G:\Děti II\sejmout0038.jpg PEDIATRIC´S PHYSIOLOGY Physiological peculiarities in children GROWTH PERIODS •CHILDREN üNewborn: 0 –28 days after born (1 month) üSuckling: 2 – 12 month üCommon term: infancy ü ü1 – 4 years old ü(Toddler 1 –3 years old) üCommon term: early childhood GROWTH PERIODS ü5 – 12 years old – late childhood ü üOther special terms: üPre-school period 5 – 7 years üSchool period – younger, older GROWTH PERIODS •ADOLESCENCE ü13 – 20 years old üThe other special terms: üTeenager -19 years üPubertas 11-15 years Evaluation of child´s development based on anthropometric parameters: WEIGHT •Birthweight: 2 500 - 3 800 g •Double birthweight: 4-5 mo •Triple birthweight: 1yr •Quadruple birthweight: 2 yr • •Pecularity in newborn: Weight loss in first few days : 5-10% of birthweight •Return to birthweight: 4 -7 days of age • •AVERADGE weights: • at birth: 3.5 kg • at 1 yr: 10 kg • at 5 yrs: 20 kg • •DAILY weight gain – important for evaluation of nutritional state: • 20-30g for first 3-4 mo • 15-20 g for rest of the first year G:\Děti II\sejmout0027.jpg The graphs were constructed based on the measurements of a large number of children. The values were statistically processes and percentile curves were generated. Physiological development meaens when the value of the measured person is in the range of the 10th-90th percentille. HEIGHT •AVERADGE length: 20 in (50 cm) at birth • 30 in (75 cm) at 1 yr • at age 3 yr, the averadge child is 3 ft tall • at 4 yr, the averadge child is 40 in (100 cm) tall (double birth length) •Averadge ANNUAL length increase: 2-3 in (5-7 cm) between age 4 yr and puberty G:\Děti II\sejmout0028.jpg HAED CIRCUMFERENCE (HC) •Averadge HC: 35 cm at birth (13.5 in) •HC increases: • 1 cm per mo for first year • 2 cm per mo for first 3 mo, then slower Newborn according the weeks of gestation and birth weight •Preterm infant (premature – earlier than 38weeks of gestation) üLow birthweight infants (LBW): • less than 2 500 g üVery low birthweight (VLBW): • less than 1 500 g •Full-term infant (38 – 40 weeks of gestation) • birthweight 3 000 - 3 500 g, 48-52 cm length, head circumference 35cm •Ower-term infant (41 – 42 weeks of gestation) • 4000 - 6 000g, 53 - 56 cm G:\Děti II\sejmout0024.jpg 36th week 38th week 40th week week of gestation The skin is covered by white muzzle – vernix caseosa Examination of newborn at the delivary room •Apgar score • Signs Points • 0 1 2 üHeart rate: 0 <100 /min >100/min ü üRespiration: none weak cry vigorous cry ü üMuscle tone none hypotonic-hypertonic limb flexion ü ü reflex irritability: none some motion cry, withdrawal • üColor of body: blue pink body, pink all over • blue extremities •more than 50 years - determined the newborn hope of survival • •now - as a recommendation for nursing practice G:\Děti\sejmout0012.jpg TRANSITION FROM FETAL TO NEONATAL PHYSIOLOGY •Specialities of fetal circulation: üPlacenta, where deoxygenated blood becomes oxygenated ü1 Umbilical vein – well-oxygenated blood ü2 Umbilical arteries – deoxygenated blood üForamen ovale üDuctus arteriosus Botalli üDuctus venosus G:\Děti II\sejmout0032.jpg RESPIRATORY SYSTEM •Respiratory movements – started about 20 weeks of gestation • • •Surfactant secretion: üA substance normally secreted into the alveoli that decreases the surface tension of the alveolar fluid, therefore allowing the alveoli to open easily during inspiration üThe surfactant secreting cells ( the type II alveolar epithelial cells) started secretion about 20 weeks of gestation •Estimation of pulmonary maturity: • ratio Lecithin/sphingomyelin production 2:1 •Dicrease of surfactant: Respiratory distress syndrome • NEONATAL JAUNDICE •Bilirubin formed in the fetus can cross the placenta into the mother and be excreted through the liver of the mother •But •Immediately after birth the only means for ridding the neonate of bilirubin is through the neonate´s own liver, which for the 1st weeks has poorly functions (without any reserves), and decrease capacity for conjugating system of bilirubin and its excretion into the bile •The plasma bilirubin concentration rises during the first 3 days of life and then gradually falls back to normal as the liver becomes functional • •This condition called physiologic hyperbilirubineamia and it is associated with a mild jaundice of the infant´s skin and especially of the sclerae of its eyes C:\Documents and Settings\ja\Dokumenty\Obrázky\bilirubin1.jpg C:\Documents and Settings\ja\Dokumenty\Obrázky\bilirubin2.jpg C:\Documents and Settings\ja\Dokumenty\Obrázky\bilirubin3.jpg C:\Documents and Settings\ja\Dokumenty\Obrázky\bilirubin4.jpg TEMPERATURE •In utero thermoregulation of the fetus is performed by the placenta, which is as an efficient heat exchanger •Fetal temperature is higher than the mother´s temperature: about 38.5 °C •After birth, the newborn infant begins life covered by amniotic fluid and situated in a cold environment: 20-25 °C •An infant´s skin temperature may fall 0.3 °C/min and the core temperature may decline 0.1 °C/min in the delivery room • •Because the body surface area is large in relation to body mass, heat is readily lost from the body •The ideal environmental temperature is called as the neutral thermal environment: the ambient temperature resulting in the lowest rate of heat production and the lowest consumption of oxygen by the infants while maintaining normal body temperature •1 hour after birth: 33-34 °C •1 day after birth: 31-33 °C •1 weeks after birth: 27-33 °C G:\Děti II\sejmout0034.jpg G:\Děti II\sejmout0039.jpg G:\Děti II\sejmout0040.jpg Empress Catherine the Great, Russia, 18th century survival against the russian winter G:\Děti II\sejmout0041.jpg Immune system •a main prenatal imunoglobulin = IgG: –passes through the placenta –At the birth – the same level as in mother –at birth is the same concentration as in the mother's body –gradually decreasing its concentration –in 3rd to 10th week reached the lowest values then again levels increase •IgM forms newborns aged 1-2 weeks • •IgA occurs at the age of one month, then the concentration slowly increases –(IgA is rich colostrum and breast milk) •After birth: üErythrocytes = 5-6 x 1012/l üLeukocytes = 20-22 x 10 9 /l üHemoglobin = 190 g/l •At 3 month of live: üErythrocytes = 4 x 10 12/l üLeukocytes = 10.5 x 10 9/l üHemoglobin = 110 g/l BLOOD - composition G:\Děti II\sejmout0026.jpg CARDIOVASCULAR SYSTEM Heart rate according age •Newborn 135-140 beat per minute •6 month 130-135 •1 year 120-125 •2 years 110-115 •5 years 98-100 •8 years 80-85 •15 years 70-76 Blood pressure •Immediately after birth – high blood pressure: –Stress after delivery, increase concentration of catecholamine and cortizol •After 1st day …….. 70/50 mmHg: –Open of pulmonary and intestine circulation •During pubertas: –Development of regulatory mechanism –Stimulation of external world •Newborn 80/46 mmHg 10,6/6,1 kPa •3 years 100/67 13,3/8,9 •10-11 years 111/58 14,8/7,7 •13-14 years 118/60 15,7/8,0 GIT and NUTRITION •In general, the ability of the neonate to digest, absorb, and metabolize foods is not different that of the older child, with the following 3 exceptions: ü1. Secretion of pancretic amylase is deficient ü2. Absorption of fats from the gastrointestinal tract is somewhat less than that in the older child (milk with a high fat content - such as cow´s milk, is inadequately absorbed) ü3. The liver function during at least the 1st week of life, the glucose concentration in the blood is unstable and low • Nutritionale needs during the early weeks of life •Need for calcium and vitamin D •Necessity for iron in the diet • •The correct and natural nutrition: ü breast milk and is necessary supported breast feeding G:\Děti III\sejmout0042.jpg G:\Děti III\sejmout0043.jpg G:\Děti III\sejmout0044.jpg G:\Děti III\sejmout0045.jpg The breast and its mammary gland Lactiferous duct Lactiferous sinus -ampulla G:\Děti III\sejmout0046.jpg Correct position of mammilla (nipple) during breastfeeding G:\Děti III\sejmout0048.jpg G:\Děti III\sejmout0049.jpg areola nipple State screening for metabolic disorder in neonate •Congenital hypothyroidism: usually arises as a sporadic mutation which causes an insufficient production of thyroxine üThe expected incidence of the disorder is as 1: 5 000 births üThe initial screening test is teh thyroxine radioimunoassey, which may be done on a heel stick blood spot at the first week after birth •Phenylketonuria (PKU) üthe annual incidence of this inborn error of metabolism is 1:16 000 live births. If the condition is not detected and treated during the first few month of life, severe or profound mental retardation occurs üScreening provide by Guthri inhibition assey test – blood spots specimen obtained from a heel stick üAs soon PKU is detected, a low phenylalanine diet is begun THEORY of AGE C:\Documents and Settings\ja\Dokumenty\Obrázky\81-svetsenioru.jpg Elderly period • •Earlier senior: 65 - 75 years old •Middle senior: 75 - 85 years old •Late senior: above 85 years old • •The „AGING“ is programming biological process • Theory of „aging“ •„Free radicals“ • •– primary reason for aging is: damages of macromolecules and structures of cells by biochemistry reactions of free oxygen radicals •(oxygen free radicals damaging our bodies are „taxes“ that people breathe oxygen on the Earth) •Neuroendocrine theory • -This theory is based on the fact, that the secretion of hormone melatonin is reduce with age (as „youth hormone“; pineal gland – coordinates of circadian rhythms) •Gene theory •Increase a lot of mutations in the cells during all of the lifetime, the mutations are a primary cause of the aging •Theory of programming of aging is based on the idea that the function of genes is reduced in time (e.g. Apoptosis – programming death of the cells) •Theory based on the hypothesis that exist „any genetic programme“ (Hayflick 1985 – observing the families with longevity) The symptoms of aging •Reduction of function of all organ systems: • loco-motor function – as general and final, decreas of forces of sceletal muscles • reduction of capacity of the lungs, cardiac output, cardiac reserve, function of excretory system, liver, metabolism •reduction of number of neurons in the brain (central nervous system) •The other symptoms: •Changes in places of fat deposits •Changes of the skin hair •Changes in the memory – main in the short-term memory •Changes of the behavior – non-tolerance, depression Thank you for your attention „Everyone is old, depending on how he/she feels to be old“