Principles of Peadiatrics
Principles of Peadiatrics
Principles of Peadiatrics
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Principles of Pediatrics by Adeleke
TABLE OF CONTENT
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Principles of Pediatrics by Adeleke
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Principles of Pediatrics by Adeleke
- A term baby doubles its BW around 4-5 mo and triples it around 12 months
- Daily weight gain is 20-30 g in the first 3-4 mo, and 15-20 g for the rest of 1st yr
- Measuring device: Bassinet weighing scale (at <2 yr) or Stadiometer (at ≥2 yr)
Length/Height
- Length is measured in children < 2 yr using the Infantometer
- An assistant helps to maintain the child in supine position on the measuring board
while measurement is being taken
- Height is measured in children > 2 yr, who are able to stand upright without support,
using the Stadiometer
- Worthy of note is that length is about 1-2cm greater than height, as joint spaces are
reduced by gravity while standing
- Normal length at birth: 50 ± 5 cm. It increases by ~25 cm in the first yr
- By age 4-5 yr, an average child would have double the birth length
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Principles of Pediatrics by Adeleke
Deficit Therapy
Mild dehydration (about 50ml/kg of body fluid or 3-5% BW has been lost)
- 50ml/kg of Oral Rehydration Solution (ORS) is administered over 4hrs (i.e. 500ml for
a 10 kg child)
- Child is then reassessed; fluid can be repeated if dehydration persists
Moderate dehydration (about 75ml/kg of body fluid or 6-10% BW has been lost)
- 75ml/kg of ORS is administered over 4hrs (i.e. 750ml for a 10 kg child)
- Child is then reassessed; fluid can be repeated if dehydration persists
Severe dehydration (about 100ml/kg of body fluid or > 10% BW has been lost)
- 20 ml/kg of isotonic solution (NS or RL) is infused intravenously over 20 min (this
fluid is subtracted from the total deficit)
- Child is then reassessed; infusion can be repeated if dehydration persists
Maintenance Therapy
- This replaces fluid loss via the skin, lungs and urine so as to prevent relapse of
dehydration
- It is estimated from patient weight as follows:
. 100ml/kg for the first 10kg
. 50ml/kg for the next 10kg
. 20ml/kg for each kg above 20kg
Thus, maintenance fluid for a child weighing 24kg will be 1580 ml
- If child can drink: maintenance is given orally as ORS (preferred) but
Pharmacotherapy
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Principles of Pediatrics by Adeleke
Phototherapy
- An inexpensive and non-invasive method first described by Cremer et al in 1958
- Light energy photo-isomerizes bilirubin into photo-bilirubin or lumirubin (a more
polar, less lipophilic, more acidic, and easily excretable form)
Indications
- Prophylaxis in preterm LBW infants
- Moderate hyperbilirubinemia
- To accelerate excretion, and prevent rebound hyperbilirubinemia post-EBT
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Principles of Pediatrics by Adeleke
Thermal control
- Incubator or radiant warmer: should be used to maintain the infant’s core
temperature at 36.5-37.0oC (to minimize heat loss and oxygen consumption)
- Kangaroo mother care: direct mother and baby skin-to-skin contact and a hat and
blanket covering the infant is a safe alternative
Intravenous fluid
- 70-80 ml/kg/day (60 ml/kg/day if asphyxiated) of 10% dextrose in water on day 1,
then increase by 10ml/kg on subsequent days to a maximum of 150ml/kg/day
- Electrolyte containing fluids (usually 4.3% D/S) are used after 48 hr of life
Respiratory Support
- Oxygen should be administered via a head hood, nasal cannula, continuous positive
airway pressure (CPAP) apparatus, or endotracheal tube to maintain stable and safe
inspired oxygen concentrations
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Principles of Pediatrics by Adeleke
- However, not all myoclonus is epileptic in nature; for example, the myoclonic jerks
during phase 1 of sleep are normal release phenomenon
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Principles of Pediatrics by Adeleke
Component
• VSD: usually large; shunting oxygenated blood from left to right ventricle
• Pulmonary Stenosis: obstructing outflow of blood from the right ventricle to the
lungs (the degree of PS is the key determinant of severity in ToF)
• Dextropositioned Aorta: so that it overrides (i.e. lies directly above) the VSD
• Right Ventricular Hypertrophy: a consequence of right ventricular overload
Clinical features
- Babies usually remain acyanosed until later in infancy
- Exertional dyspnea, feeding difficulties, failure to thrive, squatting, cyanosis,
polycythemia, digital clubbing, stroke, cerebral abscess etc.
• CVS findings: pansystolic murmur at LLSB or ejection systolic murmur at LUSB, a
single S2, and left parasternal heave with or without systolic thrill
• CXR: shows boot-shaped heart (Coeur en sabot) seen as uplifted cardiac apex, and
diminished prominence of the pulmonary arteries
• ECG: RVH, right bundle branch block
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Principles of Pediatrics by Adeleke
Gomez classification
- It classifies PEM based on the deficit in weight for age
Clinical features
Constant Common Occasional
Growth failure Moon face Flaky paint dermatoses
Muscle wasting Skin dyspigmentation/desquamation Skin ulceration/fissuring
Edema Brown, sparse, easily plucked hair Enlarged fatty liver
Mental Changes Pallor Micronutrient deficiency
(apathy, irritability) Hypothermia (stomatitis, cheilosis,
Diarrhea glossitis)
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Principles of Pediatrics by Adeleke
Treatment
Supportive Care
- Daily weighing, daily urinalysis, blood pressure monitoring, Na restriction, fluid
monitoring, moderate exercise to prevent thromboembolic event etc
Corticosteroid therapy
- > 95% of minimal change NS respond to corticosteroid therapy
• Prednisone or prednisolone should be administered as follows:
- 60 mg/m2/day or 2 mg/kg/day (maximum, 60 mg/day) for 4-6 wk. Then,
- 40 mg/m2 or 1.5 mg/kg (maximum, 40mg) on alternate-day for a period ranging from
8 wk to 5 mo, with tapering of the dose
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Principles of Pediatrics by Adeleke
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Principles of Pediatrics by Adeleke
NEUROBLASTOMA
- This is an embryonal malignancy of the peripheral sympathetic nervous system
arising from neural crest cells (neuroblasts)
- About half of cases arise in the adrenal glands, and others in the paraspinal ganglia,
neck, thorax and pelvis
Epidemiology
- It is the most common extracranial solid tumor of infancy
- Median age at diagnosis is 2 yr; about 90% are diagnosed before 5 yr
- It is slightly more common in boys
Genetics: most cases are sporadic, only about 1-2% are familial
- Familial cases occur at a younger age, and are associated with mutations in PHOX2B
and ALK genes
- ~25% of sporadic cases are associated with amplification of MYCN proto-oncogene;
which is associated with rapid tumor progression and poor outcomes
Tumor site
- Neck: Horner syndrome (unilateral ptosis, myosis, and anhidrosis)
- Paraspinal: Spinal cord and nerve root compression
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Principles of Pediatrics by Adeleke
Immunizing Agents
Vaccines: are whole or parts of microorganisms administered to prevent an
infectious disease. There are two types:
• Live attenuated vaccines: these are derived from disease-causing viruses or bacteria
that have been weakened under laboratory condition; thus,
- They cannot cause full blown disease but still has the ability to induce immunity
• Inactivated vaccines: here, the organisms are killed by heat or chemical, but still
retain their ability to induce immunity
Toxoid: is a modified bacterial toxin that is made nontoxic but is still able to induce
an active immune response against the toxin
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Principles of Pediatrics by Adeleke
Indication
Therapeutic
- Gastric decompression in intestinal
obstruction or post GI surgery
- Gastric lavage following ingestion of
poison or drug overdose
- Administration of feeds, fluids and
medications
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Principles of Pediatrics by Adeleke
O Retinoblastoma, 150
Opsoclonus-myoclonus-ataxia syndrome, Ringers lactate, 10
147 Rifampin, 94
Osmolality, 9 Rituximab, 137
Overfill hypothesis, 123 Rolandic epilepsy, 55
P S
Pathological jaundice, 20 Saucerization, 155
Paradoxical embolism, 67 Sequestration crisis, 130
Paratracheal lymphadenopathy, 89 Sequestrum, 153, 154
Partial seizure, 52 Sequestrectomy, 155
Passive Immunity, 160 Severe Acute Malnutrition, 106
Patent Ductus Arteriosus, 68 Severe malaria, 141
Pediatric-Modified Rifle Criteria, 118 Severe wasting, 106
Pencil-point sign, 96 Shakir tape, 8
Pentavalent vaccine, 161 Sickle cell habitus, 128
Persistent diarrhea, 99 Simple febrile seizure, 62
Persistent pulmonary hypertension of Simple febrile seizure plus, 64
newborn, 50 Small for gestational age, 41
Phototherapy, 23-25 Spastic cerebral palsy, 58
Physiological jaundice, 19 Spontaneous bacterial peritonitis, 124
Pneumonitis, 80 Sporadic Burkitt lymphoma, 133
Pneumatocele, 85 Sporozoites, 139
Prednisone, 125 Stadiometer, 5, 6
Priampism, 130 Starry sky appearance, 135
Primary nephrotic syndrome, 122 Status epilepticus, 56
Pulmonary tuberculosis, 88 Stem cell transplantation, 132
Pyrazinamide, 94 Steeple sign, 96
Steroid resistance, 125
Q Subacute osteomyelitis, 152
Quinine, 143
Quantitative Buffy Coat, 140 T
Thin and Thick blood film, 140
R Total Anomalous Pulmonary Venous Return,
Rasburicase, 136 71
Refeeding Syndrome, 112-113 Toxoids, 160
Renal biopsy, 116, 119, 125 Transient tachypnea of the newborn, 49
Respiratory distress syndrome, 47-48 Transposition of Great Arteries, 72
ReSoMal, 111 Trophic feeding, 44
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Principles of Pediatrics by Adeleke
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