NICU Flashcards
(132 cards)
1
Q
when are antenatal steroids recommended and what is the purpose
A
Antenatal steroids <34 +6 weeks
• lung development, IVH, NEC, mortality
2
Q
when is magnesium sulphate recommended and for what purpose?
A
Antenatal magnesium sulphate <33+6 weeks
• neuroprotection (cerebral palsy)
3
Q
maternal condition and effect on baby
diabetes
A
Diabetes:
Hypoglycemia, macrosomia, jaundice, polycythemia, small, left colon syndrome, cardiomyopathy, RDS, hypocalcemia
4
Q
maternal condition and effect on baby graves disease hyperparathyroid obesity vitamin d deficient
A
Graves disease Hyperthyroidism, IUGR, prematurity
Hyperparathyroid Hypocalcemia, hypoparathyroidism
Obesity Macrosomia, birth trauma, hypoglycemia
Vitamin D deficit Neonatal hypocalcemia, rickets
5
Q
maternal condition and effect on baby PIH ITP Rh/ABO SLE PKU
A
PIH: IUGR, thrombocytopenia, neutropenia, fetal demise
ITP: Thrombocytopenia, CNS hemorrhage
Rh / ABO: Jaundice, anemia, hydrops fetalis
SLE: IUD, heart block, neonatal lupus, decr Hb, plt, Nx
PKU: Microcephaly, MR
6
Q
Risk factors for preterm delivery
A
SES status
– <20 or >40 years
– Very low SES, Low BMI
• Past Gyne/OB
- Pyelonephritis
- Uterine / cervical anomalies
- Multiple abortions
- Preterm delivery
• Lifestyle
– >10 cigarettes/day
– Heavy work
• Pregnancy
– Multiples
7
Q
Risk factors for IUGR (maternal/fetal)
A
Maternal – Hypertensive, preeclampsia – Renal disease – Diabetes – Antiphospholipid syndrome – Severe nutrition deficiency – Smoking / substances – Maternal hypoxia (CHD, lung)
• Fetal – Multiple gestation – Placental abnormalities – Infection (viral) – Congenital anomaly, chromosomes
8
Q
What is early vitamin K deficiency bleeding (VKDB)
A
Early vitamin K deficiency bleeding (VKDB)
– 1st 24 hours, due to maternal medication
9
Q
What is classic VKDB
A
Classic VKDB – preventable by Vit K prophylaxis
– 1:400, bleeding 1st wk of life
10
Q
what is late VKDB
what are risk factors? (3)
A
Late VKDB
– 1-7:100 000, bleeding 2nd-12th wk of life up to 6 months
– Exclusive breastfeeding, no Vit K (or only 1 oral dose!), fat
malabsorption (ex CF)
11
Q
Treatment of VKDB
A
Treatment of VKDB: Vitamin K, FFP
12
Q
Vitamin K prophylaxis
A
Vitamin K prophylaxis
– 0.5mg (<1500g) 1mg (>1500g) IM in first 6 hours of life
– Oral alternative if parents refuse (less optimal):
• 2mg at 1st feed, repeat at 2-4 weeks and 6-8 weeks
13
Q
What are these shunts between:
1. Ductus Venosus
- Foramen Ovale
- Ductus Arteriosus
A
Shunts: 1. Ductus Venosus Umbilical Vein -> inferior vena cava 2. Foramen Ovale Right atrium -> Left atrium 3. Ductus Arteriosus Pulmonary artery -> Aorta
14
Q
HC grows how much in 1st 2 months? until 6 mo?
A
HC: grows 0.5cm/week for 1st 2mos
• Then ~1cm/month from 2-6mos
15
Q
most babies pass urine and meconium within what time frame?
A
24 hours
16
Q
how much weight gain per day for a baby?
A
Weight gain: “1 oz/day except on Sunday”
17
Q
Ddx for failure to pass meconium
A
Meconium plug Hirschprung’s meconium ileus (CF) imperforate anus small left colon (IDM)
18
Q
Which of the following is least likely to be
picked up using pulse oximetry screening?
1. Pulmonary atresia with intact septum
2. Total anomalous pulmonary venous return
3. Truncus arteriosus
4. Unbalanced atrioventricular septal defect
A
Unbalanced atrioventricular septal defect
19
Q
what screening is done for a newborn
A
- Universal hearing screen (Oto-acoustic emissions)
- Blood spot at >24 hours of age
- Bilirubin at 24 hours (see later) & 48 hours (late preterm)
- O2 saturation: screening for congenital heart disease
20
Q
What is the most important part of NRP?
A
The most important part of NRP is ventilation of the baby’s lungs
21
Q
what are the 3 questions to ask for neonatal resuscitation?
A
3 questions: TERMgestation? TONE, BREATHING/CRYING?
• If answer to questions is no → NRP
22
Q
Tube size: >35 weeks;
Preterm > 1kg
<1kg 2.5
A
Tube size: >35 weeks 3.5-4.0;
Preterm > 1kg 3.0; <1kg 2.5
23
Q
how do you confirm ETT placement
A
Confirm placement: • Visualize through cords • Chest movement • Bilateral air entry • Heart rate improves!
24
Q
equation for depth of ETT
A
Depth: weight + 6cm (oral)
25
Oxygen percentage at Term?
preterm?
when do you increase to 100%?
Start in room air TERM
21-30% PRETERM
Preterm end-target: 88-94%
Increase to 100% when starting compressions
26
what is the preferred route for epinephrine administration for NRP?
IV
| dose 0.01mg/kg
27
is Naloxone recommended?
No!
28
when is a plastic bag recommended at delivery?
<32 weeks
29
respiratory disease in the newborn clues:
– Prematurity, uncontrolled diabetes
– Term, elective C-section
– History oligohydramnios
– History polyhydramnios or ++ secretions
– Infection risk factors (GBS positive, chlamydia); ‘well’ then onset of resp symptoms
– Acute, asymmetric features, systemic sx
– sounds like cardiac symptoms
– Prematurity, uncontrolled diabetes: RDS
– Term, elective C-section: TTN
– History oligohydramnios: pulmonary hypoplasia
– History polyhydramnios or ++ secretions: TEF
– Infection risk factors (GBS positive, chlamydia); ‘well’ then onset of resp symptoms: pneumonia
– Acute, asymmetric features, systemic sx: pneumothorax
– sounds like cardiac symptoms: PPHN
30
what does increasing your rate do?
decreases CO2
31
when is rhogam(anti-D globulin) given?
28 weeks
32
How many kcal are in one ounce of formula? How many mLs are in an ounce?
```
Breastmilk/formula= 20kcal/oz
1oz= 30 mL
```
33
What is required to pass CCHD screen
sat >95% and <3% difference between right hand and foot
34
what is a borderline CCHD screen
90-94% OR >3% diff between right hand and foot
| should be repeated in 1 hour (x2)- if remains abnormal call health care provider
35
what is considered a fail on CCHD screen
sat <90%
36
Who should get CCHD screen and when?
>34 weeks
| >24-36h of life
37
What does MRSOPA stand for
```
Mask re-adjustment
Reposition
Suction
Open mouth
Pressure increase
Alternate airway
```
38
what color should your end CO2 detector turn after successful intubation
Gold is good
| - yellow
39
when would you consider stopping chest compressions if there is no detectable heart rate
after 10 minutes
40
```
what is the survival to discharge for the following
<22+6 weeks
23 weeks
24 weeks
25 weeks
```
≤ 22+6 weeks: 18%
23 weeks: 40%
24 weeks: 70%
25 weeks: 80%
41
what are the major morbidities associated with prematurity (4)
cerebral palsy
blindness
deafness
cognitive
42
what are 3 consequences of hypothermia (temp <35)
associated with increased mortality in infants
1. decreased surfactant production
2. hypoglycemia
3. increased oxygen consumption
43
what is the most common neurodevelopment outcome for premature babies?
```
most have no or mild neurodevelopment disability
22- 57%
23- 60%
24- 72%
25- 76%
```
44
what is the treatment for PPHN
iNO
45
what is the dose for iNO
20ppm
46
what does iNO do
decreased mortality and need for ECMO>35 weeks
47
when would you start iNO
OI >20-25
48
what is OI
FiO2 xMAP/PaO2
49
what are two examples of pulmonary vasodilators
oxygen
| nitric oxide
50
what is the treatment for a baby just born with TEF
NPO
Nasal esophageal tube to suction
Consult surgery
look for associated anomalies- VACTERL
51
does surfactant reduce the incidence of chronic lung disease?
NO!
52
what would you see on CXR for RDS (2)
ground glass
| air bronchograms
53
what are some risk factors for RDS (3)
prematurity
IDM
asphyxia
- they have high resistance and low compliance
54
what is the treatment for a baby with RDS
transfer to a tertiary center
antenatal steroids- <34 weeks (decreases severity of RDS, IVH and mortality
surfactant- decreases pneumothorax, PIE, length of stay, duration of vent support
CPAP/ventilation
55
when should you give surfactant? max number of doses?
earlier is better
as early as 2h, avg 4-6h
no more than 3 doses
56
when can you give a repeat dose of surfactant
within the first 72 hours
| if FiO2 >30%
57
what are 3 risks associated with giving surfactant
blocked tube
pneumothorax
bradycardia
58
what are 4 indications for surfactant therapy
```
intubated preterm with RDS
meconium aspiration syndrome, FiO2 >50%
Consider in sick baby with pneumonia or pulmonary
hemorrhage, when OI >15
<29 weeks prior to transport
```
59
what change would you make on the ventilator to improve oxygenation
increase PEEP
60
what are some complications of mechanical ventilation
pneumothorax
pneumonia
subglottic stenosis
BPD
61
what is the definition of bronchopulmonary dysplasia
oxygen dependence beyond 28 days or at 36 weeks post gestational age
incidence: 25% <1500g
62
are corticosteroids recommended in the first week of life for prevention of bronchopulmonary dysplasia?
no!
routine use of inhaled corticosteroids is also not recommended
could consider later use: for ventilator–dependent, severe
CLD, low-dose with tapering short course (7-10 days)
63
LBW
VLBW
ELBW
LBW < 2500g
VLBW < 1500g
ELBW <1000g
64
what are some complications of prematurity
```
Apnea of prematurity
Respiratory distress syndrome
Chronic lung disease
Patent Ductus Arteriosus
Intraventricular hemorrhage
Anemia requiring transfusions
Sepsis, Necrotizing enterocolitis
Retinopathy of prematurity
Neurodevelopment:
• CP, cognitive, hearing, blindness, learning disability, behaviour
```
65
what are some complications of late preterm (34-36 weeks)
respiratory distress, temperature instability, hypoglycemia,
| kernicterus, apnea, seizures, and feeding problems, as well as higher rates of rehospitalisation
66
what is mortality rate at 24 weeks, 25 weeks, 30 weeks
40-50% 24 weeks
25% 25 weeks
<1% > 30 weeks
67
what is the definition of apnea
cessation of breathing 20 seconds OR
| 10-20s with bradycardia (<80)
68
how long can apnea of prematurity persist for VLBW
up to 44 weeks corrected
69
how many apnea free days are required prior to discharge for a late preterm
8 days apnea free prior to discharge
70
what are two treatment option for ductus arteriosus
```
fluid management (furosemide, transfusion)
indomethacin (contraindications renal insufficiency or thrombocytopenia)
surgical ligation
```
71
how do most babies with IVH behave?
most are asymptomatic
72
who should we screen for IVH
<32 or <1500g
| head ultrasound
73
who should we screen for ROP
<31 weeks
<1250g
at 4 weeks of age or 31 weeks
74
what are two treatment options for ROP
1. laser therapy
| 2. anti VEGF (Antivascular endothelial growth factor)
75
who needs treatment for ROP
ZONE 1- any stage ROP with plus disease, stage 3 ROP without plus disease
ZONE 2- Stage 2 or 3 with plus disease
76
what are 4 risk factors for ROP
Hypotension
Prolonged ventilation
Oxygen therapy
Slow postnatal growth
77
what is seen on abdominal xray for NEC (3)
1. pneumatosis
2. portal venous air (black lines over liver)
3. Pneumoperitoneum
78
what are maternal risk factors for early onset sepsis? (3)
GBS
PROM >18h
temp >38
79
what is the treatment for maternal GBS infection
no allergy: IV Penicillin G, ampicillin >4 hours
mild allergy: cefazolin >4 hours
severe allergy: clindamycin or vancomycin *not considered adequate prophylaxis
80
what is the treatment for suspected early onset sepsis
amp+ gent
81
what is the most common cause of late onset sepsis in a baby (1 month)
CONS
| Coagulase-negative staphylococci
82
Which of the following is NOT an association or
complication of LGA?
A. Birth trauma (dystocia, fractures, ICH, hip)
B. Asphyxia / HIE
C. Anemia
D. Hypoglycemia
anemia
| * LGA are polycythemic
83
sarnat 1
```
hyperalert
hyperreflexic
normal tone
mydriasis
tachycardia
no seizures
minimal resp secretions
```
84
sarnat 2
```
obtunded
hypotonic
hyperreflexic
miosis
bradycardia
GI motility increased
seizures
lots of resp secretions
```
85
sarnat 3
stuporous
flaccid/ decerebrate
absent reflexes
86
what are the criteria for HIE
```
Indications: (≥35-36 weeks)
Criteria A or B AND C
A. Cord pH ≤ 7 or BD ≥ -16 or
B. pH 7.01 – 7.15 of -10 to -16 (cord
or 1 hour gas) AND Hx of acute
perinatal event AND APGAR ≤ 5
at 10m or at least 10m of PPV
C. Signs of moderate to severe
encephalopathy
```
87
what imaging should be done after reawarming?
```
MRI after rewarming
• Basal ganglia / thalamus / PLIC
= motor + cognitive (basal ganglia has 2 words)
• Watershed areas = more
cognitive than motor
– If unclear: repeat at 10-14 days
```
88
what is the treatment for HIE >35 weeks
```
Temperature: 33-34C x 72h
– Passive cooling (community)
– Active cooling (total body or
selective head)
start ASAP, 1st 6 hours
```
89
what are 5 complications of cooling
```
hypotension
bradycardia,
coagulopathy
PPHN
Fat necrosis
```
90
```
All of the following are recognized causes of
‘floppy baby’ except:
A. Trisomy 21
B. Zellweger syndrome
C. Becker muscular dystrophy
D. Spinal muscular atropy
E. Prader Willi syndrome
```
Becker muscular dystrophy
91
Erb's palsy
C5, 6, 7
| watch for phrenic nerve (resp distress)
92
Klumpke
C7, 8, T1
93
Flail arm
Complete C5-T1 Flail arm
| Often associated with Horner’s syndrome, less favorable
94
What is the prognosis for brachial plexus palsy
75% recover completely in first month
| 25% permanent impairment – refer at 1 month to brachial plexus team
95
what is glucose infusion rate
Glucose Infusion Rate= IV rate (ml/kg/day) x % of dextrose
| (mg/kg/min) divided by 144
96
who should be screened for hypoglycemia
```
SGA
LGA
IDM
asphyxia
preterm <37 weeks
```
97
when do you stop doing glucose checks for SGA? LGA
SGA- after 24 hours
| LGA- after 12 hours
98
what is your glucose target after treatment of hypoglycemia
>2.8 initially
| >3.3 after transition period
99
how do you treat asymptomatic infants with blood glucose levels of 1.8 - 2.5 mmol/L
feed 5ml/kg and breastfeed
or 40% dextrose gel and breastfeed
recheck blood glucose after 30 minutes
100
what should be done for refractory hypoglycemia
glucagon
101
what is the treatment for symptomatic hypoglycemia
IV bolus 2mL/kg D10 over 15 min then D10 at TFI 80ml/kg/d
| check blood glucose after 30 minutes
102
red flags for jaundice (6)
```
Onset before 24 hours
Hemolysis is a predictor of severity
Pallor, Unwell
Hepatosplenomegaly
Pale stools, dark urine
Conjugated hyperbilirubinemia
```
103
what is the treatment for clinical signs of acute bilirubin encephalopathy?
Clinical signs of acute bilirubin encephalopathy
| → immediate EXCHANGE transfusion
104
Severe TSB level=
| Critical TSB level=
Severe: TSB > 340 umol/L in 1st 28d
| • Critical: TSB > 425 umol/L in 1st 28d
105
```
No respiratory support
Postnatal age:
Week 1
Week 2
Week 3
```
No respiratory support
1- 100
2- 85
3- 75
106
what is hydrops fetalis
fluid in 2 or more fetal compartments
107
Which statement is correct regarding Neonatal
Alloimmune Thrombocytopenia?
A. Mother is often also thrombocytopenic
B. Risk of intracranial hemorrhage highest
during first 96 hours
C. IVIG is not an effective treatment
D. Expect a higher platelet count than in
autoimmune thrombocytopenia
Risk of intracranial hemorrhage highest
| during first 96 hours
108
causes of neonatal thrombocytopenia
Infection: bacterial, TORCH
– Neonatal alloimmune thrombocytopenia
– Other maternal causes
• toxemia, ITP, SLE, Drugs (hydralazine, thiazides)
– Consumption: DIC, Kassabach-Merrit (hemangioma)
– Syndromes: IUGR, TAR, Fanconi’s
– Bone marrow suppression: pancytopenia, leukemia
109
You are caring for twins with an antenatal history of
moderate (stage III) twin-twin transfusion syndrome.
Twin A had a hematocrit of .75, Twin B had a Hct .30.
Which of the following is true?
A. Twin A had a history of oligohydramnios
B. Twin A is at increased risk of congenital heart disease
C. Twin B’s bladder was visualized antenatally
D. Twin B will require an partial exchange transfusion
with saline
Twin A is at increased risk of congenital heart disease
110
Indications for treatment of apnea of prematurity? when do you stop methylxanthine? when do you stop monitoring?
>4 episodes in 8 hours
Episodes do not resolve with gentile tactile stimulation
Methylxanthine:
Apnea free period of 4-8 weeks
44 weeks postconceptual (milestone for maturity of the respiratory system)
Cardiac Monitors:
4-8 weeks after discontinuing caffeine if no recurrence of symptomatic apnea
111
who is at increased risk for polycythemia? (5)
```
small for gestational age,
post-term infants,
infants of diabetic mothers,
infants with twin to twin transfusion,
infants with chromosomal abnormalities (Down syndrome, trisomy 13 and 18)
```
112
what are 3 benefits of surfactant
decreases mortality
decreases pneumothorax
decreases PIE
113
13. Newborn with axillary temperature of 37.8 degrees, well and normal exam. What do you do?
A. Full septic work up and antibiotics
B. Rectal temperature
C. Take off all clothes for 20 minutes and recheck temperature
D. CBC and diff
Do a rectal temperature!
114
Polycythemic newborn. Hb 240, Hct 0.75. Wt 2000g. Child requires a partial exchange transfusion. What fluid do you use as the diluent? How much blood do you replace to decrease the Hct to 0.5?
Total blood volume (weight x 80mL/kg) x [ patient's hematocrit- desired hematocrit/ patient's hematocrit]
115
```
Most likely cause of late hemorrhagic disease of the newborn?
phenytoin use in mom
baby did not get Vit K prophylaxis
oral antibiotics
cystic fibrosis
```
cystic fibrosis
116
```
Which of the following is associated with polyhydramnios
IUGR
Hirschsprung’s disease
esophageal atresia
renal agenesis
```
esophageal atresia
117
CPS statement - Risk factors for developing severe hyperbili:
visible jaundice at younger than 24 hours, visible jaundice before discharge at any age, shorter gestation (<38 weeks), previous sibling with hyperbili, visible bruising, cephalohematoma, male sex, maternal age > 25 years, Asian or European background, dehydration, exclusive and partial breastfeeding
118
```
Abstinence from methadone? Neonatal sx?
Hyporeflexia
Constipation
Sneezing
Lethargy
```
sneezing
119
7 day old being resuscitated. Rate of compressions to ventillations. Patient is intubated. (2008 Toronto)
a. 3:1
b. 5:1
c. 15:2
d. 100:1
3:1
| 90 compressions: 30 breaths
120
ELBW infant. What causes CLD?
a. PPV
b. oxygen use
c. barotrauma
d. surfactant deficiency
barotrauma
121
Infant with R arm sat of 90% and L leg sat of 70%. Pt tachypneic, RR 70, no distress. Dx?
a. CoA
b. truncus
c. TGA
d. TOF
coA
122
What is the most common complication after gastroschisis repair?
Bowel obstruction
Abdominal compartment syndrome
abdominal compartment syndrome
123
```
An ex-25 week premature infant is now 18 months old. She has bilateral increased reflexes in the lower limbs. At what age can you make the definitive diagnosis?
18m
24m
36m
40m
```
24 months
124
Kleihauer-Betke Test—how does it work.
test baby for mom’s blood
test mom for baby’s blood
test cord blood
test mom for baby's blood
125
Neonate with dehydration and mom was IDDM. Baby develops hematuria. What’s the dx:
renal vein thrombosis
Renal vein thrombosis is the most common spontaneous VTE in neonates. Affected infants may present with hematuria, an abdominal mass, and thrombocytopenia. Infants of diabetic mothers are at increased risk for renal vein thrombosis, although the mechanism for the increased risk is unknown. Approximately 25% of cases are bilateral.
126
Infant in NICU admission with stone in kidney. What medication was used?
lasix
127
Disability for 23, 24 and 25 weeks
Disability
23: 30 - 60%
24: 20 - 40%
25: 10 - 20 %
128
```
Which of the following is the best predictor of risk of Rh autoimmune hemolytic disease at the time of delivery?
Bili in the cord
Hb in the cord
Mom’s Ant-Rh titres
Gestional age
```
bili in the cord
129
A newborn with omphalocele had hypoglycemia. What is this child at risk for?
a) Neuroblastoma
b) Wilm’s tumour
c) Leukemia
d) Duodenal atresia
wilm's tumor
| - think Beckwith-Wiedemann
130
what are 4 risk factors for severe hyperbili
```
jaundice <24h
male sex
gestational age <38 weeks
sibling with a history of severe hyperbilirubinemia
cephalohematoma
maternal age >25
```
131
Baby born at 41 wks. Meconium staining. Flat babe requiring resucc. Apgars 2 at 1 min 3 at 5 min and 6 at 7 min. what 5 things may you expect with this baby in the near future. What 2 tests at discharge, if normal would suggest a good neurological outcome for this child
1. decreased LOC
2. decreased tone
3. decreased activity
4. bradycardia
5. irregular resps/ apnea
6. weak suck reflex
1. EEG
2. MRI
132
Mother of 2 hour newborn who has a mass of scalp that crosses suture lines. The mother took phenytoin during pregnancy and the child was delivered via vacuum delivery. Give two reasons why the child has this lesion.
1. vacuum delivery
| 2. early vitamin k deficiency bleeding due to maternal phenytoin use
