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Paul Paul

on 9 November 2013

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Transcript of KPG1002

Mumps, Measles & Rubella vaccines
Given at 12 months
Booster at 6 years old
Evidence so far did not show association between MMR vaccine & autism Immunization To recognize normal and common problems during first few weeks.
To know when to get medical help/advice.
To understand the importance of immunization.
Breast-feeding is the best ! SUMMARY All compulsory vaccinations/immunization must be completed and documented before a child goes to school. BCG
To prevent T.B.
Given on left arm. Redness & pus in 4 to 6

Hepatitis B
3 doses at birth, 1& 5 months
Babies of Hep B carriers will need to have
Hep B Antibody & carrier status checked at 9 to 12 months old Immunization Oral thrush (Fungal infection) Fungal infection Nappy rash Abnormal skin rashes
Body When does a baby need to be taken to the paediatrician ? Different types of thermometers Jaundice
- Observe the colour of skin & eyes
- Observe under daylight or sunlight
- Not to be under estimated
- Observe urine & stool colour
- Up to 14 days

Breast-milk jaundice When does a baby need to be taken to the paediatrician ? Poor feeding
-2 to 4 hours
-2 to 4 ounces
-Demand feeding
-Lethargy/ poor sucking/vomiting/diarrhoea
-Poor weight gain
-Normal wt gain : 15 to 20 gm/day When does a baby need to be taken to the paediatrician ? Jaundice Nose block
Can use bulb suction
Saline Nasal Spray

Watery eyes & eye discharge
Blocked tears duct
Can be infection PROBLEMS IN THE FIRST WEEKS OF LIFE Meconium – black/dark green sticky stool passed during 1st 48 hours
Breastfeeding stool
Bright yellow
Soft stools
after each feed
Constipation, Hard stool, strainning and bleeding are abnormal. PROBLEMS IN THE FIRST WEEKS OF LIFE Crying
Wet nappy
Too warm or too cold
Bored & lonely
Too noisy
Tired but unable to sleep
……………………………………………….. PROBLEMS IN THE FIRST WEEKS OF LIFE Baby’s pimples Regurgitation
due to lax sphincter/small stomach
consists of milk & mucus
Put child to sleep on the side for safety
See Paediatrician if poor weight gain (change of formula and medication)

lose weight during the first few days
gain weight after 1 week
Weight gain about 15-20 gm daily PROBLEMS IN THE FIRST WEEKS OF LIFE Mongolian Spots Mongolian spots Subconjunctival haemorrhage “Stoke-bite mark” Skin mottling( Coldness ) Milia Blue limbs/feet Forceps marks Baby Bath In the delivery room
Umbilical cord blood taken for blood group, G6PD, TSH screening.
Warmed, suction nose and mouth, oxygen if needed.
Nasal passage patency confirmed.
Normal breathing.
Cord clamped.
First immunization- Hepatitis B, BCG.
Vitamin K injection- to prevent bleeding. IMMEDIATE CARE OF A NEWBORN

Dr Khaw Poh Guan
Consultant Paediatrician
PENANG ADVENTIST HOSPITAL A Newborn, A Celebration! Immunization Compulsory VS Additional Immunization Abnormal behaviour/appearance
Excessive crying
Lethargic & not active
Abnormal movement of limbs
Rapid breathing/shortness of breath
Very distended/shiny abdomen
No bowel opening for more than 3 days When does a baby need to be taken to the paediatrician ? Seborrheic dermatitis (Cradle cap) Fungal infection Fever
Normal temperature : 36.5 – 37.5 C (ear)
Check temperature 4 to 6 hrs
Fever could be due to infection When does a baby need to be taken to the paediatrician ? Neonatal jaundice
Yellow discoloration of skin
80 % of babies develop jaundice
Due to liver immaturity & red blood cell mass
Occur around 2-3 days after birth
Peaks at 5-7 days after birth
Severe jaundice may cause brain damage & fits PROBLEMS IN THE FIRST WEEKS OF LIFE Umbilical cord
Daily cleaning with alcohol swab
Drops off in about 10 days
May have bleeding
Signs of infection (smelly, pus) PROBLEMS IN THE FIRST WEEKS OF LIFE Nappy rash Erythema toxicum Rashes
Prickly heat
Baby pimples
Erythema toxicum
Diaper rash PROBLEMS IN THE FIRST WEEKS OF LIFE Breast-milk is the best !
Demand feeding
It is OK no night feeding after 2 months
Not necessary to give water
Infant formula only for medical indications Feeding in 1st 6 months Dry crack skin Port-Wine stain Antenatal tooth Skin mottling( Coldness ) Moulding Baby cleaned with oil to remove vernix.
Kept in closed incubator till stable.
Bathed when temperature is stable.
Weight, length, head circumference.
First feed
Within 1 hour
Skin to skin contact, Breast feeding!
Baby is placed in cot in Nursery
Baby is encouraged to stay in the same room with mother. IMMEDIATE CARE OF A NEWBORN Pediatrician will standby in the event of
Antenatal problems
Fetal distress
Preterm delivery
Twin delivery
Breech IMMEDIATE CARE OF A NEWBORN Phototherapy -- Light treatment
Exchange transfusion for severe cases Treatment for jaundice Contagious periods:
Healthy adults: 1 day before symptoms up to 5 days after becoming sick.
Children: For up to 7 days
Symptoms start 1 to 4 days after the virus enters the body
Those who do not have symptoms can also spread the virus

from CDC US Residents of institutions for the elderly or the disabled
Anyone with ≥ 1 of following chronic conditions:
Heart, lung, metabolic (diabetes), kidney or who have reduced immunity
Regular and frequent contact with high risk patients
Carers of elderly
Large group of pilgrims gathering in the same area for several weeks

1 CPG on Adult vaccination.MOH.2004 Special groups1 Symptomatic
Prescription of medicines to treat the symptoms
E.g. Paracetamol for fever, lozenges for sore throat, cough syrup for cough, anti histamines for runny nose
Antiviral, for severe cases.
What can you do?1
Stay at home : Prevent spread to others
Drink lots of fluids
Get rest
See a doctor for the proper medicines.

1. CDC US Treatment Aged > 50
Chronic medical conditions:
Heart disease
Lung disease,
Renal disease
Immune suppressed
Organ transplant recipients
Young children

1 Rothberg M. Complications of Viral Influenza.AMJMED.2008 Who is most at risk? 2012-2013 NH Influenza season:
# A/California/7/2009 (H1N1)- like : - Pandemic strain, currently in SH vaccine - same as in last NH vaccine
# A/Victoria/361/2011 (H3N2) - like : - New strain
# B/Wisconsin/1/2010-like : - New strain, from B/Yamagata lineage Flu viruses : Type A , B, C

WHO selects 3 new strains for vaccines yearly
Current Formulation SH (2011-2012)
B/Brisbane/60/2008 What is Influenza (flu) Virus? . What’s the flu got to do with me? CDC US. Recommendations from American College of Obst and Gynaecology + American Academy of Family Physicians.
www.vaccineinformation.org Can I get vaccinated if I am pregnant?
Current recommendations1 says “Yes” to the killed vaccine.
Can the flu vaccine give me the flu2?
No. It’s a killed virus !
Small percentage may develop influenza like symptoms but NOT the disease
Takes 1-2 weeks to offer protection, may get the disease during that window period.
Can I get vaccinated if I am breast feeding?
Yes you can. FAQ Known allergies to eggs and egg products
H/O severe allergy to previous flu vaccination
Acute illness / febrile illness: Postpone

CPG for Adult vaccination.MOH.2004 Who should not take flu vaccine?1,2 1. Weekly Epidemiological Report.WHO.2005 Inactivated vaccine
Studies done show:1
70 – 90 % protection against clinical disease in healthy adults
25 -39% reduction of hospitalization in elderly not living in institutions
35-75% reduction of overall death during influenza season
However, efficacy based on correctness of matching the virus strains with those actually circulating during the flu season Effectiveness? Anyone who wants to reduce risk of developing the flu
Healthy persons living with those at high risk
Children > 6 months to 18 years
Children > 6 months to 4 years2
Causes morbidity ( a diseased state, the occurrence of a disease in a population)
Transmission of infection
Severe clinical course noted in youngest age groups3

Weekly Epidemiological Record. WHO.2005 Anyone else?1 Influenza vaccine
2 types
Killed vaccine (most commonly used)
Live but weakened vaccine (nasal spray – unavailable in Malaysia
Once a year
Different circulating strains
Predicted by WHO based on surveillance data
Who is it for?
Anyone who is > 6 months Vaccination What is it?
We don’t have seasons in Malaysia!
Is it dangerous?
Who are most susceptible to it?
How do I protect myself and my family from Influenza? Seasonal influenza E.g.
Soreness at vaccination site
Mild fever
Muscle pain
Usually 6 – 12 hours after and lasts ~ 1-2 days

1. CPG for Adult Vaccination.MOH.2004 Side effects?1 DANGER SIGNS In children, emergency warning signs that need urgent medical attention include:
Fast breathing or trouble breathing
Bluish skin colour
Not drinking enough fluids
Not waking up or not interacting
Being so irritable that the child does not want to be held
Flu-like symptoms improve but then return with fever and worse cough
Fever with a rash

CDC US In adults, emergency warning signs that need urgent medical attention include:
Difficulty breathing or shortness of breath
Pain or pressure in the chest or abdomen
Sudden dizziness
Severe or persistent vomiting DANGER SIGNS CDC US
Rothberg M. Complications of Viral Influenza.AMJMED.2008 Complications of influenza:
Pneumonia – Infection of the lung1
Primary influenza pneumonia
Usually : Secondary to bacterial infection
Bronchitis 1 – inflammation on the air ways
Sinus and ear infections 1
Worsening of chronic diseases:2
Chronic lung disease (COPD / asthma) -25%
Congestive heart failure
Ischaemic heart disease
Uncommonly – neurological complications: 2
Aseptic meningitis
CNS most commonly seen in children Is influenza dangerous? COLD VS FLU The simple things:
Minimise contact when ill
Cover mouth and nose when coughing and sneezing
Use disposable tissues
Wash hands regularly
Clean surfaces
Vaccination Prevention Flu Exist in Malaysia JOHOR BARU: The State has been hit by a flu bug, forcing a growing number of people to seek medical help. Flu Exist in Malaysia It is learnt that some 15-20% of 26mil Malaysians suffer from some forms of ILI Anyone and everyone.
Efficiently transmit viruses
Age 5 – 9 years typically manifest the highest rates of infection and illness

Weekly Epidemiological Record. WHO. 2005 Who gets the flu? Newborn Baby Care What happened after birth? These are normal! Best feeding for baby! Problems in the first week of life Stools Warning Signs ! Immunization BCG

Given at birth, Primary 1 (If no scar)
To prevent Tuberculosis Hepatitis B

3 Doses
Given at birth, 1 month and 5th / 6th months old. Compulsory Diphtheria, Pertussis, Tetanus, Polio & Haemophilus 5 in 1
Total 5 doses
Give at 2 month, 4 month, 6 month, 18 month and Primary 1.
25% have fever Mumps, Measles & Rubella 3 in 1
Total 2 doses
Give at 1 year old and Primary 1
Can cause allergy if the baby allergy to egg Pneumococcal Total 4 doses
Give at 2 month, 4 month, 6 month & 1 year old
Prevent Pneumonia, Meningitis, Otitis Media ........... Rotavirus Total of 2 / 3 doses
By Oral
Give at 2 month, 4 month and 6 month old Influenza (Flushot) Give at 7 month & 8 month old and Yearly
To prevent flu Flushot Take Home Message Chicken Pox Total 2 doses
Give at 1 years old and Primary 1 Japanese Encephalitis Total 3 doses
Give after 1 year old Hepatitis A Total 2 doses
Give after 1 year old Human Papiloma Virus (HPV) Total 3 doses
Give after 9 years old
To Prevent Cervical Cancer
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