Paediatrics & Neonatology Flashcards
Maintenance fluid calculator for children
Routine maintenance fluids for children are calculated by weight using the Holliday-Segar formula:
100 ml/kg/day for the first 10kg of weight
50 ml/kg/day for the next 10kg of weight
20 ml/kg/day for weight over 20kg
Initial fluid bolus in shock for children
10ml/kg
If child required a bolus for shock, how much fluid should be added to maintenance to rehydrate?
Add 100ml/kg
If child did not require a bolus for shock, how much fluid should be added to maintenance to rehydrate?
Add 50ml/kg
When is jaundice physiological in neonates ?
Usually appears at day 2, peaks 3-5, gone by 10 days
Neonatal sepsis abx choice
Ben Pen and Gent
Continuous murmur in a neonate most likely?
Machinery murmur -> PDA
Most common cause of early onset neonatal sepsis =
Group B strep
Kocher criteria for osteomyeletis in children
non-weight-bearing status, fever>38.5°C, white blood cell>12 K, and erythrocyte sedimentation rate>40 mm/h
How to diagnose SUFD on XR
Klein’s line, if it doesn’t transcect the femoral epiphysis it is a positive Trethowan’s sign
School exclusion advice for whooping cough
Can return 48hrs after abx started or 21 days if not treated
Treatment for whooping cough
Clarithromycin
Treating cerebral oedema in a child with DKA
Mannitol or hypertonic saine
NLS, CRP ratio
3:1
Pre ductal SpO2 accepted
2 mins
5mins
10 mins
65%
85%
90%
5th disease is dangerous to who?
Pregnant women - causes marrow problems in the fetus
Sick cell
What to do in children with a fever of 38 or higher (unexplained)
Urine dipstick
Fever in
1 month old
1-3 month old + unwell
Treat with IV Abx
Treatment for Kawasaki
HIGH dose aspirin
and IgG
BRUE low risk
Age > 60 days
Born >32 wks gestation post conceptual age > 45 days
No CPR
< 1 min
1st event
Calculation for fluid to replace % dehydration
10 x weight x %
Most common cause for early onset neonatal sepsis
Group B strep
Cyanotic CHDs
Tetraology of fallot
Transposition of GA
Tricuspid atresia
Total anomalous pulmonary vascular return
Truncus arteriosus
When to admit a neonate with Jaundice
< 24hr hours old
or < 35 weeks gestation
Most concerning complication of neonatal jaundice
Kernicterus (encephalopathy)
Shock strength for children
4J/Kg
After rescue breaths in NLS, at what HR do we then commence CPR
<60 BPM
Upper limit of RR for children of certain ages
6-12 month
>12 months
50 breaths/min
40
Upper limit of HR for children of certain ages
< 12 months
12-24 months
2-5 yrs
160
150
140
Temp of concern in:
3-6 months
< 3months
39
38
How to monitor temp in a child < 4 weeks old
Temp probe in the axilla
Dose of Ben Pen in the community for meningitis (suspected)
<1 yr
1-9 yrs
10+ yrs
300
600
1.2g
Burns (>10%) in children calculation
% X KG X 3 (over 24hrs)
Shock dose in SVT in children
DC synchronous shock at 1-2 J/kg.
Westle croup score
DKA in children, over what time frame should deficit be corrected?
48hrs
Calculating fluid requirement in DKA in a child
When calculating the fluid requirement for children and young people with DKA, assume a 5% fluid deficit in mild-to-moderate DKA (indicated by a blood pH of 7.1 or above), or a 10% fluid deficit in severe DKA (indicated by a blood pH below 7.1).
The total replacement fluid to be given over 48 hours is calculated as follows:
Hourly rate = (deficit/48 hours) + maintenance per hour
Treatment for cerebral oedema following DKA tx in children
If cerebral oedema occurs, treat with hypertonic (3%) saline 3 ml/kg or a mannitol infusion (250-500 mg/kg over 20 min).
Causes of pneumonia in
Term / near term infants
Low birth weight infants
Group B haemolytic Streptococcus
E.coli
APGAR scoring for
Appearance (skin colour)
0
1
2
Blue or pale all over
Blue at extremities (acrocyanosis)
No cyanosis Body and extremities pink
APGAR scoring for
Pulse
0
1
2
Absent
<100
>100
APGAR scoring for
Grimace
0
1
2
No response to stimulation
Grimace on suction or aggressive stimulation
Cry on stimulation
APGAR scoring for
Activity
0
1
2
None
Some limb flexion
Flexed arms and legs that resist extension
APGAR scoring for
Respiratory effort
0
1
2
None
Weak, irregular, gasping
Strong cry
4 categories of neonatal jaundice
Haemolytic unconjugated hyperbilirubinaemia
Non-haemolytic unconjugated hyperbilirubinaemia
Hepatic conjugated hyperbilirubinaemia
Post-hepatic conjugated hyperbilirubinaemia
Which type of neonatal jaundice is always pathological?
Conjugated
Haemolytic unconjugated hyperbilirubinaemia is split into 2 categories
Intrinsic
Extrinsic
Haemolytic unconjugated hyperbilirubinaemia
Intrinsic causes of haemolysis
Hereditary spherocytosis
G6PD deficiency
Sickle-cell disease
Pyruvate kinase deficiency
Haemolytic unconjugated hyperbilirubinaemia
Extrinsic causes of haemolysis:
Haemolytic disease of the newborn
Rhesus disease
Non-haemolytic unconjugated hyperbilirubinaemia causes
Breastmilk jaundice
Cephalhaematoma
Polycythemia
Infection (particularly urinary tract infections)
Gilbert syndrome
Hepatic conjugated hyperbilirubinaemia causes
Hepatitis A and B
TORCH infections
Galactosaemia
Alpha 1-antitrypsin deficiency
Drugs
Post-hepatic conjugated hyperbilirubinaemia causes
Biliary atresia
Bile duct obstruction
Choledochal cysts
Tetralogy of fallot is associated with which congenital syndromes (4)
DiGeorge syndrome (22q11 microdeletion syndrome)
Trisomy 21
Foetal alcohol syndrome
Maternal phenylketonuria
Pyloric stenosis blood gas
hypochloraemic metabolic alkalosis
When should an APGAR assessment be done after birth?
1 & 5 mins
Dose of prednisolone in children with asthma exacerbation
Age 2-5
Age 5+
If already on a maintenance dose of pred
Use a dose of 20 mg prednisolone for children aged 2–5 years and a dose of 30–40 mg for children >5 years.
Those already receiving maintenance steroid tablets should receive 2 mg/kg prednisolone up to a maximum dose of 60 mg.
When is magnseium added to salbutamol nebs in the management of paediatric asthma?
Consider adding 150 mg magnesium sulphate to each nebulised salbutamol and ipratropium in the first hour in children with a short duration of acute severe asthma symptoms presenting with an oxygen saturation less than 92%.
Defining tachypnoea in different age groups
0-5 months
6-12 months
12 months +
RR >60 breaths/minute, age 0-5 months;
RR >50 breaths/minute, age 6-12 months;
RR >40 breaths/minute, age older than 12 months
Severe asthma attacks in children characterised by?
Age 2-5
5+
RR >40, HR >140
RR >30, HR > 125
SpO2 indicating life threatening asthma in children?
<92%
Dosing of benzos in status epilepticus (paediatrics)
Lorazepam IV / IO
Buccal midazolam
Rectal diazepam
Lorazepam 0.1 mg/kg
Buccal midazolam 0.5 mg/kg
or rectal diazepam 0.5 mg/kg
Step 3 in paediatric SE (after 2nd benzo)
IV levetiracetam, 40mg/kg (max 3g) over 5 mins
Paediatric epilepsy
If seizures continue despite loading with levetiracetam then termination with induction of anaesthesia and intubation is expected. However, if the advanced airway team is not yet prepared and the ABCDE assessment is stable, then:
If not already on phenytoin, then a phenytoin infusion should be set up (20 mg/kg IV infusion over 20 minutes)
If already taking phenytoin, then phenobarbitone can be used in its place (20 mg/kg IV infusion over 20 minutes)
Anatomical land mark of needle thoracocentesis for
tension pneumothorax in children?
2nd IC space, mid clavicular line
First line treatment for Croup
Oral dex, 0.15mg/kg
Management of those with moderate croup
Monitor for 4 hours and reassess (+ dex)
Westley croup score thresholds:
Mild
Moderate
Severe
Impending respiratory failure
Mild (croup score 0-2)
Moderate (croup score 3-5)
Severe (croup score 6-11)
Impending respiratory failure (croup score 12-17)
When using ORS to replace fluid deficit, how is this done?
Replace over 4 hours in frequent but small amounts (total replacement rate is usually 10-20ml/kg/hr)
Estimated deficit (in ml) is 5% (or 10%) X child’s weight in kg X 10
Daily maintenance
What determines the severity of tetralogy of Fallot?
The severity of cyanosis is determined by the degree of obstruction to pulmonary blood flow
Severity of dehydration as per the pH
Mild
Mod
Severe
and % dehydrated
7.2-7.3
7.1-7.2
<7.1
5%
5%
10%
What is needed for a diagnosis of DKA in children
Acidosis
and raised lactate
ANY GLUCOSE
Bronchiolitis admission criteria
apnoea (observed or reported)
persistent oxygen saturation (when breathing air) of:
- less than 90%, for children aged 6 weeks and over
-less than 92%, for babies under 6 weeks or children of any age with underlying health conditions
inadequate oral fluid intake (50% to 75% of usual volume)
persisting severe respiratory distress, for example grunting, marked chest recession, or a respiratory rate of over 70 breaths/minute. [2015]
Kawasaki diagnosis
4/5 of …
Eyes
Mouth
Fingers / toes
Rash
Lymphadeopathy
When is IN diamorphine used in children?
FOR SEVERE PAIN
After admission for an asthma attack, what triggers a child to be referred to a respiratory specialist?
Life threatening features
