2.disorders of prematurity; pediatric pathology
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Pediatric PathologyPediatric Pathology
Dr. Krishna Tadepalli, MD, www.mletips.com
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2. Disorders of Prematurity2. Disorders of Prematurity
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Disorders of Prematurity• Depends on birth weight( 2,300gm) and gestational age (34weeks), infants are
classified into1. Appropriate for gestational age ( AGA) = between 10th to 90th percentile2. Small for gestational age (SGA) below 10th percentile3. Large for gestational age (LGA) = above 90th percentile
• Pre- term = born before 37 weeks • Post – term = after 40 (?)weeks
• Causes of Prematurity = 2nd MCC of neonatal mortality, • Preterm premature rupture of membranes (PPROM) ;- 1/3rd of preterm
deliveries, risk factors are many ( previous episode, vaginal bleeding, smoking, poor nutrition etc.,)
• Intrauterine infection ;- 25% of all preterm labors, mainly due to placental infection, MC organisms Ureaplasma, Mycoplasma, Gardnerella, Trichomonas, Gonorrhea, Chlamydia; TLRs (TLR4) are key factors;
• Uterine, cervical & placental abnormalities ;- • Multiple gestations ( twin pregnancy)
Dr. Krishna Tadepalli, MD, www.mletips.com
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Disorders of Prematurity1. Fetal Growth Restriction (FGR) = low birth weight (<2500 gm); same as SGA;
also called intra uterine growth retardation (IUGR); – Risk factors (Fetal chromosomal, congenital anomalies or infections; Placental
Uteroplacental insufficiency, genetic mosaicism of placenta (Trisomy 7); Maternal toxemia of pregnancy, chronic HTN, malnutrition and Drugs & chemicals ( smoking and alcohol)
2. Neonatal RDS = DAD or Hyaline Membrane Disease; MCC of RDS Hyaline Membrane Disease (others – maternal sedation, fetal head injury etc.,); almost always preterm and AGA babies; other associations – male baby, Maternal Diabetes, C-section; X-ray of lungs ground glass like; the most important underlying factor = immaturity of lungs (lack of surfactant); – surfactant is important for innate immunity and decrease surface tension;
hyaline membrane = protein and fibrin rich exudate with necrotic type II pneumocytes, never seen in still born; hormones increase (Glucocorticoids) or decrease (insulin) surfactant synthesis;
– Grossly = solid (atlectatic) lungs, liver like, sink in water – Rx = exogenous surfactant + Oxygen; antenatal Glucocorticoids to mother;
delay labor; – Complications of Rx = Retinopathy of prematurity and Broncho-pulmonary
dysplasia, PDA, Intraventricular H.age, Necrotizing Enterocolitis
Dr. Krishna Tadepalli, MD, www.mletips.com
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RDS - PathogenesisRDS - Pathogenesis
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Anderson
Patchy Atelectasis – Neonatal LungsPatchy Atelectasis – Neonatal Lungs
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Hyaline MembraneHyaline Membrane
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Hyaline MembraneHyaline Membrane
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Anderson Dr. Krishna Tadepalli, MD, www.mletips.com
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Disorders of Prematurity3. Necrotizing Enterocolitis (NEC)• MC in Premature babies• Pathogenesis – unknown (? Multifactorial)• Associated with prematurity, enteral feeding or formula milk
(bacterial introduction), inflammatory mediators (PAF) are important ( increased mucosal permeability);
• Clinically bloody stools, abdominal distention, CVS collapse• Diagnosis = air in the intestinal walls (Pneumatosis intestinalis)
involves terminal ileum and large intestines; • Microscopy mucosal or mural necrosis, ulceration, bacterial
colonization, gas in walls, • Rx = needs bowl resection with high mortality, • Complication post – NEC strictures ( due to healing by fibrosis)
Dr. Krishna Tadepalli, MD, www.mletips.com
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NECNEC
Dr. Krishna Tadepalli, MD, www.mletips.com