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  <head>
    <title>042-01 Foundations</title>
    <ownerName>Integrated Medical Foundations</ownerName>
  </head>
  <body>
    <outline text="Paediatric and neonatal physiology and assessment">
      <outline text="Children are not small adults">
        <outline text="Anatomy, drugs, disease, measures change with age"/>
        <outline text="Limited reserve drives rapid progression">
          <outline text="Airway, fluid, glucose, cardiorespiratory limits"/>
        </outline>
        <outline text="Start with appearance, breathing, circulation, trajectory"/>
        <outline text="Family-centred care keeps the child&#x27;s voice and assent"/>
      </outline>
      <outline text="Transition at birth">
        <outline text="Placenta exchanges gas, shunts bypass lungs"/>
        <outline text="Aeration lowers pulmonary resistance"/>
        <outline text="Cord clamping raises systemic resistance"/>
        <outline text="Left-atrial pressure rises, shunts close functionally"/>
        <outline text="Disrupted by lung, heart, infection, cold, metabolism"/>
        <outline text="Duct-dependent lesions worsen as duct closes">
          <outline text="Prostaglandin keeps the duct open"/>
          <outline text="Apnoea risk needs specialist support"/>
        </outline>
        <outline text="Resuscitation: warmth, position, dry, then ventilate">
          <outline text="Heart-rate response shows ventilation success"/>
          <outline text="Compressions and drugs secondary to inflation"/>
        </outline>
      </outline>
      <outline text="Neonatal physiological reserve">
        <outline text="Rapid heat loss from surface area and thin skin"/>
        <outline text="Brown fat burns oxygen and glucose">
          <outline text="Cold worsens distress, hypoglycaemia, acidosis"/>
        </outline>
        <outline text="Glucose shifts from placenta to feeding">
          <outline text="Prematurity, growth restriction, maternal diabetes"/>
          <outline text="Silent, or jittery, apnoeic, lethargic, seizing"/>
        </outline>
        <outline text="Haemoglobin falls as erythropoietin decreases"/>
      </outline>
      <outline text="Neonatal jaundice and feeding">
        <outline text="High red-cell turnover, immature conjugation"/>
        <outline text="Physiological jaundice after the first day"/>
        <outline text="Red flags: first day, rapid rise, pale stool">
          <outline text="Haemolysis, infection, liver disease, obstruction"/>
        </outline>
        <outline text="Unconjugated bilirubin can enter the brain">
          <outline text="Encephalopathy or kernicterus"/>
          <outline text="Worse with prematurity, acidosis, low albumin binding"/>
        </outline>
        <outline text="Phototherapy makes bilirubin excretable"/>
        <outline text="Conjugated jaundice is never physiological"/>
        <outline text="Assess feeds by attachment, output, weight">
          <outline text="Excess weight loss: hypernatraemic dehydration"/>
          <outline text="Find barriers without blame"/>
        </outline>
      </outline>
      <outline text="Growth and development">
        <outline text="Serial velocity beats a single centile"/>
        <outline text="Faltering growth: intake, loss, demand, neglect"/>
        <outline text="Milestones are ranges, not deadlines"/>
        <outline text="Regression worse than isolated mild delay"/>
        <outline text="Hearing or vision loss mimics global delay"/>
        <outline text="Early intervention before a final cause"/>
      </outline>
      <outline text="Age-specific physiology">
        <outline text="Compliant chest, small airways, high oxygen use">
          <outline text="Small radius loss sharply raises resistance"/>
        </outline>
        <outline text="Recession, flaring, grunting, head bobbing"/>
        <outline text="Cyanosis is late and pigment-dependent"/>
        <outline text="Infant output depends on heart rate">
          <outline text="Bradycardia often means hypoxia"/>
        </outline>
        <outline text="More body water, faster dehydration"/>
        <outline text="Vasoconstriction preserves pressure until late">
          <outline text="Tachycardia, slow refill, low urine come first"/>
        </outline>
      </outline>
      <outline text="Nutrition and immunisation">
        <outline text="Breast milk or safe prepared formula"/>
        <outline text="Deficiency impairs development before signs">
          <outline text="Iron, vitamin D, vitamin B12"/>
        </outline>
        <outline text="Obesity can coexist with deficiency"/>
        <outline text="Vaccination builds memory before exposure"/>
        <outline text="Mild illness rarely requires delay"/>
        <outline text="Live vaccines: caution in immune deficiency, pregnancy"/>
      </outline>
      <outline text="History, observation, and examination">
        <outline text="Observe from a distance first">
          <outline text="Quiet motionless child may be sicker"/>
        </outline>
        <outline text="History spans birth, development, social setting"/>
        <outline text="Ask adolescents privately"/>
        <outline text="Caregivers detect deviation first"/>
        <outline text="Examine from least to most intrusive"/>
        <outline text="Reconcile saturation with the child"/>
      </outline>
      <outline text="Acute patterns and resuscitation">
        <outline text="Croup: stridor at rest signals severity"/>
        <outline text="Drooling, tripod posture: minimal disturbance"/>
        <outline text="Bilious vomiting suggests obstruction"/>
        <outline text="Fever risk is age-dependent">
          <outline text="Antipyretics do not prevent febrile seizures"/>
        </outline>
        <outline text="Hypoxia commonly drives arrest"/>
        <outline text="Weight-based, reassessed fluid boluses"/>
        <outline text="Dose by measured weight, checked independently">
          <outline text="Decimal and unit errors are major hazards"/>
        </outline>
      </outline>
      <outline text="Safeguarding and communication">
        <outline text="Inconsistent history, implausible injury, delay"/>
        <outline text="Non-mobile bruising, burns, fractures"/>
        <outline text="Consider mimics without delaying protection"/>
        <outline text="Document exact words without accusation"/>
        <outline text="Seek assent, avoid promises"/>
      </outline>
    </outline>
  </body>
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