IAP Color Atlas of Pediatrics

Pediatric Gastroenterologist Professor and Head Pediatric Government Medical College Calicut, Kerala, India [email protected]. Bandra(W), Mumbai, Maharashtra, India Shushrusha Citizen's Cooperative Hospital Dadar, Mumbai, Maharashtra, India [email protected].

Preface

Acknowledgments

Neonatology

S ection O utline

Neonatology

NORMAL NEWBORN Acrocyanosis

Massaging or squeezing the breasts or nipples is not recommended as this can lead to breast infection (Mastitis). The photograph shows the capillary refill time (CRT) being assessed by blanching the skin after gentle digital pressure on the sternum.

IAP Color Atlas of Pediatrics

COMMON NEONATAL CONDITIONS

Note the sign of the waiter's tip deformity: the left arm hangs to the side and is rotated medially; the forearm is extended and pronounced. Deep tendon reflexes are absent. Hand and wrist are spared and there is a normal grip.

NEONATAL SYSTEMIC DISORDERS

The defect measures 2 to 4 cm and usually lies just to the right of the navel. The swelling is painless and shows no signs of inflammation. The right side is untouched.

15Polycythemia

UNCOMMON NEONATAL CONDITIONS BUT NOT RARE

Position can be confirmed by following both mainstem bronchomas back to the carina and cephalad to the tip of the tube. Absence of air markings distal to the lung shadow, increased intercostal distance, flattened dome of the diaphragm on the right side with displacement of the mediastinum to the opposite side, indicating a tension pneumothorax.

21USG Skull-IVH

NEWBORN SCREENING

HUMANE NEONATAL CARE Developmentally Supportive Care

KC promotes baby's health and well-being by promoting effective thermal control, breastfeeding, infection prevention and bonding. KC should be continued until the baby reaches 40 weeks of conception or reaches a weight of 2500 g.

Growth and Development

27Babies: By the Age of 1

PHYSICAL GROWTH STAGES DURING FIRST-FIVE YEARS OF LIFE

The child should be placed on the infantometer in a supine position with the knees fully extended and the feet at right angles to the lower legs. The baby's head is held against the fixed board, while the sliding board is moved close to the heels.

COMMON ERRORS IN GROWTH MEASUREMENTS

The horizontal arm of the device is gently lowered to the top of the head and the height is read from the scale. The head circumference is measured by passing the tape measure over the occipital protuberance of the head at the back and supraorbital ridges at the front.

DEVELOPMENT ASSESSMENT

Nutrition

PROTEIN-ENERGY MALNUTRITION (PEM) AND NUTRIENT DEFICIENCIES
AMYLASE RICH FOODS (ARF): THE MAGIC

Figures 3.2.6A and B: Micronutrient deficiency Photograph credit: Rural Health Training Center, Vaitarna, Department of Community Medicine, LTMM College and General Hospital, Sion, Mumbai (for both photographs). Figures 3.2.10A and B: Vitamin A deficiency. Photo courtesy: Rural Health Training Center, Vaitarna, Deptartment of Community Medicine, LTMM College and General Hospital, Sion, Mumbai (for both photos).

Infectious Diseases

COMMON CONDITIONS .1 Bacterial Infections

Viral Infections
Parasites Malaria

UNCOMMON CONDITIONS BUT NOT RARE Brucellosis
INFECTIOUS DISEASE EMERGENCIES Kawasaki Disease

Erythema nodosum (EN) is an acute, nodular, erythematous eruption usually confined to the extensor aspects of the lower legs. Streptococcal infections and primary tuberculosis are one of the most common causes of erythema nodosum. Figures 4.1.1.4A and B: (A) Septic arthritis in multiple joints; (B) X-ray shows bony erosion in the lower end of the femur and the upper end of the tibia.

HIV/AIDS can affect all systems of the body and manifestations can vary. The thickness of the thick film should be uniform, which can be determined by the legibility of printed text seen through the slide. Smears should be taken shortly after blood collection, which ensures better adhesion of the films to the slide and minimizes distortion of parasites and red blood cells.

Treatment regimens should be tailored (with combination therapy with chloroquine or artemisinin) according to the species and especially according to the resistance pattern of the region under consideration. Figures 4.3.3A and B: (A) erythematous scaly lesions seen in staphylococcal scalded skin syndrome; (B) Close-up view of the same lesion.

Neurology

COMMON CONDITIONS Anterior Encephalocele
UNCOMMON CONDITIONS BUT NOT RARE

Interhemispheric lipoma replacing part of the corpus callosum is associated with a high incidence of epilepsy. Tonic seizure: One of the most common types of seizures in Lennox-Gastaut syndrome in addition to the Triad (Stark-Atypical Absence, Fall-Atonic Seizure, Jerk-Myoclonic) described above. This involves resection of the anteromedial temporal lobe (temporal lobectomy) or a more limited removal of the underlying hippocampus and amygdala (amygdalohippocampectomy).

The typical appearance of the shoulders, downward sloping clavicles and a bulge in the trapezius muscle area due to the upward displacement of the scapula. The same patient as in Figure 5.2.3, typical appearance of the shoulders and a bulge in the area of the trapezius muscle, due to an upward displacement of the scapula.

87Decerebrate Rigidity and Decorticate Rigidity

NEUROLOGIC EMERGENCIES

If status epilepticus is managed with lorazepam and if not controlled with phenytoin, followed by phenobarbitone/sodium valproate IV. Emergency intubation and hyperventilation, anti-edema measures (mannitol, frusemide, etc.) or surgical decompression (craniotomy) are life-saving. It is characterized by syndactyly of the 2nd, 3rd and 4th fingers (and also the toes as in this case).

This image is of a 17-year-old boy with severe developmental delay and seizures with thick eyebrows that meet in the midline (synophrys) - a characteristic feature of Cornelia de Lange syndrome. Heterozygous mutations in NIPBL and SMC3 and heterozygous (in females) or hemizygous (in males) mutations in SMC1A result in Cornelia de Lange syndrome.

SYNDROMES

Photograph of the same Cornelia de Lange syndrome patient showing another typical feature—joint fingers and missing fingers. Hypomelanosis of Ito (Incontinentia Pigmenti achromians) is characterized by the presence of tortuous hypochromic skin lesions that are often associated with seizures, mental retardation, hearing disorders, visual problems and orthopedic problems. Prominent forehead, small upturned nose, narrowing at temples, eyes widely spaced Associated with lissencephaly (Fig. 5.2.15).

Cardiology

HISTORY AND CLINICAL EXAMINATION
HEART DISEASES SUBSECTIONS .1 X-rays

ECGs
Echocardiography
Angiography/Pathological Specimen

SYNDROMES

Note in the ultrasound that the posterior left ventricle gives rise to a branching, wide vessel - the pulmonary artery.

Pulmonology

COMMON CONDITIONS Acute Follicular Tonsillitis

Collapsed consolidation of the middle lobe of the right lung is visible. effusion of the right side of the heart) is present. Immediate surgery and removal of the lobe can be life-saving when cyanosis and severe respiratory distress are present. The presence of gas in the stomach suggests a fistula between the trachea and the lower part of the esophagus (the most common type of esophageal atresia).

Primary repair cannot be performed if the gap between the atretic ends of the esophagus is > 3 to 4 cm. Eventration of the diaphragm - an abnormal elevation, consisting of a thinner diaphragm muscle causing an elevation of the left hemidiaphragm, is seen. Diffuse involvement of most of the lung parenchyma with clouding of the ground glass, or "fibrotic" changes with cystic lung disease.

Imaging (x-ray, CT, MRI) helps determine the presence and exact location of the tumor. Neuroblastoma (NB), the 3rd most common pediatric cancer, is an embryonal cancer of the peripheral sympathetic nervous system.

137Closed Pneumothorax

EMERGENCY SITUATIONS

Asymptomatic interval (stage 2) – the foreign body becomes lodged, the reflexes are fatigued and the immediate irritating symptoms disappear. After admission, hyperinflation of the left lung developed; air trapping was pronounced during exhalation, indicating foreign body obstruction. Air in the pleural space with collapse of the right lung with displacement of the mediastinum to the left.

Open thoracotomy and blister pack, fistula closure, pleural stripping, and basilar pleural scraping. Figure 7.5.2A and B: (A) Hydatid cyst - X-ray chest; (B) Hydatid cyst— CT scan of chest Photo courtesy: NK Kalappanavar, S Kavya, Davangere. This is a chest X-ray of an 8-year-old child showing a well-defined homogeneous opacification in the upper left area suggestive of cystic lesions (Fig. 7.5.2A).

For simple, accessible cysts, the preferred therapy is ultrasound- or CT-guided percutaneous aspiration, instillation of hypertonic physiotherapy or another scocidal agent, and reaspiration (PAIR). With MDIs, the use of a spacer device is advisable regardless of age for better drug delivery.

SYNDROME

In acute conditions nebulization can be given every 20 minutes for the first hour; 8 to 10 minutes per procedure. Figure 7.5.4A and B: (A) Some of the equipment used for resuscitation and O2 therapy, (B) Non-rebreathing O2 mask Photo: Devaraj Raichur, KIMS, Hubli. Figure 7.5.5A to C: Paraesophageal hiatus hernia: (A) Plain radiograph; (B) X-ray chest, lateral view with Ryle's tube in the intrathoracic abdomen and (C) Barium examination.

Hiatus hernia: Hernia of the stomach through the esophageal hiatus. the gastroesophageal junction slides into the thorax. - Part of the stomach is insinuated next to the esophagus within the gastroesophageal junction at the hiatus. PEHH is seen at all ages, rarer in children, but rarely occurs in the neonatal period.

When recurrent respiratory infections occur in an otherwise healthy child, the drop in growth percentiles will usually not be less than 80% of what would be expected for the child. If growth percentiles fall below 80% of expected, other related problems should be investigated.

Gastrointestinal System and

Hepatology

Gastrointestinal System and Hepatology

COMMON CONDITIONS
GI EMERGENCIES

Bronchial elements may be present in the esophageal wall at the site of stenosis.

165Alagille Syndrome

SYNDROMES

Wolman syndrome is a rare fatal AR disorder due to acid lipase deficiency characterized by the accumulation of cholesterol esters and triglycerides in the histiocytic foam cells of most visceral organs. Verner-Morrison syndrome or VIPoma or Watery diarrhea, hypokalemia, achlorhydria syndrome is a rare cause of watery diarrhea in children due to increased secretion of vasoactive intestinal peptide.

Nephrology

COMMON CONDITIONS
SYNDROMES

Cushingoid features with swollen cheeks can be clearly seen as well as eyelid puffiness, indicating edema and non-resolving nephrotic syndrome. Severe deformities of the lower limbs as in a similar case as mentioned in Figure 9.1.4. This clearly shows the extremely small size of the involutional multicystic dysplastic kidney (MCDK) described above.

CT angiography in a boy with posterior urethral valves showing a small left kidney and ostial narrowing at the origin of the left renal artery. CT angiography showing two renal arteries on either side with a narrowed segment of the right lower artery. High renin and aldosterone levels, captopril renography showing decreased kidney function are some of the tests that may be used.

This baby had Bartter's syndrome and the next picture shows how the dilation improves with treatment of the condition. Children with a plum belly have bilateral pelvic dilatation with or without vesicoureteric reflux.

Hematology