NICU Flashcards
1
Q
Which require surfactant:
- any newborn being transferred
- 29 infant with no symp being transferred
- critically ill w/ 3 doses in first 18 h
- infant w/ RDS intubated and need 50% after 72hr
A
Intubated infant with RDS before transplant (not well infant)
More than 3 doses= no benefit
No evidence for use after > 72 hr
THUS: 29 infant transfer
2
Q
Child with brachial plexus injury. How long before no change in exam is poor prognostic factor?
- 1 mo.
- 3 mo.
- 9 mo.
- 1 year
A
3 month
Erb’s: C5-C7= waiter’s tip
Klumpke’s: C8-T1= forearm and hand flexed
3
Q
Term baby. Born via forceps. 1 month vomit, lethargic, red plaque on back of hand. Check:
- Glucose
- Ca
- K
- Alk-Phos
- Cr
A
Calcium
Due to Subcutaneous fat necrosis
4
Q
Child with meningomyelocele. What do you say for next preg:
- folic acid prior and till 12 wk GA
- US at 16 wk
- amnio at 16 wk
- alpha-fetoprotein at 16wk
A
Folic acid prior to conception and then till 12 week GA.
5
Q
List three Back P/E findings that indicate you must US:
A
- Subcutaneous mass or lipoma
- Hairy patch
- Dermal sinus
- Vascular lesion (hemangioma, telangiectasia)
- Skin appendage (skin tag, tail-like)
- Atypical dimple (deep, > 5mm, > 25mm from anal verge)
- Scar-like lesion
6
Q
T or F: VPA causes NTD in 1-2 % of pregnancies.
A
True
7
Q
TORCH. cataract. HSM. bony change. Dx?
A
Rubella… blue!
- IUGR
- microcephaly
- cataract
- congenital glaucoma
- PDA, PPS
- hearing loss
- HSM
- radiolucent bone dx
- dermal erythropoiesis (blueberry muffin)
8
Q
Mom with early latent syphilis. RPR titter dropped 8 X. What do you do with BB now born?
A
Adequate response to tx = 4X drop (1:32 to 1:8)
= still check BB serology at 0, 3,6, 18 month
If BB 4X drop or < mom then can just watch and no other W/U.
9
Q
T or F: child at any age if absent Hep C antibodies= no need to re-test to R/O vertical transmission.
A
True.
10
Q
Hep B (+) mom. BB born. What do you do?
A
- HBIG asap (<12h)
- Vaccine at birth, 1 mo, 6 mo.
- post immunization testing (HBsAG and anti-HBS) after last vaccine to ensure not affected.
@ 9 month + 18 mo. if positive.
11
Q
What is the Klehauer betke test?
A
(+) if fetal blood in maternal circulation
i.e. fetomaternal hemorrhage
12
Q
Complete heart block. Thrombocytopenia. Mildly elevated liver enzyme. Dx in bb?
A
Neonatal Lupus
13
Q
Mass on scalp of newborn that crosses suture lines. Mother took phenytoin and child delivered via vacuum. What is it? 2 reasons this kid has it?
A
R/O caput versus subgaleal
Caput Succedaneum
= cross suture line versus cephalohematoma over one area of bone
Reason: instrumentation during delivery
In utero Phenytoin
- link to coag defect
= Subgaleal Hemm
14
Q
TORCH:
- snuffles + skeletal + rash
- chorio, hydrocephalus, Ca
- Blueberry + Cataracts + Hearing + Radiolucent bone dx
- Periventricular ca + low plt + HSM
A
Snuffles + Skeletal = Syphilis= The S’s
Toxo= Big Cat/ C’s
Rubella= Blue Eyes, Ear, Heart, Bones
CMV= Draw the Face with Crown
15
Q
T or F: Cr at birth= Mother Cr.
A
True.
- decline in first 1-2 wk to nadir and then stable throughout 1st year of life
16
Q
Fetal pO2 usually:
A
30-35 mmHg
Umbilical venous pO2
17
Q
Incidence of asymptomatic PFO in adults:
A
10-25%
Exam: 10%
18
Q
1 month old with vesicle on upper lip:
- sucking blister
- HSV
- varicela
- epidermolysis bullosa
A
**Sucking Blister
Sucking Blister= superficial bulallae at birth on upper limb from sucking in utero
- usually forearm, thumb, index finger
- resolve without sequelae
Sucking Pad= callus on lip on first few month. Confirmed via observed neo sucking affected area. Lead to vesicle or bull that rupture.
Versus Neonatal HSV SEM (skin, eye, mouth)
- discrete vesicles, multiple
- usually near 1-2 wk of life
19
Q
Recent extubation after course of systemic steroids. Likely AE:
- low BP
- low BG
- leukopenia
- hypertrophic cardiomyopathy
A
Hypertrophic Cardiomyopathy
Other AE:
- high BG
- HTN
- GI bleed and perf (dex)
20
Q
All normal in BB except:
- transient cyanosis w/ feed
- hypotonic after feed
- irreg resp in sleep
A
Transient cyanosis w/ feed
21
Q
What is our NRP rule with mec now?
A
Insufficient evidence to suggest routine intubation + suction in non-big infant born through mec.
Normal resus.
If mec obstructing airway intubation + suction identified.
22
Q
List APGAR criteria:
A
Appearance
- blue/ pale
- body pink
- all pink
Pulse
- absent
- <100
- > 100
Grimace/ Irritability
- flaccid
- some flexion of limb
- active (cough, pull away)
Activity/Tone
- absent
- arm + leg flex
- active movement
Resp
- absent
- slow irregular
- vigorous cry
23
Q
Polyhydraminos. Resp distress. Lots of oral secretions. Likely? Test? Work up?
A
TEF/ Esophageal Atresia
Can’t pass NG tube
VACTERL (vertebral, anal atresia, cardiac, TEF, renal, limb)
- Echo, XR (hemivertebrae), AUS
24
Q
What is the most common abnormality noted with TEF or EA?
A
Cardiac= 25%
25
List 2 things child is at risk for is neonatal persistent bradycardia?
- Syncope
- Very tired, irritable, dizzy
- Cardiac arrest/death
26
T or F: esophageal atresia is associated with polyhydraminos.
True
27
List 3 aetiologies for polyhydraminos.
Syndromes
- achondroplasia
- klippel-feil
- T18
- T21
- TORCH
Poor swallowing due to GI obstruction
- esophageal, duodenal, intestinal atresia
- TEF
Poor swallow due to neuromuscular
- ancephaly
- hydrocephaly
- spina bifida
Poor swallow due to secondary obstruction
- obstruction to GI from massive dysplastic kidney
Increased urine production
- high fetal CO (fetal anemia, fetal HF, hemolysis)
- Bartter syndrome (polyuria, met alkalosis, low K)
Other
- cystic adenomatoid lung malformation
- diaphragmatic hernia
28
Expected survival for 25 wk?
75%
24 wk GA- 60%
23 wk GA- 40%
22 wk GA- 20%
Note: < 1% mortality if > 30 weeks.
29
T or F: palliative care is the accepted standard approach when < 23 wk GA.
False.
Accepted as standard if = or < 21 wk GA.
If 22-25+6 consult maternal fetal medicine specialist + transfer to tertiary HC centre.
30
Outcome in neo since surfactant started:
- decreased mortality
- decreased BPD
- increased air leak
- increased IVH
- decreased PDA
Decreased mortality
EBM:
- reduced air leak (pneumo) and mortality from RDS
- reduces morbidity (oxygenation, pneumothorax, pul interstitial emphysema/ PIE, duration on vent support)
- increases likelihood of surviving without BPD largely by improving survival rather than BPD incidence
* * Does NOT reduce INCIDENCE of CLD
* * NO effect on IVH, BPD, NEC, ROP
31
Newborn with copious oral secretion and resp distress. What is the most appropriate next test?
- insert OG cath
- CXR
- abdo US
- barium swallow
Insertion of orogastric catheter
32
When do you give surfactant to newborns?
- Intubated w/ RDS
* intubated w/ RDS should get it before transport
- RDS + persistent vent in first 72h= repeated doses (as soon as 2h after)
- Intubated + MAS + FiO2 > 50%
- Intubated w/ pul hemm
- Sick + OI > 15
** < 29 wk GA outside tertiary care consider immediate intubation and surfactant after stabilization.
** if significant risk RDS should get propyl. within few min. of intubation
**no benefit to giving more than 3 doses.
33
T or F: there is benefit in giving surfactant > 3 doses.
False.
34
T or F: neo intubated w/ RDS should get surfactant before transport.
True
35
T or F: babies born < 30 week should get prophylactic surfactant even if not intubated.
False.
Used to be. Now immediate CPAP is alternative.
Some in NRP recommend < 26 wk GA even if they're well on CPAP.
36
PPHN post and pre-duct show what?
Right radial= Pre
Umbilical artery or other= Post
Difference min. 10%= signif.
PPHN= high PVR= extra pulmonary right to left shunting= hypoxemia
Pre duct > Post
DDX: PPHN, left heart (aortic arch hypoplasia, critical aor. stenosis, interrupted aor. arch)
If Post> Pre = DDX
- TGA with coA, TGA with super systemic pul vascular resistance
37
List 3 RF for PPHN:
- Birth asphyxia
- MAS
- early onset sepsis
- RDS
- pulmonary hypoplasia (hernia, oligohydraminos, pleural effusion)
38
Provide 3 Tx options for PPHN:
- Correct abN (low BG, high Hgb, low BP)
- Improve O2
- Intubate + Vent
- Gentle Vent (normo or permissive hypercapnia)
- Sedate
- Inotrope (dopamine, milrinone)
- iNO (vasodilator)
- ECMO
39
Newborn. thin mec. Good APGAR. 12 hr increased WOB. Hyper inflated RUL with mediastinal shift. Likely dx?
- MAS
- Neonatal pneumonia
- Cystic pul airway malformation (CPAM)
- Congenital lobar emphysema
Congenital lobar emphysema
CPAM= WOB, large cyst, pneumo
Lobar emphysema= hyperinflation of one or more pul lobes.
40
List 4 ways meconium aspiration causes respiratory problems?
1. Airway obstruction
- complete or partial
2. Surfactant
- inactivation
- decreased amount
3. Inflam/ Irritation of lung parenchyma
4. Infection
- MSAF RF for bacterial infection of amniotic cavity
41
T or F: you can use ribavirin for routine use in RSV cases.
False.
- May consider in potentially life-threatening RSV infection.
42
Newborn. 12 h. Sat increase bit with 100% O2. Mild tachypnea. Next initial management?
- I+V
- Prostaglandin
- Abx
Prostaglandin
43
3 DOL. tachypnea. Cyanosis despite 100%. B/L crackles. Weak pulses. No murmur.
1. HLHS
2. Sepsis
3. AV fistula
HLHS
- cyanosis w/in 1st 48hr of life
- as PDA close signs of poor perfusion
- typically no murmur
44
3d infant cyanosis with crying. W/U:
- ECG
- CXR
- ABG
- BCX
- Echo
Echo
Crying= increase R side pressure
= More R -> L shunt
= Cyanosis
45
Why are RF for unconjugated hyperbili?
```
< 38 wk
Male
Asian or european
Bruising
Cephalohematoma
- visible < 24h
- visible pre d/c
- dehydration
- BF
```
Adv Mom > 35 y.o.
Sibling w/ severe hyperbili
46
Baby with direct bill. E coli. sepsis. Hepatomegaly. Which test:
- RBC GALT f'n
- G6PD
- Osmotic fragility
- RBC glucose-phosphate-1 deficiency
RBC GALT F'n
47
What is most common cause of conjugated hyperbili based on incidence?
- BF
- hemolysis ABO
- neo hepatitis
- galactosemia
Neonatal Hepatitis
Top common causes:
- Biliary atresia
- Metabolic
- Neonatal Hepatitis
- Inherited
- Alpha 1 Antitrypsin
48
4 RF for kernicterus
- prem
- sepsis
- bili leel
- hemolytic dx, ABO
- G6PD
- asphyxia
- lethargy
- temp instable
- resp distress
49
32 wk with 5 exchange transfusion. Now vomit, diarrhea, abdo distension. Likely:
- sepsis
- actue gastro
- protein vein thrombosis
- NEC
NEC
50
BB. Jittery. High T, HR, BP, RR. Flushed and eyes open. Normal tone. Jaundiced. DTR low. HSM. Dx?
Dx: congenital hyperthyroidism
Most common cause: trans-placental passage of TRS (thyroid stimulating hormone receptor antibody) Ab from mom w/ Graves dx
Classic: IUGR, restless, goitre, eye exophthalmic, high VS, HSM, jaundice
Tests: T4 + TSH
Tx: propanolol + methimazole
51
BW to see with IUGR baby:
- low BG
| - polycythemia
52
List two symmetric versus asymmetric causes of IUGR:
Symmetric
- chromosomal
- genetic
- infectious/ TORCH
- teratogenic
Asymmetric
- pre-eclampsia
- placental insuff
- renal dx, DM, antiphospholipid syn
- maternal malnutrition (severe)
- if signif smoking T3 (if quit by T3 then similar BW as non-smoker)
53
Most likely cause of symmetric microcephalic IUGR.
- maternal malnutrition
- maternal smoking
- maternal PIH
- maternal infection
Maternal infection
54
What complications of asphyxia?
**Neuro: Sz, HIE, ischemic brain injury
Pul: RDS, PPHN
Cardiac: dysf'n
**GI: feeding intolerance, increased risk of NEC
**Renal: AKI
Metabolic: mito dysf'n
**Heme: low plt, high Hgb, coagulopathies
55
When do you offer Intrapartum Abx for unknown GBS:
- preterm w/ imminent risk of delivery
- preterm pre labour ROM
- ROM > 18h
- intrapartum fever 38+
56
Newborn with axillary temp 37.8. Normal P/E. What to do?
- full septic W/U
- rectal temp
- talk all clothes off x 20 min and recheck
- CBC + diff
Rectal temp
Axillary: 36.5-37.4
Definitive= Rectal
57
DOL9. Born 32 wk GA. Born to GBS (+) mom. BCX show gram (+) cocci in clusters. Likely:
- GBS
- Strep viridian's
- S. aureus
- Coag. neg. staph
Coag. Neg Staph (Clusters)
Late onset = CONS
Gram positive cocci
> clusters= Staph (either coag. + like staph aureus versus (-) epidermis)
> pairs + Chains= Strep
- group A beta lytic= s. pyogenes
- group B beta lytic= s. agalactiae
- Alpha= s. pneumoniae
- Gamma= Enterococcus or non-enterococcus
58
Galactosemia Dx?
1. RBC galactose phosphate uradyl transferase deficiency
2. DNA mutation in GALT gene
Other test: reducing substance in urine (+)
59
What are maternal RF for early onset sepsis?
- Intrapartum GBS colonization
- GBS bacteriuria during current preg
- Previous infant w/ invasive GBS dx
- ROM min. 18h
- Maternal fever (min. 38+)
60
If BB at risk for sepsis and unwell. Next?
- Investigate: CBC, BCX, LP, CXR
| - IV ABX (amp + amino glycoside)
61
If mother NOT GBS colonized or unknown but only 1 RF. Next step?
If adequate IAP: Routine care. D/c after 24h
If inadequate IAP: Observe with VS q 3-4h min. 24h
62
If GBS unknown BUT multiple RF or maternal chorioamnionitis in BB who looks well? OR GBS (+) with RF (irregardless of Abx):
- Individualize and tx
- Observe min. VS q3-4h for min. 24h
- Consider CBC after 4h
- R/A and counsel after d/c
63
List 3 signs off XR that suggest NEC
**- pneumatosis intestinalis
**- pneumoperitoneum
> Rigler sign (air on both sides of bowel)
> Football sign (air outlining the falciform ligament)
**- portal venous gas
- dilated bowel loops
64
Late onset sepsis. 3 Bacteria responsible? Initial Abx tx?
Bugs:
- coag. negative staphylococci
- staph aureus (this is coag. (+))
- E. coli
- Group B Strep (GBS)
ABX: vanco (anti-staph/MRSA) + aminoglycoside
65
How do you tx NEC?
1. NPO
2. NG to low intermittent suction
3. IVF
4. BCX
5. Amp, Gent, Flagyl
6. Serial XR
7. +/- Gen Sx consult
66
Neonate. Serum glucose 1.4 Next?
D10 W
TFI 80 cc/kg/day
= 5.5 mg glucose/kg/min
Indication: < 1.8 at 2h old or < 2 at subsequent checks
FINE IF: BG: > 2 @2h old or > 2.6 at subsequent check
67
3 wk old with hypocalcemia. Most likely dx?
Transient hypoparathyroidism
- natural fall last 3 wk in PTH
68
Baby 6 day old. Shock. Low Glucose. Cardiomegaly on XR. Likely etiology:
- cardiac
- sepsis
- endocrine
- metabolic
Metabolic
* *low BG w/ ++ heart key
* * if febrile think sepsis
69
2. 2 kg BB. seen at 2h= 1.9. Asymptomatic. Best initial management?
- feed and recheck BS in 1 hr
- IV Dextrose 4-6 mg/kg/h
- IV D10W 2cc/kg then dextrose 4-6 mg/kg/h
- Supplement BF w/ bottle and recheck BS
Feed and recheck in 1hr
At 2 hr= 1.8-2
OR later check 2-2.5
= Refeed and recheck glucose in 1 hour
If remains < 2.6 despite feed= IVF
70
Infantile cystinosis. You get?
- cataracts
- ESRD
- nephrocalcinosis
Nephrocalcinosis
Renal fanconi by 6 mo.
Usually corneal cysteine NOT glaucoma.
ESRD later ppt
71
T or F: Infantile cardiomyopathy: muscle cell hypertrophy or deposition of lipid or glycogen.
True
72
Rocker bottom think. Think of what dx?
Tri 18 (Eight= Edward's)
- Elongated skull
- Digit overlap (clenched)
- Warrior chest (shield)
- Apnea
- Rocker bottom feet
- Dysplastic feet + IQ disability
Tri 13= Patau= All midline
- cleft palate
- dysplastic ear
- polydactyly
- undescended testes
73
BB. jittery with BG 1.3. Repeat 0.8. IV order? Glucose requirement?
Order: 2-3cc/kg of D10W over 5 min.
Then D10W at TFI 80
GIR= 5.5 mg glucose/kg/minute
GIR= dextrose % x TFI/144
74
CP etiology patterns:
- spastic diplegia
- hemiplegia
- extrapyramidal
Spastic diplegia
= PVL
Hemiplegia
= periventricular venous infarct (stroke, cortical malformations)
Extrapyramidal
= birth asphyxia
75
34 wk prem. Now 8 week of age. Occasional bradycardia. Likely cause?
- apnea of prematurity
- sz
- RSV
- IEM
Apnea of prematurity
76
For the first 6 month how and where should BB sleep?
- Sleep on Back
- IN CRIB
- IN PRENT ROOM
When can turn over don't need to return them to back position
Do not use rolled up blanket, soft material (quilt, comforter, pillows)
77
T or F: baby should sleep in parents room till 2 month old.
False.
sleep IN room till 6 month of age min.
78
2 month old. Ex 32 weaker. Vent with UA/UV lines. Now HSM. Normal P/E otherwise. Likely cause:
- hepatic hemangioma
- portal vein thrombosis
- hereditary spherocytosis
- congenital CMV
- fungal infection
Portal Vein Thrombosis
79
BB w/ BPD tx with furosemide. List AE:
- low K
- low Na
- low Cl
- AKI
NICU AE w/ prem:
- severe hypercalciuria
- nephrocalcinosis
- ototoxicity
- biliary stone (cholelithiasis)
80
Who gets screening for ROP:
< 31 week GA
| or 1250g or less
81
When is initial ROP screening done?
31 week GA
unless born at
- 28 GA =32 check
- 29 GA = 33 check
- 30 GA =34 check
** Perform at 4 weeks of age or 31 weeks corrected.
82
T or F: abnormal eye movement may suggest neo sz
True
New tx: lorazepam
Prior Stnd: Phenobarb
83
TEF or EA Tx?
- ABC
- no bag mask; intubate if need to
- OG/NG to suction proximal pouch
- elevate head
- prone
- empiric Abx
- Look for other anomalies (PE, XR abdo, Echo, Renal US)
84
Can't pass NG through nare of BB. List three other physical exam findings you look for?
R/O CHARGE
```
> Coloboma
> Heart (TOF)
> Atresia Choanae
> Retarded Growth
> GU
> Ear
```
85
Barium enema of BB shows rectal ampulla narrow with dilated proximal bowel. Two investigation for dx and result seen?
Hirschsprung's Dx
Two Investigation:
1. Rectal manometry
- failure of internal anal sphincter to relax w/ rectal distension of balloon
2. Rectal Biopsy
- aganglionic cells
86
Neonate has low plt. Mom's plt normal. Like dx? Management?
Neonatal Alloimmune Thrombocytopenia
Tx::
- prenatal IVIG in T2
- C/S
- After delivery + severe transfuse maternal washed platelet (PLA-1 negative or HPA-1)
- IVIG less effective than transfusion; may help
87
Newborn w/ petechiae. WBC + Hgb normal. Plt 9. List three causes aside from sepsis:
- Neonatal alloimmune thrombocytopenia (NAIT)
- Congenital CMV
- Neonatal Autoimmune Thrombocytopenia (usually ITP)
Other:
- Preclampasia (Hgb up)
- Thrombus (dehydration, IDM)
- Kasabach-Merritt Syn
88
Which predisposes to LATE hemorrhagic dx of newborn?
- BF
- prem
- CF
- maternal phenytoin
- oral Abx
Breastfeeding
Early onset (within 24h):
- maternal med that block Vit K (like anticonvulsant)
- prevent via Vit K IM at birth
Late onset (1-3 mo):
- parental refusal of Vitamin K + exclusive BF
- fat malabsorption
- associated with intracranial hemm
89
Most likely cause of late hemorrhagic dx of newborn?
- maternal phenytoin
- no vitamin K prophylaxis
- Po Abx
- CF
No Vitamin K prophylaxis
or CF.
90
Plethoric BB. Lethargic. Poor feed. Hob 170. Hug 0.72. Glucose 3.4. Next?
- bolus D10W
- partial exchange transfusion
- Abx
Exchange Transfusion
if asymp and 60-70= hydrate
If symp= exchange transfusion (w/ NS)
91
What fluid do you use as diluent for exchange transfusion?
NS
92
BB born at home via midwife. Present with melena, Hgb 70, plt normal. Likely cause?
Vitamin K deficiency causing hemorrhagic dx of newborn
Prevention: Vit K IM
Tx: Vit K or FFP
93
Jittery 2 day old. At birth has cleft palate. Murmur. Feeding well despite this.
Dx?
Jittery b/c?
Di George
| Hypocalcemia
94
Tachypnea, Jittery, myoclonus, normal BG. Tx?
- amp/gent
- vitamin D
- morphine
Morphine
NAS:
- tremor, jittery
- hyperreflexic
- hypertonicity
- myoclonic jerk
- V/D
- cry, fist sucking
- poor feed, sneeze
95
Abstinence from methadone. Neonatal sx?
- low DTR
- constipation
- sneezing
- lethargy
Sneezing
Note: higher incidence of seizures and later onset of withdrawal w/ methadone.
96
In utero exposure to cocaine results in:
- hearing deficit
- microcephaly
- low BP
- spinal dysraphism
Microcephaly
97
HIE Criteria
HIE
1. > 36 wk GA
2. max 6 hour age
3. mod-severe encephalopathy
4. Two of:
- APGAR < 5 at 10 min
- vent or resus at 10 min
- acid < 7 or BE > 16 in gas measured 1h of birth
98
What two tests at BB d/c would suggest good neuro outcome for child w/ HIE?
Combo of=
Early EEG
+ MRI
Useful to predict outcome.
Normal= associated w/ good recovery.
99
Intestinal atresia associated defect?
- Gastroschisis
- Pyloric Web
- Malrotation
- Duodenal atresia (T21)
- Hirschsprung's
- Meconium Ileus (CF)
100
Newborn w/ Erb's palsy. Which is true?
- extension at wrist
- preserved grasp
- symmetric moro
Preserved Grasp
"Waiter's Tip"
- shoulder adduct
- internal rotation
- forearm pronated
- elbow extended
- finger and wrist flex
101
BB. Renal mass. Hematuria:
- IDM
- polycythemia
- dehydration
- UVC
Sounds Like= Renal Vein Thrombosis
highest RF=
1. asphyxia
2. IDM
3. Dehydration
4. Polycythemia
PPT:
- hematuria
- flank mass
- HTN
- oliguria
102
LP theoretical risk to preterm infants and systemic absorption. Potential risk related to:
- pain ++
- shortened PR
- metabolic alkalosis
- methemoglobinemia
Methemglobinemia
103
Name two maternal intervention to prevent birth defect:
1. Folic acid
| 2. Control BG if DM
104
What does antenatal steroid and antenatal MGSo4- help with?
Mg Sulfate < 32 GA
- neuroprotect (CP)
Steroid <34 week
- lung development, IVH, NEC, mortality
105
List effects of maternal gestational DM
- low BG
- macrosomia
- polycythemia
- RDS
- cardiomyopathy
- small left colon (poor IDM with distended BB abdo = contrast show small colon)
- jaundice
- low Ca2+
106
T or F: babies born to mom's with SSRI should be observed for 48h?
True
107
Lithium associated with anomaly?
Ebstein's
108
List RF that put you at risk of preterm delivery
```
multiple pregnancy
low SES
preterm delivery hx
uterine anomaly hx
pyelonephritis
>10cig/day
```
109
T or F: single PO dose of vitamin K prevent hemorrhagic dx of newborn.
False. Inadequate for late hemorrhagic dx.
110
What are rules for weight loss and gain for newborn BB?
<10% in 1st week
Regain BW by DOL10-14
Wt gain: 1 ounce/day except Sunday
111
pulse ox screening:
Check 24h (R hand and either foot)
= < 90= abN
= min. 95 and less than 3% diff= Normal
```
90-94 or > 3% diff=
= repeat screen in 1h
= still border
= repeat again
= still borderline= W/U
```
Failed = Peds consult, +/- cardio
112
Pale pink. HR 88. Active gasping. Good tone. Respond to nasal catheter. APGAR?
7.
```
= Appearance= Pink= 1
= Pulse < 100= 1
= Grimace= respond to catheter= 2
= Activity/Tone= 2
= Resp= Slow= 1
```
113
The 3 questions in NRP at start?
Term
Tone
Breathing/Crying?
114
T or F: you must intubate prior to chest compressions in NRP
True
115
NRP. How do you decide tube size and depth?
Tube size: GA divided by 10.
i.e. 35 wk += 3.5-4
>1 kg= 3
< 1 kg= 2.5
Oral Depth: wt + 6cm
116
What O2 should you be on when doing compressions in NRP?
100%
117
List 3 harmful effects of O2 in resus
ROP
HIE
CP
118
When do you stop resus in NRP?
no HR after 10 min.
119
As per our latest NRP when do you place BB under plastic bag?
< 32 weeks
Goal: avoid hypothermia (less surfactant, more O1 used, lower BG)
120
How do we treat pulmonary HTN?
iNO
Start when OI
(FiO2 x MAP/ PaO2) = 20-25
Dose: 20 ppm
Other: Oxygen, correct acidosis, high Co2, temperature
Volume, pressor
121
T or F: you should transfer all < 32wk to tertiary centre?
True
122
What are risks of surfactant?
Pneumothorax
Bradycardia
Blocked tube
Rarely: hemorrhage
123
T or F: post natal steroids decrease vent time but not overall mortality.
True.
Risk for neurodevelopment sequelae.
So NOT recommended in 1st week of life for prevention but can consider if vent dependent, severe CLD etc.
124
What is a late preterm? What are they at risk of?
34-36 GA
- resp distres
- temp instability
- low BG
- kernicterus
- apnea
- sz
- feeding problem
125
Findings of open PDA in BB
```
bounding pulses
hyper dynamic precordium
loud S2
initial SEM then diastolic
cardiac decompensation= HF
```
Tx: fluid management, indomethacin, ibuprofen, tylenol, Sx
126
NEC RF
prematurity
ischemia (asphyxia, CHD, PDA, severe IUGR, exchange transfusion)
infection
formula (BF protective)
127
What must each BB meet to go home?
Thermoregulation
Control breathing (spell free off caffeine)
Resp stable (Sat min. 90%)
Feeding and wt gain
128
T or F: car seat challenge still recommended.
False. No routine for SGA or late prem.
If want to screen (i.e. hypotonic, low BW) up to individual MD.
129
Sarnat Staging
Stage 1= Mild
- ++ alert
- normal tone
- mydriasis
- tachy
- no sz
- last 1-3 d
Stage 2= Mod
- lethargic
- mild low tone
- weak moro
- miosis
- bradycardia
- sz common
- last 2-14d
Stage 3= Severe
- flaccid, stupor
- absent primitive reflexes
- variable pupil
- sz uncommon
- ispotential EEG
- last hrs-weeks
130
What do you do for HIE?
Passive cooling in community
Active cooling in tertiary centre! (method or head cooling only)
KEY: w/in 6 hour
Complication: low BP, brady, coagulopathy, fat necrosis
NNT 11 to prevent 1 mortality. Risk reduction of 25%
131
Causes of neonatal sz
```
HIE
IVH
Metabolic (low BG, Ca, Mg)
IEM (intractable)
Stroke
Infection
Brain malformation
Drugs (SSRI, NAS)
```
132
What are severe and critical levels of TSB to know?
> 340 = severe
| > 425= critical.
133
What are RF on CPS nomogram for hyperbili?
- Asphyxia
- Resp distress
- Temp instability
- Sepsis
- Acidosis
- Isoimm hemolytic dx
- G6PD dx
Low risk > 38 well
Med > 38 + RF or late term but well.
High= 35-38 RF
134
All are associated with congenital hypothyroidism except?
- prolonged jaundice
- umbilical hernia
- large tongue
- small AF
- hypotonia
Small AF= actually large!
135
Hct partial exchange calculation:
Partial exchange
consider if > 75% or symptoms.
Vol= (actual-desired Hct) x wt x 90
= divided by actual hct
