Health Care and Medical Information – Freaksofcocks.info

Water represents 70 to 80% of the body weight of the normal neonate and premature baby
respectively. Total body water (TBW) varies inversely with fat content, and prematures have less fat deposits. TBW is distributed into extracellular fluid (ECF) and intracellular fluid (ICF) compartment. The ECF compartment is one-third the TBW with sodium as principal cation, and chloride and bicarbonate as anions.
The ICF compartment is two-third the TBW with potassium the principal cation. The Newborn’s metabolic rate is high and extra energy is needed for maintenance of body temperature and growth. A change in body water
occurs upon entrance of the fetus to his new extrauterine existence. There is a gradual decrease in body water and the extracellular fluid compartment with a concomitant increase in the intracellular fluid compartment. This shift is interrupted with a premature birth. The newborn’s body surface area is relatively much greater than the adults and heat loss is a major factor. Insensible water loss are from the lung (1/3) and skin (2/3). Transepithelial (skin) water is the major component and decreases with increase in post-natal age. Insensible
water loss is affected by gestational age, body temperature (radiant warmers), and phototherapy.
Neonatal renal function is generally adequate to meet the needs of the normal full-term infant but may be
limited during periods of stress. Renal characteristics of newborns are a low glomerular filtration rate and
concentration ability (limited urea in medullary interticium) which makes them less tolerant to dehydration. The neonate is metabolically active and production of solute to excrete in the urine is high. The kidney in the
newborn can only concentrate to about 400 mOsm/L initially (500-600 mOsm/L the full-term compared to 1200 mOsm/L for an adult), and therefore requires 2-4 cc/kg/hr urine production to clear the renal solute load. The older child needs about 1-2 cc/kg/hr and the adult 0.5-1 cc/kg/hr.

Cat Scratch Disease (CSD) is a self-limited condition transmitted by a Bartonella species (Rochalimaea henselae) present in unaffected kitten paws. Following inoculation by a scratch and one to two weeks of incubation period, malaise, fever, headache, anorexia and swelling of

the regional lymph nodes follow.The adenopathy generally develops in the upper extremity (epitrochlear, axilla) or head/neck areas, is minimally tender and can develop fluctuation. Median age is 14 years with highest attack rate in children less than ten years of age. The diagnosis relies on the presence of symptoms, signs, physical exam (characteristic papule at the site of the scratch), history of exposure to a cat, and a positive immunofluorescent assay for Bartonella antibodies. Most patients with clinically diagnosed CSD developed an immunologic response to Bartonella
species. Conservative symptomatic management is recommended for most children since the node will eventually disappear spontaneously. In other cases’ aspiration of fluctuant nodes is alleviating. Antibiotics are recommended during severe cases. Overall prognosis is good

Thyroglossal duct cyst (TDC) is the most common congenital anterior midline neck mass usually (2/3
of cases) presenting before the second decade of life. Symptoms appear at an average age of four with the
sudden appearance of a cystic mass at the angle of neck level moving with tongue protrusion and swallowing.
Males are more commonly affected than females. TDC is an embryologic anomaly arising from epithelial
remnant left after descent of the developing thyroid from the foramen cecum. The lining is cuboidal, columnar or pseudostratified epithelium. TDC is associated to discomfort, infection and a slight probability of malignancy. A legally protective requirement is to document that the mass is not ectopic thyroid gland. Diagnosis is physical. Sonograms will show a cyst between 0.4 and 4 cm in diameter, with variable sonographic appearance and no correlation with pathological findings of infection or inflammation. Once infected surgical excision is more difficult and recurrence will increase. Management is Sistrunk’s operation: Excision of cyst with resection of duct along with the central portion of hyoid bone (a minimum of 10-15 mm of hyoid bone should be removed) and some muscle surrounding the proximal ductules (the length of single duct above the hyoid bone spreads into many ductuli as it approach the foramen cecum). Extensive dissection can cause pharyngodynia. The greatest opportunity for cure is surgery at initial non-inflamed presentation. Inadequate excision is a risk factor for further recurrence.

The endocrine and metabolic response to surgical stress in newborns (NB) is characterized by
catabolic metabolism. An initial elevation in cathecolamines, cortisol and endorphins upon stimulation by
noxious stimuli occurs; a defense mechanism of the organism to mobilize stored energy reserves, form new
ones and start cellular catabolism. Cortisol circadian responsiveness during the first week of life is diminished, due to inmaturation of the adrenal gland. Cortisol is responsible for protein breakdown, release of gluconeogenic amino acids from muscle, and fat lipolysis with release of fatty acids. Glucagon secretion is
increased. Plasma insulin increase is a reflex to the hyperglycemic effect, although a resistance to its anabolic function is present. During surgical stress NB release glucose, fatty acids, ketone bodies, and amino acids;necessary to meet body energy needs in time of increase metabolic demands. Early postoperative parenteral nutrition can result in significant rate of weight gain due to solid tissue and water accumulation. Factors correlating with a prolonged catabolic response during surgery are: the degree of neuroendocrinological maturation, duration of operation, amount of blood loss, type of surgical procedure, extent of surgical trauma, and associated conditions (hypothermia, prematurity, etc.). They could be detrimental due to the NB limited reserves of nutrients, the high metabolic demands impose by growth, organ maturation
a) The full-term, full-size infant with a gestational age of 38 weeks and a body weight greater than 2500
grams (TAGA)- they received adequate intrauterine nutrition, passed all fetal tasks and their physiologic
functions are predictable. b) The preterm infant with a gestational age below 38 weeks and a birth weight
appropriate for that age (PreTAGA); c) The small-for-gestational-age infant (SGA) with a gestational age over 38 weeks and a body weight below 2500 grams- has suffered growth retardation in utero. d) A combination of (b) and (c), i.e., the preterm infant who is also small for gestational age.The characteristic that most significantly affects the survival of the preterm infant is the immature state
of the respiratory system. Between 27 and 28 weeks of gestation (900-1000 grams), anatomic lung
development has progressed to the extent that extrauterine survival is possible. It is only after 30 to 32 weeks of gestation that true alveoli are present. Once there is adequate lung tissue, the critical factor that decides extrauterine adaptation and survival of the preterm infant is his capabilities to produce the phospholipid-rich material, surfactant that lines the respiratory epithelium.