Mixed Deck — All NRP Topics Flashcards

What is the endotracheal dose of epinephrine if IV/IO access is unavailable during neonatal resuscitation?

Answer: 0.05–0.1 mg/kg (0.5–1 mL/kg of 1:10,000 solution)

The endotracheal dose of epinephrine is 0.05–0.1 mg/kg (0.5–1 mL/kg of 1:10,000 solution) — significantly higher than the IV/IO dose — because absorption via the pulmonary route is unreliable.

What is the normal fetal oxygen saturation (SpO2) via pulse oximetry in the minutes immediately after birth for a term infant?

Answer: SpO2 of 60–65% at 1 minute, rising gradually to 85–95% by 10 minutes

NRP provides target SpO2 ranges for the first 10 minutes of life. At 1 minute, 60–65% is normal; it rises gradually as pulmonary circulation is established, reaching 85–95% by 10 minutes.

What device is used to precisely control the fraction of inspired oxygen (FiO2) delivered during neonatal resuscitation?

Answer: Oxygen blender

An oxygen blender allows precise mixing of oxygen and air to deliver any FiO2 from 21–100%, enabling titration based on pulse oximetry during resuscitation.

Why is 100% oxygen harmful in neonatal resuscitation, and what specific risk does it pose?

Answer: 100% oxygen generates excess reactive oxygen species (free radicals), causing oxidative injury to organs including the brain and lungs

Hyperoxia generates excess reactive oxygen species (free radicals), leading to oxidative stress that can injure immature tissues including the brain, lungs, and retina. This is particularly harmful in preterm infants whose antioxidant defenses are underdeveloped.

What is the primary physiological change that must occur in the lungs immediately after birth for successful transition to extrauterine life?

Answer: Replacement of lung fluid with air and establishment of functional residual capacity

At birth, the fluid-filled lungs must be cleared and air must replace the fluid to establish functional residual capacity (FRC), enabling effective gas exchange for the first time.

In which clinical scenario would it be appropriate to use 100% oxygen during neonatal resuscitation despite NRP's standard recommendation to start at lower FiO2?

Answer: An infant receiving CPR for heart rate below 60 bpm despite PPV

NRP recommends considering 100% oxygen during active CPR for heart rate below 60 bpm, as the priority in cardiac arrest is maximizing oxygen delivery. Wean as quickly as possible once circulation is restored.

If a pulse oximetry reading cannot be reliably obtained during neonatal resuscitation, how should the team guide oxygen therapy?

Answer: Use clinical assessment including breathing effort, heart rate response, and skin color, and continue troubleshooting the oximeter

When pulse oximetry is unavailable or unreliable, clinical assessment — evaluating heart rate response to ventilation, breathing effort, tone, and color — guides management while the team troubleshoots to obtain reliable monitoring.

Which type of resuscitation device does NOT require a compressed gas source to deliver PPV?

Answer: Self-inflating bag

A self-inflating bag reinflates automatically after each compression and does not require a compressed gas source, making it available in any setting.

What clinical sign distinguishes a newborn with primary apnea from one with secondary apnea?

Answer: Primary apnea responds to stimulation; secondary apnea does not and requires PPV

Primary apnea responds to stimulation and increased oxygen, whereas secondary apnea will not resume with stimulation and requires PPV.

In the context of neonatal resuscitation, what is the principle of 'non-maleficence'?

Answer: Avoid interventions that are more likely to cause harm than benefit

Non-maleficence means 'do no harm.' In neonatal resuscitation, this principle guides decisions about when aggressive interventions may cause more suffering than benefit, especially in extreme prematurity or lethal anomalies.

What is the correct ventilation rate during PPV for a newborn?

Answer: 40–60 breaths per minute

PPV should be delivered at 40–60 breaths per minute during neonatal resuscitation.

What is the recommended initial glucose infusion rate (GIR) to prevent hypoglycemia in a post-resuscitation neonate?

Answer: 4–6 mg/kg/min of dextrose

A GIR of 4–6 mg/kg/min replicates hepatic glucose production and maintains euglycemia in neonates unable to feed orally.

What documentation is essential after every neonatal resuscitation event?

Answer: Time of each intervention, medications given, heart rate responses, and persons present

Complete documentation includes the timeline of events, all interventions, drug doses and times, responses, and team members for medical, legal, and quality-improvement purposes.

What is PEEP and why is it used during neonatal PPV?

Answer: Positive end-expiratory pressure; maintains lung volume between breaths

PEEP maintains functional residual capacity between breaths, preventing alveolar collapse especially in preterm lungs.

What is the risk of administering high-concentration oxygen for prolonged periods to a recovering neonate?

Answer: Oxidative stress, free radical injury, and retinopathy of prematurity

Prolonged hyperoxia generates reactive oxygen species that damage the brain, lungs, eyes, and other organs in neonates.

Which of the following is a key stimulus for the first breath after delivery?

Answer: Cold exposure, tactile stimulation, and chemoreceptor response to rising CO2 and falling O2

The first breath is triggered by multiple stimuli: the sudden change in temperature (cold exposure), tactile stimulation during delivery, and chemoreceptor activation from rising PCO2 and falling PO2 as placental circulation ends.

After successful resuscitation, which vital sign parameter requires the closest monitoring in the immediate post-resuscitation period?

Answer: Heart rate and SpO₂

Heart rate and oxygen saturation are the primary indicators of ongoing cardiorespiratory stability after neonatal resuscitation.

During fetal circulation, where does the most highly oxygenated blood flow after entering the right atrium from the inferior vena cava?

Answer: Through the foramen ovale to the left atrium, then to the left ventricle and brain

The most oxygenated blood from the inferior vena cava is directed by the crista dividens across the foramen ovale into the left atrium and left ventricle, then into the ascending aorta to supply the brain and coronary arteries preferentially.

Which of the following conditions is explicitly listed by NRP as one where resuscitation is NOT indicated due to near-certain early death?

Answer: Confirmed anencephaly

Confirmed anencephaly is explicitly identified by NRP as a condition where resuscitation is generally not indicated due to near-certain early death.

A percutaneous catheter or needle should be inserted into the pleural space and the air should be evacuated in order to treat a pneumothorax if it causes severe respiratory distress.

Answer: TRUE

TRUE. If a pneumothorax causes severe respiratory distress in a newborn, immediate intervention is necessary to relieve the pressure. This is typically achieved by inserting a percutaneous catheter or needle into the pleural space to evacuate the trapped air, allowing the collapsed lung to re-expand and improve the infant's breathing.