Analysis of the incidence of newborns. Perinatal pathology in Russia: level, structure of morbidity

The health of the population is an indicator of external and internal social well-being, as well as an indirect indicator of national security. The state of health of children reflects the level of realization of the biological potential of the nation and is a "mirror" of the processes taking place in society. According to Academician A. A. Baranov et al., the mode of population reproduction in many regions Russian Federation close to critical. Decreased standard of living, deterioration in accessibility medical care manifested itself in low birth rates, stabilization of high rates of infant and child mortality, negative natural population growth in most territories of Russia, deterioration in the quality indicators of the health of the child population. For more than 25 years, persistent adverse trends in the health status of children and adolescents in Russia have persisted. According to Rosstat, over 12 years (2000-2011) the primary incidence of children aged 0-15 increased by 32% (from 146,235.6 to 193,189.9 per 100,000 child population) . The analysis of child morbidity makes it possible to objectively assess the situation in the region, which contributes to the development modern approaches to their prevention. Based on this, the purpose of this study was to study the dynamics of indicators of physical development and the prevalence of diseases according to the data on the appealability of children of the first year of life in the outpatient clinic link.

Material and methods. A study was made of the health status of children of the first year of life, who were under observation on the basis of the Samara City Polyclinic No. 3" (Samara) for the period 2012-2014. The incidence of children was studied by applying to the children's polyclinic and by clinical observation during the study. A comprehensive assessment of the state of health was based on the conclusions of specialists in outpatient documentation, on extracts from the medical records of hospitals, laboratory and instrumental examination. To assess the main trends in the health status of children in the first year, we used data on the distribution by health groups at the beginning and end of the reference year, breastfeeding coverage, and morbidity.

A comparative analysis of the age structure of the child population in the pediatric area showed a steady upward trend in the number of children over the period 2012–2014. (from 815 to 835 people). Attention is drawn to significant differences in the dynamics of indicators: in 2014, in comparison with 2012 and 2013. the number of children in the first year of life increased by 15% (Figure 1).

Rice. Fig. 1. Age structure of the child population in the pediatric area for the period 2012–2014.

A comparative assessment of the distribution of newborns by risk groups revealed a significant increase in the number of newborns at risk of developing CNS pathology and with the risk of intrauterine infection over the period 2012–2014, which is associated with an increase in the prevalence of infectious and inflammatory diseases in women of reproductive age, including the urogenital area . According to literary sources, the incidence of newborns in the early neonatal period in the presence of urogenital infection in mothers ranges from 50–100%; in our study, 85–95%. A slight increase in newborns with a risk of developing congenital malformations of organs and systems and hereditary diseases from 40% to 45% was revealed (Table 1).

Distribution of newborns by risk groups for the period 2012–2014

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A study was conducted on the forms of 112 in children born in 2013 and 2014. An assessment of physical development was carried out according to centric tables at the age of the first year and the incidence of these children according to the medical examination sheet in the first year, depending on the types of feeding. The data obtained is shown below.

Obstruction of the digestive organs

Obstruction of the genitourinary system

The table shows that diseases of the respiratory organs (ARVI) predominate in the structure of morbidity. Other diseases include iron deficiency anemia. Iron deficiency anemia most often affects children after 6 months, here the ratio of children who are breastfed and artificially fed is 1: 1, since after 6 months mother's milk does not fully satisfy the body's need for iron.

After the release of the "National program for optimizing the feeding of children in the first year of life" in the Russian Federation in 2011, work was intensified in the clinic and at the site to encourage breastfeeding, conferences are regularly held with paramedical workers, health bulletins are issued, and conversations are held in the KZR (healthy child's office) for parents. I decided to find out how effectively and actively the national program is being implemented in healthcare practice using the example of a pediatric site.

I analyzed the Child Development Histories (Form 112-y) of children born in 20013-2014.

The purpose of the study of child development histories (in form 112y): establish the dependence of indicators of physical development and morbidity on the type of feeding.

For 2 years, 180 children were born at the site, of which:

From the above data, it can be seen that there is a decrease in the birth rate every year.

All children were divided according to the types of feeding.

Distribution structure of children in the first year of life by types of feeding in percent

Analyzing the data presented in the diagrams, we can say that there was no significant increase in the number of children receiving breast milk for at least 6 months compared to 2013, however, the number of children who did not receive breast milk up to 3 months.

There was an increase after the issuance of the order in the number of children receiving breast milk for at least 3 months, which may indicate targeted work carried out in maternity hospitals and during the neonatal period at the pediatric site to support breastfeeding.

Comparative characteristics of types of breastfeeding in 2014 in percent

Having studied the dynamics of types of feeding on the site, I tried to analyze the relationship between the nature of feeding in the first year of life and indicators of physical development.

I evaluated the indicators of physical development:

According to centile tables, data that were recorded in the Child Development Histories (Form 112-y) at the age of 12 months of life.

Analyzing the data of the centile tables, I divided all the children into 3 groups:

Medium development (corridor 4)

Above average (5,6,7 corridor)

Below average (corridor 1,2,3)

The data obtained are presented in diagrams:

Distribution of children by level of development (body weight) depending on the type of feeding

The data obtained indicate a high percentage of children in breastfeeding, with average indicators of body weight gain, and more children who are artificially fed have indicators below the average (50%).

Distribution of children by level of development (body length) depending on the type of feeding

Distribution of children by level of development (chest circumference) depending on the type of feeding

The data obtained indicate that breastfeeding growth rates are of average development (68.4%), 33% of formula-fed children have growth rates above average, which corresponds to the literature data.

The increase in chest circumference is the least dependent on the nature of feeding. Determining the level of physical development according to individual indicators of anthropometry turned out to be more informative than determining the somatotype, since three indicators are summed up when determining the somatotype, and as a result, more than 80% of my children had a mesosomatotype on different types of feeding. Therefore, I decided to conduct an analysis on individual indicators of anthropometry.

Analyzing the harmony of development, I was able to establish that children on artificial feeding in 62% have disharmonious development, on breastfeeding, disharmonious development is observed in 28% of children.

Distribution of children according to harmonious development on different types of feeding

The next step in the analysis of the Child Development Histories was the identification of the incidence rate of children in the first year of life in the area, depending on the type of feeding.

The health index was 24%. The average figure for the city of Omsk for 2014 is 20%. In artificially fed children, it was 22.5%, and in breastfed children, it averaged 24.5%. Analysis of the data obtained showed that 42% of breastfed children suffer from allergic diseases (most often atopic dermatitis).

I believe that this figure can be reduced if, during prenatal patronage for pregnant women, newborns and infants, more carefully collect anamnesis, teach mothers to keep a food diary, familiarize them with products - obligate allergens. In 16% of children at the site, dysbacteriosis was detected; there is no clear dependence on the nature of breastfeeding.

But intestinal infections and acute digestive disorders in children who have been breastfed for at least 6 months are 2 times less common than in artificial feeding and in children who receive mother's breast only up to 3 months. I think that in these families it is necessary to pay more attention during conversations to the following questions:

Sanitary epidemic regime

Rules for the preparation and storage of mixtures

Rules for feeding canned baby food

Rules for handling bottles and nipples

The incidence of SARS and otitis media is almost equally common in breastfed and formula-fed children. When analyzing the incidence of iron deficiency anemia, there is a clear dependence on the nature of feeding. As can be seen from Figure 8, iron deficiency anemia (IDA) occurs almost 2 times more often in formula-fed children and in early transition to artificial feeding.

Morbidity on different types of feeding (per hundred children)

Indeed, in children who were breastfed, there are much less allergic diseases.

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Abstract and dissertation in medicine (14.00.09) on the topic: The state of health of children in the first year of life and the prevention of diseases at the outpatient stage

Dissertation abstract in medicine on the topic The state of health of children in the first year of life and the prevention of diseases at the outpatient stage

Raikova Natalya Mikhailovna

FIRST YEAR OF LIFE AND DISEASE PREVENTION AT THE OUTPATIENT STAGE

dissertations for the degree of candidate of medical sciences

The work was carried out in GOU VPO "Samara State medical University Federal Agency for Health and social development»

Scientific adviser: Doctor of Medical Sciences, Professor

Official opponents: MD, professor

Candidate of Medical Sciences Sapunkova Yu.A.

Lead organization: Research Center for Children's Health of the Russian Academy of Medical Sciences, Moscow

The defense of the dissertation will take place 2 0.05.

Evaluation of neuro- mental development of patients showed that the delay in the formation of motor skills in the main group was less (4±2.9%) than in the control group II (20±5.9%), the difference is significant at p=0.049 (Fisher's test).

Children of the main group developed speech better: the difference in the lag in the formation of speech skills in the main (11±4.7%) and control group P (30±6.7%) was significant at p=0.038 (Fisher's test). In the main group, there were fewer children with a delay and more with an advance in speech development than in the control P, we noted a significant difference in the advance in the speech development of children in the main (22±6.2%) and control group II (7±3.4%) Pearson's test = 4.22 at р1^ 3 Raikova, Natalya Mikhailovna:: 2005:: Samara

CHAPTER 1. PREVENTIVE WORK WITH CHILDREN OF EARLY AGE AT THE OUTPATIENT STAGE. FACTORS DETERMINING CHILDREN'S HEALTH (REVIEW OF THE LITERATURE).

health during the antenatal period and in the first year of a child's life.9

1.2 The concept of health and a healthy child. Health groups, directed risk groups of children of the first year. Factors affecting children's health.14

1.3 Organization of medical and preventive care for young children in the system of outpatient practice.25

1.4 Prenatal education of future parents is a new step in the development of preventive medicine in a children's clinic.35

CHAPTER 2. RESEARCH METHODS.39

2.1 Methods used in the study.39

2.2 Clinical characteristics groups included in the study 45

2.3 The program and methodology of prenatal education at the school of positive motherhood "Modern parents"57

2.4 Statistical processing of the obtained results.61

CHAPTER 3. FORMATION OF THE HEALTH OF CHILDREN IN THE FIRST YEAR OF LIFE, DEPENDING ON THE METHOD OF MEDICAL SUPPORT OF THE DIAD "MOTHER AND CHILD" IN THE CONDITIONS OF THE CHILDREN'S POLYCLINIC (OWN RESEARCH)65

3.1 Comparison of health indicators of children at the age of one year in the three groups of the study, who had different organized preventive supervision.65

3.2 Analysis of breastfeeding in the study.75

3.3 Analysis of morbidity and hospitalization of children during the first year of life.81

3.4 Analysis of the formation of doctor-mother-patient relations depending on the method of medical support of the dyad

Chapter 4

PREVENTIVE DIRECTIONS IN CHILDREN'S POLYCLINIC. FORMATION OF A NEONATOLOGICAL SERVICE IN

At all times, the health of the nation was determined by the health of the younger generation. Improving the health indicators of the child population has always remained one of the urgent problems of medicine (Veltishchev Yu.E., 1998). Maternal and child health, prevention and reduction of maternal, infant and child morbidity, disability and mortality are the most important medical social problems society and state (Shabalov N.P., 2002, Savelyeva G.M., 2003). At the same time, it is obvious that one of the leading causes of progressive deterioration in health is the ineffectiveness of many preventive and corrective measures to preserve, strengthen and restore the health of children. Besides, in last years the level of financing of preventive directions of the system of protection of motherhood and childhood is extremely insufficient. This determines the need to introduce existing and develop new effective integrated medical, psychological, pedagogical and social technologies for the prevention of health improvement, treatment and rehabilitation of children (Baranov A.A., 2003). The need to develop a preventive program for monitoring a child of the first year of life at the outpatient stage in conditions of limited funding makes this work relevant.

The purpose of this work is to improve the health indicators of young children, the formation of the right parent-child relationship.

1. To study the influence of social, biological risk factors of a pregnant woman, as well as her psychological readiness for motherhood, on the health indicators of a child in the first year of life.

2. To study and substantiate the importance of prenatal education of pregnant women for the formation of a child's health at the outpatient stage of a children's polyclinic.

3. Develop and implement new organizational methods of preventive direction in work with pregnant women and children of the first year of life in a children's clinic.

4. Develop and implement a preventive program for monitoring and developing children in the first year of life at the outpatient stage.

5. To evaluate the effectiveness of the proposed preventive program for monitoring a young child in a children's clinic.

For the first time, it was proposed to improve the provision of neonatological care in the pediatric department of a city polyclinic by strengthening the continuity of medical supervision of pregnant women and newborns, improving the package of documents for prenatal care of pregnant women, and expanding the duties of a neonatologist.

For the first time, an effective model of interaction between a doctor and a child of the first year of life and his mother is presented, in which the passive position of parents in shaping the child's health is translated into an active one.

MAIN PROVISIONS OF THE THESIS TO BE DEFENDED

1. The main factors that positively influenced the health indicators of newborns of the II health group when they reached one year of age were the favorable relations of parents in the family, the high educational level of mothers, an effective educational program of parents before and after the birth of a child, and strengthening the preventive section of work with young children .

2. Improvement of neonatological care in the conditions of the pediatric department of the polyclinic included the improvement of the package of documents for prenatal care of pregnant women, monitoring of care for pregnant women and newborns, expansion of the neonatologist's functional duties, and the introduction of an educational program for future parents.

The results obtained, confirming the main factors in the formation of the health of young children, make it possible to direct the main efforts of the pediatric service to deepen the preventive section of work, and social services to strengthen the family.

The developed educational program for parents before and after the birth of a child makes it possible to effectively influence the health indicators of a child in the first year of life, as it increases the level of knowledge of parents on the care, nutrition and development of the child, contributes to the formation of the correct parent-child relationship and can be introduced into the practice of pediatric clinic departments.

The proposed improvement of neonatological care at the outpatient stage increases the efficiency of the pediatric department of the polyclinic with young children and can be used in the activities of the outpatient department of the medical institution.

IMPLEMENTATION OF RESEARCH RESULTS

Improvement and optimization of neonatological care in the conditions of the pediatric department of the Moscow Medical University of the city polyclinic No. 1 of the Industrial District of the city of Samara was carried out (chief physician, candidate of medical sciences Balzamova Lidia Alekseevna).

The program of prenatal education "Modern Parents" for pregnant women was introduced by the pediatric department of the Moscow Medical University of the city polyclinic No. 1.

New forms of medical documentation have been introduced: prenatal patronage No. 1, prenatal patronage No. 2, primary examination by a neonatologist of a newborn (rationalization proposals No. 397, No. 398, No. 399 dated April 5, 2004 were drawn up).

The dissertation materials are used in the educational process when conducting seminars and lecturing at the Department of Pediatrics, IPO Samara State Medical University.

The materials of the dissertation were discussed and reported at the VIII International All-Russian Congress "Actual problems of human ecology" (Samara, 2002), the inter-departmental meeting of the departments of pediatric dentistry and pediatrics of the IPO SSMU "Early prevention of caries among children and new directions for the organization of preventive medicine in the outpatient setting of young children" (May 2004), at the conferences of the City Center for Prevention in Samara "Support for breastfeeding" (February 2004), " Modern views on the nutrition of children in the first year of life "(April 2005), at the training of specialists working in schools of positive motherhood (September 2004), at the V international scientific and practical conference dedicated to the 35th anniversary of the opening of the Children's City Clinical Hospital No. 1 in Samara" Partnership for Children's Health (June 2005).

On the topic of the dissertation, 7 printed works were published (four of them in the central press), 3 rationalization proposals were developed and executed, an application was filed for a patent for the invention “Method of conducting medical and preventive work with a pregnant woman and a child of the first year of life” No. 2003123196 dated July 22, 2003 .

VOLUME AND STRUCTURE OF THE THESIS

The dissertation is presented on 165 pages of typewritten text, illustrated with 31 tables, 10 figures, 3 diagrams. The work consists of an introduction, literature review, own research, including three chapters, conclusions, conclusions, practical recommendations. The literature index includes 322 sources, of which 228 are works by domestic authors and 94 by foreign ones.

Conclusion of the dissertation research on the topic "The state of health of children in the first year of life and the prevention of diseases at the outpatient stage"

1. The main factors that positively influenced the formation of the health of young children were favorable intra-family relationships, a high educational level and psychological readiness of the mother, special educational training of parents and the absence of severe extragenital pathology of the mother (OR 3.1; 72.3% p = 0.025 ).

2. It was established that the health indicators of children in the first year of life are higher if the mother underwent prenatal educational training in the conditions of the pediatric department of the polyclinic (positive dynamics in children's health indicators during the year in the main group was noted in 25% of cases, in the control group II in 7% , with r in medicine, dissertation 2005, Raikova, Natalya Mikhailovna

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first year of life

Breastfeeding children

Newborn health status

Children's health status

Use of contraceptives

(number of children who were breastfed)

by main classes and groups of diseases

source

The state of health of the child population is currently the most important indicator of the quality of health care and a criterion for assessing the well-being of society as a whole. Despite the introduction of new perinatal technologies that have contributed to the reduction of perinatal and infant mortality, the prevalence of chronic pathology in children, as well as the level of childhood disability, remain virtually unchanged.
Improving the forms and methods of protecting the health of the child population is impossible without an in-depth and constant analysis of information on the patterns of formation of children's health, assessment of medical and demographic indicators related to the reproduction of the population and the quality of its health in the present and future. At the same time, taking into account regional peculiarities is necessary condition rational organization of the health care system in a particular area.
The purpose of this work was to study the structure of the incidence of children in the first year of life in the Kabardino-Balkarian Republic (KBR).
To achieve this goal, the incidence rates of children in the first year of life were studied according to the annual reporting form No. 31 "Information on medical care for children and adolescent schoolchildren" public institution health care "Medical Information and Analytical Center" of the Ministry of Health of the KBR for the period 2002-2012. A statistical analysis of the studied indicators was carried out.
Results and its discussion.
An analysis of the structure of morbidity in children in the first year of life over a ten-year period revealed a stable predominance of respiratory diseases over the rest of the pathology. This class of diseases accounts for 31.7-39.2% of all diseases. The share of respiratory diseases in the nosological structure for the study period increased by 7.5% (Table 1).
Table 1

The structure of morbidity in children of the first year of life in the KBR for 2002-2012.

Diseases of the blood, hematopoietic organs and certain disorders involving the immune mechanism

Diseases endocrine system, eating disorders and metabolic disorders

Diseases of the eye and adnexa

Diseases of the ear and mastoid process

Diseases of the digestive system

Diseases of the genitourinary system

Certain conditions arising in the perinatal period

Congenital anomalies (malformations)

Injury, poisoning and some other consequences external causes

One of the characteristic features of this class is that in its structure the main share is occupied by acute infections top respiratory tract, influenza, pneumonia, the concentration of which gradually decreased during the study period (98.7% in 2002 and 64.5% in 2012).
The second position in the structure of morbidity in children of the first year of life is occupied by individual conditions that occur in the perinatal period. Their contribution for 10 years has decreased by 1.5 times, amounting to 17.6% in 2012, which is an indicator reflecting the improvement of perinatal and pediatric care in the country.
The third ranking place in the structure of morbidity in children of the first year of life is occupied by diseases of the nervous system, accounting for 9.8-11.3%.
Thus, the proportion of the three rating classes of diseases in the nosological structure of children in the first year of life was 2/3 of the entire pathology.
It should be noted that in the structure of diseases of the blood, hematopoietic organs and individual disorders involving the immune mechanism, the frequency of which has tended to decrease over 10 years, anemia occupies the main share (97.6% in 2002, 95.1% in 2007 , 99.4% in 2012).
Among diseases of the endocrine system, eating disorders and metabolic disorders, rickets occupies a leading position. The contribution of this pathology for 10 years increased by 10.6%, amounting to 62.6% in 2012.
Conclusions.
In the structure of morbidity in children of the first year of life for the period 2002-2012. the first ranking places were occupied by diseases of the respiratory system, certain conditions that occur in the perinatal period, diseases of the nervous system, amounting to a total of 66.6% of all pathology in 2012.
The frequency of respiratory diseases as the leading class has increased by 7.5% over 10 years, which indicates the need to improve treatment and prevention work in children with this pathology.
During the analyzed period, the proportion of anemia in the structure of blood diseases, hematopoietic organs and individual disorders involving the immune mechanism increased, reaching 99.4% in 2012.
Rickets occupies a leading position among diseases of the endocrine system, eating disorders and metabolic disorders, increasing its contribution over a ten-year period by 10.6%. This dictates the need to improve measures aimed at combating anemia and rickets in children of the first year of life.

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Research work The role of a nurse in organizing the prevention of morbidity in children of the first year of life on the example of a children's clinic in the city of Satka

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"Research work The role of a nurse in organizing the prevention of morbidity in children of the first year of life on the example of a children's clinic in the city of Satka"

MINISTRY OF HEALTH OF THE CHELYABINSK REGION

STATE BUDGET PROFESSIONAL

"SATKINSKY MEDICAL COLLEGE"

Role nurse in the organization of prevention of morbidity in children of the first year of life on the example of a children's polyclinic in the city of Satka

Specialty: 34. 02. 01 Nursing

Student: Akhmetyanov Ruslan Danisovich

Head: Vasilyeva Asya Toirovna

Admitted to the defense: Final qualifying work

"__" ________ 20__ is protected with a rating of "____________"

Deputy Director for SD "_____" ____________________ 20__

Chairman of the SEC ________________

Chapter 1. Theoretical aspects in the study of prevention

morbidity in children of the first year of life

1.1. Dispensary observation of healthy children of the first

1.2. Preventive reception of a healthy child…………………..……

1.3. Monitoring of newborns from risk groups during

1.4. The role of the nurse in newborn care

1.5. Vaccination of children of the first year of life………….

Chapter 2. Empirical study of the role of the nurse in

Organizations for the prevention of morbidity in children of the first year of life on the example of the children's polyclinic in Satka

2.1. Analysis of the work of the children's polyclinic in Satka……………………….. 2.2. Clinical examination of children of the first year of life in the clinic

2.3. The work of a nurse in a vaccination room…………..……………….

2.4. The role of the nurse in newborn care

LIST OF USED SOURCES……………………

The first year of a child's life is an important and difficult period. It was at this time that the foundation was laid, the basis for the physical development of the baby, and hence his future health.

The relevance of this topic is that early childhood is decisive both in the overall development of the child and in the formation of his health. Therefore, from the effectiveness of those carried out in this age period preventive measures health of children in the future largely depends.

The role of a nurse in the organization of preventive measures for the incidence of children in the first year of life is to examine children: conducting anthropometry; psychometry, early referral of the child to specialists, laboratory and instrumental studies, determined by order No. 307 of the Ministry of Health and Social Development of Russia dated April 28, 2007 "On the standard for dispensary (preventive) observation of a child during the first year of life."

During patronage visits at home, he controls the correctness of the procedures. All data obtained during such visits are recorded in the child's developmental history. It is important that gymnastics and massage are carried out systematically with a gradual complication of exercises and massage techniques.

The purpose of the work. To analyze the role of a nurse in the prevention of morbidity in children of the first year of life using the example of a children's clinic in the city of Satka.

The study of theoretical material on this topic.

2 Analysis of the main indicators of the medical activities of the children's clinic for the period from 2013 to 2015.

3 Studying the role of a nurse in organizing the prevention of morbidity in children of the first year of life on the example of a children's clinic in the city of Satka.

Object of study. Children of the first year of life.

Subject of study. The role of the nurse in the organization of preventive measures for the incidence of children in the first year of life.

Hypothesis: The nurse plays a huge role in organizing preventive measures for the incidence of children in the first year of life.

The practical significance of the study. The research materials can be used in the study of PM. 02. Participation in medical diagnostic and rehabilitation processes. MDC 02.01.5 Nursing in pediatrics.

Work structure. The work is made of 46 pages of printed text, consists of an introduction, 2 chapters, conclusion, 26 sources, 2 tables and 6 diagrams.

1 Theoretical aspects in the study of the prevention of morbidity in children of the first year of life

Prevention - ( prophylactic- protective) a complex of various kinds of measures aimed at preventing a phenomenon and / or eliminating risk factors.

Dispensary observation of healthy children of the first year of life

Dispensary supervision of a district nurse: 1 visit at home once a month, with mandatory monitoring of visits after preventive vaccinations.

The frequency of examinations by specialists: a pediatrician in the first month of life at least 3 times, subsequently at least 1 time per month.

Inspection by narrow specialists:

– at 1 year neuropathologist, ophthalmologist, orthopedist;

- twice (1 trimester and 12 months);

- examination by ENT, dentist at 12 months.

Laboratory diagnostic examination:

– clinical analysis blood, urinalysis at 3 months (before vaccination) and at 12 months.

Surveillance Performance Indicators:

- good monthly weight gain;

- good adaptation of the child to new living conditions;

- normal physical and neuropsychic development and a decrease in the level of morbidity.

When conducting preventive examinations control is exercised:

On objective examination Special attention refers to:

- circumference of the head and chest;

- assessment of neuropsychic and physical development;

- condition skin, musculoskeletal system, internal organs;

- a trace reaction from BCG vaccination;

- Availability congenital diseases, developmental anomalies.

Additional methods of examination: anthropometry 1 time per month, clinical analysis of blood and urine by the 3rd month of life and at 1 year.

Based on objective data and additional methods research, the doctor gives a comprehensive assessment of the state of health, including an assessment of physical and neuropsychic development, behavior, the presence or absence of functional or organic deviations from the norm, determines the health group, if necessary, the risk group for the development of the disease and prescribes a set of preventive and recreational measures.

The main preventive and health measures:

- organization of rational feeding;

- Sufficient exposure to fresh air;

- gymnastics tempering procedures;

– specific prevention of rickets;

– treatment of the identified pathology.

Criteria for the effectiveness of clinical examination: indicators of neuropsychic and physical development, behavior, clinical examination data, frequency of diseases.

Depending on the state of health, children can be classified into the following groups:

- to 1st health group- healthy children with normal physical and mental development, without anatomical defects, functional and morphofunctional abnormalities;

– to 2nd health group- children who do not have chronic diseases, but have some functional and morphofunctional disorders. This group also includes convalescents, especially those who have undergone severe and moderate infectious diseases, children with a general delay in physical development without endocrine pathology (short stature, lag in the level of biological development), children with underweight or overweight, children with frequent and long-term acute respiratory diseases, children with the consequences of injuries or operations while maintaining the corresponding functions;

- to 3rd health group- children suffering from chronic diseases in the stage of clinical remission, with rare exacerbations, with preserved or compensated functional capabilities, in the absence of complications of the underlying disease. In addition, this group includes children with physical disabilities, the consequences of injuries and operations, provided that the corresponding functions are compensated. The degree of compensation should not limit the possibility of education or work of the child;

- to 4th health group- children suffering from chronic diseases in the active stage and the stage of unstable clinical remission with frequent exacerbations, with preserved or compensated functional capabilities or incomplete compensation of functional capabilities; with chronic diseases in remission, but with limited functionality. The group also includes children with physical disabilities, the consequences of injuries and operations with incomplete compensation of the corresponding functions, which to a certain extent limits the child's ability to study or work;

- to 5th health group- children suffering from severe chronic diseases, with rare clinical remissions, with frequent exacerbations, continuously relapsing course, with severe decompensation of the body's functional capabilities, the presence of complications of the underlying disease, requiring constant therapy. This group also includes children with physical disabilities, the consequences of injuries and operations with a pronounced violation of the compensation of the corresponding functions and a significant limitation of the possibility of learning or working.

In the process of observing a child, his health group may change depending on the dynamics of his state of health.

1.2 Prophylactic reception of a healthy child

1 Organization of sanitary and hygienic care for the child (microclimate of the room, quantity and quality of ventilation, lighting, organization of the place of sleep and wakefulness, walks, clothing, personal hygiene).

Mothers need to be explained that non-compliance with sanitary and hygienic care for a child can adversely affect the child's health, physical and mental development. In the history of development, the doctor fixes the shortcomings in the care of the child, gives appropriate prescriptions for their correction.

2 Organization of the mode of life and nutrition according to age. Often the mother's complaints about the child's poor appetite, increased or decreased excitability, indifference, tearfulness are not associated with any organic changes, but are the result of improper organization of the sleep and wakefulness regimen, feeding regimen.

You need to know that up to 9 months there should be the following sequence: sleep, feeding, wakefulness, which corresponds to the anatomical and physiological needs of the child. After 9 months, this sequence changes due to the lengthening of the segments of wakefulness, namely, wakefulness, feeding, sleep. During the first year of life, the time of active wakefulness increases from several minutes to 3 hours, the duration of sleep per day decreases from 18 to 14 hours. An arbitrary increase in the period of wakefulness can cause negative emotions, capriciousness, and increased excitability in a child.

3 The organization of rational feeding and nutrition is one of the main tasks of a pediatrician general practice. At each appointment or home visit, the doctor exercises strict control over the compliance of the feeding received by the child with his physiological needs for basic food ingredients. This is especially true for children born with a weight of up to 2500 and more than 4000 g. They need more frequent calculations of nutrition by ingredients and calories, as they can easily develop malnutrition.

Rules for the organization of rational feeding and nutrition:

– support, encourage and maintain breastfeeding as long as possible;

- timely transfer the child to mixed or artificial feeding with a lack of breast milk and the inability to receive donor milk;

- in a timely manner, taking into account age, type of feeding, individual features child, introduce juices, fruit purees, supplementary foods, complementary foods into the diet;

Supplementation should be given after breastfeeding and not from a spoon, but from a horn with a nipple. This is explained by the fact that in the first 3-4 months of the child, the act of sucking is physiological, which maintains the excitability of the food center. Spoon-feeding causes a decrease in the excitability of this center, a mismatch in the rhythm of sucking and swallowing, which leads to rapid fatigue of the child, and possibly refusal to eat.

Complementary foods are usually given from 4-5 months at the beginning of feeding with a high excitability of the food center. It is advisable to give it from a spoon in order to teach the child to remove food with his lips and gradually master the skills of chewing.

- periodically (up to 3 months monthly, and then once every 3 months) calculate the chemical composition of the food actually received by the child in order to make an appropriate correction if necessary;

- Correctly organize the method of feeding.

When introducing supplementary feeding, the child must be held in her arms, as with breastfeeding. When introducing complementary foods, the child should be held in his arms, sitting in an upright position.

Failure to follow the feeding methodology often leads to malnutrition in children. If an infant during a monthly examination according to the rate of increase in body weight and length corresponds to normal indicators, and is also healthy, then the nutrition received by the child should be considered rational. Therefore, he is in optimal feeding conditions.

4 Organization of physical education of the child. It renders positive impact on the body as a whole:

- increases the activity of non-specific body defense factors (lysozyme, complement components, etc.) and thereby increases resistance to viral and bacterial infection;

– improves blood supply, especially to the periphery;

- improves metabolism and thereby the utilization of food products;

- regulates the processes of excitation and inhibition;

- increases the activity of the adrenal glands (increases the production of corticosteroids);

- regulates the activity of the endocrine system;

- improves the functioning of the brain and all internal organs.

Physical education of children up to the 1st year of life includes: massage, gymnastics and kinesiotherapy (laying the child on the stomach in each period of wakefulness for the development of independent movements).

It is very important that gymnastics and massage are carried out systematically, with a gradual complication of exercises and massage techniques. If the control over the conduct of massage and gymnastics is insufficient on the part of the doctor and nurse, if the attention of parents to the great importance of physical education is not fixed at receptions, then, naturally, their effectiveness is significantly reduced.

To organize kinesiotherapy, it is necessary to have a wooden track on the floor and maintain a comfortable air temperature in the room.

The nurse needs to teach the mother how to carry out hardening procedures using air baths, organizing sleep on the street, on the balcony, bathing 2 times a day with wiping the body with a damp towel, and then dousing with a gradual decrease in temperature.

5 Organization of neuropsychic development of the child. It goes in close contact with physical development and is one of the components of health. Violation or lag in physical development often leads to a delay in neuropsychic development. In a child who is often ill, physically weakened, the formation of conditioned reflexes, various skills is delayed, it is difficult to evoke joy.

A pediatrician must take into account the mutual influence of physical and neuropsychic development and create favorable conditions for their development. It must be remembered that the theme of development and the sequence in the formation of various movements, skills, as well as speech in children of the 1st year of life depend not only on their individual characteristics, but also on the impact on the child of adults caring for children, as well as on the environment. environment. Monitoring the dynamics of the neuropsychic development of young children. Assessment of neuropsychic development (NPD) in young children is carried out according to specially developed development standards on time: in the first year of life - monthly, in the second year - 1 time per quarter, in the third year - 1 time per six months, on days, close to the child's birthday. Medical workers: a district pediatrician or a nurse, or a nurse (paramedic) of the office of a healthy child, diagnose NDP in accordance with the recommendations, according to certain indicators - lines of development. If the development of the child does not correspond to the age, then it is checked according to the indicators of the previous or subsequent age periods.

Methodology for determining the level of neuropsychic development of children in the first year of life.

In the 1st year of life, the following lines of neuropsychic development are controlled:

- development of visual orienting reactions;

- development of auditory orienting reactions;

- development of positive emotions;

- development of general orienting reactions;

- development of actions with objects;

- development of the preparatory stages of active speech;

– development of preparatory stages of speech understanding;

The development of all skills and abilities in the first year of life is closely related to the level of development of the analyzers. The most significant among them are visual, auditory, tactile and proprioceptive analyzers.

For a child up to 3 months, the timely occurrence of visual and sound concentration is very important, as well as the development of the following positive emotions: a smile and a revival complex.

At the age of 3 to 6 months, it is important to develop visual and auditory differentiations with the ability to find the source of sound, the formation of grasping movements of the hand (taking a toy from the hands of an adult and from different positions), cooing, babble (the beginning of speech development).

At the age of 6 to 9 months, the leading is the development of crawling, imitation in the pronunciation of sounds and syllables, the formation of simple connections between objects and words denoting them.

At the age of 9-12 months, the most significant are the development of understanding of adult speech, the formation of the first simple words, the development of primary actions with objects and independent walking. No less important than sensory development, is the development of movements.

The mother should be informed what movements and at what age to teach the child. From the first days and weeks of life, during periods of wakefulness, the arms and legs of the child should be free; before each feeding, it must be laid out on the stomach, developing the ability to raise and hold the head. Such free movements of the head strengthen the muscles of the neck and back, the correct bend of the spine is formed, and the blood circulation of the brain improves. If the family has conditions for maintaining a comfortable temperature for an undressed child, it is advisable to lay it out on a wooden track on the floor during the wakefulness period for the development of crawling and body sensation in space. In the future, all these movements must be continued to develop, putting toys on the track so that the child can capture them and / or purposefully move towards them. From time to time (but not too often) the child must be picked up, giving him an upright position. This stimulates holding the head, fixing the gaze on the faces of the mother, father and other relatives and friends.

From 3 months, special attention is paid to the development of hand movements, from 4 months it is necessary to teach the child to grab a free toy, by 6 months - to roll over from his stomach to his back.

In the second half of the year, it is necessary to learn to crawl, and by 8 months - to sit and sit, stand up and step over in a crib or playpen. With such a sequence of development of movements, a child by 12 months masters the ability to walk independently.

1.3 Follow-up of newborns at risk in

during the first year of life

Risk groups for young children:

- children at risk for the development of CNS pathology (having undergone perinatal CNS damage);

- children at risk for anemia, WDN, convalescents of anemia;

- children at risk of developing chronic eating disorders;

- children with constitutional anomalies;

- children suffering from rickets 1, 2 degrees;

- children born with a large body weight ("large fetus");

- children who have undergone purulent-inflammatory diseases, intrauterine infection;

- often and long-term ill children;

– children from priority families.

Principles of observation of children from risk groups:

– identification of leading risk factors. Definition of monitoring tasks (prevention of development pathological conditions and diseases)

– preventive examinations by a pediatrician and doctors of other specialties (duration and frequency);

– laboratory-diagnostic, instrumental studies;

- features of preventive examinations, preventive and therapeutic measures (nutrition, regimen, massage, gymnastics, non-drug and drug rehabilitation);

– criteria for the effectiveness of observation;

- the observation plan is reflected in the form 112-y.

– examination by a pediatrician at 1 month of life at least 5 times, in the future

– examination by a neurologist at 2 months (not later), then quarterly;

– examination by the head of the polyclinic department at the 3rd month, mandatory for each child’s illness at the 1st year;

- strict control of the pediatrician over the size of the head, neurological status, level of mental and physical development;

- preventive vaccinations strictly according to an individual plan and only with the permission of a neurologist;

- upon reaching 1 year, in the absence of pathology from the central nervous system, the child can be removed from the dispensary (f.30).

- examination daily for 10 days after discharge from the maternity hospital, then on the 20th day and at 1 month, up to a year monthly;

- strict control over the condition of the skin and umbilical wound;

- early laboratory tests (blood, urine) at 1 month and 3 months, after each disease;

- measures for the prevention, early detection and treatment of dysbacteriosis;

- in the absence of symptoms of intrauterine infection, they are removed from the register (f. 30) at the age of 3 months.

- examination by a pediatrician at 1 month of life at least 4 times, then monthly;

– examination by the head of the clinic no later than 3 months;

- the struggle for natural feeding, strict control over weight gain, the fight against hypogalactia. A balanced diet, taking into account the weight of the child;

– examination by an endocrinologist at least 2 times in the 1st year of life (in the 1st quarter and at 12 months). Before the appointment with the endocrinologist, a blood test

– dispensary observation 1 year, in the absence of pathology, the account (form 30) is removed at the age of 12 months.

- examination by a pediatrician 4 times at 1 month of life, then monthly;

- urinalysis at 1 month, then 1 time per quarter and after each disease;

- consultation of specialists in early dates at the slightest suspicion of a pathology (cardiologist, surgeon);

- dispensary observation for 1 year, in the absence of pathology, they are deregistered (form 30) at the age of 12 months.

- strict control over the quality of child care, nutrition, weight gain, neuropsychic development;

- Mandatory hospitalization for any disease;

– participation of the head of the polyclinic in the preventive monitoring of this group of children;

- earlier registration in the kindergarten (in the second year) preferably with a round-the-clock stay;

- control of the district nurse over the actual place of residence of the child.

A child of the 1st year of life is characterized by a number of features that do not occur at an older age:

– fast pace of physical and neuropsychic development;

- the need for sensory impressions and motor activity;

- immobility of the child, "sensory hunger" lead to a developmental delay;

- the interdependence of physical and neuropsychic development;

- emotional impoverishment, lack of impressions, insufficient motor activity lead to a delay in neuropsychic and physical development;

– low resistance to weather and environmental impacts and various diseases;

- a very large dependence of the development of the child on the mother (parents, guardians). A characteristic feature of this period of the child's life is the transformation of the child from a helpless creature into a person with character and certain personality traits.

There is no such period in the life of an older age that in 12 months a healthy child triples its weight and grows by 25-30 cm, i.e. it is during the 1st year of life that the growth and development of the child proceeds at a very rapid pace.

The functional speech system is also rapidly developing. The child masters the intonation of the language in which he is spoken to; cooing, babbling, the first syllables, words appear. He begins to understand the speech of adults communicating with him.

The child gradually develops skills and abilities: the ability to drink from a mug, cup, eat food from a spoon, eat bread or crackers; the first elements of the skill of cleanliness.

The emotional sphere of the child expands significantly, and he adequately responds to changing circumstances: crying, laughing, smiling, whimpering, interest in surrounding objects and actions, etc. In this regard, it is necessary to properly organize control over the development of the child and his state of health in order to notice deviations in mental and motor development as early as possible and plan recreational activities that ensure the prevention of various diseases.

1.4 The role of the nurse in newborn care

Patronage of a newborn child during the first month of life is carried out by a pediatrician and a pediatric nurse.

The overall goal of patronages is to create a program for the rehabilitation of the child.
Specific goals:

- assess the health status of the child;

- evaluate the health status of the mother;

- assess the socio-economic conditions of the family;

Develop a mother's education program aimed at meeting the vital needs of the child. During the first patronage, the nurse talks to the mother, clarifies the course of pregnancy and childbirth, studies the discharge summary, clarifies the family's anxieties and problems associated with the birth of a child.

The nurse pays attention to the conditions of the baby's stay, gives recommendations on caring for the baby.

The nurse examines the child, examines the skin and mucous membranes, evaluates reflexes. Looks at the activity of sucking and the nature of feeding. Also draws attention to the crying of the child, breathing. Palpates the tummy and examines the large fontanel, umbilical wound.

The nurse learns about the mother's well-being, somatic and mental health and lactation, the nature of nutrition, and examines the mammary glands. During the primary patronage, the mother is given recommendations for protecting her health: daytime rest, varied food, enhanced drinking regimen, personal hygiene (daily shower or wash the body to the waist, change bra daily, wash hands after coming from the street, before swaddling and feeding child, etc.).

The nurse teaches the mother the daily routine and nutrition to improve lactation, proper feeding of the child, caring for him, the method of feeding, convinces parents of the need to regularly see a doctor and follow all his recommendations. Teaches mother and all family members the technology of psycho-emotional communication with the child. For successful communication with a child, it is necessary to know the level of his age needs and communication opportunities.

Newborns up to 1 month like:

- listen to repeated soft sounds;

- focus on movement and light;

- to be on the hands, especially when he is lulled.

The task of parents is to provide the child with the opportunity to listen to their conversations and singing, soft music, feel their hands, feel bodily communication, especially during feeding. Mother's advice: even if the baby is bottle-fed, it is necessary to take him in your arms during feeding.

The main indicators of the correct psycho-emotional development of a newborn after discharge from the hospital:

- responds positively to stroking;

- calms down when picked up;

- holds his gaze for a short period of time during feeding.

The nurse must teach correct execution daily manipulations for the baby:

- treatment of the nose, ears, eyes;

It is enough to treat the umbilical wound once a day, after an evening bath. Do not strive to do this at every opportunity: this way you will rip off the crusts that form on the wound too often, which will not speed up, but only complicate and delay healing.

The purpose of such patronage is to assist the mother in organizing and conducting care for the newborn. It is important to teach her to properly perform manipulations for caring for a child. During the primary care of a newborn, the nurse receives a number of specific instructions from the doctor on the specifics of monitoring this child.

Bathing should be a daily routine for your baby. Firstly, the baby's skin is thin, and metabolic and excretory processes and skin respiration are much more active in it. Therefore, it must be cleaned regularly. Secondly, bathing is extremely useful as a hardening method.

Wash your baby after every stool and when changing the diaper. It is most convenient to wash the baby under running water, so that the water flows from front to back. If for some reason water is not available (on a walk, in a clinic), you can use wet baby wipes.

In the morning, the baby can be washed right on the changing table. Wipe the baby's face and eyes with a cotton swab dipped in boiled water. There must be a separate swab for each eye. Direct movements from the outer corner of the eye to the inner.

If the child's breathing is difficult. To do this, it is more convenient to use a cotton turunda (wick). Carefully, with twisting movements, we introduce it into the nostril. If there are a lot of dry crusts in the nose, turunda can be moistened in oil (vaseline or vegetable). From these manipulations, the baby can sneeze, which will simplify the task.

A child's ears should only be cleaned when wax is visible at the mouth of the ear canal. Do not do this too often: the more sulfur is removed, the faster it starts to be produced. When cleaning the ears, in no case should you penetrate into ear canal deeper than 5 mm. For this, there are even special cotton buds with limiters.

Nails should be cut as they grow so that the baby does not scratch himself or you. Use baby nail scissors that have extensions at the tips. Nails should be cut straight, without rounding the corners, so as not to stimulate their growth and ingrowth into the skin. This concludes the primary patronage of the newborn.

At the second patronage, the nurse checks the correctness of the procedures.

1.5 Vaccination of children in the first year of life

Infectious diseases are very common in children, sometimes they can be severe, give complications.

The goal of immunization is to develop specific immunity to infectious disease through artificial creation infectious process, which in most cases proceeds without manifestations or in mild form. Every child can and should be vaccinated, parents only need to contact a pediatrician in a timely manner. If any individual characteristics of the child's body are identified, the doctor draws up an individual plan for examining the child, his medical preparation for subsequent vaccination.

In accordance with the order of the Ministry of Health of Russia No. 125n dated March 21, 2014 "On approval of the national calendar of preventive vaccinations and the calendar of preventive vaccinations according to epidemic indications":

The implementation of this order can significantly modernize vaccination in Russia, because:

1 Mandatory vaccination of children from the age of 2 months has been introduced against pneumococcal infection.

2 The list of contingents subject to vaccination against various infections has been expanded.

3 The list of infections and the list of contingents to be vaccinated according to the Preventive Immunization Schedule for epidemic indications has been expanded. According to the Federal Law of September 17, 1998 No.

N 157 - Federal Law "On Immunoprophylaxis of Infectious Diseases" regions can finance programs for the vaccination of hemophilic, pneumococcal, rotavirus infections, and chicken pox.

To organize and conduct vaccinations, a medical institution must have a license for the relevant type of activity issued by the territorial (city, regional, regional) health authority and a room (vaccination room) that meets the requirements of SPiN 2.08.02-89.

Vaccination is a mandatory state measure for the prevention of infectious diseases. Structural changes in the current economic and demographic situation in the country, the growing international consolidation in the implementation of programs for the elimination and eradication of infections lead to increased requirements for immunoprophylaxis.

Thus, the role of a nurse in the organization of preventive measures, the incidence of children in the first year of life is to examine children: conducting anthropometry; psychometry, early referral of the child to specialists, laboratory and instrumental studies, determined by order No. 307 of the Ministry of Health and Social Development of Russia dated April 28, 2007 "On the standard for dispensary (preventive) observation of a child during the first year of life."

The nurse teaches the mother the daily routine and nutrition to improve lactation, proper feeding of the child, caring for him, the method of feeding, convinces parents of the need to regularly see a doctor and follow all his recommendations. Gives recommendations on the physical and neuropsychic education of the child, massage, hardening, development of hygiene skills, prevention of rickets. Teaches mother and all family members the technology of psycho-emotional communication with the child.

The nurse conducts psychological preparation of the child for vaccination.

2. The role of a nurse in organizing the prevention of morbidity in children of the first year of life on the example

children's polyclinic of the city of Satka

2.1 Clinical examination of children of the first year of life in the children's polyclinic of the city of Satka

Statistical data on medical examination of children of the first year of life were obtained from the Central Children's Polyclinic No. 1 in Satka.

For three years, 2,331 children (children of the first year of life) underwent medical examinations, of which 792 children underwent medical examinations in 2013, which accounted for 34% of the total number of those who underwent medical examinations for the year.

In 2014, 764 children underwent medical examinations, which accounted for 32.8% of the total number of those who underwent medical examinations for the year.

In 2015, 775 children underwent medical examinations, which accounted for 33.2% of the total number of those who underwent medical examinations for the year. The number of examined children in 2015 decreased by 0.8% compared to 2013.

Clinical examination of children of the first year of life

Number of people examined

Distribution by health groups

In 2013, the number of examined children was higher by 1.2% than in 2014 and by 0.8% than in 2015 (Figure 1).

Figure 1 - The share ratio of the number of examined

children of the first year of life for 2013 - 2015

Of the total number of children examined in 2013 (792 children), 369 children of the first year of life were with the first health group, which amounted to 46.6%. With the second group 256 children of the first year of life, which amounted to 32.4%. From the third group 117 children of the first year of life, which amounted to 14.7%, from the fourth group 29 children of the first year of life, which amounted to 3.8% and from the fifth group 21 children, which amounted to 2.5% (Fig. 2).

Figure 2 - Share ratio by health groups

for 2013 among children of the first year of life

Of the examined children of the first year of life in 2013, there were 14.2% more children with the first group than with the second group, by 31.9% than with the third group, by 42.8% than with the fourth group and by 43 .8% than from the fifth.

Figure 3 - Share ratio by health groups

for 2014 among children of the first year of life

Of the total number of children examined in 2014 (764 children) with the first health group, there were 233 children of the first year of life, which amounted to 30.4%. With the second group 383 children of the first year of life, which amounted to 50.3%. From the third group 99 children of the first year of life, which amounted to 12.9%, from the fourth group 22 children of the first year of life, which amounted to 2.8% and from the fifth group 27 children, which amounted to 3.6%.

Of the examined children of the first year of life in 2014, there were 19.9% more children with the second group than with the first group, by 37.4% than with the third group, by 47.5% than with the fourth group and by 46 .7% than with the fifth (Fig.3).

Of the total number of children examined in 2015 (775 children) with the first health group, there were 294 children of the first year of life, which amounted to 37.9%. With the second group 359 children of the first year of life, which amounted to 46.3%. With the third group 74 children of the first year of life, which amounted to 9.5%, with the fourth 16 children of the first year of life, which amounted to 2% and with the fifth group 32 children, which amounted to 4.1%.

Figure 4 - Share ratio by health groups

for 2015 among children of the first year of life

Of the examined children of the first year of life in 2015, there were 8.4% more children with the second group than with the first group, by 36.8% than with the third group, by 44.3% than with the fourth group and by 42 .2% than with the fifth group (Fig. 4).

Figure - 5 Share ratio by health groups

From 2013 to 2015 among children of the first year of life

For three years of children of the first year of life:

- with 1 health group was 38.4%;

From 2013 to 2015, the number of children with the 5th group increased by 13.7 compared to 2013 (Fig. 5).

The role of the nurse in organizing the medical examination of children in the first year of life is to examine children:

- early referral of the child to specialists;

– referral to laboratory and instrumental studies.

2.3. The work of a nurse in the vaccination room

One of the main directions in the activities of the polyclinic in prevention is to increase the literacy of the population in matters of immunoprophylaxis and the formation of an understanding of the importance of vaccines for health.

Preventive vaccinations are the main measure in the fight against many infectious diseases in children, radically influencing the epidemic process.

The Cabinet of Immunoprophylaxis currently serves:

– child population aged 0-15 years;
- adolescent population 15-18 years old.

Basic principles of immunoprophylaxis:

– mass character, availability, timeliness, efficiency;

– Mandatory vaccination against vaccine-preventable diseases;

– individual approach when vaccinating children;

- safety during preventive vaccinations;

- Free vaccinations.

Preventive vaccinations are planned in the “Vaccinal Prevention” office on a monthly basis, reports on the implementation of the preventive vaccination plan are also received here and entered into a computer database. Vaccines are stored in the refrigerator, the sales deadlines and the cold chain are respected.

Implementation of the immunization plan for children of the first year of life

I analyzed the Child Development Histories (Form 112-y) of children born in 20013-2014.

The purpose of the study of child development histories (in form 112y): establish the dependence of indicators of physical development and morbidity on the type of feeding.

For 2 years, 180 children were born at the site, of which:

In 2013 - 93

In 2014 - 87.

From the above data, it can be seen that there is a decrease in the birth rate every year.

All children were divided according to the types of feeding.

Distribution structure of children in the first year of life by types of feeding in percent

Analyzing the data presented in the diagrams, it can be said that there was no significant increase in the number of children receiving breast milk for at least 6 months compared to 2013, however, the number of children who did not receive breast milk for up to 3 months decreased.

Comparative characteristics of types of breastfeeding in 2014 in percent

Having studied the dynamics of types of feeding on the site, I tried to analyze the relationship between the nature of feeding in the first year of life and indicators of physical development.

I evaluated the indicators of physical development:

Chest circumference

According to centile tables, data that were recorded in the Child Development Histories (Form 112-y) at the age of 12 months of life.

Analyzing the data of the centile tables, I divided all the children into 3 groups:

Medium development (corridor 4)

Above average (5,6,7 corridor)

Below average (corridor 1,2,3)

The data obtained are presented in diagrams:

Distribution of children by level of development (body weight) depending on the type of feeding

The data obtained indicate a high percentage of breastfed children with average weight gain, and more formula-fed children have below average rates (50%).

Distribution of children by level of development (body length) depending on the type of feeding

Distribution of children by level of development (chest circumference) depending on the type of feeding

The data obtained indicate that breastfeeding growth rates are of average development (68.4%), 33% of formula-fed children have growth rates above average, which corresponds to the literature data.

Distribution of children according to harmonious development on different types of feeding

The next step in the analysis of the Child Development Histories was the identification of the incidence rate of children in the first year of life in the area, depending on the type of feeding.

Sanitary epidemic regime

Rules for the preparation and storage of mixtures

Rules for feeding canned baby food

Rules for handling bottles and nipples

Morbidity on different types of feeding (per hundred children)

Indeed, in children who were breastfed, allergic diseases are much less common.

Perinatal pathology in Russia: level, structure of morbidity

L.P. Sukhanov
(Part of the chapter "Dynamics of health indicators of born offspring and perinatal demography in Russia in 1991-2002" of the book by L.P. Sukhanova Perinatal problems of reproduction of the Russian population in the transition period. M., "Canon + Rehabilitation", 2006 272 p.)

The main indicators of the health of the born offspring are the level of prematurity in the population, morbidity and parameters of physical development.

prematurity associated primarily with the incidence of pregnant women, has a negative impact on the physical development of children in subsequent periods of their lives and inevitably contributes to the growth of not only perinatal morbidity and mortality, but also disability.

The increase in prematurity among newborns in Russia is noted by numerous studies and statistics. At the same time, it is emphasized that, firstly, the frequency of diseases and complications in premature infants is higher than in full-term ones (respiratory distress syndrome, hyperbilirubinemia, anemia of prematurity, infectious diseases, etc.), and secondly, that pathology in of a premature baby has its own characteristics, accompanied by severe disorders of metabolic processes and immune disorders, which determines the maximum "contribution" of premature babies to perinatal and infant mortality, as well as childhood disability.

According to the data of statistical form No. 32, during the analyzed period, the number of premature births increased from 5.55% in 1991 to 5.76% in 2002 - with uneven growth over the years (the maximum value of the indicator in 1998 was 6.53%) .

An analysis of the rate of prematurity among newborns in comparison with the number of births with low body weight (Fig. 37) in the federal districts of Russia, carried out according to statistical form No. 32, revealed that the highest level of prematurity among live births, as well as the number of low birth weight children, are observed in the Siberian and Far Eastern Federal District, and the minimum number of premature and underweight children is observed in the Southern Federal District, which is consistent with the data of the analysis of the structure of born children by body weight given earlier.

Figure 37. The ratio of the proportion of premature and "low birth weight" newborns (in % of live births) by federal districts of Russia in 2002

Characteristically, in the Central Federal District, the only one in the country, the level of prematurity (5.59%) exceeded the number of those born with low body weight (5.41%), while the figures in Russia were 5.76 and 5.99%, respectively.

Analysis newborn morbidity in Russia over the past 12 years revealed a progressive steady increase in the overall incidence rate by 2.3 times - from 173.7‰ in 1991 to 399.4 in 2002 (Table 16, Fig. 38), mainly due to an increase in the number sick full-term children (from 147.5‰ in 1991 to 364.0‰ in 2002), or 2.5 times.
The incidence of premature babies increased by 1.6 times over the same years (from 619.4 to 978.1‰), which is shown in Fig. 3.

The increase in the incidence of newborns occurred mainly due to intrauterine hypoxia and asphyxia at birth (from 61.9‰ in 1991 to 170.9‰ in 2002, or 2.8 times), as well as slowing down the growth and malnutrition of newborns, the level of which increased from 23.6‰ in 1991 to 88.9‰ in 2002, or 3.8 times. In third place in terms of morbidity in newborns is neonatal jaundice, recorded in statistical form No. 32 only since 1999; its frequency was 69.0‰ in 2002.

Figure 38. Dynamics of the incidence rate of newborns in Russia (full-term and premature, per 1000 births of the corresponding gestational age) in 1991-2002

In terms of the growth rate of the prevalence of pathology in newborns during the analyzed years (from 1991 to 2002), hematological disorders are in first place (5.2 times), growth retardation and malnutrition (congenital malnutrition) are in second place (3.8 times), on the third - intrauterine hypoxia and asphyxia at birth (2.8). Next comes intrauterine infection (2.7 times), birth trauma (1.6 times) and congenital developmental anomalies (1.6 times).

Table 16. The incidence of newborns in Russia in 1991-2002 (per 1000 live births)

Diseases	1991	1992	1993	1994	1995	1996	1997	1998	1999	2000	2001	2002	2002/1991
General morbidity	173,7	202,6	234,7	263,5	285,2	312,9	338,7	356,5			393,4	399,4	229,9
Got sick full-term	147,5	174,3		233,1	253,5	281,2	307,7		349,3	345,1	357,1		246,8
Sick premature	619,4	661,8	697,3		774,9	797,4	809,3	824,1	867,5	932,5	981,6	978,1	157,9
congenital anomalies	18,8	20,5	22,8	24,4	25,74	27,85	29,63	30,22	29,34	29,43	30,32	29,67	157,8
Slow growth, malnutrition	23,6	32,2	39,6	46,4	52,2		61,35	67,92	78,75	81,43	85,87	88,87	376,6
Birth injury	26,3	27,9	27,6	31,5	32.5	32,7	31,6	31,3	41,7	41,1	42,6	41,9	159,3
including intracranial						8,74	7,37	6,75	3,06	2,15		1,67
Hypoxia intrauterine and birth asphyxia	61,9	78,7	96,2	113,9	127,3	143,49	158,12	171,79	175,54	176,28	169,21	170,94	276,2
Respiratory distress syndrome	14,4	15,6	17,8	18,8	19,8	21,29	21,4	22,48	17,39	18,06	17,81	18,67	129,7
including RDS in term infants				7,21	7,75	9,07	8,43	9,49	5,73	6,26	5,86	6,15	120,6
Intrauterine infections		10,65	10,5	13,2	16,03	19,19	23,4	23,43	25,01	24,55	24,25	24,03
Incl. sepsis	0,33	0,28	0,32	0,40	0,34	0,41	0,42	0,42	0,59	0,50	0,44	0,35	106,1
Hemolytic disease of the newborn	6,10	6,20	6,60	7,00	7,53	8,02	8,56	10,35	9,32	8,89	8,41	8,68	142,3
Hematological disorders	2,26	3,33	4,10	5,90	6,59	8,27	9,06	9,31	10,00	10,44	11,30	11,78	521,2
neonatal jaundice									47,31	55,49	61,58	68,99	145,8
TRANSFERRED NEWBORN	6,17	6,64	7,31	7,99	8,17	8,72	9,17	9,11	9,28	9,01	9,11	8,89	144,1

Such a significant increase in the prevalence of hypoxia and malnutrition in newborn children in the last decade (Fig. 39) is an inevitable result of the growth of extragenital and obstetric pathology in pregnant women, against which placental insufficiency develops and, as a consequence of the latter, intrauterine growth retardation of the fetus.

Figure 39. Dynamics of the frequency of intrauterine hypoxia, congenital anomalies and growth retardation in newborns in 1991-2002 (per 1000)

At the same time, it is important to note that the frequency of growth retardation and malnutrition of newborns (Fig. 39) continues to progressively increase in recent years, which confirms the situation about the continuing serious ill health of the reproduced offspring. It should be emphasized that we are talking about an objective criterion - the weight and height indicators of newborns, not subject to possible erroneous or subjective interpretation. Data on an increase in the frequency of growth retardation and malnutrition of newborns are consistent with the data presented above on changes in the structure of children by body weight - a decrease in the number of large and an increase in low birth weight newborns during the analyzed period. In turn, congenital trophic disorders and previous prenatal hypoxia and asphyxia at birth are the main background condition and the cause of the child's development of neurological and somatic pathology in the future.

Figure 40. Dynamics of the frequency of birth trauma, including intracranial, in Russia in 1991-2002 (per 1000)

One of the main problems of perinatology is the birth trauma of the fetus and newborn, which is of great medical and social importance, since the heart injury of children largely determines perinatal mortality and childhood disability. During the analyzed period in Russia, there has been an increase in the frequency of birth trauma in newborns (by 1.6 times) due to the so-called "other" birth trauma (Fig. 40), while the frequency of intracranial birth trauma has sharply decreased from 9.3‰ to 1.67‰; such dynamics may be due, on the one hand, to a change in the tactics of labor management (an increase in the frequency abdominal delivery), and on the other hand, a change in the statistical accounting of this pathology since 1999, when the heading "birth trauma" began to include and clavicle fractures and cephalohematomas. This led to the observed increase over the past 4 years in the frequency of all birth trauma (due to the "other") to the level of 41.1-42.6‰, which certainly indicates an insufficient level of obstetric care in the obstetric hospital. So, today, every 25th child born has a traumatic injury during childbirth.

It should be noted that in recent years in Russia, against the background of a sharp decrease in the frequency of intracranial birth trauma (2.2 times from 1998 to 1999), there has been an equally sharp (2.3 times) increase in mortality from this pathology - from 6.17% in 1998 to 14.3% in 1999 (Figure 41). Among full-term children, mortality increased from 5.9% in 1991 to 11.5% in 2003, and among premature babies - from 26.4% to 33.2% (!) Over the same years, with a sharp rise in mortality in 1999 year with a decrease in the incidence rate also indicates a change in diagnostic approaches for this pathology. Nevertheless, such a high level of mortality, especially in premature babies, puts the problem of birth trauma in newborns in first place among obstetric problems in modern Russia.

Figure 41. Mortality of newborns from intracranial birth trauma in the dynamics of 1991-2003 (per 100 cases)

Extremely unfavorable is the increase in the frequency of neonatal jaundice in Russia - from 47.3‰ in 1999 (from which their registration began) by 1.5 times in three years. This pathology is typical for premature babies and newborns with morphofunctional immaturity, and the increase in its prevalence is consistent with the data on the continuing high level of prematurity and intrauterine growth retardation. In addition, hypoxic damage to hepatocytes contributes to impaired bilirubin conjugation in a newborn, and thus, an increase in the frequency of neonatal jaundice is naturally associated with an increase in the frequency of intrauterine hypoxia and asphyxia at birth. In an increase in the incidence of jaundice in newborns, the influence of such a factor as an increase in the frequency of induced (“programmed”) births, as well as prenatal caesarean section, in which delivery is performed under conditions of incomplete morphofunctional maturity of the enzyme systems of the fetal body, in particular, the liver transferase system.

The significance of the increase in neonatal jaundice is increasing due to the recent increase in the population mental retardation children and pathology of the nervous system, since bilirubin encephalopathy as a result of severe forms of neonatal jaundice is accompanied by significant neurological disorders. At the same time, the lack of the ability to objectively control the level of hyperbilirubinemia in jaundice in many obstetric hospitals in the country (some of which do not have laboratories at all) may be the reason for the development of this pathology in newborns.

Figure 42. The frequency of hemolytic disease of the newborn (HDN) and hematological disorders in newborns in Russia in 1991-2002, per 1000

The growth in the country of hemolytic disease of newborns by 1.4 times in 2002 in comparison with 1991 (Fig. 42) can also cause an increase in the incidence of bilirubin encephalopathy in newborns. The presented figure shows an increase in the incidence of hemolytic disease in newborns, which was also most pronounced in 1998-1999.

When discussing the problem of hemolytic disease with Rh incompatibility, it is necessary to note the unfavorable trend of a decrease in recent years in Russia in specific immunoprophylaxis of Rh conflict in Rh-negative women, which is largely due to economic factors - the high cost of anti-Rh globulin, as indicated by V.M. Sidelnikov.

The frequency of respiratory distress syndrome increased during the analyzed period from 14.4‰ to 18.7‰, while the change in the statistical registration of this nosological form since 1999 had a significant impact on its dynamics (Fig. 43). However, even under this condition, the growth of this pathology in newborns, including full-term children, characterizes the increase in the degree of morphofunctional immaturity, i.e. that background pathology, which is not taken into account independently, but is clearly detected by indirect signs (growth of conjugative jaundice, respiratory distress syndrome in full-term children).

Figure 43. Dynamics of respiratory distress syndrome (RDS) in newborns in 1991-2002 and RDS in full-term children (per 1000 of the corresponding population)

The frequency of infectious pathology specific to the perinatal period (Fig. 44) increased in newborns in 2002 in comparison with 1991 by 2.7 times and amounted to 24.0‰, which to a certain extent could be explained by an improvement in the detection of infections. However, the increase in septic morbidity among newborns, consistent with the increase in septic complications in parturients/parturient women (the maximum value of the indicator for both women and children in 1999), allows us to regard the increase in congenital infectious pathology in newborns as true.

Figure 44. Dynamics of the frequency of perinatal infections (diagram, left scale) and sepsis (graph, right scale) in newborns in Russia in 1991-2002, per 1000

In 2002, the structure of the incidence of newborns in Russia is presented as follows: in the 1st place - hypoxia, in the second - malnutrition, in the third - neonatal jaundice, in the fourth - birth trauma, in the fifth - developmental anomalies.

Noting the particular importance of congenital anomalies (malformations) and chromosomal disorders, which, although they are in fifth place in terms of the frequency of neonatal pathology, are extremely important because they cause severe pathology and disability in children, measures for prenatal diagnosis of congenital and hereditary pathology are of paramount importance. . In Russia, there is an increase in congenital anomalies in newborns from 18.8‰ in 1991 to 29.7‰ in 2002, or 1.6 times. Population frequency malformations averages from 3% to 7%, and this pathology causes more than 20% of child morbidity and mortality and is detected in every fourth death in the perinatal period. At the same time, it was shown that with a good organization of prenatal diagnosis, it is possible to reduce the birth of children with congenital pathology by 30%.

Statistical data and numerous studies convincingly show how big the role of congenital malformations (CM) in the structure of morbidity and mortality in children is. Malformations cause more than 20% of infant mortality (an increase of up to 23.5% in 2002 among all dead children under the age of one in Russia). The population frequency of congenital malformations averages from 3% to 7%, and among stillborns reaches 11-18%. At the same time, there is a pattern: the lower the PS level, the higher the frequency of congenital malformations. Thus, according to the Scientific Center for Obstetrics, Gynecology and Perinatology of the Russian Academy of Medical Sciences, a decrease in PS to 4‰-7‰ was accompanied by a sharp increase (from 14% to 39%) in the proportion of malformations among dead fetuses and newborns.

The prevalence of congenital anomalies among newborns in the dynamics of 1991-2002 is shown in fig. 45.

Figure 45. Dynamics of the frequency of congenital anomalies in newborns in Russia in 1991-2002 (per 1000 births)

As can be seen from Table. 17, in the context of the federal districts of Russia, the maximum incidence rate of newborns was noted in the Siberian Federal District, mainly due to full-term children. In this district, the maximum rate of hypoxia, malnutrition, and respiratory disorders, incl. respiratory distress syndrome of full-term infants, which characterizes a high degree of morphofunctional immaturity among newborns.

Table 17. Morbidity in newborns by federal districts of Russia in 2002 (per 1000)

	RUSSIA	Central Federal District	Northwestern Federal District	Southern Federal District	Privolzhsky Federal District	Ural Federal District	Siberian Federal District	Far Eastern Federal District
General morbidity
term
premature
Hypotrophy
Birth injury
Incl. Cheka
hypoxia
Respiratory disorders
Incl. RDS
of which RDS-premature
RDS-term
congenital pneumonia
infections, specific
Incl. sepsis
Hematological disorders

Jaundice neonatal
congenital anomalies

An extremely high level of growth retardation and malnutrition (malnutrition) of newborns (every ninth - tenth child born in the Volga, Ural and Siberian Federal Districts) and jaundice (every tenth - twelfth) determines the high incidence of older children in these territories.

The high frequency of birth trauma in the Siberian District (48.3‰ against 41.9‰ in Russia) and intracranial birth injury in the Southern Federal District (1.7 times higher than the national figure) characterize the low quality of obstetric services in these areas. The maximum level of infectious pathology of newborns was noted in the Far Eastern Federal District, 1.4 times higher than in Russia as a whole, and septic complications are most often observed in the Volga Federal District. The highest level of neonatal jaundice was also noted there - 95.1‰, with 69‰ in Russia.

The maximum frequency of congenital anomalies in the Central Federal District - 42.2‰ (1.4 times higher than the national level) dictates the need to study the causes and eliminate the factors that cause congenital malformations of the fetus, as well as take the necessary measures to improve the quality of prenatal diagnosis of this pathology.

According to the growth in the incidence of newborns in Russia, there is an increase in the number of newborns transferred from an obstetric hospital to the departments of pathology of newborns and the second stage of nursing from 6.2% in 1991 to 8.9% in 2002.

A natural consequence of an increase in the incidence of newborns is an increase in the number of chronic pathologies in children, up to severe health disorders, with limited life activity. The role of perinatal pathology as a cause of childhood disability is determined by different authors in 60-80%. Congenital and hereditary pathologies, prematurity, extremely low birth weight, intrauterine infections (cytomegalovirus, herpetic infection, toxoplasmosis, rubella, bacterial infections) occupy a significant share among the causes contributing to the disability of children; the authors note that in terms of prognosis, meningitis and septic conditions are especially unfavorable clinical forms.

It was noted that the quality of perinatal care, as well as rehabilitation measures at the stage of treatment chronic diseases, are often fundamental in the formation of a disabling pathology. Kamaev I.A., Pozdnyakova M.K. et al. note that due to the steady increase in the number of disabled children in Russia, the expediency of timely and high-quality prediction of disability at an early and preschool age is obvious. Based on a mathematical analysis of the significance of various factors (family living conditions, the state of health of parents, the course of pregnancy and childbirth, the condition of the child after birth), the authors developed a prognostic table that makes it possible to quantify the risk of a child developing disability due to diseases of the nervous system, mental sphere, congenital anomalies ; the values of prognostic coefficients of the studied factors and their informative value were determined. Among the significant risk factors for the fetus and newborn, the main risk factors were intrauterine growth retardation (IUGR); prematurity and immaturity; hypotrophy; hemolytic disease newborn; neurological disorders in the neonatal period; purulent-septic diseases in a child.

Pointing to the interconnectedness of the problems of perinatal obstetrics with pediatric, demographic and social problems, the authors emphasize that the fight against the pathology of pregnancy, which causes impaired growth and development of the fetus ( somatic diseases, infection, miscarriage) is most effective at the stage of preconception preparation.

The real factor in preventing severe disabling diseases in a child is early detection and adequate therapy of perinatal pathology, and above all placental insufficiency, intrauterine hypoxia, intrauterine growth retardation, urogenital infections, which play an important role in CNS damage and the formation of fetal abnormalities.

Sharapova O.V., notes that one of the leading causes of neonatal and infant mortality is still congenital anomalies and hereditary diseases; For this reason, according to the author, great importance acquires prenatal diagnosis of malformations and timely elimination of fetuses with this pathology.

In order to implement measures to improve prenatal diagnosis aimed at preventing and early detection of congenital and hereditary pathologies in the fetus, increase the efficiency of this work and ensure interaction in the activities of obstetrician-gynecologists and medical geneticists, an order of the Ministry of Health of Russia dated December 28, 2000 No. 457 "On improving prenatal diagnosis and prevention of hereditary and congenital diseases in children.

Prenatal diagnosis of congenital malformations, designed for active prevention of the birth of children with developmental anomalies by terminating pregnancy, includes ultrasound examination of pregnant women, determination of alpha-fetoprotein, estriol, human chorionic gonadotropin, 17-hydroxyprogesterone in the mother's blood serum and determination of the fetal karyotype by chorion cells in women over 35 years old.

It has been proven that with a good organization of prenatal diagnosis, it is possible to reduce the birth of children with severe congenital pathology by 30%. Noting the need for antenatal prevention of congenital pathology, V.I. Kulakov notes that for all its high cost (the cost of one amniocentesis procedure with chorion cell biopsy and karyotype determination is about 200-250 US dollars), it is more cost-effective than the cost of maintaining a disabled child with severe chromosomal pathology.

1 - Baranov A.A., Albitsky V.Yu. Social and organizational problems of pediatrics. Selected essays. - M. - 2003. - 511s.
2 - Sidelnikova V.M. Miscarriage. - M.: Medicine, 1986. -176s.
3 - Barashnev Yu.I. Perinatal neurology. M. Science. -2001.- 638 p.; Baranov A.A., Albitsky V.Yu. Social and organizational problems of pediatrics. Selected essays. - M. - 2003. - 511s.; Bockeria L.A., Stupakov I.N., Zaichenko N.M., Gudkova R.G. Congenital anomalies (malformations) in the Russian Federation // Children's Hospital, - 2003. - No. 1. - C7-14.
4 - Kulakov V.I., Barashnev Yu.I. Modern biomedical technologies in reproductive and perinatal medicine: prospects, moral, ethical and legal problems. // Russian Bulletin of Perinatology and Pediatrics. - 2002. No. 6. -p.4-10.
5 - Ibid.
6 - Ibid.
7 - Kagramanov A.I. Comprehensive assessment of the consequences of diseases and causes of disability in the child population: Abstract of the thesis. diss. cand. honey. Sciences. - M., 1996. - 24 p.
8 - Kulakov V.I., Barashnev Yu.I. Modern biomedical technologies in reproductive and perinatal medicine: prospects, moral, ethical and legal problems. // Russian Bulletin of Perinatology and Pediatrics. - 2002. No. 6. -p.4-10; Ignatieva R.K., Marchenko S.G., Shungarova Z.Kh. Regionalization and improvement of perinatal care. /Materials of the IV Congress of the Russian Association of Perinatal Medicine Specialists. - M., 2002. - c. 63-65.
9 - Kulakov V.I., Barashnev Yu.I. Modern biomedical technologies in reproductive and perinatal medicine: prospects, moral, ethical and legal problems. // Russian Bulletin of Perinatology and Pediatrics. - 2002. No. 6. -p.4-10

HEALTH ORGANIZATION

N.V. Gorelova1, L.A. Ogul1,2 ANALYSIS OF INCIDENCE OF NEWBORN IN THE MATERNITY HOSPITAL

1GBOU VPO "Astrakhan State medical Academy» Ministry of Health and Social Development of Russia 2MUZ "Clinical Maternity Hospital", Astrakhan, Russia

The article presents the results of the analysis of the incidence and its structure in newborns for the period 2005-2009 according to the data of the Clinical Maternity Hospital (MUZ KRD) in Astrakhan.

Key words: newborn, neonatal morbidity, newborn morbidity structure, quality of medical care.

N.V. Gorelova, L.A. Ogul THE ANALYSIS OF NEW-BORNS MORBIDITY IN THE MATERNITY HOME

The article deals with the results of made analysis according to morbidity and its structure among new-borns during the period from 2005 to 2009 using the data of clinical maternity home in Astrakhan.

Key words: new-born, new-born morbidity, new-born morbidity structure, medical aid quality.

Statistical data on the state of health of the population of the Russian Federation indicate an increase in the incidence of newborns associated with various types obstetric and somatic pathology of the mother, socio-biological, hereditary and other factors. Currently, there is a fairly high level of perinatal morbidity and mortality.

Purpose and objectives of the study: to assess the incidence and its structure in newborns in dynamics for the period 2005-2009 according to the data obtained in the Clinical maternity hospital Astrakhan.

Materials and methods. The study was conducted on the basis of the observational department of newborns of the Astrakhan Clinical Maternity Hospital based on the results of the analysis of the medical records of the maternity hospital, data on the developmental histories of newborns using the calculation of intensive and extensive morbidity rates and its structure among newborns of the clinical maternity hospital.

Results and its discussion. Among all those born in 2005-2007, 73.0% of newborns had a particular disease and concomitant pathology, which decreased in 2008 to 58.9%, in 2009 to 48.0%. The incidence rate of newborns in the maternity hospital slightly increased (from 977%o in 2005 to 1081% in 2006) and decreased to 720% by 2009 (Fig. 1).

1100 1000 900 % 800 700 600 500

Rice. 1. Dynamics of the incidence of newborns in the clinical maternity hospital from 2005 to 2009

The proportion of premature babies was stable, amounting to 7.6% in 2006, 7.3% in 2007, 7.6% in 2008, 7.7% in 2009.

The leading place in the structure of morbidity in newborns for the period 2005-2009 was occupied by neurological disorders. The frequency of lesions of the central nervous system (CNS) in newborns had unequal dynamics in the maternity hospital: it increased from 46.6% in 2005 to 52.7% by 2006

year, and a decrease to 31.8% by 2009 (r<0,05). Основными клиническими проявлениями были синдромы гипервозбудимости ЦНС и церебральной депрессии (табл. 1).

Table 1

Dynamics of the morbidity structure of newborns in the clinical maternity hospital, %

Years of pathology 2005 2006 2007 2008 2009

Cerebral status disorders 46.6 52.7 42.0 36.6 31.8

Neonatal jaundice 9.8 9.4 18.0 20.6 19.5

Slow growth and fetal malnutrition 11.0 11.4 11.6 11.8 15.2

Hemolytic disease of the newborn 2.6 2.6 5.0 5.2 8.9

Respiratory distress syndrome 2.1 2.3 3.4 6.8 5.1

Congenital malformations 6.6 4.8 4.5 3.3 4.9

Birth injuries 1.4 1.6 2.0 3.7 4.8

Anemia (and other hematological disorders) 2.3 1.8 4.2 5.9 3.7

Intrauterine hypoxia (and asphyxia of the newborn) 5.8 6.1 4.5 3.6 3.7

Intrauterine infections (including congenital pneumonia) 11.8 7.3 4.8 2.5 2.4

Total 100 100 100 100 100

In the interval from 2005 to 2006, a stable incidence of neonatal jaundice was registered (9.8% in 2005 and 9.4% in 2006), however, there was a significant increase in this pathology in 2007-2008 from 18.0% to 20 .6% (p<0,05). За 2009 год в МУЗ КРД отмечалось снижение абсолютного количества гипербилирубинемий до 19,5% (р<0,05), большинство которых носило характер функциональных расстройств, связанных с транзитор-ным нарушением коньюгации билирубина. Эта патология наиболее часто возникала у доношенных детей с выраженными признаками морфофункциональной незрелости и у недоношенных новорожденных. Снижение числа данной патологии, несмотря на рост преждевременных родов, говорит о том, что доношенных детей с проявлениями морфофункциональной незрелости стало меньше. У подавляющего числа детей неонатальная желтуха имела легкое и среднетяжелое течение. В случаях затяжного течения дети переводились на второй этап выхаживания.

The percentage of newborns with stunted growth and malnutrition who had intrauterine growth retardation (IUGR) was 11.0% in 2005, 11.4% in 2006, 11.6% in 2007, increasing by 2009 to 15.2 % (R<0,05>

In recent years, an increase in the incidence of hemolytic disease of the newborn (HDN) has been observed: from 2.6% in 2005-2006 to 5.0% in 2007, followed by its increase by 2009 to 9.0% (p<0,05). Возможно, это было обусловлено ростом рождаемости в последние годы, а также профильным направлением всех рожениц с изоиммунным конфликтом в данный клинический родильный дом.

The incidence of respiratory distress syndrome (RDS) in newborns increased from 2.1% in 2005 to 6.8% in 2008 (p<0,05). Снижение показателя заболеваемости новорожденных с РДС в 2009 году до 5,1%, несмотря на возросшее число преждевременных родов, произошло за счет снижения количества доношенных детей с морфофункциональной незрелостью. Респираторные расстройства регистрировались:

In premature babies, and were due to atelectasis of the lungs and respiratory distress syndrome;

In children with signs of morphofunctional immaturity (pulmonary atelectasis);

In newborns born by caesarean section (ACS), in which RDS developed against the background of fetal fluid retention.

All children with respiratory failure (RD) were observed and received appropriate treatment in the neonatal intensive care unit. The decrease in morbidity and mortality from RDS in the early neonatal period in the conditions of the Clinical Maternity Hospital in 2009 was undoubtedly associated with the introduction of high-tech nursing methods using modern respiratory equipment (constant positive pressure ventilation through nasal cannulas - NCPAP, high-frequency ventilation) and artificial surfactant (curosurfa). After stabilization of the condition, the children were transferred to the children's departments and to the second stage of nursing, depending on the severity and duration of DN.

During the period 2006-2008, there was a decrease in the incidence of congenital developmental anomalies from 4.8% to 3.3%, followed by an increase in their number to 4.9% in 2009 (p<0,05), связанным с улучшением диагно-

tics of congenital malformations in the antenatal period by the Family Planning Center (FPC). The available indicators also included cases of congenital malformations in children whose mothers categorically refused to terminate the pregnancy, although they knew about their unborn child's congenital pathology. A large group consisted of children in whom intrauterine diagnosis of congenital pathology was not possible due to technical reasons (“slit-like” hemodynamically insignificant defects of the interventricular septum, patent ductus arteriosus, atrial septal defects, small focal changes in the central nervous system, etc.). Children with suspected genetic or chromosomal pathology were consulted by a geneticist from the CPC. In the conditions of the Clinical Maternity Hospital, ultrasound diagnostics was of a screening nature.

Between 2005 and 2009, there was an increase in the number of birth injuries from 1.4% to 4.8% (p<0,05), однако в 2009 году 64,7% всех родовых травм не были связаны с внутричерепной родовой травмой, а были представлены в виде кефалогематом. Практически во всех случаях диагноз «кефалогематома» носил сопутствующий характер.

Anemia of unspecified etiology increased from 1.8% in 2006 to 5.9% in 2008 between 2006 and 2008 (p<0,05). Она не была связана с кровотечением или гемолизом, вызванным изоиммунизацией. Как правило, это состояние развивалось на фоне длительных гестозов, анемии у матери во время беременности, фетоплацентарной трансфузии и др.

Positive dynamics was revealed in relation to the amount of intrauterine hypoxia and asphyxia. Thus, in 2006 there was an increase in their number to 6.1%, and from 2007 to 2009 their number decreased from 4.5% to 3.7% (p<0,05). С нашей точки зрения, снижение частоты внутриутробной гипоксии и асфиксии связано с повышением качества коррекции этих состояний в антенатальном периоде. Все реанимационные мероприятия проводились с участием врача реаниматолога-анестезиолога согласно действующему приказу МЗ РФ от 28.12.1995 № 372 «О совершенствовании первичной реанимационной помощи новорожденным в родильном доме» .

During the period from 2006 to 2009, there was a decrease in the incidence of infectious diseases from 11.8% in 2005 to 7.3% in 2006, 4.8% in 2007, 2.5% in 2008, which remained stable in 2009 , amounting to 2.4% (p<0,05). Такая динамика связана с эффективным профилактическим лечением беременных с внутриутробной инфекцией в течение беременности, внедрением высоких технологий в практику работы отделения реанимации и интенсивной терапии новорожденных. При проявлении признаков внутриутробной инфекции (ВУИ) (гнойный конъюнктивит, омфалит, фарингит) дети переводились в инфекционное отделение городской детской клинической больницы для новорожденных № 1 в день постановки диагноза (1-3 сутки). Если перевод был невозможен из-за тяжести состояния, то он осуществлялся сразу после стабилизации состояния.

Conclusion. Thus, based on the analysis, an increase in the incidence of HDN, IUGR, birth injuries, congenital malformations and a decrease in the number of cerebral status disorders, intrauterine hypoxia and neonatal asphyxia, and intrauterine infections were revealed. The implementation of the National Health Project made it possible to improve diagnostics through the acquisition and implementation of modern equipment, provide high-quality medical care, and improve the skills of staff, which affected the change in neonatal morbidity rates.

BIBLIOGRAPHY

1. Volkov S.R. Health statistics: the main performance indicators of the maternal and child health service and the methodology for their calculation (Key performance indicators of the maternity hospital) // Chief Nurse. - 2008. - No. 8. - S. 25-28.

2. Zlatovratskaya T.V. Reserves for reducing maternal and perinatal morbidity and mortality in the maternity ward of a multidisciplinary hospital: Ph.D. dis. ... dr. honey. Sciences. - M., 2008. -48 p.

Analysis of the incidence of newborns. Perinatal pathology in Russia: level, structure of morbidity

Abstract and dissertation in medicine (14.00.09) on the topic: The state of health of children in the first year of life and the prevention of diseases at the outpatient stage

Dissertation abstract in medicine on the topic The state of health of children in the first year of life and the prevention of diseases at the outpatient stage

Conclusion of the dissertation research on the topic "The state of health of children in the first year of life and the prevention of diseases at the outpatient stage"

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"Research work The role of a nurse in organizing the prevention of morbidity in children of the first year of life on the example of a children's clinic in the city of Satka"