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2011-05-20 12:06:07

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  1. This blanches when pressure is applied, and resolves spontaneously?
    Nevus simplex (capillary hemangioma)-stork bite
  2. How should head circumference be to chest circumference in a newborn?
    HC 2 cm larger than CC. N=32 to 38 cm for AGA full term
  3. What is cutis aplasia?
    Localized absence of skin. Associated with trisomy 13
  4. What is the normal length of cord?
    30-90 cm. Infants with limited fetal activity is associated with down syndrome, congenital neuromuscular disorders
  5. What is the dosage for Fentanyl and the side effects?
    • Dosage-
    • Bolus 1 to 4 ug/kg/dose q 2 to 4 hours
    • by slow IV push
    • Continuous-1 to 5 ug/kg/hr

    onset immediate

    side effects- respiratory depression, chest wall rigidity, tolerance and dependance, urinary retention
  6. What is the dosage for Morphine and the side effects?
    Bolus- 0.05-0.2mg/kg/dose IV slow push, intramuscularly, subQ q 4 hours

    Continuous- give loading dose 100-150-mg/kg over 1 hour followed by 10-20 mg/kg/hr

    onset a few minutes after administration with peak around 20 minutes.

    side effects- respiratory depression, hypotension, bradycardia, transcient hypertonia, ileus, delayed gastric emptying, urinary retention, tolerance and dependence, seizures
  7. What is the reversing agent for neuromuscular agents?
  8. What is the reversing agent for benzodiazapine?
  9. What is the reversing agent for narcotic induced respiratory depression?
  10. pH 7.35-7.45
    PaCo2 35-45 mm Hg
    Pa02 50-80 mm Hg
    HC03 22-26
    Base excess -2 to +2
  11. What are the cyanotic heart defects and which way is the shift?
    • 1. Tetrology of fallot
    • 2. Transposition of the great vessels
    • 3. Truncus arteriosus
    • 4. Total anomalous pulmonary venous connection
    • 5. Tricuspid Atresia

    Right to Left shift
  12. What are the Acyanotic heart defects and which way is the shift?
    • 1. Coarctation of the aorta
    • 2. Valve stenosis
    • 3. Patent ductus arteriosus
    • 4. Septal defects (atrial or ventral)

    Left to Right Shift
  13. Fetal fibronectin is normally not present when and what does the negative test value predict?
    22-37 weeks gestation. Infant will not deliver within 7 days of testing
  14. What is a nearly flat baseline (absent variablility) indicate?
    a non-reassuring fetal heart rate pattern. Fetal compromise.
  15. What are the criteria for perinatal asphyxia?
    • 1. profound acedemia (pH <7) on umbilical artery sample.
    • 2. Apgar score of 0-3 for >5 min
    • 3. clinical neurologic sequele in the immediate neonatal period.
    • 4. clinical evidence of multiorgan system dysfunction in the immediate neonatal period
  16. What is the dose of Epinephrine via ET tube?
    1 ml/kg 1:10,000
  17. Idiopathic thrombocytopenia purpura has not been shown to be associated with cardiac abnormalities
  18. What kind of heart condition in the neonate can happen of mother with systemic lupus erythematosus?
    congenital AV block
  19. What are the most common heart defects of an infant of type I diabetic mother?
    Ventricular septal defects and transposition of the great vessels
  20. When is Respiratory distress syndrome present and how is it manifested on x-ray?
    present at birth or within hours of birth.

    Chest xray-characterized by atelectesis, air bronchograms, and diffuse granular infiltrates that often progress to severe bilateral opacity
  21. What does x-ray show on Transient tachypnea of the newborn?
    Chest x-rays consistent with over-expansion , and often fluid is seen in the fissure.
  22. What conditions are associated with hydrops?
    Cause edema through either anemia with hypoxia and subsequent capillary leak or through cardiovascular anomalies with heart failure and tissue hypoxia, vascular permeability, and decreased lymphatic flow
  23. When does the neonate with transposition of the great vessels and inadequate intra atrial communication become symptomatic?
    when the patent ductus arterious begins to close. These patients become cyanotic and tachypenic within the 1st few hours of life
  24. What can cutis marmorata (lacy like appearance) be caused by?
    cold stress or overstimulation/stress
  25. Persistent cutis marmorata may be seen in infants with?
    trisomy 21, trisomy 18, and cornelia de lange syndromes
  26. What are Acute severe intraventricular hemorrhage manifestations?
    seizures, metabolic acidosis, bulging fontanell, temperature instability, lethargy, coma, and hypotension. Often there is an unexpected low hematocrit or a hematocrit that does not rise as expected after transfusion, and an abnormally "tight" popliteal angle.
  27. When does post asphyxial seizures generally occur? and what type usually happens?
    within the first three days of life

    Multifocal clonic
  28. How is multifocal clonic activity manifested?
    as movement of one limb with migration to another part of the body in a nonorganized fashion
  29. What are associated findings of spina bifida?
    hydrocephalus, kyphosis, scoliosis, clubfoot, dislocated hips, and high risk of mental retardation
  30. What uses adduction with down pressure?
    Barlow maneuver
  31. What has a palpable clunk with abduction?
    Ortolani maneuver
  32. What syndrome is fatal in the 1st year of life, mostly female, have a high arched palate with micrognathea and microsonia?
    Trisomy 18
  33. How do you measure posture?
    measurement of arm and leg flexion and extension and leg abduction
  34. What are common problems of IDM's?
    hypoglycemia, RDS, hypocalcemia, hypomagnesemia, hyperbilirubinemia
  35. When does vernix appear and disappear?
    does not appear until the 3rd trimester. starts to disappear close to term.
  36. What conditions can cause symmetrically IUGR?
    • Intrauterine congenital infection
    • congenital malformation
    • chromosomal disease
  37. Transfer of heat between solid objest of different temperatures in contact with each other?
  38. Transfer of heat to the air moving across and around the infants body?
  39. Heat is transferred between two objects not in contact with each other. The baby loses heat by what to cooler surfaces and objects?
  40. When does anaerobic metabolism occur?
    in the absence of oxygen and leads to lactic acid production and metabolic acidosis
  41. When is NST impaired?
    When is NST inhibited?
    • pa02 <45 mm Hg
    • pa02 <30 mm Hg
  42. When can you successfully wean an infant to an open crib?
    • weight at least 1500 gms
    • tolerates feedings
    • has at least 5 consecutive days weight gain
    • no major medical conditions
  43. When does brown fat begin to develop?
    26-30 weeks gestation
  44. where is sodium absorbed?
    in both the small intestine and the colon
  45. What can excessive administration of oxytocin to mother cause in the neonate?
    hyponatremia in the neonate
  46. Where is ADH released?
    posterior pituitary
  47. Renal blood flow increases as renal vascular resistance does what?
  48. How is a chronic hyponatremic state corrected?
    gradually within 48-72 hours to prevent injury to brain cells
  49. What can happen if Na+ drops acutely or below 115 mEq/L
    apnea, irritability, twitching, or seizures
  50. Dehydration can cause high or low sodium levels?
  51. You increase fluids and put aquaphor on infants with what type NaCl levels?
    High NaCl- hypernatremia
  52. what is potentiated by digitalis toxicity?
  53. Metabolic acidosis will shift potassium where?
    out of the cells
  54. What can cause ventricular tachycardia, peaked T waves, wide QRS complex?
  55. What can cause hypotonia, weakness, irritability and poor feeding?
  56. What can cause flattened T waves, prominent U waves, ST depression, hypotonia, abdominal distention?
  57. What is one way to lower potassium levels?
    glucose and insulin and calcium gluconate.

    glucose and insulin temporarily shift potassium into cells while calcium gluconate lowers cell membrance potential
  58. What can hypocalcemia cause?
    jitterness, seizure activity, high pitched cry and stridor.
  59. When is calcium gluconate used?
    during cardiopulmonary resuscitation
  60. How long is calcium gluconate given over and what can happen if you give it through umbilical catheter?
    • 20 to 30 minutes.
    • Can cause intestinal necrosis and liver necrosis.
  61. What syndrome is the absence of thymus and parathyroid and cause low calcium?
    DiGeorge syndrome
  62. The minimal amount of glucose to be administered to maintain homeostasis is what?
    4 to 6 mg/kg/min of glucose to prevent hypoglycemia
  63. What is the correlating problem if an infant fails to respond to therapy for hypocalcemia?
  64. What does metabolic bone disease diagnostically indicate?
    normal calcium, low phosphorus, high alkaline phosphates, high 1,25 dihydroxyvitamin D levels
  65. What type infants is Portagen formula used for?
    fatty acid metabolism defect-infants cannot digest or absorb conventional lymphatic anomalies. common indications are infants with fatty acid metabolism defects and those with persistent chylothorax

    Portagen is not indicated for infants with feeding intolerance or renal insufficiency
  66. When are soy based formulas indicated?
    for infants with IgE mediated reaction to cow's milk protein.
  67. Elevated NaCl, chloride, and BUN is indicative of dehydration

    Increased creatinine level often accompanies renal failure
  68. Progestimil-
    a protein hydrolysate-based formula used for infants with malabsorption problems caused by gastrointestinal or hepatobiliary disease. Infants with these problems often have direct hyperbilirubinemia
  69. Healthy newborns require 100 to 120 Kcal/kg/day for adequate growth and development
  70. Reducing substance in the stool is indicative of excessive sugar content associated with carbohydrate malabsorption
  71. Similac PM 60/40 is a cows milk based formula that has low phosphorus content and low renal solute load

    used for renal insufficiency and infants with hypoparathyroidism
  72. Early minimal feeding of premature newborn is associated with improved calcium and phosphorus retention. They also have high serum calcium and low alkaline phosphatase levels and shorter intestinal transit times
  73. What can a deficiency of carnitine cause?
    increased apnea, bradycardia, failure to thrive, and low muscle tone
  74. What are the two month immunizations?
    DTaP, Hib, IPV, PCV
  75. What is carnitine?
    an essential nutrient for fat metabolism and the production of energy and is present in sufficient quantities in formula and human milk
  76. What can intravenous lipid cause?
    • alteration in leukocyte function
    • low pulmonary diffusion of gases
    • hyperphospholipidema
    • low peripheral oxygenation
    • displacement of bound bilirubin by free
    • fatty acids
  77. What does preterm formula have in it?
    • higher calcium and phosphorus
    • increased med-chain triglycerides as fat
    • source
    • decreased amount of lactose
    • increased protein content
  78. When is soy based formula used?
    with infants with IgE mediated reaction to cows milk protein, for those with tactose deficiency or galactosemia
  79. On a chest radiograph
    what is characterized by reticulogranular pattern with air bronchograms and diffuse alveolar infiltrates-bilateral?
    Respiratory distress syndrome
  80. On a chest radiograph that shows alveolar overdistention with multiple small cyst-like radioluciences that are unilateral would be diagnostic of?
    Pulmonary interstitial emphysema. this is due to assisted ventilation. may be bilateral, unilateral, or localized in a diffuse pattern
  81. A normal lung pattern with mild infiltrates and overexpanded lungs may be seen in what?
    some mild cases of meconium aspiration
  82. Bilateral asymmetric areas of atelectasis and hyperaeration with flattened hemidiaphragms is the generalized picture of what?
    meconium aspiration syndrome
  83. A chest radiograph shows high pulmonary vascularity, enlargement of the right atrium, right ventricle, and pulmonary artery with a snowman-type appearance. There is a widening of the superior mediastinum. The clinical diagnosis and primary intervention would be---
    total anomelous pulmonary venous return- provide support and O2 as needed and prepare for surgery.
  84. Bilious vomiting episodes in the 1st hours of life. abdominal radiograph shows dilation of the stomach and proximal duodenum producing "double bubble", down syndrome 25% of the time. support and nasograstic drainage
    Duodenal atresia
  85. ET tube placement
    1.2 cm below vocal cords and 2 cm above the carina and the neonates head in neutral position
  86. What are the two placements of a umbilical arterial catheter (UAC)
    • 1. low placement at the 3rd and 4th lumbar
    • 2. high placement at the 6th - 10th thoracic vertebrae
  87. If the maternal onset of chickenpox (varicella) of infection is within 5 days of delivery of the infant- the infant has not received the varicella-zoster virus antibody because the mother had not developed it yet, what must be done?
    give VZIG, airborne and contact precautions are recommended. Needs to room-in the mother
  88. signs and symptoms of GBS infection in infant are?
    • temperature instability
    • poor feeding
    • hypoglycemia
    • high white cell (WBC) count persisting
    • after 12 hours of age
  89. What conditions are associated with oligohydramnios?
    • anomalies of the kidneys
    • renal agenesis
    • hypoplastic lungs
    • congential contractures
  90. What conditions are associated with polyhydramnios?
    • down syndrome, neural tube defects, tracheoesphageal fistula
    • 1. central nervous system anomalies
    • 2. gastrointestinal tract anomalies
    • (gastroschisis, duodenal atresia, tracheoesophegeal fistula, diaphramatic hernia)
    • 3. down syndrome
    • 4. hydrops fetalis
  91. What is Kleihauer-Betke test?
    used to detect fetal-maternal hemorrhage
  92. PIPP score
    > 12 moderate to severe pain
    <6 minimal pain
  93. an oblication to avoid causing harm
  94. medically stable preterm infants who remain in the hospital at 2 months of chronological age should be given all vaccines recommended at that age
  95. Dopamine is the immediate precursor of epinephrine. It stimulates both a (alpha) and B (beta) adrenergic receptors as well as dopaminergic receptors, producing increased cardiac output, stroke volume, and renal perfusion
  96. Isoproternol stimulates B1 and B2 receptors, resulting in postive inotropic and chronotropic effects. It causes relaxaion of bronchial smooth muscle while increasing heart rate and contractility
  97. Albuterol relaxes bronchial smooth muscle by acting on B2 receptors with little effect on heart rate.
  98. Methlyprednisolome is a glucocortisoid that inhibits protaglandin synthesis (anti-inflammatory), macrophage accumulations, and interleukin synthesis/release. It is used in the treatment of hematologic, allergic, inflammatory, neoplastic, and autoimmune conditions.
  99. Phenyton (Dilantin) and phenobarbital (Luminal) is a pregnancy cat D- (positive evidence of risk to fetus). Infants with fetal hydantoin syndrome present with a variety of abnormalities. Most notable are digit and nail hypoplasia, unusual facies, and growth and mental deficiences. Additional craniofacial defects are common.
  100. Phenobarbital withdrawal symptoms- restlessness, hypertonicity, diarrhea, vomiting. poor suck. seizures present 2-6 days after birth due to long half-life of the drug
  101. What can IV fentanyl cause?
    respiratory depression, hypotension, chest wall rigidity
  102. Sodium bicarbonate cannot be given with fluid containing calcium- a precipitate of calcium carbonate will form
  103. No medications should be administered through a peripheral arterial line because arterial spasm and vascular compromise distally to the line may result
  104. Penicillin is incompatible with dopamine
  105. A line with inotropes should not be used for bolus administration of any med because this could cause significant blood pressure flucuations.
  106. 1st pass effect
    orally administered drugs are absored from the GI tract. when a portion of the amount absorbed is metabolized by the liver before it reaches the circulatory system for distribution
  107. Enterohepatic cycling
    Some drugs are excreting into bile and delivered to the intestines. Prior to elimination from the body the drug may be absorbed
  108. Hepatic clearance
    The amount of drug eliminated by the liver. Drugs and drug metabolites with molecular weights higher than 300 may be excreted into bile and delivered to the intestines. In the intestines bacteria hydrolyze the compound, freeing the drug to be reabsorbed into circulation. This process reduces the elimination of drugs and prolongs their half-life and duration of action in the body
  109. Phenytoin is incompatible with dextrose- administration of this drug into a line containing dextrose requires clearing the line with NS before and after the drug is administered
  110. Pneumoperitoneum
    Represents intestinal perforation. an absolute indication for surgery. In the absence of intestinal perforation, surgery may be considered for intestinal gangrene, progressive clinical deterioration, portal vein gas, persistent fixed and dilated bowel loop, abdominal wall edema, or erythema
  111. Necrotizing Enteriocolitis
    Abdominal erythema and tenderness can indicate bowl perforation. clinical deterioration- bradycardia, hypotension. lab values consistent with NEC- thrombocytopenia, leukopenia
  112. Metoclopramide
    Treatment for GER
    Increase tone and amplitude of gastric contractions. Increase in the resting tone of lower esophageal sphincter, increase duodenal and jejunal peristalsis
  113. Bilious vomiting in a previously well infant is what?
    • Malrotation with midgut volvulus.
    • midgut volvulus can cut off blood supply to bowel, leading to intestinal ischemia and infarction- can rapidly progress to profound hypovolemic shock.
  114. Cholestyramine
    used in short bowel syndrome involving loss of distal ileum because this results in unabsorbed bile salts and steotorrhea. This is an ion exchange resin that binds bile salts- thereby reducing steatorrhea
  115. Hyperammonemia is a complication of liver failure
  116. Malabsorption of fat and fat-soluble vitamins (A,D,E,K) is a common problem in infants with short bowel syndrome
  117. 90% of infants with meconium ileus have cystic fibrosis
  118. A postoperative complication of returning a large amount of bowel to a small abdominal cavity may be pressure on the inferior vena cava
  119. Common signs and symptoms associated with intestinal obstruction- history of polyhydramnios, failure to pass meconium within 24-48 hours, abdominal distention and bilious vomiting
  120. The signs and symptoms of hypothyroidism reflect slowing of metabolic processes such as gastrointestinal motility, bilirubin conjugation, and skeletal maturation- abdominal distention, prolonged jaundice, large posterior fontanelle
  121. Neonatal Grave's disease- increased T4
  122. congenital hypothyroidism- low T4, high TSH
  123. cause of metabolic bone disease/osteopenia of prematurity-inadequate calcium and phosphorus intake
  124. Many inborn error of matabolism have their onset at 2-3 days of age after a symptom free interval- can mimic sepsis- but labs do not confirm infection
  125. Ammonia level normal <65 uml/L
  126. Infants of diabetic mothers- congenital malformations, especially cardiac defects and neural tube defects
  127. Congenital adrenal hyperplasia
    xx virilized neonate-result of cause by 21 hydroxylase deficiency
  128. Erythopoetin (EPO) production is increased in response to anemia and low oxygen availability to tissues
  129. Vitamin K is required for the conversion of precursor proteins produced by the liver into active factors having coagulant capability. It is especially necessary for the conversion of the prothrombin (extrinsic) complex clotting factors and thus affects the PT time
  130. Acidosis increases the risk of bilirubin toxicity
  131. Improved extrauterine 02 delivery causes a temporary inactive stage of erythropoiesis
  132. Polycythemia in infants can be from mother- gestational diabetes, postmaturity, Pregnancy induced hypertension (PIH)
  133. Idiopathic thrombocytopenia purpura
    maternal autoantibodies bind themselves to maternal platelets cause them to prematurely destruct. the IgG antibodies then cross the placenta and destory fetal platelets. As a result, both the mother's and the infant's platelet count are low. If the neonatal thrombocytopenia is related to neonatal conditions, the mother's platelet count will remain normal
  134. Indications of term neonate having meningitis with a lumbar puncture- high protein, and low glucose
  135. What can phenobarbital in large doses cause?
    cardiac and respiratory depression
  136. Phenobarbital level
    15-40 mcg/ml
  137. IVH/PVH originates in the germinal matrix prior to 32 wks gestation. By 36 wks gestation IVH/PVH originates in the choroid plexus
  138. Arnold-chiari malformation
    almost always present in infants with myelomeningocele. It is also a defect in neural tube closure displacing the medulla, fourth ventricle, and lower cerebellum into the cervical canal-This impedes flow of SCF and leads to hydrocelphalus and pressure on brainstem-causes laryngeal stridor, apnea, reflux, and aspiration
  139. The vein of Galen drains the anterior and central regions of the brain into the sinuses of the posterior cerebral fosa. Malformations of the vein of Galen are anurysums that result in arteriovenous shunting of blood. High-output congestive heart failure ensues
  140. scalded skin syndrome is caused by a strain of staphylococus, requires isolation and treatment
  141. complications from eye exams
    apnea, bradycardia, hypertension, agitation
  142. What is the most common cause of intrinisic acute renal failure?
    Perinatal asphyxia. cellular damage involves the glomerular, tubular and collecting systems and leads to dysfunction of these components of the renal system. The hyponatremia is due to the decreased excretion of free water most likely caused by an increase in the secretion of antidiuretic hormone. This also leads to a decrease in plasma osmolality
  143. what has velocardiofacial, conotruncal anomaly facial syndrome- has undiagnosed cardiac defect, persistent hypocalcemia, and primary immunodeficiency-
    DeGeorge syndrome- 22q11. do FISH chromosome analysis
  144. prominent occiput
    60% female
    Beckwith-Wiedemman syndrome
  145. What is predominantly found in mothers breastmilk?
  146. what is coagulase negative bacteria?
    Staphylococcus epidermidis
  147. What is coagulase positive bacteria?
    Staphylococcus aureaus
  148. usually asympotomatic. general manifestation:
    neonatal jaundice (increase direct fraction)
    progressive sensorineural hearing loss
  149. When can all preterm infants of HBsAg negative mothers with a birth weight of <2000 g receive the 1st dose of Heb B vaccine series?
    Starting at 1 month oc chronologic age
  150. I:T ratio:
    mature cells=segs
    immature cells=bands, metas, myelos, promyelocytes

    I:T % immature cells
    % mature cells+
    immature cells
  151. an I:T ratio >0.2
    is referred to as a left shift and is suspect for infection
  152. What is congenital chylothorax?
    the accumulation of lymphatic fluid within the pleural space. The removal of chylous fluid results in lymphocyte loss and increases the risk of infection due to lymphopenia
  153. What is atelectasis on chest radiograph?
    increases lung density. This results in outlines of air filled bronchi (air bronchograms) against opaque, nonareated alveoli
  154. What are treatment options for PDA- patent ductus arteriorsus?
    • 1. indomethacin
    • 2. surgical ligation
    • 3. other temporary action- fluid restriction, digitalis, diuretics, packed red cell transfusions, and increase positive end expiratory pressure (PEEP)
  155. What does left to right shunting of blood through the ductus arteriosus result in?
    increased pulmonary blood flow. This results in signs of symptometic hypoperfusion (tissue mottling, diminished capillary refill, oliguria) and pulmonary congestion (tachypnea, hypercarbia)
  156. What does the chest radiograph reveal in infant with transient tachypnea of the newborn?
    prominent perihilar streaking, hyperaeation, and mild to moderate cardiomegaly. The perihilar streaking represents engorgement of the periarterial lymphatics that participate in the clearance of alveolar fluid
  157. What is Transient tachynpea of the newborn due to?
    delayed reabsorption of fetal alveolar fluid via the pneuomonary lymphatic system. Increased fluid leads to clinical signs of respiratory distress in the neonate. It usually resolves 48-72 hours.
  158. Severe asphyxia of a full-term infant in the early neonatal period may result in what?
    Persistent pulmonary hypertension of the newborn (PPHN). This results from hypoxia and acidosis. With hypoxia and acidosis, the pulmonary vasculature remains constricted. This leads to hypoperfusion of the lungs, increased pulmonary vascular resistance, with subsequent persistent pulmonary hypertension.
  159. What is central apnea defined as?
    the absence of breathing efforts-This results from either a failure of the central nervous system to initiate a breath or failure of the neuromuscular junction or muscle paralysis
  160. How do infants respond to hypoxemia and changes in PaCO2?
    they demonstrate a brief period of increased ventilation followed by respiratory depression
  161. What are side effects of prostaglandin E1-
    bradycardia, cutaneous flushing, hyperthermia, hypotension, apnea
  162. What are the side effects of methylxanthine therapy?
    tachycardia, jitteriness, increased wakefulness, hyperglycemia, gastroesphegal reflux, increased diuresis with sodium and calcium loss
  163. Who would be a good candidate for ECHMO?
    an infant over 35 wks gestation with persistent pulmonary hypertention of the newborn
  164. What is a short term complication of ECHMO?
    renal insufficiency
  165. When is persistant pulmonary hypertention of the newborn (PPHN) suspected?
    in infants with severe hypoxemia despite maximal medical management. diagnosis confirmed by echocardiogram showing extrapulmonary right to left shunting through the foramen oval and patent ductus arteriosus. A 10-15% difference between pre and post ductal pulse oximeter readings is indicative of right to left shunting through the patent foraman ovale and patent ductus arteriosus
  166. What is Inhaled nitric Oxide (iNO)?
    a selective and potent pulmonary vasodilator. It is rapidly oxidized and inactivated. because of this it exerts no effect on systemic blood pressure. potential toxicities include decreased platelet aggregation, increased risk of hemorrhage, acute lung injury in surfactant dysfunction, methemogloginemia, poorer neurodevelopmental outcomes, high mortality
  167. Continuous bubbling in the water seal chamber of the chest tube may mean what?
    water seal chamber may be a result of a leak in the system
  168. What is a pneumopericardium characterized by?
    cyanosis, muffled heart sounds, hypotension, and bradycardia. chestradiograph reveals a halo appearance surrounding the heart
  169. Chest Tube
    If visible clots and debris are seen in the chest tube are not free flowing, gentle kneading, not stripping of the chest tube may be indicated.
    Continuous bubbling in the water seal chamber may be a reult of a leak in the system.
    Frequently monitor and document tube patency, oscillation of fluid within drainage system and presence or absence of bubbling in the water seal chamber.
  170. What are clinical presentations of congenital diaphragmatic hernia?
    congenital lobar emphysema, eventration of the diaphgragm, and cycstic adenomatoid malformation.
  171. What are long term complications associated with congenital diaphragmatic hernia?
    gastroexophageal reflux, growth restriction, and neurodevelopmental delay
  172. 1/2 of infants with choanal atreasia also have what?
    other congenital abnormalities, esp CHARGE syndrome (coloboma heart defects, atresia, coanal, retardation, genital hypoplasia, ear abnormalities (deafness)
  173. What is due to mandibular hypoplasia prior to 9 weeks gestation. may be associated with other disorders. micrognathea, glossoptosis, cleft palate?
    Pierre Robin syndrome
  174. After cardiac surgery and infant cannot be weined from vent although is slightly tachpnic- may be phrenic nerve damage
  175. What is the clinical presentation of broncho pulmonary dysplasia?
    characterized by rales, rhonci, wheezing, hypoxia, hypercapnia, and respiratory acidosis.
  176. What is the chest radiograph of severe bronchopulmonary dysplasia (BDP) characterized by?
    air cysts among dense patches. The air cysts are evidence of progressive multifocal emphysema. The dense patches are largely indicative of alveolar collapse
  177. A specific B2 Agonist that has become the inhaled agent of choice in treatment of reducible broncospasm in infants with BPD is what?
  178. What are signs and symptoms of right sided heart failure?
    full pulses, tachycardia, poor circulaton, poor circulation, hepatomegaly, increased respiratory distress, loud pansystolic murmur
  179. Right sided heart failure- full pulses, tachycardia, poor circulation, hepatomegaly, increased respiratory distress, loud pansystolic murmur
  180. Furosemide is the treatment of choice for fluid overload in infants with BPD. It decreases intersitial edema and pulmonary vascular resistance. Increases urinary output by blocking chloride transport in the ascending loop of Henlie. However side effects are numerous and include volume depletion, contraction,, alkalosis, hyponatremia, hypokalemia, renal calculi, and nephrolcnosis
  181. When assessing for compensation status, examine pH and the acid/base determinants (paCO2 and Hco2). In the case the arterial blood gas reflects partial compensation in which both acid/base componants remain abnormal in opposite directions, which the pH moving toward a more normal range
  182. Full compensation is characterized by the return of the pH to a normal range. A
    Pa02 of 49 mm Hg is indicative of hypoxemia. The normal range for Pa02 is 60-80 mm Hg
  183. The clinical presentation of broncho-pulmonary dysplasia is characterised by rales, rhonchi, wheezing, hypoxia, hypercapnia, and respiratory acidosis
  184. The chest radiograph of severe bronchopulmonary dysplasia (BPD) is characterized by air cysts among dense patches. The air cysts are evidence of progressive multifocal empysemia. The dense patches are largely indicative of alveolar collapse.
  185. Right sided heart failure is characterized by full pulses, tachycardia, poor circulation, hepatomegaly, increasing respiratory distress, and a loug pansystolic murmur
  186. Decreased pulmonary vascular resistance due to increased 02 (potent vasodilator) pulmonary catecholamine surge first 4-6 hours
  187. Ductus venosus has functional closure within minutes, anatomic closure 3-14 days
  188. Foramen ovale- unidirectional flap, functional closure minutes, anatomic 9-30 months (15-20% adults still open)
  189. Ductus arteriosus functional closure 10-15 hours, anatomic 2-3 months
  190. Premature <30 weeks, all closure can be delayed. Ductal flow in fetus right to left at birth bidirectional then left to right
  191. If you have pulmonary hemorrhage do CUS, may have bleed in head
  192. PDA left to right shunting
  193. Signs and symptoms PDA- systolic or continuous murmur LUSB. wide pulse pressures, hypotension, palmer pulses, bounding peripheral pulses, overactive precordium, tachycardia
  194. In coartation do not close duct
  195. Dopamine
    catacholamine, rapidly metabolised. serum 1/2 life 2-5 minutes.
    increase blood pressure by increasing systemic vascular resistance via alpha-adrenergic effect.
    selective renal vasodilation with increase urine output in preterm @ 2-5 mcq/kg/min

    adverse effects: tachycardia and arrhythmias

    Not good in peripheral IV
  196. Systemic corticosteroids
    side effects- hyperglycemia, hypertension, hypertrophic obstructive cardiomyopathy, gastrointestinal hemorrhage, gastrointestinal perforation. growth failure and hypothalamic-pituitary-adrenal suppression increased in neuromotor impairments. have been associated with diuresis, thereby improving diuresis and any underlying pulmonary edema
  197. Calorie requirements for infants with BPD 150-200 kcal/kg/day
  198. BPD- oxygen is a pulmonary vasodilator and serves to decrease pulmonary resistance, with increasing severity of bronochopulmonary displasia (BPD), pulmonary vascular resistance increases, hypoxia worsens and right-sided ventricular hypertrophy advances to cor pulmonal. This condition ultimately progresses to pulmonary and cardiac failure
  199. Functional residual capacity (FRC)- is the volume of gas that remains in the lungs after normal expiration
  200. Tidal Volume (TV)- is the amount of air that moves into or out of the lungs with each breath at rest
  201. Vital capacity (VC)- the volume of air maximally inspired and expired
  202. Physiologic dead space is the sum of anatomic (conducting airways) and alveolar dead space
  203. Pulmonary interstitial emphysema (PIE) is caused by the rupture of overdistended alveoli or bronchioles ino the intersistium of the lung. chest radiograph findings consist of small hyperinflation cysts. Air bubble will follow the perivascular sheaths, often near the hilum
  204. Patchy infiltrates are consistent with meconium aspiration
  205. Reticulogranular appearance is consistent with RDS (respiratory distress syndrome)
  206. The hemoglobin-oxygen dissociation curve reflects the affinity of hemoglobin to oxygen
  207. A shift to the right on the hemoglobin-oxygen dissociation curve results in decreased affinity of hemoglobin for oxygen
  208. A shift to the left as with fetal hemoglobin results in an increased affinity of hemoglobin for oxygen
  209. In infants there is an increased amount of fetal hemoglobin compared with an adult. As a result, this shifts the curve to the left
  210. High frequency oscillatory ventilation (HFOV)-
    frequency is expressed in hertz
    carbon dioxide elimination is controlled by both oscillatory amplitude and hertz (breathing rate)
    oxygenation is controlled by adjusting mean airway pressure.
    breaths are delivered by a vibrating diaphragm, where inspiration and exhalation are active pressures
  211. Ventilator-
    the ventilator rate affects the carbon dioxide level, by decreasing the rate (decreasing minute ventilation). the carbon dioxide level will increase
  212. Increasing peak inspiratory pressure (PIP) and decreasing end expiratory pressure (PEEK) would increase tidal volume
  213. Coarction of aorta
    hepatomegaly, tachycardia, tachypnea, gallop rhythm. Infant with CHF. classic finding of coaraction of aorta is diminished pulses in lower extremeties a systolic BP increased by upper compared to lower
  214. Protaglandin E1 is administered in order to maintain patency of the ductus arteriosus. In the case of hypoplastic left heart syndrome, systemic circulation is dependent on the ductus arteriosus. As ductual patency improves, peripheral perfusion will improve
  215. Digoxin used for SVT. It slows conduction through the AV node
  216. Hypoplastic left heart syndrome
    diminished pulses
    color ashen gray
    systolic murmur if present
    urine output decreases secondary to decreased perfusion
  217. Indomethacin
    side effects- temporary decrease in renal function, platelet dysfunction, gastrointestinal bleeding. should monitor UO, serum electrolytes, glucose, creatinine, BUN, platelet count
  218. Supplemental oxygen is often given to infants with suspected heart disease without a full understanding of its potential adverse effects. In single ventricle physiology (hypoplastic left heart syndrome), supplemental oxygen can produce pulmonary vasodilation, resulting in increased blood flow to the lungs and decreased blood flow to the systemic circulation. The resulting clinical signs include a fall in urine output, diminished pulses, prolonged capillary refill and metabolic acidosis
  219. Factors that decrease cardiac contractility include acidosis, hypoxia, electrolyte disturbances, hypoglycemia
  220. Digitalis toxicity affects the formation and conduction of the cardiac impulse, leading to prolongation of the P-R interval, profound sinus bradycardia, and heart block
  221. Cyanosis can occur in the healthy infant with polycythemia
  222. Afterload- the resistance against which the heart has to pump is reduced by the administration of vasodilators-sodium nitroprusside is a smooth muscle relaxant that dilates both arteries and veins
  223. Propanolol is used for wolff-parkinson-white
  224. B-adrenergic agents stimulates B1 receptors in the heart. It results in increase in heart rate, AV conduction, velocity, and ventricular contractiltiy. As a result of improved contractility, blood pressure decreased, urine output may decrease
  225. A right to left cardiac shunt is characterized by deoxygenated blood that is shunted to systemic circulation going to the lungs resulting in arterial desaturation
  226. Cardiac output in neonates is primarily dependent on heart rate
  227. In ventricular septal defect with normal pulmonary vascular resistance, blood shunts left to right across the defect leading to increased pulmonary blood flow, decreased pulmonary compliance, pulmonary edema. This interfers with adequate gas exchange
  228. Tet Spell
    Hypercyanotic spells are characterized by intense cyanosis with deep and fast respirations. During a spell there is relative decrease in resistance to left ventricular outflow compared to right ventricular outflow, causing an increased right to left shunting try:
    1. knee chest position
    2. 02
    3. morphine
    4. sodium bicarbonate to metabolic acidosis
  229. Captopril is an ACE inhibitor and reduces systemic vascular resistance and increases venous capance
  230. During fetal life, alveoli are fluid filled and hopxic, leading to pulmonary artery vasoconstriction and increased pulmonary vascular resistance and pressure. systemic vascular pressure and resistance are low because a majority of the fetal circulation flows to the placenta, which is a low-resistance organ
  231. Maternal systemic lupus erythematosus- is frequently associated with complete heart block in newborns
  232. Cardiac troponin levels may be elevated in mycarditis
  233. Pressures don't autoregulate pressure in the brain of premeemies
  234. Dobutamine
    used to treat hypoperfusion and hyptotension especially if related to myocardial dysfunction synthetic catechoamine with beta-adrenegic activity
    inotropic- increased myocardial contractility, cardiac index, oxygen delivery
    effects cardiac output more than blood pressure
    onset of action 1-2 minutes after administration, peak 10 minutes
    serum half life-several minutes
    must be continuous infusion
    adverse effects-hypotension if patient hypovolemic (volume load before starting)
    arrhythmias, hypertension, cutaneous vasodilation