Neonatology and Perinatal Medicine
Neonatology and Perinatal Medicine covers delivery-room resuscitation, the preterm and growth-restricted infant, neonatal jaundice, respiratory distress, sepsis and newborn screening. Board items favour decision points: what to do in the first minute, which bilirubin needs treatment, and which antenatal or postnatal intervention changes outcome.
Delivery room
- Dry, stimulate, assess tone and breathing; delay cord clamping about 60 seconds if the baby is not compromised.
- Use a 3:1 compression-to-ventilation ratio (90 compressions and 30 breaths per minute) when compressions are needed.
- Start term infants in air (21% oxygen) and preterm infants below 35 weeks in 21-30%, titrating to preductal saturation targets.
- Apgar scores describe the baby and must never delay resuscitation.
Neonatal jaundice
- Physiological: appears after 24 hours, peaks day 3-5 in term infants (day 5-7 if preterm), unconjugated, direct fraction under 1 mg/dL.
- Pathological: onset under 24 hours, bilirubin above the treatment line on an hour-specific chart, rise over 5 mg/dL/day or 0.2 mg/dL/hour, direct fraction above 1 mg/dL, or jaundice persisting beyond 14 days (21 if preterm).
- Early or rapidly rising jaundice needs blood group, direct Coombs, full blood count and reticulocytes to look for haemolysis.
Preterm problems
- Respiratory distress syndrome: grunting, retractions, ground-glass fields with air bronchograms; antenatal steroids, early CPAP, surfactant.
- Necrotising enterocolitis: feed intolerance, abdominal distension, pneumatosis intestinalis; stop feeds, decompress, give antibiotics.
- Early-onset sepsis (under 72 hours): group B streptococcus, E. coli, Listeria; ampicillin plus gentamicin.
Screening and prophylaxis
Vitamin K 1 mg intramuscularly at birth. Newborn screening covers congenital hypothyroidism (TSH), phenylketonuria, congenital adrenal hyperplasia (17-hydroxyprogesterone), galactosaemia and hearing.
Worked example
A term baby at 30 hours has a bilirubin of 16 mg/dL. Mother is O positive, baby A positive, direct Coombs positive, haematocrit 40%. Onset before 24 hours plus a rapid rise makes this pathological, and ABO haemolysis is the likely cause. Plot on the hour-specific nomogram, start intensive phototherapy, repeat bilirubin within 4-6 hours, and prepare exchange transfusion if the level keeps climbing.
Traps
Reassuring a family about jaundice that began on day one; forgetting the direct fraction when jaundice persists; and treating a stable preterm infant with a fluid bolus instead of CPAP for early respiratory distress.