Pediatrics
NEONATOLOGY
LBW- IUGR:
VLBW-
Symmetrical Asymmetrical
ELBW-
SGA-
AGA- Etiology
LGA- HC
Physiological weight loss: AC
Ponderal index
Prognosis
MCC Of mortality:
Neonate –
U5-
Expanded new Ballard score
Benign newborn lesions
HYPOTHERMIA
[Link] position (skin to skin)
[Link] nutrition
[Link] support
[Link] discharge
NEONATAL JAUNDICE
UNCONJUGATED
PATHOLOGICAL:
• Appears <24hrs BREAST MILK BREASTFEEDING
• Jaundice persisting > 14 days JAUNDICE JAUNDICE
• Increase of bilirubin >5mg/dl/day
• Serum bilirubin>15mg/dl UDP-GT UDP-GT Prolonged
severely mildly jaundice
-Mechanism: deficient deficient
Structural isomerization:
Photo isomerization:
Photo-oxidation
-Distance:
-Wavelength:
CONJUGATED: Direct bilirubin >2mg/dl/ clay coloured stool
-Type of lamp:
-Irradiance using flux meter:30 uW/cm2/nm
MRP-2 No black Periductal fibrosis and Absent
Black liver liver proliferation periductal
Initial- fibrosis
Highest NPV-
Gold standard-
NEONATAL SEPSIS
-MCC of neonatal sepsis-
Sepsis Screen
-MCC of early onset sepsis-
-Most effective method for prevention- • Leukopenia (TLC ˂ 5000)
-Earliest C/F: • Neutropenia (ANC ˂ 1800)
-Initial Ix: • Immature neutrophil to
-IOC: • total neutrophil (I/T) ratio ˃0.2
-R/F: Preterm, ROM >18hrs, PPV • Micro-ESR ˃ 15mm 1st hour
• CRP + ve
NEONATAL RESPIRATORY DISTRESS
H/o sibling death
PRETERM TERM / LSCS POST-TERM Scaphoid abdomen
SP-B
Lecithin: Sphingomyelin ratio 1-7 days Preterm:
Nile blue sulfatase test On persistent O2 support:
Macleod syndrome refers to the inability of the lungs to grow after a severe obstructive bronchiolitis. Children with this condition often have chronic cough, recurrent pneumonia, and
wheezing. On CT scan, the affected lung shows small size and decreased vascularity,
hyperexpansion, and hyperlucency (false emphysema).
It is also called Swyer-James syndrome. It is mostly linked to adenovirus. Patients respond well to bronchodilators.
Score 0 1 2
Respirate <60 60-80 >80
Rate
Cyanosis None No cyanosis Cyanosis with
with oxygen oxygen
Retraction None Mild Moderate to
severe
Grunting None Audible with Audible without
stethoscope stethoscope
Air Entry Good Decreased Barely Audible
APGAR
APGAR Score Score 2 Score 1 Score 0 Prognostic score
A Timing:
Severe asphyxia:
APGAR:
pH:
Hypotonia
Pink Extremities Blue Pale or Blue
P ˃100 bpm ˂100 bpm No pulse
G Cries and pulls Grimaces or weak No response to
away cry stimulation
A
Active movement Arms, legs flexed No movement
R Strong cry Slow, irregular No breathing
HIE
Neonatal seizures BEDSIDE MONITOR-
DOC- INITIAL IX-
MC TYPE- IOC-
MC CAUSE-
CAUSES-
Hypoglycemia:
Best prognosis-
worst prognosis-
Patterns:
Cerebral palsy-SPASTIC type MC
Non-reversible, non-progressive
Term infant
o Parasagittal injury:
o Status marmoratus:
Preterm infant
o Periventricular leukomalacia
Neonatal reflexes
Persistent Moro’s: Appear after birth:
Exaggerated Moro’s :
Absent Moro’s:
Asymmetric Moro’s:
Feeding
Gestational age Maturation of feeding skills Initial feeding skills
<28 weeks Inadequate sucking efforts Lack IV fluids
of gut motility
28-31 weeks Sucking burst develop Orogastric or
Lack of coordination between nasogastric feeding
suck, swallow and breathing
32-34 weeks Coordination between breathing Spoon feeding
and swallowing begins
>34 weeks Mature sucking pattern Breastfeeding
NEC
R/F: Preterm, Formula, PDA
Stage Systemic Signs Treatment
IA Bradycardia, Apnea, NPO, antibiotics 3 days
Temperature instability
IB Grossly bloody stool Same as IA
IIA Absent bowel sounds NPO, antibiotics 7 to 10 days
Pneumatosis intestinalis
IIB Metabolic acidosis, NPO, antibiotics 14 days
Thrombocytopenia
PV gas
IIIA Bradycardia NPO, antibiotic 14 days,
Apnea, Acidosis fluid resuscitation, inotropic
DIC support
IIIB Pneumoperitoneum Surgery
TORCH infections
Hydrocephalus Cicatricial skin rash
Chorioretinitis Limb hypoplasia
Parenchymal calcification VZIG: 5d before/ 2d after delivery
Skin and eye lesions
Encephalitis
Microcephaly
Periventricular calcification
Most are asymptomatic SNHL
Urinary Ag test Cataract
MC eye C/F:
PDA > PS
Microcephaly
Contractures
GM-WM calcification Non-immune hydrops
PRCA
Acute Diarrhea
Parameters No Dehydration Some Dehydration Severe Dehydration
Appearance Well, alert Restless, irritable Lethargic, unconscious
Eyes Normal Sunken Very sunken
Thirst Drinks normally, Thirsty, drinks eagerly Drinks poorly or not able to drink
not thirsty
Skin pinch Goes back quickly Goes back slowly Goes back very slowly
(˂1 second ) (1 second) (2 seconds)
ZINC: 14days 75ml/kg over 4 hours
100ml/kg
<6mon: 10mg 30ml/kg 70ml/kg
>6mon: 20mg
FLUID COMPOSITION
Compositi ReSoMal Standard Reduced
on (mmol/L) ORS osmolarity
(mmol/L) ORS
Glucose 125 111 75
Sodium 45 90 75
Potassium 40 20 20
Chloride 70 80 65
Citrate 7 10 10
Magnesiu 3 --- ---
m
Zinc 0.3 --- ---
Copper 0.045 --- ---
Osmolarity 300 311 245
(mOsm/L)
GI emergencies
GI emergencies
Newborn with drooling and difficulty feeding
Cystic fibrosis
Cystic Fibrosis Finding Biochemical Evidence of
CFTR Dysfunction
≥1 Phenotypical finding Positive sweat chloride
Or >60meq/l on 2 separate days
Positive neonatal screening Pilocarpine iontophoresis
Or Or
Positive family history Positive Nasal potential
difference
Or
2 mutations in CFTR
CF: Chromosome:
-MC mutation:
-MC class of mutation:
-Trikafta: Elexacaftor + Tezacaftor +
Ivacaftor
Congenital Heart Diseases-Approach
-MC overall: PaO2 after administration of 100% oxygen
-MC to be affected by IE:
-MC cyanotic HD:
-MC cyanotic HD in neonates:
> 300 mm Hg 150-300mm 100-150mm < 100 mmHg
-MC cause of death in first week:
Normal - PPHN
NADA’S CRITERIA - Cardiac mixing lesions with increased PBF
MAJOR MINOR
1. Systolic murmur ≤ Grade 2
1. Systolic murmur Grade ≥ 3 -Cardiac condition with Parallel circulation
2. Abnormal Second hear sound -Pulmonary disorders
2. Diastolic murmur -Cardiac mixing lesions with restricted PBF
3. Abnormal ECG -CNS disorders
3. Cyanosis -Methemoglobinemia
4. Abnormal Chest Xray
4. Congestive Heart Failure
5. Abnormal Blood pressure
The total fetal cardiac output at term is approximately 450 mL/kg/min.
Acyanotic CHD
PULMONARY PLETHORA Normal PBF
2nd heart sound Pansystolic Continuous,
Goose neck Brachio-femoral delay
wide and fixed murmur + machinery Intermittent claudication
deformity
split LAD infraclavicular Hypertension
MC in downs
murmur
RAD LAD
Cyanotic + Oligemia
RAD WPW, RBBB ,Himalayan P waves LAD
Cyanotic + Plethora
LARGE PEDICLE
SMALL PEDICLE LARGE PEDICLE
2ND HS WIDE AND FIXED
NUTRITION
Indicator Parameter Interpretation
Stunting Low height for age
Wasting Low weight for height
Under weight Low weight for age
Severe acute malnutrition (SAM): 6-59 months of age
A. Weight-for-height below – 3 SD of the median
B. Visible severe wasting
C. Presence of bipedal edema
D. Mid-upper arm circumference below 11.5cm
Management of SAM
Poor appetite / Edema /Medical complications
Supervised HOME Mx HOSPITAL Mx-SHIELDED
Nutrition:
Amox *5d
Vit A
Albendazole
vAccines
Stabilisation: 0-7 days Rehabilitation: 2-6weeks Primary failure:
Day 1- 175-200 kcal /kg/day
70-80kcal /kg/day 4-6g/kg/d protein • Failure to regain apetite by day 4
0.8-1g/kg/d protein F-100 diet • Failure to lose edema by day 4
• Presence of edema on day 10
Day7- Add iron • Failure to gain at least 5mg/kg/day
100 kcal/kg/day by day 10
2-3g/kg/d protein
F-75 diet 2-3hrly
All micronutrients except iron
PEM
Kwashiorkor Marasmus
Deficient of protein Deficient of proteins and calories
Serum albumin: Serum albumin:
Subcutaneous fat preserved Subcutaneous fat not preserved
Triceps skin fold: Triceps skin fold:
Oedema Oedema absent
Flaky paint dermatitis Loose, wrinkled skin
Flag sign
Moon facies Simian facies
Enlarged fatty liver No fatty liver
Lethargic Alert and irritable
Muscle wasting mild or absent Severe muscle wasting
Poor appetite Voracious feeder
Genetic disorders
DOWN (MC) PATAU EDWARD (2nd MC)
TONE
HANDS
FEET
EYES
CVS
MOUTH
Imp MC genetic cause of Low IQ Not with maternal age Maternal age
GI: PHPV Abdominal wall
AAD, Hypothyroid, Alzheimer's, ALL, AML- Aplasia cutis defects
M Absent ribs Horseshoe kidney
Maternal Meiotic non-disjunction (95%)
CHL
SYNDROMES
Non disjunction of X Mosaic: Inheritance-
chromosome Lymphedema of feet and hands Chromosome-
Paternal age Webbing of neck, Cystic hygroma GENE-
IQ: Shield chest, Inc carrying angle CRITERIA-
Gonads: IQ: VS NOONAN:
Gynecomastia Gonads:
Sparse hair CVS:
SNHL
SYNDROMES-Pictorial diagnosis
SKULL LESIONS
MCC:
Sunset sign
Macewen sign
Mx:
IOC for shunt infection:
Anterior fontanelle:
Posterior fontanelle:
Miscellaneous
Constituent b x Breast milk Cow’s milk (gm/L) SHORT STATURE:
(gm/L)
Proteins 11 33 Bone Age ˂ Chronological Age
• Casein 4 28
• Soluble proteins 7 5
Lactose 70 50 Bone = Chronological Age
• Ca 0.33 1
• P 0.15 1
Vitamins
• C 60mg 20mg
• D 501U 251U
Buffalo > Goat > Cow
Breast milk deficient in: Weight with age: Height with age:
Birth Birth
Puberty: 5mon 3mon
FEMALES: MALES: 1yr 1yr
2yr 2yr
3yr 4yr
5yr
7yr US:LS :
10yr Birth
3yr
7yr
CAH MC Testosterone
21- hydroxylase deficiency
Screening-
Next step-
11- hydroxylase deficiency
17- hydroxylase deficiency
Neonatal hypothyroidism: Heel prick test / DBS
RAIU
Recurrent UTI in children:
Frameshift / Non-sense:
In-frame mutation:
• Hypodiploidy • TrkA +
• N-myc amplification • <18months presentation
• ALK amplification • Abundant lymphoid
• Loss of infiltrates
heterozygosity-1p,11q • Location in neck, thorax,
pelvis
Risk factors:
WT1: 11p13
WAGR
Denys Drash
WT2: 11p15- Beckwith Weidmann
Horseshoe kidney
UDT, Hyposapdias
Developmental milestones
Palmar grasp disappears
Recognize mother
Cooing Bidextrous reach
Neck holding Binocular vision
Mouthing
ROFL
Pulls to sit; no head lag
Mirror play Immature princer grasp Pivots and cruises Mature princer grasp
Unidextrous, transfers Object permanence Diagonal localization of Mouthing disappears
Monosyllables Bye-bye sound Comes when called
Tripod “Bye”-syllables Stands with support Stand without support
Stranger anxiety Sits without support Creeps Throw ball
Listens to no Crawling Peek-a-boo Casting
1-2 words
Walk alone Domestic mimicry 2 steps up and down Circle
Jargon Explores drawer 2 word sentences 1 step upwards
Imitates scribbling Unzips 2 objects Handedness
2 blocks tower Runs and kicks ball Draw 2 lines 1-2 colours
Feeds with spoon Parallel play
Dry during day 9 tower
8-10 words Tower-6 blocks
Tower of 3 cubes Asks for food and drink Dress + undress except
Names body parts buttons
Undresses completely Name, gender, age
Unscrew, door knobs
1 step downstairs Triangle draw
Square, Cross 3 step command
Scissor Tie shoelaces
Bridge with blocks Ask meaning of words
Poem Recognise 5 colours
R-L discrimination Gate with blocks
Toilet alone
Age Gross motor Milestone Age Fine motor milestone
Neck holding Bidextrous approach
Rolls over Unidextrous approach
Immature pincer grasp
Sits in tripod position
Mature pincer grasp
Sits without support
Imitates scribbling, tower of 2 blocks,
Stands without support drinks from cup
Walks alone Scribbles, tower of 3 blocks, feeds with
spoon
Runs
Tower of 6 blocks, verticular and
Walks up and downstairs, 2 feet step circular strokes, undresses
Rides tricycle, alternate feet going Tower of 9 blocks, copies circle,
upstairs dresses
Hops on one foot, alternate feet going Copies cross, bridge with blocks
downstairs
Copies triangle, gate with blocks
Age Social Milestone Age Language milestone
Social smile Alerts to sound
Recognizes mother Coos
Stranger anxiety, inhibits to no Laugh loud
Waves bye-bye, repeats activity when Monosyllables
appreciated
Bisyllabes
Comes when called, plays simple ball
game 1-2 words with meaning
Jargon, points to objects of interest 8–10-word vocabulary
Copies parents in task
2-3 word sentences, uses pronouns
Asks for food, drink, toilet Asks question
Shares toys, knows full name and
Sings song, tell stories
gender
Plays cooperatively in group, goes to Asks meaning of words
toilet alone
Helps in household tasks
Developmental quotient=
Abnormal:
Global developmental delay:
Preterm:
Screening: Denver
Goodenough-Harris
Trivandrum development
Phatak Baroda
Definitive: Bayley
Stanford Binet
Welscher Intelligence
Vineland adaptive
PAEDIATRICS PYQ
1. A woman came to OPD with a newborn who has
complaints of chest retractions, dyspnea, and lethargy.
The paediatrician diagnosed the baby with respiratory
distress syndrome. This occurs due to the deficiency of:
A. Dipalmitoyl inositol
B. Lecithin
C. Sphingomyelin
D. Dipalmitoyl phosphatidylethanolamine
2. A 8-year-old child weighing 26 kg presents with a
history of loose stools for 2 days. On examination, there is
severe dehydration. Laboratory investigations are as
follows. What is the initial management as per ISPAD
guidelines?
RBS -550
рН -7.01
Na+ -158
Urine glucose -3+
Urine Ketone +ve
A. Manage ABC, NS 20 mL/kg and start insulin after 1 hour
B. Manage ABC, NS 20 mL/kg along with insulin 0.1 IU/kg/hr
C. Manage ABC, NS 10 mL/kg along with insulin 0.1 IU/kg/hr
D. Manage ABC, NS 10 mL/kg and start insulin after 1 hour
3. Which of the following is the correct sign indicating
adequate growth in an infant with a birth weight of 3 kg?
A. Increase in length of 25 cm in the first year
B. Weight gain of 300 grams per month till 1 year
C. Anterior fontanelle closure by 6 months of age
D. Weight under 75th percentile and height under 25th percentile
4. A 3-month-old baby comes with complaints of
deafness, cataract, and patent ductus arteriosus. Which
of the following is the most likely diagnosis?
A. Congenital herpes simplex virus infection
B. Congenital toxoplasmosis
C. Congenital cytomegalovirus infection
D. Congenital rubella syndrome
5. A 3-month-old baby is brought to OPD with jaundice and
clay-colored stools. Lab work up reveals that the baby has
conjugated hyperbilirubinemia. A liver biopsy was done
and shows periductal proliferation. What is the most likely
diagnosis?
A. Crigler-Najjar syndrome
B. Rotor syndrome
C. Dubin-Johnson syndrome
D. Biliary atresia
6. A 3-week-old infant is brought to OPD with complaints
of cough and sore throat. The mother reports that the
infant develops a paroxysm of cough followed by apnea.
Blood investigations reveal total leucocyte count to be
>50,000 cells/L. Which of the following drugs is
appropriate for this patient?
A. Azithromycin
B. Amoxicillin
C. Cotrimoxazole
D. Ciprofloxacin
7. What is the fluid requirement in a 3-days old baby with
a birth weight of 1300 grams? (FMGE JULY 2024)
A. 80-90 ml/kg/day
B. 100-110 ml/kg/day
C. 120-130 ml/kg/day
D. 130-150 ml/kg/day
[Link] is the amount of milk given to term baby in first 24
hours after delivery?
A. 20ml/kg
B. 40ml/kg
C. 60ml/kg
D. 80ml/kg
9. A child presented to the clinic with complaints of recurrent
infection. Physical examination shows height for age < -2 SD.
What is the appropriate term for the above mentioned
condition?
A. Stunting
B. Wasting
C. Severe acute malnutrition
D. Kwashiorkor
10. What is the mid arm circumference for severe acute
malnutrition?
A. 12.5 cm
B. 12 cm
C. 11.5 cm
D. 11 cm
11. A neonate presents with post feed vomiting and
hypoglycemia in the first week of life. Urine was positive
for reducing substances but there was no glucose and
urine also gave positive reaction with Benedict’s reagent.
The neonate also had reversible oil drop cataract. Which
of the following is the most likely diagnosis?
A. Classical Galactosemia
B. Essential fructosuria
C. Galactokinase deficiency
D. Uridine diphosphate-glucose 4-epimerase deficiency
12 . What are the components of Nada's Minor Criteria?
1. Systolic mumur Grade 3
2. Diastolic murmur
3. Abnormal second heart sound
4. Abnormal BP
A. 3 and 4
B. 1, 2 and 3
C. 1, 2, 3 and 4
D. 2, 3 and 4
13. A baby is brought to OPD for 10-week DPT vaccination
appointment. He previously experienced a fever
exceeding 40°C and had an inconsolable cry at 6 weeks
old after receiving a vaccination. What would be the
recommended course of action moving forward?
A. Avoid DPT vaccination
B. Give DT vaccine
C. Give DPT vaccine
D. Defer by 4 weeks
14. A 4-year-old male child arrived with a history of fever,
reddened and congested conjunctiva, along with skin
exhibiting redness and peeling, as depicted in the
provided images. A 2D echocardiogram revealed the
presence of a coronary aneurysm. What constitutes the
initial course of treatment for this condition?
A. Aspirin
B. IVIG
C. Clopidogrel
D. LMWH
15. Which one among the following has the lowest risk of
perinatal transmission?
A. HSV
B. CMV
C. Rubella
D. Hepatitis B
16. What are the recommended actions according to
Neonatal Resuscitation guidelines for a baby born with
meconium-stained amniotic fluid?
1. lntrapartum suction of nose and mouth before delivery of shoulder
2. lntratracheal suction in case of non-vigorous baby
3. Gentle suction of nose and mouth in case of vigorous baby
4. PPV in case of non-vigorous baby after early steps
A. 1, 2, 3, 4
B. 2, 4
C. 3, 4
D. 1, 3, 4
17. What is the rate of increment of head circumference
in the first three months of life?
A. 3 cm per month
B. 2 cm per month
C. 1 cm per month
D. 0.5 cm per month
18. Which of the following does not play a role in fetal
growth?
A. Growth hormone
B. Insulin-like growth factors
C. Thyroxine
D. All of the above
19. INSURE technique is used in newborn, born with
which condition?
A. Meconium aspiration syndrome
B. Transient tachypnea of newborn
C. Hyaline membrane disease
D. Neonatal jaundice
20. Which of the following is not a feature of Kawasaki
disease?
A. Edema of hands and feet
B. Thrombocytosis
C. Fever with rash
D. Purulent conjunctivitis
[Link] the Downe score of a newborn who has
cyanosis which improves on giving oxygen, mild to
moderate retractions, grunting heard on naked ear, air
entry markedly decreased, RR 40 per minute?
A. 4
B. 5
C. 6
D. 7
22. Which of the following statements is not true about
febrile seizure?
A. Age 6 months – 5 years
B. Simple febrile seizure lasts for <15 minutes
C. No need for long term antiepileptics
D. 54% recurrence
23. An unconscious child is brought to the casualty. What
is the correct sequence of the management?
1. Assess breathing
2. Assess pulse
3. Assess response
4. Start compressions
5. Bag and mask ventilation
A. 3-1-2-5-4
B. 1-2-3-4-5
C. 3-1-2-4-5
D. 1-2-4-3-5
24. Which of the following statements are true regarding
cytomegalovirus (CMV) infection?
1. Neonates who are asymptomatic at birth have a lesser risk of later sequelae.
2. 20-40% are symptomatic at birth.
3. In developing countries, the rate of transmission of CMV infection to the infant is
more common from primary maternal infection than reactivation.
4. Diagnosis by urine specimen at 4 weeks of age
A. 3, 4
B. 1, 2
C. 2, 4
D. 1, 3