Neonatologist. What does this specialist do, what research does he conduct, what pathologies does he treat? Neonatologist - what does he do? Consultation, identification of pathologies Perinatal and neonatal mortality

Like many physiological control systems, the respiratory control system is organized as a feedback loop. The inhaled gas enters through the respiratory tract (RP) to the alveoli, where it participates in the exchange of gases at the level of the alveolar-capillary membrane. Receptors respond to information about humoral parameters (PaO2, PaCO2, pH) and mechanical phenomena (for example, filling or stretching of the lungs, hypervolemia). This information is integrated in the respiratory center (RC) of the medulla oblongata, which modulates the nerve impulse to the motor neurons innervating the respiratory muscles and the muscles of the upper respiratory tract. The coordinated excitation of respiratory motor neurons leads to synchronous contraction of the respiratory muscles, creating an air flow.

The purpose of this study was to study the state of organ blood flow in newborns with severe hypoxic-ischemic encephalopathy (HIE) in order to develop ideas about the pathogenesis of its disorders. 86 full-term newborns with severe HIE were examined using Doppler ultrasound on the 5-7th, 14-16th and 24-28th days of life. Blood flow was studied in the aorta, pulmonary artery, basal, anterior, middle cerebral arteries, renal artery and celiac trunk. As a result of the study, organ hemodynamic disturbances were noted throughout the neonatal period. The cause of a long-term decrease in myocardial contractility may be activation of the renin-angiotensin system, which is confirmed by the presence of signs of increased pre- and afterload. A decrease in the level of blood flow was revealed mainly in the basal and anterior cerebral arteries by the end of the early neonatal period and an increase in the middle cerebral arteries by the end of the neonatal period. The presence of a mechanism for redistribution of blood circulation in favor of cerebral blood flow at the expense of renal and, especially, splanchic blood flow was noted. The most promising areas of therapy are the development of methods for influencing the activity of the renin-angiotensin system itself, as well as the level of vasoactive substances.

Primary resuscitation of newborns is impossible without additional oxygen supplementation. Conditions accompanied by persistent cyanosis at birth (hypoxia, regardless of the reasons that caused it) certainly require the use of 100% oxygen as much as the child’s condition requires, but even more important in modern conditions is the possibility of clinically justified dosing of the gas mixture and high-quality monitoring of oximetry and oxygenation of newborns. Some experts consider the use of “selective” oxygen in the delivery room to be either “vintage” art or unfounded “underground” experiments that bring unnecessary complexity and inconvenience with questionable effectiveness. However, this happens more often either according to a “knocked-in” standard, or due to the lack of the ability to quickly and qualitatively change and control the therapy with the help of modern equipment, the use of which could largely reconsider approaches to one’s actions. The slogan “save at any cost” in emergency neonatology in the delivery room has its limitations.

Maintaining the temperature and saturation of the gas mixture with water vapor close to physiological parameters during artificial ventilation of the lungs in newborns and premature infants is an extremely important task. A heater cascade with a heating coil inside the circuit is able to carry out this task quite safely for the patient’s lungs. At the moment when the gas mixture leaves the humidifier chamber, its temperature is 37 o C, but later, when passing through the patient’s circuit, it condenses on the walls. Approaching the patient, the gas loses the necessary moisture and can be potentially dangerous, drying out the mucous membrane of the trachea and bronchi. Heating and humidification of the respiratory mixture along the entire length of the circuit avoids the formation of condensation on the walls of the breathing tube and ensures the safety of the newborn.

Modern neonatal resuscitation is unthinkable without artificial ventilation. The introduction of mechanical ventilation into the practice of neonatal intensive care has significantly increased the survival rate of newborns in critical condition. Mechanical ventilation prosthetizes the respiratory function, relieves the load on the respiratory muscles, freeing the child from energy losses. However, mechanical breathing, as a result of which the gas mixture enters the lungs under pressure, unlike spontaneous breathing, is not physiological. An increase in intrathoracic pressure during respiratory cycles can negatively affect both the hemodynamic status of the patient and the lung tissue itself.

Improvements in methods of assisted pulmonary ventilation in the last decade have made it possible to largely change the philosophy of mechanical ventilation in newborns. Today, the range of methods of respiratory support varies widely from interactive modes, which require high-quality respiratory equipment, to non-invasive ventilation using special masks or nasal cannulas. Recently, the topic of non-invasive pulmonary ventilation has received close attention. There are a large number of methods and methods for providing this type of respiratory support using various technical equipment.

The problem of safe and effective cardiorespiratory monitoring at home in children of the first year of life is very relevant. The creators of modern monitors must first of all pay attention to reducing the frequency of false alarms recorded by the devices. Both the indications for monitoring and what type of monitors should be used in each specific case deserve critical analysis. In the course of studies conducted in stationary conditions in a somnology laboratory, 59 children of the first year of life were examined. At the same time, the possibility of reducing the frequency of false alarms was studied through a logical combined analysis of the recorded parameters by a new type of monitor with software. The use of a new type of monitors made it possible to reliably reduce the frequency of false alarms and reliably improve the operating characteristics of the device.

The draft of new methodological recommendations of the Russian Academy of Medical Sciences, developed by a team of authors, is aimed at optimizing methods for diagnosing, preventing and treating RDS in newborns, including premature infants with extremely low body weight. The authors tried to take into account current trends in improving respiratory therapy in developed countries of the world, and the positive experience of leading perinatal and neonatal centers in the Russian Federation.

At the same time, the authors of the project are aware that the text of the draft methodological recommendations may contain certain inaccuracies. The team of authors hopes for a detailed and comprehensive analysis of the text of the draft guidelines by other members of the Russian Academy of Medical Sciences: neonatologists, anesthesiologists-resuscitators, obstetricians-gynecologists, pediatricians and representatives of other medical specialties, as well as from medical workers representing other professional associations.

The cerebral function monitor was invented by Prior and Maynard in 1960 for use in adult patients in intensive care units. The main goal of the scientists was to create a system for monitoring brain function that has the following characteristics: ease of maintenance, low cost, reliability of the method, direct information about neuronal function, non-invasiveness, mass availability and productivity, automaticity and flexibility. aEEG recordings can be read by a physician with basic knowledge of electrophysiology. The simplicity of the method is similar to heart rate monitoring or pulse oximetry in the neonatal intensive care unit.

If the parents gave their consent before giving birth to a blood test of the baby, then immediately after his birth, material is collected for research. The blood type and Rh factor are determined, and an analysis is carried out for jaundice and genetic congenital diseases. Interestingly, the blood is taken not from the finger, but from the heel - this is less traumatic for the baby. This study is called neonatal screening.

Like many physiological control systems, the respiratory control system is organized as a feedback loop. The inhaled gas enters through the respiratory tract (RP) to the alveoli, where it participates in the exchange of gases at the level of the alveolar-capillary membrane. Receptors respond to information about humoral parameters (PaO2, PaCO2, pH) and mechanical phenomena (for example, filling or stretching of the lungs, hypervolemia). This information is integrated in the respiratory center (RC) of the medulla oblongata, which modulates the nerve impulse to the motor neurons innervating the respiratory muscles and the muscles of the upper respiratory tract. The coordinated excitation of respiratory motor neurons leads to synchronous contraction of the respiratory muscles, creating an air flow.

The purpose of this study was to study the state of organ blood flow in newborns with severe hypoxic-ischemic encephalopathy (HIE) in order to develop ideas about the pathogenesis of its disorders. 86 full-term newborns with severe HIE were examined using Doppler ultrasound on the 5-7th, 14-16th and 24-28th days of life. Blood flow was studied in the aorta, pulmonary artery, basal, anterior, middle cerebral arteries, renal artery and celiac trunk. As a result of the study, organ hemodynamic disturbances were noted throughout the neonatal period. The cause of a long-term decrease in myocardial contractility may be activation of the renin-angiotensin system, which is confirmed by the presence of signs of increased pre- and afterload. A decrease in the level of blood flow was revealed mainly in the basal and anterior cerebral arteries by the end of the early neonatal period and an increase in the middle cerebral arteries by the end of the neonatal period. The presence of a mechanism for redistribution of blood circulation in favor of cerebral blood flow at the expense of renal and, especially, splanchic blood flow was noted. The most promising areas of therapy are the development of methods for influencing the activity of the renin-angiotensin system itself, as well as the level of vasoactive substances.

Primary resuscitation of newborns is impossible without additional oxygen supplementation. Conditions accompanied by persistent cyanosis at birth (hypoxia, regardless of the reasons that caused it) certainly require the use of 100% oxygen as much as the child’s condition requires, but even more important in modern conditions is the possibility of clinically justified dosing of the gas mixture and high-quality monitoring of oximetry and oxygenation of newborns. Some experts consider the use of “selective” oxygen in the delivery room to be either “vintage” art or unfounded “underground” experiments that bring unnecessary complexity and inconvenience with questionable effectiveness. However, this happens more often either according to a “knocked-in” standard, or due to the lack of the ability to quickly and qualitatively change and control the therapy with the help of modern equipment, the use of which could largely reconsider approaches to one’s actions. The slogan “save at any cost” in emergency neonatology in the delivery room has its limitations.

Maintaining the temperature and saturation of the gas mixture with water vapor close to physiological parameters during artificial ventilation of the lungs in newborns and premature infants is an extremely important task. A heater cascade with a heating coil inside the circuit is able to carry out this task quite safely for the patient’s lungs. At the moment when the gas mixture leaves the humidifier chamber, its temperature is 37 o C, but later, when passing through the patient’s circuit, it condenses on the walls. Approaching the patient, the gas loses the necessary moisture and can be potentially dangerous, drying out the mucous membrane of the trachea and bronchi. Heating and humidification of the respiratory mixture along the entire length of the circuit avoids the formation of condensation on the walls of the breathing tube and ensures the safety of the newborn.

Modern neonatal resuscitation is unthinkable without artificial ventilation. The introduction of mechanical ventilation into the practice of neonatal intensive care has significantly increased the survival rate of newborns in critical condition. Mechanical ventilation prosthetizes the respiratory function, relieves the load on the respiratory muscles, freeing the child from energy losses. However, mechanical breathing, as a result of which the gas mixture enters the lungs under pressure, unlike spontaneous breathing, is not physiological. An increase in intrathoracic pressure during respiratory cycles can negatively affect both the hemodynamic status of the patient and the lung tissue itself.

Improvements in methods of assisted pulmonary ventilation in the last decade have made it possible to largely change the philosophy of mechanical ventilation in newborns. Today, the range of methods of respiratory support varies widely from interactive modes, which require high-quality respiratory equipment, to non-invasive ventilation using special masks or nasal cannulas. Recently, the topic of non-invasive pulmonary ventilation has received close attention. There are a large number of methods and methods for providing this type of respiratory support using various technical equipment.

The problem of safe and effective cardiorespiratory monitoring at home in children of the first year of life is very relevant. The creators of modern monitors must first of all pay attention to reducing the frequency of false alarms recorded by the devices. Both the indications for monitoring and what type of monitors should be used in each specific case deserve critical analysis. In the course of studies conducted in stationary conditions in a somnology laboratory, 59 children of the first year of life were examined. At the same time, the possibility of reducing the frequency of false alarms was studied through a logical combined analysis of the recorded parameters by a new type of monitor with software. The use of a new type of monitors made it possible to reliably reduce the frequency of false alarms and reliably improve the operating characteristics of the device.

The draft of new methodological recommendations of the Russian Academy of Medical Sciences, developed by a team of authors, is aimed at optimizing methods for diagnosing, preventing and treating RDS in newborns, including premature infants with extremely low body weight. The authors tried to take into account current trends in improving respiratory therapy in developed countries of the world, and the positive experience of leading perinatal and neonatal centers in the Russian Federation.

At the same time, the authors of the project are aware that the text of the draft methodological recommendations may contain certain inaccuracies. The team of authors hopes for a detailed and comprehensive analysis of the text of the draft guidelines by other members of the Russian Academy of Medical Sciences: neonatologists, anesthesiologists-resuscitators, obstetricians-gynecologists, pediatricians and representatives of other medical specialties, as well as from medical workers representing other professional associations.

The cerebral function monitor was invented by Prior and Maynard in 1960 for use in adult patients in intensive care units. The main goal of scientists was to create a system for monitoring brain function that has the following characteristics: ease of maintenance, low cost, reliability of the method, direct information about neuronal function, non-invasiveness, mass availability and productivity, automaticity and flexibility. aEEG recordings can be read by a physician with basic knowledge of electrophysiology. The simplicity of the method is similar to heart rate monitoring or pulse oximetry in the neonatal intensive care unit.

When you're pregnant, you worry about every little thing that might happen. Fortunately, most babies are born healthy. However, there is a small chance that your baby will be born with serious disabilities that you should be aware of. In this article we will look at three serious and, unfortunately, quite common abnormalities among newborns.

Spina Bifida - a condition in which a baby's spine, which protects the spinal cord, does not close properly during fetal development. If the remaining opening is small, minor health problems will follow, but in severe cases, if the opening is large or the spinal cord is outside the spine, the deviation can cause paralysis and other serious illnesses.

The exact cause of the deviation is unknown, but heredity plays a certain role in its occurrence. Nutrition is also important - the disease can manifest itself when there is a lack of folic acid in the mother's diet. To reduce the likelihood of disease, obstetricians and gynecologists recommend taking folic acid to pregnant women or those trying to become pregnant. During pregnancy, you will most likely be tested to see if your baby has spina bifida. Typically, such a deviation is diagnosed in utero using ultrasound. Sometimes surgery is performed on the baby in the womb to correct the problem.

Tay-Sachs disease - this disease is caused by enzyme deficiency. Simply put, children do not break down fat deposits in the brain and nerve cells. Unfortunately, it is impossible to diagnose the disease immediately after birth. When a baby is a few months old, the accumulation of fatty deposits clogs the cells, causing the baby's nervous system to stop working. The baby stops developing, which always leads to death. Tay-Sachs disease is very rare (fewer than one hundred cases are reported each year in the United States), and the disease is caused by genetics. The disease will occur in a child if both parents have the gene. The disease is most common in Jewish families in Central and Eastern Europe. If people from your background are prone to the condition, you and your partner may be tested for the gene before you become pregnant to rule out the risk of the condition in your baby. The disease can be diagnosed in utero using amniocentesis.

Down syndrome - a term for a variety of symptoms that indicate some degree of mental retardation. Children with Down syndrome have a certain set of facial features, a large tongue and a short neck. Down syndrome varies as much as the degrees of mental retardation it causes. Some children function normally, others require constant care. In the United States, one in 1,300 children have Down syndrome. The disease is caused by the presence of an extra chromosome and is transmitted from the father or mother. Down syndrome can occur if the family already has children born with disorders, or if the child's mother is over 35 years old. Down syndrome can be detected using amniocentesis, so the test is mandatory for pregnant women over the age of 35.

It is most often caused by an extra chromosome coming from the mother or father. Down syndrome occurs when the parents already have a child with the birth disorder and when the mother is over 35 years of age. Down syndrome can be detected using amniocentesis, so this test is a common protocol for most pregnant women over 35 years of age.

Home " Diseases » Neonatology pro. Serious disorders in newborns

Intrauterine growth restriction (small and low gestational age): definition, causes, diagnostic criteria

I gr., maternal factors:

II gr., fruit factors:

III group, placental factors:

Care, feeding and medical examination in neonatology

The main risk groups for the development of pathological conditions at birth. Organization of monitoring of them in the maternity hospital

Main risk groups in the development of pathological conditions in newborns, their causes and management plan

Primary and secondary toilet of the newborn. Caring for the skin, the remnant of the umbilical cord and the umbilical wound in the children's ward and at home

Organization of feeding of full-term and premature newborns. Nutrition calculation. Benefits of Breastfeeding

Organization of nursing, feeding and rehabilitation of premature babies in the maternity hospital and in specialized departments of the 2nd stage

Small and low gestational weight newborn: leading clinical syndromes in the early neonatal period, principles of nursing and treatment

Health groups for newborns. Features of dispensary observation of newborns in outpatient settings depending on health groups

Pathology of the newborn period Borderline conditions of the newborn period

Physiological jaundice of newborns: frequency, causes. Differential diagnosis of physiological and pathological jaundice

Jaundice of newborns

Classification of jaundice in newborns. Clinical and laboratory criteria for diagnosing jaundice

Treatment and prevention of jaundice in newborns caused by the accumulation of unconjugated bilirubin

Hemolytic disease of the fetus and newborn (HDN)

Hemolytic disease of the fetus and newborn: definition, etiology, pathogenesis. Clinical course options

Hemolytic disease of the fetus and newborn: the main links in the pathogenesis of edematous and icteric forms of the disease. Clinical manifestations

Hemolytic disease of the fetus and newborn: clinical and laboratory diagnostic criteria

Features of the pathogenesis and clinical manifestations of hemolytic disease of newborns in group incompatibility. Differential diagnosis with Rhesus conflict

Principles of treatment of hemolytic disease of newborns. Prevention

Kernicterus: definition, causes of development, clinical stages and manifestations, treatment, outcome, prevention

Dispensary observation in a clinic for a newborn who has suffered hemolytic disease Respiratory distress syndrome (RDS) in newborns

Causes of respiratory disorders in newborns. The share of sdr in the structure of neonatal mortality. Basic principles of prevention and treatment

Respiratory distress syndrome (hyaline membrane disease). Predisposing causes, etiology, pathogenesis, diagnostic criteria

Hyaline membrane disease in newborns: clinical manifestations, treatment. Prevention

Neonatal sepsis

Neonatal sepsis: definition, frequency, mortality, main causes and risk factors. Classification

III. Therapeutic and diagnostic procedures:

IV. Presence of various foci of infection in newborns

Sepsis of newborns: the main links of pathogenesis, variants of the clinical course. Diagnostic criteria

Sepsis of newborns: treatment in the acute period, rehabilitation in an outpatient setting

Early age pathology Constitutional anomalies and diathesis

Exudative-catarrhal diathesis. Risk factors. Pathogenesis. Clinic. Diagnostics. Flow. Outcomes

Exudative-catarrhal diathesis. Treatment. Prevention. Rehabilitation

Lymphatic-hypoplastic diathesis. Definition. Clinic. Flow options. Treatment

Neuro-arthritic diathesis. Definition. Etiology. Pathogenesis. Clinical manifestations

Neuro-arthritic diathesis. Diagnostic criteria. Treatment. Prevention

Chronic eating disorders (dystrophies)

Chronic eating disorders (dystrophies). The concept of normotrophy, hypotrophy, obesity, kwashiorkor, marasmus. Classic manifestations of dystrophy

Hypotrophy. Definition. Etiology. Pathogenesis. Classification. Clinical manifestations

Hypotrophy. Principles of treatment. Organization of diet therapy. Drug treatment. Treatment effectiveness criteria. Prevention. Rehabilitation

Obesity. Etiology. Pathogenesis. Clinical manifestations, severity. Principles of treatment

Rickets and ricketogenic conditions

Rickets. Predisposing factors. Pathogenesis. Classification. Clinic. Variants of course and severity. Treatment. Rehabilitation

Rickets. Diagnostic criteria. Differential diagnosis. Treatment. Rehabilitation. Antenatal and postnatal prevention

Spasmophilia. Predisposing factors. Causes. Pathogenesis. Clinic. Flow options

Spasmophilia. Diagnostic criteria. Urgent Care. Treatment. Prevention. Outcomes

Hypervitaminosis d. Etiology. Pathogenesis. Classification. Clinical manifestations. Flow options

Hypervitaminosis d. Diagnostic criteria. Differential diagnosis. Complications. Treatment. Prevention

Bronchial asthma. Clinic. Diagnostics. Differential diagnosis. Treatment. Prevention. Forecast. Complications

Asthmatic status. Clinic. Emergency treatment. Rehabilitation of patients with bronchial asthma in the clinic

Bronchitis in children. Definition. Etiology. Pathogenesis. Classification. Diagnostic criteria

Acute bronchitis in young children. Clinical and radiological manifestations. Differential diagnosis. Flow. Outcomes. Treatment

Acute obstructive bronchitis. Predisposing factors. Pathogenesis. Features of clinical and radiological manifestations. Emergency treatment. Treatment. Prevention

Acute bronchiolitis. Etiology. Pathogenesis. Clinic. Flow. Differential diagnosis. Emergency treatment of respiratory failure syndrome. Treatment

Complicated acute pneumonia in young children. Types of complications and doctor’s tactics for them

Acute pneumonia in older children. Etiology. Pathogenesis. Classification. Clinic. Treatment. Prevention

Chronic pneumonia. Definition. Etiology. Pathogenesis. Classification. Clinic. Clinical course options

Chronic pneumonia. Diagnostic criteria. Differential diagnosis. Treatment for exacerbations. Indications for surgical treatment

Chronic pneumonia. Staged treatment. Medical examination at the clinic. Rehabilitation. Prevention

Diseases of the endocrine system in children

Non-rheumatic carditis. Etiology. Pathogenesis. Classification. Clinic and its options depending on age. Complications. Forecast

Chronic gastritis. Features of the course in children. Treatment. Prevention. Rehabilitation. Forecast

Peptic ulcer of the stomach and duodenum. Treatment. Rehabilitation in the clinic. Prevention

Biliary dyskinesia. Etiology. Pathogenesis. Classification. Clinic and options for its course

Biliary dyskinesia. Diagnostic criteria. Differential diagnosis. Complications. Forecast. Treatment. Rehabilitation in the clinic. Prevention

Chronic cholecystitis. Etiology. Pathogenesis. Clinic. Diagnosis and differential diagnosis. Treatment

Cholelithiasis. Risk factors. Clinic. Diagnostics. Differential diagnosis. Complications. Treatment. Forecast. Prevention of blood diseases in children

Deficiency anemias. Etiology. Pathogenesis. Clinic. Treatment. Prevention

Acute leukemia. Etiology. Classification. Clinical picture. Diagnostics. Treatment

Hemophilia. Etiology. Pathogenesis. Classification. Clinical picture. Complications. Laboratory diagnostics. Treatment

Acute glomerulonephritis. Diagnostic criteria Laboratory and instrumental studies. Differential diagnosis

Chronic glomerulonephritis. Definition. Etiology. Pathogenesis. Clinical forms and their characteristics. Complications. Forecast

Chronic glomerulonephritis. Treatment (regimen, diet, drug treatment depending on clinical options). Rehabilitation. Prevention

Hemolytic disease of the fetus and newborn (HDN) 36

Respiratory distress syndrome (RDS) in newborns 39

Neonatal sepsis 43

Pathology of early age 50

Constitutional anomalies and diathesis 50

Chronic eating disorders (dystrophies) 54

Rickets and ricketogenic conditions 57

Childhood diseases 61

Diseases of the respiratory system in children 61

Diseases of the endocrine system in children 68

Diseases of the cardiovascular system in children 68

Diseases of the digestive system in children 71

Blood diseases in children 75

Diseases of the urinary system in children 77

Pediatric infectious diseases 79

Differential diagnosis of childhood infectious diseases 83

Tuberculosis in children 85

Emergency conditions in children 85

Neonatology

Neonatology consists of three words: Greek neos- new, Latin natus- born and Greek logos- teaching.

Neonatology− a branch of pediatrics that studies age-related characteristics and diseases of children in the neonatal period.

Neonatology is a young science; it emerged as an independent branch of medicine in the twentieth century. The terms “neonatology” and “neonatologist” were proposed by American pediatrician Alexander Shaffer in 1960.

Main areas of neonatology are:

study of the impact of deviations in the health status of a pregnant woman on the development of the fetus and newborn;

study of the functional and metabolic adaptation of the newborn to extrauterine existence;

resuscitation and intensive care of newborns;

studies of the development of immune status;

study of hereditary and congenital diseases;

development of special methods for diagnosing diseases and treatment, taking into account the characteristics of the pharmacokinetics and pharmacodynamics of drugs in this period;

rehabilitation of sick newborn children;

One of the important areas is the issues of feeding and nutrition of both healthy and sick children.

Basic terms and concepts of neonatology

1. Perinatal and neonatal mortality. Definitions. Indicators. Nosological structure. Ways to reduce

Perinatal mortality(literally “death around childbirth”) - the total number of stillbirths and deaths in the first week of life = stillbirth + early neonatal mortality:

In the Republic of Belarus in 2004. perinatal mortality = 5.8‰.

The following definitions were adopted by the World Health Assembly in accordance with Article 23 of the Constitution of the World Health Organization (resolutions WHA20.19 and WHA43.24) for the purposes of international comparability and guidance on recording and reporting of data.

Live birth- complete expulsion or removal of the product of conception from the mother's body, regardless of the duration of pregnancy, and the fetus after such separation breathes or shows other signs of life, such as heartbeat, pulsation of the umbilical cord or certain movements of the voluntary muscles, regardless of whether the umbilical cord is cut or divided whether the placenta. Each product of such a birth is considered as live born.

Stillbirth(stillborn fetus)- death of the product of conception before it is completely expelled or removed from the mother’s body, regardless of the duration of pregnancy. Death is indicated by the absence of breathing or any other signs of life: heartbeat, pulsation of the umbilical cord, voluntary muscle movements.

Stillbirth rate− number of deaths before complete expulsion or removal from the mother’s body:

Early neonatal mortality− mortality in the first week of life:

In the Republic of Belarus in 2004. early neonatal mortality = 2.2‰.

Structure of early neonatal mortality:

birth defects;

congenital pneumonia;

intrauterine hypoxia;

infections, sepsis.

Neonatal mortality− mortality in the first month of life:

In the Republic of Belarus in 2004. neonatal mortality = 3.1‰.

Late neonatal mortality− mortality of those who survived a week in the first month of life :

In the Republic of Belarus in 2004. late neonatal mortality = 0.9‰.

Postneonatal mortality− mortality of those who survived a month in the first year of life:

.

To reduce perinatal, neonatal and infant mortality, it is necessary to integrate the services of obstetrician-gynecologists, pediatricians, geneticists and resuscitators. An important role in solving these issues is played by a perinatal center with good material equipment in the Republic of Belarus; such a center is the 7th Clinical Hospital, on the basis of which the Republican Scientific and Practical Center “Mother and Child” operates.

Ways to reduce these indicators:

health education work;

organizing the work of antenatal clinics;

early registration (up to 12 weeks);

organization of women's labor;

early recognition of diseases;

measures to terminate pregnancy;

rational management of childbirth;

integration of obstetric, genetic, intensive care neonatology.

Neonatologist– a specialist involved in prevention, diagnosis and treatment child diseases from birth to the first four weeks of life.

Neonatology is a science that studies the age characteristics of a newborn child, the rules newborn care, as well as prevention, diagnosis and treatment of pathological conditions. Neonatology is literally translated as the science of the newborn – neos – new ( from Greek), natus – born ( from lat.) and logos – science ( from Greek). The term “neonatology” was first introduced by the American pediatrician A. Schaffer in 1960. As an independent branch in medicine, neonatology was recognized in the second half of the 20th century.

The period after birth is critical for the child. This is due to the fact that after birth the child finds himself in a completely different environment, radically different from the mother’s womb. During this period, the newborn adapts to new living conditions. Of great importance at this stage is the role of breastfeeding, care, hygiene and disease prevention.

The periods of childhood are divided into:

• period of intrauterine development – lasts from conception to birth of the child;
• neonatal period ( neonatal) – lasts from the birth of the child to 28 days of his life;
• chest ( junior nursery) period – lasts from 29 days after birth to 1 year of the child’s life;
• period of baby teeth - lasts from 1 year to 6 years;
• period of adolescence ( junior school age) – lasts from 6 years to 11 years;
• period of puberty ( senior school age) – lasts from 11 years to 15 years.

Neonatal period(neonatal period)divided into:

• early neonatal period – the period from the birth of the child to the 7th day of the child’s life;
• late neonatal period – period from 7 to 28 days of a child’s life.

The course of pregnancy, management of childbirth and the first days of a newborn’s life are of great importance for the normal growth and development of a child. Complications during pregnancy, improper management of childbirth, birth injuries, improper care and the negative influence of external factors in the first days after birth lead to an increase in morbidity and mortality in newborns. The period from 22 weeks of pregnancy to the first week of a newborn's life is called the perinatal period.

Perinatal period(from 22 weeks of intrauterine development to the 7th day of a newborn’s life)divided into:

• antenatal period – from 22 weeks of intrauterine development to the onset of labor;
• intrapartum period – from the onset of labor to the birth of the fetus;
• early neonatal period – from the birth of the child to the 7th day of his life.

It is very important for doctors to work as a team and make every effort to deliver a healthy baby. The work of a neonatologist begins long before the birth of a child. A neonatologist needs to know how a woman’s pregnancy progresses, her life history ( history of life and diseases). If necessary, a woman undergoes genetic diagnostics for the presence of hereditary diseases. All kinds of research ( Ultrasound, laboratory blood diagnostics) allow us to assess the condition of the fetus and exclude developmental anomalies. In neonatology there is the concept of “fetus as patient”.

The intranatal period is also of great importance for the neonatologist, as birth injuries, fetal hypoxia ( oxygen starvation) can lead to irreversible consequences and disability of the newborn, even though the pregnancy was going well.

The highest risk of infant mortality occurs in the first couple of days after birth. Since after birth the child adapts to the conditions of the external environment - he begins to breathe and eat independently, and also carries out independent digestion, thermoregulation and other vital processes. Therefore, during this period, the neonatologist is faced with the task of providing optimal living conditions and care for the newborn.

What does a neonatologist do?

The neonatal period is extremely important for the growth and development of the child. Newborn children have a number of physiological characteristics due to changes in the environment and the body’s adaptation to new conditions and independent life. During this period, a specialized neonatologist is involved in the prevention, diagnosis and treatment of pathologies, as well as the care and monitoring of the child’s growth and development.

The main functions of a neonatologist are:

• examination and measurement of the newborn’s parameters;
• resuscitation and intensive care of the newborn;
• rehabilitation of sick newborns;
• prevention, diagnosis and treatment of newborn pathologies;
• ensuring proper care and breastfeeding of the child;
• training parents in proper care and feeding of a newborn;
• care and rehabilitation of premature babies;
• vaccination of the newborn.

After the baby is born, the neonatologist performs an initial toilet and examination of the newborn. All instruments and diapers must be clean and sterile. After birth, the baby is wrapped in a warm sterile diaper and placed on a table with the head end lowered by 15° to prevent the contents of the oral and nasal cavity from entering the respiratory tract. The changing table should be heated by a radiant heat source to reduce heat loss to the newborn due to evaporation of amniotic fluid.

If necessary, aspiration is performed ( suction) the contents of the oral and nasal cavities using a bulb or a special apparatus. Treatment and ligation of the navel is carried out in two stages. First, apply two clamps ( 2 cm and 10 cm from the umbilical ring), and then, after processing, the section of the umbilical cord is crossed between the clamps. At the second stage, the remainder of the umbilical cord is processed again and a plastic or metal bracket is applied at a distance of 2 - 3 millimeters from the umbilical ring and a sterile bandage is placed. The newborn is wiped dry, body length and weight are measured.

A secondary examination of the newborn is carried out in the ward half an hour after the first feeding at a temperature of at least 24° and in natural light. The examination is carried out on a changing table or in the mother's arms. The doctor examines the newborn as needed, even up to several times a day. It is especially important to retest if new symptoms or changes appear. Premature babies require special care and examination.

Secondary examination of the newborn includes:

• anamnesis - the doctor asks the mother in detail about family diseases, about her health, about the diseases and surgical interventions she has suffered, about the course of pregnancy and childbirth;
• visual inspection - body proportions, skin color, body proportionality, smell, newborn cry, etc. are assessed;
• system inspection - conduct an examination of the head, mouth, eyes, neck, chest, abdomen, count the number of respirations and heartbeats per minute;
• neurological examination – The behavioral state, communication skills, muscle tone, spontaneous motor activity, unconditioned reflexes are assessed, and tendon reflexes and cranial nerve functions are also examined.

A neonatologist deals with the prevention, diagnosis and treatment of:

• emergency conditions of a newborn;
• birth trauma;
• perinatal pathology of the nervous system;
• jaundice of newborns;
• intrauterine infections;
• diseases of the skin, umbilical cord and umbilical wound;
• diseases of the respiratory system;
• diseases of the cardiovascular system;
• diseases of the gastrointestinal tract ( Gastrointestinal tract);
• diseases of the urinary system;
• diseases of the endocrine system;
• diseases of the analyzer system;
• neonatal metabolic disorders;
• surgical pathologies.

Newborn emergencies

Emergency conditions are a set of pathological conditions of the body that threaten the patient’s life or cause irreversible consequences and require immediate medical intervention.

Newborn emergencies include:

• Asphyxia. Asphyxia is a critical condition of a newborn, characterized by a gas exchange disorder ( lack of oxygen and accumulation of carbon dioxide) and manifested by the absence of breathing or its weakening with preserved cardiac activity. Asphyxia of the newborn is caused by severe concomitant diseases of the mother, multiple pregnancies, abnormalities of the placenta and umbilical cord, bleeding, premature or late birth, rapid labor, uterine rupture and others.
• Encephalic reaction syndrome. Encephalic reaction syndrome is a set of symptoms that develop as a result of impaired blood circulation in the brain and its swelling. The causes of circulatory disorders and cerebral edema can be cerebral hemorrhage, hypoxia ( oxygen starvation), metabolic disorders. Encephalic reaction syndrome is manifested by decreased muscle tone, impaired reflexes, strabismus, anisocoria ( different pupil sizes), depression of the central nervous system, seizures, etc.
• Circulatory failure syndrome. Circulatory failure syndrome develops due to a violation of the contractile function of the heart muscle - myocardium. Vascular insufficiency represents a discrepancy between the volume of circulating blood and the volume of the vascular bed. Symptoms of circulatory failure include rapid heartbeat ( tachycardia – more than 160 beats per minute), slow heartbeat ( bradycardia - less than 90 beats per minute), lowering blood pressure and others.
• Respiratory failure syndrome. Respiratory failure is a pathological condition in which the physiological gas composition of the blood is not maintained. The cause of respiratory failure is pathological changes in the respiratory system - lack of surfactant ( substance that maintains the structure of the alveoli of the lungs), impaired ventilation and circulation of the lungs. Symptoms of respiratory failure include shortness of breath ( difficult rapid breathing - more than 60 per minute), presence of wheezing, apnea attacks ( respiratory arrest), bluish tint of the skin ( cyanosis).
• Acute adrenal insufficiency syndrome. Acute adrenal insufficiency is an acute pathological condition in which the production of hormones by the adrenal cortex is disrupted. Acute adrenal insufficiency is caused by hemorrhage into the adrenal glands during birth trauma, asphyxia, etc. The pathology manifests itself as low blood pressure, muscle weakness, shallow breathing with attacks of apnea ( lack of breathing), cold skin, etc.
• Kidney failure. Renal failure is a pathological condition in which the process of formation and excretion of urine is partially or completely disrupted, accompanied by disturbances in water, electrolyte, nitrogen metabolism and others. Renal failure occurs due to impaired blood circulation in the kidneys, kidney damage due to oxygen starvation, the presence of congenital malformations of the kidneys, and others. Symptoms of kidney failure are a decrease or complete absence of urine output, swelling, cramps, refusal to eat, loose stools, vomiting, drowsiness, etc.
• Disseminated intravascular coagulation syndrome ( ICE). DIC syndrome is characterized by a disorder of blood clotting, resulting in the formation of microthrombi in small vessels. When microthrombi form, platelets are consumed ( blood platelets involved in the blood clotting process) and other blood clotting factors. Insufficiency of blood clotting factors leads to bleeding that does not stop on its own. DIC syndrome develops against the background of respiratory failure, renal failure, and hemodynamic disorders ( movement of blood through blood vessels) etc. The symptoms of DIC syndrome depend on the stage of the pathology.

Birth injury

Birth trauma is a violation of the integrity of the organs and tissues of the newborn during childbirth with subsequent disruption of their functions. Birth injuries are caused by incorrect position of the fetus, a large fetus, rapid labor, discrepancy between the sizes of the pelvis of the mother and the fetus, prolonged intrauterine oxygen deprivation ( hypoxia) fruit.

Birth injuries include:

• damage to the nervous system - birth traumatic brain injury, spinal injury;
• soft tissue damage – birth tumor, petechiae ( pinpoint hemorrhages), adiponecrosis ( focal death of subcutaneous fat);
• damage to the skeletal system - fractures of the limbs, fracture of the collarbone, fracture of the skull;
• damage to internal organs – splenic rupture, liver rupture.

Perinatal pathology of the nervous system

Perinatal pathology of the nervous system includes lesions of the brain, spinal cord and peripheral nerves caused by the adverse effects of many factors during the period from 22 weeks of intrauterine development to 7 days after birth. Perinatal pathologies of the nervous system do not include malformations and hereditary diseases of the nervous system.

Perinatal pathologies of the nervous system include:

• hypoxic-ischemic encephalopathy – brain damage during fetal development or childbirth ( with the exception of traumatic brain injury), due to impaired blood supply to the brain, oxygen starvation or the action of toxins;
• convulsive syndrome - uncontrolled paroxysmal muscle contraction caused by brain damage, infections, toxins, metabolic disorders, etc.;
• intracranial hemorrhages - subdural hemorrhages, epidural hemorrhages, subarachnoid hemorrhages, which are the result of birth trauma, prolonged oxygen deprivation, intrauterine infections, bleeding disorders.

Diseases of the blood system

Pathologies of the newborn’s blood system include:

• HDN) – severe pathology resulting from incompatibility of the blood of the fetus and mother according to blood type or Rh factor, which leads to the destruction of red blood cells ( red blood cells) fruit;
• anemia of newborns - pathological conditions in which the number of red blood cells and the level of hemoglobin per unit of blood decreases as a result of blood loss ( posthemorrhagic anemia), destruction of red blood cells ( hemolytic anemia) etc.;
• hemorrhagic disease of newborns - pathological condition characterized by vitamin K deficiency ( participates in blood clotting) and accompanied by hemorrhagic syndrome ( bruising, bloody vomiting, hemorrhage into internal organs);
• thrombocytopenia of newborns - a pathological condition characterized by a decrease in the level of platelets in the blood and accompanied by hemorrhagic syndrome.

Jaundice of newborns

Jaundice is a syndrome characterized by excessive accumulation of bilirubin ( bile pigment) in tissues and blood and is accompanied by yellow discoloration of the skin and mucous membranes. In newborns, bilirubin is mainly released when red blood cells are broken down.

Jaundice of newborns includes:

• physiological jaundice – is a variant of the norm and represents a transient state ( passing), which is characterized by increased production of bilirubin, decreased liver function, etc.;
• hemolytic jaundice – severe pathology resulting from immunological incompatibility of the blood of the mother and fetus according to the Rh factor or blood group, which is accompanied by the destruction of fetal red blood cells and the release of bilirubin;
• hepatic ( parenchymal) jaundice – a pathological condition in which excess bilirubin enters the blood due to damage to liver cells ( for viral hepatitis, congenital pathologies);
• mechanical ( obstructive) jaundice – obstructive jaundice occurs when the outflow of bile is impaired due to pathologies of the bile ducts ( bile duct atresia, bile duct hypokinesia), in the presence of a tumor, etc., resulting in bile components ( including bilirubin) enter the blood in large quantities.

Intrauterine infections

Intrauterine infections are infectious diseases that are transmitted from mother to fetus during pregnancy ( antenatal) or during childbirth when the child passes through the birth canal ( intrapartum). The causative agents of intrauterine infections can be viruses, bacteria, fungi, mycoplasmas, protozoa and others. The outcome can be different - from the formation of fetal malformations to miscarriage.

Diseases of the skin, umbilical cord and umbilical wound can be infectious ( caused by pathogenic microorganisms) and non-infectious nature. The appearance of pathologies is caused by overheating or hypothermia of the skin, improper care of the newborn, reduced immunity, and others.

Diseases of the skin, umbilical cord and umbilical wound include:

• diaper rash – inflammatory process of the skin at the site of contact with hard surfaces, friction, skin irritation with urine or feces;
• prickly heat – local or widespread damage to the skin as a result of increased sweating;
• pyoderma ( Ritter's exfoliative dermatitis, neonatal pemphigus) – purulent-inflammatory processes of the skin caused by pathogenic flora ( staphylococci, pneumococci, Pseudomonas aeruginosa);
• necrotic phlegmon of newborns – diffuse purulent-inflammatory lesions of the skin and subcutaneous fat as a result of infection through the skin or umbilical wound, most often occurring at 2–3 weeks of a child’s life;
• umbilical hernia - an oval or round protrusion in the region of the umbilical ring, which increases with crying or stress;
• omphalitis – bacterial inflammatory process in the area of ​​the bottom of the umbilical wound, umbilical vessels and umbilical ring.

Sepsis

Sepsis is a severe pathology of an infectious nature, which manifests itself as a systemic inflammatory reaction when various infectious agents enter the blood ( pathogenic microflora, toxins, fungi). In children, sepsis most often occurs in the neonatal period. In full-term infants, the incidence of sepsis is 0.5% - 0.8%, and in premature infants, the incidence of sepsis is 10 times higher. The mortality rate of newborns with sepsis is 15–40%. In the case of intrauterine sepsis, the mortality rate is 60–80%.

Diseases of the respiratory system

The respiratory system includes organs that provide external respiration - the nose, pharynx, trachea, bronchi and lungs. In diseases of these organs, the normal supply of oxygen to the body is disrupted, which entails pathological changes in all organs and tissues. The brain and heart are the most sensitive to lack of oxygen.

Pathologies of the respiratory system of a newborn include:

• malformations of the respiratory system – represent a set of deviations from the normal structure and functioning of organs ( pulmonary hypoplasia, polycystic pulmonary disease, bronchial fistula);
• apnea – lack of breathing for 20 seconds with a simultaneous slowing of the heart rate, which appears due to damage to the central nervous system, obstructive syndrome, and dysregulation of breathing;
• atelectasis – represents a partial or complete collapse of the entire lung or its lobe as a result of the mother’s use of sedatives, aspiration of amniotic fluid during childbirth, etc.;
• meconium aspiration syndrome ( MYSELF) – a set of symptoms that appear during intrauterine aspiration ( getting something into the lungs) meconium ( baby's primary feces) if it is present in the amniotic fluid;
• hyaline membrane disease ( BGM) – a pathology in which the lungs do not expand as a result of the deposition of a hyaline-like substance in the lung tissues;
• pneumonia - an inflammatory process of lung tissue caused by aspiration of infected amniotic fluid, bacteria, protozoa, etc.

Diseases of the cardiovascular system

The cardiovascular system is a system of organs that circulate blood in the human body. The cardiovascular system consists of the heart and blood vessels ( arteries, arterioles, capillaries, veins, venules).

Diseases of the cardiovascular system of newborns include:

• congenital defects - stenosis ( narrowing of the lumen) pulmonary artery, aortic stenosis, coarctation ( segmental narrowing of the lumen) aorta, atrial septal defects, ventricular septal defects and others;
• cardiac arrhythmias – disturbance of rhythm and heart rate ( supraventricular tachycardias, ventricular tachyarrhythmias, atrial tachyarrhythmias, etc.);
• heart failure - clinical syndrome caused by the inability of the heart to perform its pumping function with resulting circulatory and neuroendocrine disorders;
• cardiomyopathy – primary pathology of the heart muscle, not associated with inflammatory, tumor, ischemic processes and characterized by cardiomegaly ( increase in heart size), heart failure, arrhythmias, etc.;
• myocarditis – isolated or generalized inflammatory process of the muscular layer of the heart ( more often of a viral nature).

Diseases of the digestive system

The digestive system provides the body with nutrients obtained from food. The digestive system includes the oral cavity ( including salivary glands), pharynx, esophagus, stomach, intestines, pancreas and liver.

Diseases of the digestive system include:

• developmental anomalies – cleft lip ( upper lip gap), cleft palate ( palatine fissure), esophageal atresia ( esophageal fusion), pylorospasm ( spasm of the stomach muscles in the area of ​​​​the transition to the duodenum), intestinal malformations, hernias, etc.;
• functional disorders – regurgitation ( release of gastric contents as a result of contraction of the stomach muscles), aerophagia ( swallowing air during feeding), dyspepsia ( indigestion) and etc.;
• inflammatory diseases – thrush of the oral mucosa, esophagitis ( inflammation of the esophageal mucosa), gastritis ( inflammation of the gastric mucosa), duodenitis ( inflammation of the intestinal mucosa) and etc.;
• pancreatic diseases - developmental anomalies ( ring-shaped), cystofibrosis, pancreatic insufficiency;
• liver diseases – congenital liver fibrosis, hepatitis ( inflammatory process in the liver);
• pathologies of the biliary tract – atresia ( congenital absence or fusion) biliary tract, cholecystocholangitis ( inflammation of the biliary tract).

Diseases of the urinary system

The urinary system includes the kidneys, two ureters, the bladder and the urethra. The main functions of the urinary system are the release of metabolic products and the maintenance of water-salt balance.

Pathologies of the urinary system are:

• developmental anomalies – absence of a kidney, hypoplasia ( downsizing) kidneys, dystopia ( bias) kidneys, kidney fusion, bladder exstrophy ( absence of the anterior wall of the bladder);
• inflammatory diseases – pyelonephritis ( kidney inflammation), cystitis ( cystitis), ureteritis ( inflammation of the walls of the ureter), urethritis ( inflammation of the walls of the urethra).

Diseases of the endocrine system

The endocrine system is a system for regulating the functions of internal organs and systems through physiologically active substances - hormones. Hormones are formed in the endocrine glands and regulate metabolic processes in the body, growth, sexual development, mental development and others.

Among endocrine pathologies, disorders include:

• epiphysis – decreased secretion of hormones ( hypopinealism), increased secretion of pineal gland hormones;
• pituitary gland – hypopituitarism ( decreased hormone secretion);
• thyroid gland - congenital hypothyroidism ( decreased hormone secretion), thyrotoxicosis ( increased thyroid hormone levels);
• parathyroid glands - hypoparathyroidism ( decreased function of the parathyroid glands), hyperparathyroidism ( increased function of the parathyroid glands);
• adrenal glands – hypofunction of the adrenal glands, hyperfunction of the adrenal glands ( for hormonally active tumors), dysfunction of the adrenal cortex ( adrenogenital syndrome).

Diseases of the analyzer system

Analyzers include the organs of vision, smell and hearing. The structural and functional development of the analyzer system occurs throughout childhood and adolescence. Despite this, all analyzer systems are functional in newborns.

Diseases of the analyzer system include pathologies:

• visual analyzer - congenital malformations ( anophthalmos, microphthalmos), injuries to the eye and its appendages, dacryocystitis, conjunctivitis and others;
• auditory analyzer - congenital malformations, otitis media.

Neonatal metabolic disorders

Metabolic disorders are a metabolic disorder that occurs when the thyroid gland, pancreas, adrenal glands, etc. malfunction. It is characterized by an imbalance in the level of glucose, hormones, ions ( sodium, potassium, calcium, chlorine).

Neonatal metabolic disorders requiring urgent treatment include:

• hypoglycemia – low blood glucose ( less than 1.9 mmol/l in the first 24 hours of life and less than 2.2 mmol/l during more than 24 hours of life), the cause of which may be maternal diabetes, pregnancy diabetes, premature newborn, sepsis, acidosis, hypoxia, etc.;
• hyperglycemia – elevated blood glucose levels ( more than 6.5 mmol/l on an empty stomach and more than 8.9 mmol/l regardless of food intake and infusion therapy);
• neonatal diabetes mellitus – diagnosed when there is a persistent increase in blood glucose levels ( more than 9.0 mmol/l on an empty stomach, more than 11.0 mmol/l 60 minutes after feeding, more than 1% glucose in the urine).

Surgical pathologies

Surgical pathologies of newborns are extremely diverse. These can be developmental anomalies and congenital pathologies, often requiring emergency surgical intervention for life-saving reasons. Prenatal ultrasound diagnosis of the fetus plays a great role in the diagnosis of pathologies and timely surgical intervention.

Surgical pathologies of newborns include:

• omphalocele ( umbilical cord hernia) – a developmental defect of the abdominal wall in which the organs ( intestinal loops, etc.) extend beyond the abdominal cavity into the hernial sac in the area of ​​the umbilical ring;
• gastroschisis – congenital pathology of the abdominal wall, in which the internal organs of the abdominal cavity protrude outside ( eventration) through a defect in the abdominal wall;
• umbilical hernia - the most common pathology in which the abdominal organs extend beyond their normal location;
• inguinal hernias – pathology in which the internal organs of the abdominal cavity ( ovaries, intestinal loops) extend beyond the abdominal wall through the inguinal canal;
• atresia ( absence, fusion) esophagus – severe pathology of the esophagus, in which the upper part ends blindly and does not communicate with the stomach, and the lower part communicates with the respiratory tract ( trachea);
• congenital intestinal obstruction – intestinal pathology, in which the movement of its contents is partially or completely disrupted as a result of compression of the intestinal lumen, rotation anomalies, blockage with viscous meconium, stenosis ( narrowing), atresia ( overgrowth) and etc.;
• Hirschsprung's disease - pathology of the large intestine caused by a violation of its innervation, which leads to impaired peristalsis and the appearance of constant constipation;
• exstrophy of the bladder - severe pathology of the development of the bladder, in which the anterior wall of the bladder and the corresponding wall of the abdominal cavity are absent, while the bladder is located outside;
• peritonitis – inflammatory process of the peritoneal layers, accompanied by an extremely severe general condition;
• congenital diaphragmatic hernia – a malformation of the diaphragm, in which abdominal organs move into the chest cavity through a defect in the diaphragm;
• trauma to the abdominal organs and retroperitoneal space – trauma to the abdominal organs and retroperitoneal space under the influence of external and internal factors ( compression, abnormal fetal position, prolonged labor, large fetal weight, asphyxia, hypoxia).

What pathological conditions does a neonatologist treat?

After the birth of a child, the neonatologist conducts a primary and secondary examination of the newborn, during which he can identify symptoms of various pathologies and prescribe instrumental and laboratory tests. Some symptoms may appear several days after birth, so the neonatologist examines the child daily. If, after discharge from the maternity hospital, the baby develops any symptoms or behavioral abnormalities, you should contact a specialist.

Symptoms in neonatology

Symptom	Mechanism of occurrence	Diagnostics	Possible disease
Yellowness of the skin and visible mucous membranes	With excessive accumulation of bilirubin in the blood and tissues ( for liver diseases, destruction of red blood cells) tissues and mucous membranes are painted in a characteristic yellow color.	ultrasound diagnostics of the abdominal organs.	hemolytic jaundice; obstructive jaundice; hepatic ( parenchymal) jaundice; mycoplasma infection; cytomegalovirus infection.
Hemorrhagic syndrome - the appearance of petechiae, bruising	Hemorrhages can appear when the integrity of blood vessels is damaged, when blood clotting is impaired, or when the permeability of the vascular wall increases.	blood chemistry; Ultrasound of the abdominal organs.	hemolytic jaundice; obstructive jaundice; mycoplasma infection.
Discolored stool	The characteristic color of stool is given by a special pigment in the composition of bile. If bile production is difficult or absent, the feces become discolored.	general blood analysis; blood chemistry; Ultrasound of the internal organs of the abdominal cavity.	hepatitis; bile stagnation; Whipple's disease;
Redness of the skin, the appearance of erosions, weeping hyperemia(redness), the appearance of abundant red spots	Redness and the appearance of ulcers appear as a result of a violation of the integrity of the skin and dilation of blood vessels.	anamnesis ( history of present illness); visual inspection.	diaper rash;
Presence of pustules, vesicles (bubbles with clear or cloudy contents)		general blood analysis; blood chemistry; coprogram.	hepatitis; congenital hypothyroidism; maternal nutritional characteristics during breastfeeding; fermentopathy ( deficiency of enzymes that break down food).
Breast refusal, loss of appetite	Intoxication of the body leads to loss of appetite ( for inflammation, acute viral diseases, hepatitis), in which the body spends all its energy on removing toxins from the body. In diseases of the gastrointestinal tract, feeding is accompanied by pain, and refusal to feed is simply a defensive reaction to pain. With a decrease in the secretion of thyroid hormones, the overall vitality decreases, metabolism is disrupted, which leads to loss of appetite. Also, the reason for breast refusal is the anatomical features of the mother's nipples. If it is difficult for a child to suck, then a lot of effort must be made to feed the child - the child simply stops eating.	general blood analysis; blood chemistry; stool analysis ( coprogram); analysis of thyroid and parathyroid hormones; microbiological analysis of stool; Ultrasound of internal organs of the abdominal cavity; Ultrasound of the thyroid gland and parathyroid gland; fibrogastroscopy ( FGS); CT scan ( CT) abdominal organs; Magnetic resonance imaging ( MRI) abdominal organs.	respiratory tract diseases; pylorospasm; hepatitis; cholecystocholangitis; congenital hypothyroidism; hyperparathyroidism.
Dysuria (urinary dysfunction, frequent urination, urine leakage, painful urination)	Mechanical obstruction of the ureters or urethra due to developmental abnormalities or inflammatory processes can lead to impaired urination. Inflammation of the bladder leads to irritation of the receptors and its reflex contraction, which leads to a frequent urge to urinate and frequent urination.	general blood analysis; general urine analysis; Ultrasound of the urinary system; selective renal angiography; contrast intravenous urography; retrograde cystourethrography; scintigraphy.	urethritis; cystitis; pyelonephritis; developmental abnormalities of the urinary system organs.
Cyanosis (bluishness of the skin)	Cyanosis is caused by a lack of oxygen, while reduced hemoglobin predominates in the blood ( gave up oxygen), which has a dark blue color, which gives the fabrics a bluish color.	general blood analysis; blood chemistry; blood test for hormones; ionogram; computed tomography of the head ( for traumatic brain injury); chest x-ray; microbiological examination of the contents of the trachea and blood.	apnea of ​​newborns; traumatic brain injury; pneumonia; arrhythmias ( heart rhythm disorder); hypoglycemia; hypocalcemia; respiratory distress syndrome; heart failure; adrenal hypofunction.
Exophthalmos (bulging eyes - pathological protrusion of the eyes from their sockets)	When the level of thyroid hormones increases, retroorbital edema appears ( behind the eye) fiber and muscle, which “pushes” the eyeball out of the orbit. Also, visible bulging eyes may be due to spasm of the muscles of the upper eyelid.	visual inspection;	thyrotoxicosis.
Tremor(trembling)hands	High levels of thyroid hormones lead to loss of calcium. A lack of calcium leads to muscle weakness and involuntary trembling of the limbs - tremor.	visual inspection; analysis of thyroid hormone levels – T 3, T 4; Ultrasound of the thyroid gland; Thyroid scintigraphy.	thyrotoxicosis.

What laboratory tests does a neonatologist prescribe?

Laboratory blood tests indicate the overall health of the newborn. These tests are prescribed routinely after birth. To diagnose diseases, your doctor may prescribe the necessary tests depending on your symptoms.

For a successful blood sampling procedure from a newborn, it is important:

• carrying out the procedure only by qualified personnel;
• explaining to parents the need for tests and procedures;
• taking blood in the morning on an empty stomach;
• use of special neonatal needles and catheters;
• taking blood from the capillaries of the fingers, veins of the forehead, head, forearm, calves, and elbows ( due to the anatomical features of the newborn);
• transfer of tubes to the laboratory within a few minutes after blood collection.

General blood analysis

Index	Normal for newborns	Increasing the indicator	Decrease in indicator
Hemoglobin	180 – 240 g/l	heart failure; pulmonary failure; blood pathologies; congenital heart abnormalities.	mycoplasma infection; cytomegalovirus infection.
Red blood cells	5.0 – 7.8 x 10 12 /l	congenital heart defects; pathologies of the respiratory system;	cytomegalovirus infection; hemolytic anemia; blood loss; autoimmune diseases; collagenoses.
Reticulocytes		hemolytic anemia; internal bleeding.	autoimmune diseases;
Leukocytes	12 – 30 x 10 9 /l	sepsis; omphalitis; intrauterine infections; inflammatory processes.	sepsis; cytomegalovirus infection;
Platelets	180 – 490 x 10 9 /l	blood diseases ( erythremia, myeloid leukemia); hepatitis; toxoplasmosis; pneumonia;	mycoplasma infection; cytomegalovirus infection; DIC syndrome; giant hemangiomas; congenital thyrotoxicosis; isoimmune thrombocytopenia.
ESR (erythrocyte sedimentation rate)	1 – 4 mm/hour	pathologies of the thyroid gland; inflammatory processes ( pneumonia, stomatitis, meningitis); allergic reactions; bleeding; intrauterine infections ( toxoplasmosis).	is the norm for the first two weeks of a child’s life; dystrophic heart diseases; dehydration with uncontrollable vomiting and diarrhea; viral hepatitis.

A biochemical blood test includes more than 100 indicators. Changes in each biochemical indicator correspond to a specific pathology.

Blood chemistry

Index	Norm	Increasing the indicator	Decrease in indicator
Total protein		dehydration; infectious diseases.	liver pathologies; diseases of the gastrointestinal tract; blood loss; thyrotoxicosis; diabetes.
Albumen		dehydration.	pathologies of the gastrointestinal tract; blood loss; sepsis; thyrotoxicosis.
AlAT, AsAT		viral hepatitis; liver pathologies; heart failure.
Bilirubin	17 – 68 µmol/l	cytomegalovirus infection; hepatitis; biliary atresia.
C-reactive protein	negative	inflammatory processes; infections; pathologies of the gastrointestinal tract ( Gastrointestinal tract);
Urea	2.5 – 4.5 mmol/l	intestinal obstruction; heart failure; renal dysfunction; blood loss
Creatinine	35 – 110 mmol/l	renal failure;
Amylase	up to 120 units/l	viral hepatitis; acute pancreatitis; acute renal failure.	thyrotoxicosis.
Alkaline phosphatase	up to 150 units/l	hepatitis; cytomegalovirus infection.
Uric acid	0.14 – 0.29 mmol/l	diabetes; liver pathologies; skin diseases; acute infectious processes.
Glucose	2.8 – 4.4 mmol/l	asphyxia; meningitis; sepsis; neonatal diabetes mellitus; excessive infusion ( intravenous drip) glucose solution.	asphyxia; maternal diabetes; premature babies; low body weight; infectious processes.

A general urine test for newborns is carried out both routinely and to diagnose diseases of the urinary system.

To properly collect urine for analysis, you must:

• wash your hands thoroughly;
• wash the child and wipe dry;
• collect urine for analysis in the morning ( urine is more concentrated in the morning);
• use sterile containers to collect urine;
• collect 20 - 30 milliliters of urine;
• transfer the tests to the laboratory no later than 1.5 hours after urine collection.

There are several ways to collect urine for testing from a newborn - using a special urine bag or special container. In some cases, urine is obtained by inserting a urinary catheter ( tubes) through the urethra into the bladder. But this method can injure the mucous membrane of the urethra.

General urine analysis

Index	Norm	Change in indicator
Color	yellow, straw shade	dark yellow – with jaundice; red – for glomerulonephritis, injury to the urinary system; colorless - with diabetes.
Smell	specific smell, but not pungent	pungent odor - with infectious diseases, diabetes, dehydration.
Transparency	Normal urine is clear	cloudy urine - with dehydration, inflammatory processes of the urinary system, infections, jaundice.
Acidity	Normal urine acidity is neutral ( pH - 7) or slightly acidic ( pH – 5 - 7)	low acidity of urine - with kidney pathologies, prolonged vomiting, inflammatory processes and infections of the urinary system, increased potassium levels; increased acidity of urine - with low potassium levels, diabetes, fever, dehydration.
Density	Normally, the density of urine in the first two weeks of a child’s life is 1.008 – 1.018	decreased density – with kidney pathology, when taking diuretics ( diuretics); increased density - with diabetes, taking antibiotics, pathology of the kidney parenchyma, dehydration, infections.
Protein		the appearance of protein in the urine of more than 5 g/l – with glomerulonephritis, pyelonephritis, allergies, heart failure, mycoplasma infection.
Glucose	absent	the appearance of glucose in the urine ( glucosuria) – for diabetes mellitus, pathologies of the endocrine system.
Epithelium	1 – 3 in field of view	the appearance of more than 3 epithelial cells in the field of view - with cystitis, urethritis, ureteritis, pyelonephritis.
Red blood cells	2 – 3 in field of view	more than 2–3 red blood cells in the field of view ( hematuria) – for acute glomerulonephritis, cystitis, ureteritis, urethritis.
Leukocytes	2 - 3 in view	a large number of leukocytes in the urine - with pyelonephritis, ureteritis, urethritis, cystitis.
Slime	normally absent	the appearance of mucus in the urine - with cystitis, pyelonephritis, urethritis, ureteritis.
Bacteria	none	the appearance of bacteria in the urine – due to a bacterial infection of the urinary system.
Bilirubin	absent	the appearance of bilirubin in the urine - with pathology of the liver and gallbladder, possibly with renal failure.
Urobilinogen	absent	the appearance of urobilinogen in the urine - with hemolytic jaundice, pathologies of the liver and intestines.

What instrumental studies does a neonatologist perform?

The neonatologist conducts instrumental examinations of the newborn after a general examination and laboratory tests. The doctor can prescribe instrumental studies to confirm the diagnosis, assess the condition of internal organs, identify pathologies, differential diagnosis, as well as when laboratory and clinical data are uninformative. Not all diagnostic methods are safe for the baby’s health, so they are carried out only if there are direct indications.

Instrumental studies in neonatology

Instrumental research	The essence of the method	What diseases does it detect?
Ultrasonography (Ultrasound)	The essence of ultrasound is to transmit ultrasonic waves through tissues and organs using a special sensor. Ultrasound waves are reflected from organs or body media ( the degree of reflection depends on the density of the organ or medium) and is captured by the sensor, displaying a picture on the monitor screen. The denser the structure, the lighter it appears on the screen, as more ultrasonic waves are reflected. Ultrasound is used to examine the heart and blood vessels, abdominal organs ( liver, gallbladder, spleen), organs of the genitourinary system ( bladder, kidneys, ovaries in girls sleeping pills). Using a sensor, the structures of the brain are examined, their symmetry, density, and the condition of the choroid plexuses of the brain is assessed.	intracerebral hemorrhage; hypoxic brain damage; traumatic brain injury; meningitis; choroid plexus cysts of the brain.
CT scan (CT)	Computed tomography is a research method in which X-rays are passed through the patient’s body at different angles, followed by obtaining a three-dimensional and layer-by-layer image of the organs and structures of the body on the monitor screen. If necessary, use a contrast agent. During the procedure, the patient must lie still, so short-term anesthesia is used ( sedation).	malformations of the gastrointestinal tract, genitourinary system, cardiovascular system, bones and joints; inflammatory processes of the gastrointestinal tract, genitourinary system, respiratory system, brain, etc.; traumatic brain injury; birth injury; surgical pathologies ( intestinal obstruction, pyloric stenosis, hernia, abscess).
Magnetic resonance therapy (MRI)	MRI allows you to obtain a three-dimensional and layer-by-layer image of organs and structures of the body. Unlike CT, it is a completely harmless research method. The essence of the method is to measure the electromagnetic response of the nuclei of hydrogen atoms to the influence of a powerful electromagnetic field. The examination is performed under sedation to prevent movement during the examination.	developmental anomalies of the gastrointestinal tract, cardiovascular system, genitourinary system, brain structures; inflammatory and dystrophic processes of internal organs and systems; pathologies of the musculoskeletal system and joints.
Radiography	In radiography, X-rays are passed through the organs and structures being examined using a special apparatus. X-rays are displayed and recorded on a special film. The denser the structure, the darker it appears on film as more waves are displayed. A contrast agent may be used for the study.	abnormal development of the gastrointestinal tract ( esophageal atresia, pyloric stenosis), genitourinary system, skeletal system, etc.; inflammatory processes of internal organs and systems ( pneumonia, bronchitis, tuberculosis, cholecystitis); surgical pathologies ( intestinal obstruction); birth injuries ( bone fractures).
Scintigraphy	The essence of scintigraphy is the intravenous introduction of radioactive isotopes into the body and recording the radiation emitted by them to obtain a two-dimensional image.	pathology of the thyroid gland ( developmental anomalies, goiter, thyroiditis); kidney pathologies ( pyelonephritis, developmental anomalies, renal-ureteric reflux); pathologies of the skeletal system ( fractures, developmental anomalies).
Endoscopic examination (bronchoscopy, esophagogastro-duodenoscopy)	Endoscopic research methods are a visual examination of hollow organs using a special device - an endoscope equipped with a camera, in real time. For examination, an endoscope is inserted into the lumen of the esophagus, stomach, intestines, bronchi, urethra, etc. It is carried out under short-term anesthesia.	esophageal atresia; pylorospasm; pyloric stenosis; intestinal obstruction; bronchitis; developmental anomalies of the gastrointestinal tract, respiratory system, and urinary system; inflammatory processes of the gastrointestinal tract, respiratory system, urinary system.

How does a neonatologist treat diseases and pathological conditions?

To treat diseases of various organs and systems, the neonatologist uses conservative ( medicinal) method and surgical method. Treatment tactics depend on the pathology, cause of the disease, severity of symptoms, and the effect of the chosen therapy. The doctor may change the treatment regimen if there is no therapeutic effect. Surgical treatment is carried out on an emergency basis ( without preoperative patient preparation) or routinely after drug therapy. The doctor must conduct laboratory and instrumental studies before starting treatment to determine treatment tactics and select medications. Diagnostic studies are also carried out during and after the end of the course of therapy to assess its effectiveness.

Basic treatment methods in neonatology

Basic treatment methods	Disease	Approximate duration of treatment
Antibiotic therapy	intrauterine infections ( erythromycin, azithromycin, tetracycline); cholecystocholangitis; postoperative period; omphalitis; pyoderma; sepsis; intrauterine infections; inflammatory diseases of the respiratory system.	The average course of antibiotic therapy is 7 days. Treatment with antibacterial drugs should not be less than 5 days.
Antiviral drugs	herpes ( acyclovir, bonaftone, helepin); cytomegalovirus infection ( ganciclovir, foscarnet); viral hepatitis ( acyclovir, vidarabine).	Average duration of treatment with antiviral drugs for ARVI ( acute respiratory viral infection), herpes is 5 days. Treatment of congenital viral hepatitis lasts 12–18 months.
Infusion therapy	herpes ( ); cytomegalovirus infection ( glucose solution, rheopolyglucin, hemodez); DIC syndrome; sepsis; hemolytic disease of the newborn ( HDN); acute renal failure ( surge arrester); surgical pathologies of the gastrointestinal tract.	Infusion therapy is calculated using special formulas, depending on the weight, age of the child and the physiological need of the body for fluid, etc. The duration of therapy depends on the pathology, indicators of the state of the cardiovascular system, etc.
Diuretics (diuretics)	meningoencephalitis; heart failure.	On average, treatment with diuretics is carried out for 3 to 5 days.
Bronchodilators (medications that dilate the bronchial tubes)	apnea; allergic reaction.	Bronchodilators are used for 2 to 5 days, depending on the pathology and severity of symptoms.
Oxygen therapy (Oxygen therapy via face mask, nasal cannulas)	apnea; asphyxia; meconium aspiration syndrome ( MYSELF); heart failure; respiratory distress syndrome.	Oxygen therapy is carried out daily for several hours for 2 to 5 days.
Antispasmodics	pylorospasm ( no-shpa, papaverine); abdominal pain syndrome.	The average duration of therapy with antispasmodics is from 5 to 7 days.
Antiarrhythmic drugs	cardiac arrhythmias ( verapamil, amiodarone).	The duration of treatment depends on the pathology and can vary from several days to several weeks.
Biological products	nutritional dyspepsia ( bifidumbacterin).	The duration of treatment is from 2 to 4 weeks.
Enzyme preparations	cystic fibrosis of the pancreas; pancreatic insufficiency; pancreatitis.	The average duration of treatment is 5 – 7 days.
Hormone therapy	herpes; toxoplasmosis; hepatitis; pneumonia ( dexamethasone); asphyxia ( dexamethasone); congenital hypothyroidism ( triiodothyronine, tetraiodothyronine, thyrotom, thyrocomb); hypoparathyroidism ( parathyroidin); hypofunction of the adrenal glands ( prednisolone, cortisone, hydrocortisone).	Intensive ( short-term) Hormone therapy is carried out for 3 – 4 days with high doses of hormones. Limited hormone therapy is carried out for a week with a gradual reduction in the dose of the drug every 3 days. Long-term hormone therapy is carried out over several months with a gradual reduction in the dose of the drug every 2 to 3 weeks.
Antithyroid therapy	thyrotoxicosis ( propylthiouracil, Lugol's solution, mercazolil).	Long-term course of treatment – ​​up to several years.
Surgery	biliary atresia; cleft lip ( upper lip gap); cleft palate ( palatine fissure); esophageal atresia; pyloric stenosis; hernia ( diaphragmatic, inguinal, umbilical); heart defects.	Surgical treatment is performed on an emergency basis ( within 2 – 4 hours after birth), urgently ( within 24 – 48 hours after birth), on an urgently deferred basis ( 2 – 7 days after birth), as planned ( at any time after birth).