CNeoN(C) cheat sheet

Gestational hypertension is BP ≥140/90 mmHg on two occasions ≥4 h apart after 20 weeks in a woman previously normotensive, without proteinuria or end-organ dysfunction.

Preeclampsia with severe features: BP ≥160/110 mmHg, platelets <100,000/µL, AST/ALT >2× upper limit, creatinine >1.1 mg/dL or doubling, pulmonary edema, new cerebral or visual symptoms.

Magnesium sulfate for seizure prophylaxis: 4–6 g IV loading dose over 15–20 min, then 1–2 g/h; monitor deep tendon reflexes, respiratory rate ≥12/min, and urine output ≥30 mL/h.

Magnesium toxicity antidote is calcium gluconate 1 g IV (10 mL of 10% solution) given slowly; stop infusion first.

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

Intrauterine resuscitation: maternal left lateral positioning, IV fluid bolus, supplemental oxygen if hypoxemic, correction of hypotension, and discontinuation of uterine tachysystole with terbutaline 250 mcg subcutaneously.

Betamethasone 12 mg IM ×2 doses 24 h apart (or dexamethasone 6 mg IM q12h ×4) between 24 0/7 and 33 6/7 weeks reduces neonatal RDS, IVH, and mortality; maximal benefit 24 h to 7 days after dosing.

Tocolytic therapy buys 48 h for steroid effect; nifedipine, indomethacin (<32 weeks, ≤48 h), and terbutaline are options; magnesium is no longer preferred solely for tocolysis due to fetal/neonatal effects.

Shoulder dystocia maneuvers in sequence: McRoberts, suprapubic pressure, internal rotation (Rubin II/Woods), delivery of posterior arm, then Gaskin all-fours; avoid fundal pressure.

Initial steps within the first minute: provide warmth, dry, stimulate, position head neutral, clear airway if needed, and assess breathing and heart rate.

Positive pressure ventilation is indicated for apnea, gasping, or heart rate <100/min; use 21–30% oxygen for ≥35 weeks and 21–30% for preterm initially, titrating to target SpO2.

Chest compressions begin when heart rate remains <60/min after 30 s of effective ventilation; compression-to-ventilation ratio is 3:1 with 90 compressions and 30 breaths per minute.

Epinephrine dose is 0.01–0.03 mg/kg IV/IO (1:10,000) or 0.05–0.1 mg/kg via endotracheal tube if IV access is unavailable.

Volume expansion with 0.9% saline or O-negative blood at 10 mL/kg IV over 5–10 min is considered when heart rate <60/min with signs of hypovolemia or blood loss.

Target preductal SpO2 after birth: ~60–65% at 1 min, 65–70% at 2 min, 70–75% at 3 min, 75–80% at 4 min, 80–85% at 5 min, 85–95% by 10 min.

Apgar scores are assigned at 1 and 5 minutes for heart rate, respiratory effort, muscle tone, reflex irritability, and color; each 0–2, and scores are not used to guide resuscitation.

Therapeutic hypothermia for hypoxic-ischemic encephalopathy is initiated within 6 hours of birth at 33.5–34.5°C for 72 hours in infants ≥36 weeks with qualifying criteria.

Respiratory distress syndrome results from surfactant deficiency; chest radiograph shows low lung volumes, reticulogranular pattern, and air bronchograms.

Surfactant replacement reduces pneumothorax and mortality in RDS; early rescue dosing is preferred, and poractant alfa is 2.5 mL/kg initial dose.

Transient tachypnea of the newborn presents within hours with tachypnea, mild hypoxemia, and a chest radiograph showing perihilar streaking, fluid in fissures, and normal-to-increased lung volumes; resolves in 24–72 h.

Meconium aspiration syndrome: below the vocal cords meconium with respiratory distress; management is supportive with oxygen, ventilation as needed, and antibiotics if infection suspected.

Bronchopulmonary dysplasia is defined as oxygen dependence at 36 weeks postmenstrual age in infants born <32 weeks; risk rises with prolonged ventilation and oxygen exposure.

Blood gas normal values in a neonate: pH 7.35–7.45, PaCO2 35–45 mmHg, PaO2 50–80 mmHg, HCO3 20–26 mEq/L.

Permissive hypercapnia (PaCO2 45–55 mmHg) may be used in ventilated preterm infants to reduce lung injury, provided pH remains ≥7.25.

Nasal CPAP at 5–8 cm H2O is first-line noninvasive support for preterm infants with RDS; intubation is indicated for apnea, FiO2 >0.40–0.60, or worsening acidosis.

Ductal-dependent lesions (pulmonary atresia, critical coarctation, interrupted aortic arch, hypoplastic left heart) worsen as the ductus closes; prostaglandin E1 at 0.01–0.05 mcg/kg/min maintains patency.

Prostaglandin E1 adverse effects include apnea, hypotension, fever, and jitteriness; be prepared to intubate.

Cyanotic congenital heart disease with decreased pulmonary blood flow produces hypoxemia unresponsive to oxygen; hyperoxia test shows no rise in PaO2 above ~100 mmHg.

Acyanotic left-to-right shunts (VSD, PDA) present with tachypnea, poor feeding, and failure to thrive; treatment includes diuretics and closure or indomethacin for PDA.

Tetralogy of Fallot spells are treated with knee-chest positioning, oxygen, morphine, IV fluids, and phenylephrine or beta-blocker for refractory cases.

Normal neonatal heart rate is 100–160/min awake and 80–120/min asleep; sinus bradycardia <80/min unresponsive to stimulation warrants evaluation.

Blood pressure in a term newborn is about 65/45 mmHg at birth, rising to ~90/60 mmHg by 1 month; hypotension is MAP below gestational age in weeks during the first day.

Wolff-Parkinson-White and SVT in neonates often respond to vagal maneuvers or adenosine 0.1 mg/kg IV rapid push, escalating to 0.2 mg/kg.

Neonatal seizures are most often subtle (lip smacking, cycling, apnea, eye deviation); EEG is required for diagnosis because many events are electrographic only.

Hypoxic-ischemic encephalopathy Sarnat staging: stage I hyperalert and irritable, stage II lethargic with hypotonia and seizures, stage III stuporous with flaccid tone.

Intraventricular hemorrhage is graded I (germinal matrix), II (into ventricle without dilation), III (with ventricular dilation), IV (intraparenchymal extension); grades I–II usually have good outcome.

Periventricular leukomalacia is a white-matter injury of prematurity associated with spastic diplegia; cranial ultrasound is the screening tool.

Universal newborn hearing screening uses otoacoustic emissions or automated auditory brainstem response; rescreen failed tests before 1 month and diagnose by 3 months.

Red reflex examination screens for retinoblastoma and congenital cataracts; absent or white reflex requires urgent ophthalmologic referral.

Neural tube defects are reduced by 400 mcg daily folic acid before conception and in the first trimester; higher-dose 4 mg is used for prior affected pregnancy.

Kernicterus results from unconjugated bilirubin deposition in basal ganglia; acute signs include lethargy, poor feeding, hypertonia, and retrocollis.

Necrotizing enterocolitis presents with feeding intolerance, abdominal distension, bloody stools, and pneumatosis intestinalis; treatment is bowel rest, decompression, and antibiotics.

Breast milk is preferred nutrition; preterm human milk plus fortifier provides adequate protein, calcium, and phosphorus for infants <1500 g.

Term infants need about 100–120 kcal/kg/day; preterm infants need 110–135 kcal/kg/day with protein 3.5–4.5 g/kg/day.

Physiologic jaundice appears after 24 hours, peaks at 3–5 days in term infants, and is due to immature glucuronidation; pathologic jaundice appears <24 hours.

Phototherapy thresholds depend on gestational age, hours of life, and risk factors; exchange transfusion is considered for levels approaching 20–25 mg/dL in term infants or with neurotoxicity signs.

Bilirubin encephalopathy risk is estimated with the Bhutani nomogram using hour-specific bilirubin percentiles; >95th percentile is high risk.

Pyloric stenosis presents at 3–6 weeks with projectile nonbilious vomiting and an olive-shaped mass; ultrasound shows pyloric muscle thickness >3 mm.

Bilious vomiting in a neonate is a surgical emergency until malrotation with volvulus is excluded by upper GI contrast study.

Neonatal hypoglycemia is blood glucose <45 mg/dL in the first 48 hours; treat symptomatic or <25 mg/dL with IV dextrose 10% at 2 mL/kg bolus followed by continuous infusion.

Asymptomatic hypoglycemia 25–45 mg/dL is treated with feeding and recheck in 30–60 minutes; persistent hypoglycemia warrants evaluation for hyperinsulinism.

Normal neonatal calcium is 8.5–10.5 mg/dL; hypocalcemia <7 mg/dL in term infants causes jitteriness, tetany, and seizures, treated with IV calcium gluconate.

Physiologic nadir of serum sodium occurs at 2–4 days; hyponatremia <130 mEq/L in the newborn is often due to SIADH or excess hypotonic fluid.

Hyperkalemia >7 mEq/L in a neonate requires ECG evaluation and treatment with calcium gluconate, insulin/glucose, and sodium bicarbonate as indicated.

Inborn errors of metabolism presenting as acute neonatal encephalopathy include urea cycle disorders (hyperammonemia), organic acidemias (metabolic acidosis, ketosis), and fatty acid oxidation defects (hypoketotic hypoglycemia).

Newborn screening in the United States uses dried blood spots at 24–48 hours of age; results are not valid if collected before 24 hours without repeat testing.

Congenital hypothyroidism is detected by elevated TSH on newborn screening; treatment with levothyroxine 10–15 mcg/kg/day should begin within 2 weeks to prevent intellectual disability.

Physiologic anemia of infancy nadir occurs at 8–12 weeks in term infants (hemoglobin ~9–11 g/dL) and 4–8 weeks in preterm infants (hemoglobin ~7–9 g/dL).

Hemolytic disease of the newborn from Rh incompatibility is prevented by Rho(D) immune globulin at 28 weeks and within 72 hours postpartum for unsensitized Rh-negative mothers.

Direct Coombs (DAT) positivity indicates antibody-coated fetal red cells; monitor bilirubin closely in ABO or Rh incompatibility.

Vitamin K deficiency bleeding is prevented with 0.5–1 mg IM vitamin K at birth; late-onset bleeding occurs at 2–12 weeks in breastfed infants without prophylaxis.

Neonatal alloimmune thrombocytopenia causes severe thrombocytopenia (often <50,000/µL) with intracranial hemorrhage risk; treat with IVIG and matched platelets.

Transient tachypnea and delayed cord clamping at 30–60 seconds improve iron stores and reduce anemia at 4–6 months.

Severe combined immunodeficiency presents with failure to thrive, chronic diarrhea, and opportunistic infections; live vaccines are contraindicated.

Newborn screening for severe combined immunodeficiency uses T-cell receptor excision circle (TREC) assay on the dried blood spot.

Early-onset sepsis presents within 72 hours; group B Streptococcus and Escherichia coli are leading causes; risk factors include maternal fever, prolonged rupture of membranes ≥18 h, and GBS colonization.

Adequate GBS intrapartum prophylaxis is penicillin G 5 million units IV then 2.5–3 million units q4h, or ampicillin 2 g IV then 1 g q4h, begun ≥4 h before delivery.

Neonatal sepsis evaluation includes blood culture, complete blood count with differential, and lumbar puncture when meningitis is suspected or the infant is ill-appearing.

Empiric therapy for early-onset sepsis is ampicillin plus gentamicin; add cefotaxime or vancomycin based on local resistance and clinical picture.

Normal neonatal total white blood cell count is 9,000–30,000/µL; the absolute neutrophil count and immature-to-total ratio (>0.2) are more informative than the total.

Congenital cytomegalovirus is the leading nongenetic cause of sensorineural hearing loss; findings include petechiae, jaundice, hepatosplenomegaly, and microcephaly.

Herpes simplex virus neonatal infection presents at 1–4 weeks with vesicles, lethargy, and seizures; treat with high-dose acyclovir 60 mg/kg/day IV divided q8h.

Universal hepatitis B vaccination at birth within 24 hours plus hepatitis B immune globulin for infants of HBsAg-positive mothers prevents perinatal transmission.

Family-centered care principles include dignity and respect, information sharing, participation, and collaboration with the family in care planning.

Informed consent requires disclosure of risks, benefits, alternatives, and the patient's or surrogate's voluntary agreement; assent is sought from minors when developmentally appropriate.

The Joint Commission identifies patient safety goals including correct patient identification with two identifiers, hand hygiene, and medication reconciliation.

Root cause analysis is a structured retrospective review of a sentinel event, focused on system factors rather than individual blame.

Just culture distinguishes human error (console), at-risk behavior (coach), and reckless behavior (punish); it supports voluntary error reporting.

Medication safety in neonates requires weight-based dosing in kilograms, double-checking high-alert medications (insulin, heparin, opioids), and using an independent second nurse verification.

Handoff communication using SBAR (Situation, Background, Assessment, Recommendation) reduces information loss at transitions of care.

Mandatory reporting of suspected child abuse or neglect applies to health care providers regardless of confidentiality; report to designated state authorities.

Neonatal medication errors are reduced by standard concentrations, smart-pump drug libraries, and barcode medication administration.

Unintended extubation and central line-associated bloodstream infection are tracked as quality indicators; central line maintenance bundles reduce CLABSI rates.

Retinopathy of prematurity screening is recommended for infants ≤30 weeks or ≤1500 g at birth, and for larger infants with an unstable course, starting at 4–6 weeks of age.

Safe sleep for newborns: supine positioning, firm flat surface, no loose bedding or soft objects, and room-sharing without bed-sharing.

Thermoregulation: target axillary temperature 36.5–37.5°C, use a prewarmed radiant warmer or incubator, and apply a plastic wrap for infants <28 weeks to reduce evaporative heat loss.

Newborn identification uses two identifiers plus matching mother-infant bands; security tags and supervised transport reduce abduction risk.

Sharps safety and needlestick prevention include not recapping needles, using safety-engineered devices, and immediate post-exposure reporting and prophylaxis evaluation.