Basics of Neonatology and Routine Newborn Care MCQs

Meconium (first stool) is passed within 24 hours. After that meconium stools (black tarry)can be passed upto 3 days. On 4th-5th days transitional stools (greenish) are passed. After 5 days regular milk stools (golden yellow) are passed. Tags: Topic: MISCELLANEOUS Difficulty level: GOOD TO KNOW Reference: Ghai essential pediatrics, 9 th ed, pg no: 133

Definition of polycythemia: a. Venous haematocrit of over 65%. b. Venous haematocrit of over 64% at 2 hours age. c. An umbilical venous or arterial haematocrit over 63% or more. The mean venous haematocrit of term infants is 53 in cord blood, 60 at 2 hours of age, 57 at 6 hours of age and 52 at 12-18 hours of age. As the haematocrit increases, there is increased viscosity and decreased blood flow. When haematocrit increases to more than 60% there is a fall in O2 transport. Definition of hyperviscosity: Viscosity greater than 14.6 centipose at a shear rate of 11.55 as measured by a viscometer. (normal is 1.4- 1.8 centipoise).

This question is a practical application-based question and very similar to an actual question asked recently. The correct answer is D. For IV cannulating a neonate, we need Gloves, Cannula, Normal saline (to flush) and a 2 ml syringe (not a 5 ml syringe) In neonates, 26G Cannula is used. Reference: The Harriet Lane Handbook 23 rd Edition

The exposed meningomyelocele sac containing neural tissue should be covered with a sterile Saline-soaked gauze. REMEMBER: Exposed neural tissue should not be covered or wiped with any irritant, not even Povidone-Iodine! Perinatal Care for Meningomyelocele Prone or lateral position nursing Cover the sac with a sterile, saline-moistened gauze Prophylactic antibiotics Consider a doughnut ring to prevent sac rupture in MC & MMC Monitor OFC, AF & Vitals closely Reference: AIIMS NICU Protocols 3 rd Edition

When to Discontinue KMC? If the mother and baby are comfortable, KMC is continued at the hospital and at home for as long as possible. Often this is desirable until the baby's gestation reaches term or the weight is around 2500 g. Once the weight cut off is reached or crossed and the neonate starts wriggling to show that she is uncomfortable, pulls her limbs out, cries, and fusses whenever put in skin-to-skin contact, the mother can wean the baby from KMC. Reference: AIIMS Protocols In Neonatology, 3 rd Edition, Volume 2, Page 527

This infant has development delay predominantly involving motor domain with history of maternal uncle dying between 15-20 years age, who was bed-ridden prior. All this indicates a likely muscle dystrophy with X-linked recessive inheritance, causing death in the 2 nd decade of life. Duchenne muscular dystrophy (DMD) is an X-linked, recessive condition affecting male infants should be ruled out in such cases Since targeted therapies are available with more emerging for DMD, sending a creatine kinase (CK) in a male infant with development delay is the next best step at the pediatrician's office. Early detection and diagnosis will enable early treatment. Serum Creatine kinase (CK) is the primary biomarker for Duchenne muscular dystrophy (DMD) and often used as a screening test. Reference: Nelson textbook of pediatrics, 1 st SA edition, pg. 2967

DONOR HUMAN MILK Donar human milk [DHM] is the milk expressed and voluntarily donated by lactating women other than the biological mother of the recipient baby. This donor human milk is pasteurized using the Holder pasteurization method [pasteurized donor human milk; PDHM] and dispensed for use of the recipient. Donation should be free and without any monetary benefit. The recipient should also be provided the DHM free of cost. World health Organization [WHO] and National Neonatology Forum [NNF], India recommends DHM as the preferred choice if mother's own milk is not available for feeding of preterm or low- birthweight [LBW] infants, including very preterm [ Reference: AIIMS Protocols In Neonatology, 3 rd Edition, Volume 2, Page 543

It is a tough question, but such questions can be answered by ruling out other options easily. Option A- Pyloric stenosis is an acquired condition and would NEVER present in the first few days of life, nor would it be associated with a large stomach at birth and polyhydramnios. Option B- Duodenal webs and atresia would likely present with bilious vomiting. Option C- Jejunoileal atresia would also likely present with bilious vomiting and abdominal distension. Option D- Neonates with pyloric atresia will present with early onset of vomiting that is nonbilious, as well as a dilated stomach at birth. The mother may also have polyhydramnios during her pregnancy. Reference: Nelson textbook of pediatrics, 1 st SA ed., pg. 1801