Physiological criteria for the development of the body of newborn children. The process of urination and bowel movement of a newborn. Features of the formation of the heart, blood vessels and the immune system
Leather newborn smooth, velvety, elastic, pale pink color. The stratum corneum is thin; the epidermis is juicy, loose.
Sweat glands - formed at birth, but the excretory ducts are underdeveloped, closed by epithelial cells, therefore, perspiration is not observed until 1 month.
Sebaceous glands - begin to function in utero; their secret with the cells of the epidermis forms a "curd lubricant", which facilitates the passage through the birth canal. On the face, they can degenerate into cysts, forming white-yellow formations - milia.
Hair - differ in the absence of a core in them, therefore they are light - "cannon" (lanugo). Located on the shoulders, back, on the head of a newborn; different lengths and colors and do not determine the further splendor of the hairline.
Subcutaneous fat - begins to develop in the 5th month of intrauterine life. In a full-term newborn, the fat layer is well developed on the cheeks, thighs, legs, forearms and weakly on the abdomen.
Umbilical wound - remains after the umbilical residue falls off on the 3-4th day. Heals by 7-10 days of life, epithelializes by 3-4 weeks. It is the main entrance gate of infection and requires careful maintenance.
Musculoskeletal system.
Scull ... The sutures of the skull are wide, not completely closed. At the junction of the bones, there are fontanelles covered with a connective tissue membrane. Between the frontal and parietal bones, at the junction of the coronary and sagittal sutures, there is a rhomboid large fontanelle ... Its size (the distance between the sides) is from 3 to 1.5-2 cm. It is open for birth in all children. Small fontanelle located between the parietal and occipital bones, open in premature infants and in 15% of term infants. Closes no later than 4-8 weeks after birth. The sagittal, coronal and occipital sutures are open and begin to close from 3-4 months of age.
The function of the fontanelle is to facilitate the adaptation of the fetal head to the size and shape of the mother's birth canal, by means of configuration (overlapping bones), thereby protecting the child's brain from injury.
Spine the newborn has no physiological curves.
Muscle Up to 3-4 months, physiological hypertonicity of the flexor muscles is characteristic, therefore, a flexion posture occurs (embryonic posture): the head is slightly brought to the chest, the arms are bent at the elbow joints and pressed to the lateral surface of the chest, the hands are clenched into fists, the legs are bent at the knee and hip joints.
The movements are chaotic, not coordinated. As a child grows, large muscles develop faster than small ones.
Respiratory system - imperfect.
Nasal passages narrow, the lower nasal passage is absent, which leads to a rapid disruption of nasal breathing, even with minor inflammation. Breathing through the mouth in a newborn is impossible due to the fact that the large tongue pushes the epiglottis backward.
The paranasal sinuses are poorly developed or absent, therefore, there are practically no sinusitis in newborns. Pharynx narrow and small. The lymphopharyngeal ring is poorly developed. But the auditory (Eustachian) tube connecting it to the middle ear is short and wide, which contributes to the frequent development of complications such as otitis media. Larynx wide, short, funnel-shaped with a distinct narrowing in the subglottic space. The vocal cords above the larynx are short, the glottis between them is narrow. These features contribute to the rapid development of laryngeal stenosis with laryngitis. Trachea narrow, soft cartilage, pliable, can subside and cause the so-called - "congenital stridor" - rough snoring breathing and expiratory dyspnea. Bronchi formed, the cartilage is soft, prone to collapse. The right bronchus is a continuation of the trachea, shorter and wider than the left, so foreign bodies often get here. Lungs rich in loose connective tissue, low elastic, low airy, rich in blood vessels, therefore they are prone to the development of edema, atelectasis (collapse of the alveoli) and emphysema (overstretching of the alveoli).
A newborn is characterized by a diaphragmatic type of breathing: superficial, frequent, arrhythmic. Respiratory rate 40-60 per minute; the ratio of the frequency of respiration and pulse (RR: HR) = 1: 2.5-3-3.5.
The purpose of the lesson: to teach students the peculiarities of the physiological course of the period of early adaptation of newborns and to acquaint them with modern perinatal technologies aimed at shaping health in the first minutes of life.
The student should know : primary assessment of the functional state of the newborn at birth, conducting the primary toilet, cord ligation and anthropometry, parameters of physical development and morpho-functional maturity of newborns, features of physiological adaptation of the respiratory system, cardiovascular and digestive systems, caring for a healthy newborn, exclusive breastfeeding and prevention of transient hypogalactia, paraphysiological conditions, prevention of tuberculosis, especially the stay and early discharge of the child from the maternity hospital.
The student must be able to : to determine the clinical and functional parameters of healthy full-term newborns, to carry out primary measures for newborns in the delivery room with physiological births .
Neonatology- a section of pediatrics that studies the physiological characteristics and diseases of children in the first month of life. The development of neonatological care at the present stage is characterized by the creation of highly specialized services for families, pregnant women, newborns, infants and young children, united in perinatal centers. The stages of medical care for newborn children are provided with the work of obstetric and pediatric services.
From the moment of birth and ligation of the umbilical cord, only one, the umbilical cord connection between the mother and the child stops, its further development begins in the neonatal period, which lasts 28 days. It is divided into the early (first 168 hours of life) and late neonatal periods. The functional state of the child in the first minutes and hours of life is characterized by the reactions of adaptation of organs and systems to new - extrauterine conditions. The adaptive features of the functional systems of the fetus and newborn depend on the mother's body, the course of pregnancy and childbirth.
PHYSIOLOGICAL DELIVERY
The birth act is a significant burden on the fetus. The three stages of labor are different from each other. The contractile activity of the uterus is accompanied by a change in metabolic processes in a woman in labor and a deterioration in the life support of the fetus. Each contraction of the uterus leads to a decrease in uteroplacental blood flow. In the first stage of labor, in the pauses between contractions, the pressure in the uterine cavity is 8-10 mm Hg. At the height of the contraction - 20-50 mm Hg. In the second stage of labor, during attempts, the pressure can increase up to 70 mm Hg. The blood flow in the uterus stops, a blood depot is formed, which provides nutrition to the fetus during contractions. The deterioration of the life support of the fetus is manifested by adaptive reactions in the form of an increase in its motor activity between contractions and an increase in the number of heart contractions of no more than 160 beats per minute. During the period of expulsion, there may be a decrease in the fetal heart rate up to 80-110 beats per minute during attempts and frequency leveling 10-30 seconds after it.
The mother's body helps the fetus to cope with childbirth stress and adapt to extrauterine existence by increasing the production of cortisol above the level of its corticobinding capacity of blood plasma, which contributes to the transition of a certain concentration of cortisol to the fetus.
The neonatal period, or neonatal, begins from the moment the baby is born, the first breath and the ligation of the umbilical cord. The first minutes and days of life are characterized by reactions of adaptation of systems and organs to new environmental conditions. The adaptation of the child proceeds safely with the continuing close physical, immunobiological and psychoemotional connection with the mother.
The timing of the clamping of the umbilical cord is not indifferent to the child. Due to the additional placental blood volume, the pulmonary system adapts, and iron stores in the body increase. At the same time, late ligation of the umbilical cord leads to hypervolemia, hyperbilirubinemia and affects the development of sexual crisis. In premature babies, immediate cord ligation creates a deficit in circulating blood volume, the risk of developing respiratory distress syndrome and hyaline membrane disease.
In full-term babies, it is advisable to clamp the umbilical cord 1-1.5 minutes after birth, in premature babies - after 1.5-2 minutes, i.e. after the first breath.
Clamping the umbilical cord and turning off the placental blood flow leads to a restructuring of the child's blood circulation: an increase in pressure in the systemic circulation. With the onset of spontaneous breathing, blood flow through the lungs increases 5-10 times compared with the prenatal period. Accordingly, the return of blood to the left atrium increases, where, as in the aorta, the pressure rises. High pressure in the left side of the heart contributes to the shutter of the oval window (in a few hours). The closure of the arterial (botallov) duct occurs due to the narrowing of its lumen. Left-to-right shunting of blood (from the aorta to the pulmonary artery) can last up to 4 days of life and is clinically manifested by murmur.
The lungs of the fetus are filled with fluid, which is produced by the cells of the respiratory epithelium. From the moment of development of labor, preparation for the expansion of the lungs begins: mechanical compression of the chest and displacement of fetal fluid occurs. Under the influence of the first breath and reflex contraction of the respiratory muscles (mainly the diaphragm), negative pressure is created in the chest, which contributes to the suction of atmospheric air into the respiratory tract. In the mechanism of lung expansion, the vascular component is of great importance. The filling of the pulmonary vessels with blood leads to a slow expansion of the small branches of the pulmonary artery and ends by 4-5 days of life.
Surfactant system, lining the epithelium of the bronchi and bronchioles, changes the force of surface tension in them during inhalation and exhalation. This self-regulating multicomponent system, in which dysdilimers, characterized by a high content of unsaturated fatty acids, are of great importance, plays a special role in the expansion and residual functional capacity of the lungs.
In the first week of life in a newborn, the respiratory rate ranges from 30 to 60 per minute and depends on the functional state of organs and systems and the characteristics of metabolism.
In the first week of life, physiological acidosis and a decrease in oxygen tension in the blood are revealed, glucose and blood lipids change. At this point, high concentrations of non-esterified fatty acids are used as energy sources. Metabolic processes in adipose tissue are active.
BASIC PRINCIPLES OF CARE FOR NEWBORNS IN THE MATERNITY HALL
Immediately after the birth of the head, it is necessary to aspirate from the oral cavity and nasopharynx using a catheter connected to an electric vacuum device, masses consisting of amniotic fluid, mucus and blood.
The child is taken on a warmed tray, covered with two sterile diapers, located at the mother's feet and carried out:
· Repeated aspiration from the oral cavity and nasopharynx;
· Prevention of blenorrhea;
· primary ligation of the umbilical cord;
· Show the child to the mother and spread it on the stomach;
· Assess the state on the Apgar scale in the first minute.
Carrying out secondary processing of the umbilical cord and secondary prevention of blenorrhea is carried out in a specially designated place for newborns on a heated changing table and, only on condition that the midwife changes into a sterile gown and her hands are prepared in compliance with the rules of asepsis and antiseptics. The brace is not applied to the umbilical cord residue, but is replaced with a ligature, provided: a thick and juicy umbilical cord, Rh-negative mother's blood, low-birth-weight newborns and children in serious condition. Primary treatment of the skin, weighing, measuring the length, head circumference, chest circumference and swaddling are carried out. Without fail, before the transfer of the mother and child to the postpartum department, the baby is applied to the mother's breast.
The primary assessment of the functional state of the newborn is carried out according to the Virginia Apgar scale (USA), proposed in 1953. In Russia, a two-fold assessment on the Apgar scale is adopted: at 1 and 5 minutes after the birth of all newborns, regardless of gestational age and birth weight. The main indicators of vital activity are: heartbeat, breathing, muscle tone, activity of reflex responses and skin color, which are rated 0, 1, 2 points. A healthy newborn has a score of 8-10 points. The scale has a predictive value in the group of term infants. Clinical symptoms indicated in the Apgar scale depend on many factors, primarily on the degree of maturity, metabolic changes and the severity of asphyxia.
SCALE APGAR
Maturity of the newborn determined by the combination of clinical, functional and biochemical parameters. In each age period, starting with the zygote, the adaptation features of the fetus, newborn and infant correspond to its calendar age in conjunction with the environment that surrounds it and interacts with it. The state of the central nervous system is an informative characteristic of maturity. When examining a child, posture, position, spontaneous facial motility, emotional reactions, congenital unconditioned reflexes and sucking activity are assessed. According to clinical signs, the maturity of the newborn is determined using assessment tables according to the sum of points for each sign.
It is customary to call 28 days of a child's life the neonatal period (neonatal period). This is the most dangerous period in a child's life. Of all children who die before reaching one year of age, 70% die within the first four weeks after birth.
And the first week of life is included in the perinatal period.
At the moment of birth, the child enters from the womb, the temperature of which is about 37 ° C, into room conditions. The temperature in the delivery room is usually maintained within an average of 20 (from 15 to 20 °), and, therefore, the temperature drop in the first minutes of a child's life is approximately 18 °. This causes a protective reaction of the newborn - a reflex increase in muscle tone, which raises the body temperature to 36-37 °. The lower the room temperature, the higher the body temperature of the newborn.
The degree of usefulness of the first in non-uterine breaths also depends on the intensity of muscle tone: inhalation, the volume of which in a physiologically mature newborn is 30-35 cubic meters. cm, and the subsequent exhalation - "the first cry". This cry can serve as a criterion for the quality of breathing: the louder the cry, the more complete the exhalation and thus the inhalation preceding it. Complete expansion of the newborn's lungs occurs within a minute and a half after leaving the mother's womb.
In the first moments after birth, the child continues to receive food (and blood) from the mother through the umbilical cord. Therefore, the umbilical cord should be ligated no earlier than its pulsation stops - so that the newborn has time to get the maximum of the blood it contains from the placenta.
An adult who is naked, that is, naked at room temperature (18-20 ° C), can maintain a constant body temperature (36-37 °) in two ways:
firstly, a decrease in heat transfer, that is, a narrowing of the blood vessels of the skin (vasoconstriction), a decrease in perspiration, or even a complete cessation of the action of the sweat glands;
secondly, an increase in the generation of heat, that is, an increase in the tone of the skeletal muscles, reaching tremors.
An increase in muscle tone in newborns immediately after birth, with a sharp decrease in environmental temperature, causes, on the contrary, not a decrease, but an increase in heat transfer. In this case, the blood vessels of the skin expand (vasodilation), and the child does not turn pale, but turns pink. Higher heat transfer prevents the possibility of increased body temperature due to a reflex-induced increase in muscle tone.
Immediately after birth (more precisely, after ligation of the umbilical cord), a newborn, laid on a special table in the delivery room, acquires a specific posture - flexion hypertension: the head bends in relation to the body, elbows are bent, fingers are bent into a fist, knees are bent, toes are bent to the sole ...
Any additional irritation - slight tingling, light flux, sharp, even not very loud sounds - increases the degree of flexion hypertension. The newborn does not yet turn its head in the direction of a flash of light or a sound source, but responds to such stimuli with a flexion flinch. The severity of flexion hypertension (in physiologically mature children born) can be judged by the child's resistance to the doctor's (midwife's) attempts to straighten the elbow or knee joint.
This resistance is the first diagnostic sign of the physiological maturity of the newborn. This sign is combined with pink
skin color - despite the nakedness of the baby and the temperature in the delivery room, which is significantly lower than in the womb.
For a more accurate diagnosis of the condition of a newly born child, it is necessary to have a portable electrodermal thermometer and the same homometer - to assess sweating.
In the forehead area of the newborn, the skin temperature is usually 34.5 °; in the shoulder region - 33.8 °, chest - 35 °, abdomen - 35.2 °, thighs and upper leg - 34 °, feet - 30.3 °. This is much higher than the temperature of the corresponding areas of the skin of adults. A rather significant temperature difference between the skin of the breast and the foot (about 5 °) shows good thermoregulation of the newborn, as well as a high level of heat transfer and, accordingly, a high level of heat production.
In a physiologically mature child who is born, full-fledged thermoregulation reactions are immediately established. However, until recently it was believed that the thermoregulatory reactions of the newborn are still imperfect, that only in the process of further development in the child's body do the mechanisms of chemical thermoregulation mature, and only after that - physical. This is not true. In fact, the reactions of chemical (reflex stimulation of skeletal muscles) and physical thermoregulation in newborns are as perfect as thermoregulation in adults, but they have their own distinctive features.
It should be noted that a physiologically mature newborn should not remain naked on the table for more than 20-30 minutes - the time during which he can maintain a constant body temperature. After this period, the muscle tone of the newborn decreases, and his body temperature drops. To prevent this from happening, it is necessary to prevent further cooling - to dress the child in the special clothing we offer (see Fig. 2)
So, within 20
For 30 minutes, it is necessary to do the toilet of the newborn, a diagnostic assessment of its physiological maturity - and immediately dress the child.
Clothing of the newborn should ensure that the child maintains an orthotonic posture of flexion hypertension. This, in particular, allows you to reduce the surface of his body and reduce heat transfer. Recommended and still TIGHT SWEATHING, in which the arms and legs of the baby are forcibly pulled out, not only disrupts chemical heat production, but also increases the heat transfer surface. In addition, tight swaddling to some extent interferes with normal blood circulation and can adversely affect the development of the neuromuscular system. Finally, tight swaddling immediately after birth drowns out the natural "instinct of freedom" in the child (according to IP Pavlov - "the reflex of freedom"). This "oriental" custom unconsciously induces in the child the habit of obeying, suppresses the will, makes it difficult to find his "I" and ultimately has a very harmful effect on the psyche of the developing individual.
Physiologically justified for a newborn can only be clothing that DOES NOT HINDER the natural (orthotonic) posture of the child, does not interfere with the implementation of his specific movements. Ego can be a blouse or undershirt made of bumazey or flannel with ribbons in front; when tying the ribbons, one edge of the undershirt should go over the other. A combination with sewn-on trousers at the ends is also possible. Along with undershirts, it is possible to use a diaper, which (together with the diaper) should not distort the bent position of the legs. Therefore, you should not stretch the legs of the child.
Such clothes, proposed by us in 1950, were not accepted then. However, since 1954 it has been accepted in maternity hospitals in Czechoslovakia and only since 1956 in our country. Later, such clothes were adopted by the World Health Organization (WHO) and recommended to all countries that are members of WHO, including our country. However, to this day, it is not used in all maternity hospitals; but even where it is used, only from the fourth or fifth day, and in the first days, tight swaddling is most often used.
Nevertheless, many young parents in our country, following the recommendations in the press, use the clothes described above after the child returns from the hospital.
No later than 20-30 minutes later, the newborn should be fed to the mother for the first breastfeeding.
In the normal course of pregnancy, the mother's mammary glands form colostrum by this time, and the newborn can receive 40-60 ml of it. As the stomach fills, the stretching of its walls reflexively slows down the sucking movements, the child falls asleep on the mother's breast, and in a sleepy state he is carefully transferred to the crib placed next to the mother's bed.
Since the 1930s, we have been conducting research on the characteristics of lactation (milk formation), first in animals and then in humans. It turned out that the late start of feeding, practiced in some places to this day (one day after birth and more), is harmful for the mother and, especially, for the child.
In the “Handbook on Children's Diet” (1977) I. M. Vorontsov and A. V. Mazurin noted: “The question of the optimal time of the first attachment to the breast is still being discussed. In many foreign countries, it is customary to carry out the first attachment in the delivery room, literally 15-20 minutes after the birth of the child. " The authors, unfortunately, did not indicate that the early initiation of breastfeeding, practiced in these countries, was first proposed in our country, although it follows: “Among Soviet scientists there are also supporters of early breastfeeding (IA Arshavsky) ... less in the practice of domestic pediatrics, this technique is not yet widespread, and this is due to clinical argumentation that requires a sparing attitude to both the mother and the child in the first hours after birth. " This is a false understanding of humanity. In fact, true humanity involves the establishment of contact between mother and child immediately after childbirth.
Lating the baby to the mother's breast later cannot be considered “sparing”; at the same time, the natural physiology of both the mother's body and the baby's body is significantly disrupted. Indeed, a child who has been receiving nutrients from the mother continuously before birth is doomed immediately after birth to prolonged starvation.
In 1980, WHO recognized the method of early breastfeeding 20-30 minutes after birth, which we proposed back in 1952, as compulsory for all countries.
This method soon began to be used in many countries of the world. Our country is also a member of WHO; our method had to be applied from the beginning of 1981.However, even if the relevant order was issued by the Ministry of Health, it would be impossible to apply the method in practice in our country, because our practice of narcotic pain relief in childbirth EXCLUDES the POSSIBILITY of an early start of feeding: the so-called medicinal substances introduced into the mother's blood during childbirth, penetrating through the placenta into the blood of the fetus, anesthetize its nerve centers and the newly born baby cannot realize the necessary sucking movements. And the mother cannot carry out the “face-to-face” attitude of the child who is born. So, due to the hypogalactia arising in the mother, the newborn is deprived of the most important thing - the colostrum period of breastfeeding.
Colostrum is very important not only due to the content of protein (casein), carbohydrate (lactose), fat (lipids), but also has a significant immunobiological effect. Colostrum contains such complex proteins as albumins, globulins (immunoglobulins - 1g), i.e. natural antibodies that bind foreign substances (antigens) with which the nascent organism can interact. In newborns, these proteins, unlike casein protein, are not yet broken down by digestive juices and are transferred unchanged into their bloodstream. Finally, colostrum contains lysozyme, an enzyme with bactericidal properties, a natural physiological antibiotic. Through passive immunization, the mother provides a high immunobiological resistance of the newborn to various infectious diseases (for example, sepsis, pneumonia, intestinal diseases). Later, the onset of feeding inhibits lactation, and in the first days the mother develops a condition known as hypogalactia; the newborn is deprived of the most important thing that he needs after birth, not only nutrients, but also immunization with colostrum.
In a normal pregnancy, the fetus is born with pronounced indicators of natural immunity. This is manifested in cellular immunity (highly expressed phagocytic activity of leukocytes, which, figuratively speaking, “devour” bacteria). And also in humoral immunity. After feeding with colostrum milk, within 2-3 days after birth, the natural immunoprotective capabilities of the baby become four or more times higher than that of the mother. A child born physiologically mature, if his natural physiology is not disturbed, not only cannot die, but cannot even get sick.
Early feeding is essential, not only for the infant, but also for the mother. Through the act of sucking, the anterior lobe of the pituitary gland is stimulated and the hormone prolactin is formed; with simultaneous stimulation of the posterior lobe of the pituitary gland, the hormone oxytocin is formed. Both hormones contribute to both the further development of breast cell function (lactogenesis) and full milk flow. This is why late initiation of feeding can lead to inadequate prolactin and oxytocin production and hypogalactia.
Oxytocin, in addition, promotes uterine contraction, bloodless placental separation and, more importantly, eliminates postpartum hemorrhage. Thus, an early start of feeding promotes rapid involution (contraction) of the uterus and prevents the pathology that may occur with a delay in uterine contraction. And such a delay may occur precisely because of the late start of feeding. Finally, the colostrum secreted in the first days of feeding, which contains a large amount of lysozyme, contributes to the abundant lubrication of the mother's breast skin and thereby prevents mastitis.
How do newborns pay in connection with the late start of breastfeeding by the mother - in a day, two or even three? They expect a weight loss of 150 g or more, it is called "physiological". Then - jaundice, due to the fact that in connection with starvation, acidosis is formed, i.e. that is the acidification of blood, which, by disrupting the function of the liver, excludes the possibility for it to translate indirect bilirubin into direct one. Indirect bilirubin, entering the bloodstream, causes jaundice, also called "physiological". Subsequently, this in the overwhelming majority of cases ends with liver disease. In the blood of newborns, in addition to the fact that they are deprived of the opportunity to obtain from colostrum milk those proteins that increase their natural immunity, their own content decreases. This is called "physiological" hypoproteinemia. Newborns lose water. Because of this, not only the urinary excretion is sharply reduced ("physiological" oliguria), but also the blood thickens sharply. It is also called “physiological” exycosis, that is, a condition caused by the loss of water. As a result, within the first month of life, there is a further decrease in the content of erythrocytes and hemoglobin in the blood. And this strongest deviation from normal development is characterized by modern pediatrics as a condition supposedly inevitable and even natural for newborn babies, and therefore called "physiological" anemia. Hence, one can understand the blood disease in newborns, in particular, malignant and known as leukemias. They occur in those children who, due to the late onset of breastfeeding by the mother, develop a sharp acidification of the blood (acidosis). We have not listed all the consequences. But even from what has been said, one can understand why children who are born perfectly healthy and physiologically mature, already in the maternity hospital, acquire the symptoms characteristic of babies born physiologically immature. So, the created state of a sharp deviation from the norm and representing an undoubted pathology is legalized as a state, supposedly "physiological". All this can be avoided if the mother begins breastfeeding early (20-30 minutes after the baby is born).
When a mother sees her newly born child for the first time, when she begins to feed him - the face and, especially, the eyes of the mother acquire features of incomparable spiritual beauty. And her pleasure is incomparable with any other emotions in her entire life. The mother, as it were, awakens an all-consuming tenderness for the child she has just born. All the hardships of life seem insignificant to the mother and fade into the background, the whole inner spiritual world of the mother seems to be ennobled. This is a maternal instinct that awakens even in those women who initially did not want to have a child. This feeling of pleasure is repeated with each subsequent breastfeeding.
Sucking movements of the child reflexively stimulate the formation of those hormones in the nursing mother, and in particular, neuropeptides, including endorphin, which neutralizes pain and causes positive emotions (“joyful sensations”). The child also receives these hormones with the mother's milk, in which the reciprocal positive emotions are thus evoked. It is as if “kindness” is poured into it, which children who are artificially fed “do not receive”.
At the birth of a physiologically mature baby and early breastfeeding in the infant, only positive emotions are usually evoked. Negative emotions can arise (in a physiologically mature infant) only if hygienic conditions are not observed or the behavior of parents and other people around them is incorrect. The indications accepted in the literature that children are supposedly born with negative emotions and only later do positive ones arise do not correspond to reality.
In many maternity hospitals, it is customary to give the child to the mother 6 times a day. We consider such a “routine” convenient for the service personnel to be unreasonable.
After the first feeding directly in the delivery room (no more than half an hour after giving birth!), The next feeding should be in the room, where the baby's bed should be placed next to the mother's bed. The timing of the second and subsequent feedings should be determined by the baby.
In a physiologically mature newborn, milk is absorbed (i.e., removed from the stomach) in an average of 2.5-3 hours, for each child at a DIFFERENT TIME. An empty stomach causes another excitement of the food center - this is most often manifested by a cry, the child seems to require another feeding, and the mother willingly (with pleasure!) Feeds her child. Physiological processes in a child's body in the first days after birth proceed WITHOUT a night break, so the child should be fed as many times a day as he “asks”, sometimes up to 8 times.
Our recommendations NOT TO SEPARATE the child from the mother aroused sharp objections back in the 50s. In pediatric guidelines, the main rule of newborn care was considered “compulsory. separation of newborns and women in labor. As we have established, such separation, as well as the late initiation of breastfeeding, is HARMFUL for development. Thus, the incidence of early-applied newborns is 34 times lower than that of late-applied newborns.
As our studies have shown, even physiologically mature newborns, falling into the fundamentally incorrect hygienic conditions adopted in our maternity hospitals, which do not correspond to the characteristics of their physiology, can become physiologically immature and, therefore, undergo many diseases, especially at the age of one year. Hence the high infant mortality rate in our country (56th place in the world!).
And if hygienic conditions are observed that correspond to the specific features of the physiology of newborns, children born physiologically mature, we emphasize again, not only cannot die, but even cannot get sick!
3. Anatomical and physiological characteristics of newborns. Newborn care.
Leather- delicate, velvety to the touch, elastic, pink, there may be remnants of vellus hair on the back and shoulder girdle. Its richness in blood vessels and capillaries, poor development of sweat glands and active sebaceous activity lead to rapid overheating or hypothermia of the child.
He has easily vulnerable skin, which is also important to take into account, because with improper care, diaper rash appears, infection easily penetrates through the pores and pustules appear. On the back of the head, upper eyelids, between the eyebrows, there may be bluish or reddish spots caused by vasodilation (telangiectasia), or punctate hemorrhages.
Sometimes there are yellowish-white nodules (milia) on the wings and bridge of the nose. All these phenomena disappear in the first months of life. In the area of the sacrum, there may also be an accumulation of skin pigment, the so-called. "Mongolian spot". It remains noticeable for a long time, sometimes all life, but is not a sign of any violations. The hair of a newborn is up to 2 cm long, eyebrows and eyelashes are almost invisible, nails reach the fingertips.
Subcutaneous fat- well developed, more dense than it will become in the future - in terms of chemical composition, refractory fatty acids now prevail in it.
Skeletal system- contains few salts, which give it strength, so bones are easily bent with improper child care. An infant feature is the presence of non-ossified areas in the skull - the so-called. fontanelles. Large, in the form of a rhombus, located in the area of junction of the parietal and frontal bones, dimensions 1.8-2.6 × 2 - 3 cm.The small, in the form of a triangle, is located at the convergence of the parietal and occipital bones and is closed at birth in most children ...
Such a soft connection of the bones of the skull is of practical importance when the head passes through the narrow birth canal. Its natural deformation into an elongated "pear" is not terrible and should not cause "panic". The correct shape is a matter of time. The conspicuous disparity of the baby's body parts should not frighten the parents either. Indeed, the head looks too large, because it is 1-2 cm larger than the circumference of the chest, the arms are much longer than the legs.
The existing imbalance is also a matter of time, which will fix everything. The ribcage is barrel-shaped: the ribs are located horizontally, and not obliquely, as in the future. They consist mainly of cartilage, as well as the spine, which does not yet have physiological curves. They will have to form later, when the child begins to sit and stand.
Muscular system- their increased tone predominates - the arms are bent at the elbows, the legs are pressed to the stomach: the posture is uterine due to the preserved inertia. The neck does not hold the head - its muscles are not strong. The child "twists" with arms and legs continuously, but targeted movements and motor skills will come with the maturity of the nervous system.
Respiratory system- the mucous membranes of the respiratory tract are delicate, contain a larger number of blood vessels, therefore, with infections, more often viral, swelling develops quickly, a large amount of mucus is released, which makes breathing very difficult. It is also hindered by the anatomical narrowness of the nasal passages of the newborn, as well as his trachea (windpipe) and bronchi.
The auditory tube, or Eustachian tube, is wider and shorter than in older children, which makes it easier for infection to penetrate and develop otitis media (inflammation of the middle ear). But then there is never an inflammation of the frontal sinus (frontal sinus) and maxillary, or maxillary, sinus (sinusitis), tk. they are not yet available. The lungs are underdeveloped, breathing is shallow and is mainly carried out at the expense of the diaphragm - a muscle located on the border of the chest and abdominal cavities.
Therefore, breathing is easily disturbed by the accumulation of gases in the stomach and intestines, constipation, tight swaddling, pushing the diaphragm upward. Hence the wish - to monitor the regular emptying of the intestines, not to swaddle the baby too tight. Since the baby does not receive enough oxygen during his shallow breathing, he breathes frequently. The norm is 40-60 breaths per minute, but this frequency increases even with an insignificant load. Therefore, it is necessary to pay attention first of all to shortness of breath, which is accompanied by a feeling of lack of air and may be a sign of a disease.
The cardiovascular system- with the birth of a newborn, changes occur in the circulatory system, at first the functional umbilical vessels and the vein cease their activity, and then the anatomical ones - the intrauterine blood flow channels are closed.
With the first breath, the small circle of blood circulation is included in the work, passing through which the blood is saturated with oxygen in the lung tissue. The pulse rate is 120-140 beats per minute, when feeding or crying, it increases to 160-200 beats. Blood pressure at the beginning of the first month was 66/36 mm. Hg, and by the end of it - 80/45 mm Hg.
Digestive system- functionally immature, and since newborns have an increased metabolism, it bears a great burden - minor errors in the diet of a breastfeeding mother and the child's diet can cause indigestion (dyspepsia). The mucous membrane of the mouth is rich in blood vessels, thin, delicate, easily vulnerable.
The tongue is big. On the mucous membrane of the lips there are so-called. "Pads" - small whitish elevations, separated by stripes, perpendicular to the longitudinal axis of the lip (Pfaundler-Lyushka rollers); the mucous membrane forms a fold along the gums (Robin-Mazjito fold); elasticity to the cheeks is given by the so-called. Bisha's lumps are accumulations of adipose tissue located in the thickness of the cheeks.
They are present both in healthy people and in those born with malnutrition - an eating disorder accompanied by a decrease in body weight. With the transition of hypotrophy to a severe form, the body loses almost all adipose tissue, except for Bish's lumps. The digestive glands, including the salivary glands, have not yet developed: very little saliva is secreted in the first days.
The muscles blocking the entrance from the esophagus to the stomach are also underdeveloped - this leads to frequent, mild regurgitation. To prevent it, after feeding, you need to hold the baby for about 20 minutes in your arms, vertically, leaning against your chest. Initially, the stomach contains about 10 ml of liquid, by the end of the first month, its capacity increases to 90-100 ml.
The muscles of the intestines are still not well trained and the movement of food through it is slowed down. Therefore, newborns are so tormented by the accumulation of gases formed during the digestion of milk and bloating - flatulence. Constipation is not uncommon. Feces in the first 1-3 days of life (called "meconium") have a characteristic viscous consistency of dark green color, there is practically no smell. Meconium is formed from amniotic fluid, mucus, bile, which enter the stomach and intestines of the fetus.
By the presence of these secretions in the first hours after birth, it is judged that the child has no defects in the development of the esophagus, stomach, intestines, anus. Obstruction of organs requires immediate surgical intervention. During the first 10-20 hours of life, the child's intestines are almost sterile, then it begins to colonize with bacterial flora necessary for digesting food.
The type of feces also changes - feces appear - a mass of yellow color, consisting of 1/3 of saliva, gastric, intestinal juices and 1/3 of food debris. The work of the digestive glands is also noticeable in this. The largest of them, which is also the body's protective barrier against toxic compounds - the liver - is relatively large in infants. But in healthy people, the edge of the liver can protrude from under the lowest rib (on the border of the chest and abdomen) by no more than 2 cm.
Genitourinary system- by the time of birth, the kidneys, ureters, bladder are well formed. However, the severe stress experienced by the baby during childbirth, for a short time, disrupts the metabolism. In areas where urine is formed, uric acid crystals are deposited and the kidney function is slightly reduced for the first few days.
The child urinates only 5-6 times a day. From the 2nd week, the metabolism gradually stabilizes, the number of urinations increases up to 20-25 times per knock. This frequency is normal for the first months, given the relatively small volume and lack of extensibility of the bladder wall. The external genitals are formed. In boys, the testicles are most often descended into the scrotum, but if they are in the lower abdomen, they can descend on their own in the first 3 years. In girls, the labia majora cover the small ones.
Metabolism- increased need for carbohydrates, increased absorption of fats and their deposition in tissues. The water-salt balance is easily disturbed: the daily requirement for fluid is 150-165 ml / kg.
Hematopoiesis- in newborns, the main focus of hematopoiesis is the red bone marrow of all bones, additional ones are the liver, spleen, and lymph nodes. The spleen is approximately equal in size to the palm of the child himself, its lower edge is in the projection of the left costal arch (the lowest protruding rib on the border of the chest and abdomen). Lymph nodes, as a rule, cannot be detected during examination, their protective function is reduced.
Endocrine system- the adrenal glands during childbirth bear the greatest load of all glands and some of their cells die, which determines the course of some borderline states. The thymus gland, which plays a protective role, is relatively large at birth and subsequently decreases in size.
The thyroid and parathyroid glands and the pituitary gland continue to develop after birth. The pancreas, which participates in digestion and takes part in the metabolism of carbohydrates (produces the hormone insulin), functions well at the time of birth.
Nervous system- immature. Brains are barely outlined. Stronger developed in those departments where there are vital centers responsible for breathing, heart function, digestion, etc. In infancy, they sleep most of the day, waking up only from hunger and discomfort. Congenital reflexes, such as sucking, swallowing, grasping, blinking, etc., are well expressed, and by the 7-10th day of life, the so-called. conditioned reflexes, reaction to the taste of food, a certain posture usually associated with feeding, by his hour the child soon begins to wake up on his own.
Normally, in healthy newborns, the following basic reflexes of the neonatal period are caused:
1. Sucking - the child responds with sucking movements to irritation of the lips by touching.
2. Babkin's palm-mouth reflex - when pressing on the child's palm with his thumbs, he opens his mouth and slightly bends his head.
3. Robinson's palmar grasping reflex - when a finger is inserted into the child's hand, the hand is squeezed and the child tightly covers the finger.
4. Moro's reflex - when hitting the surface on which the child lies or blowing into the face, the child's arms are extended at the elbows and pulled to the sides (phase I), followed by "hugging" the body (phase II).
5. Reflex of support and automatic walking - the child is taken under the armpits and placed vertically, supporting the back of the head with the fingers. At the same time, his legs first bend, and then the legs and trunk are straightened. When leaning slightly forward, the child makes step movements (automatic walking).
6. Bauer's crawling reflex - in the position of the child on his stomach, a palm is placed on his bent legs and the child begins to crawl, straightening his legs and pushing off.
7. Protective reflex of the newborn - in the prone position, the child turns his head to the side (protection).
8. Galant reflex - stroking finger movements irritate the skin along the spine from top to bottom. In response, the child bends the torso towards irritation.
Sense organs- in the first weeks, the olfactory organs almost do not smell, only an extremely loud sound can wake up, only too bright light can disturb. The child's unintelligible gaze does not linger on anything, many have physiological strabismus caused by weakness of the eye muscles, involuntary movements of the eyeballs - nystagmus.
Until 2 months, he cries without tears - the lacrimal glands do not produce fluid. So far, only taste, touch and temperature sensitivity help him to learn about the world. But you can't say about a two-month-old that he is "blind and deaf." A true omen - stubbornly stares at a ringing bright rattle.
Immunity- some factors that play a protective role in the body are produced even in utero. The child receives some of the immune substances from the mother with colostrum, in which their concentration is very high, and with breast milk, where their content is much lower, but in sufficient quantities. But in general, the immune system is imperfect, the child is vulnerable in terms of infection.
Baby care procedures up to one year old
Newborn care activities can be roughly divided into daily and weekly. But if necessary, you need to perform these procedures more often so that the newborn baby feels comfortable.
Daily newborn care
Perform the following procedures in sequence:
Washing your face with warm boiled water. You can wipe your face with your hand, or you can use cotton balls. At the same time, the auricles are rubbed;
Eye treatment. It is carried out with the help of cotton balls, which are moistened in boiled water. If you notice that the eye has become more dirty than usual, you can use a solution of furacelin (1: 5000 pharmaceutical preparation). There is an opinion that the eyes can be wiped with strong tea. If you decide to rinse with tea, be sure to make sure that there are no tea leaves on the cotton ball, they can irritate the eyes. Rinsing is carried out from the outer corner of the eye to the inner one. Use a separate cotton ball for each eye;
Skin folds can be lubricated with sterile vaseline or vegetable oil;
Umbilical wound treatment;
The smaller the child, the more often it is necessary to wash it, namely, it should be done after each urination and defecation. You need to wash it off with running water, and not in any case not in a basin or in a bath, as this increases the risk of contamination and infection of the urinary tract. Washing rules are as follows:
girls are washed from front to back;
washing is carried out by hand, on which a stream of warm water is directed (37-38 C);
Before you start washing your child, be sure to check the water temperature (first put your hand, and only then the child).
After washing on the changing table, blottingly dry your baby's skin with a clean diaper. Then, lubricate the folds of the skin with a cotton swab moistened with sterile vegetable oil (for this, you can also use baby cream).
Daily care must be done in the morning.
Weekly childcare up to one year old
The nasal passages are cleaned with cotton filaments. Better to make them from sterile cotton wool. Technique: a cotton flagellum is moistened in sterile vaseline or vegetable oil. It is introduced into the nasal passage to a depth of no more than 1-1.5 cm and cleaned from the inside out with rotary movements. The right and left nasal passages are cleaned with separate flagella. This procedure should not be carried out too long and often. Do not use solid objects for this, including matches and cotton swabs. This can lead to trauma to the mucous membrane;
The external auditory canals are cleaned with rotational movements using dry cotton flagella;
Do not wipe the mucous membranes of the oral cavity, as they are very easily injured;
Clipping nails. It is more convenient to use scissors with rounded ends or nail clippers;
Ticket 27
Physiological features of newborns
Glucose and calcium metabolism. Due to free diffusion through the placenta, the concentration of glucose in the blood of the fetus is maintained at 70-80% of the values of this indicator in the mother's body. In the later stages of intrauterine development, glycogen stores are formed in the liver, skeleton and heart muscle of the fetus, but its amount is very small. The interruption of the placental supply of glucose after birth makes the newborn child entirely dependent on glycolysis until glucose is supplied from exogenous sources.Unlike adults, who have an efficiently functioning glycogenesis system, the possibilities of newborns to use fats and proteins as a substrate for glucose synthesis are significantly limited. Within 2-3 hours after birth, the child depletes liver glycogen stores and becomes dependent on glyconeogenesis. The rate at which serum glucose decreases is dependent on gestational age-related stores and the infant's energy requirements. Babies that are "small for maturity" have a very high risk of developing hypoglycemia.
Symptoms are nonspecific and may include weak or loud screaming, cyanosis, apnea, restlessness, lethargy, or seizures. In some cases, there may be no clinical manifestations, despite extremely low blood glucose levels.
Hypoglycemia of newborns is considered a glucose content of less than 1.9 mmol / L in full-term and less than 1.4 mmol / L in children with low BM. Your glucose level should be 2.5 mmol / L or more 72 hours after birth.
Newborns at high risk of developing hypoglycemia require frequent monitoring of glucose concentrations. For the purpose of early diagnosis, the determination of blood glucose levels can be carried out directly in the neonatal unit at the patient's bedside using indicator paper soaked in a reagent. To increase the accuracy of the study, this method can be supplemented with a calorimetric method, which allows a qualitative reaction to be converted into a quantitative one, expressing the glucose content in mmol / l.
Since most newborns requiring surgical treatment are at risk of developing hypoglycemia, it is advisable to conduct a test with indicator paper immediately upon admission of the child and, if the results are positive, start administering 10% glucose, while sending the blood to the laboratory to accurately determine the blood glucose level. The goal of early glucose infusion is to prevent the development of clinical manifestations of hypoglycemia and to maintain glucose levels above 2.5 mmol / L.
When the glucose concentration drops below 2.2 mmol / l, as well as in the presence of any symptoms of hypoglycemia, intravenous administration of I — 2 ml / kg of 50% glucose. During the first 36-48 hours after major operations, the water-electrolyte balance, as a rule, undergoes rapid changes. During this period, the content of dextrose in intravenous solutions should be maintained in the range from 5% to 15%, depending on the concentration of glucose in the blood and urine.
Hyperpicemia quite often occurs in immature newborns with gestacin less than 38 weeks and weighing up to 1.1 kg, who are on parenteral nutrition. These are usually children of the first three days of life, receiving 10% glucose at a dose of 100 ml / kg / day. Gynerglycemia appears to be caused by a decreased insulin response to glucose injected. As a result of hyperglycemia, intraventricular hemorrhage can develop, as well as renal fluid and electrolyte losses associated with glzuria.
To prevent hyperglycemia, the infusion rate and glucose concentration must be adjusted depending on the serum glucose level. To provide these children with adequate caloric support, the increase in glucose concentration and volumes must be very slow and gradual. For example, you can start with a 5% dextrose solution in a volume of 100 ml / kg / day, increasing the concentration daily or every other day by 1%, as opposed to the generally accepted increase of 2.5% or 5% daily.
Calcium. The fetus is constantly supplied with calcium through the placenta. Of the total calcium obtained in this way, 75% is transported after 28 weeks of gestation.3 This circumstance partly explains the high incidence of hypocalcemia in premature infants. At birth, there is a natural tendency to hypocalcemia due to decreased calcium stores, renal immaturity, and relative hypoparathyroidism associated with high fetal calcium levels. Calcium content in a newborn usually decreases as much as possible 24 to 48 hours after birth. Ginocalcemia is defined as an ionized calcium level of less than 0.25 mmol / L.
The highest risk of hypocalcemia is in premature babies, newborns with surgical pathology, as well as those born to women with complicated pregnancy, such as diabetes, or from mothers who received bicarbonate infusions.
Substitution transfusions or massive transfusions of citrated blood can lead to the formation of calcium and citrate complexes and, accordingly, a drop in serum calcium levels. The later development of hypocalcemia (after 48 hours from birth) is rarely noted today, since most formulas received by newborns are low in phosphate.
Symptoms of hypocalcemia, as well as hypoglycemia, are nonspecific and consist in general excitability and paroxysmal anxiety. Increased muscle tone in children with gynecalcemia helps in the differential diagnosis with hypoglycemia. Of greatest importance is the determination of the levels of ionized calcium in the blood. Treatment of children with clinical manifestations of hypocalcemia consists of intravenous administration of 10% calcium gluconate solution in an amount of 1-2 ml / kg for 10 minutes against the background of continuous ECG monitoring.
For patients with asymptomatic hypocalcemia, calcium is prescribed at a dose of 50 mg / kg / day in the form of calcium gluconate, which is added to infusion solutions (1 ml of 10% calcium gluconate solution contains 9 mg of calcium). Calcium should not be mixed with sodium bicarbonate. Calcium metabolism is interrelated with magnesium metabolism. Therefore, if there is a risk of hypocalcemia, there is always a risk of hypomagnesemia. If a child with seizures, regarded as a manifestation of hypocalcemia, does not have the effect of calcium administration, hypomagnesemia should be suspected and confirmed or excluded by a serum magnesium study. Treatment consists in the urgent intramuscular injection of a 50% solution of magnesium sulfate at a dose of 0.2 mg / kg, if necessary, this dose can be repeated every 4 hours.
Blood volume. The total number of red blood cells rises to its maximum at birth. Indicators of blood volume in premature and full-term newborns, as well as in children over one month of age are presented in Table 1-2. By three months of age, the total blood volume per kg of body weight reaches values typical for adults.
Table 1-2. Blood volume indicators
The total blood volume in the neonatal period varies depending on the maturity of the child, its size, and placental transfusion. Since the placenta at birth contains 75-125 ml of blood, then with delayed cord ligation, the hemoglobin level in the newborn will be higher. It is possible to prevent placental transfusion or artificially "create" anemia if the baby is held above the placenta level before the cord ligation.
An initially high hematocrit number (more than 50%) can be used as a rough indicator of the available placental transfusion. A hemoglobin level greater than 220 g / L in combination with a hematocrit greater than 65% during the 1st week of life should be considered polycythemia. Upon reaching the hematocrit level of 65%, its further increase leads to a rapid significant increase in blood viscosity.
Polycythemia of newborns is typical for children born to women with diabetes, toxicosis of pregnancy, as well as for those who are “small for term”. Treatment of polycythemia is carried out by partial replacement transfusion of fresh blood or 5% albumin solution.
The causes of anemia at birth can be grouped into 3 large groups: blood loss, hemolysis, and decreased production of red blood cells. One of the important causes of severe chronic anemia, which can sometimes even be fatal, is fetal erythroblastosis or isoimmunization. This condition occurs when the red blood cells of an Rh-positive fetus enter the bloodstream of a Rh-negative mother.
The subsequent transition of IgG Rh antibodies from the mother into the fetal bloodstream leads to hemolysis, which causes severe manifestations of pathology. The most common signs of neonatal hemolytic disease are jaundice, pallor, and enlarged spleen or liver. In especially severe cases, massive edema occurs that is not directly related to the level of hemoglobin.
Treatment for fetal erythroblastosis should focus on preventing maternal immunization with anti-Rh immunoglobulin in every Rh-negative woman who has had Rh-positive childbirth or abortion. In severe cases, with a positive Coombs test, hemoglobin level in cord blood below 105 g / L or bilirubin above 80 mmol / L, urgent replacement transfusion is indicated. In less severe children, replacement transfusions are performed when the total indirect bilirubin level exceeds 340 mmol / L.
Fetal and "adult" hemoglobin. At an oxygen level of 27 mm Hg. Art. 50% of oxygen is released from the "adult" hemoglobin (R-50). Thus, the P-50 of "adult" hemoglobin is 27 mm Hg. Art. The decrease in the ability of hemoglobin to bind oxygen allows more of the liberated oxygen at a given level to pass into the tissues.
The P-50 index of fetal hemoglobin is 6-8 mm Hg. Art. lower than the "adult" hemoglobin. The relatively low P-50 level of fetal hemoglobin promotes more efficient delivery of oxygen from the placenta to the fetal tissue. In this situation, the curve reflecting the saturation of hemoglobin with oxygen shifts to the left. The decrease in P-50 is partly due to the lower ability of fetal hemoglobin, compared with "adult", to bind 2,3-diphosphoglycerate. By 4-6 months of age in full-term infants, the hemoglobin oxygen saturation curve gradually deviates to the right and the P-50 values approach the values of "adult" hemoglobin.
Jaundice. Bilirubin is a fat-soluble substance formed as a result of the breakdown of hemoglobin. When conjugated in hepatocytes with glucuronic acid, it becomes water-soluble. When the binding mechanism is disturbed, indirect bilirubin accumulates and acts as a neurotoxic poison, causing damage to the nervous system in the form of kernicterus. In its severe forms, complications such as cerebral palsy, hearing loss, etc. can develop.
Immediately after birth, the excretory function of the liver in newborns is significantly reduced. Therefore, even in healthy term babies, there may be increases in the level of indirect bilirubin, reaching a maximum (170 mmol / L) by the 4th day of life and returning to normal values by the 6th day. An increase in the level of total bilirubin in a full-term baby of more than 200 mmol / l should force the search for the cause of hyperbilirubinemia (Tables 1-3).
Table 1-3. Most common causes of prolonged hyperbilirubinemia (due to indirect bilirubin) 
Treatment of hyperbilirubinemia, largely determined by the child's body weight, begins with phototherapy: (1) in newborns weighing less than 1500 g, when the level of bilirubin reaches 85 mmol / L, (2) with a body weight of 1500-2000 g and an increase in the level of bilirubin up to 140 mmol / l, (3) at MT of 2000-2500 g, when the level of bilirubin reaches 220 mmol / l. In term infants who are bottle-fed and have no signs of hemolytic disease, phototherapy is started when the bilirubin level reaches 250 mmol / L.
In case of hyperbilirubinemia associated with hemolytic disease, phototherapy is recommended if the bilirubin values exceed 170 mmol / L by 12 hours after birth, 200 mmol / L - by 18 hours, 240 mmol / L - by 24 hours and 255 mmol / L - at later dates. Until now, a controversial question remains - what level of bilirubin should be an indication for replacement blood transfusion.
Retinopathy of prematurity (ROP) occurs as a result of developmental disorders (its active phase) of the retinal vessels during the first 3-4 months of life. In large departments of newborns (for example, in a hospital in Pittsburgh), ROP is found in 1.9% of premature babies. It is difficult to identify risk factors for ROP; however, two reasons undoubtedly play a significant role in the pathogenesis of ROP - oxygen exposure and prematurity. American
The Academy of Pediatrics considers it necessary to examine the retina at the age of 6-8 weeks in every premature baby who has received oxygen. Retroleital fibroplasia (RLF) is manifested by changes in the retina and vitreous body that occur after the acute stage of retinopathy (3-6 months after birth). The study of the results of cryotherapy in the treatment of ROP showed that this method is quite effective and helps to prevent complications such as retinal detachment and vitreous fibrosis.
Thermoregulation. The relatively large body surface compared to the weight of a newborn child largely explains the difficulties in maintaining a constant body temperature on their own. Heat loss can occur due to evaporation (a wet child or lying on damp laundry), direct heat loss (direct skin contact with a cold surface), convection (air movement) and radiation (the body radiates heat towards colder surfaces, even unless they are in direct contact with this organism).
It is radiation that is most difficult to control and manage. An increase in heat production in newborns can be provided by activation of metabolism, increased muscle activity (like in adults), or due to lipolysis of brown fat. However, fat thermogenesis is significantly limited by small reserves of brown fat (when depleted), as well as its possible deactivation as a result of blockage when using certain drugs (vasoconstrictor drugs or anesthetics).
The optimal ambient temperature for a newborn is one at which the child can maintain a constant body temperature through vasomotor regulation at a minimum rate of metabolic processes. The critical temperature refers to those indicators, with a further decrease in which, in order to restore heat loss, the child needs a change in metabolism. It is impossible to recommend any uniform incubation temperature setting suitable for any child.
The optimal (neutral) temperature is set taking into account the body weight and age of the newborn (Fig. 1-2 and 1-3). For low birth weight children in the first 6 weeks of life, it is usually 34-35 °, after 6 to 12 weeks - 31-32 °. For larger full-term newborns with a MT of 2–3 kg, the neutral temperature ranges from 31–34 ° on the first day of life and 29–31 ° thereafter until the 12th day. The double-walled jugs provide the best required temperature. As for heating devices, they cannot prevent convection, which results in sometimes high extrarenal water losses.
Rice. 1-2. Neutral temperature regime for newborns in the first week of life.
Rice. 1-3. Neutral: CO temperature regime for newborns aged from 7th to 35th days of life. The temperature for children weighing more than 2 kg is calculated by extrapolation.
NS. Ashcraft, T.M. Holder