NRP Post-Resuscitation Care and NICU Stabilization 2 — Questions and Answers
Question 1: What is the purpose of surfactant therapy in preterm infants after birth?
- Reduces surface tension in alveoli, improving lung compliance and gas exchange in RDS (Correct answer)
- Prevents infection in the immature lung
- Replaces amniotic fluid in the airways
- Decreases pulmonary blood flow
Correct answer: Reduces surface tension in alveoli, improving lung compliance and gas exchange in RDS
Exogenous surfactant reduces alveolar surface tension, treats respiratory distress syndrome (RDS), and significantly reduces morbidity in preterm infants.
Question 2: What does the NRP recommend regarding temperature targets in the post-resuscitation period?
- Maintain normothermia (36.5–37.5°C) unless therapeutic hypothermia is indicated (Correct answer)
- Keep all resuscitated infants slightly hypothermic at 35°C
- Warm to 38.5°C to promote metabolic recovery
- Temperature is not addressed in the NRP post-resuscitation period
Correct answer: Maintain normothermia (36.5–37.5°C) unless therapeutic hypothermia is indicated
Normothermia (36.5–37.5°C) should be maintained to avoid both hypothermia-associated metabolic stress and hyperthermia-associated brain injury.
Question 3: Which route is used to establish vascular access most rapidly during neonatal resuscitation?
- Umbilical venous catheter (UVC) (Correct answer)
- Peripheral IV in the antecubital fossa
- Intraosseous needle in the proximal tibia
- Umbilical arterial catheter (UAC)
Correct answer: Umbilical venous catheter (UVC)
A UVC can be placed rapidly in the delivery room and provides reliable central venous access for medications and fluids during resuscitation.
Question 4: What neonatal condition is associated with a 'ground-glass' appearance on chest X-ray after resuscitation?
- Respiratory distress syndrome (RDS) due to surfactant deficiency (Correct answer)
- Meconium aspiration syndrome
- Pneumothorax
- Transient tachypnea of the newborn
Correct answer: Respiratory distress syndrome (RDS) due to surfactant deficiency
RDS produces a diffuse ground-glass appearance with air bronchograms on CXR, reflecting widespread atelectasis from surfactant deficiency.
Question 5: What documentation is essential after every neonatal resuscitation event?
- Time of each intervention, medications given, heart rate responses, and persons present (Correct answer)
- Only the Apgar scores at 1 and 5 minutes
- Delivery room temperature log only
- The resuscitation is self-documenting via monitor printout
Correct 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.
Question 6: What is an umbilical venous catheter emergency insertion depth for a 3 kg newborn?
- Approximately 4–5 cm until blood return, then advance 2 cm beyond the ductus venosus (Correct answer)
- 10 cm always regardless of weight
- Until resistance is felt
- 2 cm from the umbilical ring
Correct answer: Approximately 4–5 cm until blood return, then advance 2 cm beyond the ductus venosus
For emergency access, insert the UVC until blood flows freely (approximately 4–5 cm), confirming the tip is in the inferior vena cava or right atrium.
NRP Post-Resuscitation Care and NICU Stabilization 2
What is the purpose of surfactant therapy in preterm infants after birth?