NRP Lesson 7: Special Considerations

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Which of the following is true about pneumothoraces in the newborn?

A chest radiograph must always be obtained prior to evacuating a pneumothorax

The risk of pneumothorax is increased if positive-pressure ventilation is provided

Pneumothoraces rarely complicate congenital diaphragmatic hernia

Every pneumothorax requires immediate evacuation
Teamwork, leadership, efficient communication
Your team is resuscitating a preterm newborn. Positive-pressure ventilation with bag and mask has resulted in good bilateral air entry, normal heart rate, and normal oxygen saturations. However; the baby fails to breathe effectively on her own.
Which of the following is the most likely cause of ineffective respirations in this newborn?

Maternal treatment with terbutaline

Pulmonary hypoplasia

Maternal treatment with magnesium sulfate

Congenital heart disease
Maternal treatment with magnesium sulfate
Remembering the MR SOPA acronym helps your team correct problems with ventilation.
Which of the following steps are included in MR SOPA?

Mask seal ensured, Reposition head of baby, Suction the airway

Mask seal ensured, Repeat stimulation, Suction the airway

Mouth opened, Reposition head, Saturation check

Mouth opened, Repeat stimulation, Saturation check
Mask seal ensured, Reposition head of baby, Suction the airway
While resuscitating a term newborn, you observe that the baby has severe respiratory distress and an unusually flat abdomen, with no air entry on the left side.
Which of the following is the most likely diagnosis?

Pulmonary hypoplasia

Congenital diaphragmatic hernia

Pierre Robin syndrome

Left choanal atresia
Congenital diaphragmatic hernia
You have established a team to help care for a newborn with a known congenital heart defect.

Which of the following statements is true for babies with major congenital heart disease?

The diagnosis of congenital heart disease in these babies can almost always be established in the delivery room.

These babies will always have a heart murmur on exam at birth.

These babies will have poor respiratory drive as a result of the heart disease.

These babies are rarely critically ill immediately following birth.
These babies are rarely critically ill immediately following birth.
A baby under your care has severe respiratory distress after birth, but can be easily ventilated with positive-pressure ventilation by mask.
How can you test for choanal atresia?

Attempt to pass an endotracheal tube through each naris into the posterior pharynx.

Attempt to pass a suction catheter through each naris into the posterior pharynx.

Obtain lateral skull radiographs to determine patency of the nares.

Place a carbon dioxide detector over each of the nares.
Attempt to pass a suction catheter through each naris into the posterior pharynx.
A baby does not appear to be improving after intubation.
Which of the following is a common cause of asymmetric breath sounds in an intubated baby?

Pierre Robin syndrome

Congenital goiter

Malpositioned endotracheal tube

Laryngeal web
Malpositioned endotracheal tube
A baby is unable to breath adequately after birth. Which of the following statements is true?

Hypoplastic lungs are easily ventilated with low inflation pressures.

Pulmonary hypoplasia may result from any cause of polyhydramnios.

Severe pulmonary hypoplasia usually is incompatible with survival.

Pulmonary hypoplasia is rarely associated with pneumothoraces.
Severe pulmonary hypoplasia usually is incompatible with survival
During positive-pressure ventilation of a newborn, the breath sounds suddenly become inaudible on one side of the chest.
Which of the following statements is true?

In the delivery room, a pneumothorax should only be evacuated from the 4th intercostal space in the midclavicular line

In the delivery room, a pneumothorax should only be evacuated from the 2nd intercostal space in the anterior axillary line

Prior to evacuating a pneumothorax, the baby should be positioned with the affected side (with the pneumothorax) placed superior

Prior to evacuating a pneumothorax, the baby should be positioned with the affected side (with the pneumothorax) placed inferior
Prior to evacuating a pneumothorax, the baby should be positioned with the affected side (with the pneumothorax) placed superior
Which of the following are special steps necessary in the resuscitation of a newborn with suspected congenital diaphragmatic hernia?

Bag-and-mask ventilation with high peak inspiratory pressure and high positive end-expiratory pressure

Bag-and-mask ventilation at a high rate with no end-expiratory pressure

Endotracheal intubation and placement of an orogastric tube

Support with continuous positive airway pressure and a high oxygen concentration
Endotracheal intubation and placement of an orogastric tube
Which of the following statements is true about the use of therapeutic hypothermia in a baby with hypoxic-ischemic encephalopathy?

Therapeutic hypothermia requires specialized equipment, and should only be used according to well defined protocols.

The improvement in outcome from this therapy is directly related to the degree of hypothermia.

Therapeutic hypothermia has been demonstrated to improve neurologic outcomes in newborns of all gestational ages.

Therapeutic hypothermia is effective if initiated at any time within the first 24 hours.
Therapeutic hypothermia requires specialized equipment, and should only be used according to well defined protocols.
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?

Administer 10 mL/kg normal saline bolus over 5 to 10 minutes.

Obtain a 12-lead electrocardiogram.

Assess and establish adequate ventilation.

Begin chest compressions at a rate of 90 events per minute.
Assess and establish adequate ventilation.