Pediatrics Flashcards
Measles post-exposure prophylaxis and outbreak control
1- time of exposure
2- contraindications ( Pregnancy, immunodeficiency, <6m )
- if within 3 days: MMR vaccine
- if >3 days and <6 days OR CIs: Immunoglobulin
Meningitis in neonatal period treatment?
- Ampicillin + gentamicin + 3rd generation cephalosporin
Most common organism in neonate meningitis?
- Group b streptococcal, E coli, Listeria
Neonatal hyperbilirubinemia
- Common
- Most cases are benign
Definition: total serum bilirubin above 5 mg/dl
Pathophysiology of physiological neonatal hyperbilirubinemia: in healthy newborn, unconjugated bilirubin transiently elevated during day 2 - 5 after delivery, due to turnover of fetal erythrocytes, and Usually return to normal over 1-3 weeks without intervention or adverse effects
Neurotoxicity: 1/10,000 inftants, symptoms include hyper/hypoTonia, back and neck arch, irritability, high pitch crying. This called acute billirubin encephalopathy. Most cases fully resolve but some can progress to kernicterus. ( Early: sleepiness and decrease alertness, poor sucking and feeding, hyperreflexia, hypotonia. Intermediate: Irritability, Hypertonica, arch, pitch. Advances: Pronotar spasm of upper extremities, apnea, coma
- No clear correlation between bilirubin level alone and risk of neurotoxcitiy. Risk factors: GA<38w. Hemolytic disease of newborn. G6PD. Albumin <3. Sepsis. Asphyxia. Acidosis. Clinical irritability in the past 24 h
Prevention: Screen all mother 28 weeks for Rh(D) status and ABO blood group.
Kernicterus: IRREVERSIBLE effect of bilirubin toxicity. 1/100,000 ( cerebral palsy, hearing loss, gaze paralysis, dental dysplasia, developmental disorders)
Hyperbilirubinemia examination: EVERY 12 Hrs from birth until hospital discharge. Jaundice usually not obvious in darker skin tone and clinician should check under tongue and sclera.
Bilirubin measurement: Transcutaneous bilirubin or Total serum bilirubin. Universal screening of newborns 35 GA. At 1-2 days of life or before if discharged sooner.
- if signs of acute bilirubin encephalopathy even if TSB doesn’t exceed phototherapy > exchange transfusion
- Risk of phototherapy:
Decrease exchange transfusion rate, but not show to decrease incidence of kernicterus. Short term SE is diarrhea and temp instability. Long term is increase seziure risk specially in male, and small risk of leukemia, renal and hepatic cancer. These risk highlight the importance to initiate phototherapy only in newborn excees 2022 AAP Threshold
Should decreased 0.5 mg per hour after initiation of phototherapy. If not occur. Hemolysis should be suspected for additional lab investigations if not done already.
There is a criteria for home phototherapy
BREAST FEEDING, AT LEAST 8-12 PER DAY, WITH brief interruption of phototherapy up to 30m at time to promote breast feeding.
Discontinue phototherapy when TSB at least 2mg less than phototherapy threshold
Well baby versus well child visit?
Baby: routine visits 2m-2y
Child: annually for 2-18 years
Microopthalmia main differntial?
Congenital Rubella synrome
- When does assessment for Head circumference start and ends?
- When does BMI start?
Birth till 2 years
BMI start at 2 years
Weight loss and doubling in infants?
- 10% loss in the first week of life “due to elimination of ECF”
- Regained by 2 weeks old
- infant should double up their birthweight by 6 months. And TRIPLE by 1 year
Corrected age of prematurity?
Correct only if chronological age is less than 37 weeks
How to corrected?; 40 - gestational age at birth = X
Assessed by 6months: 6 - X
When to stop corrected age?
2 years
Short stature
Bone age is equal to Chronological age
Growth velocity normal: Familial short stature (no delayed puberty in family) - skeletal dysplasia - Rickets
Growth volecity decreased: Chromosomal or genetic disorders “ down, turner “
Short stature
Bone age is LESS than Chronological age
Growth volecity is normal: Constitutional growth delay ( family history of delayed puberty )
Growth velocity is decreased: Growth hormone deficiency - OR - Psychosocial and Endocrine disorders and Chronic diseases
Short stature
Bone age is MORE THAN Chronological age
- Growth volecity usually initially increased but short adult
Normal: obesity, familial tall stature
Precocious puberty
CAH
Hyperthyroidism
Exogenous androgenic steriods
Short stature definition
Less than 5th percentile of height for age
Or more than 2 SD below the mean in height
What decrease first in Malnutrition versus Growth hormone defiency
Malnutrition: Weight first
GHD: Height first or same time as weight
RED FLAGS FOR DEVELOPMENTAL MILESTONES?
12m: No Babbling- Pointing - Gesture
16m: No single word
24m: No two-word phrases
At any age: loss of language or social skills
Reflexes and disapear?
- Stepping reflex (remember feets)
- Rooting/sucking reflex (remember time of introduction solid food)
- Palmer and Planter grasps ( remember 3+3 )
- Asymmetrical tonic reflex
- Moro reflex
- Stepping : 2m
- Rooting/sucking: 4m
- Palmer grasp: 3m
- planter grasp: 6m
- Asymmetric tonic reflex: 4m
- Moro reflex: 6m
When cow milk can be introduced?
After 1 year
To avoid risk of IDA
Galactosemia, congenital lactose defiency, and cow milk allergy?
Avoid lactose free formula
Go for soy based formula
Lactose free has no advantage over cow milk formula, EVEN for acute gastroenteritis or colic
When to stop formula?
No indication to continue formula beyoned 1 year age
1 year age is time for normal Cow milk
Iron supplements
1mg/kg/day
Starting from 4 months in breast feeding, or partially breast feeding (>50% of daily feed) till introduction of fortified iron food at about 6 months
Physical activity recommendations?
3-5 years: physically active throughout the day
6-17 years: 1 hour of moderate to vigorous activity
Killed or live vaccine?
All Viral vaccine are live except HI HI: Hepatitis A and B, IPV, inactivated Influenza
All bacterial vaccine are killed except TB: Typhoid, BCG
Vaccination schedule mnemonic
0m
2m
4m
6m
9m
12m
18m
24m
4-6y
Hey Baby 0
DR Handsome HIP 2
DR Handsome HIP 4
Really BaD Hip Hop 6
M&M 9
Old M&M Piece 12
Huda And Hasan MOVeD 18
HA! 24
MOVeD 4-6
Contraindication And Precautions to all Vaccines
Live: pregnancy and immunocompromised
All: CI (urticaria or anaphylaxis), precautions (moderate to severe illness with or without fever)
Dtap CI and Precautions?
CI:
- Encephalopathy within one week of Dtap administration, not caused by other cause
Precautions:
- GBS <6 weeks after previous dose
- Progressive neurological disorder
MMR CI and precautions
CI
- pregnancy or known immunodeficiency
- Precautions: 11month or less of antibody containing blood product receiving, thrombocytopenia, need TB testing
Rota virus CI and precautions
CI:
- Severe combined immunodefiency
- intusussception
Precautions:
- Chronic GI disease
- bladder extrophy
- spina bifida
Varicella CI and precautions
CI:
Immunodeficiency or pregnancy
Precaution:
AB containing blood product within 11m
Use of aspirin (rey syndrome)
Specific antiviral drugs 24h before vaccination “and avoid 2weeks after vaccination”
AAP recommendation for hearing screening
1 month of age
PLUS periodic hearing risk assessment throughout 4-10 years
AAP, AAFP, and USPSTS recommendation for visual screening
Amblyopia, starbismus, and visual acuity should be screened younger than 5 years of age ( usually between 3-4 years )
Then every 1-3 years throughout childhood and adolescent ( insufficient evidence in USPSTF )
Dentist referral?
Fluride ar 6m
Referral at 1y
Breastfeeding recommendations and benefit
- exclusive in the 6m, with food till 1 year, and after as desired
- colustrum: IgA and protein, lactoferrin
- mature milk: by day 5, 500ml/d
For infant, decrease:
Infection
Sudden infant death syndrome
Decrease risk of NEC
For children:
Decrease type2 dm, obesity, increase IQ, decrease risk of dental occlusion
For mothers:
Decrease PPH, decrease Ovarian, breast, and endometrial cancer, central obesity and metabolic syndrome
Contraindications for Breast Feeding
Infant factor:
- Type one galactosemia
Maternal factor:
- HIV
- Active herpes in the breast
- on Chemo or radiotherapy
- active drug or alcohol disorder
- untreated TB or Varicella
- human T-cell lymphotropic virus type 1 or 2
Storage of breast milk?
Freezer:
Up to 6 month, 12m is okay
Refigator:
Up to 4 days
Room temperature:
Up to 4 hours
If thawed “previously frozen”
Never refreeze it
1 day at refrigerator or 1-2h room temp
If leftover in the bottle: 2h then dispose
How to know the adequacy of beast feeding?
- amount of urine, 5-6 times/day at least
- amount of stool and frequency
- weight gain, 15-20 g / day in the first month
- sleep after feed, and breast is lighter
When pica needs to be investigated?
At two years and assess risk of IDA, lead poisoning, parasitic infection
Causes of secondary enuresis (dryness for 6m)
- Psycosocial
- DM
- UTI
- Constipation
More in girls and the primary more in boys
Needs U/S and urodynamic study
Swimming lessons at age of?
1 year
Seat belt in children
- up to 2y: rear
- 2y to 8y: forward
- 8 year: seat belt
