NEWBORN (neonatus) — the child from the moment of the birth, the first breath and section of an umbilical cord to four-week age.
Key features of the period of a neonatality the first minutes and hours of life are that N. passes from pre-natal to extra uterine living conditions. With the first breath the respiratory system begins to function. Blood circulation changes: the small circle of blood circulation joins and conditions of blood circulation in a big circle change — zapustevat umbilical vessels, the blood flow in the venous (Aran islands-tsiyevom) channel connecting umbilical and portal veins stops the message between auricles stops, the arterial (botall) channel between a pulmonary artery and an aorta is obliterated, blood supply of a liver changes. Radically food of the child changes. The kcal, in the beginning in the form of meconium, or so-called first-born a calla begins to be allocated. Mechanisms turn on thermal controls (see).
In the period of a neonatality there is an adaptation of metabolic processes. The N becomes capable to preservation of a homeostasis at change of parameters of the environment, to-ry is provided uniform funkts, a complex various fiziol. and biochemical, structures and systems of their regulation. There is a development and formation of circadian (daily allowance) rhythms (see. Biological rhythms ), what is also manifestation of adaptation of an organism to new living conditions.
The act of the birth («neonatal biostart»), the period of transition from a placental metabolism to independent metabolism in the new habitat, causes a number of adaptation shifts of all vitals and systems H., functioning to-rykh substantially depends on level morfol, and funkts, a maturity of its organism.
Division of newborn children on full-term is standard (see. Donoshennost ) and premature (see. Premature children ). At full-term height of the head makes 1/4 — 1/5 lengths of a body. The umbilical ring is in the middle between a xiphoidal shoot and a pubic symphysis that corresponds to the middle of length of a body.
Growth and the full-term N.' weight are individual and depend on the state of health and age of mother, the mode of her food, the course of pregnancy, number of childbirth, a sex of the child, features of the constitution of parents and other reasons. N.'s growth fluctuates from 45 to 56 cm, on average 48 — 52 cm; body weight — ranging from 2500 to 6000 g, on average 3200 — 3500 g (see the table).
Table. Average values of physical development of the full-term newborns depending on number of childbirth (the first or repeated) and a sex of the child (according to L. A. Artishevskaya, 1976)
The general assessment of a condition of N is of great importance. The scale Apgar is widely applied to assessment (in points) activity of separate bodies and systems (see. Apgar method ). More fully N.'s maturity is confirmed by the summary accounting of a complex of the following signs: loud shout, the active movements, good action of the heart, pink skin color, the expressed hypodermic cellulose, good turgor of soft tissues, the skin covered with a vernix caseosa, a small down on extremities and a trunk, hair on a head the nails covering all bed of a nail and reaching finger-tips, elastic auricles at girls cover big vulvar lips small and a clitoris, at boys both small egg are lowered in a scrotum. The mature child, as a rule, well takes a breast, actively sucks.
Skin it is characterized by a thin epithelial cover with poorly developed corneous layer, it is a little edematous and hyperemic, covered with syrovidny lubricant (see. Vernix caseosa ). The size of the relation of a surface of skin to body weight at the child is more, than at the adult.
Sweat glands are developed poorly, limited sweating and imperfection of vascular reactions of skin cause lability of tep-loreguliruyushchy functions. Sebaceous glands well function from the moment of the birth. N.'s skin is easily vulnerable. Along with it it has good reducing power and quickly heals at various damages. Protective function of skin is reduced therefore it quite often serves as entrance gate for an infection.
Hypodermic cellulose at the full-term N. is, as a rule, well-marked. In its structure prevail refractory fat to - you (palmitic and stearin) and contains olein to rather less - you, as causes density of hypodermic cellulose H. in comparison with hypodermic cellulose of children of more advanced age.
Muscular system. No more than 25% of body weight fall to the share of muscular tissue at N. (adults have more than 40%). Fine muscle fibers with well developed intersticial fabric. The tone of sgibatel of extremities prevails over a tone of razgibatel. Electroexcitability of the muscular device is expressed poorly, mechanical excitability is increased.
Bone system. N.'s bones have fibrous structure, they are rich with vessels and elements of marrow. The big fontanel at N. is always open, small is open approximately in 25%^ cases. The thorax of a barrel-shaped form, an edge soft, pliable, are located horizontally. The backbone differs in absence fiziol, bends. Joints have big mobility.
Respiratory organs. The nasal courses and upper respiratory tracts narrow are also developed insufficiently. The closing nasal stroke at N. is absent. The mucous membrane of a nasal cavity gentle, is plentifully supplied circulatory and limf, vessels, is easily vulnerable. Its slightest swelling considerably complicates breath, and also suction. Frontal and Highmore's (maxillary, T.) bosoms at N. are absent. Eustachian (acoustical, T.) pipe rather short and wide, the direction it more horizontal, than at the adult, the pharyngeal opening of an Eustachian tube is located at the level of a hard palate. At development of the catarral phenomena in a nasopharynx these features of a structure of an Eustachian tube facilitate distribution of inflammatory process to a middle ear.
A throat and a trachea narrow, with soft cartilages, with poorly developed elastic fabric. The mucous membrane of a trachea gentle, is plentifully supplied with blood vessels. Bifurcation of a trachea is at the level of III — the IV chest vertebrae, bronchial tubes rather narrow. Lungs are insufficiently elastic since they are poor in elastic fabric, well vaskulyari-zirovana. Along with weakness of respiratory muscles these factors contribute to development in N. of acute atelectases of the lungs tied with acute respiratory viral and germ diseases. The lower bound of lungs at N. is located slightly above, than at children of chest age that is caused by higher arrangement of a diaphragm.
From the moment of the birth pulmonary — external begins breath (see). The first breath is caused by a complex of exogenous and internal causes: right after the birth in blood the partial tension of carbon dioxide gas increases (pCO 2 ) to 35 — 40 mm of mercury. at a low tension of oxygen (35 — 40 mm of mercury.), what causes excitement of a respiratory center. Besides, a part is played by the reflex reactions arising at the time of the birth of a fruit (temperature, tactile), and other irritants of the environment influencing the receptor device of a fruit. The first breath is followed by the irregular, and then correct respiratory movements, number in the beginning to-rykh makes 46 — 60 in 1 min. Aeration of lungs is carried out thanks to the negative pressure arising at the first breath making 20 — 70 mm w.g. Increase in pressure causes an active exhalation. The volume of each breath at N. in the first days of 15 — 25 ml, increases further to 30 — 32 ml. Healthy N. in the first 3 hours after the birth are in a state - compensated metabolic acidosis (see). The average value of pH of capillary blood makes 7,28; in the next hours it increases and in 6 hours after the birth 7,36 — 7,38 equals. Partial tension of carbon dioxide gas (pCO 2 ) in the first 3 hours makes 44,5 mm of mercury., and in 6 hours it is stabilized within 32 — 36 mm of mercury. By the end of the first days relative increase in buffer reserves, amounts of true and standard bicarbonates is noted. On 4 — the 5th day of life indicators of acid-base equilibrium become same, as at the adult (see. Acid-base equilibrium ). In the first day of life saturation of blood oxygen makes, according to G. M. Savelyeva, 64 — 92%, the partial tension of oxygen (pO 2 ) — 68 — 88 mm of mercury. By 7th day of life saturation of blood oxygen becomes higher — 87 — 97%, pO 2 — 67 — 90 mm of mercury.
Cardiovascular system. The weight of heart of N. averages 0,89% of the weight of his body (adults have 0,48 — 0,52%). It is located more horizontally, than at adults, owing to high standing of a diaphragm. Thickness of walls of both ventricles is identical and makes about 5 mm. The volume of heart at N. is equal to 18 — 20 ml. It has big potentialitys. It is noted that at patol, states N.'s heart is capable to work without signs of a decompensation much longer, than heart of the adult. Obviously, it is connected with its bigger resistance to a hypoxia and ability of a myocardium to switch to an anaerobic pathway. Pulse rate at N. of 110 — 130 blows in 1 min., the attitude of a respiration rate towards pulse rate is equal to 1: 2,3 — 1: 2,5. Pulse usually becomes frequent at shout, during suction, at the movements; during sleep pulse urezhatsya on 20 — 25 blows in 1 min. Increased (in comparison with adults) heart rate is caused by the weakened influence of a vagus nerve that is feature of an innervation of heart of the newborn. The ABP in the 1st day of life makes, by data A. A. Balunova, on average 66/36 mm of mercury., on the 2nd — 67/31, on the 3rd — 68/37, on the 4th — 71/39, on the 5th — 72/40, on the 6th — 73/41, on the 7th — 75/42 mm of mercury.; by 1 month reaches 80/45 mm of mercury.
The full-term N.' ECG is characterized by right axis deviation. The tooth of R is well-marked in assignments of III, V1, V4. In I and V4, V6 assignments the size of a tooth of R by 7th day of life increases. Features of a tooth of R in the first days are explained by an overload of the right departments of heart in connection with the beginning of functioning of a small circle of blood circulation. Amplitude of a tooth of Q fluctuates from 0 to 8 mm. The tooth of Q is absent in the right chest assignments, and in left appears by the end of the first week of life. A tooth of Q in the I assignment low, a tooth of S the deepest in I, V3 and V4 assignments. In all chest assignments in the first 7 days of life reduction of amplitude of a tooth of S is observed. Subsequent changes of teeth of R and S are connected, apparently, with reduction of loading of a right ventricle and increase of activity of a left ventricle. Amplitude of a tooth of T fluctuates from 0 to 4 mm; the form its peculiar also depends on N. Segment's age of ST at N.'s most is located on the isoelectric line. In regulation of action of the heart influences of a sympathetic nervous system prevail. Features of cardiovascular system H. reflect process of adaptation it to new conditions of the environment.
Bodies of a hemopoiesis. The main center of a hemopoiesis at N. is red marrow, the additional centers exist in a liver, a spleen, limf, nodes, reticuloendothelial cells, etc. N. have an extensive network of peripheral lymph nodes. They are soft, their size from a pin head to a pea, have wide sine, differ in abundance of lymphatic fabric and blood vessels. Lymph nodes are underdeveloped, barrier function for protection against an infection at them is sharply reduced.
N.'s spleen weighs about 10 g, in size is approximately equal to a palm of the child, is probed under costal edge.
Hemopoiesis (see) keeps embryonal character. Along with mature cells of blood in marrow there are also young uniform elements. Total quantity of blood at N. in relation to weight makes 10,7 — 19,5%, on average 12%. By the time of the birth at the child blood contains two types of hemoglobin: fetalis (HbF) and «adult» (HbA). The ratio between them differs in considerable individual fluctuations. Fetalis hemoglobin disappears in the first months of life. The number of erythrocytes in 1 mkl averages 5 — 5,5 million. The hemoglobin content at N. fluctuates from 110 to 140 units (17 g / 100 ml). By data A. F. Tura and N. P. Shabalova (1970), in the 1st day of life number of erythrocytes in 1 mkl makes blood 6,09 million, for the 7th day — 5,64 million; a hemoglobin content in the 1st day — 21,2 g / 100 ml, on the 7th — 19,7 g / 100 ml; a hematocrit in the 1st day — 54%, on the 7th — 52,15%. The color indicator within the first week of life fluctuates from 0,9 to 1,3. Normal at N. in blood yadrosoderzhashchy erythrocytes (normoblasts, erythroblasts) are quite often observed, the quantity of reticulocytes is increased to 1,2%, the quantity of leukocytes in the first day makes from 10 000 to 30 000 in 1 mkl, in the subsequent — to 10 — to the 12th day their number decreases to 8000 — 12 000 in 1 mkl.
Considerable changes in the period of a neonatality are undergone by a leukocytic formula. In the first 4 days in it neutrocytes (65%) prevail, the quantity of lymphocytes makes 16 — 34%. For the 5th day there is the first decussation of the curves reflecting the maintenance of neutrocytes and lymphocytes. By the end of the period of a neonatality the number of neutrocytes decreases to 26 — 30%, and the number of lymphocytes increases up to 50 — 60%. The quantity of monocytes for 1 month of life makes 6 — 12%, the quantity of thrombocytes fluctuates from 143 000 to 413 000 in 1 mkl. ROE is slowed down — 2 — 4 mm an hour that, apparently, is caused by the low content in blood of fibrinogen and cholesterol. Coagulability of blood, approximately, same, as at adults: the beginning — in 4 — 4,5 min., the termination — on 6 — the 10th minute. Duration of bleeding — within 2 — 4 min. Osmotic firmness of erythrocytes fluctuates over a wide range and is a little increased (max. — 0,48%, min. — 0,26% of NaCl solution).
Digestive organs. The oral cavity of N. on volume is rather small, its surface is covered with gentle, easily vulnerable mucous membrane. A visible part of a mucous membrane of lips has an appearance of the small small pillows of whitish color divided among themselves by quite deep grooves going cross to a longitudinal axis of a lip (Pfaundler's rollers — Lushki).
Along the centerline of the sky yellow-white points — so-called UN small knots are almost always noticeable. Along maxillary shoots the dense roller which especially clearly is allocated after suction — Roben's fold — Mazhito (membrana gingivalis), the most well-marked on the site between places of eruption of future canines lasts.
Language is rather big, masseters are well developed.
In the thickness of cheeks there are quite dense and rather well delimited accumulations of fat — a so-called adipose body of a cheek (Bish's lumps); the fat forming them is poor liquid olein to - that by what its density is explained. Bish's lumps long do not disappear even at severe exhaustion of the child; they give the known elasticity to N.'s cheeks that does more effective the act suctions (see).
Sialadens in the first weeks of life of the child are developed poorly.
N.'s gullet has length of 10 — 12 cm, the distance from alveolar shoots to an entrance to a stomach is equal to 16 — 18 cm. Mucous membrane of a gullet gentle, well vaskulyari-zirovana. The muscular layer of a gullet is developed poorly.
The stomach holds slightly slanting position, its most part is located in left hypochondrium. The muscular coat is poorly developed. Capacity of a stomach in the 1st day of life of 7 — 10 ml, by the end of 1 week — 50 ml, on the 2nd week — 70 — 80 ml, on the 3rd week — 90 — 100 ml. Motor and secretory functions of a stomach are developed well. At natural feeding gastric emptying happens in 2 — 3 hours after feeding. The gastric juice at N. contains salt to - that, pepsin, a chymosin and a lipase. Activity of pepsin low. The main enzyme of a gastric juice is the chymosin.
N.'s intestines are rather longer, than at the adult. The muscular coat of an intestinal wall is developed poorly, it is easily a pronitsayema for toxins, hormones, various immune bodies and pharmaceuticals. During the first 10 — 20 hours of an extrauterine life intestines of the child are almost sterile. Then in it find colibacillus, acidophilic bacteria, staphylococcus, streptococci, pneumococci etc. The bacterial flora of intestines promotes processes of enzymatic digestion, formation of vitamins of group B and phthiocol.
N.'s liver of rather big sizes, makes 4,4% of body weight (adults have 2,8%). It is well supplied with blood vessels. Connecting tissue of a liver is developed insufficiently, hepatic lobes are badly differentiated. Glikogenobrazu-yushchy function of a liver is expressed well, Disintoxication — it is not enough. Bile is rich with colorants and is poor bilious to-tami and salts.
Bodies of urination. Kidneys at N. are located below, and their relative weight is almost twice more, than at the adult. They have lobular structure, their development by the time of the birth is not finished yet. The number of balls is rather big, but the size of each ball is small. The size of balls of renal filtering at N. makes 1/3-1/4 indicators at adults (in terms of a standard body surface of 1,72 m 2 ) also fluctuates within 15 — 30 ml in 1 min. At N. ability of kidneys to concentrate urine is reduced (see. Kidneys, age functional features ). Specific weight of urine in the first days of life makes 1,008 — 1,013, and later — 1,002 — 1,004. Mechanisms of neutralization to - t in renal tubules are imperfect in this connection at N. development of a metabolic acidosis is possible. Daily excretion of amino acids at N. reaches 10 mg! the kg whereas more senior children have sizes exceeding 2 mg/kg are considered as patol, the phenomenon. Capacity of a bladder makes apprx. 50 ml. An urination — 12 — 20 times a day. The amount of urine, according to a number of researchers, in the 1st day of life makes 19 ml, on the 2nd — 46 ml, on the 3rd — 82 ml, on the 4th — 122 ml, on the 5th — 145 ml of I on the 6th — 183 ml, on the 7th — 188 ml, on the 8th — 215 ml.
In the period of a neonatality low sensitivity of tubules of kidneys to mineralokortikoi-ladies and to antidiuretic hormone is noted. However healthy N.'s kidneys in fiziol, conditions are capable to provide constancy of structure of internal environment of an organism.
the Water salt metabolism at N. has a number of features. The condition of an overhydratation is characteristic of N.'s organism. The amount of water makes at them 70 — 75% of body weight, the adult on average has 65%. The relative volume of extracellular liquid at N. is twice more, than at children of advanced age. Extrarenal release of water at N. is rather big and reaches 50 — 75% of volume of the accepted liquid. Through skin and easy children lose 1 ml of water on 1 kg of weight in 1 hour, adult — 0,5 ml on 1 kg of weight in 1 hour. N.'s need for water on 1 kg of weight is 2 — 3 times higher, than at children of advanced age.
In the first days of life not enough protein since the amount of protein-rich colostrum is small comes to N.'s organism. During the first hours after the birth the content of residual nitrogen in blood I. is slightly higher, than at mother, and makes 32 mg! 100 ml. Level of residual nitrogen increases for the 3rd day of life, reaching 40 mg! 100 ml that is caused by a fabric catabolism and low level of renal excretion. From the 5th day of life the catabolic direction of exchange is replaced anabolic, and from now on the child begins to put on weight. Content of crude protein in blood serum II. makes 4,7 — 6,5 g / 100 ml (albumine — 50 — 65%, ah - globulins — 2 — 7%, a2-globulins — 4,5 — 9,5%, R-globulins — 14 — 16%, - (-globulins — 14 — 20%).
By data K. V. Orekhova et al. (1971), a sugar content, Hagedorn determined by method — Janszen, in blood after the birth makes 129 l of / 100 ml, in 6 hours — 72 mg! 100 ml, in 12 hours — 33 mg / 100 ml, in 24 hours — 80 mg / 100 ml, to 4 — to the 5th day of life — 62 mg / 100 ml and to 9 — to the 10th day — 75 — 80 mg / 100 ml. The Tranzitorny hypoglycemia at N. is connected about a patrimonial stress reaction, features of action of hormonal factors of mother and imperfection of fermental systems of a liver
of N. Kontsentration of all fractions of lipids (neutral fats — triglycerides, not esterified fat to - t, phospholipids, etc.) in blood at the birth of the child is 2,5 times lower, than in blood of mother. After the birth concentration free fat to - the t which are energy sources quickly increases, and in 2 hours after the birth increases by 3 times. See also Nitrogen metabolism , Water salt metabolism , Lipometabolism , Mineral metabolism , the Metabolism and energy at children , Carbohydrate metabolism .
Due to the development of the new methods of a research (radio immune, a thin-layer chromatography) allowing to carry out biochemical, researches in small volumes of the studied material information on features of functioning of endocrine system at a fruit and N. was obtained that gave the chance to deepen knowledge of a pathogeny of many diseases and it is better to prove pathogenetic therapy.
The hypophysis at N. weighs 100 — 150 mg. In it acidophilic adenotsita (eosinophial cells) producing somatotropic hormone are well developed. Quantity of AKTG in N.'s hypophysis same, as in a hypophysis of adults. Thyritropic hormone of a hypophysis begins to be emitted during the pre-natal period of development, however the small number of basphilic adenotsit says that the quantity it is small. Antidiuretic hormone of a hypophysis begins to be emitted for 4 months of embryonic development, the maximum of its allocation is noted by a year of life of the child.
In a pinus, weight to-rogo at the birth makes 7 g, the differentiation of cellular elements begins only on the first year of life and several years proceed. In process of a differentiation of cellular elements the amount of the emitted hormone grows.
The thyroid gland at N. has the form of a horseshoe, weight her from 1 to 7 Mr. Gistol, the structure of gland is not finished yet.
Iodine contains in a small amount, thyroxine is produced insufficiently.
Epithelial bodies are found on the 6th week of pre-natal development. After the birth of the child their maturing continues what tells increase in amount of the emitted hormone with age about. Hormone of these glands regulates calcic exchange, and supports acid-base equilibrium.
The thymus at N., according to various researches, weighs 10 — 14 g, in it cortical substance prevails, the amount of connecting fabric is small.
In a pancreas at children of the first 2 months of life the number of islets of Langerhans are rather more, than during the subsequent periods of development. Satisfactory function of a pancreas at N.
Ves of adrenal glands is explained by it makes apprx. 7 g: 0,3% of body weight (the adult has also 0,3%). Bark of adrenal glands at N. is capable to synthesize corticosteroids with relative dominance of corticosterone.
The child is born with a high level of corticosteroids in blood (on average 20 mkg / 100 ml). After the birth their level gradually decreases, the most low concentration them in blood is noted on 3 — the 5th day of life, in the next days it gradually raises and by the end of the first week their level reaches the level of adults (10 mkg / 100 ml).
The immune responsiveness of the newborn
the State immunol, N.'s reactivity substantially is defined by the state of health of the woman, in particular during pregnancy. At the birth at N. the cellular link of immunity actively functions what ability of cells to transformation in blasts and to rosetting testifies to. Signs of activation of a humoral link are shown after the birth and expressed in emergence and increase of amount of the immunoglobulins of a class A and M which are a product of synthesis of lymphoid system of the newborn
. In the early post-natal period ratios of timuszavisimy are defined) and tpmusnezavisimy links immunol, systems, their interaction is defined. At the birth in blood H. concentration of JgG which arrived from a maternal organism, approximately same as at mother. Then by 3 — 4 months of life its concentration considerably decreases, and approximately by 6 months of life it completely disappears from blood. In the same time thanks to stimulation synthesis of own immunoglobulins begins various antigens. And JgM, less quickly JgG is more quickly synthesized. At the full-term N.'s birth phagocytal activity of cells is at the level of activity of cells of a maternal organism and increases to 3 — to the 4th day of life of the child, and the level of a lysozyme — is much higher, than in blood of mother. Content of properdin and a complement in healthy full-term N.'s organism is much lower, than in an organism of mother, their further dynamics consists in increase in average values with growth of the child to the level of indicators at the adult. All changes of maintenance of factors nonspecific immunol, reactivity happen generally within the first week of life and most likely are connected with influence of external antigenic stimuluses.
The nervous system
the Weight of a brain at N. reaches 350 — 400 g. Bark of big hemispheres rather thin, gray matter of a brain is vaguely delimited from white, ganglionic cells are poorly differentiated (pyramidal neurocytes, T). Reduced excitability and bystry fatigue of a cerebral cortex and dominance of a subcortex is noted. The cerebellum is developed insufficiently, has oblong shape and superficial furrows.
A spinal cord in comparison with other departments of c. the N of page has more finished structure and functionally more mature. By the time of the birth of the child conduction paths of a spinal cord, except pyramidal are well developed, myelinations to-rykh it is not finished yet. Cerebrospinal liquid is transparent and often happens xanthochromatic. This fiziol, a xanthochromia is connected with transition of bilirubin to cerebrospinal liquid from blood serum at fiziol,
to N. Osobennostyami's jaundice of a nervous system at N. the atetozopodobny, in-coordinate movements speak that is caused by the dominating influence of talamopallidarny system.
At N. the tone of sgibatel of extremities therefore they are in a condition of an inflection is raised. Increase in a tone of the razgibately head and neck therefore it is tended to a zaprokidyvaniye of the head back is noted. In the first days of life at N. the tremor of extremities is observed. It is characterized by the high frequency and low amplitude. If the tremor remains also after the 4th day of life, then it is necessary to think of defeat of c. the N of page
Physiological reflexes of newborns
In N. and children of the first months of life can cause a number of the reflexes which received the name primitive or physiological, caused by immaturity of a brain. In process of maturing of a head and spinal cord these reflexes gradually die away. In development of motility of the child it is possible to note two interconnected tendencies: complication of motive functions and fading, reduction of a number of congenital instinctive reflexes. On character of a reduction, its delay and later fading of these reflexes it is possible to resolve an issue of correctness of development of the child. The main instinctive reflexes of N. can be divided into two groups: the segmented motive avtomatizm which are provided with segments of a brain trunk (oral avtomatizm) and a spinal cord (spinal avtomatizm) and the nadsegmentar-ny pozotonichesky avtomatizm providing regulation of a muscle tone depending on position of a body and the head (are regulated by the centers oblong and a mesencephalon).
1. Oral segmented avtomatizm are of great importance for N. since provide a possibility of suction. They come to light at the full-term N. from the first day of life.
The sucking reflex arises in response to irritation of an oral cavity; e.g., at insertion in N.'s mouth of a nipple of a breast of mother the rhythmical sucking movements appear. The reflex remains within the first year of life of the child.
The Hobotkovy reflex — a pulling of lips a proboscis due to reduction of a circular muscle of a mouth — arises at bystry easy blow by a finger on N. Refleks's lips is a constant component of sucking movements. Normal the reflex is defined up to 2 — 3 months, its fading is late at children with defeat of c. N of page.
The search (iskatelny) reflex of Kussmaul — during the stroking by a finger in the field of a corner of a mouth (without touching lips) a corner of a mouth falls and the child turns the head in that party where there is an irritation — is well-marked before feeding. At a research of a search reflex it should be noted intensity of turn of the head and whether there are prehensile movements lips. The search reflex is observed at all children to 3 — 4-month age, and then there is a reaction to a visual irritant, the child quickens at the sight of a small bottle with milk, at preparation by mother of a breast for feeding.
Palmar roto - the head reflex (Babkin's reflex) — at an iadavliva-pin on N.'s palm occurs opening of a mouth and reduction of the head to a breast; this reflex is more brightly expressed before feeding. Bystry formation of this reflex at the children who were born in asphyxia or with a birth trauma is predictively a favorable sign. In the first 2 months the reflex is pronounced, and then begins to weaken, and at the age of 3 months it is possible to note only its separate components.
2. Spinal motive avtomatizm. Protective reflex — if to put N. on a stomach, then it reflex turns the head aside. This reflex is expressed at N. from the first hours of life. Children with defeat have a c. the N of page a protective reflex can be absent.
A reflex of a support, straightening and automatic walking — the child put on a support straightens a trunk and costs on halfbent legs on full foot; if slightly to incline it forward, then it does the step movements (automatic gait And.). Placing reaction and automatic gait are physiologic up to 1 — 1,5 month, then they die away, and only by the end of the first year of life there is an ability to stand and go independently. Children with defeat have a c. the N of page automatic gait is late for a long time.
A reflex of crawling of Bauer — if to put N. on a stomach, he begins to make the creeping movements (spontaneous crawling) if at the same time to put a palm to soles, the creeping movements amplify and the child makes a start from a palm legs. The creeping movements become expressed on 3 — the 4th day of life. The reflex is physiologic up to 4 months of life, then it dies away.
The grasp reflex (Robinson's reflex) appears at N. during the pressing on his palm; sometimes he so strongly grabs fingers investigating that it can be lifted up. The reflex is physiologic up to 3 — 4 months
Nizhny Novgorod a grasp reflex (tonic reaction of sgibatel of fingers) — during the pressing bottom bending of toes if a finger to make shaped irritation on a sole of foot happens a thumb on a small pillow of foot of N., then there is a dorsiflexion of foot and fan-shaped discrepancy of fingers (fiziol, a Babinski's reflex).
The reflex of embrace (Moro's reflex) is caused by various receptions. It can be continuation of a grasp reflex — the child who grasped fingers of the researcher is brought up by hands, without tearing off from a bed-head, and suddenly release his hands; at the same time
N. takes hands to the parties and unclenches cams (the first phase of a reflex), in several seconds of a hand are returned to the initial position (the second phase of a reflex of Moro). The reflex is expressed right after the birth. At healthy children it is well-marked up to 4 — 5 months, then begins to die away. After 5 months it is possible to observe only its separate components. The reflex can be caused by pat on a hip or a buttock, at blow by a hand on an iyelenal-noma to a table at distance of 15 cm from the head of the child, at effleurage by a finger on N.'s breast, at sudden sharp noise, etc.
A reflex of Talent — during the carrying out by an index finger on the paravertebral line along a backbone of N. lying on one side it bends a back dugoobrazno towards an irritant. This reflex well is caused with 5 — the 6th day of life. It is physiologic to 3 — the 4th month. At damage of a spinal cord the reflex is absent.
Perez's reflex — the child is put facedown and run an index finger, slightly pressing, on acanthas of vertebrae from a tailbone to a neck; as a result there is a response which is characterized by sharp shout after a short-term apnoea, a lordosis and a pripodnimaniye of a basin, bending of top and bottom extremities, increase in a muscle tone, the urination and defecation are sometimes observed. As the reflex causes negative emotional reaction in N., it should be investigated in the last turn. It is physiologic up to 3 — 4 months. Oppression of a reflex in the period of a neonatality and a delay of its involution are observed at children with defeat of c. N of page.
3. Nadsegmentarny pozotonichesky avtomatizm. The most important stages of motor development of the child — ability to raise the head, to sit, stand, go — are closely connected with improvement of regulation of a muscle tone, its adequate redistribution depending on position of a body in space. The centers of a myelencephalon, and further the centers of a mesencephalon take active part in this regulation. The untimely reduction of nozotonichesky reflexes of a myelencephalon leads to formation patol, tonic activity, edge interferes with mastering the major motive functions.
The asymmetric cervical tonic reflex (Magnus — Klein) — if to turn the head of N. lying on spin so that the mandible was at the level of a shoulder, occurs extension of extremities, to the Crimea the face, and bending of opposite is turned. More constant is reaction of upper extremities.
Symmetric tonic cervical reflexes — during the bending of the head of H. the muscle tone in sgibatel of extremities, preferential upper raises, at extension — in razgibatel of extremities. Asymmetric and symmetric cervical reflexes are observed at N. constantly. At premature they are poorly expressed.
Tonic labyrinth reflexes — in situation H. on spin the muscle tone in razgibatel of extremities raises. In situation on a stomach — in sgibatel of extremities.
At N. knee tendon jerks are well-marked, belly reflexes are changeable and become clearer in the second half of the year when the child begins to sit down.
At N. acoustic organs are insufficiently developed, conductivity of acoustical irritation at it occurs hl. obr. through a bone tissue since by the time of the birth the drum cavity is still filled with mucous liquid, interferes edges with conductivity of hearing; in process of a rassasyvaniye of this liquid and filling of a tympanic cavity with air auditory acuity develops. The N reacts only to loud sounds start, from 4 months the child turns the head on a loud sound. Aged after one year hearing is already well developed.
The N sees from the first days of life. Eyeballs at it are rather big, curvature of a cornea is more expressed, the crystalline lens has more convex form. N.'s eye a dalnozorok, accommodation it is imperfect, and it does not allow to receive on a retina of the clear image. To 2 — 3 weeks of the movement of eyes are not coordinate, there is no coordination also a century with eyeglobes. To fix eyes objects and to monitor their movement the child begins with 2 months, from 4 — 5 months he already consciously considers objects. From 2nd half-year of life children begin to distinguish colors. The N cries without tears, the slezootdeleniye begins with 2 months of life. Slezonosova the channel at children of the first months of life is rather wide therefore to their thicket the irritation of a conjunctiva and penetration of infections on it from a nasal cavity is noted.
Sense of smell is developed poorly, but pungent smells (spirit of ammonia, acetic to - you) are perceived as unpleasant from first month of life.
Taste at children from the first days of life is developed well, they distinguish sweet, bitter and acid, from 4 — 5 months flavoring feelings develop even more.
N. have a tactile sense: at hiting at to lips it has sucking movements. Also skin of palms, soles and the person is sensitive. Painful sensitivity in the first weeks of life happens a little lowered, however in a mouth the child reacts to a prick grimaces from the 2nd day. The thermoesthesia at N. is developed well: after the birth in the cold environment the child begins to shiver and turn pale, at the placement on a hot-water bottle he calms down and his skin turns pink.
Special conditions of newborns
in the period of a neonatality are observed the special states connected with N.'s adaptation to an extrauterine life. Treat them: physiological Qatar skin, or a simple erythema, a toxic erythema, a scleredema, adiponekroz hypodermic cellulose, an urate heart attack, tranzitorny fever, fiziol, a decrease in weight, fiziol, jaundice, sexual crisis, mastitis, vomiting and vomiting.
Physiological Qatar skin, or a simple erythema — the dermahemia connected with expansion of skin capillaries in response to influence of low ambient temperature. The maximum of an erythema is necessary on 1 — the 2nd day of life then the redness begins to weaken and desquamation in the form of a small scaly peeling appears. The erythema is more expressed at premature and unripe children, at the children who were born from mothers with a diabetes mellitus.
The toxic erythema is noted at a half of N. Against the background of the general erythema there is peculiar and quickly passing polymorphic rash. It is more expressed on a face and a pilar part of the head (see. Erythema toxic ).
Adiponekroz of hypodermic cellulose. The focal necroses of hypodermic cellulose arising in connection with an injury are noted usually on buttocks, however at an application of forceps sklerodermichesky infiltrates can be also on the head. Emergence of well delimited dense infiltrates from 0,5 x 0,5 cm to 1 X 1 cm and is characteristic of it more. Infiltrates of a tsianotichna, are more rare reddish. Treatment — iodide ointments, heat baths. An outcome favorable — in several weeks or months infiltrates resolve.
The scleredema — the peculiar hypostasis which is followed by noticeable consolidation of skin and hypodermic cellulose to-ry is observed by hl. obr. at the premature and weakened N., it is caused by an originality of a structure of hypodermic cellulose (see. Sclerema, scleredema ).
Tranzitorny fever is noted on 3 — the 4th day after the birth, is characterized by temperature increase, sometimes to 40 °. At the same time there can be a concern, a tremor of extremities and even a spasm. High temperature sticks to 1 — 2 day. The reason it is considered disturbance of water exchange that is promoted by insufficient administration of liquid. Fever stops after the child is given liquid. Tranzitorny fever is identical to proteinaceous fever of babies, edges arises at insufficient introduction with food of water and existence of a large amount of protein in food (see. Alimentary fever ).
The urate heart attack is characterized by disturbance of exchange uric to - you and adjournment of crystals of its salts in renal tubules and collective tubules of marrow of kidneys at N. In process of formation of a diuresis there is a rassasyvaniye of crystals of salts uric to - you (see. Urate diathesis ).
A physiological decrease in weight. The initial lose of weight in the first 3 — 4 days of life averages 4 — 5% of body weight at the birth (as much as possible — 8 — 10%). Recovery of initial weight at healthy N. happens by the end of the first — the middle of the second week.
Physiological jaundice of newborns (a physiological hyperbilirubinemia) — the most frequent form of jaundice at N. It arises on 2 — the 3rd day of life owing to increase in content of free (indirect) bilirubin in blood serum. The reason fiziol, jaundices is temporary decrease of the activity of enzyme of a glyukuroniltransferaza in this connection transfer of free bilirubin in bilirubindiglyu-kuronid is broken (direct bilirubin), and it collects in blood. The full-term N. have a level of bilirubin in umbilical blood — 0,6 — 3 mg / 100 ml, on average 1,81 4: 0,16 mg / 100 ml. Hourly gain of bilirubin on average 0,08 mg / 100 ml at 1 o'clock. At premature children fiziol, jaundice is expressed more intensively, reaches a maximum on 5 — the 6th days and keeps is longer. After the birth enzymatic activity of a liver is quickly normalized, and jaundice disappears.
Mastitis can arise at N. in the period of a physiological nagrubaniye of mammary glands. Infection of the increased mammary glands leads to their inflammation (see. Mastitis, newborns ).
Sexual crisis arises under the influence of the hormones of mother coming to an organism of a fruit in recent weeks of pre-natal development and during the first days of life with milk of mother. It is shown in the form of a nagrubaniye of mammary glands at children of both sexes. Glands increase on 2 — the 5th day of life, reaching to 8 — to the 10th day of size of walnut. Skin over the increased gland is not changed. By the end 2 — 3rd week mammary glands decrease without special treatment. Under the influence of the hormones arriving from mother girls have a hyperemia, a loosening and exudation of a mucous membrane of a vagina and uterus. Vulval bleedings are observed at 0,7% of girls. There are they on 5 — the 6th day of life, 2 — 3 days proceed and spontaneously disappear without any effects. Treatment is not required, it is necessary to follow rules of hygiene at care of the child.
Vomiting and vomiting at N. within the first hours, and sometimes days of life most often are caused by the amniotic waters swallowed at the time of delivery, blood, slime and other contents of patrimonial ways. Emetic masses is colourless, contains a lot of slime, but often happens also brown color from impurity of blood. At early disturbance of placental blood circulation and premature emergence in the child of respiratory movements the number of the swallowed masses is especially high therefore vomiting and vomiting can be persistent and plentiful. The same is noted at the infected amniotic waters. Vomiting as a result of swallowing a secret of patrimonial ways in most cases stops without any treatment, and further development of the child proceeds normally. At the vomiting and vomiting caused by swallowing contents of patrimonial ways it is not necessary to hurry with the first applying to a breast.
The vomiting and vomiting appearing after the child begins to eat food, very often depend not only on inborn defects of passability, but also on errors of feeding that is observed much more often. Elimination of defects in technology of feeding, reduction of time of a continence of the child at a breast if control weighing confirms the assumption of excess of the milk exhausted by it, often happens quite enough that vomiting and vomiting stopped.
N.'s vomiting caused by swallowing a secret of patrimonial ways or a reforage needs to be differentiated with vomiting at pylorospasm (see) or pylorostenosis (see), achalasias of the cardia (see. Cardiospasm ), incomplete turn of intestines — Ladd's syndrome (see. Impassability of intestines ).
in the period of a neonatality more frequent incidence, than during other periods of life of the child is noted. Development of diseases can be promoted by various exchange disturbances arising still vnutriutrobno in connection with disturbances in uniform regulatory system a fruit — a placenta — mother. The most frequent reason of perinatal mortality and high incidence among N. is the pre-natal hypoxia promoting development of asphyxia (see. Asphyxia of a fruit and newborn ). After it heavy morfol, and funkts, disturbances often develop from c. N of page with deep frustration of cerebral circulation and it is frequent with intracraneal hemorrhages. The pre-natal hypoxia developing owing to air hunger of a fruit changes activity of fermental systems and exchange processes, causing shifts of a homeostasis (there are acidosis, a prothrombinopenia, fibrinolitic activity of blood amplifies, synthesis nucleinic to - t and a squirrel is slowed down). All this, in turn, breaks activity of vitals and systems — c. N of page, cardiovascular system, pituitary gipotalamo - adrenal system, system of breath, etc. The asphyxia of a fruit and N. developing as a result of a pre-natal hypoxia — not an independent disease, and only the investigation of many types of obstetric pathology and various diseases of a maternal organism and the fruit, is a symptom defined patol, processes, their final expression.
Diseases of a fruit and N. can be a consequence of various diseases of mother (hereditary, infectious, endocrine) or are caused by toxic effect of various chemical substances, pharmaceuticals, impact of ionizing radiation. Character and extent of defeat of a fruit during pre-natal development depend on at what duration of gestation (gestational age) the harmful agent or an infection began to affect a fruit. At impact on a fruit in the first 3 months of pregnancy of a viral infection (cytomegaloviruses, a rubella and d river), ionizing radiation, toxicants children are born with considerable disturbances of development in the form of various malformations (embryopathies). As a result of influence of a viral, bacterial and protozoan infection in the late period of pre-natal fetation by the time of the birth of the child meningitis, an encephalomeningitis, hepatitis, nephrite and other defeats of a pre-natal origin (fetopathies) can be observed. Such defeats of a fruit in the period of an antenatal life are noted quite often (see. Antenatal pathology ).
It is already necessary to differentiate the inborn diseases of N. caused by influence of harmful factors during pregnancy in early and late terms in the period of a neonatality with hereditary diseases (see). It is caused by the fact that a wedge, displays of hereditary diseases differ in considerable polymorphism. Achievements of modern general and medical genetics allowed to open a pathogeny numerous (apprx. 2000) hereditarily the caused diseases, a part to-rykh can be diagnosed already at the birth, and nek-ry — in the period of an antenatal life. Distinguish three groups of hereditary diseases.
1. Chromosomal diseases (see), caused by aberation chromosomes — change of number or structure of chromosomes. The majority of diseases of this group have the expressed wedges, manifestations already at the birth of the child and are easily diagnosed.
2. Diseases with monogenic inheritance (a mutation of one or couples of genes). Treat them fermento-or enzymopathies (see). The wedge, symptoms of these diseases appear in process of accumulation of metabolites the, undesirable to an organism, caused by existence of the block in exchange processes owing to deficit of this or that enzyme. Therefore many diseases of this group, e.g. Fenilketonuriya (see), galactosemia (see), adrenogenital syndrome (see), Menkes's syndrome, etc., are diagnosed in the period of a neonatality by means of biochemical, methods.
3. Diseases are multifactorial, caused by multiple insignificant genovariations (polygenic inheritance), to-rye are shown only in unfavorable conditions.
At N. these diseases, as a rule, are not shown and therefore are not diagnosed.
The considerable group of diseases of N. is made by the perinatal infections caused by viruses, bacteria, the elementary (see. Perinatal pathology ).
Among N.'s diseases the important place is taken by the diseases caused by isoimmunization of an organism of mother antigens of a fruit with the subsequent antibody formation and development of reaction antigen — an antibody at hit of antibodies in an organism of a fruit. At isoimmunization of an organism of mother the antigens which are contained in an erythrocyte (a Rhesus factor, group factors, etc.), at N. develops hemolitic disease of newborns (see), at isoimmunization platelet factors — a hemorrhagic disease of newborns (an immune form). Isoimmunization leukocytic antigens leads to development of leykopenichesky conditions of various degree of manifestation.
The big group of diseases of N. is made by the pathology which is shown disbolism, caused by diseases of mother — endocrine, cardiovascular system (the dekompensirovanny and sub-compensated heart diseases), kidneys, etc. Hard the period of a neonatality at the children who were born from the mothers sick with a diabetes mellitus who had during pregnancy the expressed toxicosis and a nephropathy with the dekompensirovanny and subcompensated heart disease, especially with the mitral heart disease which is combined with hypotonia proceeds. At these children at the birth considerable disbolism and defeats of various bodies and systems come to light (a liver, kidneys, adrenal glands, c. N of page, etc.).
Fractures of bones of extremities at N. make 40% of all birth trauma (see. the Birth trauma, at children ). Various factors can be the conditions contributing to developing of patrimonial fractures, at the same time the greatest value anthropometrical features of a fruit (a large fruit), at to-rykh the frequency of changes, especially have clavicles, sharply increases. The fracture of a clavicle meets most often — 11,7 on 1000 N.
Odnim from the frequent patol, states revealed at the birth or arising soon after the birth are pneumopathies (see) and pneumonia (see). Pneumopathies form during pre-natal development, and also in the early neonatal period and are shown in the first days of life in the form of a syndrome of respiratory frustration (see. Distress syndrome ). Lead atelectases of lungs, hyaline membranes to development of a syndrome of respiratory frustration (see. Hyaline and membrane disease of newborns ), an edematous and hemorrhagic syndrome, massive hemorrhages in lungs, share emphysema, inborn malformations of lungs, hemorrhage in a brain. More often the syndrome of respiratory frustration is observed at premature (20 — 80% of total number of premature children). Pneumonia at children of the period of a neonatality is caused by viruses, bacteria or protozoa. The high susceptibility of N. to viral diseases is proved: to flu A and B, parainfluenza, respiratory syncytial, to adenoviruses. Increase of frequency of the pneumonia caused by pathogenic staphylococcus is noted. Staphylococcus is also the reason of increase of skin pustulous diseases of N. — exfoliative dermatitis of Ritter (see. Rittera dermatitis exfoliative ), phlegmons of newborns, and also a purulent inflammation of an umbilical wound with development omphalitis (see), a periphlebitis, a periarteritis, to-rye can be the cause sepsis (see) if preventive and medical events timely are not held.
The considerable group of diseases of N. is made by various inborn malformations (see). Frequent anomaly of N. are inborn teeth. At the birth there are lower well developed cutters or the cartilaginous educations corresponding to them. Sometimes they begin to shake soon and drop out, sometimes they should be deleted if they prevent the correct feeding.
Due to the creation in the country of network of specialized departments of pathology of N. early diagnosis of diseases of N. considerably improved that gives the chance to begin their timely treatment.
Leaving and feeding
Due to fiziol, N.'s features need special leaving and feeding.
Health of children of the period of a neonatality in many respects depends on care of them from the first days of life that first of all is defined by the correct organization of work in delivery room and in children's department of a maternity home.
In the delivery room for the first toilet of N. sterile sets of linen are used, to-rye special tools and sterile first-aid kits with a set of all necessary for processing and nepog.n.zh of an umbilical cord are stored in the special thermostat or a case with heating. Suction of slime from upper respiratory tracts of N. is carried out by a suction or a cylinder to l. ««cop of the birth of a head. Prevention of a blennorea is carried out after the birth of the child by an instillation to a conjunctival meli.k \by iva< about eyes sterile ii-I from a game; •-<: to a drop of fresh 30% of solution with ulfapp. i-ifatriya. Process and tie up an umbilical cord, cut it and wrap the child in a sterile diaper, and then transfer to the swaddling table equipped with the device for heating. The rest of an umbilical cord is clamped Rogovin's bracket or tied up a sterile silk ligature.
The first toilet of N. is carried out by the midwife. The sterile soft gauze napkin moistened in sterile liquid or vegetable oil she removes slime, blood, a plentiful vernix caseosa from N.'s skin. It is inexpedient to delete completely a vernix caseosa. It contains useful substances (enzymes, vitamins etc.), to-rye are partially soaked up by skin. Then the child is weighed, measure growth (distance from a nape to calcaneal hillocks) by a sterile oil-cloth tape. Determine by the same tape a circle of a head (the tape is imposed behind on an occipital hillock, and in front — on superciliary arches). Then put on the oil-cloth bracelets fixed by special gauze ties N.'s wrists. On bracelets the surname, a name, a middle name of his mother, date and time of the birth, growth of the child and weight at the birth are written, number of history of childbirth. Wrap the child in sterile diapers and a blanket. Over a blanket put on a medallion with the same data, as on bracelets.
From the delivery room of the child transfer to children's department of maternity hospital where it is examined at once by the pediatrician, the nurse. At the same time pay attention to skin color, a condition of an umbilical wound, the nature of shout, note an otkhozhdeniye of urine, meconium. Carefully process sterile liquid or vegetable oil natural folds of skin in axillary and inguinal areas. After wiping it is reasonable to oil their thin coat 1% of tannin ointment. If on a head of the child there are remains of slime and blood, then in the absence of contraindications (most often a birth trauma) it is washed with warm running water and dry wipe a sterile diaper. N stack in a bed without pillow, slightly sideways to avoid aspiration of emetic masses during the vomiting.
The daily toilet of N. is carried out usually before morning feeding. At this time N. weigh, take it body temperature. These measurements of temperature and body weight are written down in history of development of N.
The morning toilet of N. consists of washing of the person warm boiled water or wipings by its cotton plug moistened in warm 2 — 3% solution boric to - you. Wipe with the same tampon auricles. It is necessary to watch that liquid from a tampon did not get to outside acoustical pass. It is better to process eyes the sterile wadded balls moistened with solution of Furacilin 1: 5000 or potassium permanganate (1: 10 000). For each eye it is necessary to take a separate wadded ball and to wipe with it an eye from an outside corner to internal. The nasal courses and outside acoustical pass clean the wadded flagellums moistened with sterile liquid or vegetable oil. The mucous membrane of an oral cavity is carefully examined for early detection of the milkwoman, erosion, etc. In the first 2 days of life skin folds grease 1% with spirit solution of iodine, in the next days — sterile oil or 1% tannin ointment. Emergence of an intertrigo on N.'s skin demonstrates bad care of it. It is impossible to assume that N. even short time lay in wet and dirty diapers. It is necessary to change them as required, without being limited to swaddling before feeding. N.'s clothes shall provide preservation of heat, and swaddling shall be such not to interfere fiziol, to position of the child and not to constrain his movements.
The most physiologic food for N. and the child of chest age is women's milk (see. Breast milk ). The organism of mother is adapted for needs of the child, and the chemical players of milk are changed throughout the period of a lactation. In the first 3 days after the delivery mammary glands of mother excrete colostrum (see). The quantity it is small. In the next days there is an increase of a lactation, the amount of milk increases.
For the first time healthy N. put to a breast in 6 — 12 hours after the birth. This period is necessary for rest of the child after the delivery and for overseeing by N.'s condition and mothers.
Interval between feedings of 3 — 3V2 hours, i.e. feeding 7-or 6-times. The daily amount of milk necessary for the child of the first week of life, it is possible to calculate on Finkelynteyn's formula: x = (70 or 80) x (n — 1), where x — daily amount of milk, n — day of life of the child. Weighing children less than 3200 g use coefficient 70, and weighing more than 3200 — coefficient 80.
The amount of milk on one feeding can be determined by a formula x = 10n where x — amount of milk on one feeding, n — day of life of the child. By means of the given method would calculate the necessary amount of milk in the first — 7 days of life. With the 2nd before the 6th week the necessary daily amount of milk is determined by a volume method (1/5 — 1/6 weights of the child) or method of caloric calculation (125 kcal on 1 kg of weight of P.).
belongs To duties of the local pediatrician not only post-natal prevention, in and antenatal protection of a fruit (see), carried out in contact with the obstetrician-gynecologist for what the local pediatrician visits the pregnant woman twice at home — for II and III months of pregnancy and and for the VIII month. Antenatal prevention includes studying of working conditions and life of future mother, clarification of a question of existence of professional vrednost at parents, gives advice to the woman on the mode and food, on care of mammary glands, physiopsychopro-filaktichesky preparation for childbirth, training at school of mothers, the device of a corner for the child. For the purpose of the prevention of hereditary pathology the local pediatrician is obliged to carry out the careful genealogical (family) analysis, to-ry is carried out at the first visit of the pregnant woman.
At the first visit of N. at home, for the 2nd day after an extract from maternity hospital, the local pediatrician gets acquainted with house conditions of the child, collects at mother the detailed anamnesis with obligatory drawing up a family tree, performs careful inspection of the child, gives a mother's advice on the mode, feeding and care of the child, on prevention of a hypogalactia. For 1 month N. shall be examined by the pediatrician 3 times. At identification at the child of inborn uglinesses (not fusion of an upper lip, hard palate) consultation of the surgeon and stomatologist is necessary, at a dysplasia of hip joints, a wryneck, a clubfoot — consultation of the surgeon-orthopedist, at dacryocystites — the oculist, at identification nevrol. frustration — the psychoneurologist. In case of the adverse genealogical anamnesis in need of the child it is necessary to inspect more deeply, applying biochemical, methods of a research and, whenever possible, using kliniko-biochemical screening program (see. Screening ).
An indicator of effective dispensary observation for N. is normal physical and psychological development of the child.
See also Baby .
Bibliography: Verbitsky M. Sh. Iso-antigenic disparity of organisms of mother and fruit, Minsk, 1979, bibliogr.; Clinical aspects of processes of adaptation at newborns, under the editorship of E. Ch. Novikova and G. P. Polyakova, M., 1974, bibliogr.; Levina S. E. Formation of endocrine system in prenatal development of the person, M., 1976, bibliogr.: Novikova Ch. I. Achievements in studying of physiology and pathology of children of the period of a neonatality, Pediatrics, No. 10, page 3, 1970; Newborns. under the editorship of Zh. Zh. Rapoport, Krasnoyarsk, 1974; Oskolkova M. K., Krylova JI. T. and JI about m and to about JI. T. Electric activity of heart and some features of metabolism at newborn children in dynamics of the neonatal period, Vopr. okhr. mat. also it is put., t. 25, Jsfb 4, page 15, 1980; With about t of N and to about in and K. A. and Panov N. A. Pneumonia and pneumopathies of newborn children, M., 1975, bibliogr.; The reference book on pediatrics (the period of a neonatality), under the editorship of. A. K. Us-tinovicha, Minsk, 1979; Tabolin V. A. Bilirubinovy exchange and jaundices of newborns, M., 1967, bibliogr.: Functions of adrenal glands at fruits, newborns and babies, under the editorship of V. A. Thabo-lina, M., 1975, bibliogr.; Avery M. E. a. Flet with her B. D. The lung-and its disorders in the newborn infant, Philadelphia a. o., 1974; Hathaway W. E. a. Bon n a r J. Perinatal coagulation, N. Y. a.o., 1978; The neonate, Clinical biochemistry, physiology and pathology, ed. by D. S. Young a. o. N. Y. — L., 1976; Neonatology, Pathophysiology and management of the newborn, ed. by G. B. Avery, Philadelphia — Toronto, 1975; Potter E. L. a. Craig J. M. Pathology of fetus and the infant, L., 1976; Saint-Anne Dargassies S. Neurological development in the full-term and premature neonate, Amsterdam, 1977; V u 1 1 i a m y D. G. The newborn child, Edinburgh — N. Y., 1977.
V. A. Tabolin.