GENERAL DATA:

• J.A a 1 year old male child, Filipino, Roman Catholic, Born on AUG/22/2023,
PEDIATRIC GRAND ROUND residing in Abellana ST Suba, Cebu city, Cebu

PRESENTATION DATE OF ADMISSION:

NOV, 28, 2024
GROUP A:
1. BALAS, RAGURAM
2. PAUL OFTHE CROSS, MERLIN NITHYA WARD:
3. GNANASEKARAN RAKESH PEDIA PEDIA WARD
4. Huminig, Lurence Ann

INFORMANT: MOTHER
RELIABILITY: 80%

HISTORY OF PRESENT ILLNESS

• 3 days PTA Patient had a onset of cough with whitish sputum, with no
other associated symptoms, no consult done, no meds given .
• 2 days PTA Patient still persistance of cough prompted consult in
CHIEF COMPLAINT barangay health center and was given salbutamol and paracetamol
but no relief
• Hrs PTA patient had sudden onset of high grade fever with temp
FEVER, COUGH, SEIZURE 38.2*C And patient had sudden onset of tonic clonic seizure note by
his mother described as upward rolling of eye balls And stiffening of
the extremities lasting less than 5 min then rushed to Er and
prompted admission
BIRTH HISTORY NATAL HISTORY:
• PRENATAL HISTORY: • A live term female neonate delivered cephalic via NSD with Ballard
• Mother was 29 year old during pregnancy with an OB score of Score: 40 weeks AOG assisted by Nurse at health centre duration of
G6P4(4024) Prenatal Care started at 3 month AOG at Local Health labour 1 hour noted to have Good Cry and Good Suck, no congenital
Center had a total of 6 visits throughout the pregnancy, was given defects noted.
Tetanus Toxoid Vaccine. (2 doses), given supplements ferous sulfate
and multivitamins 1 tab PO with good compliance. No reported
maternal illness and complication during pregnancy.

POST NATAL HISTORY: PAST MEDICAL HISTORY

• No prior surgical history, No allergies for food and medication. No
• Patient was given BCG , Hep B , Vitamin K , Erythromycin eye previous hospilization.
ointment, with Normal Newborn, Screening Normal Hearing
screening, admitted for 3 days and discharged with good outcomes

FEEDING HISTORY
• Exclusive breastfed since birth with a frequency of >12x per day, for
almost 10-15 minutes of duration, with good appetite
GROWTH AND DEVELOPMENTAL HISTORY: IMMUNISATION HISTORY
• The child development is at par with age developmental milestone • Patient’s mother doesn’t have the vaccination card of the child but claims to have fully
vaccinated for age in nearby health center
completed on time No motor delays No speech delay gross motor: • Vaccines given at Health centre:
1. roll back to stomach at 6 months • BCG (at birth),
• 2. sits without support at 7 months • rotavirus(6,10Weeks)
• 3. Stands alone, walks alone at 1 year • DPT(6,10,14 weeks)
• 4. Could run or walk fast at 1.2 yrs • polio(6,10,14 weeks)
• Fine motor: transfer object hand to hand at 5 months • H. Influenza b (Hib)(6,10weeks, 12-15months)
• language: monosyllabic babble 6 months • hepatitis B(0,1,6 months)
• Cognitive stares at on hands at 4 months • pneumococcal conjugate(6,10,14weeks)
• measles (9months)
• MMR(9,12 months)

FAMILY HISTORY
• History of hypertension and DM in maternal side
R.O.S
No history of Asthma, thyroid disorders on both maternal and paternal side. No
history of genetic disorders • General: (+) fever, (-) chills, (-) weight loss.
• Skin: (-) Skin lesions, (-) rash, (-) laceration, (-) bruising, (-) burn, (-) Cyanosis
• Head: (-) Injury
PERSONAL AND SOCIAL HISTORY
• Eyes: (-) redness, (-) discharge ENT: (-) nasal discharge (-) feeding difficulties
Mother is 30 years old, homemaker. Father is 35 year old, E bike driver. Both
parents are non smoker, occasional alcoholic beverage drinker. • Neck: (-) swelling
• Pulmo: (+) DOB, (+) cough, (-) hemoptysis
• GI: (-) Nausea, (-) vomiting, (-) diarrhea, (-) melena, (-) hematochezia
• ENVIRONMENTAL HISTORY • Genital: (-) dysuria, (-) hematuria
• Total of 15 household members and they reside in 1BR house that has a CR
• Neurologic: (+) Seizure, (-) Dizziness
inside the house, efficient garbage disposal system. Primary care taker of the
house is Father. They drink mineral water
PHYSICAL EXAM NEUROLOGICAL EXAM
• General: Awake, febrile, in respiratory distress. • Cerebral: Very active and attentive baby, (-) decreased muscle tone.(-) disorientation
• Vitals: T- 37.8*c, RR-42cpm, HR- 110bpm, O2:96% at room air • Cerebellar: Baby can give hand shakes and hifi, (-)Abnormal gait, (-) nystagmus. (-) Slurred speech, (-) Babinski reflex
• Anthropometric measurements • Cranial Nerves:
• Height-73cm • I-was not assed
• II- bilateral blinking of eyes
• Weight-8kg
• III [Link]- EOMs Intact V-Able to feed well
• HC-45cm
• VII-Facial symmetry is normal, can laugh and cry
• Skin: Warm to touch, Good turgor (-) jaundice (-) pallor
• VIII-Tums to source of sound
• HEENT: Anicteric sclera, pink palpebral conjunctiva, moist lips and tongue
• IX,X-Able to swallow
• Chest & lung Equal chest expansion, (+) rales BLF, (+) subcostal retractions • XI-symmetric shoulders
• Cardiovascular: Adynamic precordium, Distinct heart sound, (-) murmur • XII-Tongue in midline
• Abdomen: Flat, soft, non distended, non- tender, Normoactive bowel sound • Sensory: Able to feel heat. Pain and vibration
• Genitourinary: Grossly male • Motor: Good muscle tone in all extremities
• Extremities: Strong peripheral pulses, Crt-<2sec • Primitive Reflexes
• (+) palmar grasp reflex, (+) plantar grasp reflex, (+) rooting reflex, (+) moro reflex
 SALIENT FEATURES
• Cough with whitish sputum
• High-grade fever
• Seizure episode x1
• Age 1 yrs
• (+) Rales BLF
• (+) Subcoastal retractions
• (+) DOB

Febrile Seizure
• High-grade fever preceding seizure.
PRIMARY IMPRESSION Age (6 months to 5 years is typical for febrile seizures).
• No focal neurological deficits post-seizure.
• PCAP- HR
• SIMPLE FEBRILE SEIZURE SECODARY TO PCAP HR • KEY RECOMMENDATION: Pediatric community-acquired pneumonia (PCAP) is considered in a patient
who presents with cough or fever, PLUS any of the following positive predictors of radio graphically-
confirmed pneumonia: (Conditional recommendation, very low-grade evidence)
• Tachypnea
• 1.1. 3 months to 12 months old: ≥50 breaths per minute
• 1.2. 1 year old to 5 years old: ≥40 breaths per minute
• 1.3. 5 years to 12 years old: ≥30 breaths per minute
• 1.4. 12 years old: ≥20 breaths per minute
• 2. Retractions or chest indrawing
• 3. Nasal flaring
• 4. O, saturation <95% at room air
• 5. Grunting
DEFERENTIAL DIAGNOSIS
• Complex Febrile Seizure
RULE IN: Influenza with Secondary Encephalitis
Fever preceding the seizure is a shared feature between simple and complex febrile seizures.
Rule OUT: Rule In:
• Seizure duration was less than 5 minutes (complex febrile seizures last >15 minutes). • 1. Respiratory Symptoms
• No focality: Complex febrile seizures are often focal, but this patient had generalized seizure features (upward • 2. Seizures and CNS Involvement
rolling of eyes, stiffening of extremities). • 3. Fever
• No recurrence: Complex febrile seizures may occur multiple times in 24 hours, but this patient had only one episode. • 4. Age
• Normal sensorium post-seizure: In complex febrile seizures, patients often have a prolonged post-ictal state or
neurological deficits. • Rule Out
• Aspiration Pneumonitis • 1. Absence of Specific Neurological Findings
Rule In: • 2. Tests like Negative Influenza Testing
• Persistent cough with possible history of aspiration (e.g., during feeding or reflux, common in young children).
• Fever secondary to inflammation or infection. • 3. Lack of Post-Infectious Complications
• Seizure could be triggered by hypoxia or fever.
• Rule Out:
• No history of choking or feeding difficulties.
• Test like CXR is needed to rule out
• No hypoxia

DIAGNOSTIC
• Complete Blood Count (CBC): To assess for signs of infection or anemia.
• C-Reactive Protein (CRP) or Erythrocyte Sedimentation Rate (ESR): To assess
for systemic inflammation, which is typically elevated in bacterial infections.
• Chest X-ray: To assess for pneumonia, consolidation, or signs of respiratory
distress.
• URINALYSIS: for detecting UTI, dehydration, or renal complications
• Covid 19 Rapid Antigen Test: to rule out COVID
• Biofire FilmArray Pneumonia Panel: to find the causative organism
 Ampicillin 600mg iv drip q6hr (AD: 300mkd)
• Weight= 8kg
Course on the ER 11:48 pm Calculations • Rcommended dose for severe infections: 300-
Ivf D5lr 1l at 50cc/hr (MR+ mild) 400mkd
• PLAN l:
• MR = 100 mL/kg/day x 8kg = 800 mL/day • Give dose = RECOMENDED DOSE X
• Please admit the px to pedia ward under the service of [Link]
• Deficit = 0.05 x 8 kg = 0.4kg (5%of body weight) WEIGHT/PREPARATION
SUBJECTIVE: (+) fever (+) cough, (-) seizure • Please get consent to care
recurrence • Since 1 kg = 1000 mL of fluid, the deficit is: 0.4 kg x 1000 = 300x8/500 =4.8mg
• Trp for q4 hrs mL/kg = 400 mL • Actual dose = G.D x prep/Wt
OBJECTIVE: • O2 at 2 lpm • Total daily fluid = MR + Deficit = 800 mL/day + 400 mL =
• awake, febrile, in respiratory distress mild 1200 mL/day
= 4.8x500 /8 =300MKD
• Vital Signs: • Ivf D5lr 1l at 50cc/hr (MR+ mild) = 300x8/4= 600mg per dose
• Hourly fluid rate = 1200 mL/day /24 hours
• T-37.8 PR-120bpm • Labs CBC,COVID RAT
• RR-42cpm 02-96% • =50cc/hr
• Skin: Warm to touch, Good turgor (-) jaundice (-) • CHEST XRAY APL
pallor Paracetamol 100mg/ml, 0.8ml q 4hrs
• MEDS Diazepan 1.6mg iVTT (AD. 0.2mkd)
• HEENT: Anicteric sclerae, pink palpebral conjunctiva,
• Weight: 8kg
moist lips and tongue • Paracetamol 100mg/1drip give 0.8ml q4 hrs prn for temp >38c • Wt: 8kg
• Chest & lung: Equal chest expansion,(+) Rales (+) • recommended dose: 10-15mkd q 4 hrs
subcoastal retraction (+) wheezes • Ampicillin 600mg iv drip q6hr (AD: 300mkd) • R.D = 0.2-0.5mkd
• Abdominal: Normoactive bowel sound soft • GIVEN DOSE = RECOMENDED DOSE X
nontender • Diazepam1.6mg ivtt prn for active seizure (AD:0.2mkd) WEIGHT/PREPARATION • Give dose =RECOMENDED DOSE X
• Genitourinary: Grossly Female • CBS now then q 8 HR while on npo • = 10 x 8/ 100 = 0.8ml WEIGHT/PREPARATION
• Extremities: Strong peripheral pulses, CRT <2 Sec.
• ASSESSMENT: SIMPLE FEBRILE SEIZURE SECODARY TO • Monitor vs for q4 • actual dose = given dose x preparation/ weight = = 0.2x8/5 = 0.32mg
0.8x100/8 = 10MKD
• Actual dose = G.D x preparation/Wt
PEDIATRIC COMMUNITY ACQUIRED PNEUMONIA
• Monitor i&o qshift
• Inform pedia resident for admission =0.32x 5/ 8 = 0.2MKD
• Secure consent for lumbar puncture = 0.2x8= 1.6mg per dose

Course in the ward Day 1 7:30 am Course in ward day 1 9:53am

• S: (+) FEVER (-) SEIZURE RECURRANCE SUBJECTIVE: (-) FEVER (-)LBM ASSESSMENT: SIMPLE FEBRILE SEIZURE SECODARY TO
ASSESSMENT: SIMPLE FEBRILE SEIZURE SECODARY TO PEDIATRIC COMMUNITY ACQUIRED PNEUMONIA
• O: awake,febrile,in mild respiratory distress , febrile, in PEDIATRIC COMMUNITY ACQUIRED PNEUMONIA (-) VOMITING
respiratory distress PLAN:
• Vital Signs: PLAN: OBJECTIVE:
• T-37.8 PR-161 • awake, afebrile, in respiratory distress
• May have dropper of feeding with SAP
•
Patient awake, irritable in respiratory distress
RR-42cpm 02-98%
• Skin: Warm to touch, Good turgor (-) jaundice (-) pallor
• Vital Signs: • Decrease IVF rate to 38 mL /hr (MR+ 15%)
NPO • T-37.2C PR-134bpm
• HEENT: Anicteric sclerae, pink palpebral conjunctiva, moist lips
O2 at O2 2LPM via nasal cannula • RR-44cpm 02-96% • Ivtt D5LR 1 L 38 ML/H (MR+ 15%)
and tongue
• Chest & lung: Equal chest expansion, (+) SHALLOW SUBCOASTAL
• Skin: Warm to touch, Good turgor (-) jaundice (-) pallor • CONTINUE MEDICATION
Ivtt D5LR1 litre at 50 mL/h (+) Maculopapular rash generalised
RETRACTION (+) RALES
• Cardiovascular: Adynamic precordium, Distinct heart sound, (-) For CSF analysis • HEENT: Anicteric sclerae, pink palpebral conjunctiva, • REFER accordingly
moist lips and tongue
murmur
• Abdomen: Flat, soft, non distended, non-tender, Normoactive Follow up pending labs • Chest & lung: Equal chest expansion, (+) rales BLF, (+) • Start folic acid drops 1ml once a day
bowel sound Continue meds subcostal retractions. • Start cetirizine in 5MG/5ML, 2ML then ODHShere after
• Genitourinary: Grossly Female • Cardiovascular: Adynamic precordium, Distinct heart
• Extremities: Strong peripheral pulses, Crt 2 Sec. Active seizure precautions sound, (-) murmur • Start folic acid 1ml once a day
• Abdomen: Flat, soft, non distended, non-tender,
Accordingly Normoactive bowel sound • Refer accordingly
• Genitourinary: Grossly Female
• Extremities: Strong peripheral pulses, Crt 2 Sec.
Calculations Course in ward day 1 6pm
Cetirizine in 5MG/5ML(1MG/1ML), 2ML then ODHS
RD- 2.5mkd ASSESSMENT: SIMPLE FEBRILE SEIZURE SECODARY TO
• D5LR 438 CC/HR (MR + 15%) Give dose = RECOMENDED DOSE X SUBJECTIVE: (-) FEVER (-)LBM PEDIATRIC COMMUNITY ACQUIRED PNEUMONIA
WEIGHT/PREPARATION (-) VOMITING (+) FINE RALES (+) SHALLOW Plans
• Patient weight: 8kg
RETRACTION,
=2.5x8/1 = 20mg May have soft diet with SAP
Actual dose = G.D x prep/Wt OBJECTIVE:
• 1-10kg-100ml/kg/day = 8kg x 100 • awake, afebrile, in respiratory distress O2 PRn
= 20x1/8= 2.5MKD • Vital Signs: Decreased IVF to 30cc/hr
•
mkD = 800ml/kg/day 15% = Folic acid 1ml once a day •
T-37.0C PR-134bpm
RR-44cpm 02-96% For repeat CBC tomorrow, 5 AM
800ml/day x 0.15 = 120 ml/day • Skin: Warm to touch, Good turgor (-) FF UP UA
jaundice (-) pallor
RD – 0.1 – 0.3 • HEENT: Anicteric sclerae, pink palpebral Continue meds
• 800ml/day + 120ml/day Prep- 1mg/1ml conjunctiva, moist lips and tongue
Refer accordingly
• Chest & lung: Equal chest expansion, (+) rales
920ml/day Given dose = 0.1x8/1 = 0.8MG BLF, (+) subcostal retractions (+) wheeze
Actual dose= given dosexprep/weight= 0.8x1/8 = • Cardiovascular: Adynamic precordium,
• 920 ml/24 hrs = 38.3 ≈ 38cc/hr 0.1MKD
Distinct heart sound, (-) murmur
• Abdomen: Flat, soft, non distended, non-
tender, Normoactive bowel sound
• Genitourinary: Grossly Female
• Extremities: Strong peripheral pulses, Crt 2
Sec.

Course in ward day 2 2:29 am

ASSESSMENT: SIMPLE FEBRILE SEIZURE SECODARY TO
• D5LR at 30CC/HR (MR )
SUBJECTIVE: (+) FEVER (-)LBM PEDIATRIC COMMUNITY ACQUIRED PNEUMONIA
(-) VOMITING (+) seizure recurrence (1min) Plans
• Patient weight: 8kg OBJECTIVE:
• awake, afebrile, in respiratory distress
NPO

• 1-10kg – 100ml/kg/day = 8kg x • Vital Signs: O2 at 2L p.m., via nasal cannula

• T-38.4C PR-134bpm Maintain IVT rate at 30cc/hr
•
100 mkD RR-44cpm 02-96%
• Skin: Warm to touch, Good turgor (-) Continue present, meds

• = 800 ml/kg/day
jaundice (-) pallor Seizure precautions
• HEENT: Anicteric sclerae, pink palpebral
conjunctiva, moist lips and tongue Refer accordingly
• 800 ml/24 hrs = 30cc/hr • Chest & lung: Equal chest expansion, (+) rales
BLF, (+) subcostal retractions (+) wheeze
• Cardiovascular: Adynamic precordium,
Distinct heart sound, (-) murmur
• Abdomen: Flat, soft, non distended, non-
tender, Normoactive bowel sound
• Genitourinary: Grossly Female
• Extremities: Strong peripheral pulses, Crt 2
Sec.
 Course in ward day 2 8:20am Calculations
ASSESSMENT: SIMPLE FEBRILE SEIZURE SECODARY TO
SUBJECTIVE: (+) FEVER (-)LBM PEDIATRIC COMMUNITY ACQUIRED PNEUMONIA
(-) VOMITING Plans • Start ferrous sulphate 1ml OD
OBJECTIVE:
• awake, afebrile, in respiratory distress
O2 at 2LPM via nasal cannula • Preparation dose- 75mg/1ml(15mg elemental iron)
•
• Vital Signs: Ivtt D5LR 1L 30cc/hr
• T-38.4C PR-134bpm Continue medications
R.D- minimum dose: 2-30mkd
• RR-44cpm 02-96%
• Skin: Warm to touch, Good turgor (-) Seizure, precaution • Give dose = R.D x wt/preparation
•
jaundice (-) pallor Start salbutamol nebulisation 1 neb q4hr
• HEENT: Anicteric sclerae, pink palpebral = 2x8/15 = 1.06mg
conjunctiva, moist lips and tongue Refer accordingly
• Chest & lung: Equal chest expansion, (+) rales
BLF, (+) subcostal retractions (+) wheeze Discontinue folic acid start ferrous sulphate 1ml OD • Actual dose = G.D x prep/Wt
• Cardiovascular: Adynamic precordium,
Distinct heart sound, (-) murmur • = 1.06x15/8 = 2MKD
• Abdomen: Flat, soft, non distended, non-
tender, Normoactive bowel sound
• Genitourinary: Grossly Female
• Extremities: Strong peripheral pulses, Crt 2 • = 2x 8/1 = 16mg per dose
Sec.

Course on the ward Day 2 4:45pm Course on the ward Day 3 11:30 am
SUBECTIVE (-) cough, (-) DOB (-) seizure (-) fever, (-
)seizures recurrence ASSESSMENT: SIMPLE FEBRILE SEIZURE SUBECTIVE (-) cough, (-) DOB (-) seizure (-) fever, (- ASSESSMENT: SIMPLE FEBRILE SEIZURE
OBJECTIVE: SECODARY TO PEDIATRIC COMMUNITY )seizures recurrence
• awake, afebrile, in respiratory distress ACQUIRED PNEUMONIA SECODARY TO PEDIATRIC COMMUNITY
OBJECTIVE: ACQUIRED PNEUMONIA
• Vital Signs:
• T-36.7C PR-123bpm PLAN: • awake, afebrile, in respiratory distress
• Vital Signs: PLAN:
• RR-38cpm 02-99% • May have Breast feeding with SAP • T-36.7C PR-123bpm
• Skin: Warm to touch, Good turgor (-) jaundice (-) • Continue direct proceeding with SAP
pallor • O2 1LPM nasal cannula • RR-38cpm 02-99%
• HEENT: Anicteric sclerae, pink palpebral conjunctiva, • Skin: Warm to touch, Good turgor (-) jaundice (-) • Maintain O2 at 1lpm via nasal Cannula
moist lips and tongue • IVTT D5LR 1L at 30c/hr pallor
• Chest & lung: Equal chest expansion, (+) rales BLF (+) • HEENT: Anicteric sclerae, pink palpebral conjunctiva, • Ivtt :D5LR 1L @ 30CC/HR
shallow subcoastal retractions • Continue medication moist lips and tongue
• Cardiovascular: Adynamic precordium, Distinct heart • Chest & lung: Equal chest expansion, (+) rales BLF (+) • Continue medication
• Refer according Subcoastal retractions
sound, (-) murmur
• Abdomen: Flat, soft, non distended, non-tender, • Cardiovascular: Adynamic precordium, Distinct heart • Moderate high back rest
• Refer accordingly
Normoactive bowel sound sound, (-) murmur
• Genitourinary: Grossly Female • Abdomen: Flat, soft, non distended, non-tender,
Normoactive bowel sound
• Extremities: Strong peripheral pulses, Crt <2 Sec.
• Genitourinary: Grossly Female
• Extremities: Strong peripheral pulses, Crt <2 Sec.
 Course on ward Day 4 9:59am Calculations
SUBECTIVE (-) cough, (-) DOB (-) seizure (-) fever, (- ASSESSMENT: SIMPLE FEBRILE SEIZURE
)seizures recurrence SECODARY TO PEDIATRIC COMMUNITY
OBJECTIVE: ACQUIRED PNEUMONIA Cefuroxime 270mg iv drip q8hrs nst (AD:100mkd)
• awake, afebrile, in respiratory distress R.D= 100-200mkd
• Vital Signs:
PLAN: Preparation: 750mg
• T-36.7C PR-123bpm Given dose = R.D x wt/ prep
• RR-38cpm 02-99%
• Skin: Warm to touch, Good turgor (-) jaundice (-) • Continue direct breastfeeding with sap = 100x8/750= 1.06mg
Actual dose = G.D x preparation/Wt
pallor
• HEENT: Anicteric sclerae, pink palpebral conjunctiva, • Maintain O2 at 1LPM via nasal Cannula = 1.06 x 750/8 =100MKD
moist lips and tongue
• Chest & lung: Equal chest expansion, (+) rales BLF
• Maintain IVF rate at 30 cc/hr
= 100x 8/ 3 = 267≈270mg per dose
with wheeze (+) subcoastal retractions
• Cardiovascular: Adynamic precordium, Distinct heart
• Hold Ampicillin and start cefuroxime 250mg
sound, (-) murmur iv drip q8hrs nst (AD:100mkd)
• Abdomen: Flat, soft, non distended, non-tender,
Normoactive bowel sound • Start salbutamol nebulization 1neb q4hrs
• Genitourinary: Grossly Female • Continue medication
• Extremities: Strong peripheral pulses, Crt <2 Sec.
• Moderate high back rest
• Refer accordingly

Course on ward Day 4 4:16pm Course on the ward Day 5 10:09am

SUBECTIVE (-) cough, (-) DOB (-) seizure (-) fever (-)
SUBECTIVE, (-) DOB (-) seizure (-) fever (+) cough, (- cough, (-)seizures recurrence
)seizures recurrence ASSESSMENT: SIMPLE FEBRILE SEIZURE ASSESSMENT: SIMPLE FEBRILE SEIZURE
SECODARY TO PEDIATRIC COMMUNITY OBJECTIVE: SECODARY TO PEDIATRIC COMMUNITY
ACQUIRED PNEUMONIA • awake, afebrile, in respiratory distress
ACQUIRED PNEUMONIA
OBJECTIVE:
• awake, afebrile, in respiratory distress PLAN: • Vital Signs: PLAN:
• T-36.7C PR-123bpm
• Vital Signs:
• T-36.7C PR-123bpm
• RR-38cpm 02-99% • Continue direct breastfeeding with Sap
• Skin: Warm to touch, Good turgor (-) jaundice (-)
• RR-38cpm 02-99% • Continue direct breastfeeding with sap pallor • Maintain O2 at 1 lpm via Nasal cannula
• Skin: Warm to touch, Good turgor (-) jaundice (-)
pallor • Maintain O2 at 1LPM via nasal Cannula • HEENT: Anicteric sclerae, pink palpebral conjunctiva,
moist lips and tongue • Ivtt D5LR 1LPM @ 30CC/HR
• HEENT: Anicteric sclerae, pink palpebral conjunctiva,
moist lips and tongue • Maintain Ivtt D5LR rate at 30 cc/hr • Chest & lung: Equal chest expansion, (+) Shallows
subcoastal retraction +) rales BLF with occasional
• Hold cefuroxime and stat ceftraxine 455mg
• Chest & lung: Equal chest expansion, (+) rales (+)
• Continue medication wheeze iv drip q12hrs AD(100mkd)
Shallows subcoastal retraction
• Cardiovascular: Adynamic precordium, Distinct heart • Refer accordingly
• Cardiovascular: Adynamic precordium, Distinct heart
sound, (-) murmur • Q12 hrs
• Continue medication
sound, (-) murmur • Abdomen: Flat, soft, non distended, non-tender,
• Abdomen: Flat, soft, non distended, non-tender, Normoactive bowel sound
Normoactive bowel sound
• Genitourinary: Grossly Female
• Genitourinary: Grossly Female • Moderate high high back test
• Extremities: Strong peripheral pulses, Crt <2 Sec.
• Extremities: Strong peripheral pulses, Crt <2 Sec. • Refer accordingly
 Calculations Course on the ward Day 6 11:04am
SUBECTIVE (-) cough, (-) DOB (-) seizure (-) fever (-) ASSESSMENT: SIMPLE FEBRILE SEIZURE
Ceftriazone 400 mg. I,V drip Q12h (AD 100mkd) cough, (-)seizures recurrence SECODARY TO PEDIATRIC COMMUNITY
Wt: 10 kg ACQUIRED PNEUMONIA
Recommended dose 100 mkd OBJECTIVE: PLAN:
Given dose = R.D x wt/ prep • awake, afebrile, in respiratory distress
= 100x8/500 = 1.6mg • Vital Signs: • Insert NGT Start NGT milk feeding at 50cc q
Actual dose= Given dose (in mg) x prep/ weight (in kg) • T-36.7C PR-123bpm 3h refer if not tolerated
= 1.6x 500/8 = 100MkD • RR-38cpm 02-99%
• Skin: Warm to touch, Good turgor (-) jaundice (-)
• O2 at 2LPM
pallor • Always check pattern of NGT before
= 100x8/2= 400mg/dose • HEENT: Anicteric sclerae, pink palpebral conjunctiva, feeding
moist lips and tongue
• Chest & lung: Equal chest expansion,(+) subcoastal
retraction +) rales
• Moderate high back
• Cardiovascular: Adynamic precordium, Distinct heart • IVTT D5LR at 30cc/hr
sound, (-) murmur
• Abdomen: Flat, soft, non distended, non-tender, • Continue medication
Normoactive bowel sound
• Genitourinary: Grossly Female • Repeat CBC with platelet
• Extremities: Strong peripheral pulses, Crt <2 Sec. • Ffp CRP
• Refer accordingly

Course on the ward Day 7 11:05am Course on ward Day 8 11 am

SUBECTIVE (-) cough, (-) DOB (-) seizure (-) fever (-) SUBECTIVE (-) cough, (-) DOB (-) seizure (-) fever (+)
cough, (-)seizures recurrence cough, (-)seizures recurrence ASSESSMENT: SIMPLE FEBRILE SEIZURE
ASSESSMENT: SIMPLE FEBRILE SEIZURE SECODARY TO PEDIATRIC COMMUNITY
SECODARY TO PEDIATRIC COMMUNITY OBJECTIVE: ACQUIRED PNEUMONIA
OBJECTIVE: ACQUIRED PNEUMONIA
• awake, afebrile, in respiratory distress • awake, afebrile, in respiratory distress
PLAN: • Vital Signs:
PLAN:
• Vital Signs:
• T-36.7C PR-123bpm • T-36.7C PR-123bpm
• RR-38cpm 02-99% • So refuse, ngt insertion • RR-38cpm 02-99%
• Skin: Warm to touch, Good turgor (-) jaundice (-) • Let so clan waiver done • Skin: Warm to touch, Good turgor (-) jaundice (-) • Continue direct breastfeeding with SAP
pallor
pallor
• HEENT: Anicteric sclerae, pink palpebral conjunctiva, • Continue direct meeting with SAP • HEENT: Anicteric sclerae, pink palpebral conjunctiva, • Maintain O2 at 2 lpm via nasal cannula
moist lips and tongue
• Chest & lung: Equal chest expansion, (+) subcoastal • Maintain O2 at 2lpm via via nasal Cannula
moist lips and tongue
• Chest & lung: Equal chest expansion, (+) rales (+) • Ivtt :D5LR 1l @ 30cc/hr
retraction (+) rales with occasional wheeze
• Ivtt ;D5LR 1l @ 30cc/hr
Shallows subcoastal retraction
• Cardiovascular: Adynamic precordium, Distinct heart
• Hold ferrous sulphate po
• Cardiovascular: Adynamic precordium, Distinct heart
sound, (-) murmur
• Continue present medication
sound, (-) murmur • Continue other medications
• Abdomen: Flat, soft, non distended, non-tender, • Abdomen: Flat, soft, non distended, non-tender,
Normoactive bowel sound
• Refer accordingly
Normoactive bowel sound • Moderate high back rest
• Genitourinary: Grossly Female • Genitourinary: Grossly Female
• Extremities: Strong peripheral pulses, Crt <2 Sec. • Extremities: Strong peripheral pulses, Crt <2 Sec. • Refer accordingly
 FEBRILE SEIZURE
• A febrile seizure is a convulsion in a child that’s caused by a fever. The
fever is often from an infection. Febrile seizures occur in young,
healthy children who have normal development and haven’t had any
FINAL DIAGNOSIS neurological symptoms before.
SIMPLE FEBRILE SEIZURE SECODARY TO PEDIATRIC COMMUNITY • Classified into
ACQUIRED PNEUMONIA • 1. Simple febrile seizure
• 2. Complex febrile seizure

SYMPTOMS
• Usually, a child having a febrile seizure shakes all over and loses
consciousness. Sometimes, the child may get very stiff or twitch in just
one area of the body.
• A child having a febrile seizure may:
• Have a fever higher than 100.4 F (38.0 C)
• Sudden rise in temperature
• Lose consciousness
• Shake or jerk the arms and legs
• Febrile seizures are classified as simple or complex:
CAUSES RISK FACTORS
• Usually, a higher than normal body temperature causes febrile seizures. Even a low- • Factors that increase the risk of having a febrile seizure include:
grade fever can trigger a febrile seizure.
• Infection • Young age. Most febrile seizures occur in children between 6 months
• The fevers that trigger febrile seizures are usually caused by a viral infection, and less and 5 years of age, with the greatest risk between 12 and 18 months
commonly by a bacterial infection. The flu (influenza) virus and the virus that causes of age.
roseola, which often are accompanied by high fevers, appear to be most frequently
associated with febrile seizures. • Family history. Some children inherit a family’s tendency to have
• Post-vaccination seizures seizures with a fever.
• The risk of febrile seizures may increase after some childhood vaccinations. These
include the diphtheria, tetanus and pertussis vaccine and the measles-mumps-rubella
vaccine. A child can develop a low-grade fever after a vaccination. The fever, not the
vaccine, causes the seizure.

TREATMENT DURING SEIZURE PROGNOSIS

• Most febrile seizures stop on their own within a couple of minutes. If your child has a febrile seizure, • No long-term effects
stay calm and follow these steps:
• Outgrow by age 5
• Place your child on his or her side on a soft, flat surface where he or she won’t fall.
• Low risk of epilepsy
• Start timing the seizure.
• Stay close to watch and comfort your child.
• Low risk of mortality
• Remove hard or sharp objects near your child. • However, there are some things to consider:
• Loosen tight or restrictive clothing. • Risk of recurrence
• Don’t restrain your child or interfere with your child’s movements. • The overall recurrence rate of febrile seizures is about 35%. The risk of recurrence is higher if
children are under 1 year of age when the initial seizure occurs.
• Don’t put anything in your child’s mouth.
• Other risk factors
• Call for emergency medical attention if:
• Your child has a febrile seizure that lasts more than five minutes.
• The risk of developing a seizure disorder is higher if children have additional risk factors, such
as developmental delay or a family history of seizures.
• Your child has repeated seizures.
• First sign of a underlying disorder
• Your child’s seizure lasted less than five minutes but your child isn’t improving quickly.
 PEDIATRIC COMMUNITY ACQUIRED
PREVENTION PNEUMONIA
• Most febrile seizures occur in the first few hours of a fever, during the • Community-acquired pneumonia (CAP) is a serious lung infection in children
initial rise in body temperature. that can be caused by viruses or bacteria. It’s a leading cause of death in
children under five years old worldwide.
• Giving your child medications
• Symptoms
• Giving your child infants’ or children’s acetaminophen at the
• Fever, cough, and rapid breathing are common symptoms. In younger children,
beginning of a fever may make your child more comfortable, but it rapid breathing is the most sensitive indicator of pneumonia.
won’t prevent a seizure.
• Causes
• Prescription prevention medications
• In preschool-aged children, viral and Streptococcus pneumoniae infections are
• Rarely, prescription anticonvulsant medications are used to try to most common. In older children, Mycoplasma pneumoniae is more common.
prevent febrile seizures.

RISK FACTORS CLASSIFICATION OF PNEUMONIA

• Age: Being younger than 6 months old • Classification by Severity: • Severe CAP:
• Mild/Moderate CAP:
• Birth: Being born prematurely or with birth defects Hospitalization is required** for severe pneumonia,
especially when the child shows signs of respiratory
• Outpatient management** is typically appropriate for failure, hypoxia, or sepsi
• Immune system: Having a weak immune system, which can be caused by children with mild to moderate symptoms and no
significant comorbidities or risk factors. Symptoms include:
malnutrition, undernourishment, or HIV infections
• -Symptoms may include: Severe respiratory distress (e.g., tachypnea, use of
• Pre-existing conditions: Having a chronic lung disease, heart or lung disease, or • Low-grade fever
accessory muscles, retractions)
nervous system problems • Cough
Persistent fever
• Environmental factors: Living in crowded homes, exposure to indoor air • Mild respiratory distress
Cyanosis or hypoxia (O2 saturation < 90%)
pollution, or parental smoking • No significant hypoxia or dehydration
Dehydration

• Social determinants: Living conditions, parental health behaviors, and access • Children who respond well to initial outpatient therapy
Tachycardia or hypotension (signs of sepsis or shock)
to healthcare services and have no evidence of severe infection typically fall Altered mental status (e.g., lethargy, confusion)
into this category.
May require intensive care unit (ICU) admission if there
• Vaccinations: Not being fully vaccinated is concern for respiratory failure or need for mechanical
ventilation.
2. Classification by Etiology: Classification by Location/Extent:
Viral Pneumonia: Bacterial Pneumonia:
Common Viruses: • Common Bacterial Pathogens:
Lobar Pneumonia: Interstitial Pneumonia:
• Respiratory syncytial virus (RSV) • Streptococcus pneumoniae (most common in children under 5 years old)
• Influenza virus • Haemophilus influenzae type b (Hib)
• Involves a single lobe of the lung and typically • Involves the interstitial tissue of the lungs,
presents with more localized symptoms (e.g., leading to more diffuse infiltrates on chest X-
• Parainfluenza virus • Mycoplasma pneumoniae (more common in older children and pleuritic chest pain, focal crackles on ray.
adolescents)
• Adenovirus auscultation).
• Chlamydia pneumoniae Common in viral infections, especially RSV or
• Rhinovirus Often caused by Streptococcus pneumoniae. influenza virus.
• Staphylococcus aureus, including methicillin-resistant Staphylococcus
• Human metapneumovirus aureus (MRSA) • Bronchopneumonia: • Pleural Effusion/Empyema:
• Viral pneumonia is more common in infants and young children and• Group A Streptococcus (GAS)
tends to present with mild to moderate symptoms. • A more diffuse infection affecting multiple areas When infection extends to the pleural space, it
• Escherichia coli (more common in neonates) of the lungs (patchy infiltrates on imaging). may lead to a pleural effusion or empyema (a
• Bacterial pneumonia generally presents with higher fever, more severe collection of pus in the pleural cavity).
Atypical Pneumonia: respiratory distress, and sometimes bacteremia or sepsis. • It may be seen in viral infections or with bacterial
Caused by Mycoplasma pneumoniae, Chlamydia pneumoniae, and Fungal Pneumonia:
infections like Staphylococcus aureus or Staphylococcus aureus and Streptococcus
Legionella pneumophila. These pathogens may present with more Haemophilus influenzae. pneumoniae are common
subtle symptoms, such as: • Less common but may occur in immunocompromised children.
Persistent dry cough • Pathogens may include Histoplasmosis, Coccidioides, or Cryptococcus.
Mild fever • Tuberculosis (TB) Pneumonia:
Sometimes, extrapulmonary signs (e.g., rashes, joint pains)
Often affects children older than 5 years.

PROGNOSIS TREATMENT
• Mild to Moderate Cases: Most children recover fully with appropriate • Reduce respiratory symptoms
treatment (antibiotics, antivirals, supportive care). Full recovery is expected Eradicate infection with antimicrobials, if indicated
with no long-term complications. • Prevent complications
• Amoxicillin is the first-line choice of oral empiric treatment in school-aged children with coverage for S. Pneumoniae
• Severe Cases: Children may require hospitalization or ICU care if they have • IDSA guidelines recommend the use of macrolide antibiotics for the treatment of atypical pneumonia in children
respiratory failure, sepsis, or pleural effusion. Recovery is possible with timely
treatment, but complications may prolong recovery. Admission criteria
• Complications: Severe infections (e.g., from MRSA, Streptococcus • Respiratory distress
pneumoniae) may lead to pleural effusion, empyema, or sepsis, increasing the • Tachypnea
risk of prolonged illness or death. • Age 0 to 2 months: more than 60 breaths per minute
• Long-Term Outlook: Most children recover fully, but some may have lingering • Age 2 to 12 months: more than 50 breaths per minute
symptoms (e.g., cough, fatigue) for weeks. Repeated severe episodes may lead • Age 1 to 5 years: more than 40 breaths per minute
to chronic conditions like asthma or bronchiectasis. • Older than 5 years: more
PREVENTION
Vaccination:
• Pneumococcal vaccine (PCV13) protects against Streptococcus pneumoniae.
Influenza vaccine reduces the risk of influenza-associated pneumonia.
• Haemophilus influenzae type b (Hib) vaccine prevents Hib pneumonia.
Good Hygiene Practices:
JOURNAL 1
• Hand washing to reduce viral and bacterial transmission.
Cough etiquette (covering mouth/nose when coughing).
• Avoid Smoking Exposure:
• Second-hand smoke increases the risk of respiratory infections in children.
• Breastfeeding:
• Exclusive breastfeeding during the first 6 months boosts the immune system.
• Prompt Treatment of Respiratory Infections:
• Early diagnosis and treatment of upper respiratory infections can prevent progression to pneumonia.

Viral etiological causes of febrile seizures for

INTRODUCTION AND BACKGROUND
respiratory pathogens (EFES Study)
Authors: Background
Febrile seizures are the most common type of seizure in children and are
Kursat Bora Carman a , Mustafa Calik b , Yasemin Karal c , Sedat Isikayd often associated with viral infections, particularly those involving respiratory
, Ozan Kocake , Aysima Ozcelik f ,Ahmet Sami Yazar g , Cagatay Nuhoglu pathogens. Identifying the viral causes of febrile seizures helps improve
h , Cigdem Sagh, Omer Kilic i , Meltem Dinleyici j, Sibel Lacinel Gurlevik a diagnostic approaches and clinical management. This study investigates the
viral etiological agents of febrile seizures with a focus on respiratory
,Sevgi Yimenicioglu k , Arzu Ekici l , Peren Perkf , Ayse Tosun m , Ilhan pathogens.
Isik n , Coskun Yarar a , Didem Arslantas o ,and Ener Cagri Dinleyici, and Introduction
EFES Study l The study explores the association between febrile seizures and specific
Published on 2018 respiratory viral infections. It highlights the importance of understanding the
viral etiology to guide targeted interventions and treatment in pediatric
patients. The authors emphasize that respiratory infections are a significant
trigger for febrile seizures and that certain viruses may pose a higher risk.
CRITERIAS METHODS AND RESULTS
Inclusion Criteria • Methods
• The study includes: • The study used a prospective observational design to analyse Pediatric
• Children aged between 6 months and 5 years. patients presenting with febrile seizures. Respiratory samples were collected
and tested for viral pathogens using advanced molecular diagnostic tools.
• Diagnosed with febrile seizures. Clinical data, including age, sex, and presenting symptoms, were recorded. The
• Exhibiting symptoms of respiratory infections. analysis focused on identifying the frequency and distribution of specific viral
pathogens.
• Results
Exclusion Criteria
• The study identified multiple respiratory viruses associated with febrile
• The study excludes: seizures, including influenza, respiratory syncytial virus (RSV), and rhinovirus.
• Children with a history of afebrile seizures or epilepsy. • RSV was the most frequently detected virus.
• Presence of underlying neurological disorders. • The majority of cases occurred in children under the age of 3 years.
• Febrile seizures caused by non-infectious etiologies. • A seasonal trend was observed, with most cases occurring during the winter
months.

1. Virus Detection
• Overall Detection Rate**: At least one respiratory virus was identified in **82.7% (144/174)** of children with febrile seizures. 3. First Febrile Seizure:
• 41.6% had one virus detected. • Influenza B was the most common virus identified in children experiencing their first febrile seizure (p < 0.05).
• 31.3% had two viruses. 4. Complex vs. Simple Febrile Seizures:
• 20.8% had three viruses. • Simple Febrile Seizures: RSV A was more common.
• 4.8% had four viruses. • Complex Febrile Seizures: Human Bocavirus (HBoV) was frequently observed (p < 0.05).
• 1.4% had five viruses. 5. Seasonal Trends
• This highlights the high prevalence of co-infections among children with febrile seizures. • Influenza Viruses: Primarily seen during autumn and winter.
2. Most Frequently Detected Viruses • RSV Predominantly detected in winter and spring.
• Adenovirus: Found in 55.5% of positive cases, making it the most common virus detected. • Other viruses did not show significant seasonal variation
• Influenza Viruses (A and B) Detected in 47.2% of cases (24.3% influenza A and 22.9% influenza B). 6. Key Findings
• Respiratory Syncytial Virus (RSV): Found in 16% of cases. • Adenovirus: Detected as a single or co-infecting pathogen in more than half of the cases.
• RSV B: 9.7% • Influenza B: Strongly associated with first-time febrile seizures.
• - RSV A and B combined: 6.25% • Human Bocavirus: Associated with complex febrile seizures but often found alongside other pathogens..
• Coronavirus OC43: More common in younger children (<12 months).
• RSV A: Predominantly associated with simple febrile seizures
 DISCUSSION AND CONCLUSION
• Discussion
• The findings reinforce the strong link between respiratory viral infections and febrile
seizures in children. RSV emerged as a prominent etiological agent, which has
implications for public health strategies, including vaccination and infection
prevention. The authors discuss the role of viral load, age-related susceptibility, and
immune response in the pathogenesis of febrile seizures.
JOURNAL 2
• Conclusion
• Respiratory viral infections, particularly RSV, are significant contributors to febrile
seizures in children. Early diagnosis and prevention strategies can reduce the burden
of these seizures. Further research is needed to explore the pathophysiological
mechanisms and to evaluate the effectiveness of preventive measures, such as
antiviral treatments and vaccines.

Febrile Seizures in Children and it’s Association

with Bacterial Infection – A Hospital based Study
Background
• Febrile seizures are the most common convulsive disorders in
childhood, typically occurring in children aged 6 months to 5 years.
• Mahesh Awariwar1, Shiv Narayan Panda
While viral infections are the primary triggers, bacterial infections may
• Published on 2019 also play a role. This study examines the association between bacterial
infections and febrile seizures in children.
• Febrile seizures are classified into simple (generalized, less than 15
minutes, non-recurrent within 24 hours) and complex types. The
study aims to investigate the role of bacterial infections in febrile
seizures, as bacterial pathogens may be involved but are less
frequently studied compared to viral triggers.
Methods CRITERIA
• Study Design: Hospital-based observational study conducted on 100 children. Inclusion Criteria
• Age Groups: Divided into three: 6 months–1 year, >1–2 years, and >2–5 years. Children aged 6 months to 5 years presenting with febrile seizures.
• Data Collection: Diagnosis confirmed by clinical evaluation and laboratory investigations.
• Clinical history and physical examination.
• Blood and urine cultures obtained before initiating antibiotic treatment. Exclusion Criteria
• Laboratory investigations to identify bacterial pathogens. History of afebrile seizures.
Prior antibiotic treatment before hospitalization.
• Statistical Analysis: ANOVA, Chi-square test, and Student t-test were
performed using SPSS. Signs or symptoms of meningitis or intracranial infections.
Age below 6 months or above 5 years.

Results Discussion and Conclusion

Discussions
• Age Distribution: The highest incidence of febrile seizures was in children aged 6 months–1 year • Febrile seizures commonly occur in younger children, with viral triggers dominating.
(35%).
However, bacterial infections, such as upper respiratory tract infections, urinary tract
• Precipitating Factors: infections, and gastroenteritis, are significant contributors.
• Fever was universal (100%).
• Comparisons with other studies confirm similar findings, with Streptococcus
• Common associated symptoms included cough (51%), cold (32%), and vomiting (26%). pneumoniae being a frequently isolated pathogen in blood cultures.
• Upper respiratory tract infections (51%) and acute gastroenteritis (27%) were the primary Conclusion
precipitating illnesses.
• Bacterial Infections: • Febrile seizures are primarily seen in children aged 6 months–2 years.
• Blood Cultures: 15% were positive; most common pathogens included Streptococcus • Bacterial infections contribute to a subset of cases, with Streptococcus pneumoniae
pneumoniae (6%), Staphylococcus aureus (4%), and Enterobacteriaceae (5%). and E. Coli being the most common pathogens.
• Urine Cultures: 7% were positive, all growing E. coli. • Despite the predominance of viral triggers, bacterial infections should be thoroughly
• Stool Analysis: Among children with loose stools (27%), 5% had elevated pus cells, with E. coli evaluated in febrile seizure cases to guide appropriate treatment.
identified in 2%.