Paediatric Diseases

Paediatric Diseases - Paediatric Diseases Perinatal...

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Paediatric Diseases Perinatal Infections May be acquired transcervically (ascending) or transplacentally (hematologically) A) Transcervically Spread of infection from cervicovaginal canal; in utero or during birth; bacterial (beta haemolytic streptococcal infections and viral (herpes; if mom has active herpes lesions in vagina they will not do a vaginal delivery); fetus “inhales” infected amniotic fluid into lungs or acquires infection when passing through infected birth canal during delivery; associated with chorioamnionitis (opaque surface and thickened membrane; inflammation of placental membrane) and funistis (infection of umbilical cord); may cause pneumonia, sepsis, meningitis; increased risk with premature membrane rupture Neonatal herpes simplex virus= affects skin, eyes, mucous membranes; leads to blindness and encephalitis; outcome better with antivirals B) Transplacentally ( haematological; infection in blood that crosses plancenta); viruses, parasites, some bacteria; TORCH= t oxoplasma, r ubella, C MV, h erpes and o thers (ex. T. Pallidum); fever, encephalitis, chorioretinitis, hepatosplenomegaly, pneumonia, myocarditis, anemia (all these usually occur later in pregnancy); systemic abnormalities (growth restriction, mental retardation, cataracts) Toxoplama= originates from cat; multiple abnormalities including miscarriage and still birth Respiratory Distress Syndrome of the Newborn Many causes: excessive maternal sedation during delivery, fetal head injury during delivery, aspiration of blood or amniotic fluid, intrauterine hypoxia from nuchal cord; most common cause is respiratory distress syndrome (“hyaline membrane disease”; formation of membranes in the peripheral air spaces of infants) ; main risk factor of RDS is prematurity (born before 36 weeks gestation; full pregnancy= 40 weeks); other contributors= maternal diabetes, C-section before onset of labour, twin gestation, male infants Immature lungs cannot synthesize sufficient surfactant , which is made by type II pneumocytes (bulge into alveoli; can transform into type I if there’s damage); alveoli tend to collapse due to decreased surfactant→ infant rapidly tires from breathing→ atelectasis (collapse of lungs) sets in→ hypoxia (decreased O2) leads to epithelial and endothelial damage, leading to formation of hyaline membranes (bright pink material —protein—lining the alveoli) Treatments= corticosteroids ( stimulates fetal lungs to produce surfactant earlier; surfactant usually doesn’t get synthesized until 34-36 weeks gestation) for the mother if early delivery is unavoidable); supportive ventilation; aerosolized natural or recombinant surfactant; now uncommon for preemies to succumb to RDS Sudden Infant Death Syndrome sudden and unexpected death of an infant less than 1 year of age (1 month to 1 year) whose death remains unexplained after the performance of a complete autopsy, examination of the scene of death and review of the case history;
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This note was uploaded on 02/08/2012 for the course PATHOLOGY 3245 taught by Professor X during the Spring '11 term at UWO.

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Paediatric Diseases - Paediatric Diseases Perinatal...

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