Pathophysiology 1.1

1st month

2 months - 2 years

2 - 12 years

13-18 years

1 - 3 years

3-5 years

2-5 years

6-12 years

Number of weeks from the onset of the mother's last period until birth

38-42 weeks

34-38 weeks

< 34 weeks

> 43 weeks

• usually survive
• immature kidney's
• electrolyte problems with immature skin

Physical changes in the body

changes in body function and psychosocial behaviors

linear

growth spurts

Measure height, weight and head circumference

suggest possibility of intrauterine insult or genetic abnormality

• characteristic of growth delay and genetic short stature
• structural dystrophies
• endocrine causes of growth failure

• caloric insufficiency
• hyper-metabolic state

3-4 kg

4-5 months

12 months

24 months

• begins 10-14 years
• completed by 16-17 years
• gain 20 cm and 25 kg

• begins later
• completed 18-20
• gain 30 cm and 30 kg

< 2.5 kg

< 1.5 kg

< 1 kg

• LGA
• Subject to injuries during birth
• usually a sign of uncontrolled diabetes in the mother (increased glucose makes big baby)
• Easily hypoglycemic due to high insulin production

• Cranial Injuries
• Fractures
• Peripheral nerve injuries

• Caput succedaneum
• cephalhematoma
• subdural/subarachnoid hemorrhage

• scalp edema that may cross suture lines
• petechiae, purpura, echymosis
• resolves over the first week of life
• sub q tissue dmg from pressure on head

• subperiosteal collection of blood from ruptured blood vessels
• does not cross suture lines
• not apparent in the first 24-48 hours
• skull fracture may be present
• 2 week to 3 mo resolution

• closer to skull
• neurosurgery
• life threatening
• below skull may not show visible signs

• uncommon
• usually from forceps delivery
• usually linear = no treatment
• depressed = palpable indentation; surgery required

• most frequent fractured bone
• crepitus (bone creek)
• immobilize the arm and shoulder

• C5 to T1 nerves there is a tear
• Paralysis of upper extremity
• immobilize for recovery in 3 to 6 months

paralysis of the upper arm

paralysis of the lower arm

• efficient placental function
• adequate energy
• adequate growth substrates
• hormonal environment
• room in the uterus

• adolescent mothers
• low economic status
• short time between pregnancies
• diet restrictions
• heavy physical work
• Pre-pregnancy hypertension
• diabetes
• chonic infection or illness
• drugs
• environmental hazards

• skull bones completely connected at birth
• causes problems for brain growth

spaces of unossified tissue at suture junctions

palpable until 2 years

• Moro = startle
• Rooting = sucking
• Stepping = placing

• spinal cord completely myelinated by 2 years
• myelination complete by 7 years

• primitive reflex disappears before voluntary movements appear
• trunk coordination before extremities
• use of upper extremities before lower

• alertness
• responsiveness
• persistence
• concentration

• best predictors of cognitive performance
• hearing impairments may impede

• eustachian tube short and straight
• remains common until age 5
• keep baby upright while feeding

• causes hypoxia
• Usually in term infants

• Surfactant deficiency
• 32-34 weeks
• Give mom steriods @ 28 weeks

• chronic lung disease
• COPD
• trama to lung tissue

CO₂ levels are not registering in the brainstem due to immaturity

• cardiac
• infectious
• metabolic
• CNS

• parechymal conditions
• developmental abnormalities
• airway abnormalities
• mechanical abnormalities

• Tachypnea > 60 breaths per minute
• Cyanosis
• Retractions or nasal flaring

• Term or near term
• immediate onset improvement w/in 12-24 hours
• clinical cours < 72 hours
• Primary cause: delayed reabsorption of fetal lung fluid
• Due to poor transitioning

• Primarily preterm
• Onset w/in 1st 6 hours
• starts improving after 72 hours
• primary cause is surfactant deficiency

• death of infant < 1 year that is unexplained
• usually between 2-3 months
• brainstem abnormalities

• positioning during sleep (must be on back on firm matress)
• prematurity/LBW
• exposure to cigarette smoke
• young mother
• inadequate prenatal care

• Cessation of breathing for at least 20 seconds
• Caused by immaturity of the respiratory center in the medulla oblongota
• failed recognition of increasing CO₂ by the CO₂ receptors.

intermittent failure to breath for 10-15 seconds

• Prematurity
• Thermal instability
• Infection
• Drugs
• Impaired Oxygenation
• Metabolic disorders
• GI Reflux
• Intracranial pathology

• supplemental oxygen
• gentle tactile stimulation
• env. temperature control
• oscillation water beds
• positive airway pressure
• Methylxanthines (stimulate brain stem neurons)

• newborn's first stool
• amniotic fluid
• intestinal secretions
• mucosal cells
• sometimes blood

• underlying illness
• cystic fibrosis
• hirschprung's disease

• 12 months
• easy digestion
• sufficient nutrients and calories
• some immune protection

Levels < 40-45 mg/dL

• cyanosis
• apnea
• hypothermia
• hypotonia
• poor feeding
• lethargy
• seizures

• Infants of diabetic mothers
• SGA babies
• premature babies

excessive circulating levels of unconjugated lipid soluble bilirubin that accumulates in the skin

new born RBC life span is shorter = higher turnover rate and higher bilirubin from breakdown of hemoglobin

• hydration
• phototherapy (change to conjugated form which increases H₂O solubility)
• blood transfusion > 25-30 mg/dL

Neurologic syndrome from deposition of unconjugated bilirubin in the basal ganglia and brain stem

• Deplete iron stores around 6 months
• Introduce iron fortified cereals at this time

• Most common < 3 months
• Abdominal pain or cramping
• Crying
• Drawing legs to abdomen
• extreme irritablity

• crying for more than 3 hours a day
• crying for more than 3 days a week
• crying for more than 3 weeks

• Inadequate growth due to inability to obtain or use essential nutrients
• Metabolic genetic defects
• parental neglect

weight in kg divided by height in meters squared

BMI at or above the 95th percentile

• Prematurity (maternal transfer of IgG in later weeks)
• Rupture of membranes
• Foul smelling amniotic fluid
• Maternal fever
• GBS colonization
• Maternal UTI

• immature immune system
• bacterial endotoxins
• central vasodilation
• peripheral vasoconstriction
• systemic hypovolemia

• asthma
• epilepsy
• cancer
• developmental/learning disabilities

• endocrine system changes
• lifestyle choices
• motor vehicle accidents 1st cause
• cancer = 2nd cause
• Thicker skin
• Acne
• Hair growth

• Sebaceous and sweat gland activity increases
• Andrenal androgens stimulate the sebaceous gland