copilot neonatology i

What is the neonatal period?

The first 28 days of life after birth; a highly vulnerable stage requiring physiologic adjustments for extrauterine life.

Why is the neonatal period considered vulnerable?

Newborns undergo many physiologic changes and may need additional support or monitoring.

What are common signs of a sick newborn?

Lethargy, systemic illness, poor weight gain, and need for support like oxygen, IV fluids, or medications.

Why is obtaining a good history important in neonatology?

It helps determine the nature of illness and identifies maternal and fetal risk factors.

What does meticulous examination of sick newborns provide?

Clues to the etiology and basis for management of the illness.

What are possible origins of neonatal conditions?

In utero, during birth, or immediate postnatal period due to prematurity, congenital malformations, or acquired illnesses.

What is the significance of recognizing disease manifestations in newborns?

It aids in clinical diagnosis and understanding of pathophysiology and non-specific signs.

How many children died during the first month of life in 2021?

2.3 million, with 6400 babies dying daily.

What percentage of under-5 deaths occurred in the neonatal period in 2021?

47%, unchanged for 10 years.

What are the top causes of neonatal mortality worldwide (2012)?

Prematurity, low birth weight, perinatal asphyxia, congenital and acquired infections.

What are long-term sequelae of perinatal asphyxia?

Impaired attention span, hyperactivity, epilepsy, mental retardation, auditory deficits.

What infections are included in congenital infections?

TORCH infections.

What are examples of acquired neonatal infections?

Sepsis and pneumonia.

What accounts for 85–90% of neonatal mortality?

Prematurity, low birth weight, IUGR, serious infections, and birth asphyxia.

What percentage of neonatal deaths are due to congenital malformations?

Nearly 10%.

Why is proper care of newborns essential?

It forms the foundation for survival and quality of life without mental or physical disabilities.

What disorders can affect newborns during the postnatal period?

Prematurity, congenital malformations or acquired diseases, and injuries sustained during delivery

Why is it essential to recognize disease manifestations in newborns?

Because clinical knowledge of pathophysiology and evaluation of non-specific signs and symptoms is crucial

What is the correct order of causes of neonatal death by percentage (highest to lowest)?

Prematurity > intrapartum-related complications > sepsis > congenital anomalies

What is the most common cause of neonatal death worldwide?

Prematurity

What proportion of infants require resuscitation after birth?

A small proportion, usually due to respiratory problems causing inadequate ventilation

What is the cause of arrest during the newborn period?

Inadequate ventilation

How does neonatal arrest differ from adult cardiac arrest?

Neonatal arrest is due to inadequate ventilation; adult arrest is due to inadequate circulation

What are the goals of neonatal resuscitation?

Establish spontaneous respiration, obtain adequate cardiac output, and prevent hypoxemic tissue injury

What should be anticipated in high-risk neonatal resuscitation cases?

Pregnancy history, labor complications, and prenatal diagnosis of fetal anomalies

What are the objectives of neonatal care?

Cardio-respiratory function, temperature maintenance, infection avoidance, feeding regimen, and early detection of problems

Which of the following is NOT a goal of neonatal resuscitation?

Improve maternal nutrition

Which of the following is an objective of neonatal care?

Avoidance of infection

What is the main goal of neonatal resuscitation?

To establish ventilation within the first minute of life (the "golden minute")

When should resuscitation begin for a newborn?

Immediately if the baby is limp, cyanotic, apneic, or pulseless—before assigning the 1-minute APGAR score

Why is rapid and appropriate resuscitation important?

It improves the likelihood of preventing brain damage and achieving a successful outcome

Who must be present at every delivery?

At least one person skilled in neonatal resuscitation

What should be done in anticipation of delivery?

Counseling, team briefing, role assignment, and equipment check

What are the initial steps within the first minute of life?

Warming, drying, suctioning, and stimulation

When is positive pressure ventilation (PPV) indicated?

If heart rate is

What does PPV help assess in a newborn?

Whether the heart rate is improving or the baby is breathing

What equipment is used during PPV?

Pulse oximeter and possibly ECG monitor

What does the ECG monitor provide during resuscitation?

Faster and more reliable heart rate assessment

What should be done after 15 seconds of PPV?

Assess heart rate and chest movement

What is MR SOPA used for?

Ventilation corrective steps during neonatal resuscitation

What does MR SOPA stand for?

Mask adjustment, Reposition head, Suction mouth & nose, Open mouth, Pressure increase, Alternate airway

When should chest compressions be initiated?

If heart rate remains

What is the recommended compression-to-ventilation ratio?

3:1

What should be done if heart rate remains

Administer IV epinephrine

What underlying causes should be considered if bradycardia persists?

Pneumothorax and hypovolemia

What is the proper airway position for a newborn?

Slightly extended head in sniffing position

What are the ABCs of neonatal resuscitation?

Airway, Breathing, Circulation

How is breathing initiated in neonatal resuscitation?

Tactile stimulation, PPV, or endotracheal tube insertion

How is circulation maintained in neonatal resuscitation?

Chest compressions and medications if needed

What is the first step after receiving a newborn at birth?

Note time of birth and dry the baby with warm linen

What should be done if the baby is crying and breathing well?

Follow routine newborn care (Unang Yakap)

What should be done if the baby is not breathing properly or is limp?

Cut the cord, place under radiant warmer, and provide initial steps (drying, stimulating, repositioning, clearing airway)

What is the intervention for a gasping, apneic baby or HR

Initiate PPV using room air or oxygen

What is the intervention for spontaneous but labored breathing or cyanosis?

Give oxygen supplementation or consider NCPAP

What should be done if HR remains

Ensure adequate ventilation, continue PPV, increase oxygen to 100%, check for chest rise, perform MR SOPA

What should be done if HR remains

Perform chest compressions with a 3:1 ratio

What is the next step after successful resuscitation?

Admit the baby to NICU for post-resuscitation care and further management

True or False: All babies need resuscitation at birth.

False — all babies must be assessed, but only those who need it should be resuscitated

What is the best intervention for a cyanotic, pale, intubated preterm infant with HR = 75 bpm and O2 sat = 50%?

Start ambu-bagging with higher pressure

What are common causes of CNS damage in newborns?

Asphyxia, hemorrhage, trauma, hypoglycemia, direct cytotoxicity

What are common etiologies of neonatal CNS disorders?

Perinatal complications (e.g. HIE), postnatal hemodynamic instability, developmental abnormalities

What are predisposing factors to brain injury in neonates?

Maternal illness, utero-placental dysfunction, infection in utero, IUGR, prematurity, delivery emergencies

What is cranial hemorrhage in newborns?

Birth injuries ranging from minor to severe, often due to birth asphyxia or trauma

What delivery methods may cause cranial hemorrhage?

Mechanical force during delivery such as forceps or vacuum

What is Caput Succedaneum?

Diffuse, ecchymotic, edematous swelling of the scalp; most common and benign extracranial hemorrhage

Where is Caput Succedaneum usually located?

Parietal bone; can extend across sutures and midline

What are the characteristics of Caput Succedaneum?

Soft, superficial, pitting edema that shifts with gravity; vaguely demarcated

When does Caput Succedaneum resolve?

Within 48–72 hours; no intervention needed

What is the volume of blood in Caput Succedaneum?

Minimal

What is Cephalohematoma?

Subperiosteal bleeding over parietal bones that does not cross sutures or midline

What are the characteristics of Cephalohematoma?

Distinct margins, initially firm, becomes fluctuant after 48 hours

What is Cephalohematoma associated with?

Linear skull fractures in 10–20% of cases; cranial X-ray may be warranted

When does Cephalohematoma resolve?

Spontaneously over 2–3 weeks

What is the volume of blood in Cephalohematoma?

Rarely severe

What is Subgaleal Hemorrhage?

Bleeding beneath the epicranial aponeurosis; may extend to orbits and nape of neck

What delivery method is strongly associated with Subgaleal Hemorrhage?

Vacuum-assisted delivery

What are the characteristics of Subgaleal Hemorrhage?

Firm to fluctuant with ill-defined borders; may have crepitus or fluid waves

Why is Subgaleal Hemorrhage dangerous?

Can cause massive blood loss and hypovolemic shock; high mortality if untreated

How much blood can the subgaleal space accommodate?

Up to 240 mL

What is the management for Subgaleal Hemorrhage?

Volume expanders, inotropic support, transfusion for anemia

What causes Intracranial Hemorrhage in neonates?

Birth trauma, asphyxia, coagulopathies, hypoglycemia, or direct cytotoxicity

What are common types of intracranial hemorrhage in term infants?

Subdural, subarachnoid, subtentorial hemorrhages

What is the most frequent type of intracranial bleed in term infants?

Subarachnoid hemorrhage

What are symptoms of severe intracranial hemorrhage?

Seizures, apnea, coma, bulging fontanelle, hypotonia, pallor

What is the most common CNS complication of preterm birth?

Intraventricular Hemorrhage (IVH)

Where does IVH originate?

Subependymal germinal matrix

What is the incidence of IVH in preterm infants

Approximately 30%; risk increases with lower birth weight and gestational age

What percentage of IVH occurs within the first day of life?

70%

What is the most vulnerable site for IVH?

Germinal matrix, due to immature vasculature and poor basement membrane support

Why are preterm infants more susceptible to IVH?

Lack of cerebral autoregulation, pressure-passive blood flow, and sensitivity to CO₂ changes

What cells are produced by the germinal matrix?

Oligodendrocytes, which form myelin between 23rd and 32nd weeks gestation

What are the three clinical presentations of IVH?

Asymptomatic, saltatory progression, and catastrophic deterioration

What imaging modality is used to diagnose IVH?

Cranial ultrasound; assesses location, degree of bleeding, and ventricular dilation

What is the pathophysiology of IVH?

Bleeding in the gelatinous germinal matrix due to immature vessels and poor vascular support

What is the most common timing for IVH in preterm infants?

First 3 days of life; 95% occur by day 7

What is the risk of severe IVH in infants

24%

What defines Grade 1 IVH?

Bleeding confined to the germinal matrix or

What defines Grade 2 IVH?

Bleeding within the ventricle without ventricular dilatation; 10–50% filling; ~40% of cases

What defines Grade 3 IVH?

>50% of the ventricle involved with ventricular dilatation

What defines Grade 4 IVH?

Extension into brain parenchyma with ventricular enlargement; also called periventricular hemorrhagic infarct