Important knowledge

Indication of hospitalization ممكن ننسال عنه بال long

Pneumonia

⚡️Indications of severity in bronchiolitis (same as indication for hospitalization) ------------------------- ▪︎O2 saturation <95% (most important one) ▪︎ill or toxic appearance ▪︎ history of prematurity (gestational age < 34 wk) ▪︎atelactasis on CXR ▪︎respiratory rate (RR) > 70 beat per minute (bpm) ▪︎infants <3 months old ▪︎infant with underlying diseases as congenital heart diseases (CHD), bronchopulmonary dysplasia (BPD), immunodeficiency, & asthma.

⚡️Most common organism that causes meningitis (مهم) 🔹️Neonate (same for sepsis) ▪︎group B streptococcus (GBS) ▪︎E. Coli ▪︎Listeria monocytogenes 🔹️post neonatal period ▪︎ S. pneumoniae ▪︎ H. influenzae type b ▪︎ N. meningitides

⚡️Neonatal hypocalcemia ---------------------------------- ▪︎normal serum calcium level (8.5-10.5 mg/dl) ▪︎neonatal hypocalcemia is less than (7 mg/dl) of serum calcium (Calcium concentration in the immediate newborn period is low in all newborn infants ) 🔹️ Clinical Findings ▪︎Hypocalcemic tetany ▪︎high-pitched cry ▪︎jitteriness ▪︎tremulousness ▪︎seizure ▪︎Apnea ▪︎muscle twitching ▪︎laryngospasm (stridor ) 🔹️signs by examination ▪︎Chvostek sign ▪︎Trousseau sign 🔹️Types: ▪︎Early-onset hypocalcaemia ( first 2 days of life) Causes : ♧ prematurity ♧ maternal diabetes ♧ asphyxia ♧ maternal hypoparathyroidism (rare) ▪︎Late-onset hypocalcemia (occour on 7–10 days of age) Causes: ♧ Infants receiving modified cow's milk (high phosphorus intake). ♧ infants with hypoparathyroidism ♧ infants with hypomagnesemia ♧ Mothers with vitamin D deficiency 🔹️manegement ▪︎ acute (symptomatic) = IV calcium gluconate role of 10 ، ..... 1ml/kg ▪︎chronic hypocalcemia(due to hypoparathyroidism ) = oral calcium therapy ( oral calcium gluconate) 10% solution .... 5–10 ml/kg/day in divided doses, every 4 - 6 hours .

⚡️IV calcium gluconate is given by role of 10 10% concentration , 10ml , slowly during 10 min Except in patient with CKD & missed dialysis session who presented with hyperkalemia we give it during 2 min (to protect the heart)

⚡️Ever never put Ambu Bag for green neonate with RDS (pass meconium in utero) because risk of meconium aspiration غالبا يكون post term وتلكة اكو green meconium باضافيرة ووجهه وبطنه والحبل السري هذا اذا خليتله ambu راح تدخل ال meconium من oral cavity وتدفعه داخل ال lung وراح يموت لامحال لذلك لازم تستعملة sucker

توضيح النقطة الاولى

⚡️Contraindication for Ambu bag in RDS : ----------------------- ▪︎ baby pass meconium [ use sucker before ambu ] > (راح يدفع الميكونيوم للرئة ويسوي aspiration ) ▪︎congenital diaphragmatic hernia [ use endotrachial tube rather than ambu ] > disted the stomach (whic is beside lung) which cause pressure on lung > ⬆️ respiratory distress

Knee x ray of neonate with congenital hypothyriodism

Normal Knee x ray of neonate

⚡️Base line investigation for neonate with jaundice ------------------------- ▪︎TSB ▪︎PCV ▪︎Blood group & Rh for mother & baby

⚡️Causes of direct hyperbilirubinemia

⚡️Tuberculin Skin Test (TST) [MANTOUX TEST] ------------------- ▪︎used for diagnosis ot TB ▪︎intradermal injection of tuberculin antigene ▪︎site : volar aspect of forearm ▪︎The result should be read after 2-3 days (size of induration not size of redness). 🔹️posative if : ▪︎Induration ≥5 mm in high risk patient ▪︎Induration ≥15 mm in patient with no risk 🔹️False-negative responses ▪︎early in the illness ▪︎with use of inactivated antigen(due to poor storage) ▪︎immunosuppression 🔹️False positive responses ▪︎BCG USE (within 5year of injection). ▪︎atypical mycobacterium infection.

⚡️chest x ray ▪︎Thymus becomes smaller after the age of 2 years. It is rarely seen after the age of 8 years (عادتا نشوفها بوضوح لحد عمر سنتين الى 3 سنوات )

⚡️اهم sign بال dehydration هية ال Urine output حيث يكون oliguria او unuria ونعتمد عليها بال rehydration نعتبر الطفل rehydrated من يرجع ال urine output لل normal او near normal

⚡️Base line investigation of Gastroenteritis -------------------- ▪︎CBC ▪︎GUE (حتى نستثني ال UTI الي تجي مرات على شكل GE) ▪︎GSE

⚡️Antibiotics for chest infection [د.سيف] ----------------------------------- ▪︎in patient = 3ed generation cephalo [ceftriaxone] ▪︎out patient = amoxicillin clavulanic acid [Augmentin] Indication of azithromycin ▪︎pertussis ▪︎atypical pneumonia (mycoplasma) [ in school age child ]

⚡️Status asthmaticus Mx (د.سيف) ▪︎oxygen ▪︎ventolin ( نكدر نعيدة ٣ مرات ) ▪︎adrenaline IVi ▪︎Steriod ▪︎magnesium sulfate

⚡️Clonus vs myoclonus ----------------------------- ▪︎Clonus = >30sec & rhythmic ▪︎Myoclonus = <30 sec & not rhythmic (epilepsy)