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

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?

Accepted Answer

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

Answer

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?

Accepted Answer

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

Answer

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?

Accepted Answer

Pleural effusions and ascites impair lung expansion and may require drainage

Answer

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?

Accepted Answer

Place an oral airway to bypass the nasal obstruction

Answer

Choanal atresia obstructs nasal breathing; an oral airway or oral intubation bypasses the obstruction and establishes a patent airway.

NRP - Neonatal Resuscitation Program Practice Test