W1 - Introduction to the Newborn Flashcards
how do you weigh babies
babies - naked
toddlers - vest and pants
if someone’s height is on the line or within 1/4 of a space what centile would they be
on the X centile
if someone’s height is not on the line or within 1/4 of a space what centile would they be
between centile X and Y
what is the equation for predicting a child height as a percentile as a boy
target height = (mothers height + fathers height + 13cm) / 2
what is the equation for predicting a child height as a percentile as a girl
target height = (mothers height + fathers height - 13cm) / 2
how many growth phases are there in childhood
3
what is the first growth phase
Infancy: most rapid growth phase
what is the 2nd growth phase
Mid-childhood 5-7cm/year
- NO difference between males and females
what is the 3rd phase of growth
Puberty
Males start puberty later and have a larger growth spurt
what organ controls growth
pituitary
- revise pituitary endocrinology
what is the HPA axis
Hypothalamus
Pituitary
Liver
Growth Plates
IGF-1 and GH
Case 1
- dropping height percentiles (failure to thrive)
- coarse features
- umbilical hernia
- jaundice
- lethargy and floppy
- T4 - low
- TSH - high
DIAGNOSIS
congenital hypothyroidism
what is the treatment
thyroxine
what issue would this couse
irreversible mental handicap
- they hypothyroidism was not caught at birth. Need thyroxine for brain development
Case 2
- preceding growth
- lethargy
- cold intolerance
- goitre
- marked weight gain relative to height
DIAGNOSIS
autoimmune hypothyroidism
- give thyroxine
what is the prognosis
life long condition
will affect school progress not brain development
- tend to go into puberty early
tend to always be small in stature
case 3
- baby faced
- undeveloped scrotum
- on scan - small pituitary gland
- ectopic posterior pituitary gland
DIAGNOSIS
growth hormone deficiency
what can cause growth hormone deficiency
Congenital
Pituitary lesion
Autoimmune
functional
case 4
- short stature
- unwilling to go to school
- small hands
- high palate
- karyotype 45XO/46XX
DIAGNOSIS
turners syndrome
what is the treatment of turners syndrome
check school, kidneys, ovaries etc
BUT
give growth hormone
case 5
- small stature in keeping with parents
- caesarean
DIAGNOSIS
familial short stature
what is constitutional delay in growth
short after 1-2 years
normal growth
associated with delayed puberty
what do you give boys with CDiG
give testoserone to boys
what is prader-willi syndrome
Infantile hypotonia
Insatiable appetite
Short stature
Subtle dysmorphic features
Moderate learning disability
Behaviour problems
15q11 deletion
what is Cushing’s syndrome
Steroid excess
- ACTH dependent
- - Pituitary
- -Ectopic ACTH
- Adrenal tumour
Central obesity
Growth failure
Hypertension
Psychological effects
what is the effect of being overweight in childhood
drives faster growth
tend to start puberty earlier
case 6
- 18 months old
- 75th centile for height
- pubic and axillary hair
- no breast buds
what is the main concern
adrenals
Congenital Adrenal Hyperplasia
- 21 hydroxylase deficiency
how do you manage Congenital Adrenal Hyperplasia
Hydrocortisone
Fludrocortisone
Sodium chloride
Monitor testosterone, bone gap and puberty
