Birth Asphyxia 3 Quiz 1 / 60 What is one important long-term complication of birth asphyxia? Cerebral palsy Jaundice Neonatal acne 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. 2 / 60 What is a major risk of delayed intervention in birth asphyxia? Anemia Neonatal jaundice Growth retardation 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. 3 / 60 In asphyxiated infants, persistent pulmonary hypertension (PPHN) is caused by: Ventricular septal defect Failure of pulmonary vasodilation 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. 4 / 60 What is the goal of neonatal resuscitation in a newborn with asphyxia? Give IV fluids immediately Administer antibiotics Raise body temperature Establish effective ventilation and circulation 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. 5 / 60 What laboratory finding is commonly seen in asphyxiated neonates? Respiratory alkalosis Hypokalemia Hypernatremia Metabolic acidosis Due to anaerobic metabolism, metabolic acidosis is common in asphyxiated neonates. Due to anaerobic metabolism, metabolic acidosis is common in asphyxiated neonates. 6 / 60 What is the hallmark acid-base abnormality in severe birth asphyxia? Metabolic alkalosis Respiratory acidosis Metabolic acidosis Respiratory alkalosis Due to anaerobic metabolism, lactic acid accumulates, resulting in metabolic acidosis. Due to anaerobic metabolism, lactic acid accumulates, resulting in metabolic acidosis. 7 / 60 What is the purpose of therapeutic hypothermia in birth asphyxia? Reduce brain metabolism and injury Prevent sepsis Treat seizures Increase oxygen delivery 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. 8 / 60 In a newborn with severe HIE, what is the key long-term follow-up requirement? Hearing test only Routine vaccination Periodic renal ultrasound Neurodevelopmental assessment 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. 9 / 60 What is the pathophysiology of brain injury in birth asphyxia? Blood-brain barrier thickening Excessive CSF production Hypercapnia causing vasoconstriction Hypoxia leading to energy failure and neuronal death Hypoxia disrupts ATP production, leading to neuronal swelling, apoptosis, and necrosis. Hypoxia disrupts ATP production, leading to neuronal swelling, apoptosis, and necrosis. 10 / 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. 11 / 60 What defines birth asphyxia? Meconium in amniotic fluid Lack of crying after birth Impaired gas exchange leading to hypoxia and hypercapnia Fever and sepsis 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. 12 / 60 Which scoring system is used to assess neonatal encephalopathy severity based on clinical features? Ballard score Silverman-Anderson score Sarnat staging Bishop score 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. 13 / 60 Which clinical sign most strongly indicates the need for immediate resuscitation at birth? Absence of spontaneous breathing Caput succedaneum Tachypnea Meconium-stained fluid 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. 14 / 60 Which of the following Apgar components reflects heart rate? Pulse Grimace Activity Appearance The âPulseâ component of the Apgar score measures heart rate. The âPulseâ component of the Apgar score measures heart rate. 15 / 60 What is the significance of persistent hypotonia in a newborn? Transient neurological issue Normal variation Feeding delay Possible hypoxic brain injury Persistent hypotonia may indicate hypoxic-ischemic encephalopathy and warrants further evaluation. Persistent hypotonia may indicate hypoxic-ischemic encephalopathy and warrants further evaluation. 16 / 60 Which parameter is most reliable in monitoring asphyxiated neonates during therapeutic hypothermia? Respiratory rate Blood pressure Oxygen saturation Electroencephalogram (EEG) 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 initial management step in a newborn with birth asphyxia? Administer antibiotics Ensure airway and provide ventilation Give glucose Start IV fluids 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. 18 / 60 What is the first-line investigation to assess kidney function in asphyxiated neonates? Electrolyte panel alone Serum creatinine and urine output monitoring Renal biopsy Abdominal CT Elevated creatinine and reduced urine output indicate renal impairment post-asphyxia. Elevated creatinine and reduced urine output indicate renal impairment post-asphyxia. 19 / 60 What is the typical presentation of Stage 3 HIE? Coma, flaccidity, and absent reflexes Normal tone and feeding Seizures with some spontaneous movement Jitteriness and normal 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. 20 / 60 What should be closely monitored during therapeutic hypothermia? Electrolytes, glucose, and coagulation profile Tear production Stool color 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. 21 / 60 What defines severe birth asphyxia using the Apgar score? 10-minute score of 9 1-minute score of 6 5-minute score of 6-7 5-minute score of 0-3 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. 22 / 60 What is the role of amplitude-integrated EEG (aEEG) in birth asphyxia? Diagnose infections Monitor glucose levels Assess renal output Detect subclinical seizures and assess cerebral function 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. 23 / 60 Which maternal condition is most commonly associated with neonatal asphyxia? Asthma Hyperthyroidism Preeclampsia 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. 24 / 60 What is the significance of neonatal seizures in the first 24 hours? Often associated with birth asphyxia Caused by feeding difficulty Always due to infection 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. 25 / 60 Which clinical sign suggests worsening hypoxic injury in a neonate? Absent Moro reflex Normal tone Crying loudly 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. 26 / 60 Which of the following best describes stage 1 hypoxic-ischemic encephalopathy (HIE)? Coma with absent reflexes Irritability with normal muscle tone and reflexes Seizures and hypotonia Apnea and bradycardia 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. 27 / 60 Which organ is most sensitive to hypoxia during birth asphyxia? Brain Skin Liver Intestines 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. 28 / 60 What is a key nursing priority during therapeutic hypothermia? Stimulating the infant frequently Monitoring vital signs and preventing overcooling Frequent bathing 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. 29 / 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. 30 / 60 Hypoxic-ischemic encephalopathy (HIE) is associated with which complication? Hypoglycemia Hyperbilirubinemia 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. 31 / 60 Which of the following is a poor prognostic factor in birth asphyxia? Quick response to resuscitation Apgar score of 6 at 1 minute 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. 32 / 60 A severely asphyxiated newborn requires resuscitation. What FiOâ should be used initially? 40% 80% 100% 21% (room air) 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. 33 / 60 What intervention is contraindicated during therapeutic hypothermia? Warming the baby to normal temperature Use of anticonvulsants IV fluid monitoring 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. 34 / 60 Which of the following increases the risk of meconium aspiration syndrome and subsequent asphyxia? Twin pregnancy Post-term pregnancy Low birth weight 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. 35 / 60 What is the consequence of delayed initiation of ventilation in a non-breathing newborn? Improved circulation Decreased seizure risk 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. 36 / 60 Which electrolyte abnormality is common in birth asphyxia? Hypernatremia Hypocalcemia Hyperchloremia Hyperkalemia Hypocalcemia may result from stress and cellular injury in asphyxiated neonates. Hypocalcemia may result from stress and cellular injury in asphyxiated neonates. 37 / 60 Which factor is associated with an increased risk of intrapartum asphyxia? Cephalohematoma Male gender Jaundice Umbilical cord prolapse 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. 38 / 60 What is the best prognostic marker in a newborn after perinatal asphyxia? Neurologic examination at 7-10 days Hematocrit level Capillary refill time 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. 39 / 60 At what time should therapeutic hypothermia ideally be initiated for maximum neuroprotection? Immediately after resuscitation After 24 hours Between 12â18 hours 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. 40 / 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. 41 / 60 What is the typical duration of therapeutic hypothermia for birth asphyxia? 12 hours 72 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. 42 / 60 Which fetal condition increases the risk for perinatal asphyxia? Intrauterine growth restriction (IUGR) Polyhydramnios Neonatal diabetes Premature thelarche IUGR fetuses are more susceptible to hypoxia due to placental insufficiency. IUGR fetuses are more susceptible to hypoxia due to placental insufficiency. 43 / 60 Which of the following is NOT a sign of severe birth asphyxia? Absent reflexes Seizures Hypotonia Bradycardia >120 bpm 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. 44 / 60 Why is a low Apgar score at 10 minutes concerning? Suggests prolonged hypoxia and poor prognosis Indicates neonatal sepsis Indicates feeding problems 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. 45 / 60 Which Apgar score indicates moderate birth asphyxia? 0-3 4-6 8-10 >10 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. 46 / 60 Which parameter is critical to monitor during resuscitation of an asphyxiated newborn? Heart rate Skin color Fontanelle tension Birth weight 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. 47 / 60 Which system is least likely to be affected by birth asphyxia? Skeletal system Renal system Central nervous system Cardiovascular system The skeletal system is generally not compromised by perinatal hypoxia. The skeletal system is generally not compromised by perinatal hypoxia. 48 / 60 Which clinical sign is an early indicator of hypoxic-ischemic encephalopathy? Jitteriness Poor feeding and lethargy Persistent crying Bradycardia 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. 49 / 60 What finding during labor suggests possible fetal hypoxia? Maternal tachycardia Late decelerations on fetal heart monitoring Irregular uterine contractions 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. 50 / 60 Which imaging modality helps assess hypoxic brain injury in neonates? CT of lungs Cranial ultrasound or MRI Chest X-ray Abdominal ultrasound 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. 51 / 60 What is a potential renal complication of birth asphyxia? Polycystic kidney disease Acute tubular necrosis Obstructive uropathy 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. 52 / 60 What is the gold standard for diagnosing the extent of hypoxic brain injury? EEG Sarnat scoring MRI brain 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. 53 / 60 What is the typical EEG finding in moderate to severe HIE? Alpha waves Normal sleep-wake cycling Regular theta rhythms 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. 54 / 60 What is the most effective way to prevent birth asphyxia? Delayed cord clamping Routine cesarean section Timely identification and management of high-risk labor Neonatal antibiotics 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. 55 / 60 What is the expected outcome of Stage 1 HIE in most cases? Intractable seizures Full recovery without long-term sequelae Severe disability High mortality 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. 56 / 60 What gestational condition increases the risk of birth asphyxia? Iron deficiency anemia Maternal obesity Prolonged labor Twin pregnancy 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. 57 / 60 Which score is used to assess encephalopathy severity in asphyxiated neonates? Dubowitz score Ballard 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. 58 / 60 What is the most common cause of birth asphyxia? Placental insufficiency Maternal infection Meconium aspiration Umbilical cord prolapse 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. 59 / 60 Which blood test result supports a diagnosis of perinatal asphyxia? Respiratory alkalosis Low pH with high base deficit High bicarbonate Normal lactate 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. 60 / 60 In asphyxiated neonates, what is the role of cranial ultrasound? To detect skeletal injuries To confirm gestational age To assess liver echogenicity To screen for intraventricular hemorrhage or brain edema 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. Your score isThe average score is 36% LinkedIn Facebook VKontakte 0%