Neonatology and Perinatology
Domain focus
Neonatology and Perinatology tests delivery-room stabilization, prematurity, respiratory distress, jaundice, sepsis, feeding and thermal care. Questions reward a structured ABC approach and gestational-age-adjusted thresholds.
Core rules
- In the delivery room, provide warmth, position, dry and stimulate. Start positive-pressure ventilation if apnoea, gasping or heart rate <100/min; chest compressions if heart rate <60/min after effective ventilation; epinephrine if still <60/min.
- APGAR scores document condition but do not guide resuscitation.
- Check glucose in at-risk infants; treat symptomatic hypoglycaemia and persistent low values according to protocol.
- Measure bilirubin and use hour-specific thresholds; do not judge jaundice visually.
- For suspected early-onset sepsis, obtain cultures and start ampicillin plus gentamicin promptly.
- Preterm infants may need CPAP, caffeine and surfactant for respiratory distress syndrome.
Worked example
A 35-week infant has grunting, subcostal recession and SpO2 88% at 1 hour. Stabilize airway and breathing, give CPAP, check glucose and obtain blood culture. Start ampicillin and gentamicin because pneumonia and sepsis mimic RDS. Order chest radiograph; escalate to surfactant if signs worsen. Avoid blind 100% oxygen; titrate to target saturation.
Traps
Waiting for a low APGAR before starting ventilation; relying on visual jaundice; missing cyanotic congenital heart disease; over-oxygenating preterm infants; forgetting heat loss and hypoglycaemia in transport.