NRP Lesson 9 – NRP 7th ed

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You are called to counsel the parents of a fetus who is believed to be at the lower limits of viability and whose birth is imminent.

What should you tell the parents when they ask you how decisions about resuscitation are made?

The decision agreed to before birth may need to be modified based on the condition of the baby after birth and the postnatal gestational age assessment.
Which statement 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.

In the course of planning care for a newborn with a known genetic disorder, one of your team members suggests that no resuscitation be offered. The parents agree. Other team members think this decision might jeopardize them personally.

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 this support will be futile.
When a fetus has a borderline chance of survival, and there is a high rate of complications, what should be included in your discussion with the parents concerning options for resuscitation?
The option of only providing comfort care can be considered.

You are part of a team called to an emergency cesarean delivery done for apparent acute placental abruption at 41 weeks’ gestation. The newborn emerged without respirations or heart rate and has had no detectable heart rate (by palpation or by oximetry monitoring) from the time the baby was first assessed. You and the team are convinced that resuscitation has been adequate (good chest movement with positive-pressure ventilation; timely and correct placement of umbilical catheter and administration of medications; fluids; and performance of chest compressions).

After what duration of time might it be appropriate to discontinue resuscitative efforts?

After 10 minutes of no detectable heart rate (Asystole)
In most cases, who is (are) the usual and appropriate surrogate decision maker(s) for a newborn?
The parents

A woman is admitted at 24 weeks’ gestation with rupture of membranes, maternal fever, and premature labor. The baby is likely to be born within the next few hours with an estimated weight of 750 g. The care team offers the parents counseling.

What is likely to be helpful in this process?

It is worth obtaining up-to-date outcome data for your institution or region, or using the Neonatal Resuscitation Program Web site and National Instutite of Child Health & Human Development estimator for national data.

You are called to the birth of a newborn weighing 385 g and gestational age of just under 23 weeks, a birth weight that is associated with almost certain early death and nearly universal rate of severe morbidity among the rare survivors.

Which action is appropriate?

Attempts at resuscitation are not indicated under these circumstances; care should focus on comfort alone.

You are counseling a set of 17-year-old parents, whose baby is about to be born at 23 weeks’ gestation. You have explained that survival is unlikely and that in the event of survival, the likelihood of severe long-term morbidity is high. The parents firmly request that everything be done, starting with resuscitation at birth.

How might you answer them?

You assure them that as the parents, they are the appropriate voice for their baby and you will support their wishes.
Good decisions are based on good data. Which statement about obstetric dating and assessment is correct?
Techniques for obstetric dating are accurate to within 3 to 5 days, when assessed during the first trimester.
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.

 

Pre-ductual Spo2 Target 4 min 75-80%
Pre-ductual Spo2 Target 5 min 80-85%
Pre-ductual Spo2 Target 10 min 85-95%
Abnormal transition for a newborn apnea
tachypnea
Bradycardia/tachycardia
decreased muscle tone
low oxygen saturation
low blood pressure
Pre-ductual Spo2 Target 3 min 70-75%
Pre-ductual Spo2 Target 2 min 65-70%
Pre-ductual Spo2 Target 1 min 60-65%
If severe Bradycardia persists despite assisted ventilation and coordinated compressions what drug is administered? Epinephrine
If severe Bradycardia persists despite assisted ventilation then circulation is supported with what? Chest Compressions
Before birth, the alveoli in the fetal lungs are expanded and filled with what? Fluid
Before birth, oxygen is supplied to the fetus by the what? placenta
If 2 risk factors are present how many qualified people should be present solely to manage the baby? two

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