Paediatrics Flashcards
IV fluid choice in children
o Neonates = 10% glucose
o Older = 0.9% NaCl + 5% glucose (+/- KCl)
Fluid maintenance in neonates
o Day 1 = 60ml/kg/day
o Day 2 = 90ml/kg/day
o Day 3 = 120ml/kg/day
o Day 4 = 150ml/kg/day
Fluid maintenance in children
o (Age+4) x2 = weight in kg (approx)
o First 10kg = 100ml/kg
o Next 10kg = 50ml/kg
o Every other kg = 20ml/kg
Fluid deficit in children
- Dehydrated = 50ml/kg extra over 24/48 hrs
- Shocked = 100ml/kg extra over 24/48 hrs
Fluid bolus in children
20ml/kg of 0.9% NaCl
Presentation of bronchopulmonary dysplasia (chronic lung disease of prematurity)
- Low oxygen saturations
- Increased work of breathing
- Poor feeding and weight gain
- Crackles and wheezes on chest auscultation
- Increased susceptibility to infection
- Requires oxygen therapy after reaching 36 wks gestational age
Prevention of chronic lung disease of prematurity
- Corticosteroids to mothers that show signs of premature labour
- CPAP rather than intubation and ventilation
- Caffeine to stimulate respiratory effort
- Not over oxygenating with supplementary O2
- Surfactant
Causes of cleft lip and palate
- Benzodiazepines
- Antiepileptics
- Rubella
- Trisomy 18, 13-15
- Pierre robin short mandible = causes intermittent short airway obstruction
Management of cleft lip
- Feeding with special teats may be needed before plastic surgery
- Lip repair at 3m and palate at 6m
o Avoid NICU as decreased bonding
Risk factors for meconium aspiration syndrome
- Post-term deliveries (>42 wks)
- Maternal hypertension
- Pre-eclampsia
- Chorioamnionitis
- Smoking
- Substance abuse
Complications of meconium aspiration syndrome
- Airway obstruction
- Surfactant dysfunction
- Pulmonary vasoconstriction
- Infection
- Chemical pneumonitis
Causes of hypoxic-ischaemic encephalopathy
- Maternal shock
- Intrapartum haemorrhage
- Prolapsed cord = compression of cord during birth
- Nuchal cord = cord wrapped around neck of baby
Sarnat staging of hypoxic-ischaemic encephalopathy
- Mild = Poor feeding, general irritability and hyper-alert
- Moderate = Poor feeding, lethargic, hypotonic and seizures
- Severe = Reduced consciousness, apnoeas, flaccid and reduced/absent reflexes
Management of Hypoxic-ischaemic encephalopathy
Therapeutic hypothermia
Risk factors for necrotising enterocolitis
- Very LBW or very premature
- Formulae feeds
- Respiratory distress and assisted ventilation
- Sepsis
- Patent ductus arteriosus and other congenital heart disease
Presentation of necrotising enterocolitis
- Intolerance to feeds
- Vomiting (green bile)
- Generally unwell
- Distended tender abdomen
- Absent bowel sounds
- Blood in stools
AXR in necrotising enterocolitis
o Dilated loops of bowel
o Bowel wall oedema
o Pneumatosis intestinalis = gas in bowel wall
o Pneumoperitoneum = free gas in peritoneal cavity
o Gas in portal veins
o Rigler sign = air both inside and outside bowel wall
o Football sign = air outlining falciform ligament
Causes of neonatal hypoglycaemia
- Preterm birth
- Maternal DM
- IUGR
- Hypothermia
- Neonatal sepsis
- Inborn errors of metabolism
Management of neonatal hypoglycaemia
- Asymptomatic
o Encourage normal feeding
o Monitor blood glucose - Symptomatic or very low blood glucose
o Admit to neonatal unit
o IV 10% dextrose
Risk factors for neonatal jaundice
- Premature neonates = immature liver
- Low infant birth weight
- Male
- Visible bruising
- Maternal age >25
- Maternal DM
- Ethnicity = Asian, European, native American
- Sibling born with jaundice requiring phototherapy
- Dehydration
- Poor caloric intake/increased neonatal weight loss
Causes of neonatal jaundice
- Increased production
o Haemolytic disease of newborn
o ABO incompatibility (<24hrs)
o Haemorrhage
o Intraventricular haemorrhage
o Cephalo-haematoma
o Polycythaemia
o Sepsis and disseminated intravascular coagulation
o G6PD deficiency (<24 hrs) - Decreased clearance
o Prematurity
o Neonatal cholestasis
o Extrahepatic biliary atresia
o Endocrine disorders (hypothyroid and hypopituitary)
o Gilbert syndrome - Physiological (2-14 days)
o Breastfeeding (benign and self-limiting)
Criteria for admission of neonatal jaundice
- Emergency admission if signs of bilirubin encephalopathy
- Urgent admission (seen within 2 hrs) if jaundice appears <24hrs old
- Urgent admission (seen within 6 hrs)
o Jaundice first appeared >7 days old
o Neonate unwell (lethargy, fever, vomiting, irritability)
o Gestational age <35 wks
o Prolonged jaundice suspected = <37wks >21 days jaundice or >37 wks with >14 days jaundice
o Feeding problems or concerns about weight
o Pale stools and dark urine - Community care Record bilirubin level within 6 hrs and manage following local protocol
Treatment of neonatal jaundice
- None if bilirubin level below threshold
- Phototherapy
o Rebound bilirubin measured 12-18 hrs after - Exchange transfusions
- Early surgical treatment
Complications of neonatal jaundice
- Kernicterus = brain damage caused by excessive bilirubin levels
o Cerebral palsy
o Learning disability
o Deafness - Acute/chronic bilirubin encephalopathy (neurotoxicity)
o Atypical sleepiness
o Poor feeding
o Irritability
o Vomiting
o Hypotonia followed by hypertonia