Flashcards in Paediatrics Deck (409)
When is the 6 in 1 vaccine given?
2, 3 and 4 months
When is the pneumococcus vaccine given?
2, 4 and 12 months
When is the Men B vaccine given?
2, 4 and 12 months
When is the rotavirus vaccine given?
2 and 3 months
When is the Hib/MenC booster given?
When is the MMR given?
1 year and 3 years 4 months
When is the HPV vaccine given?
When is the Men ACWY vaccine given?
New university students aged 19-25
Outline the management of DDH.
If < 2 months, observation and serial examination and ultrasound is recommended (every months)
If it persists/worsens, hip abduction orthosis (splint) or Pavlik harness are recommended (serial follow-up and plain X-ray at 6 months)
Outline how hearing is tested in the neonate.
1st: evoked otoacoustic emission (EOEA) testing
If this is abnormal --> automated auditory brain stem (AABR) audiometry
Briefly outline the steps in the management of necrotising enterocolitis.
Stop oral feeding
Broad spectrum antibiotics (ceftriaxone and vancomycin)
Surgery if perforation/necrosis
What can be used to close a PDA?
Prostacyclin synthetase inhibitor
How is the bilirubin concentration measured in neonatal jaundice?
If < 24 hours or < 35 weeks gestation = serum bilirubin
If > 24 hours or > 35 weeks gestation = transcutaneous bilirubin (if this is > 250 µmol/L - check serum bilirubin)
What serum bilirubin levels suggests increased risk of developing kernicterus?
> 340 µmol/L in babies > 37 weeks
or rising rapidly > 8.5 µmol/L/hr
How often should serum bilirubin be measured in a neonate with jaundice?
Every 6 hours until it drops below the treatment threshold
Which investigations should be performed in a neonate who developed jaundice within 24 hours of birth?
Blood group of mother and baby
FBC and blood film
Blood G6PD level
Which antibiotics are used to treat meconium aspiration?
IV ampicillin and gentamicin
Which antibiotics may be used in the treatment of early-onset sepsis?
Benzylpenicillin and gentamicin
Which organism most commonly causes late-onset sepsis?
Coagulase-negative staphylococcus (e.g. Staphylococcus epidermidis)
How is neonatal meningitis treated?
3rd generation cephalosporin + amoxicillin/ampicillin
What is the paediatric sepsis 6?
1. Supplemental oxygen
2. Gain IV or IO access and order blood cultures, blood glucose and arterial/capillary/venous gasses
3. IV/IO broad-spectrum antibiotics
4. IV fluids (be cautious about fluid overload)
5. Experienced senior clinicians should be involved early
6. Vasoactive inotropic support (e.g. adrenaline) should be considered early
a. Considered if normal physiological parameters are NOT achieved after > 40 ml/kg of fluid resuscitation
How should neonatal conjunctivitis be treated?
Discharge and redness (staph or strep) - topical ointment (e.g. neomycin)
Gonococcus - 3rd generation cephalosporin
Chlamydia - erythromycin (2 weeks)
What should babies at risk of vertical hepatitis B transmission receive?
Hepatitis B immunoglobulin AND Hep B vaccine
How is gastro-oesophageal reflux in a breastfed infant treated?
1st line: Breastfeeding assessment
2nd line: trial of alginate therapy for 1-2 weeks
How is gastro-oesophageal reflux in a formula fed infant treated?
1st line: review feeding history (check for overfeeding)
2nd line: offer trial of smaller more frequent feeds
3rd line: offer trial of thickened formula
4th line: offer trial of alginate therapy
If conservative measures to treat GOR in an infant fail, what should you do?
Consider a 4-week trial of a PPI or histamine antagonist
State an example of an antibiotic regimen that may be used to eliminate H. pylori.
Amoxicillin + metronidazole/clarithromycin
This is given as a 7-day triple therapy with a PPI
How are the maintenance fluid values for children calculated?
0-10 kg = 100 ml/kg/day
10-20 kg = 1000 mL + 50 ml/kg/day
20+ kg = 1500 mL + 20 ml/kg/day
How is the amount of fluid required when giving a bolus to a child calculated?
20 ml/kg of NaCl in < 10 mins
NOTE: use 10 mL/kg if DKA, trauma, fluid overload or heart failure