Neonatal Resuscitation — MCQs
According to neonatal resuscitation protocol, how much oxygen to give in a term neonate with apnea and bradycardia initially?
Which of the following is an effective sign of successful neonatal resuscitation?
A patient at 37 weeks' gestation came to the hospital without antenatal check-up and presented with onset of labor. On examination, the mother is Hep B positive. What management should be given to the neonate?
During delayed cord clamping, how much blood is typically transferred to the neonate?
A woman suffering from active tuberculosis not on ATT has a full term vaginal delivery. All the following should be done except:
Where is the newborn care corner located?
The term Perinatal covers the period from :
Which virus has the highest chance of transmission to the newborn during delivery?
What is the most commonly observed fetal effect in women receiving magnesium sulphate therapy for pre-eclampsia/eclampsia ?
Which of the following is a criterion for infant at risk?
Neonatal Resuscitation Indian Medical PG Practice Questions and MCQs
Question 1: According to neonatal resuscitation protocol, how much oxygen to give in a term neonate with apnea and bradycardia initially?
- A. 100%
- B. 21% (Correct Answer)
- C. 50%
- D. 30%
Explanation: ***21%*** - According to **NRP (Neonatal Resuscitation Program) 2020 guidelines**, for **term neonates (≥35 weeks gestation)** requiring resuscitation, the initial recommendation is to use **room air (21% oxygen)** to minimize the risk of hyperoxia and oxidative injury. - Multiple randomized controlled trials have demonstrated that room air is as effective as 100% oxygen for initial resuscitation. - Supplemental oxygen is only added if **oxygen saturation targets** are not met despite adequate ventilation, and should be titrated using **pulse oximetry**. *30%* - This concentration is **higher than room air** and is not the initial recommendation for term neonates needing resuscitation. - Starting with a higher oxygen concentration can lead to **oxidative stress** without immediate benefit. - Higher initial concentrations (21-30%) are reserved for **preterm neonates (<35 weeks)**. *100%* - Administering **100% oxygen** can be harmful to a neonate, potentially causing **oxidative injury** to developing organs, including the lungs, brain, and retina. - This was the old practice but has been **discontinued** based on evidence showing increased mortality and morbidity. - High concentrations are no longer recommended even in severe cases; oxygen should be titrated to saturation targets. *50%* - While lower than 100%, 50% oxygen is still **not the initial recommended concentration** for term neonates in resuscitation protocols. - The goal is to start with **21% oxygen** and gradually increase based on **pulse oximetry monitoring** and target saturation ranges if 21% is insufficient.
Question 2: Which of the following is an effective sign of successful neonatal resuscitation?
- A. Change in skin color
- B. Presence of air entry
- C. Increased heart rate (Correct Answer)
- D. None of the options
Explanation: ***Increased heart rate*** - A definitive increase in **heart rate** (typically above 100 bpm) is the most critical and rapid indicator of effective neonatal resuscitation, signifying improved oxygenation and cardiac output. - The goal of neonatal resuscitation is to establish effective ventilation, which subsequently leads to an improved heart rate. *Change in skin color* - **Skin color** changes, while reassuring, are often a delayed and less reliable indicator of immediate resuscitation success compared to heart rate. - Peripheral cyanosis can persist even with adequate central oxygenation, making it a subjective and less sensitive marker. *Presence of air entry* - While **air entry** into the lungs is essential for effective ventilation, merely hearing breath sounds does not guarantee sufficient oxygen exchange or circulatory improvement. - Air entry can be present even with ineffective ventilation (e.g., inadequate tidal volume or airway obstruction), and it doesn't directly measure the systemic response. *None of the options* - This option is incorrect because **increased heart rate** is indeed a primary and immediate sign of successful neonatal resuscitation.
Question 3: A patient at 37 weeks' gestation came to the hospital without antenatal check-up and presented with onset of labor. On examination, the mother is Hep B positive. What management should be given to the neonate?
- A. Hep B vaccine+ IG (Correct Answer)
- B. Hep B vaccine only
- C. Only IG
- D. First IG then Hep B vaccine after 1 month
Explanation: ***Hep B vaccine + IG*** - Neonates born to mothers with **positive hepatitis B surface antigen (HBsAg)** should receive both the **hepatitis B vaccine** and **hepatitis B immune globulin (HBIG)** within **12 hours of birth**. - This combination provides both **passive immunity** (from HBIG) and **active immunity** (from the vaccine) to rapidly protect the newborn from perinatal hepatitis B transmission. *Hep B vaccine only* - Administering only the **hepatitis B vaccine** would provide active immunity, but the **onset of protection is slower**, leaving the neonate vulnerable during the immediate high-risk period of exposure. - While essential for long-term protection, the vaccine alone is **insufficient for immediate post-exposure prophylaxis** in a high-risk scenario. *Only IG* - Administering only **HBIG** provides immediate passive immunity, offering short-term protection, but it **does not confer long-lasting immunity**. - Without the vaccine, the infant would remain susceptible to future HBV infection once the passive antibodies wane, which typically occurs within a few months. *First IG then Hep B vaccine after 1 month* - Delaying the **hepatitis B vaccine** by a month would leave the neonate inadequately protected against subsequent exposure or potential continued viral replication after the HBIG's passive immunity declines. - The goal in this high-risk situation is to initiate **both passive and active immunity as quickly as possible** to maximize protection against perinatal transmission.
Question 4: During delayed cord clamping, how much blood is typically transferred to the neonate?
- A. 50-100 mL (Correct Answer)
- B. 120-150 mL
- C. 150-180 mL
- D. 100-200 mL
Explanation: ***50-100 mL*** - **Delayed cord clamping (DCC)** allows for the transfer of a significant volume of **placental blood** back to the neonate. - This typically results in an increase of approximately **50-100 mL** of blood volume in the infant, contributing to improved iron stores and hematocrit levels. *120-150 mL* - This volume is generally **higher than the average transfer** seen with standard delayed cord clamping, though individual variations can occur. - While beneficial, such a large transfer might only occur with **prolonged clamping times** or specific neonatal interventions. *150-180 mL* - This range represents a **substantially larger volume** than what is typically transferred during routine delayed cord clamping. - This volume is **uncommon** and might lead to concerns like **polycythemia** if it occurred. *100-200 mL* - While the lower end of this range (100 mL) can sometimes be achieved, 200 mL is generally **considered excessive** for typical delayed cord clamping. - Such a large volume could contribute to **hyperbilirubinemia** and **polycythemia** in the neonate.
Question 5: A woman suffering from active tuberculosis not on ATT has a full term vaginal delivery. All the following should be done except:
- A. Neonate should be isolated from mother
- B. Breastfeed the neonate
- C. Neonate should be given INH
- D. BCG should be given to the neonate (Correct Answer)
Explanation: ***BCG should be given to the neonate*** - This is the **EXCEPTION** - BCG vaccination should be **deferred** in neonates born to mothers with active, untreated tuberculosis. - **Current guidelines (WHO/CDC):** BCG is contraindicated or delayed when there is known exposure to active TB, as the neonate is at risk of developing active disease, and BCG given during the incubation period may cause disseminated BCG infection. - The neonate should first receive **INH prophylaxis for 6 months**, then be reassessed. If TB is ruled out and tuberculin skin test is negative, BCG can be given after completing prophylaxis. - Immediate BCG vaccination in an exposed neonate may lead to complications if the infant develops active TB. *Breastfeed the neonate* - **Breastfeeding should be continued** even when the mother has active tuberculosis, as per WHO and CDC recommendations. - **TB is NOT transmitted through breast milk** - the infection spreads via respiratory droplets, not through lactation. - The mother should wear a **surgical mask during breastfeeding** and feeding times to minimize respiratory transmission risk. - The benefits of breastfeeding (nutrition, immunity, bonding) outweigh the risks when appropriate precautions are taken. *Neonate should be isolated from mother* - **Temporary separation is recommended** until the mother with active, untreated TB is rendered non-infectious. - Isolation prevents **respiratory transmission** of Mycobacterium tuberculosis from mother to the highly susceptible neonate. - Once the mother has been on effective anti-tuberculosis treatment (ATT) for **at least 2 weeks** and shows clinical improvement, contact can be resumed with appropriate precautions (mask use). *Neonate should be given INH* - **Isoniazid (INH) prophylaxis is mandatory** for neonates born to mothers with active tuberculosis. - Standard protocol: **INH 10 mg/kg/day for 6 months** to prevent progression from latent to active TB. - After 6 months of prophylaxis, the infant should be evaluated with tuberculin skin test (TST). If negative and no evidence of active disease, INH can be stopped and BCG can be administered. - This prophylactic approach significantly reduces the risk of the neonate developing active tuberculosis.
Question 6: 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 7: The term Perinatal covers the period from :
- A. 28 weeks gestation to one week after birth (Correct Answer)
- B. 28 weeks gestation to one month after birth
- C. 24 weeks gestation to one week after birth
- D. First 4 weeks after birth
Explanation: ***28 weeks gestation to one week after birth*** - The **perinatal period** is traditionally defined as encompassing the period from **28 completed weeks of gestation** until **7 completed days after birth**. - This definition is crucial for statistical purposes related to **perinatal mortality and morbidity**, as it covers the late fetal and early neonatal stages when many risks are highest. - **Note:** While WHO updated the definition in 2016 to start from **22 completed weeks** for international reporting, the **28-week definition** remains the classical definition widely used in medical education and was the standard definition at the time of this exam (2013). *28 weeks gestation to one month after birth* - This definition extends beyond the typical perinatal period, which concludes at **one week post-birth** (7 completed days). - While it includes the late fetal period, the **one-month post-birth** timeframe extends into the broader **neonatal period** (0-28 days). *24 weeks gestation to one week after birth* - Although 24 weeks is close to the **viability threshold**, the standard definition for the onset of the perinatal period has traditionally been **28 completed weeks of gestation**. - Starting at **24 weeks** makes the period longer than the classically accepted definition, though it's closer to the modern WHO threshold of 22 weeks. *First 4 weeks after birth* - This period describes the **neonatal period**, which specifically refers to the time from birth up to **28 completed days** of life. - It does not include any part of the **fetal period**, which is a key component of the perinatal definition.
Question 8: Which virus has the highest chance of transmission to the newborn during delivery?
- A. HSV (Correct Answer)
- B. CMV
- C. VZV
- D. Rubella
Explanation: ***HSV*** - **Herpes Simplex Virus (HSV)** has the **highest transmission rate during vaginal delivery** if the mother has active genital lesions, with transmission rates of **30-50% for recurrent infection** and up to **85-90% for primary infection**. - Neonatal herpes can lead to severe disseminated disease, central nervous system involvement, or mucocutaneous lesions with high morbidity and mortality. - **Cesarean section is indicated** if active lesions are present at the time of labor to prevent transmission. *CMV* - **Cytomegalovirus (CMV)** is primarily transmitted **congenitally (in utero)** rather than during delivery. - While perinatal transmission can occur through cervical secretions or blood during delivery, the rate is **much lower** than HSV and most postnatal transmission occurs through **breastfeeding**. - Intrapartum transmission, when it occurs, generally causes less severe disease compared to congenital infection. *VZV* - **Varicella-Zoster Virus (VZV)** transmission to the newborn occurs primarily when maternal infection develops **within 5 days before to 2 days after delivery**. - This can cause severe neonatal varicella, but the **overall intrapartum transmission rate is lower** than HSV. - Most severe fetal effects occur with **congenital varicella syndrome** (first or second trimester infection). *Rubella* - **Rubella** is almost exclusively transmitted **congenitally during early pregnancy**, leading to **congenital rubella syndrome**. - There is **no significant transmission during delivery** itself. - The critical period for fetal damage is during the first trimester, not at the time of birth.
Question 9: What is the most commonly observed fetal effect in women receiving magnesium sulphate therapy for pre-eclampsia/eclampsia ?
- A. Intestinal obstruction
- B. Variability in fetal heart rate pattern
- C. Cerebral palsy
- D. Respiratory depression (Correct Answer)
Explanation: ***Respiratory depression*** - Magnesium sulfate readily crosses the placenta, leading to elevated magnesium levels in the fetus, which can cause **central nervous system depression** and **respiratory depression** at birth. - This is the **most commonly observed fetal effect**, manifesting as neonatal hypermagnesemia with respiratory compromise, hypotonia, and decreased reflexes. - The effect is due to magnesium's role as a **neuromuscular blocker**, reducing acetylcholine release at the neuromuscular junction. *Intestinal obstruction* - There is no direct link between maternal magnesium sulfate therapy and an increased risk of **fetal intestinal obstruction**. - Intestinal obstruction in neonates is typically associated with **structural anomalies** or conditions like meconium ileus, not magnesium exposure. *Variability in fetal heart rate pattern* - While magnesium sulfate can cause **decreased fetal heart rate variability** as a monitoring finding, this is not the "most commonly observed fetal effect." - Decreased variability is a **transient monitoring change** during therapy, whereas respiratory depression is a direct clinical effect observed at birth. - The question asks for the most common **fetal effect**, and respiratory depression at delivery is more clinically significant and commonly encountered. *Cerebral palsy* - Magnesium sulfate is actually used as a **neuroprotective agent** in preterm births to **reduce the risk of cerebral palsy**. - It does not cause cerebral palsy; rather, it provides fetal neuroprotection when given for preterm labor <32 weeks gestation.
Question 10: Which of the following is a criterion for infant at risk?
- A. Preeclampsia in pregnancy (Correct Answer)
- B. Has not taken 100 days folic acid
- C. Malpresentation during birth
- D. Working mothers
Explanation: ***Preeclampsia in pregnancy*** - **Preeclampsia** is a serious pregnancy complication characterized by high blood pressure and signs of damage to another organ system, most often the liver and kidneys. - Infants born to mothers with preeclampsia are at **significantly higher risk** for complications including **preterm birth**, **intrauterine growth restriction (IUGR)**, low birth weight, respiratory distress syndrome, and perinatal mortality. - This is a **universally recognized criterion** for identifying high-risk infants in maternal-child health programs and NICU protocols. - Such infants require close monitoring and specialized care from birth. *Has not taken 100 days folic acid* - Periconceptional **folic acid supplementation** (ideally starting 3 months before conception and continuing through early pregnancy) reduces the risk of **neural tube defects** in the fetus. - While lack of folic acid supplementation increases the risk of congenital anomalies during pregnancy, this historical factor alone does not classify the infant as "at risk" after birth unless an actual neural tube defect or other complication is present. - This is primarily a **pregnancy risk factor** rather than a postnatal infant risk criterion. *Malpresentation during birth* - **Malpresentation** (e.g., breech, transverse lie, face presentation) increases the risk of birth complications such as **birth asphyxia**, **birth trauma**, cord prolapse, and difficult delivery. - While malpresentation is recognized as a risk factor during delivery and such infants may require closer initial monitoring, **preeclampsia** represents a more comprehensive and persistent risk affecting multiple organ systems and long-term outcomes. - In the context of identifying high-risk infants for follow-up programs, maternal preeclampsia is a more significant criterion than malpresentation alone (assuming no birth complications occurred). *Working mothers* - A mother's employment status does not inherently classify an infant as "at risk" from a medical or developmental standpoint. - While **socioeconomic factors** and access to care can impact infant health, simply being a working mother is not a direct medical criterion for defining an infant as high-risk.
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