NRP Oxygen Administration and Monitoring

Question 1

What initial concentration of oxygen is recommended when starting positive-pressure ventilation for a term infant during neonatal resuscitation?

Accepted Answer

21% oxygen (room air)

Answer

NRP 8th edition recommends starting PPV with 21% oxygen (room air) for term infants, adjusting the FiO2 based on pulse oximetry targets.

Question 2

Where should the pulse oximetry probe be placed during neonatal resuscitation to measure preductal oxygen saturation?

Accepted Answer

Right hand or wrist

Answer

Preductal SpO2 is measured on the right hand or wrist, which receives blood from the right subclavian artery — before the ductus arteriosus joins the aorta — giving a more accurate reflection of cerebral oxygenation.

Question 3

What is the target preductal SpO2 at 5 minutes of life for a newborn undergoing resuscitation, according to NRP guidelines?

Accepted Answer

80–85%

Answer

The NRP target SpO2 at 5 minutes of life is 80–85%, reflecting the normal physiological rise from the fetal baseline as the pulmonary circulation opens and ventilation is established.

Question 4

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

Accepted Answer

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

Answer

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.

Question 5

What should the resuscitation team do if a newborn's SpO2 is consistently above the NRP target range during resuscitation?

Accepted Answer

Wean the supplemental oxygen (FiO2) to bring SpO2 back into the target range

Answer

If SpO2 exceeds the NRP target range, supplemental oxygen should be decreased (FiO2 weaned), since hyperoxia is harmful. The goal is to maintain SpO2 within the physiological target range, not maximize it.

NRP - Neonatal Resuscitation Program Practice Test

NRP - Neonatal Resuscitation Program Practice Test

NRP Oxygen Administration and Monitoring