CCRN-K Neonatal flashcards

31 cards. Read the term and the definition here. The deck at the top of this page is optional.

NRP compression-to-ventilation ratio

In neonatal resuscitation, chest compressions are delivered at a 3:1 ratio with positive pressure ventilation, giving 90 compressions and 30 breaths per minute when heart rate is below 60.

Epinephrine IV dose in neonates

For neonatal resuscitation with heart rate below 60 despite effective ventilation and compressions, give epinephrine 0.01-0.03 mg/kg IV/IO of the 0.1 mg/mL concentration, repeated every 3-5 minutes as needed.

APGAR score components

APGAR assesses Appearance, Pulse, Grimace, Activity, and Respiration, each scored 0-2, at 1 and 5 minutes after birth; it does not guide ongoing resuscitation decisions.

Therapeutic hypothermia window

For moderate-severe hypoxic-ischemic encephalopathy in infants >=36 weeks, initiate cooling within 6 hours of birth, target 33.5 degrees C for 72 hours, then rewarm slowly over at least 6 hours.

Volume expander in neonatal resuscitation

Give 10 mL/kg of isotonic crystalloid (0.9% NaCl) or O-negative blood over 5-10 minutes when hypovolemia is suspected and heart rate does not respond to resuscitation.

Informed consent in neonates

Parental or guardian permission is required for procedures and research in neonates; neonatal assent is not applicable; emergency exception applies only for immediate life-threatening situations.

Family-centered care in NICU

Unrestricted parental presence, kangaroo care for stable infants, shared decision-making, and structured daily communication reduce parental stress and support infant neurodevelopment.

Neonatal pain assessment tools

Validated tools include N-PASS, PIPP-R, and CRIES; assess before and after painful procedures and combine nonpharmacologic measures (sucrose, tucking, skin-to-skin) with pharmacologic agents when indicated.

High-alert neonatal medications

Opioids, insulin, potassium chloride, and concentrated electrolytes are high-alert neonatal medications requiring weight-based dosing, independent double-checks, and smart-pump safeguards.

Neonatal Resuscitation Program initial steps

Warm, dry, stimulate, and clear the airway if needed; then assess breathing and heart rate; provide positive pressure ventilation for apnea, gasping, or heart rate below 100.

Kangaroo care benefits

Skin-to-skin contact for stable infants stabilizes temperature, heart rate, and respirations; improves breastfeeding rates; reduces parental stress; and supports neurodevelopmental outcomes.

Fetal circulation shunts

Three fetal shunts are the ductus venosus, foramen ovale, and ductus arteriosus; after birth, falling pulmonary vascular resistance and rising pulmonary blood flow promote their functional closure.

Ductus arteriosus closure timing

The ductus arteriosus closes functionally within 24-72 hours after birth in term infants and anatomically over weeks; in preterm infants, delayed closure results in a patent ductus arteriosus.

Respiratory distress syndrome features

Surfactant deficiency causes grunting, retractions, nasal flaring, ground-glass infiltrates, and low lung volumes within hours of birth; treatment includes exogenous surfactant and CPAP.

Surfactant dosing

Poractant alfa is dosed at 2.5 mL/kg per instillation and beractant at 4 mL/kg per dose; administer via the endotracheal tube and monitor for airway obstruction and transient desaturation.

Bronchopulmonary dysplasia definition

BPD is defined by oxygen requirement at 36 weeks postmenstrual age with characteristic radiographic changes, associated with prematurity, mechanical ventilation, oxygen toxicity, and inflammation.

Persistent pulmonary hypertension

PPHN involves elevated pulmonary vascular resistance with right-to-left shunting; a pre- and post-ductal SpO2 difference above 5-10% suggests shunting; treatment includes inhaled nitric oxide at 20 ppm.

Inhaled nitric oxide starting dose

Inhaled nitric oxide for PPHN is typically started at 20 ppm, with optimization of lung recruitment and avoidance of hypoxia, acidosis, and hypothermia to reduce pulmonary vascular resistance.

Necrotizing enterocolitis signs

NEC presents with feeding intolerance, bloody stools, abdominal distension, and pneumatosis intestinalis on x-ray; management includes NPO, decompression, antibiotics, and surgery for perforation.

Early-onset neonatal sepsis

Early-onset sepsis occurs within 72 hours of birth, commonly from group B Streptococcus or E. coli; signs are nonspecific and a blood culture should be obtained before starting antibiotics.

Late-onset neonatal sepsis

Late-onset sepsis occurs after 72 hours, often from coagulase-negative Staphylococcus or Klebsiella, and is associated with central lines, prolonged hospitalization, and parenteral nutrition.

Physiologic jaundice peak

Physiologic jaundice in term infants peaks at 3-5 days of life; jaundice appearing within 24 hours or rising more than 5 mg/dL per day suggests pathologic hyperbilirubinemia.

Phototherapy for hyperbilirubinemia

Phototherapy is initiated based on hour-specific bilirubin nomogram thresholds; exchange transfusion is reserved for levels near or above exchange thresholds or for signs of acute bilirubin encephalopathy.

Neonatal hypoglycemia threshold

Plasma glucose below 45 mg/dL in the first 48 hours is considered hypoglycemia; at-risk infants include preterm, small-for-gestational-age, large-for-gestational-age, and infants of diabetic mothers.

Hypoglycemia treatment in neonates

For symptomatic or persistent hypoglycemia, give IV dextrose 2 mL/kg of D10W as a bolus followed by a continuous infusion, then recheck glucose within 30 minutes and titrate.

Patent ductus arteriosus signs

PDA in preterm infants causes a systolic murmur, bounding pulses, wide pulse pressure, and pulmonary edema; treatment options include conservative management, NSAIDs, or surgical ligation.

NSAID contraindications for PDA

Ibuprofen or indomethacin for PDA closure is contraindicated in necrotizing enterocolitis, renal failure, thrombocytopenia, and significant bleeding; surgical ligation is reserved for refractory cases.

Pre- and post-ductal SpO2

A pre-ductal (right hand) and post-ductal (foot) SpO2 difference greater than 5-10% suggests right-to-left shunting and supports evaluation for persistent pulmonary hypertension or congenital heart disease.

Neonatal sepsis signs

Signs of neonatal sepsis are nonspecific and include temperature instability, apnea, feeding intolerance, lethargy, and respiratory distress; obtain a blood culture before starting antibiotics.

Bell staging of NEC

Bell staging classifies NEC: stage I is suspected with mild signs, stage II is definite with pneumatosis intestinalis, and stage III is advanced with perforation or systemic deterioration.

Neonatal glucose monitoring

Screen at-risk infants (preterm, SGA, LGA, infant of diabetic mother) with bedside glucose within the first hour and before feedings until stable, and confirm low values with a laboratory plasma glucose.