PG Blazer » Paediatrics

Ultrasound features of congenital diaphragmatic hernia

pgblazer — Mon, 21 May 2012 00:22:15 +0000

Ultrasound features of congenital diaphragmatic hernia are: Visualisation of abdominal organs in the chest Absence of normally positioned stomach Mediastinal displacement Small abdominal circumference Polyhydramnios Related Articles No related posts found

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Conditions causing wormian bone formation

pgblazer — Wed, 16 May 2012 16:17:10 +0000

Conditions causing wormian bone formation are: Rickets Hypothyroidism Hypophosphatasia Cleidocranial dysostosis Osteogenesis imperfecta Related Articles No related posts found

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Causes of floppy infant syndrome

pgblazer — Thu, 12 Apr 2012 00:36:35 +0000

Causes of paralytic FIS:

Guillian Barre syndrome
Spinal muscular atrophy
Myasthenia gravis
Myotonic dystrophy
Infant botulism

Causes of non paralytic FIS:

Down’s syndrome
Cerebral palsy
Malnutrition
Turner syndrome
Marfan syndrome
Tay Sachs disease
Prader Willi syndrome

(FIS = Floppy Infant Syndrome)

Indications for renal biopsy in nephrotic syndrome

pgblazer — Sat, 13 Aug 2011 01:07:22 +0000

The most common variant of nephrotic syndrome in children in Minimal change nephrotic syndrome. In case of MCNS, there is no need to do a renal biopsy before starting treatment. But in certain atypical features at onset, it is necessary to do a renal biopsy. They are:

Age of onset less than 12 months
Gross hematuria
Persistent microscopic hematuria
Elevated blood pressure
Low blood C3
Impaired renal function
Proteinuria despite appropriate steroid therapy

Management of cyanotic spells (anoxic spells) in Tetralogy of Fallot

pgblazer — Wed, 04 May 2011 17:03:02 +0000

Knee chest position
- Compresses femoral artery – increases afterload
- Decreases return of deoxygenated blood from the muscles
Humidified oxygen
Morphine 0.1 to 0.2 mg/kg SC
- Decreases pulmonary vascular resistance
- Blunts the sympathetic drive
Propranolol
- Relieves infundibular spasm by negative ionotropic action
Vasopressors (methoxamine IV or IM)
- Increases afterload
Correction of anemia
Consider corrective surgery

Sanctuary sites in Acute Lymphoblastic Leukemia

pgblazer — Wed, 04 May 2011 13:19:27 +0000

Sanctuary sites in acute lymphoblastic leukemia refers to areas where the leukemia cells are protected from the systemic chemotherapy
CNS and testis are the important sanctuary sites for ALL
These leukemic cells can produce relapse later and hence should be taken care of

CNS prevention therapy for Acute Lymphoblastic Leukemia:

As the chemotherapeutic agents do not cross the blood brain barrier, intrathecal methotrexate and cranial irradiation is used to kill leukemia cells residing in the CNS
This results in increased survival rates but have also causes neurotoxicity and increased risk for CNS malignancies
To decreased neurotoxicity, experts now recommend a lower dose of CNS irradiation (1800cGy) with intrathecal methotrexate
Also triple regimen intrathecal chemotherapy (methotrexate, hydrocortisone and cytarabine) without CNS irradiation is also considered

Posterior urethral valves – Pathology, Clinical features, Diagnosis and Management

pgblazer — Mon, 02 May 2011 13:21:05 +0000

Posterior urethral valve is the most common cause of obstructive uropathy in a male child.
They are simply folds of urothelium
They act as flap valves – blocks flow of urine – yet allows passage of a catheter easily
Clinical presentation
- Obstructive uropathy
Diagnosis
- Voiding cystourethrogram
- Endoscopy
Management
- Transurethral ablation of valve leaflets
- If the creatinine levels are elevated, vesicostomy has to be done first to bring down creatinine levels before attempting ablation

Tracheoesophageal fistula – Clinical features, Diagnosis and Management

pgblazer — Sun, 20 Mar 2011 23:58:43 +0000

Tracheo esophageal fistula refers to an abnormal connection between the trachea and the esophagus. It is associated with polyhydramnios in mother and single umbilical artery in the newborn.

Clinical features:

Frothy discharge from baby mouth, drooling of saliva, aspiration, choking, cyanosis
Types – A, B, C, D, H
Most common – C type (85%) followed by A type

Complications:

Pneumonia
Gastro esophageal reflux disease
Atelectasis

Diagnosis:

8 or 10 F size orogastric tube cannot be passed into stomach
Xray after instillation of air

Management:

Maintenance of upright posture
Frequent suction of esophageal pouch
Intravenous fluid administration
Antibiotics
Surgical correction should be done as soon as possible

Prognostic factors:

Early diagnosis
Fetal maturity
Development of pneumonitis
Presence of associated anomalies
Surgeon’s competence

Bucket handle malformation seen in Imperforate anus

pgblazer — Fri, 18 Mar 2011 01:44:17 +0000

A bucket handle malformation is a clinical feature seen in perineal fistula
Perineal fistula is a ‘low’ type of anorectal malformation
Here the rectum opens to the skin through a small opening anterior to the normal position of the anal sphincter
In some cases, a bridge of skin is seen across the fistula
A probe can be passed under this skin tag
Such a skin tag is known as ‘bucket handle malformation’

Sacrococcygeal teratoma – Epidemiology, Embryology, Diagnosis and Management

pgblazer — Thu, 17 Mar 2011 11:30:53 +0000

Most common tumour in newborn Incidence – 1 in 35000 80% female Remnant of primitive streak – pluripotent stem cells – tissues from all 3 germ cells with incomplete differentiation Diagnosis by antenatal USG Surgical excision, good prognosis Related Articles ...

Maturation of feeding skills and choice of initial feeding method in low birth weight infants

pgblazer — Fri, 14 Jan 2011 01:02:56 +0000

	Maturation of feeding skills	Initial feeding method
< 28 weeks	No proper sucking efforts, No propulsive motility in the gut	Intravenous fluids
28 – 31 weeks	Sucking bursts develop, No coordination between suck/swallow and breathing	Oro-gastric (or naso-gastric) tube feeding with occasional spoon feeding
32 – 34 weeks	Slightly mature sucking pattern, Coordination between breathing and swallowing begins	Feeding by spoon / paladai / cup
> 34 weeks	Mature sucking pattern, More coordination between breathing and swallowing	Breast feeding

Reference:
Ghai Essential Pediatrics, 7th edition

Developmental milestones at 3 years of age

pgblazer — Wed, 17 Nov 2010 13:31:33 +0000

A normal child achieves the following developmental milestones by 3 years of age:

Motor
- Rides a tricycle
- Stands momentarily on one foot
Adaptive
- Tower of 10 cubes
- Bridge of 3 cubes
- Copies a circle
- Copies a cross
Language
- Knows age and sex
- Counts 3 objects correctly
- Repeats 3 numbers or a sentence of 6 syllables
Social
- Plays a simple game
- Helps in dressing (unbuttons clothing and puts on shoes)
- Washes hands

Child Friendly School Initiative

pgblazer — Sun, 10 May 2009 09:56:56 +0000

Child Friendly School Initiative – Presentation Transcript

Child Friendly School Initiative

What is CFSI? School environment has An initiative of Indian Academy of great impact on child’s well being Pediatrics Children spend CFSI is a set of 10 significant portion simple criteria of their time in that schools schools should meet in order to promote positive health of children

The 10 commandments 1. No physical punishment 2. No excess baggage 3. Safe and proper transportation to school 4. Hygienic drinking water 5. Clean kitchen or a place where children can bring and eat house food 6. Minimum 4 games periods in one week 7. Properly ventillated and illuminated class rooms 8. Periodic health checkups and health related lectures 9. Facility for First Aid in emergency 10. Adequate number of toilets

1. No physical punishment • Physical punishment has psychological and physical consequences • Responsibility of principal to ensure that no physical punishment is given to students • Child helplines are set up in many metropolitan cities

2. No excess baggage • Heavy school bags can lead to back pain, scoliosis and kyphosis • Bag should not weigh more than 10% of child’s weight • Bag should have 2 broad padded straps • Children should be taught to bend at knees with straight back while taking the bag • Another option – Have a duplicate set of books at home and school

3. Safe and proper transportation to school • Children account for 10% of road accidents • Bus should have 30-50 seats with no extra passenger, 2 fire extinguishers, first aid box • Trained driver and conductor • Bus speed not to exceed 40km/hr • Rickshaws not to carry more than 8 persons

4. Hygienic drinking water • Drinking water should be treated for fecal contamination and bacterial colony count • Water should be tested for chemical and biological contamination • Regular surveillance of drinking water purity • Periodic cleaning of reservoirs, disinfection, leak detection, sanitary survey, and bacteriological survey • Chlorination or use of filters

5. Clean kitchen or a place where children can bring and eat house food • No outside vendors should be allowed near school premises • There should be a separate eating / dining area in the schools • Nutritional and hygienic practices must be followed at all times • The idea of eating together ensures comradeship and secularism amongst children

6. Minimum 4 games periods in one week • It prevents children from becoming a book- worm • Helps in personality development • With increasing interest towards TV, children are losing interest in play • Provision of play field • Properly trained coach • Sufficient time to play – 4 games periods

7. Properly ventilated and illuminated class-rooms • Well ventilated and illuminated class rooms prevent pollution, infection and eye strain and promote efficiency • Each class room should have sufficient doors and windows • Class should accommodate atleast 40 students providing 10 sq ft/child • Rooms should be white washed from inside • There should be adequate sunlight and light should reach students desk from left side to illuminate reading surface

8. Periodic health checkup and health related lectures • Health checkups should be held in school premises • Time spent on each student should be atleast 10 minutes and there should be provision of follow- up • Such health checkups should be held atleast once annually • Children should be screened for vision, hearing, scoliosis, hernia,etc • Regular growth monitoring, Hb for adolescent girls and vaccination should be checked

9. Facility for first aid in emergency • Pupils can become sick / injured and may need atleast preliminary attention by the school teacher • Injuries can be from fall, motor vehicle accidents, near drowning, foreign body, poisoning, colic, etc • All concerned should have first aid knowledge and regular training of new recruits should be done • Better would be the provision of a paramedical trained person • All teachers and staff should be trained to know the ABC of resuscitation

10. Adequate number of toilets • The absence of adequate no. of toilets leads to adverse effects on health and poor hygiene and also leads to pollution • Atleast one urinal per 60 students and one latrine for 100 students although ideal would be one latrine / 25 students • Toilets should have wash basins • There should be more toilets in girl’s schools • Facility for running water rather than stored water ensures cleanliness and hygiene

Conclusion • These ten simple guidelines will go a long way in creating a healthy and supportive environment for optimum development of our children.

Symptoms of infant botulism

pgblazer — Wed, 04 Feb 2009 03:16:09 +0000

constipation poor feeding weakness lethargy loss of head control pooled oral secretions altered cry Related Articles ...