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]}