pedsPhysAirwayJan05 - Pediatric Fundamentals Drs. Greg and...

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Pediatric Fun damentals Drs. Greg and Joy Loy Gordon 26 January 2005
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McGraw-Hill 2002
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Pediatric Fundamentals Objectives Growth and development Cardiovascular physiology Respiratory physiology including Airway maintenance Explain and apply to your anesthetic practice selected elements of pediatric
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Pediatric Fundamentals – Prenatal Growth and Development Prenatal Embryonic period first 8 weeks Organogenesis 4 th – 8 th weeks Ectoderm Mesoderm Endoderm
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Pediatric Fundamentals – Prenatal Growth and Development Organogenesis 4th – 8th weeks Mesoderm somites myotomes -> segmental muscles of trunk dermatomes -> dermis of scalp, neck, trunk sclerotomes -> vertebral bodies, arches abnormal induction -> spinal bifida
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Pediatric Fundamentals – Prenatal Growth and Development Developmental Abnormalities congenital diaphragmatic hernia (CDH) esophageal atresia spina bifida Hirschsprung’s disease omphalocele gastroschisis
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Pediatric Fundamentals – Prenatal Developmental Abnormalities Congenital diaphragmatic hernia (CDH) 1 in 2,500 live births 85% left side of diaphragm defect in closure of pleuroperitoneal canal impaired lung growth prenatal (intrauterine) repair possible
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Pediatric Fundamentals – Prenatal Developmental Abnormalities Esophageal atresia failure of proliferation of esophageal endoderm in 5 th week 5 types – some with associated tracheoesophageal fistula + E = H-type (7%) 80% 10% 1% 2%
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Pediatric Fundamentals – Prenatal Developmental Abnormalities Spina bifida failure of closure of posterior neural tube during 3 rd embryonic week mild: spina bifida occulta severe: meningomyelocele 80% lumbosacral in utero repair described
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Pediatric Fundamentals – Prenatal Developmental Abnormalities Hirschsprung’s disease defect in neural crest migration leads to paralysis of that segment of colon with subsequent proximal dilation
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Pediatric Fundamentals – Prenatal Developmental Abnormalities 1 in 2,500 live births failure of return of midgut from yolk sac to abdomen by 10 weeks often associated with other abnormalities Omphalocele
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Pediatric Fundamentals – Prenatal Developmental Abnormalities 1 in 10,000 live births abdominal wall defect between developing rectus muscles just lateral to umbilicus right side may be due to abnormal involution of right umbilical vein during 5 th and 6 th weeks usually not associated with other defects Gastroschisis
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Pediatric Fundamentals – Prenatal Growth and Development Consequences of maternal disorders on intrauterine development epilepsy history of previous child with neural tube defect diabetes mellitus substance abuse alcohol tobacco cocaine benzodiazepines infectious diseases rubella toxoplasmosis human immunodeficiency virus (HIV) herpes simplex
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Pediatric Fundamentals –Consequences of Maternal Disorders Epilepsy Congenital anomalies 2 to 3 times more frequent Appear to associated with increase risk of malformation: phenytoin valproic acid multidrug therapy Neural tube defects (e.g. spina bifida) valproic acid carbamazepine low dose folate may decrease risk
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Pediatric Fundamentals – Consequences of Maternal Disorders History of previous neural tube defect: Risk of subsequent neural tube defect increased 10 times
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This note was uploaded on 12/16/2011 for the course BIOLOGY 101 taught by Professor Mr.wallace during the Fall '11 term at Montgomery College.

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pedsPhysAirwayJan05 - Pediatric Fundamentals Drs. Greg and...

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