Neonatologist. What does a neonatologist do? Consultation with a neonatologist
A neonatologist is a pediatrician who monitors a child from the moment of birth until the 28th day of his life. A neonatologist deals with both premature babies and children in hospital and maternity hospitals. Considering that this specialist monitors the health of the youngest children, one can understand how responsible and delicate his work is. It is at this age that children can be diagnosed with diseases that can lead to complications and disability in the future. The task of a neonatologist is to prevent these processes, diagnose the disease and prescribe the necessary treatment. As a rule, neonatologists are generalists. They have to deal with a variety of childhood pathologies and take an active part in the recovery of young patients.
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Who is a neonatologist?
A neonatologist is a doctor who creates conditions for the baby to adapt to the world. In the maternity hospital, the neonatologist shows the mother for the first time how to feed the baby and how to swaddle. Some maternity hospitals specialize in the pathology of childbirth; in such maternity hospitals there are several neonatologists; they are able to provide resuscitation care to a newborn if it is required.
After birth, all organs and systems of your baby are rebuilt. He experienced enormous stress when he was born! In the first week it is decided whether the child will live. It is before 7 days that spontaneous death of newborns most often occurs.
Responsibilities of a neonatologist and main functions
When planning to give birth, a woman is interested in finding good doctors (gynecologist, obstetrician); she also studies the features of maternity hospitals. Of course, this is correct, because the professionalism and qualifications of such doctors, as well as the equipment of the maternity hospital, are often the determining factors in the outcome of childbirth. Meanwhile, a good neonatologist is an equally important condition when considering childbirth and all aspects associated with it. After all, it is he who plays an extremely important role in the life of the baby.
If we consider the activities of a neonatologist in individual areas, then, for example, the Apgar scale, when the doctor compares its data with the child’s condition, is the basis for further determining the medical care necessary for the child. Moreover, in some cases, women in labor do not even fully realize that this doctor is practically “pulling out” the baby from the other world (naturally, in this case, everything depends on the specific pathology that is relevant for him).
There are maternity hospitals designed for healthy mothers and their babies born on time. In addition, there are separate maternity hospitals focused on difficult births, premature births, premature babies, etc. In the conditions of such maternity hospitals, resuscitation and survival of babies are the main tasks, and it is with these that the neonatologist is called upon to cope. In addition, it is important to note that even if we are talking about a normal birth, there is no guarantee that the child, for example, will not develop asphyxia or other unforeseen situations will arise in which urgent help from a neonatologist will be needed.
A neonatologist is the specialist you cannot do without if a baby is born weighing less than 1 kg; moreover, the WHO (World Health Organization) has a recommendation regarding the nursing of children whose weight is from 500 grams, as well as with a weight slightly exceeding this figure, which, again, determines the need for this specialist. Of course, an important point is the availability of appropriate equipment in a particular maternity hospital, however, the technology and data obtained with its help, as is known, are not always an indisputable guide to action or, conversely, to inaction. For this reason, it is so important to include a specialist such as a qualified neonatologist in the list of specialists in preparation for childbirth. He advises the mother on proper bathing and feeding of the baby, choosing formula, walking and sleeping patterns. The pediatrician-neonatologist draws up a vaccination schedule.
What does a neonatologist treat?
Many people call the first month of a child fateful. Restructuring occurs in all organs and systems of the baby. Blood circulation changes, the lungs begin to breathe, the child gets acquainted with new conditions of survival, and this process does not always go smoothly and without problems. Immediately after birth, it is possible to develop diseases that are dealt with directly by a neonatologist. Let us highlight the main ones:
- Albuminuria is a characteristic physiological disorder in the functioning of the kidneys.
- Thrush.
- Constipation (diarrhea).
- Infantile cholera.
- Diaper rash.
- Rashes of various types.
- Blenorrhea of newborns (a disease in which a child's eyes become inflamed).
- Phenylketonuria (congenital metabolic disorder).
- Hypothyroidism (a condition of low thyroid function).
- Umbilical hernia, “wild meat”, bleeding, etc.
- Difficulty breathing. The newborn often takes a breath, but it is difficult for him to exhale. This can last up to 7 days, longer in premature babies.
- Erythema toxicum is an allergic rash of newborns. Most often it goes away without treatment.
- A decrease in temperature or fever in newborns is a violation of the thermal balance due to imperfect thermoregulation of the baby. At low temperatures, it needs to be wrapped up; at elevated temperatures, an enema for newborns with analgin is recommended.
- Stool disorder – immediately after birth, the stool is thick and green. Within 10 days it returns to normal, becoming mushy and yellowish due to the normalization of the activity of beneficial intestinal bacteria.
Also, after birth, a physiological drop in the child’s body weight occurs by an average of 5%.
What does a neonatologist monitor?
Neonatologists monitor the baby’s health and are responsible for its safety. They know everything about developmental disorders, pathologies of newborns and are ready to provide assistance at any time. Its effectiveness depends on many factors; the main task of the doctor is to obtain the most complete information about the identified disorder. Diagnosis is based on studying the condition of the following organs of the newborn:
- Stomach. It is mandatory that the belly is felt by a neonatologist; this measure allows one to determine the condition of the baby’s spleen and liver (including this allows one to determine the size of these organs). During the examination, the doctor determines whether the child had bowel movements (stool) and whether there were any peculiarities in them. It should be noted that during the first day of life, the newborn’s original stool (meconium) is expelled, and if any problems arise with this (more precisely, if this passage does not occur), additional examination may be required. This may be explained by the presence of grounds for the relevance of any congenital pathologies (meconium ileus, cystic fibrosis, etc.). Note that meconium has a thick and viscous consistency, resembles resin (olive or dark green), has no odor, and is sticky.
- Neck. The collarbones are palpated, which makes it possible to ensure that there are no injuries in them that could have occurred during labor; the area of the sternocleidomastoid muscles is also palpated (if the pathology of muscular torticollis is relevant, shortening of the muscle may be noted).
- Head. The neonatologist performs a visual examination of the baby's head, in particular, he palpates the skull bones, determines the size of the fontanelles, and also examines the head area for the presence of a birth tumor (edema). Lungs, heart. Using a phonendoscope, the neonatologist listens to the lungs and heart sounds and examines the baby’s breathing rate.
- Genital organs. When examining boys, the neonatologist palpates the area of the testicles, thereby determining whether they have properly descended to the scrotum. As for the study of girls, the labia majora are examined, and in particular whether they cover the labia minora.
- Muscles. In particular, muscle tone plays an important role in general diagnostics in this area, considered as a fairly important characteristic of the general condition of the baby. As a rule, physiological hypertonicity (that is, increased tone), noted in the flexor muscles, is relevant. This feature is a factor that determines the baby’s posture, in which his head is slightly brought to the chest, the arms are bent at the elbow joints and pressed to the sides. The child's hands are clenched into fists. The legs are bent at the knees and, accordingly, bent at the hip joints. The neonatologist, flexing and extending the child’s limbs (arms and legs), determines the state of the child’s muscle tone based on their current condition.
- Hip joints. And, of course, the neonatologist also does not exclude this area from his sphere of attention. The legs should be adequately separated in the normal state of the hip joints, but if the separation of the legs is difficult, then there is a possibility of dysplasia. There should also be symmetry in the location of the skin folds on the legs.
- Reflexes. Newborns have quite a lot of them, and the assessment carried out by a neonatologist takes into account their main variants.
When should you consult a neonatologist?
Some conditions, such as wild meat, umbilical hernia, or bleeding from the belly button, require you to see this doctor. If blood appears from the umbilical cord during the first hours after birth, it can be argued that it was not bandaged well enough. As a rule, such bleeding stops quite quickly. However, the picture looks somewhat worse when blood appears in the period 3-5 days from the moment of birth of the child when the umbilical section falls off. After the umbilical section disappears, in some cases a piece of meat remains in the navel, resembling a berry on a thin stalk; it is this formation that is called wild meat in the navel.
As for such a pathology as umbilical hernia in children, the cause of its occurrence is either, again, a poorly tied umbilical cord, or the constant cry of the baby, or strong gases.
In addition to the listed conditions, a neonatologist is also contacted if a child develops diaper rash. Most often it is concentrated on the buttocks, genitals and lower part of the child’s abdomen, somewhat less often - in the area of the inguinal, axillary, thigh and axillary folds, behind the ears. Diaper rash can manifest itself in accordance with three degrees that determine its condition. Thus, degree I is characterized as mild, its features include moderate redness of the skin, no visible violation of the integrity of the skin is detected. Stage II is characterized as a degree of moderate severity, in which the redness is already bright, and erosive formations appear on the skin. And finally, grade III, which is characterized as severe. Here the skin is red, weeping, and ulcers may form. Among other things, diaper rash is also susceptible to infection within this degree.
Tests that a neonatologist may prescribe
- Total bilirubin.
- Bilirubin is direct.
- Blood type and Rh factor.
- General blood analysis.
- Immunoglobulin E.
- Allergy panel Ig G.
- Streptococcus A.
- Streptococcus B.
- General urine analysis.
- Coprogram.
- Feces for intestinal dysbiosis.
- Culture a throat swab for staphylococcus.
- Allergy panel Ig E.
- Sowing a nasal swab for microflora.
Other tests may be prescribed if indicated.
In any, even the most severe cases, when a baby is diagnosed with congenital defects and intrauterine infections, examination and research are entrusted exclusively to neonatologists. They know how to take blood from a newborn, calculate the dose of medications or administer an IV.
The need for tests immediately after the birth of a child is dictated by the growing number of serious hereditary diseases. To identify and prevent them, the doctor prescribes three main tests, the purpose of which is to determine the blood type, Rh factor and the presence of serious genetic diseases (neonatal screening). The baby's blood is taken in the maternity hospital. The resulting sample is applied to a test strip and sent to the laboratory. If a genetic disease is suspected, notification of the child’s parents is mandatory. This is done for subsequent contact with an endocrinological clinic or medical genetic consultation, and the development of an effective treatment program for the child. In cases where the diagnosis is not confirmed, no special notice is provided for the child’s parents.
What diagnostic methods does a neonatologist use?
Ultrasound of the hip joints in children, neurosonography in children, echocardiography, visual examination, palpation, thermometry, laboratory tests and other diagnostic methods as indicated.
The baby may refuse to take the breast right away. Ask your nurse to help you. For 2-3 days he will eat on his own.
In the first days of a child's life, the skin is red, dry and wrinkled. Don't be scared! And offer your baby breast and water more often, but make sure there is no overfeeding.
Ventilate the room where the child is located more often. It's good for his lungs.
If you are breastfeeding, review your diet for excess animal proteins. The child’s kidneys are not yet able to cope with them very well. Drink tea, freshly squeezed juices, compotes.
Do not invite guests to your house right away; postpone the celebration of such an important event for a week in advance. Strangers can frighten the baby.
A neonatologist is the first doctor in your child’s life. Its development depends on how you follow the recommendations given by the neonatologist in the maternity hospital.
It is during the neonatal period that the baby’s body adapts to new living conditions and the functions of all organs and systems become established. These processes must be monitored very carefully.
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Depending on the gestational age at the time of birth, full-term, premature and post-term babies are distinguished.
The first group includes those born after the 38th and before the 40th week of pregnancy, the second - those born between the 28th and 38th, the third - after the 40th week of pregnancy and with signs of overmaturity. And besides, children from all of the listed categories may be immature: their organs and systems, to one degree or another, are not able to independently support vital processes. It is precisely these crumbs that a neonatologist should deal with.
How did the profession of “neonatologist” appear?
According to Order of the Ministry of Health of Russia dated October 7, 2015 No. 700-“On the nomenclature of specialties of specialists with higher medical and pharmaceutical education,” there are positions “neonatology” (clause 37) and “pediatrics” (clause 49). The word “neonatology” arose from two different linguistic roots: the Greek véoc (new) and the Latin natus (birth). Science was transformed into a separate section at the beginning of the 20th century.
The term itself was first proposed by American pediatrician Alexander Shaffer in 1960 in a guide for doctors, “Diseases of the Newborn.” In the 1960s, with the advent of equipment for artificial ventilation of newborns, the development of neonatology began. This made it possible to fight for the survival of children with increasing degrees of prematurity. In a modern neonatal unit, infants weighing 1000 g born after 27 weeks of gestation have approximately a 90 % chance of survival. In Russia, the medical specialty of pediatrician-neonatologist officially appeared in 1987. Usually, expectant mothers carefully choose a gynecologist and obstetrician who delivers the baby. But for some reason they forget to ask if the maternity hospital has a full-time neonatologist. But the life and health of the newborn is literally in the hands of this specialist. In specialized maternity hospitals dealing with complicated births, neonatologists are required to attend them.
What do neonatologists do?
A neonatologist is a general practitioner who must distinguish and identify the symptoms of various diseases and developmental disorders. Its task is to examine all organs and systems of the baby to identify pathologies. The competence of a neonatologist includes assessing the health status of a newborn using the Apgar or Silverman scales - systematized criteria for height, weight, and body reactions, on the basis of which the level of health of the newborn is determined. Based on the results of the first examination, doctors decide on further actions: determine whether the baby needs resuscitation measures and which ones. When treating small children, it is prohibited to use standard drugs and methods used for adults. In difficult cases, a council of doctors gathers, where the chief neonatologist of the medical institution is present.
At first glance: what should a neonatologist check after the baby’s first cry?
Immediately after the first cry, the neonatologist acts according to plan and checks:
- Stomach. It is mandatory to palpate, which allows you to determine the condition of the baby’s spleen and liver and determine their size. The doctor checks whether the original stool (meconium) has passed and what its structure is. This eliminates meconium ileus, cystic fibrosis and other pathologies. Normal meconium has a thick and viscous consistency, resembles olive or dark green resin, is odorless, and sticky.
- Neck. The collarbones and the area of the sternocleidomastoid muscles are palpated for damage during labor, such as torticollis. ] Head. The doctor checks the bones of the skull, determines the size of the fontanelles and the presence of a birth tumor (edema).
- Lungs, heart. Using a phonendoscope, the neonatologist listens to breathing and heart sounds.
- Genitals. When examining boys, it is determined whether the testicles have descended into the scrotum. In girls, they check whether the labia minora are covered by the labia majora.
- Muscles. Their tone is an important characteristic of the general condition of the baby. In newborns, the muscles are normally in a state of tension, due to which the head is tilted towards the chest, the arms are bent at the elbows and pressed to the sides, the hands are clenched into fists, the legs are bent at the knees and hips.
- Hip joints. The symmetry of skin folds is checked. The legs should move apart normally: if there are difficulties, dysplasia cannot be ruled out.
- Reflexes. The neonatologist is interested in those that “wake up” earlier than everyone else.
After 28 days
Usually, the baby is discharged from the maternity hospital on the 3rd–5th day after birth, depending on several circumstances. The most important thing is weight. During the first days of a child's life it decreases. The losses are justified and considered normal, because the baby’s stay in new conditions is not as comfortable as it was in the mother’s womb. And change is not easy to get used to. Now the baby spends its own energy on heating the body, digesting food and breathing. As soon as adaptation improves and the baby stops losing weight, the neonatologist will be able to “hand over” the healthy newborn to the pediatrician, who will continue to monitor the development of the toddler. But if problems arise with the health of the newborn, and the baby is not yet 28 days old, he can make an appointment with a neonatologist. Among the most common reasons:
- suppuration or bleeding of the umbilical wound;
- umbilical hernia;
- breathing problems;
- weakening of basic reflexes;
- diaper rash, skin discoloration, pigmentation, rash.
It is a fact
It is the neonatologist who prescribes, and sometimes himself, conducts the first three blood tests of a newborn - to determine the group, Rh factor and for neonatal screening. In the maternity ward, the neonatologist must examine the child wearing disposable gloves and a medical mask. When starting to examine a child at home or in a clinic, the doctor puts on a clean gown, removes rings, watches, bracelets, bares his hands to the elbows and washes them with bactericidal soap.
What does a neonatologist treat?
There is a list of newborn diseases that the first pediatrician should treat. Here are the main ones:
- thrush;
- diaper rash;
- bronchitis;
- jaundice;
- diarrhea and constipation;
- vomit;
- inflammation of the eyes (blennorrhea of newborns);
- rash of various types;
- congenital metabolic disorders (phenylketonuria);
- decreased thyroid function (hypothyroidism);
- short frenulum of the tongue;
- umbilical hernia, umbilical bleeding, etc.
Neonatologist. What does a neonatologist do? Consultation with a neonatologist. Neonatal pathology
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Make an appointment with a Neonatologist
Who is a neonatologist?
Neonatologist is a specialist with a higher medical education, specializing in neonatology. In turn, neonatology is a branch of medicine that studies the development of the newborn. Thus, a neonatologist is a doctor involved in the prevention and treatment of pathologies in a newborn ( baby up to one month of life), as well as monitoring its development in normal and pathological conditions. Neonatology as a science has emerged recently and is a kind of branch in pediatrics. However, if a pediatrician deals with children throughout their growing up, then the competence of a neonatologist includes the treatment and prevention of pathology in children in the first four weeks of life. This period in a child's life is called neonatal. Directions in neonatology are:
- methods of rehabilitation of premature babies and their care;
- modern aspects of breastfeeding;
- study of the child’s immunity in the neonatal period;
- studying the mechanisms of adaptation of a newborn child’s body to external conditions;
- study of hereditary diseases;
- creation of modern methods of resuscitation of newborn children.
How long does it take to study to become a neonatologist?
You have to study to become a neonatologist no less than to study for other specialties. However, for this it is initially necessary to obtain a general medical education, the duration of which is 6 years. This should be followed by an internship in the specialty of neonatology. In different countries it lasts differently and can last up to 3 – 4 years. A neonatologist can also be a pediatrician, resuscitation specialist or cardiologist. Neonatologists work, as a rule, in maternity hospitals, in the departments of premature babies of republican clinics and perinatal centers. Private practice is not typical for this specialty.What does a neonatologist do?
As mentioned above, a neonatologist is involved in nursing newborn children, as well as treating and preventing diseases in the neonatal period ( during the first 28 days of a child's life). The nursing period begins from birth. So, when labor begins, the neonatologist is assigned to a group on duty, which includes an obstetrician, a nurse, a gynecologist, and, depending on the level of the institution, a surgeon and an anesthesiologist. The task of this team is to carry out childbirth in a qualified manner. If childbirth proceeds without pathology, then the main task of the neonatologist is to examine and initially clean the newborn.Reflexes of a newborn
Normally, a newborn has a certain range of reflexes that are innate. As the child grows and develops, he will develop a number of others, which will be called acquired.
Newborn reflexes include:
- sucking reflex– manifested by the fact that in response to irritation of the lips the child responds with sucking movements;
- hand-mouth reflex– when pressing the palms, the baby opens his mouth;
- Robinson's grasp reflex– if you place your thumb in the child’s palm, the hand contracts;
- support reflex– when positioning the child vertically ( At the same time, the baby’s head adheres well) legs bend;
- protective reflex– Once lying on his stomach, the child turns his head to the side.
The shape and size of the head is one of the first things you should pay attention to. A newborn child is characterized by a predominance of the cerebral part of the head over the facial part. Head circumference varies from 32 to 37 centimeters. In premature babies, the brain-to-facial ratio may be even greater. The bones of the skull are not fused, the large fontanel is normally open. The large fontanelle is the non-ossified area of the cranial vault. At birth, its size varies from 1 to 2 centimeters. As the baby grows and develops, the bones of the skull will ossify and the large fontanel will close. The condition of the fontanel may vary depending on the concomitant pathology. Thus, with increased intracranial pressure ( may occur with meningitis or congenital hydrocephalus) the fontanel bulges; when dehydrated, on the contrary, it sinks.
Since the bones of the skull are soft and pliable, the shape of the head can change. Thus, depending on the characteristics of the course of labor, the shape of the head may be asymmetrical, elongated from front to back ( dolichocephalic) or, conversely, short ( brachycephalic). Normally, the baby's head can return to its normal shape by the end of the first week of life.
Newborn's eyes
After birth and during the first days of life, a newborn's eyes are almost always closed. They close spontaneously and open when rocked. In full-term healthy babies, the sclera is always white. In premature babies they may take on a bluish tint. During a traumatic birth, small capillaries of the conjunctiva may burst, which will be accompanied by pinpoint hemorrhages. This can occur even in healthy children.
Oral cavity
An examination of the oral cavity must be carried out without fail to exclude such congenital anomalies as cleft lip and cleft palate. These pathologies are characterized by the presence of a cleft in the hard palate. Normally, small bubbles of water may be present in the oral cavity ( cysts). So, the presence of a cyst at the bottom of the mouth is not a deviation from the norm. Small cysts are also normal ( which are also called Epstein pearls) can be fixed on the hard and soft palate.
As a rule, a newborn child has no teeth. Natal teeth ( teeth at birth) are observed in one child in 4000 newborns.
Color of the skin
Skin color is often the main indicator of pathology in a newborn. So, normally a newly born baby has a dark red, sometimes purplish coloration of the skin ( called plethora). Jaundice discoloration of the skin in the first 24 hours after birth is not normal, but may indicate hemolytic disease of the newborn or an intrauterine infection. Pale skin color may indicate anemia ( decreased concentration of hemoglobin and red blood cells) or pathology of the cardiovascular system.
Of particular importance is the bluish coloration of the baby’s skin, which is also called cyanosis.
Types of cyanosis in newborns are:
- central cyanosis- characterized by a bluish coloration of the skin, lips and tongue; this type of cyanosis is observed with congenital heart defects;
- peripheral cyanosis– bluish discoloration of the skin, but the lips and tongue remain pink; noted in congenital methemoglobinemia;
- acrocyanosis– bluish tint of the skin in the area of the nose, hands and feet ( that is, in the distal parts of the body); may indicate pulmonary and cardiac pathology.
In addition to pathological cyanosis, other skin phenomena that are not pathology may be observed. One such phenomenon is Mongolian spots, which are blue spots located in the buttock area. Telangiectasia and milia are also not pathologies. The first are small reddish spots, which are nothing more than a local dilation of blood vessels. Unlike pathological hemangioma, telangiectasia disappears with pressure. Miles are represented by yellow dots located on the wings of the nose or nasolabial triangle.
Physical activity
During the examination, the neonatologist also evaluates the baby’s motor activity. In a healthy full-term baby, the movements are chaotic, large-scale, but, at the same time, symmetrical. In premature infants, slow activity is combined with spontaneous, stereotypically repetitive movements.
Main pathological syndromes in a newborn
During an examination by a neonatologist, the main pathological syndromes are identified. These syndromes are not permanent and can regress as the baby grows. This means that if a baby was born with intracranial hypertension, this does not mean that it will accompany him throughout his life.The main pathological syndromes in newborns are:
- central nervous system depression syndrome;
- syndrome of increased neuro-reflex excitability;
- convulsive syndrome;
- intracranial hypertension syndrome.
This syndrome is characterized, first of all, by the lethargy of the newborn, a weak response to external stimuli and a sharp decrease in motor activity. Depending on the degree of damage to the nervous system, innate reflexes may also be suppressed ( for example, sucking or swallowing reflex). Depending on the depth of damage to the central nervous system in newborns, three main syndromes are distinguished.
The degrees of depression of the central nervous system are:
- lethargy;
- stunned;
- stupor;
Lethargy is a phenomenon when a child is almost always asleep. He can wake up for a while ( for example, during an inspection), but then go back to sleep. Motor activity is completely absent, reflexes are reduced until they are completely absent. Such children are fed through a tube.
Stunned
The child reacts poorly to external stimuli - light, sound, touch. He may respond to tactile stimuli by changing his grimace or frowning. He may react to bright light by closing his eyes. The corneal and pupillary reflex was preserved.
Stupor
During a state of stupor, the child reacts only to painful stimuli. Such an irritant could be a prick with a dull needle. Muscle tone is sharply reduced, resulting in a frog pose. The pupillary and corneal reflex are also preserved.
Coma
It is the deepest degree of depression of the central nervous system. During this condition, the child does not even respond to painful stimuli. In turn, the coma itself can be of several degrees of severity. Thus, in first-degree coma, brainstem reflexes ( corneal and pupillary) are preserved, with a second-degree coma the corneal reflex disappears, and with a third-degree coma both brainstem reflexes disappear, the pupils are fixed ( do not respond to light). The total absence of reflexes indicates serious damage to the cerebral cortex.
Syndrome of increased neuro-reflex excitability
Characterized by increased excitability and motor disinhibition. During examination by a neonatologist in response to any stimulus ( touch, sound, light, turning over) the child responds with a piercing cry, shuddering, trembling. In this case, muscle tone is usually increased, and large-scale tremor is recorded in all extremities. In the future, such children sleep little and feeding them is difficult.
Convulsive syndrome
Another one of the most common syndromes in newborns, which manifests itself as polymorphic ( diverse) convulsions. Another name for seizures is convulsions or paroxysms. How seizures manifest in a newborn depends on their form.
Variants of convulsions in newborns are:
- focal and multifocal clonic seizures;
- tonic convulsions;
- myoclonic spasms;
- minimal seizures or convulsive equivalents.
Tonic convulsions are characterized by a painful spasm ( muscle tension) in certain muscle groups. Most often observed in premature babies. In tonic paroxysms, the focus is usually located in stem cells. Also, tonic convulsions can be a manifestation of oxygen starvation ( hypoxia) brain, hypoglycemia ( decreased blood glucose levels).
Myoclonic spasms are irregular, sudden jerks in various muscle groups. This type of seizures is often observed in newborns with abnormalities in brain development and metabolic disorders.
Intracranial hypertension syndrome
It is one of the most common pathological syndromes in newborns. The clinical picture depends on the degree of increase in intracranial pressure. With a moderately severe syndrome, motor restlessness, frequent regurgitation, and bulging of a large fontanel are noted. With severe intracranial hypertension, irregular breathing with apnea is observed ( stops), yawning, convulsions.
Neonatal pathology
Neonatal pathology covers a wide range of pathologies, from prematurity to birth trauma. It also includes congenital abnormalities of the respiratory, cardiovascular and nervous systems. The main problem in neonatology is also prematurity. Premature newborns
Premature babies are those babies who are born prematurely. The degree of prematurity is inversely proportional to the gestational age - the shorter the gestational age, the deeper the prematurity. Prematurely born children are distinguished not only by low body weight, but also by the underdevelopment of many organs and systems.Causes of prematurity include:
- concomitant pathologies in the mother– anemia, pyelonephritis, rheumatism, degenerative changes in the placenta;
- intrauterine infections– both past viral infections and chronic sexually transmitted infections;
- endocrine diseases- diabetes;
- mental and physical trauma during and before pregnancy;
- bad habits- alcoholism, smoking;
- socio-economic reasons– low level of medical care.
Features of the early developmental period in premature infants
At the time of birth, premature babies have poorly developed reflexes, including sucking. This creates certain problems in caring for such children. Therefore, moderately and extremely premature infants are often transferred to parenteral nutrition ( tube feeding). In the absence of concomitant pathologies, the sucking reflex develops by the end of the first or second week. Also, 90 percent of premature babies have jaundice at birth ( normally it develops on the second or third day).
Another problem of premature babies is their inability to maintain body temperature. Therefore, their main problem is often the prevention of hypothermia. The main method of maintaining body temperature in such children today is the method of nursing in incubators.
Indications for nursing in an incubator are:
- body weight less than 2 kilograms;
- asphyxia during childbirth;
- birth injuries;
- accompanying pathologies - edema, aspiration syndrome.
Asphyxia ( hypoxia) during childbirth
Asphyxia ( oxygen starvation) is the main pathology that damages the brain. A synonym for asphyxia in neonatology is the term hypoxia. Despite the fact that it is a universal damaging factor, asphyxia is recorded very often. At the same time, this term is the most inaccurate in this science. After all, asphyxia is translated from Greek as suffocation, which literally means a stillborn child. However, in general clinical practice, this term refers to the absence or lack of gas exchange in the child’s lungs after birth.Asphyxia can be acute ( when the lack of oxygen is fixed for several minutes) and chronic. All causes of asphyxia, one way or another, are associated with insufficient blood supply. This is explained by the fact that red blood cells ( blood elements) are the main carriers of oxygen in the body. This happens due to the ability of the iron contained in hemoglobin to accept and release oxygen.
The causes of asphyxia in newborns are:
- Lack of blood flow through the umbilical cord to the fetus. The reason for this may be umbilical cord knots, tight entanglement of the umbilical cord around the child.
- Premature placental abruption, which leads to insufficient gas exchange in it and, as a consequence, to insufficient blood supply to the fetus.
- Low hemoglobin content and, as a result, oxygen in the mother’s blood. This may be due to anemia, cardiovascular pathology and other diseases of the woman.
- Concomitant fetal pathology– congenital anomalies of the pulmonary and cardiovascular systems.
Thus, neonatal asphyxia ( hypoxia) manifests itself as multiple disorders of the internal organs and the nervous system.
Clinical picture of neonatal asphyxia
Birth injury
The term “birth injury” refers to a violation of the integrity of the tissues and organs of the child that occurred during childbirth. Examples of birth trauma are fractures of the skull, limbs, and collarbones. More often than other pathologies, birth injuries are accompanied by neonatal asphyxia ( hypoxia), which can also develop independently.Risk factors for birth trauma are:
- breech and other pathological presentations of the fetus;
- large fetal size;
- protracted or, conversely, rapid labor;
- deep prematurity;
- fetal development abnormalities;
- increased rigidity ( "inflexibility") birth canal ( for example, in elderly primiparas);
- obstetric maneuvers - turning on the leg, applying obstetric forceps, vacuum and other devices.
The clinical picture of birth injury depends on the type of injury and its duration. Thus, the most common injuries are soft tissues, the manifestations of which are petechiae and ecchymoses. Petechiae and ecchymoses are nothing more than hemorrhages of small vessels in tissue as a result of their damage. Such abrasions can occur in a wide variety of areas of the body and are the most common manifestation of birth trauma. Another type of birth injury is a birth tumor. A tumor is a swelling of the soft tissues of the head, usually at the site where the vacuum extractor was applied. It can also develop with cephalic presentation of the fetus. The tumor has a bluish tint with many petechiae ( pinpoint hemorrhages). This birth injury does not require treatment and goes away on its own in 1 to 3 days. A variant of the generic tumor is cephalohematoma, but unlike the first, it is a more serious pathology that requires treatment.
A cephalohematoma is a hemorrhage under the periosteum in any part of the skull. It takes on clear outlines a few hours after birth. Cephalohematoma is characterized by an elastic consistency and clear boundaries. It never moves to the adjacent bone, does not pulsate even with careful palpation ( feeling) is painless. The skin over it is also not changed and, unlike the birth tumor, is not covered with petechiae ( hemorrhages). Complete resorption of the cephalohematoma occurs by 6–8 weeks.
The cause of this birth injury is subperiosteal hemorrhage due to periosteal detachment. To exclude a skull fracture, children with large cephalohematomas undergo an X-ray of the skull to exclude a fracture. It happens that cephalohematoma is the first symptom of hereditary coagulopathy ( hereditary bleeding disorder).
Treatment is reduced to a single injection
A neonatologist is a pediatrician who works in departments for newborns and premature babies in maternity hospitals and hospitals. This specialist works with the youngest children, who are not yet 28 days old. During this period, the neonatologist tries to identify those diseases that can later become chronic or make the child disabled. This doctor deals not only with babies, he is a general specialist, because in his line of work he encounters a wide variety of diseases of organs and systems. In addition, this specialist is also an obstetrician and diagnostician.
Area of expertise
After the baby is born, the neonatologist conducts a thorough examination of the baby. The main bodies that the above specialist pays special attention to are:
- Head. During the consultation, the neonatologist palpates the bones of the child’s skull, determines the size of the fontanelle, and also looks to see if there is a birth tumor (edema).
- Neck. During the examination, the neonatologist palpates the sternocleidomastoid muscles and collarbones to ensure that they were not damaged at the time of birth.
- Heart and lungs. Using a phenendoscope, the doctor carefully listens to the sounds, rhythm of the baby’s heart and lungs (breathing frequency).
- Tummy. During the consultation, the neonatologist must palpate the newborn’s tummy and check the size of the liver and spleen. In addition, the doctor asks the mother about the baby’s stool.
- Genital organs. In girls, a specialist in the field of neonatology examines the labia (the labia majora should cover the labia minora), and in boys he palpates the testicles to make sure that they have descended into the scrotum.
Also, during the consultation, the neonatologist pays special attention to the baby’s muscle tone (after birth, all babies experience muscle hypertonicity), legs (they should move easily and be symmetrical) and basic reflexes (Babinski, crawling, proboscis, searching, grasping and automatic gait) .
Analyzes
- neonatal screening;
- blood group test;
- analysis for Rh factor.
In addition, the doctor must take a blood sample from newborns in the maternity hospital, which is applied to a special test strip. These test strips are tested in the laboratory for PKU and CH. If medical professionals suspect a disease, parents are notified immediately.
What does a neonatologist treat?
A neonatologist specializes in the treatment of newborn jaundice, vomiting, diaper rash, thrush, constipation, rashes, diarrhea, and bleeding from the navel. Also within his competence are such diseases as “wild meat”, umbilical hernia, infantile cholera, bronchitis, blenorrhea (purulent inflammation of the eyes), phenylketonuria and hypothyroidism. This specialist eliminates problems associated with the frenulum of the tongue.
Reason for consultation
Parents should urgently consult a neonatologist if their child has:
- Umbilical hernia. It usually occurs as a result of gas, a strong cry from the child, or a poorly tied umbilical cord.
- Bleeding from the navel or “wild meat”. Blood from the umbilical cord in the first few hours after birth indicates that the umbilical cord was poorly tied.
- Intertrigo. Most often, diaper rash is localized in the genital area, buttocks, groin, armpits, lower abdomen and behind the ears.
Neonatologist is a doctor who deals with the health of newborn children. The neonatal period lasts from birth to 28 days. Neonatologists also work in perinatal centers, where small children can be admitted even after the 28th day of life.
The fact is that when a woman is about to give birth, she learns from her friends about good gynecologists and obstetricians, and studies maternity hospitals. All this is true, the outcome of the birth often depends on how qualified the doctor, obstetrician is, and how modern the maternity hospital is equipped.
But often the child’s life depends on a good professional neonatologist. By assessing the condition of the newborn using the Apgar scale, the doctor sees whether the child needs medical attention. Sometimes women in labor don’t even understand that their baby is being resuscitated and pulled out from the other world.
There are maternity hospitals focused on healthy mothers and children born on time; they don’t even have a pediatric intensive care unit. And some maternity hospitals specialize in premature babies, premature births, difficult births, etc. There, resuscitating and caring for children is the main task of the doctor. But even a normal birth cannot guarantee that the child will not have asphyxia and will not need urgent help. neonatologist.
And here I want the woman to think about the qualifications of the doctor on whom the life of the child may depend. Gynecologists with a name work mainly with good neonatologists; it is important for them to maintain their image and not have the death of a child on their account. When negotiating the cost of childbirth, it is worth asking whether the neonatologist’s fee is included.
When a child is born weighing more than 1 kg (1000 g), the chances of survival with the modern level of medicine are high. The World Health Organization recommends nursing babies born weighing more than 500 grams. True, the equipment and the appropriate level of training are not available in all maternity hospitals.
This is a difficult job, since a neonatologist has to deal with newborns or premature babies, but they cannot tell and show where it hurts and what is bothering them. Doctors work according to protocols, but intuition and gut instinct, understanding the child, are also important.
It is wrong for this profession to remain “out of frame,” that is, unnoticed. Great love for his work and responsibility forces the neonatologist to look, think, analyze and still save those who seem doomed.
When choosing a maternity hospital and an obstetrician, it is always worth asking about a good neonatologist, maybe his work will be the most important on the day of birth.
This is what a neonatologist is!
