ABP Neonatal-Perinatal Medicine cheat sheet

Gestational age is most accurately dated by first-trimester crown-rump length (up to 13 6/7 weeks), accurate within ±5–7 days; later ultrasound dating has greater error.

Antenatal corticosteroids (betamethasone 12 mg IM every 24 hours for 2 doses or dexamethasone 6 mg IM every 12 hours for 4 doses) at 24 0/7–33 6/7 weeks reduce respiratory distress syndrome, intraventricular hemorrhage, necrotizing enterocolitis, and neonatal mortality.

Magnesium sulfate for fetal neuroprotection is given when delivery is anticipated before 32 weeks: 4 g IV loading dose followed by 1 g/hour infusion, reducing cerebral palsy.

Intrapartum group B Streptococcus prophylaxis: penicillin G 5 million units IV load then 2.5–3 million units every 4 hours; ampicillin, cefazolin, clindamycin, or vancomycin are alternatives based on allergy and susceptibility.

Fetal heart rate category III includes absent baseline variability with recurrent late decelerations, recurrent variable decelerations, bradycardia, or a sinusoidal pattern; it requires immediate evaluation and possible delivery.

Fetal heart rate category II is indeterminate: baseline 110–160 beats/min, moderate variability, and no recurrent late or variable decelerations; it requires continued surveillance and reassessment.

Middle cerebral artery peak systolic velocity greater than 1.5 multiples of the median suggests fetal anemia and guides cordocentesis or intrauterine transfusion.

Preeclampsia with severe features includes blood pressure ≥160/110 mm Hg, platelets <100,000/µL, AST or ALT >2 times normal, creatinine >1.1 mg/dL, pulmonary edema, or visual/cerebral symptoms.

Chorioamnionitis is diagnosed by maternal fever ≥39.0°C once or 38.0–38.9°C plus fetal tachycardia, maternal tachycardia, uterine tenderness, purulent discharge, or leukocytosis.

Initial resuscitation steps are warming, drying, stimulating, positioning the airway, and assessing tone, breathing, and heart rate.

Positive pressure ventilation is indicated for apnea, gasping, or heart rate <100 beats/min; use 21% oxygen for infants ≥35 weeks and 21–30% for <35 weeks, titrating to 92–95% preductal SpO2.

Chest compressions begin when heart rate is <60 beats/min after 60 seconds of effective ventilation; use a 3:1 compression-to-ventilation ratio (90 compressions and 30 breaths/min).

Epinephrine dose is 0.01–0.03 mg/kg IV or 0.05–0.1 mg/kg endotracheally, repeated every 3–5 minutes for persistent bradycardia.

Volume expansion is 10 mL/kg of isotonic crystalloid or blood over 5–10 minutes when hypovolemia is suspected.

Apgar scores are assigned at 1 and 5 minutes for heart rate, respiratory effort, muscle tone, reflex irritability, and color; they do not guide resuscitation decisions.

Meconium-stained fluid does not routinely require intubation and tracheal suction; suction only if the airway is obstructed or the infant is not breathing.

Therapeutic hypothermia for moderate-to-severe hypoxic-ischemic encephalopathy is started within 6 hours of birth in infants ≥36 weeks, targeting 33.5°C for 72 hours.

Oxygen saturation targets after birth: 1 minute 60–65%, 2 minutes 65–70%, 3 minutes 70–75%, 4 minutes 75–80%, 5 minutes 80–85%, 10 minutes 85–95%.

Respiratory distress syndrome results from surfactant deficiency; signs include grunting, retractions, tachypnea, and ground-glass lungs with air bronchograms.

Surfactant replacement is given at 100–200 mg/kg phospholipid via endotracheal tube, often as early rescue therapy, and may be repeated every 6–12 hours.

Transient tachypnea of the newborn occurs in term or near-term infants, shows perihilar streaking and fluid in fissures, and resolves in 24–72 hours.

Persistent pulmonary hypertension of the newborn is suggested by labile hypoxemia and an oxygenation index >20–25; inhaled nitric oxide is started at 20 ppm.

Bronchopulmonary dysplasia is defined by the need for oxygen or respiratory support at 36 weeks' postmenstrual age; caffeine and lung-protective ventilation reduce risk.

Pneumothorax causes sudden deterioration, asymmetric chest expansion, and transillumination; needle decompression is urgent.

Apnea of prematurity is treated with caffeine citrate 20 mg/kg loading dose and 5–10 mg/kg/day maintenance.

Target SpO2 for preterm infants receiving supplemental oxygen is 90–95% to reduce retinopathy of prematurity and bronchopulmonary dysplasia.

Continuous positive airway pressure is first-line support for preterm infants with respiratory distress and helps prevent intubation.

Functional closure of the ductus arteriosus occurs within 24–72 hours; anatomic closure takes 2–3 weeks, and patency is common in preterm infants.

Medical closure of a hemodynamically significant patent ductus arteriosus uses indomethacin, ibuprofen, or acetaminophen; avoid in renal failure, necrotizing enterocolitis, or severe thrombocytopenia.

Critical congenital heart disease screening uses pulse oximetry at 24–48 hours on the right hand and a foot; fail if SpO2 <90%, or 90–94% on repeated measures, or difference >3%.

Prostaglandin E1 at 0.01–0.05 mcg/kg/min maintains ductal patency in ductal-dependent lesions; apnea is a common adverse effect.

Coarctation of the aorta causes blood pressure and pulse difference between upper and lower extremities; prostaglandin E1 is started if ductal-dependent.

Supraventricular tachycardia has a narrow QRS and rate >220 beats/min; initial treatment includes vagal maneuvers and adenosine 0.1 mg/kg IV.

Neonatal shock is treated with 10 mL/kg isotonic fluid boluses and vasoactive agents such as dopamine or epinephrine when needed.

Hypoplastic left heart syndrome presents with cyanosis and poor perfusion as the ductus closes; prostaglandin E1 is lifesaving.

Hypoxic-ischemic encephalopathy is staged by Sarnat criteria; moderate-to-severe cases at ≥36 weeks receive therapeutic hypothermia within 6 hours.

Papile intraventricular hemorrhage grades: I = germinal matrix, II = intraventricular without dilation, III = intraventricular with ventricular dilation, IV = parenchymal hemorrhage.

Cranial ultrasound screening for infants <32 weeks is performed at 7 days and again at 4–6 weeks or near discharge.

Neonatal seizures are treated first with phenobarbital 20 mg/kg IV, then additional 10 mg/kg doses; levetiracetam is an alternative.

Hypoglycemia in the newborn is glucose <40 mg/dL in the first 4 hours or <45 mg/dL after 4 hours; treat with 10% dextrose 2 mL/kg IV.

Kernicterus risk rises with total bilirubin >20–25 mg/dL, especially in preterm or hemolytic disease; exchange transfusion may be needed.

Neonatal abstinence syndrome is scored with the Finnegan tool; nonpharmacologic care is first-line, with morphine or methadone for severe cases.

The Bayley Scales of Infant and Toddler Development assess cognitive, language, and motor outcomes in high-risk infants during follow-up.

Total parenteral nutrition: start amino acids at 2–3 g/kg/day and advance to 3.5–4 g/kg/day; start lipids at 1 g/kg/day and advance to 3 g/kg/day.

Fluid requirements: term newborns 60–80 mL/kg/day initially; preterm infants 80–100 mL/kg/day, advancing 10–20 mL/kg/day with weight and electrolyte monitoring.

Enteral feeding goal for preterm infants is 150–180 mL/kg/day of breast milk or fortified human milk to provide about 120 kcal/kg/day.

Necrotizing enterocolitis presents with feeding intolerance, abdominal distension, and bloody stools; management is stopping feeds, nasogastric decompression, and antibiotics.

Bell staging for necrotizing enterocolitis: stage I suspected, stage II definite with pneumatosis, stage III advanced with perforation or systemic instability.

Sodium requirement is 3–5 mEq/kg/day and potassium 2–3 mEq/kg/day, adjusted to serum levels and urine output.

Phototherapy thresholds for hyperbilirubinemia depend on gestational age, postnatal age, and risk factors; exchange transfusion is considered at higher levels.

Refeeding syndrome risk is reduced by starting calories low and advancing gradually in malnourished infants.

Early-onset neonatal sepsis occurs within 72 hours; common organisms are group B Streptococcus and Escherichia coli; empiric therapy is ampicillin plus gentamicin.

Late-onset sepsis after 72 hours is often caused by coagulase-negative Staphylococcus, Staphylococcus aureus, or gram-negative rods; empiric therapy often includes vancomycin plus gentamicin.

Intrapartum group B Streptococcus prophylaxis uses penicillin G; alternatives are ampicillin, cefazolin, clindamycin, or vancomycin based on allergy and susceptibility.

Neonatal herpes simplex virus disease is treated with intravenous acyclovir 60 mg/kg/day divided every 8 hours for 21 days.

Congenital cytomegalovirus is treated with ganciclovir or valganciclovir in selected symptomatic infants.

HIV-exposed newborns receive zidovudine prophylaxis, and antiretroviral regimens are adjusted by risk.

Congenital syphilis is treated with intravenous aqueous penicillin G for 10 days.

Hepatitis B vaccine is given within 24 hours of birth to infants of hepatitis B surface antigen-positive mothers, along with hepatitis B immune globulin.

Physiologic anemia nadir: term infants 9–11 g/dL at 8–12 weeks; preterm infants 7–9 g/dL at 4–8 weeks.

Vitamin K 1 mg IM at birth prevents vitamin K deficiency bleeding, including intracranial hemorrhage.

Polycythemia is a hematocrit >65%; partial exchange transfusion is considered for symptomatic infants.

Phenylketonuria is detected by newborn screening with elevated phenylalanine; treatment is a low-phenylalanine diet started early.

Congenital hypothyroidism shows elevated TSH and low thyroxine; levothyroxine 10–15 mcg/kg/day is started promptly.

Congenital adrenal hyperplasia from 21-hydroxylase deficiency causes hyponatremia, hyperkalemia, and virilization; hydrocortisone and fludrocortisone are treatments.

Rh hemolytic disease causes anemia and hyperbilirubinemia; direct Coombs test, phototherapy, and exchange transfusion guide management.

Newborn screening for metabolic disorders is ideally collected at 24–48 hours of age after feeding begins.

Trisomy 21 features include hypotonia, flat facial profile, upslanting palpebral fissures, single palmar crease, atrioventricular septal defect, and duodenal atresia.

Trisomy 18 features include micrognathia, clenched fists with overlapping fingers, rocker-bottom feet, ventricular septal defect, and omphalocele.

Trisomy 13 features include cleft lip and palate, polydactyly, holoprosencephaly, and congenital heart defects.

Turner syndrome (45,X) features include webbed neck, coarctation of the aorta, and horseshoe kidney.

22q11 deletion syndrome features include conotruncal heart defects, hypocalcemia, thymic hypoplasia, and cleft palate.

Marfan syndrome is caused by FBN1 mutations and causes aortic root dilation and lens dislocation.

Neurofibromatosis type 1 shows café-au-lait macules, axillary freckling, and neurofibromas.

Newborn screening is collected at 24–48 hours of age; repeat testing may be needed for preterm or sick infants.

Informed consent for neonatal research or treatment requires parental permission and consideration of the infant's best interests.

Root cause analysis examines system factors after serious safety events rather than assigning individual blame.

The WHO 5 moments for hand hygiene are before touching a patient, before clean/aseptic procedures, after body fluid exposure, after touching a patient, and after touching patient surroundings.

Central line-associated bloodstream infection prevention bundles include hand hygiene, maximal sterile barriers, chlorhexidine skin antisepsis, and daily review of line necessity.

PDSA cycles (Plan-Do-Study-Act) test small changes, measure results, and refine interventions for quality improvement.

Voluntary, nonpunitive error reporting systems increase reporting and reveal latent safety threats.

Safe sleep counseling includes supine sleep, firm surface, no loose bedding, and room-sharing without bed-sharing.

Newborn discharge readiness includes hearing screening, pulse oximetry screening, feeding assessment, jaundice assessment, and car seat safety.