CCRN-K Neonatal cheat sheet

Neonatal Resuscitation Program (NRP) 8th edition sequence: anticipate risk, initial steps (warm, dry, stimulate, clear airway if needed), assess breathing and heart rate, then PPV for apnea/gasping or HR <100; chest compressions at 3:1 ratio with PPV if HR <60 after 60 seconds of effective ventilation.

Epinephrine dose in NRP: 0.01-0.03 mg/kg IV/IO of 0.1 mg/mL (0.1-0.3 mL/kg) or 0.05-0.1 mg/kg via endotracheal tube of 0.1 mg/mL; repeat q3-5 min if HR remains <60.

Volume expansion in neonatal resuscitation: 10 mL/kg isotonic crystalloid (0.9% NaCl or O-negative blood) over 5-10 minutes when hypovolemia suspected and HR not responding.

APGAR scoring: five components (Appearance, Pulse, Grimace, Activity, Respiration) each 0-2, assessed at 1 and 5 minutes; score of 0-3 indicates need for immediate resuscitation; APGAR does not guide ongoing resuscitation decisions.

Therapeutic hypothermia criteria (moderate-severe HIE): gestational age >=36 weeks, birth weight >=1800 g, evidence of perinatal event, pH <=7.0 or base deficit >=16 on cord gas, or 10-minute APGAR <=5, or need for resuscitation at birth; initiate within 6 hours of birth, target 33.5 degrees C for 72 hours.

Informed consent for research or procedures in neonates: parental/guardian permission is required; assent from the minor is not applicable in neonates; emergency exception applies only when life-threatening and no time for consent.

Family-centered care principles: unrestricted parental presence, kangaroo care for stable infants, shared decision-making, and structured communication (e.g., daily rounds with parents) reduce parental stress and support neurodevelopment.

Pain assessment tools: N-PASS, PIPP-R, and CRIES for preterm/term neonates; use a validated tool before and after painful procedures; nonpharmacologic measures (sucrose, facilitated tucking, skin-to-skin) plus pharmacologic agents when indicated.

Safe medication practices: weight-based dosing in kg with double-check, dose-range checking, and use of smart pumps; high-alert neonatal medications include opioids, insulin, potassium chloride, and concentrated electrolytes.

Fetal circulation shunts: ductus venosus, foramen ovale, and ductus arteriosus; after birth, pulmonary vascular resistance falls, pulmonary blood flow rises, and shunts close functionally (ductus arteriosus within 24-72 hours, foramen ovale functionally, ductus venosus closes within days).

Surfactant deficiency in respiratory distress syndrome (RDS): onset within hours of birth, grunting, retractions, nasal flaring, ground-glass infiltrates, and low lung volumes; treatment includes exogenous surfactant (poractant alfa 2.5 mL/kg or beractant 4 mL/kg per dose) and CPAP.

Bronchopulmonary dysplasia (BPD) definition: oxygen requirement at 36 weeks postmenstrual age (or 28 days of life depending on gestational age) with characteristic radiographic changes; risk factors include prematurity, mechanical ventilation, oxygen toxicity, and inflammation.

Persistent pulmonary hypertension of the newborn (PPHN): elevated pulmonary vascular resistance with right-to-left shunting; pre- and post-ductal SpO2 difference >5-10% suggests shunting; treatment includes inhaled nitric oxide (iNO) starting at 20 ppm, optimized lung recruitment, and avoidance of hypoxia, acidosis, and hypothermia.

Necrotizing enterocolitis (NEC): preterm infants, feeding intolerance, bloody stools, abdominal distension, pneumatosis intestinalis on x-ray; management includes NPO, decompression, antibiotics, and surgery for perforation; Bell staging I-III.

Neonatal sepsis: early-onset (<=72 hours, often group B Streptococcus, E. coli) vs late-onset (>72 hours, often coagulase-negative Staphylococcus, Klebsiella); signs are nonspecific (temperature instability, apnea, feeding intolerance, lethargy); obtain blood culture before antibiotics.

Hyperbilirubinemia: physiologic jaundice peaks at 3-5 days in term infants; pathologic if onset <24 hours, rapid rise (>5 mg/dL/day), or direct fraction elevated; treat with phototherapy and exchange transfusion based on hour-specific nomogram thresholds.

Hypoglycemia in neonates: defined as plasma glucose <45 mg/dL in first 48 hours (per AAP) or <40 mg/dL in some protocols; at-risk infants include preterm, SGA, LGA, infant of diabetic mother; treat with early feeding or IV dextrose bolus 2 mL/kg of D10W followed by continuous infusion.

Patent ductus arteriosus (PDA) in preterm infants: systolic murmur, bounding pulses, wide pulse pressure, pulmonary edema; treatment options include conservative management, ibuprofen/indomethacin, or surgical ligation; contraindicated with NEC, renal failure, or thrombocytopenia.