Theme 8: Sick Child. A complete summary of all exam material!
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Course
Thema 8 Ziek Kind
Institution
Rijksuniversiteit Groningen (RuG)
Upon recommendation of my fellow students, I now sell my summaries! In this summary, I use a lot of images, tables and enumerations. This means you don't have to read long pieces of boring and complicated text. This summary contains all the material of the books, lectures and learning objectives. T...
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Week 29: The yellow child....................................................................................................................... 6
Introduction......................................................................................................................................... 6
Visiting NICU patients .......................................................................................................................... 7
Foetal → neonatal ........................................................................................................................... 7
Adaptation of spontaneous ventilation .......................................................................................... 8
IRDS ............................................................................................................................................... 10
Bronchopulmonary dysplasia ........................................................................................................ 10
Adaptation circulation ................................................................................................................... 11
Glucose regulation after birth ....................................................................................................... 12
Intraventricular haemorrhage ....................................................................................................... 13
Periventricular leukomalacia ......................................................................................................... 13
Asphyxia......................................................................................................................................... 14
Are Dutch children healthy? .............................................................................................................. 16
Measurement of health................................................................................................................. 16
Lalonde .............................................................................................................................................. 19
Model of population-based health in the future .......................................................................... 19
Rainbow of Dahlgren-Whitehead .................................................................................................. 20
Commission social determinants of health ................................................................................... 20
The organisation of vulnerable children and adolescents ................................................................ 21
Organisation of health systems ..................................................................................................... 21
Changes from intra- to extrauterine: circulation .............................................................................. 22
Congenital heart defects ............................................................................................................... 23
Transposition of the large vessels ................................................................................................. 23
Tetralogy of Fallot.......................................................................................................................... 24
Normal heart sounds vs murmurs ................................................................................................. 24
Changes from intra- to extrauterine: lungs ....................................................................................... 27
Dyspnoea ....................................................................................................................................... 27
Stridor and wheezing..................................................................................................................... 27
Allergic reactions ........................................................................................................................... 29
Anaphylactic shock ........................................................................................................................ 30
Bilirubin metabolism ......................................................................................................................... 32
Anaemia and hyperbilirubinemia ...................................................................................................... 34
Classification .................................................................................................................................. 34
Aetiology........................................................................................................................................ 34
Diagnosis and management .......................................................................................................... 35
2
, Neonatal jaundice ......................................................................................................................... 35
Kernicterus .................................................................................................................................... 37
Week 30: The blue baby ........................................................................................................................ 38
Introduction: Congenital heart defects ............................................................................................. 38
Embryonic development of the heart ............................................................................................... 40
Anatomy of the heart .................................................................................................................... 40
Development of the heart ............................................................................................................. 41
Foetal remnants in the adult heart ............................................................................................... 45
Atrial septation .............................................................................................................................. 47
Ventricle septation ........................................................................................................................ 48
Physiology of congenital heart diseases............................................................................................ 49
Transition....................................................................................................................................... 53
Cyanosis ......................................................................................................................................... 53
Duct dependent cardiac anomalies ............................................................................................... 55
Pressure load of the left ventricle ................................................................................................. 55
Compensation vs decompensation ............................................................................................... 56
Syncope, chest pain, dysrhythmias, heart failure, and cardiomyopathy in children ........................ 57
Syncope ......................................................................................................................................... 57
Chest pain ...................................................................................................................................... 57
Dysrhythmias ................................................................................................................................. 58
Heart failure .................................................................................................................................. 59
Rheumatic fever ............................................................................................................................ 60
Cardiomyopathies ......................................................................................................................... 61
The blue boy ...................................................................................................................................... 62
Case ............................................................................................................................................... 62
Congenital heart defects ............................................................................................................... 62
Social medicine: What does a youth doctor do?............................................................................... 65
Week 31: Child with fever ..................................................................................................................... 66
Introduction....................................................................................................................................... 66
Fever .............................................................................................................................................. 66
Alarm symptoms ........................................................................................................................... 66
Diagnosis........................................................................................................................................ 67
Balance of infections ..................................................................................................................... 68
The innate immune system ........................................................................................................... 69
The acquired immune system ....................................................................................................... 70
When do you start with antibiotics ............................................................................................... 70
3
, Fever and neurological signs ............................................................................................................. 71
Febrile seizures .............................................................................................................................. 71
Sepsis or meningitis ....................................................................................................................... 71
Meningitis ...................................................................................................................................... 72
Fever and skin manifestations........................................................................................................... 73
Fever in children: paediatric concepts .............................................................................................. 83
Maturation of the immune system: .............................................................................................. 84
Immunisation and prophylaxis .......................................................................................................... 85
Infections ........................................................................................................................................... 86
Brain .............................................................................................................................................. 86
ENT ................................................................................................................................................ 87
Heart .............................................................................................................................................. 89
GI-tract........................................................................................................................................... 90
Social medicine: healthcare for asylum seekers ............................................................................... 93
Week 32: Dyspnoeic child ..................................................................................................................... 94
Introduction....................................................................................................................................... 94
Coughing ............................................................................................................................................ 95
History taking .................................................................................................................................... 97
Physical examination ......................................................................................................................... 99
Auscultation..................................................................................................................................... 102
Upper airways.................................................................................................................................. 103
Laryngomalacia............................................................................................................................ 103
Croup/pseudocroup/laryngeotracheobronchitits/laryngitis subglottica .................................... 103
Epiglottitis.................................................................................................................................... 103
Inhaled foreign body ................................................................................................................... 104
Lower airways.................................................................................................................................. 105
Asthma and whooping cough .......................................................................................................... 107
Pertussis ...................................................................................................................................... 108
BPD-CF-PCD ..................................................................................................................................... 110
Bronchopulmonary dysplasia ...................................................................................................... 110
Cystic fibrosis ............................................................................................................................... 110
Primary ciliary dyskinesia ............................................................................................................ 111
Allergic rhinitis ................................................................................................................................. 112
Atopic dermatitis ............................................................................................................................. 113
Pharmacology: drugs for asthma and COPD .................................................................................... 116
Drug delivery to the lungs ............................................................................................................ 116
4
, Drugs............................................................................................................................................ 116
Asthma management strategy..................................................................................................... 117
Social medicine: the role of environmental health physicians ....................................................... 118
5
,Week 29: The yellow child
Introduction
20% of babies are born at home
Neonatology = intensive care for newborns
• Premature birth
• Asphyxia
• Congenital anomalies
• Support of vital functions:
o Infections
o Postoperative
To the NICU:
• Intrauterine transportation
o <32 weeks and/or 1250 g
o Congenital abnormalities
• Extrauterine transportation when vital functions are impaired:
o Sepsis
o Asphyxia = lack of oxygen during labour → cooling to 33 C for three days
(within 6 hours after birth)
Apgar score:
• Breathing
• Heart rate
• Colour
• Tone
• Reactivity
>7 is good
Lower temperature = higher oxygen demand
6
,Visiting NICU patients
First step: wash hands!
In Netherlands: 180000 babies born per year
→ some need support of their organs
Definitions:
• Premature babies: <37 weeks → treatment from 24 weeks
• Babies that have problems during birth: asphyxia or sepsis
• Babies with congenital anomalies
Annually: 10000 32-37 weeks
→ 2550 <32 weeks
Respiratory support for premature babies:
• C-section: no mechanical compression of the birth canal → no chest compression to
get the fluid out
• Surfactant deficiency
→ transitional problems
Vulnerability:
• Lungs
• Cardiovascular
• Gut
• Kidneys
• Brain
• Immune system
• Liver
• Skin
• Ventilation: aeration of the lungs → clearance of foetal lung fluid
• Circulation: transition of the circulation → closing of the ductus arteriole
• Placenta: removal of low resistance circulation → no more nutrients
• Metabolism: to prevent hypoglycaemia
• Body temperature control
7
, Adaptation of spontaneous ventilation
Foetal breathing movements: from week 10-11
→ Around birth no breathing movements
First breath: 6-93 seconds after birth → mostly >20 seconds
Triggers:
• Cooling
• Activation central pCO2 chemoreceptor
High inspiratory pressure: 39 cm H2O
Active expiration: crying → 72 cm H2O
Amniotic fluid = gas mixture
Foetal lung: produces fluid (for foetal lung development) → after birth water resorption in
the lung
Causes:
Wet lung = transient tachypnoea of the newborn
Also: production of surfactant!
Foetal lung development:
8
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