NORMAL VALUES IN PAEDS FOR OFFTAG ASSESSMENT_updated on 09072020

Blood investigation
FBC < 2 wks > 2 wks
HB 13-20 10-14
TWC 5-30 5-15
Platelet 150-450 150-450
Coag PT 11 – 14
PTT 34 – 44
INR 1.0 – 1.5
CSF Glucose 2.5 – 4.4
Protein 0.2 – 0.4
Pressure 5 – 10
VBG PH 7.35 – 7.45
PaCO2 40 – 45
PaO2 60 – 75
HCO3 20 – 25
BE +/- 5
LFT ALT 0 – 41
AST 0 – 38
ALP 30 – 90
TB 0 – 17.1
TP 60 – 83
BUSE/CREAT < 2 wks 2 wks – 3 mo > 3 mos
Na 135 – 145 135 – 145 135 – 145
K 3.5 – 6 3.5 – 5.7 3.5 – 5
Urea 1.8 – 9
Creatinine 22 – 67
Fluid Maintainence
D1 : Dextrose 10%
D2 – 1 MO : 1/5 NSD10
1 - 6 MO : HSD5 (150ml/kg)
6 MO – 1 yr : HSD5 (120ml/kg)
>1 yr: HSD5
Term Babies ( Up to 6 months )
Day 1 60 cc/kg/day
Day 2 90 cc/kg/day
Day 3 120 cc/kg/day
Day 4 onwards 150 cc/kg/day
Preterm Babies ( Up to 6 months )
Day 1 60 cc/kg/day
Day 2 75 cc/kg/day
Day 3 90 cc/kg/day
Day 4 105 cc/kg/day
Day 5 120 cc/kg/day
Day 6 135 cc/kg/day
Day 7 onwards 150 cc/kg/day
Children
1ST 10kg 100ml/kg = 1000 ml 4mls/kg/hr
2nd 10kg 50ml/kg = 500 ml 2mls/kg/hr
Subsequent 20ml/kg 1ml/kg/hr
Deficit (Normal saline)

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 NORMAL VALUES IN PAEDS FOR OFFTAG ASSESSMENT_updated on 09072020

% x 10 x BW (in g)
Plan A (5%) : 10cc/kg/purge
Plan B (7.5%) : 75cc/kg over 4 hours
Plan C (10%) : IV Deficit over 12 hours + IV Maintainence over 24 hours +/- bolus 10-20cc/kg

Mild Moderate (≥ 2 below Severe (≥ 2 below signs)

signs)
Look Well, alert Restless/ irritable Lethargic/unconscious
Look No sunken eyes Sunken eyes Sunken eyes
Offer Drinks normally Drinks eagerly, thirsty Not able to drink or
drinks poorly
Pinch Skin goes back Skin goes back slowly Skin goes back very
immediately slowly (> 2 secs)
Nutrition/ Calorie counting in Paediatrics
Paeds Ready made formula: 80kcal/ 100ml
Breastmilk: 70kcal/100ml
Supplements Human milk fortifier : 1 sachet into 50mls = 2kcal/ml
Polycose : 4kcal/gram
Myotein : 5kcal/gram
MCT (Medium Chain Triglycerides Oil) : 8kcal/ml
Hypoglycaemia DXT < 2.6
Symptomatic Asymptomatic
- Bolus IV D10% 2-3ml/kg, Start IVD full - Feed baby or bring forward next feed
maintainence, Maintain feeding - Repeat DXT in 30 mins, DXT still < 2.6 (x1)
- Repeat DXT in 30 minutes, < 2.6 (x1) - Feed and supplement (cup feed, add polycose/
- Bolus IV D10% 2-3ml/kg, Increase IVD to next day fortifier)
maintainence - Repeat DXT still < 2.6 (x2)
- Repeat DXT in 30 minutes, < 2.6 (x2) - Bolus IV D10% 4ml/kg
- Bolus IV D10% 2-3ml/kg, Change IVD to D12.5% - Start IVD
- Repeat DXT in 30 minutes, < 2.6 (x3)
- Bolus IV D10% 4ml/kg, Change IVD to D15% via
UVC, Start IV hydrocortisone (2-4mg/kg/dose QID), If
required 20mg/kg/min.

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 NORMAL VALUES IN PAEDS FOR OFFTAG ASSESSMENT_updated on 09072020

Antibiotics
Meningitis
Abx Neonates Paeds
1. IV C-penicillin 100000u/kg BD 100000u/kg QID
2. IV Cefotaxime < 7 d : 100mg/kg BD 75mg/kg QID
7 d to 1 m0 : 50mg/kg QID
Brochopneumonia
Abx Neonates Paeds
1. IV C-penicillin 50000u/kg BD 25000u/kg QID
2. IV Gentamycin 5mg/kg OD
Presumed sepsis
Age 1st line of abx (dose) Duration
Premature baby IV C penicillin - X symp & c+s
≤7 d : 50000u/kg/dose 12h NOG → off after
> 7 d: 50000u/kg/dose 6h 48 h
Term newborn IV Ampicillin - clinical sepsis &
≤7 d : 50mg/kg/dose 12h IV Gentamycin c+s NOG → 5-7
> 7 d: 50mg/kg/dose 6h Days
Admit after D5 of life IV Cloxacillin - if confirm
≤7 d : 50mg/kg/dose 12h infections :
> 7 d: 25mg/kg/dose 6h pneumonia/UTI
→ 7 days

Gentamycin dosing and monitor

Age DOL Dose

< 36 wks 1st week of life 5mg/kg/36 h
> 7 days of life 5mg/kg/24 h
≥ 36 wks 5mg/kg/24 h
• Monitor BUSE and Creat before 2nd dose of gentamicin
• TDM Gentamicin monitoring in
- VLBW, HIE, AKI and require > 3 doses of gentamicin
- Pre (30 mins before infusion) and post 2nd dose (1 hour after infusion)
Acute Management of asthma(Teaching by Dr. Litthiya)
1. Nebuliser < 2 yo V:N 0.5: 3.5
>/=2yo V:N 1:3
<5 yo V:A:N 1:1:2
>/= 5yo V:A:N 1:2:1
V:N given x3 : reassess, if continuous bronchospasm, no improvement
then given V:A:N
2. IVI Salbutamol 1mg/kg dilute in 50cc D5% run at
1cc/hr = 20mcg/kg/hr
3cc/hr = 60mcg/kg/hr
Monitor HR → Arrythmias
3. IV Hydrocortisone • 4mg/kg 6 hourly
4. PO Prednisolone • Given to all acute asthma, if child can tolerate orally, serve 1mg/kg
for x5/7
5. IV MgSO4 • 50mg/kg run over 20 minutes *check electrolytes

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 NORMAL VALUES IN PAEDS FOR OFFTAG ASSESSMENT_updated on 09072020

What are the choice for preventive MDI for asthma?

- MDI Fluticasone 125mcg BD
- MDI Budesonide 200mcg BD (1 puff)
Potassium correction (teaching by Dr. Kean Hwa)

K (<2.5) K (2.5 – 3.5)

Fast Correction Can consider mist KCL if patient can take orally.

Deficit : wt x 0.4 (4- serum K)

max infusion rate = 0.2 - 0.4 mmol/kg/H = .......mmol/L
max concentration = 0.05 mmol/mL Maintenance : 1-2mmol/kg/day

Ex: 12 yo boy, 25kg, K 2.0 Eg: 10kg child with K 2.5 to correct with mist KCL
1. Calculate Deficit (mmol 🡪 g)
K deficit Deficit : 10 x 0.4 x (4.0 – 2.5)
= ( desired – actual )g x weight(kg) x = 6mmol + 10 (maintainence)
0.4mmol/kg/H /13.3mmol
= 1.5g
change to gram = 16/13.3= 1.2g/day 🡪 12mls or 1200mg
2. Calculate Hour of KCL / day (1g=10mls)
0.4mmol/kg/H = 19.99mmol/25kg/H
H=2H
• PO Mist KCl 300mg QID
3. Calculate Volume • PO Tab Slow K 600mg BD (only available @
0.05mmol/mL = 19.99 mmol/ V 600mg tablet)
V = 400mls

# Patient by right correct 1.5g in 400cc in 2 hours.

26.6/400 = 0.0665 mmol/mL 🡪 acceptable

according to Dr Kean Hwa

so thats why we increase to 2g in 400cc over 2

hours.

Vital signs
Blood pressure SBP DBP
D1<1000g 39 – 59 16 – 36
D1>1000g 50 – 70 25 - 45
Neonates 87 – 105 53 – 66
Toddler 95 – 105 53 – 66
> 7 yo 97 – 122 57 – 71
> 15 yo 112-128 66-80
Respiratory rate Infant 30-60
Toddler 24-40
Preschool 22-34
School Aged Child 18-30
Adolescent 12-16
Heart Rate Age Mean
<3mo 140
3mo – 2yo 130

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 NORMAL VALUES IN PAEDS FOR OFFTAG ASSESSMENT_updated on 09072020

2yo-10yo 80
>10yo 75
Tachypnoea < 2 wks > 60
2m – 1 yo > 50
1 yr – 5 yr > 40
Mentzer index MCV/RBC : < 13 Thalassaemia ; > 13 Iron deficiency anaemia
Transfusion requirement (Desired HB – Current HB) X weight x 4 = ……..mls
Hb Drop Rate Last transfusion Tx Hb – current pre tx hb/no. of days elapsed x 7 (to current
wk) = ………g/dl/week
Exjade Desferral Dosage Current dose/weight= …..mg/kg/day
1 big tab : 500mg
1 small tab : 125mg

Vaccination Schedule ( on 1/7/2020, added on OPV because of the outbreak in Sabah

** OPV Dose 1 given at birth
** OPV Dose 2 given 10 days after the first dose

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 NORMAL VALUES IN PAEDS FOR OFFTAG ASSESSMENT_updated on 09072020

Gross motor Fine motor Speech Social

6 weeks Head lag Fixed and follow 90 Alert/ Startles to sound Smile responsively
Rounded back Hand fisted
VS: high pelvic, knee below
abd
3 months Slight head lag Fixed and follow 180 Vocalizing Social smile
VS: head above body Hand unfisted Turn head to sound Laugh
Rest forearm in prone Sustained voluntary grasp if Cooing
object placed in ulnar side
Not reaching out
4 months Prone to supine Laugh
Up on hand in prone
No head lag
5 months Supine to prone Reached out for object Mouthing
Lift head when pull to sit Plays w toes
6 months Sit w support Palmar grasp Babbles w/o meaning
Bear weight
7 months Sit w/o support Transfer object Babbling w single syllabus Stranger anxiety
Commando crawl Rakes object
Feed self with biscuits
8 months Creeping Scissor grasp w curled index Babbling w combine
syllabus

9 months Pull self to sit Inferior pincer grasp Localize sound at 1 Feed w spoon
Sit steadily meter, above and below occasionally
Stand w support ear Look to floor when
toys drop ( object
persistent )
Understand “no”
10 months Pull self to stand Index approach Waves bye-bye
Use index to poke a pea
Let go the cube
11 months Cruising, walk w both hand One word meaning Peek-a-boo
held “mama”
12 months Walk w one hand held, Neat pincer grasp Understand phrases Casting
walk like bear Bang 2 cubes 2-3 words w meaning Clap hand
Stand alone Tower of 2 (13 mo) Point to object Mouthing stop
walks well ( 13 mo ) May hand the object
to adult on request.
18 months Up and down stairs holding Tower of 3 Point to 2-3 body parts Toilet trained
on rails Cylindrical grip ( immature Picture card 1 Casting stop
Throw ball w/o falling tripod ) Recognize simple pic Feed self w spoon
Sit on chair Scribbles spontaneously Turn few pages at once and drink from cup

2 years Up and down stairs alone, Tower of 6 2-3 words sentence Dry by day
2 feet per step Digital grip Name 3 objects Put on shoes
Walk backwards Imitates trains w/o chimney Point to 4 body parts Play near other
Throw overhand Picture card 3 children
Kick w/o falling Recognize fine details
Runs Turn pages singly

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 NORMAL VALUES IN PAEDS FOR OFFTAG ASSESSMENT_updated on 09072020

2.5 years Jump on both feet Tower of 8 Knows full name and
Walk tip toes Imitate trains w chimney gender
Imitate straight line 1 colour
3 years Go upstairs one foot per Tower of 9 Count 1-10 Dress and undress w
step Imitate bridge 2 colour help
Stand on 1 foot Modified tripod grip Nursery rhymes Dry by night
Ride tricycles Copies circle and imitate plus Play w others
4 years Up and down stairs one Imitate gate 3 colours Button cloth
foot per step Tripod grip Fluent conversation Attend toilet need
Skip and hop on 1 foot Copies square and plus A-Z
5 years Skip both feet Copies cross ( 5 yo ) and Know age Dress by self
Runs on toe triangle (5 and ½ yo ) 4 colours Tie shoelaces
6 years Heal toe walk Imitate steps w 10 cubes
Kick, throw, climb Copies diamond and complex
square

Criteria for admission of asymptomatic neonates at risk of sepsis

ALL NEONATES WITH RISK OF SEPSIS MUST BE REFERRED TO PAEDIATRICS TEAM

Definition of risk of sepsis:

1. Prolonged rupture of membrane > 18 hours
2. Maternal chorioamnionitis
- foul smelling liquor OR obstetrician defined criteria
3. Maternal Urinary Tract Infection
- significant positive urine culture OR
- urine microscopic examination with WBC > 10 per hpf OR
- urine microscopic examination showing bacteriuria > 3+
4. Maternal fever
- Fever > 38 celcius (excluding intrapartum)

CRITERIA FOR ADMISSION

1. Babies < 37 weeks (e.g 36 weeks + 6 days) with ANY risk of sepsis
2. Babies ≥ 37 weeks with TWO or MORE points as listed below

RISKS SCORE
Maternal chorioamnionitis 2 points
PROM > 18 hours 1 point
Maternal UTI 1 point
Maternal fever > 38 celcius 1 point
Abnormal FBC 1 point
- Total WBC <5000/ul or > 30000/ul OR
- Absolute neutrophil count < 1500/ul
- Platelet count < 150000 /ul