- Triage flow chart for assessing oral feeding risks in newborn.

Triage flow chart for assessing oral feeding risks
Assess	Classify	Treat-Manage
< 32 wks GA severely ill very immature clinically unstable	High risk	NPO OG/NG GT
32–34 wks GA Clinically unstable	Moderate risk	Tube feeding nonnutritive sucking
≥ 35 wks GA Medically stable	Low risk	PO/tube feeding breastfeeding

Adapted from Guidelines for Acute Care of the Neonate, 21st Edition, 2013–14, James M. Adams, Caraciolo J. Fernandes.Chapter 13—Nutrition Support, p.g 125

- Tools commonly used in neonatal ICU.

NICU Tools

(Tools commonly used in neonatal ICU)

• GIR.
• Sodium replacement formula
• Plasma osmolalit
• Half correction of Bicarbonate
• UVC length
• ETT Size
• ETT length at lip
• ETT length at nares
• Dopamine / Dobutamine calculation
• Creatinine clearance (Schwartz formula)
• Exchange transfusion

For all click here

- The Fenton growth chart for preterm infants.

The Fenton growth chart for preterm infants.

  “The Fenton growth chart for preterm infants has been revised to accommodate the World Health Organization Growth Standard and reflect actual age instead of completed weeks, in order to improve preterm infant growth monitoring.”

These growth charts:
Are: “commonly used in NICUs today” -  American Academy of Pediatrics 2014 Nutrition Handbook 

To download PDFs of growth CHARTS..  
2013 Preterm Growth Chart for Girls 
2013 Preterm Growth Chart for Boys 

Adapted from 2013 GROWTH CHART

- How to use an accuhaler?

How to use an accuhaler for bronchial asthma

- Shorter Antibiotic Treatment for Otitis Media!

Shorter Antibiotic Treatment for Otitis Media!

- Wolf-Hirschhorn Syndrome.

Wolf-Hirschhorn Syndrome

*Pathophysiology:-
results from deletion of the distal short arm of chromosome no 4 (1).

* Clinically, the minimal diagnostic criteria for Wolf-Hirschhorn syndrome (ie, ‘‘core’’ phenotype) consists of typical facial appearance , mental retardation, growth delay, hypotonia and seizures (or EEG anomalies)(2).

* Different categories of the Wolf-Hirschhorn syndrome phenotype are defined according to the extent of the chromosome.4 deletion(2):-

• 1st category :- caused by small deletion that is usually associated with a mild phenotype, lacking major malformations. This category is likely under-diagnosed.
• 2nd category :- caused by large deletions that cause the widely recognizable Wolf-Hirschhorn syndrome phenotype.
• 3rd category :- caused by very large deletions that cause a severe phenotype that can hardly be defined as typical Wolf-Hirschhorn syndrome.

- Down Syndrome.

Down Syndrome.

-History:-
English physician John Down first characterized Down  syndrome as a distinct form of mental disability in 1862 due to  his perception that children with Down syndrome shared physical  facial similarities (epicanthal folds) with those of Mongolian race.

-Incidence:-

• In general population 1:660.
• It is the most common Autosomal abnormalities.
• It has equal sex distribution.

-Causes (cytogenic types):-

1-Complete Trisomy 21 (non disjunction):-

• Incidence:- 95%.
• Due to non-disjunction of chromosome 21 during meiotic division (  (i.e failure of a chromosome 21 pair to separate) so an ovum with 24 chromosomes when fertilized by a sperm carrying 23 chromosomes lead to formation of a fertilized ovum with 47 chromosome.
• It occur during oogenesis more than spermatgenesis.
• The risk increases with age of the pregnant mother especially  over 40years as the primary oocytes of the mother have satyed in the prophase for a long time ( 40 years or more).
• Karyotyping:- 

47,xx+21(female down).
47,xy+21(male down).
(+ means that an extra chromosome is present).

- Paediatric syndromes.

A Medical syndrome is defined as :- 
A group of symptoms and signs that collectively indicate or characterize a disease, psychological disorder, or other abnormal condition. There are a lot of medical syndromes and we try to list some of them:-

1. Down syndrome (click here).
2. Wolf-Hirschhorn Syndrome (click here).
3. Bartter syndrome (click here).
4. Liginac syndrome (click here) 
5. Lowe syndrome (click here)
6. Alport syndrome (click here)

- PICC Placement in the Neonate.

PICC Placement in the Neonate.

Long-term vascular access is often required in neonatal patients for the delivery of life-sustaining medications and nutrition. This video demonstrates the placement of a peripherally inserted central catheter (PICC) in a neonate.

- Umbilical Vascular Catheterization.

Umbilical Vascular Catheterization.

The placement of umbilical catheters is an essential technique for the treatment of many newborns in unstable condition. This video will demonstrate the placement of catheters in the umbilical vein and the umbilical artery. Careful preparation, sterile technique, and attention to

- Fluid and electrolyte therapy in common neonatal conditions in neonates.

Fluid and electrolyte therapy in common neonatal conditions in neonates.

1. Congestive heart failure: infants usually require fluid restriction (-30 ml/kg).

2. PDA: restrict fluid administration. This is especially important when indomethacin is
prescribed to treat PDA (as indomethacin can decrease urine output).

3. RDS: infants with RDS need appropriate fluid therapy because:

• Excessive fluid administration can lead to hyponatremia, volume overload,
• worsening the pulmonary condition and increasing the risk of developing BPD.
• Inadequate fluid administration leads to hypernatremia and dehydration.
• It has been observed that clinical improvement in infants with RDS is accompanied by an increase in urine volume that occurs on the 2nd and 3rd days of life.
• Despite the observed association between diuresis and improving lung function, there are no data to support routine administration of diuretics to the preterm infant for treatment of RDS.
• Infants with RDS and other pulmonary disorders may have increased secretion of antidiuretic hormone, especially if they develop pneumothorax , When carefully used, positive-pressure ventilation, either conventional or high frequency, does not impair diuresis or cause water retention .
• RDS commonly is associated with a combined respiratory and metabolic acidosis resulting from hypercapnia and mild lactic acidemia. If the acidosis is primarily metabolic, the underlying cause should be identified and corrected.

- Laboratory guidelines for fluid and electrolyte therapy in neonates.

Laboratory guidelines for fluid and electrolyte therapy in neonates.

Intravenous fluids should be increased in the presence of
1. Increased weight loss (>3%/day or a cumulative loss >20%)
2. Increased serum sodium (Na>145 mEq/L)
3. Increased urine specific gravity>1.020 or urine osmolality >400 mosm/L,
4. Decreased urine output (<1 ml/kg/hr).

Similarly fluids should be restricted in the presence of
1. Decreased weight loss (<1%/day or a cumulative loss <5%),
2. Decreased serum sodium in the presence of weight gain (Na<130),
3. Decreased urine specific gravity <1.005 or urine osmolality <100 mosm/L,
4. Increased urine output (>3 ml/kg/hr)

- Factors that influence insensible water loss in newborn.

Insensible water loss (IWL) is water loss that is not readily measured, and consists mostly of water lost via evaporation through the skin (two thirds) or respiratory tract (one third).

Decrease IWL 

• Advanced GA and weight
• Heat shield or double walled incubators, 10-30% 
• Plastic blankets, 30-50% 
• Clothes 
• High relative humidity (ambient ventilation gas), 20-30% 
• Emollient use 

- Indications for Admission to NICU.

Indications for Admission of neonates to Neonatal ICU.

• Prematurity ≤34 weeks' gestation 
• Low Birth Weight (LBW) <1800 gm
• Cardiopulmonary problems:

1. Central cyanosis 
2. Respiratory distress 
3. Apnea/Bradycardia 
4. Cardiac arrythmia
5. Meconium suctioned below the vocal cords 

- Pediatrics.

Pediatrics (also spelled paediatrics or pædiatrics) is the branch of medicine that deals with the medical care of infants, children, and adolescents, and the age limit usually ranges from birth up to 18 (in some places until completion of secondary education, and until age 21 in the United States).

Differences between adult and pediatric medicine:

The body size differences are paralleled by maturational changes. The smaller body of an infant or neonate is substantially different physiologically from that of an adult.