Monthly Archives: March 2017

Urinary infection in children: what need to be done?

uti

  Definition of urinary tract infection (UTI) is  growth of significant number of organisms of single species  in urine sample along with Symptoms. ( First aid for urinary pain in children. )

Types of UTI and common symptoms

Simple UTI: mild fever, irritable, Pain during urination, increased frequency and urgency

Complicated UTI: High grade fever, vomiting, stomache, dehydration and toxic looking child

Symptoms present less often are: heamturia, voiding issues, bed wetting , failure to thrive may also be present

 

Risk factors:    Girl child , poor hygiene, Vesicoureteral reflux (VUR), Voiding dysfunction, obstruction in urinary tract

Urine collection: mid stream clean catch sample gives most accurate report in home settings

Urine routine , microscopy s/o UTI: pus cells in urine sample, along with positive nitrate and leucocyte esterase .

Gold standard test is urine culture.. as its report takes aroung 48 hours to come, we can start antibiotics after sending urine sample for culture in consultation with doctor and wait for culture report for further plan of action.

Treatment:

Plenty of fluids, oral antibiotics and other supportive care as advised by your doctor

Plan of action as per age ( preferably in consultation with pediatric nephrologist)

  • Less than 1 years: Ultrasound, MCU and DMSA scan
  • 1-5 years of age: ultrasound and DMSA, ( if DMSA is abnormal than MCU to be done)
  • More than 5 years: Ultrasound only ( if abnormal  further work up)

In high risk cases ,we might need prophylaxis to prevent repeated episode of urinary infection.

Whenever in doubt consult pediatric nephrologists

Regards

Dr Rahul Varma

Erb’s palsy ( common injury to baby during birth)

 shoudlerdystocia-mayaclinic.in

Erbs palsy  ( brachial plexus injury)

One of the common type of birth injury which happens in newborn baby while delivery. (happens mostly in assisted deliveries like vaccum or forceps). In this injury there is damage to nerves supplying shoulder and arm; which in turn leads to decrease in movement of that shoulder. Nerves are 5th and 6th cranial nerve (part of brachial plexus nerves) , which are damaged while passing through a point called Erb’s point.

One way that the brachial plexus nerves are affected is when the baby is passing through the birth canal at an awkward angle, with the head being turned to one direction while the arm is being pulled in the opposite direction.

1-2 babies per 1000 newborn delivery worldwide are affected.

Various risk factors involved in this condition are

  1. Large size baby/ good weight of baby.
  2. Assisted delivery .eg use of forceps or vacuum
  3. Excessive pulling/ traction on shoulders during delivery
  4. Gestational diabetes mellitus
  5. Prolong labour

symptoms-erb's-palsy-mayaclinic.in

Symptoms:

  • Not able to move upper limb well. Especially shoulder joint. Affected arm is hanging by side of body and may be bent at elbow.
  • If not able to move even fingers; (not able to grip , your fingers properly) then it suggests severe injury and involvement of lower plexus of nerves too.
  • Can have collar bone fracture along with it, which might be worsening the movement of that side.
  • It often looks like that baby has paralysis of the affected side

 

  nerve-injury-mayaclinic.in

Types of Nerve Injuries

There are four types of nerve injuries.

  1. Neurapraxia: nerve is stretched, not complete tear. (so recovers early within 3 months).
  2. Neuroma: more serious damage to nerves
  3. Rupture: nerve is torn; will need intervention(as it will not heal on its own)
  4. Avulsion: is complete tear and most serious of all. ( luckily it is very rare)

  type-of-nerve-damage-mayaclinic.in

Treatment:

  • Multidisciplinary approach will decide the plan of care for baby: will include pediatrician, need help from neurologist, orthopedic and neuro physiotherapist.
  • Intermittent immobilization and positioning to prevent contractures
  • Gentle massage (as advised by physio)
  • Surgery if severe damage to nerve or complete tear of nerve.
  • Electric stimulation may help

erb's palsy-mayaclinic.in

Prognosis:

  • It depends on degree of damage: likely most of the cases are mild.
  • If the hand grasp/ grip is good and finger movement is present: it suggests good prognosis.
  • It may take few months to few years to recover.

Be in regular follow and adhere to advice of your doctor.

Regards

Dr Rahul varma