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 Well Newborn, we'll have to talk to Elvish about that one
So here's the plan. I'll pose a question drawn from an experience I've had, a clinical scenario I've formulated, or concepts I come across in the literature and board exam review. I will try to keep it in the vein of the NICU nurse, which will be interesting, since I've been saturated in NNP classes for a few years now.
Let's also keep in mind (and we all know this) that practice varies WIDELY from unit to unit. Feel free to answer based on your personal practice, but let's all keep in mind that the "book" answer may be different.
A little about me:
I have been practicing in NICU for almost 5 years, two in a level IIIb, and nearly 3 in a level IIIc quaternary NICU. I have had the privilege of caring for ECMO, pre/postop open hearts, single-lung ventilation, etc, as well as the gamut of preemie and surgical diagnoses. I finished up my NNP grad degree last December, and I'm now in the process of studying for my national certification/boards, as well as looking for a NNP position.
Head-sparing, or asymmetrical IUGR is reassuring. Babies with this have a head circ
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)?
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?
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.
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.
Specializes in NICU, PICU, PCVICU and peds oncology.
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!)
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?
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?
Well, I was thinking pyloric stenosis. Because often these kids aren't vomiting until a couple to several weeks of life, when they start with the projectile vomiting. (not usually bilious?) So...it doesn't present with vomiting early in the newborn period, but I suppose technically it is still considered neonatal in the first 30 days. I'm just a little hung up on the exact meaning of the wording of your question. :)
SteveNNP, MSN, NP
1 Article; 2,512 Posts
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.