NRP Thermoregulation and Temperature Management 2 — Questions and Answers
Question 1: Therapeutic hypothermia (controlled cooling) is the established neuroprotective treatment for which neonatal condition?
- Severe respiratory distress syndrome
- Hypoxic-ischemic encephalopathy (HIE) (Correct answer)
- Neonatal sepsis with multiorgan failure
- Severe jaundice (hyperbilirubinemia)
Correct answer: Hypoxic-ischemic encephalopathy (HIE)
Therapeutic hypothermia is the standard neuroprotective treatment for moderate-to-severe hypoxic-ischemic encephalopathy (HIE) in term and near-term neonates.
Question 2: What is the standard target core temperature for whole-body therapeutic hypothermia in eligible neonates?
- 30-31°C (86.0-87.8°F)
- 33-34°C (91.4-93.2°F) (Correct answer)
- 35-36°C (95.0-96.8°F)
- 37-38°C (98.6-100.4°F)
Correct answer: 33-34°C (91.4-93.2°F)
Clinical protocols target a core temperature of 33-34°C (91.4-93.2°F) during therapeutic hypothermia to reduce secondary neuronal injury after HIE.
Question 3: For how long is therapeutic hypothermia typically maintained in eligible neonates with HIE?
- 24 hours
- 48 hours
- 72 hours (Correct answer)
- 96 hours
Correct answer: 72 hours
Major randomized controlled trials established 72 hours as the standard duration for therapeutic hypothermia, after which gradual rewarming is initiated.
Question 4: Which of the following clinical findings may indicate hypothermia in a newborn?
- Flushed skin and tachycardia
- Poor feeding, lethargy, and cold extremities (Correct answer)
- Hypertension and bounding pulses
- Hyperthermia and seizures
Correct answer: Poor feeding, lethargy, and cold extremities
Hypothermic newborns typically present with poor feeding, lethargy, cold extremities, and pallor due to peripheral vasoconstriction and decreased metabolic activity.
Question 5: Hyperthermia (temperature >38°C) during or after neonatal resuscitation is associated with which outcome?
- Improved neurological outcomes
- Reduced risk of seizures
- Increased risk of brain injury and worsened outcomes (Correct answer)
- Faster restoration of normal cardiorespiratory function
Correct answer: Increased risk of brain injury and worsened outcomes
Hyperthermia increases excitotoxicity and metabolic demands in injured brain tissue, and is associated with worsened neurological outcomes, particularly after perinatal asphyxia.
Question 6: When a preterm infant is placed in both a polyethylene wrap AND on a chemical warming mattress, the primary concern is:
- Increased risk of skin infection
- Risk of overheating (hyperthermia) (Correct answer)
- Impaired umbilical access for procedures
- Reduced effectiveness of chest compressions
Correct answer: Risk of overheating (hyperthermia)
Combining multiple warming interventions (polyethylene wrap, chemical mattress, and radiant warmer) can cause hyperthermia; temperature must be monitored closely when using these together.
Question 7: Which metabolic complication is commonly caused by cold stress and hypothermia in newborns?
- Hyperglycemia
- Metabolic alkalosis
- Hypoglycemia (Correct answer)
- Hypernatremia
Correct answer: Hypoglycemia
Hypothermia triggers cold stress, which increases metabolic rate and energy expenditure, rapidly depleting glucose stores and causing hypoglycemia.
NRP Thermoregulation and Temperature Management 2
Therapeutic hypothermia (controlled cooling) is the established neuroprotective treatment for which neonatal condition?