This document discusses the diagnosis and management of pediatric hypoglycemia. It defines hypoglycemia as blood glucose levels less than 40-45 mg/dl accompanied by symptoms. It outlines the causes, symptoms, definitions, and treatment approaches for both transient neonatal hypoglycemia and persistent neonatal hypoglycemia. It also discusses childhood hypoglycemia, including common etiologies like hormone deficiencies, insulin excess, and metabolic diseases. The document provides guidance on diagnosing and managing acute hypoglycemic episodes in infants and children.
Febrile seizure / Pediatrics
Simple vs. Complex seizure
Possible explanation of febrile seizure
Risk Factors for Febrile Seizures
Risk Factors for Recurrence of Febrile Seizure
Risk Factors for Occurrence of Subsequent Epilepsy After a Febrile Seizure
Genetic Factors
Evaluation
Lumbar Puncture
Optional LP
Electroencephalogram
Blood Studies
Neuroimaging
TREATMENT
Febrile seizure / Pediatrics
Simple vs. Complex seizure
Possible explanation of febrile seizure
Risk Factors for Febrile Seizures
Risk Factors for Recurrence of Febrile Seizure
Risk Factors for Occurrence of Subsequent Epilepsy After a Febrile Seizure
Genetic Factors
Evaluation
Lumbar Puncture
Optional LP
Electroencephalogram
Blood Studies
Neuroimaging
TREATMENT
This presentation was done by Dr. Julius P. Kessy,MD. An intern Doctor at Dodoma Regional Referral Hospital (DRRH) during pediatrics unit clinical meeting and supervised by Dr. Christina K. Galabawa,MD,Mmed2, Pediatrics and Child Health, University of Dodoma (UDOM) in November, 2017.
Diabetes is fast gaining the status of a potential epidemic in India with more than 65 million diabetic individuals currently diagnosed with the disease. Ranked second in the world, the burden of the disease is expected to compound in the years to come. Worryingly, diabetes is now being shown to be associated with a spectrum of complications and to be occurring at a relatively younger age within the country.
It is a known fact that most of the diabetes cases in our country is managed by primary care Physicians(PCP) who have a pivotal role to play in ensuring that diabetes patients receive effective care by practicing evidence based management. This said, the sad fact is that health care providers-primary care and specialists alike are not managing our patients with diabetes as well as we should be.
The complexities of the disease and its association with lot of other medical conditions make the management of diabetes more challenging to the PCPs. Patients feeling of frustration and denial about having the chronic condition often are a challenge to the practitioners in convincing the patients for initiation of treatment. With no clear cut national policy guidelines for management of diabetes, we rely on western guidelines which have certain pitfalls and fallacies in our setting.
This presentation was done by Dr. Julius P. Kessy,MD. An intern Doctor at Dodoma Regional Referral Hospital (DRRH) during pediatrics unit clinical meeting and supervised by Dr. Christina K. Galabawa,MD,Mmed2, Pediatrics and Child Health, University of Dodoma (UDOM) in November, 2017.
Diabetes is fast gaining the status of a potential epidemic in India with more than 65 million diabetic individuals currently diagnosed with the disease. Ranked second in the world, the burden of the disease is expected to compound in the years to come. Worryingly, diabetes is now being shown to be associated with a spectrum of complications and to be occurring at a relatively younger age within the country.
It is a known fact that most of the diabetes cases in our country is managed by primary care Physicians(PCP) who have a pivotal role to play in ensuring that diabetes patients receive effective care by practicing evidence based management. This said, the sad fact is that health care providers-primary care and specialists alike are not managing our patients with diabetes as well as we should be.
The complexities of the disease and its association with lot of other medical conditions make the management of diabetes more challenging to the PCPs. Patients feeling of frustration and denial about having the chronic condition often are a challenge to the practitioners in convincing the patients for initiation of treatment. With no clear cut national policy guidelines for management of diabetes, we rely on western guidelines which have certain pitfalls and fallacies in our setting.
pediatrics emergency, hypoglycemia of infancy.
Glucose level can drop if:
There is too much insulin in the blood (hyperinsulinism). Insulin is a hormone that pulls glucose from the blood.
The baby is not producing enough glucose.
The baby's body is using more glucose than is being produced.
The baby is not able to feed enough to keep glucose level up.
Hypoglycemia in the NICU is one of the most important conditions. This presentation will therefore help the healthcare provider to develop skills that will enable them to quickly identify and effectively manage this condition
Some special situations, such as Prematurity,immunosuppression, pregnancy and exposure to infectious diseases increased the risk of diseases or adverse post-vaccination events or weak immuno response to vaccine .
In these situations, special vaccines or special vaccination schedules are indicated, or vaccines should be postponed or even forbidden.
A previously healthy 3-year-old female presented to our pediatric clinic with two days history of high temperature 38- 40 c
Mother gave ibuprofen susp. With diclofenat in alternative way aiming to control temperature .
On the second day the mother asking to medical advice for this illness and she was diagnosis as acute tonsillephyrgitis and azithoromcin described to ttt the infection
At that time only the increase in temperature & mild abdominal pain there is no vomiting or diarrhea
At night the mother called here doctor prescribing a bloody stool twice with no vomiting or colic
He ask the mother to do abdominal ultra sound & erect X RAY for her daughter
But the results was –ve nothing wa found to explain the bloody stool
He ask here to make alab evaluation for C B C &stool analysis
On the third day she pass a fleshy, bulky bloody mass twice was passed one of them referred to pathology lab. & the patient was referred to be evaluated by surgeon who ask to repeat the ultrasound and the results referred to signs of intussusception but there is no any clinical signs of obstruction like vomiting or bouts of colic she referred to Cairo for further evaluation .
Ultrasound was done for the third time but surprising us
There is no any suggestive signs of intussusceptions so the decision was wait and see with the time no blood in stool general condition improved with time temperature disappeared
So she was referred to PEDIATRIC G. I .T consultant for revaluation
Drug induced GIT BLEEDING
During the last decades advances in neonatal intensive care have led to an impressive decrease of neonatal mortality and morbidity. However, infectious episodes in the early postnatal period still remain serious and potentially life-threatening events with a mortality rate of up to 50% in very premature infants. [1, 2] The signs and symptoms of neonatal sepsis can be clinically indistinguishable from various noninfectious conditions such as respiratory distress syndrome or maladaptation. Therefore rapid diagnosis is crucial for preventing the child from an adverse outcome. The current practice of starting empirical antibiotic therapy in all neonates showing infection-like symptoms results in their exposure to adverse drug effects, nosocomial complications, and in the emergence of resistant strains. [3] Sepsis results from the complex interaction between the invading microorganism and the host immune, inflammatory, and coagulation response. [4, 5] Inflammatory cytokines (TNF-α, IL-1β, IL-6, IL-8, IL-15, IL-18, MIF) and growth factors (IL-3, CSFs), and their secondary mediators, including nitric oxide, thromboxanes, leukotrienes, platelet-activating factor, prostaglandins, and complement, cause activation of the coagulation cascade, the complement cascade, and the production of prostaglandins, leukotrienes, proteases and oxidants. [6] Laboratory sepsis markers represent a helpful tool in the evaluation of a child with clinical signs and complement the evaluation of a neonate with a potential infection. During the last decades efforts were done to improve laboratory sepsis diagnosis and a variety of the above mentioned markers and more were studied with different success. Despite the promising results for some of them current evidence suggests that none of them can consistently diagnose 100% of infected cases. C-reactive protein (CRP) is the most extensively acute phase reactant studied so far and despite the ongoing rise (and fall) of new infection markers it still remains the preferred index in many neonatal intensive care units.
A voluntary, Internet-based reporting system for neonatal healthcare providers recently revealed that a broad range of medical errors occur in the NICU.[3] The most frequent error categories reported were wrong medication, dose, schedule, or infusion rate (including nutritional agents and blood products; 47%); error in administration or method of using a treatment (14%); patient misidentification (11%); other system failure (9%); error or delay in diagnosis (7%); and error in the performance of an operation, procedure, or test (4%). Errors in patient misidentification, for example, were a common cause of feeding a mother's expressed breast milk to the wrong baby.[3]
Definition of High-risk Neonate: Any baby exposed to any condition that make the survival rate of the neonate at danger.
Factors that contribute to have a High-risk Neonate:
A) High-risk pregnancies: e.g.: Toxemias
B) Medical illness of the mother: e.g.: Diabetes Mellitus
C) Complications of labor: e.g.: Premature Rupture Of Membrane (PROM), Obstructed labor, or Caesarian Section (C.S).D) Neonatal factors: e.g.: Neonatal asphyxia
According to the WHO, malnutrition is by far the biggest contributor to child mortality
Under-weight births and IUGR (intra-uterine growth restrictions) cause 3 million child deaths a year.
According to the Lancet, consequences of malnutrition in the first two years is irreversible.
Malnourished children grow up with worse health and lower educational achievements.
Malnutrition can exacerbate the problem of diseases such as measles, pneumonia and diarrhoea.
But malnutrition can actually cause diseases itself , and can be fatal in its own right
The term 'faltering growth' is widely used in relation to infants and young children whose weight gain occurs more slowly than expected for their age and sex.
In the past, this was often described as a ‘failure to thrive’ but this is no longer the preferred term :-
partly because ‘failure’ could be perceived as negative,
but also because lesser degrees of faltering growth may not necessarily indicate a significant problem but merely represent variation from the usual pattern when measured against the standardized growth charts (WHO Growth Charts
Anemia can be seen in the emergency department both as a primary pathological process or secondary to both medical and surgical diseases. Moreover, acute anemia can occur in children who have been otherwise healthy, who have systemic disease, or who have known hematologic disorders. Anemia may indicate a disorder with a single hematopoietic cell line (eg, red blood cells) or may be associated with changes in multiple cell lines indicative of bone marrow involvement, immunologic disease, peripheral destruction of erythrocytes, or sequestration of cells. Independent of the etiology, prompt diagnosis is predicated on understanding the classifications of anemia, the associated presenting symptoms, and the proper ordering and interpretation of laboratory studies. This article will discuss the evaluation, proper classification, differential diagnosis, and initial management of acute anemia using cases representative of those that might be seen in the pediatric emergency department.
How to support & dealing with parents in nicuOsama Arafa
We admit babies to the Neonatal Intensive Care Unit (NICU), because they need specialized medical and nursing care.
We recognize that, this can be a very stressful and confusing time for parents and family.
Separation from your new baby is difficult .
Understanding the needs of your baby will help you get through this difficult time.
Child with recurrent infections
Prof osama arafa .
Pediatrics PHD consultant& head of pediatric department Port Fouad hospital
General secretary of Port Said Pediatrics Conference.
Abstract
The child with recurrent chest infections presents the clinician with a difficult diagnostic challenge. Does the child have a simply-managed cause for their symptoms, such as recurrent viral respiratory infections or asthma, or is there evidence of a more serious underlying pathology, such as bronchiectasis? Many different disorders present in this way, including cystic fibrosis, a range of immunodeficiency syndromes, and congenital abnormalities of the respiratory tract. In some affected children, lung damage follows a single severe pneumonia: in others it is the result of inhalation of food or a foreign body.
The assessment of these children is demanding: it requires close attention to the history and examination, and in selected cases, extensive investigations. Early and accurate diagnosis is essential to ensure that optimal treatment is given and to minimise the risk of progressive or irreversible lung damage.
The aim of this presentation is to examine the causes of recurrent chest infections and to describe how this complex group of children should be assessed and investigated.
Probiotics – PrebioticsNovel Strategies That May Prevent Neonatal Disease
by
Richard J. Schanler, M.D.
Schneider Children’s Hospital at North Shore, Manhasset, NY
and Albert Einstein College of Medicine, Bronx, NY
schanler@nshs.edu
Pacifier &Thumb sucking is it good or bad?
Many parents and doctors express concern over their child's thumb sucking or use of a pacifier. Often worried about affects on teeth and language development In fact, it has been shown that embryos actually suck on their thumbs while in the mother's womb. Thumb sucking and pacifier use both help children become comfortable with their environment, as well as offer children a sense of security. Most children should grow out of thumbsucking and pacifier use by age 3 or 4. As long as the habit is discontinued before their permanent teeth come in (around ages 4-5) your child will be fine. If, however, they continue this habit as their permanent teeth come in it is best to help your child discontinue their habit.
In this presentation we will put spotlight on advantages and disadvantages of both pacifiers & thumb sucking trying to answer is it good or bad?
Dr.Osama Arafa Abd EL Hamed
M. B.,B.CH - M.Sc Pediatrics - Ph. D.
Consultant of
Pediatrics &Neonatology
Head of pediatrics department Port-fouad hospital
E mail; osama_1967@hotmail.com
¬¬¬¬¬¬¬¬¬¬¬¬¬¬¬¬¬¬¬¬¬¬¬¬Tel:- Mob. 010 5196625
Clin. 066 3423252
Hom. 066 3412624
The French Revolution, which began in 1789, was a period of radical social and political upheaval in France. It marked the decline of absolute monarchies, the rise of secular and democratic republics, and the eventual rise of Napoleon Bonaparte. This revolutionary period is crucial in understanding the transition from feudalism to modernity in Europe.
For more information, visit-www.vavaclasses.com
This is a presentation by Dada Robert in a Your Skill Boost masterclass organised by the Excellence Foundation for South Sudan (EFSS) on Saturday, the 25th and Sunday, the 26th of May 2024.
He discussed the concept of quality improvement, emphasizing its applicability to various aspects of life, including personal, project, and program improvements. He defined quality as doing the right thing at the right time in the right way to achieve the best possible results and discussed the concept of the "gap" between what we know and what we do, and how this gap represents the areas we need to improve. He explained the scientific approach to quality improvement, which involves systematic performance analysis, testing and learning, and implementing change ideas. He also highlighted the importance of client focus and a team approach to quality improvement.
How to Split Bills in the Odoo 17 POS ModuleCeline George
Bills have a main role in point of sale procedure. It will help to track sales, handling payments and giving receipts to customers. Bill splitting also has an important role in POS. For example, If some friends come together for dinner and if they want to divide the bill then it is possible by POS bill splitting. This slide will show how to split bills in odoo 17 POS.
Students, digital devices and success - Andreas Schleicher - 27 May 2024..pptxEduSkills OECD
Andreas Schleicher presents at the OECD webinar ‘Digital devices in schools: detrimental distraction or secret to success?’ on 27 May 2024. The presentation was based on findings from PISA 2022 results and the webinar helped launch the PISA in Focus ‘Managing screen time: How to protect and equip students against distraction’ https://www.oecd-ilibrary.org/education/managing-screen-time_7c225af4-en and the OECD Education Policy Perspective ‘Students, digital devices and success’ can be found here - https://oe.cd/il/5yV
Welcome to TechSoup New Member Orientation and Q&A (May 2024).pdfTechSoup
In this webinar you will learn how your organization can access TechSoup's wide variety of product discount and donation programs. From hardware to software, we'll give you a tour of the tools available to help your nonprofit with productivity, collaboration, financial management, donor tracking, security, and more.
We all have good and bad thoughts from time to time and situation to situation. We are bombarded daily with spiraling thoughts(both negative and positive) creating all-consuming feel , making us difficult to manage with associated suffering. Good thoughts are like our Mob Signal (Positive thought) amidst noise(negative thought) in the atmosphere. Negative thoughts like noise outweigh positive thoughts. These thoughts often create unwanted confusion, trouble, stress and frustration in our mind as well as chaos in our physical world. Negative thoughts are also known as “distorted thinking”.
2. Hypoglycemia
• Two or more sequential blood glucose
values less than 40-45 mg/dl
• “Hypoglycemia” refers to symptoms or
“low blood sugar” and is not a diagnosis.
3. Hypoglycemia – Learning
Objectives
• Symptoms and Definitions
• Causes of Hypoglycemia
– Neonatal
• Transient vs. Persistent
• Treatment Options
– Childhood
• Management
4. Management Questions
in Acute Hypoglycemia
• [2 am phone call]: “Doctor, I just checked a
blood sugar on your patient, and it’s 45.
What do you want me to do?”
5. Management Questions
in Acute Hypoglycemia
• “Is the patient having a hypoglycemic
episode?”
• “What are the symptoms of
hypoglycemia?”
7. Symptoms of Hypoglycemia
• Non-specific and non-diagnostic
• Correlation between an individual blood
sugar value and
– Acute clinical symptoms: YES
– Long term clinical outcome: NO
Pediatrics 105(5):1141-1145; 2000
8. Definitions of Hypoglycemia
Whipple’s Triad
Diagnosis of acute hypoglycemia requires
1. Clinical symptoms of hypoglycemia plus
2. Simultaneous low plasma glucose plus
3. Clinical signs must resolve when
normoglycemia is established
Ann Surg 101:1299-1310; 1935
9. Management Questions
in Acute Hypoglycemia
• “Is the patient having a hypoglycemic episode?”
• “What are the symptoms of hypoglycemia?”
• “Do I need to treat ? How? When ?”
10. Definitions of Hypoglycemia
Suggested Treatment Thresholds
• Controversies Regarding Definition of
Neonatal Hypoglycemia: Suggested
Operational Thresholds
M. Cornblath et. al., Pediatrics 105(5): 1141-
1145; 2000.
• “Blood glucose levels at which clinical
interventions should be considered”
11. Definitions of Hypoglycemia
Suggested Treatment Thresholds
• Any symptomatic infant with plasma
glucose less than 45 mg/dl
• Asymptomatic at risk infants with
– Plasma glucose < 36 mg/dl (feed if possible)
– Plasma glucose < 20-25 mg/dl (IV glucose)
• Therapeutic objective is plasma glucose
over 45-60 mg/dl
Pediatrics 105(5):1141-1145; 2000
12. Management Questions
in Hypoglycemia
• “Is the patient having a hypoglycemic episode?”
• “What are the symptoms of hypoglycemia?”
• “Do I need to treat ? How? When ?”
• “Does this patient have an underlying medical
condition causing low blood sugars?”
13. Hypoglycemia – Learning
Objectives
• Symptoms and Definitions
• Causes of Hypoglycemia
– Neonatal
• Transient vs. Persistent
• Treatment Options
– Childhood
15. Neonatal Hypoglycemia
Transient
• Postnatal instability, inadequate fuel
• 2 – 3 per 1000 live births
• Occurs within first 12 hours after birth
• Resolves within 3 – 5 days
16. Transient Neonatal Hypoglycemia
High Risk Groups
• Premature, SGA, smaller of twins
• Respiratory distress, sepsis, other stress
• Large birth weight infants
– Infant of diabetic mother
hyperinsulinemia from islet cell hyperplasia
17. Transient Neonatal Hypoglycemia
Treatment
1. Anticipate hypoglycemia in infants at risk
2. Early feeding, if possible
3. Supplemental IV glucose as needed
4. Medication (e.g. steroids) rarely needed
18. Neonatal Hypoglycemia
Persistent
• 5% of infants with hypoglycemia
• Persistent (recurrent) hypoglycemia
– Does not resolve within 5-7 days
• Hormone deficiencies and excess
• Metabolic diseases
22. Persistent Neonatal Hypoglycemia
Suspect Hyperinsulinemia if:
1. Persistent IV glucose requirement of 10-
12 mg/kg/min plus
2. Absence of serum / urine ketones plus
3. Insulin level over 5-10 mcgU/ml with a
simultaneous plasma glucose of less than
40 mg/dl
23. Persistent Neonatal Hypoglycemia
Treatment of Hyperinsulinemia
1. Diazoxide
10 – 25 mg / kg / day divided t.i.d.
1. Octreotide (Sandostatin)
1 – 20 mcg / kg / day SQ divided t.i.d. or
continuous infusion via insulin pump
1. Glucagon
1 mg / 24 hrs continuous infusion
1. Pancreatectomy
24. Hypoglycemia – Learning
Objectives
• Symptoms and Definitions
• Causes of Hypoglycemia
– Neonatal
• Transient vs. Persistent
• Treatment Options
– Childhood Hypoglycemia