After the umbilical residue falls off, an umbilical wound remains, which epithelializes by the end of 2-3 weeks.
Omphalitis - inflammatory process in the umbilical wound. The umbilical wound is the entrance gate for the penetration of pathogenic microorganisms into the newborn's body.
The following forms of omphalitis are distinguished:
1.catarrhal omphalitis (weeping navel)
2.fungus navel
3.purulent omphalitis
4.phlegmonous
5.necrotic
With the defeat of the umbilical vessels, they speak of phlebitis and arteritis.
Etiology:
1. Gram-positive flora (St, Str)
2. Gram-negative flora (Escherichia coli, Proteus, Pseudomonas aeruginosa, etc.).
1) Catarrhal omphalitis
The most frequent and prognostically favorable form of the disease, when a granulating wound that does not heal for a long time with scanty serous discharge occurs on the navel. The child's condition is satisfactory. Periodically, the wound is covered with a crust, granulations can grow excessively, forming a mushroom-shaped protrusion (navel fungus).
Catarrhal omphalitis -(weeping navel), this form of the disease occurs, as a rule, with delayed epithelialization of the umbilical wound. More often in children with a large body weight, with a wide umbilical ring.
Clinic:
The umbilical wound constantly gets wet, serous discharge is released, the bottom of the wound is covered with granulations, the formation of bloody crusts is possible;
There is slight hyperemia and moderate infiltration of the umbilical ring;
With a prolonged process of epithelialization, mushroom-shaped granulations (fungus) may appear at the bottom of the umbilical wound - the formation is dense, painless, pale pink (cauterized with a lapis pencil or excised surgically);
The umbilical vessels are not palpable;
The condition of the newborn is not disturbed, the temperature is normal;
Healing takes place within a few weeks.
A long weeping navel should alert you due to the presence of purulent fistulas !!! Consultation with a surgeon!
Treatment: treatment of the navel of the wound with 3% hydrogen peroxide, dried with a gauze swab with ethyl. alcohol, burned with 1% brilliant green, 5% potassium permanganate solution;
Sprinkle with xeroform into the wound;
Local UFO;
No bandages!
Purulent omphalitis
Purulent omphalitis - characterized by the spread of the inflammatory process to the tissues around the umbilical ring (skin, subcutaneous tissue, umbilical vessels) and severe symptoms of intoxication.
Clinic:
The skin around the navel is hyperemic, edematous;
The umbilical wound is an ulcer covered with fibrinous plaque; when pressed, purulent discharge is released from the navel;
Gradually, the umbilical region begins to protrude above the surface of the abdomen, since deeply lying tissues are involved in the inflammatory process;
The umbilical vessels are inflamed (thicken and palpable in the form of bundles);
Expansion of the venous network on the anterior abdominal wall is noted;
The condition is severe, symptoms of intoxication are pronounced: the child is lethargic, does not suck well, often spits up, the temperature rises, there is no weight gain.
Treatment: hospitalization in the surgical department;
Local treatment - the umbilical wound is injected with antibiotics in the early stages;
How does a purulent discharge appear, the umbilical wound is drained, a bandage is applied with a hypertonic solution, then with Vishnevsky's ointment;
UHF, UFO;
General treatment: antibiotics, detoxification, immunocorrective therapy; vitamins, symptomatic treatment.
3) Phlegmonous omphalitis
It occurs as a result of the spread of the inflammatory process to the umbilical region. Edema, tissue infiltration, skin hyperemia, protrusion of the umbilical region are noted. An ulcer may form at the bottom of the umbilical wound. Inflammation spreads through the lymphatic vessels, edema and infiltration go far beyond the umbilical region, sometimes there is an expansion of the veins of the anterior abdominal wall (phlegmon of the anterior abdominal wall). The child's condition is impaired, lethargic, appetite is reduced, regurgitates, weight gain is reduced or absent, the skin is pale or pale gray, the temperature is elevated to febrile numbers.
4). Necrotizing omphalitis - extremely severe complication of phlegmonous form in premature, severely weakened children. The process extends in depth. The skin becomes purple-cyanotic, its necrosis and detachment from the underlying tissues occurs. This creates an extensive wound. The muscles and fascia in the abdominal wall are exposed. Subsequently, there may be an intestinal eventration. This form is the most severe and often leads to sepsis.
With thrombophlebitis of the umbilical vein, an elastic band is palpated over the navel. In thrombarteritis, the umbilical arteries are palpated below the umbilical ring, radially. With the development of periphlebitis and periarteritis, the skin over the affected vessels is edematous and hyperemic, possibly tension in the muscles of the anterior abdominal wall. With light massaging movements from the periphery of the affected vessel to the umbilical ring, a purulent discharge appears at the bottom of the umbilical wound.
UAC- in severe forms: leukocytosis, neutrophilia, shift of the formula to the left, increased ESR.
Care and treatment:
1.with catarrhal omphalitis and navel fungus with daily observation and good social conditions in the family, hospitalization is not necessary. With other forms of omphalitis and inflammation of the umbilical vessels, it is necessary to hospitalize the child.
2. Local drug treatment depends on the form of the disease.
ü In catarrhal and purulent omphalitis - treatment of the umbilical wound with 3% hydrogen peroxide solution, then 70% ethyl alcohol, then 5% KMnO4 solution or 2% shaved solution. green.
ü With fungus - cauterization of granulations with 5% silver solution, lapis.
ü In case of phlegmonous form - dressings with hypertonic solutions of 5-10% sodium chloride, with ointments (levosin, levomekol).
ü In case of necrotic - after surgery (necrectomy) - it is administered in an open way using ointments on a hydrophilic basis.
3. general treatment: antibiotics, symptomatic.
4. in severe cases, skin toilet with wet wipes, in mild cases, hygienic baths with a solution of potassium permanganate 1:10 000, decoctions of a series, chamomile are shown.
The prognosis is favorable for mild forms with timely therapy. In other cases, complications may develop, including sepsis and death.
Sepsis
In recent decades, the problem of neonatal sepsis is gaining relevance again. As you know, in the 80s of the XX century, there was a decrease in the number of cases of this formidable disease due to the expansion of the spectrum of antibacterial and immunosubstitution therapy. However, now the incidence of sepsis in newborns has increased and is 0.1–0.2% in term babies and 1–1.5% in premature babies.
The latest definition of neonatal sepsis was published in the National Guidelines for Neonatology at the end of 2007.
Sepsis is a disease based on a generalized pyoinflammatory infection caused by opportunistic bacterial microflora, the pathogenesis of which is dysfunction of the immune, mainly phagocytic, body system with the development of an inadequate systemic inflammatory response (SVR), focus (s) of purulent inflammation or bacteremia and multiple organ failure.
(In newborns, early and late sepsis are isolated. Early neonatal sepsis is sepsis in children during the first 3 days of life.
With the clinical manifestation of sepsis in the later stages of a child's life, it is customary to talk about late neonatal sepsis. In late sepsis, infection of the newborn occurs postnatally. The primary site of infection is usually present. Septicopyemia is more often recorded, i.e. sepsis proceeds with the formation of one or more septicopyemic, metastatic, purulent-inflammatory foci. A typical metastatic lesion is purulent meningitis.)
Bacterial sepsis of a newborn- this is the generalization of a bacterial infection, characterized by a breakthrough of local and regional protective barriers, the release of the pathogen into the general bloodstream, the development of toxicosis and multiple organ failure against the background of immunological restructuring and suppression of nonspecific resistance of the organism.
-Sepsis- A SEVERE GENERAL INFECTIOUS DISEASE CAUSED BY THE DISTRIBUTION OF BACTERIAL FLORA FROM THE LOCAL FOCUS OF INFECTION INTO THE BLOOD BODY, LYMPHOSIS, AND FROM THEM IN ALL ORGANS AND TISSUES OF THE ORGANISM, ORGANOSIS
Etiology. The causative agent of neonatal sepsis is various pathogenic and opportunistic hospital strains of microorganisms, both gram-negative (E. coli, Pseudomonas aeruginosa, Klebsiella, enterobacteria, Proteus) and gram-positive (staphylococcus, streptococcus, anaerobic) and others.
Staphylococcus aureus
Gram-negative flora
§ Predisposing factors in relation to sepsis are factors that reduce the protective properties of natural pathways - repeated catheterization of the umbilical and central veins, tracheal intubation, artificial ventilation of the lungs, birth defects, acute respiratory viral infections, skin lesions; factors that suppress the immunological reactivity of the newborn - complicated antenatal period, pathological course of labor leading to asphyxia, intrauterine hypoxia, immaturity of the newborn, intracranial birth trauma; factors that increase the risk of massive bacterial contamination of the child are a long dry period, especially if the mother has chronic foci of infection, an unfavorable sanitary and epidemiological situation in the maternity hospital.
Pathogenesis:
§ Entrance gate of infection - umbilical wound, injured skin and mucous membranes, as well as intact skin and mucous membranes of the upper respiratory tract, gastrointestinal tract.
§ Infection of a child can occur intrauterinely, during childbirth and after birth. At the site of infection, a primary inflammatory focus is formed, adjacent vessels and tissues are affected. Degenerative-necrotic changes in the walls of blood vessels develop, from where pathogenic microbes spread hematogenously throughout the newborn's body, exerting a damaging effect on tissues and organs due to their enzymes and toxins, causing a severe pathological process with profound disturbances in homeostasis. Under the influence of enzymes of microorganisms, cell lysis occurs, as a result of which intoxication increases.
Factors contributing to the development of sepsis
1. Infectious and inflammatory diseases of the genitourinary organs in a pregnant woman (pyelonephritis, adnexitis, colpitis), extragenital pathology.
2. Infections in postpartum women (endometritis, mastitis).
3. Pathology during labor (prolonged labor, anhydrous period in labor> 6 hours, "dirty" water, placenta overlap).
4. Community-acquired childbirth.
5. Severe intrapartum asphyxia against the background of chronic intrauterine hypoxia.
6. Prematurity< 32 недель гестационного возраста
7. Birth weight< 1500 г.
8. Birth trauma.
9. Malformations and hereditary diseases.
11.therapeutic and diagnostic manipulations in the provision of resuscitation care, leading to a violation of the integrity of the skin and mucous membranes:
ü Mechanical ventilation (tracheal intubation)> 3 days.
ü Catheterization of peripheral veins> 3 times.
ü Duration of intravenous infusion> 10 days.
ü Surgical interventions.
High risk factors for bacterial infection of the fetus and newborn
12. Infectious and inflammatory diseases in a pregnant woman (pyelonephritis, adnexitis, colpitis).
13. Infections in postpartum women (endometritis, mastitis).
14. Anhydrous labor period> 6 hours.
15. Signs of infection of the amnion ("dirty" water, overlapping on the placenta).
16. Community-acquired childbirth.
High risk factors for generalization of bacterial infection
(macroorganism factors)
1. Severe intrapartum asphyxia against the background of chronic intrauterine hypoxia.
2. Birth trauma.
3. Malformations and hereditary diseases.
5. Prematurity< 32 недель гестационного возраста.
6. Birth weight< 1500 г.
A particularly high risk of developing a septic process is observed in the group of children with extremely low birth weight. Thus, in children weighing 500–750 g, the frequency of sepsis can reach 30–33%, which is also associated with an increase in the survival rate of these children outside the early neonatal period.
Iatrogenic factors of high risk of generalization of bacterial infection in newborns
1. Mechanical ventilation (tracheal intubation)> 3 days.
2. Catheterization of peripheral veins> 3 times.
3. Duration of intravenous infusion> 10 days.
4. Surgical interventions.
Clinic: varied. Sister needs to look for signs of early infection
Late falling off of the umbilical cord, slow healing of the umbilical wound, pyoderma
Persistent regurgitation
· Long-term preservation of jaundice.
There are two forms of sepsis:
1.septicemic (a form of sepsis without obvious purulent foci, manifested by intoxication, damage to internal organs, an inflammatory reaction). More often in premature babies.
2. septicopyemic (a form of sepsis, occurring with the formation of one or more purulent - inflammatory foci with severe symptoms of intoxication (more often - purulent meningitis, pneumonia, enterocolitis, osteomyelitis, etc.).
Clinic:
Distinguish between acute (within 3 - 6 weeks), subacute (1.5 - 3 months), protracted (more than 3 months) and fulminant course of the disease. Depending on the entrance gate of infection, the umbilical, cutaneous, pulmonary, intestinal, and otogenic sepsis are distinguished.
If the septic process occurs in the antenatal period and the child is already born sick, his condition is severe: there is an increase in temperature, pale gray skin with extensive dermatitis, hemorrhagic rash, swelling, exsicosis, regurgitation, vomiting, jaundice, enlarged liver and spleen, large initial loss of mass of thaw, greenish coloration near fertile waters.
Sepsis, which developed intra- and postnatally, is more often manifested by a gradual onset of the disease - a deterioration in the general condition in the first or second week of a child's life, low-grade fever, pallor of the skin with a gradual acquisition of a gray or earthy hue, lethargy, refusal to breast, regurgitation, vomiting, weight loss body, flattening of the body weight curve, increased duration and increased severity of jaundice, hemorrhagic phenomena on the mucous membranes, pyoderma, edema of the anterior abdominal wall and extremities.
There is a delay in mummification and separation of the umbilical residue, prolonged bleeding of the umbilical wound with late epithelialization, a long-lasting bloody crust in the center of the navel, a symptom of a reopened navel, omphalitis, unstable stupas, interstitial pneumonia, etc.
Weakening of physiological reflexes, weakness, muscle hypotension, restlessness, stools with mucus and greenery, bloating, swelling or pastiness of the abdominal wall, skin hyperemia over the arteries, strengthening of the subcutaneous venous network, thickening of the umbilical vein or artery, increased bleeding of the umbilical wound.
The septicopyemic form is characterized by the occurrence of purulent foci most often in the brain with the development of purulent meningitis. Development of pneumonia, ulcerative necrotizing enterocolitis, pyelonephritis, otitis media, conjunctivitis, etc.
Diagnostics is carried out on the basis of the clinical picture and laboratory data. In peripheral blood, anemia, neutrophilic leukocytosis with shifts of the leukocyte formula to the left, monocytosis, thrombopenia, increased serum bilirubin, alkaline phosphatase, thymol test, violation of the ratio of aspartic and alanine transaminases; in urine - transient albuminuria, bacterio- and leukocyturia. Isolation of the pathogen from a child's blood is a valuable but optional diagnostic criterion.
Regardless of the form of sepsis, the severity of the general condition of the child is characteristic. The earliest symptom is signs of intoxication and damage to the central nervous system.
CNS: depression, decreased motor activity, reflexes, muscle tone, agitation, convulsions.
Respiratory system: tachypnea, apnea, retraction of the compliant places of the chest.
The cardiovascular system: tachy- / bradycardia, hypo- / hypertension, deafness of heart sounds, threadlike pulse.
Leather: pallor, gray / icteric shade, rash, edema, sclera, marbling, cyanosis, necrosis, white spot symptom.
Gastrointestinal tract: refusal to suck, intestinal paresis, diarrhea, pathological weight loss, hepatosplenomegaly.
urinary system: oligo- / anuria.
Hemostasis system: bleeding, thrombosis.
When examining a child, a nurse should suspect sepsis by finding 7 "C":
- WEAKNESS
- Regurgitation
- GRAY SKIN
- SUBFEBRILLE LONG TEMPERATURE
- REDUCED TURGOR OF SOFT TISSUE AND MUSCLE TONE
- WORTH IN WEIGHT
- CHAIR UNSTABLE
With a favorable course, the duration of the disease against the background of treatment is 8-10 weeks. The acute period manifests itself for 10-14 days, then the symptoms of toxicosis fade away, the function of organs and systems is gradually restored, purulent foci are sanitized. During this period, cross-infection can easily join.
KLA in the acute period - pronounced leukocytosis (less often leukopenia, normopenia), left shift, anemia, m. thrombocytopenia.
There may be a lightning-fast course of sepsis 1-7 days, the development of septic shock.
Septicemia, caused by Staphylococcus aureus proceeds with a rapid malignant course, with the rapid development of multiple organ failure, rapid exhaustion, decompensation of all types of metabolism, toxic delirium, septic endocarditis, hepatolienal syndrome, infectious toxic nephrosis, endotoxic shock.
Clinic: Symptoms of intoxication predominate. General exhaustion, yellowness of the skin and mucous membranes, hemorrhages on the skin, mucous membranes, serous membranes, hemorrhages in the stomach cavity, internal organs and adrenal glands develop. From the side of the central nervous system - violations. Septicemia is characterized by intoxication of the body without local purulent-inflammatory foci, while septicopyemia reveals pyemic foci (abscesses, phlegmon, meningitis, otitis media, destructive pneumonia with pleural complications, etc.).
Laboratory diagnostics
1. KLA - in the acute period - pronounced leukocytosis (less often leukopenia, normopenia), left shift, anemia, m. thrombocytopenia.
2.bacteriological examination of blood, urine, feces and pus from pyemic foci (repeated cultures)
Forecast: serious. Mortality 25 - 55%.
CARE AND TREATMENT
Care:
1. Urgent hospitalization in a separate box, strict adherence to asepsis, hygiene regime (hygiene of the skin, mucous membranes)
2. Provision of a medical and protective regimen with anesthesia of invasive manipulations
3. Compliance with thermal and humid conditions: incubation of newborns (especially premature babies), temperature not lower than +30, humidity not lower than 60%.
4. organization of rational feeding of the child (priority of breastfeeding - by breastfeeding, from a bottle, through a tube), in the absence - with adapted formulas for feeding newborns, enriched with bifidobacteria. Increase the frequency of feeding by 1-2. According to indications - partial or complete parenteral nutrition (AA solutions).
3. In the period when the clinical manifestations of sepsis subside, the careful use of therapeutic massage, dry immersion, exercise in water begins.
5. the mother's care is obligatory in nursing and maintaining a positive emotional status, in the prevention of cross-infection, cooling, the implementation of the toilet of the skin and mucous membranes.
Treatment:
The goal of treatment is to prevent the death of the disease, which develops in the absence of therapy or inadequate treatment.... It should be remembered that the entire volume of drug therapy should be started as early as possible.
Treatment. They are urgently hospitalized in specialized departments of neonatal pathology if surgical intervention is necessary. Feeding with breast milk (mother's breast or expressed breast milk through a tube, from the nipple).
Treatment is symptomatic with the use of broad-spectrum antibiotics in combination with drugs that stimulate defense mechanisms and restore biological balance.
When the patient's condition improves, active immunization agents are used - staphylococcal toxoid, autovaccine, staphylococcal bacteriophage, drugs that stimulate immunogenesis. All this is used in combination with biologically active substances such as lactobacterin, bifidumbacterin and vitamins.
Drug therapy for sepsis suggests a combination of the main - etiotropic treatment with pathogenetic correction of metabolic, immune and organ disorders
1.Etiotropic therapy:
Antibiotics: Currently, there is no universal drug, a combination of drugs that could be used equally effectively to treat any newborn with sepsis. Antibiotics are prescribed empirically, taking into account the most likely spectrum of possible infectious agents in a given patient and depending on the type of sepsis. Therapy is ineffective, during which an increase in the severity of the condition and organ failure is noted within 48 hours. This is the basis for the transition to alternative antibiotic therapy. With successful antibiotic therapy, its duration is at least 4 weeks, and (with the exception of aminoglycosides, the course of which should not exceed 10 days), the course of the same drug, with its apparent efficacy, can reach 3 weeks. The basis for the abolition of antibacterial drugs is the sanitation of primary and piemic foci, the absence of new metastatic foci, relief of signs of a systemic inflammatory reaction (SVR), persistent increase in body weight, normalization of the peripheral blood count and platelet count.
3.semi-synthetic penicillins (ampicillin, oxacillin) + aminoglycosides (amikacin, netilmecin)
4.cephalosporins 1-2-3 generations (cefazolin, cefuroxime, ceftriaxone, cefatoxime) + aminoglycosides
2. Given the need for long-term and intensive antibiotic therapy, dysbiosis is corrected: at the same time, probiotics(bifidum-bacterin, lactobacterin, linex, etc.) and antimycotics(Diflucan, Medoflucon, Forcan, etc.)
3.INFUSION THERAPY
They start with colloidal solutions (fresh frozen plasma, gelatinol, dextran, but not albumin, which, when administered, leaves the body tissues), which are administered at the rate of 20 ml / kg of the child's body weight in the first 5-10 minutes of infusion therapy by bolus or drip. Then crystalloids are injected drip, on average 40-60 ml / kg of body weight, but they can be injected when indicated (for example, with exicosis) and in large quantities. Fresh frozen plasma contains antibodies, proteins, in addition, it is a donor of antithrombin III, the level of which significantly decreases with the development of sepsis, which, in turn, causes depression of fibrinolysis and the development of disseminated intravascular coagulation syndrome (DIC), therefore, fresh frozen plasma is especially indicated with DIC - syndrome. Infusion therapy also includes solutions of potassium, calcium, magnesium, and, if necessary, parenteral nutrition - solutions of amino acids.
4.oxygen therapy
§ FACE MASK
§ NOSE CATHETERS
5. ANTI-SHOCK THERAPY In septic shock and adrenal insufficiency, glucocorticoids are indicated.
6.IMMUNO REPLACEMENT THERAPY
§ LEUKOCYTE SUSPENSION
(For sepsis, accompanied by absolute neutropenia (less than 1.5 * 10 9 / L neutrophils in the analysis of peripheral blood), as well as with an increase in the neutrophilic index of more than 0.5 for the purpose of immunocorrection, transfusion of a suspension of leukocytes is used at the rate of 20.0 ml / kg of weight the child's body every 12 hours until the level of leukocytes of 4.0 ¥ 109 / L in peripheral blood is reached.This method of treatment is due to the key value of neutrophils in the pathogenesis of SVR in sepsis).
§ IMMUNOGLOBULINS (preparations of immunoglobulin with increased titers of IgM (Pentaglobin) .– for intravenous administration. (The concentration of IgM and IgA in the neonatal period is extremely low and begins to increase only from 3 weeks and 3 months of age, respectively).
§ LIKOPID
§ RECOMBINANT INTERFERONS (Viferon)
§ human leukocyte interferon
7.NORMALIZATION OF EXCHANGE OF SUBSTANCES
§ VITAMINS
§ AMINO ACIDS
§ ENZYMES
8 SYMPTOMATIC AND SYNDROMIC THERAPY
9.LOCAL TREATMENT OF PURULENT FOCUS
Dispensary supervision
1.Observation in a polyclinic for three years
2.examination by a pediatrician, neurologist (other specialists according to indications)
3.planned restorative therapy
4.medical withdrawal from occupational vaccinations, consultation with an immunologist
Prevention
1. Antenatal:
ü Identification and treatment of chronic foci of infection and acute diseases in pregnant women
ü Correct organization of the daily routine and nutrition, walks
ü Prevention and treatment of pregnancy complications
2. Postnatal:
ü Careful adherence to asepsis during childbirth, when caring for a newborn
ü Compliance with hygiene by the mother and persons caring for the child
ü Early breastfeeding
ü Timely detection and treatment of localized pyoinflammatory diseases
After discharge from the hospital - observation in a polyclinic for three years by a pediatrician, neuropathologist and other specialists, depending on the nature of the course of the disease.
With cerebral dysfunction, phenibut, aminalon, encephabol, etc. are shown for six months.
Prevention - strict adherence to the sanitary and epidemiological regime in obstetric institutions, departments of newborns in city hospitals.
Target:
Prevention of infection and early healing
Equipment:
Medicines: 3% solution of H2O2, 70% ethyl alcohol, 5% solution of potassium permanganate;
Sterile material: cotton balls, napkins, wooden sticks with cotton swabs;
Tags, tweezers, phantom doll, changing table, underwear, gloves.
The progress of the treatment of the umbilical wound in the maternity hospital :
Unwrap the baby on the table or crib;
Wash, dry and treat hands (gloves) with an antiseptic solution;
If necessary, wash the child and treat his hands again;
Dissolve the edges of the umbilical ring and, using a pipette or a cotton swab taken with tweezers, abundantly cover the umbilical wound with 3% solution of H2O2;
After 20-30 seconds, dry the wound by extinguishing it with a cotton swab on a stick;
Treat the wound and skin around with a wooden stick with a tampon moistened with 70% ethyl alcohol, another stick with 5% solution of potassium permanganate, treat only the wound, without touching the skin, swaddle the child;
Swaddle the baby.
NB! The umbilical cord residue is treated with 96% or 70% alcohol and 5% permanganate solution daily, after removing the Chistyakova bandage. When cutting off the umbilical cord residue on the 3rd day, a tampon with 3% solution of H2O2 and a pressure bandage is applied to the wound for 5 hours. Then daily processing according to the above algorithm.
At home, the umbilical cord wound is treated in the morning and after bathing with alcohol solution of brilliant green with a sterile stick or from a pipette. The mother washes her hands with soap and treats her with cologne or any antiseptic. The maximum wound healing time is 2 weeks.
NB! With prolonged healing of the umbilical wound (more than a week), prescribe 2-3 UFO sessions (do not lubricate with brilliant green before the session). If there is no healing for 2-3 weeks, consult a surgeon to exclude fistula (provided that there are no signs of inflammation).
Omphalitis- inflammation of the umbilical wound.
Local and general treatment.
Treatment:
1. Dilute the edges of the umbilical wound, drip 3% solution of HO (with gloves)
2. Dry with a sterile stick
3. alternate applications with a hypertonic solution (10% NaCl) and with antibiotics (zinacef, claforan, amoxiclav)
P.S. Compositions levomekol and levosin combine hypertensive antibacterial and keratoplastic action, they can be used after treatment with 3% HO.
Administration of monovalent mumps (measles) vaccine
Purpose of the introduction:
prevention of epidparotitis, measles, rubella.
Equipment:
Sterile table with cotton balls, napkins, tweezers;
Gloves;
Mumps (measles) vaccine;
Solvent for mumps and measles vaccines;
Beaker for placing vaccine ampoules in it;
Light protection cone made of black paper (for live bark protection);
A tray with a disinfectant solution for dropping syringes;
Container with a disinfectant solution for waste material;
70% ethyl alcohol.
Stages:
Wash and dry hands, wear gloves;
Remove the ampoules with the vaccine and the solvent from the package;
Wipe the necks of the ampoules with a cotton ball with alcohol, cut with an emery disc;
Open with a sterile napkin and break;
Spent cotton balls, throw a napkin into a container with a disinfectant solution;
Opened ampoules with a dry live vaccine must be placed in a beaker;
Open the package of the syringe, put a needle with a cap on it, fix the needle on the cannula of the syringe;
Remove the cap from the needle;
Take an ampoule (ampoules) with a solvent and draw it into a syringe in the amount calculated earlier;
Inject the solvent (carefully along the wall) into the ampoule with the vaccine;
Stir the vaccine by reciprocating the piston in the syringe;
Draw 0.5 ml of the dissolved mumps (measles) vaccine into a syringe;
Return the ampoule with the remaining dissolved vaccine to the beaker and cover with a sterile gauze cap (and a light-shielding cone, if it is a measles vaccine);
Take a napkin from a sterile table with tweezers and release air from the syringe into it (throw the napkin into a container with a disinfectant solution);
Put the syringe inside the sterile table;
Treat the skin in the subscapularis or the outer part of the shoulder with 70% ethyl alcohol (leave a cotton ball in your hand);
Grab a section of skin in a fold between 1 and 2 fingers;
Introduce a needle directed at an angle of 45 into the formed fold;
Introduce the vaccine;
Remove the needle;
Treat the injection site with a cotton ball left in your hand after processing the injection field;
Throw the cotton ball and syringe into the tray with disinfectant (after rinsing the syringe);
Remove gloves and discard them in disinfectant solution.
P.S. There is a combined vaccine measles epidparotitis or measles + rubella + epidparotitis (trimovax). The technique of administration and the dose of rubella vaccine are the same 0.5 ml s / c! release in bottles! 10 doses!
- 17- 34
Insulin administration rules
1. Insulin is administered subcutaneously, in a coma, IV. The patient himself s / c - into the anterior abdominal wall and the lateral surface of the thigh. Nurse: n / a lower angle of the shoulder blades and middle third of the shoulder.
2. Introduce, observing the triangle rule (insulin should not be injected in the same place).
3. The skin is treated with any sterile solution (you cannot use alcohol or another sterile solution after alcohol).
4. After the injection of insulin, the patient must be fed in 15-20 minutes.
5. Do not mix prolonged and simple in one syringe, prolonged can not be administered IV.
NB! Insulin comes in a ready-to-use form; it is a pancreatic hormone that promotes glucose uptake by tissues.
Complications after insulin administration:
Lipodystrophy (disappearance of the subcutaneous layer at the injection sites)
Abscessing
Allergic reactions
Hypoglycemic conditions
False croup is a stenosing laryngotracheitis.
This is an acute disease characterized by impaired airway patency in the larynx and the development of respiratory failure in ARVI and influenza.
Development mechanism:
2.edema of the garter space
3. accumulation of sputum in the lumen of the larynx.
Clinical manifestations:
Rough barking cough;
The phenomenon of respiratory failure (the child is restless, tosses about in the crib, inspiratory dyspnea, cyanosis are manifested, auxiliary muscles are involved in the act of breathing: the wings of the nose, intercostal muscles, the diaphragm), stenotic breathing.
After being discharged from the hospital, the mother stays alone with the child and faces the need for him. Some phenomena can scare a woman, in particular, many young mothers do not know how to properly care for an umbilical wound. Often, babies have a problem in the form of a wet navel, how to deal with this?
Symptoms of a weeping navel
In the first minutes after birth, the baby's umbilical cord is clamped with a clamp and cut. The umbilical cord residue normally disappears within two to four days. In its place, an umbilical wound is formed, which is covered with a crust. Complete healing of the navel occurs within two to three weeks.
Normally, the healing process of the umbilical wound may be accompanied by slight weeping and the formation of yellowish crusts. But in the case of severe weeping and poor healing of the umbilical wound, they speak of the development of catarrhal omphalitis (weeping navel).
In the development of omphalitis, bacteria (- and,) are to blame, which penetrate into the tissues through the umbilical cord or the umbilical wound. The vital activity of bacteria leads to the development of inflammation.
Symptoms of catarrhal omphalitis (weeping navel) are:
With long-term weeping, an overgrowth of mushroom-shaped granulation tissue can form - this is called the navel fungus. Catarrhal omphalitis does not affect the general condition of the child. This form of the disease is the most favorable and often occurs among newborns.
Symptoms of purulent omphalitis in newborns
If the discharge from the umbilical wound becomes yellow, thick, this indicates the development purulent omphalitis... At the same time, the skin around the navel swells and turns red. When inflammation spreads to the umbilical region, phlegmonous omphalitis, which is characterized by pronounced edema, redness of the skin around the navel, as well as protrusion of the umbilical region. The skin around the navel is hot to the touch, and when you press on this area, pus flows out of the umbilical wound.
A complication of this form of the disease is necrotizing omphalitis... This is a very rare condition often found in weakened babies. With necrotizing omphalitis, the inflammatory process spreads deep into the tissues. The skin in the umbilical region becomes purplish-cyanotic and soon peels off from the underlying tissues with the formation of a large wound. This is the most severe form of omphalitis and can lead to sepsis.
Purulent omphalitis is difficult, children become lethargic, suckle poorly, and an increase in temperature is noted. Fortunately, purulent forms of omphalitis are rare.
Prevention and treatment of a weeping navel in newborns
If parents are faced with such a problem as navel weeping, it is necessary to contact a pediatrician. The doctor will process the umbilical wound and teach this manipulation to the parents. With catarrhal omphalitis (weeping navel), the doctor can treat the disease at home. However, with purulent forms of omphalitis, hospitalization of the baby is mandatory.
Treatment and prevention of a weeping navel is carried out as follows:
All newborns need to carry out this procedure once a day until the umbilical wound is completely healed. Babies with a weeping navel can be manipulated two to three times a day.
Fungus of the navel is treated by cauterization of granulations with a 5% solution of silver nitrate. In the case of phlegmonous omphalitis, the baby is prescribed antibiotics internally, as well as externally in the form of ointments. With a necrotic form of the disease, in addition to antibacterial treatment, surgical excision of dead tissue is performed.
What is unnecessary to do with a wet navel?
Unfortunately, good intentions do not always lead to the fastest recovery. So, some manipulations can further aggravate the poor healing of the umbilical wound.
What mistakes do parents often make when caring for a baby's navel?
- You should refrain from bathing your child in baths. It is enough to wipe the baby with a wet towel every day.
- Do not cover the navel with a plaster, diapers, clothes. Contact of the skin with air helps to dry out the wound.
- Try to forcefully tear off the crusts.
- Treat the wound with an antiseptic more often than the doctor advised.
After being discharged from the hospital, a young mother stays alone with her baby and faces all the problems that arise when caring for a child. Some situations can be intimidating for parents. The main problem is the lack of necessary data on navel care. Many children have a wet navel, but only a few know how to cope with this situation.
Weeping navel or omphalitis is a process, the main characteristic of which is the presence of serous discharge from the umbilical wound and a reduced rate of its epithelialization.
In most situations, the disease occurs in the second week of a child's life. The group of the main pathogens includes staphylococci, streptococci, Escherichia coli and other pathogenic flora. A wet navel is the most common and mildest form of the condition.
As a rule, still before the baby is discharged from the hospital, the wound on the navel becomes covered with a bloody crust, which heals within 10-14 days. In the presence of an inflammatory reaction, the wound heals slowly and serous discharge appears on its surface, and a slight hyperemia of the umbilical ring is also possible. More details about the healing time and how to avoid problems during this period can be found in the article on.
Omphalitis is a harmless inflammatory disease that, in the absence of the necessary treatment, can lead to the formation of formidable complications. Therefore, every parent who does not know how to cope with the treatment of an umbilical wound should seek help from a specialist.
Often, omphalitis develops due to insufficient or improper care. For example, if the baby was not bathed in boiled water, after which the wound was not worked out with a disinfectant, or if the cleanliness of the linen was not sufficiently taken care of, then inflammation of the umbilical wound may develop.
All of the above factors can contribute to its infection, which is manifested by the release of serous fluid, the formation of a crust, its rejection and the subsequent formation of small ulcers.
Warning signs of poor healing
If you find the symptoms described, you should immediately seek the advice of a pediatrician Omphalitis can be a threat to the life of a child only in the following situations:
- The shade of the fluid separated from the navel has changed (there is an admixture of blood and pus);
- The volume of discharge has increased;
- The liquid has an unpleasant specific odor;
- Swelling of the skin is found around the wound;
- The baby's general condition has worsened: moodiness, poor breastfeeding and fever;
- The wound heals for more than 21 days;
- The presence of other suspicious manifestations that cause fear and anxiety in the mother.
Consequences and complications
With timely treatment for medical care, the prognosis of omphalitis is favorable. It should be noted that the duration of the course of the disease directly depends on its form:
- a simple form is quite simple to cure, it proceeds easily and is not characterized by the presence of complications;
- in the presence of purulent inflammation, complications, as a rule, do not appear, but the disease becomes longer;
- phlegmonous and necrotic forms occur with complications.
The main thing that parents should remember: if the treatment of omphalitis occurs without the supervision of a pediatrician, then the risk of developing a number of complications increases significantly.
The most common are:
- the development of an inflammatory reaction in the umbilical lymphatic vessels (lymphangitis);
- inflammation of the blood vessel (arteritis, phlebitis);
- inflammation of the bone tissue;
- inflammation of the digestive tract.
Abscesses, peritonitis, lymphangitis - complications of omphalitis which can be avoided with proper wound care. In order to properly cope with this task, you need to promptly seek help from a pediatrician.
With the development of phlegmonous and necrotic forms of omphalitis, the following complications may occur:
- development of phlegmon of the abdominal wall;
- inflammation of the abdominal cavity;
- general infection with pathogenic flora, which has entered the baby's body in large quantities;
- the development of abscesses in the internal organs;
- with excessively prolonged infection, an overgrowth of granulation tissue and the further formation of a small tumor from the connective tissue may occur.
Treatment features
- Before starting the toilet of the umbilical wound, you must thoroughly wash your hands with soap and water;
- After that, 2-3 drops of hydrogen peroxide (3%) should be poured into the area of the umbilical wound (using a sterile pipette);
- The next step is to remove the crust: to do this, you need to gently move along the surface of the umbilical wound and the bottom of the navel;
- The last step is to treat the wound with a sterile cotton swab and 2% brilliant green solution.
- All babies without fail need to carry out such a procedure once a day until the wound is completely healed. For children with the excretion of serous fluid, the toilet of the wound surface can be carried out up to 3-4 times a day.
How to care for an umbilical wound
A few main rules:
- Do not put pressure on the navel;
- No need to poke around in the wound with cotton swabs or your finger;
- No need to try to get rid of all the crusts in one procedure;
- It is strictly forbidden to squeeze out pus;
- You do not need to bandage the wound or seal it with a plaster;
- The child needs to be undressed more often in order for the skin to breathe and in parallel with this the wound dries up;
- Do not hope for self-healing of the inflammation that has arisen;
- Before touching the baby, be sure to wash your hands;
- To care for a child, you need to use only sterile materials and dress him only in clean clothes;
- Things in contact with the wound should be made of hypoallergenic material and before using them, you need to iron the fabric with a hot iron;
- Don't wear one thing twice;
- If the treatment used does not normalize the situation, then you need to seek help from a doctor as soon as possible.
Is it possible to bathe if the umbilical wound oozes
In case of problems with the umbilical wound, bathing is possible with the observance of precautions Most mothers are interested in the question of whether it is possible to bathe the child if the navel gets wet, the answer is - it is possible, but this must be done with caution.
To bathe your baby, you need to purchase a special bath in advance and you only need to fill it with boiled water.
There is no need to add gels or bath foam to the water. Potassium permanganate solution may be the only additional agent.
To prepare it, you need to dilute 5 grams of potassium permanganate in half a glass of water and then pour the resulting liquid into the bath. Care must be taken to ensure that all crystals are dissolved.
It must be remembered that potassium permanganate dries out the skin., therefore, it is not recommended to do such baths too often. What should be the temperature of the water in the bath when bathing a newborn, you can find out from this. How to properly rinse a baby's nose (saline, Aquamaris) - read in this publication.
What and how to process
The development of omphalitis is characterized by the presence of serous discharge from the wound, redness of the skin and slow healing. Daily cleaning of the wound surface with a disinfectant solution can correct the situation.
- Brilliant solution is a universal remedy for treating wounds on children's skin. It is he who has drying and disinfecting effects that prevent the multiplication of pathogenic microorganisms on the wound surface. If the child's navel gets wet, then this remedy can be used without any fear.
- 3% hydrogen peroxide can also be used as a treatment for a weeping navel. The main thing is not to use the product too often, because this can make it more wet.
- Furacil and chlorophyllipt are disinfecting alcohol solutions, the action of which is aimed at the speedy drying and healing of the wound surface.
To find out how much the navel heals and 5 simple steps how to handle it, go to.
What not to do during treatment
- Some pediatricians are convinced that you can do without bathing your baby in a tub. To do this, you need to wipe the child with a damp towel every day.
- No need to cover the navel with a plaster, put on a diaper or clothes to cover the wound. It is the contact of oxygen with its surface that contributes to drying and crust formation.
- Don't try to peel off the crusts.
- There is no need to treat the wound surface using an antiseptic more often than the pediatrician said.
Prevention
Prevention of inflammation of the umbilical wound consists in its timely treatment and proper care. The baby's skin is treated after bathing. Once the wound has healed, you can stop using disinfectants.
From the experience of parents
Alina, 23 years old, daughter 4 months old, Lyubertsy
Omphalitis is a disease that I have come across face to face. The presence of discharge, the constant formation of crusts and redness of the skin disappeared a week after the start of the correct toilet of the wound.
Oleg, 23 years old, 3 months old son, Balashikha
Before discharge, as well as after it, in addition to reading books and advice from relatives and friends, it seemed that we could easily cope with such a trifle as taking care of the umbilical wound.
After we took our son from the hospital, my wife and I tried to take care of him as much as possible, but we could not avoid inflammation of the navel. Only his daily treatment on the advice of the district pediatrician helped to improve the situation.
Maintenance of the umbilical cord and umbilical wound in the maternity hospital and after discharge from the maternity hospital.
The ears are lavaged once a week as needed.
In case of illness - according to the doctor's prescription.
Nutrition of the child before birth is carried out at the expense of the mother's body through the placenta and umbilical cord. After the baby is born, a disposable plastic clip is applied to the umbilical cord. The cult of the umbilical cord dries up and mummifies when exposed to air without any treatment with antiseptics. The fall of the umbilical cord stump with a plastic clamp applied to it usually occurs by 10-14 days after the birth of the child.
When caring for the umbilical cord and umbilical wound, you must adhere to the following rules:
1. The main conditions for accelerating the drying process of the umbilical cord residue and its fall off, as well as for preventing infection of the umbilical cord residue and umbilical wound - dryness and cleanliness.
2. Avoid getting fat, urine, feces on the umbilical cord residue.
3. In case of contamination of the umbilical cord residue - it must be washed with running water (you can use soap) and wipe dry with a gauze cloth or a clean ironed diaper
5. Keep the navel area open to the air (while feeding and waking the baby).
6. When using a diaper, fix it below the navel area.
7. You can bathe a child with an umbilical cord residue, you can bathe in unboiled water (it is not advisable to add "potassium permanganate" - it dries the skin excessively, removes beneficial microflora from the skin, the risk of colonizing the skin with conditionally pathogenic and pathogenic microflora)
8. If signs of infection of the umbilical cord stump or umbilical wound appear (the appearance of pus from the umbilical cord stump or from the bottom of the umbilical wound, redness of the skin around the navel, an unpleasant odor) - consult a pediatrician.
In most cases, when caring for the area of the umbilical fossa after the umbilical cord has fallen off, it is sufficient to observe dryness and cleanliness, bathe the child daily.
Only in isolated situations - with the development or threat of the development of the inflammatory process, it is necessary to conduct a toilet of the umbilical wound before it heals with the use of antiseptics.
Target: Therapeutic.
Equipment:
1.3% hydrogen peroxide solution
2.1% alcohol solution of brilliant green.
3. Sterile tweezers.
4. Sterile material (sterile cotton swabs).
5. Sterile rubber gloves.
6. Tray for waste material.
Sequencing:
1. Introduce yourself to the mother, explain the purpose and course of the upcoming procedure, obtain verbal consent.
2. Prepare the necessary equipment.
3. Wash your hands and dry your hands.
4. Put on sterile gloves.
5. Take a sterile stick with sterile tweezers.
6. Moisten the stick with 3% hydrogen peroxide solution over the tray.
7. Separate the edges of the umbilical wound with the thumb and forefinger of the left hand
8. Insert a stick dipped in hydrogen peroxide into the umbilical wound strictly perpendicularly and process the wound from the center to the periphery
9. Dispose of the stick into the waste material tray (class B waste).
10. Dry the wound with another sterile stick.
11. Dispose of the stick into the waste material tray (class B waste).
12. Moisten the third sterile stick with 1% alcoholic solution of brilliant green.
13. Dissolve the edges of the umbilical wound, process it from the center to the periphery, without touching the skin.
14. Dispose of the stick into the waste tray (class B waste).
15. Disinfect and dispose of used material, gloves.
16. Remove gloves, wash and dry hands.
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