Rus Articles Journal

The kid in maternity hospital of

the First days of life - the most difficult for the newborn. It came to the world, new to it. It for the first time began to breathe, eat independently, came into contact with a set of microbes. It has all for the first time. Therefore newborns together with mothers spend the first week of life in maternity hospital where obstetricians and children`s doctors carefully watch their state.

the first minutes of life

Right after the child was born, to it are cleared by airways of excess of slime and moisture for simplification of breath, put on mother`s stomach, cut umbilical kanatik and on the formed stump impose a special bracket. Then once dig in in eyes 2 drops antiseptics - 1% solution of nitrate of silver for the prevention of possible infection of a conjunctiva of the newborn of a gonokokkama when it passed through patrimonial ways. If mother has a negative Rhesus factor, then from an umbilical cord (from the maternal rest) take blood, define group and a Rhesus factor. Only after this kid transfer to special children`s office.

allocate to

In physiological office along with posts for healthy newborns a post for premature and the children who were born in asphyxia, had a pre-natal hypoxia, a patrimonial trauma, and other children from risk groups.

Each child at receipt in office for newborns during the entire period of stay is under fixed round-the-clock supervision of medical personnel. In office of newborns it is strictly carried out sanitarno - the anti-epidemic mode, rules of the existing normative documents are accurately carried out. In each postnatal chamber there is all necessary for care of newborns, including a sink for washing and a podmyvaniye of kids under flowing water.

At reception of the child in chamber the nurse verifies documents - the text a brasletok, a medallion and history of development of the newborn, - notes exact time of reception and feature of a condition of the child: activity of shout, existence of short wind, coloring of integuments; weighs the kid, writes down his body weight and temperature in the special column of history of development of the newborn.

After reception of the child in children`s office the nurse starts secondary processing of the newborn. If the condition of the child allows, she washes it, processes leather and skin folds, swaddles.

Daily procedures

In offices of newborns work with

specially pro-thinned out pediatricians. They are called by neonatologam. Neonatolog performs obligatory daily inspection of children, and after round of children`s chamber daily tells mothers about health of each kid, including about how it should it look after after an extract from maternity hospital.

Pediatric survey includes the general survey of the newborn at which the doctor pays attention to color of integuments and visible mucous membranes, physical activity, a condition of a muscular tone, expressiveness of unconditioned reflexes. Already in maternity hospital to the kid will surely conduct examination of hearing. The doctor - neonatolog will daily carry out an activity assessment warmly - vascular, respiratory, digestive, urinary and sexual systems and if in it there is a need, will invite for more profound survey of any separate system of narrower expert (the oculist, the surgeon, the neurologist). At suspicion on a disease of the central nervous system of maternity hospital to the child can conduct ultrasonic examination of a brain through a big fontanel - a neyrosonografiya.

Processing of a stump of an umbilical cord and umbilical wound are carried out by the pediatrician at daily survey of children. If at the birth the bandage is applied the funic rest, then the doctor removes it for the second day of life of the newborn. The funic rest and leather around it are processed daily at first 95% ethyl alcohol, and then 5% solution of permanganate of potassium, without touching skin. The umbilical cord of each child is processed an individual stick with cotton wool which is moistened in 5% solution of potassium of permanganate just before the use. If the funic rest is badly mummified (dries up), then in the first days it is in addition tied up, and the nurse during each swaddling processes an umbilical cord solution of permanganate of potassium (potassium permanganate). Removal of the funic rest on 2 - 3 is possible - and days - carries out procedure neonatolog by means of scissors.

At falling away of the funic rest an umbilical wound is daily consistently processed 3% peroxide of hydrogen, 95% ethyl alcohol and 5% solution of potassium of permanganate, without touching skin around an umbilical ring. Conditioning agents behind an umbilical cord and an umbilical wound, integuments and mucous train the newborn for each swaddling of children.

are carried out by

In maternity hospital of weighing of the child daily, any changes of his body weight which to some extent corresponds to a condition of the newborn are considered. So, in ordinary representation big weight is identified with the fortress and health, and small - with weakness and diseases. This very approximate judgment: the mass of newborn from 2,5 to 4 kg is considered normal. All children on 2 - 3 - y lose day of life on average till 200 - 300. It is so-called physiological loss, it is called still the maximum decrease of weight and connected with hydrophily change (ability to accumulate water) of tissues of the newborn and insufficient ability to assimilation of food. In the next days (by the time of an extract from maternity hospital) this loss is, as a rule, made up. On the second week of life body weight is restored completely and begins to increase naturally.

Analyses

In maternity hospital to each kid carry surely out by

analyses on a number of a serious congenital illness, such as a fenilketonuriya and a hypothyroidism. Their early diagnostics is especially important, health, intellectual and mental development of the child during all his life directly depends on terms of the beginning of special treatment.

Fenilketonuriya`s

is a congenital, descended metabolic disorder. As its reason serves insufficiency of a certain enzyme, namely phenylalanine - hydroxylases. It is necessary for a normal exchange of amino acids of which proteins - “bricks“ of a human body are under construction. For lack of this enzyme there is no phenylalanine amino acid transformation into other amino acid - tirozin. As a result sharply phenylalanine levels in blood and its derivative - a fenilketon increase in urine. The collecting phenylalanine influences the central nervous system of the kid. The heaviest complication of a disease - a delay of mental development which for lack of treatment is almost inevitable.

Blood tests on a fenilketonuriya take

from all newborns in maternity hospitals now. If the analysis finds the high level of phenylalanine, further researches are necessary for confirmation of the diagnosis. Importance of preliminary analyses at newborns is connected with what displays of a disease, especially a delay of mental development, it is possible to prevent only a diet with small amount of phenylalanine. Special nutritious mixes are for this purpose developed. Therefore it is extremely important to establish the diagnosis in the most initial stage in maternity hospital or, at least, not later than 2 - go month of life when the first symptoms of an illness can be shown. For this purpose all newborns are examined regarding increase of concentration of phenylalanine in blood and urine in the first weeks of life. The carried-out analyses belong to the category approximate therefore at positive results special inspection with use of exact quantitative methods of determination of content of phenylalanine in blood and urine is required (a chromatography of amino acids, use of aminoanalyzers, etc.) which is carried out by the centralized biochemical laboratories.

In maternity hospital conduct also a blood test for an exception of such disease as a hypothyroidism at which deficiency of hormones of a thyroid gland is observed. In the absence of treatment this disease results in heavy intellectual backwardness.

the Congenital hypothyroidism meets on average in 1 case on 4000 newborns. Its prenatal diagnostics is still complicated. And right after the birth clinical manifestations are observed no more than at 10% of newborns with this disease. Practically all newborns with a congenital hypothyroidism look usually, without differing in anything from ordinary children.

Therefore the most reliable way to reveal this disease - the program of mass inspection of newborns which works in our country since 1994. Main goal of screening - early (in the first 2 weeks of life) diagnostics and therapy of a disease as each missed day without treatment at the child with a congenital hypothyroidism leads to irreversible changes in cells of a brain owing to what the kid becomes a disabled person.

- e days at full-term and on 7 - 14 - e - take

In all maternity hospitals of our country on 4 - 5 several drops of blood from patches from premature children and apply on the special paper form which is sent to the regional physician - genetic laboratory. In the prenatal record of the kid a mark about the carried-out test is given.

be convinced by

At an extract from maternity hospital that to your kid screening - the test for a fenilketonuriya and a hypothyroidism is carried out.

If results screening - the test for a congenital hypothyroidism and a fenilketonuriya normal, then is not reported about it to parents, in children`s policlinic. If violations are revealed, then call parents with the kid for carrying out the repeated analysis. If the disease is revealed, it is very important to begin treatment with preparations of hormones of a thyroid gland at once. If to begin treatment later 14 - go day of life, there is a high probability that the child will lag behind in nervously - mental development, there can be difficulties when training at school. Further process of treatment of such children has to be under control of the doctor - the endocrinologist.

the First inoculations are made by

of the Inoculation to the child in maternity hospital. Your kid was just born, and in the first days of life the first vaccination against hepatitis B is necessary to him - it is carried out within 24 hours after the birth, the injection is given in a hip.

the Second inoculation which is also carried out in maternity hospital, - against tuberculosis. It is done to all healthy newborns on 5 - 7 - y day of life by intracutaneous introduction of a vaccine of BTsZh representing culture of the weakened tubercular sticks. On the place of introduction of a vaccine on skin of an external surface of the left shoulder by the time of the newborn`s extract from maternity no traces stay at home. But in 4 - 6 weeks in the place of introduction of a vaccine there is an infiltrate (consolidation) with a diameter of 3 - 8 mm, then there is a pustula (gnoynichok) reminding a bubble then the crust and, at last, the small involved scar remaining for the rest of life is formed. Yet the scar is not formed, the place of introduction of a vaccine needs to be preserved against pollution and injuries: not to rub its sponge during bathing, to protect from friction about clothes. There is no need it something to grease, to cover with cotton wool or bandage. At a considerable inflammation and furthermore - at emergence of symptoms of suppuration of the child it is necessary to show to the doctor immediately.

If after a tuberculosis inoculation remains no trace, it is impossible to be sure that immunity developed in a due measure. About it it is necessary to consult also surely with the doctor.

If the child lies separately from mother...

the Approximate daily routine for the newborn who is in children`s chamber separately from mother, is as follows:

is In children`s chamber 4 - 10 kids. The nurse has an opportunity to watch all kids as partitions between chambers, as a rule, glass. Kids lie in special transparent plastic beds. In the same beds their each 3 hours bring to mothers on feeding.

If the kid is in children`s chamber, then in many maternity hospitals the desire of mother concerning feeding is considered. So, if mother insists on breastfeeding, then the kid is not given anything, except a mother`s breast. If mother does not insist only on breastfeeding, the child can be finished feeding the adapted dairy mix, especially at night. Glucose solution refused practice of a dopaivaniye of the kid now.

Washing, processing of skin, skin folds the nurse repeats

at each reswaddling. In the oseena - winter time of the child swaddle in a blanket or an envelope with the blanket enclosed in it, and in a hot season - only in diapers or an envelope. All diapers used for newborns are processed in special autoclaves (devices where the high temperature allowing to disinfect linen is created). They are changed in process of pollution and when swaddling before each feeding. At the full-term children the head leave uncovered. From the second day of life of the full-term children swaddle with open hands (free swaddling). In this case use baby`s undershirts with the long opened sleeves that there was free access of air to skin folds.

in the Morning before the first feeding the nurse washes away

children under the crane, then takes them temperature and weighs, makes a morning toilet which includes processing of eyes, the nasal courses and faces. The nasal courses and external acoustical passes clean only if necessary the sterile cotton wool twisted zhgutiky and moistened in sterile vaseline oil. At an extract delay from maternity for various reasons for the newborn at absence on it contraindications spend daily bathings with addition in a bathtub with water of solution of permanganate of potassium 1:10 000 at home (1 ml of 5% solution on 100 ml of water).

by

Joint stay of mother and kid

In many maternity hospitals created chambers of joint stay of mother and the child where the children`s sister helps to look after newborns in the first days to mother. In the next days the woman in childbirth herself looks after the baby under control of the children`s sister and pediatrician. If for any reasons (for example, for health reasons mothers) the kid from chamber of joint stay is temporarily transferred to the general children`s chamber, the duty nurse constantly will observe and look after him there therefore to worry that the kid will remain without supervision it is not necessary.

At an opportunity should give preference to joint stay of mother and child. Such stay considerably reduces the frequency of diseases of women in childbirth in the postnatal period and the frequency of diseases of children. At the same time mother actively participates in care of the kid that limits contact of the child with personnel of obstetric office, creates favorable conditions for settling of an organism of the newborn microflora of mother, reduces a possibility of infection of the child with the microbes living in maternity hospital. At such mode the kid at a satisfactory condition can be put to a breast on demand. Joint stay of mother and child, breastfeeding promote fast adaptation both in the postnatal period and an early extract from a hospital.

the Approximate daily routine for the newborn at joint stay with mother practically does not differ in

from that which is offered usually during this period. The only difference is that at joint stay there is a continuous contact of mother with the baby, and therefore more frequent (on demand) applying to a breast that is more favorable as promote approach of an early lactation, good reduction of a uterus, faster obtaining skills on care of the child. At joint stay of mother and kid all manipulations necessary for care of the kid, mother carries out. In the first swaddling the children`s sister will train mother in necessary skills. If something is impossible, then it is always possible to ask for the help the duty nurse. As a rule, if it is heavy to mother to cope with new obyazannostto hole, there is also an opportunity to send the kid to the nursery - if not for all day then for the night.

the Extract

At an uncomplicated current of the postnatal period at the woman in childbirth and the early neonatal period at the newborn, at the disappeared umbilical cord and a good shape of an umbilical wound, positive dynamics of body weight of the child and on condition of the correct and timely patronage mother with the child can be written out home on 4 - 5 - e days after the delivery.

Before an extract from maternity hospital the pediatrician in each chamber leads discussion with women in childbirth about leaving and feeding of the child in house conditions, and the duty nurse processes and swaddles the child, dressing it in in advance brought house clothes.

Air temperature of the vypisny room (22 - 24 ° C) it is daily controlled. Swaddling of children is made on specially established pelenalny tables which after each child are processed by freshly cooked disinfecting solution. For observance of necessary continuity in service of the newborn between maternity hospital and children`s policlinic the pediatrician of maternity hospital notes the main information about mother in the prenatal record: a state of her health, features of a course of pregnancy and childbirth taking place surgeries, the newborn`s assessment on a scale Apgar, the events held in the delivery room (if the child needed them). In the prenatal record also features of a current of the early neonatal (postnatal) period are noted: time of falling away of an umbilical cord and condition of an umbilical wound, body weight, length, circles of the head and breast, state at the time of the birth and at an extract, date of vaccination and a series of a vaccine of BTsZh (if did not do - justification of its branch), data of laboratory and other inspections, including tests on a fenilketonuriya and a hypothyroidism. In case of incompatibility of blood of mother and the newborn on a Rhesus factor - accessories or on AVO - system (blood type) in the prenatal record note a Rhesus factor - accessory, a blood type of mother and child and indicators of blood of the kid in dynamics.

a condition of the kid will be watched further by the pediatrician and other specialists of children`s policlinic or medical center.