What is persistent pulmonary hypertension of the newborn associated with
Meconium aspiration
Birth asphyxia
Septicaemia
Respiratory distress syndrome
Explain the pathology of PPHN
High pulmonary resistance which causes a right to left shunt at the aterial and ductal levels
Baby becomes cyanotic very soon after birth
Treatment of PPHN
Mechanical ventilation
Circulatory support (Iontropes)
Inhaled nitric oxide
? sildenafil
More severe
Oscillatory ventilation
Extracorpeal membrane oxygenation
Management of asthma ( not acute management)
1. B2 agonist 2+ inhaled corticosteriod 3. <5yrs add montelukast / >5yrs salmeterol 4. Increased corticosteroid 5. Add prednisolone
Assessment of control in an asthmatic child
No of oral course of steroids (> 4 in 6mnths) Hospital admission Been to ICU Number of blue inhalers Time off school Check technique
Symptoms of bronchiolitis
Coryza Cough Fever Tachypnoea Wheeze Inspiratory crackles Intercostal recession Cyanosis
Reasons to admit
Inadequate feeding
Respiratory distress
Hypoxia
Treatment of bronchiolitis
O2
Nasogastric feeds
Confirm the diagnosis of the bronchiolitis
Nasopharyngeal aspirate
Symptoms of Kawasaki disease
Fever 5/7 days Bilateral non purulent conjunctivitis Mucous membrane changes (strawberry tongue, red dry cracked lips) Cervical lymphadenopathy Rash (polymorphous) Oedematous and desquamation of the fingers and the toes Reactivation of the BBG site Coronary aneurysums
Treatment of Kawasakis disease
IV IgG
Aspirin
Echo and a f/up echo in 4-6 weeks
Tests/ Investigations in Kawasakis disease
ESR/CRP WCC Bilirubin AST Alpha 1 antitrypsin Platelets
Clinical presentation of ALL
Malaise Anorexia Anaemia Neutropenia Thrombocytopenia HSM Lymphadenopathy
Investiagations
FBC BM aspirate ( blast cells)
Treatment of ALL
Induction Consolidation Interim maintenance Delayed intensification Continued maintenance
Types of brain tumours
Astrocytoma
Medulooblastoma
Brainstem glioma
Craniopharynioma
Pathophysiology of a neuroblastoma
Arise from neural crest tissue in the adrenal medulla and the SNS
Clinical features
Pallor Weight loss Abdominal mass Hepatomegaly Bone pain Limp
Investigations for a neuroblastoma
Raised urinary catecholamines
Pathology of Wilm’s tumour
Origanates from embryonal renal tissue
Clinical features of a Wilm’s tumour
Large abdominal mass
Anaemia
Haematuria
Hypertension
Pathology of retinoblastoma
Malignant tumour of the retinal cells
Chromosome 13
Autosomal dominant inheritance ( can have incomplete penterance)
Clinical features of retinoblastoma
Loss of red pupillary reflex
White pupillary reflex
Pathology of pyloric stenosis
Congeitial hypertrophy of the pyloric muscle causing outflow obstruction
Management of pyloric stenosis
- Correct any fluid or electrolyte disturbances
Hyponatraemia, hypokalaemia, hypochloraemic alkalosis - Ramsted pyloromyotomy
Clinical features of TGA
Cyanosis ( Day 2 following closure of the PDA)
Second heart loud and single
~ systolic murmur
Egg on side appearance on CXR
Management of TGA
Prostaglandin infusion- patency of the duct
Balloon atrial septostomy
Surgery for definitive treatment
Clinical features of coarctation of the aorta
Circulatory collapse
Absent femoral pulses
Metabolic acidosis
Treatment of coarctation of the aorta
Surgical repair soon after diagnosis