RNC-NIC Neonatal Evaluation & Monitoring 4 — Questions and Answers
Question 1: A term neonate's cranial ultrasound shows a germinal matrix hemorrhage confined to the caudothalamic groove. This is classified as which grade?
- Grade I IVH (Correct answer)
- Grade II IVH
- Grade III IVH
- Grade IV IVH
Correct answer: Grade I IVH
Grade I (or subependymal) hemorrhage is confined to the germinal matrix at the caudothalamic groove without ventricular involvement.
Question 2: Which amplitude-integrated EEG (aEEG) pattern is most consistent with severe hypoxic-ischemic encephalopathy requiring therapeutic hypothermia?
- Continuous normal voltage pattern
- Burst suppression pattern (Correct answer)
- Sleep-wake cycling
- Discontinuous normal voltage
Correct answer: Burst suppression pattern
Burst suppression on aEEG — alternating high-amplitude bursts with suppressed background — indicates severe cortical dysfunction consistent with HIE.
Question 3: A neonate receiving therapeutic hypothermia has a heart rate of 88 bpm. The RNC recognizes this as:
- Dangerous bradycardia requiring immediate pacing
- An expected physiologic response to cooling (Correct answer)
- A sign of severe hyperkalemia
- Indicative of complete heart block
Correct answer: An expected physiologic response to cooling
Mild bradycardia (80-100 bpm) is an expected and acceptable physiologic response to therapeutic hypothermia in neonates with HIE.
Question 4: When performing a gestational age assessment using the New Ballard Score, a score of 25 corresponds to approximately which gestational age?
- 30 weeks
- 32 weeks (Correct answer)
- 34 weeks
- 36 weeks
Correct answer: 32 weeks
On the New Ballard Score, a total score of 25 corresponds to approximately 32 weeks gestation.
Question 5: A 25-week neonate on high-frequency oscillatory ventilation (HFOV) has a MAP of 12 cmH2O and amplitude of 30. The CO2 is 68 mmHg. Which adjustment addresses hypercarbia on HFOV?
- Increase MAP
- Increase amplitude (delta P) (Correct answer)
- Decrease frequency (Hz)
- Decrease FiO2
Correct answer: Increase amplitude (delta P)
On HFOV, CO2 elimination is primarily controlled by amplitude (delta P); increasing amplitude improves CO2 clearance.
Question 6: Which finding on a neonatal echocardiogram most strongly suggests a hemodynamically significant patent ductus arteriosus (hsPDA)?
- Left atrium to aortic root ratio (LA:Ao) of 1.0
- Retrograde diastolic flow in the descending aorta (Correct answer)
- Right ventricular hypertrophy
- Pulmonary venous return to right atrium
Correct answer: Retrograde diastolic flow in the descending aorta
Retrograde (reversed) diastolic flow in the descending aorta indicates significant left-to-right ductal steal, confirming hemodynamic significance.
Question 7: A preterm infant at 32 weeks shows apnea lasting 25 seconds with bradycardia to 80 bpm and oxygen desaturation to 78%. This episode is best classified as:
- Periodic breathing
- Apnea of prematurity — obstructive type
- Apnea of prematurity — mixed type (Correct answer)
- Apnea of prematurity — central type
Correct answer: Apnea of prematurity — mixed type
Mixed apnea — the most common type in preterm infants — involves both central cessation of respiratory drive and obstructive components, with associated bradycardia and desaturation.
RNC-NIC Neonatal Evaluation & Monitoring 4
A term neonate's cranial ultrasound shows a germinal matrix hemorrhage confined to the caudothalamic groove.
This is classified as which grade?