Analysis of the incidence of newborns for 2 years. Features of the incidence of pregnant women, women in labor and newborns in the Irkutsk region

The health of the population is an indicator of external and internal social well-being, as well as an indirect indicator of national security. The state of health of children reflects the level of realization of the biological potential of the nation and is a "mirror" of the processes taking place in society. According to Academician A. A. Baranov et al., The mode of population reproduction in many regions of the Russian Federation is close to a critical state. The decline in the standard of living, the deterioration in the availability of medical care manifested itself in low fertility rates, stabilization of high rates of infant and child mortality, negative natural population growth in most territories of Russia, and deterioration of the quality indicators of children's health. Over the course of more than 25 years, persistent unfavorable trends in the health status of children and adolescents in Russia have persisted. According to Rosstat data, over 12 years (2000–2011), the primary incidence of children aged 0–15 years increased by 32% (from 146235.6 to 193 189.9 per 100 thousand children). The analysis of childhood morbidity makes it possible to objectively assess the situation in the region, which contributes to the development of modern approaches to their prevention. Proceeding from this, the purpose of this study was to study the dynamics of indicators of physical development and the prevalence of diseases according to the data on the appealability of children in the first year of life in the outpatient clinic.

Material and methods. The study of the state of health of children of the first year of life, who were under observation on the basis of GBUZ SO "Samara City Polyclinic No. 3" (Samara) for the period 2012–2014 was carried out. The morbidity of children was studied by referring to the children's polyclinic and by clinical observation during the study. A comprehensive assessment of the state of health was based on the conclusions of specialists on outpatient documentation, on extracts from the case histories of hospitals, data from laboratory and instrumental examinations. To assess the main trends in the health status of children of the first year, we used data on the distribution by health groups at the beginning and end of the reference year, coverage with breastfeeding, and morbidity.

A comparative analysis of the age structure of the child population in the pediatric area showed a steady trend towards an increase in the number of children over the period 2012–2014. (from 815 to 835 people). Attention is drawn to significant differences in the dynamics of indicators: in 2014 in comparison with 2012 and 2013. the number of children in the first year of life increased by 15% (Figure 1).

Rice. 1. Age structure of the child population in the pediatric area for the period 2012–2014.

A comparative assessment of the distribution of newborns by risk groups revealed a significant increase in the number of newborns with the risk of developing CNS pathology and the risk of intrauterine infection for the period 2012–2014, which is associated with an increase in the prevalence of infectious and inflammatory diseases in women of reproductive age, including the urogenital area ... According to literary sources, the incidence of newborns in the early neonatal period in the presence of urogenital infection in mothers ranges from 50-100%; in our study - 85–95%. An insignificant increase in newborns with the risk of developing congenital malformations of organs and systems and hereditary diseases was revealed from 40% to 45% (Table 1).

Distribution of newborns by risk groups for the period 2012–2014.

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A study was carried out on the forms of 112y children born in 2013 and 2014. The assessment of physical development was carried out according to centel tables at the age of the first year and the incidence of these children according to the list of medical examination in the first year, depending on the types of feeding. The data obtained is shown below.

Zab-Iya of the digestive system

Zab-Iya of the genitourinary system

The table shows that respiratory diseases (ARVI) prevail in the morbidity structure. Other diseases include iron deficiency anemia. Iron deficiency anemia most often affects children after 6 months, here the ratio of breastfed and artificially fed children is 1: 1, since after 6 months breast milk does not fully satisfy the body's need for iron.

After the release of the "National Program for Optimizing Feeding of Infants in the First Year of Life" in the Russian Federation in 2011, work to encourage breastfeeding was intensified in the clinic and at the site, conferences with paramedics are regularly held, health bulletins are issued, and conversations are held in the KZR (office of a healthy child) for parents. I decided to find out how effectively and actively the national program is being introduced into healthcare practice using the example of the pediatric section.

I conducted an analysis of the Child Development Stories (Form112-y) of the children of the site who were born in 20013-2014.

The purpose of the study of the stories of the development of the child (according to the form 112y): to establish the dependence of indicators of physical development and morbidity on the type of feeding.

For 2 years, 180 children were born on the site, of which:

From the above data, it can be seen that a decrease in the birth rate is observed annually.

All children were divided by type of feeding.

The structure of the distribution of children in the first year of life by type of feeding in percent

Analyzing the data presented in the diagrams, we can say that there was no significant increase in the number of children receiving mother's breast for at least 6 months compared to 2013, however, the indicator of children who did not receive breast milk for up to 3 months decreased.

An increase was noted after the release of the order in the number of children receiving breast milk for at least 3 months, which may indicate purposeful work carried out in maternity hospitals and during the neonatal period at the pediatric section to support breastfeeding.

Comparative characteristics of types of breastfeeding in 2014 in percent

Having studied the dynamics of the types of feeding at the site, I tried to analyze the relationship between the nature of feeding in the first year of life and indicators of physical development.

I have assessed the indicators of physical development:

According to centile tables, data that were recorded in the Child Development Histories (Form 112) at the age of 12 months.

Analyzing the data of centile tables, I divided all the children into 3 groups:

Medium development (4 corridor)

High intermediate (corridor 5,6,7)

Pre-intermediate (1,2,3 corridor)

The data obtained is presented in diagrams:

Distribution of children by developmental level (body weight) depending on the type of feeding

The data obtained indicate a high percentage of breastfed children with average rates of weight gain, and bottle-fed children have rates below average (50%).

Distribution of children by developmental level (body length) depending on the type of feeding

Distribution of children by developmental level (breast circumference) depending on the type of feeding

The data obtained indicate that breastfeeding growth indicators have an average development (68.4%), 33% of artificially fed children have growth indicators above average, which corresponds to the literature data.

The increase in breast circumference indicators is least of all dependent on the nature of feeding. Determination of the level of physical development by individual indicators of anthropometry turned out to be more informative than determining the somatotype, since three indicators are summed up when determining the somatotype, and as a result, more than 80% of my children had a mesosomatotype on different types of feeding. Therefore, I decided to conduct an analysis on individual indicators of anthropometry.

Analyzing the harmony of development, I was able to establish that 62% of bottle-fed children have disharmonious development, while breastfeeding disharmonious development is observed in 28% of children.

Distribution of children according to the harmony of development on different types of feeding

The next step in the analysis of the Child Development Stories was to identify the incidence rate of children in the first year of life at the site, depending on the type of feeding.

The health index was 24%. The average indicator for the city of Omsk for 2014 is 20%. In formula-fed children, it was 22.5%, and in breastfed children it averaged 24.5%. Analysis of the data obtained showed that 42% of breastfed children suffer from allergic diseases (most often atopic dermatitis).

I believe that this indicator can be reduced if, when conducting antenatal care for pregnant women, newborns and infants, to more carefully collect anamnesis, teach the mother to keep a food diary, familiarize herself with products - obligate allergens. Dysbacteriosis was revealed in 16% of children on the site; there is no clear dependence on the nature of breastfeeding.

But intestinal infections and acute digestive disorders in children who have been breastfed for at least 6 months are 2 times less common than those on artificial feeding and in children who receive their mother's breasts only up to 3 months. I believe that in these families it is necessary to pay more attention to the following questions during conversations:

Sanitary Epidemic Regime

Rules for the preparation and storage of mixtures

Rules for feeding canned baby food

Rules for handling bottles and nipples

The incidence of acute respiratory viral infections and otitis media is almost equally common in breastfed and artificially fed children. When analyzing the incidence of iron deficiency anemia, there is a clear dependence on the nature of feeding. As can be seen from Figure 8, iron deficiency anemia (IDA) occurs almost 2 times more often in formula-fed children and early transition to artificial feeding.

Morbidity with different types of feeding (per hundred children)

Indeed, in children who were breastfed, allergic diseases are much less common.

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Abstract and dissertation in medicine (14.00.09) on the topic: The state of health of children in the first year of life and the prevention of diseases at the outpatient stage

Dissertation abstract on medicine on the topic The health status of children in the first year of life and the prevention of diseases at the outpatient stage

Raikova Natalia Mikhailovna

THE FIRST YEAR OF LIFE AND PREVENTION OF DISEASES AT THE AMBULATORY STAGE

dissertation for the degree of candidate of medical sciences

The work was carried out at GOU VPO "Samara State Medical University of the Federal Agency for Healthcare and Social Development"

Scientific adviser: Doctor of Medical Sciences, Professor

Official opponents: Doctor of Medical Sciences, Professor

Candidate of Medical Sciences Sapunkova Yu.A.

Leading organization: State Institution Scientific Center of Children's Health, Russian Academy of Medical Sciences, Moscow

The defense of the thesis will take place 2 0.05.

Assessment of the neuropsychic development of patients showed that the delay in the formation of motor skills in the main group was less (4 ± 2.9%) than in the control group II (20 ± 5.9%), the difference is significant at p = 0.049 (Fisher's test ).

The children of the main group developed better speech: the difference in the lag in the formation of speech skills in the main (11 ± 4.7%) and control group P (30 ± 6.7%) was significant at p = 0.038 (Fisher's test). In the main group, there were fewer children with a delay and more with an advance in speech development than in the control group P, we noted a significant difference in the advance of speech development among children in the main (22 ± 6.2%) and control group II (7 ± 3.4%) Pearson criterion = 4.22 for p1 ^ 3 Raikova, Natalia Mikhailovna :: 2005 :: Samara

CHAPTER 1. PREVENTIVE WORK WITH EARLY CHILDREN AT THE AMBULATORY STAGE. FACTORS DEFINING CHILDREN'S HEALTH (LITERATURE REVIEW).

health in the antenatal period and in the first year of a child's life.9

1.2 Concept of health and a healthy child. Health groups, groups of directed risk of children of the first year. Factors affecting children's health.14

1.3 Organization of medical and preventive care for young children in the system of outpatient practice. 25

1.4 Prenatal education of future parents is a new stage in the development of preventive medicine in a children's polyclinic. 35

CHAPTER 2. RESEARCH METHODS. 39

2.1 Methods used in the study. 39

2.2 Clinical characteristics of study groups 45

2.3 Program and methodology of prenatal education at the school of positive motherhood "Modern parents" .57

2.4 Statistical processing of the results obtained. 61

CHAPTER 3. FORMATION OF HEALTH IN CHILDREN OF THE FIRST YEAR OF LIFE, DEPENDING ON THE METHOD OF MEDICAL SUPPORT OF THE DIAD "MOTHER AND CHILD" IN THE CONDITIONS OF A CHILDREN'S POLYCLINIC (OWN RESEARCH) .65

3.1 Comparison of health indicators of children at the age of one year in three study groups that had differently organized preventive observation.65

3.2 Analysis of breastfeeding in the study. 75

3.3 Analysis of morbidity and hospitalization in children during the first year of life. 81

3.4 Analysis of the formation of the doctor-mother-patient relationship depending on the method of medical support of the dyad

Chapter 4. EFFICIENCY OF THE NEW MODEL OF MEDICAL SUPPORT OF THE DIAD "MOTHER AND CHILD"

PREVENTIVE DIRECTIONS IN CHILDREN'S POLYCLINIC. FORMATION OF A NEONATOLOGICAL SERVICE ON

At all times, the health of a nation has been determined by the health of the younger generation. Improving the health indicators of the child population has always remained one of the urgent problems of medicine (Veltischev Yu.E., 1998). Protection of maternal and child health, prevention and reduction of maternal, infant and child morbidity, disability and mortality are the most important medical and social problems of society and the state (Shabalov N.P., 2002, Savelyeva G.M., 2003). At the same time, it is obvious that one of the leading reasons for the progressive deterioration of health is the ineffectiveness of many preventive and corrective measures to preserve, strengthen and restore the health of children. In addition, in recent years, the level of funding for the preventive areas of the system of maternal and child health care has been extremely inadequate. This determines the need to introduce existing and develop new effective complex medical, psychological, pedagogical and social technologies for the prevention of health improvement, treatment and rehabilitation of children (Baranov A.A., 2003). The need to develop a preventive program for monitoring a child in the first year of life at the outpatient stage in conditions of limited funding makes this work relevant.

The aim of this work is to improve the health indicators of young children, the formation of correct parent-child relationships.

1. To study the influence of social, biological risk factors of a pregnant woman, as well as her psychological readiness for motherhood on the health indicators of a child in the first year of life.

2. To study and substantiate the importance of prenatal education of pregnant women for the formation of the child's health at the outpatient stage of the children's polyclinic.

3. To develop and introduce new organizational methods of preventive direction in work with pregnant women and children of the first year of life in a children's clinic.

4. To develop and implement a preventive program of observation and development of children in the first year of life at the outpatient stage.

5. To assess the effectiveness of the proposed prophylactic program of observation of an early age child in a children's polyclinic.

For the first time, it is proposed to improve the provision of neonatological care in the conditions of the pediatric department of the city polyclinic by strengthening the continuity of medical supervision of pregnant women and newborns, improving the package of documents on antenatal care for pregnant women, expanding the duties of a neonatologist.

For the first time, an effective model of interaction between a doctor and a child of the first year of life and his mother is presented, in which the passive position of parents in shaping the child's health is transferred to an active one.

THE MAIN PROVISIONS OF THE DISSERTATION FOR THE PROTECTION

1. The main factors that positively influenced the health indicators of newborns of the II health group when they reached the age of one were the happy relations of parents in the family, a high educational level of mothers, an effective educational program for parents before and after childbirth and strengthening of the preventive section of work with young children. ...

2. Improvement of neonatological care in the conditions of the pediatric department of the polyclinic included the improvement of the package of documents on antenatal care of pregnant women, monitoring of the observation of pregnant women and newborns, expansion of the functional responsibilities of a neonatologist, and the introduction of an educational program for future parents.

The results obtained, confirming the main factors in the formation of the health of young children, make it possible to direct the main efforts of the pediatric service to deepen the preventive section of work, and to the social services to strengthen the family.

The developed educational program for parents before and after the birth of a child makes it possible to effectively influence the health indicators of a child in the first year of life, as it increases the level of knowledge of parents on issues of care, nutrition and development of a child, contributes to the formation of correct parent-child relationships and can be introduced into the practice of pediatric polyclinic departments.

The proposed improvement of neonatological care at the outpatient stage increases the efficiency of the pediatric department of the polyclinic with young children and can be used in the activities of the outpatient unit of a medical and prophylactic institution.

IMPLEMENTATION OF RESEARCH RESULTS

Improvement and optimization of neonatological care in the conditions of the pediatric department of the Moscow Medical University of the city polyclinic No. 1 of the Industrial District of the city of Samara (chief physician, candidate of medical sciences Balsamova Lidiya Alekseevna) has been carried out.

The program of prenatal education "Modern parents" for pregnant women was introduced by the pediatric department of the Moscow Medical University of the city polyclinic No. 1.

New forms of medical documentation have been introduced: prenatal nursing № 1, antenatal nursing № 2, initial examination of a newborn by a neonatologist (rationalization proposals № 397, № 398, № 399 dated April 5, 2004).

The dissertation materials are used in the educational process during seminars and lectures at the Department of Pediatrics, IPO SamSMU.

The materials of the dissertation were discussed and reported at the VIII International All-Russian Congress "Actual problems of human ecology" (Samara, 2002), an interdepartmental meeting of the departments of pediatric dentistry and pediatrics IPO SSMU "Early prevention of caries among children and new directions of organizing preventive medicine in outpatient settings for young children" (May 2004), at the conferences of the City Center for Prevention of Samara "Breastfeeding support" (February 2004), "Modern ideas about the nutrition of children in the first year of life" (April 2005), at the training of specialists working in schools of positive motherhood (September 2004) ), at the V international scientific and practical conference dedicated to the 35th anniversary of the opening of the Children's City Clinical Hospital No. 1 of the city of Samara "Partnership for the sake of children's health" (June 2005).

On the topic of the dissertation, 7 publications were published (four of them in the central press), 3 rationalization proposals were developed and issued, an application was filed for a patent of the invention "A method of conducting therapeutic and prophylactic work with a pregnant woman and a child of the first year of life" No. 2003123196 dated July 22, 2003 ...

SCOPE AND STRUCTURE OF THE DISSERTATION

The thesis is presented on 165 pages of typewritten text, illustrated with 31 tables, 10 figures, 3 diagrams. The work consists of an introduction, a review of the literature, own research, including three chapters, conclusions, conclusions, practical recommendations. The literature index includes 322 sources, of which 228 are works by domestic authors and 94 are foreign.

Conclusion of the dissertation research on the topic "The state of health of children of the first year of life and the prevention of diseases at the outpatient stage"

1. The main factors that positively influenced the formation of the health of young children were favorable intra-family relations, a high educational level and psychological readiness of the mother, special educational training of parents and the absence of pronounced extragenital pathology of the mother (OR 3.1; 72.3% p = 0.025 ).

2. It was found that the health indicators of children in the first year of life are higher if the mother underwent prenatal educational training in the conditions of the pediatric department of the polyclinic (positive dynamics in the indicators of children's health during the year in the main group was noted in 25% of cases, in the control group II in 7% , with p in medicine, dissertation 2005, Raikova, Natalya Mikhailovna

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First year of life

Breastfeeding children

Health status of newborns

Children's health status

Contraceptive use

(number of children who were breastfed)

by main classes and groups of diseases

a source

The health status of the child population is currently the most important indicator of the quality of health care work and a criterion for assessing the well-being of society as a whole. Despite the introduction of new perinatal technologies, which contributed to a decrease in perinatal and infant mortality, the prevalence of chronic pathology in children, as well as the level of child disability, remain practically unchanged.
Improving the forms and methods of protecting the health of the child population is impossible without in-depth and constant analysis of information on the patterns of formation of children's health, assessment of medical and demographic indicators related to population reproduction and the quality of its health in the present and future. At the same time, taking into account regional characteristics is a prerequisite for the rational organization of the health care system in a specific territory.
The aim of this work was to study the morbidity structure of children in the first year of life in the Kabardino-Balkarian Republic (KBR).
To achieve this goal, the incidence rates of children in the first year of life were studied according to the annual reporting of form No. 31 "Information on medical care for children and adolescent schoolchildren" of the state health institution "Medical Information and Analytical Center" of the Ministry of Health of the KBR for the period 2002-2012. The statistical analysis of the studied indicators has been carried out.
Results and its discussion.
Analysis of the morbidity structure of children in the first year of life over a ten-year period revealed a stable prevalence of respiratory diseases over the rest of the pathology. This class of diseases accounts for 31.7- 39.2% of all diseases. The proportion of respiratory diseases in the nosological structure during the study period increased by 7.5% (Table 1).
Table 1

The structure of the incidence of children in the first year of life in the KBR for 2002-2012

Diseases of the blood, hematopoietic organs and certain disorders involving the immune mechanism

Endocrine system diseases, eating disorders and metabolic disorders

Diseases of the eye and its adnexa

Diseases of the ear and mastoid

Diseases of the digestive system

Diseases of the genitourinary system

Certain conditions arising in the perinatal period

Congenital anomalies (malformations)

Injury, poisoning and some other consequences of external causes

One of the characteristic features of this class is that in its structure the main share is occupied by acute infections of the upper respiratory tract, influenza, pneumonia, the concentration of which gradually decreased during the study period (98.7% in 2002 and 64.5% in 2012). G.).
The second position in the structure of morbidity in children of the first year of life is occupied by certain conditions arising in the perinatal period. Their contribution over 10 years decreased by 1.5 times, amounting to 17.6% in 2012, which is an indicator reflecting the improvement of perinatal and pediatric care in the republic.
The third ranking place in the structure of morbidity in children of the first year of life is occupied by diseases of the nervous system, amounting to 9.8-11.3%.
Thus, the share of three rating classes of diseases in the nosological structure of children in the first year of life was 2/3 of all pathology.
It should be noted that in the structure of diseases of the blood, hematopoietic organs and individual disorders involving the immune mechanism, the frequency of which tended to decrease over 10 years, anemias occupy the main share (97.6% in 2002, 95.1% in 2007. , 99.4% in 2012).
Among diseases of the endocrine system, nutritional disorders and metabolic disorders, rickets occupies a leading position. The contribution of this pathology over 10 years increased by 10.6%, amounting to 62.6% in 2012.
Conclusions.
In the structure of morbidity in children of the first year of life for the period 2002-2012. the first ranking places were occupied by diseases of the respiratory system, individual conditions arising in the perinatal period, diseases of the nervous system, accounting for a total of 66.6% of all pathology in 2012.
The frequency of respiratory diseases as the leading class has increased by 7.5% over 10 years, which indicates the need to improve treatment and prevention work in children with this pathology.
During the analyzed period, the share of anemia in the structure of diseases of the blood, hematopoietic organs and certain disorders involving the immune mechanism increased, reaching 99.4% in 2012.
Rickets occupies a leading position among diseases of the endocrine system, eating disorders and metabolic disorders, increasing its contribution over a ten-year period by 10.6%. This dictates the need to improve measures aimed at combating anemia and rickets in children of the first year of life.

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Research work The role of a nurse in organizing the prevention of morbidity in children of the first year of life on the example of a children's polyclinic in the city of Satka

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"Research work The role of a nurse in organizing the prevention of morbidity in children of the first year of life on the example of a children's polyclinic in the city of Satka"

MINISTRY OF HEALTH OF THE CHELYABINSK REGION

STATE BUDGET PROFESSIONAL

"SATKINSKY MEDICAL TECHNICUM"

The role of a nurse in organizing the prevention of morbidity in children of the first year of life on the example of the children's polyclinic in the city of Satka

Specialty: 34.02.01 Nursing

Student: Akhmetyanov Ruslan Danisovich

Head: Vasilyeva Asya Toirovna

Qualified for defense: Final qualifying work

"__" ________ 20__ protected with a rating of "____________"

Deputy Director for SD "_____" ____________________ 20__

Chairman of the SEC ________________

Chapter 1: Theoretical Aspects in the Study of Prevention

morbidity in children of the first year of life

1.1. Dispensary observation of healthy children of the first

1.2. Preventive reception of a healthy child ………………… .. ……

1.3. Monitoring newborns from risk groups during

1.4. The role of the nurse in newborn care

1.5. Vaccine prophylaxis of children of the first year of life ………….

Chapter 2. An Empirical Study of the Nurse's Role in

Organization of the prevention of morbidity in children of the first year of life on the example of the children's polyclinic in Satka

2.1. Analysis of the work of the children's polyclinic in Satka ……………………… .. 2.2. Clinical examination of children of the first year of life in a polyclinic

2.3. The work of a nurse in the vaccination room ………… .. ……………….

2.4. The role of the nurse in newborn care

LIST OF USED SOURCES……………………

The first year of a child's life is an important and difficult period. It was at this time that the foundation was laid, the basis for the physical development of the baby, and therefore, his future health.

The relevance of this topic is that early childhood is decisive both in the general development of the child and in the formation of his health. Therefore, the health of children in the future largely depends on the effectiveness of preventive measures carried out in a given age period.

The role of a nurse in organizing preventive measures for the incidence of illnesses in children of the first year of life consists in examining children: conducting anthropometry; psychometrics, early referral of the child to specialists, for laboratory and instrumental studies, determined by order No. 307 of the Ministry of Health and Social Development of Russia dated April 28, 2007 "On the standard of dispensary (preventive) observation of a child during the first year of life."

During home visits, monitors the correctness of the procedures. All data obtained during such visits is recorded in the history of the child's development. It is important that gymnastics and massage are carried out systematically with a gradual complication of exercises and massage techniques.

The purpose of the work... To analyze the role of a nurse in the prevention of morbidity in children of the first year of life on the example of a children's polyclinic in the city of Satka.

Study of theoretical material on this topic.

2 Analysis of the main indicators of the medical activity of the children's polyclinic for the period from 2013 to 2015.

3 Study of the role of a nurse in organizing the prevention of morbidity in children of the first year of life on the example of a children's polyclinic in the city of Satka.

Object of study. Children of the first year of life.

Subject of study. The role of a nurse in the organization of preventive measures for the incidence of illnesses in children of the first year of life.

Hypothesis: The nurse plays a huge role in the organization of preventive measures for the incidence of illnesses in children of the first year of life.

The practical significance of the study. Research materials can be used in the study of PM. 02. Participation in medical, diagnostic and rehabilitation processes. MDK 02.01.5 Nursing in Pediatrics.

Work structure. The work is made of 46 pages of printed text, consists of an introduction, 2 chapters, a conclusion, 26 sources, 2 tables and 6 diagrams.

1 Theoretical aspects in the study of the prevention of morbidity in children of the first year of life

Prevention - ( prophylaktikos- protective) a set of various kinds of measures aimed at preventing any phenomenon and / or eliminating risk factors.

Dispensary observation of healthy children of the first year of life

Dispensary observation of the district nurse: once a month home visit, with mandatory monitoring of visits after preventive vaccinations.

The frequency of examinations by specialists: a pediatrician in the first month of life at least 3 times, subsequently at least 1 time per month.

Inspection by narrow specialists:

- at 1 year neuropathologist, ophthalmologist, orthopedist;

- twice (1 trimester and 12 months);

- examination by an ENT, dentist at 12 months.

Laboratory diagnostic examination:

- clinical blood test, general urine analysis at 3 months (before vaccination) and at 12 months.

Monitoring effectiveness indicators:

- good monthly weight gain;

- good adaptation of the child to new living conditions;

- normal physical and neuropsychic development and a decrease in the incidence rate.

When carrying out preventive examinations, control is carried out:

During an objective examination, special attention is paid to:

- head and chest circumference;

- assessment of neuropsychic and physical development;

- condition of the skin, musculoskeletal system, internal organs;

- trace reaction from BCG vaccination;

- the presence of congenital diseases, developmental anomalies.

Additional examination methods: anthropometry once a month, a clinical analysis of blood and urine by 3 months of life and at 1 year.

Based on these objective and additional research methods, the doctor gives a comprehensive assessment of the state of health, including an assessment of physical and neuropsychic development, behavior, the presence or absence of functional or organic deviations from the norm, determines the health group, if necessary, the risk group for the development of the disease and prescribes a complex of preventive and recreational activities.

The main preventive and recreational activities:

- organization of rational feeding;

- sufficient stay in the fresh air;

- gymnastics hardening procedures;

- specific prevention of rickets;

- treatment of the revealed pathology.

Criteria for the effectiveness of clinical examination: indicators of neuropsychic and physical development, behavior, clinical examination data, frequency of diseases.

Depending on the state of health, children can be assigned to the following groups:

- To 1st health group- healthy children with normal physical and mental development, without anatomical defects, functional and morphofunctional deviations;

- NS 2nd health group- children who do not have chronic diseases, but have some functional and morphofunctional disorders. This group also includes convalescents, especially those who have undergone severe and moderate infectious diseases, children with a general delay in physical development without endocrine pathology (short stature, lagging behind in the level of biological development), children with underweight or overweight, children often and for a long time suffering from acute respiratory diseases, children with the consequences of injuries or operations with the preservation of the corresponding functions;

- To 3rd health group- children suffering from chronic diseases in the stage of clinical remission, with rare exacerbations, with preserved or compensated functional capabilities, in the absence of complications of the underlying disease. In addition, this group includes children with physical disabilities, the consequences of trauma and operations, provided that the corresponding functions are compensated. The degree of compensation should not limit the child's ability to study or work;

- To 4th health group- children suffering from chronic diseases in the active stage and the stage of unstable clinical remission with frequent exacerbations, with preserved or compensated functional capabilities or incomplete compensation of functional capabilities; with chronic diseases in remission, but with limited functionality. The group also includes children with physical disabilities, the consequences of injuries and operations with incomplete compensation of the corresponding functions, which to a certain extent limits the child's ability to study or work;

- To 5th health group- children suffering from severe chronic diseases, with rare clinical remissions, with frequent exacerbations, continuously relapsing course, with a pronounced decompensation of the body's functional capabilities, the presence of complications of the underlying disease, requiring constant therapy. This group also includes children with physical disabilities, the consequences of injuries and operations with a pronounced violation of compensation for the corresponding functions and a significant restriction of the possibility of learning or work.

In the process of observing a child, his health group may change depending on the dynamics of the state of health.

1.2 Preventive reception of a healthy child

1 Organization of sanitary and hygienic care of the child (microclimate of the room, quantity and quality of ventilation, lighting, organization of the place of sleep and wakefulness, walks, clothing, adherence to the rules of personal hygiene).

It is necessary to explain to the mother that non-observance of sanitary and hygienic care for the child can adversely affect the child's health, his physical and mental development. In the history of development, the doctor fixes the deficiencies in caring for the child, gives appropriate prescriptions for their correction.

2 Organization of the mode of life and nutrition according to age. Often the mother's complaints about the child's poor appetite, increased or decreased excitability, indifference, tearfulness are not associated with some organic changes, but are the result of improper organization of sleep and wakefulness, feeding regime.

You need to know that up to 9 months there should be the following sequence: sleep, feeding, wakefulness, which corresponds to the anatomical and physiological needs of the child. After 9 months, this sequence changes due to the lengthening of the segments of wakefulness, namely, wakefulness, feeding, sleep. During the first year of life, the time of active wakefulness increases from several minutes to 3 hours, the duration of sleep per day decreases from 18 to 14 hours. An arbitrary increase in the period of wakefulness can cause negative emotions, moodiness, and increased excitability in a child.

3 Organization of rational feeding and nutrition is one of the main tasks of a general practitioner pediatrician. At each appointment or home visit, the doctor exercises strict control over the adequacy of the nutrition received by the child, his physiological needs for the main food ingredients. This is especially true for children born with a weight of up to 2500 and over 4000 g. They need more frequent calculations of nutrition by ingredients and calorie intake, as they can easily develop malnutrition.

Rules for the organization of rational feeding and nutrition:

- support, encourage and maintain breastfeeding as long as possible;

- timely transfer the child to mixed or artificial feeding with a lack of breast milk and the inability to receive donor milk;

–. In a timely manner, taking into account the age, type of feeding, individual characteristics of the child, to introduce juices, fruit purees, supplementary foods, complementary foods into the diet;

Supplementation should be given after breastfeeding and not from a spoon, but from a nipple bottle. This is explained by the fact that in a child of the first 3-4 months, the act of sucking is physiological, which maintains the excitability of the food center. Feeding from a spoon causes a decrease in the excitability of this center, a mismatch in the rhythm of sucking and swallowing, which entails rapid fatigue of the child, and possibly refusal to eat.

Complementary feeding is usually given from 4-5 months at the beginning of feeding with high excitability of the food center. It is advisable to give it from a spoon in order to teach the child to remove food with his lips and gradually master the skills of chewing.

- periodically (up to 3 months monthly, and then 1 time in 3 months) to carry out calculations of the chemical composition of food actually received by the child, in order to make the appropriate correction, if necessary;

- to organize correctly the feeding technique.

When introducing supplementary feeding, the child must be held in his arms, as with breastfeeding. When introducing complementary foods, the child must be held in his arms, sitting in an upright position.

Failure to follow the feeding method often leads to malnutrition in children. If the infant, at a monthly examination, in terms of the rate of increase in body weight and length, corresponds to normal indicators, and is also healthy, then the nutrition received by the child must be considered rational. Therefore, he is in optimal feeding conditions.

4 Organization of physical education of the child. It has a positive effect on the body as a whole:

- increases the activity of nonspecific factors of the body's defense (lysozyme, complement components, etc.) and thereby increases resistance to viral and bacterial infection;

- improves blood circulation, especially in the periphery;

- improves metabolism and thus the utilization of food;

- regulates the processes of excitation and inhibition;

- increases the activity of the adrenal glands (increases the production of corticosteroids);

- the activity of the endocrine system is regulated;

- the work of the brain and all internal organs improves.

Physical education of children up to the 1st year of life includes: massage, gymnastics and kinesiotherapy (putting the child on his stomach during each period of wakefulness for the development of independent movements).

It is very important that gymnastics and massage are carried out systematically, with a gradual complication of exercises and massage techniques. If the control over the conduct of massage and gymnastics is insufficient on the part of the doctor and the nurse, if the attention of parents is not fixed at the receptions on the great importance of physical education, then, naturally, their effectiveness is significantly reduced.

To organize kinesiotherapy, it is necessary to have a wooden track on the floor and maintain a comfortable air temperature in the room.

The nurse needs to teach the mother how to carry out hardening procedures using air baths, organizing sleep on the street, on the balcony, bathing 2 times a day, wiping the body with a damp towel, and then dousing with a gradual decrease in temperature.

5 Organization of the child's neuropsychic development. It goes in close contact with physical development and is one of the constituent parts of health. Violation or lag in physical development often leads to a delay in neuropsychic development. In a child who is often ill, physically weakened, the formation of conditioned reflexes, various skills is delayed, it is difficult to evoke joy.

The pediatrician must take into account the mutual influence of physical and neuropsychic development and create favorable conditions for their development. It must be remembered that the theme of development and the sequence in the formation of various movements, skills, and speech in children of the 1st year of life depend not only on their individual characteristics, but also on the impact on the child of adults caring for children, as well as on the environment. setting. Control over the dynamics of neuropsychic development in young children. Assessment of neuropsychic development (NDP) in young children is carried out according to specially developed development standards within the established timeframe: in the first year of life - monthly, in the second year - once a quarter, in the third year - once every six months, on days, close to the birthday of the child. Medical workers: a district pediatrician or a nurse, or a nurse (paramedic) of a healthy child's office, diagnose CPD in accordance with the recommendations, according to certain indicators - developmental lines. If the development of the child does not correspond to age, then it is checked according to the indicators of the previous or subsequent age periods.

Methods for determining the level of neuropsychic development of children in the first year of life.

In the 1st year of life, the following lines of neuropsychic development are controlled:

- development of visual orienting reactions;

- development of orienting auditory reactions;

- development of positive emotions;

- development of general orienting reactions;

- development of actions with objects;

- development of the preparatory stages of active speech;

- development of the preparatory stages of understanding speech;

The development of all skills and abilities in the 1st year of life is closely related to the level of development of analyzers. The most significant among them are visual, auditory, tactile and proprioceptive analyzers.

For a child under 3 months of age, the timely emergence of visual and sound concentration, as well as the development of the following positive emotions: a smile and a revitalization complex is very important.

At the age of 3 to 6 months, it is important to develop visual and auditory differentiations with the ability to find the source of sound, the formation of grasping movements of the hand (taking a toy from an adult's hands and from different positions), humming, babbling (the beginning of speech development).

At the age of 6 to 9 months, the leading is the development of crawling, imitation in the pronunciation of sounds and syllables, the formation of simple connections between objects and the words denoting them.

At the age of 9-12 months, the most significant are the development of an adult's understanding of speech, the formation of the first simple words, the development of primary actions with objects and independent walking. Just as important as sensory development is movement development.

The mother should be informed about which movements and at what age to teach the child. From the first days and weeks of life, during periods of wakefulness, the arms and legs of the child should be free, before each feeding it should be laid out on the stomach, developing the ability to raise and hold the head. Such free movements of the head strengthen the muscles of the neck and back, the correct curvature of the spine is formed, and the blood circulation in the brain improves. If the family has conditions for maintaining a comfortable temperature for a naked child, it is advisable to lay it out on a wooden track on the floor during wakefulness to develop crawling and sensation of the body in space. In the future, all these movements must be continued to develop, putting toys on the track so that the child can grab them and / or purposefully move towards them. From time to time (but not too often), the child must be picked up, giving him an upright position. This stimulates holding the head, fixing the gaze on the faces of the mother, father and other relatives and friends.

From 3 months, special attention is paid to the development of hand movements, from 4 months it is necessary to teach the child to grab a free toy, by 6 months - to roll over from stomach to back.

In the second half of the year, it is necessary to learn to crawl, and by 8 months - to sit down and sit, climb on legs and step over in a crib or arena. With such a sequence of development of movements, the child masters the ability to walk independently by 12 months.

1.3 Observation of newborns from risk groups in

during the first year of life

Risk groups for young children:

- children at risk for the development of CNS pathology (who have undergone perinatal CNS damage);

- children at risk of anemia, ID, convalescents of anemia;

- children at risk of developing chronic eating disorders;

- children with constitutional anomalies;

- children suffering from rickets 1, 2 degrees;

- children born with a large body weight ("large fetus");

- children who have suffered from purulent-inflammatory diseases, intrauterine infection;

- often and long-term ill children;

- children from priority families.

Principles for monitoring children at risk:

- highlighting the leading risk factors. Determination of monitoring tasks (prevention of the development of pathological conditions and diseases);

- preventive examinations of a pediatrician and doctors of other specialties (terms and frequency);

- laboratory diagnostic, instrumental studies;

- features of conducting preventive examinations, preventive and therapeutic measures (nutrition, regimen, massage, gymnastics, non-drug and drug rehabilitation);

- criteria for the effectiveness of observation;

- the observation plan is reflected in the form 112.

- examination by a pediatrician at 1 month of life at least 5 times, in the future

- examination by a neurologist at 2 months (no later), then quarterly;

- examination by the head of the department of the polyclinic for 3 months, mandatory for every illness of a child for 1 year;

- strict control of the pediatrician over the size of the head, neurological status, the level of mental and physical development;

- preventive vaccinations strictly according to an individual plan and only with the permission of a neuropathologist;

- upon reaching 1 year, in the absence of pathology from the central nervous system, the child can be removed from the dispensary registration (form 30).

- examination daily for 10 days after discharge from the maternity hospital, then on the 20th day and 1 month, up to a year every month;

- strict control over the condition of the skin and umbilical wound;

- early laboratory tests (blood tests, urine tests) at 1 month and 3 months after each illness;

- measures for the prevention, early detection and treatment of dysbiosis;

- in the absence of symptoms of intrauterine infection, they are removed from the register (form 30) at the age of 3 months.

- examination by a pediatrician at 1 month of life at least 4 times, then monthly;

- examination by the head of the polyclinic no later than 3 months;

- the struggle for natural feeding, strict control over weight gain, the fight against hypogalactia. A balanced diet taking into account the weight of the child;

- examination by an endocrinologist at least 2 times in the 1st year of life (in the 1st quarter and at 12 months). Before going to the endocrinologist, a blood test

- dispensary observation for 1 year, in the absence of pathology, registration is taken off (form 30) at the age of 12 months.

- examination by a pediatrician 4 times in 1 month of life, then monthly;

- urine analysis at 1 month, then 1 time per quarter and after each disease;

- consultation of specialists in the early stages at the slightest appearance of suspicion of pathology (cardiologist, surgeon);

- dispensary observation for 1 year, in the absence of pathology, they are removed from the register (form 30) at the age of 12 months.

- strict control over the quality of child care, nutrition, weight gain, neuropsychic development;

- compulsory hospitalization for any disease;

- participation of the head of the polyclinic in the preventive supervision of this group of children;

- earlier registration in a preschool institution (in the second year), preferably with a round-the-clock stay;

- control of the district nurse over the actual place of residence of the child.

A child of 1 year of life is characterized by a number of features that do not occur at an older age:

- fast pace of physical and neuropsychic development;

- the need for sensory impressions and physical activity;

- immobility of the child, "sensory hunger" lead to a delay in development;

- the interdependence of physical and neuropsychic development;

- emotional impoverishment, lack of impressions, insufficient physical activity lead to a delay in neuropsychic and physical development;

- low resistance to meteorological and environmental influences and various diseases;

- a very high dependence of the child's development on the mother (parents, guardians). A characteristic feature of this period of a child's life is the transformation of the child from a helpless being into a person with character and certain personality traits.

There is no such period in the life of an older age when a healthy child triples its weight in 12 months and grows by 25-30 cm, i.e. it is during the first year of life that the growth and development of the child proceeds at a very rapid pace.

The functional speech system is also rapidly developing. The child masters the intonation of the language spoken to him; humming, babbling, first syllables, words appear. He begins to understand the speech of adults who communicate with him.

The child gradually develops skills and abilities: the ability to drink from a mug, cup, eat food from a spoon, eat bread or crackers; the first elements of the skill of cleanliness.

The child's emotional sphere expands significantly, and he adequately reacts to changing circumstances: crying, laughing, smiling, whining, interest in surrounding objects and actions, etc. In this regard, it is necessary to properly organize control over the development of the child and over the state of his health in order to notice deviations in mental and motor development as early as possible and plan health-improving measures that ensure the prevention of various diseases.

1.4 The role of the nurse in the care of newborns

Patronage of a newborn child during the first month of life is carried out by a pediatrician and a nurse of the pediatric section.

The general goal of patronage is to create a child rehabilitation program.
Specific goals:

- to assess the state of health of the child;

- to assess the state of health of the mother;

- to assess the socio-economic conditions of the family;

Develop a mother's education program aimed at meeting the vital needs of the child. During the first patronage, the nurse conducts a conversation with the mother, clarifies the course of pregnancy and childbirth, examines the discharge report, clarifies family anxieties and problems associated with the birth of a child.

The nurse pays attention to the conditions of the baby's stay, gives recommendations for caring for the baby.

The nurse examines the child, examines the skin and mucous membranes, and evaluates reflexes. Looks at sucking activity and feeding pattern. It also draws attention to the crying of the child, breathing. Palpates the tummy and examines the large fontanelle, umbilical wound.

The nurse learns about the mother's well-being, somatic and mental health and the state of lactation, the nature of the diet, examines the mammary glands. When conducting primary patronage, the mother is given recommendations for protecting her health: daytime rest, varied food, increased drinking regime, adherence to personal hygiene (take a shower every day or wash your body to the waist, change your bra daily, wash your hands after coming from the street, before swaddling and feeding child, etc.).

The nurse teaches the mother the daily routine and nutrition to improve lactation, proper feeding of the child, caring for him, using the feeding method, convinces parents of the need to regularly see a doctor and follow all his recommendations. Teaches the mother and all family members the technology of psycho-emotional communication with the child. For successful communication with a child, it is necessary to know the level of his age-related needs and communication opportunities.

Newborns under 1 month old like:

- listen to repetitive soft sounds;

- focus on movement and light;

- to be in his arms, especially when he is being lulled to sleep.

The task of parents is to provide the child with the opportunity to listen to their conversations and singing, soft music, feel their hands, feel bodily communication, especially during feeding. Mother's advice: Even if the baby is bottle-fed, you should pick him up while feeding.

The main indicators of the correct psycho-emotional development of the newborn after discharge from the hospital:

- responds positively to stroking;

- calms down when picked up;

- holds its gaze for a short period of time during feeding.

The nurse should teach the correct implementation of daily manipulations for the baby:

- treatment of the nose, ears, eyes;

It is enough to treat the umbilical wound once a day, after an evening swim. Do not strive to do this at every opportunity: this way you will too often rip off the crusts formed on the wound, which will not speed up, but only complicate and delay healing.

The purpose of such patronage is to assist the mother in organizing and carrying out the care of the newborn. It is important to teach her how to properly perform childcare manipulations. During the primary care of a newborn, the nurse receives from the doctor a number of specific instructions on the peculiarities of monitoring this child.

Bathing should be a daily routine for your little one. First, the baby's skin is thin, and metabolic and excretory processes and skin respiration are much more active in it. Therefore, it must be cleaned regularly. Secondly, bathing is extremely beneficial as a hardening method.

The baby should be washed after every chair and when changing a diaper. It is most convenient to wash your baby under running water so that the water flows from front to back. If for any reason water is not available (for a walk, in the clinic), you can use wet baby wipes.

In the morning, the baby can be washed right on the changing table. Wipe the baby's face and eyes with a cotton swab dipped in boiled water. There must be a separate swab for each eye. Guide movements from the outer corner of the eye to the inner one.

If the child has difficulty breathing. To do this, it is more convenient to use a cotton turunda (wick). Carefully, with twisting movements, we introduce it into the nostril. If there are a lot of dry crusts in the nose, turunda can be moistened with oil (vaseline or vegetable oil). From these manipulations, the baby can sneeze, which will simplify the task.

A child's ears should only be cleaned when earwax is visible at the mouth of the ear canal. You don't need to do this too often: the more often sulfur is removed, the faster it starts to be produced. When cleaning your ears, never go deeper than 5 mm into the ear canal. For this, there are even special cotton swabs with stops.

As the nails grow, they need to be trimmed so that the baby does not scratch himself or you. Use an infant nail scissors that have extensions at the tips. The nails should be cut straight, without rounding the corners, so as not to stimulate their growth and ingrowth into the skin. This is the end of the primary care for the newborn.

On the second home visit, the nurse checks the correctness of the procedures.

1.5 Vaccine prophylaxis of children of the first year of life

Infectious diseases are very common in children, sometimes they can be severe and cause complications.

The purpose of immunization is to form specific immunity to an infectious disease by artificially creating an infectious process, which in most cases proceeds without manifestations or in a mild form. Every child can and should be vaccinated; parents only need to consult a pediatrician in a timely manner. If any individual characteristics of the child's body are identified, the doctor draws up an individual plan for examining the child, his medical preparation for subsequent vaccination.

In accordance with the order of the Ministry of Health of Russia No. 125n of 03/21/2014 "On the approval of the national calendar of preventive vaccinations and the calendar of preventive vaccinations for epidemic indications":

The implementation of this order can significantly modernize vaccine prevention in Russia, since:

1 Introduced compulsory vaccination of children from 2 months of age against pneumococcal infection.

2 The list of contingents subject to vaccination against various infections has been expanded.

3 The list of infections and the list of contingents subject to vaccination according to the Calendar of preventive vaccinations for epidemic indications has been expanded. According to the Federal Law of September 17, 1998 No.

N 157 - FZ "On immunization of infectious diseases" regions can finance programs for vaccine prevention of hemophilic, pneumococcal, rotavirus infections, chickenpox.

To organize and conduct vaccinations, a medical and prophylactic institution must have a license for the relevant type of activity issued by a territorial (city, regional, regional) health authority and a room (vaccination room) that meets the requirements of SPiN 2.08.02-89.

Vaccine prophylaxis is a mandatory state measure for the prevention of infectious diseases. Structural changes in the current economic and demographic situation in the country, the growing international consolidation in the implementation of programs for the elimination and elimination of infections lead to increased requirements for immunization.

Thus, the role of a nurse in the organization of preventive measures, morbidity in children of the first year of life is to examine children: anthropometry; psychometrics, early referral of the child to specialists, for laboratory and instrumental studies, determined by order No. 307 of the Ministry of Health and Social Development of Russia dated April 28, 2007 "On the standard of dispensary (preventive) observation of a child during the first year of life."

The nurse teaches the mother the daily routine and nutrition to improve lactation, proper feeding of the child, caring for him, using the feeding method, convinces parents of the need to regularly see a doctor and follow all his recommendations. Gives recommendations on the physical and neuropsychic education of the child, massage, hardening, the development of hygiene skills, the prevention of rickets. Teaches the mother and all family members the technology of psycho-emotional communication with the child.

The nurse conducts psychological preparation of the child for the vaccination.

2. The role of a nurse in the organization of the prevention of morbidity in children of the first year of life on the example

children's polyclinic in Satka

2.1 Clinical examination of children of the first year of life in the children's clinic in the city of Satka

Statistical data on prophylactic medical examination of children of the first year of life were obtained from the Central Children's Clinic No. 1 in Satka.

Over the past three years, 2,331 children (children of the first year of life) underwent medical examination, of which 792 children passed in 2013, which amounted to 34% of the total number of those who underwent medical examination for the year.

In 2014, 764 children underwent medical examination, which amounted to 32.8% of the total number of those who underwent medical examination for the year.

In 2015, 775 children underwent medical examination, which amounted to 33.2% of the total number of children who underwent medical examination for the year. The number of children examined in 2015 decreased by 0.8% compared to 2013.

Clinical examination of children of the first year of life

Number of people examined

Distribution by health groups

In 2013, the number of children examined was 1.2% higher than in 2014 and 0.8% higher than in 2015 (Fig. 1).

Figure 1 - Fractional ratio of the number of examined

children of the first year of life in 2013 - 2015

Of the total number of children examined in 2013 (792 children) with the first health group, there were 369 children in the first year of life, which amounted to 46.6%. With the second group, there are 256 children in the first year of life, which amounted to 32.4%. From the third, 117 children in the first year of life, which amounted to 14.7%, from the fourth, 29 children in the first year of life, which amounted to 3.8%, and with the fifth group, 21 children, which amounted to 2.5% (Fig. 2).

Figure 2 - Share ratio by health groups

for 2013 among children of the first year of life

Of the examined children in the first year of life in 2013, there were more children with the first group of children by 14.2% than with the second group, by 31.9% than with the third group, by 42.8% than with the fourth group and by 43 , 8% than the fifth.

Figure 3 - Share ratio by health groups

for 2014 among children of the first year of life

Of the total number of children examined in 2014 (764 children) with the first health group, 233 children were in the first year of life, which amounted to 30.4%. With the second group there were 383 children in the first year of life, which amounted to 50.3%. From the third 99 children of the first year of life, which amounted to 12.9%, from the fourth 22 children of the first year of life, which amounted to 2.8% and with the fifth group of 27 children, which amounted to 3.6%.

Of the examined children in the first year of life in 2014, the number of children with the second group was 19.9% ​​more than with the first group, 37.4% more than with the third group, 47.5% more than with the fourth group, and 46 , 7% than with the fifth (Fig. 3).

Of the total number of children examined in 2015 (775 children) with the first health group, there were 294 children in the first year of life, which amounted to 37.9%. With the second group there were 359 children in the first year of life, which amounted to 46.3%. With the third group there are 74 children in the first year of life, which amounted to 9.5%, with the fourth group - 16 children in the first year of life, which amounted to 2% and with the fifth group - 32 children, which amounted to 4.1%.

Figure 4 - Share ratio by health groups

for 2015 among children of the first year of life

Of the examined children in the first year of life in 2015, there were 8.4% more children with the second group than with the first group, 36.8% more than with the third group, 44.3% more than with the fourth group, and 42 , 2% than with the fifth group (Fig. 4).

Figure - 5 Share ratio by health groups

From 2013 to 2015 among children of the first year of life

For three years of children in the first year of life:

- with group 1 health was 38.4%;

From 2013 to 2015, the number of children with the 5th group increased by 13.7 compared to 2013 (Fig. 5).

The role of a nurse in organizing medical examination of children in the first year of life is to examine children:

- early referral of the child to specialists;

- referral to laboratory and instrumental research.

2.3. Vaccination room nurse job

One of the main directions in the activities of the polyclinic in prevention is to increase the literacy of the population in matters of immunization and the formation of an understanding of the importance of vaccines for health.

Preventive vaccinations are the main measure in the fight against many infectious diseases in children, which radically affect the epidemic process.

The Immunoprophylaxis Office currently serves:

- child population aged 0-15 years;
- adolescent population 15-18 years old.

Basic principles of immunization:

- mass character, availability, timeliness, efficiency;

- compulsory vaccination against vaccine-preventable infections;

- an individual approach when vaccinating children;

- safety during preventive vaccinations;

- free of charge preventive vaccinations.

Prophylactic vaccinations are planned in the office "Vaccine prophylaxis" - monthly, reports on the implementation of the preventive vaccination plan are also received here and entered into a computer database. Vaccines are refrigerated, lead time and cold chain respected.

Implementation of the immunization plan for children in the first year of life

Perinatal pathology in Russia: level, structure of morbidity

L.P. Sukhanova
(Part of the chapter "Dynamics of health indicators of newborn offspring and perinatal demography in Russia in 1991-2002" of the book by L.P. Sukhanova Perinatal Problems of the Reproduction of the Population of Russia in the Transition Period. M., "Canon + Rehabilitation", 2006 272 p.)

The main indicators of the health of the nascent offspring are the level of prematurity in the population, morbidity and parameters of physical development.

Prematurity , associated primarily with the morbidity of pregnant women, has a negative impact on the physical development of children in subsequent periods of their lives and inevitably contributes to the growth of not only perinatal morbidity and mortality, but also disability.

The increase in prematurity among newborns in Russia is noted by numerous studies and statistical indicators. At the same time, it is emphasized that, firstly, the frequency of diseases and complications in premature infants is higher than in term infants (respiratory distress syndrome, hyperbilirubinemia, anemia of preterm infants, infectious diseases, etc.), and secondly, that pathology in A premature baby has its own characteristics, is accompanied by severe metabolic disorders and immune disorders, which determines the maximum "contribution" of premature babies to perinatal and infant mortality, as well as childhood disability.

According to the data of statistical form No. 32, during the analyzed period, the number of preterm births increased from 5.55% in 1991 to 5.76% in 2002 - with uneven growth over the years (the maximum value of the indicator in 1998 was 6.53%) ...

The analysis of the rate of prematurity among newborns carried out in accordance with statistical form No. 32 in comparison with the number of births with low birth weight (Fig. 37) in the federal districts of Russia, revealed that the highest level of prematurity among those born alive, as well as the number of low birthweight babies, is observed in Siberian and Far Eastern FD, and the minimum number of premature and low birth weight babies is observed in the Southern FD, which is consistent with the data of the analysis of the structure of children born by body weight given earlier.

Figure 37. The ratio of the proportion of premature and "low birthweight" newborns (in% to live births) by federal districts of Russia in 2002

It is characteristic that in the Central Federal District, the only one in the country, the level of prematurity (5.59%) exceeded the number of births with low birth weight (5.41%) - with indicators in Russia of 5.76 and 5.99%, respectively.

Analysis morbidity in newborns in Russia over the past 12 years has revealed a progressive steady increase in the overall incidence rate by 2.3 times - from 173.7 ‰ in 1991 to 399.4 in 2002 (Table 16, Fig. 38), mainly due to an increase in the number of sick full-term children (from 147.5 ‰ in 1991 to 364.0 ‰ in 2002), or 2.5 times.
The incidence of premature babies increased 1.6 times over the same years (from 619.4 to 978.1 ‰), which is shown in Fig. 3.

The increase in the incidence of newborns occurred mainly due to intrauterine hypoxia and asphyxia at birth (from 61.9 ‰ in 1991 to 170.9 ‰ in 2002, or 2.8 times), as well as a slowdown in growth and malnutrition of newborns, the level of which increased from 23.6 ‰ in 1991 to 88.9 ‰ in 2002, or 3.8 times. In third place in terms of morbidity in newborns is neonatal jaundice, registered in statistical form No. 32 only since 1999; its frequency was 69.0 ‰ in 2002.

Figure 38. Dynamics of the incidence rate of newborns in Russia (full-term and premature, per 1000 births of the corresponding gestational age) in 1991-2002

In terms of the growth rate of the prevalence of pathology in newborns during the years analyzed (from 1991 to 2002), hematological disorders are in first place (5.2 times), in the second place is growth retardation and malnutrition (congenital malnutrition) - (3.8 times), on the third - intrauterine hypoxia and asphyxia at birth (2,8). This is followed by intrauterine infection (2.7), birth trauma (1.6) and congenital malformations (1.6 times).

Table 16. Morbidity of newborns in Russia in 1991-2002 (per 1000 live births)

Diseases	1991	1992	1993	1994	1995	1996	1997	1998	1999	2000	2001	2002	2002/1991
General morbidity	173,7	202,6	234,7	263,5	285,2	312,9	338,7	356,5			393,4	399,4	229,9
Sick full-term	147,5	174,3		233,1	253,5	281,2	307,7		349,3	345,1	357,1		246,8
Sick of premature babies	619,4	661,8	697,3		774,9	797,4	809,3	824,1	867,5	932,5	981,6	978,1	157,9
Congenital anomalies	18,8	20,5	22,8	24,4	25,74	27,85	29,63	30,22	29,34	29,43	30,32	29,67	157,8
Stunted growth, malnutrition	23,6	32,2	39,6	46,4	52,2		61,35	67,92	78,75	81,43	85,87	88,87	376,6
Birth injury	26,3	27,9	27,6	31,5	32.5	32,7	31,6	31,3	41,7	41,1	42,6	41,9	159,3
W.t.ch. intracranial						8,74	7,37	6,75	3,06	2,15		1,67
Intrauterine hypoxia and birth asphyxia	61,9	78,7	96,2	113,9	127,3	143,49	158,12	171,79	175,54	176,28	169,21	170,94	276,2
Respiratory distress syndrome	14,4	15,6	17,8	18,8	19,8	21,29	21,4	22,48	17,39	18,06	17,81	18,67	129,7
incl. RDS in full-term				7,21	7,75	9,07	8,43	9,49	5,73	6,26	5,86	6,15	120,6
Intrauterine infections		10,65	10,5	13,2	16,03	19,19	23,4	23,43	25,01	24,55	24,25	24,03
Incl. sepsis	0,33	0,28	0,32	0,40	0,34	0,41	0,42	0,42	0,59	0,50	0,44	0,35	106,1
Hemolytic disease of the newborn	6,10	6,20	6,60	7,00	7,53	8,02	8,56	10,35	9,32	8,89	8,41	8,68	142,3
Hematological disorders	2,26	3,33	4,10	5,90	6,59	8,27	9,06	9,31	10,00	10,44	11,30	11,78	521,2
Neonatal jaundice									47,31	55,49	61,58	68,99	145,8
TRANSLATED NEWBORNS	6,17	6,64	7,31	7,99	8,17	8,72	9,17	9,11	9,28	9,01	9,11	8,89	144,1

Such a significant increase in the prevalence of hypoxia and malnutrition in newborns in the last decade (Fig. 39) is an inevitable result of the growth of extragenital and obstetric pathology in pregnant women, against which placental insufficiency develops and, as a consequence of the latter, intrauterine fetal growth retardation.

Figure 39. Dynamics of the frequency of intrauterine hypoxia, congenital anomalies and growth retardation in newborns in 1991-2002 (per 1000)

It is important to note that the frequency of growth retardation and malnutrition in newborns (Fig. 39) continues to progressively increase in recent years, which confirms the position of continuing serious problems with the level of health of reproductive offspring. It should be emphasized that we are talking about an objective criterion - the mass and height indicators of newborns that are not subject to possible erroneous or subjective interpretation. The data on an increase in the frequency of growth retardation and malnutrition in newborns are consistent with the data presented above on changes in the structure of children by body weight - a decrease in the number of large and an increase in low birth weight newborns during the analyzed period. In turn, congenital trophic disorders and the transferred prenatal hypoxia and asphyxia at birth are the main background condition and the cause of the development of neurological and somatic pathology in the child in the future.

Figure 40. Dynamics of the frequency of birth trauma, including intracranial injury, in Russia in 1991-2002 (per 1000)

One of the main problems of perinatology is birth traumatism of the fetus and newborn, which is of great medical and social importance, since the bottom trauma of children largely determines perinatal mortality and childhood disability. During the analyzed period in Russia there is an increase in the frequency of birth trauma of newborns (1.6 times) due to the so-called "other" birth trauma (Fig. 40), while the frequency of intracranial birth trauma has sharply decreased from 9.3 ‰ to 1.67 ‰; Such dynamics can be caused, on the one hand, by a change in the tactics of labor management (an increase in the frequency of abdominal delivery), and, on the other hand, by a change in the statistics of this pathology since 1999, when the heading "birth trauma" began to include both clavicle fractures and cephalohematomas. This led to the noted increase over the past 4 years in the frequency of all birth trauma (due to the "other") to the level of 41.1-42.6 ‰, which undoubtedly indicates an insufficient level of obstetric care in the obstetric hospital. So, today every 25th born child has a traumatic injury in childbirth.

It should be noted that in recent years in Russia - against the background of a sharp decrease in the frequency of intracranial birth trauma (by 2.2 times from 1998 to 1999), there has been an equally sharp (2.3 times) increase in mortality from this pathology - from 6.17% in 1998 to 14.3% in 1999 (Fig. 41). Among full-term babies, mortality increased from 5.9% in 1991 to 11.5% in 2003, and among premature babies - from 26.4% to 33.2% (!) Over the same years, with a sharp rise in mortality in 1999 year with a decrease in the incidence rate also indicates a change in diagnostic approaches for this pathology. Nevertheless, such a high mortality rate, especially in premature babies, puts the problem of birth traumatism in newborns in first place among obstetric problems in modern Russia.

Figure 41. Mortality of newborns from intracranial birth trauma in the dynamics of 1991-2003 (per 100 cases)

The increase in the incidence of neonatal jaundice in Russia is extremely unfavorable - from 47.3 ‰ in 1999 (from which their registration began) by 1.5 times in three years. This pathology is typical for premature babies and newborns with morphofunctional immaturity, and the increase in its prevalence is consistent with the data on the continuing high level of prematurity and intrauterine growth retardation. In addition, the impairment of bilirubin conjugation in a newborn is facilitated by hypoxic damage to hepatocytes, and thus, an increase in the incidence of neonatal jaundice is naturally associated with an increase in the incidence of intrauterine hypoxia and asphyxia at birth. In an increase in the incidence of neonatal jaundice, the influence of such a factor as an increase in the frequency of induced ("programmed") births, as well as prenatal cesarean section, in which delivery is performed under conditions of incomplete morphofunctional maturity of the enzyme systems of the fetus, in particular, the liver transferase system, cannot be excluded.

The significance of the growth of neonatal jaundice is increasing in connection with the recent increase in the population of mental retardation of children and the pathology of the nervous system, since bilirubin encephalopathy as a result of severe forms of neonatal jaundice is accompanied by significant neurological disorders. At the same time, the lack of the ability to objectively control the level of hyperbilirubinemia in jaundice in many obstetric hospitals in the country (some of which do not have laboratories at all) may be the reason for the development of this pathology in newborns.

Figure 42. The incidence of hemolytic disease of the newborn (HDN) and hematological disorders in newborns in Russia in 1991-2002, per 1000

The growth of hemolytic disease of newborns in the country by 1.4 times in 2002 in comparison with 1991 (Fig. 42) may also lead to an increase in the incidence of bilirubin encephalopathy in newborns. The presented figure demonstrates an increase in the incidence of hemolytic disease in newborns, which was also most pronounced in 1998-1999.

Discussing the problem of hemolytic disease in case of Rh incompatibility, it is necessary to note an unfavorable tendency towards a decrease in the specific immunoprophylaxis of Rh conflict in Rh-negative women in recent years in Russia, which is largely due to economic factors - the high cost of anti-Rh globulin, as indicated by V.M.Sidelnikov.

The frequency of respiratory distress syndrome increased during the analyzed period from 14.4 ‰ to 18.7 ‰, while the change in the statistics of this nosological form since 1999 had a significant impact on its dynamics (Fig. 43). However, even under this condition, the growth of this pathology in newborns, including full-term babies, characterizes an increase in the degree of morphological and functional immaturity, i.e. that background pathology that is not taken into account independently, but is clearly detected by indirect signs (the growth of conjugational jaundice, respiratory distress syndrome in term infants).

Figure 43. Dynamics of respiratory distress syndrome (RDS) in newborns in 1991-2002 and RDS in term infants (per 1000 corresponding contingent)

The frequency of infectious pathology specific for the perinatal period (Fig. 44) increased in newborns in 2002 compared to 1991 by 2.7 times and amounted to 24.0 ‰, which could be explained to a certain extent by an improvement in the detection rate of infections. However, an increase in septic morbidity among newborns, consistent with an increase in septic complications in women in labor / puerperas (the maximum value of the indicator in both women and children in 1999), allows us to regard the increase in congenital infectious pathology in newborns as true.

Figure 44. Dynamics of the frequency of perinatal infections (diagram, left scale) and sepsis (graph, right scale) in newborns in Russia in 1991-2002, per 1000

In 2002, the structure of the incidence of newborns in Russia is presented as follows: in the first place - hypoxia, in the second - malnutrition, in the third - neonatal jaundice, in the fourth - birth trauma, in the fifth - developmental anomalies.

Noting the particular importance of congenital anomalies (malformations) and chromosomal abnormalities, which, although they are in fifth place in terms of the frequency of neonatal pathology, are extremely important, since they cause severe pathology and disability in children, measures for prenatal diagnosis of congenital and hereditary pathology are of paramount importance. ... In Russia, there is an increase in congenital anomalies in newborns from 18.8 ‰ in 1991 to 29.7 ‰ in 2002, or 1.6 times. The population frequency of malformations on average ranges from 3% to 7%, and this pathology accounts for more than 20% of childhood morbidity and mortality and is detected in every fourth death in the perinatal period. At the same time, it has been shown that with a good organization of prenatal diagnostics, it is possible to reduce the birth of children with congenital pathology by 30%.

Statistical data and numerous studies convincingly show how important is the role of congenital malformations (CM) in the structure of morbidity and mortality in children. Malformations account for more than 20% of infant mortality (an increase in the indicator to 23.5% in 2002 among all deceased children under one year of age in Russia). The population frequency of congenital developmental anomalies is on average from 3% to 7%, and among stillborns it reaches 11-18%. At the same time, there is a regularity: the lower the PS level, the higher the frequency of congenital defects. Thus, according to the Scientific Center of Obstetrics, Gynecology and Perinatology of the Russian Academy of Medical Sciences, a decrease in PS to 4 ‰ -7 ‰ was accompanied by a sharp increase (from 14% to 39%) in the proportion of malformations among dead fetuses and newborns.

The prevalence of congenital anomalies among newborns in the dynamics of 1991-2002 is shown in Fig. 45.

Figure 45. Dynamics of the incidence of congenital anomalies in newborns in Russia in 1991-2002 (per 1000 births)

As you can see from the table. 17, in the context of the federal districts of Russia, the maximum level of neonatal morbidity was noted in the Siberian FD, mainly due to term babies. In this district, the maximum indicator of hypoxia, malnutrition, and respiratory disorders, incl. full-term respiratory distress syndrome, which characterizes a high degree of morphofunctional immaturity among newborn children.

Table 17. Morbidity of newborns by federal districts of Russia in 2002 (per 1000)

	RUSSIA	Central Federal District	North-West Federal District	Southern Federal District	Privolzhsky Federal District	Ural Federal District	Siberian Federal District	Far East Federal District
General morbidity
full-term
premature
Hypotrophy
Birth injury
Incl. VChK
Hypoxia
Respiratory Disorders
Incl. RDS
of which RDS-premature
RDS-full-term
Congenital pneumonia
Specific infections
Incl. sepsis
Hematological disorders
Neonatal jaundice
Congenital anomalies

The extremely high level of growth retardation and malnutrition (malnutrition) of newborns (every ninth - tenth born child in the Volga, Ural and Siberian FDs) and jaundice (every tenth - twelfth) predetermines the high incidence of older children in these territories.

The high frequency of birth trauma in the Siberian District (48.3 ‰ at 41.9 ‰ in Russia) and intracranial birth trauma in the Southern FD (1.7 times higher than the national indicator) characterize the low quality of obstetric service in these territories. The maximum level of infectious pathology of newborns was noted in the Far Eastern FD, 1.4 times higher than in the whole of Russia, and septic complications are most often observed in the Volga FD. The highest level of neonatal jaundice was also noted there - 95.1 ‰, with 69 ‰ in Russia.

The maximum frequency of congenital anomalies in the Central FD is 42.2 ‰ (1.4 times higher than the national level) dictates the need to study the causes and eliminate factors that cause congenital malformations of the fetus, as well as to take the necessary measures to improve the quality of prenatal diagnosis of this pathology.

Accordingly, the increase in the incidence of newborns in Russia is marked by an increase in the number of newborns transferred from the obstetric hospital to the department of newborn pathology and the second stage of nursing from 6.2% in 1991 to 8.9% in 2002.

A natural consequence of an increase in the incidence of newborns is an increase in the number of chronic pathologies in children, up to severe health disorders, with limited life activity. The role of perinatal pathology as a cause of childhood disability is determined by different authors in 60-80%. Among the reasons contributing to the disability of children, a significant proportion is taken by congenital and hereditary pathology, prematurity, extremely low birth weight, intrauterine infections (cytomegalovirus, herpes infection, toxoplasmosis, rubella, bacterial infections); the authors note that in terms of prognosis, meningitis and septic conditions are especially unfavorable clinical forms.

It is noted that the quality of perinatal care, as well as rehabilitation measures at the stage of treatment of chronic diseases, are often fundamental in the formation of a disabling pathology. Kamaev I.A., Pozdnyakova M.K. and co-authors note that due to the steady increase in the number of disabled children in Russia, the expediency of timely and high-quality forecasting of disability at an early and preschool age is obvious. Based on the mathematical analysis of the significance of various factors (living conditions of the family, the state of health of the parents, the course of pregnancy and childbirth, the state of the child after birth), the authors have developed a prognostic table that makes it possible to quantitatively assess the degree of risk of developing a child's disability due to diseases of the nervous system, mental sphere, congenital anomalies. ; the values ​​of the predictive coefficients of the factors under study and their informative value have been determined. Among the significant risk factors for the fetus and newborn, the main risk factors were intrauterine growth retardation (IUGRP); prematurity and immaturity; hypotrophy; hemolytic disease of the newborn; neurological disorders in the neonatal period; purulent-septic diseases in a child.

Pointing to the interconnectedness of the problems of perinatal obstetrics with pediatric, demographic and social problems, the authors emphasize that the fight against the pathology of pregnancy, which causes impaired growth and development of the fetus (somatic diseases, infection, miscarriage) is most effective at the stage of pregravid preparation.

A real factor in the prevention of severe disabling diseases in a child is early detection and adequate therapy of perinatal pathology, and above all placental insufficiency, intrauterine hypoxia, intrauterine fetal growth retardation, urogenital infections that play an important role in damage to the central nervous system and the formation of fetal anomalies.

Sharapova OV, notes that congenital malformations and hereditary diseases are still one of the leading causes of neonatal and infant mortality; in this regard, according to the author, prenatal diagnosis of malformations and timely elimination of fetuses with this pathology are of great importance.

In order to implement measures to improve prenatal diagnostics aimed at preventing and early detection of congenital and hereditary pathologies in the fetus, increasing the efficiency of this work and ensuring interaction in the activities of obstetricians-gynecologists and medical geneticists, an order of the Ministry of Health of Russia dated 28.12.2000 No. 457 "On improving prenatal diagnosis and prevention of hereditary and congenital diseases in children. "

Prenatal diagnostics of congenital malformations, designed for the active prevention of the birth of children with developmental abnormalities by termination of pregnancy, includes ultrasound examination of pregnant women, determination of alpha-fetoprotein, estriol, chorionic gonadotropin, 17-hydroxyprogesterone in the mother's blood serum and determination of the fetal karyotype by chorionic cells in women over 35 years old.

It has been proven that with a good organization of prenatal diagnostics, it is possible to reduce the birth of children with gross congenital pathology by 30%. Noting the need for antenatal prophylaxis of congenital pathology, V.I. Kulakov notes that for all its high cost (the cost of one amniocentesis procedure with a biopsy of chorionic cells and determination of the karyotype is about 200-250 US dollars), it is economically more profitable than the cost of maintaining a disabled child with severe chromosomal pathology.

1 - Baranov A.A., Albitsky V.Yu. Social and organizational problems of pediatrics. Selected Essays. - M. - 2003 .-- 511s.
2 - Sidelnikova V.M. Miscarriage. - M .: Medicine, 1986.-176p.
3 - Barashnev Yu.I. Perinatal neurology. M. Science. -2001 .- 638 p .; Baranov A.A., Albitskiy V.Yu. Social and organizational problems of pediatrics. Selected Essays. - M. - 2003. - 511s .; Bockeria L.A., Stupakov I.N., Zaichenko N.M., Gudkova R.G. Congenital anomalies (malformations) in the Russian Federation // Children's Hospital, - 2003. - №1. - C7-14.
4 - Kulakov V.I., Barashnev Yu.I. Modern biomedical technologies in reproductive and perinatal medicine: perspectives, moral, ethical and legal problems. // Russian Bulletin of Perinatology and Pediatrics. - 2002. No. 6. -s. 4-10.
5 - Ibid.
6 - Ibid.
7 - Kagramanov A.I. Comprehensive assessment of the consequences of diseases and causes of disability in the child population: Author's abstract. diss. Cand. honey. sciences. - M., 1996 .-- 24 p.
8 - Kulakov V.I., Barashnev Yu.I. Modern biomedical technologies in reproductive and perinatal medicine: prospects, moral, ethical and legal problems. // Russian Bulletin of Perinatology and Pediatrics. - 2002. No. 6. -s. 4-10; Ignatieva R.K., Marchenko S.G., Shungarova Z.Kh. Regionalization and improvement of perinatal care. / Materials of the IV Congress of the Russian Association of Specialists of Perinatal Medicine. - M., 2002 .-- p. 63-65.
9 - Kulakov V.I., Barashnev Yu.I. Modern biomedical technologies in reproductive and perinatal medicine: perspectives, moral, ethical and legal problems. // Russian Bulletin of Perinatology and Pediatrics. - 2002. No. 6. -s. 4-10

DYNAMICS OF CLINICAL-CHEMISTRY VALUES UNDER THE HEMOLYTIC DISEASE OF THE NEWBORNS

Nadezhda Liavina

master's Degree Student, Kuban State University,

Russia, Krasnodar

Nina ulitina

associate Professor, Candidate of Biological Sciences, Kuban State University,

Russia, Krasnodar

Irina Sysoeva

manageress, Regional Affiliated Hospital №2,

Russia, Krasnodar

ANNOTATION

The article is devoted to the current problem of obstetrics and neonatology, in particular, hemolytic disease of the newborn. The blood of 162 newborns was examined, the level of bilirubin, hemoglobin and reticulocytes was determined using automatic analyzers Cobas Integra 400 plus and Sysmex 21N. As a result of the study, it was revealed that in all forms of hemolytic disease of the newborn, reticulocytosis, hyperbilirubinemia and anemia are observed.

ABSTRACT

The article is devoted to the up to date topical issue concerning obstetrics and neonatology: hemolytic disease of the newborn. Blood examination of 162 newborns is carried out; the level determination of bilirubin, hemoglobin and reticulocytes is performed by automatic analyzers Cobas Integra 400 plus and Sysmex 21N. As a result of research it has been found that reticulocytosis, hyperbilirubinemia and anemia are present in all forms of the hemolytic disease of the newborn.

Keywords: hemolytic disease of the newborn; hyperbilirubinemia; reticulocytosis; rhesus conflict.

Keywords: hemolytic disease of the newborn; hyperbilirubinemia; reticulocytosis; rhesus incompatibility.

Purpose of the study- to identify clinical and biochemical blood parameters that change in various forms of hemolytic disease of newborns.

Material for research- umbilical and venous blood of newborns.

Research methods: photometric and non-cyanide hemoglobin method.

Laboratory studies were performed on automatic analyzers Cobas Integra 400 plus, ABL 800 FLEX and Sysmex 21 N.

Over the past decade, the incidence of newborns has increased from 2,425 per 10,000 live births in 2004 to 6,022.6 in 2014. Analysis of the nature of morbidity and the structure of early neonatal mortality shows that causes such as neonatal infection, pathology caused by inadequate care during childbirth have ceased to be the leading causes of morbidity and mortality in newborns. Currently, a special role is assigned to the significance of fetal pathology, which further leads to a violation or impossibility of adaptation of the newborn to extrauterine life. In 2014, the structure of the causes of infant mortality consisted mainly (69%) of the pathology of the perinatal period and congenital anomalies. A great influence on the structure of neonatal morbidity and mortality is exerted by hemolytic disease of the newborn and fetus - a disease of newborns caused by an immunological conflict due to the incompatibility of the blood of the mother and the fetus in terms of erythrocyte antigens. The detection of cases of hemolytic disease of newborns in Russia over the past five years has not tended to decrease, amounting to 87.0 per 10,000 live births in 2014 (in 2004 - 88.7 per 10,000 live births).

Hemolytic disease occupies a special place among the diseases of newborns. With various clinical manifestations, the pathology is characterized by an intense increase in the level of conjugated bilirubin, which leads to damage to the central nervous system and other organs, as well as to permanent disability or death. In Russia, in 2014, hemolytic disease of newborns was diagnosed in 0.9% of newborns. Currently, significant advances have been made in the treatment of icteric forms of hemolytic disease of the newborn (HDN), but this, unfortunately, does not apply to the edematous form of HDN, which develops as a result of Rh-conflict. One of the main activities of modern medicine is to reduce not only perinatal mortality, but also perinatal morbidity. These indicators are influenced by cases of manifestation of hemolytic disease of the fetus and newborn. Despite the good knowledge of the causes of the development of hemolytic disease of the newborn, significant difficulties in its treatment still exist. The developed tactics of therapy for hemolytic disease in the postnatal period is more aimed at eliminating hyperbilirubinemia and preventing possible encephalopathy. Rational use of conservative treatment led to a decrease in the cases of replacement blood transfusion in newborns with hemolytic disease, but could not completely eliminate the need for replacement blood transfusion in HDN.

Results and discussion

During the study, 162 newborns were examined, of which the experimental group consisted of 142 newborns with hemolytic disease: 27 (19%) - with Rh-conflict and 115 (81%) - with incompatibility for antigens of the ABO system, and 20 newborns from the neonatal department represented the control group ...

During the observation, the following laboratory parameters were analyzed: the level of total bilirubin, the level of hemoglobin, the number of erythrocytes and reticulocytes.

In all newborns with hemolytic disease, the concentration of total bilirubin in the blood serum was determined in the first hours after birth (from the umbilical cord vein) and in dynamics at least twice a day until the beginning of its decrease (with the calculation of the rate of increase in the concentration of bilirubin in the blood). In the first five days of life, newborns were examined daily to determine the level of hemoglobin and count the number of erythrocytes and reticulocytes.

The results of the examination of newborns in the first hours of life with Rh-conflict HDN are shown in Table 1.

Table 1.

Laboratory indicators of newborns diagnosed with HDN with Rh incompatibility (at birth)

Laboratory indicators	Severity of HDN			Age norms
		moderate
Hemoglobin (g \ l)
The number of reticulocytes

Studies have shown that Rh-conflict HDN in 63% of cases had a severe course (17 out of 27). The average severity of the disease was diagnosed in 23% of cases (6) and mild - in 14% (4).

Rh-conflict HDN is characterized by the early appearance of hyperbilirubinimia. According to our observations, in 22 out of 27 cases, the appearance of icteric staining of the skin in the first 24 hours of life is noted, including in 15 babies - in the first 6 hours. With AVO-HDN, jaundice was diagnosed in 17 out of 115 newborns in the first 6 hours of life.

Indicators of the red blood of newborns at birth (hemoglobin, erythrocytes) correspond to age norms. Reticulocytosis (more than 43%) was detected in moderate and severe hemolytic disease of newborns with Rh incompatibility.

The results of the ABO examination of newborns in the first hours of life with hemolytic disease are shown in Table 2.

Table 2.

Laboratory indicators of newborns diagnosed with HDN according to the ABO system (at birth)

Laboratory indicators	Severity of HDN			Age norms
		moderate
Hemoglobin (g \ l)
Erythrocyte count (10 12 / l)
The number of reticulocytes
Cord blood bilirubin level (μmol / L)
Hourly increase in bilirubin levels in the first 12 hours after birth (μmol / L)

During the implementation of the conflict for antigens of the ABO system, a mild form of the disease was diagnosed in 49 newborns (42.6%) out of 115, moderate in 44 (38.3%) and severe in 22 (19.1%). With the implementation of a hemolytic conflict for antigens of the ABO system, a mild form of hemolytic disease is more often diagnosed. For a conflict on antigens of the ABO system, jaundice appears at the end of the first day of a child's life - in 89 cases out of 115. Red blood counts of newborns at birth (hemoglobin, erythrocytes) correspond to age norms. Reticulocytosis (more than 43%) was detected in moderate and severe neonatal hemolytic disease.

Severe HDN developed more often in the case of a conflict over antigens of the Rhesus system (63.0%) than in a conflict over antigens of the ABO system (39.0%). In newborns, hemolytic disease prevails with incompatibility for antigens of the ABO system (81%) over Rh-conflict (19%). The most important symptom that characterizes HDN is hyperbilirubinimia. It is detected at different times both in infants with Rh-conflict HDN, and in conflict according to the ABO system. Jaundice in newborns appears primarily on the face, most noticeable in the nose and nasolabial triangle. At the onset of the disease, the baby's face is always more jaundiced than the torso. This is due to the thin skin on the face, the presence of developed subcutaneous fat and better blood supply to the tissues in this area. The development and course of HDN has its own patterns: the conflict is realized in newborns already from the first pregnancy in a conflict according to the ABO system or from a repeated pregnancy in Rh-conflict. The severity of Rh-conflict HDN directly depends on the titer of maternal Rh antibodies and the coincidence of the blood groups of the mother and the newborn. The most important symptom that characterizes various forms of HDN is jaundice. In case of Rh-conflict hemolytic disease, 55% of newborns showed its early appearance, in the first 6 hours of life. Early onset of jaundice, in the first 6 hours of life, is diagnosed with Rh-conflict HDN more often (55.6%) than with ABO-HDN (14.8%). With AVO-HDN, 77.3% of the observed jaundice was detected at the end of the first day of life. In 84.3% of cases, hyperbilirubinimia, which appeared early and increasing in intensity, was the only clinical sign (monosymptom) of HDN.

conclusions

Based on the results of the observation, the following conclusions can be drawn:

• with all forms of hemolytic disease of newborns, reticulocytosis, anemia and hyperbilirubinemia are observed;
• for Rh-conflict hemolytic disease of newborns, a reduced level of red blood cells is characteristic, due to their increased decay, and an intense increase in bilirubin in the first 12 hours after birth, which very often leads to replacement blood transfusion;
• for hemolytic disease of newborns according to the ABO system, the following is characteristic: the number of erythrocytes within the age norms and an increase in bilirubin, requiring phototherapy treatment, but not requiring replacement blood transfusion;
• Determination of the level of bilirubin and its hourly increase in the first 12 hours after birth have relative diagnostic significance in various forms of hemolytic disease of the newborn.

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1. Morbidity and mortality of the newborn.
Principles of organizing pathology departments
newborns.
2. Intracranial birth injury: risk factors,
causes of occurrence, main clinical
symptoms of cerebral hemodynamic disorders and
hemorrhage. Modern examination methods
children (fundus ophthalmoscopy, radiography,
computed tomography, MRI, electromyography,
ultrasound examination, thermal imaging
diagnostics, lumbar puncture).
3. Asphyxia. Risk factors, reasons. Complex method
resuscitation. Prevention of secondary asphyxia.
4. Hemolytic disease of the newborn: causes,
pathogenesis, clinical forms, symptoms,
severity criteria, laboratory diagnostics.
5. Sepsis: etiology, routes of infection, clinical forms
(septicemia, septicopyemia), clinical
manifestations, laboratory diagnostics, care,
principles of treatment.

Neonatal period

Neonatal period - from cord ligation
up to 28 days - the period of adaptation to extrauterine
life.
Enteral feeding begins
Characterized by intensive development
analyzers, the formation of conditioned reflexes,
the emergence of emotional and tactile
contact with the mother.
A newborn baby sleeps a lot, usually
wakes up with hunger or discomfort.

Newborn baby

Full-term newborn - born in
period from 38 to 42 weeks. intrauterine
development.
Premature - born at term
pregnancy from 22 to 37 weeks. with body weight
2500g or less and 45cm or less in length.
Post-term - a child born after
42 weeks pregnant

Order of the Ministry of Health of Ukraine from _04.04.2005_ No. _152__ Protocol of medical care for a healthy newborn

Order of the Ministry of Health of Ukraine
від _04.04.2005_ No. _152__
Protocol
medical look for a healthy New Nation
child
The modern principle of perinatal assistance
based on the concept of the WHO
conduction of vaginosti, currents and physiological foresight
for a child with medical caretakers, get involved without
good showing.
Protocol of the medical man to the health
a new narodzhena child, destruction with a mark
I will become healthy children,
modern effective technologies of physiological
look for new people, practical help
to the medical staff.

Perinatal period

lasts from the 22nd week of gestation, includes the intrapartum period and the first 7 days
life.
Perinatal mortality is the number
stillborn (children born
dead with a gestational age of more than 22 weeks) and
number of deaths in the first week of life
(6 days 23 hours and 59 minutes) per 1000 births
alive and dead.

The perinatal management program includes
medical and socio-psychological support
women in ante, intra- and postnatal periods.
Analyze family, obstetric and genetic history,
socio-economic status, nutrition, physical
activity.
The condition of the pregnant woman and the degree of risk are assessed;
blood group, Rh-factor, hemoglobin and hematocrit are determined.
If a pregnant woman belongs to the risk group for
isoimmunization (Rh-negative blood type, obstetric
anamnesis), testing for isoimmune antibodies is performed.
According to the indications, an examination is carried out in order to identify
TORCH infections (toxoplasmosis, other viruses, rubella,
cytomegaly, herpes) and sexually transmitted infections
(testing for syphilis, hepatitis B in our country
necessarily).

Maternal serum alpha-fetoprotein testing

Maternal serum alpha-fetoprotein testing
is mandatory in economically developed
countries. Elevated levels of alpha-fetoprotein
in the second trimester of pregnancy (16-17 weeks) may
be with malformations of the neural tube,
is the basis for further
antenatal examination (ultrasonography II
level, amniocentesis with determination of concentration
alpha-fetoprotein and activity
acetylcholinesterase in amniotic fluid with
accurate to 90-95% verifies the diagnosis of defects
neural tube.

The main tasks of the regional perinatal center:

1. Diagnostics
and treatment of perinatal problems of any degree
difficulties (of both children and mothers).
2. Round-the-clock advisory assistance to institutions with
a lower level of perinatological activity.
3. Transportation of newborns and pregnant women from these
institutions.
4. Generalization of the experience of perinatal management of pregnant women and
high-risk newborns.
5. Development and implementation of new perinatal technologies.
6. Control and analysis of the work of perinatal institutions with less
the level of treatment and diagnostic capabilities.
7. Training of students, interns, postgraduate
advanced training for doctors, midwives and nurses.
8. Release of audio and video materials.
9. Coordination of activities and management of the entire system

Healthy full-term newborn

SIGNS
NORMAL PARAMETERS
Heart rate
100-160 per min.
Breathing rate
30-60 per min.
Color of the skin
Movement
pink,
No
central cyanosis
Active
Muscle tone
satisfactory
Temperature
newborn
36.5-37.5 C

Criteria for
appraisals
0 points
Skin coloration
cover
Pink body color
Pallor or
and bluish coloration
cyanosis (cyanotic
limbs
coloring)
(acrocyanosis)
Pink coloration of everything
body and limbs
Heart rate in 1 minute
Absent
<100
>100
Reflex
excitability
(baby reaction
on introduction
nasal catheter)
Does not react
The reaction is weak
pronounced (grimace,
traffic)
Reaction in the form
movement, coughing,
sneezing loud
screaming
Muscle tone
Absent,
limbs
hang down
Reduced, some
flexion
limbs
Active
movement
Breath
Absent
Irregular, scream
weak
Normal, cry
loud
1 point
2 points

Apgar score

Amount 8-10 points -
satisfactory condition
newborn
7-6 points - the state of the average
severity - slight asphyxia
5-4 points - serious condition -
moderate asphyxia ("blue")
3-1 point - extremely serious condition -
severe asphyxia ("white")
0 points - stillborn

Necessary additional examinations of the newborn

Laboratory
Instrumental (optional)
Neurosonography (if available
Complete blood count: hemoglobin,
clinical symptoms
erythrocytes, hematocrit, platelets, encephalopathy, and
newborns weighing at
leukocyte formula
birth<1500 г)
Blood glucose
General urine analysis
Blood electrolytes (K, Na, Ca)
Chest x-ray
cells (in the presence of respiratory
disorders)
Echocardiography, ECG (with
the presence of physical changes
from the heart, disorders
heart rate, increase
heart size)
Rivine and creatine5
Gas storage and acid-lined
6
EEG (in the presence of seizures)

The term "birth injury" is understood as violations of the integrity of the tissues and organs of the child that occur during childbirth.

The term "birth injury" means
violations of the integrity of tissues and organs
baby arising during childbirth.
Perinatal hypoxia and asphyxia are often
accompany birth trauma.

Intracranial birth injury

These are brain disorders that occur during
time of delivery due to mechanical
damage to the skull and its contents,
cause compression of the brain, tissue edema and how
usually hemorrhage.

Perinatal brain damage

Intracranial hemorrhage (ICH).
Distinguish between subdural, epidural,
subarachnoid, peri- and
intraventricular, parenchymal,
intracerebellar and other VChK.
Intracranial hemorrhage rate
highly variable. Among the full-term she
is 1: 1000, in premature babies with
body weight less than 1500 g reaches 50%.

Predisposing factors:

inconsistency in the size of the fetal head and
birth canal, fast or impetuous
childbirth, improper imposition of obstetric
cavity forceps, vacuum extraction of the fetus,
delivery by cesarean section,
chronic intrauterine hypoxia.
Birth brain injury and hypoxia
pathogenetically related to each other and, as
usually go together. Ratio
traumatic and non-traumatic
hemorrhage in the brain and its soft membranes
is 1:10.

Clinic

Clinic
The most typical manifestations of any
intracranial hemorrhages are:
1) sudden deterioration in general condition
child with the development of various options
depression syndrome with intermittent
emerging signs of hyperexcitability;
2) change in the nature of the cry;
3) bulging of the large fontanelle or its
voltage,
4) abnormal movements of the eyeballs;
5) violations of thermoregulation (hypo- or
hyperthermia);

Clinic

Clinic
6) vegetative-visceral disorders (regurgitation,
abnormal loss of thaw mass, flatulence,
unstable stool, tachypnea, tachycardia,
disorders of peripheral circulation);
7) pseudobulbar and movement disorders;
convulsions;
8) progressive post-hemorrhagic anemia;
9) acidosis, hyperbilirubgnemia and others
metabolic disorders;
10) the addition of somatic diseases
(meningitis, sepsis, pneumonia, cardiovascular
and adrenal glands due to lack of capacity, etc.).

Subarachnoid hemorrhage

occur as a result of integrity violations
meningeal vessels. Their most frequent localization
- the parietal-temporal region of the cerebral hemispheres and
cerebellum. Blood settling on the membranes of the brain causes
their aseptic inflammation and further leads to
cicatricial and atrophic changes in the brain and its
membranes, violation of CSF dynamics.
Clinical manifestations of SAH: either immediately after
birth, or after a few days appear
signs of general agitation, anxiety,
"cerebral" cry, sleep inversion, children lie with wide
open eyes, alert face, or
alarming, increased physical activity due to
hyperesthesia, muscle tone and congenital reflexes.

Risk factors for intracranial birth injury

macrosomia,
prematurity,
postmaturity,
developmental anomalies
intrauterine viral and mycoplasma
fetal infections (the latter as a result
vascular lesions and frequent lesions
brain),
pathology of the birth canal of the mother
(infantilism, long-term consequences of rickets,
rigidity).

The incidence of IVH in newborns with a body weight is less
1000 g exceeds 60%.
The incidence of IVH in newborns with a body weight is greater
1000 g ranges from 20-60%.
Of all DRCs, 90% develops in the first hour of life !!!
Rice. 1 Bleeding in subpendymal
matrix in a premature baby with gestation term
less than 28 tizh.

Clinical manifestations of intracranial birth injury

sudden deterioration of the child's condition with development
various variants of central depression syndrome
nervous system, which sometimes turns into
excitation; change in the nature of the cry;
bulging fontanelle;
abnormal eye movements
violation of thermoregulation (hypo- or hyperthermia)
vegetative-visceral disorders; pseudobulbar and
movement disorder;
seizures muscle tone disorders
progressive post-hemorrhagic anemia,
metabolic disorders; accession
somatic diseases,

Diagnostics

it is necessary to determine the severity,
the nature of the course of the disease, localization of injury
brain and leading neurological
syndromes. In the presence of intracranial
hematomas indicate suspected
localization.
It is necessary to analyze the clinical anamnestic data, pay attention to
neurological symptoms that
appear on the 3-4th day of life and are stored in
further.

Diagnostics

The study of cerebrospinal fluid is carried out
with severe intracranial hypertension,
repeated seizures (characterized by the presence
erythrocytes over 1000 / μl, increase
protein content).
Carry out a study of the fundus, use
neurosonography, computed tomography,
echoencephalography, if fractures are suspected
bones of the skull - craniography.
Additionally, the level is determined
glucose in serum and cerebrospinal
fluid (diagnostic criterion is
decrease in the ratio of glucose in
cerebrospinal fluid and blood up to 0.4).

Diagnosis

possible when taking into account a complex of anamnestic (course
pregnancy and childbirth, childbirth benefits, medication
maternal therapy during pregnancy and childbirth, etc.),
analysis of the dynamics of the child's clinical picture and assessment
the results of such diagnostic methods:
- neurosonography - ultrasound scanning of the head
brain through the fontanelle. This method is high
informative, non-invasive, not burdened by radiation exposure and
gives an image of various structures of the brain;
- computed tomography of the brain - allows you to analyze
both the condition of the bones of the skull and the brain parenchyma;
- nuclear magnetic resonance and emission tomography can detect pathological changes in the brain,
determine the difference between white and gray matter of the brain and
to clarify the degree of myelination (maturity) of various sites
brain;
- electroencephalography (EEG).

Treatment

Provide maximum peace, gentle
swaddling and performing various procedures;
"Temperature protection" - the child is placed in
jug, where the temperature is 30-33 ° C.
They begin to feed with breast expressed milk
12-24 hours after birth, dependence on
the severity of the condition. To the breast of the baby's mother
apply only after reducing acute
symptoms of intracranial hemorrhage.
In a complex of therapeutic measures
the leading is dehydration,
antihemorrhagic and sedative therapy.

Monitoring of basic parameters
vital activity: blood pressure and heart rate, respiration rate,
body temperature, etc.
Speedy recovery of normal
airway patency and adequate
ventilation of the lungs.
maintaining adequate brain perfusion;
correction of pathological acidosis and other
biochemical parameters (hypoglycemia,
hypocalcemia, etc.); systematic delivery to
energy to the brain in the form of a 10% glucose solution.
Prevention and early treatment of intrauterine
hypoxia and asphyxia of the newborn.

Seizure Syndrome Treatment

In the presence of seizures, immediately determine the content
blood glucose. If this indicator<2,6 ммоль / л, медленно
inject 10% glucose solution at the rate of 2 ml / kg into
within 5-10 minutes, then switch to continuous administration
10% glucose solution at the rate of 6-8 mg / kg / min. After 30
minutes to re-determine the blood glucose level:
if baseline blood sugar is> 2.6 mmol / L or if
after correction of hypoglycemia, the convulsions did not disappear, enter
phenobarbital, and in its absence, phenytoin.
Phenobarbital is administered intravenously or orally (after the onset of
enteral nutrition) at a loading dose of 20 mg / kg for 5
minutes.
In the absence or ineffectiveness of phenobarbital and
phenytoin, as well as, if possible, carry out a long
artificial ventilation of the lungs and the presence
qualified specialists, you can use:
diazepam lidocaine -;
thiopental -

Correct laboratory confirmed
violations by supporting:
blood glucose level within 2.8-5.5
mmol / l;
total calcium level - 1.75-2.73 mmol / l;
sodium level - 134-146 mmol / l;
potassium level - 3.0-7.0 mmol / l.

Perinatal injuries of the spinal cord and brachial plexus

forced increase in the distance between the shoulders and
the base of the skull, which occurs when pulling the head with
fixed hangers and pull on the hangers when
a fixed head (with breech presentation) and
excessive rotation (with facial presentation). In the moment
the birth of such children often used the imposition
forceps, hand aids.
Pathogenesis:
1. Injury to the spine
2. Hemorrhages in the spinal cord and its membranes
3. Ischemia in the region of the vertebral arteries due to stenosis,
spasm or occlusion of them
4. Injury of intervertebral discs
5. Damage to the cervical roots and brachial plexus

Clinic

With an injury of the cervical spine
pain syndrome is noted with
change in the position of the child, sharp crying;
possible - fixed torticollis,
shortened or elongated neck,
bruising, no sweat, dry skin
over the site of the lesion.

In case of damage to the upper cervical segments (C1-C4)

lethargy, weakness, diffuse
muscle hypotension, hypothermia,
arterial hypotension, hypo- or
areflexia, paralysis of movements, SDR; at
changing the position of the child - strengthening
respiratory disorders up to apnea.
Delay is characteristic
urination or urinary incontinence, "posture
frogs, "spastic torticollis, symptoms
lesions III, VI, VII, IX, X pairs of cranial nerves.

Duchenne-Erb paresis and paralysis

- develop with damage to the spinal cord at the level
C5-C6 or brachial plexus.
Clinic: the affected limb is reduced to
torso, unbent at the elbow joint, turned
inward, rotated in the shoulder joint, pronated
in the forearm, hand in palmar flexion and rotated
back and out. The head is tilted more often. The neck seems
short with many transverse folds.
Turning the head is due to the presence of spastic or
traumatic torticollis. Passive movements in
paretic limbs are painless; reflexes
Moro, Babkina, grasping reduced, tendon
reflex is absent.

Fetal hypoxia

is a pathological condition based on
which intrauterine deficiency lies
oxygen.
Risk factors for the development of antenatal
fetal hypoxia are:
post-term pregnancy,
long-term (more than 4 weeks) gestosis of pregnant women,
multiple pregnancy,
the threat of termination of pregnancy,
diabetes mellitus of a pregnant woman,
bleeding, somatic and infectious
diseases in the 1st trimester of pregnancy,
smoking and other types of drug addiction
pregnant women.

Under acute asphyxiation

the newborn implies the absence
gas exchange in the lungs after the birth of a child, i.e.
choking with other signs
live births as a result of exposure
intranatal factors (oxygen deficiency,
accumulation of carbon dioxide and under-oxidized
products of cellular metabolism). Asphyxia,
developed against the background of chronic
intrauterine hypoxia is asphyxia
newborn, developed antenatally in
conditions of placental insufficiency.

The main high risk factors for the development of intrapartum fetal asphyxia:

- cesarean section; pelvic, gluteal and other abnormal
presentation of the fetus;
- premature and late birth;
- anhydrous interval of 10 hours;
- rapid labor - less than 4 hours in primiparous and less
2 hours in multiparous;
- presentation or premature placental abruption,
ruptured uterus;
- use of obstetric forceps 11 other aids in childbirth
from the mother (shock, etc.);
- disorders of the placental-fetal (umbilical cord)
blood circulation with tight entanglement, true nodes, etc.;
- diseases of the heart, lungs and brain in the fetus, abnormal frequency
fetal heartbeats;
- meconium in amniotic fluid and its aspiration;
narcotic analgesics administered 4 hours or less before
birth of a child.

Classification of newborn asphyxia

depending on the severity of the condition
a child at birth, there are:
1. Asphyxia of moderate severity (moderate) 4-6 points in the first minute, by the fifth - 8-10
points
2. Severe asphyxia - 0-3 points on a scale
Apgar in the 1st minute, by the 5th - less than 7 points

Clinic of moderate to moderate asphyxia:

the condition of the child at birth is of moderate severity,
the child is lethargic, but spontaneous
physical activity, reaction to examination and
weak irritation. Physiological reflexes
the newborn is depressed. The cry is short
low-emotional. The skin is cyanotic, but
during oxygenation they quickly turn pink, often at the same time
remains acrocyanosis. Poi auscultation is auscultated
tachycardia, muffled heart sounds, or
increased sonority. Breathing after prolonged apnea
rhythmic, with sighs. Repeated
apnea. Hyperexcitability is noted,
shallow hand tremor, frequent regurgitation,
hyperesthesia

For severe asphyxia:

general condition at birth is severe or very
heavy. Physiological reflexes are practically
are not called. With active oxygenation (more often with
with the help of mechanical ventilation), the possibility remains
restore skin color to pink. Tones
hearts are often deaf, it is possible that
systolic murmur. When very hard
the condition of the clinic can correspond
hypoxic shock - the skin is pale with earthy
shade, a symptom of "white spot" 3 seconds and
more, lower blood pressure, spontaneous breathing
absent, no reaction to examination and pain
irritation, areflexia, muscle atony,
closed eyes, sluggish pupil response to light, or
lack of reaction

Treatment

Primary resuscitation system
newborns developed by the American
the Heart Association and the American
Academy of Pediatrics. Main steps
resuscitation centers are called "ABC - crocs".
Main steps:
A. Ensuring the patency of respiratory
ways (Airways);
B. stimulation or restoration of breathing
(Breathing);
C. maintaining blood circulation
(Circulation).

Jaundice

- visual manifestation of hyperbilirubinemia,
which is noted in full-term at the level
bilirubin 85 μmol / l, in premature babies more than 120 μmol / l.

Neonatal jaundice (jaundice of the newborn)

The appearance of a visible yellow coloration
skin, sclera and / or mucous membranes
shells of the child due
increase in the level of bilirubin in
blood of a newborn.

Early jaundice - appears before 36 hours of a child's life.
Jaundice that appears in the first 24 hours is always a sign
pathology.
"Physiological" jaundice, manifests itself after 36 hours
life of the child and is characterized by an increase in the level
total bilirubin is not higher than 205 μmol / l. Such jaundice
more often due to the peculiarities of development and metabolism
newborn during this period of life. "Physiological"
jaundice can have both uncomplicated and complicated
flow, therefore requires careful monitoring of
the condition of the child.
Complicated "physiological" jaundice is a physiological
jaundice, the course of which may be accompanied by a change
the condition of the child.
Prolonged (lingering) jaundice, which is defined
after 14 days of life in a full-term newborn and after
21 days of life in a premature baby.
Late jaundice that appears after 7 days of life
newborn. This jaundice always requires careful
survey.

Physiological jaundice

Physiological jaundice (hyperbilirubinemia)

Develops 2-3 days after birth
Duration on average 8-12 days
Hyperbilirubinemia develops in everyone
newborns in the first days of life, however
yellowness of the skin is observed only in 6070%. Bilirubin concentration (hereinafter
referred to as B) in blood serum in the first days of life
increases at a rate of 1.7-2.6 μmol / l / h and
reaches an average of 103-137 μmol / l on 3-4 days (B c
cord blood serum is 26-34
μmol / L).
Total and indirect bilirubin increases

Pathogenetic classification of neonatal jaundice

Jaundice caused by
advanced education
bilirubin
(unconjugated
hyperbilirubinemia)
A. hemolytic causes
Hemolytic disease of the fetus and
newborn with isoimmunization for:
Rh factor, ABO system
other antigens
Increased hemolysis caused by
taking medications
Hereditary hemolytic
anemia.
B. non-hemolytic reasons:
Hemorrhage
Polycythemia
Enhanced enterohepatic
circulation of bilirubin (thin atresia
intestines; pyloric stenosis; disease
Hirschsprung;
Jaundice caused by
reduced
conjugation
bilirubin
(mostly non
conjugated
hyperbilirubinemia)
Jaundice caused by
decreased excretion
bilirubin
(mainly with
elevated straight
fraction of bilirubin)
1. Crigler Naiyar disease, types 1 and 2
2.Gilbert's syndrome
3. Hypothyroidism
4. Jaundice
newborns,
located on
chest
feeding
Hepatocellular
diseases:
Toxic
infectious
Metabolic
Bile thickening syndrome
Bile outflow obstruction
(biliary atresia):
extrahepatic
intrahepatic

Risk factors affecting bilirubin levels and severity of jaundice

Prematurity
Hemorrhages (cephalohematoma, hemorrhages
skin)
Inadequate nutrition, frequent vomiting
A sharp decrease in the child's body weight
The presence of a generalized infection
Incompatibility of the blood of the mother and the child
group and rhesus factor
Hereditary hemolytic anemia or
hemolytic disease

Clinical examination and assessment of jaundice

Color of the skin
Inspection for the presence of icteric
staining of the skin should be carried out,
when the child is completely undressed, when
condition of sufficient (optimal
daylight) lighting. For this
light pressure on the skin
child to the level of subcutaneous tissue.

Prevalence of icteric skin coloration

jaundice first appears on the face, with
subsequent dissemination across
towards the limbs of the child,
reflecting the degree of increase in the level of bilirubin
in blood serum.
An alternative to using visual
assessment can be level determination
bilirubin of the skin by the method of transcutaneous
bilirubinometry (TCB)

Basic principles of examination and treatment of a newborn with jaundice

Newborn with bilirubin levels
umbilical cord blood more than 50 μmol / l
It is necessary to redefine the overall
serum bilirubin (serum bilirubin) no later than
than 4 hours after birth and calculate
hourly increase in bilirubin. V
it is further recommended that
laboratory examination depending on
the clinical condition of the child.

Newborn with early or "dangerous" jaundice

Newborn with an early or "dangerous"
jaundice
Phototherapy must be started immediately
Simultaneously with the start of phototherapy
take a blood sample to determine the total blood serum bilirubin
If, at the birth of a child, his
blood group, Rh-affiliation and direct
Coombs' test was not determined, it follows
conduct research data
Recommended level determination
hemoglobin, hematocrit, and counting
the number of erythrocytes and reticulocytes

Phototherapy for neonatal jaundice

Phototherapy is the most
effective method of reducing the level
bilirubin in newborns with
neonatal jaundice. Timely and
correct phototherapy
reduces the need for substitution
blood transfusion up to 4% and reduces
the likelihood of complications
neonatal jaundice.

Hemolytic disease of the newborn (HDN)

Cause of hemolytic disease
newborns are most often
incompatibility by Rh factor or ABO
(group) blood of mother and child, or
other red blood cell antigens.
Jaundice with HDN is the result of increased
hemolysis of erythrocytes,
hyperbilirubinemia with
unconjugated bilirubin.

Clinical forms of HDN:

The icteric form occurs most often. She
manifests itself as icteric staining of the skin and
mucous membranes.
Anemic form occurs in 10-20% of newborns
and is manifested by pallor, low hemoglobin levels
(<120 г / л) и гематокрита (<40%) при рождении.
Edema (hydrops fetalis) is severe
manifestation of the disease and has a high percentage
lethality. Almost always associated with
incompatibility of the blood of the mother and the child according to the Rh factor. Manifested by generalized edema and
anemia at birth.
Mixed form combines symptoms of 2 or 3
forms described above.

Mandatory examinations:

1. Determination of the blood group of the child and his
Rh accessories (if it was not
previously defined)
2. Determination of the level of total bilirubin in
serum
3. Determination of the hourly level increase
bilirubin
4. Determination of direct Coombs' test
5. Complete blood count with counting
erythrocytes, hemoglobin, hematocrit,
parts of reticulocytes

Coombs reaction -

Coombs reaction -
antiglobulin test to determine
incomplete anti-erythrocyte antibodies. Test
Coombs' is used to detect antibodies to
Rh factor in pregnant women and
determination of hemolytic anemia in
newborn children with Rh incompatibility, leading to destruction
erythrocytes. The fundamentals of the method are described in 1908
year Moreshi, in 1945 - Coombs, Muran
and Race, later named
"Coombs reaction".

Diagnosis criteria

The birth of a child with generalized
edema and anemia (hemoglobin<120 г / л и
hematocrit<40%)
The appearance of icteric discoloration of the skin
a child 1 day after birth and
positive Coombs test. General level
serum bilirubin corresponds to the level
performing a replaceable blood transfusion
The appearance of a pale skin color in 1 day and
laboratory confirmation of anemia
(hemoglobin<135 г / л и гематокрита <40%), а
also an increase in the level of reticulocytes

Purulent-inflammatory diseases of the skin and subcutaneous tissue

Vesiculopustulosis is a disease
predominantly staphylococcal nature,
appears already in the middle of the early
neonatal period and is characterized by
inflammation of the mouths of the eccrine sweat glands.
The main symptoms of the disease are
small surface bubbles up to
a few millimeters in diameter,
filled at first with transparent and then
cloudy contents. Most beloved
their location is the skin of the buttocks,
thighs, natural folds and head.
The course of the disease is benign.

Omphalitis

bacterial inflammation of the bottom of the umbilical wound, umbilical
rings, subcutaneous tissue around the umbilical ring and
umbilical vessels.
The disease usually begins at the end of the early neonatal
period when purulent discharge from the umbilical
wounds, hyperemia and edema of the umbilical ring, infiltration
subcutaneous tissue around the navel, vasodilation
anterior abdominal wall, red stripes (lymphangitis).
The general condition of the child is disturbed, he becomes lethargic, bad
sucks the breast, regurgitates, Weight gain decreases.
Body temperature rises, sometimes to febrile. In analysis
blood leukocytosis with a shift to the left, increased ESR. Possible
metastatic infections and generalization of the process.
A navel ulcer occurs as a complication of a bacterial
inflammation of the navel or omphalitis. the umbilical wound is covered
serous-purulent or purulent discharge. General state
the child in the first days of the disease may not be disturbed, in
further intoxication syndrome occurs.

Neonatal sepsis

Sepsis - is a bacterial infection
with primary (entrance gate) and secondary
(arising metastatic) focus, from
which constantly or periodically into the bloodstream
microorganisms enter and cause severe
manifestations of the disease.
This is a bacterial infection that develops in the first
90 days of life. Its manifestations are varied and
include a decrease in spontaneous activity,
sucking vigor, apnea, bradycardia,
instability of temperature, respiratory
failure, vomiting, diarrhea, abdominal enlargement,
anxiety, cramps, and jaundice.

Early sepsis

Early sepsis
usually results from
infection of the newborn during
childbirth. In more than 50% of cases, early
sepsis clinical manifestations
develop within 6 hours after
birth, and within 72 hours - at
most patients. When late
neonatal sepsis infection is common
comes from the environment.

Sepsis of newborns - etiology
Group B streptococci and gram-negative
intestinal microorganisms cause 70% of the early
sepsis. When cultured from the vagina and rectum in
women at the time of delivery in 30% can be identified
colonization of the SGV. Massive colonization
determines the degree of risk of invasion of the microorganism,
which is 40 times higher with massive colonization.
Although only 1 in 100 newborns,
colonized GBS, an invasive
disease, more than 50% of them develop
disease in the first 6 hours of life.
Non-typeable Haemophilus influenzae strains all
are more often the causative agents of sepsis in
newborns, especially premature babies.

Other gram-negative intestinal
sticks and gram-positive
microorganisms - Listeria monocytogenes,
enterococci, group D streptococci, alphahemolytic streptococci and staphylococci
cause most of the rest of the cases.
Streptococcus pneumoniae H.
influenzae type b and, less commonly, Neisseria meningitidis.
Asymptomatic gonorrhea occurs in 5-10%
pregnancy, therefore N. gonorrhoeae also
may be the causative agent of neonatal
sepsis.

Staphylococci cause 30-50% of late
neonatal sepsis, most often in
connection with the use of intravascular
devices. Isolation of Enterobactercloacae £
Sakazakii from blood or cerebrospinal fluid
suggests food contamination. At
outbreaks of in-hospital pneumonia
or sepsis caused by Pseudomonas
aeruginosa suggest contamination
equipment for mechanical ventilation.

Candida sp are getting more and more important
causes of late
sepsis, which develops in 12-13%
very low birth weight infants with
birth.
Some viral infections can
manifest as early or late
neonatal sepsis.

Early manifestations

often nonspecific and worn out and do not differ in
depending on the etiology.
A decrease in spontaneous
activity, vigor of sucking, apnea,
bradycardia, temperature instability.
Fever occurs in only 10-50%, however
if persists usually indicates
infectious disease. Other manifestations
include respiratory distress,
neurological disorders, jaundice, vomiting,
diarrhea and abdominal enlargement. About availability
anaerobic infection is often indicated
unpleasant putrid smell of amniotic
fluid at birth.

Septicopyemia

Leaks from febrile hectic
fever
pronounced symptoms of intoxication,
weight loss
local multiple
purulent lesions: purulent
peritonitis, purulent meningitis, osteomyelitis and
arthritis, otitis media, phlegmon of various areas,
pleurisy and abscesses of the lungs, etc.
hemorrhagic syndrome

Septicemia

The clinical form of sepsis, in which
the patient has pronounced signs
increasing bacterial toxicosis
in the absence of foci of purulent inflammation.
A large number of microbes trapped in
blood, multiplying intensively,
hematogenously deposited in tissues in
not enough to
local purulent foci were formed.

In most newborns with early sepsis,
caused by GBS, the disease is manifested by respiratory
deficiency that is difficult to distinguish from disease
hyaline membranes.
Skin redness, discharge or bleeding from
umbilical wound in the absence of hemorrhagic diathesis
suggest omphalitis.
Coma, seizures, opisthotonus, or bulging fontanelle
suggest meningitis or brain abscess.
Decrease in spontaneous movements of the limb and its
edema, erythema and local fever, or
soreness in the joint area indicates
osteomyelitis or purulent arthritis.

Unexplained bloating may indicate peritonitis or necrotizing ulcerative enterocolitis.

Umbilical sepsis

Most common. Entrance gate
the infection is the umbilical wound. Infection
can occur during the processing of the umbilical cord and from
the beginning of the demarcation of the umbilical cord stump to complete
epithelialization of the umbilical wound (usually from 2-3 to 10-12
days, and when processing the remainder of the umbilical cord with a metal
parenthesis - up to 5-6 days).
The primary septic focus is rarely solitary in
umbilical fossa, more often the foci are found in different
combinations: in the umbilical arteries and fossa or in the umbilical
vein and arteries.
Umbilical sepsis can proceed as in the form
septicemia, and in the form of septicopyemia. Metastases
with umbilical sepsis: purulent peritonitis, purulent
meningitis, osteomyelitis and arthritis, phlegmon of various
areas, pleurisy and lung abscesses.

Early diagnosis

In newborns with suspected sepsis and
those whose mothers allegedly had
place chorioamnionitis as quickly as possible
a complete blood count should be taken with
calculating the leukocyte formula and the number
platelets, blood and urine cultures,
perform a lumbar puncture if
allows the condition of the child. In the presence of
respiratory symptoms
X-ray is required
organs of the chest. Diagnosis
confirmed by isolation of the pathogen
bacteriological method.

Sepsis of newborns - isolation of the pathogen

If the child has several foci of purulent
infection and at the same time severe toxicosis diagnosis
sepsis is usually not difficult. Exact
diagnosis is possible after detection
pathogen in blood culture. Diagnostic value
has a bacteriological study of pus, cerebrospinal fluid,
urine, mucus from throat, stool, punctate or smear from any
possible primary foci of sepsis or its
metastases. It is advisable to do all crops before starting.
antibiotic therapy with mandatory use
media for the isolation of gram-negative microbes and
anaerobic flora. Blood must not be sown
less than three times in an amount of at least 1 ml and in
sowing ratio 1:10. The seeded medium should
be immediately placed in a thermostat.

Analysis and culture of urine

Urine must be obtained by
catheterization or suprapubic puncture, rather than
using bags to collect urine. Though
only have diagnostic value
urine culture results, detection more than 5
leukocytes in the field of view with a large
an increase in centrifuged urine or
any number of microorganisms in fresh
non-centrifuged urine, stained by
Gram, is preliminary
evidence of urinary infection
systems

Other tests to check for infection and inflammation

Reactions of counter immunoelectrophoresis and latexagglutination make it possible to detect antigens in biological
liquids; they can be used when the preliminary
antibacterial therapy makes the results of the crops
unreliable. They can also detect capsule
polysaccharide antigen GBS, E. coli K1, N. Meningitidis type B,
S. pneumoniae, H. influenzae type b.
Acute phase indicators are proteins produced by
the liver under the influence of IL-1 in the presence of inflammation.
The most significant are tests for quantitative
determination of C-reactive protein. Concentration 1
mg / dL gives the frequency of false positives and
false negative results 10%. The increase in C-reactive protein occurs during the day with a peak at 2-3rd
day and decreases to the sensitivity of the pathogen and
localization of the focus of infection.

Treatment

Urgent hospitalization in a separate box
specialized department.
You need to breastfeed your baby or
breast expressed milk.
Detoxification infusion therapy,
which often begins as parenteral
food and at the same time is carried out for the purpose
correction of violations of water-electrolyte
exchange and acid-base state.

Antibiotics for sepsis in newborns

Antibiotics for sepsis in
newborn
Pending results
antibiotics are used
combinations of ampicillin with
aminoglycosides or cephalosporins with
carbenicillin, aminoglycosides.
One of the antibiotics is given intravenously.
Antibiotics are changed every 7-10 days.
Antibiotics can be modified like
only the pathogen will be isolated.

Prevention - strict adherence
sanitary and epidemiological regime in obstetric
institutions, departments of newborns
city ​​hospitals.
After discharge from the hospital - observation
in the clinic for three years
pediatrician, neurologist and others
specialists, depending on the nature
the course of the disease.

HEALTH PROTECTION ORGANIZATION

UDC 616 - 053.31 - 036. © N.V. Gorelova, L.A. Ogul, 2011

N.V. Gorelova1, L.A. Ogul1,2 ANALYSIS OF INFANTS INCIDENCE IN THE MATERNITY HOSPITAL

1GBOU VPO "Astrakhan State Medical Academy" of the Ministry of Health and Social Development of Russia 2MUZ "Clinical Maternity Hospital", Astrakhan, Russia

The article presents the results of the analysis of morbidity and its structure in newborns for the period 2005-2009 according to the data of the MUZ "Clinical Maternity Hospital" (MUZ KRD) in Astrakhan.

Key words: newborn, newborn morbidity, structure of newborn morbidity, quality of medical care.

N.V. Gorelova, L.A. Ogul THE ANALYSIS OF NEW-BORNS MORBIDITY IN THE MATERNITY HOME

The article deals with the results of made analysis according to morbidity and its structure among new-borns during the period from 2005 to 2009 using the data of clinical maternity home in Astrakhan.

Key words: new-born, new-born morbidity, new-born morbidity structure, medical aid quality.

Statistical data on the health status of the population of the Russian Federation indicate an increase in the incidence of newborns associated with various types of obstetric and somatic pathology of the mother, socio-biological, hereditary and other factors. Currently, there is a fairly high level of perinatal morbidity and mortality.

Purpose and objectives of the study: to assess the morbidity and its structure in newborns in dynamics for the period 2005-2009 according to the data obtained in the Clinical Maternity Hospital in Astrakhan.

Materials and methods. The study was carried out on the basis of the observational department of newborns of the Clinical Maternity Hospital in Astrakhan based on the results of the analysis of the medical documentation of the maternity hospital, data from the histories of the development of newborns using the calculation of intensive and extensive indicators of morbidity and its structure among newborns of the clinical maternity hospital.

Results and its discussion. Among all those born in 2005-2007, 73.0% of newborns had one or another disease and concomitant pathology, which decreased in 2008 to 58.9%, in 2009 to 48.0%. The incidence rate of newborns in the maternity hospital increased slightly (from 977% in 2005 to 1081% in 2006) and decreased to 720% by 2009 (Fig. 1).

1100 1000 900 % 800 700 600 500

Rice. 1. Dynamics of morbidity in newborns in a clinical maternity hospital from 2005 to 2009.

The proportion of premature babies was stable, amounting to 7.6% in 2006, 7.3% in 2007, 7.6% in 2008, 7.7% in 2009.

The leading place in the structure of morbidity in newborns for the period 2005-2009 was occupied by neurological disorders. The frequency of lesions of the central nervous system (CNS) in newborns had unequal dynamics in the maternity hospital: there was an increase from 46.6% in 2005 to 52.7% by 2006

year, and a decrease to 31.8% by 2009 (p<0,05). Основными клиническими проявлениями были синдромы гипервозбудимости ЦНС и церебральной депрессии (табл. 1).

Table 1

Dynamics of the morbidity structure of newborns in a clinical maternity hospital%

Years of pathology 2005 2006 2007 2008 2009

Cerebral status disorders 46.6 52.7 42.0 36.6 31.8

Neonatal jaundice 9.8 9.4 18.0 20.6 19.5

Slow growth and malnutrition of the fetus 11.0 11.4 11.6 11.8 15.2

Hemolytic disease of newborns 2.6 2.6 5.0 5.2 8.9

Respiratory distress syndrome 2.1 2.3 3.4 6.8 5.1

Congenital malformations 6.6 4.8 4.5 3.3 4.9

Birth trauma 1.4 1.6 2.0 3.7 4.8

Anemia (and other hematological disorders) 2.3 1.8 4.2 5.9 3.7

Intrauterine hypoxia (and newborn asphyxia) 5.8 6.1 4.5 3.6 3.7

Intrauterine infections (including congenital pneumonia) 11.8 7.3 4.8 2.5 2.4

Total 100 100 100 100 100

In the interval from 2005 to 2006, a stable incidence of neonatal jaundice was recorded (9.8% in 2005 and 9.4% in 2006), however, there was a significant increase in this pathology in 2007-2008 from 18.0% to 20 , 6% (p<0,05). За 2009 год в МУЗ КРД отмечалось снижение абсолютного количества гипербилирубинемий до 19,5% (р<0,05), большинство которых носило характер функциональных расстройств, связанных с транзитор-ным нарушением коньюгации билирубина. Эта патология наиболее часто возникала у доношенных детей с выраженными признаками морфофункциональной незрелости и у недоношенных новорожденных. Снижение числа данной патологии, несмотря на рост преждевременных родов, говорит о том, что доношенных детей с проявлениями морфофункциональной незрелости стало меньше. У подавляющего числа детей неонатальная желтуха имела легкое и среднетяжелое течение. В случаях затяжного течения дети переводились на второй этап выхаживания.

The percentage of newborns with stunted growth and malnutrition with intrauterine growth retardation (IUGR) was 11.0% in 2005, 11.4% in 2006, 11.6% in 2007, having increased to 15.2 by 2009 % (R<0,05>

In recent years, there has been an increase in the incidence of hemolytic disease of the newborn (HDN): from 2.6% in 2005-2006 to 5.0% in 2007, with a subsequent increase by 2009 to 9.0% (р<0,05). Возможно, это было обусловлено ростом рождаемости в последние годы, а также профильным направлением всех рожениц с изоиммунным конфликтом в данный клинический родильный дом.

The incidence of respiratory distress syndrome (RDS) in newborns increased from 2.1% in 2005 to 6.8% in 2008 (p<0,05). Снижение показателя заболеваемости новорожденных с РДС в 2009 году до 5,1%, несмотря на возросшее число преждевременных родов, произошло за счет снижения количества доношенных детей с морфофункциональной незрелостью. Респираторные расстройства регистрировались:

In premature infants and were caused by atelectasis of the lungs and respiratory distress syndrome;

In children with signs of morphofunctional immaturity (atelectasis of the lungs);

In newborns born by caesarean section (ACS), in whom RDS developed against the background of fetal fluid retention.

All children with respiratory failure (DN) were observed and received appropriate treatment in the intensive care unit of newborns. The decrease in morbidity and mortality from RDS in the early neonatal period under the conditions of the Clinical Maternity Hospital in 2009 was undoubtedly associated with the introduction of high-tech methods of nursing using modern respiratory equipment (ventilation of the lungs by the method of constant positive pressure through nasal cannulas -NCPAP, high-frequency mechanical ventilation) and an artificial surfactant (kurosurfa). After stabilization of the condition, the children were transferred to children's departments and to the second stage of nursing, depending on the severity and duration of DN.

During the period 2006-2008, there was a decrease in the incidence of congenital malformations from 4.8% to 3.3%, followed by an increase in their number to 4.9% in 2009 (р<0,05), связанным с улучшением диагно-

congenital malformations in the antenatal period by the Family Planning Center (PSC). The available indicators also included cases of congenital malformations in children whose mothers categorically refused to terminate the pregnancy, although they knew about the congenital pathology that their unborn child had. A large group consisted of children in whom intrauterine diagnostics of congenital pathology was not possible for technical reasons ("slit" hemodynamically insignificant defects of the interventricular septum, patent ductus arteriosus, atrial septal defects, small focal changes in the central nervous system, etc.). Children with suspected genetic or chromosomal abnormalities were consulted by a CPS geneticist. In the conditions of the Clinical Maternity Hospital, ultrasound diagnostics was of a screening nature.

In the period from 2005 to 2009, there was an increase in the number of birth injuries from 1.4% to 4.8% (p<0,05), однако в 2009 году 64,7% всех родовых травм не были связаны с внутричерепной родовой травмой, а были представлены в виде кефалогематом. Практически во всех случаях диагноз «кефалогематома» носил сопутствующий характер.

Between 2006 and 2008, there was an increase in the incidence of anemia of unspecified etiology: from 1.8% in 2006 to 5.9% in 2008 (p<0,05). Она не была связана с кровотечением или гемолизом, вызванным изоиммунизацией. Как правило, это состояние развивалось на фоне длительных гестозов, анемии у матери во время беременности, фетоплацентарной трансфузии и др.

A positive trend was revealed in relation to the amount of intrauterine hypoxia and asphyxia. So, in 2006, there was an increase in their number to 6.1%, and from 2007 to 2009, their number decreased from 4.5% to 3.7% (p<0,05). С нашей точки зрения, снижение частоты внутриутробной гипоксии и асфиксии связано с повышением качества коррекции этих состояний в антенатальном периоде. Все реанимационные мероприятия проводились с участием врача реаниматолога-анестезиолога согласно действующему приказу МЗ РФ от 28.12.1995 № 372 «О совершенствовании первичной реанимационной помощи новорожденным в родильном доме» .

During the period from 2006 to 2009, there was a decrease in infectious morbidity from 11.8% in 2005 to 7.3% in 2006, 4.8% in 2007, 2.5% in 2008, which remained stable in 2009 , amounting to 2.4% (p<0,05). Такая динамика связана с эффективным профилактическим лечением беременных с внутриутробной инфекцией в течение беременности, внедрением высоких технологий в практику работы отделения реанимации и интенсивной терапии новорожденных. При проявлении признаков внутриутробной инфекции (ВУИ) (гнойный конъюнктивит, омфалит, фарингит) дети переводились в инфекционное отделение городской детской клинической больницы для новорожденных № 1 в день постановки диагноза (1-3 сутки). Если перевод был невозможен из-за тяжести состояния, то он осуществлялся сразу после стабилизации состояния.

Conclusion. Thus, on the basis of the analysis, an increase in the incidence of HDN, IUGR, birth trauma, congenital malformations and a decrease in the number of disorders of cerebral status, intrauterine hypoxia and asphyxia of newborns, intrauterine infections were revealed. The implementation of the National Project "Health" made it possible to improve diagnostics through the purchase and introduction of modern equipment, to provide high-quality medical care, to improve the qualifications of personnel, which was reflected in the change in the morbidity rate of newborns.

BIBLIOGRAPHY

1. Volkov S.R. Health statistics: the main indicators of the maternity and childhood protection service and the methodology for calculating them (Main indicators of the maternity hospital) // Main nurse. - 2008. - No. 8. - S. 25-28.

2. Zlatovratskaya T.V. Reserves for reducing maternal and perinatal morbidity and mortality in the maternity ward of a multidisciplinary hospital: author. dis. ... dr. honey. sciences. - M., 2008.-48 p.