DAMS DVT - DEC - 2023 (Final)

Sunday, December 17, 2023 4:19 PM

Neonatal Resuscitation
0 Ap n e a Labored breathing
OY
DAMS DVT -
DEC - 2023… Gasping Or persistent cyanosis
07

€ HR below 100/min

+
SpO2 monitor SpO2 monitor

Positive pressure ventilation Consider CPAP

(B9 t mask
Kn-hlahon)
2. Monitoring is done by Heart rate
 HR <60/min

3 :1 : PPV every 2 46
Chest compression
seconds

100% oxygen is given

Are given using 2

thumbs from the head of the bed-(,

Thumbs are placed over the lower third of sternum with

hands encircling the chest

Approximately one third of the anteroposterior diameter of

the chest is compressed

FL

E pinephote
2 Dose

Intravenous or intraosseous = 0.02 mg/kg (equal to 0.2 ml/kg)

 Position of the endotracheal tube

The tip of the ET tube should be 1 cm above the carina.

If the carina cannot be visualized then position of T2-T3 is
adequate.

Administration
Intravenous or Intraosseous
Flush with 3 ml normal saline followed y
Repeat every 3 to 5 minutes if heart rate remains less than 60 bpm

Endotracheal: Administer PPV breaths to distribute into lungs.

No flush
 A. Intravenous
B. Intratracheal

„ C. Intraarterial
D. Intraosseous v

aghk upper
Sp02 monitoring is done from limb
1 min - 60 - 65%
O
Peduckal Spo
2 min - 65 - 70%
So 3 min - 70 - 75%
Ço 4 min - 75- 80%
So 5 min - 80 - 85%
10 min - 85 -95%

20
If there is no heart rate at birth minimum duration of resuscitation
minutes
 Preterm child Term
Periventricular leucomalacia

(PVL)
Spastic diplegic type of Status Marmoratus Parasagittal
cerebral palsy (Most Common) Cerebral Injury

( bgrdadia)
Choreoathetoid Spastic

dustuncke type of cerebral quadriplegic type

palsy of cerebral palsy

Extra pyamidal,

Cause of Neonatal seizure within first 24 hours of life

Hypoxic ischemic encephalopathy Mic cauet

Hypoglycemia / Hypocalcemia
Mic calm IDM
•

Sepsis / Meningitis

Subdural / Subarachnoid / Intraventricular haemorrhage

Intrauterine infection
Pyridoxine deficiency
Drug effect / withdrawl
mIc cauR- podeum
Selectire seotonin
xeubtala unhibitas
duint betnancy
 Airbronchogram HMD)

MIc caum $ Sulpditsen - teum child

Transient tachypnea of newborn - Fluid in the intralabor fissure,

Prominent perihilar vascular markings

SunRoyabporane
¿Mickindus
Meconium aspiration syndrome Patchy infiltrates, Increased

anteroposterior diameter, Flattening of the diaphragm

Diagnosis

Hyaline membrane disease Chest X-ray

In atypical case tracheal aspirate. For lecithin: sphingomyelin ratio and
phosphatidyl-glycerol confirms the diagnosis

Persistent pulmonary hypertension of the newborn - Real time

echocardiography

Congenital diaphragmatic hernia

O Prenatal - Ultrasonography

0 After delivery - Chest X-ray

Necrotizing enterocolitis plain abdominal X-ray USG

Hypoxic ischemic encephalopathy - MRI
Intraventricular hemorrhage - Cranial ultrasonography
 Neonatal seizure

Conventional EEG - gold standard for neonatal seizure detection

Amplitude intergrated EEG - Screening tool

AEEG
Retinopathy of prematurity Indirect ophthalmoscopy
CROP) Wide field digital camera
C Ret Cam)

Radiographic study to detect specific neurologic finding

1) Intraventricular haemorrhage: Crarial USG

2) Hypoxic ischemic encephalopathy:
MRI
3) Subdural haemorrhage:_
CT Scan
4) Cerebellar haemorrhage:
CT Scan
IA Occult blood in stool Nor mal or mild ileus
Bradycardia
Apnea
- Temperature instability
IB Same as above P l u s g ro s s b l o o d i n s t o o l Same as above

IIA Same as above Absent bowel sounds Pneumatosis intestinalis

IIB Plus Definite abdominal Portal vein gas with or

Metabolic tenderness without ascites
Acidosis
T h ro m b o c y t o p e n i a
Right lowu quadrant
ab donin al man
IlIA Plus Peritonitis Definite ascites
• Acidosis

Neutropenia
DIC
IIIB Same as above Same as above Pneumoperitoneum

Neonatal jaundice (according to the time of presentation)

Presenting within 24 Presenting between 24 Prolonged jaundice (3 2

hours of birth hours and 2 weeks weeks)

abways palhrlotral, Pailum

Rh incompatibility Breast feeding jaundice Biliary atresia 1 CB
MIc caun -Inia A

ABO incompatibility Physiological jaundice Hypothyroidism

G6PD deficiency Polycythemia Neonatal hepatitis

Hereditary Resolving Breast jaundice

Spherocytosis cephalohematoma milk
post natal life of life

2. Due to insufficient intake causing 2. Due to B-glucuronidase that causes

increased enterohepatic circulation increased enterohepatic circulation

times hypernatremia F
3. Associated with weightloss and some Good weight gain

Neonatal cholestasis
(Conjugated bilirubin > 1mg/dl regardless of total serum bilirubin)

Pigmented stool Pale stools

Ultrasound Urgency to rule

GGT out biliary atresia
gaumé glutanyl banspprdey
Low/Nor mal GGT High GGT U l t r a s o u n d + H I DA s c a r

L i ve r b i o p sy coMharmation
Progressive familial PFIC3
intrahepatic Biliaryatresia Liver biopsy
o n b i o p sy equivocal
cholestasis PFIC 1,2
with
PFICL,2 kasai
nonexcreto;
HIDA

swy eu Peroperative
cholangiogram
Gold,
Standad
Spherical shaped RBCs Spherical shaped RBCs
Direct Coomb's test negative Direc t Coomb's test positive A camthouyles
MCHC/MCV elevated MCHC/MCV normal
P yruvate kinase deficiency

-
€
Hereditary spherocytosis Hemolytic disease of the

new bonl Suythsoblatous

tetalrs
elnurc onp ahbwila
ABO

Kangaroo Mother Care Components:

1. KMC pasition M'avi toseup

contact
CC Hallmaukys
2.
Peedug -excluai bxat fredzj
3.
Eauly diochayeb
Palow up
 should be 21-30% leumchild- room aui)
Continuous murmur in left infraclavicular area or upper left

sternal border + no cyanosis + wide pulse pressure Patent

ductus arteriosus
nenobtnctive
hemorrhage - hydrocephalus
& Complication of intraventricular
Cranial ultrasonography for intraventricular hemorrhage is

routinely recommended in preterm child - < 32 weeks of gestation

IVA-sbortaneous h'oge

Preterm Child

Antenatal steroids given decrease the incidence of following in

S
preterm child Hyaline membrane disease, Necrotizing

enterocolitis, intraventricular hemorrhage

S Physiological jaundice can persist upto - 3 weeks in preterm child

( teum- 2 neks
Hyaline membrane disease usually manifests within 6 hours of
S°
birth (maximum 24 hours)

Apnea of prematurity manifests between 2-7 days after birth

8
Prematurity Gestation < 37 week Premature closure of ductus due to
• Mast impotant leum maternal NSAID exposure

For mula feeding Rupture of Lung hypoplasia

membranes > 18
-Oligohydraminos
h o u rs
-Congenital diaphragmatic hernia
Patent duc tus Low birth weight Parenchymal lung disease
arteriosus
-Meconiumaspiration syndrome
Late Neonatal
Aebtio -Respiratory distress syndrome

Hand Cantanviahas -Pneumonia

Indomethacin

Hemorrhagic disease of the Newborn

(Vitamin K deficiency bleeding)

L
Early onset 0 24 hours Classic disease 2 - 7 Late onset

days 1 - 6 months Pal

malalsipior
Mother has been Delivered at home •Cholestasis

treated with enzyme and on exclusive •Malabsorption of

inducer drug during breast feeds vitamin K -Cystic

pregnancy
Mic vit de fibrosis
in bacant nilt
er. Pherytorn Vit K • Abetalipoproteinemia

Prfambain
 Macrosomia / large tor gestational age
Hypoglycemia
OntoyoniA to conAsol
Surfactant deficiency
Caudal regression syndrome
Most speufc dekot
CVS
Most- spcahre
-Transposition of great arteries CHD
-Ventricular septal defect MIG CHD
Small left colon syndrome

Polycythemia CEPO HIO detay ct punore

Renal vein thrombosis
4 Wrcou um
Cardiomegaly - MicHindus
146
[Hypertrophic cardiomyopathy
- Reveleible

Reflexes

Present at Birth Not Present at Birth

Doll's eye reflex Symmetrical tonic neck reflex

uipfo 2ntto dage Crawli xeflex
* Placing and stepping reflex Y Parachute reflex
dioabbeaus appcass- a mmnlh 4 Nc
Babinski sign Nñ 6-8 Landau reflex
4 +K at weks . abytase
brth 3-u moniho e ale
ubto 2 gearo

Hydrops - Defined by ≥2 abnormal fetal fluid collection such as ascites,

pleural, pericardial or cutaneous edema (> 5 mm)
 Hematologic a thalassemia, G6PD deficiency, Red cell enzyme
U)
deficiencies

Uu) Infections - Parvovirus B19, Cytomegalovirus, Toxoplasma

v Chromosomal - Trisomy 21,18,13, 45XO

Thoracic - Congenital cystic adenomatoid malformation of lung,

pulmonary sequestration

Out of the following hydrops fetalis is least

likely to be present in:
1. a - thalassemia
HbF- dL12
ß-thalassemia
3. ABO incompatibility
4. Rhesus iso immunization

Dysmorphology
1. Single error in morphogenesis that results in a series of subsequent
defects - Sequence
 deformity, puumenary
3. Appearance of multiple malformations in unrelated tissues
that have a known unifying cause • syndrome
E.g. Trisomy 21

Moderate Acute Severe Acute

malnutrition malnutrition
MAM SAM

Weight for height 2ScOx Zscox

-2t0-3 4-3
Mid upper arm 11•5-12•S0m < 11- SOM
circumference

Pedal Edema
alsent paoent
Nonrellable Rellable

Skin turgor Urine output (Most)

Mental state Weak or absent radial pulse

Mouth & tongue Prolonged capillary filling time

CFT
Recent sunken eyes

Increased thirst

History of diarrhea

Fluid therapy in Severe dehydration

Normal child Severe acute malnutrition

Ringer Lactate Or
Sldextex +RL
Initial fluid of choice
Normal Saline On% NS+ Si.dHe

<lyr- 1hr 2hrs

Duration of initial 30
>1yr - 30mins
ml fluid
 Immediate 1 LakhiU 2lakhTU

Next day 2 1 LakhIU 2 lathIV

Af t e r 2 we e ks 14 1 lathIV 2 lakhIV

SAM/repeat monthly till LlaknIU 2lakh TV

S A M re s o l ve s )

Non Nutritional Rickets - No response to cholecalciferol

Vit D Rieitanti Re-racory
Increased PTH
Normal Serum phosphorus Decreased Serum phosphorus

Normal PTH Normal PTH

CRF Distal RTA

Proximal Renal tubular acidosis

( Fa n c o n i sy n d ro m e )
VDDRLA,
1 B,2A,
28
Increased amount of fibroblast

PTH lexl
excludlo
ne g row t h fa c to r 2 3

vitD xWited Hypobhobhakinc

yiclaks
duarnd gdrauneg Mc Cune Albnght syndiore

Marasmus Kw a s h i o k o r

Tr i c e p s s k i n fo l d <5th >50th

Subcutameque, tat
Fa c e
hmontryl
Simian Moon VK un
colncal bundar
Oldmantacu plolein

Shiny and edematous Flaky paint

Skin Loose and wrinkled dermatitis

• duue ta loss
* si Lot bathomomeric

Intrauterine Infection

Congenital Congenital Rubella Parvo Virus B19

(
Toxoplasmosis Syndrome infection

Hydrocephalus 0 Congenital anemia

U SNHL (Most Common)

Chorioretinitis Cataract Myocarditis

Intracranial
P DA > P S Hydrops fetalis
|Calcification
 (Cytomegalovirus Congenital Zika syndrome
•Periventricular calcification •Intracranial calcification

•SNHL V •Ocular findings - mainly

•Microphthalmia affecting posterior segment

ò> •Congenital contractures

Herpes Simplex Virus Varicella Zoster Virus

•Mainly intrapartum transmission

Congenital Varicella Neonatal Varicella
•Can present as
•Visceral Braun
la
•Limb hypoplasia
-Skin, eye or mucous membrane
SEM •Cicatrical skin rash dissemination lurp
•Encephalitis
Any lobx •Recurrent skin
present in
•Disseminated infection brawn
dermatomal vesicles

distribution Lomorthosc
iblosis
 Mother develops Hospitalized premature Hospitalized preterm

chickenpox within 5 infant ≥ 28 weeks infants <28 weeks

days before delivery or gestational age whose regardless of the

within 48 hours after mother has no history maternal history of

delivery of chickenpox or varicella orserologic

serologic evidence of status

prior infection

Health supervision guidelines for children with Turner syndrome

System and disease Monitoring
Growth At every visit from birth
Skeletal Start screening yearly at 5 years of age
Scoliosis / Kyphosis Every visit from birth to 12 months
Hip dysplasia

Sensori neural hearing loss Hearing test at birth & every 2 - 5 years
mE
Celiac disease and inflammatory Every 2 - 5 years after 3 years of age
Bowel disease At bith
5) /Cardiovascular defects At diagnosis echocardiography
Renal defects At diagnosis
oR Hypothyroidism (Hashimoto's Start screening from 4 years
thyroiditis)
Ovary - ovarian failure Start evaluation from 10 years of age

Kumdeleds syndion - (ed SLE

 Simian
Over labbis CRoa poly dadyly lympheduma
4 dupts Turner's
Thisomy 13
-TMSOT Y 24 Syaduent
Tnsony 18 / -Coiduchat
Edwaids
syndione
Pundione

T
rSandal Shot yl Metotael) Rockeu bottom Poot
ytn Motacaubal
Edwadls
gap
Tnsony
Tuneis syrdione
21 syrdliene
 Murmur Present

willians
s yrdilce
Aloulle syrcleme Micadonhal Andonhia,
JAG1 gne -ch 20
CHD-Pulmonic Supravalvulai As
stHenolus

GROWTH

1. Weight - by 5 months doubles & by 1 year triples

2. Height - Half of adult height - 2 years 18 - 24 months

3. Upper segment = Lower segment equal at the age of 10 years

4. Head circumference

At the end of 2nd year - 90% of adult size

At the end of 12 years - Adult size is attained

5. Chest circumference at birth

3 cms
Occipitofrontal circumference > Chest circumference = 3 cm
OFC > CC
wants bye bye Objtct Claps
peimantma
J
amenths

, MoiN
Speech 15monte
Jargons Understand a story --244
Use past tense 4yp
Use future tense
Sya
Handedness

Develops at Byeaso doge

Early handedness
Abashc Heniplexc -CP.
 the end of chemotherapy
Annual inactivated influenza vaccine is the only vaccine

recommended for children during chemotherapy

Sibling immunization should continue uninterrupted except for

oral polio vaccine which needs to be substituted by the

injectable vaccine

Non live vaccines are also best given after 6 months from the

end of treatment for durable immunity.

Vaccination in hematopoietic stem cell transplants

Recipients of HSCT are like the unimmunized as they have lost all memory

responses during marrow ablation.

They need to given

3 doses of tetanus / diphtheria containing vaccine should be administered 6

months after HSCT.

For patients aged ≥ 7 years, a dose of Tdap vaccine followed by two doses
of Td vaccine.

O 3 doses of IPV, Hib and Hepatitis B vaccine should be administered 6 - 12

months after HSCT.

O 3 doses of PCV should be given to adults and children starting at age 3 - 6

months after HSCT.
 2 mg/kg (< 10 kg) > 2 mg/kg (< 10 kg) 2 mg/kg < 10 kg)

20 mg/kg (> 10 kg) 20 mg/kg (> 10 kg) 20 mg/kg/> 10 kg)

No immunosuppression For 2 weeks 2 weeks

No immunosuppression No live vaccine till 1

Can be given all
Can be given all month after stopping
vaccines
vaccines steroids

Vaccines of persons with primary and secondary immune deficiencies

Category Contraindicated vaccine

Phagocytic function Live bacterial vaccines

Chronic granulomatous
disease NADPH Oxidou dd
Líx nral vacaurio
Chediak Higashi syndrome Ccon be ynén
Jo Leukocyte adhesion defects
Myeloperoxidase deficiency
Category Contraindicated vaccine
II) B lymphocyte immunodeficiency OPV LAIV BCG
severe Yellow fever
X-linked agammaglobinemia Live bacterial vaccines
Common variable
immunodeficiency

III) T lymphocyte defect All live vaccines

Severe combined immunotherapy
Digeorge syndrome

IV) Complement deficiency No vaccine is contraindicated

Menvyo caccal vaccni is xCa n hended .

Full term male infant, with birth weight 4.1 kg is born to a female with
insulin dependent diabetes mellitus. Child is a not able to accept breast
feeds. On examination blood sugar is 30 mg/dL. Out of the following
most likely the pathogenesis of hypoglycaemia is
a. Intrauterine passage of maternal insulin to the fetus across the
placenta X
b.
Diabetes mellitus in the infant X
Increased insulin production by the infant
d. Liver dysfunction in neonate due to intrauterine exposure to
maternal insulin X
age there is no respiratory distress and a soft l/VI systolic heart
murmur heard to left upper mid sternal border. Chest radiograph is
normal. Most likely cause of decreased initial oxygen saturation is
a. Hypertrophic cardiomyopathy X
b. Cyanotic congenital heart disease X
Polycythemia
d. Surfactant deficiency X

Newborn had APGAR score of 4 at 1 min. Positive pressure ventilation

was started and now APGAR score is 8 at 5 minutes. The significance of
low APGAR at 1 minute of age is
APGAR score is poor indicator of neurological outcome
b. Amplitude EE6 should be done to assess the neural damage X
C.
MRI brain should be done after 5th day of life X
d. Therapeutic hypothermia should be started X

MAPGAR
HIE - Swns
newborn
a. Cardiac monitor
b. Auscultation
"Umbilical cord palpation D Pulac oximety
d. Pulse oximetry

In preterm newborn all are the potential benefits of delayed cord

clamping except
a. Higher blood pressure and blood volume
b. Lower risk of necrotising enterocolitis
Lower risk of hyaline membrane disease
d. Lower risk of brain haemorrhages
 C. To confirm the perception of persistent central cyanosis
SAII the above

4 days old on examination is found to have brisk Moro reflex. Out o

the following which may be a cause
a. Chronic bilirubin encephalopathy
b. Erb's palsy

Hypoglycemia 6 stoye 1 HIE

d. 3 Stage 3 hypoxic ischemic encephalopathy
0 Mon's abset
weight, icterus present upto thighs. Total serum bilirubin is 11.5 mg/dL
and conjugated bilirubin is 0.8 mg/dL. Most appropriate management
in this child is
a. Liver function test and ultrasound of abdomen
Reassurance to mother and continue breast feed
C. Liver biopsy and ultrasound of abdomen
d. Blood group of baby and direct coomb's test

Breast milk jaundice

Premature infants often cannot achieve an APGAR score above 6. Out

of the following the physiological reason is
a. Persistent of fetal circulation
b. Persistent ductus arteriosus
C. Low heart rate causing poor perfusion
Immaturity of nervous system
continue

b. Absent nasal airflow and absent breathing ii) Periodic breathing

efforts followed by absent nasal air flow while
breathing efforts are continued

C. Pause is breathing that is less than 20 seconds iii) Mixed apnea

followed by several rapid shallow breaths

d. Absent nasal airflow and absent breathing iv) Obstructive apnea

efforts

Out of the following, the least likely to be beneficial in decreasing the

severity of respiratory distress in preterm infant is
Avoidance of supplemental oxygen in the delivery room
b. Giving dexamethasone antenatally
C. Early continuous positive airway pressure
d. Tocolysis to delay preterm birth
At birth there IS respirator rate of neart rate 130/min ana

moving all 4 limbs. Out of the following what is the best next management
a. X-ray abdomen to rule out intestinal obstruction
b. Chest x-ray to rule out hyaline membrane disease
C. Prophylactic sepsis screen to be done
d. Start prophylactically continuous positive airway pressure

Paeleum child
40-60|mun
120-140lmin rudi aut
vieohnal
obstwchon

Child continues to search for the hidden object. At this developmental age
what other milestones can be seen
a. Helps in household activities
b. Walks independently
c. Waves bye-bye
d. Jargons
 InIs chila naving selzures
a. Within first 24 hours of life
b. 24 to 48 hours after birth
C. 48 to 72 hours after birth
d. > 72 hours after birth

Male infant born to O positive mother had jaundice at 12 hours of age.

The child blood group is B positive, direct coomb's test is positive and
reticulocytotic is present. Child was started on phototherapy and
monitored. At 4 to 8 weeks of age which of the following can be seen
a. Light coloured stools
b. Recurrence of jaundice
C. Cyanosis and sweating during feedings
d. Pallor, tachycardia, and decreased activity
 a. Oral and intramuscular routes of vitamin K administration are
equally effective
b. Breast feeding newborns are less likely to need vitamin K
prophylaxis compared with formula feed newborns
C. One intramuscular dose of vitamin K provides complete
protection against haemorrhagic disease of the newborn
d. All the above

Match the inheritance pattern

a. If both parents are affected i) X linked recessive

recurrence risk is 75%

b. If both parents are affected ii) X linked dominant

recurrence risk is 100%

C. An affected female has 50% chance iii) Autosomal recessive

of passing the disease to her daughter
or sons

d. An affected father cannot transmit iv) Autosomal dominant

the disease or carrier state to his sons
and all daughters will be carriers
but recently started babbling / trying to imitate sound of others. Which of
the following of development is delayed
a. Social and fine motor delay
b. Social and language
C. Delayed social development
d. Fine motor delay

18-month-old child comes with bowing of legs and no teeth eruption till
now. Child was breastfed till 15 months of age with no supplements.
Which of the following finding is likely to seen in this child
a. Increased reabsorption of phosphate by the kidney
b. High circulating parathyroid hormone concentration
C. Inadequate stimulation of bone resorption by parathyroid hormone
d. Decreased conversion to 25 hydroxy cholecalciferol to 1,2,5
dihydroxycholecalciferol
a. DiGeorge syndrome
b. Beckwith - Wiedemann
syndrome
i) Monitor for risk of failure to thrive
in infancy
ii) Monitor for delayed
developmental milestones and risk
for seizures

c. Angelman syndrome iii) Monitor for hypoglycemia

d. Prader - Willi syndrome iv) Monitor for hypocalcemia

Dreams make you live

Dreams make you give

Dreams make you feel

Dreams are the zeal
Dreams do become true

If you are really through

Dreams make you tense
Dreams are the sense

With all problems faced

Dreams are to be chased dr.ashutoshaggarwal
Dreams are to be believed

Follow them till you are relieved