100+ Free Cert Neonatology(SA) Paed Practice Questions

Explanation: According to NRP 8th Edition, the initial steps of resuscitation for any non-vigorous infant involve placing the baby under a radiant warmer, positioning the head and neck (sniffing position) to open the airway, suctioning secretions if airway is obstructed, drying thoroughly, and providing tactile stimulation. If apnea or heart rate < 100 bpm persists after these initial steps (completed within 30 seconds), positive pressure ventilation (PPV) must be initiated.

Explanation: For preterm infants born at <35 weeks gestation, resuscitation should be initiated using 21% to 30% FiO2 (air or low oxygen concentration blended). Hyperoxia causes oxidative stress and lung injury, while hypoxia must be avoided by targeting pre-ductal oxygen saturations using pulse oximetry.

Explanation: Respiratory Distress Syndrome (RDS) in preterm infants is primarily caused by a deficiency of pulmonary surfactant (produced by Type II pneumocytes) combined with structural immaturity of the lungs. This leads to high alveolar surface tension, microatelectasis, ventilation-perfusion mismatch, and classic ground-glass radiograph appearances with air bronchograms.

Explanation: European and international RDS guidelines recommend initiating CPAP at 5 to 6 cm H2O via nasal prongs or mask immediately after birth for spontaneously breathing infants at risk of RDS. This maintains functional residual capacity (FRC) and reduces the need for intubation.

Explanation: In South Africa, national ROP guidelines recommend screening all infants with a birth weight < 1500 g or gestational age < 32 weeks, as well as selected infants between 1500-2000 g with unstable clinical courses (e.g., prolonged supplemental oxygen exposure).

Explanation: If the newborn's heart rate remains below 60 bpm despite at least 30 seconds of effective PPV that inflates the lungs (confirmed by chest movement), chest compressions must be initiated immediately, and the oxygen concentration should be increased to 100% FiO2.

Explanation: The standard ratio for neonatal CPR is 3 compressions to 1 ventilation (3:1 ratio). This delivers 90 compressions and 30 breaths per minute (total 120 events per minute), emphasizing that asphyxia/hypoxia is the predominant cause of cardiac arrest in neonates.

Explanation: Antenatal corticosteroids administered to mothers at risk of preterm birth between 24 and 34 weeks gestation accelerate fetal lung maturity and decrease neonatal mortality, Respiratory Distress Syndrome (RDS), intraventricular hemorrhage (IVH), and necrotizing enterocolitis (NEC).

Explanation: LISA involves introducing a thin catheter (e.g., vascular catheter or dedicated semirigid catheter) through the vocal cords into the trachea using direct or video laryngoscopy while the infant continues spontaneously breathing on nasal CPAP. This avoids positive pressure mechanical ventilation.

Explanation: Caffeine citrate is a methylxanthine that acts as a competitive antagonist of central adenosine receptors (A1 and A2A). Adenosine inhibits respiratory drive; blocking adenosine increases central respiratory drive, enhances medullary sensitivity to hypercapnia, and improves diaphragmatic contractility.