ChemPath: Paediatric Clinical Chemistry Flashcards
What is the average birthweight of male babies born at term?
3.3 kg
List some common problems in LBW babies.
- Respiratory distress syndrome
- Retinopathy of prematurity
- Intraventricular haemorrhage
- Patent ductus arteriosus
- Necrotising enterocolitis
What is necrotising enterocolitis?
- Inflammation of the bowel wall progressing to necrosis and perforation
- Characterised by bloody stools, abdominal distension and intramural air (pneumatosis intestinalis)
In the developing fetus, when do:
- Nephrons develop
- Start producing urine
- Have fully competent nephrons
- Achieve functional maturity of glomerular function
- Nephrons develop = week 6
- Start producing urine = week 10
- Have fully competent nephrons = week 36
- Achieve functional maturity of glomerular function = 2 years
What are the implications of the large SA:V ratio of babies?
- Low GFR for surface area
- Results in slow excretion of solute load
- Limited Na+ available for H+ exchange
List some key differences of the neonatal kdineys compared to adult kidneys and their implications.
- Short proximal tubule so lower reabsorptive capability
- Reduce reabsorption of bicarbonate leading to a propensity to acidosis
- Loop of Henle and distal collecting ducts are short and juxtaglomerular leading to reduced concentrating ability (maximum urine osmolality of 700 mmol/kg)
- Distal tubule is relatively unresponsive to aldosterone leading to persisten sodium loss and reduced potassium excretion (sodium loss of 1.8 mmol/kg/day, and upper limit of K+ of 6 mmol/L in neonates)
Why does glycosuria occur at a lower plasma glucose level in neonates?
Short proximal tubule means that they have a lower ability to reabsorb
Describe how body water content is different in neonates compared to adults.
Term neonates are 75% water compared to 60% in adults (and 85% in preterm infants)
What happens to the body water content in the first week of life?
- Pulmonary resistance drops and you get release of ANP leading to redistribution of fluid
- This can lead to up to 10% weight loss within the first week of life
- Roughly 40 mL/kg loss in preterm infants
How are the daily fluid and electrolyte requirements different in neonates compared to adults?
- Sodium, potassium and water requirements are higher
NOTE: sodium requirements are particularly high in preterm neonates (<30 weeks), so plasma Na+ should be measured daily in these patients. K+ supplements should be given once urine output > 1mL/kg/hr has been achieved
Why do babies have higher insensible water loss?
- High surface area
- Increased skin blood flow
- High respiratory rate and metabolic rate
- Increased transdermal fluid loss
NOTE: skin is not keratinised in premature infants
Drugs can cause electrolyte disturbances in neonates. Give examples of drugs that an do this and briefly describe the mechanism.
- Bicarbonate for acidosis (contains high Na+)
- Antibiotics (usually sodium salts)
- Caffeine/theophylline (for apnoea) - increases renal Na+ loss
- Indomethacin (for PDA) - causes oliguria
NOTE: growth can also cause electrolyte disturbance
What is hypernatraemia usually caused by in neonates?
- Dehydration
NOTE: usually uncommon after 2 weeks
NOTE: food poisoning and osmoregulatory dysfunction are differentials
What is hyponatraemia usually caused by in neonates?
Congenital adrenal hyperplasia
Outline the pathophysiology of congenital adrenal hyperplasia.
- Most commonly caused by 21-hydroxylase deficiency
- Leads to reduced cortisol and aldosterone production and shunting of 17-OH progesterone and 17-OH pregnenelone which goes towards androgen synthesis
Outline the clinical features of congenital adrenal hyperplasia.
- Hyponatraemia/hyperkalaemia
- Hypoglycaemia
- Ambiguous genitalia in female neonates
- Growth acceleration
List three reasons for physiological neonatal hyperbilirubinaemia.
- High level of bilirubin synthesis
- Low rate of transport into the liver
- Enhanced enterohepatic circulation
How much bilirubin can 1 g/L of albumin bind?
10 µM/L
How much albumin does the average term neonate have? How much bilirubin can this albumin bind?
34 g/L of albumin
340 µM/L of bilirubin
What is the issue with free bilirubin?
It can cross the blood-brain barrier leading to kernicterus
What are the three bilirubin thresholds in neonates?
- No treatment
- Phototherapy
- Exchange transfusion
List some causes of neonatal jaundice.
- G6PD deficiency
- haemolytic anaemia (ABO, rhesus)
- Crigler-Najjar syndrome
What is prolonged jaundice?
Jaundice that lasts >14 days in term babies or >21 days in preterm babies
List some causes of prolonged jaundice.
- Prenatal infection/sepsis
- Hypothyroidism
- Breast milk jaundice
