BCPP Neonatology Guide Questions/Answer 2025/2026
Graded A+
RDS- natural vs synthetic surfactant - Natural products result in improved outcomes
compared with synthetic product
**AAP concluded unclear whether significant difference in clinical outcomes between
natural products
RDS- prophylaxis surfactant - Given to neonates at high risk of RDS to PREVENT,
rather than treat
Typically given within 10-30 minutes after birth
RDS- rescue surfactant - Given to neonates with established RDS
Early= within 1-2 hours after birth
Delayed/late= >/= 2 hours after birth (typically within 12 hours)
Prophylaxis vs Rescue surfactant - Prophylactic surfactant does NOT result in clinically
important benefits (reduced mortality, incidence of BPD) compared with CPAP in
delivery room, followed by rescue surfactant
Early vs Delayed rescue surfactant - Early- decreases risk of mortality & chronic lung
disease compared with delayed treatment
RDS- surfactant ADRs - Apnea, bradycardia, oxygen desaturation, pulmonary
hemorrhage (rarely occurs BUT most common in extremely low-birth weight neonates)
**Pneumothorax may occur if changes to mechanical ventilation setting not quickly
made
RDS- preventive treatment (antenatal corticosteroids) - Betamethasone 12 mg IM Q24H
x 2 doses (in preterm labor between 24-34 weeks gestation)
**Delay delivery at least 24 hours (improved response); benefit lasts up to 7 days
*Promotes fetal lung maturation AND surfactant production
*Significantly reduces mortality & incidence of RDS (additive with surfactant therapy)
Dexamethasone 6 mg IM Q12H x 4 doses (alternative)
RDS- does inhaled nitric oxide benefit patient? - No difference in mortality or incidence
of BPD with inhaled nitric oxide vs without
**CANNOT be recommended for routine treatment of preterm neonates with RDS
Bronchopulmonary dysplasia (BPD) - AKA chronic lung disease
** Significant risk of mortality and long-term morbidity
BPD- "new" definition (mild) - Period of oxygen requirement of at least 28 days, but on
room air by 36 weeks postmenstrual age
BPD- "new" definition (moderate) - Continued oxygen requirement with a FiO2 < 30%
, BPD- "new" definition (severe) - Continued oxygen requirement with a FiO2 of at least
30% OR any form of positive pressure ventilation or CPAP
BPD- risk factors - Premature birth
Very low (< 1500 g) and extremely low (< 1000 g) birth weight
Invasive mechanical ventilation resulting in barotrauma and volutrauma
Chorioamnionitis, airway colonization with Ureaplasma urealyticum, pulmonary edema,
persistent PDA, poor nutrition
BPD- name the 2 medications for prevention? - Caffeine
Vitamin A
BPD- prevention (vitamin A) - 5000 units IM three times a week x 4 weeks to neonates
with birth weight < 1000 g
BPD- treatment (diuretics) - Thiazide
Potassium-sparing
Loop
**Short-term benefits benefits of improved oxygenation & lung compliance do NOT
correspond to improvements in long-term outcomes
BPD- treatment (bronchodilators) - Shown to improve lung compliance and decrease
pulmonary resistance
Apnea of prematurity- definition - Immature central respiratory drive, inability to maintain
airway latency, and underdeveloped respiratory muscles cause hypoventilation resulting
in apneic and cyanosis spells
Apnea of prematurity- risk factors - Prematurity (incidence inversely related to
gestational age)
Extremely low birth weight (< 1000 g)
Apnea of prematurity- methylxanthine ADRs - Tachycardia, feeding intolerance,
irritability, jitteriness, seizures
Apnea of prematurity- treatment (theophylline) - Dose: 5-6 mg/kg PO (loading dose),
then 1-2 mg/kg/dose every 8-12 hours
NOT beneficial to preventing apnea
Narrow therapeutic index (5-10 mcg/mL therapeutic range)
Apnea of prematurity- treatment (aminophylline) - Dose: 6-8 mg/kg IV (loading dose),
then 1-2 mg/kg/dose every 8-12 hours
Apnea of prematurity- treatment (caffeine) - Dose: 20 mg/kg IV/PO (loading dose), then
5-10 mg/kg/dose every 24 hours
Graded A+
RDS- natural vs synthetic surfactant - Natural products result in improved outcomes
compared with synthetic product
**AAP concluded unclear whether significant difference in clinical outcomes between
natural products
RDS- prophylaxis surfactant - Given to neonates at high risk of RDS to PREVENT,
rather than treat
Typically given within 10-30 minutes after birth
RDS- rescue surfactant - Given to neonates with established RDS
Early= within 1-2 hours after birth
Delayed/late= >/= 2 hours after birth (typically within 12 hours)
Prophylaxis vs Rescue surfactant - Prophylactic surfactant does NOT result in clinically
important benefits (reduced mortality, incidence of BPD) compared with CPAP in
delivery room, followed by rescue surfactant
Early vs Delayed rescue surfactant - Early- decreases risk of mortality & chronic lung
disease compared with delayed treatment
RDS- surfactant ADRs - Apnea, bradycardia, oxygen desaturation, pulmonary
hemorrhage (rarely occurs BUT most common in extremely low-birth weight neonates)
**Pneumothorax may occur if changes to mechanical ventilation setting not quickly
made
RDS- preventive treatment (antenatal corticosteroids) - Betamethasone 12 mg IM Q24H
x 2 doses (in preterm labor between 24-34 weeks gestation)
**Delay delivery at least 24 hours (improved response); benefit lasts up to 7 days
*Promotes fetal lung maturation AND surfactant production
*Significantly reduces mortality & incidence of RDS (additive with surfactant therapy)
Dexamethasone 6 mg IM Q12H x 4 doses (alternative)
RDS- does inhaled nitric oxide benefit patient? - No difference in mortality or incidence
of BPD with inhaled nitric oxide vs without
**CANNOT be recommended for routine treatment of preterm neonates with RDS
Bronchopulmonary dysplasia (BPD) - AKA chronic lung disease
** Significant risk of mortality and long-term morbidity
BPD- "new" definition (mild) - Period of oxygen requirement of at least 28 days, but on
room air by 36 weeks postmenstrual age
BPD- "new" definition (moderate) - Continued oxygen requirement with a FiO2 < 30%
, BPD- "new" definition (severe) - Continued oxygen requirement with a FiO2 of at least
30% OR any form of positive pressure ventilation or CPAP
BPD- risk factors - Premature birth
Very low (< 1500 g) and extremely low (< 1000 g) birth weight
Invasive mechanical ventilation resulting in barotrauma and volutrauma
Chorioamnionitis, airway colonization with Ureaplasma urealyticum, pulmonary edema,
persistent PDA, poor nutrition
BPD- name the 2 medications for prevention? - Caffeine
Vitamin A
BPD- prevention (vitamin A) - 5000 units IM three times a week x 4 weeks to neonates
with birth weight < 1000 g
BPD- treatment (diuretics) - Thiazide
Potassium-sparing
Loop
**Short-term benefits benefits of improved oxygenation & lung compliance do NOT
correspond to improvements in long-term outcomes
BPD- treatment (bronchodilators) - Shown to improve lung compliance and decrease
pulmonary resistance
Apnea of prematurity- definition - Immature central respiratory drive, inability to maintain
airway latency, and underdeveloped respiratory muscles cause hypoventilation resulting
in apneic and cyanosis spells
Apnea of prematurity- risk factors - Prematurity (incidence inversely related to
gestational age)
Extremely low birth weight (< 1000 g)
Apnea of prematurity- methylxanthine ADRs - Tachycardia, feeding intolerance,
irritability, jitteriness, seizures
Apnea of prematurity- treatment (theophylline) - Dose: 5-6 mg/kg PO (loading dose),
then 1-2 mg/kg/dose every 8-12 hours
NOT beneficial to preventing apnea
Narrow therapeutic index (5-10 mcg/mL therapeutic range)
Apnea of prematurity- treatment (aminophylline) - Dose: 6-8 mg/kg IV (loading dose),
then 1-2 mg/kg/dose every 8-12 hours
Apnea of prematurity- treatment (caffeine) - Dose: 20 mg/kg IV/PO (loading dose), then
5-10 mg/kg/dose every 24 hours
