Neonatology and Perinatology
Core concepts
Master the transition from fetal to neonatal circulation, the Apgar score as an assessment (not a resuscitation tool), and the physiology of neonatal jaundice. Know the causes and timing of respiratory distress (TTN, RDS, MAS, pneumonia, pneumothorax), the approach to hypoglycemia in the at-risk infant, and the classification of preterm birth by gestation and weight. Understand sepsis risk stratification (maternal GBS status, PROM duration, chorioamnionitis) and the indications for phototherapy in the hour-specific bilirubin nomogram.
Traps
Questions often present a vigorous newborn with a low 1-minute Apgar and expect you to start resuscitation based on tone, breathing, and heart rate - not on the number alone. Another trap is treating jaundice by total bilirubin alone without considering age in hours and risk factors. Hypoglycemia thresholds and screening times (especially in infants of diabetic mothers, LGA, SGA, and preterm infants) are frequently tested.
Worked example
A term infant at 36 hours has a total bilirubin of 15 mg/dL, is feeding well, and is not hemolyzing. The decision hinges on the hour-specific threshold for that age and risk category. If the value sits below the phototherapy line, the correct answer is continued feeding and a repeat level in 12–24 hours - not immediate exchange transfusion or discharge without follow-up.
Rule of thumb
In the delivery room, ask three questions in order: is the baby term, is the tone good, is the baby breathing or crying? If yes to all, the baby stays with the mother; if not, move to the resuscitation algorithm.