Apgar score and Neonatal Resuscitation MCQs

Answer- A. Control of fever Prompt reduction of temperature by hydrotherapy (sponging) and antipyretics (paracetamole, ibuprofen) is the most important measure. If seizures lasts for more than 5 minutes, diazepam (rectal or IV) is the anticonvulsant of choice. Phenobarbitone is an alternative

Morbidities associated with post-term pregnancy include the presence of Meconium-stained amniotic fluid ( option a) Meconium aspiration Oligohydramnios Non-reassuring fetal heart rate tracing in labor Low apgar scores, Birth injury ( option c) Fetal macrosomia (option d) Fetal weight loss Tags : Topic : HIGH RISK NEWBORN Difficulty level : MUST KNOW Reference : Cloherty and Stark's Manual of Neonatal care, SA ed., pg. 88

In such a situation, BEDSIDE CRANIAL USG is a very useful and informative investigation. Cranial Ultrasound (CUS) in neonates is safe and radiation free. Safety of sonography is well established in fetus and infants CUS can be easily performed at the bedside. Reliable for commonly occurring neonatal events like hemorrhage, cystic lesions, major malformations and fluid collections. CUS can be initiated even immediately after birth and hence suitable for screening. It can be repeated as often as possible without any adverse effects and hence helps in proper follow up of babies with neurological problems. CUS is a significantly cheaper modality of neuroimaging compared with other techniques Reference: AIIMS NICU Protocols, 3 rd Edition

The therapeutic effect of phototherapy depends on Light energy emitted in the effective range of wavelengths, Distance between the lights and the infant, Surface area of exposed skin Rate of hemolysis and in vivo metabolism and excretion of bilirubin. Dark skin does not reduce the efficacy of phototherapy . Tags : Topic : NEONATAL JAUNDICE Difficulty level : MUST KNOW PYQ : AIIMS JULY 2020 Reference : Nelson textbook of pediatrics, 1 st SA ed., pg. 877

Let us evaluate the options sequentially Option A is False- Intrapartum suctioning is not indicated anymore in neonates Option B is False- Tracheal suction is not indicated anymore in neonates. Furthermore, vigorous MSL babies do not need resuscitation, including suction Option C is True- PPV is life-saving in non-vigorous MSL babies Option D is False- Vigorous babies do not need suction or any other initial steps of resuscitation. Reference: OP Ghai 10 th Edition, Pages 122-123; NRP 8 th Edition Guidelines

Clues in the question Preterm delivery Periventricular calcification Hepatosplenomegaly with jaundice Petechial Rash Failure of neonatal hearing screening, indicating likely SNHL This entire picture corresponds to a likely diagnosis of Congenital CMV Infection. Remember that petechial rash occurs commonly due to thrombocytopenia in such children. Reference: OP Ghai 10 th Edition, Page 285

Medications are rarely required in neonatal resuscitation since the mainstay of management is adequate ventilation with or without chest compressions, but epinephrine should be administered when the heart rate is The umbilical vein can generally be readily cannulated and is the preferred method for administration of medications like epinephrine and volume expanders during neonatal resuscitation. Reference: Nelson 21 st Edition Chapter 121, NRP Guidelines 8 th Edition

Essential Criteria For Perinatal Asphyxia Prolonged Metabolic or Mixed Acidemia (pH Persistence of APGAR Score of 0-3 for >5 min Neurological manifestations e.g., Seizures, coma, hypotonia or HIE Evidence of multiorgan dysfunction in the immediate neonatal period Reference: OP Ghai 10 th Edition, Table 9.23