Neonatal & Pediatric Respiratory Care 2026 – 150 Questions on Fetal Development, Surfactant, Shunts, Perinatal Risk & Neonatal Adaptation

This Neonatal & Pediatric Respiratory Care 2026 exam review contains approximately 150 structured questions and detailed answers focused on fetal lung development, surfactant physiology, fetal circulation, perinatal risk factors, and neonatal respiratory adaptation. The document begins with the five stages of fetal lung development (embryonal, pseudoglandular, canalicular, saccular, and alveolar), including timing of airway branching, vascular bed formation, surfactant production, and extrauterine viability at 22–24 weeks. It also reviews alveolar maturation, percentage of alveoli present at birth, and the role of Type II pneumocytes in surfactant production and secretion. Core surfactant physiology is thoroughly explained, including its composition (phospholipids, protein, cholesterol), function in reducing surface tension, and its relationship to lung compliance, FRC, and neonatal respiratory distress syndrome (RDS). Causes of decreased surfactant such as prematurity, hypoxia, maternal diabetes, and malnutrition are clearly outlined. Prenatal and postnatal lung growth factors, pulmonary hypoplasia, fetal lung fluid dynamics, and the importance of lung fluid clearance before birth are also comprehensively reviewed. The document provides detailed coverage of fetal circulation, including the umbilical cord structure (1 vein, 2 arteries), chorionic villi gas exchange, fetal hemoglobin oxygen affinity, the double Bohr effect, and the three major shunts: ductus arteriosus, ductus venosus, and foramen ovale. It explains the physiologic changes at birth, pulmonary vascular resistance reduction, closure timelines of fetal shunts, and transition to adult circulation patterns. Maternal and perinatal risk factors are extensively addressed, including preterm birth, cervical insufficiency, diabetes (gestational and pregestational), preeclampsia, substance use (alcohol, tobacco, cocaine, opioids), infectious diseases (Group B Streptococcus, HIV, Hepatitis B), premature rupture of membranes, placental abruption, placenta previa, oligohydramnios, polyhydramnios, cord abnormalities, and post-term pregnancy complications. Diagnostic and monitoring tools such as ultrasound, amniocentesis, nonstress testing, and contraction stress testing are also included. This resource is especially relevant for: Respiratory Therapy students (CRT and RRT programs) Neonatal and Pediatric Respiratory Care coursework NICU clinical rotations NBRC board exam preparation Nursing students in neonatal or maternal-child health Physician Assistant and medical students in pediatrics Obstetric and perinatal care modules The structured question-and-answer format supports mastery of fetal physiology, neonatal transition, high-risk pregnancy factors, and foundational neonatal respiratory concepts essential for board and clinical success. Keywords: fetal lung development stages, embryonal pseudoglandular canalicular saccular alveolar, surfactant production week 24, type II pneumocytes, surfactant composition phospholipids, respiratory distress syndrome neonate, fetal circulation shunts, ductus arteriosus closure, foramen ovale function, ductus venosus shunt, fetal hemoglobin oxygen affinity, double bohr effect fetus, pulmonary vascular resistance newborn, alveolar maturation postnatal, pulmonary hypoplasia causes, fetal lung fluid clearance, preterm birth risk factors, maternal diabetes neonatal effects, preeclampsia management, group B streptococcus neonate, premature rupture membranes, placental abruption complications, oligohydramnios disorders, polyhydramnios risks, amniocentesis lung maturity