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?
The endotracheal tube is not in the trachea.
Excessive ventilation pressure.
Epinephrine contamination.
Low cardiac output.
low cardiac output
What are the primary methods of confirming endotracheal tube placement within the trachea?
Continued central cyanosis and no mist in the tube
Auscultation of bilateral breath sounds and no air entry heard over the abdomen
Demonstration of exhaled carbon dioxide (CO2) and a rapidly increasing heart rate
Absence of crying and no abdominal distension
Demonstration of exhaled carbon dioxide (CO2) and a rapidly increasing heart rate
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 heart rate remains less than 100 bpm and is not increasing.
The baby’s heart rate is between 60 and 100 bpm and the heart rate is increasing.
The baby’s heart rate is >100 bpm and the baby is beginning to breathe.
The baby’s heart rate is >100 bpm and oxygen saturation is less than the target range.
The baby’s 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
In the delivery room or operating room at every birth
Available on call at home
Available on call from a remote area of the hospital
In the hospital and immediately available
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?
After chest compressions are performed for at least 2 minutes
When an alternative airway is inserted
Immediately after epinephrine is administered
Anytime pulse oximetry is used to assess oxygen saturation
alternative airway
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)?
2
1
0
00
0
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 30 seconds to auscultate the heart rate.
Briefly interrupt chest compressions and palpate the brachial pulse.
Briefly interrupt chest compressions every 60 seconds to assess the heart rate using the cardiac monitor.
Briefly interrupt chest compressions to palpate the umbilical cord.
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
Pulse oximeter
CO2 detector
Direct auscultation
Cardiac monitor
When are chest compressions indicated?
When the heart rate is less than 80 bpm
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
When the heart rate remains less than 100 bpm after 30 seconds of PPV that moves the chest preferably through an alternative airway
When the heart rate remains less than 100 bpm despite PPV with 100% oxygen
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.
Continue chest compressions and continue PPV.
Stop chest compressions and stop PPV.
Administer epinephrine while continuing chest compressions and PPV with 100% oxygen.
Stop chest compressions and continue PPV.
What is the recommended depth of chest compressions?
One-third of the anterior-posterior diameter of the chest
One-fourth of the anterior-posterior diameter of the chest
Half of the anterior-posterior diameter of the chest
Two-thirds of the anterior-posterior diameter of the chest
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 Breathe-two-three; breathe-two-three….
The compression to ventilation ratio is 15 compressions:2 ventilations.
Most babies who require chest compressions will also require volume expander.
To coordinate compressions and ventilations, the compressor calls out one-and-two-and-three-and-breathe-and….
To coordinate compressions and ventilations, the compressor calls out one-and-two-and-three-and-breathe-and….
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?
0.5 mL
1 mL
3 mL
5 mL
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)
0.05 mg/kg (equal to 0.5 mL/kg
0.1 mg/kg (equal to 1.0 mL/kg)
0.3 mg/kg (equal to 3.0 mL/kg)
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.
The baby’s heart rate is increasing but the color remains poor.
The baby’s heart rate is increasing but there is a history of acute blood loss.
The baby’s heart rate is >160 bpm but there are no spontaneous respirations.
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 1 to 2 minutes
Over 5 to 10 minutes
Over 15 to 20 minutes
Over 20 to 25 minutes
Over 5 to 10 minutes
How soon after administration of intravenous epinephrine should you pause compressions and reassess the baby’s heart rate?
10 to 15 seconds
30 seconds
60 seconds
90 seconds
60 sec
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% to 30%
40%
60%
100%
21% to 30%
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?
Begin CPAP at 5 cm H2O.
Begin PPV by mask.
Stimulate more vigorously to initiate breathing.
Administer free-flow oxygen.
Begin PPV by mask.
Choose the appropriate step(s) to prepare for the birth of a newborn <32 weeks gestation.
Prepare a size 1 laryngoscope and size 3.5-mm endotracheal tube in case intubation is required
Decrease the delivery room temperature to approximately 65˚F to 66˚F (18.3˚C to 18.8˚C).
Prepare the preheated radiant warmer with a thermal mattress, plastic wrap or bag, a hat, and a skin temperature sensor.
Set the oxygen blender to 100% the flowmeter to 15 L/min and the suction to 100 mm Hg
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.
Maintain a body temperature >38˚C to avoid cold stress after resuscitation.
Initiate formula feeding promptly to avoid electrolyte abnormalities.
Administer 100% oxygen and sodium bicarbonate to prevent pulmonary hypertension
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?
Determine who the baby’s pediatrician will be after discharge.
Decide how long the baby should stay in the hospital before discharge.
Identify who will continue to monitor the baby in the mother’s room.
Determine which vaccines the baby will receive in the hospital.
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?
Oral mass
Neck mass
Endotracheal tube inserted into the right mainstem bronchus
Robin sequence
Endotracheal tube inserted into the right mainstem bronchus
During 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?
Obstruction of the endotracheal tube with thick secretions
Displacement of the endotracheal tube from the trachea into the esophagus
Choanal atresia
Left-sided pneumothorax
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?
Begin face-mask ventilation and insert an orogastric tube into the stomach.
Intubate the trachea and insert an orogastric tube into the stomach.
Start CPAP and stimulate the baby.
Obtain intravenous access and administer epinephrine.
ntubate 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.
Administer naloxone (Narcan).
Continue vigorous stimulation.
Administer bicarbonate.
Start PPV
In most cases, who are the usual and appropriate surrogate decision makers for a newborn?
The hospital chaplains
The newborn’s parents
The members of the health care team
The hospital ethics committee
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.
The resuscitation team alone will make the appropriate decision after birth.
No resuscitation will be started under any circumstances.
The hospital ethics committee will be consulted to make a decision.
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.
Administer PPV with an initial inflation pressure of 30 to 35 cm H2O.
Provide supplemental oxygen to increase the baby’s oxygen saturation above 95%.
Intubate the newborn with a size 2.5 endotracheal tube.
Administer CPAP at 5 cm H2O pressure with 21% oxygen.
Ideally, how quickly should the intubation procedure be completed?
30 seconds
40 seconds
60 seconds
90 seconds
30 sec
Which of the following is an indication for placement of an alternate airway?
The presence of meconium-stained amniotic fluid
A gestational age of less than 30 weeks
The need to administer CPAP
The need for PPV is prolonged
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
3.0 mm
3.5 mm
4.0 mm
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
4 seconds
6 seconds
8 seconds
2 sec
When chest compressions are in progress, how often should the heart rate be assessed?
Every 60 seconds
Every 30 seconds
Every 90 seconds
When spontaneous respirations return
60 sec
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.
Begin PPV.
Increase the oxygen concentration.
Continue CPAP and 30% oxygen.
Decrease the oxygen concentration.
When is the placement of endotracheal tube recommended?
A- HR<100
Intubation skills be available?
A- In hospital and immediately available
Confirming endotracheal tube
C- exhaled Co2 and inc HR
Co2 detector not yellow
D- Low cardiac output
8th edition cardiac monitor recommended
B- When alternative airway is inserted
Laryngoscope blade sizes
D- single 0 not 00
HR during chest compression
C- 60 sec and use cardiac monitor
HR low and poor perfusion
A-cardiac monitor
Chest compression indicated?
B- HR<60 after 30 sec PPV
HR 70 bpm after PPV
A- Stop chest compression and continue PPV
Depth of chest compressions
A- 1/3rd AP dia of chest
chest compressions
D- 1-2-3 and breathe
Saline Flush
C- 3ml
8th annual NPR – Epi
A- 0.02 mg/kg
Volume expanders
A- Hr not inc and sign of shock and hx of acute blood loss
10ml/kg saline
B- 5 to 10 min
After IV check HR after
C- 60 sec
Conc of O2 for PPV
A- 21-30%
Gentle stimulation and 1 min old. not breathing
A- Begin PPV by mask
Birth<32 weeks gestations
C- Preheat radiant warmer
A-
Team plan to leave baby with mother
C-who will monitor baby in mother room
asymmetric breath sounds immediately after intubation suggest?
C- Rt main bronchus
D- left pneumothorax
congenital diaphragmatic hernia
B- Intubate and orogastric tube
No breathing. Next intervention
A- Start PPV
Surrogate
B- Newborn parents
morbidity burden and option for resuscitations
A-Comfort care
Labored breathing
A- CPAP 5 cm h2o
Intubation speed
A- 30 sec
Need for alternative airway
D- need for PPV is prolonged
Gestation age of 26 weeks
A- 2.5 mm
3 compression and 1 breath
A- 2 seconds
How often HR during compression
A- Every 60 sec
CPAP inc O2 so next step
A- Dec o2 concentration