Birth Asphyxia 3 Quiz 1 / 60 What is the role of amplitude-integrated EEG (aEEG) in birth asphyxia? Monitor glucose levels Assess renal output Detect subclinical seizures and assess cerebral function 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. 2 / 60 Which scoring system is used to assess neonatal encephalopathy severity based on clinical features? Silverman-Anderson score Sarnat staging Bishop score Ballard 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. 3 / 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. 4 / 60 In a newborn with severe HIE, what is the key long-term follow-up requirement? Periodic renal ultrasound Routine vaccination Hearing test only 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. 5 / 60 Which maternal condition is most commonly associated with neonatal asphyxia? Preeclampsia Asthma Prolonged labor Hyperthyroidism 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. 6 / 60 What is the typical duration of therapeutic hypothermia for birth asphyxia? 24 hours 48 hours 12 hours 72 hours Cooling is typically maintained for 72 hours to maximize neuroprotection. Cooling is typically maintained for 72 hours to maximize neuroprotection. 7 / 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. 8 / 60 What is the significance of neonatal seizures in the first 24 hours? Caused by feeding difficulty Often associated with birth asphyxia Benign if isolated Always due to infection 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. 9 / 60 What is the typical EEG finding in moderate to severe HIE? Alpha waves Suppressed background activity or burst suppression 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. 10 / 60 A severely asphyxiated newborn requires resuscitation. What FiOâ should be used initially? 21% (room air) 100% 80% 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. 11 / 60 What is the purpose of therapeutic hypothermia in birth asphyxia? Increase oxygen delivery Prevent sepsis Reduce brain metabolism and injury 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. 12 / 60 In asphyxiated infants, persistent pulmonary hypertension (PPHN) is caused by: Failure of pulmonary vasodilation Low lung compliance Hyperoxygenation Ventricular septal defect Hypoxia leads to pulmonary vasoconstriction, maintaining fetal circulation and causing PPHN. Hypoxia leads to pulmonary vasoconstriction, maintaining fetal circulation and causing PPHN. 13 / 60 What should be closely monitored during therapeutic hypothermia? Tear production Electrolytes, glucose, and coagulation profile 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. 14 / 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. 15 / 60 What gestational condition increases the risk of birth asphyxia? Prolonged labor Twin pregnancy Iron deficiency anemia Maternal obesity 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. 16 / 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. 17 / 60 What is a key nursing priority during therapeutic hypothermia? Stimulating the infant frequently Frequent bathing Feeding every 2 hours Monitoring vital signs and preventing overcooling Close monitoring is essential to maintain target temperature and detect complications. Close monitoring is essential to maintain target temperature and detect complications. 18 / 60 Which score is used to assess encephalopathy severity in asphyxiated neonates? Silverman score Sarnat staging Dubowitz score Ballard 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. 19 / 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. 20 / 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. 21 / 60 What intervention is contraindicated during therapeutic hypothermia? IV fluid monitoring EEG monitoring Warming the baby to normal temperature Use of anticonvulsants 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. 22 / 60 In asphyxiated neonates, what is the role of cranial ultrasound? To confirm gestational age To detect skeletal injuries To screen for intraventricular hemorrhage or brain edema To assess liver echogenicity 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. 23 / 60 What is the hallmark acid-base abnormality in severe birth asphyxia? Metabolic alkalosis Respiratory alkalosis Metabolic acidosis Respiratory acidosis Due to anaerobic metabolism, lactic acid accumulates, resulting in metabolic acidosis. Due to anaerobic metabolism, lactic acid accumulates, resulting in metabolic acidosis. 24 / 60 What defines birth asphyxia? Meconium in amniotic fluid Impaired gas exchange leading to hypoxia and hypercapnia Lack of crying after birth 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. 25 / 60 Hypoxic-ischemic encephalopathy (HIE) is associated with which complication? Hyperbilirubinemia Cerebral palsy Hypoglycemia Congenital heart disease HIE can cause long-term neurological damage including cerebral palsy. HIE can cause long-term neurological damage including cerebral palsy. 26 / 60 What is the pathophysiology of brain injury in birth asphyxia? Hypercapnia causing vasoconstriction Excessive CSF production Hypoxia leading to energy failure and neuronal death Blood-brain barrier thickening Hypoxia disrupts ATP production, leading to neuronal swelling, apoptosis, and necrosis. Hypoxia disrupts ATP production, leading to neuronal swelling, apoptosis, and necrosis. 27 / 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. 28 / 60 What is the most common cause of birth asphyxia? Maternal infection Meconium aspiration Placental insufficiency 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. 29 / 60 What laboratory finding is commonly seen in asphyxiated neonates? Hypokalemia Hypernatremia Metabolic acidosis Respiratory alkalosis Due to anaerobic metabolism, metabolic acidosis is common in asphyxiated neonates. Due to anaerobic metabolism, metabolic acidosis is common in asphyxiated neonates. 30 / 60 What is one important long-term complication of birth asphyxia? Cerebral palsy Clubfoot Jaundice Neonatal acne 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. 31 / 60 Which of the following increases the risk of meconium aspiration syndrome and subsequent asphyxia? Low birth weight Gestational diabetes Twin pregnancy 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. 32 / 60 What finding during labor suggests possible fetal hypoxia? Late decelerations on fetal heart monitoring Maternal tachycardia Accelerations with fetal movement 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. 33 / 60 Which parameter is most reliable in monitoring asphyxiated neonates during therapeutic hypothermia? Blood pressure Oxygen saturation Electroencephalogram (EEG) 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. 34 / 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. 35 / 60 Which Apgar score indicates moderate birth asphyxia? 0-3 8-10 4-6 >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. 36 / 60 What is the expected outcome of Stage 1 HIE in most cases? Intractable seizures Severe disability Full recovery without long-term sequelae 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. 37 / 60 Which blood test result supports a diagnosis of perinatal asphyxia? Normal lactate Low pH with high base deficit High bicarbonate Respiratory alkalosis 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. 38 / 60 Which fetal condition increases the risk for perinatal asphyxia? Intrauterine growth restriction (IUGR) Neonatal diabetes Polyhydramnios Premature thelarche IUGR fetuses are more susceptible to hypoxia due to placental insufficiency. IUGR fetuses are more susceptible to hypoxia due to placental insufficiency. 39 / 60 What is the consequence of delayed initiation of ventilation in a non-breathing newborn? Improved circulation Increased temperature Worsening hypoxia and acidosis Decreased seizure risk Every second countsâdelayed ventilation prolongs hypoxia, increasing brain injury and mortality. Every second countsâdelayed ventilation prolongs hypoxia, increasing brain injury and mortality. 40 / 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. 41 / 60 Which of the following Apgar components reflects heart rate? Activity Appearance Pulse Grimace The âPulseâ component of the Apgar score measures heart rate. The âPulseâ component of the Apgar score measures heart rate. 42 / 60 Which clinical sign suggests worsening hypoxic injury in a neonate? Crying loudly Normal tone Absent Moro reflex 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. 43 / 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. 44 / 60 Which parameter is critical to monitor during resuscitation of an asphyxiated newborn? Birth weight Skin color Fontanelle tension 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. 45 / 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. 46 / 60 What is the first-line investigation to assess kidney function in asphyxiated neonates? Serum creatinine and urine output monitoring Electrolyte panel alone 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. 47 / 60 What is the most common neurologic sequela of severe birth asphyxia? Cerebral palsy Epilepsy Hydrocephalus Autism 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. 48 / 60 What is the gold standard for diagnosing the extent of hypoxic brain injury? Skull X-ray MRI brain EEG 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. 49 / 60 Which system is least likely to be affected by birth asphyxia? Renal system Central nervous system Skeletal system Cardiovascular system The skeletal system is generally not compromised by perinatal hypoxia. The skeletal system is generally not compromised by perinatal hypoxia. 50 / 60 Which clinical sign is an early indicator of hypoxic-ischemic encephalopathy? Persistent crying Jitteriness Poor feeding and lethargy 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. 51 / 60 Which of the following best describes stage 1 hypoxic-ischemic encephalopathy (HIE)? Coma with absent reflexes Seizures and hypotonia Irritability with normal muscle tone and reflexes 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. 52 / 60 What defines severe birth asphyxia using the Apgar score? 1-minute score of 6 5-minute score of 6-7 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. 53 / 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. 54 / 60 What is a major risk of delayed intervention in birth asphyxia? Growth retardation Neonatal jaundice Permanent neurologic damage 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. 55 / 60 At what time should therapeutic hypothermia ideally be initiated for maximum neuroprotection? After 24 hours Between 12â18 hours Within 6 hours of birth Immediately after resuscitation 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. 56 / 60 Which of the following is NOT a sign of severe birth asphyxia? Seizures Hypotonia Absent reflexes 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. 57 / 60 What is the best prognostic marker in a newborn after perinatal asphyxia? Hematocrit level Serum bilirubin Neurologic examination at 7-10 days Capillary refill time 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. 58 / 60 What is the significance of persistent hypotonia in a newborn? Possible hypoxic brain injury Feeding delay Normal variation Transient neurological issue Persistent hypotonia may indicate hypoxic-ischemic encephalopathy and warrants further evaluation. Persistent hypotonia may indicate hypoxic-ischemic encephalopathy and warrants further evaluation. 59 / 60 Why is a low Apgar score at 10 minutes concerning? Indicates neonatal sepsis Suggests prolonged hypoxia and poor prognosis 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. 60 / 60 What is the goal of neonatal resuscitation in a newborn with asphyxia? Administer antibiotics Raise body temperature Give IV fluids immediately 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. Your score is The average score is 36% LinkedIn Facebook Twitter 0%