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