After the umbilical remnant falls off, an umbilical wound remains, which epithelializes by the end of 2-3 weeks.
Omphalitis - inflammatory process in the area umbilical wound. The umbilical wound is the entrance gate for the penetration of pathogenic microorganisms into the body of a newborn.
The following forms of omphalitis are distinguished:
1. catarrhal omphalitis (weeping navel)
2. navel fungus
3. purulent omphalitis
4. phlegmonous
5. necrotic
When the umbilical vessels are affected, they speak of phlebitis and arteritis.
Etiology:
1. Gram-positive flora (St, Str)
2. Gram-negative flora (Escherichia coli, Proteus, Pseudomonas aeruginosa, etc.).
1) Catarrhal omphalitis
The most common and prognostically favorable form of the disease is when a long-term non-healing granulating wound with scanty serous discharge appears on the navel. The child's condition is satisfactory. Periodically, the wound becomes covered with a crust, granulations can grow excessively, forming a mushroom-shaped protrusion (umbilical fungus).
Catarrhal omphalitis –(wet navel), this form of the disease occurs, as a rule, with delayed epithelization of the umbilical wound. More often in children with large body weight, with a wide umbilical ring.
Clinic:
The umbilical wound constantly gets wet, serous discharge is released, the bottom of the wound is covered with granulations, and bloody crusts may form;
There is mild hyperemia and moderate infiltration of the umbilical ring;
With a prolonged process of epithelization, mushroom-shaped granulations (fungus) may appear at the bottom of the umbilical wound - a dense, painless, pale pink formation (cauterized with a lapis pencil or surgically excised);
The umbilical vessels are not palpable;
The condition of the newborn is not impaired, the temperature is normal;
Healing occurs over several weeks.
A long-wetting navel should alert you to the presence of purulent fistulas!!! Surgeon consultation!
Treatment: treatment of the navel wound with 3% hydrogen peroxide, dry with a gauze pad with ethyl. alcohol, cauterized with 1% brilliant green, 5% potassium permanganate solution;
Xeroform is sprinkled into the wound;
Local Ural Federal District;
No bandages!
Purulent omphalitis
Purulent omphalitis – characterized by the spread inflammatory process on the tissue around the umbilical ring (skin, subcutaneous tissue, umbilical vessels) and severe symptoms intoxication.
Clinic:
The skin around the navel is hyperemic and swollen;
The umbilical wound is an ulcer covered with a fibrinous coating; when pressed, purulent discharge is released from the navel;
Gradually, the umbilical region begins to bulge above the surface of the abdomen, as deep-lying tissues are involved in the inflammatory process;
The umbilical vessels are inflamed (thicken and palpable in the form of tourniquets);
There is an expansion of the venous network on the anterior abdominal wall;
The condition is severe, the symptoms of intoxication are pronounced: the child is lethargic, sucks poorly, regurgitates frequently, the temperature rises, and there is no weight gain.
Treatment: hospitalization in the surgical department;
Local treatment- umbilical wound on early stages injected with antibiotics;
As soon as purulent discharge appears, the umbilical wound is drained, a bandage is applied with a hypertonic solution, then with Vishnevsky ointment;
UHF, Ural Federal District;
General treatment: antibiotics, detoxification, immunocorrective therapy; vitamins, symptomatic treatment.
3) Phlegmonous omphalitis
It occurs as a result of the spread of the inflammatory process to the umbilical area. Edema, tissue infiltration, skin hyperemia, and protrusion of the umbilical region are noted. An ulcer may form at the bottom of the umbilical wound. Inflammation spreads through the lymph vessels, swelling and infiltration extend far beyond the umbilical region, and sometimes dilatation of the veins of the anterior abdominal wall is noted (phlegmon of the anterior abdominal wall). The child’s condition is disturbed, lethargic, decreased appetite, regurgitation, decreased or no weight gain, the skin is pale or pale gray, the temperature is elevated to febrile levels.
4). Necrotizing omphalitis - extremely severe complication phlegmonous form in premature, severely weakened children. The process extends deeper. The skin becomes purplish-bluish, necrosis and detachment from the underlying tissue occurs. This creates a large wound. The muscles and fascia in the abdominal wall are exposed. Subsequently, intestinal eventration may occur. This form is the most severe and often leads to sepsis.
With thrombophlebitis of the umbilical vein, an elastic cord above the navel is palpated. With thrombarteritis, the umbilical arteries are palpated below the umbilical ring, radially. With the development of periphlebitis and periarteritis, the skin over the affected vessels is swollen and hyperemic, and tension in the muscles of the anterior abdominal wall is possible. With light massaging movements from the periphery of the affected vessel to the umbilical ring, purulent discharge appears at the bottom of the umbilical wound.
UAC- at severe forms: leukocytosis, neutrophilia, shift of the formula to the left, increased ESR.
Care and treatment:
1. for catarrhal omphalitis and navel fungus with daily observation and good social conditions In the family, hospitalization is not necessary. For other forms of omphalitis and inflammation of the umbilical vessels, it is necessary to hospitalize the child.
2. local drug treatment depends on the form of the disease.
ü For catarrhal and purulent omphalitis - treatment of the umbilical wound with a 3% solution of hydrogen peroxide, then 70% ethyl alcohol, then a 5% solution of KMnO4 or 2% bril solution. green.
ü For fungus - cauterization of granulations with a 5% silver solution, lapis.
ü For phlegmonous form - bandages with hypertonic solutions of 5-10% sodium chloride, with ointments (levosin, levomekol).
ü For necrotic – after surgical intervention(necrectomy) – lead open method using hydrophilic ointments.
3. general treatment: antibiotics, symptomatic.
4. for severe cases, wash the skin with wet wipes; for mild cases, hygienic baths with a solution of potassium permanganate 1:10,000, decoctions of string, chamomile are indicated.
The prognosis is favorable for non-severe forms with timely therapy. In other cases, complications may develop, including sepsis and death.
Sepsis
In recent decades, the problem of neonatal sepsis has again become relevant. As is known, in the 80s of the 20th century there was a decrease in the number of cases of this terrible disease due to the expansion of the range of antibacterial and immunoreplacement therapy. However, now the frequency of sepsis in newborns has increased and is 0.1–0.2% in full-term and 1–1.5% in premature babies.
The latest definition of neonatal sepsis was published in National leadership"Neonatology" at the end of 2007
Sepsis is a disease based on a generalized purulent-inflammatory infection caused by opportunistic bacterial microflora, the basis of the pathogenesis of which is dysfunction of the immune, predominantly phagocytic, system of the body with the development of an inadequate systemic inflammatory reaction(SVR), focus(es) of purulent inflammation or bacteremia and multiple organ failure.
(In newborns, early and late sepsis are distinguished. Early neonatal sepsis is sepsis of children in the first 3 days of life. For early sepsis characterized by intrauterine or early postnatal infection. In this regard, the child does not have a primary purulent focus, but so-called intrauterine pneumonia is often detected.
When sepsis clinically manifests itself later in a child’s life, it is customary to speak of late neonatal sepsis. In late sepsis, infection of the newborn occurs postnatally. Primary focus infection is usually present. Septicopyemia is most often recorded, i.e. sepsis occurs with the formation of one or more septicopyemic, metastatic, purulent-inflammatory foci. A typical metastatic lesion is purulent meningitis.)
Bacterial sepsis of the newborn- this is generalization bacterial infection, characterized by a breakthrough of local and regional protective barriers, the release of the pathogen into the general bloodstream, the development of toxicosis and multiple organ failure against the background of immunological restructuring and suppression of the body’s nonspecific resistance.
-Sepsis– A SEVERE GENERAL INFECTIOUS DISEASE CAUSED BY THE SPREAD OF BACTERIAL FLORA FROM A LOCAL FOCUS OF INFECTION INTO THE BLOOD BED, LYMPHOWAY, AND FROM THEM TO ALL ORGANS AND TISSUE OF THE BODY, ARISING DUE TO IMMUNITY INSUFFICIENCY ORGANISM.
Etiology. Pathogen neonatal sepsis are various pathogenic and opportunistic hospital strains of microorganisms, both gram-negative (Escherichia coli, Pseudomonas aeruginosa, Klebsiella, Enterobacteriaceae, Proteus) and gram-positive (staphylococcus, streptococcus, anaerobic, clostridia), etc.
· gram-negative flora
§ Predisposing factors for sepsis are factors that reduce protective properties natural ways, – multiple catheterizations of the umbilical and central veins, tracheal intubation, artificial ventilation lungs, birth defects, acute respiratory viral infections, skin lesions; factors that inhibit the immunological reactivity of a newborn are a complicated antenatal period, a pathological course of labor leading to asphyxia, intrauterine hypoxia, immaturity of the newborn, intracranial birth trauma; Factors that increase the risk of massive bacterial contamination of a child are a long period without water, especially if the mother has chronic foci of infection, and an unfavorable sanitary and epidemiological situation in the maternity hospital.
Pathogenesis:
§ The entrance gate of infection is the umbilical wound, injured skin and mucous membranes, as well as intact skin and mucous membranes of the upper respiratory tract, gastrointestinal tract.
§ Infection of a child can occur intrauterinely, during childbirth and after birth. At the site of infection, a primary inflammatory focus is formed, and adjacent vessels and tissues are affected. Degenerative-necrotic changes in the walls of blood vessels develop, from which pathogenic microbes spread hematogenously throughout the newborn’s body, exerting a damaging effect on tissues and organs due to their enzymes and toxins, causing a severe pathological process with deep violations homeostasis. Under the influence of microorganism enzymes, cell lysis occurs, resulting in increased intoxication.
Factors contributing to the development of sepsis
1. Infectious and inflammatory diseases genitourinary organs in a pregnant woman (pyelonephritis, adnexitis, colpitis), extragenital pathology.
2. Infections in the postpartum mother (endometritis, mastitis).
3. Pathology during childbirth ( protracted labor, anhydrous period during labor > 6 hours, “dirty” water, placental deposits).
4. Out-of-hospital birth.
5. Severe intrapartum asphyxia against the background of chronic intrauterine hypoxia.
6. Prematurity< 32 недель гестационного возраста
7. Birth weight< 1500 г.
8. Birth injuries.
9. Developmental defects and hereditary diseases.
11. therapeutic and diagnostic manipulations during the provision of resuscitation care, leading to disruption of the integrity of the skin and mucous membranes:
ü mechanical ventilation (tracheal intubation) > 3 days.
ü Catheterization of peripheral veins > 3 times.
ü Duration of intravenous infusions > 10 days.
ü Surgical interventions.
High risk factors for bacterial infection of the fetus and newborn
12. Infectious and inflammatory diseases in a pregnant woman (pyelonephritis, adnexitis, colpitis).
13. Infections in a postpartum mother (endometritis, mastitis).
14. Anhydrous period during labor > 6 hours.
15. Signs of infection of the amnion (“dirty” water, deposits on the placenta).
16. Out-of-hospital birth.
High risk factors for generalization of bacterial infection
(macroorganism factors)
1. Severe intrapartum asphyxia against the background of chronic intrauterine hypoxia.
2. Birth injuries.
3. Developmental defects and hereditary diseases.
5. Prematurity< 32 недель гестационного возраста.
6. Birth weight< 1500 г.
Especially high risk development of the septic process is observed in a group of children with extremely low birth weight. Thus, in children weighing 500–750 g, the incidence of sepsis can reach 30–33%, which is also associated with an increase in the survival rate of these children beyond the early neonatal period.
Iatrogenic factors of high risk of generalization of bacterial infection in newborns
1. Mechanical mechanical ventilation (tracheal intubation) > 3 days.
2. Catheterization of peripheral veins > 3 times.
3. Duration of intravenous infusions > 10 days.
4. Surgical interventions.
Clinic: diverse. The nurse needs to look for signs of early infection
· late fall of the umbilical cord, slow healing of the umbilical wound, pyoderma
persistent regurgitation
· long-term persistence of jaundice.
There are two forms of sepsis:
1. septicemic (a form of sepsis without obvious purulent foci, manifested by intoxication, damage to internal organs, and inflammatory reaction). More often in premature infants.
2. septicopyemic (a form of sepsis that occurs with the formation of one or several purulent-inflammatory foci with severe symptoms of intoxication (usually purulent meningitis, pneumonia, enterocolitis, osteomyelitis, etc.).
Clinic:
There are acute (within 3 - 6 weeks), subacute (1.5 - 3 months), prolonged (more than 3 months) and fulminant course of the disease. Depending on the entrance gate of the infection, umbilical, cutaneous, pulmonary, intestinal, and otogenic sepsis are distinguished.
If the septic process occurs in the antenatal period and the child is already born sick, his condition is serious: there is an increase in temperature, the skin is pale gray in color with extensive dermatitis, hemorrhagic rash, swelling, exicosis, regurgitation, vomiting, jaundice, enlarged liver and spleen, large initial loss of thalas weight, greenish coloration near the fetal fluid.
Sepsis that developed intra- and postnatally is more often manifested by a gradual onset of the disease - a deterioration in the general condition in the first or second week of the child’s life, low-grade fever, pallor of the skin with the gradual acquisition of a gray or earthy tint, lethargy, refusal to breastfeed, regurgitation, vomiting, weight loss, flattening of the body weight curve, increased duration and increased severity of jaundice, hemorrhagic phenomena on the mucous membranes, pyoderma, edema of the anterior abdominal wall and limbs.
There is a delay in mummification and separation of the umbilical remnant, prolonged bleeding of the umbilical wound with late epithelization, a long-lasting bloody crust in the center of the navel, a symptom of a newly opened navel, omphalitis, unstable stasis, interstitial pneumonia, etc.
Weakening of physiological reflexes, adynamia, muscle hypotension, anxiety, stool with mucus and greens, bloating, swelling or pastiness of the abdominal wall, hyperemia of the skin over the arteries, strengthening of the network of subcutaneous venous vessels, thickening of the umbilical vein or artery, increased bleeding of the umbilical wound.
The septicopyemic form is characterized by the appearance of purulent foci, most often in the brain with the development purulent meningitis. Development of pneumonia, ulcerative necrotizing enterocolitis, pyelonephritis, otitis media, conjunctivitis, etc.
Diagnosis is based on clinical picture and laboratory data. In the peripheral blood, anemia, neutrophilic leukocytosis with shifts of the leukocyte formula to the left, monocytosis, thrombopenia, increased levels of bilirubin in the blood serum, alkaline phosphatase, thymol test, violation of the ratio of aspartic and alanine transaminases; in the urine - transient albuminuria, bacterio- and leukocyturia. Isolation of the pathogen from the child's blood is a valuable, but optional diagnostic criterion.
Regardless of the form of sepsis, the severity of the child’s general condition is characteristic. Most early symptom– signs of intoxication and damage to the central nervous system.
CNS: oppression, decline motor activity, reflexes, muscle tone, excitement, convulsions.
Respiratory system: tachypnea, apnea, retraction of the compliant areas of the chest.
Cordially - vascular system : tachy/bradycardia, hypo/hypertension, muffled heart sounds, thready pulse.
Leather: pallor, gray/icteric tint, rash, swelling, sclerema, marbling, cyanosis, necrosis, “white spot” symptom.
Gastrointestinal tract: refusal to suck, intestinal paresis, diarrhea, pathological weight loss, hepatosplenomegaly.
urinary system: oligo-/anuria.
Hemostasis system: bleeding, thrombosis.
When examining a child, the nurse should suspect sepsis by finding the 7 Cs:
- WEAKNESS
- RETURNING
- GRAY SKIN
- SUBFEBRAL LONG-TERM TEMPERATURE
- REDUCED SOFT TISSUE TURGOR AND MUSCLE TONE
- WORTH WEIGHT
- CHAIR IS UNSTABLE
At favorable course The duration of the disease during treatment is 8-10 weeks. The acute period manifests itself for 10-14 days, then the symptoms of toxicosis fade, the function of organs and systems is gradually restored, and purulent foci are sanitized. During this period, cross infection can easily occur.
UAC in acute period– pronounced leukocytosis (less commonly leukopenia, normopenia), shift to the left, anemia, maybe. thrombocytopenia.
There may be a lightning-fast course of sepsis for 1-7 days, the development of septic shock.
Septicemia, caused Staphylococcus aureus proceeds with a rapid malignant course, with the rapid development of multiple organ failure, rapid exhaustion, decompensation of all types of metabolism, toxic delirium, septic endocarditis, hepatolienal syndrome, infectious toxic nephrosis, endotoxic shock.
Clinic: Symptoms of intoxication predominate. General exhaustion, yellowness of the skin and mucous membranes, hemorrhages on the skin, mucous membranes, serous membranes, hemorrhages in the stomach cavity, internal organs and adrenal glands develop. On the part of the central nervous system – disorders. Septicemia is characterized by intoxication of the body without local purulent-inflammatory foci, while with septicopyemia, pyemic foci are detected (abscesses, phlegmon, meningitis, otitis, pneumonia of a destructive type with pleural complications, etc.).
1. CBC - in the acute period - pronounced leukocytosis (less commonly leukopenia, normopenia), shift to the left, anemia, maybe. thrombocytopenia.
2. bacteriological examination of blood, urine, feces and pus from pyuemic foci (repeated cultures)
Prognosis: serious. Mortality 25 – 55%.
CARE AND TREATMENT
Care:
1. Urgent hospitalization in a separate room, strict adherence to asepsis, hygienic regime (hygiene of skin, mucous membranes)
2. Providing a therapeutic and protective regime with anesthesia for invasive manipulations
3. Compliance with thermal and humidity conditions: incubation of newborns (especially premature ones), temperature not lower than +30, humidity not lower than 60%.
4. organization of rational feeding of the child (priority breastfeeding– breast, from a bottle, through a tube), in the absence – with adapted formulas for feeding newborns, enriched with bifidobacteria. Increase the frequency of feeding by 1-2. According to indications - partial or complete parenteral nutrition (AA solutions).
3. During the period of subsidence of clinical manifestations of sepsis, careful use begins therapeutic massage, dry immersion, exercises in water.
5. The mother’s care is required in nursing and maintaining a positive emotional status, in preventing cross-infection, cooling, and cleaning the skin and mucous membranes.
Treatment:
The goal of treatment is to prevent the fatal outcome of the disease, which develops in the absence of therapy or inadequate treatment. It should be remembered that the entire volume of drug therapy must be started as early as possible.
Treatment. Urgently hospitalize in specialized neonatal pathology departments if surgical intervention is necessary. Feeding with mother's milk (mother's breast or expressed breast milk through a tube, from a nipple).
Treatment is symptomatic with antibiotics wide range actions in combination with drugs that stimulate defense mechanisms and restoring biological balance.
When the patient's condition improves, active immunization agents are used - staphylococcal toxoid, autovaccine, staphylococcal bacteriophage, drugs that stimulate immunogenesis. All this is used in combination with such biologically active substances, such as lactobacterin, bifidumbacterin and vitamins.
Drug therapy sepsis involves a combination of basic etiotropic treatment with pathogenetic correction of metabolic, immune and organ disorders
1.Etiotropic therapy:
Antibiotics:Currently there is no universal drug, combination of drugs that could be equally effectively used to treat any newborn with sepsis. Antibiotics are prescribed empirically, taking into account the most likely range of possible infectious agents in a given patient and depending on the type of sepsis. Therapy is ineffective if, within 48 hours, there is an increase in the severity of the condition and organ failure. This is the basis for switching to alternative antibacterial therapy. If successful antibacterial therapy its duration is at least 4 weeks, and (with the exception of aminoglycosides, the course duration of which should not exceed 10 days) the course of the same drug, with its obvious effectiveness, can reach 3 weeks. Grounds for cancellation antibacterial drugs are the rehabilitation of primary and pyemic foci, the absence of new metastatic foci, relief of signs of a systemic inflammatory response (SIR), persistent increase in body weight, normalization of the peripheral blood count and platelet count.
3. semisynthetic penicillins (ampicillin, oxacillin) + aminoglycosides (amikacin, netilmecin)
4. cephalosporins 1-2-3 generations (cefazolin, cefuroxime, ceftriaxone, cefatoxime) + aminoglycosides
2. Given the need for long-term and intensive antibacterial therapy, dysbiosis is corrected: simultaneously prescribed probiotics(bifidum-bacterin, lactobacterin, linexa, etc.) and antimycotics(Diflucan, Medoflucon, Forkan, etc.)
3.INFUSION THERAPY
Start with colloidal solutions (fresh frozen plasma, gelatinol, dextran, but not albumin, which when administered goes into the body tissues), which are administered at the rate of 20 ml/kg of the child’s body weight in the first 5–10 minutes of infusion therapy as a bolus or drip. Then crystalloids are injected dropwise at an average of 40–60 ml/kg body weight, but can be administered when indicated (for example, with exicosis) and in large quantities. Fresh frozen plasma contains antibodies, proteins, in addition, it is a donor of antithrombin III, the level of which drops significantly with the development of sepsis, which, in turn, causes depression of fibrinolysis and the development of disseminated intravascular coagulation syndrome (DIC syndrome), therefore fresh frozen plasma is especially indicated with DIC syndrome. Infusion therapy also includes solutions of potassium, calcium, magnesium, and, if parenteral nutrition is necessary, solutions of amino acids.
4.OXYGEN THERAPY
§ FACE MASK
§NASAL CATHETERS
5. ANTI-SHOCK THERAPY When septic shock and adrenal insufficiency, glucocorticoids are indicated.
6.IMMUNOREPLACEMENT THERAPY
§ LEUKOCYTE SUSPENSION
(In case of sepsis accompanied by absolute neutropenia (less than 1.5 * 10 9 /l of neutrophils in the analysis of peripheral blood), as well as with an increase in the neutrophil index of more than 0.5, for the purpose of immunocorrection, transfusions of a leukocyte suspension are used at the rate of 20.0 ml / kg of weight the child's body every 12 hours until the level of leukocytes reaches 4.0 x 109/l in the peripheral blood. This treatment method is due to the key importance of neutrophils in the pathogenesis of SVR in sepsis).
§ IMMUNOGLOBULINS (immunoglobulin preparations with increased IgM titers (Pentaglobin). – for intravenous administration. (The concentrations of IgM and IgA in the neonatal period are extremely low and begin to increase only from 3 weeks and 3 months of age, respectively).
§ LYCOPIDE
§ RECOMBINANT INTERFERONS (Viferon)
§ human leukocyte interferon
7.NORMALIZATION OF METABOLISM
§ VITAMINS
§ AMINO ACIDS
§ ENZYMES
8. SYMPTOMATIC AND SYNDROMAL THERAPY
9. LOCAL TREATMENT OF PURULENT FOCI
Dispensary observation
1. observation in a clinic for three years
2. examination by a pediatrician, neurologist (other specialists as indicated)
3. planned restorative therapy
4. medical exemption from professional vaccinations, consultation with an immunologist
Prevention
1. Antenatal:
ü Identification and treatment of chronic foci of infection and acute diseases in pregnant women
ü Proper organization daily routine and nutrition, walks
ü Prevention and treatment of pregnancy complications
2. Postnatal:
ü Careful observance of asepsis during childbirth and when caring for a newborn
ü Maintaining hygiene by the mother and caregivers of the child
ü Early breastfeeding
ü Timely detection and treatment of localized purulent-inflammatory diseases
After discharge from the hospital, observation in the clinic for three years by a pediatrician, neurologist and other specialists, depending on the nature of the disease.
For cerebral dysfunction, phenibut, aminalon, encephabol, etc. are indicated for six months.
Prevention - strict adherence to sanitary and epidemiological regulations in maternity institutions, newborn departments of city hospitals.
sterile tray;
tweezers in disinfection solution;
Check for clean diapers.
7. Unwaddle the baby in the crib. (Wash it, dry the skin - if necessary)
Performing the manipulation:
Toilet the umbilical wound several times a day (as prescribed by a doctor)
Then apply a bandage with a hypertonic solution - 10% sodium chloride solution or 25% magnesia solution or 10% sodium chloride solution for 20 minutes (do not allow the bandage to dry out!)
a bandage with a hypertonic solution alternates with treatment of the umbilical wound with an alcohol solution of chlorophyllipt
The final stage:
1. Swaddle the child (it is better to leave the umbilical wound open during treatment:
the child is placed in an open incubator, swaddled separately in the upper half of the abdomen with arms, and the lower half with legs).
2.Put him in bed.
5.Wash and dry your hands.
Skin treatment for vesiculopustulosis.
Technical preparation:
1.Wash your hands and dry.
2. Place on the manipulation table:
sterile tray;
tray for waste material;
craft bag with cotton swabs, balls and gauze napkins;
tweezers in disinfection solution;
medicines: 3% hydrogen peroxide solution, 5% potassium permanganate solution, 70% alcohol.
3.Check for clean diapers.
4. Open the waste bin;
5. Wash and dry your hands. Leave the water tap on +З7С;
6. Spread diapers on the changing table;
7. Unwaddle the baby in the crib. (Wash it and dry the skin, if necessary)
8. Place the baby on the prepared changing table;
9. Wash and dry your hands (gloves).
Performing the manipulation:
Wash your hands thoroughly and wear gloves.
Remove vesicles and pustules with a cotton swab soaked in 70% alcohol.
Treat the wound with an alcohol solution of chlorophyllipt or a 5% solution of potassium permanganate.
Hygienic baths with an intense pink solution of potassium permanganate.
The final stage:
1. Swaddle the baby.
2.Put him in bed.
3.Soak in disinfectant. solution of used material for the purpose of disinfection (chloramine, macrocid-liquid, terralin, sidex).
4. Treat the changing table with disinfectant. solution.
5.Wash and dry your hands.
After being discharged from the maternity hospital, the young mother is left alone with the baby and faces all the problems that arise when caring for the child. Some situations can be scary for parents. The main problem is the lack of necessary information on navel care. Many children have a wet navel, but only a few know how to cope with this situation.
Weeping navel or omphalitis is a process, the basis of which is the presence of serous discharge from the umbilical wound and a reduced rate of epithelization.
In most situations, the disease occurs in the second week of a child’s life. The group of main pathogens includes staphylococci, streptococci, coli and other pathogenic flora. Weeping belly button is the most common and mild form diseases.
As a rule, still Before the baby is discharged from the maternity hospital, the wound on the navel becomes covered with a bloody crust, which heals within 10-14 days. In the presence of an inflammatory reaction, the wound heals slowly and serous discharge appears on its surface, and slight hyperemia of the umbilical ring is also possible. You can read more about healing times and how to avoid problems during this period in the article on.
Omphalitis - harmless inflammatory disease, which in the absence necessary treatment can lead to serious complications. Therefore, every parent who does not know how to cope with the treatment of the umbilical wound should seek help from a specialist.
Often, omphalitis develops due to insufficient or improper care. For example, if the baby was not bathed in boiled water, after which the wound was not treated disinfectant or you haven’t taken good care of the cleanliness of your linen, then inflammation of the umbilical wound may develop.
All of the above factors can contribute to its infection, which is manifested by the release of serous fluid, the formation of a crust, its rejection and the subsequent formation of small ulcers.
Warning signs of poor healing
If you experience the symptoms described, you should immediately consult a pediatrician Omphalitis can be a threat to the life of a child only in the following situations:
- The shade of the liquid discharged from the navel has changed (there is an admixture of blood and pus);
- The volume of discharge has increased;
- The liquid has an unpleasant specific odor;
- There is swelling of the skin around the wound;
- General state the baby has worsened: moodiness, poor breastfeeding and fever;
- The wound heals over 21 days;
- The presence of other suspicious manifestations that cause concern and anxiety in the mother.
Consequences and complications
If you seek medical help in a timely manner, the prognosis for omphalitis is favorable. It is worth noting that The duration of the disease directly depends on its form:
- the simple form is quite easy to cure, it proceeds easily and is not characterized by the presence of complications;
- in the presence of purulent inflammation, complications, as a rule, do not appear, but the disease becomes longer lasting;
- phlegmonous and necrotic forms occur with complications.
The main thing that parents should remember is that if omphalitis is treated without the supervision of a pediatrician, then the risk of developing a number of complications increases significantly.
The most common include:
- development of an inflammatory reaction in the periumbilical lymphatic vessels(lymphangitis);
- inflammation blood vessel(arteritis, phlebitis);
- inflammation of bone tissue;
- inflammation of the digestive tract.
Abscesses, peritonitis, lymphangitis - complications of omphalitis, which can be avoided with proper wound care. In order to properly cope with this task, you need to promptly seek help from a pediatrician.
With the development of phlegmonous and necrotic forms of omphalitis, the following complications may occur:
- development of phlegmon of the abdominal wall;
- inflammation abdominal cavity;
- general infection pathogenic flora, which entered the baby’s body in large quantities;
- development of abscesses in internal organs;
- with excessively prolonged infection, proliferation of granulation tissue and further formation of a small tumor from the connective tissue may occur.
Features of treatment
- Before toileting the umbilical wound, you must thoroughly wash your hands with soap;
- After this, you need to pour 2-3 drops of hydrogen peroxide (3%) into the area of the umbilical wound (using a sterile pipette);
- Next step is to remove the crust: to do this, you need to move lightly along the surface of the umbilical wound and the bottom of the navel;
- The last step is to treat the wound with a sterile cotton swab and a 2% solution of brilliant green.
- To all the kids in mandatory You need to carry out this procedure once a day until the wound is completely healed. For children with removal of serous fluid, toileting of the wound surface can be performed up to 3-4 times a day.
How to care for the umbilical wound
A few main rules:
- Do not press on the navel;
- No need to pick at the wound with cotton swabs or finger;
- There is no need to try to get rid of all the crusts in one procedure;
- Squeezing out pus is strictly prohibited;
- There is no need to put a bandage on the wound or cover it with a band-aid;
- The child needs to be undressed more often so that the skin can breathe and at the same time the wound dries out;
- You should not hope for self-healing of the inflammation that has arisen;
- Before touching the baby, be sure to wash your hands;
- To care for the child, you need to use only sterile materials and dress him only in clean clothes;
- Things that come into contact with the wound should be made of hypoallergenic material and the fabric should be stroked with a hot iron before using them;
- You shouldn't wear the same thing twice;
- If the treatment used does not normalize the situation, then it is necessary to as soon as possible seek help from a doctor.
Is it possible to bathe if the umbilical wound is oozing?
If you have problems with the umbilical wound, swimming is possible with precautions Most mothers are interested in the question of whether it is possible to bathe a child if the navel gets wet, the answer is yes, but this must be done with caution.
To bathe your baby, you need to purchase a special bath in advance and you only need to fill it boiled water.
No need to add gels or bathing foam to the water. The only additional remedy may be a solution of potassium permanganate.
To prepare it, you need to dilute 5 grams of potassium permanganate in half a glass of water and then pour the resulting liquid into the bath. You need to carefully ensure that all the crystals dissolve.
It must be remembered that potassium permanganate dries out the skin, therefore, it is not recommended to do such baths too often. You can find out what temperature of water in the bathtub should be when bathing a newborn from this. How to properly rinse a baby’s nose (with saline solution, Aquamaris) - read in this publication.
What and how to process
The development of omphalitis is characterized by the presence of serous discharge from the wound, redness of the skin and slow healing. Daily treatment of the wound surface with a disinfectant solution can correct the situation.
- Diamond solution is a universal remedy for treating wounds on children's skin. It is he who has drying and disinfecting effects that prevent the proliferation of pathogenic microorganisms on the wound surface. If a child's navel gets wet, then this remedy can be used without any fear.
- 3% hydrogen peroxide can also be used as a remedy for a weeping belly button. The main thing is not to use the product too often, because... this may cause it to become more wet.
- Furacil and chlorophyllipt are disinfecting alcohol solutions, the action of which is aimed at speedy drying and healing of the wound surface.
To find out how long it takes for the navel to heal and 5 simple steps on how to treat it, go to.
What not to do during treatment
- Some pediatricians are convinced that it is possible to do without bathing a child in a bathtub. To do this, you need to dry your child with a damp towel every day.
- There is no need to cover the navel with a band-aid, wear a diaper or clothes to cover the wound. It is the contact of oxygen with its surface that promotes drying and crust formation.
- Don't try to tear off the crusts.
- There is no need to treat the wound surface using an antiseptic more often than the pediatrician said.
Prevention
Prevention of inflammation of the umbilical wound consists of its timely treatment and proper care. The baby's skin is treated after bathing. After the wound has healed, you can stop using disinfectants.
From the experience of parents
Alina, 23 years old, daughter 4 months old, Lyubertsy
Omphalitis is a disease that I came face to face with. The presence of discharge, constant formation of crusts and redness of the skin disappeared a week after the start of proper toileting of the wound.
Oleg, 23 years old, son 3 months old, Balashikha
Before discharge, and also after it, in addition to reading books and advice from family and friends, it seemed that we could easily cope with such a trifle as caring for the umbilical wound.
After we took our son from the maternity hospital, my wife and I tried to care for him as much as possible, but we could not avoid inflammation of the navel. Only his daily treatment on the advice of the local pediatrician helped improve the situation.
Target:
Preventing infection and speeding healing
Equipment:
Medicines: 3% H2O2 solution, 70% ethyl alcohol, 5% potassium permanganate solution;
Sterile material: cotton balls, napkins, wooden sticks with cotton swabs;
Tags, tweezers, phantom doll, changing table, underwear, gloves.
Progress of treatment of the umbilical wound in the maternity hospital :
Unwaddle the baby on the table or crib;
Wash, dry and treat hands (gloves) with an antiseptic solution;
If necessary, wash the child and sanitize your hands again;
Separate the edges of the umbilical ring and, using a pipette or a cotton swab taken with tweezers, generously cover the umbilical wound with 3% H2O2 solution;
After 20-30 seconds, dry the wound, extinguishing it with a cotton swab on a stick;
Treat the wound and the skin around it with a wooden stick with a swab moistened with 70% ethyl alcohol, another stick with 5% pH of potassium treat only the wound with permanganate, without touching the skin, swaddle the baby;
Swaddle the baby.
NB! The umbilical cord residue is treated with 96% or 70% alcohol and 5% permanganate solution daily, after removing the Chistyakova bandage. When cutting off the umbilical cord remnant on the 3rd day, a tampon with 3% H2O2 solution and pressure bandage for 5 o'clock. Then daily processing according to the above algorithm.
At home, the umbilical cord wound is treated in the morning and after bathing with brilliant green alcohol solution using a sterile stick or pipette. The mother washes her hands with soap and treats them with cologne or any antiseptic. The maximum healing period for the wound is 2 weeks.
NB! If the umbilical wound takes a long time to heal (more than a week), prescribe 2-3 sessions of ultraviolet irradiation (do not lubricate it with brilliant green before the session). If there is no healing within 2-3 weeks, consult a surgeon to rule out a fistula (provided there are no signs of inflammation).
Omphalitis- inflammation of the umbilical wound.
Treatment is local and general.
Treatment:
1. Separate the edges of the umbilical wound, drip 3% H O solution (wearing gloves)
2. Dry with a sterile stick
3.alternate applications with a hypertonic solution (10% NaCl) and antibiotics (zinacef, claforan, amoxiclav)
P.S. The compositions levomekol and levosin combine hypertonic antibacterial and keratoplastic effects; they can be used after treatment with 3% H O.
Administration of monovalent mumps (measles) vaccine
Purpose of introduction:
prevention of mumps, measles, rubella.
Equipment:
Sterile table with cotton balls, napkins, tweezers;
Gloves;
Mumps (measles) vaccine;
Solvent for mumps and measles vaccines;
A beaker for placing an ampoule with a vaccine into it;
Light protection cone made of black paper (for live measles protection);
Tray with disinfectant solution for discarding syringes;
Container with disinfectant solution for waste material;
70% ethyl alcohol.
Stages:
Wash and dry your hands, put on gloves;
Remove ampoules with vaccine and solvent from the packaging;
Wipe the necks of the ampoules with a cotton ball and alcohol, cut with an emery disc;
Open with a sterile napkin and break;
Throw the spent cotton balls and napkin into a container with a disinfectant solution;
Opened ampoules with dry live vaccine must be placed in a beaker;
Open the package of the syringe, put a needle with a cap on it, fix the needle on the cannula of the syringe;
Remove the cap from the needle;
Take an ampoule (ampoules) with a solvent and draw it into a syringe in the amount calculated earlier;
Introduce the solvent (carefully along the wall) into the ampoule with the vaccine;
Mix the vaccine using back-and-forth movements of the piston in the syringe;
Draw 0.5 ml of dissolved mumps (measles) vaccine into a syringe;
Return the ampoule with the remaining dissolved vaccine to the beaker and cover with a sterile gauze cap (and a light-protective cone, if necessary). measles vaccine);
Take a napkin from the sterile table with tweezers and release air from the syringe into it (drop the napkin into a container with a disinfectant solution);
Place the syringe inside the sterile table;
Treat the skin in the subscapular region or the outer part of the shoulder with 70% ethyl alcohol (leave the cotton ball in your hand);
Grasp the skin area in a fold between 1 and 2 fingers;
Insert a needle into the resulting fold, directed at an angle of 45;
Administer the vaccine;
Remove the needle;
Treat the injection site with a cotton ball left in your hand after treating the injection field;
Place the cotton ball and syringe into the tray with the disinfectant solution (after rinsing the syringe);
Remove gloves and throw them into the disinfectant solution.
P.S. There is a combined vaccine: measles and mumps or measles + rubella + mumps (Trimovax). The administration technique and dose of the rubella vaccine are the same 0.5 ml s.c.! release in bottles! 10 doses each!
- 17- 34
Rules for administering insulin
1. Insulin is administered subcutaneously, in a coma, intravenously. The patient himself s/c - in the anterior abdominal wall and the outer lateral surface of the thigh. Nurse: s/c the lower angle of the shoulder blades and the middle third of the shoulder.
2. Inject, observing the triangle rule (insulin cannot be injected in the same place).
3. The skin is treated with any sterile solution (not alcohol or another sterile solution after alcohol).
4. After injecting insulin, be sure to feed the patient within 15-20 minutes.
5. You can’t mix long-acting and regular syringes in one syringe; long-acting can’t be administered intravenously.
NB! Insulin is available in ready-to-use form; it is a pancreatic hormone that promotes the absorption of glucose by tissues.
Complications after insulin administration:
Lipodystrophy (disappearance of the subcutaneous layer at the injection sites)
Abscessation
Allergic reactions
Hypoglycemic conditions
“False croup” is stenosing laryngotracheitis.
This acute illness, characterized by obstruction of the airway in the larynx and the development of respiratory failure for ARVI and influenza.
Development mechanism:
2. swelling of the garter space
3. accumulation of sputum in the lumen of the larynx.
Rough "barking" cough;
The phenomenon of respiratory failure (the child is restless, rushes about in the crib, inspiratory shortness of breath, cyanosis are manifested, auxiliary muscles are involved in the act of breathing: wings of the nose, intercostal muscles, diaphragm), stenotic breathing.
Indication:
“open” umbilical wound.
Equipment:
Sterile cotton swabs;
Tray for processed material;
3% hydrogen peroxide solution;
70% ethyl alcohol;
5% potassium permanganate solution;
Sterile pipette;
Changing kit prepared on the changing table;
Latex gloves;
- container with disinfectant solution, rags.
Required condition:
When treating the umbilical wound, be sure to stretch its edges (even if a crust has formed).
Treatment of the umbilical wound for omphalitis.
It is performed more often by m/s, but the mother can be trained, because Treatment of the umbilical wound is carried out 3-4 times a day.
Algorithm:
1) Prepare: medications:
5% potassium permanganate solution
3% peroxide solution hydrogen
70% alcohol
1% brilliant green solution
Sticks
Brushing brushes
Sterile material
2) Maintain asepsis: wash your hands or wear gloves
3) Turn the child around
4) With your left hand, spread the edges of the umbilical wound
5) Take a shaving brush with your right hand, moisten it with 3% hydrogen peroxide solution and generously cover the wound with peroxide. Then treat only the wound, moisten the swab with potassium permanganate solution or brilliant green solution
6) As prescribed by a doctor, for purulent omphalitis, bandages with hypertonic solution and instillation of chlorophyllipt solution into the wound can be prescribed
Source: Methodological manual for students. Nursing process for diseases of newborns (diseases of the skin, navel, sepsis). 2007(original)
