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Primary resuscitation of newborns. Premature babies - stages of nursing by weeks, feeding rules, weight gain, observation by doctors. What vaccinations to give a premature baby

1. General principles

Immediately after the birth of the head, mucus is removed from the nasopharynx and oropharynx of the fetus using a rubber pear or a catheter connected to a special suction. When the baby is born completely, it is wiped dry with a sterile towel. After the appearance of spontaneous breathing or the cessation of pulsation of the umbilical cord, a clamp is applied to the umbilical cord and the newborn is placed in the incubator, giving it a position with a slightly lowered head end. With obvious asphyxia, the umbilical cord is immediately clamped and resuscitation begins. Normally, the newborn takes the first breath within 30 seconds after delivery, and steady spontaneous breathing is established within 90 seconds. The norm of respiratory rate is 30-60/mip, and heart rate is 120-160/min. Respiration is assessed by auscultation of the lungs, heart rate - by auscultation of the lungs or by palpation of the pulse at the base of the umbilical cord.

In addition to breathing and heart rate, it is necessary to assess the color of the skin, muscle tone and reflex excitability. The generally accepted method is to assess the child's condition on the Apgar scale (Table 43-4), produced at the 1st and 5th minute of life. The Apgar score at the 1st minute of life correlates with survival, at the 5th minute - with the risk of neurological disorders.

The norm is an Apgar score of 8-10 points. Such children need only mild stimulation (patting on the feet, rubbing the back, vigorous towel drying). The catheter is carefully passed through each nasal passage to rule out choanal atresia, and through the mouth into the stomach to rule out esophageal atresia.

2. Meconium admixture in amniotic fluid

The admixture of meconium in the amniotic fluid is observed in approximately 10% of all births. Intrauterine hypoxia, especially at a gestational age of more than 42 weeks, is often associated with dense staining of amniotic fluid with meconium. With intrauterine hypoxia, the fetus develops deep convulsive breaths, during which meconium, along with amniotic fluid, can enter the lungs. During the first breaths after birth, meconium moves from the trachea and main bronchi to the small bronchi and alveoli. Meconium that is thick or contains solid particles can close the lumen of the small bronchi, which is the cause of severe respiratory failure, which occurs in 15% of cases with the admixture of meconium in the amniotic fluid. In addition, with this complication, the risk of persistence of the fetal circulation type is high (Chapter 42).

With light staining of amniotic fluid with meconium, sanitation of the respiratory tract is not required. If the amniotic fluid is densely stained with meconium (pea soup), then immediately after the birth of the head, before the shoulders are removed, the obstetrician must quickly suck out the contents of the nasopharynx and oropharynx using a catheter. Immediately after birth, the newborn is placed on a heated table, the trachea is intubated and the contents of the trachea are sucked off. A special suction is connected directly to the endotracheal tube, which is slowly removed. If meconium is found in the trachea, intubation and aspiration of the contents continue until it stops flowing through the tube - but no more than three times, after which further attempts cease to be effective. A mask is placed near the mouth of the newborn, through which humidified oxygen is supplied. It is also necessary to aspirate the contents of the stomach to prevent passive meconium regurgitation. Meconium aspiration is a risk factor for pneumothorax (the frequency of pneumothorax with meconium aspiration is 10%, while with vaginal delivery it is 1%).

3. Asphyxia of the newborn

At least two people are needed to resuscitate a newborn: one person secures the airway and administers

TABLE 43-4. Apgar score

IVL, the second performs an indirect heart massage. The participation of a third person, who catheterizes the vessels, injects drugs and infusion solutions, is very useful.

The most common cause of newborn asphyxia is intrauterine hypoxia, so the key to resuscitation is the normalization of breathing. Another important cause of asphyxia is hypovolemia. Causes of hypovolemia: too early clamping of the umbilical cord, too high position of the child relative to the birth canal at the time of clamping of the umbilical cord, prematurity, bleeding in the mother, crossing the placenta during caesarean section, sepsis, cross-circulation in twins.

If the neonate does not improve despite adequate respiratory resuscitation, vascular access and arterial blood gas analysis should be performed; pneumothorax (1% prevalence) and congenital airway anomalies, including tracheoesophageal fistula (1:3000-5000 newborns) and congenital diaphragmatic hernia (1:2000-4000) should be ruled out.

Apgar score at the 1st minute of life allows to standardize the approach to resuscitation: (1) mild asphyxia (5-7 points): stimulation (wiping the body, patting on the feet, debridement of the respiratory tract) is indicated in combination with inhalation of pure oxygen through a face mask located near the mouth; (2) moderate asphyxia (3-4 points: ventilation with a breathing bag through a mask is indicated; (3) severe asphyxia (0-2 points): immediate tracheal intubation is indicated, external cardiac massage may be required.

Indications for mechanical ventilation in a newborn: (1) apnea; (2) heart rate

If, despite adequate ventilation, the heart rate does not exceed 80 / min, then closed heart massage is indicated.

For tracheal intubation (Fig. 43-3), a Miller laryngoscope is used. The size of the laryngoscope blade and endotracheal tube depends on the weight of the child: 2 kg - 1 and 3.5 mm. If the tube is chosen correctly, then at an airway pressure of 20 cm of water. Art. there is a slight discharge of the respiratory mixture. Intubation of the right main bronchus is ruled out by auscultation. The depth of insertion of the endotracheal tube (from its distal end to the child's lips) is calculated as follows: 6 is added to the child's weight in kilograms, the result is expressed in centimeters. It is advisable to carry out pulse oximetry using a handheld sensor. The use of a transcutaneous oxygen tension monitor is also quite informative, but it takes a lot of time to set it up.

External cardiac massage

External cardiac massage is indicated when, after 30 hours of adequate ventilation with 100% oxygen, the heart rate is
Heart massage is carried out simultaneously with IVL with 100 oxygen. The frequency of pressure on the sternum should be 90-120 / min (Fig. 43-4). The cardiac massage technique described for young children (Chapter 48) can be used for newborns weighing > 3 kg. The ratio of the frequency of compressions and injections should be 3:1, so that within 1 minute 90 compressions and 30 injections are performed. Heart rate should be checked periodically. At heart rate > 80/min, chest compressions are stopped.

Rice. 43-3. Newborn intubation. The head is in a neutral position. The laryngoscope is held between the thumb and forefinger of the left hand, holding the chin with the middle and ring fingers. The little finger of the left hand is pressed against the hyoid bone, which helps to see the vocal cords. The best view is provided by a straight blade, for example, a No. 0 or No. 1 Miller laryngoscope

Vascular access

The most optimal method of vascular access is the placement of a 3.5F or 5F catheter in the umbilical vein. It is necessary that the distal tip of the catheter is located directly below the level of the skin and the reverse flow of blood when the syringe plunger is pulled is free; with deeper administration, transfused hypertonic solutions can go directly to the liver.

Catheterization of one of the two umbilical arteries, which allows monitoring blood pressure and facilitating the analysis of arterial blood gases, is technically more difficult. Special catheters for the umbilical artery have been developed, which allow not only to measure blood pressure, but also to conduct long-term monitoring of PaO2 and SaO2. Care must be taken to prevent air from entering the vein or artery.

Infusion therapy

Of the newborns who require resuscitation, hypovolemia is present in some full-term and two-thirds of preterm infants. Hypovolemia is diagnosed with arterial hypotension and pallor of the skin, combined with a poor response to resuscitation. In newborns, BP correlates with BCC, so all newborns should have BP measured. Normally, blood pressure depends on weight and ranges from 50/25 mm Hg. Art. (weight 1-2 kg) up to 70/40 mm Hg. Art. (weight > 3 kg). Arterial hypotension indicates hypovolemia. To replenish the BCC, an erythrocyte mass of group 0 (I) Rh (neg), combined with maternal blood, or a 5% solution of albumin or Ringer's solution with lactate at a dose of 10 ml / kg is used. Rarer causes of arterial hypotension include hypocalcemia, hypermagnesemia, and hypoglycemia.

Rice. 43-4. Closed heart massage in a newborn. With both hands they clasp the newborn so that the thumbs are located on the sternum immediately below the line connecting both nipples, and the remaining fingers are closed on the back of the body. The depth of depression of the sternum is 1-2 cm, the frequency of pressure is 120/min. (Reproduced with modifications from Neonatal life support, Part VI. JAMA 1986;255:2969.)

Medications

A. Adrenaline: Indications: asystole; Heart rate less than 80 beats / min, despite adequate mechanical ventilation and cardiac massage. A dose of 0.01-0.03 mg / kg (0.1-0.3 ml / kg of a 1:10,000 solution) is administered every 3-5 minutes until the effect is achieved. If there is no venous access, it can be introduced into the trachea through an endotracheal tube.

B. Naloxone: Indications: elimination of respiratory depression caused by the administration of opioids to the mother in the last 4 hours before delivery. Dose: 0.01 mg/kg IV or 0.02 mg/kg IM. If the mother has abused opioids, then naloxone can provoke a withdrawal syndrome in the fetus.

B. Other drugs: In some cases, other drugs are used. Sodium bicarbonate (dose 2 meq/kg body weight, 1 ml solution contains 0.5 meq) is indicated only for severe metabolic acidosis verified by arterial blood gas analysis. Sodium bicarbonate is also used in prolonged resuscitation (> 5 min), especially if arterial blood gas analysis is not technically possible. The rate of administration should not exceed 1 meq/kg/min to avoid hyperosmolarity and intracranial hemorrhage. In addition, to avoid hyperosmolarity-induced damage to hepatocytes, the distal tip of the catheter should not be located in the liver. Calcium gluconate 100 mg/kg (or calcium chloride 30 mg/kg) is only indicated for documented hypocalcemia or suspected hypermagnesemia (usually due to maternal magnesium sulfate); clinical manifestations include hypotension, decreased muscle tone, and vasodilation. Glucose (200 mg/kg, a 10% solution is used) is only indicated for documented hypoglycemia, as hyperglycemia exacerbates neurological deficits. Surfactant is indicated for respiratory distress syndrome in preterm infants, it can be injected into the trachea through an endotracheal tube.

Profound changes occur in the cardiovascular and respiratory systems at birth. Violation of these changes can lead to death or damage to the CNS. Accordingly, at all births, a doctor who knows how to resuscitate newborns should be present. Wasting time looking for someone who can resuscitate a newborn can be disastrous for the child. This article discusses the causes and consequences of cardiorespiratory failure at birth and methods of resuscitation. Where possible, the recommendations of the American Academy of Pediatrics were followed.

Guidelines for neonatal resuscitation have been issued by many organizations, including the American Heart Association and the American Academy of Pediatrics. The recommendations are useful for remembering the sequence of resuscitation. Failure to follow the principles leads to bad results. However, thoughtlessly following the recommendations can also lead to poor results. Understanding the physiology of labor and birth is key to success.

Neonatal resuscitation requires training and hands-on experience. Unfortunately, there is little opportunity for most anesthesiologists to acquire and maintain neonatal resuscitation skills as few of their patients require resuscitation. Simulators can solve this problem. In the near future, neonatal resuscitators will need to train on a simulator and repeat this training several times a year to maintain certification.

Detecting potential problems and preparing to address them before birth increases the likelihood of successful resuscitation of patients. Fetal heart rate monitoring is a very reliable and widely used method for the early detection of serious fetal problems. Analysis of blood gases and fetal pH can be used to detect hypoxia and decide on the need for urgent premature removal of the fetus.

Asphyxia (ie, decreased PaO 2 and pHa and increased PaCO 2 ) occurs when gas exchange between the placenta (fetus) and lungs (newborn) is inadequate or when there is right-to-left shunting of blood to the heart or lungs after birth. It also occurs in myocardial dysfunction.

With fetal asphyxia, PaO 2 decreases from the normal 25-40 mm Hg. Art. to less than 5 mm Hg. Art. for about 2 minutes, followed by anaerobic metabolism. After five minutes of asphyxia, the pH drops to 6.90 or less, PaCO 2 increases to more than 100 mm Hg, and PaO 2 decreases to a level at which it is not detectable. Blood flow to the liver, kidneys, intestines, skin, and muscles decreases, while blood flow to the heart, brain, adrenal glands, and placenta remains unchanged or increases. The consumption of oxygen from the blood is greatly increased. Myocardial function is maintained by myocardial glycogen and lactic acid metabolism. Heart rate less than 100 beats / min significantly reduces cardiac output. Catecholamines are also important for survival after asphyxia. Asphyxia during childbirth can lead to hypervolemia or hypovolemia.

Fetal assessment at birth

The Apgar score, properly performed, is a simple, useful guide to the condition and need for resuscitation of the newborn, but it is only a guide. The 1-minute score correlates well with acidosis and survival. The 5-minute score predicts neurological outcome, but not always. To get an overall score, each parameter must be scored at 1 and 5 minutes. However, newborns with severe acidosis may have relatively normal Apgar values ​​at 1 and 5 minutes due to peripheral vasoconstriction, which is manifested by pale skin with normal heart rate and blood pressure.

heart rate

In healthy fetuses and newborns, the heart rate ranges from 120 to 160 beats / min. When the heart rate is less than 100 bpm, cardiac output and tissue perfusion are reduced.

Breath

Respiration usually begins 30 seconds after birth and is maintained for 90 seconds. A few minutes after birth, the respiratory rate of healthy newborns is 30-60 per minute.

The absence of a pause between inhalation and exhalation helps to develop and maintain FRC. Apnea and bradypnea prolong expiration, decrease FRC, and cause hypoxia. Apnea and bradypnea can be caused by severe acidosis, asphyxia, maternal drugs, infections, and CNS damage. Tachypnea (>60 breaths/min) occurs due to:

    hypoxemia;

    hypovolemia;

    metabolic and respiratory acidosis;

    hemorrhage of the central nervous system;

    air leakage syndrome;

    lung disease (eg, hyaline membrane disease, aspiration syndromes, infections);

    pulmonary edema;

    drugs used by the mother (eg, drugs, alcohol, magnesium, barbiturates).

Resuscitation with 100% oxygen can be detrimental. Resuscitation of newborns with room air is as successful as resuscitation with oxygen. Animals resuscitated with air had less hydrogen peroxide in their brain tissue than those resuscitated with oxygen. Polymorphonuclear cells were less activated by room air. The supply of oxygen in excess of that in room air increases the likelihood of an inflammatory reaction. When possible, room air rather than oxygen should be used for neonatal resuscitation.

Muscle tone

Most newborns, including those born prematurely, are active immediately after birth and move their limbs in response to stimulation. Postponed asphyxia, CNS damage, congenital amyotonia and myasthenia gravis, as well as the appointment of maternal medications can contribute to a decrease in muscle tone in the newborn. Flexion contractures and the absence of skin folds in the joints are signs of intrauterine CNS damage.

reflex activity

A newborn child in a normal state reacts with motor activity in response to stimulation, and when a catheter is inserted into the nasal passage, it cries or shows a grimace of crying on its face. A newborn may not move in the event of hypoxia and acidosis, as well as in the presence of CNS damage, congenital muscle diseases, and when the mother is prescribed sedatives.

Color of the skin

In the first minutes after birth, all newborns have a bluish skin color. After 60 seconds, most children's skin turns pink, except for the hands and feet, which are still cyanotic. If central cyanosis persists for more than 90 s, especially with ongoing oxygen therapy and controlled ventilation, then suspect asphyxia, low cardiac output syndrome, pulmonary edema, methemoglobinemia, polycythemia, congenital cardiovascular disease, arrhythmia, and lung disease (eg, respiratory distress syndrome, airway obstruction, pulmonary hypoplasia, diaphragmatic hernia).

Pale skin at birth is often observed in children in the case of asphyxia, hypovolemia, acidosis, or in the presence of a congenital malformation of the cardiovascular system. If a newborn has a pale skin color for more than 2 minutes, alcohol intoxication, hypermagnesemia, or alkalosis (pH> 7.50) should be suspected. Rubeosis of the skin is observed with polycythemia.

Resuscitation equipment

The resuscitation bed should be positioned so that the child's head is below the level of the lungs. This is necessary to ensure the drainage of lung fluid and prevent aspiration of gastric contents. In the absence of asphyxia, it is necessary to maintain the body temperature of the newborn at the level of 36-37°C. To do this, use an infrared heater with servo control. In the case of asphyxia, to ensure the protection of the brain, the child's body temperature must be reduced to 34-35 ° C. The resuscitation area should be equipped with a suction device with adjustable suction pressure; it is unacceptable to use pressure less than - 100 mm Hg. Art.

Tracheal intubation requires straight laryngoscope blades in sizes 00 and 0; pencil type laryngoscope; endotracheal tubes with an internal diameter of 2.5, 3.0 and 3.5 mm; suction catheters of the appropriate diameter.

The ventilator must be able to ventilate the lungs at a rate of up to 150 breaths/min and maintain PEEP. Be aware of the potential for “sticky” breathing circuit valves, especially when ventilating at high frequency and high gas flow. If the specialist has the appropriate training, modified Jackon-Rice or Eyre circuits can be used for ventilation. Overinflation of the lungs during ventilation with a large tidal volume causes lung damage and activation of the systemic inflammatory response, which can lead to the development of chronic lung disease. Careful ventilation of the lungs has less damaging effect. When performing assisted or controlled ventilation in a delivery room environment, peak inspiratory pressure should be constantly monitored and overpressure and high tidal volume ventilation should be avoided.

As in any critical situation, decision-making should be based on the information received. In this regard, it is mandatory to control the gas composition of the blood and the pH level, while the test results should be obtained within 10 minutes from the moment the blood was taken. It is convenient to use an arterial umbilical catheter to monitor blood pressure and take blood for research. In case of emergency, an infusion can be carried out through it.

Arterial blood saturation (SaO 2 ) in the first minutes after birth can be determined by attaching a pulse oximeter sensor to the palm or foot of the newborn. A pulse oximeter allows you to quickly detect changes in oxygenation or FiO. Normally, in newborns, SaO 2 is 87-95%, which corresponds to a PaO 2 of 55-70 mm Hg. Art.

Pulmonary resuscitation

If the heart rate is less than 80 beats/min and SaO 2 is less than 85%, the need for tracheal intubation should be considered and mechanical ventilation should be started at a rate of 30-60 breaths/min. During the first minutes, the duration of each fifth breath should be 2 s. This increase in inspiratory time allows the atelectatic lungs to open and the lung fluid to be removed. PEEP is maintained at 3-5 cm H 2 O. Excessive peak inspiratory pressure should be avoided. In an experiment on preterm lambs, it has been shown that delivering just six overpressure rescue breaths significantly increases lung tissue damage and interferes with surfactant response. Excess tidal volume is also associated with inflammation and chronic lung disease. Airway pressure detection helps prevent overpressure and tidal volume ventilation.

Tracheal intubation

During mask ventilation and tracheal intubation, the child's head should be in the "sniffing" position. After visualization of the glottis, an endotracheal tube is inserted into the trachea to a depth of 1-2 cm below the level of the glottis, depending on the size of the child. This usually corresponds to a depth of 7, 8, 9, 10 cm from the anterior edge of the gums in a newborn weighing 1, 2, 3 and 4 kg, respectively. When ventilating with a peak pressure of 15-25 cm H 2 O, a small air leak should be heard on auscultation at the child's mouth. This is usually observed when using tubes with an internal diameter of 2.5 mm in children weighing less than 1.5 kg, tubes with a diameter of 3.0 mm in children weighing 1.5-2.5 kg and tubes with a diameter of 3, 5 mm in children weighing more than 2.5 kg. Confirmation of successful tracheal intubation is the visualization of the passage of the endotracheal tube behind the vocal cords, the movement of both halves of the chest with each artificial breath, the appearance of perspiration on the inner surface of the tube during each exhalation. Breath sounds should be louder on lung auscultation than on abdominal auscultation. Once positive pressure ventilation is initiated, skin color should improve, as should heart rate and SaO. At the time of exhalation, carbon dioxide should be determined (capnometry).

However, the small tidal volume and low pulmonary blood flow found in some infants at birth can make effective use of capnography difficult.

Adequate ventilation

During inspiration, both halves of the chest should move simultaneously and symmetrically, however, the expansion of the chest during artificial ventilation should not exceed the excursion during normal spontaneous breathing of the newborn. The presence of breath sounds on auscultation is not a reliable sign of ventilation adequacy, due to the possibility of breathing sounds from another lung in infants with a small chest. Asymmetric breath sounds on bilateral lung auscultation may indicate endobronchial intubation, pneumothorax, atelectasis, or congenital lung anomaly. The presence of loud breath sounds on auscultation in the epigastric region suggests esophageal intubation or tracheoesophageal fistula. In the case of adequate ventilation, the child turns pink, spontaneous breathing appears and the heart rate normalizes.

Because most suffocated neonates do not have lung disease, they can be effectively ventilated with a peak pressure of less than 25 mmHg. Art., including at the first breaths. Neonates with "tough" lungs (eg, fetal erythroblastosis, congenital pulmonary anomalies, pulmonary edema, severe meconium aspiration, diaphragmatic hernia) may require high peak inspiratory pressure ventilation, which increases the likelihood of air leak syndrome. It can be prevented by ventilating at a peak pressure of 15-20 cm H 2 O and a rate of 150-200 breaths/min. If low pressure (low volume) high frequency ventilation does not improve oxygenation, high pressure high tidal volume ventilation may be required. Ineffective ventilation at birth can exacerbate hypoxemia and lead to CNS damage and even death. With an increase in PaO 2 more than 70-80 mm Hg. Art. or SaO 2 more than 94%, the concentration of inhaled oxygen (if a breathing mixture with a high oxygen content was previously used) should be brought to a level at which SaO 2 and PaO 2 will be maintained at a normal age level. In children less than 34 weeks of gestation, oxygenation is maintained at the lower limit of normal to prevent the development of neonatal retinopathy. During tracheal intubation in a newborn in a state of hypoxia, there is a risk of arrhythmias, and therefore, the heart rate should be constantly monitored.

Routine tracheal sanitation

In the presence of an admixture of dense meconium in the amniotic fluid, as well as in the case of massive vaginal bleeding, ventilation of the lungs is started only after aspiration of the contents of the trachea. The description of the meconium aspirator is widely presented in the literature.

Meconium particulates must be removed from the lungs prior to ventilation. The mouth and throat must be sanitized immediately after the birth of the baby's head. After tracheal intubation, the endotracheal tube is connected to a special suction device and removed from the trachea at the time of aspiration. The laryngoscope is not removed. After aspiration of meconium, an endotracheal tube is inserted into the trachea, after which a second aspiration is performed. Then careful ventilation of the lungs is carried out. At the time of laryngoscopy and aspiration, it is necessary to constantly monitor the heart rate and insufflate 100% oxygen near the face of the newborn. Meconium should also be aspirated from the stomach to avoid regurgitation and aspiration. Newborns with an Apgar score of 9-10 do not require tracheal suctioning. Removal of liquid meconium from the trachea of ​​a newborn at the time of birth does not have a positive effect, while removal of solid particles of meconium is effective.

Other causes of respiratory failure

Pneumothorax

Pneumothorax occurs in 1% of cases during vaginal delivery, in 10% of cases in the presence of meconium in the amniotic fluid, and in 2-3% of newborns who require mechanical ventilation in the delivery room. In the presence of unilateral pneumothorax, one half of the chest is overinflated and its respiratory excursion is limited. The cardiac impulse is shifted to the healthy side. Heart sounds may be muffled.

In the presence of pneumothorax, a glow of the affected part of the chest is observed when it is illuminated with a narrow beam of highly intense cold light. Elimination of pneumothorax is carried out by puncture or drainage of the pleural cavity.

Prescribing a surfactant

Administration of a surfactant resulted in a significant reduction in the incidence of air leak syndrome, including interstitial emphysema, as well as hyaline membrane disease, bronchopulmonary dysplasia (BPD), and mortality. Surfactant is administered intratracheally at a dose of 5 ml of solution per kilogram of body weight immediately at birth or within a short period of time after it. The introduction of a surfactant is accompanied by a short episode of desaturation. In most cases, SaO 2 rises rapidly in the future due to an increase in pulmonary compliance, which, in turn, can lead to hyperinflation of the lungs with subsequent damage to the lung tissue or the occurrence of an air leak syndrome, if a timely decrease in inspiratory pressure is not made.

Premature babies often require nasal CPAP after birth to reduce the chance of tracheal intubation and mechanical ventilation. However, this does not reduce the incidence of CNS hemorrhage and chronic lung disease. The duration of oxygen dependence and chronic lung disease does not change.

Vascular resuscitation

Vascular resuscitation is not a major aspect of neonatal resuscitation. If the condition of the newborn does not improve with ventilation, oxygenation (if necessary) and tactile stimulation, it is necessary to catheterize the umbilical artery in order to take blood for the study of the gas composition and pH level, and also for the purpose of carrying out infusion therapy if necessary.

Acidosis correction

Correction of respiratory acidosis is carried out with the help of artificial lung ventilation. To correct metabolic acidosis, sodium bicarbonate solution is introduced. Its osmolarity is 1800 mosmol/l, so rapid administration of this solution (>1 mmol/kg/min) in preterm infants may lead to intracranial bleeding. The interaction of hydrogen ions with 50 mmol of bicarbonate leads to the formation of 1250 ml of CO. If pulmonary ventilation is adequate, this does not lead to an increase in PaCO 2 ; with inadequate ventilation, a significant increase in PaCO 2 occurs, which can cause cardiac arrest and / or intracranial hemorrhage. Therefore, sodium bicarbonate solution should only be given to newborns with metabolic acidosis, provided there is adequate pulmonary ventilation. In hypovolaemic neonates, administration of sodium bicarbonate may cause hypotension by reversing the peripheral vasoconstriction caused by acidosis. Trisamine (THAM) is an alternative drug. Its appointment leads to a decrease in the level of PaCO.

If, despite tactile stimulation and ventilation, the Apgar score is 2 or less at 2 minutes or 5 or less at 5 minutes, administration of sodium bicarbonate at a dose of 2 mmol / kg may be required against the background of ongoing ventilation. If the pH is less than 7.0, PaCO 2 is less than 35 mm Hg. Art., and at the same time the blood volume is adequate, one-fourth of the base deficiency should be corrected. If the pH is more than 7.1, sodium bicarbonate is not administered, but pulmonary ventilation is continued. If the pH is more than 7.15, then only ventilation is performed. If, against this background, the pH decreases or remains at the same level, continue ventilation of the lungs and correct one-fourth of the deficiency of buffer bases by administering sodium bicarbonate or trisamine. No significant increase in PaO 2 was observed until the pH increased from 7.1 to 7.2, when Rudolph and Yuen found the most significant decrease in PVR.

Typically, metabolic acidosis develops as a result of reduced tissue perfusion as a consequence of hypovolemia or heart failure. Acidosis-induced heart failure usually occurs when the pH drops below. With an increase in pH over 7.15, cardiac output improves. In heart failure against the background of congenital bradycardia, isoproterenol is prescribed (at an initial dose of 0.05 μg / kg / min, with a further increase if necessary) or a transvenous pacemaker is installed. Hypoglycemia may be the cause of heart failure. Therefore, during resuscitation of a newborn, it is necessary to control the level of glucose in the blood.

Expansion of intravascular volume

If the umbilical cord is clamped early, or if the umbilical cord is tightly wrapped around the fetal neck, when the umbilical cord must be cut for the baby to be born, the baby may become hypovolemic. It is also observed with asphyxia in childbirth, abruption and placenta previa.

Diagnosis of hypovolemia

Hypovolemia is determined by measuring blood pressure and physical examination (i.e., skin color, perfusion, capillary refill time, pulse refill, and extremity temperature). CVP measurements are useful in diagnosing hypovolemia and in determining the adequacy of fluid replacement. Venous pressure in healthy newborns is 2-8 cm H 2 O. If the CVP is less than 2 cm H 2 O, hypovolemia should be suspected.

Therapy for hypovolemia

To treat hypovolemia, it is required to replenish the intravascular volume with blood and crystalloids. Albumin can also be used, but the evidence for its effectiveness is limited. If a newborn is suspected to be hypovolemic at birth, then a bag of Rh-negative type 0 blood should be available in the delivery room before the baby is born.

Sometimes, in order to raise blood pressure to normal, huge amounts of blood and solutions are required. At times, more than 50% of the blood volume needs to be replaced (85 ml/kg in term newborns and 100 ml/kg in preterm infants), especially if placental abruption or trauma occurs during childbirth. In most cases, up to 10-20 ml / kg of solutions are required to restore the mean arterial pressure to normal.

Excessive intravascular volume expansion should be avoided because sudden systemic hypertension can rupture brain vessels, leading to intracranial hemorrhage, especially in preterm infants.

Other causes of hypotension

Hypoglycemia, hypocalcemia, and hypermagnesemia cause hypotension in neonates. Hypotension caused by alcohol or magnesium intoxication usually responds well to volume replacement or dopamine, or both. Neonatal hypermagnesaemia is usually treated with 100–200 mg/kg of calcium gluconate given over 5 minutes.

Heart massage

If, despite stimulation and ventilation, the heart rate at the 1st minute of life or earlier is less than 80 beats / min, it is necessary to intubate the trachea, carry out mechanical ventilation with oxygen and start a closed heart massage. Place both thumbs on the sternum and support the baby's back with the rest of your fingers. Squeeze the sternum 2-2.5 cm at a frequency of 100-120 per minute. There is no need to interrupt ventilation during cardiac massage. The effectiveness of heart massage is assessed by measuring blood gases and pH, created by blood pressure and examining the pupils, which should be in the middle position or constricted. If the pupils are dilated and no atropine has been used, then cerebral blood flow and oxygenation are inadequate.

Preparations for resuscitation

In severe acidosis (pH< 7,0) эффективность этих лекарств уменьшается. Т.е. необходимо как можно быстрее поднять рН выше. Все препараты необходимо вводить в минимальном объеме растворителя, чтобы снизить риск возникновения гиперволемии.

When to stop resuscitation

The decision to stop resuscitation is usually based on the experience of the doctor, the condition of the patient, and the wishes of the parents. If the chances of a productive, successful life are very low, then consideration should be given to stopping all revitalization efforts. Whether to resuscitate deeply preterm infants is a big question, since the outcomes of nursing newborns born before 26 weeks of gestation are very deplorable. If possible, the situation should be discussed frankly with the family before the baby is born. If this is not done, then you need to start resuscitation and stop it after talking with the parents.

Relevance of the topic. According to WHO, approximately 5-10% of all newborns need medical care in the delivery room, and about 1% - in full resuscitation. Providing adequate care to newborns in the first minutes of life can reduce their mortality and/or morbidity by 6-42%. The degree of mastery of the medical personnel present at childbirth, methods of primary resuscitation of newborns has a positive effect not only on their survival, but also on their further development, the level of health in subsequent age periods.

Common goal: improve knowledge on the assessment of the condition of the newborn, determine the indications for resuscitation and their volume. Know your own; temporarily start resuscitation, master the skills of resuscitation of a newborn;

Specific Purpose: on the basis of the perinatal anamnesis, objective examination data, determine the main signs of an emergency, conduct a differential diagnosis, and provide the necessary assistance.

Theoretical questions

1. Preparation for the provision of resuscitation to the newborn in the delivery room or operating room.

2. Assessment of the condition of the newborn child, determination of the need for intervention.

3. Activities after the birth of a child. Providing airway patency, oxygen therapy, artificial ventilation of the lungs with a bag and mask, tracheal intubation, chest compressions, etc.

4. Algorithm for providing emergency care to newborns with clean amniotic fluid.

5. Algorithm for providing emergency care to newborns in case of contamination of amniotic fluid with meconium.

6. Medicines for primary resuscitation of newborns.

7. Indications for termination of resuscitation.

Indicative basis of activity

During preparation for the lesson, it is necessary to familiarize yourself with the main theoretical issues through the treatment algorithm (Fig. 1), literature sources.

Preparing to provide resuscitation care to a newborn in the delivery room

Staffing: 1 person who can provide resuscitation assistance; 2 people with these skills in high-risk deliveries that may require full resuscitation. In the case of multiple pregnancy, the presence of several resuscitation teams is necessary. Before each birth, it is necessary to assess the temperature in the room (not lower than 25 ° C), the absence of drafts, select, mount and check the functioning of resuscitation equipment:

1. Before delivery, turn on the source of radiant heat, heat the surface of the resuscitation table to 36-37 ° C and prepare warmed diapers.

2. Check the oxygen supply system: presence of oxygen, pressure, flow rate, presence of connecting tubes.

3. Roll up a roll under the shoulders from the diaper.

4. Prepare equipment for suctioning the contents of the upper respiratory tract (rubber balloon, adapter for connecting the endotracheal tube directly to the suction tube).

5. Prepare an 8F gastric tube, a 20 ml syringe for aspiration of gastric contents, adhesive tape, scissors.

6. Prepare equipment for artificial lung ventilation (ALV): resuscitation bag (volume no more than 75 ml) and mask. The oxygen flow rate must be at least 5 l/min. Check the operation of the control valve, the integrity of the bag, the presence of oxygen in the tank, it is desirable to have a pressure gauge.

7. Prepare an intubation kit.

Urgent care

Activities after the birth of a child

Immediately determine the need for resuscitation. Estimate:

— the presence of meconium contamination;

- breathing;

- muscle tone;

- color of the skin;

- determine the gestational age (full-term, premature).

Full-term active babies with adequate breathing, loud crying and normal motor activity do not require resuscitation. They are laid out on the mother's stomach, dried and covered with a dry diaper. Sanitation of the upper respiratory tract is carried out by wiping the mucous membranes of the mouth and nose of the child.

Indications for further assessment of the condition of the newborn and determination of the need for intervention:

1. Meconium contamination of the amniotic fluid or skin of the newborn.

2. Absence or decrease in the child's response to stimulation.

3. Persistent central (diffuse) cyanosis.

4. Premature birth.

If any of these signs are present, newborns require standard initial resuscitation steps and need constant monitoring.

If the newborn needs emergency care, while the amniotic fluid is clear and there is no meconium on the baby's skin, you must:

1. Place the baby under a radiant heat source on a warm diaper.

2. Ensure the patency of the airways: position on the back with the head moderately reclined back (roller under the shoulders).

3. Suck out the contents from the mouth, then from the nasal passages. In case of a significant amount of secretion, turn the child's head to one side.

4. Dry the skin and hair with a diaper with quick blotting movements.

5. Remove the wet diaper.

6. Again ensure the correct position of the child.

7. If there is no effective spontaneous breathing, perform one of the tactile stimulation techniques, which is repeated no more than two times (patting the soles, lightly hitting the heels, rubbing the skin along the spine)1.

8. If the skin of the trunk and mucous membranes remain cyanotic in the presence of spontaneous breathing, oxygen therapy should be carried out. Apply a free flow of 100% oxygen directed to the child's nose through the anesthesia bag and mask, or through an oxygen tube and a funnel-shaped palm, or using an oxygen mask.

After the cyanosis has been resolved, oxygen support should be gradually discontinued so that the child remains pink when breathing room air. The persistence of the pink color of the skin when the end of the tube is removed by 5 cm indicates that the child does not need high concentrations of oxygen.

In case of any contamination of amniotic fluid with meconium:

- it is necessary to assess the activity of the newborn, clamp and cut the umbilical cord, inform the mother about the child's breathing problems, without taking away the diaper and avoiding tactile stimulation;

- if the child is active - screams or breathes adequately, has satisfactory muscle tone and a heart rate (HR) of more than 100 beats per minute, it is laid out on the mother's stomach and observed for 15 minutes. A child at risk of meconium aspiration may require subsequent tracheal intubation, even if active after birth;

- in the absence of respiratory disorders, they provide standard medical care in accordance with the clinical protocol for medical observation of a healthy newborn child (Order No. 152 of the Ministry of Health of Ukraine of 04.04.2005);

- if the newborn has respiratory depression, muscle tone is reduced, heart rate is less than 100 beats per minute, immediately suck meconium from the trachea through the endotracheal tube. Aspiration of meconium is carried out under the control of heart rate. With an increase in bradycardia, stop repeated aspiration of meconium and start mechanical ventilation with a resuscitation bag through the endotracheal tube.

All measures for the primary treatment of a newborn are performed in 30 seconds. After that, the child's condition (respiration, heart rate and skin color) is assessed to decide whether further resuscitation is necessary2.

Breath assessment. Normally, the child has active chest excursions, and the frequency and depth of respiratory movements increases a few seconds after tactile stimulation. Convulsive respiratory movements are ineffective, and their presence in a newborn requires a complex of resuscitation measures, as in the complete absence of breathing.

Assessment of heart rate. The heart rate should exceed 100 beats per minute. Heart rate is calculated at the base of the umbilical cord, directly in the area of ​​​​its attachment to the anterior abdominal wall. If there is no pulse at the umbilical cord, a heartbeat over the left side of the chest should be heard with a stethoscope. The heart rate is calculated for 6 seconds and the result is multiplied by 10.

Skin color assessment. The lips and torso of the child should be pink. After normalization of heart rate and ventilation, the child should not have diffuse cyanosis. Acrocyanosis usually does not indicate low oxygen levels in the blood. Only diffuse cyanosis requires intervention.

After eliminating heat loss, ensuring airway patency and stimulating spontaneous breathing the next step in resuscitation should be ventilation support.

Artificial ventilation of the lungs with a bag and a mask

Indications for IVL:

- lack of breathing or its inefficiency (convulsive respiratory movements, etc.);

- bradycardia (less than 100 beats per minute), regardless of the presence of spontaneous breathing;

- Persistent central cyanosis with a free flow of 100% oxygen in a child who breathes independently and has a heart rate of more than 100 beats per minute.

The effectiveness of ventilation is determined: by the excursion of the chest; auscultation data; increase in heart rate; improving the color of the skin.

The first 2-3 breaths are performed by creating an inhalation pressure of 30-40 cm of water column, after which ventilation is continued with an inhalation pressure of 15-20 cm of water column and a frequency of 40-60 per minute. In the presence of pulmonary pathology, ventilation is carried out with an inspiratory pressure of 20-40 cm of water column. IVL for newborns is carried out with 100% humidified and warmed oxygen.

After 30 s of ventilation under positive pressure, the heart rate and the presence of spontaneous breathing are again determined. Further actions depend on the result obtained.

1. If the heart rate is more than 100 beats per 1 minute:

- in the presence of spontaneous breathing, mechanical ventilation is gradually stopped, reducing its pressure and frequency, a free flow of oxygen is supplied and skin color is assessed;

- in the absence of spontaneous breathing, continue mechanical ventilation until it appears.

2. If the heart rate is from 60 to 100 beats per 1 minute:

- continue IVL;

- if mechanical ventilation was carried out with room air, anticipate the transition to the use of 100% oxygen, the need for tracheal intubation.

3. Heart rate less than 60 beats per minute; chickpeas:

- begin an indirect heart massage with a frequency of 90 compressions per minute, continue mechanical ventilation with 100% oxygen at a frequency of 30 breaths per 1 minute and determine the need for tracheal intubation.

The heart rate is monitored every 30 seconds until it exceeds 100 beats per minute and spontaneous breathing is established.

Mechanical ventilation for several minutes requires the introduction of an orogastric tube (8F) in order to prevent gastric inflation with air and subsequent regurgitation of gastric contents.

Indirect cardiac massage indicated if heart rate is less than 60 beats per minute after 30 with effective ventilation with 100% oxygen.

An indirect heart massage is performed by pressing on the lower third of the sternum. It is below the conditional line that connects the nipples. It is important not to press on the xiphoid process to avoid rupture of the liver.

Two indirect massage techniques are used, according to which pressure is applied to the sternum:

the first - with two thumbs, while the remaining fingers of both hands support the back;

the second - with the tips of two fingers of one hand: II and III or III and IV; while the second hand supports the back.

The depth of pressure should be one third of the anteroposterior diameter of the chest.

The frequency of pressure is 90 per 1 minute.

It is important to coordinate chest compressions with mechanical ventilation, avoiding both procedures at the same time, and do not remove your fingers from the surface of the chest in the pause between pressures. After every three pressures on the sternum, a pause is made for ventilation, after which the pressures are repeated, etc. For 2 seconds, you need to do 3 pressures on the sternum (90 in 1 minute) and one ventilation (30 in 1 minute). Stop chest compressions if the heart rate is more than 60 beats per minute.

Tracheal intubation can be carried out at all stages of re-animation, in particular:

- if necessary, suck meconium from the trachea;

— if prolonged ventilation is required to increase its efficiency;

- to facilitate the coordination of chest compressions and ventilation;

- for the introduction of adrenaline;

- if a diaphragmatic hernia is suspected;

- with deep prematurity.

The use of medicines. The introduction of drugs is indicated if, despite adequate ventilation of the lungs with 100% oxygen and chest compressions for 30 seconds, the heart rate remains less than 60 beats per minute.

In the primary resuscitation of newborns, medicines are used: adrenaline; means that normalize the BCC; sodium bicarbonate, antagonists of narcotic drugs.

Adrenalin. Indications for use:

- Heart rate less than 60 beats per minute after at least 30 seconds of mechanical ventilation with 100% oxygen and chest compressions;

- the absence of heart contractions (asystole) at any time during resuscitation.

Adrenaline is administered as quickly as possible in / in or endotracheally at a dose of 0.1-0.3 ml / kg of a solution at a concentration of 1: 10,000. The concentration of the solution is 1: 10,000 (to 0.1 ml of a 0.1% solution of adrenaline hydrochloride or 0.9 ml of isotonic sodium chloride solution is added to 0.1 ml of a 0.18% solution of adrenaline hydrotartrate).

Endotracheally, epinephrine is administered from a syringe directly into the tube or through a probe inserted into the tube. In this case, a solution of adrenaline at a concentration of 1: 10,000 can be further diluted with isotonic saline to a final volume of 1 ml, or the endotracheal tube (probe) can be washed with isotonic sodium chloride solution (0.5-1.0 ml) after administration of an undiluted dose. In the case of endotracheal administration, it is always recommended to use a dose of 0.3-1.0 ml/kg. After the introduction of epinephrine into the trachea, it is important to immediately conduct several effective positive pressure ventilations.

In the absence of effect, the introduction of adrenaline is repeated every 3-5 minutes, repeated injections only in / in.

Large doses of intravenous epinephrine for resuscitation of newborns are not recommended, since their administration can cause damage to the brain and heart of the child.

Means that normalize the BCC: 0.9% sodium chloride solution; Ringer's lactate solution; in order to correct significant blood loss (with clinical signs of hemorrhagic shock) - transfusion of O (I) Rh (-) erythrocyte mass. Indications for use:

- lack of response of the child to resuscitation;

- signs of blood loss (pallor, pulse of weak filling, persistent tachycardia or bradycardia, no signs of improved blood circulation, despite all resuscitation measures).

With the development of hypovolemia, children whose condition does not improve during resuscitation are given intravenously slowly, over 5-10 minutes, up to 10 ml / kg of one of these solutions (isotonic sodium chloride solution is recommended). 3

sodium bicarbonate indicated for the development of severe metabolic acidosis during prolonged and ineffective resuscitation against the background of adequate mechanical ventilation. Enter into the vein of the umbilical cord slowly, no faster than 2 ml / kg / min 4.2% solution at a dose of 4 ml / kg or 2 meq / kg. The drug should not be administered until ventilation of the lungs of the newborn is established.

Narcotic drug antagonists (naloxone hydrochloride)

Indication for use: Persistent severe respiratory depression during positive pressure ventilation, with normal heart rate and skin color in a child whose mother was injected with narcotic drugs during the last 4 hours before delivery. Naloxone hydrochloride is administered at a concentration of 1.0 mg / ml solution, at a dose of 0.1 mg / kg IV. With intramuscular administration, the action of naloxone is slow, with endotracheal it is ineffective.

Naloxone should not be given to a child of a mother with suspected drug dependence or of a mother who is on long-term drug treatment. This can cause severe seizures. Other drugs administered to the mother (magnesium sulfate, non-narcotic analgesics, anesthetics) can also depress the child's breathing, but their effect will not be blocked by the administration of naloxone.

If the child's condition does not improve, despite effective mechanical ventilation and indirect heart massage, the introduction of drugs, exclude abnormalities in the development of the respiratory tract, pneumothorax, diaphragmatic hernia, congenital heart defects.

Resuscitation of the newborn is stopped if, despite the correct and complete implementation of all resuscitation measures, there is no cardiac activity for 10 minutes.

1 It is forbidden to pour cold or hot water on a child, direct a stream of oxygen to the face, squeeze the chest, hit the buttocks, and carry out any other activities that have not been proven safe for a newborn.

2 Apgar score characterizes the general condition of the newborn and the effectiveness of resuscitation and is not used to determine the need for resuscitation, its volume or the timing of resuscitation. Apgar scores should be taken at 1 and 5 minutes after birth. If the result of the assessment at the 5th minute is less than 7 points, it should be additionally carried out every 5 minutes until the 20th minute of life.

Literature

1. Decree of the Ministry of Health of Ukraine No. 437 dated 31.08.04 "On the approval of clinical protocols for the provision of medical assistance in emergency situations in children at the hospital and pre-hospital stages."

2. Ordinance of the Ministry of Health of Ukraine No. 152 dated 04.04.2005 “On the approval of the clinical protocol for medical supervision of a healthy newborn child”.

3. Ordinance of the Ministry of Health of Ukraine No. 312 dated 08.06.2007 “On the approval of the clinical protocol for primary resuscitation and post-reanimation care for new people”.

4. Inconsistencies in Pediatrics: Navch. posib. / Volosovets O.P., Marushko Yu.V., Tyazhka O.V. ta іnshi / For red. O.P. Volosovtsya and Yu.V. Marushko. - Kh. : Prapor, 2008. - 200 p.

5. Emergency conditions in children / Petrushina A.D., Malchenko L.A., Kretinina L.N. and others / Ed. HELL. Petrushina. - M .: LLC "Medical Information Agency", 2007. - 216 p.

6. Peshy M.M., Kryuchko T.O., Smyan O.I. Nevidkladna dopomoga in pediatric practice. - Poltava; Sumi, 2004. - 234 p.

7. Emergency medical care for children at the prehospital stage / G.I. Posternak, M.Yu. Tkacheva, L.M. Beletskaya, I.F. Volny / Ed. G.I. Belebeziev. - Lviv: Medicine of the world, 2004. - 186 p.

Additional

1. Aryaev M.L. Neonatology. - K .: ADEF - Ukraine, 2006. - 754 p.

2. Helper of neonatology: Per. from English / Ed. John Cleorty, Anne Stark. - K .: Fund for helping the children of Chornobil, 2002. - 722 p.

3. Shabalov N.P. Neonatology: Textbook for students and residents of pediatric faculties of medical institutes. — Second edition, revised and enlarged. - St. Petersburg: Special Literature, 1997. - T. 1. - 496 p.

4. Resuscitation of the new people: Podruchnik / For red. J. Kavintela: Translated from English. - Lviv: Spolom, 2004. - 268 p.

is a separate, special area of ​​our Consultative Center for Emergency Medicine. Pediatric care in the best educational institutions of the capital is aimed at restoring the life of the child and his speedy recovery.

Department of Pediatric Intensive Care - Workshop of Miracles

Our center employs experienced pediatricians who, using the latest diagnostic methods, examine the condition of a small patient, identifying ailments in the early stages. According to the conclusion of a specialist, a decision can be made about a sick child in a specialized clinic in Moscow. We can also arrange a home consultation with one of the best experienced specialists in pediatrics, surgery, traumatology and other fields of medicine.

The key to our success in saving children's lives is:

  • A qualified team, including pediatrics, neonatologists, and more.
  • The practice of our employees and diagnostic methods allow us to make the correct diagnosis.
  • Special ambulance vehicles, with special equipment for children born prematurely, as well as comfortable conditions for them, make it possible to avoid injuries as much as possible and maintain the vitality of the body while the child is on the road.
  • We always keep up with the times thanks to the regular exchange of experience and world practices with children's specialists, taking courses, confirming the level of qualifications, certification.
  • Round-the-clock work of the well-coordinated mechanism of our company and colleagues.

Health workers solve problems of any complexity, for example: children, heart disease, respiratory arrest, infectious diseases.

Emergency medical care for a child in Moscow

Our on-site team provides all types of emergency medical care to children of any age and condition.

Especially often there is a need for delivery from the maternity ward of a state maternity hospital or in the case of childbirth in a place not intended for this. However, in addition to the safe and comfortable transportation of a mother and her baby, our company provides a number of other useful services:

  • Initial general examination and assessment of the child's condition.
  • Doctor's opinion on the state of health and the need for hospitalization, as well as the preferred method of transportation.
  • If necessary, we take upon ourselves the issue of coordinating with the host, if necessary, placing the child in a hospital or a specialized medical institution.
  • We carry out safe loading of the child into the vehicle and under the supervision of the sanitary brigade.

After the initial restoration of vital functions, according to the doctor's conclusion, the child can be sent to the pediatric intensive care unit. Here the children pass, are under the supervision of several doctors until their condition stabilizes. At the discretion of the treating doctor, small patients are assigned individual visiting hours, milk feeding intervals. In the future, it is possible to transfer to a separate ward together with the parent.

Private ambulance for newborns in Moscow

Special care is provided to newborns, they are placed in special cuvettes, and a sensor is installed on each baby, signaling the condition to a common nursing console. Visitors and staff must wash their hands before entering. Works around the clock. All research equipment is moved to the ward, and the medicines enter the body of the crumbs through special dosing systems.

Throughout the entire period, you will be informed about all the actions of doctors, be aware of the dynamics of the state. After discharge from the intensive care unit of the children's hospital, observation continues at the place of residence or in the one selected by us.

Invaluable help will be provided to the little creature, the main thing is to tell us in a timely manner about the need to act!

Sometimes there are situations when a newly born child ends up in the intensive care unit. Let's see what kind of department it is and why there is a need for additional medical supervision of a newborn, because parents in such cases have thousands of questions and concerns.


Usually the intensive care unit consists of 2 blocks:

1) intensive care unit

2) block of the second stage of nursing

Intensive care unit

Babies who require increased attention and resuscitation are placed in the intensive care unit. Here they help children who have serious neurological problems, who cannot breathe on their own or who were born with a very low birth weight. This block has everything for an intensive child and constant monitoring of his health: incubators, monitor monitoring and, of course, qualified personnel.

Block of the second stage of nursing

In this block, a recovery is carried out. Premature babies or babies with newborn jaundice are transferred here.

Equipment

The intensive care unit is usually equipped with modern medical equipment that allows you to create comfortable conditions for babies: modern incubators protect newborns from noise and bright light, conditions are created for severely premature babies that are as close to life as possible. For children who cannot feed on their own, nutrient solutions are introduced through a special probe. You may also need drugs to regulate heart rate, stimulate breathing, blood pressure, ultrasound and x-rays. In the premises of the department, the level of humidity and air temperature is constantly monitored. If necessary, the child is treated with antibiotics.

A little about the medical staff

The medical staff of the intensive care unit is one of the most highly qualified. Parents are constantly informed of all the information on the state of health of the newborn, on the characteristics of the disease and the tactics of its treatment. Also, doctors can answer all the questions that concern the further care of children after discharge. Daily care of the child is carried out by nurses, with whom the parents establish close communication during the child's stay in the department. In addition to them, a whole team of specialists will observe the newborn. This is, first of all, a pediatrician, neonatologist, cardiologist, neurologist, physiotherapist, pharmacist, nutritionist, laboratory assistants.

In what cases can a child be referred to the intensive care unit?

Newborns with a variety of perinatal pathologies are admitted to the intensive care unit. Usually they require mechanical ventilation, parenteral nutrition, infusion therapy, correction and restoration of important body functions. Very premature newborns with low body weight, who often have severe health problems, also come here.

If your newborn baby has been transferred to the intensive care unit, do not panic and fall into despair. Here you will inevitably get acquainted with new medical technologies, new medical language, new rules and procedures that are designed to help your child. The ward staff will teach you how to care for your baby during this time. Thanks to medical workers, parents quickly get used to, and begin to understand the needs of the baby, find out what can be done for him. And this is very important, because the correct care of the child in these difficult first days of his life depends on how quickly he will be able to adapt to new living conditions outside the mother's body. Only after the baby's health improves so much that it does not cause concern, when he is ready for a full life under normal conditions, we can talk about the discharge of the child from the intensive care unit.