General and special care for some groups of newborns

May 30, 2018 08:00 | Baby Diseases
The newborn, transferred from the delivery room after a thorough examination, is taken to the sector or ward for the newborn. Sorting is carried out, which is especially important for children with birth trauma, after asphyxia( primary or secondary), prematurity, etc.

In the first hours after birth, newborns need to be monitored for possible bleeding from the navel. Particular attention is required by children born in asphyxia, with cardiovascular and pulmonary abnormalities. It is obligatory to examine the navel's area for the second hour of life( before it's better, if the newborn remains in the delivery room) and three more times during the first day. Re-bandaging the umbilical cord is sometimes a measure that saves a child's life.

In the first hours of life, newborns often experience vomiting. In premature infants and children in serious condition, vomit( mucus, meconium, blood) can aspirate into the lungs and cause a number of complications. The tender skin of the newborn in contact with emetic matters is irritated, so it must be lubricated with suitable sterile fats containing vitamins A, D, and often change the laundry.

In case of good observation, secondary asphyxia, cyanosis, convulsions, etc. are detected in a timely manner. When and how breathing is restored, normal skin color, determine the nature of seizures, the frequency of cardiac activity, etc., are important data for diagnosis and treatment.

Observing the appearance of jaundice in a newborn and especially the increase in its intensity in the first hours after birth, timely carrying out the necessary to clarify the diagnosis of studies are crucial for the successful treatment of the newborn( exchange blood transfusion, medication, etc.).

The first hours also reveal the presence of fractures and pareses that were not recognized immediately after birth, and anomalies, especially those in the presence of which immediate surgical intervention is necessary.

Particularly important is the first feeding. The further lactation, prevention of cracking of the nipples, etc., depends on the way the baby is applied to the breast. Since the birth of the baby, a certain regime is necessary with respect to feeding, sleeping, toileting, etc. When the regime is disturbed, the children become uneasy, the work of the department is upset,individual hours of the day are overloaded by the staff, which prevents correct execution of manipulations, and in the home environment tires the mother and loved ones.

In the enumerated groups of children toilet, diaper change, watering, etc., do not differ from those of healthy newborns, except in cases when there are contraindications.

Care for babies born to mothers with late toxicosis of pregnancy .In this state of the mother, due to a metabolic disorder and a malnutrition of the fetus through the placenta, the normal development of the newborn is disrupted. In mild forms of the disease, children are born in a relatively good general condition, relatively quickly adapt to the environment, but their weight is less than the weight corresponding to maturity. In severe forms, significant hypotrophy, a general condition is impaired, resistance to infection and environmental adaptability are reduced. These disorders in a newborn can be explained by prolonged hypoxia - changes in the placenta, metabolic disorders in the mother and fetus, etc. The type of such children is quite characteristic. Such children are small, with dry skin and a decreased turgor, with subnormal temperature. After birth, they are more and more seriously ill, perinatal mortality among them is higher and the percentage of anomalies is higher. They badly suck, quickly lose and difficult to restore weight. Lactation in the mother usually begins later, hypogalactia is often observed. All this progressively increases hypotrophy. There is a well-known relationship between the severity of a mother's condition before childbirth and the condition of a child after birth. In serious condition there are children, whose mothers and before pregnancy suffered from kidney diseases( so-called transplanted nephropathy).

The method of caring for such children is determined not only on the basis of weight, but after a thorough careful evaluation of the condition and on the basis of the maturity of the newborn. Assign an individual diet with the addition of proteins to correct hypoproteinemia. In the first days of life, intravenous infusions of plasma, peristone N are successfully used for this purpose. In more light cases, a mouthful of 5% glucose solution is prescribed through 50-100 ml per day. For these children, vitamin therapy is essential. Assign vitamins A, B1, C and E. When caring for the children of this group carefully observe the rules of asepsis and antiseptics. Otherwise, care for them is no different from caring for healthy newborns.

Care for children whose mothers have cardiovascular diseases .Currently, the level of our knowledge and organization of health care allows us to provide a significant part of women with heart disease with constant medical supervision during pregnancy, childbirth and after childbirth. Care for children born from such mothers, provides for the prevention of asphyxia, birth injuries, pneumonia, etc. With compensated forms of the mother's disease, the weight and height of the newborn usually corresponds to the length of the pregnancy. But in severe forms( decompensation, etc.), most children are born with low weight, and the percentage of true prematurity is two to three times higher. It is believed that in these cases the greatest reflection on the development of the fetus is stagnation in the intervillaceous spaces, severe changes in the blood vessels of the placenta and changes in metabolism. Stagnation of blood creates conditions for the development of hypoxia, to which the fetal organism tries to adapt by all possible means. Violation of protein metabolism, as in the first group of children, causes the development of hypoproteinemia. Therefore, immediately after birth, these children need a full-fledged diet, vitamin therapy. In severe cases, fighting with exsicosis, peripheral collapse, etc. is conducted.

Caring for children whose mothers suffer from anemia .In certain regions of the country, pregnant women are particularly often anemic, which is a rather serious problem. Stillbirth in them is 1-3 times higher. Lactation at birth of live children is late, often insufficient in quantity, and the protein and lactose content in milk is lowered. The malnutrition associated with these indicators explains the weak protective forces of the organism of such newborns and a number of other abnormalities. Timely correction of eating disorders helps normal development of this category of newborns.

Some febrile conditions of the mother are more or less dangerous for the child. Treatment of the mother, isolation of the child and effective disinfection prevent complications. For a child, any unearned episiotomy, inflammatory process in the mammary gland, etc. is dangerous. Unfortunately, it is often underestimated that the connection between mother and child is of great importance not only during pregnancy and childbirth, but also in the postpartum period.

Systematic monitoring of pregnant and parturient women with viral hepatitis shows the adverse effect of this disease on the course of pregnancy - the frequency of preterm labor is increased. The development of embryopathy is not always necessary, but in such children they are observed much more often. Perhaps intrauterine infection and fetal disease with hepatitis with specific lesions.

Both the mother and the baby, after the birth, may develop other viral diseases, for example herpes simplex. This disease is very difficult for the newborn, sometimes even life-threatening.

Children belonging to the above groups need individual treatment both for treatment in the first days of life and for stimulating the body's defenses through the introduction of gamma globulin, transfusions, etc.

Care for children whose mothers have diabetes .Thanks to the successful use of insulin in many women with this disease, pregnancy can proceed normally and result in the birth of a healthy child. If diabetes is compensated and there are no complications( especially from the eyes and kidneys), pregnancy sometimes even favorably affects the course of the disease. The known share of risk considerably decreases at a regular observation of a course of pregnancy. Diabetologists recommend early pregnancy and childbirth with diabetes in order to avoid abortions, and not give birth to more than 1-2 children. In pregnancy accompanied by diabetes, it is necessary to maintain almost normal sugar content in the blood( the most suitable remedy is insulin), and the sugar content in the urine should be insignificant. In the last months of pregnancy the patient must be hospitalized. Nevertheless, among the patients with diabetes, the percentage of toxicoses and infections is significant. A high percentage of prematurity is associated with impaired metabolism, especially protein. Often observed vascular circulatory disorders create conditions for hypoxia. Worn children are often distinguished by gigantism, which some authors attribute to hyperinsulinism, while others are considered a genetically determined feature. Sometimes such children are poorly and slowly adapting to environmental conditions, suffer from infections, they are more often observed the development of hyaline membranes, anomalies, etc. An unfavorable end can be caused by many other reasons already described.

Despite the fact that such children are born large, they often need warming( even in the use of kuvez), aspiration due to abundant secretion, in the appointment of oxygen( with humidity above 80%), intravenous infusion of 10% glucose solution( itscan be appointed and through the mouth).It is often necessary to prescribe antibiotics and diuretics.

Physiological weight loss in them reaches 10 or more percent and this not only should not cause anxiety, but to a certain extent is a sign of good excretory capacity of the kidneys. It is necessary to spare the heart and not overload the cardiovascular system. Children born to mothers with diabetes often have to early supplement, in the first months of life, to switch to mixed feeding, prescribe protein preparations for them.

Childcare for multiple births .Observations show that multiparty has a high mortality rate associated with asphyxia and pneumonia, prematurity, usually after a pathological pregnancy. Almost half of children with multiple births are born with a weight of about 2500 g, often with birth trauma, especially in the second twin, with anemia as a result of reverse blood flow( from child to mother or from one twin to another).

Special attention is paid to feeding. Children are born with low weight, but often with a normal sucking and swallowing reflex, that is, with a discrepancy between fullness and maturity. Approximately only 10% of children in the first days of life need feeding through a probe, the remaining children are fed from a spoon or breast. But the mother often has a relative hypogalactia, that is, an insufficient amount of milk for two or more children, so for breastfeeding it is necessary to use the milk of another lactating mother, "Eldon", "Tuman", and later other milk formulas. The prognosis for children with multiple births is also worsening due to the fact that in these cases, very often, surgical intervention is used during childbirth.

Caring for the transferred children .The prolonged pregnancy is indicated by anamnestic data, vaginal lubrication, pregnantioluria, some radiographic data, etc., but they are not absolute proof of the true fetal transferability. In fact, the transferred newborns are characterized by dry skin with a decreased turgor, muffled cardiac tones, sometimes expressed in varying degrees by degenerative changes of some parenchymal organs. Very often such children are hypotrophic, with signs of excision, rarely their weight is higher than normal.

Mature children need immediate administration of a sufficient number of fluids per os and intravenously to restore the disturbed ratio of electrolytes and water in the body. In case of peripheral weakness, sympathon and caffeine are successfully prescribed. Vitaminotherapy is also important. For dry skin appoint ointments with vitamins A, D, etc. in this group of children treatment and even prevention of antibiotics is justified.

Care for prematurely born children .The problem of prematurity and miscarriage with various etiologic causes of her and not always successful medical methods still needs to solve many problems. Mortality among preterm infants is proportional to the degree of immaturity, although, in addition to immaturity, many other reasons also have a very significant significance( mother's diseases, placental abnormalities, umbilical cord anomalies, etc.).The danger to the life of a newborn is primarily the immaturity of the center of breathing and thermoregulation, a tendency to infection and bleeding. There is a need for readiness for aspiration, artificial respiration, for oxygen therapy, sometimes for medicinal prophylaxis with vitamin K, etc.; at a hypoxia and an acidosis - to intravenous infusions of a glucose and alkaline solutions, to necessity in kuveze. The temperature regime is determined by the degree of immaturity, that is, within 28-33 ° C.It is also necessary to clarify the question of nutrition. Nutrition should correspond to the degree of maturity, age, receptivity, etc. Any method of nutrition - from a spoon, through a probe or breast should provide weight gain no later than the 2-3rd week.

Care for children born with the vacuum extractor .Children born with a vacuum extractor need special care, especially if the birth was accompanied by profuse and deep aspiration, asphyxiation, etc. In the area of ​​application of the vacuum extractor, 40% of newborns develop bruises and abrasions on the skin, which are treated withaseptic powders, ointments and sterile dressings. Vacuum extraction gives a high percentage of a cephalohematome, in need of preventive measures, preventing their infection. With a good general condition, feeding can begin 12 hours after birth, but if complications arise from the CNS, rest, feeding through the probe, oxygen therapy, and haemostatic agents are necessary.

Care for children born with the application of forceps .Care for children of this group is determined by the condition of the child during childbirth and after childbirth, the duration of aspiration and indications for the application of forceps. If these children do not show abnormalities or there are small deviations from the norm, they begin to be fed for the 12th hour of life. The remaining newborns of this group are fed from a spoon or through a probe, prescribe antibiotics, oxygen therapy, painkillers. Only 1/3 of children with birth trauma need systematic treatment or in special care. The rest of the children do not need treatment. But sometimes, after applying forceps, you have to take the same measures as with birth trauma or asphyxiation, and preventive measures that prevent such a frequent complication as pneumonia.

When peripheral nerves are affected, special care is needed to prevent the development of paresis and paralysis of the affected musculature or gangrene of the corresponding limb. Assign fortification, vitamin therapy, physiotherapy.

Care for babies born by cesarean section .Cesarean section provides the most favorable results for the so-called.primary section in elderly women at first birth, with a narrow pelvis, etc., and less favorable results are observed with previa and premature detachment of the placenta, with nephropathies, etc. Children born with caesarean section do not contract the chest accompanying normal birth, and the upper respiratory tract is not released from mucus, meconium, blood, etc., so these newborns, as a rule, need aspiration of the respiratory tract and stomach, and sometimes in the gastric lavage with a warm physiological plantthief. Anesthesia performed during the operation sometimes has a depressing effect on the respiratory center of the newborn, lowering the reflexes and predetermining the need for artificial respiration immediately after birth. The flatulence observed in the first 24 hours of life is explained by the action of curare assigned to the mother during anesthesia. Usually such children do not need special care. The time of the beginning of the feeding is determined individually depending on the indications for the operation, the condition of the newborn, etc.( before this, the children of this group receive fluids and mother's milk according to established rules).Often in women who gave birth for the first time in adulthood, after nephropathies, etc. hypogalactia is observed, so newborns have to supplement the milk of another lactating mother or milk formulas and prescribe protein preparations.

Children of these groups after discharge from the maternity hospital need active patronage until the disappearance of any abnormalities.
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