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Tips for doing well in neonatology section of Pediatric Boards

Some general points. There are no negative markings and hence no questions SHOULD be left unansweredWhen the answers are not clear in the first reading then try the method of exclusion to get to the best possible answer. Rastogi's Rule. Common presentations of common diseasesRare presentations of

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Tips for doing well in neonatology section of Pediatric Boards

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    1. Tips for doing well in neonatology section of Pediatric Boards Shantanu Rastogi, MD, FAAP Neonatologist, Maimonides Medical Center Assistant Professor of Pediatrics Mount Sinai School of Medicine

    2. Some general points There are no negative markings and hence no questions SHOULD be left unanswered When the answers are not clear in the first reading then try the method of exclusion to get to the best possible answer

    3. Rastogi’s Rule Common presentations of common diseases Rare presentations of common diseases Common presentations of rare diseases Rare presentations of rare diseases

    4. FETAL WELL BEING

    5. Biophysical profile 5 categories with score of 0 or 2 NST, fetal body movements, breathing, fetal tone, amniotic fluid volume 10 is well fetus, 2 is certain fetal asphyxia, 4 or 6 needs frequent reevaluation for delivery

    6. Electronic Fetal Heart Rate Monitoring Normal – FHRv of 6-15bpm, basis of nonstress test-reactive positive test is normal Abnormal patterns Tachycardia, >160, infection Bradycardia, <110, head compression Loss of FHRv, hypoxia Decelerations Early, mirror image of uterine contractions, head compression Variable, irregular, umbilical cord compression Late , occur 10sec after uterine contraction and last longer, uterine placental insufficiency

    7. RESUSCITATION

    8. Resuscitation-recent changes No intrapartum meconium suctioning Oxygen use Can use <100% but if no improvement in saturations, increase to 100% If <32w to use pulse oximeter keeping saturations between 90-95% Epinephrine IV is preferred but if using ET use x10 dose Special use of laryngeal mask, CO2 monitor, and careful temp. control-use of clear plastic bags

    9. Case 28 w baby is delivered vaginally has HR of 90/m and irregular respiration, cyanosis, hypotonia with no reflexes WHAT IS THE APGAR SCORE? WHAT IS THE FIRST STEP? WHAT IS THE SUBSEQUENT STEP?

    10. Case continued After 1 min of IPPV the HR is 60/m WHAT IS THE NEXT STEP?

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