Thursday, January 31, 2013

Monitoring your child's growth

Proper growth of a child is of concern to every parents. Comparing your child with other children of same age group can give you some idea but all children do not have the same growth potential. The birth weight, nutritional status, health, parental height and genotype influence the child’s potential to grow.

Monitoring weight gain in children:

The normal birth weight of a baby is 2.5 to 4 kg. On an average a baby is born with around 3 kg weight.
Baby loses 7-10% of birth weight by 1st week and regains birth weight by 10 days.
Then with good health and nutrition, gains on an average  20-40 gm/day for 1st 3 months of life. 20 gm/day for next 3 months. Then 15 g/day in next 3 months then 12 g/day and so on.

Baby’s weight:
  • Doubles: 5 months
  • Triples: 1 year
  • Quadruples: 2 year
  • 2-2.5 kg per year is gained there after till the child is an adolescent.
Rapid gain in weight occurs during adolescence. Earlier weight gain occurs in females.
Here are few Formulas used to estimate weight for your child:
1. For  3mths to 12 mth=  ( Age in months + 9 )/2
2. 1 yr to 6 yr= 2 X age in years +8
3. 7-12 years= ( 7 X Age in years -5) /2
Monitoring height in children

Height is of a big concern in parents. Will my child grow tall enough? Why is my child lagging behind? These are common questions faced by a doctor.
  • A baby at birth is around 50 cm in length.
  • Height  increases to 75 cm at 1 year
  • Then  up to 90 cm  at 2 years.
  • At 13 years a child attains the Triple the length at birth.
  • A normal child gains 4-5cm/year till onset of adolescence
If a child attains < 4 cm height per year should arouse a concern in parents and seeing a doctor is recommended.
Formula for expected height in cm (2-12 years) = Age in years X 6 + 77
Estimated Final Height = (Ht of father in cm  + height of mother in cm + 13 cm)/2 in Males
 (Ht of father in cm  + height of mother in cm - 13 cm)/2 in Females

Please feel free to ask any questions you have in mind.

Saturday, January 26, 2013

Classical case of Congenital Diaphragmatic Hernia

A Single/ Term Male Baby weighing 3.0 kg was delivered via emergency LSCS for fetal distress who was prenatally diagnosed to have congenital diaphragmatic hernia in utero. He was born with Apgar score 4/10, 6/10, was immediately intubated and transferred to NICU. After stabilizing was put under ventilator and planned for Operation by Pediatric surgery team.

Chest Xray -
Showed B/L severe pulmonary hypoplasia with Intestinal content in the lt chest with displacement of the mediastinum to right.

Almost entire bowel loops were in the chest.

Initial Stabilization till Intubation can be done-
1. Oxygen by blow-by and insert 10 F Orogastric tube. Remove air manually by aspiration.
2.Attach the OG tube to an intermittent suction device set at 40 mmHg pressure or do frequent manual aspirations.
3.Get a Chest Xray and be sure gastric tube is in place. Locate the stomach.
4. Make sure of adequate oxygenation to prevent PPHN
5.Evlauate for PPHN with preductal and post ductal saturation measurements.
6.Maintain adequate hydration and if needed - Inotropic support.
7.Watch closely for Pneumothorax.
8.Keep the infant calm with anagesia.

In such Scenario-
1. Bag and Mask Ventilation is contraindicated as it inflates the gut and further compromising the lung functions
2. Intubation and Bagging should be done and NG should be inserted.
Intuabtion is preferred with cuffed ET tube.