Neonatology — Extended Topics MCQs

Pediatrics · 8 free questions with answers & explanations.

1. A 26-week preterm neonate is being managed on CPAP for RDS. Despite FiO2 of 0.45, SpO2 is persistently 84–88%. The neonatologist decides to initiate INSURE (INtubation-SURfactant-Extubation) technique. What is the PRIMARY advantage of INSURE over traditional intubation-ventilation for surfactant delivery?
2. A preterm neonate at 30 weeks receives erythromycin for Ureaplasma urealyticum pneumonia. Two days later, the nursing staff notes projectile vomiting and abdominal distension. Abdominal X-ray shows a distended stomach with a 'double bubble' appearance. Which adverse effect of erythromycin has likely caused this?
3. A very low birth weight (VLBW) neonate (birth weight 980 g, 29 weeks) develops feed intolerance at day 7 of life. Examination shows a new grade 3/6 continuous machinery murmur below the left clavicle, bounding peripheral pulses, wide pulse pressure, and hyperdynamic precordium. Echo confirms a haemodynamically significant PDA with large left-to-right shunt. Which is the CURRENT first-line pharmacological option for medical closure in most NICU protocols?
4. A term neonate develops respiratory distress at 6 hours of life. Chest X-ray shows a ground-glass appearance with an air bronchogram. The mother had elective Caesarean section at 38 weeks without labour. On day 2, the respiratory distress resolves completely. Surfactant was NOT required. The mechanism of the transient pulmonary disorder is:
5. A 35-week gestation neonate weighing 1700 g is born to a mother who received no antenatal care. At 24 hours, the baby develops jitteriness, hypotonia, high-pitched cry, and seizures. Serum glucose is 68 mg/dL. Serum calcium is 5.8 mg/dL (ionized Ca 0.72 mmol/L). What is the pathophysiology of hypocalcemia in this preterm neonate?
6. A 32-week gestation neonate is on mechanical ventilation for RDS. Surfactant was given at 2 hours of life. On day 3, the baby develops increasing oxygen requirements, bounding pulses, widened pulse pressure, and a continuous murmur at the left upper sternal border. Echocardiography confirms a large hemodynamically significant patent ductus arteriosus (hsPDA). What is the CURRENT preferred pharmacological treatment for hsPDA in a 32-week neonate?
7. A term neonate at 6 hours of life has total serum bilirubin (TSB) of 6 mg/dL. The mother is G2P1 with O negative blood group; the baby is O positive, direct Coombs positive. The baby is well and feeding well. A repeat TSB at 12 hours is 12 mg/dL. According to the AAP 2022 revised nomogram for neonatal jaundice, when should phototherapy be initiated in a term, Coombs-positive (isoimmune hemolytic disease) neonate?
8. A 26-week neonate is started on total parenteral nutrition (TPN). The composition includes amino acids 3 g/kg/day, dextrose 10 g/kg/day, lipid emulsion 2 g/kg/day. On day 5, the baby develops conjugated hyperbilirubinemia (direct bilirubin 2.8 mg/dL), elevated ALT, and acholic stools. Which intervention has the best evidence to prevent progression of parenteral nutrition-associated liver disease (PNALD)?