Preterm infant — viva

Stem

Examiner-led viva on the preterm infant from delivery-room stabilisation through longitudinal follow-up. [6]

Examiner: The infant is grunting and desaturating. How do you open in the delivery room? [6]

Strong answer: I dry and warm the infant under a radiant heater with a polyethylene wrap, assess tone, breathing and heart rate, and provide gentle CPAP at 5–7 cm water for the grunting baby. I start with air or low oxygen — 21 to 30 per cent — and titrate upward against a pre-ductal saturation nomogram, avoiding routine 100 per cent oxygen. [6]

Examiner: What about the cord? [5]

Strong answer: If the infant does not need immediate resuscitation, I defer cord clamping for 30 to 60 seconds. The Seidler individual-participant-data network meta-analysis shows deferred clamping reduces mortality compared with immediate clamping in preterm infants. [5]

Examiner: The oxygen need rises to 35 per cent on CPAP. What now? [7]

Strong answer: This is established respiratory distress syndrome. I give rescue surfactant and extubate back to CPAP as quickly as possible. The SUPPORT trial established that early CPAP with selective surfactant is viable in extremely preterm infants and reduces intubation without worsening outcomes. [7]

Examiner: When do you start caffeine and why? [8]

Strong answer: I start caffeine citrate early in ventilated or CPAP-dependent very preterm infants for apnoea prevention and extubation readiness. The CAP trial showed caffeine improves survival without neurodevelopmental disability at 18 to 21 months, with benefits persisting to age five — so it is both symptomatic and neuroprotective. [8] [9]

Examiner: Maternal milk supply is dropping. What is your nutritional strategy? [14]

Strong answer: Maternal milk is first choice; I support lactation and use donor human milk rather than preterm formula when maternal supply is insufficient, because Cochrane evidence shows donor milk reduces necrotising enterocolitis. I fortify to meet protein and energy growth targets and plot on Fenton charts. [14]

Examiner: Name three complications you actively screen for. [11] [12]

Strong answer: Serial cranial ultrasound for intraventricular haemorrhage and periventricular leukomalacia; retinopathy of prematurity screening by gestational age and birthweight criteria starting around 31 to 34 weeks post-menstrual age; and sepsis surveillance with line-care bundles and antibiotic stewardship. [11] [12]

Examiner: How do you assess development at follow-up? [20]

Strong answer: I correct for prematurity by subtracting the weeks born early from chronological age, continuing until at least two years. Structured follow-up at corrected ages of 4, 8, 12 and 18 to 24 months assesses motor development with standardised tools, growth, hearing and vision, with school-readiness evaluation near age five. [20]