Growth Flashcards
What are the three types of growth?
- Physical growth
- Child development
- Emotional growth
Why does growth matter?
It is the most important index of health and wellbeing
What is auxology?
The demographics of growth
What physical measurements of growth do we use?
- Weight
- Height/length
- Head circumference
What is defined as short stature?
More than 2.5 SD velow mean, or child falls outside mid-parental height range
What is considered decreased growth velocity?
Growth of less than 4 cm per year during mid-childhood
Decreased growth velocity less than 25th centile for over 12 months, on growth velocity chart
What is considered faltering growth?
dropping more than two centile lines on a growth chart over a period of 12 months
What are some of the most common causes of short stature?
- Familial short stature
- Short for gestational age with poor catchup
- Extreme prematurity
- Constitutional delay of growth and puberty
- Nutritional or chronic illness
- Chromosome disorder
- Psychosocial deprivation
- Endocrine
What is the first line of investigation for short stature?
FBC, Ferritin, CRP, IIGF-1, coeliac screen, bona age, karyotype
What is the second line of investigation for short stature?
GH provocation test
MRI brain
Skeletal survey
What are the three stages of fetal growth?
- Blastogenesis
- Zygote rapidly divides and embeds in uterus wall
- Embryonic stage
- Organs and membranes develop
- Nutrients primarily from maternal blood
- Critical period of development
- Lack of nutrients will influence baby in this stage a lot
- Fetal stage
- Nutrients supplied via placenta
- Tisses and organs contine to grow
What are the calorie recommendations for pregnancy?
Same calorie intake up until 3rd trimester, then 200kcal/day more because of rapid fetal growth
What two vitamines are absolutely vital during pregnancy?
Folic acid, vitamin D
What are the folic acid RDA?
400 micrograms
What is the vitamin D RDA?
10 microgram
What risks does obesity pose for a pregnant woman?
- Gestational diabetes
- Caesarean
- Pre-eclampsia
- Maternal infection
- Reduced breastfeeding
- Antenatal and postnatal depression
If the mother is obese, what risks does this pose on the baby?
Stillbirth NICU Macrosomia Pre-term Congenital anomalies Increased risk of obesity in early childhood
When is breastfeeding especially important?
First 6 months
What are the main benefits of breastfeeding?
- Optimal nutrition composition
- Contains bioactive factors
- Composition is variable
- Bonding for mother and child
What are the top reasons for mothers not to breastfeed?
- Think they don’t make enough milk
- Baby might not be latching properly
- Too painfully
- Baby too hungry
- Takes too long
What are the three signs a baby may be ready for solids?
- Can stay in a sitting position and hold their head steady
- Can co-ordinate eyes, hands and mouth so that they can look at food, pick it up and into their mouth by themselves
- Can swallow food. Babies who aren’t ready will push food out
How does iron change during pregnancy?
Low iron requirements at first but increases significantly
RBC mass increases
What is the RDA for iron during pregnancy?
14.8 mg per day
What is the RDA for iodine during pregnancy?
140 micrograms per day
When should faltering growth be investigated?
Birth weight below 9th centile - a drop of one or more centiles
Birth weight between 9th - 91st centile - a drop of two or more centiles
Birth weight above 91st centile - a drop of three or more centiles
What are the signs of fetal alcohol syndrome?
Microcephaly, short palpebral fissures, smooth philtrum, thin upper lip, short nose, flat midface.
What do you know about fetal hemoglobin?
This type of haemoglobin has a higher affinity for oxygen due to its higher affinity for 2,3-diphosphoglycerate (DPG).
What is fetal valproate syndrome?
Children born to mothers taking valproate can have a plethora of deformities such as:
Spina bifida
Cleft lip / palate
Developmental delay
Limb defects
How does oestrogen change in pregnancy?
Increases throughout pregnancy
Initially produced in the corpus luteum and then in the fetus.
Stimulates fatty acid and cholesterol synthesis in mother
It helps to prepare or prime the uterus for labour
How does progesterone change in pregnancy?
Increases throughout pregnancy
Initially produced in the corpus luteum and then in the placenta.
Serves as a substrate for fetal adrenal gland production of steroids.
It helps prepare the mammary glands, and inhibits uterine contractility
How does hCG change in pregnancy?
Increases throughout pregnancy
Stimulates CL to keep secreting progesterone
Stimulates thyroid activity by binding TSH receptor
Where is hCG secreted?
Human chorionic gonadotropin (hCG) is a glycoprotein involved in implantation.
It is secreted by syncytiotrophoblasts of the trophoblast cell layer
This communicates with the corpus luteum, which then continues to secrete progesterone to prevent menstruation.
If the blastocyst is defective, hCG levels will plateau, potentially leading to abortion of the fetus.
When does the blastocyst implantate?
Around day 5, the blastocyst emerges from the pellucid zone.
Around day 10, the blastocyst implants itself into the wall of the uterus in three stages
What are the two layers of the trophoblast?
The inner cytotrophoblast layer is where there is lots of mitosis occuring
The outer syncytiotrophoblast layer secretes HCG, lytic enzymes and apoptotic factors that facilitate penetration of the syncytiotrophoblast into the endometrium
What are the three stages of implantation of the blastocyst?
Apposition - the blastocyst comes into contact with the uterine endometrium
Adhesion - microvilli on outer surface of blastocyst interact with endometrium via glycoproteins
Penetration - syncytiotrophoblast grows into wall of uterus
After how many weeks is life sustainable?
22 weeks because differentiation of lung tissue into pneumocytes. Type I alveolar cells are where gas exchange takes place whereas type II alveolar cells are where surfactant is produced.
Premature infants also have insufficient stores of glycogen and brown adipose tissue.
Eye development is also not complete and retinopahty of prematurity can develop where retinal blood vessels grow abnormally potentially causing retinal detachment.
What are the lab tests for Addisons disease?
Plasma adrenocorticotropic hormone (ACTH) is high Morning cortisol is low Sodium is low Potassium is high Urea is high
What are the 4 parts of the ovary?
- Medulla (contains neurovascular features)
- Hillum
- Cortex (contains follicles)
- Cuboidal epithelium
Where is the pituitary gland located?
Superior to the sphenoid sinus, in a pocket of the sphenoid bone
What is the main component of surfactant?
Phospholipid
What do mature lungs need (3 things)?
Mature lungs need three things:
Structural maturity, differentiated epithelial cells and a large vascular network
