Professional Documents
Culture Documents
Pediatrics Pocket Guide
Pediatrics Pocket Guide
Dear Lord, You are the greatest Healer. Protect with Your mighty angels
All life and health comes from You. Those under my care. • Heart Rate • BP N – FiO2 <50
NB 3-3.5 <1kg 2.5 mm
Without Your blessing and Your grace, When their need of me is greatest, – ET SIZE – P/F
There is nothing I can do. May I always be there. – <2 mo 140-160 – Systolic: 1-3kg 3 mm – no electrolyte imbalance
Infant 3.5-4 – >2y/o:
– 2-12 mo 120-140 • upper: yrs X 2 + 90
age(yrs) + 16 – control of infection
I thank you for this noble role, When my zeal is at its lowest, 1y/o 4-4.5 >3kg 3.5 mm – good muscle mass
My service unto Thee. Tiredness meeting me at every turn, – 1-2 yo 100-12 • lower: yrs X 2 + 70
Stand by me with my patients, May you then be my Healer, 3y/o 4.5-5 4
– 2-8 yo 90-110 – Diastolic WT v Sz
• PT: 2 or 2.5
‘Til the work is done daily. Renewed joy and vigor earn. 6y/o 5-5.5 • Racemic epi
• 30 mmHg lower 1-1.5 7 3 • FT: 3 or 3.5
• RR 10y/o 6-6.5
– 0.3 ml + 4.7 PNSS
Give me knowledge, wisdom and skill All this I ask from You Lord, – ET Length – 2.5 ml X 3d (q4-6)
To do the tasks at hand, That I may a good doctor be, – <2 mo up to 60 1.5-2 8 3
Provide the best care needed That in my life as a physician,
Adolescent 7-7.5 age/2
kg
+cm12 • Dexamethasone 6 hrs
For each person’s best interest, stand May they see You in me. – 2mo-1yr 50 Adult 7.5-8 2-3 9 3.5 prior then 24 hrs
1 7
– 1yr-5yr 40 2 8
Let me lend a helping hand NGT and FC size age (yrs) + 16 / 2
To those who cannot pay, 3 9
ET size age (yrs) / 4 + 4
Bringing good health to all
ET depth age (yrs) / 2 + 12 or ET size x 3
Send them fit for homeward’s way.
wt + 6 (neo)
• Reasons for • Extubation Orders IV Drips Meds Prep Dose Drug + D5W Conc
• Parameters for weaning Dopamine 40mg/ml 2-20 5 + 45 4000
Extubation – epinephrine neb: 0.5 + Alpha1-adrenergic effects: vascular smooth muscle contraction
– Improvement in CXR 10 + 40 8000
–
W – ork of breathing 1.5cc PNSS x 3 doses Alpha2-adrenergic effects: vascular smooth muscle contraction 5 + 495 400
– ABG showing P02 >/= 50 mmHg q15 then q4 for 24 Beta1-adrenergic effects: Inotropy (contractility), Chronotropy (HR)
– Blood PH >/= 7.3
–
E – lectrolytes Dobutamine 12.5mg/ml 5-20 20 + 30 5000
hours Beta2-adrenergic effects: Vasodilation, Bronchodilation
–
A – BG Midazolam 5mg/ml 1-10 3 + 47 300
– PC02 </= 55 mmHg – O2 mask at 10 → 5lpm Formulas Epinephrine 1mg/ml 0.1-1 5 + 15 250
– Hgb 12-15g% or Hct 36-45 –
N – utrition then titrate Conc: mL (drug) x prep (mg/mL) x 1000 Furosemide 10mg/ml 0.2-0.4 2 + 18
• Weaning from CPAP –
I – nfection – – ABG 1 hour post Total Volume Nitroglycerin 1mg/ml 1-3 10 + 10 500
resolved extubation Dose: conc x rate / 60
– Decrease Fi02 by 3-5% every time Pa02 > 70 DOPAMINE
– N – eurologic Status – NPO for 4 hours weight •Indications: Cardiogenic and Distributive shock
– With Fi02 of 40%, reduce pressure by increments of 2
– CXR 6 hours after Rate: weight x dose x 60 • 2-5 mcg/kg/min: improve renal perfussion
cm water every 2-4h until pressure of 2-3cm is – G – help me GOD! • 5-10 mcg/kg/min: improve cardiac output
extubation. conc
achieved. • Start dexamethasone • 10-20 mcg/kg/min: post-resuscitation stabilization in patients with
Rule of 6 : wt x 6 = _ mL to make 100cc D5W (rate = dose) hypotension (conjunction with fluid therapy)
– Transfer patient to oxygen hood with Fi02 of 15-50% 0.5-1mg/kg q6 prior to •Onset: 1-2 min Peak: 10min Duration: <10min when infusion stopped
prep to run at _ cc / hr
extubation •Do not mix with NaHCO3!
• RESPIRATORY ALKALOSIS >45 Comp met and resp acid Resp acid Mixed met alk and resp acid
Acute [HCO3] ↓ by 2 for each 10mmHg ↓ in PCO2
– Acute: ∆pH=0.08x (40 - actual
pCO2 )/10 35-45 Met acid Normal Met alk
– Chronic: ∆pH=0.03x (40- actual Chronic [HCO3] ↓ by 4 for each 10mmHg ↓ in PCO2
pCO2 )/10 Mixed met acid and resp Combined resp and
<35 Resp alk
alkalosis metabolic alka
A B C D
Hypoxemia Oxygen Therapy(PaO2) • Recurrent Pneumonia
• dFiO2 Comorbid None + + +
• dFiO2= pCO2/0.8 – defined as 2 or more episodes in a single yr or 3 or Compliant + + - -
Normal 80-100 Uncorrected <60
• 713 (FiO2 decimal) - a mode episodes ever, with radiographic clearing caregivers
<80 Mild Corrected 60-100 • PO2 /b between occurences Ability to ff up Possible Possible Not possible
• {dFiO2x 100/c)+a} x 0.14 Dehydration None Mild Mod Severe
<60 Mod Overcorrected • FiO2(mechanical ventilation)= liters/min x 4 +20
• Persistent Pneumonia Ability to feed Able Able Unable Unable
>100
↓FiO2 PIP,PEEP • FiO2 of room air=0.2 – no CXR and resolution of symptoms for 1 month Age >11m >11 m <11m <11m
<40 Severe • P/F= pO2/FiO2 • Radiologic Lag RR
2-12 mo >50 >50 >60 >70
– no radiologic change for 1 month 1-5 year >40 >40 >50 >50
• Normal Values > 5 year >30 >30 >35 >35
Hypoxemia Treatment • <60y/o: 400-500 – infiltrates should resolved after 4 weeks
Retractions - - IC/SC Supra
PO2 <expected Uncorrected Give O2 or ↑FiO2 • >60y/o: 400−(every year above 60x 5) Head bob - - + +
Cyanosis - - + +
PO2=expected Corrected Maintain 02 Grunting - - - +
• P/F <expected →Hypoxemic Apnea - - - +
PO2>expected Overcorrected ↓FiO2 • P/F=expected →Non-hypoxemic Sensorium Awake Awake irritable lethargic
Complication - - - +
Pain Ff up after 1 week After 3 days Admit ICU
• Initially CPAP is set at 6cm water. If there is no inc in • Acute Respiratory Distress • CCAM
• FiO2 = [(CAx0.2) + (PAx1)] / TFR or PEEP • Tidal Volume (TV) = BW(kg) x factor Syndrome – Type 1 (50%)
PO2 in 15 min, pressure must be increased in 2 cm
increments to a maximum of 10 cm. (if by ETT) or by 12 – FiO2 < 60% = ↑ CA, ↓O2; FiO2 >60% = ↓O2, ↑CA – Normal TV: 6-10cc/k/day Factor: 5-7 cc/kg (normal lung) – PaO2/FiO2 ratio < 200 mmHg • Is macrocystic
– bilateral infiltrates • Single or several large (>2
cm (in other method). – CA = (100-FiO2)/79 x TFR – Child: 10-15cc/kg 10 cc/kg (abnormal lung) cm in diameter) cysts lined
– acute onset
– Adult: 10 cc/kg with ciliated
– If there is a increase in PaO2, reduced pressure. – TFR = minute volume x 2 (I:E) +2000 – No evidence of left sided heart pseudostratified epithelium
failure
– If 10-20 cm water pressure is attained and if PaO2 remains
= CA + PA (NV: 6-8) • IE: (60/RR – IT)/ IT • Acute Lung Injury
• Has good prognosis for
survival
under 50, FiO2 must be increased by 5-10% increments.
– CPAP failure is evident if PaO2 remains less than 50 in 100% – Minute Vent = RR x expected TV (age grp [10-12 • PEFR – PaO2/FiO2 ratio must be < 300 – Type 2 (0%)
mmHg • Microcystic
FiO2 with 10-12 cm water. ml/kg]) – Ht=x-100x5 + 170 (F)/175(M) • Multiple small cyst with
• Interstitial Lung Disease
• If CPAP fails under non invasive method, an ETT must be – TFR = wt x 10 x 2.5 x RR / 2000 – Usual Interstitial Pneumonitis
similar histology to type
– % PEFR = actual/expected x 100 • Associated with other
inserted. • most common form in adult congenital anomalies
• If CPAP fails w/ ETT, mechanical ventilation is indicated. • Oxygen = TFR – CA – Lymphocytic Interstitial • Poor prognosis
Pneumonitis – Type 3
– TFR = TV x BW(kg) x RR + 2000 to 3000 (dead space) • most common form in children
• (<10*)
– Acute Interstitial Pneumonitis • The lesion is solid with
• rapidly progressive form of ILD bronchiole – like structures
• Carries the poorest
prognosis and can be fatal
• Thalassemia • Aplastic Anemia • 0-5 mins DIAZEPAM • >30 but <60 mins PHENYTOIN • If with significant • THIOPENTAL DRIP • CSF Pathway:
– Anemia – Pallor – Dose: 0.3 mg/kg or 0.5 mg/kg – Dose: 20 mg.kg IV hyponatremia – Dose: 5mg/kg/bolus – Choroid plexus→ Lateral ventricle→Foramen of Monroe →
per rectum – Rate: 1 mg/kg/min – Give 3% NaCl at 4 cc/kg IV to – Drip: 1-5 mg/kg.hr
– Hepatosplenomegaly – Petechiae 3rd ventricle→Aqueduct of Sylvius → 4th ventricle →
– Rate: 1 mg/min – Max: 100 mg run for 1 hr – Prep: 1 g/50 mL vial
– Skin Bruising – Increased susceptibility to Foramen of Lushka and Magendie→ Subarachnoid space →
– Max: 5 mg for infants, 10 mg in – Onset: 10-30 mins, Duration: 48- – Prep: 1 cc of 2.5 meqs/cc NaCl + • PROPOFOL DRIP
– Failure to thrive infection older children/adults 4cc SW Subarachnoid villi→Venous system
96 hours – Dose: 2 mg/kg IV bolus (1
– Slight to jaundice – Easy fatigability – Onset: 2-3mins, Duration of • LUMBAR PUNCTURE:
• >60 mins → REFRACTORY • MIDAZOLAM DRIP mL/kg)
– Abnormal facies – malar – Labs action: 16-90mins, may repeat
after 15 mins STATUS EPILEPTICUS – Dose: 0.4-0.5 mg/kg bolus – Drip: 2-10 mg/kg/hr – Done bet. L2-L3 at level of ASIS
prominence, frontal bossing, • Anemia
• For myoclonic and Absence – Drip: 1-18 mcg/kg/min, can – Prep: 10 mg/mL/50 mL vial – Normal Opening Pressure: 80-150 mm H2O
depression of nasal bridge, • Leucopenia • 5-20 mins PHENOBARBITAL increase to 23 mcg/kg/min
exposure of upper central teeth • Thrombocytopenia – Dose: 20 mg/kg IV or IM Status Epiplepticus: VALPROIC – Normal Closing Pressure: 10-20 mm H2O
– Prep: 3 mg/kg in 50cc D5W
– Treatment: – Treatment: – Rate: 1-2 mg/kg/min ACID where 1 mcg/kg/min=1 – Random Blood Sugar: 3.9-6.7 mgs%
• Transfuse when hgb falls – Max: 800 mg – 20-40 mg/kg IV, infuse at 0.5-1 ugtt/min may increase by 1 ugtt
• Prednisone 1 mg/kg/day
mg/kg/hr to be given in 30 mins q 10-15 mins as needed
– Order:
<7g/dl • Blood transfusion – Onset: 20-30 mins after the loading dose • Send the ff. for analysis:
• If ferritin is > 1000ng/ml, – Duration: 24-72 hours
give40-60 mkd SQ over 8-10hr – Exclusion: <1 yo, plt ct <150,000, Tube 1= cell ct., diff ct.
x 5 days/week, monitor levels • 20-30 mins deranged LFTs 2= sugar, CHON
q3-6 months – additional 10 mg/kg if max dose 3= GSCS
• splenectomy had not been reached yet, • NPO for 4 hrs, resume feeding once fully awake, flat on bed for 4 hrs
otherwise proceed to Phenytoin
• Monitor VS q15 for 1 hr, q30 for next 2 hrs, q1 until stable
• Traumatic/Bloody Tap: TERM PRETERM
OLDER
PMN Mono Wbc Bacterial Meningitis
CHILDREN
– For every 1,000 RBC= 1 WBC Partially Tx
110-140 PT 0-100 0-25 0-100 Bacterial TB/ Fungal Viral • Common organisms
– For every 800 RBC= increase of 1 mg% protein Quantity 40 mL 10-30 mL Bacterial
mL NB 0-170 0-20 0-500 – 0-1 Month: GBS, E. Coli, L. Monocytogenes, Gram Neg
– For every 1 WBC= 600-1,000 RBC
– CSF/Blood Ratio= 0.6 Color
Xanthoch Clear-
Clear Early Color Purulent Turbid Colorless Colorless – 1-3 month: Above + H. Influenzae, S. Pneumoniae
romic xantho 0-25 0-5 0-30
Neonate – 3month- 6 years: H. Influenzae, S. Pneumoniae, N. Meningitides
• Lumbar Tap 0-100 None
RBC 0-100 Late Appearance Milk like Sl turbid Ground glass Clear • Treatment:
– Pressure (in cm H2O) 0-5 0-5 0-10
Neonate
• G 22 (1 ½ )= gtts in 21 sec 0-15 0-10 – N. Menigitides PCN 5-7 days
• G 22 (3 ½ )= gtts in 39 sec WBC 0-32 Sugar <50% >50% <40% 40-60
thereafter 0 0-5 0-50 – H. Influenzae: Ampicillin/ Chloro 7- 10 days
• G 20 (3 ½ )= gtts in 12 sec
79-80% 70-80% 50% – S. Pneumoniae: PCN 10- 14 days
– WBC correction in traumatic tap Glucose CHON 100-200 Dec >100mg% 50-100
– E. Coli: Ceftriaxone 14-21 days
Peripheral WBC x 1000 = WBC Protein 60-150 60-200 10-20
5,000,000 1000 RBC RBC Almost neg 0 0 0
– C/I
CSF Protein CSF Sugar= CSF Sugar CSF Cell count:
• Increase ICP WBC >1000 100’s 20-500 0-20
NB 45-100 mg/dL RBS or Hgt 500 RBC= 1WBC
• Severe CP depression
Child 10-20 mg/dL cut off: >50-60% 500-700 RBC = 1g/%CHON Inc lympho (inc
• Infected skin Almost 100%
Ado 15-30 mg/dL If Hgt: divide by 18 Diff. count L>P PMN in 1st 48 lympho
• Decreased platelet ct. or Blood D.O PMN
hrs
• Brain Abscess
clearing of macular
Juvenile Rheumatoid Arthritis
INFECTIOSUM (5TH
symptoms of mild
low grade fever,
Slapped cheek
extremities as
headache and
stage. Central
and proximal
Vital Signs
TTP, aseptic
appearance
4-28d (16d)
ERYTHEMA
reticulated
Parvovirus
meningitis
DISEASE)
5-15 yrs
STAGE I MILD II MODERATE III SEVERE
• Age at onset: <16 yr
none
none
URTI
Incubation period 14d 10-14d <10d Age BP CR RR
• Arthritis (swelling or effusion, or the presence of > 2 of the ff signs:
Asymptomatic, mild
junction (Nagayama
occurs at the uvulo-
Rose colored, small
– Limitation of range of motion Duration >6d 3-6d <3d Premature 55-75/35-45 120-170 40-70
lymphadenopathy
URTI, conjunctival
face and proximal
trunk and usually
discrete papules
– Tenderness or pain on motion Moderate, risus
6-15th month
palatoglossal
(EXANTHEM
0-3 mos 65-85/45-55 100-150 35-55
5-15d (10d)
extremities
Trismus Mild Severe
SUBITUM)
ROSEOLA
sardonicus
3-5 days
– Increased heat in > 1 joint
HHV-6
3-6 mos 70-90/50-65 90-120 30-45
None
spots
none
none
rare
Dysphagia Absent Present Severe
• Duration of disease: > 6 wk 6-12 mos 80-100/55-65 80-120 25-40
Pronounced, gen Severe, causing
spreads centrifugally
begins; suboccipital,
anterior cervical LN
Begins on the face
appearance of the
Congenital rubella
lymphadenopathy
and neck as small,
malaise, anorexia,
postauricular, and
5 days before to 6
pregnant exposed
esp <14 wks AOG
with episthotonus fracture
eyes, headache,
sore throat, red
after
coalesce, and it
ISG 20-30cc to
days following
rashes appear
irregular pink
6-18th month
macules that
Mild, transient More sever, longer, Violent, frequent,
Spasms 3-6 yrs 95-110/60-75 65-110 20-25
MEASLES)
– Polyarthritis : > 5 inflamed joints
minimal
<10sec 10-30secs >30secs
14-21 d
3 days)
Toga
– Oligoarthritis: > 4 inflamed joints
rash
and
Symp NS absent absent Present 6-12 yrs 100-120/60-75 60-95 14-22
• Systemic disease: arthritis with a characteristic intermittent fever >12 yrs 110-135/65-85 55-85 12-18
RUBEOLA (MEASLES)
rash appears
d5 exposure
Diazepam PRN: 0.05-0.15 mg/kg/dose
Mild fever,
Paramyxo
1°C ↑ Temp = ↑ RR by 4
eruption
All ages Midazolam drip: 0.01-0.06 mg/kg/hr
Branny
8-12d
Infective period
Desquamation
Epidemiology
Complication
Tetanus Ig: 3,000-6,000 u/IM SD
Prophylaxis
Prodrome
Etiology
Fever
Weight Length/Height BMI Weight Status Head Circumference
BP (for ages 1-10 yrs) At birth 3 kg or 6.5 lbs At birth 50 cm or 20 in <18.5 Underweight At birth 35cm Growth Assessment
0-3 mos + 9 cm 18.5 – 24.9 Normal weight 1st 4 mos ½ in/mo = 2 in Average Weight Gain: 10-20g/kg/d
• SBP = 2 x yrs +70 (p5) 0-6 mos mos x600 + BW (g)
25 – 29.9 Overweight 5-12 mos ¼ in/mo =2 in – < 2kg: >15g/kg/d
2 x yrs +90 (p95) 6-12 mos mos x 500 + BW (g) 3-6 mos + 8 cm
30 – 34.9 Obese 2nd yr 1 in/yr – > 2kg: >20g/kg/d
6-9 mos + 5 cm
• DBP = 2/3 SBP 3-12 mos mos + 9 / 2 35 – 39.9 Moderately obese 3-5 yrs ½ in/yr =1.5 in – Preterm: (age in days – 7-10) x 15-20 + BW (g)
9-12 mos + 3 cm
1-6 yrs yrs x 2 +8 40 – 49.9 Morbid obesity 6-20 yrs ½ in/ 5 yr =0.5 in – Term: (age in days – 10-14) x 15-20 + BW (g)
1-6 yrs yrs x 5 + 80 = cm
Pre HPN 7-12 yrs (yrs x 7 – 5) / 2
yrs x 2 +32 = in Average Length Gain: 0.7-1cm/wk
Term (Age in days – 10) x 20 + BW in Body Surface Area
• Average SBP or DBP that ≥ p90 but ≤ 95th 4-6 mos 2x BW gm – Term: 0.69-0.75cm/wk
4 yrs 2x BL 0-5 = wt x 0.05 + 0.05
• 10 = it takes 10 days to regain – Preterm: 0.8-1cm/wk
HPN 1 yr 3x BW 2-12 yrs yrs x 6 +77 = cm its BW 6-10 = wt x 0.04 +0.1
• 20 = 20 gm/day Average Head Circumference: 0.5-1cm/wk
• Average SBP or DBP ≥ 95th on ≥ 3 occasions 2 yr 4x BW 6-12 yrs yrs x 2.5 + 30 (in) Preterm (Age in days – 14) x 15 + BW in 11-20 = wt x 0.03 +0.2
– >1.25cm/wk is abnormal (HCP, IVH)
Ave wt gain *500 = 15g/day ½ in / 5 yrs = 1.5 in gm 21-40 = wt x 0.02 +0.4
• 14 = it takes 14 days to regain
*600 = 20g/day 13 yrs 3x BL its BW Shortcut = (wt x 4 +9) / 100
– Depth: size +6
4
- PHYSIOLOGIC PATHOLOGIC
1
• Dopamine/Dobutamine 4 2nd-4th day (term)
• Respiratory Distress syndrome 0 1 2 3 ONSET At birth <24
4th-7th day (preterm)
– Amount = (wt x dose x 6)/preparation rate: 0.5cc/hr TV 50cc d Age of onset 1-4 5-8 9-12 >12
PEAK 20 days 20h
Severity Reticulogram Cardiothymic Air bronchogram a Interval b/w No spontaneous
– Amount = (wt x dose x 6)/preparation/2 rate: 1cc/hr TV 25cc Pattern Shadow y <24 24-48 >48 ≤12mg/dl (term) >12mg/dl (term)
s
symptoms spasm LEVEL (TB)
Mild mild, hazy, Clear, defined Perihilar, within Duration of Transient on ≤14mg/dl (preterm) >14mg/dl (PT)
persistent >2 <2
– Order: amount + __cc of diluent to make50cc of solution generalized shadow a spasms stimulation FRACTION Inc. B1 B2>B1
f Temperature
mod generalized Discernible Just past CT t >3°C 2-3°C 1-2°C Normal- 1°C B2 (DIRECT) 1.5-2mg/dl >2mg/dl
borders Variation
e
Pneumonia definite definite Suspect Nil RATE OF INCREASE Not >mg/dl/24h >5mg/dl
• Initial Vent Settings in neonate Moderate Heavier, confluent Hazy Past 2/3 of lung r
Atelectasis widespread limited Mild Gradually dec by 5th day,
b DURATION disappear ny 7th day (term), Persists beyond 2 weeks
Settings Low Moderate High Severe White out lungs Up to lung periphery Cardiac borders not i NEONATAL SEPSIS
r LATE, LATE or 14th day (PT)
visible CHARACTERISTICS EARLY ONSET LATE ONSET
PIP <18 18-24 >24 t (NOSOCOMIAL ONSET) H.influenza, E.coli,
ETIOLOGY S. pneu, S. aureus, Pseudo
h Birth to 7 days, usually Klebsiella
PEEP <4 5-6 >7 • Treatment: Age at onset
<72hrs
7-30 days >30 days
MORTALITY 20% 10-50%
(
– Betamethasone 12mg q24 x 2 doses OR Dexamethasone 4mg IV q6h r Maternal complications Common Uncommon varies
I Time 0.4 0.4-0.8 >0.8 – No steroids if >34wks AOG e
BREASTFEEDING JAUNDICE BREASTMILK JAUNDICE
a Prematurity Frequent Varies Usual Rises 4th DOL, may reach 20-30mg/dl on D14 then
Rate <20 20-40 >40 – Surfactant 4-6cc/kg within 1st 8-12HOL, given on 4 quadrants, s Maternal genital Environment/communit
3RD-4TH DOL (1st WOL); 12mg/dl
dec slowly N by 4-12 weeks
hyperventilate, do not suction then CXR after 6hrs s Organism source Maternal genital tract Due to B-glucoronidase w/c inc enterohepatic circ,
Flow <8 8-10 >10 e
tract/environment y Dec milk intake—enterohepatic circ
normal LFT, no hemolysis
s Manifestation Multisystem Multisystem or focal Multisystem or focal
MAP <8 8-12 >12 s
Normal, NSY, NICU,
If BF stopped, rapidly dec bilirubin level in 48th
Site NICU, community NICU, community Fluid and caloric supplementation more frequently hour if resumed may inc to 2-4mg/dl but not to
s Community previous level
c
ZONE JAUNDICED AREAS EST. BILIRUBIN (mg/dl) • usually begins on the face- 5mg/dl; midabdomen- 15mg/dl; feet- PRETERM:
20mg/dl
I Head, neck 6-8 EXCHANGE
• B1 hyperbilirubinemia is bright yellow or orange CATEGORY PHOTOTHERAPY
II Upper trunk 9-12 TRANSFUSION
• B2 is greenish or muddy yellow
III Lower trunk, thigh 12-16 <1250 5-7 10-13
• Manifestation of color starting at serum bilirubin levels 5-7mg%
IV Arms, legs, elbow, knees 15-18 1250-1499 7-10 13-16
V Hands, feet >15 1500-1999 10-12 16-18
• CRITERIA TO RULE OUT PHYSIOLOGIC JAUNDICE:
– Clinical Jaundice in the 1st 24h of life 2000-2495 12-14 18-20
– Inc in TB at >5mg/dl/day (85umol/L)
– TB >12mg/dl in FT and >15mg/dl in PT HEALTHY TERM:
– B2 >1.5-2mg/dl (26-34umol/l)
<24H
– Jaundice lasting for more than 1wk for term, 2 weeks for PT
24-48H >15 >20
49-72H >18 >25
>72H >20 >25
SICK TERM:
<24 10-14 20
>24 15 20
• Phototherapy: • Ex: PT, Wt 1.36kg INTRAVENTRICULAR HEMORRHAGE Cranial Ultrasound
– A TSB f 20mg/dl at 48 hr of life may be treated initially with – wt x 100 = 1.36 x 100 = 136 x 2 = 275ml
phototherapy • Early < 72 hours • < 1.2 kg
– 36 x 10% = 13ml (5-10% bid vol) • Initial
– If the TSB decreases by 1-2mg/dl within 4-6hr of starting
phototherapy, exchange transfusion may not be necessary • ml for exchange should be <13ml • Late >72 hours – Premature <34 weeks • PT < 27 wks AOG
• may give 50-70% of 13ml per exchange – < 1000g: within 1st 3-5
– Distance from the light to the infant: 12-16 centimeters (460- • Grading
490nm) • exchanges = 275ml/10 = 27.5 exchanges
– In germinal matrix only days of age, 75% will be • Asphyxia with CNS
– Surface area: Larger skin area that is exposed, the more • Order detectable
effective – Without ventricular
– 1-1.5kg = at 7-14 days
• PT 36 weeks with trauma
– Prepare & transfuse type O FWB < 3 days old 275cc for DVET, get dilatation
• DVET electrolytes, bili, PT, PTT prior to DVET
– With ventricular dilatation – CT SCAN done at 4-7 • Full/bulging fontanel
– Removes 50% bilirubin, 98% previous blood circulating – after DVET: get Hgt, ABG, elec, CBC, PT, PTT 6 hrs post get bilirubin 6, 12 DOL
antibodies (30-45%) incidence of • Seizure
hrs after DVET
– PT 90-100cc/kg Term: 80cc/kg
motor/intellectual • Ff-up study
• Risk: acidosis, hypocalcemia, hypokalemia, impairment – done at 36-40 wks post • PT with apnea (1-2 days)
– Blood: FWB <3days old coz’ K+ increases rapidly
– With parenchymal menstrual age or prior to
– Modified WB: no platelet extension (60-80%) discharge
– Use 10cc syringe for >1kg, 5cc for <1kg incidence of •
motor/intellectual
impairment
SODIUM
Neonatal Seizures POTASSIUM
HYPERKALEMIA: >6
• PT 2-3 meq/kg/d Term: 2-5 meqs/kg/d • PT 0-1 meq/kg/d Term: 1-2meqs/kg/d Maintain normal pH: if acidotic, consider NaHCO3 (1 meq/kg) and/or
• Preparation: 2.5 meqs/mL
• Check glucose, if (+) give • If sz > 60 mins refractory • Preparation: 2 meqs/mL Maximize acetate in hyperalimentation (acidosis drives K out of the cell).
2cc/kg D10W status epilepticus • K infusion rate: not =/> 0.3 meq/kg/hr for more than 3 hours Give Ca gluconate 50mg/kg to neutralize cardiac effects (arrythmia) of
HYPONATREMIA <135
• Pb 20mg/kg IV at rate of 1-2 • Start Midazolam drip Hyperkalemia
mg/kg/min Deficit = (Desired Na – Actual Na) x 0.6 x wt Consider glucose 0.5-1.0 and insulin 0.1u/k infusion for 30 minutes
– LD: 0.15 mg/kg HYPOKALEMIA
– MD: 0.1-0.4 mg/kg/hr 2.5 mEq/mL
• If uncontrolled, Pb 10mg/kg Deficit = (Desired K – Actual K) x wt x 0.01 x 50
IV, max of 40 – Prep: 3 mg/kg in 50cc D5W = (135 mEq – 128 mEq) 0.6 x 1.5 kg CALCIUM
where: 1mcg/kg/min = 1 2.5 mEq/mL 2 mEq/mL Maintainance: 100meqs/kg/d
• If still uncontrolled, give ugtt/min, may increase 1 ugtt
Phenytoin 20mg/kg IV rate = 6.3/2.5mL = 2.3mL Maintainance = 2mEqs/kg/d Preparation: 100mg/mL
q 10-15 mins PRN
of 1 mg/kg/min 2mEq/mL
• Or Lidocaine drip 10% Ca gluconate (9.4 mg/mL elemental Ca)
• If uncontrolled, give Maintainance at 3 mEq/k/day = 6.3/2.5mL = 2.3mL
– LD 4 mg/kg/hr (1st day) or 2 = 0.8 kg x 100mg/kg = _80mg___
Lorazepam (0.05-0.1 mg/kg mg/kg NaCl = 1.5 x 3mEq/k = 4.5 mEq
100mg/mL 100mg/mL
IV) or Diazepam (0.3 mg/kg – Reduce by 1 mg/kg/hr on 2.5 mEq/mL 2.5 mEq/mL KIR: meqs x rate/wt CT: TKR x 100/meq = 0.8 mL to be incorporated in 24 hr fluid
max 5mg) subsequent days = 1.8mL
– WOF hypotension 100 rate
Total NaCl = 10.8 mEq (4.3mL) to be incorporated in 24 hr fluid with repeat
serum Na 12 hours later
INTRALIPID
HYPOCALCEMIA (<2.2 mmol/L)
20/oz
1.1 ccal/cc (10%)
10% = 10 g/100mL
20cal/67 cal/dL
CHO
72.7
66.4
13.3
For ionized Ca <0.1, supplement with 10% gluconate (100mg/kg q6h x 4 doses)
0.2 cal/cc (5%)
7.8
7.5
7.4
8.6
8.9
Then recheck after 4th dose 20% = 20g/100mL (180cal/100mL)
41.96
38.93
Eg: wt 2k at intra dose = 0.5 gkD (10%)
30cal/oz
24cal/cc
20cal/cc
FAT
MJ &Nestle = 1:1
75 mg/kg/day based on the elemental Ca (400-500/k/day of 10% Ca gluconate divided into ABG in NEO
20% = kcal/cc
3.6
4.5
3.6
3.9
3.5
4.2
4.1
31
82
40 cal 2kg x 0.5 x 100 = 10 mL (of 10%1L)
40cal/100cc/10g
4 doses)
20cal/100cc/5kg
4 cal/sachet
•pH 7.3 – 7.5
20cal/100cc/5g
1cc = 4 cal
2.25/dL
10
200cal/cc/5 g
•pCO2 35 – 45
20cal/100cc
100cc •pO2 60 – 80
3.42g/dL
Ca = 1.5kg x 200mg/kg = __300mg___
CHON g
0.4cal/k
0.2cal/k
•HCO3 19 – 32
7%
125mL
1.1d/L
2.5/dL
2.8/dL
1.5/dL
2.4/dL
100mg/mL 100mg/mL CHON: 2.5 – 4 kd Amino 6%
24/oz
14.09
9.09
1 oz. evaporated milk
2.3
2.4
•O2 90 – 95%
2.5
1.1
1.2
= 3.0 mL diluted 1:1 slow IV push
3
Glucose: 5.9 MK
1 oz powdered milk
Correction at 400mg/kg//day
67.6/dL
21.4/oz
AMINOPLASMIN
100/dL
813/dL
120/oz
75/dL
Prep per Liter: CHON 60g
72/dL
67/dL
80/dL
81/dL
699/L
671/L
22/oz
21/oz
22/oz
20/oz
22/oz
20/oz
Ca= 1.5kg x 400mg/kg = __600mg___ Vitamin K
CAL
100
100mg/mL 100mg/mL Calories: 650 cal • <1 kg: 0.5mg
Ordinary MF
5 gms sugar
INTRALIPID
D5 0.3 NaCl
ALBUMER
Karo syrup
1 oz sugar
= 6.0 mL divided into 4 doses then diluted 1:1 for SIVP with cardiac Glucose: 100g
Pediasure
monitoring
D5 IMB
VAMIN
Nutren jr
HMF
Neosure
Caro syr
D10
Corn oil
1kg x 0.5 x 1000 = 8.3cc Vamin/12h
Lactum
S26lbw
Enfalac
Prenan
bm(pt)
HYPERCALCEMIA: >2.6 mmol/l
Promil
Bonna
D5
bm (t)
Alfare
Nan 1
MILK
MLIK
Gain
S26
Hydrate the patient at wice the maintenance then give Furosimide 1mg/kg/dose 60