Appendix

mgllOOml mmol/l mmHg kPa

1260 70.0 ISO 20.0

10ro 60.0

900 SO.O 135 18.0

720 40.0 120 16.0

540 30.0

360 20.0 105 14.0

270 15.0 252 14.0 90 12.0 234 13.0 216 12.0 75 10.0 198 11.0 180 10.0 162 9.0 60 8.0 144 8.0 126 7.0 45 6.0 108 6.0

90 5.0 72 4.0 30 4.0

54 3.0 36 2.0 15 2.0 18 1.0

0 0 0

Blood glucose Blood gases: Carbon dioxide (Peal) and oxygen (Pal)

SI unit conversions

297

Centile table for boys

Age Weight Height Head circumference (kg) (cm) (cm)

Centile 3 50 97 3 50 97 3 50 97

Birth 2.5 3.5 4.4 50 33 35 38 3 months 4.4 5.7 7.2 55 60 65 38 41 43 6 months 6.2 7.8 9.8 62 66.5 71 41 44 46

9 months 7.6 9.3 11.6 66.5 71 76 43 46 47 12 months 8.4 10.3 12.8 70 75 80 44 47 49

18 months 9.4 11.7 14.2 75 81 87 46 49 51 2 years 10.2 12.7 15.5 80 87 93 47 50 52

3 years 11.6 14.7 18.0 86 94 101 48 50 53 4 years 13.0 16.7 20.4 94 102 110

5 years 14.4 18.5 23.2 99 108 117 49 51 54 6 years 16 20.5 26.5 105 115 124

7 years 17 23 30 110 121 131 8 years 19 25 34 115 126 137 50 52 55

9 years 21 27.5 39 120 132 143 10 years 23 30 44 125 137 148

11 years 25 34 48 130 142 154 12 years 27 36.5 53 135 147 159 51 54 56

13 years 30 40.5 64 138 153 168 14 years 36 48 66 148 161 173 53 56 58

15 years 43 56 74 156 169 181 16 years 47 60 78 160 172 187

17 years 49 62 80 162 174 187 18 years 50 64 81 162 175 187

Centile table for girls

Age Weight Height Head circumference (kg) (cm) (cm)

Centile 3 50 97 3 50 97 3 50 97

Birth 2.5 3.5 4.4 50 32 35 37 3 months 4.2 5.2 7.0 55 58 62 37 40 43 6 months 5.9 7.3 9.4 61 65 69 40 43 45

9 months 7.0 8.7 10.9 65 70 74 42 44 47 12 months 7.6 9.6 12.0 69 74 78 43 46 48

18 months 8.8 10.9 13.6 75 80 85 45 47 50 2 years 9.6 12.0 14.9 79 85 91 46 48 51

3 years 11.2 14.4 17.6 86 93 100 47 49 52 4 years 13 16 20 92 100 109

5 years 15 18 23 98 107 116 48 50 53 6 years 16 20 27 104 114 123

7 years 18 23 30 109 119 130 8 years 19 25 35 114 125 136 50 52 54

9 years 21 28 40 120 130 142 10 years 23 31 45 125 136 147

11 years 25 34 50 130 142 153 12 years 29 40 58 138 149 161 51 53 56

13 years 37 47 66 145 157 168 14 years 42 53 71 149 160 172 52 54 57

15 years 44 55 74 150 162 173 16 years 45 56 75 151 162 174

17 years 46 56 75 18 years 46 57 75

Weight and height centi1es adapted from Tanner, J. M., Whitehouse, R. H. and Takaishi, M. (1966). Arch. Dis. Child., 41, 454. Head circumference centi1es adapted from Westrop, C. K. and Barber, C. R. (1956). J. Neurol. Neurosurg. Psychiatr., 19, 52.

APPENDIX

Drug doses for children

A list follows of the commonly prescribed drugs in acute paediatrics. The dose stated is for each individual dose prescribed and the recom­mended number of times it is given per 24 hours has been stated. It is not the total daily dosage.

Drug doses in children can be estimated according to age, body weight or surface area. Calculations based on surface area are generally agreed to be the most reliable way to estimate dosage for a child. A nomogram is needed to calculate the surface area. It is easier in practice to express doses as a percentage of the adult dose. Table 1 shows a comparison of the dose expressed as a percentage of the adult level based on the surface area when applied to a child of average size.

Doses may also be expressed in terms of weight but a uniform scheme suitable for children of all ages cannot be formulated on this basis. In addition the dose for an obese child may be overestimated as fat plays little part in drug metabolism. These factors are auto­matically recognized when using the percentage method which com­pensates for the relatively larger surface area of children in relation to their weight and so this method of dose estimation has been adopted. For children under one year the dose has been shown on a mg/kg basis because of the rapid growth in this period. It actually results in a slight underdosage in the first few months of life. In view of the very different metabolism and excretion of drugs in neonates a separate list has been made for the neonatal period.

Full details of the indications for use of the various drugs and their side effects can be found in the British National Formulary and the Paediatric Prescriber by P. Catzel and R. Olver (Blackwell Scientific Publications, Oxford, 1981).

Table 1

Adult 7 years 3 years I year

Doses for different ages as percent of adult dose

299

100% 50% 33%

approx25%

Dru

g do

ses

Dru

g

Adr

enal

ine

(epi

neph

rine

) 1:

1000

1:10

000

All

opur

inol

(Z

ylor

ic)

Am

ikac

in

(Am

ikin

)

Am

inop

hyll

ine

Rou

te

s.c.

I.V

.

Do

wn

ET

tu

be

Intr

acar

dia

c

Co

nti

nu

ou

s in

fusi

on

ora

l

l.m

. i.v

.

l.V.

Tim

es

dail

y

Sin

gle

dose

Sin

gle

dose

3 2

Dos

age

per

dose

giv

en

0-2

2

wee

ks-

1 ye

ar

7 ye

ars

wee

ks

1 ye

ar

--0

.01

mlj

kg

--

0.12

S 0.

2Sm

l m

l

--0

.01

ml/

kg

--

Iml

2.S

ml

------O

.S-I.S

/lg

kg

-l

min

-1

See

Tab

le 2

Sm

g/kg

SO

mg

100m

g

7.S

mg/

kg

Adu

lt

O.S

ml

Sm

l

20

0m

g

Loa

ding

dos

e: S

-6 m

g/kg

, ov

er 2

0 m

in t

hen

by c

onti

nuou

s in

fusi

on:

Loa

ding

do

se

6.2

mg

/ kg

the

n 4

.4m

g

kg

-1

(24

h)-

l by

con

­ti

nuou

s in

fusi

on

I m

g kg

-1

h -

1 if

< 9

y,

or:

0.7

mg

kg

-1 h

-1

if >

9y

Rem

arks

Fo

r as

thm

a, a

naph

ylax

is.

Rep

eat

afte

r IS

min

x 2

if n

eces

sary

.

Fo

r ca

rdia

c ar

rest

, lif

e th

reat

enin

g an

aphy

laxi

s. M

ay p

rodu

ce a

rryt

hmia

s.

Fo

r pr

ofou

nd h

ypot

ensi

on.

Incr

ease

do

se a

ccor

ding

to

resp

onse

.

Fo

r pr

even

tion

of

uric

aci

d ne

phro

path

y in

mal

igna

nt d

isea

se.

Sid

e-ef

fect

s-as

Gen

tam

icin

.

Fo

r st

atus

ast

hmat

icus

. M

on

ito

r le

vels

if

nec

essa

ry.

Arr

ythm

ias,

con

vuls

ions

m

ay o

ccur

.

Ap

no

ea in

pre

term

inf

ants

.

Am

inop

hyll

ine,

or

al

2 1

0-1

4m

g/k

g--

225-

Fo

r as

thm

a. M

onit

or le

vels

. T

able

ts

slow

rel

ease

4

50

mg

22

5,10

0mg.

(P

hyll

ocon

tin)

Am

oxyc

illi

n or

al

3 --6

2.5

mg

--

125m

g 25

0mg

500m

g S

yrup

125

mg/

5 m

l. (A

mox

il)

l.v.

4 Se

e 12

.5-2

5 12

5mg

25

0m

g

500m

g M

enin

giti

s: 4

00 m

g k

g-

I (2

4 h)

-I.

l.m.

Tab

le 2

ru

g/kg

Am

pici

llin

or

al

4 --6

2.5

mg

--

125m

g 2

50

mg

50

0mg

Syr

up 1

25 m

g/5

ml.

(Pen

brit

in)

i.v.

4 Se

e 12

.5-2

5 12

5mg

25

0m

g

500m

g M

enin

giti

s: 4

00 m

g kg

-1

(24

h) -

I.

i.m.

Tab

le 2

ru

g/kg

Asp

irin

, or

al

3 o

r 4

No

t su

itab

le-u

se

100

mg

300m

g 60

0mg

As

anti

pyre

tic,

ana

lges

ia.

Sol

uble

so

lubl

e pa

race

tam

ol

tabl

ets

300

mg,

Pae

diat

ric

75 m

g.

Ant

irhe

umat

ic:

100

mg

kg -

1 (2

4 h)

-1

divi

ded

4-6

hou

rly

and

mea

sure

sa

licy

late

lev

el.

Atr

opin

e i.v

. Si

ngle

-0

.01

-0.0

3m

g/k

g-

0.1

5m

g

0.3

mg

0

.6m

g

Fo

r ca

rdia

c ar

rest

, br

adyc

ardi

a.

dose

Azl

ocil

lin

l.v.

4 Se

e 50

-100

50

0mg

I g

2g

D

oubl

e do

se in

sev

ere

infe

ctio

ns.

May

(S

ecur

open

) T

able

2

mg/

kg

caus

e hy

poka

laem

ia.

Ben

dro-

oral

O

nce

-0.1

25

mg

/kg

-1.

25m

g 2

.5m

g

5m

g

Pot

assi

um s

uppl

emen

t re

quir

ed.

flua

zide

Cal

cium

l.v

. Si

ngle

--0

.1 m

ljk

g--

1.2m

l 2

.5m

l 5

ml

Fo

r ca

rdia

c ar

rest

, as

ysto

le.

Inje

ct

chlo

ride

(10

%)

slow

ly u

nder

EC

G c

ontr

ol.

Ver

y ir

rita

nt i

f inf

usio

n tis

sues

.

Cal

cium

l.v

. Si

ngle

--3

mljk

g--

3.5m

l 7.

5ml

15m

l F

or

card

iac

arre

st,

asys

tole

. gl

ucon

ate

(10%

)

l.v.

Sing

le

0.2

Neo

nata

l te

tany

. In

ject

slo

wly

. M

ay

ml/

kg

caus

e br

adyc

ardi

a.

Dru

g R

oute

D

osag

e pe

r do

se g

iven

T

imes

R

emar

ks

dail

y 0

-2

2 w

eeks

-1

year

7

year

s A

dult

w

eeks

1

year

Car

bam

azep

ine

oral

2

or3

IO

mg/

kg

100m

g 20

0mg

400m

g (T

egre

tol)

Car

beni

cill

in

l.v.

4 Se

e 50

-100

50

0mg

I g

2g

D

ose

may

be

doub

led

in s

ever

e (P

yope

n)

Tab

le 2

m

g/kg

in

fect

ions

. M

ay c

ause

hyp

okal

aem

ia.

Cef

urox

ime

i.m

.or

3 Se

e 20

mg/

kg

200m

g 37

5mg

750m

g (Z

inac

ef)

i.v.

Tab

le 2

Cep

hazo

lin

i.m.

or

4 12

.5-2

5 l2

5m

g

250m

g 50

0mg

(Kef

zol)

l.v

. m

g/kg

Cep

hale

xin

oral

4

--1

2 m

g/k

g--

125m

g 25

0mg

500m

g (C

epor

ex,

Kef

lex)

Cep

hrad

ine

oral

4

--

12 m

g/kg

--

l25

mg

25

0mg

500m

g (V

elos

ef)

l.m.

or

4 Se

e 12

.5-

125m

g 25

0mg

500m

g l.v

. T

able

2

25m

g/kg

Cha

rcoa

l or

al

Sin

gle

---

0.5-

1 g/

kg w

ith

wate

r--

10-5

0 g

Acu

te p

oiso

ning

. ac

tiva

ted

in 5

0ml

(Med

icoa

l)

wat

er

Chl

oral

or

al

Sin

gle

--

30 m

g/kg

--

300

mg

500m

g l.

Og

Sing

le h

ypno

tic

dose

. E

lixi

r 20

0 m

g/

hydr

ate

5 m

l, 50

0 m

g/5

ml.

Chl

oram

-or

al

4 Se

e 12

.5

--1

2.5

-25

mg

/kg

-l.

Og

M

ay c

ause

apl

asti

c an

aem

ia.

phen

icol

l.v

. T

able

2

mg/

kg

(Chl

orom

ycet

in)

Chl

orot

hiaz

ide

oral

2

-IO

mg

/kg

--

12S

mg

2S0m

g SO

Om

g P

otas

sium

sup

plem

ent

need

ed.

(Sal

uric

)

Chl

oroq

uine

or

al

Init

ial

IS

ISO

mg

300m

g 60

0mg

Fo

r be

nign

ter

tian

mal

aria

. F

ollo

w w

ith

(as

base

) do

se:

mg/

kg

Pri

maq

uine

for

14

days

. F

or

P.

(Niv

aqui

ne)

then

7.

S 7S

mg

ISO

mg

300m

g Ja

lcip

arum

fro

m c

hlor

oqui

ne r

esis

tant

ar

ea u

se q

uini

ne o

r F

ansi

dar

give

n 6

h

mg/

kg

(pyr

imet

ham

ine

and

sulf

adox

ine)

la

ter:

then

3.

7S

37.S

mg

7Sm

g IS

Om

g do

se

mg/

kg

give

n 12

-ho

urly

fo

r 2

days

:

Chl

orph

enir

-or

al

30

r4

Img

2

mg

4

mg

A

cute

ana

phyl

axis

am

ine

i.v.

Sing

le

0.2S

2.

Sm

g S

mg

IOm

g (P

irit

on)

mg/

kg

Cho

line

or

al

3 S

mg/

kg

SOm

g 10

0mg

200m

g M

on

ito

r le

vels

. T

able

ts 1

00 m

g an

d th

eoph

ylli

nate

20

0 m

g. S

yrup

62.

S m

g/S

ml.

(Cho

ledy

l)

Cim

etid

ine

oral

4

S-I

Om

g/kg

10

0mg

20

0m

g

Tab

lets

200

mg.

Syr

up 2

00 m

g/S

ml.

(Tag

amet

) td

s an

d td

san

d

200m

g 4

00

mg

at

nig

ht

at n

ight

i.v.

4 4

mg

/kg

10

0mg

20

0m

g

(ove

r 2

hour

s)

Clo

naze

pam

or

al m

ain-

4 0.

2Sm

g O

.Sm

g Im

g

2m

g

Ant

icon

vuls

ant.

May

cau

se d

row

sine

ss

(Riv

otri

l)

tena

nce

and

incr

ease

d sa

liva

tion

. S

tart

wit

h do

se

dose

st

ated

onc

e a

day,

and

gra

dual

ly

incr

ease

.

Dos

age

per

dose

git'

en

Rem

arks

D

rug

Rou

te

Tim

es

dail

y 0

-2

2 w

eeks

-I

year

7

year

s A

dult

w

eeks

J

year

Co-

trim

oxaz

ole

oral

2

See

24

240m

g 4

80

mg

96

0mg

Dos

e gi

ven

in t

erm

s o

f tot

al o

f (S

eptr

in,

Tab

le 2

m

g/kg

T

rim

etho

prin

I p

art

and

Bac

trim

) i.v

. P

roph

y-Se

e 12

12

0mg

240m

g 4

80

mg

S

ulph

amet

hoxa

zole

5 p

arts

. T

able

ts:

lact

ic

Tab

le 2

m

g/kg

96

0,48

0, 1

20m

g. S

uspe

nsio

n: 4

80

mg

/ at

nig

ht

5 m

!. P

aedi

atri

c sy

rup

240

mg/

5 m

!.

Des

ferr

ioxa

min

e i.

m.a

nd

S

ingl

e 20

mg/

kg g

iven

i.m

. im

med

iate

ly.

If

Fo

r se

vere

iro

n po

ison

ing.

May

cau

se

(Des

fera

l)

i.v.

nece

ssar

y, t

hen

i.v.

80m

g/kg

ove

r 24

hou

rs.

hypo

tens

ion.

R

ate

not

to e

xcee

d 15

mg/

kg.

Dex

amet

haso

ne

i.v.

4 --0

.1 m

g/kg

--

I mg

2m

g

4m

g

Fo

r ce

rebr

al o

edem

a. M

ay i

niti

ally

giv

e (D

ecad

ron.

do

uble

thi

s do

se.

In G

ram

-neg

ativ

e O

rade

xon)

sh

ock,

up

to 1

0 ti

mes

sta

ted

dose

.

Dex

tros

e. 5

0%

l.v.

Sin

gle

up to

4 m

l/kg

(2 g

/kg)

F

or

hypo

glyc

aem

ia.

Dil

ute

befo

re

inje

ctio

n.

Dia

zepa

m

l.v.

Sin

gle

-0.

25 m

g/k

g-

2.5m

g 5

mg

IO

mg

As

anti

conv

ulsa

nt o

r fo

r se

dati

on.

May

(V

aliu

m.

slow

ly

repe

at i

n 15

min

if

nece

ssar

y. M

ay c

ause

D

iaze

mul

s)

resp

irat

ory

depr

essi

on.

Inje

ctio

n: 5

mg/

m

!. D

iazo

xide

i.v

. U

pt0

4

3-5

mg

/kg

30

0mg

Fo

r se

vere

hyp

erte

nsio

n. M

ay c

ause

(E

udem

ine)

hy

pote

nsio

n. I

njec

t ra

pidl

y.

Dic

hlor

al-

oral

O

nce

-2

2.5

mg

/kg

-22

5mg

65

0m

g

l.3

g

Fo

r se

dati

on.

Tab

lets

650

mg.

Eli

xir

phen

azon

e 22

5 m

g/5

m!.

(Wel

ldor

m)

Dic

yclo

min

e or

al

4 ---5

mg

--

Fo

r th

ree

mo

nth

col

ic.

Giv

e 15

min

(M

erbe

ntyl

) be

fore

fee

d. S

yrup

10

mg/

5 m

!.

Dig

oxin

se

e pa

ge 2

15

(Lan

oxin

)

Dis

opyr

amid

e i.v

. Si

ngle

--

2 m

g/kg

to

max

of

ISO

mg,

slo

wly

, the

n --

F o

r ve

ntri

cula

r ar

rhyt

hmia

s,

(Nor

pace

, O

Am

g k

g-

I h

-I by

con

tinu

ous

infu

sion

pa

roxy

smal

sup

rave

ntri

cula

r R

hyth

mod

an)

tach

ycar

dia.

Dio

ctyl

sod

ium

or

al

3 12

.Sm

g 12

.S-

20

mg

4

0m

g

sulp

hosu

ccin

ate

2Sm

g (D

ioct

yl- M

edo)

Dop

amin

e l.v

. Si

ngle

S

20

Ilg

kg

-I m

in -

I. A

djus

t do

se a

ccor

ding

to

res

pons

e In

otro

pic

agen

t fo

r hy

pote

nsio

n an

d (l

ntro

pin)

p

oo

r ca

rdia

c ou

tput

. C

orre

ct

hypo

vola

emia

fir

st.

May

cau

se

arrh

ythm

ias.

Dob

utam

ine

l.v.

Sing

le

2.S

10 Il

g kg

-1

min

-I.

Adj

ust

dose

acc

ordi

ng t

o In

otro

pic

agen

t.

hydr

ochl

orid

e re

spon

se

(Dob

utra

x)

Dro

peri

dol

i.v.

i.m

. Si

ngle

--

0.1

mg

/kg

--1.

2Sm

g 2.

Sm

g S

mg

F

or

seda

tion

or

prem

edic

atio

n. T

able

ts

(Dro

lept

an)

oral

2

.Sm

g,I

Om

g.

Ery

thro

myc

in

oral

4

--1

2 m

g/k

g--

12S

mg

2S0m

g SO

Om

g (E

ryth

roci

n,

Ery

thro

ped,

Il

oson

e)

Eth

ambu

tol

oral

O

nce

-1

2-2

Sm

g/k

g-

May

cau

se o

cula

r to

xici

ty.

(Mya

mbu

tol)

Eth

osux

imid

e or

al

Onc

e 12

2S

0mg

SOO

mg

Init

ial

dose

. In

crea

se b

y 2S

0 m

g ev

ery

4 (Z

aron

tin,

m

g/kg

(m

ax.

(max

.2g

) 7

days

acc

ordi

ng t

o re

spon

se,

to

Em

esid

e)

(up

to S

O 1 g

) m

axim

um d

ose.

m

g/kg

Fer

rous

or

al

3 6

mg

/kg

6

0m

g

120m

g 20

0mg

Tre

atm

ent

of i

ron

defi

cien

cy a

naem

ia.

sulp

hate

T

able

ts 2

00 m

g an

d 30

0 m

g. P

aedi

atri

c m

ixtu

re 6

0 m

g/S

m!.

Dos

age

per

dose

giv

en

Dru

g R

oute

T

imes

R

ema

rks

dail

y 0

-2

2 w

eeks

-I

year

7

year

s A

dult

w

eeks

I

year

Flu

clox

acil

lin

oral

4

See

62.5

mg

l25

mg

2

50

mg

50

0mg

Bet

ter

oral

abs

orpt

ion

wit

h (F

loxa

pen)

an

d

i.m

. T

able

2

fluc

loxa

cill

in.

Syr

up 1

25 m

g/5

m!.

clox

acil

lin

or

(Orb

enin

) i.v

.

Fol

ic a

cid

oral

O

nce

0.25

2.

5mg

5m

g

10

mg

T

able

ts 0

.1 m

g an

d 5

mg.

m

g/kg

Fru

sem

ide

oral

O

nce

--2

mg

/kg

--

20

mg

4

0m

g

80

mg

N

eeds

K s

uppl

emen

ts u

nles

s gi

ven

wit

h (L

asix

) sp

iron

olac

tone

. P

aedi

atri

c m

ixtu

re

lmg

/m!.

i.

m.

Sin

gle

--lm

g/k

g-

10m

g 2

0m

g

40

mg

D

ou

ble

the

dos

e if

nec

essa

ry.

I.V.

Fus

idic

aci

d or

al

4 12

.5 m

g/kg

as

25

0m

gas

50

0mg

as

Fus

idic

aci

d su

spen

sion

250

mg/

5 m

!. (F

ucid

in)

fusi

dic

acid

so

dium

so

dium

C

apsu

les,

sod

ium

fus

idat

e 25

0 m

g.

fusi

date

fu

sida

te

i.v.

3 12

.5

l25

mg

2

50

mg

50

0mg

Giv

en a

s a

cont

inuo

us in

fusi

on.

mg/

kg

Gen

tam

icin

l.m

. 3

See

2

mg

/kg

M

ay b

e ot

otox

ic a

nd

nep

hrot

oxic

. (G

enti

cin,

i.v

. T

able

2

Mo

nit

or

seru

m l

evel

s. I

ncre

ase

tim

e C

idom

ycin

) be

twee

n do

ses

in r

enal

fai

lure

. D

o n

ot

com

bine

wit

h ca

rben

icil

lin

in s

ame

infu

sion

.

Glu

cago

n i.m

. S

ingl

e -

25-1

00 Ilg

/kg

-0.

25 m

g 0

.5m

g

Img

F

or

hypo

glyc

aem

ia.

l.V.

Gly

cero

l or

al

4 I g

/kg

Use

d in

No

rth

Am

eric

a fo

r ce

rebr

al

oede

ma.

Hyd

rala

zine

l.V

. 4

0.2-

0.4

mg/

kg

Fo

r se

vere

hyp

erte

nsio

n.

(Apr

esol

ine)

i.m

.

Hyd

roco

rtis

one

I.v.

4-6

Sm

g/kg

SO

mg

100m

g 20

0mg

Fo

r st

atus

ast

hmat

icus

. F

or

Gra

m-

nega

tive

sho

ck, i

niti

al d

ose

up t

o S

times

do

se s

tate

d. I

njec

tion

: IO

Om

g as

sod

ium

su

ccin

ate.

Indo

met

haci

n or

al

Sing

le

0.2

In n

eona

tes,

to

clos

e a

pate

nt d

uctu

s (I

ndoc

id)

mg/

kg

arte

rios

us.

Rep

eat

x 2,

8 h

ourl

y if

ne

cess

ary.

Ipec

acua

nha

oral

Si

ngle

IO

ml

ISm

l IS

ml

30m

l P

aedi

atri

c ip

ecac

uanh

a-em

etic

m

ixtu

re.

Rep

eat

afte

r 20

min

if

nece

ssar

y.

Ipra

trop

ium

ne

buli

zed

3 O

.I-O

.S m

g in

2 m

l ste

rile

wat

er

Fo

r st

atus

ast

hmat

icus

in c

hild

ren

over

(A

trov

ent)

3

y.

Ison

iazi

d or

al

Onc

e 7.

S 7.

S 7S

mg

ISO

mg

300m

g m

g/kg

m

g/kg

Isop

rena

line

i.v

. O

nce

O.I-

O.S

/lg

kg-

1 m

in -I by

con

tinu

ous

infu

sion

. A

djus

t In

otro

pic

agen

t fo

r br

adyc

ardi

a,

(Iso

prot

eren

ol;

dose

acc

ordi

ng t

o th

e re

spon

se

hypo

tens

ion

and

poor

car

diac

out

put.

Is

upre

l)

Lac

tulo

se

oral

O

nce

Sml

IOm

l 20

ml

30m

l D

ose

of e

lixir

, con

tain

ing

lact

ulos

e (D

upha

lac,

3.

3Sg/

Sm

l.

Gaf

inar

)

Lig

noca

ine

i.v.

Onc

e B

olus

of

I mg/

kg,

repe

at a

fter

S m

in i

f nec

essa

ry,

then

F

or

vent

ricu

lar

tach

ycar

dia.

(X

yloc

ard)

10

-SO

/lg

kg

-I m

in -I by

con

tinu

ous

infu

sion

Mag

nesi

um

I.m.

Sing

le

0.1

Fo

r ne

onat

al h

ypom

agne

saem

ia.

Giv

e su

lpha

te

i.v.

mg/

kg

i.v.

inje

ctio

n sl

owly

. (S

O%

)

Man

nito

l I.v

. Si

ngle

O

.S-I

g/k

g F

or

cere

bral

oed

ema.

Rep

eat

as

(20%

) .o

ver

indi

cate

d. M

ay c

ause

cir

cula

tory

20

min

ov

erlo

ad.

Mon

itor

osm

olal

ity.

Dos

age

per

dose

giv

en

Dru

g R

oute

T

imes

R

emar

ks

dail

y 0

-2

2 w

eeks

-1

year

7

year

s A

dult

w

eeks

1

year

Met

hici

llin

i.

m.

4 S

ee

2S

2S0m

g SO

Om

g I g

(C

elbe

nin)

L

V.

Tab

le 2

m

g/kg

Met

hyld

opa

ora

l 3

6m

g/k

g

62.S

mg

12S

mg

2S0m

g In

crea

se a

ccor

ding

to

resp

onse

, up

to

3 (A

ldom

et,

tim

es s

tate

d do

se.

Co

pam

et,

Med

omet

)

Met

ocJo

pram

ide

oral

3

0.1

Img

S

mg

IO

mg

Syr

up S

mg/

S m

L

(Max

olon

, L

m.

Sin

gle

mg/

kg

Pae

diat

ric

liqu

id I

mg/

mL

P

rim

pera

n)

Lv.

S

ingl

e T

able

ts 1

0 m

g.

Met

roni

dazo

le

oral

3

7.S

mg/

kg

40

0m

g

Fo

r an

aero

bic

infe

ctio

ns.

(Fla

gyl)

re

ctal

3

7.S

mg/

kg

I g

LV

. 3

7.S

mg/

kg

SOO

mg

Mo

rph

ine

l.m

. S

ingl

e 0.

2 2.

Sm

g S

mg

1

0m

g

May

cau

se r

espi

rato

ry d

epre

ssio

n,

sulp

hate

L

v.

mg/

kg

espe

cial

ly in

you

ng c

hild

ren.

Nal

idix

ic a

cid

oral

4

2S0m

g SO

Om

g I g

S

uspe

nsio

n 30

0 m

g/S

mL

Fo

r (N

egra

m)

prop

hyla

xis,

giv

e on

ly t

wic

e da

ily.

Nal

oxon

e H

CI

Lm

. S

ingl

e -O

.Olm

g/k

g-

O.l

mg

0.2

mg

O

.·lm

g N

arco

tic

over

dosa

ge.

Rep

eat

in 2

min

if

(Nar

con)

Lv

. ne

cess

ary.

Inj

ecti

on 4

00 Il

g/m

L N

eona

tal

20 Il

g/m

L

Neo

myc

in

oral

4

--2

Sm

g/k

g--

2S0m

g SO

Om

g I g

su

lpha

te

(Niv

emyc

in)

Nit

rofu

ran

toin

or

al

4 A

void

2.

S 2S

mg

SOm

g 10

0mg

Tab

lets

SO

mg,

100

mg.

Sus

pens

ion

(Fu

rad

anti

n)

mg/

kg

2S m

g/S

mL

Fo

r pr

ophy

laxi

s, g

ive

twic

e da

ily.

Con

trai

ndic

ated

in i

nfan

ts <

I

mo

nth

old

.

Nys

tati

n or

al

4 F

or

oral

thr

ush,

100

000u

nits

S

uspe

nsio

n 10

0000

uni

ts/m

!.

(Nys

tan)

Pap

aver

etum

or

al

Sing

le

200

2.S

-Sm

g S

-IO

mg

10-2

0 F

or

seda

tion

, ana

lges

ia,

prem

edic

atio

n.

(Om

nopo

n)

i.m.

Jlg/

kg

mg

Dos

e o

f Om

nopo

n-S

copo

lam

ine

is

i.v.

0.03

mlj

kg i.

m.

(pap

aver

etum

20

mg

and

hyos

cine

400

j.tg

/ml)

I h

ou

r be

fore

op

erat

ion.

Par

acet

amol

or

al

4-6

24

24

0mg

SOO

mg

Ig

Tab

lets

SOO

mg,

sus

pens

ion

(Cal

pol)

(A

ceta

min

ophe

n m

g/kg

12

0 m

g/S

m!.

Pan

adol

, C

al p

ol,

Tyl

enol

(U

SA

)

Par

alde

hyde

i.m

. Si

ngle

--O

.IS

mlj

kg

--Im

l S

ml

IOm

l T

o a

void

ste

rile

abs

cess

es,

give

dee

p i.m

. do

se

Rep

eat

in I

S-3

0 m

in i

f nec

essa

ry.

rect

al

Sing

le

0.3

mlj

kg

Mix

wit

h eq

ual

volu

me

of m

iner

al o

i!.

dose

Pen

icil

lin

G

i.m.

4 Se

e IS

IS

Om

g 30

0mg

600m

g In

crea

se d

ose

and

fre

quen

cy i

n se

vere

(b

enzy

l i.v

. T

able

2

mg/

kg

infe

ctio

ns.

peni

cill

in,

Cry

stap

en)

Pen

icil

lin,

i.m

. E

very

tv

ial

!via

l 1

vial

O

ne v

ial

cont

ains

ben

etha

min

e pe

nici

llin

pr

olon

ged

2-3

47S

mg,

pro

cain

e pe

nici

llin

2S0

mg,

ac

tion

da

ys

benz

ylpe

nici

llin

300

mg.

(b

enet

ham

ine

peni

cill

in,

Tri

plop

en)

Pen

icil

lin

V

oral

4

--6

2.S

mg

--

12S

mg

2S0m

g SO

Om

g S

yrup

12S

mg,

2S

0mg/

Sm

!.

(phe

noxy

met

hyl

peni

cill

in)

(Cry

stap

en V

, V

-Cil

-K e

tc).

Dos

age

per

dose

giv

en

Dru

g R

oute

T

imes

R

ema

rks

dail

y O~2

2 weeks~

1 ye

ar

7 ye

ars

Adu

lt

wee

ks

1 ye

ar

Pet

hidi

ne

i.m.

Sing

le

--1

-2

mg

/kg

-12.5~2S

2S~SO

SO~IOO

Fo

r an

alge

sia,

sed

atio

n, p

rem

edic

atio

n m

g m

g m

g I

hour

bef

ore

oper

atio

n.

Phe

noba

rbit

one

oral

O

nce

4~6mg/kg

60~120

60~360

As

an a

ntic

onvu

lsan

t. M

ay c

ause

m

g m

g be

havi

our

dist

urba

nce

in s

ome

chil

dren

. i.v

. Si

ngle

S~lOmg/kg

Sta

tus

epil

epti

cus.

May

cau

se

resp

irat

ory

depr

essi

on.

Rep

eat

afte

r 20

min

if n

eces

sary

. P

heny

toin

or

al

2 3m

g/kg

30

mg

SOm

g 10

0mg

Mai

nten

ance

ant

icon

vuls

ant

ther

apy.

(E

panu

tin)

Si

de e

ffec

ts i

nclu

de g

um h

yper

trop

hy,

atax

ia a

nd li

ver

dam

age.

Tab

lets

SO,

10

0 m

g. S

uspe

nsio

n 30

mg/

Sm

l.

i.v.

15~20mg/kg

Sta

tus

epil

epti

cus.

May

cau

se

(slo

w)

hypo

tens

ion

and

card

iac

dysr

hyth

mia

s.

Phy

tom

enad

ione

or

al

Sing

le

1 m

g 3m

g S

mg

IOm

g (V

it K

, i.m

. K

onak

ion)

i.v

.

Pot

assi

um

oral

1~2mmol K

+ kg~1 (

24h)

-1

Sta

rtin

g do

se in

diu

reti

c th

erap

y. B

ase

supp

lem

ents

do

se o

n cl

inic

al r

equi

rem

ents

and

pl

asm

a K

. G

ive

as p

otas

sium

chl

orid

e,

or

pota

ssiu

m g

luco

nate

, or

effe

rves

cent

po

tass

ium

(po

tass

ium

bic

arbo

nate

).

Pre

dnis

olon

e or

al

Onc

e ---2

mg

kg

-1 (

24h)~ I

or 60mgm~2(24h)~I-

For

indu

ctio

n o

f rem

issi

on in

nep

hrot

ic

synd

rom

e. M

inim

um d

ose

2S m

g/24

h,

max

80

mg/

24 h

.

Pri

maq

uine

or

al

Onc

e 37

S 3.

7Sm

g 7.

Sm

g IS

mg

Fo

r er

adic

atio

n o

f ben

ign

tert

ian

jlg/

kg

mal

aria

. Giv

e fo

r 14

day

s af

ter

trea

tmen

t wit

h ch

loro

quin

e. T

est f

or

G6P

D d

efic

ienc

y. T

able

ts o

nly,

7.S

mg.

Pro

met

hazi

ne

oral

3

0.5

5m

g

10m

g 25

mg

Fo

r us

e as

an

anti

hist

amin

e. F

or s

ingl

e H

CI

mg/

kg

seda

tive

dos

e th

e st

ated

dos

e ca

n be

(P

hene

rgan

) do

uble

d.

Pro

pran

olol

or

al

3 ---

0.2-

0.3

mg/

kg.

Max

dos

e 20

mg

Fo

r ar

rhyt

hmia

s.

(Ind

eral

) l.v

. Si

ngle

--

0.1

-0.1

5 m

g/kg

. M

ax s

ingl

e do

se 1

0 m

g---

Fo

r ar

rhyt

hmia

s, c

yano

tic

atta

cks

in

tetr

alog

y o

f F

allo

t. R

epea

t in

6 h

ours

if

nece

ssar

y.

Pro

stag

land

in

i.v.

Sing

le

0.05

-1 J

lg k

g -

1 1.

5 m

g pr

osta

glan

din

in 5

00 m

l de

xtro

se.

El

and

Ez

min

-1

as a

n

Giv

e vi

a a

syri

nge

pum

p.

infu

sion

Rif

ampi

cin

oral

O

nce

15

150m

g 30

0mg

600m

g M

ay c

ause

uri

ne,

sali

va t

o go

red

. In

(R

ifad

in,

mg/

kg

prop

hyla

xis

for

men

ingo

cocc

al o

r H

. R

imac

tane

) in

jlue

nzae

con

tact

s, 2

-4 d

ays

only

. C

apsu

les,

150

, 300

mg.

Sus

pens

ion

IOO

mg/

5m!.

Sal

buta

mol

or

al

3-4

0.1

Img

2

mg

4

mg

T

able

ts 2

mg,

4 m

g, 8

mg

(lon

g-ac

ting

).

(Ven

toli

n)

mg/

kg

Syr

up 2

mg/

5 m

!.

inha

la-

4 20

0 Jl

g 20

0-R

otac

aps

200,

400

Jlg

wit

h R

otah

aler

. ti

on

400

Jlg

(pow

der)

ne

buli

-4-

8 0.

05

0.5m

l Im

l 2

ml

In s

tatu

s as

thm

atic

us.

Res

pira

tor

zer

mlf

kg

solu

tion

0.5

% m

ade

up t

o 2

ml

wit

h no

rmal

sal

ine.

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HEIGHT !eml SA WE IGHT Ikgl

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Nomogram to calculate the surface area of a child

APPENDIX

Table 2 Doses of antibiotics in neonates (born at term)

0-7 days old 7-14 days old

Drug Route Times Dose Times Dose Remarks daily daily

Amikacin i.m. 2 7.5mg/kg 3 7.5mg/kg Side-effects and i.v. monitor serum

levels as for Gentamicin.

Amoxycillin i.v. 2 25mg/kg 3 25mg/kg i.m. 2 50mg/kg 4 50mg/kg For Group B

streptococcal sepsis or meningitis.

Ampicillin i.v. 2 25mg/kg 3 25mg/kg i.m. 2 50mg/kg 4 50mg/kg For Group B

streptococcal sepsis or meningitis.

Azlocillin i.v. 2 lOOmg/kg 3 100mg/kg if <2.0kg

4 100mglkg if >2.0 kg

Carbenicillin i.v. 2 100mg/kg 3 100mg/kg if <2.0kg

4 100mgjkg if >2.0kg

Cefuroxime I.V. 2 20mgjkg 3 20mgjkg i.m.

Cephalothin i.v. 2 20mg/kg 3 20mgjkg i.m.

Chloramphenicol i.v. 2 12.5 2 12.5-25 Monitor serum mg/kg mg/kg levels. May cause

the 'grey-baby syndrome'.

Co-trimoxazole i.v. 2 24 mg/kg 2 24 mg/kg Avoid if baby is (Septrin, jaundiced. Bactrim)

Flucloxacillin I.V. 2 25 mg/kg 3 25mg/kg or cloxacillin

315

PAEDIATRIC EMERGENCIES

0--7 days old 7-14 days old

Drug Route Times Dose Times Dose Remarks daily daily

Gentamicin i.m. 3 2mg/kg 3 2.5mg/kg May be ototoxic i.v. or nephrotoxic.

Monitor serum levels.

Isoniazid oral Single 10 mg/kg Single 10 mg/kg

Methicillin i.v. 2 25mg/kg if 2 25mg/kgif <2.0kg <2.0kg

3 25 mg/kg if 3 25mg/kg if >2.0kg >2.0kg

Penicillin G l.v. 2 15mg/kg 3 15mg/kg (benzyl i.m. penicillin) 2 30-45 mg/kg 4 25-35mg/ For group B

kg streptococcal sepsis or meningitis.

Tobramycin i.m. 2 2 mg/kg 3 2mg/kg Side-effects and i.v. monitor serum

levels as for Gentamicin

Further details may be found in Antimicrobial Therapyfor Newborns by McCracken. G .. and Nelson. 1. D .. 1977. Grune and Stratton. New York.

316

Index

abdominal pain see pain accidents 56, 223-8

see also burns, head injury, poisoning N-acetyl cysteine and paracetamol

poisoning 236 acidosis 17, 20 I

bicarbonate 129, 132 breathing 123 cardiac arrest, treatment 27, 129, 132 dehydration 81 diabetes 120,122

ACTH and infantile spasms 161 acyclovir 152 adrenaline

anaphylaxis 194 asystole 29 dose in cardiopulmonary arrest 28 indication 16 infusion and cardiac output 31,191 intracardiac 29 racemic aerosol in laryngotracheo­

bronchitis 42 resuscitation 9

airway anaphylaxis 194 coma 171 establishment in cardiopulmonary

arrest 21, 24 airway obstruction 5

common sites 51, 52 lower 51,52 over-distension 52 relief, Medicut 50 upper 49-51

alcohol poisoning 240 alkali poisoning and ulcers 240 allergens causing anaphylaxis 193, 194 aminophylline

acute asthma 71-3 anaphylaxis 194 blood level monitoring 75 dose in asthma 72

amitryptyline 238 amoxycillin 143,203

r"'~umonia 65 ampicillin 151,201

epiglottitis 47 and pneumonia 65

analgesia maternal and fetus 14 and naloxone 17

anaphylaxis see shock antibiotics 143, 144

diabetic ketoacidosis 132 dosages 315-16 epiglottitis 44-6 gastroenteritis 92 meningitis 142,151

317

INDEX

antibiotics-cont. osteomyelitis 145 pneumonia 65 septic arthritis 146

antidepressants, poisoning by tricyclic 238, 239

clinical features 239 antiemetics 92 Apgar score

intubation II neonatal assessment 7, 8 response 10

apnoea 18,211,212 bronchiolitis 59 clinical features 3 colour and heart rate 3 events in rhesus monkeys I, 2 intubation 10, II monitoring 271 pertussis 67 primary 1-4 secondary 1-4 sudden infant death syndrome 267,

271 ventilation 10

appendicitis 108-111, 116 arterial blood sampling 278-82

catheter, radial artery 281, 282 exsanguination 282 oxygen tension 278 radial artery puncture 279-81

arthritis, septic 146; see also Still's disease

aryepiglottic folds 37 in epiglottitis 45

asphyxia, need for resuscitation 4 asplenism 152 aspiration, food and fluid 9,68 aspirin, side-effects in fever 139 asthma 60, 61, 68

acute 70-6 blood gas analysis 74 drug doses 72 drugs 71,72 hospital 70, 71, 73 hydration 75 incidence 70 intensive care 75,76 intravenous drugs 73, 74

long-term management 76 management, acute 70, 71 mortality 70 nebulizer 72 peak flow measurement 72, 73 precipitating factors 76 ventilation 76 wheezing 68

asystole duration 32 treatment 29

atopy 60,69 atropine 191,237,238

dose in cardiopulmonary arrest 28

bacterial infections antibiotics 142 babies, hazard 141 meningitis 148-52 septic shock 192, 193 see also infections

barbiturates and oxygen utilization 32 barium swallow 93

intussusception treatment 104-6 barrier nursing 92 bicarbonate 9, 15

in acidosis, disadvantages 129,132 dose in cardiopulmonary arrest 28,

29 hazards 29, 132 indications in resuscitation 16 tissue damage 286

birth, high-risk 6 blood gas measurement 57

arterial samples 278 bronchiolitis 59 hyperoxia test 210,211 in laryngotracheobronchitis 41 respiratory distress 74 shock 190

blood pressure measurement 294 normal systolic 294

blood samples arterial see arterial sampling capillary, heel prick sites 275,276 venous, sites and procedure 277, 278

brain damage

318

and asphyxia at birth 4 cardiopulmonary arrest 21

epilepsy 68 febrile convulsions 163 nonaccidental injury 256 pertussis 174

brain stem trauma 5 breath-holding 167

cyanotic and pallid 167 breathing

abnormal and diagnosis 122-4 artificial in cardiopulmonary

arrest 24 reasons for abnormal at birth 5 ventilation position 24

bronchiectasis 68 bronchiolitis 68

and asthma 60, 61 cardiac failure 60 clinical features 59 cough 59 drugs 60 hydration 60 incidence and age 57, 58 management 59, 60 pathophysiology 58 recovery 60 ventilation hazard 59 viral cause 58

bronchopneumonia 68 bronchoscopy 52 burns and scalds 226, 227

assessment 226 fluid replacement 226 hospital admission 227 nonaccidental 256, 257

Caesarean section and apnoea 18 calcium chloride

asystole 29 dose in cardiopulmonary arrest 28 indications in neonatal

resuscitation 16 Campylobacter spp.

abdominal pain 113 antibiotics 92 gastroenteritis features 79, 80

cardiac failure age and digitalization 214-16 bronchiolitis 60 causes 212,213

INDEX

chest radiograph 215 drugs 214,215 heart lesions 208, 213 investigations 214 management 214-16 patent ductus 214 presentation 212

cardiac output, drugs increasing 191 cardiorespiratory arrest 21-32

airway and breathing 24,25 asystole treatment 29 brain damage 21 drug doses 28 drug use 26-9 equipment needed 22,23 follow-up 32 inotropic agents 30, 31 intubation 25 management 23 resuscitation 21-3 sequence mnemonic 23 team 22

cardiovascular emergencies 207-17 age of onset 208 congenital disorders 207, 208, 211,

213 see also cardiac failure, cyanosis

catheter, central venous 288-91 ascepllc msertlOn 291 complications 289 infusion sites 289 insertion site, jugular vein 290

central venous pressure line 190, 191, 290,291

cerebral oedema 184, 225 drugs reducing 183

cerebrospinal fluid meningitis 149 normal neonate 141

child abuse (nonaccidental injury, NAI) age 248

319

assessment and investigations 260 background factors 248, 249 bites 255, 256 black eyes 253, 255 bruise examination 252-5 burns and scalds 256, 257 case conference 261, 262 child personality 250

child abuse-conI. ear bruise 253 head injury 256 history 251, 252 hospital admission 259-61 incidence 247 parental factors 249, 250 poisoning 258 radiological evidence 257, 258 types 258

chloral hydrate 109 chloramphenicol

epiglottitis 44, 45 meningitis 142,151

chlorpheniramine in anaphylaxis 193, 194

circulation, fetal 4 clonazepam 161 cloxacillin in pneumonia 65 coarctation of the aorta 208,211,213 coma 171-84

abscess 172 assessment 180, 181 causes 172 cerebral oedema 183, 184 drugs 177, 178 encephalopathy 179, 180 eye movements 181 infections 171-4 investigations 181, 182 management 182-4 Reye's syndrome 175-7 scale 181 subdural haematoma 178, 179 viral encephalitis 173, 174

congenital abnormalities 66 endocarditis 145 heart 207,208,211,213

congenital adrenal hyperplasia 96-8 constipation and abdominal pain 116 convulsions 159-70

and coma 175 intravenous infusion 168 see also spasms, febrile; status

epilepticus cot death see sudden infant death

syndrome co-trimoxazole

pneumonia 143,203

65

INDEX

croup 36; see also laryngotracheobronchitis

croupette 39,40 CTscan 172

cerebellar abscess 173 coma 182 cranial haemorrhage 225, 226

cyanosis cardiac lesions 208 central, causes in neonate 209 clinical identification 207,210 investigations 210,211 management 211, 212 peripheral 209 prostaglandin infusion 211,212

cyanotic attacks and surgery 216 cystic fibrosis

chest radiograph 66 wheezing 68

cystourethrogram, micturating 204

defibrillation 31-2 dehydration

deficits 91 diabetes 122, 127, 180 electrolyte requirements 87 eyes sunken 82,83 feeding 84 fever 89 fluid replacement 86, 87,90 hospital admission 85, 86 hypernatraemic 90, 91 intravenous infusion regimen 86-9 investigations 86 oral rehydration fluids 83-5 pyloric stenosis 95 severe, clinical features 81, 82 signs and loss of weight 81 skin recoil 81 - 3

delivery 8 deoxycortone pivalate and congenital

adrenal hyperplasia 98 dexamethasone, cerebral oedema 183 dextrose

asystole 29 cardiopulmonary arrest 28 indications in resuscitation 16, 28

diabetes 119, 120

320

INDEX

diabetic ketoacidosis 119-34 acute abdomen 124 blood and urine glucose

monitoring 134 differential diagnosis 122-4 fluids and electrolytes 120,124,188 fluid replacement calculation 125-8 insulin deficiency 119,121 insulin dose and administration 126,

127, 129, 130 intravenous infusion 124-6. 128.130 investigations 122, 123, 134 management programme 127 mechanism 119 metabolic acidosis 120,122 potassium replacement 129 rehydration effects 129 therapy chart 132 thirst and symptoms 122 treatment 124-34

diarrhoea 77-98, 188; see a/so gastroenteritis

diazepam in convulsions 166, 168, 20 I sedative 274 side-effects 169

diazoxide 180 dimercaprol (British Anti­

Lewisite) 243 diphenoxylate, danger in infants 91,

92,237,238 diphtheria 52, 53 disseminated intravascular coagulation

(DIC) 192 dobutamine, myocardial effects 31 dopamine

cardiac output 30, 191, 192 doses in cardiopulmonary arrest 28,

30 infusion regime 30, 31

drowning, cold-water 32 drugs

asthma 71, 72 cardiac failure 214, 215 cardiorespiratory arrest 23, 26-31 cerebral oedema 183 child-resistant containers 229 dosages 298- 315 lead chelation 243

neonatal resuscitation 15, 16 status epilepticus 169 fiz-sympathomimetic 71,73

ductus arteriosus patency and drugs 211, 214

duodenal atresia, double bubble 96

electrocardiogram analysis in children 219-22 cardiorespiratory arrest 29-32 Q RS axis calculation 220, 221 ventricular hypertrophy 221, 222

encephalitis incidence and measles 174 mortality of viral 173

encephalopathy hypertensive, retina 179 lead 244 post-anoxic 179, 180

endocarditis, infective and congenital disorders 145

endotracheal intubation 9, 10 asthma 77 cardiorespiratory arrest 25 difficulties 14, 15 glottis visualization 12 laryngotracheobronchitis 39-42 in position 13 positioning 15 size and vocal cords 13, 25 technique 11-14

epiglottis 37 in epiglottitis 42-4 long 53

epiglottitis age and mortality 43 airway obstruction 43 antibiotic use 44-6 appearance at presentation 46 clinical features 43, 44 differences to

laryngotracheobronchitis 44 intubation 46 lateral neck 38 management 43-8 nasotracheal tube size 41 radiograph 44, 45 and stridor 35, 42-8 viral cause 43

321

epilepsy and febrile convulsions 163, 164

erythromycin and pertussis 68 and pneumonia 66

Escherichia coli 192 features of gastroenteritis 80 in infants 61, 141 meningitis, postmortem 142 urinary tract 203

external cardiac massage 22 diagram 16 heart rate 9, 15 monitoring 25 technique 25

febrile convulsions age 162 drug prophylaxis 166 fever source 163 prognosis and epilepsy 163-5 prophylaxis 164-7 sponging 162, 163

fetus monitoring 5 fever 139-57

age, over 2 months 143-52 age, under 2 months 139-43 convulsions 139,162-7 CSF 141 hospital role 139 investigations 140, 141 paracetamol 139 see also infections

fluid, normal intake 77 foreign bodies 35,48-52, 66

chest massage techniques 49 examples 48, 49 lower airways obstruction 51, 52 symptoms 48, 49 upper airway obstruction 49-51 wheezing 68

frusemide 215

gastroenteritis 78-93 agents causing 78-80 antibiotics 92 dehydration danger 81-90 drug use 91, 92

INDEX

fluid intake 77 isolation 92 mortality 78 pain 113 recurrence 92, 93 rehydration 83, 84

gastro-oesophageal reflux 70 gentamicin 65,201 glucagon

in hypoglycaemia 136 intussusception 106

glucose-electrolyte mixture 83, 84, 85

haemolytic-uraemic syndrome 198, 200

features and management 202 Haemophilus influenza 143, 144, 146

antibiotics and 47, 143 epiglottitis 43,44 meningitis 149-52 pneumonia 61 sensitivity 47

head injury 224-6 cerebral oedema 225 cranial haemorrhage 225, 226 hospital admission role 224, 225 nonaccidental 256

heart rate 3, 8 age 219 resuscitation procedure 9

Heimlich manoeuvre, technique and visceral damage 49

Henoch-Schonlein purpura 114, 115 hernia, diaphragm 14 Hirschprung's disease 95

abdominal distension 97 hydralazine 180 hydration

asthma 75 bronchiolitis 60

hydrocortisone acute asthma 71-3 congenital adrenal hyperplasia 98 dose in asthma 72

hydronephrosis 113 21-hydroxylase deficiency 98 hyperkalaemia 201 hypernatraemia and dehydration 83,

85,90,91

322

hypernatraemic dehydration 90,91 hyperoxia test 210 hypertension

drug use 179, 180 renal failure 201

hypoglycaemia 135~8

hyponatraemia and dehydration 91 hypothermia and preterm infants 18 hypovolaemia 27

causes 188 detection 196 indications for treatment 196, 197 investigations 190 nephrotic syndrome 195, 196 plasma expander 189, 190 renal failure 198 shock management 189~92

see also shock hypoxia relief 59

immunodeficiency 152 infections

babies 139~43

children and fever 143~52

children at risk 152, 153 coma causes 171 ~4 diarrhoea 77 incidence in infants nephrotic syndrome symptoms and signs vomiting 94

56 197,198 140

see also individual infections inguinal hernia 106, 107

strangulation and age 106 insulin

administration in diabetic acidosis 126,127,129

paediatric infusion 130,131 insulin deficiency 119~21; see also

diabetic ketoacidosis intensive care unit 32

asthma 71,72,75,76 epiglottitis 43

intermittent positive pressure ventilation (IPPV)

bronchiolitis 59, 60 resuscitation 14

intestinal atresia 95 intestinal obstruction 95,96; see also

INDEX

inguinal hernia, intussusception, pyloric stenosis

intravenous infusion 282~91

cannulae 284,288 central venous catheter 288~91

cut-down in shock 288 local anaesthetic 288 needle fixing on scalp 287 peripheral 283,284 scalp, procedure 285, 287 sites 282,283 tissue damage 285, 286 winged needles, fixing 284, 285

intravenous lines 26, 27, 282~91 intussusception

age 106 diagnosis 104 gangrenous bowel 105 incidence and site 103 pain 103~6, 110 palpation 103, 104 treatment I 04~6

ipecacuanha 231 and laryngeal spasm 42

iron tablets, poisoning 236, 237 clinical features 237 treatment 237

isoprenaline cardiac output 30, 91 dose in cardiopulmonary arrest 28

Kawasaki's disease (mucocutaneous lymph node syndrome) 154~ 7

ketone bodies 120 kidney disorders 195~202; see also

nephrotic syndrome, renal failure Kussmaul breathing 122~4

lactose intolerance test 92 Ladd's bands in malrotation 107 laryngoscope and intubation II laryngotracheobronchitis 35~42, 68

323

airflow reduction 37 anxiety 39 cause of stridor 35, 36 clinical features 36,37,44 cough 37,43,44 diagnosis 37,38 drug use 42

INDEX

laryngotracheobronchitis-cont. hospital role 39 intubation 39,40,44 investigations 44 lateral neck 38 nursing 39 viral origin 36

lead poisoning abdominal radiograph 242 chelating drugs 243, 244 clinical features 243 encephalopathy 244 lead lines in bones 241,242 screening test, free erythrocyte

protoporphyrin 241 treatment and serum lead levels 244

lignocaine dose in cardiopulmonary arrest 28

lomotil poisoning 228, 231 composition 237 treatment 238

lumbar puncture 291,292

malrotation causes 107 peritoneal bands 107, 108

mannitol in cerebral oedema 184 Meckel's diverticulum 106, 112 meCOnIum

aspiration 17 intubation 17 thick and intubation II

Medicut. insertion site in obstruction 50, 51

meningitis bacterial 148-52 coma 171 convulsions 151 CSF findings 149 difficulty to treat 142 incidence 149 origins and causes 150 prophylaxis 151, 152 symptoms 149,150 treatment 151

meningococcal septicaemia 147, 148 mesenteric adenitis

pain 110,112 infections 112

methionine and paracetamol poisoning 236

milk lactose intolerance 92 rehydration 84, 85

minoxidil 180 mucus extractor 8 Mycoplasma pneumoniae

antibiotics 66 culture and diagnosis 62 pneumonia and age 61, 62 symptoms of infection 62

naloxone and resuscitation 9, 16, 17 nasogastric tube 40,47 nasotracheal tube 40,41,47,48 nebulizer 72, 75 neck

anatomy 37 lateral, diagram and stridor 38

Neisseria meningitides 150, 192 nephrotic syndrome 195-8 nonaccidental injury (NAI) see child

abuse

osteomyelitis 145, 146 otitis media, bacteria causing and

treatment 143, 144 oxygen

asthma 74 humidified 40,59

pain, acute abdominal 101-17 appendicitis 108, 109 extra-abdominal causes 101, 102,

110 gastrointestinal causes intestinal obstruction intra-abdominal causes urine sample 112

113-16 103-8

102,110

pain, recurrent abdominal 116, 117 pancreatitis and mumps 114 paracetamol poisoning 234-6

clinical features 235 drugs 236 liver toxic effects 235 plasma levels 235,236

paraldehyde side-effects 170

324

status epilepticus 169, 170 paraquat poisoning 239, 240 parents

involvement with treatment 273 sudden infant death syndrome 268

70 paroxysmal supraventricular

tachycardia 216,217 drugs 217 electrocardiogram 216 symptoms 217

peanuts 69 irritation 48,49 wheezing 70

penicillin, intravenous 65 perinatal mortality, countries I, 2 periorbital cellulitis 144, 145 peritonitis, causes and diagnosis 112,

197 pertussis

age and mortality 67 clinical features 66-8 complications 68 cough 67 epidemic 67 immunization 66, 174, 175 nursing role 68

pethidine, effects on fetus 17 phenobarbitone in status

epilepticus 169 phenytoin in status epilepticus 169 Place of Safety Order 259,262 plasma expanders 17, 86, 189 plasma protein fraction 189 pneumatocoele 63, 64 pneumomediastinum 14 pneumonia

antibiotic choice 65 culture 65 hospital role and age 64, 65 management 64-6 monitoring 65 organisms causing 61 pain 101, 102 pneumococcal, radiograph 62, 63 respiratory rate 101,137 staphylococcal, radiograph 61-4 viral 61,62

pneumothorax 14,289

INDEX

tension 64 trocar and obstruction 51

poisoning 228-44 activated charcoal use 231, 232 aftercare 232 causes 228 emesis induction 231 gastric lavage 231 household products 240 identification 230 incidence and mortality 228 management 230 nonaccidental 258 observation 232 precautions 229 see also individual drugs and poisons

Poisons Information Service, UK centres 230

potassium loss in diabetic ketoacidosis 124,

129 in rehydration 87-9

Polter's syndrome 5, 14 prednisolone 161

dose in asthma 72-4 preterm infants, risks 18 procedures 273-94 prochlorperazine combination and

oculogyric crisis 229 prostaglandins in cyanosis 211

ductus patency 212 side effects 211,212

Pseudomonas aeruginosa 192 in infants 141

pulmonary hypoplasia 5 pyelonephritis 113 pyloric stenosis

test feed 95 treatment 95 and vomiting 94, 95

Ramstedt's operation 95 rash, purpuric 114, 115, 147 rehydration 83-5; see also dehydration renal failure, acute 198-201

325

catabolism prevention 201 classification 198 fluid balance 200 investigations 200

INDEX

renal failure~cont. management 20 I pre-and post - 198 urine features 199

respiration, fetal and maternal drugs 10 respiratory distress 21

assessment 74 bronchiolitis 59

respiratory failure epiglottitis 41 laryngotracheobronchitis 41

respiratory function assessment 57, 59 respiratory tract, congenital

malformations 5 respiratory tract infections, lower 55-

76 constitutional disturbances 55, 56 cough 68 epidemiology in infants 55-7 feeding 55 hypoxaemia 56 incidence 56 maternal smoking 56, 57 radiographs 56

resuscitaire 6 resuscitation, neonatal 1-19, 151,268,

269 anticipation, high risk deliveries

5,6 cardiorespiratory arrest 21-3 check list 7 delay and gasping 3 drugs 7,15,16 duration 19 equipment 5-7 failing, check list 14 heart rate 3,4,8,9, 14 informing parents 19 response in monkeys 4 sequence 9

retropharyngeal abscess 35, 38, 52 Reye's syndrome

cerebral oedema, management 184 clinical features 175, 176 liver function 175, 176 liver histology and fatty

infiltration 176, 177 mortality 177

rifampicin 151

salbutamol acute asthma 71, 72 dose in asthma 72 wheezing 70

salicylate overdose 123 clinical features 233, 234 serum levels 233, 234

Salmonella sp. abdominal pain 113 carrier and antibiotics 92 features of gastroenteritis 80

scalded skin syndrome (toxic epidermal necrolysis) 227, 228

synonyms 227 sedation 109

painful procedures 274 Shigella sp, features of

gastroenteritis 79,80 shock 187-94

aetiology, types 188, 189 anaphylaxis, causes and

treatment 193, 194 clinical signs 187 definition 187 and dehydration 81, 86 hypovolaemic 189-92; see also

hypovolaemia management 189 resuscitation 14, 17 septic, pathogens and

antibiotics 192, 193 symptoms and treatment 17, 187

smoking and infant respiratory tract infections 55

social worker nonaccidental injury 261,262 sudden infant death 270

sodium in rehydration 87 sodium bicarbonate, see bicarbonate sodium nitroprusside 180,191 spasms, infantile 159-62

associated disorders 160, 161 drug therapy 161, 162 electroencephalogram 159, 160

spironolactone 215 Staphylococcus spp. infections 56 Staphylococcus aureus 52, 146

antibiotics 65 pneumonia 61

326

INDEX

toxin and scalded skin syndrome 227,228

status epilepticus 167-70 management and drugs 168, 169

Still's disease (systemic juvenile chronic arthritis)

fever pattern 154 stools

features 77 red currant jelly 103 reducing substances 93

Streptococcus spp" group B, J1-haemolytic in infants 141

Streptococcus pneumoniae 150 Streptococcus pyogenes 146 stridor

causes 35, 52, 53 causes, acute and chronic 35, 36 congenital laryngeal 53 definition 35, 36 epiglottitis 42-8 foreign bodies 35,48-52 laryngotracheobronchitis 36-42 timing 36

subdural haemorrhage and coma 178, 179

radiograph and suture separation 178

subglottic stenosis 42 sudden infant death syndrome (cot

death) 263-71 age 263,265 autopsy findings 265,266 coroners role 268, 270 and disease 265 incidence 263 informing and managing

parents 268-'70 paediatrician and parents 270, 271 resuscitation 267,268 sibling risk 271 theories 265-7 ventilatory control 267

supraglottis 42 location 37

suprapubic aspiration of urine 292-4

tachypnoea and dehydration 81 terbutaline in acute asthma 71,72

tissue turgor and dehydration 81-3 tracheostomy

diptheria 53 epiglottitis 46 laryngotracheobronchitis 42

transposition of the great arteries 208, 209

trimeprazine 109 trunk, colour 3, 8 tuberose sclerosis, diagnosis and

depigmentation 161

urinary tract infection 147 antibiotics 202,203 baby 140, 141 clinical features 203 incidence 202 investigations 203,204 organisms 202 pain llO, 112, 1l3, 147 two year follow-up 205

urine data in renal failure 199 suprapubic aspiration 292-4

urogram 113, 203 hydronephrosis 113 vesicoureteric reflux 204

urticaria 56

vaccine neurological side effects 174, 175 pneumococcal 152, 153

ventilation bag and mask 10,23 mouth-to-mouth 23, ~4

ventricular fibrillation, defibrillation 31, 32

vesicoureteric reflux 203 ViruS

327

adenovirus 61, 62 bronchiolitis 58 encephalitis 173, 174 influenza 61,62 measles 36 parainfluenza 36,44,61,62 pneumonia 61 respiratory syncitial 58, 61, 62, 66 rhinovirus 61

virus-conI. rota virus and gastroenteritis 78-80

vocal cords and intubation 12, 13 vomIting 77,93·8, 103

appendicitis III bile 95 causes 93,94 congenital adrenal hypoplasia 97 failure to thrive, tests 93 Henoch-Schiinlein purpura 114 induced in poisoning 231 intestinal obstruction 94-6 management 93 reduction 83

INDEX

in rotavirus gastroenteritis 78 see also diarrhoea

Waterhouse-Friderichsen syndrome 148

wheezing age and asthma 69,70 causes in children 68-70 peanut choking 69

wheezy bronchitis antibiotics 70 and asthma 69,70

whooping cough 56 Wright peak flow meter 72, 73

328