This document discusses diseases of infancy and childhood. It covers a range of topics including congenital anomalies, prematurity, perinatal infections like respiratory distress syndrome, necrotizing enterocolitis, and sudden infant death syndrome. Mortality rates for different age groups are provided. Causes of congenital anomalies include genetic, environmental, and multifactorial factors. Specific conditions discussed in more depth include prematurity, fetal growth restriction, respiratory distress syndrome, and necrotizing enterocolitis.
This document discusses diseases of infancy and childhood. It begins by listing common congenital anomalies and conditions affecting infants, such as prematurity and low birth weight. It then covers major time spans in infant development. Mortality rates are provided for different age groups. Causes of death vary according to age. Congenital anomalies and their causes, including genetic, environmental, and multifactorial factors, are then examined in more detail. Specific maternal conditions that can cause anomalies, such as diabetes, infections, and drug use, are outlined. Prematurity, fetal growth restriction, and organ immaturity are also addressed.
This document outlines the management of high risk infants. It defines high risk infants as those exposed to conditions that endanger survival, such as prematurity, low birthweight, or maternal medical conditions. The management of high risk infants requires close observation and individualized care plans. Key aspects of management include prevention of complications, treatment when problems occur, careful advancement of feeding and fluid plans, and addressing the specific needs of special populations like preterm infants and those from multiple births. The overall goal is to identify and address the unique risks faced by each high risk infant.
This document defines prematurity and related terms like low birth weight (LBW), small for gestational age (SGA), very low birth weight (VLBW), and extremely low birth weight (ELBW). It discusses the public health importance of prematurity, describing the high rates of prematurity globally and associated increased mortality. The document outlines maternal and fetal risk factors for prematurity and methods for differentiating preterm and SGA infants. It also provides extensive details on potential health complications in preterm infants and recommendations for management and prevention.
Management of Preterm And Low Birth Weight
Dr. Raheel Ahmed FCPS Pediatrics
Children Hospital, Chandka Medical College Larkana
Definitions
Prevalent
Etiology
Assessment of gestational age
Problems of prematurity
Management
Antenatal (Prevention)
Natal (Delivery room care)
Post natal (after birth care)
Prognosis
Discharge criteria
Definitions
Term?
Preterm?
Immature?
LBW? VLBW?ELBW? ILBW?
SGA?
IUGR?
Gestational Age
Full-term
infant born after 37 completed menstrual weeks of pregnancy
Preterm (or premature) infant
infant born before 37 completed weeks of gestation
Late preterm infant (a recently identified category)
infant born between 34 and 36 weeks gestation
Moderately preterm infant
infant born between 32 and 34 completed weeks of gestation
Very preterm infant/ Early preterm
infant born before 32 completed weeks of gestation
Immature < 28 weeks
ELGAN: Extremely Low Gestational Age Newborn < 26 weeks
Weight
Low birth weight (LBW)
infant who weighs less than 2,500 grams at delivery
Very low birth weight (VLBW)
infant who weighs less than 1,500 grams at delivery
Extremely low birth weight (ELBW)
infant who weighs less than 1,000 grams at delivery
Incredible Low birth weight
infant who weighs less than 750 grams at delivery
The document discusses updates in obstetrics and gynecology, focusing on Millennium Development Goals 4 and 5 which aim to reduce child and maternal mortality. It then outlines key topics including hyperemesis gravidarum, miscarriages, molar pregnancy, and ectopic pregnancy. For each topic, it defines terms, discusses risk factors, clinical presentation, diagnosis, and management approaches.
This document discusses intrauterine fetal demise (IUFD), also known as stillbirth. It defines IUFD as the death of a fetus in the uterus after 20 weeks of gestation. The document then covers the objectives, incidence, causes and risk factors, maternal complications, types and classifications, diagnosis, and management of IUFD. It describes the various placental, fetal, and maternal conditions that can potentially lead to IUFD, such as preeclampsia, fetal growth restriction, and maternal infections. Methods for diagnosing IUFD include ultrasound, biophysical profile, and Doppler velocimetry. Postmortem examination of the fetus and placenta is also discussed.
This document discusses prenatal diagnosis and screening for fetal abnormalities. It defines prenatal diagnosis as detecting abnormalities in the fetus before birth through various screening and testing methods. The goals of prenatal diagnosis are to provide informed choices for couples at risk, provide reassurance, allow for confirmation of disorders, and enable prenatal management or treatment when possible. Several screening modalities are described that use biomarkers like alpha-fetoprotein, human chorionic gonadotropin, unconjugated estriol, and nuchal translucency measurements to detect disorders like Down syndrome, neural tube defects, and chromosomal abnormalities. Integrated screening combining tests is noted to have the lowest false positive rates.
This document discusses diseases of infancy and childhood. It begins by listing common congenital anomalies and conditions affecting infants, such as prematurity and low birth weight. It then covers major time spans in infant development. Mortality rates are provided for different age groups. Causes of death vary according to age. Congenital anomalies and their causes, including genetic, environmental, and multifactorial factors, are then examined in more detail. Specific maternal conditions that can cause anomalies, such as diabetes, infections, and drug use, are outlined. Prematurity, fetal growth restriction, and organ immaturity are also addressed.
This document outlines the management of high risk infants. It defines high risk infants as those exposed to conditions that endanger survival, such as prematurity, low birthweight, or maternal medical conditions. The management of high risk infants requires close observation and individualized care plans. Key aspects of management include prevention of complications, treatment when problems occur, careful advancement of feeding and fluid plans, and addressing the specific needs of special populations like preterm infants and those from multiple births. The overall goal is to identify and address the unique risks faced by each high risk infant.
This document defines prematurity and related terms like low birth weight (LBW), small for gestational age (SGA), very low birth weight (VLBW), and extremely low birth weight (ELBW). It discusses the public health importance of prematurity, describing the high rates of prematurity globally and associated increased mortality. The document outlines maternal and fetal risk factors for prematurity and methods for differentiating preterm and SGA infants. It also provides extensive details on potential health complications in preterm infants and recommendations for management and prevention.
Management of Preterm And Low Birth Weight
Dr. Raheel Ahmed FCPS Pediatrics
Children Hospital, Chandka Medical College Larkana
Definitions
Prevalent
Etiology
Assessment of gestational age
Problems of prematurity
Management
Antenatal (Prevention)
Natal (Delivery room care)
Post natal (after birth care)
Prognosis
Discharge criteria
Definitions
Term?
Preterm?
Immature?
LBW? VLBW?ELBW? ILBW?
SGA?
IUGR?
Gestational Age
Full-term
infant born after 37 completed menstrual weeks of pregnancy
Preterm (or premature) infant
infant born before 37 completed weeks of gestation
Late preterm infant (a recently identified category)
infant born between 34 and 36 weeks gestation
Moderately preterm infant
infant born between 32 and 34 completed weeks of gestation
Very preterm infant/ Early preterm
infant born before 32 completed weeks of gestation
Immature < 28 weeks
ELGAN: Extremely Low Gestational Age Newborn < 26 weeks
Weight
Low birth weight (LBW)
infant who weighs less than 2,500 grams at delivery
Very low birth weight (VLBW)
infant who weighs less than 1,500 grams at delivery
Extremely low birth weight (ELBW)
infant who weighs less than 1,000 grams at delivery
Incredible Low birth weight
infant who weighs less than 750 grams at delivery
The document discusses updates in obstetrics and gynecology, focusing on Millennium Development Goals 4 and 5 which aim to reduce child and maternal mortality. It then outlines key topics including hyperemesis gravidarum, miscarriages, molar pregnancy, and ectopic pregnancy. For each topic, it defines terms, discusses risk factors, clinical presentation, diagnosis, and management approaches.
This document discusses intrauterine fetal demise (IUFD), also known as stillbirth. It defines IUFD as the death of a fetus in the uterus after 20 weeks of gestation. The document then covers the objectives, incidence, causes and risk factors, maternal complications, types and classifications, diagnosis, and management of IUFD. It describes the various placental, fetal, and maternal conditions that can potentially lead to IUFD, such as preeclampsia, fetal growth restriction, and maternal infections. Methods for diagnosing IUFD include ultrasound, biophysical profile, and Doppler velocimetry. Postmortem examination of the fetus and placenta is also discussed.
This document discusses prenatal diagnosis and screening for fetal abnormalities. It defines prenatal diagnosis as detecting abnormalities in the fetus before birth through various screening and testing methods. The goals of prenatal diagnosis are to provide informed choices for couples at risk, provide reassurance, allow for confirmation of disorders, and enable prenatal management or treatment when possible. Several screening modalities are described that use biomarkers like alpha-fetoprotein, human chorionic gonadotropin, unconjugated estriol, and nuchal translucency measurements to detect disorders like Down syndrome, neural tube defects, and chromosomal abnormalities. Integrated screening combining tests is noted to have the lowest false positive rates.
This document discusses various factors that can cause birth defects and abnormal development, including drugs, chemicals, maternal diseases, infections, and environmental factors. It notes that while only around 2-3% of newborns have congenital malformations, the cause is unknown in 40-60% of cases. Known causes include genetic/chromosomal factors (10-15%), environmental agents (10%), and multifactorial origins (20-25%). Certain drugs are identified as known teratogens, like thalidomide, while others like oral hypoglycemics appear to be safe. The timing and type of exposure can influence the effects. Counseling is important to prevent unnecessary pregnancy terminations due to misperceptions of risk.
Prematurity & and its complication on different organs, Dr Iraguha Bandora Yv...IRAGUHA BANDORA Yves
The document discusses preterm birth and summarizes key information. It defines a preterm baby as one delivered before 37 weeks of gestation. Worldwide, preterm birth complicates 5-18% of births, with rates of 5-9% in Europe and 12-13% in the USA. Prematurity is associated with short and long term complications affecting multiple organ systems. Prevention strategies aim to reduce preterm birth through screening and treating at-risk women. Treatment includes steroids, antibiotics, tocolysis and neonatal care to improve outcomes.
The document discusses Apgar scoring, which evaluates newborns on factors like heart rate, breathing effort, muscle tone, and skin color to assess their transition from fetus to newborn. It notes that various medical factors can affect Apgar scores, either raising or lowering them despite the infant's actual condition. It also presents data showing greatly increased risk of neonatal death for infants with very low 5-minute Apgar scores. Additional sections cover definitions of preterm and postterm birth, risk factors for jaundice, signs that jaundice requires further evaluation, and graphs on neonatal mortality rates and average daily weight gain by postnatal age.
- Stillbirth is defined as fetal death occurring after 20 weeks of gestation or a fetal weight of at least 500 grams. The worldwide stillbirth rate is over 3 million per year.
- The causes of stillbirth are often unknown, but may include maternal conditions like diabetes or hypertension, fetal conditions like growth restriction, and placental conditions like abruption. Advanced maternal age, obesity, and multiple gestations are also risk factors.
- Evaluation of stillbirth includes fetal autopsy, placental examination, and genetic testing. However, the optimal testing and management for subsequent pregnancies after an unexplained stillbirth remains uncertain due to lack of evidence.
The document discusses various topics related to preterm and post-term infants. It defines preterm babies as those born before 37 weeks of gestation and notes that preterm births account for 2/3 of low birth weight babies. Potential causes of preterm birth are discussed. The document also summarizes the characteristics, assessment findings, and care needs of preterm infants. Risk factors and screening for intrauterine growth restriction are outlined. Post-term infants are defined as those born after 42 weeks gestation and their characteristics are summarized. Methods for screening and monitoring post-term pregnancies are also mentioned.
Congenital anomalies are the leading cause of death in the first year of life. They can be malformations, disruptions, deformations, sequences, or syndromes. The causes include genetic factors like chromosomal abnormalities and Mendelian disorders, as well as environmental factors like infections, drugs, chemicals, and radiation exposure. The timing of exposure to teratogens is important, as the embryonic period from 3-9 weeks is highly susceptible. Many congenital anomalies have multifactorial etiologies from interactions between genetics and the environment. Common birth defects in the US include Down syndrome, cleft lip/palate, heart defects, spina bifida, and gastrointestinal anomalies.
This document discusses abortion, including definitions, classifications, causes, diagnosis, management, and complications. It defines abortion as the expulsion or extraction of an embryo or fetus weighing 500g or less. Abortions are classified as spontaneous, threatened, inevitable, incomplete, complete, missed, or septic. Causes include genetic, anatomic, endocrine, infectious, immunological factors. Management involves controlling bleeding, infection, removing products of conception. Complications can be immediate like hemorrhage, or remote like infertility.
This document discusses the classification and care of low birth weight and preterm newborns. It begins by outlining the presentation which will cover classification based on gestational age and birth weight, as well as essential newborn care. The objectives are then stated as describing newborn classification, explaining elements of early care, and outlining care principles. The document proceeds to define terms, discuss epidemiology and risk factors for low birth weight, potential health issues for low birth weight babies, and classification in more depth. Pathogenesis, prevalence, risk factors, causes, clinical manifestations, and diagnosis of preterm birth are also covered.
This document provides information on prematurity and caring for premature babies. It defines prematurity as birth occurring between 28-37 weeks gestation. Key points include:
- Premature babies are at risk due to immature organ systems and low physiologic reserves. The lower the gestational age and birth weight, the higher the risk.
- They are susceptible to conditions like respiratory distress syndrome, intraventricular hemorrhage, and infections.
- Care involves maintaining temperature, respiratory, cardiovascular, nutritional and hematologic status.
- Assessment of preterm babies includes Apgar scoring, physical exam, and determining gestational age using the Ballard exam.
Intrauterine growth restriction (IUGR) refers to a fetus with an estimated weight less than 10th percentile for gestational age. IUGR can occur due to reduced fetal growth potential from genetic/structural issues or infections, or reduced fetal growth support from maternal/placental factors like malnutrition, hypoxia, or drugs. IUGR increases risks of complications during labor like meconium aspiration or fetal distress. Intrauterine death refers to fetal death after 20 weeks of gestation, which can have unknown causes or be due to maternal/fetal/placental conditions like preeclampsia, infections, or cord accidents. Diagnosis involves assessing fetal movement and heart rate. Management depends on gestational
The document discusses fetal growth restriction (FGR) and summarizes an expert panel discussion on the topic. The panelists discuss various aspects of FGR including definitions, phases of fetal growth, factors that can influence growth, ultrasound evaluation techniques, use of Doppler ultrasound, monitoring protocols, and criteria for delivery. Key points addressed include differentiating FGR from SGA, importance of serial ultrasounds and growth curves, criteria for diagnosing growth restriction, and fetal response to hypoxia involving blood flow redistribution.
This document discusses intrauterine growth restriction (IUGR), including definitions, incidence, classification, etiology, diagnosis, complications, prevention, treatment, and management. Some key points:
- IUGR refers to failure of a fetus to reach its growth potential, putting it at risk of morbidity and mortality. SGA refers to weight below 10th percentile for gestational age.
- Incidence of IUGR is 3-5% of pregnancies. Perinatal mortality is 8-10 times higher for growth restricted fetuses.
- Etiology includes fetal, maternal, and placental factors like infections, vascular problems, and placental insufficiency.
- Diagnosis involves clinical
Neonatal jaundice, sepsis, and asphyxia are common neonatal conditions addressed in the document.
[1] Neonatal jaundice is the yellow discoloration of skin from bilirubin accumulation, which is a normal transitional phenomenon in newborns but can become pathological. It is important to differentiate between physiological versus pathological jaundice based on onset and duration.
[2] Neonatal sepsis is a serious bacterial infection occurring in the first 90 days of life, divided into early-onset within 7 days (acquired in utero or birth canal) and late-onset between 7-90 days (acquired from environment). It has non-specific clinical signs but requires
This document provides information about intra-uterine growth retardation (IUGR). It begins with general and specific objectives of the topic. IUGR is defined as fetal growth restriction, and can be classified as symmetrical or asymmetrical based on onset and organ size. Causes include maternal, fetal, placental and unknown factors. Diagnosis involves ultrasound to measure head circumference, abdominal circumference, femur length and amniotic fluid. Complications for the fetus include hypoxia, acidosis, hypoglycemia and multi-organ failure. Long term risks include delayed development and metabolic syndrome in adulthood.
This document summarizes information about spontaneous abortion (miscarriage). It defines spontaneous abortion as the unintentional termination of a pregnancy before viability. The most common causes are identified as fetal chromosomal abnormalities in over 50% of early spontaneous abortions, with aneuploidy being the leading cause. Maternal factors like infections, endocrine abnormalities, nutrition deficiencies, drug/environmental exposures like smoking and alcohol are also discussed as potential contributing causes. The document provides detailed descriptions of the etiology, pathogenesis, clinical presentations and classifications of spontaneous abortion.
1. Intrauterine growth restriction (IUGR) is a complication of pregnancy where the fetus does not attain its full growth potential, affecting up to 10% of pregnancies.
2. Risk factors for IUGR include maternal conditions, fetal anomalies, infections, and placental insufficiency. Abnormal umbilical artery Doppler is associated with increased risk of adverse outcomes.
3. Serial ultrasounds and Doppler studies are used to monitor fetal growth and well-being. Timing of delivery depends on gestational age and severity of IUGR.
1) First trimester fetal death refers to death of the fetus before 12 weeks of gestation, often called a miscarriage. About 80% of spontaneous pregnancy losses occur in the first trimester.
2) Chromosomal abnormalities account for about 50% of first trimester losses, with the most common being trisomy 16, monosomy X, and translocations. Other causes include diabetes, thyroid disorders, infections, and luteal phase defects.
3) Diagnosis involves history, ultrasound to check for cardiac activity, and beta-hcg levels. Management depends on stability of the woman and includes expectant, medical, or surgical options. Recurrent losses should be further evaluated and treated.
An appropriate for gestational age (AGA) baby is one whose size falls within the normal range for their gestational age and sex. AGA babies tend to have the lowest health risks. Gestational age can be determined through physical and neurological criteria. Small for gestational age (SGA) refers to babies smaller than the 10th percentile, while large for gestational age (LGA) means greater than the 90th percentile. Factors that influence birth weight include genetics, infections, fetal growth issues, and maternal health behaviors and characteristics. Complications for SGA infants include respiratory issues and infections, while LGA babies face risks like shoulder dystocia and hypoglycemia. Gestational age and fetal growth are
Local Advanced Lung Cancer: Artificial Intelligence, Synergetics, Complex Sys...Oleg Kshivets
Overall life span (LS) was 1671.7±1721.6 days and cumulative 5YS reached 62.4%, 10 years – 50.4%, 20 years – 44.6%. 94 LCP lived more than 5 years without cancer (LS=2958.6±1723.6 days), 22 – more than 10 years (LS=5571±1841.8 days). 67 LCP died because of LC (LS=471.9±344 days). AT significantly improved 5YS (68% vs. 53.7%) (P=0.028 by log-rank test). Cox modeling displayed that 5YS of LCP significantly depended on: N0-N12, T3-4, blood cell circuit, cell ratio factors (ratio between cancer cells-CC and blood cells subpopulations), LC cell dynamics, recalcification time, heparin tolerance, prothrombin index, protein, AT, procedure type (P=0.000-0.031). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and N0-12 (rank=1), thrombocytes/CC (rank=2), segmented neutrophils/CC (3), eosinophils/CC (4), erythrocytes/CC (5), healthy cells/CC (6), lymphocytes/CC (7), stick neutrophils/CC (8), leucocytes/CC (9), monocytes/CC (10). Correct prediction of 5YS was 100% by neural networks computing (error=0.000; area under ROC curve=1.0).
- Video recording of this lecture in English language: https://youtu.be/kqbnxVAZs-0
- Video recording of this lecture in Arabic language: https://youtu.be/SINlygW1Mpc
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
This document discusses various factors that can cause birth defects and abnormal development, including drugs, chemicals, maternal diseases, infections, and environmental factors. It notes that while only around 2-3% of newborns have congenital malformations, the cause is unknown in 40-60% of cases. Known causes include genetic/chromosomal factors (10-15%), environmental agents (10%), and multifactorial origins (20-25%). Certain drugs are identified as known teratogens, like thalidomide, while others like oral hypoglycemics appear to be safe. The timing and type of exposure can influence the effects. Counseling is important to prevent unnecessary pregnancy terminations due to misperceptions of risk.
Prematurity & and its complication on different organs, Dr Iraguha Bandora Yv...IRAGUHA BANDORA Yves
The document discusses preterm birth and summarizes key information. It defines a preterm baby as one delivered before 37 weeks of gestation. Worldwide, preterm birth complicates 5-18% of births, with rates of 5-9% in Europe and 12-13% in the USA. Prematurity is associated with short and long term complications affecting multiple organ systems. Prevention strategies aim to reduce preterm birth through screening and treating at-risk women. Treatment includes steroids, antibiotics, tocolysis and neonatal care to improve outcomes.
The document discusses Apgar scoring, which evaluates newborns on factors like heart rate, breathing effort, muscle tone, and skin color to assess their transition from fetus to newborn. It notes that various medical factors can affect Apgar scores, either raising or lowering them despite the infant's actual condition. It also presents data showing greatly increased risk of neonatal death for infants with very low 5-minute Apgar scores. Additional sections cover definitions of preterm and postterm birth, risk factors for jaundice, signs that jaundice requires further evaluation, and graphs on neonatal mortality rates and average daily weight gain by postnatal age.
- Stillbirth is defined as fetal death occurring after 20 weeks of gestation or a fetal weight of at least 500 grams. The worldwide stillbirth rate is over 3 million per year.
- The causes of stillbirth are often unknown, but may include maternal conditions like diabetes or hypertension, fetal conditions like growth restriction, and placental conditions like abruption. Advanced maternal age, obesity, and multiple gestations are also risk factors.
- Evaluation of stillbirth includes fetal autopsy, placental examination, and genetic testing. However, the optimal testing and management for subsequent pregnancies after an unexplained stillbirth remains uncertain due to lack of evidence.
The document discusses various topics related to preterm and post-term infants. It defines preterm babies as those born before 37 weeks of gestation and notes that preterm births account for 2/3 of low birth weight babies. Potential causes of preterm birth are discussed. The document also summarizes the characteristics, assessment findings, and care needs of preterm infants. Risk factors and screening for intrauterine growth restriction are outlined. Post-term infants are defined as those born after 42 weeks gestation and their characteristics are summarized. Methods for screening and monitoring post-term pregnancies are also mentioned.
Congenital anomalies are the leading cause of death in the first year of life. They can be malformations, disruptions, deformations, sequences, or syndromes. The causes include genetic factors like chromosomal abnormalities and Mendelian disorders, as well as environmental factors like infections, drugs, chemicals, and radiation exposure. The timing of exposure to teratogens is important, as the embryonic period from 3-9 weeks is highly susceptible. Many congenital anomalies have multifactorial etiologies from interactions between genetics and the environment. Common birth defects in the US include Down syndrome, cleft lip/palate, heart defects, spina bifida, and gastrointestinal anomalies.
This document discusses abortion, including definitions, classifications, causes, diagnosis, management, and complications. It defines abortion as the expulsion or extraction of an embryo or fetus weighing 500g or less. Abortions are classified as spontaneous, threatened, inevitable, incomplete, complete, missed, or septic. Causes include genetic, anatomic, endocrine, infectious, immunological factors. Management involves controlling bleeding, infection, removing products of conception. Complications can be immediate like hemorrhage, or remote like infertility.
This document discusses the classification and care of low birth weight and preterm newborns. It begins by outlining the presentation which will cover classification based on gestational age and birth weight, as well as essential newborn care. The objectives are then stated as describing newborn classification, explaining elements of early care, and outlining care principles. The document proceeds to define terms, discuss epidemiology and risk factors for low birth weight, potential health issues for low birth weight babies, and classification in more depth. Pathogenesis, prevalence, risk factors, causes, clinical manifestations, and diagnosis of preterm birth are also covered.
This document provides information on prematurity and caring for premature babies. It defines prematurity as birth occurring between 28-37 weeks gestation. Key points include:
- Premature babies are at risk due to immature organ systems and low physiologic reserves. The lower the gestational age and birth weight, the higher the risk.
- They are susceptible to conditions like respiratory distress syndrome, intraventricular hemorrhage, and infections.
- Care involves maintaining temperature, respiratory, cardiovascular, nutritional and hematologic status.
- Assessment of preterm babies includes Apgar scoring, physical exam, and determining gestational age using the Ballard exam.
Intrauterine growth restriction (IUGR) refers to a fetus with an estimated weight less than 10th percentile for gestational age. IUGR can occur due to reduced fetal growth potential from genetic/structural issues or infections, or reduced fetal growth support from maternal/placental factors like malnutrition, hypoxia, or drugs. IUGR increases risks of complications during labor like meconium aspiration or fetal distress. Intrauterine death refers to fetal death after 20 weeks of gestation, which can have unknown causes or be due to maternal/fetal/placental conditions like preeclampsia, infections, or cord accidents. Diagnosis involves assessing fetal movement and heart rate. Management depends on gestational
The document discusses fetal growth restriction (FGR) and summarizes an expert panel discussion on the topic. The panelists discuss various aspects of FGR including definitions, phases of fetal growth, factors that can influence growth, ultrasound evaluation techniques, use of Doppler ultrasound, monitoring protocols, and criteria for delivery. Key points addressed include differentiating FGR from SGA, importance of serial ultrasounds and growth curves, criteria for diagnosing growth restriction, and fetal response to hypoxia involving blood flow redistribution.
This document discusses intrauterine growth restriction (IUGR), including definitions, incidence, classification, etiology, diagnosis, complications, prevention, treatment, and management. Some key points:
- IUGR refers to failure of a fetus to reach its growth potential, putting it at risk of morbidity and mortality. SGA refers to weight below 10th percentile for gestational age.
- Incidence of IUGR is 3-5% of pregnancies. Perinatal mortality is 8-10 times higher for growth restricted fetuses.
- Etiology includes fetal, maternal, and placental factors like infections, vascular problems, and placental insufficiency.
- Diagnosis involves clinical
Neonatal jaundice, sepsis, and asphyxia are common neonatal conditions addressed in the document.
[1] Neonatal jaundice is the yellow discoloration of skin from bilirubin accumulation, which is a normal transitional phenomenon in newborns but can become pathological. It is important to differentiate between physiological versus pathological jaundice based on onset and duration.
[2] Neonatal sepsis is a serious bacterial infection occurring in the first 90 days of life, divided into early-onset within 7 days (acquired in utero or birth canal) and late-onset between 7-90 days (acquired from environment). It has non-specific clinical signs but requires
This document provides information about intra-uterine growth retardation (IUGR). It begins with general and specific objectives of the topic. IUGR is defined as fetal growth restriction, and can be classified as symmetrical or asymmetrical based on onset and organ size. Causes include maternal, fetal, placental and unknown factors. Diagnosis involves ultrasound to measure head circumference, abdominal circumference, femur length and amniotic fluid. Complications for the fetus include hypoxia, acidosis, hypoglycemia and multi-organ failure. Long term risks include delayed development and metabolic syndrome in adulthood.
This document summarizes information about spontaneous abortion (miscarriage). It defines spontaneous abortion as the unintentional termination of a pregnancy before viability. The most common causes are identified as fetal chromosomal abnormalities in over 50% of early spontaneous abortions, with aneuploidy being the leading cause. Maternal factors like infections, endocrine abnormalities, nutrition deficiencies, drug/environmental exposures like smoking and alcohol are also discussed as potential contributing causes. The document provides detailed descriptions of the etiology, pathogenesis, clinical presentations and classifications of spontaneous abortion.
1. Intrauterine growth restriction (IUGR) is a complication of pregnancy where the fetus does not attain its full growth potential, affecting up to 10% of pregnancies.
2. Risk factors for IUGR include maternal conditions, fetal anomalies, infections, and placental insufficiency. Abnormal umbilical artery Doppler is associated with increased risk of adverse outcomes.
3. Serial ultrasounds and Doppler studies are used to monitor fetal growth and well-being. Timing of delivery depends on gestational age and severity of IUGR.
1) First trimester fetal death refers to death of the fetus before 12 weeks of gestation, often called a miscarriage. About 80% of spontaneous pregnancy losses occur in the first trimester.
2) Chromosomal abnormalities account for about 50% of first trimester losses, with the most common being trisomy 16, monosomy X, and translocations. Other causes include diabetes, thyroid disorders, infections, and luteal phase defects.
3) Diagnosis involves history, ultrasound to check for cardiac activity, and beta-hcg levels. Management depends on stability of the woman and includes expectant, medical, or surgical options. Recurrent losses should be further evaluated and treated.
An appropriate for gestational age (AGA) baby is one whose size falls within the normal range for their gestational age and sex. AGA babies tend to have the lowest health risks. Gestational age can be determined through physical and neurological criteria. Small for gestational age (SGA) refers to babies smaller than the 10th percentile, while large for gestational age (LGA) means greater than the 90th percentile. Factors that influence birth weight include genetics, infections, fetal growth issues, and maternal health behaviors and characteristics. Complications for SGA infants include respiratory issues and infections, while LGA babies face risks like shoulder dystocia and hypoglycemia. Gestational age and fetal growth are
Local Advanced Lung Cancer: Artificial Intelligence, Synergetics, Complex Sys...Oleg Kshivets
Overall life span (LS) was 1671.7±1721.6 days and cumulative 5YS reached 62.4%, 10 years – 50.4%, 20 years – 44.6%. 94 LCP lived more than 5 years without cancer (LS=2958.6±1723.6 days), 22 – more than 10 years (LS=5571±1841.8 days). 67 LCP died because of LC (LS=471.9±344 days). AT significantly improved 5YS (68% vs. 53.7%) (P=0.028 by log-rank test). Cox modeling displayed that 5YS of LCP significantly depended on: N0-N12, T3-4, blood cell circuit, cell ratio factors (ratio between cancer cells-CC and blood cells subpopulations), LC cell dynamics, recalcification time, heparin tolerance, prothrombin index, protein, AT, procedure type (P=0.000-0.031). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and N0-12 (rank=1), thrombocytes/CC (rank=2), segmented neutrophils/CC (3), eosinophils/CC (4), erythrocytes/CC (5), healthy cells/CC (6), lymphocytes/CC (7), stick neutrophils/CC (8), leucocytes/CC (9), monocytes/CC (10). Correct prediction of 5YS was 100% by neural networks computing (error=0.000; area under ROC curve=1.0).
- Video recording of this lecture in English language: https://youtu.be/kqbnxVAZs-0
- Video recording of this lecture in Arabic language: https://youtu.be/SINlygW1Mpc
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
Basavarajeeyam is a Sreshta Sangraha grantha (Compiled book ), written by Neelkanta kotturu Basavaraja Virachita. It contains 25 Prakaranas, First 24 Chapters related to Rogas& 25th to Rasadravyas.
TEST BANK For Basic and Clinical Pharmacology, 14th Edition by Bertram G. Kat...rightmanforbloodline
TEST BANK For Basic and Clinical Pharmacology, 14th Edition by Bertram G. Katzung, Verified Chapters 1 - 66, Complete Newest Version.
TEST BANK For Basic and Clinical Pharmacology, 14th Edition by Bertram G. Katzung, Verified Chapters 1 - 66, Complete Newest Version.
TEST BANK For Basic and Clinical Pharmacology, 14th Edition by Bertram G. Katzung, Verified Chapters 1 - 66, Complete Newest Version.
TEST BANK For Basic and Clinical Pharmacology, 14th Edition by Bertram G. Katzung, Verified Chapters 1 - 66, Complete Newest Version.
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2. Diseases of Infancy
and Childhood
Congenital Anomalies
Birth Weight and Gestational Age
Birth Injuries
Perinatal Infections
Respiratory Distress Syndrome (RDS)
Necrotizing Enterocolitis
Intraventricular Hemorrhage
Hydrops
Inborn Metabolic/Genetic Errors
Sudden Infant Death Syndrome (SIDS)
Tumors
3. INFANT MORTALITY
USA 1970: 20
USA 2000: 7
USA WHITE: X
USA BLACK: 2X
SWEDEN 3
INDIA 82
4. Major Time Spans
Neonatal period
first four weeks of life
Infancy
the first year of life
Age 1 – 4 years (preschool)
Age 5 – 14 years (school age)
5. MORTALITY by TIME SPAN
NEONATE (0-4 WEEKS): CONGENITAL,
PREMATURITY
UNDER ONE YEAR: CONGENITAL,
PREMATURITY/WEIGHT, SIDS
1-4 YEARS: ACCIDENTS, CONGENITAL,
TUMORS
5-14 YEARS: ACCIDENTS, TUMORS,
HOMICIDES
15-24 YEARS: ACCIDENTS, HOMICIDE,
SUICIDE (NONE ARE “NATURAL” CAUSES)
6. Cause of Death Related
with Age
Causes1
Rate 2
Under 1 Year: All
Causes
727.4
1–4 Years: All
Causes
32.6
5–14 Years: All
Causes
18.5
15–24 Years: All
Causes
80.7
1Rates are expressed per 100,000 population
2Excludes congenital heart disease
8. • Malformations
– primary errors of morphogenesis, usually multifactorial
– e.g. congenital heart defect
• Disruptions
– secondary disruptions of previously normal organ or body region
– e.g. amniotic bands
• Deformations
– extrinsic disturbance of development by biomechanical forces
– e.g. uterine constraint
• Sequence
– a pattern of cascade anomalies explained by a single localized
initiating event with secondary defects in other organs
– e.g. Oligohydramnios (Or Potter) Sequence
• Syndrome
– a constellation of developmental abnormalities believed to be
pathologically related
– e.g Turner syndrome
14. Organ Specific Anomalies
• Agenesis: complete absence of an organ
• Atresia: absence of an opening
• Hypoplasia: incomplete development or
under- development of an organ with decreased
numbers of cells
• Hyperplasia: overdevelopment of an organ
associated with increased numbers of cells
• Hypertrophy: increase in size with no change
in number of cells
• Dysplasia: in the context of malformations
(versus neoplasia) describes an abnormal
organization of cells
15. Implantation and the Survival of
Early Pregnancy
Only 50-60% of all conceptions advance
beyond 20 weeks
Implantation occurs at day 6-7
75% of loses are implantation failures and
are not recognized
Pregnancy loss after implantation is 25-40%
NEJM 2001; 345:1400-1408
16. Approximate Frequency of the More Common Congenital “Malformations” in
the United States
Malformation
Frequency per
10,000 Total
Births
Clubfoot without central nervous system anomalies 25.7
Patent ductus arteriosus 16.9
Ventricular septal defect 10.9
Cleft lip with or without cleft palate 9.1
Spina bifida without anencephalus 5.5
Congenital hydrocephalus without anencephalus 4.8
Anencephalus 3.9
Reduction deformity (musculoskeletal) 3.5
Rectal and intestinal atresia 3.4
Adapted from James LM: Maps of birth defects occurrence in the U.S., birth defects monitoring
program (BDMP)/CPHA, 1970–1987. Teratology 48:551, 1993.
18. CAUSES OF ANOMALIES
Genetic
– karyotypic aberrations
– single gene mutations
• Environmental
– infection
– maternal disease
– drugs and chemicals
– irradiation
• Multifactorial
•Unknown
19. Causes of Congenital Anomalies in Humans
Cause
Frequency
(%)
Genetic
Chromosomal aberrations 10–15
Mendelian inheritance 2–10
Environmental
Maternal/placental infections 2–3
Maternal disease states 6–8
Drugs and chemicals 1
Irradiations 1
Multifactorial (Multiple Genes ?
Environment)
20–25
Unknown 40–60
Adapted from Stevenson RE, et al (eds): Human Malformations and Related Anomalies.
New York, Oxford University Press, 1993, p. 115.
20. Embryonic Development
Embryonic period
weeks 1- 8 of pregnancy
organogenesis occurs in this period
Fetal period
weeks 9 to 38
marked by further growth and maturation
22. Genetic Causes
Karyotypic abnormalities
80-90% of fetuses with aneuploidy die in utero
trisomy 21 (Down syndrome) most common
karyotypic abnormality (21,18,13)
sex chromosome abnormalities next most
common (Turner and Klinefelter)
autosomal chromosomal deletion usually lethal
karyotyping frequently done with aborted
fetuses with repeated abortions
Single gene mutations
covered in separate chapters
23. Maternal Viral Infection
• Rubella (German measles) 1st TRIMESTER
– at risk period first 16 weeks gestation
– defects in lens (cataracts), heart, and CNS
(deafness and mental retardation)
– rubella immune status important part of prenatal
workup
• Cytomegalovirus 2nd TRIMESTER
– most common fetal infection
– highest at risk period is second trimester
– central nervous system infection predominates
25. Teratogen Actions
• Proper cell migration to predetermined locations that
influence the development of other structures
• Cell proliferation, which determines the size and form of
embryonic organs
• Cellular interactions among tissues derived from
different structures (e.g., ectoderm, mesoderm), which
affect the differentiation of one or both of these tissues
• Cell-matrix associations, which affect growth and
differentiation
• Programmed cell death (apoptosis), which, as we have
seen, allows orderly organization of tissues and organs
during embryogenesis
• Hormonal influences and mechanical forces, which
affect morphogenesis at many levels
26. Diabetes Mellitus
Fetal Macrosomy (>10 pounds)
maternal hyperglycemia increases insulin
secretion by fetal pancreas, insulin acts with
growth hormone effects
Diabetic Embryopathy
most crucial period is immediately post
fertilization
malformations increased 4-10 fold with
uncontrolled diabetes, involving heart and CNS
Oral agents not approved in pregnancy
Diabetics attempting to conceive should be
placed on insulin
27. Birth Weight and Gestational Age
Appropriate for gestational age (AGA)
between 10 and 90th percentile for gestational
age
Small for gestational age (SGA) , <10%
Large for gestational age (LGA) , >90%
Preterm
born before 37 weeks (<2500 grams)
Post-Term
delivered after 42 weeks
28. Prematurity
Defined as gestational age < 37 weeks
Second most common cause of neonatal
mortality (after congenital anomalies)
Risk factors for prematurity
Preterm Premature Rupture Of fetal
Membranes (PROM)
Intrauterine infection
Uterine, cervical, and placental abnormalities
Multiple gestation
29. Fetal Growth Restriction
At least 1/3 of infants born at term are < 2.5kg
Undergrown rather than immature
Commonly underlies SGA (small for gestational
age)
Prenatal diagnosis: ultrasound measurements
Classification
Fetal
Placental
Maternal
30. Fetal FGR
Chromosomal abnormalities
17% of FGR overall
up to 66% of fetuses with ultrasound
malformations
Fetal Infection
Infection: TORCH (Toxoplasmosis, Other,
Rubella, Cytomegalovirus, Herpes)
Characterized by symmetric growth
restriction – head and trunk proportionally
involved
31. Placental FGR
Vascular
umbilical cord anomalies (single artery,
constrictions, etc)
thrombosis and infarction
multiple gestation
Confined placental mosaicism
mutation in trophoblast
trisomy is common
Placental FGR tends to cause
asymmetric growth with relative
sparing of the head
32. Maternal FGR
Most common cause of FGR by far
Vascular diseases
preeclampsia (toxemia of pregnancy)
hypertension
Toxins
ethanol
narcotics and cocaine
heavy smoking
33. Organ Immaturity
Lungs
alveoli differentiate in 7th month
surfactant deficiency
Kidneys
glomerular differentiation is incomplete
Brain
impaired homeostasis of temperature
vasomotor control unstable
Liver
inability to conjugate and excrete bilirubin
34. Evaluation Of The Newborn Infant
Sign 0 1 2
Heart rate Absent Below 100 Over 100
Respiratory
effort
Absent Slow, irregular Good, crying
Muscle tone Limp Some flexion of
extremities
Active motion
Response to
catheter in
nostril (tested
after
oropharynx is
clear)
No
response
Grimace Cough or
sneeze
Color Blue, pale Body pink,
extremities blue
Completely
pink
Data from Apgar V: A proposal for a new method of evaluation of the
newborn infant. Anesth Analg 32:260, 1953.
APGAR (Appearance, Pulse, Grimace, Activity, Respiration)
35. Apgar Score and 28 Day Mortality
Score may be evaluated at 1 and
5 minutes
5 minute scores
0-1, 50% mortality
4, 20% mortality
≥ 7, nearly 0% mortality
36. Perinatal Infection
• Transcervical (ascending)
– inhalation of infected amniotic fluid
• pneumonia, sepsis, meningitis
• commonly occurs with PROM
– passage through infected birth canal
• herpes virus– caesarian section for active herpes
• Transplacental (hematogenous)
– mostly viral and parasitic
• HIV—at delivery with maternal to fetal transfusion
• TORCH-Toxo, Other, Rubella, Cmv, Herpes
• parvovirus B19 (Fifth), erythema infectiosum
– bacterial
• Listeria monocytogenes
38. Neonatal Respiratory Distress
Syndrome (RDS)
• 60,000 cases / year in USA with 5000
deaths
• Incidence is inversely proportional to
gestational age
• The cause is lung immaturity with decreased
alveolar surfactant
– surfactant decreases surface tension
– first breath is the hardest since lungs must be
expanded
– without surfactant, lungs collapse with each
breath
39. RDS Risk Factors
1) Prematurity
by far the greatest risk factor
affected infants are nearly always premature
2) Maternal diabetes mellitus
insulin suppresses surfactant secretion
3) Cesarean delivery
normal delivery process stimulates surfactant
secretion
40. RDS Pathology
Gross
solid and airless (no crepitance)
sink in water
appearance is similar to liver tissue*
Microscopic
atelectasis and dilation of alveoli
hyaline membranes composed of fibrin and
cell debris line alveoli (HMD former name)
minimal inflammation
44. RDS Prevention and Treatment
Delay labor until fetal lung is mature
amniotic fluid phospholipid levels are useful in
assessing fetal lung maturity
Induce fetal lung maturation with antenatal
corticosteriods
Postnatal surfactant replacement therapy
with oxygen and ventilator support
45. Treatment Complications
Oxygen toxicity
oxygen derived free radicals damage tissue
Retrolental fibroplasia
hypoxia causes ↑ Vascular Endothelial Growth Factor
(VEGF) and angiogenesis
Oxygen Rx suppresses VEGF and causes endothelial
apoptosis
Bronchopulmonary “dysplasia”
oxygen suppresses lung septation at the saccular stage
mechanical ventilation
epithelial hyperplasia, squamous metaplasia, and peribronchial
and interstitial fibrosis were seen with old regimens of ventilator
usage and no surfactant use, but are now uncommon
lung septation is still impaired
46. Necrotizing Enterocolitis
Incidence is directly proportional to
prematurity, like RDS
approaches 10% with severe prematurity
2000 cases yearly in USA
Pathogenesis
not fully understood
intestinal ischemia
inflammatory mediators
breakdown of mucosal barrier
50. Immune Hydrops
Fetus inherits red cell antigens from the
father that are foreign to the mother
Mother forms IgG antibodies which cross
the placenta and destroy fetal RBCs
Fetus develops severe anemia with CHF
and compensatory ↑ hematopoiesis
(frequently extramedullary)
Most cases involve Rh D antigen
mother is Rh Neg and fetus is Rh Pos
ABO and other antigens involved less often
51. Pathogenesis of Sensitization
Fetal RBCs gain access to maternal
circulation largely at delivery or upon
abortion
Since IgM antibodies are involved in
primary response and prior sensitization is
necessary, the first pregnancy is not
usually affected
Maternal sensitization can be prevented in
most cases with Rh immune globulin
(Rhogam) given at time of delivery or
abortion (spontaneous or induced)
52. Treatment of Immune Hydrops
In utero
identification of at risk infants via blood typing
by amniocentesis, (Chorionic Villi Sampling)
CVS, or fetal blood sampling
fetal transfusions via umbilical cord
early delivery
Live born infant
monitoring of hemoglobin and bilirubin
exchange transfusions
57. PHENYLKETONURIA (PKU)
• Ethnic distribution
– common in persons of Scandinavian descent
– uncommon in persons of African-American and
Jewish descent
• Autosomal recessive
• Phenylalanine hydroxylase deficiency leads to
hyperphenylalaninemia, brain damage, and
mental retardation
• Phenylananine metabolites are excreted in the
urine
• Treatment is phenylalanine restriction
• Variant forms exist
58. GALACTOSEMIA
• Autosomal recessive
• Lactose → glucose + galactose
• Galactose-1-phosphate uridyl transferase (GALT)
– GALT is involved in the first step in the transformation of
galactose to glucose
– absence of GALT activity → galactosemia
• Symptoms appear with milk ingestion
– liver (fatty change and fibrosis), lens of eye (cataracts),
and brain damage involved (mechanism unknown)
• Diagnosis suggested by reducing sugar in urine
and confirmed by GALT assay in tissue
• Treatment is removal of galactose from diet for at
least the two first years of life
60. Cystic Fibrosis (Mucoviscidosis)
Autosomal recessive
Most common lethal genetic disease
affecting Caucasians (1 in 3,200 live births in
the USA)
2-4% of population are carriers
Uncommon in Asians and African-Americans
Widespread disorder in epithelial chloride
transport CFTR affecting fluid secretion in
exocrine glands, (SWEAT)
epithelial lining of the respiratory,
gastrointestinal, and reproductive tracts
Abnormally viscid mucus secretions
61. Cellular Metabolism Of The Cystic Fibrosis
Transmembrane Regulator (CFTR)
Harrison’s Internal Med, 16th Ed
62. CFTR Gene: Normal
Cystic Fibrosis Transmembrane Conductance
Regulator (CFTR)
CTFR → epithelial chloride channel protein
agonist induced regulation of the chloride channel
interacts with epithelial sodium channels (ENaC)
Sweat gland
CTFR activation increases luminal Cl− resorption
ENaC increases Na+ resorption
sweat is hypotonic
Respiratory and Intestinal epithelium
CTFR activation increases active luminal secretion of
chloride
ENaC is inhibited
63. CFTR Gene: Cystic Fibrosis
Sweat gland
CTFR absence decreases luminal Cl− resorption
ENaC decreases Na+ resorption
sweat is hypertonic
Respiratory and Intestinal epithelium
CTFR absence decreases active luminal secretion of
chloride
lack of inhibition of ENaC is opens sodium channel with
active resorption of luminal sodium
secretions are decreased but isotonic
65. CFTR Gene: Mutational Spectra
More than 800 mutations are known
These are grouped into six classes
mild to severe
Phenotype is correlated with the
combination of these alleles
correlation is best for pancreatic disease
genotype-phenotype correlations are less
consistent with pulmonary disease
Other genes and environment further
modify expression of CFTR
67. Organ Pathology
Plugging of ducts with viscous mucus and loss of
ciliary function of respiratory mucosa
Pancreas
atrophy of exocrine pancreas with fibrosis
islets are not affected
Liver
plugging of bile canaliculi with portal inflamation
biliary cirrhosis may develop
Genitalia
Absence of vas deferens and azoospermia
Sweat glands
normal histology
68.
69.
70. Lung Pathology in CF
• More than 95% of CF patients die of
complications resulting from lung infection
• Viscous bronchial mucus with obstruction
and secondary infection
– S. aureus
– Pseudomonas
– Hemophilus
• Bronchiectasis
– dilatation of bronchial lumina
– scarring of bronchial wall
73. CF Diagnosis
Clinical criteria
sinopulmonary
gastrointestinal
pancreatic
intestinal
salt loss
male genital tract
Sweat chloride analysis
Nasal transepithelial potential difference
DNA Analysis
gene sequencing
74. Clinical Course and Treatment
Highly variable – median life expectance is
30 years
7% of patients in the United States are
diagnosed as adults
Clearing of pulmonary secretions and
treatment of pulmonary infection
Transplantation
lung
liver-pancreas
76. Sudden Infant Death Syndrome
NIH Definition
sudden death of an infant under 1 year of age
which remains unexplained after a thorough
case investigation, including performance of a
complete autopsy, examination of the death
scene, and review of the clinical history
“Crib” death
another name based on the fact that most die
in their sleep
77. Epidemology of SIDS
*Leading cause of death in USA of
infants between 1 month and 1 year of
age
90% of deaths occur ≤ 6 months age,
mostly between 2 and 4 months
In USA 2,600 deaths in 1999 (down from
5,000 in 1990)
78. Risk Factors for SIDS
• Parental
– Young maternal age (age <20 years)
– Maternal smoking during pregnancy
– Drug abuse in either parent, specifically paternal marijuana and
maternal opiate, cocaine use
– Short intergestational intervals
– Late or no prenatal care
– Low socioeconomic group
– African American and American Indian ethnicity (? socioeconomic
factors)
• Infant
– Brain stem abnormalities, associated defective arousal, and
cardiorespiratory control
– Prematurity and/or low birth weight
– Male sex
– Product of a multiple birth
– SIDS in a prior sibling
– Antecedent respiratory infections
• Environment
– Prone sleep position
– Sleeping on a soft surface
– Hyperthermia
– Postnatal passive smoking
79. Morphology of SIDS
SIDS is a diagnosis of exclusion
Non-specific autopsy findings
Multiple petechiae
Pulmonary congestion ± pulmonary edema
These may simply be agonal changes as they
are found in non-SIDS deaths also
Subtle changes in brain stem neurons
Autopsy typically reveals no clear
cause of death
80. Pathogenesis of SIDS
Generally accepted to be multifactorial
Triple risk model
Vulnerable infant
Critical development period in homeostatic
control
Exogenous stressors
Brain stem abnormalities, associated
defective arousal, and cardio-respiratory
control
81. Prevention of SIDS
Maternal factors
attention to risk factors previously mentioned
redress problems in medical care for underprivileged
Environmental
avoid prone sleeping
back to sleep program: infant should sleep in supine position
Avoid sleeping on soft surfaces
no pillows, comforters, quilts, sheepskins, and stuffed toys
Sleeping clothing (such as a sleep sack) may be used in
place of blankets.
Avoid hyperthermia
no excessive blankets
set thermostat to appropriate temperature
avoid space heaters
82. Diagnosis of SIDS
SIDS is a diagnosis of exclusion
Complete autopsy
Examination of the death scene
Review of the clinical history
Differential diagnosis
child abuse
intentional suffocation
85. Hemangioma
Benign tumor of blood vessels
Are the most common tumor of infancy
Usually on skin, especially face and scalp
Regress spontaneously in many cases
87. Teratomas
Composed of cells derived from more than
one germ layer, usually all three
Sacrococcygeal teratomas
most common childhood teratoma
frequency 1:20,000 to 1:40,000 live births
4 times more common in boys than girls
Aproximately 12% are malignant
often composed of immature tissue
occur in older children
90. TABLE 10-9 -- Common Malignant Neoplasms of Infancy and Childhood
0 to 4 Years 5 to 9 Years 10 to 14 Years
Leukemia Leukemia
Retinoblastoma Retinoblastoma
Neuroblastoma Neuroblastoma
Wilms tumor
Hepatoblastoma Hepatocarcinoma Hepatocarcinoma
Soft tissue sarcoma (especially
rhabdomyosarcoma)
Soft tissue sarcoma Soft tissue sarcoma
Teratomas
Central nervous system tumors Central nervous system
tumors
Ewing sarcoma
Lymphoma Osteogenic sarcoma
Thyroid carcinoma
Hodgkin disease
91. Small Round Blue Cell Tumors
Frequent in pediatric tumors
Differential diagnosis
Lymphoma
Neuroblastoma
Wilms tumor
Rhabdomyosarcoma
Ewings tumor
Diagnostic procedures
immunoperoxidase stains
electron microscopy
chromosomal analysis and molecular markers
92. Neuroblastomas
Second most common malignancy of
childhood (650 cases / year in USA)
Neural crest origin
adrenal gland, medulla, like a pheo – 40 %
sympathetic ganglia – 60%
In contrast to retinoblastoma, most are
sporadic but familiar forms do occur
Median age at diagnosis is 22 months
93. Neuorblastoma Morphology
Small round blue cell tumor
neuorpil formation
rosette formation
immunochemistry – neuron specific enolase
EM – secretory granules (catecholamine)
Usual features of anaplasia
high mitotic rate is unfavorable
evidence of Schwann cell or ganglion
differentiation favorable
Other prognostic predictors are used by
pathologists and oncologists
97. Clinical Course and Prognosis
Hematogenous and lymphatic metastases to liver,
lungs and bone
90% produce catecholamines, but hypertension is
uncommon
Age and stage are most important prognostically
< 1 year age: good prognosis regardless of stage
Amplification of N-myc oncogene
present in 25-30% of cases and is unfavorable
up to 300 copies on N-myc has been observed
Risk Stratification
low risk: 90% cure rate
high risk 20% cure rate
98. Wilms Tumor
Most common primary renal tumor of
childhood
Incidence 10 per million children < 15 years
Usually diagnosed between age 2-5
5 – 10 % are multi-focal, i.e., bilateral
synchronous
metachronous
99. Clinical Features
Most children present with a large
abdominal mass
Treatment
nephrectomy and combination chemotherapy
two year survival up to
90% even with spread
beyond the kidney
100. Pathogenesis of Wilms Tumor
10% of Wilms tumors arise in one of three
congenital malformation syndromes with
distinct chromosomal loci
Familial disposition for Wilms is rare, and most
of these patients have de novo mutations
Nephrogenic rests of adjacent parenchyma
present in 40% of unilateral tumors, 100% of
bilateral tumors
if found in one kidney, these rests predict an
increased risk for tumor in the contralateral
kidney
101. Pathology of Wilms Tumor
Gross
well circumscribed fleshy tan tumor
areas of hemorrhage and necrosis
Microscopic: triphasic appearance
Blastema: small blue cells
Epithelial elements: tubules & glomeruli
Stromal elements
Anaplasia
correlates with p53 mutation and poor
prognosis and resistance to chemotherapy