Que. 1. Can newborn resuscitation be initiated without oxygen?

Ans. 1. Newborn Resuscitation can be initiated virtually anywhere, including those places where oxygen is not available.

Que. 2. What are the common causes of failed Newborn Resuscitation?

Ans. 2. The common causes of failed newborn resuscitation are as follows –

• Failure to recognize the problem promptly
• Not reacting quickly enough
• Not ventilating efficiently

Correct technique and assessment of the effectiveness of ventilation are critical.

Que. 3. What do you mean by newborn resuscitation?

Ans. 3. It means to revive or restore life to a baby from the state of asphyxia.

Que. 4. What preparations will you do in the delivery room before birth of a baby?

Ans. 4. Following preparations should be done in the delivery room before birth of a baby –

• A draught free, warm room with temperature equal to or more than 25 degree Celsius
• A clean, dry and warm delivery surface
• A functional radiant warmer
• Two clean and warm towels/clothes
• A folded piece of cloth (1/2 to 1 inch thick)
• A newborn size self-inflating bag
• Infant mask in two sizes – 1 for normal weight baby & 0 for small baby
• A suction device or mucus extractor
• Oxygen (If available)
• A clock with seconds hand

Que. 5. What should be the volume of the newborn inflating bag and how much pressure should it generate?

Ans. 5. The volume of the bag should not be more than 250-500 ml and generate a pressure of at least 35 cm of water.

Que. 6. What should be the limit of negative pressure of a suction apparatus for newborn?

Ans. 6. Suction should not exceed a negative pressure of 100 mm of Hg or 130 cm water.

Que. 7. How will you ensure draught free, warm delivery room with temperature equal to or more than 25 degree Celsius?

Ans. 7. Draught free & warm delivery room can be ensured by –

• Closing the windows and switching off the fan
• Putting curtains on the windows
• Switch on radiant warmer or overhead lamp at least half hour before anticipated time of delivery

Que. 8. How will you test the function of the bag and mask for ventilation?

Ans. 8. Functionality of Bag and Mask for ventilation can be checked by –

• Fit mask on to the bag and deliver the test breaths against the palm of the hand. You should feel the pressure in the palm as bag is squeezed.
• Form a seal between the mask and the palm of the hand. Squeeze the bag enough for the pop off (pressure release) valve to open and make a sound as the air escapes.
• Check that the bag re-inflates quickly when you release after squeezing the bag.

Que. 9. What are the components of the routine care of a newborn?

Ans. 9. Followings are the component of the routine care of a newborn –

• Provide warmth
• Suction mouth and nose (If necessary)
• Cut the cord in 1-3 minutes
• Keep baby with the mother
• Initiate breast feeding

Que. 10. What are the components of Post Resuscitation Care of a newborn?

Ans. 10. Followings are the components of Post Resuscitation Care of a newborn –

• Provide Warmth
• Observe breathing, temperature, color, CFT
• Monitor Blood Sugar
• Watch for complications (Convulsions, Coma, Poor Feeding, lethargy, Respiratory Distress)

Refer, if complications present. If newborn is well then start breast feeding.

Que. 11. What is meconium? What does it indicate if present on newborn?

Ans. 11. Meconium is the faeces passed by fetus in utero; it is greenish to brownish in color. If meconium is present and the baby is not crying, immediate suction is indicated, first in the mouth then in nose.

Que. 12. Which are the steps of newborn resuscitation?

Ans. 12. The steps of Newborn Resuscitation are given below –

• Tie & Cut the cord
• Inform mother about baby’s position and you are taking the newborn to radiant warmer
• Transfer the baby to a warm, clean, flat and dry surface (platform of radiant warmer)
• Provide warmth
• Position the baby
• Clear the airway by suction
• Stimulate and reposition

Que. 13. How will you stimulate the baby to breath during newborn resuscitation?

Ans. 13. One can stimulate the baby to breath during newborn resuscitation by –

• Slapping or flicking the soles of the feet
• Gently rubbing the newborn’s back or extremities

Que. 14. What is the role of Pop off valve?

Ans. 14. Pop-off valve is a pressure release valve, situated on front side of bag. It opens if excess pressure is generated, thus limiting the pressure being transmitted to the baby. If you ventilate with high pressure/or rate, the lungs may become over inflated, causing the rupture of alveoli.

Que. 15. What is the preferred position for bag & mask ventilation?

Ans. 15. Sniffing position. You may use shoulder roll below the shoulder for better positioning of head.

Que. 16. What should be the rate of delivered breath to a newborn in the bag & mask ventilation?

Ans. 16. During the initial stages of newborn resuscitation, breathe should be delivered at a rate of 40-60 breaths per minute, or slightly less than once in a second.

Que. 17. What are the reasons for inadequate or absent chest movement during bag & mask ventilation?

Ans. 17. The reasons for inadequate or absent chest movement are as follows –

• The seal is inadequate
• The airway is blocked
• Not enough pressure is being given

Que. 18. How do you evaluate the success of ventilation?

Ans. 18. If Bag & Mask ventilation is successful, the baby will start breathing spontaneously (chest is rising symmetrically) with frequency 30-60/min, and there is no chest in drawing and no grunting for one minute.

Que. 19. If a baby is not breathing well (gasping or not breathing at all) after 30 seconds of adequate ventilation, what will be further course of action?

Ans. 19. Future course of action is given below –

• Call for help. A more skilled worker will be required to evaluate and assist in resuscitation.
• Continue bag & mask ventilation
• Provide the oxygen through bag & mask if available
• Assess the heart rate

Que. 20. What are the components of Post Resuscitation Care?

Ans. 20. The components of post resuscitation care are given below –

• Keep the baby warm
• Check breathing, temperature, color & CFT
• Monitor blood sugar
• Watch for complications
• Initiate breastfeeding if well

Que. 21. Which are the basic needs of all newborns at the time of birth?

Ans. 21. The basic needs of all newborns at the time of birth is given below –

• Warmth
• Normal breathing
• Mother’s milk
• Protection from infection

Que. 22. What do you mean by WARM CHAIN?

Ans. 22. It means that the temperature maintenance should be a continuous process starting from the time of delivery and continued till the baby is discharged from the hospital.

Que. 23. Which are the components of Warm Chain?

Ans. 23. The components of warm chain are given below –

1. AT DELIVERY –

• Ensure the delivery room is warm (25-degree C), with no draught
• Dry the baby immediately, remove the clothes
• Wrap the baby with clean dry cloth
• Keep the baby close to the mother (Ideally skin – to – Skin) to stimulate early breastfeeding
• Postpone bathing/sponging for 24 hours

1. AFTER DELIVERY –

• Keep the baby clothed and wrapped with the head covered
• Minimize the bathing especially in cool weather or for small babies
• Keep the baby close to the mother
• Use Kangaroo mother care for stable LBW babies and for rewarming stable bigger babies.

Que. 24. What do you mean by the WHO six cleans for clean delivery?

Ans. 24. WHO six cleans are as follows –

• Clean attendant’s hands (washed with soap)
• Clean delivery surface
• Clean cord cutting equipment
• Clean string to tie cord
• Clean cloth to wrap the baby
• Clean cloth to wrap the mother

Que. 25. What are the steps of the immediate care of the umbilical cord?

Ans. 25. The steps are as follows –

• Put the baby on mother’s abdomen or on a dry, clean & warm surface close to the mother
• Change gloves; if not possible, wash gloved hands
• Put the tie (using a sterile tie) tightly around cord at 2cm & 5 cm from the abdomen
• Cut between the ties with a sterile equipment (e.g. blade)
• Observe for oozing of blood. If blood oozes, place a second tie between the skin & first tie
• Don’t apply any substance to the stump
• Don’t bind or bandage stump
• Leave the umbilical stump uncovered

Que. 26. What are the steps of eye care in a newborn?

Ans. 26. The steps of newborn eye care are as follows –

• Clean eye immediately after birth with swab soaked in sterile water, using separate swab for each eye. Clean from medial to lateral side.
• Give prophylactic eye drop within one hour of birth as per hospital policy.

Que. 27. Which are the parameters needed to be monitored in the baby in the first hour after birth?

Ans. 27. The parameters are as follows –

• Breathing
• Temperature or warmth

Que. 28. What is the hand washing norms in baby care area?

Ans. 28. Two minutes, handwashing (6 steps) to be done before entering the unit. Twenty seconds hand washing to be done before and after touching the baby.

Que. 29. Which is the single, most important, very simple & cheap method for prevention of infection in the baby care area?

Ans. 29. Hand Washing.

Que. 30. Why are newborns prone to develop hypothermia?

Ans. 30. Newborns are prone to develop hypothermia because of following reasons –

• Large surface area
• Decreased thermal insulation due to lack of subcutaneous fats
• Reduced amount of brown fat

Que. 31. What is the role of brown fat in thermogenesis?

Ans. 31. Brown fat is the site of heat production. It is localized around the adrenal glands, Kidneys, nape of neck, inter-scapular & axillary region. Metabolism of brown fat results in heat production. Blood flowing through the brown fat becomes warm and through circulation transfers heat to other parts of the body. This mechanism of heat production is called non-shivering thermogenesis. LBW babies lack this mechanism.

Que. 32. What are the consequences of hypothermia in a newborn?

Ans. 32. A cold baby –

• Is less active
• Does not breastfeed well
• Has a weak cry
• Has respiratory distress

He/ she is at more risk of becoming hypoglycemic. If condition worsens, the baby eventually may die.

Que. 33. What is the normal temperature of a newborn?

Ans. 33. 36.5 to 37.4 degree Celsius.

Que. 34. Which are the different ways a newborn lose heat to the environment?

Ans. 34. Different ways a newborn lose heat to the environment are as follows –

• Radiation
• Conduction
• Convection
• Evaporation

Que. 35. How is axillary temperature recorded?

Ans. 35. It is recorded by placing the bulb of thermometer against the roof of dry axilla free from moisture. Baby’s arm is held close to the body to keep thermometer in place. The temperature is read after 3 to 5 minutes.

Que. 36. How the skin temperature of the newborn is recorded?

Ans. 36. Skin temperature is recorded by a thermistor. The probe of the thermistor is attached to the skin over upper abdomen.

Que. 37. Enumerate common situations when cold stress can occur to a newborn.

Ans. 37. Common situations where cold stress can occur to a newborn are as follows –

• At birth
• After giving birth
• During changing of nappy/clothes
• Malfunctioning heat source or removing the baby from heat source
• While transporting a sick baby

Que. 38. Enumerate the steps to prevent heat loss in Labor room.

Ans. 38. The steps to prevent heat loss in labor room are as follows –

• Warm delivery room (25 degree Celsius)
• Newborn care corner temperature to be maintained at 30 degree Celsius
• Drying immediately. Dry with one towel. Remove the wet towel and cover with another pre-warm towel.
• Skin to skin contact between mother and baby.

Que. 39. Enumerate steps to prevent heat loss in postnatal ward.

Ans. 39. Steps to prevent heat loss in postnatal ward are given below –

• Breastfeeding
• Appropriate clothing, cover head and extremities
• Keep mother and baby together
• Keep room warm
• Postpone bathing & weighing

Que. 40. How will you keep delivery room warm?

Ans. 40. Delivery room can be kept warm by taking measures given below –

• Avoid using air-conditioner even in summer
• Don’t use ceiling fan especially at high speed
• Keep doors & windows closed in winter
• Warm the room by convector/heater

Que. 41. How will you keep the baby warm?

Ans. 41. The baby can be kept warm by taking measures given below –

• Use dry, warm towel to hold the baby at birth. Remove wet towel after cleaning.
• Adequate and appropriate clothing
• Skin to skin contact or next to mother (Rooming In)
• Radiant warmer in nursery
• Keep the room temperature of baby care area around 25 degree Celsius

Que. 42. What is Kangaroo mother care (KMC)?

Ans. 42. Kangaroo Mother Care (KMC) is a special way of caring the low birth weight (LBW) babies. It improves their health and wellbeing by promoting effective thermal control, breastfeeding, infection prevention and bonding.

Que. 43. What are the components of Kangaroo mother care (KMC)?

Ans. 43. The components of Kangaroo mother care (KMC) are as follows –

• Prolonged skin to skin contact (Infant placed on her mother’s chest between the breasts)
• Exclusive breastfeeding

Que. 44. What are the pre-requisites of Kangaroo Mother Care (KMC)?

Ans. 44. The Pre-requisites of KMC are as follows –

• Support to the mother in hospital & at home
• Post discharge follow – up regularly

Que. 45. What are the benefits of the Kangaroo Mother Care (KMC)?

Ans. 45. The benefits of KMC are given below –

• Temperature Maintenance with a reduced risk of hypothermia
• Increased Breastfeeding rates
• Early discharge from the facility
• Less morbidities such as apnea and infections
• Less stress (for both baby and mother) and
• Better infant bonding

Que. 46. What are the eligibility criteria for KMC?

Ans. 46. All stable LBW babies are eligible for KMC. However, very sick babies needing special care should be cared under radiant warmer initially. KMC should be started after the baby is hemodynamically stable.

Que. 47. What are the advantages of Exclusive Breast Feeding?

Ans. 47. Exclusively breast-fed babies are at decreased risk of the following –

• Diarrhoea
• Pneumonia
• Ear infection and
• Death in first year of life

Que. 48. What are the advantages of breast feeding to the baby?

Ans. 48. The advantages of breast feeding to the baby are given below –

• Complete food, species specific
• Easily digested and well absorbed
• Protects against infection
• Promotes emotional bonding
• Better brain growth

Que. 49. What are the advantages of breast feeding to the mother?

Ans. 49. The advantages of breast feeding to the mother are given below –

• Helps in involution of uterus
• Delays pregnancy
• Lowers risk of breast & ovarian cancer
• Decreases the mother’s work load
• Helps in spacing between children

Que. 50. Enumerate four key points of proper positioning during breast feeding.

Ans. 50. The four key points of proper positioning during breast feeding are as follows –

• Baby’s head & body should be straight
• Baby’s face should face mother’s breast
• Baby’s body should be close to the mother body
• She should support the baby’s whole body

Que. 51. Enumerate four key signs of good attachment during breast feeding.

Ans. 51. The four key signs of good attachment during breast feeding are as follows –

• More areola is visible above the baby’s mouth than below it
• The baby’s mouth is wide open
• Baby’s lower lip is everted or turned outwards
• The baby’s chin is touching the breast

Que. 52. What are the causes of poor attachment during breast feeding?

Ans. 52. The causes of poor attachment during breast feeding are as follows –

• Use of feeding bottles
• Inexperienced mother
• Lack of skilled support
• Inverted nipples

Que. 53. What are the problems associated with poor attachment during breast feeding?

Ans. 53. The problems associated with poor attachment are as follows –

• Pain or damage to nipple or sore nipple.
• Breast milk not removed effectively thus causing breast engorgement
• Poor milk supply hence baby is not satisfied after feeding
• Breast produces less milk resulting in a frustrated baby and refusal to suck. This leads to poor weight gain.

Que. 54. How frequently a mother has to breastfeed her baby?

Ans. 54. A healthy newborn baby can be breastfed on demand i.e. whenever baby cries for feeds. The usual time interval between each feed is about 2-3 hours. Mothers should be advised that they should feed their babies at least 8-10 times in 24 hours and importantly they should not omit any night feeds.

Que. 55. What is the treatment of inverted or flat nipple of mother?

Ans. 55. Treatment is started after birth of the baby. Nipple is manually stretched and rolled out several times a day.

Que. 56. What are the causes of sore nipples in a mother?

Ans. 56. The causes of sore nipples are given below –

• Incorrect attachment: Nipple sucking
• Frequent use of soap & water
• Fungal infection of the nipple

Que. 57. How will you treat sore nipples in a mother?

Ans. 57. Treatment of sore nipples in a mother are as follows –

• Continue breast feeding and change position
• Attach baby to the areola while feeding
• Apply hind milk to the nipple after breast feed
• Expose the nipple to air between feeds. Do not wash each time before and after feed
• If fungal infection apply medicine on the nipple and inside the mouth of the baby

Que. 58. What is the treatment of the breast engorgement?

Ans. 58. Breast engorgement treatment consists of local warm water packs for not more than 15 minutes. Paracetamol can be given to the mother to relieve pain. Gently express the milk to soften the breast and then help the mother to correctly latch the baby to the breast.

Que. 59. How can breast engorgement be prevented?

Ans. 59. Breast engorgement can be prevented by early and frequent breast feeds and correct attachment of the baby to the breast.

Que. 60. Which is the fluid of choice for newborns for initial 48-hours?

Ans. 60. 10% Dextrose.

Que. 61. Enumerate the clinical features of Possible Serious Bacterial Infections (PSBI) or suspected sepsis in young infants.

Ans. 61. The clinical features of PSBI or suspected Sepsis in young infants are as follows –

• Not able to feed/ no breast attachment at all/ not suckling at all
• Less than normal movements
• Lethargic or unconscious
• Convulsions
• Fast Breathing (60 breaths per minute or more)
• Severe chest indrawing
• Nasal flaring
• Grunting
• 10 or more pustules or a big boil
• Axillary temperature 37.5 degree Celsius or more (or feels hot to touch) or temperature less than 35.5 degree Celsius (or feels cold to touch)
• Blood in the stool.

Que. 62. In which situations, ANM should administer injection gentamicin with oral amoxicillin to young infants (0-2 years)?

Ans. 62. Followings are three situations when ANM should administer injection gentamicin and oral amoxicillin –

1. Pre-referral dose – The ANM will give the first dose of both antibiotics before referral to a health facility.
2. Completion of antibiotic treatment – If the infant has not completed a course of either antibiotics following discharge from a facility, the ANM will complete the course of treatment as prescribed by the medical officer.
3. Referral not possible or refused – Under this special situation, the ANM will continue to give treatment for seven days.

Que. 63. What is the dose of injection gentamicin?

Ans. 63. 5 mg/Kg body weight once a day intramuscularly.

Que. 64. Where the injection gentamicin should be given to the young infant?

Ans. 64. Antero-lateral aspect of thigh.

Que. 65. What are the storage conditions for injection Gentamicin?

Ans. 65. Gentamicin is a heat stable drug and can be stored at the room temperature.

Que. 66. Which type of syringe and needle should be used for administering injection gentamicin?

Ans. 66. 1 ml disposable syringe and 23-gauge needle. Alternatively, insulin syringe could be used.

Que. 67. What is the total duration of treatment with injection gentamicin for suspected sepsis in a young infant?

Ans. 67. Seven days.

Que. 68. What is the dose of syrup amoxicillin?

Ans. 68. 15-25 mg/Kg per dose given 12 hourly orally.

Que. 69. What is duration of the treatment with Syrup Amoxicillin for suspected sepsis in a young infant?

Ans. 69. Seven days

Que. 70. What are the steps of management of sepsis in young infants by the ANM?

Ans. 70. The steps of management of sepsis in young infants by the ANM are as follows –

• Assess
• Classify
• Pre-referral dose and refer
• Manage if referral not possible
• Follow up

Que. 71. Enumerate steps to be taken by the ANM before and during the referral to health facility in sepsis of a young infant?

Ans. 71. The steps are as follows –

• Warm the young infant by Skin to skin contact with mother/care giver if temperature less than 35.5-degree C (or feels cold to touch) while arranging referral and during transport.
• Treat to prevent low sugar levels in young infants.

Que. 72. How will you prevent low sugar level in young infants during referral to health facility?

Ans. 72. Low sugar level in young infants during referral to health facility can be prevented by following steps –

• If the client is able to breast feed – Ask the mother to breast feed the child
• If the child is not able to breast feed but is able to swallow – Give 20-50 ml (10 ml/Kg) expressed breast milk or locally appropriate animal milk (with added sugar) before departure. If neither of these is available, give 20-50 ml (10ml/Kg) sugar water.

To make Sugar Water – dissolve 4 level tea spoon full of sugar (20 grams) in a 200 ml cup of clean water.

Que. 73. How will you define Pre-term baby?

Ans. 73. A pre-term baby is defined as a baby who is born alive before 37 weeks of pregnancy are completed (WHO).

Que. 74. How will you classify pre-term newborns?

Ans. 74. Pre-term newborns are classified on the basis of completed gestation period as follows –

• Extremely Pre-term (5%) – Less than 28 weeks
• Very pre-term (10%) – 28 to <32 weeks
• Late & Moderate pre-term (85%) – 32 to <37 weeks

Que. 75. Which is the most common cause of death among pre-term babies less than 34 weeks of gestation?

Ans. 75. Respiratory distress syndrome (RDS)

Que. 76. What do you mean by respiratory distress syndrome (RDS)?

Ans. 76. Respiratory distress syndrome (RDS) is an acute lung disease due to surfactant deficiency in the lungs which leads to atelectasis and subsequent failure of gas exchange.

Que. 77. How can Respiratory distress syndrome (RDS) be prevented?

Ans. 77.  Respiratory distress syndrome can be prevented largely by administering injection corticosteroids to the pregnant woman as soon as she is diagnosed with preterm labour.

Que. 78. Which corticosteroid should be used in pre-term labour to prevent Respiratory distress syndrome (RDS)?

Ans. 78. Inj. Dexamethasone preferably (Inj. Betamethasone alternatively).

Que. 79. What is the mechanism of action of injectable antenatal corticosteroids?

Ans. 79. Injection Corticosteroids when administered to the pregnant women ante-natally, crosses the placenta and reach the fetal lungs and stimulate surfactant synthesis and maturation of other systems. If this fetus is now delivered prematurely, s/he will have a low risk of developing RDS, therefore much higher chance of surviving with supportive care.

Que. 80. What is the clinical impact in newborns of using timely antenatal corticosteroids?

Ans. 80. The clinical impact is as follows –

• 34% reduction in RDS
• 46% reduction in Intra ventricular Hemorrhage (IVH)
• 54% reduction in Necrotizing Enterocolitis (NEC)
• 31% reduction in mortality

Que. 81. When should antenatal corticosteroids be administered?

Ans. 81. Single course of injection of dexamethasone to be administered to women with pre-term labor (between 24 to 34 weeks of gestation) at all levels of health facilities in the public as well as private sector (GoI Recommendation).

Que. 82. What is the course of injection Dexamethasone in pre-term labor?

Ans. 82. 4 injections of 6 mg (1.5 ml) each, 12 hours apart deep I/M.

Que. 83. Which is the site of administration of injection dexamethasone?

Ans. 83. Anterolateral aspect of thigh of pregnant woman.

Que. 84. Which type of syringe and needle should be used for injection dexamethasone?

Ans. 84. 2 ml disposable syringes & 22/23-gauge needle.

Que. 85. Is there any stringent condition of storage of injection Dexamethasone?

Ans. 85. No stringent condition of storage. Can be stored at room temperature.

Que. 86. What are the indications of antenatal corticosteroids?

Ans. 86. Indications of antenatal corticosteroids are as follows –

• Preterm labor
• Following conditions that lead to imminent delivery –

1. Ante partum Hemorrhage (APH)
2. Pre-term rupture of membranes
3. Severe pre-eclampsia

Que. 87. What are the contraindications of Ante natal corticosteroids?

Ans. 87. Frank Chorioamnionitis.

Que. 88. Why all neonates have low levels of vitamin K?

Ans. 88. The reasons are as follows –

• Poor transport of vitamin K across placenta
• Low vitamin K content in breastmilk
• Gut colonization that is critical for vitamin K synthesis takes a few days to establish

Que. 89. What are the different forms of vitamin K deficiency bleeding (VKDB)?

Ans. 89. There are three different forms of VKDB –

• Early VKDB
• Classical VKDB
• Late VKDB

Que. 90. What do you mean by the Early Vitamin K deficiency bleeding (VKDB)?

Ans. 90. Early VKDB presents with bleeding within 24 hours of birth of newborn. It takes place in newborns of the mother taking drugs such as Anticoagulants, Anticonvulsants (Phenytoin, phenobarbitone) or antitubercular drugs (Rifampicin).

Que. 91. What do you mean by classical VKDB?

Ans. 91. Classical VKDB is the commonest variant and presents after 24 hours but within the first week of life.

Que. 92. What do you mean by the late VKDB?

Ans. 92. Late VKDB is relatively uncommon and manifests between 2-12 weeks of age primarily among breastfed infants who have received no or inadequate vitamin k prophylaxis. In addition, infants on antibiotics and those having intestinal malabsorption are at risk of this disorder.

Que. 93. What are the sites of bleeding in a young infant suffering from late VKDB?

Ans. 93. Following are the sites of the bleeding –

• Cranium
• Skin
• Mucus membrane
• GIT

Que. 94. What is GOI recommendation for vitamin K prophylaxis for preventing VKDB?

Ans. 94. All newborns weighing more than 1000 gram should be given 1 mg of Vitamin K1 intramuscularly after birth (i.e. the first hour by which infants should be in skin to skin contact with the mother and breastfeeding is initiated). For babies weighing less than 1000 gm, a dose of 0.5 mg is recommended by GOI. Vitamin K1 should not be given after 24 hours of the birth.

Que. 95. When should breastfeeding be initiated in a newborn?

Ans. 95. Breastfeeding in a newborn should be initiated immediately after birth, preferably within one hour.

Que. 96. How many under five deaths can be prevented by the exclusive breast feeding up to 6 months?

Ans. 96. 13% of the estimated under five deaths.

Que. 97. When the world breastfeeding week is celebrated?

Ans. 97. 1^st to 7^th August every year.

Que. 98. Who is the provider of home-based newborn care (HBNC)?

Ans. 98. ASHA.

Que. 99. Which type of care is provided to newborn during HBNC?

Ans. 99. Following care is provided to newborn during HBNC –

• Exclusive breast feeding
• Cord care
• Maintenance of temperature
• Early detection of pneumonia & sepsis and first level care
• Promoting hygiene practices
• Greater care & support to the high-risk baby

Que. 100. Which are the key objectives of HBNC?

Ans. 100. The key objectives of HBNC are as follows –

• The provision of essential newborn care to all newborns and the prevention of the complications
• Early detection and special care of pre-term and low birth babies
• Early identification of illnesses in the newborn and provision of appropriate care & referral
• Support to the family for adoption of healthy practices & build confidence & skills of the mother to safe guard her health and that of the newborn.

Que. 101. Which are the key activities in HBNC?

Ans. 101. The key activities in HBNC are as follows –

• Care for every newborn through a series of home visits by a ASHA in the first 6 weeks of life
• Information and skills to the mother and family of every newborn to ensure better health outcomes
• An examination of every newborn for prematurity & LBW
• Extra home visits for pre-term & LBW babies by the ASHA /ANM and referral for appropriate care as defined in the protocols
• Early identification of the illness in the newborn and provision of appropriate care at the home or referral
• Follow up of sick newborns after they are discharged from facilities
• Counselling the mother on postpartum care, recognition of postpartum complications and enabling referral
• Counseling the mother for adoption of an appropriate family planning method

Que. 102. For HBNC, when ASHA is entitled to get her payments for home visits?

Ans. 102. On 45^th day.

Que. 103. Which conditions have to be fulfilled for payments to ASHA for HBNC?

Ans. 103. The conditions which have to be fulfilled are as follows –

• Enabling that birth weight is recorded in the MCP cards
• Ensuring that the newborn is immunized with BCG, first dose of OPV & DPT/ Pentavalent and entered into MCP cards
• Enabling birth registration
• Both mother and newborn are safe until the 42^nd day of delivery

Que. 104. What are the benefits of breastfeeding for the mothers?

Ans. 104. The benefits of breast feeding for the mothers are as follows –

• Mothers less likely to become pregnant in early months
• Lowers risk of maternal cancers (ovarian & breast cancers)
• Faster maternal recovery and weight loss postpartum
• Less postpartum depression

Que. 105. Ideally, where the newborn care corner (NBCC) should be situated?

Ans. 105. In Labour room (MCH Level I, II, III) & Operation Theatre (MCH Level II, III).

Que. 106. What do you mean by Newborn Care Corner (NBCC)?

Ans. 106. Newborn Care Corner (NBCC) is mandatory in all facilities where deliveries take place and immediate newborn care is provided at birth to all newborns.

Que. 107. What is the main objective of NBSU?

Ans. 107. To provide care to sick & Low birth weight newborns for short periods.

Que. 108. Which are the two services, not provided at Special Newborn Care Unit (SNCU) to sick newborns?

Ans. 108.  Those services are as follows –

• Assisted Ventilation
• Major surgery

Que. 109. What are the criteria of establishing SNCU in a facility?

Ans. 109. More than 3000 deliveries annually (Most of DH & few SDH are eligible).

Que. 110. Which services should be offered to Newborns at NBCC?

Ans. 110. The services offered to newborns at NBCC are as follows –

• Prevention of infection at birth
• Provision of warmth at birth
• Newborn Resuscitation if required
• Early initiation of breastfeeding
• Weighing of the newborns
• Identification & prompt referral of at risk or sick newborn
• Immunization Services

Que. 111. For establishing a NBCC, what should be the earmarked area in Labour Room or OT?

Ans. 111. 20-30 square feet.

Que. 112. Which services can be offered at NBSU for care of sick Newborns?

Ans. 112. Services offered at NBSU for care of sick newborns are as follows –

• Management of LBW infants equal to or more than 1800 grams with no other complications
• Phototherapy of newborns with hyperbilirubinemia
• Management of newborn sepsis
• Stabilization & referral of sick newborns and those with very low birth weight
• Referral services

Que. 113. What is the space required for setting a 4- bedded NBSU?

Ans. 113. At least 200 square feet.

Que. 114. Which services should be offered at SNCU for care of sick newborns?

Ans. 114. Following services are available at SNCU for care of sick newborns –

• Management of LBW infants < 1800 grams
• Managing all sick newborns
• Follow up of all babies discharged from SNCU & high-risk newborns
• Immunization services
• Referral services

Que. 115. What is the minimum number of beds required for a SNCU at District Hospital?

Ans. 115. Twelve (12). Addition of 4 beds for each extra 1000 deliveries beyond 3000 deliveries.

Que. 115. What is total area required per patient in a SNCU?

Ans. 115. 100 square feet per patient.

Que. 116. Which are the principles that guide India Newborn Action Plan (INAP)?

Ans. 116. Following are the principles that guide INAP –

• Integration
• Equity
• Gender
• Quality of Care
• Convergence
• Accountability
• Partnerships

Que. 117. Which are the six pillars of intervention packages across various stages of INAP?

Ans. 117. The six pillars are as follows –

• Pre-conception & Antenatal care
• Care during Labour and childbirth
• Immediate newborn care
• Care of healthy newborns
• Care of small & sick newborns
• Care beyond newborn survival

Que. 118. What is the aim of neonatal mortality rate in INAP to be achieved by 2030?

Ans. 118. < 10 (NMR).

Que. 119. Which are the indications of IV fluids among newborns?

Ans. 119. Followings are the indications of IV fluids among newborn –

• Newborn with lethargy and refusal to feed
• Moderate to severe breathing difficulty
• Newborn with Shock
• Newborns with severe asphyxia
• Abdominal distention with bilious or blood-stained vomiting

Que. 120. Which are the major causes of newborn deaths in India?

Ans. 120. The major causes of newborn deaths in India are as follows –

• Prematurity/ pre-term (35%)
• Neonatal Infections (38%)
• Intrapartum complication / Birth Asphyxia (20%)
• Congenital Malformations (9%)

Que. 121. What is the management of severe hypothermia (<32 degree Celsius)?

Ans. 121. Management of Hypothermia can be done as follows –

• Keep Newborn under radiant warmer
• Cover the baby with blanket and clothes and prevent further heat loss
• Infuse 10% dextrose IV @ 60 ml/kg/day
• Injection Vitamin K1 1.0 mg IM
• Provide oxygen
• Consider and assess for sepsis

Que. 122. What is the prevalence of birth defects?

Ans. 122. 6-7%.

Que. 123. Which are the intervention packages in descending order of impact on still births?

Ans. 123. The intervention packages are as follows –

• Care during Labour and childbirth
• Pre-conception & antenatal care

Que. 124. Which are the intervention packages in descending order of impact on neonatal mortality?

Ans. 124. The intervention packages are as follows –

• Care during labour and childbirth
• Care of small & sick newborn
• Care of healthy newborn
• Immediate Newborn Care
• Pre-conception & antenatal care

Que. 125. What do you mean by Kangaroo Mother Care (KMC)?

Ans. 125. It is early, continuous & prolonged Skin to Skin contact along with exclusive breastfeeding which –

• Prevents complications such as hypothermia
• Prevents infections
• Provides faster growth to babies

Que. 126. Which are the criteria of hemodynamically stable baby?

Ans. 126. Normal Capillary filling time (<3 Sec) & Strong peripheral pulse.

Que. 127. What are the benefits of Kangaroo Mother Care (KMC)?

Ans. 127. Following are the benefits of KMC –

• Stabilizes & maintains temperature of the newborn, thereby reducing the risk of hypothermia
• Stimulates breathing and reduces risk of apnoea
• Facilitates breastfeeding and increases frequency and duration of breastfeeding and ensures exclusivity of breastfeeding
• There is faster improvement in weight, length and head circumference of baby and better neurodevelopment
• Prevents infections due to improved immunity
• Better mother infant bonding

Que. 128. Which are the contents of KMC Kits?

Ans. 128.  The contents of KMC Kits are as follows –

• Sheet and blanket to cover mother and baby
• Feeding equipment
• Pillows
• Appropriate clothing for mother and baby
• Resuscitation kit
• Weighing machine

Que. 129. Which is the correct position of baby for KMC?

Ans. 129. Following are the correct position of baby for KMC –

• Infant should be placed between the mother’s breast in an upright position.
• Infant’s abdomen should be at the level of mother’s epigastrium
• The head should be turned to one side and in a slightly extended position
• The hips should be flexed and abducted in a frog position, the arms should be flexed
• Support the infant from the bottom with a sling / binder and wrap the baby snugly to mother’s chest

Que. 130. Which are the criteria for breastfeeding during KMC?

Ans. 130.  The criteria are –

• Breastfeeding on demand and/or every 2 hours
• Breastfeed through day and night and about 8-12 times in a 24-hour period

Que. 131. How will you count duration of KMC?

Ans. 131. Duration will be counted as cumulative completed hours of KMC during a 24-hour period.

Que. 132. How will you classify KMC on the basis of duration?

Ans. 132. In following way KMC may be classified –

• Short ——————- 4 hours a day
• Extended ————– 5-8 hours a day
• Long ——————– 9-12 hours a day
• Continuous ———– > 12 hours a day

Que. 133. At what interval, you will monitor KMC?

Ans. 133. Every 2 hours for first 12 hours; there after every 4 hours till discharge.

Que. 134. During KMC monitoring, which things will you monitor?

Ans. 134. During KMC monitoring, things to be monitored are as follows –

• Position of neck
• Breathing
• Clear Airways
• Skin color
• Temperature
• Urination
• Time of last feeding
• Duration of KMC

Que. 135. Which are the danger signs to be educated to mother for newborn?

Ans. 135. Following are the danger signs in newborn –

• Irregular or abnormal breathing
• Change in skin color from pink to pale or blue
• Feet and/or hands cold to touch
• Feeding difficulties or inability to feed

Que. 136. Which are the discharge criteria for KMC?

Ans. 136. Following are the discharge criteria for KMC –

• Sustained pattern of weight gain – 15-20 grams for at least 3 consecutive days
• Competent feeding – Sucking & Swallowing directly from the breast
• Maintaining normal temperature
• Stable vital parameters – Breaths without difficulty at a rate of 30-59 breaths/min
• There are no signs of infection, illness & danger signs

Que. 137. What will be content of counselling at time of discharge to the mother providing KMC?

Ans. 137. The content of counselling at the time of discharge should be as follows –

• Continue KMC till the baby weighs 2500 grams and/or reaches gestation period of term
• KMC can be stopped when baby cries in KMC position or pulls the limbs out

Que. 138. Which are the precautions to be followed in KMC?

Ans. 138. Don’t of KMCs are –

• Don’t bathe till infant weighs 2500 grams
• Don’t handle newborn too frequently
• Don’t give bottle feed
• Don’t allow newborn to be in contact with sick persons

Que. 139. On which factors, the choice of method of providing fluids and feeds depend in LBW babies?

Ans. 139. Choice of method depends upon –

• Maturity of newborn
• Birth weight
• Condition of the newborn

Que. 140. Which are different feeding methods for LBW newborn?

Ans. 140. Different feeding methods for LBW newborns are as follows –

• About 34 weeks ————- Initiate breastfeeding immediately after birth
• 30-34 weeks —————— Feeding through Paladi, cup or spoon
• < 30 weeks ——————– Feeding through intragastric tube

Que. 141. If mother’s milk is unavailable for feeding of LBW babies, which are the other choices?

Ans. 141. The other choices are –

• Expressed donor milk from other lactating women
• Formula milk
• Cow or buffalo milk

Que. 142. If newborn is not able to swallow, which method will you adopt for feeding newborn?

Ans. 142. Intragastric feeding.

Que. 143. If newborn does not tolerate enteral feeds, what will you do?

Ans. 143. Give intravenous fluids.

Que. 144. What should be the frequency of feeding of expressed milk?

Ans. 144. At least 6-8 times in 24-hours; or every 3-4 hours.

Que. 145. How long one can store expressed milk at room temperature and Refrigerator (2-8 degree Celsius)?

Ans. 145. At room temperature —————— 6-8 hours

In Refrigerator —————————————– 24 hours

Que. 146. What is the fluid requirement on 1^st day of life of a newborn?

Ans. 146. It completely depends on weight of newborn.

Equal to or >1500 grams ————– 60 ml/Kg/day

< 1500 grams —————————– 80 ml/kg/day

Que. 147. What do you mean by triaging of neonates?

Ans. 147. Triaging is sorting of neonates to rapidly screen sick neonates for prioritizing management.

Que. 148. When will you call a newborn hypothermic?

Ans. 148. Newborn whose body temperature is less than 35.5 degree Celsius or feels cold on touch.

Que. 149. What is the contribution of India in asphyxia deaths globally?

Ans. 149. 1/3^rd of all deaths due to asphyxia across globe.

Que. 150. How many newborns do require some assistance to begin breathing at birth?

Ans. 150. 10% of the newborns.

Que. 151. How much percentage of newborns do require extensive resuscitation to survive?

Ans. 151. 1% of the newborns.

Que. 152. Why is a mucus extractor with bulb not recommended for aspiration?

Ans. 152. As they are difficult to clean and might act as a source of cross infection.

Que. 153. Which condition may result if after birth the wet baby is not dried immediately?

Ans. 153. Can lead to heat loss which may result in rapid decrease in newborn’s body temperature (Hypothermia).

Que. 154. While resuscitating a baby, how will you apply suction?

Ans. 154. Apply suction, in mouth first up to 5 cm & then in nose up to 2 cm, while withdrawing the suction tube.

Que. 155. What will you do, if the baby is not breathing or breathing is abnormal at the end of 30 seconds after providing initial steps of newborn resuscitation?

Ans. 155. In this condition, one should start bag & mask ventilation immediately.

Que. 156. Which is the single most important step in resuscitation of a newborn?

Ans. 156. Ventilation of the lungs.

Que. 157. Whether one should apply traditional remedies to the umbilical cord?

Ans. 157. Never as doing so may cause infection & tetanus.

Que. 158. Which are the processes of heat gain in a newborn?

Ans. 158. The processes of heat gain in a newborn are –

• Conduction
• Convection
• Radiation
• Non-shievering thermogenesis.

Que. 159. Which is the safest method of taking a newborn’s temperature?

Ans. 159. Temperature taken in axilla.

Que. 160. What do you mean by Exclusive Breast Feeding?

Ans. 160. Breastfeeding an infant up to 6 months of life exclusively, not giving water, honey or any other prelacteals.

Que. 161. When will you start complementary feeding?

Ans. 161. After 6 months of life.

Que. 162. What are the advantages of correct positioning?

Ans. 162. The advantages of correct positioning are as follows –

• Ensures effective sucking
• Prevent sore nipples
• Prevent breast engorgement.

Que. 163. When will you consider breastfeeding adequate?

Ans. 163. If the infant passes urine 6-8 times in 24 hours, sleeps for 2-3 hours after feeds and gain weight adequately.

Que. 164. What is recommendation regarding colostrum (first breast milk)?

Ans. 164. Do not discard colostrum, always feed colostrum to the baby.

Que. 165. What is the contribution of sepsis in the neonatal deaths?

Ans. 165. 33% of the neonatal deaths.

Que. 166. What is the treatment of choice for young infants with sepsis in a community where referral is not possible or refused?

Ans. 166. A combination of injection gentamicin with oral amoxicillin.

Que. 167. Which are the two most common causes of death among children under 5 years of age?

Ans. 167. Pneumonia & Prematurity (Preterm birth).

Que. 168. In which strength injection dexamethasone phosphate is available?

Ans. 168. 4mg/ml strength.

Que. 169. What is the role of vitamin K in the body?

Ans. 169. Helps in synthesis of coagulation factors that prevent and control bleeding.

Que. 170. In which type of bleeding disorder, neonatal vitamin k prophylaxis is not effective?

Ans. 170. Early VKDB form of bleeding disorders.

Que. 171. What are the bleeding sites in newborns in classical VKDB?

Ans. 171. Bleeding sites are –

• Umbilical stump
• GI tract
• Any surgical wound e.g. following circumcision.

Que. 172. In which VKDB, intracranial haemorrhage is very common?

Ans. 172. Late VKDB.

Que. 173. In which types of VKDB, neonatal vitamin K prophylaxis is useful?

Ans. 173. Classical & Late VKDB.

Que. 174. How many HBNC visits ASHA has to give in case of institutional delivery?

Ans. 174. 6 visits (Day 3,7,14, 21, 28 & 42).

Que. 175. How many HBNC visits ASHA has to give in case of home delivery?

Ans. 175. 7 visits (Day 1, 3, 7, 14, 21, 28 & 42).

Que. 176. How many incentive is to be given to ASHA after she completes all HBNC visits?

Ans. 176. Rs. 250/- only.

Que. 177. How many HBNC visits ASHA has to give in case of caesarean section delivery?

Ans. 177. 5 visits (Day 7, 14, 21, 28 & 42 days).

Que. 178. What is the recommended minimum duration of each session in KMC?

Ans. 178. One hour.

Suggested Further Readings –

• Navjaat Shishu Suraksha Karyakram – Basic Newborn Care and Resuscitation Program – Training manual by Ministry of Health & Family Welfare, Government of India.
• Operational Guidelines, use of Gentamicin by ANMs for Management of Sepsis in Young Infants under specific situations, 2014, by Ministry of Health & Family Welfare, Government of India
• INAP India Newborn Action Plan, 2014, by Ministry of Health & Family Welfare, Government of India
• Guidelines for enhancing Optimal Infant & Young Child feeding Practices, 2013, by Ministry of Health & Family Welfare, Government of India
• Operational Guidelines, Use of Antenatal Corticosteroids in Preterm Labour (Under Specific conditions by ANM), 2014, by Ministry of Health & Family Welfare, Government of India
• Home Based Newborn Care, Operational Guidelines, Revised 2014, by Ministry of Health & Family Welfare, Government of India
• Operational Guidelines, Injection Vitamin K Prophylaxis at Birth (In Facilities), by Ministry of Health & Family Welfare, Government of India
• Facility based Newborn Care Operational Guide 2011, by Ministry of Health & Family Welfare, Government of India.