NExT Pediatrics including Neonatology Syllabus

Define low birth weight, very low birth weight, and extremely low birth weight.

LBW < 2500 g; VLBW < 1500 g; ELBW < 1000 g.

How is prematurity defined and what are its subcategories by gestational age?

Preterm = born before 37 completed weeks. Extremely preterm <28 wk, very preterm 28-32 wk, moderate-to-late preterm 32-37 wk.

What is the most common cause of respiratory distress in a preterm newborn, and what is its pathophysiology?

Respiratory Distress Syndrome (hyaline membrane disease) due to surfactant deficiency causing alveolar collapse; treated with antenatal steroids and exogenous surfactant.

What bilirubin level/zone of physiological jaundice differentiates it from pathological jaundice in a term newborn?

Physiological: appears after 24 hr, peaks day 3-5, <15 mg/dL, resolves by 1-2 weeks. Pathological: appears <24 hr, rises >5 mg/dL/day, total >15 mg/dL, conjugated >2 mg/dL, or persists >2 weeks.

What is the most common cause of jaundice appearing within the first 24 hours of life?

Hemolysis - especially Rh isoimmunization, ABO incompatibility, or G6PD deficiency.

What is kernicterus and at what unconjugated bilirubin levels does the risk rise in a term baby?

Kernicterus is bilirubin-induced brain damage (deposition in basal ganglia) causing choreoathetoid cerebral palsy, hearing loss, and gaze palsy; risk rises with unconjugated bilirubin >20-25 mg/dL in term infants.

What are the categories of neonatal sepsis by onset and their typical organisms?

Early-onset (<72 hr): GBS, E. coli, Klebsiella - vertical transmission. Late-onset (>72 hr): Staph (CONS), Klebsiella, Pseudomonas, Candida - nosocomial/community.

Define perinatal/birth asphyxia and the Sarnat staging used for HIE.

Birth asphyxia = failure to initiate/sustain breathing at birth causing hypoxia. HIE is staged by Sarnat: Stage 1 (mild - hyperalert), Stage 2 (moderate - lethargy, seizures), Stage 3 (severe - stupor/coma, flaccid).

What is the established neuroprotective therapy for moderate-to-severe HIE in term/near-term neonates?

Therapeutic hypothermia (whole-body or selective head cooling to 33.5°C for 72 hours), started within 6 hours of birth.

Under India's Universal Immunization Programme, which vaccines are given at birth?

BCG, OPV (zero dose), and Hepatitis B (birth dose).

What vaccines are given at 6, 10, and 14 weeks under the UIP schedule?

Pentavalent (DPT+HepB+Hib), OPV, Rotavirus vaccine, and fIPV (fractional inactivated polio) at each visit; PCV is also given at 6 and 14 weeks (plus a booster).

When is the first dose of measles-rubella (MR) vaccine given in the UIP schedule?

First MR dose at 9-12 months; second dose at 16-24 months.

What is the route and site of BCG vaccine administration, and the normal post-vaccination reaction?

Intradermal, over left upper arm (deltoid); produces a papule -> ulcer -> heals as a scar over ~6-12 weeks.

What are Koplik spots and which disease are they pathognomonic for?

Koplik spots are small bluish-white spots on a red base on the buccal mucosa - pathognomonic for measles, appearing 1-2 days before the rash.

Describe the characteristic rash progression of chickenpox (varicella).

Centripetal (trunk > extremities) rash with rapid evolution; lesions in different stages simultaneously (macule -> papule -> vesicle -> pustule -> crust) - 'dew drops on a rose petal'.

What organism causes whooping cough and what is its classic clinical hallmark?

Bordetella pertussis; classic paroxysmal cough with inspiratory 'whoop' followed by post-tussive vomiting.

Per WHO/IMNCI, what respiratory rate defines fast breathing (pneumonia) by age group?

<2 months: >=60/min; 2-12 months: >=50/min; 12 months-5 years: >=40/min.

What clinical signs classify pneumonia as 'severe pneumonia' under IMNCI?

Cough/difficult breathing plus any general danger sign or chest indrawing or stridor in a calm child (lower chest wall indrawing indicates severe pneumonia).

What is the most common bacterial cause of community-acquired pneumonia in children, and the first-line oral antibiotic for non-severe cases?

Streptococcus pneumoniae; first-line oral antibiotic is amoxicillin.

What is the composition of WHO low-osmolarity ORS (osmolarity and key contents)?

Total osmolarity 245 mOsm/L: sodium 75, chloride 65, glucose 75, potassium 20, citrate 10 mmol/L.

Under IMNCI, what are the three plans (A, B, C) for managing diarrhea by dehydration status?

Plan A: no dehydration - home ORS + zinc. Plan B: some dehydration - 75 ml/kg ORS over 4 hr. Plan C: severe dehydration - IV fluids (Ringer's lactate).

What is the recommended zinc supplementation for childhood diarrhea?

Zinc 20 mg/day (10 mg/day if <6 months) for 10-14 days, reduces severity, duration, and recurrence of diarrhea.

What is the most common congenital cyanotic heart disease beyond infancy, and its four components?

Tetralogy of Fallot: pulmonary stenosis, VSD, overriding aorta, and right ventricular hypertrophy ('boot-shaped' heart on X-ray).

What is the most common congenital acyanotic heart defect, and its characteristic murmur?

Ventricular septal defect (VSD); harsh pansystolic murmur at the left lower sternal border.

What are the diagnostic Jones criteria categories for acute rheumatic fever?

Major: carditis, polyarthritis, chorea, erythema marginatum, subcutaneous nodules. Minor: fever, arthralgia, raised ESR/CRP, prolonged PR. Need 2 major OR 1 major + 2 minor plus evidence of preceding strep infection.

What is the classic triad of nephrotic syndrome, and the most common type in children?

Triad: heavy proteinuria, hypoalbuminemia, and edema (plus hyperlipidemia); minimal change disease is the most common type, typically steroid-responsive.

What is the classic presentation and most common cause of acute post-streptococcal glomerulonephritis (nephritic syndrome) in children?

Hematuria (cola-colored urine), edema, hypertension, oliguria following group A streptococcal throat/skin infection (1-2 weeks later); low C3.

What deficiency causes the most common nutritional anemia in children, and the lab picture?

Iron deficiency anemia; microcytic hypochromic anemia with low ferritin, low serum iron, high TIBC, low transferrin saturation.

What is the most common childhood malignancy, and its peak age of incidence?

Acute lymphoblastic leukemia (ALL); peak incidence at 2-5 years of age.

What is the classic triad of febrile seizures and the age range in which they occur?

Seizure with fever (no CNS infection/metabolic cause) in children 6 months to 5 years; simple febrile seizures are generalized, <15 min, and do not recur within 24 hours.

What is the karyotype and key clinical features of Down syndrome (Trisomy 21)?

47,XX/XY +21 (or translocation/mosaic); features: hypotonia, upslanting palpebral fissures, epicanthal folds, flat nasal bridge, single palmar crease, Brushfield spots, intellectual disability, and AV canal cardiac defects.

What are the age range and key components (the four As) of the Rashtriya Kishor Swasthya Karyakram (RKSK) target group?

Adolescents 10-19 years; RKSK addresses nutrition, sexual & reproductive health, mental health, substance misuse, injuries/violence, and non-communicable diseases, delivered through Adolescent Friendly Health Clinics and Peer Educators.