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Omphalitis in newborns - causes and treatment of inflammation of the umbilical wound. Diseases of the umbilical wound Technique for DPT vaccination

After the umbilical remnant falls off, an umbilical wound remains, which epithelializes by the end of 2-3 weeks.

Omphalitis - inflammatory process in the umbilical wound area. The umbilical wound is the entrance gate for the penetration of pathogenic microorganisms into the body of a newborn.

The following forms of omphalitis are distinguished:

1. catarrhal omphalitis (weeping navel)

2. navel fungus

3. purulent omphalitis

4. phlegmonous

5. necrotic

When the umbilical vessels are affected, they speak of phlebitis and arteritis.

Etiology:

1. Gram-positive flora (St, Str)

2. Gram-negative flora (Escherichia coli, Proteus, Pseudomonas aeruginosa, etc.).

1) Catarrhal omphalitis

The most common and prognostically favorable form of the disease is when a long-term non-healing granulating wound with scanty serous discharge appears on the navel. The child's condition is satisfactory. Periodically, the wound becomes covered with a crust, granulations can grow excessively, forming a mushroom-shaped protrusion (umbilical fungus).

Catarrhal omphalitis –(wet navel), this form of the disease occurs, as a rule, with delayed epithelization of the umbilical wound. More often in children with large body weight, with a wide umbilical ring.

Clinic:

The umbilical wound constantly gets wet, serous discharge is released, the bottom of the wound is covered with granulations, and bloody crusts may form;

There is mild hyperemia and moderate infiltration of the umbilical ring;

With a prolonged process of epithelization, mushroom-shaped granulations (fungus) may appear at the bottom of the umbilical wound - a dense, painless, pale pink formation (cauterized with a lapis pencil or surgically excised);

The umbilical vessels are not palpable;

The condition of the newborn is not impaired, the temperature is normal;

Healing occurs over several weeks.

A long-wetting navel should alert you to the presence of purulent fistulas!!! Surgeon consultation!

Treatment: treatment of the navel wound with 3% hydrogen peroxide, dry with a gauze pad with ethyl. alcohol, cauterized with 1% brilliant green, 5% potassium permanganate solution;

Xeroform is sprinkled into the wound;

Local Ural Federal District;

No bandages!

Purulent omphalitis

Purulent omphalitis – characterized by the spread of the inflammatory process to the tissue around the umbilical ring (skin, subcutaneous tissue, umbilical vessels) and severe symptoms of intoxication.

Clinic:

The skin around the navel is hyperemic and swollen;

The umbilical wound is an ulcer covered with a fibrinous coating; when pressed, purulent discharge is released from the navel;

Gradually, the umbilical region begins to bulge above the surface of the abdomen, as deep-lying tissues are involved in the inflammatory process;

The umbilical vessels are inflamed (thicken and palpable in the form of tourniquets);

There is an expansion of the venous network on the anterior abdominal wall;

The condition is severe, the symptoms of intoxication are pronounced: the child is lethargic, sucks poorly, regurgitates frequently, the temperature rises, and there is no weight gain.

Treatment: hospitalization in the surgical department;

Local treatment - the umbilical wound is injected with antibiotics in the early stages;

As soon as purulent discharge appears, the umbilical wound is drained, a bandage is applied with a hypertonic solution, then with Vishnevsky ointment;

UHF, Ural Federal District;

General treatment: antibiotics, detoxification, immunocorrective therapy; vitamins, symptomatic treatment.

3) Phlegmonous omphalitis

It occurs as a result of the spread of the inflammatory process to the umbilical area. Edema, tissue infiltration, skin hyperemia, and protrusion of the umbilical region are noted. An ulcer may form at the bottom of the umbilical wound. Inflammation spreads through the lymph vessels, swelling and infiltration extend far beyond the umbilical region, and sometimes dilatation of the veins of the anterior abdominal wall is noted (phlegmon of the anterior abdominal wall). The child’s condition is disturbed, lethargic, decreased appetite, regurgitation, decreased or no weight gain, the skin is pale or pale gray, the temperature is elevated to febrile levels.

4). Necrotizing omphalitis - an extremely severe complication of the phlegmonous form in premature, severely weakened children. The process extends deeper. The skin becomes purplish-bluish, necrosis and detachment from the underlying tissue occurs. This creates a large wound. The muscles and fascia in the abdominal wall are exposed. Subsequently, intestinal eventration may occur. This form is the most severe and often leads to sepsis.

With thrombophlebitis of the umbilical vein, an elastic cord above the navel is palpated. With thrombarteritis, the umbilical arteries are palpated below the umbilical ring, radially. With the development of periphlebitis and periarteritis, the skin over the affected vessels is swollen and hyperemic, and tension in the muscles of the anterior abdominal wall is possible. With light massaging movements from the periphery of the affected vessel to the umbilical ring, purulent discharge appears at the bottom of the umbilical wound.

UAC- in severe forms: leukocytosis, neutrophilia, shift of the formula to the left, increased ESR.

Care and treatment:

1. for catarrhal omphalitis and navel fungus, with daily observation and good social conditions in the family, hospitalization is not necessary. For other forms of omphalitis and inflammation of the umbilical vessels, it is necessary to hospitalize the child.

2. Local drug treatment depends on the form of the disease.

ü For catarrhal and purulent omphalitis - treatment of the umbilical wound with a 3% solution of hydrogen peroxide, then 70% ethyl alcohol, then a 5% solution of KMnO4 or 2% bril solution. green.

ü For fungus - cauterization of granulations with a 5% silver solution, lapis.

ü For phlegmonous form - bandages with hypertonic solutions of 5-10% sodium chloride, with ointments (levosin, levomekol).

ü In case of necrotic - after surgical intervention (necrectomy) - it is carried out in an open way using hydrophilic ointments.

3. general treatment: antibiotics, symptomatic.

4. for severe cases, wash the skin with wet wipes; for mild cases, hygienic baths with a solution of potassium permanganate 1:10,000, decoctions of string, chamomile are indicated.

The prognosis is favorable for non-severe forms with timely treatment. In other cases, complications may develop, including sepsis and death.

Sepsis

In recent decades, the problem of neonatal sepsis has again become relevant. As is known, in the 80s of the 20th century there was a decrease in the number of cases of this terrible disease due to the expansion of the range of antibacterial and immunoreplacement therapy. However, now the frequency of sepsis in newborns has increased and is 0.1–0.2% in full-term and 1–1.5% in premature babies.

The latest definition of neonatal sepsis was published in the National Neonatology Guidelines at the end of 2007.

Sepsis is a disease based on a generalized purulent-inflammatory infection caused by opportunistic bacterial microflora, the basis of the pathogenesis of which is dysfunction of the immune, predominantly phagocytic, system of the body with the development of an inadequate systemic inflammatory response (SIR), focus(es) of purulent inflammation or bacteremia and multiple organ failure.

(In newborns, early and late sepsis are distinguished. Early neonatal sepsis is sepsis of children in the first 3 days of life. Early sepsis is characterized by intrauterine or early postnatal infection. In this regard, the child does not have a primary purulent focus, but so-called intrauterine pneumonia is often detected.

When sepsis clinically manifests itself later in a child’s life, it is customary to speak of late neonatal sepsis. In late sepsis, infection of the newborn occurs postnatally. The primary site of infection is usually present. Septicopyemia is most often recorded, i.e. sepsis occurs with the formation of one or more septicopyemic, metastatic, purulent-inflammatory foci. A typical metastatic lesion is purulent meningitis.)

Bacterial sepsis of the newborn– this is the generalization of a bacterial infection, characterized by a breakthrough of local and regional protective barriers, the release of the pathogen into the general bloodstream, the development of toxicosis and multiple organ failure against the background of immunological restructuring and suppression of the body’s nonspecific resistance.

-Sepsis– A SEVERE GENERAL INFECTIOUS DISEASE CAUSED BY THE SPREAD OF BACTERIAL FLORA FROM A LOCAL FOCUS OF INFECTION INTO THE BLOOD BED, LYMPHOWAY, AND FROM THEM TO ALL ORGANS AND TISSUE OF THE BODY, ARISING DUE TO IMMUNITY INSUFFICIENCY ORGANISM.

Etiology. The causative agent of neonatal sepsis is various pathogenic and conditionally pathogenic hospital strains of microorganisms, both gram-negative (Escherichia coli, Pseudomonas aeruginosa, Klebsiella, Enterobacteriaceae, Proteus) and gram-positive (staphylococcus, streptococcus, anaerobes, clostridia), etc.

Staphylococcus aureus

· gram-negative flora

§ Predisposing factors for sepsis are factors that reduce the protective properties of natural pathways - multiple catheterizations of the umbilical and central veins, tracheal intubation, artificial ventilation, birth defects, acute respiratory viral infections, skin lesions; factors that inhibit the immunological reactivity of a newborn are a complicated antenatal period, pathological course of labor leading to asphyxia, intrauterine hypoxia, immaturity of the newborn, intracranial birth trauma; Factors that increase the risk of massive bacterial contamination of a child are a long period without water, especially if the mother has chronic foci of infection, and an unfavorable sanitary and epidemiological situation in the maternity hospital.

Pathogenesis:

§ The entrance gate of infection is the umbilical wound, injured skin and mucous membranes, as well as intact skin and mucous membranes of the upper respiratory tract and gastrointestinal tract.

§ Infection of a child can occur intrauterinely, during childbirth and after birth. At the site of infection, a primary inflammatory focus is formed, and adjacent vessels and tissues are affected. Degenerative-necrotic changes in the walls of blood vessels develop, from where pathogenic microbes spread hematogenously throughout the newborn’s body, exerting a damaging effect on tissues and organs through their enzymes and toxins, causing a severe pathological process with profound disturbances of homeostasis. Under the influence of microorganism enzymes, cell lysis occurs, resulting in increased intoxication.

Factors contributing to the development of sepsis

1. Infectious and inflammatory diseases of the genitourinary organs in a pregnant woman (pyelonephritis, adnexitis, colpitis), extragenital pathology.

2. Infections in the postpartum mother (endometritis, mastitis).

3. Pathology during childbirth (prolonged labor, anhydrous period during labor > 6 hours, “dirty” water, placental deposits).

4. Out-of-hospital birth.

5. Severe intrapartum asphyxia against the background of chronic intrauterine hypoxia.

6. Prematurity< 32 недель гестационного возраста

7. Birth weight< 1500 г.

8. Birth injuries.

9. Developmental defects and hereditary diseases.

11. therapeutic and diagnostic manipulations during the provision of resuscitation care, leading to disruption of the integrity of the skin and mucous membranes:

ü mechanical ventilation (tracheal intubation) > 3 days.

ü Catheterization of peripheral veins > 3 times.

ü Duration of intravenous infusions > 10 days.

ü Surgical interventions.

High risk factors for bacterial infection of the fetus and newborn

12. Infectious and inflammatory diseases in a pregnant woman (pyelonephritis, adnexitis, colpitis).

13. Infections in a postpartum mother (endometritis, mastitis).

14. Anhydrous period during labor > 6 hours.

15. Signs of infection of the amnion (“dirty” water, deposits on the placenta).

16. Out-of-hospital birth.

High risk factors for generalization of bacterial infection

(macroorganism factors)

1. Severe intrapartum asphyxia against the background of chronic intrauterine hypoxia.

2. Birth injuries.

3. Developmental defects and hereditary diseases.

5. Prematurity< 32 недель гестационного возраста.

6. Birth weight< 1500 г.

A particularly high risk of developing a septic process is observed in the group of children with extremely low birth weight. Thus, in children weighing 500–750 g, the incidence of sepsis can reach 30–33%, which is also associated with an increase in the survival rate of these children beyond the early neonatal period.

Iatrogenic factors of high risk of generalization of bacterial infection in newborns

1. Mechanical mechanical ventilation (tracheal intubation) > 3 days.

2. Catheterization of peripheral veins > 3 times.

3. Duration of intravenous infusions > 10 days.

4. Surgical interventions.

Clinic: diverse. The nurse needs to look for signs of early infection

· late fall of the umbilical cord, slow healing of the umbilical wound, pyoderma

persistent regurgitation

· long-term persistence of jaundice.

There are two forms of sepsis:

1. septicemic (a form of sepsis without obvious purulent foci, manifested by intoxication, damage to internal organs, and inflammatory reaction). More often in premature infants.

2. septicopyemic (a form of sepsis that occurs with the formation of one or several purulent-inflammatory foci with severe symptoms of intoxication (usually purulent meningitis, pneumonia, enterocolitis, osteomyelitis, etc.).

Clinic:

There are acute (within 3 - 6 weeks), subacute (1.5 - 3 months), prolonged (more than 3 months) and fulminant course of the disease. Depending on the entrance gate of the infection, umbilical, cutaneous, pulmonary, intestinal, and otogenic sepsis are distinguished.

If the septic process occurs in the antenatal period and the child is already born sick, his condition is serious: there is an increase in temperature, the skin is pale gray in color with extensive dermatitis, hemorrhagic rash, swelling, exicosis, regurgitation, vomiting, jaundice, enlarged liver and spleen, large initial loss of thalas weight, greenish coloration near the fetal fluid.

Sepsis that developed intra- and postnatally is often manifested by a gradual onset of the disease - deterioration of the general condition in the first or second week of the child’s life, low-grade fever, pallor of the skin with a gradual acquisition of a gray or earthy tint, lethargy, refusal to breastfeed, regurgitation, vomiting, weight loss body, flattening of the body weight curve, increased duration and increased severity of jaundice, hemorrhagic phenomena on the mucous membranes, pyoderma, edema of the anterior abdominal wall and extremities.

There is a delay in mummification and separation of the umbilical remnant, prolonged bleeding of the umbilical wound with late epithelization, a long-lasting bloody crust in the center of the navel, a symptom of a newly opened navel, omphalitis, unstable stasis, interstitial pneumonia, etc.

Weakening of physiological reflexes, adynamia, muscle hypotension, anxiety, stool with mucus and greens, bloating, swelling or pastiness of the abdominal wall, hyperemia of the skin over the arteries, strengthening of the network of subcutaneous venous vessels, thickening of the umbilical vein or artery, increased bleeding of the umbilical wound.

The septicopyemic form is characterized by the appearance of purulent foci, most often in the brain with the development of purulent meningitis. Development of pneumonia, ulcerative necrotizing enterocolitis, pyelonephritis, otitis media, conjunctivitis, etc.

Diagnosis is based on the clinical picture and laboratory data. In the peripheral blood, anemia, neutrophilic leukocytosis with shifts of the leukocyte formula to the left, monocytosis, thrombopenia, increased levels of bilirubin in the blood serum, alkaline phosphatase, thymol test, violation of the ratio of aspartic and alanine transaminases; in the urine - transient albuminuria, bacterio- and leukocyturia. Isolation of the pathogen from the child's blood is a valuable, but optional diagnostic criterion.

Regardless of the form of sepsis, the severity of the child’s general condition is characteristic. The earliest symptom is signs of intoxication and damage to the central nervous system.

CNS: depression, decreased motor activity, reflexes, muscle tone, agitation, convulsions.

Respiratory system: tachypnea, apnea, retraction of the compliant areas of the chest.

The cardiovascular system: tachy/bradycardia, hypo/hypertension, muffled heart sounds, thready pulse.

Leather: pallor, gray/icteric tint, rash, swelling, sclerema, marbling, cyanosis, necrosis, “white spot” symptom.

Gastrointestinal tract: refusal to suck, intestinal paresis, diarrhea, pathological weight loss, hepatosplenomegaly.

urinary system: oligo-/anuria.

Hemostasis system: bleeding, thrombosis.

When examining a child, the nurse should suspect sepsis by finding the 7 Cs:

WEAKNESS
RETURNING
GRAY SKIN
SUBFEBRAL LONG-TERM TEMPERATURE
REDUCED SOFT TISSUE TURGOR AND MUSCLE TONE
WORTH WEIGHT
CHAIR IS UNSTABLE

If the course is favorable, the duration of the disease during treatment is 8-10 weeks. The acute period manifests itself for 10-14 days, then the symptoms of toxicosis fade, the function of organs and systems is gradually restored, and purulent foci are sanitized. During this period, cross infection can easily occur.

CBC in the acute period - pronounced leukocytosis (less commonly leukopenia, normopenia), shift to the left, anemia, m.b. thrombocytopenia.

There may be a lightning-fast course of sepsis for 1-7 days, the development of septic shock.

Septicemia, caused by Staphylococcus aureus occurs with a rapid malignant course, with the rapid development of multiple organ failure, rapid exhaustion, decompensation of all types of metabolism, toxic delirium, septic endocarditis, hepatolienal syndrome, infectious toxic nephrosis, endotoxic shock.

Clinic: Symptoms of intoxication predominate. General exhaustion, yellowness of the skin and mucous membranes, hemorrhages on the skin, mucous membranes, serous membranes, hemorrhages in the stomach cavity, internal organs and adrenal glands develop. On the part of the central nervous system – disorders. Septicemia is characterized by intoxication of the body without local purulent-inflammatory foci, while with septicopyemia, pyemic foci are detected (abscesses, phlegmon, meningitis, otitis, pneumonia of a destructive type with pleural complications, etc.).

Laboratory diagnostics

1. CBC - in the acute period - pronounced leukocytosis (less commonly leukopenia, normopenia), shift to the left, anemia, maybe. thrombocytopenia.

2. bacteriological examination of blood, urine, feces and pus from pyuemic foci (repeated cultures)

Prognosis: serious. Mortality 25 – 55%.

CARE AND TREATMENT

Care:

1. Urgent hospitalization in a separate room, strict adherence to asepsis, hygienic regime (hygiene of skin, mucous membranes)

2. Providing a therapeutic and protective regime with anesthesia for invasive manipulations

3. Compliance with thermal and humidity conditions: incubation of newborns (especially premature ones), temperature not lower than +30, humidity not lower than 60%.

4. organization of rational feeding of the child (priority of breastfeeding - breastfeeding, from a bottle, through a tube), in the absence - with adapted formulas for feeding newborns, enriched with bifidobacteria. Increase the frequency of feeding by 1-2. According to indications - partial or complete parenteral nutrition (AA solutions).

3. During the period of subsidence of the clinical manifestations of sepsis, the careful use of therapeutic massage, dry immersion, and exercises in water begins.

5. The mother’s care is required in nursing and maintaining a positive emotional status, in preventing cross-infection, cooling, and cleaning the skin and mucous membranes.

Treatment:

The goal of treatment is to prevent the fatal outcome of the disease, which develops in the absence of therapy or inadequate treatment. It should be remembered that the entire volume of drug therapy must be started as early as possible.

Treatment. Urgently hospitalize in specialized neonatal pathology departments if surgical intervention is necessary. Feeding with mother's milk (mother's breast or expressed breast milk through a tube, from a nipple).

Treatment is symptomatic with the use of broad-spectrum antibiotics in combination with drugs that stimulate defense mechanisms and restore biological balance.

When the patient's condition improves, active immunization agents are used - staphylococcal toxoid, autovaccine, staphylococcal bacteriophage, drugs that stimulate immunogenesis. All this is used in combination with such biologically active substances as lactobacterin, bifidumbacterin and vitamins.

Drug therapy for sepsis involves a combination of basic etiotropic treatment with pathogenetic correction of metabolic, immune and organ disorders

1.Etiotropic therapy:

Antibiotics:Currently there is no universal drug, combination of drugs that could be equally effectively used to treat any newborn with sepsis. Antibiotics are prescribed empirically, taking into account the most likely range of possible infectious agents in a given patient and depending on the type of sepsis. Therapy is ineffective if, within 48 hours, there is an increase in the severity of the condition and organ failure. This is the basis for switching to alternative antibacterial therapy. With successful antibacterial therapy, its duration is at least 4 weeks, and (with the exception of aminoglycosides, the course duration of which should not exceed 10 days) the course of the same drug, with its obvious effectiveness, can reach 3 weeks. The grounds for discontinuation of antibacterial drugs are the rehabilitation of primary and pyemic foci, the absence of new metastatic foci, relief of signs of a systemic inflammatory response (SIR), persistent increase in body weight, normalization of the peripheral blood count and platelet count.

3. semisynthetic penicillins (ampicillin, oxacillin) + aminoglycosides (amikacin, netilmecin)

4. cephalosporins 1-2-3 generations (cefazolin, cefuroxime, ceftriaxone, cefatoxime) + aminoglycosides

2. Given the need for long-term and intensive antibacterial therapy, dysbiosis is corrected: simultaneously prescribed probiotics(bifidum-bacterin, lactobacterin, linexa, etc.) and antimycotics(Diflucan, Medoflucon, Forkan, etc.)

3.INFUSION THERAPY

They start with colloidal solutions (fresh frozen plasma, gelatinol, dextran, but not albumin, which, when administered, goes into the body tissues), which are administered at the rate of 20 ml/kg of the child’s body weight in the first 5–10 minutes of infusion therapy by bolus or drip. Then crystalloids are injected dropwise at an average of 40–60 ml/kg body weight, but can be administered when indicated (for example, with exicosis) and in large quantities. Fresh frozen plasma contains antibodies, proteins, in addition, it is a donor of antithrombin III, the level of which drops significantly with the development of sepsis, which, in turn, causes depression of fibrinolysis and the development of disseminated intravascular coagulation syndrome (DIC syndrome), therefore fresh frozen plasma is especially indicated with DIC syndrome. Infusion therapy also includes solutions of potassium, calcium, magnesium, and, if parenteral nutrition is necessary, solutions of amino acids.

4.OXYGEN THERAPY

§ FACE MASK

§NASAL CATHETERS

5. ANTI-SHOCK THERAPY For septic shock and adrenal insufficiency, glucocorticoids are indicated.

6.IMMUNOREPLACEMENT THERAPY

§ LEUKOCYTE SUSPENSION

(In case of sepsis accompanied by absolute neutropenia (less than 1.5 * 10 9 /l of neutrophils in the analysis of peripheral blood), as well as with an increase in the neutrophil index of more than 0.5, for the purpose of immunocorrection, transfusions of a leukocyte suspension are used at the rate of 20.0 ml / kg of weight the child's body every 12 hours until the level of leukocytes reaches 4.0 x 109/l in the peripheral blood. This treatment method is due to the key importance of neutrophils in the pathogenesis of SVR in sepsis).

§ IMMUNOGLOBULINS (immunoglobulin preparations with increased titers of IgM (Pentaglobin). – for intravenous administration. (The concentration of IgM and IgA in the neonatal period is extremely low and begins to increase only from 3 weeks and 3 months of age, respectively).

§ LYCOPIDE

§ RECOMBINANT INTERFERONS (Viferon)

§ human leukocyte interferon

7.NORMALIZATION OF METABOLISM

§ VITAMINS

§ AMINO ACIDS

§ ENZYMES

8. SYMPTOMATIC AND SYNDROMAL THERAPY

9. LOCAL TREATMENT OF PURULENT FOCI

Dispensary observation

1. observation in a clinic for three years

2. examination by a pediatrician, neurologist (other specialists as indicated)

3. planned restorative therapy

4. medical exemption from professional vaccinations, consultation with an immunologist

Prevention

1. Antenatal:

ü Identification and treatment of chronic foci of infection and acute diseases in pregnant women

ü Proper organization of daily routine and nutrition, walks

ü Prevention and treatment of pregnancy complications

2. Postnatal:

ü Careful observance of asepsis during childbirth and when caring for a newborn

ü Maintaining hygiene by the mother and caregivers of the child

ü Early breastfeeding

ü Timely detection and treatment of localized purulent-inflammatory diseases

After discharge from the hospital, observation in the clinic for three years by a pediatrician, neurologist and other specialists, depending on the nature of the disease.

For cerebral dysfunction, phenibut, aminalon, encephabol, etc. are indicated for six months.
Prevention - strict adherence to sanitary and epidemiological regulations in maternity institutions and newborn departments of city hospitals.

sterile tray;

tweezers in disinfection solution;

Check for clean diapers.

7. Unwaddle the baby in the crib. (Wash it, dry the skin - if necessary)

Performing the manipulation:

Toilet the umbilical wound several times a day (as prescribed by a doctor)

Then apply a bandage with a hypertonic solution - 10% sodium chloride solution or 25% magnesia solution or 10% sodium chloride solution for 20 minutes (do not allow the bandage to dry out!)

a bandage with a hypertonic solution alternates with treatment of the umbilical wound with an alcohol solution of chlorophyllipt

The final stage:

1. Swaddle the child (it is better to leave the umbilical wound open during treatment:

the child is placed in an open incubator, swaddled separately in the upper half of the abdomen with arms, and the lower half with legs).

2.Put him in bed.

5.Wash and dry your hands.

Skin treatment for vesiculopustulosis.

Technical preparation:

1.Wash your hands and dry.

2. Place on the manipulation table:

sterile tray;

tray for waste material;

craft bag with cotton swabs, balls and gauze napkins;

tweezers in disinfection solution;

medicines: 3% hydrogen peroxide solution, 5% potassium permanganate solution, 70% alcohol.

3.Check for clean diapers.

4. Open the waste bin;

5. Wash and dry your hands. Leave the water tap on +З7С;

6. Spread diapers on the changing table;

7. Unwaddle the baby in the crib. (Wash it and dry the skin, if necessary)

8. Place the baby on the prepared changing table;

9. Wash and dry your hands (gloves).

Performing the manipulation:

Wash your hands thoroughly and wear gloves.

Remove vesicles and pustules with a cotton swab soaked in 70% alcohol.

Treat the wound with an alcohol solution of chlorophyllipt or a 5% solution of potassium permanganate.

Hygienic baths with an intense pink solution of potassium permanganate.

The final stage:

1. Swaddle the baby.

2.Put him in bed.

3.Soak in disinfectant. solution of used material for the purpose of disinfection (chloramine, macrocid-liquid, terralin, sidex).

4. Treat the changing table with disinfectant. solution.

5.Wash and dry your hands.

Daily skin toilet

Skin care is very important. It prevents its damage and the development of such unpleasant conditions as diaper rash and diaper dermatitis.

Contact of the baby's skin with mother's hands, a towel and just water helps his senses develop. A child receives a huge amount of information during a bath or sponge bath. Daily skin cleansing does not replace bathing.

Be sure to wipe the natural folds 3-4 times a day: behind the ear, cervical, axillary, elbow, inguinal, gluteal and subcutaneous.

Linen folds. It is in these places that diaper rash forms if not properly cared for.

The baby's skin should be cleaned with cotton swabs moistened with boiled water. If your skin is irritated, you can follow this procedure with baby powder if your skin is oily, or if your skin is dry, with an emollient cream recommended by your pediatrician.

If the genitals are not kept clean, the child may experience: inflammation of the urethra, kidneys, diseases of the female genital area in girls, etc. You should wash your child every time you change soiled or wet diapers and onesies. You can use cotton swabs for this. Girls and boys are washed differently.

For girls, the genital area is cleaned first. Simply run the swab over them to remove any remaining urine. Be sure to wash the girl from front to back. Then another swab is used to clean the anal area. This sequence is very important to avoid the transfer of microbes from the rectum to the vagina.

For boys, the sequence of processing is not so important. You must first remove the feces with a napkin, then wash the anal area and all soiled areas with a cotton swab. When treating the penis, there is no need to retract the foreskin. Finally, wipe the groin, buttock and thigh folds.

Treatment of the umbilical wound

The navel usually heals completely by the 20th day of a child’s life. Until this time, it needs to be regularly treated once a day, after bathing. First, 2-3 drops of a 3% hydrogen peroxide solution are instilled into the umbilical wound and dried with a cotton swab. Then they are treated with a 1% alcohol solution of brilliant green (brilliant green), or a 5% solution of potassium permanganate (potassium permanganate) or a 5% alcohol solution of iodine. These products stain the skin, so it is not always possible to notice signs of navel inflammation in time. Because of this, some pediatricians recommend using colorless solutions instead of colored ones: 70% ethyl alcohol or alcoholic tinctures of wild rosemary, chlorophyllipt, etc.

When treating the umbilical wound, do not touch or remove the crust, because the healing process is most active under it. When the wound surface is completely covered with healthy cells, it will fall off on its own. After bathing, the navel should be patted dry with sterile cotton wool. A wet diaper should not come into contact with an unhealed wound, as this can cause irritation and inflammation. Each time you treat your belly button, carefully inspect the area around it for redness, swelling, or any unusual discharge. Such signs appear when an infection gets into the wound. You need to see a doctor immediately!

You need to bathe your baby from the first day after discharge from the maternity hospital, every day. This procedure requires a separate bath, which is not used for washing diapers or baby clothes. In the first 2 weeks, it should be doused with boiling water and washed with soap before bathing. The water temperature should be about 37 °C, and for a premature baby slightly higher than 38-38.5 °C. A special thermometer is used for control. The bathroom should be warm, 22-25 °C. You need to lower the diaper to the bottom of the bath. The procedure should last no more than 5-7 minutes.

Treatment of the umbilical wound

The navel usually heals completely by the 20th day of the child’s life. Until this time, it needs to be regularly treated once a day, after bathing. First, 2-3 drops of a 3% solution of hydrogen peroxide are instilled into the umbilical wound and dried with a cotton swab. Then they are treated with a 1% alcohol solution of brilliant green (brilliant green), or a 5% solution of potassium permanganate (potassium permanganate) or a 5% alcohol solution of iodine. These products stain the skin, so it is not always possible to notice signs of navel inflammation in time. Because of this, some pediatricians recommend using colorless solutions instead of colored ones: 70% ethyl alcohol or alcoholic tinctures of wild rosemary, chlorophyllipt, etc.

When treating the umbilical wound, do not touch or remove the crust, because the healing process is most active under it. When the wound surface is completely covered with healthy cells, it will fall off on its own. After bathing, the navel should be blotted dry with sterile cotton wool. A wet diaper should not come into contact with an unhealed wound, as this can cause irritation and inflammation. Each time you treat your belly button, carefully inspect the area around it for redness, swelling, or any unusual discharge. Such signs appear when an infection gets into the wound. You need to see a doctor immediately!

You need to bathe your baby from the first day after discharge from the maternity hospital, every day. This procedure requires a separate bath, which is not used for washing diapers or baby clothes. In the first 2 weeks, it should be doused with boiling water and washed with soap before bathing. The water temperature should be about 37 "C, and for a premature baby a little higher than 38-38.5 °C. A special thermometer is used for control. The bathroom should be warm, 22-25 °C. A diaper should be lowered to the bottom of the bath. The procedure will last. should no more than 5-7 minutes.

It is advisable to bathe your baby in the evening, before the last evening feeding. This will help improve your baby's appetite and sleep at night. You can add decoctions and infusions of soothing herbs to the bath: mint, valerian, motherwort, if your child is restless and has trouble falling asleep. To prevent and treat prickly heat and mild degrees of diaper rash, you can add decoctions of herbs with anti-inflammatory effects: string, chamomile, yarrow, calendula. Twice a week, but not more often, the child should be bathed with baby soap. Take your time using your favorite delicately scented French soaps for bathing. These cosmetics are not yet suitable for the child’s age and can only cause harm. For bathing, you need to use an individual sponge, soft, preferably foam rubber. Baby's head and back

place it on your left hand, and support your buttocks and legs with your right. Carefully immerse it in water, take your time, make sure that water does not get into the ears or nose. Wash your body carefully so as not to damage the delicate baby skin. After bathing, the child is placed face down on the palm of the right hand and rinsed with boiled warm water from a jug. Then the baby’s body needs to be dried with a terry towel or sheet, using gentle blotting movements. You should not wipe it, as this can injure the skin. Particular attention should be paid to the natural folds, which should be completely dry after bathing. After bathing, these areas are treated with some kind of emollient or moisturizer: sterile sunflower oil, baby cream or powder.

Don't forget to treat the umbilical wound!

Modern skin care products

Places of natural folds are treated with baby powder or starch; in case of dry or irritated skin, a special cream recommended by the pediatrician.

It is important that the baby's delicate and sensitive skin does not come into contact with irritating substances, such as strong powders and soaps.

To wash children's clothes, use specially designed detergents. Every

Mom should first try a cosmetic product on herself.

Apply a little product to the back of the hand or to the inside of the elbow, where the skin is most delicate, and massage lightly. After 10-15 minutes, look to see if irritation appears on the skin, pay attention to how well or poorly the substance is absorbed, and whether it causes discomfort.

Then apply a little product to a limited area of the baby’s skin, preferably on a leg or arm, and evaluate the reaction. The skin should be clean, velvety, of normal color. If redness, swelling or flaking appears, then this remedy is not suitable for the child.

Be sure to ask if your family is allergic to cosmetic substances, and if they are, what product and what its components are. Carefully study the composition of the product. There should be no particularly odorous substances, concentrated herbal essences, fewer preservatives and emulsifiers.

And only after all the preparations can you use this product to treat relatively large surfaces of the skin.

Nowadays, a huge number of high-quality cosmetics for the care of children’s skin have appeared, not only foreign, but also domestically produced.

Good series of children's cosmetics meet a whole range of requirements. They have neu-

normal environmental reaction (pH), as well as children's skin, do not contain preservatives or odorous substances; mineral components in them predominate over organic ones, which are most often artificially synthesized. Many products include natural ingredients: extracts of chamomile, aloe, string, calendula, etc. Cosmetic products for bathing are necessarily based on the “tearless” formula, which makes bathing a pleasant and fun experience for mother and baby. Rules for using cream and oil:

1) apply a thin layer to problem areas, for example, in the perineum or in areas of large folds. Can be applied to the entire body only if the skin is very dry and prone to flaking;

2) in a special way, which is called “dosing through maternal hands.” To do this, the woman takes a little product, rubbing it into her palms, and applies the remaining cream or oil to the baby’s skin. It is so easy to avoid an overdose of the drug.

Specially moistened baby wipes are convenient for use. The material from which they are made must be durable, but soft. After treatment, there should be no lint or threads left on the skin. These wipes are very convenient if you are in an environment where it is not possible to wash your baby. Typically, such wipes are not just wet, but also impregnated with baby

Ski cleansing milk, which effectively removes all impurities from the baby’s skin, does not contain soap or alcohol base.

Omphalitis is inflammation of the skin and subcutaneous tissue in the navel area, caused by infection of the umbilical wound. The main cause of omphalitis is non-compliance with sanitary and hygienic rules for caring for newborns. More often, omphalitis develops in weakened children born from mothers with unfavorable pregnancy and childbirth.

Equipment. Sterile: gauze pads, pipettes, swabs with cotton balls, rubber gloves; others: 70% ethyl alcohol, 5% potassium permanganate solution, 3% hydrogen peroxide solution.

1. Explain the goal to the mother and conduct psychological preparation.

2. Wash your hands, disinfect, put on an apron and sterile rubber gloves.

3. Separate the edges of the umbilical wound.

4. Pipette a few drops of a 3% hydrogen peroxide solution.

5. Instill a 3% solution of hydrogen peroxide into the umbilical wound.

6. Take a stick with a cotton ball and move from the center to the periphery to remove the foam that has formed in the umbilical wound.

7. Take a stick with a cotton ball and moisten it with 70% ethyl alcohol.

8. Treat the umbilical wound from the center to the periphery.

9. Again take a sterile swab with a cotton ball. Moisten the umbilical wound with a 5% solution of potassium permanganate, treat the umbilical wound with a 5% solution of potassium permanganate (without touching the skin around the umbilical ring). For omphalitis, the umbilical wound is treated 3-4 times a day.

10. Disinfect the changing table, apron and rubber gloves.

11. Make a mark on the appointment sheet.

Treatment of omphalitis consists of daily washing of the umbilical wound with a 0.02% solution of furatsilin or a 3% solution of hydrogen peroxide, followed by lubricating it with a 1% alcohol solution of brilliant green, a 5% solution of potassium permanganate or 70% alcohol. When granulations grow and navel fungus forms, it is necessary to wash the wound with a 3°/o solution of hydrogen peroxide, followed by cauterization of the granulations with a lapis stick. If the mushroom is large, it is recommended to bandage it at the base with a sterile silk ligature. In severe cases with a general reaction, not only local, but also general treatment is carried out using broad-spectrum antibiotics. Along with the use of antibiotics, it is important to increase the resistance of the newborn’s body with good care and proper breastfeeding, the introduction of gamma globulin, hemotherapy and blood transfusions.

To prevent infection of the navel, careful adherence to asepsis is necessary when ligating the umbilical cord and when caring for its remnant and umbilical wound in the future (use of aseptic drying dressings). Accelerated falling off of the umbilical cord with improved methods of ligating it (staples according to V. E. Rogovin, treatment of the umbilical cord with an alcohol solution of gramicidin 1: 100) promotes faster epithelization of the umbilical wound and prevents its infection.

99. Technique for DPT vaccination.

DTP vaccine (adsorbed, pertussis-diphtheria-tetanus) is an associated vaccine, 1 ml of which contains 20 billion killed pertussis microbes, 30 flocculating units of diphtheria and 10 antitoxin-binding

The vaccine should be stored in a dry, dark place at a temperature of 6±2°C. The DPT vaccine is administered intramuscularly in a dose of 0.5 ml into the upper outer quadrant of the gluteal muscle or into the anterior outer part of the thigh.

The pertussis component has the most toxic and sensitizing effect. The response to the vaccine depends on the major histocompatibility complex. Children with HLA B-12 are at risk of encephalic reactions, children with HLA B-5 and B-7 are prone to allergic reactions, children with HLA B-18 are prone to toxic complications.

Most children who receive the DTP vaccine do not experience a reaction to the vaccine. In the first two days, some vaccinated people may experience general reactions in the form of fever and malaise, and local reactions (swelling of soft tissues, infiltrate less than 2 cm in diameter).

Local reactions usually develop in the first two days after vaccination: a) infiltrate (over 2 cm in diameter); b) abscess, phlegmon.

General reactions:

1. Excessively strong reactions with hyperthermia (40°C and above) and intoxication develop in the first two days after vaccination.

2. Reactions with damage to the nervous system (neurological):

a) persistent high-pitched scream on the 1st day after vaccination, at night (increased intracranial pressure). It is observed in children in the first six months of life, more often after the 1st or 2nd vaccination;

b) convulsive syndrome without hyperthermia (4-20 days after vaccination) - large or small seizures, twitching, Salaam convulsions in series during phase states (when falling asleep or waking up). Children may grimace and freeze. Often parents and doctors do not notice these phenomena and continue to vaccinate. Epilepsy subsequently develops;

c) convulsive syndrome due to hyperthermia (febrile convulsions - tonic or clonic-tonic, develop during the first 48 hours after vaccination).

Post-vaccination encephalitis - occurs 3-8 days after vaccination. Rare complication (1 in 250-500 thousand vaccine doses). It occurs with convulsions, prolonged loss of consciousness, hyperkinesis, paresis with gross residual effects.

Allergic reactions:

a) anaphylactic shock, develops in the first 5-b hours after vaccination;

b) collaptoid state in children under 1 year of age (severe pallor, lethargy, cyanosis, drop in blood pressure, appearance of cold sweat, sometimes accompanied by loss of consciousness). May occur within 1 week after vaccination. Rarely encountered;

c) polymorphic rashes, Quincke's edema, hemolytic-uremic syndrome.

Vaccination rules

Vaccinations should be carried out in medical institutions. Before vaccination, the doctor must conduct a thorough analysis of the condition of the child being vaccinated and determine the presence of possible contraindications to vaccination. Simultaneously with the study of the medical history, it is necessary to take into account the epidemiological situation, that is, the presence of infectious diseases in the child’s environment. This is very important, since the addition of infections in the post-vaccination period aggravates its course and can cause various complications. In addition, the production of specific immunity is reduced. If necessary, laboratory examination and consultation with specialists are carried out. Before carrying out a preventive vaccination, a medical examination is carried out to exclude an acute disease, and thermometry is mandatory. A corresponding entry by the doctor (paramedic) about the vaccination is made in the medical documentation. It is recommended to vaccinate, especially with live vaccines, in the morning. Vaccination should be carried out in a sitting or lying position to avoid falling during fainting. Within 1-1.5 hours after vaccination, medical supervision of the child is necessary, due to the possible development of immediate allergic reactions. Then, for 3 days, the child must be observed by a nurse at home or in an organized group. After vaccination with live vaccines, the child is examined by a nurse on the 5th and 10-11th days, since reactions to the administration of live vaccines occur in the second week after vaccination. It is necessary to warn the parents of the vaccine recipient about possible reactions after administration of the vaccine, recommend a hypoallergenic diet and a protective regime.

sterile tray;

tray for waste material;

craft bag with cotton balls, brushes and gauze napkins;

tweezers in disinfection solution;

medicines: 3% hydrogen peroxide solution, 5% potassium permanganate solution, 70% alcohol.

Check for clean diapers;

Treat the changing mattress with a disinfectant solution (macrocid-liquid, terralin, sidex);

Open the waste bin.

Wash and dry your hands, put on gloves.

Place diapers on the changing table.

Unwaddle the baby in the crib. (Wash it and dry the skin, if necessary).

9. Place the baby on the prepared changing table. Performing a manipulation

With your left hand, spread the edges of the umbilical ring.

Moisten the brush with 3% hydrogen peroxide solution by pouring it over the tray for used material.

Coat the umbilical wound generously with hydrogen peroxide in one motion, inserting the shaving brush perpendicular to the navel, rotating the shaving brush 360° in a comma-like motion.

With your left hand, spread the edges of the umbilical ring, dry the wound with a dry shaving brush (introducing the shaving brush perpendicular to the navel into the wound with a movement similar to a comma).

Throw the shaving brush into the waste tray.

Moisten a new shaving brush with 70% ethyl alcohol.

With your left hand, spread the edges of the umbilical ring, treat the wound with a movement similar to a point, introducing the shaving brush perpendicular to the navel.

Throw the shaving brush into the waste tray.

As prescribed by the doctor: use a brush moistened with a 5% solution of potassium permanganate to treat only the wound without touching the skin; point movement. Discard the shaving brush.

The final stage of the manipulation

Swaddle the baby.

Put him to bed.

Treat the changing table with disinfectant. solution.

Remove gloves, wash and dry your hands.

Schematic representation of manipulation

1) H2O2 2) dry 3)● alcohol 70° 4 ) ● K MnO4 5%

Giving a hygienic bath to a newborn baby

The first hygienic bath is carried out on the 2nd day after discharge from the hospital; Before the umbilical wound heals, use boiled water or a permanganate solution

potassium (2-3 weeks);

in the 1st half of the year they bathe daily for 5-10 minutes, in the 2nd half of the year you can bathe every other day.

The water temperature in the bath is 37-38.0 C; soap is used once a week.

Air temperature in the room is 22-24 C.

Bathed before the penultimate feeding.

Technical training

Two containers - with cold and hot water (or tap water).

Potassium permanganate solution (95 ml of water - 5 g of K Mn O4 crystals, the prepared solution is filtered through cheesecloth, and the crystals should not

get into the bath).

Rinse jug.

Bath.

Water thermometer.

"Mitten" made of terry cloth (flannel).

7.Baby soap (baby shampoo).

8. Sterile oil (baby cream, vegetable).

9. Diapers, vests. 10. Changing table.

11.Des. solution

Preparatory stage

Wash and dry your hands.

Lay out the diapers on the changing table.

Place the bath in a stable position (pre-treated with a disinfectant solution or washed with baby soap).

The bath is filled to 1/2 or 1/3 of its volume.

Add a 5% solution of potassium permanganate to a slightly pink solution.

Measure the temperature of the water with a thermometer.

Performing the manipulation:

Undress the child. After defecation, wash with running water. Throw dirty laundry into the waste bin.

Take the child with both hands: place the child on the adult’s left arm, bent at the elbow, so that the child’s head is on the elbow; With the same hand, grab the child’s left shoulder.

Place the baby in the bath, starting from the feet so that the water reaches the baby's nipple line.

The legs remain free after diving. Immersion level - up to the nipple line.

Wash the baby's neck and chest for several minutes.

Washing the body:

put on a mitten;

lather the mitten with gel, or soap, or shampoo;

gently soap the child’s body;

wash the baby’s folds with a soapy mitten;

rinse the baby.

Washing head:

It is advisable to wash your hair last, as this procedure can cause a negative reaction in the child).

wet your hair (from the forehead to the back of your head) by pouring water from a ladle (jug);