Your team has provided face-mask PPV with chest movement for 30 seconds. When is placement of an endotracheal tube strongly recommended? - The baby's
... [Show More] heart rate remains less than 100 bpm and is not increasing.
During a delivery, when and where should a person with intubation skills be available? - In the hospital and immediately available
What are the primary methods of confirming endotracheal tube placement within the trachea? - Demonstration of exhaled carbon dioxide (CO2) and a rapidly increasing heart rate
You are resuscitating a critically ill newborn whose heart rate is 20 bpm. The baby has been intubated and the endotracheal tube insertion depth is correct. You can see chest movement with PPV and hear bilateral breath sounds, but the colorimetric CO2 detector does not turn yellow. What is the likely reason for this? - Low cardiac output
According to the Textbook of Neonatal Resuscitation, 8th edition algorithm, at what point during resuscitation is a cardiac monitor recommended to assess the baby's heart rate? - When an alternative airway is inserted
What size laryngoscope blade is recommended to intubate a preterm newborn with an estimated gestational age of 32 weeks (estimated birth weight of 1.4 kg)? - 0
What size laryngoscope blade is recommended to intubate a preterm newborn with an estimated gestational age of 28 weeks? - 00
Even brief interruptions of chest compressions may significantly reduce their effectiveness, but it is also important to assess the need to continue chest compressions. What is the preferred way to assess the heart rate during chest compressions? - Briefly interrupt chest compressions every 60 seconds to assess the heart rate using the cardiac monitor.
Your team is resuscitating a newborn at birth. The heart rate is low and the baby has poor perfusion. Which is the preferred method to assess the heart rate? - Cardiac monitor
When are chest compressions indicated? - When the heart rate remains less than 60 bpm after at least 30 seconds of PPV that moves the chest, preferably through an alternative airway
After 60 seconds of PPV coordinated with chest compressions, the cardiac monitor indicates a heart rate of 70 beats per minute. What is your next action? - Stop chest compressions and continue PPV.
What is the recommended depth of chest compressions? - One-third of the anterior-posterior diameter of the chest
During chest compressions, which of the following is correct? - To coordinate compressions and ventilations, the compressor calls out one-and-two-and-three-and-breathe-and....
During chest compression with of the following is correct? - Your team is resuscitating a newborn whose heart rate remains less than 60 bpm despite effective PPV and 60 seconds of chest compressions.
You have administered epinephrine intravenously. According to the Textbook of Neonatal Resuscitation, 8th edition, what volume of normal saline flush should you administer? - 3 mL
According to the Textbook of Neonatal Resuscitation, 8th edition, what is the suggested initial dose for IV epinephrine (0.1 mg/1 mL=1 mg/10 mL)? - 0.02 mg/kg (equal to 0.2 mL/kg)
When is the administration of a volume expander indicated during newborn resuscitation? - The baby's heart rate is not increasing and there are signs of shock or a history of acute blood loss.
Your team is caring for a term newborn whose heart rate is 50 bpm after receiving effective ventilation, chest compressions, and intravenous epinephrine administration. There is a history of acute blood loss around the time of delivery. You administer 10 mL/kg of normal saline (based on the newborn's estimated weight). At what rate should this be administered? - Over 5 to 10 minutes
How soon after administration of intravenous epinephrine should you pause compressions and reassess the baby's heart rate? - 60 seconds
You are called to the birth of a newborn at 30 weeks gestation. As you prepare your equipment, what concentration of oxygen will you use initially if PPV is required? - 21-30% oxygen
A baby is born at 26 weeks gestation. The initial steps of care, including gentle stimulation, have been completed and the baby is nearly 1-minute old. The baby is not breathing. What is the most appropriate next step? - being PPV by mask
Choose the appropriate step(s) to prepare for the birth of a newborn <32 weeks gestation. - Prepare the preheated radiant warmer with a thermal mattress, plastic wrap or bag, a hat, and a skin temperature sensor
A term newborn was born via emergency cesarean section in the setting of fetal bradycardia. The baby was limp and bradycardic at birth and was intubated at 6 minutes after birth for persistent apnea. The cord blood gas demonstrates a severe metabolic acidosis, and the physical examination is consistent with hypoxic-ischemic encephalopathy (HIE). Which of the following is the most appropriate intervention for this newborn? - Admit the newborn to a center with capability to perform therapeutic hypothermia.
A term baby was vigorous at birth but receives CPAP for 3 minutes after birth for grunting respirations. The baby is now 15 minutes old, breathing comfortably in room air, and bonding with their mother. The team plans for the baby to room-in with their mother. What immediate decision needs to be made regarding post-resuscitation care? - Identify who will continue to monitor the baby in the mother's room.
A baby's heart rate does not increase after intubation and the breath sounds are louder on the right side than on the left side of the chest. Which of the following is a common cause of asymmetric breath sounds in an intubated baby? - Endotracheal tube inserted into the right mainstem bronchus
uring resuscitation, a baby initially responds to PPV with a rapidly increasing heart rate. Subsequently, the baby's heart rate and oxygen saturation suddenly worsen. The baby has decreased breath sounds on the left side and transillumination reveals a bright glow. What is the most likely cause of this distress? - Left-sided pneumothorax
You attend the birth of a baby with prenatally diagnosed severe congenital diaphragmatic hernia. What are the most appropriate steps as you begin your resuscitation? - Intubate the trachea and insert an orogastric tube into the stomach.
A woman in labor received opioid medication for pain relief 1 hour before delivery. The baby does not breathe spontaneously and remains apneic after stimulation. What is your next intervention? - Start PPV
In most cases, who are the usual and appropriate surrogate decision makers for a newborn? - The newborn's parents
When a newborn has a high risk of mortality and there is a significant burden of morbidity among survivors, what should be included in the discussion with the parents concerning options for resuscitation? - The option of providing comfort care can be considered.
You are in the delivery room caring for a preterm newborn at 27 weeks gestation. The baby is 5 minutes old and breathing spontaneously. The baby's heart rate is 120 bpm and the oxygen saturation is 90% without respiratory support. The baby's respirations are labored. Which of the following is an appropriate action? - Administer CPAP at 5 cm H2O pressure with 21% oxygen.
Ideally, how quickly should the intubation procedure be completed? - 30 seconds
Which of the following is an indication for placement of an alternate airway? - The need for PPV is prolonged
What size (internal diameter) endotracheal tube should be used to intubate a newborn with an estimated gestational age of 26 weeks (estimated birth weight of 0.8 kg)? - 2.5 mm
When coordinating PPV with chest compressions how long does it take to complete a cycle of 3 compressions and 1 breath? - 2 seconds
When chest compressions are in progress, how often should the heart rate be assessed? - Every 60 seconds
A baby is delivered at 29 weeks gestation. At 5 minutes after birth, the baby is breathing spontaneously while receiving CPAP (at a pressure of 5 cm H2O) and 30% oxygen. A pulse oximeter sensor on the baby's right hand is reading 95% and oxygen saturation is increasing. What is the most appropriate next step? - Decrease the oxygen concentration
What are the indicators for performing PPV on a neonate? - apnea, gasping, and heart rate < 100
5 steps in the NRP algorithm - rapid evaluation, airway, breathing, circulation, drug
What happens in the rapid evaluation phase? - if baby can stay with mother or moved to radiant warmer
what happens in the airway phase? - opening neonates airway and support spontaneous respirations
what happens in the breathing phase? - assist with PPV if the baby is apneic, gasping, or bradycardic (cpap or oxygen may be appropriate for labored breathing or low oxygen saturation)
what hapens in the circulation phase? - perform chest compressions if HR remains < 100 after giving effective PPV
what happens in the drug phase? - administer epinephrine if HR remains < 100
what is the pulmonary resistance in fetal lungs? - high pulmonary vascular resistance (high PVR, low SVR)
blood bypasses the lungs and passes into the aorta via ____ in the neonate? - ductus arteriosis
What is the single and most important step in the neonatal resuscitation? - ventilation:
Newborn arrest r/t respiratory failure
Very few newborns will require chest compressions or medication
Learning how to provide PPV is the foundation of NRP
What 3 questions will you ask to help determine if the baby will need resuscitation? - what is the expected gestational age, is the amniotic fluid clear, what is the umbilical cord management plan
risk factors for resuscitation? - § Gestational age < 36 0/7 weeks
§ Gestational age > or = to 41 0/7 weeks
§ Preeclampsia or eclampsia
§ Maternal hypertension
§ Multiple gestation
§ Fetal anemia
§ Polyhydramnios
§ Oligohydramnios
§ Fetal hydrops
§ Fetal macrosomia
§ IUGR
§ Significant fetal malformation or anomalies
§ No prenatal care
§ Emergency cesarean delivery
§ Forceps or vacuum-assisted delivery
§ Breech or other abnormal presentation
§ Category 2 or 3 fetal heart rate pattern
§ Maternal general anesthesia
§ Maternal Magnesium therapy
§ Placental abruption
§ Intrapartum bleeding
§ Chorioamnionitis
§ Opioids administered to mother w/in 4 hours of delivery
§ Shoulder dystocia
§ Meconium-stained amniotic fluid
§ Prolapsed umbilical cord
Who should attend a normal birth? - At every birth, at least ONE qualified provider skilled in initial steps of newborn care and PPV
Who attend birth if RISK FACTORS are present? - If risk factors are present, at least TWO qualified providers to solely manage baby
Who should be present for every neonate resuscitation? - Qualified team with full resuscitation skills be immediately available for every resuscitation (FOUR or more providers)
Who should be present for birth when meconium-stained fluid is the only risk factor? - When meconium-stained fluid is the only risk factor, at least TWO qualified providers must be present from time of birth to manage baby. Provider with intubation skills be immediately available.
What should you use when checking supplies and equipment before every birth? - standardized equipment checklist
identify items on the standardized checklist for essential supplies - Warm: preheated warmer, warm towels or blankets, temperature sensor and sensor cover for prolonged resuscitation, hat, plastic bag or warm and thermal mattress for < 32 weeks' gestation
Clear airway: bulb syringe, 10F or 12F suction catheter with wall suction set to 80-100 mm Hg, tracheal aspirator
Auscultate: stethoscope
Ventilate: flowmeter set to 10L, oxygen blender set to 21% (21-30% if < 35 weeks'), PPV device, term- and preterm-sized masks, 8F orogastric tube and mL syringe, laryngeal mask (size 1) and 5-mL syringe, 5F or 6F orogastric tube if insertion port present on laryngeal mask, access to cardiac monitor and leads
Oxygenate: equipment to give free-flow oxygen, pulse ox, target oxygen saturation table
Intubate: laryngoscope with size-0 and 1 straight blades (size 00 optional), stylet (optional), ETT (size 2.5, 3.0, and 3.5), CO2 detector, measuring tape and/or ETT insertion depth table, tube securement tape/device, scissors
Medicate: 0.1 mg/mL epinephrine, normal saline for volume expansion and flush (100 L or 250 mL bag) or prefilled syringes, supplies for placing emergency umbilical venous catheter and administering medications, table of pre-calculated emergency medication dosages for babies weighing 0.5 to 4 kg
What equipment is included on the NPR quick equipment checklist? - ETT, equipment to give free-flow oxygen, bulb syringe, preheat warmer-towels-and blankets (blood pressure cuff not on this checklist)
· According to the NRP Quick equipment checklist, how should the flowmeter be set to prepare for ventilation? - 10 L/min
What is the positive inspiratory pressure you should start with for a term neonate when using a T-piece? - 20-25 cm H2O, may have to increase up to 40 cm H2O for effective ventilation
PIP is the highest pressure delivered with each breath
How long should delayed cord clamping last? - 30-60 seconds
If baby not vigorous at birth but placental circulation intact, it's reasonable to briefly delay cord clamping while the pro [Show Less]