NRP Special Resuscitation Circumstances 1 — Questions and Answers
Question 1: What is the current NRP recommendation when a vigorous newborn is born through meconium-stained amniotic fluid (MSAF)?
- Proceed with initial steps; routine intubation for suctioning is NOT recommended (Correct answer)
- Intubate all meconium-exposed newborns for tracheal suctioning
- Suction the oropharynx on the perineum before delivery is complete
- Withhold PPV until the airway is suctioned
Correct answer: Proceed with initial steps; routine intubation for suctioning is NOT recommended
Routine intubation for tracheal suctioning in vigorous MSAF infants is no longer recommended; resuscitation proceeds as for any newborn.
Question 2: When is intubation and tracheal suctioning still considered in a meconium-exposed newborn?
- When the infant is non-vigorous (depressed tone, poor respiratory effort, bradycardia) (Correct answer)
- In all MSAF deliveries regardless of infant condition
- Only when thick particulate meconium is visible
- Only if SpOâ‚‚ is below 90% at 1 minute
Correct answer: When the infant is non-vigorous (depressed tone, poor respiratory effort, bradycardia)
Intubation and tracheal suctioning may be considered in non-vigorous MSAF infants, though evidence supporting benefit remains limited.
Question 3: How is resuscitation of a newborn with a known congenital diaphragmatic hernia (CDH) modified?
- Immediate intubation; avoid bag-mask ventilation to prevent bowel distension (Correct answer)
- High-flow oxygen by mask; no intubation until NICU arrival
- Immediate chest compressions to reduce herniated bowel
- Bag-mask ventilation is acceptable if face seal is good
Correct answer: Immediate intubation; avoid bag-mask ventilation to prevent bowel distension
CDH requires immediate intubation at delivery because mask PPV inflates herniated abdominal organs, further compressing the lungs.
Question 4: What is the primary concern when resuscitating an infant with suspected hydrops fetalis?
- Pleural effusions and ascites impair lung expansion and may require drainage (Correct answer)
- Hyperkalemia requiring emergent treatment
- Skin fragility limiting chest compressions
- Polycythemia causing airway obstruction
Correct answer: Pleural effusions and ascites impair lung expansion and may require drainage
Hydrops is associated with large pleural effusions and ascites that significantly reduce lung volumes and may require needle thoracentesis.
Question 5: What modification is made when resuscitating a newborn with a suspected airway malformation such as choanal atresia?
- Place an oral airway to bypass the nasal obstruction (Correct answer)
- Use only nasal PPV
- Attempt intubation via the nose
- Increase mask pressure to overcome the obstruction
Correct answer: Place an oral airway to bypass the nasal obstruction
Choanal atresia obstructs nasal breathing; an oral airway or oral intubation bypasses the obstruction and establishes a patent airway.
Question 6: A newborn with a large omphalocele requires which modification to the initial resuscitation setup?
- Covering the defect with a sterile, moist dressing and avoiding compression (Correct answer)
- Applying compression to reduce the hernia before PPV
- Placing the infant prone to protect the defect
- Immediate surgical repair before initiating resuscitation
Correct answer: Covering the defect with a sterile, moist dressing and avoiding compression
The exposed viscera must be covered with a warm, moist sterile dressing to prevent desiccation and heat loss during resuscitation.
NRP Special Resuscitation Circumstances 1
What is the current NRP recommendation when a vigorous newborn is born through meconium-stained amniotic fluid (MSAF)?