Background of the lecture презентация

Intrauterinal (embrional, fetal)
Extrauterinal
Labor, pediatric aspects
Newborns. First examination, CNS estimation. Common transitory states, Neonatal primary care

toddler!

pediatrics as a science about well and sick child

social developmental estimations in children.
The anatomical and physiological particularities of internal organs and their systems in children according the age. The Methods of the clinical study. The Semiotics the most important symptoms and syndroms in pediatrics.
Nursing (feeding) and common looking after
Emergency care in typical situations

a study of the individual child particularities, it is important to work out the differential approaches to children depending on their age. Though the early growing and development it is a permanent process. Each child passes determined stages or periods of the growth.

it is necessary to select two the most important stages of individual life: intrauterinal and extrauterinal.

lasts 9 weeks of the pregnancy. In this time the main organogenesis, amnion and chorion are forming.

The fetogenesis begins since 9 weeks and ends approximately on 40-th week of the full pregnancy. In this period the differentiation and maturation of the body organ systems happen following by development, maturation and aging of placenta.

Intrauterinal period of the human development

shown signs of life has to be estimated as a premature.

Children been born after 42 weeks of pregnancy and later must be classified as a postterms.

development goes only to account of the increase of cellular mass (hyperplasia).

Within the following 16 weeks, (since 17 till 32 weeks of gestation) the rate of cellular multiplication begins gradually to decrease. At this time gradually the processes of the cellular size increasing take power. It is so called combined hyperplasia and hypertrophy phase of the intrauterinal development.

Within 7 weeks of gestation (since 33 till 40 weeks of pregnancy) in fetal development the cellular hypertrophy dominates setting fetal growth (fetal cellular hypertrophy phase). As a rule the fetus accumulates subcutaneous fat in consequence of the adipocytes hypertrophy.

takes place unevenly, in the certain terms for every system of organs. Critical periods appear at the moment of stormy differentiation and growth of organ's weight. It creates preconditions for the damage. For example, the virus gets into the blood stream of embryo. Due to their biological feature to create the best preconditions for reproduction the viral bodies will be directed into the most intensively proliferating tissue. Thus this tissues will be damaged firstly and congenital disease starts. There is a rule: as sooner an unfavorable factor for a fetus begins acting as the severity of the teratosis incriases. A fetus can have almost all defects of organs and systems. Gathering the history of pregnancy you have to pay attention to a possibilities of harmful environmental factors.

the critical periods of pregnancy when the embryo or fetus is especialy sensitive to disadvantage influences into several periods.
The First critical period is a time of the fertilized egg into the womb implantation. Its mistakes lead the embrio to death and spontaneous abortion.
The Second critical period can happen in time of placenta development, begins at 3-st week of pregnancy and lasts till 11-12 weeks of pregnancy.
The Third critical period corresponds to the time of internal organs systemogenesis. For all organs the proper sensitive periods exist. Some times the organogenesis does not finish with delivery and continues within the early childhood.

pregnancy till the day of delivery and also next 7 days of life

The neonatal and infantile mortality rates is closely connected with the happening perinatal abnormalities.

appearance has not undergone any sensitive l changes and delivery still are carried out by very hard, threatening to life manner. The condition of child birth are so hard, that it is said about an traumatic epidemia that is peculiar to the newborns and this phenomenon is comparable with results of the wars.

– 12 mo)
Toddlers (1 – 3 yr)
Preschoolers (3 -7 yr)
Early school children (7 – 12 yr)
Late schoolers (12 – 18 yr)
Teens (10 – 18 yr)

Newborn

score (pediatrician Virginia Apgar score) in 1st and 5th minute after the labor. Examination using Аpgar score is based on the sum of points (grades) that are given for five groups of symptoms. They are color of the skin, breathing, heart rate, muscular tonus, intensity of child irritation to unpleasant stimulus.
According to the assessment of their intensity appearance they are given 0, 1 or 2 points agreeably. Healthy new-born usually demonstrates 8 - 10 points in the first minute of his life and has 9 - 10 points by the Apgar score fifth minutes later.

1-st and 5-th min of life

the most dangerous condition in neonatal practice - asphyxia.
Asphyxia is an absence of natural breathing. The respiratory deficiency in asphyxia can be seen in the presence of heartbeats and must be revealed immediately after the labor. The development of asphyxia as a rule is a result of antenatal deep hypoxia which damages a breathing regulatory center and can be a result of the premature placenta detachment, umbilical cord rupture or its compression because of the tight knot etc.

- 4 – moderated
3 - 1 – severe, life threatening

In asphyxic children with low index of Аpgar score on 1-th and 5-th minutes and especially after 2 hours of treatment it is necessary to expect the development of severe neurological disease like cerebral palsy.

terms of antenatal development and weight of body:
1st degree of prematurity is the most prognostic well. It is characterized by the term of antenatal development less than 34-38 weeks and by the weight of body from 2000 to 2500 grams.
2nd degree - 32 - 34 weeks, mass from 1500 to 2000 grams.
3rd degree - 30 - 32 weeks, mass from 1000 to 1500 grams.
4th degree is the most severe premature state with extremely low weight. The term of antenatal development lasts less than 30 weeks. The weight corresponds to 1 kg and less.

term correspondes to expectant body weight but has morphological and functional features of preterm newborn, this condition should be considered as an immaturity. For inmature children especially are typical of the low muscle tone and weak sucking. Many mother`s condition make fetuses prone to inmaturity especially renal, heart end endocrinal diseases as well as the young mother`s age.

criterion for determination of the fetus maturity and for prognosis of his life.

18 – 22 h per day. Within the sleeping the children hold “conscious appearance”. After awake the most children scream from hungry requiring the mother`s breast. At this moment a plenty of spontaneous motions is a typical style of the behavior in full-term, mature and healthy children. The relative flexors hypertonia is also common property of the skeletal muscles state. The manifestation of flexors hypertone perhaps is the consequence of newborn's trying to save so-called "pose of embryo" after the birth. The presence of primitive neonatal reflexes is also necessary for full-term, mature healthy child. These reflex arches are closed on different levels of spinal cord and brainstem. The neonatal reflexes as a rule persist in infants within the first months. The follow up to their appearance and disappearance can give important information about CNS development.

small children. Its absence in newborns means severe condition. The response fades in children aged approximately 1 yr.

does it work: A baby reacts strongly to a loud noise or sudden movement. He arches his back, throws open his arms and legs, and may cry before pulling back arms again. The best way to deal with this particular reflex is to avoid sudden movements and noises and to hold your baby close and soothe if he becomes startled. How long does it last: Until the 4th month.

fingers and palm, he'll grasp your finger tightly. Most new parents are astounded by the strength of a newborn baby's grip. How long does it last: The grasping reflex is at its strongest during the first 2 months of life, disappearing entirely by the time the baby is 5 months old.

fingers provokes dorsiflaction and common finger adduction. The response persists within 2 yr. Babinsky sign in adult persons is a relevant symptom of pyramidal insufficiency.

on his stomach, he will automatically assume a crawling position with his knees pulled up under his abdomen. He may kick his legs and be able to propel herself in a crawling-like fashion. (It's not "real" crawling, of course. You'll have to wait a few months longer to see that.) Once the "crawling" reflex disappears, he'll stretch his legs out behind him when he's placed on his belly. How long does it last? Throughout the early weeks of life. Be careful, do not leave a baby along at the table!

a walking position with his feet touching a flat surface, he'll start taking steps. Your baby will exhibit similar reflexes when placed on his stomach: he'll start trying to "swim" forward. How long does it lasts: Typically subsides around the 2nd month.

a baby is placed on her back, she will turn her head to one side and extend the arm and leg on that same side in a classic fencing position. She'll then turn her head in the opposite direction and extend her other arm and leg in turn. How long it lasts: About 6 months.

adaptation to the extrauterinal life and can be missed with pathologic states.

by brief child inability to move and short apnea. Deep inspiration and scream follow after that. During the following 5-6 minutes a child is getting active with typical mydriatic pupils in spite of the bright light in delivery room. This condition appears due to reaction on catecholamins surplus production getting into the child's blood. Also the primary reaction of cerebral cortex for the new tactile, gravity, temperature stimuluses can explicate the condition.

getting the areas of lungs which are still being in pulmonary collapse to inflate up. Expiration efforts followed by the first neonatal scream also is very useful in this situation to fight pulmonary collapse. Some children develop the so-called gasps-breathing. Gasp is the sort of exaggerated deep breathing with prolonged expiration. During the gasp breathing the CO 2 level is getting low. That's why often the children have short periods of breathing absents (apnoes) till to 5 sec. long (irregular breathing). Transitory hyperventilation in newborns is completely self limited condition and does not need any treatment.
The cases of long gasping and apneas lasted more 20 sec., accompanied by cyanosis (pathological apnea) are peculiar to the children with intracranial hemorrhages or pulmonary diseases.

3-4 day of life, riches 4 -10% calculating on initial mass and restores approximately at day 7 – 10 .
Physiological skin redness
Physiological intestinal disfunction
Uric acid crystalluria

of life or little bit later and looks like intensive yellow coloration of the skin. At this time the level of bilirubin riches 100 - 140 mmol/l of blood serum. Jaundice disappears spontaneously in 10 - 14 days.
In any case the physiologic (benign) jaundice should be distinguished from the neonatal hemolytic disease which can be life threatening condition in affected baby.

amazing physiological states in newborns. The fact is that 75% of babies have sexual crisis and more often in girls. It's characterized by:
a) Transitory mastopathy (enlargement of breasts) in newborn usually symmetric. It appears on 3-4 day and is being evident for 1-1,5 months. The outflow of milk (so-called "milk of witches") from this breasts is not rare.
b) The girls quite often have desquamative vulvovaginitis or neonatal menses. It is featured by appearance of bloody excretions from vagina. As a rule not more then 1-2 ml of blood can be excreted. Does not require treatment, but requires a close hygienic care.

Neonatal mastitis

It is not allowed to squeeze out the milk, because there is the danger of microbial contamination and local infection`s development. Like other benign neonatal states it need only observation.

labors take place without the necessity of a doctor`s close intervention.
But prime measures of care are executed in all cases.

easy procedure prevents an aspiration of fluids and secretions during the first breath-in (after the appearance of fetus head) and should be done in any case before the umbilical cord cut.

the umbilical cord can be:
a) ordinary or traditional in 1,5 - 2 minutes after the labor in healthy full-term children, usually after the first inspiration and in 1 - 1,5 minutes after in children who has been born prematurely. In case of the late umbilical cord clamping, especially when a newborn is disposed below the cavity of uterus there is the danger of additional placental-fetal hemotransfusion. The surplus volume of blood gets to the fetus. Clinically it can be evident by blood concentration and its high viscosity, by total skin dark blue-red appearance (cyanosis), because of the heightened load on the pumping ability of heart. A physiological jaundice proceeds in children considerably longer.
b) Clamping of the umbilical cord after stopping of its pulsation in children which were born by cesarean section should be done into the practice in more late terms;
c) an umbilical cord cut should be put into the practice in early terms after the birth in condition of very low body weight, in women with fever and in condition when the hemolytic diseases is expected.
In such situation the early umbilical cord cut prevents the penetration of mother's pathogens to the child after the labor and relieves severity of hemolytic or infectious diseases of newborns.

mother newborn has to be placed on a sterile and heated diaper. The amniotic fluids must be removed gently from the skin. The moist diaper should be changed. After the child is set on the mother chest and covered with blanket. The identification bracelets on the hands and legs showing the exact time of delivery, baby sex and mother`s name must be put.

To warm up!

antiseptic solution or ointment (for instance, sodium sulphacyl 20% in water) instillation from the individual dropper into the conjunctival bag twice: immediately after the delivery and 2 h later. The same procedure must be done in girls for external genitalia.

born at home without rendering medical help. On 5 day after birth at checkup the child demonstrates severe eyelids edema, brightly red conjunctiva and abundant purulent discharge from the eyes.

отработки лекций и индивидуальные консультации производятся на второй академической неделе с 15 до 17.30 по понедельникам в кабинете зав. кафедрой д.м.н., проф. Иванько Олегом Григорьевичем.

40 days
D. 40 weeks
E. 4 mo
The most important hereditary response in newborns is:
A. Crying
B. Crawling
C. Cramping
D. Suckling
E. Sleeping