1. Apgar Score
A rapid scoring system used to evaluate a newborn’s cardiopulmonary adaptation after birth.
- Assessed at 1 minute and again at 5 minutes.
- Higher score = better adaptation and stability.
Apgar Parameters and Scoring
| Sign | 0 Points | 1 Point | 2 Points |
|---|---|---|---|
| Activity (Muscle tone) | No movement | Arms flexed, legs extended | Active movement |
| Pulse (Heart rate) | Absent | <100 beats/min | >100 beats/min |
| Grimace (Reflex irritability) | No response | Some flexion of extremities | Coughs / sneezes / pulls away |
| Appearance (Color) | Cyanosis or pale | Pink body, blue extremities (acrocyanosis) | Completely pink |
| Respiration | Absent | Weak/slow cry | Vigorous cry |
Interpretation of Apgar Score
- 0–3 → Severe depression, requires immediate resuscitation.
- 4–7 → May require assistance; keep under observation.
- 8–10 → No resuscitation needed, good cardiopulmonary adaptation.
2. Neonatal Jaundice
Yellowish discoloration of skin and sclera in newborn due to elevated serum bilirubin (>5 mg/dL).
| Feature | Physiological Jaundice | Pathological Jaundice |
|---|---|---|
| Time of appearance | Not present in 1st 24 hrs | Present within 24 hrs |
| Bilirubin rise | ↑ 5 mg/dL | <5 mg/dL/day |
| Peak bilirubin | <15 mg/dL | <15 mg/dL |
| Duration | Resolves within 1–2 weeks | Persists >2 weeks |
Kernicterus
- Occurs when bilirubin level is >25 mg/dL.
- A complication of conjugated hyperbilirubinemia.
Conjugated Jaundice = Always pathological.
Bilirubin Metabolism Disorders
| Step in Pathway | Defect | Syndrome |
|---|---|---|
| Unconjugated → Conjugated (via UDP-glucuronyl transferase) | Enzyme absent | Crigler–Najjar Syndrome |
| Enzyme partially works / stress-induced defect | Gilbert Syndrome | |
| Conjugated → Hepatic Canaliculi (excretion) | Transport absent | Dubin–Johnson Syndrome |
| Transport partially defective | Rotor Syndrome |
3. Neonatal Respiratory Distress Syndrome (NRDS)
Most common cause of respiratory failure in preterm babies due to lack of surfactant (mainly dipalmitoylphosphatidylcholine – DPPC) produced by Type II pneumocytes.
Surfactant Production in Pregnancy
- Insufficient levels in preterm → ↑ risk of NRDS
- Appears: 26–34 weeks
Clinical Features (onset 48–72 hours after birth)
- Expiratory grunting
- Tachypnea (>60/min)
- Nasal flaring
- Subcostal retractions
- Cyanosis
Investigations
- Chest X-ray: Ground-glass appearance
- Lecithin/Sphingomyelin (L/S) ratio:
- <1.5–2 → ↑ risk of NRDS
Treatment
- Surfactant infusion
- CPAP (Continuous Positive Airway Pressure)
5. Febrile Seizures
A seizure occurring in children due to a sudden rise in temperature or infection.
Common risk factor: Genetic predisposition.
Epidemiology
- Peak age: 6 months – 5 years
- After 5 years → risk decreases
Types
| Feature | Simple Seizure | Complex Seizure |
|---|---|---|
| Number of attacks (24 hr) | Single attack | Multiple attacks |
| Recovery | Quick return to normal | Delayed recovery |
| Duration | < 15 minutes | > 15 minutes |
| Fever | Occurs with fever (before seizure) | Low-grade fever for few days |
Investigations
Main aim: Exclude sepsis / CNS infection
- Clinical diagnosis
- Lumbar puncture → rule out meningitis
- Urine R/E
- Sepsis workup if suspected
Treatment
- Antipyretics: Paracetamol (Panadol)
- Antiepileptics: Only if recurrent/complex (e.g., Carbamazepine)
- Reassure parents (most febrile seizures are benign & self-limiting)
6. Cerebral Palsy
A group of disorders causing abnormal development or function of movement and posture due to damage/dysfunction of the cerebrum, basal ganglia, or cerebellum.
Causes / Risk Factors
- Exact mechanism: unknown
- Possible causes:
- IUGR
- Hypoxia / birth asphyxia
- Chromosomal / genetic disorders
Types
- Spastic type (≈75%)
- Quadriplegia → all 4 limbs weak
- Diplegia → both lower limbs weak
- Monoplegia → one limb weak
- Hemiplegia → one side of body weak
- Ataxic type (5–10%)
- Poor balance & coordination
- Dyskinetic type
- Athetoid palsy → involuntary jerky movements
Investigations
- CT Scan
- MRI (preferred for detailed assessment)
Treatment
- Supportive care (multidisciplinary approach):
- Physiotherapy
- Occupational therapy
- Speech therapy
- Medications if needed (e.g., antispastic agents)
Here are other materials for NLE NRE step 1
7. Childhood Bone Tumors
| Feature | Osteosarcoma | Ewing Sarcoma |
|---|---|---|
| Peak Age | 10–20 years & 50–60 years (bimodal) | 12–22 years |
| Clinical Features | Intense bony pain at night, usually no systemic symptoms | Bony pain + systemic symptoms (fever, weight loss) |
| Origin | Metaphysis of long bones (e.g., distal femur, proximal tibia) | Diaphysis of long bones |
| X-ray Findings | Codman’s triangle (periosteal reaction) | Onion-skin appearance |
8. Vesicoureteral Reflux (VUR)
Definition
A condition in which urine refluxes from the bladder back into the ureter.
Clinical Features
- Asymptomatic (mild cases)
- Flank pain
- Weak urinary stream, dribbling
- Recurrent UTIs
Notes
- Mild reflux → often asymptomatic
- Severe reflux → can lead to renal scarring, raised creatinine, CKD
Investigations
- Urine R/E (routine)
- Urine C/S (culture & sensitivity)
- USG KUB
- CT Scan (if needed)
- Serum creatinine (may be raised)
Treatment
- Fluids
- Antibiotics (for UTI prophylaxis/acute infection)
- Surgery (for severe reflux or failed medical management)