Spinal Vascular Malformations

Manual of Neonatal Care (Spiral Manual Series)

This Spiral(R) Manual provides a practical approach to the diagnosis and medical management of newborns. Chapters cover maternal, fetal, and neonatal problems and common neonatal procedures. An outline format provides quick access to a large amount of information, and the outline headings are standardized in this edition. The updated coverage includes new information on fetal assessment, survival of premature infants, and perinatal asphyxia and new guidelines on neonatal jaundice. The popular appendices include effects of maternal drugs on the fetus, maternal medications during lactation, and NICU medication guidelines. A neonatal dosing chart and intubation/sedation guidelines appear on the inside covers

Vascular ring and Double aortic arch

What is vascular ring ?

vascular ring is a malformation of the aortic arch that results in vascular branches or major blood vessels encircling the trachea and esophagus. In the double aortic arch (one of the most common vascular ring malformation patterns)It is most often due to persistence of the double aortic arch "right-sided aortic arch is present" after the second month of fetal life.

The two arches surround the esophagus and trachea which, if sufficiently constrictive, may cause breathing or swallowing difficulties.

In other vascular ring malformations, vascular remnants such as the ligamentum arteriosum (formerly the ductus arteriosus) may be part of the ring encircling the trachea and esophagus.

The esophagus and trachea are both compressed by the vascular ring made by malformation of the brachial arch vessels.

Caring For a Newly Circumcised Baby

Assessment of Head injuries in children

Perform a primary survey and ensure that the child’s airway, cervical spine, breathing and circulation are secure.

Rapidly assess the child’s mental state using the AVPU scale. Use firm supraorbital pressure as the painful stimulus.

* A Alert
* V Responds to voice
* P Responds to pain
----> Purposefully
----> Non-purposefully :

•  Withdrawal/flexor response
•  Extensor response

* U Unresponsive
Assess pupil size, equality and reactivity and look for other focal neurological signs.

Perform a secondary survey looking specifically at:

* Neck and cervical spine – deformity, tenderness, muscle spasm
* Head – scalp bruising, lacerations, swelling, tenderness, bruising behind the ear (Battles sign)
* Eyes – pupil size, equality and reactivity, fundoscopy
* Ears – blood behind the ear drum, CSF leak
* Nose – deformity, swelling, bleeding, CSF leak
* Mouth –dental trauma, soft tissue injuries
* Facial fractures
* Motor function – examine limbs for presence of reflexes and any lateralising weakness
* Perform a formal Glasgow Coma Score
* Consider the possibility of non-accidental injury during secondary survey especially in infants with head injury.
* Other injuries

Duchenne muscular dystrophy and Gower sign

Duchenne Muscular Dystrophy is a common sex-linked recessive trait appearing in 20 to 30 per 100,000 boys. The disease results from absence of a large protein called dystrophin that is associated with the muscle fiber plasma membrane.  
Becker muscular dystrophy arises from an abnormality in the same gene locus that results in the presence of dystrophin that is abnormal in either amount or molecular structure. It has the same clinical symptoms as Duchenne dystrophy, but onset is later, and progression is slower.

Clinically Manifested at about 2 to 3 years of age, boys develop an awkward gait and an inability to run properly. Some have an antecedent history of mild slowness in attaining motor milestones, such as walking and climbing stairs.
By Examination .......> firm calf hypertrophy and mild to moderate proximal leg weakness exhibited by a hyperlordotic, waddling gait and inability to arise from the ground easily. The child typically arises from a lying position on the floor by using his arms to "climb up" his legs and body (Gower sign). Arm weakness is evident by 6 years of age, and most boys are confined to a wheelchair by 12 years of age. By age 16, little mobility of arms remains, and respiratory difficulties increase.
Cause of death :Pneumonia or congestive heart failure resulting from myocardial involvement.

Gower's Sign:

Practical Paediatric Problems: A Textbook for MRCPCH

The problem based approach of the book presents the reader with a slightly different perspective from that found in the traditional system based textbook. Junior doctors deal with and learn from dealing with children with problems – so this textbook with its alternative approach will be a useful additional source of advice and help to many starting off their careers in paediatrics.

This innovative text, modelled on the current RCPCH syllabus for paediatric training, provides all the information that the senior house officer and specialist registrar in paediatrics will need during training and when preparing for the MRCPCH examination. A series of chapters discussing general principles in paediatric medicine is followed by a section covering the problems associated with the major body systems. Each chapter within this latter section is divided into three elements. Element A covers the background basic science to the particular problems being discussed in the chapter, including basic embryology and anatomy, biology and physiology. A description of the techniques involved in investigation where these will be critical to the diagnoses that follow is also included here; Element B presents the core system problems for the chapter. Tables are provided to summarise the different causes, classifications and differential diagnoses, clinical features, key investigations, therapeutic options and outcomes. Concise supporting text provides more detailed information where appropriate. Selected short case histories are also included to highlight the key issues covered in the chapter. Element C is a concise bibliography, incorporating a short series of key primary papers and review articles and suggestions for further reading. Subjects covered under general principles include developmental paediatrics, behavioural issues and learning difficulties, community paediatrics and clinical pharmacology. Clinical chapters include the respiratory, cardiovascular, endocrine and all other body systems. Haematology, oncology, psychiatry, surgical problems and tropical paediatric medicine are also covered here. All chapters contain up-to-date and appropriate information written by practising paediatricians who are each acknowledged specialists in their own field. This textbook will fast become an indispensable guide to the specialty for all trainee paediatricians in preparation for the MRCPCHexamination and beyond .

APGAR Scoring for Newborns

Click on diagrams for enlargment

A score is given for each sign at one minute and five minutes after the birth. If there are problems with the baby an additional score is given at 10 minutes. A score of 7-10 is considered normal, while 4-7 might require some resuscitative measures, and a baby with apgars of 3 and below requires immediate resuscitation.

Illustrated Cephalohematoma Vs Caput succedaneum

Cephalohematoma is a collection of blood under the periosteum of a skull bone "very tough tissue covering that encapsulates bones"
Because of its location,.................

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Pediatric Vital Signs; Normal values

Respiratory rate at rest

Age (years)........................Respiratory rate (breaths/min)
<1 .........................................30–40
1–2 .....................................25–35
2–5 .....................................25–30
5–12 ...................................20–25
>12 .....................................15–20

Heart rate

Age (years) ........................Heart rate (beats/min)
<1 .......................................110–160
1–2 .....................................100–150
2–5 ......................................95–140
5–12 ....................................80–120
>12 ......................................60–100

Systolic blood pressure

Age (years) ........................Systolic blood pressure (mmHg)
<1 ........................................70–90
1–2 ......................................80–95
2–5 ......................................80–100
5–12 ....................................90–110
>12 ......................................100–120