Chempath - paediatric chemistry Flashcards

1
Q

list common problems in LBW babies

A
RDS
ROP
IVH 
PDA 
NEC
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2
Q

features of NEC

A

inflammation of bowel wall progressing to necrosis and perforation
bloody stools
abdominal distension
intramural air (pneumatosis intestinalis)

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3
Q

how do neonatal kidneys differ to adult ones

A

low GFR to surface area - slow excretion of solute load, limited Na+ available for H+ exchange

short proximal tubule - lower resorptive capacity, lower threshold for glycosuria, worse reabsorption of bicarb - acidosis

short LOH/ DCD - reduced concentration ability

distal tubule relatively unresponsive to aldosterone - persistent loss of sodium and reduced potassium excretion (6 normal)

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4
Q

when do neonatal kidneys function

A

nephrons develop week 6
produce urine week 10
fully competent nephrons from 36 w
functional maturity of GFR - 2 years

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5
Q

why do all babies lose weight 1st week of life

A

redistribution of fluid

up to 10% of birth weight

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6
Q

why is there a high insensible water loss in neonates

A

high surface area
increased skin blood flow
high metabolic and RR
increased transdermal fluid loss

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7
Q

what drugs in neonates may cause electrolyte disturbance

A

bicarb for acidosis - contains high Na+
antibiotics - usually sodium salts
caffeine/ theophylline - increases renal sodium loss
indomethacin (for PDA) - oliguria (reduced urine output)

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8
Q

causes of hypernatraemia in neonates

A

uncommon after 2w

associated with dehydration/ overly concentrated milk formula

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9
Q

causes of hyponatraemia in neonates

A

1st 4-5 days:

  • excessive intake
  • SIADH secondary to infection or IVH (rare)

after 4-5 days:
- immature tubular function in patients on diuresis

CAH - addisonian presentation

  • 21-hydroxylase deficiency
  • reduced cortisol and aldosterone
  • high androgens
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10
Q

clinical features of CAH

A
hyponatraemia 
hyperkalaemia
volume depletion
hypoglycaemia 
ambiguous genitalia 
growth acceleration
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11
Q

causes of prolonged jaundice

A

> 14 days term
days preterm

perinatal infection/sepsis
hypothyroidism
breast milk jaundice

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12
Q

calcium and phosphate in neonates

A

laid down in 3rd trimester
phosphate higher in babies
osteopenia of prematurity (fraying, splaying, cupping of long bones) - calcium normal, phosphate low, high ALP, treat with phosphate/calcium supplements

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13
Q

presentation of rickets

A
frontal bossing
bowlegs/ knock knees
muscular hypotonia
tetany/ hypocalcaemic seizures
hypocalcaemic cardiomyopathy
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14
Q

list genetic causes of rickets

A

pseudo- vit D deficiency

familial hypophosphateamias

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