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  <head>
    <title>042-02 Developmental physiology, neonatal transition, and recognition of paediatric deterioration</title>
    <ownerName>Integrated Medical Foundations</ownerName>
  </head>
  <body>
    <outline text="Paediatric development, transition, and deterioration">
      <outline text="Physiology changes with age">
        <outline text="Gestation, postnatal age, growth, puberty"/>
        <outline text="Infant reserve is small">
          <outline text="High oxygen demand, narrow airway"/>
          <outline text="Limited stroke volume and glycogen stores"/>
        </outline>
        <outline text="Watch trajectory before hypotension"/>
      </outline>
      <outline text="Birth transition and resuscitation">
        <outline text="First breaths replace lung liquid with air">
          <outline text="Pulmonary vascular resistance falls"/>
        </outline>
        <outline text="Placenta removed: systemic resistance rises"/>
        <outline text="Foramen ovale closes, ductal flow reverses"/>
        <outline text="Oxygen and less prostaglandin constrict duct"/>
        <outline text="Failed aeration or hypoxia keeps fetal shunts">
          <outline text="Severe cyanosis"/>
        </outline>
        <outline text="Resuscitation is principally respiratory">
          <outline text="Bradycardia follows poor aeration and hypoxia"/>
          <outline text="Chest rise and heart rate confirm ventilation"/>
          <outline text="Fix mask, head position, pressure first"/>
          <outline text="Compressions only for persistent bradycardia"/>
        </outline>
        <outline text="After resuscitation: glucose, temperature, seizures"/>
        <outline text="Too little or too much oxygen harms"/>
      </outline>
      <outline text="Duct-dependent heart disease">
        <outline text="Lesions emerge as the duct closes"/>
        <outline text="Pulmonary dependence: worsening cyanosis"/>
        <outline text="Systemic dependence: shock, weak femorals"/>
        <outline text="Unexplained shock includes heart disease"/>
        <outline text="Prostaglandin E1 reopens the duct">
          <outline text="Apnoea and hypotension need airway readiness"/>
        </outline>
      </outline>
      <outline text="Temperature, glucose, and bilirubin">
        <outline text="Temperature is a metabolic intervention">
          <outline text="Evaporation, conduction, convection, radiation"/>
          <outline text="Brown fat worsens hypoxaemia and acidosis"/>
        </outline>
        <outline text="Glucose reflects supply, stores, insulin, demand">
          <outline text="Diabetic mothers: persisting hyperinsulinism"/>
          <outline text="Recurrent need suggests endocrine cause"/>
        </outline>
        <outline text="Short red-cell lifespan raises bilirubin">
          <outline text="Intestinal deconjugation promotes reabsorption"/>
          <outline text="Albumin binding limits brain entry"/>
        </outline>
        <outline text="Conjugated rise signals hepatobiliary disease"/>
      </outline>
      <outline text="Feeding, growth, and development">
        <outline text="Feeding is a cardiorespiratory task">
          <outline text="Suck-swallow-breathe coordination"/>
          <outline text="Observe a feed, not reported duration"/>
        </outline>
        <outline text="Serial weight and sodium detect poor transfer"/>
        <outline text="Weight fast, length slow, head for brain"/>
        <outline text="Centile crossing after birth can be normal">
          <outline text="Sustained deceleration warrants evaluation"/>
        </outline>
        <outline text="Milestone is a probability distribution"/>
        <outline text="Skill loss worse than slow acquisition"/>
      </outline>
      <outline text="Respiratory deterioration and airway">
        <outline text="Compensation: rate, recession, grunting">
          <outline text="Sucking competes with breathing"/>
        </outline>
        <outline text="Fatigue lowers rate and effort">
          <outline text="Quiet child is more dangerous"/>
        </outline>
        <outline text="Saturation cannot judge ventilation">
          <outline text="Assess carbon dioxide and clinical state"/>
        </outline>
        <outline text="Escalate on work of breathing, not one number"/>
        <outline text="Small swelling greatly raises resistance"/>
        <outline text="Drooling, tripod, muffled voice: supraglottic">
          <outline text="Throat examination can precipitate obstruction"/>
        </outline>
        <outline text="Foreign body despite normal radiograph"/>
      </outline>
      <outline text="Circulation, fluids, and dehydration">
        <outline text="Tachycardia and vasoconstriction hold pressure"/>
        <outline text="Early shock: mottling, slow refill, low urine"/>
        <outline text="Reassessed weight-based aliquots">
          <outline text="Poor response with liver enlargement, crackles"/>
          <outline text="Reconsider cardiac and vasoactive support"/>
        </outline>
        <outline text="Cause-specific fluid strategies"/>
        <outline text="Oral rehydration uses sodium-glucose coupling"/>
        <outline text="Controlled sodium correction protects brain"/>
      </outline>
      <outline text="Fever and prescribing safety">
        <outline text="Young infants may show only poor feeding"/>
        <outline text="Red flags need urgent assessment at any age"/>
        <outline text="Antipyretics do not separate viral from bacterial"/>
        <outline text="Independent calculation chain">
          <outline text="Leading zeros, no trailing zeros"/>
        </outline>
        <outline text="Liver enzymes and filtration mature separately">
          <outline text="A neonatal dose may later be wrong"/>
        </outline>
        <outline text="High-risk drugs: three independent checks">
          <outline text="Kilograms versus pounds, daily versus single"/>
        </outline>
        <outline text="Caregiver demonstrates the syringe volume"/>
      </outline>
      <outline text="Safeguarding and final assessment">
        <outline text="Injury must fit developmental capability"/>
        <outline text="Consider bleeding, bone, metabolic mimics"/>
        <outline text="Record statements close to the words used"/>
        <outline text="Explain confidentiality limits beforehand"/>
        <outline text="Not as usual is longitudinal data"/>
        <outline text="Closed safety plan with named follow-up"/>
      </outline>
    </outline>
  </body>
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