Infection of the slaughter system in children. About the hardened methodical recommendations for antenatal and postnatal prognosis for groups of newborns and health groups of children from the period of new births

MINISTRY OF HEALTH PROTECTION OF THE RYAZAN REGION

ORDER

I mark the safety of yakisnoї medical aid for a new child, for the increase and decrease of illness and mortality of new children, I punish:

2. To the chief politicians of the powers medical organizations Ryazan oblast to protect the visas, consolidated by the mandate, of methodical recommendations in pediatric medical organizations.

3. Control over the vikonannyam the order of obeisance to the intercessor of the minister EE Bolshakov.

ministr
L.N. TYURINA

Dodatok N 1. Methodical recommendations for antenatal and postnatal prognosis of GROUPS for new born children

Dodatok N 1
until the order
Ministry of Health Protection
Ryazan region
from April 8, 2014 to Roku N 508

Dodatok N 2
until the order
Ministry of Health Protection
Ryazan region
from April 8, 2014 to Roku N 508

The value of the health group in children of the new age

Group 1 - the health of Novonarodzhen Ditin.

2nd group - prices of new diseases from the group for the vision of adaptation and development of the disease:

"A" pidgroup - children from mothers who lose their pelvis, children with physiological immaturity, prematurity of the I stage, toxic erythema, full of the syndrome of the I stage, the delivery of the I stage.

"B" pidgroup - accelerated somatic history of the mother: chronic illness of organs, endocrinopathy, illness of the heart-vascular system, allergic illness, illness of the secular system.

The obstetric and gynecological anamnesis of the mother: hospitals and chronic illnesses of body organs, canopy in the bed, vacuum extractions, insertion of obstetric forceps, caesar rosters. Hypogalactia in the mother. Asphyxia of the lung step (rating on the Apgar scale 6 - 7 points), a child with a poor vaginosis, an intrauterine development of a child, TOLERANCE 2 steps, a child with a mass less than 2000 years, more than 4000 transient fever, pathological decline in muscle mass (more than 8%).

3-cha group -. Nedonoshenіst II, novonarodzhenі of glibokoї morphofunctional nezrіlіstyu in stadії klіnіchnoї remіsії, prenatalnoї hypotrophy bіlshe 2 tbsp, Zatrimkoyu vnutrіshnoutrobnogo rozvitku, asfіksієyu serednogo stage tyazhkostі, RDS vnutrіshnoutrobnoї іnfektsієyu, vrodzhenim vice sericite at vіdsutnostі nedostatnostі krovoobіgu, vazhkoї birth injury with saving or compensating functional possibilities, embryopetopathies of non-infectious genesis, chromosomal pathology in the stage of clinical remission with saving or compensating for functional possibilities, hemorrhagic

4th group - nedonoshenіst III i bіlsh stage novonarodzhenі of glibokoї morfofunktcionalnoj nezrіlіstyu in aktivnіy stadії i stadії nestіykoї klіnіchnoї remіsії, asfіksієyu serious stage in stadії nestіykoї klіnіchnoї remіsії that nepovnoї kompensatsієyu funktsіonalnih mozhlivostey, vnutrіshnoutrobnoї іnfektsієyu in aktivnіy stadії of frequent relapses, SSMSC vimagayut pіdtrimuyuchoї terapії, vrodzhenim vice sericite of torn down krovoobіgu 1 stage vazhkoї birth trauma of obmezhennyam abo nepovnoyu kompensatsієyu funktsіonalnih mozhlivostey, chromosomal patologієyu in stadії nestіykoї klіnіchnoї remіsії s often zagostrennyami i obmezhennyam funktsіonalnih mozhlivostey, dіti of fіzichnimi Vadamee, naslіdkami injuries i operatsіy of nepovnoyu kompensatsієyu specific functions.

The 5th group of health - children with the presence of chronic pathology, a history of development, traumas and operations with signs of rotational decompensation and significant interchange of functional abilities.

Dispensary for the care of healthy newborns

1st group of health:

14th day of life:

21st day of life;

28th day of life;

in the first 3 days for a whiskey from a flat booth;

2nd group of health:

Guarded by a pediatrician:

in the first 3 days for a whiskey from a flat booth:

14th day of life:

21st day of life;

28th day of life;

at the last 1 month of the visit to the child of the polyclinics, the distance to the view of the polyclinics is up to 12 months.

Precautionary medical care. sister:

in the first 3 days for a whiskey from a flat booth;

patronage m / s from 2 months to 12 months 1 time per month;

3rd group of health:

Guarded by a pediatrician:

at the same time, hesitated to lead the main illnesses at the same time with the high school specialists.

Cautionary nursery nurse:

in the first 3 days for a whiskey from a flat booth;

patronage m / s from 2 months to 12 months 2 times per month;

4th and 5th health groups:

Guarded by a pediatrician:

in pershu dobu pislya whiskey from the shallow booth;

Newborns looking around

Sposter for the main ailments, for the sisters, send them to the hospital.

Precautionary medical care. sister:

in the first 3 days for a whiskey from a flat booth;

patronage m / s from 2 months to 12 months 2 times per month.

Clinical examination and rehabilitation of newborns from children to groups on pediatric hospitals:

To a group of new-born children (methodical recommendations of the CPSR from 1984)

Group 1 - neonatal disease with development of CNS pathology.

Group 2 - neonatal infants with intrauterine infection.

3rd group - neonatal with risik the development of trophic porcine and endocrinopathies.

4th group - new population with risik development of natural wad organs and systems.

5th group - new people from the group of social risk.

See also additional groups (according to the order of the Ministry of Health of the Russian Federation N 108 dated 03/29/1996 and methodical recommendations from Ivanovo from 1988 r):

group for deafness and deafness;

anemia group;

the group on the development of the raptor death syndrome;

group for the development of allergic diseases.

Group for deafness and deafness:

Riziku factor:

infectious viral zvoryuvannya mother for an hour of vaginosis (rubella, influenza, cytomegalovirus or herpesvirus infection, toxoplasmosis); toxicosis of vaginosti;

asphyxia;

intrauterine birth trauma;

hyperbylirubinemia (more than 200 μmol / l);

hemolytic ailment of the newborn;

masa tila when people are less than 1500 g;

prematurity;

ototoxic drugs, which are taken by the mother before the hour of vaginosity;

gestation week for 40 days;

decline in the mother's illness, which is supervised by the auditory analyzer.

plan with caution

Newborns from a given group of patients are provided with a pediatric pediatrician with an otolaryngologist, who will look at him at 1, 4, 6 and 12 months. Conduct an audiological screening.

Loop control of the development of the auditory analyzer.

There is a unique characteristic of aminoglycosides, ototoxic drugs (furosemid, chinin, vushny krapli sofradex, Anauran, garazone).

Spared up to 18 rock_v.

Anemia development group:

Riziku factor:

impairment of the uterine-placental blood circulation, placental deficiency (toxicosis, the threat of overtreatment, prolonged vaginosis, hypoxia, aggravation of somatic and infectious diseases):

fetal and placental bleeding;

high availability;

intrauterine melena;

prematurity;

abundance;

a glib and trivial deficiency in the body of the vagina;

peredchana or piznya ligation of the umbilical cord;

Intranatal bleeding;

prematurity;

great children;

children with constitutional anomalies;

malabsorption syndrome, chronic intestinal discomfort.

Plan with caution:

Pediatrician up to 3 m / s. 2 times per month.

Zagalny blood analysis at 3, 6, 12 months. In most early terms - for shown.

Pre-treatment of syrovatovaya zaliza, zalous zalizvaya zazuvalnoy zdatnosti sirovatki (OZhSS).

Electrocardiography (EKG).

Consultations of university specialties (cardiologist, gastroenterologist) for showing.

early introduction food additives (minced meat, Сік, fruit puree).

Appointment of ferrotherapy for the prevention of hypertrophy.

Caution to 1 rock.

Group for the development of raptor death syndrome:

Riziku factor:

negatively placing the mother before the child;

ugly people mind;

not the same family;

non-establishment of schlub;

alcoholism, kurinnya batkiv;

low sanctuary of the family;

Yuniy Vіk Materі;

prematurity, population less than 2000 g;

children first 3 m / s. life, as they have transferred the state of illness;

children with intrauterine infection;

children with vrodzhenny vads develop life and important organs.

Plan with caution:

With the pre-logical abo primary patronage of the newly born zyasuvati, all the possible addresses of the child's residence.

The caution of the pediatrician is not earlier than 1 time per day with a stretch of the first month of life, 1 time for 2 days. until vikonannya rock.

Able children up to 1 rock sposter from day to day.

Inform the manager of pediatric information about children from this group.

Robot sanitation and sanitation

Chi not vicladati the child to sleep on live.

Do not overwhelm the child.

Do not burn in the primitive, de there is a child.

Lіzhechko guilty is known in one room with daddies.

Preservation of natural vigoduvannya in pershі 4 міс. life.

Dynamically watch out for a child up to 1 rock to make out at viglyadі epіkrizіv in 3, 6, 9, 12 months. and press the history to reconcile the pediatric information.

Group for the development of allergic diseases:

Riziku factor:

suspicion of an allergic family history;

state-of-the-art diseases and chronic diseases before the hour of visit;

taking a mother before an hour of vaginosity of antibiotics, sulfanilamides, blood transfusions;

overridden vaginosti;

accelerated vaginosti (toxicosis, the threat of entrapment);

ominous vaginal allergens;

professional schooling from hour to hour;

intestinal dysbiosis and symptoms in vagina;

improper eating of a child, early transition to a piece of vigodovuvannya;

often and inefficiently antibacterial therapy.

Plan with caution:

Inspection of the pediatrician not less than 4 times with a stretch of the first month of life, far in the decreed terms.

Inspection by high school specialists (including an allergologist, immunologist, gastroenterologist) for demonstrations.

Laboratory analyzes in decree terms, including analysis of feces for dysbacteriosis.

Hypoallergenic child of mother and child.

Private sanitation of infections.

Struggle for nature vigodovuvannya.

Elimination of byte allergens.

sucking antibacterial drugs strictly behind the show.

The triviality of caution is up to 2-3 rocky.

The standard of dispensary (prophylactic) wary of a child by holding out the first fate of life

Head of the doctor-pediatrician for pre-medical patronage:

Revealing to the group.

Fold to the forecast I will become healthy and the development of the child.

vigodovuvannya that kharchuvannya.

Head of the medical pediatrician at the primary patronage of the newborn:

Registration and assessment of the genealogical anamnesis.

Zbir and assessment of the data from the biological history.

Collection and assessment of social history data.

Revealing to the group.

Forecast I will become healthy and develop a child.

Viznachennya sprymovanosti riziku.

Estimation of the properties for the period, before going to look around.

Assessment of physical development.

Diagnostics and assessment of neuropsychic development, including:

diagnostics of neuropsychic development;

assessment of the neuropsychic development with the value of the variant of the group development;

seeing to the group.

Assessment of resistance, including:

analysis of the frequency, triviality and gravity of the gostrykh zahvoryuvan.

Diagnostics and assessment of the functional state of the body, including:

revealing skarg;

a look at the organs and systems:

assessment of the frequency of heart rate (HR), frequency dikhalnykh rukhiv(ЧДЦ) і arterial vise(AT);

selection of views and assessment of the child's behavior;

seeing the group for behavioral outcomes.

Visnovok about a healthier camp, including:

straightening the risik, group;

assessment of physical development;

assessment of neuropsychic development;

assessment of resistance;

assessment of the functional standard and behavior;

adaptation forecast;

sanitary-hygienic mind;

vigodovuvannya that kharchuvannya;

physical activity and charting;

laboratory and іnshі methods of advancement, which include audiological screening, ultrasound (including ultrasound of kulšovy slopes), EKG;

non-drug, drug methods for improving health and development (in case of manifestation);

statement to the dispensary region and guarding for the regional form N 030 (if indicated).

A skinny vagina woman, who became a child in a woman's consultation, is guilty to undergo a test on VIL dvichi - at the first beastly and in the third trimester. In case of development of a positive or total analysis for antibodies to VIL, the woman should immediately go for a consultation to the SNIDu Center to clarify the diagnosis.

The transfer of VIL from mother to child is possible for an hour of vaginosti, often on different terms, for an hour of low and when drinking mother's milk.

Without carrying out preventive visits to the risky transfer of the VIL warehouse, up to 30%. Rizik infirmity of the child is moving, as the mother was infected with a stretch of six months before the vagina, or during the period of in different stages VIL-Infections. Rizik grows with high on a line(There is a bit of virus in the blood) and low immunity. Increased risk of child's infirmity is seen during repeated visits.

With proper prophylactic visits, the risk of transmission of VIL-infection from mother to child will decrease to 2%.

In this brochure, you will know information about those who change the risk of an infected child and about the terms of the dispensary guarding a child in the Center for SNIDu.

Reducing the risk of transmission of HIV infection from mother to child

In case of a visit to the Center for SNID, a woman will receive a consultation from a doctor-infectious disease specialist, an obstetrician-gynecologist, a doctor-pediatrician; All the necessary analyzes are needed (not available, immune status and information), in order to receive nutrition about the prescribed antiretroviral (ARV) drugs. With the correct intake of ARV drugs, the number of viruses in the blood will decrease and the risk of transmission of HIV may be reduced. Vibir of the scheme and the term of administration of ARV drugs are given individually. Brought to the safeguard for the fetus and the very vaginal woman. Preparations are available without koshtovno for recipes for drugs in the Center SNID.

The efficacy of the drug production is guilty but revised up to the end of vaginosity ( laboratory dosage on the new option).

The lady's wife is guilty for the long-term promotion of her stay in life counseling.

Prevention of transmission of VIL from mother to child includes 3 steps:

1 step. Acceptance of drugs in vaginal women. Prophylaxis needs to be repaired earlier, after 13 months of vaginosity, three drugs and prodovzhuvati until the bed.

2 step. Intravenous administration of ARVs to the drug for an hour after the fall ("dribble").

3 step. Taking the drug in a new baby. Taking the preparation in a child should be repaired in the first 6 years of age (not less than 3 days). Most children take zidovudine syrup at a dose of 0.4 ml per 1 kg of vagina twice a day (skin 12 years) for 28 days. V in particular The doctor can give the child 2 a drug for prophylaxis: a suspension of Vyramun - 3 days, a dose of epivir - with one stretch.

The canopies pass in shallow booths behind the woman's place of residence. The small houses of the Moscow region are provided with all the necessary ARV drugs for prophylaxis. The way of birth (natural bedding or caesar rostin) is provided with the out-of-pocket solutions of the doctor-infectious diseases specialist and obstetrician-gynecologist.

Breast vygodovannya є one of the ways of transmission of VIL-infection (not only itself applied to the breasts, but also given milk). All women without a blame for VIL-infectious disease are not guilty of breastfeeding!

Terms of carrying out the maintenance of children,
the people of the bridegroom VIL-informed mothers on the first rotsi of life.

Up to 1 fate of the child's life, there are three things:

• At the first 2 days of life, a shelter is taken into the shelter for advancement on VIL by the PLR ​​method (particles of a virus) and IFA (antibodies are detected - bots, which are sent to the center of delivery of people for the presence of people).
• In 1 month of life - shelter is taken on the VIL by the PLR ​​method in the child's clinic, in the clinic for the prevention of VIL-Infections for the place of living (as if the Center was not given shelter for the place of living, during the day
• In 4 months of life - it is necessary to come to the Center of SNID of the Moscow region to look at the child with a pediatrician and to receive blood on HIV by the PLR ​​method. Likewise, the drug can indicate additional analysis of your child (immune status, hematology, biochemistry, hepatitis C and in.).

If you missed one of the terms of coverage, do not submit it for more than an hour. From 1 month to 1 month, the child's life is to blame for the situation on the VIL using the PLR ​​method at least 2 times!

What do the results of analyzes mean?

Positive result of blood test for antibodies to IL

All children of VIL-positive mothers from the people are also positive, and normal! Mati passed her bilka (anti-tila), get ready to kill the child. Maternal antibodies are guilty of drinking from the blood of a healthy child up to 1.5 years (in the middle).

Positive result of PLR

Dane, the virus itself appears to have appeared, and it means that a positive PLR ​​can be caused on a possible infected child. It is necessary for the child to come to the SNID Center for a second look.

negative PLR

A negative result is the best result! Virus is not a manifestation.

• Negative PLR ​​for another day of the child's life talk about those who hire a child without getting infected for an hour of vaginosti.
• There is a negative PLR ​​in 1 month of life to say that the child has not become infected and after an hour is low. The reliability of this analysis in the monthly week is close to 93%.
• Negative PLR ​​in people older than 4 months - the child is not identified with a value of up to 100%.

Defending children by fixing them from 1 rock.

Even the child has negative results of blood tests for HIV by the PLR ​​method, by the main method of monitoring the child's age from the first age of the child's age to HIV. The middle age, if the child's shelter will be “cleansed” from the mother's bills - 1.5 times.

• In the 1st place, the child is given shelter for antibodies to VIL in the Center SNID or for a month of living. A negative result of the analysis is also recognized - a repeat after 1 month and a child can be taken from the field up to date. positive abo total result for antibodies to VIL in the form of re-distribution of 1.5 years.
• For those older than 1.5 years - to achieve one negative result for antibodies up to VIL for the child's nobility in the absence of an obvious condition.

Children in the field

• Vіk ditini - older than 1 rock;
• The presence of two or more negative PLRs in a person older than 1 month;
• Evidence of two or more negative results before the test for antibodies to IL in patients older than 1 year;
• visibility thoracic treatment lasting 12 months.

Support for the diagnosis of HIV infection in a child

Confirmation is possible in any period from 1 to 12 months in case of rejection of two positive results of PLR VIL.

In children older than 1.5 years, the criterion for setting the diagnosis of yak in older adults (appearance positive analysis blood for antibodies to IL).

Diagnosis is confirmed only by fahivtsy to the SNID Center.

Children from the VIL-Infectious Disease consistently spend time before the visual pediatrician at the SNID Center, as well as in the children's clinic for a moment of living. VIL -infection can be asymptomatic, or the moment comes, if the car denotes a child of a disease. Suchasnі lykarskі drugs allow to strangle the virus to immunodeficiency, by themselves becoming infused into the organism of the child, which grows. Children from VIL can lead a new way of life, see if they are children, install them on the farmsteads.

vaccination

Children of positive mothers are accustomed to being like all children from the national calendar, with two special features:

• Vaccine against poliomyelitis maє buti inactive (not live).
• I called on the BCG chips (chips against tuberculosis), yakyay to roam in the shelter,

The telephone number of the pediatric office: 8-9191397331 (from 09:00 to 15:00 on Thursday).

We check with you at once with children only on Thursdays from 8:00 to 14:00, in the last days (except for the weekend) you can get a consultation from the pediatrician, to see the results of the child's analyzes from 09:00 to 16:00.

Your child's health is in your hands!

Yaksho Vi VIL-Information and plan for mothers of healthy children, it is necessary to inform the SNID Center before the ear of your vaginosity!

It’s just an hour of your visit that you have a VIL-infection, I’ll go to the SNID Center in order to get in on the spot for a quick visit, directing to the lower risk of infection with VIL-infection malfunction!

Intrauterine infection is a potential problem for the health of an unnatural child. In cich vipadkahs, fetuses become infected with ailments of mothers with infectious diseases, which can be the cause of many diseases such as development of the brain or spinal cord, heart, as well as dullness, deafness and death of a newly born fetus. All pupils of internal uterine infections by foreign pregadnants shared the term TORCH (for the first English letters the names of toxoplasmosis, rubella, cytomegalovirus, herpes). It means that in a large number of infections and infections there are no symptoms. Inodi pislya nontrivial easy to get sick zbudnik prodovzhu dovgі rocky perebuvati in organizmі women. In the latent state of wines, it is not safe for the fetus: the immunity of the mother of the first nadіyno conquest. If the primary infection with toxoplasmosis, cytomegalovirus, chlamydiasis, herpes in the first 3 months of vaginosis or acute persistent infection (that is, there is also a stream of infections) through stress for non-medication immunity

The prevalence of IUI: 20-30% of females of early childhood infections are diagnosed with toxoplasmosis, 50-70% - cytomegalovirus, herpes simplex and in.

Important infections є the main cause of neonatal deaths in the light of early canopies and asphyxia, and in countries with even higher mortality, it becomes more than half of all types.

Causes of intrauterine infections in newborns

Ethiology: viruses, microplasms, trash, simple, fungi, bacteria.

In the mother, the infectious process can be counterproductive, subclinical, latent. Particularly significant is the ma sechostatev infection in the mother as an illiterate with generalized VUI (pyelonephritis, inflammation of the appendages, pikhvi and іn.). Mother has a great hour in a small number of staphylococcus, streptococcus, intestinal flora, listeria, toxoplasma, Koch's sticks, fungi, vicious chronic illnesses of the female spheres.

The souls of the patron saint can be dear ones. Antenatally, the infectious agent is consumed to the fetus hematogenically, or through the infarction of the disease, in the middle, on the school, in the leg, in the eyes. At the same time, the mother can be informed by the low path through the uterine tubes, through the near-formed membranes with endometritis, the placenta, as well as by the fetus itself, an inflammatory type of hematogenous

Bacteriological educators are most often informative of food intranatally, they suffer from children of importance bacterial infections, Right up to sepsis (streptococcus group B, kishkova palichka, Sinyogniina palichka, citrobacter, klebsiєla, proteus).

Zbudnik, penetrating to the embryo or to the fetus, settles in tissues and wikliks. Great significance is the hour of penetration of the infectious zealot.

• Blastopathy: the penetration of the fetus to the embryo in the first 14 days of vaginosity during the period of blastogenesis, to bring the fetus to the bend, post-fetal vaginosity, coarse development from the damaged wasp of the embryo, but the vicinities of such coarse porn s lives, mimovilny abortion.
• In case of infection of the embryo during the period of embryogenesis (from the 16th to the 75th day), embryopathy is detected - defects in the development of certain organs and systems, teratomy, vaginosis. Coarse wadi development, which can be produced up to wikids, is especially often formed in the first 8 days of vaginosity. An important role in the formulated infectious diseases of the virus is rubella, cytomegalovirus, herpes, hepatitis B.
• When an infectious agent gets into the fetus (from the 76th day to the 280th day of vaginosis), fetopathy is diagnosed. The fetal period lasts into the early (3 months - 7 months) and early (from 7 months to the nation).

In the early fetal period, there is a differentiation of tissues in the same nasal organs and systems. As soon as it occurs in the whole period, then the deterioration of tissue differentiation with the development of sclerosis as a result of the growth of the resulting tissue is seen. Attachments of early fetopathy can be liver cirrhosis, hydrocephalus, microcephaly, hydrocephalus, fibroelastosis of the heart.

As soon as there is more development of organs and systems, then more of a child from the IUGR is able to develop an intrauterine development, a variety of adaptive processes, an advanced

Be-microorganism, what is inhabited by the Sechosta's highways or lower viddili herbal tract mothers, may be the cause of early infections in newborns. Coca-coca - GBS, a-hemolytic streptococci (Streptococcus viridans), Staphylococcus aureus, Enterococcus (Enterococcus faecalis, Enterococcus faecium), parasitic sticks (Escherichia Haophil. ), gram-negative coca (Neisseria gonorrhoeae, Neisseria meningitidis), gram-positive sticks (Listeria monocytogenes), fungi (mainly Candida albicans), simpler (Chlamydia trachomatis, Mycoplasma homineris, U. ure Ethiological significance of microorganisms in development. Microorganisms with low virulence (such as lactobacilli, diphtheroids and Staphylococcus epidermidis) are rarely the cause of important infections. Unimportant to those U. urealyticum and M. hominis, sometimes they are seen from the blood of fetuses, whose mass is less than 1500 g, their role in the development of early neonatal sepsis (RNS) is unclear.

It is also unavoidable that the inflow of microorganisms into the development of the RNS is seen from the amniotic birth and the blood of newborns. Chi is not brought to the role of Gardnerella vaginalis, most often seen from amniotic birth.

It is statistically insignificant for the increase in infection of mothers and children with S. trachomatis being seen from amnotic birth (approximately in 4% of cases of mothers of newborns with C. trachomatis).

For the tribute of the National Institute childish healthі development of people, the most frequent diseases of the RNS є GBS (37.8%), E. coli (24.2%), S. viridans (17.9%), S. aureus (4.0%) і H. influenzae (4.0-8.3%). GBS is the most frequent cause of infections in the group of full-term newborns, and E. coli - in premature babies. Mortality rate in neonatal infants, infected with E. coli, in cases of GBS (33% vs 9%; р<0,001). Также высока летальность недоношенных новорожденных при сепсисе, вызванном Н. influenzae (до 90%), который может иметь молниеносное течение, начинаясь как тяжелый РДС.

The appearance of GBS in the amniotic birth of women from the intra-amniotized infectious supernatant is being treated by the bacterial mother or the newly born in 25% of the cases. When E. coli is detected, bacteremia of the mother or neonatal occurs in 33% of cases.

Near the land where they develop (Latin America, Caribbean, Asia and Africa) E. coli, Klebsiella spp. and S. aureus are developed more often and are considered for a quarter of all types of RNS. Naybіlsh extensions gram-positive zabudnik in the lands, scho developing - golden staphylococcus.

anaerobic bacteria... I’ll look at the large number of anaerobic bacteria є part of the normal microflora of the intestinal tract, state nobles and shkiri, the stench can be a potential disease in new people. Anaerobic infection develops mainly in case of decreased resistance to organisms, impaired immunity, which often occurs in newborns, especially premature babies. The greatest value for RNS may be gram-positive anaerobic bacteria (Clostridium, Peptostreptococcus, Peptococcus). Anaerobic infections, clostridium wikis, can manifest themselves as systemically ill or localized infections, such as cellulitis or omphalitis. Anaerobic bacteria became the reason for RNS for the period 1989-2003. in total in 1% of vipadk_v.

Newborn women

You can see a few of the main paths for the extension of the infection:

• Viskhidny shlyakh.
• Hematogenous (transplacental) path - as a result of bacteria in the mother. In general, the disease has been generalized for infection with frequent lesions of the liver, legends, nirok, and the brain.
• Contact path - the contamination of the newborn when passing through the birth canal. With a wide range of cases, colonization of the nasopharynx and mucous membranes of the newborn, including the nasopharynx, oropharynx, conjunctiva, umbilical cord, naval organs of the intestinal tract (in It means that in a large number of new-born microorganisms multiply in cich mice, not to get sick. The umbilical cord is the most popular for the entrance of the infection. In the context of the diagnosis of the RNS with a horizontal mechanism of transmission, it is possible to call the diagnosis, the ditch for the duration of the hygiene for the hour of the

Specific factors are assigned to the risk, which will increase the ability to develop infections:

• front canopy is the most significant factor in the risk of infection in children without the need for an average until about one hour of bedtime;
• motherboard colonization;
• Cutting out the shells of fruit michur more than 18-24 years before the population increases the rate of neonatal sepsis by 1%. Yaksho the baby is premature, the rizik grows by 4-6%. What is less of a gestational age of a new neonatal and less than a trivial anhydrous period, it is less a development of neonatal sepsis;
• maternal intra-amniotiological infection (chorioamnionitis): according to the data of the National Institute of Child Health and Development of People (USA), from 14 to 28% of women who gave birth to premature babies at 22-28 years old. vaginosti, mayut signs, characteristic of chorioamnionita. For winter data, with chorioamnion of mothers, sepsis is defined as 1-4% to 3-20% of newborns. Yaksho chorioamnionitis will go down with a trivial anhydrous period, the development of the RNS will grow 4 times.

The Іnshі factories of riziku, which stimulate the possibility of realizing the generalized infection:

• low social and economic status of women (due to the high frequency of information about cold waters, bacteriuria, reduced antimicrobial activity of amnotic birth);
• cholovich become a child;
• low score on the Apgar scale (hypoxia and acidosis can degrade the function of immunological disease);
• accelerated canopy in premature newborns;
• the appearance of the sign of the RDS;
• mother's diabetic diabetic;
• hypothermia in newborns, get sick if rectal temperature starts<35°С, связана со значительным увеличением числа случаев сепсиса, менингита, пневмонии и других тяжелых бактериальных инфекций;
• trivial transfer of mothers to the stationary;
• inadequate capacity for screening and antibacterial prophylaxis before the hour is low;
• spadkova pathology obminu rechovin.

Symptoms and signs of internal uterine infections in newborns

In the anamnesis: wickedness, dead births, non-guilt in front of vaginities, people who have developed and died in early life, anomalies in the flow of vaginosity and flatness, shortness of the odor of overtaking, baggage prirіst abo vіdsharuvannya placenta zahvoryuvannya sechostatevoї sphere in materі, іnfektsії in zhіnki pid hour vagіtnostі, in addition chislі GRVІ, nayavnіst in zhіnki hronіchnih vognisch іnfektsії in sechostatevіy sferі, hronіchny tonzilіt, hronіchny cholecystitis, lihomanka in materі pid hour pologіv, vazhky іnfektsіyny Process in materі before pid hour abo vіdrazu pіslya pologіv, akusherskі posіbniki pid hour pologіv, narodzhennya ditini in asfіksії holding reanіmatsіynih zahodіv ditinі, pogіrshennya will vnutrіshnoutrobnogo rozvitku, vnutrіshnoutrobnoї gіpotrofієyu, s nedonoshenіstyu, stigma dіsembrіogeneza, defects rozvitku, gіdrotsefalієyu abo mіkrotsefalієyu.

Zagalnі klіnіchnі manifest vnutrіshnoutrobnoї іnfektsії: іntoksikatsіya, nizka crowbar when narodzhennі, CAA growth crowbars, trash appetite, zriguvannya, blyuvota, nespokіyna povedіnka abo mlyavіst, shkіrnі crooked suhі, blіdі of tsіanotichnim, sіrim abo zhovtyanichnim vіdtіnkom, zhovtyanitsya Mauger Buti turns, shkіra zbiraєtsya in folds, there may be polymorphic viscera, vitality of the pediatric fat globule, reduction of lymph nodes, liver and spleen growth, abnormalities in general, eruptions, hemorrhage, hemorrhage syndrome - hemorrhage

Specific symptoms and syndromes characteristic of singular infections.

rubella: Meningoencephalitis, hepatitis with zhovtyanitsyu, pneumonia, congenital heart disease, rotation of homosexuals and feet, iridocyclitis, deafness in 50%, if the mother is sick on the first month of vaginosis - Gregg's triad - eye defects, deafness.

Cytomegalovirus infection: be-a kind of organ, like a little epithelial cell. Zhovtyanitsya, hepatitis, hemorrhagic manifestations (petechia, melena), meningoencephalitis, pneumonia, calcification in the brain, nirok lesions, nephritis, eye lesions. Most often it manifests itself during the period of new birth. Microcephalus, polycystosis of nirok, heart progression, early delay - deafness, dullness, encephalopathy, microcephaly, pneumosclerosis, liver cirrhosis are possible.

Herpes infection: vesicular viscosity on the mucus membranes, keratitis, important hepatitis, zhovtyanitsya, pneumonia, disseminated intravascular coagulation. Defects: hypoplasia of children, microcephaly, microophthalmia, cicatrices. Uskladnennya - slap, deafness, brought into psychomotor development.

Viral hepatitis: hepatitis, zhovtyanitsya, the slash is dark, not barren style. Vices are the atresia of the zhivchnyh nobles, the acceleration is the cirrhosis of the liver, which is brought into psychomotor development.

listeriasis: Meningoencephalitis, papulo-roseolous visp on the back, abdomen, legs, bluish-jovtuvati vuzlics with a diameter of 1-3 mm at the posterior pharyngeal stance, conjunctivitis, delayed - hidrocephalus.

tuberculosis: Improved peripheral and cranial lymph nodes, ascites, lesions, meningitis, nirkova deficiency, defects of the cyst system.

syphilis: Specific visibility on skirts, obov'yazkovo on valleys and feet, rhinitis, sensation, periostitis, osteochondritis of tubular cysts, tricycles in rota coats. In the preschool child: Hutchinson's triad (keratitis, deafness, dystrophy of the teeth), gray-eyed nis, shable-like homilies.

toxoplasmosis: Meningoencephalitis with calydifikatamy, hydrocephalus, eye damage, microcephaly, microphthalmia, hepatitis. Gradually scratch his eyes in the older senior.

chlamidiasis: Gn_inny conjunctivitis, rhinitis, otitis media, pneumonia, onset of onset cough.

Demonstration on the appearance of VUI p_dlyagayut new people from the group of high risik.

Diagnostics of internal uterine infections in newborns

Laboratory diagnostics of infections

Yakogos characteristic signs only for infectious diseases. In this world, all Lankans react to a stressful situation, and not only to an infectious agent. The diagnosis of infection only for laboratory parameters is much more convenient. We have violated the main markers of infections, laboratory tests of which in the given hour can be allowed by a large number of medical devices. Bagato transferred markers (cytokines, surface antigens, blood cells, granulocytic colony-stimulating factor) are readily available, but not stagnant for routine diagnostics. Numerical publications show that, when taken, such indicators as the concentration of leukocytes, thrombocytes, the number of adult and immature neutrophils and CRP may be low in sensitivity and specificity. Besides, the stench to lie down like:

• postnatal and gestational health;
• from the hour to the ear of the infectious process.

Adjustments and information content of these indicators can be:

• їх spіlne vikoristannya;
• common symptomatology;
• dynamism of changes (in case of non-infectious reasons, such as labor stress, it is difficult to prevent rapid development).

With a trace of memory, no laboratory data can replace the gradual lykarsky caution, as soon as possible, more sensitively, symptoms of infection will appear (for example, when there is an increase in frequency and apnea) before the change of laboratory indicators.

concentration of leukocytes... With infections, leukocytosis and leukopenia can develop. At the same hour, non-infected children may be more susceptible to pathological changes in the concentration of leukocytes in conjunction with childbirth stress. The most frequent occurrence of leukocytosis / leukopenia in the period of neonatal disease is as follows:

• leukopenia - the concentration of leukocytes is less than 6000 in pershu dobu life, dal - less than 5000 in 1 mm 3;
• leukocytosis - the concentration of leukocytes is more than 30,000 in pershu dobu, sometimes - more than 20,000 in 1 mm 3.

concentration of neutrophils... An additional serum of neutrophils є trocha is more sensitive for the detection of infection, less leukocytes, if a pathological number of neutrophils with the onset of symptoms of sepsis is more susceptible to early onset of ultrasound. A large number of neutrophils move up to the population and reach their peak up to 6-8 hours of life. The lower range of norms per hour should be 7500, 3500 and -1500 / mm3, as appropriate for newborns> 36 t., 28-36 t. i<28 нед. гестации.

A more sensitive indicator (sensitivity 60-90%) є neutrophilic index (HI), which is detected as the development of immature forms of neutrophils (mylocytes, neutrophilic cells, palitic cells)

The status of this indicator is determined by the quality and identification of the type of neutrophils by laboratory technicians.

The normal value of the neutrophilic index in populations is 0.16, in the later period of the psychoanalyst it drops to 0.12. The majority of authors for the diagnosis of sepsis has a value of HI> 0.2, and protects against a value (0.25; 0.3).

Dani, in the lines from 6 to 12 years old, from the people, there may be more chances of being changed, not just because of the change in the number and stock of leukocytes due to the manifestation of flashover reactions.

thrombocytopenia... Rizni authorize thrombocytopenia with thrombocyte concentration less than 100 or 150 000x109 / l. The number of thrombocytes in a healthy newborn in the first 10 days of life is less than 100x109 / l. Indicators of the lower can be detected in case of sepsis with an early ear, who want the indicator to become susceptible to in case of nosocomial infection. Thrombocytopenia is not a specific sign of sepsis through a great number of reasons, which can lead to development. In general, the presence of thrombocytopenia, a non-specific, insensitive indicator and a large world, is characteristic of acute sepsis.

The speed of the deposition of erythrocytes... Vikoristannya shvidkostі The deposition of erythrocytes in the period of the new generation is of little significance for diagnostics, as well as for monitoring of serious bacterial infections.

analysis of the section for diagnostics of RNS is not very informative.

CRBєbіlkom gosudarstvo fazi zapalennya, the advancement of the ryvnya is tied to fabrics, and to transfer, and its main function is foreign bacterial or toxic toxic words, which can be seen from the tissues in the presence of CRP of admissions in 50-90% of newborns with systemic bacterial illnesses.

After 6-8 years, the ear of the infectious process of the concentration of CRP gradually grows and reaches the maximum value after 24 years. This is often the case in newborns with RNS, the first value of CRP in the first place may not appear as normal values. Normal ranges of CRP can change over the first 48 years of life in fallow lands.

Gestational health, however, does not add to the validity of the results, however, in some robots it is evident that in premature babies, the basic value of CRP can be lower, and their role in the diagnosis of sepsis in the new child's life. It is unimportant on the day of birth, most often the threshold value of 10 mg / l is observed, regardless of the term of vaginal capacity and psychophysiological condition of the newborn, since the sensitivity of the CRB value is more than 10 mg / l, not more than 10 mg / l. Normalization of CRP can be a good indicator of successful infection control. On the dynamics of indicators of CRP, the value of the triviality of antibiotic therapy can be grounded. Due to an altogether short period of time from blood (close to 19 years), the level of SRB rapidly decreases and turns in more children to normal values ​​for 5-10 days.

Sensitivity of CRP in case of cob sepsis in the warehouse is 50-90%, specificity is 85-95%. The sensitivity of the analysis grows sharply, as the first analysis of the fractures after 6-12 years was sent to the people. Two normal CRP values ​​(<10 мг/л) - первое через 8-24 ч после рождения, а второе спустя 24 ч - позволяют на 99,7% исключить сепсис.

Bagato іnshі stani (asphyxia, RDS, mother's fever, trivial anhydrous period, MSC, meconian aspirations, virus infection) can also be found in similar conditions of concentration of SRB. In addition, approximately 9% of healthy newborns have CRP> 10 mg / l.

Procalcitoninє an alternator to the hormone calcitonin, which is a good hypocalcemic effect. Basically, procalcitonin circulates in the neuroendocrine C-cells of the thyroid gland. In case of important systemic infections, procalcitonin, imovirno, is produced by tissues and posture of the thyroid zone (monocytes and hepatocytes). Sensitivity to procalcitonin in bacterial infections is the same with CRP or trochidosis, but it is more specific. For children under 48 years of age, the sensitivity to procalcitonin for diagnostics of early neonatal sepsis was 92.6%, and the specificity was 97.5%. It was also found that the level of procalcitonin growth after 3 years after the introduction of the bacterial agent, at that hour CRP appears only after 12-18 years.

Procalcitonin is a marker for the prevention of septic shock from the shock of nature, if you want to take a dose of procalcitonin concentration adjustment in RDS, trauma, hematopoietic disease, perinatal

Techniques that have not entered the routine of clinical practice:

• Proprietary cytokines IL-6 and IL-8.
• Iaip (Inter-alpha Inhibitor Protein).
• Syrovatkovy amіloid (SAA).
• sTREM-1.
• Superficial antigens of blood cells.

Інші methods of diagnostics of infectious diseases

Serological methods. Detection of antigens and antibodies by serological methods has not been extensively expanded in the diagnosis of infection in newborns due to the lack of accuracy in the recognition of the results, or the folding of the results.

molecular diagnostics... Polymerase lantsyuga reaction and method of hybridization of detection of bacterial genomes allow for a quick identification of any infection on the basis of the detection of a bacterium specific for them from a human genome The sensitivity of the methods of molecular diagnostics of sepsis can be less than cultural methods, and from 41 to 100%, with a large number of times showing the value between 90 and 100%, and the specificity in the range of 78-100%.

Heart rate variability monitoring... In a number of robots, the temporality of the variability of the heart rhythm is shown at the stage of maladjustment to the organism, as it is possible in case of older masses, including in case of sepsis. Zmіna indicators of the heart rhythm have become familiar in new-born children, to be restructured in 24 years before the first key signs of sepsis. Uninterrupted monitoring of the heart rhythm can lead to a greater early detection of infection and an early ear of antibacterial therapy.

The advantage of this method can be the possibility of uninterrupted and non-invasive control and information content at the early stages of diagnostics.

visnovka

From the flow markers to the infectious process, it is impossible to unequivocally diagnose the incidence of infection by 100%. Bagatoserious localized infections (such as pneumonia, large abscesses, ventriculitis) can be antibacterial therapy, but in many cases, markers in the blood can be normal. For early diagnostics of sepsis in clinical practice, sensitivity is a more important indicator in terms of specificity, since the inheritance of an unjustified practice of uninfluenced new-born children

Diagnostic tests are more effective when spared in dynamism, less when there is a single delay.

Laboratory diagnostics

The "golden standard" є the vision of the child from inviting sterile middle-class organisms, for example, from the center of ceremonies, blood. Seeing microorganisms from other cities can only talk about contamination.

When susceptible to sepsis, 1 blood culture was taken. The minimum amount of blood, necessary for sowing in the middle, is 1.0 ml for all newborns with adolescence for sepsis.

In the last hour (in the provinces, mothers undergo antibacterial therapy for the prevention of sepsis in newborns), the number of positive blood cultures in newborns with RNS has passed up to 2.7%. The other reasons for the poor vision of cultures from biological families (shelter, CSR) are the smallness of the bacterium in the newborn, the smallness of the child, the small amount of material taken for the sowing. This culture of blood in the given hour does not help much for the prevention of sepsis in newborns.

Seeding trachea aspirate... Learning to aspirate from the trachea can be meaningful, as the stench is rejected at once due to the trachea intubation. The triviality of intubation lowers the value of the last, since the intubation tube is in the trachea for a few days, the aspirate's eyes will consume the value.

The visualization of bacteria from the surface of the thylum, from the slurry instead of and the slaughter in the diagnosis of early sepsis is not of any value.

Likuvannya of internal uterine infections in newborns

The treatment of serious infections can be divided into substitution and antimicrobial therapy.

I will become

• The temperature is normal.
• Correction of glucose and electrolytes.
• Correction of anemia: optimal indicators of red blood in case of important infections in neonatal women, but it is recommended to take hemoglobin levels of 120-140 g / l, hematocrit - 35-45% (minimally 100% hemoglobin).
• Respiratory podtrimka in fallowness of the severity of DN: O 2, nCPAP, SHVL, iNO, surfactant. It is recommended to take the following blood gas indicators: pH 7.3-7.45, PaO 2 = 60-80 mm Hg. (SaO 2 = 90-95%), PaCO 2 = 35-50 mm Hg.
• Stabilization of hemodynamics (infusion, inotropov / vasopressor, GCS) is guilty of normalization of the arterial vise, development / reduction of arterial pressure> 2 ml / kg / year, adjustment of BE in the act of development
• Internal combustion engine therapy.
• Nutritional support / infusion therapy: whenever possible, it is necessary to maximize the amount of food you can eat. Navigate the intestinal mucosa and reduce the translocation of bacteria.

Come with a summary efficiency / lack of availability

• Internal immunoglobulin (IgM).
• Myelopoietic cytokines (granulocytic colony-stimulating factor - G-CSF and a factor that stimulates the activity of gran-locytes-macrophages - GM-CSF).
• Transfusion of granulocytes into neonatal disease with neutropenia.
• Stagnation of current detoxification methods.
• Pentoxifyline.

Independently on those who have a large number of robust design (up to PCI) (as far as PCI), which are known by the authors of the past, to show a positive injection of such drugs as roncoleukin (recombinant interleukin-2), Recommended interferon-α2β people) for the survival and early transfer in the hospital for new gestational age patients with sepsis and pneumonia, in the future, it is not necessary to carry out a series of tests

Come in, I have not shown your efficiency

• Internal immunoglobulin (IgG).
• Protein C (Drotecogen-alpha) is activated.

Postnatal prophylaxis and etiotropne treatment

The main therapy for infectious diseases is in the correct selection and timely use of antibacterial drugs. Antibacterial therapy is indicated for all children with clinical and laboratory signs of sepsis. The prevalence of bacteriological support is not a major factor for non-maternal antibacterial therapy; Cochrane's survey, including 2 randomized pre-births from the 1970s, did not give evidence of nutrition, those who were guilty of a newborn child without clinically symptomatic, but perhaps one or more anti-prophylactic factors. Bagato authors, primed on vlastnoe dosvіdі, vvazhayut for beautifully carry out antibacterial prophylaxis in the presence of factors in the risk of infection in case of one-hour guarding for the child. In the majority of countries, protocols can be developed that are rich in spirits, which are more developed in the countries (mainly for the types of antibiotics and terms of therapy). Below, one of the protocols is to be imposed;

Newborn women who require antibiotic therapy

I. Novonarodzheni with key signs of sepsis.

A neonatal skin in a critical state, or if the patient is depleted, should be evaluated for an increase in nutrition about an ear of empirical antibacterial therapy (after having spent time on hemoculture, to see if there are obvious factors)

II. Health in the eyes of new people with high ymovirnistyu RNS.

GBS is not a factor in risk, as long as mothers have taken adequate antibacterial prophylaxis (penicilin, ampicilin, cefazolin) not less than 4 years before or even before half a day, or they carried out cesar rosters for non-malignant fruits.

1. Newborns with a guest service<37 нед. без key signs sepsis, ale with 1 factor of rhizic (trivial (> 18 years) anhydrous period, or chorioamnionitis, or inadequate antibacterial prophylaxis of mothers for an hour):
   • lykuvannya antibiotics;
   • • in case of negative results in blood culture, good child status and normal laboratory parameters, antibacterial therapy is prescribed.
2. Newborns with a gestational age> 37 years. without clinical signs of sepsis, ale with 1 factor rhizik (chorioamnionitis):
   • lykuvannya antibiotics;
   • laboratory diagnostics (leukocytes, CRP, blood culture at 6-12 years old):
     • in case of a positive result in blood culture - lumbar puncture, antibacterial therapy for progression;
     • in case of a negative result in blood culture, a good standard of a child, ale pathological laboratory indicators - antibacterial therapy for progression, if the mother has eliminated antibiotics for an hour;
     • in case of a negative result in blood culture, a good standard of the child and normal laboratory parameters, antibacterial therapy is prescribed and spared for 48 years.
3. Newborns with a gestational age> 37 years. without clinical signs of sepsis and other factors of rhizic (NOT for chorioamnionitis): trivial (> 18 years of age) anhydrous period or inadequate antibacterial prophylaxis of mothers before an hour of sleep 4 hours before flat):
   • antibacterial therapy is not carried out;
   • caution;
   • condition (leukocyte, CRP, blood culture at 6-12 years old).

Kozhen region, ymovirno, is guilty of the mother's vlast protocol, adaptations to the minds of the mind.

Ethiotropic treatment of bacterial infections

Ethiotropic RNS therapy is practically empirical. It’s not enough to give an allowance for an infectious anamnesis of the mother, microflora, much more for everything, if it is represented by the most common representatives of the urogenital tract. Just before the canopies, the woman passed into the stationary, and there was a nosocomial flora. Information about the colonization of mothers is necessary to provide information if antibiotics are recognized.

The empirical antibacterial therapy of early infections in the developed regions of the mother is based on GBS, E. coli and L. monocytogenes. Consider a combination of therapy, which includes the sign of penicilin with an expanded spectrum of activity (ampicilin and amoxicilin) ​​and aminoglycosides (give gentamicin and netromicin) / tobramycin. In a large number of types, the whole range of pathogenic maternal microflora is inexpensive. At the same hour, as soon as possible, GBS resistance will appear dopeniciliniv. A slid of memory, which aminoglycoside does not penetrate well enough through the hematoencephalic bar, which, when changing, often appears to be a combination of aminoglycosides and cephalosporins III generation... Cephalosporins of the III generation do not contain the concentration of drugs in a large number of infectious diseases, which significantly outweighs the smallest infectious pathogenic microorganisms of coli (GBS, E. However, the activity of cephalosporins is not active, apparently lysters and enterococks, and there is little activity in the commonly aureus staphylococcus.

Cephalosporin III generation will not succumb to vicorism as an alternative to aminoglycosides through a low specificity:

• rapid development of resistance to cephalosporins of III and IV generations with wide vikoristanna;
• in case of trivial vicorian, it is significant to increase the development of invasive candidiasis;
• Ceftriaxone is a contraindication to neonatal disease in the event of a competitive vitality of bilirubin with a link with a biloba, which can lead to the development of nuclear energy.

In addition, the vicious cephalosporins (with the indicated empirical therapy) are surrounded by the licensed meningitis, the vicious gram-negative microorganisms. Cefotaxime is the most reliable for cephalosporins, the splinters do not turn into bilirubin because of the link with albumin and does not cause contamination toxic lesion Central nervous system.

In the provinces, which are developing, the staff of the RNS are seen from such in the developing countries, the combination of penicilians and aminoglycosides may be ineffective. Therefore, in such countries, an empirical antibacterial therapy is guilty of but assigned individually for the skin disease and for the region.

A review of the literature on the sensitivity of patients with sepsis in outpatient neonatal patients to antibiotics in Africa and Asia, showing that there are 2 of the most advanced children - S. aureus and Klebsiella spp. - boules of highly stable antibiotics (such as ampicilin, ceftriaxone, chloramphenicol, cotrimoxazole, macrolide and gentamicin). Good dryness to all significant factors, except for co-moxazole, demonstrating only Str. pneumoniae.

Anaerobic microflora can be trapped before the endpoint of metronidazole.

Antibacterial therapy is necessary for the development of an antibacterial therapy. Іsnuє-valued rіznitsya in rekomendatsіyah on trivalostі empіrichnoї antibakterіalnoї terapії at pіdozrі on PHC, if not blood cultures vidіliti vdaєtsya, ale standard practice Je pripinennya antibakterіalnoї terapії at otrimannі negatively rezultatіv posіvu krovі (zazvichay 48-72 year) i vіdsutnostі klіnіchnih abo gematologіchnih Find our іnfektsії.

triviality of liking

The optimal triviality of empirical antimicrobial therapy is to reduce the development of resistance;

Bacteremia in antibacterial therapy 10-14 days (for GBS) or take 5-7 days more to take away the clinical result.

Many authors recommend more trivial antibacterial therapy for negative blood cultures in newborns with adolescence on the RNS and necrotic enterocolitis. Interchangeable dates, but a 7-day course of treatment can be sufficient for persistent bacteria.

It’s a lot of authors to cite data that short courses of antibacterial therapy (5 days or less) with culture-induced sepsis (vyklyuchayu meningit and osteomyelitis) do not compromise on more trivial courses. Similar data are taken for bully during short (4-7 days) courses of therapy for pneumonia. The author found that the speed of triviality of antibacterial therapy does not increase the risk of recurrence of infection in newborns with early sepsis, while reducing the frequency of sepsis with an ear.

It is a great triviality (> 5 days) of cob empirical antibacterial therapy with a wide range of antibiotics for the development of necrotic enterocolitis, acute neonatal sepsis, and deaths in the newborn. Some of the unpleasant traces of trivial empirical antibacterial therapy include changes in the development of neonatal candidiasis and changes in intestinal microfloria. Vibir of cefotaxime (III generation of cephalosporins) replace gentamicin in the first 3 days of life of dressings with a greater mortality. Newborns (especially premature babies), if they take a trivial course of therapy with broad-spectrum antibiotics (especially cephalosporins), require fluconazole to prevent candidiasis.

control

According to the material, it is necessary to repeat it in 24-48 years after the completion of the therapy, which will be introduced into the development of bacteria. Continuously positive culture allow for inadequate therapy and / or manifestations of infection (for example, infection of an infusion catheter). In case of significant triviality of antibacterial therapy, it is followed by a clinical course of neonatal babies and according to laboratory indicators: neutrophil index, an extraordinary number of leukocytes and CRP in the distance of 72 normal therapy.

visnovka

Newborns, as a result of the population in a large number of cases, are unfortunately too late to transfer the development of infections. Antibacterial therapy in the first days of life is practically empirical in nature. It is recognized that it is primed to develop the infectious process (it is especially priced before premature babies). The framework of "rudimentary" to lie down from the bagatokh bureaucrats - the stench can sound as it expands in the accumulation of the minds of the mind (quality, information to the staff, safety of resources, organization of protection of health). In most vipads, there is sufficient ampicilin and aminoglycoside (gentamicin, netromicin). In general, as there is no evidence of bacterial infections, antibacterial therapy is creeping up. As soon as the sick person is not sick, it is necessary to include the cause of an important condition, infection and etiology, or the resistance of the child to the signs of the drug.

VIL-infection is not transmitted to large children, people of VIL-positive mothers

Rizik transmissions VIL from mother to child

20% - per hour of visit.
60% - during the flat period.
20% - for breastfeeding.

Is it necessary for a VIL-informed woman to give birth to a healthy child?

Prevention of vertical transmisis (HTP) - a complex of entries, direct to the forward transmission of VIL from mother to child on all many steps(Vagіtnіst, curtains, vigodovannya).

Algorithm of proactive entry:

• As soon as the vagina woman was diagnosed with VIL-infection, it is necessary to go to the doctor-gynecologist at the SNID center.
• From 24-28 VIL-positive vagina the woman is guilty of taking anti-tartar preparations (from the hardened protocol) until the moment of flatness. Preparations їy vidut in the regional center SNIDu bezkoshtovno.
• The method of development is selected individually from the doctor-gynecologist at the SNIDU center individually, according to the approved protocol in the number of virus nesting (a few viruses in the woman's blood).
• When there is a small amount of prophylactic ART (before the hour is low), for the most high-ranking people, it is recommended to use a cesarean rosette to maximize the contact of the child with the blood and the mother's visions.
• Immediately, the message of the people, the skin child, the people from the VIL-positive mother is indicated anti-tier drug Zidovudine in trivial syrup 7 or 28 days The drug should be seen in a shallow booth for the entire course of reception.
• It is not recommended to breastfeed the baby. Immediately, the message of the child's folk is translated into the piece by adapting dairy sums.

When carrying out all the high-speed transmissions, the VIL from the mother to the child should not be more than 1-2%.

Factor for the risk of transmission of VIL from mother to child

1. Stage VIL-infectious mother.
2. The duration of prophylactic treatment during the period of pregnancy.
3. Bagatoplіdna vagіtnіst.
4. Trivial anhydrous period.
5. Before the birth.
6. Self-contained canopies.
7. Bleeding, aspirations from the hour to bed.
8. Breast year bath.
9. Vzhivannya ін'кційний drugs, malignant alcohol per hour of vaginosti.
10. Coinfection (tuberculosis, hepatitis).
11. Extragenital pathology.

The peculiarities of the child's life, the people from the VIL-positive mother on the pediatric hospital

1. It is important to vivchіt vipiska from the sleeping booth.
2. Zvernit respect for: vaccination of the child (vaccination against hepatitis B - carried out, BCG has not been carried out); the scheme of prophylactic treatment with Zidovudine (7 or 28 days).
3. Reverse the appearance of Zidovudine syrup in mothers and know about the regimen and triviality of the drug (2 times a day with a dose of 4 mg / kg for skin treatment, lasting 7 or 28 days). Once again, to explain to mother, it is necessary to accept it (prevention of VIL-information of a newly born child).
4. All children, until the VIL-status is clarified, are located at the visual pediatric center of the SNID center, the pediatric pediatrician and the child's phthisiatrician.
5. Ditina is in order and will not take care of the drive of all fellow sickness, Behind the place of living, on out-of-the-way pavilions.
6. Medical documentation of a child must be kept in an inaccessible place for both children and memory, so information about the status of the child and his father is strictly confidential.
7. When the child's knowledge is from the field of VIL-infection, it is recommended to replace the outpatient card with a new one, in the future there will be information about those, that the child was transferred to the field in the center of SNIDu.

Criteria for staging on the region and the nobility from the region in the center of SNIDu

For the first look and the improvement of the child, it is necessary to correct the direction to the regional center of the SNID at one month, even if the blood sampling for the determination of VIL RNA by the PLR ​​method is carried out and the determination of antibodies to VIL by the IFA method. It’s a tactic for the child to keep all the results from the last.

Debriefing on the designation of PLR RNA VIL in 1 month

The main clinical symptoms of HIV infection in children

1. Covering the improvement and growth. Anthropometry is mandatory.
2. Covering psychomotor and physical development. Organizational warning of a neurologist.
3. painless improvement lymphatic universities(Ponad 0.5 cm) in two or more groups
4. Improvement of liver and spleen without apparent reason.
5. Recurrent parotitis
6. Recurrence of thrush or manifest thrush in children older than 6 months.
7. Shkіri і mucous membranes candidiasis.
8. Recurrent bacterial infections: pneumonia, otitis media, sinusitis, pyoderma and other infections.
9. Relapse herpes simplex and herpes zoster.
10. Relapse the vitrieness.
11. Enlarged contagious molluscs.
12. Angulyarny cheilit, "go".

Peculiarities of caution, feeding and vaccination of VIL-positive children

1. All VIL-positive children stay at the clinic near the pediatrician center SNIDu, pediatrician pediatrician, child phthisiatrician.
2. Inspection of a VIL-positive child by a pediatrician at the SNID center and a pediatric pediatrician is carried out at least once every 3 months.
3. At the reception in the center of SNID, anthropometry is carried out, examining by the pediatrician, assessment of the immunity (blood collection for the number of CD4 lymphocytes), and the test of the viral response.
4. Vaccination of HIV-positive children is carried out in the polyclinic for the first time of their stay until the Order No. 48 on 03.02.06 and on the Order No. 206 on 07.04.06.
5. VIL-positive children are recommended to increase the calorific value of food in the middle by 30% according to the norms.
6. At the pediatric hospital for the place of residence, the provision of a VIL-positive child includes:
   • Anthropometry (up to 6 months - 1 time per month), 6 months 1 time in 3 months.
   • Inspection of the phthisiatrician 1 time in 6 months.
   • Mantoux reaction once every 6 months.
   • Inspection of the oculist with the description of the face-to-face bottom 1 time in 12 months.
   • ОАК, ОАМ, biochemistry of blood, blood supply - 1 time in 6 months.

IMPORTANT: VIL-positive children visit kindergartens and schools at out-of-town schools. For the birth of the father, we will inform about the child's VIL-status, we can only put the child's medical staff or school.

IMPORTANT: VIL-positive children undergo health improvement in children’s health care facilities, according to the profile.

Principles and approaches to the development of VIL-infection in children

1. Highly active antiretroviral therapy (HAART) is highly active antiretroviral therapy (HAART) for the treatment of HIV infection, which is a combination of decilcox antiretroviral drugs, which are prescribed one hour, without interruption, and once in a while.
2. Appointment of HAART VIL-INFORMATION CHILDREN HELD COMIC FACILITATIVELY to the SNID center. according to the written age of batkiv (opikuniv).
3. Preparations for the treatment of VIL-infection are seen in the hands of the daddy's children when they are brought to the SNID center with recommendations and doses.
4. HAART to lead to strangulation of the proliferation of the virus, or even not to lead it to the body.
5. Stagnation of monotherapy (one ARV drug) or biotherapy (two ARV drugs) is unacceptable, and it cannot be reduced to the level of VIL strength before ARV drugs and the ineffectiveness of forged drug use.
6. It is important to take into account the regimen of drug intake (dose, hour, frequency of administration) - the breakdown of the treatment regimen can be quickly brought to its ineffectiveness.
7. If you need a stationary treatment, VIL-informed child can be hospitalized in a special medical institution, or in any medical facility (ascertained before showing).

Naybіlsh vazhlivimi zavdannyami at robotі of dіtmi, narodzhenimi VІL-іnfіkovanimi mothers Je hіmіoprofіlaktika VІL-іnfіkuvannya that Povny dispanserizatsіya, in addition chislі, of metoyu zdіysnennya rannoї dіagnostiki VІL-іnfektsії, holding profіlaktiki oportunіstichnih іnfektsіy, Vibor optimalnoї schemes vaktsinoprofіlaktiki, svoєchasnogo priznachennya antiretrovіrusnoї terapії ...

Dytina, people of VIL-Infectious Woman, for the purpose of re-establishment according to the code R75 “Laboratory detection of a virus in a human immunodeficiency [VIL]. (Insufficient test for VIL, manifestations in children) "International statistical classification of ailments and problems associated with health, Tenth glance. In that case, as a child, a population of VIL-infected woman, as there is no situation on VIL by laboratory methods, it must be re-instated as a case in point to the code Z20.6 "Contact with a sick person and the possibility of being infected with a human immunodeficiency virus." In both cases the diagnosis "Perinatal contact with HIV infection" is displayed.

Obstezhenyu on VIL-Infection for contingent of children, women:

s VIL-Infectious;

not being sent for an hour of visit to the field in the life consultation;

they did not check-in on VIL until after an hour of vaginosti;

inject drugs internally until і / abo pіd hour of vaginosti;

may have partner partners who inject drugs internally;

mali for an hour of vaginosis of venereal ailments;

suffering from viral hepatitis B and / or C.

In addition, the maintenance of the VIL is suitable for children, who have lost their lives without taking fathers.

Dispensary for the child's care, who has perinatal contact with VIL-Infections, healthy pediatric clinics of outpatient-polyclinic fences, for any kind of medical and / or social protection In the process of dispensary caution, there are: diagnostics of VIL-infection, confirmation of diagnostics about health problems from the dispensary area; guarded by the child by the pediatrician and the physicians-fakhivtsy; carrying out standard and additional laboratory tests; prevention of pneumocystis pneumonia; assessment of physical and psychomotor development.

Dispensary examination of children, people of VIL-positive women, who are guilty of being aware of them, who may be informed by robots in the whole region, due to the success of the most recent methods of diagnostics, diagnosis and monitoring of diagnostics She is an outpatient, non-ad hoc and advisory help to children, people living with VIL-positive women, going to children policlinics for a moment of living at out-of-town pedagogues. Specialized to help children find professional hospitals directly from children’s clinics and / or Centers for prevention and control of SNID.

Table 3. Schedule of care for children, people of VIL-informed women

Table 4. Graph of laboratory dosages of children, women who are married with VIL-positive women

1 pre-examination of the immune status is carried out for rejection of positive results in the pre-diagnosis on VIL by the PLR ​​method. If the other person is unavailable, it is possible to serve one of the diagnostic criteria (decrease in the number of CD4 (+) - T-lymphocytes є a characteristic manifestation of HIV infection);

2 not є binding;

3 children who receive chemoprophylaxis of pneumocystis pneumonia with Biseptol;

4 onset of uptake: in case of a negative result - after 1 month, and with positive / unimportant results - after 3 months (as well, the PLR ​​method is used for diagnostics of HIV infection).

When a child of VIL nucleic acids is detected by the PLR ​​method, and if there are any clinical signs of VIL-infection, a deterioration is performed: , and also receive nutrition about the therapy, including antiretroviral therapy. Vaccination of a VIL-positive child will stay at the place of residence according to the recommendation of the pediatrician to the Center for Prevention and Fighting with SNIDom.

Ditina s VIL-Infections in a planned manner, the Center for Prevention and Fighting with SNIDoms at a frequency of 1 time in 3-6 months in the presence of clinical laboratory indicators. on early stages VIL-infections with normal CD4-lymphocyte counts in dispensary examination will not last more than once at a time; at the lower stages and with a decrease in CD4 lymphocyte counts - not earlier than once a quarter.

People from the dispensary oblast of the child, the people of the VIL-Infectious Woman, come together comically for the availability of clinical and laboratory signs of VIL-Infections. When you see the nutrition about the presence of VIL-infection in the child, assess the anamnesis, development of the child, klinichny camp, The results of laboratory conditions for HIV infection, for children, for breastfeeding.

Remaining decision about the prevalence of VIL-infection can be taken on the basis of negative results indicating antibodies to VIL. The minimal term of guarding a child when the child is out of sick is guilty of becoming not less than 12 months from the moment of the population, or of the child being guarded for the reasoning of adequate diagnostics, including the diagnosis of the diagnosis. If monitoring is done using serological methods, or less than two different virological methods before the establishment of conditions, the child can be taken from the field for the duration of the VIL at least 18 months.

In case of viral infection in the child, it is always necessary to go to the oblivion. In practice, children who have diagnoses of VIL-infection know-how, or live in families with VIL-infected fathers, will continue to be promoted by contact.