NEONATOLOGY BOARD REVIEW AND CLINICAL MASTERY
VERIFIED EXAM QUESTIONS AND EXPLAINED ANSWERS -
LATEST VERSION 2026 /2027
Q1 What are the initial steps of neonatal resuscitation at birth?
Warm and dry the infant, stimulate, position airway, and clear
secretions if needed. Assess tone, breathing, and heart rate
ANS simultaneously. The 'Golden Minute' concept emphasizes
completing initial steps and beginning PPV if needed within 60
seconds of birth.
Q2 At what heart rate should you initiate PPV in a newborn?
PPV should be initiated if heart rate is <100 bpm or if the infant has
ANS apnea or gasping respirations despite initial steps. PPV is the most
important intervention in neonatal resuscitation.
What is the recommended initial FiO2 for PPV in term and preterm
Q3
infants?
For term infants (≥36 weeks), start PPV with 21% O2 (room air).
For preterm infants (<35 weeks), start with 21–30% O2. Titrate
ANS
based on pulse oximetry, targeting pre-ductal SpO2 targets per NRP
guidelines.
When is chest compressions indicated during neonatal
Q4
resuscitation?
For Educational Use Only | Page 1
, Chest compressions are indicated when HR remains <60 bpm
despite at least 30 seconds of adequate PPV. Use 3:1 compression-
ANS
to-ventilation ratio (90 compressions: 30 breaths per minute).
Increase FiO2 to 100% when starting compressions.
What are the pre-ductal SpO2 targets in the first 10 minutes of life
Q5
per NRP?
1 min: 60–65%; 2 min: 65–70%; 3 min: 70–75%; 4 min: 75–80%; 5
ANS min: 80–85%; 10 min: 85–95%. Pre-ductal monitoring (right
hand/wrist) reflects oxygen delivery to the brain and heart.
Q6 What is the dose of epinephrine in neonatal resuscitation?
IV/IO: 0.01–0.03 mg/kg (0.1–0.3 mL/kg of 1:10,000). ETT: 0.05–
ANS 0.1 mg/kg (higher dose needed due to poor absorption). IV route is
preferred. May repeat every 3–5 minutes.
Q7 When is volume expansion indicated during neonatal resuscitation?
When the infant doesn't respond to resuscitation and there is
evidence of hypovolemia (pallor, poor perfusion, weak pulse
ANS
despite adequate ventilation). Use normal saline 10 mL/kg IV/IO
over 5–10 minutes. O-negative blood if hemorrhage suspected.
Q8 What Apgar score at 5 minutes warrants continued concern?
An Apgar score of 0–3 at 5 minutes, or failure to reach ≥7 by 10
minutes, warrants concern and continued resuscitation evaluation.
ANS
Apgar scores do not direct resuscitation but are used for
documentation and prognosis assessment.
For Educational Use Only | Page 2
, What is meconium aspiration syndrome (MAS) and how does
Q9
delivery room management differ?
MAS results from fetal aspiration of meconium-stained amniotic
fluid causing airway obstruction, chemical pneumonitis, and
ANS pulmonary hypertension. If infant is vigorous (strong respiratory
effort, good tone, HR>100), routine care suffices. If non-vigorous
with meconium, intubate and suction before PPV.
What is the recommended temperature range for neonatal
Q10
resuscitation in delivery room?
Delivery room temperature should be 23–25°C. Preterm infants
(<32 weeks) should be placed in a polyethylene bag/wrap
ANS
immediately without drying to prevent heat loss. Target
normothermia (36.5–37.5°C) on NICU admission.
Q11 When is therapeutic hypothermia indicated in neonates?
HIE meeting criteria: ≥36 weeks GA, ≤6 hours of age, evidence of
perinatal depression (pH <7.0 or base deficit ≥16, or 10-min Apgar
ANS
≤5 or need for resuscitation at 10 min), AND moderate-to-severe
encephalopathy on exam. Target 33–34°C for 72 hours.
Q12 What are contraindications to therapeutic hypothermia?
Prematurity <36 weeks, birth weight <1800g (relative), major
congenital anomalies incompatible with life, severe coagulopathy
ANS
unresponsive to treatment, and presentation >6 hours after birth.
Moribund status is also a relative contraindication.
For Educational Use Only | Page 3
, What is the role of laryngeal mask airway (LMA) in neonatal
Q13
resuscitation?
LMA (size 1) is indicated as an alternative airway when ETT
intubation is unsuccessful and infant is ≥34 weeks and ≥2000g. It
ANS
can be used for PPV but not for tracheal suctioning or drug
delivery. It is a bridge to definitive airway.
What is the etiology of congenital diaphragmatic hernia (CDH) and
Q14
its resuscitation approach?
CDH results from failure of diaphragm closure, causing herniation
of abdominal contents into the thorax, leading to pulmonary
ANS hypoplasia and PPHN. Resuscitate without bag-mask ventilation
(causes bowel distension). Intubate immediately; place NG tube,
avoid high PIPs.
What is the significance of a persistent HR <60 bpm after 60
Q15
seconds of CPR?
Consider IV epinephrine, assess for pneumothorax, confirm ETT
placement and adequate ventilation, ensure IV/IO access, check for
ANS
hypovolemia. If persistent, consider discontinuation discussion after
10–20 minutes with no response per NRP guidelines.
2. Respiratory Distress & Pulmonary Disorders
What is Respiratory Distress Syndrome (RDS) and its
Q16
pathophysiology?
RDS (hyaline membrane disease) is caused by surfactant deficiency
ANS in preterm lungs, leading to alveolar collapse, ventilation-perfusion
mismatch, hypoxemia, and respiratory failure. Surfactant normally
For Educational Use Only | Page 4
VERIFIED EXAM QUESTIONS AND EXPLAINED ANSWERS -
LATEST VERSION 2026 /2027
Q1 What are the initial steps of neonatal resuscitation at birth?
Warm and dry the infant, stimulate, position airway, and clear
secretions if needed. Assess tone, breathing, and heart rate
ANS simultaneously. The 'Golden Minute' concept emphasizes
completing initial steps and beginning PPV if needed within 60
seconds of birth.
Q2 At what heart rate should you initiate PPV in a newborn?
PPV should be initiated if heart rate is <100 bpm or if the infant has
ANS apnea or gasping respirations despite initial steps. PPV is the most
important intervention in neonatal resuscitation.
What is the recommended initial FiO2 for PPV in term and preterm
Q3
infants?
For term infants (≥36 weeks), start PPV with 21% O2 (room air).
For preterm infants (<35 weeks), start with 21–30% O2. Titrate
ANS
based on pulse oximetry, targeting pre-ductal SpO2 targets per NRP
guidelines.
When is chest compressions indicated during neonatal
Q4
resuscitation?
For Educational Use Only | Page 1
, Chest compressions are indicated when HR remains <60 bpm
despite at least 30 seconds of adequate PPV. Use 3:1 compression-
ANS
to-ventilation ratio (90 compressions: 30 breaths per minute).
Increase FiO2 to 100% when starting compressions.
What are the pre-ductal SpO2 targets in the first 10 minutes of life
Q5
per NRP?
1 min: 60–65%; 2 min: 65–70%; 3 min: 70–75%; 4 min: 75–80%; 5
ANS min: 80–85%; 10 min: 85–95%. Pre-ductal monitoring (right
hand/wrist) reflects oxygen delivery to the brain and heart.
Q6 What is the dose of epinephrine in neonatal resuscitation?
IV/IO: 0.01–0.03 mg/kg (0.1–0.3 mL/kg of 1:10,000). ETT: 0.05–
ANS 0.1 mg/kg (higher dose needed due to poor absorption). IV route is
preferred. May repeat every 3–5 minutes.
Q7 When is volume expansion indicated during neonatal resuscitation?
When the infant doesn't respond to resuscitation and there is
evidence of hypovolemia (pallor, poor perfusion, weak pulse
ANS
despite adequate ventilation). Use normal saline 10 mL/kg IV/IO
over 5–10 minutes. O-negative blood if hemorrhage suspected.
Q8 What Apgar score at 5 minutes warrants continued concern?
An Apgar score of 0–3 at 5 minutes, or failure to reach ≥7 by 10
minutes, warrants concern and continued resuscitation evaluation.
ANS
Apgar scores do not direct resuscitation but are used for
documentation and prognosis assessment.
For Educational Use Only | Page 2
, What is meconium aspiration syndrome (MAS) and how does
Q9
delivery room management differ?
MAS results from fetal aspiration of meconium-stained amniotic
fluid causing airway obstruction, chemical pneumonitis, and
ANS pulmonary hypertension. If infant is vigorous (strong respiratory
effort, good tone, HR>100), routine care suffices. If non-vigorous
with meconium, intubate and suction before PPV.
What is the recommended temperature range for neonatal
Q10
resuscitation in delivery room?
Delivery room temperature should be 23–25°C. Preterm infants
(<32 weeks) should be placed in a polyethylene bag/wrap
ANS
immediately without drying to prevent heat loss. Target
normothermia (36.5–37.5°C) on NICU admission.
Q11 When is therapeutic hypothermia indicated in neonates?
HIE meeting criteria: ≥36 weeks GA, ≤6 hours of age, evidence of
perinatal depression (pH <7.0 or base deficit ≥16, or 10-min Apgar
ANS
≤5 or need for resuscitation at 10 min), AND moderate-to-severe
encephalopathy on exam. Target 33–34°C for 72 hours.
Q12 What are contraindications to therapeutic hypothermia?
Prematurity <36 weeks, birth weight <1800g (relative), major
congenital anomalies incompatible with life, severe coagulopathy
ANS
unresponsive to treatment, and presentation >6 hours after birth.
Moribund status is also a relative contraindication.
For Educational Use Only | Page 3
, What is the role of laryngeal mask airway (LMA) in neonatal
Q13
resuscitation?
LMA (size 1) is indicated as an alternative airway when ETT
intubation is unsuccessful and infant is ≥34 weeks and ≥2000g. It
ANS
can be used for PPV but not for tracheal suctioning or drug
delivery. It is a bridge to definitive airway.
What is the etiology of congenital diaphragmatic hernia (CDH) and
Q14
its resuscitation approach?
CDH results from failure of diaphragm closure, causing herniation
of abdominal contents into the thorax, leading to pulmonary
ANS hypoplasia and PPHN. Resuscitate without bag-mask ventilation
(causes bowel distension). Intubate immediately; place NG tube,
avoid high PIPs.
What is the significance of a persistent HR <60 bpm after 60
Q15
seconds of CPR?
Consider IV epinephrine, assess for pneumothorax, confirm ETT
placement and adequate ventilation, ensure IV/IO access, check for
ANS
hypovolemia. If persistent, consider discontinuation discussion after
10–20 minutes with no response per NRP guidelines.
2. Respiratory Distress & Pulmonary Disorders
What is Respiratory Distress Syndrome (RDS) and its
Q16
pathophysiology?
RDS (hyaline membrane disease) is caused by surfactant deficiency
ANS in preterm lungs, leading to alveolar collapse, ventilation-perfusion
mismatch, hypoxemia, and respiratory failure. Surfactant normally
For Educational Use Only | Page 4
