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Healthy newborn and neonatal resuscitation.

Classification of the newborn: preterm 37 sdg (late preterm 34-36) (premature

extreme) <28 sdg. To term 37-42 sdg RN poster term >42 sdg
Thermoregulation: the newborn is not capable of self-regulating its temperature.

Skin: at birth, the newborn is covered with vernix caseosa.

Circulatory system closure of fetal shunts (ductus venosus,

arterial and oval foramen) HR (130-140) RR (30-40)

Umbilical cord care water soap, DRY

Hemorrhage prevention vit k

HBV prophylaxis IM vaccine in the first 12 hours

Neonatal conjunctivitis prophylaxis (chlamydia) chloramphenicol, silver nitrate

erythromycin, tetracyclines.

Neonatal screening first 48 hours (hypothyroidism, phenylketonuria, cystic fibrosis..)

Hearing test 1-3 out of every 1000 are affected, risk factors premature
hyperbilirubinemia, TORCH infection, ischemic hypoxia, malformations
craniofacial, ototoxic drugs, prolonged mechanical ventilation.

affects 50% of term newborns, begins on the 2nd to 3rd day

Skin: toxic erythema of the newborn
of life and lasts a week, small vesicles on erythematous macules,
They affect generally except on palms and soles, cause unknown.
(hypersensitivity reaction)

present since birth, upon disappearing they leave

Pustular melanosis of the newborn
a hyperpigmented lesion, affects the entire body including hands and palms.

Miliaria 50% common in the first hours of life, white papules in

they can also appear on the palate (Epstein pearls) or gums (nodules of
bowl).

Mongolian spot proliferation of dermal melanocytes at the lumbosacral level,

the injury is decreasing in size with its total or partial disappearance at 4
years, (not associated with intellectual disability)
Care of the healthy newborn

Definition: a series of actions, care, interventions, and procedures, from their

birth to the first 24 hours, to promote their well-being and prevent
complications.
{"APGAR":{"activity":"muscle tone","pulse":"pulse","grimace":"response to stimuli","appearance":"appearance"}}
(color), breathing.

Neonatal resuscitation prevent heat loss, patent airway, ventilation with

positive pressure, cardiac massage, adrenaline.

Umbilical hernia surgical closure if it does not close before 2 years or measures more than 1.5 cm

Umbilical cord 2 arteries 1 vein, the cord falls off between 7-14 days. A delay in the
A drop lasting more than a month should raise suspicion of primary immunodeficiencies.

Omphalocele def: congenital defect, herniation of abdominal viscera through the

umbilical ring, viscera COVERED by a sac formed of amnion and peritoneum. Dx
prenatal: ultrasound or elevation of alpha-fetoprotein. Tx surgical

Gastroschisis def: congenital defect of the lateral paraumbilical wall, the contents spill out
intestinal surfaces NOT covered by peritoneum. Tx qx
Omphalitis purulent secretion of the cord, can lead to liver abscesses.
peritonitis and sepsis. Pathogens: staph aureus, staph epidermidis, strep a, e. Coli. Tx:
cloxacillin and gentamicin IV, in mild forms topical tx.

All things considered light yellow liquid output, acidic pH (urine) without odor.

Alternative omphalomesenteric duct discharge of liquid or purulent material, foul odor, ph

alkaline (fecal matter).

Hypoxic-ischemic encephalopathy brain damage due to asphyxia occurs in 1-2 out of each
1,000 rn. Dx: pH less than 7 in cord arterial blood, APGAR 0-3 after 5 min, alteration
neurological or multi-organ dysfunction. Neuro exam: level of alertness, muscle tone,
motor responses, reactivity. Auxiliary diagnosis: cranial ultrasound, electroencephalogram,
TAC skull, MRI, MRI angiography. Pharmacological treatment: phenobarbital and DFH. No non-pharmacological treatment.
pharmacological: early ID of high-risk patient, basic therapy measures,
neuroprotection, assisted mechanical ventilation, nutrition, hypothermia (indi: rn greater than 36
sdg, weighs more than 1,800, less than 6 hours of life with evidence of an asphyxia event.
It can cause acute kidney failure, elevation of transaminases, coagulopathies,
ischemic enterocolitis, ischemic myocardial damage, ventricular dysfunction. Scales
used garcía alix.
Apnea of premature infants It appears on the 2nd-3rd day, there is no pathology that explains it alone.
his premature condition, respiratory absence >20 seconds. Dx thoracic impedance for
detection of apneas. Tx prone position, thermal environment, methylxanthines (caffeine).
Mortality 60% and neurological sequelae 20%.

Transitory neonatal hypoglycemia below 45 mg/dl of glucose in the first 7 days

of life. Dx: enzymatic determination of glucose levels by the method of
hexokinase. Asymptomatic hypoglycemia Tx: give 27-45 mg immediately
breastfeeding without supplementing with formula. Values below 27mg.
indicate glucose infusion 6 mg/kg/min. symptomatic hypoglycemia treatment: administer solution
10 percent dextrose IV in bolus if seizures present 4 ml/kg if not 2 ml/kg, indicate
glucose infusion IV 6 mg/kg/min.

Periventricular leukomalacia typical brain injury of premature newborns, in those under 32

sdg, ischemic lesion of the periventricular white matter, motor type lesions,
intellectual and visual.

it is a case of mild respiratory distress,

Transitory tachypnea of the newborn
precocious, autolimited, delay in fetal lung fluid reabsorption. EF: tachypnea
>60 rpm and >12 hrs is self-limiting (24-72 hrs) RX perihilar ingurgitation (heart
hairy), pleural effusion, fluid in the fissures. GASO hypoxemia <50 mmHg with Fio
>60% CO2 normal limit, compensated respiratory acidosis. Tx oxygen obj (88-95%) no
use 100% oxygen, CPAP in severe cases.
Hyaline membrane disease early, severe, progressive respiratory difficulty,
with respiratory failure (hypoxemia, CO2 retention) preterm newborn less than 34
The disease is secondary to a quantitative and qualitative deficiency of surfactant.
RX: reticular-granular parenchymal pattern (FROSTED GLASS), air bronchogram,
atelectasis. Prevention: administration of corticosteroids 7 days before delivery. TX: INSURE
(intubation - surfactant - extubation)

Meconium aspiration syndrome 5% will develop severe meconium aspiration syndrome.

meconium aspiration hinders breathing, causes obstruction with atelectasis if it is total or
with hyperinflation if it is partial. Complications: pneumothorax, pneumomediastinum, damages the
surfactant and causes chemical pneumonitis. X-ray: fluffy or patchy infiltrates,
zonas de consolidación, atelectasia, hiperinsuflación pulmonar. TX: medidas de soporte
50% will require mechanical ventilation, in the case of pulmonary hypertension use nitric oxide,

Bronchopulmonary dysplasia most common respiratory complications in preterm newborns

define as the need for supplemental oxygen for more than 28 days in a preterm infant.
risk factors: invasive mechanical ventilation, high concentrations of O2, excess supply
water, presence of patent ductus arteriosus, malnutrition, inflammation, infection. X-ray:
sponge pattern, fibrous tracts, areas of interstitial emphysema, pulmonary edema
bullae, atelectasis. TX: vitamin A, caffeine, corticosteroid cycles, supplemental oxygen, restriction
hydration, bronchodilators.
Persistent pulmonary hypertension of the newborn persistence of fetal circulation. More
frequent in term and post-term newborns, is associated with perinatal asphyxia, aspiration of
meconium, infections, and pulmonary development abnormalities. DX: assessment
echocardiographic. TX: o2, nitric oxide, invasive mechanical ventilation, ECMO (extracorporeal o2).

Congenital diaphragmatic hernia communication between abdominal and thoracic cavity.

tipos: hernia de hiato (esofágico), hernia anterior (morgagni) y hernia diafragmática
congenital (bochdalek). It is associated with hepatic herniation and has a poor prognosis. In 30%
associated anomalies are found (neural tube and cardiac).
Bochdalek hernia: more common, posterior, left-sided predominance, early symptoms
Hernia of Morgagni: rarer, anterior, right predominance, mild symptoms or
late.
Clinical picture: respiratory distress, cyanosis, circulatory instability secondary to
pulmonary hypertension. PE: sunken abdomen, distended chest, hydroaeric sounds at
thoracic level, absence or decrease of vesicular murmur. X-ray: displacement of the
cardiac silhouette on the right side, circular aerial images. DX: echocardiography. TX:
["stabilization","mechanical ventilation","pulmonary vasodilators","sedation","relaxation"]
neuromuscular, ECMO, nasogastric tube. Surgical treatment is not urgent.

Choanal atresia RN with cyanosis that DISAPPEARS with crying. DX: catheter does not pass to
through the nasal passages, then confirm with fibroscopy, the CT is the imaging technique
of choice. TX: oral airway or EMERGENCY intubation until repaired
surgically.
Neonatal digestive pathology

Necrotizing enterocolitis acute inflammatory bowel disease with necrosis

coagulative of the intestinal wall and risk of perforation, commonly affecting the ILEUM
DISTAL and the PROXIMAL COLON, typical of preterm infants. Risk factors: prematurity, early enteral nutrition.
with formula. FP: breastfeeding and prenatal corticosteroids. It appears in the 2nd or
3rd week of life. Distension, abdominal pain, poor tolerance, bleeding. X-ray: BREAD CRUMBS.
presence of a fixed loop, loop edema, pneumatosis, pneumoperitoneum, gas in the system
portal. Neumoperitoneum = perforation = surgery. BH: leukocytosis, leukopenia, thrombocytopenia,
elevated PCR, metabolic acidosis, hyponatremia (poor prognosis). TX: absolute diet with tube feeding
nasogastric decompression and initiation of antibiotic therapy, if it does not resolve or there is
tx sx drilling. Complications: an obstructive picture may manifest later due to
intestinal stenosis.

Meconium obstruction After childbirth, 48 hours without the onset of meconium emission.
Meconium plug syndrome, fr: PTB, IUGR, maternal consumption of opioids or sulfate
magnesium, son of a diabetic mother. Hirschsprung. Treatment: resolves with rectal stimulation.
glycerin or hypertonic solution enemas,
Meconial ileus: congenital intestinal obstruction: 90% cause cystic fibrosis. Perform test.
serum immunoreactive trypsinogen. Abdominal distension and meconium bilious vomiting. X-ray:
dilation of intestinal loops in SOAP BUBBLES. TX: hyperosmolar enemas, surgery if
failure tx.
Neonatal Sepsis early 0-7 days, late 8-90 days. Early: vertical origin
(pneumonia) (better prognosis). Late: vertical origin or by transmission
vertical (bacteremia, meningitis) (worse prognosis). Epidemiology:
maternal chorioamnionitis (vaginal colonization by group B streptococcus agalactiae)
síntomas: taq fetal, dolor uterino, líquido amniótico purulento, leucocitosis,
fever. Early sepsis: maternal colonization by GBS, premature rupture of membranes,
prolonged rupture of membranes, prematurity, chorioamnionitis, urinary tract infection
maternal, maternal fever intrapartum. Late sepsis: central lines, intubation,
prematurity, gastrointestinal pathology. Microbiology: gram positives
staph epidermidis, gram negatives e coli. Clinic: tachypnea, hypoxemia,
taqui, bradi, hipotensión, bajo gasto cardiaco, hipertensión pulmonar, hipo
hyperglycemia, metabolic acidosis, bulging fontanelle, seizures, poor
tolerance to intake, fever. DX: positive blood culture, lumbar puncture, complete blood count.
with leukopenia, neutropenia and left shift. Complications: rn
low weight, sepsis from gram negatives, and meningitis worse prognosis. TX:
minimum 2 antibiotics. Early sepsis; beta-lactams, aminoglycosides plus
cephalosporin. Late sepsis: vancomycin, teicoplanin, amikacin,
ceftazidime.
Neonatal Jaundice bilirubin greater than 5 mg. Causes: first 24 hours: hemolysis,
TORCH, 2nd-3rd day: physiological, infections, sepsis, TORCH, hemolytic anemias.
4th-7th day: sepsis, TORCH, intestinal obstruction, breastfeeding. More than one
metabolic disorders, obstructive jaundice, galactosemia, hypothyroidism, breastfeeding
gilbert. Coombs indirect mother coombs direct newborn. TX: hyperbilirubinemia
indirect: phototherapy, exsanguination as rescue. Direct hyperbilirubinemia:
phenobarbital, ursodeoxycholic acid.

Physiological jaundice It occurs on the third day and lasts a week, no treatment is required.

Isoimmune jaundice hemolysis, ABO incompatibility (phototherapy tx).

Rh incompatibility (more serious) (isoimmunization with anti-D appears at the second
pregnancy) tx: intensive phototherapy, exchange transfusion, gamma globulins.

Jaundice due to breastfeeding begins at 4-7 days of life. Tx: phototherapy,

increases in breastfeeding sessions.

Kernicterus (bilirubin encephalopathy) indirect bilirubin crosses the barrier

blood-brain barrier causes hypotonia, hypokinesia, poor sucking, lethargy/irritability,
primitive reflexes increase. Bilirubin deposits in the basal ganglia, with
frequency the patient dies or is left with severe neurological sequelae.
Neonatal cholestasis bilirubin above 2, signs: coluria, hypocholia/acolia,
hepatospleno. Consider where the lesion is located. Intrahepatic: parenteral nutrition
prolonged, infections, galactosemia, familial intrahepatic cholestasis, alpha-1 deficiency
antitrypsin, Alagille syndrome: autosomal recessive inheritance, associated with malformations
cardiac, bird-like face, bulging forehead, butterfly vertebrae.
Neonatal hemochromatosis: severe cholestasis, reduced liver size, diagnosis:
iron deposits. Extrahepatic: atresia of extrahepatic bile ducts and cyst of
choledochus.

Atresia of extrahepatic bile ducts most common cause of surgical cholestasis and the
most frequent of liver transplantation, 2 acquired forms (80-90%) embryonic (10-20%).
It is classified into 3, type 1: bile duct obstruction, type 2: obliteration of the hepatic duct
common, type 3: (the most frequent) affects the entire extrahepatic bile duct. Coluric urine,
bilirubin stools, hepatosplenomegaly, does not respond to phenobarbital/ursodeoxycholic acid treatment. DX:
increase in direct bilirubin, ultrasound sign of the TRIANGULAR CORD, biopsy of the ducts
biliary conclusive, ductal proliferation, portal fibrosis, biliary thrombi. Laparotomy
exploratory when a suspected diagnosis has been established. Definitive treatment transplant
hepatic.

Neonatal polycythemia venous hematocrit above 65% may be a consequence of

fetal hypoxemia, the main causes: placental insufficiency, smoking, child of
diabetic mother, preterm, down syndrome. Secondary complications:
hyperbilirubinemia, thrombocytopenia. The first 24 hours are at maximum risk, especially
the first 6-12 hours of life. TX: exchange transfusion with saline replacement
Physiological target of hematocrit 50-55%
Congenital TORCH infections

Toxoplasmosis Sabin's tetrad: chorioretinitis, hydrocephalus, calcifications

intracerebral, seizures. Diagnosis confirmation: positive IgM in the mother
increase in IgG antibody title. RN: positive IgM or persistence of IgG longer than
6-12 months of life. TX: to all infected newborns even if they do not have the disease.
clinic, the treatment lasts at least 12 months. Treatment for pregnant women: spiramycin (less than 18 weeks gestation)
pyrimethamine + sulfadiazine + folinic acid (more than 18 weeks of gestation). Tx newborn: pyrimethamine
more sulfadiazine more folinic acid (12m) prednisone (if affected by CNS, or
coriorretinitis) shunt valve if hydrocephalus.

Syphilis can be transmitted throughout the entire pregnancy, via transplacental or

birth canal. Early manifestations (less than 2 years); hepatosplenomegaly,
osteochondritis with periostitis, syphilitic pemphigus, blistering skin lesions with
palmoplantar affectation, condyloma lata, lymphadenopathy, hydrops, jaundice, anemia.
Late manifestations (more than 2 years): neurosyphilis, saddle nose,
clutton's joints, hutchinson's teeth, sensorineural deafness. The
Development of the clinic is preventable with treatment (penicillin). Diagnosis: non-treponemal tests:
VDRL. Treponemal tests: FTA-ABS and TP-PA. If positive, treat the mother with
penicillin G for 10 days.
Mild febrile exanthematous measles, the severity is greater the earlier it occurs. Gregg's triad:
sensorineural hearing loss, eye abnormalities, congenital heart disease (patent ductus)
arteriosus and pulmonary artery stenosis). Dx: fetal/neonatal IgM positive at birth, persistence
IgG for more than 8 months with a titre greater than 4 times what is expected, Tx: there is none, only monitoring.

Herpes vhs 1 (oral-labial infection) vsh2 (genital infection) 75-80% of neonatal disease
It is VHS2. Two forms of infection: local with skin-mucosal involvement including ocular involvement.
Disseminated, with central nervous system involvement and/or systemic clinical effects. Presence of vesicular exanthem in the
fetal presentation zone (normally cephalic). Mortality of herpes encephalitis 15% and risk
of high neurological sequelae. The most affected organs are the lungs, liver, and glands.
adrenal glands. Dx: serology and culture of the virus in CSF, scraping of skin vesicles when present.
present. If genital lesions are present, it is an indication for cesarean section. Tx: acyclovir.

Chickenpox manifests in 2 forms: congenital or neonatal. The congenital form is severe.

secondary to a transplacental infection, is characterized by skin scars on limbs
lower, height of growth, eye lesions and of the central nervous system, is often a cause of abortion
neonatal varicella: more severe when the maternal rash appears 2 days before delivery and
5 days later. Tx: with acyclovir and specific gamma globulin against VZV.

Cytomegalovirus is the most common infection, the most frequent etiology of hearing loss and
childhood sensorineural hearing loss. Most common symptoms at birth: IUGR, jaundice, petechiae
purple (blueberry muffin baby), hepatosplenomegaly, microcephaly, chorioretinitis. Calcifications of
periventricular predominance. Long-term sequelae include auditory neuropathy and mental retardation. Tx:
ganciclovir
Consumption of toxins during pregnancy high-risk pregnancy, increases the
neonatal morbidity and mortality, preterm birth, intrauterine growth restriction, neurological symptoms due to intoxication
malformations, breastfeeding contraindicated.

Cocaine obstetric complications, preterm delivery, placental abruption,

["perinatal asphyxia","cerebral infarction","enterocolitis","intestinal atresia","malformations"]
cardiac and genitourinary.

Low weight heroine, RCIU, abortion, neonatal withdrawal syndrome occurs in the first
48 hours of life, but incidence of seizures.

Opioid withdrawal symptoms irritabilidad, hiperreflexia, febricula, apnea, taquipnea,

reticular cyanosis, seizures. Tx: phenobarbital, morphine sulfate, methadone, of
clonidine rescue.

Alcohol syndrome fetal alcohol, flat philtrum, thin upper lip, epicanthus, short nose
low bridge, growth delay, neurological symptoms

Breastfeeding it should be maintained for the first 6 months of life, along with
complementary feeding, at least until one year of age. Supplementation when
["hypoglycemia","severe dehydration","prolonged mother-child separation"]
suction difficulties. Benefits: protects against necrotizing enterocolitis, decreases
the risk of sudden infant death syndrome, protects against infections, protects from
childhood neoplasms, decreases cardiovascular diseases. Contraindications: galactosemia,
mother HIV positive, mother with active TB without treatment, maternal psychiatric illness, substance use
drugs.
Growth and Development

Psychomotor development 1.5m: sonrisa social, 3m: sostén cefálico, 4m: coge obj
large with one hand, 5 months: alternating grasping of objects, 6 months; starts sitting up,
8-9m: oposición del pulgar, 9-10m; inicia la reptación, 10-11 m: bipedestación, 12-15 m;
of first steps and first word, 18-22m: makes combinations of 2 words,
24m: goes up and down stairs, stacks 4 or 6 blocks to form a tower.

Kwashiorkor malnutrition (edematous protein-calorie malnutrition), marasmus

(no edema). Labs: albumin, prealbumin, and retinol-binding protein.
Kwashiorkor (EDEMATOUS); lethargy, loss of muscle mass, infections of
["repetition","vomiting","diarrhea","anorexia","flaccidity of subcutaneous connective tissue","edema"]
hepatomegaly and edema of other organs, dermatitis, sparse hair
de-pigmented.

Marasmus (NON- EDEMATOSUS); irritability then apathy, loss of skin turgor,

loss of brown fat, distended or flat abdomen, muscle atrophy, hypotonia,
hypothermia, bradycardia.
Tx: first phase 24.48hrs rehydration, second phase 7-10 days: start feeding
and antibiotics, third phase: high-calorie recovery diet.
Dehydration with negative hydro-saline balance. Causes: inadequate intake or
insufficient liquids, increased losses: vomiting, diarrhea, polyuria, diabetes
cystic fibrosis, burns, polypnea...
Types of dehydration:
Isotonic: (285 mOsm, Na 130-150) the most common, affects the extracellular space.
positive skin fold sign, dry mucous membranes, hypotension, oliguria.
Hypotonic (hyponatremic or hypoosmolar): (less than 270 mOsm, Na less than 130)
it affects the extracellular space more significantly, with greater severity,
seizures due to neuronal overhydration.
Hypertonic (more than 300 mOsm, Na greater than 150) intracellular compartment,
dry mucous membranes, intense thirst, fever, hypertonic agitation, can cause a
subdural hemorrhage, during replacement, sodium levels must be gradually reduced
due to the risk of central pontine myelinolysis if done quickly.

Sudden Infant Death Syndrome (SIDS) position in the cradle lying down
prone (face down), smoking, excessive wrapping, environmental heat, mattresses
soft, share a bed with an adult, male, premature with dysplasia
bronchopulmonary, low birth weight, facial malformations, increased tone
vulnerable, young women without partners facing social issues, substance or alcohol use.
Pediatric Respiratory Pathologies.

Laringomalacia y Traqueomalacia laryngomalacia (congenital flaccidity of the epiglottis and the

supraglottic opening) tracheomalacia (weakness of the walls of the trachea) are the
most common causes of congenital stridor. Diagnosis: direct laryngoscopy or fiberendoscopy.
80% resolves spontaneously, only if it causes different response than surgical treatment.

Common cold rhinovirus, rinorrea, tos, fiebre.

Pharyngotonsillitis fever, odynophagia, redness of the tonsils and pharynx,

exudates. Viral: in children under 3 years old, caused by rhinovirus, rhinitis, cough, sores, diarrhea,
symptomatic tx. Bacterial: beta-hemolytic strep A or pyogenes, between 5 and 15 years old.
intense odynophagia, sudden onset fever, cervical lymphadenopathy, exudate, dx: taking of
exudate, tx: penicillin for 10 days. Complications: rheumatic fever.

Rhin sinusitis obstruction of the sinus ostium hinders ventilation and drainage. Factors
locales: desviación septal, factores generales: dm, alt electrolíticas, factores ambientales:
low temperature. Etiology: pneumococcus, Haemophilus influenzae, Moraxella catarrhalis. Clinical:
headache, jaw, maxillary, pain when lying down, the ethmoid sinus is the most
affected. Dx: prolonged catarrhal condition, persistence of nasal secretion
mucopurulent, cough and fever. Tx: amoxicillin-clavulanate for 10-14 days. Complications: orbital, more
frequent, intracranial, meningitis of ethmoidal or sphenoidal origin.
Acute Otitis Media (AOM) bacterial infection, strep pneumoniae, h influenzae, m
catarrhalis, mode of transmission retrograde dissemination, incidence from 6m to 3
years. Tx: amoxicillin, in recurrent otitis, myringotomy with drainage insertion.

Croup laryngitis, 3 to 5 years. Viral laryngitis: parainfluenza, barking cough

metallic, stridor with inspiratory predominance, nighttime worsening. Tx: O2,
dexa, nebulized adrenalin, humid and cold environment.
Spasmodic laryngitis: laryngeal hyperreactivity, more frequent in winter, among
2 and 6 years. Clinic: sudden and nocturnal, metallic cough, inspiratory stridor, usually does not
fever tx the same as the viral.

Acute epiglottitis etologia: s pyogenes, s pneumoniae, s aureus. Clínica: fiebre

high, baby, different response, inspiratory stridor, worsens with crying in supine position, the
the child stays in tripoid position, avoid manipulation of the oral cavity and
pharynx, laryngeal examination in the operating room, intubation is proceeded with. Tx: establish access
aerial, ceftriaxone, cefotaxime, or ampicillin-sulbactam for 6-7 days,
corticosteroids in the first phase of treatment.

Bacterial tracheitis S aureus, after an episode of croup, leads to a

progressive worsening, diffuse respiratory fever, of increasing intensity, appearance of
mixed stridor. Diagnosis: clinical. Treatment: hospitalization, oxygen as needed, intravenous cloxacillin.
intubation.
Pneumonia fever, respiratory symptoms, in x-ray condensations, infiltrates. Between 1 and 5
years. Etiology: less than 3 weeks: s agalactiae, l monocytogenes. 3 weeks to 3
meses: c trachomatis, vrs. 3m a 4 años: vsr, s pneumoniae. 5-15 años: m. pneumoniae,
S. pneumoniae. Clinic: typical pneumonia: high fever with abrupt onset, cough with
purulent expectoration, general condition impairment, chest pain, in children more
small abdominal pain, auscultation: hypoventilation or focal crackles, main
Pneumococcus as the etiological agent. Atypical pneumonia: slow progression, symptoms
catarrhal and feverish symptoms, dry irritating cough, respiratory disease symptoms. Diagnosis: x-ray consolidation
lobar, there may be pleural effusion, in the atypical patterns of diffuse interstitial. Tx:
analgesics, antipyretics, and O2. Severity criteria:
Under 1 year old, intercostal retraction, tachypnea, altered consciousness, dehydration,
pleural effusion. Treatment for typical pneumonia: in admitted patient: intravenous ampicillin, in no
entered: amoxicillin (80-100 mg/kg/day), pleural effusion: cefotaxime IV. Treatment for atypical:
less than 3 symptomatic, more than 3 macrolide iv. Complications: pleural effusion,
abscess formation, appearance of necrotizing pneumonia.

Acute bronchiolitis and recurrent wheezing in infants.

Acute bronchiolitis first episode of differential respiratory with wheezing, etiology: RSV.
Clinic: prolonged expiration, respiratory wheezing. Diagnosis: clinical, X-ray: hyperinflation.
areas of condensation/atelectasis. Tx: hydration and oral nutrition. Elevation of the
header, O2 therapy, nebulized adrena. Prophylaxis: palivizumab, in premature infants,
children with chronic lung disease, congenital heart disease, immunocompromised.
Chronic inflammatory asthma, bronchial hyperreactivity, reversible obstruction.
Etiología: hereditaria, fenómenos ambientales: atópica, alergenos, infecciones,
tobacco. Dx: dyspnea, wheezing, cough, and sometimes chest tightness. Spirometry: pattern
obstructive or normal with bronchial hyperreactivity test.

Classification: intermittent asthma; less than once a week, less than 2 episodes
nocturnal attacks per month, exercise-induced asthma. Mild persistent asthma: more than one crisis
weekly, more than 2 nocturnal crises per month. Moderate persistent asthma: symptoms
continuous, more than one nighttime crisis a week, limitation of activity and the
dream. Severe persistent asthma: frequent exacerbations and nighttime crises and
graves, limitación de la actividad y sueño.

rescue drugs: short-acting beta-adrenergic and long-acting.

Oral and systemic corticosteroids. Disease-modifying drugs:
inhaled corticosteroids, long-acting beta-agonists, antagonists of
leukotrienes. Treatment of chronic asthma: short-acting beta-adrenergics as needed.
Cystic Fibrosis recessive hereditary, main cause of severe lung disease in children,
original pancreatic insufficiency at an early age. Genetics: CFTR, long arm gene of
chromosome 7. Clinic: cough, expectoration (clear mucus, low viscosity, and it progresses and becomes
more compact), respiratory dif, pneumonia due to bacterial superinfection, (pseudomonas
aeruginosa), right ventricular failure, thoracic hyperinflation. Pancreas: 85%
presents exocrine pancreatic insufficiency (diarrhea, steatorrhea, caloric malnutrition)
Protein deficiency of vitamin E), decreased glucose tolerance can lead to diabetes.
Digestivo: ileo meconial, sx de obstrucción intestinal distal, prolapso rectal, hepatopatía,
dehydration (hyponatremia, hypochloremia).

Dx: at least one phenotypic feature, brother with cystic fibrosis, neonatal screening
positive (immunoreactive trypsinogen). Criteria: positive sweat test, identify a mutation of
cystic fibrosis in both copies of the gene that encodes CFTR, nasal potential difference test
positive.
Respiratory treatment: treatment of obstruction, respiratory physiotherapy plus short-acting bronchodilators.
action, anti-inflammatory treatment azithromycin. Treatment of pulmonary complications, atelectasis,
IV antibiotic therapy, intensive respiratory physiotherapy, bronchodilators, and pressure ventilation
intermittent positive. Pneumothorax due to rupture of subpleural bullae. Aspergillosis
allergic broncopulmonary: hypersensitivity to Aspergillus fumigatus, oral corticosteroids,
itraconazole. Nutritional treatment: high-calorie diet, pancreatic enzymes, supplements a,d,e,k.
Forecast: survival over 40 years, more than 90% survive to 20.
Digestive Pathologies

clasificación, tipo 1: atresia sin fístula, tipo 2:

Esophageal atresia and tracheoesophageal fistula
proximal fistula and distal atresia, type 3: proximal atresia and distal fistula, type 4: double
fistula, type 5: fistula without atresia. Clinical: history of polyhydramnios,
inability to pass a nasogastric tube, excessive salivation, cyanosis and
choking with intakes. Tx: surgical, postoperative complication more
frequent reflux.

Gastroesophageal reflux retrograde and effortless passage of gastric content

towards the esophagus. Physiological (GERD): does not cause delay in children under 2 years
postural ponderance. Pathological reflux (EGRE): other symptoms appear along with
reflux. Clinic: atonic vomiting, postprandial regurgitation of food content.
In ERGE, other symptoms occur: poor weight gain, respiratory symptoms,
esophagitis, Sandifer syndrome. Dx: 24-hour pH monitoring, endoscopy with biopsy sampling,
gammagraphy. Tx: dietary guidelines, postural measures, omeprazole, fundoplication
in refractory cases.

Pyloric stenosis Immediate projectile vomiting after feeding, hunger

irritability begins between 3-6 weeks of life, due to vomiting
produces hypochloremic metabolic alkalosis. Physical exam: pyloric olive. Diagnosis: abdominal ultrasound. Treatment:
correction of dehydration and Ramstedt's pyloromyotomy.
Hirschsprung's disease (congenital aganglionic megacolon) It is secondary to
a disorder in the migration of neuroblasts, absence of ganglion cells
so that mesenteric plexuses are formed. 75% of patients the segment
affected is the recto-sigmoid. Clinic: constipation, in the neonatal period delay in the
meconium elimination, abdominal distension, bilious vomiting. Physical examination: abdominal distension and
a large fecal mass can be palpated in the left iliac fossa, on rectal examination the
the vial is empty. Complications: bacterial overgrowth, risk of
enterocolitis due to Clostridium difficile. Diagnosis: simple abdominal X-ray: significant distension of
asas with absence of air at the rectal level. Opacifying enema, anorectal manometry:
absence of inhibitory anal reflex. Biopsy provides the definitive diagnosis. Treatment: surgery
resection of the entire aganglionic segment.

Meckel's diverticulum most common congenital anomaly of the digestive tract, it

located 50-75 cm from the ileocecal valve, on the antimesenteric border.
Clinical: it usually manifests in the first 2 years of life with rectal bleeding.
painless intermittent. Dx: scintigraphy with technetium-99m. Tx: if it is
symptomatic surgical excision.
Intestinal invagination: One intestinal segment slips into another distal segment.
Between 3 months and 6 years in males. The most common form of intussusception is
ileocolic. Clinic: intermittent crises of intense colicky abdominal pain onset
sudden outburst, crying crisis, contraction of lower limbs and skin paleness,
stool in currant jelly. EF: void in the right iliac fossa and palpable mass
elongated and painful localized in the right hypochondrium with a cephalocaudal direction,
presence of bloody mucus after touch. Diagnosis: abdominal ultrasound: image of
donut or diana. Tx: less than 48 hrs hydrostatic reduction, if there is perforation or
surgical correction shock.

Chronic nonspecific diarrhea: motor diarrhea due to intestinal peristalsis

increased of unknown etiology. Between 6 months and 3 years, the patient does between 3-10
Liquid stools with mucus, plant fibers but without blood, leukocytes or eosinophils.
No decay, dehydration, or weight loss occurs. Tx: normal diet
balanced in fats.

Celiac disease: permanent intolerance to gliadin, affects individuals

genetically predisposed, Class II HLA haplotypes, Affects mucosa of
duodenum and jejunum, appearance of an inflammatory infiltrate in the lamina propria, more
In the evening, hyperplasia of the crypts is observed, and finally, villous atrophy. Clinical:
chronic diarrhea with weight delay. Dx: anti-transglutaminase IgA, genetic study
HLA DQ. Tx: lifelong gluten-free diet, non-compliance with the diet increases
the risk of developing non-Hodgkin intestinal lymphoma.
Hypertransaminasemia: Elevation of ALT and AST, rule out viral and toxic etiologies.
after thinking about less common pathologies such as: autoimmune hepatitis disease
Wilson's disease, celiac disease, alpha-1 antitrypsin deficiency, hemochromatosis, myopathies, intolerance to milk
cow, congenital metabolic disorders.

Reye's syndrome: Acute encephalopathy and degeneration of liver fat. Clinical: 4-12
Years, taking aspirin, symptoms begin between 5 and 7 days after the infection starts;
persistent sudden vomiting, delirium, aggressive behavior, stupor, hepatomegaly, altered
Liver function without jaundice. Dx: labs increase in AST, ALT, CPK, and LDH, CSF (normal). Tx:
provide glucose via IV, treat coagulopathy, manage cerebral edema by restricting supply
of liquids.

Chronic autoimmune hepatitis: chronic necroinflammatory activity and phenomena

immunological. More frequent in girls. Type 1 autoimmune hepatitis: presents ANA antibodies and
SMA. Type 2 autoimmune hepatitis: LKM1. Pathogenesis: genetic factors, environmental agents,
autoantigens. Clinic: prolonged acute hepatitis, elevated transaminases,
hepatomegaly, persistence of jaundice or coluria. Dx: increase in transaminases,
detection of antibodies ANA, SMA, and LKM1. Tx: immunosuppressants, prednisone 2 mg/kg/day
azathioprine 1-2 mg/kg/day.
I hope it helps you a lot
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