PEDIATRIC PHYSIOLOGY Repetition of fetal blood circulation - how and why individual short circuits are closed: foramen ovale - pressure reasons; ductus arteriosis Botalli - change of partial pressure o2 (saturation); ductus venosus - a change in the strength of the blood flow through this duct; umbilical vessels - manipulation of the umbilical cord activates all 3 types of muscle fibers present in the wall of these vessels (circular, longitudinal, transverse) - everything leads to vasoconstriction. 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 the thyroxine radioimunoassey, which may be done on a heel stick blood spot at the first week after birth •Phenylketonuria (PKU) •Hereditary disorder of phenylalanine (Phe) metabolism with a predominantly autosomal recessive type of heredity. The essence is a disorder of Phe conversion, which results in an increase in the level of Phe in tissues and serum. The result is the formation of abnormal Phe catabolites that damage brain tissue; without early detection and early treatment with a low Phe diet, mental retardation begins (IQ below 50) 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 Hereditary disorder of phenylalanine (Phe) metabolism with a predominantly autosomal recessive type of heredity The essence is a disorder of Phe conversion, which results in an increase in the level of Phe in tissues and serum The result is the formation of abnormal Phe catabolites that damage brain tissue; without early detection and early treatment with a low Phe diet, mental retardation begins (IQ below 50) 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 Breast milk is the best……… ….. in the world. The breast and its mammary gland Lactiferous duct Lactiferous sinus -ampulla Fat tissue Milk producing cell Connective tissue Muscle cells Proper grip of the breast (nipple) through the baby's mouth and sucking areola nipple Tongue lip gums bad grip of the nipple, only pacification with the possibility of damage to the nipple Left - description; right - bad grip of the nipple, only pacification with the possibility of damage to the nipple •Period of non-milk additions in children nutrition: 5th – 7th month •5th month: vegetable soup – meat-vegetable supplement, boiled egg yolk 2/week (not eggwhite-albumen), vegetable oil 5-10g •Replacement of breast milk (e.g. SUNAR, other products (Nutrilon, Hipp…) •6th month: fruits-milk supplement , cottage cheese, yoghurt, mixed fruits, sugar free •7th month – cereals with gluten, pap, biscuits •milk period 0-6 month •non-dairy period and transition period to a mix diet (lunchtime is replaced with the soup) This is a very general overview of how to gradually convert a child into a mixed diet using the Czech breast milk substitute - Sunar. Today there is a huge amount of milk, please refer to the experience of your pediatrician or pediatric teacher dealing with baby food. -someone Beba… milk against blinking, milk with probiotics, milk with prebiotics ……… •transition period to a mix diet 8th – 12th month •The same diet as in the previous slide •+ from 9th month – a piecemeal, grainy diet •important fiber (fruit juices, juices, oat flakes ...) - increases the water content of the intestinal contents - slows the passage time through the intestines - has a beneficial effect on microbiology (microecology) in the large intestine • •fibrous indigestible material in vegetable foodstuffs that aids the passage of food has a good influence to intestine function trvalé zuby Sinel mléčné zuby Sinel Milk teeth Permanent teeth Psycho-motor development •Gross motor control •Fine motor control •Language •Personal – social control PSYCHOMOTOR DEVELOPMENT Neurological examination, based on the presence or absence of certain types of reflexes that reflect the proper development of the nervous system, is also helpful in assessing the child's proper well-being. •Newborn reflexes: •(primary neonatal reflexes - congenital) •palmar grasp (grip) •the rooting reflex as you touch the face of the newborn, he turns his head to the side of the touch… searches…..what about? ... eating. •labial – suckling – swallow •Moro-opening of the hands and extension and abduction of the arms is an example of positional vestibular reflex. Reaction (extension of the head and limbs and return of the upper limbs to the crossed position) to a fast and short linear jerk of the pad under the lying newborn, which simulates horizontal movement. The disappearance of this typical reaction by the 3rd month of life is evidence of the physiological development of the CNS Neurological examination, based on the presence or absence of certain types of reflexes that reflect the proper development of the nervous system, is also helpful in assessing the child's proper well-being. The slide describes the most basic reflexes that occur immediately after birth - congenital (no one taught the baby). The grip reflex is basically so-called rudimentary .. our babies no longer need it .. it has persisted since the time of our ancestors - monkeys, so when it moves from tree to tree, the monkey young must hold very tight for her. The rooting reflex - as you touch the face of the newborn, he turns his head to the side of the touch… searches…..what about? ... eating. Moro reflex - is an example of positional vestibular reflex. Reaction (extension of the head and limbs and return of the upper limbs to the crossed position) to a fast and short linear jerk of the pad under the lying newborn, which simulates horizontal movement. The disappearance of this typical reaction by the 3rd month of life is evidence of the physiological development of the CNS. (pevné uchopení předmětu) (plazení se) (tahá za věci) ---------Crawl on their knees – lézt po kolenou The following 5 slides show different scales for evaluating psychomotor development - large motor skills, fine motor skills, social behavior, etc.