RNC NIC

I/T ratio

%Metas + Bands / %Metas + Bands + Segs I/T ratio greater than >0.2 to >.25 suggestive of infection >0.8 associated with shock

GIR Calculation

(%dextrose x IV rate) / (6 x wt in kg)

Bilirubin metabolism ( Fig. 29-9 ).

(1) Synthesis: bilirubin is primarily the metabolic end-product of erythrocyte (red blood cell [RBC]) breakdown. One gram of heme produces 34 mg of bilirubin; normal neonates produce 8 to 10 mg/kg/day. (2) Transport: heme reversibly binds to albumin (1 g of albumin can bind with approximately 8 mg of bilirubin) and is transported via the bloodstream to the liver as an unconjugated, fat-soluble product with a propensity for fatty tissues such as subcutaneous and brain tissue. (3) Metabolism: glucuronyl transferase converts bilirubin and glucuronic acid into water-soluble glucuronide. (4) Excretion: glucuronide is excreted into bile and enters the intestine, where bacteria convert it to urobilinogen. Urobilinogen is converted to stercobilin and excreted in feces, giving feces a brownish color. (5) Enterohepatic reabsorption of bilirubin: In the small intestine, the high concentration of β-glucuronidase in the brush border in newborn infants can convert conjugated bilirubin into the unconjugated form, which is easily absorbed from the small intestine into the portal circulation. In fetal life, this permits bilirubin to be transported across the placenta for maternal excretion. Increased amounts of bilirubin in the amniotic fluid may indicate hemolytic disease or fetal intestinal obstruction below the bile ducts.

Nagele Rule

+ 1 Year, - 3 months, + 7 days

Meconium Aspiration Syndrome Radiologic Findings

- Coarse, nodular opacities, atelectasis, over inflation

CHARGE association

- Colobomas (ocular tissue defects) - Heart defects ( - Atresia of nasal choanae - Retardation - Genital anomalies - Ear anomlies

Surfactant reduced in

- IDM -Hydrops Fetalis -Smaller Twin

Phosphatidoglcerol (Pg)

-2nd most common phospholipid found in surfactant -appears @ 36 weeks -Prescience of PG indicates decreased risk of RDS

PPHN

-Affects term infants predominately -Elevated Pulmonary Vascular Resistance causes right-to left shunting of blood passed the PDA or FO which leads to hypoxemia

Pneumopericardium

-Air becomes trapped in the pericardial sac that surrounds the heart -Air can accumulate and compress the heart impairing cardiac output -S/s cyanosis, muffled or inaudible heart sounds,

kerniticus

-Cerebral Palsy -Mental Retardation -Hearing * and vision impairment

Surfactant increased in

-Corticosteroids (Should be given 26-28 weeks) -PROM >48 Hours -HTN

Candidas

-Diaper dermatitis presents with intense erythema and satellite lesions. -Congenital candidiasis presents with widespread erythematous maculopapular rash, and preterm infants may present with pneumonia.

Pneumonia Radiology Findings

-Diffuse or focal infiltrates -Hazy or opaque lung fields -Lobar Consolidation

Residuals feeding normal

-Feeding tube is aspirated every 2-4 hours -Incompletely digested aspirates of less than 50% of the previous feedings, OR 2 to 4mL/kg may be normal

TTN Radiology Findings

-Fluid in the fissures -Perihilar streaking or opacity -lung over inflation / pulmonary edema

TTN X RAY

-Hyperexpansion -streaky infiltrates radiating from the hilum -Perhilar streaking

Physiologic Jaundice

-Never visible in first 24 hours of life -Rapid progressive increase in TSB concentration from 2 mg/dl to 5 to 6 mg/dl between 4 days of life. -Does not exceed 15mg/dl

Choanal atresia

-One or two nasal passages may be blocked -When both are blocked by a bony septum or soft tissue membrane -Infant may be cyanotic at rest, will pink up at crying -Insert oral airway, or intubate

Surfactant helps to prevent the alveoli from collapsing by ________.

-Reduces surface tension -Allows Alveli to stay open -Increases lung compliance -Provide alveolar stability -Enhances Alveolar Fluid Clearance

Pierre Robin

-Small jaw, normal size tongue that obstructs the airway -May have cleft palate -To relieve airway obstruction, turn the infant prone -If airway still obstructed despite positioning prone, insert nasopharngeal tube

Congenital Diaphragmatic Hernia

-have a hole in the diaphragm that allows the stomach and bowel to migrate up into the chest most often occur in left chest (pulmonary hypoplasia results) -hypoplastic lungs makes oxygenation and ventilation very difficult -PPHN can present, which is very common with CDH.

Treatment of TEF

-insert feeding tube into stomach, obtain chest xray to determine if there is a pouch -insert orgastric tube into stomach if there is no blind pouch to vent out air -provide low continuous suction to remove secretions -*turn infant prone, head of bed elevated 30 degrees to reduce reflux **radiographic studies are CONTRAINDICATED!

Risks associated with Congenital Diaphragmatic Hernia

-pneumothorax (due to lungs being hypoplastic) -excessive volume or pressure can cause the hypoplastic lungs to collapse -do not over ventilate -dilated bowel and stomach can compress the lung and heart comprising oxygenation, ventilation, and perfusion -right to left shunting can occur secondary to PPHN, check the pre and post saturations

Lipid rate

0.5 to 1 g/kg/day

UVC Placement

1 to 2cm above the diaghragm Low Lying 2-4cm in the cord

Urinary Output

1 to 2ml/kg/hour urinary outpu

Emergency treatment of blood loss resulting in hypovolemia

1. 10-20mL/kg of group O RH negative blood 2. Saline solution if no blood available 10 to 15mL/kg

Beginning tidal volume setting

1. 4 to 5 mL/kg 2. Tidal volume is the primary factor affecting both oxygenation and ventilation.

Omphacele associated with

1. 50% cardiac anaomolies 2. Neurologic anomolies, neural tube 3. Chromosomal anomalies. Common anomalies include trisome 13, 18, 21 (18 most frequent). Very common with Trisomy 18 and Beckwith-wiedemann syndrome

NEC general considerations

1. Acquired disease affects GI system, mainly premature infants 2. Characterized by inflammation of the bowel wall followed by area of necrosis 3. Areas are most commonly in the terminal ileum and proximal colon *Fereding and medications may increase intestinal oxygen demand during absorption, resulting in hypoxia

PEEP

1. Aids in maintaining FRC 2. Stabilizes and recruits atelectatic areas for gas exchange 3. Improves complication 4. Improve VQ matching PEEP is important for surfactant deficient infants due to alveolor collapse.

PIE chest x ray

1. Alveolar overdistention is due to assisted ventilation, visualized as multiple small, cystlike radiolucencies that are bilateral, unilateral, localized, or in a diffuse pattern 2. Condition may lead to a pneumothorax or other air leak.

Imperforate anus

1. Anorectal malformations characterized by a stenotic or atretic anal canal. 2. A fistula between the rectum and perineum, vagine in femals, urethra in males, may occur.

TTN chest x ray

1. Bilateral, symmetrical perihilar streakiness due to increased interstitial and alveolar fluid 2. Mild to moderate overaeration of the lungs and streaky appearing densities

Intermittent Mandatory Ventilation

1. Breaths are delivered at a predetermined rate, regardless of where pt is in resp cycle 2. Delivers fresh gas, aids in spontaneous respirations 3. Possible to stack vent breath on spontaenous breath, will lead to air trapping, air leaks

Billirubin

1. By product of heme breakdown

Methylxanthines (caffeine)

1. Caffeine is preferred, given once daily, has fewer adverse effects. 2. Loading Dose 10mg/kg, maintenance 5mg/kg 3. Adverse effects tachycardia, jitteriness, mild glycosuria

Short bowel syndrome

1. Chronic malabsorption and malnutrition as of a result of bowel shortening. 2. Substantial small intestine is removed during surgery 3. Malabsorption can have diarrhea

PDA

1. Closes with 72 hours 2. Increased oxygen tension closes PDA Clinical Manifestations 1. increased PVR and cardiomegaly 2. Bounding peripheral pulses 2. *hyperactive precordium 3. Widening pulse pressure

High Lesion

1. Colon is higher up in the pevlis, there is a fistula connecting the rectum and the bladder, urethra, or the vagina

Low lesion imperforate anus

1. Colon remains close to the skin (Stenosis), or anus may be missing altogether, with the rectum in a blind pouch.

Increasing PEEP/CPAP

1. Decreases tidal volume 2. Adds to MAP 3. Holds open alveoli and terminal airways on end expiration, thus raising closing volume and aiding in equal distribution of ventilation

Beckwith-Wiedemann Syndrome

1. Defect in the short arm of chromosome 11 2. Omphacele, macroglossia, hypoglycemia

Reticulocyte count

1. Detects new erythroid activity 2. Persistently elevated with ongoing RBC destruction 3. Best test to test for causes of anemia

Radiologic findings of NEC

1. Diffuse gaseous distention of intestines 2. Asymmetric bowel gas pattern 3. Pneumatosis intestinalis (air within the wall of the intestine) 4. Pneumoperitoneu, (Represents instestinal perforamation)

22q11 deletion syndromes (DiGorge)

1. Downslanting eyes 2. short philthrum 3. micrognathia 4. fish mouth Persistent hypocalcemia. Evaluate serum calcium and PTH Absence of thymus, T cell abnormalities Obtain a FISH chromosomal analysis

Hyperbillirubinemia

1. Elevated TSB 2. TSB is a cominbation of conjugated and unconjugated serum billirubin levels

Anatomic events Five stages of lung development

1. Embryonic development (weeks 1 to 5). The endoderm-derived embryonic foregut provides a single lung bud that begins to divide ventrocaudally through the mesenchyme surrounding the foregut. The pulmonary vein develops and extends to join the lung bud. The trachea develops at the end of the embryonic period. There are three divisions on the right side and two on the left side that will eventually become the lobes of the lungs. 2. Pseudoglandular period (weeks 6 to 16). All conducting airways are formed. Cartilage appears; main bronchi are formed; demarcation of major lobes occurs; formation of new bronchi is complete; capillary bed is formed with connecting bronchial blood supply; no connection made with terminal air sacs. The lung at this time undergoes 14 more generations of branching and the formation of the terminal bronchioles. The lung resembles an exocrine organ because of surrounding loose mesenchymal tissues, hence the name pseudoglandular . 3. Canalicular period (weeks 16 to 26). Formation of gas-exchanging acinar units (i.e., respiratory units). The appearance of glycogen-rich cuboidal cells and inclusions for surface-active material storage are seen; capillaries invade terminal airway walls; type II alveolar epithelial cells appear. Airway changes from glandular to tubular and increases in length and diameter. Vascular system proliferates and the capillaries are now closer to the epithelium-conducting airways. Respiratory bronchioles that will participate in gas exchange can be differentiated. 4. Terminal sac period (weeks 26 to birth). Around week 26 alveolar sacs are formed; air-blood surface area is limited for gas exchange; and type II cells are unable to release surfactant in sufficient quantity to maintain air breathing. Capillary loops increase; type II cells cluster at alveolar ducts, become numerous and mature; more budding occurs from alveolar ducts; and lung size increases rapidly because there is an exponential increase in surface area for gas exchange. 5. Alveolar period (week 32 to 8 to 10 years). This phase is characterized by continued alveolar proliferation and development.

polcycythemia pathophysiology, causes, treatment

1. Excess in circulating RBC mass 2. HCT greater than 65% and HgB greater than 22% 3. Blood viscosity a concern 4. leads to a reduction of blood flow to the organs Causes: 1. Hypoxia stimulates erythropoiesis, increasing RBC mass 2. preeclampsia/eclampsia 3. IUGR 4. smoking Complications: 1. hyperbillirubinemia 2. hyperviscosity syndrome (reduced blood flow and vascular thrombosis)

Malrotation etiology

1. Failure of intestine to rotate and fixate appropriately 2. Intestines may fixate on themselves (midgut volvulus) 3. May occlude the inestinal lumen or twist around mesenteric artery occluding intestinal blood supply. 4. Duodenal obstruction due to peritoneal (Ladds) bands encircling the duodenum.

Rh incompatibility pathophysiology, causes, outcome

1. Fetal blood cells containing Rh antigen (rH positive) enter the maternal circulation. 2. Maternal RBCs have no antigen (RH negative) 3. Maternal system produces antibodies against the foreign fetal antigens. 4. Maternal antibodies enter fetal circulation and destroy fetal RBCs 5. Less frequent, more severe if untreated Causes: previous pregnancy, abortion Fetal maternal hemorrhage Amniocentisis, chorionic venus sampling Outcome: 1. Anemia, tissue hypoxia 2. CHF, Hydrops (fetus attempts to expand blood volume and cardiac output, resulting in generalized edema) 3. Hypoglycemia, petechiae, hepatosplenomegaly, positiver direct coombs test

Umbilical Cord Prolapse

1. Fetal decelerations due to cord compression often accompany umbilical cord prolapse. 2. These infants typically have prolonged bradycardia with severe variable decelerations and are at high risk of fetal asphyxia. 3. Approximately one third of infants with umbilical cord prolapse had Apgars less than 7 at 5 minutes of life. 4. Umbilical cord prolapse and the subsequent compression of the cord lead to respiratory acidosis and, if prolonged, anaerobic metabolism. 5. The resulting blood gas is likely to demonstrate a mixed respiratory and metabolic acidosis. 6.Lactate levels will also be elevated in the case of a prolapsed cord and asphyxia.

Signs and symptoms of NEC

1. Gastric residuals (>50%) 2. Signs of sepsis (lethargy, hypotension, apnea, bradycardia, temp instability, hypoperfusion). 3. Blood in stools: occult or frank blood 4. Third spcaing of fluids is common, can lead to hypovolemia and hypotension

Indomethicin (NSAID

1. Hypoglycemia 2. Platelet dysfunction 3. Gastrointestinal perforation w/ steroids 4. Renal effects, decreases urine output! Used if PDA fails to close to prevent pulmonary over circulation and PPHN

Kleihauer-Betke test

1. Identifies fetal hemoglobin in maternal blood

Cholestasis general manifestation

1. Impairment in bile flow 2. Neonatal liver is prone to cholesasis because bile acid pool size is diminished and hepatic uptake and excretion mechanisms are immature 3. Skin is green bronze color due to hyperbillirubinemia, jaundice does not show for 2+ weeks

Vitamin K pathophysiology

1. Important in formation of calcium binding sites, necessary for functional activation of clotting factors Vitamin K levels can be reduced by women taking anticonvulsants, and vitamin K antagonists like warfarin

Response to hypoxemia

1. Increase depth of breathing (tidal volume), however, if the hypoxia worsens, there will be a depression of the respiratory drive Hypoxia is associated with an increase in periodic breathing and apnea

Increasing PIP

1. Increases TV 2. Adds little to MAP 3. Affects maximum dilation of alveoli already open, contributing to barotrauma 4. Opens alveoli

NST (non-stress test)

1. Indicated for patients at risk of placental insufficiency, started as early as 30 to 32 weeks. 2. Reactive test result is reassuring

Organisms commonly associated with NEC

1. Klebsiellia 2. E. Coli 3. Clostridium

Varicella (chicken pox) sign and symptom

1. Limb Hypoplasia 2. Microcephaly 3. Chorioretinitis 4. microphalthemia 5. **cictrical scarring

IDM fetal presentation

1. Macrosomia (Weight >4000g) 2. RDS 3. Hypoglycemia 4. Polycythemia, hyperviscosity, hyperbillirubinemia 5. Cardiomyopathy 6. CHF

Truncus arteriosis management

1. Maine SpO2 between 75-85% to increase pulmonary vascular resistance to decrease excessive pulmonary blood flow. 2. Prostaglandin E1 if interrupted aortic arch 3. Evaluate for 22q11 deletion syndrome (FISH chromosome, immunodeficiency profile, calcium level).

Patient triggered ventilation

1. Mechanical breaths are delivered in response to a signal derived from the patient and detected as a spontaneous respiratory effort 2. Goal is to avoid asynchrony of breathing by the patient and breaths given by the ventilator.

MAS

1. Meconium finds its way into amniotic fluid, sign of fetal distress, most commonly occurring from hypoxic event 2. Causes atelectasis, air trapping, inflammation

Diuretics effects

1. Metabolic Alkalosis 2. Ototoxicity 3. Decreased calcium absorption in bones

MAS chest x -ray

1. Mild cases may show a normal lung pattern to mild infiltrates with overexpanded lungs. 2. Bilateral asymmetrical areas of atelectasis; hyperaeration and air trapping due to debris, with flattened hemidiaphragms 3. Possible air leaks (pneumothorax or pneumomediastinum) resulting from overdistention and rupture of the alveoli.

High Imperforate Anus

1. More common, more complex 2. Male Predominance 3. Rectourinary and rectovaginal fistulas are common **High imperforate anus can be associated with incontinence

Mother's with Chorioamnitis presentation, placental abruption, placental previa, and prolapse

1. Mothers with chorioamnionitis present with fever >100.4° F, tachycardia >100 beats per minute, and uterine tenderness. Foul-smelling amniotic fluid and leukocytosis may also be present. 2. Placental abruption may present with uterine tenderness, but vaginal bleeding is also present. 3. Placenta previa occurs when the placenta is covering the cervical opening. The symptoms are painless bleeding in the absence of uterine tenderness. 4. Umbilical cord prolapse occurs when the umbilical cord presents alongside or before the fetal presenting part. Umbilical cord prolapse is not associated with infection, but rather fetal hypoxia.

Amniocentisis

1. Needle used to aspirate 20mL of amniotic fluid at 18-20 weeks.

Pyloric Stenosis clinical presentation

1. Nonbilious vomit that becomes projectile over time 2. Visible Peristaltic waves in epigastrium 3. Palpable Olive in right upper quadrant (70-90%) Diagnose with ultrasound or Upper GI tract contrast study

Biliary Atresia general manifestation and presentation

1. Obstruction of bile flow in the bile duct system 2. Bile fails to exit the liver, resulting in hepatic fibrosis and cirrhosis, portal hypertension 3. Skin is not yellow, rather green-bronze color because of conjugated billirubinemia, always pathologic 4. jaundice does not show for 2+ weeks 4. **Acholic stools, dark urine 5. May see ascites 6. Hepatosplenomegaly. Liver is hard

Pneumonia

1. Occasionally asymmetrical, patchy, or streaky bilateral interstitial infiltrate. A nodular pattern may predominate in hazy lungs, and an effusion is a common occurrence 2. Reticulogranular pattern similar to that of RDS. Some alveoli contain inflammatory exudate, which will appear more opaque on x-ray than those filled

Early onset GBS infection

1. Occurs 1-7 days of life 2. Manifests as generalized sepsis 3. Pneumonia 4. Meningitis

Choanal atresia airway management and imgaing

1. Orpharyngeal air way is sufficient 2. Order CT scan **Intubate ONLY with bilateral atresia with severe asphyxia

PIP setting

1. PIP is the primary factor used for determining tidal volume and affect PAo2. 2. A beginning PIP of 20 cm H2o is appropriate.

Thrombocytopenia

1. PLT count <150,000 Causes: 1. Maternal IgG antibodies cross placenta and destroy fetal platelets 2. Neonatal alloimmune thrombocytopenia (most common cause of significant, early-onset thrombocytopenia in a health neonate) 3. Rh incompatibility 4. fetal PLTs contain antigen lacking in mother, enter matneral circulation, result in maternal production of antibodies, maternal antibodies cross into fetal circulation and coat fetal platelets, which are destroyed

DIC diagnostic study

1. PLT low 2. PT and PTT prolonged (may be normal in early DIC) 3. Fibronigen is low 4. D-Dimer elevated (marker for endogenous thrombin/plasmin production)

Coombs test Indirect

1. Positive indirect Coomb's test means that antibodies against the infant's RBCs are present in maternal blood

Coombs test Direct

1. Positive test indicates maternal immunoglobulin G (IgG) antibodies on the surface of infant RBCs

SIMV

1. Preset number of ventilator breaths is synchronized with the onset of spontaneous breaths. 2. When the infant initiaties a breath, ventilator supports that breath according to the preset PIP and inspiratory time. 3. Unassisted breaths occur between ventilator breaths

Pressure Support ventilation

1. Pressure limited and flow cycles. 2. Ventilator supports each breath and terminates the breath when the inspiratory flow drops below a preset threshold. 3. Avoids prolonged inspirations.

Group B strep

1. Principal pathogen in the neonate for over 50 years 2. Nearly 50% of infants who pass through a colonized birth canal become colonized Risk factors include: 1. Prematurity (<37 weeks) 2. PROM >18 hours 3. Chorio 4. Maternal GBS Bacteriuria during pregnancy

Pneumopericardium

1. Radiolucent halo of free air surrounds the heart as air accumulates within the pericardial space 2. Width of air around the heart is proportional to the amount of air present. Air is limited to the pericardium and cannot extend beyond the origins of the aorta and pulmonary artery. 3. Decreased cardiac size may indicate cardiac tamponade.

Parameters to be set during mechanical ventilation

1. Rate of 40bpm for an infant without respiratory failure 2. Rate of 20-30 for an infant with respiratory failure

Surfactant administration leads to

1. Reduction in surface tension 2. Improvement in gas exchange 3. Improved lung compliance 4. INCREASE in lung volume

Cri du chat

1. Short arm of chromosome 5 2. Unusual, weak, cat like cry 3. SGA 4. Hypotonic 5. microcephalic

Truncus Arteriosis

1. Single enlarged artery from the left and right ventricular 2. Single Truncal Valve 3. VSD Blood flow pattern in TA - Deoxygenated blood from the right ventricle mixes with oxygenated blood from the left ventricle at the VSD. Blood is ejected through the truncal root to the systemic, pulmonary, and coronary circulation.

Cholestasis presentation

1. Skin is green bronze color due to hyperbillirubinemia, jaundice does not show for 2+ weeks 2. Acholic stools, malabsoprtion of fat (steatorrhea) 3.

ETT can cause

1. Subglottic stenosis 2. Palatal grooves 3. Tracheosophegeal perforation 4. Aspiration 5. Infection

Assist control

1. Synchronized breath is delivered each time a spontaneous patient breath meeting the threshold criteria is detected.

Infants of moithers with uncontrolled diabetes have an increased risk of

1. Transposition of great vessels 2. VSD 3. Cardiomyopathy 4. Complex congenital heart disease

Exchange tranfusion

1. Treatment of pathological jaundice caused by blood group incompatibility 2. Partial exchange if necessary to treat severe anemia of hydrops without increasing intravascular volume

Jejunal atresia radiologic finding

1. Type Bubble 2. Barium enema reveals a microcolon

Umbilical vein and artery oxygen concentrations

1. Umbilical artery has the lowest oxygen concentration 2. Umbilical vein has the highest oxygen concentration

DIC

1. Uncontrolled activation of coagulation and fibrinolysis Causes: 1. infection 2. RH incompatibility 3. Thrombocytopenia Signs and symptoms: 1. Hemorrhage 2. Petechia 3. Prolonged oozing 4. Localized necrosis and gangrene resulting from microvascular thrombosis of peripheral vessels

Nitric Oxide

1. Used to promote relxation of pulmonary smooth muscle to facilitate perfusion and gas exchange. 2. Duration usually less than 5 days 3. May cause platelet aggregation, methomoglobinemia 4. short half life

HFOV

1. Uses small tidal volumes at rates of at least 150 breaths per minute 2. Advantage of HFV is the ability to deliver mintue volumes using small tidal vume with lower distal airway pressures

Corticosteroids implications

1. adverse reactions bowel perforation 2. neurodevelopmental outcomes can be poor 3. monitor gastric aspirates for blod. 4. Echocardiogram if treatment greater than 7 days 5. Other effects include hyperglycemia, glycosuria, hypertension, cardiac effects, sodium and water retention, sepsis, hypocalcemia

NEC X-Ray

1. air in the intestine walls, often termed "pneumatosis intestinalis" 2. Caused by microperforations within the bowel wall caused by necrosis and edema 3.

MAS x-ray

1. air trapping 2. hyperexpansion 3. hyperinflation 4. Diffuse coarse patchy infiltrates

Umbilical cord compression

1. leads to CO2 accumulation and acidosis

Trisomy 13 (patua syndrome)

1. microcephaly 2. CNS malformations 3. coloboma of the iris 4. postaxial polydactyly

ABO incompatibility infant presentation

1. mild hemolysis, anemia, reticulocytosis 2. hyperbillirubinemia (may become pathological)

Neonatal Sepsis Early Onset , most common pathogens

1. occurring before 72 hours of life, 2. The most common pathogens leading to early-onset neonatal sepsis are group B streptococcus and Escherichia coli. Septic infants may present with lethargy and poor feeding, but may also have more systemic manifestations, such as respiratory distress, hypotension, and temperature instability.

Neonatal Late Onset Sepsis , most common pathogens

1. occurring between 72 hours and 7 days of life. 2. Staphylococcus aureus, Candida spp., and Pseudomonas aeruginosa are common organisms contributing to late-onset sepsis. Septic infants may present with lethargy and poor feeding, but may also have more systemic manifestations, such as respiratory distress, hypotension, and temperature instability.

RDS chest X-ray

1. reduced lung volume 2. air bronchograms -- from collapsed aveoli 3. reticulogranularity 4. patchy infilitrates 5. this is a restrictive lung disease

Causes of anemia

1. result of blood loss (hemorrhage) 2. shortened RBC survival (hemolysis) 3. underproduction of erythrocytes Decreased oxygen carrying capacity = hypoxia RBC life term infant 60-70 days Preterm infant 35-50 days

Glocse 6 phosphate dehydrogenase (G6PD)

1. sex linked disease affecting mainly male offspring, occasional female carriers 2. Deficiency of RBC enzyme, exposure to oxidant stress 3. causes hemoysis and shortened erythrocyte life 4. most common in African American infants

BPD chest x ray

1. there is a persistent haziness of vessel margins progressing to linear densities that persist into the third or fourth week of life. 2. Subsequently there is gradual development of a bubbly appearance of the lungs in association with hyperaeration, which is more pronounced at the lung bases. This persists after 1 month of age and represents a modified form of BPD

Lasix

1.Causes loss of chloride, sodium, potassium, and calcium. 2. Dieresis may decrease pulmonary blood flow, decrease vascular resistance, and increase pulmonary compliance.

TTN

1.Result of delayed re absorption of normal lung fluid (wet lung syndrome). 2. Known as an obstructive lung disease 3. Generally occurs in term or late term babies 4. Tachypnea, nasal flaring, grunting, retractions may be seen

Cardiac disease 100% fIO2

100% Fio2 administration will not change the PA02.

Fluid Volume Bolus

10mL/kg

FHR baseline

110-160 beats per minute

Preterm Parenteral Fluid Requirement

120 Enteral 150-200ml/kig/day

Platelet Range

150-400k Thrombocytopenia (< 100,000/mm 3 ): possible association with bacterial sepsis or viral infection, but usual onset does not occur until 1 to 3 days after infection onset (late indicator). May also occur with maternal HELLP syndrome ( h emolysis, e levated l iver function test results, and l ow p latelet count), pregnancy-induced hypertension, and intrauterine growth restriction, as well as some syndromes such as trisomies 13, 18, and 21, Turner's syndrome, and hemolytic disease.

Hemoglobin binds with

2,3-diphosphoglycerate (2,3 DPG), releasing oxygen molecule

Signs of late onset pneumonia

2-4 weeks caused by chlamydia trachomatis

Weight gain

24 - 32 weeks : 15-20 g/kg/day

Gestational age for testing diabetes

24 to 28 weeks' gestation.

The optimal ratio of calcium to phosphorus to meet recommended dietary daily requirements and enhance growth for the premature infant is:

2:1

D10 Bolus

2mL/kg

Tidal Volume

4 to 6 ml/kg Amount of air that moves in and out of the lungs during a normal breath

Dopamine Dose

5-20mcg/kg/min < 5 mcg/kg/min used for vasodilation of renal, mesenteric, cerebral, and coronary vasculature

Maintain Blood Glucose Levels

50-110 mg/dL

Endotracheal Measurement

6 + wt in kg Proper placement on an endotracheal tube is midway between the thoracic inlet and the carina.

GIR

6-8mcg/kg/min caloric intake

Optimal glucose range

70 to 100 mg/dL

GIR for infants <1000g

8-9 mg/kg/min

Parenteral Calorie Intake

80 to 100 kcal/kg/day <20% of enteral caloric intake

Term Parenteral Fluid Requirement

80mL/kg/day Enteral 100-150 mlk/kg/day

GIR increase

9 to 12 mg/kg/min over 2 to 7 days

Chest Compression and Ventilation Resuscitation

90 Compressions a minute, 1/3 of the diameter 30 breathes a minute

A hyperoxia test PPHN results in

<100% PaO2.

Polyethylene wrap

<29 weeks gestation <1500 grams Cover from the neck to the feet

Olighydraminos fluid volume

<500mL = renal agenesis or dysgenesis

Polyhydraminos fluid volume

>2000mL

Residuals feedings abnormal

>50% of amount of feeding given in 3hr Or 2-4mL/kg

Candida Rash

A candida rash is most often found in the groin and consists of lesions over an erythematous base with satellite lesions extending beyond the groin.

Balloon atrial septostomy

A cardiac catheter is placed across the atrial septum at the foramen ovale. A balloon is inflated and then pulled across to open the septum to provide a way for the two parallel circuits to mix the deoxygenated blood from the body with the oxygenated blood from the lungs at the atrial level. There is no dilatation of the coronary arteries as a result of this procedure.

Cephelhematoma

A cephalohematoma is a collection of blood between the periosteum and the skull that does not cross the suture line. It may enlarge during the 24 hours after birth and may take several months to resolve. These infants are at a higher risk for developing hyperbilirubinemia

CSF glucose levels r/t meningitis

A cerebrospinal (CSF) glucose less than 25 mg/dl is abnormal and could indicate meningitis. Normal mean glucose values are 79 to 83 mg/dl (range 64-106 mg/dl) for preterm infants, and 51 to 55 mg/dl (range 32-78 mg/dl) for term infants.

Turner Syndrome

A chromosomal disorder in females in which either an X chromosome is missing 1. Short webbed neck 2. downslanted palpebral fissures 3. micrognathia 4. low set posterriorly rotated ears 5. broad thorax 6.

Hirschubrung Disease signs and symptoms

A clinical sign of Hirschsprung disease is the failure to pass meconium in the first 24 to 48 hours after birth, which may be accompanied by bilious vomiting and progressive abdominal distention. The disease is marked by a congenital absence of parasympathetic innervation to the distal intestine due to the absence of ganglionic cells.

Deformation

A deformation is an alteration of morphogenesis caused by unusual forces on previously normal tissue. Clubfoot and plagiocephaly are examples of deformation.

Disruption

A disruption is an abnormality of morphogenesis caused by disruptive forces acting on the developing structures. Defects that result from amniotic bands are an example of disruption.

What type of nerve block for a circumcision?

A dorsal penile nerve block or other regional block or topical anesthetic would be appropriate for a circumcision.

A hyperoxia test RDS vs. cardiac

A hyperoxia test is performed by administering 100% oxygen for 10 minutes and then measuring the arterial preductal PaO2 (right radial artery). A significant increase in PaO2 levels, particularly a Pa O2 level >150 mm Hg, makes the likely cause respiratory distress rather than cardiac in origin.

Recommendations for asympotmatic infants with chorio

A limited evaluation blood culture at birth and complete blood count with differential and platelets at birth, 6 to 12 hours of life, or both and antibiotic therapy is the recommended management for asymptomatic infants when maternal chorioamnionitis is diagnosed clinically.

Malformation (Anomaly)

A malformation is an abnormality of morphogenesis caused by an intrinsic abnormal developmental process. Examples are neural tube defects, cleft lip, and cleft palate.

A mydriatic agent, or agent that dilates the pupil of the eye

A mydriatic agent, or agent that dilates the pupil of the eye, is an anticholinergic meaning that it blocks acetylcholine in the central and peripheral nervous system. If systemic absorption occurs, other anticholinergic effects could be observed, including tachycardia and restlessness.

A nonrandom occurrence is an

A nonrandom occurrence of multiple anomalies is classified as an association. VATER association (vertebral anomalies, anal atresia, tracheoesophageal fistula, radial and renal dysplasia) and CHARGE association (coloboma of the eye, heart anomaly, choanal atresia, retardation, and genital and ear anomalies) are examples.

direct Coombs test

A positive result on the direct Coombs test indicates that maternal immunoglobulin G antibodies have crossed the placenta and are attached to the surface of the baby's red blood cells.

A preterm infant with a birth weight of 1800 g was delivered to a mother who was not tested during pregnancy for hepatitis B surface antigen (HBsAg). A maternal blood sample was drawn at delivery for HBsAg determination. While the results are awaited, and within 12 hours of birth, the infant should receive hepatitis B vaccine. When should the nurse administer hepatitis B immune globulin?

A preterm infant weighing less than 2000 g whose mother's hepatitis B surface antigen (HBsAg) status is unknown should receive hepatitis B immune globulin (HBIG, 0.5 ml) within the initial 12 hours after birth if the mother's status cannot be determined within 12 hours, because the vaccine has potentially decreased immunogenicity in these infants.

CCHD screening

A screen result would be considered positive if any oxygen saturation measures less than 90%, oxygen saturation is less than 95% in both extremities on three measures—each separated by 1 hour, or there is a 3% absolute difference in oxygen saturation between the right hand and foot on three measures, each separated by 1 hour. Any screening that is >95% in either extremity with no more than a 3% absolute difference in oxygen saturation between the upper and lower extremity would be considered a "pass" result, and screening would end.

A sequence is defined as a(n):

A sequence is a group of anomalies resulting from a cascade of events initiated by a single malformation. Pierre Robin is an example of a sequence.

Radiology x-ray findings pneumothorax

A sharp edge sign, in which the cardiac border and the diaphragm are seen in sharp contrast, is a radiographic finding of a pneumothorax.

amniocentesis

A technique of prenatal diagnosis in which amniotic fluid, obtained by aspiration from a needle inserted into the uterus, is analyzed to detect certain genetic and congenital defects in the fetus. Used to determine Lecithin/sphingomyelin and prescence of phsophatidylglycerol

point of maximal impulse definition and shift

A tension pneumothorax on the left will shift the mediastinum to the right, moving the point of maximal impulse (PMI) to the right. The point of maximal impulse, known as PMI, is the location at which the cardiac impulse can be best palpated on the chest wall (at apex of heart, left side)

Thiazide Diuretic and calcium

A thiazide diuretic causes calcium absorption and therefore decreases any urinary excretion.

voiding cystourethrogram (VCUG)

A voiding cystourethrogram (VCUG) will evaluate for the presence of vesicoureteral reflux (VUR).

ABO incompatibility

ABO incompatibility affects babies when mothers have blood group O and the babies have blood group A or B (seen as antigens) Mom will make antibodies and attack fetal RBCs by maternal anti-ab antibodies Protects against fetal RH disease because of rapid destruction of fetal A/B cells, preventing RH antigen exposure While it occurs more frequently than Rh isoimmunization (partially because of the use of RhoGAM for Rh), the hemolytic disease is less severe.

Congenital Diaphragmatic Hernia

Abdomen may appear scaphoid (sunken). Decreased breath sounds on side with hernia -Intubate patient -Insert orogastric or nasogastric tube and frequently remove air from the stomach to prevent the air from entering the bowel ***

Hydrops Fetalis

Abnormal fluid in two or more fetal compartments such as peritoneum, pericardium, skin, pleura Caused by massive hemolysis , sensitized mother's antibody crosses the placenta and attaches to fetal red blood cells Perform thoracentesis, pericentisis

Neurodevelopmental Positioning

Abnormal head molding, hip adduction and external rotation, and arching posture are prevented by correct neurodevelopmental positioning.

Cyanotic congenital heart disease

Abnormal heart structure causes blood to byhpass the lungs for oxygenation (1) Pulmonary atresia (2) hypoplastic right heart (3) Hypoplastic left heart (4) severe PS (5) Tetrology of fallot (6) TGA (7) TAPVR (8) Truncus arteriosus (9) Tricuspid atresia

Total anomalous pulmonary venous return (TAPVR)

Abnormal pulmonary venous drainage directly or indirectly to the right atrium. Pulmonary venous returns enters the left atrium through a right-to left shunt across the foramen ovale or ASD.

Clinical signs of Biliary Atresia

Acholic stools, bronze undertones, dark urine, hepatosplenomegaly

Surfactant secretion can be stimulated by _ _ _

Adenosine triphosphate is a purine receptor agonist that is a potent stimulator of surfactant secretion. Surfactant secretion is stimulated by hyperventilation.

Hyperoxia Test

Administer 100% oxygen for 10 minutes PaO2 >150% associated with respiratory disease PaO2<50-100% associated with cardiac disease, PPHN, right to left shunt

Hyperoxia Test

Administer 100% oxygen for 10 minutes and then measure the arterial preductal PaO2 (right radial artery). 1. A significant increase in PaO2 levels (>150 mmg Hg); makes the likely cause respiratory distress rather than cardiac related. 2. Levels below 50 to 60 mm Hg may be related to transposition of the great vessels or from defects in the pulmonary outflow. 3. Mixing lesions may have PaO2 values from 75 to 150 mm Hg. 4. Infants with PPHN commonly present with hypoxia and hypoxemia.

Neonatal Circulation after birth

After cord cut: -Blood pressure in aorta increases, increasing systemic vascular resistance -Blood pressure in lung decreases, decreasing pulmonary vascular resistance. More blood enters lungs and fills left atrium. The increased pressure in the left atrium helps to functionally close the right to left shunt through the foramen ovale.

Albuterol is a

Albuterol is a bronchodilator—specifically, a β2-adrenergic agent—that within minutes effectively increases compliance and decreases airway resistance.

Amnioinfusion

Amnioinfusion is a method in which isotonic fluid is instilled into the amniotic cavity in order to correct fetal heart rate changes thought to be caused by compression of the umbilical cord [variable decelerations]. Amnioinfusion is used to attempt to resolve variable fetal heart rate decelerations by correcting umbilical cord compression as a result of oligohydramnios. When amnioinfusion is used during labor to treat recurrent severe variable decelerations, it has been proven to reduce the incidence of cesarean deliveries. Amnioinfusion may assist with oligohydramnios (amniotic fluid index <5 cm)

Omphacele and cardiac defect

Among infants with omphalocele, 50% have accompanying cardiac defects.

Tidal Volume

Amount of air that moves in and out of the lungs during a normal breath

Anterior Posterior x-ray

An A/P chest x-ray will reveal pathology of the lungs, not the abdomen.

lecithin/sphingomyelin (L/S) ratio

An L/S ratio greater than 2:1 is considered to indicate fetal lung maturity.

Autosomal recessive

An autosomal-recessive inheritance pattern requires that the corresponding genes on both chromosomes of a pair be defective for the gene's effect to be expressed. T

Shift to the right oxygen-hemoglobin curve

An increase in PaCO2, an increase in temperature, and an increase in diphosphoglycerate level all cause a shift to the right in the oxygen dissociation curve.

Potential problems with SGA

An infant born at 40 weeks' gestation weighing 2000 g is well below the 10th percentile for weight and would be classified as small for gestational age (SGA). Potential problems for which SGA infants are at risk include polycythemia, hypoglycemia, hypothermia, hypoxia, and infection.

Hyperinflation on chest x ray

An x-ray showing overaerated but clear lung fields is indicative of hyperinflation.

Anterior posterior (AP) abdomen and cross-table

Anterior posterior (AP) abdomen and cross-table lateral films will determine the presence of free air, given the concern for pneumoperitoneum per the clinical examination. Because free air rises, the cross-table lateral has the capability of showing free air positioned just under the abdominal wall. A 3-cm increase in abdominal girth, visible bowel loops, increased apnea episodes, and a 50% residual from the infant's last feed is noted upon clinical examination. The nurse should anticipate an order for which type of x-ray?

Rh incompatibility treatment

Anti-D antiobodies injected into maternal circulation Recommended at 28 weeks of gestation, within 72 hours after delivery, and after *amniocentisis, or any type of sampling

Anticholinergic side effects in neonate

Anticholinergic drugs block acetylcholine at parasympathetic muscarinic receptors. Their actions include increased heart rate, pupil relaxation, and decreased tone and motility of the gastrointestinal tract.

Which of the following cardiac lesions can be palliated with a transcatheter balloon valvuloplasty?

Aortic Stenosis A balloon valvuloplasty can be performed in the catheterization laboratory immediately after the infant has been stabilized with medical and pharmacologic treatment, including prostaglandin E1.

Arachidonic acid and docosahexaenoic acid

Arachidonic acid and docosahexaenoic acid are considered conditional essential nutrients in preterm infants and should be provided during enteral feedings to improve neurologic and visual development and modulate immune functions.

Blood Gas Values

Arterial pH 7.30-7.45 PC02 35-45 PO2 50-80 Bicarbonate 22-26 Base excess -4 to +4 Capillary pH 7.30-7.45 PCO2 35-50 PO2 35-45 (not useful for assessing oxygenation) Bicarbonate 22-26 Base Excess -4 to +4

Bruit auscultation over liver

Arteriovenous malformation

Assessment finding of term infant

As gestation progresses beyond 38 weeks, the subcutaneous tissue decreases, which causes the skin to wrinkle. At term gestation, the breast tissue nodule measures up to 10 mm. There is cartilage present in the pinna, which allows it to spring back from being folded.

Truncus arteriosus

As pulmonary vascular resistance decreases in neonatal period, blood flow to the lungs increases and leads to pulmonary overcirculation and CHF. S/s - tachypnea, bounding pulses, tiring, shortness of breath, diaphoresis

Hydrops fetalis -Ascites X ray finding

Ascites is seen as a centralized bowel gas pattern on x-ray. generalized edema in the fetus secondary to severe anemia resulting from destruction of erythrocytes.

Gastroschesis care

At the time of delivery, protection of the intestines is important. The infant should be placed in a sterile bowel bag to allow for visualization of the intestines. In absence of a sterile bowel, another option to protecting the intestines includes covering the intestines with warm sterile saline-soaked gauze that covers the exposed intestines and then applying a plastic covering over the gauze to prevent evaporation and heat loss.

RDS Radiology findings

Atelactsis with air bronchograms, under inflated lungs

Preductal oxygen saturation

Attach oximeter probe to the right palm at birth.

Most apparent type of anomilies associated with Kerniticus

Auditory abnormalities are most apparent in kernicterus because the auditory pathway is the neuronal system most sensitive to bilirubin.

Early onset bacterial and viral cause of pneumonia

Bacterial - group b strep and e coli Viral - HSV

RH Incompatibility and amniocentisis

Because an amniocentesis can cause minute amounts of fetal red blood cells to enter the maternal circulation, maternal antibodies (IgM and IgG) can result if the mother is Rh negative and the baby is Rh positive.

Assessing point of maximal intensity

Because of the dominance of the right ventricle, the point of maximal intensity is best heard over the fifth intercostal space in the immediate newborn period.

Chest x-rayu pneumonia

Bilateral alveolar densities Air bronchograms Patchy infiltrates

Which chest x ray findings best represent pneumonia?

Bilateral streakiness, hyperexpansion, reticulogranular pattern is found with pneumonia

Pale Stool

Biliary atresia

The clinical presentation of tachypnea, hypercarbia, tissue mottling, diminished capillary refill, and oliguria associated with patent ductus arteriosus in the preterm infant is the result of which of the following conditions?

Blood flow through a patent ductus arteriosus (PDA) is pressure dependent. In a preterm infant, as pulmonary vascular resistance decreases, blood leaves the aorta and enters the pulmonary artery, which results in a left-to-right shunt, pulmonary edema, and diminished gas exchange at the alveolar level.

Breastmilk Jaundice presentation, value, cause, treatment

Breast milk jaundice occurs after 4 to 7 days of life and is related to two substances found in the maternal breast milk that interfere with bilirubin conjugation and increase the resorption of bilirubin from the intestine, resulting in increased indirect bilirubin. The resulting level of total bilirubin is often between 12 and 20 mg/dl. In breast milk jaundice, stopping feeding breast milk for 24 to 48 hours will decrease the level of the total bilirubin by 50%

Methylxanthines (Theophylline)

Bronchodilator

Theophylline

Bronchodilator. Opens airways. Short half life, caffeine preferred treatment due to longer half life and more tolerable side effect profile.

End of Canalicular Stage

By the end of the canalicular stage of pulmonary development, the bronchial tree is completely formed and immature type II pneumocytes capable of surfactant synthesis begin to appear.

Avoid CPAP in

CDH TEF/EA

CRP level

CRP level usually <1.6 for the first two days of life Elevated cord blood CRP levels are associated with chorioamnionitis with prolonged rupture of membranes.

Methylxanthine medications are

Caffeine, theophylline, and aminophylline are methylxanthines used to treat apnea.

Ultrasonography

Can be used to diagnose pyloric stenosis, biliary artresia

Erythroblastis Fetalis

Can result from RH incompatibility

HIE Candidates

Candidates for therapeutic hypothermia must be greater than or equal to 36 weeks' gestation and less than 6 hours of age.

Capillary Blood Gas Values

Capillary ** pH 7.30-7.45 PCo2 35-50** PO2 - (in capillary not useful for assessing oxygenation) Bicarbonate 19-26 Base Excess -4 - +4

Carnitine

Carnitine is a carrier molecule needed to transport long-chain fatty acids into mitochondria for oxidation.

Bruit

Caused by tuburlent blood flow through an artery

cystic hygroma

Cavernous lymphangioma of the neck. Associated with Turner syndrome.

S/s of TEF

Choking, coughing, cyanosis with feeding, risk of aspiration high can cause pneumonia Excessive salivation **history of polyhydraminos related to GI anomalies, fetus is unable to swallow amniotic fluid, think TE and bowel obstruction Remember VACTERL

Gold standard test of erythrocyte mass

Chromium-labeled erythrocytes

Chronic Intrauterine Stress with fetal lung development

Chronic fetal stress increases endogenous corticosteroids, resulting in accelerated lung maturity and a decrease in the severity of respiratory distress syndrome (RDS).

Varicella (chicken pox)

Cicatricial scarring (hair follicles are replaced with scar tissue) is a classic finding in congenital varicella. Limb hypoplasia and microphthalmia (small eyes) are also described with this infection.

Turner Syndrome

Clinical features of Turner syndrome include low posterior hairline with the appearance of a short neck, small stature, low-set ears, broad chest with widely spaced nipples, limb abnormalities, and ptosis of the eyelids.

Trisomy 18

Clinical features of trisomy 18 include low birth weight in a term infant, ears that are low set and/or of abnormal shape, micrognathia and microstomia, rocker-bottom feet, clenched hand with flexed fingers, and flexion contraction of the middle two fingers.

What is the organism most commonly responsible for nosocomial bloodstream infection in NICU patients?

Coagulase-negative STAPHYLCOCCI are the organisms that most commonly cause nosocomial infections in the NICU, accounting for approximately 50% of bloodstream infections.

Coartication of the aorta

Coarctation of the aorta has the classic finding of decreased perfusion and pulses in the lower extremities. These infants can develop temperature instability and poor feeding. Congenital heart disease should be suspected when infants present with an increase in respiratory rate in the absence of any other respiratory signs of distress and cyanosis.

Placental Abruption Risk Factors

Cocaine use and cigarette smoking are two risk factors commonly associated with placenta abruption as a result of a hypertensive state. Hypovolemia is a known neonatal complication of placenta abruption due to acute blood loss at the time of delivery.

charge

Colobomata Heart Disease Choanal Atresia Mental Retardation Genital Hypoplasia Ear Anomoalies

A chest radiograph is ordered for an infant with a suspected patent ductus arteriosus. The nurse should anticipate which of the following findings?

Common clinical manifestations of a patent ductus arteriosus include: -increased pulmonary vasculature and cardiomegaly on chest radiograph -bounding peripheral pulses, and an active precordium. -A widening pulse pressure with a low diastolic blood pressure may be present. Unexplained acidosis may be present.

Variable Decelerations

Compression of the umbilical cord, could be caused by oligohydraminos

biliary atresia

Congenital absence of the opening from the common bile duct into small intestine (duodenum). Acholic stools, bronze undertones, dark urine, and hepatosplenomegaly are clinical manifestations of biliary atresia.

XX Virilization in Newborn for ambiguous genitalia

Congenital adrenal hyperplasia caused by 21-hydroxylase deficiency is the most common cause of ambiguous genitalia in the newborn and is also the most common cause of virilization (development of male characteristics in a female) in a genetically female infant.

TORCH Infection

Congenital cytomegalovirus (CMV; TORCH spectrum) manifestations include intrauterine growth restriction, jaundice, purpura, hepatosplenomegaly, microcephaly, seizures, intracerebral calcifications, chorioretinitis, and progressive sensorineural hearing loss. Submit

Congenital Rubella

Congenital rubella syndrome is a result of in utero transmission of the rubella virus. Common clinical findings with congenital rubella syndrome include "blueberry muffin" rash, thrombocytopenia, growth restriction, hepatosplenomegaly, and jaundice. Microcephaly, cataracts, and deafness are also commonly seen with congenital rubella syndrome.

Congenital Toxoplasmosis Presentation

Congenital toxoplasmosis is rare and most likely results from in utero exposure to maternal toxoplasmosis infection during the third trimester. Affected infants present with purpuric rash, hepatosplenomegaly, ventriculomeglay, and chorioretinitis, and HYDROCEPHALUS

conjugated (water soluble) unconjugated (fat soluble)

Conjugated : direct serum hyperbillirubenmia Unconjugated: indirect hyperbillirubenmia

Abnormal residual in 24 hour interventions

Consider infection screen Discard residual Hold feedings

Convective Heat Loss

Convective heat loss occurs when the infant's body heat is swept away by air currents, such as when the infant is exposed to drafts from air bents, air conditions, windows, doors, heaters, fans, incubator portholes Incubator reduces convective heat loss by providing a warmer environment with an enclosed space

Corticosteroid effects (dexamethasone) on lungs and kidneys

Corticosteroids have been shown to decrease the permeability of the pulmonary vasculature, which minimizes pulmonary edema. Dexamethasone has also been shown to increase diuresis. A urine output of 5 ml/kg/hr is indicative of increased diuresis.

Most common pathogens

Currently, GBS E. coli

Signs of obstructed endotracheal tube

Cyanosis with vigorous respirations is indicative of an obstructed endotracheal tube.

Cyanotic heart defects

Cyanotic Tetralogy of Fallot (TOF) Transposition of the greater arteries (TGA) or vessels (TGV) Truncus arteriosus Tricuspid Atresia Hypoplastic Left Heart Syndrome (HLHS)

Cystic Fibrosis genetics

Cystic fibrosis is an autosomal-recessive condition, which carries a 25% chance with each pregnancy of having an affected offspring. The risk of inheriting this condition is gender neutral.

Bronchopulmonary Dysplasia on x-ray

Cystic lung fields with hyperinflation and atelectasis****

Cytomegalovirus presentation

Cytomegalovirus infection is associated with microcephaly, periventricular calcifications, thrombocytopenia, jaundice, and hearing loss.

Trisomy 21 (Down Syndrome)

Definitive Features 1. Small size 2. short round head flat facial profile 3. Epicanthal folds 4. upslanting palepbral fissures 5. Brushfield spots 6. small earts 7. Protruding tongue, short narrow palate 8. Simian crease (line across hand) 9. Excess skin on back of neck *Duodenal atresia/umbilical hernia

Clinical Signs of Pyloric Stenosis

Dehydration Non bilious projectile vomiting Peristaltic waves in the epigastrium Electrolyte disturbances

Signs and symptoms of pyloric stenosis

Dehydration, nonbilious projectile vomiting, peristalic waves in the epigastrium, and electrolyte imbalances, including hypochloremia, are clinical symptoms of pyloric stenosis.

BPP score for delivery

Delivery is recommended for scores less than or equal to 4. Electronic fetal monitoring is used to evaluate fetal response in relate to uterine contractions

Lower GI series

Detects hirschsprung, malrotation, meconium ileuis, meconium plug syndrome

Most frequent disorder associated with downsyndrome

Deudonal Atresia Double Bubble May see VSD, AV Canal, Tetralogy of Fallot

Nephron develops at how many weeks Best indicator of GFR on lab is?

Develops at 34 weeks Creatinine Clearance

DiGeorge Syndrome Testing

DiGeorge syndrome is one of several velocardiofacial syndromes caused by a deletion in chromosome band 22q11. Fluorescence in situ hybridization is a genetic testing method used to detect microdeletions on chromosomes.

ECMO for what congenital defect?

Diaphragmatic Hernia

Signs and symptoms of DIC

Disseminated intravascular coagulation (DIC) is an acquired hemorrhagic disorder associated with an underlying disease such as septic shock. Presenting signs of DIC include sudden hemorrhage, prolonged oozing, petechiae, and purpura.

Volume expansion in VLBW ELBW infants

Dopamine increases the blood pressure (BP) in 90% of extremely low-birth-weight infants, and volume expansion only improves BP in 40% of these infants.

Medication used to treat apnea refractory to methylxanthine therapy

Doxapram is a respiratory stimulant used to treat apnea that is refractory to methylxanthine therapy.

Polyethelane Wrap for Infant < 29 weeks

Dry infants head only Place infant in bag, from neck down Remove bag once infant is in an NTE and humidified environment

Double bubble

Dudeonal Atresia

A 34-week-gestation infant is found to have anemia and hyperbilirubinemia at 12 hours of life. The infant is direct antibody positive. Which condition should the nurse consider as the most likely the etiology of these findings?

Due to immature hepatic function, physiologic jaundice in preterm infants should be closely monitored. Physiologic jaundice in preterm infants peaks between 10 and 12 mg/dl on the fifth day of life. There are a number of causes of pathologic unconjugated hyperbilirubinemia, with Rh isoimmunization being one of the more common causes. Rh isoimmunization results when fetal erythrocytes carry different antigens than maternal erythrocytes. The maternal immune system reacts against the foreign antigen and produces IgG antibodies, which bind to and then subsequently destroy the fetal erythrocyte. Infants with Rh incompatibility present with jaundice within a few hours of birth and pallor due to the destruction of fetal erythrocytes. Common laboratory findings with Rh isoimmunization include anemia, reticulocytosis, and a positive direct antiglobulin test.

Normal Transition to Extra Uterine Life

During normal transition from fetal to extrauterine life, the pulmonary vascular resistance decreases largely in part to air entry into the lung and increase in pulmonary blood flow. Systematic vascular resistance increases with the removal of the placenta. Persistent pulmonary hypertension continues to have the increase in pulmonary vascular resistance with constriction of the pulmonary vessels. This increase in pulmonary resistance can lead to the shunting of blood through fetal channels (ie, ductus arteriosus, foramen ovale). The shunting of blood from right to left through the fetal shunts further contributes to hypoxemia.

ELBW, VLBW, LBW weights

ELBW<100grams VLBW <1500grams LBW <2500grams

Early decelerations

Early decelerations appear to be caused by vagal discharge produced when the head is compressed by uterine contractions.

Early decelerations

Early decelerations occur in conjunction with uterine contractions and have a uniform pattern with gradual deceleration and return to baseline: the increased intracranial pressure causes vagal nerve stimulation resulting in fetal bradycardia. (The fetal heart rate slows with the initiation of a contraction)

What other conditions might mimic drug withdrawal in the newborn?

Early-onset hypocalcemia is similar to opiate withdrawal. It might present within the first 2 days of life, and the symptoms are similar to neonatal abstinence syndrome (NAS). Symptoms of hypocalcemia and NAS are hypotonia, tachycardia, tachypnea, apnea, poor feeding, jitteriness, tetany, and seizures.

The nurse should expect an infant to have which of the following heart defects when a chest radiograph reveals a heart that fills the entire chest?

Ebstein malformation on x-ray reveals extreme cardiomegaly

End Tidal Co2

End-tidal CO2 monitoring cannot be relied on for accuracy in infants with severe lung disease (large alveolar-arterial gradient).

Downsyndrome (Trisomy 21) Cardiac Anomolies

Endocardial Cushion defect, VSD, AV canal, tet

Digoxin

Enhances contractility Inhibits Na + K+ ATP Reduces HR, CI'd if HR <60 Hypokalemia increases drug concentration

Erythema toxicum

Erythema toxicum is characterized by pustules with an erythematous base, said to be caused by histamine release. The pustules can come and go on varying sites of the body, including the face, trunk, and limbs, but are never visualized on the palms of the hands or the soles of the feet.

Long Chain fatty acids (fats)

Essential for brain development

VCUG

Evaluate function and flow of kidneys Abnormal finding in infants = Vesicoureteral reflux Urine backflows from the bladder into the upper urinary tract

Upper GI series

Evaluates pyloric stenosis, malrotation, strictures Contrast material such as barium is administered via a NGT

Upper GI study

Evaluates structure and function of upper gi system containing: 1) the esophagus 2) the stomach Water soluble contrast solution is swallowed series of x rays under fluoroscopy Complications: vomiting, reflux, aspiration Do NOT do an upper GI series on TEF/EA

Evaluation for extubation of newborn

Evaluation for extubation should be considered when ventilator parameters are low: supplemental oxygen ranging between 21% and 30%; peak inspiratory pressure 14 to 18 cm H2O; VT 3.5 to 5 ml/kg; and intermittent mandatory ventilation 10 to 20/minute.

TEF signs and symptoms

Excessive salivation and choking, coughing, and cyanosis with feeding

Increasing inspiratory time reduces

Exhalation time and may cause Paco2 to rise

Expiatory grunting

Expiratory grunting is an attempt to slow expiratory flow rates, prevent alveolar atelectasis, and maintain functional residual capacity.

Nondisjunction

Failure of two homologous chromosomes to separate equally during cell division in two daughter cells

Which of the following is the most important element of management when caring for a neonate with medium-chain acyl-coenzyme A dehydrogenase deficiency, a disorder of fatty acid oxidation?

Feed frequently and avoid prolonged periods of fasting. Rationale: Infants who have fatty acid oxidation defects cannot break down fatty acids to supply energy, so energy needs must be met exogenously. Long periods of fasting (and other stressors) lead rapidly to hypoglycemia.

oligohydraminos is associated with

Fetal anomalies, particularly of the renal and urinary system. Renal agenesis (missing one or both kidneys) and urinary tract obstructions are commonly diagnosed if pregnancy affected by oligohydramnios.

Amniotic Fluid Function and Measurement

Fetal breathing, swallowing, and urination regulate the amniotic fluid volume. Amniotic fluid volume can be measured using ultrasonography and is reported as the amniotic fluid index, which is the summation of the measurement of the largest pocket of amniotic fluid in each quadrant.

fetal fibronectin

Fetal fibronectin is a protein found in the extracellular matrix between the chorion and the decidua.

Fetal hyperinsulinemia and lung development

Fetal hyperinsulinemia contributes to delayed maturation of the lungs, which inhibits the production of surfactant and increases the risk of surfactant deficiency related to respiratory distress syndrome. The reticulograndular pattern is suggestive of respiratory distress syndrome.

O2 challenge test

For Cardiac Cyanotic CHD PaO2 < 150

A 1500-gram preterm infant born to a hepatitis B surface antigen-negative mother should receive the initial dose of hepatitis B vaccine at:

For infants weighing less than 2000 grams, the initial dose of hepatitis B vaccine should be delayed until 1 month of age or hospital discharge, whichever is first, because of suboptimal immune response in some preterm infants. The exception is when hospital discharge occurs in less than 1 month of age, in which case, the vaccine should be given at discharge.

Management of nonpathologic unconjugated hyperbilirubinemia.

Frequent enteral feeding, including promotion and support of breastfeeding. This promotes removal of meconium from the intestines. Meconium contains 1 mg of bilirubin per 1 g of meconium. Delayed stooling promotes enterohepatic recirculation of bilirubin. b. Establish protocols to identify hyperbilirubinemia and measure bilirubin levels. Interpret results by infant's age—gestationally and hours of life. Follow-up care postdischarge is required for all infants discharged before 48 hours of age. c. At discharge, provide caregivers with verbal and written information about hyperbilirubinemia, need for follow-up monitoring, and how monitoring will be accomplished.

IgA antibodies

Fresh human milk contains secretory IgA.

Movement and flexion of extremities

Generates warmth in muscles Decreases surface area for heat loss

Signs of meningitis (values and follow up testing)

Glucose <30mg/dL in Term Glucose < 20<mg/dL in preterm Elevated CSF protein >100 in term Elevated CSF protein >150 in preterm If CSF culture is poisitive, repeat culture should be done in 24 to 36 hours

Grade II IVH

Grade II is an intraventricular hemorrhage without ventricular dilation.

What is the diagnostic modality of choice for diagnosis of HIV-infected infants?

HIV DNA or RNA polymerase chain reaction HIV DNA or RNA polymerase chain reaction (PCR) has a high sensitivity and specificity. At birth, the sensitivity is <100%, but both DNA and RNA PCR have 100% sensitivity and specificity (ie, all cases are diagnosed without false positives).

Supraventricular Tachycardia

HR >220 Vagal Maneuvers: 1. Stimulate a gag 2. Suction at nasopharnx 3. Apply crushed ice to nose and forhead Adenosine - antiarrythmiac agent Drug restores normal sinus rhythm by allowing AV nodal conduction, interrupting its reentry patterns Rapid IV push (half life 5-10 seconds), follow up w/ 2-3mL sterile water Reactions: Bradycardia, hypotension, heartblock, dyspnea

HSV risk factors , signs and symptoms, testing

HSV type 1 and 2 may be present in maternal genital tract without MOB knowledge Severe HSV infection is more likely if the mother contracted a primary (first episode) HSV infection in late gestation Infants may be asymomptomatic for 3-14 days Signs and symptoms include skin VESICLES, Obtain culture or PCR testing. Start Acyclovir If MOB has active genital or buttock lesions start acyclovir to infant.

Ventral Septal Defect murmur type

Harsh Holosystolic Murmur heard over Apex

Hydrops fetalis

Heart failure and generalized edema in the fetus secondary to severe anemia resulting from destruction of erythrocytes. (fetus attempts to expand blood volume and cardiac output, resulting in generalized edema)

With increased affinity (shift to the left)

Hemglobin holds on to o2, o2 is unloaded less rapidly

With decreased affinity (shift to the right)

Hemoglobin releases O2 more easily to the tissues

Hemophilia A

Hemophilia A has a normal or prolonged partial thromboplastin time and a normal prothrombin time and platelet count. Factor VIII is deficient.

Diagnostic image test for cholestasis

Hepatobiliary HIDA scan

Biliary Atresia radiologic imaging studies

Hepatobiliary iminodiacetic acid scan (HIDA)

UAC Placement

High Placement T6-T9 Low Placement L3-L4

fetal fibronectin

High level associated with neural tube defect. Low level associated with in some cases of down syndrome.

Active inspiration and expiration HFOV

High-frequency oscillatory ventilation (HFOV) utilizes active inspiration and expiration; the electromagnetically driven diaphragm used in HFOV moves gas into the lung and pulls air from the lung.

High Resolution Ultrasonography

High-resolution ultrasonography is useful for determining ascites, pericardial and pleural effusion, and other conditions in the baby before delivery. The test gives the resuscitation team the ability to anticipate what degree of resuscitation may be needed.

Toxoplasmosis clinical presentation

Hydrocephalus with generalized calcifications and chorioretinitis are clinical findings suggestive of congenital toxoplasmosis.

Signs of alcohol withdrawal in infant

Hyperactivity, crying, irritability, poor suck, tremors, seizures, poor sleeping pattern, hyperphagia, and diaphoresis are all signs and symptoms of alcohol withdrawal.

Hyperglycemia and hyperinsulinemia cause ..

Hyperglycemia and hyperinsulinemia present in diabetes inhibit surfactant C (phosphatidylcholine) protein synthesis.

Sodium Bicarb

Hypertonic solution if given too rapidly may lead to IVH. Infant must be ventilated if given bicarb due to the an acute increase in CO2 as the bicarbonate is metabolized.

Prolonged, severe hypocapnia (or hypocarbia, low Co2) results in

Hypocapnia induces cerebral ischemia, leading to neuronal cell injury and death.

Which chest x-ray findings best represent primary surfactant deficiency?

Hypoexpansion due to atelectasis, air bronchograms from atelectasis of the alveoli interspersed with open airways and a reticulogranular pattern, and open alveoli interspersed with atelectatic alveoli are the classic findings of surfactant deficiency.

Which chest x ray findings best represent a pneumomediastinum?

Hypoexpansion, sail sign, fluid in the fissure

Hyponatremia effect on CNS

Hyponatremia is the electrolyte abnormality that would most likely cause seizure activity (ie, pedaling, sucking, blinking movements). This is because hyponatremia disrupts brain volume, particularly the equal osmolality of extracellular and intracellular fluid.

Effective pulmonary vasodilators

Hypoxia increases the pulmonary vascular restriction, which leads to further acidosis. Alkalosis and oxygen both are effective pulmonary vasodilators.

Serum alfa fetoprotein

If elevated, could indicate neural tube defects or polycystic kidneys

Colostrum antibody abundance is

IgA

Which immunoglobulin (Ig) crosses the placenta in significant amounts?

Immunoglobulin G (IgG) placental transport begins during fetal development, and the term infant has a complete store of maternal IgG antibodies, which protects the newborn from many infections during the first months of life.

Prolonged expiration

Improves oxygenation, especially in air trapping condition (air trapped in alveoli due to MAS)

X-linked recessive disorder

In X-linked recessive disorders male offspring are affected and carrier females transmit the disorder. In almost all cases, only male offspring have the disorder. The mother will require genetic counseling with subsequent pregnancies.

Shunting of PDA

In a newborn a patent ductus arteriosus causes right to left shunting resulting in additional blood flow to the aorta. This causes peripheral pulses to feel full and bounding.

The most common cystic malformation of the lung resulting in obstructive air trapping is congenital...

In congenital lobar emphysema (CLE), air is trapped in one or more lung lobes at birth due to a defect in bronchial cartilage; obstructive emphysema occurs because air enters but cannot leave the lobe due to collapse of the poorly structured airway. CLE is generally limited to the upper lobes and is the most common cystic lung defect.

patent ductus arteriosus (PDA) location and murmur type

In healthy term infants the ductus arteriosus normally closes in the first 24 to 48 hours of life. The murmur associated with a patent ductus arteriosus (PDA) is systolic and is best heard over the upper left sternal border and sometimes radiates to the axilla.

New Ballard Findings of Term Infant

In postterm infants, the skin is cracked and wrinkled, plantar creases cover the entire foot sole, and the skin is mostly bald of lanugo. The ears are stiff with thick cartilage. The labia majora cover the labia minora as well as the clitoris. Breast areolae are full with 5- to 10-mm buds.

Transposition of the great vessels

In transposition of the great vessels, the degree of cyanosis depends on the amount of mixing between the pulmonary and systemic circulations. Oxygenated pulmonary venous blood is returned to the lungs, and desaturated systemic blood is returned to the body. Thus the two circulations exist in parallel. Some mixing between them must occur to allow oxygenated blood to reach the systemic circulation and the desaturated blood to reach the lungs.

increasing PIP

Increase tidal volume , decreases Pco2

Pulmonary vascular markings (radiology findings)

Increased - increased heart size, pulmonary edema, heart defects with increased pulmonary blood flow / left outflow tract obstruction Decreased markings - heart lesions with DECREASED pulmonary blood flow (i.e. tet), and PPHN

Increase of direct billirubin (conjugated)

Increased direct billirubin occurs when the liver cannot EXCRETE conjugated billiurubin into the bile ducts or biliary tract (biliary atresia, cholestasis) Cholestasis is a condition where bile cannot flow from the liver to the duodenum.

Increase of indirect billirubin (unconjugated)

Increased indirect billirubin occurs when liver function is reduced or there is an excessive load of unconjugated billirubin (hemolysis)

If pco2 already elevated

Increasing PIP may be better option

The form of circulating bilirubin that places the infant at the highest risk for kernicterus is:

Indirect, free bilirubin is not attached to albumin and easily crosses the blood-brain barrier, potentially resulting in signs of kernicterus.

grunting

Infant's attempt to increase functional residual capacity (lung volume) when there is collapse aveoli. Infant will try to collapse vocal cords to try and trap air in the lungs. Grunting sound is made when the infant exhals through the partial closed vocal cords. Grunting "splint open" small airways and helps to maintain functional residual capacity in the aveoli.

Macrosomia

Infants >4000g

Tet Spell

Infants become irritable, pale, hypoxemic, flaccid Blood flow across the right ventricular outflow tract is decreased, right to left shunt through VSD out of aorta, bypasses lungs. Treatment = increase SVR to decrease right to left shunt at the VSD Place infant to knee to chest position, this will increase peripheral vascular resistance , thus reducing right to left shunt and increasing pulmonary blood flow. Administer to infant

Signs and symptoms of sublgeal hemorrhage

Infants may present with signs of shock, which include a rapidly falling hematocrit, hypovolemia, pallor, hypotension, tachycardia, tachypnea, and hypotonia.

An early cause of hypocalcemia in the neonate is:

Infants of diabetic mothers are at risk of developing early hypocalcemia that can persist for several days due to maternal magnesium losses and can lead to fetal magnesium deficiency and secondary functional hypoparathyroidism in the newborn. The severity of the maternal diabetes is associated with the degree of hypocalcemia observed in the neonate.

Beckwith-Weidemann syndrome

Infants with Beckwith-Wiederman present with macroglossia and hypoglycemia. Additional findings include macrosomia, umbilical hernia, omphalocele, abnormally large organs, ear creases or pits, and kidney abnormalities.

Features of Digeorge

Infants with DiGeorge Syndrome (22q11.2 deletion) frequently have heart abnormalities, recurrent infection caused by problems with the immune system and absent thymus, and hypocalcemia, which can result in seizures. Many other problems also can occur with DiGeorge Syndrome, including breathing problems, renal issues, thrombocytopenia, and cleft palate.

An infant is born with low-set ears, excess nuchal skin, a broad chest, widely spaced nipples, peripheral lymphedema, and absent pulses in the lower extremities. The nurse suspects the infant has coarctation of the aorta. Which chromosomal defect can cause this constellation of findings?

Infants with Turner syndrome can present with cardiovascular anomalies, short stature, low-set ears, excess nuchal skin, a broad chest with widely spaced nipples, peripheral lymphedema, and ovarian dysgenesis. Common defects are coarctation of the aorta and bicuspid aortic valve. About 30% of infants with Turner syndrome will have a coarctation of the aorta.

Turner Syndrome

Infants with Turner syndrome can present with cardiovascular anomalies, short stature, low-set ears, excess nuchal skin, a broad chest with widely spaced nipples, peripheral lymphedema, and ovarian dysgenesis. Common defects are coarctation of the aorta and bicuspid aortic valve. About 30% of infants with Turner syndrome will have a coarctation of the aorta.

VSD at 1 to 2 months of age can result in

Infants with a small isolated defect are often asymptomatic. The murmur of a small defect may be detected within the first 24 to 36 hours of life, because the very restrictive opening permits the normal rapid fall in pulmonary arterial resistance and pressures. In term infants born at sea level with a large ventral septal defect, clinical deterioration may occur at any time from approximately 3 to 12 weeks after birth.

congenital herpes simplex virus presentation

Infants with congenital herpes simplex virus typically present with skin lesions, such as vesicles and scarring, neurologic abnormalities, and chorioretinitis.

Signs and symptoms of neonatal hypoglycemia

Infants with hypoglycemia may exhibit irritability, jitteriness, hypotonia, hypothermia, and seizures but do not sneeze.

Signs and symptoms of neonatal sepsis

Infants with neonatal sepsis commonly present with irritability, apnea, respiratory distress, and lethargy, with hypothermia more common than hyperthermia.

TTN Radiographic findings

Infants with transient tachypnea of the newborn have chest radiographic findings that include perihilar streaking, overexpansion, haziness, increased vascular markings, and fluid in the fissure, which traps air in the alveoli. This air trapping results in an increase in the anteroposterior diameter of the chest, leaving the infant with a barrel-shaped chest.

infant at risk for experiencing hyperthermia?

Infection increases the infant's body temperature. Because the infant has limited ability to dissipate heat, the infant is at risk of hyperthermia

Infectious Pustulosis (Gram +)

Infectious pustulosis is usually caused by Staphylococcus aureus, a gram-positive coccus. Lesions are commonly found in the axillae, groin, and periumbilical area. Benign rashes, such as erythema toxicum and transient pustular melanosis, typically have a generalized distribution.

Ampicillin 100mg/kg/dose

Infuse 3-5 minutes followed with flush

Digoxin MOA

Inhibition of Na/K/ATPase pumps in the heart, increasing cardiac cell potentials and contractility

Chlorothiazide

Inhibits chloride reabsorption Decreases calcium excretion

Meconium ileus

Inpissated meconium obstructs the terminal ileum just prior to the ileocecal valve. Associated with Cystic Fybrosis (requires pancreatic enzymes to breakdown digest intestinal contents)

I/E ratio

Inspiration/Expiration ratio If respiratory cycle 1 second, an I/E ratio of 1:! means 0.5 seconds inspiration 0.5 seconds expiration

Conductive Heat Loss

Involves transfer of heat between two solid objects. For example, a mattress, scale, x-ray plate. Ways to reduce conductive heat loss place a chemical thermal mattress underneath the infant , clothing and hats, warm blanket on scale.

Klinefelter Syndrome (XXY)

Klinefelter syndrome is a genetic disorder related to several factors, including advanced maternal age, parental nondisruption errors, maternal meiosis errors, and production of XY sperm by older fathers. All of these factors increase the risk of the disease.

Klumpe Paralysis

Klumpe paralysis exhibits swelling in the shoulder and supraclavicular fossa, which can be accompanied by clavicle fracture. Due to intrinsic muscle involvement of the hand, there is a clawlike appearance. There will be no grasp of the affected hand.

Klumpke palsy

Klumpke palsy results in wrist and hand paralysis with an absent grasp reflex.

Lanugo in preterm infant

Lanugo covers the entire body beginning at 20 weeks' gestation and does not start disappearing until 28 weeks' gestation.

Tetralogy of Fallot (Cyanotic Heart)

Large VSD, right ventricular hypertrophy, right ventricular outflow tract obstruction (pulmonary stenosis), overriding aorta of the ventricular septum Severity of cyanosis depends on degree of right ventricular outflow tract obstruction Boot shaped heart

Laryngomalicia

Laryngomalacia is the most common cause of stridor in infants and typically presents in the first month of life. Risk factors include prematurity and respiratory support.

Position for gastroschesis

Lateral (side lying) to prevent occlusion of the mesenteric arteries that supply blood to the bowel. Tie bag to the axilla.

Surfactant administration within 30 minutes of birth

Linked to right to left shunting An increase in ductal size

Listeria monocytogenes

Listeria monocytogenes is typically a gram-positive rod.

Situs Inversus totalis

Liver located in the left abdomen Heart located in the right chest

What are the expected laboratory results for a patient with disseminated intravascular coagulation?

Low platelet count, low fibrinogen level, and elevated D-dimer level

HFOV tidal volume

Low tidal volumes of 2.5 to 3.5 ml/kg help prevent the barotrauma and decreased cardiac output associated with PEEP

Placenta vascular resistance

Low vascular resistance, readily accepts the return of fetal arterial blood

IUGR Symmetric

Lower weight, height, length, and head circumference for gestational age Results from intrauterine viral infection, chromosomal genetic abnormalities, long standing disease

minimal inhibitory concentration (MIC)

Lowest concentration of a medication (antimicrobial) in the tissue that stops visible organism growth

Minimal bactericidal concentration (MBC)

Lowest concentration of a medication that results in a >99.9% decline in microbial number.

What type of drainage is impaired with BPD ?

Lymphatic drainage is impaired in infants with bronchopulmonary dysplasia (BPD), which predisposes them to pulmonary edema.

Magnesium and Nifidepine

Magnesium an anticonvulsant used for pre-eclampsia, substitutes for calcium Nifidepine, CCB, allows the movement of calcium into the smooth muscle of the uterus. Contraction of smooth muscle depends on the availability of calcium

Low Imperforate anus

Male/ female ratio 1:1 Perineal Fistula is more common

Upper GI Gold Standard for

Malrotation

Congenital Syphillis presentation

Many infants with congenital syphilis do not present with symptoms in the neonatal period. Affected infants often do not present with active disease until 3 to 8 weeks of life. Characteristic symptoms include a maculopapular rash, snuffles, hepatosplenomegaly, and chorioretinitis.

Ventilation perfusion ratio

Matching pulmonary ventilation and perfusion is necessary for efficient gas exchange. Normal ratio is 1:1 Causes of mismatch 1. Too little blood flow with normal ventilation 2. Too little ventilation with normal ventilation

Factor associated with decreased total neutrophil count

Maternal hypertension is associated with decreased total neutrophil counts. The cause is uncertain.

What strategy is effective for preventing influenza in newborns?

Maternal immunity is the only effective means to prevent influenza in newborns because the vaccine is not approved for use in infants younger than 6 months.

Fetal Thrombocytopenia related to maternal hypertension

Maternal preeclampsia leads to placental insufficiency and exposes the fetus to chronic hypoxia. The fetal response to chronic hypoxia is increased erythropoiesis, which is thought to suppress platelet production.

A 36-week infant is born to a mother with known systemic lupus erythematosus, what do you order?

Maternal systemic lupus erythematosus has been associated with neonatal congenital heart block. Infants with neonatal lupus should receive an electrocardiogram at birth.

IgM antibodies

Maternal-fetal transfer of IgM does not occur due to the large size of the IgM molecule. An elevated concentration of IgM is indicative of infection in the fetus or newborn.

Imperforate anus lack of bowel movement time

May be up to a week of a bowel movement to occur

Increasing the PEEP without increasing PIP

May decrease tidal volume and pco2 may rise

Infant of the diabetic mother

May have CHD, Cardiomyopathy CHD defects include: TGA, VSD, COA IDM have respiratory issues, PPHN, RDS Could also have polycythemia (venous HCT >65%) High glucose uptake and high metabolic rate cuases a cellular hypoxia, leading to an elevated erythropoietin level Hypocalcemia, hypomagnesemia result from a functional hypoparathyroidsm due to maternal magnesium loss

Meconium Ileus

Mechanical Obstruction of distal ilem due to intraluminal accumulation of thick menconium ** Predominant cause cystic fibrosis S/s - abdominal distention, bilious vomiting, failure to pass meconium 12-24 hours X-ray shows soap bubble or ground glass appearance of distal intestine Treatment: Hypertonic contrast water soluble enema

Ball Valve Phenomenon Meconium Aspiration Syndrome

Meconium aspiration syndrome (MAS) places the infant at risk for air leak due to the ball-valve phenomenon: Air enters the alveoli but cannot escape. Distended alveoli rupture, which results in air leak. Air leak is a major risk factor associated with assisted ventilation in infants with MAS.

Imperforate anus in female

Meconium from a fistula external to the hymen = rectovestibular fistula, most common in females

Antimicrobial medications

Medications that inhibit the growth of or kill microorganisms (bacterial, fungi, viruses, protozoa, and amebae)

Neonatal meningitis

Meningitis is most often associated with late-onset sepsis E. Coli Group B. Strep

Immature WBCs

Meta, Bands, Stabs

Microcephaly causes

Microcephaly may be caused by teratogens, including abuse of street or prescription drugs, alcohol, and/or viral infection under the TORCH (toxoplasmosis, syphilis, rubella, CMV or herpes) spectrum.

Features of Trisomy 13

Microcephaly, polydactyly, cutis aplasia

Chest Tube Placement

Mid Clavicular line with distal chest tube hole inside the thoracic space

Pink tet (acrocyanotic)

Mild Pulmonary artery stenosis - blood flow to lung not restricted, blood shunts from left ventricle through vsd to pulmonary artery and lungs (left to right shunt), resulting in excessive pulmonary blood flow = acrocyanotic or pink tent

Milronone

Milrinone also provides dose-dependent increase in cardiac contractility and is a systemic and pulmonary vasodilator and thus an effective agent in both right and left ventricular systolic dysfunction.

Milronone mechanism of action and monitoring

Milrinone is phosphodiesterase inhibitor that increases heart rate and contractility and is a vasodilator. Some patients may need volume infusion after a load of milrinone. The other vital signs are not affected

Minimal Enteral (trophic) feedings with human expressed milk should be initiated at a rate of

Minimal enteral feedings should be initiated at a rate of 10 to 20 ml/kg/day to facilitate postnatal gastrointestinal maturation and to minimize mucosal atrophy.

Truncus arteriosus radiology findings

Moderate cardiomegaly Increased vascular markings

ABO

Mom O Baby A or B

Prolonged inspiration

More efficient ventilation, optimal arterial oxygenation, higher risk for air leak, may affect pulmonary return

Gas trapping

More gas enters the lung than leaving the lung. Occludded ETT and MAS may cause this.

Candidiasis

Most common form results in: Oral pharyyngeal (thrush) Vaginal Cervical (lesions of gluteal folds, buttocks, groin, neck) Diaper dermatitis presents with intense erythema and satellite lesions

Imperforate anus in a male

Most common lesion is the rectoprostatic fistula , distal bowel and urethra

Renal Vasculature in the neonate

Most healthy premature, full-term, and postterm infants void by 24 hours of life. This is because at birth renal blood flow may not increase initially, but will increase by 24 hours once the renal vascular resistance falls.

Neonatal autoimmune thrombocytopenia

Neonatal alloimmune thrombocytopenia has a similar pathophysiology to Rh incompatibility. It occurs when maternal platelets come into contact with fetal platelets containing an antigen lacking in the mother. Maternal antibodies cross the placenta and coat the fetal platelets—primarily on subsequent pregnancies. The maternal platelet count is normal. Neonatal partial thromboplastin time and prothrombin time are normal. Treatment of neonatal alloimmune thrombocytopenia includes giving the baby washed maternal platelets, which are free of the platelet antigen.

Nephrocalcinosis

Nephrocalcinosis (deposition of calcium salts in the renal parenchyma ) occurs in neonates secondary to high urinary calcium excretion from chronic treatment with loop diuretics.

Ganciclovir side effects

Neutropenia

Which of the following sets of hematologic values best predicts infection in a 1-hour-old term neonate?

Neutropenia:absolute neutrophil count of <1750/mm3 Ratio of immature to total neutrophils (I:T) of >0.2 From the WBC count (4.7 × 103/mm3) and differential (27% segmented neutrophils, 8% bands), the absolute neutrophil count (ANC) is calculated as follows: ANC = (% segmented cells + % immature cells) × WBCs ANC = (0.27+ 0.08) × 4700 ANC = (0.35) × 4700 = 1645/mm3 I:T ratio is calculated as follows: Mature cells = segmented cells Immature cells = bands, metamyelocytes, myelocytes, promyelocytes I:T = (% immature cells) ÷ (% mature cells + % immature cells) I:T = (0.08) ÷ (0.27 + 0.08) I:T = 0.08 ÷ 0.35 I:T = 0.23

Newborn cocaine exposure presentation

Newborns exposed to cocaine prenatally are born with lower birth weights and birth lengths. Cocaine has vasoconstriction properties, which decrease blood flow to the placenta and fetus, contributing to fetal growth restriction.

INO half life and reaction with hemoglobin

Nitric oxide in the circulation reacts with the iron-containing molecules in hemoglobin. Nitric oxide reduces oxyhemoglobin, producing methemoglobin.

Blood pressure first week of life

Normal blood pressure for the first week of life is considered to be a mean arterial blood pressure at least equal to the gestational age of the infant. This infant is hypotensive given the gestational age of 24 weeks and the mean arterial pressure of 23 mm Hg. Low BP = hypotensive

Pathological Jaundice

Occurs in the first 24 hours Associatged with a hemolytic process, RH isoimmunization, or congenital hepatitis

Evaporative Heat Loss

Occurs when moisture on the skin surface or respiratory tract mucosa is converted into vapor. Most common forms of insensible losses are from the skin and respiration. Sensible fluid loss are associated with sweating. Ways to reduce evaporative heat loss: quickly dry the infant with pre warmed blanket or towels , polyethylene plastic bags. Humidify respiratory or environmental sources.

oligohydramnios

Oligohydramnios, a decreased amount of amniotic fluid, is defined as a single deepest pocket of <2 cm, or an amniotic fluid index of <5 cm.

Fetal Circulation Right side of heart

On right side of heart: -Oxygenated blood drains from brain to the right atrium, then to right ventricle. -Approximately 90% of right ventricular output is ejected into the pulmonary artery and then directly into the ductus ateriosis which connects to the PDA, which connects to the aorta. *This is called right to left shunt (right ventricle --> ductus arteriosis --> aorta). -Roughly 10% of the right ventricular output is ejected into the pulmonary artery and into the lungs.

Pulmonary interstitial emphysema

On the chest radiograph, pulmonary interstitial emphysema is characterized by hyperinflated lungs with coarse radiolucencies extending from the pleura to the hilum.

Starting Ventilator Support

PEEP 4-6 cm H2o PIP 16-20 cm H2o Rate 40-60

PIP and tidal volume

PIP and tidal volume are related PIP (Peak Inspiratory pressure) is the maximum pressure measured during the delivery of gas (inspiration)

What is contraindicated in CDH?

PPV by mask or BCPAP, will fill the bowel with air and compress lungs and heart. -use minimal ventilation settings (volume)

Treatment to stop subgleal hemorrhage

PRBCs, cryoprecipitate, NS volume infusion, dopamine

Hyperoxia level

PaO2 >80%

PTH

Parathyroid hormone (PTH) increases serum Ca by mobilizing Ca from the bone and intestines and reducing renal excretion of Ca. PTH is stimulated by low serum Ca and magnesium (Mg) levels and is suppressed by high Ca and Mg levels.

Preterm Fluid Requirement

Parenteral (IV) 120 to 150ml/Kg/day Enteral 150 to 200ml/kg/day

Acyanotic heart defects

Patent ductus arteriosus(PDA) Atrial septal defect (ASD) Ventricular septal defect(VSD) Atrioventricular canal (AVC) Pulmonic stenosis (PS) Aortic stenosis (AS) Coarctation of the aorta

Criteria for PPHN

Patient selection criteria for extracorporeal membrane oxygenation (ECMO) include gestational age of more than 34 weeks, birth weight of more than 2 kg, presence of grade II or less intracranial hemorrhage, absence of complex congenital heart disease or lethal malformations, and reversible lung disease. Persistent pulmonary hypertension of the newborn (PPHN) is an acute and reversible cardiorespiratory disease. ECMO is warranted if standard therapies fail to reverse PPHN.

Penetrance

Penetrance is the degree to which an inherited trait is manifested in the person who carries the affected gene.

Fetal Fibronectin test

Performed on vaginal secretions in symptomatic women, may help prevent false positive diagnosis of PTL

Calcitonin in perinatal asphyxia

Perinatal asphyxia and stress will cause an increase in calcitonin. Calcitonin is a counterregulatory hormone that is secreted from C cells of the thyroid gland and functions to decrease calcium levels by inhibiting bone-resorbing osteoclasts. Calcitonin reduces the blood serum concentration

Perinital Asphyxia role on calcium

Perinatal asphyxia is a significant risk factor for hypocalcemia in the neonate. Asphyxia stimulates a surge in calcitonin level, which inhibits the release of calcium from the bone.

Phenotype

Phenotype is the observable characteristics of an individual.

PKU (phenylketonuria)

Phenylketonuria (fen-ul-key-toe-NU-ree-uh), also called PKU, is a rare inherited disorder that causes an amino acid called phenylalanine to build up in the body. PKU is caused by a defect in the gene that helps create the enzyme needed to break down phenylalanine. Without the enzyme necessary to process phenylalanine, a dangerous buildup can develop when a person with PKU eats foods that contain protein or eats aspartame, an artificial sweetener. This can eventually lead to serious health problems.

Phototherapy

Phototherapy: converts bilirubin to a water-soluble product at 0.5 to 1 mg percent per hour, and by 30% to 40% after 24 hours of treatment. Effectiveness influenced by the following:

Intervention on the ventilator for visible pink secretions suggestive of pulmonary hemorrhage ?

Pink-tinged secretions are indicative of a pulmonary hemorrhage with minimal bleeding. Treatment of a pulmonary hemorrhage in an intubated patient is to increase the peak end-expiratory pressure to tamponade the bleeding at the site.

Impeforate anus imaging studies

Plain and contrast radiographs Ultrasonography

Chylothorax

Pleural fluid draining from a chylothorax contains a high number of lymphocytes. Removal of these cells, which play a significant role in the immune system, places the infant at risk for infection due to lymphopenia.

Cause of Pneumoperitenium, type of x-ray, and intervention to remove air

Pneumoperitoneum is free abdominal air resulting from bowel perforation. Insertion of a sump tube with low suction will continue to remove air from the bowel.

Mature WBCs

Poly, Segs, Neutrophils

Polyhydraminos

Polyhydramnios—the overproduction of amniotic fluid—is often a result of impaired swallowing, gastrointestinal anomalies and obstructions, or neurologic anomalies.

Neonate pneumothorax positioning

Positioning with the affected side down may prevent worsening of a pneumothorax.

Hyperkalemia ECG

Potassium assists in regulating membrane potentials, so any disturbance in potassium can affect the muscle cells of the heart. Hypokalemia causes flattened T waves, whereas hyperkalemia causes peaked T waves and a widened QRS.

Antiepileptic Drugs affects (teratogenic) on fetus

Pregnant women should receive the smallest dose of antiepileptic drugs (AEDs) to effectively control the seizures and should be managed with monotherapy whenever possible to avoid the risk of tetragenicity. Congenital malformations often seen with AED use during pregnancy include neural tube defects, heart disease, limb anomalies, intestinal atresias, and cleft lip and palate. Many AEDs, particularly valproic acid and carbamazepine, are associated with low maternal folate levels and pose a significant risk for neural tube defects in the fetus.

Gonococcal conjunctivitis presentation and tx

Presentation: The newborn nursery nurse observes edematous eyelids with purulent exudate in a 1-day-old infant brought by ambulance to the hospital emergency department immediately after being born at home to a mother who had no prenatal care. Treatment: Intravenous ceftriaxone. The symptoms are consistent with gonococcal conjunctivitis. Symptoms of gonococcal conjunctivitis begin 1 to 4 days after birth. Although chlamydial conjunctivitis is the most commonly identified infectious conjunctivitis in the United States and may present with similar symptoms, chlamydial conjunctivitis does not present until 5 to 14 days of age. The appropriate treatment for gonococcal conjunctivitis is a single dose of ceftriaxone IV.

Pressure support ventilation

Pressure ventilator support is pressure limited and flow cycled in which the ventilator supports each breath and terminates the breath when the inspiratory flow drops below a preset threshold.

Transitional sleep

Preterm infants do not have significant quiet sleep cycles until approximately 36 weeks' gestation; hence a third sleep state called transitional sleep is identified in preterm infants.

Prostaglandin E1 (alprostadil)

Prevent premature closure of the PDA Side Effects: Apnea, hypotension, hyperthermia, bradycardia

Glucose

Primary fetal energy source, accounts for 80% of fetal energy

Which of the following is the best predictor of the occurrence of preterm labor?

Prior preterm delivery Women with cervical length less than 25 millimeters are at risk of preterm labor.

Isoimmunization and Rh isomminuzation (incompatibility)

Production by an individual of antibodies against constituents of the tissues of another individual of the same species If fetal Rh-positive blood leaks into the Rh-negative mother's circulation, her body may respond by making antibodies to destroy the Rh-positive erythrocytes.

Blue Tet

Pronounced pulmonary stenosis , blood flow to lungs restricted Deoxygenated blood shunts from right ventricle through VSD to aorta (right to left shunt). Smaller amount of blood enters lungs, more blue than red entering aorta.

RDS X Ray

Pronounced under aeration. Fewer than eight ribs expand on inspiration on anteroposterior film with doming of the hemidiaphragms on lateral view. 2. Bilateral diffuse alveolar infiltrates. Reticulogranular (ground-glass) appearance is due to microatelectasis of the alveoli 4. Air bronchograms. Air-filled bronchi (black) are contrasted against the more radiopaque (whiter)

Proper placement of ETT

Proper placement on an endotracheal tube is midway between the thoracic inlet and the carina.

Complication to lungs from a PDA

Pulmonary Hemorrhage

Pulmonary interstitial emphysema

Pulmonary interstitial emphysema occurs when gases collect in the connective tissue of the peribronchovascular sheaths and is a complication of mechanical ventilation.

Extrauterine PVR

Pulmonary vascular resistance will decrease due to lung expansion

Sleeping state respiration

REM = associated with irregular respirations Quiet sleep = regular respirations

Radiant Heat Loss

Radiant heat loss is the transfer of heat between solid surfaces that are NOT in contact with each other. The infant temperature is usually warmer than the surrounding surfaces. The cooler the surfaces, the greater the heat loss. Cool windows or walls can cause radiant heat loss. Ways to prevent : DOUBLE wall isolates, move infant away from cold windows or walls,

Bicarb administration time and associated risks from rapid infusion

Rapid infusions of sodium bicarbonate may result in elevations of carbon dioxide, causing a rapid dilation of cerebral blood vessels, which could lead to intracerebral hemorrhage. Therefore infusing sodium bicarbonate at 4.2% concentration over 30 minutes will avoid a rapid infusion of a hyperosmolar solution.

Initial Ventilator Settiongs

Rate 20-30 for very sick 30-40 for moderaately sick Pip 16-20 PEEP 4-7

Galactosemia

Recessive genetic disorder; characterized by body's inability to tolerate galactose Supplement with calcium

Prolonged PT, decreased PTT

Reflects decreased vitamin K dependent coltting factors

Cryoprecipitate

Replaces Fibrinogen, factor VIII

FFP (fresh frozen plasma)

Replaces all factors, coagulation proteins, and coagulation inhibitors (Small amount of fibronigen)

Phenylketonuria nutritional supplementation

Restrict the amino acid phenylalanine, supplement with tyrosine

Pneumonia Radiology findings

Reticulogranular pattern, lack of air bronchograms, over inflation of the lungs

Trisomy 18 (edwards syndrome)

Rocker bottom feet w/ protrusion of calcaneus Prominent occiput Clenched fists w/overlapping fingers third and fourth fingers(camptodactyly) Congenital heart disease Horseshoe kidneys Umbilical hernia

Features of Trisomy 18

Rocker-bottom feet, cleft lip/palate, small size

Rubella Mnemonic

Rubber= Rubella Ducky = Patent Ductus Arteriosus, Deafness I'm = Eyes (cataracts, retinopathy, micropthalmia, glaucoma) So = Slow or growth and developmental retardation Blue = Blueberry Muffin" purpura on skin

Rubella Presentation

Rubella is associated with cataracts, cloudy cornea, pigmented retina, blueberry muffin syndrome, and certain cardiac abnormalities.

hich of the following statements by the nurse would be correct regarding PPROM?

Rupture of the fetal membranes before labor prior to 37 weeks' gestation

Scalded Scar Syndrome

Scalded skin syndrome is an infection caused by Staphylococcus aureus. Occurring most often in the diaper area or around the umbilicus, it consists of vesicles that may coalesce to form bullae. When the vesicles rupture they leave areas of denuded skin resembling a burn.

Congenital Diaphragmatic Hernia presentation

Scaphoid abdomen (sunken) Barrel chest (displaced stomach and bowel filled up with air in the chest) -decreased breath sounds on side with defect

Apgar scale

Scores obtained 1 minute and 5 minute after Birth A-Appearance (color) P- Pulse G- Grimace (reflex/irritability) A- Activity (muscle tone) R- Respiration I like to think CHRMR

The signs and symptoms of an inborn error of metabolism in a newborn infant are most likely to be mistaken for

Sepsis

CRP Serial Sensitivity testing

Serial C-reactive protein (CRP) measurements at 24 and 48 hours improve sensitivity to 82% to 84% and improve positive predictive value to 83% to 100%. Serial measurements may be helpful in monitoring resolution of infection and guiding antibiotic therapy.

Placenta Previa testing and management, and vaginal birht based on placenta cm from cervical os

Serial fetal ultrasounds are needed to confirm diagnosis of placenta previa, rule out IUGR and monitor fetal growth. No vaginal examinations should be performed with could precipitate bleeding. Activity restrictions will be determined by clinical presentation but avoidance of intercourse or orgasm which can cause uterine contractions is necessary. Vaginal birth can be planned if the placenta is greater than 2-3 cms from the cervical os.

What is the most prevalent thyroid disorder in preterm and low-birth-weight infants?

Serum levels of thyroid hormones in preterm neonates are significantly lower and more variable than those of term neonates and correlate with gestational age and birth weight.

Short Bowel Syndrome is most commonly associated with

Short bowel is most commonly associated with malabsorption and diarrhea and is often a sequela of surgical necrotizing enterocolitis (NEC) and the loss of a significant portion of small bowel.

Ventilator settings for BPD and MAS

Short inspiratory times allow for longer expiratory times. In bronchopulmonary dysplasia (BPD), expiration is prolonged.

Erb palsy

Shoulder dystocia places the infant at increased risk of Erb palsy, an injury to the brachial plexus. With Erb palsy the Moro reflex is asymmetrical and the arm and wrist are positioned in what is referred to as waiter's tip.

Glucose is the primary

Source of energy

Congenital Diaphragmatic Hernia

Space occupying lesion, intestinal contents fill the lung cavity Presents with a scaphoid abdomen, barrel chest Can result in pulmonary hypoplasia, pulmonary hypertension Requires intubation, HFOV, ECMO Insert OG or NG tube CPAP is Contraindicated!

Stage 1 CLD

Stage I CLD occurs in the first 3 days of life and is characterized by a reticulogranular pattern and air bronchograms or respiratory distress syndrome.

Stage III CLD

Stage III chronic lung disease (CLD) develops in the first 10 to 20 days of life and is characterized by multiple small cyst formation within opaque lungs and visible cardiac borders.

Stage IV CLD

Stage IV CLD occurs after 28 days of life and is characterized by irregular larger cyst formation that alternates with areas of increased density.

Staphylococcus aureus

Staphylococcus aureus is a gram-positive, coccus-shaped organism that is coagulase positive.

Staphylococcus epidermidis .

Staphylococcus epidermidis is coagulase negative.

Hirschbrung Disease

Starts in distal rectum Clinical sign : failure to pass meconium within first 24-48 hours May be associated with bilious emesis and a distended abdomen Associated with CF Types of test to determine diagnosis: Barium enema, biopsy of rectum

Glucagon

Stimulates glycogewn release from the liver May also stimulate insulin release, use requires the prescence of an IV glucose infusion

Subcutaneous lidocaine should be used for

Subcutaneous lidocaine should be considered for lumbar puncture and chest tube insertion.

Subgleal Hemmorrhage

Subgleal space holds 240mL of blood potentially the entire blood volume Feels boggy Crosses suture lines Can lead to severe anemia and hypovolumec shock

Brown fat

Substance accumulated in increasing amounts as the infant advances through gestation, especially third trimester Brown fat is located around the kidneys, adrenal mediastinum, axillary regions. In response to cold stress, norepinephrine is released into nerve endings in brown fat, causing it to be burned or metabolized. Process is called "non-shivering thermogenesis" **Production of heat***

Diazoxide

Suppresses pancreatic insulin secretion Used for profound hyperinsulinism

Black stool associated with blood

Swallowed blood or blood from high GI tract lesion

Symmetric IUGR

Symmetrical intrauterine growth restriction (IUGR) begins early in gestation and is most often caused by intrauterine infection or genetic abnormalities.

Symptoms of chlamydial eye infection

Symptoms of chlamydial eye infection include severe eyelid edema and purulent discharge. Eye prophylaxis should be administered as soon as possible after birth. Assessment of the eyes should be ongoing.

simv

Synchronized intermittent mandatory ventilation (SIMV) is a type of patient-triggered ventilation. SIMV delivers a preset number of ventilator breaths with a preset peak inspiratory pressure and inspiratory time synchronized with the onset of the patient's spontaneous breaths.

Billirubin Lab Values

TB .2-1.2 D.B. 0-0.2 I - 0.2-0.8

VACTERAL, associated with what two disorders?

TEF/EA vertebral defects anal atresia cardiac anomalies trachoesophageal fistula radial defects renal and limb anomalies

Nonpathologic unconjugated hyperbilirubinemia:

TSB levels generally peak on day 3 of life in full-term infants and on days 5 to 6 in preterm infants. Result of an elevated hematocrit level at birth, increased RBC destruction (neonatal RBCs have a 70- to 90-day life span), reduced hepatic uptake of unconjugated bilirubin, and enterohepatic reabsorption of bilirubin. Jaundice develops in more than 60% of term newborn infants and 80% of preterm infants; it is visible when the serum bilirubin concentration is greater than 6 to 7 mg/dL.

Hemoglobin and Hematocrit lab values

Term Hgb 17 HCT 53 34 weeker Hgb 15 HCT 47 Hemoglobin levels decline after birth

Moderate Variability

The 2008 National Institute of Child Health and Human Development consensus report states that moderate variability reliably predicts the absence of fetal metabolic acidemia at the time it is observed.

apt test

The Apt test distinguishes swallowed maternal blood from neonatal gastrointestinal blood loss.

Blood pressure gradient Coart of Aorta

The BP (>15 mm Hg) is the most consistent factor in critical coarctation of the aorta and is present in 97% of cases.

Kleihauer-Betke test

The Kleihauer-Betke test looks for fetal hemoglobin in maternal blood. A positive result in the test would imply that a prenatal hemorrhage had occurred either through a fetal-maternal hemorrhage or a placenta or cord accident.

The Ortolani test is used in assessing for what condition?

The Ortolani test is used in conjunction with the Barlow test to assess for developmental dysplasia of the hip.

ventilation-perfusion matching (Va/Qc)

The Va/Qc ratio expresses the interaction between pulmonary ventilation and perfusion. Matching ventilation and perfusion is required for efficient gas exchange. Mismatching is the most common cause of hypoxia.

Pulmonary Vascular Resistance in Utero

The amount of blood entering the pulmonary vasculature is limited because of the high pulmonary vascular resistance during fetal life. **The lungs are not needed for gas exchange nor do they function in utero.

Intermittent Cyanosis after birth a sign of

The anatomy of truncus arteriosus involves a single great artery originating from both the left and right ventricles. The blood flow to the lungs is directly dependent on the pulmonary vascular resistance. As the pulmonary vascularity changes, the pulmonary blood flow will also change, causing changes in the amount of blood flowing into the lungs.

The formation of respiratory bronchioles (ie, acini) during the canalicular stage of fetal lung development is significant because it heralds:

The canalicular phase of fetal lung development (16-26 weeks' gestation) is characterized by the formation of gas-exchanging acini. The development of respiratory bronchioles and pulmonary capillaries occurs. The degree of acinus-capillary coupling has a direct effect on the gas exchange that occurs.

The classic radiographic sign of a pneumomediastinum

The classic radiographic sign of a pneumomediastinum is the "sail sign," which results from free air lifting the thymus.

A mother is admitted for hypertension, proteinuria, and a headache at 32 weeks' gestation. Shortly after admission, she progresses to eclampsia. The nurse should anticipate that the definitive treatment for this condition is:

The development of seizures in the setting of preeclampsia is termed eclampsia when all other causes of seizure have been ruled out. In the setting of preeclampsia in an otherwise stable mother, expectant management may be considered if less than 32 weeks' gestation. Mothers with preeclampsia who present before 34 weeks' gestation should be given antihypertensive medications for blood pressure control, magnesium sulfate for seizure prophylaxis and fetal neuroprotection, and betamethasone for fetal lung maturation. However, immediate delivery should occur with any maternal or fetal deterioration such as eclampsia.

Twin to Twin Tranfusion

The donor twin presents with oligohydramnios and smaller crown-rump length and abdominal circumference, whereas the recipient twin often manifests with polyhydramnios and larger growth parameters. The donor twin is typically smaller and may present with anemia and hypovolemia, which can progress to congestive heart failure.

What should the nurse anticipate when caring for an infant whose mother had been exposed to Toxoplasma gondii in the first trimester of her pregnancy?

The evaluation of an infant with suspect congenital toxoplasmosis should include a review of maternal history and serology; a complete physical examination; Toxoplasma gondii serology; and evaluation for ophthalmologic, neurologic, and other manifestations that may not be evident upon cursory physical examination. Chorioretinitis may be the only finding, and is evident upon an ophthalmologic examination. Neurologic testing would include a lumbar puncture and a head computed tomograph (CT), the former to test for elevated cerebrospinal fluid (CSF) protein and/or mononuclear CSF pleocytosis. One can also test for Toxoplasma-specific IgM in the CSF or isolation of T. gondii from the CSF. A head CT would be performed in lieu of a brain magnetic resonance imaging (MRI) or head ultrasound to test for the presence of hydrocephalus or focal brain lesions, because a CT is less costly than an MRI and can be done without sedation, and is better at visualizing small calcified lesions than an ultrasound. The nurse should also observe the infant for potential seizure activity, as such has been found to occur in roughly 41% of relevant cases. The most common clinical manifestation of congenital T. gondii is chorioretinitis, which is typically evident upon ophthalmologic examination.

This phenomenon is referred to as the Kashbach-Merrit phenomenon.

The findings are consistent with a cavernous hemangioma. Although rare, vascular anomalies resembling a cavernous hemangioma can be associated with platelet sequestration and thrombocytopenia.

Prevent air trapping on ventilator

The history and clinical findings suggest that this infant has meconium aspiration syndrome (MAS). Hyperinflation occurs due to ball-valve air trapping. Lower inspiratory time will allow adequate exhalation time to prevent air trapping.

infants are at the greatest risk for developing retinopathy of prematurity?

The incidence of retinopathy of prematurity (ROP) appears inversely proportional to gestational age and birth weight. Therefore those infants at greatest risk for development of ROP are the smallest, most premature infants.

myelomeningocele position and treatment

The infant should be positioned in the prone kneeling position. Initial delivery room management is to protect the lesion by covering with sterile gauze moistened with warm sterile saline solution.

Signs and symptoms of adrenal hemorrhage, necessary imaging required to detect enlarged adrenal glands

The infant's history (macrosomia and breech presentation), along with pallor and jaundice, lethargy with periods of irritability, poor feeding, and vomiting, are signs of potential adrenal hemorrhage. The relatively large size of the adrenal gland at birth may contribute to injury. A nurse should prepare for an abdominal ultrasound before any treatments to determine the cause of the infant's signs.

The initial assessment for neonatal abstinence syndrome (NAS) should be done within

The initial assessment for neonatal abstinence syndrome (NAS) should be done within the first 2 hours of admission to the nursery.

Intermittent mandatory ventilation

The intermittent mandatory ventilation mode of ventilator support delivers breaths at a predetermined rate, irrespective of where the patient's spontaneous breath is in the respiratory cycle.

Main parental nutritional source for neural tissue / metabolic processes in an infant weighing less than 1000g is

The main intravenous energy source for neural tissue and metabolic processes is glucose. The rate of glucose production in neonates weighting less than 1000 grams is approximately 8 to 9 mg/kg/min

The most common type of duodenal atresia is

The most common type of tracheoesophageal fistula (TEF) is esophageal atresia with distal TEF (85%). This type also has a blind pouch for the upper esophagus.

Nephron consists of

The nephron consists of a glomerulus, descending and ascending loops of Henle, and distal convoluted tubule.

BPD epidemiology

The newer description of bronchopulmonary dysplasia (BPD) is that BPD is characterized by altered lung development with decreased numbers of alveoli and abnormal blood vessel development as opposed to lung damage.

Polhydraminos

The presence of an esophageal atresia in an infant with tracheoesophageal fistula prevents the fetus from swallowing amniotic fluid. Polyhydramnios occurs as a result.

In an infant with tetralogy of Fallot, the severity of symptoms will be most affected by which of the following?

The presence of an obstruction to right ventricular (RV) outflow with a large ventral septal defect causes a right-to-left shunt at the ventricular level with arterial desaturation. The greater the obstruction and the lower the systemic vascular resistance, the greater is the right-to-left shunt. Thus the clinical findings vary with the degree of RV outflow obstruction. Patients with mild obstruction are minimally cyanotic or acyanotic. Those with severe obstruction are most likely to be deeply cyanotic from birth. Few children are asymptomatic. In those with significant RV outflow obstruction, many have cyanosis at birth, and nearly all have cyanosis by age 4 months..

The presence of phosphatidylglycerol (PG)

The presence of phosphatidylglycerol (PG) in amniotic fluid is associated with a very low risk for the development of respiratory distress syndrome (RDS), whereas the absence of PG is associated with RDS. PG determination is valid even in the presence of blood-contaminated amniotic fluid.

Recommended pharmacologic medication for NAS

The recommended pharmacologic treatment for neonatal abstinence syndrome related to opiate use is morphine. It controls all the symptoms and contains few additives.

Prophalaxis of RSV

The risk of severe respiratory syncytial virus (RSV) disease and hospitalization is reduced by approximately 50% when prophylaxis with palivizumab is given.

Most important ductal dependent intervention

The single most important intervention for a ductal-dependent lesion is the infusion of IV prostaglandin E1 (PGE1) to ensure ductal patency and improve left-to-right shunting and systemic blood flow. The initial dose of PGE1 is usually 0.1 mcg/kg/min. PGE1 should then be titrated to the lowest effective dose and can be administered through an umbilical venous catheter, central line, IO line, or peripheral IV line with equal efficacy, although central access is preferred.

Which of the following statements is the most accurate about what occurs during the terminal sac stage of fetal lung development?

The terminal sac stage of fetal lung development is characterized by the refinement of the acini. Primary saccules continue to divide. The development of the surfactant system occurs. An increase in the alveolar-blood barrier surface area increases secondary to capillary invasion. The respiratory system continues to mature through childhood, with the greatest growth in the first 1 to 2 years.

Antimicrobial contraindicated in newborns is

The use of sulfonamides, such as sulfamethoxazole/trimethoprim, is contraindicated in newborns because these agents displace bilirubin from albumin-binding sites.

Renal Blood Flow after birth

There is high vascular resistance in the kidneys in utero. Renal blood flow increases gradually throughout gestation, and there is a dramatic increase immediately after birth. Renal blood flow does not reach adult levels until 2 years of age.

A newborn infant presents with hepatomegaly and cataracts, with noted petechiae and purpuric lesions on the trunk and extremities. A screening complete blood count shows an elevated white blood count but is otherwise unremarkable. What is the most likely cause of these skin lesions?

These lesions are often described as "blueberry muffin" spots, or dermal hematopoiesis, and occur when the skin is called upon to perform blood cell production, which can occur in instances of congenital viral infections, typically rubella, but also cytomegalovirus, toxoplasmosis, syphilis, and herpes. Associated symptoms can include growth restriction, cataracts, jaundice, hepatosplenomegaly, and thrombocytopenia.

A 7-day-old infant with a postmenstrual age of 24 weeks has a history of hyperglycemia and is receiving steroids for treatment of hypotension. The nurse caring for the patient notices erosive skin lesions with serous drainage and crusting on the infant's back. Suspicion should be raised for infection with which of the following agents?

Think steroids == mainly fungal! A gestational age of less than 26 weeks, hyperglycemia, and postnatal steroid therapy are risk factors for invasive fungal dermatitis caused by microorganisms such as Aspergillus or Candida species in the first 2 weeks of life. The characteristic lesions typically appear on dependent surfaces such as the back or abdomen.

neonatal herpes presentation

This presentation is concerning for neonatal herpes. Herpes can be localized central nervous system disease; disseminated disease; or localized to the skin, eyes, and mouth. Herpes can be transmitted to the newborn during delivery and often will have vesiculopustules on the presenting part. Given that this infant had a scalp electrode, the nurse knows that the infant's head was thus exposed and therefore vulnerable to transmission. When vesicles are noted and herpes is suspected, treatment with acyclovir should begin immediately.

Anomolies of hypospadias

Three anomalies typically found with hypospadias are ectopic opening of the urethral meatus, chordee, and hooded foreskin.

Thrombocytopenia associated with Candidiasis, DIC, and Hemorrhage

Thrombocytopenia may be associated with fungal infection, particularly Candida spp., disseminated intravascular coagulation, and hemorrhage; however, the thrombocytopenia is more likely to be late-onset thrombocytopenia, occurring after 72 hours of life.

Placement of UVC

Tip should be above diaphragm at inferior vena cava/right atrial junction

Treatments of candidiasis:

Topical mystatin (Nystatin) Fluconazole Amphotericin B

First sensory sense for infant is

Touch is the first sense to develop at approximately 7.5 weeks of age, and sensitivity to touch is very well developed in the face, lips, and hands.

MAS suctioning

Tracheal suctioning is ONLY recommended for non vigorous, depressed infants (decreased tone, decreased respirations, heart rate less than 100).

Transmission of RSV

Transmission is usually by close or direct contact with contaminated secretions.

Transposition of the great vessels

Transposition of the great vessels occurs when the aorta arises from the right ventricle and the pulmonary artery arises from the left ventricle. Marked cyanosis is a presenting feature of transposition because the aorta carries deoxygenated blood from the right ventricle to the systemic circulation.

Midgut volvulus

Twisting and spiraling of entire gut around the superior mesenteric artery Vascular compromise, necrosis, perforation

TEF most common type, interventions

Type

Most common type of TEF

Type C Air can enter the stomach via the tracheal fistula

Unconjugated hyperbilirubinemia is pathologic when

Unconjugated hyperbilirubinemia is pathologic when (a) Jaundice appears in the first 24 hours of life, (b) TSB level increases by more than 5 mg/dL/day, (c) TSB level exceeds 12.9 mg/dL in a term infant or 15 mg/dL in a preterm infant, (d) TSB level is in the 95th percentile for age (e) Jaundice lasts for more than 1 week in a term infant or 2 weeks in a preterm infant.

Malrotation acute tests and presentation

Upper GI radiograph gold standard Bilous vomiting Abdominal Distention Signs of Shock and sepsis Rectal Bleeding

Exchange transfusion.

Used when intensive phototherapy has been unsuccessful in controlling TSB, and at any time signs of acute bilirubin encephalopathy are present regardless of TSB level; used more often in hemolytic conditions. Hemolyzed and antibody-coated RBCs are removed over approximately 2 hours in small aliquots (3 to 5 mL/kg in preterm infants, 10 mL/kg in term infants) and replaced with donor blood. Double volume exchange (160 mL/kg) will reduce the TSB by 50%. Expect a rebound TSB of 60% to 70% of the preexchange transfusion level. (a) Electrolyte and substrate abnormalities: hyperkalemia, hypocalcemia, hypomagnesemia, hypoglycemia, hyperglycemia. (b) Clotting abnormalities: thrombocytopenia, embolization, thrombosis. (c) Respiratory and cardiovascular events: apnea, bradycardia, cardiac dysrhythmias and arrest, cyanosis, vasospasm, heart failure, acidosis. (d) NEC and infection. (9) Postexchange care. (a) Continue phototherapy. (b) Laboratory studies: TSB every 4 hours. Rebound usually occurs within 1 hour after the exchange.

HFV anatomical dead space

Using the mechanisms of convection and molecular diffusion, gas exchange using high- frequency ventilation (HFV) occurs even when tidal volume approaches or is less than anatomical dead space due to the increase in turbulence of the gas molecules during HFV.

Atropine

Vagolytic Increases the heart rate Blocks vagal response Minimizes oral sections Suggested dose .01-.03 mg/kg/dose

Variable decelerations

Variable decelerations are due to umbilical cord compression and exhibit a nonuniform pattern. Variable decelerations typically have an abrupt onset and recovery and are often preceded by heart rate accelerations.

Response to cold stress

Vasoconstriction Prevents blood from reaching skin surface Prolonged vasoconstriction may impair perfusion and tissues Can cause apnea **

Physiology of PPHN

Vasoconstriction related to acidemia, hpoxemia, hypothermia, and sepsis Blood shunts away from the lungs through the ductus arteriosis and or foramen ovale. 1. Pulmonary blood vessels constrict 2. increases resistant to blood flow into the lungs 3. blood flows via pathway of least resistance 4. Right ventricle to pulmonary artery 5. Pulmonary arteryy to ductus arteriosis and aorta 6. Deoxygenated blood enters arterial circulation 7. Hypoxemia 8. Perpetuates pulmonary vascular resistance and right to left shunting Vasospasm delayed relaxation causes arterioles to constrict

Prostaglandin E1 is a potent

Vasodilator may cause hypotension, hyperthermia, apnea.

Syphillis testing

Venereal disease research laboratory (VDRL) testing on cerebrospinal fluid is mandatory in all infants suspected of congenital syphilis because treatment regimens differ depending on whether or not there is central nervous system involvement.

Monitoring an infant for pain who has undergone surgery and still showing affects of anesthesia; the nurse should monitor

Vital Signs An elevated heart rate and/or blood pressure may indicate the need for pain medication.

The PIVKA test can be used to evaluate:

Vitamin K absence

Vocal Cord Paryli

Vocal cord paralysis is a known complication of surgical ligation of the ductus arteriosus. Symptoms of vocal cord paralysis include hoarseness or stridor, choking, and feeding difficulty.

Volvulus

Vomiting of bile stained emesis Make NPO Decompress stomach Abdomen film Upper UGI study Surgical correction to untwist bowel and restore blood flow

Absolute Neutrophil COUNT

WBC x (%) Segmented neutrophils + band neutrophils + metamyelocytes Example. 15,000 x 35 segs + 15 bands + 3 metas (turns into percent) 15,000 x .53 = 7950 ANC <1800 suggestive of infection Normal Range

IUGR asymmetrical

Weight low for Gestation Age Head Sparing (less restriction on brain growth) Old man appearance Appear wasted, thin Results from: Poor Placental function Maternal Hypertension* Smoking

balloon septostomy with transposition of the great vessels

When an infant has a restrictive atrial septal defect (ASD), a balloon atrial septostomy, a technique developed by William Rashkind in 1966, may be performed. The procedure involves inserting a balloon-tipped catheter across the foramen ovale into the left atrium. The balloon is then inflated and forcibly withdrawn so that the catheter tears the septum primum and enlarges the ASD. Mixing should increase immediately, with a corresponding increase in arterial oxygen saturation.

BPD x-ray and physical sign and symptoms

Which of the following is a pathologic condition characterized by right ventricular hypertrophy and right axis deviation on electrocardiogram, respiratory wheezing, hepatomegaly, and radiographic findings of cystic lesions with lung hyperinflation?

congenital candidiasis

Widespread erythematous maculopapular rash

assist control ventilation

With the assist/control mode of ventilation, either a synchronized breath is delivered with each spontaneous breath that meets threshold criteria or in the absence of spontaneous respirations, mechanical breaths are delivered at a preset regular rate.

NAS withdrawal symptoms appear within

Withdrawal symptoms often appear within the first 2 to 3 days of life, and nearly 60% to 90% of exposed infants develop withdrawal symptoms.

Pathologic Jaundice

Within 24 hours of life TSB elevation exceeding 17 mg/dl should be presumed pathologic w/in 24 hours of life Coombs POSITIVE = suspect hemolytic disease of newborn due to ABO incompatibility

persistent cloaca

a complex anorectal malformation in which the rectum, vagina, and urethra drain into a common channel opening into the perineum

imperforate anus

a congenital defect in which the rectal opening is missing or blocked.

Management of breast feeding Jaundice

a. Increase enteral intake by breastfeeding 8 to 12 times per day. The AAP does not encourage the interruption of breastfeeding b. No supplementation with water or glucose water in term, nondehydrated infants. c. Systematic assessment for hyperbilirubinemia risk, including maternal blood typing and neonatal direct antibody testing for incompatibility. d. Ensure normal thyroid and galactosemia screen.

If shoulder dystocia occurs, the physician or midwife will:

a. Use the McRoberts maneuver (maternal hip flexion; an exaggerated lithotomy position). b. Apply suprapubic pressure to attempt to release the anterior shoulder; the pressure may be directly downward or lateral. c. Turn the woman onto her side or pull the hips off the bed to free the sacrum. d. Turn the woman on "all fours" facing downward to widen the pelvic outlet if this can be easily accomplished (Gaskin's maneuver). e. Manually rotate the shoulders from the anteroposterior to the oblique diameter. f. Use the Woods' corkscrew maneuver, in which both hands are inserted internally to rotate the posterior shoulder to the anterior position for delivery under the pubic bone, with the maneuver repeated for the other side. g. Deliver the posterior arm. h. The expulsive efforts of the mother, as opposed to traction by the provider, are of the utmost importance.

Hirschbrung testing

abdominal x-ray Contrast Enema Anorectal Manometry Rectal Biopsy

Nagel's Rule for EDD

add a year, subtracting three months, and adding seven days to the origin of gestational age. 280 days at childbirth.

Upper GI Series gold standard for

an upper gastrointestinal radiograph is considered the gold standard to diagnose malrotation, a common cause of bilious emesis.

Mean Airway Pressure

average pressure transmitted to the airways through an entire respiratory cycle

Grade IV IVH

blood within the ventricles and an echogenic focus within the periventricular tissue.

Grade III IVH

blood within the ventricles and associated dilation of the ventricle.

Theophyline

bronchodilator, which relaxes the smooth muscle of the bronchiles and stimulates the central nervous system and skeletal muscles. The infant receiving theophyline requires continuous respiratory and heart rate monitoring. Assessment includes oxygen saturation and improved circulation by observation of improved skin color.

Cephalahematoma

collection of blood between a skull bone and its periosteum Resolves in 2 weeks to 3 months

Congenital CMV infection

congenital infection include: intrauterine growth restriction, hepatosplenomegaly, jaundice, purpura, pneumonitis, microcephaly, hydrocephalus, intracerebral calcifications, hearing loss, chorioretinitis, and optic atrophy.

Gastroinsetinal defect associated with down syndrome

duodenal atresia.

Wolff-Parkinson-White syndrome

episodic supraventricular tachycardia that resolves spontaneously. An echocardiogram is performed, and there is slurred upstroke of the QRS and the presence of a delta wave.

Biophysical Profile BPP

fetal tone, fetal breathing, fetal movement, nonstress test, and amniotic fluid volume.

cardiac tamponade

filling of the pericardial sac with blood and possibly fluid, thus causing a decline in cardiac function. Symptoms may include a period of initial tachycardia followed by bradycardia, pulse paradoxus, PR depression, ST elevation, electrical alternans, declining or absent pulses, and quiet or absent heart sounds.

Aspiration Pneumonitis

group B streptococci and gram-negative organisms

Reverse differential cyanosis

he infant has reversed differential cyanosis. This can be seen with transposition of the great arteries when the preductal saturations are lower than the postductal saturations. The transposition of the arteries leads to two separate circulations. The deoxygenated blood goes out the right atrium to the aorta to the body (right hand); therefore the pulse oximeter reading is lower.

polycythemia in newborn

hematocrit >65% seen in the first few hours or days of life possible symptoms -altered mental status -poor feeding -plethora (excessive blood in circulatory system or one organ or one area) -acrocyanosis -hyperbilirubinemia

Polyhydraminos

history of polyhydraminos related to GI anomalies, fetus is unable to swallow amniotic fluid, think TE and bowel obstruction

In addition to hypoglycemia, an infant of a diabetic mother should be assessed for the development of:

hypocalcemia.

The Kleihauer-Betke test

identifies fetal cells in the maternal blood. Although the Kelihauer-Betke test can be useful in determining whether the mother needs RhIgG, it will not determine the infant's condition at the time of delivery.

Ultrasonography findings commonly associated with trisomy 21

include increased nuchal translucency, absent nasal bone, cardiac anomalies—specifically atrioventricular canal defect—and shortened humerus and femur.

Single umbilical artery

increased risk for congenital abnormalities A single umbilical artery is concerning for renal abnormalities.

Karyotype

karyotype is a pictorial representation of an individual's chromosomes that can be used to look for abnormal numbers or structure of chromosomes.

Correct positon of endotracheal tube

midway between the trachea and carina

pathological jaundice

occurs before 24 hours and may indicate early hemolysis

Potter sequence (syndrome)

oligohydramnios-->compression of developing fetus-->limb deformities, facial anomalies (low-set ears, retrognathia), compression of chest pulmonary hypoplasia (cause of death) **Arthrogryposis (describes congenital joint contracture in two or more areas of the body)

Breastfeeding jaundice:

onset 2 to 4 days of life; related to low enteral intake. Self-limiting as milk supply increases. Breast milk jaundice: onset 4 to 7 days of life; exaggerated physiologic jaundice related to substances in maternal breast milk that cause glucuronyl transferase inhibition. Occurs in 10% to 30% of breastfed newborns; TSB levels may reach 12 to 20 mg/dL and persist for up to 2 months.

Arterial Blood Gas Values

pH 7.35-7.45 PCO2 35-45 Po2- 60-80 Bicarb 19-26 Base Excess - 4 to +4

A bedside immunoassay called AmniSure is performed. This test identifies a glycoprotein abundant in amniotic fluid. This glycoprotein is called:

placenta α-microglobulin-1 (PAMG-1 protein)

acute bilirubin encephalopathy clinical signs and symptoms

progressive changes to an infants mental and behavioral status lethargy, poor feeding, hypotonia, and alternating tone followed by hypertonia apnea, seizure, and death can be untreated outcome

Late decelerations

result from uteroplacental insufficiency.

Erb-Duchenne palsy

results from excessive traction and stretching of the brachial plexus nerves. These infants present with an internally rotated arm and a pronated, flexed wrist and typically have an absent Moro reflex.

caput succedaneum

serosanguineous fluid under subcutaneous tissue of the fetal scalp that crosses the suture lines. reabsorbes within 24-72 hours

Stridor

strained, high-pitched sound heard on inspiration (associated with upper airway obstruction) -Expiration (usually associated with lower airway obstruction)

Minute Ventilation

total volume of air inhaled and exhaled each minute

A late deceleration is a reflex fetal response to

transient hypoxemia during uterine contractions.

Amniotic Fluid Measurement

ultrasonography

Anatomic deadspace

volume of gas within area of the pulmonary conducting airways that cannot engage in gas exchange

Alveolar dead space

volume of inspired gas that reaches alveolar but does not participate in gas exchange due to inadequate perfusion to the alveoli