answer 66

morphine Clinical signs of NAS reflect dysfunction in 4 domains: control and attention, motor and tone control, sensory integration and autonomic functioning.

Answer 67

needle Emergent treatment without CXR confirmation if unresponsive to resuscitation efforts, asymmetric breath sounds, bradycardia, cyanosis. Needle thoracentesis followed by chest tube for definitive management.

Answer 68

needle thoracentesis

Answer 69

persistant apnea of prematurity Apnea of prematurity usually resolves by 37 weeks of postconceptal age, may persist beyond term gestation particularly in extremely preterm infants (GA < 28 weeks) does not predict SIDS

Answer 70

a. Keep baby in hospital for 24 hours and then reassess

Answer 71

observe till 24 h

Answer 72

b. Polyethylene bag, stimulate, suction baby. Polyethylene bag-<32 weeks

Answer 73

b. Administer Phenobarbital 20 mg/kg bolus Age 1-4 days · HIE: most common cause of neonatal seizures. 50-60% of patients, seizures secondary to encephalopathy usually occur within the first 12 hours of birth · Vascular events: IVH, ischemic strokes 10-20% of patients. · Infection: TORCH, meningitis, herpes encephalitis

Answer 74

methadone TX- morphine/methadone and buprenorphine treat NAS) valproate - inc neural tube defect lithrium- ebstein anomaly - TV changes, cardiomeg, GI bleed,hypo, HSM, DI, cocaine- sx 48-72 hrs, present upto 7 days

Answer 75

sneezing with metahdone

Answer 76

CAH: hyponatremia with hyperkalemia RTA: affects H+/K+ transporter, hyper/hypokalemia, acidosis, hypocalcemia/hyperchloremia Cl = 120 is high - maybe they remembered wrong since all the other ones had normal Cl

Answer 77

resuscitation is based on parental wishes

Answer 78

c. The parents’ wishes should be supported whether they want to resuscitate or not. 22GA or 24GA with weight 350g - PALLIATION RECC 23-34w, 25w GA with aneimial or abn placental care - both icu or pallaition concisdered 25GA, 24 and well growth, ICU recc

Answer 79

PLA-1 negative platelets/ Human platelet antigen neg if NAIT is anticipated, the mother's platelets can be collected prior to delivery and used for transfusion. Maternal platelets need to be concentrated, however, in order to reduce the amount of antibody-containing serum given to the neonate. Otherwise, donor platelets that are typed and matched for the patient can be used.

Answer 80

b. transfuse PLA-1 negative platelets

Answer 81

CHD who have congenital heart disease or congestive heart failure appear to be at increased risk for the development of hypoglycemia. The pathogenesis of hypoglycemia is unclear, although perhaps decreased hepatic perfusion compromises the rate of glucose production ?Beckwith-Wiedmann syndrome - ?? hypoglycemia, cardiomegaly?

Answer 82

flow inflating bag with oxygen Air (21% oxygen) is recommended as the initial gas for all babies, with the exception of very preterm (< 32 weeks) babies in whom supplemental oxygen (between 30% and 90%) Self-inflating resuscitation bags, even without a reservoir, can deliver higher concentrations of oxygen than previously suggested

Answer 83

anesthesia bag - connected to oxygen >35w GA 21% <35w GA 21-30%

Answer 84

flow inflating bag with o2 source

Answer 85

rpt screen Repeat TSH, T4 for all high TSH results. If low T4, high TSH, start treatment. If normal, transient hypothyroidism (maternal antithyroid meds or antibodies). Normal T4 with high TSH needs more repeats.

Answer 86

echo r/o VACTERL ``` vetrebal abn anal cardiac TE renal abn limb abN ```

Answer 87

``` coloboma Heart dect atresia of choanae genital abn Ear - deafness ``` CHD7 mutation

Answer 88

maternal opioids

Answer 89

Erb's Palsy (C5-C6): loss of sensation in the arm and paralysis and atrophy of the deltoid, biceps, and brachialis muscles.[8] The position of the limb is characteristic: the arm hangs by the side and is rotated medially; the forearm is extended and pronated. The arm cannot be raised from the side; all power of flexion of the elbow is lost, as is also supination of the forearm asx moro with notic neck and absent bicep relfex, RISK of phrenic nerve

Answer 90

Treatment: supportive, positioning, ROM exercises, nerve grafting if persistent

Answer 91

“if there is no heart rate after 10 minutes of complete and adequate resuscitation efforts, and there is no evidence of other causes of newborn compromise, discontinuation of resuscitation efforts may be appropriate

Answer 92

barotrauma or oxygen toxicity

Answer 93

weight and r/a in 24 hours | FALLS high intermediate, if DAT NEG, then routine care, if DAT + then f/u 24-48h

Answer 94

intesnive phototherapy

Answer 95

fu 24 hours

Answer 96

. thyrotoxicosis Neonatal thyrotoxicosis from maternal transfer of thyroid stimulating antibodies. The prevalence of Grave's disease in pregnancy is 0.2%.

Answer 97

thyrotoxicosis

Answer 98

flow inflating bag connected to oxygen source

Answer 99

rpt screen with a t4

Answer 100

dec mortality secondary to RDS

Answer 101

increase sedation

Answer 102

will have good neurological outcome

Answer 103

will resolve with no tx

Answer 104

staph epi (coag NEG)

Answer 105

coag NEG staph

Answer 106

cord bilirubin Amniocentesis was classically used to assess fetal hemolysis. Hemolysis of fetal RBCs --> hyperbili before anemia. Bili is cleared by the placenta but enter the amniotic fluid and can be measured by spectrophotometry Maternal titres - presence of elevated Ab titers or a rapid rise suggests significant hemolytic disease but exact titre correlates poorly with disease severity

Answer 107

bili in cord

Answer 108

LOW PROB most cases of cerebral palsy are related to an event occurring before labour Spastic diplegia (35% of cases) is usually caused by PVL associated with prematurity, ischemia, infection or endocrine/metabolic causes Neonatal signs consistent (not necessarily diagnostic) with an acute peripartum or intrapartum event: Apgar score of <5 at 5 minutes and 10 minutes. Fetal umbilical artery pH <7.0, or base deficit ≥12 mmol/L, or both. Neuroimaging evidence of acute brain injury seen on brain MRI Presence of multisystem organ failure consistent with systemic hypoxic-ischemic insult.

Answer 109

sucking blister Intact blisters or erosions may be found on the forearm, wrist, hands or fingers. They resolve within a few days. Suckling ‘blisters’ are firm swellings on the upper lip and are a hyperplastic response to suckling.

Answer 110

PLA1 neg PLT >50 = no therapy, repeat a few days later  - PLT <50 = infuse maternal PLT into baby, if available, or request CMV-negative, irradiated, PLA1–negative PLT (may give random donor PLT and IVIG while waiting), check PLT count 1h after transfusion and obtain head US to rule out ICH  - Measure PLT q6h × 24h, then q2d once stable  - Consider IVIG in neonates who require repeated PLT transfusions 

Answer 111

right away start acylvor A is true if it’s mother’s first episode (IV acyclovir x10d and swab mucous membranes before acyclovir is started), but if recurrent episode, would just swab mucous membranes at 24 hours (CPS Statement - Neonatal HSV) Mucous membrane swabs should be obtained from the mouth, nasopharynx, and conjunctivae at least 24h after delivery (additional swabs may be obtained, ex. from sites of scalp electrodes) If swab negative = 10 days If swab +ve, blood and CSF neg = 14 days If swab +ve, blood OR CSF pos = 21 days If she has recurrent disease swab at 24 hours and only treat if positive If swab +ve and CSF and blood neg = 14 days If swab +ve and CSF or blood pos = 21 days

Answer 112

CHECK GLUCOSE AT 2 HRS AND EVERY 3-6 HOURS (BEFORE FEEDS) AS LONG AS INFANT REMAINS WELL, UNTIL FEEDS ARE ESTABLISHED AND GLUCOSE ≥2.6 mmol/l <1.8 mmol/L or <2 mmol/L on subsequent checks, consider IV treatment 1.8-2 at 2 hrs of age or 2-2.5 mmol/L at subsequent checks, refeed and check in an hr >2 at 2 hrs of age, or >2.6 mmol/L at subsequent checks → routine care

Answer 113

refeed and check in 1 hour

Answer 114

vreastfeed

Answer 115

``` Important distinction Neonatal ALLOIMMUNE (NAIT) - give PLA-1 negative platelets (or washed maternal) ``` ``` Neonatal AUTOIMMUNE (ITP) - give IVIG the matenral plt is LOW took ```

Answer 116

cardiogenic

Answer 117

cardiogenic

Answer 118

congenital lobar emphysema

Answer 119

apnea of prematurity

Answer 120

preterm on vnentliation with fi02 50%

Answer 121

needing fi02 or 50%, can rpt q2h Intubated infants with mec aspiration syndrome requiring more than 50% oxygen should receive surfactant - Infants who are at significant risk of RDS should receive prophylactic natural surfactant as soon as stable within a few minutes after intubation - Infants with RDS who have persistent or recurrent oxygen and ventilatory requirements within the first 72h of life should have repeated doses of surfactant but administering more than 3 doses has not been shown to have a benefit -infant outside tertiary <29w

Answer 122

bagging erspiratory depression from opiates should be treated with narcan (0.1 mg/kg) IV or IM but this is contraindicated in infants born to mothers with opiate addiction as it may precipitate acute neonatal withdrawal with seizures. Artificial respiration should be continued until the infant is able to sustain ventilation. (Nelsons) Pharmacologic treatment of heroin and methadone withdrawal requires opiate replacement during the first week or 2 of life. (Nelsons

Answer 123

tef UTD: Polyhydramnios and a nonvisualized or small stomach (image 1), whether due to partial obstruction or imaging of gastric secretions, are the two key abnormalities that should prompt consideration of esophageal atresia.

Answer 124

Serum creatinine at birth is equal to the concentration in the mother (usually less than 88), it then rapidly declines over the first week of life (in term) and 1-2 months (in preterm) to nadir values (18-35) which remains stable through the first year of life. Newborns are considered to have renal failure if the serum creatinine is >133.

Answer 125

a. Repeat after 20 minutes of unbundling

Answer 126

increase sedation

Answer 127

apnea of prematurity

Answer 128

PREM Almost all preterm infants less than 35 weeks gestation have elevated bilirubin (UpToDate) also cpephlaheoma, asian, vrusing, or family hx Male sex is a risk factor for the development of severe hyperbilirubinemia (CPS Statement - Hyperbilirubinemia)

Answer 129

no spontaneous resp

Answer 130

33 week premature infant is born to a mother with hypertension. Baby is SGA. What other associated findings do you expect? a. Polycythemia (placental insufficiency leads relatively hypoxic environment and increased EPO production) b. hyperglycemia c. hypomagnesimia d. hypercalcemia

Answer 131

surfactant dec mortality “Surfactant replacement therapy, either as rescue treatment or prophylactic natural surfactant therapy reduces mortality (evidence level 1a) and several aspects of morbidity in babies with RDS

Answer 132

Take off all clothes for 20 minutes and recheck temperature

Answer 133

partial exchange polycythemia = hematocrit of 65% or higher (Nelsons)

Answer 134

hydronephrosis

Answer 135

abn eye movement

Answer 136

portal vein thrombosis

Answer 137

matneral infxn Symmetric IUGR = head circumference, length, weight equally affected - earlier onset, associated with chromosomal, genetic, malformation, teratogenic, infectious, or severe maternal hypertensive etiologies - consider incorrect overestimation of gestational age Asymmetric IUGR = relative sparing of head growth - late onset, preservation of doppler waveform velocity to carotid vessels, associated with poor maternal nutrition or late onset/exacerbation of maternal vascular disease (preeclampsia, chronic hypertension)

Answer 138

transient cyanosis wiht feeds

Answer 139

portal vein thrombiosis - clots form in/about the tips of 95% of catheters placed in umbilical artery - thrombosis is risk associated with UAC and UVC - with UVC, can get portal HTN from portal vein thrombosis, especially with omphalitis

Answer 140

required after 30 sec ppv wiht HR less then 60 Babies who experience persistent bradycardia (HR <60) despite 30s of effective ventilation should receive chest compressions and 100% oxygen The recommended chest compression to ventilation ratio is 3:1

Answer 141

no resp effort

Answer 142

abo incomtapbile Anemia in first few days is most frequently a result of hemolytic disease of the newborn (erythroblastosis fetalis) ABO incompatibility is the most common cause of hemolytic disease of the newborn Transplacental hemorrhage with bleeding from fetal into maternal circulation reported in 5-15% of pregnancies but is not usually sufficient to cause clinically apparent anemia at birth (Nelsons)

Answer 143

2 year to catchu up growhth in IUGR n the absence of congenital abnormalities, CNS injury, VLBW, or marked IUGR, the physical growth of LBW infants tends to approximate that of term infants by the 2nd year VLBW infants may not catch up, especially if they have severe chronic sequelae, insufficient nutritional intake, inadequate caretaking environment both premature and IUGR are at risk for significant metabolic conditions (eg. obesity, type 2 DM) and CVS disorders (ischemic heart disease, hypertension) as adults - hypothesized to involve insulin resistance

Answer 144

reassure last 4-12w

Answer 145

2 yr catch up

Answer 146

PASS CATHETER IN NOSE Airway - choanal atresia (improves with crying), micrognathia/retrognathia/Pierre Robin Sequence (obstruction worse supine), laryngomalacia (worse with crying and feeding), vocal cord paralysis Breathing - neonatal pneumonia, CCAM, CDH Circulation - polycythemia, methemoglobinemia, CHD (typically worse with feeding and crying)

Answer 147

intubate till breath on own

Answer 148

``` A fetal po2 is 25-30 cord venous gas the pO2 is higher than the arterial ?does ‘pO2’ refer to UV or UA? pO2 of fetal UA is 20 pO2 of fetal UV is 30-35 ``` PFO occurs in 25-30% of the general population

Answer 149

consult ortho when extubated

Answer 150

set up LP - on the way

Answer 151

bacteiral infection

Answer 152

start photo

NICU Flashcards

(202 cards)