Neonatology: acute bilirubin encephalopathy: practice question

A Pediatrics question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

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Pediatrics · Neonatology: acute bilirubin encephalopathy

Sample item

A 5-day-old term breastfed baby is lethargic, hypotonic and sucks poorly, with deep jaundice and a total bilirubin well above the exchange line. What should be done?

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

A. Start intensive phototherapy and arrange an urgent exchange transfusion

Lethargy, hypotonia and poor suck with a very high bilirubin are early signs of acute bilirubin encephalopathy, a medical emergency. Intensive phototherapy and preparation for exchange transfusion should start at once, because early encephalopathy is reversible but later stages are not.

Option by option

  • A. Start intensive phototherapy and arrange an urgent exchange transfusion (correct)

    Correct. Neurological signs plus a very high bilirubin call for urgent exchange transfusion.

  • B. Stop breastfeeding and observe

    Stopping feeds does not remove bilirubin and may worsen dehydration.

  • C. Continue routine phototherapy and review in the morning

    Routine phototherapy and delay risk irreversible kernicterus.

  • D. Give phenobarbitone

    Phenobarbitone acts too slowly and does not treat an acute crisis.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

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Questions about this Pediatrics question

What is the answer to this Pediatrics question?

The best answer is A, Start intensive phototherapy and arrange an urgent exchange transfusion. Lethargy, hypotonia and poor suck with a very high bilirubin are early signs of acute bilirubin encephalopathy, a medical emergency.

Why is "Stop breastfeeding and observe" not the answer?

Stopping feeds does not remove bilirubin and may worsen dehydration.

Why is "Continue routine phototherapy and review in the morning" not the answer?

Routine phototherapy and delay risk irreversible kernicterus.

Why is "Give phenobarbitone" not the answer?

Phenobarbitone acts too slowly and does not treat an acute crisis.

What concept does this question test?

It tests Neonatology: acute bilirubin encephalopathy in Pediatrics. Intensive phototherapy and preparation for exchange transfusion should start at once, because early encephalopathy is reversible but later stages are not.

How hard is this question?

We tag it as a multi-step question: it asks you to combine more than one idea. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Neonatology: acute bilirubin encephalopathy?

Memorise milestones and the vaccine schedule as tables and revise them often. Then use the flashcards and the other Pediatrics questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.