Neonatal Resucitation

Question 1

What is the critical period for physiologic changes in a newborn?

Answer 1

The first several breaths after birth.

Question 2

What is the main result of lung expansion in a newborn?

Answer 2

Elevation of partial pressure of oxygen (PO2) in alveoli and arterial circulation.

Question 3

What happens to pulmonary vascular resistance after birth?

Answer 3

It decreases.

Question 4

What happens to right-to-left shunting through the ductus arteriosus after birth?

Answer 4

It decreases.

Question 5

What happens to venous return to the left atrium after birth?

Answer 5

It increases.

Question 6

What is the result of an increase in left atrial pressure after birth?

Answer 6

Cessation of right-to-left shunting through the foramen ovale.

Question 7

What does adequate systemic arterial oxygenation depend on?

Answer 7

Well-expanded, well-ventilated lungs and adequate circulation.

Question 8

What is the fetal response to hypoxia?

Answer 8

Becoming apneic.

Question 9

What is primary apnea?

Answer 9

A brief period of oxygen deprivation leading to apnea, reversible with stimulation and oxygen.

Question 10

What is secondary apnea?

Answer 10

A prolonged period of oxygen deprivation leading to irregular gasping and apnea.

Question 11

What percentage of neonates require some assistance at birth for normal transition?

Answer 11

0.1

Question 12

What percentage of neonates require extensive resuscitation?

Answer 12

Less than 1%.

Question 13

Name two maternal conditions that increase the risk of high-risk delivery.

Answer 13

Diabetes mellitus, hypertension.

Question 14

Name two obstetric conditions that increase the risk of high-risk delivery.

Answer 14

Placental anomalies, premature rupture of membranes.

Question 15

Name two fetal conditions that increase the risk of high-risk delivery.

Answer 15

Prematurity, macrosomia.

Question 16

What is the first goal of neonatal resuscitation?

Answer 16

Minimizing immediate heat loss.

Question 17

What is the main method to establish normal respiration and lung expansion?

Answer 17

Clearing the upper airway and using positive pressure ventilation if necessary.

Question 18

What percentage of newborns need advanced resuscitation?

Answer 18

Less than 1%.

Question 19

What percentage of newborns need basic resuscitation with bag-mask ventilation?

Answer 19

3-6%.

Question 20

What percentage of newborns need simple stimulation at birth?

Answer 20

5-10%.

Question 21

Name two pieces of essential suction equipment needed in the delivery room.

Answer 21

Bulb syringe, mechanical suction with tubing.

Question 22

What size ET tubes should be prepared for full-term neonates?

Answer 22

3.5 mm.

Question 23

What medication is used for neonatal resuscitation in cases of severe bradycardia?

Answer 23

Epinephrine.

Question 24

What is the first step immediately after a baby is born and is crying?

Answer 24

Routine care: drying, clearing secretions, and skin-to-skin contact.

Question 25

What are the three initial questions to assess the need for neonatal resuscitation?

Answer 25

Is it a term gestation? Does the baby have good muscle tone? Is the baby crying or breathing?

Question 26

What are the components of the Apgar score?

Answer 26

Heart rate, respiratory effort, muscle tone, reflex irritability, color.

Question 27

What is the normal Apgar score at 1 minute?

Answer 27

Between 7 and 10.

Question 28

What Apgar score at 5 minutes requires further evaluation?

Answer 28

6 or less.

Question 29

What does an Apgar score of 0-3 indicate?

Answer 29

Severe distress requiring immediate resuscitation.

Question 30

What are the initial steps of resuscitation?

Answer 30

Provide warmth, clear the airway, dry the baby, stimulate breathing.

Question 31

What is the mnemonic for ventilation corrective steps?

Answer 31

MRSOPA (Mask adjustment, Reposition airway, Suction, Open mouth, Pressure increase, Alternative airway).

Question 32

When should chest compressions be started in neonatal resuscitation?

Answer 32

If heart rate remains below 60 bpm after 30 seconds of adequate ventilation.

Question 33

What is the preferred method of chest compressions for neonates?

Answer 33

Two-thumb encircling technique.

Question 34

What is the compression-to-ventilation ratio in neonatal CPR?

Answer 34

3:1.

Question 35

How long should chest compressions be given before reassessing heart rate?

Answer 35

45-60 seconds.

Question 36

What medication is used if heart rate remains below 60 bpm despite ventilation and chest compressions?

Answer 36

Epinephrine.

Question 37

What is the IV dose of epinephrine in neonatal resuscitation?

Answer 37

0.1 – 0.3 ml/kg of 1:10,000 solution.

Question 38

What is the recommended volume expander in neonatal shock?

Answer 38

Normal saline or blood products.

Question 39

What volume of fluid should be given for neonatal shock?

Answer 39

10 mL/kg IV over 5-10 minutes.

Question 40

What is the indication for endotracheal intubation in neonatal resuscitation?

Answer 40

Ineffective bag-mask ventilation or prolonged need for ventilation.

Question 41

What is the purpose of delayed cord clamping?

Answer 41

Improves neonatal iron stores and reduces risk of anemia.

Question 42

When should cord clamping be done in a stable neonate?

Answer 42

At 60 seconds after birth.

Question 43

When should resuscitation efforts be stopped?

Answer 43

If there is no detectable heartbeat after 10 minutes of resuscitation.

Question 44

What temperature should be maintained for a newborn during resuscitation?

Answer 44

Between 36.5 - 37.5°C.

Question 45

What is the most common cause of neonatal cardiac arrest?

Answer 45

Respiratory failure leading to hypoxia.

Question 46

What is the first-line treatment for apnea in neonates?

Answer 46

Positive pressure ventilation.

Question 47

What is the preferred oxygen concentration for resuscitation of term neonates?

Answer 47

21% (room air).

Question 48

What oxygen concentration should be used in preterm neonates?

Answer 48

21-30% oxygen.

Question 49

What device is used to measure oxygen saturation during resuscitation?

Answer 49

Pulse oximeter.

Question 50

What is the ideal chest compression depth in neonatal resuscitation?

Answer 50

One-third of the anteroposterior chest diameter.

Question 51

What should be done if there is persistent hypoxia despite ventilation?

Answer 51

Consider pneumothorax, diaphragmatic hernia, or airway obstruction.

Question 52

What is the gold standard for confirming endotracheal tube placement?

Answer 52

Capnography (CO2 detection).

Question 53

What is the main determinant of neonatal resuscitation success?

Answer 53

Adequate lung inflation.

Question 54

What is the optimal heart rate for a newborn after resuscitation?

Answer 54

Above 100 bpm.

Question 55

How should persistent bradycardia be managed in a newborn?

Answer 55

Ensure effective ventilation, then consider epinephrine.

Question 56

What are two causes of poor response to resuscitation?

Answer 56

Hypothermia, metabolic acidosis.

Question 57

What is the normal respiratory rate in a newborn?

Answer 57

40-60 breaths per minute.

Question 58

What are two early signs of neonatal distress?

Answer 58

Retractions, nasal flaring.

Question 59

What does central cyanosis in a newborn indicate?

Answer 59

Hypoxia requiring oxygen therapy.

Question 60

What does persistent grunting in a newborn suggest?

Answer 60

Respiratory distress syndrome.

Question 61

What should be done if a newborn has severe respiratory distress?

Answer 61

Provide CPAP or mechanical ventilation.

Question 62

What is a late sign of neonatal hypoxia?

Answer 62

Bradycardia.

Question 63

What should be done if a newborn has meconium-stained amniotic fluid?

Answer 63

If non-vigorous, perform endotracheal suctioning before positive pressure ventilation.

Question 64

What does persistent hypotension in a newborn suggest?

Answer 64

Sepsis or hypovolemia.

Question 65

What is the most important step in preventing neonatal hypothermia?

Answer 65

Immediate skin-to-skin contact and drying.

Question 66

What is the significance of a weak cry in a newborn?

Answer 66

Possible respiratory distress or neurological depression.

Question 67

What is the primary method of neonatal temperature regulation?

Answer 67

Non-shivering thermogenesis via brown fat metabolism.

Question 68

What are the three key components of neonatal resuscitation?

Answer 68

Ventilation, oxygenation, circulation.

Question 69

What should be assessed first in a non-crying neonate?

Answer 69

Airway patency and respiratory effort.

Question 70

What is the first step in neonatal resuscitation?

Answer 70

Drying the baby and providing warmth.

Question 71

When should an orogastric tube be placed during resuscitation?

Answer 71

If bag-mask ventilation is needed for more than 2 minutes.

Question 72

What is the most effective way to improve neonatal oxygenation?

Answer 72

Providing adequate ventilation.

Question 73

What is the leading cause of neonatal death worldwide?

Answer 73

Birth asphyxia.

Question 74

What is the role of sodium bicarbonate in neonatal resuscitation?

Answer 74

Used only for severe metabolic acidosis.

Question 75

What does poor muscle tone in a newborn suggest?

Answer 75

Neurological impairment or hypoxia.

Question 76

What is the most common metabolic abnormality in neonatal shock?

Answer 76

Hypoglycemia.