4 B's of labs for ?infection prior to transfer - Answer-1. Blood count (CBC)
2. Blood culture
- at least 1 mL/culture bottle (if not enough blood, take aerobic before anaerobic)
3. Blood glucose
4. Blood gas
/.Absolute Neutrophil Count (ANC) - Answer-ANC = {segmented neutrophil + band
neutrophils + metamyelocytes} (count, %) * WCC (# cells)
- normally, the WBC and neutrophil counts rise for the first day after birth; in term
infants, neuts peak at 8 hours
** Therefore, a DECLINING neutrophil count (rather than the expected physiologic rise)
should raise concern that the infant may be infected **
- low ANC means depleted neutrophil reserves, which means high risk of dying from
sepsis
- infants born to hypertensive mothers might have low ANC compared to others; also
with trisomies
- ANC increases with increasing gestational age
- use ANC charts which considers hours from birth for different gestational ages
/.Airway Obstruction - Answer-1. Choanal Atresia
- term or preterm, F>M
- in >50% of cases there is other congenital abnormality, including incidence of CHD
- can have one or both posterior nasal passages blocked by bony septum or soft tissue
membrane
- cyanotic at rest, but pinks up with crying
- if bilateral, can be severely cyanotic at rest, even severe asphyxia --> need an oral
airway
- dx: inability to pass 6-French feeding tube through nares
2. Pierre Robin Syndrome
- term or preterm
- small jaw with normal sized tongue that obstructs airway; half can have cleft palate
- to relieve obstruction, turn infant prone
- if still obstructed, insert NP tube; if that doesn't work, then LMA (ET intubation may be
difficult)
/.Ampicillin - Answer-Dose: 50 mg/kg/dose
< 29 weeks:
,30-36 weeks:
37-44 weeks:
- every 12 hours
- IV slow push over 3-5 minutes, not faster than 100 mg/min
S/E:
- prolongs bleeding time because impacts platelet function; use with caution
/.Anion Gap - Answer-Na - (Cl + HCO3)
Normal for neonates is 5-15
1. High:
- lactic acidosis
- ketoacidosis
- renal failure
- late metabolic acidosis
- toxins
2. Normal
- loss of bicarb, usually GI or renal losses
- excessive Cl in fluids
- aldosterone deficiency
- hyperchloremia is a compensatory mechanism
3. Low
- caused by hypoalbuminemia
/.Arterial Blood Gas in young infants - Answer-pH 7.35 - 7.45
PCO2 35-45 mmHg
PO2 60-80 mmHg
HCO3 19-26 mEq/L
Base Excess -4 to + 4
capillary not useful for assessing oxygenation
/.Aspiration - Answer-- of amniotic fluid, blood, or gastric contents
- affects term, preterm
- onset of resp distress at birth or at time of aspiration
- CXR: variable, may show patchy infiltrates, areas of atelectasis, hyperinflation
/.Bilious emesis - Answer-= bowel obstruction
- work up: bloods, PFA, UGI series
/.Calculating Umbilical Catheter Depth - Answer-1. High UAC (cm) = {3 x BW (kg)} + 9 +
length of umbilical stump (cm)
, --> between T6 and T9 (above diaphragm, below aortic valve)
2. Low UAC (cm) = BW (kg) + 7 + length of umbilical stump (cm)
--> between L3 and L4 (above bifurcation)
3. UVC (cm) = {0.5 X high line UAC length (cm)} + 1 + length of stump (cm)
--> at jcn of IVC and RA (above diaphragm)
/.Caput Succedaneum - Answer-- molding of head during labour, causing superficial
edema
- in subcutaneous tissues of scalp; can cross suture lines
- shifts with position
- soft and spongy, pits on pressure
- resolves in 48-72 hours
/.Cardiac Enzymes - Answer-BNP - raised in:
- CHF
- Pulmonary Htn
- CHD
- Septic shock
Troponin
- newborns have slightly higher levels than adults
- increased levels when asphyxiated
/.Cardiogenic Shock - Answer-1. Causes
- intrapartum or postpartum asphyxia
- hypoxia and/or metabolic acidosis
- bacterial or viral infection
- severe resp distress requiring ventilation
- severe hypoglycemia
- severe metabolic/electrolyte disturbance
-arrhythmias
- CHD
/.Causes of Bowel Obstruction - Answer-Congenital: Stenosis/Atresia, Malrotation +
volvulus, imperforate anus
Functional: Hirschprung's, meconium plug (?CF), meconium ileus, hypothyroidism
Acquired: NEC, peritoneal adhesions (congenital = bands)
** Note: consider obstruction if polyhydramnios is present **
/.Causes of Bradypnea - Answer-- exhaustion
- decrease central resp drive due to HIE, hemorrhage, cerebral edema
2. Blood culture
- at least 1 mL/culture bottle (if not enough blood, take aerobic before anaerobic)
3. Blood glucose
4. Blood gas
/.Absolute Neutrophil Count (ANC) - Answer-ANC = {segmented neutrophil + band
neutrophils + metamyelocytes} (count, %) * WCC (# cells)
- normally, the WBC and neutrophil counts rise for the first day after birth; in term
infants, neuts peak at 8 hours
** Therefore, a DECLINING neutrophil count (rather than the expected physiologic rise)
should raise concern that the infant may be infected **
- low ANC means depleted neutrophil reserves, which means high risk of dying from
sepsis
- infants born to hypertensive mothers might have low ANC compared to others; also
with trisomies
- ANC increases with increasing gestational age
- use ANC charts which considers hours from birth for different gestational ages
/.Airway Obstruction - Answer-1. Choanal Atresia
- term or preterm, F>M
- in >50% of cases there is other congenital abnormality, including incidence of CHD
- can have one or both posterior nasal passages blocked by bony septum or soft tissue
membrane
- cyanotic at rest, but pinks up with crying
- if bilateral, can be severely cyanotic at rest, even severe asphyxia --> need an oral
airway
- dx: inability to pass 6-French feeding tube through nares
2. Pierre Robin Syndrome
- term or preterm
- small jaw with normal sized tongue that obstructs airway; half can have cleft palate
- to relieve obstruction, turn infant prone
- if still obstructed, insert NP tube; if that doesn't work, then LMA (ET intubation may be
difficult)
/.Ampicillin - Answer-Dose: 50 mg/kg/dose
< 29 weeks:
,30-36 weeks:
37-44 weeks:
- every 12 hours
- IV slow push over 3-5 minutes, not faster than 100 mg/min
S/E:
- prolongs bleeding time because impacts platelet function; use with caution
/.Anion Gap - Answer-Na - (Cl + HCO3)
Normal for neonates is 5-15
1. High:
- lactic acidosis
- ketoacidosis
- renal failure
- late metabolic acidosis
- toxins
2. Normal
- loss of bicarb, usually GI or renal losses
- excessive Cl in fluids
- aldosterone deficiency
- hyperchloremia is a compensatory mechanism
3. Low
- caused by hypoalbuminemia
/.Arterial Blood Gas in young infants - Answer-pH 7.35 - 7.45
PCO2 35-45 mmHg
PO2 60-80 mmHg
HCO3 19-26 mEq/L
Base Excess -4 to + 4
capillary not useful for assessing oxygenation
/.Aspiration - Answer-- of amniotic fluid, blood, or gastric contents
- affects term, preterm
- onset of resp distress at birth or at time of aspiration
- CXR: variable, may show patchy infiltrates, areas of atelectasis, hyperinflation
/.Bilious emesis - Answer-= bowel obstruction
- work up: bloods, PFA, UGI series
/.Calculating Umbilical Catheter Depth - Answer-1. High UAC (cm) = {3 x BW (kg)} + 9 +
length of umbilical stump (cm)
, --> between T6 and T9 (above diaphragm, below aortic valve)
2. Low UAC (cm) = BW (kg) + 7 + length of umbilical stump (cm)
--> between L3 and L4 (above bifurcation)
3. UVC (cm) = {0.5 X high line UAC length (cm)} + 1 + length of stump (cm)
--> at jcn of IVC and RA (above diaphragm)
/.Caput Succedaneum - Answer-- molding of head during labour, causing superficial
edema
- in subcutaneous tissues of scalp; can cross suture lines
- shifts with position
- soft and spongy, pits on pressure
- resolves in 48-72 hours
/.Cardiac Enzymes - Answer-BNP - raised in:
- CHF
- Pulmonary Htn
- CHD
- Septic shock
Troponin
- newborns have slightly higher levels than adults
- increased levels when asphyxiated
/.Cardiogenic Shock - Answer-1. Causes
- intrapartum or postpartum asphyxia
- hypoxia and/or metabolic acidosis
- bacterial or viral infection
- severe resp distress requiring ventilation
- severe hypoglycemia
- severe metabolic/electrolyte disturbance
-arrhythmias
- CHD
/.Causes of Bowel Obstruction - Answer-Congenital: Stenosis/Atresia, Malrotation +
volvulus, imperforate anus
Functional: Hirschprung's, meconium plug (?CF), meconium ileus, hypothyroidism
Acquired: NEC, peritoneal adhesions (congenital = bands)
** Note: consider obstruction if polyhydramnios is present **
/.Causes of Bradypnea - Answer-- exhaustion
- decrease central resp drive due to HIE, hemorrhage, cerebral edema
