Maternal risk factors of Birth asphyxia:
1-Hypertension
2-Eclampsia and preeclampsia
3-Diabetes Mellitus
4-Nephritis
5-Hypotension
6-Infection
7-Uterine tetany due to excessive oxytocin.
8-Maternal hypoxia
9-Elderly or young mothers
10-Antepartum and intrapartum anemia.
#Pediatrics
1-Hypertension
2-Eclampsia and preeclampsia
3-Diabetes Mellitus
4-Nephritis
5-Hypotension
6-Infection
7-Uterine tetany due to excessive oxytocin.
8-Maternal hypoxia
9-Elderly or young mothers
10-Antepartum and intrapartum anemia.
#Pediatrics
Maternal causes of IUGR:
1-Chronic illness like essential hypertension, pregnancy induced hypertension, chronic renal failure, DM and heart disease.
2-Young maternal age <18 years.
3-Poor maternal weight gain during pregnancy.
4-Fundal lag less 4 cm for gestional age.
5-Short stature.
6-Anemia.
7-Pre-pregnancy weight <50 kg.
8-Prior history of IUGR in a baby.
9-Multiple pregnancy.
10-Poor socioeconomic status.
11-Malnutrition of mother.
12-Smoking in mother.
13-Drugs "like phenytoin, valoprate).
#Pediatrics
1-Chronic illness like essential hypertension, pregnancy induced hypertension, chronic renal failure, DM and heart disease.
2-Young maternal age <18 years.
3-Poor maternal weight gain during pregnancy.
4-Fundal lag less 4 cm for gestional age.
5-Short stature.
6-Anemia.
7-Pre-pregnancy weight <50 kg.
8-Prior history of IUGR in a baby.
9-Multiple pregnancy.
10-Poor socioeconomic status.
11-Malnutrition of mother.
12-Smoking in mother.
13-Drugs "like phenytoin, valoprate).
#Pediatrics
Complications of hypothermia:
1-Hypglycemia, metabolic acidosis and hypoxia.
2-Clotting disorders: DIC and pulmonary haemorrhage.
3-Shock, decreased perfusion.
4-Intraventricular haemorrhage.
5-Apnea, severe sinus bradycardia and increased neonatal mortality.
#Pediatrics
1-Hypglycemia, metabolic acidosis and hypoxia.
2-Clotting disorders: DIC and pulmonary haemorrhage.
3-Shock, decreased perfusion.
4-Intraventricular haemorrhage.
5-Apnea, severe sinus bradycardia and increased neonatal mortality.
#Pediatrics
Criteria of Physiologic Jaundice:
It is a diagnosis of exclusion, having the following criteria:
1-It occurs in apparently healthy infants. "No pallor, organomegaly nor risk of kernicterus".
2-Clinical Jaundice appears after 24 hours of age, 2-3rd day in full term while 3-4th day in preterm.
3-Total bilirubin rises by less than 5mg/dl/day.
4-Peak bilirubin occurs at the 4th day"3-5 days" of age in term while in preterm its peak at 6th -8th day with a total bilirubin of no more than 12.9 mg/dl in term and more than 15mg/dl in preterm infant.
5-Clinical jaundice is resolved by 1 week in the term while 2 weeks in the preterm infant.
#Pediatrics
It is a diagnosis of exclusion, having the following criteria:
1-It occurs in apparently healthy infants. "No pallor, organomegaly nor risk of kernicterus".
2-Clinical Jaundice appears after 24 hours of age, 2-3rd day in full term while 3-4th day in preterm.
3-Total bilirubin rises by less than 5mg/dl/day.
4-Peak bilirubin occurs at the 4th day"3-5 days" of age in term while in preterm its peak at 6th -8th day with a total bilirubin of no more than 12.9 mg/dl in term and more than 15mg/dl in preterm infant.
5-Clinical jaundice is resolved by 1 week in the term while 2 weeks in the preterm infant.
#Pediatrics
Criteria of Pathological Jaundice:
Jaundice is pathologic if:
1-It is evident in the first day of life, also at any time.
2-Bilirubin increases more than 0.5mg/dl/hr or 5mg/dl/day.
3-Peak bilirubin is greater than 13mg/dl in trerm or 15mg/dl in preterm infant.
4-Direct bilirubin fraction is greater than 1.5-2 mg/dl.
5-Associated problems (e.g. anemia, hepatosplenomegaly, signs of sepsis, kernicterus).
6-Clinical jaundice persisting for more than 1week in a full term infant or 2 weeks in a preterm infant.
#Pediatrics
Jaundice is pathologic if:
1-It is evident in the first day of life, also at any time.
2-Bilirubin increases more than 0.5mg/dl/hr or 5mg/dl/day.
3-Peak bilirubin is greater than 13mg/dl in trerm or 15mg/dl in preterm infant.
4-Direct bilirubin fraction is greater than 1.5-2 mg/dl.
5-Associated problems (e.g. anemia, hepatosplenomegaly, signs of sepsis, kernicterus).
6-Clinical jaundice persisting for more than 1week in a full term infant or 2 weeks in a preterm infant.
#Pediatrics
Some equations to ease calculation:
Child’s weight at 3–12 months = (age in months + 8)/2
Child’s weight at 1–6 years = 2(age in years) + 8
In children aged 2–12 years, height can also be estimated by using the following formula:
-Child’s height in centimeters = 6.5(age in years) + 75
#Infections
Child’s weight at 3–12 months = (age in months + 8)/2
Child’s weight at 1–6 years = 2(age in years) + 8
In children aged 2–12 years, height can also be estimated by using the following formula:
-Child’s height in centimeters = 6.5(age in years) + 75
#Infections
Complications of exchange transfusion:
1- Apnea and bradycardia, thrombocytopenia, hypervolemia due to overload may lead to cardiac failure.
2-Hypothermia due to exposure especially during winter months.
3-Incompatible blood transfusion reactions.
4-Vomiting and aspiration if stomach isn't empty.
5-Cardiac arrhythmias or arrest.
6-Hypocalcemia.
7-Infections,e.g. sepsis, hepatitis, etc.
8-Air embolism.
9-Hypoglycemia.
10-Metabolic acidosis,vascular spasm.
#Pediatrics
1- Apnea and bradycardia, thrombocytopenia, hypervolemia due to overload may lead to cardiac failure.
2-Hypothermia due to exposure especially during winter months.
3-Incompatible blood transfusion reactions.
4-Vomiting and aspiration if stomach isn't empty.
5-Cardiac arrhythmias or arrest.
6-Hypocalcemia.
7-Infections,e.g. sepsis, hepatitis, etc.
8-Air embolism.
9-Hypoglycemia.
10-Metabolic acidosis,vascular spasm.
#Pediatrics
Clinical manifestations of Sickle cell anemia:
1-It is common in negros.
2-Starting after the 6th month of age. Because in this asymptomatic period high levels of HbF protect the patient.
3-Features of anemia"Non- specific":
-Fatigue, Headache, Poor feeding, Lethargy, Dizziness, Dyspnea, irritability, Arthralgias, abdominal pain.
Also signs such pallor, Jaundice, tachycardia and postural Hypotension.
4-Features of chronic hemolysis such as hepatospleenomegaly, GB stones, skeletal manifestations.
5-Renal disorders (CRF, NS, Proteinuria.).
6-Crisises such as splenic sequestration crisis, aplastic crisis, vaso-occlusive episodes such as stroke, pulmonary infarction hepatopathy or hematuria, acute chest syndrome.
May be the presenting features.
PP of crisis: hypoxia, dehydration, infection, stress, trauma..etc.
7-Increase susceptibility to overwhelming infection especially S.pneumoniae.
8-Late manifestations:
1-Long term consequences of chronic hemolytic anemia.
2-Tissue hemosiderosis.
3-Gallstones.
4-Leg ulcers.
5-Renal disease.
#Pediatrics
1-It is common in negros.
2-Starting after the 6th month of age. Because in this asymptomatic period high levels of HbF protect the patient.
3-Features of anemia"Non- specific":
-Fatigue, Headache, Poor feeding, Lethargy, Dizziness, Dyspnea, irritability, Arthralgias, abdominal pain.
Also signs such pallor, Jaundice, tachycardia and postural Hypotension.
4-Features of chronic hemolysis such as hepatospleenomegaly, GB stones, skeletal manifestations.
5-Renal disorders (CRF, NS, Proteinuria.).
6-Crisises such as splenic sequestration crisis, aplastic crisis, vaso-occlusive episodes such as stroke, pulmonary infarction hepatopathy or hematuria, acute chest syndrome.
May be the presenting features.
PP of crisis: hypoxia, dehydration, infection, stress, trauma..etc.
7-Increase susceptibility to overwhelming infection especially S.pneumoniae.
8-Late manifestations:
1-Long term consequences of chronic hemolytic anemia.
2-Tissue hemosiderosis.
3-Gallstones.
4-Leg ulcers.
5-Renal disease.
#Pediatrics
Why do newborns develop
physiological jaundice?
1-Decreased RBC life span.
2-Decreased Y protein and Ligandin in liver.
3-Decreased activity of UDP glucronyl transferase.
4-Increased enterohepatic circulation.
#Pediatrics
physiological jaundice?
1-Decreased RBC life span.
2-Decreased Y protein and Ligandin in liver.
3-Decreased activity of UDP glucronyl transferase.
4-Increased enterohepatic circulation.
#Pediatrics
-Minimal change nephrotic syndrome (MCNS) is most commonly seen in 85% of all cases of nephrotic syndrome in children.
#Pediatrics
#Pediatrics
Note
•Adult remnants of fetal circulation includes:
1- Umbilical vein = Ligamentum teres
2- Ductus venosus = Ligamentum venosus
3- Foramen Ovale = Fossa cialis
4- Umbilical arteries = Proximal part contribute to the internal iliac arteries and superior vesical arteries whereas the distal parts collapse and become fibrotic forming the medial umbilical ligaments.
5- Ductus arteriosus= Ligamentum arteriosum or Harvey's ligament.
#Surgery
•Adult remnants of fetal circulation includes:
1- Umbilical vein = Ligamentum teres
2- Ductus venosus = Ligamentum venosus
3- Foramen Ovale = Fossa cialis
4- Umbilical arteries = Proximal part contribute to the internal iliac arteries and superior vesical arteries whereas the distal parts collapse and become fibrotic forming the medial umbilical ligaments.
5- Ductus arteriosus= Ligamentum arteriosum or Harvey's ligament.
#Surgery
Remember:
-The term malnutrition is used to denote undernutrition, overnutrition and selective nutritional deficiencies.
However, the terms malnutrition, PEM and undernutrition are often used interchangeably.
-Undernutrition occurs due to inadequate intake, poor absorption or excessive loss of nutrients.
-Overnutrition occurs due to excessive intake of nutrients.
#Pediatrics
-The term malnutrition is used to denote undernutrition, overnutrition and selective nutritional deficiencies.
However, the terms malnutrition, PEM and undernutrition are often used interchangeably.
-Undernutrition occurs due to inadequate intake, poor absorption or excessive loss of nutrients.
-Overnutrition occurs due to excessive intake of nutrients.
#Pediatrics
Obesity is a condition with exceas amount of body fat.
-There is an increase in the number and size of adipocytes.
-A child whose weight for age is between 110% and 120% of the standard weight is known as overweight.
-While that more than 120% of the
standard weight is obese.
#Pediatrics
-There is an increase in the number and size of adipocytes.
-A child whose weight for age is between 110% and 120% of the standard weight is known as overweight.
-While that more than 120% of the
standard weight is obese.
#Pediatrics
Remember:
-PDD "Postdiarrheal abdominal distension"
It occurs as a complication after diarrhea due to hypokalemia, paralytic ilius.
#Pediatrics
-PDD "Postdiarrheal abdominal distension"
It occurs as a complication after diarrhea due to hypokalemia, paralytic ilius.
#Pediatrics