Birth Asphyxia 3 Quiz 1 / 60 What is the initial management step in a newborn with birth asphyxia? Give glucose Administer antibiotics Start IV fluids Ensure airway and provide ventilation The priority is to open the airway and provide effective ventilation, especially if the baby is apneic or bradycardic. The priority is to open the airway and provide effective ventilation, especially if the baby is apneic or bradycardic. 2 / 60 Hypoxic-ischemic encephalopathy (HIE) is associated with which complication? Hyperbilirubinemia Hypoglycemia Cerebral palsy Congenital heart disease HIE can cause long-term neurological damage including cerebral palsy. HIE can cause long-term neurological damage including cerebral palsy. 3 / 60 In asphyxiated neonates, what is the role of cranial ultrasound? To assess liver echogenicity To screen for intraventricular hemorrhage or brain edema To confirm gestational age To detect skeletal injuries Cranial ultrasound is a non-invasive, bedside tool to assess for complications like IVH and cerebral edema. Cranial ultrasound is a non-invasive, bedside tool to assess for complications like IVH and cerebral edema. 4 / 60 Which clinical sign most strongly indicates the need for immediate resuscitation at birth? Meconium-stained fluid Caput succedaneum Absence of spontaneous breathing Tachypnea Apnea at birth is a critical sign of asphyxia and requires immediate intervention. Apnea at birth is a critical sign of asphyxia and requires immediate intervention. 5 / 60 Which scoring system is used to assess neonatal encephalopathy severity based on clinical features? Ballard score Bishop score Silverman-Anderson score Sarnat staging The Sarnat staging system evaluates mental status, tone, reflexes, and seizures to classify HIE severity. The Sarnat staging system evaluates mental status, tone, reflexes, and seizures to classify HIE severity. 6 / 60 Which electrolyte abnormality is common in birth asphyxia? Hypernatremia Hypocalcemia Hyperkalemia Hyperchloremia Hypocalcemia may result from stress and cellular injury in asphyxiated neonates. Hypocalcemia may result from stress and cellular injury in asphyxiated neonates. 7 / 60 What intervention is contraindicated during therapeutic hypothermia? Warming the baby to normal temperature IV fluid monitoring Use of anticonvulsants EEG monitoring Hypothermia must be maintained for 72 hours; rewarming too early negates its neuroprotective effects. Hypothermia must be maintained for 72 hours; rewarming too early negates its neuroprotective effects. 8 / 60 What is the most common neurologic sequela of severe birth asphyxia? Hydrocephalus Autism Cerebral palsy Epilepsy Cerebral palsy is the most frequent long-term complication from hypoxic brain injury. Cerebral palsy is the most frequent long-term complication from hypoxic brain injury. 9 / 60 What defines birth asphyxia? Impaired gas exchange leading to hypoxia and hypercapnia Fever and sepsis Lack of crying after birth Meconium in amniotic fluid Birth asphyxia results from failure of gas exchange causing low oxygen and high carbon dioxide levels. Birth asphyxia results from failure of gas exchange causing low oxygen and high carbon dioxide levels. 10 / 60 What is the typical duration of therapeutic hypothermia for birth asphyxia? 48 hours 12 hours 72 hours 24 hours Cooling is typically maintained for 72 hours to maximize neuroprotection. Cooling is typically maintained for 72 hours to maximize neuroprotection. 11 / 60 What laboratory finding is commonly seen in asphyxiated neonates? Hypokalemia Metabolic acidosis Hypernatremia Respiratory alkalosis Due to anaerobic metabolism, metabolic acidosis is common in asphyxiated neonates. Due to anaerobic metabolism, metabolic acidosis is common in asphyxiated neonates. 12 / 60 Which organ is most sensitive to hypoxia during birth asphyxia? Intestines Brain Skin Liver The brain is highly sensitive to oxygen deprivation, making it the most vulnerable organ during asphyxia. The brain is highly sensitive to oxygen deprivation, making it the most vulnerable organ during asphyxia. 13 / 60 Which imaging modality helps assess hypoxic brain injury in neonates? CT of lungs Abdominal ultrasound Cranial ultrasound or MRI Chest X-ray Cranial ultrasound or MRI can detect brain injury due to hypoxia, such as periventricular leukomalacia. Cranial ultrasound or MRI can detect brain injury due to hypoxia, such as periventricular leukomalacia. 14 / 60 What is the most common arrhythmia associated with severe birth asphyxia? Atrial fibrillation Supraventricular tachycardia Bradycardia Tachycardia Hypoxia typically leads to bradycardia, especially if the heart rate drops below 100 bpm. Hypoxia typically leads to bradycardia, especially if the heart rate drops below 100 bpm. 15 / 60 What is a major risk of delayed intervention in birth asphyxia? Neonatal jaundice Growth retardation Anemia Permanent neurologic damage Delay in management may lead to irreversible brain injury such as cerebral palsy or cognitive delay. Delay in management may lead to irreversible brain injury such as cerebral palsy or cognitive delay. 16 / 60 Which parameter is most reliable in monitoring asphyxiated neonates during therapeutic hypothermia? Electroencephalogram (EEG) Blood pressure Respiratory rate Oxygen saturation EEG helps monitor seizure activity and brain function in neonates undergoing therapeutic hypothermia. EEG helps monitor seizure activity and brain function in neonates undergoing therapeutic hypothermia. 17 / 60 What is the consequence of delayed initiation of ventilation in a non-breathing newborn? Decreased seizure risk Improved circulation Increased temperature Worsening hypoxia and acidosis Every second countsâdelayed ventilation prolongs hypoxia, increasing brain injury and mortality. Every second countsâdelayed ventilation prolongs hypoxia, increasing brain injury and mortality. 18 / 60 What is the role of amplitude-integrated EEG (aEEG) in birth asphyxia? Assess renal output Detect subclinical seizures and assess cerebral function Diagnose infections Monitor glucose levels aEEG provides continuous monitoring of brain activity, helping detect seizures and assess the severity of encephalopathy. aEEG provides continuous monitoring of brain activity, helping detect seizures and assess the severity of encephalopathy. 19 / 60 What defines severe birth asphyxia using the Apgar score? 5-minute score of 6-7 1-minute score of 6 5-minute score of 0-3 10-minute score of 9 A 5-minute Apgar score of 0-3 is concerning and indicative of severe birth asphyxia. A 5-minute Apgar score of 0-3 is concerning and indicative of severe birth asphyxia. 20 / 60 Which factor is associated with an increased risk of intrapartum asphyxia? Jaundice Umbilical cord prolapse Cephalohematoma Male gender Umbilical cord prolapse can interrupt blood and oxygen supply to the fetus, increasing the risk of asphyxia. Umbilical cord prolapse can interrupt blood and oxygen supply to the fetus, increasing the risk of asphyxia. 21 / 60 Which parameter is critical to monitor during resuscitation of an asphyxiated newborn? Skin color Fontanelle tension Birth weight Heart rate Heart rate is the most reliable indicator of effective resuscitation and guides further steps. Heart rate is the most reliable indicator of effective resuscitation and guides further steps. 22 / 60 What is the best prognostic marker in a newborn after perinatal asphyxia? Capillary refill time Hematocrit level Neurologic examination at 7-10 days Serum bilirubin A thorough neurological exam after the first week of life is a strong predictor of long-term outcomes. A thorough neurological exam after the first week of life is a strong predictor of long-term outcomes. 23 / 60 Which of the following best describes stage 1 hypoxic-ischemic encephalopathy (HIE)? Irritability with normal muscle tone and reflexes Apnea and bradycardia Seizures and hypotonia Coma with absent reflexes Stage 1 HIE presents with hyperalertness or irritability, mild symptoms, and generally a good prognosis. Stage 1 HIE presents with hyperalertness or irritability, mild symptoms, and generally a good prognosis. 24 / 60 Why is a low Apgar score at 10 minutes concerning? Indicates feeding problems Suggests prolonged hypoxia and poor prognosis Indicates neonatal sepsis Predicts low birth weight Persistently low Apgar scores beyond 10 minutes suggest severe asphyxia and are associated with increased risk of death or long-term disability. Persistently low Apgar scores beyond 10 minutes suggest severe asphyxia and are associated with increased risk of death or long-term disability. 25 / 60 Which fetal condition increases the risk for perinatal asphyxia? Intrauterine growth restriction (IUGR) Polyhydramnios Premature thelarche Neonatal diabetes IUGR fetuses are more susceptible to hypoxia due to placental insufficiency. IUGR fetuses are more susceptible to hypoxia due to placental insufficiency. 26 / 60 In asphyxiated infants, persistent pulmonary hypertension (PPHN) is caused by: Hyperoxygenation Ventricular septal defect Low lung compliance Failure of pulmonary vasodilation Hypoxia leads to pulmonary vasoconstriction, maintaining fetal circulation and causing PPHN. Hypoxia leads to pulmonary vasoconstriction, maintaining fetal circulation and causing PPHN. 27 / 60 Which of the following increases the risk of meconium aspiration syndrome and subsequent asphyxia? Low birth weight Twin pregnancy Post-term pregnancy Gestational diabetes Post-term babies are more likely to pass meconium in utero, increasing the risk of aspiration and birth asphyxia. Post-term babies are more likely to pass meconium in utero, increasing the risk of aspiration and birth asphyxia. 28 / 60 Which maternal condition is most commonly associated with neonatal asphyxia? Preeclampsia Hyperthyroidism Asthma Prolonged labor Prolonged labor increases the risk of fetal distress and hypoxic events during delivery. Prolonged labor increases the risk of fetal distress and hypoxic events during delivery. 29 / 60 A severely asphyxiated newborn requires resuscitation. What FiOâ should be used initially? 21% (room air) 80% 100% 40% Initial resuscitation begins with room air (21% Oâ); supplemental oxygen is added only if necessary. Initial resuscitation begins with room air (21% Oâ); supplemental oxygen is added only if necessary. 30 / 60 What is the typical presentation of Stage 3 HIE? Seizures with some spontaneous movement Jitteriness and normal reflexes Coma, flaccidity, and absent reflexes Normal tone and feeding Stage 3 HIE is the most severe and presents with coma and brainstem dysfunction. Stage 3 HIE is the most severe and presents with coma and brainstem dysfunction. 31 / 60 What is the purpose of therapeutic hypothermia in birth asphyxia? Prevent sepsis Reduce brain metabolism and injury Increase oxygen delivery Treat seizures Therapeutic hypothermia (33â34°C) slows brain metabolism, reducing damage from hypoxic-ischemic events. Therapeutic hypothermia (33â34°C) slows brain metabolism, reducing damage from hypoxic-ischemic events. 32 / 60 What is the pathophysiology of brain injury in birth asphyxia? Hypercapnia causing vasoconstriction Hypoxia leading to energy failure and neuronal death Blood-brain barrier thickening Excessive CSF production Hypoxia disrupts ATP production, leading to neuronal swelling, apoptosis, and necrosis. Hypoxia disrupts ATP production, leading to neuronal swelling, apoptosis, and necrosis. 33 / 60 In a newborn with severe HIE, what is the key long-term follow-up requirement? Periodic renal ultrasound Neurodevelopmental assessment Hearing test only Routine vaccination Early and ongoing neurodevelopmental assessment is crucial to detect and manage delays or disabilities. Early and ongoing neurodevelopmental assessment is crucial to detect and manage delays or disabilities. 34 / 60 Which system is least likely to be affected by birth asphyxia? Central nervous system Cardiovascular system Skeletal system Renal system The skeletal system is generally not compromised by perinatal hypoxia. The skeletal system is generally not compromised by perinatal hypoxia. 35 / 60 What is the most common cause of birth asphyxia? Maternal infection Meconium aspiration Umbilical cord prolapse Placental insufficiency Placental insufficiency leads to chronic fetal hypoxia, making it a leading cause of birth asphyxia. Acute events like cord prolapse are less common. Placental insufficiency leads to chronic fetal hypoxia, making it a leading cause of birth asphyxia. Acute events like cord prolapse are less common. 36 / 60 What is a potential renal complication of birth asphyxia? Acute tubular necrosis Polycystic kidney disease Hypoplastic kidneys Obstructive uropathy Hypoxic injury may lead to reduced renal perfusion and acute tubular necrosis. Hypoxic injury may lead to reduced renal perfusion and acute tubular necrosis. 37 / 60 What is the most effective way to prevent birth asphyxia? Timely identification and management of high-risk labor Neonatal antibiotics Routine cesarean section Delayed cord clamping Effective monitoring and early intervention in complicated labor can significantly reduce the incidence of asphyxia. Effective monitoring and early intervention in complicated labor can significantly reduce the incidence of asphyxia. 38 / 60 Which clinical sign suggests worsening hypoxic injury in a neonate? Good suck reflex Normal tone Crying loudly Absent Moro reflex Loss of primitive reflexes, such as the Moro reflex, is a sign of worsening neurological function. Loss of primitive reflexes, such as the Moro reflex, is a sign of worsening neurological function. 39 / 60 What gestational condition increases the risk of birth asphyxia? Maternal obesity Prolonged labor Twin pregnancy Iron deficiency anemia Prolonged or obstructed labor can compromise fetal oxygenation and lead to birth asphyxia. Prolonged or obstructed labor can compromise fetal oxygenation and lead to birth asphyxia. 40 / 60 Which investigation helps detect hypoxic damage to the basal ganglia? MRI brain Chest ultrasound Renal scan Skull X-ray MRI is the imaging modality of choice to assess specific brain injury patterns such as basal ganglia damage in HIE. MRI is the imaging modality of choice to assess specific brain injury patterns such as basal ganglia damage in HIE. 41 / 60 What is the hallmark acid-base abnormality in severe birth asphyxia? Respiratory acidosis Metabolic alkalosis Respiratory alkalosis Metabolic acidosis Due to anaerobic metabolism, lactic acid accumulates, resulting in metabolic acidosis. Due to anaerobic metabolism, lactic acid accumulates, resulting in metabolic acidosis. 42 / 60 What is the typical EEG finding in moderate to severe HIE? Suppressed background activity or burst suppression Alpha waves Regular theta rhythms Normal sleep-wake cycling Burst suppression or reduced background activity is characteristic of moderate-to-severe HIE. Burst suppression or reduced background activity is characteristic of moderate-to-severe HIE. 43 / 60 What is the significance of neonatal seizures in the first 24 hours? Caused by feeding difficulty Benign if isolated Always due to infection Often associated with birth asphyxia Seizures within 24 hours of life are often due to hypoxic brain injury. Seizures within 24 hours of life are often due to hypoxic brain injury. 44 / 60 Which clinical sign is an early indicator of hypoxic-ischemic encephalopathy? Persistent crying Jitteriness Bradycardia Poor feeding and lethargy Lethargy and poor feeding are early neurological signs of HIE due to brain hypoxia. Lethargy and poor feeding are early neurological signs of HIE due to brain hypoxia. 45 / 60 What is the expected outcome of Stage 1 HIE in most cases? Full recovery without long-term sequelae Intractable seizures High mortality Severe disability Stage 1 HIE is mild and often resolves completely without long-term consequences. Stage 1 HIE is mild and often resolves completely without long-term consequences. 46 / 60 What is the first-line investigation to assess kidney function in asphyxiated neonates? Abdominal CT Serum creatinine and urine output monitoring Renal biopsy Electrolyte panel alone Elevated creatinine and reduced urine output indicate renal impairment post-asphyxia. Elevated creatinine and reduced urine output indicate renal impairment post-asphyxia. 47 / 60 Which of the following Apgar components reflects heart rate? Activity Grimace Appearance Pulse The âPulseâ component of the Apgar score measures heart rate. The âPulseâ component of the Apgar score measures heart rate. 48 / 60 Which score is used to assess encephalopathy severity in asphyxiated neonates? Ballard score Silverman score Sarnat staging Dubowitz score The Sarnat score is used to grade the severity of hypoxic-ischemic encephalopathy (HIE) in neonates. The Sarnat score is used to grade the severity of hypoxic-ischemic encephalopathy (HIE) in neonates. 49 / 60 Which blood test result supports a diagnosis of perinatal asphyxia? Respiratory alkalosis Normal lactate Low pH with high base deficit High bicarbonate Metabolic acidosis, indicated by low pH and high base deficit, is a hallmark of perinatal asphyxia. Metabolic acidosis, indicated by low pH and high base deficit, is a hallmark of perinatal asphyxia. 50 / 60 What is a key nursing priority during therapeutic hypothermia? Frequent bathing Monitoring vital signs and preventing overcooling Feeding every 2 hours Stimulating the infant frequently Close monitoring is essential to maintain target temperature and detect complications. Close monitoring is essential to maintain target temperature and detect complications. 51 / 60 What should be closely monitored during therapeutic hypothermia? Electrolytes, glucose, and coagulation profile Stool color Cranial suture closure Tear production Electrolyte disturbances, hypoglycemia, and coagulopathy are common and must be monitored in cooled neonates. Electrolyte disturbances, hypoglycemia, and coagulopathy are common and must be monitored in cooled neonates. 52 / 60 At what time should therapeutic hypothermia ideally be initiated for maximum neuroprotection? Within 6 hours of birth Immediately after resuscitation Between 12â18 hours After 24 hours Therapeutic hypothermia is most effective when started within the first 6 hours of life. Therapeutic hypothermia is most effective when started within the first 6 hours of life. 53 / 60 What is the gold standard for diagnosing the extent of hypoxic brain injury? EEG MRI brain Skull X-ray Sarnat scoring MRI provides detailed structural imaging to assess the areas affected by hypoxic injury. MRI provides detailed structural imaging to assess the areas affected by hypoxic injury. 54 / 60 What is the significance of persistent hypotonia in a newborn? Feeding delay Possible hypoxic brain injury Transient neurological issue Normal variation Persistent hypotonia may indicate hypoxic-ischemic encephalopathy and warrants further evaluation. Persistent hypotonia may indicate hypoxic-ischemic encephalopathy and warrants further evaluation. 55 / 60 Which of the following is NOT a sign of severe birth asphyxia? Absent reflexes Bradycardia >120 bpm Seizures Hypotonia Bradycardia >120 bpm is not a clinical concern; severe asphyxia causes heart rates below 100 or 60 bpm. Bradycardia >120 bpm is not a clinical concern; severe asphyxia causes heart rates below 100 or 60 bpm. 56 / 60 What finding during labor suggests possible fetal hypoxia? Irregular uterine contractions Late decelerations on fetal heart monitoring Maternal tachycardia Accelerations with fetal movement Late decelerations are a sign of uteroplacental insufficiency and may indicate fetal hypoxia. Late decelerations are a sign of uteroplacental insufficiency and may indicate fetal hypoxia. 57 / 60 Which Apgar score indicates moderate birth asphyxia? 4-6 8-10 >10 0-3 An Apgar score of 4â6 at 1 and 5 minutes suggests moderate asphyxia. An Apgar score of 4â6 at 1 and 5 minutes suggests moderate asphyxia. 58 / 60 Which of the following is a poor prognostic factor in birth asphyxia? Apgar score of 6 at 1 minute Quick response to resuscitation Birth weight >2.5 kg Need for resuscitation beyond 10 minutes Prolonged resuscitation beyond 10 minutes is associated with poor neurological outcomes. Prolonged resuscitation beyond 10 minutes is associated with poor neurological outcomes. 59 / 60 What is one important long-term complication of birth asphyxia? Clubfoot Neonatal acne Cerebral palsy Jaundice Birth asphyxia is one of the leading causes of cerebral palsy due to hypoxic brain damage. Birth asphyxia is one of the leading causes of cerebral palsy due to hypoxic brain damage. 60 / 60 What is the goal of neonatal resuscitation in a newborn with asphyxia? Administer antibiotics Raise body temperature Establish effective ventilation and circulation Give IV fluids immediately The primary goal is to restore oxygenation and perfusion through effective ventilation and chest compressions if needed. The primary goal is to restore oxygenation and perfusion through effective ventilation and chest compressions if needed. Your score isThe average score is 36% LinkedIn Facebook VKontakte 0%