NRP Special Resuscitation Circumstances 2 — Questions and Answers
Question 1: What is the most common cardiac arrhythmia seen in neonates during resuscitation?
- Bradycardia due to hypoxia (Correct answer)
- Ventricular fibrillation
- Supraventricular tachycardia
- Complete heart block
Correct answer: Bradycardia due to hypoxia
Neonatal cardiac arrest is almost always due to respiratory failure leading to hypoxic bradycardia, not primary arrhythmia.
Question 2: How should resuscitation of a newborn with Pierre Robin sequence be modified?
- Prone positioning may improve airway patency; consider nasopharyngeal airway (Correct answer)
- Immediate intubation is always required
- Mask ventilation is contraindicated
- Elevate the head of the bed to 45°
Correct answer: Prone positioning may improve airway patency; consider nasopharyngeal airway
Prone positioning uses gravity to move the tongue forward, and a nasopharyngeal airway can bypass the glossoptosis in Pierre Robin sequence.
Question 3: Which infant is at highest risk for requiring resuscitation at birth?
- Preterm infant at 27 weeks with fetal heart rate decelerations (Correct answer)
- Term infant with MSAF and vigorous at birth
- Post-term infant at 41 weeks with reassuring fetal monitoring
- Term infant born by elective cesarean section
Correct answer: Preterm infant at 27 weeks with fetal heart rate decelerations
A 27-week preterm infant with signs of fetal distress has the highest combination of risks: immaturity and acute compromise.
Question 4: What is therapeutic hypothermia and when is it indicated after neonatal resuscitation?
- Cooling to 33–34°C for 72 hours in ≥36-week infants with moderate–severe HIE (Correct answer)
- Cooling to 30°C in all infants who required intubation
- Mild cooling to 36°C for all asphyxiated infants
- Hypothermia initiated in the delivery room for all infants needing compressions
Correct answer: Cooling to 33–34°C for 72 hours in ≥36-week infants with moderate–severe HIE
Therapeutic hypothermia (33–34°C for 72 hours) is indicated for ≥36-week infants with moderate-to-severe hypoxic-ischemic encephalopathy (HIE).
Question 5: A newborn is born with a pneumothorax causing deterioration. What emergency bedside procedure is performed?
- Needle thoracentesis at the 2nd intercostal space, midclavicular line (Correct answer)
- Chest tube placed at the 5th intercostal space, midaxillary line
- Bilateral needle decompression simultaneously
- Emergency pericardiocentesis
Correct answer: Needle thoracentesis at the 2nd intercostal space, midclavicular line
Emergency needle thoracentesis at the 2nd intercostal space midclavicular line (or 4th–5th intercostal space anteriorly) rapidly decompresses a tension pneumothorax.
Question 6: Which prenatal condition places a newborn at greatest risk for pulmonary hypertension requiring specialized resuscitation?
- Prolonged oligohydramnios causing pulmonary hypoplasia (Correct answer)
- Gestational diabetes mellitus
- Mild preeclampsia
- Group B Streptococcus colonization without chorioamnionitis
Correct answer: Prolonged oligohydramnios causing pulmonary hypoplasia
Prolonged oligohydramnios restricts lung growth, resulting in pulmonary hypoplasia and persistent pulmonary hypertension at birth.
NRP Special Resuscitation Circumstances 2
What is the most common cardiac arrhythmia seen in neonates during resuscitation?