Morning Rounds · Neonatology Series
Neonatology
A Guide to the Morning Rounds Series
A Guide to the Morning Rounds Series
Seven rounds · 40 clinical cases · NEET-PG and UPSC CMS · +4 / −1 scoring
Neonatology is not a gentle subject. It is the medicine of the most vulnerable patients in any hospital — infants who cannot describe their symptoms, who deteriorate without warning, and whose prognosis can hinge on a single clinical decision made in the first hour of life. It is also, for this reason, one of the most reliably examined subjects in both NEET-PG and UPSC CMS.
This series of seven Morning Rounds covers the full clinical arc of neonatology: from the jaundiced term infant on the postnatal ward to the 24-week preterm in the NICU fighting four simultaneous complications; from a cord prolapse at midnight to the biochemistry of pyridoxine-dependent epilepsy. Each round is five clinical cases — ten for the final omnibus round — with +4/−1 scoring and a full debrief after every answer.
The rounds are designed to be taken in any order, but the sequence below follows a natural clinical progression — from the first hours of life outward, from common to complex, from the delivery room to the NICU.
The Seven Rounds
Round 01 · Neonatology Series
Neonatal Jaundice
The commonest neonatal problem on the postnatal ward. Covers the distinction between physiological and pathological jaundice with the 24-hour rule, phototherapy and exchange transfusion thresholds plotted against age in hours on the gestational-age-stratified nomogram, ABO incompatibility versus Rh disease with the Coombs test and spherocytes, G6PD deficiency with its trigger drugs and the mechanism of oxidative haemolysis, and the role of IVIG in confirmed isoimmune haemolytic disease. A bilirubin action-zone nomogram is included in the debrief.
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Round 02 · Neonatology Series
Neonatal Respiratory Distress
The four causes of respiratory distress in the newborn, with the clinical and radiological discriminators that separate them. Covers RDS with its ground-glass CXR and the central role of surfactant deficiency, TTN as the great mimic of the near-term elective LSCS infant with its self-resolving wet-lung pattern, MAS with thick meconium-stained liquor and the feared complication of PPHN diagnosed by right-to-left ductal shunt on echocardiography, and tension pneumothorax with its sudden deterioration on CPAP and the life-saving bedside needle decompression. The paradox of RDS in the infant of a diabetic mother is the fifth case. A comparison table SVG is included in the debrief.
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Round 03 · Neonatology Series
Neonatal Sepsis
Infection in the newborn, from the delivery room to the NICU at three weeks of life. Covers early-onset sepsis with the empirical benzylpenicillin plus gentamicin regimen and the reasons GBS is not treated with cephalosporins, late-onset CoNS line-associated sepsis with the non-negotiable source control of PICC line removal, the LP decision in a neonate with seizures and a bulging fontanelle, Listeria monocytogenes and its intrinsic resistance to all cephalosporins — the pharmacological fact that resolves the most common confusion in neonatal sepsis — and invasive candidiasis in the ELBW neonate with the four-pronged management: antifungal, line removal, ophthalmology, and echocardiography. An EOS vs LOS comparison table is included in the debrief.
Open Round →
Round 04 · Neonatology Series
Birth Asphyxia & HIE
Hypoxic-ischaemic encephalopathy — the commonest cause of neonatal death and acquired disability worldwide. Covers therapeutic hypothermia with its strict eligibility criteria (pH ≤7.0 or base deficit ≥16, ≥36 weeks, Grade II or III HIE), the 6-hour window that must not be missed, and the NNT of 7 to prevent one death or major neurodisability; Apgar score calculation from clinical descriptors and the distinction between the 1-minute and 5-minute predictive values; the NRP algorithm with the 3:1 compression:ventilation ratio and the adrenaline threshold; phenobarbitone as first-line anticonvulsant with the pharmacokinetic caution during hypothermia; and MRI brain timing with diffusion-weighted imaging at 5–7 days, the PLIC signal, and the pattern that predicts dyskinetic versus spastic cerebral palsy. The Sarnat grading table is included in the debrief.
Open Round →
Round 05 · Neonatology Series
Neonatal Seizures
Seizures in the newborn: a diagnostic challenge because the neonatal brain seizes differently from the adult brain, and because the causes change dramatically depending on the hour of onset. Covers HIE as the dominant cause in the first 24 hours with the clinical features of subtle seizures, focal clonic seizure classification and the bedside test that distinguishes seizure from jitteriness, late hypocalcaemia in the formula-fed infant with the high-phosphate mechanism, HSV encephalitis at 7–14 days of life with the critical lesson that aciclovir must precede the PCR result and that 30–40% of CNS HSV occurs without skin vesicles, and pyridoxine-dependent epilepsy with the ALDH7A1 mutation, the collapse of GABA synthesis, and the dramatic response to a single IV dose of pyridoxine. A causes-by-onset SVG table is included in the debrief.
Open Round →
Round 06 · Neonatology Series
The Preterm Infant
The four major complications of extreme prematurity, each with its own staging system, screening protocol, and treatment ladder. ROP: Type 1 disease as the treatment threshold, the 48–72 hour urgency window, and laser versus intravitreal bevacizumab. IVH: Papile grading from subependymal to parenchymal, and post-haemorrhagic hydrocephalus managed from serial lumbar punctures through ventricular reservoir to VP shunt. NEC: Bell staging with pneumatosis intestinalis as the pathognomonic AXR finding and portal venous gas signalling Stage IIB. BPD: the definition anchored at 36 weeks corrected gestational age with oxygen dependency, and caffeine as the drug that reduces both apnoea and BPD incidence. The fifth case addresses neonatal hypoglycaemia in a 33-week SGA infant at 1.4 mmol/L — the glucose infusion rate calculation. A four-complication summary SVG is included in the debrief.
Open Round →
Round 07 · Neonatology Series · 10 cases
Neonatology Omnibus — The Full Ward Round
Ten cases across the full neonatology shelf — the topics that do not belong to a single clinical theme but carry reliable examination weight. Neonatal hypoglycaemia in the IDM with fetal hyperinsulinaemia and the GIR calculation. Congenital CMV with its periventricular calcification fingerprint and valganciclovir for 6 months. ABO incompatibility versus Rh disease. Congenital hypothyroidism with the 2-week treatment window that prevents irreversible neurodevelopmental damage. Polycythaemia with partial exchange transfusion. NAIT and its paradox: HPA-1a antibodies causing intracranial haemorrhage in the first pregnancy while the mother's own platelets are entirely normal. Breast milk and human milk fortifier in the preterm. PDA with COX inhibition and prostaglandin E2. Congenital syphilis and why aqueous penicillin IV is mandatory while IM benzathine fails. Neonatal abstinence syndrome with Finnegan scoring, oral morphine, and the absolute contraindication to naloxone.
Open Round →
Topics not covered in this series
This series is thorough but not encyclopaedic. Areas of neonatology outside these seven rounds include congenital heart disease in depth (acyanotic vs cyanotic, prostaglandin E1 to maintain ductal patency, balloon atrial septostomy), neonatal surgical emergencies (oesophageal atresia, diaphragmatic hernia, gastroschisis, omphalocele, Hirschsprung's disease, pyloric stenosis), inborn errors of metabolism in full detail, neonatal haematological malignancy, and the pharmacology of pain management and sedation in the NICU. These topics are more naturally addressed in dedicated Paediatric Surgery and Paediatric Medicine series.
A note for doctor-examinees
Neonatology carries weight in NEET-PG and UPSC CMS disproportionate to the time most candidates spend on it. The cases in this series are written at NEET-PG ceiling level, not superspeciality depth — they cover what a competent postgraduate generalist should know about the newborn, not what a neonatology fellow would know. If you have worked through these rounds and found a question that is clinically inaccurate, off-pitch in difficulty, or missing a key discriminator, that feedback is genuinely useful. The contact page is always open.
Morning Rounds · atsixty.com · Seven rounds · 40 high-yield clinical cases · +4 / −1 scoring · NEET-PG and UPSC CMS