Paeds ILAs - 5 and 6 Flashcards
Developmental milestones at 6 months
GM
- Head control
- Sits unsupported - Arched back
VFM
- Palmar grasp
- Passes objects from one hand to the other
HSL
- Babbles
- Turns in response to sound
Social
- Puts objects in mouth
- Shakes rattle
- Reaches for bottle
Developmental milestones at 12 months
GM
- Cruises for 10 metres
VFM
- Refined pincer grip
- Puts blocks in a cup
HSL
- Knows and responds to name
- Knows 2/3 words
Social
- Drinks from a cup with both hands
Primitive reflexes and significance
Moro reflex - Sudden loss of support
- Arm abduction
- Arm adduction
- Crying
Persisting after 4 months - Sign of UMN lesion
What is cerebral palsy
Non-progressive disorder of movement and position
Occurs in the developing brain
Symptoms may appear to change over time - This is because as the child gets older the things they cannot do become more apparent
Cerebral palsy aetiology
Antenatal - 80%
- Infection
- Genetics
- Vascular occlusion
Intrapartum
- HIE
- Asphyxia
- Trauma
Post-partum
- Trauma
- Meningitis
- Periventricular leukomalacia
Cerebral palsy early features
Poor feeding
Delayed motor milestones
Asymmetrical hand function < 12 months
Persistent primitive reflexes
Abnormal tone
Abnormal gait
Spastic cerebral palsy
80-90% - Damage to motor cortex - UMN signs
Hemiplegic
- Arm and leg
- Face sparing
- Tip toe walk
- Asymmetrical hand
Diplegic - Periventricular leukomalacia
- Knock-kneed gait
Quadriplegic
- All 4 limbs
- Extensor posturing
Dyskinetic cerebral palsy
Problem in the basal ganglia - Extrapyramidal tracts
Associated with HIE and kernicterus
Chorea
Athetosis
Dystonia
Ataxic cerebral palsy
Lesion in the cerebellum
Broad gait
Hypotonia
Poor balance
Cerebral palsy MDT
Occupational therapy S/L School Paediatrician Neurologist Social worker Physiotherapy
Cerebral palsy risk factors
Twins
Prematurity
Maternal infections
Difficult delivery
Cerebral palsy associations
Learning difficulties Epilepsy Squint Deafness Poor feeding - Poor growth
Cerebral palsy investigations
MRI Cytogenetic Metabolic profile Biopsy and histopathology EEG
Absence seizure presentation
Child stops what they’re doing
Remains conscious
Can occur with hyperventilation
Absence seizure investigations
EEG 3Hz
Hearing test
ADHD assessment
Absence seizure management
Valproate
Ethosuximide
Juvenile myoclonic epilepsy presentation
Teenage girls
Myoclonic jerks - Suddenly throwing things
History of absence seizures
JME investigations and management
Investigations - EEG - Polyspike and wave
Management - Valproate
Types of strabismus (squint)
Paralytic
- Nerve palsy
- Can only move the eye in certain directions
Non-paralytic
- Misalignment
- Can move the eye in all directions
Manifesto - Always present
Latent - Comes and goes
Strabismus investigations
ONLY IF PARALYTIC
Cover test
- Ask the child to focus on an object
- Cover one eye
- Observe movement of uncovered eye
- Cover other eye and repeat
Strabismus management and complications
Management - Patching
Complications - Amblyopia
RDS presentation
Tachypnoea
Intercostal recession
Expiratory grunting
Cyanosis
RDS risk factors
Prematurity
- 26-28 weeks - 50%
- 30-31 weeks - 25%
Maternal diabetes
CS
Male
Second born of premature twins
RDS prevention
Dexamethasone
Delayed cord clamping - 45 seconds
RDS investigations
CXR - Ground glass
RDS management
O2
CPAP
Surfactant therapy - Through ET tube
RDS complications
Pneumothorax
BPD
Retinopathy
Renal failure
BPD
Chronic lung disease
Occurs due to mechanical ventilation and oxygen supplementation
Requires long-term oxygen therapy
BPD investigations
O/E - Crackles and wheeze
CXR
- Round radiolucent areas
- Fibrosis
CT - Mosaic lunch parenchyma
BPD management
Dexamethasone
Palivizumab
O2
Neonatal jaundice < 24 hours
BAD
Rhesus incompatibility ABO incompatibility Hereditary spherocytosis G6PD Infection Sepsis
Neonatal jaundice
24 hours - 2 weeks
NORMAL
Dehydration
Infection
Physiological
Bleeding
Neonatal jaundice > 2 weeks
BAD
High conjugated bilirubin = Biliary atresia!
Cystic fibrosis Congenital hypothyroidism Pyloric stenosis Hepatitis Infection
Neonatal jaundice investigations
Conjugated bilirubin
Unconjugated bilirubin
Coombs test
Blood film
FBC
U/E
LFT
TFT
Urinalysis
Kernicterus
Deposition of unconjugated bilirubin in the basal ganglia
Presentation
- Arching of back
- Seizures
- Comas
Complications
- Learning difficulties
- Sensorineural deafness
- Cerebral palsy
Necrotising enterocolitis
Bacterial infection of ischaemic bowel wall
Inflammatory bowel necrosis due to premature GI tract
Risk factors - Cow’s milk
NEC presentation
Bilious vomiting
Distended abdomen - Tense, shiny and red
Blood in stool
Decreased bowel sounds
Palpable abdominal mass
Shock
NEC investigations - AXR
Intramural gas
Distended bowel
Thickening of the bowel
Perforation - Pneumoperitoneum
Rigler sign - Air inside and outside the bowel wall
Football sign - Air outlining the falciform ligament
NEC investigations - Bloods
Thrombocytopenia
Neutropenia
Acidosis
NEC management
Broad spectrum abx
Cefotaxime
Vancomycin
Gentamicin
NG tube - Decompress
Surgery - Bowel resection
NEC complications
Perforation
Peritonitis
Short bowel syndrome - Following surgery
