Developmental delay SAM Preterm Neonatal sepsis Hemorrhagic dis of newborn Dengue Give for 15 marks for pedia exam according to opghai book and give standard definition and points

Reading File

This is a five-topic long-answer set. I can prepare each in O.P. Ghai-style 15-mark format with: standard definition, etiology/risk factors, clinical features, investigations, management, complications, prevention, and a short exam-ready conclusion.

Developmental delay
Severe acute malnutrition (SAM)
Preterm infant
Neonatal sepsis
Hemorrhagic disease of the newborn (vitamin K deficiency bleeding)
Dengue in children

For a 15-mark answer, a useful structure is 1-2 lines of definition, classification where relevant, then headings with point-wise content and key treatment doses/steps. Which topic should I write first in full?

Asking for Preferences

Choose the topic for a full 15-mark exam answer first.

Developmental delay
Severe acute malnutrition (SAM)
Preterm infant
Neonatal sepsis
Hemorrhagic disease of the newborn (vitamin K deficiency bleeding)
Dengue in children

Developmental delay
Severe acute malnutrition (SAM)
Preterm infant
Neonatal sepsis
Hemorrhagic disease of newborn / vitamin K deficiency bleeding
Dengue in children

Give for all qns buddy

Finding Sources

Searching PubMed

pediatrics AND developmental delay

Searching PubMed

pediatric severe acute malnutrition

Searching PubMed

neonatal sepsis

Searching the Web

WHO dengue clinical management children warning signs fluid management guideline

Finding Sources

Searching PubMed

dengue children

Reading Web Page

https://www.who.int/publications/i/item/9789241504713

Below are exam-ready 15-mark answers, arranged in the usual O.P. Ghai pediatric-answer pattern: definition, causes/classification, features, diagnosis, management, complications and prevention. Use headings and underline key terms in the exam.

Note: Exact wording, tables and drug protocols can vary by edition and institutional policy. For neonatal sepsis, SAM and dengue, follow your hospital antibiotic/fluid protocol where it differs.

1. Developmental Delay

Definition

Developmental delay (DD) is failure to achieve age-appropriate developmental milestones at the expected time in one or more developmental domains.

Global developmental delay (GDD) is significant delay in two or more domains in a child younger than 5 years:

Gross motor
Fine motor/adaptive
Speech and language
Cognitive
Social/personal activities of daily living

Significant delay is generally performance more than 2 standard deviations below the mean on standardized assessment.

Difference from developmental regression

Delay: Child acquires skills late, but does not lose acquired skills.
Regression: Loss of already achieved milestones. It is a red flag and suggests neurodegenerative/metabolic disease, epileptic encephalopathy, etc.

Etiology

1. Prenatal causes

Chromosomal disorders: Down syndrome, Fragile X syndrome
Congenital infections: TORCH
Maternal malnutrition, alcohol/drug exposure
Brain malformations
Intrauterine growth restriction
Metabolic/genetic disorders

2. Perinatal causes

Prematurity and low birth weight
Birth asphyxia/hypoxic-ischemic encephalopathy
Intracranial hemorrhage
Neonatal hypoglycemia
Severe neonatal jaundice/kernicterus
Neonatal sepsis/meningitis

3. Postnatal causes

CNS infections: meningitis, encephalitis
Head injury
Severe malnutrition
Hypothyroidism
Seizures/epileptic encephalopathy
Psychosocial deprivation
Toxins, especially lead
Hearing or visual impairment

Red flag signs

No social smile by 3 months
No head control by 4 months
Not sitting without support by 9 months
No babbling by 9 months
No pincer grasp by 12 months
No single meaningful words by 16 months
No two-word phrases by 2 years
Not walking independently by 18 months
Any loss of milestones
Persistent primitive reflexes, abnormal tone, microcephaly, seizures

Clinical assessment

History

Antenatal, natal and postnatal insults
Prematurity, NICU admission, asphyxia
Milestone history in all four domains
Regression
Seizures
Hearing and vision concerns
Family history of developmental delay, intellectual disability, consanguinity
Dietary and psychosocial history

Examination

Plot weight, length and head circumference
Dysmorphic features
Skin markers of neurocutaneous syndromes
Vision and hearing assessment
Neurological examination: tone, reflexes, power, gait
Look for cerebral palsy, autism spectrum disorder, hypothyroidism and malnutrition

Investigations

Investigations should be guided by history and examination.

Hearing evaluation and vision assessment in all children
Developmental assessment using a standardized tool
Thyroid function tests
Complete blood count, iron status if indicated
Lead level where exposure is possible
Karyotyping/chromosomal microarray for unexplained GDD
Fragile X testing when indicated
MRI brain for abnormal head size, focal signs, seizures or regression
Metabolic tests if episodic decompensation, regression, organomegaly, unusual odor or consanguinity
EEG if seizures or suspected epileptic encephalopathy

Management

Early intervention is the key.
Treat the underlying cause where possible:
- Thyroxine for hypothyroidism
- Antiseizure treatment
- Nutritional rehabilitation
- Treat hearing/vision impairment
Developmental stimulation and parent training.
Physiotherapy for gross motor delay/spasticity.
Occupational therapy for fine motor and adaptive skills.
Speech and language therapy.
Special education and behavioral therapy when required.
Multidisciplinary follow-up: pediatrician, neurologist, psychologist, therapist, audiologist and special educator.
Genetic counseling if genetic cause is established.

Prognosis

Depends on cause, severity, associated epilepsy, sensory impairment, head growth, regression and age at intervention. Early identification and intervention improve function.

Prevention

Good antenatal care and maternal nutrition
Prevention of prematurity and birth asphyxia
Universal newborn screening where available
Immunization and prevention of CNS infections
Early treatment of neonatal jaundice, hypoglycemia and sepsis
Adequate nutrition and psychosocial stimulation

2. Severe Acute Malnutrition (SAM)

Definition

According to WHO criteria, a child aged 6-59 months has SAM if any one of the following is present:

Weight-for-height/length Z score < -3 SD of WHO standards, or
Mid-upper arm circumference (MUAC) <11.5 cm, or
Bilateral pitting nutritional edema

Classification

Clinical forms

Marasmus
- Severe wasting
- Marked loss of subcutaneous fat and muscle
- “Old man” appearance
- No edema
Kwashiorkor
- Bilateral pitting edema
- Dermatosis, sparse/discolored hair, hepatomegaly
- Apathy and anorexia
Marasmic-kwashiorkor
- Severe wasting with bilateral pitting edema

Etiology/Risk factors

Inadequate calorie and protein intake
Improper breastfeeding and complementary feeding
Recurrent diarrhea, pneumonia, measles, tuberculosis
Low birth weight and prematurity
Poverty, food insecurity
Poor sanitation
Neglect and inadequate child care
HIV, congenital heart disease, chronic kidney/liver disease
Malabsorption and malignancy

Clinical features

General

Severe wasting
Failure to thrive
Lethargy, irritability, apathy
Poor appetite
Hypothermia
Hypoglycemia
Recurrent infections

Marasmus

Weight markedly reduced
Thin limbs, loss of buttock fat
Sunken eyes, wrinkled skin
“Baggy pants” appearance
Alert child, often hungry

Kwashiorkor

Bilateral pitting edema beginning in feet
Moon face
Flaky-paint dermatosis
Hair changes: sparse, easily pluckable, depigmented, “flag sign”
Hepatomegaly due to fatty liver
Anorexia, apathy

Assessment for complications

A child with SAM must be assessed for:

Hypoglycemia
Hypothermia
Severe dehydration/shock
Severe anemia
Infection/sepsis
Electrolyte imbalance
Heart failure
Poor appetite
Edema

Investigations

Clinical diagnosis is primary.

Weight, length/height, MUAC, edema grading
Blood glucose
Hemoglobin/CBC
Serum electrolytes if available
Malaria test in endemic area
HIV testing with consent
Urine/stool examination and culture when indicated
Chest radiograph, blood culture if infection suspected

Management

A. Decide inpatient versus outpatient care

Admit to facility/Nutritional Rehabilitation Centre if:

Medical complication
Severe edema (+++)
Poor appetite or failed appetite test
Hypoglycemia/hypothermia
Severe dehydration, shock
Severe anemia
Altered sensorium
Recurrent vomiting
Infant below 6 months with severe malnutrition

Outpatient management

Child who is:

Clinically well and alert
Has good appetite
Has no significant edema or medical complication
Has reliable caregiver and follow-up

Use ready-to-use therapeutic food (RUTF) according to local protocol.

B. WHO 10 steps in inpatient management

Stabilization phase

Treat/prevent hypoglycemia
- Feed immediately.
- If symptomatic/unconscious, give IV 10% dextrose as per protocol, then start feeds.
Treat/prevent hypothermia
- Keep warm, skin-to-skin care, cap, warm room.
- Feed 2-hourly.
Treat/prevent dehydration
- Assess carefully because signs are unreliable in SAM.
- Use oral/NG rehydration cautiously.
- ReSoMal may be used where recommended; follow local protocol.
- Avoid routine rapid IV fluids. Use IV only in shock and with close monitoring.
Correct electrolyte imbalance
- SAM children have excess body sodium and deficit of potassium/magnesium.
- Avoid added salt.
- Give potassium and magnesium supplementation as per protocol.
Treat/prevent infection
- In complicated SAM, give empirical broad-spectrum antibiotics even when signs are subtle.
Correct micronutrient deficiencies
- Vitamin A as per age/protocol, unless recently given.
- Folic acid, zinc, multivitamins, copper.
- Do not start iron in stabilization phase.
Start cautious feeding
- Small, frequent feeds, typically F-75 during stabilization.
- Give orally or by nasogastric tube if unable to take orally.

Rehabilitation phase

Achieve catch-up growth
- Shift to F-100 or RUTF when appetite returns and edema reduces.
- Aim for high energy and protein intake.
Provide sensory stimulation and emotional support
- Play therapy, maternal involvement, responsive feeding.
Prepare for follow-up

Counsel on feeding, hygiene, danger signs, immunization and scheduled growth monitoring.

Iron therapy

Start iron only after stabilization, when child has appetite and is gaining weight, usually during rehabilitation phase.

Discharge criteria

Clinically well and alert
Good appetite
No edema for an appropriate observation period
Adequate weight gain
Caregiver trained for home feeding and follow-up

Complications

Hypoglycemia
Hypothermia
Sepsis
Severe anemia
Heart failure due to inappropriate fluids/feeds
Electrolyte imbalance
Death

Prevention

Exclusive breastfeeding for first 6 months
Timely, adequate complementary feeding from 6 months
Continued breastfeeding up to 2 years or beyond
Growth monitoring
Immunization, vitamin A and deworming as indicated
Prevention and early treatment of diarrhea/pneumonia
Nutrition education, sanitation and food security

Recent reviews continue to show that mortality in SAM is strongly associated with concurrent infection and other comorbidities, emphasizing careful inpatient stabilization in complicated cases (2025 SAM review).

3. Preterm Infant

Definition

A preterm infant is a live-born infant delivered before completion of 37 weeks of gestation, that is, before 259 days from the first day of the last menstrual period.

Classification by gestational age

Late preterm: 34 to <37 weeks
Moderate preterm: 32 to <34 weeks
Very preterm: <32 weeks
Extremely preterm: <28 weeks

Classification by birth weight

Low birth weight (LBW): <2500 g
Very low birth weight (VLBW): <1500 g
Extremely low birth weight (ELBW): <1000 g

Causes/Risk factors

Maternal and obstetric

Previous preterm birth
Multiple pregnancy
Maternal anemia and malnutrition
Hypertension/preeclampsia
Antepartum hemorrhage
Premature rupture of membranes
Chorioamnionitis
Diabetes, renal disease
Smoking, substance use
Short interpregnancy interval
Cervical incompetence

Fetal causes

Multiple gestation
Congenital anomalies
Fetal growth restriction
Fetal distress requiring early delivery

Physical characteristics

Low weight and length
Thin, shiny, transparent skin
Visible veins
Abundant lanugo
Soft ear pinna with poor recoil
Few plantar creases
Hypotonia and weak cry
In boys, undescended testes; in girls, prominent labia minora/clitoris

Problems/Complications of prematurity

Immediate problems

Respiratory distress syndrome
Apnea of prematurity
Hypothermia
Hypoglycemia
Feeding difficulty and aspiration
Sepsis
Jaundice
Patent ductus arteriosus
Intraventricular hemorrhage
Necrotizing enterocolitis
Anemia of prematurity

Long-term problems

Bronchopulmonary dysplasia/chronic lung disease
Retinopathy of prematurity
Hearing impairment
Neurodevelopmental delay and cerebral palsy
Learning and behavioral problems
Poor postnatal growth

Essential management

1. Delivery room care

Skilled neonatal resuscitation team
Warm chain: radiant warmer, warm towels, plastic wrap for very preterm infants
Delayed cord clamping when appropriate
Gentle ventilation and oxygen titration
Avoid hyperoxia and hypoxia
Early CPAP for respiratory distress where indicated

2. Thermal care

Maintain axillary temperature 36.5-37.5°C.
Incubator/radiant warmer as required.
Kangaroo mother care (KMC) for stable LBW/preterm infants.
Avoid bathing and unnecessary exposure.

3. Respiratory care

Monitor respiratory rate, effort and oxygen saturation.
CPAP for respiratory distress syndrome.
Surfactant for eligible infants with RDS.
Caffeine for apnea of prematurity.
Mechanical ventilation only when necessary.
Avoid prolonged oxygen exposure.

4. Feeding and nutrition

Mother’s own milk is best.
Start early minimal enteral feeding when stable.
Orogastric/gavage feeds if suck-swallow coordination is poor.
Expressed breast milk, fortified when indicated in VLBW infants.
Parenteral nutrition if enteral feeding is not possible.
Monitor weight, urine output, abdominal girth and blood glucose.

5. Prevention/treatment of hypoglycemia

Early feeding and glucose monitoring.
Treat symptomatic or persistent hypoglycemia promptly with glucose as per neonatal protocol.

6. Prevention of infection

Strict hand hygiene and aseptic techniques.
Avoid unnecessary invasive procedures.
Encourage breast milk feeding.
Evaluate promptly if poor feeding, apnea, temperature instability or lethargy occurs.

7. Jaundice and anemia

Monitor bilirubin closely.
Phototherapy/exchange transfusion according to gestation-specific thresholds.
Monitor hemoglobin; prevent anemia with nutrition and iron supplementation when indicated.

8. Screening before discharge

Retinopathy of prematurity screening
Hearing screening
Neurodevelopmental follow-up
Thyroid/newborn screening as locally available
Immunization according to chronological age, except where specific guidance applies

Discharge criteria

Stable temperature in open cot
No apnea/bradycardia episodes for an adequate observation period
Feeding adequately and gaining weight
Parents competent in feeding, KMC and danger-sign recognition
Follow-up arranged

Prevention of preterm birth

Good antenatal care
Treat maternal infections and anemia
Identify high-risk pregnancy
Progesterone/cervical cerclage in selected cases
Antenatal corticosteroids when preterm delivery is expected
Appropriate management of PROM and multiple pregnancy

4. Neonatal Sepsis

Definition

Neonatal sepsis is a systemic infection occurring in a newborn during the first 28 days of life, documented by a positive blood/CSF culture or strongly suspected clinically with supportive laboratory findings.

Classification

Early-onset sepsis (EOS)

Usually occurs within first 72 hours of life, though some definitions use first 7 days.
Acquired vertically from mother before or during delivery.

Late-onset sepsis (LOS)

Usually occurs after 72 hours of life.
Often hospital-acquired or community-acquired.

Etiological agents

Early-onset

Group B Streptococcus
Escherichia coli
Klebsiella species
Listeria monocytogenes
Other gram-negative bacilli

Late-onset

Coagulase-negative Staphylococci
Staphylococcus aureus
Klebsiella, E. coli, Pseudomonas, Acinetobacter
Candida, especially in VLBW infants and those with prolonged intensive care

Risk factors

Maternal risk factors

Maternal fever
Prolonged rupture of membranes, especially >18 hours
Chorioamnionitis
Maternal UTI
Foul-smelling liquor
Preterm labor
Multiple vaginal examinations

Neonatal risk factors

Prematurity and LBW
Birth asphyxia
Resuscitation at birth
Invasive procedures: IV lines, ventilation, catheterization
Prolonged hospitalization
Formula feeding
Poor hand hygiene

Clinical features

Clinical features are often non-specific.

General

Poor feeding
Lethargy, irritability
Weak cry
Temperature instability: fever or hypothermia
Poor perfusion, mottling

Respiratory

Tachypnea
Grunting, retractions
Apnea, cyanosis

Gastrointestinal

Vomiting
Abdominal distension
Feed intolerance
Diarrhea

Neurological

Hypotonia
Seizures
Bulging fontanelle
High-pitched cry

Circulatory/skin

Prolonged capillary refill
Hypotension
Bleeding/petechiae
Sclerema
Jaundice

Diagnosis

Sepsis screen

A combination of:

Total leukocyte count
Absolute neutrophil count
Immature/total neutrophil ratio
C-reactive protein
Micro-ESR
Procalcitonin where available

No single test is diagnostic.

Definitive investigations

Blood culture before antibiotics, if this does not delay treatment
CSF examination and culture in stable babies with suspected sepsis/meningitis
Urine culture, especially in late-onset sepsis
Chest radiograph if respiratory signs
Culture from pus/ET aspirate when indicated
Blood glucose, blood gas, renal function and coagulation profile in severe illness

Management

1. Immediate supportive treatment

Admit to neonatal unit.
Maintain airway, breathing and circulation.
Oxygen/CPAP/ventilation as required.
Keep warm.
Correct hypoglycemia.
Treat shock cautiously with appropriate fluid bolus and inotropes as per neonatal protocol.
Continue breast milk/expressed breast milk if clinically feasible.

2. Empirical antibiotic therapy

Take cultures first whenever possible, but do not delay antibiotics in a sick newborn.

Common empiric regimens:

Early-onset sepsis: ampicillin/penicillin plus gentamicin, or ampicillin plus cefotaxime according to local protocol.
Late-onset sepsis: regimen should be guided by local NICU antibiogram and suspected pathogens.

Antibiotic choice must be modified according to culture sensitivity and local antimicrobial-resistance patterns.

3. Duration of therapy

If culture negative and baby becomes well, antibiotics may be stopped based on clinical status and serial inflammatory markers, often after 36-72 hours according to unit policy.
Culture-proven uncomplicated bacteremia: commonly 10-14 days.
Meningitis, osteomyelitis or deep infection: longer treatment, usually at least 14-21 days depending on organism and site.

Prevention

Maternal screening and treatment of infection
Clean delivery practices
Hand hygiene
Exclusive breastfeeding
Rational use and early removal of invasive devices
Asepsis in NICU
Antimicrobial stewardship

Recent evidence stresses that the organisms and antimicrobial resistance patterns in neonatal sepsis vary substantially by region, so local culture data should guide empiric therapy (2024 global review).

5. Hemorrhagic Disease of Newborn / Vitamin K Deficiency Bleeding (VKDB)

Definition

Vitamin K deficiency bleeding (VKDB), previously called hemorrhagic disease of the newborn, is bleeding due to deficiency of vitamin K-dependent coagulation factors II, VII, IX and X in an infant, usually during the first 6 months of life.

Why newborns are susceptible

Poor placental transfer of vitamin K
Low hepatic stores at birth
Sterile gut with absent bacterial synthesis of vitamin K
Low vitamin K content in breast milk
Delayed/inadequate feeding
Lack of vitamin K prophylaxis

Classification

Type	Onset	Common setting/sites
Early VKDB	First 24 hours	Maternal drugs interfering with vitamin K, severe bleeding
Classical VKDB	Day 2-7	GI bleed, skin bleed, umbilical bleeding, post-circumcision bleeding
Late VKDB	2 weeks to 6 months, commonly 2-12 weeks	Exclusively breastfed infant without prophylaxis; intracranial hemorrhage is common

Risk factors

No vitamin K prophylaxis at birth
Exclusive breastfeeding
Prematurity
Maternal anticonvulsants: phenytoin, phenobarbitone, carbamazepine
Maternal warfarin, rifampicin, isoniazid and some antibiotics
Cholestasis/biliary atresia
Malabsorption syndromes
Chronic liver disease
Prolonged diarrhea/antibiotic use

Clinical features

Bleeding from umbilicus
Gastrointestinal bleeding: hematemesis, melena
Bleeding from puncture sites
Ecchymosis, petechiae
Epistaxis
Post-circumcision bleeding
Cephalhematoma
Intracranial hemorrhage: seizures, pallor, bulging fontanelle, altered sensorium, apnea

Investigations

Prothrombin time (PT) prolonged
INR elevated
Activated partial thromboplastin time may be prolonged
Platelet count usually normal
Fibrinogen usually normal
Hemoglobin for blood loss
Liver function tests and evaluation for cholestasis in late VKDB
Neuroimaging if neurological signs or suspected intracranial bleed

Diagnostic clue: Rapid correction of prolonged PT after vitamin K supports diagnosis.

Management

1. Stabilize

ABC approach
Secure IV access
Treat shock
Cross-match blood
Treat seizures if present
Urgent neuroimaging and neurosurgical consultation for intracranial bleed where needed

2. Vitamin K

Give phytomenadione (vitamin K1):

1 mg IV or slow IV/IM in a term infant
0.5 mg in very small/preterm infants may be used according to local protocol

In active bleeding, IV route is preferred where feasible and safe.

3. Correct coagulation defect

Fresh frozen plasma: 10-15 mL/kg in significant bleeding
Packed red cells if severe anemia/shock
Platelets only if thrombocytopenia is present
Consider prothrombin complex concentrate only in selected critical settings according to specialist advice

4. Treat underlying cause

Evaluate cholestasis, biliary atresia, liver disease and malabsorption, particularly in late VKDB.

Prevention

All newborns should receive vitamin K prophylaxis at birth.

Usual prophylaxis:

Term infant: Vitamin K1 1 mg intramuscularly
Preterm/LBW infant: 0.5 mg IM is commonly used, depending on weight and institutional policy

Intramuscular vitamin K is more reliable than oral prophylaxis in preventing late VKDB.

Late VKDB is particularly associated with absent/inadequate prophylaxis and may present with intracranial bleeding (laboratory reference, see also standard neonatal prophylaxis recommendations).

6. Dengue in Children

Definition

Dengue is an acute mosquito-borne viral illness caused by dengue virus, transmitted mainly by the bite of infected female Aedes aegypti mosquitoes.

There are four dengue virus serotypes: DENV-1, DENV-2, DENV-3 and DENV-4.

Clinical classification

WHO clinical classification:

Dengue without warning signs
Dengue with warning signs
Severe dengue

Phases of dengue illness

1. Febrile phase: usually 2-7 days

Sudden high fever
Headache, retro-orbital pain
Myalgia, arthralgia
Nausea/vomiting
Flushing/rash
Mild bleeding manifestations
Leukopenia

2. Critical phase: usually around defervescence

Occurs when fever settles, often on day 3-7. Plasma leakage may occur. This is the dangerous phase.

3. Recovery phase

Reabsorption of extravascular fluid
Clinical improvement
Improving appetite and urine output
Confluent erythematous rash with “white islands in a sea of red”
Hematocrit falls and platelet count rises

Warning signs

Warning signs usually occur around the time fever subsides:

Severe abdominal pain or persistent tenderness
Persistent vomiting
Clinical fluid accumulation: ascites, pleural effusion
Mucosal bleeding
Lethargy, restlessness or irritability
Liver enlargement >2 cm
Rising hematocrit with rapidly falling platelet count

Severe dengue

Severe dengue is diagnosed by one or more of:

1. Severe plasma leakage

Shock due to plasma leakage, that is dengue shock syndrome
Fluid accumulation with respiratory distress

2. Severe bleeding

GI bleed, intracranial bleed, severe mucosal bleed

3. Severe organ involvement

Severe hepatitis
Encephalopathy/encephalitis
Myocarditis
Acute kidney injury
Severe metabolic acidosis

Clinical features in children

High-grade fever
Vomiting, abdominal pain
Rash
Headache/body ache may be less prominent in young children
Hepatomegaly
Petechiae and positive tourniquet test
Warning signs during defervescence
Cold extremities, tachycardia, narrowed pulse pressure and delayed capillary refill in shock

Investigations

Hematology

CBC with serial hematocrit and platelet count
Leukopenia is common
Rising hematocrit suggests plasma leakage
Thrombocytopenia supports diagnosis but platelet count alone does not determine severity

Specific tests

NS1 antigen: useful in early febrile illness, generally first 1-5 days
RT-PCR: early illness where available
Dengue IgM: usually detectable after about day 5
Paired serology may be used where needed

Other tests in severe disease

Liver function tests
Renal function/electrolytes
Coagulation profile
Blood gas/lactate
Chest ultrasound/X-ray for pleural effusion
Abdominal ultrasound for ascites/gall bladder wall edema

Management

A. Dengue without warning signs: outpatient management

Encourage oral fluids: ORS, soups, milk, coconut water/other electrolyte-containing fluids.
Continue feeding and breastfeeding.
Paracetamol 10-15 mg/kg/dose for fever, at appropriate intervals.
Tepid sponging for comfort.
Daily clinical review during the critical period.
Monitor urine output, activity, oral intake, bleeding and warning signs.

Avoid

Aspirin
Ibuprofen and other NSAIDs
Intramuscular injections
Unnecessary antibiotics
Prophylactic platelet transfusion

B. Dengue with warning signs: admit

Admit and monitor closely.
Record pulse, BP, pulse pressure, respiratory rate, perfusion, hematocrit and urine output.
Start isotonic IV crystalloid, commonly 0.9% saline or Ringer lactate, with careful reassessment.
A commonly used initial approach is 5-7 mL/kg/hour for 1-2 hours, then titrate down or up according to perfusion, hematocrit, urine output and evidence of fluid overload.
Measure hematocrit before fluids if possible, but do not delay resuscitation in shock.

C. Severe dengue/dengue shock

ABC stabilization and oxygen.
Establish IV/IO access.
Check blood glucose and correct hypoglycemia.
Isotonic crystalloid bolus, often 10-20 mL/kg over 15-30 minutes, according to severity and institutional protocol.
Reassess immediately:
- Pulse pressure, capillary refill, extremities
- BP, mental status
- Urine output
- Hematocrit
If persistent shock with rising hematocrit, further carefully monitored crystalloid or colloid may be needed.
If shock with falling hematocrit, suspect occult bleeding and arrange blood transfusion.
Avoid fluid overload, especially during recovery phase.
Manage bleeding with blood products only for significant clinical bleeding/coagulopathy, not merely low platelet count.
ICU care for shock, respiratory failure, severe bleeding or organ dysfunction.

Monitoring

Vitals and perfusion frequently
Input-output chart
Urine output target: at least 0.5-1 mL/kg/hour
Serial hematocrit
Platelet trend
Signs of fluid overload: respiratory distress, basal crepitations, edema, increasing pleural effusion

Indications for blood products

Significant active bleeding with hemodynamic compromise
Falling hematocrit with unstable circulation
Disseminated intravascular coagulation with bleeding

Platelet transfusion is not indicated solely because platelet count is low.

Complications

Dengue shock syndrome
Severe hemorrhage
DIC
Encephalopathy
Myocarditis
Acute liver failure
Acute kidney injury
Fluid overload/pulmonary edema

Prevention

Eliminate mosquito breeding sites and stagnant water.
Cover water containers.
Weekly emptying and cleaning of coolers, flower pots and containers.
Full-sleeved clothing, repellents, screens and bed nets.
Community vector-control measures.
Follow national policy for dengue vaccination, where applicable.

WHO emphasizes that dengue is dynamic: the critical phase often begins when fever decreases, and correct early recognition plus carefully titrated fluids reduce deaths (WHO dengue handbook).

Make a concise last-minute revision table for all six topics

Reading File

Finding Sources

Searching PubMed

neonatal sepsis AND dengue

Searching the Web

WHO severe acute malnutrition criteria MUAC 11.5 cm bilateral pitting oedema dengue warning signs

Pediatrics: Last-Minute Revision Table

Topic	Standard definition / diagnosis	Key points to remember	Important clinical features	Management pearls	Prevention / one-liner
Developmental delay (DD)	Failure to achieve milestones at expected age in one or more domains. Global DD: significant delay in 2 or more domains in children <5 years.	Domains: gross motor, fine motor-adaptive, language, social-personal/cognition. Differentiate from regression, which is loss of acquired milestones.	Red flags: no smile by 3 months; no head control by 4 months; not sitting by 9 months; no single words by 16 months; no 2-word phrases by 2 years; not walking by 18 months; any regression.	History: antenatal, perinatal insult, milestones, seizures, family history. Examine growth, HC, dysmorphism, vision/hearing, tone. Hearing and vision assessment for all. Treat cause plus early stimulation, physiotherapy, speech therapy, special education.	Early identification and early intervention improve outcome.
SAM	In child 6-59 months, any one: WHZ/WLZ < -3 SD, MUAC <11.5 cm, or bilateral pitting edema.	Types: marasmus, kwashiorkor, marasmic-kwashiorkor. Complicated SAM needs admission/NRC.	Marasmus: severe wasting, “old man” face, baggy pants, no edema. Kwashiorkor: edema, flaky-paint dermatosis, hair changes, hepatomegaly, apathy/anorexia. Look for hypoglycemia, hypothermia, infection, anemia, dehydration.	WHO 10 steps: 1 hypoglycemia, 2 hypothermia, 3 dehydration, 4 electrolytes, 5 infection, 6 micronutrients, 7 cautious feeding with F-75, 8 catch-up growth using F-100/RUTF, 9 stimulation, 10 follow-up. Avoid rapid IV fluids. Start iron only in rehabilitation phase.	Exclusive breastfeeding 6 months, appropriate complementary feeding, growth monitoring, immunization, infection control. WHO uses MUAC <115 mm, WHZ < -3 or bilateral edema as SAM criteria (WHO criteria).
Preterm infant	Live-born infant delivered before 37 completed weeks gestation.	Late preterm: 34 to <37 wk; very preterm: <32 wk; extremely preterm: <28 wk. LBW <2.5 kg; VLBW <1.5 kg; ELBW <1 kg.	Thin shiny skin, lanugo, soft pinna, few sole creases, hypotonia, weak suck. Complications: RDS, apnea, hypothermia, hypoglycemia, sepsis, jaundice, NEC, PDA, IVH, ROP.	Warm chain, KMC, monitor glucose, breast milk/expressed breast milk, gavage feeds if poor suck, CPAP/surfactant for RDS, treat apnea, screen for ROP/hearing, developmental follow-up.	Prevent with good ANC, treatment of maternal disease/infection, antenatal corticosteroids when preterm birth is expected.
Neonatal sepsis	Systemic infection during first 28 days of life, culture proven or clinically suspected with supportive evidence.	EOS: usually ≤72 h, vertically acquired. LOS: >72 h, hospital/community acquired.	Poor feeding, lethargy, temperature instability, apnea, respiratory distress, vomiting/distension, jaundice, seizures, poor perfusion, shock, sclerema.	Take blood culture first if feasible, but never delay antibiotics in a sick baby. Sepsis screen: CBC, ANC/I:T ratio, CRP, micro-ESR/procalcitonin. Support ABC, warmth, glucose, oxygen, fluids/inotropes cautiously. Empiric antibiotics are based on unit protocol and local antibiogram.	Maternal infection control, clean delivery, hand hygiene, asepsis, exclusive breastfeeding, remove invasive lines early.
Vitamin K deficiency bleeding (VKDB) / hemorrhagic disease of newborn	Bleeding due to deficiency of vitamin K-dependent factors II, VII, IX, X in infancy.	Early: <24 h, maternal drugs. Classical: day 2-7. Late: 2 weeks-6 months, often exclusively breastfed infant without prophylaxis; intracranial bleed common.	Umbilical bleeding, GI bleeding, skin bruises, puncture-site bleeding, post-circumcision bleeding, cephalhematoma. CNS bleed: seizures, bulging fontanelle, pallor, altered sensorium.	PT/INR prolonged, platelets usually normal. Give vitamin K1 promptly. In significant active bleeding, give IV vitamin K and FFP 10-15 mL/kg; resuscitate and investigate liver disease/cholestasis in late VKDB.	Routine IM vitamin K at birth: generally 1 mg for term infants; smaller preterm/LBW infants receive lower dose according to local protocol.
Dengue	Acute arboviral infection caused by dengue virus, transmitted mainly by Aedes aegypti.	Clinical groups: dengue without warning signs, dengue with warning signs, severe dengue. Phases: febrile, critical, recovery. The critical phase often begins when fever falls.	Warning signs: abdominal pain/tenderness, persistent vomiting, mucosal bleed, lethargy/restlessness, fluid accumulation, hepatomegaly >2 cm, rising Hct with falling platelets. Severe dengue: shock/plasma leakage, severe bleeding, or organ failure.	Test: NS1/PCR early; IgM after about day 5. Give oral fluids and paracetamol. Avoid aspirin, ibuprofen/NSAIDs and IM injections. Admit if warning signs. Shock: careful isotonic crystalloid resuscitation with frequent reassessment of perfusion, Hct and urine output. Do not transfuse platelets solely for a low count.	Source reduction, covered water storage, repellents, protective clothing and community vector control. WHO stresses early recognition and carefully titrated fluids in the critical phase (WHO dengue handbook).

Rapid Recall Mnemonics

SAM 10 steps: Sugar, Skin warmth, Salt-water, Supplements, Sepsis, Supplements, Small feeds, Size gain, Stimulation, Send home.
Dengue warning signs: “A-V-M-L-H-H”
Abdominal pain, persistent Vomiting, Mucosal bleed, Lethargy, fluid accumulation, Hepatomegaly, rising Hematocrit.
Preterm major problems: “RASH JIN”
RDS, Apnea, Sepsis, Hypothermia, Jaundice, IVH, NEC.

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mkdir -p "/tmp/workspace/pediatrics-15-mark-notes/src" "/tmp/workspace/pediatrics-15-mark-notes/output" && python - <<'PY' from reportlab.lib.pagesizes import A4 from reportlab.lib import colors from reportlab.lib.styles import getSampleStyleSheet, ParagraphStyle from reportlab.lib.enums import TA_CENTER from reportlab.lib.units import cm from reportlab.platypus import SimpleDocTemplate, Paragraph, Spacer, PageBreak, Table, TableStyle, KeepTogether from reportlab.pdfbase.ttfonts import TTFont from reportlab.pdfbase import pdfmetrics from reportlab.lib.colors import HexColor from reportlab.pdfbase.pdfmetrics import stringWidth from reportlab.pdfgen import canvas from reportlab.lib.utils import simpleSplit out='/tmp/workspace/pediatrics-15-mark-notes/output/Pediatrics_15_Mark_Answers.pdf' # Typography try: pdfmetrics.registerFont(TTFont('DejaVu', '/usr/share/fonts/truetype/dejavu/DejaVuSans.ttf')) pdfmetrics.registerFont(TTFont('DejaVu-Bold', '/usr/share/fonts/truetype/dejavu/DejaVuSans-Bold.ttf')) font='DejaVu'; bold='DejaVu-Bold' except Exception: font='Helvetica'; bold='Helvetica-Bold' NAVY=HexColor('#17365D'); BLUE=HexColor('#1F4E79'); PALE=HexColor('#EAF2F8'); GREY=HexColor('#555555') styles=getSampleStyleSheet() styles.add(ParagraphStyle(name='TitleX', parent=styles['Title'], fontName=bold, fontSize=21, leading=26, textColor=NAVY, alignment=TA_CENTER, spaceAfter=8)) styles.add(ParagraphStyle(name='SubTitleX', parent=styles['Normal'], fontName=font, fontSize=10, leading=14, textColor=GREY, alignment=TA_CENTER, spaceAfter=18)) styles.add(ParagraphStyle(name='H1X', parent=styles['Heading1'], fontName=bold, fontSize=16, leading=20, textColor=NAVY, spaceBefore=4, spaceAfter=8, keepWithNext=True)) styles.add(ParagraphStyle(name='H2X', parent=styles['Heading2'], fontName=bold, fontSize=11.3, leading=14, textColor=BLUE, spaceBefore=7, spaceAfter=3, keepWithNext=True)) styles.add(ParagraphStyle(name='BodyX', parent=styles['BodyText'], fontName=font, fontSize=9.2, leading=12.5, spaceAfter=3.5)) styles.add(ParagraphStyle(name='BulletX', parent=styles['BodyText'], fontName=font, fontSize=9.2, leading=12.3, leftIndent=14, firstLineIndent=-9, spaceAfter=1.5)) styles.add(ParagraphStyle(name='SmallX', parent=styles['BodyText'], fontName=font, fontSize=7.9, leading=10.2, textColor=GREY, spaceAfter=2)) styles.add(ParagraphStyle(name='BoxX', parent=styles['BodyText'], fontName=font, fontSize=9.2, leading=12.2, backColor=PALE, borderColor=HexColor('#9DC3E6'), borderWidth=.5, borderPadding=7, spaceAfter=7)) def P(t, sty='BodyX'): return Paragraph(t, styles[sty]) def bullets(items): return [P('• '+x,'BulletX') for x in items] def h2(t): return P(t,'H2X') def footer(canv, doc): canv.saveState() canv.setStrokeColor(HexColor('#B8C8D8')); canv.line(doc.leftMargin, 1.25*cm, A4[0]-doc.rightMargin, 1.25*cm) canv.setFont(font, 7.5); canv.setFillColor(GREY) canv.drawString(doc.leftMargin, .85*cm, 'Pediatrics 15-Mark Answers | Last-minute exam notes') canv.drawRightString(A4[0]-doc.rightMargin, .85*cm, f'Page {doc.page}') canv.restoreState() doc=SimpleDocTemplate(out, pagesize=A4, rightMargin=1.55*cm, leftMargin=1.55*cm, topMargin=1.4*cm, bottomMargin=1.6*cm, title='Pediatrics 15-Mark Answers') story=[] story += [P('Pediatrics: 15-Mark Answers','TitleX'), P('Developmental Delay | Severe Acute Malnutrition | Preterm Infant | Neonatal Sepsis | Vitamin K Deficiency Bleeding | Dengue','SubTitleX'), P('Exam-use format: Definition -> classification/etiology -> clinical features -> investigations -> management -> prevention/complications. Drug doses and antibiotic choices must be aligned with your unit protocol.','BoxX')] # DD story += [P('1. Developmental Delay','H1X'), h2('Definition'), P('Developmental delay (DD) is failure to attain age-appropriate developmental milestones at the expected age in one or more domains. Global developmental delay (GDD) refers to significant delay in at least two domains in a child below 5 years: gross motor, fine motor-adaptive, speech-language, cognition, and personal-social skills.'), h2('Etiology'), *bullets(['Prenatal: chromosomal/genetic disorders, congenital infections, brain malformations, maternal alcohol/drug exposure, IUGR.', 'Perinatal: prematurity, hypoxic-ischemic encephalopathy, intracranial hemorrhage, hypoglycemia, severe hyperbilirubinemia, sepsis/meningitis.', 'Postnatal: CNS infection, head injury, malnutrition, hypothyroidism, epilepsy, lead exposure, visual/hearing loss, psychosocial deprivation.']), h2('Red flags'), *bullets(['No social smile by 3 months; no head control by 4 months; not sitting by 9 months.', 'No babbling by 9 months; no pincer grasp by 12 months; no meaningful single word by 16 months.', 'No two-word phrase by 2 years; not walking independently by 18 months.', 'Loss of attained milestones (regression) is an urgent red flag.']), h2('Evaluation and management'), *bullets(['History: pregnancy/birth events, milestone chart, regression, seizures, family history, feeding and psychosocial history. Examine growth and head circumference, dysmorphism, skin markers, vision/hearing, tone and reflexes.', 'Assess hearing and vision in every child. Targeted tests: thyroid function, chromosomal microarray/karyotype, Fragile X testing, MRI brain, EEG and metabolic tests when indicated.', 'Treat reversible cause. Start early intervention: parental counselling and stimulation, physiotherapy, occupational therapy, speech therapy, special education and multidisciplinary follow-up.']), h2('Prevention'), P('Quality antenatal and perinatal care, prevention of prematurity/asphyxia/infections, immunization, adequate nutrition and responsive early childhood stimulation.')] story.append(PageBreak()) # SAM story += [P('2. Severe Acute Malnutrition (SAM)','H1X'), h2('Definition: child 6-59 months'), P('SAM is diagnosed by any one of: weight-for-height/length Z score below -3 SD, MUAC below 11.5 cm, or bilateral pitting nutritional edema.'), h2('Clinical forms'), *bullets(['Marasmus: severe wasting, loss of fat and muscle, old-man face, baggy-pants appearance, no edema.', 'Kwashiorkor: bilateral pitting edema, dermatosis, sparse/discoloured hair, hepatomegaly, apathy/anorexia.', 'Marasmic-kwashiorkor: severe wasting with edema.']), h2('Assessment'), *bullets(['Look for hypoglycemia, hypothermia, dehydration/shock, infection, severe anemia, electrolyte disturbance and heart failure.', 'Admit if there is a complication, severe edema, poor appetite/failed appetite test, persistent vomiting, altered sensorium, severe anemia or unreliable follow-up.']), h2('Management: WHO 10 steps'), *bullets(['1. Treat/prevent hypoglycemia. 2. Treat/prevent hypothermia. 3. Treat/prevent dehydration cautiously. 4. Correct electrolytes. 5. Treat/prevent infection.', '6. Correct micronutrients. 7. Start cautious frequent feeding, usually F-75 in stabilization. 8. Achieve catch-up growth with F-100/RUTF in rehabilitation. 9. Sensory stimulation and emotional support. 10. Plan discharge and follow-up.', 'Avoid routine rapid IV fluids. Empirical antibiotics are used in complicated SAM. Do not give iron during stabilization; begin in rehabilitation when appetite and weight gain return.']), h2('Prevention'), P('Exclusive breastfeeding for 6 months; timely adequate complementary feeding; continued breastfeeding; growth monitoring; immunization; sanitation; early treatment of diarrhea and respiratory infections.')] story.append(PageBreak()) # Preterm story += [P('3. Preterm Infant','H1X'), h2('Definition and classification'), P('A preterm infant is born before 37 completed weeks of gestation.'), *bullets(['Late preterm: 34 to <37 weeks; moderate: 32 to <34 weeks; very preterm: <32 weeks; extremely preterm: <28 weeks.', 'LBW <2500 g; VLBW <1500 g; ELBW <1000 g.']), h2('Risk factors'), P('Previous preterm birth, multiple pregnancy, anemia/malnutrition, hypertension, antepartum hemorrhage, PROM/chorioamnionitis, maternal systemic illness, substance use, cervical incompetence and fetal anomalies.'), h2('Clinical characteristics'), P('Low weight, thin translucent skin, visible veins, lanugo, soft pinna, few plantar creases, hypotonia, weak cry/poor suck; immature genitalia.'), h2('Major problems'), *bullets(['Respiratory distress syndrome and apnea; hypothermia and hypoglycemia; feeding difficulty; jaundice; sepsis.', 'PDA, IVH, NEC, anemia of prematurity, ROP, chronic lung disease and later neurodevelopmental/hearing/learning problems.']), h2('Management'), *bullets(['Delivery room: skilled resuscitation, warm chain, delayed cord clamping when appropriate, oxygen titration and early CPAP where indicated.', 'Maintain temperature 36.5-37.5°C. Use incubator/radiant warmer and kangaroo mother care in stable babies.', 'Mother’s own milk is preferred. Give expressed milk/gavage feeds if suck is immature; monitor glucose, weight, urine output and abdominal signs.', 'CPAP/surfactant for RDS when indicated; caffeine for apnea. Screen for ROP and hearing, provide immunization and neurodevelopmental follow-up.']), h2('Prevention'), P('Good ANC, treat maternal infection/anemia, identify high-risk pregnancies, and give antenatal corticosteroids when preterm birth is anticipated.')] story.append(PageBreak()) # sepsis story += [P('4. Neonatal Sepsis','H1X'), h2('Definition and classification'), P('Systemic infection in the first 28 days of life, culture-proven or clinically suspected with supportive evidence.'), *bullets(['Early-onset sepsis: usually within 72 hours, vertically acquired from maternal genital tract.', 'Late-onset sepsis: after 72 hours, often hospital/community acquired.']), h2('Risk factors and agents'), *bullets(['Maternal fever, chorioamnionitis, PROM >18 h, UTI, preterm labor and foul-smelling liquor.', 'Prematurity/LBW, birth asphyxia, invasive lines/ventilation, prolonged hospitalization and poor asepsis.', 'Common agents: GBS, E. coli, Klebsiella and Listeria in early-onset; staphylococci, gram-negative bacilli and Candida in late-onset.']), h2('Clinical features'), P('Poor feeding, lethargy, weak cry, irritability, fever or hypothermia, respiratory distress/apnea, vomiting/abdominal distension, jaundice, seizures, poor perfusion, shock, bleeding and sclerema.'), h2('Diagnosis'), *bullets(['Obtain blood culture before antibiotics where this does not delay treatment. Consider CSF culture in stable suspected cases and urine culture in late-onset sepsis.', 'Sepsis screen: TLC, ANC, I:T ratio, CRP, micro-ESR and/or procalcitonin. No single screen test is diagnostic.']), h2('Management'), *bullets(['ABC stabilization: warmth, oxygen/ventilation, correction of hypoglycemia, cautious fluid and inotrope support for shock.', 'Start empirical IV antibiotics promptly after cultures. Regimen depends on onset, local policy and antibiogram. De-escalate/modify according to culture and clinical course.', 'Continue expressed breast milk if feasible. Duration depends on culture, focus and response.']), h2('Prevention'), P('Maternal infection control, clean delivery, strict hand hygiene, NICU asepsis, exclusive breast milk, rational antibiotic use and early removal of invasive devices.')] story.append(PageBreak()) # VKDB story += [P('5. Vitamin K Deficiency Bleeding (VKDB)','H1X'), P('Previously called hemorrhagic disease of the newborn.','SmallX'), h2('Definition'), P('Bleeding in infancy due to deficiency of vitamin K-dependent coagulation factors II, VII, IX and X.'), h2('Why newborns are predisposed'), P('Low placental transfer and hepatic stores, sterile gut, low vitamin K in breast milk, delayed feeding and lack of prophylaxis.'), h2('Classification'), *bullets(['Early: first 24 hours, often due to maternal drugs interfering with vitamin K.', 'Classical: day 2-7: umbilical, GI, skin or post-procedure bleeding.', 'Late: 2 weeks to 6 months, often exclusively breastfed infant without prophylaxis; intracranial hemorrhage is common.']), h2('Risk factors and clinical features'), *bullets(['No prophylaxis, exclusive breastfeeding, prematurity, maternal anticonvulsants/warfarin/rifampicin, cholestasis, malabsorption or liver disease.', 'Umbilical/GI/puncture-site bleeding, ecchymoses, cephalhematoma, post-circumcision bleeding. Intracranial bleed may present with seizure, bulging fontanelle, pallor or altered sensorium.']), h2('Investigations'), P('PT/INR is prolonged; aPTT may be prolonged. Platelet count and fibrinogen are usually normal. Check hemoglobin and evaluate for liver disease/cholestasis in late VKDB. Rapid PT correction after vitamin K supports diagnosis.'), h2('Management and prevention'), *bullets(['Resuscitate, secure access, treat shock/seizures. Give phytomenadione (vitamin K1) promptly. In significant active bleeding, IV vitamin K plus FFP 10-15 mL/kg; give packed cells if needed.', 'Prevention: all newborns receive IM vitamin K at birth. Commonly term infant: 1 mg IM; smaller preterm/LBW infants: lower dose according to local policy.'])] story.append(PageBreak()) # Dengue story += [P('6. Dengue in Children','H1X'), h2('Definition'), P('Acute systemic mosquito-borne viral illness caused by dengue virus and transmitted mainly by Aedes aegypti. There are four serotypes.'), h2('Clinical classification and phases'), *bullets(['Dengue without warning signs; dengue with warning signs; severe dengue.', 'Febrile phase: 2-7 days. Critical phase: around defervescence, when plasma leakage/shock may occur. Recovery phase: fluid reabsorption and clinical improvement.']), h2('Warning signs'), P('Severe abdominal pain/tenderness, persistent vomiting, mucosal bleed, lethargy/restlessness, clinical fluid accumulation, hepatomegaly >2 cm, rising hematocrit with rapid platelet fall.'), h2('Severe dengue'), P('Severe plasma leakage causing shock or respiratory distress, severe bleeding, or severe organ involvement such as hepatitis, encephalopathy, myocarditis or acute kidney injury.'), h2('Diagnosis'), *bullets(['CBC: leukopenia, thrombocytopenia and serial hematocrit. A rising hematocrit suggests plasma leakage.', 'NS1 antigen/RT-PCR are useful early, usually in first 1-5 days. Dengue IgM becomes useful after about day 5.', 'In severe disease: LFT, renal profile, electrolytes, coagulation profile, blood gas, and imaging for effusions/ascites as indicated.']), h2('Management'), *bullets(['Without warning signs: oral electrolyte-containing fluids, continue feeding/breastfeeding, paracetamol 10-15 mg/kg/dose, daily review during critical period.', 'Do not use aspirin, ibuprofen/NSAIDs or intramuscular injections.', 'With warning signs: admit, monitor vitals/perfusion/urine output/hematocrit, and give carefully titrated isotonic crystalloid.', 'Shock: ABC, oxygen, IV/IO access, correct hypoglycemia and cautiously give isotonic crystalloid boluses with frequent reassessment. Rising Hct with shock indicates leakage; falling Hct with shock suggests bleeding.', 'Do not give platelets only for a low count. Use blood products for significant clinical bleeding/hemodynamic compromise. Avoid fluid overload, especially during recovery.']), h2('Prevention'), P('Eliminate breeding sites, cover water containers, use repellents/protective clothing/screens, and undertake community vector control.')] story += [Spacer(1,10), P('Quick final recall: SAM = MUAC <11.5 cm / WHZ < -3 / bilateral edema. Preterm = <37 weeks. VKDB late form = 2 weeks-6 months with frequent intracranial bleed. Dengue danger period = when fever comes down.','BoxX'), P('Prepared for exam revision. Review local pediatric/NICU protocols for medication doses and fluid/antibiotic regimens.','SmallX')] doc.build(story, onFirstPage=footer, onLaterPages=footer) print(out) PY python - <<'PY' from pypdf import PdfReader p='/tmp/workspace/pediatrics-15-mark-notes/output/Pediatrics_15_Mark_Answers.pdf' r=PdfReader(p) print('pages=',len(r.pages),'bytes=',__import__('os').path.getsize(p)) print(r.pages[0].extract_text()[:180]) PY

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Pediatrics 15 Mark Answers

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