NRP Basics
What does MR SOPA stand for?
Adjust Mask, Reposition airway, Suction mouth then nose, Open Mouth, increase Pressure, Airway (LMA or advanced)
Fill in the Blanks:
Mean pulmonary arterial pressure ______ at birth.
Pulmonary Blood flow ______ at birth.
Pulmonary Vascular Resistance ____ at birth.
Decreases, Increases, Decreases
A baby has a single umbilical artery, what genetic anomaly is it associated with?
What else is associated with single umbilical arteries?
Trisomy 18
Urogenital anomalies and Cardiac malformations.
Define Fetal Hydrops and what TORCH infection is it related to?
Abnormal accumulation of fluid in two or more fetal compartments.
B19 Parvovirus
ACE Inhibitors increase the risk of what congenital anomalies (3 things)?
Renal Dysgenesis
Oligohydramnios
Skull Oscification Defects
What is the difference between a Caput and Cephalohematoma?
Caput - associated with prolonged vaginal births/vacuum extractions, above periosteum, edema crosses suture lines and midline, resolves over days
Cephalohematoma - under Periosteum, usually above parietal bone, doesn't cross midline, resolves over weeks to months. Can calcify.
You are called to resuscitate a baby with no prenatal care. He looks very blue and is satting 60%. You give him supplemental oxygen but it doesn't help.
Name the 5 Cyanotic Heart Lesions you think it may be!
TOF, Tricuspid Atresia, TGA, Total Anomalous Pulmonary Venous Return (TAPVR), Truncus Arteriosus
A mom brings her newborn baby girl to the ER and is complaining that her hands look swollen...What do you suspect? What additional findings do you see? What test do you want to order prior to discharge?
Order a ECHO - check for a coarctation!
A baby is very cyanotic, but it improves when he starts crying..what do you suspect? How can you confirm? Associated with what other anomalies?
Bilateral Choanal Atresia, try passing a NG feeding tube, consider CHARGE syndrome
A late preterm baby is delivered via c-section. Mom had no prenatal care. APGARs were 5 and 8. He required PPV and is continuing to have respiratory distress requiring CPAP 6/30%. What's on your differential? What do you want to order?
TTN, RDS, Pneumonia, congenital heart lesion, pneumothorax, meconium aspiration .
Start with a physical exam, get a CXR, CBG, check the cord gases
The intern is called to the NICU for neonatal tachycardia....EKG reveals HR 220. Describe your approach for Unstable and Stable SVT.
Stable - Vagal maneuvers, ice to face
Unstable - Adenosine x 2, synchronized cardio version
Describe the findings in Trisomy 18? Also called _________ Syndrome!
EDWARD SYNDROME!
TRISOMY 18 - hypoplastic nails, clenched hand, overlapping digits, rocker bottom feet, micrognathia, malformed ears
Baby has a microcolon, what do you suspect mom has?
DIABETES MELLITUS
What is the number one effect of cigarette smoke on neonates?
Low Birth Weight...Also associated with prematurity, stillbirth, SIDS, miscarriages
A baby is born with a "discoid rash" that appears annular in appearance. The baby is up for adoption and mom leaves AMA. What is on your differential? What is the most feared complication? What do you want to order?
Name the Congenital Heart Lesion via CXR findings:
-Egg on a String?
-Boot Shaped Heart?
- 3 sign?
-Snowman?
-TGA
-TOF
-Coarctation of Aorta
-Total anomalous Pulmonary venous circulation
https://www.chestmedicine.org/2016/06/classical-x-ray-signs-in-congenital.html
5 clinical features - transverse palmar crease, flat facies, wide gap between toes 1-2, inner epicentral folds, large tongue, hypotonia, short, large tongue
Risks - Endocardial Cushion defects, Hirschsprung, Duodenal Atresia, ALL (Leukemia), transient myeloproliferative disorder, hypothyroidism, atlantoaxial instability, hearing loss, mental retardation
DAILY DOUBLE!!!!!!!!
A ex 29 week old baby is now 38 weeks old and is not taking her feeds very well. She is also very small for her age, regardless of how many calories you give her. The nurse also says her platelets are chronically low.
The attendings asks for a better maternal TORCH history. What is on the differential? What other tests should you get? What medication would you treat with?
CMV!!!
Get a Urine CMV, Brain MRI to look for calcifications circumventing the ventricles, check the eyes for chorioretinitis, check for hearing loss, get a CBC to check for thrombocytopenia, and check her abdomen for hepatosplenomegaly.
Ask for a ID and Optho consult!
Treat with ganciclovir!
Neurotube defects are more like in moms who take part in what activity and take these types of medications
Activities like Hot Tub use
Take AEDs like Valproic Acid and Carbamezepime
The OB team calls you to the OR for a c-section of a mom with concern for placental abruption. The amniotic fluid is bloody. Baby appears pale with no movement. As you resuscitate, you have trouble getting a pulse....What do you do?
Think neonatal blood loss - severe anemia. Baby needs fluid resuscitation ASAP! Put in an emergent UVC and push blood or a fluid bolus.
You are the Cardio fellow. The intern on Rainbow team pages you freaking out about a baby with a known congenital heart lesion. He is so worried that the patient is satting 75% so he put the patient on HFNC and increased the FIO2 to 60%. You tell the intern that is not the right management because.......
You can flood the lungs! Most cogenital heart lesions with mixing can have sats between 75-85%. By increasing your FI02, you can increase the pulmonary vasocirculation, shunting more blood to the lungs!
There is a baby in the NICU with a really high direct hyperbili. He has never been on TPN. The attending asks you to describe the findings in Alagile Syndrome as a possible differential diagnosis?
Butterfly Vertebrae, Direct Hyperbili, Pulmonic Stenosis, Triangular facies
You are called to a random room in Hutzel for a mom with NO prenatal care. A baby boy with a "wrinkly" abdomen is put on the warmer.
What's a possible diagnosis? What do you order for the baby?
PRUNE BELLY SYNDROME - EAGLE BARRETtS
Triad: Bilateral Cryptorchidism, Deficient/Absent abdominal wall musculature, Urinary Tract Abnormalities
Order - RUS, VCUG, Abdominal US
A baby is born via c-section, "stunned" according to the NP on your team. She says that the baby was difficult to arouse during resuscitation and she's even worried about HIE. What is on your differential diagnosis for potential causes?
Anesthesia, maternal drugs like SSRIs, HIE, severe anemia