Birth Asphyxia 3 Quiz 1 / 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. 2 / 60 At what time should therapeutic hypothermia ideally be initiated for maximum neuroprotection? Between 12â18 hours Immediately after resuscitation After 24 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. 3 / 60 Which parameter is most reliable in monitoring asphyxiated neonates during therapeutic hypothermia? Oxygen saturation Respiratory rate Blood pressure 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. 4 / 60 Which investigation helps detect hypoxic damage to the basal ganglia? Skull X-ray MRI brain Chest ultrasound Renal scan 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. 5 / 60 What is the most common arrhythmia associated with severe birth asphyxia? Tachycardia Atrial fibrillation Bradycardia Supraventricular 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. 6 / 60 What is the purpose of therapeutic hypothermia in birth asphyxia? Prevent sepsis Treat seizures Reduce brain metabolism and injury 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. 7 / 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. 8 / 60 Which score is used to assess encephalopathy severity in asphyxiated neonates? Silverman score Ballard 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. 9 / 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. 10 / 60 Which imaging modality helps assess hypoxic brain injury in neonates? Chest X-ray CT of lungs Abdominal ultrasound Cranial ultrasound or MRI 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. 11 / 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. 12 / 60 In asphyxiated neonates, what is the role of cranial ultrasound? To confirm gestational age To assess liver echogenicity To screen for intraventricular hemorrhage or brain edema 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. 13 / 60 Which blood test result supports a diagnosis of perinatal asphyxia? Normal lactate Low pH with high base deficit Respiratory alkalosis 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. 14 / 60 What is the gold standard for diagnosing the extent of hypoxic brain injury? EEG Skull X-ray Sarnat scoring MRI brain 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. 15 / 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. 16 / 60 What is a key nursing priority during therapeutic hypothermia? Stimulating the infant frequently Feeding every 2 hours Frequent bathing 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. 17 / 60 What is one important long-term complication of birth asphyxia? Cerebral palsy Neonatal acne Clubfoot 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. 18 / 60 Which organ is most sensitive to hypoxia during birth asphyxia? Liver Intestines Brain Skin 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. 19 / 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. 20 / 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. 21 / 60 What is the goal of neonatal resuscitation in a newborn with asphyxia? Raise body temperature Administer antibiotics 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. 22 / 60 What is the typical EEG finding in moderate to severe HIE? Regular theta rhythms Alpha waves Normal sleep-wake cycling 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. 23 / 60 What is the consequence of delayed initiation of ventilation in a non-breathing newborn? Increased temperature Worsening hypoxia and acidosis Decreased seizure risk Improved circulation Every second countsâdelayed ventilation prolongs hypoxia, increasing brain injury and mortality. Every second countsâdelayed ventilation prolongs hypoxia, increasing brain injury and mortality. 24 / 60 What is the hallmark acid-base abnormality in severe birth asphyxia? Respiratory acidosis Metabolic acidosis Respiratory alkalosis Metabolic alkalosis Due to anaerobic metabolism, lactic acid accumulates, resulting in metabolic acidosis. Due to anaerobic metabolism, lactic acid accumulates, resulting in metabolic acidosis. 25 / 60 Which Apgar score indicates moderate birth asphyxia? 4-6 8-10 0-3 >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. 26 / 60 Which parameter is critical to monitor during resuscitation of an asphyxiated newborn? Birth weight Heart rate Skin color Fontanelle tension 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. 27 / 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. 28 / 60 Which of the following Apgar components reflects heart rate? Appearance Grimace Pulse Activity The âPulseâ component of the Apgar score measures heart rate. The âPulseâ component of the Apgar score measures heart rate. 29 / 60 Which clinical sign suggests worsening hypoxic injury in a neonate? Normal tone Absent Moro reflex 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. 30 / 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. 31 / 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. 32 / 60 Hypoxic-ischemic encephalopathy (HIE) is associated with which complication? Congenital heart disease Cerebral palsy Hypoglycemia Hyperbilirubinemia HIE can cause long-term neurological damage including cerebral palsy. HIE can cause long-term neurological damage including cerebral palsy. 33 / 60 Which factor is associated with an increased risk of intrapartum asphyxia? Umbilical cord prolapse Male gender Cephalohematoma Jaundice 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. 34 / 60 Which of the following best describes stage 1 hypoxic-ischemic encephalopathy (HIE)? Seizures and hypotonia Coma with absent reflexes Apnea and bradycardia 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. 35 / 60 What is the initial management step in a newborn with birth asphyxia? Administer antibiotics Start IV fluids Ensure airway and provide ventilation Give glucose 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. 36 / 60 Which electrolyte abnormality is common in birth asphyxia? Hypernatremia Hyperkalemia Hypocalcemia Hyperchloremia Hypocalcemia may result from stress and cellular injury in asphyxiated neonates. Hypocalcemia may result from stress and cellular injury in asphyxiated neonates. 37 / 60 What is a major risk of delayed intervention in birth asphyxia? Growth retardation Anemia Permanent neurologic damage Neonatal jaundice 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. 38 / 60 What is the best prognostic marker in a newborn after perinatal asphyxia? Serum bilirubin Capillary refill time Neurologic examination at 7-10 days 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. 39 / 60 What is the significance of neonatal seizures in the first 24 hours? Always due to infection Caused by feeding difficulty Benign if isolated 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. 40 / 60 Which system is least likely to be affected by birth asphyxia? Central nervous system Renal 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. 41 / 60 What intervention is contraindicated during therapeutic hypothermia? Warming the baby to normal temperature IV fluid monitoring EEG monitoring 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. 42 / 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. 43 / 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. 44 / 60 What is the pathophysiology of brain injury in birth asphyxia? Blood-brain barrier thickening Hypercapnia causing vasoconstriction Hypoxia leading to energy failure and neuronal death 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. 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 Which of the following is NOT a sign of severe birth asphyxia? Absent reflexes Hypotonia Seizures 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. 47 / 60 What laboratory finding is commonly seen in asphyxiated neonates? Metabolic acidosis Hypokalemia Respiratory alkalosis Hypernatremia Due to anaerobic metabolism, metabolic acidosis is common in asphyxiated neonates. Due to anaerobic metabolism, metabolic acidosis is common in asphyxiated neonates. 48 / 60 What is the typical presentation of Stage 3 HIE? Normal tone and feeding Coma, flaccidity, and absent reflexes Jitteriness and normal reflexes Seizures with some spontaneous movement 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. 49 / 60 Which maternal condition is most commonly associated with neonatal asphyxia? Asthma Hyperthyroidism Prolonged labor 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. 50 / 60 What should be closely monitored during therapeutic hypothermia? Cranial suture closure Electrolytes, glucose, and coagulation profile Stool color 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. 51 / 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. 52 / 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. 53 / 60 What is the most effective way to prevent birth asphyxia? Timely identification and management of high-risk labor Delayed cord clamping Routine cesarean section 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. 54 / 60 A severely asphyxiated newborn requires resuscitation. What FiOâ should be used initially? 80% 40% 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. 55 / 60 In asphyxiated infants, persistent pulmonary hypertension (PPHN) is caused by: Low lung compliance Hyperoxygenation Failure of pulmonary vasodilation 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. 56 / 60 Why is a low Apgar score at 10 minutes concerning? Indicates feeding problems Suggests prolonged hypoxia and poor prognosis Predicts low birth weight Indicates neonatal sepsis 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. 57 / 60 Which scoring system is used to assess neonatal encephalopathy severity based on clinical features? Bishop score Ballard score Sarnat staging Silverman-Anderson 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. 58 / 60 What defines birth asphyxia? Fever and sepsis Lack of crying after birth Impaired gas exchange leading to hypoxia and hypercapnia 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. 59 / 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. 60 / 60 What is a potential renal complication of birth asphyxia? Polycystic kidney disease Obstructive uropathy Hypoplastic kidneys Acute tubular necrosis Hypoxic injury may lead to reduced renal perfusion and acute tubular necrosis. Hypoxic injury may lead to reduced renal perfusion and acute tubular necrosis. Your score is The average score is 36% LinkedIn Facebook Twitter 0%