Pediatrics 1 of 3 Comprehensive Review of Pediatric High-Yield Content
Disclaimer: Content is for educational exam preparation only and does not constitute medical advice. Medicine changes quickly; always verify with current, local guidelines before applying to patient care.
1. Pediatric Equations and Anthropometric Norms
- Minimum Systolic BP: 60 mmHg (first month of life); 70 mmHg (rest of the year); 70 +age*2 (moving forward).
- Weight: 7 + (age x 3)
- Weight Loss/Gain: Expected to lose 10% of weight after birth, gained back by one to two weeks. Gain 30 g/day (first 3 months); 15 g/day (next three months).
- Newborn Feeds: 1 ounce per kilogram every 2 to 3 hours (approx. 2–3 ounces every 2–3 hours).
- ETT Size (Uncuffed): 4 + age/4
- ETT Size (Cuffed): 3.5 + age/4
- ETT Size (Preterm/Newborn): Gestational age/10
- Foley Catheter Size: ETT size x 2
- Chest Tube Size: ETT size x 4
2. Pediatric Assessment and Initial Management Toxic Neonate The pneumonic for a toxic neonate is THE MISFITS
- Trauma
- Heart
- Endocrine (such as congenital adrenal hyperplasia)
- Metabolic (bilirubin and electrolytes)
- Intestinal catastrophes (e.g., NEC, midgut volvulus, Hirschsprung's enterocolitis)
- Sepsis
- Feeding (e.g., watering down formula)
- Inborn error of metabolisms
- Toxins
- Seizure
Pediatric Assessment Triangle (PAT) The PAT assesses Appearance, Breathing, and Circulation (ABC).
- Appearance (Ticls): Tone, Interactiveness, Consolability, Look, Speech.
- Breathing: Assess quality, posture, sounds (stridor, wheezing), and work of breathing.
- Circulation at the skin: Assess color, mottling, cyanosis, pallor, and capillary refill.
3. Pediatric Fever: Risk Stratification (0–90 Days) Patients with high-risk factors (pre-term status, prior hospitalizations/extended hospital time post-birth, past medical history/immunodeficiency, recent antibiotics, or focal infections) cannot undergo risk stratification. For well-appearing, non-high-risk patients, three tools can be used: A. Pecarn Criteria
- Urinalysis (Negative): Negative nitrates, negative leucocyte esterase, AND
- ANC: ≤4,090
- Procalcitonin: ≤1.71
B. Step-by-Step Criteria
- Well appearing.
- Age 22-90d old
- Urinalysis negative for leucocytes.
- Procalcitonin
- CRP ≤ 20 AND ANC ≤10,000 (combined).
C. Arensson Criteria (Low Risk is ≤1) This tool can be used without Procalcitonin.
- Age: 1 point).
- ED Temperature: 38–38.4°C (2 points); 38.5°C or higher (4 points). Note: Any fever in the ED results in the patient not being low risk.
- ANC: ≥5185 (2 points).
- Urinalysis: Must be totally negative (negative leucocytes,
Empiric Treatment and Disposition
- Age Group: 0–28 days
- Empiric Regimen: Ampicillin and Gentamicin. Add Cefotaxime if suspicion of meningitis.
- Additional Agents / Management: Admission is mandatory. LP may be omitted if low risk/no high risk, but admission with or without antibiotics is required.
- Age Group: 29–60 days
- Empiric Regimen: Ampicillin and Ceftriaxone.
- Additional Agents / Management: Ceftriaxone is safe in this group as it avoids worrisome bilirubin displacement. Add Vancomycin if resistance is suspected. Add Acyclovir if HSV risk factors present.
- Disposition (29–60 days): If low risk or only urine positive, treat UTI, LP is optional, and the patient may go home with antibiotics and 24–48 hour follow-up. If high risk, LP and empiric treatment are required.
4. Brief Resolved Unexplained Event (BRUE) BRUE is defined as an event that is brief , resolved, and unexplained. Low-Risk Criteria (321 CHEO)
- 3: Must be > 32 weeks gestational age at birth OR >45 weeks corrected gestational age.
- 2: Must be > 2 months old (precisely 60 days).
- 1: Event lasted
- CPR not done.
- History normal.
- Exam normal.
- O for zero prior episodes.
Management for Low-Risk BRUE
- Allowed: Observation for 3–4 hours, ECG, Pertussis testing, education, offering CPR training, and assessment for social risk factors.
- Avoided: Lab work, chest x-rays, echoes, home monitoring devices, prophylactic acid suppression, anticonvulsant medications, or hospital admission.
5. Infective Endocarditis (Modified Duke Criteria) The pneumonic used is BE TIMER.
- Criteria Type: Major (BE)
- Blood culture positive
- Positive More than 2 times 12 hours apart (persistent), 2 positive with typical organisms or Any positive for coxiella
- Echo positive
- Criteria Type: Minor (TIMER)
- Tempo over 38°C
- Immunologic phenomenon
- Roth spots or Osler nodes
- Microbiological evidence
- Evidence that does not meet major criteria
- Embolic phenomenon
- Septic or arterial embolisms
- Risk factors
- IV drug use or valve disease
Diagnostic Thresholds:
- Definite Endocarditis: 2 Major OR 1 Major + 3 Minor OR 5 Minor.
- Possible Endocarditis: 1 Major + 1–2 Minor OR 3 Minor.
6. Pediatric Head Trauma Algorithms A. PECarn Rule: High vs. Intermediate Risk
- Age Group:
- High-Risk Criteria (Requires CT): GCS
- Intermediate-Risk (Observe or CT): Non-frontal hematoma, acting weird/not themselves, LOC > 5 seconds, severe mechanism.
- Severe Mechanism Thresholds: Fall height up to 3 feet. Mechanisms include MVC with death/ejection, fall, pedestrian struck, rollover, high-velocity object struck.
- Age Group: > 2 Years Old (GAB HVL DEFPRO)
- High-Risk Criteria (Requires CT): GCS
- Intermediate-Risk (Observe or CT): Severe headache, vomiting, loss of consciousness, severe mechanism.
- Severe Mechanism Thresholds: Fall height up to 5 feet. Mechanisms are the same as the younger age group.
B. Catch 2 Rule (GOHIM BHV)
- GCS .
- Open or depressed skull fracture.
- Worsening Headache.
- Irritable.
- Mechanism.
- Signs of Basilar skull fracture.
- Boggy Hematoma.
- Vomiting four or more times.
Dangerous Mechanisms (Catch 2): MVC, fall from > 3 ft or 5 stairs, and fall from bicycle with no helmet. C. PECarn C-Spine Rule (UPN ANT)
- CT Immediately (UPN):
- Unresponsive (AVPU or GCS 3–8).
- Primary survey abnormality needing intervention.
- Neurologic deficit (motor, sensory, including paresthesias).
- Proceed to X-ray (ANT):
- Altered mental status.
- Neck pain/tenderness offered (meaning the patient volunteers this information).
- Trauma significant and adjacent to the head or thorax.
- If none of these criteria are present, the patient can be cleared clinically.
7. Neonatal Resuscitation (NRP) Initial Steps
- Assess term, tone, breathing.
- If inadequate: Transfer to warmer set at 25C.
- Dry and stimulate (if > 32 weeks GA); if younger, use a plastic bag.
Management Based on Heart Rate (HR)
- HR Start PPV for 15 seconds. If still 30 seconds.
- HR Intubate, give 100% FiO2, and start CPR.
Mr. SOAPA Components Mask adjust, Reposition airway, Suction, Open mouth and do OPA, Pressure increase, Alternative airway (LMA or ETT). CPR and Dosing
- CPR Rate/Ratio: 120 events per minute (3 compressions to 1 breath).
- Epinephrine Dosing: 0.01 mg/kg IV every 3 to 5 minutes.
- Tube Size: Gestational age/10
Target Oxygen Saturation (Lowest Acceptable)
- Time: 1 minute
- Lowest Acceptable Saturation (%): 60
- Time: 2 minutes
- Lowest Acceptable Saturation (%): 65
- Time: 3 minutes
- Lowest Acceptable Saturation (%): 70
- Time: 4 minutes
- Lowest Acceptable Saturation (%): 75
- Time: 5 minutes
- Lowest Acceptable Saturation (%): 80
- Time: 10 minutes
- Lowest Acceptable Saturation (%): 85
