Paediatrics Flashcards
Global burden of childhood pneumonia
-Top infectious cause of death in children <5
-98% pneumonia deaths occur in LMICs
->700,000 annual deaths [15% of under 5 mortality]
WHO - severe paediatric pneumonia - signs
Cyanosis
Grunting
Inability to drink
Head bobbing
Altered consciousness
SpO2 <90%
Convulsions
Vomiting everything taken in
PERCH study
Largest pneumonia aetiology study
Paediatric pneumonia - pathogens
Virus [61%] - RSV, rhinovirus, human metapneumovirus, parainfluenza
Bacteria [27%] - Penumococcus, haemophilus influenzae, staphlyococcus
TB [6%]
Fungi [5%] - pneumocystic jirovecii
Paediatric tropical neurology - burden
1/3rd children present with neuro signs/symptoms
Cranial neuropathies in TB meningitis
Through cavernous sinuses:
-III [oculomotor]
-IV [trochlear]
-V1 + V2 [Ophthalmic + maxillary]
-VI [abducens]
TB meningitis - clinical staging
1 = fever, meningism
2 = CN palsies, seizures
3 = coma
Paediatric neurology - motor/sensory exam
Pyramidal = weak, spasticity, hyper-reflexia
Basal ganglia/thalami = normal power + reflexes, choreathoid, dystonia
Cerebllum = ataxia, slurred speech, nystagmus
Cord = weak, sensory level, hyper-reflexia below level
Peripheral = weak, flaccid, areflexia
Paediatric neurology - trigger for anti-NDMA encephalitis
HSV encephalitis
TB meningitis paediatric - probability criteria
Marais, 2010 = uniform case definition, for all ages, numeric score based on clinical, CSF, neuro-imaging and evidence of TB
Diarrhoea in children - epidemiology
2nd leading cause of death in <5s globally
Mortality declining
Extremes of age most at risk
Diarrhoea in children - risk factors
For acquiring diarrhoea:
-Infants and children
-Immunosuppression
-Exposure to faecal-oral contamination
-Not breastfeeding [WHO recommendation = exclusive for 6 months, minimum of 2 years]
For morbidity and mortality:
-Undernutrition
-Extremes of age
-Poor supportive care
-Causative pathogen = neurotoxin [C botulinum, S aureus, Bacillus caerus], enterotoxin [cholera], and cytotoxin [shiga, EHEC, C diff, C perfringens]
Diarrhoea in children - causative pathogens
Top causes:
-Rotavirus
-Shigella
-Norovirus
-Adenovirus
-Cryptosporidium
-ETEC
-Shigella
Diarrhoea in children - Initial management
Rehydration
Zinc supplementation = restores mucosal barrier integrity, promotes production of antibodies and circulating lymphocytes and prevents chlorine secretion
Continued feeding and prevention
Diarrhoea in children - treatment plans
Plan A = treatment at home [no dehydration]
-ORS
-Zinc supplements
Plan B = some dehydration
-ORS in clinic over 4 hrs
-Zinc supplements
-Continue feeding
-Safety netting
Plan C = severe dehydration
-IV fluid treatment
-Down-staging as patient response - ORS as soon as child can drink
In malnutrition = IV treatment on if shocked
Diarrhoea in children - ORS components
NaCl, trisodium citrate, KCl, glucose
In acute malnutrition - ReSoMal = less sodium, lower osmolality
Diarrhoea in children - classification of dehydration
Severe = 2 or more of:
-Lethargy or unconscious
-Sunken eyes
-Unable to drink
-Skin pinch >2s
Some dehydration = 2 or more of:
-Restlessness
-Sunken eyes
-Drinks/thirsty
-Skin pinch slow
No dehydration
Diarrhoea in children - persistent diarrhoea [>14 days]
Monitor nutritional status
Consider HIV
Stool microscopy - isospora, cryptosporidium
Other infection - pneumonia, UTI
Chronic diarrhoea - may lead to environmental enteric dysfunction [EED]
Diarrhoea in children - prevention
WASH
Breastfeeding
Nutrition
Child maltreatment - burden
1 billion children experience physical, sexual or emotional violence each year
Childhood vaccinations - special characteristics of infant immunity
Initial protection mainly from innate immunity and maternal antibodies
Majority of antibody transfer occur after 28 weeks gestation
Childhood vaccinations - core vaccination [birth]
BCG
OPV [IPV from 6 weeks]
Hepatitis B
Childhood vaccinations - core vaccinations [from 6 weeks]
Rotavirus
Hib
Pneumococcal
Diptheria-tetanus-pertussis [DTP]
IPV
Childhood vaccinations - core vaccinations [from 9-12 months]
Rubella
Measles
Childhood vaccinations - core vaccinations [antenatal + adolescent]
Antenatal = maternal tetanus toxoid
Adolescent = HPV
Childhood vaccinations - vaccination rates
More than 22 million children undervaccinated
14.3 million zero-dose children
60^ from 10 countries:
Angola, Brazil, DRC, Ethiopia, India, Indonesia, Mozambique, Nigeria, Pakistan, Philippines
