NCC NNP-BC cheat sheet

Normal fetal heart rate baseline is 110-160 bpm; baseline bradycardia is <110 bpm for ≥10 minutes, tachycardia is >160 bpm for ≥10 minutes.

Category I tracing: baseline 110-160 bpm, moderate variability (6-25 bpm), no late or variable decelerations, with or without accelerations and early decelerations.

Category III tracing includes absent variability with recurrent late or variable decelerations, bradycardia, or a sinusoidal pattern; it requires prompt evaluation and intrauterine resuscitation.

Accelerations at ≥32 weeks: ≥15 bpm above baseline lasting ≥15 seconds; before 32 weeks: ≥10 bpm lasting ≥10 seconds.

Uterine tachysystole is >5 contractions in 10 minutes averaged over 30 minutes; treatment is maternal repositioning, IV fluid bolus, and reduction or discontinuation of oxytocin.

Variable decelerations reflect umbilical cord compression; late decelerations reflect uteroplacental insufficiency; early decelerations mirror contractions from head compression and are benign.

Tocolytic/acute intrauterine resuscitation sequence: stop oxytocin, left lateral positioning, IV crystalloid bolus, oxygen if hypoxemic, and consider terbutaline for tachysystole.

Group B streptococcus prophylaxis: penicillin G is first-line; cefazolin for non-anaphylactic penicillin allergy; clindamycin only if susceptibility testing confirms sensitivity.

NRP initial steps for a non-vigorous newborn: warm, dry, stimulate, position airway; suction only if airway obstruction is suspected.

Apnea or gasping, heart rate <100 bpm, or poor tone after initial steps warrants positive pressure ventilation at 40-60 breaths per minute.

Compressions begin when heart rate remains <60 bpm after at least 30 seconds of effective ventilation; ratio is 3 compressions to 1 breath, 90 compressions and 30 breaths per minute.

Epinephrine dose in neonatal resuscitation is 0.01-0.03 mg/kg IV/IO of 0.1 mg/mL solution; endotracheal dose is 0.05-0.1 mg/kg of 1 mg/mL solution.

Targeted preductal oxygen saturation: about 60-65% at 1 minute, 70-75% at 2 minutes, 80-85% at 3 minutes, 85-95% at 5 minutes, and 90-95% by 10 minutes.

Volume expansion in neonatal resuscitation is 10 mL/kg of normal saline or blood over 5-10 minutes, indicated for hypovolemia or blood loss.

Apgar score components are heart rate, respiratory effort, muscle tone, reflex irritability, and color; it is assigned at 1 and 5 minutes and does not guide resuscitation.

Delayed cord clamping for at least 30-60 seconds is recommended for term and preterm infants not requiring immediate resuscitation.

Surfactant deficiency in respiratory distress syndrome produces decreased compliance, atelectasis, and ground-glass infiltrates with air bronchograms on chest radiograph.

Transient tachypnea of the newborn presents within hours of birth with tachypnea, mild hypoxemia, and perihilar streaking or fluid in fissures; it usually resolves within 24-72 hours.

Meconium aspiration syndrome risk increases with thick meconium and fetal distress; management includes airway clearance and respiratory support as needed.

Bronchopulmonary dysplasia is defined in infants born <32 weeks as oxygen requirement for ≥28 days, graded by respiratory support at 36 weeks postmenstrual age.

Physiologic nadir of arterial oxygen tension occurs at 24-48 hours of life and may fall to 50-70 mmHg in preterm infants.

Apnea of prematurity is a pause in breathing ≥20 seconds, or shorter with bradycardia or desaturation, and is treated with caffeine citrate.

Nasal CPAP is preferred initial support for preterm infants with respiratory distress; intubation and surfactant are indicated for escalating oxygen and work of breathing.

Oxygen saturation targets for preterm infants receiving supplemental oxygen are typically 90-95% to reduce retinopathy of prematurity risk.

Ductal closure occurs functionally within hours to days after birth; anatomic closure takes weeks, and patency is maintained by prostaglandin E1 and low oxygen tension.

Prostaglandin E1 infusion at 0.01-0.1 mcg/kg/min maintains ductal patency in ductal-dependent lesions such as pulmonary atresia and critical coarctation.

Ductal-dependent lesions presenting with cyanosis include transposition of the great arteries, pulmonary atresia, tricuspid atresia, and tetralogy of Fallot with severe pulmonary stenosis.

Ductal-dependent systemic lesions include hypoplastic left heart syndrome, critical aortic stenosis, and interrupted aortic arch; they present with shock and diminished pulses.

Normal neonatal heart rate is 120-160 bpm awake; sinus bradycardia is <90 bpm and may require evaluation for congenital heart block.

Hyperoxia test: an arterial oxygen tension >150 mmHg after 100% oxygen suggests pulmonary rather than cyanotic cardiac disease.

Closure of a patent ductus arteriosus may be achieved with indomethacin or ibuprofen; contraindications include renal failure, thrombocytopenia, and necrotizing enterocolitis.

Hypoplastic left heart syndrome initial management includes prostaglandin E1 and avoidance of excessive pulmonary blood flow by limiting supplemental oxygen.

Hypoxic-ischemic encephalopathy staging by Sarnat includes stage I (mild), stage II (moderate), and stage III (severe); therapeutic hypothermia is indicated for moderate to severe HIE.

Therapeutic hypothermia is initiated within 6 hours of birth, targets 33.5-34.5 degrees Celsius for 72 hours, and requires sedation, monitoring, and slow rewarming.

Neonatal seizures may present as subtle, clonic, tonic, or myoclonic movements; electroencephalography is required for confirmation because clinical signs are unreliable.

Normal newborn reflexes include Moro, rooting, sucking, palmar grasp, and stepping; the Babinski sign is positive in normal newborns.

Intraventricular hemorrhage in preterm infants is graded I-IV by Papile criteria; grade III involves ventricular dilation and grade IV involves parenchymal hemorrhage.

Periventricular leukomalacia is white matter injury associated with prematurity, ischemia, and infection, and is a major cause of cerebral palsy.

A bulging fontanelle with sunsetting eyes and increasing head circumference suggests hydrocephalus or increased intracranial pressure.

Kernicterus results from bilirubin deposition in basal ganglia and brainstem; acute signs include lethargy, poor feeding, hypertonia, and retrocollis.

Necrotizing enterocolitis presents with feeding intolerance, abdominal distension, bloody stools, and pneumatosis intestinalis; management includes bowel rest, antibiotics, and parenteral nutrition.

Physiologic jaundice appears after 24 hours; jaundice within the first 24 hours is pathologic and requires urgent bilirubin measurement.

Breastfed infants should receive vitamin D supplementation of 400 IU daily beginning in the first days of life.

Preterm infants have higher caloric needs, approximately 110-150 kcal/kg/day, and enteral feeding advancement is typically 15-30 mL/kg/day in stable infants.

Meconium should pass within 48 hours; delayed passage suggests Hirschsprung disease, meconium plug, or cystic fibrosis.

Bilirubin encephalopathy risk is assessed using hour-specific nomograms; exchange transfusion is considered at very high bilirubin levels based on age, weight, and risk factors.

Gastroesophageal reflux in infants is usually managed with positioning and small frequent feeds; pharmacologic therapy is reserved for complicated cases.

Pyloric stenosis presents at 3-6 weeks with projectile nonbilious vomiting, visible peristalsis, and hypochloremic hypokalemic metabolic alkalosis.

Newborn urine output is typically 1-3 mL/kg/hour; oliguria is defined as <1 mL/kg/hour.

Physiologic weight loss in the first week is up to 7-10% in term infants and up to 15% in preterm infants; greater loss requires feeding and hydration assessment.

Insensible water loss is highest in extremely preterm infants and increases with radiant warmers, phototherapy, and tachypnea.

Neonatal sodium requirements are approximately 2-4 mEq/kg/day for preterm infants and 1-2 mEq/kg/day for term infants.

Potassium should not be given until urine output is established; typical maintenance is 1-2 mEq/kg/day.

Hyperkalemia in preterm infants may be non-oliguric and is treated with calcium gluconate, insulin with glucose, and sodium bicarbonate if acidotic.

Normal newborn blood urea nitrogen is lower than in adults; a creatinine obtained in the first days reflects maternal values and should be rechecked.

Acute kidney injury is staged by creatinine rise and urine output; causes include asphyxia, sepsis, nephrotoxic drugs, and obstructive lesions.

Physiologic anemia of infancy occurs at 8-12 weeks in term infants and 4-8 weeks in preterm infants due to low erythropoietin and shortened red cell lifespan.

Hemoglobin values at birth average 14-20 g/dL in term infants; the nadir is approximately 9-11 g/dL in term and 7-9 g/dL in preterm infants.

Hemolytic disease of the newborn from Rh incompatibility is prevented by Rho(D) immune globulin given to unsensitized Rh-negative mothers.

Vitamin K prophylaxis at birth is 0.5-1 mg intramuscularly to prevent hemorrhagic disease of the newborn.

Neonatal alloimmune thrombocytopenia results from maternal antibodies against fetal platelet antigens and may cause severe intracranial hemorrhage.

Maternal immunoglobulin G crosses the placenta and provides passive immunity; immunoglobulin A is present in breast milk and protects the intestinal mucosa.

Newborn screening for severe combined immunodeficiency uses T-cell receptor excision circles on the dried blood spot.

Physiologic nadir of platelets is not expected; platelet count <150,000/microliter requires evaluation for sepsis, alloimmune destruction, or congenital infection.

Early-onset sepsis presents within 72 hours and is associated with maternal group B streptococcus colonization, prolonged rupture of membranes, chorioamnionitis, and prematurity.

Group B streptococcus prophylaxis is indicated for maternal colonization, previous infant with invasive disease, or unknown status with rupture of membranes ≥18 hours or intrapartum fever.

Ampicillin plus gentamicin is standard empiric therapy for early-onset neonatal sepsis; add a third agent if meningitis is suspected.

Neonatal herpes simplex virus infection presents with skin vesicles, lethargy, poor feeding, or seizures; treatment is high-dose acyclovir.

Congenital cytomegalovirus is the leading nongenetic cause of sensorineural hearing loss; screening often uses urine or saliva polymerase chain reaction.

Congenital syphilis evaluation includes maternal serology, infant physical examination, and cerebrospinal fluid analysis; treatment is aqueous penicillin G.

Late-onset sepsis occurs after 72 hours and is often caused by coagulase-negative staphylococci, Staphylococcus aureus, and gram-negative organisms in preterm infants.

Universal hepatitis B vaccination is given at birth within 24 hours, with hepatitis B immunoglobulin for infants of hepatitis B surface antigen-positive mothers.

Congenital hypothyroidism is detected by newborn screening; treatment with levothyroxine should begin within 2 weeks of life to prevent intellectual disability.

Congenital adrenal hyperplasia from 21-hydroxylase deficiency causes salt-wasting crisis with hyponatremia, hyperkalemia, and hypotension in the second week of life.

Newborn screening for congenital adrenal hyperplasia uses 17-hydroxyprogesterone on the dried blood spot.

Infants of diabetic mothers are at risk for hypoglycemia, macrosomia, polycythemia, and congenital anomalies including cardiac septal defects and caudal regression.

Hypoglycemia in newborns is defined as glucose <45 mg/dL in the first 24 hours; treatment includes feeding and intravenous dextrose if symptomatic or persistent.

Phenylketonuria is managed with a phenylalanine-restricted diet; untreated disease causes intellectual disability and musty odor.

Galactosemia presents with jaundice, hepatomegaly, vomiting, and cataracts after milk feeding; treatment is a lactose-free and galactose-free diet.

Maple syrup urine disease presents in the first week with poor feeding, lethargy, and a sweet odor; treatment includes dietary restriction of branched-chain amino acids.

Trisomy 21 features include hypotonia, upslanting palpebral fissures, a single palmar crease, and an increased risk of congenital heart disease and duodenal atresia.

Trisomy 18 features include micrognathia, clenched overlapping fingers, rocker-bottom feet, and congenital heart defects; survival beyond infancy is limited.

Trisomy 13 features include cleft lip and palate, polydactyly, microphthalmia, and holoprosencephaly.

Turner syndrome (45,X) presents in females with webbed neck, lymphedema, short stature, and coarctation of the aorta.

Klinefelter syndrome (47,XXY) presents in males with tall stature, gynecomastia, small testes, and infertility.

Fragile X syndrome is the most common inherited cause of intellectual disability and is associated with macroorchidism and a family history of male intellectual disability.

A single umbilical artery is associated with renal and cardiac anomalies and warrants renal ultrasound evaluation.

Aneuploidy risk increases with maternal age; cell-free DNA screening detects trisomy 21 with high sensitivity but is not diagnostic.

Family-centered care includes parents as partners in decision-making, protected skin-to-skin contact, and involvement in rounds and care planning.

Informed consent requires disclosure of risks, benefits, and alternatives, assessment of understanding, and voluntary agreement without coercion.

Neonatal nurses must report suspected child abuse or neglect under state mandatory reporting laws.

Kangaroo care reduces mortality, improves thermoregulation, and supports breastfeeding in low-birth-weight infants.

Developmental care includes clustered care, minimal handling, dim lighting, and protected sleep to reduce stress in preterm infants.

Quality improvement in neonatal units commonly uses the Institute for Healthcare Improvement model and measures central line-associated bloodstream infections and ventilator-associated events.

Discharge teaching for preterm infants includes car seat tolerance testing, safe sleep, feeding plan, and follow-up for hearing and developmental screening.

Cultural humility in neonatal care includes interpreter use, respect for family beliefs, and shared decision-making about feeding and end-of-life care.