Growth and Development

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Growth and Development
Questions
1. a. b. c. d. 2. The most unlikely cause for neonatal seizures on Day 2, in an infant is Metabolic Birth Asphyxia Intraventricular Hemorrhage Neonatal tetanus A full term neonate is having episodes of cyanosis and apnea which worsen on feeding and seems better when he is crying. The next step to establish a quick immediate diagnosis is Echocardiogram Bronchoscopy Upper GI Nasal exploration with a catheter All of the following are seen in infants with Laryngomalacia, except, Stridor beginning at (or) shortly after birth No evidence of significant Expiratory obstruction Stridor is typically loudest during feeding Usually increases during crying Which of the following childhood problems improves with increase in age Conduct disorder Emotional problems Temper tantrum Sleep disorder An Infant exhibits stranger reaction by 4 months 6 months 10 months 1 year

a. b. c. d. 3. a. b. c. d. 4. a. b. c. d. 5. a. b. c. d.

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2 6. a. b. c. d. 7. a. b. c. d. 8. a. b. c. d. 9. a. b. c. d. 10. a. b. c. d. 11. a. b. c. d. 12. a. b. c. d.

Paediatrics Vocabulary of a 3 year old child is 100 words 150 words 250 words 500 words “Handedness” is evident in a child by 2 years 3 years 4 years 5 years The Hormone not essential for inutero fetal growth is Insulin Insulin like growth factor Somatotropic hormone Thyroxine A child can walk up and down stairs, alternating his feet by 3 years 2 years 4 years None of the above External Genitalia can be clearly differentiated in a fetus by 12 weeks 20 weeks 8 weeks 10 weeks Child changes rattle from one hand to another at the age of 3 Months 6 Months 8 Months 1 Year Visual acuity reaches Adult level by 3 years 4 years 5 years 7 years

Growth and Development 13. a. b. c. d. 14. a. b. c. d. 15. a. b. c. d. 16. a. b. c. d. 17. a. b. c. d. 18. a. b. c. d. 19. a. b. c. d. Pincer grasp is seen at 3 months 9 months 5 months 7 months A child starts to take self decisions by the age of 7 years 3 years 10 years 12 years Deciduous Dentition is completed by the age of 6 months 6 weeks 6 years None of the above Fatty acids necessary during 0 to 6 months of age for brain are Arachidonic acid Linoleic acid Both of the above None of the above The triad of Autistic Spectrum Disorders (ASD) are all except. Impaired social interaction Impaired learning Impaired Communication Impaired imagination Breast Milk at room temperature can be stored for 7 hours 24 hours 4 hours 10 hours

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Nipple Confusion occurs when A Baby is allowed to suckle on one side most of the times A suckling baby is pulled half way and placed on the opposite side during feeding When the baby is positioned incorrectly None of the above

4 20. a. b. c. d. 21. a. b. c. d. 22.

Paediatrics Order of development of 2º sexual characteristics in a male is Testis development – Axillary hair – Pubic hair – beard Testis development – Pubic hair – Auxillary hair - beard Beard – Axillary hair – Pubic hair – Testis development Axillary hair – Pubic hair – beard – Testis development Order of development of 2º sexual characteristics in female is Thelarche – Menarche – Pubarche – Adrenarche (Axillary Hair) Menarche – Thelarche – Pubarche – Adrenarche (Axillary Hair) Adrenarche (Axillary hair) – Thelarche – Pubarche – Menarche Menarche – Pubarche – Adrenarche – Thelarche An Infant sits with minimal support, rolls over from supine to prone position, reaches for a toy, does not have a pincer grasp – the developmental age is 3 Months 4 Months 6 Months 8 Months Incorrect about Thumb sucking Can lead to malocclusion Is a source of pleasure Is a sign of insecurity Must be treated at 1 year to prevent stubborness Two Infants are born at 36 weeks. Infant A weighs 2.6 Kg, Infant B weighs 1.6 Kg. Infant B is more likely to have Congenital malformations Low Hematocrit Hyperglycaemia None of the above Which of the following drugs given during the last 2 weeks of pregnancy is most likely to have deleterious effects on the fetus Propranolol Penicillin Heparin Phenytoin The most uncommon manifestation / sign in Neonatal meningitis is Lethargy Neck stiffness Vomiting Hypothermia

a. b. c. d. 23. a. b. c. d. 24. a. b. c. d. 25. a. b. c. d. 26. a. b. c. d.

Growth and Development 27. a. b. c. d. 28. a. b. c. d. 29. a. b. c. d. 30. a. b. c. d. 31. a. b. c. d. 32. a. b. c. d. 33. a. b. c. d.

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The most common Intra cranial tumor in 2 – 12 years age group is Cerebellar Astrocytoma Medulloblastoma Ependymoma Choroid plexus papilloma The Important Prognostic Anthropometric measurement in a newborn is Weight Head circumference Length None of the above In a standard growth chart; Head circumference is included for the age upto 1 Year 3 Years 2 Years 5 Years The brain size of a one year old Infant in relation to an adult brain is 67% 75% 90% 60% The average normal blood pressure of a 3 year old child is 75/50 mmHg 90/60 mmHg 65/45 mmHg None of the above All are early indications for Exchange blood transfusion in Infants with Rh-Hemolytic Disease except Cord Hb > 12g/dL Cord Bilirubin 5 mg/dL (or) more Unconjugated Bilirubin > 10 mg/dL – 24 hrs Rise of Bilirubin more than 0.5 mg/dL/hour Two carpal bones are radiologically seen in the wrist X-ray by the end of 1 Year 2 years 4 years 12 years

6 34. a. b. c. d. 35. a. b. c. d. 36. a. b. c. d. 37. a. b. c. d. 38. a. b. c. d. 39. a. b. c. d. 40. a. b. c. d. e.

Paediatrics IQ between 50-70 indicates Moderate Mental Retardation Mild Mental Retardation Severe Mental retardation Profound MR Weight gain during first 3 months of age 250 gm/month 500 gm/month 350 gm/month 750 gm/month Length of the babies is recorded upto 1 Year 2 Years 21/2 years 11/2 years Head circumference at 12 years of age is 48 cm 50 cm 52 cm 49 cm Anthropometric measure that does not show much change in 1– 4 years is Abdominal circumference Head circumference Skinfold thickness Mid arm circumference A 5 year old child is assessed to have developmental age of 1 year. His IQ is 20 40 80 100 Shakir tape is used to measure Height Length Midarm circumference Head circumference Chest circumference

Growth and Development 41. a. b. c. d. 42. a. b. c. d. 43. a. b. c. d. 44. a. b. c. d. 45. a. b. c. d. 46. a. b. c. d. 47. a. b. c. d. Skeletal age of Infants of 8 months age is assesed by X ray of Pelvis X ray of Radius&ulna X ray of skull X ray of shoulder Capacity of stomach in a newborn is 20 ml 30 ml 50 ml 100 ml Vomiting on the first day in a newborn is due to Esophageal atresia Pyloric stenosis Amniotic fluid gastritis Congenital megacolon Air in the jejunum in an X ray of an Infant can be seen in 2–3 Hrs 15 Min.–60 Min. 3 Hrs to 6 Hrs 24 Hrs. Large doses of Vit K administered to a new born may result in Hyperammonemia Hypobilirubinaemia Prolonged Hyperbilirubinaemia Prolonged bleeding time Foetal scalp Blood pH; Less than –– is abnormal 7.25 7.3 7.35 7.4

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Neonatal seizures – cause of which carries the best prognosis; Birth asphyxia Hypoglycaemia Meningitis Late onset Hypocalcemia

8 48. a. b. c. d. 49. a. b. c. d. 50. a. b. c. d. 51. a. b. c. d. 52. a. b. c. d. 53. a. b. c. d. 54.

Paediatrics The normal heart rate at Birth is 60–80 bpm 80–110 bpm 70–120 bpm 110–150 bpm In Neonatal necrotising enterocolitis all of following are found except Blood in stools Delayed gastric emptying Temperature instability Increased Bowel sounds Umbilical cord usually falls after 5–10 days 3 days 14 days None of the above The bone most frequently fractured during delivery is the Radius Clavicle Ulna Femur The Characteristics of caput succedaeneum, are all except Crosses midline Crosses the suture line Does not disappear within 2–3 days None of the above All are true about Cephalohematoma except Limited to sutural lines Subperiosteal hemorrhage Visible several hours after birth Requires I and D A child following delivery, incomplete moro’s reflex, grasp preserved one UL; Abduction and supination difficulty. The lesion is at the level of C8 T1 C2 – C3 C5 C6 C6 C7

a. b. c. d.

Growth and Development 55. a. b. c. d. 56. a. b. c. d. 57. a. b. c. d. 58. a. b. c. d. 59. a. b. c. d. 60. a. b. c. d. 61. a. b. c. d. 25% of Infants void within 72 hrs 48 hrs 24 hrs 8 hrs

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Most common cause of convulsions on the first day of life in a neonate is Anoxia Head injury Hypoglycaemia Meningitis Most common cause of respiratory distress after birth in the first 24 hrs is Neonatal sepsis Meconium Aspiration Pneumonia Air embolism All of the following increase the risk of respiratory distress syndrome (RDS), except Maternal diabetes Alkalosis Caesarean section Maternal diabetes All are true regarding use of prenatal corticosteroids in the prevention of HMD, in cases of preterm labour except; All mothers at risk of preterm delivery between 24–34 wks need the therapy Maternal Hypertension is not a contraindication Maternal diabetes is not a contraindication The effect of one course lasts for 2 weeks True regarding Transient Tachypnoea of newborn is Benign self limiting disease Usually occurs in Preterm neonates Chest X ray shows absent vascular markings Significant respiratory distress is present Low birth weight baby is defined as Birth weight <1500 gms Birth weight <1500–2000 gms Birth weight <2500 gms None of the above

10 62. a. b. c. d.

Paediatrics All are seen during hypothermia in early neonate except; Bradycardia Excess shivering Fall in core temperature Metabolic acidosis

Growth and Development

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Growth and Development
Answers
1. (d) Neonatal tetanus Ref : (1) O.P.Ghai – 6th Edition 2005 Page 164 (2) Nelson’s Essentials of paediatrics – 3rd Edn. Page 217 to 222 Neonatal tetanus is very rare nowadays. The clinical features usually start on Day 5 to Day 10 and NEVER IN FIRST TWO DAYS, rarely after 2 weeks. Common Metabolic causes are (1) hypoglycaemia (2) hypocalcaemia. Birth Asphyxia is the most common cause of Neonatal seizures. (d) Nasal exploration with a catheter Ref : Nelson’s Essentials page 475 The Diagnosis is Bilateral choanal atresia : (1) Infants are mostly obligate Nasal breathers (2) Immediate diagnosis → bedside-passing a narrow 8 Fr. Catheter. (3) Confirmatory: Endoscopy and CT Scan (4) Oral airway –– Lifesaving (5) Treatment –– Surgical (d) Usually increases during crying Ref : Nelson’s Essl Pediatrics Page 475. (1) Stridor due to laryngomalacia, usually diminishes during sleep (or) when the child is crying (↑ed Muscle tone may hold the supraglottic structures out of airstream) (2) No treatment is needed usually (c) Temper tantrum (or) Oppositionalism (1) From the age of 18 months to 3 years child begins to develop autonomy and starts separating from primary caregivers. (2) They tend to do the opposite of what has been requested and get frustated when they can’t express their autonomy. (3) Some children show their frustration by physical aggression (Biting, kicking, hitting) (or) resistance. This physical aggression is known as Temper tantrum. (4) Reaches a peak → 2nd to 3rd year of life and subsides at 3 to 6 years.

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Paediatrics (b) 6 Months Ref : O.P.G : Page 57 (1) By 6-7 months, an infant can differentiate between strangers and primary caregivers. It develops fear of strangers and turns away or runs toward primary caregiver in sight of strangers. (2) It is a normal phenomenon, may last upto 13 months. (c) 250 words Ref : O.P.G : 47 18 months – 6 – 20 words 3 years – 250 words 2 years – uses Pronouns 1 year – 2 words with meaning (b) 3 years Ref : Nelson Page 44 (c) Somatotropic Hormone Ref : O.P.G : 2nd page Insulin and Insulin like growth factor are most essential for fetal growth. Thyroxine is also essential. Somatotropic Hormone (or) Growth hormone is not essential for fetal growth in utero. (a) 3 years Ref : O.P.G : Page 46 Climb upstairs – 2 years Coordinated climbing – 3 years (d) 10 weeks Ref : Nelson page 27 8 weeks– Ovaries and Testis distinguishable 10 weeks – External genitalia distinguishable (b) 6 months Ref : Nelson Page 33 Table 3– months – Holds rattle 5–6 months – Transfers any object from hand to hand. (d) 7 years Ref : O.P.G. Page 46. Binocular vision develops by 3 – 6 months. Adult acuity and depth perception by 6–7 years.

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Growth and Development 13. (b) 9 months Ref : Page 44 Table 3 months– Grasp appears 5 months– Bidextrous Grasp with Reaching 7 months– Palmar grasp 9 months– Pincer grasp

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(a) 7 years Ref : Page 51 A child starts to make self evaluations and decisions from 6 years and this continues upto 12 years during which refinement occurs. Self esteem becomes a central issue. (d) None of the above Ref : Nelson Page 1204 (Table) Deciduous dentition appears by 6–7 months. Lower central incisor is usually the first tooth to erupt and completed by 20 – 30 months (second molars) – last deciduous tooth to erupt. First permanent dentition 6 - 7 years (3 tooth) (1) Lower central incisor and first molar (2) Upper First molar (c) Both of the above Ref : Nelson page 154. (b) Impaired Learning Ref : O.P.G. Page 65 ♦ (a), (c), (d) are the classic triad of ASD ♦ Onset usually before 3 years ♦ Impaired learning is associated finding. (d) 10 hours Ref : O.P.G. Page 151 Expressed Breast milk can be stored for 1) 10 hours at Room temperature 2) 24 hours in a Refrigerator 3) 3 months –– at –20º C in a freezer. (d) None of the above Ref : O.P.G. Page 149 NIPPLE CONFUSION occurs in a baby who has been fed with bottle feeds, when put on to suckle at the breast. It finds very difficult and confusing to feed at the breast. (b) Testis development – Pubic hair – Axillary hair - Beard Ref : Nelson (55)

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Paediatrics (a) Thelarche – Menarche – Pubarche – Adrenarche (Axillary Hair) Ref : Nelson (55) (b) 4 months Ref : Nelson (55) Pincer grasp – 9 months Palmar grasp – 3 months – 4 months (d) Must be treated at 1 year to prevent stubborness. Ref : O.P.G. (55) Thumb sucking usually between 1–4 years. Intervention required only if it persists beyond 4–6 years. (a) Congenital malformations Ref : Behrman 16/e. 475 – 477 Macmillan 3/e. PP 206–209. ♦ Small for Date babies have different complications than appropriate for date preterm infants. ♦ Congenital malformations, Asphyxia and Meconuim aspiration Syndrome are common. Pneumothorax, Pulmonary hemorrhage are more common than Hyaline membrane disease in these infants. ♦ Neonatal symptomatic hypoglycaemia and elevated (or) normal Hematocrit are common. (a) Propranolol ♦ Pencillin and Heparin have not been shown to cause ill effects on the fetus. ♦ Phenytoin – causes Fetal hydantoin Syndrome when given in first trimester. ♦ Propranolol – causes decrease in Heart rate, low cardiac output at times of ↑ ed demand and may cause hypoglycaemia. (b) Neck stiffness Ref : IAP Textbook 2nde / Page 299 Behrman 1b/e – 544 – 546. (1) The signs and symptoms of Neonatal meningitis are subtle and nonspecific (2) Neck stiffness is usually seen in older children. (3) Temperature instability, Irritability, Vomiting, bulging AF, Lethargy are common. (a) Cerebellar Astrocytoma Ref : I A P text book 2nd edition – Page 306, 307 (1) Commonest Intracranial tumors in 2-12 yrs → INFRA TENTORIAL IN LOCATION

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(2) Of the Infra tentorial tumors, cerebellar astrocytoma, medulloblastoma and brain stem gliomas are in order most common. (3) Less than 2 years and adolescence, Infratentorial = Supratentorial tumors. (4) *Commonest Intra Cranial Tumor in general is secondary metastasis. 28. (a) Weight Ref : I A P : 76 page chapter (7.1) ♦ In any Newborn, be it Term / Preterm weight is the most important measurement. Appropriate weight for date babies tend to do well (prognostic point) than small / low birth weight babies. ♦ Among low birth weight babies, those with normal or near normal Head circumference have a good prognosis. (b) 3 years Ref : I A P text book Page 79 (c) 90% Ref : I A P – Page (79), (1) At Birth : 67% Adult Brain Size (2) At One year : 90% ♦ Brain Growth is most rapid in 20 – 36 weeks of Intrauterine life and then in the first year of life. (b) 90/60 mm Hg Ref : I A P 2nd edition Page 31 The average normal BP in children ♦ New born 65/45 mm Hg ♦ 1 Year 75/50 mm Hg ♦ 3 Years 90/60 mm Hg ♦ 10 years 100/70 mm Hg (a) Cord Hb > 12 g/dl Ref : I A P Page 73 Cord Hb < 10 mg/dl is an early indication. (a) 1 year Ref : Nelson – Page 37 Capitate and Hamate appear as early as 2 – 3 months (b) Mild Mental Retardation Ref : O.P.G. 543

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Intelligence Quotient =

Mental age Chronological age

× 100

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Paediatrics ♦ Mild MR ♦ Moderate MR ♦ Severe MR ♦ Profound MR – – – – 51 – 70 36 – 50 Sub Normal Intelligence - 71 – 89 21 – 35 Normal Intelligence - 90 – 100 0 – 20

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(d) 750gm / month Ref : O.P.G. – 4th page

First 4 months – 30gm / day Next 4 months – 20gm / day Wt. gain Last 4 months – 10gm / day
♦ Average Birth Wt. : 3 Kg – (O.P.G – 4) ♦ By 10th day : Birth Wt. is regained (3) Kg ♦ 5 months : Doubles Birth weight (6) Kg ♦ 12 months : Tribles Birth Wt. (9) Kg ♦ 24 months : Quadruples Birth Wt. (12) Kg; ie (1/5) of adult weight Height at 2 yrs = (1/2) Adult Height; (i.e) (85–90 cm) 36. (b) 2 years Ref : O.P.G. 4 ♦ Length of a Neonate is 50 cm 3 months – 60 cm 9 months – 70 cm 1 year – 75 cm 2 years – 90 cm (c) 52 cm At Birth – 35 cm 3 months– 40 cm 12 months – 45 cm 2 years – 48 cm 12 years – 52 cm Increase in Head circumference >1 cm/2 weeks → Hydrocephalous Head circumference equals chest circumference at 1 year. (d) Mid arm circumference Ref : Nelson 2131 Between 1 – 4 years the subcutaneous fat gets gradually replaced by increase in muscle mass. Both occur equally. Hence the loss of fat equals increase in muscle. So there is little change in Midarm circumference between 1 – 4 years.

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Growth and Development 39. (a) 20

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IQ =

Mental age Chronological age = 1 5 × 100

× 100

IQ = 20
40. 41. (c) Midarm Circumference (d) X ray of shoulder Ref : O.P.G – 6 ♦ 3 – 6 months – X ray shoulder ♦ 1 – 13 yrs – Hands & wrist ♦ 12 – 14 yrs – Elbow and Hip (b) 30 ml Ref : Chaurasia Vol II 4/e – Page 238 (a) Esophageal atresia Ref : Nelson 588 (1) Vomiting from esophageal atresia occurs with the first feed. (2) The diagnosis is suspected when excess, unusual drooling of saliva is observed and resistance is encountered on attempting to pass a catheter into stomach. (3) Vomiting in pyloric obstruction can occur anytime but mostly occurs in 4th to 6th week. (b) 15 min. – 60 min. Ref : Nelson – 588 Air can be demonstrated in the X ray of an infant in (a) Jejunum – 15 – 60 min. (b) Ileum – 2 – 3 hrs. (c) Colon – 3 hrs. Absence of rectal gas in 24 hr film → Abnormal. (c) Prolonged Hyperbilirubinaemia Ref : Nelson 190 ♦ Hypoprothrombinaemia – due to deficiency of Vit K. otherwise called Hemorrhagic Disease of new born. Prevented by prophylactic administration of Vit K. ♦ Hyperbilirubinaemia is caused by administration of large doses of Synthetic Vit K analogues. It does not occur with Synthetic Vit K analogues.

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Paediatrics (a) 7.25 Ref : Nelson 538 Fetal scalp blood pH ; during normal labour, decreases from 7.33 to 7.25. Any value less than 7.25 indicates Fetal distress, and pH less than 7.2 requires active intervention. Acidosis is mainly due to hypoxia induced Lactic Acidosis and monitoring of fetal scalp blood lactate levels also shows the condition of the fetus. (d) Late onset hypocalcaemia (d) 110 – 150 bpm Ref : Nelson 280 – Table 57.1
Age Heart Rate Resp. Rate Preterm 120 – 170 40 – 70 0 – 3 months 100 – 150 35 – 55 3 – 6 months 90 – 120 30 – 45 6 – 12 months 80 – 120 25 – 40 1 – 3 yrs. 70 – 110 20 – 30 3 – 6 yrs. 65 – 110 20 – 25 6 – 12 yrs. 60 – 95 14 – 22 12 yrs. 55 – 85 12 – 18

47. 48.

(near Adult values)

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(c) Temperature Instability Ref : Nelson 590. NEC – Neonatal Necrotizing Enterocolitis ♦ NEC is the most common life threatening emergency of GIT in neonates ♦ Common in LBW and PreMature babies ♦ Distal ileum and Proximal colon are the commonest sites to be involved. ♦ Less common in Infants fed on Breast milk. ♦ Rarely occurs before initiation of enteral feeds. ♦ DIC, Shock, Acidosis are sequelae. (a) 5 – 10 days Ref : Nelson – 608 (b) Clavicle Ref : Nelson 572 (c) Does not disappear within 2–3 days Ref : Nelson 562 Caput Succedaneum

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It is a diffuse edematous sometimes ecchymotic swelling of the layers of scalp in the presenting part of the baby during delivery. It is seen during birth ♦ Usually disappears in 3–5 days ♦ Large caput indicates prolonged labour. ♦ Moulding of the head and overriding of parietal bones usually seen. ♦ Crosses Midline and Sutural lines. 53. (d) Requires I and D Ref : Nelson 562 Caphalohematoma is a subperiosteal hemorrhage limited to a cranial bone. It is viable several hours after birth. I & D contraindicated. May cause Hyperbilirubinaemia and prolongation of physiological jaundice. (c) C5 C6 Ref : Nelson 565 Erb’s paralysis due to pulling of the infant vigorously by the arm. C8 T1 – Klumpkis paralysis (c) 24 hrs. ♦ Urine is passed usually during birth (or) immediately after birth. ♦ 95% of all infants void within 24 hrs. Meconium : 99% → Pass within 48 hrs. (a) Anoxia Ref : O.P.G. Page 511 Nelson P: 567 Hypoxic ischaemic encephalopathy is the most common cause of neonatal convlusions(50%). Sepsis, meningitis are the next common causes. Metabolic disturbances, like hypoglycaemia, hypocalcaemia and dyselectrolytemia account for 25%. (b) Meconium Aspiration Ref : O.P.G. 167 Table. Commonest cause of respiratory distress in a preterm neonate –– Hyaline Membrane disease. Post term and SFD babies, with H/o Meconium aspiration may develop respiratory distress in 15% of cases. Thin meconium causes, chemical pneumonitis, thick meconium causes airway obstruction causing areas of atelectasis and emphysema.

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Paediatrics (b) Alkalosis Ref : O.P.G : 166 RDS :Respiratory Distress Syndrome almost always occurs in PRETERM (< 34 weeks) babies. Surfactant production starts after 34 weeks and optimum levels occur only after 36 – 37 weeks. Surfactant is a lipoprotein containing phosphotydyl choline and phosphotydyl glycerol. Secreted by Type II Alveolar cells. It helps to reduce surface tension (soap like effect) and thus prevents the collapse of alveoli during expiration. Respiratory distress is evident within SIX hours of life. Lecithin / Sphingomyelin ratio – Prenatal diagnosis – normal > 2 and indicates adequate lung maturity. Test – shake test. A simple bed side test. Where the amniotic fluid is mixed with absolute alcohol in a test tube and shook for 15 minutes. Copious bubbles indicates adequate surfactant and thus lung maturity. Treatment ♦ Intratracheal administration of surfactant is now recommended. ♦ Ventilatory support - Intermittent Mandatory ventilation –– severe disease (IMV). Mild disease – Continuous Positive Airway Pressure (CPAP). (d) The Effect of one course lasts for 2 weeks Ref : O.P.G: 168 Table The benefits of prenatal corticosteroids are (1) 50% reduction in reduction of RDS (2) 40% reduction in mortality in babies with RDS Chorioamnionitis is a contraindication for the therapy. Treatment schedule : (1) Inj. Betamethasone 12 mg Intramuscular every 24 hours ; 2 doses -(preferred drug) (2) Alternatively, Inj. dexamethasone 6mg i.m every 12 hours (4) doses. Optimal effect occurs after 24 hrs of initiating treatment. One course lasts for 7 days. Hence if labour prolongs / continues after the expected preterm date (i.e. example 34 – 36 weeks) the course should be repeated on the 7th day to have the desired effect. (a) Benign self limiting disease Ref : O.P.G. 168 TTN : (1) Occurs in Term Neonates (2) Due to delay in clearance of lung fluids (3) No respiratory distress or very minimal (4) Oxygen treatment in adequate

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(5) X ray shows Prominent vascular markings and prominent interlobar fissure. (6) Prognosis – good. 61. (c) Birth wt < 2500 gms. Ref : Nelson 550 Low Birth weight : < 2500 gms Very low birth weight : < 1500 gms Normal Birth weight : < 3.5 Kg (b) Excess shivering Ref : Nelson 528 Shivering mechanism is not developed in a neonate. Non shivering thermogenesis occuring in Brown fat (nape of neck) accounts for the source of heat in an infant.

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