INLEIDING TOT DE ZIEKTELEER VAN HET KIND SAMENVATTING
PROF. KAREL ALLEGAERT – 2025-2026
1. Vroege neonatale zorg – de eerste levensweken ____________________________________ 6
Identificatie vd probleemneonatus ______________________________________________________ 6
Te vroeg – te laat – op tijd______________________________________________________________ 6
Te licht – te zwaar – normaal gewicht ____________________________________________________ 6
Onderzoek neonatus door (kinder)arts ___________________________________________________ 7
Het eerste klinisch onderzoek ___________________________________________________________ 8
Adaptatieproblemen bij een normale voldragen baby ______________________________________ 12
2. Waarom screenen we? ________________________________________________________ 19
Wanneer screenen?__________________________________________________________________ 20
Hielprik ____________________________________________________________________________ 20
Auditory Brainstem Response__________________________________________________________ 21
3. Metabole aanpassingen _______________________________________________________ 22
Hypothermie _______________________________________________________________________ 22
Hypoglycemie ______________________________________________________________________ 23
Vitamine K _________________________________________________________________________ 25
4. Wiegendood ________________________________________________________________ 26
Wiegendood – preventie ______________________________________________________________ 26
Definitie ___________________________________________________________________________ 26
Hoe wiegendood begrijpen ____________________________________________________________ 27
Gedocumenteerde wiegendood ________________________________________________________ 27
Preventieve campagnes ______________________________________________________________ 28
Voordelen van bedsharen _____________________________________________________________ 29
Risico’s van bedsharen _______________________________________________________________ 29
Aanbevelingen voro de materniteit _____________________________________________________ 29
Aanbevelingen voor thuis _____________________________________________________________ 30
Advies en tips_______________________________________________________________________ 30
5. Vaccinaties – bij pasgeborenen en bij zuigelingen (<15 maanden) _____________________ 32
1
, Enkele definities ____________________________________________________________________ 32
Actieve en passieve immunisatie _______________________________________________________ 34
Afweersysteem _____________________________________________________________________ 34
‘Haard’protectie ____________________________________________________________________ 36
Overzicht vaccinaties _________________________________________________________________ 37
Preventie van infectieziekten: vaccinatiebeleid____________________________________________ 38
Hoe werkt een vaccin? _______________________________________________________________ 39
Waarom vaccineren tegen…? __________________________________________________________ 40
Contra-indicaties voor vaccinatie _______________________________________________________ 43
6. Middelengebruik tijdens de zwangerschap ________________________________________ 45
Cijfers _____________________________________________________________________________ 45
Relevantie voor foetus, neonaat, kind? __________________________________________________ 46
FAS: Foetaal Alcohol Syndroom ________________________________________________________ 47
NAS: Neonatal Abstinence Syndrome ___________________________________________________ 49
7. Diabetes mellitus – chronische ziektebeelden ______________________________________ 55
Vormen van diabetes mellitus bij het kind________________________________________________ 55
Oorzaken insulinetekort ______________________________________________________________ 56
Vormen van diabetes mellitus bij het kind________________________________________________ 56
Pathofysiologie van diabetes mellitus type 1 ______________________________________________ 57
Gevolgen insulinetekort ______________________________________________________________ 58
Farmacotherapie van diabetes mellitus __________________________________________________ 60
Diagnose diabetes mellitus ____________________________________________________________ 61
Keto-acidose of niet? → niet gezien _____________________________________________________ 61
Behandeling van diabetes type 1 _______________________________________________________ 62
Diabetes mellitus type 2 ______________________________________________________________ 63
Farmacotherapie van diabetes mellitus __________________________________________________ 63
Behandeling van diabetes type 1 _______________________________________________________ 64
Insuline en analogen _________________________________________________________________ 65
Ernstige hypoglycemie _______________________________________________________________ 66
Gevolgen overgewicht – obesitas _______________________________________________________ 67
Preventieve behandeling?_____________________________________________________________ 67
8. Epilepsie – chronische ziektebeelden _____________________________________________ 68
Epilepsie ___________________________________________________________________________ 68
Definities __________________________________________________________________________ 69
2
, Kinder-epilepsie: ‘window of vulnability’ _________________________________________________ 70
Diagnose __________________________________________________________________________ 70
Epileptische aanvallen ________________________________________________________________ 71
Neonatale neurologie ________________________________________________________________ 72
Focale aanvallen ____________________________________________________________________ 72
Gegeneraliseerde aanvallen ___________________________________________________________ 73
Uitlokkende factoren_________________________________________________________________ 73
Oorzaken epilepsie __________________________________________________________________ 74
Structurele afwijkingen _______________________________________________________________ 74
Absence epilepsie ___________________________________________________________________ 75
Rolandische epilepsie ________________________________________________________________ 76
West syndroom – zuigeling ____________________________________________________________ 77
Koortsconvulsies ____________________________________________________________________ 77
Behandeling ________________________________________________________________________ 78
Stoppen van een aanval ______________________________________________________________ 79
Valproate (depakine) fetopathie _______________________________________________________ 80
9. Atopie ______________________________________________________________________ 81
Ziektemechanisme __________________________________________________________________ 81
Oorzaken atopie ____________________________________________________________________ 83
Ziektebeelden atopie_________________________________________________________________ 84
Diagnostiek – atopie _________________________________________________________________ 84
Acute therapie – atopie _______________________________________________________________ 85
10. Eczeem ____________________________________________________________________ 87
Atopische/constitutionele eczeem ______________________________________________________ 87
Lokale dermatotherapeutica___________________________________________________________ 88
11. Astma _____________________________________________________________________ 89
Wheezing __________________________________________________________________________ 89
Diagnose – astma ___________________________________________________________________ 90
Longfunctie – astma _________________________________________________________________ 91
Doel van behandeling – astma _________________________________________________________ 92
Uitlokkers van astma _________________________________________________________________ 92
Therapie – astma ____________________________________________________________________ 92
12. Groei en puberteit ___________________________________________________________ 99
Gewichtsevolutie ____________________________________________________________________ 99
3
, Definities __________________________________________________________________________ 99
Braken – GERD _____________________________________________________________________ 100
Pyloorhypertrofie __________________________________________________________________ 102
Coeliakie__________________________________________________________________________ 103
Cystic fibrosis – mucoviscidose ________________________________________________________ 103
Groei_____________________________________________________________________________ 104
Puberteit _________________________________________________________________________ 109
Pubertas praecox ___________________________________________________________________ 112
Pubertas tarda _____________________________________________________________________ 114
13. Neuromusculaire disorders ___________________________________________________ 117
Cerbral palsy: UMN _________________________________________________________________ 117
Neuromusculaire disorders: Lower Motor Neuron ________________________________________ 121
Neuromusculaire disorders ___________________________________________________________ 123
Anterior horn cell (motor neuron) _____________________________________________________ 126
Perifere zenuw _____________________________________________________________________ 130
Neuromusculaire junctie _____________________________________________________________ 131
Spieren ___________________________________________________________________________ 132
14. Nierziekten en urologische problemen – chronische ziektebeelden ___________________ 136
Nefrologische en urinaire problemen ___________________________________________________ 136
Chronologie van mictiecontrole (stadia) ________________________________________________ 136
Overactieve blaas __________________________________________________________________ 139
Dysfunctionele leging _______________________________________________________________ 140
Basis blaasfysiologie ________________________________________________________________ 140
Plasproblemen overdag: aandoeningen _________________________________________________ 141
Urotherapie _______________________________________________________________________ 141
Enuresis __________________________________________________________________________ 142
Urineweginfectie ___________________________________________________________________ 144
Nierfunctie ________________________________________________________________________ 145
Proteïnurie ________________________________________________________________________ 145
Hematurie ________________________________________________________________________ 146
Klinische ziektebeelden bij chronisch nierlijden __________________________________________ 146
15. Kinderorthopedie___________________________________________________________ 148
‘Dynamiek’ van de positie van de voeten _______________________________________________ 148
Het mankende kind (heupafwijkingen) _________________________________________________ 151
4
PROF. KAREL ALLEGAERT – 2025-2026
1. Vroege neonatale zorg – de eerste levensweken ____________________________________ 6
Identificatie vd probleemneonatus ______________________________________________________ 6
Te vroeg – te laat – op tijd______________________________________________________________ 6
Te licht – te zwaar – normaal gewicht ____________________________________________________ 6
Onderzoek neonatus door (kinder)arts ___________________________________________________ 7
Het eerste klinisch onderzoek ___________________________________________________________ 8
Adaptatieproblemen bij een normale voldragen baby ______________________________________ 12
2. Waarom screenen we? ________________________________________________________ 19
Wanneer screenen?__________________________________________________________________ 20
Hielprik ____________________________________________________________________________ 20
Auditory Brainstem Response__________________________________________________________ 21
3. Metabole aanpassingen _______________________________________________________ 22
Hypothermie _______________________________________________________________________ 22
Hypoglycemie ______________________________________________________________________ 23
Vitamine K _________________________________________________________________________ 25
4. Wiegendood ________________________________________________________________ 26
Wiegendood – preventie ______________________________________________________________ 26
Definitie ___________________________________________________________________________ 26
Hoe wiegendood begrijpen ____________________________________________________________ 27
Gedocumenteerde wiegendood ________________________________________________________ 27
Preventieve campagnes ______________________________________________________________ 28
Voordelen van bedsharen _____________________________________________________________ 29
Risico’s van bedsharen _______________________________________________________________ 29
Aanbevelingen voro de materniteit _____________________________________________________ 29
Aanbevelingen voor thuis _____________________________________________________________ 30
Advies en tips_______________________________________________________________________ 30
5. Vaccinaties – bij pasgeborenen en bij zuigelingen (<15 maanden) _____________________ 32
1
, Enkele definities ____________________________________________________________________ 32
Actieve en passieve immunisatie _______________________________________________________ 34
Afweersysteem _____________________________________________________________________ 34
‘Haard’protectie ____________________________________________________________________ 36
Overzicht vaccinaties _________________________________________________________________ 37
Preventie van infectieziekten: vaccinatiebeleid____________________________________________ 38
Hoe werkt een vaccin? _______________________________________________________________ 39
Waarom vaccineren tegen…? __________________________________________________________ 40
Contra-indicaties voor vaccinatie _______________________________________________________ 43
6. Middelengebruik tijdens de zwangerschap ________________________________________ 45
Cijfers _____________________________________________________________________________ 45
Relevantie voor foetus, neonaat, kind? __________________________________________________ 46
FAS: Foetaal Alcohol Syndroom ________________________________________________________ 47
NAS: Neonatal Abstinence Syndrome ___________________________________________________ 49
7. Diabetes mellitus – chronische ziektebeelden ______________________________________ 55
Vormen van diabetes mellitus bij het kind________________________________________________ 55
Oorzaken insulinetekort ______________________________________________________________ 56
Vormen van diabetes mellitus bij het kind________________________________________________ 56
Pathofysiologie van diabetes mellitus type 1 ______________________________________________ 57
Gevolgen insulinetekort ______________________________________________________________ 58
Farmacotherapie van diabetes mellitus __________________________________________________ 60
Diagnose diabetes mellitus ____________________________________________________________ 61
Keto-acidose of niet? → niet gezien _____________________________________________________ 61
Behandeling van diabetes type 1 _______________________________________________________ 62
Diabetes mellitus type 2 ______________________________________________________________ 63
Farmacotherapie van diabetes mellitus __________________________________________________ 63
Behandeling van diabetes type 1 _______________________________________________________ 64
Insuline en analogen _________________________________________________________________ 65
Ernstige hypoglycemie _______________________________________________________________ 66
Gevolgen overgewicht – obesitas _______________________________________________________ 67
Preventieve behandeling?_____________________________________________________________ 67
8. Epilepsie – chronische ziektebeelden _____________________________________________ 68
Epilepsie ___________________________________________________________________________ 68
Definities __________________________________________________________________________ 69
2
, Kinder-epilepsie: ‘window of vulnability’ _________________________________________________ 70
Diagnose __________________________________________________________________________ 70
Epileptische aanvallen ________________________________________________________________ 71
Neonatale neurologie ________________________________________________________________ 72
Focale aanvallen ____________________________________________________________________ 72
Gegeneraliseerde aanvallen ___________________________________________________________ 73
Uitlokkende factoren_________________________________________________________________ 73
Oorzaken epilepsie __________________________________________________________________ 74
Structurele afwijkingen _______________________________________________________________ 74
Absence epilepsie ___________________________________________________________________ 75
Rolandische epilepsie ________________________________________________________________ 76
West syndroom – zuigeling ____________________________________________________________ 77
Koortsconvulsies ____________________________________________________________________ 77
Behandeling ________________________________________________________________________ 78
Stoppen van een aanval ______________________________________________________________ 79
Valproate (depakine) fetopathie _______________________________________________________ 80
9. Atopie ______________________________________________________________________ 81
Ziektemechanisme __________________________________________________________________ 81
Oorzaken atopie ____________________________________________________________________ 83
Ziektebeelden atopie_________________________________________________________________ 84
Diagnostiek – atopie _________________________________________________________________ 84
Acute therapie – atopie _______________________________________________________________ 85
10. Eczeem ____________________________________________________________________ 87
Atopische/constitutionele eczeem ______________________________________________________ 87
Lokale dermatotherapeutica___________________________________________________________ 88
11. Astma _____________________________________________________________________ 89
Wheezing __________________________________________________________________________ 89
Diagnose – astma ___________________________________________________________________ 90
Longfunctie – astma _________________________________________________________________ 91
Doel van behandeling – astma _________________________________________________________ 92
Uitlokkers van astma _________________________________________________________________ 92
Therapie – astma ____________________________________________________________________ 92
12. Groei en puberteit ___________________________________________________________ 99
Gewichtsevolutie ____________________________________________________________________ 99
3
, Definities __________________________________________________________________________ 99
Braken – GERD _____________________________________________________________________ 100
Pyloorhypertrofie __________________________________________________________________ 102
Coeliakie__________________________________________________________________________ 103
Cystic fibrosis – mucoviscidose ________________________________________________________ 103
Groei_____________________________________________________________________________ 104
Puberteit _________________________________________________________________________ 109
Pubertas praecox ___________________________________________________________________ 112
Pubertas tarda _____________________________________________________________________ 114
13. Neuromusculaire disorders ___________________________________________________ 117
Cerbral palsy: UMN _________________________________________________________________ 117
Neuromusculaire disorders: Lower Motor Neuron ________________________________________ 121
Neuromusculaire disorders ___________________________________________________________ 123
Anterior horn cell (motor neuron) _____________________________________________________ 126
Perifere zenuw _____________________________________________________________________ 130
Neuromusculaire junctie _____________________________________________________________ 131
Spieren ___________________________________________________________________________ 132
14. Nierziekten en urologische problemen – chronische ziektebeelden ___________________ 136
Nefrologische en urinaire problemen ___________________________________________________ 136
Chronologie van mictiecontrole (stadia) ________________________________________________ 136
Overactieve blaas __________________________________________________________________ 139
Dysfunctionele leging _______________________________________________________________ 140
Basis blaasfysiologie ________________________________________________________________ 140
Plasproblemen overdag: aandoeningen _________________________________________________ 141
Urotherapie _______________________________________________________________________ 141
Enuresis __________________________________________________________________________ 142
Urineweginfectie ___________________________________________________________________ 144
Nierfunctie ________________________________________________________________________ 145
Proteïnurie ________________________________________________________________________ 145
Hematurie ________________________________________________________________________ 146
Klinische ziektebeelden bij chronisch nierlijden __________________________________________ 146
15. Kinderorthopedie___________________________________________________________ 148
‘Dynamiek’ van de positie van de voeten _______________________________________________ 148
Het mankende kind (heupafwijkingen) _________________________________________________ 151
4
