Neonatal Nurse Practitioner Practice Exam

What should be the next intervention if positive pressure ventilation with 21% oxygen is administered at delivery and the heart rate increases to 102 bpm after 30 seconds?

1. Continue ventilation for a minimum of one minute

2. Discontinue ventilation

3. Observe for spontaneous respirations, then discontinue ventilation

4. Call for additional support

The correct answer is: Observe for spontaneous respirations, then discontinue ventilation

In the scenario where positive pressure ventilation with 21% oxygen has been provided at delivery and the heart rate has increased to 102 bpm after 30 seconds, observing for spontaneous respirations before discontinuing ventilation is an appropriate next step. The increase in heart rate indicates that the infant is responding positively to the initial ventilation, which suggests improvement in oxygenation and possibly in the overall condition. After administering ventilation for a short period and observing a positive change in heart rate, it is critical to assess whether the infant can breathe spontaneously. If the infant begins to breathe on their own, then continuing to provide positive pressure ventilation may no longer be necessary, allowing for a reduction of the intervention and minimizing the risk of over-assisting, which can lead to issues like respiratory depression or dependence. Monitoring for spontaneous respirations ensures that the infant is not just stable but is also capable of maintaining adequate ventilation independently. If spontaneous breaths are noted, the ventilation can be safely discontinued. This approach aligns with the principles of neonatal resuscitation, where the goal is to promote effective, independent breathing as soon as possible. Continuing ventilation for a full minute without reassessment may delay the recognition of the infant's capability to breathe on their own. Discontinuing ventilation without confirming