pediatrics

• Techniques to maintain a patent airway

  1. Wipe off nose and mouth with sterile gauze

  2. Suctioning with the use of rubber bulb syringe or suction catheter

  3. Positioning: Side Lying or Supine

  4. Stimulating the newborn to cry
• Infants are nasal breathers: 4 -6 months
• 2 Factors that the baby cries

  • Thermal
  • Chemical
• Unang Yakap


  Evidence based interventions that helps in ensuring the survival of the neonate
• Heart of the EINC protocol A.O 2009 – 0025 – is four time bound procedures


  1. Immediate drying – 30 seconds

  2. Skin to skin contact

  3. Clamping of the cord after 1 – 3 minutes

  4. Non – separation of the newborn of the mother and breastfeeding initiation within 90 minutes
• Non Time bound Interventions

  • Give Vitamin K
  • Hepatitis B and BCG
  • Examine the Newborn
  • Cord care
• Unnecessary Procedures


  • Routine Suctioning
  • Early bathing
  • Foot printing
  • Give sugar water, formula or other pre lacteals and the use of bottles or pacifiers
  • Application of Alcohol, medicine and other substances on the cord stump and bandaging the cord stump of abdomen
• Provide Optimum Temperature


  1. Vasoconstriction

  2. Metabolism of brown fat

  3. Gluconeogenesis
• How to provide warmth?

  1. Dry newborn skin

  2. Wrap using soft blanket

  3. Use pre – heated bassinet or crib, radiant warmer, droplight or floor lamp
• Normal Glucose of the Pedia and Adult

  • Pedia/Newborn: 40 – 60 mg/dl
  • Adult: 70 – 120 mg/dl
• APGAR SCORING


  • Tool to evaluate extra uterine life of babies
  • Developed by Dr. Virginia Apgar in 1952
  • Done on the 1st minute, 5 and 10 minutes after
  • Based on 5 parameters, ranked in order of importance

  
• Cord care


  • Normal: 1 vein 2 arteries
  • Abnormal: 2 veins 2 arteries
  • 1 vein, 1 artery – renal angiogenesis
• Skin care


  1. Bathe after 6 hours

  2. Warm water and hypoallergenic soap

  3. Cleanliest to dirtiest
• Prophylaxis


  • Eye (Crede's Prophylaxis)
  • Hypoprothombinemia
• Mother and Child Bonding

  • Bonding
  • Involution
  • Breastfeeding stimulation
• Take note the religion of the baby
• Document the baptism of the infant
• Anthropometric measurements


  • Weight and length
  • Head circumference
  • Chest circumference
  • Abdominal circumference
• Nursing Considerations for weighing the patient

  • Weighing the patient with the same weighing scale
  • Same type of clothes
  • Same time and day
  • Weigh the patient before the feeding and bathing
• Newborn loses 5-10% or 6-9% of his body weight during the first few days of life
• Newborn will regain weight in 10-14 days of age
• Later on, he will be gaining 1 lb/month for the 1st 6 mos. Of life
• Newborn weight doubles at 6 months, triples at 1 year, and quadruples at 2 years
• Vital Signs


  • Temperature
  • Respiration
  • Heart rate
  • Blood pressure
• Skin color variations


  • Gray
  • Pallor
  • Acrocyanosis
  • Cyanosis
  • Harlequin sign
  • Physiologic jaundice or Neonatal hyperbilirubinemia
• Physiological Jaundice


  • Jaundice that appears on day 2 or 3 of life
  • This is expected and not considered pathologic unless other issues arise
  • This is simply due to the normal transition from the placenta removing bilirubin, to the infant's liver doing the work
  • Followed up outpatient with pediatrician
• Pathological Jaundice


  • Jaundice that occurs within the first 24 hours of life
  • Serum bilirubin will be compared to normal value based on hours of life
  • Jaundice appearing in the first 24 hours indicates some problem or disease process that needs addressed
  • Could be an issue with the liver, or an ABO incompatibility
• Treatment for Jaundice


  1. Phototherapy

  2. Cover eyes

  3. Cover genitalia in Males
• Fontanels


  • Anterior - is diamond shaped, closes at 12 - 18 months
  • Posterior - is triangular in shape, closes at 2 - 3 months
• Variations in the head

  • Molding
  • Caput succedaneum
  • Cephalhematoma
  • Craniotabes
• Normal Findings in the Eyes

  • Subconjuctival hemorrhage
  • Edemas of eyelids for 2 – 3 days until the kidneys are able to excrete urine efficiently
  • Pseudo strabismus or transient strabismus (cross eyed)
• Abnormal Findings in the Eyes

  • Doll Eyes
• Ears


  • Should be in line with the outer canthus of the eyes
  • Ears set lower are found in those with chromosomal aberrations like trisomy 18 and with mental retardation
• Nose


  • Appears large for his face
  • Should be patent, with thin, white mucoid nasal discharge
  • Abnormal: non-patent, bloody nasal discharge, choanal atresia
• Variations and Abnormalities in the Mouth

  • Epstein pearls
  • Thrush (Candida infection or Moniliasis)
  • Cleft lip / palate
  • Protruding tongue
  • Drooling
  • Inability to pass NGT
• Neck


  • Short and chubby (thick) surrounded by skin folds with tonic neck reflex
  • Abnormal: Nuchal rigidity, Congenital torticolis - rigidity of neck due to injury to sternocleidomastoid muscles during birth
• Lungs


  • 30 - 60 breaths per minute; chiefly abdominal
  • Abnormal: apnea more than 20 secs, dyspnea, rate above 60/min, grunting, seesaw respiration
• Abdomen


  • Cylindrical in shape; liver, spleen, kidneys are palpable
  • Umbilical cord - appears as a white gelatinous structure during the first hour. Check for AVA
  • After the first hour = begins to dry, shrink and become discolored
  • 2nd-3rd day = turns black
  • 6th-10th day = sloughs off, should have no bleeding at site
• Abnormal Findings in the Anogenital Area (Female)


  • Enlarged clitoris with urethral meatus at tip
  • No vaginal opening
  • Fecal discharge per vaginal opening
  • No urination
• Abnormal Findings in the Anogenital Area (Male)


  • Hypospadia - urethral opening under the penis
  • Epispadia - urethral opening above the penis
  • Cryptorchidism
  • Inguinal hernia