Pedia Small Notebook Edited

7/25/2019 Pedia Small Notebook Edited

1/17

ESSENTIAL NEWBORN CARE PROTOCOL [from DOH]

What should be done immediately after birth is to dry the baby because

hypothermia can lead to several risks

Delaying the cord clamping to 3 mins after birth (or waiting until the

umbilical cord has stopped pulsing)

Instead of immediately washing the NB, the baby should be placed on

the mothers chest or abdomen to provide warmth, increase theduration of breastfeeding, and allow the good bacteria from themothers skin to infiltrate the NB

Washing should be delayed until after 6 hours because this exposes the

NB to hypothermia and remove vernix. Washing also removes the babyscrawling reflex.

NEWBORN CARE

Umbilical Cord

Cut 8 inches above abdomen after 30 sec

In nursery, cut the umbilical cord 1 inch above the abdomen

Healing should take place around 7 10 days

Eye Prophylaxis

1% silver nitrate drops [most effective against Neisseria]

Erythromycin 0.5% [Chlamydia]

Tetracycline 1% Povidone iodine 2.5%

Vitamin K

1 mg Vit K1

PT: 0.5 mg

Vaccine

BCG

Hep B

Newborn Screening

Done on 16th hr of life . can be repeated after 2 weeks

Patients w/ CAH will die 7 14 days if not treated

Patient w/ CH will have permanent growth defect and MR if not

treated before 4 weeks

Disorder Screened Effects ScreenedEffects if Screened &

treated

Congenital

Hypothyroidism

Severe MR Normal

Congenital Adrenal

Hyperplasia (CAH)

Death Alive &Normal

Galactosemia (Gal) Death of Cataract Alive &Normal

Phenylketonuria PKU Severe MR Normal

G6PD Severe Anemia

Kernicterus

Normal

APGAR SCORE

Evaluates the need for resuscitation

Taken 1 and 5 minutes after birth

0 1 2

Color Blue, pale Body pink,

extremities blue

All pink

HR 0 100

Reflex irritability No response Grimace Cough

Activity Limp Some flexion Active

Respiration Absent Slow, irregular Good

The APGAR Score

81047

03

Good cardiopulmonary adaptationNeed for resuscitation, esp ventilatory support

Need for immediate resuscitation

NICU

Please admit under RI, LI, PD or AP

TPR q4H

May breastfeed if NSD; NPO x 2hrs if CS

Labs:

NBS at 24 hrs old, secure consent

CBC, BT (if w/ maternal illness, PROM or UTI

HGT now then 1, 3, 6, 12, 24, 48 hrs old (GDM)

HGT now (SGA or LGA)

Medications:

Erythromycin eye ointment both eyes

Vit K 1 mg IM (term); 0.5 mg (PT)

Hep B vaccine 0.5 ml IM, secure consent

BCG 0.05 ml ID (PT); 0.1 ml (term), secure onsent

SORoutine NB care

Monitor VS q30 mins until stable

Thermoregulate at 36.5 to 37.5C

Place under droplight (NSD); isolette (CS)

Suction secretion prn

Will infrom AP /AP attended delivery

IMMUNIZATION

Vaccine Min age of 1st

dose

# of

doseInterval Booster

BCG At birth

Before 1 mo

1 - -

DPT 6 wks

(2, 4, 6 mos)

3 4 wks 18 mos

46 yo

OPV/IPV 6 wks2, 4, 6 mos)

3 4 wks Same asDPT

Hep B At birth

(0, 1, 6 mos)

EPI (6, 10, 14)

3 6 wks from 1st

dose; 8 wks

from 2nd dose

Measles 69 mos 1 -

MMR 15 mos 1

Hib 2, 4, 6 mos 18 mos

Pneumococcal 6 mos (PCV7)

2 yrs (PPV)

18 mos

Rotavirus 3 and 5 mos 2 I month

Hep A 1 yr and up 2 612 mos

apart

Varicella 1st: 1215 mos

2nd: 46 yo

2 Bet 1st & 2nd

dose: at least

3 mos

Flu 6 months yearly

NEONATAL SEPSIS

Classification

Early:birth to 7th day of life Late:8th to 28th day of life

Risk factors:

Maternal infection during pregnancy

Prolongrupture of membranes (18 hrs)

Prematurity

Common organism:

Bacteria:GBS, E. coli& Listeria(early) Viruses:HSV, enteroviruses

Signs & symptoms: Non-specific

Dx: CBC, CXR, blood and urine culture, lumbar tap for CSF studies

Treatment: Empiric antibiotics [Ampicillin + 3rd gen Cephalosporin or

Aminoglycoside) / Supportive

NEONATAL JAUNDICE

Risk Factors

Jaundice visible on first day of life

Asibling w/ neonatal jaundice or anemia

Unrecognized hemolysis

Non-optimal feeding

Deficiency: G6PD

Infection

Cephalhemaoma or bruising / Central hct >65%

East Asian/ Mediteranean in origin

PHYSIOLOGIC vs PATHOLOGIC

FACTORS PHYSIOLOGIC PATHOLOGIC

Onset > 24 hrs of life < 24 hrs of life

Rate of inc of TSB < 0.5mg/dl/hr > 0.5mg/dl/hr

Persistent < 14 days FT: > 8 days

PT: > 14 days

Total S. Bilirubn FT: < 12 mg/dl

PT: < 14 mg/dl

Any level requiring

phototherapy

Signs/Symptoms Vomiting, lethargy, poor

feeding, excess wt loss, apnea,

inc RR, temp instability

KRAMER CLASSIFICATION

ZONE JAUNDICE mg/dl

I Head/neck 68

II Upper trunk 912

III Lower trunk, thigh 1216IV Arms, leg, below knee 1518

V Hands/feet > 15

BREAST FEEDING vs BREASTMILK JAUNDICE

Parameter BREASTFEEDING BREASTMILK

Onset 3rd to 5th day

of life

Late; start to rise on day 4; may reach

2030 mg/dl on day 14 then slowly

Normal by 412 weeks

Patho-

physiology

milk intake

enterohepatic

circulation

Unknown; Prob. due to glucoronidase

in BM which enterohepatic circulation

Normal LFT; (-) hemolysis

Mngt Fluid and

caloric

supplement

If breastfeeding is stopped, rapid in

bilirubin level in 48 hrs, if resumed will

to 24 mg/dl but no precipitating

previous events


2/17

MILK FORMULAS

1:1dilution

Mead-Johnson, Nestle, Glaxo,

Dumex, Milupa

1:2dilution

Wyeth, Abbott, Unilab

0-6 months (20cal/oz) Lactose free (0-6months)

Mead-johnson: Alacta , Enfalac

Nestle: NAN1, Nestogen

Glaxo: Frisolac

Dumex: Dulac

Abbott: Similac advance

Milupa: AlaptamilWyeth: S26, Bonna

Unilab: Mylac

Mead-johnson: Enfalac lacto-free

Nestle: AL110

Milupa: HN25

Wyeth: S26Lacto-free

6months onwards (20cal/oz) Lactose free (6months onwards)

Mead-johnson: Enfapro

Nestle: NAN2, Nestogen 2

Glaxo: Frisomil

Dumex: Dupro

Abbott: Gain

Wyeth: Bonnamil. Promil

Unilab: Hi-nulac

Mead-johnson: Enfapro lacto-free

1 year onwards (20 cal/oz) Premature Infant (24cal/oz)

Mead-johnson: Enfagrow, Lactum

Nestle: NAN3, Neslac

Glaxo: Frisorow

Dumex: Dugrow

Abbott: Gainplus

Wyeth: Progress, Promil

Unilab: Enervon bright

Mead-johnson: Enfaprem

Nestle: PreNAN

Abbott: Similac prem

Milupa: Preaptamil

Hypoallergenic (20cal/oz) Soy-Based (20cal/oz)

Mead-johnson: Pregestimil

Nestle: Alfare, NAN HA1, NAN HA2

Mead-johnson: Prosoybee

Abbott: Isomil

Wyeth: Nursoy

TPN for NEONATESWt 2kg1.TFR = 100 ml/kg/day x 2 kg 200 ml

2.Intralipid 20%

1 g/kg/day x 2kg = 2g/day 10 ml

2 g = 20g

x 100ml

3. Compute for TFR 1TFR1 = TFRIntralipid = 200 -10ml = 90 ml

4. Vamin 7%

1 g/kg/day x 2 kg = 2g = 29 ml2 g = 7g

x 100ml5. Multivitamins Benutrex c 0.5 ml/100ml

0.5 ml = x 1 ml

100ml 190 ml

6. Ca gluc 10% 2ml/kg/day x 2 kg 4 ml

7.Dextrosity (D10) get d50wTFR 1 x dextrosity factor (0.11) 21 ml

190 x 0.118 . D5IMB= TFR 1(Vamin + MTV + Ca gluc + D50W)

190(29 + 1+ 4+ 21) = 135 ml

9. IV rate = TFR 1 / 24H 190 ml/ 24H 8 ml/H

Order:Start TPN as ff:

TFR= 100ml/kg/dayD5 IMB 135 mlD50W 21 mlVamin 7% 29 mlCa Gluc 4 mlMTV 1 ml

190 ml to run at 8 ml/hIntralipid 20% 10 ml to run for 24H

TPN

Vamin 9% 0.67 cal/ml

Start 0.5 g/k/day inc by 0.5 g until 3 -3.5g/k/day

Compute = wt x dose x prep (100/9)

Intralipid 10% 20%

Start 0.5 g/k/day inc by 0.5 g until 3 g/k/day

Compute = wt x dose x prep (100ml/ 10) = ml/24H

Amino acidsStart 0.5 g/k/day inc by 0.5 g until 3 g/k/day

Compute = wt x dose x prep (100ml/g) = ml/24H

TPN shortcut computation

Wt 10 kg TFR= 100 ml/k/day TFI = 1000ml/day

Vamin 7% 7 = 2 g/kg x 10kg 285 ml

100

CaGluc 2ml/kg 20 ml

D5IMB 485 ml

D50W 0.11 x 1000ml 110 ml

1000ml x 37 cc/h

TPN (PEDIATRICS)

Energy Requirment

AGE/WT Caloric Rquirement

Neonates 90-120 kcal/kg

Infants & Older Children

20

10-120 kcal/kg

1000kcal + 50 kcal foe each kg > 101500 + 20 for each more than 20

Fluid Requirement

AGE/WT Fluid Rquirement

Neonates: VLBW

( 1500 gm)

AGA & LBW

Initiate at 4060 ml/kg/day and increase by 10

ml/kg/day till 120 ml/kg is reached

Initiate at 60 ml/kg/day and increase by 15 ml/

kg/day till 120 ml/kg is reached on the 5 thday of

PN

Neonates under radiant heaters/on phototx an extra 30ml/kg/dayof water

Infants & Older Children

20

100120 ml/kg

1000ml + 50 ml foe each kg > 10

1500 + 20 for each more than 20

Protein Requirement

AGE/WT Dosage (gm/kg/day)

VLBW ( 1500 gm)

012 months

18 yrs

8 yrs and above

2.25

2.50

1.502.0

1.001.50

With the initiation of PB|N, start w/ 0.5gm/kg/day and gradually increased

by 0.5gm/kg/day till recommended protein is reached.

Carbohydrate Requirement

% dextrose = gram dextrose x 100

Vol infused (ml

Should provide 5060 % 0f total non-protein calories

Requirement ranges frm 10 to 25 gm/kg/day

Infusion should not exceed 12.5mg/kg/min

Should be decreased if urinary glucose 0.5% (2+) or blood sugar exceeds 7

mmol/L in neoanate or 9.7 mmol/L I above 1 mo of age

Fat Requirement

AGE Dosage (gm/kg/day)

012 months

18 yrs

8 yrs and above

2

4

2.5

3040 % of total calories shud b provided as fats

24% as EFA

Start at 0.5 gm/kg/day and gradually increase by 0.5 gm/kg/day tillrecommended amt is reached

Daily Electrolyte Requirements

Elect.

(mmol/kg)Neonates 1-6 mos 6m-11yrs Adolescents

NaCl

Potassium

Cal gluc

Phosphate

Magnesium

35

24

0.61.0

1.0

0.125-0.250

34

23

0.251.2

(max of 4.7)

12

0.125-0.250

34

23

0.251.2

(max of 4.7)

12

0.125-0.250

60100

80120

4.7

3045

48

Calcium gluconate contains 100 mg calcium gluconate or 9mg elemental

calcium/ml; 1 gm of Ca gluconate contains 4.7mEq or 2.35 mmol of Ca.


3/17

Trace Elemental Requirements

Trace

ElementalPrematures

(ug/kg)

Infants & Children

(ug/kg)

Adolescents

(mg)

Zinc

Copper

Chromium

Manganese

Iodine

Selenium

Flouride

400

50

0.3

10

8

4

57

100500

20

0.140.2

210

8

4

57

2.54

0.51.5

0.010.04

0.150.5

0.2

0.3

0.9

In the absence of available prep of trace elements; weekly blood

transfusion may be given at 20 ml/kg

Iron: 2 mg/kg, with dose increased to 6 mg/kg if Fe def is documntd;

provided by adding iron dextran to amino acid soln

OSTERIZED FEEDING

TFR 60 - 70% = 100/feeding q 6H10 kg x 60%

TFR = 600

CHON 0.5 g/kg inc q other day by 0.5 , max of 2 g/kgDose x wt x prep (Vamin 7%, 9%)

0.5 x 10 kg x (100 /7) = 71 g/kgCHON = 71 g/kg

If no prep = dose x wt x 4 = 20 g/kg

CHO 60%

(TFRCHON) x 0.6

(600- 71) x 0.6 = 317CHO = 317

Fats 181 (the rest are fats , div ided into 6 feedings)

COMPOSITION OF ORS

ORS Na K Cl GluGlucolyte 60 20 50 100

Hydrite 90 20 80 111

WHO 75 20 65 75

Pedialyte 30

45

90

30

45

90

20

20

20

30

35

80

Gatorade 41 11 9/100

VITAMINS

Stimulants Mosegar Vita 0.25 mg/day prep 0.25 /5 ml

Buclizine (syrup) Appetens

Propan

Appebon

2 - 8yo 5 - 10 ml OD

7 - 14yo 10 - 20 ml OD

w/ Folic acid

(Megaloblastic

Anemia)

Molvite

7 - 12yo 10 - 15 ml OD

3 - 6yo 5 - 10 ml OD

1 - 2yo 2.5 - 5 ml OD

Iberet

Ferlin (10 mcg folic acid)

Macrobee

1 - 2yo 2.5 - 5 cc OD3 - 6yo 5 - 10 cc OD

7 - 12yo 10 - 15 cc OD

Pizotifen

(drowsiness)Mosegor vita syr

Appetens

MTV w/ Iron Propan w/ iron syr (Fe So4; elem fe 30mg)

Appebon w/ iron syr (FeSo4; elem fe 10mg)

w/ Serotonin (for

migraine + dec

wt)

Mosegor vita

Mosegor plain

Appeten

Jagaplex syrup

1-2yo 5ml OD

3-6yo 10 ml OD

7-12yo 15 ml OD

Clusivol Power syrup

syr 100mg/5ml

2-6yo 5 ml OD

7-12yo 10 ml OD

Zeeplus

20

Daily Requirement [ml/kg]

100 ml

1000 + 50ml/kg for each kg >10

1500 + 20ml/kg for each kg >20

Maintenance water rate

010

1020

>20

4ml/kg/hr

40 mk/hr + 2ml/kg/hr x wt

60 mk/hr + 1ml/kg/hr x wt

COMPOSITION OF IV SOLUTION

Fluid Na K Cl HCO3 Dxt

PNSS 154 - 154 - -

0.45 NaCl 77 - 77 - -

D50.3 NaCl 51 - 51 - 5

D5LRS 130 4 109 28 5

D5NM 40 13 40 16 5

D5IMB 25 20 22 23 5

D5NR 140 5 98 27 5

Na requirement:24 meq/k/day K requirement: 23 meq/k/day

KIR: 0.20.3 meq/k/hr ; max 40 meq

KIR = Rate x incorporation/ wt


4/17

CLINICAL FEATURES of PNEUMONIA

Bacterial Fever >38.5C

Chest recession

Wheeze not a sign of primary bacterial URTI

Viral Wheeze Marked recession

Fever < 38.5 RR normal or increased

Mycoplasma School children

Cough

wheeze

CXR in assessing CAP etiology

Alveolar infltrates Bacterial pneumonia

Interstitial infiltrates Viral pneumonia

Both infiltrates Viral, Bacterial, or Mixed

Microbial causes of CAP according to Age

Birth to 20 days Grp B Strep CMV

Gram (-) enterobacteria L. monocytogenesis

3 weeks to 3

months

RSV B. pertussis

Parainfluenza virus S. aureus

S. pneumonia

4 months to 4 yo RSV, Parainfluenza virus H. influenzae

Influenza virus, Adeno, Rhinovirus M.tuberculosis

S. Pneumonia M.pneumoniae

5 years to

15 years

M.pneumoniae S. pneumonia

C. Pneumoniae M.tuberculosis

Clinical Practice Guidelines in the Evaluation and Management of PCAP

Predictors of CAP in patients with cough

(3 mos to 5 yrs)tachypnea &/or chest retractions(512 yrs)fever, tachypnea & crackles

(>12 yo)(a) fever, tachypnea & tachycardia; (b) at least 1 AbN CXR

WHO Age Specific classification for tachpynea

2 to 12 mos: >50 RR

1 to 5 yrs: >40 RR

>5 yrs: >30 RR

PCAP A/PCAP B

No diagnostic usually requestedPCAP C/PCAP D

The ff shud b routinely requested

CXR APL (patchyviral; consolidatedbacterial)

WBC

C/S (blood, Pleural Fluid, tracheal aspirate on initial intubation)

Blood gas/Pulse oximeter

The ff may be requested: C/S sputum

The ff shud NOT be routinely requested: ESR & CRP

Antibiotic Recommendation

PCAP A/PCAP B and is beyond 2 yo & having fever w/o wheeze

PCAP C and is beyond 2 yo, having high grade fever, having alveolar

consolidation on CXR, having WBC >15,000

PCAP Drefer to specialist

Antibiotic Recommendation

PCAP A/PCAP B w/o previous antibiotic

Amoxicillin (4050 mkday) TID

PCAP CPen G IV (100,000 IU/k/d) QID

PCAP C who had no HiB immunization

Ampicillin IV (100mkd) QID

PCAP Drefer to specialist

What should be done if px is not responding to current antibiotics?

If PCAP A/PCAP B not responding w/n 72 hrs

Change initial antibiotic

Start oral Macrolide

Reevaluate dx

PCAP C no responding w/n 72 hrs consult w/ specialisr

PCN resistant S pneumonia

Complication

Other dx

PCAP D not responding w/n 72hrs, then immediate consultto a specialist is

warranted

Switch from IV to Oral Antibiotic done in 2 3 days after initiation in px who:

Respond to initial antibiotic

Is able to feed with intact GI tract

Does not have any pulmo or extra pulmo complication

Ancillary Treatments

O2 and Hydration

Bronchodilators, CPT, steam inhalation and Nebulization

Prevention

Vaccines

Zinc Supplementation (10mg for infants / 20mg for children > 2 yo)

THERAPEUTIC MANAGEMENT OF CAP

OPD MANAGEMENT

Birth to 20 days Admit

3 weeks to 3 months Afebrile: Oral Erythromycin (30-40mkd)

Oral Azithromycin (10 mg/kg/day) day 1

5 mkday for day 2 to 5

Admit: febrile or toxic

4 months to 4 yo Oral Amoxicillin (90mkd/3doses)

Alternative: Amox-Clav, AZM, Cefaclor

Clarithromycin, Erythromycin

5 years to 15 years Oral Erythromycin (30-40mkd)

Oral AZM 10mkday day 1, 5mkday day 2-5

Clarithromycin 15mkday/2 doses

Pneumococcal infxn: Amoxicillin alone

IN-PATIENT MANAGEMENT

Birth to 20 days Ampicillin + Gentamicin w or w/o Cefotaxime

3 weeks to 3 months Afebrile: IV Erythromycin (30-40mkd)

Febrile: add Cefotaxime 200mkd

Cefuroxime 150 mkd

4 months to 4 yo If w/ pneumococcal infection:

IV Ampicillin (200mkd) Cefotaxime 200mkd

Cefuroxime 150 mkd

5 years to 15 years Cefuroxime 150 mkd + Erythromycin 40mkd

IV or orally for 10-14 days

If pneumococcal is confirmed: Ampicillin 200mkd

P C A PVARIABLE A(Min Risk) B(Low Risk) C(Mod Risk) D(High Risk)

Comorbid

IllnessNone Present Present Present

Compliant

caregiverYes Yes No No

Ability to

follow upPossible Possible Not Not

DHN None Mild Moderate Severe

Feeding Able Able Unable Unable

Age >11 mos >11 mos 50/min

>40/min

>30/min

>50/min

>40/min

>30/min

>60/min

>50/min

>35/min

>70/min

>50/min

>35/min

Signs of Respiratory Failure

VARIABLE A(Min Risk) B(Low Risk) C(Mod Risk) D(High Risk)

Retractions

Head

bobbing

Cyanosis

GruntingApnea

Sensorium

-

-

-

--

None

-

-

-

--

Awake

Subcostal/

Intercostal

+

+

--

Irritable

Subcostal/

Intercostal

+

+

++

Lethargy /

Stupor

Coma/

Comp:

Effusion

Pneumo

-thorax

None None Present Present

Action Plan OPD

f/u at end

of tx

OPD

f/u after 3

days

Admit to

regulat ward

Admit to

CCU; Refer

to specialist

BRONCHIOLITIS

Acute inflammation of thesmall airwaysin children


5/17

VIRAL CROUP vs EPIGLOTTITIS

VIRAL CROUP EPIGLOTTITIS

Age group 3 mos to 3 yrs 37 yrs

Stridor 88% 8%

Pathogen Parainfluenza virus H. influenzaetype B

Onset Prodrome (17 days) Rapid (412 hrs)

Fever Severity Low grade High grade

Associated symptom Barking cough,

hoarseness

Muffled voice,

Droolong

Respond to racemic

epinephrineStridor improves None

CXR steeple sign thumbprint sign

BRONCHIAL ASTHMA

Please admit under the service of Dr. _____________

TPR q4H and record

NPO if dyspneic

Labs:

CBC

U/A (MSCC)

ABG* CXR APL*

IVF:

D5 0.3 NaCl 1P (50cc/kg in 8 h if 2 yo)

D5LR 1L at 30cc/kg in 8hif >40 kg

Medications:

Paracetamol prn q4h for T > 37.8C (10 15 mkdose)

USN with Salbutamol or Salbu+Ipratropium neb; 1 neb x 3 doses

Incorporate Budesonide 10 mkd LD (max 200mg IV); then

5mkd q6h IV (max of 100 mg IV)

Ranitidine IVTT at 1mkdose (if on NPO)

SO:MIO q shift and record

Monitor VS q2h and record

Refer for persistence of tachypnea, alar flaring and retractions

O2at 2 lpm via NC, refer for desaturations


6/17

ANAPHYLAXIS

A syndrome involving a rapid & generalized immunologically mediated rxn

After exposure to foreign allergens in previously sensitized individuals

A true emergency when cardio and respi system are involvedED Management

O2

Aqueous Epinephrine 1:1000 IM (0.01ml/kg with 0.5ml max)

Prepare intubation if w/ stridor & if initial therapy of epi is not effective

Continuous monitor ECG and O2 sat & establish IV access

Antihistamine to prevent progression

H1 & H2 blocker

Diphenhydramine (1mg/kg) IM

Steroids may modify late phase or recurrent reaction (Hydrocortisone

5mg/kg/dose)

Epinephrine 1:10,000 IV (0.1ml/kg; 10ml max)

Epinephrine drip (0.01ml/kg/min)

Indication for Admission

Persistent bronchospasm

Hypotension requiring vasopressors

Significant hypoxia

Patient resides some distance from a hospital facility

SEIZURE

BENIGN FEBRILE SEIZURE CRITERIA

6 mos6 yrs

< 15 mins

Febrile

Family history of febrile seizure

GTC

Not > 1 episode in 1 febrile episode; EEG done after 2 w ks of seizure

episode

3% of general population develop epilepsy

12 % of BFS develop epilepsy

25% recurrence of seizure

Seizureparoxysmal, time limited change in motor activity and/or behavior

that results from abnormal electrical activity in the brain

Epilepsypresent when 2 or more unprovoked seizure/s occur at an interval

greater than 24 hrs apart

SEIZURE Simple Complex

Type GTC Focal then gen post ictal

Duration < 15 min > 15 min or may go into

status

Recurrence None Recurrent (w/in 24H)

CNS exam Normal Abnormal

Sequelae None Neurodev abnormalities

FEBRILE SEIZURE

Please admit under the service of Dr. ______________

TPR q4H and record

DAT once fully awake

Labs:

CBC

U/A (MSCC)IVF:



Medications:

Paracetamol prn q4h for T > 37.8C

SO:

MIO q shift and record


Monitor neurovital signs q4h and record

Continue TSB for fever

Seizure precaution at bedside as ff:

Suction machine at bedside

O2with functional gauge; if with active sz give O2at 2lpm via NC

Diazepam IVTT (0.3 mkd max of 5 mg IV) prn for seizure

Will inform AP

Pls inform Dr _____ of this admission

Thank you.

S H O C K

CO = HR x SV / CO is primarily maintained by changes in HR

HYPOVOLEMIC Pump empty

Truma, hemorrhage,

DHN (diarrhea/

vomiting)

Metabolic dse (DM)

Excessive sweating

MC in infant &children

Normal BV of children

80ml/kg

CARDIOGENIC Weak/sick pump

CHF, cardiomegaly,

drug intoxication,

hypothermia,

after cardiac

surgery

Compromise CO

DISTRIBUTIVE Sepsis

Anaphylaxis

Barbiturate intox

CNS injury (SCI)

Redistribution of fluid w/n

vascular space

SIGNS OF SHOCK

EARLY LATE

Narrowed pulse pressure

Orthostatic changes

Delayed capillary filling

Tachycardia

Hyperventilation

Decrease systolic pressure

Decrease diastolic pressure

Cold, pale skin

Altered mental state

Diaphoresis

Decrease urine output

EDMNGT

PositionOxygen & Assisted ventilation

Intravenous access & Fluid (isotonic crystalloid)

Reassess (look for improvement in VS, skin signs, mental status;

insert foley cath & monitor UO)

Inotropeshelp stabilize BPEpinephrine - (0.11 ug/kg/min)- Infusion of choice for

Hypotensive pxsDobutamine - (5 20 ug/kg/min)

Cardiogenic shock but not severely hypotensiveDopamine[(520 ug/kg/min constrictor effect) [(10 15

ug/kg/min]

Distributive shock after successful fluid resuscitation

Cardiogenic shock

Diureticpxs may get worse after fluid challenge

Adenosine / synchronize cardioversionSVT

DefibrillationVenticular fibrillation

BELLS PALSY

Acute unilateral facial nerve palsy that is not associated with other

cranial neuropathies or brainstem dysfunction

Usually develops abruptly about 2 wks after SVI [EBV, HSV, mumps]

Upper and lower portions of the face are paretic; corner of the mouth

drops; unable to close the eye on the involved side

Protection of cornea with methylcellulose eye drops or an ocular

lubricant; excellent prognosis

CEREBRAL PALSY

Non-progressive disorder of posture & movement often associated with

epilepsy & abnormalities of speech, vision & intellect resulting from

defect or lesion of the developing brain

Etiology: infections, toxins, metabolic, ischemia

Classifications

Physiologic

[major motor abnormality]

Topogrphic

[involved extremities]Spastic

Athetoidworm like

Rigid

Ataxic

Tremor

Atonic

Mixed

unclassified

Monoplegia [1 side/portion]

Paraplegia

Hemiplegia

Triplegia [3 limbs]

Quadriplegia [all]

Diplegia [LE/UE]

Double hemiplegia

Clinical Manifestations

Spastic

hemiplegia

Arms > legs

Dificulty in hand manipulation obviously by 1 yo

Delayed walking or walk on tiptoes

Spasticity apparent esp. in ankles

Seizure & cognitivr impairment

Spastic diplegia Bilateral spasticity of the legs

Commando crawl

Increased DTRs & (+) Babinski sign

Normal intellect

Spastic

quadriplegia

Most severe form, due to marked motor impairment

of all extremities & high association w ith MR &

seizures

Swallowing difficulties

Management

Baseline EEG & cranial CT scan

Hearing & visual function tests

Multidisciplinary approach in the assessment & treatment

For tight heel cord: tenotomy of the Achilles tendon

CSF PATHWAY

Choroid plexus (lateral ventricle) Foramen of Monroe 3rdventricle

Aqueduct of sylvius 4 thventricle Foramina of Luschka (2 laterals)

& Magendie (median) SAS Absorbed in the arachnoid villi,

then in the Venous System


7/17

HYDROCEPHALUS

Result from impaired circulation & absorption of CSF or from inceased

production

Obstructive or Noncommunicating

Due to obstruction w/n ventricular system

Abnormality of the aqueduct or a lesion in the 4th venticle

(aqueductal stenosis)

Non-obstructive or Communicating

Obliteration of the subarachnoid cisterns or malfunction of the

arachnoid villi

Follows SAH that obliterates arachnoid villi; leukemic infiltrates

Clinical Manifestations Infant: accelerated rate of enlargement of the head; wide anterior

fontanel & bulging [Normal fontanel size: 2 x 2 cm]

Eyes may deviate downward: due to impingement of the dilated

suprapineal recess on the tectum [settingsun sign]

Longtract sign: [brisk DTR, spasticity, clonus, Babinski sign]

Percussion of skull produce a crackedpot or Macewen sign

[separation of sutures]

Foreshortened occiput [Chiari malformation]

Prominent occiput [Dandy-Walker malformation]

Treatment

Depends on the cause

Extracranial shunt

Acetazolamide & Furosemide [provide temporary relief by reducing

the rate of CSF production]

DEEP TENDON REFLEXESMOTOR

Full resistance with gravitySome resistance with gravity

Movement with gravity

Movement w/o gravity

Flicker

No movement

5/54/5

3/5

2/5

1/5

0/5

Very brisk

Brisker than average

Normal

Diminished

No response

+4

+3

+2

+1

0

CRANIUM

Caput succedaneum

Diffuse edematous swelling of soft tissues of scalp

Extend across midline

Edema disappears w/in 1stfew days of life

Molding and overriding of parietal bones-frequent

Disappear during 1stwks of life

No specific tx

Cephalhematoma

Subperiosteal hemorrhage; limited to1 cranial bone

Occur 1-2 % cases

No discoloration of overlying scalp

Swelling not visible for several hours after birth (blding slow process)

Firm tense mass with palpable rim localized over 1 area of skull

Resorbed w/in 2wk- 3mos and calcify by end of 2ndwk

Few remain for years

10-25% cases underlying linear skull fracture

No tx but phototherapy in hyperbilirubinemia

Pre Lumbar Tap

NPO

RBS by gluco prior to lumbar tap

Prepare lumbar tap set

2% Lidocaine # 1

G 23 spinal needle

Mannitol 250 cc 1 bot - do not open

Solvent

Diazepam 1 amp

3 cc syringe #2

2 manometers

sterile bottles # 3

sterile gloves # 2

Sterile gauze # 1

Sterile gauze w/ Betadine #1

Sterile towel w/ hole #1

Sterile clamp #1

3-way stopcock #1Post Lumbar Tap

NPO x 4H; Flat on bed

Monitor NVS to include BP q 30mins x 4H, then qH

CSF exams

Bottle # 1Gm stain, AFB, India ink, K OH

Bottle # 2Cell count, CHON, Sugar

Bottle # 3C/S, save remaining specimen

Watch out for vomiting, HA and hypotension

ANTICONVULSANTS

DIAZEPAM 0.20.3 mkdose

Drip: 1amp in 50cc D5W

10mg/amp

MIDAZOLAM 0.15 mkdose prn 23 mins interval IV (1, 5mg/ml)

6 mos - 5 yo 0.05 - 0.10 max of 0.6 mg/kg

6 yo - 12 yo 0.25 - 0.05 max of 0.4 mg/kg

>12 yo 0.50 - 2 mg/dose over 2 mins

PHENOBARBITAL LD: 15 20 mkd MD: 5 mkdose q 12h

(max load 20 mkday IV

Tabs: 15, 30, 60, 90, 100 mg

Caps: 16 mg

ELIXIR 20mg/5ml

Inj: 30, 60, 65, 130 mg/ml

MD: PO/ IV

Neonate: 3 - 5 mkD QID/ BID

Infant/child: 5 - 6 mkD

1 - 5 yo: 6 - 8 mkD

6 - 12 yo: 4 - 6 mkD

> 12 yo: 1 - 3 mkD

Hyperbil < 12 yo: 3 - 8 mkD BID/TID

PHENYTOIN LD: 1520 mg/kg/IV

MD:

Neonate: 5 mkD PO/ IV BID

Infant/child: 5 7mkD BID/ TID

6mos3y: 810 mkD

46y: 7.59 mkD

79y: 78 mkD

1016 y: 67 mkD

Dilantin Tab: 50mg 100mg TID

Extended release caps 30, 100, 200, 300 mg OD, BID

Inj: 50 mg/ml

Contraindications to LP

Evidence of Inc ICP

Severe CP compromise

Skin infection at site of puncture

CARBAMAZEPINE

Tegretol Tab 200mg, 100mg chew

XR 100mg, 200mg, 400mg

Susp 100mg/ 5ml (QID)

Initial Increment Maintenance

< 6 yo 10 - 20 mkD BID /TID q wkly til 35 mkD

6 - 12 yo 10 mkD BID 100 mg/ 24H at

1 wk interval

20 - 30 mkD BID/

QID

> 12 y 200 mg BID 200 mg/ 24H at

1 wk interval

800 - 1200

mg/24H

BID/ QID

OXCARBAMAZEPINE (8 - 10 mkd BID)

Initial: 8 -10 mkD PO BID then

Increment: increase over 2 week pd to

Maintenance doses:

20 -29 kg: 900 mg/24H PO BID

29.1 -39 kg: 1200 mg/24H PO BID

>39 kg: 1800 mg/24H PO BID

Trileptal Tab 150 mg 300mg 600 mg

Susp 300mg/5ml

VALPROIC ACID PO:

Initial : 10 - 15 mkD OD - TID

Increment: 10 mkD at wkly interval BID

Maintenance: 30 - 60 mkD BID/TIDIV: same dose as PO q 6H

Rectal : (syrup mix with water 1:1)

LD: 20 mkd

MD: 10 -15mkd TID

Depakene Tab 250 mg

Syr 250mg/5ml

Depacon IV 100mg/ml

TOPIRAMATE 2 - 16 yo

Initial: 1 - 3 mkd PO q HS x 7 days then Increment:

Increase by 1 - 3 mkday for 1 - 2 wks then

Maintenance: 5 -9 mkD BID

Topamax Caps: 15 mg, 25 mg

Tabs: 25, 50, 100, 200mg


8/17

Glasgow Coma Scale GCS for Infants

Activity Activity

Eye Opening

Spontaneous

To speech

To pain

None

4

3

2

1

Spontaneous

To speech

To pain

None

4

3

2

1

Verbal

Oriented

Confused

Inappropriate words

Inappropriate sounds

None

5

4

3

2

1

Coos, babbles

Irritable

Cries to pain

Moans to pain

None

5

4

3

2

1

Motor

Follows commandLocalizes pain

Withdraws to pain

Abnormal flexion

Abnormal extension

None

65

4

3

2

1

N spontaneous movtWithdraws to touch

Withdraws to pain

Abnormal flexion

Abnormal extension

None

65

4

3

2

1

CSF ANALYSIS

Color RBC WBCDiff

ctSugar CHON

Infant (Term) Xantho 0 -

100

0 -32 L

100

%

70 to

80%

60 -

150

Infant (Preterm) Clear 0 -

100

0 -15 L

100

%

70 to

80%

60 -

200

Older child Clear 0 0 -10 L

100

%

> 50% 10 - 20

Viral Meningitis Clear 0 0 -20 L

100

%

40 to

60%

40 - 60

TB/Fungal Clear 0 20 -

500

L >

N

< 40% > 100

g%

Bacterial

MeningitisPurulent 0 >

1000

N >

L

< 50% > 100

g%

Partially tx BM Clear 0 100 L >

N

> 50% Dec

VIRAL INFECTIONS

MEASLES (Rubeola) [Paramyxoviridae]

MOT Droplet spray

IP 1012 days

Prd of comm 4 days before & 4 days after onset of rash

Enanthem Koplik spots (opposite lower molars)

Prodrome High grade fever, conjunctivitis, catharr (35 days)

Rash Appear during height of fever

Cephalocaudal[1st along hairline, face, chest]

[+] brawny desquamationdisappear w/n 710 days

Complication Otitis media Diarrhea

Pneumonia Exacerbation of M tb infection

Encephalitis

Tx Vit A SD 100,000 IU orally for 6 mos1 yo / 200,000 IU >1 yo

Post exposure

prophylaxis

Ig w/n 6 days of exposure

(0.25ml/kg max 15 ml) IM

Vaccine Susceptible children >1 yo w/n 72 hrs

SSPE Chronic condition due to persistent measles infxn

Rare but found in 6 mo to >30 yrs of age

Subtle change in behavior & deterioration o schoolwork

followed by bizarre behavior

Elevated titers of Ab to measles virus(IgG, IgM)

Inosiplex (100mg/kg/day) may prolong survival

GERMAN OR 3 DAY MEASLES [RUBELLA] [Togaviridae]

MOT Oral Droplet; transplacentally to fetus

IP 1421 days

Prd of comm 7 days before &7 days after onset of rash

Enanthem Forchheimer spots [soft palate] just b4 onset of rash

Rash Cephalocaudal

Charac. sign Retroauricular, posterior cervical & postoccipital LAD [24

hrs before rash & remains for 1 wk]

TxVit A SD 100,000 IU orally for 6 mo1 y / 200,000 IU >1 yo

Post exposure

prophylaxis

Immunoglobulin [not routine]

Considered if termination of preg is not an option

0.55ml/kg) IM

Vaccine w/n 72 hrs of exposure

Congenital

RubellaGreatest during 1st trimester; IUGR

Congenital cataract, microcephaly, PDA, blueberry

muffin skin lesions

Congenital or profound SNHL | Motor/mental retardation

ROSEOLA [HSV 6] Exanthem subitum

Age of onset < 3 yo with peak at 6 15 months

High grade fever for 35 days but behave

normally

Rash Appears 1224 hrs of fever resolution fades in 1

3 days

HERPANGINA [Coxsackie A]

Sudden onset of fever with vomitingSmall vesicles & ulcers w/ red ring found in anterior tonsillar pillars, may also

seen on the soft palate, uvula & pharyngeal wall

VARICELLA [HSV]

MOT Direct contact

IP 14 days

Prd of comm 12 days before the onset of the rash until 5 6

days after onset & all the lesions have crusted

Rash Start from the trunk then spread to othe parts of the

body

All stages present; pruritic

Macule/papule vesicle crust

Complication Secondary bacterial infection Reye syndrome

Encephalitis or meningitis GN

Pneumonia

Congenital

Varicella

6 -12 wks AOG: maximal interruption w/ limb devt

with cicatrix(ski lesion w/ zigzag scarring)

1620 wks: eye and brain involvement

Tx Acyclovir 1530 mg/kg/day IV or 200400 mg tabq 4hrs minus midnight dose x 5 days: risk of severity

Post exposure

prophylaxis

VZIg 1 dose up to 96 hrs after exposure

Dose: 125 U/10 kg (max 625 U) IM

NB whos mother develop varicella 5 days before to 2

days after delivery shud recv 1 vial

Vaccine Susceptible children >1 yo w/n 72 hrs

ERYTHEMA INFECTIOSUM [Parvovirus B 19] FIFTH DISEASE

MOT Droplet spread & blood & blood products

IP 1617 Days average

Prodrome Low grade fever, headache, URTI

Rash Erythematous facial flushing slapped cheekand

spreads rapidly to the trunk & proximal extremities as

a diffuse macular erythema; palms & soles spared

Resolves w/o desquamation but tend to wax and

wane in 13 wks

MUMPS [Paramyxoviridae]

MOT Direct contact, airborne droplets, fomites

contaminated by saliva

IP 1618 days

Period of

communicability

12 days before onset of parotid swelling until 5 days

after the onset of swelling

Prodrome Fever, neck muscle pain, headache, malaise

Parotid gland

swelling

Peak in 13 days

1st in the space between posterior border of mandible

& mastoid then extends being limited above zygoma

Complications Meningoenephalitis - most frequent, 10 days; M>F

Orchitis & Epididymitis

Oophoritis

Dacryoadenitis or optic neuritis

Hx of

Absorbed TTClean minor Wound All other Wounds

Td TIG Td TIG

Unknown or

No No No No

< 7 yo Dtap is recommended

> 7 yo Td is recommended

If ony 3 doses of TT received, a 4th dose should be given

Give TT (clean minor wounds) if > 10 y since last dose

All other wounds (punctured wds, avulsions, burn)

Give TT (all clean wounds) if > 5 yrs since last dose

RABIES VACCINE

VERORAB 0.5 cc/amp; 1 amp IM

Day: 0 3 7 14 and 28

BERIRAB RD: 20 iu/kg

300 iu/vial 1 vial = 2ml

at wound site

deep IM

Reqd amt in IU: wt x RD (20IU)

Amount in ml = wt x RD (20) x 2

300

Ig (Human)

Equine

20 iu/kg

Bayrab 300 iu/2ml | Berirab 300 iu/2ml

40 iu/kg

Favirab 200400 iu/5ml

10002000 iu/5ml


9/17

VACCINES

BCG

DPT

OPV

IPV

MMR, Measles

Varicella

Hep B

Hep A

Hib

Typ

Pneumococcal

Influenza

Live attenuated M bovis

Diptheria and TTinactivated B pertussis

Sabin trivalent live attenuated virus

Salk inactivated virus

Live attenuated virus

Recombinant DNA, plasma derived

Inactivated virus

Capsular polysacc linked to carrier CHON

Live typhoid vaccine3 doses x 2 days

IMSCVi antigen typ vaccine

Capsular polysaccharide 0.5 ml

SC /IM23 valent purified capPolysacc Antigen of 23 serotyp

Split or whole virus IM

DENGUE FEVER

Please admit under the service of Dr. ________________

TPR q4H and record

DAT (No dark colored foods)

Labs:

CBC, Plt (optional APTT and PT)

Blood typing

U/A (MSCC)

IVF:

D5 0.3 NaCl 1P/1L (40 kg) at 35 cc/kg

Medications:


Omeprazole 1mkdose max 40 mg IVTT OD

SO:

MIO q shift and recordMonitor VS q2h and record, to include BP


Refer for Hypotension, narrow pulse pressure (< 20mmHg)

Refer for signs of active bleeding like epistaxis, gum bleeding,

melena, coffee ground vomitus

Will inform AP


Thank you.

DENGUE HEMORRHAGIC FEVER

Serotype 1, 2, 3, & 4

Aedes egypti

IP: 46 days (min 3 days; max 10 days)

DHF SEVERITY GRADING

GRADE MANIFESTATION

I Fever, non-specific constitutional symptoms such as

anorexia, vomiting and abdominal pain (+) Torniquet

test

II Grade I + spontaneous bleeding; mucocutaneous, GI

III Grade II w/ more severe bleeding +

Evidence of circulatory failure: violaceous, cold &

clammy skin, restless, weak to imperceptible pulses,

narrowing of pulse pressure to < 20mmHg to

actualHPON

IV Grade III but shock is usually refractory or irreversible

and assoc w/ massive bleeding

CRITERIA FOR CLINICAL DX (WHO)

DHF DSS

Fever, acute onset, high, lasting 27

days

Hemorrhagic manif:

(+) Torniquet test

Minor & Major bleeding

phenomenon

Thrombocytopenia 2yo5-7 mkd TID, BID PO

INFECTIVE ENDOCARDITISDUKE CRITERIA

Major ManifestationMinor manifestation

DiagnosisHighly probable: 2 major OR 1 major and 2 minor manifestation

RHEUMATIC HEART DISEASE

JONES CRITERIA

Major Manifestations

Arthritis (70%)

Carditis (50%)

Tachycardia Pericarditis

Heart murmur of valvulitis Cardiomegaly

Signs of CHF [gallop rhythm, distant heart sounds, cardiomegaly]

Erythema marginatum (10%)

Subcutaneous nodules (210%)

Sydenhams chorea (15%)

Minor manifestations

Arthralgia Acute Phase Reactants (CRP & ESR)

Fever at least 38.8C Prolonged PR interval on the ECG

Diagnosis: Highly probable : 2 major OR 1 major and 2 minor manifestation

ACUTE GASTROENTERITIS

Please admit under the service of Dr. ________________

TPR q4H and record

DAT once fully awake; NPO x 2hrs if with vomiting

Labs:

CBC

U/A (MSCC)

F/A (Concentration Method)

IVF:

D5 0.3 NaCl 1P (50cc/kg in 8 h if 2 yo)D5LR 1L at 30cc/kg in 8hif >40 kg

Medications:


Zinc (E Zinc)Drops 10mg/ml 1ml OD (2 yo) 5ml OD

Ranitidine IVTT at 1mkdose (if with abdominal pain)

SO:




Chart character, frequency and amount of GI losses and replace w/

PLR 1L/1P vol/vol

Will inform AP


Thank you.


10/17

BPN

Please admit under the service of Dr. ______________

TPR q4H and record

NPO if dyspneic

Labs:

CBC

U/A (MSCC)

ABG* CXR APL*

IVF:



Medications:

Paracetamol prn q4h for T > 37.8C (10 15 mkdose)

USN with Salbutamol or Salbu+Ipratropium neb; 1 neb x 3 doses

then refer

NaCl (Muconase) nasal spray, 2 sprays per nostrils, then suction

using bulb QID

Ranitidine IVTT at 1mkdose (if on NPO)

SO:




Refer for persistence of tachypnea, alar flaring and retractions

O2at 2 lpm via NC, or 6 lpm via facemask

Attach to pulse oximeter, refer for desaturations


11/17

PHOTOTHERAPY

10 Bulbs; 20 watts; 200 hrs; 30 cms

Bilirubin in the skin absorbs light energy

Photo-isomerizationreaction converting the toxic native unconjugated

4Z, 15Z-bilirubin into an unconjugated configurational isomer 4Z,15E-

bilirubin, which can then be excreted in bile without conjugation

Major product from phototherapy is lumirubin, which is an irreversible

structural isomer converted from native bilirubin and can be excreted by

the kidneys in the unconjugated stateComplications

Loose stools, erythematous macular rash, purpuric rash associated with

transient porphyrinemia, overheating, dehydration (increased insensiblewater loss, diarrhea), hypothermia from exposure, and a benign

condition called bronze baby syndromedark, grayish-brown skin

discoloration in infants

Bilirubin (Total)

Cord

Preterm

Term


12/17

Regular milk: 20 cal/oz

Preterm milk: 24 cal/oz

Total Caloric Intake: rate x 24 x caloric content of IVF wt

To get factor: Dextrosity x 0.04 = cal/cc

Caloric content of IVF

D5 = 0.2 cal/cc

D7.5 = 0.3 cal/cc

D10 = 0.4 cal/cc

D15 = 0.6 cal/cc

Caloric requirement & Protein requirement

Cal/kg g/kg

0-5mo

6-11mo1-2 yo

3-6 yo

7-9 yo

1012 yo

13-15 yo

1619 yo

115

110110

90100

8090

7080

5565

4550

3.5

32.5

2

1.5

1.5

1.5

1.5

Approximate Daily Water Requirement

03 do

10 do

15 mo

612 mo

13 yo

120cc/k/d

150cc/k/d

150cc/k/d

140cc/k/d

120cc/k/d

46 yo

79 yo

1012 yo

1315 yo

1619 yo

100 cc/k/d

90 cc/k/d

80 cc/k/d

70 cc/k/d

50 cc/k/d

Estimated Catch up Growth Requirement

= cal/k/day (age for wt) x IBW (wt for ht)

Actual BW

CHON reqt = CHON reqt for age x IBW

Actual BW

Growth and Caloric requirements

AGE RDA kcal/kg/day

03 mos

36 mos

69 mos

912 mos

13 yo

46 yo

115

110

100

100

100

90100

Double Volume Exchange Therapy (DVET)

Wt x 80 x 2 = Volume/ amt of fresh whole blood

(Use mothers blood type)

Volume _ = # of exchange

aliquots per exchange

> 3 kg 20 ml

2-3 kg 15 ml

1-2 kg 10 ml

850g-1kg 5 ml

< 850 g 1-3 ml

Prepare the ff:

2 pcs 3 way stopcock

1 pc 5 cc syringe

1 pc BT set

1 pc IV tubing

1 pc empty bottle

Gloves

Calcium gluconate 100 mg every 10 exchanges

Criteria for Hypoxic Ischemic Encephalopathy

pH < 7 (profound met. Acidosis)

Apgar 10 yo cuffed

Laryngoscope sizes

PT Miller 00 or 0

Term Miller 0

0-6mos Miller 1

6-24 mos Miller 2

>24 mos Miller 2 or Mac 2

NORMAL VALUES

AVERAGE WEIGHT (3,000 grams)

06 mos Age in months x 600 + BW

712 mos Age in months x 500 + BW

Children16 yo

712

yo

Age in years x 2+ 8

Age in years x 75 / 2

HEAD CIRCUMFERENCE [35 cm (+ 2cm)] (inch = 2.54cm)

14 months

512 mos

2 years old

35 yo

620 yo

inch per month

inch per month

1 inch per year

inch per year

inch per 5 years

LENGTH (50 cm)

03 months

46

79

1012

9 cm

8 cm

5 cm

3cm

BLOOD TRANSFUSION

FWB 10 - 20 cc/kg 34H

PRBC 5 - 10 34H

Plasma 10 - 15 12 H

PRP 10 - 15 12 H

Plt conc 1 u/ 7 -10 kg FD

Cryoprecipitate 1 u/kg

Hemophilia A 1 bag(200mg fibrinogen)

VW dse 50 -100 mg/kg

Fibrinogen dse 100 cc

(2-5 kg)

FD

Factor 8 Hemophilia A 50 u/kg

Hemophilia B 100 u/kg

1 - 3 days 1 mo 2mos 612y >12y

Hgb 14.522.5 9 -14 11.5 -15.5 13-16

Hct .48 - .69 .28 - .42 .35 - .45 .37 - .49

Wbc 9 -30 birth 519.5 6 -17.5 4.5 -13.5

Plt 84478 NB After 1 wk, same as adult

150 - 400

Retic 0.4 - 0.6 < 1 -1.2 0.1 -2.9

1 u FWB = 200 cc PRBC

= 50 cc platelet concentrate

= 150200cc PRP

= 150 cc FFP

MCV Hgb / rbc x 10 80 -94

MCH Hgb / rbc x 10 27 - 32

MCHC Hgb/ hct x 10 3238

Absolute reticulocyte count= pts hct x retic %

N hct for age

Reticulocyte Index

Absolute Retic Ct > 2 hemorrhage

2 < 2 rbc production abn

PRBC to be transfused for correction= 40hct x wt

GLUCOSE

PT 20 -60

NB 3060

1 d 40 -60

> 1d 50 -90

Child = 60 -100

Adult = 70-105


13/17

ANC - % of neutrophils & cells that become neutrophilsmultiplied by wbc

ANC = wbc x (% seg + % stabs + % meta)

Other formula: wbc x (seg + meta + stabs ) x 10

Ex 2.1 x 53 (seg) x 10 = 1113

ANC > 1000 Normal

ANC < 2000 Neutropenia

ANC 1000 -1500 Low risk of infection

ANC 500 -1000 Mod risk of infection

ANC < 500 High risk of infection

IT ratio > 0.25 sepsis

> 0.80 higher risk of death from sepsis

Anemia

< 10 g mild anemia

8 - 9 g mod anemia

40 kg

wt x 0.05 + 0.05

wt x 0.04 + 0.10

wt x 0.03 + 0.20

wt x 0.02 + 0.40

wt x 0.01 + 0.80

Age K (mean value) KI

LBW < 1 yr 0.33 29.17

FT < 1 yr 0.45 39.78

2-12 y 0.55 48.62

13-21 y (female) 0.55 48.62

13 -21 y (male) 0.70 61.88

Age GFR Range

Preterm

2- 8 d

4 - 28 d

30 -90 d

11

20

50

1115

1528

4065

Term

2- 8 d

4 - 28 d

30 - 90 d

39

47

58

1760

2668

3086

1- 6mo 77 39 -114

6 - 12 mo 103 49157

2 - 19mo 127 62191

2 - 12y 127 89165

Adult males 131 88174

Adult females 117 87147

Age

(months)

Ht (cm)

boys

Ht (cm)

girls

Wt for Ht

(cm)

Boys

(kg)

Girls

(kg)

0 50.5 49.9 49 3.1 3.3

1 54.6 53.5 50 3.3 3.4

2 58.1 56.8 51 3.5 3.5

3 61.1 59.5 52 3.7 3.7

4 63.7 62.0 53 3.9 3.9

5 65.9 64.1 54 4.1 4.1

6 67.8 65.9 55 4.3 4.3

7 69.5 67.6 56 4.6 4.5

8 71.0 69.1 57 4.8 4.8

Age

(months)

Ht (cm)

boys

Ht (cm)

girls

Wt for Ht

(cm)

Boys

(kg)

Girls

(kg)

9 72.3 70.4 58 5.1 5.0

10 73.6 71.8 59 5.4 5.3

11 74.9 73.1 60 5.7 5.5

12 76.1 74.3 61 5.9 5.8

13 77.2 75.5 62 6.2 6.1

14 78.3 76.7 63 6.5 6.4

15 79.4 77.8 64 6.8 6.7

16 80.4 78.9 65 7.1 7.0

17 81.4 79.9 66 7.4 7.3

18 82.4 80.9 67 7.7 7.5

19 83.3 81.9 68 8.0 7.8

20 84.2 82.9 69 8.3 8.1

21 85.1 83.8 70 8.5 8.4

22 86.0 84.7 71 8.8 8.6

23 86.8 85.6 72 9.1 8.9

24 87.6 86.5 73 9.3 9.1

25 88.5 87.3 74 9.6 9.4

26 89.2 88.2 75 9.8 9.6

27 90.0 89.0 76 10.0 9.8

28 90.8 89.8 77 10.3 10.0

29 91.6 90.6 78 10.5 10.2

30 92.3 91.3 79 10.7 10.4

31 93.0 92.1 80 10.9 10.6

32 93.7 92.8 81 11.1 10.8

33 94.5 93.5 82 11.3 11.0

34 95.2 94.2 83 11.5 11.2

Age

(months)

Ht (cm)

boys

Ht (cm)

girls

Wt for Ht

(cm)

Boys

(kg)

Girls

(kg)

35 95.8 94.9 84 11.7 11.4

36 96.5 95.6 85 11.9 11.6

3.5 yo 98.4 97.3 86 12.3 11.8

4 102.9 101.6 87 12.3 11.9

4.5 106 104.5 88 12.5 12.2

5 109.9 108.4 89 12.8 12.4

5.5 112.6 111.0 90 13.0 12.6

6 116.1 114.6 91 13.2 12.8

6.5 118.5 117.1 92 13.4 13.0

7 121.7 120.6 93 13.7 13.3

7.5 123.9 123.0 94 13.9 13.5

8 127.0 126.4 95 14.1 13.8

8.5 129.1 128.8 96 14.4 14.0

9 132.2 132.2 97 14.7 14.3

9.5 134.4 134.7 98 14.9 14.6

10 137.5 138.3 99 15.2 14.9

10.5 139.9 140.9 100 15.5 15.2

11 143.3 144.8 101 101.0 15.5

11.5 145.8 147.6 102 16.1 15.9

12 149.7 151.5 103-105 16.5-17.1 16.2-16.7

12.5 152.5 154.1 106-108 17.4-18.0 17.0-17.6

13 156.5 157.1 109-111 18.3-19.0 17.9-18.6

13.5 159.3 158.8 112-114 19.3-20.0 18.9-19.5

14 163.1 160.4 115-117 20.3-21.1 19.9-20.6

14.5 165.7 161.1 118-120 21.4-22.2 21.0-21.8

15 169.0 161.8 121-123 22.6-23.4 22.2-23.1


14/17

Height for Age= Actual Height (cm)

P50 Ht for Age

Age

(months)

Ht (cm)

boys

Ht (cm)

girls

Wt for Ht

(cm)

Boys

(kg)

Girls

(kg)

15.5 171.1 162.1 124-126 23.9-24.8 23.6-24.6

16 173.5 162.4 127-129 25.2-26.2 25.1-26.2

16.5 174.9 162.7 130-132 26.8-27.8 26.8-28.0

17 176.2 163.1 133-135 28.4-29.6 28.7-30.1

17.5 176.7 163.3 136-140 30.2-33.0 30.8-32

18 176.8 163.7 141-145 33.7-36.9

Weight for Height = Actual BW (kg)

P50 Wt for Ht (kg)

WaterlooClassification

Wasting(Wt for Ht)

Stunting(Ht for Age)

Normal

Mild

Moderate

Severe

>90

8190

7080

95

9095

8589

5 - 15

ANAPHYLAXIS

Epinephrine

(1:1000)0. 01ml/kg max of 0.5 mg/dose SC

< 30 kg 0.15 mg

> 30 kg 0.3 mg

Diphen = 50mg IM (1mkdose)

USN w/ Salbu x 3 doses

ANTIBIOTICS

Amoxicillin (30 50 mkday) TID

Pediamox Susp : 250mg/5ml

Drops : 100mg/ml

Himox Cap : 250mg, 500mg

Moxicillin Susp : 125mg/5ml 250mg/5ml

Harvimox

Novamox

Drops : 100mg/ml

Amoxil Susp : 125mg/5ml 250mg/5ml

Cap : 250mg 500mg

Glamox

Globapen

Drops : 100mg/ml

Amoxicillin + Clavulanic acid (30 50 mkday)

Augmentin Tab: 375mg (250mg); 625 (500mg)

Amoclav Susp: 156.25mg/5ml (125mg) TID

228.5mg/5ml (200mg) BID

312.5mg/5ml (250mg) TID457mg/5ml (400mg) BID

Cloxacillin (50 100 mkday) q6h

Prostaphlin A Tab: 250mg 500mg

Orbinin Susp: 125mg/5ml

Flucloxacillin ( 50 100 mkday) q6h

Staphloxin Susp: 125mg/5ml

Cap : 250mg 500mg

Chloramphenicol (50 75 mkd) q6h

Pediachlor

Chloramol

Kemicetine

Chloromycetin

Susp: 125mg/5ml

Tab : 250mg 500mg

CEPHALOSPORINS

1st Generation

Cefalexin (25 100 mkd ) q 6-8 h

Lexum Cap : 250mg; 500mg

Cefalin Susp : 125mg/5ml 250mg/5ml

Keflex Drops : 100mg/ml

Ceporex Cap : 250mg 500mg

Selzef Caplet: 1 gmGranules: 125mg/5ml 250mg/5ml

Drops: 125mg/1.25ml

2nd Generation

Cefaclor (20 40 mkd ) q 8 12 h

Ceclor

Ceclor CD

CD ext release

Pulvule: 250mg 500mg 375mg

750mg

Susp: 125mg/5ml 187mg/5ml

250mg/5ml 375mg/5ml

Drops: 50mg/ml

Xelent

Vercef

Cap : 250mg 500mg

Susp : 125mg/5ml 250mg/5ml

Cefuroxime (20 40mkd) q 12h

Zinnat Cap : 250mg 500mg

Sachet: 125mg/sat 250mg/sat

Susp: 125mg/5ml

Cefprozil (20 40mkd) q 12h

Procef Susp : 125mg/5ml 250mg/5ml

3rd GenerationCefixime (6 12 mkd) q 12h

Tergecef

Zefral

Ultrazime

Susp : 100mg/5ml

Drops: 20mg/ml

Cefdinir (7mg/kg q 12h OR 14mg/kg OD)

Omnicef Cap : 100mg

Sachet/ Susp: mg/5ml

COTRIMOXAZOLE (TM 5 8 mkd) q 12h

BactilleTS

Bacidal

Susp/5ml SMZ 400mg TM 80mg

Tab 800mg 160mg

Susp/5ml 400mg 80mg

Trizole Susp/5ml 400mg 80mg

Globaxole Tab 800mg 160mg

Susp/5ml 400mg 80mg

Trimethoprim + Sulfadiazone (TM 5 8 mkd)

Triglobe Tab Sdz 410mg TM 90mg

Forte 820mg 180mg

Susp/5ml 205mg 45mg

AMINOGLYCOSIDES

Tetracycline 2550 mkday q6h

Doxycycline 5 mkday BID

Furaxolidone 58 mkday q6hMACROLIDES

Erythromycin (30 50 mkd) q 6h

Macrocin Susp: 200mg/5ml

Ethiocin Drops: 100mg/2.5ml

Erycin Cap : 250mg 500mg

Susp: 200mg/5ml

Drops: 100mg/2.5ml

Erythrocin Film tab: 250mg 500mg

Granules: 200mg/5ml

DS Granules: 400mg/5ml

Drops: 100mg/2.5ml

Ilosone/

Ilosone DS

Tab: 500mg DS Liquid: 200mg/5ml

Pulvule: 250mg Drops: 100mg/ml

Liquid: 125mg/5ml

Clarithromycin (6 15 mkday OR 7.5 mkdose q12h)

Klaricid

Klaz

Susp : 125mg/5ml 50mg/5ml

Tab: 250mg 500mg

Roxithromycin


15/17

IV ANTIBIOTICS

Penicillin 50,000100,000 ukd q 6h

Amoxicillin 50100 mkd q 68 h

Ampicillin 50100 mkd q 68 h

Chloramphenicol 50100 mkd q 46 h

Ampi + Cloxa 50100 mkd q 6 h

Oxacillin 50100 mkd q 68 h

Flucloxacillin 50100 mkd q 68 h

Gentamicin 57.5 mkd OD

Netromycin 5mkd q 12 h

Amikacin 15mkd q 12 h

Cephalexin 50100 mkd q 6 h

Cefuroxime 50100 mkd q 68 h

Ceftriazone 50100 mkd OD

Ceftazidime 50100 mkd q 12 h

HYDROCORTISONE LD: 10 mkdose

MD: 5 mkdose q 6, 8 or 12h

*max dose: LD 200 MD 100

ANTIVIRAL

Acyclovir (20 mkdose) q 4 6 h

Max 800mg/day x 5 days

Zovirax

Acevir

Susp: 200mg/5ml

Blue: 400mg

Pink: 800mg

ORAL ANTIFUNGALS

Ketoconazole (6mkd) q 4 6h

Daktarin Adult & Child: tsp q 6h

Infant: tsp q 6 h

Nystatin

Mucostatin

Ready mix susp

Susp: 100,000 u/5ml

Tab: 500,000 u

Fluoconazole (3 6 mkd) OD x 2wks

Diflucan Cap: 50mg 150mg 200mg

Vial: 2mg/ml x 100 ml

ANTI-HELMINTHICS

Oxantel + Pyrantel pamoate (10 20 mkd) SD

Trichiuriasis: x 2 days Hookworm: x 3 days

Quantrel Susp : 125mg/5ml

Tab : 125mg 250mg

Mebendazole *not recommended below 2 yo

Antiox Susp: 50 mg/ml 100mg/ml

Tab: 125mg 250mg

100 mg BID x 3 days

500mg SD (>2 yo)

Albendazole 2yo: 400mg SD

*may give x 3 days if with severe infestation

Zentel Susp: 200mg/5ml

Tab : 400mgAMOEBICIDES

Metronidazole PO: 30 50 mkday q 8h

IV: 30 mkday q 8h

Anaerobia Susp : 125mg/5ml

Tab : 250mg

Servizol Susp: 200mg/5ml

Tab : 250mg 500mg

Flagyl Susp : 125mg/5ml

Tab : 250mg 500mg

Etofamide (15 20 mkd) TID

Kitnos Susp : 125mg/5ml

Tab : 200mg 500mg

Diloxanide furoate (20mkd) q8h x 10 days

Furamide Tab : 500mg

Dilfur Susp: 125mg/5ml

Secnidazole

Flagentyl 2 tab now then 2 tabs after 4 hrsErcefuryl (20mkday)

ANTICONVULSANT

Diazepam 0.20.3 mkdose

Drip: 1amp in 50cc D5W

10mg/amp

Midazolam 0.15 mkdose OR

0.050.2 mkdose

Phenobarbital LD: 10 mkdose q 12h

MD: 5 mkdose q 12h

ANTI-TB MEDS

Isoniazid (1012 mkd) ODAC or 2hrs PC

Comprilex

Nicetal

Trisofort

Odinah

Suspension:

200mg/5ml

100mg/5ml

200mg/5ml

150mg/5ml

Tablet 400mg

Rifampicin (1020 mkd) ODAC or 2hrs PC

Natricin

Rifadin

Rimactane

Rimaped

100mg/5ml 200mg/5ml

100mg/5ml

100mg/5ml

200mg/5ml

Tablet 300mg 450mg

Pyrazinamide (PZA) (1630 mkd) BID/TID

CIBA

Zcure

Zinaplex

250mg/5ml

500mg/5ml

Tablet 500mg

MUCOLYTIC

Solmux Drops: 40mg/ml

13 mos: 0.5ml TID/

QID

36 mos 0.75ml

612 mos 1ml

12 yo 1.5 ml

Susp: 100mg/5ml200mg/5ml

23 yo 5ml

2.5ml

47 yo 10ml

5 ml

812 yo 15ml

7.5mlForte: 500mg/5ml

Cap: 500mg

Adult & >12 yo: 510ml

1 cap

Solmux

Broncho

Capsule

Suspension

Solmux

Chewable tab

Tab: 500mg

1 tab q 8h

Carbocisteine Infant Drops QID

12 yo 1015ml 23 tspCapsule TID

Adult & >12 yo 1 cap

Lovsicol Infant drops 50mg/ml

Ped Syrup 100mg/5ml

Adult Susp 250mg/5ml

Cap 500mg

Ambroxol Infant drops 6mg/ml 75mg/ml BID

< 6 mo 0.5ml 0.5ml

712 mo 1 ml 0.75ml

1324 mo 1.25ml 1mlPedia Syrup

10 yo = 5ml TID

Retard cap: Adult & >10 yo = 1 cap OD

Tab: Adult & >10 yo = 1 tab TID

Inhalation

5 yo = 1 2 inhalation of

23ml soln daily

Mucosolvan Infant drops 6mg/ml

Ped liquid 15mg/5ml

Adult liquid 30mg/5ml

Retard cap 75mg

Tab 30mg

Inhalation Soln 15mg/2ml

Ampule 15mg/2ml

Ambrolex

Zobrixol

Infant drops 7.5mg/ml

Ped liquid 15mg/5ml

Adult liquid 30mg/5ml

Tab 30mg


16/17

B2 AGONIST

Salbutamol (0.10.15 mkdose)

Ventolin Tab 2mg

Syr 2mg/5ml

Nebule 2.5mg/2.5ml

Ventar

Hivent Syrup

Tab 2mg

Syr 2mg/5ml

Salbutamol + Guaifenesin

Asmalin

Broncho

Pulmovent

Tab

1 tab TID

Syrup

26 yo 510 ml BID/TID

712 yo 10ml

Terbutaline sulfate ( 0.075 mkdose)

Terbulin Tab 2.5mgPulmoxel Tab 2.5mg Nebule 2.5mg/ml

Syr 1.5mg/5ml

Bricanyl Tab 2.5mg Nebule 5mg/2ml

Syr 1.5mg/5ml Expectorant

Doxophelline (68 mkdose) BID x 710 days

Ansimar Syrup 100mg/5ml Tab 400mg

Procaterol HCl (0.25ml/kg)

Meptin Syrup 5mcg/ml

Tab 25mcg

Nebuliser soln 100mcg/ml

Theophylline 1020 mkdose 35 mkdose

DECONGESTANT

NasalNaCl 24 drps/spray per nostril TID/QID

2 sprays/nostril then suction q6h x 3 days

Salinase

Muconase

Nasal spray

Nasal drops

Oxymetazoline HCl 25 yo: 23 drops/nostril BID

>5 yo: 23 sprays/nostril BID

Drixine Nasal spray: 0.05%

Nasal soln: 0.025%

Xylometazoline

HCl< 1 yo: 12 drps OD/BID

16 yo: 12 drps OD/BID max TID

Adult: 23 drps / 1 squirt T ID max QID

Otrivin

OralPhenylpropanolamine HCl (0.3

0.5 mkdose)Disudrin 13 mos: 0.25 ml

46 mos: 0.5 ml

712 mos: 0.75 ml

12 yo: 1 ml

26 yo: 2.5 ml

712 yo: 5 ml

Drops: 6.25ml q6h

Syr: 12.5mg/5ml q6h

Brompheniramine maleate + PPA

Dimetapp 16 mos: 0.5ml TID/QID

724 mos: 1ml TID/QID

24 yo: tsp

412 yo: 5ml

Adult: 510 ml

1 tab BID

Infant drops: (0.1mkdose)

Syr

Extentab

Carbinoxamine maleate + Phenylephrine HCl

Rhinoport 15 yo: 5ml BID

612 yo: 10ml BID

Adult & > 12yo: 1 cap / 15ml BID

Syrup Cap

Loratadine + PPA

Loraped 30 kg: 5ml BID

Syrup: 5mg/ml

ANTITUSSIVES

Butamirate citrate 3 yo 5 ml TID

>6 yo 10ml TID

>12 yo 15ml TID

Adult 15ml QID

1 tab TID/QID

Sinecod Forte Syrup 7.5mg/5ml Tab 50mg

Dextromethorphan + Guaifenesin

26 yo 2.55ml q 68h

612 yo 5ml q 68h

Adult 510ml q 6h

RobitussinDM

Syrup

ANTIHISTAMINE

Diphenhydramine HCl (5mkd) q 6h | IM/IV/PO: 12 mkdose

Benadryl Syr: 12.5mg/5ml Inj: 50mg/ml

Cap: 25mg 50mg

Hydroxyzine (1mkd) BID

Adult: 10mg BID 25mg ODHS

Iterax Syr: 2mg/ml

Tab: 10mg 25mg 50mg

Ceterizine (0.25mkdose)

6mos - 12 y : 1 tab OD

Claritin/Allerta/Loradex Syr: 5mg/ml Tab: 10mg

Desloratadine 612 mos: 2ml OD

15 yo: 2.5ml OD

612 yo: 5ml OD

Aerius Syr: 2mg/5ml Tab: 5mg

ANTIPYRETIC

Paracetamol (1020 mkdose) q 4h

Tempra Drops: 60mg/0.6ml

Syrup: 120mg/5ml

Forte : 250mg/5ml

Tablet: 325mg 500mg

Calpol Drops: 100mg/ml

Syrup: 120mg/5m

250mg/5ml

Defebrol Syrup: 120mg/5m

250mg/5ml

Afebrin Drops: 60mg/0.6ml

Syrup: 120mg/5ml

Forte : 250mg/5ml

Tablet: 600mg

Tylenol Drops: 80mg/ml

Syrup: 160mg/5ml

Naprex Drops: 60mg/0.6ml

Syrup: 250mg/5ml

Inj: 300mg/2ml

Rexidol Drops: 60mg/0.6ml

Syrup: 250mg/5ml

Tablet: 600mg

Biogesic Drops: 100mg/ml

Syrup: 120mg/5m

250mg/5mlTablet: 500mg

Aeknil Ampule (2ml) 150mg/ml

Opigesic Suppository: 125mg 250mg

Mefenamic Acid (6 8mkdose) q 6h

Ponstan Suspension: 50mg/5ml

Cap SF: 250mg

Tab: 500mg

Aspirin (60 100 mkd)

Ibuprofen (5 10 mkday) q8h (max 20mkday)

Dolan FP

Dolan Forte

Advil

Suspension: 100mg/5ml

200mg/5ml

Drops: 100mg/2.5ml

100mg/5

Tab: 200mg

H2-BLOCKER

Ranitidine 12 mkdose q 12h

Zantac Tab 75mg 150mg 300mg

Cimetidine Neonates: 520 mkday q612 h

Infants: 1020 mkday

Child; 2040 mkday

Adult: 300mkdose QID

400mkdose BID

800mkdose QID

Tagamet Susp: 300mg/5ml

Tab: 100mg 200mg 300mg 400mg

800mg

Famotidine PO: 0.5 mkdose q 12 h

IV: 0.60.8 mkday q 812h


17/17

ANTISPASMODIC

Dicycloverine 6mos2 yo 0.51ml TID

Relestal Drops 5mg/ml

Syrup 10mg/5ml

Domperidone 0.30.6 mkdose q 68 h

2.55ml/10kg BW TID

Dyspepsia: 2.5/10kg TID

Nausea: 2.55ml/kg TID

0.30.6 ml/5kg BW TID/QID

Motilium Susp 1mg/ml Tab 10mg

Vometa Oral drops 5mg/ml Tab 10mg

Susp 5mg/5ml

INHALED STEROIDS

Budesonide Budecort 250mcg q 12h

500mcg q 12h

500mcg OD for allergic rhinitis

250mcg /ml (2ml)

500mcg /ml (2ml)

Flexotide neb 250mcg /ml (2ml)

250mcg q 12h

ORAL STEROIDS LD: 10mkdose 200mg

MD: 5mkdose

Prednisone 12 mkday

Prednisolone

Liquidpred

12 mkday

Syrup 15mg/5ml

ANTIHYPERTENSIVES

Hydralazine

Apresoline

PO: 0.751.0 mkday q 612 h

IV: 0.10.2 mkdose

Spirinolactone 13 mkday

ANTACIDS

Maalox

(plain, plus)

5ml/10kg

Available in 180ml bottle

Simethicone

Restime < 2 yo 0.5ml qid

212 yo 4ml qid

Oral drops 40mg/ml

Edited by:

frankydinks (2015)

Pedia Small Notebook Edited

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