Neonatal & Pediatric Respiratory Care Module Overview & Mock Exam
This module overview pulls together the core concepts from Lessons 1 through 6. Use it as a final pass before taking the cumulative mock exam.
Topics Covered
- Lesson 1 — Neonatal & Pediatric Foundations: neonatal/pediatric terminology, the three fetal shunts (ductus venosus, ductus arteriosus, foramen ovale), prostaglandin, maternal risk factors, the placenta, and fetal assessment tests.
- Lesson 2 — The Newborn Assessment & RDS: newborn evaluation, resuscitation and oxygen targets, APGAR and Ballard scores, weight classifications, the Colorado growth chart, the Silverman score, RDS, surfactant therapy, blood-gas targets, pre/post-ductal monitoring, and pediatric assessment.
- Lesson 3 — Disease Processes: RDS, TTN, AOP, PPHN, BPD, MAS, CDH, ROP, PIE, gastroschisis, NEC, SIDS, GERD, bronchiolitis, croup, epiglottitis, and cystic fibrosis.
- Lesson 4 — Conventional Mechanical Ventilation: NCPAP/NIV, respiratory time constants, infant ventilators, settings (PIP, PEEP, ∆P, Vt, rate, I-time, FiO₂), AARC criteria, and air leak syndromes.
- Lesson 5 — High-Frequency Ventilation: HFV principles, the five gas-transport mechanisms, HFOV settings, HFJV settings, and servo pressure.
- Lesson 6 — Neonatal & Pediatric Equipment: transcutaneous monitoring, iNO, ECMO, incubators/warmers, oxygen-delivery devices, ETT sizing, HFNC, blenders, and bedside medication delivery.
High-Yield Review
| Concept | High-yield point |
|---|---|
| Mature vs. premature | Mature = 38–42 weeks; premature = before 38 weeks (high risk). |
| Fetal shunts | Ductus venosus (liver ↔ IVC), ductus arteriosus (PA ↔ aorta), foramen ovale (RA ↔ LA). |
| Prostaglandin | Keeps the ductus arteriosus open; given to maintain patency in ductal-dependent defects. |
| Surfactant testing | L/S ratio of 2:1 and phosphatidylglycerol > 1% indicate mature lungs. |
| Fetal heart rate | Normal 100–160/min; tachycardia suggests hypoxemia, prematurity, or maternal fever. |
| Resuscitation | HR < 100 or apneic → bag-mask at 40–60/min, room air; HR < 60 → PPV ×30 s, then compressions. |
| Starting FiO₂ | > 35 weeks → 21%; < 35 weeks → 30%. |
| APGAR | ≥ 7 normal; < 6 at 1 minute may need aggressive support. |
| Weight classes | LBW < 2500 g, VLBW < 1500 g, ELBW < 1000 g. |
| Pre/post-ductal | > 5% difference (right arm vs. left leg) = R-to-L shunt (PDA/PFO). |
| RDS x-ray | Reticulogranular "ground glass," air bronchograms, low lung volumes. |
| Surfactant drugs | Beractant (Survanta), calfactant (Infasurf), poractant alfa (Curosurf) — all via ETT. |
| TTN | Type II RDS; retained lung fluid (C-section); resolves in 24–48 h. |
| PPHN | PVR > SVR → shunting through PDA/foramen ovale after birth. |
| Croup vs. epiglottitis | Croup = subglottic, steeple sign, parainfluenza; epiglottitis = supraglottic, thumb sign, H. influenzae. |
| ROP prevention | Keep PaO₂ < 80 mmHg; SpO₂ > 88% and < 94%. |
| Time constant | TC = C × R; neonates = short (shorter I:E), asthma = long (longer I:E). |
| PIP limit | ≤ 30 cmH₂O (may break for prematurity/fentanyl rigidity); ∆P = PIP − PEEP. |
| HFV goal | Tiny Vt < dead space, rapid rate; ventilate while limiting lung injury. |
| HFOV | Bias flow/MAP → oxygenation; amplitude (∆P) → CO₂; ↓ frequency to remove more CO₂. |
| iNO | Selective pulmonary vasodilator; start 20 PPM; keep NO₂ < 2 PPM and metHgb < 5%. |
| ECMO | VA = heart + lungs; VV = lungs only. |
Mock Exam
The quiz for this lesson is a cumulative 50-question mock exam. It mixes recall, comparison, and clinical application questions from the full Neonatal & Pediatric Respiratory Care module.