Home Smell from the mouth Structure of newborn morbidity. Perinatal pathology in Russia: level, morbidity structure

Smell from the mouth

Structure of newborn morbidity. Perinatal pathology in Russia: level, morbidity structure

A study was conducted on forms 112 in children born in 2013 and 2014. An assessment was made of physical development using valuable tables at the age of the first year and the morbidity of these children using a medical examination sheet in the first year, depending on the type of feeding. The data obtained is shown below.

The table shows that the structure of morbidity is dominated by respiratory diseases (ARVI). Other diseases include iron deficiency anemia. Iron deficiency anemia most often affects children after 6 months, here the ratio of children who are breastfed and artificial feeding 1:1, since after 6 months mother’s milk does not completely satisfy the body’s need for iron.

After the release of the “National Program for Optimizing Feeding of Children 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 are regularly held with paramedical workers, health bulletins are issued, and conversations are held in the health care center (healthy child room) for parents. I decided to find out how effectively and actively the national program is being implemented into healthcare practice using the example of a pediatric department.

I conducted an analysis of the Child Development Stories (Form 112-u) of the children of the site, born in 20013 - 2014.

The purpose of researching child development histories (form 112u): to establish the dependence of indicators of physical development and morbidity on the type of feeding.

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

In 2013 – 93

In 2014 – 87.

From the above data it is clear that there is a decrease in the birth rate every year.

All children were divided by type of feeding.

Structure of distribution of children in the first year of life by type of feeding in percentage

Analyzing the data presented in the diagrams, we can say that there has been no significant increase in the number of children receiving breast milk for at least 6 months compared to 2013, but the rate of children not receiving breast milk for up to 3 months has decreased.

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

Comparative characteristics of types of breastfeeding in 2014 in percentage

Having studied the dynamics of types of feeding on 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 assessed the indicators of physical development:

Chest circumference

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

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

Medium development (4th corridor)

Above average (5,6,7 corridor)

Below average (1,2,3 corridor)

The data obtained is presented in diagrams:

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

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

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

Distribution of children by level of development (chest circumference) depending on the type of feeding

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

The increase in breast circumference indicators is least dependent on the nature of feeding. Determining the level of physical development using individual anthropometric indicators turned out to be more informative than determining the somatotype, since when determining the somatotype, three indicators are summed up 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 based on individual anthropometric indicators.

Analyzing the harmonious development, I was able to establish that 62% of bottle-fed children have disharmonious development, and 28% of breast-fed children have disharmonious development.

Distribution of children according to harmonious development on different types of feeding

The next stage in the analysis of child development histories was to identify the level of morbidity in children in the first year of life in the area, depending on the type of feeding.

The health index was 24%. The average 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 figure can be reduced if, during prenatal care for pregnant women, newborns and children infancy collect anamnesis more carefully, teach the mother to keep a food diary, and familiarize her with foods that are obligate allergens. Dysbacteriosis was detected in 16% of children at the site; there was 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 in formula-fed children and in children who receive their mother’s breasts only for 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 products

Rules for processing bottles and nipples

The incidence of ARVI and otitis media is almost equally common in breastfed and bottle-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 No. 8, iron deficiency anemia (IDA) occurs almost 2 times more often in children on artificial feeding and with early transfer to artificial feeding.

Morbidity in different types of feeding (per hundred children)

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

MINISTRY OF HEALTH OF THE CHELYABINSK REGION

STATE BUDGET PROFESSIONAL

EDUCATIONAL INSTITUTION

"SATKA MEDICAL TECHNIQUE"

Research

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

Specialty: 34.02.01 Nursing

Full-time form of education

Student: Akhmetyanov Ruslan Danisovich

Group 41 "c"

Head: Vasilyeva Asya Toirovna

___________________________________________

«____» _______________________________ 2016

Admitted to defense: Graduation qualifying work

"__"________20__g is protected with a rating of "___________"

Deputy Director for SD “_____”____________________20__

Chairman of the State Examination Committee ________________

I.A. Sevostyanova

Satka 2016

INTRODUCTION……………………………………………………………..…...
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 years of life……………………………………………………………………………….…. 1.2. Preventive appointment healthy child…………………..…… 1.3. Observations of newborns from risk groups during first year of life………………………………………………………... 1.4. The role of the nurse in newborn care children………………………………………………………………………………………. 1.5. Vaccinal prevention of children in the first year of life…………. Chapter 2. Empirical study of the role of the nurse in Organizations for the prevention of morbidity in children of the first year of life using the example of the children's clinic in Satka 2.1. Analysis of the work of the children's clinic in Satka……………………….. 2.2. Clinical examination of children of the first year of life in the clinic Satka…………………………………………………………………………………. 2.3. The work of a nurse in the vaccination room…………..………………. 2.4. The role of the nurse in newborn care children of Satka…………………………………………………….………….
CONCLUSION………………………………………………….…………
……………………
APPLICATIONS……………………………………………………………

INTRODUCTION

The first year of a child’s life is an important and difficult period. It is at this time that the foundation is 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 overall development of the child and in the formation of his health. Therefore, the effectiveness of preventive measures carried out in a given age period largely determines the health of children in the future.

The role of the nurse in organizing preventive measures for morbidity in children in the first year of life is to examine children: conduct anthropometry; psychometry, 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, he monitors the correctness of procedures. All data obtained during such visits is recorded in the child’s developmental history. It is important that gymnastics and massage are carried out systematically with 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 in the first year of life using the example of a children's clinic in the city of Satka.

Research objectives:

Studying theoretical material on this topic.

2 Conducting an analysis of key indicators medical activities children's clinic for the period from 2013 to 2015.

3 Studying the role of a nurse in organizing the prevention of morbidity in children of the first year of life using the example of a children's clinic in the city of Satka.

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

Subject of study. The role of the nurse in organizing preventive measures for morbidity in children in the first year of life.

Research methods:

1 work with documentation;

2 analytical;

3 statistical;

4 mathematical.

Hypothesis: The nurse plays a huge role in organizing preventive measures for morbidity in children in the first year of life.

Practical significance of the study. The research materials can be used in the study of PM. 02. Participation in diagnostic, treatment and rehabilitation processes. MDK 02.01.5 Nursing in pediatrics.

Work structure. The work consists 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 – ( prophylactic– preventive) complex of various kinds of measures aimed at preventing any phenomenon and/or eliminating risk factors.

Dispensary observation of healthy children in the first year of life

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

Frequency of examinations by specialists: 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, a neurologist, ophthalmologist, orthopedist;

– twice (1 trimester and 12 months);

– ENT examination by a dentist at 12 months.

Laboratory diagnostic examination:

– urine test for PKU 2x;

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

Surveillance performance indicators:

– good monthly weight gain;

– good adaptation of the child to new living conditions;

– normal physical and neuropsychic development and reduced morbidity levels.

When carrying out preventive examinations, the following is monitored:

- daily routine;

– feeding a child;

– providing a massage;

– hardening activities;

During an objective examination, special attention is paid to:

– body weight and height;

– head and chest circumference;

– assessment of neuropsychic and physical development;

- teething;

– bite property;

– behavior;

- state skin, musculoskeletal system, internal organs;

– subsequent reaction from BCG vaccination;

– presence of congenital diseases, developmental anomalies.

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

Based on objective and additional methods examination, the doctor gives a comprehensive assessment of health status, including 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 developing the disease and prescribes a set of preventive and health measures.

Basic preventive and health measures:

– organization of rational feeding;

– sufficient exposure to fresh air;

– performing a massage;

– gymnastics, hardening procedures;

– tasks of education;

– specific prevention of rickets;

– prevention of anemia;

– treatment of identified pathology.

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

Depending on their health status, children can be classified into the following groups:

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

– to 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 suffered severe and moderate infectious diseases, children with a general delay in physical development without endocrine pathology(short stature, retardation in the level of biological development), children with underweight or overweight, children who often suffer from acute respiratory diseases for a long time, children with consequences of injuries or operations while maintaining 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 functionality, in the absence of complications of the underlying disease. In addition, this group includes children with physical disabilities, consequences of injuries and operations, subject to compensation for the corresponding functions. 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, 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 severe decompensation of the functional capabilities of the body, the presence of complications of the underlying disease, requiring constant therapy. This group also includes children with physical disabilities, consequences of injuries and operations with a pronounced impairment of compensation of relevant functions and significant limitations in the ability to study or work.

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

1.2 Preventive care for a healthy child

1 Organization of sanitary and hygienic care for the child (microclimate of the room, quantity and quality of ventilation, lighting, organization of sleeping and waking places, walks, clothing, adherence to personal hygiene rules).

The mother must be explained that failure to comply with sanitary and hygienic care for the child can adversely affect the child’s health, physical and mental development. In the developmental history, the doctor records any deficiencies in the child’s care and gives appropriate prescriptions to correct them.

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

You need to know that up to 9 months there should be the following sequence: sleep, feeding, wakefulness, which corresponds to the anatomy physiological needs child. After 9 months, this sequence changes due to the lengthening of periods 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 the child.

3 Organization of rational feeding and nutrition is one of the main tasks of a general pediatrician. At each appointment or home visit, the doctor strictly monitors the compliance of the feeding the child receives with his physiological needs for basic food ingredients. This is especially true for children born weighing up to 2500 and more than 4000 g. They need more frequent nutritional calculations based on ingredients and calories, as they can easily develop nutritional disorders.

Rules for organizing rational feeding and nutrition:

– support, encourage and maintain breastfeeding for as long as possible;

– promptly transfer the child to mixed or artificial feeding if there is a lack of breast milk and it is impossible to receive donor milk;

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

Supplementary feeding should be given after breastfeeding and not from a spoon, but from a horn with a pacifier. This is explained by the fact that in a child of the first 3-4 months, the physiological act of sucking is the act of sucking, which maintains the excitability of the food center. Spoon feeding 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 a refusal to eat.

Complementary foods are usually given from 4-5 months at the beginning of feeding when the food center is highly excitable. It is advisable to give it from a spoon to teach the child to remove food with his lips and gradually master chewing skills.

– periodically (up to 3 months monthly, and then once every 3 months) carry out calculations of the chemical composition of the food actually received by the child in order to make appropriate adjustments if necessary;

– correctly organize the feeding technique.

When supplementary feeding is introduced, the baby must be held in your arms, as when breastfeeding. When introducing complementary foods, the baby should be held in your arms, sitting in an upright position.

Failure to comply with feeding methods often leads to nutritional disorders in children. If an infant, during a monthly examination, corresponds to normal indicators in terms of the rate of increase in body weight and length, and is also healthy, then the nutrition the child receives should be considered rational. Therefore, he is in optimal feeding conditions.

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

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

– improves blood supply, especially to the periphery;

– improves metabolism and thereby the utilization of food products;

– regulates the processes of excitation and inhibition;

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

– activities are regulated endocrine system;

– the functioning of the brain and all internal organs improves.

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

It is very important that gymnastics and massage are carried out systematically, with 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 nurse, if the parents’ attention is not focused on the enormous importance of physical education during the appointments, 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 outside, 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 components of health. Impaired or delayed physical development often leads to delayed neuropsychic development. In a child who is often ill and physically weakened, the formation of conditioned reflexes and various skills is delayed, and it is difficult to evoke joy.

A 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, as well as speech in children of the 1st year of life depend not only on their individual characteristics, but also on the influence on the child of adults caring for children, as well as on the environment. situation. Monitoring the dynamics of neuropsychological development of children early age. Assessment of neuropsychological development (NPD) in young children is carried out according to specially developed development standards within established periods: 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 child's birthday. Medical workers: a local pediatrician or a nurse, or a sister (paramedic) in a healthy child’s office diagnoses NPD in accordance with the recommendations, according to certain indicators - developmental lines. If the child’s development does not correspond to his age, then he is checked according to the indicators of the previous or subsequent age periods

Methodology 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 monitored:

Up to 6 months:

– development of visual indicative reactions;

– development of auditory orientation reactions;

– development of positive emotions;

– development of general indicative reactions;

– development of hand movements;

– development of skills.

From 6 months to 1 year:

– sensory development;

– development of general movements;

– development of actions with objects;

– development of the preparatory stages of active speech;

– development of the preparatory stages of speech understanding;

– development of skills.

The development of all skills 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, the timely emergence of visual and auditory concentration, as well as the development of the following positive emotions: a smile and a complex of revival, are very important.

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

At the age of 6 to 9 months, the leading development 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 developments are the development of understanding of adult speech, the formation of the first simple words, the development of primary actions with objects and independent walking. No less important than sensory development is the development of movements.

The mother must be informed what movements and at what age to teach the child. From the first days and weeks of life, during periods of wakefulness, the baby’s arms and legs should be free; before each feeding, he should be placed on his stomach, developing the ability to lift and hold his head. Such free movements of the head strengthen the muscles of the neck and back, the correct curvature of the spine is formed, and blood circulation in the brain improves. If the family has conditions for maintaining a comfortable temperature for an undressed child, it is advisable to place him on a wooden track on the floor during wakefulness to develop crawling and body sensation in space. In the future, all these movements must be continued to be developed by placing 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 a vertical 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, the child must be taught to grab a free toy; by 6 months, to roll over from the stomach to the back.

In the second half of the year, it is necessary to learn to crawl, and by 8 months - to sit and sit, stand up and walk around in a crib or playpen. With this sequence of movement development, the child masters the ability to walk independently by 12 months.

1.3 Observations of newborns from risk groups in

during the first year of life

Risk groups for young children:

– children at risk of developing central nervous system pathology (who have suffered perinatal damage to the central nervous system);

– children at risk for anemia, VDS, convalescents of anemia;

– children at risk of developing chronic eating disorders;

– children with constitutional anomalies;

– children suffering from rickets 1st, 2nd degree;

– children born with a large body weight (“large fetus”);

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

– children who are often and long-term ill;

– children from priority families.

Principles of monitoring children at risk:

– identification of leading risk factors. Determination of monitoring objectives (prevention of the development pathological conditions and diseases);

– preventive examinations of a pediatrician and doctors of other specialties (timing and frequency);

– laboratory diagnostic, instrumental studies;

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

– criteria for the effectiveness of observation;

– the observation plan is reflected in form 112-u.

– examination by a pediatrician at least 5 times at 1 month of life, subsequently

monthly;

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

– examination by the head of the clinic department at the 3rd month, mandatory for every illness of the child at the 1st year;

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

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

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

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

– strict control over skin condition and umbilical wound;

– early laboratory tests (blood and 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 deregistered (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 clinic no later than 3 months;

– the fight for natural feeding, strict control over weight gain, the fight against hypogalactia. A balanced diet taking into account the child’s weight;

– 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

on an empty stomach for sugar;

– dispensary observation for 1 year, in the absence of pathology, records are removed (form 30) at the age of 12 months.

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

– urine test every 1 month, then once a quarter and after each illness;

– consultation with specialists in early dates at the slightest suspicion of pathology (cardiologist, surgeon);

– dispensary observation for 1 year, in the absence of pathology, deregistered (form 30) at the age of 12 months.

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

– mandatory hospitalization for any disease;

– participation of the head of the clinic in preventive monitoring of this group of children;

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

– control by the district nurse over the actual place of residence of the child.

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

– rapid pace of physical and neuropsychic development;

– need for sensory impressions and motor activity;

– immobility of the child, “sensory hunger” lead to developmental delays;

– interdependence of physical and neuropsychic development;

– emotional impoverishment, lack of impressions, insufficient physical activity lead to delayed neuropsychic and physical development;

– low resistance to weather and environmental influences and various diseases;

– a very large 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 creature into a person with character and certain personality traits.

There is no such period in the life of an older person that in 12 months healthy child tripled his weight and grew by 25-30 cm, i.e. It is during the first year of life that the child’s growth and development proceeds at a very rapid pace.

The functional speech system is also rapidly developing. The child masters the intonation of the language in which he is spoken; humming, babbling, the first syllables, words appear. He begins to understand the speech of adults communicating 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.

Expanding significantly emotional sphere child, and he reacts adequately 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 child’s development and the state of his health in order to notice deviations in mental and motor development as early as possible and plan health-improving activities 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 pediatric nurse.

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

– assess the socio-economic conditions of the family;

Develop a mother education program aimed at meeting the child's vital needs. During the first visit, the nurse conducts a conversation with the mother, clarifies the course of pregnancy and childbirth, studies the discharge summary, and clarifies the family’s concerns and problems associated with the birth of a child.

The nurse pays attention to the conditions of the baby’s stay and gives recommendations on caring for the baby.

The nurse examines the child, examines the skin and mucous membranes, and evaluates reflexes. Looks at sucking activity and feeding patterns. He also pays attention to the child’s crying and breathing. He palpates the tummy and examines the large fontanel and umbilical wound.

The nurse learns about the mother’s well-being, somatic and mental health and lactation status, nutritional status, and examines the mammary glands. When carrying out primary patronage, the mother is given recommendations on protecting her health: daytime rest, varied food, increased drinking regimen, personal hygiene (shower daily or wash the body up to the waist, change your bra daily, wash your hands after coming from outside, 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, the method of feeding, convinces parents of the need to regularly see a doctor and follow all his recommendations. Teaches 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 capabilities.

Newborns up to 1 month like:

– suck;

– listen to repeated low sounds;

– focus on movement and light;

- be held in arms, especially when 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 physical communication, especially during feeding. Mother's advice: even if the baby is bottle-fed, you need to hold him in your arms during feeding.

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

– reacts positively to stroking;

– smiles spontaneously;

– calms down when picked up;

– holds his gaze for a short period of time during feeding.

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

– treatment of the umbilical wound;

– bathing the child;

– washing;

– nail care.

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

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

Bathing should become a daily routine for your baby. Firstly, the baby’s skin is thin, and metabolic and excretory processes and skin respiration occur much more actively in it. Therefore, it must be cleaned regularly. Secondly, bathing is extremely useful as a hardening method.

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

In the morning, the baby can be washed directly 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. Direct the movements from the outer corner of the eye to the inner.

If the child's breathing is difficult. To do this, it is more convenient to use a cotton pad (wick). Carefully, using twisting movements, insert it into the nostril. If there are a lot of dry crusts in the nose, the turunda can be soaked in oil (vaseline or vegetable). These manipulations may cause the baby to sneeze, which will make the task easier.

Your child's ears should only be cleaned when earwax is visible at the opening of the ear canal. There is no need to do this too often: the more often sulfur is removed, the faster it begins to be produced. When cleaning your ears, you should never penetrate the ear canal deeper than 5 mm. There are even special cotton swabs with limiters for this purpose.

Nails need to be trimmed as they grow, so that the baby does not scratch himself or you. Use baby nail scissors that have extensions on 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 ends the primary care for the newborn.

At the second visit, the nurse checks that the procedures are being performed correctly.

1.5 Vaccinal prevention of children in 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 the formation of specific immunity to an infectious disease through the artificial creation infectious process, which in most cases occurs 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 examination plan for the child, medical training for subsequent vaccination.

In accordance with the order of the Ministry of Health of Russia No. 125n dated March 21, 2014 “On approval national calendar preventive vaccinations and the calendar of preventive vaccinations according to epidemic indications»:

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

1 Mandatory vaccination of children, starting from 2 months of age, against pneumococcal infection has been introduced.

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

3 The list of infections and the list of contingents subject to vaccination have been expanded according to the Calendar of Preventive Vaccinations for Epidemic Indications. In accordance with the Federal Law of September 17, 1998.

N 157 – Federal Law “On Immunoprophylaxis of Infectious Diseases”, regions can finance vaccine prevention programs for Haemophilus influenzae, pneumococcal, rotavirus infections, chickenpox.

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

Vaccine prevention is a mandatory government measure to prevent infectious diseases. Structural changes in the current economic and demographic situation in the country, growing international consolidation in the implementation of infection elimination and eradication programs lead to increased requirements for immunoprophylaxis.

Thus, the role of the nurse in organizing preventive measures and morbidity in children in the first year of life is to examine children: conduct anthropometry; psychometry, 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.”

A nurse is psychologically preparing a child for vaccination.

2. The role of the nurse in organizing the prevention of morbidity in children of the first year of life using an example

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

Over three years, 2,331 children (children of the first year of life) underwent medical examination, of which 792 children underwent medical examination 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 those who underwent medical examination for the year. The number of children examined in 2015 decreased by 0.8% compared to 2013.

Table 1

Medical examination of children in the first year of life

Children of the first year of life	Number of people examined	Distribution by health group
		Group 1 – 369 (46.6%) Group 2 – 256 (32.4%) Group 3 – 117 (14.7%) Group 4 – 29 (3.8%) Group 5 – 21 (2.5%)
		Group 1 – 233 (30.4%) Group 2 – 383 (50.3%) Group 3 – 99 (12.9%) Group 4 – 22 (2.8%) Group 5 – 27 (3.6%)
		Group 1 – 294 (37.9%) Group 2 – 359 (46.3%) Group 3 – 75 (9.5%) Group 4 – 16 (2%) Group 5 – 32 (4.1%)

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 – Proportion of the number of people examined

children of the first year of life for 2013 – 2015

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

Figure 2 – Share ratio by health group

for 2013 among children of the first year of life

Figure 3 – Share ratio by health group

for 2014 among children of the first year of life

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

Of the children examined in the first year of life in 2014, there were 19.9% more children with the second group than with the first group, 37.4% than with the third group, 47.5% 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, 294 were children in the first year of life, which was 37.9%. With the second group there were 359 children of the first year of life, which amounted to 46.3%. The third group included 74 children of the first year of life, which amounted to 9.5%, the fourth group included 16 children of the first year of life, which amounted to 2%, and the fifth group included 32 children, which amounted to 4.1%.

Figure 4 – Share ratio by health group

for 2015 among children of the first year of life

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

Figure – 5 Proportion ratio by health groups

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

– with the second group 42.7%;

– with the third group 12.4%;

– with the fourth group 3%;

– with the fifth group 3.5%.

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

– conducting anthropometry;

– psychometrics;

– early referral of the child to specialists;

2.3. The work of a nurse in a vaccination room

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

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

The immunoprophylaxis office currently serves:

– child population aged 0-15 years;
– teenage population 15-18 years old.

Preventive vaccinations are planned in the “Vaccinal Prophylaxis” office - monthly; reports on the implementation of the preventive vaccination plan are also received here and entered into a computer database. Vaccines are stored in the refrigerator, sales deadlines and cold chain are respected.

table 2

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

Name of vaccinations	Done	Done	Done
diphtheria tetanus
polio
rubella mumps
tuberculosis
Viral Hepatitis IN
Pneumococcal infection
Haemophilus influenzae infection

Over three years, 31,836 vaccinations were given to children in the first year of life; in 2013, 10,288 vaccinations were given, which is 32.3% of all vaccinated children in the first year of life per year. In 2014, there were 9920 vaccinations, which is 31.1% of all vaccinated children in the first year of life during the year. In 2015, there were 11,630 vaccinations, which is 36.6% of all vaccinated children in the first year of life during the year. From this we can conclude that the number of vaccinated children is increasing every year. Since 2013, it has increased by 4.3% compared to 2015 (Fig. 6).

Figure - 6 Proportion of the number of vaccinated children under 1 year of age

Work of a nurse in the vaccination office in Satka

The nurse checks the number of vaccine vials for the work day, monitors the temperature in the refrigerator, and notes the readings in a log.

A nurse is psychologically preparing a child for vaccination. In the history of development, it records the doctor’s admission to vaccination, the intervals between vaccinations and their compliance with the individual vaccination calendar. Registers the vaccination in the preventive vaccination card (form No. 063/u), the preventive vaccination logbook (form No. 064/u) and in the child’s development history (form No. 112/u) or in individual card child (form No. 026/u). Performs vaccinations and gives recommendations to parents on child care.

The nurse receives vaccinations and medications. Responsible for the use and rejection of bacterial preparations. Complies with the rules for storing vaccines during immunization and the rules for processing vaccination instruments. Responsible for the sanitary and hygienic regime of the vaccination room.

During the workday, she destroys any remaining vaccine in open vials, records in a log book the amount of vaccine used and totals (number of doses remaining), and checks and records the temperature of refrigerators.

The nurse prepares a monthly report on vaccination work.

1 Organization of work in accordance with these instructions, hourly work schedule.

Organization treatment room according to the standard.

Compliance with the requirements for labeling medical supplies.

4 Clear and timely management medical documentation. Timely submission of a report on the performed manipulations for a month, half a year, year.

5 Preparing the office for work.

6 Perfect knowledge of methods of carrying out preventive, therapeutic, diagnostic, sanitary and hygienic procedures, manipulations and high-quality, modern implementation of them.

7 Strict adherence to blood collection technology for all types laboratory research.

8 Timely and correct transportation of the test material to laboratory departments.

9 Timely notification to the attending physician about complications from the manipulations, about the patient’s refusal to undergo the manipulation.

10 Ensuring the availability and completeness of a first aid kit to provide emergency care, provision of emergency first aid.

11 Carrying out control of the sterility of the received material and medical instruments, compliance with the shelf life of sterile products.

12 Regular and timely medical examination, examination for RW, HbSAg, HIV infection, carriage of pathogenic staphylococcus.

13 Ensuring proper order and. sanitary condition of the treatment room.

14 Timely discharge and receipt from the main medical. nurses necessary for work medicines, instruments, systems, alcohol, honey. instruments, medical items. appointments.

15 Ensuring proper accounting, storage and use of medicines, alcohol, honey. instruments, medical items. appointments.

16 Carrying out dignity. enlightenment of work on health promotion and disease prevention, propaganda healthy image life.

17 Continuous improvement of the professional level of knowledge, skills and abilities. Timely completion of improvement.

Conclusion of the study.

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

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

– with 1 health group it was 38.4%;

– with the second group 42.7%;

– with the third group 12.4%;

– with the fourth group 3%;

– with the fifth group 3.5%.

2.4 The role of the nurse in newborn care

children of the city of Satka

The head nurse of the children's clinic in Satka, having received information about the baby's discharge from the maternity hospital, enters the data into the newborn registration register on the same day; she fills out the development history of the newborn, pastes prenatal care inserts into it, and transmits the development history to the registry or directly to the local nurse.

The first patronage of a newborn is carried out 1-2 days after discharge from the hospital; discharged premature babies with symptoms of perinatal and congenital pathology are visited by a nurse and a local doctor on the day of discharge. If this day falls on a weekend or holiday, these children are visited by the doctor on duty - a pediatrician.

General purpose of patronage:

– create a child rehabilitation program;

– assess the child’s health status;

– assess the mother’s health status;

– assess the socio-economic conditions of the family.

CONCLUSION

Protecting the health of children in our country is one of the priorities, since there is no greater value than human health, which is an indicator of the well-being of society.

Particular attention is paid to preventive and health measures that help reduce morbidity.

The nurse teaches the mother the daily routine and nutrition to improve lactation, proper feeding of the child, caring for him, the method of feeding, 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, development of hygiene skills, and prevention of rickets. Teaches mother and all family members the technology of psycho-emotional communication with the child.

The nurse teaches the correct performance of daily manipulations for the baby:

– treatment of the umbilical wound;

– bathing the child;

– washing;

– treatment of the nose, ears, eyes;

– nail care.

All the nurses at the children's clinic in Satka do their job well. They competently explain the rules of caring for children in the first year of life.

The vaccination nurse prepares the child psychologically for vaccination. In the history of development, it records the doctor’s admission to vaccination, the intervals between vaccinations and their compliance with the individual vaccination calendar.

Registers the vaccination in the preventive vaccination card (form No. 063/u), the preventive vaccination record book (form No. 064/u) and in the child’s development history (form No. 112/u) or in the child’s individual record (form No. 026) /y). Performs vaccinations and gives recommendations to parents on child care.

Over three years, 2,331 children (children of the first year of life) underwent medical examination. The number of children examined in 2015 decreased by 0.8% compared to 2013.

In 2013, the number of children examined was higher by 1.2% than in 2014 and by 0.8% than in 2015.

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

– with 1 health group it was 38.4%;

– with the second group 42.7%;

– with the third group 12.4%;

– with the fourth group 3%;

– with the fifth group 3.5%.

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

Basic principles of immunoprophylaxis:

– mass scale, accessibility, timeliness, efficiency;

– mandatory vaccination against vaccine-preventable diseases;

– individual approach when vaccinating children;

– safety during preventive vaccinations;

– free preventive vaccinations.

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

– conducting anthropometry;

– psychometrics;

– early referral of the child to specialists;

– referral for laboratory and instrumental studies.

One of the main sections of the work of a pediatric nurse is hygienic education of family members, especially young parents, teaching them how to raise a healthy child, which implies individual sessions taking into account the cultural and general educational level of the family, the psychological climate and many other factors. At each pediatric site, an annual plan for sanitary and educational work with the population must be drawn up, in accordance with which the pediatrician and nurse systematically organize lectures and conversations.

LIST OF SOURCES USED

1. Akimova, G. N. Classes with a child from birth to six years old / G. N. Akimov. – M.: GEOTAR-Media, 2006. – 416 p.

2. Baranov, A.A. The state of health of children in Russia / A. A. Baranov. – M.: Publishing House Dynasty, 2005. – 207 p.

3. Baranova, A. A. Assessment of the health of children and adolescents during preventive medical examinations / A. A. Baranova, V. R. Kuchma. – M.: Publishing House Dynasty, 2004. – 158 p.

4. Baranova, A.A. Guide to outpatient pediatrics / A. A. Baranova. – M.: GEOTAR-Media, 2006. – 608 p.

5. Gulova, S.A. Nurse: A practical guide to nursing / S. A. Gulova, T. F. Kazakova, I. E. Galakhova. – M.: PROFI-INFORM, 2004. – 316 p.

6. Doskin, V.A. Polyclinic pediatrics / V.A. Doskin, T.V. Kosenkova, T.G. Avdeeva, - M.: GEOTAR-Media, 2002. - 303 p.

7. Efimkina, R.P. Child psychology methodological instructions / R. P. Efimkina. – M.: GEOTAR-Media, 2005. – 212 p.

8. Zhdanova, L.A. Preventive work with young children in the clinic / L.A. Zhdanova, G.N. Nuzhdina, A.V. Shishova. – M.: Phoenix, 2011. – 308 p.

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10. Zhdanova, L.A. Medical and pedagogical measures to facilitate children’s adaptation to educational institutions / L.A. Zhdanova, A.V. Shishova, G.N. Need, - M.: Ivanovo, 2010. -116 p.

11..Karpova, S.S. Health status and prospects for rehabilitation of children of an early age group / S.S. Karpova, A.I. Volkov, Yu.P. Ipatov. – M.: GEOTAR-Media, 2004. – 209 p.

12. Kotok, A. D. Vaccinations in questions and answers / A. D. Kotok. – M.: Phoenix, 2009. – 104 p.

13. Krasnov, M.V. Preventive work to protect the health of young children / M.V. Krasnov, O.V. Sharapova, V.M. Krasnov. – M.: Ivanovo, 2002. – 252 p.

14. Migunov, A. I. Vaccinations: a reference book / A. I. Migunov. – M.: Vest, 2005. – 160 p.

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13. Nikitin, B.P. Creativity steps or educational games. – M.: Education, 2009. – 160 p.

14. 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.”

15. Order of the Ministry of Health of Russia No. 125n dated March 21, 2014 « On approval of the national calendar of preventive vaccinations and the calendar of preventive vaccinations for epidemic indications.”

16. Rumyantsev, A.G. Monitoring the development and health of children / A.G. Rumyantsev, M.V. Timakova, S.M. Chechelnitskaya. – M.: Medpraktika, 2004. – 388 p.

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APPLICATIONS

Annex 1

Criteria for assessing the effectiveness of preventive work

– Coverage of pregnant women with antenatal care;

– Coverage of patronage for children in the first year of life;

– Complete coverage of children with preventive examinations (at least 95% of the total number of children of the corresponding age subject to preventive examinations; in the first year of a child’s life – 100% at 1 month, 3 months, 6 months, 9 months, 12 months. );

– Complete coverage of preventive vaccinations in accordance with the National Calendar (at least 95% of the total number of children subject to vaccination);

– The share of the number of children in the first year of life who are breastfed (at 3 months - at least 80%, at 6 months - at least 50%, at 9 months - at least 30%);

– Carried out on the first day after discharge from the maternity hospital (in the first three days if the newborn is healthy);

– Clarify and evaluate the social, genealogical and biological history, using data from the mother’s survey, prenatal care and information from the newborn’s exchange card (f-113-u);

– Questions and problems of feeding a newborn;

– Objective examination of the newborn;

– Conclusion on diagnosis, health group and risk group;

– Medical examination plan for the first month;

– Prevention of hypogalactia, vitamin and micronutrient deficiency, nutrition of a nursing woman;

– Maximum adherence to the principles of professional ethics, internal culture, friendliness and solemnity of the atmosphere.

Observation of a newborn baby

Order of the Ministry of Health of the Russian Federation dated April 28, 2007 No. 307 “On the standard of dispensary (preventive) observation of a child during the first year of life

– Visits from a local pediatrician on the 14th and 21st days of life, according to indications (health group) on the 10th, 14th, 21st days of life;

– Nurse visits at least 2 times a week;

– During the first month of life, medical care for children is provided by a pediatrician and specialists from a children’s clinic only at home;

– Commission examination at 1 month of life in the clinic (neurologist, pediatric surgeon, traumatologist-orthopedist, ophthalmologist, pediatrician, head. pediatric department, audiological screening, ultrasound of the hip joints);

– Assessment of physical development based on anthropometric indicators, neuropsychic development, determination of health group, identification of risk groups;

– Plan for clinical observation during the first year of life.

Observation of children in the first year of life Order of the Ministry of Health of the Russian Federation dated April 28, 2007 No. 307 “On the standard of dispensary (preventive) observation of a child during the first year of life:

– Pediatrician – monthly: assessment of medical history, identification of risk groups, prognosis of health status, direction of risk, assessment of information from the previous period, physical development, neuropsychic development, assessment of resistance, diagnosis and assessment of the functional state of the body, conclusion on health status, recommendations.

– Neurologist – 3, 6, 12 months, pediatric dentist and pediatric surgeon – 9 and 12 months, orthopedist, ophthalmologist, otolaryngologist – 12 months, pediatric gynecologist – up to 3 months and at 12 months for girls.

– Registration at the dispensary and observation according to registration form No. 030-u.

Laboratory and instrumental research:

– At the age of 1 month – audiological screening and ultrasound of the hip joints;

– At 3 months – blood and urine tests, at 12 months – blood and urine tests, ECG;

– In risk groups – additional blood and urine tests at 1 month and 9 months, and an ECG at 9 months.

Newborn health groups

Group 1 – healthy children (without deviations in health status or risk factors).

Group 2 – depending on the number and direction of risk factors, as well as their potential or actual implementation, is divided into options: A and B.

Group 3 – the presence of a chronic disease in the compensation stage.

Groups 4 and 5 - by analogy with the corresponding groups of older children.

At the end of the neonatal period, he transfers to the early childhood health group (Order No. 621).

Appendix 2

The procedure for carrying out preventive vaccinations for citizens within the framework of the national calendar of preventive vaccinations

1 Preventive vaccinations within the framework of the national calendar of preventive vaccinations are carried out to citizens in medical organizations if such organizations have a license providing for the performance of work (services) on vaccination (carrying out preventive vaccinations).

2 Vaccination is carried out by medical workers who have been trained in the use of immunobiological drugs for the immunoprophylaxis of infectious diseases, the organization of vaccination, vaccination techniques, as well as in the provision of emergency or emergency medical care.

3 Vaccination and revaccination within the framework of the national calendar of preventive vaccinations are carried out with immunobiological drugs for the immunoprophylaxis of infectious diseases, registered in accordance with the Russian Federation, in accordance with the instructions for their use.

4 Before carrying out a preventive vaccination, the person subject to vaccination or his legal representative is explained the need for immunoprophylaxis of infectious diseases, possible post-vaccination reactions and complications, as well as the consequences of refusal to carry out a preventive vaccination, and informed voluntary consent to medical intervention is drawn up in accordance with the requirements Federal Law dated November 21, 2011 N 323-FZ “On the fundamentals of protecting the health of citizens in the Russian Federation.”

5 All persons who should receive preventive vaccinations are first examined by a doctor (paramedic).

6 If the timing of vaccination changes, it is carried out according to the schedules provided for in the national calendar of preventive vaccinations and in accordance with the instructions for the use of immunobiological drugs for the immunoprophylaxis of infectious diseases. It is allowed to administer vaccines (except for vaccines for the prevention of tuberculosis), used within the framework of the national calendar of preventive vaccinations, on the same day with different syringes in different parts of the body.

7 Vaccination of children for whom immunoprophylaxis against pneumococcal infection was not started in the first 6 months of life is carried out twice with an interval between vaccinations of at least 2 months.

8 Vaccination of children born to mothers with HIV infection is carried out within the framework of the national calendar of preventive vaccinations in accordance with the instructions for the use of immunobiological drugs for the immunoprevention of infectious diseases. When vaccinating such children, the following are taken into account: HIV status of the child, type of vaccine, indicators of immune status, age of the child, concomitant diseases.

9 Revaccination of children against tuberculosis born from mothers with HIV infection and who received three-stage chemoprophylaxis for mother-to-child transmission of HIV (during pregnancy, childbirth and the neonatal period) is carried out in maternity hospital vaccines for the prevention of tuberculosis (for gentle primary vaccination). In children with HIV infection, as well as when HIV nucleic acids are detected in children by molecular methods, revaccination against tuberculosis is not carried out.

10 Vaccination with live vaccines within the framework of the national calendar of preventive vaccinations (with the exception of vaccines for the prevention of tuberculosis) is carried out for children with HIV infection with immune categories 1 and 2 (no immunodeficiency or moderate immunodeficiency).

11 If a diagnosis of HIV infection is excluded, children born to mothers with HIV infection are vaccinated with live vaccines without a preliminary immunological examination.

12 Toxoids, killed and recombinant vaccines As part of the national calendar of preventive vaccinations, they are administered to all children born to mothers with HIV infection. For children with HIV infection, the specified immunobiological drugs for immunoprophylaxis of infectious diseases are administered in the absence of pronounced and severe immunodeficiency.

13 When vaccinating the population, vaccines containing antigens relevant to the Russian Federation are used to ensure maximum effectiveness of immunization.

14 When vaccinating against hepatitis B in children of the first year of life, against influenza in children from 6 months of age, studying in educational institutions, and pregnant women, vaccines that do not contain preservatives are used.

Perinatal pathology in Russia: level, morbidity structure

L.P. Sukhanova
(Part of the chapter “Dynamics of health indicators of born offspring and perinatal demography in Russia in 1991-2002” of the book by L.P. Sukhanova Perinatal problems of reproduction of the Russian population in the transition period. M., "Canon+ Rehabilitation", 2006 272 p.)

The main indicators of the health of the born 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. It is emphasized that, firstly, the frequency of diseases and complications in premature infants is higher than in full-term ones (respiratory distress syndrome, hyperbilirubinemia, anemia of prematurity, infectious diseases, etc.), and secondly, that pathology in A premature baby has its own characteristics, 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 statistical form No. 32, during the analyzed period the number of premature 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%) .

An analysis of the indicator of prematurity among newborns, carried out using statistical form No. 32, in comparison with the number of births with low body weight (Fig. 37) according to federal districts Russia, revealed that the highest level of prematurity among live births, as well as the number of low birth weight children, are observed in the Siberian and Far Eastern Federal Districts, and the minimum number of premature and low birth weight children is observed in the Southern Federal District, which is consistent with the data from the analysis of the structure of children born by body weight given previously.

Figure 37. Ratio of the share of premature and “low birth weight” newborns (as a percentage of 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 low birth weight births (5.41%) - with indicators in Russia of 5.76 and 5.99%, respectively.

Analysis newborn morbidity 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 sick full-term children (from 147.5‰ in 1991 to 364.0‰ in 2002), or 2.5 times.
The incidence of premature infants increased 1.6 times over the same years (from 619.4 to 978.1‰), as shown in Fig. 3.

The increase in the incidence of newborns was 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 slower growth and malnutrition in 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 (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 analyzed years (from 1991 to 2002), hematological disorders are in first place (5.2 times), growth retardation and malnutrition (congenital malnutrition) are in second place (3.8 times), in the third - intrauterine hypoxia and asphyxia at birth (2.8). Next comes intrauterine infection (2.7), birth trauma (1.6) and congenital anomalies (1.6 times).

Table 16. Morbidity rate 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
Full term sick	147,5	174,3		233,1	253,5	281,2	307,7		349,3	345,1	357,1		246,8
Prematures got sick	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
Incl. intracranial						8,74	7,37	6,75	3,06	2,15		1,67
Intrauterine hypoxia and asphyxia during childbirth	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 babies				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
NEWBORN TRANSPORTED	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 newborn children in the last decade (Fig. 39) is an inevitable result of the growth of extragenital and obstetric pathology in pregnant women, against the background of which placental insufficiency develops and, as a consequence of the latter, intrauterine growth retardation of the fetus.

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

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

One of the main problems of perinatology is birth trauma of the fetus and newborn, which is of great medical and social importance, since birth trauma in children is largely responsible for perinatal mortality and childhood disability. During the analyzed period in Russia, there was an increase in the frequency of birth trauma in newborns (1.6 times) due to the so-called “other” birth trauma (Fig. 40), while the frequency of intracranial birth trauma sharply decreased from 9.3‰ to 1.67‰; such dynamics may be due, on the one hand, to changes in labor management tactics (increased frequency abdominal delivery), and on the other hand, a change in the statistical accounting of this pathology since 1999, when the category “birth injury” began to include both clavicle fractures and cephalohematomas. This has led to a marked increase over the past 4 years in the frequency of all birth trauma (due to “other”) to a level of 41.1-42.6‰, which certainly indicates an insufficient level of obstetric care in the obstetric hospital. Thus, today every 25th child born has a traumatic injury during 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 (2.2 times from 1998 to 1999), there has been an equally sharp (2.3 times) increase in mortality from this pathology - with 6.17% in 1998 to 14.3% in 1999 (Figure 41). Among full-term infants, mortality increased from 5.9% in 1991 to 11.5% in 2003, and among premature infants - 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. However, such a high mortality rate, especially in premature babies, puts the problem of birth trauma in newborns in first place among obstetric problems in modern Russia.

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

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

The significance of the increase in neonatal jaundice is increasing due to the recent increase in mental retardation of children and pathology in the population nervous system, since bilirubin encephalopathy resulting from severe forms of neonatal jaundice is accompanied by significant neurological disorders. At the same time, the lack of ability to objectively monitor the level of hyperbilirubinemia during 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. Frequency of hemolytic disease of newborns (HDN) and hematological disorders in newborns in Russia in 1991-2002, per 1000

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

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

The frequency of respiratory distress syndrome increased during the analyzed period from 14.4‰ to 18.7‰, while the change in the statistical recording 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 children, is characterized by an increase in the degree of morphofunctional immaturity, i.e. that background pathology that is not taken into account independently, but is clearly identified by indirect signs (an increase in conjugation jaundice, respiratory distress syndrome in full-term infants).

Figure 43. Dynamics of respiratory distress syndrome (RDS) in newborns in 1991-2002 and RDS in full-term children (per 1000 of the corresponding population)

The frequency of infectious pathologies specific to the perinatal period (Fig. 44) increased in newborns in 2002 compared to 1991 by 2.7 times and amounted to 24.0‰, which to a certain extent could be explained by an improvement in the detection of infections. However, the increase in septic morbidity among newborns, consistent with the increase in septic complications in women in labor (the maximum value of the indicator in both women and children in 1999), allows us to evaluate 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 morbidity among newborns in Russia is presented as follows: in 1st place is hypoxia, in second place is malnutrition, in third place is neonatal jaundice, in fourth place is birth trauma, and in fifth place is developmental anomalies.

Noting the particular importance of congenital anomalies (malformations) and chromosomal disorders, which, although they are in fifth place in the frequency of neonatal pathology, are extremely important because 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 developmental defects averages from 3% to 7%, and this pathology causes more than 20% of childhood morbidity and mortality and is detected in every fourth person who died in the perinatal period. It has been shown that with good organization of prenatal diagnostics, the birth of children with congenital pathology can be reduced by 30%.

Statistical data and numerous studies convincingly show how great the role of congenital malformations (CHD) is in the structure of morbidity and mortality of children. Developmental defects account for more than 20% of infant mortality (the rate increased to 23.5% in 2002 among all deaths of children under one year in Russia). The population frequency of congenital malformations averages from 3% to 7%, and among stillborns it reaches 11-18%. In this case, there is a pattern: the lower the level of PS, the higher the frequency of congenital defects. So, according to Science Center obstetrics, gynecology and perinatology of the Russian Academy of Medical Sciences, a decrease in PS to 4‰-7‰ was accompanied sharp increase(from 14% to 39%) the proportion of malformations among dead fetuses and newborns.

The prevalence of congenital anomalies among newborns over the years 1991-2002 is presented in Fig. 45.

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

As can be seen from table. 17, in the context of federal districts of Russia, the maximum level of morbidity in newborns was noted in the Siberian Federal District, mainly due to full-term children. In this district maximum rate and hypoxia, and malnutrition, and respiratory disorders, incl. respiratory distress syndrome of full-term infants, which characterizes a high degree of morphofunctional immaturity among newborn children.

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

	RUSSIA	Central Federal District	Northwestern Federal District	Southern Federal District	Privolzhsky Federal District	Ural Federal District	Siberian Federal District	Far Eastern Federal District
General morbidity
full-term
premature
Hypotrophy
Birth injury
Incl. Cheka
Hypoxia
Respiratory disorders
Incl. RDS
of which RDS-premature
RDS-term
Congenital pneumonia
Infections specific
Incl. sepsis
Hematological disorders

Neonatal jaundice
Congenital anomalies

An extremely high level of growth retardation and malnutrition (hypotrophy) of newborns (every ninth to tenth child born in the Volga, Ural and Siberian Federal Districts) and jaundice (every tenth to twelfth) determines the high incidence of older children in these territories.

The high frequency of birth trauma in the Siberian District (48.3‰ compared to 41.9‰ in Russia) and intracranial birth trauma in the Southern Federal District (1.7 times higher than the all-Russian indicator) characterizes low quality obstetric service in these territories. The maximum level of infectious pathology in newborns was noted in the Far Eastern Federal District, 1.4 times higher than in Russia as a whole, and septic complications are most often observed in the Volga Federal District. 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 Federal District is 42.2‰ (1.4 times higher than the national level) dictates the need to study the causes and eliminate the factors causing congenital malformations of the fetus, as well as take the necessary measures to improve the quality of prenatal diagnosis of this pathology.

According to the increase in the incidence of newborns in Russia, there is an increase in the number of newborns transferred from the obstetric hospital to the departments of neonatal pathology and the second stage of nursing from 6.2% in 1991 to 8.9% in 2002.

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

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 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 feasibility of timely and high-quality prediction of disability in early and preschool age is obvious. Based on a mathematical analysis of the significance of various factors (family living conditions, parents’ health, the course of pregnancy and childbirth, the child’s condition after birth), the authors developed a prognostic table that allows us to quantify the degree of risk of a child developing disability due to diseases of the nervous system, mental sphere, and congenital anomalies ; The values of the prognostic coefficients of the studied factors and their information value were determined. Among the significant risk factors for the fetus and newborn, the main risk factors were intrauterine growth retardation (IUGR); prematurity and immaturity; malnutrition; hemolytic disease newborn; neurological disorders in the neonatal period; purulent-septic diseases in a child.

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

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

Sharapova O.V., notes that one of the leading causes of neonatal and infant mortality continues to be congenital anomalies and hereditary diseases; in this regard, according to the author, prenatal diagnosis of developmental defects 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, the order of the Ministry of Health of Russia dated December 28, 2000 No. 457 “On improving prenatal diagnosis and prevention of hereditary and congenital diseases in children."

Prenatal diagnosis of congenital malformations, designed for the active prevention of the birth of children with developmental anomalies by terminating pregnancy, includes ultrasound examination of pregnant women, determination of alpha-fetoprotein, estriol, human chorionic gonadotropin, 17-hydroxyprogesterone in maternal blood serum and determination of fetal karyotype by chorionic cells in women over 35 years old.

It has been proven that with good organization of prenatal diagnostics, it is possible to reduce the birth of children with severe congenital pathology by 30%. Noting the need for antenatal prevention of congenital pathology, V.I. Kulakov notes that despite its high cost (the cost of one amniocentesis procedure with chorionic cell biopsy and karyotype determination is about 200-250 US dollars), it is more economically 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. - 511 p.
2 - Sidelnikova V.M. Miscarriage. - M.: Medicine, 1986. -176 p.
3 - Barashnev Yu.I. Perinatal neurology. M. Science. -2001.- 638 pp.; Baranov A.A., Albitsky V.Yu. Social and organizational problems of pediatrics. Selected Essays. - M. - 2003. - 511 p.; Bockeria L.A., Stupakov I.N., Zaichenko N.M., Gudkova R.G. Congenital anomalies (developmental defects) in the Russian Federation // Children's Hospital, - 2003. - No. 1. - C7-14.
4 - 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. -p.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: Abstract of thesis. diss. Ph.D. honey. Sci. - 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. -p.4-10; Ignatieva R.K., Marchenko S.G., Shungarova Z.Kh. Regionalization and improvement of perinatal care. /Materials of the IV Congress Russian Association perinatal medicine specialists. - M., 2002. - p. 63-65.
9 - 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. -p.4-10