NRP Airway Management and Intubation 1 — Questions and Answers
Question 1: Which laryngoscope blade size is used for a term newborn during neonatal intubation?
- Size 1 (straight Miller blade) (Correct answer)
- Size 2 (curved Macintosh blade)
- Size 0 (straight blade)
- Size 3 (curved blade)
Correct answer: Size 1 (straight Miller blade)
A size 1 straight (Miller) blade is used for term newborns; a size 0 blade is reserved for very preterm infants.
Question 2: What endotracheal tube (ETT) inner diameter is appropriate for a term newborn (≥38 weeks)?
- 3.5 mm (Correct answer)
- 2.5 mm
- 4.0 mm
- 3.0 mm
Correct answer: 3.5 mm
A 3.5 mm ID ETT is recommended for term infants ≥38 weeks gestation; smaller tubes are used for preterm infants.
Question 3: During intubation, which landmark confirms the tube is passing through the vocal cords?
- The vocal cord guide (black line) at the level of the cords (Correct answer)
- The tube tip seen below the carina
- Equal bilateral breath sounds
- A colorimetric CO₂ detector turning yellow
Correct answer: The vocal cord guide (black line) at the level of the cords
The vocal cord guide is a black line printed on the ETT; it should be positioned at the level of the vocal cords during insertion.
Question 4: How long should an intubation attempt last before pausing to ventilate?
- No more than 30 seconds (Correct answer)
- No more than 60 seconds
- Until SpO₂ falls below 80%
- Until the tube is placed regardless of time
Correct answer: No more than 30 seconds
Each intubation attempt should be limited to 30 seconds; if unsuccessful, resume PPV before retrying.
Question 5: What is the most reliable primary confirmation of correct ETT placement?
- Detection of exhaled CO₂ with a colorimetric detector (Correct answer)
- Equal bilateral breath sounds
- Visible chest rise
- Absence of gastric sounds
Correct answer: Detection of exhaled CO₂ with a colorimetric detector
A colorimetric CO₂ detector that changes color with exhaled CO₂ is the most reliable primary confirmation of tracheal placement.
Question 6: At what depth (lip-to-tip) should a 3.5 mm ETT be placed in a 3 kg term newborn?
- ~9–10 cm at the lip (Correct answer)
- ~6 cm at the lip
- ~13 cm at the lip
- ~7 cm at the lip
Correct answer: ~9–10 cm at the lip
A useful estimate is 6 cm + weight in kg; for a 3 kg infant: 6 + 3 = 9 cm at the lip.
NRP Airway Management and Intubation 1
Which laryngoscope blade size is used for a term newborn during neonatal intubation?