ICD 10 premature baby. Prematurity - description, causes, symptoms (signs), treatment
Brief description
Prematurity- the condition of a fetus born before the end of the normal period of intrauterine development (before 37 weeks of gestation), with a body weight of less than 2,500 g, a height of less than 45 cm, characterized by imperfect thermoregulation, a tendency to asphyxia, and insufficient resistance to environmental factors. Considering the individual variability of indicators, the arbitrariness of anthropometric criteria for prematurity cannot be ruled out. Frequency - 5–10% of newborns.
Code according to the international classification of diseases ICD-10:
- P05 Poor fetal growth and malnutrition
Classification by body weight I degree - 2,001–2,500 g II degree - 1,501–2,000 g III degree - 1,001–1,500 g IV degree - less than 1,000 g.
Etiology On the maternal side Kidney diseases, cardiovascular system, endocrine disorders, acute infectious diseases, gynecological pathology Complications of pregnancy - gestosis Intrauterine contraceptives Injuries, incl. mental Intoxication- smoking, alcohol and drug use Immunological incompatibility (Rhesus - conflict, blood group conflict) Young or old age of the mother Occupational hazards On the father's side Chronic diseases Old age On the fetal side Genetic diseases Erythroblastosis of the fetus Intrauterine infections.
Clinical picture Disproportional body structure - large head with a predominance of the cerebral part of the skull over the facial part Open cranial sutures, supple skull bones, soft auricles Thick layer of cheese-like lubricant, abundant vellus hair Poor development of subcutaneous fatty tissue, imperfect thermoregulation Hypotonia of muscles, frog pose In boys, the testicles are not descended into the scrotum, in girls the labia majora do not cover the labia minora Weakly expressed physiological reflexes of newborns (sucking, searching, grasping, Moro, automatic walking) Breathing is shallow, weakened, respiratory rate 40–54 per minute, periodic episodes of apnea Pulse labile, weak filling, heart rate 120–160 per minute, low blood pressure (average blood pressure 55–65 mm Hg) Regurgitation Transient hypothyroidism Frequent urination.
TREATMENT
Premature babies are nursed in a special ward with an air temperature of 25 ° C and a humidity of 55–60%. Individual conditions are created using incubators or additional heating of the crib. Closed incubators are used in the first days of life for nursing children weighing 2 kg or less.
Healthy premature babies are discharged home when they reach a body weight of 2 kg, but not earlier than on the 8th–10th day.
Healthy premature babies who have not reached 2 kg of body weight in the first 2 weeks of life, and patients, regardless of body weight, are transferred to the second stage of nursing. In the hospital of the second stage of nursing, children are transferred in specially equipped resuscitation machines with an incubator and oxygen supply. In specialized departments, children are placed in boxed wards. Very premature and sick children are nursed in incubators. Bathing of healthy premature infants begins at 2 weeks of age (with epithelization of the umbilical wound), with a body weight of less than 1000 g, hygienic baths begin from the 2nd month of life. Walks are carried out from 3–4 weeks of age upon reaching body weight 1700–1800 g Healthy children are discharged from the department of the second stage of nursing when they reach a body weight of 1700 g.
Feeding Feeding with expressed mother's breast milk (or donor milk), in the absence of contraindications and a long gestation period, begins 2–6 hours after birth. General scheme of enteral feeding: first a test with distilled water, then several injections of 5% glucose solution with increasing volume, with good glucose tolerance - breast milk. Parenteral nutrition using a nasogastric or orogastric tube is indicated for immature and critically ill children in the first 24 years. –48 hours of life Attachment to the breast is carried out according to individual indications, with active sucking and body weight 1800–2000 g The volume of one feeding on the first day is 5–10 ml, on the 2nd day - 10–15 ml, on the 3rd day - 15–20 ml Calculation of nutrition is carried out according to calorie content The first 3–5 days - 30–60 kcal/kg/day By the 7–8th day - 60–80 kcal/kg/day By the end of the first month - 135–140 kcal/ kg/day From 2 months onwards, for children born with a body weight of more than 1500 g, the calorie content is reduced to 135 kcal/kg/day. For children with lower body weight, the calorie content is kept at 140 kcal/kg/day up to 3 months. The daily requirement for food ingredients depends on type of feeding Natural feeding (native breast milk or pasteurized milk): first 6 months: protein - 2.2–2.5 g/kg, fats - 6.5–7 g/kg, carbohydrates 12–14 g/kg; second half of the year: protein - 3–3.5 g/kg, fats - 5.5–6 g/kg Mixed and artificial feeding: protein 3–3.5 and 3.5–4 g/kg, respectively; calorie content is increased by 10–15 kcal/kg Total daily fluid volume: 87.5% of the volume is milk, the rest consists of drinking (a mixture of Ringer's solution with 5% glucose solution) and intravenous infusions By the end of the first week of life, the total daily fluid volume is 70–80 ml/kg for body weight less than 1500 g and 80–100 ml/kg for body weight more than 1500 g By the 10th day of life - 125–130 ml/kg By the 15th day of life - 160 ml /kg By the 20th day - 180 ml/kg By 1–2 months - 200 ml/kg Administration of vitamins In the first 2–3 days of life - menadione sodium bisulfite 0.001 g 2–3 times a day for the prevention of hemorrhagic disorders Ascorbic acid 30-100 mg/day, thiamine, riboflavin Vitamin E - 5% solution - solution 2-5 drops/day for 10-12 days Specific prevention of rickets In case of severe immaturity and severe concomitant pathology - pyridoxine, vitamins B5, B15 and lipoic acid In the absence of maternal or donor milk, from the 2nd week, adapted milk formulas are used - Novolact - MM, Premalalak, Prepiltti, etc. The timing of the introduction of complementary foods is determined individually.
Course and prognosis Survival depends on the gestational age and body weight at birth With III–IV degrees of prematurity and less than 30–31 weeks of gestation, childbirth ends in the birth of a live child in 1% of cases With intensive treatment, survival of children with a gestational age of 22–23 weeks is possible Mortality increases with the presence of factors risk Bleeding in the mother before childbirth Multiple pregnancy Childbirth with breech presentation Perinatal asphyxia Male sex of the fetus Hypothermia Respiratory distress syndrome.
Concomitant pathology Agenesis, aplasia, hypoplasia, pulmonary atelectasis Respiratory distress syndrome Fetal erythroblastosis Retinopathy of prematurity Anemia of prematurity Wilson-Mikiti syndrome Dysbacteriosis Intestinal infections Pneumonia Omphalitis.
ICD-10 P05 Slow growth and malnutrition of the fetus
ICD Classification
Name:
Other cases of prematurity
Subgroup:
Sub-subgroup:
P07 Disorders associated with short gestation and low birth weight, not elsewhere classified
- P07.0 Extremely low birth weight
- P07.1 Other cases of low birth weight
- P07.2 Extreme immaturity
- P07.3 Other cases of prematurity
Top clinics:
01033, Kiev region, Kyiv,
st. Saksaganskogo, 60
01004, Kiev region, Kyiv,
st. Tereshchenkovskaya, 21
Kyiv region, Kyiv,
01030, Kyiv, st. B. Khmelnitsky, 40/25
Khmelnitsky region, Khmelnitsky,
st. Svobody, 47
,
Kyiv, st. Heroes of Stalingrad, 47
PREMATURE honey.
Prematurity is a condition of a fetus born before the end of the normal period of intrauterine development (before 37 weeks of gestation), with a body weight of less than 2,500 g, a height of less than 45 cm, characterized by imperfect thermoregulation, a tendency to asphyxia, and insufficient resistance to environmental factors. Considering the individual variability of indicators, the arbitrariness of anthropometric criteria for prematurity cannot be ruled out.
Frequency - 5-10% of newborns.
Classification by body weight
I degree - 2,001-2,500 g
II degree - 1,501-2,000 g
III degree - 1,001-1,500 g
IV degree - less than 1,000 g.
Etiology
Mother's sideKidney diseases, cardiovascular system, endocrine disorders, acute infectious diseases, gynecological pathology
Complications of pregnancy - gestosis
Intrauterine contraceptives
Injuries, incl. mental
Intoxication - smoking, alcohol, drugs
Immunological incompatibility (blood group conflict)
Young or old age of mother
Industrial hazards
From my father's side
Chronic diseases
Old age
From the fetus
Genetic diseases
Erythroblastosis fetalis
Intrauterine infections.
Clinical picture
Disproportional body structure - large head with a predominance of the cerebral skull over the facial oneOpen cranial sutures, supple skull bones, soft auricles
Thick layer of cheese-like lubricant, abundant vellus hair
Poor development of subcutaneous tissue, imperfect thermoregulation
Muscle hypotonia, frog pose
In boys, the testicles are not descended into the scrotum; in girls, the labia majora are underdeveloped
Weakly expressed physiological reflexes (sucking, searching, grasping, Moro, automatic walking)
Breathing is shallow, weakened, frequency -40-54 per minute, periodic episodes of apnea
Pulse is labile, weak filling, 120-160 per minute, low blood pressure (average blood pressure - 55-65 mm Hg)
Regurgitation
Transient hypothyroidism
Frequent urination.
Treatment:
Premature babies are nursed in a special ward with an air temperature of 25 ° C and a humidity of 55-60%. Individual conditions are created using incubators or additional heating of the crib. Closed incubators are used in the first days of life for nursing children weighing 2 kg or less.Healthy premature babies are discharged home when they reach a body weight of 2 kg, but not earlier than 8-10 days.
Healthy premature babies who have not reached a body weight of 2 kg in the first 2 weeks of life, and patients, regardless of body weight, are transferred to the second stage of nursing
To the hospital
In the 2nd stage of nursing, children are transferred to specially equipped resuscitation machines with an incubator and oxygen supply
In specialized departments, children are placed in boxed wards. Very premature and sick children are nursed in incubators
Bathing of healthy premature babies begins at 2 weeks of age (with epithelization of the umbilical wound), with a body weight of less than 1,000 g, hygienic baths begin at 2 months of life
Walking is carried out from 3-4 weeks of age when a body weight reaches 1,700-1,800 g
Healthy children are discharged from the department of the 2nd stage of nursing when they reach a body weight of 1,700 g.
Breastfeeding
Feeding with expressed mother's breast milk (or donor milk), in the absence of contraindications and a long gestation period, begins 2-6 hours after birth. General scheme of enteral feeding: first a test with distilled water, then several injections of 5% glucose solution with increasing volume, with good glucose tolerance - breast milk.
Parenteral nutrition using a nasogastric or orogastric tube is indicated for immature and critically ill children in the first 24-48 hours of life.
Attachment to the breast is carried out according to individual indications, with active sucking and body weight 1,800-2,000 g.
The volume of one feeding on the 1st day is 5-10 ml; in
2nd day - 10-15 ml; on the 3rd day - 15-20 ml.
Nutrition calculations are based on calorie content
The first 3-5 days - 30-60 kcal/kg/day
By day 7-8 - 60-80 kcal/kg/day
By the end of 1 month - 135-140 kcal/kg/day
From 2 months of age, for children born weighing more than 1,500 g, caloric intake is reduced to 135 kcal/kg/day
For children with lower body weight, caloric intake is maintained at 140 kcal/kg/day for up to 3 months.
The daily need for food ingredients depends on the type of feeding
Natural feeding (native breast milk or pasteurized milk); first 6 months: protein - 2.2-2.5 g/kg, fats - 6.5-7 g/kg, carbohydrates 12-14 g/kg; second half of the year: protein - 3-3.5 g/kg, fats
5.5-6 g/kg
Mixed and artificial feeding: protein 3-3.5 and 3.5-4 g/kg, respectively; calorie content is increased by 10-15 kcal/kg.
Total daily fluid volume: the sum of 87.5% of the volume of milk, drinking (a mixture of Ringer solution with 5% glucose solution) and intravenous infusions
By the end of the first week of life, the total daily fluid volume is 70-80 ml/kg for body weight less than 1,500 g and 80-100 ml/kg for body weight more than 1,500 g
By the 10th day of life - 125-130 ml/kg
By the 15th day of life - 160 ml/kg
By day 20 -180 ml/kg
By 1-2 months - 200 ml/kg.
Introduction of vitamins
In the first 2-3 days of life - vitamin K (Vicasol) 0.001 g 2-3 times a day for the prevention of hemorrhagic disorders
Ascorbic acid 30-100 mg/day, vitamins B1, B2
Vitamin E - 5% solution, 2-5 drops/day for 10-12 days
Specific prevention of rickets
In case of severe immaturity and severe concomitant pathology - vitamins B6, B5, B|5 and
lipoic acid.
In the absence of mother's or donor milk from
Adapted milk formulas Novolakt-MM, Premalalak, Prepiltti, etc. are used for 2 weeks.
The timing of the introduction of complementary foods is determined individually.
Course and prognosis
Survival depends on gestational age and birth weightWith HI-IV degrees of prematurity and less than 30-31 weeks of gestation, labor ends in the birth of a live child in 1% of cases
With intensive treatment, survival of children with a gestation period of 22-23 weeks is possible
Mortality increases in the presence of risk factors:
Bleeding in the mother before childbirth
Multiple pregnancy
Childbirth with gas presentation
Perinatal asphyxia
Male sex of the fetus
Hypothermia
Respiratory distress syndrome.
Concomitant pathology
Agenesis, aplasia, hypoplasia, pulmonary atelectasis
Respiratory distress syndrome
Erythroblastosis fetalis
Retinopathy of prematurity
Anemia of prematurity
Wilson-Mikiti syndrome
Dysbacteriosis
Intestinal infections
Pneumonia
Omphalitis.
See also, Rickets
ICD
P07 Disorders associated with short gestation and low birth weight, not elsewhere classifiedP07.0 Extremely low birth weight
P07.1 Other cases of low birth weight
P07.2 Extreme immaturity P07.3 Other cases of prematurity
17-a-HYDROXYLASE DEFICIENCY
Biochemistry and genetics. P450C17, or steroid 17-a-monooxygenase (*202PO, EC 1.14.99.9, 10q24.3, at least 14 mutations of the CNo/7 gene are known [belongs to the P450 gene family], p) catalyzes both 17-a- hydroxylation of pregnenolone and progesterone, and 17,20-ligation of 17-a-hydroxypregnenolone and 17-a-hydroxyprogesterone (therefore, the product of expression of the CKRU gene is known as both 17a-hydroxylase and 17,20-lyase ).
Etiology, pathogenesis, clinical picture
Adrenogenital syndrome
Excessive formation of corticosterone and deoxycorticosterone - arterial hypertension and hypokalemic alkalosis
Aldosterone, testosterone, estrogens are practically not formed
Excessive levels of ACTH (adrenal cortical hyperplasia) and FSH
Primary amenorrhea, absence of puberty due to estrogen deficiency
Boys have mild virilization and male pseudohermaphroditism
The sexual phenotype in girls is normal, but secondary sexual characteristics are not formed.
Treatment
Dexamethasone (lowering blood pressure)Estrogens (feminization).
See also, Disorders of sexual differentiation
ICD
E2S.O Congenital adrenogenital disorders associated with enzyme deficiency3 HYDROXYACYL COA DEHYDROGENASE DEFICIENCY
Long-chain 3-hydroxyacyl-CoA dehydrogenase deficiency (LCHAD) is a hereditary disease with many manifestations (including myopathies, predisposition to sudden infant death, preeclampsia, Reye's syndrome).
Biochemistry and genetics
DCAD (mitochondrial trifunctional protein, locus 2p23) catalyzes the β-oxidation of fatty acids in mitochondria and is characterized by the enzymatic activity of DCAD (EC 1.1.1.211), enoyl-CoA hydratase (EC 4.2.1.17) and 3-ketoacyl-CoA thiolaseThe DKAD heterocomplex consists of 4 a- (*600890, 2p23, MTPA gene, at least 5 defective alleles of the HADHA gene) and 4 p-subunits (*143450, at least 6 defective alleles of the HADHB gene).
Manifestations of the disease are varied
Sudden infant death syndrome
Liver pathology (up to fulminant necrosis)
Cardiomyopathy
Myopathy
Episodes of myoglobinuria
Episodes of acute hypoglycemia
Laboratory tests: increased activity of liver enzymes, lactic aciduria.
Synonyms
Mitochondrial trifunctional protein deficiencySee also, Defects of acyl-CoA dehydrogenases. Sudden infant death syndrome, Reye's syndrome, various hereditary cardiomyopathies
Abbreviations. DCAD - long chain hydroxyacyl-CoA dehydrogenase (omLCHAD - Long Chain 3-Hydroxyl-CoA Dehydrogenase)
ICD
ESS.9 Metabolic disorder, unspecified MIM. 143450, 600890 Insufficiency of long-chain 3-hydroxyacyl-CoA dehydrogenaseNotes
Insufficiency of DCBP in children may be associated with pathology in the mother during pregnancy (acute fatty liver syndrome during pregnancy, arterial hypertension during pregnancy, increased activity of liver enzymes, uncontrollable vomiting, HELLP syndrome)HELLP syndrome (from Hemolysis, Elevated Liver enzyme values, and Low Platelet counts; hemolysis, increased activity of liver enzymes, decreased platelet count), cause unknown.
ICD 10. CLASS XVI. SELECTED CONDITIONS ARISING IN THE PERINATAL PERIOD (P00-P96)
Includes: disorders occurring during the perinatal period, even if death or illness occurs later
Excluded: congenital anomalies, deformities and chromosomal disorders ( Q00-Q99)
diseases of the endocrine system, nutritional disorders and metabolic disorders ( E00-E90)
injuries, poisoning and some other consequences of external causes ( S00-T98)
neoplasms ( C00-D48)
tetanus of the newborn ( A33)
This class contains the following blocks:
P00-P04 Damage to the fetus and newborn caused by maternal conditions, complications of pregnancy, labor and delivery
P05-P08 Disorders associated with duration of pregnancy and fetal growth
P10-P15 Birth trauma
P20-P29 Respiratory and cardiovascular disorders characteristic of the perinatal period
P35-P39 Infectious diseases specific to the perinatal period
P50-P61 Hemorrhagic and hematological disorders in the fetus and newborn
P70-P74 Transient endocrine and metabolic disorders specific to the fetus and newborn
P75-P78 Digestive system disorders in the fetus and newborn
P80-P83 Conditions affecting the skin and thermoregulation in the fetus and newborn
P90-P96 Other disorders occurring in the perinatal period
The following category is marked with an asterisk:
P75* Meconium ileus
LESIONS OF THE FETUS AND NEWBORN DUE TO MOTHER'S CONDITIONS, COMPLICATIONS OF PREGNANCY, LABOR AND DELIVERY (P00-P04)
Included: maternal conditions listed below, when specified
as a cause of death or illness of a fetus or newborn
P00 Affects of the fetus and newborn due to maternal conditions that may not be related to the current pregnancy
Excluded: effects on the fetus and newborn:
complications of pregnancy in the mother ( P01. -)
endocrine and metabolic disorders in the mother ( P70-P74)
harmful substances that pass through the placenta or breast milk ( P04. -)
P01.0 Lesions of the fetus and newborn caused by isthmic-cervical insufficiency
P01.1 Lesions of the fetus and newborn caused by premature rupture of membranes
P01.2 Lesions of the fetus and newborn caused by oligohydramnios
Excluded: due to premature rupture of membranes (P01.1)
P01.3 Lesions of the fetus and newborn caused by polyhydramnios. Hydramnios
P01.4 Lesions of the fetus and newborn caused by ectopic pregnancy. Abdominal pregnancy
P01.5 Damages of the fetus and newborn caused by multiple pregnancies
When pregnant with triplets. During pregnancy with twins
P01.6 Damages of the fetus and newborn caused by the death of the mother
P01.7 Lesions of the fetus and newborn caused by malpresentation of the fetus before birth
Gluteal)
External turn)
Facial) (presentation)
Transverse position) before birth
Unstable position)
P01.8 Damages of the fetus and newborn caused by other maternal diseases complicating pregnancy
Spontaneous miscarriage, effect on the fetus
P01.9 Lesions of the fetus and newborn caused by unspecified conditions complicating pregnancy
P02 Lesions of the fetus and newborn caused by complications of the placenta, umbilical cord and membranes
P02.0 Damages of the fetus and newborn caused by placenta previa
P02.1 Damage to the fetus and newborn due to other complications associated with separation of the placenta
and bleeding. Placental abruption. Sudden bleeding. Damage to the placenta during amniocentesis, caesarean section
or surgery. Mother's blood loss. Premature separation of the placenta
P02.2 Lesions of the fetus and newborn caused by unspecified and other morphological and functional abnormalities of the placenta
Placenta:
dysfunction
heart attack
failure
P02.3 Lesions of the fetus and newborn caused by placental transfusion syndrome
Abnormalities of the placenta and umbilical cord causing fetal-to-fetal transfusion or other placental transfusion
If necessary, an additional code is used to identify the emerging condition of the fetus and newborn.
P02.4 Damages of the fetus and newborn caused by umbilical cord prolapse
P02.5 Lesions of the fetus and newborn caused by other types of umbilical cord compression
Neck entanglement with umbilical cord. Umbilical cord entanglement. Umbilical cord knot
P02.6 Affections of the fetus and newborn due to other and unspecified conditions of the umbilical cord
Short umbilical cord. Vascular presentation
Excludes: single umbilical artery (Q27.0)
P02.7 Lesions of the fetus and newborn caused by chorioamnionitis
Amnionitis. Membrane. Placentitis
P02.8 Lesions of the fetus and newborn caused by other anomalies of the chorion and amnion
P02.9 Lesions of the fetus and newborn caused by unspecified anomalies of the chorion and amnion
P03 Affections of the fetus and newborn due to other complications of labor and delivery
P03.0 Lesions of the fetus and newborn caused by breech delivery and fetal extraction
P03.1 Lesions of the fetus and newborn caused by another type of malpresentation, position
and imbalances during labor and delivery. Narrowed pelvis. Lesions of the fetus and newborn caused by conditions classified in the headings O64-O66. Persistent high position of the head. Transverse position
P03.2 Lesions of the fetus and newborn caused by forceps delivery
P03.3 Lesions of the fetus and newborn caused by the use of a vacuum extractor
P03.4 Damages of the fetus and newborn caused by cesarean section delivery
P03.5 Damages of the fetus and newborn caused by rapid labor. Fast second period
P03.6 Lesions of the fetus and newborn caused by disturbances in the contractile activity of the uterus
Lesions of the fetus and newborn caused by conditions classified in the heading O62. — , with the exception of the subcategory O62.3. Hypertonicity of the uterus. Inert uterus
P03.8 Lesions of the fetus and newborn caused by other complications of labor and delivery
Soft tissue abnormalities. Fruit-destroying operations
Affections of the fetus and newborn due to other conditions classified under O60-O75, And
other procedures used during childbirth and delivery, not included in the section P02. - and subcategories
P03.0-P03.6. Artificial birth
P03.9 Lesions of the fetus and newborn due to complications of labor and delivery, unspecified
P04 Damage to the fetus and newborn due to exposure to harmful substances passing through the placenta or breast milk
Included: non-teratogenic effects of substances that cross the placenta
Excluded: congenital anomalies ( Q00-Q99)
jaundice of newborns caused by hemolysis caused by drugs or toxic agents,
administered to the mother ( P58.4)
P04.0 Damages to the fetus and newborn caused by the use of anesthesia and analgesics in the mother during pregnancy, labor and delivery. Reactions and intoxications caused by the administration of opiates and tranquilizers to the mother during labor and delivery
P04.1 Damages of the fetus and newborn caused by other therapeutic effects on the mother
Chemotherapy for cancer. Cytotoxic drugs
Excludes: warfarin-induced dysmorphia ( Q86.2)
fetohydantoin syndrome ( Q86.1)
mother's drug use P04.4)
P04.2 Damages of the fetus and newborn caused by maternal tobacco consumption
P04.3 Damages of the fetus and newborn caused by maternal alcohol consumption
Excluded: fetal alcohol syndrome ( Q86.0)
P04.4 Damages of the fetus and newborn caused by maternal drug use
Excluded: due to the use of anesthesia and analgesic drugs in the mother ( P04.0)
abstinence symptoms in a newborn caused by maternal drug addiction ( P96.1)
P04.5 Damages of the fetus and newborn caused by maternal use of food chemicals
P04.6 Damages of the fetus and newborn caused by exposure of the mother to chemical substances contained
in the environment
P04.8 Damage to the fetus and newborn due to other harmful effects on the mother
P04.9 Affects of the fetus and newborn due to unspecified harmful effects on the mother
DISORDERS ASSOCIATED WITH PREGNANCY DURATION AND FETAL GROWTH (P05-P08)
P05 Poor fetal growth and malnutrition
P05.0“Small” fetus for gestational age
Typically refers to a condition where body weight is below and length is above the 10th percentile for gestational age
age... “Low weight” for the calculated period
P05.1 Small fetus size for gestational age
Typically refers to a condition where weight and length are below the 10th percentile for gestational age.
The fruit is small for the expected period. Small and “light weight” for the calculated period
P05.2 Fetal malnutrition without mention of “small for gestational age” or small for gestational age
A newborn who is not experiencing weight loss but has signs of malnutrition, such as
dryness, flaking of the skin and inferiority of subcutaneous tissue.
Excludes: fetal malnutrition with mention of:
«
low weight” for gestational age ( P05.0)
small for gestational age ( P05.1)
P05.9 Fetal growth retardation, unspecified. Fetal growth restriction NOS
P07 Disorders associated with short gestation and low birth weight, not elsewhere classified
NoteIf birth weight and gestational age data are available, preference should be given to
Included: listed conditions without further specification that cause death, illness, or additional care of the newborn
Excluded: low birth weight status due to slow growth and malnutrition
fetus ( P05. -)
P07.0 Extremely low birth weight. Birth weight 999 g or less.
P07.1 Other cases of low birth weight. Body weight at birth 1000-2499 g.
P07.2 Extreme immaturity. The gestational age is less than 28 completed weeks (less than 196 completed days).
P07.3 Other cases of prematurity. Gestational age is 28 completed weeks or more but less than 37 completed weeks (196 completed days but less than 259 completed days). Prematurity NOS
P08 Disorders associated with prolonged gestation and high birth weight
Note: If data on birth weight and gestational age are available, preference should be given to
body weight at birth.
Includes: listed conditions, without further specification, that cause death, illness, or
additional care for the fetus or newborn
P08.0 Excessively large child
This category is usually used when birth weight is 4500 g or more.
Excluded: syndrome:
newborn from a mother with diabetes ( P70.1)
a newborn from a mother suffering from gestational diabetes ( P70.0)
P08.1 Other children are “overweight” for their term. Other fetuses or newborns whose body weight or height at birth exceeds the indicators corresponding to the given stage of pregnancy, regardless of its duration.
P08.2 A post-term baby, but not “overweight” for the term. A fetus or child born at gestational age 42 complete
weeks or more (294 days or more), the body weight or height of which does not exceed that corresponding to the gestational age
indicators. Postmaturity NOS
BIRTH TRAUMA (P10-P15)
P10 Intracranial tissue rupture and bleeding due to birth trauma
Excluded: intracranial hemorrhage in a fetus or newborn:
NOS ( P52.9)
caused by anoxia or hypoxia ( P52. -)
P10.0 Subdural hemorrhage due to birth trauma. Subdural hematoma (localized) due to birth trauma
Excluded: subdural hemorrhage accompanying rupture of the tentorium ( P10.4)
P10.1 Cerebral hemorrhage due to birth trauma
P10.2 Hemorrhage into the cerebral ventricle due to birth trauma
P10.3 Subarachnoid hemorrhage due to birth trauma
P10.4 Rupture of the tentorium due to birth trauma
P10.8 Other intracranial ruptures and hemorrhages due to birth trauma
P10.9 Intracranial ruptures and hemorrhages due to birth trauma, unspecified
P11 Other birth injuries of the central nervous system
P11.0 Cerebral edema due to birth trauma
P11.1 Other specified brain lesions due to birth trauma
P11.2 Unspecified brain lesions due to birth trauma
P11.3 Damage to the facial nerve due to birth trauma. Facial paralysis due to birth trauma
P11.4 Damage to other cranial nerves due to birth trauma
P11.5 Damage to the spine and spinal cord due to birth trauma. Spinal fracture due to birth trauma
P11.9 Damage to the central nervous system due to birth trauma, unspecified
P12 Birth trauma of the scalp
P12.0 Cephalhematoma due to birth trauma
P12.1 Hair damage due to birth trauma
P12.2 Subaponeurotic hemorrhage due to birth trauma
P12.3 Hematoma of the scalp due to birth trauma
P12.4 Damage to the scalp due to monitoring procedures
Skin incision to collect blood. Damage to the scalp with a clip (electrode)
P12.8 Other damage to the scalp during childbirth
P12.9 Damage to the scalp during childbirth, unspecified
P13 Birth trauma to the skeleton
Excludes: birth injury of the spine ( P11.5)
P13.0 Fracture of the skull bones due to birth trauma
P13.1 Other cranial injuries due to birth trauma
Excludes: cephalhematoma ( P12.0)
P13.2 Fracture of the femur due to birth trauma
P13.3 Fracture of other long bones due to birth trauma
P13.4 Clavicle fracture due to birth trauma
P13.8 Damage to other parts of the skeleton due to birth trauma
P13.9 Skeletal damage due to birth trauma, unspecified
P14 Birth injury of the peripheral nervous system
P14.0 Erb's palsy due to birth trauma
P14.1 Klumpke's palsy due to birth trauma
P14.2 Phrenic nerve palsy due to birth trauma
P14.3 Other birth injuries of the brachial plexus
P14.8 Birth injuries of other parts of the peripheral nervous system
P14.9 Birth injury of peripheral nerves, unspecified
P15 Other types of birth trauma
P15.0 Liver damage due to birth trauma. Liver rupture due to birth trauma
P15.1 Damage to the spleen due to birth trauma. Splenic rupture due to birth trauma
P15.2 Damage to the sternocleidomastoid muscle due to birth trauma
P15.3 Birth trauma of the eye
Subconjunctival hemorrhage)
Traumatic glaucoma) due to birth trauma
P15.4 Birth trauma to the face. Facial hyperemia due to birth trauma
P15.5 Damage to the external genitalia due to birth trauma
P15.6 Necrosis of subcutaneous tissue caused by birth trauma
P15.8 Other specified birth injuries
P15.9 Unspecified birth injury
RESPIRATORY AND CARDIOVASCULAR DISORDERS CHARACTERISTIC IN THE PERINATAL PERIOD (P20-P29)
P20 Intrauterine hypoxia
Includes: abnormal fetal heart rate
fetal or intrauterine:
acidosis
anoxia
asphyxia
distress
hypoxia
meconium in amniotic fluid
passing meconium
Excluded: intracranial hemorrhage caused by anoxia or hypoxia ( P52. -)
P20.0 Intrauterine hypoxia, first noted before the onset of labor
P20.1 Intrauterine hypoxia, first noted during labor and delivery
P20.9 Intrauterine hypoxia, unspecified
P21 Birth asphyxia
Note: This rubric should not be used for low Apgar scores without mention of
asphyxia or other respiratory disorders.
Excluded: intrauterine hypoxia or asphyxia ( P20. -)
P21.0 Severe asphyxia at birth
Birth pulse less than 100 beats/min, slow or steady, absent or labored breathing, skin
pale, muscles atonic. Asphyxia with an Apgar score of 0-3 1 minute after birth. White asphyxia
P21.1 Moderate and moderate asphyxia at birth
Normal breathing was not established within the first minute after birth, but the heart rate was 100 beats/min
or more, slight muscle tone, slight response to irritation.
Apgur score 4-7 1 minute after birth. Blue asphyxia
P21.9 Unspecified birth asphyxia
Anoxia)
Asphyxia) NOS
Hypoxia)
P22 Respiratory distress in the newborn [distress]
Excludes: respiratory failure in a newborn ( P28.5)
P22.0 Respiratory distress syndrome in a newborn. Hyaline membrane disease
P22.1 Transient tachypnea in a newborn
P22.8 Other respiratory disorders in the newborn
P22.9 Respiratory distress in a newborn, unspecified
P23 Congenital pneumonia
Includes: infectious pneumonia that develops in utero or at birth
Excludes: neonatal pneumonia due to aspiration ( P24. -)
P23.0 Viral congenital pneumonia
Excluded: congenital pneumonitis caused by rubella virus ( P35.0)
P23.1 Congenital pneumonia caused by chlamydia
P23.2 Congenital pneumonia caused by staphylococcus
P23.3 Congenital pneumonia caused by group B streptococcus
P23.4 Congenital pneumonia caused by Escherichia coli
P23.5 Congenital pneumonia caused by Pseudomonas
P23.6 Congenital pneumonia caused by other bacterial agents. Haemophilus influenzae. Klebsiella pneumoniae
Mycoplasma. Streptococcus, except group B
P23.8 Congenital pneumonia caused by other pathogens
P23.9 Congenital pneumonia, unspecified
P24 Neonatal aspiration syndromes
Includes: neonatal pneumonia due to aspiration
P24.0 Neonatal meconium aspiration
P24.1 Neonatal aspiration of amniotic fluid and mucus. Aspiration of amniotic fluid
P24.2 Neonatal blood aspiration
P24.3 Neonatal aspiration of milk and regurgitated food
P24.8 Other neonatal aspiration syndromes
P24.9 Neonatal aspiration syndrome, unspecified. Neonatal aspiration pneumonia NOS
P25 Interstitial emphysema and related conditions arising in the perinatal period
P25.0 Interstitial emphysema arising in the perinatal period
P25.1 Pneumothorax occurring in the perinatal period
P25.2 Pneumomediastinum arising in the perinatal period
P25.3 Pneumopericardium arising in the perinatal period
P25.8 Other conditions associated with interstitial emphysema occurring in the perinatal period
P26 Pulmonary hemorrhage occurring in the perinatal period
P26.0 Tracheobronchial bleeding that occurred in the perinatal period
P26.1 Massive pulmonary hemorrhage that occurred in the perinatal period
P26.8 Other pulmonary hemorrhages occurring in the perinatal period
P26.9 Pulmonary hemorrhage occurring in the perinatal period, unspecified
P27 Chronic respiratory diseases that developed in the perinatal period
P27.0 Wilson-Mikiti syndrome. Lung immaturity
P27.1 Bronchopulmonary dysplasia arising in the perinatal period
P27.8 Other chronic respiratory diseases that arose in the perinatal period
Congenital pulmonary fibrosis. “Ventilation” lung in a newborn
P27.9 Unspecified chronic respiratory diseases arising in the perinatal period
P28 Other respiratory disorders arising in the perinatal period
Excluded: congenital anomalies of the respiratory system ( Q30-Q34)
P28.0 Primary atelectasis in a newborn. Primary non-expansion of terminal respiratory structures
Pulmonary:
hypoplasia associated with prematurity
immaturity NOS
P28.1 Other and unspecified atelectasis in the newborn
Atelectasis:
NOS
partial
secondary
Resorption atelectasis without respiratory distress syndrome
P28.2 Attacks of cyanosis in a newborn
Excluded: apnea in the newborn ( P28.3-P28.4)
P28.3 Primary sleep apnea in a newborn. Sleep apnea in the newborn NOS
P28.4 Other types of apnea in a newborn
P28.5 Respiratory failure in a newborn
P28.8 Other specified respiratory conditions in the newborn. Newborn's runny nose
Excluded: early congenital syphilitic rhinitis ( A50.0)
P28.9 Respiratory disorder in a newborn, unspecified
P29 Cardiovascular disorders arising in the perinatal period
Excluded: congenital anomalies of the circulatory system ( Q20-Q28)
P29.0 Heart failure in newborns
P29.1 Heart rhythm disturbances in a newborn
P29.2 Hypertension in a newborn
P29.3 Persistent fetal circulation in the newborn. Delayed closure of the ductus arteriosus in the newborn
P29.4 Transient myocardial ischemia in a newborn
P29.8 Other cardiovascular disorders arising in the perinatal period
P29.9 Cardiovascular disorder occurring in the perinatal period, unspecified
INFECTIOUS DISEASES SPECIFIC TO THE PERINATAL PERIOD (P35-P39)
Includes: infections acquired in utero or during childbirth
Excluded: asymptomatic human immunodeficiency virus [HIV] infection ( Z21)
congenital:
gonococcal infection ( A54. -)
pneumonia ( P23. -)
syphilis ( A50. -)
disease caused by human immunodeficiency virus [HIV] ( B20-B24)
infectious diseases acquired after birth ( A00-B99
, J10
-J11
)
intestinal infectious diseases ( A00-A09)
laboratory confirmation of carriage of the human immunodeficiency virus [HIV] ( R75)
infectious diseases of the mother as a cause of death or illness of the fetus or newborn, but without manifestations
these diseases in the fetus or newborn ( P00.2)
tetanus of the newborn ( A33)
P35 Congenital viral infections
P35.0 Congenital rubella syndrome. Congenital pneumonitis caused by rubella virus
P35.1 Congenital cytomegalovirus infection
P35.2 Congenital infection caused by herpes simplex virus
P35.3 Congenital viral hepatitis
P35.8 Other congenital viral infections. Congenital chickenpox
P35.9 Congenital viral disease, unspecified
P36 Bacterial sepsis of the newborn
Included: congenital septicemia
Excluded: congenital syphilis ( A50. -)
necrotizing enterocolitis in the fetus and newborn ( P77)
newborn diarrhea:
infectious ( A00-A09)
non-infectious ( P78.3)
ophthalmia of the newborn caused by gonococcus ( A54.3)
tetanus of the newborn ( A33)
P39.0 Neonatal infectious mastitis
Excluded: swelling of the mammary glands in a newborn ( P83.4)
non-infectious mastitis in a newborn ( P83.4)
P39.1 Conjunctivitis and dacryocystitis in a newborn
Neonatal conjunctivitis caused by chlamydia. Ophthalmia of the newborn NOS
Excluded: gonococcal conjunctivitis ( A54.3)
P39.2 Intra-amniotic infection of the fetus, not elsewhere classified
P39.3 Neonatal urinary tract infection
P39.4 Neonatal skin infection. Neonatal pyoderma
Excluded: pemphigus of the newborn ( L00)
L00)
P39.8 Other specified infection specific to the perinatal period
P39.9 Infection specific to the perinatal period, unspecified
HEMORRHAGIC AND HEMATOLOGICAL DISORDERS
IN THE FETUS AND NEWBORN (P50-P61)
Excluded: congenital stenosis and stricture of the bile ducts ( Q44.3)
Crigler-Najjar syndrome ( E80.5)
Dubin-Johnson syndrome ( E80.6)
Gilbert's syndrome ( E80.4)
hereditary hemolytic anemia ( D55-D58)
P50 Fetal blood loss
Excludes: congenital anemia from fetal blood loss ( P61.3)
P50.0 Fetal blood loss from the presenting vessel
P50.1 Fetal blood loss from a severed umbilical cord
P50.2 Loss of fetal blood from the placenta
P50.3 Bleeding in the fetus of the other identical twin
P50.4 Bleeding from the fetus into the mother's bloodstream
P50.5 Loss of blood in the fetus from the cut end of the umbilical cord in identical twins
P50.8 Another form of fetal blood loss
P50.9 Unspecified fetal blood loss. Fetal hemorrhage NOS
P51 Bleeding from the umbilical cord in a newborn
Excluded: omphalitis with minor bleeding ( P38)
P51.0 Massive bleeding from the umbilical cord in a newborn
P51.8 Other bleeding from the umbilical cord in a newborn. Ligature slipping from the umbilical cord stump NOS
P51.9 Unspecified umbilical cord bleeding in a newborn
P52 Intracranial non-traumatic hemorrhage in the fetus and newborn
Includes: intracranial hemorrhage due to anoxia or hypoxia
Excluded: intracranial hemorrhage caused by:
birth trauma ( P10. -)
mother's injury ( P00.5)
other injury ( S06. -)
P52.0 Intraventricular hemorrhage (non-traumatic) 1st degree in the fetus and newborn
Subependymal hemorrhage (without spread to the ventricles of the brain)
P52.1 Intraventricular hemorrhage (non-traumatic) 2nd degree in the fetus and newborn
Subependymal hemorrhage extending into the ventricles of the brain
P52.2 Intraventricular hemorrhage (non-traumatic) of the 3rd degree in the fetus and newborn
Subependymal hemorrhage extending into the ventricles and brain tissue
P52.3 Unspecified intraventricular (non-traumatic) hemorrhage in the fetus and newborn
P52.4 Cerebral hemorrhage (non-traumatic) in the fetus and newborn
P52.5 Subarachnoid (non-traumatic) hemorrhage in the fetus and newborn
P52.6 Hemorrhage into the cerebellum and posterior cranial fossa (non-traumatic) in the fetus and newborn
P52.8 Other intracranial (non-traumatic) hemorrhages in the fetus and newborn
P52.9 Intracranial (non-traumatic) hemorrhage in the fetus and newborn, unspecified
P53 Hemorrhagic disease of the fetus and newborn
Vitamin K deficiency in a newborn
P54 Other neonatal bleeding
Excluded: fetal blood loss ( P50. -)
pulmonary hemorrhage that occurs in the perinatal period ( P26. -)
P54.0 Neonatal hematemesis
Excluded: caused by ingestion of maternal blood ( P78.2)
P54.1 Melena of the newborn
Excluded: caused by ingestion of maternal blood ( P78.2)
P54.2 Bleeding from the rectum in a newborn
P54.3 Gastrointestinal bleeding in a newborn
P54.4 Hemorrhage into the adrenal gland in a newborn
P54.5 Skin hemorrhage in a newborn
Bruising)
Ecchymoses)
Petechiae) in the fetus and newborn
Superficial)
hematoma)
Excluded: hematoma of the scalp due to birth trauma ( P12.3)
cephalhematoma due to birth trauma ( P12.0)
P54.6 Bleeding from the vagina in a newborn. Pseudomenstruation
P54.8 Other specified bleeding in the newborn
P54.9 Neonatal bleeding, unspecified
P55 Hemolytic disease of the fetus and newborn
P55.0 Rh isoimmunization of the fetus and newborn
P55.1 AB0-isoimmunization of the fetus and newborn
P55.8 Other forms of hemolytic disease of the fetus and newborn
P55.9 Hemolytic disease of the fetus and newborn, unspecified
P56 Hydrops fetalis due to hemolytic disease
Excludes: hydrops fetalis NOS ( P83.2)
not caused by hemolytic disease ( P83.2)
P56.0 Hydrops fetalis due to isoimmunization
P56.9 Hydrops fetalis due to other and unspecified hemolytic disease
P57 Kernicterus
P57.0 Kernicterus due to isoimmunization
P57.8 Other specified forms of kernicterus
Excluded: Crigler-Najjar syndrome ( E80.5)
P57.9 Kernicterus, unspecified
P58 Neonatal jaundice due to excessive hemolysis
Excludes: jaundice due to isoimmunization ( P55-P57)
P58.0 Neonatal jaundice due to bruising
P58.1 Neonatal jaundice due to bleeding
P58.2 Neonatal jaundice due to infection
P58.3 Neonatal jaundice due to polycythemia
P58.4 Neonatal jaundice caused by drugs or toxins passed from the body
mother or administered to a newborn. If necessary, an additional code (class XX) is used to identify the cause.
P58.5 Neonatal jaundice caused by ingestion of maternal blood
P58.8 Neonatal jaundice due to other specified forms of excessive hemolysis
P58.9 Neonatal jaundice due to excessive hemolysis, unspecified
P59 Neonatal jaundice due to other and unspecified causes
Excluded: caused by inborn errors of metabolism ( E70-E90)
kernicterus ( P57. -)
P59.0 Neonatal jaundice associated with preterm delivery
Hyperbilirubinemia of prematurity. Neonatal jaundice due to delayed bilirubin conjugation associated with preterm delivery
P59.1 Bile thickening syndrome
P59.2 Neonatal jaundice due to other and unspecified liver cell damage
Excluded: congenital viral hepatitis ( P35.3)
P59.3 Neonatal jaundice due to lactation inhibitors
P59.8 Neonatal jaundice due to other specified causes
P59.9 Neonatal jaundice, unspecified. Physiological jaundice (severe) NOS
P60 Disseminated intravascular coagulation in the fetus and newborn
Defibration syndrome in the fetus and newborn
P61 Other perinatal hematological disorders
Excludes: transient hypogammaglobulinemia in children ( D80.7)
P61.0 Transient neonatal thrombocytopenia
Neonatal thrombocytopenia caused by:
exchange transfusion
idiopathic thrombocytopenia in the mother
isoimmunization
P61.1 Polycythemia of the newborn
P61.2 Anemia of prematurity
P61.3 Congenital anemia due to fetal blood loss
P61.4 Other congenital anemias not elsewhere classified. Congenital anemia NOS
P61.5 Transient neonatal neutropenia
P61.6 Other transient neonatal coagulation disorders
P61.8 Other specified perinatal hematological disorders
P61.9 Perinatal hematological disorder, unspecified
TRANSIENT ENDOCRINE AND METABOLIC DISORDERS,
SPECIFIC FOR FETUS AND NEWBORN (P70-P74)
Includes: transient endocrine and metabolic disorders, as a response to endocrine and metabolic disorders in the mother or to adaptation to extrauterine life
P70 Transient disorders of carbohydrate metabolism specific to the fetus and newborn
P70.0 Syndrome of the newborn from a mother with gestational diabetes
P70.1 Newborn syndrome from a diabetic mother
Diabetes mellitus (developed before pregnancy) in the mother, affecting the fetus or newborn (with hypoglycemia)
P70.2 Diabetes mellitus of newborns
P70.3 Iatrogenic neonatal hypoglycemia
P70.4 Other neonatal hypoglycemia. Transient neonatal hypoglycemia
P70.8 Other transient disorders of carbohydrate metabolism in the fetus and newborn
P70.9 Transient disorder of carbohydrate metabolism in the fetus and newborn, unspecified
P71 Transient neonatal disorders of calcium and magnesium metabolism
P71.0 Hypocalcemia of the newborn from cow's milk
P71.1 Other forms of neonatal hypocalcemia
Excluded: neonatal hypoparathyroidism ( P71.4)
P71.2 Neonatal hypomagnesemia
P71.3 Neonatal tetany without calcium and magnesium deficiency. Neonatal tetany NOS
P71.4 Transient neonatal hypoparathyroidism
P71.8 Other transient neonatal disorders of calcium and magnesium metabolism
P71.9 Transient neonatal disorder of calcium and magnesium metabolism, unspecified
P72 Other transient neonatal endocrine disorders
Excluded: congenital hypothyroidism with or without goiter ( E03.0-E03.1)
dyshormonal goiter ( E07.1)
Pendred's syndrome ( E07.1)
P72.0 Neonatal goiter, not elsewhere classified. Transient congenital goiter with normal function
P72.1 Transient neonatal hyperthyroidism. Neonatal thyrotoxicosis
P72.2 Other transient neonatal thyroid disorders not elsewhere classified
Transient neonatal hypothyroidism
P72.8 Other specified transient neonatal endocrine disorders
P72.9 Transient neonatal endocrine disorder, unspecified
P74 Other transient neonatal disorders of water-salt metabolism
P74.0 Late metabolic acidosis in the newborn
P74.1 Dehydration in a newborn
P74.2 Sodium imbalance in the newborn
P74.3 Potassium imbalance in a newborn
P74.4 Other transient disorders of water-salt metabolism in a newborn
P74.5 Transient tyrosinemia in a newborn
P74.8 Other transient metabolic disorders in the newborn
P74.9 Transient metabolic disorder of the newborn, unspecified
DIGESTIVE DISORDERS IN THE FETUS AND NEWBORN (P75-P78)
P75* Meconium ileus ( E84.1+)
P76 Other types of intestinal obstruction in the newborn
Excludes: intestinal obstruction classified under K56.
P76.0 Meconium plug syndrome
P76.1 Transient ileus in a newborn
Excludes: Hirschsprung's disease ( Q43.1)
P76.2 Intestinal obstruction due to thickening of milk
P76.8 Other specified intestinal obstruction in a newborn
P76.9 Intestinal obstruction in a newborn, unspecified
P77 Necrotizing enterocolitis in the fetus and newborn
P78 Other disorders of the digestive system in the perinatal period
Excluded: neonatal gastrointestinal bleeding ( P54.0-P54.3)
P78.0 Intestinal perforation in the perinatal period. Meconium peritonitis
P78.1 Other forms of neonatal peritonitis. Neonatal peritonitis NOS
P78.2 Hematemesis and melena due to ingestion of maternal blood
P78.3 Non-infectious diarrhea in a newborn. Diarrhea in newborn NOS
Excludes: neonatal diarrhea NOS in countries where infectious origin of the condition can be suspected ( A09)
P78.8 Other specified disorders of the digestive system in the perinatal period
Congenital cirrhosis (of the liver). Peptic ulcer in a newborn
P78.9 Digestive system disorder in the perinatal period, unspecified
CONDITIONS INVOLVING THE EXTERNAL INTEGRATION AND THERMOREGULATION OF THE FETUS AND NEWBORN (P80-P83)
P80 Hypothermia of the newborn
P80.0 Cold injury syndrome. Severe and usually chronic hypothermia, associated with redness, swelling, neurological and biochemical changes.
Excluded: mild hypothermia in the newborn ( P80.8)
P80.8 Other hypothermia of the newborn. Mild hypothermia of the newborn
P80.9 Neonatal hypothermia, unspecified
P81 Other thermoregulation disorders in the newborn
P81.0 Neonatal hypothermia caused by environmental factors
P81.8 Other specified disorders of thermoregulation in the newborn
P81.9 Unspecified thermoregulation disorder in a newborn. Fever in the newborn NOS
P83 Other external changes specific to the fetus and newborn
Excluded: congenital abnormalities of the skin and other external integuments ( Q80-Q84)
seborrhea of the head [cap] in an infant ( L21.0)
diaper dermatitis ( L22)
hydrops fetalis due to hemolytic disease ( P56. -)
skin infections of the newborn ( P39.4)
syndrome of staphylococcal skin lesions in the form of burn-like blisters ( L00)
P83.0 Newborn sclerema
P83.1 Neonatal erythema toxicum
P83.2 Hydrops fetalis not associated with hemolytic disease. Hydrops fetalis NOS
P83.3 Other and unspecified edema specific to the fetus and newborn
P83.4 Swelling of the mammary glands in a newborn. Non-infectious mastitis of the newborn
P83.5 Congenital hydrocele
P83.6 Umbilical cord stump polyp
P83.8 Other specified changes in the external integument specific to the fetus and newborn
Bronze skin syndrome. Scleroderma of the newborn. Newborn urticaria
P83.9 Changes in the outer integument, specific to the fetus and newborn, unspecified
OTHER DISORDERS ARISING IN THE PERINATAL PERIOD (P90-P96)
P90 Neonatal seizures
Excluded: mild neonatal convulsions (familial) ( G40.3)
P91 Other disorders of cerebral status in the newborn
P91.0 Brain ischemia
P91.1 Periventricular cysts (acquired) in a newborn
P91.2 Cerebral leukomalacia in a newborn
P91.3 Cerebral excitability of the newborn
P91.4 Cerebral depression in the newborn
P91.5 Neonatal coma
P91.8 Other specified brain disorders in the newborn
P91.9 Neonatal brain disorder, unspecified
P92 Problems feeding a newborn
P92.0 Vomiting of a newborn
P92.1 Newborn spitting and rumination
P92.2 Sluggish sucking of a newborn
P92.3 Underfeeding a newborn
P92.4 Overfeeding a newborn
P92.5 Difficulties in breastfeeding a newborn
P92.8 Other problems of feeding a newborn
P92.9 Problem feeding a newborn, unspecified
P93 Reactions and intoxications caused by drugs administered to the fetus and newborn
“Gray” syndrome in a newborn due to the use of chloramphenicol
Excluded: jaundice caused by drugs or toxins from the mother ( P58.4)
reactions and intoxications caused by the mother’s use of opiates, tranquilizers and other drugs ( P04.0-P04.1, P04.4)
drug withdrawal symptoms caused by:
mother's drug addiction P96.1)
administration of drugs to a newborn ( P96.2)
P94 Muscle tone disorders in the newborn
P94.0 Transient neonatal myasthenia gravis
Excludes: myasthenia gravis ( G70.0)
P94.1 Congenital hypertonicity
P94.2 Congenital hypotonia. Syndrome of nonspecific lethargy of the child
P94.8 Other muscle tone disorders in the newborn
P94.9 Neonatal muscle tone disorder, unspecified
P95 Fetal death from unspecified cause
Dead fetus NOS
Stillborn NOS
P96 Other disorders occurring in the perinatal period
P96.0 Congenital renal failure. Uremia in a newborn
P96.1 Symptoms of drug withdrawal in a newborn caused by maternal drug addiction
Abstinence syndrome in an infant due to maternal drug addiction
Excluded: drug reactions and intoxications caused by maternal administration of opiates and tranquilizers ( P04.0)
P96.2 Withdrawal symptoms after administering medications to a newborn
P96.3 Wide cranial sutures. Newborn craniotabes
P96.4 Termination of pregnancy, effects on the fetus and newborn
Excluded: termination of pregnancy (effect on mother) ( O04. -)
P96.5 Complications caused by intrauterine interventions, not elsewhere classified
P96.8 Other specified disorders occurring in the perinatal period
P96.9 Disorder occurring in the perinatal period, unspecified. Congenital weakness NOS
Premature children are considered to be those born during the period from 28 to 37 weeks of pregnancy, having a body weight of 1000-2500 g and a body length of 35-45 t. The most stable criterion is the gestational age; Anthropometric indicators, due to their significant variability, are considered conditional criteria for prematurity. Every year, as a result of spontaneous premature birth or artificially induced termination of pregnancy in the later stages, 5-10% of the total number of newborns are born prematurely.
According to the WHO definition (1974), a fetus is considered viable at a gestational age of more than 22 weeks, a body weight of 500 g, a body length of 25 t. less than 35 cm is regarded as a late miscarriage. However, if such a child was born alive and lived after birth for at least 7 days, he is registered as premature. The neonatal mortality rate among premature infants is much higher than that among full-term infants, and largely depends on the quality of medical care in the first minutes and days of a child’s life.
Features of caring for premature babies.
Children born prematurely require special care. Their step-by-step care is carried out by neonatologists and pediatricians, first in the maternity hospital, then in the children's hospital and clinic. The main components of caring for premature babies are: ensuring optimal temperature and humidity conditions, rational oxygen therapy and dosed feeding. In premature infants, constant monitoring of the electrolyte composition and ABS of the blood, monitoring of the gas composition of the blood, pulse and blood pressure is carried out.Very premature babies immediately after birth are placed in incubators, where, taking into account the child’s condition, a constant temperature (32-35°C), humidity (in the first days about 90%, then 60-50%), and oxygenation level (about 30%) are maintained. Premature babies of the I-II degree are usually placed in heated cribs or in regular cribs in special boxes where the air temperature is maintained at 24-25°C.
Premature babies who are able to independently maintain normal body temperature, have reached a body weight of 2000 g, and have good epithelization of the umbilical wound can be discharged home. The second stage of nursing in specialized departments of children's hospitals is indicated for premature babies who have not reached a body weight of 2000 g in the first 2 weeks, and for children with perinatal pathology.
Feeding premature babies should begin in the first hours of life. Children with absent sucking and swallowing reflexes receive nutrition through a gastric tube; if the sucking reflex is sufficiently expressed, but the body weight is less than 1800 g, the child is fed through a pacifier; children weighing over 1800 g can be breastfed. The frequency of feedings for premature infants of stage I-II is 7-8 times a day; III and IV degrees - 10 times a day. Nutrition calculations are made using special formulas.
Premature infants with physiological jaundice should receive phototherapy (general ultraviolet radiation). As part of the rehabilitation of premature babies at the second stage, communication between the child and the mother, skin-to-skin contact, is useful.
Medical examination of premature babies.
After discharge, children born prematurely require constant monitoring by a pediatrician during the first year of life. Inspections and anthropometry are carried out weekly in the first month, once every two weeks in the first half of the year, once a month in the second half of the year. In the first month of life, premature babies should be examined by a pediatric surgeon, a pediatric neurologist, a pediatric orthopedic traumatologist, a pediatric cardiologist, and a pediatric ophthalmologist. At the age of 1 year, children need consultation with a speech therapist and a child psychiatrist.From 2 weeks of age, premature babies need prevention of iron deficiency anemia and rickets. Preventive vaccinations for premature babies are carried out according to an individual schedule. In the first year of life, repeated courses of baby massage, gymnastics, and individual health and hardening procedures are recommended.
Prematurity- the condition of a fetus born before the end of the normal period of intrauterine development (before 37 weeks of gestation), with a body weight of less than 2,500 g, a height of less than 45 cm, characterized by imperfect thermoregulation, a tendency to asphyxia, and insufficient resistance to environmental factors. Considering the individual variability of indicators, the arbitrariness of anthropometric criteria for prematurity cannot be ruled out. Frequency - 5-10% of newborns.
Code according to the international classification of diseases ICD-10:
Classification by body weight. I degree - 2,001-2,500 g. II degree - 1,501-2,000 g. III degree - 1,001-1,500 g. IV degree - less than 1,000 g.Reasons
Etiology. On the maternal side.. Kidney diseases, cardiovascular system, endocrine disorders, acute infectious diseases, gynecological pathology.. Complications of pregnancy - gestosis.. Intrauterine contraceptives.. Injuries, incl. mental.. Intoxication- smoking, drinking alcohol and drugs.. Immunological incompatibility (Rhesus - conflict, blood group conflict).. Young or old age of the mother.. Occupational hazards. On the father's side.. Chronic diseases.. Old age. On the part of the fetus.. Genetic diseases.. Erythroblastosis fetalis.. Intrauterine infections.
Symptoms (signs)
Clinical picture. Disproportional body structure - large head with a predominance of the cerebral part of the skull over the facial part. Open cranial sutures, the skull bones are pliable, the auricles are soft. A thick layer of cheese-like lubricant, abundant vellus hair. Poor development of subcutaneous fat tissue, imperfect thermoregulation. Muscle hypotonia, frog pose. In boys, the testicles are not descended into the scrotum; in girls, the labia majora do not cover the labia minora. Weakly expressed physiological reflexes of newborns (sucking, searching, grasping, Moro, automatic walking). Breathing is shallow, weakened, respiratory rate 40-54 per minute, periodic episodes of apnea. The pulse is labile, weak filling, heart rate 120-160 per minute, low blood pressure (average blood pressure 55-65 mm Hg). Regurgitation. Transient hypothyroidism. Frequent urination.
Treatment
TREATMENT
. Premature babies are nursed in a special ward with an air temperature of 25 ° C and a humidity of 55-60%. Individual conditions are created using incubators or additional heating of the crib. Closed incubators are used in the first days of life for nursing children weighing 2 kg or less.
. Healthy premature babies are discharged home when they reach a body weight of 2 kg, but not earlier than 8-10 days.
. Healthy premature babies who have not reached 2 kg of body weight in the first 2 weeks of life, and patients, regardless of body weight, are transferred to the second stage of nursing. Children are transferred to a hospital for the second stage of nursing in specially equipped resuscitation machines with an incubator and oxygen supply.. In specialized Departments of children are placed in boxed wards. Very premature and sick children are nursed in incubators. Bathing of healthy premature infants begins from 2 weeks of age (with epithelization of the umbilical wound), with a body weight of less than 1000 g, hygienic baths begin from the 2nd month of life. Walking is carried out from 3-4 - weeks of age when a body weight reaches 1700-1800 g. Healthy children are discharged from the department of the second stage of nursing when a body weight reaches 1700 g.
. Feeding... Feeding with expressed breast milk from the mother (or donor) in the absence of contraindications and a long gestation period begins 2-6 hours after birth. The general scheme of enteral feeding: first a test with distilled water, then several injections of 5% glucose solution with increasing volume, with good glucose tolerance - breast milk. Parenteral nutrition using a nasogastric or orogastric tube is indicated for immature and critically ill children in the first 24-48 hours of life.. Attachment to the breast is carried out according to individual indications, with active sucking and body weight 1800-2000 g. The volume of one feeding on the first day is 5-10 ml, on the 2nd day - 10-15 ml , on the 3rd day - 15-20 ml.. Calculation of nutrition is carried out according to calorie content... The first 3-5 days - 30-60 kcal / kg / day... By the 7-8th day - 60-80 kcal /kg/day... By the end of the first month - 135-140 kcal/kg/day... From the age of 2 months, for children born with a body weight of more than 1500 g, calorie content is reduced to 135 kcal/kg/day... Children with with a smaller body weight, the calorie content is maintained at 140 kcal/kg/day for up to 3 months. The daily requirement for food ingredients depends on the type of feeding... Natural feeding (native breast milk or pasteurized milk): the first 6 months: protein - 2.2- 2.5 g/kg, fats - 6.5-7 g/kg, carbohydrates 12-14 g/kg; second half of the year: protein - 3-3.5 g/kg, fats - 5.5-6 g/kg... Mixed and artificial feeding: protein 3-3.5 and 3.5-4 g/kg, respectively; calorie content is increased by 10-15 kcal/kg.. Total daily fluid volume: 87.5% of the volume is milk, the rest is drink (a mixture of Ringer's solution with 5% glucose solution) and intravenous infusions... K At the end of the first week of life, the total daily volume of fluid is 70-80 ml/kg with a body weight of less than 1500 g and 80-100 ml/kg with a body weight of more than 1500 g... By the 10th day of life - 125-130 ml/kg. .. By the 15th day of life - 160 ml/kg... By the 20th day - 180 ml/kg... By 1-2 months - 200 ml/kg.. Introduction of vitamins... In the first 2- 3 days of life - menadione sodium bisulfite 0.001 g 2-3 r/day for the prevention of hemorrhagic disorders... Ascorbic acid 30-100 mg/day, thiamine, riboflavin... Vitamin E - 5% r - r 2- 5 drops/day for 10-12 days... Specific prevention of rickets... In case of severe immaturity and severe concomitant pathology - pyridoxine, vitamins B5, B15 and lipoic acid.. In the absence of mother's or donor milk, use from the 2nd week adapted milk formulas - Novolakt - MM, Premalalak, Prepiltti, etc. .. The timing of the introduction of complementary foods is determined individually.
Course and prognosis. Survival depends on the gestational age and body weight at birth. With III-IV degrees of prematurity and less than 30-31 weeks of gestation, childbirth ends in the birth of a live child in 1% of cases. With intensive treatment, survival of children with a gestation period of 22-23 weeks is possible. Mortality increases in the presence of risk factors.. Maternal bleeding before childbirth.. Multiple pregnancy.. Breech birth.. Perinatal asphyxia.. Male sex of the fetus.. Hypothermia.. Respiratory distress syndrome.
Concomitant pathology. Agenesis, aplasia, hypoplasia, pulmonary atelectasis. Respiratory distress syndrome. Erythroblastosis fetalis. Retinopathy of prematurity. Anemia of prematurity. Wilson-Mikiti syndrome. Dysbacteriosis. Intestinal infections. Pneumonia. Omphalitis.
ICD-10. P05 Poor fetal growth and malnutrition
