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Physiology of newborns. The nervous system of a newborn child. Functional formation of the excretory system

Physiological features of newborns

Metabolism of glucose and calcium. Due to free diffusion through the placenta, the concentration of glucose in the blood of the fetus is maintained at a level of 70-80% of the values ​​of this indicator in the mother's body. In the later stages of intrauterine development, glycogen stores are formed in the liver, skeleton and heart muscle of the fetus, but its amount is very small. The interruption of the supply of glucose through the placenta after birth makes the newborn child entirely dependent on glycolysis until glucose begins to come from exogenous sources.

Unlike adults who have an efficiently functioning system of glycogenesis, the ability of newborns to use fats and proteins as a substrate for glucose synthesis is significantly limited. Within 2-3 hours after birth, the baby depletes liver glycogen stores and becomes dependent on gluconeogenesis. The rate of decrease in serum glucose depends on the reserves determined by gestational age, as well as on the energy needs of the child. Small-to-term babies are at a very high risk of developing hypoglycemia.

Its symptoms are nonspecific and may include weak or loud crying, cyanosis, apnea, restlessness, lethargy, or seizures. In some cases, there may be no clinical manifestations despite extremely low blood glucose levels.

Hypoglycemia in newborns is defined as a glucose content of less than 1.9 mmol/l in term infants and less than 1.4 mmol/l in infants with low body weight. At 72 hours after birth, the glucose level should be 2.5 mmol/L or more.

Newborns at high risk of developing hypoglycemia require frequent monitoring of glucose levels. For the purpose of early diagnosis, determination of the level of glucose in the blood can be carried out directly in the neonatal department at the patient's bedside using indicator paper impregnated with a reagent. To increase the accuracy of the study, this method can be supplemented by a calorimetric method, which allows the qualitative reaction to be converted into a quantitative one, expressing the glucose content in mmol / l.

Since most newborns requiring surgical treatment are at risk of developing hypoglycemia, it is advisable to conduct a test with indicator paper immediately upon admission of the child and, if the results are positive, begin the administration of 10% glucose, while sending blood to the laboratory for an accurate determination of blood glucose levels. The goal of early glucose infusion is to prevent the development of clinical manifestations of hypoglycemia and maintain glucose levels above 2.5 mmol/L.

When the glucose concentration falls below 2.2 mmol / l, as well as in the presence of any symptoms of hypoglycemia, I-2 ml / kg of 50% glucose is administered intravenously. During the first 36-48 hours after major operations, the water-electrolyte balance, as a rule, undergoes rapid changes. During this period, the content of dextrose in intravenous solutions should be maintained in the range from 5% to 15%, depending on the concentration of glucose in the blood and in the urine.

Hyperpicemia quite often occurs in immature newborns with a gestacin period of less than 38 weeks and a body weight of up to 1.1 kg, who are on parenteral nutrition. These are usually children of the first three days of life, receiving 10% glucose at a dose of 100 ml / kg / day. The cause of hyperglycemia appears to be a decreased insulin response to administered glucose. As a result of hyperglycemia, intraventricular hemorrhage can develop, as well as renal fluid and electrolyte losses associated with glasuria.

To prevent hyperglycemia, the rate of infusion and the concentration of glucose should be adjusted depending on the level of glucose in the serum. In order to provide these children with adequate caloric support, the increase in glucose concentrations and volumes must be very slow and gradual. For example, you can start with 5% dextrose at 100 ml/kg/day, increasing daily or every other day by 1%, as opposed to the conventional increase of 2.5% or 5% daily.

Calcium. The fetus is constantly supplied with calcium through the placenta. Of the total calcium obtained in this way, 75% is transported after 28 weeks of gestation.3 This circumstance partly explains the high incidence of hypocalcemia in preterm infants. At birth, there is a natural tendency to hypocalcemia due to depleted calcium stores, immaturity of the kidneys, and relative hypoparathyroidism associated with high fetal calcium levels. The content of calcium in a newborn usually decreases as much as possible 24-48 hours after birth. Gynocalcemia is considered to be an ionized calcium level of less than 0.25 mmol/L.

Preterm infants, newborns with surgical pathology, as well as those born to women with a complicated pregnancy, such as diabetes, or from mothers who received bicarbonate infusions, have the greatest risk of hypocalcemia.

Exchange transfusions or massive transfusions of citrated blood can lead to the formation of calcium and citrate complexes and, accordingly, a drop in serum calcium levels. Later development of hypocalcemia (after 48 hours from birth) is rarely observed at the present time, since most mixtures received by newborns have a low phosphate content.

Symptoms of hypocalcemia, as well as hypoglycemia, are nonspecific and consist of general excitability and paroxysmal anxiety. Increased muscle tone in children with gynocalcemia helps in the differential diagnosis from hypoglycemia. Of greatest importance is the determination of the levels of ionized calcium in the blood. Treatment of children with clinical manifestations of hypocalcemia consists in intravenous administration of a 10% solution of calcium gluconate in an amount of 1-2 ml / kg for 10 minutes against the background of constant ECG monitoring.

For patients with asymptomatic hypocalcemia, calcium is prescribed at a dose of 50 mg / kg / day in the form of calcium gluconate, which is added to infusion solutions (1 ml of 10% calcium gluconate solution contains 9 mg of calcium). Calcium should not be mixed with sodium bicarbonate. Calcium metabolism is interconnected with magnesium metabolism. Therefore, if there is a risk of hypocalcemia, there is always a risk of hypomagnesemia. If a child with seizures thought to be hypocalcemia does not respond to calcium supplementation, hypomagnesemia should be suspected and confirmed or ruled out by testing serum magnesium levels. Treatment consists of urgent intramuscular injection of a 50% solution of magnesium sulfate at a dose of 0.2 mg/kg, if necessary, this dose can be repeated every 4 hours.

Blood volume. The total number of red blood cells rises at birth to its maximum. Indicators of blood volume in premature and full-term newborns, as well as in children older than a month of life are presented in Table 1-2. By the age of three months, the total volume of blood per kg of body weight reaches the values ​​characteristic of adults.

Table 1-2. Blood volume indicators


The total volume of blood in the neonatal period varies depending on the maturity of the child, its size, as well as placental transfusion. Since the placenta at birth contains 75-125 ml of blood, the hemoglobin level of the newborn will be higher with delayed cord ligation. It is possible to prevent placental transfusion or artificially “create” anemia by holding the child above the level of the placenta before tying the umbilical cord.

An initially high hematocrit (greater than 50%) can be used as a proxy for placental transfusion. A hemoglobin level greater than 220 g/l in combination with a hematocrit greater than 65% during the 1st week of life should be regarded as polycythemia. Upon reaching the hematocrit level of 65%, its further increase leads to a rapid significant increase in blood viscosity.

Neonatal polycythemia is typical for children born from women with diabetes, pregnancy toxemia, as well as for "small to term". Treatment of polycythemia is carried out by partial exchange transfusion of fresh blood or 5% albumin solution.

Causes of anemia at birth can be grouped into 3 large groups: blood loss, hemolysis, and decreased production of red blood cells. One of the important causes of severe chronic anemia, which can sometimes even lead to death, is fetal erythroblastosis or isoimmunization. This disease occurs when the red blood cells of an Rh-positive fetus enter the bloodstream of an Rh-negative mother.

The subsequent transition of IgG Rh antibodies from the mother into the fetal circulation leads to hemolysis, which causes severe manifestations of the pathology. The most common signs of hemolytic disease of the newborn are jaundice, pallor, and an enlarged spleen or liver. In especially severe cases, massive edema occurs that is not directly related to the level of hemoglobin.

Treatment of fetal erythroblastosis should focus on preventing maternal immunization by administering anti-Rh immunoglobulin to every Rh-negative woman who has had an Rh-positive childbirth or abortion. In severe cases, with a positive Coombs test, cord blood hemoglobin level below 105 g/l or bilirubin above 80 mmol/l, urgent replacement transfusion is indicated. In less severe children, an exchange transfusion is performed when the total level of indirect bilirubin exceeds 340 mmol / l.

Fetal and "adult" hemoglobin. At an oxygen level of 27 mm Hg. Art. from the "adult" hemoglobin 50% of oxygen is released (P-50). Thus, the P-50 of "adult" hemoglobin is 27 mm Hg. Art. A decrease in the ability of hemoglobin to bind oxygen allows more of the released oxygen at a given level to pass into the tissues.

The P-50 index of fetal hemoglobin by 6-8 mm Hg. Art. lower than "adult" hemoglobin. The relatively low level of P-50 fetal hemoglobin contributes to a more efficient supply of oxygen from the placenta to the fetal tissues. In this situation, the curve reflecting the saturation of hemoglobin with oxygen shifts to the left. The decrease in P-50 is partly due to the lower ability of fetal hemoglobin, compared with "adult" hemoglobin, to bind 2,3-diphosphoglycerate. By the age of 4-6 months in full-term children, the hemoglobin saturation curve with oxygen gradually deviates to the right and the P-50 values ​​approach the values ​​of "adult" hemoglobin.

Jaundice. Bilirubin is a fat-soluble substance formed as a result of the breakdown of hemoglobin. When conjugated in hepatocytes with glucuronic acid, it becomes water-soluble. When the binding mechanism is violated, indirect bilirubin accumulates and acts as a neurotoxic poison, causing damage to the nervous system in the form of kernicterus. In severe forms, complications such as cerebral palsy, hearing loss, etc. can develop.

Immediately after birth, the excretory function of the liver in newborns is significantly reduced. Therefore, even in healthy full-term infants, rises in the level of indirect bilirubin can be noted, reaching a maximum (170 mmol / l) by the 4th day of life and returning to normal levels by the 6th day. An increase in the level of total bilirubin in a full-term child by more than 200 mmol / l should force us to look for the cause of hyperbilirubinemia (Tables 1-3).

Table 1-3. The most common causes of prolonged hyperbilirubinemia (due to indirect bilirubin)



Treatment of hyperbilirubinemia, which is largely determined by the child's body weight, begins with phototherapy: (1) in newborns weighing less than 1500 g, when the level of bilirubin reaches 85 mmol / l, (2) with a body weight of 1500-2000 g and an increase in the level of bilirubin up to 140 mmol/l, (3) at BW 2000-2500 g, when the level of bilirubin reaches 220 mmol/l. In full-term formula-fed infants with no signs of hemolytic disease, phototherapy is started when the bilirubin level reaches 250 mmol/L.

For hyperbilirubinemia associated with hemolytic disease, phototherapy is recommended if bilirubin levels exceed 170 mmol/L by 12 hours after birth, 200 mmol/L by 18 hours, 240 mmol/L by 24 hours and 255 mmol/L at later dates. Until now, the question remains - what level of bilirubin should be an indication for exchange transfusion.

Retinopathy of prematurity (RP) occurs as a result of impaired development (its active phase) of retinal vessels during the first 3-4 months of life. In large departments of newborns (for example, in a hospital in Pittsburgh), ROP is found in 1.9% of preterm infants. It is difficult to identify risk factors for ROP, but two causes undoubtedly play a significant role in the pathogenesis of ROP - oxygen exposure and prematurity. American

The Academy of Pediatrics considers it necessary to examine the retina in every premature baby who received oxygen at the age of 6-8 weeks. Retroleital fibroplasia (RLF) is manifested by changes in the retina and vitreous body that occur after the acute stage of retinopathy (3-6 months after birth). The study of the results of the use of cryotherapy in the treatment of ROP showed that this method is quite effective and contributes to the prevention of complications such as retinal detachment and vitreous fibrosis.

Thermoregulation. The relatively large body surface compared to the mass of a newborn child largely explains the difficulty of self-maintaining a constant body temperature. Heat loss can occur due to evaporation (wet baby or lying on damp clothes), direct heat loss (direct skin contact with a cold surface), convection (air currents) and radiation (the body radiates heat towards colder surfaces, even unless they are in direct contact with that organism).

It is radiation that is most difficult to control and manage. An increase in heat production in newborns can be provided by the activation of metabolism, increased muscle activity (similar to adults), or due to brown fat lipolysis. However, adipose thermogenesis is significantly limited by small reserves of brown fat (when depleted), as well as its possible deactivation as a result of blocking when using certain drugs (vasoconstrictor drugs or anesthetics).

The optimal ambient temperature for a newborn is the one at which the child can maintain a constant body temperature by vasomotor regulation at a minimum rate of metabolic processes. The critical temperature refers to those of its indicators, with a further decrease in which, in order to restore heat loss, the child needs a change in metabolism. It is not possible to recommend any single incubator temperature regime that is suitable for any child.

The optimal (neutral) temperature is established taking into account the body weight and age of the newborn (Fig. 1-2 and 1-3). For small children in the first 6 weeks of life, it is usually 34-35°, after 6 to 12 weeks - 31-32°. For larger full-term newborns with a BW of 2–3 kg, the neutral temperature ranges from 31–34° on the first day of life and 29–31° thereafter until the 12th day. The required temperature is best provided by double-walled couveuses. As far as heaters are concerned, they cannot prevent convection, resulting in sometimes high extrarenal water losses.



Rice. 1-2. Neutral temperature conditions for newborns in the first week of life.




Rice. 1-3. Neutral: CO temperature regime for newborns aged 7 to 35 days of life. The temperature for children weighing more than 2 kg is calculated by extrapolation.


K.U. Ashcraft, T.M. Holder

The neonatal period is characterized by the following basic needs: sleep; drink; allocate; move; communicate; avoid danger; be clean; to be healthy; maintain a constant body temperature.

Anatomical and physiological features of the newborn

The period of infancy includes children from 1 month to 1 year (12 months).

The main feature of the period of infancy is the high rate of physical and neuropsychic development based on accelerated metabolic processes.

In many ways, the structure and functions of the main body systems retain the same features that were characteristic for the neonatal period:

1) abundant blood supply

2) reduced protective functions

3) imperfection of regulatory functions of the nervous and endocrine systems.

NERVOUS SYSTEM

By the time of birth, the least developed. The mass of the brain in relation to body weight is 1/8-1/9 part, in an adult 1/40 part. The sulci of the gyrus are formed, weakly expressed with age, becoming more numerous, more prominent, especially at 5-6 years. The cerebellum is poorly developed. The movements of the child are not coordinated. Myelin sheaths of nerve fibers are absent, brain tissue is rich in water, its blood supply is more intense than in adults. The arterial network is better developed than the venous network. The number of nerve cells is the same as in an adult. The spinal cord is better developed than the brain. Conditioned reflexes are well expressed.

SKIN AND ITS APPENDIX

The stratum corneum is thin, the epidermis is juicy, loose. The blood vessels of the skin are wide and form a dense network. The sweat glands are formed, but their ducts are poorly developed and covered with epithelial cells, therefore, up to 1 month. sweating is not observed. The sebaceous glands still function in utero, their secret forms a "curdled lubricant". Skin functions: protective, excretory, thermoregulatory, respiratory, restorative, vitamin-producing. The umbilical wound after the fall of the umbilical residue remains for 3-4 days. Heals by 7-10 days of life, epithelializes by 1 month.

musculoskeletal system

It is poor in mineral salts, a lot of water and organic matter. The bones are flexible, rarely break, but are easily deformed. A large fontanel is located between the frontal and parietal bones, closes by 1 year. In all full-term babies, all lateral fontanelles are closed. The fontanel is needed for a soft passage through the birth canal. The spine has no curves, straight. The teeth are not visible, but have rudiments. Formula x=N-4, where N is the number of months of the child up to 24 months (by 2 years) milk bite (20 teeth) is fully formed.

Measures to prevent bone deformation in children 1 year of life: 1) Rational breastfeeding. 2) Prolonged exposure to fresh air. 3) Massage and gymnastics. 4) Adequate physical activity. 5) Sleep on a firm mattress without a pillow. 6) Change of position on the hands and the crib. 7) Free swaddling.

RESPIRATORY SYSTEM

Small nasal passages. The inferior nasal passage is absent due to the overhang of the turbinates. The pharynx is narrow, but the auditory or Eustachian tube, which connects to the middle ear, as a result, children often have otitis media. The larynx is short, wide, funnel-shaped with a narrowing in the subglottic space. The vocal cords are short, and the glottis is narrow, resulting in stenosis of the larynx often with laryngitis. The trachea is narrow, the cartilage is soft, may collapse, and may cause congenital stridor—rough, snoring breathing with expiratory shortness of breath. The bronchi are soft, prone to collapse. The right bronchus is a continuation of the trachea. The diaphragm is located higher than in adults.

THE CARDIOVASCULAR SYSTEM

Heart -20-25 g. The vessels are well developed, but the arteries are better developed than the veins. The pulse is relatively accelerated, arrhythmic, reckoned for 60 seconds. BP systolic-70/75 mm Hg

URINARY SYSTEM

The kidneys are anatomically immature. The ureters are wider and more tortuous. The bladder is located relatively higher than in an adult. The muscular layer is poorly developed, as a result, involuntary urination appears due to the underdevelopment of the regulatory function of the central nervous system. The urethra is 0.5-1 cm in girls, 5-6 cm in boys.

DIGESTIVE SYSTEM

There are many devices in the oral cavity - Bish's pads - fat lumps in the thickness of the cheeks, a roller-like thickening along the gums, folding on the mucous membrane of the lips, a relatively large tongue. Salivation is weak. Esophagus 10-11 cm funnel-shaped. The stomach has the same sections as in adults. The sphincter of the inlet part of the stomach, the cardial, is poorly developed, and the pyloric part is well developed, as a result of which regurgitation occurs. The volume of the stomach is 30-35 ml. The baby is born with a sterile intestine. The microflora depends on the type of feeding. The original cal-meconium is a thick viscous mass of dark green or olive color, odorless, 2-3 days of life are released. When breastfeeding from 4-5 days of life, the stool is 1-4 times a day, ointment-like, homogeneous, golden yellow with a sour smell. With artificial feeding - 1-2 times. The stool is dense, light yellow in color, homogeneous, with a putrid odor. The liver is the largest organ, which occupies half of the abdominal cavity, protrudes from under the right hypochondrium by 1.5-2 cm.

The main problems of the neonatal period

Borderline conditions of newborns

Transient (physiological) - are not diseases, but require more attention and necessary measures.

1) Physiological weight loss in 100% of newborns and manifests itself on the 3rd-4th day of life, max. resp. 10% of the original weight, and by 7-10 days the weight is restored.

Causes: eats little, excretion of water through the skin and lungs, loss of water with urine and feces, regurgitation of amniotic fluid, drying out of the umbilical cord.

Tactics: early attachment to the breast, feeding on demand, combating hypogalactia, controlling the baby's weight.

2) Transient skin erythema (redness)

Simple - redness of the skin due to vasodilation of the skin due to the powerful influence of environmental factors on the skin receptors of the newborn. Remains from several hours to 1-2 days.

Toxic (allergic reaction) - occurs on the 2nd-5th day of life in the form of hyperemic spots, papules, vesicles, except for the palms and feet. The rash subsides in 2-3 days. May turn into peeling.

Tactics: skin care, hygienic bath with potassium permanganate solution.

3) Transient fever

Manifested on the 2nd-3rd day of life, T. 38-39C, thirst, dry skin and mucous membranes. After 1-2 days T. normalizes.

Causes: little fluid enters the body, high protein content in colostrum, overheating.

Tactics: additional drinking of 5% glucose solution.

4) Jaundice - staining of the skin and mucous membranes (icteric) without disturbing well-being. Cases 40-60%. Appears on the 3rd day. The maximum reaches 4-5 days. By 7-10 days of life disappears.

The reason: the collapse of the "shorn" intrauterine erythrocytes with the release of hemoglobin from them, from which bilirubin is formed, because. the liver is temporarily unable to convert indirect bilirubin (POISON!!!) into direct one, so it accumulates in the blood and passes into the tissues and stains them.

Tactics: condition monitoring, additional drinking of 5% glucose solution, UVI.

5) Hormonal crisis - the transition of mothers' sex hormones into the blood of the fetus in the antenatal and intranatal periods or comes with mother's milk. It can manifest itself in the form of: 1) physiological mastopathy in boys and girls. The child has symmetrical engorgement of the mammary glands without signs of inflammation, grayish discharge from the nipples. It appears on the 3-4th day, reaches a maximum on the 7-8th day, disappears after 2-3 weeks. 2) in boys - swelling of the scrotum, in girls - labia majora. Passes symmetrically without treatment. 3) vulvovaginitis in girls - discharge from the genital slit of a gray-whitish discharge, sometimes brown. Appears in the first days of life, disappears by the 3rd day.

The tactic is skin care.

6) Acne (milium) - blockage of the sebaceous glands with abundant secretion. They look like whitish-yellowish nodules 1-2 ml in size. More often located on the wings of the nose, bridge of the nose, forehead, chin. Lasts up to 2-4 weeks. Does not require treatment.

Tactics - 2-3 times a day, wash with a slightly pink solution of potassium permanganate.

7) Uric acid infarction of the kidneys - the deposition of uric acid in the form of crystals in the lumen of the urinary tubules. The reason is the decay of a large number of cells, especially protein metabolism. Urine becomes cloudy, yellow-brown in color. On diapers after drying, a yellow spot or sand. It is found on the 3-4th day of life. Disappears within 7-10 days.

Tactics - drinking 5% glucose solution.

Many parents, speaking of, mean the time from the baby's first cry to the onset of 12 months of age. However, in neonatology, under this concept, the period from the first minute to the 28th day of life is considered. This is the most difficult time in terms of adaptation, and it is important to overcome it by minimizing possible risks.

Periods of adaptation of newborns

In the neonatal period, in connection with the characteristics of the child, two periods are conventionally distinguished.

1. Early neonatal period. This physiological period of the newborn lasts from the ligation of the umbilical cord to the 7th day of life;

2. Late neonatal period. This period lasts from the 8th to the 28th day of life.

At this time, the body of newborn children is adapting to new living conditions. This physiological process under adverse conditions can take an unfavorable course. There are borderline conditions that do not require special treatment. At the time of birth, the baby has a “newborn baby syndrome”, which is characterized by dehydration, deep breathing, screaming, increased muscle tone, the posture of a newborn baby with arms bent, brought to the body, hands clenched into fists.

Adaptation of newborns in both periods to new living conditions is not an easy process. The child's feelings are made up of intrauterine experience and impressions of a new, unfamiliar world. The only source of habitual emotions is the mother, so the baby needs a symbiotic unity with her, including the care and satisfaction of the physiological needs of the baby. The newborn remembers that he was completely safe in the womb. After birth, he feels protected only if his mother is close. The most important condition for the adaptation of an infant is physiological contact with the mother: warmth, carrying on hands, maternal touch, stroking, etc. Physiological contact between mother and child is necessary for the full development of the endocrine, immune and other systems.

Assessment of the state of the newborn baby

Immediately after birth, the physiological state of the child during the neonatal period is assessed using the Apgar scale.

According to this scale, 5 most important signs are determined:

  • heart rate and rhythm;
  • nature of breathing;
  • muscle bonus;
  • reflex excitability;
  • coloration of the skin.

Each sign for the characteristics of the neonatal period is estimated by 0, 1, 2 points. Points add up; a sum equal to 1-3 indicates a serious condition of the newborn. Healthy children gain 8-10 points. After 5 minutes, the assessment of the infant's condition on the Apgar scale is repeated. The general characteristic of this neonatal period in digital terms must be reported to the mother.

Table "Assessment of the state of the newborn on the Apgar scale":

Index

Score in points

Heart rate

Missing

Less than 100 per minute

Over 100 per minute

Missing

Irregular - hypoventilation

Regular

Muscle tone

Missing

Frequent bending

active movements

Reflex excitability

Missing

Weakly expressed

Loud cry, active movements

Color of the skin

Pale, bluish

Pink coloration of the body and cyanotic coloration of the limbs

Pink coloration of the whole body and limbs

Physiological features of newborns

Speaking about the physiological features of the neonatal period, they consider breathing, blood circulation, temperature, physiological weight loss, skin color changes and other indicators.

Features of respiration and blood circulation in an infant after birth. The child's lungs expand due to deep inhalation and labored exhalation. At the same time, in the first 3 days of life, such a feature of the neonatal period as increased ventilation of the lungs is noted. It is associated with the restructuring of the circulatory organs and the beginning of the functioning of the small and large circles of blood circulation, the closure and cessation of the umbilical vessels, the oval opening in the atrium.

Temperature regime. After birth, the child adapts to the new temperature regime, which is constantly changing. The thermoregulation system in the first days of the baby is imperfect, and in the first hours after birth, his body temperature may decrease by 1-2 ° C, and on the 3rd-5th day there is sometimes a transient fever, in which the body temperature rises for several hours remains within 38-39 °C. The main reasons for these fluctuations are the imperfection of thermoregulation, the loss of fluid after birth, and the excess intake of protein with colostrum into the baby's body.

Physiological weight loss. In newborns, physiological loss does not exceed 10% of birth weight in full-term infants and 10-12% in premature infants. This feature of the course of the neonatal period occurs due to malnutrition in the first days of life, loss of water through the skin, with urine, feces, through the lungs and skin. Restoration of body weight to the original in full-term children occurs by the 5th-7th day of life, in premature babies this process is slower.

Change in skin color. This is one of the main features of the neonatal period: babies are born with reddened skin, the so-called erythema. There are simple and toxic erythema. Simple erythema is observed in all newborns, it manifests itself in response to the influence of the external environment. In full-term babies, redness is mild and disappears within a few hours to 3 days after birth. In premature babies, redness is bright and lasts up to a week. Then, at the site of erythema, peeling remains, especially pronounced in children with large weight. Toxic erythema, appearing on the 2nd-5th day of life, is considered an allergic reaction. It manifests itself in the form of single or multiple spots of redness, sometimes blisters. Rashes are absent on the palms, feet, mucous membranes; usually the elements fade in 1-3 days. Toxic erythema is diagnosed in 30% of newborns. Treatment is not required, erythema disappears spontaneously within a few days.

Physiological jaundice of newborns. Physiological jaundice appears on the 2-3rd day of life, it is observed in 60% of newborns and is manifested by icteric staining of the proteins of the eyes and mucous membranes of the mouth. The child's condition is not disturbed, feces and urine have a normal color.

Jaundice disappears by the end of the first week of life. If jaundice is delayed, then an examination is necessary to identify the pathology that caused it.

Sexual crisis (hormonal crisis) of newborns. Sexual crisis is registered in two thirds of newborns. It is manifested by engorgement of the mammary glands; vaginal bleeding in girls; swelling of the external genital organs; boys may have darkening of the skin of the scrotum and nipples. Breast engorgement is symmetrical, usually not accompanied by skin changes; from the mammary glands there is sometimes a discharge of white or gray color.

Usually the symptoms of a sexual crisis appear on the 3-4th day of life, they usually disappear on the 2nd week without any consequences.

What is feces and urine in newborns

Many mothers are interested in what kind of feces newborns have in the early neonatal period and what kind of urine babies have. The original feces are the contents of the digestive tract, mixed with swallowed amniotic fluid. This is a thick, dark green mass called meconium. In the subsequent period of the newborn, with the development of the child, meconium gradually passes into the usual stool of a newborn child - yellowish-golden mushy feces that stand out several times a day.

In the first week of life, in connection with adaptation to new living conditions, the child needs special care, special hygienic conditions in order to prevent diseases that may occur during this period.

One of the characteristic anatomical and physiological features of the neonatal period is 4-5 urination on the first day and more frequent urination by the end of the first week of life. What is the urine of a newborn in the early neonatal period? In the early days, the baby excretes protein in the urine. In the lumen of the urinary tubules, uric acid may be deposited (uric acid infarction); in such cases, the urine is more brightly colored, has a yellowish-brown color, brown spots remain on the diapers with a sediment in the form of sand. By the end of the first week, these changes disappear spontaneously.

Anatomical and physiological features and signs of premature newborns

Premature babies are those born before the 40th week of pregnancy (between 28-3 of the 7th week of pregnancy), with a body weight of 1000 to 2500 g and a height of 35-40 cm. An exception may be full-term children from multiple pregnancies, they are in Normally, they have a mass of up to 2500 g. In addition, full-term children from smoking and alcohol-abusing mothers, infants with malformations, have a low weight.

Children born with a weight below 2500 g and a height of less than 45 cm, regardless of the gestational age, are immature.

External signs of prematurity in premature newborns are manifested as follows:

  • the subcutaneous fat layer is absent or very poorly developed;
  • the whole body of the baby is covered with abundant fluff;
  • the bones of the skull are quite dense, but can overlap each other;
  • small fontanel is not closed;
  • auricles are soft, asymmetrical;
  • the size of the head exceeds the size of the chest;
  • nails are thin and usually reach the end of the nail bed;
  • the umbilical ring is located in the lower quadrant of the abdomen.

Anatomical and physiological features of premature newborns and functional signs of prematurity:

  • underdevelopment of the central nervous system and other organs and their functional immaturity;
  • imperfection of thermoregulation. This feature of premature newborns is the inability to maintain body temperature at a constant level;
  • imperfection of the act of breathing, fluctuations in its rhythm up to a stop and sudden death;
  • weak expression of sucking and swallowing reflexes;
  • underdevelopment of the vascular system, manifested in the fragility and thinness of the blood vessels, which contributes to the occurrence of cerebrovascular accidents and cerebral hemorrhages.

How to care for a newborn baby: morning toilet algorithm

The morning toilet of a newborn baby and the subsequent daily care of the baby is a necessary condition for the quick adaptation of the baby to new conditions.

The newborn toilet algorithm is as follows:

  • face washing;
  • washing the eyes with a solution of furacilin;
  • treatment of the umbilical residue with 70% alcohol, followed by its cauterization with a 5% solution of potassium permanganate. After the umbilical cord falls off, the umbilical wound is treated with a 3% solution of hydrogen peroxide, and then with 70% alcohol and a 5% solution of potassium permanganate;
  • according to indications, treatment of nasal passages and auditory canals (with flagella moistened with sterile vaseline);
  • in the presence of thrush, the toilet of a newborn child necessarily includes the treatment of the oral mucosa with a 20% solution of borax in glycerin.

And how to care for a newborn after the umbilical wound has healed? At this time, the baby is allowed to bathe. Bathing water is taken warm - its temperature should be 36.5-37.5 ° C, a child under 1 year old can stay in the bath for no more than 5-10 minutes.

A newborn baby, quickly unwrapped, is immersed in water, supporting the head and back with one hand, the lower part of the body with the other. They wash the child, putting his head on his arm, slightly bent at the elbow joint, supporting him by the armpit with the palm of his hand. First, the head is lathered, then the neck, chest, back and, last but not least, the legs and arms. When caring for a newborn baby, remember not to wash your baby's face with bath water.

Children, when they can sit and stand confidently on their own, are washed while sitting.

How to do air and sun baths for a newborn

Not a single person, and infants in particular, can do without fresh air and sunlight. Walking with the baby begins the next day after discharge from the hospital, if the air temperature is not lower than -5 ° C, starting from 15-20 minutes 2 times a day. By the age of one month, the duration of the walk is adjusted to 45-60 minutes, or they walk with the baby 2 times a day for 30 minutes. Children 3-6 months old need a longer stay in the fresh air - up to 4-6 hours, divided into 2 walks, and the baby is able to calmly endure the ambient temperature down to -12 ° C. By one year, the child should walk 6-10 hours a day.

The needs of newborns and air baths: in the cold season they are carried out in a well-ventilated room with an air temperature of + 18 ... + 20 ᵒС, in warm times - with open windows or in the fresh air. The baby is unfolded and left to lie down undressed for 1-3 minutes, gradually increasing the bath time to 15-20 minutes. At this point, the baby can be massaged or do gymnastics with him. And how to make air baths for newborns of the second half of the year of life? Such babies need to carry out air baths 2 times a day for 15 minutes.

In the first days after birth, sunbathing is not recommended for newborns, only starting from the age of 3-4 months of the child (if there are no contraindications) can you take out “sunbathe” in the shade for 2-10 minutes, provided that the ambient temperature is not lower than 23 °C. By the age of one year, the duration of sunbathing can be gradually increased to 20 minutes. By the way, an excellent way of hardening is pouring water on a child after a sunbath: at 3-6 months with a temperature of 35-36 ᵒС, at 6-12 months - 19-20 °С. But such procedures should be carried out with great care: the appearance of "goosebumps" and even more so - trembling is unacceptable.

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Leather the newborn is smooth, velvety, elastic, pale pink. The stratum corneum is thin; the epidermis is juicy, loose.

sweat glands - formed by birth, but the excretory ducts are underdeveloped, closed by epithelial cells, therefore, up to 1 month of sweating is not observed.

Sebaceous glands - begin to function in utero; their secret with the cells of the epidermis forms a “curdled lubricant”, which facilitates passage through the birth canal. On the face, they can degenerate into cysts, forming white-yellow formations - milia.

Hair - are distinguished by the absence of a core in them, therefore they are light - “cannon” (lanugo). They are located on the shoulders, back, on the head of the newborn; different lengths and colors and do not determine the further splendor of the hairline.

Subcutaneous fat - begins to develop on the 5th month of intrauterine life. In a full-term newborn, the fat layer is well developed on the cheeks, thighs, shins, forearms and weakly on the abdomen.

umbilical wound - remains after the fall of the umbilical residue on the 3-4th day. Heals by 7-10 days of life, epithelializes by 3-4 weeks. It is the main entrance gate of infection and requires careful care.

Musculoskeletal system.

Scull . The sutures of the skull are wide, not completely closed. At the junction of the bones there are fontanelles covered with a connective tissue membrane. Between the frontal and parietal bones, at the junction of the coronal and sagittal sutures, there is a rhomboid large fontanel . Its size (the distance between the sides) is from 3 to 1.5-2 cm. By birth, all children are open. Small spring located between the parietal and occipital bone, open in premature babies and 15% full-term. Closes no later than 4-8 weeks after birth. The sagittal, coronal, and occipital sutures are open and begin to close at 3–4 months of age.

The function of the fontanel is to help adapt the fetal head to the size and shape of the mother's birth canal, by changing it (by overlapping bones one on top of the other), thereby protecting the child's brain from injury.

Spine the newborn has no physiological curves.

muscles Up to 3-4 months, physiological hypertonicity of the flexor muscles is characteristic, therefore, a flexion posture (embryonic posture) occurs: the head is slightly brought to the chest, the arms are bent at the elbow joints and pressed against the lateral surface of the chest, the hands are clenched into fists, the legs are bent at the knees and hip joints.

Movements are chaotic, not coordinated. As a child grows, large muscles develop faster than small ones.

Respiratory system - imperfect.

nasal passages narrow, the lower nasal passage is absent, which leads to a rapid disruption of nasal breathing even with minor inflammation. Breathing through the mouth in a newborn is impossible due to the fact that a large tongue pushes the epiglottis backwards.


The paranasal sinuses are poorly developed or absent, so there are practically no sinusitis in newborns. Pharynx narrow and small. The lymphopharyngeal ring is poorly developed. But the auditory (Eustachian) tube that connects it to the middle ear is short and wide, which contributes to the frequent development of complications such as otitis media. Larynx wide, short, funnel-shaped with a distinct narrowing in the region of the subglottic space. The vocal cords above the larynx are short, the glottis between them is narrow. These features contribute to the rapid development of laryngeal stenosis in laryngitis. Trachea narrow, the cartilage is soft, pliable, can subside and cause the so-called - "congenital stridor" - rough snoring breathing and expiratory dyspnea. Bronchi formed, cartilage soft, prone to subsidence. The right bronchus is a continuation of the trachea, shorter and wider than the left, so foreign bodies often get here. Lungs rich in loose connective tissue, low-elastic, low-air, rich in blood vessels, therefore prone to the development of edema, atelectasis (collapse of the alveoli) and emphysema (overstretching of the alveoli).

A newborn is characterized by a diaphragmatic type of breathing: shallow, frequent, arrhythmic. Respiratory rate 40-60 per minute; the ratio of respiratory rate and pulse (RR: HR) \u003d 1: 2.5-3-3.5.

Anatomical and physiological features of the newborn. The neonatal period lasts 4 weeks, of which the first 7 days after birth belong to the early neonatal period. Of particular importance is the transition from intrauterine to extrauterine life, when the placental oxygen supply changes to pulmonary - the first breath. In the process of adaptation to the external environment and pulmonary respiration, blood circulation changes, the arantia (venous) and arterial (botall) ducts close, as well as the oval opening, and the remnants of the umbilical vessels reverse development. From the first hours after birth, the basal metabolism changes, thermoregulation improves, urine begins to be excreted.

A born child may have features of full-term, prematurity and postmaturity.

Children born with a body weight of up to 2500 g are considered premature, up to 1500 g - to those born with a low birth weight, up to 1000 g - to those born with an extremely low birth weight. The baby may match the gestational age in length, but significantly lag behind in mass, indicating malnutrition.

Prematurity is determined to a large extent, but not absolutely, by the gestational age (38-40 weeks). However, a baby may correspond to a full-term one at earlier (37 weeks) and later (41 weeks) of gestation, and a baby born at 38-40 weeks may be immature.

Currently, there is an acceleration of the physical development of children, starting from the neonatal period. The body weight of full-term newborns ranges from 2500 to 4000 g. In 10% of newborns, the body weight at birth is 4000 g or more. The growth coefficient (the ratio of body weight to its length) in full-term newborns is 60.

Features of a full-term baby. The skin is pink, delicate, elastic, with remnants of vellus hair (lanugo) on the back and shoulder girdle. The nails reach to the tips of the fingers. There are small whitish elevations on the mucous membrane of the lips. Along the gums, the mucous membrane forms a fold.

Immediately after the birth of the child, the arms are bent at the elbow joints, the legs are at the hips and pressed to the stomach. The bones of the skull are of moderate density, a large fontanelle is preserved between the frontal and parietal bones. The small fontanel is often closed, but is well palpated between the occipital and parietal bones. Sometimes a local edema is noted on the head - a generic tumor that disappears after 1-2 days.

In newborns, a large fontanel in the form of a rhombus is well palpated, located at the junction of the parietal and frontal bones (its dimensions are 1.5-2.532-3 cm), and a small fontanel, which has the shape of a triangle, located at the convergence of the parietal and occipital bones. The chest is barrel-shaped. The ribs are made up primarily of cartilage.

In the breathing of newborns, the diaphragm mainly takes part. Superficial breathing - 40-60 respiratory movements per minute.

Heart rate at rest does not differ from that in the prenatal period and is 120-140 per minute. BP is 55-70/30-40 mm Hg. Art.

When pressing on the tummy, meconium is released from the rectum, sometimes immediately after birth. Meconium leaves before the end of the 1st day. Up to 3 days the child's stool is yellow, odorless, viscous. After colonization of the intestine with bacterial microflora, the feces acquire a yellow color and become mushy. The abdomen is soft on palpation, the edge of the liver protrudes 2 cm from under the edge of the costal arch. The cardiac sphincter of the stomach is underdeveloped, which contributes to regurgitation. The functional capacity of the stomach at birth is about 10 ml, by the end of the 1st month it increases to 90-100 ml. Intestinal peristalsis is slowed down. Flatulence is often noted. By the time of birth, the urinary organs are formed. In boys, the testicles, as a rule, are lowered into the scrotum, in girls, the large labia cover the small ones.

Some excitement immediately after birth in most newborns is replaced by sleep, which lasts intermittently up to 24 hours. The state of the central nervous system can be assessed by physiological reflexes.

1. Search reflex. Stroking in the area of ​​the mouth of the newborn causes the lip to lower and the head to turn towards the stimulus.

2. Sucking reflex.

3. Babkin's reflex(palmar-oral). When pressing on the palm of the newborn, he opens his mouth.

4. Grasping reflex. In response to stroke stimulation of the palm of the newborn, flexion of the fingers and grasping of the object occur.

5. Support reflex. The newborn attached to the support unbends his legs and firmly rests on the surface of the table with his entire foot.

Other reflexes are also known (automatic gait, Galant, Moreau, Perez, Babinsky).

During the first days of life, the newborn adapts to the external environment, and certain changes occur in his body, which gradually disappear.

Within a few hours or several days, fetal communications are closed (botallian duct, foramen ovale). During this period, cyanosis of the extremities is sometimes observed.

In the first three days, oliguria may be observed.

All newborns experience a loss of body weight (up to 3-8%), maximum on the 3rd-4th day, and then the body weight gradually increases. Body temperature is unstable (hypo or some hyperthermia).

In 60-70% of children, transient (physiological) jaundice appears on the 2nd-3rd day of life, which reaches a maximum on the 3rd-4th day, and disappears by the end of the 1st week of life. The appearance of jaundice is associated with the destruction of excess red blood cells, which is characteristic of the prenatal period.

As a result of the mother's sex hormones entering the child's bloodstream, engorgement of the mammary glands is possible (begins on the 3-4th day of life, reaches a maximum on the 7-8th day); milia (whitish-yellow nodules rising above the level of the skin, on the wings of the nose, bridge of the nose, in the forehead, chin); desquamative vulvovaginitis in girls (abundant grayish-white mucous discharge); bleeding from the vagina, on the 5th-8th day of life in 5-10% of girls and hydrocele in boys (accumulation of fluid between the membranes of the testicles), which disappears without treatment on the 2nd-3rd day of life.