Neonatology and Perinatal Medicine
Neonatology questions in the Czech board exam concentrate on delivery-room stabilisation, the physiology of the preterm infant, and the screening programme every newborn passes through before discharge. Expect short vignettes giving a gestational age, a birth weight and one borderline observation, and expect the answer to hinge on what you do first.
Delivery room
- The Apgar score is a description at 1 and 5 minutes. It never determines whether or how to resuscitate; heart rate and breathing do.
- Sequence: warm, dry, stimulate, open the airway. If apnoeic or heart rate below 100/min, start positive pressure ventilation with 21% oxygen in term infants and 21-30% in very preterm infants.
- Start chest compressions when heart rate stays below 60/min despite effective ventilation: a 3:1 ratio, 90 compressions and 30 breaths per minute, with 100% oxygen once compressions begin.
- Preductal saturation rises slowly: roughly 60% at 2 minutes, 70-75% at 4 minutes, 80-85% at 5 minutes, 85-95% by 10 minutes.
Preterm problems
- Respiratory distress syndrome: early CPAP, early surfactant, caffeine for apnoea of prematurity.
- Intraventricular haemorrhage graded 1-4 on cranial ultrasound; necrotising enterocolitis with feed intolerance, bloody stools and pneumatosis; retinopathy of prematurity screening below 32 weeks or 1500 g.
- Screen at-risk infants for hypoglycaemia and treat below 2.6 mmol/L with feeding or intravenous glucose.
Screening before discharge
Heel-prick newborn screening (congenital hypothyroidism, congenital adrenal hyperplasia, phenylketonuria, cystic fibrosis, fatty-acid oxidation defects, galactosaemia and others), pulse oximetry for critical congenital heart disease at 24-48 hours, hearing screening by otoacoustic emissions, hip ultrasound at 6 weeks, and 1 mg intramuscular vitamin K.
Worked example
A term boy of 3.4 kg, uncomplicated labour, is floppy and apnoeic at 1 minute with a heart rate of 70/min. The Apgar is 4, but that number does not drive management. Dry, stimulate, position the airway, then give positive pressure ventilation with 21% oxygen; reassess at 30 seconds. If the heart rate is still below 60/min, secure the airway and begin 3:1 compressions with 100% oxygen, rechecking the heart rate every 60 seconds and thinking of pneumothorax or hypovolaemia if there is no response.
Traps that cost marks
Starting with 100% oxygen; routine suctioning of a vigorous baby; treating a low 5-minute Apgar as an automatic indication for intubation; postponing the screening card because the infant is preterm; forgetting that a newborn with a saturation of 97% can still have a duct-dependent lesion once the duct closes.