Breeding is associated with the risk of infectious and non-infectious diseases, which occur quite often in both large enterprises and small farms. Knowing the most common symptoms will allow early recognition of the disease in the early stages and prevent infection of the entire herd. In this article, we will discuss the symptoms, treatment and prevention of pasteurellosis in cattle.
What kind of disease?
Pasteurellosis is a contagious infectious disease to which domestic and wild animals are susceptible. The causative agent of this disease is the bacterium Pasteurella multocida (sometimes P. haemolytica).
Pasteurella is found on the mucous membranes of the gastrointestinal tract (GIT) of animals, but the disease develops only in weakened, unvaccinated animals.
Once in the blood, the bacterium is carried by the blood throughout the body and causes edema, inflammation, hemorrhages in various organs: lungs, pleura, intestines, joints.
Young animals are considered the most susceptible to infectious diseases, since in the first days after birth they do not have a full-fledged immune defense. In cattle, outbreaks of pasteurellosis are more common in summer and early autumn - in July, August and September.
Did you know? Louis Pasteur received a pure culture of the pathogen and for the first time tried to make a killed vaccine. In his honor, in 1910, this microorganism was named Pasteurella.
This disease leads to large losses when it enters large livestock farms, since it leads to the death and slaughter of livestock, the cost of treatment.
Causes and causative agent
Pasteurella multocida, the causative agent of pasteurellosis, belongs to aerobic bacteria. Microscopic examination of the culture reveals short oval rods arranged in pairs or chains.
These are immobile bacteria, gram-negative when stained. Pasteurella has low resistance, since it does not form spores: it can be found in them within 2–3 weeks, and in corpses, they persist for 3–4 months.
These bacteria are quickly killed by sunlight and many disinfectants. Sources of infection in cattle can be any sick animals (pigs,) and pasteurel carriers.
The carriers are non-diseased individuals who were kept next to the sick. In some farms, pasteurelling can reach 70%. Those in contact with sick animals can be a source of infection throughout the year. The spontaneous incidence of pasteurellosis is facilitated by changes in housing conditions, driving or transporting livestock, as this can weaken the animals.
Important! Often pasteurellosis develops as a result of autoinfection in prosperous farms - with a decrease in the immunity of pasteurella, which are in the host's body, penetrate the bloodstream and affect the internal organs.
Sick animals excrete the pathogen with feces, urine, saliva, milk and coughing. can get sick from contact with care items, manure, feed, water. Infection can also occur through damaged skin, for example, when bitten by rodents or bloodsucking.
Bacteria enter the mucous membranes of the gastrointestinal tract and respiratory tract or directly into the blood (scratches, animal and insect bites). 
Symptoms of manifestation in different forms
The incubation period lasts up to 2-3 days, and if it enters the bloodstream through damaged skin, the disease develops after a few hours. The duration of the disease can vary and depends on the immunity of the animal, the virulence of the bacteria, the living conditions of the livestock, and concomitant diseases.
Often pasteurellosis occurs in combination with salmonella, diplococcosis, parainfluenza and adenovirus infection. Depending on the duration of the disease and the rate of development of symptoms, acute, hyperacute, subacute and chronic forms of the disease are distinguished.
Did you know? You can also become infected with pasteurellosis through contact with wild animals. Even cats can carry Pasteurella.
Sharp
In case of an acute course in a cow, the temperature rises to 40–42 ° С. The animal becomes lethargic and eats worse. Milk flow stops. In some cases it develops.
Against the background of fever, swelling of the pharynx and oral cavity appears (edematous form). The breast form of cattle pasteurellosis is characterized by the predominance of symptoms of respiratory failure, which appears against the background of croupous pneumonia, and impaired swallowing. 
The patient breathes quickly and heavily, there may be a dry cough. In young animals, in most cases, the intestinal form develops. A mixture of flakes and blood appears in the watery stool.
Sometimes nosebleeds, inflammation of the conjunctiva of the eyes and blood in the urine begin. Intoxication, breathing disorders and cardiac activity lead to death in 2-3 days.
Subacute
For the subacute course, the development of pleuropneumonia, inflammation of the joints (arthritis) and nasal mucosa (rhinitis) is characteristic. Against the background of fever, a cough, mucous or mucopurulent discharge from the nose appears.
At the end of the disease, bloody diarrhea may begin. The disease ends in death in 3-5 days.
Hyperacute
With a hyperacute course, the symptoms of the thoracic form of the disease develop rapidly. The temperature rises to 41 ° C, inflammation of the vocal cords and pharynx begins. This is manifested by heavy breathing, coughing. 
The neck and intermaxillary region swell. In some cases, bloody diarrhea may appear. Animals die within 12 hours of the day due to asphyxia or pulmonary edema.
In some cases, death occurs suddenly due to acute heart failure before the onset of clinical manifestations of the disease. In the septic form, the rapid death of the animal occurs against the background of diarrhea and high fever.
Chronic
The chronic course of the disease is characterized by less pronounced respiratory and digestive disorders. Prolonged diarrhea (frequent, runny bowel movements) lead to weight loss and wasting.
Pneumonia develops slowly. Swelling of the joints gradually appears. With this course of the disease, animals die in a few weeks. 
Diagnosis of the disease
The diagnosis is made taking into account the analysis of data on the incidence of pasteurellosis in cattle in the region, based on the development of symptoms in sick cows. An autopsy of dead cattle is mandatory to assess structural changes in the tissues.
For microscopic and bacteriological examination, samples of parenchymal organs and blood are taken.
Pathological changes in organs depend on the course and form of the disease. With acute and hyperacute development of the disease, multiple hemorrhages are found in the heart and liver.
Inflammatory changes in the lungs, swelling of organs, foci of necrosis in the kidneys and liver are characteristic of the chronic course of the disease. Organs of dead animals are taken for examination no later than 3-5 hours after death. 
In hot weather, samples should be preserved with a 40% glycerin solution prior to transportation. Nasal mucus and blood are taken from calves and adult cows with pasteurellosis.
Laboratory diagnostics consists of:
- examination of blood smears under a microscope;
- isolation of culture in special environments;
- infecting laboratory mice and rabbits with a culture grown in a nutrient medium;
- determining the degree of virulence of the pathogen.
Treatment of pasteurellosis in cattle
Affected cows are isolated in a warm, dry room. It is important to provide the animal with adequate nutrition during treatment. Intravenous and intramuscularly injected, to which pasteurella is sensitive: tetracycline, chloramphenicol, streptomycin and sulfa drugs.
For treatment, hyperimmune sera are used against pasteurellosis in cattle. Additionally, a glucose solution and physiological saline are injected intravenously. Serum administration begins when the first symptoms of the disease appear.A good therapeutic effect is provided by the combined intravenous administration of a double prophylactic dose of serum and long-acting antibiotics. Recovered animals within 6-12 months have good immune protection against pasteurellosis. 
Did you know? Some calves born on problem farms have a natural immunity to Pasteurella. Their immunity is not always inherited from their mothers, but transmitted through the generation.
Prevention measures
Compliance with the sanitary rules for keeping and caring for livestock is important for the prevention of pasteurellosis, as this helps to improve immunity. If pasteurellosis is detected in a herd, not sick cattle must be vaccinated.
After a double injection of the precipitated vaccine, immunity is formed, which lasts 6 months. A single injection of emulsified vaccines provides immune protection against Pasteurella for at least a year.
The nutrition of a premature baby should be based on the needs of his body and the capabilities of his digestive system.
Premature babies are characterized by high rates of physical development. Naturally, their body also needs more calories per 1 kg of weight compared to full-term babies. The capabilities of the digestive apparatus in the first weeks of life are very limited. The discrepancy between the need and the ability of the organism during this period also predetermines the calculation of nutrition.
Feeding premature babies begins with a small daily diet, providing about 20-35 calories per 1 kg of the baby's weight. The calorie intake is gradually increased and by the end of the first month it is brought to 130-140 calories per 1 kg of body weight. This calorie intake is currently considered optimal for the normal physical development of premature babies.
An approximate calculation of nutrition in the first 10 days of life is given in table 4.
Table 4. Approximate calculation of nutrition (daily amount of milk) for premature babies in the first 10 days of life
| Age (in days) | Milk quantity in g per 1 kg of child's weight (per day) |
Calorie count per 1 kg of child's weight (per day) |
| 2 | 30 | 20 |
| 3 | 30-45 | 20-30 |
| 4 | 40-60 | 30-42 |
| 5 | 50-75 | 35-52 |
| 6 | 60-90 | 42-63 |
| 7 | 70-105 | 49-73 |
| 8 | 80-120 | 56-84 |
| 9 | 90-135 | 63-94 |
| 10 | 100-150 | 70-105 |
As can be seen from Table 4, the daily increase in milk during this period is on average 10-15 g per 1 kg of the child's weight. In the following days, the rate of increase in the daily amount of milk decreases.
For children over the age of 10 days, it is more advisable to calculate food in a volumetric way (depending on the weight of the child). In doing so, we use the following relationships. In children aged 10-14 days, the daily amount of food is 1/7 of body weight (approximately 100 calories per 1 kg of body weight). Children at the age of three weeks receive a daily amount of food corresponding to 1/6 of their body weight (approximately 120 calories per 1 kg of body weight). For children about a month old, the daily amount of food corresponds to 1/5 of the child's body weight (approximately 135-140 calories per 1 kg of body weight).
For example, a child weighing 1960 g at the age of 11 days will receive about 280 g of milk per day (1960: 71 = 280), which will correspond to 100 calories per 1 kg of weight.
The number of calories that a child receives per 1 kg of weight is calculated as follows. 1 liter of human milk contains 700 calories, and 100 g of milk contains 70 calories. Therefore, 280 g of milk that this child receives will contain 196 calories (2.8X70), which, in terms of 1 kg of weight, will be 100 calories (196: 1.96 = 100).
When calculating nutrition, the individual characteristics of the child should be taken into account (sucking activity and daily weight gain). If a child sucks sluggishly and, as a result, receives a lower calorie intake than he should be in terms of age, this does not affect his weight curve, then there is no particular need to increase the amount of food.
The increase in the amount of food in deeply premature babies should be done carefully and gradually. In this case, it is necessary to pay attention not only to the age of the child, but also to his general condition. In case of a sudden deterioration, the amount of milk during each feeding must be reduced, and in some cases it is advisable to skip the next feeding. In case of sudden bloating, the child should not be fed until the symptoms of flatulence are completely or partially eliminated.
When feeding premature babies, especially those with low birth weight, the nurse should strictly adhere to the amount of food indicated by the doctor and never increase it on her own. If the nurse thinks that the child is not eating enough, she must notify the doctor about this, and only with his permission, the previously prescribed nutrition is changed.
1. Rommel's formula
V days / YO mass gr. = N + 10
Khazanov's formula
V days / South Ossetian mass = n x 10 (15)
3 Chagall's formula(per 100 g. mass)
1 week - n + 10
2 week - n + 15
3 week - n + 18
4 week - n + 20
Volumetric method
1 week - 1/8 of body weight
2 week - 1/7 - "-
3 week - 1/6 - "-
4 week - 1/5 - "-
5Formula R.A. Malysheva(first 10 days of life)
V = 14 x mass x age (days of life)
V - daily volume of milk or mixture (ml)
m is the weight of the child (kg).
6. Calorie method
The first 10 days of life - 10 calories x day x mass
2 weeks - 110cal / kg / day
3 week - 110 - 120 cal / kg / day
4 week - 130 - 140 cal / kg / day
After 10 days of life - 100 calories + 10 calories for each week of life. The energy requirements of premature babies by 3-4 weeks of life increase to 130 kcal / kg / day with artificial feeding and up to 140 kcal / kg / day with breastfeeding. Starting from the second month of life of a premature baby born with a body weight of more than 1500 grams, the calorie content of the diet decreases monthly by 5 kcal / kg / s to the norms adopted for mature children (115 kcal / kg / s). The reduction in the caloric content of deeply premature babies (weight less than 1500 grams) is carried out at a later date - after three months of age. Nutrition calculations are carried out taking into account the body weight at birth, and with the beginning of a complete restoration of weight and the emerging increase in the weight curve, taking into account the actual weight.
When calculating nutrition for premature babies, it is better to use only the "calorie method".
Nutrition for children aged 1 to 3 years.
In the second and third years of life, the child continues to grow intensively, the processes of assimilation prevail over the processes of dissimilation. The child's motor activity increases, energy costs increase. Skeleton formation continues, muscle mass increases. The functional ability of the digestive tract increases, taste perception becomes more differentiated. After the first year, the food becomes more varied, approaching in composition and taste to the food of adults.
By the age of one year, a child may have 8 milk teeth, by the age of 2 - 20. The development of the chewing apparatus allows the introduction of more solid food that requires careful chewing. However, the transition to new foods should be gradual. For children from 1 to 1.5 years old, all dishes are prepared pureed (soups, cereals, meat and fish - in the form of soufflés, steamed cutlets, meatballs). By the age of 1.5 - 2 years, food can be denser (vegetable, curd and cereal casseroles, stewed vegetables, salads from chopped boiled and raw vegetables), at the age of 2-3 years, a child can be offered boiled and fried fish, deboned, fried cutlet, stew of small pieces of meat.
The correct diet is important. Up to 1.5 years old, it is advisable to feed a child 5 times a day: breakfast, lunch, afternoon tea, dinner and evening milk feeding (about 23-24 hours); by the end of the second year of life, many children gradually abandon the fifth, nighttime, feeding and switch to 4 meals a day. Regardless of the number of meals, feeding hours should be strictly fixed, deviations from the set time should not exceed 15-30 minutes. Between feedings, babies should not receive any food, especially candy, cookies, rolls, as this reduces appetite.
Children over the age of 1 year should be taught to eat on their own, chewing food thoroughly. By the end of the first year of life, the child must independently hold the spoon in his hand, first for the middle of the cutting, and after 2 years, children are taught to hold the spoon correctly. Children hold the cup with both hands. In early childhood, when skills and habits are actively formed and consolidated, it is of great importance to educate the child in cultural and hygienic skills related to food intake. Sets up the preparation for food for it: the baby's hands are washed, a bib is tied, a napkin is prepared. It is necessary to develop the aesthetics of food intake in the little person: cover the table with a bright napkin or oilcloth, put colorful dishes. It is important that the appearance of the dishes attracts the child's attention, arouses interest in the food, and whets the appetite. During feeding, the child should not be distracted by telling fairy tales, showing pictures, toys, etc.
Force-feeding is categorically excluded, so as not to cause negative emotions and further decrease in appetite. Feeding should take place in a calm, welcoming environment. You should feed the child slowly, not rush, not get irritated and not scold the baby for the slow pace of eating, for the inaccuracy that is natural at first at this age.
The ratio of proteins, fats and carbohydrates should be approximately 1: 1: 4; proteins of animal origin - 75% of the total daily amount of protein. Fats need to provide about 30-40% of the total caloric intake; at least 10-15% of all fats should be vegetable fats.
Milk and dairy products, including cottage cheese and cheese, rich in proteins, calcium and phosphorus salts, play an important role in the nutrition of children over one year old. Sour cream is used in soups and salads.
Gradually increase the amount of meat and fish. It is recommended to use low-fat beef, veal, chicken, rabbit, offal (liver, tongue, heart). Lean pork and lamb are acceptable. Low-fat varieties of river and sea fish (in the form of fillets) are used. Children under 3 years old should not be given dishes of fatty meat, goose and duck meat, since they contain a large amount of hard-to-digest fats. Under 2 years old, it is not recommended to feed children with sausages and wieners.
Bread is served daily for the first and second courses. Bread made from rye flour and whole wheat is especially useful. From cereals up to 1.5 years, they mainly use buckwheat, rice, oat, semolina, at an older age - millet, pearl barley, barley.
Norms of consumption of nutrients and energy
(approved by the Board of the Ministry of Health of the Russian Federation on May 31, 1999)
| Nutrients | 1-3 years | 3-7 years |
| Proteins, total, g. | ||
| Fats, total, g. | ||
| including vegetable, g. | 5-10 | |
| Carbohydrates, g. | ||
| Energy, total, kcal. | ||
| Calcium, mg | ||
| Phosphorus, mg | ||
| Magnesium, mg | ||
| Iron, mg. | ||
| Vitamin A, ret. eq. mcg. | ||
| Vitamin E, ME | ||
| Vitamin D, mcg. | 2,5 | |
| Vitamin B 1e mg. | 0,8 | 1,0 |
| Vitamin B 2, mg. | 0,9 | 1,3 |
| Vitamin B 6, mg. | 0,9 | 1,3 |
| Vitamin PP, mg n. NS. | ||
| Vitamin B 12, mcg. | 1,0 | 1,5 |
Due to the fact that all types of tea (black, green and herbal) and coffee contain phenolic compounds that bind iron and prevent its absorption, they are not recommended for use until 2 years. After this age, you should avoid drinking tea with meals.
An approximate set of products for one day for children
1 to 3 years old
The daily amount of food for children aged 1 to 1.5 years should be 1000-1200 ml, from 1.5 to 3 years -1200-1400 ml. An excess of the required volume leads to a decrease in appetite, a disruption of the normal function of the digestive organs, impairs the absorption of food, and a reduction leads to malnutrition. It is especially unacceptable to increase the portions of the first courses, since the child, having eaten an excess amount of soup, may not completely eat the second course. Soups should not be too thick. Children aged 1-3 years should be given no more than 100-150 ml of soup, 80-100 g of a side dish for main courses.
The diet should contain a sufficient amount of fresh vegetables, fruits, berries, herbs. With them, the child receives the necessary mineral salts, as well as vitamins A, C, group B.
The daily volume of food by calorie content is distributed as follows: breakfast and dinner at 25%, lunch - 35%, afternoon tea - 15%. Foods rich in protein and fats, lingering longer in the stomach and requiring especially active work of the digestive glands for processing, give in the first half of the day. For dinner, they give more easily digestible dishes - dairy, vegetable and cereal.
All new products are introduced into the child's diet gradually, given the tendency of young children to respond inadequately to some common foods. Special care should be taken with obligate allergens.
Children usually eat separately, preferably at a small table. When a child eats with an adult, he is distracted and often demands food that he cannot. But sometimes separate meals can be organized for all family members - this is pleasant for the child, and in addition, it can also have educational value. Children imitate adults, so the personal example of adults is very important.
Babies weighing about 1,500 g or less usually do not suck well at the breast, and are very tired, and it is advisable to feed them from a bottle or apply to the breast not every feeding. When the first symptoms of fatigue appear (lethargy, cyanosis of the nasolabial triangle), the baby should be weaned and fed from the bottle.
If a baby's birth weight is about 2,000 g, then he usually takes a good breast and sucks out the required amount of milk.
The number of feedings for a premature baby is determined by its weight, condition, and the degree of functional maturity. Most often, 7 meals a day with a 6-hour night break are prescribed. Only with a deep and ill child, the number of meals can be increased to 10. When the body weight of a premature baby reaches 3000-3500 g, at the age of 2-3 months it can be transferred to 6 meals a day. The subsequent feeding scheme is not much different from the physiological scheme of the first year of life.
When determining the amount of food required for a premature baby, usually proceed from his individual characteristics, body weight at birth, general condition. A premature baby has increased vigor compared to a full-term one, so he needs such an amount of food that would satisfy his energy needs. At the same time, food tolerance in premature infants is reduced due to functional immaturity of the gastrointestinal tract. The capacity of the gastrointestinal tract in such children is small, and the digestive activity of juices is significantly reduced. All this requires a very precise and precise determination of the amount of food.
Usually, on the first day of life, a premature baby receives 5-10 ml of milk for one feeding, on the second day - 10-15 ml, on the third day - 15-20 ml. Over the next 10 days, the amount of food required for a premature baby can be roughly calculated using Rommel's formula:
V = n + 10,
where V is the amount of milk in ml for every 100 g of the child's body weight, and n is the number of days of life.
For example, if the child's body weight on the 5th day of life is 2000 g, then the amount of food per day should be (5 + 10) X 20 = 300 ml. Then, for one feeding with 7 meals a day, the child should receive 43 ml of milk (300: 7).
However, when calculating nutrition according to Rommel's formula, slightly overestimated amounts of food are obtained. Therefore, a more correct method is to calculate food by calorie content, which is mainly used in the domestic one. According to these recommendations, a premature baby in the first three days of life should receive 30-60 kcal / kg of body weight, by the 7-8th day of life - 70-80 kcal / kg of weight, by the 10-14th day of life - 100- 120 kcal / kg of body weight, and at the age of one month - 135-140 kcal / kg of body weight. From 2 months of age, the calculation of calorie content is carried out taking into account the body weight at birth. For children born with a weight of more than 1500 g, the calorie content is reduced to 130-135 kcal / kg of body weight. In children born with a weight of 1000-1300 g, up to 3 months of age, the calorie content of food should be 140 kcal / kg of body weight, and at 4-5 months - 130 kcal / kg of body weight. This takes into account the general condition of the child, his ability to assimilate food, the intensity of the increase in mass, etc.
For example, a child's body weight by the 8th day of life is 2300 g. At this age, per 1 kg of weight, he should receive 80 kcal, which will be 184 kcal per day. This amount of calories is contained in 260 ml of breast milk, the calorie content of which is 70 kcal per 100 ml. With seven meals a day, the child should receive an average of 37 ml at each meal.
Feeding premature babies (enteral nutrition). Certain difficulties that arise when feeding premature babies are associated with their physiological immaturity: 1) The ability to suck and swallow, the coordination of these reflexes are not developed until 32-34 weeks; 2) the small volume of the stomach and the lengthening of the evacuation time of its contents with an unformed lower esophageal sphincter lead to a tendency to regurgitation; 3) the ability of acidification and production of pepsinogen in the stomach is low; 4) decreased intestinal perstalsis, which leads to bloating, overstretching of the intestine; 5) reduced activity of lactase; 6) low fat absorption due to decreased production of bile salts and pancreatic lipase, reduced ability to form micelles; 7) the breakdown of proteins is incomplete; 8) the secretion of immunoglobulins in the intestine and the immunological response are reduced; 9) the level of cell proliferation and migration in the intestinal wall is low; 10) a decrease in the functional activity of organs (liver - immaturity of enzymes, kidneys - reduced ability to retain important electrolytes, such as sodium and chlorides, lungs - maturation of lung tissue continues), which requires additional energy consumption. First feeding - depends on gestational age, body weight and health status. In the absence of somatic pathology, enteral nutrition begins from the first day, the calculation is carried out according to different methods: 1) Gestational age is more than 33-34 weeks, with a body weight of more than 2.5 kg. In the presence of sufficient strength of sucking movements, coordination of sucking and swallowing, sufficient intestinal motility, the first feeding begins 2-3 hours after birth with breast or expressed milk through the nipple. 2) Gestational age is less than 33-34 weeks, with a body weight of less than 2 kg. Principle: caution and gradualness! The first trial introduction of food in the form of distilled water, if everything is normal (there was no regurgitation and deterioration of the child's condition), then 2 and 3 feedings are carried out with 5% glucose with a gradual increase in volume, then they are fed with milk or a mixture; at mass 1.5-2 kg the volume of the first feeding with distilled water is 5-7 ml, then the feeding volume is increased after 3 hours with a possible night break for children over 2 kg. In the world literature, a very large range of the initial volume of trophic nutrition is given from 0.1 to 20 ml / kg / day, more often 10-14 ml / kg / day. Feeding in this volume lasts from 7 to 14 days, then slowly increase the concentration and volume of the mixture. With body weight 1-1.5 kg the volume of the first feeding is 2-4 ml and then is gradually increased by 3-5 ml, the interval between feedings is 3 hours without a night break, i.e. 8-10 feedings. With a mass less than 1000 g the volume of the first feeding is 1 ml and then gradually increased by 1 ml over 8 hours, then an interval of 2 hours and an increase in volume by 2 ml until a volume of 12 ml (5% glucose) is reached. Transfer to breastfeeding only after 16-48 hours through the nipple, and if the weight is less than 700 g through a tube Feeding mode h-tube can be used. intermittent and prolonged (drip, microjet) For bolus administration of milk, the tube is used to deliver a single portion of milk after feeding, immediately removed (usually every 3 hours). The probe is inserted to a length equal to the distance from the bridge of the nose to the xiphoid process, which is 1012 cm. At the free end there is an opening for the injection of a syringe with milk, milk is warm. Orogastric tube insertion is preferable to nasogastric insertion because of apnea. A single injection of the probe leads to a cyclical release of hormones, and this stimulates the growth and development of the gastrointestinal tract. Children weighing less than 1500 g are injected with a permanent tube, because there is a tendency to stagnation of intestinal contents. Such a probe is in the stomach for 7-10 days, milk is also injected drip at a given rate using an infusion pump, some studies show that with drip administration, weight gain is greater. It is necessary to suck out the contents of the stomach at each next feeding, if at the same time 10% of the previous feeding is obtained, the dose of milk should be reduced, in the case of pathological impurities, enteral feeding is stopped. Regurgitation, vomiting, bloating is an indication for canceling the standard feeding scheme until the reasons that caused them are clarified. When sucking movements appear, it is possible to transfer to the nipple. Nutrient requirements: proteins - is 3.5-4 g / kg / day, 9-12% of the total calorie content is needed to maintain growth. To maintain the immune system of the orgma, nucleotides and mixtures are needed. Containing nucleotides continue to be developed. Carbohydrates - premature babies have a transient difficulty in assimilating lactose, the volume of the total daily calorie intake is 35-55%. Fats - should make up 40-55% of the total daily accloration. The formula for premature babies necessarily includes the omega-3 fatty acid present in human milk and linoleic acid. Vitamins and minerals - the rapid growth of premature babies requires, first of all, an increased content of calcium, phosphorus, and vitamin D for optimal bone mineralization. Premature babies are able to absorb Vit D and convert it to its active form (1.25 hydroxycholecalciferol). A daily intake of 400 IU of Vit D is sufficient for most children, although the recommended range is 400 to 800 IU. Additionally, calcium should be given - 50 mg / kg / day, phosphorus - 30 mg / kg / day (if the child receives only breast milk). Additional administration of iron for breastfed infants and for infants on formula should begin from 2 months at 2 mg / kg / day with preliminary saturation of org-ma Vit E (by mouth 25 IU / kg / day with the beginning of full enteral nutrition). The recommended dose of folic acid is from 50 to 70 mcg / day. Female milk- a source of all essential nutrients, which are optimally balanced and easily digestible. It is very important that the main protective properties of breast milk are provided directly by the immune system of the mammary gland. In this regard, in nursing premature babies, such techniques as "non-nutritious attachment to the breast", "kangaroo method" are used, which are favorable for the child. One of the important advantages of breast milk is that it gives the mother a sense of the need for the baby and includes her in the nursing process. There are 2 problems when feeding babies with VLBW breast milk. The first is the content of minerals in milk, especially calcium and phosphorus. inadequate. The second is that the calorie intake and protein content in the milk of the mother of a premature baby is reduced to their level in the milk of a woman who gave birth on time. For this purpose, in world practice, 2 types of additives to breast milk ("enhancers") are used: produced in the form of a dosed powder, which is diluted in 25 ml of milk, or in the form of a liquid fortifier, which is recommended to be mixed with breast milk in a 1: 1 ratio. , then. they help prolong breastfeeding. For example, there is a fortifier containing inositol, which is important for children with respiratory disorders. Adaptation mixtures for premature babies. Such mixtures are prepared in accordance with international guidelines. They contain relatively more energy per unit volume than standard mixtures. The protein / calorie ratio is also higher. The ratio of whey protein / casein should be 60 \ 40, which is comparable to them in breast milk. Currently available - Frisopre, Pre-NAN, Enfamil, Pre-Bona, Humana-0. In mixtures for term babies there is no such important polyunsaturated fatty acid as docosahexaenoic acid (DHA), it is necessary for the development of mental abilities and normal vision. In premature infants, its synthesis is reduced. Protein and vitamin supplements for breast milk have appeared: "Pre-Sample Protein and Mineral", developed for children with a birth weight of less than 1500 grams. It is used from the first months of life until the child reaches a body weight of 2000-2500 g. Calculation of nutrition for premature babies. The calculation of nutrition is based on body weight at birth, and only from the beginning of the increase is performed on the existing body weight. Malysheva's formula up to 10 days:Day volume = 14 × M (kg) × days of life. The volume of 1 feeding = 3 × M body × days of life, calculation in children with physical weight loss for weight at birth, before they began to gain.After the 10th day, the "calorie method". For each day of life, add 10 kcal (1 day - 10 kcal + 2nd day 10 kcal, etc. up to 10 days, i.e. in 10 days 100 calories; on day 14 - 120 kcal / kg / day ; 21 days - 130 kcal / kg / day; 1 month - 135-140 kcal / kg / day; 2 months - depending on the weight at birth, if the weight is ≥ 1.5 kg, then 130 kcal / kg / day or slightly less, if the birth weight ≤ 1.5 kg, then 135-140 kcal / kg / day, this calculation is made up to the 3rd month inclusive, from the 4th month it is reduced to 130 kcal \ kg \ day, 130 kcal \ kg \ day is considered to be children with ENMT, in older children - 120 kcal / kg / day. Lure. The following are used as complementary foods product groups: fruit-vegetable-based dishes - fruit, berry, vegetable purees, juices (from 5-6 months, juices from 3 months); cereal-based foods and dishes (cereals, crackers, cookies - from 6-7 months); fermented milk products, cottage cheese (from 8 months), meat (from 7-8 months), fish (from 10 months), vegetable and butter (from 6 months), egg yolk (from 6-7 months). Indications for the introduction of complementary foods: the child reaches a certain degree of biological maturity (age 5-6 months or more); the presence of signs of readiness for the introduction of complementary foods; the presence of signs of dissatisfaction of the child with the volume of milk received with sufficient lactation from the mother (anxiety, increased crying frequency, repeated night awakenings with a "hungry" cry, slowing down the rate of weight gain). Signs of a child's readiness for complementary foods: sufficient maturity of the digestive system for the digestion of new food products (no dyspepsia, allergic districts); the child's emotional perception of food and the feeding procedure (a hungry child reaches towards the spoon with food being served); it is desirable that the reb-k is already sitting steadily and making active purposeful movements with his head and arms; extinction of the reflex "pushing out" by the tongue, the appearance of readiness for chewing movements, the use of the tongue to move food in the mouth.
Intrauterine hypotrophy - a chronic nutritional disorder of the fetus, i.e. the birth of a child on time, but with a lower body weight than it should be according to the gestational age. Causes: intrauterine infections, chromosomal aberrations (trisomy, Shereshevsky-Turner syndrome), hereditary metabolic anomalies (galactosemia), congenital hypofunction of the thyroid gland, cerebral hypothalamic dwarfism, multiple pregnancy, changes in the placenta and umbilical cord (the presence of one umbilical artery, malnutrition), umbilical cord attachment mothers during pregnancy. In the first place among the causes of intrauterine malnutrition are intrauterine infections and late toxicosis of pregnant women, then - mother's diseases (cardiovascular diseases, endocrinopathies), occupational hazards (chemical production, vibration). Pathogenesis. The main link is chronic placental insufficiency, i.e. disorder of the uteroplacental circulation. The state of prolonged oxygen starvation leads to a violation of the oxidative processes in the fetus, causes a violation of the most important types of metabolism, the formation of functional and morphological immaturity of the fetus. Classification and clinic. It is customary to distinguish hypotrophy of the I degree (mild form) - a moderate decrease in the weight of the newborn is characteristic compared to the weight of a healthy child born at the same gestational age. Weight deficit does not exceed 10-20% of the weight of healthy children. A moderate decrease in the subcutaneous fat layer is also characteristic. The skin has a pale pink color with varying degrees of cyanosis, while a decrease in tissue turgor and muscle tone is noted. Hypotrophy II degree (moderate) - there is a lag in the mass of 20-30%. Such children lag behind in growth by 1-1.5 cm in comparison with healthy children born at the same gestational age. Dystrophic changes in the skin and subcutaneous fat layer are clearly visible. Due to a decrease in elasticity, the skin easily folds, it straightens poorly, against the background of pallor of the skin, cyanosis is more constant, dry skin develops with abundant peeling. Grade III hypotrophy (most severe) - typically a sharp decrease in the subcutaneous fat layer. The mass deficit is more than 30%. More permanent is the deep backwardness of the child, not only in weight and height - the growth deficit is 2-4 cm compared to healthy newborns. In these children, dystrophy of the skin is noted in the form of severe dryness and skin cracks in the feet, inguinal folds, and the lower abdomen. In a newborn born in a state of malnutrition, changes in a number of organs and systems are very often observed. In the first hours and days of life in such children, attention is drawn to general lethargy, sleep disturbances, a decrease or complete absence of the sucking, less often swallowing reflex, and a change in muscle tone. Reflexes of a newborn are often reduced or absent (Robinson, Babkin, Babinsky, Moreau, etc.). In some cases, there is an increased neuro-reflex excitability associated not only with hemo-liquorodynamic disorders in the central nervous system, but also with metabolic disorders, hypoglycemia, metabolic acidosis, etc. Often there are respiratory disorders associated with both hypoxic damage to the central nervous system, metabolic disorders and with immaturity of lung tissue, impaired formation of postnatal pulmonary circulation. Breathing in such children is shallow, the frequency and rhythm of respiratory movements are impaired, and secondary asphyxia may develop. Often there are also changes in the cardiovascular system: muffling of heart sounds, bradycardia, the appearance of a systolic murmur at the apex of the heart. Quite often, there is a violation of the function of the gastrointestinal tract, a tendency to frequent regurgitation, a decrease in appetite, a change in stool (delay in the discharge of meconium, increased frequency). Among other features of the development of newborns with manifestations of intravenous hypotrophy in the period 7-10 days after childbirth, it is necessary to note a greater decrease in weight and its slow recovery, a delay in the disappearance of the umbilical residue and poor healing of the umbilical wound. Children with intravenous hypotrophy have low body resistance, they are susceptible to various infectious diseases. There are violations of ossification in the bones of the skull, chest, upper and lower extremities, violations of the development of ossification nuclei. Dystrophic changes in the skin are revealed in the form of increased dryness with abundant lamellar or rough peeling, often cracks in the groin folds, lower abdomen, hands and feet are observed. An increased amount of hemoglobin is observed in the blood, which is associated with a compensatory increase in fetal hemoglobin. The number of leukocytes in newborns with intravenous malnutrition at birth is slightly reduced and continues to decrease until the 7th day of life. In 50% of children, the first crossing is late. In proportion to the severity of hypotrophy in the study of factors of the blood coagulation system, hypocoagulation is observed, and therefore such children are prone to bleeding. In part, it is associated with the morphological immaturity of the liver, since hypocoagulation, even during treatment, remains pronounced after the 7th day of life. Jaundice in such children appears by the 2-3rd day of life, remains long and disappears only with its treatment, since there is a decrease in the conjugating function of the liver due to a decrease in the activity of the enzyme system of glucuronic acid transferase. A feature of digestion in newborns with intravenous hypotrophy is that these children do not withstand 6-12 hours after birth. On the first day of life, they on average suck no more than 50 ml of expressed breast milk and up to 75 ml of 5% or 10% glucose. The suggested breast milk rate for these babies results in frequent regurgitation and increased bowel movements. The meconium character of the stool is sometimes delayed until the 4th - 5th day of life, daily urine output is usually increased in the first 3 days of life. Newborn children with intravenous hypotrophy are already born with metabolic disorders (hypoproteinemia, hypoglycemia, lipemia), severe hypocoagulation, reduced function of enzyme systems, disorders of water and bilirubine metabolism, CBS and buffer systems that are not physiological in nature, typical of healthy newborns, but indicative of profound pathological changes, especially in newborns with II and III degrees of intravenous hypotrophy. Treatment. All therapeutic measures should be carried out against the background of properly organized feeding and caring for the newborn. Feeding a newborn with manifestations of intravenous malnutrition is often associated with great difficulties. They are primarily due to the fact that sucking and swallowing reflexes are weakened in such children. Therefore, with a decrease in the food reflex, the feeding process should take place with the help of a probe. The question of the first attachment to the breast is decided differentially, depending on the general condition of the child and the degree of w / u malnutrition. It is most rational to feed a newborn with malnutrition 7 to 8 times a day. For the first 5-7 days of life, only breast milk should be given. With an improvement in the general condition, appetite, some increase in weight from the end of the 1st week of life, protein preparations should be additionally administered. The best protein preparation is cottage cheese made from kefir and ion exchanger milk. It should be added to breast milk in an amount of 5-7 g per day. The principles of caring for newborns with intravenous hypotrophy, especially grade II-III, and feeding them are the same as for premature newborns. Children need constant warming, careful care of the umbilical wound and skin. After discharge from the maternity hospital, children should be under the dispensary supervision of a neurologist and pediatrician. In the first days of life, such children are shown intravenous infusions of plasma and blood at the rate of 5-7 ml / (kg day). The number of plasma transfusions is determined depending on the condition of the newborn (on average, up to 5-7 transfusions should be carried out). The complex of treatment should also include vitamins: ascorbic acid 100 mg per day orally, vitamin B1 10-15 mg orally, vitamin B6 15-20 mg (2.5% solution intramuscularly every other day). Shown and vitamin B12 30-50 mcg intramuscularly (only 10-15 injections) every other day. To raise the general tone of the body and improve metabolic processes in children with intravenous hypotrophy, the appointment of hormones is shown. From the 3-4th week of life, it is advisable for a newborn to prescribe anabolic hormones at 0.1 mg / (kg day) for 3-4 weeks. As a stimulant, it is necessary to apply apilak for 10-14 days in the form of suppositories. Prevention. Currently, methods of antenatal diagnosis of developing fetal malnutrition are proposed: an ultrasound method for measuring parameters in the dynamics of its development, a study of the excretion of estriol in the urine and enzymes of oxytocinase and thermostable isoenzyme of alkaline phosphatase in the blood of a pregnant woman, creatinine level and the amino acid spectrum of amniotic fluid. The development and improvement of methods of antenatal diagnostics will also contribute to an earlier start of treatment for dystrophic conditions. To this end, along with preventive treatment of diseases in the mother, it is recommended to use drugs that improve uteroplacental blood circulation.
The concept of intrauterine malnutrition. Causes of intrauterine fetal malnutrition. Pathogenesis. Etiological factors in the development of intrauterine malnutrition. Classification. Prevention. Dispensary observation.
Delay (slowing down) in / in growth and development (IUGR) is diagnosed in children who are underweight at birth in relation to their gestational age. Among children with low birth weight, 3 groups are distinguished: 1) premature babies with a body weight corresponding to their gestational age; 2) premature babies with a body weight less than the due date of pregnancy; 3) full-term (born after the end of the 37th week of pregnancy) or post-term (born at the 42nd week of pregnancy and later), having a body weight below 10% of the centile for a given gestational age. Etiological factors. There are 4 groups of risk factors that can lead to IUGR: 1) Maternal - very low body weight and dystrophy before and at the time of pregnancy, nutritional defects during pregnancy (severe deficiency of proteins and vitamins, zinc, selenium and other trace elements), short term (less than 2 years between pregnancies), multiple pregnancies, antiphospholipid syndrome (APS) , hypertension and diseases of the cardiovascular system with heart failure, chronic diseases of the kidneys and lungs, hemoglobinopathies, type I diabetes mellitus with vascular complications, obesity, connective tissue diseases, prolonged infertile period, miscarriages, the birth of previous children in a family with a low weight, gestosis, bad habits of the mother - smoking, alcoholism, drug addiction, infections leading to intrauterine infection of the fetus, taking certain medications (for example, antimetabolites, beta-blockers, diphenin, oral anticoagulants, etc.). 2) Placental - insufficient mass and surface of the placenta (less than 8% of the newborn's body weight), its structural abnormalities (heart attacks, calcification, fibrosis, hemangioma, a single umbilical artery, vascular thrombosis, pladentitis, etc.) and partial detachment (all of the above factors can be a consequence of APS) , as well as anomalies of attachment (low location of the placenta, presentation, etc.) and malformations of the placenta, both primary and secondary in relation to maternal pathology. 3) Socio-biological - low socioeconomic and educational level of the mother (often accompanied by an "unhealthy lifestyle" - smoking, drinking, poor nutrition, and hence frequent chronic diseases of the gastrointestinal tract, frequent infections, work in unfavorable conditions, imbalance, "undesirability" of the child and others), adolescence, living in highlands, occupational hazards in the mother (work in a hot workshop, vibration, penetrating radiation, chemical factors, etc.). 4) Hereditary - maternal and fruiting genotypes. In 40% of children, it is not possible to identify the cause of IUGR (idiopathic IUGR), while a third of them have other family members with low birth weight in the pedigree (more often on the mother's side). Pathogenesis. If a child born on time has only a small birth weight, then the factor that slowed down the rate of its intrauterine development acted in the last 2-3 months of pregnancy, but if he has a deficit in weight and body length at the same time, then unfavorable conditions for fetuses occurred in the II trimester of pregnancy. The first variant of IUGR is called hypotrophic, the second - hypoplastic. The most common cause of IUGR for the hypotrophic type is severe preeclampsia in the second half of pregnancy, placental insufficiency syndrome, and for the hypoplastic type - multiple pregnancies, family negligence at birth, living in the highlands, a teenage mother, mild nutritional deficiencies without deep vitamin deficiencies. Often, children with hypotrophic and hypoplastic IUGR are even more mature than children without IUGR of the same gestational age: they rarely have respiratory distress syndrome, episodes of apnea, transient oliguria is less pronounced, and therefore electrolyte deficiencies - sodium, calcium, develop earlier. Nutritional deficiencies of a pregnant woman can affect the rate of fetal weight gain, which has been proven in numerous animal experiments. The nutrition of a pregnant woman significantly affects the activity of the synthesis of insulin-like growth factor-1 by the fetus. A relationship was established between birth weight and the level of insulin-like growth factor-1 in the blood of a newborn. Nutritional deficiencies in early pregnancy lead to increased expression of genes that regulate the synthesis of glucocorticoids and angiotensin, receptors for angiotensin and glucocorticoids, and an increase in the weight of the adrenal glands and kidneys. IUGR can be accompanied by a perversion of fetal development - the formation of malformations, dysembryogenetic stigmas, a violation of the proportions of the body, physique. This variant of IUGR - dysplastic - occurs in children with chromosomal and genomic mutations, generalized intrauterine infections, with occupational hazards in the mother, and the effect of teratogenic factors on the fetus. Among chromosomal abnormalities in IUGR of the dysplastic type, trisomy for the 13th, 18th or 21st, 22nd pairs of autosomes, Shereshevsky-Turner syndrome (45, XO), triploidy (triple set of chromosomes), additional X or Y chromosome, etc. IUGR of the dysplastic type can be combined with neural tube defects, chondrodystrophy, osteogenesis imperfecta, primordial nanism, etc. Classification. When diagnosing IUGR, there are: 1) etiological factors and risk conditions (maternal, placental, fetal, combined); 2) clinical variant (hypotrophic, hypoplastic, dysplastic); 3) severity (mild, moderate and severe); 4) the course of the intrapartum neonatal periods (without complications or with complications and concomitant conditions - indicate which ones). With the hypotrophic variant of IUGR, the diagnosis of intrauterine (prenatal) hypotrophy can also be made. The severity of the hypoplastic IUGR variant is determined by the deficit in body length and head circumference in relation to gestational age: mild - 1.5-2 sigma deficit, moderate - more than 2, but less than 3 sigma, and severe - more than 3 sigma. The severity of the dysplastic variant is determined not so much by the severity of the shortage of body length, but by the presence and nature of malformations, the number and severity of stigmas of dysembryogenesis, the state of the central nervous system, and the nature of the disease that led to IUGR.
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