ELECTIVE COURSE

"PUBLIC HEALTH ASPECT OF

CHILDHOOD DISEASES ¨“

Slides focused on questions from the test

april 2023
Newborns according body weight
• Appropriate weights for the duration of pregnancy - neonatus
eutrophicus

• Too little weight for the duration of pregnancy - neonatus

hypotrophicus

• Overweight for the duration of pregnancy-neonatus hypertrophicus

 Preterm newborn weight
• Born before the 37th week of gestational development
Their body weight can be:
• appropriate,
• small or
• large weight, for your gestational age
According to birth weight (PT) can be:
BW less than 2500g (low birth weight)
BW less than 1500g (very low birth weight) and
BW less than 1000g (extremely low birth weight)-incidence 0,6%
Calendar of obligatory vaccinas

• BCG
• Dyphteria, teteanus pertussis
• Polyomyelitis
• Haemophylus Influenzae TYPE B
• Measles ( Morbilli)Rubeolla, Parotitis
 5

PREVENTION - type

PRIMARY
. PREVENTION has the task of preventing the onset of the
disease, and is the most effective and cheapest form of health care

SECONDARY PREVENTION has the task of detecting the

disease early and preventing its further development.

TERTIARY PREVENTION takes care of patients with

advanced disease, prevents complications, provides
continuous support and enables inclusion in regular life
activities.
ELECTIVE COURSE "PUBLIC HEALTH ASPECT OF CHILDHOOD DISEASES"
• Growth and development of child could be divided in
folowing periods:

• prenatal age
• infancy
• preschool age
• school age
• pubertal age,
• adolescent age
Major et minor congenital anomalies are:
• As major congenital anomalies a clasiffied to : those who need
conservative and congenital anomalies which limitatione stvaraju
funkcionalna ograničenja.
• Minor anomalies are usual phenotypic features which do
not provoke some serious complications, and they are not
lifethreatening.
• They are common on the face and on distal ppart of the limbs
• Most frequent are: epicantus, hypertelorisam, bad modeled
ears, hypoplastic

mandibula, syndactilia.
MENTAL DISABILITY (RETARDATION)

Mental disability includes:

1. intellectual abilities significantly below average

2. mental disability as a result of an injury or illness that occurred

before the age of 18 years
• The population distribution of intelligence can be represented in the form of a
Gaussian curve.

• The mean IQ is about 100, and the range of normal intelligence includes 2
standard deviations more and less than this mean.

• A person with an IQ score that is 2 standard deviations below the mean,

• IQ score below 70, is considered mentally disabled.

• Mental disability is present in 2.5% of the population,

• while 2.5% of people have above-average intelligence.

Impact of obesity on the endocrine system

• Obese children may have significantly accelerated growth

• Basal growth hormone (HR) concentration is a consequence of the stimulatory effect of
hyperinsulinemia on IGF-1 synthesis (growth factor)

• Obese individuals have increased sensitivity of the hypothalamic-pituitary-adrenal axis,

that leads to increased cortisol secretion and increased response to both positive and
negative stimuli, especially in individuals with abdominal obesity.

• Obese girls have early presentation of menarche, but menstrual cycles are often
irregular with irregular bleeding, oligomenorrhea or amenorrhea, hirsutism and
infertility
• Obese children have decreased bone density
Obese patients morbidity
• 10 x higher incidence for T2 DM

• 90% of T2 DM patients are obese

• 60% of the obese patients have insulin resistance

• 10% of obese have elevated level of ´´hungry insulin˙˙ (over 100

pmol / l)

Pinhas Hamiel 1999. Geisinger 2004. Cochran 2009.

FAT
• FAT is necessary for normal growth, developmen and activity of the child.
• According to to its chain lenght fat acids are divided to those with long chains ( 14 C
atoms or more) medium chain lenght ( 6-12 C atoms ) and those with the short chain
( less to 6 C atoms).
• In regard to the bonds between moleculs fats are divides into unsaturated and
saturated fat acids.
• Unsaturated are essential and they are necessary for growth and development of
child.
• Over 98% of the fats are triglicerides and only 2% are free fat
masti su iz reda
triglicerida, a samo 2% su slobodne masti.
• Dnevna potreba u mastima je 0,6-0,9 g/kg.
• Brestfeeding exclusively is recommande up to the age of 6 months.
• Mother‘s milk has enough water , so there is no need for water
supplemetation in this period
CARE OF PRETERM NEWBORNS
• Immaturity of organs and systems in the preterm infant is the reason
for their disorders especially of central nervous sistem and
respiratory system.

• Reanimation in delivery room is the key procedure and also

resuscitation and regulating body temperature and than preventing
infection at the Intensive care unit ( ICU)
Termoregulation
• Is the key procedure for care od preterm newborn babies
• Premature born newborns are cooled quickly and also could be over
overheated fast

Their body temperature mostly

depends on outside temperaure.
Main causes of chidren’s death in different ages of the life

Postneonatal period
Neonatal period
• Prematurity
• Congenital
malformations
• Perinatal asphyxia Developed
• Birth trauma Undeveloped countries
countries • Accidents
• Intestinal infections • Congenitaal
• Other infections malformations
• Undefined • Malignanicies
• Sudden death
conditions
syndroma
iznenadne smrti
• As country is less developed and poorer, infant mortality increases
even in neonatal but also in postneonatal period
• Infant mortality in developed countries is less than 10/1000
• In the poorest countries it is 20 times higher
• Trends in infant mortality rate in developed countries indicate
changing proportion , in fact rate of postneonatal mortality increases.
That is explained by modern and functional health care sitsems,
what coul postpone mortality from neonatal to postneonatal period.
 Protein malnutrition
( Quaschiorkor)
The clinical picture of protein malnutrition is due to:
• Insufficient protein intake
• Poor protein absorption (chronic diarrhea)
• Abnormal protein loss in proteinuria (nephrotic
syndrome)
• Due to infections, burns, liver damage (impaired
protein synthesis)
• Quaschiorcor is a clinical syndrome of severe protein
deficiency and inadequate caloric intake
• It occurs by the age of five
• Means "disease of a small child weaned due to a new
pregnancy of the mother" (eats cereals with
insufficient protein intake)
• Clinical picture:
• atrophy of musculature,
• hypoalbuminemic edema,
• changes in the child's behavior,
• changes in hair (depigmentation) and skin
(depigmentation and desquamation),
• atrophy of musculature,
• subcutaneous adipose tissue is relatively preserved
• Laboratory findings: hypoproteinemia, low cholesterol,
hyperaminoaciduria
 Low potassium level- Hypokalemia

• Occurs when plasma K ion values ​are below 4 mmol / l

• This is due to a decrease in intake or an increase in K ion loss
• It manifests itself with muscle weakness, weakened or missing tendon reflexes
• In advanced hypokalemia, flatulence, constipation, paralytic ileus with vomiting are seen
• Hypokalemia also leads to heart rhythm disorders, heart block and eventually heart failure
• In infancy and male children, prolonged hypokalaemia may cause growth retardation
 Definitions for some terms

Childbirth weight - body weight at birth, ie. first measured weight

after delivery
Gestational well-being of intrauterine life in which the fetus grows
and develops
Functional maturity - the ability of the newborn to adapt to life in
the external environment (the most important factor)
Predisposing factors for prematurity
• Low socio-economic status
• Place of birth (developed or less developed countries)
• Mother's age (under 16, over 35)
• Acute and chronic diseases of the mother
• Multiple pregnancies
• Previous abortions
• Obstetric factors
• Congenital anomalies of the fetus
Oesophageal atresia with tracheoesophageal fistula
• Oesophageal atresia is an incomplete development of the osophagus
• It can be narrowed or end blindly, ie. not to reach the stomach
• May be associated with tracheoesophageal fistula (junction between
trachea and esophagus)
There are 3 types of atresia
• Type I (90%) esophageal atresia with fistula between trachea and
distal esophagus
• 2. type II (10%) atresia without fistula
• 3. type III (H-type) no esophageal atresia, fistula present
Symptoms:
• polyhydroamnion,
• foamy secretions from the mouth and nose of the child,
• choking on secretions when trying to feed
• abdominal distension (air enters the stomach through the fistula)

• Th. Surgery
 •
Etiology The most common genetic
causes are Down syndrome
and fragile X syndrome.

• The causes are numerous:

• Intrauterine infections
• Fetal alcohol syndrome
• In most
• Perinatal complications cases, the
• ostnatal infections cause is
• Chromosomopathy unknown
• Congenital metabolic diseases
• Trauma
• Environmental toxins (lead)
 28

CHILD‘S RIGHTS

According to the Convention on the Rights of the Child,

every human being under the age of 18 is a child,
unless the law applicable to the child reaches the
age of majority earlier.
The concept of unique health for children is regulated
by:
UN Convention on the Rights of the Child - since 1989
Ottawa Declaration - since 1998.

ELECTIVE COURSE "PUBLIC HEALTH ASPECT OF CHILDHOOD DISEASES"

 29

CHILD‘S RIGHTS

The UN Convention contains a total of 54 articles that can be divided into three groups:

▰ Those that define ▰ The right to conditions that help
protection against neglect, children realize their potential, the
abuse, exploitation and standard in health and health services
discrimination as well as the standard of living in
general - accommodation, food,
education.
▰ The right to the
participation of children
themselves, the right to
respect, an active role
in the family, the
community and in
organizations that serve
children.

ELECTIVE COURSE "PUBLIC HEALTH ASPECT OF CHILDHOOD DISEASES"

RICKETS
• Diagnosis - based on clinical picture, laboratory and X-
ray findings
• Serum calcium is normal or low, phosphorus is low,
alkaline phosphatase is high
• Treatment is usually carried out with vitamin D at a
dose of 5000 units per day orally, 3-4 weeks, and then
the dose is reduced to prophylactic values
 31
HEALTH ASSESSMENT
INDICATORS OF CAUSES OF DEATH - are very important, but the less
developed the community, the higher the share of insufficiently defined
conditions as causes of death and disease..

GROWTH AND DEVELOPMENT INDICATORS - e.g. Incidence of low birth

weight infants; less than 2500g; incidence of prematurity, etc.

MORTALITY
POKAZATELJI INDICATORS
SMRTNOSTI - aresu
good indicators
dobri of the
pokazatelji health status
zdravstvenog of majki i djece kada se
stanja
mothers
koristeandza children whenALI
veća podrčja usednjihov
for larger areas BUT
nedostatak their lackosjetljivost,
je nedovoljna is insufficient
naročito ako se
sensitivity, especially
primjenjuju if applied
u razvijenim in developed countries.
zemljama.

INDICATORS OF OBOLIJEVANJA
POKAZATELJI DISEASE - are very important
su veomabecause
značajnimany diseases and
iz razloga što mnoge
conditions do not necessarily lead to death but to disability and as such
bolest i stanja ne dovode nužno do smrti već do invaliditeta i kao takve
represent a health problem.
predstavljaju zdravstveni problem.
HYPERTROPHYC NEWBORNS

This category includes all newborns whose body weight is above the
90th percentile, which means that they can be born prematurely,
before term or after term.

They often come from mothers with latent or overt diabetes.

 MALNUTRITION

Malnutrition or undernourishment is a state of the organism in which

the intake of energy and nutrients is less than their consumption
Malnutrition can be :
• mild (the child's weight is 80-89% of the corresponding BW)
• moderate ( 70-79% corresponding BW )
• heavy (weight less than 70% of the corresponding TT)
• According to the World Health Organization (WHO), there are about 600 million
people in the world today who can be considered disabled.

• The main causes of disability: congenital anomalies, chronic non-communicable

diseases, malnutrition and injuries.

• Access to children with disabilities is based on the identification of the child's

abilities and difficulties.

• Functional skills are grouped into categories: speech and communication, mobility
and hand function, sight and hearing, behavior and emotions, physical health,
social aspects, daily life activities, learning ability.
 Chronic renal failure
Permanent damage, the kidneys are unable to maintain normal
homeostasis in the body

It can be divided into 4 stages:

• Mild (kidney function is between 80 and 50% of normal)
• Moderate (between 50 and 25%)
• Severe (less than 25%)
• Final stage (12 to 5%)
Complications:

• Renal osteodystrophy
• Acidosis
• Anemia
• Hypertension
• Infection
• Impaired growth
 37

VACCINATION as prevention

Immunization creates resistance to a certain disease, and this resistance can be strengthened by
repeated vaccination.
ACTIVE IMMUNIZATION (vaccination, vaccination) is the process of giving a specific
antigen (eg live attenuated pathogens, their parts or products, and antigens produced by
genetic technology) to create a specific immunity that protects the recipient from a particular
infectious disease
.Thanks to immunization, some infectious diseases have completely disappeared (smallpox),
and the incidence of others has been drastically reduced (diphtheria, polio, tetanus)

ELECTIVE COURSE "PUBLIC HEALTH ASPECT OF CHILDHOOD DISEASES"