A laboring woman received a narcotic medication for pain relief 1 hour before delivery.The baby does not have spontaneous respirations and does not improve with stimulation.Your first priority is to
Start positive-pressure ventilation
During resuscitation, a baby is responding to positive-pressure ventilation with a rapidly increasing heart rate. Her heart rate and oxygen saturation suddenly worsen.She has decreased breath sounds on the left side and transillumination also reveals a bright glow on the left side.What is the most likely cause of this distress?
Left-sided pneumothorax
Which of the following is true about the preparation and resources needed for a very preterm birth?
Prepare the preheated radiant warmer with a thermal mattress, plastic wrap or bag, and a hat.
Which of the following may be associated with delayed cord clamping in vigorous preterm newborns?
Decreased need for blood transfusions
For a newborn weighing 1 kg, what dose of 1:10,000 (0.1 mg/mL) concentration of intravenous epinephrine is indicated?
0.1 mL
A baby required ventilation and chest compressions. After 60 seconds of chest compressions, the electronic cardiac monitor indicates a heart rate of 70 beats per minute. What is your next action?
Stop chest compressions; continue positive-pressure ventilation.
How soon after administration of intravenous epinephrine should you pause compressions and reassess the baby’s heart rate?
1 minute
What is the preferred method for assessing heart rate during chest compressions?
Electronic cardiac (ECG) monitoring
A baby’s heart rate does not increase after intubation and the breath sounds are louder on the right side than 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 too deep
If a preterm birth is anticipated, at what temperature should the room be set?
23ºC to 25ºC (74° F – 77° F)
After chest compressions with coordinated ventilations are started, the heart rate should be assessed:
After 60 seconds
In most cases, who is (are) the usual and appropriate surrogate decision maker(s) for a newborn?
The newborn’s parents
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 beats per minute and the oxygen saturation is 90% in room air. The baby’s respirations are labored. Which of the following is an appropriate action?
Administer CPAP at 5 cm H20 pressure
You are in the delivery room caring for a preterm newborn at 27 weeks’ gestation. Resuscitation has been completed and the baby is ready to be transported to the neonatal intensive care unit. Which of the following is a true statement about the baby’s subsequent care?
Monitor blood glucose levels because of the risk of hypoglycemia after birth.
What time frame should be used to administer intravenous epinephrine?
Rapid push, as quickly as possible
When are chest compressions indicated?
When the heart rate remains less than 60 beats per minute after 30 seconds of positive-pressure ventilation that moves the chest, preferably through an alternative airway.
Which statement best describes the ethical principle(s) that guide the resuscitation of a newborn?
The approach to decisions in the newborn should be guided by the same principles used for adults and older children.
A baby born at 36 weeks’ gestation was apneic after birth and required positive-pressure ventilation and oxygen supplementation in the delivery room. He continues to require supplemental oxygen after birth. Which of the following statements is true?
His blood glucose level should be checked soon after resuscitation and then at regular intervals until stable and normal.
What is the appropriate dose of 1:10,000 (0.1 mg/mL) concentration of epinephrine for endotracheal administration to a baby weighing 3 kg?
1.5 mL
When coordinating positive-pressure ventilation with chest compressions, how many events are performed each minute?
30 breaths, 90 compressions
A newborn requires complex resuscitation. You have intubated and are administering positive-pressure ventilation and chest compressions. Which 3 signs are used to evaluate the effectiveness of your actions, and the need to continue one or both of these measures?
Respirations, heart rate, oxygen saturation
Which of the following statements is true about resuscitating and stabilizing extremely premature newborns?
They have more difficulty achieving effective spontaneous ventilation than term newborns
Which of the following is the best indication for volume expansion after resuscitative efforts that included intubation, chest compressions, and IV epinephrine?
The baby’s heart rate remains 50 beats per minute after resuscitative efforts and pulses are weak.
A mother had an emergency cesarean birth at 39 weeks’ gestational because of sudden fetal bradycardia and a suspected placental abruption. After birth, the baby required extensive resuscitation including positive pressure ventilation, intubation, chest compressions and intravenous epinephrine. Afterward, the baby has poor tone, lethargy, and apnea. Which of the following statements is true?
Promptly evaluate her for possible therapeutic hypothermia (cooling) treatment and contact the nearest cooling center.
When a newborn has a high risk of mortality and there is a significant burden of morbidity among survivors, what should be included in your discussion with the parents concerning options for resuscitation?
The option of providing comfort care can be considered.
Premature newborns are vulnerable to hyperoxia.Which action is appropriate with a pulse oximeter and blender during and immediately following resuscitation of preterm babies?
Adjusting the oxygen concentration to maintain oxygen saturations in the 85% to 95% range at 10 minutes after birth.
A newborn requires complex resuscitation. You have intubated and are administering positive-pressure ventilation and chest compressions. Which 3 signs are used to evaluate the effectiveness of your actions, and the need to continue one or both of these measures?
Respirations, heart rate, oxygen saturation
What is the target axillary temperature range for the preterm newborn?
36.5ºC to 37.5ºC
In the course of planning care for a newborn with a known and confirmed fatal genetic disorder, the parents and healthcare providers agree that life-sustaining treatment is not in the baby’s best interest and you do not plan to initiate resuscitation.Which of the following statements is true?
Withdrawal or non-initiation of support may be acceptable if there is agreement between parents and the treating team that resuscitation is not in the baby’s best interest.
Your team begins administering chest compressions to a newborn. Correct technique includes which of the following?
Chest compressions done Just below nipples
A laboring woman received a narcotic medication for pain relief 1 hour before delivery.The baby does not have spontaneous respirations and does not improve with stimulation.Your first priority is to
Start positive-pressure ventilation
During resuscitation, a baby is responding to positive-pressure ventilation with a rapidly increasing heart rate. Her heart rate and oxygen saturation suddenly worsen.She has decreased breath sounds on the left side and transillumination also reveals a bright glow on the left side.What is the most likely cause of this distress?
Left-sided pneumothorax
Which of the following is true about the preparation and resources needed for a very preterm birth?
Prepare the preheated radiant warmer with a thermal mattress, plastic wrap or bag, and a hat.
Which of the following may be associated with delayed cord clamping in vigorous preterm newborns?
Decreased need for blood transfusions
For a newborn weighing 1 kg, what dose of 1:10,000 (0.1 mg/mL) concentration of intravenous epinephrine is indicated?
0.1 mL
A baby required ventilation and chest compressions. After 60 seconds of chest compressions, the electronic cardiac monitor indicates a heart rate of 70 beats per minute. What is your next action?
Stop chest compressions; continue positive-pressure ventilation.
How soon after administration of intravenous epinephrine should you pause compressions and reassess the baby’s heart rate?
1 minute
What is the preferred method for assessing heart rate during chest compressions?
Electronic cardiac (ECG) monitoring
A baby’s heart rate does not increase after intubation and the breath sounds are louder on the right side than 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 too deep
If a preterm birth is anticipated, at what temperature should the room be set?
23ºC to 25ºC (74° F – 77° F)
After chest compressions with coordinated ventilations are started, the heart rate should be assessed:
After 60 seconds
In most cases, who is (are) the usual and appropriate surrogate decision maker(s) for a newborn?
The newborn’s parents
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 beats per minute and the oxygen saturation is 90% in room air. The baby’s respirations are labored. Which of the following is an appropriate action?
Administer CPAP at 5 cm H20 pressure
You are in the delivery room caring for a preterm newborn at 27 weeks’ gestation. Resuscitation has been completed and the baby is ready to be transported to the neonatal intensive care unit. Which of the following is a true statement about the baby’s subsequent care?
Monitor blood glucose levels because of the risk of hypoglycemia after birth.
What time frame should be used to administer intravenous epinephrine?
Rapid push, as quickly as possible
When are chest compressions indicated?
When the heart rate remains less than 60 beats per minute after 30 seconds of positive-pressure ventilation that moves the chest, preferably through an alternative airway.
Which statement best describes the ethical principle(s) that guide the resuscitation of a newborn?
The approach to decisions in the newborn should be guided by the same principles used for adults and older children.
A baby born at 36 weeks’ gestation was apneic after birth and required positive-pressure ventilation and oxygen supplementation in the delivery room. He continues to require supplemental oxygen after birth. Which of the following statements is true?
His blood glucose level should be checked soon after resuscitation and then at regular intervals until stable and normal.
What is the appropriate dose of 1:10,000 (0.1 mg/mL) concentration of epinephrine for endotracheal administration to a baby weighing 3 kg?
1.5 mL
When coordinating positive-pressure ventilation with chest compressions, how many events are performed each minute?
30 breaths, 90 compressions
A newborn requires complex resuscitation. You have intubated and are administering positive-pressure ventilation and chest compressions. Which 3 signs are used to evaluate the effectiveness of your actions, and the need to continue one or both of these measures?
Respirations, heart rate, oxygen saturation
Which of the following statements is true about resuscitating and stabilizing extremely premature newborns?
They have more difficulty achieving effective spontaneous ventilation than term newborns
Which of the following is the best indication for volume expansion after resuscitative efforts that included intubation, chest compressions, and IV epinephrine?
The baby’s heart rate remains 50 beats per minute after resuscitative efforts and pulses are weak.
A mother had an emergency cesarean birth at 39 weeks’ gestational because of sudden fetal bradycardia and a suspected placental abruption. After birth, the baby required extensive resuscitation including positive pressure ventilation, intubation, chest compressions and intravenous epinephrine. Afterward, the baby has poor tone, lethargy, and apnea. Which of the following statements is true?
Promptly evaluate her for possible therapeutic hypothermia (cooling) treatment and contact the nearest cooling center.
When a newborn has a high risk of mortality and there is a significant burden of morbidity among survivors, what should be included in your discussion with the parents concerning options for resuscitation?
The option of providing comfort care can be considered.