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Exam Code: C-NNIC
Exam Name: Certified Neonatal Neuro-Intensive Care
Number of Questions: 125 multiple-choice items total. Of these- 100 are scored- and 25 are pretest items used for statistical data on future exams (unscored and indistinguishable from scored items).
Time Allotted: 2 hours.
Passing Score: The exam uses a criterion-referenced scoring method- where the passing score is predetermined by NCC based on expert judgment of minimum competency. The exact passing percentage is not publicly specified (varies by exam form) and is not provided to candidates. Results are pass/fail only; if passed- you receive feedback on performance strengths/weaknesses across content areas (e.g.- "Very Weak" to "Very Strong"). Official results are available in your NCC account within 15 business days (up to 21 days for new exam forms).

NEUROLOGIC DEVELOPMENT AND EVALUATION OF THE FETUS AND NEWBORN
- Normal CNS Development
- Fetal CNS and sensory development
- Neural tube
- Prosencephalic
- Synaptogenesis
- Organization
- Proliferation- migration- myelination
- Pruning
- Apoptosis
- Overproduction of neurons
- Neural plasticity
- Antepartum and intrapartum Neurologic Risk Factors and Outcomes
- Maternal risk factors to fetal CNS development
- Genetic predisposition
- Maternal health
- Placental health
- Toxin exposure
- Infection
- Neurologic risks to the fetus and neonate duringlabor and delivery- stabilization- resuscitation and transition
- Perinatal emergencies
- Delivery instrumentation
- Preterm labor and delivery
- Fetal assessment
- Nonstress test and stress test
- Biophysical profile
- Doppler measurements
- Cord gas interpretation
- Neurologic Assessment
- Comprehensive neurologic exam at all gestational ages
- Cranial nerves- basic function and testing
- Neonatal reflexes
- Primitive
- Deep tendon
- Motor function and neuromuscular maturity (Gestational age assessment)
- Tone
- Posture
- Strength
- Activity
- Level of consciousness
- Head examination and development (visual-palpation)
- Positional molding
- Cephalohematoma
- Caput
- Impact of pharmacological agents on the neonatal neurologic exam
- Benzodiazepines
- Opioids
- Maternal drugs
- SSRI
- Magnesium sulfate
- Anesthesia
- Abnormal findings
- Dysmorphic features
- Hair tufts
- Dimples
- Birth marks
- Congenital anomalies
DIAGNOSTIC TOOLS
- Neurologic Monitoring and Evaluation
- Cerebral monitoring
- EEG/aEEG/NIRS
- Classification
- Background patterns
- Artifact
- Clinical use
- Indications and limitations
- Voltage
- Continuity
- Clinical indications and significance of normal and abnormal findings of EEG/aEEG
- Background patterns
- Seizures
- Impedance
- Patient care needs during neurologic monitoring
- Skin assessment and protection
- Neurologic Imaging and Evaluation
- Neurologic Imaging
- MRI
- Sequences (Myelinated and Unmyelinated)
- Diffusion weighted
- Clinical indications of neuro imaging (MRI- Cranial Ultrasounds- CT scan)
- Identification of anatomical structures and recognition of significant neuro-imaging findings
- Intraventricular hemorrhage
- Periventricular leukomalacia
- Hypoxic ischemic encephalopathy
- Post-hemorrhagic hydrocephalus
- Stroke
- Intracranial hemorrhage
- Subdural
- Subgaleal
- Congenital brain malformations
- Patient care needs during neurological imaging
- Thermoregulation
- Comfort measures
- Off unit transport
PATHOPHYSIOLOGIC STATES AND NEUROPROTECTION
Neurologic Pathophysiology For all injuries: incidence- etiology- clinical presentation- complications- diagnostics- lab studies- treatments- management
- CNS Malformations
- Anatomical
- Chiari
- Vascular
- Genetic
- Horner Syndrome
- Congenital Hypoventilation syndrome
- Congenital hydrocephalus
- Neural tube defects
- Anencephaly
- Myelomeningocele
- Spina bifida occulta
- Encephalocele
- Holoprosencephaly
- Agenesis of the corpus callosum
- Septo-optic dysplasia
- Micro/Macrocephaly
- Schizencephaly/lissencephaly
- Dandy-Walker malformation
- Cerebellar hyper/hypoplasia
- Intracranial- intraventricular- cerebellar hemorrhages and periventricular leukomalacia
- Subdural
- Subarachnoid
- Intraventricular hemorrhage
- Grading
- Complications
- Post hemorrhagic hydrocephalus
- Ventricular reservoir
- Shunts
- Periventricular hemorrhagic infarction
- Cerebellar hemorrhage
- Periventricular leukomalacia
- Perinatal Asphyxia and hypoxic ischemic encephalopathy
- Overview
- Hypoxia- hypoxemia- anoxia
- Asphyxia and ischemia
- Neonatal encephalopathy
- HIE
- Phases of injury
- Classifications
- Biochemical findings
- Diagnostic and imaging findings
- Therapeutic hypothermia
- Contraindications
- Timing
- Considerations
- Complications
- Medications/ comfort measures
- Encephalopathies
- Bilirubin
- Glucose
- Hypoglycemia
- Inborn errors of metabolism
- Metabolic screening
- Seizures
- Classification
- Electrographic
- Electroclinical
- Focal or generalized
- Types/causes
- Management/Treatments
- Assessment and evaluation
- Antiepileptics
- Electrolyte considerations
- Neonatal stroke
- Perinatal ischemic stroke classifications
- Arterial (Prenatal/Fetal- Neonatal)
- Venous stroke
- Periventricular venous infarct
- Cerebral sinovenous thrombosis
- Neonatal hemorrhagic stroke
- CNS infections
- Common pathogens
- Bacterial (early and late onset)
- Fungal
- Viral
- Degenerative Disorders
- Gray matter
- Tay-sachs disease
- Menkes disease
- White matter
- Krabbe disease
- Canavan disease
- Alexander disease
- Mixed
- Peroxisomal
- Mitochondrial
- Zellweger spectrum disorder
- Neuromuscular disorders
- Components of the motor system
- Level above the lower motor neuron
- Lower motor neuron
- Genetic spinal muscular atrophies
- Peripheral nerve
- Neuromuscular junction
- Myasthenic syndromes
- Muscle (Myopathies)
- Injuries at birth
- Subgaleal
- Caput succedaneum
- Cephalohematoma
- Skull fractures
Linear
Depressed
- Peripheral nerve injury
- Brachial plexus
- Phrenic/diaphragmatic
- Facial paralysis
- Postnatal Trauma
- Falls
- Shaken baby
- SUID/SIDs
- Drug exposure
- Neonatal opioid withdrawal syndrome (NOWS)/Neonatal Abstinence Syndrome (NAS)
- Iatrogenic
- Eat- sleep- console
- Non-pharmacologic and pharmacologic management
- Safe discharge
Neuroprotection- Management- and Maintenance of Health
- Eligibility- contraindications- and interventions tinitiate therapeutic hypothermia- maintaining treatment and rewarming
- Perinatal risk factors
- Fluid requirements
- Electrolyte monitoring
- Nutrition
- Comfort measures
- Complications
- Recognition and management of apnea
- Prematurity
- Central
- Obstructive
- Mixed
- Interventions to prevent or minimize brain injury
- Positioning (neutral head positioning)
- Delayed cord clamping
- Maternal and neonatal pharmacological agents
- Corticosteroids
- Magnesium sulfate
- Caffeine
- Maternal antibiotics
- Hemodynamic stability
- Blood pressure
- Vital signs
- Thermoregulation
- Temperature instability
- Consequences of hypo/hyperthermia
- Optimize ventilatory strategies
NEURO-SENSORY DEVELOPMENT- PSYCHOSOCIAL BEHAVIORAL STATES-FOLLOW-UP AND DISCHARGE
Neurosensory Environmental Experiences
- Auditory- Visual- Vestibular- Olfactory- Tactile
- Therapeutic positioning
- Neutral body alignment
- Appropriate containment
- Swaddle
- Skin-to-skin
- Facilitated hold
- Protected sleep
- Environment of care (clustered care times- cycledlighting- reducing noxious stimuli- language nutrition)
- Maturation of sleep cycles
- Negative effects of sleep deprivation
Pain and Stress pathways and the impact on behavioral and physiologic parameters
- Neurobehavioral development
- Habituation
- Motor organization
- State organization
- Pain assessment
- Special considerations
- neurologically compromised neonate
- sedated/paralyzed
- Neonatal pain management
- Non-pharmacologic
- Pharmacologic
- Stress response
- Hormones and neurotransmitters
- HPA axis
- Stress cues
- Toxic stress
- Trauma informed care
- Long term outcomes related to pain and stress
Interprofessional Collaboration- Family-Centered Care- Palliative and End-of-Life Care
- Family centered and integrated care
- Parental-neonatal attachment
- Stress and separation
- Participation in decision making and daily caregiving
- Culturally and spiritually sensitive care
- Discharge preparation/process
- Developmental follow up
- Specialty follow up
- Hearing screening
- Family support
- Teaching
- SIDS prevention
- Motor- cognitive and language delays
- End-of-life care/ palliative care/ grieving process
- Non-initiation
- Comfort care
- Redirection of care
- Compassionate Care
- Palliative sedation
- Declaring brain death
- Palliative care
- Enhance quality of life (infant and family)
- Family and staff support
- Grief

PROFESSIONAL ISSUES (E.G. EVIDENCE-BASED PRACTICE- PROFESSIONAL- LEGAL- ETHICAL AND SAFETY)
- Evidence-based research
- Risks and outcomes
- Benchmarking
- QI/process improvement
- Best practice guidelines and bundles
- Translocation science
- Professional practice
- Communication
- Teamwork
- Continuity of care
- Patient safety
- Education and training
- Compassion fatigue
- Self-care
- Simulation
- Cultural care
- Ethical and legal issues that impact the neurologically impaired neonate