NRP/ Neonatal

Question 1

List 8 interventions to perform in the delivery room for a hypotonic baby

Answer 1

Dry baby
Place under warmers
Assess: breathing? Tone? (poor) Term? (yes)
Clear airway via suction
Stimulate
Apply pulse oximetry, assess heart rate, temperature
Provide PPV with 21% oxygen
Assess heart rate change, oximetry change, respiratory change and apply MRSOPA
Prepare intubation equipment, for compressions, and for a dose of epi

Question 2

List the differential diagnosis for respiratory distress in a neonate (8 items)

Answer 2

o Pulmonary: RDS, TTN, meconium aspiration, pneumonia, CCAM, pneumothorax, PPHN
o Infectious: sepsis, pneumonia
o Cardiac: congenital heart disease
o Congenital diaphragmatic hernia, TEF

Question 3

What are the five objective signs measured by the Apgar score?

Answer 3

Appearance (color)
Pulse (< or > 100)
Grimace 
Activity (tone)
Respirations (/cry)

Question 4

When to start chest compressions in NRP? And at what rate?

Answer 4

Chest compressions if HR < 60 after 30 sec of effective PPV, 3:1 (90 compressions, 30 breaths/minute (120 events)), along with 100% FiO2

Question 5

Rate of breaths in NRP (if performing PPV)

Answer 5

40-60 breaths/min, 21% FiO2, 15-20 cmH2O

Question 6

Steps for improving ventilation in NRP

Answer 6

MRSOPA (mask size/ position, reposition, suction, open airway, increase pressure, alternative airway)

Question 7

Caput succudaneum, cephalohematoma, subgaleal bleed - what are the differences?

Answer 7

• Caput succedaneum – boggy swelling, crosses suture lines
• Cephalohematoma – subperiosteal blood, does not cross suture lines. Resolves over 4-6 weeks
• Subgaleal hemorrhage can lead to hypovolemic shock. Swelling can extend down to the neck/ears

Question 8

Treatment of lacrimal duct obstruction

Answer 8

Tx with gentle wiping of the eyes, and massage over nasolacrimal duct a few times/ day. Refer to ophtho if doesn’t resolved by 1 year (90% resolve by then).

Question 9

Work-up of cyanotic newborn

Answer 9

Check pre/post ductal sats, 4 limb BP’s (abnormal if legs have 20 mmHg less than arms), CXR, ECG, echo, hyperoxia test

Question 10

Describe the presentation and usual course of laryngomalacia

Answer 10

• Presents by 2-4 weeks, worse with feeds, when supine, agitation, crying. Often associated with GERD. Stridor improves when prone. Improves by 18 months of age.
• Obtain ENT consult and fiberoptic laryngoscopy if moderate-severe, or progressive symptoms. Treatment is usually conservative, watchful waiting, treat GERD

Question 11

Which conditions can predispose to developing a meconium plug (list 4)?

Answer 11

prematurity, IDM, Hirschprungs, CF

Question 12

List the findings of NEC on x-ray

Answer 12

pneumatosis intestinalis, porto-venous gas, free air, ileus

Question 13

List 3 categories of neonatal HSV

Answer 13

1. Skin, eye, mouth (SEM) – vesicles usually appear 10-12 d after birth, can lead to corneal scarring
2. CNS – 17-19 days, seizures, lethargy, bulging fontanelle, 30-60% have no skin lesions
3. Disseminated – septic shock at 10-12 days, worst prognosis, multi-organ failure, 40% have no skin lesions

Question 14

Describe the management of neonatal HSV

Answer 14

All categories (including just skin lesions) need full septic work-up: CBC, chemistry, LFT’s, urinalysis, blood and urine culture, LP, HSV PCR of blood and CSF and surface culture of mucous membranes. Admit to hospital for IV acyclovir