LECTURES

Dr Ray Parascandolo

The Child with Pallor

§ Causes of pallor (other than anaemia)

§ Definition of anaemia

§ Hb values in infancy and childhood

§ Classification of anaemia

§ Physiological aspects of anaemia

§ Clinical features of mild, moderate to severe and chronic anaemia

§ Clinical assessment

§ Investigations: baseline and specialised

Case presentations:

§ anaemia of prematurity

§ iron deficiency anaemia (nutritional, malabsorption, GI bleeding,)

§ congenital haemolytic anaemia (spherocytosis, thalassaemia, G6PD, sickle cell disease)

§ acquired haemolytic anaemia (mycoplasma, autoimmune)

Examination of the Newborn

History of pregnancy, labour and delivery

Gestation and birth weight

General appearance and examination of systems

Congenital abnormalities, dysmorphic features and birth trauma

Birth Injuries:

Caput succedaneum

Forceps Marks

Scalpel cuts

Bruising in breech presentations

Traumatic cyanosis

Cephalhaematoma

Conjunctival haemorrhages

Subaponeurotic haemorrhage

Facial nerve palsy

Erb’s palsy

Klumpke’s palsy

Fracture clavicle

Rupture of liver/spleen

Cerebral Haemorrhage (Tentorial tear, Subaracnoid, Intraventricular, Subdural haematoma)

Two video presentations on the above topics will also be shown and discussed.

Failure to thrive

Monitoring of growth - measuring of growth parameters; growth charts

Causes - organic and psychosocial

Clinical assessment:

History taking; old records of growth

Physical examination: assessment nutritional status, signs of underlying disease

Investigations: baseline; specialised

Assessment by dietician

Serial measurements of growth

Observation of child in hospital

Treatment of underlying condition; calorie supplementation

Short stature

Causes

Assessment:

History

Examination: measure growth parameters, dysmorphic features, staging of puberty, signs of systemic disease

Investigations: baseline; specialised

Serial measurements

Case presentations:

§ Familial short stature

§ Constitutional short stature

§ Familial maturation delay

§ Growth hormone deficiency

Resuscitation of the Newborn

§ Pathophysiology of asphyxia

§ Sequence of events following asphyxia: primary apnoea, secondary (terminal) apnoea

§ High risk pregnancies

§ Maternal history

§ Monitoring for foetal distress

§ Meconium stained liquor

§ Resuscitation equipment

§ Drugs used in resuscitation

Assessment at delivery:

1. Apgar scores

2. Fit and healthy infant

3. Breathing inadequately

4. Terminal apnoea

5. Fresh stillbirth

Principles of resuscitation

§ No response to resuscitation: causes

§ Post resuscitation care

§ Acute complications of severe asphyxia

§ Neurological sequelae

A video presentation on above topic will also be shown and discussed.