Facts read from nccwebsite.org · last checked Nov 7, 2026
General Management is the largest single area after the systems, 19% of the score. Most of it is the work of the first days: keeping the baby warm, getting the transition right, then feeding and fluids. NCC's job analysis names the arithmetic outright: intake and output, calories, glucose infusion rate, doses.
Practice questions
60 questions written to the NNP-BC outline; each choice is explained once you pick.
Thermoregulation: how heat is gained and lost, the neutral thermal environment, rewarming.
Resuscitation and stabilization: transition, delivery-room assessment, interventions and their triggers, cord blood gases, transport.
Growth and nutrition: digestion and absorption, requirements, enteral and parenteral feeding, human milk, donor milk and formula, lipid emulsions including fish oil.
Fluids, electrolytes and acid–base: requirements, insensible water loss, central and peripheral infusions, common disorders.
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Glucose infusion rate, worked
A 1.8 kg infant receives D10W at 80 mL/kg/day.
Dextrose concentration × daily fluid800
10 × 80
→
Divide by 144 (1,440 minutes a day, grams per 100 mL to mg)5.6 mg/kg/min
800 ÷ 144
→
Glucose infusion rateabout 5.6 mg/kg/min
The weight cancels out when fluid is already per kilogram. Calories work the same way: 24 kcal/oz ÷ 30 mL/oz = 0.8 kcal/mL, so 150 mL/kg/day gives 120 kcal/kg/day.
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16 questions on NICU management
0 / 16 answered16 questions
Tap an option: why each one is right or wrong appears under it.
General Management · 19%
Cold stress is especially dangerous for a term infant with meconium aspiration because the norepinephrine it releases causes
Catecholamines can relax airways, but air trapping in meconium aspiration comes from ball-valve obstruction, not from cold stress.
Cold stress does the opposite: brown-fat metabolism raises oxygen consumption, which is exactly what a hypoxemic infant cannot afford.
Norepinephrine released for nonshivering thermogenesis also constricts pulmonary vessels, so a cold infant with meconium aspiration can slide into PPHN and worse right-to-left shunting.
A term infant whose mother received IV morphine 1 hour before delivery is apneic at birth. With effective mask PPV the heart rate rises to 140/min, but spontaneous breathing does not start. The MOST appropriate management is to
Once PPV restores the heart rate, an opioid-depressed infant simply needs ventilation continued until the drug wears off; NRP does not recommend naloxone during initial resuscitation.
Caffeine treats apnea of prematurity; it does not reverse opioid respiratory depression in a term infant.
Naloxone is never given by the endotracheal route, and it can trigger acute withdrawal and seizures if the mother used opioids chronically.
Because neonatal ECMO requires systemic heparinization, which surveillance study is performed routinely during the run?
EEG is used when seizures are suspected; it does not detect hemorrhage, the complication systemic heparin makes most dangerous.
Kidney injury on ECMO is followed with urine output and creatinine; routine renal imaging does not screen for the bleeding that heparin causes.
Intracranial hemorrhage is the most feared ECMO complication because of heparin, low platelets and neck-vessel cannulation, so head ultrasounds are repeated, especially in the first days.
A 38-week infant with moderate HIE is first identified at a referral hospital at 8 hours of age. Under the 2026 AAP clinical report, therapeutic hypothermia
Treating 6 hours as an absolute cut-off is the older reading; under the 2026 report a later start can still be weighed with the family.
Standard cooling starts by 6 hours, but the 2026 AAP report allows cooling between 6 and 24 hours to be considered after discussion, based on the late-hypothermia trial.
Moderate-to-severe encephalopathy alone qualifies for cooling; waiting for seizures delays treatment and misreads the entry criteria.
A 33-week PMA infant on full gavage feeds is in room air, roots, and sucks vigorously on a pacifier. The BEST approach to oral feeding is to
Cue-based feeding offers the breast or bottle when the infant shows readiness and gives the remaining volume by tube, so endurance builds without exhausting the infant.
Switching every feed to oral overtaxes a 33-week infant's stamina, leading to fatigue, desaturation and poor total intake.
A fixed PMA cut-off ignores the readiness this infant already shows and delays oral skills and discharge.
A 1,000 g infant is in an incubator in skin servo-control mode. Over 6 hours the incubator air temperature falls steadily while the skin temperature stays at 36.5 °C. This MOST likely indicates
A detached probe reads the cooler air, so the incubator heats harder and the air temperature rises, the opposite of this trend.
Cold stress would push the incubator to raise its output to keep the skin warm, not let the air temperature fall.
In skin servo mode the incubator cuts its heat output to hold the skin at the set point, so a steadily falling air temperature means the infant is producing heat, as with infection, and the fever is masked.
A 26-week infant has received lipid-free PN for 12 days because of a lipid shortage. He has dry, scaly skin, thrombocytopenia and a triene:tetraene ratio of 0.3. The most likely cause is
Low vitamin A is common in preterm infants but affects lungs and eyes; it does not raise the triene:tetraene ratio.
Without IV lipid, preterm infants develop biochemical essential fatty acid deficiency within days; a triene:tetraene ratio above 0.2 with scaly skin and thrombocytopenia confirms it.
Zinc deficiency gives erosive perioral and diaper-area lesions and leaves the triene:tetraene ratio normal, so it does not explain this lab result.
A 29-week, 850 g infant with prenatal absent end-diastolic flow is stable on day 2. Based on current evidence, the BEST enteral plan is to
Waiting for meconium has no evidence behind it and only delays gut priming in an infant who is already stable.
In growth-restricted preterm infants with absent end-diastolic flow, starting feeds on day 2 reached full feeds sooner without more NEC (ADEPT), and maternal milk is the preferred feed.
A large first-day formula volume loses the protection of human milk and of a cautious start, the combination linked to NEC in this high-risk infant.
A term infant born at home is found at 6 hours with a temperature of 32 °C, lethargy, edema of the extremities and bright red cheeks. The red color is BEST explained by
In neonatal cold injury the oxygen dissociation curve shifts left, so oxygen stays on hemoglobin and the infant looks deceptively bright red despite tissue hypoxia.
Carbon monoxide also causes a cherry-red color, but it needs an exposure source and would not explain profound hypothermia with edema.
Reactive hyperemia follows rewarming or pressure release; at 32 °C the skin vessels are constricted, not dilated.
A 5-week-old who was cooled for HIE has firm, red subcutaneous nodules on the back and a serum calcium of 14.2 mg/dL. Vitamin D supplements are stopped. The BEST initial treatment is
Thiazides reduce urinary calcium and raise serum calcium, so this choice reverses the diuretic that is needed.
Bisphosphonates are reserved for hypercalcemia that does not respond to hydration, a loop diuretic and a low-calcium, vitamin D–free diet.
Subcutaneous fat necrosis after cooling raises calcium through calcitriol made in the inflamed fat; a level above 14 mg/dL is treated first with saline hydration, then a loop diuretic to increase urinary calcium loss.
A 29-week infant has pneumatosis intestinalis on radiograph without free air and is hemodynamically stable. The BEST management is
Pneumatosis without free air in a stable infant is definite (stage II) NEC, treated medically with bowel rest, gastric decompression, broad-spectrum antibiotics, PN and serial radiographs.
Surgery is reserved for perforation or deterioration despite medical therapy; operating on stable pneumatosis adds risk without benefit.
Halving feeds treats NEC like feeding intolerance; once pneumatosis is present, any enteral feeding risks progression.
A 4-day-old with poor feeding has Na 138, Cl 104, and HCO3 12 mEq/L. The BEST interpretation is
The gap is high, but diarrhea loses bicarbonate and produces a normal-gap acidosis, so the cause does not match the calculation.
Renal tubular acidosis gives a normal-gap, hyperchloremic acidosis; the chloride here is not high enough to keep the gap normal.
Anion gap = 138 − (104 + 12) = 22 mEq/L, which is high; in a newborn that points to lactic acidosis from shock or sepsis or an inborn error such as an organic acidemia.
A well-perfused 25-week infant on day 4 has urine output of 3 mL/kg/h, a serum sodium of 133 mEq/L and a fractional excretion of sodium (FENa) of 6%. This FENa MOST likely reflects
Before about 32 weeks the tubules reabsorb sodium poorly, so a FENa of 5% or more is common in a well-perfused preterm infant with good urine output; it calls for sodium replacement, not a renal workup.
In a preterm infant a high FENa alone does not mean tubular necrosis; ATN would bring oliguria, a rising creatinine and a history of shock or asphyxia.
SIADH retains water and lowers urine output; this well infant passes 3 mL/kg/h, so water retention is not the problem.
An intubated term infant is inadvertently overventilated to a PaCO2 of 22 mmHg (pH 7.60). Total serum calcium is normal, but the infant becomes jittery and the QTc lengthens. The MOST likely cause is
Urinary calcium loss would lower the total calcium as well, but the total level here is normal, so the problem is binding, not loss.
Severe hypocarbia does reduce cerebral blood flow and threatens the white matter, but it does not prolong the QTc.
Alkalosis increases calcium binding to albumin, so ionized calcium falls while total calcium stays normal, causing jitteriness and a longer QTc; correcting the ventilation comes first.
After extensive bowel resection for NEC, which finding BEST predicts successful intestinal adaptation and weaning from PN?
The stomach and pylorus are nearly always spared after NEC, so they do not separate infants who wean from those who stay on PN.
Along with residual small-bowel length and colon in continuity, an intact ileocecal valve slows transit and limits bacterial overgrowth, predicting weaning from PN.
The distal colon absorbs little, so keeping the sigmoid alone does not predict intestinal adaptation.
A running total sits here; it fills in after your last pick.
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Delivery room and fluid traps
Cord clamping by an old number. The 2025 AHA and AAP neonatal resuscitation guideline, reflected in the 9th edition of the NRP textbook, defers clamping for at least 60 seconds in newborns who do not need immediate resuscitation. Answers built on “30 to 60 seconds” come from earlier material.
Oxygen at the start. Term and late-preterm newborns are resuscitated starting in room air; titrate to the pre-ductal target table, measured on the right hand.
Meconium. A nonvigorous baby born through meconium-stained fluid gets the same initial steps as any other; routine intubation for tracheal suction was dropped from the program in 2015.
Mixing hypoglycemia standards. AAP's 2011 numbers apply to at-risk newborns in the first 24 hours; the Pediatric Endocrine Society's higher 2015 targets apply beyond 48 hours. Read the age in the stem before choosing a cut-off.
Hyperkalemia, in order. Calcium gluconate steadies the myocardium and leaves the potassium level unchanged; insulin given with glucose shifts potassium into cells. Exchange resins are a poor choice in a preterm infant because of bowel injury (Cochrane review, 2012).
Plan on it. The job analysis lists glucose infusion rate and calorie calculations as tasks. The testing screen has a calculator, so the formula is what you must bring.
Which resuscitation edition does the neonatal NP board follow?
NCC's 2026 reading list names the 9th edition of the Textbook of Neonatal Resuscitation, published in 2025.