(SYNOPTIC) Neonates + Paediatrics COPY Flashcards
How should pain be assessed when they are unable to tell you verbally, i.e. a neonate?
Facial Expression?
0 - relaxed
1 - grimace
Crying?
0 - no
1 - whimper
2 - vigorous crying
Arms?
0 - relaxed
1 - flexed/ extended
Legs?
0 - relaxed
1 - flexed/ extended
Posture?
0 - relaxed
1 - flexed/ extended
State of arousal?
0 - asleep/ awake
1 - restless
Heart rate?
0 - baseline
1 - increase by 10-40BPM
2 - increase by ≥40BPM
Respiratory rate?
0 - baseline
1 - alteration in breathing
When observing pain of a neonate, and having allocated a score, how are the scores interpreted?
1-3: Nurse-controlled measure
- non-nutritive sucking
- repositioning
4-7: Consider sucrose/ alternative pain relief + nurse-controlled measures
8-10: Review with medical team
- discuss alternative prescription for pain relief
What is FLACC, with regard to pain?
Pain assessment score
Face
Legs
Activity
Crying
Consolability
What are some behavioural indicators of pain?
- Irritability
- Unusual quietness or lethargy
- Restlessness
- Sobbing, screaming or whimpering
- Increased clinging
- Loss of appetite
- Laying ‘scared stiff’
What are some physiological indicators of pain?
- heart rate
- respiratory rate
- blood oxygen
- blood pressure
Treatment for mild pain
Paracetamol
Treatment for mild to moderate pain
Paracetamol + NSAID
Treatment for moderate pain
Paracetamol + NSAID + codeine?? look at codeine cards
Treatment for severe and very pain
Paracetamol + NSAID + morphine
For what patient age group is codeine considered suitable?
Patients older than 12
For what patient age group is codeine contraindicated?
All children under 18yrs who undergo removal of tonsils/ adenoids
For the purpose of sleep apnoea
What do you do in suspected asthma?
Diagnosis and assessment
What do you do in diagnosed asthma?
- assess symptoms
- measure lung function
- check inhaler technique and adherence
- adjust dose
- update self-management plan
- move up and down as appropriate
What is the management of suspected asthma in neonates and paediatrics?
Initiation of treatment with very low-> low dose ICS
What is the management ladder of diagnosed asthma in neonates and paediatrics?
(1) Regular preventer
(2) Initial add-on therapy
- VERY low dose ICS
- ≥5 add LABA/ LTRA
- <5 add LTRA
(3) Additional controller therapies:
- Consider increasing ICS to low dose
- ≥5 add LABA/ LTRA
- no response to LABA: consider stopping
(4) Refer for specialist care
When would you consider moving up the ladder?
If using 3 doses or more a week
If child is at 5 and still have symptoms what would we do?
Objective tests
- FeNO
- Spirometry
- Bronchodilator reversibility
Monitor peak flow for 2-4 weeks if there is diagnostic uncertainty
FeNO
35ppb or more
Spirometry
FEV1/FVC ratio < 70%
What is LTRA treatment?
Leukotriene receptor antagonist therapy
What dose of beclometasone dipropionate is considered to be a very low dose for use in children?
50 microgram
2 puffs
BD
What dose of beclometasone dipropionate is considered to be a low dose for use in children?
100 micrograms
2 puffs
BD
What dose of beclometasone dipropionate is considered to be a medium dose for use in children?
200 micrograms
2 puffs
BD
Why should you use a spacer with your child’s inhaler?
- Spacers help get medicine into the lungs more effectively
- Stop meds from sticking to the back of the mouth
- Reduces risk of thrush and sores
Management of moderate asthma in A+E: 1st line
- Give b2 bronchodilator (e.g. salbutamol) via spacer
- Oral prednisolone 30-40mg
- Reassess within 1 hour
Management of acute severe asthma in A+E: 1st line
- Give O2 via face masks/nasal pongs to achieve SpO2 94-98%
- B2 bronchodilator via nebuliser (pref oxygen-driven), salbutamol 5mg (or via spacer if nebuliser unavailable)
- Oral prednisolone 30-40mg or IV HC 4mg/kg if vomiting
Poor response:
- add nebulised 0.25mg ipratropium to every nebulised B2-bronchodilator and repeat every 20 mins for 2 hours according to response
Main treatments to give when someone presents to emergency room with acute asthma (asthma attack)
- Oxygen
- B2 agonist
- Oral steroids
- Ipratropium
What is the treatment for mild atopic eczema in children?
- emollients: ensure SLS free. Thought to irritate skin by stripping natural oils
- mild topical CS: HC
What is the treatment for moderate atopic eczema in children?
- emollients
- moderate topical corticosteroids (betamethasone/ clobetasone)
- topical calcineurin inhibitors (tacrolimus, pimecrolimus)
- bandages
What is the treatment for severe atopic eczema in children?
- emollients
- potent topical CS (betamethasone/ mometasone)
- topical calcineurin inhibitors
- bandages
- phototherapy
- systemic treatment
Name some side effects of systemic corticosteroid use.
- impairment of growth and healing
- fluid retention
- osteoporosis
- weight gain
- peptic ulcers
- altered mood/ psychosis
- electrolyte imbalances
- blood glucose increase
Name some side effects of topical corticosteroid use.
TOPICAL
* may thin skin if very potent
SYSTEMIC
* Osteoporosis
* weight gain
* peptic ulcers
- if used on younger children, may get systemic exposure via skin
When should oral antihistamines be offered to children with eczema?
Not to be used routinely
Offer 1 month trial of NON-SEDATING to children with SEVERE atopic eczema/ severe itching
Offer 7-14 day trial of SEDATING if ≥6 months with sleep disturbance
What is the first line treatment for secondary infections of eczema in children?
- Flucloxacillin, Erythromycin
- if penicillin allergy - Topical treatment with Abx only if infection is localised (max 2 weeks)
What is the treatment for a meningitis infection in children?
Broad spectrum ABx
(1) Cephalosporin: use does in hgih end of range to ensure effective treatment
- ceftriaxone
- cefotaxime
(2) Add amoxicillin for babies <3 months
What is a potential complication of this drug when used in children?
Chloramphenicol
Neonates liver is not mature enough to metabolise correctly.
Can result in grey baby syndrome
What is a potential complication of this drug when used in children?
Sulfonamides
Kernicterus in neonates
- Brain damage due to high levels of bilirubin in blood
What is a potential complication of this drug when used in children?
Ceftriaxone
Kernicterus in neonates
- Brain damage due to high levels of bilirubin in blood
Forms precipitate with calcium
What is a potential complication of this drug when used in children?
Nitrofurantoin
Haemolytic anaemia in children <3 months
What is a potential complication of this drug when used in children?
Tetracyclines
Bind to calcium in growing bones + teeth
Causes discolouration
What is a potential complication of this drug when used in children?
Quinolones
Arthopathy in children
- joint disease
What are some common reasons for having to admit term babies?
- Hypoglycaemia
- Hyperbilirubinaemia
- Infection
- Poor feeding
- Asphyxia during birth
What are some common issues for preterm babies?
- hypoglycaemia
- electrolyte imbalance
- hyperbilirubinaemia
- infection/ necrotising colitis
- respiratory distress syndrome
- patient ductus arteriosus
ø condition where blood flows back to lungs from heart - intraventricular haemorrhage
Newborn respiratory distress Syndrom (NRDS)
- baby’s lungs are not fully developed
- cannot provide enough oxygen
- causing breathing difficulties
- usually affects premature babies.
Curosurf
- Poractant alfa
- Reduces initial oxygen and ventilation requirements
- Most babies are born with surfactant that lines the lungs and stops them from sticking together, making normal breathing possible.
- Curosurf given to babies that don’t have this
Why is vitamin K injection prescribed to all babies
- All babies, not just premature ones
- Babies have low levels of vitamin K at birth which can lead to bleeds in the brain
- Vitamin K protects them from this risk of high bleeding
Why is vitamin K given IM?
- Vitamin K is a fat soluble vitamin
- IM it will act as a depot
- Provide longer term protection than oral or IV
- Works better IM but can be given orally if parents wishes
Why might maternal breastmilk not be nutritionally sufficient for preterm babies - PHOSPHATE
- Phosphate essential for bone growth and mineralision; deficinecy frequent in preterm infants
- Preterm infants fed exclusively on breast milk, which is relatively phosphate poor
- Should recieve PO phosphate supplementation
- Plasma phospahte levels should be checked regularly to guide supplementation
Why might maternal breastmilk not be nutritionally sufficient for preterm babies - VITAMIN D
- Vitamin D important for bone mineralisation
- In preterm neonates, all vit D obtained from dietary sources
- Most infants receiving milk feeds will require some form of vit D supplementation, normally administered in a combination multivitamin product (eg, Abidec).
- e.g. Abidec
Why might maternal breastmilk not be nutritionally sufficient for preterm babies - IRON
- For preterm babies w/ symptomatic anaemia iron supplementation is used infrequently as these babies often recieve blood transfusions
- However, breast-fed preterm infants will commonly be discharged home on oral iron supplements (eg, Sytron – sodium feredetate) to prevent iron deficiency anaemia developing at home during the first year of life.
- Formula milk is manufactured with additional iron content so ex-preterm babies discharged on formula feeds generally do not need supplementation
Why might maternal breastmilk not be nutritionally sufficient for preterm babies - SODIUM
- Sodium is required for consistent linear growth
- Preterm beenfits may need sodium supplementation, either IV or oral
Abidec
Multivitamin containing vit D
pre-term 0.6mL
term 0.3mL
daily
Sytron
Sodium feredate
1mL daily start 4-6 weeks after birth
