Meconium, Preterm and Low-birth-weight Infants, and Prevention of Hypothermia Practice Questions

25 multiple-choice questions on Meconium, preterm and low-birth-weight infants, and prevention of hypothermia 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. Meconium in the amniotic fluid is most often a sign that the fetus:

   1. A. Has a blocked intestinal tract
   2. B. Has a congenital infection
   3. C. Is less than 32 weeks old
   4. D. Was stressed or is postterm
   Show answer

   Answer: D. Was stressed or is postterm

   Hypoxic stress and postterm maturity both cause the fetus to pass meconium before birth. Meconium-stained fluid is uncommon in very preterm infants, whose gut is less mature.

2. A term infant is born through meconium-stained fluid, cries at once, and has good tone. You should:

   1. A. Intubate and suction below the cords
   2. B. Give routine care with the mother
   3. C. Suction the stomach before drying
   4. D. Begin ventilation with 100% oxygen
   Show answer

   Answer: B. Give routine care with the mother

   A vigorous infant born through meconium receives the same routine care as any vigorous newborn, with the mouth and nose cleared with a bulb syringe if needed. Tracheal suctioning of vigorous infants has never been shown to help and can cause injury.

3. During labor, the bag of waters breaks and the fluid is thick and dark green. Before the infant is born, you should:

   1. A. Ask the mother to stop pushing until you reach the hospital
   2. B. Plan to suction the infant's stomach before drying
   3. C. Prepare equipment and a second rescuer for ventilation
   4. D. Plan to intubate the infant whether or not it cries
   Show answer

   Answer: C. Prepare equipment and a second rescuer for ventilation

   Meconium-stained fluid raises the chance the infant will need resuscitation, so you set up the bag-mask, suction, and warming and assign a rescuer to the infant. Planned intubation regardless of the infant's condition is no longer recommended; a vigorous infant gets routine care.

4. When is intubation and tracheal suctioning indicated for a newborn born through meconium?

   1. A. When thick meconium blocks the airway
   2. B. Whenever the amniotic fluid is stained green
   3. C. When the 1-minute Apgar is below 7
   4. D. Whenever the infant is postterm
   Show answer

   Answer: A. When thick meconium blocks the airway

   Intubation with a meconium aspirator is reserved for an infant whose airway is obstructed and who cannot be ventilated. Routine tracheal suction of every non-vigorous infant with meconium is no longer recommended.

5. Meconium aspiration syndrome is dangerous mainly because meconium in the lungs can cause:

   1. A. Fluid overload and pulmonary edema
   2. B. Airway plugging, air trapping, and pneumonitis
   3. C. Bronchospasm that responds well to inhaled albuterol
   4. D. Hyperglycemia and metabolic alkalosis
   Show answer

   Answer: B. Airway plugging, air trapping, and pneumonitis

   Aspirated meconium plugs small airways, traps air with a risk of pneumothorax, inactivates surfactant, and inflames the lungs, often with persistent pulmonary hypertension. It is not primarily a bronchospastic disease, and albuterol is not the treatment.

6. An infant born at 36 weeks' gestation looks much like a term baby and is crying well. Compared with a term infant, this late-preterm newborn is at higher risk for:

   1. A. Cold stress, low glucose, and poor feeding
   2. B. Thick meconium and dry, peeling, cracked skin
   3. C. Lower bilirubin levels and less jaundice
   4. D. Large size and a shoulder dystocia injury
   Show answer

   Answer: A. Cold stress, low glucose, and poor feeding

   Late-preterm infants (34 0/7 to 36 6/7 weeks) look mature but have less brown fat and glycogen, a weaker suck and swallow, and immature breathing control, so they are more prone to hypothermia, hypoglycemia, feeding problems, jaundice, and apnea than term infants; check glucose and temperature and keep them warm. Thick meconium and dry, peeling, cracked skin are features of a postterm infant. Late-preterm infants have more jaundice, not less, because of an immature liver and poor feeding. Large size and shoulder dystocia go with macrosomia, as in an infant of a diabetic mother, not with early birth. (AAP, late-preterm infants.)

7. A low-birth-weight infant is defined as weighing less than:

   1. A. 3,500 g (7.7 lb)
   2. B. 1,500 g (3.3 lb)
   3. C. 2,500 g (5.5 lb)
   4. D. 1,000 g (2.2 lb)
   Show answer

   Answer: C. 2,500 g (5.5 lb)

   Low birth weight is under 2,500 g, very low birth weight is under 1,500 g, and extremely low birth weight is under 1,000 g. Mixing up these thresholds understates how many infants need special thermal and respiratory care.

8. Preterm infants are at higher risk for respiratory distress syndrome mainly because they lack:

   1. A. Enough red blood cells to carry oxygen
   2. B. A functioning foramen ovale
   3. C. Enough brown fat to stay warm
   4. D. Adequate surfactant in the alveoli
   Show answer

   Answer: D. Adequate surfactant in the alveoli

   Surfactant production matures late in gestation, so preterm lungs have stiff, collapsing alveoli. Brown fat deficiency explains their heat loss, not their lung disease.

9. Compared with term infants, preterm newborns are more prone to brain bleeding during resuscitation because:

   1. A. Their platelet counts are very low at birth
   2. B. Their thin skull offers little protection
   3. C. Their cerebral blood flow is tightly autoregulated
   4. D. Their germinal matrix vessels are fragile
   Show answer

   Answer: D. Their germinal matrix vessels are fragile

   The fragile vessels of the germinal matrix in the preterm brain can rupture with rapid shifts in blood pressure or fluids, causing intraventricular hemorrhage. Preterm infants have weak, not tight, autoregulation of cerebral blood flow, which is part of the problem, and the bleeding is not caused by a thin skull or by low platelets at birth. This is why boluses are given slowly and handling is gentle.

10. An infant at 29 weeks is born in the field. The most effective step to prevent heat loss immediately after birth is to:

    1. A. Dry the body thoroughly with towels first
    2. B. Bathe the infant in warm water at once
    3. C. Place the wet body in a plastic bag or wrap
    4. D. Place the infant on a cold, clean surface
    Show answer

    Answer: C. Place the wet body in a plastic bag or wrap

    Infants under 32 weeks are placed, without drying the body, in food-grade polyethylene wrap or a bag up to the neck, with a cap on the head. Vigorous drying is the term-infant approach and removes protective moisture while causing more evaporative loss in fragile skin.

11. The ambient room temperature recommended while resuscitating a very preterm newborn is about:

    1. A. 23 to 25 °C (73 to 77 °F)
    2. B. 18 to 20 °C (64 to 68 °F)
    3. C. 15 to 17 °C (59 to 63 °F)
    4. D. 30 to 32 °C (86 to 90 °F)
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    Answer: A. 23 to 25 °C (73 to 77 °F)

    Guidelines recommend a room of 23 to 25 °C for preterm deliveries, combined with plastic wrap, a cap, and a thermal mattress. A typical cool room at 18 to 20 °C accelerates radiant and convective losses.

12. After placing a preterm infant in plastic wrap, you should still:

    1. A. Remove the cap to prevent overheating
    2. B. Monitor temperature to avoid overheating
    3. C. Unwrap the infant every 2 minutes
    4. D. Tape the wrap tightly over the face
    Show answer

    Answer: B. Monitor temperature to avoid overheating

    Combining plastic wrap, a warm room, and a thermal mattress can overheat an infant, so temperature is monitored to keep it at 36.5 to 37.5 °C. The face must stay uncovered, and a cap is part of the bundle, not a cause of overheating.

13. An exothermic chemical warming mattress is used for a newborn. To prevent burns, you should:

    1. A. Place the infant directly on the bare pad
    2. B. Place a thin blanket between it and the skin
    3. C. Heat the pad in a microwave beforehand
    4. D. Leave it in place until arrival at the receiving unit
    Show answer

    Answer: B. Place a thin blanket between it and the skin

    Chemical mattresses can reach high temperatures, so a thin layer between the pad and skin plus temperature checks reduce the burn risk. Microwaved packs heat unevenly and have caused serious burns in infants.

14. An infant born at 33 weeks needs positive-pressure ventilation. You should start with:

    1. A. 100% oxygen until the infant is pink
    2. B. No added oxygen even if saturations stay low
    3. C. 21% to 30% oxygen, then titrate to SpO2
    4. D. Oxygen by nasal cannula at 6 L/min
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    Answer: C. 21% to 30% oxygen, then titrate to SpO2

    For infants born at 32 0/7 to 34 6/7 weeks, the 2025 AHA/AAP guidelines and NRP 9th edition start resuscitation at 21% to 30% oxygen and adjust it to preductal SpO2 targets (infants under 32 weeks start at 30% or more, and those of 35 weeks or more start in room air). Running 100% oxygen until the infant looks pink relies on an unreliable sign and risks oxygen toxicity, including retinopathy and lung injury. Withholding oxygen when saturations stay below target despite good ventilation leaves the infant hypoxic. A nasal cannula does not deliver positive-pressure breaths, which this infant needs. (AHA/AAP 2025; NRP 9th ed.)

15. When ventilating a preterm newborn, the inflation pressure should be:

    1. A. As high as needed to keep the chest very full
    2. B. Twice the pressure used in term newborns
    3. C. Set at 40 cm H2O for the first five breaths
    4. D. The lowest pressure that moves the chest
    Show answer

    Answer: D. The lowest pressure that moves the chest

    Preterm lungs are fragile, so you use the lowest pressure that produces gentle chest rise and a rising heart rate, with PEEP to keep alveoli open. Excessive pressure causes volutrauma and pneumothorax.

16. Preterm infants are more prone to hypoglycemia than term infants mainly because they have:

    1. A. Smaller stores of glycogen and fat
    2. B. Higher levels of maternal insulin
    3. C. Less need for glucose in the brain
    4. D. A slower metabolic rate overall
    Show answer

    Answer: A. Smaller stores of glycogen and fat

    Glycogen and fat stores accumulate in the third trimester, so preterm infants have little reserve once the cord is cut. Their high metabolic demand relative to size makes the problem worse, not better.

17. You are called to a home where a woman with no prenatal care has just delivered. She thinks she was about 23 weeks pregnant. The infant is gasping with a heart rate of about 80. You should:

    1. A. Withhold care because the infant is under 24 weeks
    2. B. Wait for a heart rate under 60 before acting
    3. C. Give blow-by oxygen and watch the heart rate
    4. D. Begin resuscitation and contact medical direction
    Show answer

    Answer: D. Begin resuscitation and contact medical direction

    At 22 to 24 weeks, survival is possible but uncertain. ACOG and SMFM advise individualized decisions made with the family before birth, and in recent US data about half of actively treated 23-week infants survived. In the field, the dates are often off by a week or two, no counseling has taken place, and this infant shows signs of life, so you begin newborn resuscitation (warmth and a plastic wrap, airway, positive-pressure ventilation) and involve medical direction early; decisions to limit care are made with the family and physicians, or under a clear local protocol. A 24-week cutoff would withhold care from infants who often survive. Waiting for the heart rate to fall below 60 delays ventilation, which gasping and a rate under 100 already require. Blow-by oxygen does not ventilate an infant who is not breathing effectively. (ACOG/SMFM periviable birth; AHA/AAP 2025.)

18. A 24-year-old delivers at about 30 weeks. The infant is breathing weakly with a heart rate of 110 and labored respirations. An appropriate early intervention is:

    1. A. Immediate intubation and suctioning
    2. B. CPAP with a mask at about 5 cm H2O
    3. C. Chest compressions at a 3:1 ratio
    4. D. Vigorous back rubbing for 2 minutes
    Show answer

    Answer: B. CPAP with a mask at about 5 cm H2O

    A spontaneously breathing preterm infant with distress and a heart rate above 100 benefits from CPAP, which keeps the stiff alveoli open. Intubation is reserved for apnea, failed mask ventilation, or the need for compressions.

19. A newborn is born through meconium and is vigorous, but after 10 minutes develops grunting, tachypnea, and falling saturations. The most likely problem is:

    1. A. Meconium aspiration
    2. B. Transient tachypnea of the newborn
    3. C. Respiratory distress syndrome
    4. D. Neonatal abstinence
    Show answer

    Answer: A. Meconium aspiration

    Respiratory distress developing after birth through meconium suggests aspiration, which can progress to air trapping, pneumothorax, and pulmonary hypertension. Transient tachypnea is milder and more typical after cesarean birth without labor, and surfactant-deficient respiratory distress syndrome is a disease of preterm infants. Neonatal abstinence usually appears a day or more after birth with tremors and irritability.

20. A postterm infant is more likely than a term infant to have:

    1. A. Abundant vernix and fine lanugo hair
    2. B. Very thin, gelatinous skin
    3. C. Meconium passage and low glucose
    4. D. Surfactant deficiency
    Show answer

    Answer: C. Meconium passage and low glucose

    Postterm infants often pass meconium, may outgrow their placental supply, and have dry, cracked skin with little vernix and a risk of hypoglycemia. Abundant vernix and lanugo are features of a younger infant.

21. A preterm infant in plastic wrap needs umbilical or IO access. The best approach is to:

    1. A. Cut a small opening in the wrap
    2. B. Remove the wrap and dry the infant
    3. C. Place access through the wrap's seam
    4. D. Wait for the hospital to place it
    Show answer

    Answer: A. Cut a small opening in the wrap

    A small opening can be cut over the umbilicus or the access site so the rest of the wrap stays in place and heat loss is limited. Removing the wrap for the procedure gives up the most effective thermal protection.

22. Very preterm infants have immature respiratory centers. This makes them especially prone to:

    1. A. Sustained hyperventilation
    2. B. Apnea with bradycardia
    3. C. Respiratory alkalosis
    4. D. Chronic bronchospasm
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    Answer: B. Apnea with bradycardia

    Apnea of prematurity, often with bradycardia and desaturation, is common in very preterm infants and can occur during transport. It is treated with stimulation and ventilation as needed.

23. You delivered a 33-week infant 15 minutes ago. Its axillary temperature is 35.2 °C (95.4 °F). Hypothermia in this infant is concerning mainly because it:

    1. A. Protects the brain from injury
    2. B. Has no effect on the preterm infant's outcome
    3. C. Speeds up the infant's maturation
    4. D. Increases mortality and complications
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    Answer: D. Increases mortality and complications

    In preterm infants, each degree below normal on admission is associated with higher mortality and complications such as hypoglycemia, acidosis, and respiratory distress. Therapeutic cooling is a hospital treatment for selected term infants with brain injury, not a reason to tolerate cold in a preterm infant.

24. When a preterm delivery is expected, the best way to improve the infant's outcome is often:

    1. A. Giving oxygen to the mother en route
    2. B. Driving fast to a nearby clinic
    3. C. Transport to a hospital with a NICU
    4. D. Giving tocolytics in the field
    Show answer

    Answer: C. Transport to a hospital with a NICU

    Delivery at a center with neonatal intensive care improves outcomes, so a woman in preterm labor should go to the right facility when time allows. A clinic without newborn resuscitation capability adds a second transfer. Supplemental oxygen for a mother with normal saturation does not help the fetus, and tocolytic drugs are a hospital decision that EMS does not routinely give.

25. You begin positive-pressure ventilation for an apneic infant born at 27 weeks. Your partner suggests one 15-second sustained inflation to open the lungs first. You should:

    1. A. Give it, then repeat it every 60 seconds
    2. B. Extend it to 30 seconds for full effect
    3. C. Give it in place of PEEP and CPAP
    4. D. Give regular breaths with PEEP instead
    Show answer

    Answer: D. Give regular breaths with PEEP instead

    Routine sustained inflations longer than 5 seconds are not recommended for preterm infants. The SAIL trial in infants of 23 to 26 weeks was stopped early because more infants died early in the sustained-inflation group, and AHA/AAP and ILCOR guidance advise ordinary positive-pressure breaths at 30 to 60 per minute with PEEP of about 5 cm H2O, using the lowest pressure that moves the chest. Repeating the inflation every minute multiplies the exposure to that risk. Making it longer adds pressure exposure with no proven benefit. A sustained inflation does not replace PEEP or CPAP, which keep the alveoli open after the lungs are aerated. (SAIL trial; AHA/AAP 2020 and 2025.)