Neurologic and Sensory System
Core concepts
Focus on neonatal neurologic assessment: tone, reflexes (Moro, suck, rooting, grasp), level of alertness, and seizure recognition. Understand hypoxic-ischemic encephalopathy (HIE) and therapeutic hypothermia as the standard for eligible infants, including timing (within 6 hours) and eligibility criteria. Know neonatal seizures - often subtle, may be hypoxic, metabolic, or infectious in origin. Understand intraventricular hemorrhage in preterm infants, periventricular leukomalacia, and the role of antenatal magnesium sulfate for neuroprotection. Recognize hyperbilirubinemia as a neurologic risk (kernicterus) and the importance of bilirubin monitoring and phototherapy thresholds. Also address sensory screening: hearing screening and retinopathy of prematurity screening in at-risk infants.
Traps
Questions often test that therapeutic hypothermia must begin early and that not all encephalopathic infants qualify. Another trap is missing subtle seizures (lip smacking, cycling movements) that differ from adult tonic-clonic patterns. Also beware attributing all jitteriness to seizures - jitteriness is stimulus-sensitive and stops with holding.
Worked example
An infant with low Apgar scores and acidosis develops encephalopathy. Rule of thumb: therapeutic hypothermia within 6 hours of birth improves outcomes for eligible infants with moderate-to-severe HIE; initiate the process early while completing eligibility assessment.
Study focus
Link neurologic findings to timing of injury and to evidence-based neuroprotective interventions.