39308 - Paediatrics and Neonatology

Learning outcomes

At the end of the course students will possess the theoretical tools necessary for a correct understanding and conduct of nursing practice in Pediatric, Neonatal, and Neonatal/Pediatric Intensive Care Units, as well as any other context characterized by the presence of pediatric or neonatal patients.

Course contents

The topics of the course are divided into two main branches focused on the newborn and the pediatric patient
For each of these, the main physiological and developmental characteristics, physiopathology, and diagnostic-therapeutic framework of the main diseases characterizing newborns and children will be addressed, as well as the medical devices that distinguish pediatric and neonatal patients from adult ones.
The course is aimed to provide theoretical tools for the correct understanding and conduct of nursing practice in Pediatric, Neonatal, and Neonatal/Pediatric Intensive Care Units, as well as any other context characterized by the presence of pediatric or neonatal patients.

This course will cover the following topics:

The topics covered will be:

1. Physiology of the Newborn:

• Definition, characteristics, and classification of the newborn:
  • Gestational age
  • Weight
  • Percentiles and growth
• Physiological neonatal adaptation:
  • Respiratory
  • Cardiovascular
  • Thermal
• Apgar score
• Nursing care in the delivery room:
  • Prophylaxis
  • Umbilical cord blood gas analysis
• Placental and umbilical cord physical examination: main physiological and pathological characteristics
• Neonatal physical examination:
  • Skin
  • Head
  • Sensory organs
  • Nose and nasal patency
  • Oral cavity
  • Cardiovascular system
  • Respiratory system
  • Abdomen
  • Peripheral pulses
  • Esophageal patency and oro/naso-gastric tube
  • Anal patency and meconium
  • Genital anomalies
  • Umbilical stump
• Neonatal neurological examination:
  • Consciousness
  • Motility
  • Posture
  • Tone
  • Pupils
  • Neonatal reflexes
• Neonatal screenings:
  • Pulse-oximetry
  • Red reflex
  • Otoacoustic emissions
  • Congenital hip dysplasia screening
  • Metabolic screening

2. Neonatal Pathology: diagnostic-therapeutic framework and necessary measures for nursing management of the following conditions:

• Neonatal resuscitation: guidelines, methods, and measures
• Perinatal asphyxia, hypoxic-ischemic encephalopathy, and neonatal hypothermic treatment
• Neonatal neurological disorders:
  • Intracranial hemorrhage
  • Seizures
  • Neonatal abstinence syndrome
  • Neural tube defects
• Neonatal respiratory disorders:
  • Neonatal respiratory pathophysiology
  • Apnea
  • Respiratory distress
  • Transient tachypnea
  • Hyaline membrane disease
  • Meconium aspiration
  • Pneumothorax
  • Pulmonary hemorrhage
  • Congenital pneumonia
  • Persistent pulmonary hypertension
  • Bronchopulmonary dysplasia
• Neonatal respiratory support devices:
  • Oxygen therapy
  • High flow
  • CPAP
  • Mechanical ventilation
• Physiological and pathological weight loss
• Neonatal hyperbilirubinemia
• Neonatal hypoglycemia
• Gastroesophageal reflux
• Neonatal orthopedic problems:
  • Clavicle fracture
  • Congenital hip dysplasia
  • Congenital clubfoot
  • Spinal dysraphism
• Neonatal cardiovascular disorders:
  • Shock
  • Congenital heart diseases
  • Arrhythmias
• Neonatal nephrological disorders:
  • Congenital Kidney and Urinary Tract Malformations
  • Acute kidney injury
  • Renal thrombosis
• Neonatal hematological disorders:
  • Blood products and exsanguinotransfusion
  • Hemorrhagic states
  • Thrombosis
  • Anemia
  • Polycythemia
  • Thrombocytopenia
• Congenital metabolic errors and their manifestations
• Neonatal infectious diseases:
  • CMV
  • HBV
  • HIV
  • HCV
  • HSV
  • VZV
  • Parvovirus B19
  • Rubella
  • Syphilis
  • Toxoplasmosis
  • Tuberculosis
  • Early- and late-onset sepsis
  • Respiratory Syncytial Virus (RSV)
  • fungal infections
• Physiopathological characteristics of the premature neonate and its development
• Necrotizing enterocolitis
• Retinopathy of prematurity

3. Pediatric Physiology:

• Classification and characteristics of pediatric age
• Medical history collection
• Signs and symptoms
• Physical examination and approach
• Growth and development
• Nutrition

4. Pediatric Prevention:

• Screening
• Health check-ups
• Vaccines

5. Anxiety and pain in neonatal and pediatric age:

• Physiopathology and development
• Signs and symptoms
• Evaluation
• Treatment
• Pediatric palliative care network

6. General Pediatric Pathology:

• Celiac disease
• Diabetes
• Allergies
• Asthma and wheezing
• Complex patient

7. Pediatric Infectious Diseases:

• Fever
  • Kawasaki diseas
  • Febrile seizures
• Exanthems
• Gastroenteritis
• Pharyngotonsillitis
• Croup
• Pneumonia
• Bronchiolitis
• Meningitis
• Encephalitis
• Osteomyelitis
  
• Otitis, Mastoiditis, Cellulitis
• Urinary Tract Infections

8. Pediatric Emergencies and Life Support:

• Patient evaluation in the emergency setting:
  • Initial: ABC
  • Primary: ABCDE
  • Secondary
• Cardiac arrest:
  • Recognition
  • Management
  • Resuscitation
  • Defibrillation and drugs
  • Special cases: trauma, drowning, anaphylaxis, intoxication, congenital heart disease, pulmonary hypertension
• Respiratory distress/failure:
  • Rescue ventilation
  • Initial management: ABC
  • Secondary management:
    • Upper airway obstruction: croup, anaphylaxis, foreign body
    • Lower airway obstruction: bronchiolitis, asthma
    • Parenchymal disorder: infectious pneumonia, chemical pneumonia, aspiration pneumonia, cardiogenic pulmonary edema, non-cardiogenic pulmonary edema (ARDS)
    • Respiratory control disorders: intracranial hypertension, opioid overdose, neuromuscular disease
• Shock:
  • Physiopathology
  • Identification and management:
    • Hypovolemic shock
    • Distributive shock: septic, anaphylactic, neurogenic
    • Cardiogenic shock
    • Obstructive shock: cardiac tamponade, tension pneumothorax, duct-dependent congenital heart diseases, massive pulmonary embolism

Readings/Bibliography

Pediatria Generale e Specialistica - A. Pession, G. Faldella
Nelson, Manuale di Pediatria - 21° Edizione
Cloherty e Stark’s. Manuale di neonatologia - 8° Edizione
Pediatric Advanced Life Support - Manuale per operatori - linee guida 2020

Teaching methods

Lectures

Assessment methods

Oral test

At the exam, candidates will be required to demonstrate their preparation on the topics covered in the course, as outlined in the program above.

The final exam aims to assess the achievement of the educational objectives and to evaluate the candidate's ability to present and critically analyse about the main characteristics of the topics covered in the lectures.

Final grading:

• Preparation on a very limited number of topics covered in the course and ability to analyze only with the help of the instructor, overall correct language expression → 18-19
• Preparation on a limited number of topics covered in the course and  ability to autonomously analyze only purely executive issues, correct language expression → 20-24
• Preparation on a wide range of topics covered in the course, ability to make autonomous choices of critical analysis, mastery of specific terminology → 25-29
• Substantially exhaustive preparation on the topics covered in the course, ability to make autonomous choices of critical analysis and connection, full mastery of specific terminology, and ability to argue and reflect → 30-30L

Teaching tools

Slides (projected and commented during frontal lectures)

Office hours

See the website of Enrico Cocchi