A neonate born at 34 weeks gestation develops hypotonia, seizures, and encephalopathy within 12 hours. EEG shows burst-suppression pattern. The baby had a 10-minute APGAR of 4. Which intervention, if started within 6 hours of birth, has been shown to reduce death and disability in this condition?

• A High-dose phenobarbital loading
• B High-frequency oscillatory ventilation
• C Intravenous magnesium sulfate infusion
• D Therapeutic hypothermia (33–34°C for 72 hours) ✓

Explanation

Therapeutic hypothermia (body temperature 33–34°C for 72 hours) is the standard of care for hypoxic-ischemic encephalopathy (HIE) in neonates ≥36 weeks gestation when initiated within 6 hours of birth. It reduces neuronal death by slowing apoptosis and reducing excitotoxic injury. Phenobarbital is used for seizure control in HIE but does not modify the underlying encephalopathic process. The current protocol requires ≥36 weeks; at 34 weeks this remains investigational but the question stem tests the principle.

Reference: Ghai Essential Pediatrics, 10th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.