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Samenvatting Anatomie en fysiologie van de pasgeborene
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Anatomie en fysiologie van de pasgeborene
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ANATOMIE EN FYSIOLOGIE VANDE PASGEBORENE
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Fysiologie: aanpassingen vd circulatie & de long bij de geboorte............................................................................2
Foetale circulatie...................................................................................................................................................3
Neonatale circulatie..............................................................................................................................................3
Aanpassingen in de long bij de geboorte..............................................................................................................4
Schematische weergave vd overgang naar de neonatale circulatie.....................................................................5
De Apgarscore.......................................................................................................................................................5
De normale pasgeborene: is het gewoon of ongewoon?.........................................................................................5
De huid..................................................................................................................................................................6
De normale huid bij de boreling........................................................................................................................6
Fysiologische & genetische variëteiten van de huid.........................................................................................6
Nevi & tumoren.................................................................................................................................................7
Vesicobulleuze erupties....................................................................................................................................8
Verworven aandoeningen.................................................................................................................................8
Houding & bewegingen.........................................................................................................................................9
Schedel & aangezicht............................................................................................................................................9
Ogen......................................................................................................................................................................9
Oren.....................................................................................................................................................................10
Neus.....................................................................................................................................................................10
Mond...................................................................................................................................................................11
Hals......................................................................................................................................................................11
Thorax..................................................................................................................................................................11
Abdomen & navel................................................................................................................................................12
Genitalieën..........................................................................................................................................................12
Ledematen...........................................................................................................................................................13
Anus.....................................................................................................................................................................13
Hyperbilirubinemie..................................................................................................................................................14
Het normale bilirubinemetabolisme...................................................................................................................14
oorzaken van neonatale hyperbilirubinemie......................................................................................................14
Wat is fysiologische icterus?...............................................................................................................................15
Borstvoedingsicterus...........................................................................................................................................15
Hoe fysiologische icterus van pathologische icterus onderscheiden?................................................................15
1
, Toxiciteit van bilirubine-Kernicterus...................................................................................................................16
De bloed-hersenbarrière.................................................................................................................................16
De kliniek van bilirubine-encefalopathie........................................................................................................16
Behandeling van hyperbilirubinemie..............................................................................................................17
Metabole screening.................................................................................................................................................17
Criteria voor het bepalen van een screeningsonderzoek...................................................................................18
Welke aandoeningen worden gescreend in Vlaanderen?..................................................................................18
De Guthriekaart...................................................................................................................................................18
Tijdstip van afname.............................................................................................................................................18
Procedure bij een afwijkend resultaat................................................................................................................18
Enkele opgespoorde aandoeningen....................................................................................................................18
Fenylketonurie (PKU)......................................................................................................................................19
congenitale hypothyroidie..............................................................................................................................19
Congenitale bijnierschorshyperplasie (CAH)...................................................................................................19
Glucosehomeostase................................................................................................................................................19
Fysiologie.............................................................................................................................................................19
Pathologie............................................................................................................................................................20
Symptomen.........................................................................................................................................................20
Oorzaken van neonatale hypoglycemie..............................................................................................................20
Preventie & behandeling.....................................................................................................................................20
Praktische aanpak van de pasgeborene..............................................................................................................21
Thermoregulatie......................................................................................................................................................21
Pre- & dysmaturiteit................................................................................................................................................22
Definities..............................................................................................................................................................22
Oorzaken van intra-uteriene groeiretardatie & dysmaturiteit...........................................................................23
Soorten IUGR (intra-uteriene groeiretardatie)...................................................................................................23
Voeding tijdens het eerste levensjaar/Supplementen...........................................................................................23
Vaccinaties...............................................................................................................................................................24
FYSIOLOGIE: AANPASSINGEN VD CIRCULATIE & DE LONG BIJ DE GEBOORTE
2
, FOETALE CIRCULATIE
Voor de geboorte is gasuitwisselng id placenta
relatief O₂-rijk bloed via vena umbilicalis (navelstrengader) & ductus venosus de vena cava inferior
(onderste holle ader)
in vena cava inferior stroomt dit bloed same met O₂-arm bloed uit lichaam nr het rechteratrium
(voorkamer)
geen volledige menging door dunne bindweefselschotten
In rechteratrium stroomt relatief O₂-rijk bloed vie foramen ovale nr het linkeratrium
O₂-arm bloed uit vena cava superior (bovenste holle ader) & inferior stroomt via rechterventrikel (kamer) nr
arteria pulmonalis (longslagader)
Door hoge vaatweerstand in longen stroomt bloed vn daar via ductus arteriosus nr de aorta (lichaamsslagader),
waar het zich mengt met relatief O₂-rijk bloed dat uit rechterventrikel komt
Via arteri umbilicalis (navelstrengslagader) stroomt een deel vn dit bloed nr de placenta
Door dit stelsel vn bloedstromen krijgen de hersenen relatief O₂-rijk bloed; de carotis-slagaders takken af vr de
inmonding vd ductus arteriosus
NEONATALE CIRCULATIE
3
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