NICU

This blanches when pressure is applied, and resolves spontaneously?

How should head circumference be to chest circumference in a newborn?

What is cutis aplasia?

What is the normal length of cord?

What is the dosage for Fentanyl and the side effects?

What is the dosage for Morphine and the side effects?

What is the reversing agent for neuromuscular agents?

What is the reversing agent for benzodiazapine?

What is the reversing agent for narcotic induced respiratory depression?

pH 7.35-7.45
PaCo2 35-45 mm Hg
Pa02 50-80 mm Hg
HC03 22-26
Base excess -2 to +2

What are the cyanotic heart defects and which way is the shift?

What are the Acyanotic heart defects and which way is the shift?

Fetal fibronectin is normally not present when and what does the negative test value predict?

What is a nearly flat baseline (absent variablility) indicate?

What are the criteria for perinatal asphyxia?

What is the dose of Epinephrine via ET tube?

Idiopathic thrombocytopenia purpura has not been shown to be associated with cardiac abnormalities

What kind of heart condition in the neonate can happen of mother with systemic lupus erythematosus?

What are the most common heart defects of an infant of type I diabetic mother?

When is Respiratory distress syndrome present and how is it manifested on x-ray?

What does x-ray show on Transient tachypnea of the newborn?

What conditions are associated with hydrops?

When does the neonate with transposition of the great vessels and inadequate intra atrial communication become symptomatic?

What can cutis marmorata (lacy like appearance) be caused by?

Persistent cutis marmorata may be seen in infants with?

What are Acute severe intraventricular hemorrhage manifestations?

When does post asphyxial seizures generally occur? and what type usually happens?

How is multifocal clonic activity manifested?

What are associated findings of spina bifida?

What uses adduction with down pressure?

What has a palpable clunk with abduction?

What syndrome is fatal in the 1st year of life, mostly female, have a high arched palate with micrognathea and microsonia?

How do you measure posture?

What are common problems of IDM's?

When does vernix appear and disappear?

What conditions can cause symmetrically IUGR?

Transfer of heat between solid objest of different temperatures in contact with each other?

Transfer of heat to the air moving across and around the infants body?

Heat is transferred between two objects not in contact with each other. The baby loses heat by what to cooler surfaces and objects?

When does anaerobic metabolism occur?

When is NST impaired?
When is NST inhibited?

When can you successfully wean an infant to an open crib?

When does brown fat begin to develop?

where is sodium absorbed?

What can excessive administration of oxytocin to mother cause in the neonate?

Where is ADH released?

Renal blood flow increases as renal vascular resistance does what?

How is a chronic hyponatremic state corrected?

What can happen if Na+ drops acutely or below 115 mEq/L

Dehydration can cause high or low sodium levels?

You increase fluids and put aquaphor on infants with what type NaCl levels?

what is potentiated by digitalis toxicity?

Metabolic acidosis will shift potassium where?

What can cause ventricular tachycardia, peaked T waves, wide QRS complex?

What can cause hypotonia, weakness, irritability and poor feeding?

What can cause flattened T waves, prominent U waves, ST depression, hypotonia, abdominal distention?

What is one way to lower potassium levels?

What can hypocalcemia cause?

When is calcium gluconate used?

How long is calcium gluconate given over and what can happen if you give it through umbilical catheter?

What syndrome is the absence of thymus and parathyroid and cause low calcium?

The minimal amount of glucose to be administered to maintain homeostasis is what?

What is the correlating problem if an infant fails to respond to therapy for hypocalcemia?

What does metabolic bone disease diagnostically indicate?

What type infants is Portagen formula used for?

When are soy based formulas indicated?

Elevated NaCl, chloride, and BUN is indicative of dehydration

Increased creatinine level often accompanies renal failure

Progestimil-
a protein hydrolysate-based formula used for infants with malabsorption problems caused by gastrointestinal or hepatobiliary disease. Infants with these problems often have direct hyperbilirubinemia

Healthy newborns require 100 to 120 Kcal/kg/day for adequate growth and development

Reducing substance in the stool is indicative of excessive sugar content associated with carbohydrate malabsorption

Similac PM 60/40 is a cows milk based formula that has low phosphorus content and low renal solute load

used for renal insufficiency and infants with hypoparathyroidism

Early minimal feeding of premature newborn is associated with improved calcium and phosphorus retention. They also have high serum calcium and low alkaline phosphatase levels and shorter intestinal transit times

What can a deficiency of carnitine cause?

What are the two month immunizations?

What is carnitine?

What can intravenous lipid cause?

What does preterm formula have in it?

When is soy based formula used?

On a chest radiograph
what is characterized by reticulogranular pattern with air bronchograms and diffuse alveolar infiltrates-bilateral?

On a chest radiograph that shows alveolar overdistention with multiple small cyst-like radioluciences that are unilateral would be diagnostic of?

A normal lung pattern with mild infiltrates and overexpanded lungs may be seen in what?

Bilateral asymmetric areas of atelectasis and hyperaeration with flattened hemidiaphragms is the generalized picture of what?

A chest radiograph shows high pulmonary vascularity, enlargement of the right atrium, right ventricle, and pulmonary artery with a snowman-type appearance. There is a widening of the superior mediastinum. The clinical diagnosis and primary intervention would be---

Bilious vomiting episodes in the 1st hours of life. abdominal radiograph shows dilation of the stomach and proximal duodenum producing "double bubble", down syndrome 25% of the time. support and nasograstic drainage

ET tube placement

What are the two placements of a umbilical arterial catheter (UAC)

If the maternal onset of chickenpox (varicella) of infection is within 5 days of delivery of the infant- the infant has not received the varicella-zoster virus antibody because the mother had not developed it yet, what must be done?

signs and symptoms of GBS infection in infant are?

What conditions are associated with oligohydramnios?

What conditions are associated with polyhydramnios?

What is Kleihauer-Betke test?

PIPP score
> 12 moderate to severe pain
<6 minimal pain

an oblication to avoid causing harm

medically stable preterm infants who remain in the hospital at 2 months of chronological age should be given all vaccines recommended at that age

Dopamine is the immediate precursor of epinephrine. It stimulates both a (alpha) and B (beta) adrenergic receptors as well as dopaminergic receptors, producing increased cardiac output, stroke volume, and renal perfusion

Isoproternol stimulates B1 and B2 receptors, resulting in postive inotropic and chronotropic effects. It causes relaxaion of bronchial smooth muscle while increasing heart rate and contractility

Albuterol relaxes bronchial smooth muscle by acting on B2 receptors with little effect on heart rate.

Methlyprednisolome is a glucocortisoid that inhibits protaglandin synthesis (anti-inflammatory), macrophage accumulations, and interleukin synthesis/release. It is used in the treatment of hematologic, allergic, inflammatory, neoplastic, and autoimmune conditions.

Phenyton (Dilantin) and phenobarbital (Luminal) is a pregnancy cat D- (positive evidence of risk to fetus). Infants with fetal hydantoin syndrome present with a variety of abnormalities. Most notable are digit and nail hypoplasia, unusual facies, and growth and mental deficiences. Additional craniofacial defects are common.

Phenobarbital withdrawal symptoms- restlessness, hypertonicity, diarrhea, vomiting. poor suck. seizures present 2-6 days after birth due to long half-life of the drug

What can IV fentanyl cause?

Sodium bicarbonate cannot be given with fluid containing calcium- a precipitate of calcium carbonate will form

No medications should be administered through a peripheral arterial line because arterial spasm and vascular compromise distally to the line may result

Penicillin is incompatible with dopamine

A line with inotropes should not be used for bolus administration of any med because this could cause significant blood pressure flucuations.

1st pass effect
orally administered drugs are absored from the GI tract. when a portion of the amount absorbed is metabolized by the liver before it reaches the circulatory system for distribution

Enterohepatic cycling
Some drugs are excreting into bile and delivered to the intestines. Prior to elimination from the body the drug may be absorbed

Hepatic clearance
The amount of drug eliminated by the liver. Drugs and drug metabolites with molecular weights higher than 300 may be excreted into bile and delivered to the intestines. In the intestines bacteria hydrolyze the compound, freeing the drug to be reabsorbed into circulation. This process reduces the elimination of drugs and prolongs their half-life and duration of action in the body

Phenytoin is incompatible with dextrose- administration of this drug into a line containing dextrose requires clearing the line with NS before and after the drug is administered

Pneumoperitoneum
Represents intestinal perforation. an absolute indication for surgery. In the absence of intestinal perforation, surgery may be considered for intestinal gangrene, progressive clinical deterioration, portal vein gas, persistent fixed and dilated bowel loop, abdominal wall edema, or erythema

Necrotizing Enteriocolitis
Abdominal erythema and tenderness can indicate bowl perforation. clinical deterioration- bradycardia, hypotension. lab values consistent with NEC- thrombocytopenia, leukopenia

Metoclopramide
Treatment for GER
Increase tone and amplitude of gastric contractions. Increase in the resting tone of lower esophageal sphincter, increase duodenal and jejunal peristalsis

Bilious vomiting in a previously well infant is what?

Cholestyramine
used in short bowel syndrome involving loss of distal ileum because this results in unabsorbed bile salts and steotorrhea. This is an ion exchange resin that binds bile salts- thereby reducing steatorrhea

Hyperammonemia is a complication of liver failure

Malabsorption of fat and fat-soluble vitamins (A,D,E,K) is a common problem in infants with short bowel syndrome

90% of infants with meconium ileus have cystic fibrosis

A postoperative complication of returning a large amount of bowel to a small abdominal cavity may be pressure on the inferior vena cava

Common signs and symptoms associated with intestinal obstruction- history of polyhydramnios, failure to pass meconium within 24-48 hours, abdominal distention and bilious vomiting

The signs and symptoms of hypothyroidism reflect slowing of metabolic processes such as gastrointestinal motility, bilirubin conjugation, and skeletal maturation- abdominal distention, prolonged jaundice, large posterior fontanelle

Neonatal Grave's disease- increased T4

congenital hypothyroidism- low T4, high TSH

cause of metabolic bone disease/osteopenia of prematurity-inadequate calcium and phosphorus intake

Many inborn error of matabolism have their onset at 2-3 days of age after a symptom free interval- can mimic sepsis- but labs do not confirm infection

Ammonia level normal <65 uml/L

Infants of diabetic mothers- congenital malformations, especially cardiac defects and neural tube defects

Congenital adrenal hyperplasia
xx virilized neonate-result of cause by 21 hydroxylase deficiency

Erythopoetin (EPO) production is increased in response to anemia and low oxygen availability to tissues

Vitamin K is required for the conversion of precursor proteins produced by the liver into active factors having coagulant capability. It is especially necessary for the conversion of the prothrombin (extrinsic) complex clotting factors and thus affects the PT time

Acidosis increases the risk of bilirubin toxicity

Improved extrauterine 02 delivery causes a temporary inactive stage of erythropoiesis

Polycythemia in infants can be from mother- gestational diabetes, postmaturity, Pregnancy induced hypertension (PIH)

Idiopathic thrombocytopenia purpura
maternal autoantibodies bind themselves to maternal platelets cause them to prematurely destruct. the IgG antibodies then cross the placenta and destory fetal platelets. As a result, both the mother's and the infant's platelet count are low. If the neonatal thrombocytopenia is related to neonatal conditions, the mother's platelet count will remain normal

Indications of term neonate having meningitis with a lumbar puncture- high protein, and low glucose

What can phenobarbital in large doses cause?

Phenobarbital level
15-40 mcg/ml

IVH/PVH originates in the germinal matrix prior to 32 wks gestation. By 36 wks gestation IVH/PVH originates in the choroid plexus

Arnold-chiari malformation
almost always present in infants with myelomeningocele. It is also a defect in neural tube closure displacing the medulla, fourth ventricle, and lower cerebellum into the cervical canal-This impedes flow of SCF and leads to hydrocelphalus and pressure on brainstem-causes laryngeal stridor, apnea, reflux, and aspiration

The vein of Galen drains the anterior and central regions of the brain into the sinuses of the posterior cerebral fosa. Malformations of the vein of Galen are anurysums that result in arteriovenous shunting of blood. High-output congestive heart failure ensues

scalded skin syndrome is caused by a strain of staphylococus, requires isolation and treatment

complications from eye exams

What is the most common cause of intrinisic acute renal failure?

what has velocardiofacial, conotruncal anomaly facial syndrome- has undiagnosed cardiac defect, persistent hypocalcemia, and primary immunodeficiency-

prominent occiput
omphalocele
macroglossia
polycythemia
hypoglycemia
60% female

What is predominantly found in mothers breastmilk?

what is coagulase negative bacteria?

What is coagulase positive bacteria?

usually asympotomatic. general manifestation:
IUGR
neonatal jaundice (increase direct fraction)
purpura
hepatosplenomegaly
microcephally
chorioretinitis
progressive sensorineural hearing loss

When can all preterm infants of HBsAg negative mothers with a birth weight of <2000 g receive the 1st dose of Heb B vaccine series?

I:T ratio:
mature cells=segs
immature cells=bands, metas, myelos, promyelocytes

I:T % immature cells
% mature cells+
immature cells

an I:T ratio >0.2
is referred to as a left shift and is suspect for infection

What is congenital chylothorax?

What is atelectasis on chest radiograph?

What are treatment options for PDA- patent ductus arteriorsus?

What does left to right shunting of blood through the ductus arteriosus result in?

What does the chest radiograph reveal in infant with transient tachypnea of the newborn?

What is Transient tachynpea of the newborn due to?

Severe asphyxia of a full-term infant in the early neonatal period may result in what?

What is central apnea defined as?

How do infants respond to hypoxemia and changes in PaCO2?

What are side effects of prostaglandin E1-

What are the side effects of methylxanthine therapy?

Who would be a good candidate for ECHMO?

What is a short term complication of ECHMO?

When is persistant pulmonary hypertention of the newborn (PPHN) suspected?

What is Inhaled nitric Oxide (iNO)?

Continuous bubbling in the water seal chamber of the chest tube may mean what?

What is a pneumopericardium characterized by?

Chest Tube
If visible clots and debris are seen in the chest tube are not free flowing, gentle kneading, not stripping of the chest tube may be indicated.
Continuous bubbling in the water seal chamber may be a reult of a leak in the system.
Frequently monitor and document tube patency, oscillation of fluid within drainage system and presence or absence of bubbling in the water seal chamber.

What are clinical presentations of congenital diaphragmatic hernia?

What are long term complications associated with congenital diaphragmatic hernia?

1/2 of infants with choanal atreasia also have what?

What is due to mandibular hypoplasia prior to 9 weeks gestation. may be associated with other disorders. micrognathea, glossoptosis, cleft palate?

After cardiac surgery and infant cannot be weined from vent although is slightly tachpnic- may be phrenic nerve damage

What is the clinical presentation of broncho pulmonary dysplasia?

What is the chest radiograph of severe bronchopulmonary dysplasia (BDP) characterized by?

A specific B2 Agonist that has become the inhaled agent of choice in treatment of reducible broncospasm in infants with BPD is what?

What are signs and symptoms of right sided heart failure?

Right sided heart failure- full pulses, tachycardia, poor circulation, hepatomegaly, increased respiratory distress, loud pansystolic murmur

Furosemide is the treatment of choice for fluid overload in infants with BPD. It decreases intersitial edema and pulmonary vascular resistance. Increases urinary output by blocking chloride transport in the ascending loop of Henlie. However side effects are numerous and include volume depletion, contraction,, alkalosis, hyponatremia, hypokalemia, renal calculi, and nephrolcnosis

When assessing for compensation status, examine pH and the acid/base determinants (paCO2 and Hco2). In the case the arterial blood gas reflects partial compensation in which both acid/base componants remain abnormal in opposite directions, which the pH moving toward a more normal range

Full compensation is characterized by the return of the pH to a normal range. A
Pa02 of 49 mm Hg is indicative of hypoxemia. The normal range for Pa02 is 60-80 mm Hg

The clinical presentation of broncho-pulmonary dysplasia is characterised by rales, rhonchi, wheezing, hypoxia, hypercapnia, and respiratory acidosis

The chest radiograph of severe bronchopulmonary dysplasia (BPD) is characterized by air cysts among dense patches. The air cysts are evidence of progressive multifocal empysemia. The dense patches are largely indicative of alveolar collapse.

Right sided heart failure is characterized by full pulses, tachycardia, poor circulation, hepatomegaly, increasing respiratory distress, and a loug pansystolic murmur

Decreased pulmonary vascular resistance due to increased 02 (potent vasodilator) pulmonary catecholamine surge first 4-6 hours

Ductus venosus has functional closure within minutes, anatomic closure 3-14 days

Foramen ovale- unidirectional flap, functional closure minutes, anatomic 9-30 months (15-20% adults still open)

Ductus arteriosus functional closure 10-15 hours, anatomic 2-3 months

Premature <30 weeks, all closure can be delayed. Ductal flow in fetus right to left at birth bidirectional then left to right

If you have pulmonary hemorrhage do CUS, may have bleed in head

PDA left to right shunting

Signs and symptoms PDA- systolic or continuous murmur LUSB. wide pulse pressures, hypotension, palmer pulses, bounding peripheral pulses, overactive precordium, tachycardia

In coartation do not close duct

Dopamine
catacholamine, rapidly metabolised. serum 1/2 life 2-5 minutes.
increase blood pressure by increasing systemic vascular resistance via alpha-adrenergic effect.
selective renal vasodilation with increase urine output in preterm @ 2-5 mcq/kg/min

adverse effects: tachycardia and arrhythmias

Not good in peripheral IV

Systemic corticosteroids
side effects- hyperglycemia, hypertension, hypertrophic obstructive cardiomyopathy, gastrointestinal hemorrhage, gastrointestinal perforation. growth failure and hypothalamic-pituitary-adrenal suppression increased in neuromotor impairments. have been associated with diuresis, thereby improving diuresis and any underlying pulmonary edema

Calorie requirements for infants with BPD 150-200 kcal/kg/day

BPD- oxygen is a pulmonary vasodilator and serves to decrease pulmonary resistance, with increasing severity of bronochopulmonary displasia (BPD), pulmonary vascular resistance increases, hypoxia worsens and right-sided ventricular hypertrophy advances to cor pulmonal. This condition ultimately progresses to pulmonary and cardiac failure

Functional residual capacity (FRC)- is the volume of gas that remains in the lungs after normal expiration

Tidal Volume (TV)- is the amount of air that moves into or out of the lungs with each breath at rest

Vital capacity (VC)- the volume of air maximally inspired and expired

Physiologic dead space is the sum of anatomic (conducting airways) and alveolar dead space

Pulmonary interstitial emphysema (PIE) is caused by the rupture of overdistended alveoli or bronchioles ino the intersistium of the lung. chest radiograph findings consist of small hyperinflation cysts. Air bubble will follow the perivascular sheaths, often near the hilum

Patchy infiltrates are consistent with meconium aspiration

Reticulogranular appearance is consistent with RDS (respiratory distress syndrome)

The hemoglobin-oxygen dissociation curve reflects the affinity of hemoglobin to oxygen

A shift to the right on the hemoglobin-oxygen dissociation curve results in decreased affinity of hemoglobin for oxygen

A shift to the left as with fetal hemoglobin results in an increased affinity of hemoglobin for oxygen

In infants there is an increased amount of fetal hemoglobin compared with an adult. As a result, this shifts the curve to the left

High frequency oscillatory ventilation (HFOV)-
frequency is expressed in hertz
carbon dioxide elimination is controlled by both oscillatory amplitude and hertz (breathing rate)
oxygenation is controlled by adjusting mean airway pressure.
breaths are delivered by a vibrating diaphragm, where inspiration and exhalation are active pressures

Ventilator-
the ventilator rate affects the carbon dioxide level, by decreasing the rate (decreasing minute ventilation). the carbon dioxide level will increase

Increasing peak inspiratory pressure (PIP) and decreasing end expiratory pressure (PEEK) would increase tidal volume

Coarction of aorta
hepatomegaly, tachycardia, tachypnea, gallop rhythm. Infant with CHF. classic finding of coaraction of aorta is diminished pulses in lower extremeties a systolic BP increased by upper compared to lower

Protaglandin E1 is administered in order to maintain patency of the ductus arteriosus. In the case of hypoplastic left heart syndrome, systemic circulation is dependent on the ductus arteriosus. As ductual patency improves, peripheral perfusion will improve

Digoxin used for SVT. It slows conduction through the AV node

Hypoplastic left heart syndrome
diminished pulses
color ashen gray
systolic murmur if present
urine output decreases secondary to decreased perfusion

Indomethacin
side effects- temporary decrease in renal function, platelet dysfunction, gastrointestinal bleeding. should monitor UO, serum electrolytes, glucose, creatinine, BUN, platelet count

Supplemental oxygen is often given to infants with suspected heart disease without a full understanding of its potential adverse effects. In single ventricle physiology (hypoplastic left heart syndrome), supplemental oxygen can produce pulmonary vasodilation, resulting in increased blood flow to the lungs and decreased blood flow to the systemic circulation. The resulting clinical signs include a fall in urine output, diminished pulses, prolonged capillary refill and metabolic acidosis

Factors that decrease cardiac contractility include acidosis, hypoxia, electrolyte disturbances, hypoglycemia

Digitalis toxicity affects the formation and conduction of the cardiac impulse, leading to prolongation of the P-R interval, profound sinus bradycardia, and heart block

Cyanosis can occur in the healthy infant with polycythemia

Afterload- the resistance against which the heart has to pump is reduced by the administration of vasodilators-sodium nitroprusside is a smooth muscle relaxant that dilates both arteries and veins

Propanolol is used for wolff-parkinson-white

B-adrenergic agents stimulates B1 receptors in the heart. It results in increase in heart rate, AV conduction, velocity, and ventricular contractiltiy. As a result of improved contractility, blood pressure decreased, urine output may decrease

A right to left cardiac shunt is characterized by deoxygenated blood that is shunted to systemic circulation going to the lungs resulting in arterial desaturation

Cardiac output in neonates is primarily dependent on heart rate

In ventricular septal defect with normal pulmonary vascular resistance, blood shunts left to right across the defect leading to increased pulmonary blood flow, decreased pulmonary compliance, pulmonary edema. This interfers with adequate gas exchange

Tet Spell
Hypercyanotic spells are characterized by intense cyanosis with deep and fast respirations. During a spell there is relative decrease in resistance to left ventricular outflow compared to right ventricular outflow, causing an increased right to left shunting try:
1. knee chest position
2. 02
3. morphine
4. sodium bicarbonate to metabolic acidosis

Captopril is an ACE inhibitor and reduces systemic vascular resistance and increases venous capance

During fetal life, alveoli are fluid filled and hopxic, leading to pulmonary artery vasoconstriction and increased pulmonary vascular resistance and pressure. systemic vascular pressure and resistance are low because a majority of the fetal circulation flows to the placenta, which is a low-resistance organ

Maternal systemic lupus erythematosus- is frequently associated with complete heart block in newborns

Cardiac troponin levels may be elevated in mycarditis

Pressures don't autoregulate pressure in the brain of premeemies

Dobutamine
used to treat hypoperfusion and hyptotension especially if related to myocardial dysfunction synthetic catechoamine with beta-adrenegic activity
inotropic- increased myocardial contractility, cardiac index, oxygen delivery
effects cardiac output more than blood pressure
onset of action 1-2 minutes after administration, peak 10 minutes
serum half life-several minutes
must be continuous infusion
adverse effects-hypotension if patient hypovolemic (volume load before starting)
arrhythmias, hypertension, cutaneous vasodilation