Neonatal Resuscitation Flashcards

According to the Neonatal Resuscitation Program (NRP), what is the first step when a newborn is delivered?

Answer: Provide warmth, dry and stimulate, position and clear airway if needed, and assess the newborn's condition

The initial steps of neonatal care are warmth, drying and stimulation, positioning, and assessment of breathing and heart rate.

At what heart rate threshold does the NRP recommend initiating positive-pressure ventilation (PPV) in a newborn?

Answer: Below 100 beats per minute with labored breathing or apnea

PPV should be initiated if the newborn has apnea, gasping respirations, or a heart rate below 100 bpm after the initial steps.

What is the recommended initial oxygen concentration for PPV in term (≥37 weeks) newborns during resuscitation?

Answer: 21% oxygen (room air)

Current NRP guidelines recommend starting PPV with room air (21% oxygen) for term newborns, titrating upward if oxygen saturation remains low.

What is the recommended compression-to-ventilation ratio for neonatal CPR?

Answer: 3:1 (90 compressions and 30 breaths per minute)

Neonatal CPR uses a 3:1 ratio (3 compressions to 1 breath), giving 90 compressions and 30 ventilations per minute.

When should chest compressions be initiated in neonatal resuscitation?

Answer: When the heart rate remains below 60 bpm despite 30 seconds of adequate PPV

Chest compressions begin when the heart rate is <60 bpm after at least 30 seconds of effective PPV, confirming that ventilation alone is insufficient.

What is the APGAR score and what does it assess in newborns?

Answer: It is a 5-category scoring system (Appearance, Pulse, Grimace, Activity, Respiration) scored at 1 and 5 minutes of life

The APGAR score assesses five components—Appearance (color), Pulse, Grimace, Activity (tone), and Respiration—each scored 0-2 at 1 and 5 minutes.

In NRP, what is meant by the 'Golden Minute'?

Answer: The first 60 seconds after birth in which initial assessment and PPV (if needed) should be completed

The Golden Minute is the first 60 seconds after birth—if PPV is needed, it should begin by the end of this minute.

What is the preferred technique for neonatal chest compressions according to current NRP guidelines?

Answer: Two-thumb encircling technique with hands encircling the chest

The two-thumb encircling technique is preferred for neonatal compressions as it generates higher coronary perfusion pressure and is less fatiguing.

What is the first-line medication for persistent bradycardia in neonatal resuscitation despite effective PPV and compressions?

Answer: Epinephrine 0.01-0.03 mg/kg IV/IO (1:10,000 solution)

Epinephrine 0.01-0.03 mg/kg IV/IO is the first-line medication in neonatal resuscitation when heart rate remains <60 bpm despite effective ventilation and compressions.

What special resuscitation consideration applies to meconium-stained amniotic fluid when the newborn is born vigorous?

Answer: Routine initial steps without routine tracheal suctioning; only suction the trachea if the newborn is non-vigorous and has airway obstruction

Current guidelines no longer recommend routine tracheal suctioning for vigorous newborns with meconium—intervene only if the newborn shows signs of airway obstruction.

What is the primary cause of cardiac arrest in neonates (versus adults), and how does this affect resuscitation priorities?

Answer: Respiratory failure/hypoxia; ventilation and oxygenation are the top priorities before compressions

Neonatal cardiac arrest is almost always secondary to respiratory failure; effective ventilation takes priority over compressions.

What does therapeutic hypothermia (targeted temperature management) achieve in neonatal hypoxic-ischemic encephalopathy (HIE)?

Answer: It reduces ongoing neuronal death after severe perinatal asphyxia, improving survival and neurological outcomes when initiated within 6 hours

Therapeutic hypothermia (33-34°C for 72 hours) initiated within 6 hours of birth reduces cell death from reperfusion injury in HIE, improving neurological outcomes.

What does 'MR SOPA' stand for in the NRP corrective steps for failed PPV ventilation?

Answer: Mask adjustment, Reposition airway, Suction mouth and nose, Open mouth, Pressure increase, Alternative airway

MR SOPA is the systematic approach to improving ineffective PPV: Mask adjustment, Reposition, Suction, Open mouth, Pressure increase, Alternative airway.

What oxygen saturation target range is acceptable at 5 minutes of life for a term newborn during resuscitation?

Answer: 80-85%

The NRP SpO2 target at 5 minutes is 80-85% for a term newborn, recognizing that normal transition takes several minutes.

What is the preferred vascular access route for medication administration during neonatal resuscitation?

Answer: Umbilical venous catheter (UVC)

The umbilical venous catheter (UVC) is the preferred vascular access route in neonatal resuscitation due to rapid placement and proximity to central circulation.

Which of the following findings suggests a pneumothorax complicating neonatal resuscitation?

Answer: Unilateral decreased breath sounds, hypoxia worsening despite PPV, and shift of the heart sounds to one side

Pneumothorax in a neonate presents with asymmetric breath sounds, worsening oxygenation during PPV, and mediastinal shift away from the affected side.

When is delayed cord clamping recommended, and what are its benefits?

Answer: For vigorous term and preterm infants not requiring resuscitation, waiting 30-60+ seconds before clamping improves iron stores, hematocrit, and cerebral oxygenation

Delayed cord clamping (≥30-60 seconds for term, ≥30-60 seconds for preterm) benefits infants who don't require immediate resuscitation by increasing blood volume and iron stores.

What is the NRP recommendation for when to discontinue neonatal resuscitation?

Answer: Discontinuation is appropriate when there is no detectable heart rate after 10 minutes of complete and adequate resuscitative efforts

NRP guidelines suggest that discontinuation may be appropriate after 10 minutes of effective resuscitation with no detectable heart rate, though each case requires individual consideration.

Which NRP action should be performed in the first 30 seconds after birth for ALL newborns?

Answer: Perform the initial steps: warm, dry, stimulate, and position

The initial stabilization steps—warming, drying, stimulating, and positioning—apply to every newborn regardless of anticipated condition.

What is the recommended depth of chest compressions in neonatal CPR?

Answer: One-third of the anteroposterior diameter of the chest (approximately 1.5 inches or 4 cm)

Neonatal compressions should compress approximately one-third the anteroposterior chest diameter, about 1.5 inches (4 cm).