Neonates

Question 1

Definition of neonate

Answer 1

≤28 days

Question 2

Late preterm

Answer 2

35-36.6

Question 3

Preterm

Answer 3

<37 weeks

Question 4

extreme preterm

Answer 4

<30 weeks

Question 5

Neonate cardiac output

Answer 5

Preload in the neonates is fixed with less stretch/frankstarlings law. heart is underdeveloped and won’t stretch
A decreased ability to manipulate contractility and very afterload dependant. (milironone/dobutamine)

Question 6

Name the three ducts for fetal transition

Answer 6

1. ductus venous
2. formamen ovale
3. ductus arteriosus

Question 7

Describe cardiovascular transitional changes during delivery

Answer 7

1. Ductus venous functionally closes soon after clamping, and structurally over days to weeks.
2. Fluid in the lungs need to be absorbed to allow air into the lungs, oxygen dilates the pulmonary vasculature, decreasing PVR. Which then increases pulmonary blood flow which will increase the left atrial pressures and causes the FO to close.
3. During transition the PVR decreases to or below SVR and the Right to Left shunt decreases
4. The FO closes and DA beings to constrict but can remain as a bidirectional shunt for days.

Question 8

8 step process for acorn

Answer 8

1. ID neonates who are unwell
2. Is immediate intervention required
3. ACoRN Primary
4. Infection
5. Problem list
6. Address problem list
7. early consultation
8. support family

Question 9

The unwell baby

Answer 9

Poor tone/reflexes. Increased WOB. Poor perfusion, poor temperature, hypoglycaemia.

Question 10

At risk baby

Answer 10

Preterm <37 weeks/SGA. Mom of DM, substance using mom, PPROM, abnormal warm/cold environment.

Question 11

Central Cyanosis ethology

Answer 11

Respiratory in nature, CHD, increasing PVR and shunt physiology

Question 12

Tx of ineffective breathing

Answer 12

HR < 100 effective IPPV and reassess HR. If HR 60-100 continue IPPV. If HR <60, begin CPR.

Question 13

Respiratory sequence for acorn

Answer 13

• recheck patients airway/breathing
• administered o2 as need to maintain spo2 88-95%
• establish/continue monitors: sat, bp, cardiorespiratory, oxygen analyzer
• calculate ACoRN score if spontaneously breathing.

Question 14

Resp score values (mild/mod/severe)

Answer 14

mild: <5
Moderate: 5-8
Severe: >8

Question 15

Mild resp distress

Answer 15

focused hx, physical exam, review dx gets, establish working dx

Question 16

Moderate resp distress

Answer 16

consider/adjust resp support (CPAP/PPV)

Question 17

Severe resp distress

Answer 17

intubate, optimize ventilation. vascular access, cxr, blood gases, consider immediate consult

Question 18

Define TTN

Answer 18

is a parnchymeal lung disorder characterized by pulmonary edema resulting from delayed resorption and clearance of fetal alveolar fluid

Question 19

Define RDS

Answer 19

Defined primarily by deficiency of pulmonary surfactant in an immature lung.

In the premature lung, inadequate surfactant activity results in high surface tension leading to instability of the lung at end-expiration, low lung volume and decreased compliance.

Question 20

Altering signs

Answer 20

laboured breathing (nasal flaring, grunting, intercostal retractions, sternal retractions, gasping)

• RR >60
• receiving resp support

Question 21

Neonatal CVS key concepts

Answer 21

1. Shock, cyanosis, o2 therapy or tachycardia are indictors of CVS instability
2. Prostaglandin E1 is the life saving tx for ductus dependant lesions
3. SVT >220
4. Shock may be the initial presentation of sepsis
5. The classic presentation of a ductus dependent lesion is cyanosis and/or shock

Question 22

cardiovascular sequence clues

Answer 22

pale, mottled, or grey.
weak pulses or low bp
cyanosis unresponsive to o2
heart rate >220

Question 23

cardiovascular sequence

Answer 23

• pale/mottled = consider IV/volume expansion
• cyanosis unresponsive to o2= perform hyperoxia test
• HR >220 = record ECG

Question 24

Neonate shock tx

Answer 24

Hypovolemic = volume expansion
Distributive = volume/inotropes/vasoconstrictors
Cardiogenic= inotropes/prostaglandin

Question 25

Hyperoxia Test

Answer 25

Ideal 15-20 minutes FiO2 of 1.0 then check PaO2 to see if there is an increase. Modifiable for spo2 >10%

Question 26

Assuming a normal Hb level and adequate cardiac output, how are various degrees of desaturation (hypoxemia) tolerate?

Answer 26

SpO2 >75 = mild - moderate defat = well tolerated SpO2 65-75% =marked= may be less well tolerated if baby otherwise sick Spo2 <65= severe= poorly tolerate

Question 27

Neonate severe cardiac instability

Answer 27

listless, or lethargic and/or distressed, decreased tone cap refill >3s pulses weak gallop edema or signs of other third space fluid congested lungs or pleural effusions and/or enlarged heart on cxr

Question 28

Neonate neurology alerting signs

Answer 28

abnormal tone, jitteriness, seizures

Question 29

Neonate glucose <2.6

Answer 29

D10W bolus 2ml/kg | initiate D10W infusion at 4ml/kg/hr

Question 30

Front line seizure med for neonates

Answer 30

phenobarbital 20mg/kg

Question 31

Hx and focused investigations for Neo neuro

Answer 31

CBC with diff, glucose, sodium, calcium, potassium, and magnesium, blood gases, blood cultures

Question 32

Perinatal brain injury

Answer 32

HIE stroke ICH

Question 33

Neonate Abx

Answer 33

ampicillin, gentamycin, acyclovir for neonates

Question 34

Neonate seizure clock

Answer 34

``` Phenobarb 20mg/kg then 10mg/kg x 2 phenytoin 20mg/kg keppra 40-60mg/kg midaz midaz infusion pyridoxine ```

Question 35

Neonate BGL <1.8 tx

Answer 35

2ml/kg bolus then 4ml/kg/hr of D10w

Question 36

Neonate <2.6 BGL

Answer 36

4ml/kg/hr of D10w

Question 37

Neonate hypothermia

Answer 37

<36

Question 38

neonate normothermia

Answer 38

36.3-37.2

Question 39

Fluid required for 0 days

Answer 39

60-80ml/kg/d

Question 40

fluid required for 1 day

Answer 40

80-100ml/kg/d

Question 41

fluid required for 2 day

Answer 41

100-120ml/kg/d

Question 42

fluid required for 3 day

Answer 42

120-140ml/kg/d

Question 43

fluid required for 4 day

Answer 43

150ml/kg/d

Question 44

Closure of Fontanelles

Answer 44

posterior 2-3m after birth sphenoid close at 6 months mastoid 6-18mon anterior 12-18 months