📊 Download Fetal Growth Assessment Charts
➤ Estimated Fetal Weight (Hadlock's Growth Chart)
➤ Fetal Head Circumference Chart
➤ Fetal Occipitofrontal Diameter Chart
➤ Fetal Femur Length Chart
➤ Fetal Abdominal Circumference Chart
➤ Fetal Biparietal Diameter Chart
Scabies treatment in neonates
According to Americation academy of dermatology Association 5% Permethrin is FDA Approved to treat scabies in babies 2 month of age and older
While Sulphur can be used safely below 2 months of age.
World Prematurity Day, 17th November, 2025
تحریر از ڈاکٹر توصیف عمر۔۔۔
وقت سے پہلے پیدا ہونے والا بچہ جب نرسری میں داخل ہوتا ہے تو والدین کو ایک ایسا تجربہ دیتا ہے جو شاید زندگی میں کوئی اور واقعہ نہ دے سکے۔ میں ایسے والدین کے چہرے روز دیکھتا اور روز پڑھتا ہوں۔
والدین اپنی سب سے قیمتی چیز، اپنی جان کا ٹکڑا، ننھی سانسوں والا بچہ کتنے حوصلے سے ہمارے حوالے کرتے ہیں۔ وقت سے پہلے پیدا ہونے والے بچے کی ماں اپنی تمام امیدیں نرسری کے ڈاکٹروں اور نرسوں پر لگا دیتی ہے۔ اپنی سب سے قیمتی امانت ایک ڈبے میں رکھوا دیتی ہے جو اس کے بچے کو گرم رکھتا ہے۔
ہسپتال میں داخل ہوتے ہی اسے سب سے پہلے پھیپھڑوں کی کمزوری کی کہانی سننے کو ملتی ہے۔ پہلی بار "سر فیکٹنٹ" جیسے الفاظ اس کے کانوں میں پڑتے ہیں۔ وہ اپنا دودھ نکال کر بچے تک پہنچاتی ہے۔ ننھا سا بچہ منہ سے پیٹ تک ڈالی گئی نالی کے ذریعے دودھ لیتا ہے۔ ایسی جان جسے سانس لینا بھی صحیح طرح نہیں آتا، کبھی اپنا سانس روک لیتا ہے اور پوری نرسری کی ٹیم کو دن رات ہلا کر رکھ دیتا ہے۔
اسے سانس چلانے والی دوا دی جاتی ہے۔ ماں حیران ہوتی ہے کہ یہ ننھی جان "کیفین" لے گی تاکہ سانس درست چلے۔ کبھی خون میں شکر کم ہو جاتی ہے، کبھی زیادہ۔ کبھی جسم ٹھنڈا ہو جاتا ہے، کبھی گرم۔ کبھی نالی سے دودھ ہضم ہوئے بغیر باہر آ جاتا ہے، کبھی پیٹ پھول جاتا ہے اور پھر پانچ سے سات دن تک بچے کو بھوکا رکھنا پڑتا ہے۔ ماں بے چین ہو جاتی ہے کہ بچہ تو ٹھیک ہو رہا تھا، اب پیٹ کیوں خراب ہو گیا۔
اسی دوران کبھی آکسیجن کم ہو جاتی ہے، کبھی پیٹ بہتر ہونا شروع ہو جاتا ہے۔ پانچویں دن دوبارہ دودھ دیا جاتا ہے۔ یہ قصہ لمبا چلتا ہے۔ بیس دن، تیس دن، پچاس دن… یہ بچے نرسری میں داخل رہتے ہیں۔ اور پھر ایک دن خوش ماں کے ساتھ گھر ڈسچارج ہو جاتے ہیں۔
لیکن کہانی یہیں ختم نہیں ہوتی۔ ان کی آنکھوں کا معائنہ، سماعت کا ٹیسٹ، نشوونما کا جائزہ جاری رہتا ہے۔ اور کتنے ہی بچے ایسے ہیں جو چند دن یا چند مہینوں بعد وفات پا جاتے ہیں۔ والدین ہسپتال سے نکلتے ہیں تو ڈاکٹروں، نرسوں اور عملے کے میٹھے یا کبھی سخت الفاظ کو اپنی زندگی کا حصہ بنا لیتے ہیں۔
کہا جاتا ہے کہ نرسری میں والدین کے ساتھ کیا گیا برتاؤ انہیں پوری زندگی یاد رہتا ہے۔ اور یہ سو فیصد سچ ہے، کیونکہ یہ معاملہ جان کے ٹکڑے کا ہے۔ وقت سے پہلے پیدا ہونے والے بچے خاص توجہ اور خاص علاج سے بہتر ہوتے ہیں۔
پاکستان میں ہمیں آج بھی ان بچوں کے علاج کے حوالے سے ایک طویل سفر طے کرنا ہے۔ لیکن پہلا قدم ہمیشہ یہی رہے گا کہ چاہے بچہ ڈسچارج ہو کر گھر جائے یا وفات پا جائے، ہم والدین کے نرسری کے تجربے کو کبھی برا نہ ہونے دیں۔
Written by Dr. Tauseef Omer…
When a premature baby enters the nursery, the parents undergo an experience unlike anything else in life. I see and read those faces every single day.
Parents hand over their most precious possession—their very piece of life, a child with tiny breaths—with remarkable courage. The mother of a premature baby places all her hopes in the doctors and nurses of the nursery. She entrusts her most valuable treasure into a box that keeps her baby warm.
As soon as she enters the hospital, she hears the story of weak lungs. For the first time, words like “surfactant” reach her ears. She expresses her milk and sends it to her baby. The tiny infant receives it through a tube passed from mouth to stomach. A fragile life that doesn’t even know how to breathe properly sometimes stops breathing altogether, shaking the entire nursery team day and night.
The baby is given medicine to keep breathing. The mother is astonished that this little soul will take “caffeine” so that breathing continues smoothly. Sometimes blood sugar drops, sometimes it rises. Sometimes the body becomes cold, sometimes hot. Sometimes milk comes back out of the tube undigested, sometimes the stomach swells—and then the baby must be kept hungry for five to seven days. The mother grows restless: the baby seemed to be improving, so why is the stomach now upset?
Meanwhile, oxygen levels may fall, or the stomach may begin to recover. On the fifth day, milk is given again. The story stretches on—twenty days, thirty days, fifty days… these babies remain admitted in the nursery. And then one day, they are discharged home with a joyful mother.
But the story does not end there. Their eyes are examined, hearing is tested, growth is monitored. And many of these babies pass away after a few days or months. Parents leave the hospital carrying the sweet—or sometimes stern—words of doctors, nurses, and staff as part of their lives forever.
It is said that the way parents are treated in the nursery stays with them for life. And this is one hundred percent true, because this is about their very piece of life. Premature babies improve only with special care and special treatment. In Pakistan, we still have a long journey ahead in treating these babies. But the very first step must always be this: whether the baby is discharged home or passes away, we must never let the parents’ nursery experience turn bitter.
Clenil (beclomethasone) nebulization in neonates
Draft
Clenil ampule
800mg per 2 ml
400mgr per 1 ml
Clenil dose
50 mcg/kg/dose to 800mcg/kg/dose according to research articles ( depends upon clinical decision )
So if we give lower doses of clenil I.e 80mcg/kg/dose then it means
80 mcg= 0.2 ml
So 0.2ml/kg/dose is required
We can not give this amount in 2.5 cc n/s so we will take 3 cc N/s in nebulizer then we will add 3 x the dose required then we will nebuliser for only 3 min( in 3 min 1 cc n/s is nebulized ) means onlu single dose is provided to pt in 3 min
Order Summary
0.6ml/kg/dose diluted in 3 ccN/S then nebulize for 3 min x BD
Albumin - Neonatal guidelines
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Neonatal Guidelines & Protocols
Prof. Dr. Rafiq
Neonatal Unit, Dept. of Pediatric Medicine Unit 1,
Services Institute of Medical Sciences, Services Hospital, Lahore.
Please Note: The search feature is available above if you need to search for a specific guideline or neonatal condition. This page was last updated on 05-11-2025
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5% albumin means 5g albumin in 100mL volume (or 2.5g in 50mL volume, or 0.5g in 10mL volume).
20% albumin means 20g albumin in 100mL (or 10g in 50mL, or 2g in 10mL volume)
Caution: If you do not check percentage of albumin available, there may be overdose leading to circulatory overload and heart failure.
Reminder: Albumin is a blood product, get informed written consent before infusion.
Reminder: Allow albumin to reach room temperature before infusion.
Reminder: Must mention the batch number of albumin vial on medication chart where signatures are done ny staff nurse at the time and date of infusion.
Caution: Check expiry date on vial before infusion.
Dilution: Compatible with Normal Saline 0.9%. 5% albumin may be given without dilution. 20% albumin may be diluted in thi way before infusion (1mL of 20% albumin to be diluted in 3mL of Normal Saline 0.9%). Do not dilute with distilled water as it can then cause hemolysis.
Infusion time: Infuse over 3 hours.
Furosemide: inj furosemide 0.5mg per kg to be given post albumin infusion.
Read the detailed guideline at this link.
Seizures (fits) versus jitteriness in newborn babies
Differentiating Neonatal Seizures (Fits) from Jitteriness
Dr. M. Tauseef Omer
Seizures (True Fits)
Pathologic: Always abnormal and require urgent evaluation.
Urgency: Immediate management is essential to prevent neurological injury.
Clinical Features:
May involve upward eye deviation, facial twitching, lip smacking, central cyanosis, bradycardia, tachycardia, apnea, rowing or pedaling limb movements, and altered consciousness.
Not suppressible by gentle passive restraint.
Movements are typically slower (lower frequency) and have greater amplitude than jitteriness.
Common Etiologies:
Hypoxic-ischemic encephalopathy (HIE)
Intracranial hemorrhage
Metabolic disturbances: hypoglycemia, hypocalcemia, hypomagnesemia
Central nervous system infections: e.g., meningitis
Investigations:
Blood glucose, calcium, magnesium
Sepsis screen
EEG
Lumbar puncture (if meningitis is suspected)
Cranial ultrasound scan (especially in preterm infants or suspected hemorrhage)
Neuroimaging (MRI/CT if indicated)
Management:
Correct underlying causes: e.g., treat hypoglycemia, infections, or metabolic derangements.
Supportive care: oxygen supplementation, airway management during seizures.
Antiepileptic therapy may be considered based on etiology and severity, but specific drug choice should follow updated neonatal neurology guidelines.
Jitteriness
Nature: Often benign and self-limited, especially in preterm or neurologically immature neonates.
Clinical Features:
May involve one or all four limbs.
Infant remains alert and conscious during episodes.
No associated signs such as eye deviation, cyanosis, apnea, or abnormal facial movements.
Movements are suppressible with gentle limb restraint.
Characterized by faster (higher frequency), lower amplitude, tremor-like movements.
Duration may vary: episodes can last several minutes and recur multiple times per hour or day.
Common Etiologies:
Immature central nervous system
Metabolic causes: hypoglycemia, hypocalcemia
Drug withdrawal (e.g., maternal substance use)
Investigations:
EEG is normal
Basic metabolic screening to rule out reversible causes
Management:
Observation is often sufficient.
Correct reversible factors (e.g., treat hypoglycemia or hypocalcemia).
No role for anticonvulsants
Parental reassurance is key.
Defining skin lesions
Macular (flat) <1cm
papular (raised) upto 1cm
nodular (raised) upto 2 cm
vesicular (raised) <1cm (fluid filled)
bullous (raised) > 1cm (fluid filled)
pustular (raised with pus)
petechiae (pinpoint redness)
petechiae/purpura/ecchymosis are non-balanchable (it contrasts with erythema that is balanchable)
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CDC: How to clean feeding bottles
The link below is from Center of Disease control, US.
Go through the section there with heading, "Cleaning by Hand".
Please note, sterilization of bottles on daily basis is required for preterm babies' bottles, and modify the method given there as this (dip all paets of feeding bottle, separately, in a boiled water with fire turned off, for few seconds and take out.) This is because we we use plastic bottles on Pakistan mostly. Plastic bottles will not withstand boiling water for long and will get damaged.
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Instructions in Urdu to increase breast milk production
The following video has instructions in Urdu language to increase breast milk production.
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TB in pregnancy and management of newborns of mothers with TB disease
The module proceeds from here.
National Tuberculosis program of Pakistan: Desk guides and Childhood TB training module
Childhood Tuberculosis
Empowering healthcare professionals with the latest protocols from Pakistan’s National TB Program. Explore these essential desk guides and training resources to enhance diagnosis, treatment, and integrated care of childhood TB.
Neonatal Dose of Chloral Hydrate
Syp Chloral Hydrate may be used as sedative for short term sedation like CT and MRI.
Onset of action 10 minutes
Dose: 20mg/Kg per oral
Reference: Gomellas Neonatology, 8th Edition.
Documentation for Shifting of a baby from one hospital to the other.
REMEMBER: Patient cannot be referred or shifted unless a DMS - to - DMS communication has been done, or communication has been done with the consultant in the ward on the receiving end, use referral proforma that must be signed by Onduty RESIDENT, Senior Registrar, and DMS of the hospital from where the baby is being shifted.
> Case summary (discussed below) will be handed over to the doctors on receiving end, photocopies of laboratory test results may be provided to them, Patient Chart or its copy will not be given to attendants or the receiving doctors, it is our hospital property.
Documentation for shifting of baby:
PRESHIFTING
Date of referral __________
Time of referral __________
Name of the hospital where being shifted:____________________
Dr on duty at that hospital who confirmed the request to shift the baby:____________________
Baby Name __________
Pre shifting vital signs: HR __________ RR __________ spo2__________ temperature __________ CRT __________ BSR __________
Prepare case summary of the baby that should include detailed history, examination findings, issues over time and management done, investigations summary, treatment given, and reason for shifting.
This case summary will be handed over to the doctor on the receiving end.
Accompanying healthcare professionals' names
1. ________
2. ________
Equipment/drugs taken along during shifting:
1.__________
2.__________
3.__________
4.__________
5.__________
6.__________
7.__________
8.__________
DURING SHIFTING
Any issues encountered during shifting:
1. patient related:
2. Vehicle related
3. any other:
AFTER SHIFTING
Name of the doctor at the receiving end:___________
Time of receiving the patient
Vitals signs at handover:
Heart rate __________ RR__________ spo2__________ temperature __________ CRT __________
Name of doctor documenting the notes:__________
signs __________ date __________ time __________
Mean Airway Pressure and Oxygen Saturation Index (based on spO2)
Mean Airway Pressure and Oxygen Saturation Index Calculator
(If FiO₂ is 60% on ventilator, input 0.6. For 100%, input 1)
Mean Airway Pressure and Oxygenation Index (Its based on ABGs)
Mean Airway Pressure and Oxygenation Index Calculator
(If FiO₂ is 60% on ventilator, input 0.6. For 100%, input 1)
Adrenaline infusion dosage
1. Starship Neonatal guidelines suggest maximum infusion rate of 1 microgram per kg per minute.
Click Here
2. Queensland guidelines suggest maximum infusion rate of 1.5 microgram per kg per minute, titrated to effect.
Click Here
CBC values reference
Source:
Reference range values for pediatric care , 2nd Edition
American Academy of Pediatrics
CSF Report interpretation
There are 2 references being shared here.
Gomellas Neonatology
&
Reference Range Values for pediatric care (American Academy of Pediatrics, 2nd Edition)
Gomellas:
Reference Range Values for pediatric care, 2nd Edition (AAP)
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