Care of the Normal Newborn — MCQs
Which vaccine is given at birth to provide protection against tuberculosis as per the National Immunization Schedule in India?
Basanti, a 29-year-old female from Bihar, presents with drug-sensitive tuberculosis. She delivers a baby. All of the following are indicated except:
Newborn can be given breast milk after how much time following normal delivery?
A child of 8 kg has Bitot's spots in both eyes. Which of the following is the most appropriate schedule to prescribe vitamin A to this child?
Which best indicates the quality of MCH services in a community?
An asymptomatic infant with a history of TB exposure, is 3 months old and had taken 3 months of chemoprophylaxis, what is to be done next?
Where is the newborn care corner located?
Which of the following is best for the transport of a newborn, ensuring maintenance of a warm temperature?
When should breastfeeding be initiated after a normal delivery?
Consider the following statements with regard to Home Based Newborn Care (HBNC) : I. Early detection and special care of pre-term newborns is one of the major objectives of HBNC. II. ANM is the main person involved in the delivery of HBNC. III. Supporting the family for adoption of healthy practices helps achieve the key objectives of HBNC. IV. The primary aim of HBNC is to improve newborn survival. Which of the statements given above are correct?
Care of the Normal Newborn Indian Medical PG Practice Questions and MCQs
Question 1: Which vaccine is given at birth to provide protection against tuberculosis as per the National Immunization Schedule in India?
- A. Measles
- B. BCG (Correct Answer)
- C. OPV
- D. Hepatitis B
Explanation: ***Correct: BCG*** - The **BCG vaccine** (Bacille Calmette-Guérin) is the only vaccine given at birth specifically to protect against **tuberculosis** - It is administered at birth or as early as possible as part of the **National Immunization Schedule** - BCG is particularly important in India due to the high burden of tuberculosis *Incorrect: Measles* - The **measles vaccine** is given at **9 months of age**, not at birth - Early administration is less effective due to the presence of **maternal antibodies** that can interfere with vaccine response *Incorrect: OPV* - While **OPV zero dose (OPV0)** is also given at birth for early polio protection, it protects against **poliomyelitis**, not tuberculosis - OPV is followed by subsequent doses at 6, 10, and 14 weeks *Incorrect: Hepatitis B* - **Hepatitis B birth dose** is also given within 24 hours of birth to prevent **vertical transmission** - However, it protects against **Hepatitis B virus infection**, not tuberculosis
Question 2: Basanti, a 29-year-old female from Bihar, presents with drug-sensitive tuberculosis. She delivers a baby. All of the following are indicated except:
- A. Administer INH to the baby
- B. Withhold breast feeding (Correct Answer)
- C. Separate the baby from mother immediately
- D. Ask mother to ensure proper disposal of sputum
Explanation: ***Withhold breast feeding*** - For mothers with **drug-sensitive tuberculosis**, breastfeeding is **strongly encouraged** by WHO and CDC guidelines as the benefits far outweigh any theoretical risks. - Tuberculosis is **not transmitted through breast milk**, and the nutritional and immunological benefits of breastfeeding are crucial for the newborn. - With appropriate maternal treatment and **INH prophylaxis** for the baby, breastfeeding poses no significant risk and should **never be withheld**. *Administer INH to the baby* - **Isoniazid (INH) prophylaxis** for 6 months is the standard of care for newborns exposed to maternal tuberculosis. - This protects the infant from potential infection via respiratory droplets while the mother is receiving treatment. - After completing prophylaxis, BCG vaccination is given if tuberculosis is excluded. *Separate the baby from mother immediately* - **Immediate routine separation** is generally not recommended for drug-sensitive TB if the mother has been on appropriate treatment for at least 2 weeks and is clinically improving. - **Rooming-in is encouraged** with respiratory hygiene measures (mask wearing, hand hygiene, covering mouth when coughing). - Separation may be considered only for untreated or inadequately treated mothers, or those with multi-drug resistant TB. *Ask mother to ensure proper disposal of sputum* - **Proper sputum disposal** and adherence to respiratory hygiene are essential infection control measures. - This reduces environmental contamination and protects healthcare workers, family members, and the newborn from infectious aerosols. - This is a standard precaution for all tuberculosis patients regardless of drug sensitivity.
Question 3: Newborn can be given breast milk after how much time following normal delivery?
- A. Half hour
- B. 2 hours
- C. 1 hour (Correct Answer)
- D. 3 hours
Explanation: ***1 hour*** - Initiating breastfeeding **within 1 hour** after a normal vaginal delivery is the **WHO and UNICEF recommended standard** for optimal newborn care. - This practice, often called the **"golden hour"**, allows the newborn to benefit from **colostrum** (rich in antibodies and nutrients), promotes **mother-infant bonding**, and helps stimulate **uterine contractions** to reduce postpartum hemorrhage. - Early initiation within this timeframe supports **successful establishment of breastfeeding** and improves exclusive breastfeeding rates. *Half hour* - While initiating breastfeeding within 30 minutes is **excellent and encouraged**, the standard guideline allows up to 1 hour. - Immediate or very early feeding (within 30 minutes) is ideal when mother and baby are stable, but the flexibility up to 1 hour accommodates immediate postpartum care needs. *2 hours* - Delaying breastfeeding until 2 hours post-delivery **exceeds the recommended window** and can lead to the infant becoming **less alert** and less interested in feeding. - This delay is associated with **lower rates of successful exclusive breastfeeding** and may impact milk supply establishment. *3 hours* - A 3-hour delay in initiating breastfeeding is **significantly beyond recommended guidelines** after a normal, uncomplicated delivery. - Such delays can contribute to **poor latch**, **infant fatigue**, increased **formula supplementation**, and may hinder **long-term breastfeeding success**.
Question 4: A child of 8 kg has Bitot's spots in both eyes. Which of the following is the most appropriate schedule to prescribe vitamin A to this child?
- A. 2 lakh units orally on day 0, 14
- B. 2 lakh units orally on day 0, 1, 14 (Correct Answer)
- C. 1 lakh units orally on day 0, 14
- D. 1 lakh units orally on day 0, 1, 14
Explanation: ***2 lakh units orally on day 0, 1, 14*** - For a child weighing **8 kg** with **Bitot's spots (WHO classification X1B)**, the therapeutic dose is **200,000 IU** (2 lakh units) of vitamin A. - The standard WHO/IAP schedule for treating **vitamin A deficiency with ocular signs** is administration on **Day 0, Day 1, and Day 14** to rapidly replete stores and prevent progression. - The **oral route** is preferred for **Bitot's spots without corneal ulceration**, as it is effective, safe, and well-tolerated. - **IM route** is reserved for severe xerophthalmia (X2/X3 with corneal ulceration), persistent vomiting, or inability to take oral medications. *2 lakh units orally on day 0, 14* - Although the individual dose of **200,000 IU** is correct for this 8 kg child with **Bitot's spots**, this schedule misses the critical **Day 1 dose**. - The missing dose on Day 1 delays rapid **vitamin A replenishment**, which is crucial for preventing progression of **ocular damage** and achieving adequate tissue stores. *1 lakh units orally on day 0, 14* - This dose of **100,000 IU** is inadequate for a child weighing **8 kg or more** with clinical **vitamin A deficiency**. - WHO guidelines recommend **100,000 IU for children <8 kg** and **200,000 IU for children ≥8 kg**, making this dosage insufficient. - Additionally, the schedule is incomplete as it misses the **Day 1 dose**. *1 lakh units orally on day 0, 1, 14* - While the schedule of Day 0, Day 1, and Day 14 is appropriate, the **dose of 100,000 IU is inadequate** for a child weighing **8 kg**. - This lower dose may not provide sufficient **vitamin A replenishment** to reverse **Bitot's spots** and prevent progression to more severe xerophthalmia.
Question 5: Which best indicates the quality of MCH services in a community?
- A. Neonatal Mortality Rate
- B. Perinatal Mortality Rate (Correct Answer)
- C. Post-neonatal Mortality Rate
- D. Infant Mortality Rate
Explanation: ***Perinatal Mortality Rate*** - The **perinatal mortality rate** includes deaths from 22 weeks of gestation up to 7 completed days after birth, encompassing both stillbirths and early neonatal deaths. - This broad scope makes it the most sensitive indicator of the overall quality of routine **Maternal and Child Health (MCH) services**, as it reflects care during pregnancy, labor, and immediate postpartum. *Neonatal Mortality Rate* - The **neonatal mortality rate** accounts for deaths within the first 28 days of life (0-27 days), focusing primarily on the health of the newborn. - While important, it doesn't fully capture issues during pregnancy or delivery that might lead to stillbirths, which are a critical component of assessing comprehensive MCH quality. *Post-neonatal Mortality Rate* - The **post-neonatal mortality rate** covers deaths from 28 days up to one year of life. - This rate often reflects environmental factors, nutritional status, and infectious diseases more than the direct quality of prenatal, delivery, and immediate postnatal care. *Infant Mortality Rate* - The **infant mortality rate** includes all deaths from birth up to one year of age. - While a general indicator of child health, it is less specific to the quality of direct maternal and newborn health services than the perinatal mortality rate, as it includes deaths outside the perinatal period, which might be influenced by broader socio-economic factors.
Question 6: An asymptomatic infant with a history of TB exposure, is 3 months old and had taken 3 months of chemoprophylaxis, what is to be done next?
- A. Immunise with BCG and stop prophylaxis
- B. Continue prophylaxis for 3 months
- C. Test sputum, then decide
- D. Tuberculin test, then decide (Correct Answer)
Explanation: ***Tuberculin test, then decide*** - A **tuberculin skin test (TST)** or **IGRA** should be performed after completing the initial chemoprophylaxis period to determine if the infant has developed **latent TB infection (LTBI)**. - According to **IAP guidelines**, if TST is **negative**, complete a total of **6 months of prophylaxis** and then administer **BCG vaccine**. - If TST is **positive**, it indicates LTBI and the infant should complete the full course of treatment as per standard protocols. - The decision to continue, modify, or stop treatment depends on **TST results** and **clinical evaluation**. *Immunise with BCG and stop prophylaxis* - **BCG vaccination** should not be given during or immediately after stopping prophylaxis without first performing a **TST**. - In TB-endemic areas, BCG is ideally given at birth, but if delayed due to TB exposure, it should only be given after **ruling out infection** with a negative TST. - Stopping prophylaxis prematurely without assessment can increase the risk of developing **active TB**. *Continue prophylaxis for 3 months* - While the standard duration of prophylaxis is **6 months total**, blindly continuing for another 3 months without TST assessment is not the most appropriate next step. - The decision to continue should be based on **TST results** performed at this juncture, not arbitrary time extension. - Prolonged unnecessary prophylaxis can lead to **drug toxicity** and **poor compliance**. *Test sputum, then decide* - An **asymptomatic infant** is unlikely to produce sputum, making this test impractical and inappropriate. - Sputum testing is used for diagnosing **active pulmonary TB**, which is not suspected in this asymptomatic child. - Sputum testing is invasive and reserved for children with **clinical symptoms** suggestive of active disease such as persistent cough, fever, or weight loss.
Question 7: Where is the newborn care corner located?
- A. NICU
- B. OPD
- C. Labour room (Correct Answer)
- D. Wards side room
Explanation: ***Labour room*** - A **newborn care corner** is an essential facility located in the **labour room** to provide immediate care, resuscitation, and stabilization for newborns right after birth. - This setup ensures that critical interventions like **drying**, **warming**, **suctioning**, and initiation of **ventilation** can be performed promptly, improving neonatal outcomes. *NICU* - The **NICU (Neonatal Intensive Care Unit)** is for sick or premature newborns requiring intensive medical care, not the initial care at birth for all newborns. - While newborns from the labour room may be transferred to the NICU if they require specialized care, the initial care corner is distinct. *OPD* - **OPD (Outpatient Department)** is for patients seeking consultation without admission, and is not equipped or intended for immediate newborn care. - Newborns are brought to OPD for follow-up visits or routine check-ups much later, not immediately after birth. *Wards side room* - A **ward side room** is part of a general hospital ward, usually for inpatient care, and is not specifically designed or staffed for the initial, immediate care of a newborn at the moment of delivery. - While mothers and newborns may be transferred to a ward side room after stabilization, it's not where delivery and immediate postnatal care occur.
Question 8: Which of the following is best for the transport of a newborn, ensuring maintenance of a warm temperature?
- A. Skin-to-skin contact method
- B. Portable temperature-controlled device (Correct Answer)
- C. Heated water container
- D. Insulated thermal box
Explanation: **Portable temperature-controlled device** ✓ - A **portable temperature-controlled device**, such as an infant transport incubator, is specifically designed to maintain a stable and warm environment for newborns during transfer - These devices offer precise **thermoregulation**, protection from environmental factors, and allow for continuous monitoring and interventions during transport - This is the **gold standard** for neonatal transport, ensuring optimal temperature maintenance *Skin-to-skin contact method* - While excellent for immediate bonding and initial warmth in stable newborns, **skin-to-skin contact** cannot consistently maintain optimal temperature during prolonged or inter-facility transport - It requires constant close contact with a caregiver and limits medical interventions during transport - Not suitable for sick or unstable newborns requiring monitoring *Insulated thermal box* - An **insulated thermal box** offers passive warmth retention but lacks active temperature control and monitoring - Cannot prevent heat loss effectively over extended periods or compensate for fluctuations in external temperature - No provision for medical interventions during transport *Heated water container* - A **heated water container** is not a standard or safe method for maintaining newborn temperature during transport - Carries significant risks of burns, inconsistent warming, and potential for rapid cooling once the heat source diminishes - Unsafe and not recommended for neonatal care
Question 9: When should breastfeeding be initiated after a normal delivery?
- A. 2 hours after delivery
- B. 4 hours after delivery
- C. 6 hours after delivery
- D. Immediately after delivery (Correct Answer)
Explanation: **Correct: Immediately after delivery** - Initiating breastfeeding **within the first hour** of birth (early initiation) is crucial for establishing **successful lactation** and promoting optimal infant health. - This early initiation allows for **skin-to-skin contact**, which helps stabilize the newborn's temperature, heart rate, and breathing, and facilitates **bonding** between mother and baby. - Aligned with **WHO and UNICEF recommendations** for best practice in postpartum care. *Incorrect: 2 hours after delivery* - While earlier is generally better, waiting two hours misses the **optimal window** for initiating feeding and bonding. - The newborn's **alert period** is typically strongest in the first hour post-birth, making it an ideal time for the first latch. *Incorrect: 4 hours after delivery* - Delaying breastfeeding by four hours can make it more challenging for the baby to latch effectively as they may have passed their **initial alert state** and become sleepy. - This delay can also hinder the establishment of the mother's **milk supply**, as stimulation from early feeding is important for prolactin release. *Incorrect: 6 hours after delivery* - Waiting six hours significantly **misses the critical window** for early initiation and can lead to increased difficulties with breastfeeding. - Prolonged delays may necessitate supplementation, potentially interfering with exclusive breastfeeding and establishing a **strong milk supply**.
Question 10: Consider the following statements with regard to Home Based Newborn Care (HBNC) : I. Early detection and special care of pre-term newborns is one of the major objectives of HBNC. II. ANM is the main person involved in the delivery of HBNC. III. Supporting the family for adoption of healthy practices helps achieve the key objectives of HBNC. IV. The primary aim of HBNC is to improve newborn survival. Which of the statements given above are correct?
- A. I, III and IV only (Correct Answer)
- B. I and II only
- C. I, II, III and IV
- D. II and III only
Explanation: ***I, III and IV only*** - **Statement I is CORRECT**: Early detection and special care of **pre-term and low birth weight newborns** is a major objective of HBNC, as preterm birth is a significant risk factor for neonatal morbidity and mortality. - **Statement III is CORRECT**: Supporting families in adopting **healthy practices** like optimal breastfeeding, cord care, thermal regulation, and recognition of danger signs is fundamental to achieving HBNC objectives. - **Statement IV is CORRECT**: The **primary aim of HBNC** is to **improve newborn survival** and reduce neonatal mortality by ensuring essential healthcare services reach every newborn through home visits. - **Statement II is INCORRECT**: **ASHA workers** are the main persons involved in delivering HBNC through home visits (minimum 6 visits for institutional deliveries, more for home deliveries). ANMs provide **supervisory support** but are NOT the primary service deliverers. *I and II only* - Incorrect because statement II is false - **ASHA workers**, not ANMs, are the primary HBNC service providers. *I, II, III and IV* - Incorrect because statement II is false - ANMs supervise HBNC but **ASHA workers** conduct the actual home visits and deliver care. *II and III only* - Incorrect because statement II is false, and statements I and IV (which are correct) are excluded from this option.
Want unlimited practice?
Get full access to all questions, explanations, and performance tracking.
Start For Free