Pediatrics and Neonatology
The paediatric section tests neonatal resuscitation, nutrition and growth, the national immunisation calendar, dehydration management and the common paediatric emergencies - pneumonia, bronchiolitis, acute diarrhoea, febrile convulsions and intussusception.
Core rules
- Neonatal resuscitation: warm, dry, stimulate, position the head; assess breathing and heart rate. Heart rate below 100 beats/min means positive-pressure ventilation; below 60 after 30 seconds of effective ventilation means chest compressions at a 3:1 ratio. Routine suctioning is not indicated; delayed cord clamping for 1–3 minutes.
- Jaundice appearing within the first 24 hours is always pathological; measure bilirubin and apply phototherapy thresholds.
- Dehydration from diarrhoea: World Health Organization plans A, B and C. For some dehydration, 75 mL/kg oral rehydration solution over 4 hours plus zinc for 10–14 days.
- Immunisation in Kazakhstan: hepatitis B and BCG within the first days of life, DTP with polio at 2, 3 and 4 months, measles–mumps–rubella at 12 months and 6 years, then scheduled revaccinations.
- Danger signs requiring admission: inability to feed, convulsions, lethargy, chest indrawing, stridor at rest, severe dehydration.
Worked example
A 3-month-old has temperature 38.5 °C, refuses feeds, respiratory rate 70, chest indrawing and saturation 90%. Reasoning: cough or difficult breathing with indrawing and hypoxaemia defines severe pneumonia; the child is admitted, given oxygen, and started on ampicillin plus gentamicin according to the integrated management guidance, with feeding support and reassessment.
Traps
- Giving aspirin to a child with fever - risk of Reye syndrome.
- Using adult drug doses or assuming a child is a small adult.
- Missing intussusception: colicky pain, drawing up the legs, red-currant stool.
- Stopping oral rehydration too early or replacing it with sugary drinks.