A term baby is born through thick meconium-stained liquor in the labour room and is limp and not breathing. After the initial steps under a radiant warmer, including clearing the mouth and nose, drying and stimulation, the baby is still apnoeic with a heart rate of 80/min. What is the next step?

Bag-and-mask ventilation with room air

Adrenaline through the umbilical vein

Intubation to suction meconium from the trachea

Chest compressions with ventilation

A 4-day-old term baby with unconjugated hyperbilirubinaemia is placed under LED phototherapy in the postnatal ward. Which change in the bilirubin molecule chiefly allows it to be excreted?

Structural isomerisation to lumirubin

Tighter binding to serum albumin

Conjugation with glucuronic acid in liver

At a PHC, a 4-day-old baby weighing 1.9 kg has an axillary temperature of 35.6°C. He is alert, sucking well and has no other danger signs, and his mother is with him. What is the best way to rewarm him?

Skin-to-skin contact with the mother

A warm bath followed by oil massage

Hot water bottles packed around the baby

A baby born at 30 weeks to a mother who received no antenatal steroids develops grunting, nasal flaring and subcostal retractions within an hour of birth, with a rising oxygen need over the next few hours. Chest X-ray shows low lung volumes, a diffuse ground-glass (reticulogranular) pattern and air bronchograms. What is the most likely diagnosis?

Transient tachypnoea of the newborn

Congenital diaphragmatic hernia

A 6-day-old baby girl admitted with poor feeding and lethargy was started on IV antibiotics after a blood culture was taken. The culture grows Escherichia coli. She is now stable, but no lumbar puncture was done at admission. What is the next best step?

Stop antibiotics after 72 hours

Repeat CRP and discharge if normal

Neonatal resuscitation, jaundice, sepsis and RDS

31 NEET-PG practice questions on Neonatal resuscitation, jaundice, sepsis and RDS, part of Paediatrics. The first 25 are below; the first 5 with answers and explanations (tap Show answer after you have chosen), the rest in Learn with a free account.

Question 1 · Medium
A term baby is born through thick meconium-stained liquor in the labour room and is limp and not breathing. After the initial steps under a radiant warmer, including clearing the mouth and nose, drying and stimulation, the baby is still apnoeic with a heart rate of 80/min. What is the next step?
1. AAdrenaline through the umbilical vein
2. BIntubation to suction meconium from the trachea
3. CChest compressions with ventilation
4. DBag-and-mask ventilation with room air
Show answerHide answer
Answer: D · Bag-and-mask ventilation with room air
An apnoeic baby, or one with a heart rate below 100/min after the initial steps, needs positive pressure ventilation within the first minute of life. Current neonatal resuscitation guidance no longer advises routine tracheal suction for non-vigorous babies born through meconium, because it delays ventilation without improving outcome. A term baby is ventilated with room air at 40-60 breaths per minute, and effective ventilation is the most important step of newborn resuscitation. Chest compressions start only if the heart rate stays below 60/min after 30 seconds of effective ventilation, and adrenaline only if it stays below 60/min despite compressions.
- A: Adrenaline follows failed ventilation and compressions.
- B: Routine tracheal suction delays ventilation and is no longer advised.
- C: Compressions start only when the heart rate is below 60/min.
Question 2 · Easy
A 4-day-old term baby with unconjugated hyperbilirubinaemia is placed under LED phototherapy in the postnatal ward. Which change in the bilirubin molecule chiefly allows it to be excreted?
1. ATighter binding to serum albumin
2. BStructural isomerisation to lumirubin
3. CConjugation with glucuronic acid in liver
4. DOxidation back to biliverdin
Show answerHide answer
Answer: B · Structural isomerisation to lumirubin
Blue-green light (about 460-490 nm) absorbed by bilirubin in the skin converts it into water-soluble photoisomers. Lumirubin, a structural isomer, forms irreversibly and is excreted in bile and urine without needing conjugation by the liver, so it is the main route of elimination; the configurational isomer forms faster but partly reverts. Effectiveness depends on the irradiance and on how much skin is exposed. Photo-oxidation to small polar products contributes only a little.
- A: Albumin binding keeps bilirubin out of the brain but does not remove it.
- C: Glucuronidation happens in the liver and is not what light does.
- D: Photo-oxidation is a minor pathway; it does not form biliverdin for excretion.
Question 3 · Medium
At a PHC, a 4-day-old baby weighing 1.9 kg has an axillary temperature of 35.6°C. He is alert, sucking well and has no other danger signs, and his mother is with him. What is the best way to rewarm him?
1. ASkin-to-skin contact with the mother
2. BA warm bath followed by oil massage
3. CHot water bottles packed around the baby
4. DWarm IV fluids given rapidly
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Answer: A · Skin-to-skin contact with the mother
Skin-to-skin contact (kangaroo mother care) in a warm room, with the baby's head covered and the pair wrapped together, is an effective and safe way to rewarm a stable low birth weight baby. It also supports breastfeeding, which supplies the energy needed for heat production. The temperature is checked often until it is normal, and the baby is watched for signs of sepsis, of which hypothermia can be the first. A radiant warmer is used if skin-to-skin care is not possible or the baby is unwell.
- B: Bathing causes evaporative heat loss and worsens hypothermia.
- C: Hot water bottles can cause burns on a newborn's thin skin.
- D: IV fluids do not rewarm a stable baby and carry risks of overload.
Question 4 · Medium
A baby born at 30 weeks to a mother who received no antenatal steroids develops grunting, nasal flaring and subcostal retractions within an hour of birth, with a rising oxygen need over the next few hours. Chest X-ray shows low lung volumes, a diffuse ground-glass (reticulogranular) pattern and air bronchograms. What is the most likely diagnosis?
1. ARespiratory distress syndrome
2. BMeconium aspiration syndrome
3. CTransient tachypnoea of the newborn
4. DCongenital diaphragmatic hernia
Show answerHide answer
Answer: A · Respiratory distress syndrome
Respiratory distress syndrome (hyaline membrane disease) is due to surfactant deficiency in the immature lung, so alveoli collapse at the end of expiration. It starts within hours of birth, worsens over the first 48-72 hours and shows low-volume lungs with a ground-glass pattern and air bronchograms. Prematurity and absent antenatal steroids are the main risks. Because early-onset pneumonia can look the same on X-ray, blood culture is sent and antibiotics are often started until sepsis is excluded.
- B: Meconium aspiration affects term or post-term babies and shows patchy infiltrates with hyperinflation.
- C: Transient tachypnoea shows well-expanded lungs with fissure fluid, usually after a term caesarean.
- D: Diaphragmatic hernia shows bowel loops in the chest with a scaphoid abdomen.
Question 5 · Medium
A 6-day-old baby girl admitted with poor feeding and lethargy was started on IV antibiotics after a blood culture was taken. The culture grows Escherichia coli. She is now stable, but no lumbar puncture was done at admission. What is the next best step?
1. AStop antibiotics after 72 hours
2. BLumbar puncture for CSF study
3. CRepeat CRP and discharge if normal
4. DSwitch to oral cefixime
Show answerHide answer
Answer: B · Lumbar puncture for CSF study
Meningitis is present in a significant share of newborns with bacteraemia, often without specific signs, since a bulging fontanelle and neck stiffness appear late or not at all. A lumbar puncture is done once the baby is stable, because proven meningitis changes the choice of drug (one that reaches the CSF well) and calls for a longer course. Gram-negative meningitis in newborns carries a high risk of complications such as ventriculitis and abscess.
- A: Culture-proven sepsis needs a full course, not 72 hours.
- C: A normal CRP cannot rule out meningitis or shorten treatment of proven bacteraemia.
- D: Oral drugs are not adequate for proven Gram-negative sepsis in a newborn.
Question 6 · Easy
A term baby who needed bag-and-mask ventilation in the delivery room is now being monitored, and the team attaches a pulse oximeter to guide how much oxygen to give. Where should the probe be placed?
1. ALeft great toe
2. BLeft wrist or palm
3. CRight wrist or palm
4. DSole of the right foot
Answer and explanation in LearnFree account
Question 7 · Hard
A baby born at 36 weeks is 40 hours old and jaundiced. The resident must choose the phototherapy curve on the AAP 2022 chart, which uses lower thresholds when neurotoxicity risk factors are present. Consider: 1. Gestational age of 36 weeks. 2. A positive direct antiglobulin test with anti-A. 3. Serum albumin of 2.6 g/dL. 4. Exclusive breastfeeding with 8% weight loss. Which of these are neurotoxicity risk factors?
1. A2, 3 and 4 only
2. B1, 2, 3 and 4
3. C2 and 3 only
4. D1, 2 and 3 only
Answer and explanation in LearnFree account
Question 8 · Medium
A term baby born through thick meconium-stained liquor at a medical college in Madurai is ventilated for respiratory distress. At 12 hours, on 100% oxygen, the pulse oximeter reads 95% on the right hand but 80% on a foot. Echocardiography shows a structurally normal heart with right-to-left shunting across the ductus arteriosus and the foramen ovale. Which therapy acts as a selective pulmonary vasodilator in this baby?
1. AIntravenous propranolol
2. BInhaled nitric oxide
3. CIntravenous prostaglandin E1
4. DIntravenous indomethacin
Answer and explanation in LearnFree account
Question 9 · Medium
In the labour room, the paediatric resident is deciding which newborns need close watch for early-onset sepsis. Consider four perinatal factors: 1. Rupture of membranes 24 hours before delivery. 2. Maternal temperature of 38.6°C in labour. 3. Foul-smelling amniotic fluid. 4. Elective caesarean section before labour with intact membranes. Which of these are risk factors for early-onset sepsis?
1. A1 and 2 only
2. B2 and 3 only
3. C1, 2 and 3 only
4. D1, 2, 3 and 4
Answer and explanation in LearnFree account
Question 10 · Medium
A 3-week-old exclusively breastfed term baby is brought to the OPD because his eyes are still yellow. He feeds well, has regained his birth weight and gained 600 g since, and passes yellow stools and pale yellow urine. Total bilirubin is 12 mg/dL with direct bilirubin 0.4 mg/dL, and the newborn thyroid screen was normal. What is the most likely cause?
1. ACrigler-Najjar syndrome type 1
2. BLow-intake (breastfeeding) jaundice
3. CBiliary atresia
4. DBreast milk jaundice
Answer and explanation in LearnFree account
Question 11 · Hard
A baby born at 34 weeks, now 30 hours old, in an SNCU develops lethargy, poor feeding and temperature instability. His mother had rupture of membranes 22 hours before delivery. Results: total leucocyte count 4,200/µL (abnormal below 5,000), immature-to-total neutrophil ratio 0.26 (abnormal 0.2 or more), micro-ESR 4 mm in the first hour (abnormal above the age in days plus 3), CRP 1.8 mg/dL (abnormal above 1 mg/dL). Blood culture has been sent. What is the next best step?
1. AStart IV ampicillin and gentamicin now
2. BRepeat the sepsis screen after 12 hours
3. CStart oral amoxicillin and observe
4. DWait for the blood culture report
Answer and explanation in LearnFree account
Question 12 · Easy
On a winter morning in a village in Rajasthan, an ASHA visits a 3-day-old baby with a birth weight of 2.1 kg and records an axillary temperature of 35.2°C. How is this temperature graded in the WHO classification of neonatal hypothermia?
1. ANormal for low birth weight
2. BCold stress
3. CSevere hypothermia
4. DModerate hypothermia
Answer and explanation in LearnFree account
Question 13 · Hard
A 3 kg term baby still has a heart rate of 40/min after 60 seconds of chest compressions coordinated with effective ventilation through an endotracheal tube with 100% oxygen. An umbilical venous catheter is in place, and the adrenaline available is 0.1 mg/mL (1:10,000). What dose should be given?
1. A0.3-0.9 mL IV, then a saline flush
2. B0.03-0.09 mL IV, then a saline flush
3. C1.5-3 mL IV, then a saline flush
4. D3-9 mL IV, then a saline flush
Answer and explanation in LearnFree account
Question 14 · Medium
A baby born at 28 weeks with respiratory distress syndrome is on nasal CPAP and is given intratracheal surfactant through a thin catheter. Which component of surfactant is chiefly responsible for lowering surface tension in the alveoli?
1. ASphingomyelin
2. BDipalmitoyl phosphatidylcholine
3. CSurfactant protein A
4. DPhosphatidylglycerol
Answer and explanation in LearnFree account
Question 15 · Easy
A 24-year-old woman in preterm labour at 30 weeks is admitted to a district hospital. Which drug given to the mother most reduces her baby's risk of respiratory distress syndrome?
1. AFludrocortisone
2. BHydrocortisone
3. CBetamethasone
4. DPrednisolone
Answer and explanation in LearnFree account
Question 16 · Medium
In a district hospital SNCU, a newborn is at risk of heat loss in several ways. Consider four statements: 1. Weighing the baby on a cold metal scale causes heat loss by conduction. 2. Leaving the baby wet after birth causes heat loss by evaporation. 3. A cot placed next to a cold outer wall loses heat by convection. 4. A draught from an open window causes heat loss by convection. Which statements are correct?
1. A1, 2 and 4 only
2. B1, 2, 3 and 4
3. C1, 2 and 3 only
4. D1 and 2 only
Answer and explanation in LearnFree account
Question 17 · Easy
A baby is born at 27 weeks of gestation in the labour room of a tertiary hospital and is placed under a radiant warmer. Which measure best prevents hypothermia in the first minutes?
1. AThorough drying and wrapping in dry towels
2. BOil massage of the whole body
3. CPolyethylene wrap of the body without drying
4. DA warm bath to remove the vernix
Answer and explanation in LearnFree account
Question 18 · Medium
A 7-week-old girl from Kanpur has had jaundice since her second week, with pale clay-coloured stools and dark urine that stains the nappy. The liver is firm and 4 cm below the costal margin. Total bilirubin is 8.6 mg/dL with direct 6.1 mg/dL, and GGT is 620 U/L. Ultrasound shows a small irregular gallbladder and a triangular cord sign. If an operative cholangiogram confirms the diagnosis, what is the treatment?
1. AUrsodeoxycholic acid alone
2. BKasai portoenterostomy
3. CExchange blood transfusion
4. DPhototherapy until bilirubin falls
Answer and explanation in LearnFree account
Question 19 · Hard
A baby is born to a 28-year-old O Rh-negative woman in her third pregnancy who never received anti-D. He is pale with hepatosplenomegaly, his cord Hb is 10 g/dL, his group is B Rh-positive, and the DAT is strongly positive. Despite intensive phototherapy, his bilirubin rises to the exchange threshold. Which blood should be chosen for the exchange transfusion?
1. AO Rh-negative cells cross-matched with mother's serum
2. BAB Rh-negative cells cross-matched with baby's serum
3. CB Rh-positive cells cross-matched with baby's serum
4. DO Rh-positive cells suspended in AB plasma
Answer and explanation in LearnFree account
Question 20 · Medium
A baby born at 28 weeks is not breathing adequately after the initial steps, and positive pressure ventilation is started with a T-piece resuscitator connected through an oxygen blender. At what oxygen concentration should ventilation begin?
1. A100%
2. B21-30%
3. C40-50%
4. D60-70%
Answer and explanation in LearnFree account
Question 21 · Medium
A baby born at 37 weeks by elective caesarean section, before the onset of labour, has a respiratory rate of 84/min with mild retractions at 2 hours of age; SpO2 is 93% in room air. Chest X-ray shows prominent perihilar streaking, fluid in the horizontal fissure and well-expanded lungs. What is the main mechanism of this condition?
1. ADeficiency of surfactant phospholipid
2. BAspiration of meconium into the airways
3. CFailure of pulmonary vascular resistance to fall
4. DDelayed clearance of fetal lung fluid
Answer and explanation in LearnFree account
Question 22 · Medium
A 3-year-old boy born at home in a remote hamlet had deep jaundice in his first week that was never treated. He now has writhing involuntary movements, cannot look upward, has bilateral sensorineural hearing loss and has enamel defects of his milk teeth. Bilirubin damage to which brain region best explains his movement disorder?
1. APeriventricular white matter
2. BMotor cortex and the corticospinal tract
3. CGlobus pallidus and subthalamic nucleus
4. DAnterior horn cells of the cord
Answer and explanation in LearnFree account
Question 23 · Hard
A 5-day-old term boy, born at home and feeding poorly, is brought with deep jaundice. He is lethargic with a high-pitched cry, arches his neck and back, and has increased tone. Total serum bilirubin is 27 mg/dL with direct bilirubin 0.8 mg/dL, and a G6PD screen shows deficiency. What is the next best step?
1. APhenobarbitone to induce bilirubin conjugation
2. BIV immunoglobulin and a repeat TSB
3. CUrgent exchange transfusion with intensive phototherapy
4. DIntensive phototherapy and a repeat TSB in 6 hours
Answer and explanation in LearnFree account
Question 24 · Medium
A term baby girl born by normal delivery is noticed in the postnatal ward to be yellow over the face and upper chest at 18 hours of age. She is feeding well and her vital signs are normal. The mother's blood group is O positive. What is the next best step?
1. AStop breastfeeding and give formula
2. BAdvise sunlight exposure at home
3. CSerum bilirubin, blood groups and DAT
4. DReassure that this is physiological jaundice
Answer and explanation in LearnFree account
Question 25 · Medium
A baby born at 33 weeks by vaginal delivery cries at birth, has good tone and is breathing well. What should be done about the umbilical cord?
1. AClamp at once and pass to the warmer team
2. BClamp only after the placenta separates
3. CClamp at once to prevent polycythaemia
4. DDelay clamping for at least 30-60 seconds
Answer and explanation in LearnFree account

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Neonatal resuscitation, jaundice, sepsis and RDS

A term baby is born through thick meconium-stained liquor in the labour room and is limp and not breathing. After the initial steps under a radiant warmer, including clearing the mouth and nose, drying and stimulation, the baby is still apnoeic with a heart rate of 80/min. What is the next step?

A 4-day-old term baby with unconjugated hyperbilirubinaemia is placed under LED phototherapy in the postnatal ward. Which change in the bilirubin molecule chiefly allows it to be excreted?

At a PHC, a 4-day-old baby weighing 1.9 kg has an axillary temperature of 35.6°C. He is alert, sucking well and has no other danger signs, and his mother is with him. What is the best way to rewarm him?

A 6-day-old baby girl admitted with poor feeding and lethargy was started on IV antibiotics after a blood culture was taken. The culture grows Escherichia coli. She is now stable, but no lumbar puncture was done at admission. What is the next best step?

A term baby who needed bag-and-mask ventilation in the delivery room is now being monitored, and the team attaches a pulse oximeter to guide how much oxygen to give. Where should the probe be placed?

On a winter morning in a village in Rajasthan, an ASHA visits a 3-day-old baby with a birth weight of 2.1 kg and records an axillary temperature of 35.2°C. How is this temperature graded in the WHO classification of neonatal hypothermia?

A 3 kg term baby still has a heart rate of 40/min after 60 seconds of chest compressions coordinated with effective ventilation through an endotracheal tube with 100% oxygen. An umbilical venous catheter is in place, and the adrenaline available is 0.1 mg/mL (1:10,000). What dose should be given?

A baby born at 28 weeks with respiratory distress syndrome is on nasal CPAP and is given intratracheal surfactant through a thin catheter. Which component of surfactant is chiefly responsible for lowering surface tension in the alveoli?

A 24-year-old woman in preterm labour at 30 weeks is admitted to a district hospital. Which drug given to the mother most reduces her baby's risk of respiratory distress syndrome?

A baby is born at 27 weeks of gestation in the labour room of a tertiary hospital and is placed under a radiant warmer. Which measure best prevents hypothermia in the first minutes?

A baby born at 28 weeks is not breathing adequately after the initial steps, and positive pressure ventilation is started with a T-piece resuscitator connected through an oxygen blender. At what oxygen concentration should ventilation begin?

A term baby girl born by normal delivery is noticed in the postnatal ward to be yellow over the face and upper chest at 18 hours of age. She is feeding well and her vital signs are normal. The mother's blood group is O positive. What is the next best step?

A baby born at 33 weeks by vaginal delivery cries at birth, has good tone and is breathing well. What should be done about the umbilical cord?