Version 1.0 — Published March 2026
Quick Answer
Neonatology contributes 3–4 direct questions per NEET PG paper. Master these 10 high-yield areas:
- NRP 2020 Golden Minute — warmth, position, clear airway (if needed), dry, stimulate → if apnea / HR <100 → PPV with room air (term) or 21–30% O2 (preterm)
- Compression:ventilation — 3:1 (90 compressions + 30 breaths/min); start only if HR <60 after 30 s effective PPV with O2
- Adrenaline — IV/UV 0.01–0.03 mg/kg (1:10,000); 0.05–0.1 mg/kg ET if IV access delayed
- Apgar — 5-parameter score at 1 and 5 min; 7–10 normal, 4–6 moderate, 0–3 severe; 5-min score correlates with outcome
- Meconium (2015+) — no routine ET suction for non-vigorous meconium infants; give PPV first
- HIE / Sarnat — Stage 1 mild, Stage 2 moderate (target for hypothermia), Stage 3 severe
- Therapeutic hypothermia — 33.5°C × 72 h within 6 h of birth for Sarnat 2/3 at >=36 weeks
- RDS surfactant — poractant 200 mg/kg OR beractant 100 mg/kg; INSURE or LISA; rescue when FiO2 >0.30–0.40 on CPAP
- Sepsis — EOS <72 h (GBS, E. coli, Listeria) → ampicillin + gentamicin; LOS >72 h nosocomial → pip-tazo or vancomycin + amikacin
- Hyperbilirubinemia — AAP 2022 nomogram; phototherapy at TSB 15 @ 24 h / 18 @ 48 h / 20 @ 72 h term well infant; exchange ~5 mg/dL above phototherapy
Neonatal resuscitation is the structured response to a non-vigorous newborn in the first minutes of life, and it is a NEET PG goldmine because it integrates pediatrics, obstetrics, and community medicine. The student who memorises the NRP 2020 algorithm, Sarnat staging, and AAP bilirubin thresholds covers 3–4 marks across papers. Pair this guide with daily MCQ practice on the pediatrics subject hub, cross-reference the pediatrics high-yield topics overview, and revise the bilious vomiting and malrotation clinical case for neonatal surgical emergency integration.
NRP 2020 algorithm — the Golden Minute
Neonatal resuscitation follows the NRP 2020 algorithm — a time-anchored sequence that must reach positive pressure ventilation within the Golden Minute (60 seconds of birth) if the newborn is non-vigorous.
Antenatal risk assessment (predict need):
- Maternal: chronic illness, preeclampsia, GDM, infection, no antenatal care
- Intrapartum: preterm, post-term, multiple gestation, meconium-stained liquor, PROM >18 h, prolonged labour, abruption, prolapsed cord
- Fetal: IUGR, macrosomia, congenital anomaly
Three rapid questions at birth:
- Term gestation?
- Good tone?
- Breathing or crying?
If YES to all three → routine care (skin-to-skin, warmth, clear airway if needed, delayed cord clamping).
If NO to any → move to resuscitation table.
Initial steps (30 seconds):
- Warmth — radiant warmer; plastic wrap for <32 weeks
- Position — sniffing position (slight neck extension, shoulder roll 1 inch)
- Clear airway — only if obstructing (mouth before nose)
- Dry and stimulate
- Reposition
Assess at 30 s:
- Apnea, gasping, or HR <100 → start PPV
Positive pressure ventilation:
- Bag and mask or T-piece resuscitator
- 40–60 breaths/minute
- Initial pressure: 20–25 cm H2O (up to 30 cm if no chest rise)
- FiO2: 21% (room air) for >=35 weeks; 21–30% for <35 weeks
- Titrate FiO2 by SpO2 (pre-ductal, right hand)
Target pre-ductal SpO2 by minute after birth:
| Minute | SpO2 |
|---|
| 1 min | 60–65% |
| 2 min | 65–70% |
| 3 min | 70–75% |
| 4 min | 75–80% |
| 5 min | 80–85% |
| 10 min | 85–95% |
MR SOPA for ineffective PPV (chest not rising):
- Mask adjustment
- Reposition head
- Suction mouth and nose
- Open mouth
- Pressure increase
- Airway (intubate / LMA)
Assess at 60 seconds (end of Golden Minute):
- HR >=100 and spontaneous breathing → routine care / observation
- HR 60–99 + breathing inadequate → continue PPV
- HR <60 → intubate + chest compressions + increase FiO2 to 100%
Chest compressions:
- 3:1 ratio (3 compressions to 1 ventilation)
- 90 compressions + 30 breaths/min (120 events/min)
- Two-thumb encircling technique (preferred) or two-finger
- Lower third of sternum, 1/3 anteroposterior depth
- Reassess HR every 60 seconds
Adrenaline (if HR <60 after 30 s of coordinated compressions + PPV with 100% O2):
- IV / UV: 0.01–0.03 mg/kg of 1:10,000 (0.1–0.3 mL/kg)
- ET: 0.05–0.1 mg/kg (higher dose, less reliable) — if IV not available
- Repeat every 3–5 minutes if HR remains <60
Volume expansion:
- Normal saline or O-negative blood 10 mL/kg IV over 5–10 minutes
- Indication: hypovolemia (pallor, poor pulses, weak perfusion, history of blood loss)
Discontinuation:
- If HR undetectable for 10 minutes despite adequate resuscitation → consider stopping (ethics committee / family discussion)
Apgar scoring
The Apgar score is a 5-parameter assessment of newborn well-being at 1 and 5 minutes (and at 10, 15, 20 min if the 5-min score is <7).
| Parameter | 0 | 1 | 2 |
|---|
| Appearance | Blue / pale all over | Body pink, extremities blue (acrocyanosis) | Fully pink |
| Pulse | Absent | <100/min | >=100/min |
| Grimace | No response | Grimace only | Cry / cough / sneeze |
| Activity | Flaccid | Some flexion | Active motion |
| Respiration | Absent | Weak / irregular / slow | Strong cry |
Interpretation:
- 7–10 — normal
- 4–6 — moderate depression
- 0–3 — severe depression
Key points:
- Apgar is NOT used to trigger resuscitation — HR, respiratory effort, and tone drive NRP
- 5-minute Apgar correlates better with long-term outcomes
- Apgar can be falsely low in preterm infants (less tone, slower reflexes)
- 10-minute Apgar <=5 is one criterion for therapeutic hypothermia consideration
Meconium aspiration syndrome
Meconium-stained amniotic fluid (MSAF) occurs in 10–15% of deliveries; meconium aspiration syndrome (MAS) is its respiratory complication — and the 2015 guideline change is still a favourite NEET PG tester.
Pathophysiology:
- In-utero or intrapartum passage of meconium (fetal distress, postdates)
- Fetal gasping → aspiration of meconium into distal airways
- Airway obstruction → ball-valve → air trapping, atelectasis, pneumothorax
- Chemical pneumonitis
- Surfactant inactivation
- Pulmonary vasoconstriction → persistent pulmonary hypertension of the newborn (PPHN)
Clinical features:
- Meconium staining of skin, cord, nails
- Respiratory distress: tachypnea, grunting, retractions
- Barrel chest (air trapping)
- Coarse crackles
- Cyanosis (from shunting / PPHN)
Chest X-ray:
- Patchy, asymmetric infiltrates
- Hyperinflation
- Areas of atelectasis alternating with hyperinflation
- Pneumothorax / pneumomediastinum in severe cases
Management (NRP 2015+ change):
- Vigorous meconium-stained infant (good tone, HR >100, adequate respiration) → routine care and observation
- Non-vigorous → initial steps + PPV
- Routine endotracheal suctioning is NO LONGER recommended
- Intubation + ET suction only if PPV is ineffective due to airway obstruction
- Amnioinfusion — not recommended
Supportive care for established MAS:
- Oxygen / CPAP / mechanical ventilation
- Surfactant (exogenous, for severe MAS)
- Antibiotics (cannot distinguish MAS from bacterial pneumonia easily)
- Inhaled nitric oxide for PPHN
- ECMO for severe refractory disease
Birth asphyxia, HIE and therapeutic hypothermia
Birth asphyxia is the impairment of gas exchange during labour causing hypoxia and acidosis, and its neurological sequela is hypoxic-ischaemic encephalopathy (HIE).
WHO definition of birth asphyxia: failure to initiate and sustain breathing at birth.
AAP/ACOG criteria for intrapartum hypoxic-ischaemic event:
- Cord arterial pH <7.0 OR base deficit >=12 mmol/L
- 5-minute Apgar <=5 (or prolonged low Apgar at 10 min)
- Moderate-to-severe encephalopathy
- Multi-organ dysfunction
- Acute intrapartum event (abruption, cord prolapse, uterine rupture)
Sarnat-Sarnat staging (based on exam in first 24 h):
| Stage | Level of consciousness | Tone | Reflexes | Seizures | Duration | Outcome |
|---|
| 1 — Mild | Hyperalert | Normal | Exaggerated | No | <24 h | Near-normal |
| 2 — Moderate | Lethargic | Hypotonic | Weak | Common | 2–14 days | 20–30% deficits |
| 3 — Severe | Stuporous / comatose | Flaccid | Absent | Prolonged | Days–weeks | High mortality; severe sequelae |
Therapeutic hypothermia (TH) — the game changer:
Indications (all must be met):
- Gestational age >=36 weeks
- Birth weight >=1800 g
- Postnatal age <6 hours at initiation
- Evidence of acute perinatal event (cord pH <7.0 OR base deficit >=16 OR 10-min Apgar <=5 OR ongoing resuscitation >10 min)
- Moderate-to-severe encephalopathy (Sarnat Stage 2 or 3) on exam
- Abnormal amplitude-integrated EEG (aEEG) — optional, supports diagnosis
Protocol:
- Whole-body cooling to 33.5°C core (rectal) temperature
- Duration: 72 hours
- Slow rewarming at 0.5°C per hour over 6–12 hours
- Continuous cardiorespiratory, aEEG, glucose monitoring
- Alternative: selective head cooling (Cool Cap) — less common now
Evidence (Cochrane 2013):
- Reduced death or major disability at 18 months: NNT 7
- Reduced cerebral palsy: NNT 9
Complications:
- Sinus bradycardia (usually asymptomatic)
- Thrombocytopenia
- Subcutaneous fat necrosis
- Mild coagulopathy
- Pulmonary hypertension
Contraindications:
- Major congenital anomaly incompatible with life
- Severe head trauma with active bleeding
- Already cooled >6 h before identification
Respiratory distress syndrome (RDS)
Respiratory distress syndrome is a surfactant-deficiency lung disease of preterm infants, pathognomonic for <34-week neonates.
Pathophysiology:
- Pulmonary surfactant (dipalmitoylphosphatidylcholine + proteins A/B/C/D) produced by type II pneumocytes from 24 weeks, mature by 35 weeks
- Deficiency → increased surface tension → alveolar collapse → atelectasis → V/Q mismatch → hypoxemia
- Hyaline membranes (fibrin + cellular debris) line collapsed alveoli
Risk factors:
- Prematurity (inverse relationship with gestation)
- Male sex, twin pregnancy
- Maternal diabetes (insulin delays surfactant maturation)
- Perinatal asphyxia
- Elective caesarean without labour
Clinical presentation:
- Onset within hours of birth
- Progressive respiratory distress: tachypnea (>60), grunting, flaring, retractions
- Cyanosis
- Decreased breath sounds
- Peak at 48–72 h; improvement thereafter if supported
Chest X-ray:
- Fine reticulogranular "ground-glass" opacities
- Air bronchograms
- Low lung volumes
- "White-out" in severe cases
Management:
- Antenatal corticosteroids — betamethasone 12 mg IM × 2 doses 24 h apart (or dexamethasone 6 mg IM × 4 doses 12 h apart) between 24 and 34 weeks reduces RDS by ~40%
- Early CPAP — nasal CPAP from birth in preterm with respiratory distress (reduces need for ventilation)
- Exogenous surfactant — rescue therapy:
- Poractant alfa (Curosurf) 200 mg/kg first dose
- Beractant (Survanta) 100 mg/kg
- Given via endotracheal tube or LISA/MIST
- INSURE — INtubate, SURfactant, Extubate to CPAP
- LISA / MIST — Less Invasive Surfactant Administration / Minimally Invasive Surfactant Therapy via thin catheter during spontaneous breathing on CPAP
- Oxygen — titrate to SpO2 90–95% (avoid hyperoxia — ROP risk)
- Mechanical ventilation if CPAP fails — synchronised IPPV or HFOV
- Fluid restriction, nutritional support (parenteral then enteral)
- Caffeine for apnea of prematurity
Complications:
- Bronchopulmonary dysplasia (BPD)
- Pneumothorax, PIE
- PDA
- IVH
- Retinopathy of prematurity
- Necrotising enterocolitis
Transient tachypnea of the newborn (TTN)
Transient tachypnea of the newborn is delayed absorption of fetal lung fluid causing short-lived respiratory distress — the most common cause of neonatal respiratory distress overall.
Risk factors:
- Elective caesarean (no labour squeeze)
- Precipitous vaginal delivery
- Macrosomia
- Maternal diabetes
- Fetal polycythemia
- Male sex
Clinical features:
- Tachypnea (often >80/min) within hours of birth
- Mild grunting and retractions
- Clear breath sounds
- Oxygen requirement usually <40%
- Resolves within 24–72 hours
Chest X-ray:
- Hyperinflation
- Prominent perihilar streaking ("wet lung")
- Fluid in the interlobar fissures
- Cardiomegaly (apparent, not real)
Management:
- Supportive: oxygen to maintain SpO2, IV fluids if unable to feed
- CPAP in severe cases
- Empirical antibiotics sometimes started (cannot initially distinguish from early sepsis / pneumonia) — stop at 48 h if cultures negative
DDx (early respiratory distress):
- TTN, RDS, MAS, pneumonia, pneumothorax, congenital diaphragmatic hernia, sepsis, cyanotic CHD, PPHN
Neonatal sepsis — EOS vs LOS
Neonatal sepsis is systemic infection in an infant <28 days old, and the EOS/LOS distinction drives organism coverage and empirical antibiotics.
| Feature | Early-onset sepsis (EOS) | Late-onset sepsis (LOS) |
|---|
| Timing | <72 hours (some use <7 days) | >72 hours (to 28 days) |
| Source | Vertical (intrapartum) | Horizontal (nosocomial, community) |
| Organisms | Group B Strep, E. coli, Listeria, Enterococcus | Coagulase-negative Staph (CONS), S. aureus, Klebsiella, Pseudomonas, Candida |
| Risk factors | Maternal GBS colonisation, PROM >18 h, chorioamnionitis, preterm, low Apgar | Central lines, ventilation, parenteral nutrition, prolonged NICU stay, poor hand hygiene |
| Empirical antibiotics | Ampicillin + gentamicin | Varies; piperacillin-tazobactam OR vancomycin + amikacin (unit-based) |
Clinical features (non-specific):
- Temperature instability (hypothermia or fever)
- Lethargy, poor feeding, hypotonia
- Respiratory distress, apnea
- Tachycardia or bradycardia
- Hypotension, poor perfusion
- Vomiting, abdominal distension
- Jaundice
- Seizures, bulging fontanelle (meningitis)
Investigations:
- Blood culture (gold standard; 1 mL minimum; ideally 2 samples)
- CSF analysis if meningitis suspected (not routine in all EOS workups)
- Urine culture (suprapubic aspiration or catheter) in LOS workup
- CBC with differential (I/T ratio >0.2 suggests infection)
- CRP (serial — initially normal, rises 12–24 h; >10 mg/L suggestive)
- Procalcitonin (>2 ng/mL suggestive; rises earlier than CRP)
- Chest X-ray if respiratory distress
- Gastric aspirate for neutrophil count (controversial)
GBS chemoprophylaxis (for prevention):
- Maternal vaginorectal GBS screen at 35–37 weeks
- Intrapartum penicillin (or ampicillin / cefazolin; clindamycin if penicillin-allergic) for:
- GBS+ on screening
- Previous GBS-affected infant
- GBS bacteriuria in current pregnancy
- Unknown GBS + preterm labour / PROM >18 h / intrapartum fever
Treatment duration:
- Culture-positive: 7–10 days (bacteremia), 14 days (meningitis with GBS), 21 days (Gram-negative meningitis)
- Culture-negative but clinically ill: 5–7 days
- Rule out at 48 h if cultures negative and clinically well
Neonatal hyperbilirubinemia
Neonatal jaundice is yellow discolouration of skin and sclerae due to unconjugated or conjugated hyperbilirubinemia, and clinically visible when total serum bilirubin (TSB) exceeds ~5 mg/dL.
Physiological vs pathological:
| Feature | Physiological | Pathological |
|---|
| Onset | After 24 hours | Within 24 hours |
| Peak | Day 3–5 term; Day 5–7 preterm | Variable; higher |
| Rate of rise | <5 mg/dL/day | >5 mg/dL/day OR >0.5 mg/dL/hour |
| Peak TSB | <15 mg/dL term; <10 in preterm infants historically | Exceeds nomogram thresholds |
| Duration | <1 week term; <2 weeks preterm | >2 weeks term, >3 weeks preterm (prolonged) |
| Fraction | Unconjugated | Can be conjugated / mixed |
| Clinical | Well infant | Ill, anemic, hepatosplenomegaly |
Causes of pathological jaundice by day of onset:
| Day | Likely causes |
|---|
| <24 h | Haemolysis (Rh, ABO, G6PD), congenital infection, sepsis |
| Day 2–3 | Physiological (exclusion), sepsis, cephalohematoma |
| >2 weeks | Breast milk jaundice, hypothyroidism, biliary atresia (conjugated), UTI, Crigler-Najjar, galactosemia |
AAP 2022 phototherapy nomogram (term well infant, 40 weeks):
| Postnatal age | Phototherapy start (TSB mg/dL) |
|---|
| 24 h | ~15 |
| 48 h | ~18 |
| 72 h | ~20 |
| 96 h | ~21 |
Thresholds are lower with: lower gestational age, sepsis, haemolysis, birth asphyxia, hypoalbuminemia, acidosis.
Phototherapy:
- Wavelength 425–475 nm (blue-green light)
- Bilirubin photoisomerisation to water-soluble lumirubin → excreted in urine/bile
- Skin fully exposed except eye shields and minimal diaper
- Ensure hydration (10–20% extra feeds)
- Monitor TSB every 6–24 h depending on severity
- Intensive phototherapy if TSB nearing exchange threshold
Exchange transfusion:
- Threshold: ~5 mg/dL above phototherapy line OR TSB >=25 mg/dL in term well infant
- Double volume exchange (~160 mL/kg) via umbilical vein
- Removes bilirubin and maternal antibodies; corrects anemia
- Complications: thrombocytopenia, hypocalcemia, hypoglycemia, NEC, infection, cardiac arrhythmia
- Pre-exchange: IV immunoglobulin (IVIG) 0.5–1 g/kg can reduce exchange need in isoimmune haemolysis
Kernicterus / bilirubin encephalopathy:
- Unconjugated bilirubin >=25–30 mg/dL crosses BBB → basal ganglia deposition
- Acute: poor feeding, lethargy, opisthotonos, retrocollis, seizures, high-pitched cry
- Chronic (at 1 year): athetoid cerebral palsy, sensorineural deafness, gaze palsy, dental enamel dysplasia
Breast milk jaundice vs breastfeeding jaundice:
| Feature | Breastfeeding jaundice | Breast milk jaundice |
|---|
| Onset | First week (day 2–5) | 2nd week; peaks day 10–21 |
| Cause | Suboptimal intake → dehydration + enterohepatic recirculation | Substance in milk (β-glucuronidase; pregnanediol) → increased reabsorption |
| Management | Increase breastfeeding frequency | Continue breastfeeding; phototherapy if TSB high; temporary interruption rarely needed |
Sources and references
- American Academy of Pediatrics / American Heart Association. Neonatal Resuscitation Program (NRP) 8th Edition Textbook (2021) and AHA Guidelines for Neonatal Resuscitation 2020.
- Ghai OP. Essential Pediatrics, 9th Edition (2019) — Chapters on Neonatology, Birth Asphyxia, HIE, RDS, Sepsis, Hyperbilirubinemia.
- Sweet DG et al. European Consensus Guidelines on the Management of Respiratory Distress Syndrome — 2022 update. Neonatology 2023; 120(1):3-23.
- Jacobs SE et al. Cooling for newborns with hypoxic ischaemic encephalopathy. Cochrane Database of Systematic Reviews 2013; (1):CD003311.
- American Academy of Pediatrics. Clinical Practice Guideline Revision: Management of Hyperbilirubinemia in the Newborn Infant 35 or More Weeks of Gestation (AAP 2022). Pediatrics 2022; 150(3):e2022058859.
- Puopolo KM et al. Management of Neonates Born at >=35 0/7 Weeks' Gestation With Suspected or Proven Early-Onset Bacterial Sepsis (AAP COFN). Pediatrics 2018; 142(6):e20182896.
Frequently asked questions
How many neonatology questions appear in NEET PG?
Neonatology contributes 3-4 direct questions per NEET PG paper, split across pediatrics, obstetrics, and community medicine. NRP 2020 algorithm, Apgar scoring thresholds, therapeutic hypothermia indications, surfactant replacement for RDS, and phototherapy thresholds for hyperbilirubinemia are the most tested subtopics based on 2019-2025 pattern analysis.
What are the initial steps of neonatal resuscitation?
NRP 2020 initial steps (within the Golden Minute) are provide warmth (radiant warmer), position the head in the sniffing position, clear secretions (only if obstructing), dry and stimulate, and reposition. Move on if the newborn is apneic, gasping, or heart rate is less than 100/min — start positive pressure ventilation with room air (21 percent) for term and 21-30 percent for preterm infants. Avoid routine endotracheal suctioning for meconium-stained non-vigorous infants (guideline change from NRP 2015).
What is the compression-to-ventilation ratio in neonatal CPR?
The compression-to-ventilation ratio in neonatal resuscitation is 3:1 (three compressions to one ventilation) with a target of 90 compressions and 30 breaths per minute (120 events/minute total). This differs from adult and pediatric CPR (30:2). Compressions are started only if heart rate remains less than 60/min despite 30 seconds of effective PPV with supplemental oxygen. Use the two-thumb encircling-hands technique at the lower third of the sternum, compressing one-third of the antero-posterior chest depth.
What is the Apgar score and how is it interpreted?
Apgar score assesses newborn well-being at 1 and 5 minutes after birth on 5 parameters (each 0-2): Appearance (colour), Pulse (heart rate), Grimace (reflex irritability), Activity (tone), and Respiration. Interpretation: 7-10 normal, 4-6 moderate depression, 0-3 severe depression. Score at 5 minutes (not 1 minute) correlates with long-term outcomes. Apgar is NOT a trigger for resuscitation — heart rate, respiratory effort, and tone drive the NRP algorithm.
How has meconium aspiration management changed?
In the 2015-2020 NRP update, routine endotracheal suctioning of non-vigorous meconium-stained infants was removed. Current recommendation: if the infant is vigorous (good tone, adequate respiration, heart rate over 100/min), routine care with observation. If non-vigorous, begin initial steps and positive pressure ventilation — endotracheal suction is no longer routine but may be considered if PPV is ineffective due to airway obstruction. This shift reflects evidence that routine suction did not improve outcomes and delayed ventilation.
What is Sarnat staging for HIE?
Sarnat-Sarnat staging classifies hypoxic-ischaemic encephalopathy (HIE) severity. Stage 1 (mild) — hyperalert, normal tone, jittery, lasts less than 24 hours, usually normal outcome. Stage 2 (moderate) — lethargy, hypotonia, seizures, weak reflexes, lasts 2-14 days, 20-30 percent long-term deficits. Stage 3 (severe) — coma, flaccid, absent reflexes, prolonged seizures, high mortality and severe sequelae in survivors. Sarnat Stage 2-3 within 6 hours of birth is the trigger for therapeutic hypothermia.
What is therapeutic hypothermia and when is it indicated?
Therapeutic hypothermia is whole-body or selective head cooling to 33.5 degrees Celsius core temperature for 72 hours, started within 6 hours of birth, in term or late preterm (greater than or equal to 36 weeks) neonates with moderate-to-severe HIE (Sarnat Stage 2 or 3). Entry criteria: cord pH less than 7.0 or base deficit greater than or equal to 16, 10-minute Apgar less than or equal to 5, or ongoing resuscitation beyond 10 minutes, PLUS clinical/neurological evidence of moderate-severe encephalopathy. Cooling reduces death or major disability by 25-30 percent (Cochrane 2013).
When is surfactant given in neonatal RDS?
Exogenous surfactant (poractant alfa 200 mg/kg first dose, or beractant 100 mg/kg) is given for neonatal respiratory distress syndrome to preterm infants on increasing oxygen needs or respiratory distress. Current evidence supports INSURE (INtubate, SURfactant, Extubate to CPAP) or LISA/MIST (Less Invasive Surfactant Administration) techniques. Prophylactic universal surfactant at birth is no longer recommended — rescue therapy when FiO2 greater than 0.30-0.40 on CPAP is the current standard (European Consensus 2022).
What are the phototherapy thresholds for neonatal hyperbilirubinemia?
Phototherapy thresholds are gestational-age- and postnatal-age-stratified by the AAP 2022 nomogram. For a term well infant without risk factors at 24 hours: start phototherapy at total serum bilirubin (TSB) greater than or equal to 15 mg/dL; at 48 hours greater than or equal to 18 mg/dL; at 72 hours greater than or equal to 20 mg/dL. Exchange transfusion threshold is approximately 5 mg/dL above the phototherapy threshold, or TSB greater than or equal to 25 mg/dL at or after 72 hours in a well term infant. Lower thresholds apply for preterm, sepsis, hemolysis, hypoalbuminemia.
How do you differentiate early-onset vs late-onset neonatal sepsis?
Early-onset sepsis (EOS) presents within 72 hours of birth and is caused by vertical transmission — Group B Streptococcus, E. coli, Listeria. Risk factors: maternal GBS colonisation, PROM greater than 18 hours, chorioamnionitis, prematurity. Treatment: ampicillin plus gentamicin. Late-onset sepsis (LOS) presents after 72 hours and is usually nosocomial — coagulase-negative Staph, Staph aureus, Klebsiella, Pseudomonas, Candida. Treatment varies by setting but commonly piperacillin-tazobactam or vancomycin plus an aminoglycoside. Blood culture is the gold standard; CRP greater than 10 mg/L and procalcitonin support the diagnosis.
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This content is for educational purposes for NEET PG exam preparation. It is not a substitute for professional medical advice, diagnosis, or treatment. Clinical information has been reviewed by qualified medical professionals.
Written by: NEETPGAI Editorial Team
Reviewed by: Pending SME Review
Last reviewed: March 2026
This article is reviewed by qualified medical professionals for clinical accuracy and exam relevance. For corrections or updates, contact the editorial team.
