clinical notes of pediatrics

Boot shaped 💚 TOF With picture of pneumonia

what is the abnormality 🤔

TGA ... egg shaped 💚

Bleeding in neonatal period 🎈 🎃 Baby looks well ? ✔ swallowing of maternal blood product . ✔ Vit . K def . ➡️ Hemorrhagic disease of newborn ✔ Bleeding tendency ➡️ thrombocytopnea of inherited coagulopathy ✔ immunthrombocytopnea ➡️ mother has SlE or ITP ...... Looks ill ☹ ✔ DIC ➡️ bleeding from any site ✔ Sepsis with multiorgan failure ➡️ with hematological dysfunction ✔ Malena and abdominal distension with red abdomen ➡️ NEC esp in premature infants .

✴ Indication of biopsy in nephrotic syndrome :- ✔ Age less than 1 yr or more than 8 yr ✔ persistanct Hypertension or hematurea ➡️ features against MCNS ✔ positive viral screen ✔ positive FHx of kidney disease ✔ symptoms of systemic disease .

Amount of ascite that can be detected clinically ➡️ more than 150 ml By US ➡️ 50 ml By Ct ➡️ 20 ml

❌ Contraindicatiom for phototherapy ✔ direct hyperbilirubinemia ✔ porphyria ✔ Familial non hemolytic anemia ✔ Gilbert syn . ✔ Criglar najar syn .

✴ Diffrentiate between Spleen and kidney :) ✔ splenic notch maybe felt ✔ spleen on percussion ➡️ dullness Kidney ➡️ resonance ✔ kidney bimanually palpable ✔ enlargment of spleen toward the umblicus While kidney inferiorly ✔ spleen move with respiration

❌ In abdominal examination don't forget to examine ✔ The back for spina bifida ✔ Examine the genitalia for Ambigous genitalia ✔ Femoral LN and vessels ✔ Supraclavicular LN ✔ If less than 2 month examine for congenital Hip dislocation شلون نفحص ال superficial mass ؟ ✴ Cheek should touch the chest حسب د اعلان ... يعني نگول للمريض يرفع راسه واذا هو صغير احنه نرفعه

🤔 How to diffrentiate between cyanosis of respiratory and cardiac cause ? ✴ give the patient O2 if there is improvement ➡️ respiratory cause . If not its cardiac ...

🚫 Approach to Neonatal vomiting ⚛ When you have patient with vomiting you have to be sure if its real vomiting ? What is the type of this vomiting ? Does the patient active , alert , or sick and ill ? Not bile stain ? Tolerate feeding ? No hx of constipation ? No abdominal distension No blood in vomitus لذلك ال General look مهم 🚫 If well , active , no abdominal distension , no constipation , no bile or blood in vomitus ➡️ Benign causes ✔ overfeeding لذلك نسألها كم مرة ترضعه ✔ GERD ➡️ usually in late neonatal period and its effortless ✔ Swallowing of maternal blood and secretion ➡️ Gastritis ➡️ Rx ⚛ Gastric wash with Ns ندفع 5 cc ونسحبها لحد ما يصير clear ✔ Food or milk allergy ✔ Hypertrophic pyloric stenosis ( baby earlier is healthy ) . 🚫 If ill patient ⚛ Medical causes ➡️ ✔ Infection ➡️ sepsis , meningitis ✔ Raised intracranial pressure ✔ Inborn error of metabolism ⚛ Surgical causes ✔ Esophageal atresia ➡️ large amount of frothy secretion , scaphoid abdomen cuz there is no Air . If with SOB ➡️ Fistula ✔ Doudenal atresia ➡️ On x ray double bubble sign .......... 🚫 Upper GIT obstruction ✔ earlier vomiting ✔ less abdominal diatension 🚫 Lower Git obstruction ✔ vomiting late ✔ remarkable abdominal distension ✔ multiple air fluid level on X ray

Ix for neonatal convulsion ➡️ ✔RBS if Hpoglycemia ➡️ manage it ✔S ca ➡️ If hypoca ... ➡️ Rx حسب ما معروف وال meningitis ندزهم CBC CRP Lp ال Rx نعالج سبب ال convulsion بالإضافة الى علاج ال convulsion نفسه Drug of choice in neonate ➡️ luminal ( phenobarbital ) Loading dose ➡️ 20 mg / kg نگدر نضيف عليها بعد 10 mg / kg لحد ما نوصل لل 40 mg /kg وراهة ب 12 - 24 ساعة نحول ع ال maintenance 5 mg / kg ÷2 لأن ال diazepam اكو risk of hypotension and apnea

🚫 When we have patient with seizure Its important to know the cause ✔ hypoglycemia ➡️ send for RBS ✔ hypocalcemia ➡️ send for S.ca ✔ CNS infection ➡️ CBC , CRP , Lp ✔ CNS Hemorrhage ✔ Neonatal encephalopathy ( birth asphyxia ) ➡️ the commnest one ✔ Hyponatremia ( introducing hypotonic fluid to the mother * oxytocin in GW 5% * ➡️ cross placenta ➡️ dilutional hyponatremia . لذلك مهم نعالج السبب ونمنع حدوث ال convulsion مرة ثانية من خلال ال Anticonvulsant

Pneumothorax

Neonatal seizure 🚫 There is no Generalised tonic clonic seizure in infancy where there is ➡️ incomplete myelination and incomplete aborization ... اكثر نوع شائع هو ال subtle يعني ما يكون واضح مثلاً Abnormal eye movement ( repeated wrinkling ) Abnormal mouth movement ( chewing , yawing ) ... Or period of apnea or tachypnea Abnormal limb movement او مثلاً يغص هواي بس not related to feeding شلون نميز بين ال apnea of convulsion وال apnea of respiratory disorder ؟ ⚛ if convulsion ➡️ asso. With tachycardia ⚛ if respiratory ➡️ bradycardia نخلي السماعة ونشوف ..... شلون نميز بين بين ال Gitrness وال convulsion ؟ 🚫 ✔ when we handle the limb gitrness disappear ✔ من نسوي فد stimulation للطفل رح يصير عنده gitrness ✔ convulsion asso . With tachycardia