Disease symptoms in newborns
neonatal period begins with the first child inhalation and ligation of the umbilical cord and lasts 3-4 weeks.This period is characterized by the immaturity of all organs and systems, especially the central nervous system, as well as a number of functional, biochemical and morphological changes caused by the transition from fetal development to extrauterine life of a child.
The body of the newborn characterized by a great lability of water metabolism.Water demand averages 160-200 g / kg body weight per day in a child.All the basic functions of the body are in a state of unstable equilibrium;even a minor violation of environmental conditions can lead to major changes in the body and some physiological processes easily turn into pathological.All this requires special hygienic conditions and rigorous special newborn care, proper organization of feeding.
for neonatal period is characterized by a special state border between physiology and pathology, such as erythema, neonatal physiological jaundice physi
Diseases neonatal period are also fundamental features.In this period can be observed:
1) congenital diseases that develop a child in utero (toxoplasmosis, congenital viral hepatitis, salivary gland disease, listeriosis, congenital malaria, tuberculosis, syphilis);
2) diseases caused by congenital malformations of organs and systems (congenital malformations of the heart, lungs, gastrointestinal tract, etc.)..;
3) diseases associated with a generic act, birth injuries (skeletal damage, peripheral and central nervous system - the brain circulatory disorders, the effects of intrauterine asphyxia, cerebral hemorrhage, paresis and paralysis);4) hemolytic disease of the newborn, neonatal hemorrhagic disease and other diseases of the blood;
5) diseases caused by infectious onset and primarily coccal flora, to which the defenseless newborn, and infection can occur in utero, during childbirth and after childbirth.Marked tendency to the rapid generalization of the process with the development of severe sepsis and toxic-septic conditions, pneumonia.
Some diseases (measles, rubella) infants are not susceptible, as her mother is still in utero, and then passes into breast milk child-specific antibodies.
in the neonatal period are short-lived, never in the future are not repeated, but under adverse conditions can go in the pathological process.
Albuminuria - increased protein content in the urine of up to 0.25 g / L: there is almost all infants during the first weeks of life and is due to increased capillary permeability and increased erythrocytolysis, as well as stagnation in the kidney during childbirth.The treatment is not required.
Urine acid myocardial kidney.In the first 2-4 days of life the newborn is 4-5 urination per day (due to the limited fluid intake), at the end of the first week it already happens 15-20 times a day.Uric acid infarcts observed in the first days of a child's life and caused increased production of uric acid due to the enhanced disintegration of the cellular elements and features of protein metabolism, as well as a small amount of high concentration and urine with a high content of urate.
urine while painted in a reddish color, and leaves a stain diapers reddish-brown color.By increasing the amount you drink fluids and urine output during the first 10-15 days of a heart attack goes unnoticed.The treatment is not required.
Sexual crises. Regardless of the child's sex in the first days of life may experience breast enlargement, usually bilateral.From the nipples with pressure (which is contraindicated) is allocated liquid resembling colostrum.Condition due to the transition of estrogenic hormones in utero from mother to fetus.As the body of the child exemption from maternal hormones breast tenderness disappears.In girls, as a result of the presence in the body of maternal hormones, there may be mucous, bloody discharge from the genital slit.Furthermore, there may be swelling of the genitals.All this is usually at 5-7 days of life and persists for several days.Treatment of sexual crisis is not required.Only at very high magnification of the mammary glands is recommended to dry heat in the form of cotton bandages and vaginal discharge - a toilet with a weak solution of potassium permanganate (1: 5000-8000).
Transient fever occurs more often in children born with high birth weight, in the period of maximum weight loss - 3-6-day life.Body temperature can rise to 381-39 ° C and above, maintained for a few hours, at least 1-2 days.Typically, the general condition is not violated, but in some cases there are agitation, anxiety, temporary refusal of food.Treatment and prevention of transient fever are administered in a timely fluid (boiled water, isotonic sodium chloride solution, Ringer's solution, 5% glucose solution) at a rate of 200 g per day, but not more than 10% of body weight.Child swaddled not tight, easy to wear.
Physiologic jaundice observed in 60-70% of neonates appears on the 3rd day of life and gradually fading away, disappearing in the 7-10 th day, and in some cases (birth asphyxia, prematurity, birth trauma) is savedup to 2-3 weeks.There icteric staining of the skin, mucous membranes, sclera while continuing normal color of urine and stool.Jaundice is caused by the relative immaturity of the liver and the rapid disintegration of red blood cells in the first days of life.The treatment is not required.When strongly pronounced jaundice prescribe drinking 5-10% glucose solution.
physiological loss of weight varies from 3 to 8% of body weight at birth, the maximum observed in the 3-4th day of life.Most children recover their initial weight in 7-10-th day.The reason for the weight loss is due to the relative malnutrition in the first few days, the mismatch between the received and allocated liquid regurgitation of amniotic fluid, and others. The weight loss of more than 8% requires clarification reasons.
Physiological erythema .Flushing of the skin sometimes with cyanotic tinge due to the significant expansion of the surface capillaries, saved 2 to 3 days, then comes the peeling, more on the palms of the hands and feet.We observed in all newborns, and if it is not in the first days of life, you must find out the reason (pathology mother during pregnancy, birth trauma, pulmonary atelectasis).With abundant peeling skin lubricated sterile fish oil, sunflower oil.Some newborns may be toxic erythema as a slightly infiltrated rash.Along with the bright spotty rash appear whitish, yellowish nodules surrounded by a rim of hyperemia.After 2-3 days the rash disappears without a trace.
About newborn discharge from the hospital reported to the clinic by telephone.Primary nursing paramedic carries out the first day after discharge, the doctor within 3 days.Currently paramedic patronage is held daily for the first 2 weeks of stay of the child at home.A systematic and qualitative nursing reduces morbidity and infant mortality.
room in which lives a newborn should be kept clean and tidy, well ventilated.Cot must stand close to the window.Mattress hard, covered with oilcloth and then bed sheet.Under head lay flat small pillow (not feather!).Bedding aired daily, and oil cloth wash with soap and water.Children's underwear after washing, be sure to iron a hot iron on both sides.
Newborn bathe daily in boiled water of 37 ° C, followed by pouring water, which is 1 ° C lower temperature.The temperature in the room where the baby is bathed, should be 22-23 ° C.It is better to bathe the child in the evening, before feeding;You can use the "Children" soap.The child should wash away after each bowel movement, better flow temperature 36 ° C water, from front to back of the genitals to the anus, so as not to infect the genitals.The nails on the hands and feet carefully cut small scissors once in 7-10 days.
Given the high susceptibility to infection of the newborn, it is necessary to protect it from contact with strangers, to observe strict hygiene caring for the child;if using teats and pacifiers, they should be boiled before drinking.
pulmonary atelectasis more often in children debilitated, prematurity, birth asphyxia.Detected by X-ray examination.Clinically expressed phenomena of respiratory failure, pneumonia easily attached.
treatment.If there is no pneumonia, prescribed oxygen, cardiac agents, kordiamin caffeine.
esophageal atresia - malformation.Maybe complete esophageal obstruction, but often there is a combination of esophageal atresia with fistula into the trachea.
symptoms are typical: at the first feeding or receiving fluid through 2- 3 sips all accepted food pours back, there is a painful cough, the baby is choking and turning blue.All the symptoms recur in any attempt to feed.Very quickly it can develop aspiration pneumonia.It confirms the diagnosis of X-ray examination with Lipiodol.Barium mass can not be used, since it easily penetrates fistula into the lungs and causes severe pneumonia.
treatment.Emergency surgery (in the first days of life).Prognosis is very serious and it depends on the timing of diagnosis and connection of aspiration pneumonia.
biliary atresia - malformation with possible complete absence of bile ducts or partial atresia (obstruction) of the liver inside and outside.
symptoms: jaundice in the first days of life, or a little later with the gradual increase of its intensity.Feces discolored or retains slightly yellow in color, intensely colored urine contains bile pigments.The general condition of the child is not broken first, but gradually develop cirrhosis of the liver, increases dystrophy, the liver increases in size, becomes dense, lumpy.Reduced blood prothrombin, hemorrhage appear.
Treatment only operative.Prognosis is very serious.
hemolytic disease of the newborn.The disease develops in utero, due to incompatibility of blood between mother and fetus or Rh (rezusotritsatelnaya mother, child rezuspolozhitelny) or on blood groups ABO.
When rhesus conflict in the mother's body produces Rh antibodies which, once through the placental barrier into the baby's blood to cause hemolysis of erythrocytes containing the Rh factor.The intensity of the hemolysis is usually dependent on the titer of Rh antibodies in the mother (in some cases, such strict parallelism can not be marked).Most hemolytic disease in newborns manifested especially after the second and third after pregnancy.So, the first child is usually born healthy, the second - with mild symptoms of anemia, and only the third - with obvious signs of disease.If a woman is before pregnancy was sensitized rezuspolozhitelnoy transfusions of blood, even the first pregnancy may end in miscarriage, stillbirth, or a child with severe manifestations of hemolytic disease.When blood incompatibility for the ABO system are more common lighter clinical types of hemolytic disease, but they can occur after the first pregnancy.
Clinically hemolytic disease of the newborn may be manifested in three forms - edematous, jaundiced and anemic.
edematous form - the most severe;often children are stillborn, macerated, or die in the first hours after birth.Characterized by the appearance of the newborn: a sharp pale skin and mucous membranes, generalized edema subcutaneous tissue, accumulation of fluid in the pleural, peritoneal cavities.Sharp anemia, the number of red blood cells drops to 1 -1.5 million., Hemoglobin-up 32-48 g / l.
Severe neonatal jaundice - one of the fundamental frequency of hemolytic disease syndromes.The child is usually born full-term with yellow integuments or jaundice in the first or second day, and progressively increasing.The skin is yellow-green or yellow-brown color.Amniotic fluid and vernix may also be painted yellow.The liver and spleen are enlarged.Children sluggish, apathetic, poor suck.Heart sounds are muffled.Dark urine, feces normal coloring.In the blood, anemia, a high content of indirect bilirubin in cord blood (from 51.3 to 171 mol / L or higher at a rate of 25.6 mmol / L).Further rapid increase in the level of bilirubin in the blood becomes toxic to the central nervous system and may develop kernicterus clinic - there are cramps, stiff neck and opisthotonos, oculomotor disturbances, symptom "of the setting sun."Duration of jaundice to 3 weeks or more.In severe forms, especially with kernicterus, death can occur within the first week;if the child is still alive, there may be serious consequences in terms of the backlog of mental and physical development.
Anemia - the most mild form of hemolytic disease of the newborn.Usually occurs at the end of the first week of life, the number of red blood cells is reduced to 2-3 million. The liver and spleen may be enlarged.Diagnosis is based on the definition of the mother's blood and the baby and studies of Rh-factor.The prognosis is good.
treatment.In severe forms of hemolytic disease must be early exchange transfusion rezusotritsatelnoy blood.Blood is introduced at the rate of 150 ml / kg body weight of the child (the maximum of 160-170 ml / kg, and at extreme jaundice - 250 ml / kg).According to the testimony of exchange transfusion can be repeated.Recommended intravenous drip of 10-20% glucose solution, transfusion of plasma (10 ml / kg baby weight), the introduction of the B vitamins, hormones;when the defeat of the nervous system - glutamic acid, vitamins B6, B12.
When anemic forms - fractional repeated transfusions rezusotritsatelnoy desirable odnogruppnoy blood by 30 to 50 ml.Within 2 weeks the baby to the breast is not applied, are fed donor milk (due to the presence in the milk of the mother Rh antibodies).
Prevention.All pregnant women are conducting a study on the blood Rh factor and blood group.When blood rezusotritsatelnoy detect antibodies to the Rh factor.With a significant increase in antibody titer hospitalized pregnant, carry a specific and non-specific desensitization and premature delivery.If necessary, the child is replacing blood transfusions.
Hemorrhagic disease of the newborn develops as a result of physiological deficiency in the blood of certain blood clotting factors.
symptoms.There are various localization and intensity of bleeding and bleeding (bloody vomit, bloody stools, bleeding from the umbilical wound, nose, bloody urine, may be intracranial hemorrhage in the adrenal glands, and so on. D.).Sometimes it develops true melena (bloody vomiting and copious bloody stools, general pallor) 2-4-day life, which takes place in 1-3 days.For large bleeding can develop sharp anemia, the child becomes lethargic, dystrophic.
treatment.Early administration of vitamin K to 0,002 g 3 times a day orally for 3 days or vikasola / m to 0,2 ml.Ascorbic acid, vitamins B1, B12, R. 5% on 1 teaspoon 3-5 times a day, the solution of calcium chloride.Severe bleeding - odnogruppnoy transfusion of blood and plasma at the rate of 5-10 ml / kg body weight, the introduction of aminocaproic acid.With timely treatment prognosis is usually favorable, but in severe cases, death can occur on the background of massive bleeding.
pulmonary hyaline membrane - homogeneous protein formation, which accumulate in the alveoli, lining their walls, alveolar ducts and lead to a drastic violation of gas exchange.Most often seen in premature or children born in asphyxia, in the application of cesarean section, to mothers with diabetes during the pre-lying placenta or premature detachment of the placenta.