Many young mothers, after being discharged from the hospital, become very worried because of the uncertainty in their actions in caring for a newborn in the first month. After all, there are many questions about breastfeeding and baby regimen. Answers to them can be obtained from the district pediatrician or nurse of the children's clinic. For this, a woman does not need to go to a medical facility herself, and even more so carry a baby there. The fact is that in Russia there is a system of newborn patronage, that is, monitoring newborns at home.

Patronage of a newborn is carried out by a pediatrician and a nurse from a children's clinic and applies to all babies, regardless of whether their parents have permanent registration and a general health insurance policy.

The main task of doctors in the patronage of a newborn is to assess the health status of the child, his mother, as well as the socio-economic conditions of the family.

When to expect a doctor?

From the maternity hospital, information about the discharge of the newborn is reported by phone to the children's clinic, to which the baby will be attached, depending on the address of the actual residence of the family. In the registry of the polyclinic, in a special register of newborns, the surname, name, patronymic of the mother and the date of birth of the child are recorded.

Primary patronage of a newborn is carried out during the first two days after discharge from the hospital. Children who belong to the high-risk group for the development of a number of diseases (prematurity, postmaturity, malnutrition, cerebrovascular accidents) should be visited by the local doctor on the day of discharge from the hospital. If the day of the visit falls on a weekend or holiday, then the pediatrician on duty will come to the baby. If the doctor, while conducting patronage, notices any deviations in the health of the child or the infant is at risk, the number of visits may be increased.

If the doctor did not come to the newborn in the first two days after being discharged from the hospital, then the mother should call the children's clinic at the place of residence and find out the reason for the absence of a patronage doctor.

Primary care of a newborn

During the primary patronage of a newborn, the doctor will ask the mother many different questions about the course of pregnancy, childbirth, the condition of the child at birth and discharge from the hospital, take an interest in living conditions, find out if the mother, father or their relatives have any hereditary and chronic diseases, etc. All this information helps the doctor to identify the risk group for the development of hereditary diseases in the child.

Then the doctor will examine the child: he will assess his physical development, the presence or absence of malformations and stigmas of disembryogenesis (microanomalies). Stigmas are a kind of microgenetic background of the family. These are small deviations from the norm that can occur in a particular family member. For example: a flattened back of the nose, protruding ears, large birthmarks, low hair growth, etc. If the doctor detects more than five or six such stigmas, then the baby is at risk for developing various diseases.

When assessing the neurological condition of the child, the doctor takes into account the posture of the newborn, his motor activity, muscle tone, and the severity of unconditioned reflexes. The shape and dimensions of the head, the size and degree of tension of the large and small fontanels, the condition of the sutures of the skull bones are also evaluated.

Further, during the primary patronage of the newborn, the doctor examines the child's skin: evaluates its color, the presence of prickly heat, diaper rash, etc. The doctor will pay special attention to the condition of the umbilical wound: examine the skin around the navel, the degree of healing of the umbilical wound, whether there are any discharges from it.

Then the pediatrician listens with a phonendoscope to the breathing and heartbeat of the crumbs in order to assess the state of the respiratory and cardiovascular systems and exclude congenital malformations. After that, the doctor probes the baby's tummy.

During the primary patronage of a newborn child, the doctor must check the symmetry of the gluteal folds and the spread of the legs to the sides for early detection of hip dysplasia. If this pathology is suspected, the baby should be consulted by an orthopedist and sent for an ultrasound of the hip joints. With this disease, early diagnosis is very important, since with timely treatment, the function of the hip joint is completely restored.

At the end of the patronage visit, the pediatrician can answer all questions about caring for a newborn in the first month (bathing, walking, caring for the umbilical wound, the child’s daily toilet), daily routine, and feeding. Particular attention is paid to feeding the newborn in order to help the mother establish proper breastfeeding. The doctor must make sure that the woman has breast milk, examine the mammary glands (the condition of the nipples), observe whether she correctly attaches the baby to the breast, tell her about the feeding schedule for the baby and about the nutrition of the nursing woman.

During the primary care of a newborn, the doctor must tell the mother about all the baby's conditions requiring urgent medical care and about where to go in case of emergency.

The visit lasts an average of 15-20 minutes. The doctor can come at any time of the day (as a rule, the visit is made unannounced), with or without a nurse.

Second patronage of a newborn

The second patronage of a newborn child is carried out on the 14th day of life. The doctor re-examines the baby, examining all organs and systems to assess the processes of adaptation and determine his state of health. Adaptation processes show how the baby adapts to the external conditions around him. To understand this, the pediatrician needs to find out how the newborn sleeps, how he behaves during wakefulness, what his daily routine is.

Also, the doctor should pay attention to how the baby is gaining weight, whether he is worried about regurgitation or colic in the abdomen. If the baby is not worried about anything, he eats well and sleeps peacefully, the doctor concludes that the child's adaptation is easy (or good). With a difficult adaptation process (the baby gains weight poorly, burps, often cries for no reason, etc.), the pediatrician gives the mother recommendations on how to cope with the problems that have arisen.

In addition, during the second patronage, the doctor monitors compliance with care recommendations (skin treatment, the presence of prickly heat or diaper rash, the condition of the umbilical wound, etc.) and feeding, and answers questions that have arisen.

Third patronage of a newborn

The third patronage of a newborn is carried out on the 21st day of the child's life. Its purpose is to monitor the dynamics of the health and development of the child. The doctor examines the baby, assesses its neuropsychic development and overall health.

During the visit, the doctor gives the mother recommendations on the prevention of rickets, discusses with her the issues of hardening the baby, shows some massage techniques and gymnastics for the baby of the first month of life, which parents can do every day themselves.

The district pediatrician after each patronage registers the data obtained in the history of the development of the child. By the end of the first month, he makes a forecast of the state of health of his ward and determines the risk groups. If there are deviations, the pediatrician sends the newborn to a consultation with the appropriate specialist (orthopedist, allergist, etc.) for an in-depth examination and treatment.

Nurse Patronages

The nurse visits the newborn in the first week of life twice with the doctor or on her own, and then weekly during the first month.

During the first patronage, the nurse checks to see if there is everything necessary for caring for the child (crib, bath, stroller, etc.), gives recommendations on walks, shows how to properly bathe the baby, carry out the daily toilet of the newborn, treat the umbilical wound. At repeated visits, the nurse monitors the fulfillment by the mother of medical appointments and recommendations for care.

If for some reason the baby's parents are not satisfied with the medical staff conducting patronage observation, you can contact the head of the clinic with a written request to replace the doctor or nurse.

Border states

During a patronage visit, a pediatrician can ask the mother about her complaints and talk about borderline conditions that a child may experience in the first weeks of life. They are not a disease and do not require special treatment. The most common borderline conditions in newborn babies are:

• Physiological jaundice of newborns(associated with the immaturity of liver enzymes and an increase in the level of bilirubin in the blood). On the 2-3rd day of life, an icteric coloration of the skin appears in the infant, which increases by the 5th day, and disappears by the 7-10th day.
• Erythema of the newborn. It is observed on the 2nd day of life and is expressed in reddening of the skin, sometimes accompanied by a rash (papules and vesicles). It disappears on its own by the end of the first week.
• Hormonal crisis in newborns. It can manifest itself in engorgement of the baby's mammary glands (begins on the 3-4th day, reaches a maximum by the 7-8th day, then decreases); mucous or bloody discharge from the vagina in girls appears in the first week of life and disappears by the 14th day.

From the maternity hospital where the baby was born, information about his discharge will be necessarily 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 maternity hospital, on the same day enters the data into the register of newborns; she fills in the developmental history of the newborn, pastes prenatal care inserts into it, transfers the developmental history to the registry or directly to the district nurse.

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

Goals of patronage

The overall goal of patronages is to create a program for the rehabilitation of the child.

Specific goals:

Assess the health status of the child;

Assess the health status of the mother;

Assess the socio-economic conditions of the family;

Develop a mother's education program aimed at meeting the vital needs of the child.

Treatment of the umbilical wound

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

You will need:

• cotton buds,
• ALCOHOL SOLUTION OF BRILLIANT GREEN ("brilliant green") or CHLORPHYLLIPT,
• clean pipette,
• 3% HYDROGEN PEROXIDE SOLUTION.

  Step by step:

  Wiping (more precisely, getting wet) the baby's skin after bathing, dry the navel area well as well.

  Soak a cotton swab in the antiseptic solution and apply it to the wound.

  If there is a lot of discharge and crusts in the wound (usually this happens in the first days of the baby's life), they can be removed with a 3% HYDROGEN PEROXIDE SOLUTION.

  Draw the HYDROGEN PEROXIDE SOLUTION into the pipette.

  Release the solution into the umbilical wound. In contact with biological media, it will begin to foam and bring crusts and discharge to the surface.

  Dry the wound with a dry cotton swab or cotton swab.

  Using another stick, lubricate the wound with an antiseptic solution.

  Currently, in most large obstetric institutions, the umbilical cord is removed surgically 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 usually proceeds smoothly.

  Bathing

  Schedule of visits
  

  What is neonatal care made up of?
  His official program includes as many as 10 visits to the doctor and nurse. But parents can change it as it is convenient for them and the child.
  

  • 1,3,10,14th day - visiting a 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.
  Bathing should be a daily routine for your baby. Firstly, the skin of the baby is thin, and metabolic and excretory processes and skin respiration are much more active in it than in ours. Therefore, it must be cleaned regularly. Secondly, bathing is extremely useful in terms of hardening.

  You will need:

  • bath or baby bath
  • water thermometer,
  • crystals of potassium permanganate (in the first 7-10 days of a baby's life),
  • baby soap or bath foam (1-2 times a week),
  • terry mitt or soft sponge (optional),
  • a large diaper or terry towel to wrap the baby after bathing.

    The water temperature should be about 36-37o C. In order to harden the water temperature can be lowered by about 1o every 2 weeks. In the first 10 days of a baby's life, neonatologists recommend bathing him in a weak (light pink!) solution of potassium permanganate. To do this, the crystals should not be thrown directly into the bath, but first dissolved in a small amount of water, having prepared a rather saturated solution, and filtered through several layers of gauze or bandage. Otherwise, undissolved crystals can get on the skin or mucous membranes of the child and cause serious chemical burns. You need to wash the baby with soap or in baby bath foam 1-2 times a week, in other cases it will be enough to bathe him in plain water. After the bath, it is useful to rinse the child with running water (from a jug or shower), the temperature of which can be 1–2 degrees lower. After bathing, wrap the baby in a diaper or towel. Thin children's skin can only get wet, but in no case rub it, because it is very easily injured. After the bath, you should start processing the navel.

    Washing away

    Wash your baby after every stool and when changing the diaper. It is most convenient to wash the baby under running water, so that the water flows from front to back. If for some reason water is not available (on a walk, in a clinic), you can use wet baby wipes.

    We wash ourselves

    In the morning, the baby can be washed right on the changing table.

    You will need:

    • a few cotton swabs
    • boiled water.

      We wipe the baby's face and eyes with a cotton swab dipped in boiled water. There must be a separate swab for each eye. Direct movements from the outer corner of the eye to the inner.

      We clean the nose

      The need for this arises when it is heard that the breathing of the crumbs is difficult. To do this, it is more convenient to use a cotton turunda (wick). Carefully, with twisting movements, we introduce it into the nostril. If there are a lot of dry crusts in the nose, turunda can be moistened in oil (vaseline or vegetable). From these manipulations, the baby can sneeze, which will simplify the task.

      We clean the ears

      A child's ears should only be cleaned when wax is visible at the mouth of the ear canal. Do not do this too often: the more sulfur is removed, the faster it starts to be produced. When cleaning the ears, in no case should you penetrate the ear canal deeper than 5 mm. There are even special cotton swabs with limiters for this.

      Trimming nails

      These little nails grow so fast! As they grow, they need to be trimmed so that the baby does not scratch himself or you. Use "baby" nail scissors that have extensions at the tips. For some, it is more convenient to use special wire cutters. Nails should be cut straight, without rounding the corners, so as not to stimulate their growth and ingrowth into the skin.

      This concludes the primary patronage of the newborn. At the second patronage, the nurse checks the correctness of the procedures.

How is patronage provided? monitoring newborns at home?

In our country, there is a system of free patronage monitoring of newborn children aged 0 to 1 month. The first and most detailed examination is carried out by the local pediatrician and nurse during the first 3 days after the baby is discharged from the hospital. The next visits are on the 14th and 21st days of the baby's life. And when the child turns one month old, you will have the first trip to the children's clinic. The local doctor and nurse visit the newborn without prior warning.

It is very important to note that patronage supervision should be carried out free of charge and in full for everyone newborn children, regardless of whether their parents have a permanent residence permit and compulsory health insurance policies. If the baby, for one reason or another, was born outside the medical hospital, then the local pediatrician draws up a birth certificate, on the basis of which the parents then register the child in the registry office.

Who informs the children's clinic about the appearance of a newborn?

If a woman is discharged from a maternity hospital in her city, then the nurse provides information about the child to the children's clinic or the birth took place outside the hospital, then the mother herself must inform the local pediatrician about the appearance of a newborn. To do this, just call the district children's clinic.

How is the first visit of a pediatrician going?

At the first visit, the district pediatrician enters a medical card for the child. He enters into it information about the parents (full name, education, place of work), evaluates the living conditions in which the baby will live (the presence of a crib and a place for swaddling, the ecology of the room). Then the doctor should ask about the state of health of parents and close relatives. If the family knows the facts of kidney disease, neurological pathology, bronchial asthma and allergies, alcoholism, infectious diseases, this information will be recorded in the medical record.

A woman in the maternity hospital is given an exchange card, which contains information regarding her state of health, the course of childbirth and the postpartum period (this part should be given to the doctor of the antenatal clinic), as well as information about the child addressed to the local pediatrician. After reviewing the information contained in this extract, the doctor will certainly ask the mother to tell the following:

• How was the pregnancy and childbirth?
• did the child cry immediately after birth, what, in the opinion of the mother, was the nature of his cry;
• whether the baby was attached to the breast in the delivery room;
• whether the child was in the hospital with the mother and how feeding was arranged. Next, the doctor proceeds directly to the examination of the newborn.

What does the district pediatrician pay attention to when conducting the first examination of a newborn?

Each pediatrician has his own method of examination. A qualified examination involves obtaining the most complete information about the baby. To do this, the doctor examines the child literally from head to toe. Let's talk about everything in order.

Leather. The pediatrician is interested in skin color, the presence of birthmarks and vascular spots, rashes. The doctor also pays attention to the manifestation of physiological jaundice. Usually the icteric shade disappears by the middle of the first - the beginning of the second week, and the skin becomes pale pink. To the touch, the skin of the baby should be smooth and velvety.

Head. The doctor measures the volume of the baby's head and carefully examines it, paying attention to its shape, the condition of the fontanelles and the sutures of the skull. The purpose of such an examination is to exclude defects in the skeletal system of the head and timely detection of signs of increased intracranial pressure.

Eyes. The doctor monitors how the pupils react to light, whether they move together or separately from each other. He also pays attention to the condition of the eyelids. Swelling and redness of the eyelid may be signs of a blocked tear duct or conjunctivitis.

Nose. A healthy baby breathes through the nose. If the nasal passages are clogged, he has to breathe through his mouth - in this case, it may be difficult to feed the baby.

Oral cavity. The oral cavity is examined in order to exclude congenital anomalies: splitting of the lips or palate, flaws in the structure of the tongue, the presence of congenital teeth. The oral mucosa deserves special attention. Sometimes it can show manifestations of fungal stomatitis (thrush) in the form of a white cheesy plaque.

Neck. The doctor determines whether the child's lymphatic glands located on the neck are enlarged, whether there are cysts. At the same time, he checks the condition of the muscular system. Unfortunately, during childbirth, the muscles of the neck are often injured (especially in breech presentation). If pathological changes are not noticed in time, then the child may develop torticollis.

Clavicles. To check the clavicles, the doctor stretches the child's arms, spreads them apart and winds them over the baby's head - it is important how the child reacts to such manipulations. If his handle hangs like a whip (paresis of the arm), the doctor will suspect a broken collarbone.

Rib cage. The pediatrician measures the volume of the chest. With the help of a stethoscope, it determines the frequency with which the child's heart beats. The normal heart rate for a newborn is 120-140 beats per minute. It is very important to rule out a heart defect, which can be indicated by various murmurs. The pediatrician listens to the child's breathing in front and from the back - for the presence of wheezing. Breathing in a healthy baby is quite uniform - 35-40 breaths per minute. Some doctors begin the examination with just such manipulations - until the child screams.

Stomach. The pediatrician will usually feel the baby's belly to make sure it is soft. Then he checks to see if the internal organs are enlarged. It is very important that the size of the liver and spleen are within the normal range.

Umbilical wound. The doctor will tell you how to properly care for the umbilical wound, because if not properly cared for, it can become a source of infection. If the baby has a small swelling, it is important not to miss the appearance of an umbilical hernia.

Hips. The doctor will lay the child on his back, bend his legs and try to spread them apart so that they touch the surface of the table. Thus, they check if the baby has a congenital dislocation of the hip. When a child begins to walk in a year, his hip joints will have to cope with a serious load. If pathology is detected, then the success of treatment depends on how early it is carried out.

Sex organs. The doctor must make sure that the genitals have a normal shape. In a girl, the general shape of the structure of the labia is important: the labia minora should be covered by the large ones. In a full-term boy, the testicles should be lowered into the scrotum. On examination, the doctor also excludes dropsy of the testicles.

reflexes. Checking reflexes is a mandatory element of the first examination. It sometimes seems to mothers that the doctor is doing real acrobatic stunts with their children. In order to check the grasping reflex (hugs), sucking, palmar-mouth and grasping reflexes, the child is placed on the back. The support and automatic gait reflex can be observed by supporting the baby under the armpits so that his legs touch a horizontal surface. When checking the protective reflex and the crawling reflex, the child is laid out on the stomach. For a complete assessment of the work of the baby's nervous system, the doctor will also check other spinal automatisms - Galant, Perez reflexes, a reaction to fright (Moro reflex).

Muscle tone. Muscle tone is one of the criteria by which the work of the child's nervous system is evaluated.

Normally, the physiological increase in muscle tone persists in children up to 2.5 months on the arms and up to 4 months on the legs. Mom will probably notice how difficult it is to unbend the arms and legs of a newborn baby. If the doctor detects violations of muscle tone (significantly increased or decreased tone, asymmetry of muscle tension on the right and left sides of the body), he will prescribe a consultation with a neurologist.

behavior and well-being. Examining the baby, the doctor necessarily plays and talks with him, at the same time carefully observing his behavior: is the child not lethargic, does he feel normal. Perhaps it would be useful to note that, at the request of the parents of the child, a pediatrician from another site can observe. To do this, the mother must personally agree with the doctor. If the main load does not allow the pediatrician to fully observe the baby from another site, such a request may be denied.

How is a nursing visit going?

At the first patronage visit, the nurse will definitely talk with the mother about the rules for caring for the baby, teach the techniques of stroking massage and simple gymnastics. In addition, the nurse will leave information that parents must have, namely:

• address and telephone number of the district polyclinic, outpatient clinic and children's district hospital;
• hours of consultations of the district pediatrician and appointments on the "baby day";
• emergency phone number or medical department where you can go for urgent help at home;
• information on where and how to apply for a compulsory health insurance policy for a child.

Having come to your house, the doctor and nurse should certainly wash their hands. Among the normative documents there is no provision according to which they are required to take off their shoes and wear a bathrobe. But if you prepare shoe covers in advance (it is clear that you may not have shoe covers at hand - we will take the liberty of advising you to offer ordinary clean plastic bags to the medical worker) and a gown, then the doctor or nurse is unlikely to refuse.

Patronage of a newborn is a visit to the baby at home by medical workers in the first month of his life. Even at the maternity hospital, they will ask you for your actual address and send the data to the nearest clinic. And on the 1st, 2nd day after you visit a pediatrician or a nurse. Home patronage is usually carried out three times. This is very convenient for the mother, since the necessary examination of the child will be carried out at home, recommendations for caring for the baby will be given, and during it you can ask any questions you have about the baby and your condition.

Primary care of a newborn

It is better to prepare in advance for the primary care of a newborn and make a list of questions that concern you that you want to ask the doctor. During the visit, the nurse or pediatrician will perform the following manipulations:

• examine the umbilical wound and give recommendations for its treatment;
• feel the tummy;
• examine the baby's skin for diaper rash, giving advice on its care;
• they will ask if the baby is breastfeeding or is, they will tell you the rules of feeding;
• make a conclusion about the health of the baby;
• collect information about the course of pregnancy, childbirth, vaccinations in the maternity hospital, hereditary family diseases, etc.;
• make a conclusion about the physical and psychological state of the mother;
• fill the nursery;
• examine the living conditions and their suitability for the baby;
• they will tell you the address and phone number of the nearest clinic, the visiting hours of your local pediatrician and the day on which the babies are received.

During the examination of the baby, not all doctors tell the mother in detail about caring for the baby, so ask all the questions yourself persistently.

Secondary care of a newborn

The second visit of the doctor or nurse at home is carried out approximately on the 14th day of the baby's life. During it, a medical worker will also examine the child. He will see how timely the umbilical wound healed and the physiological jaundice disappeared. The doctor will ask about breastfeeding, give advice on this matter. For this visit, also make a list of your concerns about caring for your baby (nails, ears, eyes, skin, diaper rash treatment, bathing and washing, feeding, cleansing "milk crusts", etc.). You can also ask about your health and ask for guidance about it.

Third patronage of a newborn

The third home visit by a health worker takes place around day 21 of the baby's life. During it, the pediatrician will examine the child, make a conclusion about his health, give useful recommendations and advice. He will also remind you that you must visit the clinic to examine the child when he is one month old. As with the first and second visits, don't forget to ask questions that concern you.

Patronage of newborns at home. Summarizing

In the first month of his life, a baby is monitored at home three times free of charge, regardless of whether the parents have registration or not. However, in order to visit the clinic after a month, you need to make a child and register it at the address of one of the parents.

OBSERVATION OF NEWBORN IN THE PEDIATRIC SITE

A healthy newborn is a child born from a practically healthy mother who had no complications during pregnancy and childbirth, with an Angar score of 8-10 points, having a body weight of 3 to 4.5 kg, with a weight-height coefficient of 60-80, with a normally proceeding period of adaptation, with a maximum decrease in the initial body weight of not more than 6-8%, breast-fed and discharged from the maternity hospital for 5-6 days.

To newborns conditionally include children of the first month of life (up to 28 days).

The following clinical groups of newborns are distinguished.

Full-term babies born at 38-40 weeks gestation
with a body weight of 2501 g or more, a height of 47 cm or more, morphologically and
functionally appropriate for gestational age.

Premature babies born at gestational age less than
38 weeks, body weight less than 2500 g, height less than 47 cm.
they can be mature, immature, with intrauterine malnutrition.

■ Classification of degrees of prematurity by gestational
age at birth is given below.

♦ I degree - 35-37 weeks of pregnancy.

♦ II degree - 32-34 weeks of pregnancy.

♦ III degree - 29-31 weeks of pregnancy.

♦ IV degree - less than 29 weeks of pregnancy.

■ Until now, there is a classification of premature babies in
depending on body weight.

♦ Body weight from 2500 to 2001 - I degree prematurity.

♦ Body weight from 2000 to 1501 g - prematurity II degree.

♦ Body weight from 1500 to 1001 g - III degree prematurity.

♦ Body weight from 1000 to 500 g - IV degree prematurity.

Immature children - not corresponding to the degree of maturity of the gestation
it's age. They can be full-term and premature.

Postterm babies - those born at a gestational age of more than
42 weeks and showing signs of postmaturity.

Children with intrauterine malnutrition - children who have a mass-growing
the indicator is below the norm (norm 60-80) or there are signs of
support for intrauterine development.

■ Forms of intrauterine growth retardation are listed below.

♦ Hypotrophic form: characterized mainly by defi
cyt of body weight in relation to length.

♦ Hypoplastic shape: relatively proportional
decrease in all indicators of physical development.

♦ Dystrophic (dysplastic) form: pronounced
imbalances, physique disorder, trophic races
devices against the background of a significant reduction not only in mass
body, but also body length and head circumference.

■ Allocate the following degrees of severity of intrauterine growth retardation.

♦ Mild: 2 sigma weight loss compared to normal
small value of the body weight of the corresponding gestational
age with normal or moderately reduced length
no, head sizes do not go beyond M - 2 sigma.

♦ Medium, reduction in body weight and length by 2 or more sigmas
compared with the normal values ​​of these indicators with
appropriate gestational age. In 75% of these children
note a similar decrease in head circumference.

♦ Severe: a significant decrease in all physical parameters
whom development and especially body length (by 3 or more sigma)

Small children born at term - children weighing less than 2500 g, anatomically and functionally mature in accordance with gestational age, having a growth proportional to body weight.

After the newborn is discharged from the maternity hospital, the child is transferred under observation to the children's clinic. Information about the discharge of children comes to the children's clinic daily. These data are recorded in the register of newborns and transferred to the local pediatricians on the same day.

Medical and nursing patronage for a newborn is carried out regardless of the mother's registration. Preventive work with this age group of children consists in conducting primary medical and nursing patronage in the first 3 days after discharge from the maternity hospital, if the newborn is healthy, and necessarily on the first day, if he has deviations in health or unfavorable living conditions.

PRIMARY NURSING PATRONAGE

Primary medical and nursing patronage is carried out according to a certain scheme.

The district pediatrician should clarify and evaluate the social, genealogical and biological history using information from the mother's interview, prenatal care and data from the newborn's exchange card.

Particular attention is paid to feeding the newborn.

Assess mother's skills and knowledge about breastfeeding
to identify feeding difficulties and problems.

Examine the mammary glands of the mother.

How to properly position and apply the baby to the breast.

Feed the baby on demand (up to 8-12 times a day) without nightly
breaks.

Do not give the newborn any food other than breastfeeding.
milk.

Do not use pacifiers or pacifiers.

During an objective examination of a newborn, attention is paid to a number of signs

General condition, crying, sucking activity.

The condition of the skin, mucous membranes, the presence of edema, pasty
ty, cyanosis, "transient states", reactions to the introduction of the vaccine
BCG.

Body type, nutrition.

Posture, muscle tone, motor activity.

Skeletal system: the shape of the skull, sutures, fontanelles, stigmas of disembri-
genesis, clavicle, congenital dislocation of the hip

Respiratory system: type, frequency, breathing pattern, chest shape
cell, percussion, auscultation of the respiratory organs.

CCC: borders of the heart, sonority of tones, noises, visible pulsation,
heart rate.

Abdominal condition: examination of the umbilical ring and umbilical wound, op
determination of the size of the liver, spleen, examination of the genital organs. vyyas
nyat the frequency and nature of the chair.

Anthropometric data of a newborn are compared with indicators of the physical development of children of a given age, and an assessment of physical development is given.

There are a number of features of the neurological examination of newborns, characteristic only of this age period. First, all reflexes are checked in the supine position, then in the state of vertical suspension with the legs down, and lastly in the prone position. Pay attention to the position of the head, torso, limbs, the severity of spontaneous movements of the arms and legs. Determine the posture of the child, the shape of the skull, its size, the state of the cranial sutures, the size and condition of the fontanelles, the presence of cephalohematoma, a birth tumor, and hemorrhages in the scalp , face, eye sclera.

Newborns are characterized by physiological, unsharp hypertonicity of the flexor muscles of the limbs, the legs are slightly apart at the hips, and the hands are clenched into fists. The muscle tone of the extensor muscles of the head and neck is somewhat increased, so in normal newborns, a slight tendency to tilt the head back is noted. Lying on his back, the newborn independently turns his head to the side. In the position on his stomach, he sometimes raises his head for 1-2 s.

In the first week of life, the following features are noted.

The child squints and worries in bright light, shudders when
loud sound (bell, clap), eyeballs float to the side
loud sound.

There may be mild convergent strabismus.

Inhibition prevails over excitation.

When waking up and hungry, the child screams, and appears on his face
grimace of displeasure.

Sleep is calm, the child wakes up if wet.

At the mother's breast, well-fed and dressed, the child falls asleep.

All unconditioned reflexes are symmetrical; from tendon reflexes
owls are the most permanent knee.

You can well cause physiological reflexes: Babkina,
Robinson, Moreau, plantar, suspension reflexes, support, extrusion
fumbling, automatic walking, Perez, Talent, sucking, swallowing.
By the 10th day, the baby, laid on his stomach, tries to raise his head,
keeps her eyes on her mother's face.

The presence of a pronounced hand tremor, nystagmus, a symptom of the "setting sun", convulsions, stiff neck, paresis, paralysis indicate a functional or organic lesion of the nervous system of the newborn.

As a result of the assessment of the state of health, they determine the health group, the risk group and draw up a medical examination plan for the first month of life. The plan should include moments of regimen, care, upbringing, feeding and hardening of the child, and, if indicated, restorative, preventive and therapeutic measures. It also provides for measures to prevent hypogalactia in the mother.

The data of the primary medical and nursing patronage are entered into the history of the development of the child (form No. 112 / y).

During subsequent examinations, the adaptation of the newborn to new living conditions, his state of health, body weight dynamics, behavioral features and neuropsychic development are assessed, compliance with the rules of care, feeding and the implementation of prescribed measures are monitored.

REPEATED MEDICAL PATRONAGE

The district pediatrician conducts repeated medical patronage of a healthy newborn on the 14th-21st days of the child's life, and at the age of 1 month, the mother and child are invited for a preventive visit to the clinic. As a rule, the doctor visits children of II-V health groups more often:

The pediatrician examines children of the II health group on the first day of the
le discharge from the maternity hospital, on the 10th, 14th and 21st days of life, and in
grow up 1 month, the mother and child are invited to a preventive appointment in
clinic.

Children of the III health group are visited on the first day after discharge
ki from the maternity hospital, then every 5 days for the first month
life, then according to the underlying disease.

Children of IV-V health groups must be examined in the first
days after discharge from the neonatal pathology department, then
2 times a week during the first month of life and thereafter, respectively
underlying disease.

The patronage nurse visits the child 20-25 times in the first year of life: in the first month on the first day after discharge, then 2 times a week, during the 2nd and 3rd months - 3 times a month, during the 4th , 5th and 6th months - 2 times a month and in the 2nd half of the year - 1 time per month. If purulent-inflammatory diseases are suspected, the nurse examines the newborn daily for 10 days.

During the first month of life, medical care for children is provided by a pediatrician and specialists of a children's clinic only at home.

By the end of the newborn™ period, the local pediatrician draws up a medical examination plan for the first year of the child's life, depending on the health group and risk groups. The plan includes the following activities.

Carrying out preventive vaccinations.

Examinations by specialists (dispensary observation is possible).

Additional examinations (blood tests, urine tests, as
niyam biochemical, radiological and instrumental studies
dovaniya, etc.).

Preventive (prevention of anemia, rickets), correcting
schee and recreational activities.

When providing medical care to a sick newborn at home, a district pediatrician and a nurse observe him daily until he is fully recovered. According to the testimony of the child at home, all the necessary laboratory tests are carried out, they are called for con-

consultations of specialists of a narrow profile. In case of difficulties in diagnosis or differential diagnosis, the district pediatrician identified in the newborn pathology is obliged to invite the head of the department or a more highly qualified specialist. The doctor has no right to leave a child with an unclear diagnosis at home without medical assistance or consultation.

ORGANIZING NEWBORN CARE AT HOME

For a healthy newborn, it is very important to create an optimal individual regimen. The alternation of sleep and wakefulness with timely feeding of the child contributes to the normal activity of all functional systems of the body.

When feeding a newborn, it is recommended to use the method of free feeding, in which the child receives food 8-10 times a day, including at night. With this practice of feeding the newborn, the mother develops a quick and sufficient production of breast milk, the child's behavior becomes calmer, his need for nutrients is fully satisfied, which ensures high-quality and full physical and neuropsychic development. With free feeding, a newborn, as a rule, does not need additional fluids (except in special cases, for example, in the hot season, with heavy regurgitation, during diseases, etc.). Usually at home, by the end of the neonatal period, when the mother has sufficient lactation, and the child is able to suck out the required amount of milk for each feeding, he develops an individual feeding regimen (6 or 7 times a day, usually without a night break).

For children who are late attached to the breast, or who are on early mixed and artificial feeding, it is advisable to prescribe probiotics for 3-4 weeks.

By the time the newborn is discharged from the maternity hospital, it is necessary to prepare the room where he will be and the items to care for him. Before discharge, the room should be subjected to a general wet disinfection cleaning.

The crib should be placed in the brightest and warmest place in the room, but not near the battery and not in a draft. The constant stay of the child in the stroller is undesirable. In order for the upper half of the body of the newborn to be slightly raised (by about 30 °), slightly raise the head end of the mattress (a flat pillow or a folded blanket is placed under it).

The air temperature in the room where the newborn is located should be within 22 "C, and for a premature or child with malnutrition - 23-24 ° C. The room should be ventilated every 3 hours for 10-20 minutes at any time of the year. In winter, the window should be covered with a mesh to reduce the airflow rate.

The following items should be prepared in advance for the newborn.

Bath tub, wash bowl and washbasin
child, a jug for water.

3 thermometers: for measuring body temperature, air and water.

Rubber canisters: for cleansing enema and for cleaning
nasal passages from mucus and crusts.

Gas tube.

2 pots: for boiling nipples and for boiling bottles.

3-5 bottles with divisions (in case of artificial feeding
niya).

Glass jars with lids for sterile cotton, nipple, lo
zhechki.

Container for collecting dirty linen.

For the daily care of a newborn and his toilet, the following are necessary.

Baby cream or boiled and then strained sunflower
oil.

5% potassium permanganate solution.

Baby soap.

Scissors, pipettes (for nose and eyes).

4-6 baby sheets.

3 duvet covers.

2 thin and 1 warm blanket.

20 thin square diapers with an area of ​​​​1 m 2.

10 flannel diapers.

25-30 diapers 65 cm long and 60 cm wide made of gauze or
worn out cotton fabric.

10-12 vests, of which 6-8 cotton and 4-6 flannel
out.

2-3 caps or scarves.

Pampers of the appropriate size.

It is necessary to carry out daily toilet of the newborn.

The toilet of the eyes is carried out by wiping the palpebral fissures with separate
each eye with sterile cotton swabs moistened with cool
boiled water. If necessary, use a solution of fu-

racillin (1:5000). Wipe the palpebral fissures from the outer edge of the eye to the inner. If there are indications, after the toilet, a 20% solution of albucid, 0.25% solution of levomycetin is instilled into the eyes. With persistent preservation of purulent discharge from the eyes, it is recommended to consult the child with an ophthalmologist, to do a bacteriological examination.

The toilet of the nose is carried out in the morning and during the day as needed.
distance. The nasal passages are cleaned with cotton flagella (for
each nasal passage use a separate flagellum), moistened
sterile vegetable oil. In the presence of dry crusts, you can
use saline or breast milk (if
purulent discharge). With the appearance of rhinitis (congestion
nose, profuse serous discharge) should be before each feeding
eat, and if necessary, more often, suck mucus from the nasal passages
small rubber spray, the tip of which is lubricated
sterile vegetable oil. After suction into the nasal passages
instill a 0.01% solution of Nazivin, furacillin-adrenaline caps
Whether, use antiviral ointments. In the presence of purulent
which requires an examination by an otolaryngologist, bacteriological examination
dovanie.

The toilet of the umbilical wound is carried out with 70% ethyl alcohol, and then
5% potassium permanganate solution or 2% diamond
green. In the presence of fresh or dried discharge from the umbilical
wound, it is previously removed with a 2-3% solution
hydrogen oxides. In cases of hemorrhagic crusts or bleeding
for the treatment of the wound, a solution of adrenaline hydrochloride is used.

Treatment of the oral mucosa in a newborn
a bank is necessary when thrush appears. Processing is carried out by 2%
soda solution (1 teaspoon of soda per 200 ml of boiled water) or
antifungal drugs. The oral cavity is treated with
before each feeding with a gauze pad. Effective
The effectiveness of treating thrush in a child depends on the quality of ma
Terinsky's nipple before breastfeeding. With persistent
thrush and a history of AN therapy in the mother or child
tibacterial drugs, it is necessary to examine the child for disbacte-
riosis.

The toilet of the external auditory canals is rarely produced: they are against
rayut with dry cotton flagella.

Newborn and infant nails should be trimmed. It is more convenient to use scissors with rounded jaws or nail clippers.

Newborn skin care includes morning toilet, washing after bowel movements and a hygienic bath. In the morning after sleep, the mother wipes all the skin folds of the child with a napkin dipped in boiled water, and after drying them with a soft diaper, lubricates with sterile vegetable oil or baby cream. Currently, there is a wide range of these products on sale. It is undesirable to use baby powders, because they roll into balls with the skin discharge of the child and cause microtraumatization of the skin of the newborn, which can cause diaper rash and pustular rashes.

The child's underwear must be clean. You can wash it only with baby soap or special powders for baby clothes, and then be sure to iron it on both sides.

Bathing the baby should be done after the umbilical cord falls off daily. Bathing is carried out in boiled water with a temperature of 36.5-37 ° C, and for children aged 6-12 months - with a temperature of 36-36.5 ° C. Twice or thrice a week when bathing use baby soap. On other days, the child is bathed without soap, using a flannel or terry mitten. It is better to bathe the baby before the last feeding. The duration of bathing should be 5-10 minutes. The face and head are washed last. After bathing, the child is poured from a jug with water at a temperature of 36 ° C. The skin is then thoroughly dried with a soft sheet or diaper. Skin folds (behind the ears, on the neck, in the armpits and inguinal areas) are lubricated with baby cream or oil. If the parents are inexperienced, then at the first bath, a nurse should be present, who conducts this bath. After bathing, the mother feeds the child and puts her to bed.

If the sanitary and hygienic conditions of care are violated, a newborn may develop prickly heat - a small, reddish rash localized in places of natural folds on the skin of the trunk and extremities. The appearance of prickly heat is associated with insufficient or improper care of the child, with his overheating. Miliaria usually disappears after the elimination of these factors. Baths with decoctions of string, celandine, oak bark, chamomile, St. John's wort can be recommended as therapeutic agents. A decoction of herbs is prepared at the rate of 15 g of dry matter per bath.

In a newborn, if the conditions of care are violated, diaper rash may appear. More often they are localized in the buttocks, inner thighs, in natural folds and behind the ears. There are 3 degrees of diaper rash.

I degree: moderate reddening of the skin without a visible violation of its integrity.

II degree: bright hyperemia of the skin with large erosions.

III degree, bright hyperemia of the skin, weeping as a result of plums
erosion.

Diaper rash II and III degree can become infected.

The treatment of diaper rash consists in proper sanitary and hygienic care for the newborn: thorough washing of the child after the act of defecation, followed by drying the skin with a soft diaper or sheet and treating the folds with oil or baby cream, drapolene ointment, 1% brilliant green solution. It is advisable to carry out a hygienic bath with the addition of decoctions of medicinal herbs 2 times a day (morning and evening). Diapers must be carefully ironed on both sides. With diaper rash of the II and III degrees, open swaddling and local UV irradiation of the affected skin areas can be used. The district doctor should pay attention to the mother's diet, excluding obligate allergens from it, and prescribe antihistamines to the child. If an allergic genesis of diaper rash is suspected, the drugs of choice are chloropyramine, hifenadine, clemastine in doses appropriate for age. Antihistamines can also be used in the form of ointments.

When prickly heat or diaper rash become infected, ointments with antibacterial agents can be prescribed, which can be combined with medicinal baths from herbal decoction. In such cases, the child should be examined for dysbacteriosis.

HARDENING ACTIVITIES

A newborn in the room is recommended to be without a cap. It is necessary to swaddle the child during sleep or feeding in order to limit his general motor activity. During wakefulness, the child should be in a vest, sliders or panties. A good means of hardening from the neonatal period is the exposure of the feet. If the feet are cold and the baby starts sneezing, you can cover the lower body with a blanket, but do not swaddle the baby.

Walking in the warm season, in the absence of contraindications, can be started immediately after discharge from the maternity hospital, avoiding direct sunlight on the child. The duration of the walk should first be 15-20 minutes, and then it is gradually brought up to 1.5-2 hours. On windy, rainy, and very hot days (more than 30 °C), it is better for a child to sleep indoors with open windows or on a veranda. In winter, walks with a newborn should be started at home with an open window or window. To stay in the fresh air in the cool time of the child should be accustomed gradually, starting from

the duration of the walk is 15-20 minutes. You can take it out for a walk at a temperature not lower than minus 10 ° C. The child's face should not be covered, but should be dressed appropriately for the weather.

For proper physical development, it is necessary from the age of 2 weeks to lay the newborn on the stomach before feeding for 2-3 minutes with a gradual increase in this time to 10 minutes. First, the child is laid out on the stomach 1-2 times, then 3-4 times a day.

An indicator of the effectiveness of dispensary observation of a newborn in the pediatric area is his normal physical and neuropsychic development in the absence of diseases.

The results of monitoring the newborn and assessing his condition are recorded by the doctor in the history of development (form No. 112 / y).