Newborn and premature baby care features presentation. Lesson presentation: Caring for premature babies

The main condition for successful nursing of premature babies is the creation of stage II departments, where children are transferred on the 710th day of life with a body weight of up to 2000 g from the maternity hospital. Transfer of premature newborns from stage I (maternity hospital) to stage II is carried out after a preliminary agreement to a pre-prepared place.

The main task of the department is to provide highly qualified neonatological care to newborns and premature babies, including those with extremely low body weight and very low body weight, both born in the perinatal center and transferred from other obstetric institutions. The department is widely used modern methods nursing of premature infants: nursing in a “nest” simulating the intrauterine position of the fetus, the “kangaroo” method - daily close contact “skin to skin” of mother and baby, kinesiotherapy. The department adheres to the principle of humanization medical care for newborns - compliance with the protective regime (light and noise insulation, thermal comfort, minimizing medical interventions), reducing the invasiveness of medical procedures.

Basic principles of clinical examination of premature infants: 1) dynamic monitoring of physical and psychomotor development; 2) control over rational feeding; 3) prevention, early diagnosis and treatment of rickets, anemia; 4) timely detection and treatment of neurological and orthopedic disorders.

The structure of the department includes a number of premises intended for carrying out medical activities and equipped with the necessary furniture, care items and equipment. Separate from the general reception department hospital reception and examination room. Box rooms for newborns with 2-3 beds with transparent partitions that allow you to view the boxes from the corridor and neighboring rooms, with an area of ​​6 m2 per bed. Individual rooms for a mother and a newborn who do not require intensive care, with an area of ​​9 m2. Isolators with a vestibule, at least two per department. Treatment and physiotherapy rooms designed exclusively for the preparation of manipulations. Premises for ultrasound and other functional studies (in the absence of portable equipment). Separate X-ray room (for departments with more than 100 beds).

Premises for sterilization of breast milk and preparation of adapted formulas, consisting of three compartments: - for sanitary processing of baby dishes; - for sterilization of baby bottles, pasteurization and bottling of breast milk; - for storing pasteurized milk in a special refrigerator. Room for expressing breast milk. Dining room and pantry for mothers. Rest room for mothers. Linen room for storing clean linen; a room for collecting, counting and packaging used linen. The office of the head of the department, the resident's room for doctors, the offices of the head nurse and the hostess sister. Dressing rooms for outer dresses and shoes, changing rooms (separate for mothers and staff). Showers (separate for mothers and staff). Premises for medical examination mothers and staff (separate for mothers and staff). Toilet rooms (separate for mothers and staff). Utility rooms (for disinfection of equipment, storage of processed equipment, etc.).

What does a premature baby look like? Appearance and the behavior of a newborn premature baby depend on its gestational age (the number of completed weeks of pregnancy at the time of birth). Its physique is very peculiar: the head is relatively large, the cranial sutures are often open, the small and lateral fontanelles are large. In boys, the testicles may not descend into the scrotum, and in girls, the labia and fontanelles are underdeveloped

A premature newborn has a number of anatomical features: its weight is usually below 2500 g; height is less than 45 cm, and the head circumference, on the contrary, is 3-4 cm greater than the chest circumference. Therefore, the head appears large in comparison with the body, the sutures and fontanelles (small in the crown and large above the forehead) are wide; the ears are very soft and fit tightly to the skull; the skin is thin, abundantly covered with fluff, especially on the face, cheeks, and forehead. The subcutaneous fat layer is slightly expressed. In extremely premature babies, the subcutaneous fat layer is completely absent. A thin voice, sometimes similar to a squeak, is a consequence of underdevelopment of the vocal cords. The navel is low. The walls of blood vessels are poor in elastic fibers, as a result of which intracranial hemorrhages may occur during childbirth. Navel

The "kangaroo" method Today it is considered proven that a premature baby needs communication with its mother during its hospital stay. The baby must hear the mother's voice and feel her warmth, and this is achieved by the kangaroo method. This method of caring for premature babies was first used in those poor and underdeveloped countries where, for purely economic reasons, there was no means to provide all premature babies with incubators equipped with equipment to maintain a constant temperature.

The essence of the method is that the baby is nursed while in direct contact with the mother’s skin, on her chest and abdomen. The mother puts on loose clothing that opens in the front, and the baby wears a diaper and sometimes a hat. The baby is placed between the breasts, the clothes are fastened to prevent heat loss. The baby's temperature is monitored by a nurse or monitors.

Studies have shown that maternal warmth perfectly warms the child and his body temperature is maintained at the proper level. Breathing also becomes more regular and stable, as does the heartbeat and oxygen saturation of the blood. Moreover, the newborn’s skin is populated with the mother’s microflora, which promotes healing processes. You can switch to this method of nursing when, in a relatively satisfactory condition, the baby still needs artificial thermoregulation and monitoring of the heartbeat and breathing. In large maternity hospitals, premature babies are allocated separate rooms, specially equipped and serviced by the most qualified personnel. Where it is not possible to allocate a separate room, partitions separate the most well-lit and ventilated part of the children's room, which is insulated and equipped accordingly. The air temperature is maintained within 23-27°C, and in the crib 25-30°C. A thermometer is placed under the blanket next to the child for accurate control.

"Greenhouse conditions"Maintaining optimal room temperature in the first days of life is extremely important not only for survival, but also for the further full development of premature newborns, which allows the body, which is not yet mature enough, to withstand aggressive influences external factors environment, due to the fact that the possibilities of thermoregulation are limited. This is due to the relatively larger surface area of ​​the skin compared to body weight, which leads to significant heat loss. Insufficient development of the subcutaneous fat layer in combination with a pronounced network of skin vessels also contributes to increased heat transfer. Therefore, premature babies easily become cold, and excessive external heating quickly leads to overheating, which creates certain difficulties in the process of caring for them. This circumstance gave rise to the development of medical equipment systems that could simulate thermal comfort external environment, comparable to the “maternal warmth” that is so necessary for a premature baby to mature.

In maternity hospitals and departments for premature babies in special children's hospitals, incubators are used. The simplest of them looks like an open-top bathtub with double walls, between which hot water circulates (its temperature is up to 50-60°C). The latest models have electric water heating with regulation of its temperature and air humidity and with automatic oxygen supply. The incubator (incubator) method of nursing with an individual microclimate is the most effective. It is characterized by the creation of physiological conditions from the first minutes of extrauterine existence. The incubator maintains optimal temperature and humidity. This allows you to reduce the child’s energy expenditure on maintaining body temperature, fluid loss through the skin and during breathing.

The length of stay in the incubator depends on the body weight at birth, maturity and general condition of the child. Children with a low degree of prematurity are in the incubator for 2-4 days or several hours, very premature children weighing up to 1500 g for 8-14 days, and those weighing up to 1750 g for 7-8 days.

Prevention of rickets and anemia in premature infants: To prevent rickets, from the 810th day of life, ergocalciferol (vitamin D) in an oil or alcohol solution is prescribed, IU per day for 25 days (per course of IU) and calcium supplements. Instead of using ergocalciferol, ultraviolet radiation can be performed (25 sessions). To prevent anemia, it is advisable to introduce microelements into the child’s diet from three weeks of age. Midi sulfate (0.01% solution, 1 ml/kg body weight) and cobalt sulfate (0.001% solution, 0.2 ml/kg body weight) are added to breast milk or formula once a day for 610 weeks. Iron supplements (hemostimulin, iron lactate, etc.) are prescribed from eight weeks of age for 35 months.

Peculiarities of feeding premature infants Peculiarities of feeding premature infants are due to their increased need for nutrients due to intensive physical development, as well as the functional and morphological immaturity of the gastrointestinal tract, and therefore food should be administered carefully. Even very premature babies should begin to be fed in the first hours of life due to the catabolic nature of metabolism, hypoproteinemia and hypoglycemia. With parenteral nutrition, the child’s intestines are quickly populated by opportunistic microflora. At the same time, the permeability of the mucous membranes of the gastrointestinal tract increases, which contributes to the generalization of the infectious process. Parenteral nutrition is used only in extremely severe conditions in very premature infants and for a limited period of time. For such children, it is more appropriate to prescribe round-the-clock drip administration of native mother's milk through a nasogastric tube.

Infants with a gestational age of less than 28 weeks, as well as all premature infants with SDD and a weak sucking reflex, breast milk is administered through a gastric tube. If the general condition is satisfactory and the sucking reflex is sufficiently pronounced, feeding in the first 3-4 days is carried out through a nipple. It is not advisable to put the baby to the breast before this period, since breastfeeding is a difficult physical activity for him and can lead to secondary asphyxia or intracranial hemorrhage. Premature babies with a birth weight of less than 1500 g are put to the breast from the 3rd week of life.

Nutrition calculations are made in accordance with the needs of the child’s body per 1 kg of body weight per day: 1-2 days of life - 30 kcal, 3rd day - 35 kcal, 4th day - 40 kcal, then 10 kcal more daily up to the 10th day of life; on the 14th day kcal, from the 21st day of life kcal. When determining the volume of food, the individual characteristics of the child should be taken into account: very premature babies from the 2nd month sometimes absorb a volume of breast milk corresponding to kcal/kg.

Babies will definitely be examined by a neurologist, an ophthalmologist (who will conduct fundus examinations) and an otolaryngologist to check the child’s hearing. Taking blood from such children, especially from a wreath, is very problematic. It is not enough to conduct a full examination, so one should not be surprised that the child has many puncture marks. They can be found on the fingers and toes, on the elbows and arms. This is simply a necessity that cannot be avoided. Children are almost always prescribed antibiotics, vitamin E and drugs to restore intestinal microflora, and nootropic drugs are prescribed. Babies' temperatures are measured every 3 hours, they are fed, hygiene procedures are carried out (diapers and nappies are changed if necessary). It should be remembered that this is done nurse or nannies. They have a very large workload, approximately babies per person, so you should not be surprised by the appearance of prickly heat or irritation. They cannot afford to spend a lot of time with their children. Therefore, very often, if the baby does not eat on his own, he is given a tube and nutrition is administered through it. The staff tries very hard to pay attention to each child and there is no need to be too strict with them. After all, the life and health of your child often depends on these people, and they will do everything they can. They simply cannot do it any other way.

Criteria for discharge of premature babies from the department. A premature baby is discharged from the department when the weight reaches 2500 g with a continuous increase in weight, absence of diseases, and stable body temperature. Information about the discharged child is transferred to the children's consultation at the place of residence on the day of discharge from the hospital. The epicrisis from the history of the child’s development must be detailed and contain: information about the child’s medical history, a description of his condition at birth and upon admission, the dynamics of the child’s health in the department, feeding methods and treatment provided.

Nursing is carried out in 2 stages:

- the first - in the maternity hospital;

- the second - in a specialized department for premature babies. Then the child comes under the supervision of the clinic.

The first stage of nursing

Ensuring optimal temperature conditions:

the air temperature in the department should be 25°C;

immediately after birth, suction of mucus from the upper respiratory tract and the initial treatment of the umbilical cord is carried out on a warm tray with warm diapers;

children weighing less than 1500 g are placed in a closed incubator (temperature 30-34°C, humidity 90%, oxygen supply). Children are in an incubator from 2-7 to 14 days.;

The body temperature of premature infants can also be maintained in a heated crib.

Drug therapy

It is carried out for the prevention of pathological conditions and for children with a high risk of disease (extremely premature, with intrauterine hypoxia and asphyxia during childbirth)

- for the prevention of hemorrhagic syndrome: 1% Vicasol for 3 days;

- for the prevention of kernicterus: phototherapy, intravenous administration of albumin, choleretic drugs;

- at 3.4 tbsp. prematurity - correction of PCP: 4% solution of sodium bicarbonate with 10% glucose, ascorbic acid, KKB;

- to eliminate hypoglycemia, hypoproteinemia, hypocalcemia – 10% glucose solution, albumin, calcium preparations.

On days 7-8, premature babies are transferred to a specialized department, where they are nursed and treated until complete recovery and achievement of body weight.

Second stage of nursing

1. Maintaining temperature: in in box wards the temperature d.b. 22-24°C, humidity 60%, airing the rooms 6 times a day.

2. Depending on body weight temperature regime is prescribed and supported with the help of incubators, heated beds, and heating pads.

3. If necessary, continue drug therapy started on

first stage.

Features of feeding premature babies

- the choice of feeding method depends on the severity of the child’s condition, body weight at birth, and gestational age;

- early start of nutrition, regardless of the method (during the first 2-3 hours after birth and no later than 6-8 hours);

- children with a body weight of more than 2000 g with an Apgar score of 7 points or more - are put to the breast on the first day, feeding frequency 7-8 times. If you get tired easily, supplement with expressed breast milk from a bottle.

Children weighing 1500-2000 g are given a trial bottle feeding. In case of unsatisfactory sucking activity - tube feeding in full or partial volume;

- children weighing less than 1500 g - feeding through a tube using the method of long-term infusion of native breast milk.

Nutrient and energy requirements

In the 1st month of life 120-140 kcal/kg/day.

2-3 months life – reduction in calorie content to 115 kcal/kg/day. B – 3.8-3.0 g/kg/day.

F – 6.0-6.5 g/kg/day. U – 10-14 g/kg/day.

In order to meet the high need of premature infants for nutrients Specialized milk formulas for premature and low birth weight babies based on highly hydrolyzed proteins (Alfare, Nutrilak Peptidi MCT, etc.) in a volume of up to 20-30% are introduced into the diet of breastfed children.

If the mother does not have milk, children receive full amounts of formula for

feeding premature babies.

Complementary feeding for premature babies is introduced from 4-5 months: fruit purees, vegetable purees or porridge. Meat puree from 5.5 months.

Juices – after 5-6 months.

Description of the presentation by individual slides:

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Teacher G.G. Fomenko Nursing care for premature babies. GB POU NMK PM 02. PARTICIPATION IN TREATMENT, DIAGNOSTIC AND REHABILITATION PROCESSES Nursing care in pediatrics Specialty: 02.34.01 Nursing MDK 02.01 Nursing care for various diseases and conditions

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Plan: Features of the structure and functioning of the newborn’s body at various degrees of prematurity. Stages of nursing. Nursing process when caring for a premature baby (features of feeding, warming and oxygen therapy). Prevention of miscarriage.

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Gestational age of premature babies Premature birth (birth of a premature baby) is a birth that occurs before the end of the full 37 weeks of pregnancy. Pregnancy period (gestational age) is conventionally counted from the first day of the last menstrual cycle.

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Gestational age is the age of the baby from conception to birth. This is the most important indicator of assessing the degree of maturity of a newborn and his ability to adapt to environmental conditions. The degree of maturity of premature infants depends on gestational age and birth weight.

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Premature baby According to the WHO definition, a premature baby is a child born alive, before the 37th week of intrauterine development, with a body weight of less than 2500 g and a length of less than 45 cm. A newborn with a birth weight of more than 500 g who has made at least one breath.

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According to the order of the Ministry of Health of Russia No. 318 dated December 4, 1992, the following terminology is recommended: all children with body weight<2500 г - это новорожденные с малой массой. Среди них выделяют группы: 2500- 1500 г - дети с низкой массой тела при рождении (НМТ); 1500- 1000 г-с очень низкой массой тела (ОНМТ); 1000 г - с экстремально-низкой массой тела (ЭНМТ).

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Health care institutions must register all children born alive and stillborn, who have a birth weight of 500 g or more, a length of 25 cm or more, with a gestational age of 22 weeks. and more (industry indicators). However, state statistics of live births only take into account children from 28 weeks. gestation or more (body weight 1000 g or more, length 35 cm or more). Of those born alive with a body weight of 500-999 g, only those newborns who lived 168 hours (7 days) are subject to registration with the registry office. In order for domestic statistics to be comparable with international criteria in the field of perinatology, Russia, taking into account WHO recommendations, switched to new criteria (order No. 318 of the Ministry of Health of the Russian Federation).

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When diagnosing a “premature newborn,” the gestational age in weeks at which the birth occurred (gestational age of the newborn) is indicated. Based on the ratio of body weight and gestational age, both full-term and premature infants are divided into three groups: large for gestational age (BGA); appropriate for gestational age (GAA); small for gestational age (SGA).

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Risk factors leading to increased mortality in premature infants: maternal bleeding before birth; multiple pregnancy; breech birth; lack of steroid therapy in the mother (prevention of SDR); perinatal asphyxia; male gender; hypothermia; type I respiratory distress syndrome (RDS, RDS - respiratory distress syndrome, hyaline membrane disease).

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1. Socio-economic factors: occupational hazards (work in hazardous industries, with computers, with salts of heavy metals, chemicals, etc.); level of education of parents (the lower the level of education of the mother and father, the higher the likelihood of prematurity); a woman’s attitude towards pregnancy: in cases of unwanted pregnancy, especially in unmarried women, premature birth of a child is observed 2 times more often; smoking of both mother and father. Typical complications of pregnancy in smokers - placenta previa, premature placental abruption and rupture of the membranes - contribute to miscarriage. Heavy paternal smoking reduces the likelihood of conception and is a risk factor for having a low birth weight child; Alcohol and/or drug use leads to a high incidence of premature births. Causes of miscarriage

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2. Socio-biological factors: age of the mother (primiparas under 17 years old and over 30 years old) and father (under 17 years old); subclinical infection and bacterial carriage; previous abortions; i “deficient” nutrition of a pregnant woman. Causes of miscarriage 3. Clinical factors: extragenital diseases of the mother (especially if they worsen or decompensate during pregnancy); antiphospholipid syndrome in the mother (in 30-40% of cases of recurrent miscarriage - for more details, see Chapter III); chronic diseases of the genitourinary system in the mother; surgical interventions during pregnancy; psychological and physical trauma and other pathological conditions; gestosis lasting more than 4 weeks.

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4. In vitro fertilization. Multiple pregnancy. Causes of miscarriage

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Risk factors for giving birth to a premature baby: 1. On the maternal side: age of the pregnant woman (primiparas under 18 years of age and over 30 years of age); severe somatic and infectious diseases suffered during pregnancy; genetic predisposition; abnormalities in the development of the reproductive system; burdened obstetric history (frequent previous terminations of pregnancy or surgical intervention, pathology of pregnancy, recurrent miscarriages, stillbirths, etc.); mental and physical trauma; uncontrolled use of medications.

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Risk factors for the birth of a premature baby: 2. From the fetus: chromosomal aberrations; developmental defects; immunological conflict; intrauterine infection.

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Criteria for prematurity Degree of prematurity Gestational age Body weight I 37 - 35 weeks 2500 - 2000 g II 34 - 32 weeks 2000 - 1500 g III 31 - 29 weeks 1500 - 1000 g IV 28 - 22 weeks less than 1000 g

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Signs of prematurity The appearance of a premature baby differs from a full-term baby in its disproportionate physique, significant predominance of the cerebral skull over the facial skull, relatively large body, short neck and legs.

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Signs of prematurity: the skin is red, thin, wrinkled, abundantly covered with fluff (lanugo), the subcutaneous fat layer is not expressed, muscle tone is reduced; the bones of the skull are soft, pliable, mobile, sometimes overlap each other, the sutures are not closed, the large, small and lateral fontanelles are open; the ears are soft, shapeless, pressed closely to the head; the areolas and nipples of the mammary glands are underdeveloped or absent; fingernails and toenails are thin and do not reach the edges of the nail bed; plantar folds are short, shallow, sparse or absent; the stomach is spread out like a frog, the umbilical ring is located in the lower third of the abdomen; in girls, the labia majora do not cover the labia minora, the genital slit gapes, the clitoris is enlarged; in boys, the testicles are not descended into the scrotum and are located in the inguinal canals or in the abdominal cavity.

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From the side of the central nervous system: decrease or absence of sucking, swallowing and other physiological reflexes (Moro, Bauer, Robinson, etc.), uncoordinated movements of the limbs, strabismus, nystagmus (horizontal floating movement of the eyeballs), muscle hypotonia, adynamia, disturbance of processes thermoregulation (due to insignificant energy intake from food, a thin subcutaneous fat layer with a low content of brown adipose tissue, a relatively large body surface compared to mass), lack of ability to maintain normal body temperature, which manifests itself in hypothermia (severe hypothermia - body temperature 35.9 -32°C, in severe cases - below 32°C, hypothermia can cause swelling of the subcutaneous fatty tissue - sclerema). AFO of organs and systems of a premature baby

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From the side of peripheral analyzers: visual and hearing impairment (with severe prematurity). On the part of the respiratory system: uneven breathing in rhythm and depth (pathological breathing), respiratory rate varies from 40 to 90 per minute, tendency to apnea, absent or weak cough reflex. There is no surfactant in the alveoli or its content is insufficient, which causes the development of atelectasis and respiratory disorders. From the cardiovascular system: decreased blood flow speed (bluish discoloration of the feet and hands), “harlequin” syndrome (in the child’s position on its side, the skin of the lower half of the body becomes red-pink, and the upper half becomes white). Blood pressure is low, pulse is labile. AFO of organs and systems of a premature baby

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From the immune system: functional immaturity and a decrease in the number of T-lymphocytes, a decrease in the ability to synthesize immunoglobulins (high risk of infections). From the digestive organs: low activity of the secretory function of digestive enzymes (lipase, amylase, lactase, etc.) and food absorption, small stomach capacity, which does not allow one to retain the required amount of food at once, increased tendency to regurgitate due to insufficient development of the cardiac sphincter, monotonous the nature of intestinal motility (lack of increase in response to food intake). AFO of organs and systems of a premature baby

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From the liver: immaturity of enzyme systems, which causes a decrease in the synthesis of protein, prothrombin (hemorrhagic syndrome), impaired bilirubin metabolism, accumulation of indirect bilirubin in the blood and brain tissue (bilirubin encephalopathy). On the part of the kidneys: reduced ability to concentrate urine, almost complete reabsorption of sodium and insufficient reabsorption of water, imperfect maintenance of urine output. Daily diuresis by the end of the first week is 60-140 ml, the frequency of urination is 8-15 times a day. AFO of organs and systems of a premature baby

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Stage III. Dynamic observation in a children's clinic. System of nursing a premature baby, stage I. Intensive care in the maternity hospital, stage II. Observation and treatment in a specialized department for premature babies

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