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.
What is the target axillary temperature range for the preterm newborn?
35.5ºC to 37ºC
X
X
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.
If a preterm birth is anticipated, at what temperature should the room be set?
23ºC to 25ºC (74° F – 77° F)
What time frame should be used to administer intravenous epinephrine?
Over 3 to 5 minutes
X
X
Over 1 to 2 minutes
X
Rapid push, as quickly as possible
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
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 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?
Administer 100% oxygen and sodium bicarbonate to prevent pulmonary hypertension.
X
X
Promptly evaluate her for possible therapeutic hypothermia (cooling) treatment and contact the nearest cooling center.
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.
Which of the following may be associated with delayed cord clamping in vigorous preterm newborns?
Decreased need for blood transfusions
How soon after administration of intravenous epinephrine should you pause compressions and reassess the baby’s heart rate?
1 minute
In most cases, who is (are) the usual and appropriate surrogate decision maker(s) for a newborn?
The newborn’s parents
What do you expect to happen after administration of a dose of intravenous epinephrine during a resuscitation?
The heart rate will increase within 5 to 10 seconds.
X
X
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 resuscitation team alone will make the appropriate decision after birth.
X
X
The option of providing comfort care can be considered.
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.
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.
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?
Maintain the baby’s body temperature above 38 ºC (100.4 ºF).
X
X
Monitor blood glucose levels because of the risk of hypoglycemia after birth.
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
You attend the birth of a baby with prenatally diagnosed congenital diaphragmatic hernia. After birth, you should
Begin face-mask ventilation and insert an orogastric tube into the stomach
X
X
After chest compressions with coordinated ventilations are started, the heart rate should be assessed:
After 90 seconds
X
After 60 seconds
X
After 60 seconds
You are counseling a set of 17-year-old parents,whose baby is about to be born at 23 weeks’ gestation. You have explained the chance of survival is low and that if the baby survives there is a high likelihood of long-term morbidity.The parents understand your discussion and clearly request that you provide life-sustaining treatment in the delivery room.How might you answer them?
You assure them that, as the parents, they are the appropriate decision makers for their baby and you will support their decision.
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.
When coordinating positive-pressure ventilation with chest compressions, how many events are performed each minute?
30 breaths, 90 compressions
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.
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
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?
Provide vigorous stimulation on the back, trunk, and extremities
X
X
Administer positive-pressure ventilation with an initial inflation pressure of 30 to 35 cm H20
X
Administer CPAP at 5 cm H20 pressure
Your team begins administering chest compressions to a newborn. Correct technique includes which of the following?
Press down on the xiphoid process approximately one-third of the anterior-posterior diameter of the chest.
X
X
What is the preferred method for assessing heart rate during chest compressions?
Pulse oximeter reading on the right hand or wrist
X
X
Auscultate with a stethoscope
X
Palpate the umbilical cord
X
During chest compressions, which of the following is correct?
To coordinate compressions and ventilations, the compressor calls out “Breathe-two-three, breathe-two-three…”
X
X
A 10-day-old, mechanically ventilated newborn suddenly develops a low heart rate (bradycardia) and low oxygen saturation, despite increasing the oxygen concentration to 100%.What is the first and the most important step in the resuscitation of this newborn?
Assess and establish adequate ventilation.
Which of the following statements about post-resuscitation care is true?
Among babies with brain injury from decreased oxygen and blood flow to the brain (hypoxic-ischemic encephalopathy), high body temperature (hyperthermia) may worsen neurologic outcomes.
After what duration of time might it be reasonable to consider discontinuing resuscitation following complete resuscitation efforts with no detectable heart rate?
20 minutes
X
X
What is the ideal depth of chest compressions for a newborn?
One-third of the anterior-posterior diameter of the chest
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
Which of the following statements is true?
The same dose is used for endotracheal and intravenous administration of epinephrine.
X
X
A 10-day-old, mechanically ventilated newborn suddenly develops bradycardia and low oxygen saturation, despite the oxygen concentration being increased to 100%. What is the first and the most important step in the resuscitation of this newborn?
Assess and establish adequate ventilation.
X
X
A woman is admitted at 24 weeks’ gestation with rupture of membranes, maternal fever, and premature labor.The care team offers the parents counseling.What is likely to be helpful?
Provide parents with accurate prognostic information using all relevant information affecting their baby’s prognosis.
