Neonatology Practice Questions

Q: A newborn after prolonged labour is not breathing well and after 30 seconds of receiving 100% oxygen by bag and mask, heart rate is 88 beats per minute. What is the next step in management?

Continue oxygen and ventilation. ***Continue oxygen and ventilation*** - A **heart rate less than 100 beats per minute** in a newborn needing resuscitation indicates ongoing compromise, mandating continued positive pressure ventilation. - The goal is to achieve a heart rate above 100 bpm, regular breathing, and improving oxygen saturation, which requires continued support. *Discontinue oxygen and ventilation* - This action would be appropriate only if the newborn's heart rate was **above 100 bpm** and they were breathing effectively. - Discontinuing support when the heart rate is 88 bpm would lead to further deterioration and potentially irreversible harm. *Discontinue oxygen, continue ventilation* - Reducing oxygen to room air might be considered if the newborn's **heart rate improves** and oxygen saturations are appropriate, but not when the heart rate is still below 100 bpm. - Continuing ventilation without adequate oxygen when indicated could be detrimental, as the goal is to improve oxygen delivery to tissues. *Start chest compressions* - Chest compressions are indicated when the newborn's heart rate remains **below 60 beats per minute** despite 30 seconds of effective positive pressure ventilation. - In this scenario, the heart rate is 88 bpm, which is above the threshold for initiating chest compressions but still requires continued ventilatory support.

Q: What is the recommended technique for performing chest compressions on a newborn?

Using two thumbs on the lower third of the sternum. ***Using two thumbs on the lower third of the sternum*** - The **two-thumb encircling technique** is recommended for newborns, especially when two rescuers are present, as it provides better coronary and cerebral perfusion pressures compared to the two-finger technique. - Compressions should be applied to the **lower third of the sternum**, just below the nipple line, to avoid injury to the xiphoid process. *Using two fingers on the middle third of the sternum* - The **two-finger technique** can be used if there is only one rescuer, but it is generally less effective in generating optimal perfusion than the two-thumb technique. - Compressing the **middle third of the sternum** is incorrect; the appropriate landmark is the lower third. *Using three fingers on the lower third of the sternum* - Using **three fingers** is generally not a standard recommended technique for neonatal CPR, as it can be difficult to achieve the correct depth and pressure distribution. - While the **lower third of the sternum** is correct, the multiple finger approach is less precise than the two-thumb or two-finger methods. *Using the palm on the lower third of the sternum* - Using the **palm of the hand** is too broad and provides excessive pressure for a fragile newborn's chest, risking serious injury to internal organs or ribs. - This technique is more appropriate for **adult CPR** and should not be applied to neonates.

Q: Colour of stools in breastfed newborn is -

Golden. ***Golden*** - The typical color of stool in healthy, breastfed newborns is **golden-yellow** to **mustard-yellow**. - This color is due to the presence of **bilirubin**, a byproduct of red blood cell breakdown, which is normal in breastfed infants. *Green* - While occasional green stools can be normal, particularly with **iron supplementation** or a **foremilk-hindmilk imbalance**, consistently bright green stools without other causes might indicate rapid transit. - Darker green stools can also be seen in newborns passing **meconium** initially, but this typically transitions to yellow within the first few days. *Red* - **Red stools** in a newborn are a concerning sign, often indicating the presence of **blood** in the stool. - This could be due to anal fissures, infections, allergies, or other gastrointestinal pathologies, requiring medical evaluation. *Black* - **Black, tarry stools** in a newborn usually indicate the passage of **meconium**, which is normal in the first few days of life. - However, persistent black stools after the meconium phase can signify **upper gastrointestinal bleeding** (melena) and warrant immediate medical attention.

Q: What is the IV dose per kg of 1:10000 concentration of epinephrine in a pre-term baby in milliliters (ml)?

0.1 ml. ***0.1 ml*** - The recommended **IV dose of epinephrine** for a preterm baby in a 1:10,000 concentration is **0.01 mg/kg**. - Since 1:10,000 solution contains 0.1 mg/ml, the volume administered would be **0.1 mL/kg** (0.01 mg/kg divided by 0.1 mg/mL). *0.2 ml* - This dose would be twice the recommended starting dose, increasing the risk of **epinephrine side effects** such as **tachycardia** or **arrhythmias**. - **Overdosing** with epinephrine can lead to significant **cardiovascular complications**, which are particularly dangerous in fragile preterm infants. *0.3 ml* - This volume is three times the standard **epinephrine dose**, significantly increasing the likelihood of toxicity. - Delivering such a high dose could cause severe adverse effects including **hypertension**, **myocardial ischemia**, or **intracranial hemorrhage** in a preterm infant. *0.4 ml* - This dose is four times higher than what is typically recommended, posing a considerable threat to the infant's health. - Administering this much epinephrine would significantly elevate the risk of **life-threatening arrhythmias** and **cardiovascular collapse**.

Q: Post term baby with tachypnea - commonest cause?

Meconium aspiration syndrome. ***Meconium aspiration syndrome*** - Post-term infants are at increased risk of **meconium staining of amniotic fluid** and subsequent **meconium aspiration**, leading to respiratory distress. - Meconium in the lungs causes **airway obstruction**, chemical pneumonitis, and surfactant inactivation, resulting in tachypnea and hypoxemia. *Transient tachypnea of newborn* - This condition is more common in **term or late preterm infants delivered by C-section**, rather than post-term. - It is caused by **delayed reabsorption of fetal lung fluid**, leading to mild respiratory distress that typically resolves within 24-48 hours. *Hyaline membrane disease* - Also known as **respiratory distress syndrome**, this condition primarily affects **preterm infants** due to **surfactant deficiency**. - It would be highly unusual in a post-term infant, as surfactant production is mature by term or post-term. *Infection* - While infection (e.g., **neonatal sepsis**, pneumonia) can cause tachypnea in any newborn, it is **not the commonest cause of respiratory distress specifically in a post-term baby** with tachypnea. - Infection would typically be accompanied by other signs like fever/hypothermia, poor feeding, lethargy, or signs of systemic illness.

Q: Which drug is primarily used in neonatal resuscitation?

Adrenaline. ***Adrenaline*** - **Adrenaline (epinephrine)** is the primary drug used in neonatal resuscitation when **bradycardia** (heart rate <60 bpm) persists despite adequate ventilation and chest compressions. - It acts as a **vasopressor** and **cardiac stimulant**, increasing heart rate and contractility. - Administered intravenously or via endotracheal tube at a dose of **0.01-0.03 mg/kg**. *Sodium bicarbonate* - **Sodium bicarbonate** is rarely used in neonatal resuscitation due to concerns about potential side effects like **intracranial hemorrhage** and paradoxical intracellular acidosis. - Its use is generally reserved for prolonged resuscitation with documented **metabolic acidosis**. - Not recommended for routine use in the delivery room. *Naloxone* - **Naloxone** is an opioid antagonist used to reverse severe **respiratory depression** caused by maternal opioid administration shortly before delivery. - It is not indicated for primary resuscitation efforts in the absence of opioid exposure, and ventilation remains the priority. - Current NRP guidelines emphasize **ventilation over naloxone** administration. *Atropine* - **Atropine** is no longer recommended in neonatal resuscitation protocols. - It was previously considered for bradycardia but has been removed from **NRP guidelines** due to lack of evidence for efficacy. - **Adrenaline** has replaced atropine as the drug of choice for persistent bradycardia.

Q: Which of the following statements about Kangaroo Mother Care is false?

It is only applicable to mothers.. ***It is only applicable to mothers.*** - This statement is false because **Kangaroo Mother Care (KMC)** involves skin-to-skin contact, which can be provided by any adult caregiver, including the **father** or other family members, not exclusively the mother. - The benefits of KMC, such as **thermal regulation**, improved **bonding**, and **breastfeeding promotion**, are achieved regardless of whether the mother or another caregiver provides the contact. *Can also be provided by the father.* - This statement is true; **fathers** are increasingly recognized as important caregivers in providing **KMC**, offering similar benefits as when provided by the mother. - Involving fathers can enhance **parental bonding** and share the caregiving responsibilities for the infant, especially for **low birth weight** or **premature infants**. *It is especially beneficial for low birth weight infants.* - This statement is true; **KMC** is particularly recommended for **low birth weight (LBW)** infants, especially those weighing under 2500 grams, as it has been shown to reduce mortality and improve their health outcomes. - It helps stabilize **cardiorespiratory function**, promotes **weight gain**, and facilitates **exclusive breastfeeding** in these vulnerable infants. *It provides effective thermal control.* - This statement is true; **KMC** involves direct **skin-to-skin contact**, which helps regulate the infant's body temperature, preventing both **hypothermia** and **hyperthermia** more effectively than conventional incubators in some settings. - The caregiver's body acts as a **human incubator**, providing a stable and appropriate thermal environment for the infant.

Q: Meconium can be passed up to how many days in a healthy baby?

2. ***2*** - Most healthy term infants pass **meconium** within the first 24 hours of life (90-95%). - Passage of meconium up to **48 hours (2 days)** can still occur in healthy term infants. - **Failure to pass meconium by 48 hours** warrants investigation for potential underlying conditions such as **Hirschsprung disease**, meconium plug syndrome, or intestinal obstruction. - This is the accepted standard in pediatric practice for initiating evaluation. *3* - Waiting **72 hours (3 days)** before investigating delayed meconium passage is not recommended. - By 3 days, the delay is considered **abnormal** and should have already prompted medical evaluation. - Most guidelines recommend investigation by **48 hours**, not 72 hours. *5* - A delay in meconium passage for **5 days** represents a significant abnormality requiring urgent evaluation. - Such delays are typically associated with conditions like **Hirschsprung disease**, intestinal atresia, or other causes of obstruction. - This duration would never be considered normal in a healthy baby. *7* - A delay of **7 days** would be a severe abnormality indicating serious underlying pathology. - This would require urgent medical and likely surgical intervention. - Complete failure to pass meconium for this duration strongly suggests **intestinal obstruction or severe motility disorder**.

Q: The most common bone fractured during birth is

Clavicle. ***Clavicle*** - The **clavicle** is the most common bone fractured during birth due to the stresses applied during delivery, especially in cases of shoulder dystocia. - Its relatively superficial location and slender shaft make it vulnerable to fracture as it may get compressed or stretched against the maternal pelvis. *Scapula* - Fractures of the **scapula** are extremely rare in newborns due to its protected position and broad, flat structure. - It would require a significant, unusual force to fracture the scapula during birth. *Radius* - While long bone fractures can occur, a **radial fracture** is less common than a clavicle fracture during birth. - Fractures of the radius typically occur from direct trauma or hyperextension injuries, rather than the compressive forces seen during normal birth. *Humerus* - Fractures of the **humerus** are less common than clavicle fractures but can occur, particularly in difficult deliveries or when excessive force is applied during extraction. - However, the clavicle remains the most frequently fractured bone overall in neonates during birth.

Question 1

A newborn after prolonged labour is not breathing well and after 30 seconds of receiving 100% oxygen by bag and mask, heart rate is 88 beats per minute. What is the next step in management?

Accepted Answer

Continue oxygen and ventilation

Answer

Discontinue oxygen and ventilation

Answer

Discontinue oxygen, continue ventilation

Answer

Start chest compressions

Question 2

What is the recommended technique for performing chest compressions on a newborn?

Accepted Answer

Using two thumbs on the lower third of the sternum

Answer

Using two fingers on the middle third of the sternum

Answer

Using three fingers on the lower third of the sternum

Answer

Using the palm on the lower third of the sternum

Question 3

Colour of stools in breastfed newborn is -

Accepted Answer

Golden

Answer

Red

Answer

Green

Answer

Black

Question 4

What is the IV dose per kg of 1:10000 concentration of epinephrine in a pre-term baby in milliliters (ml)?

Accepted Answer

0.1 ml

Answer

0.3 ml

Answer

0.4 ml

Answer

0.2 ml

Question 5

Post term baby with tachypnea - commonest cause?

Accepted Answer

Meconium aspiration syndrome

Answer

Transient tachypnea of newborn

Answer

Hyaline membrane disease

Answer

Infection

Question 6

A newborn with blood group O positive, whose mother is Rh negative, has a cord bilirubin level of 7 mg/dl. What is the appropriate treatment?

Accepted Answer

Check Direct Coomb's Test (DCT)

Answer

Monitor bilirubin levels

Answer

Prepare for exchange transfusion

Answer

Start phototherapy

Question 7

Which drug is primarily used in neonatal resuscitation?

Accepted Answer

Adrenaline

Answer

Sodium bicarbonate

Answer

Naloxone

Answer

Atropine

Question 8

Which of the following statements about Kangaroo Mother Care is false?

Accepted Answer

It is only applicable to mothers.

Answer

Can also be provided by the father.

Answer

It is especially beneficial for low birth weight infants.

Answer

It provides effective thermal control.

Question 9

Meconium can be passed up to how many days in a healthy baby?

Accepted Answer

2

Answer

3

Answer

5

Answer

7

Question 10

The most common bone fractured during birth is

Accepted Answer

Clavicle

Answer

Scapula

Answer

Radius

Answer

Humerus

Neonatology — MCQs

Neonatology — MCQs

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