Zhyipmpzyueulye "reteipdosche" upufpsoys opchptptsdeooschi. All about transitional (borderline) conditions of a newborn baby
After the birth, the newborn immediately enters a completely different environment. The temperature here is much lower compared to the intrauterine one, gravity appears, a lot of visual, tactile, acoustic and other stimuli. After birth, the baby needs a different type of breathing (pulmonary) and a way of obtaining nutrients (digestion). This transition is accompanied by changes in almost all organs and systems of the body. Such a “restructuring” is laid down by nature itself, but it still takes a certain time for the newborn to adapt to the outside world.
Moment of transition
This is precisely the reason for the appearance in children of the first month of life of the so-called transitory (transitional, borderline) states. Transitional states occur immediately after birth and then, after a while, disappear without a trace. They are completely natural for newborns. However, they are called borderline not only because they arise at the border of two main periods of human life (intrauterine and extrauterine). It turns out that usually physiological for healthy full-term babies, under certain conditions, such conditions can take on pathological features and become the basis for the development of various diseases. Such a transition of borderline conditions into pathology is often provoked by the birth of a premature or underweight baby, the unfavorable course of pregnancy and childbirth, stressful conditions after birth, inadequate care and feeding. That is why the observation and treatment of children in the neonatal period is carried out by special doctors - neonatologists.
There are quite a few transitory states, since literally every functional system of the child's body adapts to new conditions. It should be noted that not all borderline conditions necessarily develop in every baby. Many of them do not have clinical manifestations, proceed unnoticed and are detected only by laboratory methods. Therefore, they are more important for doctors than for parents.
Body mass
Let us dwell in more detail on the obvious, noticeable boundary states. In the first days of life, infants weight loss, which is called physiological, or natural. It is observed in all newborns, regardless of birth weight, in full-term and premature babies. The main reason is that the body of a newborn in the first days of life loses a lot of water, uses the reserves of nutrients received by him in utero, that is, he spends his "internal reserves". Normally, this weight loss usually does not exceed 6-7% of the original body weight. By the 8-10th day, full-term and by the 14th day, premature babies restore their original weight. Then the mass regularly increases and serves as one of the indicators of proper development and growth. For a faster adaptation of the newborn to new conditions, an adequate thermal regime, rational care, and the correct organization of feeding are important. Let's pay attention to the fact that weight loss is a natural process, and parents should not worry about the fact that the baby does not gain weight in the first days of life. But if a newborn has lost more than 10% of body weight at birth and has not recovered the loss by the 10-12th day of life, it should definitely be shown to a pediatrician.
Heat exchange
The transition states also include transient disturbance of heat exchange when the baby's body temperature slightly rises or falls. The fact is that in newborns, the processes of thermoregulation are still immature and imperfect. Young children cannot maintain a constant body temperature and are very sensitive to environmental changes. They respond to any fluctuations in temperature indoors or outdoors. Thermolability - instability of the thermoregulatory center - leads to rapid overheating or hypothermia of the child. This is due to the structural features of the skin, rich in blood vessels and poor in sweat glands. Therefore, it is very important to observe the temperature regime in the baby’s room, protect the baby from overheating and drafts, and properly dress for a walk. The temperature in the nursery should be from 20 to 22 ° C (for premature babies - 23 - 24 ° C). With sharp and frequent fluctuations in body temperature in crumbs, it is necessary to consult a neonatologist.
Skin
Transient skin changes observed in almost all children in the first week of life. Most often this simple erythema- redness of the skin, which manifests itself after the removal of the original lubricant. It becomes brightest on the second day after birth and usually disappears completely by the end of the first week of life. Peeling of the skin often occurs on the 3rd-5th day of life, more often on the abdomen, chest and limbs. Especially abundant peeling is observed in post-term children. This condition does not require treatment, however, it is better to lubricate the peeling areas after bathing with a moisturizing baby cream. Often in babies in the first week of life appears toxic erythema. This is a spotted rash with grayish-yellow seals in the center, which is usually located on the limbs around the joints, on the chest. The state of health of the child is not disturbed, the body temperature is normal. Within 1-3 days, new rashes may appear, but after 2-3 days the rash disappears.
On the skin of babies often appear so-called milia. These are whitish-yellow nodules 1-2 mm in size, rising above the level of the skin. They are located more often on the wings of the nose and bridge of the nose, in the forehead, chin. Their occurrence is associated with abundant secretion and blockage of the ducts of the sebaceous glands of the skin under the influence of estrogens. They usually do not require treatment and go away on their own in 1-2 weeks.
Often parents are worried that the skin and sclera of the child's eyes turn yellow after birth. If jaundice is mild, appeared after the 2nd day of life or later, does not disturb the child's condition, the color of urine and feces does not change, then this is - physiological jaundice of newborns. It is due to the temporary immaturity of the liver enzyme system and, as a result, the difficult transport of bilirubin. Usually physiological jaundice disappears before the 14th day of life. But if jaundice, even minor, appears on the first day after birth, drags on for a longer period, intensifies over time, is accompanied by a deterioration in the condition of the newborn, we can talk about pathological jaundice. In this case, you need to urgently contact a pediatrician.
Hormonal crisis
One of the transitional states, which often occurs in young children and often frightens parents, is sexual, or hormonal crisis. It is observed more often in girls. Sometimes in the first 7 - 10 days after birth, the child's genitals increase in size. At the same time, the mammary glands are often enlarged and engorged; when pressed, a few drops of a liquid similar to milk are released from the nipples. These phenomena are due to the fact that after birth, maternal sex hormones circulate in the child's body. They act on the receptors of the genitals and mammary glands of the baby, causing their response in the form of an increase and engorgement. The increase in the mammary glands and genital organs disappears without a trace by the end of the month. These conditions usually do not require treatment. But if the engorgement of the mammary glands becomes significant, will be accompanied by the child's anxiety and fever, consult a pediatrician. In no case should you try to reduce the size of the mammary glands by squeezing liquid out of the baby's nipples. This will not only cause pain to the baby, but is also fraught with infection.
In girls, in the first days of life, abundant mucous discharge from the genital tract often appears. These are manifestations of the so-called transient (desquamative) vulvovaginitis. Vaginal discharge may be bloody. This condition does not require treatment. However, if mucous or bloody discharge from the vagina continues for more than 3-4 weeks or becomes purulent, the girl must be examined by a pediatric gynecologist.
excretory organs
All newborns develop a transitional state such as transient dysbacteriosis And physiological intestinal dyspepsia. Transient dysbacteriosis is associated with colonization of the intestinal mucosa by bacteria. The baby's intestines are inhabited not only by beneficial bifidobacteria and lactobacilli, but also by conditionally pathogenic flora. Transient dysbacteriosis is a physiological phenomenon, however, under certain circumstances (unfavorable course of pregnancy, reduced body defenses, artificial feeding), it can cause a secondary infection and illness in a child.
Also in the middle of the first week of life there is a disorder of the stool. This is due to the transition of the newborn to a new enteral type of nutrition and the development of such an important function as digestion. After passing in the first 1-2 days of the original stool - meconium (thick viscous mass of dark green color), on the 3-4th day a transitional stool appears - heterogeneous in consistency and color (with lumps, mucus, green-yellow color). By the end of the first week of life, the stool usually settles in the form of a yellow slurry.
The urinary organs of the newborn also adapt to new living conditions. They adapt to work against the background of altered blood circulation, hormonal changes and large water losses. Often develops the so-called uric acid infarction of the kidneys. Outwardly, it is manifested by the release of cloudy urine of a brick-yellow color. This condition is associated with metabolic disorders in the kidneys and the deposition of crystals of uric acid salts in them. By the end of the first week, these phenomena pass. If the color of the urine does not normalize by the end of the second week of life, it is worth consulting the baby with a neonatologist.
immune deficiency
The newborn is very vulnerable in terms of infection and the development of inflammatory diseases. The entire immune system (including the barrier and protective properties of his skin, mucous membranes) is still immature. In the mother's tummy, the baby is in sterile conditions. After birth, his skin, oral cavity, upper respiratory tract, intestines are populated by bacterial flora from the environment. Its effect on the background of the still unformed natural barriers of the skin and mucous membranes explains the appearance in the first weeks of life of such a borderline condition as transient immunodeficiency. The decrease in the body's defenses is especially pronounced in premature and low birth weight newborns. The duration of immunodeficiency can be different, up to a month or more. That is why good care and impeccable cleanliness of everything that surrounds the baby is very important. Particular attention after discharge from the hospital should be given to the treatment of the umbilical wound that has not yet healed. At birth, a special bracket is placed on the rest of the umbilical cord. On the 4-5th day of life, a healthy child spontaneously falls off the remainder of the umbilical cord. In our country, the technique of surgical removal of the umbilical cord residue in the maternity hospital is common. This manipulation is performed by neonatologists on the second day of the baby's life and is aimed at accelerating the healing time of the wound, since, due to its anatomical structure, it is often the gateway for infection. The navel should be treated twice a day: in the morning and after the bath. Caring for the umbilical wound is a very important point. Processing is carried out with a 3% solution of hydrogen peroxide and an alcohol solution of brilliant green. It is not necessary to bandage the wound. It is also necessary to provide air baths to the entire body of the crumbs. The air will dry the umbilical wound and possible diaper rash. With proper care, the blood crust disappears and the umbilical wound epithelizes by the end of the 2nd week of life. If the crust persists on the 3rd week, or after it falls off, discharge (bloody or serous) reappears, you should consult a pediatrician. A doctor's examination should not be postponed even if, during the treatment of the wound, you notice signs of its inflammation: redness of the umbilical ring, its swelling, weeping of the bottom of the wound.
Physiological (transitional) conditions of newborns
After birth, the child enters an environment that is completely different from the intrauterine environment. Temperature, tactile, visual, sound stimuli are fundamentally different from the conditions in which the fetus existed for 10 lunar months. States that reflect the process of adaptation to life are called physiological (transitional, transient, borderline). Some of the painful phenomena that accompany them pass relatively quickly. However, under certain circumstances (for example, pathologies of the prenatal period, birth dates, etc.), serious deviations and health can also result.
To the number physiologically transient states relate:
Albuminuria. Violation of the activity of the kidneys and, in connection with this, protein in the urine occurs in almost all newborns in the first days of life. This is due to the increased permeability of the kidney cells that produce urine against the background of the peculiarities of the movement of blood through the vessels (after birth, the pulmonary circulation begins to function and, as a result, the length of the vascular bed and the resistance of the walls of the vessels change). However, the reaction to the protein may be positive in the study of urine due to impurities of salts and mucus in the urine.
Physiological jaundice. It is observed in 2/3 of newborns due to the immaturity of the liver enzyme systems and the increased formation of bilirubin. On the 2-3rd day of life, icteric coloration of the skin, and sometimes the mucous membranes of the eyes, appears. Stool and urine retain their normal color. This state lasts no more than 10 days. And if the state of health is satisfactory, no treatment is required. With a noticeable weight loss, lethargy, passivity of the child, immediately consult a pediatrician, because. this condition is not characteristic of physiological jaundice. You should also think about hemolytic disease if jaundice does not occur on the 2-3rd day, but on the first day of life.
Labored breathing. The first breath after birth does not fully expand the lungs. This requires a special type of breathing, which the newborn unconsciously uses. He takes a deep breath periodically, and holds back the exhalation, pushing the air out as if with difficulty - "inflates" the lung tissue. In a premature or weak, sick child, this process takes longer. In healthy people, on the 5th day of life, the lung tissue usually straightens to the end.
Skin changes:
Physiological erythema- the reaction of the skin to the removal of the original lubricant, which the child was covered with in utero, is expressed by its redness. Increases on the 3rd day of life and disappears by the end of the first week.
Physiological peeling- appears after erythema, as its outcome, more often on the chest and abdomen. It is especially pronounced in post-term children. With strong peeling, you can lubricate with baby cream.
birth tumor- swelling of a part of the body, more often the head, which by the time of delivery was closer to the exit from the uterus (presented). Keeps 1-2 days. Sometimes, at the site of the birth tumor, small-point hemorrhages appear, disappearing on their own.
Toxic erythema- reddish, slightly dense spots, sometimes with bubbles in the center. It occurs in 20-30% of newborns. It is located mainly on the legs and arms around the joints, on the buttocks, chest, less often on the stomach, face. An allergic reaction usually does not require treatment. But with abundant rashes, when the child is restless, he should drink plenty of water, and also consult a doctor who will prescribe calcium gluconate, diphenhydramine in age dosages.
Uric acid infarction of the kidneys. It happens to almost all newborns. It is caused by a metabolic disorder in the kidneys and the deposition of crystals of uric acid salts in its zones. Outwardly, it is manifested by the release of cloudy, brick-yellow urine. By the end of the 1st week, these phenomena disappear, from the middle of the 2nd symptom is considered pathological.
Sexual crises. Associated with changes in hormonal balance in most newborns. One of the manifestations is engorgement of the mammary glands (both in girls and boys) with a maximum increase on the 7-8th day, usually disappears by the end of the month. From the engorged mammary glands, one should not try to squeeze out the secret, because. this leads to infection and the development of mastitis. It is more useful to apply a sterile dry cloth moistened with boiled and chilled camphor oil. In the first 2 days of life, the vaginal mucosa may become inflamed. Abundant grayish-whitish discharges appear from the genital slit, which disappear on their own on the third day. It is recommended to wash girls with a weak solution of potassium permanganate (potassium permanganate), while making sure that crystals do not get into the solution, which can cause severe burns. You can also use decoctions of chamomile, St. John's wort, succession for the same purposes. These herbs have disinfecting properties. More rare manifestations of a hormonal crisis are: swelling of the external genitalia - labia, penis, scrotum, which can last 1-2 weeks or more, darkening of the skin around the nipples and scrotum skin. Dropsy of the testicle is the accumulation of fluid between its membranes. It sometimes goes away only at the end of the first month of life on its own and does not require treatment.
Transient decrease in temperature, transient fever. Physiological violations of the thermal balance are associated with the imperfection of thermoregulation of newborns, who cannot maintain a constant body temperature and react to any changes in it indoors or outdoors. Due to the peculiarities of the structure of their skin, rich in blood vessels and capillaries and poor in sweat glands, the child quickly overheats or hypothermia. When a newborn releases more liquid than he receives during feeding, this is expressed by anxiety, dry mucous membranes, fever up to 38.5 °C and above, and thirst. It must be undressed, wiped with alcohol, cologne, drink plenty of sweet tea or boiled water. If there is no effect, make an enema with analgin. To do this, they first do the usual one to cleanse the intestines and ensure better absorption of the drug, and then directly an enema with analgin. Crush one tablet (0.5 g) into powder, and dissolve 1/10 of it in water with a volume of a small rubber spray designed specifically for newborns. The expected relief will come in 20-30 minutes. If the temperature of the child, on the contrary, is lowered, which most often happens in the first hours of his life, he should be quickly wrapped in sterile diapers (ironed if the birth took place at home) and placed on the changing table under the lamp. A constant body temperature is established, as a rule, by the middle of the first day.
physiological dyspepsia, dysbacteriosis. The complete absence of bacteria is inherent only in the fetus, which is sterile during normal pregnancy, and the newborn in the first hours of life. But already after 10-20 hours, his skin, mucous membranes of the respiratory tract and intestines are inhabited by microorganisms, some of which are necessary for digestion, and how it proceeds can be seen from the stool. Stool disorder - physiological dyspepsia, occurs in all newborns. Initially, the first three days, the original meconium is released - thick, dark green. Then blotches of yellow and whitish color appear in it, bowel movements become more frequent - from dense lumps to a liquid consistency. Such physiological dyspepsia does not last long. After 2-4 days, the stool becomes mushy, of a uniform yellow color - a permanent stool is established, which indicates the growth of bacteria in the intestines that normalize digestion.
Physiological weight loss. This condition is typical for children on the 3-5th day of life. The child loses 5-8% of body weight at birth, mainly due to the evaporation of fluid from the breath due to insufficient intake of it from the outside. Most restore body weight by the end of the first - the beginning of the second week. Early, less than 2 hours after birth, attachment to the breast contributes to less loss. It should also be remembered that in addition to milk, a child needs additional drink - water, and that someone who experiences overheating or hypothermia spends energy for other purposes - at least for partial restoration of heat balance. Body weight tends to decrease and with insufficient milk supply from the mother. The pediatrician observing the child should choose the best option for a special milk formula and instruct in detail about how much to give it when supplementing. It is unwise to choose a mixture on your own without consulting a doctor.
After birth, the child's living conditions change radically, he immediately finds himself in a completely new environment, where the temperature is much lower, there is a mass of visual, tactile, sound, vestibular and other stimuli, a different type of breathing and way of eating is needed, which leads to changes in almost all functional systems of the body.
Conditions and reactions that reflect the process of adaptation (adaptation) to extrauterine conditions of life are called transitional (boundary) states of newborns.
The neonatal period is an adaptation to the conditions of extrauterine life, the end of the period is associated with the disappearance of borderline (transient, adaptive) states. The duration of the neonatal period is from 2.5 to 3.5 weeks, in premature babies it is longer.
The following periods of the greatest stress of adaptive reactions are distinguished:
acute respiratory-hemodynamic adaptation (first 30 minutes of life);
the period of auto-stabilization, synchronization of the main functions of the body (lasts 1-6 hours);
intense metabolic adaptation (transition to anabolic metabolism within 3-4 days).
TRANSITIONAL BORDER STATES
Newborn Baby Syndrome
In the first seconds of life, the child is immobilized, does not respond to pain, fat, light stimuli, there is no muscle tone and reflexes. And for the next 5-10 seconds, a deep breath, a cry, a flexor posture, spontaneous motor activity are formed. The pupils are dilated despite the bright light.
Transient hyperventilation
Pulmonary ventilation during the first 2-3 days is 1.5-2 times greater than in older children. The first breath in 4-8% of cases occurs according to the type of GASP (deep breath and difficult exhalation), which contributes to the expansion of the lungs and the evacuation of fluid from the alveoli.
Transient circulation
The onset of pulmonary respiration contributes to the closure of fetal communications. The ductus arteriosus closes 10-15 minutes after birth. Within 24-48 hours, a shunt can occur both from left to right, and vice versa (less often), a bidirectoral (in both directions) shunt is also possible. The foramen ovale closes after birth. Anatomical closure of the arterial (botallian) duct occurs in most cases by the 8th week, anatomical obliteration of the opening - after a few months or years. The umbilical arteries contract after 15 s, and after 45 s they are already functionally closed. The venous (arantian) duct closes anatomically after 3 weeks, functionally - after 2-3 days.
Transient polycythemia (erythrocytosis)
In the first hours and during the first week of life, hemoconcentration occurs - an increase in hemoglobin content (180-220 g / l), the number of erythrocytes (6-8x10 / l), leukocytes (10-15x10 / l), an increase in hematocrit (0.55+ 0.06).
Physiological jaundice
It occurs in 60-70% of newborns. Causes:
hemolysis of erythrocytes containing fetal hemoglobin:
insufficient conjugation ability of the liver.
Icteric coloration of the skin occurs on the 3rd day, intensifies to
day and disappears by the 7-10th day. Feeling is not affected. The minimum concentration of bilirubin is 26-34 µmol/l, the maximum is 130-170 µmol/l.
Transient skin changes
In the first week of life, all newborns experience specific skin changes.
Simple erythema is a reactive redness of the skin that occurs after the removal of the original lubrication and the first bath. Redness in the first hours has a slightly cyanotic hue, on the second day it becomes the brightest, then the intensity of erythema gradually decreases: by the end of the first week of life, the redness disappears. In preterm infants, erythema is more pronounced and lasts longer - up to 2-3 weeks, does not require treatment, goes away on its own.
Physiological peeling of the skin - large-lamellar) peeling of the skin. Occurs on the 3-5th day of life in children with bright simple erythema in the stage of extinction. Excessive peeling of the skin occurs in post-term children. Treatment does not require, passes on its own.
A birth tumor is an edema of the presenting part due to venous hyperemia-1, which disappears on its own within 1-2 days. Sometimes petechiae are visible at the site of the birth tumor.
Toxic erythema is an allergic reaction. It is observed in 20-30% of newborns. Appears on the 2-5th day of life in the form of erythematous, slightly dense spots with papules or vesicles in the center. Localization: extensor surfaces of the limbs around the joints, buttocks, chest, abdomen, face. Eruptions are profuse. Elements do not happen on the palms, feet, mucous membranes. After 2-3 days after the appearance, the rash disappears without a trace. The condition of children is usually not disturbed, the body temperature is normal. With abundant erythema, the child is restless, the stool is liquefied, micropolyadenia, enlargement of the spleen, eosinophilia. Only in this case, it is advisable to prescribe an additional drink of 30-50 ml of 5% glucose solution, diphenhydramine 0.002 g 2-3 times a day.
Transient loss of initial body weight
It occurs mainly due to starvation (lack of milk and water) in the first days of life. MUMT usually falls on the 3-4th day of life. Under optimal conditions of feeding and nursing in healthy worn newborns, MUMT does not exceed 6% (permissible levels are from 3 to 10%).
Prematurity, a large miss of the body at birth (over 3500 g), protracted labor, birth trauma, I hypogalactia in the mother, high temperature and insufficient humidity of the air in the neonatal ward, etc. contribute to large values of MUMT. MUMT more than 10% in a full-term newborn indicates a disease or violations in nursing the child. Pathogenesis - dehydration, imperceptible loss of water -
breathing (up to 50%) and then (up to 20%).
There are three degrees of MUMT (corresponding to three degrees of hypohydration):
degree (MUMT less than 6%) - signs of exsicosis are not expressed, but intracellular hypohydration occurs. Greedy sucking, sometimes restless; hyperemia of the mucous membranes with pallor of the skin, slow straightening of the skin fold;
degree (MUMT 6-10%) - there are no symptoms or there is thirst, irritable cry, shortness of breath, tachycardia; it is possible to detect signs of intracellular hypohydration - an increase in hematocrit, total protein in the blood serum, a tendency to oliguria, etc.;
degree (MUMT more than 10%) - thirst, dry mucous membranes and skin, slow spreading of the skin fold, sunken fontanel, shortness of breath, tachycardia, tremor, weakness, marbling of the skin, acrocyanosis, hypernatremia above 160 mmol/l, oliguria, etc.
Prevention of the 3rd degree of hypohydration: early attachment of children to the breast, stimulation of lactation in the mother, prevention of overheating of the child, supplementing the child between feedings with 5% glucose solution or Ringer's solution, in half with 5% glucose solution. At an air temperature in the ward of more than 25 ° C, in addition to milk, a drink is prescribed at the rate of 5-6 ml / (kghs day). Recovery of body weight occurs by 6-7 days of life.
Transient violation of heat balance
Violation of the thermal balance occurs due to the imperfection of the processes of thermoregulation, an increase or decrease in the ambient temperature, inadequate to the adaptive capabilities of the child. The main conditions for thermoregulation in newborns are:
high heat loss in comparison with heat production, due to a 3 times larger body surface of a newborn per 1 kg of body weight, 2 times greater minute respiratory volume in relation to similar indicators in adults. Heat loss occurs mainly by convection and evaporation;
a sharply limited ability to regulate heat transfer during overheating or heat production in response to cooling;
incapacity for a typical febrile reaction, i.e. restructuring of thermal homeostasis is similar to fever in adults due to the insensitivity of the brain of a newborn to the leukocyte pyrogen, a high concentration of arginine-vasopressin in the blood, which reduces body temperature.
Transient hypothermia
A decrease in body temperature occurs in the first 30 minutes after birth (by 0.3 ° C per minute), and by 5-6 hours of life, the temperature rises! body, homoiothermia is established. Late recovery reduced! after birth, the body temperature indicates an insufficiently active compensatory-adaptive reactions of the child. In order to prevent hypothermia of the child, immediately after birth, a heated diaper is wrapped in a sterile, carefully blotted with it to prevent heat loss during the evaporation of amniotic fluid from the skin, placed on a heated table under a source of radiant heat, and the temperature is maintained; air in the delivery room is not lower than 24-25 ° C.
Transient hyperthermia
An increase in body temperature occurs on the 3rd-5th day of life, reaching 38.5-39.5 ° C and above. The child is restless, greedily drinks, he shows signs of dehydration. Overheating contributes to the development of transient hyperthermia (the air temperature in the ward for healthy full-term newborns is above 24 °C, the location of the child's bed next to the radiator or under direct sunlight, etc.), lack of drinking water, as well as dehydration, the catabolic orientation of the exchange and etc. Therapeutic tactics for hyperthermia is reduced to the physical cooling of the child (unwrapping), the appointment of an additional amount of liquid (5% glucose solution up to 50-100 ml inside).
Transient features of kidney function
Early neonatal oliguria - urine output in the amount of less than
ml/kg per day. It is noted in all healthy newborns in the first three days of life and is considered as a very important compensatory-adaptive reaction (in the first days of life, a child experiences fluid deficiency due to unsteady nutrition, suffers large losses of fluid with breathing - about 1 ml / kg / h).
Proteinuria occurs in all newborns in the first days of life due to increased permeability of the epithelium of the renal glomeruli and tubules.
Uric acid infarction - the deposition of uric acid in the form of crystals, mainly in the lumen of the collecting ducts of the kidneys. In the urine sediment, in addition to uric acid crystals, hyaline and granular casts, leukocytes, and epithelial cells are found. All of them disappear by the 7-10th day of life without treatment. Uric acid infarction is based on the catabolic orientation of metabolism and the decay of a large number of cells (mainly leukocytes), purine and pyrimidine bases are formed from nucleic acids, the final stage of metabolism of which is uric acid.
pop crisis
A hormonal crisis is diagnosed by engorgement of the mammary glands. The crisis begins on the 3rd-4th day of life and reaches a maximum by the 7th-8th day of INPNI. Then gradually the engorgement decreases. Increasing milk ♦um! 1 1 is usually symmetrical, the skin over them is not changed, sometimes slightly mii "small. The degree of enlargement of the gland in diameter is 1.5-KM.
(white, and then whitish-milky in color, in composition approaching - | and to the mother's colostrum. Squeezing out the contents of the increased milk haze should not be done (danger of infection). Treatment is not required. IH protection from irritation by clothing (sometimes a compress is made with camphor oil).
all girls and half the boys.
Desquamagic vulvovaginitis - abundant mucous discharge of gray-Ipto-whitish color from the genital slit in 60-70% of girls in the first 3 days of life. After about 2-3 days, they gradually disappear.
Bleeding from the vagina occurs on the 5-8th day of life in 5-10% / (points, although occult blood in the vaginal mucus can be detected
all girls with desquamative vulvovaginitis. The duration of vaginal bleeding is 1-3 days, the volume is 0.5-1 ml. Treatment is not rowed.
Milia - whitish-yellow nodules 1-2 mm in size, somewhat elevated above the level of the skin and localized more often on the wings of the nose and bridge of the nose, in the forehead, chin. Nodules are sebaceous glands with abundant secretion and clogged excretory ducts. They disappear without treatment after 1-2 weeks, there are rarely signs of mild inflammation around the nodules, requiring treatment with a 0.5 ° / o potassium permanganate solution.
Hyperpigmentation of the skin around the nipples and scrotum in boys, swelling of the external genitalia in newborns, moderate hydrocele - changes that disappear without any treatment at the 2nd week of a newborn's life.
In preterm infants, a sexual crisis is less common, its severity is low. The genesis of the sexual crisis: increased production of estrogens in the fetus, which stimulates the growth and development of the mammary glands, structural sections of the uterus.
Transient features of neonatal hematopoiesis
It is believed that a low content of lymphocytes in a newborn is associated with both a low intensity of lymphopoiesis and a massive destruction of lymphocytes in tissues; released products contribute to the activation of compensatory-adaptive reactions of the body in response to stress (birth).
Features of neonatal hematopoiesis.
High activity of erythropoiesis at birth - the number of normoblasts in the myelogram on the 1st day of life is 18-41%, n
1st day - 12-15%; active erythrocytopoiesis in children during the first hours of life - a response to the active destruction of erythrocytes, hypoxia in childbirth, as well as to a high concentration of erythropoietin in the blood"
In the future, the synthesis of erythropoietin decreases, and the production of erythrocytes decreases proportionally.
o Increased activity of myelopoiesis by 12-14 hours of life with a further decrease in intensity by the end of the 1st week of life: activation of myelopoiesis is explained by a high content of colony-stimulating neutrophil factor, increased release of neutrophil! from the bone marrow under the influence of stress hormones (cortisol, adrenaline), as well as the release of neutrophils into the blood from tissue depots.
o- Decrease in the intensity of lymphopoiesis immediately after birth, accompanied by a deficiency of lymphocytes in the peripheral curvature
th day of life. In the future, there is a sharp activation and dominance of lymphopoiesis: from the end of the 1st week of life, the number of lymphocytes is greater than the number of polymorphonuclear leukocytes.
Transient neonatal immunodeficiency is formed in the early stages of gestation, by the time of the birth of a full-term baby, immunity is quite mature, although it has a number of features.
<>Increased content of T-lymphocytes and "G-suitors.
Normal number of B-lymphocytes and normal concentration of class O immunoglobulins.
Decreased blood levels of fibronectin and y-interferon with normal concentrations of lymphokines.
Decreased levels of complement activation components in the blood. ]
An increased content of neutrophils in the blood against the background of a decrease in their proliferation and storage pool in the bone marrow, a low ability of the bone marrow to release neutrophils into the blood in severe infections, sepsis. |
Reduced motor activity of neutrophils (chemotaxis, chemokinesis), inhibition of phagocytosis.
The causes of transient immunodeficiency, one of the borderline conditions of newborns, include:
stress hormones during childbirth;
massive antigenic attack immediately after birth;
physiological starvation for children of the first days of life:
transient dysbiocenosis with unformed natural barriers of the skin and mucous membranes;
the end of the receipt of humoral factors of immunity through the placenta.
Transient immunodeficiency is most pronounced in the first 3 days. what is the particular risk of infection during this period.
"NPA HEALTH OF NEWBORN
Pediatricians distinguish several transient (transient) conditions that can occur in a baby in the first few days after birth. Usually these conditions do not require any treatment and after a short amount of time they go away on their own.
Physiological jaundice of newborns
Physiological jaundice (jaundice of newborns), associated with enzymatic immaturity of the liver, occurs 2-3 days after birth and disappears by 7-10 days. It is manifested by staining of the mucous membranes (conjunctiva, oral mucosa), as well as the skin of the child in yellow.
A blood test reveals an increase in the level of total bilirubin (not higher than 256 µmol/l for a full-term baby and 171 µmol/l for a premature baby with an hourly increase in this indicator by no more than 5.1 µmol/hour).
Jaundice is easier if a nursing woman has enough milk. "Excess" bilirubin quickly turns into stercobilin, which is excreted in the child's feces, and into urobilin, which leaves the body with urine. In addition, bilirubin, which stains the skin yellow, is well destroyed in the light. Therefore, it is recommended to install the baby's crib in a well-lit area of the apartment and pay sufficient attention to walking with the child on the street (at least 3 hours a day).
Transient skin changes in newborns
Simple erythema of the newborn
Simple erythema of the newborn occurs as a response to a change in the environment, removal of the original lubrication and toilet of the newborn. It goes away in 1-3 weeks.
Physiological peeling of the skin
In newborns, physiological peeling of the skin may appear on the 3-5th day, more often on the abdomen and chest. This condition is especially typical for post-term children.
birth tumor
A birth tumor is swelling of the presenting part, usually disappears in 1-2 days.
The skin of a newborn baby remains red for 1-2 days after birth (physiological erythema). Sometimes on the skin of the sacrum, abdomen, feet, occiput, and other anatomical areas, foci of compaction of a bright red color (phenomena of toxic erythema) are noted. The occurrence of toxic erythema signals a predisposition to allergic reactions.
With a large number of foci, with their intense coloring, the child may be prescribed an additional drink (30-60 ml of glucose), as well as antiallergic drugs that help reduce swelling.
acne in newborns
Neonatal acne is a neonatal pustulosis that appears as small red pustules on the face that lasts up to 7 days.
Urinary infarction in newborns
Urinary infarction is a condition accompanied by the release of bloody discharge from the genital tract of the baby. It is caused by the fact that uric acid crystals damage the delicate, still forming kidney tissue, causing its necrosis (necrosis). This transient state passes on its own within 1-2 days and does not pose a danger to the newborn.
Hypo- or hyperthermia in newborns
The functions of thermoregulation are imperfect in absolutely all infants. Their skin is still very thin, quickly loses moisture. The sweat glands do not function fully, therefore, in case of overheating, they cannot respond in time and to the right extent with an increase in sweating. Any hypothermia can lead to an acute respiratory disease in an infant, and overheating threatens to cause hyperthermic syndrome (T> 38 ° C) with the risk of febrile convulsions.
To avoid adverse consequences, it is enough to maintain the optimal temperature regime (24-25 ° C) in the room where the small child is located, and also to dress him adequately to the surrounding temperature conditions. Body temperature up to 37.5 ° C is normal for a child in the first months of life. To reduce heat loss, babies should wear a cap, since the head of newborns makes up 20% of the entire body surface.
Physiological weight loss
Weight loss up to 5-8% of the initial weight at birth is considered the norm. This phenomenon is associated with the discharge of the child's original urine, meconium (feces), as well as with imperfect lactation in the mother. As soon as the woman's milk begins to arrive and it becomes enough, the first weight gain in the child will be noted, as a rule, on the 4th day from birth.
Sexual crisis of newborns (small puberty, hormonal crisis)
The sexual crisis of newborns is very important in the sexual differentiation of the brain. In children who have undergone it, the neonatal period proceeds more smoothly. In such children, neonatal jaundice is less common, and weight loss is less pronounced.
White dots on the nose of newborns or milia
Milia of newborns are clogged sebaceous glands of a child. They appear as white dots on the nose, on the forehead of the child. The condition does not require treatment and resolves on its own by the first month of life.
Hyperpigmentation of the skin around the nipples and scrotum
Hyperpigmentation of the skin of the nipples and scrotum occurs in 10% of newborns, disappears within 1-2 weeks.
Swelling of the external genitalia
Swelling of the external genital organs occurs in 5-10% of children, disappears on its own after 1-2 weeks.
An increase in mammary glands in size is noted in newborns of both sexes. This is due to the ingestion of the maternal hormone estrogen into their blood during the last stages of pregnancy. In girls, a liquid sometimes comes out of the nipples, resembling breast milk in appearance. Squeezing is strictly prohibited.
For faster resorption of formed infiltrates (seals) in cases of pronounced engorgement of the mammary glands, doctors advise applying compresses. For these purposes, Vishnevsky's ointment is widely used. It is applied in a thin layer to the bandage, which is applied to the area of the child's mammary glands and placed under a plastic bag. Compresses are usually left overnight, and for better fixation they are bandaged to the child's body. 5-7 such compresses lead to a noticeable softening of the infiltrates and to a decrease in their size.
Desquamative vulvovaginitis in girls
Desquamative vulvovaginitis is manifested in 60-70% of girls, in the form of mucous discharge from the genital slit of white-gray color. They may appear on the 3rd day of life and gradually disappear after 2-4 days. Treatment is not required.
Bleeding from the vagina (metrorrhagia)
Bleeding from the vagina in girls may appear on the 5-8th day, you should not be afraid of this, they pass on their own within 3-4 days. Metrorrhagia occurs in 5-10% of newborn girls.
After the umbilical stump falls off (usually for 3-4 days), an umbilical wound forms in its place. In order to avoid its infection, the necessary processing should be carried out in a timely manner. It is enough to treat the wound 2 times a day with 3% hydrogen peroxide and a solution of brilliant green (brilliant green). By 7-10 days, the umbilical wound will begin to epithelialize and sanitation with antiseptics can be stopped.
Transient states of newborns are called borderline because they very easily pass from a state of physiological norm to pathology. That is why a child discharged from the maternity hospital in the first month is regularly examined by a pediatrician and a patronage nurse. However, one should not worry too much about the occurrence of a particular borderline state in a child. In 97% of cases, they pass on their own, without requiring any medical intervention at all.
Childbirth is certainly stressful for a child who has just been born. It is caused by large physical overload (“pain attack”) that the baby experiences at the time of contractions. In addition, after the birth of the baby, the work of the whole organism is rebuilt.
This is due to the fact that:
* The baby enters a completely different environment where the temperature is lower than in the mother's womb.
* He is bombarded with a huge amount of irritants. (sound, auditory, sensitive, tactile and others).
* After birth the child already has a different way of breathing (pulmonary) and a new way of obtaining nutrients.
The baby must adapt to all these changes, so he has borderline (physiological, transient, transitional) states.
What is the danger of borderline states?
Transient states occur during or after childbirth, but for a healthy newborn they Not pose no threat, disappearing on their own by the 28th day of his life.
However under certain conditions they can lead to the development of pathological processes or diseases. For example, if a child was born prematurely or with low body weight, if he has congenital anomalies, non-compliance with the conditions of feeding and care, as well as other reasons.
Therefore, you must be aware of the most common borderline conditions and their manifestations so that you can distinguish physiology from incipient diseases.
Physiological conditions of newborns
There are many borderline states, they proceed with varying degrees of severity of visible manifestations. And some of them are diagnosed only with the help of laboratory tests.
However, we will talk about the most common physiological conditions of the child that occur after his birth, talk about their causes and manifestations.
Weight loss
It occurs in absolutely all newborns.
Causes of occurrence:
* During childbirth, a mechanism is triggered that enhances metabolism and energy expenditure.
* Normally, after stress, a certain amount of fluid is excreted from the body with sweat and breathing.
All this leads to losses that cannot be compensated from the outside, since an insufficient amount of colostrum and milk enters the body. Therefore, in the first few days of life, the baby makes up for losses from its “reserves”, which were prepared during pregnancy in the form of accumulations of brown fat.
Normally, subject to all conditions of feeding and care, the child loses up to 6% of body weight at birth.
In the presence of adverse factors (prematurity, birth trauma, and others), the child may lose more than 6%. This already considered a pathology , which requires replenishment of lost fluid, and sometimes even drug treatment.
Recovery of lost body weight occurs in different ways:
* A full-term baby fully restores its weight on the 7th-10th day of life.
* If the baby is premature, he slowly restores his body weight: as a rule, by the 14th day of life. However, much depends on the degree of prematurity, care and feeding, the presence of diseases and other factors.
If the child does not lose weight, this is an alarming sign, since it indicates fluid retention in the body, which is most often associated with kidney pathology.
Transient violation of thermoregulation (heat exchange)
In a newborn baby, the thermoregulation center system is located in the brain, but it is not perfect enough. In addition, the baby's skin has some features: it is rich in blood vessels, but poor in sweat glands. Therefore, the baby is very sensitive to changes in the environment and can both quickly overcool (hypothermia) and overheat (hyperthermia).
Hypothermia
risk it development is great immediately after birth, because the baby gets into conditions in which the temperature is lower than in the womb.
Therefore, in order to prevent heat loss, the child is immediately laid out with his tummy on his mother's stomach immediately after birth and covered with a dry, heated diaper. And all medical manipulations and examination by a doctor are carried out on a heated changing table.
In addition, it is important to observe one more condition: the air temperature in the delivery room should be maintained at a level of about 24-25 ° C.
hyperthermia
Usually, develops on the third or fifth day of life . The body temperature of the baby can rise to 38.5-39 o C (at a rate of 37 o C).
The causes of hyperthermia are a defect in care, a violation of the temperature regime in the newborn's room, the location of the baby's bed in direct sunlight or near the battery, and other factors.
With hyperthermia, the newborn is physically cooled (left in a vest and diaper) and fed with additional drink. Of course, body temperature is systematically measured.
Recently, these two conditions rarely develop, since optimal conditions are created for the newborn baby. However, if the baby is premature, That the risk of developing hypothermia or overheating increases significantly.
Physiological dyspepsia and dysbacteriosis
Both conditions develop in all newborns.
The first stool of a newborn is meconium. It is released on the first or second day of life (less often on the third) and is a thick mass of dark green color. Further, the stool becomes heterogeneous (lumps, mucus appear), more liquid, its color changes (areas of a greenish stool alternate with yellow or white). Normally, by the end of the first or beginning of the second week of life, the stool becomes mushy and becomes yellow.
These changes are due to two things.:
* The beginning of a different type of nutrition, the inclusion of digestive enzymes and glands in the process of digestion. In addition, the intestines are irritated by fats, proteins and carbohydrates that have not hitherto entered it.
*
The colonization of the sterile intestine with flora that enters the baby's digestive system from the mother and caregivers. Unfortunately, the intestines are not always inhabited only by “beneficial bacteria”. Therefore, a “struggle for territory” begins between “bad” and “good” bacteria, which causes intestinal colic.
Transient dysbacteriosis and dyspepsia are physiological conditions. However, when exposed to adverse factors (non-compliance with hygiene standards, artificial feeding, and others), they become the basis for the addition of a secondary infection and the development of diseases.
Sexual (hormonal) crisis
Occurs in 70-75% of newborns (more often in girls).
It includes the following states:
* Physiological mastopathy. It occurs in both girls (almost all) and boys (approximately 50%).
Begins on the third or fourth day of life. It is usually manifested by a symmetrical increase in the mammary glands, which reaches a maximum on the seventh or eighth day of life. Then the mammary glands gradually decrease in size.
It is noteworthy that the skin of the mammary glands does not change, but sometimes there may be a slight redness.
In addition, there may be discharge from the mammary glands. At first they are grayish, and then milky white. Remember that it is impossible to squeeze out the contents of the mammary glands, because the risk of infection is very high.
The condition does not require treatment.
* Dexvamative vulvovaginitis. It occurs in 60-70% of girls.
Manifested by abundant discharge from the genital slit of a grayish-white color during the first three days of life. Then, by the end of the second or third week of life, they disappear on their own. Discharges are not a cause for concern. In addition, there is no redness of the external labia and vagina.
*Metrorrhagia or bleeding from the vagina. It occurs in 5-10% of girls.
Occurs on the fifth or eighth day of life and lasts from one to three days. The maximum total volume of blood loss is not more than two milliliters (usually about 1 ml).
* Moderate swelling of the external genital organs. It occurs in 5-10% of newborns.
In boys, this is an accumulation of a small amount of fluid in the scrotum. Passes independently by the end of the second week of life, but sometimes a little later: by the age of one month.
* Milia. It occurs in 40% of newborns.
These are clogged excretory ducts of the sebaceous glands, which work actively during a sexual crisis. They are yellowish-white nodules (1-2 mm) rising above the level of the skin. Their most frequent localization is the wings of the nose, the bridge of the nose, the forehead and chin.
Nodules disappear on their own on the 7-14th day of life.
Physiological features of the kidneys
Includes two states:
* Absence or excretion of a small amount of urine in the first hours of life (early oliguria). It develops in all newborns.
However, with the beginning of the second day of life, the baby excretes urine in sufficient volume.
* The appearance of cloudy urine of a yellow-brick color (uric acid infarction). It develops in 30% of full-term and 15% of premature babies.
Passes independently on the seventh or eighth day of life.
Physiological jaundice
It develops in all newborns due to an increase in the level of bilirubin in the blood. However, it is manifested by yellowness of the skin and visible mucous membranes (sclera, oral cavity) only in 60-70%.
In newborns, jaundice can develop as a manifestation of the disease (incompatibility of the blood type or Rh of the child and mother), and as a borderline condition.
Causes of physiological jaundice:
* Normally, an adult erythrocyte lives 80-120 days. A newborn erythrocyte - no more than 5-7 days, then it is destroyed and replaced by an "adult" erythrocyte. This leads to a high concentration of bilirubin in the blood from the erythrocyte.
* Of great importance is the physiological immaturity of the liver. Therefore, its enzymes do not have time to bind incoming bilirubin.
For the health of the crumbs, a high concentration of bilirubin in the blood is dangerous, since it is very toxic to brain cells. That's why Very it is important to distinguish physiological jaundice from pathological jaundice in time.
Signs of physiological jaundice:
* occurs by the end of the second and the beginning of the third day of life;
* maximum icterus of the skin and mucous membranes is observed on the 4th-5th day of life;
* in a full-term newborn disappears by 10-14 days of life, in a premature baby, as a rule, in the third week of life;
* the general condition of the baby is not disturbed.
Transient jaundice resolves on its own and does not require treatment.
Any other jaundice that occurred earlier or lasts longer indicates a serious deviation in the health of the baby.
The best prevention of physiological jaundice is early breastfeeding.
Borderline skin changes
Develop in all newborns in varying degrees of severity and include the following conditions:
* Simple erythema (reddening of the skin). It occurs in response to the removal of the original lubrication. The maximum erythema manifests itself on the second day, but disappears on its own by the seventh day of life.
* Peeling of the skin. It develops on the third or fifth day of life, most often in post-term children. It fades on its own in 7-10 days.
* Toxic erythema. It occurs in 1/3 of newborns.
This red spots sometimes with grayish-yellow seals or vesicles in the center. Most often they are located in groups on the extensor surfaces of the arms and legs, around the joints, less often on the chest, buttocks and facial skin. Toxic erythema has distinctive features: it never settles on the feet, palms and does not affect the mucous membranes.
The first rashes appear on the 2-5th day of life, and after 2-3 days new elements of the rash may appear. However, after another 2-3 days, the rash disappears without a trace.
Transient immunodeficiency
By the time of birth, the child's immune system is sufficiently developed. However, the protective mechanisms of the skin and mucous membranes have not yet been formed. Therefore, when the oral mucosa, nasopharynx, oropharynx and skin are colonized with a “new” flora, infection can occur.
The umbilical wound is especially vulnerable, since it is the “entrance gate” for any infection, so follow the rules for caring for the baby.
That, perhaps, is all that could be told about the most frequently developing borderline conditions in a newborn child.
As you can see, in most cases, the line between a physiological state and a disease is thin. Therefore, if you have slightest suspicion that the baby is sick, be sure to tell the doctor about it. Since a newborn child has one feature: the rapid development of all the symptoms of the disease (within a few hours).
And always remember: the health of your baby is in your hands!
pediatric resident doctor
