Paediatric Clinical Chemistry Flashcards
What babies are most at risk of death?
Very low birth weight babies
Explain foetal nephron development
Start to develop at week 6
Produce urine at week 10
Full complement of nephrons by week 36
When is functional maturity of GFR achieved?
2 years of age
What is the baby response to aldosterone like?
Distal tubule is relatively UNRESPONSIVE
So there is loss of Na
and reduced potassium excretion
What happens to babies weight after they are born?
They lose weight (up to 10%) due to redistribution of fluid
What are a babies fluid requirements like?
much higher compared to adults
What are causes of hypernatraemia in babies?
DEHYDRATION
occasionally SALT POISONING
What is the main cause of acute hyponatraemia in babies?
Congenital adrenal hyperplasia
Explain congenital adrenal hyperplasia
Deficiency of 21 hydroxylase
Leads to reduced cortisol and aldosterone, leading to salt loss
Also to an accumulation of androgens
What are the clinical features of CAH
hyponatraemiab
hyperkalaemia
hypoglycaemia (lack of cortisol)
ambivalent genitalia in F
What are causes for neonatal hyperbilirubinaemia?
High bilirubin synthesis
Low rate of transport into liver
Enhanced enterohepatic circulation
is bilirubin conj/unconj in neonates?
generally unconjugated
if conjugated, it is PATHOLOGICAl
What is a dangerous occurrence with high free bilirubin?
Kernicterus (bilirubin encephalopathy)=
What are treatments for high bilirubin in neonates?
None
phototherapy
exchange transfusion
What are causes of unconj bilirubin?
haemolytic anaemia
G6PD deficiency
Crigler-Najjar syndrome
What is prolonged jaundice?
jaundice lasting >14 in term babies and >21 days in preterm babies
What are causes of prolonged jaundice?
prenatal infection
hypothyroidism
breastmilk jaundice
What are causes of conjugated bilirubin in neonates?
Biliary atresia
Choledochal chest
Ascending cholangitis caused by TPN
Inherited metabolic diseases eg. galactosaemia
Which trimester are most Ca and PO laid down in?
In last trimester
What is osteopenia of prematurity?
Ostopoenia in premature babies born before the last trimester, as they did not have time to lay down bone
What bloods are important to identify osteopenia of prematurity?
Phosphate will be LOW
calcium may be normal as it is the last to drop
How do you treat osteopenia of prematurity?
Phosphate/calcium supplements
1 alpha calcidol
