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Pediatric rheumatology, the health of the baby. Organization of pediatric rheumatologists.
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Mental characteristics of infants following healthy full-term babies from the first days of life record the view, watching the subject, clearly responding to auditory stimulus.
For newborns without pathology burdened by the typical loud, sometimes exasperated cry. The Creek appears in the background of the pain manipulation or spontaneously, with the feeling of hunger or symptoms of discomfort (wet diaper, uncomfortable position in bed). As a manifestation of the pain response cry often marked with flatulence and abdominal pain, but in the first week of life is very rare.
Respiratory distress syndrome in newborns is one of the common symptoms or syndromes, especially in infants with low gestational ages. They are a group of diseases or pathological conditions, primarily reflects the deep lung immaturity with a primary or secondary surfactant deficiency, with the layering of various burdened factors, including infectious and iatrogenic.
In preterm infants, they constitute the basis for:
- SDR or HMD (hyaline membrane disease);
- in utero, intrapartum or postnatal pneumonia;
- hypoxic and hemorrhagic lesions of the brain;
- functioning arterial duct;
- interstitial and alveolar pulmonary edema;
- transient tachypnea of the newborn.
syndrome aspiration of meconium;
- in utero, intrapartum, and significantly less postnatal pneumonia;
- hypoxic brain damage;
- transient tachypnea of the newborn;
- cord trauma when damage to the spinal cord.
The term respiratory distress syndrome in newborns is currently associated not only with the disease of hyaline membranes, and that extends to other pathological condition or an illness with respiratory failure, a diagnosis that in the early days may not be updated.
In the differentiation of lungs x-rayed the lungs in the dynamics and assessed the clinical picture, taking into account the effectiveness of treatment. It is important to clarify whether the lung isolated disease if it is combined with other pathological conditions, or part of a generalized infection.
Clinical picture it is possible to allocate some variants of respiratory distress syndrome in newborns:
- children in need from the first hours of life in ICU and in intratracheal introduction Curosurf; these include children with gestation until 27-28 weeks (patients with HMD), with intrapartum infection Streptococcus of group b and some types of intrauterine pneumonia;
- children with a birth weight of 1200 g who have symptoms of respiratory failure may not appear immediately, but after a few hours after birth or on the 2nd day of life, as the destruction of surfactant, and which need not only in ICU but also in intratracheal introduction Curosurf;
- children requiring short-term intubation without the introduction of Curosurf;
- children for which treatment is sufficient to create light positive pressure using a nasal cannula (NCPAP);
- children receiving oxygen through a mask or funnel.
In the presence of full-term or premature baby with a large gestational age with birth or the first hours of life of the expressed syndrome of respiratory disorders of the newborn requiring ventilation with rigid parameters, primarily exclude in utero or intrapartum pneumonia. In addition to the radiological data in favor of pneumonia will testify to the serious condition of infectious toxicosis.
SDR, depending on the surfactant deficiency, observed mainly in children with the lowest gestational ages, up to 26-28 weeks, and the birth weight of 1250 g and significantly less in children with birth weight of 1251 to 1500 g.
Respiratory distress syndrome in newborns 86% of cases develop in infants with a birth weight of 501 to 750 g, in 75% of cases with a weight of 751 to 1000 g, in 48% of cases with birth weight of 1001 to 1250 g and 27% of cases with birth weight of 1251 to 1500 g.
The symptoms of respiratory failure is expressed already at birth or may appear during the first 6 h of life, although in some children they may develop later during the first and even the second day. The clinical picture is characterized by tachypnea, nasal flaring, retraction of the pliable portions of the chest and sternum, cyanosis, moaning "grunt" exhale; auscultation — weakened breath, and expiratory wheezing krepitiruyuschie.
The x-ray in severe cases, the disease is manifested by bronchograms, reduced pneumatization lung fields, granular-mesh pattern as a whole resembles frosted glass.
In moderate and severe forms of SDR is not complicated by underlying health conditions clinical manifestations of the disease on the background of artificial lung ventilation and intratracheal introduction Curosurf does not exceed 2-3 days.
Assessment of a newborn baby in the first place reflects its vitality and adaptability to the external environment during the first 5 days of life. It depends on the degree of maturity, neurological status, the nature and severity of the pathological process and by the sum of these indicators can be represented as:
- very heavy,
- extremely heavy,
The main criteria that assess the state of the newborn include:
- the survival rate at the moment or the next few days,
- the need for intensive therapy, with the inclusion or absence of resuscitation,
- acute symptoms of systemic infection,
the possibility of severe complications:
- intestinal perforation (ANPC),
- pneumothorax (hard parameters of mechanical ventilation),
- the gestational age of the newborn: the following 25-27 weeks.
The determination of the terminal condition of the newborn does not require any comments, as there and so everything is clear.
Evaluation of critical condition is applied in cases, when the question of the survival of the child requires further observation or a child needs a comprehensive resuscitation biscuits.
Assessment of the newborn as heavy or very heavy in addition to need intensive treatment, including mechanical ventilation, reflects the acute phase of diseases such as purulent meningitis, osteomyelitis, combined with arthritis, ulcerative-necrotic lesions of the intestines, presence of infectious toxicosis, the inability enteral nutrition, acute manifestations of congenital adrenal insufficiency, seizure and hemorrhagic syndrome.
Naturally, the first 3-5 days of life indications for determining the state of the newborn as heavy diverging and, in particular, include lower gestational age 25-27 weeks. However, it should be noted that differentiation of status between heavy and medium-heavy is quite subjective, and in most cases, subjectivity extends in the direction of overstating the severity of the condition. This is true not only for individual neonatologists but also for a number of departments as a whole.
Such tactics, unfortunately, leads to unnecessarily prolonged antibiotic treatment where she was not shown.
Assessment of newborns with a birth weight of 900-1250 g and a gestational age of 28-30 weeks in the first 3-5 days of life is no exception. Everything is decided by the dynamics of the clinical picture and the duration of intensive care, including ventilation if necessary.
Statement of condition as of medium gravity, children of this weight and age is perfectly acceptable if they are on independent breath, not in need of oxygen support, no apnea events, able to receive enteral nutrition in the age and neurological status is not significantly different from the characteristic of their gestation.
But it is possible that the child from group of risk layering of various pathological processes in the dynamics may worsen their condition, but it does not give grounds to regard it as heavy as it currently is not.
Another thing is that in conversation with parents, you must warn them in an accessible form that their child is very small, immature and at any moment can worsen your condition, but at the moment it is quite stable.
In conclusion, we will focus on the assessment of the status of children in the first month of life with severe brain lesions and hopeless in its further psychomotor development, but quite decent in its somatike. Their condition can be regarded as moderate or as severe, but with the obligatory caveat — heavy nature of the disease.
Polycythemia in infants manifested intense pink with a purple tint the color of the skin. Hematocrit of venous blood when it exceeds 65 %. The hematocrit of capillary blood is higher than venous.