CCRN Neonatal cheat sheet

Normal neonatal heart rate is 110–160 bpm while awake; a narrow-complex rate above 220 bpm suggests supraventricular tachycardia.

Ductal-dependent lesions require prostaglandin E1 at 0.01–0.05 mcg/kg/min; apnea is the most common adverse effect.

A pre- to post-ductal SpO2 difference greater than 3% indicates right-to-left shunting from PPHN or a ductal-dependent cardiac defect.

Coarctation presents with higher blood pressure in the arms than the legs, weak femoral pulses, and a systolic murmur; ductal closure can precipitate shock.

Indomethacin or ibuprofen for PDA closure is contraindicated with renal failure, thrombocytopenia, necrotizing enterocolitis, or active bleeding.

Adenosine 0.1 mg/kg rapid IV push (maximum 6 mg) is first-line for neonatal supraventricular tachycardia after vagal maneuvers.

Umbilical venous catheter tip should lie at the IVC–right atrial junction near T8–T9; a high umbilical arterial catheter tip lies at T6–T9.

In hypoplastic left heart syndrome, avoid excessive FiO2 and hyperventilation, which lower pulmonary vascular resistance and steal systemic blood flow.

Neonatal shock signs include capillary refill over 3 seconds, mottling, and tachycardia; mean arterial pressure below the gestational age in weeks is a commonly used threshold.

Respiratory distress syndrome reflects surfactant deficiency; grunting, retractions, and ground-glass lungs improve with surfactant and CPAP.

Beractant is dosed at 100 mg/kg (4 mL/kg) intratracheally; poractant alfa initial dose is 200 mg/kg.

Oxygenation index = (mean airway pressure × FiO2 × 100) ÷ PaO2; an OI above 25 signals severe hypoxemic failure and consideration of inhaled nitric oxide.

Inhaled nitric oxide at 20 ppm treats PPHN; abrupt discontinuation can cause rebound pulmonary hypertension.

Oral endotracheal tube depth at the lip in centimeters approximates weight in kg plus 6 for infants over 1 kg.

Caffeine citrate 20 mg/kg load followed by 5–10 mg/kg/day reduces apnea of prematurity.

Target preductal SpO2 is 90–95% for preterm infants on supplemental oxygen and 92–97% for term infants with PPHN.

Meconium-stained fluid raises the risk of pneumothorax and PPHN; routine intubation is not required for vigorous infants.

Transient tachypnea of the newborn occurs in term or late-preterm infants, often after cesarean birth, and resolves within 24–72 hours.

Hypoglycemia is a glucose below 40 mg/dL in the first 4 hours; treat with 2 mL/kg D10W IV and start a continuous infusion.

Glucose infusion rate (mg/kg/min) = (dextrose percent × mL/hr) ÷ (weight in kg × 6); typical maintenance is 4–8 mg/kg/min.

Congenital hypothyroidism shows elevated TSH and low T4; levothyroxine 10–15 mcg/kg/day started within 2 weeks prevents neurodevelopmental delay.

Physiologic anemia in term infants nadirs at 9–11 g/dL near 8–12 weeks; preterm infants nadir earlier and at lower values.

Necrotizing enterocolitis presents with feeding intolerance, bloody stools, and pneumatosis intestinalis; treat with NPO, gastric decompression, and antibiotics.

Bilious emesis in a neonate is a surgical emergency until malrotation with volvulus is excluded.

Vitamin K 1 mg IM at birth (0.5 mg if under 1.5 kg) prevents vitamin K deficiency bleeding.

Urine output should reach 1–3 mL/kg/hr after the first 24 hours; the first void normally occurs within 24 hours of birth.

Hypocalcemia is a total calcium below 8 mg/dL in term or 7 mg/dL in preterm infants, or an ionized calcium below 4.4 mg/dL.

Therapeutic hypothermia for HIE targets 33.5°C for 72 hours, initiated within 6 hours of birth, with rewarming no faster than 0.5°C per hour.

Apgar scores at 1 and 5 minutes rate heart rate, respiratory effort, muscle tone, reflex irritability, and color from 0 to 2 each.

The Moro reflex is present at birth and disappears by 3–6 months; persistence or asymmetry suggests neurologic injury.

Erb palsy from C5–C6 injury produces the waiter's tip posture with the arm adducted and internally rotated.

Phenobarbital 20 mg/kg IV is first-line for neonatal seizures; persistent seizures receive additional 10 mg/kg doses.

Intraventricular hemorrhage grade III involves ventricular dilation, and grade IV includes parenchymal infarction with the worst prognosis.

Preterm infants carry the highest risk for intraventricular hemorrhage during the first 72 hours of life.

Nonpharmacologic neonatal pain control includes facilitated tucking, swaddling, nonnutritive sucking, and oral sucrose.

Early-onset sepsis presents within 72 hours, usually from group B Streptococcus or E. coli; empiric therapy is ampicillin plus gentamicin after blood culture.

Late-onset sepsis after 72 hours is often caused by coagulase-negative Staphylococcus in infants with central lines.

NRP: term newborns start resuscitation at 21% oxygen; preterm infants under 35 weeks start at 21–30%, titrating to preductal SpO2 targets.

A neutral thermal environment keeps core temperature at 36.5–37.5°C, minimizing oxygen consumption and preventing hypoglycemia.

SBAR (Situation, Background, Assessment, Recommendation) structures handoff communication and reduces omission of critical information.

Surrogate decisions for a neonate apply the best-interests standard through shared decision-making with parents.

Two patient identifiers must be verified before medication administration or any procedure.

Transport of a sick neonate requires securing the airway, warmth, glucose, and vascular access before departure.