NICU concepts based on questions Flashcards
(53 cards)
Which weeks of pregnancy should the mother be getting regular fetal echos if mom has SLE or anti-Ro/ SSA/SSB antibodies?
Weeks 17-26 GA
If mother has SLE / positive antibodies, and baby has normal fetal echocardiograms, when does baby need postnatal ECG?
Within first month of life needs ECG and then consider at 12 months (per Nelson’s)
If mother has SLE / positive antibodies, and fetal echo shows PR interval 140msec or longer, and/or mod tricusbid regurg, when to repeat fetal echo?
24-48 hours
If mother has SLE / positive antibodies and fetal echo shows PR interval > 150msec, what is the next step in management
dexamethasone 4-8mg daily for 1 week
If mother has SLE / positive antibodies and fetal echo shows 2nd degree AV block, or AV block with signs of EFE, myocarditis, CHF or hydrops, what is the next best step in management
Dexamethasone 4-8mg daily plus IVIG
Which part of the world are patients often from with hereditary spherocytosis?
Northern European descent
if mom has positive TRaB autoantibodies, what is the neonate at risk for?
autoantibodies can cross placenta and stimulate neonatal/fetal thyroid leading to thyrotoxicosis
- presents as small fontanelle, FTT, tachycardia, hypertension, loose stool, poor sleep, irritability (think increased metabolic/hyperthyroid)
DAT and ABO incompatibility in hyperbilirubinemia
Can be misleading - can be weakly positive or even negative
Diastasis recti in infancy - worrisome or not?
Normal finding - normal infant
Severity of hemolysis in hereditary spherocytosis?
Can be quite severe and present in first few days of life
Inheritence pattern of G6PD?
x-linked
Inheritence pattern of hereditary spherocytosis?
AD
Which deliveries are at highest risk for TTNB? / Risk factors for TTNB
C-section, IDM, precipitous vaginal deliveries, perinatal depression, maternal sedation
Which age group of infants are highest risk for TTNB?
Term and late preterm infants
CXR in TTNB?
Fluid in the fissures, perihilar vascular markings (sunburst pattern)
When does TTNB present?
Immediately within a few hours of birth
When does RDS typically present?
Usually > 6 hours after birth (1-3 days old is peak incidence)
Correcting prematurity - difference between extreme prems and prems?
Extremely prem infants - up to 36 months
Prem infants - up to 24 months
Complications of NEC?
Death
Sepsis (1/3 of cases)
AKI - usually oliguric followed by polyuria
BPD
Neurodevelopmental impairment
Post-NEC stricture (10%)
Liver cirrhosis secondary to prolonged TPN
Difference between diaphragmatic hernia vs eventration?
Eventration is an abnormal elevation consisting of a thinned diaphragmatic muscle that causes elevation of the entire hemidiaphragm, but is not an actual communication between the abdominal and thoracic cavities with or without abdominal contents in the thorax
Which portion of the diaphragm accounts for 90% of hernias in CDH?
Posterolateral (Bochdalek) portion of the diaphragm - 80-90% left side
common teratogenic maternal medications and their effects
phenytoin - vitamin K deficiency and bleeding, dysmorphic facies
isoretinoin - hydrocephalus, cns defects, micrognathia, developmental delay, congenital heart defects
alcohol - FASD features
VPA - neural tube defects
Red flags for sacral dimples?
Location above gluteal fold (> 2.5cm from anal verge)
> 5mm width across base
Deep, unable to visualize base
Associated skin findings - tuft of hair, hemangioma, subcutaneous appendage
Other findings: leaking from pit, lower extremity, sphincter anomalies
Do not image simple sacral dimples in otherwise asymptomatic child
Which antibiotics to use in suspected NEC?
Broad spectrum coving gram negative bacteria (aminoglycoside, cephalosporin), gram positive bacteria (ampicillin, Vanco), and anaerobes (metronidazole)
