NRP Preterm Infant Resuscitation 2

Question 1

What is the risk of providing excessive tidal volumes during PPV in a preterm infant, and how can this be mitigated?

Accepted Answer

Volutrauma from excessive tidal volumes causes alveolar overdistension and inflammatory lung injury, increasing risk of bronchopulmonary dysplasia

Answer

Volutrauma — lung injury from excessive tidal volumes — causes alveolar overdistension, epithelial disruption, and inflammatory mediator release that can lead to bronchopulmonary dysplasia (BPD) in preterm infants.

Question 2

What is the rationale for using antenatal corticosteroids before preterm delivery, and how do they affect delivery room management?

Accepted Answer

Antenatal corticosteroids accelerate fetal lung maturation and surfactant production, reducing the severity of RDS and the need for delivery room interventions

Answer

Antenatal corticosteroids (betamethasone or dexamethasone) administered 24–48 hours before preterm delivery significantly accelerate lung maturation, increase surfactant production, and reduce the incidence and severity of RDS, IVH, and NEC.

Question 3

What is 'gentle' chest rise in the context of PPV for preterm infants, and why is it important?

Accepted Answer

Slight, visible chest rise described as a gentle movement of the chest — indicates appropriate tidal volume without overdistension

Answer

NRP recommends aiming for slight, visible chest rise ('a gentle wiggle') during PPV for preterm infants. Excessive chest rise indicates high tidal volumes that risk volutrauma and BPD.

Question 4

Which of the following methods can help prevent cold stress in a preterm infant less than 32 weeks in the delivery room?

Accepted Answer

Polyethylene wrap, prewarmed delivery room (25–26°C), prewarmed radiant warmer, and chemical warming mattress

Answer

A bundle of interventions is recommended: polyethylene wrap/bag (without drying), prewarmed radiant warmer, room temperature ≥25–26°C, and a chemical warming mattress for the most premature infants.

Question 5

At what gestational age is a preterm infant considered to have adequate thermal regulation without a polyethylene wrap?

Accepted Answer

32–36 weeks

Answer

NRP specifically recommends polyethylene wrap for infants less than 32 weeks. Infants 32–36 weeks have better thermoregulation and can be managed with standard drying and warm blankets, though individual assessment is needed.

NRP - Neonatal Resuscitation Program Practice Test

NRP - Neonatal Resuscitation Program Practice Test

NRP Preterm Infant Resuscitation 2