COLOUR ATLAS OF CHILDREN’S DISEASES EBENEZER BADOE COLOUR ATLAS OF CHILDREN’S DISEASES Professor Ebenezer Badoe MBChB (Ghana) MRCP(UK ) FGCP FRCPCH DCH (lon) Department of Child Health University of Ghana Medical School COLOUR ATLAS OF CHILDREN’S DISEASES A distillation of clinical experience starting off as “what you should know” about a disease condition and then differential diagnosis for a disease state. It is written in a straightforward, easy-to-digest format. It covers virtually every clinical condition a student is likely to meet during training and subsequent years. The Atlas is targeted at medical students and early trainees in the field of Paediatrics who wish to improve their knowledge in the shortest possible time. Nurses and other allied Health Professionals may find the atlas useful as they try to understand the varied cases that may present to them on the wards. It is recommended that standard textbooks in Paediatrics are consulted for more information on the images shown. This electronic textbook was developed through funding from the University of Ghana Building Stronger Universities Programme III, Office of Research, Innovation and Development, University of Ghana, Legon, Accra Ghana. Copyright ©2023 Ebenezer Badoe All rights reserved. No part of this publication may be reproduced transmitted or stored in a retrieval system, in any form or by any means without permission of the author. Publisher Office of Research, Innovation and Development, University of Ghana, Legon, Accra Ghana. Under the auspices of the University of Ghana Building Stronger Universities Programme III Contact: Prof. Richard Boateng. Email: richboateng@ug.edu.gh Cover Design and Typeset: Prof. Richard Boateng Email: richboateng@ug.edu.gh Printed by: University of Ghana Author Contact: Prof. Ebenezer Badoe, University of Ghana Email: evbadoe@ug.edu.gh Ghana Library Cataloguing-in-Publication Data Badoe, Ebenezer Colour atlas of children/ Ebenezer Badoe – Accra: Research, Innovation and Development, 2023. 1. Child Health 2. Medical Sciences I. Title DDC 618.92 - - dc 20 ISBN: 978-9988-3-5933-1 COLOUR ATLAS OF CHILDREN’S DISEASES i Preface The idea of an atlas of Children’s Diseases was borne out of an apt descrip7on in a personal conversa7on with the late Professor Samuel Annobil that the department was a “museum” and ” no where in the world would you see such cases”. It then dawned on me to arm myself with a digital camera and start documen7ng cases. The real mo7va7on and further inspira7on came from the actual cases I began seeing. There were unusual presenta7ons of common diseases as well as rare diseases that had not been previously published in our literature. Students in West Africa use textbooks mainly wriFen abroad and textbook descrip7ons do not frequently match what is seen at our wards and clinics. Rapid visual iden7fica7on is important in paediatric training as a host of diagnoses can be made on the spot. With reduced exposure 7me of students on the wards, trainees struggle to diagnose common condi7ons. My aim is to produce doctors who are workforce ready and can handle the period of Housemanship and further training in the field of paediatrics with ease. An emerging area like child protec7on is captured. The atlas would be an effec7ve teaching tool for lecturers too and it is recommended they become familiar with its contents. AUDIENCE: The Atlas is targeted at medical students and early trainees in the field of Paediatrics who wish to improve their knowledge in the shortest possible 7me. Nurses and other allied Health Professionals may find the atlas useful as they try to understand the varied cases that may present to them on the wards. HOW TO USE THE E-BOOK: The atlas is presented as an e-atlas and the informa7on being sought would ordinarily be under the relevant chapters listed in the book. A computer or a mobile device will be required to access the material. EBENEZER BADOE ii Acknowledgements The majority of the pictures have been taken by Prof. E. Badoe. However, I would like to thank the following for their photographic contribu7on. Dr. J. Ameyaw, Department of Child Health, Kwame Nkrumah University of Science and Technology Medical School, gladly gave me a significant collec7on to create this atlas. Dr. Glover Addy, Dr. Etwire, and Dr. W. Appeadu-Mensah, all of the Department of Pediatric Surgery, Korle Bu Teaching Hospital, offered classic surgical pictures for the atlas. Photographic contribu7ons also came from Prof. L. Renner (Oncology), Prof. M. Lartey (Dermatology), Prof. Onike Rodrigues, Dr. V. Adabayeri (Renal), Prof. Y. TeFey (who gave permission to photograph some specimens from the W. Laing Museum, Korle Bu Teaching Hospital), and the wonderful old black and white pictures taken in the Department of Child Health archives by Dr. A. Boohene, Prof. F. Nkrumah, Dr. Cardiocos, Mr. Arbenser, and Prof. Y. Asirifi. Special thanks to Dr. Ella Amoako, Cape Coast Teaching Hospital, who got this project started. Mr. Maurice Lomo of the IT department, College of Health Sciences, sat by me pa7ently for weeks to guide the atlas crea7on. Finally, thanks to the residents in the Department of Child Health who called me whenever there was an interes7ng case. Their enthusiasm was wonderful, and some may have donated pictures too that may never have been acknowledged. COLOUR ATLAS OF CHILDREN’S DISEASES iii Foreword This wonderful color atlas, developed from the walls of the Children’s Department at Korle Bu Teaching Hospital, is already a great asset to all doctors who care for children worldwide, including the sub-region in West Africa. Professor Ebenezer Badoe proposed the idea of a local picture Atlas in a personal conversa7on I had with him one Christmas Eve several years ago when I was the Head of the Department. He seemed very excited about the prospect of capturing a lot of interes7ng cases that would benefit medical student training if formally documented in a comprehensive framework spanning all areas of pediatric training. He had already made a promising start by documen7ng images of many unusual cases that had not been previously seen in the department. He had my full support, and today, a`er several years of hard work and some frustra7ng periods on the project, I am pleased to write this foreword for this significant collec7on of images that will educate both students in training and established doctors caring for children. This remarkable piece of work, the first of its kind from the University of Ghana Medical School and Korle Bu Teaching Hospital, comprises 13 chapters that primarily cover various systems of the body, along with chapters on Pediatric Surgery, Child Abuse, and Gene7cs. The pictures depict various condi7ons, both common and uncommon, that have been encountered in the Department of Child Health over the past two decades. I myself was amazed by the extensive coverage of the atlas in notable areas such as child abuse, neurology, dermatology, and pediatric surgery, making it a comprehensive resource for all. The pictures are also of superb quality. As a teaching and learning tool for our students, this atlas will enable them to beFer appreciate some of the less common condi7ons and refresh their understanding of the important aspects of common condi7ons in child health. The author presents a picture of a condi7on and highlights its significant features. Below the descrip7on, there is a brief paragraph outlining what the student should know, including associa7ons, complica7ons, and differen7al diagnoses. This unique EBENEZER BADOE iv tool will undoubtedly leave a las7ng impression on the students' minds during their learning journey, par7cularly regarding condi7ons that they may not have encountered during their dynamic rota7ons, which involved a rapid turnover of pa7ents. In a post-Covid era, where pa7ent contact has significantly reduced, and there is a tendency to shorten rota7ons in medical training worldwide, this atlas has arrived at the right 7me to fill that gap. As a former Head of Department and Dean of the University of Ghana Medical School, I consider this development in medical training a significant milestone. Being the first electronic atlas of its kind, it gives me great pleasure to introduce this outstanding atlas to the world. Professor Jennifer E. Welbeck MBCHB(Ghana) FRCP(Canada) FWACP FGCP COLOUR ATLAS OF CHILDREN’S DISEASES 1 Contents PREFACE ......................................................................................................... I ACKNOWLEDGEMENTS .................................................................................. II FOREWORD ................................................................................................... III CONTENTS ...................................................................................................... 1 NEONATOLOGY .............................................................................................. 4 ENDOCRINE DISORDERS ............................................................................... 38 DERMATOLOGY ............................................................................................. 49 CHILD PROTECTION ....................................................................................... 91 NEUROLOGY ............................................................................................... 106 GASTROENTEROLOGY / NUTRITION ............................................................ 136 OPHTHALMOLOGY ...................................................................................... 166 GENETICS .................................................................................................... 179 INFECTIOUS DISEASES IN CHILDREN ............................................................ 199 PAEDIATRIC SURGERY ................................................................................. 230 RHEUMATOLOGY AND MUSCULO-SKELETAL DISORDERS ............................. 244 ONCOLOGY ................................................................................................. 248 HAEMATOLOGY ........................................................................................... 259 CARDIOLOGY .............................................................................................. 270 RESPIRATORY DISORDERS IN CHILDREN ..................................................... 282 RENAL DISORDERS IN CHILDREN ................................................................. 298 BIBLIOGRAPHY AND FURTHER READING ..................................................... 311 PROFILE OF AUTHOR .......................................................................................... 312 EBENEZER BADOE 2 KORLE-BU TEACHING HOSPITAL COLOUR ATLAS OF CHILDREN’S DISEASES 3 Department of Child Health, Korle-Bu Teaching Hospital EBENEZER BADOE 4 NEONATOLOGY COLOUR ATLAS OF CHILDREN’S DISEASES 5 Fig.1 Prematurity: 650g premature infant born at 26 weeks gesta7on, pictured with a nasogastric tube in situ. The baby is obviously small, with liFle subcutaneous fat and a head rela7vely bigger than the body. What you should know. Live-born infants delivered 37 weeks from the first of the last menstrual period are termed premature by the world health organiza7on. Prematurity is associated with increased morbidity and mortality. Early problems within the 1st 72hours include respiratory distress syndrome (RDS), hypoxia, apnea, jaundice, sepsis, hypoglycemia, hypothermia, electrolyte imbalance, patent ductus arteriosus, func7onal ileus and periventricular bleeds, Later problems include sepsis and necro7zing enterocoli7s, jaundice, bronchopulmonary dysplasia, re7nopathy of prematurity, anaemia of prematurity (iaotrogenic, nutri7onal, folic acid deficiency), and learning difficul7es. DifferenNal diagnosis: Not all low-birth-weight infants are premature. Infants with intrauterine growth restric7on also have low birth weights. They however do not show signs of immature organ development. EBENEZER BADOE 6 Fig. 2 Extremely premature baby undergoing mechanical venNlaNon. What you should know: Nny babies require support for their respira7on. Very premature babies develop respiratory distress syndrome. Elec7ve intuba7on is usually done below 1000 g and when there is clinical failure to establish effec7ve ven7la7on like the onset of apneas, irregular or exhausted respira7on. Pneumothorax in such neonates is an ever- present complica7on of mechanical ven7la7on as well as laryngeal stenosis and bronchopulmonary dysplasia COLOUR ATLAS OF CHILDREN’S DISEASES 7 Fig. 3 A modern neonatal intensive care unit at a terNary hospital. Korle Bu Teaching Hospital. Note the headbox from which the neonate receives enriched oxygen to help with respira7on. EBENEZER BADOE 8 Fig. 4 Cup feeding in a premature infant What you should know: Cup feeding is ini7ated when the infant is not mature to suck on his or her own at the breast. A typical scene at any neonatal unit, milk is pumped out by the mother (breast milk) or its formula milk. COLOUR ATLAS OF CHILDREN’S DISEASES 9 Fig. 5 BreasUeeding: The picture illustrates a good breasjeeding technique (good latch). Baby’s mouth is opened wide with lips flanged out, high posi7on on mother's areola, the angle between the baby’s two lips should be close to 180 degrees and baby’s chin is pressed to the breast. Also, note that the mother has adequate breast support. What you should know. Breasjeeding should be ini7ated in the first 30 minutes of life. Successful breasjeeding depends on the mother and infant being relaxed. A key factor in the success of breasjeeding is an appropriate latch. UNICEF’s ten steps to successful breasjeeding can be accessed on the following website hFps://www.unicef.org/newsline/tenstps.htm EBENEZER BADOE 10 Fig. 6 Post-term infant; Characteris7c desquama7on (peeling skin) seen in a post-term infant. What you should know. Post-term infants are those born a`er 42 weeks gesta7on from the maternal last menstrual period, regardless of weight at birth. The ae7ology is s7ll unknown. Risks to the baby include reduced placenta perfusion, meconium aspira7on and oligohydramnios. Other signs include long nails, loose skin, especially around the thigh and buFocks, meconium-stained nails, skin and umbilical cord. COLOUR ATLAS OF CHILDREN’S DISEASES 11 Fig. 7 Vaginal discharge; Creamy, thick discharge seen from the vagina of this two-day old. What you should know. This is a benign condi7on, self-limi7ng and is due to the withdrawal of maternal oestrogen. This may be noted intermiFently, during the first few days of life, may be associated with vaginal bleeds or spoong. It requires no treatment and usually subsides a`er a few weeks. Reassurance is key. EBENEZER BADOE 12 Fig. 8 Reddish urine in diaper; Mother no7ced reddish urine in baby’s diaper on day 5 of life and reported to the doctor. What you should know. It is not uncommon to find reddish brown or rust coloured urine in baby’s diapers. Parents usually mistake this for blood and come in quite anxious. These are urate crystals present in the urine. Commonly seen in breasjed infants. No treatment is required, encourage more breasjeeding and reassure mother. COLOUR ATLAS OF CHILDREN’S DISEASES 13 Fig. 9 Café au lait macule; Note a uniformly dark brown (hyperpigmented) lesion with smooth borders over baby’s right breast. What you should know. One to three café au lait spots are common in normal children. DifferenNal diagnosis. Six or more café au lait spots are usually seen in neurofibromatosis. Large, asymmetrical café au lait spots with irregulars borders are seen in McCune– Albright syndrome and is associated with precocious puberty. EBENEZER BADOE 14 Fig. 10 Mongolian spot; Mul7ple Mongolian spots seen in a two-week-old neonate. Several, poorly defined pigmented spots noted on the back of this neonate. What you should know. Rela7vely common in African children, usually fade with 7me. Requires no treatment. DifferenNal diagnosis. May resemble bruising in non-accidental injury. COLOUR ATLAS OF CHILDREN’S DISEASES 15 Fig. 11 Accessory nipple Accessory nipple is seen here in a neonate. What you should know. Also known as supernumerary nipples, usually occurs on the mammary line. This condi7on is benign and requires no treatment. Can be removed later in life, for cosme7c reasons. DifferenNal diagnosis. O`en mistaken for a freckle, mole or dimple. EBENEZER BADOE 16 Fig. 12 Giant congenital pigmented Naevus Neonate pictured with a big hyperpigmented lesion seen over the posterior trunk and buFocks. What you should know. Also known as congenital melanocy7c naevus. May develop malignant melanoma in later life hence early removal is indicated. Can some7mes be hairy. MRI scan of the head is indicated if the naevus is situated over head and spine. Follow-up is required. . COLOUR ATLAS OF CHILDREN’S DISEASES 17 Figure 13 Meconium; early stool of neonates, usually very dark , s7cky and odourless. Figure 14 Normal stool of a breasUed infant; yellow, so` and mild smelly stools Figure 15 Pale stool; characteris7c pale or chalk like stool from a neonate with biliary atresia. What you should know. Over 95% percent of neonates pass meconium within 48 hours of life. Delayed passage of meconium may be due to congenital hypothyroidism, maternal exposure to opioids during labour, presence of a meconium pug and Hirschsprung’s disease. Normal stools of a breasjed infant is yellow and can be pasty to watery. Breasjed infants should have at least six stools per day by the third to fi`h day of life. Most infants pass stool a`er every feed. Pale stools are characteris7c of biliary atresia, due to lack of bile pigment in stool. Fig. 13 Fig. 14 Fig. 15 EBENEZER BADOE 18 Fig. 16 Forceps Marks Scars le` on a neonate a`er a forceps applica7on during delivery. What you should know. Mode of delivery is important to determining apparent facial bruises to a neonate. COLOUR ATLAS OF CHILDREN’S DISEASES 19 Fig. 17 Subgaleal Bleed Edematous swelling, subcutaneous hematoma seen around the posterior auricular area down to the neck. The baby also has eye shades on, as she is receiving phototherapy. What you should know. Subgaleal haemotoma occurs between the skull periosteum and the epicranial aponeurosis. It usually crosses suture lines and may spread to scalp. Neonates may be anaemic and present later with jaundice from red blood cell breakdown. DifferenNal diagnosis; Cephalhematoma and Caput Succedanum. EBENEZER BADOE 20 Fig. 18 Natal tooth Neonate on day three of life seen with the tooth. What you should know. Natal teeth are rare. When they occur at birth, they are called natal teeth and if they erupt within the first thirty days of life thy are termed neonatal teeth. They are usually le` in arch, except they are highly mobile (risk of aspira7on) or interfere with feeding. Can occur as an isolated finding or may be associated with some syndromes. . COLOUR ATLAS OF CHILDREN’S DISEASES 21 Fig. 19 Cephalhematoma Large boggy scalp swelling over the le` parietal area with clear edges. What you should know. Cephalhematoma is limited to a single cranial bone in contrast to caput succedaneum. It is caused by sub periosteal haemorrhage and appears a few hours a`er birth. It may some7mes be bilateral. This swelling gradually hardens (some7mes with calcifica7on) and leaves a rela7vely so` center. It resolves over a few months. Management is conserva7ve and aspira7on is NOT recommended as it increases risk of infec7on. Skull X-Ray or head CT scan is done if neurological symptoms appear, or a skull fracture is suspected. Jaundice is the commonest neonatal complica7on. Anaemia or hypotension can also occur. DifferenNal diagnosis; Subgaleal haemorrhage and Caput succedaneum. Rarely, an encephalocoele may present in a similar area. These tend to pulsate. EBENEZER BADOE 22 Fig. 20 SubconjuncNval Haemorrhage. Note the bright red discoloura7on underneath the bulbar conjunc7va. What you should know. This is seen a`er the stress of delivery in some neonates. It is the collec7on of blood underneath the conjunc7va from rupture of capillaries. Resolves spontaneously. COLOUR ATLAS OF CHILDREN’S DISEASES 23 Fig. 21 Erb’s Palsy. Characteris7c posture of arm adducted and internally rotated and wrist drop . What you should know. Caused by peripheral nerve damage; C5 and C6 in the brachial plexus. It may occur due to shoulder dystocia from vaginal delivery; may also occur during breech delivery. In Erb’s palsy. There is loss of abduc7on and external rota7on of shoulder, prona7on of elbow and wrist drop. Spontaneous recovering occurs in most pa7ents. Early recovery suggests a beFer long-term prognosis. Nerve gra`ing may be required if there is non recovery. DifferenNal Diagnosis. Klumpke Palsy involving C7 and T1 with a characteris7c claw hand deformity. EBENEZER BADOE 24 Fig. 22 Ambiguous genitalia Obvious clitoral hypertrophy with prominent labioscrotal folds, making it difficult to dis7nguish gender. What you should know. Enquire about parental consanguinity, symptoms of viriliza7on in the mother, drugs during pregnancy, familial hirsu7sm and unexplained infant deaths. The commonest cause of ambiguous genitalia is congenital adrenal hypertrophy. They would commonly present with salt was7ng crisis (vomi7ng, unexplained shock, metabolic acidosis, electrolyte imbalance typically hyperkalemia and hyponatremia.). Physical examina7on should include looking for palpable gonads in inguinal or labia area. A decision about sex of the child should be taken a`er establishing a diagnosis and weighing the long term consequences. COLOUR ATLAS OF CHILDREN’S DISEASES 25 Fig. 23a) and 23(b) AmnioNc bands; Whilst figure 20(a) shows amputa7on of the digits, figure 20(b) shows a constric7ng ring of the lower limb. What you should know. It is also known as amnio7c band disrup7on complex, these bands are caused by small strands of amnion around the developing structure. They may cause amputa7on, constric7on or craniofacial disrup7on. EBENEZER BADOE 26 Fig. 24 Milia. Whi7sh yellow papules are seen on and around the nose of a neonate. What you should know. Milia are 7ny superficial inclusion cysts which contain kera7n. It is caused by blockade of pilosebaceous gland of the newborn. Usually found over the nose, nasolabial fold and cheek. Occurs in 40% of all newborns. It is self limi7ng. COLOUR ATLAS OF CHILDREN’S DISEASES 27 Fig. 25 (a&b) Infant of a DiabeNc mother (Macrosomia) Baby weighed 4.8kg at birth and also had hairy ears. What you should know. Known as large for gesta7onal age infant. Infant of diabe7c mothers are macrosomic, have round facies and hairy ears. Tests for hypoglycemia must always be done in large for gesta7onal age infants. Birth trauma is common in such deliveries. Infants may also present with polycythemia or respiratory distress DifferenNal diagnosis. Infants with Soto’s syndrome (macrosomia, big head, large hands and feet) or Beckwith Weidemann (macrosomia, large tongue, omphacoele, horizontal earlobe crease and persistent hypoglycemia) may present as such. Fig. 25(b) EBENEZER BADOE 28 Fig. 26 Myelomeningocele. A closed lumbosacral myelomeningocele pictured in a day- old neonate. Note the patulous anus. What you should know. Midline defect over the spine which protrudes as a sac-like structure containing neural 7ssue and cerebrospinal fluid. There may be accompanying neurological signs in the lower limbs and bladder and bowel dysfunc7on. Hydrocephalus should be excluded. Neural tube defects like these may be prevented by folic acid supplementa7on in early pregnancy and preconcep7on. COLOUR ATLAS OF CHILDREN’S DISEASES 29 Fig. 27 Hydrocephalus. 7-day old neonate with a hydrocephalus. The head is obviously big with a dispropor7onately large forehead. The baby also had widened fontanelle and sutures. Also note widened scalp veins. His head circumference was above the 97th percen7le. What you should know. Hydrocephalus is an increase in the volume of cerebrospinal fluid in the brain, par7cularly the ventricles. This can be due to excessive produc7on, decreased absorp7on and obstruc7on of cerebrospinal fluid. Early infancy is characterized by accelerated head growth; more than 1cm per week in neonates, bulging fontanelle, prominent scalp veins, widened cranial sutures, sun-seong eyes, irritability, poor feeding and impaired development. Treatment is surgical (ven7culoperitoneal shunt). Ventriculoartrial shunts are now out of favour. Inves7ga7ons include transfontanelle ultrasound, Head CT scan or MRI. DifferenNal Diagnosis. Chronic subdural hematoma, space occupying lesions or megaencephaly. EBENEZER BADOE 30 Fig. 28 a&b NecroNzing enterocoliNs. X ray show gas in the portal venous system and intraluminal air (pneumatosis intes7nalis) giving an appearance of a ‘double gut wall shadow’. Neonate presented with bilious vomi7ng, abdominal disten7on, and blood in the faeces. She progressed to bowel perfora7on (fig 25b, showing bowel perfora7on seen at laparotomy). Bowel was resected. What you should know. This is damage to the bowel wall following many causes including infec7on. Manifests as abdominal distension, rectal blood and intraluminal air on x-ray. More common in preterms and babies less than 1500g at birth. Onset is in the first few days with coagula7on disorders, low platelet counts and a posi7ve blood culture. Strictures and malabsorp7on are long-term complica7ons. Note that breastmilk is protec7ve. DifferenNal Diagnosis. Any other cause of intes7nal obstruc7on should be ruled out. COLOUR ATLAS OF CHILDREN’S DISEASES 31 Fig. 29 a&b Neonatal tetanus. Neonate with tetanus experiencing spasms. Pictures illustrate s7ffening of the neck, back, abdomen and limbs. This is the spasmodic stage. What you should know. Tetanus is caused by Clostridium Tetani; which is a gram posi7ve anaerobic and spore forming bacilli. Maternal vaccina7on has greatly reduced incidence of neonatal tetanus, but sporadic case are seen. Risk factors include no maternal vaccina7on, use of unsterile instruments during delivery and applica7on of contaminated foreign material to the cord (e.g. cow dung for cultural reasons). There is difficulty in sucking and swallowing, irritability and s7ff jaw. Spasms and s7ffness develop and infants are in opisthotonus posi7on. DifferenNal Diagnosis. Should be differen7ated from infan7le spasms. EBENEZER BADOE 32 Fig. 30 Umbilical granuloma What you should know In this baby the umbiical cord has failed to separate completely and there is a low grade infec7on around it resul7ng in a granuloma. Treatment is with silver nitrate . DifferenNal diagnosis Umbilical polyp, patent urachus, patent vitello-intes7nal duct. COLOUR ATLAS OF CHILDREN’S DISEASES 33 Fig. 31 osteogenesis imperfecta note the mul7ple fractures which have led to shortening of the extremi7es. What you should know: in this condi7on there is abnormal fragility of bone. Infants are born with mul7ple fractures. there are several forms described DifferenNal diagnosis: non accidental injury EBENEZER BADOE 34 Fig. 32 Severe jaundice of the unconjugated type. Deep jaundice involving the palms and soles What you should know: jaundice may be physiological and its seen in half-of term infants and 85% of premature. Breast milk jaundice also occurs in a small percentage of healthy term infants. Significant Causes of jaundice in our environment include severe rhesus iso immuniza7on, sepsis, ABO incompai7lity, G6PD deficiency . Unconjugated bilirubin is fat soluble and when transported in serum it is bound to albumin which is safe. When the albumin binding capacity is exceeded the free frac7on not bound to albumin may cross the blood brain barrier causing bilirubin encephalopathy (Kernicterus). COLOUR ATLAS OF CHILDREN’S DISEASES 35 Fig. 33 Neonate undergoing phototherapy at the neonatal unit. What you should know: phototherapy works by light energy isomerizing unconjugated bilirubin to a more water soluble product which passes through the liver rapidly. Phototherapy using the firefly equipment for instance has decreased the need for exchange transfusion. Complica7ons of phototherapy include loose stools, rashes, overhea7ng, bronze baby syndrome. EBENEZER BADOE 36 Fig. 34 Exchange transfusion What you should know: this procedure is done for urgent reduc7on of unconjugated bilirubin levels, especially rhesus isoimminiza7on or G6PD . Complica7ons of exchange include vascular problems like air/blood clot emboli, thrombosis, cardiac failure or arrhythmias, hypoglycemia, hyperkalemia, or infec7ons which could be bacterial or viral. COLOUR ATLAS OF CHILDREN’S DISEASES 37 Fig. 35 Talipes equinovarus (club foot) a common congenital abnormality What you should know: both feet show plantarflexion of the hindfoot (equinus) with inversion of the ankles and adduc7on of the forefoot. Affects more boys than girls. Most cases are idiopathic and some are secondary to neuromuscular disorders like a myelomeningocele. Fibroids may predispose to this condi7on as the foot has liFle room to manoeuvre in the womb. EBENEZER BADOE 38 ENDOCRINE DISORDERS KINDLY CONTACT THE AUTHOR FOR A FULL COPY OF THIS E- BOOK THE AUTHOR’S DETAILS ARE LOCATED AT THE COPYRIGHT PAGE A distillation of clinical experience starting off as “what you should know” about a disease condition and then differential diagnosis for a disease state. It is written in a straightforward, easy-to-digest format. It covers virtually every clinical condition a student is likely to meet during training and subsequent years. The Atlas is targeted at medical students and early trainees in the field of Paediatrics who wish to improve their knowledge in the shortest possible time. Nurses and other allied Health Professionals may find the atlas useful as they try to understand the varied cases that may present to them on the wards. It is recommended that standard textbooks in paediatrics are consulted for more information on the images shown. ISBN to be Placed Here Prof. Ebenezer Badoe received his medical training at the University of Ghana Medical school, and after Houseman Positions at Korle Bu Teaching Hospital and a stint as a casualty officer, proceeded to the United Kingdom for postgraduate training. He held various positions in prestigious UK hospitals, including St Mary’s Hospital in Carshalton, Surrey, Kings College Hospital, Bristol Royal Children’s Hospital and Chelsea and Westminster Hospital in London. He returned to Ghana in 2002 and has been heading the Neurology/Developmental service ever since and the Child Protection service he founded at the Korle Bu Hospital. He has two decades of teaching experience and has published widely in neurology, genetics/dysmorphology and infections affecting the Central Nervous system. Prof. Badoe is a member of the Royal College of Physicians (London) and a Fellow of the Royal College of Paediatrics and Child Health (UK), and a Fellow of the Ghana College of Physicians and Surgeons. He is a recipient of an award by UNICEF for his dedication to child protection services in Ghana. He is a former Head of the Department of Child Health and a former President of the Paediatric Society of Ghana.