PGIM MD Paediatrics cheat sheet

Paediatrics - High-Yield Reference

• Neonatal jaundice: phototherapy thresholds rise with postnatal age and gestational age; in term infants consider phototherapy around 15 mg/dL (257 µmol/L) at 48 h, and exchange transfusion roughly 5 mg/dL above the phototherapy line. Always plot on the hour-specific nomogram rather than using a single cut-off.

• Paediatric maintenance fluids (Holliday-Segar): 100 mL/kg/day for first 10 kg, 50 mL/kg/day for next 10 kg, 20 mL/kg/day thereafter; hourly rate = 4/2/1 mL/kg/h. Isotonic crystalloid with added glucose is preferred over hypotonic fluids because of hyponatraemia risk.

• Paediatric CPR: compression rate 100-120/min, compression:ventilation 15:2 for two rescuers (30:2 for single rescuer lay provider), compression depth at least one-third of AP chest diameter (~4 cm infant, ~5 cm child). Give adrenaline 10 µg/kg IV/IO (0.1 mL/kg of 1:10,000) every 3-5 min.

• Weight estimation in emergencies: APLS formula weight (kg) = (age in years + 4) × 2 for children 1-10 years. Use length-based tape if available; the formula underestimates weight in obese children.

• Fever without source in infants: full sepsis screen (blood, urine, CSF) and empirical antibiotics for all infants ≤28 days; for 29-90 days use risk stratification (e.g., Rochester or step-by-step algorithms) including urinalysis, WBC, and procalcitonin/CRP.

• Kawasaki disease: fever ≥5 days plus 4 of 5 features (conjunctivitis, oral mucositis, cervical lymphadenopathy, polymorphous rash, extremity changes); give IVIG 2 g/kg plus aspirin. Coronary artery assessment by echocardiography at diagnosis and again at 2 weeks.

• Bronchiolitis: diagnose clinically; routine use of bronchodilators, corticosteroids, antibiotics, or chest physiotherapy is not recommended. Supportive care with oxygen (target saturations >90-92%) and hydration; palivizumab is reserved for high-risk prophylaxis.

• Growth: use WHO charts for 0-2 years and national/CDC charts thereafter. Crossing two major centile lines on a growth chart warrants investigation for failure to thrive; calculate mid-parental height to assess familial short stature.

• Developmental milestones: sits unsupported 6-8 months, walks independently 12-18 months, two-word phrases by 18-24 months, three-word sentences by 2.5-3 years. Loss of previously acquired skills is always pathological and requires urgent assessment.