Test Your Neonatal Critical Care Knowledge - page 2

by SteveNNP

15,857 Views | 52 Comments

So, by popular demand..... here is a thread dedicated to questions posed to help increase one's knowledge base in regards to the acute care NICU population. If anyone desperately wants a separate thread dedicated solely to the... Read More


  1. 0
    Great thread Steve! As an NNP student half way through, I'm sure I'll find this fun and beneficial.
  2. 0
    Good job so far, everyone!

    So, the most important thing to remember is that SGA does not necessarily mean IUGR, but IUGR babies are always SGA. IUGR is something that's prenatally diagnosed, an ultrasound-detected failure of the fetus to grow at normal rates. This is usually caused by placental insufficiency, PIH, smoking, or infection.

    Head-sparing, or asymmetrical IUGR is reassuring. Babies with this have a head circ >10% pct, but the length and weight plot <10% pct. This form of IUGR occurred later in pregnancy and the brain and head were spared from lack of oxygen/nutrients. These kids almost always catch up. Symmetric IUGR kids plot <10% on all counts, and this form occurs early in pregnancy, (usually infection) and often have neurodevelopmental delays.
    Last edit by SteveNNP on Mar 4, '10 : Reason: Thanks, littleneorn!
  3. 0
    Question #3:

    Name the cyanotic congenital heart defect most commonly diagnosed within the first week, and briefly describe the path of circulation in the heart.
  4. 0
    Quote from SteveNNP
    Head-sparing, or asymmetrical IUGR is reassuring. Babies with this have a head circ <10% pct, but the length and weight plot normally. This form of IUGR occurred later in pregnancy and the brain and head were spared from lack of oxygen/nutrients.
    Steve, do you mean the opposite? That kids with head sparing have weight and length that plots small but the head plots normal (or least higher on the scale than weight/length)?
  5. 1
    Quote from littleneoRN
    Steve, do you mean the opposite? That kids with head sparing have weight and length that plots small but the head plots normal (or least higher on the scale than weight/length)?
    You're right! See what happens when I post before coffee?
    Kalila likes this.
  6. 0
    OK, I was just going to comment how much I was enjoying this. I am woefully lacking in knowledge of maternal factors influencing infants. I recognize this as a flaw that needs improving. The section on end-diastolic flow was so so helpful, I see that all the time on our infant hx section. It makes so much sense now!

    One thing I remember hearing from one of our neonatologists was that though generally asymmetric IUGR is not as ominous as symmetric for neuro outcomes, they (the asymmetric infants) are still at increased risk compared to other preemies for PVL. I don't know why, but if it's true, I bet someone here knows.
  7. 0
    Quote from stevennp
    question #3:

    name the cyanotic congenital heart defect most commonly diagnosed within the first week, and briefly describe the path of circulation in the heart.
    transposition of the great arteries (tga). in tga the aorta exits the right ventricle, and the pulmonary artery arises exits left ventricle.

    in the immediate post natal period the pressures in pulmonary circulation remain roughly the same as the pressures in the peripheral circulation and this allows the structures associated with the fetal circulation (ductus arteriosus and foramen ovale) remain open. this initially allows oxygenated blood to shunt to the right side of the heart. as these structures begin to close, this shunting will either stop, or change direction and become a right to left shunt, further complicating the problem by overloading the pulmonary circulation leading to congestive heart failure.

    eventually the infant will require an arterial switch procedure, however prior to that he or she will likely be started on prostaglandins to maintain the ductus arteriosus and undergo a rashkind procedure (balloon atrial septostomy) to maintain and/or enlarge the foramen ovale.
  8. 0
    My son has a corrected TGA. He was born in the Senning-Mustard era so has a functionally backwards heart, with intra-artial baffles redirecting blood flow. Fortunately he has managed to avoid the usual complications and morbidities associated with these procedures, the atrial dysrhythmias, the vegetations and emboli, the baffle and vascular stenosis, the RV failure that are so common in adolescent and adult patients. His heart looks very different on echo; it's almost vertical, rotated a bit posteriorly and to the left with long, narrow ventricles, giving the tech some difficulty in getting good images. The cardiologist told me the last echo looked "normal" and was confused when I said, "REALLY??" then laughed and said, "Normal for HIM!" I work with the staff from the cardiology department and I love to tease Warren, one of our echo techs about the time he recognised me but couldn't make the connection to the conversation we'd had the day before over a bed in PICU. His wife is a nurse on another unit and a friend, so she got the whole story.

    Here's a related question: What surgical challenge is most significant to the arterial switch patient in the first 24-48 hours post-op? (Sorry Steve, hope your toes are okay!)
  9. 0
    Very good answers so far!

    Next question: What is the only neonatal GI obstructive disease that does NOT present with bilious vomiting in the neonatal period?
  10. 0
    Usually the proximal obstructions present with bilious vomiting, but the distal obstructions such as hirschsprungs, meconium ileus, and meconium plug syndrome do not present with bilious vomiting. Am I on the right track?


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