MCQs on Neonatology

Written by Dr. Emily Chang (MBBS, FRACP) – Paediatrician

Question 1

A full-term baby is born via vaginal delivery after an uncomplicated pregnancy. At birth, the baby is limp, not crying, and has a heart rate of 80 beats per minute. The baby is pale and has poor muscle tone. What is the most appropriate initial step in resuscitation?

A) Start chest compressions immediately
B) Provide positive pressure ventilation with a bag and mask
C) Administer intravenous adrenaline
D) Provide supplemental oxygen by nasal cannula
E) Perform endotracheal intubation

Correct Answer: B) Provide positive pressure ventilation with a bag and mask

In neonatal resuscitation, the first priority after initial assessment is to ensure effective ventilation if the baby is apnoeic or has a heart rate less than 100 bpm. Positive pressure ventilation with a bag and mask is the most effective initial step to improve oxygenation and heart rate.

Chest compressions are indicated only if the heart rate remains below 60 bpm despite adequate ventilation. Intravenous adrenaline is reserved for persistent bradycardia despite ventilation and compressions. Supplemental oxygen by nasal cannula is inadequate in resuscitation. Endotracheal intubation is considered if bag-mask ventilation is ineffective or prolonged.

Question 2

A 3-day-old term newborn presents with yellowing of the skin and sclera. The baby is feeding well, active, and has no fever. Physical examination reveals jaundice extending to the abdomen but no hepatosplenomegaly or bruising. Total serum bilirubin is 220 µmol/L (normal < 200 µmol/L for age).

What is the most appropriate next step?

A) Start immediate phototherapy
B) Order blood group and Coombs test
C) Reassure the parents and monitor clinically
D) Admit for intravenous antibiotics
E) Perform exchange transfusion

Correct Answer: A) Start immediate phototherapy

This newborn shows jaundice at 3 days with a bilirubin level above the age-specific threshold, indicating the need for phototherapy to prevent kernicterus. The baby is otherwise well, suggesting physiological or early pathological jaundice.

Blood group and Coombs test are important if haemolytic disease is suspected, but treatment should not be delayed. Reassurance alone is inappropriate due to bilirubin level. IV antibiotics and exchange transfusion are reserved for severe cases or sepsis, which are not evident here.

Question 3

Jacob, a 5-day-old term infant, is brought to the hospital with poor feeding, lethargy, and temperature instability. He was born vaginally after an uncomplicated pregnancy. On examination, he is irritable, has a temperature of 37.8°C, and mild respiratory distress. Blood cultures are pending.

Which of the following is the most appropriate initial management?

A) Start empirical intravenous antibiotics immediately
B) Wait for blood culture results before starting antibiotics
C) Admit for observation without antibiotics
D) Start oral antibiotics at home
E) Administer corticosteroids for inflammation

Correct Answer: A) Start empirical intravenous antibiotics immediately

Neonatal sepsis can progress rapidly and is a medical emergency. In any neonate with signs of possible sepsis (poor feeding, lethargy, temperature instability), empirical intravenous antibiotics should be started immediately after blood cultures are taken.

Waiting for culture results risks deterioration. Oral antibiotics are inadequate for systemic infection. Observation alone is unsafe in symptomatic neonates. Corticosteroids are not standard treatment for neonatal sepsis.

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15. Paediatrics Module

15.1 Neonatology

15.2 Growth and Development

15.3 Paediatric Neurology

15.4 Paediatric Cardiology

15.5 Paediatric Respiratory

15.6 Paediatric Gastroenterology

15.7 Paediatric Nephrology

15.8 Paediatric Infections

15.9 Other Paediatric Disorders

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