NRP Special Resuscitation Circumstances

Question 1

What is the current NRP recommendation when a vigorous newborn is born through meconium-stained amniotic fluid (MSAF)?

Accepted Answer

Proceed with initial steps; routine intubation for suctioning is NOT recommended

Answer

Intubate all meconium-exposed newborns for tracheal suctioning

Answer

Suction the oropharynx on the perineum before delivery is complete

Answer

Withhold PPV until the airway is suctioned

Question 2

When is intubation and tracheal suctioning still considered in a meconium-exposed newborn?

Accepted Answer

When the infant is non-vigorous (depressed tone, poor respiratory effort, bradycardia)

Answer

In all MSAF deliveries regardless of infant condition

Answer

Only when thick particulate meconium is visible

Answer

Only if SpO₂ is below 90% at 1 minute

Question 3

How is resuscitation of a newborn with a known congenital diaphragmatic hernia (CDH) modified?

Accepted Answer

Immediate intubation; avoid bag-mask ventilation to prevent bowel distension

Answer

High-flow oxygen by mask; no intubation until NICU arrival

Answer

Immediate chest compressions to reduce herniated bowel

Answer

Bag-mask ventilation is acceptable if face seal is good

Question 4

What is the primary concern when resuscitating an infant with suspected hydrops fetalis?

Accepted Answer

Pleural effusions and ascites impair lung expansion and may require drainage

Answer

Hyperkalemia requiring emergent treatment

Answer

Skin fragility limiting chest compressions

Answer

Polycythemia causing airway obstruction

Question 5

What modification is made when resuscitating a newborn with a suspected airway malformation such as choanal atresia?

Accepted Answer

Place an oral airway to bypass the nasal obstruction

Answer

Use only nasal PPV

Answer

Attempt intubation via the nose

Answer

Increase mask pressure to overcome the obstruction

Question 6

A newborn with a large omphalocele requires which modification to the initial resuscitation setup?

Accepted Answer

Covering the defect with a sterile, moist dressing and avoiding compression

Answer

Applying compression to reduce the hernia before PPV

Answer

Placing the infant prone to protect the defect

Answer

Immediate surgical repair before initiating resuscitation