How neonatology is examined
The RACP Divisional Written Examination for Paediatrics & Child Health has two papers: Clinical Applications (100 questions, 3 hours 10 minutes) and Medical Sciences (70 questions, 2 hours 10 minutes). Most questions are single-answer MCQs with four options, plus a small number of extended matching questions, and some use images such as X-rays or ECGs. The score is combined across both papers, and the pass mark is set with the modified Angoff method; the RACP notes it has historically ranged between 55% and 65%. The paediatric blueprint sets a target number of items for each specialty, so check the current blueprint on the RACP website.
High-yield neonatal topics
| Topic | Key points |
|---|---|
| Resuscitation | Airway and effective ventilation first; heart rate guides escalation (ANZCOR) |
| Jaundice | Under 24 hours is pathological; treatment thresholds by gestation and age in hours |
| Respiratory distress | TTN, RDS, meconium aspiration, pneumonia, pneumothorax, congenital heart disease |
| Early-onset sepsis | Group B streptococcus and E. coli; benzylpenicillin and gentamicin |
| Hypoglycaemia | Risk groups: preterm, small, infant of a diabetic mother |
| Prematurity | RDS, NEC, IVH, ROP, BPD and PDA |
| Newborn examination | Red reflex, hips, femoral pulses, palate, spine |
Neonatal jaundice
- Jaundice in the first 24 hours needs urgent assessment for haemolysis (ABO or Rh incompatibility, G6PD deficiency).
- Prolonged jaundice (over 14 days in term infants) needs a conjugated bilirubin to exclude biliary atresia; pale stools and dark urine are red flags.
- Phototherapy thresholds depend on gestation and age in hours; exchange transfusion is for severe hyperbilirubinaemia or signs of encephalopathy.
Complications of prematurity
| Complication | Key feature |
|---|---|
| RDS | Surfactant deficiency; antenatal steroids reduce it |
| NEC | Feed intolerance, abdominal distension, pneumatosis intestinalis |
| IVH | Most occur in the first days; screen with cranial ultrasound |
| ROP | Screening by gestation and birth weight |
| BPD | Oxygen need at 36 weeks corrected age |
Worked questions
Worked question 1 · Jaundice
A term baby is visibly jaundiced at 18 hours of age. The mother is blood group O positive. What is the most appropriate next step?
- A Reassure and review again at 3 days of age
- B Bilirubin, blood group and DAT
- C Stop breastfeeding for 48 hours
- D Abdominal ultrasound for biliary atresia
- E Start oral ursodeoxycholic acid
Show the reasoning
Answer B. Jaundice in the first 24 hours is pathological until proven otherwise. Measure bilirubin and look for haemolysis, such as ABO incompatibility with a positive direct antiglobulin test.
Worked question 2 · Prematurity
A 28-week infant on day 10 develops feed intolerance, a distended abdomen and bloody stools. What is the most likely diagnosis?
- A Hirschsprung disease
- B Necrotising enterocolitis
- C Pyloric stenosis
- D Cow's milk protein allergy
- E Malrotation without volvulus
Show the reasoning
Answer B. NEC typically affects preterm infants after feeds are established, with distension, feed intolerance and bloody stools. Abdominal X-ray may show pneumatosis intestinalis.
A 4-week neonatology revision block
| Week | Focus |
|---|---|
| 1 | Resuscitation and the newborn examination |
| 2 | Jaundice and haematology |
| 3 | Respiratory distress and sepsis |
| 4 | Prematurity and mixed questions |
Pair each week with 25 timed questions a day and review every explanation, including the options you ruled out.
Common traps
- Treating early jaundice as physiological.
- Missing conjugated hyperbilirubinaemia.
- Forgetting maternal risk factors for sepsis.
- Confusing TTN with RDS.
Free sample neonatology questions
Questions from our Paediatrics (RACP) bank. Choose your answer, then open the explanation.
A baby is visibly jaundiced at 18 hours of age. What is the most important consideration?
- AGilbert syndrome
- BPhysiological jaundice
- CBiliary atresia
- DHaemolysis, so measure bilirubin urgently
- EBreast milk jaundice that will settle over several weeks without treatment
Show answer and explanation
Answer D. Jaundice within 24 hours is always pathological, most often haemolysis (ABO or Rh incompatibility, G6PD deficiency) or sepsis. Measure serum bilirubin, blood group, DAT and FBC urgently.
Learning point: Jaundice under 24 hours is pathological until proven otherwise.
A term baby born by elective caesarean has tachypnoea at 2 hours with mild recession. Chest X-ray shows fluid in the fissures. What is the most likely diagnosis?
- ATransient tachypnoea
- BGroup B streptococcal pneumonia
- CCongenital diaphragmatic hernia
- DMeconium aspiration syndrome
- ESurfactant deficiency
Show answer and explanation
Answer A. Delayed clearance of lung fluid after caesarean birth without labour causes transient tachypnoea of the newborn, which usually settles within 24 to 72 hours.
Learning point: Caesarean without labour: transient tachypnoea is common.
A 5-week-old has persistent jaundice with pale stools and dark urine. What is the most urgent diagnosis to exclude?
- ACrigler-Najjar type 2 with unconjugated hyperbilirubinaemia
- BBiliary atresia
- CBreast milk jaundice
- DPhysiological jaundice
- EGilbert syndrome
Show answer and explanation
Answer B. Conjugated hyperbilirubinaemia with pale stools after 2 weeks suggests biliary atresia, which needs a Kasai portoenterostomy ideally before 6 to 8 weeks for best outcomes. Measure split bilirubin.
Learning point: Prolonged conjugated jaundice with pale stools: exclude biliary atresia urgently.
Practise more neonatology questions free
Every neonatology subtopic in our bank
The bank holds 15 neonatology questions across 15 subtopics. You can filter by any of them, build a custom block and track your accuracy subtopic by subtopic.
- Apgar score1
- Bilious vomiting in a neonate1
- Breastfeeding contraindication1
- Group B streptococcus prophylaxis1
- Infant of a diabetic mother1
- Necrotising enterocolitis1
- Neonatal abstinence1
- Neonatal hypoglycaemia1
- Neonatal jaundice in first 24 hours1
- Neonatal resuscitation1
- Neonatal sepsis organisms1
- Newborn hip screening1
- Prolonged jaundice1
- Respiratory distress in preterm1
- Transient tachypnoea of the newborn1
Common questions
Is neonatology in the RACP paediatric written exam?
Yes. The paediatric blueprint includes neonatal and perinatal medicine as its own area.
Which resuscitation guideline applies?
ANZCOR guidelines are used in Australia and New Zealand.
When is jaundice pathological?
Jaundice in the first 24 hours, rapidly rising bilirubin, or conjugated hyperbilirubinaemia.
Sources
Clinical content is summarised from current Australian guidance at the date above. Guidelines change, so always check the latest edition.