A term neonate born via emergency cesarean section for fetal distress has Apgar scores of 3 at 1 min and 5 at 5 min. After initial resuscitation, the infant has encephalopathy signs. The most neuroprotective intervention to be initiated within 6 hours is:
- A Phenobarbital IV to prevent seizures
- B Therapeutic hypothermia — whole body or selective head cooling to 33–34°C for 72 hours ✓
- C High-dose IV methylprednisolone to reduce cerebral edema
- D Supplemental oxygen to maintain SpO2 100%
Correct answer: B. Therapeutic hypothermia — whole body or selective head cooling to 33–34°C for 72 hours
Explanation
Therapeutic hypothermia (whole-body cooling to 33–34°C for 72 hours) is the only proven neuroprotective intervention for hypoxic-ischemic encephalopathy (HIE) in term infants. It must be initiated within 6 hours of birth during the latent phase before secondary neuronal injury. It reduces death or major disability by approximately 30%. Phenobarbital is used to treat seizures, not as a prophylactic neuroprotector. Steroids and hyperoxia are harmful. Cooling is indicated for moderate-severe HIE by Thompson score or Sarnat staging.
Reference: Ghai Essential Pediatrics, 10th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.