Neonatal Resuscitation Algorithm Flashcard 3
Rationale
D. Rationale: As the newly born takes the first breaths, the presence of oxygen in the alveoli stimulates the pulmonary vessels to dilate, an essential step in transition. This allows the blood flow to be diverted into the alveoli, transitioning into a left-to-right shunt.
Question
During the transitional circulation after birth, which one of the following stimulates the pulmonary vessels to dilate?
a. Oxytocin
b. Agglutinin
c. Carbon dioxide
d. Oxygen
Answer
d. Oxygen
Rationale
A. Rationale: The first assessment determines if positive pressure ventilation is adequate, and it should be performed 15 seconds after initiating positive pressure ventilation. If providing positive pressure ventilation is sufficient, there should be an increase in the newborn’s heart rate.
Question
How much time after the initiation of positive pressure ventilation should the first assessment be performed?
a. 15 seconds
b. 30 seconds
c. 1 minute
d. 2 minutes
Answer
a. 15 seconds
Rationale
A. Rationale: Chest compressions are indicated if the newly born fails to achieve a heart rate of 60 bpm or more after providing at least 30 seconds of positive pressure ventilation with visible chest rise.
Question
If the newly born fails to improve after positive pressure ventilation, chest compressions should be initiated at what cardiac rate?
a. < 60 bpm
b. < 50 bpm
c. < 120 bpm
d. When there is no pulse and no spontaneous breathing
Answer
a. < 60 bpm
Rationale
C. Rationale: It is recommended to continue positive pressure ventilation in this case. The heart rate has improved, but it is still too early to wean the neonate off assisted ventilation. The heart rate is not at an optimal level, but this is not an indication to start chest compressions. Also, since the newly born’s status is improving, there is no need to intubate.
Question
The neonatal resuscitation team is attending to an apneic newly born. After the initial steps, the newborn does not improve. You then start providing positive pressure ventilation. The first assessment reveals that the newborn’s heart rate is 40 bpm. After delivering 30 seconds of positive pressure ventilation with a visible chest rise with every delivered breath, the heart rate increases to 80 bpm. What is your next course of action?
a. Immediately start chest compressions.
b. Intubate the newly born.
c. Continue positive pressure ventilation.
d. Monitor the newly born and prepare for transfer to the neonatal intensive care unit.
Answer
c. Continue positive pressure ventilation.
Rationale
C. Rationale: If chest compressions are necessary, adjust the oxygen concentration to 100%. It is vital to raise arterial oxygen content, as it is possibly the reason cardiac function has been compromised.
Question
The neonatal resuscitation team leader decides to perform chest compressions. What oxygen concentration should be used with the positive pressure device?
a. At 30%
b. At 50%
c. At 100%
d. Titrate oxygen concentration as necessary
Answer
c. At 100%
Rationale
D. Rationale: Two conditions must be met so that a CPAP (rather than positive pressure ventilation) can be implemented in a newly born that does not improve after the administration of supplemental oxygen. These are a heart rate > 100 bpm and persistent labored breathing.
Question
The neonatologist recommends that a newly born patient receive continuous positive airway pressure (CPAP) because the baby has persistent labored breathing after oxygen administration. Before applying CPAP instead of giving positive pressure breaths, what other condition must be met?
a. Decreasing blood pressure
b. Central cyanosis
c. The presence of upper airway obstruction
d. Heart rate > 100 bpm
Answer
d. Heart rate > 100 bpm
Rationale
A. Rationale: Routine care involves rooming in with their mothers to facilitate bonding, initiate breastfeeding, and undergo routine care. When a newly born is placed in a warmer with radiant heat and given oxygen supplementation, the team is preparing the patient to undergo the initial steps in resuscitation. This is not part of routine care for the vigorous newborn without any complications when transitioning from intrauterine to extrauterine life.
Question
The routine care of approximately 90% of newly born infants involves which of the following?
a. Rooming-in
b. Thermoregulation with radiant heat
c. Oxygen supplementation
d. All of the above
Answer
a. Rooming-in
Rationale
B. Rationale: The rapid assessment consists of the following essential questions that the newborn healthcare provider must answer are (1) “Term gestation?” (2) “Good tone?” and (3) “Breathing or crying?” The heart rate, although a critical physiologic parameter, is not part of the rapid assessment.
Question
To provide the best management for the newborn, the neonatal team must perform an initial assessment. To quickly determine the newly born’s state at birth, the rapid assessment was formulated. Which of the following is NOT part of the rapid assessment?
a. Term gestation
b. Heart rate
c. Good tone
d. Breathing or crying
Answer
b. Heart rate
Rationale
B. Rationale: NRP recommends a ration of 3 compressions and 1 ventilation every 2 seconds.
Question
What are the goals of coordinated chest compressions and ventilation during neonatal resuscitation?
a. 3 compressions + 1 ventilation every 1 second
b. 3 compressions + 1 ventilation every 2 seconds
c. 15 compressions + 2 ventilation every 15 seconds
d. 30 compressions + 2 ventilation every 30 seconds
Answer
b. 3 compressions + 1 ventilation every 2 seconds
Rationale
B. Rationale: The team performs routine neonatal care in a vigorous newly born with good respiratory function and muscle tone. It involves drying the baby in a warm towel then placing with the mother to initiate skin-to-skin contact. Afterward, the newly born is roomed-in with the mother.
Question
What intervention involves drying and placing the newly born with the mother to initiate skin-to-skin contact?
a. The initial steps of neonatal resuscitation
b. Routine neonatal care
c. Basic life support of the newly born
d. Spontaneous delivery
Answer
b. Routine neonatal care