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Infectious diseases

After reading this chapter you should: be able to assess, diagnose and manage infections acquired in the UK and overseas Infections acquired in the UK Infections present at all ages, in any organs and can cause mild or life-threatening illness. They can present with symptoms that are nonspecific, particularly in younger infants, where it can be difficult to distinguish between viral and bacterial infection. Clinical presentation…

Safeguarding

After reading this chapter you should be able to: recognise the different presentations of abuse assess and manage abuse and fabricated illness know the emotional and behavioural consequence of abuse and neglect Safeguarding children is the responsibility of everyone Parents, wider family members, carers, teachers, health professionals, law enforcement agencies and society at large must have a role in protecting children and young people from physical…

Fluids and electrolyte management

After reading this chapter you should: be able to assess, diagnose and manage fluid and electrolyte disturbances be able to assess, diagnose and manage disorders of acid-base balance (included elsewhere) An understanding of fluid and electrolyte requirements in children and young people is of major clinical importance. Patients who are well may need little intervention with their fluid requirements, but an assessment should always be made…

Unintentional injuries and poisoning

After reading this chapter you should be able to assess, diagnose and manage: unintentional injuries including trauma and drowning life-threatening haemorrhage head and spinal injuries burns and scalds life- or limb-threatening injuries injuries that can be managed less urgently and their x-ray appearances poisoning Unintentional injuries Children and young people can present to the emergency department with significant and life-threatening injuries. Their emergency care and management…

Emergency medicine

After reading this chapter you should be able to assess diagnose and manage: cardiac arrest shock anaphylaxis and acute upper airways obstruction acute seizures acute neurological emergencies Children and young people frequently present to emergency departments with overwhelming and life-threatening acute conditions. Prompt assessment and management is crucial and requires the coordinated effort of skilled paediatric practitioners. Basic life support When any vulnerable children (premature infants…

Behavioural medicine and mental health

After reading this chapter you should: be able to assess, diagnose and manage common emotional and behavioural problems know about the effects of physical diseases on behaviour and vice versa know and understand the presentation of conduct disorders and antisocial behaviour understand the role of Child and Adolescent Mental Health Services (CAMHS) be able to assess and diagnose important mental health problems be able to identify…

Nutrition

After reading this chapter you should be able to assess, diagnose and manage: problems arising during the establishment of infant feeding regimes malnutrition, obesity and their complications specific vitamin, mineral and micronutrient deficiencies The assessment of nutrition in paediatric practice requires an understanding of the requirements through the periods of growth and development along with an appreciation of the actual intake and content of fluids and…

Genetics and dysmorphology

After reading this chapter you should: be able to explain and provide advice regarding patterns of inheritance be able to diagnose and manage common genetic and dysmorphological conditions be able to discuss the role of pre- and postnatal genetic investigations understand the effects of environmental factors affecting the fetus Patterns of inheritance Chromosomal abnormality and mutations There are many conditions seen in paediatric practice that are…

Growth and puberty

After reading this chapter you should: know the causes of problems relating to growth and puberty be able to assess, diagnose and manage problems relating to growth and puberty Disorders of growth Growth is an excellent clinical tool to help distinguish between health and disease in any child in any setting and can be affected by genetics, nutrition and pathology in any system. It is a…

Adolescent medicine

After reading this chapter you should be able to: manage transition of adolescents with chronic health needs to adult services assess and diagnose risk-taking behaviours including non-adherence, self-harm, alcohol and substance misuse and make appropriate referral to specialist services to assess, diagnose and manage eating disorders and know the risks and complications of treatment to assess, diagnose and manage problems relating to sexual health including contraception,…

Neonatology

After reading this chapter you should be able to diagnose and manage: birth injury short and long-term consequence of preterm birth common medical conditions common surgical conditions congenital anomaly common postnatal problems and know the effect of prenatal and perinatal events on neonates Antenatal assessment of fetal growth Antenatal assessment of the mother and fetus requires a comprehensive history and examination, investigations for potential congenital infections…

Preparing for the AKP exam

After reading this chapter you should understand: the structure and format of the AKP examination the range of topics covered by the syllabus the style of questions presented in the examination how each question is produced and reviewed advice on some aspects of examination preparation The Applied Knowledge in Practice (AKP) examination is one of the three theory exams that must be passed before a candidate…

Necrotizing enterocolitis

Introduction Infants in the neonatal intensive care unit (NICU) are faced with several debilitating diseases that significantly increase the rates of morbidity and mortality. Many of these illnesses are not greatly understood, and many theories have been postulated in terms of pathogenesis and diagnostic and treatment approaches. One of these diseases is necrotizing enterocolitis (NEC), which largely affects premature infants by causing intestinal gut necrosis. There…

Surgical emergencies in the newborn

This chapter discusses common presentations of surgical emergencies in the newborn. Frequently encountered scenarios are presented as a descriptive case followed by a discussion and explanation of the disease process and treatment options. Necrotizing enterocolitis (NEC) is the most commonly encountered abdominal emergency in the premature newborn and is discussed in further detail in a separate section of this book. Emergencies of the trachea, esophagus, and…

Intraventricular hemorrhage

Intraventricular hemorrhage (IVH) is a major complication of prematurity. Despite the term referring to hemorrhage within the ventricle, it encompasses hemorrhage confined to the germinal matrix (grade I), extension to lateral ventricles without (grade II) or with (grade III) ventricular dilatation, and periventricular parenchymal hemorrhage (grade IV). Although periventricular hemorrhage (grade IV) may be considered as a separate entity ( ), for the purpose of this…

Neonatal seizures

Video 19.1 Benign Neonatal Seizure Introduction Seizure incidence is at its highest in the neonatal period, estimated at 1 to 3 per 1000 term neonates and 10 times higher for preterm/low birth weight newborns ( ). Most cases are considered acute symptomatic seizures, result from acute brain injury, and occur in its immediate aftermath ( Fig. 19.1 ). The underlying etiologies for acute symptomatic seizures in…

Renal failure in neonates

The etiology of neonatal renal failure encompasses both chronic conditions such as congenital defects of the kidney and urinary tract and acute insults such as hypoxia, ischemia, or drug toxicity leading to acute kidney injury (AKI) ( ). AKI in the neonate has been difficult to define, especially in the setting of prematurity, as standard definitions for both adult and pediatric patients rely on changes in…

Persistent pulmonary hypertension of the newborn and hypoxemic respiratory failure

The fetus is in a state of physiologic pulmonary hypertension. The PaO 2 in the descending aorta of the fetus is approximately 20 to 25 mm Hg with an oxygen saturation (Sa o 2 ) of 55% to 58% ( Fig. 17.1 ). In spite of being “hypoxemic” (low PaO 2 levels relative to postnatal standards), the fetus can deliver adequate oxygen to its tissues and…

Congenital heart disease in the newborn period

Introduction Children with congenital heart disease (CHD) have structural defects of the heart and/or great vessels that are present before birth. Defects range from relatively simple lesions, which neither induce symptoms nor need therapy, to complex life-threatening lesions, which require surgery in the neonatal period. CHD is the most common birth defect. Recent prevalence estimates for CHD range from 6 to 10 per 1000 live births.…

Neonatal hypotension

Introduction Hypotension of the premature newborn is a condition commonly encountered in the neonatal intensive care setting. Although no definite cut-off values exist in considering a given newborn to be hypotensive, certain blood pressure ranges will cause significant anxiety among caregivers. The goal of this chapter is to illustrate the complexity involved in the diagnosis and management of neonatal hypotension and guide the clinician in decision…