PEDIATRICS

Dr. Singaram Ashok

 GROWTH AND DEVELOPMENT
I size MENTAL DEVELOPMENT

GROWTH DEPENDS ON

• NUTRITION

• HORMONES GH → ACT ONLY AFTER 1 YEAR

→ STEROIDS THYROID

→ INSULIN → MI FOR FETAL GROWTH

• GROWTH FACTOR → IGF I -

( INSULIN LIKE GROWTH FACTOR)

> MI GROWTH FACTOR

PRENATAL PERIOD

OVUM → 0-2 weeks

EMBRYO → UPTO 8 weeks

FETUS → 9 WEEK ONWARDS

PERINATAL PERIOD

→ FROM 22 weeks GESTATION TO 7

DAYS

AFTER BIRTH

→ THIS IS THE VIABILITY PERIOD ( SURVIVAL)

POSTNATAL PERIOD

NEWBORN → O -
4 WEEKS

INFANCY → FROM BIRTH TO HEAR

TODDLER → I - 3 YEAR
PRESCHOOL PERIOD -73 - 6 YEARS

SCHOOL AGE → 6- 12 YEARS

ADOLESCENCE → 10-19 YEARS

EARLY → 10 -
13 YEARS

MID → 14 -
16 YEARS

LATE → 17 - 19 YEARS

PUBERTY → DEVELOPMENT OF 20 SEXUAL CHARACHTERISTICS

SEQUENCE OF PUBERTAL CHANGES

FEMALES → THE LARCH E

t
PUB ARCHE
tr
MENARCHE

MALES -7 A SIZE OF TESTIS

t
PENILE ENLARG MENT
to
PUBARCHE
I
APPEAR ENCE OF FACIAL AND AXILLARY HAIR .

SMR → SEXUAL MATURITY RATING

TANNER 'S SMR → STAGE I -

II

BRAIN GROWTH

9040 BY 24 EARS
( BODY)

-
SOMATIC GROWTH
9
0/0
'
ADULT
I

SIZE
l

l
l

'
I ! :( 10 -
12 YEARS )
,
{ I 6 'S AGE (YEARS)

PERIODS OF RAPID GROWTH → GROWTH SPURT → i → 0-2 YEARS

→ 2 → > 10-12 years

 PUBERTAL GROWTH SPURT

HEIGHT GAIN → lb -
2b cm in FEMALE

→ 20 - 30 cm in MALE

→ FINAL HEIGHT IS MORE IN MALES

-
-
- - -
-

200 #

ADULT i
100 -
i

SIZE ,
i

1
1

50 l l
l l

I I
'

s 's AGE

IN BETWEEN 4- 8 YEARS ÷

TONSILS
ADENOIDS BIG SIZE

LYMPH NODES -

THIS IS CALLED PHYSIOLOGICAL LYMPHOID HYPERPLASIA

AS SEGMENT OF GROWTH

•
ANTHROPOMETRY :
-

→ WEIGHT -7 Avn BIRTH WT -73 KG

101 .
WT LOSS
✓
10 DAYS REASON : LOSS OF ECF

REGAIN BIRTH WEIGHT -7 14 DAYS

'

^
20-309 DAY A 3 months
✓

✓ T 400g MONTH AFTER 3 MONTHS TILL I YEAR

AFTER 1 YEAR → STEADY BIRTH WEIGHT -

2kg YEAR

5- 6 MONTHS → DOUBLE BIRTH WEIGHT

1 YEAR → TRIPLE BIRTH WEIGHT

→ APPROX WEIGHT OF A CHILD AFTER # YEAR → AGE X 2 + 8

 HEIGHT LENGTH

LENG H TH IS MEASURED TILL 2. YEAR WITH INF ANTO METER

HEIUHT IS MEASURED WITH STADIOMETER

AT BIRTH → 50 CM

f t 25cm

AT 1 YEAR → 75 CM

I + 12.5 cm

2 YEAR → 87.5cm

AFTER 2 YEARS STEADY INCREASE OF 6cm YEAR

APPROX EXPECTED HEIGHT OF A CHILD →

AGE
(YEARS) x G t 77

DOUBLING OF HEIGHT → 4 YEARS

TRIPLING OF HEIGHT -7 12 YEARS

CIRCUMFERENCE

HEAD CIRCUMFERENCE He

•
OCCIPI TO FRONTAL

• MEASURE OF BRAIN GROWTH

• AT BIRTH → 35 cm

2cm ) month x 3 MONTHS

✓

AT 3 MONTHS -7 41cm

lcml Month x 3 months

✓

AT 6 MONTHS → 44 cm

AT 1 YEAR → 47 CM

V
AT 2 YEAR → 49 cm

CHEST CIRCUMFERENCE cc

• MEASURED AT 4th INTERCOSTAL SPACE

• IT SHOWS OVERALL NUTRITION STATUS OF BABY

• AT BIRTH → He > CC

( 2.5cm )
• AT 1 YEAR → He = CC

• I TEAR → CC HC
 MID ARM CIRCUMFERENCE MAC

• IT IS AGE INDEPENDENT -7 I -
5 YEARS

• N IS 15 -
17 CM

• IN MALNUTRITION → 13.5cm

• IN SEVERE MALNUTRITION → L 11.5 CM

• IT IS MEASURED BY → SH Akers 3 COLOURED TAPE

• SKIN FOLD THICKNESS MEASUREMENT -7 HAR PENDER'S CALIPER

→ FOR MEASURING FAT

→ Iv SHOWS MALNUTRITION

→ MC AREA IS TRICEPS REGION

BODY PROPORTION
HEAD

UPPER SEGMENT → TO CHECK SPINAL COLUMN

→
us

t
PUBIS
[

→ TO CHECK LONG BONES

LOWER SEGMENT
→ LS

LEG

US : LS RATIO

1.7 : I
AT BIRTH →

→ 1.3 it
AT 3 YEARS
7- 10 YEARS -7 l : I
AT
> 10 YEARS → 0.9 : l

DENTAL ASSES MENT

DENTITION 20 DENTITION

TOTAL 20 32

FIRST LOWER CENTRAL INCISORS 1st MOLAR

TIME 6 MONTHS 64 EARS

* *
• 6 -
12 Yeats → MIXED DENTITION
 DELAYED DENTITION

•
No APPEARENCE OF TEETH EVEN AFTER → 213 MONTHS

• CAUSED BY → IDIOPATHIC → MCC

→ MALNUTRITION ,
RICKETS
→
HYPOTHYROIDISM
→ DOWN SYNDROME

GROWTH CHART

WHO CHART → GROWTH AS SEGMENT AND MONITORING TOOL

PINK → GIRLS BOYS → BLUE

• W H

• H A

• W A
• HC

• BMI
• SKIN FOLD THICKNESS
•
MID ARM CIRCUMFERENCE CHART

PERCENTILE → POSITION OF A CHILD IN A GIVEN POPULATION

MAJOR PERCENTILES-7 .

I, t a tr I
3Rd 15M b- Oth 85lb 97
th

r TALL STATURE +25 D

HIGH x
x

+
+ ISD
×
t

N
th STANDARD
91 x x
x

x - ISD
th
HEIGHT T 8 's
x
x

gon )
×

x
5- 2 SD

't A
15
×

SHORT STATURE
3rd
✓

3yd In Ess ages

AGE →

STANDARD DEVIATION → DEVIATION FROM b- Oth PERCENTILE

• EXCEPTION → MICROCEPHALY
H L L -
3 SD

BMI
WT KG

m2 ]
-

H T
 DISORDERS OF GROWTH

SHORT STATURE → HEIGHT FOR AGE BELOW -

LSD FROM MEAN

SHORT STATURE

v v

I -7 N VARIANT PATHOLOGICAL
2→

3rd
3rd percentile

H x
" "

t
, H
f
t -
t t
t x x
←
t t
f
t t
t
T t
+

A
A

GROWTH VELOCITY IS N GROWTH VELOCITY IS ABNORMAL A- BSCENT

1-7 N VARIANT

v V

CONSTITUTIONAL DELAY FAMILIAL

3rd

-
3rd

19yd 19 yes

• ADULT HEIGHT IS N • ADULT HEIGHT IS SHORT

• PARENTS N • PARENTS ARE SHORT

• PUBERTY IS DELAYED • PUBERTY IS N

• BONE AGE IS DELAYED • BONE AGE N

2-7 PATHOLOGICAL SHORT STATURE

• ASSO E CHRONIC MALNUTRITION CSHUNTING ) ; RICKETS

GENETIC SYNDROME DOWN SYNDROME EXCEPT -7 KFS i 47 XXY
•
Eg :

• BONE DISORDERS Eg : ACHONDROPLASIA

• ANY CHRONIC ILLNESS

• HORMONE I → + BONE AGE PRECOCIOUS PUBERTY -7 ADVANCED BONE AGE

BONE AGE

→ BASED ON it

1. APPEARENCE OF OSSIFICATION CENTRE

I. FUSION OF EPIPHYSIS
 X RAYS FOR
- BONE AGE ASSES MENT

AHE X-RAY

•
NEW BORN . KNEE

• 3-9 MONTHS . SHOULDER

. I - 13 YEARS .
HANDS AND WRIST (CARPAL BONES)
. 12 - 1h YEARS . ELBOW AND HIP

CHRONOLOGICAL AGE : ACCORDING TO DOB

• DELAY IN BONE AGE → BONE AGE L CHRONOLOGICAL AGE

•
MALNUTRITION
• Iv HORMONE
CONSTITUTIONAL N VARIANT
•
DELAY →

BODY PROPORTION
Eg :

N → 1.3 : I → 3 yes

SHORT

1.3 :L v
V
DISPROPORTIONATE
PROPORTIONATE
All N VARIANT
Eg : i
* *
•
MALNUTRITION ✓ ✓

US AFFECTED LS AFFECTED
• GH DEFICIENCY
(SHORT TRUNK SHORT )
STATURE (SHORT LIMB SHORT STATURE

+ RATIO T RATIO
✓
V
Mn : ARC
Eg : VERTEBRAL DISORDERS
ACHONDROPLASIA
Muc OPOLYSACCAROIDOSIS RICKETS
CONGENITAL HYPOTHYROIDISM
im ** *

TURNERS SYNDROME NOON ANS SYNDROME

45 XO AD DISEASE

KARYOTYPE GIRLS BOTH BOYS AND GIRLS AFFECTED

IQ N LOW IQ ( INTELLECTUAL DISABILITY )

BOYS : CRYPT ORCHID15ha
STREAK OVARIES
GONADS → AMENNHORIA -
DELAYED PUBERTY
→ INFERTILITY - DECREASED FERTILITY

DEFECT **
ASSOCIATED L SIDED HEART DEFECT R HEART

ANOMALIES → BICUSPID AORTIC VALVE PULMONARY STENOSIS

→ COARCTATION OF AORTA

K F S → •
TALL STATURE

•
CRYPT ORCHID ISM
• LOW IQ

TALL STATURE SEEN IN .

•
CONSTITUTIONAL DELAY
Tg
• KFS
• GIGANTISM [ PITUITARY ADENOMA TTGH]

ARM SPAN > > HEIGHT SEEN IN

→ MARIANS SYNDROME

→ HOMOCYSTENVRIA

MARFAN SYNDROME HOMOLYSTENURIA

INHERITANCE AD AR

FIBRIL LIN DEFECT I CYSTATHIONEB SYNTHASE

LENS DISLOCATION SUPER 10 TEMPORAL INFERIO NASAL

IQ N T

JOINTS Lax STIFF

 DEVELOPMENT -7 MATURATION OF FUNCTION

DOMAINS
I → GROSS MOTOR

I → FINE MOTOR

LANGUAGE
III →

II → SOCIAL

I → GROSS MOTOR DEVELOPMENT → CEPHALO CAUDAL PROGRESSION

3 MONTHS → HEAD CONTROL ( NECK HOLDING)

4 -
6 MONTHS → ROLL OVER

6 MONTHS -7 SIT WITH SUPPORT

8 MONTHS → SIT WITHOUT SUPPORT ,

CRAWUNH

10 MONTHS -7 STAND WITH SUPPORT ,

CREEPING

12 MONTHS → STAND WITHOUT SUPPORT

15 MONTHS -7 WALK INDEPENDENTLY

18 MONTHS → RUNNING
PER STEP CLIMBING
2 YEARS → 2 FOOT

3 YEARS → I FOOT STEP UPSTAIRS ,

RIDING TRICYCLE

→ I FOOT STEP DOWNSTAIRS

4 YEARS

II → FINE MOTOR MOVEMENT

1. GRASP
2. WRIT INN DRAWING
3. DRESSING SKILL

3 MONTHS → HANDS CLOSED [PALMAR GRASP REFLEX)

4 MONTHS -7 131 DEXTRO VS GRASP

GMO NTHS → UNIDEXTROUS GRASP IMMATURE ULNAR ,

PALMAR GRASP TRANSFER OBJECT
,

8 MONTHS → MATURE (RADIAL] PALMAR GRASP

10 MONTHS -7 IMMATURE PINCER GRASP

12 MONTHS → MATURE PINCER GRASP

15 MONTHS -7 SCRIBBLING
18 MONTHS →

2- YEAR →
J→ DRAW LINE

3 YEARS → CIRCLE

2 YEARS -7 UNDRESSING
[ ] HEARS → cross PLUS t
4112 YEARS -7 SQUARE
" "
3 YEARS -7 DRESSING
" "
¥ b- YEARS → TRIANA LE
** *
b- YEARS → WITHOUT ANY HELP 6-7 YEARS → DIAMOND
III → LANGUAGE DEVELOPMENT

3 MONTHS → COOING SOUND

4 MONTHS → LAUGHING SOUND

6 MONTHS → SINGLE MONOSYLLABLE (MA ,

PA)

9 MONTHS → DISYLLABLE (PAPA , MAMA)

12 MONTHS → I -
2 WORD WITH MEANING

15 MONTHS → JARGON SPEECH

18 MONTHS → 8 -
10 WORDS E MEANING
2 YEARS → 2. WORD SENTENCES
**
3 YEARS → NAME AGE GENDER
, ,

4 YEARS → TELL STORY RHYME

,

II → SOCIAL MILESTONE DEVELOPMENT

2 MONTHS → SOCIAL SMILE

3 MONTHS → MOTHER REGARD

6 MONTHS → STRANGER ANXIETY, SMILES AT MIRROR

9 MONTHS → BYE -
BYE

14 EAR → SIMPLE BALL GAME

15 MONTHS → JARGON SPEECH
18 MONTHS -3 DOMESTIC MIMICRY
3 YEARS → PARALLEL PLAY

4 YEARS → GROUP PLAY

BEHAVIORAL DISORDERS IN CHILDREN

→ PILA

→ TEMPER TANTRUMS 234125

→ BREATH HOLDING SPELL

→ Tics

→ BRUXISM (TOOTH GRINDING )

→ NOCTURNAL ENURESIS

PICA
→ EATING INEDIBLE OBJECTS THINGS INAPPROPRIATE FOR AGE DEVELOPMENTAL AGE

→ ASSOCIATED WITH IRON DEFICIENCY ANEMIA

→ PROBLEMS
I -
MALNUTRITION

2. WORM INFECTION

3. LEAD POISONING

→ TREATMENT
-
IRON

-
ALBENDAZOLE
BREATH HOLDING SPELLS

→ SEEN IN CHILDREN 23 YRS

→ IT OCCURS DURING EXPIRATION SO BREATH HOLDING IS A MISNOMER

→ ASSOCIATED WITH IRON DEFICIENCY .

> CYANOTIC BREATH HOLDING SPELL

INITIAL EVENT → CYANOSIS 1- SEIZURE LIKE MOVEMENTS

CRY + t → NO EYE DEVIATION

→ NO POST KTAL PERIOD

HOLDING BREATH NORMAL EEG

PALID SPELL
>
→ WHITE (PALE)
→ SUDDEN LOSS OF CONSIOVSNESS

→ SYNCOPE LIKE EPISODES

NOCTURNAL ENURESIS
→ NIGHT WETTING > b-YRS

✓ EoMN v

10 20
( SINCE BIRTH ) ( PREVIOSLY NORMAL CHILD )
→ MATURATIONAL DELAY IN BLADDER → UTI

→ RX : NON PHARMACOLOGICAL → DM
•
BEHAVIORAL MODIFICATION → DI (t ,
)
ADH

• BED ALARM THERAPY

IF IT FAILS

→
• DRUG
-

. DESNIOPRESSINCADH)
 NUTRITION

BREAST FEEDING START AS SOON AS POSSIBLE

GOOD ATTACHMENT -7 LATCHING

→ WIDE OPEN MOUTH

→ LIPS EVER TED

→ NIPPLE AND AREOLA INSIDE BABYS MOUTH (UPPER AREOLA MAYBE VISIBLE )

EXCLUSIVE BREASTFEEDING → ONLY BREAST MILK UPTO 6 MONTHS

PROLACTIN REFLUX

→ PRODUCTION OF MILK
( GALACTOPOESIS)
→ ACTIVE IN BETWEEN FEED IN h

→ SECRETION IS MORE AT NIGHTTIME

OXYTOCIN REFLUX
→ EJECTION OF MILK (GAL ALTO KINE SIS) BY CONTRACTION OF 1940 EPITHELIAL CELLS

→ NO DIURNAL VARIATION

IMMUNOLOGICAL PROPERTIES OF BREAST MILK

→ IgA (SECRETORY )
Mn : PLA B

P→ Low LEVELS OF PABA (PARA PROTECTS FROM MALARIA

AMINO BENZOIC ACID →
)
L → LACTOFE RIN → PROTECT FROM E- COLI

A →
IgA
B PROTECT FROM E
1,331ft
→ DANS FACTOR - -
COLI

ILE SALT PROTECT FROM GIARDIA SIS

-

NUTRITION OF BREAST MILK .

ENERGY → 67 KCAL 100mL → SAME IN COW MILK

COW MILK HUMAN MILK

CARBOHYDRATES to A

PROTEIN T 4

FAT SAME SAME

CARBOHYDRATES
→ MORE IN BREAST MILK

LACTOSE

V V

GLUCOSE
GALACTOSE
in a

\ I
,
t
\
< ,

→ LACTOSE PRODUCE LACTOFERRIN

→ LACTOSE PRODUCE LACTOBACILLUS

PROTEINS
→ LESS IN BREAST MILK TIMES LESS )
→ BREAST MILK PROTEIN ARE EASILY DIGESTED

→ WHEY PREDOMINANCE

→ WHEY PROMOTE BRAIN GROWTH

→ AMINO ACID IN BREAST MILK IS TAURINE AND CYSTEINE

→ COW MILK IS CASEIN PREDOMINANT

→ LESS EASILY DIGESTED

→ CASEIN IS ALLERGIC
**
→ ( MPA (COW MILK PROTEIN ALLERGY )

FATS
→ BREAST MILK = COW MILK
→ POLYUNSATURATED FATTY ACID
(PUFA) IS MORE IN BREAST MILK
,
THEY PROMOTE BRAIN GROWTH

→ eg : DHA

ARA
'

DEFICIENCIES OF BREAST MILK .

→ Vit K

→ Vit D
Vit 13,2 (IN VEG MOTHER
)
→ IRON

CONTRAINDICATIONS OF BREAST FEEDING

V U

ABSOLUTE RELATIVE

BABY : → HIV

→ LACTOSE INTOLERENCE (l ) → TB

→ GALACTOSEMIA → IF MOTHER NOT TAKING

MOTHER : RX

RADIO CHEMOTHERAPY → HERPES INFECTION

→
 COLOSTRUM TRANSITIONAL MILK MATURE MILK
q r

BIRTH RICH IN IgA 3 DAYS 14 DAYS

FORE MILK HIND MILK

→ RICH IN WATER → THICKER SLIGHTLY YELLOWISH

→ SATISFY THIRST → RICH IN FAT

→ SATISFY SATIETY

EXPRESSED BREAST MILK STORAGE

IN ROOM TEMPRATURE → 6 8 hours

-

IN REFRIGERATOR → 24 hours

IN FREEZER f-20°C) -7 3 MONTHS

BUFFALO MILK → HMH ENERUY FAT ,

PROTEIN
,

BUFFALO MILK → HIGHEST CALCIUM PHOSPHOROUS

BREAST MILK → HIGHEST CARB

imp
MALNUTRITION

PEM = PROTEIN ENERGY MALNUTRITION

WHO CLASSIFICATION OF MALNUTRITION

V
DURATION severity

v
r

ACUTE CHRONIC MODERATE SEVERE

WEIGHT It → HEIGHT It -2 To -3 SD L -
3513
→
WASTING → STUNTING → B L PEDAL EDEMA
→

FOR HEIGHT CHART → HEIGHT FOR AGE CHART

→ WEIGHT

-
2 SD

^
MODERATE
-3512
✓
^
SEVERE

SAM (SEVERE ACUTE MALNUTRITION )

1. WH L -
3513
2 . B L PEDAL EDEMA -7 CALLED Dx OF EXCLUSION (RULE OUT HEART RENAL LIVER FAILURE
, ,
)
3. MID ARM CIRCUMFERENCE L II. 5cm [6190 NTH - 5 YEARS ]

IF ANYONE OF THESE THREE IS PRESENT IT SHOWS SAM

KWASHIORKOR = KINASHIOS = DISPLACED CHILD

MARASMUS (ADAPTIVE STARVATION ) KWASHIORKOR (DIS ADAPTATION) .

AGE OF ONSET AT OR SOON AFTER BIRTH AROUND 1 YEAR

DEFICIENCY CALORIE th PROTEIN did, (ALBU IN )

ONCOTIC PRESSURED,
I
E- DE MA

EDEMA
-
t t

WASTING PROMINENT + t MASKED BY EDEMA + t

APPEARENCE ALERT LETHARGIC

APPETITE AND POOR

GOOD
OUTCOME

OTHER FEATURES - 3 't 's → FATTY LIVER

→ FLAG SIGN
→ FLAKY PAINT DERMATOSIS
imp
RICKETS
→ Caused BY VIT D DEFICIENCY

→ CAUSES di MINERALISATION OF BONES

→ RESULTS IN → I -
SHORT STATURE

I -
DEFORMITIES

TI -
DELAYED DENTITION

DEFORMITIES OF RICKETS .

HEAD → CRANIOTE BES (SOFT SKULL ; PING PONG BALL CONSISTENCY )

→ SOFT SKULL ALSO SEEN IN SYPHILIS AND OSTEOGENESIS IMPERFECTA

→ FRONTAL BOSSING

CHEST → CHOSTOCHONDRAL JUNCTION SWELLINGS IN RIBS CALLED AS RACHITIC ROSARY APPEARENCE

OR STRING OF BEAD APPEAR ENCE

→ HARIS SON SULCUS GROOVE → DIAPHRANI MOVEMENTS SEEN OUTSIDE

EXTREMETIES → GENU HARUM → BENDING OR BOWING OF LEG

→ GENU VACUUM -7 KNOCK KNEES

→ VALGUS t HARUM -3 WINDSWEPT DEFORMITY

INVESTIGATION OF RICKETS

is . Ca → e

→ t
-
S Poy
ALP
'

→ in
'

i. PTH → in

25 (OH) CHOLECALCIFEROL - V

X RAY-
IN RICKETS

→ BEST INVESTIGATION

→ SPLAYING → LATERAL DEVIATION OF END OF A BONE

→ FRAYING → IRREGULAR END OF LONG BONE

→ CUPPING
RX OF RICKETS
→ Vet D - 3-6 Lakh 1. U

→ 60,000 IV DAILY x 5- 10 DAYS

→ STOSS REGIMEN → SINGLE DOSE OF VIT D INJECTION IN

→ HEALING WHITE LINE → SEEN IF PATIENT IS RESPONDING TO TREATMENT

SCURVY
→ Vit C DEFICIENCY

WEAK COLLAGEN
Inn →

VIT C HYDROXYLATION

+ PROLINE LYSINE
,
✓

HELIX STRONG COLLAGEN

ThNNN- TRIPLE

VIT C ly
t
WEAK COLLAGEN

t
BLEEDING

1. GUM BLEED
2. PERI FOLLICULAR BLEED
3. SUBPERIOSTEAL BLEED (PSEUDO PARALYSIS )
 CHROMOSOMAL DISORDERS

TRISOMIES 21 18 13

→ DOWN SYNDROME EDWARD SYNDROME → PAT AU SYNDROME

• NIL TRISOMY IN ABORTIONS → TRISOMY 16

• NIL CHROMOSOMAL ABNORMALITY IN ABORTIONS → TURNER SYNDROME (45×0)

MI SEX CHROMOSOMAL ANEUPLOIDY KLEINFELTER S SYNDROME
•
→
(47 xxx )
• MC CHROMOSOMAL ANEUPLOIDY → TRISOMY 21 DOWNS SYNDROME

TRISOMY -21 → DOWNS SYNDROME

→ MC CAUSE IS MATERNAL MEIOTIC NONDISJUNCTION CNDDM )

→ ALSO ELDERLY MOTHER 735 YRS RISK IS 41 .

→ RISK OF TRISOMY 21 IN PREGNANCY IS lit .

FEATURES OF DOWNS SYNDROME

IN FACE ÷
1. MON HOLO ID SLANT

2. BRUSH FIELD SPOTS IN IRIS

3. BLUE DOT CATARACT OR CERULEAN CATARACT BUT DOES NOT AFFECT THE VISION
,

4. EPKAN THAL FOLD NEAR EYE

5- LOW SET EARS

6. PROTRUDING TONGUE DUE TO SMALL MANDIBLE

IN EXTREMITIES : .

1- SIMIAN CREASE (SINGLE TRANSVERSE PALMAR CREASE )

IN LEG :

I -
SANDAL GAP

2. KENNEDY CREASE IN SOLES

IN HEART : -

1. ATRIOVENTRICULAR SEPTAL DEFECT

AKA ENDOCARDIAL CUSHION DEFECT

IN GIT : .

I -
INTESTINAL ATRESIA (NO PROPER GROWTH )
2- ML is DUODENAL ATRESIA
 → THEY HAVE INCREASED RISK OF HYPOTHYROIDISM

→ THEY GET PRE SENILE ALZHEIMERS DISEASE → IN Ch 21 → AMYLOID PRECURSOR PROTEIN ( APP)
→ THEY HAVE T RISK OF CANCERS ; Mc IS ALL ( LYMPHOBLASTIC)

ANTENATAL DETECTION OF DOWNS SYNDROME

→ SCREENING

→ IN USG ; TNT (NUCHAL THICKNESS TKANSLUSCENCY )

→ SERUM MARKERS

→ PAPP A → PREGNANCY ASSO PLASMA PROTEIN A

-
DONE IN FIRST TRIMESTER CALLED AS
\

DOUBLE TEST
→ BHLH → HUMAN CHORIONIC GOHAD OTRO PHIN

→ Btech → HUMAN CHORIONIC GONADOTROPIN N SECOND TRIMESTER CALLED AS

DONE IN

→ AFP TRIPLE TEST

→ UN CONJUGATED ESTRAIOL

' '

→ TRIPLE TEST t INHIBIN A -7 QUADRUPLE TEST

IMP
pan : High

THC Cr TINHIBIN
→ ALL OTHERS ARE DECREASED

→ AMNIOCENTESIS

→ Cvs ( CHORIONIC VILLI SAMPLING) -705 -

l 't .
RISK OF ABORTION

EDWARD SYNDROME → TRISOMY 18

Mn : EDWARD

E → ELONGATED OCCIPUT
D -7 DIGITS OVERLAPPED

IN -7 VENTRICULAR SEPTAL DEFECT

A → APNEA [RESP FAILURE → CAUSE OF DEATH ]

12-7 ROCKER BOTTOM FEET

D -7 DISABILITY ( INTELLECTUAL)
 PATAV SYNDROME → TRISOMY 13

→ POLYDACTYL I

→ CLEFT PALATE

→ CLEFT LIP

→ APLASIA CUTIS

→ VSD

→ MC GENETIC CAUSE OF LOW IQ → DOWN SYNDROME

→ MC INHERITED CAUSE OF LOW IQ → FRAGILE X SYNDROME (X LINKED RECESSIVE )

FRAGILE X SYNDROME

Mn : FRAGILE

f- → FACE (ELONGATED) ; FMRI GENE

R -7 RECESSIVE (X LINKED)
A → T RISK OF AUTISM ADHD
G -7 GONADS (MACRO ORCHID ISM ) C -
CONGENITAL

G- GIANT

G -
GONAD
I -7 INTELLECTUAL DISABILITY
[→ LARGE EAR

E- →

X -7 X ch ( long Aom 9)
 NEWBORN

EARLY NEWBORN
→ 1st 7 DAYS

→ AT RISK PERIOD FOR NEONATAL MORTALITY

LATE NEWBORN

→ DAY 8 - 28

TILL 36 Wk
PRETERM 6 DAYS TERM POST TERM
11 1

37 Wk 42 Wk

→ 228 wks
→ EXTREME PRETERM
→ AVG WT → 3kg
LBW → L2
→ -

5kg
→ V LBW → < 1.5kg
→ EL Blat L
→
1kg
→ BIG BABY (MACRO SONIA) → > 4kg

WEIGHT ACCORDING TO GESTATIONAL AGE

LGA → LARGE

AG A → APPROPRIATE
SGA → SMALL

^ LGA 9 Oth PERCENTILE

AGA

B. WT
U 'd
r IO PERCENTILE

SGA

GESTATIONAL AGE

SGA (SMALL TO GESTATIONAL AGE ) ( less THAN I Oth PERCENTILE )

PATHOLOGICAL → l UU R =
MALNUTRITION
=
EVIDENCE OF WASTING

N VARIANT = LOOKING LIKE NORMAL BUT SMALL

( CONSTITUTIONAL )
 IUGR
b -

common n v

MATERNAL (PLACENTAL INSUFFICIENCY) FETAL

Eg : INFECTION Eg : ANOMALIES
→ HYPERTENSION → ONSET IS 1ST TRIMESTER

→ BLEEDING PLACENTA → NO BRAIN SPARING

ONSET → LATE TRIMESTER → THE BABY IS SMALL FROM

→ BRAIN SPARING EFFECT HEAD TO TOE

→ HEAD SIZE N → AKA SYMMETRIC NGR

→ SMALL BODY
→ AKA ASSYMETRK IVAR

PONDRAL INDEX = Wt (9) × 100

length ( ) cm

L2 ASSY METRIC IUGR

> 2 ASSY METRIC LUG R

Q .
2 kg NEWBORN AT 32 WEEK GESTATION
,
LENGTH 50cm

ANS : 0.16

( GA → (LARGE TO GESTATIONAL AGE )

Eg : DIABETIC MOTHER

MOTHER T SUGAR

PLACENTA
V

FETUS T SUGAR

T INSULIN

T ANABOLISM
V

BIG BABY
ENBS → EXPANDED NEW BALLARD SCORING

→ ASSES MENT OF GESTATION AGE AT BIRTH

V V

PHYSICAL APPEARENCE NEUROMUSCULAR EVALUATION

✓ v

TERM BABY PRETERM BABY

→ FLEXED LIMBS → Ex TENSED LIMBS

→ M TONE OF MUSCLE → I TONE OF MUSCLE

→ BREAST BUD INSIGNIFICANT K5cm) → BREAST BUD PROMINENT (25cm)

→ Ruh AE t → RUGAE IS ABSENT
→ TESTIS IS PALPABLE IN SCROTUM → TESTIS NOT PALPABLE IT IS NOT

→ ONLY LABIA MAJORA IS SEEN FULLY DESCENDED

→ LOT OF SOLE CREASES → LABIA MAJORA AND LABIA MINORA
→ RECOIL OF EAR IS FAST ARE EQUALLY VISIBLE

→ NOT MUCH SOLE CREASES

→ RECOIL OF EAR IS SLOW

 CARE OF NORMAL NEWBORN

AT BIRTH

A- SCEPTIC PRECAUTION :

→ CLEAN HANDS

→ CLEAN SURFACE

→ CLEAN SCISSORS BLADE

→ CLEAN UMBILICAL CORD CLAMP

→ NOTHING APPLIED ON THE CORD

37.5°C
MAINTENANCE OF TEMPKATURE → N 36.5 -

AFTER BIRTH → IMMEDIATE

BREASTFEEDING

PROPHYLAXIS → INT VIT K -

INI → ANTEROLATERAL THIGH

TO PREVENT HEMORRHAGIC DISEASE OF NEWBORN EU : GI BLEED

→ FOR THE EYES ERYTHROMYCIN OR TETRA CYCLIN OINTMENT IS USED TO

PREVENT OPHTHALMIA NEON ATOR UM

imp NORMAL OBSERVATION IN BABY AFTER BIRTH

I. WEIGHT LOSS -
101 . IN FIRST 10 DAYS

2. PASS URINE WITHIN 24 HOURS

MECONIUM UPTO 48 HOURS

3. CRYING WITH URINATION -

UTI

EITHER BEFORE OR AFTER URINATION N

-
imp

NORMAL FINDINGS IN A NEWBORN

IN SKIN AND MUCOSA
" '

1. ERYTHEMA TOXICUM i. TOXIC UNI IS A MISNOMER

→ RED PAPULO
-
PISTULO LESIONS

→ USUALLY SEEN IN FACE AND TRUNK

2. MONGOLIAN SPOTS ÷ FLAT GREENISH BLACK LESIONS (MACULES)

3. MILIA i. AKA MILK SPOTS (WHITE COLOUR ) IN FACE

DUE TO MATERNAL ESTROGEN

→ ENGORGEMENT OF BREAST

→ WHITE DISCHARGE PER VAGINAL

→ BLEEDING PER VAGI HUM → DUE TO WITHDRAWAL OF MATERNAL ESTROGEN N

HEAD SWELLINGS IN NEWBORN

CAPUT SUCCEDANEUM CEPHAL HEMATOMA

→ COMMON TYPE OF HEAD SWELLING → ITS A DEEP LOCALISED SWELLING

→ SUPERFICIAL SWELLING → SUBPERIOSTEAL BLEEDING

→ LIKE A CAP IT LOVERS ENTIRE HEAD → REASON TRAUMA IN INSTRUMENTAL DELIVERY

→ CONTENT IS FLUID → IT IS LOCALISED BECAUSE IT IS LIMITED

→ REASON IS PROLONGED DELIVERY BY SUTURES IN SKULL

AND CONGESTION OF SCALP VEIN → IT APPEARS > 12 24 HOURS AFTER BIRTH

-

RESULTS IN FLUID LEAKAGE → RISK OF DEVELOPING NEONATAL JAUNDICE

→ APPEAR AT SOON AFTER BIRTH

→ NO COMPLICATIONS NO Rx IS REQUIRED
,
imp
=

TEMP RATURE REGULATION OF A NEW BORN

'

N 36.5-737-5 C

→ PREFFERED SITE FOR RECORDING TEMP → AXILLA (min FOR 3 -

mins )

HYPOTHERMIA 136 5 C
-

COLD STRESS -7 HANDS AND FEET ARE COLD 36

-

IST STAGE →
-

36.4 C

32
-

2nd STAGE -3 MODERATE → -

36 C

3RD STAGE -7 SEVERE T MORTALITY ; < 32L

WAYS OF TEMP RATU 'RE LOSS OF NEWBORN

1. CONDUCTION

2. EVAPORATION
3. CONVECTION

4. RADIATION → MOST IMPORTANT → HEAD AREA ( LARGE SURFACE AREA )

PREVENTION OF HYPOTHERMIA IN NEWBORN

→ NON SHIVERING THERMOGENESIS

→ DUE TO BROWN FAT (UNCOUPLING OF OXIDATIVE PHOSPHORYLATION )

→ COVER THE BABY

→ STABLE PRETERM BABY lunk

→ KANGAROO MOTHER CARE ( KMC)
•
KANGAROO POSITION -
UPRIGHT

•
KANGAROO FEEDING -
BREASTFEED
BABY ATTAINS TERM 37 WEEKS
→ KMC IS DONE STILL THE OR WEIGHT 225kg

→ FOR UNSTABLE PRETERM BABY

V V

WARMER INCUBATOR
→ OPEN SOURCE RADIANT → CLOSED

NEONATAL REFLEXES -7 IMMATURE / PRIMITIVE (DISAPPEAR AFTER SOME TIME )

i. ROOTING REFLEX
2 .
MORO REFLEX -
AKA EMBRACE REFLEX

7
ASSYMETRK
3. TONIC NECK REFLEX

> SYMMETRIC
MORO REFLEX

→ ONSET -732 WEEKS

→ COMPLETE -737 WEEKS

→ DISAPPEAR-76 MONTHS
→ RE ONCE -7 ABDUCTION EXTENSION

ADDUCTION FLEXION

→ IN N PRETERM IT IS ABSENT

→ IF MORO REFLEX IS ABSENT IN TERM NEWBORN IT MAY BE DUE TO

→ HYPOXIC ISCHEMIC ENCEPHALOPATHY (HIE)

→ ANOMALIES OF BRAIN
→ ASSY METRICAL OR UNILATERAL MORO REFLEX

v t
NERVE INJURY BONE

✓ ( Chi Cb)
-
v

Mc : ERB 'S PALSEY Mc : CLAVICLE #

→ PERSIS TAN CE OF MORO REFLEX > 6 MONTHS MAY BE DUE TO IMMATURE BRAIN → CEREBRAL PAVEY

ROUTING REFLEX

→ APPEAR AT → 32 Wk

→ COMPLETE AT -734 WK

→ FOR BABY 232 Wk

→ NASOGASTRIC 10120 GASTRIC TUBE FEEDS

→ FOR BABY BETWEEN 32 -

34 wks
→ PALA DAI FEEDS / KATORI SPOONFEEDS

→ FOR BABY > 34 wks

→ DIRECT BREAST FEED

PARACHUTE REFLEX

→ PROTECTOR REFLEX

→ PERSISTING THROUGHOUT LIFE

→ APPEAR G -
7 MONTHS AFTER BIRTH
*
→ WONT DISAPPEAR
 NEONATAL RESUSITATION
TA B C

→ TEMPRATURE
→ AIRWAY

→ BREATHING

→ CIRCULATION

ALGORITHM → IF BABY DOESNT CRY

INITIAL STEPS :
I - WARMER

2. POSITION AIRWAY
3. CLEAR THE SECRETION IN AIRWAY → MOUTH
+
NOSE
4. TACTILE STIMULATION : -

→ RUBBING THE BACK

→ FLICKING THE SOLES

HR 4100 NO CRY
✓

PPV -
POSITIVE PRESSURE VENTILATION

1. BAG AND MASK VENTILATION

2. ENDOTRACHEAL INTUBATION

THR > 100

HR 260 NO CRY
×

CHEST COMPRESSION
COMPRESSION 1- VENTILATION → 90 t 30
CHEST
c Y

NO RESPONSE
RATIO → 3 ! I
✓

ADRENALINE BY UMBILICAL VEIN

VIII APGAR SCORING

→ GIVEN BY VIRGINIA APGAR

Mn : A P G AR

A → APPEAR ENCE → COLOUR

p → PULSE → HR

G → GRIMACE → RESPONSE TO CATHETER IN NOSE

A -7 ACTIVITY → TONE
*
R→ RESPIRATORY EFFORT

→ MAX APGAR SCORE -710

→ MIN APGAR SCORE → O

→ NORMAL APGAR → 7- to go

BIRTH ASPHYXIA LT
→ → 10
 APGAR SCORE

ABNORMAL I 2N

APPEARANCE CYANOSIS FEW PINK ) BLUE PINK

HR O 4100 7100

GRIMACE NO RESPONSE GRIMACE CRYING

ACTIVITY COMPLETE EXTENSION PARTIAL FLEXION COMPLETE FLEXION

( FLACCIDITY)

RESPIRATORY EFFORT NO LABOURED / STRONG CRY

DIFFICULT BREATHING

NEONATAL DISORDERS

RESPIRATORY DISTRESS

→ FAST BREATHING : -

7601 MIN
(TACHYPNEA)
→ CHEST RETRACTION (INDRAWING)
→ CYANOSIS → IN SEVERE RD

(GRUNTING)

CONDITIONS

1. TTNB (TRANSCIENTTACHYPNEA) → ML
2 . RDS ( RESPIRATORY DISTRESS SYNDROME )
3. MAS (MECONIUM ASPIRATION SYNDROME )
h CONGENITAL
. ANOMALIES

TTNB → TR ANCIENT TACHYPNEA OF NEWBORN

→ TERM BORN BY LSCS (LOWER SEGMENT CESSERIAN SECTION )

→ IT IS DUE TO RETAINED LUNG FLUID IT IS CALLED AS WET LUNG SYNDROME
→ IT SETTLES WITHIN 72 HOURS

→ ON X -
RAY
→ PERI HILA R STREAKS

→ SUN BURST APPEAR ENCE

→ FLUID IN INTER LOBAR FISSURE OF LUNGS

→ Rx : SYMPTOMATIC
 RDS
→ AKA HYALINE MEMBRANE DISEASE
→ IN PRETERM BABY 234 Wks

→ DUE TO IMMATURITY OR DEFICIENCY OF SURFACTANT

→ COLLAPSE OF ALVEOLI

→ WHITE OUT LUNGS OR GROUND GLASS APPEAR ENCE

→ AIR IN BRONCHIOLES AIR BRONCHO GRAM SIGN

→ Rx :

→ 02
→ CPAP (CONTINO VS POSITIVE AIRWAY PRESSURE

→ MECHA MICHAL VENTILATION

→ SURFACTANT ADMINISTRATION BY ENDOTRACHEAL ROUTE

→ TO PREVENT RDS STEROIDS → DEXAMETHASONE (IN INDIA)

WE GIVE ANTENATAL
→ BETA METHASONZ

ANOMALIES ASSO IS

→ CONGENITAL DIAPHRAGMATIC HERNIA ( CDH)

→ SITE IS POSTEROLATERAL ON LEFT SIDE KNOWN AS BOCH DALEK DEFECT

→ FEATURES :

→ RESP DISTRESS

→ HEART SOUND ON RIGHT SIDE OF HEART

→ SUNKEN ABDOMEN OR SCAPHOID ABDOMEN

→ SURGICALLY TREATABLE CONDITION

BAG CII CAUSES MORE LUNG COMPRESSION

-

AND MASK VENTILATION IT

'

→ is .
 BIRTH ASPHYXIA

→ BABY NOT BREATHING AT BIRTH

→ CAUSES HYPOXIA
→ LEAD TO ANAEROBIC METABOLISM AND RESULT IN LACTIC ACIDOSIS
→ CAUSE BRAIN DAMAGE HIE HYPOXIC ISCHEMIC ENCEPHALOPATHY AND PRESENT WITH SEIZURES

→ MC CAUSE OF SEIZURE IN NEWBORN IS HIE

→ LEADS TO MULTI ORGAN FAILURE

→ 2nd Me ORHAN FAILED IS KIDNEY
→ APGAR SCORE is 2%0

→ MC CAUSE OF NEONATAL MORTALITY IS PREMATURITY

→ 2nd ML CAUSE OF NEONATAL MORTALITY IS SEPSIS

NEONATAL SEPSIS
-

→ BACTERIAL INFECTION "

*
→ IN INDIA MC BACTERIA IS KLEBSIELLA
→ WORLD =
GROUP B STREPTOCOCCI 7 E COLI

INVESTIGATION

→ BLOOD CULTURE → BEST

SCREENING TEST

1 → SEPSIS SCREEN

WE SEE

+ WBL → LEUCOPENIA

+ NEUTROPHIL -7 NEUTROPENIA

2 → IN BLOOD SMEAR
T IMMATURE NEUTROPHILS

3 → MICRO ESR T
→ CRPT

OUT OF THESE THREE TWO SHOULD BE PRESENT FOR DX .

Rx :
→ EMPIRICAL ANTIBIOTIC Rx !

PENCIL IN
+
AMINOGLYCOSIDE

NEONATAL JAUNDICE
→ IN NEONATES T BILIRUBIN > 5mg Idl
→ IN ADULTS > 2mg Idl

→ TOTAL BILIRUBIN IN LAB

→
→ DIRECT BILIRUBIN ( CONJUGATED)

→ INDIRECT BILIRUBIN (UNC ON JUGATE D) → TOTAL -

DIRECT
 RBC BREAKDOWN → HAE M

V
BILL VERDIN

BILIRUBIN LUNLONJUGATED)

CONJUGATED
E" " "
E
IN "VER

§ Y
GW RONDE

re
is

-
→ ENTERS 2nd PART OF DUODENUM

→ BACTERIA CONVERTS IT INTO

✓ V

UROBKINOGEN ( IO 't) STERCOBIUNOGEN (901 )

.

y V

URINE (STRAW COLOURED) STOOL ( YELLOWISH)

KRAM MERS RULE

→ WHEN UN CONJUGATED BILIRUBIN T IN STARTS HEAD TO FOOT

BODY JAUNDICE FROM
AND HANDS

→ HEAD

L S
HAND
✓
FOOT

→ 1st AREA TO GET AFFECTED → EYES

→ LAST AREA TO GET AFFECTED → PALMS & SOLES

→ IF PALMS / SOLE IS AFFECTED

→ DANGEROUS JAUNDICE
IS LIPID SOLUBLE
UN CONJUGATED BILIRUBIN
SO
×

CROSS BBB

AFFECT BASAL GANGLIA OF BRAIN

t
KERN ICTERUS
ti t

DEEP PART OF BRAIN YELLOWISH

 PHYSIOLOGICAL JAUNDICE PATHOLOGICAL JAUNDICE
→ NIL TYPE → TIN CONJUGATED 10N CONJUGATED
→ ALWAYS TINUNCONTUHATED BILIRUBIN BILIRUBIN
→ IT APPEARS AFTER 24 HOURS OF BIRTH → UNICOM JUUATED BILIRUBIN
→ DURATION : -
CAUSED BY :
• 1- WEEK IN TERM BABY • EXCESS RBC → POLYCYTHEMIA
• 2 WEEK IN PRETERM BABY . CEPHAL HEMATOMA

→ NEVER INVOLVES : - • HEMOLYSIS → INHERITED DISORDERS

• PALMS AND SOLES • HEMOLYSIS MATERNAL ANTIBODIES

→ ALL OF THESE PROPERTIES SHOULD BE PRESENT BLOOD GROUP

INCOMPATIBILITY
MOTHER FETUS

ABO O A/B
Rh -
t

• UDP GT.
-

→ CRIGGER NAJAR SYNDROME

TYPE I -7 NO UDP -
GT → SEVERE

TYPE IT -7 LOW LEVEL UDP -

GT

→ LOW LEVEL UDP - GT -7 GILBERT

SYNDROME

→ Rx :

→ PHOTOTHERAPY
→ EXCHANGE TRANSFUSION

TLONTUGATED BILIRUBIN → PATHOLOGICAL

¥
" ""

'
-
-

um
-
Hi
- -
f - - -

1-
STOOLS → PALE (
WHITE KLAY
- mm

→ AKA OBSTRUCTIVE JAUNDICE / NEONATAL CUOLE STASIS

→ MCC IS BILIARY ATRESIA

→ STOOLS WILL BE → PALE CLAY WHITE

, ,

→ URINE COLOUR → DEEP YELLOW

→ AKA OBSTRUCTIVE JAUNDICE

 NERVOUS SYSTEM

GROOVES
PLATE → I .
-

te
POR E
73-4 wks
U
to

NEURAL TUBE DEFECT

→ FAILURE OF CLOSURE OF NEURO PORE

TYPES

<

✓
* v

CAUDAL CRANIAL

→ MC → ANENCEPHALY

→ SPINA BIFIDA OCULTA → ENCE PHA LO LELE

→ SPINA BIFIDA WITH MENINGOCELE

→ SPINA BIFIDA WITH MENIN GO MY ECOCELE

CAUSED BY :

→ DIABETIC MOTHER
→ MOTHER TAKIN U ANTICONVULSANTS
→ PHENYTOIN

→ VAL PRO ATE

→ FOLIC ACID DEFICIENCY

→ 400mg / DAY
0.4mg
→ FOR A MOTHER WITH PREVIOUSLY AFFECTED
CHILD =
4000µg 4mg

→ SHOULD TAKE AROUND THE TIME OF

PREGNANCY CALLED AS PERI CONCEPTIONAL SUPPLEMENTATION

(1 MONTH BEFORE PLANNED CONCEPTION)

ANTENATAL DETECTION .
'
. -7 User -
14-16 WK GESTATION
→ MARKERS = AFP T

= ACETYLCHOLINESTERASE T (BEST MARKER)

 HYDROCEPHALUS
→ TCSF

N → 150Mt ADULTS

→ 50 - 100Mt CHILDREN

→ CSF = ULTRA FILTRATE OF PLASMA

CAUSED BY

→ T PRODUCTION 4 ABSORPTION → NON OBSTRUCTIVE

→ OBSTRUCTION TO THE FLOW → OBSTRUCTIVE

→ ML TYPE

→ SITE → CONGENITAL AQUEDUCTAL STENOSIS

→ T PRODUCTION → CHOROID PLEXUS PAPILLOMA

→ 4 ABSORPTION → SAH (BLOOD)

→ MENINGITIS ( Pvs)

FEATURES OF HYDROCEPHALUS :

→ VERY RAPID T OF HEAD CIRCUMFERENCE → > 2cm / MONTH

→ SUTURAL SEPE RATION dlt T ICP

→ TOL FONTANE LES AT BIRTH → 6 FONTANE LES

→ BULGING FONTANELLES

→ DILATED SCALP VEIN

→ SUNSET SIGN

→ CRACKING POT RESONANCE CALLED AS MACEWAN 551hm

Rx :
→ VP → VENT RICVLO PERITONEAL SHUNT
→ DRUG I CSF PRODUCTION → ACETAZOLAMIDE

SEIZURES AND EPILEPSY OF NEWBORN

SEIZURE → INCREASED ELECTRICAL ACTIVITY

CONVULSION → EXTERNAL MANIFESTATION OF SEIZURES

EPILEPSY → RECURRENT UNPROVOKED SEIZURES

"
→ INVSTG OF CHOICE → EEG

SEIZURE TYPES

r
v
GENERALISED (Rt : VALPROATE ) FOCAL (Rx : CARBAMAZEPINE )
+ -

# CONS to US NESS
V V
V V
v
FOCAL AWARE FOCAL UNAWARE
GTC S ABSENCE MYOCLONIC
SEIZURE SEIZURE
( GRAND MAL) (PETIT MAL)

→ OVERALL MC TYPE IS → GTCS

 SPECIAL TYPE OF SEIZURE IN NEONATE

→ SUBTLE SEIZURE

( MINIMAL)
→ CAUSED BY HIE

FEBRILE SEIZURE
→
Age → 6 MONTU - 5 YRS

→ NEUROLOGICALLY N

→ FEVER IS PRESENT

TWO TYPES OF FEBRILE SEIZURES

1 SIMPLE FEBRILE SEIZURES (TYPICAL)

→ 1 EPISODE OF GTCS AT FEVER

→ DURATION 215 min

→ SEIZURE OCCURS WITHIN 24 HRS OF FEVER ONSET

Rx :

→ CONTROL FEVER → PARACETAMOL

IV
→ CONTROL SEIZURE → BENZODIAZEPINE
OR

PER RECTAL DIAZEPAM

→ PROPHYLAXIS → INTERMITTENT

→ FIRST 3 DAYS OF FEVER GIVE → CLOBAZAM /DIAZEPAM

→ NO RISK OF EPILEPSY

2 COMPLEX FEBRILE SEIZURES (ATYPICAL)

→ SLIGHT T RISK OF EPILEPSY

ABSENT SEIZURES
→ DAY DREAMING INATTENTION IN SCHOOL

→ SCHOOL GOING CHILDREN → > b- yes

→ MULTIPLE EPISODES / CLUSTERS DURING DAYTIME

→ DURATION 30 -
60 Sec

→ NO POST ICTAL PERIOD

→ INVSTGN → EEG

I see
N

ABSENT SEIZURES -fwff- → 3 Sec SPIKE AND WAVE PATTERN

RX : ANTIEPILEPTIC

→ VAL PROA TE -
DOC
 MENINGITIS

→ FEVER 't SEIZURES T SIGNS OF T ICT -1 SIGNS OF MENINGEAL IRRITATION

→ SIGNS OF MENINGEAL IRRITATION → BRVDZINIKISIHN

→ Kuk NIU 'S SIGN
→ MC BACTERIA → STREP PNEUMONIA

→ MC BACTERIA IN NEONATES → E -
COLI

→ MENIN GO ENCEPHELITIS → VIRUS

→ MC -
JAPANESE BENCEPHEUTIS

→ WORLD → ENTEROVIRUS

DX : → LUMBAR PUNCTURE
→ CSF ANALYSIS AND CULTURE

( SF ANALYSIS BACTERIAL MENINGITIS VIRAL MENINGITIS

(pyo HENK) (NO PUD

APPEAR ENCE TURBID CLEAR

CELLS TT NEUTROPHILS TT LYMPHOCYTES

BIOCHEMICAL
GLUCOSE flu (HYPOLRLYCORACHIA) N

'

.
PROTEINS T T N

BENIGN CENTRO TEMPORAL EPILEPSY

→ ROLAND IL EPILEPSY

AT CENTRAL SULCUS ROLAND K sulcus

→
→

→ PRESENT WITH RECURRENT FOCAL SEIZURES

→ Rx : CARBAMAZEPINE

NEONATAL SEIZURES

→ ML CAUSE → HIE

→ MC TYPE → SUBTLE SEIZURES

→ DOC → PHENO BARBITONE

 RESPIRATORY SYSTEM

→ INFECTIONS
→ FOREIGN BODY

→ ASTHMA

CASE I

6 MONTH OLD CHILD BOUGHT BY MOTHER CHILD

.
HAVING NOISY BREATHING SINCE BIRTH
,

OIE → WELL GROWN CHILD

→ STRIDOR
Dx : LARY NGO MALAGA

Rx : NO TREATMENT

CASE 2 :
-

ZUEAR OLD CHILD PRESENT WITH NOISY BREATHING HIGH GRADE FEVER (BACTERIAL) FOR

2 DAYS AND STRIDOR

OIE
→ SICK CHILD

→ TRIPOD POSITION

→ OPEN MOUTH BREATHING

→ DROOLING OF SALIVA

→ ODYNOPHAGIA (PAIN IN SWALLOWING)

→ X -
RAY -
THUMB SIGN

DX : ACUTE EPIGLOTTIS (MOST SEVERE CAUSE OF UPPER AIRWAY OBSTRUCTION)

Rx : I -7 AIRWAY ESTABLISHMENT
MIC → H INFLUENZA TYPE B

I→ ANTIBIOTICS → 3rd GEN CEPHALOSPORIN

→ CEFTRIAXONE

→ CEFOTAXI ME

EASEL
TODDLER ,
LOW GRADE FEVER (VIRAL)
→ STRIDOR

→ BARKING COUGH
→ MUD RETRACTION
→ WELL CHILD

→ X -
RAY - STEEPLE SIGN

→ CAUSED BY PARA INFLUENZA VIRUS

Dx : CROUP ( ACUTE LARY NUO TRACUEO BRONCHITIS)

Rx : SINGLE DOSE DEXAMETHASONE
CASE 4 :

18 MONTU OLD CHILD

,
WINTER SEASON
→ FAST BREATHING

→ BILATERAL WHEEZE ( 1st EPISODE )

→ 1st EPISODE OF WHEEZE IN A CHILD < 2 YRS (SEASONAL)
→ X RAY → BILATERAL HYPERINFLATION
-

→ CAUSED BY RESPIRATORY SYNCYTIAL VIRUS ( RSV)

Dx :
ACUTE BRONCHI OLI -115
Rx : BRONCHO DILATORS → SALBUTAMOL

→ HYPERTONIC SALINE 31 SALINE

. TO t EDEMA
→ FOR CHILDREN I COMORBIDITY UWE ANTIVIRAL → RI BAHARI N

FOREIGN BODY

IN LOWER AIRWAY → RIGID BRON LUOSCOPK REMOVAL

IN UPPER AIRWAY → HEIMLICH S MANEUVER > 1- YEAR

→ b- BACK BLOW + b- CHEST THRUST 41 YEAR

PNEUMONIA
→ INFECTION OF LUNG PARENCHYMA
→ Mcc → STREPTOCOCCUS PNEUMONIA

→ MCC OF UNDER b- -

MORTALITY → PNEUMONIA

REVISED WHO GULD LINES =

COMMUNITY MANAGEMENT

IMNCI → INTEGRATED MANAGEMENT OF NEONATAL AND CHILDHOOD ILLNESS

NO PNEUMONIA → FEVER COUGH COLD

, ,

→ HOME TREATMENT PARACETAMOL

→ COLOUR CODE → GREEN

PNEUMONIA → FEVER ,
COUGH ,
COLD

→ FAST BREATHING AND/OR CHEST RETRACTION

→ COLOUR CODE → YELLOW

→ Rx : PARACETAMOL + ANTIBIOTIC (AMOXICILLIN ) HOME Mx

FAST BREATHING

22 MONTHS → > 601mi n

2- 12 MONTHS -7 > 501 min

> 12 MONTHS → > 401 min
SEVERE PNEUMONIA

→ HYPOXIA t

( 51702292 t)
'

→ OR ANY 1 DAN HER SIGN

•
CYANOSIS
• Not fee ING

• LETHARGIC

• CONVULSIONS

Rx :
Refer TO HOSPITAL

COLOUR CODING → PINK

X-RAY

LOBE CONSOLIDATION
→ UPPER

→ STREP T PNEUMONIEA
I

BIL PATCH OPACITIES

→ STAPH AUREUS
÷,

→ RISK OF PNEUMOTHORAX
'

I
,
.

÷' .
i
.

→ INTERSTITIAL BRONCHO ( ) PNEUMONIA / ATYPICAL PNEUMONEA

I

÷ i÷ ÷ ÷ ÷÷÷÷÷
:
→ RSV -

RESPIRATORY SYNCITIAL VIRUS Mycoplasma

.

PNEUMONIAE
 ASTHMA

→ RECCURENT WHEEZING (23 EPISODES)

→ DUE TO BRONCHO CONSTRICTION ( RESPONSE TO )
ALLERGEN

→ REVERSIBLE

INTERMITTENT ASTHMA PERSISTANT ASTHMA

FREQUENCY L2 ( WEEK > 2) week

( CONTROLLERS)
DRUG SALBUTAMOL (RELIEVER) STEROIDS -
DOC

(ASI WHEN REQUIRED) INHALED

-
BUDESONIDE
- BECLOMETHASONE
-

f- LU TI LA SONE

→ BY METERED DOSE

INHALER (MDI) WITH

A SPACER

→ FOR CHILDREN

MDI 1- SPACER t FACE MASK .

 CONGENITAL HEART DEFECTS

✓
COMMON V

A- CYANOTIC CYANOTIC

→ A PULMONARY BLOOD FLOW

→ LUNG CONGESTION
→ DYSPNEA L v
4 PULMONARY T PULMONARY BLOOD
→ RECURRENT RESP INFECTIONS
FLOW
BLOOD FLOW
→ FEATURES OF HEART FAILURE

V
→ X -
RAY ONLY CYANOSIS
→

A BRONCHO VASCULAR MARKINGS I MARKIN US ON

→

→ CARDIOMEGALY X RAY
-

→ PULMONARY
04h EMIA

AEYANOTIC HEART DISEASES

OXY DEOXY
1
1 - ASD SHUNT LESIONS : L
-
R
.

2 2 . VSD → Mc

3. PDA
t

VSD
VSD
→ Perl MEMBRANEOUS
→ Mc

Rv Lv

PA > LUNG CONGESTION

in
S , S2

→ PAN SYSTOLIC MVRMER .

 ASD
OSTEUM SECOND UM
•

→ MC IS OSTEUM SECUNDUM RA LA

→ MIN PRESSURE DIFFERENCE

•

OSTIUM
→ NO SHUNT MUR MER
PRIMUM
→ WIDE FIXED SPLIT 52

RA L O LA

EXPIRATION

v
v PV

RV LV

close LATE

PDA

*
→ CONTI NOUS MACHINERY MVRMER

→ If PDA in PRE TERM Rx is Ph INHIBITOR

NSAID → eg : INDONIETHACIN

→ PDA IN TERM BABY

Rx : SURGERY

(OARCTATION OF AORTA

or
ARCH

ASCENDING
AORTA
¢ DEAFENING
DUCTUS

→ Site → DESCENDING AORTA

UXTA DUCTAL
) POST DUCTAL)

→ LESS BLOOD TO LOWER LIMB

→ POOR DEVELOPED LOWER LIMB

→ FEEBLE FEMORAL PULSE

→ RADIO -
FEMORAL DELAY
*
→ KIDNEY 4 BLOOD SUPPLY → RENIN → HYPERTENSION
 → BODY ADAPTS BY DEVE PMENT OF COLLATERAL IN INTERCOSTAL ARTERIES

→ SO INTERCOSTAL ARTERIES BECOME DILATED

→ IN X -
RAY THE RIBS APPEAR TO BE BENDING BECAUSE OF DILATED ARTERIES CALLED AS

INFERIOR RIB NOTCHING

CYANOTIC HEART DISEASE

I 2 3 4 5

I → SINGLE ARTERY FROM HEART KNOWN AS TRUNCUS ARTERIOSUS

"
V
'

2 → CHANGE IN POSITION OF 2 ARTERIES KNOWN AS TRANSPOSITION OF GREAT ARTERIES

→ ON X -
RAY → EGG ON STRINH APPEAR ENCE

3
→
TRICUSPID ATRESIA
→ X -
RAY → BOX SHAPED HEART

4 → TETRO LOGY OF FALLOT

→ TRANSPOSITION OF AORTA OVER RIGHT ATRIUM

→ CAUSES COMPRESSION OF PA
→ RESULTS IN SUB PULMONARY STENOSIS
→ VSD

→ RIGHT VENTRICULAR HYPERTROPHY

→ X -
RAY → BOOT SHAPED HEART CAUSED BY RUH

→ IN FRENCH → COER EN SABOT

5 → PULMONARY VEIN

→ TAPVC → TOTAL ANOMALOUS PULMONARY VENOUS CONNECTION

→ ie ; PULMONARY VEINS DRAIN INTO RIGHT ATRIUM BY JOINING WITH SUPERIOR VENA CAVA

→ DILATED SVC

→ ON X RAY-

→ FIGURE OF 8 APPEARENCE

→ SNOW MAN APPEAR ENCE

→ COTTAGE LOAF APPEAR ENCE

PRENATAL MATERNAL EXPOSURE

→
DIABETES Vsp

RUBELLA → PDA

(SLE) LUPUS → HEART BLOCK

PHENYTOIN
TERATOGENS -2
Alcyone , } VSD
 CORONARY ARTERY IN CHILDREN

KAWASAKI DISEASE → ML VASCULITIS IN CHILDHOOD

→ IT IS A MEDIUM VESSEL VASCULITIS

→ NARROWING OF CORONARY ARTERY

→ CAUSES MYOCARDIAL ISCHEMIA
→ ANEURYSM

→ CORONARY PROBLEMS OCCUR > 2 WEEKS

→ SO EARLY DETECTION O -

2 WEEKS IS IMPORTANT

FEATURES

→ FEVER 25 DAYS

Mn : CREAM

( - C → CONTUCTIVITIS

2 - R → RASH

3 -
E → EDEMA ,
EXTREMITIES PEELING

4- A -7 LYMPHADENOPATHY
5 -

M → MUCOSAL CHANGES (STRAWBERRY TONGUE )

FOR DX : FEVER t FOUR OUT OF FIVE FINDING ARE NEEDED

Rx : IVI G

INTRAVENOUS IMMUNOGLOBULIN

G1 DISORDERS

DIARRHEA
→ IT IS AN INFECTION

→ MC 15 ROTAVIRUS

→ ML BACTERIA E COLI
-

→ ETEC (ENTER OTON GENIC E -

COLI )

DV SENTRY

→ LOOSE STOOLS + BLOOD IN STOOLS Kla DY SENTRY

→ IT IS ALWAYS CAUSED BY BACTERIA SHIGELLA FLEXNER

limp DEHYDRATION

NO DEHYDRATION SOME DEHYDRATION SEVERE DEHYDRATION

CHILD IS ALERT THIRSTY 1- 1- LETHARGIC

IRRITABLE tt SKIN PINCH → > ZSEC

V. SLOW

Rx : 0125 Rx : 0125 Rx : IV FLUID

 TREATMENT OF DEHYDRATION

PLAN A → REPLACEMENT OF ONGOING LOSS

( NO DEHYDRATION ) ORS 10 -20Mt 1kg / LOOSE STOOLS

PLAN B → I CORRECT DEHYDRATION

( SOME DEHYDRATION) 751mL 1kg 0125 OVER 4 HRS

→ I REPLACE ONGOING LOSS

10 -
20 my kg / LOOSE STOOLS

→ III DAILY MAIN TEN EN LE FLUID

HOLIDAY SEGAR FORMULA

O -
10 Kg → 100 my kg

(O -
20kg → +50 my kg

> 20kg → +20 my kg

Eg :
22kg

10129
O - 10 → 1000

10×910.20 → 500

2kg > 40
20kg →

1540 ml
=

PLAN C
#
→ IV FLUID RINGER LACTATE CONTAINS K THAN NORMAL SALINE
"
→ IN LOOSE STOOLS K IS LOST SO RINGER LACTATE IS PREFFERED
I
→ . 100
mykg
SPLIT

30Mt 1kg TOMYKG

Llyr 1- hour b-has

> lyr Yzhovr 2 Yzhoue

 ORI

composition
Low osmolarity : WHO

245 mush / L

Na → 75

GLU → 75

K → 20

Cl → 65
I 0
CITRATE →

245

DIARRHEA

RX : 0125/1 V FLUIDS

zinc : 11 STOOLS

→ REGENERATION OF GI EPITHELIUM

DURATION DOSE
< 6 MONTH
10mg ( day
14 DAYS
> Gnaonl TH 20mg ) day

→ DY SENTRY Rx : ANTIBIOTICS
→ 3rd GEN CEPHALOSPORIN

DIARRHEA

→ ACUTE → 27 DAYS

→ CAUSED BY INFECTION

PERSIST ANT → I 14 DAYS

→ INFECTION

→ COMMON IN IMMUNOCOMPROMISED CHILDREN OR CHILDREN I MALNUTRITION

→ Rx : Vit A
→ DO DIETERY MODIFICATION
→ AVOID MILK AND DAIRY PRODUCTS SECONDARY
'

OR DECREASE IN PERSIS TANT DIARHHEA OF

'

LACTOSE INTOLERANCE

→ PERI ANAL
}
RASH LACTOSE INTOLERANCE
→ GASEOUS STOOLS
 UTI
commie
-

UPPER LOWER

( PYELONEPHRITIS) ( LYSTEITIS ,
URETHRITIS )

APPEARENCE SICK CHILD WELL CHILD

FEVER HIGH GRADE LOW GRADE

OTHER FEATURES FLANK OR LOIN PAIN T FREQUENCY OF URINATION

OLIGURIA DYSURIA
SUPRA PUBIC PAIN

→ UTI MORE COMMON IN FEMALES > MALES

LIYE AR M SPREAD
'

F OF HEMATOGENOUS
i

→ BUT IN A CHILD
-
.

→ ML ORGAN IS E. COLI
→ 10C → URINE CULTURE

→ MID STREAM CLEAN CATCH URINE SAMPLE

→ SUPRA PUBIC ASPIRATION

→ URINARY CATHETER SAMPLES

METHOD OF COLLECTION COLONY COUNT

→ SUPRA PUBIC ASPIRATION → ANY OF PATHOGEN

NUMBER
→ URETHRAL CATHETERIZATION → I 50,000 CFUIMI
→ MIDSTREAM CLEAN CATCH → I 1 LAKH LFU MIL

→ ASYMPTOMATIC BACTERIUM A → Rx ONLY IN PREGNANCY

NEPHROTIC SYNDROME

PR0TElNURIA_ → 740mg /m2/hz NIL

(SIGNIFICANT) TRACE

OR It
P :C RATIO 22 2-1

( PROTEIN : CREATINE ) 3T

OR Gt
URINE
3-1/4-1
( DIPSTICK TEST )
→ HYP
0µA LBUMINEMIA
= SERUM ALBUMIN
52.59/41
I
→ EDEMA ( GENERALISED EDEMA ) → ANASARCA

→ HYPER LIPID ENNA = SERUM CHOLESTEROL > 200

m9/dl

(MCD)

&
MINIMAL CHANGE DISEASE

←
:÷÷÷÷:*:
o
"
.

My - FOOT PROCESS

→ Loss OF FUSION OF FOOT PROCESS OF PODOCYTES

→ THIS CAUSE LOSS OF -

VE CHARGE IN GLOMERULUS SO PROTEIN ESCAPES IN URINE

→ AGE → 2- 6 yrs

→ NO NEED OF RENAL BIOPSY

→ Rx : EXCELLENT RESPONSE TO STEROIDS

STEROID RESISTANT NEPHROTIC SYNDROME

v ( RENAL BIOPSY IS REQUIRED) V

L 24125 > 6 YRS

(ADOLESCENT ,
ADULTS )
→ CONGENITAL → SIGNIFICANT CHANGE DIS
NEPHROTIC SYNDROME (FOCAL GLOMIERVLO SCLEROSIS)
1) Fscrs
v
SEGMENTAL

→ A GENETIC DISORDER NIC IN ADULTS

→ IXIUTATION : N EPHRIN ( NPH S1) 2) MEMBRANEOUS NEPHROPATHY

PODOCIN ( NPH S2 ) 3) ME MBKANO PROLIFERATIVE
GLOMERULONEPHRITIS
Rx : CYCLOSPORIN
TALLOSPORIN ,
} IMMUNO MODULATORS

NEPHRITIC SYNDROME

GLOMERULONEPHRITIS
→ HEMATURIA ( 751213C /Hpf ) RBC CAST

→ DYSMORPHIC RBC's

→ MILD PROTEINURIA

→ HYPERTENTION
→ EDEMA (PEDAL ,
PERI ORBITAL )
→ Mcc is PS GN (IMMUNE COMPLEX (Agt Ab) COMPLEX DEPOSITION IN KIDNEY BY TYPE LIT HSN RXN
 PSU N IGA NEPHROPATHY

AGE SCHOOL GOING OLDER

> b- yrs (5-15485) ADOLESCENT / ADULTS

*
UPPER RESPIRATORY INFECTION I -2 WKS I -2 DAYS
de
HEMATURIA

ANTI STRYPTOLYSIN O T N

SERUM Cz te N

RECURRENCE RECURRENCE IS NOT RECURRENCE IS NOT COMMON

COMMON

*
ALPORT SYNDROME

→ COLLAGEN DEFECT

→ COL 4 A- b- → 25 CHAIN OF TYPE II COLLAGEN

→ SNHL

→ ANTERIOR LENTIC ONUS

HSP
→ HENOCH SCHON LEIN PURPURA

→ PALPABLE PURPURA

→ SMALL VESSEL VASCULITIS

→ NEPHRITIS → HEMATURIA

→ PAIN → ABDOMINAL PAIN

→ JOINT PAIN

→ SKIN
H s p

HEMATURIA

→ IgA DEPOSITION

CONGENITAL HYPOTHYROIDISM
→ CAUSED BY THYROID DYSGENESIS

→ HOARSE VOICE

→ PATHOLOGICAL JAUNDICE
→ LETHARGIC
→ COLD SKIN

→ UMBILICAL HERNIA
→ BIG TONGUE
→ NO GOITRE

→ TSH LEVEL T
 PUBERTY DISORDERS

DELAYED PUBERTY PRECOCIOUS PUBERTY

'
-
n 1

AGE 313 YRS F L8yrs F

I
-
t

> 144ps M 294ps M

-

\ /

MCC CONSTITUTIONAL DELAY IDIOPATHIC IN F

'

HYPOTHALAMIC HAMAR-10mA IN 'M

ADRENAL BIOSYNTHESIS OF STEROIDS

CAH → CONGENITAL ADRENAL HYPERPLASIA

PITUITARY
+ ACTH

ADRENAL
V

CHOLESTROL

✓ ENZYMES ✓ ENZYMES ✓ ENZYMES

ALDOSTERONE CORTISOL TESTOSTERONE

→ IN CAH THERE IS DEF OF ENZYMES IN ADRENAL GLAND

→ PRODUCES LESS ALDOSTERONE AND CORTISOL ENZYME

-

: OF AB SENSE OF

→ DUE TO FEEDBACK MECHANISM ACTH INCREASES AND RESULTS IN HIUH TESTOSTERONE

ENZYMES DEFICIENT

21 - OH I → MC

(l - OH I

17 - OH I

TESTOSTERONE TIN FETUS

FEMALE → AMBIGOUS GENITALIA

→ VIRILIZATION

MALE → EARLY PUBERTY (PRECAGOUS)

IF TESTOSTERONE I IN FETUS

FEMALE → -

MALE → DELAYED PUBERTY

→ AMBIGUOUS GENITALIA
 BP TESTOSTERONE

21 -
OH 24 4

11 - OH T t

17 -
OH T 74