Premature children: care in maternity hospital of
your child was born before the put term. It looks much less than the peers who were born in time. Your heart can clench for fear when you for the first time see it. How to address with so tiny and defenseless creation?
In the rodzal
Obstetricians - gynecologists know: the obstetric care to premature children should be given very carefully not to injure them and not to put pressure upon the head. After separation from mother they are transferred to in advance prepared warmed pelenalny table, under beams of an electric reflector. All manipulations of the first toilet make carefully, but quickly and accurately. Then the child is wrapped in warm, sterile diapers, in a blanket with a hot-water bottle or placed in the warmed portable couveuse and brought to chamber for premature children. From clothes such remains right after the birth especially suit soft flannel jackets with a hood and long sleeves. It is recommended to put on a hat and socks the head and legs at once.
Not all children born before “official“ term by all means get to the offices specializing in nursing of premature. Making the decision on need of the placement of the kid who was born before term to the intensive care unit or intensive therapy of newborns, doctors consider not only its gestational age (pregnancy time in which the kid was born), but also a ratio of weight and growth, existence of trouble breathing, congenital anomalies or malformations, diseases, especially infectious, and many other factors.
If, according to doctors, the condition of the newborn does not pose threat of his life and to health, the child is written out home in usual terms.to
If needs reanimation...
So, first possible stage of nursing children`s reanimation. In case of considerable immaturity of the vital systems of the newborn (for example if the premature child is not able to breathe independently), he right after the birth gets to office of children`s reanimation. Here kids lie in the special couveuses closed by transparent caps with four openings - on two from each party (for medical manipulations). All couveuses are supplied with medical ventilators.to
Children at whom is absent or poorly expressed a sosatelny reflex, the first several weeks receive food - the warmed-up maternal milk, sometimes with specially picked up additives - through a probe - the thin tubule entered into a stomach.by
In the couveuse maintains the constant temperature (danger is constituted not only by overcooling, but also an overheat) and humidity of air (about 60%) that at the child mucous membranes did not dry. Sometimes couveuses are supplied with water mattresses which bring closer conditions to stay in amniotic liquid. By means of numerous tubes and wires the kid is connected to the monitors, droppers and other devices which are controlling his pulse, temperature and breath, regularly carrying out blood tests, and also entering necessary drugs and carrying out a set of other important functions. If the indicators registered by these devices dangerously deviate norm, the alarm signal is distributed.
Resuscitation procedures are not limited to artificial ventilation of lungs and giving of food through a probe. The children who were born prematurely are endangered developments of various complications, the majority of which at modern development of neonatal reanimation can be prevented or cured. For example, in lungs, as we know, there is a process, major for human life, - gas exchange: oxygen of air passes into blood, and carbon dioxide - from blood in air. The tiny bubbles braided with a network of capillaries - alveoluses are responsible for it. The substance counteracting fall of alveoluses in lungs during an exhalation, so-called surfactant is formed only on 22 - 24 - y to week of pregnancy therefore deeply premature children need introduction of artificially synthesized surfactant. Such examples it is possible to give a set.
When the child is able to breathe independently and need for artificial ventilation of lungs disappears, the second stage of nursing which is usually carried out in an intensive care unit of newborns begins. Here premature children are also located in couveuses. Unlike intensive care units, intensive care units are not equipped with medical ventilators. Additional supply of the moistened and warmed up oxygen in couveuses, and also optimum moisture and temperature condition nevertheless here is provided. The child is in the couveuse until is able independently to maintain body temperature and to do without additional supply of oxygen.the Method “kangaroo“
is taken by
for granted Today the fact that during stay in a hospital the premature child needs communication with mother. The kid has to hear a maternal voice, feel its heat, and it is reached by the kangaroo method. This method of nursing of premature children was for the first time applied in that poor and underdeveloped countries where for purely economic reasons there were no means to provide all premature children with the couveuses equipped with the equipment for maintenance of constant temperature.
the Essence of a method consists that the child is nursed, being in direct contact with mother`s skin, - at it on a breast and a stomach. Mother puts on the free, undone in front clothes, and are put on the child a diaper and sometimes - a hat. The kid is located between breasts, the clothes are clasped in order to avoid loss of heat. Temperature of the kid is controlled by the nurse or monitors.
of Research was shown that maternal warmly perfectly warms the child and temperature of his body is maintained up to standard. Breath also becomes more correct and stable as well as heartbeat, and blood saturation by oxygen. Besides, skin of the newborn becomes populated by microflora of mother that promotes recovery processes. It is possible to pass to this method of nursing when at rather satisfactory condition the kid still needs artificial thermal control and supervision over heartbeat and breath.
In large maternity hospitals for premature children are allocated by the separate chambers which are specially equipped and served by the most qualified personnel. Where there is no opportunity to allocate separate chamber, partitions separate the most well lit and aired part of a nursery which is warmed and as appropriate equip. Air temperature is maintained in limits 23 - 27 ° With, and in a bed - 25 - 30 ° C. Near the child under a blanket for exact control put the thermometer.the First feeding of the premature child usually begins
in 6 - 8 hours after the birth. Frequency and methods of feeding are defined according to degree of prematurity and other specific features.
As the premature kid
Appearance and behavior of the newborn premature child looks depend on his gestational age (number of full weeks of pregnancy by the time of the birth). Its constitution is very peculiar: the head is rather big, cranial seams are often open, small and lateral fontanels have the big sizes. At boys testicles can be not lowered in a scrotum, and at girls vulvar lips are underdeveloped.
the Premature newborn differs in a number of anatomic features: weight it usually is lower than 2500; height less than 45 cm, and a head circle, on the contrary, on 3 - 4 cm exceeds a breast circle. Therefore the head seems big in comparison with a trunk, seams and fontanels (small - in the field of a darkness and big - it is necessary a forehead) - wide; ears very soft and densely adjoin to a skull; skin is thin, plentifully covered with a down, especially on a face, cheeks, a forehead. The layer is expressed to Podkozhnozhirova slightly. At deeply premature children the hypodermic fatty layer completely is absent. The thin voice, sometimes similar to peep, is a consequence of an underdevelopment of vocal chords. The navel is located low. Walls of vessels are poor in elastichesky fibers owing to what at the time of delivery there can be intra cranial hemorrhages.
As the term of pre-natal development of premature children was less, the individual food, warmth and protection coming from the outside are necessary for them. At kids ability to suck a breast and therefore sometimes at first they should be fed through a probe or even intravenously can be not completely developed. Besides, they have less than the level of glucose in blood from - for immaturity of a liver. The immune system of these children is weak therefore they are often placed in a special incubator where they are protected from an infection and receive necessary heat. Sometimes they need an artificial respiration as in their lungs is not enough superficially - the active agents (surfactant) facilitating intake of air. In these cases carry out ventilation of lungs. Unconditioned reflexes at premature children are weak and die away very quickly, and at deeply premature often are absent, including even the vital reflexes - swallowing and sucking. The muscular tone can be lowered (in this case the kid is relaxed, lies with raskinuty handles and legs) or, on the contrary, is raised (handles and legs are pressed to a trunk, are hardly straightened). Owing to immaturity of the center of thermal control premature cannot maintain body temperature up to standard therefore they are easily cooled and do not even react rise in temperature to infectious diseases. Respiratory, digestive, it is warm - vascular, nervous and other systems at them are underdeveloped (in comparison with the full-term babies) and have a number of features which define the course of diseases at this group of children. The visual system ripens approximately between 22 - y and 34 - y for weeks of pregnancy therefore first premature kids spend not enough time with open eyes and do not focus a look. By 30 weeks of the period of pre-natal development they already react to bright light, blinking or narrowing eyes, and at soft lighting open eyes, consider surrounding objects and focus on them a look, however, focusing of a look takes them more time, than the full-term children.the Behaviour premature differs in
from behavior of other newborns a little: they have more deep sleep, the smaller number of the movements, the reduced general physical activity, thin monotonous shout, they experience negative emotions more often and show discontent.
Immaturity of systems of an organism, in general characteristic of newborns, at premature is expressed especially sharply and is especially slowly liquidated. So, violations of thermoregulation are a consequence of an underdevelopment of the centers regulating heat and big loss of heat.
Knows that the relative surface of a body (per unit mass) at premature is more, than at the full-term children. Some role in big loss of heat is played by lack of a podkozhnozhirovy layer, and also insufficiency of oxidizing processes and a metabolism in general. Therefore premature children should be preserved especially against cooling, overheating, sudden and sharp fluctuations of surrounding temperature.
Breath at premature speeded more up, superficial, spasmodic. (Sharp oxygen insufficiency owing to respiratory standstill) children weighing up to 2 kg are especially subject to asphyxia attacks: at various manipulations (swaddling, feeding), and sometimes and at rest the child suddenly ceases to breathe, becomes blue and in such state can remain within several seconds. Then most often it independently comes back to a usual state. Otherwise the artificial respiration or grinding of a chest wall, oxygen inhalation or maybe even a hot bathtub are required for it (water temperature - to 39 - 40 ° Ń). If such phenomena are observed, the kid should be shown to the doctor. Often in such cases it for some period is placed in a special bed with an adjustable temperature and supply of oxygen for creation of comfortable living conditions, necessary for it for more successful passing of the period of adaptation to world around after the birth.the Gastrointestinal tract of the premature child also so far works with
not at full capacity. Weakness of sosatelny movements from - for immaturity of a sosatelny reflex can be noted, and it makes one of the main difficulties of feeding of such newborn. It is important to know that immunity (protective forces) to an infection at premature children is, as a rule, reduced. Therefore they are easily subject to any viral infections (for example, to flu), to pneumonia, septic diseases. Therefore, the premature child should be protected from any contacts with other people, now his destiny completely depends on degree of immaturity, environmental conditions, careful leaving and food.
Preservation of optimum temperature of the room in the first days of life is extremely important
“Hothouse conditions“ not only for a survival, but also for further full development of premature newborns which allows still insufficiently mature organism to resist to aggressive influence of external factors of the environment because possibilities of thermal control are limited. It is caused by rather bigger surface of integuments in comparison with body weight that leads to considerable loss of heat. Insufficiency of development of a hypodermic fatty layer in combination with the expressed network of vessels of skin also promotes the strengthened thermolysis. Therefore premature children are easily cooled, and excessive external warming quickly leads to overheating that creates certain difficulties in the course of care of them. This circumstance was the cause of development of systems of medical equipment which could model thermal comfort of external environment, comparable with “maternal heat“, so necessary to the premature child for maturing.
In maternity hospitals and offices for premature children in special children`s hospitals are used by couveuses. The simplest of them has an appearance of the bathtub opened from above with double walls between which hot water (its temperature to 50 - 60 ° circulates; Ń). The latest models have electric heating of water with regulation of its temperature and humidity of air and with automatic supply of oxygen.
Incubator (kuvezny), with an individual microclimate the method of nursing is the most effective. It is characterized by creation of physiological conditions from first minutes of extra uterine existence. Optimum temperature and humidity are maintained in the couveuse. It allows to reduce power costs of the child of preservation of body temperature, loss of liquid through skin and at breath.
Terms of stay in the couveuse depend on body weight at the birth, a maturity and the general condition of the child. Children with small degree of prematurity are in the couveuse 2 - 4 days or several hours, deeply premature children with body weight till 1500 - 8 - 14 days, and with a weight till 1750 - 7 - 8 days.