I .The main problems of the patient against the background of asphyxia

P/ P

Real

Potential

Priority

Breathing rhythm disturbance

Single breaths;

Apnea;

Difficulty breathing;

Rare

superficial

breath

Breathing rhythm disturbance

Heartbeat disturbance

Lack of pulse;

Bradycardia;

Tachycardia;

Arrhythmia

Change

muscle tone

Muscle atony;

Decreased muscle tone;

Tremor of the chin, limbs;

Convulsions

Change in color of the skin and mucous membranes

Pale skin;

Cyanosis;

Acrocyanosis;

Earthy skin tone;

- “marbling”

II

priority problem “Respiratory rhythm disturbances”

The rhythm will be restored if:

Carry out resuscitation measures for asphyxia according to the action algorithm;

Create maximum peace;

Carry out the prescribed manipulations sparingly;

Warm the newborn;

Provide constant oxygen supply;

Carry out a thorough toileting of the skin, mucous membranes and umbilical wound in compliance with asepsis and antiseptics;

Monitor body weight;

Carry out regular nutrition calculations;

Feed the child in a gentle way (as prescribed by the doctor);

Increase the frequency of feeding to 7-10 times a day;

Calculate pulse, respiratory rate, evaluate their characteristics;

Have a conversation with your mother and relatives about the disease and tactics in the post-asphyxial period.

I . The main problems of the patient in acute

period of intracranial birth injury

P/ P

Real

Potential

Priority

Hypo- and adynamia

Muscular hypotonia;

Suppression or absence of physiological reflexes;

Coma

Motor restlessness

Motor restlessness

Increased muscle tone;

Tremor of hands and chin;

Convulsive readiness, convulsions;

Stiff neck

Regurgitation

Vomit;

Anorexia;

Aspiration

II . Nursing Intervention Plan

priority problem “Motor restlessness”

Motor restlessness will decrease if:

Inform your doctor and follow his instructions;

Provide the child with complete rest (daily toilet and necessary manipulations should be carried out in the crib where he lies);

Create a position for the child in bed with the head end elevated;

Provide skin care, mucous membranes, change linen;

Apply cold to the head;

Monitor your general condition, measure pulse, respiratory rate,tbodies;

Early and long-term use of oxygen;

Feed the child (depending on the severity of the condition) in the first days through a tube, then from a bottle, and only when the general condition improves can one begin to put it to the breast under the control of m/s;

Provide comfortable conditions in the ward, incubator;

Extend deep sleep time;

Limit painful manipulations to a minimum;

It is better to administer medications through a tube during feeding or give orally from a spoon;

Administer phenobarbital, bromides, diphenhydramine as prescribed by a doctor;

During an attack of convulsions, administer intramuscularly 25% magnesium sulfate solution, droperidol solution, GHB;

Inform relatives about the disease and its consequences.

I . Main patient problems

against the background of HDN

P/ P

Real

Potential

Priority

Increased muscle tone

Neck stiffness;

Hands clenched into fists;

Tension of the large fontanel;

Convulsions

Increased muscle tone, cramps

Edema

Accumulation of transudate in cavities;

Anasarca (skin swelling);

Violation of a comfortable state

Lethargy

Drowsiness;

Suppression of reflexes;

Refusal to eat

II . Nursing Intervention Plan

priority problem “Seizures”

Convulsions in a child are stopped if:

Inform your doctor and follow his instructions;

Restore breathing (suck out mucus from the mouth and nose);

Place the child on a flat surface (protect from mechanical injuries);

Free the child from restrictive clothing;

Provide a flow of fresh air;

Make sure that the child does not bite his tongue; to do this, place a spatula or the handle of a spoon, wrapped in a thick layer of bandage, between the molars, or place a knot of a napkin (handkerchief);

- as prescribed by a doctor, administer anticonvulsants intravenously or intramuscularly:

Seduxen, or

Droperidol, or

25% solution of magnesium sulfate, or

GHB;

Feed carefully, in small portions (after the cramps end);

Provide the child with breast milk or fermented milk formulas;

Create a protective regime for the child;

Create comfortable conditions (fresh air, ventilation, wet cleaning);

Monitor pulse rate, respiratory rate, measure blood pressure;

Maintain physical and mental peace;

Provide skin care, mucous membranes, change of underwear and bed linen;

Drink frequently, in small doses.

I

localized purulent infection

P/ P

Real

Potential

Priority

Promotiontbodies up to 38C

Poor appetite, breast refusal;

Weakness, lethargy;

Poor sleep;

Irritability;

Tearfulness

Decreased appetite

Poor weight gain;

Regurgitation, vomiting;

Breast refusal

The presence of a purulent focus on the skin and mucous membranes

Violation of the integrity of the skin and mucous membranes (erosions, ulcers, weeping, necrosis);

Infiltration;

Infection of healthy skin areas;

Transition of local inflammatory process into generalized infection

II . Nursing Intervention Plan

priority problem “The presence of a purulent focus on the skin and mucous membranes”

A localized purulent lesion will decrease if:

Inform your doctor and follow his instructions;

Isolate the patient and his mother from healthy children, in a separate box, and examine;

Allocate special personnel to service them;

Provide individual care using gloves, masks, separate gowns, and safety glasses;

Provide the patient with physical and mental rest, protective regime;

Maintain sanitary and hygienic conditions in the ward;

Use personal care items, medical equipment, instruments, and disinfect them;

- influence the etiological factor, prevent further spread of infection:

Carry out external treatment from the first days;

Treat the surrounding apparently healthy skin with disinfectant. solutions;

Use external antibacterial agents, administer antibiotics as prescribed by a doctor;

Treat pyogenic elements and erosions with a 1% solution of aniline dyes (diamond green, methylene blue) or disinfectant ointments;

Treat healthy areas of the skin with alcohol and irradiate them with ultraviolet radiation;

Give newborns and infants baths with a weak solution of potassium permanganate;

- increase the body's defenses:

Prescribe a nutritious diet with limited carbohydrates, increased protein, and vitamins;

Prescribe immunotherapy drugs;

Prohibit older children from washing in baths or saunas;

Cut your hair and nails short;

Use sterile diapers and linen, soak them in a chloramine solution, and deliver them to the laundry separately;

Conduct regular examinations of service personnel;

Do not allow employees with purulent diseases of the skin and mucous membranes to work;

Ensure comfortable conditions in the room (ventilation, fresh air, wet cleaning);

Conduct a conversation with parents and relatives about behavioral tactics and elements of care.

I . The main problems of the patient in the background

sepsis

P/ P

Real

Potential

Priority

The presence of a purulent focus (usually in the area of ​​the umbilical wound)

Promotiontbodies;

Decreased appetite;

Generalization of the infectious process

The presence of a purulent focus - omphalitis

Weight loss

Emaciation;

Weakness, lethargy;

Exhaustion;

Decline motor activity

Promotiontbodies up to 39C

Refusal to eat;

Weakness, lethargy;

Restless sleep;

Irritability;

Tearfulness

Regurgitation

Vomit

Loose stools;

Dehydration;

Breast refusal;

Weight loss;

Dry skin and mucous membranes

II . Nursing Intervention Plan

priority problem “Presence of a purulent focus - omphalitis”

The symptoms of omphalitis will decrease if:

Inform your doctor and follow his instructions;

Isolate the child in a box, open incubator;

Highlight individual care items;

Provide the child with rational feeding with mother's milk (feed from a bottle or apply to the breast);

Ventilate the box frequently;

Irradiate the box daily with a bactericidal lamp and thoroughly disinfect it;

- toilet the umbilical wound several times a day (2-3 times):

Stretch the edges of the wound;

Rinse with 3% hydrogen peroxide solution and dry;

Treat the wound with a 1% solution of brilliant green;

Leave the umbilical wound open so as not to injure it with diapers or clothes;

Swaddle the baby separately: the upper half of the belly with arms, and the lower half with legs;

Inform mother and close relatives about the disease and possible complications;

Provide the child with individual care items, sterile diapers, linen;

I . The main problems of the patient in the background

malnutrition

P/ P

Real

Potential

Priority

Lack or decreased appetite

Impaired motor activity;

Weakness, lethargy;

Emaciation, weight loss

Regurgitation, vomiting

Poor weight gain

Emaciation;

Retarded physical development;

Exhaustion

Unstable chair

Stomach ache;

Maceration of the skin around the anus;

Anxiety, flatulence

Regurgitation, vomiting

Violation of a comfortable state;

Dehydration;

Weight loss

II . Nursing Intervention Plan

priority problem “Spitting up, vomiting”

Urging frequencyvomiting will decrease and stop if:

Tell your doctor;

Raise the head of the child's bed;

Turn the child's head to the side, provide a tray, basin;

Rinse the child’s stomach as prescribed by the doctor;

Rinse the child's mouth and give him a small amount of boiled water to drink;

Give a drink (as prescribed by a doctor) a solution of novocaine 0.25% in an age-appropriate dosage:

up to 3 years – 1 teaspoon;

from 3 to 7 years – 1 day. spoon4

over 7 years – 1 tbsp. spoon.

Do not feed the child if there is repeated vomiting;

Provide the child with fractional drinks (as prescribed by the doctor): a solution of glucosalan, rehydron, smecta, 5% glucose solution, saline, sweet tea, boiled water (at the rate of 100-150 ml per 1 kg of weight per day);

Administer antiemetic drugs (as prescribed by a doctor);

Provide the child with skin care, mucous membranes, a change of linen, weigh the child daily;

Create comfortable conditions for the child:tplus 24-27C, room ventilation – 3 times a day for 20 minutes; wet cleaning - 2 times a day with disinfectant. means; disinfection of vomit;

Provide physical, psychological peace, psychological support (screen, separate room, box);

Observe and record the frequency, quantity, nature, color of vomit and stool, inform the doctor;

Calculate pulse, respiratory rate;

Conduct a conversation with the mother about the prevention of aspiration of vomit, about the elements of care;

Follow doctor's orders.

I . The main problems of the patient in the background

exudative-catarrhal diathesis

P/ P

Real

Potential

Priority

Itchy skin

Attachment of a secondary infection;

Poor sleep;

Anxiety;

Irritability;

Tearfulness;

Skin scratches, scratches

Itchy skin

Hyperemia of the skin in the area of ​​the cheeks and natural folds

Itchy skin;

Wetting of the skin;

Violation of skin integrity;

Poor sleep;

Peeling skin

Gneiss on eyebrows and scalp

Anxiety;

Poor sleep;

Itchy skin;

Dry and weeping eczema

II . Nursing Intervention Plan

priority problem “Itchy skin”

Itching of the skin will decrease if:

Inform your doctor and follow his instructions;

Inform the mother and relatives of the child about the disease, possible progression of the disease and consequences;

Teach mom how to keep a “food diary”;

Ensure strict adherence to the cleanliness of the child’s skin and mucous membranes;

Train mother and close relatives to treat the skin, cheeks, natural folds, and scalp;

Organize a protective regime for the child;

Support tair in the room where the child is located is within +20-22C;

Carry out daily wet cleaning of the premises and ventilation;

Use underwear and bedding for the child made from cotton fabrics;

Wash clothes with baby soap;

Put cloth mittens on the child’s hands or place cardboard splints on the elbows (to prevent scratching);

Exclude from the diet foods that cause an exacerbation of the child’s disease;

Use fermented milk mixtures and Biolact kefir in the first year of life;

Limit salt and liquid in your diet;

Maintain a careful daily routine, ensure long stays fresh air, promote improvement and duration of sleep;

Carry out hardening procedures carefully;

Use ointments, mash, medicinal baths, sedatives (as prescribed by a doctor);

Prevent intercurrent (additional) diseases and exclude contact with animals.

Dispensary observation.

Prevention.

Forecast.

In recent years, due to the emergence of new technologies for caring for premature babies, their mortality rates have decreased.

Children with I – II degrees of prematurity have a favorable prognosis. With a birth weight below 1500g, the prognosis is less favorable. These children have a higher mortality rate from secondary infections; pathologies of the visual organs (myopia, astigmatism, strabismus - 25%) and hearing organs (hearing loss - 4%) are more common. They are often diagnosed with neurological changes of varying severity (vegetative-vascular disorders, convulsive, hypertensive-hydrocephalic syndromes, cerebral palsy). The formation of persistent psychopathological syndromes is possible.

· Protecting the health of the expectant mother, starting from early childhood.

· Timely sanitation of chronic foci of infection of a girl - an expectant mother.

· Planning pregnancy.

· Creating favorable conditions for pregnancy.

· Regular monitoring of the pregnant woman in the antenatal clinic, timely detection and treatment of diseases and toxicoses.

· Refusal of a pregnant woman from bad habits.

· If there is a threat of miscarriage, mandatory hospital treatment pregnant woman.

A premature baby must be registered at a dispensary in health group II (risk group) for 2 years. Once every 3 months, and more often if indicated, the child is examined by a neurologist, ophthalmologist, and once every 6 months by an otolaryngologist. At the age of 1 and 3 months - an orthopedist. In the second and third years, consultations with a child psychiatrist, speech therapist, endocrinologist, and gastroenterologist are necessary.

Possible problems for parents:

• Stress and worries in connection with premature birth.
• Worry and concern for the child.
• Feeling helpless.
• Lack of knowledge and skills in child care.
• High risk of developing hypogalactia.
• Lack of breast milk from the mother.
• Lack of family support.
• The search for those responsible for the premature birth of a child.
• Situational crisis in the family.

Nursing interventions:

1. Give recommendations to a nursing mother on daily routine and nutrition:

• To maintain lactation, a nursing woman must adhere to a correct daily routine, which includes adequate sleep, exposure to fresh air, balanced nutrition, psycho-emotional comfort in the family, and moderate physical activity.
• Complete nutrition for a lactating woman can be provided with a daily set of products: 150-200g of meat or fish, 50g of butter, 20-30g of cheese, one egg, 0.5 liters of milk, 800g of vegetables and fruits, 300-500g of bread. In addition, the diet should include fermented milk products, juices, various cereals, and nuts. Eliminate garlic, onions, hot seasonings (they worsen the taste of milk), strong coffee, and alcoholic drinks from your diet.
• The amount of liquid consumed should not exceed 2.5 liters per day (with 0.5-1 liters for milk and fermented milk products).

Recommend that the mother stop taking medications if possible.

Give recommendations for feeding premature baby:

· If breast milk is available, use a free feeding mode, convince the mother of the need to put the baby to the breast frequently, because this stimulates lactation and develops the sucking reflex in the baby.

· The duration of feeding should not be limited; it can fluctuate at different times of the day.

· The baby needs night feeding until he can suck the volume of milk he needs during the day.

· After the establishment of lactation and active sucking, with positive dynamics of body weight gain, the child can be transferred to a 6-time feeding regimen.

· If there is a lack of breast milk, use a mixed feeding regimen. Supplementary feeding is carried out with specialized adapted formulas for premature babies during the first 2-3 months, then they switch to feeding with adapted formulas for children in the first half of the year, and after 6 months - on formulas for children in the second half of the year. It is necessary to explain to the mother that supplementary feeding is introduced after breastfeeding, given using a spoon or from a horn, the nipple should be soft, imitate the shape breast nipple, have an opening adequate to the child’s sucking efforts.

· In the absence of breast milk, use an artificial feeding regimen - feeding 6 times a day with formula recommended by a doctor.

· With mixed and artificial feeding, it is necessary to teach parents the technology of preparing and storing formula and the rules of feeding. If individual tolerance is good, it is advisable to use formulas from the same manufacturer, which reduces the risk of developing food allergies and increases the efficiency of feeding.

· Juices and complementary foods are introduced from 4 months. All types of complementary foods are introduced carefully, using the training method, starting with drops and bringing to the desired volume over 8-10 days.

· It is necessary to monitor the child’s absorption of food (regurgitation, bloating, change in stool character).

1. It is necessary to train parents on the features of caring for a premature baby:

· The temperature of the room where the child is located must first be maintained within 24-26 o C, and gradually reduced to 22-20 o C.

· Train parents in the technique of performing a hygienic bath (room temperature not lower than 25 o C, water temperature 38-38.5 o C, then the water temperature is gradually reduced to 37-36 o C, and from the second half of the year - to 34-32 o C ), Hygienic baths are carried out daily, at first their duration is 5-7 minutes, gradually it increases.

· For irritated skin, teach parents how to conduct medicinal baths with infusions of string, sage, chamomile, and St. John's wort.

· Clothing for a premature baby should be made of soft, thin natural hygroscopic fabrics, without rough seams, scars, or buttons. Clothing should be multi-layered, and swaddling should be loose.

· Placement on the stomach must be carried out from the first day of the child’s stay at home. It is recommended to place it on a hard surface 3-4 times a day before feeding.

· Training methods of hardening (lowering water temperature, contrast dousing after bathing, air baths) begin to be used depending on the degree of maturity, individual characteristics and health status of the child. Air baths begin from 1.5-3 months for 1-3 minutes 3-4 times a day, gradually increasing the time to 10-15 minutes in combination with a stroking massage. From 4 months you can introduce other hardening elements.

· Stroking massage begins from 1-1.5 months, from 2-3 months other massage techniques are gradually introduced - rubbing, kneading, passive hand movements. To improve psychomotor development, hand massage and gymnastics are performed daily, and from 8-9 months, to stimulate the development of speech centers and coordination of small movements, the child is offered games with small objects. It is necessary to train parents in performing all massage techniques and playing games.

1. Train parents in the technology of psycho-emotional communication with their child:

· In the early stages, nursing a premature baby directly on the mother’s chest (“kangaroo method”), only for a short time the baby is placed in a crib.

· Subsequently, it is necessary to convince the mother to pick up the child more often, touch him using the language of bodily communication, constantly communicate and talk to him in a gentle voice, quietly sing songs to him

1. Help parents realistically assess the child’s physical and mental development, accept him as he is, see his achievements and prospects.
2. Advise parents to maintain an atmosphere of emotional comfort in the family, avoid tension in a timely manner, avoid violent manifestations of emotions, actively interact with each other, pay as much attention to the child as possible, select toys and games according to age, and constantly engage with him.
3. To acquaint parents with the features of the physical and neuropsychic development of a premature baby:

· Large loss of initial body weight (9-14%).

· Low weight gain in the first month of life. Subsequent monthly weight gain up to one year on average should be greater than in full-term infants.

· The monthly increase in height in premature babies is greater than in full-term babies (on average it is 2.5-3 cm).

· Head circumference in the first 2 months is 3-4 cm greater than chest circumference; by the end of the 1st year of life, head circumference is 43-46 cm, chest circumference is 41-46 cm.

· Teething begins later than in full-term babies (on average at 8-10 months).

· The appearance of psychomotor skills in the first year of life may be delayed (visual and auditory concentration, purposeful hand movements, the ability to sit, stand, walk, speak), especially in children with a birth weight of 1000 to 1500 g (for 2-3 months), from 1500 to 2000g (for 1.5 months).

· Most children with a birth weight of 2500 g catch up with their full-term peers by one year, and very premature children are compared with them by 2-3 years.

Control questions:

1. What risk factors for having a premature baby do you know?

2. What determines the degree of maturity of a premature baby?

3. List the degrees of prematurity and their main criteria.

4. What morphological signs of a premature baby do you know?

5. What are the manifestations of immaturity of functional systems in a premature baby?

6. What are the principles of feeding premature babies?

7. What is the purpose of the first stage of nursing premature babies and where is it carried out?

8. What is the purpose of the second stage of nursing and where is it carried out?

9. What are the requirements for the microclimate when nursing premature babies at the second stage?

10. What are the principles of drug therapy for a premature baby?

11. What are the criteria for discharging a premature baby home?

12. What is the individual rehabilitation program and dispensary observation for a premature baby?

13. What is the prevention of premature birth of children?

14. What is the prognosis for a premature birth?

15. What are the features of the physical and neuropsychic development of premature babies?

Information sources:

· Textbook by Svyatkina K.A., pp. 25-27.

· Textbook of Ezhova N.V., pp. 148-160.

· Textbook by Sevostyanova N.G., pp. 171-191.

Basic lecture notes

The successful adaptation of the child to extrauterine life depends on the correctness of their implementation. We'll tell you how to care for newborns in conditions medical institution and after discharge from the maternity ward.

Nursing care for a healthy newborn is a complex medical events, which help the child adapt from intrauterine to extrauterine conditions of existence.

Nursing care for a healthy newborn

The neonatal period begins from the moment the birth process is completed, from the baby’s first breath until the end of the period of adaptation to life. Typically this period lasts 28 days.

Nursing care for newborns is provided by trained staff. The care nurse should be aware of the following issues related to this period:

1. Features of the structure of the child’s basic systems and organs, which help him adapt to living conditions.
2. Features of diagnosing the level of vision and hearing of a child, his psychomotor development.
3. Features of the development of a newborn, its assessment, types of physical abnormalities that can be detected in newborns in the first month of life.
4. Principles and technique breastfeeding, its importance for the normal development of the child and the formation of body systems. Ways to replace breastfeeding if it is not possible. Child nutritional disorders.
5. Nursing care for a healthy newborn includes assessing the condition of its skin and mucous membranes. The nurse should also be aware of the functions of the skin and how to care for it.
6. Features of the development of the child’s gastrointestinal tract in the first month of life, possible deviations and principles of care.

Newborn skin care

Child skin hygiene is necessary not only to keep the child’s skin clean - proper care allows you to avoid the development of infections that are dangerous for a fragile body.

The nurse should know what factors influence the condition of the child’s skin and mucous membranes:

• frequent use of diapers and diapers, under which a warm and humid environment occurs. This leads to water and acid imbalance, irritation, and increases bacterial activity;
• strong friction between clothing or diapers and the skin, which increases when the skin is wet;
• frequent rubbing of the skin;
• insufficient air flow to the baby’s skin;
• skin disorders due to exposure to feces, urine and fluids.

In order for your child to have healthy and clean skin, you must adhere to the following rules:

1. Avoid contact of the child's skin with feces and urine.
2. Prevent the effects of mechanical and physical factors on the skin (moisture, friction, exposure to sunlight).
3. Avoid products that can irritate the skin and make it sensitive.
4. Provide opportunities for breastfeeding.
5. Provide air flow to the buttocks.

Thus, nursing care for newborns includes a daily examination of the child’s buttocks and armpits. The nurse pays special attention to areas prone to pustules and diaper rash.

If irritation, dryness or redness occurs, the affected areas are lubricated with sterile vegetable oil (sunflower, Vaseline and special baby oil).

When choosing skin care products, you should choose those that contain a minimum amount of fragrances and fragrances. Otherwise, they can cause dermatitis and allergies.

Look at the technique for collecting venous blood, the sequence of filling tubes for laboratory research in the Chief Nurse System. Download a complete algorithm for taking blood from a vein from a newborn.

Hygiene rules when bathing a newborn

Nursing care for a healthy newborn includes regular bathing. If there are no pathologies, it is recommended to start bathing the child immediately after discharge.

Therefore, the nurse should explain to the mother how to organize a safe bathing procedure:

• For swimming, the water temperature is 37 °C and the air temperature is about 20-24 °C;
• in the first days, until the wound in the navel heals, it is recommended to select the water temperature no more than 37-37.5 ° C;
• before starting the procedure, you need to prepare a heated towel or other things in which to wrap the child;
• It is recommended that a nurse or a second adult help bathe a child in the first days of life.

The bathing technique itself consists of several stages:

• holding the child tightly by the hands and slowly lowering him into the water under the buttocks;
• the baby's head is placed on the mother's bent arm;
• bathing occurs according to the “top to bottom” principle;
• wash the child’s hair last;
• for boys, the genitals are washed first, and then the anus;
• Intense friction should be avoided, because possible skin damage;
• The natural folds of the skin are carefully washed.

Finally, rinse in clean warm water. To easily harden a child, the water temperature can be 36 °C.

The entire procedure takes no more than 10-15 minutes, and the nurse or mother should focus on the child’s condition and his reaction to the procedure.

Treatment of the umbilical wound

When providing nursing care for a healthy newborn, special attention must be paid to the umbilical wound.

In a healthy child it has the following symptoms:

• the edges of the wound are closed, the wound itself is visually reduced;
• Normally, serous discharge and ichor are acceptable, which require careful cleaning of the wound;
• Normally, the edges of the wound do not differ in color from the rest of the skin.

The umbilical wound should be treated no more than once a day for 10 days. For this purpose, such agents as potassium permanganate 5%, brilliant green 1%, hydrogen peroxide 3% are used.

In this case, there is no need to try to tear off the “crust”, because... underneath it, the edges of the wound are actively healing.

Before treating the wound, the nurse washes her hands, then dips a cotton swab in a solution of hydrogen peroxide and soaks the wound.

A warning sign in this case is copious discharge with foam. In this case, the affected area is dried with a cotton swab and treated again with the solution.

When providing nursing care for a newborn, it is important to pay attention to pathological processes in the umbilical duct:

• presence of edema;
• edge hyperemia;
• gaping umbilical wound;
• purulent discharge when pressed.

If these signs are present, you should urgently call a doctor, because such processes can lead to the development of sepsis.

Using diapers in the first days of a child's life

Caring for the mucous membranes of a newborn

Nursing staff should know that the baby's mucous membranes can easily be injured by careless movements. If the appearance is normal, it does not require additional processing.

Normal breastfeeding can cause a whitish coating on the roof of your mouth and tongue.

A cheesy coating may indicate the presence of thrush. If the nurse removes it, a surface affected by fungal erosion appears.

Procedure for treating the oral area:

• hygiene of the hands of the nurse;
• a soft, clean cloth or sterile bandage is wrapped around the finger;
• the finger is dipped in a 2% solution of soda or a 20% solution of borax in glycerin;
• Next, the child’s mouth is carefully treated from the inside. In this case, there is no need to strive to remove plaque from the mucous membrane, but simply apply a medicinal agent to it;
• Afterwards, the nurse removes the cloth or bandage from his hand and washes his hands.

The same solutions should be used to treat the nipples of the newborn’s mother if the baby is breastfed.

Feeding bottles and nipples should be thoroughly boiled, and pacifiers should be changed after each feeding.

Caring for the mucous membrane of the eyes

If nursing care is provided for a healthy newborn, the eyes are treated once a day after a night's sleep.

To do this, each eye is wiped with a cotton swab dipped in water, which is passed over the upper and lower eyelids separately. For each eye you need to prepare a separate swab.

If there is eye discharge, the nurse should perform thorough cleaning. For this, use a chamomile solution or a tea solution. To avoid allergies, they can be replaced with 1% furatsilin solutions.

Treatment is carried out as needed, depending on the amount and appearance of the discharge.

Reminder for caring for the skin and mucous membranes of a child

Let us highlight several general rules that must be followed when treating the mucous membrane and skin of a child:

• before hygiene procedures, the nurse or mother of the child should wash their hands with soap and hot water;
• The nurse’s hands should be cut short and jewelry should be removed from them;
• To wash the face, just moisten a cotton swab with boiled water and wipe the child’s face with gentle movements;
• disposable diapers need to be changed when they become wet and dirty;
• During the newborn period, diapers are changed 6-10 times a day.

How to cut a newborn baby's nails

Nail treatment should be done after bathing the child.

To do this, you need to prepare clean tweezers or small scissors in advance.

Toenails should be trimmed evenly; fingernails should be rounded.

This will prevent ingrown nails and the formation of skin tags.

Avoid cutting your nails too short as this can cause pain to your baby and damage delicate skin.

To ensure that procedural nurses observe epidemiological safety, perform manipulations correctly and fill out documents, regulate their work using SOPs and algorithms.

Algorithm for washing a child

During the day, the child has to be washed several times; it is important to do this correctly in a medical facility or at home.

The algorithm of actions is as follows:

• adjust the water temperature and check it by hand;
• the child is positioned on the nurse’s left forearm with his back;
• the newborn is washed under running water no more than 37-38°C;
• After finishing washing, the baby’s skin is blotted with a soft diaper.

The procedure is mandatory after each bowel movement of the baby.

Nursing care for a healthy newborn: treatment of natural folds

When processing a child’s natural folds, the following procedure is followed:

1. Hand hygiene.
2. Squeeze a little baby cream or powder onto your hands and rub in your hands.
3. All folds of a newborn baby are processed in order from top to bottom: the area behind the ears and neck, then the armpit area, elbows, etc. to the groin area.
4. To avoid diaper rash, do not squeeze the cream or sprinkle powder directly onto the baby's body. First, the product is rubbed in the nurse’s hand.

Hygienic bath

When caring for a newborn baby, hygiene plays an important role. There are a number of rules for making a hygienic bath correctly.

1. The nurse washes the bathtub with soap and rinses it with boiling water.
2. A diaper folded several times is spread at the bottom of the bath.
3. A bath is being prepared: hot and cold water is poured alternately; the temperature of the bathing water should not exceed 36-37°C.
4. For washing, prepare a jug of water at a similar temperature.
5. When bathing the child, support the buttocks and hips with one hand, and the back and back of the head with the other hand.
6. Gradually, the child is immersed in the bath; the water level should reach the nipple line. The child's head is supported with one hand so that it is constantly above the water.
7. The newborn's head should be washed with baby soap. The whole body is washed with a flannel diaper or rag. Particular attention is paid to the areas between the buttocks, groin, and folds of the skin.
8. After finishing bathing, the child is turned over and doused with clean water from a jug.
9. After the bath, the baby is wrapped in a clean, warm towel and diaper.

Introduction

Chapter 1. Newborn period (neonatal)

1.1Characteristics of the neonatal period

2Activities with the child in the delivery room

3Primary toilet of a newborn baby

4Organization of the first feeding of a newborn baby

5Anthropometry of a newborn child

6Preparing documentation. Developmental history of the newborn

Chapter 2. Organization of care for a newborn child

2.1 Immunoprophylaxis of a newborn child

2 Assessment of the condition of a newborn child

3 Physiological conditions of a newborn child

4 Caring for the mucous membranes and skin of a newborn baby

5 Screening testing

Chapter 3. Study of the problems of newborn children at polyclinic No. 4 in Bataysk

Conclusion

Bibliography

Introduction

Neonatology is a branch of pediatrics that studies physiological characteristics and diseases of children in the first month of life. Development of neonatological care in modern stage characterized by the creation of highly specialized services for families, pregnant women, newborns, infants and children early age, united in perinatal centers. Stages medical care newborn children are provided with obstetric and pediatric services.

The staff of obstetric (sometimes also gynecological) departments is responsible for the life of both mother and child. In obstetrics and gynecology departments, the nurse must be ready to provide emergency obstetric and gynecological care to women, and in some cases, to newborns, until the doctor arrives. She also has to work in the pregnancy pathology department, and sometimes in the maternity ward, replacing a midwife.

The staff of obstetrics and gynecology departments must be proficient in the methods of psychological therapy, since in anticipation of childbirth it is necessary to instill in the woman confidence in her own abilities; it is necessary to take into account the psychological status of patients in order to avoid premature termination of pregnancy, eclampsia, exacerbation of extragenital pathology (hypertension, heart failure).

Medical care for newborns begins in the maternity ward. Examination of a newborn in the delivery room represents an important, so-called primary filter, on the basis of which most serious deviations from the norm are identified, in urgent cases indications for appropriate therapy are given, and the nature of further assistance is determined in the event of the child being transferred to the appropriate department. It should be taken into account that we provide medical care to children not only in the maternity ward, but also in the obstetric hospital. From how sanitary conditions will be observed - hygiene rules, obstetric assistance during childbirth, the primary toilet of a newborn, daily care of the baby, will depend on his health in the future. Therefore, professional medical care for a newborn in an obstetric hospital is very important.

The purpose of this course work is to study the activities of medical staff in the neonatal period and determine the importance of compliance with all norms and rules for caring for a newborn child for his future health.

Objectives: to expand and consolidate knowledge on the organization of medical care for newborns, on compliance with the sanitary and epidemiological regime in an obstetric hospital, to analyze theoretical sources on the research problem, to develop a leaflet on nursing care for newborn children.

Chapter 1. Newborn period (neonatal)

1.1Characteristics of the neonatal period

The newborn period (neonatal) is divided into early and late neonatal periods. It begins with the birth of the child and lasts 4 weeks.

The early neonatal period is from the moment of birth to the 7th day of life.

The body's basic adaptation to life in new conditions occurs. The speed of adaptive processes in the body during this period is the highest and never happens again in life. The respiratory system begins to function, the circulatory system is rebuilt, and digestion is activated.

All organs and systems are in a state of unstable balance, so the child needs especially careful care.

During this period, the child may have developmental defects, hemolytic disease, respiratory distress syndrome and other pathologies. In addition to pathologies, the newborn exhibits various physiological conditions that reflect adaptation processes. These include: physiological catarrh of the skin, physiological jaundice, sexual crisis. Due to the predominance of inhibition processes in the central nervous system, the newborn sleeps almost continuously. By the end of this period, all body systems reach a fairly stable equilibrium, gas exchange is established at the level of an adult, and body weight begins to gain. By the end of the first week of life, close contact between the newborn and the mother is established, especially if the child is breastfed. For most of this period, the child is in the maternity hospital.

Late neonatal period - from the 8th day to the 28th day of life. Characterized by further adaptation to the environment. At this time, the umbilical wound heals completely, body weight and body length rapidly increase, analyzers develop, and begin to form. conditioned reflexes and coordination of movements.

Gestational age or the true age of the newborn is considered the weeks of gestation from the first day of the last menstrual period. Depending on the gestational age, newborns are divided into:

full-term (38-42 weeks)

premature (less than 38 weeks)

post-term (more than 42 weeks).

Signs of full term:

cycle intrauterine development 38-42 weeks;

body weight not less than 2500 g;

body length not less than 45 cm;

have all the signs of maturity: maintains a constant body temperature, has pronounced swallowing and sucking reflexes, a stable and correct rhythm of breathing and heartbeat, and actively responds to external stimuli.

2 Activities with the child in the delivery room

The first task after removing the baby and separating him from the mother is to avoid unnecessary heat loss, especially in low birth weight babies and in newborns who require special care, such as resuscitation, prolonged examination, etc. The newborn should be placed under the source of radiant heat and its skin must be carefully dried with prepared heated diapers.

In accordance with the generally accepted scheme, the oral cavity, pharynx and nasal passages should be suctioned simultaneously. This traditional technique acts as a powerful reflex stimulus, usually causing the first extinguishing breath, and its use is therefore justified.

The presence and quality of this reflex response is also a sign used for scoring when assessing vital functions. The absence of this reaction indicates the possibility of inhibition of the respiratory centers. The role of suction in clearing the airways should not be overestimated, since the amount of contents aspirated is usually insignificant and is not significant for respiratory function.

As a matter of principle, the suction time should not be too prolonged, since prolonged irritation of the upper respiratory tract can reflexively cause bradycardia or apnea. 1 minute after complete extraction of the fetus, the doctor evaluates the newborn’s vital functions using the Apgar scale.

3 Primary toilet of a newborn

Primary toileting of a newborn is one of the first procedures that is performed by medical staff immediately after the birth of the child.

The first procedure is suction of the contents of the oral cavity and nasopharynx. It is performed as soon as the baby's head appears in the birth canal to prevent aspiration of amniotic fluid. Suction of the contents is carried out using a sterile rubber bulb or suction.

The next procedure is to ligate the umbilical cord and treat it. This element of newborn care consists of two stages. Immediately after the baby is born, two sterile Kocher clamps are placed on the umbilical cord within the first ten to fifteen seconds. The distance between them is 2 cm. The first clamp is applied 10 cm from the umbilical ring. The umbilical cord between the clamps is treated with a 5% alcohol solution of iodine or 96% ethyl alcohol and intersected with sterile scissors. The final ligation of the umbilical cord is carried out mainly to avoid secondary bleeding from the umbilical cord vessels.

It must be aseptic, since the drying residue and the demarcation zone are the main site of infection, which can spread deep into the vessels and cause umbilical sepsis. From a mechanical and hygienic point of view, compression with a clamp is optimal for closure of the umbilical cord remnant.

The clamps currently produced, as a rule, are plastic, have small sharp corrugations, due to which they retain elasticity when bent and cannot slip off the remnant of the umbilical cord.

The advantage of this clamp is the persistent elastic pressure, which ensures the stability of the compression of the residue during the process of mummification. Covering the remainder with a sterile tape, which also leaks secretions and creates a breeding ground for microorganisms, is less beneficial.

Disinfection with a Polybaktrin spray (polymyxin, bacitracin, neomycin) also gives good results, which, however, is associated with a risk of sensitization. The treated umbilical cord residue is left open or a light air bandage is applied to it. After 2 days or later, the mummified part of the stump is cut off with a knife at the border of healthy tissue. The baby is then wrapped in a sterile, warm diaper and placed on a changing table, which should be heated from above by a radiant heat source. This avoids cooling the baby and also reduces heat loss from evaporating amniotic fluid. After this, the processing of the umbilical cord remains continues, that is, they proceed to the second stage. The umbilical cord is treated with a cloth soaked in an alcohol solution, and then with a dry sterile gauze cloth. Next, at a distance of 0.2-0.3 cm from the umbilical ring, a special Rogovin clamp is applied to the umbilical cord. The umbilical cord is crossed at a distance of 1.5 cm from the staple. The intersection site is treated with a 5% solution of potassium permanganate, and a sterile Chistyakova gauze bandage is applied.

The next stage of the newborn’s primary toilet is the treatment of the baby’s skin. A sterile gauze pad, pre-moistened in sterile Vaseline or vegetable oil, removes excess vernix and mucus.

When carrying out the primary toileting of a newborn, it is very important to prevent gonoblenorrhea. it is carried out with a 20% sodium sulfate solution (albucid) immediately after birth, in the first minutes of life. Instill one drop of the solution under the conjunctiva of the lower eyelids. Repeat after 2 hours. You can also use 1% tetracycline eye ointment for this. For girls, 1-2 drops of a 1-2% silver nitrate solution are instilled into the genital opening once. Prevention of gonorrheal eye infection (creedization) is mandatory in the Russian Federation. According to Crede's original, almost 100-year-old proposal, the main preventive method Instillation of a 1% solution of Argentum nitricum or Argentum aceticum into the conjunctival sac remains. The effect is very reliable, but its disadvantage is that the solution sometimes has a chemically irritating effect and is toxic to the eyes at an occasional high concentration.

The solution should be stored in a tightly closed dark glass bottle and replaced with a freshly prepared one every week. Less irritating is the instillation of Ophthalmo-Septonex solution, but the effect of this drug on gonococci is controversial.

Prevention should be carried out very carefully so that the disinfectant solution penetrates the entire conjunctival sac. Experience shows that this condition is not always met. The determination of body weight and length ends the primary care of the newborn in the delivery room. Establishing linear parameters (head-heel length, head and chest circumference) immediately after birth is not very reliable, because the head can be deformed by the birth tumor and compression in the birth canal, the lower limbs are in a tonic position of flexion.

If you need to obtain accurate data, for example, for the purpose of research and statistics, then it is better to repeat the measurement of linear parameters after the disappearance of postpartum changes, i.e. after 3-4 days.

Bathing a newborn in the delivery room, which was common in the past, is no longer performed. The baby’s skin is only gently wiped with a soft diaper to remove grease and blood or original feces. In newborns who require special care, mainly ensuring respiration, primary treatment is carried out only after the condition has normalized; some procedures are carried out only when the child is already in the appropriate department.

4 Organization of the first feeding

If the baby was born full-term and the mother’s labor progressed normally, the first attachment to the mother’s breast is recommended immediately after birth. It is important to establish a feeding schedule for the baby in the neonatal department. Subsequent feedings are carried out after 3 -3 * / 2 hours. In most maternity hospitals, it is customary to feed newborns 7 times. Before feeding nurse carefully examines newborns, changes diapers if necessary, then the children are transported on special gurneys or carried in their arms to the mother's wards. Before feeding, the mother thoroughly washes her hands and carefully washes the nipple with a solution of furatsilin (1:5000) or 0.5% solution with a cotton swab. ammonia. The mother expresses a few drops of milk with her hand to remove accidental contamination of the excretory ducts of the mammary glands. It is necessary to ensure that when sucking the child takes into his mouth not only the nipple, but also the isola. In the first 2 - 3 days, the mother feeds the baby while lying down. The baby is placed on only one breast. On the 3rd - 4th day, the mother begins to feed the baby while sitting. Breastfeeding lasts 20-30 minutes. Once lactation is established, the baby remains at the mother's breast for 15 - 20 minutes, during which time he sucks out all the required amount of milk. At the end of feeding, the breasts are washed with boiled water and dried with gauze or cotton wool.

In the first days after birth, the baby sucks from 5 to 30 - 35 ml of milk from the mother's breast, i.e., on average about 150 - 200 ml per day. From the 3rd -4th day, the amount of milk the baby receives increases, reaching 450 - 500 ml per day by the 8th -9th day. Quantity necessary for the child milk during the first days of life can be calculated using the formula:

where n is the day of the child’s life, 7 is the number of feedings.

The pediatrician and nurse carefully monitor the condition of the newborn and the movement of his body weight curve. If it is necessary to determine whether the mother’s lactation is sufficient, control weighing of the child before and after feeding is carried out. The difference in body weight indicates the amount of milk sucked. A more complete picture of the state of lactation can be obtained after 2 - 3 control weighings during the day. One of the main conditions for full lactation of a nursing mother is regular attachment of the baby to the breast and adherence to the time and duration of feedings.

After 10 days of life, the child should receive a daily amount of milk equal to 1/5 of his body weight.

There are three types of feeding of children of the 1st year of life: breast (natural), mixed (supplementary feeding) and artificial.

Natural feeding is feeding when the baby is during the first 5 months. life receives only mother's milk, and after 5 months. up to 1 year of age receives complementary foods along with breast milk.

Mixed feeding is a type of feeding when a child, due to certain circumstances, in the first half of the year, along with mother's milk, receives supplementary feeding in the form of milk formulas, and the mixtures should make up more than "/5 of the child's daily diet. The most common indication for transferring a child to mixed breastfeeding by the mother is developing (gradually or quickly) hypogalactia - insufficient amount of breast milk.

Artificial feeding is a type of feeding when the child does not receive mother's milk in the first half of the year or its amount is less than 1/5 of the total amount of food. The grounds for transferring a child to artificial feeding are a serious illness of the mother or a complete lack of milk from her. This type of feeding of children of the 1st year of life is rarely used. With the current level of knowledge, properly carried out artificial feeding, as a rule, gives a good effect.

5 Anthropometry of the newborn

After the primary toilet, a mandatory element of newborn care is the anthropometry of the child. Anthropometry includes: determination of body weight and length, measurement of head and chest circumference. At the end of the anthropometry, gauze ties with oilcloth bracelets are put on the child’s wrist. They indicate: mother’s name, date and time of birth, gender of the child, weight and length.

The child remains in the delivery room for 2 hours under the supervision of an obstetrician-gynecologist or pediatrician, then is transferred to the ward (department) for newborns. Before transferring to the neonatal department, the doctor re-examines the child and checks the condition of the umbilical wound. If there is bleeding, the umbilical cord must be re-tied.

When admitting a newborn in the children's ward, the doctor or nurse checks the passport data of the bracelet and medallion with the records in the history of its development and notes in it the time of admission of the child.

6 Preparation of documentation. Developmental history of the newborn

When registering the developmental history of a newborn, the number of the child’s developmental history must necessarily correspond to the number of the maternal birth history.

The corresponding columns of the child’s development history reflect in detail information about:

diseases of the mother during pregnancy by trimesters and the course of labor, the duration of the first and second stages of labor separately, the duration of the anhydrous interval, the nature of the amniotic fluid, drug therapy for the mother during labor, information on steroid prophylaxis and antibacterial therapy, indicating the name of the drug, deserves special attention , dates of prescription and withdrawal, route of administration, course duration and single dose of the drug. Special emphasis is placed on information from the tuberculosis clinic about the epidemiological situation on this issue in women.

During surgical delivery, the indications for it, the nature of pain relief and surgical intervention are indicated.

The neonatologist, in the appropriate columns on page 2 of the development history of the newborn, gives a detailed assessment of the child’s condition on the Apgar scale at the end of 1 minute and after 5 minutes, as well as in accordance with the Methodological Recommendations of the Ministry of Health and Social Development of Russia N 15-4/10/2-3204 dated 04/21/2010 . “Primary and resuscitation care for newborn children” after 10 minutes, if the Apgar score 5 minutes after birth has not reached 7 points.

All newborn children are required to fill out the insert card for primary and resuscitation care for a newborn in the delivery room, provided for in Appendix N5 of the Methodological Recommendations of the Ministry of Health and Social Development of Russia N15-4/10/2-3204 dated 04/21/2010. “Primary and resuscitation care for newborn children.”

It is possible to use an expanded version of the card insert, on back side which added columns for a brief description of the examination of the child in the delivery room immediately after birth (Appendix 21).

The history of the development of a newborn provides indicators of the child’s weight and height, head and chest circumference, and indicates the method of processing the umbilical cord. A special note is made about the prevention of gonoblenorea.

At premature birth if the child’s body weight at birth is exceeded and the average height for the specified gestational age is exceeded, a report is drawn up by a neonatologist together with an obstetrician-gynecologist (an option for drawing up a report is presented in Appendix 22).

If there is blood type O (I) and/or a negative Rh factor in the mother, as well as if there is a Rh conflict, a note is made about taking blood from the umbilical cord for the group and Rh factor, bilirubin.

The developmental history of the newborn monitors the child's body temperature throughout the entire period of his stay in the delivery room, and also indicates the method of maintaining heat (kangaroo method or skin-to-skin contact). The results are entered into a card for monitoring the child’s body temperature in the delivery room (Appendix 6).

2 hours after birth, the neonatologist makes a note in the developmental history of the newborn about the condition of the child (when transferring him to the neonatal unit) in the section “Initial examination of the newborn” with the obligatory indication of the date and exact time (hours and minutes) of the examination. If necessary due to the severity of the condition or other objective reasons, the recording of the initial examination of the newborn can be performed earlier than 2 hours after birth with the obligatory indication of the date and exact time (hours and minutes) of the examination.

When a newborn develops respiratory failure in the first minutes and hours after birth, the neonatologist assesses the state of the newborn's respiratory function at the time of transfer using the Silverman scale (the form is presented in Appendix 23).

According to the order of the Ministry of Health of the Russian Federation N 921n dated November 15, 2012 “On approval of the Procedure for providing medical care in the specialty “neonatology” during the first day of life in the physiological department, the child is examined by a pediatric nurse every 3-

5 hours to assess the condition of the newborn and, if necessary, provide him with emergency medical care with the obligatory entry of the examination results into the medical documentation (option of the examination card in Appendix 6.

According to the order of the Ministry of Health of the Russian Federation N 921n dated November 15, 2012 “On approval of the Procedure for the provision of medical care in the specialty “neonatology”, a neonatologist examines the newborn daily, and if the child’s condition worsens, with such frequency as determined by medical indications, but not less than once every three hours. The results of the examination are recorded in the developmental history of the newborn, indicating the date and time of the examination.

Daily notes from the neonatologist (see above, paragraph 1, section 2, paragraph 2.8). Daily appointments in the history of the development of the newborn are entered by the attending neonatologist in the fields on the right in compliance with the necessary requirements (see above, paragraph 2, section 2, paragraph 2.20).

To maintain the necessary continuity in the supervision of a newborn between the maternity hospital and the children's clinic, the neonatologist of the maternity hospital must note in the discharge summary:

− basic information about the mother: her state of health, features of the course of pregnancy and childbirth, surgical interventions that took place,

− assessment of the newborn on the Apgar scale, activities carried out in the delivery room (if the child needed them),

− features of the course of the early neonatal period: time of umbilical cord shedding and condition of the umbilical wound, body weight and condition at the time of birth and at discharge, date of vaccination and series of vaccine against hepatitis B and BCG-M (if not given, justification for its withdrawal), data on the implementation neonatal screening and audio screening, laboratory and other examination data,

− in case of incompatibility of the blood of the mother and the newborn according to Rhesus or the ABO system, the Rhesus affiliation, blood group of the mother and child and blood parameters in dynamics are noted in the exchange card,

- in case of hypogalactia in the mother, this is indicated in the exchange card, recommendations are given for solving this problem,

− in cases of asphyxia, birth trauma, illness of the child, the exchange card indicates not only the diagnosis, examination data of the child and the treatment provided, but also recommendations for further management of the child, feeding, and therapeutic measures.

Along with the discharge summary, handed to the mother, the head nurse of the neonatal department clarifies the mother’s home address and, on the day of the child’s discharge, reports by telephone to the children’s clinic at the place of his residence (except for non-resident ones) basic information about the discharged child - for a faster first visit. at home - and notes in the journal of the department (ward) for newborns and at the end of the development history of the newborn the date of discharge and the name of the clinic employee who received the telephone message.

Instructions for filling out the insert card for primary and resuscitation care for a newborn in the delivery room

The insert card for primary and resuscitation care for a newborn in the maternity room (Appendix No. 5 of Methodological Recommendations No. 15-4/10/2-3204 dated April 21, 2010 “Primary and resuscitation care for newborn children”) is filled out for each newborn in all treatment and prophylactic hospitals institutions where obstetric care is provided, by a doctor (neonatologist, pediatrician, obstetrician-gynecologist, anesthesiologist-resuscitator) or, in the absence of a doctor, a midwife after completing a set of primary resuscitation measures. It is an insert sheet for form 097/у “History of the development of a newborn.”

The insert card for primary and resuscitation care for a newborn in the delivery room contains information:

- about the nature of amniotic fluid;

− about the condition of the newborn based on signs of live birth ( spontaneous breathing, heartbeat, pulsation of the umbilical cord, voluntary muscle movements), as well as by the color of the skin, in dynamics;

− about the ongoing primary and resuscitation measures;

− about the outcome of primary and resuscitation care.

Chapter 2. Organization of care for a newborn child

2.1 Immunoprophylaxis

In the maternity hospital, a newborn baby receives two vaccinations. On the first day of life, a vaccine against hepatitis B is administered. Then, over the next 3-7 days, a vaccination against tuberculosis is given - BCG or BCG-M.

Primary vaccination is carried out for healthy full-term newborns in the first four days of life and for premature infants upon reaching a body weight of 1.5 kilograms. Newborns are allowed to undergo vaccination after examination by a pediatrician, with registration of admission to vaccination in the history of the newborn.

Vaccinations for newborns are carried out in a vaccination room equipped with a refrigerator, a thermal container, disposable tuberculin syringes, vaccination material, and anti-shock therapy drugs. Vaccination of newborns is carried out by a nurse in the vaccination room, who has permission to administer vaccinations, based on medical prescription, in the presence of the child’s mother. The received vaccination, data about the vaccine (manufacturer, series, dose, expiration date, date of vaccination) are entered into the newborn’s history and exchange card, which, after the child is discharged from the maternity hospital, is transferred to the medical institution at the place of residence.

During the mother's stay in the maternity hospital, she is taught the timing of further vaccinations that the child will receive after discharge from the maternity hospital and is given a Vaccination Passport with the vaccinations received in the maternity hospital included in it.

The BCG vaccine is administered strictly intradermally at the border of the upper and middle third of the outer surface of the left shoulder in a volume of 0.05 ml for children under one year of age and in a volume of 0.1 ml for children over a year old vaccinated with vaccines from foreign countries. The Russian vaccine is administered in a volume of 0.1 ml, regardless of age.

To obtain a vaccination dose equal to a volume of 0.05 ml, 1.0 ml of a standard solvent is added to a 20-dose bottle (ampoule); to dilute a 40-dose vaccine, 2.0 ml of solvent is required. The diluted vaccine should give a uniform suspension within one minute.

Due to the high sensitivity of the BCG vaccine to daylight and sunlight, it should be stored in a dark place, for which a black paper cylinder is used.

The BCG vaccine can only be used within six hours from the moment of dilution, so the time and date of opening of the vaccine is indicated on the label. Unused vaccine is destroyed by boiling for 30 minutes or immersing in a 5% chlorine disinfectant solution for two hours or burning in an oven.

Before using the vaccine, you must carefully study the instructions attached to it, check the labeling and integrity of the ampoule (vial) and the compliance of the drug with the attached instructions.

In the fight against viral hepatitis B, the main role is given to active specific immunization - vaccination against hepatitis B, which in Russia is included in the National Vaccination Calendar and is enshrined in law. There are several vaccination schemes against this virus, consisting of 3 or 4 doses of vaccination (they are vaccinated according to such schemes in our country).

Traditional option:

Under normal conditions, the vaccination course consists of 3 vaccinations (according to the 0-1-6 scheme):

The vaccination (the first dose of the vaccine) is administered on the so-called day 0 (the first 12 hours of life).

The vaccination (second dose of the vaccine) is administered 1 month after the first.

The I vaccination (the third dose of the vaccine) is administered 6 months after the first vaccination (that is, when the baby is six months old).

To create full immunity, you should adhere to the recommended timing of vaccine administration. Then effective immunity against hepatitis B is formed in no less than 95% of vaccinated people. However, in a number of cases (child illness, change of place of residence, lack of vaccine), the vaccination schedule is disrupted. It must be remembered that the interval between the first and second doses of the vaccine should not exceed 2-3 months, and the administration of the third vaccination should not be later than 12-18 months from the start of vaccination.

Hepatitis B vaccines are generally well tolerated. Side effects(redness, thickening and soreness at the injection site, poor health and a slight increase in body temperature up to 37.5 degrees C) are rare, short-term in nature, usually mild and, as a rule, do not require medical attention. It is extremely rare that severe allergic reactions may occur: anaphylactic shock or urticaria.

2 Assessment of the newborn's condition

The child’s condition is assessed in the first and fifth minutes of life. The result is written as a fraction, for example - 8/9. The Apgar scale is an assessment of the state of health of a newborn and no predictions about the future condition of the child can be made based on it. At the time of implementation, the results are assessed as follows:

7-10 points - no deviations in health status were identified;

5-6 points - minor deviations;

3-4 points - serious deviations from the normal state;

0-2 points - a condition that threatens the life of a newborn.

If possible (this depends mainly on the condition of the mother), the obstetrician-gynecologist conducts a cursory examination of the newborn, paying attention to its vital functions and the presence of serious malformations or birth trauma.

To assess the physical development of newborns, statistical indicators of basic parameters depending on gestational age or percentile assessment tables are used. Parameters of the physical development of a newborn, located in the interval M ± 2 s (s - standard deviation) or P10 - P90 refer to normal physical indicators for a given gestational age. The parameters of the physical development of newborns depend on the parameters and age of their parents, nutritional characteristics, living conditions and the serial number of the woman’s pregnancy. The characteristic of the proportionality of the physique and nutrition of newborns is important.

A full-term newborn is a child born at 37-42 weeks gestation. In a full-term newborn, due to the prevailing development of the brain, the head makes up 1/4 of the body. Of particular importance is the determination of head circumference at birth (and over time), body weight, as well as its shape. Variants of the normal shape include the following: dolichocephalic - elongated in the anteroposterior direction, brachiocephalic - transversely, and a tower skull. The bones of the skull are malleable and can overlap each other along the sagittal and coronal sutures. Features are reflected in the maturity table.

A premature newborn is a child born at less than 37 weeks of gestation. Born alive at 22 - 28 weeks' gestation and surviving the first 168 hours of life. Normal development parameters at 28-37 weeks include children with a body weight from 1000.0 to 2500.0 g, a length of 38-47 cm, a head circumference of 26-34 cm and a chest circumference of 24-33 cm. According to statistical data from different countries, premature From 6 to 13% of children are born. Body weight cannot be the main criterion for prematurity. There is the concept of “low birth weight” or “low birth weight” - these are children weighing less than 2500.0 g at birth who were born at term.

Post-term newborns include children born after 294 days or 42 weeks of gestation. The birth rate of such children is from 8 to 12%. In children, clinical signs of trophic disorders are observed: decreased skin turgor, thinning of the subcutaneous fat layer, desquamation, dryness and flaking of the skin, lack of lubrication, dense skull bones, often with closed sutures.

When comparing gestational age and indicators of physical development, the following groups are distinguished:

with normal physical development for a given gestational age;

with low body weight for gestational age or with intrauterine growth retardation.

The following types of IUGR are found: immaturity or “small for date”, dysplastic or asymmetrical and late type or intrauterine malnutrition. Combinations of different types of IUGR can occur in one child. The pathogenesis of developmental and growth retardation in the fetus is diverse. When only body weight lags behind the gestational age of the fetus, unfavorable factors, as a rule, interact in the last trimester of pregnancy. When body weight and length lag behind gestational age, unfavorable living conditions for the fetus are observed at the end of the first and beginning of the second trimester of pregnancy. Disturbances in body proportion, often combined with dysesbryogenetic stigmas and developmental defects, are classified as the dysplastic type and are observed in children with chromosomal and genomic disorders, as well as in intrauterine, generalized infections. Various types IUGR occurs in full-term, premature and post-term newborns.

The maturity of a newborn is determined by a combination of clinical, functional and biochemical parameters. In every age period, starting from the zygote, the adaptation features of the fetus, newborn and infant correspond to its calendar age in conjunction with the environment surrounding it and interacting with it. The state of the central nervous system is an informative characteristic of maturity. When examining a child, posture, position, spontaneous facial motor skills, emotional reactions, innate unconditioned reflexes and sucking activity are assessed. Based on clinical signs, the maturity of a newborn is determined using scoring tables based on the sum of points for each sign.

3 Physiological conditions of the newborn

Some newborns experience temporary conditions specific to this age, depending on changes in external and internal environmental conditions that occur after birth.

These conditions, being physiological, are observed only in newborns and never recur in the future. However, these conditions border on pathology and, under unfavorable conditions, can develop into disease processes.

The most common physiological conditions are the following.

The skin of a newborn is covered with a cheese-like lubricant - vernix caseosa. This lubricant consists of almost pure fat, glycogen, extractives, carbon dioxide and phosphoric acid salts, as well as cholesterol, odorous and volatile acids. Under normal conditions, its color is grayish-white. If it has a yellow, yellow-green or dirty gray color, then this indicates intrauterine pathological processes (hypoxia, hemolytic processes, etc.). As a rule, the cheese-like lubricant is not removed in the first 2 days, since it protects the body from cooling and the skin from damage, contains vitamin A, and has beneficial biological properties. And only in places of accumulation (groin, axillary folds) does the lubricant undergo rapid decomposition, so here the excess should be carefully removed with sterile gauze soaked in sterile vegetable oil.

In a full-term baby, yellowish-white dots are often observed on the tip and wings of the nose, slightly raised above the skin. Their origin is explained by excessive secretion of the sebaceous glands, especially in the last months of intrauterine development of the fetus. By the end of the 1st week or in the 2nd week, they disappear when the epidermis changes and the ducts open.

Erythema of newborns, or physiological catarrh of the skin, develops as a consequence of skin irritation to which it is exposed in new environmental conditions, while the skin becomes brightly hyperemic, sometimes with a slight bluish tint. Hyperemia is observed from several hours to 2-3 days, then small, rarely large peeling appears, especially pronounced on the palms and soles. In case of excessive peeling, the skin is lubricated with sterile oil (castor, sunflower, olive, fish oil). In the absence of erythema in a newborn in the first hours and days of life, it is necessary to find out the reason for this: it is absent in pulmonary atelectasis, intrauterine toxemia, due to various pathological conditions mothers during pregnancy, intracranial hemorrhages.

Physiological jaundice usually appears on the 2-3rd day after birth and is observed in 60-70% of newborns. The general condition of the children is good. In this case, a more or less pronounced icteric staining of the skin, mucous membranes of the oral cavity and, to a lesser extent, the sclera appears. Due to the intense redness of the skin in the first days, jaundice may not be noticeable at first, but is easily detected if you press on any area of ​​the skin with your finger. The stools are normal in color and the urine does not contain bile pigments. From the outside internal organs no deviations from the norm are observed. At the same time, children actively suck.

The appearance of jaundice is caused by an emerging imbalance between the enzymatic capacity of the liver (glucoronyl transferase deficiency) and the increased breakdown of red blood cells (the number of which is increased during fetal development). The immature enzymatic system of the liver is not able to process and excrete large amounts of bilirubin.

Physiological jaundice lasts for several days, and its intensity gradually decreases, and by the 7-10th day, rarely by the 12th, it disappears. Much less often, jaundice lasts 2-3 weeks. A prolonged course of jaundice is often observed in children born prematurely or with severe asphyxia, who were injured during childbirth.

The prognosis for physiological jaundice is favorable. No treatment required. With severe jaundice, children are given a 5-10% glucose solution, an isotonic sodium chloride solution - 50-100 ml/day with 100-200 mg of ascorbic acid. If jaundice appears very early, a rapid increase in coloration of the skin and a long course, it is necessary to doubt the physiological nature her, thinking first of all about hemolytic disease of the newborn, and show the child to the doctor.

Physiological mastitis—swelling of the mammary glands—is observed in some newborns, regardless of gender. It is caused by the transition of estrogen hormones from mother to fetus during the prenatal period. Swelling of the mammary glands is usually bilateral, appears in the first 3-4 days after birth, reaching its maximum value by the 8-10th day. Sometimes the swelling is insignificant, and in some cases it can be the size of a plum or more. The swollen glands are mobile, the skin over them is almost always of normal color. The nipple may discharge a fluid that resembles colostrum. As the body frees itself from maternal hormones, the swelling of the glands disappears. Any pressure is strictly prohibited due to the risk of injury, infection and suppuration of the glands. Physiological mastitis does not require treatment.

Catarrhal vulvovaginitis occurs in some newborn girls. It occurs under the influence of mother's follicular hormones. In the first days after birth, flat epihelium is secreted along with the glandular tissue of the cervix in the form of a mucous, viscous secretion; sometimes there may be bloody issues from the genital slit. In addition, swelling of the vulva, pubis and general swelling of the genitals may be observed. Normal phenomena that occur under the influence of maternal hormones include swelling of the scrotum that is sometimes observed in boys. All these phenomena can be observed on the 5-7th day of life and last 1-2 days. No special treatment is required. Girls should only be washed more often with a warm solution of potassium permanganate (dissolved with boiled water in a ratio of 1:5000-1:8000), squeezing it out of cotton wool.

Physiological weight loss is observed in all newborns and amounts to 3-10% of birth weight. The maximum drop in weight is observed by the 3-4th day of life. In most newborns, body weight is restored by the 10th day of life, and in some even by the end of the 1st week; only in a small group of children the initial body weight is restored only by the 15th day. Overheating, cooling, insufficient air humidity and other factors increase weight loss. The amount of physiological weight loss is also influenced by the course of labor, the degree of term and maturity, the duration of jaundice, the amount of milk sucked and fluid received. The physiological drop in body weight in newborns is due to the following circumstances: 1) malnutrition in the first days; 2) the release of water through the skin and lungs; 3) loss of water through urine and feces; 4) discrepancy between the amount of fluid received and released; 5) often regurgitation of amniotic fluid, slight loss of moisture when the umbilical cord remains dry. If there is a loss of more than 10% of the initial body weight, it is necessary to clarify the reason for this. It is always necessary to remember that often a large drop in body weight is one of the initial symptoms of a particular disease. It is possible to prevent a large loss of body weight if the following conditions are met: proper care, early latching of children to the breast - no later than 12 hours after birth, administration of a sufficient amount of fluid (5-10% in relation to the child’s body weight).

Uric acid infarction of the kidneys occurs in half of newborns and manifests itself in the excretion of a large amount of uric acid salts in the urine. The urine becomes cloudy, more brightly colored, and on the days of the greatest drop in body weight takes on a brown tint. When standing, a significant sediment appears in the urine, which dissolves when heated. A large amount of uric acid salts in the urine can be judged by the reddish color of the sediment and by the reddish-brown spots remaining on the diapers. All this is associated with the release of urates as a result of uric acid infarction of the kidneys, which is based on the increased formation of uric acid in the body of a newborn due to the increased breakdown of cellular elements and the characteristics of protein metabolism. With the administration of large amounts of fluid and the release of large amounts of urine, the infarction disappears within approximately the first 2 weeks of life. As a rule, it leaves no consequences and does not require treatment.

Physiological conditions also include transitional stool after the passage of meconium from the intestine.

Meconium is the original feces, which is formed from the fourth month of intrauterine life. It is a dark olive, viscous, thick, odorless mass, which consists of secretions of the embryonic digestive tract, separated epithelium and swallowed amniotic fluid; the first portions do not contain bacteria. By the 4th day of life, meconium is completely removed from the intestines. The transition to normal milky bowel movements in a child occurs when proper feeding not right away. This is often preceded by a so-called transitional stool. In this case, the stool is rich in brownish-greenish mucus, watery, and sometimes foamy. Newborns often experience gas accumulation and bloating, which causes the baby to become restless, the frequency of bowel movements fluctuates dramatically, and the appearance of bowel movements changes. Stool occurs 2-6 times a day, homogeneous, the color of mashed mustard, with a mushy consistency.

4 Caring for the mucous membranes and skin of a newborn baby

After the baby is admitted to the neonatal ward, the nurse constantly monitors the nature of his behavior, crying, sucking, and regurgitation. Particular attention is paid to the care of the skin, mucous membranes, and umbilical cord stumps.

Every day before morning feeding, the newborn is toileted in a certain sequence: washing, treating the eyes, nose, ears, skin and, last of all, the perineum. Wash the child with running warm water. If there is irritation of the conjunctiva or discharge from the eyes, a furatsilin solution (1:5000) is used, and each eye is washed with a separate cotton swab moving from the outer corner of the eye to the inner. Toilet the nose and ears is done with separate sterile wicks moistened with a solution of furatsilin or sterile oil (sunflower or vaseline). Sticks, matches and other hard objects should not be used for this purpose.

During the first 2 days, skin folds (cervical, axillary, popliteal) are lubricated with a cotton ball soaked in a 1% alcohol solution of iodine, and in subsequent days they are lubricated with sterile petroleum jelly or vegetable oil. The use of powders on a newborn is not recommended, as they can cause maceration of the skin.

To wash the newborn, the nurse places him on his back on his left arm so that the head is at the elbow joint, and the nurse's hand is holding the newborn's thigh. The area of ​​the buttocks and perineum is washed with warm running water and baby soap from front to back, dried by blotting with a sterile diaper and lubricated with a sterile Vaseline oil.

Care of the umbilical cord is carried out in an open way. The umbilical cord stump is treated 1-2 times a day with 70% ethyl alcohol, 2% hydrogen peroxide solution. Treatment of the umbilical wound is carried out until it heals (on average from 10 days to 2 weeks). Until the umbilical cord falls off, it is recommended to use only sterile diapers and diapers. At this time, it is undesirable to use diapers of the diaper type due to possible reactive changes as a result of friction of the edge of the diaper on the wound.

Newborns are weighed daily before the first feeding. The undressed baby is placed on a diaper and weighed, then the weight of the diaper is subtracted from the resulting figure and the net body weight of the newborn is obtained.

A newborn should be swaddled before each feeding and after each urination to prevent diaper rash. The child's clothes should be light, comfortable, and warm. The first set of linen for a newborn includes 4 sterile diapers, a vest and a blanket.

A pediatric nurse must be able to properly swaddle a child. It must be remembered that clothing should protect the newborn from large heat loss and at the same time not restrict his movements and not interfere with evaporation from the skin.

A full-term newborn is swaddled with arms for the first 2-3 days, and in subsequent days, at the appropriate air temperature in the room, the arms are laid out on top of the blanket.

The generally accepted method of swaddling has the following disadvantages: the child’s physiological posture is forcibly changed, his movements are constrained, breathing becomes difficult, and blood circulation is impaired. Taking this into account, special clothing for newborns was introduced in maternity hospitals. The child is wearing two long-sleeved blouses (one light, the other flannel, depending on the time of year). He is then loosely wrapped in three swaddling clothes, leaving his head and arms exposed without restricting his legs. In this form, the newborn is placed in an envelope made of cotton fabric, into which is placed a soft flannelette blanket, folded 3 times. If necessary, place a second flannelette blanket on top of the envelope. With this method of swaddling, the movements of the newborn are not limited and, at the same time, heat is better retained under the clothes.

When swaddling, the baby is placed in such a way that the top edge of the diaper reaches the armpits. The diaper is placed on the perineum, after which the baby is wrapped in a thin diaper. Place a polyethylene diaper (oilcloth) measuring 30x30 cm (top edge at lumbar level, bottom edge to knee level). The baby is then wrapped in a warm diaper. If necessary, the child is covered with a blanket on top. From 1-2 months of age, during daytime “waking”, diapers are replaced with onesies; from 2-3 months of age, disposable diapers begin to be used (usually on walks), which are changed every 3 hours, and at 3-4 months. when profuse salivation begins, a breastplate is put on over the vest. A scarf or cap made of cotton fabric is put on the head only after a bath and while walking. At 9-10 months. baby vests are replaced with a shirt, and rompers are replaced with tights (in winter with socks or booties).

Swaddling is done before each feeding, and more often in children with irritated skin or diaper rash.

After changing each child, the changing table and the oilcloth mattress on it are thoroughly wiped with a disinfectant solution. Healthy babies are swaddled on the changing table. If the child is isolated, swaddling is done in the crib.

5 Screening testing

Newborn screening is an analysis for common hereditary diseases: phenylketonuria, cystic fibrosis, galactosemia, congenital hypothyroidism and adrenogenital syndrome.

Neonatal screening is a government program for screening all newborn babies.

Its goal is to detect certain serious genetic diseases as early as possible.

Newborn screening includes a group of fairly common problems among babies. Provided that they are detected early and their treatment is started on time, these diseases either do not develop at all or do not cause severe complications. It is almost impossible to diagnose them without the help of a special laboratory test, since their signs may not appear until a certain age. It may be too late to treat a disease that has already developed.

The analysis is taken in the maternity hospital on the 4th day in full-term infants and on the 7th day in premature infants. A few drops of blood from the baby's heel are applied to a special test strip, which is dried and sent to the laboratory. If the birth took place at home, the analysis is usually carried out in a children's clinic at the place of residence.

In Russia, screening is carried out for 5 diseases: cystic fibrosis, phenylketonuria, congenital hypothyroidism, galactosemia and adrenogenital syndrome.

Cystic fibrosis is one of the most common hereditary diseases, in which the respiratory and digestive system of a child is affected and its growth is impaired. Timely prescribed treatment with drugs in a specialized center allows you to avoid serious complications.

Phenylketonuria is a serious disorder in which the brain primarily suffers - the child develops serious neurological disorders and mental retardation. Having discovered this problem in a child, specialists prescribe him a long-term diet, the observance of which allows the child to develop normally.

Congenital hypothyroidism is a disease in which, due to congenital deficiency of thyroid hormones, the physical and mental development of the child is delayed. Timely treatment with thyroid hormones leads to complete restoration of the baby’s growth and intellectual development.

Galactosemia is a problem due to which, when consuming milk and dairy products, a child can develop severe damage to internal organs (liver, nervous system and others). Following a dairy-free diet (and, possibly, timely treatment with special medications) will help avoid these problems.

Adrenogenital syndrome is associated with increased production of androgen hormones by the adrenal cortex. If the disease is not treated, babies begin to experience too rapid sexual development, growth slows down, and infertility develops in the future. Taking the necessary hormones establishes a normal rhythm of development and relieves other manifestations of the disease.

If the screening results show that the child is healthy, the mother does not receive any notifications. If it turns out that the child is at risk for any of the five listed diseases, the analysis is carried out again. After laboratory confirmation of the diagnosis, the mother and baby come to an appointment with a geneticist, who tells how to prevent the development of the disease and, if necessary, prescribes treatment.

Conclusion

Nursing personnel play a huge role in neonatal departments, performing a significant amount of work in caring for newborns, medical procedures, and preventing nosocomial infections.

Careful monitoring of the condition of a newborn from the first days of his life, creation of optimal conditions for his development, proper care for him, organization of a regimen, appropriate breast (natural) feeding ensure the normal development of the child during this period of life, when his organs and systems are especially vulnerable.

Immunological prevention of infections has become widespread throughout the world, which has significantly reduced the incidence of tuberculosis, polio, whooping cough, diphtheria, measles and tetanus, and smallpox has been completely eradicated thanks to vaccination. An undeniable achievement recent years- vaccination of children with chronic diseases, use of inactivated vaccines. A fairly large list of chronic health problems in children has been compiled, considered as serious indications for vaccination against influenza and pneumococcal pneumonia. Only by vaccinating people with health problems can 95℅ of children in the first years of life be vaccinated, which is a prerequisite for maintaining the incidence of vaccine-preventable infections only at a sporadic level. Physicians have been tasked with the global eradication of polio, measles (by 2010), rubella, mumps, and Haemophilus influenzae (dates to be determined). Only recently they stopped using vitamin D2, replacing it with vitamin D3. Vitamin D3 in a dose of 400-500 IU is recommended to be given to a child in autumn and winter, when there is no active sun.

Attention to the baby in the family and in medical institutions of the healthcare system is the key to his health. At the same time, it is necessary to both use the achievements of science in this area and not neglect the experience of previous generations. Interest in new things and moderate conservatism are the basis of the approach to the problems of child care and upbringing.

This work helps to expand and consolidate knowledge on the organization of medical care for newborns, on compliance with the sanitary and epidemic regime in an obstetric hospital.

neonatal anthropometry newborn immunoprophylaxis

Bibliography

1. Tulchinskaya V.D. Children's health. Textbook. - Rostov-on-Don, Phoenix, 2014.

Shabalov N.P. Neonatology. Textbook in 2 volumes - Moscow, MEDpress-inform, 2013.

Tseregradskaya Zh.V. Newborn. Care and education. Toolkit. - Rozhana, Rozhana, 2010.

Shabalov N.P. Pediatrics. Textbook for students of higher educational institutions. - St. Petersburg, SpetsLit, 2009.

Valman B., Thomas R. The first year of a child’s life. Guide for doctors, specialty: Pediatrics/Neonatology. - Moscow, Binom, 2012.

Zelinskaya D.I. Nursing care for a healthy newborn child in an outpatient setting. Textbook for medical schools and colleges. - Moscow, GEOTAR-Media, 2010.

CHAPTER 9 FEATURES OF CARE FOR NEWBORNS AND INFANTS

CHAPTER 9 FEATURES OF CARE FOR NEWBORNS AND INFANTS

IN last decade There have been significant changes in early childhood care practices. Primitive cotton wool and gauze have been replaced by modern children's hygiene items, convenient disposable tampons, electronic scales, children's ear thermometers, smart toys, children's toothbrushes with a limiter, bottles with a heating indicator, pacifiers with an anti-vacuum effect, nasal aspirators, children's tweezers - nippers (scissors), various sponges, mittens, washcloths, baby creams, oils, lotions, gels, diapers, etc. However, the fundamental principle of child care remains the same - adherence to the daily routine, which sick children especially need. The so-called free regime, when the child sleeps, is awake and feeds depending on his desire (the method is widespread in our country thanks to the books of the American pediatrician B. Spock) is unacceptable in a hospital setting. For children in the first year of life, the main elements of the daily routine should be fixed: time of wakefulness, sleep, frequency and time of feeding the sick child (Fig. 14).

In newborns and infants, all pathological processes in the body occur extremely rapidly. Therefore, it is important to promptly note any changes in the patient’s condition, accurately record them and notify the doctor in time to take urgent measures. The role of a nurse in caring for a sick infant cannot be overestimated.

The basis of care is the observance of the strictest cleanliness, and for a newborn child - sterility (asepsis). Care for infants is carried out by nursing staff with mandatory supervision and participation of a neonatologist (the first weeks of life) or a pediatrician. Persons with infectious diseases and purulent processes, malaise or elevated body temperature are not allowed to work with children. Medical workers in the infant department are not allowed

Rice. 14.Basic elements of an infant's daily routine

wear woolen items, jewelry, rings, use perfume, bright cosmetics, etc.

The medical staff of the department where infants are located must wear disposable or white, carefully ironed gowns (replace them with others when leaving the department), caps, and in the absence of a forced ventilation mode - disposable or four-layer marked masks made of gauze and removable shoes. Strict personal hygiene is mandatory.

When a newborn is admitted to the children's ward, the doctor or nurse checks the passport data of the “bracelet” (a “bracelet” is tied to the child’s hand in the maternity ward, on which the mother’s last name, first name and patronymic, body weight, gender, date and hour of birth are indicated) and “ medallion" (the same notes on the medallion placed over the blanket) with notes in the history of its development. In addition, the time of the patient's appointment is noted.

For newborns and children in the first days of life with jaundice, it is fundamentally important to control the level of blood bilirubin, a significant increase in which requires serious measures, in particular the organization of replacement blood transfusion. Bilirubin in the blood is usually determined using the traditional biochemical method. Currently, they also use “Bilitest”, which allows, using photometry, with one touch of the skin, to obtain operational information about the level of hyperbilirubinemia (increased levels of bilirubin in the blood).

Care of skin and mucous membranes. The goal of care is healthy skin. The integrity of the protective layer of a newborn’s skin is facilitated by absolute cleanliness, avoidance of contact with potent substances, a decrease in the degree of moisture and friction of the skin on diapers and other external surfaces. Any items for caring for a newborn, underwear - everything should be disposable. The equipment of a children's ward or room includes only the necessary care items and furniture. The air temperature should reach 22-23°C, the chambers must be constantly ventilated or use air conditioning. The air is disinfected with UV rays. After the end of the adaptation period, the air temperature in the nursery is maintained within 19-22 °C.

A newborn baby, as well as an infant in the future, needs to observe the most important rules of hygiene: washing, bathing, caring for the navel, etc. When swaddling, the baby's skin is carefully examined each time. Leaving should not cause him any discomfort.

Morning and evening toilet for a newborn consists of washing the face with warm boiled water, rinsing the eyes with a sterile cotton swab moistened with boiled water. Each eye is washed with a separate swab in the direction from the outer corner to the bridge of the nose, then dried with clean napkins. During the day, the eyes are washed as needed.

The baby's nasal passages have to be cleaned quite often. To do this, use cotton buds made from sterile cotton wool. The flagellum is lubricated with sterile vaseline or vegetable oil and carefully moved into the depths of the nasal passages by 1.0-1.5 cm with rotational movements; the right and left nasal passages are cleaned with separate flagella. This manipulation should not take too long.

The external auditory canals are cleaned as needed; they are wiped with dry cotton wool.

The oral cavity of healthy children is not wiped, as the mucous membranes are easily injured.

A swab moistened with vegetable oil is used to treat the folds, removing excess cheese-like lubricant. To prevent diaper rash, the skin of the buttocks, axillary areas, and folds of the thighs is lubricated with 5% tannin ointment.

Newborn babies and infants need to have their nails trimmed. It is more convenient to use scissors with rounded jaws or nail clippers.

At the end of the newborn period (3-4 weeks), the baby is washed in the morning and evening, and also as needed. The child’s face, neck, ears (but not the ear canal), and hands are washed with warm boiled water or wiped with cotton wool moistened with water, then wiped dry. At the age of 1-2 months, this procedure is carried out at least twice a day. From 4-5 months you can wash your baby with tap water at room temperature.

After urination and defecation, the child is washed, following certain rules. Girls are washed from front to back to avoid contamination and infection of the genitourinary tract. Washing is carried out with your hand, onto which a stream of warm water (37-38 °C) is directed. For severe contamination, use neutral soap (“Children’s”, “Tic-Tac”, etc.).

It is unacceptable to wash children with standing water, for example in a basin.

After washing, the baby is placed on the changing table and the skin is blotted with a clean diaper. Then the folds of the skin are lubricated with a sterile cotton swab moistened with sterile vegetable (sunflower, peach) or vaseline oil. For pros

To prevent diaper rash, skin folds are lubricated with sterile vegetable oil or baby creams (cosmetic oils such as “Alice”, “Baby Johnson-and-Johnson”, ointments “Desitin”, “Drapolen”, etc.) in a certain sequence: behind the ears, neck fold, axillary, elbow, wrist, popliteal, ankle and groin areas. The method of applying the oil or cream is called "mother's hand dosing": the mother (nurse) first rubs the oil or cream into her palms and then applies the remainder to the baby's skin.

Treatment of the umbilical wound carried out once a day. Recently, it has been recommended to refrain from using dyes so as not to miss redness and other signs of inflammation of the umbilical wound. Usually 70% ethyl alcohol, alcohol tincture of wild rosemary, etc. are used. After the umbilical cord falls off (4-5 days), the umbilical wound is washed with a 3% solution of hydrogen peroxide, then with 70% ethyl alcohol and cauterized with a 5% solution of potassium permanganate or a lapis pencil.

Bathing. Wash newborn babies with baby soap under warm (temperature 36.5-37 °C) running water, wipe the skin dry with a diaper using light blotting movements.

The first hygienic bath is usually given to a newborn after the umbilical cord falls off and epithelization of the umbilical wound (7-10 days of life), although there are no contraindications to taking a bath from 2-4 days of life. During the first 6 months, the child is bathed daily, in the second half of the year - every other day. For bathing you need a bath (enamel), baby soap, a soft sponge, a water thermometer, a jug for rinsing the baby with warm water, a diaper, a sheet.

The bath is pre-washed with hot water, soap and a brush, then treated with a 0.5% chloramine solution (if bathing is carried out in children's institution) and rinse with hot water.

For children of the first half of the year, the water temperature in the bath should be 36.5-37 °C, for children of the second half of the year - 36-36.5 °C. The duration of the bath in the first year of life should be no more than 5-10 minutes. With one hand they carefully support the child’s head and back, with the other they lather the neck, torso and buttocks; Wash especially thoroughly the folds in the neck, elbow, groin areas, behind the ears, under the knees, between the buttocks (Fig. 15, a). At the final stage of bathing, the child is taken out of the bath, turned back up and doused with clean water.

(Fig. 15, b). The baby is quickly wrapped in a diaper and dried with blotting movements, after which, after treating the skin folds with sterile vaseline oil, he is dressed and placed in a crib.

Rice. 15.Bathing an infant:

a - bathing position; b - dousing after bathing

When bathing, use soap no more than 2 times a week; it is better to use Johnson's baby or "Children's" foam shampoo from head to toe. For some children, daily bathing, especially in hard water, can cause skin irritation. In these conditions, it is recommended bath with added starch: 100-150 g of starch is diluted with warm water and the resulting suspension is poured into the bath.

Children of the first half of the year are bathed in a lying position, while children of the second half of the year are bathed while sitting.

Sometimes after frequent washing with soap, hair becomes dry. In such cases, after bathing, they are lubricated with boiled vegetable oil or a mixture consisting of 1/3 castor oil and 2/3 vaseline (or boiled sunflower) oil. After treatment, wipe the hair with a dry cotton swab.

Cosmetics for newborn care. Children's cosmetics are a special type of cosmetic products designed for daily care and complete protection of a child's sensitive skin. Cosmetic lines of the companies “World of Childhood”, “Svoboda”, “Nevskaya Cosmetics”, “Ural Gems” (Dragon and Little Fairy series), “Infarma”, “Johnson's baby”, “Avent”a, "Huggies", "Bubchen", "Ducray" (A-Derma), "Noelken GmbH" (Babyline), "Qiicco" and others contain

all the necessary products for caring for the baby: moisturizing, protective creams, toilet soap, shampoo, bathing foams, lotions, creams, powders, etc. Like many other products, children's cosmetics contain extracts of medicinal plants: chamomile, string, celandine, calendula, yarrow and wheat germ. These extracts are well tolerated and gentle on baby's skin.

It is usually recommended to use products from the same cosmetic line, as they complement and enhance each other’s effects. Domestic children's cosmetics are not inferior to imported ones. In the production of most of them, the basic dermatological requirements are met: neutral pH, no preservatives, a predominance of mineral components over organic ones (in oils), high-quality animal fats and herbal extracts are used, the “tearless” formula is used in shampoos, exclusive medicinal ones are included in diaper rash creams components - panthenol or zinc.

Rules for swaddling and clothing for children of the first year of life. It is better to swaddle a full-term newborn with his hands for the first 2-3 weeks, and then, at the appropriate air temperature in the room, his hands are placed on top of the blanket. Considering that tight swaddling restricts movement, the newborn is dressed in special clothes: first they put on two long-sleeved vests (one light, the other flannel), then they wrap them in a diaper. In this form, the child is placed in an envelope made of cotton fabric. Usually a soft flannelette blanket is placed in the envelope, and if necessary, a second flannelette blanket is placed on top of the envelope.

Swaddling is carried out before each feeding, and for children with diaper rash or skin diseases - more often. The swaddling process is schematically as follows: you need to bend the top edge of the diaper and lay the baby down; the upper edge of the diaper should coincide with the shoulder line; the baby's arms are fixed along the body; the right edge of the diaper is wrapped around the baby and secured; wrap the baby with the left side of the diaper. The lower end of the diaper is straightened, folded and secured. To keep your hands free, the diaper is lowered so that the upper edge of the diaper reaches the armpits (Fig. 16).

The diaper is placed on the perineum, after which the baby is wrapped in a thin diaper. If necessary, lay polyethylene

Rice. 16.Stages of swaddling a baby. Explanation in the text

a new diaper (oilcloth) measuring 30x30 cm (top edge - at lumbar level, bottom - to knee level). Then the child is wrapped in a warm diaper and, if necessary, covered with a blanket on top.

After swaddling each child, the changing table and oilcloth mattress are thoroughly wiped with a 0.5-1% chloramine solution. Children are swaddled on the changing table without purulent manifestations; if it is necessary to isolate the child, all manipulations (including swaddling) are carried out in bed.

Subject to daily washing and boiling of clothes for children in the first months of life, a certain set of clothes is provided (Table 11).

Table 11.Set of linen for children in the first months of life

A thin vest is wrapped on the back, and a warm one is wrapped on the child’s chest. The sleeves of a warm vest are longer than the arms; they should not be sewn up. The bottom edge of the vest should cover the navel.

From 1-2 months of age, during the daytime “waking”, diapers are replaced with onesies or “bodysuits”, from 2-3 months of age they begin to use diapers (usually for walks), which are changed every 3 hours, and at 3-4 months, when profuse salivation begins, a bib is put on over the vest.

Caps, a scarf or a cap made of cotton fabric are put on the head only after a bath and while walking.

At 9-10 months, baby undershirts are replaced with a shirt, and rompers are replaced with tights (in winter with socks or booties). In Fig. 17 shows the basic clothing of children of the first year of life.

Diapers. In the modern system of caring for children in the first year of life, disposable diapers confidently occupy a dominant place, displacing reusable ones. Disposable diapers are a different system for caring for a baby, freeing up time for parents to spend time with the baby, providing real “dry” nights, the possibility of long walks, and quiet visits to medical institutions.

The main “purpose” of application disposable diapers- ensuring dryness of the child’s skin and minimal traumatization. This is achieved by selecting the correct size diaper

Rice. 17.Basic clothing for children of the first year of life

use, timely change and appropriate skin care under the diaper.

A disposable diaper works on the following principle: liquid passes through the cover layer and is absorbed by the absorbent material. This turns the liquid into a gel, which allows it to stay inside the diaper, leaving the surface dry. Nowadays, polyethylene diapers with replaceable absorbent inserts, which retain moisture and create a “compress” effect, are no longer available.

When choosing a diaper, be sure to ask your parents what brand of diapers they use. However, diapers from well-known manufacturing companies do not differ much in their basic characteristics. Thus, a high-end diaper (for example, breathable HUGGIES Super-Flex diapers, etc.) usually consists of 6 main elements:

1. The inner layer, which is adjacent to the baby’s skin, must be soft so as not to cause irritation by friction against the skin, and allow liquid to pass through well.

2. The conductive and distributing layer quickly absorbs moisture and promotes its even distribution throughout the diaper so that it does not accumulate in one place.

3.The absorbent layer absorbs moisture from the conductive layer and retains it inside by turning the liquid into a gel. The amount of absorbent material (absorbent) is not infinite, and at some point the diaper “overflows”, which can be determined by its appearance or feel. This is the main signal that the diaper needs to be changed. If you do not change it, then it continues to function like an impenetrable cloth diaper and acts as a compress with a local increase in temperature and a greenhouse effect.

4.Internal barriers block liquid, preventing it from leaking out the side of the diaper, around the legs. The quality of the internal barriers is an important feature when selecting a diaper for a baby, since the ratio of tightness and elasticity differs in different types of diapers. This determines a number of negative phenomena: moisture leakage when the child moves, pinching or loose coverage of the hips, etc.

5. Outer covering of the diaper. It should not allow liquid to pass through, but it should be porous (breathable). Breathability is ensured by porous fabric that allows air to pass through to the baby's skin, which creates an additional effect of evaporation and increased dryness.

6. Mechanical fasteners. They can be disposable or reusable. Reusable and elastic fasteners are more convenient, as they allow you to refasten the same diaper more than once if necessary. For example, to make sure that the child is dry and not dirty.

When using disposable diapers, it is preferable not to lubricate the skin with anything, but only dry the buttocks. If necessary, use special creams, light lotions or milk for diapers with dosed application through the hands of the caregiver, powders, but not talc or flour. Fatty oils are also undesirable.

If irritation or diaper rash occurs, it is necessary to take air baths as often as possible, and after applying medicinal ointments or creams, you should wait at least 5-10 minutes for maximum absorption, remove any remaining wet wipe, and only then put on a disposable diaper.

It is necessary to change the diaper when it is full and always after bowel movements - this is the most important factor in the prevention of lower urinary tract infections in children, vulvitis in girls and balanitis in boys.

Feeding children in the first year of life. There are three types of feeding: natural (breast), mixed and artificial.

Natural (breast) is called feeding a child with mother's milk. Human milk is a unique and the only balanced food product for a newborn baby. No milk formula, even one close in composition to human milk, can replace it. It is the duty and responsibility of any health professional, be it a doctor or a nurse, to constantly emphasize the benefits human milk, make every effort to ensure that every mother breastfeeds her child for as long as possible.

Mother's milk contains proteins, fats, carbohydrates, macro- and microelements in optimal proportions. With the first drops of milk (in the first 5-7 days after the birth of a child, this is colostrum), the newborn receives a complex of specific and nonspecific protective components. Thus, in particular, immunoglobulins (Ig) of classes A, M, G ensure the transfer of passive immunity factors from mother to child. The levels of these immunoglobulins are especially high in colostrum.

This is why early attachment of the baby to the mother’s breast (some authors now recommend

breathing in the delivery room) improves mother's lactation and ensures the transfer of several (5-8) to tens (20-30) g of immunologically complete protein to the newborn. For example, IgA in colostrum contains from 2 to 19 g/l, IgG - from 0.2 to 3.5 g/l, IgM - from 0.5 to 1.5 g/l. In mature milk, the level of immunoglobulins decreases, averaging 1 g/l, which nevertheless provides natural protection against various pathogenic microorganisms.

Great importance is attached to early breastfeeding - in this case, the newborn's intestinal microflora is better and faster formed. Feeding itself leads to the development of the so-called dynamic food stereotype, which ensures the interaction of the child’s body with the external environment. It is important that natural feeding allows the newborn to better tolerate the conditions characteristic of this period of life. They are called transitional or borderline - this is a transient loss of initial body weight, hyperthermia, etc.

From the moment the baby is first attached to the mother's breast, a special relationship is gradually established between them, and essentially the process of raising the newborn begins.

When breastfeeding, certain rules must be followed:

1. Before feeding, the mother should carefully wash her breasts with boiled water with clean, washed hands.

2. Express a few drops of milk, which removes bacteria from the final sections of the excretory glandular ducts.

3. Take a comfortable position for feeding: sitting, placing your left leg on a stool if feeding from the left breast, and right leg- from the right chest (Fig. 18).

4. It is necessary that when sucking, the child captures with his mouth not only the nipple, but also the areola. The baby's nose must be free to breathe properly. If nasal breathing is difficult, then before feeding, the nasal passages are cleaned with a cotton swab moistened with petroleum jelly or using an electric suction.

5.The duration of feeding should not exceed 20 minutes. During this time, the child should not be allowed to fall asleep.

6.If the mother has milk left after feeding, then express the remaining milk into a sterile container (a bottle with a funnel or a glass). The most effective way is to suction milk using a vacuum device. If it is not available, use a rubber pad or a breast pump with a rubber cartridge. Breast pumps must be sterilized before breastfeeding begins (Fig. 19).

Rice. 18.Breastfeeding the baby in the following position: a - sitting; b - lying down

Rice. 19.Breast pump options

In the absence of a breast pump, milk is expressed by hand. First, the mother washes her hands with soap and wipes them dry. Then he places his thumb and index finger on the outer border of the isola, squeezes the fingers tightly and rhythmically. The nipple should not be touched.

7. In order to prevent the formation of cracks and maceration of the nipples, after finishing feeding, the breasts should be washed with warm water and dried with a clean, thin linen diaper.

When breastfeeding, the child himself regulates the amount of food he needs. However, in order to know the exact amount of milk he received, it is necessary to systematically carry out so-called control feeding. For this, the baby is swaddled as usual before feeding, then weighed (in diapers), fed, weighed again in the same clothes without changing diapers. The difference in mass is used to judge the amount of milk sucked. Control feeding is mandatory if the child’s weight gain is insufficient and if the child is ill.

If the baby has not sucked enough milk, and also if he is sick or the mother is sick, then he is fed or supplemented with expressed breast milk. Store expressed milk in the refrigerator at a temperature not exceeding 4 °C. Within 3-6 hours after expressing and if stored correctly, it can be used after heating to a temperature of 36-37 ° C. When stored for 6-12 hours, milk can be used only after pasteurization, and after 24 hours of storage it must be sterilized. To do this, place a bottle of milk in a saucepan and pour warm water slightly above the level of the milk in the bottle. Next, during pasteurization, the water is heated to a temperature of 65-75 ° C and the bottle of milk is kept in it for 30 minutes; during sterilization, the water is brought to a boil and boiled for 3-5 minutes.

Bottles of expressed milk are stored in the refrigerator at the nurse's station along with formula. Each bottle should have a label that says what it contains (breast milk, kefir, etc.), the date of preparation, and on the bottle of expressed milk the hour of pumping and the mother’s name.

Unnecessary introduction of partial bottle feeding (other food and drink) should be prohibited as this may have a negative effect on breastfeeding. Additionally, breastfeeding mothers should be aware that returning to breastfeeding is very difficult.

If there is a lack of breast milk, an additional feeding system is used. The baby will suckle at the breast while receiving nutrition from a bottle through special capillaries. At the same time, the physiological and psycho-emotional components of breastfeeding are preserved and milk production is stimulated.

When a mother has temporary difficulties feeding her baby with breastfeeding or breast milk, it is recommended to use a soft spoon (SoftCup). The graduated spoon is convenient for feeding thanks to a continuous dosed supply of food. A graduated spoon can be used to feed a child immediately after feeding, during the pre- and postoperative period in children with pathology of the maxillofacial apparatus.

Mixed is called feeding, in which the child, along with breast milk, additionally receives artificial milk formula.

Artificial is called feeding a child in the first year of life with artificial milk formulas.

For hygienically perfect feeding of infants, special utensils are used: bottles made of the purest and heat-resistant glass, nipples made of rubber and silicone and quick sterilizers for them (Fig. 20).

Feeding a baby with formula milk during mixed and artificial feeding is mainly done through a nipple from a bottle. Use graduated bottles with a capacity of 200-250 ml (division price - 10 ml). A nipple with a hole is put on the bottle. A hole is pierced in the nipple with a needle heated over a flame. The hole in the nipple should be small so that when you turn the bottle over, the milk flows out in drops and does not flow in a stream. Formula or milk should be given to the child heated to a temperature of 37-40 ° C. To do this, before feeding, place the bottle in a water bath for 5-7 minutes. The water bath (pan) must be labeled “For heating milk.” Each time you need to check whether the mixture is warm enough and not too hot.

When feeding children with adapted (closer in composition to mother's milk) milk formulas such as “Detolakt”, “Malyutka”, “Bona”, the sequence of preparatory operations is somewhat different. Boiled water is poured into a sterilized bottle, and the dry milk mixture is added with a measuring spoon. Then shake the bottle and put a clean nipple on it. After feeding, wash the bottle with soda using a brush.

Rice. 20.Baby food bottles, pacifiers, pacifiers, thermoses and bottle sterilizers, bottle cleaning brushes

When feeding, the bottle must be held so that its neck is always filled with milk, otherwise the baby will swallow air, which often leads to regurgitation and vomiting (Fig. 21).

The baby is held in his arms in the same position as when breastfeeding, or in a position on his side with a small pillow placed under his head. During feeding, you should not leave the baby; you need to support the bottle and monitor how the baby sucks. You cannot feed a sleeping baby. After feeding you need to carefully

Rice. 21.Correct (a) and incorrect (b) position of the bottle during artificial feeding

but dry the skin around the baby’s mouth, carefully lift him and place him in an upright position to remove air swallowed during feeding.

When feeding a child, every little thing matters. For children prone to hiccups and flatulence, it is better to use so-called exclusive anti-hiccup nipples, for example Antisinghiozzo Kikko, which have unloading channels-grooves for free access of air inside the bottle during feeding. This compensates for the volume of milk sucked by the baby. The process of gas formation is reduced, and thereby the possibility of developing intestinal colic in a newborn and infant. There is a choice of special slots in the nipple for any type of nutrition, so that it is possible to offer the child the right option at the right time (Fig. 22).

Rice. 22.Options for holes in the nipple for various types of artificial nutrition

Rice. 23.Feeding "in the hem"

the pose prevents impaired motility of the gastrointestinal tract, eliminates the possibility of curvature of the child’s spine, and is also comfortable for a nursing mother.

For better absorption of food, it is necessary to adhere to the established feeding hours. If the general condition is not disturbed and the appetite is preserved, then the diet of patients can be the same as for healthy children of the same age (children up to 2 months are fed 6-7 times, up to 5 months - 6 times, from 5 months to 1-1, 5 years - 5 times). If the child is in a serious condition or has poor appetite, they are fed more often (every 2-3 hours) and in smaller portions.

Sick children are sometimes very difficult to feed, not only because they have a poor appetite, but also because of habits acquired at home. Great patience is required, since even a short-term refusal to eat in weak and malnourished children can adversely affect the course of the disease. In hospitals, all formula for children of the first year of life is received in the catering department. Dry formulas in the buffet are converted into ready-to-use formulas immediately before feeding the baby. The type of formula, its volume and frequency of feeding for each child is determined by the doctor.

The younger the child is, the more he needs the most adapted mixtures. Recommended mixtures for feeding children in the first six months of life include Nutrilak 0-6 (Nutritek, Russia), Nutrilon-1 (Nutricia, Holland), Semper Baby-1 (Semper, Sweden) ), “Pre-Hipp” and “HiPP-1” (HiPP, Austria), “Humana-1” (“Humana”, Germany), “Enfamil-1” (“Mead Johnson”, USA), “NAS-1 "(Nestte, Switzerland), Gallia-1 (Danone, France), Frisolak-1 (Friesland Nutrition, Holland), etc.

“Subsequent” mixtures recommended for feeding children in the second half of life: “Nutrilak 6-12” (“Nutritek”, Russia), “Nutrilon 2” (“Nutricia”, Holland), “Semper Baby-2” (“Semper”, Sweden), “HiPP-2” (HiPP, Austria), “Humana-2”, “Humana Folgemilch-2” (“Humana”, Germany), “Enfamil-2” (“Mead Johnson”, USA), “NAS-2” (“Nestte”, Switzerland), “Gallia-2” (“Danone”, France), “Frisolak-2” (“Friesland Nutrition”, Holland), etc.

For children of the first year of life, in addition to sweet adapted formulas, adapted fermented milk formulas have been created: liquid fermented milk mixture “Agusha-1” (Russia) for children aged 2-4 weeks to 5-6 months; “Baby” (Russia); “NAN fermented milk” (“Nestb”, Switzerland) with bifidobacteria, “Gallia lactofidus” and “Lactofidus” (“Danon”, France). Partially adapted acid-

There are also infant formulas that are prescribed to newborns with low birth weight (Alprem, Humana-0), with intolerance to milk sugar (A1-110, NutriSoya), with polyvalent allergies to cow's milk proteins, soy , severe diarrhea (“Alfare”, “Prosobi”, “Portagen”, “SimilakIzomil”).

When artificial feeding, the volume of milk formula sucked is determined using the graduated scale of the bottle. The amount of milk sucked from the mother's breast or formula from a bottle is noted after each feeding on an individual nursing sheet filled out for each infant.

Already in the first year of life, starting from the 4-5th month, the child is gradually accustomed to new types of food (complementary feeding). When introducing complementary foods, certain rules must be followed. Complementary foods are given before breastfeeding or formula feeding, and from a spoon. Complementary feeding dishes include porridge, vegetable purees, meat hashes (minced meat, meatballs), yolk, broth, cottage cheese, etc. Since the child begins to sit at 6 months, he should be fed at a special table or sitting on the lap of an adult. When feeding the baby, an oilcloth apron or just a diaper is tied to the chest.

The timing of introducing complementary foods into the diet of breastfed children is regulated by the Institute of Nutrition

RAMS (Table 12).

Table 12.Timing for introducing complementary foods during breastfeeding

children's research institute

In the first year of life, especially in infant wards, sterile feeding utensils should be used for feeding.

Feeding premature babies - an extremely difficult and responsible task. Premature babies who lack swallowing reflex or breathing stops during feeding, receive feeding through a tube (Fig. 24). Feeding with a disposable tube is carried out when it is inserted into the child’s stomach for only one feeding, and permanent when the tube is left in the stomach for 2-3 days. A permanent probe, unlike a disposable one, is smaller in diameter, so it can be inserted through the nasal passages, although inserting a probe through the mouth is considered more physiological, since external respiration is not disturbed.

Rules for sterilizing nipples and bottles. Dirty nipples are thoroughly washed first with running water, and then with warm water and soda (0.5 teaspoon of baking soda per glass of water), and they are turned inside out. Then the nipples are boiled for 10-15 minutes. Nipple sterilization is carried out once a day, usually at night. It is carried out by the ward nurse. Clean rubber pacifiers are kept dry in a closed (glass or enamel) container labeled “Clean pacifiers.” Clean nipples are taken out with sterile tweezers, and then put on the bottle with clean, washed hands. Used pacifiers are collected in a container marked “Dirty pacifiers.”

Bottles are sterilized in the pantry. First, the bottles are degreased in hot water with mustard (50 g of dry mustard per 10 liters of water), then washed with a brush, rinsed with running water

Rice. 24.Feeding a premature baby through a tube

outside and inside (use a device in the form of fountains for rinsing bottles) and rinse. Clean bottles, neck down, are placed in metal nets, and when the remaining water has drained, the bottles in the nets are placed in a dry-heat oven for 50-60 minutes (temperature in the oven is 120-150 °C).

Bottles can be sterilized by boiling. To do this, they are placed in a special container (tank, pan), filled with warm water and boiled for 10 minutes.

Store sterile bottles with necks closed with sterile cotton-gauze swabs in separate cabinets designated for this purpose.

Observation and recording of stools. In newborns, the original feces (meconium), which is a thick, viscous mass of dark color, passes by the end of the first day of life. On the 2-3rd day, the so-called transitional stool appears, having a mushy consistency and a darkish color, and then normal yellow stool with a sour odor appears. The frequency of stool in newborns is 2-6 times a day, by a year - 2-4 times a day.

The nature and frequency of stool depend on the type of feeding. When breastfeeding, stool occurs 3-4 times a day, yellow, mushy, with a sour odor. With artificial resuscitation

When pouring, stools are observed less often - 1-2 times a day, more dense, shaped, light green, sometimes grayish-clayey, the consistency resembles putty, with a pungent odor.

Loose stools can be due to digestive disorders; the color of the stool changes, pathological impurities appear in the form of mucus, greenery, blood, etc.

The nurse must be able to determine the nature of the stool, since its appearance can reveal the initial signs of the disease. You should report any pathological changes in your stool to your doctor and show your stool. The nursing report must indicate how many times the stool has occurred, and a special symbol indicates its character: mushy (normal); liquefied; mixed with mucus; with an admixture of greenery; blood in stool; decorated chair.

Prevention of skeletal deformities. Skeletal deformities occur if a child lies in a crib for a long time in one position, with tight swaddling, with a soft bed, a high pillow, or with an incorrect position of the child in his arms.

In order to prevent skeletal deformations, a thick mattress stuffed with cotton wool or horsehair is placed on the crib. For children in the first months of life, it is better to place a pillow under the mattress: this prevents excessive bending of the head and also prevents regurgitation.

The baby in the crib must be placed in different positions and periodically picked up.

When swaddling, it is necessary to ensure that the diapers and vests fit loosely around the chest. Tight swaddling and constriction of the chest can lead to deformation of the chest and breathing problems.

Given the weakness of the muscular-ligamentous system, children under 5 months of age should not be seated. If the child is picked up, then the buttocks should be supported with the forearm of the left hand, and the head and back with the other hand.

Transportation of infants. Transporting infants does not present any serious difficulties. Children are usually carried in their arms (Fig. 25, a). It is necessary to use the most physiological and comfortable position. This position can be created by using only one hand to carry the child, and leaving the other free to perform various manipulations (Fig. 25, b, c).

Rice. 25.Ways to carry an infant. Explanation in the text

Rules for using the incubator. Incubators are used to care for weakened newborns, premature babies and children with low body weight. Kuvez is a special medical incubator in which constant temperature, humidity and the required concentration of oxygen in the air are maintained. Special devices allow you to organize the necessary care for the child, carry out various manipulations, including weighing, without removing the child from the incubator (Fig. 26). The upper part of the incubator is transparent, made of organic glass or plastic, which allows you to monitor the condition and behavior of the child. A thermometer and a hygrometer are mounted on the front wall of the hood, based on the readings of which one can judge the temperature and humidity of the air inside the incubator.

Before use, the incubator must be well ventilated and disinfected. According to the operating instructions, it is recommended to disinfect the incubator with formaldehyde. To do this, place a piece of cotton wool moistened with a 40% formaldehyde solution under the hood and turn on the incubator for 6-8 hours, after which the cotton wool is removed and the incubator is left turned on with the hood closed for another 5-6 hours. In addition, the inner walls of the hood, the bed for The child and the support mattress are thoroughly wiped with a 0.5% chloramine solution.

The incubator is turned on in the following sequence: first, the water evaporation system is filled with water, then it is connected to the network, then the required microclimate is selected by smooth rotation of the temperature and humidity regulator.

Rice. 26.Closed type couvez

The child in the incubator is naked. A constant temperature of 34-37 °C and relative air humidity of 85-95% are maintained. Oxygen mixed with atmospheric air is supplied to the incubator, and the oxygen concentration does not exceed 30%. A special alarm system notifies with a sound signal about violation of parameters.

The length of stay in the incubator is determined by the general condition of the child. If a newborn stays in it for more than 3-4 days, then microbial contamination increases significantly. By existing rules in this case, the child should be transferred to another incubator, washed and ventilated.

Nursing premature babies in an incubator for 3-4 weeks significantly increases the effectiveness of therapeutic measures and nursing, and reduces the risk of various complications.

Rice. 27.Rehabilitation bed for newborns with neurological pathology

Rehabilitation bed for newborns and infants. For premature newborns and infants with neurological pathology, special bed-baths (such as “Saturn-90”) are used, which provide comfort for a sick child by creating a buoyancy effect and simulating conditions close to those in the womb. The lowest possible contact pressure on the child’s body prevents microcirculatory and trophic disorders. The device is a stainless steel bath with a porous bottom filled with glass microbeads. Under the bathtub on the frame there is a supercharger, a unit for stabilizing the temperature of the discharged air, a control and automatic control system. A filter sheet separates the child's body floating in the “dry liquid” from the glass microbeads (Fig. 27).

CONTROL QUESTIONS

1.Which persons are not allowed to care for infants?

2.What is the care of the skin and mucous membranes of a newborn and infant?

3.How is a hygienic bath performed?

4.What is included in the clothing set for children in the first months of life and the second half of the year?

5.Name the rules for breastfeeding a child.

General child care: Zaprudnov A. M., Grigoriev K. I. textbook. allowance. - 4th ed., revised. and additional - M. 2009. - 416 p. : ill.