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AGE OF INFANT
IDEAL WEIGHT
At Birth
3kg (Filipinos)
or 3.25kg (for Caucasians)
At 4-5 Months
2 x Birth Weight
Weight in kg
= Age in Months x 600 + Birth Weight
1 Year
3 x Birth Weight
< 6 months
2 Years
4 x Birth Weight
> 6 months
Weight in kg
= Age in Months x 500 + Birth Weight
3 Years
5 x Birth Weight
5 Years
6 x Birth Weight
2 to 6 years
7 Years
7 x Birth Weight
6 to 12 years
10 years
10 x Birth Weight
AGE
LENGTH
At Birth
50 cm or 20 inches
B. DESIRED LENGTH
GAIN in 1st Year is ~25cm,
Distributed as Follows:
3cm
+ 9cm
per month
AGE
Birth to 3
months
3-6 months
+ 8cm
2.67 cm
per month
1 year Old
6-9 months
+ 5cm
1.6cm
per month
2 years old
9-12 months
+ 3cm
1cm
per month
3 years old
3 Feet Tall
4 years old
1yr and above
Height in cm
= Age (years) x 5 + 80
13 years old
40 inches or 2 x Birth
Length
3 x Birth Length
C. HEAD CIRCUMFERENCE
AGE OF INFANT
1 to 4 Months
4 to 12 Months
1 to 2 Years
3 to 5 Years
6 to 20 Years
D. CHEST MEASUREMENT
AGE OF INFANT
Birth
1 Year Old
6 Years Old
REMARKS
Transverse = AP (Barrel Chest)
Transverse > AP
Transverse >>> AP
E. WATERLOW CLASSIFICATION
1.
Wasting
Actual Weight
Ideal Weight for Actual Length / Height
2.
. X 100
Classification:
Mild = 80-90%
Moderate = 70-80%
Severe < 70%
Classification:
Mild = 90-95%
Moderate 80-90%
Severe < 80%
Stunting
Actual Height/Length
Ideal Length / Height for Age
X 100
APGAR
0
Appearance
Blue / Pale
Completely Pink
Pulse
Absent
Slow (<100)
>100
Grimace
No Response
Grimaces
Activity
Respiration
No Movement
(Limp)
Absent
8-10: Normal
4-7: Mild / Moderate Asphyxia
0-3: Severe Asphyxia
FONTANEL
Anterior Fontanel:
Posterior Fontanel:
DENGUE VIRUS
I. DENGUE INFECTION
A. DHF Clinical Criteria
o 1) Fever: 2-7 days, regardless of characteristic
o 2) Hemorrhagic Manifestations:
(+) Tourniquet Test (>20/in2)
Mucocutaneous Bleeding
GI Bleeding
B. DHF Laboratory Criteria
o 1) Evidence of Consumptive Coagulopathy
Decreased Platelet Count (<150,000)
Prolonged BT
Prolonged PT (II, V, VII, X, Fibrinogen)
Prolonged PTT (II, V, VII, IX, X, XI, XII, Fibrinogen)
o 2) Steadily Increasing Hematocrit (20% or more) in spite of proper hydration or Increased Vascular
Permeability
C. DSS Criteria
o DHF Criteria + Evidence of Circulatory Failure:
Violaceous, cold, clammy skin
Restlessness, weak to imperceptible pulses
Narrowing of Pulse Pressure to <20mmHg
Hypotension
D. Dengue Classification:
o Undifferentiated Fever
o Dengue Fever Syndrome
o Dengue Hemorrhagic Fever
o Dengue Shock Syndrome
GRADE 2
GRADE 3
GRADE 4
Grade 1 + 2 PLUS:
Anorexia
Vomiting
Convulsion
Restlessness
Flushed Skin
(+) Tourniquet Test
Abdominal Pain
Hepatomegaly
Pleural Effusion (Unilateral R /
Bilateral)
Constipation
Abdominal Distention
Grade I
Grade II
Grade III
Grade IV
Grade 1 PLUS:
Gum Bleeding
Epistaxis
Petechiae on Palate
Petechiae on Axillae
Rashes on
Extremities
Chest Pains
Chough
Lethargy
Violaceous Skin
Flushed Face
Hematemesis
Melena
Purpura
Hemoptysis
Cold Clammy Extremities
Shock (Hypotension,
Tachycardia)
Ecchymoses
Grade 1 + 2 + 3 PLUS
Profound SHOCK
= Fever + Non-Specific Constitutional Symptoms ([+] Tourniquet is the only hemorrhagic manifestation)
= Grade I + Spontaneous Bleeding
= Grade II + Severe Bleeding + Circulatory Failure (rapid / weak pulse, narrow pulse pressure, hypotension)
= Grade III + Irreversible Shock + Massive Bleeding (undetectable pulse and BP)
SEVERE
(DHF Gr. I & II)
SEVERE (DSS)
(DHF Gr. III)
AND
OR
AND
OR
OR
No signs of Respiratory
Distress or Pulmonary
Edema
AND
AND
OR
AND
AND
AND
No signs of Dehydration
Good Peripheral Perfusion
Normal BP
OR
AND
AND
No Metabolic or End Organ
Failure
OR
(+) Tourniquet Test
Low PC < 100,000
Increased Hct (>20%)
Life Threatening Anemia,
bleeding, associated with DIC
OR
Metabolic Disorder:
Hypoglycemia
Metabolic Acidosis
V. MANAGEMENT OF DENGUE
A. Vital Signs and Laboratory Monitoring (Vital Signs and Laboratory Monitoring)
o Monitor BP, Pulse Rate
o We have to watch out for Shock (Hypotension)
INITIALLY
IF WITH RISING HEMATOCRIT
Blood Pressure
Every 24 hours
Hourly
Every 15 to 30 with Hypotension
Hematocrit
Every 24 hours
Every 6 hours
Platelet Count
Every 24 hours
Every 6 hours
Hemoglobin
Every 24 hours
B. Management of Hemorrhage
CONDITION
If due to Vascular Changes (first few days of Illness)
MANAGEMENT
No TREATMENT is Required!
5) IMCI
I. MODULE 1: GENERAL DANGER SIGNS IN 2 MONTHS TO 5 YEARS OLD
Inability to Drink or Feed
Convulsions
Lethargy or Unconsciousness
Vomiting of Everything Taken
II. MODULE 2: COUGH / DIFFICULTY OF BREATHING
A. Tachypnea (MUST KNOW!!!)
AGE
RESPIRATORY RATE
0 to 2 months
2 to 12 months
12 months to 5 years old
> 60/minute
> 50/minute
> 40/minute
CLASSIFY AS
Severe Pneumonia
or
Very Severe Disease
*Fast Breathing
Pneumonia
Triad of Pneumonia:
Fever, Cough, Tachypnea
No Pneumonia
Cough or Cold
TREATMENT
*Give first dose of appropriate Antibiotic
*Give Vitamin-A
*Treat Child to prevent Low Blood Sugar
*Refer urgently to Hospital
*Give appropriate Antibiotic (5 days)
*Soothe throat & relieve cough
*Advice mother when to return
immediately
*Follow up in 2 days
*If coughing > 30 days, refer for
assessment
*Soothe throat & relieve cough
*Advice mother when to return
immediately
*Follow up in 5 days if not improving
3) DECIDE
4) TREAT
Treatment Plan-A
Weigh patient
Treatment Plan-B
Weigh Patient
Treatment Plan-C Urgently
MANAGEMENT
*Give Vitamin-A
*Refer URGENTLY to a Hospital
Anemia
or
Very Low Weight
No Anemia and
Not Very Low Weight
AGE
BCG-1
DTP
Polio
Hepatitis B
Measles
BCG-2
Tetanus Toxoid
6 weeks
6 weeks
6 weeks
9 months
School entry
Childbearing women
DOSE
B. Contraindications to Vaccinations:
ABSOLUTE CONTRAINDICATIONS
Severe anaphylactic / allergic reaction
to previous vaccine
Moderate to severe illness +/- fever
Encephalitis within 7 days of
administration (Pertussis)
Immunodeficiency in patient
(congenital all live vaccines) or
household contact (OPV)
Pregnancy (MMR, OPV/IPV)
NO.
ROUTE
SITE
ID
R deltoid region
3
3
3
1
1
3
IM
PO
IM
SC
ID
IM
INTERVAL
BETWEEN
DOSES
4 weeks
4 weeks
4 weeks
1 month;
Then 6-12 months
RELATIVE CONTRAINDICATIONS
Immunosuppressive therapy (all live
vaccines)
Egg allergy (MMR)
Seizure within 3 days of last dose
(Pertussis)
Shock within 48hrs of last dose (Pertussis)
Fever >40.50C within 48hrs of last dose
(Pertussis)
C. NOT Contraindications
o Mild Illness +/- low-grade fever
o Current antibiotic therapy
o Recent infectious disease exposure
o Positive PPD
o Prematurity, except if infant is still hospitalized at 2 months, OPV should be delayed until
discharge. Or, if mother is HBsAg(-), Hep-B Vaccine delayed until child > 2000g
VII. MODULE 7: MANAGEMENT OF THE SICK YOUNG INFANT (1 week to 2 months old)
Signs and Symptoms of Possible Bacterial Infection in a Young Infant
o Convulsion
o Respiratory Rate more than 60/minute
o Severe Chest Indrawing
o Nasal Flaring
o Grunting
o Bulging fontanelle
o Pus draining from the ear
o Erythema and discharge from the umbilicus
o Abnormal body temperature
o Severe skin pustules
o Lethargy or unconsciousness
o Abnormal movements
7) NEWBORN SCREENING
Congenital Hypothyroidism (puffy eyelids)
Phenylketonuria (MR)
G6PD
CAH
Galactossemia
8) MILESTONES
MILESTONES
Regards
Smiles
Turns Head
Holds Head
Rolls over
Transfers object
Sits briefly
Creeps
Pulls up
Cruises
Walks with support
Stands alone
NORMAL
(months)
1
2
3
4
5
6
7
8
9
10
11
12
ANTIBIOTICS
Penicillin G
Rifampicin
10-20 mkD OD AC
200mg/5mL, 100mg/5mL, 150, 300, 450, 600mg
Penicillin V
50-200 mkD
Isoniazid
Ampicillin
10-20 mkD OD AC
200mg/5mL, 100mg/5mL, 50, 100, 150, 200, 400mg
Pyrazinamide
Amoxicillin
30-50 mkD q8
20-30 mkD OD PC
250mg/5mL, 500mg
Cloxacillin
50-100 mkD q6
250mg, 500mg, 125mg/5mL, 250mg/5mL
Ethambutol
15 mkD OD
Streptomycin
10 mkD OD q480
1g/vial
Dicloxacillin
12.5-25mkD
Nafcillin
Amikacin
Gentamycin
5-8 mkD OD
Netilmycin
6-8 mkD OD
25mg, 60mg, 100mg/mL
Tetracycline
25-50 mkD
CoTrimoxazole
CoAmoxiclav
Erythromycin
Clarithromycin
15 mkD q12
Azithromycin
10mkD x 3days OD
Cefalexin (1st)
25-50 mkD q6
100mg/mL, 125mg/5mL, 250mg/5mL, 250mg, 500mg, 1g
Cefazolin (1st)
50-100mkD
1g/vial
Cefaclor (2nd)
20-40 mkD q8
250mg, 500mg, 125mg/5mL, 250mg/5mL
Cefuroxime (2nd)
Ceftazidime (3rd)
100-150 mkD q8 IV
250mg, 500mg, 1g, 2g
Ceftriaxone (3rd)
50-100 mkD OD IV
250mg, 500mg, 1g, 2g/vial
Cefotaxime (3rd)
Cefixime (3rd)
Meropenem
Piperacillin
200-300 mkD q6
2g/vial
Unasyn
ANALGESICS / ANTIPYRETICS
Paracetamol
Aeknil: 150mg/mL
Ibuprofen
Mefenamic Acid
6.5 mkd
Aspirin
ANTICONVULSANTS
Diazepam
0.3-0.5 mkd IM
Not to exceed 10mkD
2mg, 5mg, 10mg tab; 5mg/mL, 10mg/mL
Phenobarbital
3-5 mkd
10-20 mkd LD; 5 mkD q12 MD
20mg/5mL
Phenytoin
5-7 mkd
10-20 mkd LD; 5 mkD q12 MD
125mg/5mL, 250mg/5mL, 15mg, 30mg, 60mg, 90mg
Valproic Acid
15 mkD LD
Not > 60mkD
250mg/5mL
ANTIHISTAMINE
Diphenhydramine
1 mkd IV
2-6y/o: 2-5mL q6/8
6-12y/o: 5mL
12.5mg/5mL
Hydroxizine
STEROIDS
Prednisone
Hydrocortisone
10
BRONCHODILATORS
Salbutamol
0.15 mkd
Theophylline
ANTI-ULCER
Ranitidine
1 mkd q8
Omeprazole
0.6-0.7 mkD OD
10, 20, 50mg
Cimetidine
5 mkd q6
DIURETICS / ANTI-HPN
Furosemide
1 mkd IV
20, 40, 60mg tab; 20mg/mL
Nifedipine
0.25 mkD
Propranolol
1-2 mkD q6
Aldactone
2-3.5 mkD q6
ANTIVIRALS
Acyclovir
100 mkD q6
Amantadine
ANTI-PARASITISM
Mebendazole
Pyrantel Pamoate
11 mkD x 3 doses OD
125mg/5mL, 250mg/5mL
Fluconazole
Metronidazole
Ketoconazole
Griseofulvin
10 mkD
Amphotericin-B
0.3-0.7 mkD
OTHERS
Epinephrine
0.1-0.3mL/kg IV
Carbocisteine
(Solmux) q8
For 100mg/5mL
8-12y/o: 15mL
4-7y/o: 10mL
2-3y/o: 5mL
For 200/5mL
8-12y/o: 7.5mL
4-7y/o: 5mL
2-3y/o: 2.6mL
Solmux Broncho
* Salbutamol 2mg
* Carbocisteine 500mg
Cetrizine
For 5mg/5mL:
>12y: 2 tsp OD
Cinnarizine
(Stugerone)
25mg
Serc
(Betahistine)
8-16mg TID
ANTIFUNGAL
11
10) IV FLUIDS
Ludans
Holiday-Segar Method
I. LUDANS METHOD (HYDRATION THERAPY)
MILD DEHYDRATION
< 15kg, < 2y/o
> 15kg, 2y/o
50 cc/kg
30 cc/kg
D50.3% in 6-8hours
MODERATE
DEHYDRATION
100 cc/kg
60 cc/kg
1st hr: 1/4 PLRS
Next 5-7hrs: 3/4 D50.3%
SEVERE
DEHYDRATION
150 cc/kg
90 cc/kg
1st hr: 1/3 PLRS
Next 5-7hrs: 2/3 D50.3%
50
50
50
50
50
50
50
50
Na+ mEq/L
130
154
25
51
77
154
25
130
40
140
Cl- mEq/L
109
154
25
51
77
154
22
109
40
98
K+
mEq/L
Lactate mEq/L
Others
mEq/L
Ca2+:3
28
20
4
13
5
23
28
Mg2+:3; Acetate: 26
Mg2+:3; Acetate: 27; Gluconate:
23
12
Paramyxovirus
(RNA-Virus)
INCUBATION
PERIOD
8-12 days
PRODROMAL PERIOD
2-4 days
Exanthem (Koplik Spots) on
the Buccal and Pharyngeal
Mucosa after 2-3d
Fever, Conjunctivitis and
Increasingly Severe Cough /
Brassy Cough (Catarrhal
Stage)
German Measles
(Rubella)
Togavirus
(RNA-Virus)
14-21 days
1-5 days
Lymphadenopathy (PostCervical or Post-Occipital)
ONSET OF
FEVER
Fever + Rashes
T abruptly
(40C) as rash
appears
T when rash
reaches legs
and feet
Spots after
Fever
Sudden onset
(39-410C)
RASH
Centrifugal Spread
Maculopapular
Begins in face
Centrifugal Spread
Maculopapular
Begins trunk
arms, neck face legs
T on 3-4d as
rash appear
Roseola
Infantum
Human Herpes
Virus-6
(DNA-Virus)
7-17 days
Chickenpox
(Varicella)
Varicella-Zoster
Virus
(DNA-Virus)
Parvovirus B19
(DNA-Virus)
10-23 days
In Children = unusual
In Adults = 1-2 days
Erythema
Infectiosum
7-28 days
Centripetal Pattern
Slapped Cheek
Appearance
Sparing of Palms &
Soles
13
B. Aspirin
HIGH Dose ASA (80-100mg/kg/day divided q 6h) should be given Initially in Conjunction with IV-IG
THEN
Reduced to Low Dose Aspirin (3-5mg/kg/day)
AND
Continued until Cardiac Evaluation COMPLETED
(approximately 1-2 months AFTER Onset of Disease)
CLASSIFY AS:
TREATMENT:
Refer URGENTLY to
Hospital
Give first dose of an
Antibiotic
Treat Fever, if present
Treat Wheezing, if present
If Cerebral Malaria is
possible, give an
Antimalarial
Chloramphenicol IM, IV
Chest Indrawing
If also recurrent
wheezing, go directly
to Treat Wheezing
Severe Pneumonia
Refer Urgently to
Hospital
Give 1st dose of
Antibiotic
Treat Fever, if present
Treat Wheezing, if
present
If referral is not
feasible, treat with an
Antibiotic and follow
closely
Benzyl Penicillin IM,
IV
No Chest Indrawing;
and
Fast Breathing
No Chest Indrawing;
and
No Fast Breathing
50/minute or more if
child 2 months to 12
months; 40 per minute
or more if child 12
months up to 5 years
Pneumonia
Cough or Cold
(NO Pneumonia)
If cough > 30 days,
refer to assessment
Assess / Treat Ear
problem or Sore
Throat, if present
Assess / Treat other
problems
Advise mother Home
Care
Treat Fever if present
Treat Wheezing if
present
CoTrimoxazole PO
14
(60/minute or More)
Severe Pneumonia
CLASSIFY AS:
TREATMENT:
Cough or Cold
(NO Pneumonia)
Advise Mother to give following
Home Care:
Breastfeed frequently
Benzyl Penicillin +
Gentamycin IM, IV
15
PARTLY CONTROLLED
None
None
None
> 2x / week
Any
Any
< 2x / week
Normal
None
> 2x / week
< 80%
> 1x / year
UNCONTROLLED
3 or more symptoms of
Partly Controlled
Asthma in any week
1x / week
16
C. Duration of Chemoprophylaxis
RF without Carditis
RF with Carditis WITHOUT Residual Heart
Disease
RF with Carditis WITH Residual Heart Disease
Repeated attacks
17
V. ASSIGNMENT
PATHOPHYSIOLOGY
CLINICAL
MANIFESTATIONS
TREATMENT
Mitral Insufficiency
Mitral Stenosis
Aortic Insufficiency
Tricuspid Valve
Disease
747 kcal/kg
(+)
Same
3.7 g/L
7 g/L
6.5 7%
45.4 g/L
0.150.25%
0.61 mg/L
--52 mg/L
(-)
Lower
6.8 7.4
COW
701 kcal/kg
(-)
Same
24.9 g/L
7 g/L
4%
38 g/L
0.70.75%
0.27 mg/L
--11 mg/L
(-)
Higher
6.8 7.4
Breastmilk has Less Minerals = Less Solute for the Babys Underdeveloped Kidneys
Breastmilk has Less Vitamin-K = give Vitamin-K IM to prevent Hemorrhagic Disease of the Newborn
According the Prenotes, we have to know this table by Heart
18
4. Minerals
Minerals and Electrolytes in Breast Milk are LOWER than in Cows Milk
Lower Electrolytes = ensure that Sufficient Free Water is available to the Infant
5. Vitamins
Depends on the Maternal Intake
Both Human & Cows Milk contain Large Amounts of Vitamin-A and Minimal Vitamin-D
Breastfed Infants should be routinely given Vitamin-K at Birth as Prophylaxis against
Hemorrhagic Disease of the Newborn (1mg Vitamin-K 1 IM or p.o)
19) JAUNDICE
I. DEFINITION OF TERMS
A. Jaundice
o Yellowish Discoloration of the skin, sclera, and Mucous Membranes of the body
B. Hyperbilirubinemia
o Total Serum Bilirubin Level (TSB) exceeds more than 12mg/dL
o To differentiate between Unconjugated and Conjugated Hyperbilirubinemia = Van den Bergh
Reaction
1. Unconjugated Hyperbilirubinemia
Elevation of Indirect-Reacting or Unconjugated Bilirubin Concentration to > 1.31.5mg/dL
2. Conjugated Hyperbilirubinemia
Elevation in the Direct-Reacting Fraction in the Van den Bergh Reaction to more than
2mg/dL or 20% of Total Serum Bilirubin (TSB)
II. PHYSIOLOGIC JAUNDICE
Physiologic Jaundice: occurs after 36 hours of life
Pathologic Jaundice: occurs within the first 24 hours of life
PHYSIOLOGIC JAUNDICE
PATHOLOGIC JAUNDICE
Early Onset < 24 HOL
TSB Increasing more than 5mg/dL/day
TST Concentration exceeding 12.9mg/dL (FT)
and >15mg/dL (PT)
DSB > 2mg/dL or 20% of TSB
Persists > 1 week (FT) or > 2weeks (PT)
19
OLDER CHILDREN
Spontaneous
To Voice
To Pain
None
Verbalization
Oriented
Confused
Inappropriate
Incomprehensible
None
5
4
3
2
1
Spontaneous
Localizes Pain
Withdraws
Reflex Flexion
Reflex Extension
None
Obeys
Localizes Pain
Withdraws
Reflex Flexion
Reflex Extension
None
6
5
4
3
2
1
Motor
Total Score
SCORE
4
3
2
1
15
21) SEIZURES
I. TYPES OF SEIZURES
A. Partial Seizures (Focal / Local)
o Simple Partial
o Complex Partial (Partial Seizure + Impaired Consciousness)
o Partial Seizures evolving to Tonic-Clonic Convulsion)
B. Generalized Seizures
o Absence (Petit mal)
o Myoclonic
o Clonic
o Tonic
o Tonic-Clonic
o Atonic
20
Type
Duration
Recurrence
Neuro Exam
Sequelae
SFS
Generalized Tonic Clonic
< 15 minutes
None during same time
Normal
None
CFS
Focal onset, then Generalized Post-Ictal
> 15 minutes or may even go into Status
Recurrent within 24hours
Abnormal, Post-Ictal
Neurodevelopmental abnormalities
21
22
CLASSIFICATION
SYSTEMIC SIGNS
INTESTINAL SIGNS
RADIOLOGY
IA
Suspected NEC
Temperature Instable
Apnea
Bradycardia
Lethargy
Normal
Intestinal Dilation
Mild Ileus
IB
Suspected NEC
Temperature Instable
Apnea
Bradycardia
Lethargy
Normal
Intestinal Dilation
Mild Ileus
Temperature Instable
Apnea
Bradycardia
Lethargy
II A
Proven NEC
Intestinal Dilation
Ileus
Pneumatosis
Intestinalis
Abdominal Tenderness
II B
III A
III B
Proven NEC
Moderately Ill
Advanced NEC
Severely Ill
Bowel INTACT
Advanced NEC
Severely Ill
Bowel PERFORATED
Temperature Instable
Apnea
Bradycardia
Lethargy
Metabolic Acidosis
Thrombocytopenia
Temperature Instable
Apnea
Bradycardia
Lethargy
Metabolic Acidosis
Thrombocytopenia
Respiratory Acidosis
Metabolic Acidosis
Hypotension
Bradycardia
DIC
Marked Neutropenia
Temperature Instable
Apnea
Bradycardia
Lethargy
Metabolic Acidosis
Thrombocytopenia
Respiratory Acidosis
Metabolic Acidosis
Hypotension
Bradycardia
DIC
Intestinal Dilation
Ileus
Pneumatosis Intestinalis
HPVG
Ascites may be (+)
Intestinal Dilation
Ileus
Pneumatosis Intestinalis
HPVG
Definite Ascites
Marked Tenderness
Abdominal Distention
Intestinal Dilation
Ileus
Pneumatosis Intestinalis
HPVG
Definite Ascites
Pneumoperitoneum
Marked Tenderness
Abdominal Distention
Marked Neutropenia
23
23) PROCEDURES
I. UMBICAT
A. Indications:
o Vascular Access
o BP and ABG monitoring in critically ill neonates
B. Complications:
o Hemorrhage
o Thrombosis
o Ischemia / Infarction of lower extremities, bowel, kidney
o Infection
o Arrhythmias
C. Contraindications
o Omphalitis
o Possible NEC / Intestinal Hypoperfusion
D. Line Placement
1. Low Line VS Highline
a. Low Line
Tip of catheter just above Aortic Bifurcation between L3 and L5
Avoids renal and mesenteric aorta near L1 (decreased incidence of thrombosis)
b. High Line
Tip of catheter above diaphragm between T6-T9
High line recommended in infants < 750g when a low line easily slips out
2. Catheter Length
Determines the length of catheter required using either a standard graph or the regression
formula: Add length for the Height of the Umbilical Stump
Standard Graph: Determine the shoulder-umbilical length by measuring the
perpendicular line dropped from the tip of the shoulder to the length of umbilicus
Birth Weight [BW] Regression Formula:
Low Line: UA Catheter Length (cm) BW [kg] + 7
High Line: UA Catheter Length (cm) (3 x BW [kg]) + 9
E. Procedure
o 1) Determine length of catheter to be inserted
o 2) Restrain infant. Prep and drape umbilical cord and adjacent skin using sterile technique
o 3) Flush catheter with sterile saline solution before insertion
o 4) Place sterile umbilical tape around base of the cord. Cut through cord horizontally about 1.5-2cm from
skin; tighten umbilical tape to prevent bleeding
o 5) Identify the one, large, thin-walled umbilical vein and two smaller, thick-walled arteries. Use one tip of
open, curved forceps to probe and dilate artery gently; use both points of closed forceps and dilate artery
by allowing forceps to open gently
o 6) Grasp catheter 1cm from tip with toothless forceps and insert catheter into lumen of artery. Aim the tip
toward the feet, and gently advance catheter to desired distance. Do not force. If resistance is
encountered, try loosening umbilical tape, applying steady gently pressure or manipulating angle of
umbilical cord to skin. Often catheter cannot be advanced because of creation of a false luminal tract
o 7) Secure catheter with a suture through the cord, a marker tape and a tape bridge. Confirm position of
the catheter tip radiologically. Line may be pulled back, but not advanced once sterile field is broken
o 8) Observe. If any complications occur, line should be removed. NOTE: Infants remain on NPO until 24th
hour after catheter is removed. Never run hypoosmolar fluids through the line. Isotonic fluids should
contain 0.5unit Heparin/mL
Better Doctors Pediatrics Reviewer for Junior Interns Batch 2011
24
F. Differential Count:
APPEARANCE
CELLS (WBC)
GLUCOSE
PROTEIN (mg/100mL)
(mmol/L)
Normal CSF
Viral Infection
Bacterial Infection
TB-Meningitis
Fungal Infection
Cerebral Abscess
GBS (Guillan-Barre)
Clear
Clear
Turbid
Clear & Opalescent
Clear
Clear
Clear
0-5 (Lymphocytes)
25 500
100 20,000
300 500
0 500 (Lymphocytes)
10-60 (Lymphocytes)
Normal
2.2 4.4
> 2.2
< 0.5 1.5
0 2.0
1.0 2.0
Normal
Normal
15 40
50 100
100 200
Up to 300 or More
100 500
20-80
Slight-Marked Increase
25
AGE
DOSE
BCG-1
DTP
Polio
Hepatitis B
Measles
BCG-2
Tetanus Toxoid
6 weeks
6 weeks
6 weeks
9 months
School entry
Childbearing women
NO.
ROUTE
SITE
ID
R deltoid region
3
3
3
1
1
3
IM
PO
IM
SC
ID
IM
INTERVAL
BETWEEN
DOSES
4 weeks
4 weeks
4 weeks
1 month;
Then 6-12 months
0
Appearance
Pulse
Grimace
Activity
Respiration
Blue / Pale
Absent
No Response
No Movement (Limp)
Absent
1
Pink Body + Blue Extremities
Slow (<100)
Grimaces
Some Flexion / Extension
Slow / Irregular
2
Completely Pink
>100
Coughs, Sneezes, Cries
Active Movement (All Extremities)
Good, Strong Cry
B. Temperature Regulation
o When we bate Babies in the Incubator, we want to put the baby in the Neutral Thermal Environment (NTE)
o NTE = Range of Environmental Temperature wherein the Body is able to maintain constant temperature with the
LEAST Metabolic Expenditure [NTE (Axilla) = 36.3 37.2 0C]
C. Nursery Care
o Entire Skin and Umbilical Cord is Cleansed with Warm Water and Mild Soap babies are bathed
o Routine Cord Care should be rendered
Opthalmia Neonatorium = also known as Conjunctivitis of the Newborn characterized by Redness and
Swelling of Eyelids and Conjunctiva, with Discharfe
o Baby is placed inside Bassinet and Monitor Temperature (36.4 37 0C) to prevent Hypothermia
o Feeding Started, preferably Breastfeeding, as soon as the baby can Suck (to Prevent Hypoglycemia)
Mothers Milk may be given through a Dropper or Gavages done with Caution
26
V. BALLARDS SCORING
A. Neuromuscular Scoring
B. Physical Maturity
SIGN
-1
Skin
Sticky, Friable,
Transparent
Gelatinous,
Red,
Translucent
Smooth, Pink,
Visible Veins
Lanugo
None
Sparse
Abundant
Plantar
Creases
Heel-Toe=40 to
50mm
Heel-Toe
>50mm
No Creases
Parchment,
Deep
Cracking, No
Vessels
Mostly Bald
Leathery,
Cracked,
Wrinkled
Superficial
Peeling &/or
Rash,
Few Veins
Thinning
Cracking,
Pale Areas,
Rare Veins
Faint Red
Marks
Anterior
Transverse
Crease only
Creases
Over
Anterior 2/3
Creases over
Entire Sole
Raised
Areola,
3-4mm Bud
Formed &
Firm, with
Instant
Recoil
Full Areola,
5-10mm Bud
Bald Areas
*If <40mm = -2
Breast
Imperceptible
Barely
Perceptible
Flat Areola,
No Bud
Stipple Areola,
1-2mm Bud
Eye &
Ear
Lids Fused
Loosely
Lids open,
Pinna Flat,
Stays Folded
Slightly Curved
Pinna, Soft
with Slow
Recoil
Well-Curved
Pinna, Soft but
ready Recoil
*If Tightly = -2
Thick
Cartilage,
Ear Stiff
Male
Genital
Scrotum Flat,
Smooth
Scrotum Empty,
Faint Rugae
Testes in Upper
Canal,
Rare Rugae
Testes
Descending, Few
Rugae
Testes
Down, Good
Rugae
Testes
Pundulous,
Deep Rugae
Female
Genital
Clitoris Prominent,
Labia Flat
Clitoris
Prominent,
Small Minora
Clitoris
Prominent,
Enlarging
Minora
Majora &
Minora Equally
Prominent
Majora
Large,
Minora
Small
Majora cover
Clitoris &
Minora
27