Prematurity and intrauterine growth retardation (IUGR)

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1. Newborn ca!!i"ication ba!ed on weight and ge!tationa age
a. #ppropriate "or ge!tationa age (#G#)
b. $ma "or ge!tationa age ($G#)
%ighe!t mortaity rate
c. &arge "or ge!tationa age (&G#)
U!uay due to materna diabete! meitu!
'. Prematurity
a. Ge!tationa age e!! than () wee*!
U!uay weigh e!! than '500g
b. +o!t common cau!e o" neonata death and morbidity
c. Ri!* "actor!
ii Premature rupture o" membrane!
iii ,horioamnioniti! (e.g.- Streptococcus agalactiae)
iiii Pacenta abnormaitie!
ivi .win pregnancie!
b. ,ompication!
ii Re!piratory di!tre!! !yndrome (R/$- decrea!ed !ur"actant)
iii Necroti0ing enterocoiti! (inte!tina i!chemia)
iiii Intra1entricuar hemorrhage
'. IUGR u!uay occur! in $G# in"ant!.
a. +aterna "actor!
ii +o!t common cau!e o" IUGR in $G# in"ant!
iii 23ampe!4preecamp!ia- diabete! meitu!- drug addiction- acohoi!m-
!mo*ing
b. 5eta cau!e!
ii ,hromo!oma di!order!- congenita ma"ormation!- congenita
in"ection!
iii $ymmetric growth retardation
#""ect! a organ !y!tem! e6uay
c. Pacenta cau!e!
ii #bruptio pacentae- pacenta in"arction
iii #!ymmetric growth retardation
23ampe4the brain i! !pared reati1e to 1i!cera organ! !uch a!
the i1er
Neonata period
1. 5ir!t 7 wee*! o" i"e
'. +a8ority o" death! in chidhood occur during thi! period.
(. ,ommon cau!e! o" death incude R/$ and congenita anomaie!.
Diagnosis of Genetic and Developmental Disorders
#mniocente!i!
U!ed to identi"y prenata genetic de"ect!
#mniocente!i!
U!ed to identi"y prenata genetic de"ect!
Utra!ound
U!ed to rue out neura tube de"ect!
+aterna tripe mar*er !creen
1. 945etoprotein (#5P)
a. Increa!ed in neura tube de"ect!
b. ,au!ay reated to "oate de"iciency prior to conception.
'. %uman chorionic gonadotropin (h,G)
o &e1e! 1ary with ge!tationa age.
2. Urine "or uncon8ugated e!trio
o 23ceent mar*er o" "eta- pacenta- or materna dy!"unction
3. .ripe mar*er "inding! in /own !yndrome
a. #5P decrea!ed
b. h,G increa!ed
c. Urine e!trio decrea!ed
Genetic anay!i!
1. ,hromo!ome *aryotyping
o Identi"ie! numeric and !tructura abnormaitie!
'. /N# poymera!e chain reaction
o #mpi"ie! /N# "ragment! harboring abnorma gene oci
(. Re!triction "ragment ength poymorphi!m (R5&P)
o Identi"ie! abnorma gene when the e3act !ite i! un*nown
Aging
.heorie!
1. $tocha!tic theory
a. ,umuati1e in8ury to ce membrane! and /N# due to "ree radica in8ury
b. Increa!ed cro!!4in*ing o" protein!
/ecrea!e! ea!ticity
c. #ccumuation o" error! in protein !ynthe!i! ad1er!ey a""ect! ceuar "unction.
'. Programmed
o #popto!i! gene! are programmed to *i ce! at a !et time.
.heorie!
1. $tocha!tic theory
a. ,umuati1e in8ury to ce membrane! and /N# due to "ree radica in8ury
b. Increa!ed cro!!4in*ing o" protein!
/ecrea!e! ea!ticity
c. #ccumuation o" error! in protein !ynthe!i! ad1er!ey a""ect! ceuar "unction.
'. Programmed
o #popto!i! gene! are programmed to *i ce! at a !et time.
Table 5-6. Age-Dependent Changes
System Description
#uditory Pre!bycu!i!: !en!orineura hearing o!!- particuary at high "re6uency
;to!cero!i!: "u!ion o" ear o!!ice! producing conducti1e hearing o!!
,ardio1a!cuar &o!! o" ea!ticity in aorta (increa!e! !y!toic pre!!ure)
,N$ ,erebra atrophy with mid "orget"une!!
Impaired !eep pattern! !uch a! in!omnia- eary wa*ening
/ecrea!ed dopaminergic !ynthe!i!: par*in!onian4i*e gait
5emae reproducti1e <rea!t and 1u1ar atrophy
/ecrea!ed e!trogen and proge!terone: increa!ed 5$% and &%- re!pecti1ey
Ga!trointe!tina /ecrea!ed ga!tric acidity: predi!po!e! to Helicobacter pylori in"ection
/ecrea!ed coonic motiity: con!tipation predi!po!ing to di1erticuo!i!
Genera Increa!ed body "at: decrea!ed number in!uin receptor! (guco!e intoerance)
Immune /ecrea!ed !*in re!pon!e to antigen! (caed anergy)
+ae reproducti1e Pro!tate hyperpa!ia: predi!po!e! to urinary retention
Pro!tate cancer
+u!cuo!*eeta ;!teoarthriti! in weight4bearing 8oint!
Rena /ecrea!ed G5R: increa!ed ri!* o" drug to3icity "rom !ow cearance o" drug!
Re!piratory +id ob!tructi1e pattern in pumonary "unction te!t!: e.g.- increa!ed .&,
+id hypo3emia and increa!ed #4a gradient
$*in /ecrea!ed !*in ea!ticity due to increa!ed cro!!4bridging o" coagen
$enie purpura o1er the dor!um o" the hand! and ower eg!
=i!ua ,ataract!: 1i!ua impairment- increa!ed ri!* "or "a!
Pre!byopia: inabiity to "ocu! on near ob8ect!
#4a- a1eoar4arteria> ,N$- centra ner1ou! !y!tem> 5$%- "oice !timuating hormone> G5R- gomeruar "itration rate> &%-
uteini0ing hormone> .&,- tota ung capacity.
Disorders > Aging > Age-related changes
#ge4reated change!
Re"er! to change! that ha1e a greater incidence with age but are not ine1itabe
Table 5-7. Age-elated Changes
System Description
,ardio1a!cuar #thero!cero!i!: increa!ed ri!* "or coronary artery di!ea!e- periphera 1a!cuar
di!ea!e- !tro*e!
#ortic !teno!i!: mo!t common 1a1uar abnormaity in the edery
$y!toic hyperten!ion: due to o!! o" aortic ea!ticity
,N$ #0heimer?! di!ea!e: mo!t common cau!e dementia in peope @65 year! od
Par*in!on?! di!ea!e
$ubdura hematoma!: due to "a!
2ndocrine .ype ' diabete! meitu!
5emae reproducti1e Increa!ed incidence o" cancer! o" the brea!t- endometrium- o1ary
Ga!trointe!tina Increa!ed incidence o" coorecta cancer
Immune +GU$: mo!t common cau!e o" monocona gammopathy
+u!cuo!*eeta ;!teoporo!i!: 1ertebra coumn in "emae! and "emora head in mae!
RenaAower urinary
tract
Reno1a!cuar hyperten!ion !econdary to athero!cero!i!
Urinary incontinence
Re!piratory Pneumonia: u!uay Streptococcus pneumoniae
Primary ung cancer: particuary in !mo*er!
$*in U=<4induced cancer!: e.g.- ba!a ce carcinoma (mo!t common)
#ctinic (!oar) *erato!i!: precur!or "or !6uamou! ce carcinoma
Pre!!ure !ore!: pre!!ure on capiarie! i! the mo!t important ri!* "actor
=i!ua +acuar degeneration: mo!t common cau!e o" bindne!! in the edery
,N$- centra ner1ou! !y!tem> +GU$- monocona gammopathy o" undetermined !igni"icance> U=<- utra1ioet ight <.