Patronage of the child after discharge. Why do you need a newborn baby to be patronized by medical workers? What advice do young parents get from a doctor and nurse? Algorithm and scheme of the procedure

05.08.2019

The primary care of a newborn, that is, examination of the baby by a pediatrician at home, should usually be carried out within the first two to three days after the mother and child are discharged from the hospital. This is a free visit that every newborn is entitled to. It takes place at the place of actual residence of the mother with the baby. To do this, the mother, upon discharge from the hospital, must indicate her residential address, which will be entered in the exchange card. This card will then go to the appropriate clinic and a doctor's visit can be expected soon.

Newborn care is needed to make sure that everything is in order with the baby after discharge from the hospital. Often the mother is not sure if she is treating the baby correctly. In this case, the arrival of the doctor and nurse home will greatly help the parents.

Patronage is carried out not only by a pediatrician, but also by a nurse; they have slightly different purposes of visiting. The specialist examines the baby and draws conclusions about his condition. The nurse, on the other hand, tells her mother about the rules of caring for a newborn, talks about proper nutrition, shows how to treat the umbilical wound, ears, nose, and basic techniques of massage for a baby.

Many parents are interested in how the child is examined. Here's what happens during the first patronage:

There is an acquaintance with the parents and with the newborn himself. The specialist will find out if there were any diseases in the family that could be transmitted to the baby.
The pediatrician assesses the living conditions in which the baby is to grow up.
The doctor carefully examines the baby's skin color to see if it has passed.
Examines the umbilical wound for healing.
The pediatrician feels the fontanelle and records its size, examines the baby for the presence of postpartum hematomas, looks if the eyes, ears, chest, abdomen and genitals are developed and symmetrical.
The doctor assesses the muscle tone of the newborn, reflexes, feels the tummy, listens to the heartbeat and breathing of the baby.
The specialist also assesses the condition of the young mother.

The day after the visit to the doctor, the visiting nurse must come. She will talk about caring for a child, explain how to bathe and wash him correctly, do exercises and massage with him, nose and eyes,.

The nurse specifies whether the baby is breastfed or artificially fed and gives recommendations on the baby's nutrition. If the baby is breastfed, the patronage nurse talks about the diet of the nursing mother.

How often should the doctor come

Parents usually ask how many times the doctor and nurse must come home to examine the baby. The so-called secondary patronage is carried out by a pediatrician around the 14th day of a baby's life. This time, the doctor also examines the newborn to assess his development, how he gains weight, how the navel heals. For this visit, the mother can make a list of questions of concern to her about the child. It can be regurgitation, colic onset, thrush in crumbs. Do not hesitate to ask the pediatrician about the incomprehensible moments in caring for a baby.

The third visit to the doctor is about 21 days after the baby is born. This time, the pediatrician performs the same manipulations as in the past. It is also better to write down the questions that have accumulated during this time for a specialist so as not to miss anything.

In addition to three visits to the doctor, a nurse should also come to the baby. She should visit him about once a week for the entire first month of life and help her mother with pressing issues of caring for the newborn.

When the baby is one month old, the mother herself goes with him to the clinic on a specially designated day for the baby. On this day, healthy children under one year old should be admitted to the clinic, which reduces the risk of their infection with various infections from the sick.

Sometimes a mother with a baby needs more frequent visits to health professionals. This can happen after a difficult birth, when the baby's condition leaves much to be desired and requires more attention. Then a special note is made in the exchange card stating that the child needs urgent patronage.

Patronage of a newborn helps a mother learn the rules of caring for a baby and become confident that she is doing everything right. In addition, the doctor and nurse can identify early signs of illness that are invisible to the eyes of young parents. Good luck in caring for your baby!

LECTURE No. 3. The neonatal period. Newborn patronage

After the newborn is discharged from the maternity hospital, the information is sent by phone to the children's clinic, where the mother's name, address and date of birth are recorded in the newborn's visit log. During the first three days after discharge from the maternity hospital, the district doctor and nurse perform the first patronage of the newborn. Children with risk factors, congenital anomalies and diseases, premature or post-term, as well as the first child in the family, should be examined on the first day after discharge from the maternity hospital.

1. The first patronage of the newborn

Anamnesis is collected to identify and clarify risk factors, an objective examination of the child, instructing the mother and drawing up a document (f. No. 112).

The history includes the collection of social, biological and genealogical information. The parameters of the social history are: the completeness of the family and the psychological climate in it, housing and living conditions, material security, the level of sanitary and hygienic conditions for caring for a child and an apartment, lifestyle. The biological history covers the features of the antenatal period, the state of health of the mother and child, the genealogical history - the state of health of parents and relatives (at least 3 generations). The mother hands over to the doctor the exchange card received upon discharge from the maternity hospital. It contains information about pregnancy and childbirth, the state of the child at birth (assessed on the Apgar scale), the main parameters of physical development (body weight, body length, head and chest circumference), health group and risk group.

Objective examination

Objective examination is carried out by systems. Congenital malformations, symptoms of intrauterine infection and purulent-septic diseases, birth trauma should not go unnoticed.

The newborn's skin should be pink, clean and velvety. Changes in the color of the skin (cyanosis, icterus, an earthy gray tint and pallor) require a special examination. Prickly heat and diaper rash indicate defects in care. The turgor and elasticity of the skin matter. With abscesses on the skin, purulent discharge from the umbilical wound or hyperemia around the navel, it is necessary to send the child to a hospital for examination and treatment.

The pose of a newborn can be physiological or pathological (posture "frog", "cop dog"). In physiological posture, the tone of the flexors of the arms and legs prevails ("embryonic" posture). Forced position indicates pathology.

The head of a newborn is rounded. Sometimes it may have a cephalohematoma (subperiosteal hemorrhage as a result of birth trauma). The size of the large fontanelle ranges from 1 to 3 cm in medians. The small fontanelle is closed in most newborns. Bulging of the fontanelle above the level of the bones of the skull, a suffering expression on the face indicate an increase in intracranial pressure (with hydrocephalus, meningitis, cerebral hemorrhage). Such a child should be monitored by a neurologist.

When examining the eyes, the pupils should be symmetrical, with a lively reaction to light. Nystagmus, a symptom of the "setting sun" usually indicates a severe pathology of the central nervous system and the need to consult a neurologist. Underdeveloped and low-lying auricles can be combined with congenital malformations of internal organs and deafness. When examining the pharynx, attention is paid to the soft and hard palate to reveal a hidden cleft and arched configuration. The frenum of the tongue can be shortened, and if this leads to a violation of the sucking act, its surgical correction is necessary.

The rib cage is actively involved in the act of breathing, it is symmetrical. Pay attention to the frequency and nature of breathing, percussion and auscultation data when examining the lungs and heart. It should be remembered that congenital heart defects rank first among other congenital malformations. Their first manifestation may be a harsh murmur, found during au-scultation for the first time in the neonatal period. When auscultation of wheezing in the lungs, the child should be examined in a hospital. It should be remembered that percussion data in a newborn are more reliable than auscultation data, since due to the thin chest, breathing is well conducted from one half of the chest to the other, which makes it difficult to fix the weakened breathing.

The abdomen is palpated counterclockwise. The edge of the liver can normally be 1–2 cm below the costal arch. When palpating pathological formations, the child should be sent for ultrasound of the abdominal organs.

The genitals should be shaped according to the sex and age of the child.

Extremities. Legs bent at the hip joints at an angle of 90 ° can be retracted until they fully touch the table surface. With a congenital dislocation of the hip, a dull click will be heard. The paralysis of Erb-Duchenne and Dejerine-Klumpke indicate a birth traumatic injury to the brachial plexus.

The nervous system and mental development are assessed when observing a child and communicating with him - according to activity, gaze, and the severity of unconditioned reflexes. Reflexes of the greatest diagnostic value are: sucking, searching, grasping, crawling, protective, support and automatic walking, Babkin's reflex. Tendon reflexes, their symmetry, muscle tone are determined.

Briefing

Parents' instruction concerns issues of childcare, feeding and upbringing.

Care recommendations. Cleanliness is important to the health of a newborn. The crib should be placed in a bright place in the room, but not in a draft. The newborn is placed on its side in the crib, without a pillow. The air temperature is maintained at 20–22 ° C.

Bathing is done every day in a special baby bath, which is not used for washing diapers or baby clothes. Bathing duration - 10 minutes.

You can bathe your child in the morning or in the evening. The best time is in the evening, before the last feed, as this improves the baby's nighttime sleep. Before bathing in the first 2 weeks, the bath must be scalded with boiling water. The newborn should be bathed in boiled water until the umbilical wound has healed. The water temperature is 37–38 ° C. Water is poured into the tub to cover the bottom. It is good to add decoctions of herbs (string, chamomile) to the water. The baby should be gradually immersed in water, wrapped in a diaper, so as not to cause anxiety. They support the child's head with one hand, and wash it with the other.

It is convenient to use an individual soft sponge for washing. The soap is used 2 times a week, only for children. After bathing, the child is laid face down on the palm, clasping the chest, and rinsed with water from a jug. Then you should dry the baby's skin with a towel, while making blotting movements. It is especially important that the skin folds are dry.

They are treated with baby cream, dusting powder or boiled sunflower oil. Each mother chooses the products for the child's skin care herself. The area of the umbilical wound is treated with brilliant green solution or 5% potassium permanganate solution, or 5% iodine solution.

Morning toilet - every morning after the first feeding of the child, wash with a cotton swab moistened with warm boiled water, eyes - from the outer corner to the inner, each eye with a separate swab. The nose is cleaned with cotton wool soaked in vaseline oil.

Swaddling is an important part of caring for a newborn. Loose and wide swaddling is recommended. For free swaddling, the child is put on a jersey with sewn-on sleeves. The legs are laid in a diaper. The rib cage remains free, making breathing easier and preventing lung disease. For wide swaddling, an additional diaper is placed between the thighs, so that the thighs remain in a dilated state, which contributes to the reduction of the femoral head into the acetabulum and is a conservative treatment for congenital hip dislocation.

Outdoor walks should be started immediately after leaving the maternity hospital. For the first time, the duration of the walk is 5 minutes at a temperature not lower than -10 ° C. In order to adapt to the environment, the duration of walks is increased gradually, adding 5 minutes daily. Walking is contraindicated in case of a child's illness. They should be renewed after recovery, gradually increasing in duration.

Correct feeding of a newborn ensures its timely harmonious development and forms immunity. Latching the baby to the breast immediately after birth stimulates lactopoiesis. It is necessary to explain to the mother the advantages of breastfeeding and to recommend breastfeeding at the request of the child during the period of lactation. With breastfeeding, a very important emotional contact is established between the mother and the child, which favorably affects the psycho-emotional state of the mother and the formation of the child's personality. It is necessary to alternate feeding with each mammary gland. To determine the amount of milk eaten by a child, control weighing is used.

Before feeding, the mother should put on a scarf, wash her hands with soap and water, and strain one drop of milk. Most often, difficulties in breastfeeding are caused by the irregular shape of the nipples, their cracks. To improve the shape, you should gently pull the nipples for 2-3 minutes 3-4 times a day. For the treatment of cracks, 1–5% synthomycin liniment, 0.2% furacilin ointment, and calendula ointment can be used. After using these products, the breasts should be thoroughly washed with warm water and baby soap before feeding the baby.

Sometimes breastfeeding is contraindicated. This may be due to the condition of the mother or child. Contraindications to breastfeeding on the part of the mother include renal, heart failure, malignant tumors, severe blood diseases, severe infectious diseases (such as tuberculosis, meningitis, diphtheria, tetanus, etc.).

The child is not applied to the breast in case of severe intracranial birth trauma, respiratory, heart failure, deep prematurity with the absence of sucking and swallowing reflexes, hemolytic disease of the newborn (if high titer antibodies are found in the mother's milk), hereditary metabolic disorders (phenylketone-ria, galactosemia and etc.). All these conditions are absolute contraindications. Mastitis in the mother is a relative contraindication. With a serous nature of the inflammation, feeding from a healthy breast is allowed. With purulent mastitis, breastfeeding stops completely.

Sometimes there is a decrease or cessation of lactation in the mother. Hypogalactia can be primary and secondary. Primary hypogalactia is caused by neurohormonal disorders, therefore, hormones are prescribed for the development of lactation: lactin 70-100 units. intramuscularly 1-2 times a day for 5-6 days; oxytocin 1.5–2 units. (0.3-0.4 ml) intramuscularly 2-3 times a day daily for 3 days, pituitrin 2.5 units. (0.5 ml) 1-2 times a day intramuscularly for 5-6 days. Secondary hypogalactia is more common. Its occurrence is facilitated by insufficient sleep, malnutrition, violation of the rules of breastfeeding, taking medications (antibiotics, diuretics, barbiturates, furazolidone, etc.). Treatment of secondary hypogalactia consists in eliminating its causes. To stimulate lactopoiesis, vitamins are prescribed (A, B 12 , B6 C, PP), apilak (0.01 g 3 times a day under the tongue for 10-15 days), dry brewer's yeast (1-2 g 3 times a day inside for 10-15 days), use phytotherapeutic agents ( hawthorn, lemon balm, strawberry leaves, oregano herb, dill). If it is impossible to restore lactation, then it is necessary to provide the child with donor breast milk. Collecting points for breast milk have been created in dairy kitchens. The donor woman must be healthy and clean.

In the absence of human milk, its substitutes can be prescribed - mixtures adapted to human milk. Unadapted simple mixtures have now lost their meaning.

Upbringing. From the very beginning, mutual understanding is established between the parents and the child with the help of specific signals, a unique form of relationship is formed - attachment. A newborn child has the ability to withstand the adverse effects of a new environment and to selectively respond to certain stimuli. The mental structure of the personality of a newborn, individual characteristics of temperament are visible from the first days of life ("difficult child", "easy child"). The variability of the child's behavior is due to changes in his forming consciousness. Breastfeeding plays an important role in the upbringing of a small person. A breastfed baby feels protected, needed, wanted. In conditions of positive mental contact, children grow up more obedient.

From the first days of life, the baby needs the correct daily regimen (alternation in time of the basic physiological needs: sleep, wakefulness, nutrition, walks, hygienic and tempering measures). This contributes to the formation of a certain rhythm of life. Children develop a reflex for a while, a dynamic stereotype of behavior is formed, biological rhythms are established, which provides him with a calm and quick fall asleep, good appetite, active behavior during wakefulness. Children living according to a set rhythm do not need additional reassurance (motion sickness, carrying on their hands, using a dummy).

In the future, such a child easily gets used to the daily routine. This teaches him to be organized and makes life easier for him and his parents. The correct daily routine should not be imposing. A child can be taught better and faster if you adapt to the level of his mental development, individual biological rhythm, taking into account the physical condition and individual mental characteristics. Deviations from the regime by 30 minutes or, in extreme cases, by 1 hour are allowed.

The leading factor in the regime is feeding the child. Feeding on demand is carried out during the adaptation period in order to establish the optimal feeding regime for the mother and child. The subsequent transition to feeding according to the regimen should be gradual. The criterion for a correctly chosen regimen is the child's health, primarily the functions of the central nervous system. In conditions of impaired adaptation, the child becomes capricious, whiny and irritable.

In accordance with the feeding regime, other regimes are formed: sleep and wakefulness, walks, hardening and hygienic measures.

At the first patronage of a newborn, it is necessary to tell the mother about the conditions requiring urgent medical attention, and inform where to go for help in case of diseases.

Document execution

Information about the content of the first newborn patronage is recorded in the history of the child's development (form No. 112) under the heading "First newborn patronage". The recording is made according to the following scheme: history, physical examination data, diagnosis indicating the health group and risk group, recommendations for care, feeding and upbringing. If the child belongs to the II-V health groups, then recommendations for rehabilitation should be given in accordance with the risk group or nosological form of the disease.

2. Second patronage of the newborn

The second patronage of the newborn is carried out on the 14th day of the child's life. Its purpose is a repeated examination of the newborn in organs and systems to establish the state of health, monitoring the implementation of recommendations, answering questions from the mother in connection with the problems that have arisen, instructing.

When collecting an anamnesis, it is necessary to find out the issues of feeding, the daily routine, the behavior of the newborn.

Objective examination

An objective examination is carried out in stages. It should be treated no less carefully than during the first patronage, since a pathology that did not appear earlier can be detected at this age.

It is necessary to evaluate how the child is gaining weight. If there are regurgitation, then it should be explained to the mother that children under 1 year old have a physiological insufficiency in the work of the sphincter apparatus of the gastrointestinal tract. If air is swallowed while feeding, the baby should be held upright for 10 minutes after feeding. If the regurgitation is persistent, constant, there is vomiting in a fountain, the child does not gain weight well, then he must be examined in a hospital.

From the age of two weeks, children may experience cramping abdominal pain (colic), which is due to the adaptation of the gastrointestinal tract to new living conditions. This is manifested by the child's sudden anxiety.

The mother is obliged to report such symptoms to the local doctor, who assesses whether these changes are functional abnormalities or are caused by organic pathology.

Briefing

The mother should be reminded of the importance of massage and gymnastics for the newborn. Massage and gymnastics are connected to hardening and health-improving activities.

The main massage techniques are stroking, rubbing, kneading, tapping, vibration. In the initial stages, massage should be light; of all the techniques, stroking is mainly used, since it helps to relax the muscles. During the massage, the baby's mass grows faster. A lethargic child becomes more lively and active, an excitable one falls asleep faster, his sleep becomes deeper and longer.

Massage is carried out with clean, warm, dry hands. They start with the face: the forehead is stroked from the center outward with the thumbs of the right and left hands. The cheeks are massaged from nose to ear and from the center of the upper lip to the ear, then from the chin to the ear. Limb massage is carried out from the distal end to the proximal from the outside and inside. When massaging the back, stroking movements are carried out with the palms from top to bottom and the back of the hand from bottom to top. When massaging the chest, the ends of the fingers are moved along the intercostal spaces from the sternum to the sides, without pressing on the ribs. Massage the abdomen clockwise, it is necessary to spare the liver area and not touch the genitals. The feet and palms are massaged last.

If during the procedure the child is capricious and crying, you need to interrupt it and calm the baby. Carrying out the massage from 2–3 weeks of age should be alternated with laying the baby on the stomach to strengthen the muscles of the back, abdomen and limbs. Spreading is done for 2-3 minutes before feeding.

Using special exercises during the neonatal period will help the baby to control his body. Since hypertonicity of the flexor muscles predominates in the newborn, it is necessary to help them relax. Movements should be performed slowly, rhythmically and smoothly. Gymnastics is carried out during wakefulness, when the child is in a good mood. The exercises are done while playing with the baby, while the mother should smile, talk to him affectionately or hum a song.

First exercise: the baby lies on its back, the mother lets him grab her thumbs with her hands, then spreads the newborn's arms to the sides and brings them together, crossing them on her chest. Exercise helps relax the muscles in your chest and shoulder girdle.

The second exercise: the child lies on his back, the mother raises his arms above his head and lowers him through the sides down. The exercise relaxes the muscles of the shoulder girdle and upper limbs.

The third exercise: the child lies on his back, the mother takes him by the shins and gently bends his knees to the stomach, then extends his legs. Exercise relaxes the muscles in the legs, helps the child to free the intestines from gases.

The fourth exercise: the baby lies on his stomach, the mother props the baby's feet with her hands, this makes the baby straighten his legs and crawl forward (reflex crawling). Exercise helps develop muscles in the legs, arms and back.

For the upbringing and development of visual concentration of the newborn, toys are suspended over the bed at a distance of 40–50 cm from the face.

The first toys after discharge from the maternity hospital can be 2-3 large brightly colored balls, suspended above the bed in turn every 2-3 days. This contributes to the development of the visual analyzer and creates a joyful mood in the child.

Patronage data are documented in the history of the child's development (f. No. 112) under the heading “Second patronage for a newborn”.

3. Third patronage of the newborn

The third newborn patronage is carried out on the 21st day of the child's life. Its goals are to monitor the dynamics of the health and developmental conditions of the newborn, feeding, conduct sanitary and educational work, and treat the identified developmental deviations.

Objective examination

When examining a newborn, it is necessary to pay attention to his behavior, health, reaction to the environment. In dynamics, the indicators of body weight, height, head circumference, chest, condition of the large fontanel are assessed.

On the oral mucosa, there may be thrush with defects in child care. A newborn in the third week of life can already fix his gaze, react with positive emotions to an affectionate appeal to him.

The skin is normally elastic, velvety, pink, clean. In the presence of pustules, treatment at home is necessary with a satisfactory condition of the child and the possibility of good care.

In a state of moderate severity or an unfavorable sanitary-cultural level in the family, the district doctor gives a referral for examination and treatment in a hospital.

The navel area should be epithelized by the 21st day of the child's life. With purulent discharge from the umbilical wound, hyperemia around the navel, the child should be sent to a hospital.

To determine the state of the newborn, the doctor re-evaluates the unconditioned physiological reflexes (Babkina, sucking, grasping, automatic gait, crawling), conducts percussion and auscultation of the lungs, heart, and palpation of the abdomen.

Briefing

Then the doctor clarifies in a conversation with the mother the nature of the child's physiological functions, gives recommendations on feeding and caring for the newborn, and answers questions that arose in her during the third week of the child's life.

During the third patronage, you should tell your mother about rickets in children and prepare her for the need to prevent this disease, inform about the importance of ultraviolet rays, vitamin D for the vital activity of the body and write a prescription for purchasing an oil solution of vitamin D at a pharmacy in a prophylactic dose of 450 IU / day.

It is necessary to talk about deficiency anemia in children, the importance of breastfeeding and the prevention of anemia. The doctor discusses with the mother the issues of hardening the child's body and strengthening its resistance, introduces the method of teaching swimming.

At the end of the conversation, the district doctor invites the mother and the child to an appointment at the outpatient clinic for the baby one month old, informs the work schedule of the district doctor and specialists, and informs about the day of a healthy child.

The data obtained are recorded in the history of the child's development (f. No. 112) under the heading "Third patronage for a newborn."

By the end of the neonatal period, the local doctor should make a forecast of the child's health for the first year of life. Some children of risk groups can be removed from dispensary observation and from the second month they can be observed in the same way as healthy children. In the presence of deviations in the state of health and development of the child, it is necessary to conduct an in-depth examination with the involvement of specialists, to correct the tactics of health-improving measures.

4. Features of observation and rehabilitation of premature and post-term newborns

All premature and premature newborns are at risk. They require increased attention from the district doctor: the first patronage to them is carried out the next day after discharge from the maternity hospital or hospital (departments of the I and II stages of nursing), since they need special care due to their weakening.

When collecting anamnesis, it is necessary, if possible, to establish the etiological factors that led to the birth of a premature or post-term baby, since the volume of rehabilitation measures depends on this.

With an objective examination, one should remember about the functional characteristics of premature babies. On the part of the nervous system, depression syndrome, a weak cry, a decrease in muscle tone, physiological reflexes, and imperfect thermoregulation are characteristic.

When assessing the state of the respiratory system, the lability of the respiratory rate (35–80 per 1 min), uneven breathing depth, weakened breathing during auscultation over the area of atelectasis, and apnea attacks can be detected. Heart rate is also variable and can vary between 140-180 beats per minute.

Vascular dystonia is noted. Immaturity of the respiratory and circulatory organs leads to an insufficient supply of oxygen to the child's body, as a result of which his condition worsens even more.

Nursing premature babies is extremely challenging. To preserve their vital activity, it is necessary to create special conditions for care and feeding.

The air temperature in the apartment should be in the range of 24-26 ° C (as premature babies quickly cool down), the baby should be swaddled quickly in pre-warmed diapers. Cooling of a premature baby can occur with prolonged lying in wet diapers. After bathing, the child is wrapped in a heated towel. Coldness of the nose is a symptom of hypothermia. Due to imperfect thermoregulation, overheating of a premature baby can easily occur. Then beads of sweat appear on the forehead and at the root of the nose.

Feeding premature babies presents significant difficulties. Due to the small capacity of the stomach, frequent feeding in small portions is recommended for such children. For a premature baby, breastfeeding is especially important, since the secretion of its own digestive enzymes is not enough. Breastfeeding compensates for the low level of humoral immunity of the premature baby and nonspecific protective factors. The risk of developing anemia in prematurity with breastfeeding is lower. For their artificial feeding, adapted formulas can be used.

Given the immaturity of the nervous system, a premature baby should create a protective regime, protect it from strong external stimuli: loud music, screams, bright light. You should talk more and take in your arms a premature baby, which contributes to his mental development. Sensory stimulation plays a huge role in neurological and physical maturation. However, it is necessary to remember about the rapid fatigability of premature babies.

For the prevention of respiratory diseases, given the tendency of such children to stagnation, the position of the premature baby in the crib should be changed more often.

It is necessary to pick up the child slowly, since due to vascular dystonia, when the position of the child's body changes, a violation of the blood supply to the brain can easily develop.

All premature babies are examined by a neurologist, otolaryngologist, ophthalmologist in the first month of life. If violations of the central nervous system, musculoskeletal system, hearing, visual impairment are detected, premature babies are under the supervision of a specialist of the appropriate profile.

Nursing a premature baby after discharge from the hospital is carried out in accordance with an individual rehabilitation program, which depends on the identification of risk factors for the development of pathology. Premature newborns belong to the II health group. Strict adherence to medical recommendations and close contact with the family are required. Most often, premature babies are characterized by a lag in physical and neuropsychic development, neurological diseases leading to disability (cerebral palsy, hydrocephalus, epilepsy, deafness); long-term consequences are mental and personality defects. Unfavorable outcomes (disability and death) in some cases are caused by the low socioeconomic status of the family, a lack of attention to the child, and improper upbringing.

Morbidity and mortality among post-term infants is also significantly higher than in term infants. They often have asphyxia, birth trauma of the central nervous system, aspiration syndrome, pyoderma, acute respiratory diseases, mental retardation, a tendency to overweight, viscerovegetative disorders (hyperexcitability, regurgitation, constipation, dyskinesia of the gastrointestinal tract).

The rehabilitation program, like in premature babies, is compiled on an individual basis in accordance with the identified risk factors.

Given the tendency of post-term newborns to be overweight, it is recommended to increase the number of feedings (7 instead of 6), but to reduce the one-time amount of food in the first months of life. With pronounced dryness of the skin, its peeling, hygienic baths have a good effect, softening and nourishing the skin. To do this, add rye or wheat bran, potato starch (50-100 g per 10 liters of water) to the water. For dry skin, baby soap can be used no more than 2 times a week. In connection with the dysfunction of the nervous system, a protective mode is prescribed. They give recommendations for the development of motor skills and education, taking into account the physiological characteristics of preterm and post-term newborns.

Outpatient pediatrics: lecture notes Lecture notes, cheat sheets, textbooks "EKSMO"

1. The first patronage of the newborn

Anamnesis is collected to identify and clarify risk factors, an objective examination of the child, instructing the mother and drawing up a document (f. No. 112).

Objective examination

Objective examination is carried out by systems. Congenital malformations, symptoms of intrauterine infection and purulent-septic diseases, birth trauma should not go unnoticed.

The genitals should be shaped according to the sex and age of the child.

Briefing

Parents' instruction concerns issues of childcare, feeding and upbringing.

Bathing is done every day in a special baby bath, which is not used for washing diapers or baby clothes. Bathing duration - 10 minutes.

In the absence of human milk, its substitutes can be prescribed - mixtures adapted to human milk. Unadapted simple mixtures have now lost their meaning.

In accordance with the feeding regime, other regimes are formed: sleep and wakefulness, walks, hardening and hygienic measures.

At the first patronage of a newborn, it is necessary to tell the mother about the conditions requiring urgent medical attention, and inform where to go for help in case of diseases.

Document execution

From the book The Magic of the Brain and the Labyrinths of Life the author Natalia Petrovna Bekhtereva

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From the maternity hospital where the baby was born, information about his discharge will be transferred to the children's district clinic, where the baby will be attached to the actual address of residence. The senior nurse of the children's polyclinic, having received information about the discharge of the baby from the hospital, on the same day enters the data in the newborn register; she fills in the developmental history of the newborn, inserts prenatal care inserts into it, transfers the developmental history to the registry or directly to the district nurse.

The first patronage of a newborn should be performed no later than 1-2 days after discharge from the hospital; For premature babies discharged with symptoms of perinatal and congenital pathology, the nurse and the local doctor should visit on the day of discharge. If this day falls on weekends or holidays, such children are visited by the pediatrician on duty.

The goals of patronage

The general goal of patronages is to create a child rehabilitation program.

Specific goals:

Assess the child's health;

Assess the state of health of the mother;

Assess the socio-economic conditions of the family;

Develop a mother's education program to meet the child's vital needs.

Umbilical wound treatment

It is enough to treat the umbilical wound once a day, after an evening swim. Do not strive to do this at every opportunity: this way you will too often rip off the crusts formed on the wound, which will not speed up, but only complicate and delay healing.

You will need:

cotton swabs,
ALCOHOLIC SOLUTION OF BRILLIANT GREEN ("brilliant green") or CHLORPHILLIPT,
clean pipette,
3% HYDROGEN PEROXIDE SOLUTION.
Step by step:
Wiping (more precisely, wetting) the baby's skin after bathing, dry well the navel area as well.
Soak a cotton swab in an antiseptic solution and lubricate the wound with it.
If there is a lot of discharge and crusts in the wound (usually this happens in the first days of a baby's life), they can be removed with a 3% HYDROGEN PEROXIDE SOLUTION.
Pipette the HYDROGEN PEROXIDE SOLUTION.
Release the solution into the umbilical wound. When it comes into contact with biological media, it will begin to foam and carry crusts and discharge to the surface.
Dry the wound with a dry cotton swab or cotton swab.
Use another stick to lubricate the wound with an antiseptic solution.
Currently, in most large obstetric institutions, the umbilical cord is surgically removed on the 2nd day of the baby's life. Usually, with this approach, there is no need to use hydrogen peroxide, since the healing process is usually smooth.
Bathing
Schedule of visits
What makes up newborn patronage?
Its official program includes as many as 10 doctor and nurse visits. But parents can change it in the way that suits them and the child.
- 1,3,10,14 day - visit to the pediatrician
- 2,4,11,15,21,28th day - visits of the patronage nurse
- By the end of the first month of life, the baby will have time to get stronger and the mother will be able to go with him to the clinic herself.

After discharge from the hospital, every inexperienced mother has a lot of questions related to the care, feeding of the baby and his health. As a rule, the older generation comes to their aid, grandmothers recall with pleasure how to swaddle a baby correctly, when to start the first bathing and how to treat an umbilical wound. Young mothers do not remain without qualified consultations. When you and your baby settle at home, a nurse and a pediatrician will definitely start visiting you.

The first patronage of a newborn is a very exciting event, so you should prepare for it in advance so as not to get confused, not to forget to ask the competent specialists something important for you. They will visit you at home throughout the year to monitor your baby's pace of development and advise you.

Patronage

The free home care service was created specifically to provide home counseling to new mothers throughout the first year of a baby's life. A nurse or pediatrician will come to see you, examine your baby, advise you on how to care for your baby, and recommend breastfeeding or bottle feeding.

From the maternity hospital, information about the newborn baby is transferred to the clinic at the place of your actual residence, but if the birth took place in another city, you yourself should inform the medical institution that you have a baby.

Upon discharge, within three days, the nurse and / or pediatrician must visit you at home and carry out the primary care of the newborn. If the child has pathologies, then specialists will come to you on the day you leave the hospital.

First visit

For the first time, the health visitor may visit you with your pediatrician. They will be interested in how the pregnancy proceeded and how the childbirth went, how many points a newborn has on the Apgar scale, what hereditary diseases do you have in your family. All this information is collected by the nurse and pediatrician to fill out the card and the initial assessment of your baby's health.

The visiting nurse and pediatrician are also required to assess the social and living conditions.... Therefore, do not be surprised or offended when you are asked how many rooms you have in your apartment and who lives with you. The specialists will also make sure that you have the necessary items for caring for your baby, a crib and a stroller.

Prepare ahead of time for your visit to the health visitor. It is clear that you will not know the exact time and day of her arrival, but still you should have shoe covers, a clean towel and a chair for the paramedic ready. Think about where in the apartment the pediatrician and nurse will examine the baby, and prepare disposable and non-woven nappies.

First inspection

In addition to collecting history and data at the first visit, the health visitor will examine the baby:

assess the color and condition of the skin;
determine the size of fontanelles;
will appreciate the correctness of the shape and size of the head;
see if there are birth hematomas;
will check the reaction of the pupils to light and the symmetry of the organs of sight and hearing.

Also, the health visitor will appreciate the symmetry and shape of the chest and abdomen. The specialist will pay special attention to the degree of development of the genitals, position and motor activity of the limbs. According to the position of the baby, the tone is assessed, and the presence of congenital reflexes is also checked at the first visit. The nurse will examine the baby's throat, note the correct structure of the baby's palate, listen to the heartbeat and lungs.

The patronage nurse will show you how to properly handle the umbilical residue in children, and will give thematic lectures at each visit on the peculiarities of caring for babies up to one year old. She will examine your breasts, give advice on breastfeeding and nutrition for a nursing mother, proper expression and hygiene, and answer any questions you may have.

Do not hesitate to ask the nurse about anything, because she is a competent person who comes to help and teach.

If you are in doubt or do not know when and how best to bathe a baby, or how to cut his nails and clean his ears, with which means it is better to take care of the baby's skin, the specialist will answer them in detail.

Further visits

Before your baby is 10 days old, you will have a daily visit from a pediatrician, visiting nurse, or doctor on call. The next visits will be less frequent - the specialist will come to you when the baby is 2 weeks old. On the 21st day of life, the nurse will visit you, examine the baby and appoint a date when to come with the newborn to the clinic for a full appointment. This is not the end of the patronage: the nurse will come and observe the child for up to six months - twice a month. From six months to one year, such visits will be made once every four weeks.

For up to a year, the patronage nurse will examine the child at home, assess the pace of his development and advise you in a calm and comfortable environment for you and your baby. You can ask the health care provider those questions that are often uncomfortable or uncomfortable to ask you in the clinic when many children are waiting for the doctor's appointment.

The health visitor can show you how to give your baby a gentle prophylactic massage.
She will tell you how to get rid of a specific crust from the baby's scalp.
The paramedic will show you how to properly rinse your baby's eyes, clean the ears and nose.
The health visitor can demonstrate how to wash children properly.
If the baby has stomatitis or thrush, she will show how to properly treat the child's oral cavity with drugs.

The patronage nurse is a kind of observer and consultant for childcare and breastfeeding. She will accompany you at home and give recommendations for up to a year. But a nurse cannot make diagnoses, as well as prescribe treatment, so if you suspect a baby has an illness, you should contact a pediatrician.