Algorithm for performing the toilet of the umbilical wound. Skin toilet, umbilical wound treatment Umbilical wound toilet
After falling away umbilical remnant the umbilical wound remains, which epithelizes by the end of 2-3 weeks.
Omphalitis - inflammatory process in the umbilical wound. The umbilical wound is the entrance gate for the penetration of pathogenic microorganisms into the body of the newborn.
There are the following forms of omphalitis:
1. catarrhal omphalitis (weeping navel)
2. fungus of the navel
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 (E. coli, Proteus, Pseudomonas aeruginosa, etc.).
1) Catarrhal omphalitis
The most frequent and prognostically favorable form of the disease, when a long-term non-healing granulating wound with poor serous discharge occurs on the navel. The child's condition is satisfactory. Periodically, the wound is covered with a crust, granulations can grow excessively, forming a mushroom-shaped protrusion (fungus of the navel).
Catarrhal omphalitis -(weeping navel), this form of the disease occurs, as a rule, with delayed epithelization of the umbilical wound. More often in children with a large body weight, with a wide umbilical ring.
Clinic:
The umbilical wound is constantly wet, serous discharge is secreted, the bottom of the wound is covered with granulations, bloody crusts may form;
There is slight hyperemia and moderate infiltration of the umbilical ring;
With a prolonged process of epithelization at the bottom of the umbilical wound, mushroom-shaped granulations (fungus) may appear - the formation is dense, painless, pale - color pink(cauterized with a lapis pencil or excised surgically);
The umbilical vessels are not palpable;
The condition of the newborn is not disturbed, the temperature is normal;
Healing occurs within a few weeks.
A weeping navel for a long time should alert you due to the presence of purulent fistulas !!! Surgeon's advice!
Treatment: treatment of the navel of the wound with 3% hydrogen peroxide, dried with a gauze swab with ethyl. alcohol, cauterized with 1% brilliant green, 5% solution of potassium permanganate;
Sprinkle xeroform into the wound;
Local UVI;
No bandages!
Purulent omphalitis
Purulent omphalitis - characterized by the spread of the inflammatory process to the tissues around the umbilical ring (skin, subcutaneous tissue, umbilical vessels) and severe symptoms of intoxication.
Clinic:
The skin around the navel is hyperemic, edematous;
The umbilical wound is an ulcer covered with a fibrinous coating; when pressed, a purulent discharge is released from the navel;
Gradually, the umbilical region begins to swell above the surface of the abdomen, since 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 serious, symptoms of intoxication are expressed: the child is lethargic, sucks poorly, often burps, the temperature rises, there is no weight gain.
Treatment: hospitalization in the surgical department;
Local treatment - umbilical wound on early stages pricked with antibiotics;
As a purulent discharge appears, the umbilical wound is drained, a bandage is applied with a hypertonic solution, then with Vishnevsky's ointment;
UHF, UFO;
General treatment: antibiotics, detoxification, immunocorrective therapy; vitamins, symptomatic treatment.
Occurs as a result of the spread of the inflammatory process to the umbilical region. Edema, tissue infiltration, skin hyperemia, protrusion are noted umbilical region. An ulcer may form at the bottom of the umbilical wound. Inflammation spreads through the lymphatic vessels, edema and infiltration go far beyond the umbilical region, sometimes dilatation of the veins of the anterior abdominal wall (phlegmon of the anterior abdominal wall) is noted. The child's condition is impaired, lethargic, appetite is reduced, regurgitation, weight gain is reduced or absent, the skin is pale or pale gray, the temperature is elevated to febrile numbers.
4). Necrotic omphalitis - extremely severe complication phlegmonous form in premature, severely weakened children. The process goes deeper. The skin becomes purple-cyanotic, its necrosis and detachment from the underlying tissues occurs. This creates a large wound. Exposed muscles and fascia in the abdominal wall. Subsequently, there may be eventration of the intestine. This form is the most severe and often leads to sepsis.
With thrombophlebitis of the umbilical vein, an elastic band 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 edematous and hyperemic, muscle tension of the anterior abdominal wall is possible. With light massaging movements from the periphery of the affected vessel to the umbilical ring, a 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. With catarrhal omphalitis and fungus of the navel, with daily monitoring and good social conditions in the family, hospitalization is not necessary. In 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 With catarrhal and purulent omphalitis - treatment of the umbilical wound with a 3% solution of hydrogen peroxide, then 70% ethyl alcohol, then 5% KMnO4 solution or 2% bril solution. green.
ü With fungus - cauterization of granulations with a 5% solution of silver, lapis.
ü With phlegmonous form - dressings with hypertonic solutions of 5-10% sodium chloride, with ointments (levosin, levomekol).
ü With necrotic - after surgical intervention(necrectomy) - conducted in an open way using hydrophilic ointments.
3. general treatment: antibiotics, symptomatic.
4. at severe course skin toilet with wet wipes, with a mild course, hygienic baths with a solution of potassium permanganate 1:10,000, decoctions of a string, chamomile are shown.
The prognosis is favorable for non-severe forms with timely therapy. In other cases, complications may develop up to sepsis and death.
Sepsis
In recent decades, the problem of neonatal sepsis has again become relevant. As is known, in the 80s of the XX century there was a decrease in the number of cases of this formidable disease due to the expansion of the spectrum 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 a dysfunction of the immune, predominantly phagocytic, system of the body with the development of inadequate systemic inflammatory response(SVR), focus(s) purulent inflammation or bacteremia and multiple organ failure.
(In newborns, early and late sepsis are isolated. Early neonatal sepsis is the sepsis of children in the first 3 days of life. Early sepsis is 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.
With the clinical manifestation of sepsis in the later stages of 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 more often recorded, i.e. sepsis occurs with the formation of one or more septicopyemic, metastatic, purulent-inflammatory foci. A typical metastatic focus is purulent meningitis.)
Sepsis bacterial newborn is a generalization bacterial infection, characterized by a breakthrough of local and regional protective barriers, the release of the pathogen into the general circulation, the development of toxicosis and multiple organ failure against the background of immunological restructuring and suppression of nonspecific resistance of the body.
-Sepsis– A SEVERE GENERAL INFECTIOUS DISEASE CAUSED BY THE SPREAD OF BACTERIAL FLORA FROM THE LOCAL FOCUS OF INFECTION INTO THE BLOOD COURSE, LYMPHOPATHS, AND FROM THEM TO ALL ORGANS AND TISSUES OF THE BODY, ARISING DUE TO INSUFFICIENCY OF THE BODY IMMUNITY.
Etiology. The causative agent of neonatal sepsis are various pathogenic and opportunistic hospital strains of microorganisms, both gram-negative (E. coli, Pseudomonas aeruginosa, Klebsiella, enterobacteria, Proteus) and gram-positive (staphylococcus, streptococcus, anaerobic, clostridia), etc.
· Staphylococcus aureus
Gram-negative flora
§ Predisposing factors for sepsis are factors that reduce the protective properties of natural pathways - multiple catheterizations of the umbilical and central veins, tracheal intubation, artificial ventilation lungs, congenital defects, acute respiratory viral infections, skin lesions; factors that inhibit the immunological reactivity of the newborn - a complicated antenatal period, pathological course childbirth, leading to asphyxia, intrauterine hypoxia, immaturity of the newborn, intracranial birth trauma; factors that increase the risk of massive bacterial contamination of the child are a long anhydrous period, especially if the mother has chronic foci of infection, and an unfavorable sanitary and epidemiological situation in the maternity hospital.
Pathogenesis:
§ Entrance gates of infection - 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 in utero, during childbirth and after birth. At the site of infection, a primary inflammatory focus is formed, adjacent vessels and tissues are affected. Degenerative-necrotic changes in the walls of blood vessels develop, from where pathogenic microbes spread hematogenously throughout the body of the newborn, exerting a damaging effect on tissues and organs due to their enzymes and toxins, causing a severe pathological process with profound disturbances of homeostasis. Under the influence of enzymes of microorganisms, cell lysis occurs, resulting in increased intoxication.
Factors contributing to the development of sepsis
1. Infectious and inflammatory diseases urinary organs in a pregnant woman (pyelonephritis, adnexitis, colpitis), extragenital pathology.
2. Infections in the puerperal (endometritis, mastitis).
3. Pathology in childbirth (prolonged labor, anhydrous period in childbirth> 6 hours, "dirty" water, placental deposits).
4. Out-of-hospital delivery.
5. Severe intranatal asphyxia against the background of chronic intrauterine hypoxia.
6. Prematurity< 32 недель гестационного возраста
7. Birth weight< 1500 г.
8. Birth trauma.
9. Malformations and hereditary diseases.
11. medical and diagnostic manipulations in the provision of resuscitation care leading to a violation 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 the puerperal (endometritis, mastitis).
14. Anhydrous period in childbirth> 6 hours.
15. Signs of infection of the amnion ("dirty" water, imposition on the placenta).
16. Out-of-hospital delivery.
High risk factors for generalized bacterial infection
(macroorganism factors)
1. Severe intranatal asphyxia against the background of chronic intrauterine hypoxia.
2. Birth trauma.
3. Malformations and hereditary diseases.
5. Prematurity< 32 недель гестационного возраста.
6. Birth weight< 1500 г.
A particularly high risk of developing a septic process is observed in the group of children with extremely low birth weight. Thus, in children weighing 500–750 g, the frequency of sepsis can reach 30–33%, which is also associated with an increase in the survival of these children beyond the early neonatal period.
Iatrogenic risk factors for generalization of bacterial infection in newborns
1. Mechanical ventilation (tracheal intubation) > 3 days.
2. Catheterization of peripheral veins> 3 times.
3. Duration of intravenous infusions> 10 days.
4. Surgical interventions.
Clinic: varied. M/sister should be screened for signs of early infection
Late fall of the umbilical cord residue, 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 an inflammatory reaction). More common in premature babies.
2. septicopyemic (a form of sepsis that occurs with the formation of one or more purulent-inflammatory foci with severe symptoms of intoxication (more often - purulent meningitis, pneumonia, enterocolitis, osteomyelitis, etc.).
Clinic:
There are acute (within 3-6 weeks), subacute (1.5-3 months), protracted (more than 3 months) and fulminant course of the disease. Depending on the entrance gate of infection, umbilical, skin, pulmonary, intestinal, otogenic sepsis are distinguished.
If the septic process occurs in the antenatal period and the child is already born sick, his condition is severe: fever, pale gray skin with extensive dermatitis, hemorrhagic rash, swelling, exsicosis, regurgitation, vomiting, jaundice, enlarged liver and spleen, large initial loss of body weight, greenish color near the amniotic 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 a child's life, low-grade fever, pale skin with a gradual acquisition of a gray or earthy hue, lethargy, refusal of the breast, regurgitation, vomiting, weight loss body, flattening of the body weight curve, an increase in the duration and severity of jaundice, hemorrhagic phenomena on the mucous membranes, pyoderma, swelling of the anterior abdominal wall and limbs.
There is a delay in mummification and separation of the umbilical residue, prolonged bleeding of the umbilical wound with late epithelialization, a bloody crust in the center of the navel that does not fall off for a long time, a symptom of a secondarily opened navel, omphalitis, unstable mortar, interstitial pneumonia, etc.
Weakening of physiological reflexes, weakness, muscle hypotension, anxiety, stools with mucus and greenery, bloating, swelling or pastosity of the abdominal wall, hyperemia of the skin over the arteries, increased 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. The development of pneumonia, ulcerative necrotic 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, an increase in the level of bilirubin in the blood serum, alkaline phosphatase, thymol test, a 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 general condition of the child is characteristic. Most early symptom- signs of intoxication and damage to the central nervous system.
CNS: oppression, decline motor activity, reflexes, muscle tone, arousal, convulsions.
Respiratory system: tachypnea, apnea, retraction of compliant places chest.
The cardiovascular 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 suckle, 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
- regurgitation
- GRAY SKIN
- SUBFEBRILLE PROLONGED TEMPERATURE
- REDUCTION OF SOFT TISSUES TURGOR AND MUSCLE TONE
- WORTH IN WEIGHT
- CHAIR UNSTABLE
With a 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 away, the function of organs and systems is gradually restored, and purulent foci are sanitized. During this period, cross-infection can easily join.
KLA in the acute period - pronounced leukocytosis (less often leukopenia, normopenia), shift to the left, anemia, m.b. 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: The 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 develop, internal organs and adrenals. From the side of the central nervous system - violations. Septicemia is characterized by intoxication of the body without local purulent-inflammatory foci, while with septicopyemia, pyemic foci (abscesses, phlegmon, meningitis, otitis media, destructive type pneumonia with pleural complications, etc.) are detected.
1. KLA - in the acute period - pronounced leukocytosis (less often leukopenia, normopenia), shift to the left, anemia, m.b. thrombocytopenia.
2. bacteriological examination blood, urine, feces, and pus from pyemic lesions (repeated cultures)
Forecast: serious. Lethality 25 - 55%.
CARE AND TREATMENT
Care:
1. Urgent hospitalization in a separate box, strict adherence to asepsis, hygienic regimen (hygiene of the skin, mucous membranes)
2. Ensuring a medical and protective regimen with anesthesia for invasive manipulations
3. Compliance with the thermal and humid regime: incubation of newborns (especially premature babies), temperature not lower than +30, humidity not lower than 60%.
4. organization of rational feeding of the child (breastfeeding priority - breastfeeding, from a bottle, through a tube), in the absence of adapted mixtures 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. In the period of subsidence clinical manifestations sepsis begins cautious use therapeutic massage, dry immersion, exercise in water.
5. The care of the mother is obligatory in nursing and maintaining a positive emotional status, in the prevention of cross-infection, cooling, toileting the skin and mucous membranes.
Treatment:
The goal of treatment is to prevent the death of the disease, which develops in the absence of therapy or inadequate treatment.. It should be remembered that the entire volume of drug therapy should be started as early as possible.
Treatment. Urgently hospitalized in specialized departments pathology of newborns if surgical intervention is necessary. Breastfeeding (mother's breast or expressed breast milk through a probe, from a nipple).
Treatment is symptomatic with broad-spectrum antibiotics in combination with stimulant drugs. defense mechanisms and restore 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 like lactobacterin, bifidumbacterin and vitamins.
Medical therapy sepsis involves a combination of the main - etiotropic treatment with pathogenetic correction of metabolic, immune and organ disorders
1.Etiotropic therapy:
Antibiotics: there is currently no generic drug, drug combinations that could be used equally effectively to treat any newborn with sepsis. Antibiotics are prescribed empirically, taking into account the most likely spectrum of possible infectious agents in a given patient and depending on the type of sepsis. Ineffective is the therapy, during which within 48 hours there is an increase in the severity of the condition and organ failure. This is the basis for the transition to alternative antibiotic therapy. With successful antibiotic therapy, its duration is at least 4 weeks, and (with the exception of aminoglycosides, the course of which should not exceed 10 days), the course of the same drug, with its apparent effectiveness, can reach 3 weeks. The basis for the abolition of antibacterial drugs is the sanitation of the primary and pyemic foci, the absence of new metastatic foci, the relief of signs of a systemic inflammatory response (SVR), a persistent increase in body weight, the normalization of the peripheral blood count and platelet count.
3. semi-synthetic penicillins (ampicillin, oxacillin) + aminoglycosides (amikacin, netilmecin)
4. 1-2-3 generation cephalosporins (cefazolin, cefuroxime, ceftriaxone, cefatoxime) + aminoglycosides
2. Given the need for long-term and intensive antibiotic therapy, dysbiosis is corrected: probiotics(bifidum-bacterin, lactobacterin, linex, 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 tissues of the body), 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 dripped in an average of 40–60 ml/kg of body weight, but can be administered when indicated (for example, with exsicosis) and in large quantities. Fresh frozen plasma contains antibodies, proteins, in addition, it is a donator 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 (DIC) syndrome, therefore, fresh frozen plasma is especially indicated with DIC syndrome. Infusion therapy also includes solutions of potassium, calcium, magnesium, and, if necessary, parenteral nutrition amino acid solutions.
4.OXYGEN THERAPY
§ FACE MASK
§ NASE CATHETERS
5. ANTI-SHOCK THERAPY septic shock and adrenal insufficiency, glucocorticoids are indicated.
6. IMMUNE REPLACEMENT THERAPY
§ LEUKOCITERAL 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 leukocyte suspensions are used at the rate of 20.0 ml / kg of weight body of the child every 12 hours until the level of leukocytes reaches 4.0¥109/l in peripheral blood.This method of treatment is due to the key role of neutrophils in the pathogenesis of SVR in sepsis).
§ IMMUNOGLOBULINS (immunoglobulin preparations with elevated IgM titers (Pentaglobin).– for intravenous administration. (The concentration of IgM and IgA in the neonatal period is extremely low and begins to increase only from 3 weeks and 3 months of age, respectively).
§ LYCOPID
§ 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 the clinic for three years
2. examination by a pediatrician, neurologist (other specialists according to indications)
3. planned restorative therapy
4. medical withdrawal from professional vaccinations, consultation of an immunologist
Prevention
1. Antenatal:
ü Identification and treatment of chronic foci of infection and acute diseases in pregnant women
ü Proper organization of the daily routine and nutrition, walks
ü Prevention and treatment of pregnancy complications
2. Postnatal:
ü Careful observance of asepsis in childbirth, when caring for a newborn
ü Maintaining hygiene by the mother and caregivers
ü Early breastfeeding
ü Timely detection and treatment of localized pyoinflammatory diseases
After discharge from the hospital - observation in the clinic for three years by a pediatrician, neuropathologist and other specialists, depending on the nature of the course of the disease.
With cerebral dysfunction, phenibut, aminalon, encephabol, etc. are indicated for six months.
Prevention - strict observance of the sanitary and epidemiological regime in obstetric institutions, departments of newborns in city hospitals.
After discharge from the maternity hospital, the mother remains alone with the child and is faced with the need for him. Some phenomena can frighten a woman, in particular, many young mothers do not know how to properly care for an umbilical wound. Often, babies have a problem in the form of weeping of the navel, how to deal with it?
Weeping belly button symptoms
In the first minutes after birth, the baby's umbilical cord is clamped with a clamp and cut. The umbilical cord normally falls off within two to four days. In its place, an umbilical wound is formed, which is covered with a crust. Complete healing of the navel occurs within two to three weeks.
Normally, the healing process of an umbilical wound may be accompanied by a slight weeping and the formation of yellowish crusts. But in the case of pronounced weeping and poor healing of the umbilical wound, they speak of the development of catarrhal omphalitis (weeping navel).
Bacteria (- and,) are to blame for the development of omphalitis, which penetrate the tissues through the umbilical cord residue or umbilical wound. The vital activity of bacteria leads to the development of inflammation.
Symptoms of catarrhal omphalitis (weeping navel) are:
With a long-term weeping, an overgrowth of mushroom-shaped granulation tissue can form - this is called the fungus of the navel. Catarrhal omphalitis does not affect the general condition of the child. This form of the disease is the most favorable and often occurs among newborns.
Symptoms of purulent omphalitis in newborns
If the discharge from the umbilical wound becomes yellow, thick, this indicates the development purulent omphalitis. In this case, the skin around the navel swells and turns red. With the spread of inflammation to the umbilical region develops phlegmonous omphalitis, which is characterized by pronounced swelling, redness of the skin around the navel, as well as protrusion of the umbilical region. The skin around the navel is hot to the touch, and when pressed on this area, pus flows out of the umbilical wound.
A complication of this form of the disease is necrotic omphalitis. This is a very rare condition, often found in debilitated babies. With necrotic omphalitis, the inflammatory process extends deep into the tissues. The skin in the umbilical region becomes purple-cyanotic and soon exfoliates from the underlying tissues with the formation of a large wound. This is the most severe form of omphalitis and can lead to sepsis.
Purulent omphalitis is difficult, the children become lethargic, they suck badly at the breast, there is an increase in temperature. Fortunately, purulent forms of omphalitis are quite rare.
Prevention and treatment of a weeping navel in newborns
If parents are faced with such a problem as weeping of the navel, you should contact your pediatrician. The doctor will treat the umbilical wound and teach this manipulation to parents. With catarrhal omphalitis (weeping navel), the doctor can treat the disease at home. However, when purulent forms omphalitis hospitalization of the baby is required.
Treatment and prevention of a weeping navel is carried out as follows:
All newborns need to carry out such a procedure once a day until the umbilical wound is completely healed. For babies with a weeping navel, manipulation can be carried out two to three times a day.
Fungus of the navel is treated by cauterization of granulations with a 5% solution of silver nitrate. In the case of phlegmonous omphalitis, the baby is prescribed antibiotics inside, as well as externally in the form of ointments. In the necrotic form of the disease, in addition to antibiotic treatment, surgical excision dead tissues.
What is unnecessary to do with a weeping navel?
Unfortunately, good intentions do not always lead to a speedy recovery. So, some manipulations can further aggravate the poor healing of the umbilical wound.
What mistakes do parents often make when caring for their baby's navel?
- You should refrain from bathing the child in bathtubs. It is enough to wipe the baby every day with a wet towel.
- You can not close the navel with a band-aid, diapers, clothes. Contact of the skin with air contributes to the drying of the wound.
- Try to forcefully tear off the crusts.
- Treat the wound with an antiseptic more often than the doctor advised.
sterile tray;
waste material tray;
kraft bag with cotton balls, shaving brushes and gauze napkins;
tweezers in des. solution;
medicines: 3% hydrogen peroxide solution, 5% potassium permanganate solution, 70% alcohol.
Check for clean diapers;
Treat the changing mattress with a disinfectant solution (macrocid-liquid, terralin, sideks);
Open the used laundry bin.
Wash and dry hands, put on gloves.
Spread diapers on the changing table.
Unwrap the baby in the crib. (Wash it, dry the skin, if necessary).
9. Place the baby on the prepared changing table. Performing a manipulation
With your left hand, spread the edges of the umbilical ring.
Moisten the shaving brush with 3% hydrogen peroxide by watering over the tray for the used material.
Liberally coat the umbilical wound with hydrogen peroxide, in one motion, inserting the shaving brush perpendicular to the umbilical wound, rotating the brush 360° in a comma-like motion.
With your left hand, spread the edges of the umbilical ring, dry the wound with a dry shaving brush (introducing the shaving brush perpendicular to the navel of the wound with a movement similar to a comma).
Throw the shaving brush into the waste tray.
Moisten a new shaving brush with 70% ethyl alcohol.
With your left hand, spread the edges of the umbilical ring, treat the wound with a movement similar to a dot, introducing the shaving brush perpendicular to the navel.
Throw the shaving brush into the waste tray.
As prescribed by the doctor: with a brush moistened with a 5% solution of potassium permanganate, treat only the wound, without touching the skin; point movement. Throw off the brush.
The final stage of the manipulation
Swaddle the child.
Lay in bed.
Process the changing table dez. solution.
Remove gloves, wash and dry hands.
Schematic representation of manipulation
1) H2O2 2) dry 3)● alcohol 70° 4 ) ● K MnO4 5%
Carrying out a hygienic bath for a newborn baby
The first hygienic bath is carried out on the 2nd day after discharge from the hospital; Until the umbilical wound heals, boiled water or permanganate solution is used.
potassium (2-3 weeks);
in the 1st half of the year they bathe daily for 5-10 minutes, in the 2nd half of the year you can bathe every other day.
The temperature of the water in the bath is 37-38.0 C; soap is used once a week.
T air in the room - 22-24 C.
Bathe before the penultimate feeding.
Technical training
Two containers - with cold and hot water(or tap water).
A solution of potassium permanganate (95 ml of water - 5 g of K Mn O4 crystals, the prepared solution is filtered through cheesecloth, and the crystals should not
get into the bath).
Jug for rinsing.
Bath.
Water thermometer.
"Mitten" made of terry cloth (flannel).
7. Baby soap (baby shampoo).
8. Sterile oil (baby cream, vegetable).
9. Diapers, undershirts. 10. Changing table.
11.Des. solution
Preparatory stage
Wash and dry hands.
Lay out the diapers on the changing table.
Put the bath in a stable position (pre-treated with a disinfectant solution or washed with baby soap).
The bath is filled - by 1/2 or 1/3 of its volume.
Add 5% potassium permanganate solution to a slightly pink solution.
Measure the T° of the water with a thermometer.
Performing manipulation:
Undress the child. After defecation, rinse with running water. Throw soiled linen into the waste bin.
Take the child with both hands: put the child on the adult's left arm, bent at the elbow, so that the child's head is on the elbow; With the same hand, grab the left shoulder of the child.
Place the baby in the bath, starting with the legs so that the water reaches the line of the baby's nipples.
Legs after immersion remain free. Immersion level - up to the nipple line.
For several minutes, wash the neck and chest of the child.
Body wash:
put on a mitten;
lather the glove with gel, or soap, or shampoo;
gently lather the body of the child;
wash the folds of the child with a soapy mitten;
rinse the child.
Washing head:
it is advisable to wash your head last, as this procedure can cause a negative reaction of the child).
moisten the hair (from the forehead to the back of the head), pouring water over them from a ladle (jug);
apply shampoo or foam to the hair;
gently massaging the head, lather shampoo or foam;
wash off the soap foam with water in the direction from the forehead to the back of the head so that the soapy water does not get into the eyes;
turn the child over the bath with his back up;
rinse the child with water from a jug
Remove the child from the water in the position - face down.
Rinse with water from a jug and wash.
Throw a towel or diaper over the baby, put it on the changing table and dry the skin. Throw a wet diaper into the tank.
The final stage
Treat skin folds with vegetable oil.
Treat the umbilical wound, hold the toilet of the nasal and auditory passages.
Swaddle the child.
Drain the water and process the bath.
Wash and dry hands.
The very first treatment of the navel is carried out 3 minutes after childbirth, because then the pulsation of the vessels stops. Completely the tail of the navel should fall off 5-8 days after birth, and by 10-15 days it is already covered with skin.
Omphalitis has several forms:
1. Weeping navel or catarrhal omphalitis. A clear liquid comes out of the navel, which does not allow the navel to heal. The skin around the navel turns red;
2. Fungus. This form of omphalitis is more common in large children, and in those newborns who have a thick umbilical cord;
3. Phlegmonous omphalitis. The child often spits up, eats poorly, does not gain weight, etc.;
4. Necrotic omphalitis. In this form, the infection can spread to other tissues.
If the child's mother asked for help in a timely manner, then the prognosis will be favorable, but such children are often prone to portal hypertension. It is also worth remembering that one should monitor not only the physical ailments of our children, but also the psychological one.
When discharged from the hospital (as instilled on the third day), each woman is explained how to properly care for a fresh umbilical wound.
The very first treatment of the navel is carried out 3 minutes after childbirth, because then the pulsation of the vessels stops. The tail of the navel should completely fall off 5-8 days after the birth of the child, and by 10-15 days it is already covered with skin.
How to care for an umbilical wound?
The navel area should always be dry and clean, because it is in a humid environment that microbes multiply faster, which, as a rule, lead to its infection. Twice a day, it is necessary to treat the child's navel, the first time with the morning toilet and the second time after bathing.
First, the navel is treated with hydrogen peroxide. Dry the wound only with blotting movements with a sterile cotton ball or gauze. After these procedures, the navel is smeared with brilliant green.
Until when should the belly button be treated?
This must be done until it heals and there are no crusts or any discharge on it. Also, do not stop processing if hydrogen peroxide foams.
It is imperative to call a doctor if the mother noticed discharge from the wound on the umbilical wound and the skin around the navel turned red.
How to treat the navel with omphalitis?
Omphalitis has several forms:
1. Weeping navel or catarrhal omphalitis. A clear liquid comes out of the navel, which does not allow the navel to heal. The skin around the navel turns red;
2. Fungus. This form of omphalitis is more common in large children, and in those newborns who have a thick umbilical cord;
3. Phlegmonous omphalitis. The child often spits up, eats poorly, does not gain weight, etc.;
4. Necrotic omphalitis. In this form, the infection can spread to other tissues.
Only catarrhal omphalitis is treated at home, and all other forms are treated only in a hospital under the supervision of a doctor.
With a simple form of omphalitis, treatment should begin with a peroxide solution. Next, a water antiseptic or alcohol is applied to the navel. It is necessary to process the umbilical cord 4 times. You can bathe a newborn, but it is necessary to add a decoction of chamomile, string or a weak solution of potassium permanganate (potassium permanganate) to the water (boiled).
Also, with omphalitis, the pediatrician prescribes physiotherapy, for example, microwave, UFO, UHF. Sometimes a course of immunotherapy is required.
If the child's mother asked for help in a timely manner, then the prognosis will be favorable, but such children are often prone to portal hypertension. It is also worth remembering that we should monitor not only the physical ailments of our children, but also psychological health.
Material support and preparatory stage (clauses 1-7), see "Secondary treatment of the newborn."
8) Unwrap the baby in the crib (or on a “non-sterile” changing table). Unfold the inner diaper without touching the baby's skin with your hands.
9) Wash, dry and treat hands (gloves) with an antiseptic solution.
10) Wash the baby (if necessary) and put it on the changing table.
Main stage:
11) Wash, dry and treat hands (gloves) with an antiseptic solution.
12) Separate the edges of the umbilical ring.
13) Using a pipette or a cotton swab taken with tweezers, generously cover the umbilical wound with a 3% hydrogen peroxide solution.
14) After 20-30 sec. dry the wound, quenching it with a cotton swab on a stick.
15) Treat the wound and the skin around wooden stick with a cotton swab moistened with 70% ethyl alcohol.
16) With another stick with a cotton swab dipped in 5% potassium permanganate solution, treat only the wound without touching the skin.
The final stage (items 16-22) see "Algorithm for performing the toilet of the umbilical cord"
Features of the implementation of the toilet of the umbilical cord
and umbilical wound with a film-forming antiseptic
Before spraying the antiseptic, cover the face and perineum of the child with diapers to avoid getting the drug on the mucous membranes of the eyes, respiratory tract and genital organs. Grab the ligature with your hand and pull the umbilical cord over it. Shake the aerosol can, press the spray head index finger and from a distance of 10-15 cm, apply the drug to the umbilical cord residue (umbilical wound) and the skin around. Repeat pressing three times with pauses of 30-40 seconds. to dry the film. The time of pressing the valve head is 1-2 seconds. The film remains on the umbilical cord (umbilical wound) up to 6-8 days.
Daily morning toilet of a newborn in a children's ward
Every day before the 6-hour feeding, the toilet of the newborn, weighing and measuring the temperature with a mark in the history of development are carried out. Thermometers (1 for 5-6 newborns) should be stored in a tray with 0.5% chloramine B solution in a horizontal position or in 3% hydrogen peroxide solution (washed before use). The toilet of the baby must be carried out in a certain sequence: first, the child’s face is washed with warm water, the eyes, nose, ears, skin are treated, and lastly, the perineum.
The eyes are treated simultaneously with two separate cotton balls moistened with a solution of furacilin 1:5000 or potassium permanganate 1:8000, from the outer corner of the eye to the bridge of the nose. The toilet of the nasal passages is carried out using sterile wicks moistened with a solution of furacilin or sterile vaseline oil, ears - with dry sterile balls. Skin folds are treated with sterile vaseline or vegetable oil. The area of the buttocks and the perineum are washed with warm running water with baby soap, dried with blotting movements with a sterile diaper and lubricated with sterile vaseline oil or zinc paste. When washing, the nurse lays the child with his back on his left arm so that his head is at the elbow joint, and the sister's hand holds the hip of the newborn. Washing is carried out with running water in the direction from front to back.
The rest of the umbilical cord is cared for in an open way, the bandage is removed the next day after birth. The stump of the umbilical cord is treated with 70% ethyl alcohol or 3% hydrogen peroxide solution, then 5% potassium permanganate solution. To stimulate the mummification of the remainder of the umbilical cord and its falling off, it is advisable to reapply a silk ligature or tighten the one applied on the previous day. After the umbilical cord falls off, which most often occurs on
3-4 days of life, the umbilical wound is treated with 70% ethyl alcohol, followed by the use of 5% potassium permanganate. Treatment of the umbilical wound is carried out daily until it heals. The crusts of the umbilical wound are to be removed during processing. In the literature, there are indications of the need to limit the use of iodine preparations for the daily toilet of newborns (including the treatment of the umbilical wound) due to the possibility of its resorption with further inhibition of thyroid function.
Swaddling a newborn
Indication: protection of the child from loss of heat, protection of bed linen from pollution.
In a maternity facility, swaddling is performed before each feeding using only sterile underwear. For a child in the first months of life, the most physiological is wide swaddling, which consists in the fact that when swaddling, the child's hips do not close, but spread apart. In this case, the femoral head is installed in the acetabulum, favorable conditions are created for the final formation of the hip joints.
There are several options for swaddling. Their choice depends on the maturity of the newborn child. In the first days of life, closed swaddling is used, when children are swaddled with their hands. In the future, newborns are put on undershirts, leaving their hands free (open, or free, swaddling). During the first day, the baby's head must be covered with a diaper.
Open swaddling eliminates compression of the chest, promotes the development of the child's motor activity. For open swaddling, chintz and flannel undershirts with tightly sewn sleeves are used. This prevents heat loss and prevents injury to the face and eyes from uncoordinated hand movements of the newborn. The undershirts should be spacious enough, the floors should freely go one after the other. At low ambient temperatures, the child is wrapped in a blanket or placed in a loose envelope.
Newborn underwear should not have coarse scars and buttons, folds. At first, the vests are put on inside out, with the seams out.
To prevent irritation and infection of the skin, diapers should be changed in a timely manner, and the washed linen should be thoroughly rinsed from soap and other detergents. Until the umbilical wound heals, it should be boiled and ironed on both sides. It is strictly forbidden to use diapers dried after urination. When swaddling, it is not recommended to use hard and rough diapers, lay an oilcloth between them. Swaddling should not be accompanied by violence, sharp rough movements.
Swaddling a newborn in a maternity facility
Material equipment:
Sterile diapers and undershirts;
Waterproof disinfected apron;
Soap for children and staff;
Tool table;
Baby cot with mattress;
Changing table with mattress;
Containers with antiseptic and disinfectant solutions for disinfecting hands and surfaces;
Oilcloth bag and tank for used linen;
Phantom doll.
Algorithm for performing manipulation:
Preparatory stage
1) Open the laundry tub.
2) Wash your hands with soap and running water, dry.
3) Wear an apron and gloves.
4) Treat the changing mattress and apron with a disinfectant solution. If there is an additional “non-sterile” changing table in the box to free the child from dirty diapers, treat it with a separate rag. Wash and dry hands.
5) Check the diaper sterilization date, open the sterile diaper bag.
6) Spread 4 diapers on the changing table: 1st flannel; Fold the 2nd chintz diaper diagonally and put it folded up above the level of the 1st diaper by 15 cm (for making a scarf) or fold it in half in length and put it above the level of the 1st diaper to make a hat; 3rd cotton diaper; Fold the 4th cotton diaper four times in a long rectangle to make a diaper (you can use Pampers, Libero, Haggis, etc. diapers instead).
With insufficient air temperature in the ward, an additional 1-2 diapers are used, folded four times and placed in a “rhombus” after the 2nd or 3rd diaper.
To make a cap, the folded edge must be tucked back by 15 cm. Move the corners of the upper edge of the diaper to the center, connect them. Fold the bottom edge several times to the bottom edge of the cap. Lay at the level of the top edge of the 1st diaper.
main stage
7) Untie the newborn in the crib or on a “non-sterile” table. Unfold the inner diaper without touching the baby's skin with your hands.
11) Hold the 4th diaper (diaper) between the legs of the child, place its upper edge in the armpit on one side.
12) With the edge of the 3rd diaper on the same side, cover and fix the shoulder, the front of the child's torso and the armpit on the other side. Cover and fix the second shoulder of the child with the opposite edge of the diaper. Separate the feet from one another with its lower edge. Loosely roll up the excess diaper from below and lay between the child's feet.
13) Put on a hat or scarf made from the 2nd diaper.
14) Fix all previous layers and a hat (scarf) with the 1st diaper. Wrap the lower end of it up and circle around the child's body 3-4 cm below the nipples and fasten it to the side, tucking the corner of the diaper over its tightly stretched edge.
15) Before feeding to prevent contact of the diaper of the newborn with bed linen the mother needs to use another diaper. It should be spread out in a rhombus, placing the child wrapped in swaddling clothes diagonally. Wrap the side corners of the rhombus on the stomach under the back, the lower end of the diaper, diagonally. Wrap the lateral corners of the rhombus on the stomach under the back, the lower end of the diaper along the midline at an angle formed by its lateral parts.
The final stage
16) Treat the surface of the crib mattress with a disinfectant solution. Wash and dry hands.
17) Put the baby in the crib.
18) After swaddling all children in the ward (box), disinfect gloves and an apron in appropriate containers with a disinfectant solution.
19) Transfer the bag with dirty diapers to the collection and storage room for used linen, decontaminate it. Decontaminate the used laundry bin and put a clean rubberized bag into it.
Other Ways to Swaddle Babies
Wide swaddling (closed method)
Material support and preparatory stage (p. 1-5), see "Swaddling a newborn in a maternity facility."
6) Spread 4 diapers on a sterile changing table: the 1st flannel and 2nd chintz at the same level, the 3rd chintz 10 cm below and the 4th diaper diaper.
main stage
7) Untie the baby in the crib or on a “non-sterile” table.
8) Wash, dry and treat hands with an antiseptic solution.
9) Take the baby in your arms, wash it, dry it first on the weight, and then on the changing table. Dispose of wet diapers and diapers left in the crib in a laundry bag.
10) Wash, dry and treat hands with an antiseptic solution.
11) Pass the 4th diaper between the baby's legs.
12) From the 3rd diaper, make "panties". To do this, hold the upper edge of the 3rd diaper at the level armpits so that the child's legs are open above the level of the knees. Draw the bottom edge between the legs, press the diaper tightly against the baby's buttocks and fasten around the torso.
13) Cover and fix the shoulders of both sides with the edge of the 2nd diaper, lay the lower edge between the child's feet, separating them and the shins from one another.
14) Fix all previous layers with the 1st diaper and fix the swaddling.
The final stage (items 16-19), see "Swaddling a newborn in a maternity facility."
Wide swaddling (open method)
Material support and the preparatory stage (pp. 1-5), see "Swaddling a newborn in a maternity facility."
6) Spread 4 diapers on the changing table at the same level: 1st flannel, 2nd chintz, 3rd chintz, 4th diaper diaper and flannel vest. Put a chintz undershirt on the table.
main stage
7) Untie the baby in the crib or on the "sterile" table.
8) Wash, dry and treat hands with an antiseptic solution.
9) Take the baby in your arms, wash it, dry it first on the weight, and then on the changing table. Dispose of wet diapers and diapers left in the crib or on a “non-sterile” table into a laundry bag.
10) Wash, dry and treat hands with an antiseptic solution.
11) Dress the child in a cotton undershirt with a cut back, then in a flannel one with a cut forward, tuck the edge of the undershirt up at the level of the umbilical ring.
12) Pass the 4th diaper between the baby's legs.
13) Make "pants" from the 3rd diaper.
14) Fasten the 2nd diaper on top, like the 3rd, lay the bottom edge between the child's feet.
15) Fix all previous layers with the 1st diaper and fix the swaddling.
The final stage (items 16-19), see "Swaddling a newborn in a maternity facility."
Newborn feeding technique
One of the most important factors determining the degree of adaptation of newborns is properly organized, rational feeding, which has a huge impact on the subsequent growth and development of the child. Quantitatively insufficient or qualitatively malnutrition leads to impaired growth and development of children, negatively affects the activity of the brain.
A newborn child is prepared for the assimilation of mother's milk, which for him is the most adequate food product both in terms of the composition of the ingredients and the degree of their assimilation. The importance of early breastfeeding for activation of the mechanisms of lactopoiesis, establishing emotional contact between mother and child, as well as the possible early receipt of passive immunity by the child due to immunoglobulins contained in maternal colostrum are invaluable. And only if there are contraindications to early attachment on the part of the child or mother, they refrain from the latter. When breastfeeding, it is important to create a position for the mother that is comfortable for feeding (the first day - lying down, later - sitting).
It is necessary to alternate feeding with each mammary gland, decanting the remaining milk after feeding. If the volume of milk in one mammary gland is insufficient, it is permissible to supplement from the other mammary gland, after the child has sucked from the first, followed by alternating the order of application to the breast. To determine the amount of milk sucked by a child, control weighing is used before and after feeding, since sluggish babies and premature babies sometimes have to be supplemented with a spoon. The intervals between feedings are 3 or 3.5 hours with a 6-6.5 hour night break. The duration of one feeding varies widely, since it depends on the activity of sucking, the degree of lactation, but on average it should not exceed 20 minutes.
Despite the fact that nine-tenths of the baby's diet is usually sucked out in 5 minutes, it should be kept at the breast longer so that, in addition to hunger, it satisfies the need for sucking. During sucking, the child experiences joy, he gets to know his mother, and through her the world around him. However, there are cases when breastfeeding is contraindicated for a child (severe diseases of the newborn), or situations when the mother cannot breastfeed (postpartum and other infectious diseases, surgical interventions in childbirth, eclampsia, etc.).
To determine the amount of milk needed by a newborn in the first 2 weeks of life, you can use the formula of G.I. Zaitseva, where the daily amount of milk is equal to 2% of body weight at birth, multiplied by the day of the child's life. From 2 weeks of age, the daily requirement for milk is 1/5 of body weight.
For optimal body activity, a newborn needs water in addition to milk. Water (tea, Ringer's solution) is given between feedings, in the first two days - 20-30 ml, and in the following days - up to 50 ml.
In case of insufficient lactation in the mother, infant formulas are used for feeding newborns, which, in terms of their composition and the ratio of food ingredients, are adapted to mother's milk. Used for newborns adapted mixtures"Baby", "Detolakt", "Frisolak", "Semilko", etc., which are able to ensure the harmonious, full development of the child.
Considering the advantages of natural feeding, it is necessary to observe the diet of a nursing mother in the fight against hypogalactia. It should include daily milk, fermented milk products (at least 0.5 l), cottage cheese or products made from it (50-100 g), meat (about 200 g), vegetables, eggs, butter, fruits, bread. From food products that increase lactation, take honey, mushroom soups, walnuts, yeast, fish dishes. It should be remembered, however, that honey and fish dishes can cause allergic reactions. A nursing mother should drink at least 2-2.5 liters of liquid per day. It is necessary to avoid foods that have a highly allergenic effect: citrus fruits, strawberries, chocolate, natural coffee, strong meat broths, canned foods, salty foods, etc. Smoking and drinking alcohol is prohibited.
Sanitary and epidemic regime in the department of newborns
and when working with newborns
Personnel Requirements
Persons admitted to work in the maternity hospital undergo a complete medical examination by specialists, a fluorographic examination of the chest, a bacteriological examination for the intestinal group, Staphylococcus aureus, blood test for syphilis, HIV infection. The personnel must be vaccinated against diphtheria, all the data obtained are entered in the sanitary book, which is kept by the elder sister.
In addition to routine examinations, the nurse of the department, starting on duty, must measure the body temperature and pass the control of a doctor or a senior nurse with an examination of the pharynx and skin to identify pustules, infected abrasions, rashes, etc. Inspection data are recorded in a special journal. Sick personnel are not allowed to work. Daily sanitation of the nasopharynx is carried out only in case of epidemic trouble.
After the examination, the nurse puts on sanitary clothing (daily change of dressing gown, light cotton shirt dress, socks, leather shoes). Rings, bracelets and wrist watch It is recommended to remove during operation. Nails should be cut short and rounded with a file, the sleeves of the robe rolled up above the elbow. Particular attention is paid to washing hands: they are washed thoroughly up to the elbow with warm water and soap, dried with a clean film, treated with a disinfectant. In order to prevent dermatitis from repeated use of antiseptics, it is recommended to work in surgical gloves, which are disinfected before contact with the skin of each child.
Medical staff use masks in the neonatal unit for invasive interventions (punctures of the great vessels, lumbar puncture etc.), constantly during an influenza epidemic and other epidemic troubles.
Requirements for the equipment and maintenance of the chambers
In the physiological department for healthy full-term babies, an area of at least 2.5 m 2 per bed is provided, in the observational department - 4.5 m 2. At each post, cribs, heated changing tables, medical scales for weighing newborns, a table for medicines necessary for caring for a child, and built-in wardrobes are installed. It is unacceptable to transfer equipment and care items from one ward to another.
Beds for newborns are numbered, they put mattresses with tightly sewn oilcloth covers. While feeding children, the covers are wiped with a rag moistened with a disinfectant. Mattresses are covered with sheets, pillows are not used. When using hammocks, they are changed at least once a day.
The changing table is covered with a mattress in an oilcloth cover. It should be easy to clean and disinfect. In the wards, it is advisable to install an additional changing table, on which only the unswaddling of the child is performed. Next to the changing table, a baby scale is placed on the nightstand.
Chambers provide a supply of warm and cold water, baby bath. In the absence of a centralized water supply for washing children, pedal washbasins with warm water are installed. A soap dish with soap and a container with a disinfectant are placed next to the sink on a shelf or bedside table.
Behind each post of the physiological department, with separate placement of mothers and newborns, wheelchairs with cell partitions for one child are fixed. After feeding, the wheelchairs are treated with a disinfectant and quartz for 30 minutes. Premature, injured and in the observational department, in the absence of contraindications to breastfeeding fed to mothers in their arms.
Intensive care wards provide centralized oxygen supply, incubators, special equipment and equipment for emergency care in emergencies.
During the entire period of stay of newborns in maternity hospital only sterile underwear is used. Its daily supply for one newborn is at least 48 diapers, 10 undershirts for 5-7 times a shift. For the entire stay in the maternity hospital, a newborn is given one mattress, two blankets, three envelopes. Clean linen is stored on the shelves of cabinets in a set of 30-50 pieces in a double pack of cotton bags. The shelf life of linen
More than two days from the moment of sterilization. Unused linen is transferred to the sterilization room. In the closet, in a specially designated place, bedding delivered after disinfection is stored.
To collect dirty laundry serves as a tank with a lid and a pedal device. Inside it put oilcloth or plastic bag.
To care for newborns, it is necessary to have a set of medical instruments, dressings, care items. They should correspond to the number of children's beds, be single-use and stored in a medical cabinet. Before each swaddling, the nurse prepares a working table with sterile material, care products and tools, puts a container with a disinfectant solution and a tray for waste material on the bottom shelf of the table.
After use, balloons, catheters, gas outlet tubes, enemas, medical instruments are immersed in separate containers with a disinfectant solution, then subjected to pre-sterilization cleaning and sterilization. Decontaminated care items are stored in a separate labeled dry sterile container. Eyedroppers, spatulas and other instruments must be sterilized. Sterile tweezers (forceps) used to collect decontaminated products medical purpose, during each swaddle is stored in a container with a disinfectant. Tweezers (forceps) and disinfectant are changed once a day. Medical thermometers are completely immersed in a disinfectant, washed in boiled water, dried in a diaper and stored dry. Used nipples are washed under hot water, boiled for 30 minutes in a dedicated enamel pan. Then, without removing the lid, drain the water and store in the same container.
To care for the remainder of the umbilical cord and the umbilical wound, skin and mucous membranes, only sterile cotton-gauze swabs, suture dressings, and instruments are used. Sterile material is placed in bix, it is changed once a day. The nurse is responsible for the correct styling and timely delivery of biks. Sterile material not used from packings is subject to re-sterilization.
Medicines for the care of newborns (ointments, oils, aqueous solutions, etc.) must be sterile. They are prepared in a single package or packaged in an amount not exceeding the daily requirement for one child.
Medicines, used to treat newborns, are not stored at the posts of the physiological department. Medicines in intensive care wards are placed in a dedicated medical cabinet. In the room of the head nurse in a closed closet (refrigerator) they constantly store three - and ten-day supplies of medicines and sterile material. The shelf life of sterile solutions for injections prepared in a pharmacy and sealed with an aluminum cap for running in is one month, without running in - 2 days. The shelf life of ointments, powders, powders is 10 days.
Wards for newborns are filled strictly cyclically with a difference in the term of birth of children up to three days. In the wards, the air temperature is maintained at +22°С (for preterm infants +24°С). The relative humidity of the air is controlled by the readings of the psychrometer and should be 60%. The air is disinfected with bactericidal lamps. To reduce microbial burden and dust removal, it is advisable to use air conditioners. The wards are ventilated 6 times a day, when newborns are being fed in the mothers' wards or taken out to an adjacent room.
Cleaning of wards (boxes), procedural and other premises is carried out by junior medical personnel. Their work is controlled by the head nurse of the department and the hostess, at night - by the responsible nurse on duty. Cleaning equipment is strictly marked, rags for processing hard equipment are boiled daily and stored, as well as the dishes in which they are boiled, in the back room.
In the wards of newborns, wet cleaning is carried out at least three times a day: once with a disinfectant (after the third feeding), twice (in the morning and in the evening) with a washing solution. After cleaning, bactericidal lamps are turned on for 30 minutes and the room is ventilated. Only shielded lamps may be used in the presence of children.
The final disinfection of the wards is carried out after the discharge of newborns, but at least once every 7-10 days. All linen from the ward is handed over to the laundry, blankets and mattresses - for chamber disinfection. Remove all furniture if possible. Glass partitions, a wardrobe, a window are washed with ammonia. Wash basins and baths are cleaned with soda ash. Beds, tables, bedside tables, scales, partitions, walls, fluorescent lamps, bactericidal irradiators, baseboards, batteries are carefully treated with a washing solution. Then they are wiped with a disinfectant, and the floor is washed last. The chamber is closed for 1 hour. After disinfection, all surfaces are washed with hot water and bactericidal lamps are turned on for 1 hour. Then the staff changes sanitary clothes and lays out mattresses, blankets received from the disinfection chamber. Having completed the wards, the bactericidal lamps are turned on again for 1 hour and the room is ventilated. Cribs are filled with bed linen before the arrival of the newborn. General cleaning is carried out alternately in all newborn wards in accordance with the schedule for their filling. In addition, twice a year, the department of newborns, along with all maternity hospital closed for extended sanitization and redecoration.
In the observational department of newborns, the wards are cleaned at least three times a day, and once (in the morning) - using a washing solution, and after the third and fifth feedings - with disinfectants. After each cleaning, the air is irradiated with bactericidal lamps for 60 minutes and the rooms are ventilated. When moving to the observational department medical staff other departments changes overalls.
For the current and final processing of wards and equipment, imported disinfectants (Microcid, Lisetol, Sagrosept, Gigasept, Octeniderm, etc.) can be used. They are used in accordance with the enclosed instructions.
Requirements for caring for newborns
Newborn babies should be under the constant supervision of medical staff. When a child is admitted to the ward, the nurse checks the text of the medallion with similar information indicated on the bracelets and in the history of the development of the newborn (last name, first name, patronymic of the mother, weight and gender of the child, date and hour of birth, birth history number). He signs in the history of the development of the newborn (f. No. 97) about the admission of the newborn to the children's ward, registers him in the journal of the department (f. No. 102).
When examining a child, the nurse pays special attention to the nature of the child's cry, the color of the skin, the condition of the umbilical cord, the passage of urine and meconium. Carries out secondary treatment of the newborn. In case of early transfer from the delivery room (for example, to the intensive care unit)
A newborn 2 hours after birth undergoes secondary prevention of gonoblenorrhea with a 30% solution of sulfacyl sodium. The nurse makes a record of the prophylaxis carried out in the history of the development of the newborn, and then enters the data of observation and feeding into it.
In the morning, before feeding, the nurse washes the children, measures the temperature, weighs them, and takes the morning toilet.
The treatment of the umbilical cord residue and the umbilical wound is carried out during the daily examination of children, according to indications - more often. As prescribed by the doctor, the umbilical cord residue and the umbilical wound are carried out in an open way or under a film of an aerosol antiseptic. To speed up the mummification of the umbilical cord, an additional silk ligature is applied at its base. The umbilical cord falls off on the 3-5th day of life. Epithelialization of the umbilical wound occurs after a few days, in premature babies - later.
Before each feeding, the nurse changes diapers. Undershirts are changed daily, if dirty - as needed. Full-term babies cover their heads and swaddle together with their hands only in the first days of life, then use the open method of swaddling. In the cold season, they swaddle in a blanket or an envelope, with a blanket enclosed in it, in the hot season - only in diapers. In the event of a delay in discharge, as directed by the doctor, newborns are bathed.
When the mother and child stay together, the nurse takes care of the newborn on the first day. She is obliged to draw the attention of the mother to the need to observe the rules of personal hygiene, the sequence of processing the skin and mucous membranes, to teach the mother how to use sterile material and disinfectants.