Diseases of Infancy and Childhood II Flashcards Preview

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Flashcards in Diseases of Infancy and Childhood II Deck (51):
1

fetal causes of FGR

chromosomal disorders
congenital anomalies
congenital infections (TORCH group)

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TORCH infections

toxoplasmosis
rubella
cytomegalovirus
herpesvirus

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proportionate FGR

symmetric growth restriction

-often due to fetal factor

4

placental causes of FGR

unbilical-placental vascular anomalies

placenta abruption, previa, thrombosis, infection, etc.

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asymmetric FGR

disproportionate growth retardation
-sparing of brain

often due to placental FGR

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placental mosaicism

mutations at first or second postzygotic division - fetus and placenta

mutation in trophoblast or inner cell mass - placental only

often trisomy 7

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maternal causes of FGR

most common*

preeclampsia and HTN
inheritied thrombophilias
-factor V mutation

narcotic, alcohol, cigarettes

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nRDS

neonatal respiratory distress syndrome
-surfactant low**
-hyaline membrane disease

male
maternal diabetes
C section

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nRDS presentation

after delivery - breathing difficulty and cyanosis

rales in lungs

with therapy, good prognosis

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surfactant production

type II pneumocytes

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risk factors for nRDS

male
maternal diabetes
-bc insulin inhibits production
C section

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glucocorticoids and surfactant

increase its production

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atelactasis

lung collapse
-seen with nRDS

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histology of nRDS

stiff lungs lead to protein and fibrin exudate in alveolar spaces
-formation of hyaline membranes

barriers to gas exchange

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O2 treatmnet of nRDS

oxygen toxicity
-retrolental fibroplasia
-bronchopulmonary dysplasi

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retrolental fibroplasia

oxygen toxicity in Tx of nRDS

hyperoxic - VEGF decrease with treatment

endothelial apoptosis

VEGF increases with return to room oxygen - retinal vessel proliferation
-causes lesions in retina

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bronchopulmonary dysplasia

oxygen toxicity in Tx of nRDS

airway hyperplasia
-squamous metaplasia, interstitial fibrosis

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risk for infants with RDS

patent ductus arteriosus, intraventricular hemorrhage, necrotizing enterocolitis

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type II pneumocytes

produce surfactant
-can regenerate
-necrotic in nRDS

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type I pneumocytes

cannot regenerate

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Tx of nRDS

oxygen
surfactant
steroids

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necrotizing enterocolitis

low birth weight infants
-associated with enteral feeding
-introduction of bacteria

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inflammatory mediator with NEC

PAF - increases mucosal permeability

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presentation of NEC

blood stools
abdomen distension
circulatory collapse

gas in intestinal wall
-pneumatosis intestinalis

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location of NEC

right side
-terminal ileum, cecum, right colon

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Tx for NEC

severe cases require resection
-of necrotic bowel
-often develop post-NEC strictures

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transcervical infection

ascending

most bacterial and few viral (herpes I)

inhalation of amniotic fluid
-or infected birth canal

pneumonia, sepsis, meningitis

28

transplacental infection

hematologic

most parasitic and viral infections
few bacteria (listeria, treponema)

via chorionic villi

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parvovirus B19

causes erythema infectiosum

attacks erythroid cells
-diagnostic viral inclusions form

30

TORCH infections

fever
encephalitis
chorioretinitis
hepatosplenomegaly
pneumonitis
myocarditis
hemolytic anemia
skin lesions

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pneumatosis intestinalis

with NEC
-multiple cysts

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early onset sepsis

group B strep

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group B strep

early onset sepsis - within first 7 days

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late onset sepsis

listeria and candida

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listeria and candida

late onset sepsis - after first 7 days

36

infection acquired during vaginal delivery

HIV
Hep B
herpes

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immune fetal hydrops

Rh incompatability
-rhogam has decreased this significantly

may be blocked by ABO blood grouping (anti-A and anti-B IgM)

38

primary fetal hydrops

non-immune

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hydrops fetalis

generalized edema of newborn

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path of Rh incompatability

Rh-negative mother immunized against Rh-positive fetal red cells

antibodies pass free across placenta

anemia and Hg degradation
-lead to cardiac decompensation and bilirubin
-lead to hydrops, jaundice, kernicterus

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IgM antibodies

don't cross placenta

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IgG antibodies

cross placenta
-formed during second pregnancy

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common antigen in Rh incompatability

D-antigen

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anemia in Rh incompatability

hypoxic injury to heart and liver

decreased plasma protein production

generalized edema

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jaundice in Rh incompatability

hemolysis produces unconjugated bilirubin
-binds lipids in brain - kernicterus

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nonimmune hydrops

cardiovascular defects
chromosomal anomalies
fetal anemia - alpha thalassemia

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chromosomal hydrops

45,X (turner)
trisomy 21 and 18

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turner and hydrops

abnormal lymph drainage
-cystic hygromas
-postnuchal fluid

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parvovirus B19

can cause hydrops

destruction and decrease in RBCs

50

most serious threat in hydrops fetalis

kernicterus

51

cystic hygroma

edema around neck