Neo/Peds NRP quiz

What are the indications for endotracheal intubation in neonatal resuscitation?

Ineffective PPV by mask, prolonged PPV needed, chest compressions required, suspected diaphragmatic hernia, extremely preterm infant, surfactant administration.

What laryngoscope blade size is used for a micropreemie?

00.

What laryngoscope blade size is used for a preterm infant?

0.

What laryngoscope blade size is used for a term infant?

1.

What should be checked before intubation?

Laryngoscope light, batteries, ET tube size, stylet placement, cardiac monitor.

What position should the infant be in for intubation?

Sniffing position.

Which hand holds the laryngoscope during intubation?

Left hand.

How long should one intubation attempt last?

No longer than 30 seconds.

How should the laryngoscope be lifted?

Lift upward in the direction the handle is pointing; never rock back on the gums.

When should the ET tube be inserted?

When the vocal cords are open.

How is correct ET tube depth estimated?

Lip marking = 6 + weight (kg) or Nose-to-Tragus Length (NTL) + 1 cm.

Who should perform neonatal intubation?

The most experienced available provider.

What should be done if intubation is unsuccessful within 30 seconds?

Resume mask PPV before attempting again.

What are the assistant's responsibilities during intubation?

Prepare equipment, position baby, monitor HR, assist with suction, apply cricoid pressure if directed, attach CO₂ detector, confirm placement, secure tube.

How is ET tube placement confirmed?

Bilateral breath sounds, no gastric sounds, chest rise, ETCO₂ detector, chest X-ray.

What is the most definitive confirmation of ET tube placement?

Chest X-ray.

What should be absent if the ET tube is correctly placed?

Gastric breath sounds and gastric distention.

How can thick tracheal secretions be suctioned?

Pass a suction catheter through the endotracheal tube.

What is the preferred airway alternative after failed intubation?

Laryngeal Mask Airway (LMA).

When are chest compressions started in neonatal resuscitation?

Heart rate remains below 60 bpm after 30 seconds of effective PPV.

What is the preferred chest compression technique?

Two-thumb encircling hands technique.

Where should compressions be performed?

Lower third of the sternum, below the nipple line and above the xiphoid.

How deep should compressions be?

One-third of the anterior-posterior chest diameter.

What oxygen concentration should be used during chest compressions?

100% oxygen.

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

3:1.

How many compressions and breaths are given each minute?

90 compressions and 30 breaths (120 total events/minute).

How long are compressions performed before reassessment?

60 seconds.

When should chest compressions be stopped?

When the heart rate rises above 60 bpm.

If HR is above 60 but below 100 after compressions, what should continue?

Positive-pressure ventilation.

If HR remains below 60 after compressions, what should be prepared?

Umbilical venous catheter and medications.

Why are chest compressions performed?

To improve circulation when myocardial function is depressed.

When is epinephrine indicated during neonatal resuscitation?

Heart rate remains below 60 bpm despite effective PPV and 60 seconds of chest compressions.

What is the preferred route for epinephrine administration?

Intravenous via umbilical venous catheter (UVC).

What concentration of epinephrine is used in neonatal resuscitation?

0.1 mg/mL (1:10,000).

What is the IV/IO dose of epinephrine?

0.2 mL/kg.

What is the ET tube dose of epinephrine?

1 mL/kg.

How is IV epinephrine administered?

Push rapidly followed by a 3 mL saline flush.

How often may epinephrine be repeated?

Every 3-5 minutes if HR remains below 60 bpm.

What is the purpose of epinephrine?

Increase coronary blood flow and improve heart rate and contractility.

When are volume expanders indicated?

Evidence of shock or blood loss not responding to resuscitation.

What volume expander is commonly given?

Normal saline or O-negative packed red blood cells.

What is the dose of a volume expander?

10 mL/kg.

How are volume expanders administered?

IV or IO over 5-10 minutes.

What should be done if the infant still does not improve after epinephrine and a volume expander?

Continue high-quality resuscitation and evaluate for reversible causes.

Where is an emergency umbilical venous catheter inserted?

Into the umbilical vein 2-4 cm or until blood return is obtained.

How much saline is used to flush medications through the UVC?

3 mL.

What can be used if umbilical venous access is unavailable?

Intraosseous (IO) needle.

What can an IO needle be used for?

Administration of IV medications and fluids.

Why are premature infants high risk during resuscitation?

Immature lungs, fragile capillaries, poor temperature regulation, low blood volume, immature nervous and immune systems.

How should temperature be maintained in premature infants?

Polyethylene bag, warming mattress, transport incubator, room temperature 74-77°F.

What body temperature should be maintained in preterm infants?

36.5°C to 37.5°C.

What oxygen saturation target is used for premature infants after stabilization?

85-95%.

How should ventilation be modified in premature infants?

Use the lowest effective PIP and CPAP when appropriate.

How should neurologic injury be minimized in premature infants?

Handle gently, avoid excessive pressures, avoid rapid oxygen changes, avoid rapid fluid infusions.

How should congenital diaphragmatic hernia be managed?

Immediate intubation, no mask ventilation, insert a large OG tube.

How is choanal atresia managed?

Insert an oral airway or endotracheal tube.

How is Pierre Robin sequence managed?

Place infant prone, insert a nasopharyngeal airway, consider LMA.

How should a neonatal pneumothorax be treated?

Needle aspiration or chest tube after confirmation.

How should resuscitation be modified for babies born outside the hospital?

Provide warmth, clear airway, dry infant, mouth-to-mouth/nose ventilation if needed.

What are the four ethical principles in neonatal resuscitation?

Autonomy, beneficence, nonmaleficence, justice.

Who are the surrogate decision makers for neonates?

The parents.

When may neonatal resuscitation be withheld?

When treatment is futile or survival is extremely unlikely.

Examples of when resuscitation may be withheld?

Less than 22-24 weeks gestation, weight less than 400-500 g, lethal anomalies, prolonged asystole.

What should be done if prognosis is uncertain?

Begin resuscitation and reassess as more information becomes available.

Should resuscitation decisions always remain fixed?

No. Decisions may change after initial assessment.

What should healthcare providers say when a baby dies?

Use clear language such as "Your baby has died."

What should be done after a neonatal death?

Remove tubes if appropriate, clean and wrap the baby, provide privacy, offer memory items, and emotional support.

What memory items may be offered after neonatal death?

Handprints, footprints, molds, lock of hair, photographs.

How can parents and staff be supported after neonatal death?

Follow-up appointments, grief support groups, memorial services, and team debriefing.

What is the single most important intervention in neonatal resuscitation?

Effective positive-pressure ventilation.

What heart rate requires PPV?

Less than 100 bpm.

What heart rate requires chest compressions?

Less than 60 bpm despite effective PPV.

What is the DOPE mnemonic used for?

Troubleshooting sudden deterioration of an intubated infant (Dislodgement, Obstruction, Pneumothorax, Equipment failure).