The neonate has a limited ability to ________urine. - correct answer concentrate
The best time for alpha-fetoprotein screening is: - correct answer
... [Show More] 15-22 weeks
Low or high levels of alpha-fetoprotein are associated with chromosomal anomalies? - correct answer Low
Nuchal lucency screening is useful in diagnosing: - correct answer trisomy 21 risk
True or false: A negative contraction stress test is more reassuring than a nonreactive non-stress test. - correct answer True
The biophysical profile is determined by what 5 factors? - correct answer Fetal tone, fetal HR, amniotic fluid volume, fetal breathing, fetal movement
__________ decels result from cord compression. - correct answer Variable
__________ decels are associated with utero-placental insufficiency. - correct answer Late
_________ decels mirror uterine contractions in time of onset, duration and termination. - correct answer Early
List etiologies of fetal growth restriction: - correct answer preeclampsia, placenta previa, maternal substance abuse, TORCH infections, chromosomal anomalies, congenital malformations
Complications seen in infants of mothers with severe preeclampsia: - correct answer IUGR, Mag toxicity (hypotonia, resp depression), thrombocytopenia
Neonates born to women receiving mag sulfate may have these rare abnormalities: - correct answer abnormalities in CA homeostasis, parathyroid abnormalities
Apgar scoring elements: 5 - correct answer HR (absent/<100/>100), Respiratory effort, tone, grimace, color
Difference between primary and secondary apnea: - correct answer Primary: inability to immediately spontaneously breath but responds to stim. Secondary: no response to two attempts of tactile stim.
Guidelines for initiation of chest compressions for infant: - correct answer HR<60bpm after intubation & 30 seconds of ventilation with 100% fiO2
Correct rate & depth of compressions: - correct answer 90/min, 3 compressions per breath (one and two and three and..)
recommended dose and strength of epinephrine for neonatal resuscitation? - correct answer 0.01-0.03mg/kg IV, 0.03-0.1mg/kg ETT. 1:10,000 0.1mg/mL concentration
One minute Apgar scores correlate with: - correct answer umbilical cord blood pH & index of intrapartum depression.
5/10 min Apgar scores correlate with: - correct answer infants change in condition and adequacy of resuscitative effort
When to discuss withholding/withdrawing treatment: - correct answer after 10 min of aggressive resuscitative effort with no evidence for other causes of newborn compromise. Assess GA & wishes of parents
5 etiologies of non-immune hydrops fetalis: - correct answer hypoplastic L heart, parvovirus, extra thoracic tumors, chromosomal (trisomy 21/18), congenital lymphatic dysplasia
Delivery room management for fetal hydrops: - correct answer Intubations supplies, thoracentesis, paracentesis, thoracotomy, line placement, & subspecialty presence
5 Risk factors of birth trauma: - correct answer primiparity, small maternal stature, maternal pelvic anomalies, prolonged or precipitous labor, oligohydramnios
________ nerve palsy may result from lateral hyperextension of the neck. - correct answer Phrenic
In Duchenne erb palsy, which reflexes are absent on the affected side? - correct answer moro, bicep, and radial reflexes (arm is adducted and internally rotated)
Klumpke's palsy, what is absent? - correct answer grasp reflex
What are two neonatal complications of maternal UTI? - correct answer preterm birth & neonatal sepsis
What are two neonatal complications of maternal cigarette smoking? - correct answer increased perinatal mortality & IUGR
What are some neonatal complications of maternal anemia? - correct answer stillbirth, IUGR, hydros fetalis, preterm birth, asphyxia
What are some neonatal complications of maternal bleeding? - correct answer stillbirth, preterm birth, anemia
Etiologies for SGA? - correct answer underweight Mom, maternal HTN, placenta previa, single umbilical artery, congenital infections, chromosomal anomalies
Etiologies for LGA? - correct answer maternal diabetes, large parents, post-term, syndromes (beckwith-wiedemann)
Factors that increase risk for premature birth? - correct answer low socioeconomic status, African American, <16yrs or >35years, placenta previa, abruption, IUGR, hydros
What are the risks associated with oligohydramnios? - correct answer fetal demise, placental insufficiency, IUGR, renal agenesis, pulmonary hypoplasia, deformations
What are the risks associated with multiple gestations? - correct answer IGUR, T-T transfusion, preterm birth, asphyxia, birth trauma
What are the risks associated with polyhydramnios? - correct answer anencephaly, neuromuscular/CNS disorders, chylothorax, swallowing issues, neurotube defects
Identify 5 problems associated with prematurity: - correct answer perinatal depression (apnea), RDS, PVL, IVH, hypotension & PDA
Management of intrauterine growth restriction: - correct answer Determine cause, monitor fetal wellbeing, offer glucocorticoids for lung maturity, deliver with NICU team
Short term outcomes of SGA/IUGR infants: - correct answer increased morbidity & mortality, poor postnatal growth, neurologic impairment, delayed cognitive development, poor academic achievement
Long term outcomes of SGA/IUGR infants: - correct answer increased risk of coronary heart disease, HTN, diabetes, stroke, COPD, renal impairment, decreased reproductive function, psychosocial issues
What is the significance of a split in the S2 heart sound? - correct answer evidence of presence of two semilunar valves
Erythema toxicum is a rash filled with_________. - correct answer eosinophils
Milia usually resolves when? - correct answer within the first week of life
Dermal melanocytosis is _________ in color. - correct answer bluish
Barlow maneuver: - correct answer 'clunk' causes posterior dislocation of unstable hip (congenital hip dysplasia)
Ortolani maneuver: - correct answer Causes reduction of hip & 'click' (Congenital hip dysplasia)
True or false: mobility of suture lines rules out craniosynotosis - correct answer true
Cephalohematoma/Caput: which crosses suture lines? - correct answer Caput crosses suture lines ('cap'), cephalohematoma does not
What etiologies should be considered when marked jitteriness occurs? - correct answer hypoglycemia, hypocalcemia, hypomagnesemia, withdrawal from opiates/cocaine/tobacco/SSRI
Three drugs that are known human teratogens: - correct answer methotrexate, lithium, warfarin
Physical findings found with Trisomy 13: - correct answer Growth restriction, cleft lip, small ears, short neck, microcephaly, hypertonia, seizures, apnea, ASD/VSD, multicystic kidneys, polydactyly
Physical findings with trisomy 18: - correct answer IUGR, low set ears, microcephaly, hypertonia, apnea, valvular anomalies, omphalocele, renal anomalies, overlapping fingers, decreased subcutaneous fat
Physical findings with trisomy 21: - correct answer epicanthal folds, neck folds, tongue thrusting, microcephaly, hypotonia, AV canal, VSD/ASD, duodenal atresia, palmar crease
What physical finding warrants consideration of a muscle biopsy? - correct answer severe hypotonia (use in conjunction with nerve biopsy)
Growth patterns in twin gestations diverge from singleton pregnancies in the _____ week of pregnancy. - correct answer 30th
True or false: Mortality increases threefold and fourfold for triplets and quads respectively. - correct answer True
Most common illicit drugs abused in the US: - correct answer marijuana, psychotherapeutics, cocaine, hallucinogens
Clinical signs of withdrawal of alcohol: - correct answer hyperactivity, crying, irritability, poor suck, tremors, seizures, diaphoresis
Clinical signs of withdrawal of barbiturates: - correct answer irritability, tremors, hyperacusis, excessive crying, vasomotor instability, diarrhea, restlessness, hypertonia, vommiting
Clinical signs of withdrawal from diazepam: - correct answer hypertonia, poor suck, hypothermia, apnea, hyperreflexia, vomiting, tachypnea
Three drugs utilized to treat neonatal abstinence syndrome: - correct answer opioids (morphine), methadone, phenobarbitals (if unable to wean after 3 weeks)
Treat NAS scores > or = - correct answer 8
Increase meds for NAS score greater than 8 x _____ and wean for NAS scores <8 after ______hrs. - correct answer 2, 24-48
Substance exposed infants can breastfeed if: - correct answer Mom is in a program, mom as abstained for 90 days prior to delivery, no psych meds, negative urine tox, prenatal care, and no marijuana use
Elements of NAS Score: - correct answer Cry: unable to self console in 15 seconds or up to 5 mins with intervention
Feedings: excessive suck/uncoordinated, gulping, not breathing
Fever: 37.2-38.3, or 38.4 or higher
Moro reflex: elicit from quiet infant, clonus of hands/arms
Muscle tone: total body rigidity at rest
Tremors: tremors without handling, 15-30 seconds after touch
___ out of ten ELBW infants are at risk for PDA. - correct answer 7/10
Respiratory support for ELBW infants: - correct answer CPAP for infants exposed to steroids (6-8cm). Conventional ventilation @ lowest tidal volume. Avoid hyperoxia. Surfactant administration for MAP's >7 & 30% fiO2. Surf immediately upon intubation.
Target O2 range for ELBW infant: - correct answer 90-95%
Start at what mL/kg/day fluid status for day one ELBW infant? - correct answer Start at 60ml/kg/day.
Lipids should start on day ___, max of __mg/kg/day. - correct answer Lipids on day 2 (max 3mg/kg/day).
When do you fortify to 24 cal for ELBW? - correct answer when enteral feeds reach 90-100mL/kg/day.
Max feed volumes? - correct answer 150-160mL/kg/day
Protein should be added to feeds to promote what? - correct answer somatic & head growth
Signs of stress in preterm infants: - correct answer tachypnea, apnea, mottling, cyanosis, cough/sneeze, yawns, hiccups, spitting up, tremors, twitching, hyper/hypotonia, fussing, prolonged wakefulness
Sound should not exceed ____ decibels around a preterm infant. - correct answer 45 decibels
Factors that interfere with the premature infant's ability to maintain adequate body temperature: - correct answer higher ratio of skin surface to weight, increased permeability of skin (trans-epidermal H2O loss), decreased subcutaneous fat, decreased brown fat (decreased glycogen stores), poor vasomotor control
Physiologic changes that occur with cold stress: - correct answer peripheral vasoconstriction, anaerobic metabolism, increased O2 consumption, chronic calorie loss (weight loss or inability to gain)
Neutral thermal environment: - correct answer Environment in which infant has minimal heat production (measured by O2 consumption) and core temp is within normal range
Radiational heat loss: - correct answer loss of heat to colder object without touching (ie isolette wall)
Evaporative heat loss: - correct answer heat loss through conversion of H2O to gas (ie wet baby/bath)
Convection heat loss: - correct answer heat lost to moving air (ie draft)
Conduction heat loss: - correct answer heat lost to surface/object infant touches (ie cold mattress)
The most common cause of respiratory infection in premature infants is: - correct answer respiratory syncytial virus
When should preterm infants receive their hep B immunization? - correct answer 2kg, or DOL 30 regardless of weight or GA, or before DC
Incidence of CP in VLBW infants: - correct answer <1500gs: 7-12%
Incidence of CP in ELBW infants: - correct answer <1000g: 11-15%
Hearing loss occurs in ___-____% of VLBW infants. - correct answer 2-11%
VLBW infants should see a dentist at: - correct answer 12 months
Dalton's law: - correct answer increased altitude is inversely related to decrease in barometric pressure and partial pressure of O2, which decreases alveolar tension. Leads to increased need of fiO2
Boyle's Law - correct answer as altitude increases, volume of gas expands. Gas trapped in closed spaces expand= increase in pneumothorax and GI distention.
Management of an infant with suspected ductal dependent congenital heart disease during transport: - correct answer Initiate PGE (prostaglandin E) PRIOR to transport. S/E of PGE: apnea, fever, hypotension. Secure airway, assess for impaired perfusion.
four central tenants of family centered care: - correct answer dignity & respect, information sharing, family participation in care, collaboration with family
Indications for initiating parenteral nutrition: - correct answer infants <1500g, significant oral intake not anticipated 3-5 days, cardiac disease requiring ca supplement
Peripherally infused TPN osmolality should be ___-___osm/L. - correct answer 300-900osm/L
True/False: Peripheral solutions cannot adequately support growth in ELBW infants. - correct answer True
Glucose needs in preterm infant: - correct answer need higher glucose because of higher brain to body weight ratio & higher energy needs.
Initial GIR should be: - correct answer 4-8mg/kg/min
Three signs of glucose intolerance: - correct answer hyperglycemia, secondary glucosuria with osmotic diuresis
True or false: the amount of calcium and phosphorus that can be administered by IV is limited by the precipitation of calcium phosphate. - correct answer True
___________ and ________ should be withheld in PN feedings for infants with cholestatic liver disease. - correct answer Copper & manganese
________ is not routinely added to PN but should be considered with infants requiring long-term PN. - correct answer Carnitine
Three complications of parenteral nutrition: - correct answer cholestasis (reduced bile flow), metabolic bone disease, metabolic abnormalities (increased BUN (azoemia), hyper ammonia, hyperchloremic metabolic acidosis (from bicarb loss)
Three benefits of trophic feedings: - correct answer improved levels of gut hormones, decreased feeding intolerance, improved weight gain
Criteria for transpyloric feedings: - correct answer intolerance to naso/oralgastric feedings, increase risk of aspiration, severe gastric retention & regurg, anatomic abnormalities (microgastria)
Formula for gastroesophageal reflux: - correct answer standard formula or enfamil AR
Formula for cystic fibrosis: - correct answer semi-elemental formula containing reduced LCT with MCT
Formula for baby with cow's milk allergy: - correct answer extensively hydrolyzed protein
Formula for baby with renal insufficiency: - correct answer standard formula
Formula for baby with chylothorax: - correct answer significantly reduced LCT with supplemental MCT
Nutritional management of infant with NEC: - correct answer Provide complete PN during acute phase followed by gradual intro to enteral feeds after stabilization. Start 10-20mL/kg/day and advance by 10mL/kg/day q12-24hrs.
Nutritional management for babies with BPD: - correct answer Increased caloric requirement [Show Less]