Use the “Initial 30 seconds – Golden Minute” principle (per NRP 2021).

Model Answer:
Immediately after birth:

1. Dry and provide warmth.
2. Clear airway if necessary (mouth → nose).
3. Assess breathing and tone.
4. If baby is crying → routine care.
5. If not breathing → stimulate → start bag-mask ventilation within 1 minute (“Golden Minute”).
6. Clamp and cut cord after 30–60 seconds if baby is stable.

📘 Tip: Always mention “warmth → clear → breathe → stimulate → ventilate” — it’s the UPSC cue line.
(Ref – NRP 7ᵗʰ Ed., Nelson 22/e Ch. 100)

💙 NEONATAL RESUSCITATION —

 (Based on NRP 8th Edition, 2021 / IAP-NRP Guidelines)

🔹 1️⃣ Initial Steps (within 30 sec – “Warm, Dry, Stimulate”)

• Warm the baby, position head slightly extended.
• Clear airway if needed (mouth → nose).
• Dry and gently stimulate.
• Assess cry, tone, breathing, HR.

🔹 2️⃣ If baby not breathing or HR < 100/min → Start PPV

• Bag-mask ventilation with room air (21% O₂).
• Check chest rise — effective ventilation is key.

🔹 3️⃣ If HR < 60/min after 30 sec of PPV → Start Chest Compressions

• Ratio: 3 compressions : 1 breath.
• Technique: Two-thumb method on lower sternum.
• Continue for 60 sec, reassess HR.

🔹 4️⃣ If HR < 60/min despite ventilation + compressions → Give Epinephrine

• 0.01–0.03 mg/kg IV (1 : 10 000) via umbilical vein.

🔹 5️⃣ Post-Resuscitation Care

• Maintain warmth, glucose, and oxygen saturation.
• Monitor for apnea or hypoglycemia.

💙 Tip: “Warm → Ventilate → Compress → Drug.”
(Every 30 seconds, reassess HR & breathing.)

Apgar assesses newborn condition at 1 min and 5 min after birth.

Interpretation:

• 7–10 = Normal
• 4–6 = Moderate asphyxia
• 0–3 = Severe asphyxia

📘 Tip: Use 1 min → need for resuscitation; 5 min → prognosis.

1. Physiological jaundice (after 24 h – peaks day 3–4 – resolves by 10 days).
2. Pathological:
   • Hemolytic disease (ABO/Rh incompatibility)
   • Sepsis
   • G6PD deficiency
   • Prematurity / breastfeeding jaundice

📘 Tip: “< 24 h onset = always pathological.”

• Assess bilirubin vs age (Bhutani nomogram).
• Phototherapy – first-line.
• Exchange transfusion if severe (TSB > 20 mg/dL term / > 15 mg/dL preterm or neurological signs).
• Maintain hydration and treat cause.

📘 Tip: Eye protection + monitor temperature + stop when TSB < 12 mg/dL.

• Maternal: Malnutrition, anemia, hypertension, infection.
• Placental: Insufficiency, abruption.
• Fetal: IUGR, multiple pregnancy, congenital anomalies.

📘 Tip: India ≈ 20 % LBW births — key indicator of maternal health status.

• Clean delivery practices.
• Early breastfeeding.
• Cord care with dry technique (no spirit).
• Hand hygiene for handlers.
• Prompt treatment of maternal UTI/PROM.
• 📘 Tip: Sepsis = preventable by antenatal and intrapartum hygiene.

• Early initiation of breastfeeding (within 1 hour).
• Exclusive breastfeeding for 6 months.
• Rooming-in & mother–infant bonding.
• No pre-lacteal feeds / bottle feeding.
• Support to mothers after discharge.

📘 Tip: BFHI = joint WHO–UNICEF initiative (1991).

Model Answer:
For baby:

• Ideal nutrition — correct protein:fat ratio (1 : 4).
• Passive immunity (IgA, lactoferrin, lysozyme).
• Protects against diarrhoea, pneumonia, NEC, otitis media.
• Promotes bonding and jaw development.

For mother:

• ↓ PPH by oxytocin release.
• Delays ovulation (lactational amenorrhoea).
• Lowers breast & ovarian cancer risk.

For society:

• Economical, hygienic, eco-friendly.

🔹Tip: Quote “exclusive breastfeeding for first 6 months — WHO guideline.”

(4 key C’s):

1. Calm & comfortable posture for mother.
2. Close contact — baby’s whole body facing mother.
3. Chin-to-breast, mouth wide open, areola inside.
4. Complete emptying of one breast before shifting to other.

🔹Tip: “Good attachment → more areola visible above mouth.”

Continuous skin-to-skin contact between mother and LBW/preterm baby with exclusive breastfeeding.
Components:

• Skin-to-skin contact (warmth & bonding).
• Exclusive breast milk.
• Early discharge + follow-up.

Benefits:
Maintains temperature, reduces apnea & infection, promotes weight gain, improves survival.

🔹Tip: “KMC = warmth + love + nutrition — the best incubator in low-resource settings.”

Birth weight < 2500 g irrespective of gestational age.
Sub-types:

• VLBW < 1500 g, ELBW < 1000 g.

• Phototherapy: Clue light 460–490 nm (when bilirubin > threshold chart).
• Exchange transfusion: For severe/rapid rise or hemolytic disease.
• Treat underlying cause: Infection, hypothyroidism, etc.

🔹Tip: “Target bilirubin < 15 mg/dL at 72 h in term baby.”

• Bacterial: Shigella, E. coli (EHEC), Salmonella, Campylobacter.
• Parasitic: Entamoeba histolytica.

Management:
Rehydration (ORS), nutrition, zinc 10–20 mg × 14 days, antibiotics if Shigella suspected.

• Assess severity (IMNCI): fast breathing, chest indrawing, danger signs.
• Outpatient: Oral Amoxicillin × 5 days.
• Severe: IV Ampicillin + Gentamicin.
• Oxygen, fluids, antipyretics.

🔹Tip: “Cough + fast breathing = pneumonia until proved otherwise.”

• Plan A/B/C as per dehydration.
• ORS (75 ml/kg), zinc 10 mg < 6 m; 20 mg > 6 m.
• Continue feeding & breastfeeding.
• Avoid unnecessary antibiotics.

Side effects: mild fever, irritability, diarrhoea.

🔹Tip: “Three P’s of prevention — PCV, Pentavalent, Polio.”

• Nephrotic syndrome (most common).
• Acute glomerulonephritis.
• Chronic liver disease.
• Protein-energy malnutrition.
• Congestive heart failure.

🔹Tip: “Edema + proteinuria = renal origin until proved otherwise.”

Mnemonic — PALE:

• Proteinuria > 3.5 g/day
• Albumin ↓ < 2.5 g/dL
• Lipid ↑ (hypercholesterolemia)
• Edema (generalized)

Most common type: Minimal Change Disease (MCD).

Urine protein (3+), microscopy, serum albumin, cholesterol, renal function, ultrasound.

• Prednisolone 2 mg/kg/day × 6 weeks → taper.
• Salt restriction, diuretics for edema.
• Pneumococcal vaccination.
• Relapse → cyclophosphamide / Levamisole.