CCRN Neonatal flashcards

32 cards. Read the term and the definition here. The deck at the top of this page is optional.

Prostaglandin E1 infusion

A continuous infusion of 0.01–0.05 mcg/kg/min maintains ductal patency in ductal-dependent congenital heart lesions; apnea is a common adverse effect, so airway support must be ready.

Coarctation clinical signs

Upper extremity hypertension with lower extremity hypotension, weak or absent femoral pulses, and a systolic murmur; spontaneous ductal closure may precipitate shock.

Pre/post-ductal SpO2 difference

A difference greater than 3% between the right hand and either foot suggests right-to-left shunting, as seen in persistent pulmonary hypertension or ductal-dependent cardiac lesions.

PDA closure contraindications

Indomethacin or ibuprofen should be avoided with renal impairment, thrombocytopenia, active bleeding, necrotizing enterocolitis, or significant hyperbilirubinemia because of adverse drug effects.

Neonatal SVT treatment

Supraventricular tachycardia shows a narrow-complex rate above 220 bpm; vagal maneuvers followed by adenosine 0.1 mg/kg rapid IV push are first-line therapy.

UVC tip location

A properly positioned umbilical venous catheter tip sits at the junction of the inferior vena cava and right atrium, approximately at the T8–T9 level on chest radiograph.

HLHS management priorities

Systemic perfusion is ductal dependent, so maintain prostaglandin E1, avoid excessive supplemental oxygen and hyperventilation, and target balanced systemic and pulmonary blood flow.

Respiratory distress syndrome cause

Surfactant deficiency in preterm infants causes grunting, retractions, nasal flaring, and ground-glass opacities; exogenous surfactant and CPAP reduce work of breathing and air leak.

Surfactant dosing

Beractant is given at 100 mg/kg (4 mL/kg) per intratracheal dose; poractant alfa uses an initial dose of 200 mg/kg, with repeat doses as clinically indicated.

Oxygenation index formula

OI = (mean airway pressure × FiO2 × 100) ÷ PaO2; values above 25 indicate severe hypoxemic respiratory failure and often prompt inhaled nitric oxide therapy.

Inhaled nitric oxide use

Inhaled nitric oxide at 20 ppm treats persistent pulmonary hypertension of the newborn; response is judged by improved oxygenation, and abrupt discontinuation can cause rebound hypertension.

Endotracheal tube depth

For infants over 1 kg, oral tube depth at the lip in centimeters approximates weight in kg plus 6; position is confirmed with a chest radiograph.

Caffeine citrate for apnea

A loading dose of 20 mg/kg followed by 5–10 mg/kg/day reduces apneic episodes in preterm infants by stimulating the respiratory center.

Meconium aspiration risks

Meconium-stained fluid increases the risk of pneumothorax and persistent pulmonary hypertension; avoid routine intubation of vigorous infants, and give positive pressure ventilation if breathing is inadequate.

Neonatal hypoglycemia treatment

A glucose below 40 mg/dL in the first 4 hours is treated with 2 mL/kg of D10W IV bolus, followed by a continuous dextrose infusion with serial reassessment.

Glucose infusion rate formula

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

Congenital hypothyroidism treatment

Elevated TSH with low T4 confirms the diagnosis; levothyroxine 10–15 mcg/kg/day started within two weeks prevents irreversible neurodevelopmental delay.

Physiologic anemia of infancy

Hemoglobin nadirs near 9–11 g/dL at 8–12 weeks in term infants as erythropoietin falls; preterm infants nadir earlier and at lower values.

Polycythemia definition

A central hematocrit above 65% defines neonatal polycythemia; partial exchange transfusion is considered when hyperviscosity symptoms such as hypoglycemia or poor perfusion occur.

Necrotizing enterocolitis signs

Feeding intolerance, abdominal distention, bloody stools, and pneumatosis intestinalis on radiograph; management is NPO, gastric decompression, antibiotics, and surgery if perforation occurs.

Bilious emesis in newborn

Green emesis in a neonate is a surgical emergency suggesting malrotation with volvulus; obtain immediate surgical consultation and keep the infant nothing by mouth.

Therapeutic hypothermia criteria

Infants at or beyond 36 weeks with hypoxic-ischemic encephalopathy receive cooling to 33.5°C for 72 hours, started within 6 hours of birth, with slow rewarming.

Apgar score components

Heart rate, respiratory effort, muscle tone, reflex irritability, and color are each scored 0–2 at 1 and 5 minutes after birth.

Moro reflex timeline

Symmetric arm abduction and extension followed by adduction appears at birth and normally disappears by 3–6 months; persistence or asymmetry suggests neurologic abnormality.

Erb palsy presentation

Brachial plexus injury to C5–C6 causes the affected arm to be adducted and internally rotated with the wrist flexed, known as the waiter's tip posture.

Neonatal seizure first-line drug

Phenobarbital 20 mg/kg IV loading dose is first-line for neonatal seizures, followed by additional 10 mg/kg doses if seizures persist.

Intraventricular hemorrhage grades

Grade I is germinal matrix only, grade II extends into ventricles without dilation, grade III dilates the ventricles, and grade IV involves parenchymal infarction.

Early-onset neonatal sepsis

Presents within 72 hours, commonly from group B Streptococcus or E. coli; empiric ampicillin plus gentamicin is started after obtaining a blood culture.

NRP initial oxygen

Term newborns are resuscitated with 21% oxygen; preterm infants under 35 weeks start at 21–30%, titrating to preductal SpO2 targets.

Neutral thermal environment

An environment maintaining core temperature at 36.5–37.5°C with minimal oxygen consumption, preventing cold stress, hypoglycemia, and metabolic acidosis.

SBAR handoff

Situation, Background, Assessment, and Recommendation is a structured communication format used during handoffs to reduce omissions and improve patient safety.

Surrogate decision-making

When parents decide for an infant, the ethical standard applied is the infant's best interests, reached through shared decision-making with the care team.