Housemanship: Finishing Paediatrics

Inshallah I’ll be finishing paediatrics in 3 weeks on 6^th of July. My next posting gonna be Obstetrics and Gynaecology (O&G). Finishing paeds means I have 1 more year to finish housemanship. Still long way to go. I hope I can grasp as much knowledge as I can before being a medical officer. Scary much thinking of being just me during oncall. “anxious face.jpg”

Well, first time is always the difficult one. Every time entering a new posting, most of the time I would be a clueless little kid. I would go attach to seniors asking here and there. First day in paeds, I remember I reviewed a neonatal jaundice case. It’s just a simple case actually, but for a first timer, I kept on asking my seniors questions like,

      1.      What is the significant of asking about feeding history?
2.       If the mother’s breasts still feel engorged after breastfeeding, what does it means?
3.       How to calculate total fluid per day?
4.       How to look at the total bilirubin chart?
5.       How do you calculate intensive phototherapy?

And many more.

On my first day, I learned how to take a newborn blood. It was hard at first, obviously. Day by day practice, alhamdulliah it is manageable. When things get hard, there’s seniors, akak staff nurse and sisters, just call their names, they’ll surely help. In adult you can feel the veins very prominent, in newborn, I just depends on my eyes, but this akak-akak staff nurse I tell you what, they’re very good, I didn’t even see any veins, they just poke and walla the blood flows fast! Not lying. Even MOs sometimes ask their help to insert art-line. Art= artery.

Tagging period is always the exhausting ones. Everyday going to work 7am-10am , one off day. Need to study for off tag some-more. I worked 9 days straight during tagging, it was tiring. The only thing  in mind when reaching home is SLEEPING,  I need to squeeze in some time to study for off tag. The first session was the worst. Thank goodness, my MO give me another chance the next day and I nailed it ha-ha. I think in paeds I studied a lot more than my two previous postings, ya lahhh got 6 assessments in total, no time to play. 

My first time assisting long line insertion and UAC/ UVC insertion, I need to look at my notes while preparing the stuffs for the procedures. Hmmmm now I guess I remember 50-50 kot ha-ha. It was fun in NICU. During oncall, the scariest thing ever when intubated baby suddenly desaturated, and when labour room calls for baby flat! Adrenaline rushed. I ran to labour room. Glad when I came in the baby already crying.

In NICU, the most important topics that we (house officers) should know are:


 -         Neonatal jaundice
-          Neonatal sepsis
-          Neonatal hypoglycaemic
-          Fluid management in newborn
-          Premature babies

These are the bread and butter in NICU, which frequently asked in assessments; off tag, mo, theory, and specialist assessment. 

Usually they’ll give you a situation like,

Day 5 of life, referred from KK Sungai Mati with high bilirubin level. TSB 305 (after x17). Birth weight 3.4kg, current weight 3.32kg.

First we start with taking a full history; ask regarding the jaundice itself, the risk factor and causes of jaundice, detailed feeding history, rule out any family history of blood disorder and liver diseases. Next, proceed with physical examination. Look for the causes of jaundice eg; cephalohaematoma, signs of sepsis, the level of jaundice, then signs of acute bilirubin encephalopathy.

They’ll give you answers to each of the questions which will lead you to the provisional diagnosis. The next questions would be investigations and management. Usually it won’t be a straight forward case. It can be a baby came in with neonatal jaundice (NNJ) develops fever during admission or any signs and symptoms of sepsis. So, you have to take all the septic workout and start antibiotics.

I have seen a baby with NNJ developed fever and behavioural changes during admission. We diagnosed her as presumed meningitis. We did lumbar puncture and started antibiotics that covers central nervous system (CNS).

Some questions need you to calculate total fluid required per day, feeding and IV and type of fluid required. 

Other cases that I’ve seen in NICU include: 

      -          Respiratory distress in newborn
-          Congenital heart diseases; cyanotic and acyanotic heart disease
-          Persistent pulmonary hypertension in newborn (PPHN)
-          Hypoxic- ischaemic encephalopathy (HIE)

I had fun in NICU. Throughout my time in NICU especially when MCO started implementing, there were many premature babies, and there were 3 sets of twins admitted. And today I heard there’s a set of triplets babies! Wow! I always dreamed of having twins 😊 I know it’s already tiring with one baby, imagine having 2, double the tired anddddd double the fun!

After 2 months in NICU, the ward rotation begins. I was shocked on my first day in ward. Wow, so little patients, just a single digit. Usually before MCO ward is full with patients, up to the point they need to put extension beds in the TV room. Now we rarely seen bronchial asthma, acute bronchiolitis and pneumonia patients. I’m glad during my tagging period as MCO hasn’t started yet, we could see the mentioned cases. Like everyday theres new admission.

We talked about NICU common topics, now the bread and butter in ward are:

-          Respiratory cases; bronchial asthma, acute bronchiolitis, pneumonia, epiglottitis even it is rare need to know to differentiate it from croup
-          Gastrointestinal cases; acute gastroenteritis, food poisoning, dysentery
-          Seizures; febrile seizure, epilepsy, meningitis
-          Renal cases: nephrotic syndrome, nephritic syndrome, urinary tract infection

Apart from that, we need to know regarding shock. For example, patient with AGE with severe dehydration can lead to hypovolemic shock anytime.  

If you were assigned to day care, you can see thalassemia cases.

Same as NICU, the bread and butter cases surely will be asked in MO and specialist assessment. As in my case, I was asked regarding asthma, and seizures secondary to brain abscess.

When talking about paediatrics, not to forget neonatal resuscitation protocol (NRP). There is specific exam for it, anddd specialist will ask you during assessment. My suggestion read the 300 pages book. It tells you the steps of NRP in detailed manner clearly. I like that book. In fact I love it! Ha-ha. Easier to understand. I read it during 1 week quarantine in Pagoh. Yasss all the house officers in Hospital Muar needed to be quarantine for 1 week in the early April. Have you heard about Hospital Muar cluster? Alhamdulliah, its over already!

With that, I end this post with,

Bye :p

Picture taken with mommy's permission.