UKOM Sp.A cheat sheet

Apgar score is assigned at 1 and 5 minutes (and every 5 minutes up to 20 if <7); it predicts mortality but is not used alone to diagnose asphyxia or guide resuscitation.

Surfactant is indicated for RDS with FiO2 >0.30 on CPAP/PEEP ≥6 cmH2O, or prophylactically in intubated extremely preterm infants; porcine/bovine preparations reduce pneumothorax and mortality.

Neonatal hypoglycemia threshold: <47 mg/dL (2.6 mmol/L) in the first 48 h warrants intervention; <25 mg/dL (1.4 mmol/L) is severe and needs IV dextrose bolus (200 mg/kg = 2 mL/kg D10W).

Physiologic jaundice appears after 24 h; jaundice within the first 24 h is always pathologic (hemolysis, sepsis, TORCH). Treat with phototherapy per hour-specific nomogram; exchange transfusion if signs of bilirubin encephalopathy or high levels unresponsive.

Necrotizing enterocolitis: Bell stage I (suspected) to III (advanced with perforation); classic triad is abdominal distension, bloody stools, and pneumatosis intestinalis on radiograph. Stop feeds, decompress, give antibiotics.

Therapeutic hypothermia (33.5 °C for 72 h) is standard for moderate-to-severe hypoxic-ischemic encephalopathy in infants ≥36 weeks born at ≥1800 g, started within 6 h of birth.

Persistent pulmonary hypertension of the newborn: pre/post-ductal SpO2 difference >10% suggests right-to-left shunt; treat with inhaled nitric oxide, optimize lung recruitment, avoid acidosis and hypothermia.

Retinopathy of prematurity screening: infants <30 weeks gestation or <1500 g birth weight, starting at 4-6 weeks chronological age; laser or anti-VEGF for type 1 disease.

WHO growth charts for 0-24 months, CDC charts for 2-20 years. Crossing ≥2 major percentile lines suggests failure to thrive or a growth disorder.

Expected growth velocity: 0-3 months ~30 g/day; 3-6 months ~20 g/day; 6-12 months ~10 g/day; height velocity 25 cm/year in infancy, 5-6 cm/year prepubertal.

Developmental milestones: social smile 6 weeks; sits unsupported 6-8 months; walks alone 12-15 months; 2-word phrases 18-24 months; tricycle 3 years.

Red flags: no social smile by 2 months, no babbling by 6 months, no sitting by 9 months, no walking by 18 months, no words by 16 months, loss of skills at any age.

Autism screening with M-CHAT-R/F at 18 and 24 months; refer for comprehensive evaluation if positive. Early intensive behavioral intervention improves outcomes.

ADHD diagnosis requires symptoms before age 12, in ≥2 settings, ≥6 months duration, and functional impairment; first-line for preschool is behavioral parent training, then stimulants.

Toilet training typically begins at 18-30 months; enuresis is not diagnosed before age 5; nocturnal enuresis first-line is behavioral (bedwetting alarm) then desmopressin.

BMI percentile interpretation: <5th underweight, 5th-84th normal, 85th-94th overweight, ≥95th obesity, ≥99th severe obesity.

Exclusive breastfeeding for ~6 months, then complementary foods; iron-fortified cereal or meat is needed from ~6 months because breast milk iron is insufficient.

Phenylketonuria: deficient phenylalanine hydroxylase; treat with low-phenylalanine diet and sapropterin (BH4) in responsive patients; untreated causes intellectual disability.

Galactosemia: avoid galactose/lactose; classic form presents with jaundice, hepatomegaly, cataracts, and E. coli sepsis in the neonate.

Medium-chain acyl-CoA dehydrogenase (MCAD) deficiency: fasting intolerance, hypoketotic hypoglycemia; treat with frequent feeds and carnitine; avoid fasting.

Maple syrup urine disease: sweet-smelling urine, encephalopathy, elevated branched-chain amino acids (leucine, isoleucine, valine); restrict these and give thiamine trial.

Urea cycle disorders: hyperammonemia with respiratory alkalosis; treat with nitrogen scavengers (sodium benzoate, sodium phenylbutyrate) and arginine/citrulline.

Vitamin D: 400 IU/day for breastfed infants and all infants from birth; rickets prevention in older children 600 IU/day.

Kwashiorkor = protein deficiency with edema, fatty liver, and skin changes; marasmus = severe caloric deficiency with wasting. Refeeding syndrome risk requires gradual reintroduction.

UK routine schedule: 8, 12, 16 weeks (6-in-1, rotavirus, PCV, MenB); 1 year (Hib/MenC, MMR, PCV); 3 years 4 months (4-in-1, MMR); 12-13 years (HPV, Td/IPV, MenACWY).

MMR is contraindicated in severe immunosuppression and pregnancy; two doses give ~99% protection against measles.

Kawasaki disease: fever ≥5 days plus ≥4 of conjunctivitis, mucositis, rash, extremity changes, cervical lymphadenopathy; treat with IVIG 2 g/kg and aspirin; risk of coronary aneurysms.

Scarlet fever: group A Streptococcus, sandpaper rash, strawberry tongue, circumoral pallor; treat with penicillin or amoxicillin for 10 days to prevent rheumatic fever.

Sepsis in the neonate: group B Streptococcus and E. coli are leading causes; give benzylpenicillin plus gentamicin empirically.

Tuberculosis: interferon-gamma release assay preferred over tuberculin skin test in BCG-vaccinated children >2 years; latent TB treated with rifampicin plus isoniazid for 3 months (or 6 months isoniazid).

HIV: mother-to-child transmission prevented with maternal ART and infant prophylaxis; early infant diagnosis by HIV DNA PCR at 4-6 weeks.

Hand, foot, and mouth disease: coxsackievirus A16 or enterovirus 71; supportive care; EV71 can cause severe neurological disease.

Acute asthma: salbutamol via spacer is as effective as nebulizer; add ipratropium for severe; systemic corticosteroids within 1 h; magnesium sulfate for life-threatening.

Croup: barking cough, inspiratory stridor; treat with single-dose dexamethasone (0.15-0.6 mg/kg) and nebulized adrenaline for moderate-severe.

Bronchiolitis: supportive care; no routine bronchodilators, steroids, or antibiotics; oxygen if SpO2 <90-92%; RSV is the commonest cause.

Cyanotic congenital heart disease: five Ts - Truncus arteriosus, Transposition, Tricuspid atresia, Tetralogy of Fallot, Total anomalous pulmonary venous return.

Ventricular septal defect is the commonest congenital heart lesion; acyanotic with left-to-right shunt; large defects cause failure to thrive and heart failure.

Coarctation of the aorta: upper-limb hypertension with lower-limb hypotension, radiofemoral delay; associated with Turner syndrome and bicuspid aortic valve.

Duct-dependent lesions (transposition, pulmonary atresia, critical coarctation) respond to prostaglandin E1 infusion to keep the ductus open.

Cystic fibrosis: sweat chloride >60 mmol/L diagnostic; newborn screening with immunoreactive trypsinogen; treat with airway clearance, dornase alfa, and CFTR modulators.

Nephrotic syndrome: triad of edema, proteinuria (>40 mg/m²/h or urine protein:creatinine >200 mg/mmol), and hypoalbuminemia (<25 g/L); first-line prednisolone.

Hemolytic uremic syndrome: microangiopathic hemolytic anemia, thrombocytopenia, acute kidney injury; Shiga toxin-producing E. coli is the commonest cause; avoid antibiotics and antimotility drugs.

Acute kidney injury is staged by KDIGO criteria using serum creatinine rise and urine output; pre-renal causes respond to fluid challenge.

Vesicoureteral reflux and urinary tract infection: investigate with ultrasound after first febrile UTI in infants; antibiotic prophylaxis for high-grade reflux.

Biliary atresia: conjugated hyperbilirubinemia in the first 2 months, pale stools, dark urine; Kasai portoenterostomy before 60 days improves outcome.

Gastroesophageal reflux in infants is physiologic; avoid over-treatment; consider cow's milk protein allergy if poor response.

Celiac disease: anti-tTG IgA with total IgA level; confirm with duodenal biopsy; lifelong gluten-free diet.

Intussusception: colicky pain, redcurrant jelly stools, sausage-shaped mass; treat with air or contrast enema if no peritonitis or perforation.

Iron deficiency anemia: microcytic hypochromic, low ferritin; treat with oral iron 3-6 mg/kg/day elemental iron; response expected within 2-4 weeks.

Sickle cell disease: hydroxyurea reduces crises; penicillin prophylaxis from 3 months; transcranial Doppler screening for stroke risk.

Thalassemia major: regular transfusions with iron chelation (deferasirox); monitor ferritin and cardiac T2*.

Acute lymphoblastic leukemia is the commonest childhood malignancy; presents with pallor, bruising, bone pain, hepatosplenomegaly; diagnose with bone marrow aspirate.

Wilms tumor: abdominal mass, hematuria, hypertension; treat with nephrectomy plus chemotherapy; associated with WT1 mutations and WAGR syndrome.

Primary immunodeficiency red flags: ≥4 ear infections/year, ≥2 sinus infections/year, ≥2 pneumonias, failure to thrive, family history; investigate with immunoglobulin levels and lymphocyte subsets.

Anaphylaxis: intramuscular adrenaline 0.01 mg/kg (max 0.5 mg) into the anterolateral thigh; repeat after 5 minutes if needed.

Neutropenic sepsis: fever ≥38 °C with absolute neutrophil count <0.5 × 10⁹/L is an emergency; start broad-spectrum antibiotics within 1 hour.

Febrile seizure: age 6 months-5 years, fever, no CNS infection; simple if <15 min and generalized; no routine EEG or imaging.

Status epilepticus: benzodiazepine first-line (midazolam buccal or lorazepam IV), then phenytoin/fosphenytoin or levetiracetam; escalate to anesthetic if refractory.

Pediatric basic life support: 5 rescue breaths then 15:2 compressions:ventilations for two rescuers; rate 100-120/min; depth one-third of chest.

Pediatric Advanced Life Support: shockable rhythms (VF/pVT) get defibrillation 4 J/kg; non-shockable get adrenaline 10 mcg/kg.

Head injury: Glasgow Coma Scale ≤13 or focal deficit warrants CT; observe for signs of raised intracranial pressure (bradycardia, hypertension, irregular breathing - Cushing triad).

Meningitis: do not delay antibiotics for lumbar puncture; give ceftriaxone plus dexamethasone; bacterial meningitis in neonates uses ampicillin plus cefotaxime.

Drowning and hypoxic-ischemic injury: prioritize oxygenation and rewarming; do not stop resuscitation prematurely in cold-water immersion.

Poisoning: activated charcoal within 1 h for most ingestions except hydrocarbons, corrosives, and metals; naloxone for opioids; N-acetylcysteine for paracetamol.

Congenital hypothyroidism: newborn screening with TSH; treat with levothyroxine 10-15 mcg/kg/day started within 2 weeks to prevent intellectual disability.

Type 1 diabetes: ketoacidosis presents with polyuria, polydipsia, weight loss, Kussmaul breathing; treat with fluids, insulin infusion, and potassium replacement.

Growth hormone deficiency: short stature with low height velocity, delayed bone age, and failed GH stimulation test; treat with recombinant GH.

Turner syndrome: 45,X; short stature, webbed neck, coarctation, streak ovaries; treat with GH and estrogen replacement.

Down syndrome: trisomy 21; screen for congenital heart disease (AVSD), hypothyroidism, and atlantoaxial instability.

Klinefelter syndrome: 47,XXY; tall stature, gynecomastia, small testes, infertility; testosterone replacement in adolescence.

Congenital adrenal hyperplasia: 21-hydroxylase deficiency is commonest; salt-wasting crisis in neonates with ambiguous genitalia in females; treat with hydrocortisone and fludrocortisone.

Precocious puberty: before 8 years in girls, 9 years in boys; GnRH agonist is treatment for central precocious puberty.

Gillick competence: a child under 16 may consent if they have sufficient understanding and intelligence to make the decision; assess case by case.

Children Act 1989: the child's welfare is paramount; parental responsibility can be shared by married parents, mothers, and unmarried fathers on the birth certificate.

Best interests principle: treatment decisions for children unable to consent must consider benefits, burdens, and the child's views.

Confidentiality: adolescents have a right to confidential care; disclose only if risk of serious harm or with consent, following local safeguarding policy.

Child protection: follow local safeguarding procedures; a child protection medical examination requires consent from someone with parental responsibility or a court order.

Research in children requires assent where developmentally appropriate plus parental consent; assent is not legally binding.

Duty of candour: disclose harm from care openly and apologise; statutory duty in the UK for moderate or severe harm.

Mental Capacity Act 2005: applies to those ≥16; for under-16s use Gillick/Fraser guidelines; best interests decision-making for those lacking capacity.

Randomized controlled trial: randomization reduces selection bias; intention-to-treat analysis preserves randomization benefits.

Sensitivity = true positives / (true positives + false negatives); specificity = true negatives / (true negatives + false positives).

Positive predictive value depends on prevalence; a test with high sensitivity is useful for ruling out disease (SnNout); high specificity rules in (SpPin).

Number needed to treat = 1 / absolute risk reduction; number needed to harm = 1 / absolute risk increase.

Odds ratio approximates relative risk when the outcome is rare (<10%); use relative risk for cohort studies.

Confidence intervals: a 95% CI excluding 1 for ratios or 0 for differences indicates statistical significance at p<0.05.

Systematic review with meta-analysis: assess heterogeneity with I²; >50% suggests substantial heterogeneity; use random-effects model when heterogeneity is high.

Quality improvement: use the Model for Improvement (Plan-Do-Study-Act cycles); measure with run charts or statistical process control; aim statements should be SMART.