Facts Learned in the NICU

1. Caffeine past adjusted age of 32 weeks is not helpful (to restart)
2. Dextrose/aa/lipids/Na/K/Ca
3. Decrease the lipids by half when you have reached 50% of oral feeds; stop them all together when you reach 75%
4. Enfameal AR is thicker but it is not compatible with PPI
5. PE has more vitamins for little ones
6. ROP = retinopathy of prematurity = the blood vessels at the back of the retina don’t grow out to the edge of the eye until 40 weeks gestational age or after, when you have a premie they are not anywhere near where they need to be. Oxygen is toxic to these vessels. The need frequent eye appointments to look at the vessels and grade where they are: “Immature zone II.” If the vessels begin to get disorganized, they will have to be treated with laser surgery and hopefully will regrow in the right direction. This does create small blind spots in the peripheral vision.
7. CLD = chronic lung disease = defined as requiring oxygen past 32 weeks gestational age
8. RDS = respiratory distress syndrome = treat with surfactant
9. AOP = apnea of prematurity = breathing centers are not developed in even the term newborn; these are very undeveloped in the premie. When they get hypoxic, the centers become even less sensitive to CO2—a bad downward spiral
10. PPHN = peripheral pulmonary hypertension of the newborn; newborn circulation in a term baby; lungs capillaries don’t relax
11. SIMV = give PEEP/PIP; time to take off when 18/5
12. NCPAP = give PEEP, usu lowest is 5
13. HiFi = crazy vibrating thing that provides constant opening of the airways; supposed to be more gentle to premie lungs
14. INO = inhaled nitrous oxide; to dilate vessels in the lung in PPHN
15. Babies need a carseat test before they go home
16. Reflux precautions at 45 degree angle
17. Careful of NEC and feeding advancement
18. Glycerin 0.5 ml pr prn no stool in 24 hours
19. Lansoprazole better in newborns than ranitidine?
20. The first two days of life, give life in hours instead of days
21. Dextrose infusion rate: (([dextrose] x rate)/weight)/6 want a glucose infusion rate in HAL of no more than 12-14 mg/kg/minute
22. Don’t put more than 12.5% dextrose in PIV HAL, don’t put more calcium in PIV (infiltration)
23. When HAL, check BMP, mg, phos, triglycerides to adjust
24. Intubation medications: atropine, fentanyl, mev
25. Diabetic Fetus: polycythemic, increased fibrinogen, delayed lung maturation, “soggy” lungs leading to “big baby RDS” leading to pulmonary hypertension and tricuspid midsystolic murmur
26. 1/3 of the fetal lung fluid is cleared by the TSH surge in vaginal delivery
27. Writing the delivery note “Peds call to the vaginal delivery secondary to… Infant handed to us floppy and blue. BBO2 used for 50 seconds. Routing NALS followed. Three vessel cord visualized. Baby brought to the ISCC.”
28. Give gastroschesis babies lots of fluid! Cover the gut quickly. Stay sterile
29. Ampicillin 100 mg/kg bid
30. Gentamicin 4 mg/kg once a day