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Textbook of Neonatal Resuscitation (NRP) 7th Edition Test Bank

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Foundations of Neonatal Resuscitation What you will learn ■ Why neonatal resuscitation skills are important ■ Physiologic changes that occur during and after birth ■ The format of the Neonatal Resuscitation Program® Flow Diagram ■ Communication and teamwork skills used by effective resuscitation teams Used with permission of Mayo Foundation for Medical Education and Research. 1 Antenatal counseling. Team briefing and equipment check. Birth 1 minute Labored breathing or persistent cyanosis? Yes The Neonatal Resuscitation Program (NRP®) will help you learn the cognitive, technical, and teamwork skills that you need to resuscitate and stabilize newborns. Although most newborns make the cardiorespiratory transition to extrauterine life without intervention, many will require assistance to begin breathing and a small number will require extensive intervention. After birth, approximately 4% to 10% of term and late preterm newborns will receive positive-pressure ventilation (PPV), while only 1 to 3 per 1,000 will receive chest compressions or emergency medications. Because the need for assistance cannot always be predicted, teams need to be prepared to provide these lifesaving interventions quickly and efficiently at every birth. During your NRP course, your team will learn how to evaluate a newborn, make decisions about what actions to take, and practice the steps involved in resuscitation. As you practice together in simulated cases, your resuscitation team will gradually build proficiency and speed. Why do newborns require a different approach to resuscitation than adults? Most often, adult cardiac arrest is a complication of trauma or existing heart disease. It is caused by a sudden arrhythmia that prevents the heart from effectively circulating blood. As circulation to the brain decreases, the adult victim loses consciousness and stops breathing. At the time of arrest, the oxygen and carbon dioxide (CO2) content of blood is usually normal. During adult cardiopulmonary resuscitation, chest compressions are used to maintain circulation until electrical defibrillation or medications restore cardiac function. In contrast, most newborns requiring resuscitation have a healthy heart. When a newborn requires resuscitation, it is usually caused by a problem with respiration leading to inadequate gas exchange. Respiratory failure may occur either before or after birth. Before birth, fetal respiratory function is performed by the placenta. If the placenta is functioning normally, oxygen is transferred from the mother to the fetus and CO2 is removed. When placental respiration fails, the fetus receives an insufficient supply of oxygen to support normal cellular functions and CO2 cannot be removed. The blood level of acid increases as cells attempt to function without oxygen and CO2 accumulates. Fetal monitoring may show a decrease in activity, loss of heart rate variability, and heart rate decelerations. If placental respiratory failure persists, the fetus will make a series of gasps followed by apnea and bradycardia. If the fetus is born in the early phase of respiratory failure, tactile stimulation may be sufficient to initiate spontaneous breathing and recovery. If the fetus is born in a later phase of respiratory failure, stimulation will not be sufficient and the newborn will require assisted ventilation for recovery. The most

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TEXTBOOK OF




Neonatal
Resuscitation
7th Edition
®

,Textbook of Neonatal
Resuscitation, 7th Edition
Editor
Gary M. Weiner, MD, FAAP

Associate Editor
Jeanette Zaichkin, RN, MN, NNP-BC

Editor Emeritus
John Kattwinkel, MD, FAAP

Assistant Editors Educational Design Editor
Anne Ades, MD, FAAP Jerry Short, PhD
Christopher Colby, MD, FAAP
Eric C. Eichenwald, MD, FAAP Managing Editors

Kimberly D. Ernst, MD, MSMI, FAAP Rachel Poulin, MPH
Marilyn Escobedo, MD, FAAP Wendy Marie Simon, MA, CAE
John Gallagher, MPH, RRT-NPS
Based on original text by
Louis P. Halamek, MD, FAAP
Ronald S. Bloom, MD, FAAP
Jessica Illuzzi, MD, MS, FACOG
Catherine Cropley, RN, MN
Vishal Kapadia, MD, MSCS, FAAP
Henry C. Lee, MD, FAAP Textbook of Neonatal
Linda McCarney, MSN, APRN, Resuscitation, 7th Edition,
NNP-BC eSim Cases:
Patrick McNamara, MB, FRCPC Anne Ades, MD, FAAP
Jeffrey M. Perlman, MB, ChB, FAAP Kimberly D. Ernst, MD, MSMI, FAAP
Steven Ringer, MD, PhD, FAAP Jeanette Zaichkin, RN, MN, NNP-BC
Marya L. Strand, MD, MS, FAAP
Myra H. Wyckoff, MD, FAAP

,Published by the American Academy of Pediatrics
141 Northwest Point Blvd
Elk Grove Village, IL 60007-1019
Telephone: 847/434-4000
Facsimile: 847/228-1350
www.aap.org
The recommendations in this publication and the accompanying materials do not indicate an exclusive course of treatment or
serve as a standard of care. Variations, taking into account individual circumstances, nature of medical oversight, and local
protocols, may be appropriate.
Every effort has been made to ensure that contributors to the Neonatal Resuscitation Program materials are knowledgeable
authorities in their fields. Readers are nonetheless advised that the statements and opinions expressed are provided as guidelines
and should not be construed as official policy of the American Academy of Pediatrics or the American Heart Association.
This material is made available as part of the professional education programs of the American Academy of Pediatrics and the
American Heart Association. No endorsement of any product or service should be inferred or is intended.
The American Academy of Pediatrics and the American Heart Association disclaim any liability or responsibility for the
consequences of any actions taken in reliance on these statements or opinions.
The American Academy of Pediatrics reserves the right to disclose personal information related to course completion of course
participants/providers for administrative purposes such as to verify participation or classes taken or to validate the status of any
Course Completion Card. In no event shall the American Academy of Pediatrics or American Heart Association have any liability for
disclosure or use of information for such purposes or responsibility for the consequences of any actions taken in reliance on such
information.
Copyright © 2016 American Academy of Pediatrics and American Heart Association

All rights reserved. No part of this publication or its accompanying materials may be reproduced, stored in a retrieval system, or
transmitted in any form or by any means—electronic, mechanical, photocopying, recording, or otherwise–without prior permission
from the publisher (locate title at http://ebooks.aappublications.org and click on © Get Permissions; you may also fax the
permissions editor at 847/434-8780 or e-mail ). First edition published 1987; second, 1990; third, 1994;
fourth, 2000; fifth, 2006; sixth, 2011.
Printed in the United States of America
NRP323
ISBN: 978-1-61002-024-4
eBook: 978-1-61002-025-1

Library of Congress Control Number: 2015950716
5-276/0416 1 2 3 4 5 6 7 8 9 10

, Acknowledgments
NRP Steering Committee Members
Myra H. Wyckoff, MD, FAAP, Co-chair 2011-2015 Erich C. Eichenwald, MD, FAAP
Steven Ringer, MD, PhD, FAAP, Co-chair 2013-2015 Kimberly D. Ernst, MD, MSMI, FAAP
Marilyn Escobedo, MD, FAAP, Co-chair 2015-2017 Vishal Kapadia, MD, FAAP
Anne Ades, MD, FAAP Henry C. Lee, MD, FAAP
Christopher Colby, MD, FAAP Marya L. Strand, MD, MS, FAAP

Liaison Representatives
Eric C. Eichenwald, MD, FAAP Linda McCarney, MSN, APRN, NNP-BC
AAP Committee on Fetus and Newborn National Association of Neonatal Nurses
John Gallagher, MPH, RRT-NPS Patrick McNamara, MB, FRCPC
American Association for Respiratory Care Canadian Paediatric Society
Jessica Illuzzi, MD, MS, FACOG
American College of Obstetricians
and Gynecologists


Associated Education Materials for the Textbook of Neonatal Resuscitation, 7th Edition
Instructor Toolkit, Jeanette Zaichkin, RN, MN, NRP Key Behavioral Skills Poster, Louis P. Halamek,
NNP-BC, Editor MD, FAAP, Editor
Instructor Course, Jeanette Zaichkin, RN, MN, NRP Equipment Poster, Jeanette Zaichkin, RN, MN,
NNP-BC, Editor; Vishal Kapadia, MD, MSCS, FAAP; NNP-BC, Editor
Henry C. Lee, MD, FAAP; Taylor Sawyer, DO, MEd, NRP App, Steven Ringer, MD, PhD, FAAP and
FAAP; and Nicole K. Yamada, MD, FAAP, Marya L. Strand, MD, MS, FAAP, Editors
Contributors
Neonatal Resuscitation Scenarios, Jeanette Zaichkin,
NRP Online Examination for Instructors, Jeanetet RN, MN, NNP-BC, Editor; Myra H. Wyckoff, MD,
Zaichkin, RN, MN, NNP-BC FAAP; Vishal Kapadia, MD, MSCS, FAAP; Marya L.
NRP Online Examination for Providers, Steven Ringer, Strand, MD, MS, FAAP, Contributors
MD, PhD, FAAP, and Jerry Short, PhD, Editors
NRP Reference Chart, Code Cart Cards, and Pocket
Cards, Vishal Kapadia, MD, MSCS, FAAP, Editor


The committee would like to express thanks to the following reviewers and contributors
to this textbook:
American Academy of Pediatrics Committee on Fetus Jeffrey M. Perlman, MB, ChB, FAAP,
and Newborn Co-chairJonathan Wylie, MD, Co-chair
American Academy of Pediatrics Section on Bioethics
International Liaison Committee on Resuscitation,
Neonatal Delegation

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