NRP - Neonatal Resuscitation Program Ethical Considerations in Neonatal Resuscitation 1

Question 1

According to NRP ethical principles, which party should serve as the primary decision-maker for resuscitation of an extremely premature infant when outcomes are uncertain?

Accepted Answer

The parents, in collaboration with the medical team after thorough counseling

Answer

The neonatologist, who has the most clinical expertise

Answer

The labor and delivery nursing staff, as they are present at birth

Answer

The hospital ethics committee, which must approve all borderline cases

Question 2

Which ethical principle most directly underlies the NRP guidance to focus on the 'best interest of the infant' when making resuscitation decisions?

Accepted Answer

Beneficence

Answer

Autonomy

Answer

Justice

Answer

Veracity

Question 3

When a neonate is born at a gestational age where survival is possible but outcomes are highly variable, NRP recommends that the care plan should ideally be established:

Accepted Answer

During antenatal counseling before delivery whenever possible

Answer

In the delivery room immediately after birth, based on Apgar scores

Answer

By the resuscitation team leader without parental input to avoid emotional distress

Answer

Only after the infant has failed to respond to initial resuscitation steps

Question 4

A neonate is successfully resuscitated but subsequently develops signs consistent with severe hypoxic-ischemic encephalopathy with a very poor prognosis. According to NRP ethical guidance, the most appropriate next step is:

Accepted Answer

Meet with the family to discuss redirection of care to comfort-focused goals

Answer

Continue all aggressive interventions indefinitely regardless of prognosis

Answer

Immediately withdraw all support without consulting the family

Answer

Transfer the infant to another institution where more aggressive care will be provided

Question 5

A family's cultural or religious beliefs lead them to request continued resuscitative efforts for a newborn that the medical team believes has no chance of survival. The NRP-aligned approach is to:

Accepted Answer

Acknowledge the family's values, continue compassionate communication, and involve palliative care or an ethics consultation if conflict persists

Answer

Honor the family's wishes without limit, as parental rights are absolute

Answer

Immediately stop resuscitation and defer all further discussions to the ethics committee

Answer

Document disagreement and proceed with team's decision regardless of parental input

Question 6

Which of the following scenarios would most support continuing resuscitative efforts rather than withholding or withdrawing them, according to NRP ethical guidance?

Accepted Answer

A 28-week infant with Apgar score of 2 at one minute who has not yet responded to positive pressure ventilation

Answer

A confirmed gestational age of 22 weeks with no antenatal steroids and no fetal heart tones for 20 minutes

Answer

A term infant with a confirmed diagnosis of anencephaly made prior to delivery

Answer

A term infant following a cord prolapse who has been without cardiac activity for 45 minutes prior to delivery