CHAIR OF PAEDIATRICS WITH CHAIR OF PAEDIATRICS WITH MEDICAL GENETICSMEDICAL GENETICS

THEME OF LECTURETHEME OF LECTURE ::

““ Intrauterine growth Intrauterine growth retardation. Premature retardation. Premature

children children ””

Definition.

Intrauterine growth retardation (IGR) – Intrauterine growth retardation (IGR) – deceleration of growth and development of deceleration of growth and development of fetus, which is manifested at birth with fetus, which is manifested at birth with parameters of physical development (weight parameters of physical development (weight and height, head circumference and chest and height, head circumference and chest circumference) and low morphological indexes circumference) and low morphological indexes of maturity in relation to gestational age.of maturity in relation to gestational age.

Actuality

IGR is one of leading reasons of perinatal morbidity IGR is one of leading reasons of perinatal morbidity and death rate. Perinatal lethality among new-born with and death rate. Perinatal lethality among new-born with IGR on 4-8 times higher, than for children with normal IGR on 4-8 times higher, than for children with normal indexes of physical development;indexes of physical development;

in Ukraine frequency of IGR is at full-term children 5-in Ukraine frequency of IGR is at full-term children 5-32% and 16-42% at premature children at general 32% and 16-42% at premature children at general amount of births;amount of births;

at half of children with IGR severe acute and chronic at half of children with IGR severe acute and chronic diseases arise in future;diseases arise in future;

the consequences of IGR (delay of physical and the consequences of IGR (delay of physical and neural-psychological development, violation of neural-psychological development, violation of metabolism and immunological reactions) are observed metabolism and immunological reactions) are observed to 4-6-years-old ageto 4-6-years-old age..

Risk factors and etiologic factors

Socialbiological factorsSocialbiological factors (age of mother <18 and >35 years, high (age of mother <18 and >35 years, high psycho-emotional stress, occupational hazard).psycho-emotional stress, occupational hazard).

Socio-economic conditionsSocio-economic conditions (low socio-economic level, (low socio-economic level, inaccessibility of medicare).inaccessibility of medicare).

Features of feedFeatures of feed (low mass of body at mother, insufficient increase (low mass of body at mother, insufficient increase of mass of body and insufficient feed during pregnancy, protracted of mass of body and insufficient feed during pregnancy, protracted starvation, vegetarian diet).starvation, vegetarian diet).

Complicated obstetric-gynecological anamnesisComplicated obstetric-gynecological anamnesis (genital (genital infantilism, malformations of uterus, tumor of genitalia, disorders infantilism, malformations of uterus, tumor of genitalia, disorders of menstrual cycle, habitual no carrying of pregnancy, stillborn).of menstrual cycle, habitual no carrying of pregnancy, stillborn).

Complication of pregnancyComplication of pregnancy (gestosis of ІІ half of pregnancy, (gestosis of ІІ half of pregnancy, bleeding in ІІ, ІІІ trimesters of pregnancy, threat of miscarriage, bleeding in ІІ, ІІІ trimesters of pregnancy, threat of miscarriage, postmature or multiple pregnancy, anomalies of umbilical cord and postmature or multiple pregnancy, anomalies of umbilical cord and placenta. placenta. . .

Risk factors and etiologic factors Mother’s harmful habitsMother’s harmful habits (alcohol, smoking, drugs). (alcohol, smoking, drugs). Extragenital diseases (Extragenital diseases (hypertensive illness, diabetes hypertensive illness, diabetes

mellitus, disease of kidneys, lungs, severe anemia, mellitus, disease of kidneys, lungs, severe anemia, autoimmune diseases, congenital heart disease).autoimmune diseases, congenital heart disease).

Infections.Infections. Congenital or hereditary pathology.Congenital or hereditary pathology. Influence of radiation.Influence of radiation. Miscarriage of pregnancy is reason of IGR in 50-77% Miscarriage of pregnancy is reason of IGR in 50-77%

cases, gestosis – in 32%, extragenital pathology – 25-cases, gestosis – in 32%, extragenital pathology – 25-45%, approximately 10% cases are related to pathological 45%, approximately 10% cases are related to pathological karyotype , other 10% - IUI; in 20% cases, determining of karyotype , other 10% - IUI; in 20% cases, determining of the concrete factor of IGR is not identifiedthe concrete factor of IGR is not identified

Pathogenesis In case of forming of IGR in the phase of embryonal In case of forming of IGR in the phase of embryonal

development there is decreasing of amount of cells, which causes development there is decreasing of amount of cells, which causes gradual delay of growth and development. If IGR developed in gradual delay of growth and development. If IGR developed in the phase of placenta development, there is diminishing of sizes the phase of placenta development, there is diminishing of sizes of cells, that causes change of sizes of organs, especially liver. of cells, that causes change of sizes of organs, especially liver. Also at late development of IGR adaptation mechanisms which Also at late development of IGR adaptation mechanisms which influence on haemodynamic processes are involved influence on haemodynamic processes are involved (centralization of circulation of blood).(centralization of circulation of blood).

Basic role in pathogenesis of IGR is related to FPI. Structural Basic role in pathogenesis of IGR is related to FPI. Structural changes in the vessels of placenta are basis of violations of changes in the vessels of placenta are basis of violations of placenta blood circulation, access of oxygen and glucose from a placenta blood circulation, access of oxygen and glucose from a mother to fetus directly depends on intensity uterine-placenta mother to fetus directly depends on intensity uterine-placenta circulation of blood. An insufficient perfusion of fetus with circulation of blood. An insufficient perfusion of fetus with oxygen and glucose causes not only metabolic acidosis, oxygen and glucose causes not only metabolic acidosis, hypoglycemia and hypoinsulinemia , decline of synthesis of hypoglycemia and hypoinsulinemia , decline of synthesis of insulin-like growth factor , but also rupture of neurohumoral insulin-like growth factor , but also rupture of neurohumoral mechanisms of regulation of plastic processes.mechanisms of regulation of plastic processes.

ClassificationEtiological:Etiological: Mother’s factors;Mother’s factors; Placenta factors;Placenta factors; Sociobiological factors;Sociobiological factors; Fetal factors.Fetal factors.After variants:After variants: Hypotrophic (the degree of hypotrophy is estimated in relation to GA);Hypotrophic (the degree of hypotrophy is estimated in relation to GA); Hypoplastic;Hypoplastic; Dysplastic.Dysplastic.After the severity of IGR:After the severity of IGR: I degree is retardation of fetus on weight and height related to GA on I degree is retardation of fetus on weight and height related to GA on

2-3 weeks;2-3 weeks; II degree is retardation of fetus on weight and height related to GA on II degree is retardation of fetus on weight and height related to GA on

3-4 weeks;3-4 weeks; III degree is retardation of fetus on weight and height related to GA on III degree is retardation of fetus on weight and height related to GA on

>5 weeks;>5 weeks;

ClassificationAfter course of early neonatal period:After course of early neonatal period: metabolic metabolic

disorders, protracted transient states, violations of disorders, protracted transient states, violations of thermoregulation, hemorrhagic syndrome, thermoregulation, hemorrhagic syndrome, anaemia, defeat of CNS.anaemia, defeat of CNS.

Example of diagnosisExample of diagnosis:: INTRAUTERINE INTRAUTERINE GROWTH RETARDATION hypotrophy type, GROWTH RETARDATION hypotrophy type, caused by mother’s factors (CFPI), moderate caused by mother’s factors (CFPI), moderate degree (deficit of weight related to GA 20%, degree (deficit of weight related to GA 20%, rejection in 2 sigma, WHC 55, metabolic disorders rejection in 2 sigma, WHC 55, metabolic disorders (hypoglycemia, hypocalcaemia).(hypoglycemia, hypocalcaemia).

Clinical manifestation HypotrophicHypotrophic (asymmetric variant) – weight of newborn is not adequate to (asymmetric variant) – weight of newborn is not adequate to

gestational age more than height and head circumference (HC=DB>WB). gestational age more than height and head circumference (HC=DB>WB). Appearance of child: tall and emaciated. Appearance of child: tall and emaciated.

Levels of severity: Levels of severity:

Mild severity is Mild severity is a deficit of weight related to GA 10-20%, rejection in a 1-1,5 sigma-a deficit of weight related to GA 10-20%, rejection in a 1-1,5 sigma-meson, <10% centile, WHC 59-56, mionectic elasticity and turgor of skin, meson, <10% centile, WHC 59-56, mionectic elasticity and turgor of skin, subcutaneous fat is thin everywhere, mass of muscles and head circumference are subcutaneous fat is thin everywhere, mass of muscles and head circumference are not changed. not changed.

Course of early neonatal period: morbid conditions (large primary decline of weight Course of early neonatal period: morbid conditions (large primary decline of weight and its slower renewal, slow healing of umbilical wound, protracted transient and its slower renewal, slow healing of umbilical wound, protracted transient icterus, hypoglycemia) are observed in 35% newborn with IGR.icterus, hypoglycemia) are observed in 35% newborn with IGR.

Moderate severity is Moderate severity is deficit of weight related to GA 20-30%, rejection in 1,5-2 deficit of weight related to GA 20-30%, rejection in 1,5-2 sigma-mesons, <5% centile, WHC 55-50, skin is dry, pale, subcutaneous fat on sigma-mesons, <5% centile, WHC 55-50, skin is dry, pale, subcutaneous fat on abdomen is absent, turgor of tissues is considerably mionectic, mass of muscles abdomen is absent, turgor of tissues is considerably mionectic, mass of muscles (especially of buttocks and femur) is diminished, head circumference on 3 and (especially of buttocks and femur) is diminished, head circumference on 3 and more cm. prevails circumference of thorax.more cm. prevails circumference of thorax.

Course of early neonatal period: morbid conditions (perinatal defeats of CNS, Course of early neonatal period: morbid conditions (perinatal defeats of CNS, violations of thermoregulation, polycythemia, hypoglycemia, hypocalcaemia, violations of thermoregulation, polycythemia, hypoglycemia, hypocalcaemia, hypomagnesaemia, hyponatremia, hyperbilirubinemia) are observed in 46% hypomagnesaemia, hyponatremia, hyperbilirubinemia) are observed in 46% newborn with IGR.newborn with IGR.

Clinical manifestationSevere disease Severe disease is deficit of weight related to GA is deficit of weight related to GA

>30%, rejection in 3 sigma-mesons, <1% centile, >30%, rejection in 3 sigma-mesons, <1% centile, WHC <50, skin is very dry, with scaled WHC <50, skin is very dry, with scaled desquamation, subcutaneous fat is everywhere desquamation, subcutaneous fat is everywhere absent, turgor of tissues is diminished, mass of absent, turgor of tissues is diminished, mass of muscles (especially of buttocks and femur) is muscles (especially of buttocks and femur) is diminished, head circumference on 3 and more cm. diminished, head circumference on 3 and more cm. prevails circumference of thorax.prevails circumference of thorax.

Course of early neonatal period is complicated with Course of early neonatal period is complicated with prevailing of signs of brain defeat, often anaemia, prevailing of signs of brain defeat, often anaemia, metabolic disorders, violations of thermoregulation, metabolic disorders, violations of thermoregulation, hemorrhagic syndrome, arising of infection. It is hemorrhagic syndrome, arising of infection. It is observed in 66% newborn with IGRobserved in 66% newborn with IGR

Clinical manifestation

HypoplasticHypoplastic (symmetric variant) - weight, (symmetric variant) - weight, height, head circumference is proportionally decreased height, head circumference is proportionally decreased related to gestational age (HC=DB=WB). A child is related to gestational age (HC=DB=WB). A child is developed proportionally, but he is “little” to gestational developed proportionally, but he is “little” to gestational age. It can be solitary disembriogenetic stigmas. Course age. It can be solitary disembriogenetic stigmas. Course of early neonatal period is same as the hypotrophic of early neonatal period is same as the hypotrophic variant of IGR of moderate degree. variant of IGR of moderate degree.

Dysplastic Dysplastic – except the deficit of weight – except the deficit of weight and height related to GA is characterized with: and height related to GA is characterized with: disproportionate type, malformations, plural disproportionate type, malformations, plural disembriogenetic stigmas. Often it is related to disembriogenetic stigmas. Often it is related to chromosomal and genomic mutations. Course of early chromosomal and genomic mutations. Course of early neonatal period is same as at hypotrophic variant of neonatal period is same as at hypotrophic variant of IGR of severe degree.IGR of severe degree.

Antenatal diagnostics Risk factors.Risk factors. USE of fetus (fetometry - abdominal circumference , correlation of USE of fetus (fetometry - abdominal circumference , correlation of

head circumference to abdominal circumference, biophysical type of head circumference to abdominal circumference, biophysical type of fetus, for the estimation of it they use Maning’s scale, research of fetus, for the estimation of it they use Maning’s scale, research of urinary excretion of fetus).urinary excretion of fetus).

USE - placentometry (localization, maturity, thickness of placenta, USE - placentometry (localization, maturity, thickness of placenta, are estimated).are estimated).

Doppler research of blood stream in the system mother-placenta-Doppler research of blood stream in the system mother-placenta-fetus.fetus.

Hormonal methods of diagnostics of FPI.Hormonal methods of diagnostics of FPI. Clinical signs of development of IGR at pregnant (insufficient Clinical signs of development of IGR at pregnant (insufficient

increase of weight, height of fundus of uterus on 3 sm. less than increase of weight, height of fundus of uterus on 3 sm. less than normal indexes).normal indexes).

Neonatal diagnostics

Estimation of parameters of physical Estimation of parameters of physical development and determination of relation development and determination of relation to gestational age.to gestational age.

Determination of gestational age and Determination of gestational age and morphological maturity.morphological maturity.

Laboratory researches (CBA, ABB, Laboratory researches (CBA, ABB, biochemical blood test, clinical uranalysis, biochemical blood test, clinical uranalysis, at dysplastic variant - genetic research and at dysplastic variant - genetic research and research on IUI).research on IUI).

Treatment Treatment-protective and temperature regime.Treatment-protective and temperature regime. Adequate feeding (method and beginning depends on weight Adequate feeding (method and beginning depends on weight

at birth and variant of IGR. Amount of milk is determined at birth and variant of IGR. Amount of milk is determined according to the same principles, as at premature children).according to the same principles, as at premature children).

Pharmacotherapy - primary after birth all children with IGR Pharmacotherapy - primary after birth all children with IGR are entered: 1-2 mg of vit.К, from 1th day 1 dose 2 times a are entered: 1-2 mg of vit.К, from 1th day 1 dose 2 times a day per os of bifidus bacterine is prescribed, vitamin therapy day per os of bifidus bacterine is prescribed, vitamin therapy – vit. Е, A, С, group B in age doses. Subsequent – vit. Е, A, С, group B in age doses. Subsequent (symptomatic) therapy depends on course of early neonatal (symptomatic) therapy depends on course of early neonatal period and presence of complications. Prescribing of period and presence of complications. Prescribing of actovegine for newborn with IGR provides anti-oxidative actovegine for newborn with IGR provides anti-oxidative action , effective neuroprotection, adequate functioning of action , effective neuroprotection, adequate functioning of lipid peroxidation.lipid peroxidation.

Prophylaxis and treatment of metabolical violation (control Prophylaxis and treatment of metabolical violation (control of level of glucose at birth, at 30 and 120 min. after birth, of level of glucose at birth, at 30 and 120 min. after birth, correction of hypoglycemia.correction of hypoglycemia.

Premature children.Definition and actuality

Premature childPremature child – newborn which was born earlier than 37 weeks – newborn which was born earlier than 37 weeks of gestation. of gestation.

Levels of prematurityLevels of prematurity: : I – GA 35-37 weeks., weight at birth 2001– 2500 g.;I – GA 35-37 weeks., weight at birth 2001– 2500 g.; II – GA 32-34 weeks., weight at birth 1501– 2000 g.;II – GA 32-34 weeks., weight at birth 1501– 2000 g.; III – GA 29-31 weeks., weight at birth 1001– 1500 g.;III – GA 29-31 weeks., weight at birth 1001– 1500 g.; IV – GA less than29 weeks., weight at birth less than 1000 g.;IV – GA less than29 weeks., weight at birth less than 1000 g.;They also distinguish newborn with very low weight – GA <28 They also distinguish newborn with very low weight – GA <28

weeks, weight at birth 999 g. (International classification of Х weeks, weight at birth 999 g. (International classification of Х revision), and extremely low weight GA – 22 weeks., weight at revision), and extremely low weight GA – 22 weeks., weight at birth is 500 g., height 25 cm (WHO). Percent of incapacitating birth is 500 g., height 25 cm (WHO). Percent of incapacitating among newborn with extremely low weight is 10-50% and it is among newborn with extremely low weight is 10-50% and it is proportional to diminishing of GA.proportional to diminishing of GA.

Basic criterion of prematurity level is gestational age, less Basic criterion of prematurity level is gestational age, less considerable – weight at birth. considerable – weight at birth.

Definition and actuality Part of premature children is 6-12% among the general Part of premature children is 6-12% among the general

amount of all newborn; among them part of children amount of all newborn; among them part of children with very low weight – 1-1,8%, and children with with very low weight – 1-1,8%, and children with extremely low weight – 0,5%. Survival rate in the extremely low weight – 0,5%. Survival rate in the developed countries is 10-12% for children with weight developed countries is 10-12% for children with weight at birth <500 g., 50% - at weight 500-749 g. and 80% at at birth <500 g., 50% - at weight 500-749 g. and 80% at weight 750-1000 g. weight 750-1000 g.

Premature new-born are characterized with high Premature new-born are characterized with high morbidity and death rate in the structure of which: morbidity and death rate in the structure of which: hypoxia 55%, birth injury of CNS 17%, RDS I type hypoxia 55%, birth injury of CNS 17%, RDS I type 15%, sepsis 6% (lethality at which is 30-60%), purulent 15%, sepsis 6% (lethality at which is 30-60%), purulent meningitis 3,8% (lethality at which is 16%), congenital meningitis 3,8% (lethality at which is 16%), congenital pneumonia 3%.pneumonia 3%.

Factors of risk of noncarrying of pregnancy

Socio-economic Socio-economic is character of feed of mother, is character of feed of mother, living conditions, occupational hazard, undesirable living conditions, occupational hazard, undesirable pregnancy, level of education, incomplete family, pregnancy, level of education, incomplete family, harmful habits.harmful habits.

Socialbiological Socialbiological is age of mother <18 or > 35 is age of mother <18 or > 35 years, age of father <17 or >50 years, abortions, years, age of father <17 or >50 years, abortions, pregnancy at straight away after births.pregnancy at straight away after births.

Clinical Clinical are chronic somatic or gynaecological are chronic somatic or gynaecological diseases, pathology of pregnancy, disease of fetus.diseases, pathology of pregnancy, disease of fetus.

Clinical signs of premature children small sizes;small sizes; disproportional constitution (vertical diameter of head - 1/3 of height, short neck, feet, low position of disproportional constitution (vertical diameter of head - 1/3 of height, short neck, feet, low position of

navel);navel); predominance of neurocranium on visceral cranium;predominance of neurocranium on visceral cranium; hyperemia of skin;hyperemia of skin; thin or absent subcutaneous fat;thin or absent subcutaneous fat; expressed lanugo;expressed lanugo; wooly hair, low location of it on a forehead;wooly hair, low location of it on a forehead; aplasia of nails;aplasia of nails; a occipital fontanel and cranial sutures are always spread;a occipital fontanel and cranial sutures are always spread; divergence of rectus muscles of abdomen;divergence of rectus muscles of abdomen; hypoplasia of pectoral glands;hypoplasia of pectoral glands; empty scrotum;empty scrotum; motive activity and muscular tone, reflexes are decreased.motive activity and muscular tone, reflexes are decreased.

Clinical signs of prematurity are in direct connection with the term of gestation (less GA, more signs and more Clinical signs of prematurity are in direct connection with the term of gestation (less GA, more signs and more they manifestatedthey manifestated

Anatomico-physiological features of premature children

Respiratory system: immaturity of lungs, insufficient producing of Respiratory system: immaturity of lungs, insufficient producing of surfactant, less depth and higher frequency of breathing, often surfactant, less depth and higher frequency of breathing, often pathological types of breathing and apnoea.pathological types of breathing and apnoea.

Digestive system: small volume of stomach, diminishing of acidity Digestive system: small volume of stomach, diminishing of acidity of gastric juice, high permeability of intestinal wall, decline of of gastric juice, high permeability of intestinal wall, decline of enzyme activity of pancreas, functional immaturity of liver, frequent enzyme activity of pancreas, functional immaturity of liver, frequent regurgitation.regurgitation.

Urinatory system: considerable decline of glomerular filtration and Urinatory system: considerable decline of glomerular filtration and concentrative function. diurnal diuresis is 60-130 ml, hourly diuresis concentrative function. diurnal diuresis is 60-130 ml, hourly diuresis from 3-ї day of life is 2-5 ml/kg/hour.from 3-ї day of life is 2-5 ml/kg/hour.

Endocrine system: insufficient excretion of hormones, Endocrine system: insufficient excretion of hormones, hypoglycemia. hypoglycemia.

ABB: from 4 to 20 days uncompensated acidosis is observed.ABB: from 4 to 20 days uncompensated acidosis is observed. Water metabolism: quick growth of dehydration.Water metabolism: quick growth of dehydration. Electrolyte metabolism: hypocalcemia.Electrolyte metabolism: hypocalcemia. Immune system: immaturity and lability, low activity specific Immune system: immaturity and lability, low activity specific

immunityimmunity

Anatomico-physiological features of premature children

System of hemostasis: decreased level of prothrombin, System of hemostasis: decreased level of prothrombin, proconvertin ІХ, Х factor of hemopexis, plasminogen, proconvertin ІХ, Х factor of hemopexis, plasminogen, the functional condition of thrombocytes and vessels is the functional condition of thrombocytes and vessels is oppressed. oppressed.

Features of adaptation to conditions of extrauterine life: Features of adaptation to conditions of extrauterine life: loss of primary mass of body 9-14% and slower its loss of primary mass of body 9-14% and slower its renewal, there is not hormonal crisis transien renewal, there is not hormonal crisis transien hypothyroiditis often develops. Transient hypothyroiditis often develops. Transient hyperbilirubinemia has some features: develops in 20% hyperbilirubinemia has some features: develops in 20% premature children, it does not have connection with premature children, it does not have connection with intensity of icterus and level of hyperbilirubinemia, intensity of icterus and level of hyperbilirubinemia, threat of bilirubin intoxication.threat of bilirubin intoxication. ..

Nursing stages for premature newborn

The 1 stage is provided in a maternity hospital or The 1 stage is provided in a maternity hospital or perinatal center.perinatal center.

The 2 stage – at the age 5-10 days of premature children The 2 stage – at the age 5-10 days of premature children without pathology or with non-infectious diseases without pathology or with non-infectious diseases planned transition to the specialized department of planned transition to the specialized department of somatic hospital or perinatal center. Department must somatic hospital or perinatal center. Department must be with box. The arrival of children takes place directly be with box. The arrival of children takes place directly to the department, skipping reception department.to the department, skipping reception department.

The 3 stage - reabilitation of child under surveillance of The 3 stage - reabilitation of child under surveillance of district paediatrician after the discharge of child with district paediatrician after the discharge of child with weight 2500 g.weight 2500 g.

Principles of nursing of premature newborn Antenatal steroid therapy with the purpose of prophylaxis of RDS, transportingAntenatal steroid therapy with the purpose of prophylaxis of RDS, transporting

inin, , utero utero to the perinatal center.to the perinatal center. Immediately primary medical care and reanimation, including replacement Immediately primary medical care and reanimation, including replacement

artificial Anatomico-physiological features surfactanttherapy, early nasal artificial Anatomico-physiological features surfactanttherapy, early nasal spontaneous breathing under positive pressure (SBUPP).spontaneous breathing under positive pressure (SBUPP).

The infectious checking system in the departments of intensive care and nursing.The infectious checking system in the departments of intensive care and nursing. Competent organization of care of newborn with taking into account their Competent organization of care of newborn with taking into account their

Anatomico-physiological features ( APF ); simulation of conditions maximally Anatomico-physiological features ( APF ); simulation of conditions maximally close to intrauterine and exception of stress and aggressive influences.close to intrauterine and exception of stress and aggressive influences.

The most important at nursing of premature children is thermal conditions, The most important at nursing of premature children is thermal conditions, feeding and warning of harmful influence of external factors of environment. For feeding and warning of harmful influence of external factors of environment. For providing of temperature balance they use infant incubator, temperature condition providing of temperature balance they use infant incubator, temperature condition in which is regulated individually. For children with hypothermia the temperature in which is regulated individually. For children with hypothermia the temperature in the incubator is set no more than on 10С higher than temperature of body of in the incubator is set no more than on 10С higher than temperature of body of child. The axillar and rectal temperature of child is measured each 15 min. They child. The axillar and rectal temperature of child is measured each 15 min. They watch its increase, regulate the temperature in the incubator. Humidity in the watch its increase, regulate the temperature in the incubator. Humidity in the incubatory must be 70%.incubatory must be 70%.

Principles of nursing of premature newborn

It is necessary to take into account at the decision of question of feeding It is necessary to take into account at the decision of question of feeding premature newbonpremature newbon

-beginning of feeding;-beginning of feeding;

-volume of feeding;-volume of feeding;

-method of feeding;-method of feeding;

-type of feeding.-type of feeding. The method of feeding depends on GA. If GA <30 weeks they conduct The method of feeding depends on GA. If GA <30 weeks they conduct

parenterally feeding, if GA <32 weeks– feeding with expressed breast milk parenterally feeding, if GA <32 weeks– feeding with expressed breast milk through a nasogastric tube, if GA <34 weeks – feeding from a bottle, if GA > 34 through a nasogastric tube, if GA <34 weeks – feeding from a bottle, if GA > 34 weeks it is the breast feeding. weeks it is the breast feeding.

A parenterally feeding with glucose 4 ml/hour 5% solution is begun not later than A parenterally feeding with glucose 4 ml/hour 5% solution is begun not later than in 2 hours after birth. On 2th day they enter solution of amino acid of 0,5 g/kg/day, in 2 hours after birth. On 2th day they enter solution of amino acid of 0,5 g/kg/day, 10% solution of calcium chloride 2,5 ml on each 100 ml of infusional solution. At 10% solution of calcium chloride 2,5 ml on each 100 ml of infusional solution. At a complete parenterally feed it is necessary to use the lipophilics 1g/kg/day. a complete parenterally feed it is necessary to use the lipophilics 1g/kg/day.

A transition from parenteral to the enteral feeding takes place slowly (test with the A transition from parenteral to the enteral feeding takes place slowly (test with the distilled water ( a few feedings with 5% solution of glucose ( breast milk 10 distilled water ( a few feedings with 5% solution of glucose ( breast milk 10 ml/kg/day during 10-14 days).ml/kg/day during 10-14 days).

Principles of reabilitation of premature children

Early beginning (2-3 weeks of life);Early beginning (2-3 weeks of life); Individual approach to a child from position of integral Individual approach to a child from position of integral

organism taking into account morphofunctional organism taking into account morphofunctional maturity, neurological, somatic and sensory violations;maturity, neurological, somatic and sensory violations;

Study of parents to the modern methods of care of Study of parents to the modern methods of care of premature children;premature children;

Complex use of facilities and methods of reabilitation;Complex use of facilities and methods of reabilitation; Stage and following the process of reabilitation;Stage and following the process of reabilitation; Duration of supervision (for very premature children Duration of supervision (for very premature children

not less than 5-7 years).not less than 5-7 years).).).

Thank you for attention!