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PAEDIATRIC PERSPECTIVES

Birth injuries

Introduction to birth injuries Birth injuries are those suffered during childbirth. They include extensive caput succedaneum, cephalhaematoma, subgaleal haemorrhage, nerve palsies and fractures. The presentation varies depending on type and site of injury. Excessive traction may result in injury to the brachial plexus and may be associated with fracture or injury of the humerus or …

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Malnutrition

Introduction Malnutrition occurs when there is a deficiency in intake of essential nutrients (i.e. proteins, carbohydrates, fats, vitamins and minerals). It is most commonly seen in children less than five years, particularly after weaning. Malnutrition reduces the individual\’s ability to fight disease and infection thereby increasing the likelihood of the patient presenting with diarrhoea, vomiting, …

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Blood Transfusion In The Newborn

Introduction Blood transfusion is the administration of blood for therapy. Blood transfusion in the newborn is indicated by: Acute haemorrhage Anaemia For haemorrhage, the decision to transfuse should be based on the infant\’s haemodynamics – pulse, blood pressure -and not on haematocrit which is usually normal immediately after haemorrhage. Cross-match is desirable only if the …

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Malaria in Children

Introduction Malaria in the newborn babies presents as sepsis in most instances as the clinical features are very similar. Investigations Rapid Diagnostic Tests for rapid detection of Plasmodium falciparum in situations of poor laboratory services Peripheral blood film microscopy with Giemsa staining which most frequently reveals Plasmodium falciparum. Full blood count: anaemia and leucocytosis. Blood …

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Bacterial Meningitis in Children

Introduction Bacterial meningitis refers to inflammation of the leptomeninges as a result of bacterial infection. This condition occurs more frequently in Late-Onset Sepsis compared to Early-Onset Sepsis. See Sepsis It is associated with high mortality because early diagnosis is usually difficult since the early features are non-specific. Clinical Features The early, non-specific features include: fever, …

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Necrotizing Enterocolitis in Children

Introduction Necrotizing enterocolitis refers to extensive necrosis of the intestine of multi-factorial origin. It may ultimately result in intestinal perforation. It commonly affects the terminal ileum and proximal colon but it may involve the entire length of the gut. Predisposing Factors Prematurity and very low birth weight, early infant formula feeding, intra-uterine growth restriction, polycythaemia, …

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Hyperglycaemia in Children

Introduction Hyperglycaemia is a state of high blood glucose level. A random blood glucose of > 8.0 mmol/1 is hyperglycaemic. Preterm infants particularly when treated with 10% dextrose infusion or total parenteral nutrition are prone to it. Hypothermia, sepsis, post-operative cases, neonatal diabetes (transient or persistent) are also associated. Clinical features Persistent dehydration with glycosuria. …

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Hypoglycaemia in Children

Introduction. Hypoglycaemia is an abnormally low level of glucose in the blood (less than 4 millimoles per litre or 40 mg/dl) irrespective of age and gestational age. Most infants with mild to moderate  hypoglycaemia are asymptomatic. Normal glucose utilization rate is 4-6mg/kg/minute but high-risk infants require 6-10mg/kg/minute. In the extreme cases of hyperinsulinism, the infants …

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Post-resuscitation Care of Asphyxiated Babies

Introduction Clinical manifestations of this case depends on the severity and degree of hypoxic. They include: Ischaemic encephalopathy), inability to cry or suck, global hypotonia and poor activity or global hypertonia with brisk deep tendon reflexes, shock, poor temperature regulation, paralytic ileus, respiratory distress, bleeding tendencies, seizures, oliguria Management Management is largely anticipatory. Serial monitoring …

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