Pediatric Facts from Previous Papers

·         IMP DZ WITH HYPERTONIA:

Edward’s, 21q-, Krabbe’s, Kernicterus(Acute), Menke Kinky Hair Syndrome, SSPE,

·         Clinical pointers towards specific IEM’s

·         Coarse facies: Lysosomal disorders

·         Cataract: Galactosemia, Zellweger syndrome

·         Retinitis pigmentosa: Mitochondrial disorders

·         Cherry red spot: Lipidosis

·         Hepatomegaly: Storage disorders, urea cycle defects

·         Renal enlargement: Zellweger syndrome

·         Eczema/alopecia: Biotinidase deficiency

·         Abnormal kinky hair: Menke disease

·         Decreased pigmentation: Phenylketonuria

·         Hiccups: Nonketotic hyperglycinemia

·         Ophthalmoplegias: MSUD, Nonketotic hyperglycinemia

·         Apnea monitors based on chest wall movement are likely to miss obstructive apnea. Monitors with facilities for measuring heart rate and oxygen saturation would be more useful in the monitoring of significant apnea in preterm infants.

·         Methylxanthines have been the mainstay of pharmacologic treatment of AOP. The loading dose of intravenous aminophylline is 5 to 6 mg/kg, followed by 1.5 to 3 mg/kg every 8 to 12 hours. Caffeine available for both oral and intravenous use has some advantages over theophylline. Because it has a higher therapeutic index, toxicity is less of a concern. Also, once-daily dosing is possible due to its longer halflife. A typical loading dose of 20 mg/kg caffeine citrate is followed in 24 hours by 5 to 8 mg/kg per dose, administered once every 24 hours. Recommended therapeutic levels are 5 to 10 μg/ml for  minophylline and 8 to 20 μg/ml for caffeine.

Caffeine: The drug is not available in India at present.

The drug of choice would be caffeine, which is not available in India. Hence we prefer to use aminophylline as the drug of choice in the management of AOP.

·         Injection doxapram has 0.9% benzyl alcohol as a preservative. The recommended dose of 2-2.5 mg/kg/hr would deliver 21.6-32.4 mg/kg/day of benzyl alcohol. Although this dose is below the toxic dose of alcohol (45 mg/kg/day), there have been case reports of “gasping syndrome” with this lower dose in literature.

·         Similarly, extubation to CPAP following early surfactant administration (‘INtubateSURfactantExtubate’ = INSURE Approach) has been shown to reduce the need for mechanical ventilation but it is still uncertain if BPD is reduced by this approach.

·         Preterm infants are susceptible to oxidant injury because they are deficient in antioxidant enzymes. Hence, antioxidants such as superoxide dismuatase (SOD) promise to be an exciting strategy for prevention of BPD. A randomized trial that enrolled around 300 infants proved the safe nature of the drug CuZnSOD, but did not find any difference in the primary outcome of BPD at 36 weeks PMA. Interestingly, SOD treated infants had fewer episodes of respiratory illness at I year of age suggesting that the drug could prevent long-term lung injury caused by reactive oxygen species.43 Further studies are needed to define its exact role in the management of BPD. Other antioxidants/free radical scavengers like vitamins C and E, allopurinol, N-acetyl-Cysteine have not been proved to be useful till now.

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·         Spitzer's laws of neonatology

1.       The more stable a baby appears to be, the more likely he will "crump" that day.

2.       The nicer the parents, the sicker the baby.

3.       The likelihood of bronchopulmonary dysplasia (BPD) is directly proportional to the number of physicians involved in the care of that baby.

4.       The longer a patient is discussed during rounds, the more certain it is that no one has the faintest idea of what is going on or what to do.

5.       The sickest infant in the nursery can always be discerned by the fact that he or she is being cared for by the newest, most inexperienced nursing orienteer.

6.       The surest way to have an infant linger interminably is to inform the parents that death is imminent.

7.       The more miraculous the "save," the more likely that you will be sued for something totally inconsequential.

8.       If they are not breathin', they may be seizin'.

9.       Antibiotics should always be continued for ____ days. (Fill in the blank with any number 1-21.)

10.   If you cannot figure out what is going on with a baby, call the surgeons. They won't figure it out either, but they will sure as hell do something about it.

·         Yale Observation Scales

This set of six items of observation and physical signs was designed at Yale to assist in detecting serious illness in febrile children who were <24 months old. Normal (1 point), moderate impairment (3 points), and severe impairment (5 points) scores are given for quality of cry, reaction to parental stimulation, state of alertness, color, hydration, and response to social overtures. Scores of =10 correlate with a low likelihood of serious illness, primarily in infants >2 months old