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
