NEONATOLOGY LEVEL OF CONSCIOUSNESS

ALERT – responds fully and appropriately to stimuli

LETHARGIC – drowsy, responds to questions then fall asleep
OBTUNDED – open eyes, responds slowly, confused
STUPOROUS – arouses from sleep only after painful stimuli
COMATOSE – unarousable with eyes closed

Normal Physical Exam and Maturity Testing

• Skin: Vernix, lanugo, jaundice (>24 hours), harlequin color, mottling
(thermoregulatory instability), Mongolian spots, milia, erythema
toxicum (harmless small erythematous papules)

• Head and Neck:HC= 33-35 cm (till 3 y/o); fontanels (tense, bulging/

depressed)
▪ Caput Succedeneum – edema without ecchymosis, ill defined
borders;
disappearing in a few days.
▪ Cephalhematoma – subperiosteal bleed limited by periosteal
attachments, not crossing suture lines, absorbed slower than caput.
▪ Craniotabes – soft areas of bone, “pingpong” ball sensation when
depressed
▪ Epstein Pearls – whitish shiny cysts on palate and gums

• Chest: Normal RR: 30-60 cpm, diaphragmatic

Periodic breathing (apnea <10 sec) = Normal in pre-term
Normal CR: 120-160 bpm; auscultation for murmurs
Brachial: femoral pulse intensity
BP (term): 50-70/25-50 mmHg

• Abdomen/Back: globular, but not distended; diastasis recti (separation of

rectus
One minute score: gives index of necessity for resuscitation muscles, common in newborn)
Five minute score: more valuable in predicting mortality, success of Liver edge: palpable 2-3 cm subcostalmargin
resuscitation, neurologic deficit at 1 year of age. Back: without dimpling or tuft of hair

Interpretation of APGAR Score:

1 min: <7= CNS Depression
<4= severe CNS depression

5 mins: >8= no aspiration

<7= high risk for subsequent CNS dysfunction

5-7 = Mid Asphyxia

3-4 = Moderate Asphyxia
0-2 = Severe Asphyxia
 • Neurologic:
MEASUREMENTS:
REFLEX APPEARS DISAPPEARS

Moro Birth 5-6 months Weight: 50 – 52 cm Birth: HC > CC

Rooting Birth 3 months Length: ≥ 2500 grams 6 months: HC = CC
Tonic Birth 5-6 months Head Circumference: 33- 35 till 3 y/o 1 year: HC < CC
Palmar Grasp Birth 6 months
Plantar Birth 9-10 months Low Birth Weight: < 2500 gm
Grasp 6-8 months Very Low Birth Weight: <1500 gm
Landau 6-8 months Persist Extremely Low Birth Weight: <1000 gm
Parachute
SGA: BW < 10th percentile for gestation or below 2 standard deviations from mean
LGA: BW > 90th percentile
FONTANELS CLOSES AT: Anterior – 18 months, as early as 4-12 months
Posterior – 6-8 weeks
Physiologic Changes in Newborn

1. Physiologic weight loss – not more than 10% BW; occurs on 2nd day,
recovered by 10th day (14th day – Premature)

2. Physiologic Jaundice (unconjugated hyperbilirubenemia)

Predisposing factors:

- surplus of RBC; increased cell mass
- Decreased red cell survival
- Immature hepatic function (slow bilirubin metabolism)
- Breastfeeding

3. Vasomotor Instability
4. Genital Crisis – pseudomenses
5. Witch milk
6. Transitional stool
7. Inanition fever – 1st week due to dehydration
8. Physiologic desquamation of skin for not > 1 week
9. Falling off the cord
10. Physiologic Anemia at 2-3 months, permissible fever
PEDIA VITAL SIGNS FLUIDS AND ELECTROLYTES
❖ Maintenance
AGE Heart Rate BP Respiratory Rate ❖ <15 kg. = D5IMB
❖ > 15 kg. = D5NM
Premature 120-170 110-135 / 65-85 40-70

0-3 months 100-150 55-75/ 35-45 35-55 Weight (kgs) Fluid requirement
( cc/kg/day)
3-6 months 90-120 65-85 / 45-55 30-45
<3 75
6-12 months 80-120 80-100 / 55-65 25-40
3 - 10 100
1-3 years 70 -110 90-105 / 55-70 20-30

3-6 years 65-110 90-105 / 55-70 20-25 10 - 20 75

6-12 years 60-95 95-110 / 60-75 14-22 20 - 30 60

>12 years 55-85 100-120 / 8-75 12-18 30 -40 50

> 40 40

Ex: 9 kg patient
9 kgs. x 100 = 900/24
=37 to 38 uggts./min or convert it to gtts divide by 4
= 9 -10 gtts/min
IVF: D5IMB 500 cc to run at 37 – 38 uggts/min

25 kgs patient
25 x 60 = 1500 cc/ 24 hours
= 62 – 63 uggts / min or 15 – 16 gtts/min
IVF: D5NM I L to run at 15 -16 gtts/min

FLUID RESUSCITATION
< 2 y/o >2 y/o
< 10 kgs >10 kgs

MILD 50 30
D50.3NaCl

MODERATE 100 60
D50.3NaCl
D5LRS

SEVERE 150 90
PNSS
PLRS
MILD hydration: DAY TERM PRETERM SGA
8 months old , 9 kgs.
9 x 50 = 450 / 8 hours 1 70 60 60
= 56 – 57 uggts/min
IVF: D 50.3 NaCl 450 cc to run at 56 -57 ugtts/min for 8 hours then refer 2 85 80 90
for R/A
3 100 100 120

4 110 120 150

5 130 140 180

6 140 160 210

7 160 180 240

8 160 200 240

❑ 1ST day of LIFE use D10 Water

❑ 2nd day of LIFE use D10 IMB
❑ if patient is feeding with good HGT may use D5IMB
❑ D10IMB dextroxity

desired – actual 10 - 5
------------------------------ = ---------- = 0.11
D highest –D lowest 50 - 5

Day 1 of life, term, wt = 3kgs

3kgs x 70 = 210
= 210/2 = 105
IVF : Hook to D10 water to release 105 cc/soluset to run at 8 – 9 ugtts /min
for 12 hours x 2 doses

D2 of life , preterm wt.= 1.2 kgs

TFR = 80 cc/kg/day
1.2 kgs x 80 = 96 cc
IVF = D10 IMB
D5IMB 85.5 cc
D5050 10.5 cc
------------
96 cc/soluset to run at 4 uggts/min for 24 hours
RENAL/CARDIAC PATIENTS
➢ BSA = square root of wt x ht divided by 3600
➢ Eg. Day 1 = BSA x 1500 cc
= 0.5 x 1500
= 750 cc in 24 hours at 31-32 ugtts/min
* if px is feeding regulate IVF at 10 ugtts/min
* if limit fluid intake by subtracting 240 cc from TFR
= 750 – 240 = 510/3 = 170 cc
❖ Limit fluid intake to170 cc per shift, pls. provide measuring cup.
COMPUTATION OF MEDICATIONS
mkDay
ml = weight x TD x denominator / numerator / frequency
TD = ml given x frequency x numerator / denominator / weight
TD (IV) = mg given x frequency / weight
mkdose
ml = weight x TD x denominator / numerator
TD = ml given x numerator / denominator / weight

➢ Day 2 = BSA x 400 + ½ urine output

Eg. UO = 600 cc 1. Ampicillin (100-200 MKD)
= 0.5 x 400 + 300 ➢ 7 days = q 12 hours
= 500 cc to run at 20-21 ugtts/min ➢ 7 days = q 6 hours
Eg. 3 kgs Px, 3 days term
3 x 100 = 300/2 = 150 mg q 12 hours
Start ampicillin 150 mg q 12 hours

2. Pen G Na (100-300 thousand u/kg/D)

100T = Renal/Cardiac
200T = Pneumonia
300 T = meningitic dose
eg. 10 kg patient
10 x 100,000 = 1,000,000 u/4
= 250 T units q 6 hours
eg. Pen G Na 250,000 u q 6 hours in a 10 kg px
250,000 x 4 = 1,000,000 u/10 kg = 100,000 UKD

3. Paracetamol (10-20Mkd)
Prep:
60mg/0.6 ml drop
100mg/ml
120mg/5ml
125mg/5ml
150mg/5ml
250mg/5ml
Eg. 5 mos., 6 kg
Dose = wt x TD x 1/100
= 6 x 10 x 1/100
= 0.6ml
TD = ml given x numerator x denominator/weight
= 0.6 x 100/1/6= 10 MKD
4. Diazepam (0.2 – 0.8 MKd) AMIKACIN
Prep: 10mg/2ml; 10 mg tab • 15mkd q8, q12, OD
Eg. Px is 10 kg • 250mg, 500mg/vial
IV = 10 x 0.2 = 2 mg IM/IV
Rectal = 10 x 0.5 = 5 mg / rectum AMINOPHYLLINE
• LD 8m/kg IV infusion x 30mins
5. Amoxicillin (30-50 mkD) • MD 3ml dose q8
Prep: 60mg/0.6ml • 25mg/ml amp
100mg/ml • 26.7 mg/5ml, 80mg/5ml syr
125mg/ml
250mg/ml ALLOPURINOL
Eg. 10 kg Px • 10mkd; TID
• 300mg/tab
dose = wt x TD x denominator/numerator/freq. of giving
= 10x50x5ml/125mg /3 = 6.6 ml AMPICILLIN
• 100mkd q6, q12
TD = ml given x frequency of giving xnumerator/denominator/wt • 500mg, 1g/vial
= 6.6ml x 3 x 125mg/5mg/10
= 49.5 mkD AMPICILLIN SULBACTAM
• 50-100 mkd q6-q8 (IV)
6. Cotrimoxazole (5-8 MKD) • 500mg=250mg; 750mg = 500mg
Prep: 200mg/40mg/5ml • 50MKD q12 PO < 30kgs
400mg/80mg/5ml susp • >30 kgs; adult dose
400mg/80mg tab • 250mh/5ml; 375 mg; 750mg/tab
800mg/1680mg tab
AMOXICILLIN
EG Px is 10 kgs. • 50MKD
dose = wt x TD x 5/40/freq. ofgiving • 100mg/ml, 125/5, 250/5; 500mg/cap
= 10 x 8 x 5/40/2
= 5 ml AMOXICILLIN-CLAVULANIC ACID
• 50MKd q 8-12 hours
TD = ml given x freq of giving x 40/5/wt
= 5 x2 x 40 / 5 / 10 ASPIRIN
• 100mkd QID
PROCATEROL • 10-15 MKd q4-6 hours
• 0.25 mg/kg/ dose • 30mg, 80mg, 100mg/tab
• Eg. 8kgs.
8 x .25 = 2 ml BID AZITHROMYCIN
• 10mkd x 3 days PO OD
• 200/5, 250mg, 500mg/tab
• 10mkd on 1st day then 5 mkd on D2-D5
BENZATHINE PEN G CEFTRIAXONE
• 600,000 u if <27 kgs • 50 mkd OD IV = sepsis
• 1.2 mu if <27 kgs • 100mkd OD = meningitis
• 500mg/1g/vial
BENZYL PEN G
• 100,000 – 200,000 ukd q6 CEFTAZIDIME
• 400,000 ukd q6 = meningitic dose • 30mkd q8
• 1MU/2MU • 500mg, 1g, 2g /vial
• Max: 2 MU q6
CLINDAMYCIN
BUTAMIRATE CITRATE • 10-25 mkd q5 PO
• 0.5mkd q8 • 150 & 300mg; 75 mg/5ml
• 7.5 mkd q8 • 10-40 mkd q6 IV/IM via S/P x 30 mins
• 7.5mg/5 ml syr, 50mg/tab • 150mg/ml vial

CAPTOPRIL CHLORAMPHENICOL
• 1-5 MKD Q8-Q12 • 100mkd q6 PO, IV
• 25 mg/tab, 50mg/tab • 125 mg/5ml susp, 1g/vial

CEFALEXIN CEFOTAXIME
• 30-50 mkd q8 • 50 mkd q12
• 100-200 mkd q6-q8
CEFEPIME • 1g/vial
• 100-150 mkd q8-q12 IV
• 500mg, 1g, 2g vial CETIRIZINE
• 0.25 mkd BID
CEFIXIME • 1mg/ml, 10mg/ml, 10 mg/tab
• 8 mkd q12, OD PO
• Susp: 20 mg/ml, 50mg/ml, 100mg/5ml CLARITHROMYCIN
• Cap 100mg, 200mg • 7.5 mkd q12
• 125/5, 250/5, 250mgtab, 500mgtab, 500mg vial
CEFUROXIME
• 40mkd q12 PO CHLORAMPHENICOL
• 100mkd q8 IV • 100mkd q6 PO IV
• 250/5, 500mgtab, 750mg/vial • 125 mg/5ml susp, 1g/vial

CEFACLOR CLOXACILLIN/OXACILLIN
• 20-40 mkd q8, q12, PO • 100mkd q6 PO/IV
• 50/ml, 125/5, 250/5 • 125/5; 250/5;
• Cap 250mg, 500mg
• Vial 250 mg, 500mg
CO-TRIMOXAZOLE DOBUTAMINE DRIP
• 5.8 mkd q12 PO • 10-20 UG/KG/MIN
• Susp: 200mg/40mg/5ml; 400mg/80mg/5ml • Cc/hr = dose x wt x 60 / ug/cc
• Tab 400mg, 800mg • Single Conc: 200mg/250cc (1000ug/cc)
• Double Conc 500mg/250cc (2000ug/cc)
DIAZEPAM • Penta Conc: 1250 mg/250cc (5000ug/cc)
• 0.3 mkd
• 10mg/2ml amp; 5 mg tab DEXAMETHASONE
CROUP
DIPHENHYDRAMINE • 0.6 mkd single dose IM
• 5mkd q6-8 hrs Airway Edema/Prior Extubation
• Max 300/day Neonates
• 1mkd; 1 mk IM • 0.25mkd IV q12 x 3-4 doses
• Cap: 25, 50mg • Give >4hours before extubation
• 12.5/5 susp, 50mg/ml amp Children
• 0.5-2 mkd q6 x 4-6 doses
DIGOXIN • Give 24 hrs before extubation and continue 4-6 doses post
• 0.004 MKD Q12 extubation (IV,PO,IM)
• 0.25 mg/tab; 0.05 mg/ml elixir; 0.25mg/2ml amp Bacterial Meningitis
• Rapid Digitalization: • 0.6mkd q6 IV D1-4 of antibiotics
Total Digitalizing Dose IV Cerebral Edema
• Wt x dose x 75% = mcg • 1.2 mkd as LD then 1-1.5mkd q4-6 hrs then taper over 1-6 weeks
½ of TDD at 1st hour
¼ of TDD at 8th hour ERYTHROMYCIN
¼ of TDD at 16th hour • 10mkd q6-8H PO; 5-10mkd q6H IV
Maintenance Dose • 100mg/ml, 125mg/5ml, 200mg/5ml; 400mg/5ml, 500mg/vial
• Wt x dose = mcg q12
NB: 0.03-0.04 mg/kg HYDRALAZINE
0.02-0.025 mg/kg • 0.5mkd q4-6H
<2 y/o: 0.03-0.05 mg/kg • 20mg/ml, 25mg/tab
>2 y/o: 0.02-0.03 mg/kg
FLUCONAZOLE
DOPAMINE DRIP • 12mg/kg x 30 min via ISP
• 10-20mg/kg/min • 6mg/kg x 30mins via ISP
• Cc/hr = dose x wt x 60 /ug/cc • 50, 150, 200 mg/cap; 2mg/ml vial
• Single conc: 200 mg/250 cc (800ug/cc)
• Double Con: 400mg/250cc (1600 ug/cc) FLUCLOXACILLIN
• Penta Conc: 1000mg/50 cc (400 ug/cc) • 25-50 mkd q6
• 125/5, 250mg, 500mg

GENTAMYCIN
• 5mkd OD
• 80mg/2ml

HYDROCORTISONE
 • 4mkd TID QID q4 METOCLOPROMIDE
• 100,200, 500mg/vial • 0.1 mkd PO/IV q8
• 5mg/5ml syrup, 10mg/tab, 10mg/2ml amp
IBUPROFEN
• 10-15 mkd q6 NIFEDIPINE
• 100/5, 200/5, 200mg/cap • 0.6-0.9 mkd q6-8h
• 5, 10, 20 mg/cap
LAGUNDI
• 15 mkd TID NALBUPHINE
• 300mg/5ml syr • 0.1 mkd
• 300mg, 600 mg tab • 10mg/ml amp

MEROPENEM NALOXONE
• 20mkd q12 IV = sepsis • 0.1-0.2 mkd q 6-8 hours
• 40mkd q8 = meningitis • 1mg/ml, 20 mcg/ml, 400mcg/ml
• 500mg, 1 g vial
NETILMICIN
MANNITOL • 9mkd OD
• LD 0.5-1g/kg; MD 0.25-0.5g/kg q4-6H • 100mg/2ml, 150mg/1.5ml
• Not to exceed 5 days 20% IV solution
• 0.5 g/kg = 2.5ml/kg NALOXONE
• 0.25 g/kg = 1.25 ml/kg • 0.1-0.2 mkd
• 20mcg/ml, 400mcg/ml
METHYPREDNISOLONE
• 20mkd IV q6 x2-3days; 2 mkd/PO PREDNISONE
• 15-30 mkd OD x 2 hours q other day x 3 doses (Pulse tx AGN) • 1-2 mkd BID
• 500mg, 1g/vial, 4mg, 16mg tab • 1-2 mkd BID-TID or 40-60 mg/day in cardiac patients
• 10mg/5ml
METOPROLOL • 2.3, 5, 10, 20, 30 mg/tab
• 1.5mkd BID
• 50mg, 100mg, 200mg/tab PHYTOMENADIONE
• Infants = 1-2 mkd q4-6
METRONIDAZOLE • Child = 0.6 mkd
• Amoebiasis: 35-50mkd q8 PO x 10 days • 10 mg/ml amp
• Anaerobic Infection: 30 mkd q6 hours IV/PO 0r 7.5mkd IV q 8
PREDNISOLONE
MEBENDAZOLE • Same dose
• >2yo: 5ml BID x 3 days • 15mg/5ml; 20mg/5ml syrup
• <2yo: 2.5 ml BID x 3days
• 100/5, 500mg/tab PYRANTEL pAMOATE
• 11mk as single dose
• 125/5 susp, 125mg. 250mg tab
PANCURONIUM SODIUM BICARBONATE
• 0.1 mkd Acidosis
• 4mg/2ml • 1-2 mk + equal vol of DW SIVP
PPHN
PIPERACILLIN TAZOBACTAM • Full Strength: 0.15 x TFR /3 = ml/shift
• 50mkd q12 • Half Strength: 0.075 x TFR/3ml q shift
• 1g/2g • Full Correction: BD x wt x 0.3/2
• Via Infusion syringe pump over 30 minutes • Add equal volume of DW, give 1st half SIVP, then 2nd half x 2 hours
via infusion pump
PARACETAMOL • 325mg, 650mg/tab; 40 meq/amp
• 10-20mkd q4
• 100mg/ml, 120/5, 125/5, 250/5, 325mg, 500mg/tab SALBUTAMOL
• 150mg/ml amp • 0.15 mkd TID
• 2.5 mg/tab, 15mg/ml syrup
POTASSIUM CHLORIDE
• 1-2 mkD OD/BID
• 750mg/tab = 10 meqs STATUS ASTHMATICUS
• TERBUTALINE: 0.01 mkdSQ
PROCATEROL • EPINEPHRINE: 1: 10,000 prep give 0.01 mk SQ
• 0.25 ml/kg BID
• 5 mcg/ml, 25 mcg/ml, 50mcg/tab TERBUTALINE DRIP
• 0.1-0.4 mcg/kg/hr
PHENOBARBITAL
• LD = 10-40 mkd; MD = 5-8 mkd q12 • 6 x doses x wt /RR = mg terbutaline in 100c D5W @ ____cc/hr
• 130mg/ml amp; 15mg, 30mg,60mg tab • Running Rate (RR) = 2 cc/hr
• RR x 24H = _____ml of terbu/day
PHENYTOIN
• LD: 20-40 mkd; MD: 5mkd q12 VANCOMYCIN
• 10mg/2ml amp; 30mg, 100mg, 30mg/5ml, 15 mg/5ml syrup • 10-15 mkd via SIP x 1 hr
• 40-60 mkd q6-12 via SIP x 1hr q 10-20 ml
PREDNISONE • 500 mg tab
• 1-2 mkD BID
• 1-2 mkd BID-TID or 40-60 mg/day in cardiac patients
• 10mg/5ml, 20mg/5ml syr
• 2.5,5,10,20,30 mg tab

ROXITHROMYCIN
• 5-8 mkd q12 PO
• 50, 100, 150, 300 mg/tab

RANITIDINE
• 1-2 mkd
• 50mg/2ml amp
• 75, 150, 300 mg/tab
PPN (cvmc)
Patient’s weight x 3kg BLOOD TRANSFUSION
TFR = 150 x 3 = 450 cc/24 hours • PRBC 10 cc/kg
• FWB 20 cc/kg
1. D50-50 (50mg/100ml) • Plasma 15-20 cc/kg
10-15 g/day • PC 1 “u” /10 kg
Wt x 10 • Dextran 10 cc/kg
3 x 10 = 30
30 x 100 ÷ 50 = 60 ml in 24 hours Desired Amount of BT
• Ideal HCT – present hct x wt
2. AMINOGEN (chons) • Rate of transfusion should not exceed 5 cc/kg/hr
(7g/100ml)
Wt x 1 (constant) DVET
3x1=3 • Blood vol (80) x 2x weight
3 x 100 ÷ 7 = 42ml in 24 hours
PHLEBOTOMY
3. CALCIUM GLUCONATE Criteria
(100/2ml) • Plethora
1cckg/8 hours • Headache sec to Ischemia
3 x 3 = 9cc in 24 hours • Hct >65%

Use
• PNSS, Fresh Plasma, FFP
1. PNSS Vol of blood to Remove & plasma vol to give
(154meq/1000) • Actual Hct – Desired HCT / actual Hct x blood vol x wt
Wt x 2 (constant)
3x2=6 PNEUMONIA
6 x 1000 ÷ 154 = 38cc in 24 hours
1. PNEUMONIA – Cough, Tachypnea, rales
5. MgSO4 • DOC: Amoxicillin, Co-Trimoxazole
(1 meq/ml) • Alternative: Co-Amoxiclav, Clarithromycin, Roxithromycin
0.125 mkD 2. PNEUMONIA SEVERE – Pneumonia with chest indrawing
• Admit
6. VITAMIN C • DOC: PenG ; 3months Ampi/Genta
1cc • Nebulize with PNSS + Salbutamol/Terbutamol
• If not responding give cefuroxime, ceftriaxone, azithromycin
7. Kcl (2 meq/ml) 3. PNEUMONIA VERY SEVERE - Pneumonia Severe + Cyanosis,
2 meq x wt failure to feed, seizure, malnutrition
2 x 3 = 6 meq • DOC: Chloramphenicol
6 x 1 ÷ 2 = 3 ml • <3months: Ampi/Genta
ABG’S • If without improvement, admit and give hydrocortisone, neb, O2,
inhalation and antibiotics if needed.
pH PCO2 HCO3 • Home meds: Bronchodilator (PO/Inhalation) with or without steroid
Metabolic Uncompensated ↓ N ↓ inhalation (Flixotide/Budecort)/oral prednisone
Acidosis

Compensated N ↓ ↓

Respiratory Uncompensated ↓ ↑ N
Acidosis

Compensated N ↑ ↑

Respiratory Uncompensated ↑ ↓ N
Alkalosis

Compensated N ↓ ↓
• When to correct Metabolic Acidosis
o HCO# <15
o BC excess >10
• Wt + BE x -.3 (0.6 in newborn) / 2
o Give ½ of the computed correction now then repeat ABG
o Give the ½ if repeat ABG still with metabolic acidosis

ET TTUBES
• ET Size = Age (years) +4 / 4
• ET level – ET size x 3
• Insertion Distance + Wt + 6

Tube size Wt (g) AOG (wks)

2.5 <1000 <28

3.0 1000-2000 28-34

3.5 2000-3000 34-38

3.5-4.0 >3000 >38

BRONCHIAL ASTHMA
• Nebulize with salbutamol/terbutaline; 1 nebule q15 minutes x 3 doses
• If improved, MGH with bronchodilator oral/inhalation
• If the cause of exacerbation is infection like cough/pneumonia, give
antibiotics
• May give prednisone x 3 days
POST LUMBAR PUNCTURE VACCINES
• Maintain patient flat on bed for 4 hours
BCG Birth & 6 years Right Deltoid / ID 0.25 ml
• NPO temporarily x4 old till 28
• Pressure pack at puncture site days
• WOF any untoward s/s
• Send Specimen for CSF analysis DPT 1 6 weeks
o Tube 1 – Cell count, diff count, SG, LDH 2 10 weeks Right anterolateral thigh /
o Tube 2 – CHON, Gluc, 3 14 weeks Deep IM 0.5 ml
o Tube 3 – AFB, GS, CS, India Ink 4 18 weeks
5 4-5 years old

Contraindications of LP: OPV 1 6 weeks

❑ Evidenced of increased ICP 2 10 weeks Per orem
❑ Severe cardio-pulmonary compromised 3 14 weeks 2 drops
❑ Infection at site of injection – absolute contraindication 4 18 weeks
❑ Thrombocytopenia (50,000) 5 4-5 years old

Hepa B 1 At birth Right anterolateral thigh /

deep IM 0.5 ml
IV FLUIDS & ELECTROLYTE CONTENTS 2 6 weeks Left anterolateral thigh /
IV FLUID Na K Glucose Cl deep IM
3 14 weeks Right anterolateral thigh /
D5NR 140 5 50 deep IM

D5LRS 130 4 50 HIB 1 8 weeks

2 16 weeks Anterolateral thigh / IM 0.5 ml
D50.9NaCl 154 0 50 3 24 weeks

D50.3NaCl 50 0 50 Measles 6-9 months Anterolateral Thigh / 0.5 ml

Subcutaneous
D5IMB 25 20 50
MMR 6 months after last Deltoid / Anterolateral
D5NM 40 13 50 dose of measles Thigh / Subcutaneous
(15 weeks) 0.5 ml
PLRS 130 4
Varicella 1 year old and Deltoid / anterolateral thigh/
PNSS 154 0 154 above (1 dose) subcutaneous 0.5 ml

Hepa A 1 2 years old Deltoid / IM 0.5 ml

2 5 months after 1st
dose

Thyphoid 2 years old then Deltoid / IM 0.5 ml

every 3 years

Flu Vaccine 1 6 months older

2 1 month after 1st Anterolateral thigh / IM 0.5 ml
dose then 1 year
after
Pneumococcal 1st dose – 2 years Deltoid / IM 0.5 ml Vitamin A
old then every 3 < 6 months: 50,000 unit per orem
years > 6 months: 100,000 units per orem

Meningococcal 1st dose – 2 years Deltoid / Subcutaneous PENTAVALENT

old & older then 0.5 ml Penta 1 + OPV 1: after 6 weeks of life (1 month & 2 weeks)
every 3 years
Penta 2 + OPV 2: after 10 weeks of life (2 months & 2 weeks)
Penta 3 + OPV 3: after 14 weeks of life (3 months & 2 weeks)

IMMUNIZATION SCHEULE
• Hepa B1 & BCG – at birth or any time after birth
• DPT1 OPV1, HepaB2 – 6 weeks after birth (1month & 2 weeks)
• DPT2, OPV2 – 10 weeks after birth (2months & 2 weeks) or 4 weeks
after the 1st dose
• DPT3, OPV3, Hepa B3 – 14 weeks after birth (3months & 2 weeks) or 4
weeks after the 2nd dose
• Measles – 6-9 months
• Measles booster – 15 months (1 year and 3 months)
• DPT4,OPV4 – 18 months (1 year and 6 months)
• DPT5, OPV5 – 4-5 years old
• BCG Booster – before school entrance

BOOSTERS:
BCG 6 years old Left Deltoid / ID 0.1 ml

DPT 1 year after last Anterolateral thigh, deltoid / 0.5 ml

dose of DPT IM

OPV 1 year after last Per orem 2 drops

dose of OPV

Measles 6 weeks after Anterolateral thigh or deltoid 0.5 ml

last dose of / subcutaneous
measles

WATERLOW CLASSIFICATION
WEIGHT-FOR-HEIGHT MEASUREMENTS:
➢ Accurately assesses body build ; useful in identifying a
child who is acutely malnourished
Waterlow Classification for Wasting:
actual weight_______ x 100= ____%
Ideal weight for actual length/ht
 Waterlow Classification for Wasting
> 90% - normal
80-90% - mild
70-80% - moderate
<70% - severe

Waterlow Classification for Stunting:

Computation:
____actual ht/length_ X 100 = _____%
ideal ht for age
Classification:
> 95 % - normal
90-95% - mild
80-90% - moderate
<80% - severe

MNEMONICS : WEIGHT
➢ Formula for Average Approximate Weight:
AGE Formula
<6 mos age(mos) x 600 + BW
6-12 mos age(mos) x 500 + BW
1-6 yrs age(yrs) x 2 + 8
12.yrs age(yrs) x 7 – 5
2

➢ Usual changes in weight at different ages:


4-5 months ------------- 2 x BW
1 yr --------------------- 3 x BW
2 yrs -------------------- 4 x BW
3 yrs -------------------- 5 x BW
5 yrs -------------------- 6 x BW
7 yrs -------------------- 7 x BW
10 yrs ------------------- 10 x BW
MNEMONICS : HEIGHT Z – SCORE
➢ Height (cm) = age (yrs) x 5 + 80
➢ Height (in) = age (yrs) x 2 + 32
➢ Ave BL = 50 cm or 20 inches
➢ Total Ave Gain During 1st Year = 25 cm
birth-3 mos – 9 cm
3-6 months – 8 cm
6-9 months – 5 cm
9-12 months – 3 cm

At 1 yr ---------- -------- 30 inches or 1 ½ x BL

2 yrs -------------------- ½ mature height
3 yrs -------------- ----- 3 feet
4 yrs -------------------- 40 inches or 2 x BL
13 yrs ------------------- 3 x BL

HEAD CIRCUMFERENCE:
➢ Has to be ff up w/ regularity during 1st 3 yrs of life.
➢ Reflects status of brain growth & might be the 1st
indication of disturbances of the skull & its contents.
➢ HC :CC
at birth – HC > CC
6 mos – HC = CC
1 yr – HC < CC
➢ RATE OF GROWTH
1 yr of life ---------------------
st 10 cm
1-4 mos – ½ in/mo – 2 in (5cm)
5-12 mos – ¼ in/mo – 2 in (5cm)
2nd yr ----------------------------- 1 in
3 -5 yr -------------------------
rd th ½ in/yr
6th-20th yr ----------------------- ½ in/5 yrs
JONES CRITERIA for RHEUMATIC FEVER
IDA Alpha and Beta Anemia of chronic
Major criteria Thalassemia disease
• J – Joint involvement which is usually migratory and inflammatory
joint involvement that starts in the lower joints and ascends to upper Haemoglobin Decreased Decreased Decreased
joints
• O – (“O” Looks like heart shape) – indicating that patients can MCV Decreased Decreased Normal –
Decreased
develop myocarditis or inflammation of the heart
• N – Nodules that are subcutaneous
RDW Increased Normal Normal –
• E – Erythema marginatum which is a rash of ring-like lesions that
Decreased
can start in the trunk or arms. When joined with other rings, it can
create a snake-like appearance RBC Decreased Normal – Increased Normal – Increased
• S – Sydenham chorea is a late feature which is characterized by
jerky, uncontrollable, and purposeless movements resembling Serum Ferritin Decreased Normal Increased
twitches Total Ferrous Increased Normal Decreased
Binding Capacity
Minor criteria
• C – CRP Increased Transferrin Decreased Normal Decreased
• A – Arthralgia saturation
• F – Fever
Free Erythrocyte Increased Normal Increased
• E – Elevated ESR
Photoporphyrin
• P – Prolonged PR Interval
• A – Anamesis Transferrin right Increased Normal Increased
• L – Leukocytosis
Reticulocyte Decreased Normal Normal - Decreased
haemoglobin
concentration

HYPOCHROMIC – MICROCYTIC
(MCV low – red cells size < 70 fl) MACROCYTIC
❑ IDA (MCU high: red cell size > 85 fl)
❑ Alpha and Beta Thalassemia ❑ Normal newborn
❑ Sideroblastic Anemia ❑ Increased erythropoiesis
❑ Chronic disease: ❑ Post splenectomy
o Cancer ❑ Liver disease
o Infection ❑ Obstructive jaundice
o Inflammation ❑ Aplastic anemia
o Renal disease
❑ Lead toxicity
❑ Hgb E trait
❑ Atransferrinemia
❑ Inborn errors of Fe meta
❑ Copper deficiency
❑ Severe malnutrition
SEVERITY OF DEHYDRATION

Signs and Mild Moderate Severe

symptoms Dehydration Dehydration Dehydration

BW loss % 3-5 6-9 ≥10

Infant& younger Thirsty, alert; Thirsty, restless/ Drowsy, limp,

child restless lethargy; irritable cold, sweaty,
to touch/ drowsy cyanotic, may be
comatose

Older child/ Thirsty; alert, Thirsty, alert, Usually

adult restless postural conscious,
hypotension apprehensive,
cold sweaty,
cyanotic
extremities,
wrinkled skin of
fingers and toes

Radial pulse Normal Rapid & weak Rapid, feeble/

impalpable

Respiration Normal Deep/ rapid Deep and rapid

Anterior Normal Sunken Very sunken

fontanel

Systolic BP Normal Normal/ Decreased/ not

decreased, recordable
orthostatic
hypotension

Skin elasticity Retracts Slowly Very slowly

immediately

Eyes Normal Sunken Grossly sunken

Mucus Moist Dry Very dry

membrane

Urine output Normal Decreased; dark Anuria; severe

oliguria

CRT Normal +/- 2 seconds ➢ 3 seconds

Diarrhea – passing of liquid or watery stools at least 3x in 24 hours period TRIAD of NEPHROTIC SYNDROME:
❑ Acute – hours/ days ❑ Proteinuria
❑ Persistent – lasting for ≥ 2 weeks ❑ Hypoalbuminemia
❑ Hyperlipidemia

TRIAD OF AGN
❑ Hypertension
❑ Edema
❑ Hematuria

TRIAD OF HENOCH-SCHOLEIN PURPURA

❑ Erythematous purpuric rash
❑ Arthritis
❑ Renal disorder

APPROXIMATION IN BILIRUBIN
AREAS OF THE BODY RANGE OF BILIRUBIN
(mg/100ml)

Face 4-8

Upper trunk 5-12

Lower trunk & Thighs 8-16

Arms and Lower legs 11-18

Palms and Soles >15

GLASCOW COMA SCALE OF INFANTS 


 HOW TO INTERPRET AN X-RAY


A – AIRWAY
❑ Obstruction
❑ Good inspiratory effort
o Paloob (anterior) curve – 6-8 ICS
o Harap (posterior) _ 8-10 ICS
❑ Trachea is in the midline

B – BONE FRACTURE
❑ Clavicle

C – CARDIOTHORACIC RATIO
❑ Widest diameter of thorax (T)
❑ Widest cardiac diameter (C)
CT ratio =C/ T
Normal pedia = 0.6
Normal adult = 0.5

D – DIAPHRAGM
❑ Flat (emphysema) or Raised (area of airspace/ consolidation),
Pneumonia
❑ RIGHT DIAPHRAGM – higher due to presence of liver
❑ COSTOPHRENIC ANGLE – sharp
– blunting
o 300 – 500 cc to blunt

E – EFFUSION

F - INFILTRATES
❑ Vascular markings
❑ Symmetry
❑ Presence of any mass
❑ Nodules
❑ Fluids
❑ Solid – consolidation (pneumonia)

G – GASTRIC BUBBLE
❑ Air is black

H – HILUM
❑ Hilar infiltrates
❑ lymphadenopathy
ELECTORLYTE CORRECTION S – sensory
P – pathologic signs
SODIUM (Na+)
Deficiency = ideal – actual x weight x 0.6
m = weight x 3

Deficiency + m = needed

POTASSIUM (K+)
Deficiency = ideal – actual x weight x 0.4
m = weight x 2

NEURO EXAM
Neonates Child Consciousness

MSE Activity, cry Alert, active LOC

I N/A Can identify N/A

II ERTL ERTL

III, IV, VI Doll’s eye EOMS

V Grimace (+) corneal reflex

VII Facial asymmetry Facial asymmetry Facial

asymmetry

VIII Startles to sound Turns to sounds, N/A

responds to name

IX, X Can swallow Can swallow

XI N/A Move head, shrug N/A

shoulder

XII N/A Tongue in the N/A

midline

NEUROLOGIC EXAM (sequence)

MSE
C – cerebellum
M – motor
C – cranila nerves
D – deep tendon reflexes
ABC’s in BABYGRAM MICROORGANISMS RESPONSIBLE FOR INFECTION

A – ABDOMEN 0-2 MONTHS

❑ Bowel gas pattern ❑ E. coli
❑ Presence of obstruction ❑ Listeria monocytogen
❑ Shape: polyhedral ❑ GAHBS
o (hindi dapat masyado makapal) o 9+ AMPICILLIN
❑ Look if air reached rectal vault (18 hours of life) o <9 GENTAMYCIN

B – BONES 2-5 MONTHS

❑ Clavicles (fracture) ❑ S. pneumoniae
❑ Spine (midline) ❑ H. influenza
❑ Ribs ❑ N. meningitides
❑ Density o Pen G
o Chloramphenicol
C – CHEST
❑ Heart TWIN GESTATION
o If in place Look for
o Size Weight both babies
o Silhouette (appreciated) Hct & Hgb find out if there is twin transfusion
o LOCATION Placentation
❑ Lungs
o Infiltrations
o Vascularities ABSOLUTE RETICULOCYTE COUNT
Normal > 2
D – DEVICES ARC = pts HCT ÷ normal HCT x reticulocyte count
❑ Level of ET – should be above carina
❑ OGT RETICULOCYTE INDEX
❑ Umbilical arterocath – tip: 9th thoracic vertebra RI = absolute reticulocyte count ÷ 2
❑ Umbilical vein cath – midway between right atrium anf inferior vena
cava
TEENAGERS PERSONAL AND SOCIAL HISTORY
DHF III
H - home
E - environment Fast drip – maximum 60cc/kg
A - activity 20 cc/kg x wt
D - diet
D - drugs Panget BP
D - depression
S - school 20 cc/kg x wt
S - suicide
S - sexual Panget BP

SYSTEMATIC ASSESSMENT OF PROBLEMS Another 20 cc/kg

F – fluids
R – respiration
I – infection Dopamin (max 20)
C – cardiac 10 cc/kg
H – hematologic
M – metabolic
O – 0ncology Voluven (colloid) 20 cc/kg
N – neurologic (hydroxyethyl starch)
D – developmental 10 cc
Max 50
BREASTFEEDING
B – best for babies 10 cc
R – readily available
E – easily digested
A – allergies/ antibodies Dopamine increased 15 cc/kg
S – safe
T – temperature controlled Panget bp
F – flora (maternal)
E – economical Dobutamine – Dopamine
E – emotional bonding 12 cc/kg 10 cc/kg
D – developmental Max 30 max 30

Panget BP

FFP – 15 cc/kg
RISK CLASSIFICATION FOR PNEUMONIA
DOCTOR’s ORDER Mother’s Bed Side (MBS)

Post- NICU Date Time >To MBS

HC >BF with SAP
Date Time >Please admit to Post NICU under the service of Dr. CC >Diagnostics:
HC >Secure consent for admission and management AC NBS after 24 hours of life
CC >(NPO temporarily) BF c SAP BL Hearing screening advice
AC >Diagnostics: Wt >Therapeutics:
BL CBC c APC BT Vitamin K 1 mg / IM
Wt Blood CS NBS after 24 hours ( ) PNCU Crede’s prophylaxis
Hearing screening of life ( ) MVS Hepa B & BCG
Advice ( ) MI >EINC
( ) Good cry >Therapeutics: >Routine newborn care and cord care
( ) Alar flaring Insert heplock ( ) good (suck) cry >Baby bath after 6 hours of life
( ) Retractions (100) Ampicillin /IV q 12hrs URTI ( ) alar flaring >Keep baby dry, warm and thermoregulated
(5) Gentamycin /IV OD ( ) retractions >VS q 2 hours then record
( ) PNCU (100) Ceftazidime UTI >Watch out for any untoward signs and symptoms
( ) MVS (15) Amikacin A> >Refer
( ) MI Vitamin K 1 mg/ IM
Crede’s prophylaxis
Hepa B & BCG *LGA/SGA – Hgt monitoring q 6 hours refer if ≤60 m/dL
A. Potential Sepsis >EINC * NPO/ BF – assess if the patient is tachypneic
2o to maternal >Routine newborn care and cord care - NPO temporarily for 4 hours then for RA
( ) URTI >Keep baby dry, warm, and thermoregulated
( ) UTI >Baby bath after 6 hours of life
( ) PROM >VS q 2 hours then record
≥ 18 hours >Watch out for any untoward signs and symptoms
>Refer
Imperforate Anus AGE with some signs of DHN

➢ Please admit to ➢ Please admit to ……

➢ Secure consent for admission and management ➢ Secure consent for admission and management
➢ TPR q Shift and record ➢ BRAT diet / DAT
➢ NPO ➢ Dx:
➢ Dx: - CBC cAPC
- CBC c PAC - BT - UA c SG
- UA c SG - Blood CS - FA
- SE - TB B1 B2 (if with jaundice) - SE
- Baby gram c cross table ➢ Tx:
Lateral - D50.3 NaCl (mild)
➢ Tx: - (100) Ampicillin (for shigella or with UTI)
- IVF: - (10) Paracetamol IV q 4 hours for fever ≥ 38.8 oC
- (100) Ampicillicin q 12 hours or q 6 hours ▪ Oral 37.8 – 38.7 oC
- (5) Gentamycin OD - (15) Metronidazole q 8 hours (if with amoebiasis)
- (15/7.5) Metronidazole now then OD - (1) Ranitidine (if with abdominal pain) q 8 hours
- (1) Ranitidine q 8 hours - (0.1) Metoclopramide (for vomiting) q 8 hours
➢ Monitor VS q 1 & record - Probiotics Lactobacillus clausii BID
➢ Monitor I & O q shift and record - Zinc syrup: >2 y/o: 5ml
➢ Insert OGT & connect to BSB (if with abdominal distention) <2 y/o: 2.5 ml
➢ Insert IFC & connect to BSB ➢ Volume/volume replacement
➢ Refer ➢ Monitor I&O q Shift and record
➢ Monitor VS q 2 hours & record
*CFC = no need to load Phenobarbital ➢ TSB for fever
➢ Refer
 BFC secondary to URTI Pneumonia Severe

➢ Please admit to …… ➢ Please admit to ……

➢ Secure consent for admission and management ➢ Secure consent for admission and management
➢ NPO temporarily ➢ TPR q shift and record
➢ Dx: ➢ NPO temporarily for 4 hours
- CBC c APC ➢ Dx:
- Blood C/S - CBC c APC
- SE - UA c SG
- CXR AP/L - CXR AP/L
- UA c SG ➢ Tx:
- Hgt - IVF: D50.3 NaCl or D5LRS
➢ Tx: - (200) Penicillin G q 6hours
- IVF: D50.3 NaCl or D5LRS - (10) Paracetamol IV q 4 hours
- (100) Chloramphenicaol q 6hours - Salbutamol neb now then q 20 mins x 3 doses the for
- (10) Paracetamol IV q 4 hours RA
- (0.2) Diazepam PRN q 6hours - Ipratropium +salbutamol ned q 4 hours or q 6 hours
- (200) Ampicillin if BFC secondary to ATP ➢ Hook to O2 inhalation @ 1-2 Lpm
➢ O2 inhalation ➢ Moderate high back rest
➢ Secure precaution at bedside ➢ V/S q 1 and record
➢ TSB for fever ➢ I & O q shift and record
➢ Monitor VS q 2 hours & record ➢ Watch out for any untoward signs and symptoms
➢ I & O q shift and record ➢ Refer
➢ WOF any untoward signs and symptoms
➢ Refer