Birth Injuries, Newborn Transport, Family Considerations, Ending Resuscitation, and SIDS and BRUE Practice Questions

25 multiple-choice questions on Birth injuries, newborn transport, family considerations, ending resuscitation, and SIDS and BRUE for paramedic and EMT students, from Chapter 43 (Neonatal Care). Read each question, pick your answer, then tap Show answer to check it and read the explanation.

25 practice questions

1. Soft swelling of a newborn's scalp that crosses the suture lines and is present at birth is most likely:

   1. A. Caput succedaneum
   2. B. Cephalohematoma
   3. C. Skull fracture
   4. D. Congenital hydrocephalus
   Show answer

   Answer: A. Caput succedaneum

   Caput succedaneum is edema of the scalp from pressure during delivery and crosses suture lines, resolving in a few days. A cephalohematoma is bleeding beneath the periosteum, so it stops at the sutures.

2. A firm swelling over one parietal bone appears several hours after birth and does not cross the suture lines. This is most likely a:

   1. A. Caput succedaneum
   2. B. Cephalohematoma
   3. C. Subgaleal bleed
   4. D. Normal fontanelle
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   Answer: B. Cephalohematoma

   A cephalohematoma is a subperiosteal collection of blood limited by the sutures that may raise the risk of jaundice as it breaks down. A subgaleal hemorrhage is more dangerous because it crosses sutures and can hold a large share of the blood volume.

3. A newborn has a boggy scalp swelling that crosses the sutures and is enlarging, with pallor and a rising heart rate. You should suspect:

   1. A. Benign caput succedaneum
   2. B. A normal molding of the skull bones
   3. C. A small cephalohematoma
   4. D. Subgaleal hemorrhage with shock
   Show answer

   Answer: D. Subgaleal hemorrhage with shock

   Bleeding into the large subgaleal space, often after vacuum delivery, can hold much of a newborn's blood volume and cause shock. A caput succedaneum is edema, not blood, and does not cause pallor and tachycardia.

4. The bone most often fractured during birth is the:

   1. A. Clavicle
   2. B. Femur
   3. C. Humerus
   4. D. Parietal bone
   Show answer

   Answer: A. Clavicle

   Clavicle fractures are the most common birth fracture, often after shoulder dystocia, and they usually heal well. The humerus and femur fracture less often, typically in breech or difficult deliveries.

5. After a delivery complicated by shoulder dystocia, the newborn holds one arm limp, extended, and turned inward with the wrist flexed. This suggests:

   1. A. Facial nerve palsy on that side
   2. B. Spinal cord injury in the neck
   3. C. Brachial plexus injury (Erb palsy)
   4. D. Dislocated shoulder on the same side
   Show answer

   Answer: C. Brachial plexus injury (Erb palsy)

   Stretching of the upper brachial plexus produces the 'waiter's tip' posture of Erb palsy. Facial nerve palsy causes facial asymmetry with crying, not a limp arm.

6. A newborn delivered with forceps has an asymmetric face when crying, with one side not moving. The most likely cause is:

   1. A. Stroke in the brain
   2. B. Clavicle fracture
   3. C. Facial nerve injury
   4. D. Choanal atresia
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   Answer: C. Facial nerve injury

   Pressure from forceps or the maternal pelvis on the facial nerve causes temporary weakness of one side of the face, usually resolving over weeks. A newborn stroke more often presents with seizures than with an isolated facial droop.

7. Newborns delivered with a vacuum extractor have a higher risk of:

   1. A. Scalp injury and subgaleal hemorrhage
   2. B. Clavicle fracture and Erb palsy
   3. C. Hip dislocation and a femoral fracture
   4. D. Choanal atresia and cleft palate
   Show answer

   Answer: A. Scalp injury and subgaleal hemorrhage

   Suction on the scalp can cause a chignon, cephalohematoma, or the more serious subgaleal hemorrhage. Clavicle fractures and Erb palsy are linked more to shoulder dystocia.

8. When transporting a newborn, the safest way to secure the infant in an ambulance is:

   1. A. In the mother's arms on the stretcher
   2. B. In an isolette or approved infant restraint
   3. C. On the bench seat, wrapped snugly in a blanket
   4. D. In a car seat placed loose on the floor
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   Answer: B. In an isolette or approved infant restraint

   A newborn should travel in an isolette or a restraint device designed for infants and secured to the stretcher, because an unrestrained infant becomes a projectile in a crash. Holding the infant in the mother's arms is unsafe during transport.

9. A transport isolette is used for a newborn mainly to:

   1. A. Deliver high-flow oxygen by mask
   2. B. Keep the infant sterile during transport
   3. C. Isolate an infant with an infection
   4. D. Provide warmth and secure the infant
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   Answer: D. Provide warmth and secure the infant

   An isolette provides a controlled thermal environment and secures the infant during transport, while letting the crew watch the infant. It is not a sterile or infection-isolation device, and oxygen, when needed, is given through a separate hood or mask rather than by the isolette itself.

10. During a long transport of a stable newborn, you should check the infant's temperature:

    1. A. Once, at the very start of the transport
    2. B. When the infant starts to shiver
    3. C. Only on arrival at the hospital
    4. D. Repeatedly, to prevent cold and overheating
    Show answer

    Answer: D. Repeatedly, to prevent cold and overheating

    Temperature should be monitored throughout, because a newborn can cool or overheat quickly and cannot shiver as a warning sign. Waiting for shivering would miss hypothermia entirely.

11. Neonatal intensive care is regionalized. When a critically ill newborn needs transfer between hospitals, the usual best practice is:

    1. A. Private vehicle with the parents driving
    2. B. Standard crew without any added staff
    3. C. A specialized neonatal transport team
    4. D. Air transport for every short distance
    Show answer

    Answer: C. A specialized neonatal transport team

    Specialized neonatal transport teams bring the equipment, medications, and expertise for critically ill newborns. Air transport is chosen by distance and condition, not used for every transfer.

12. During a field resuscitation, the newborn's mother asks what is happening to her baby. The best response is:

    1. A. Briefly explain what you are doing
    2. B. Tell her that everything will be fine
    3. C. Ask her to stop asking questions
    4. D. Ignore her until care is finished
    Show answer

    Answer: A. Briefly explain what you are doing

    Brief, honest updates in plain language support the family and maintain trust, and a crew member can be assigned to stay with her. False reassurance damages trust if the outcome is poor.

13. A newborn has had no detectable heart rate despite 20 minutes of resuscitation in which every recommended step, including epinephrine, was done well. Per current guidelines, you should:

    1. A. Continue for at least 60 more minutes
    2. B. Discuss stopping with medical direction
    3. C. Switch to 30:2 compressions and continue
    4. D. Stop now and tell the family later
    Show answer

    Answer: B. Discuss stopping with medical direction

    When no heart rate is detected after all steps of resuscitation have been done well, the AHA/AAP guidelines say it is reasonable to discuss redirecting care with the team and family at around 20 minutes after birth. In the field, that decision goes through online medical direction and local protocol, which may require continuing during transport. A fixed 60 more minutes is not required and rarely changes the outcome. A 30:2 ratio is for older infants and children; newborns receive 3:1. Stopping without consultation and keeping the family uninformed is not appropriate; families should be told honestly and supported. (AHA/AAP 2020 and 2025; NRP 9th ed.)

14. You arrive at a home where a woman delivered 10 minutes ago. The infant is cool and apneic with no heart rate, but there are no signs of decomposition or obvious lethal deformity. You should:

    1. A. Pronounce death at once
    2. B. Wait for police first
    3. C. Begin resuscitation
    4. D. Call for the coroner
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    Answer: C. Begin resuscitation

    Unless there are clear signs of prolonged death or anomalies incompatible with life, field resuscitation should begin and medical direction should be contacted. Pronouncing death without trying denies the infant a chance of survival.

15. Sudden infant death syndrome is defined as the sudden death of an infant under 1 year that:

    1. A. Results from a known congenital heart defect
    2. B. Follows a witnessed choking episode at home
    3. C. Is caused by an infection acquired at birth
    4. D. Stays unexplained after a full investigation
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    Answer: D. Stays unexplained after a full investigation

    SIDS is a diagnosis of exclusion, made only after an autopsy, scene investigation, and review of history fail to find a cause. Deaths from known defects or choking are classified by their cause.

16. The peak age for sudden infant death syndrome is:

    1. A. 2 to 4 months
    2. B. The first week
    3. C. 9 to 12 months
    4. D. 1 to 2 years
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    Answer: A. 2 to 4 months

    Most SIDS deaths occur between 1 and 6 months, peaking at 2 to 4 months. SIDS is rare in the first week, so a sudden death then prompts a search for other causes.

17. Which practice most reduces the risk of SIDS?

    1. A. Placing the infant prone on soft bedding
    2. B. Placing the infant on the back to sleep
    3. C. Sharing the parents' bed with pillows
    4. D. Keeping the infant warmly overdressed
    Show answer

    Answer: B. Placing the infant on the back to sleep

    Back-to-sleep positioning on a firm, flat surface without soft bedding has sharply lowered SIDS rates. Prone sleep, soft bedding, bed sharing, and overheating all increase risk.

18. At the scene of a suspected SIDS death, your approach to the parents should include:

    1. A. Calm, nonjudgmental support
    2. B. Questions about possible abuse
    3. C. Telling them it was avoidable
    4. D. Keeping them out of the room
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    Answer: A. Calm, nonjudgmental support

    Parents of an infant who died suddenly need compassionate support; you document the scene objectively and leave the investigation to law enforcement. Accusatory questions add to grief and are not your role.

19. A brief resolved unexplained event (BRUE) in an infant under 1 year is an episode lasting less than 1 minute that includes:

    1. A. Brief redness of the face with crying that settles
    2. B. Choking and gagging during a feed, then quick recovery
    3. C. Cyanosis or pallor, altered breathing, tone, or responsiveness
    4. D. Ongoing seizure activity that has still not resolved on your arrival
    Show answer

    Answer: C. Cyanosis or pallor, altered breathing, tone, or responsiveness

    A BRUE is a sudden, brief, resolved episode of cyanosis or pallor; absent, decreased, or irregular breathing; a marked change in tone; or altered responsiveness, with no explanation after evaluation. Redness of the face with crying does not count. Choking and gagging during a feed has an explanation, such as reflux or a swallowing problem, so it is not a BRUE. An ongoing seizure has not resolved, so it is not a BRUE and needs treatment now. (AAP BRUE guideline 2016.)

20. A 6-week-old infant briefly turned blue and limp during sleep, but on your arrival is pink, alert, and has normal vital signs. You should:

    1. A. Reassure and leave the infant home
    2. B. Suggest the parents call tomorrow
    3. C. Advise sleeping the infant prone
    4. D. Recommend transport for evaluation
    Show answer

    Answer: D. Recommend transport for evaluation

    Even when the infant looks well, a BRUE needs evaluation because it can reflect infection, seizures, cardiac disease, airway problems, or abuse. A normal exam at the scene does not exclude a serious cause.

21. When the parents of a critically ill newborn are present during resuscitation, the textbook recommends that:

    1. A. The parents be removed from the scene
    2. B. A team member explain and support them
    3. C. Care be paused to answer their questions
    4. D. The parents assist with chest compressions
    Show answer

    Answer: B. A team member explain and support them

    Allowing family presence with a designated crew member to explain and support is the preferred approach, if it does not interfere with care. Pausing care to answer questions delays critical interventions.

22. A term newborn needs epinephrine during resuscitation, and no scale is available. To calculate the dose, you should:

    1. A. Delay the drug until a scale is found
    2. B. Estimate weight from gestational age
    3. C. Give 1 mg as a fixed newborn dose
    4. D. Use the pediatric formula 8 + 2 × age
    Show answer

    Answer: B. Estimate weight from gestational age

    Newborn drugs are dosed per kilogram of estimated weight, using gestational age, the infant's size, or a length-based tape; a term infant is usually estimated at about 3 to 3.5 kg. Delaying epinephrine until a scale is found would withhold a time-critical drug. A fixed 1-mg dose is an adult arrest dose, many times too much for a newborn, and the 8 + 2 × age formula is meant for children over 1 year and would estimate 8 kg at birth. (NRP 9th ed.; Caroline.)

23. A newborn has a bluish-gray, flat discoloration over the lower back and buttocks that looks like a bruise. This finding is most likely:

    1. A. A sign of inflicted physical abuse
    2. B. A birth-related fracture
    3. C. Congenital dermal melanocytosis
    4. D. A sign of neonatal sepsis
    Show answer

    Answer: C. Congenital dermal melanocytosis

    These flat, blue-gray patches, once called Mongolian spots, are a common benign birthmark, especially in infants with darker skin, and fade over years. Mistaking them for bruising can lead to false reports of abuse; they should be documented as present at birth.

24. A term newborn needed 3 minutes of positive-pressure ventilation and is now pink, breathing well, and has a heart rate of 150. During the 30-minute transport, you should also:

    1. A. Give dextrose without testing first
    2. B. Give naloxone 0.1 mg/kg IM
    3. C. Stop monitoring once the HR is normal
    4. D. Check a blood glucose level
    Show answer

    Answer: D. Check a blood glucose level

    A newborn who needed resuscitation has used up glycogen under stress and can become hypoglycemic, so post-resuscitation care includes checking glucose, keeping the infant warm, and continuous monitoring of breathing, heart rate, and saturation. Dextrose is given for a documented low glucose or clear symptoms, not without testing, because the check guides the dose and the need. Naloxone is not part of newborn resuscitation or post-resuscitation care; ventilation treats the depressed breathing. An infant who needed ventilation can slip back into apnea or bradycardia, so monitoring continues throughout transport. (NRP 9th ed., post-resuscitation care; AHA/AAP 2025.)

25. When an infant dies in the field after attempted resuscitation, an appropriate step for the family is to:

    1. A. Let them hold the infant if they wish
    2. B. Have them wait outside until police arrive
    3. C. Clean and dress the infant before they see it
    4. D. Tell them the cause of death right away
    Show answer

    Answer: A. Let them hold the infant if they wish

    Allowing parents to see and hold their infant can help with grief, while you remain respectful of the investigation's needs. Sending them outside to wait separates them from their child at the worst moment, washing or dressing the infant can disturb findings the investigation needs, and the cause of death cannot be known on scene, so it should not be guessed.