Neonatology: Transition, Resuscitation, and Common Newborn Problems
Core concepts
Neonatology questions hinge on the fetal-to-neonatal transition: lung fluid clearance, surfactant-mediated alveolar stability, and closure of the ductus arteriosus and foramen ovale. Understand the NRP-style resuscitation sequence - warmth, position/clear airway, dry and stimulate, then breathing and heart rate assessment - with positive pressure ventilation for apnea or heart rate below 100, and chest compressions when the heart rate stays below 60 despite effective ventilation. Know that ventilation, not compressions, is the priority in neonates.
Master jaundice timing: jaundice in the first 24 hours is always pathologic; breast-feeding jaundice appears early with inadequate intake; breast-milk jaundice appears later and is benign. Know hypoglycemia risk groups (infant of diabetic mother, preterm, small or large for gestational age) and the principle of early feeding plus glucose screening. Understand sepsis risk with maternal group B streptococcus colonization, prolonged rupture of membranes, and maternal fever.
Traps
- Choosing compressions before establishing effective ventilation.
- Attributing early jaundice to breastfeeding when it must be investigated for hemolysis or infection.
- Confusing physiologic weight loss (up to ~7–10% in the first week, regained by ~2 weeks) with pathologic loss.
- Missing respiratory distress signs: grunting, nasal flaring, retractions, tachypnea.
Worked example
A term infant at 6 hours of life has a bilirubin above the treatment threshold and a positive direct antiglobulin test with maternal–infant ABO incompatibility. The timing (first 24 hours) plus hemolysis markers point to pathologic, immune-mediated jaundice: initiate phototherapy per the age-in-hours nomogram and monitor for anemia.