Neonatology
Domain focus
Neonatology tests delivery-room stabilization, transition physiology, preterm complications, and common newborn problems such as jaundice, hypoglycemia, and sepsis.
Core rules
- NRP sequence: warm, dry, stimulate, position; assess tone, breathing, and heart rate. Provide positive-pressure ventilation for apnea, gasping, or HR <100/min. If HR remains <60/min after effective ventilation, start chest compressions at 3:1 (90 compressions and 30 breaths/min) and consider epinephrine.
- APGAR scores describe status at 1 and 5 minutes; they do not drive resuscitation.
- Visible jaundice within 24 hours is pathologic: check total and direct bilirubin, blood type, Coombs, and CBC; treat according to hour-specific thresholds.
- At-risk infants (preterm, SGA, infant of diabetic mother) need glucose monitoring; symptomatic or persistent hypoglycemia requires IV dextrose, not just feeding.
Worked example
A term newborn at 2 hours has jaundice. Total bilirubin is 12 mg/dL and the infant is 38 weeks. Reasoning: jaundice before 24 hours is never physiologic. The baby needs a hemolytic workup and treatment threshold review using the hour-specific nomogram; a level of 12 mg/dL at 2 hours is far above the expected rise and may require phototherapy. Do not discharge on the basis of “breastfeeding jaundice.”
Traps
- Waiting for a 1-minute APGAR before starting ventilation.
- Treating jaundice at 48 hours with the same threshold used at 96 hours.
- Missing conjugated hyperbilirubinemia: direct bilirubin >1 mg/dL or >20% of total is cholestasis, not physiologic jaundice.