Purpose - to devote the main peculiarities of teaching neonatology to students of the medical and psychological faculty (MPF). The main principles of distance learning are emphasized as problem-solving, interactivity and orientation on personal development. The advantages of problem-solving learning are declared; it helps students in the development of clinical thinking, of the ability to predict the occurrence of psychological problems, and develops optimal tactics in communication with parents and medical personnel. In teaching the neonatology cycle to MPF students, special emphasis is placed on certain pathological conditions in newborns, which require psychological support for families. The need to provide comprehensive medical and psychological assistance to mothers, the effectiveness of which is based on key professional competencies and in-depth clinical knowledge, is emphasized. A point is placed on the fact that in the process of training in neonatology, students of the MPF must understand their special role in preventing medical stress and medical trauma for both the child and the parents, since the environment of intensive neonatology contains numerous stress factors due to excessive sensory stimulation, such as light, sound and pain, which conflict with the requirements of the brain development of a newborn baby, especially in case of preterm birth. That is why it is important to providing complete information to the parents regarding the role of each member of the team of specialists in the organization of treatment and care of the child and the need to use developmental care that meets the needs of the early development of a premature child is also highlighted. The role of the future medical psychologist in providing support to parents with perinatal loss is also determined. This problem affects many families, most of whom are dealing with their loss often alone without adequate support and help. The problem of perinatal losses and recovery of mothers and families after them is the competence of medical psychologists. The underlined requirements for the teacher are the individual preparation of high-quality learning content, which may require additional time, but the involvement of the students themselves in the preparation of the necessary materials will even more increase the interactivity of the educational process. The possibilities of using the modern educational technologies are analyzed: these are «case technologies» in small groups, «business (role) games», an inverted classroom approach. No conflict of interests was declared by the authors.
Неонатологія, хірургія та перинатальна медицина Т. V, № 1(5), 2015 ВступНекротичний ентероколіт у новонародженого (НЕК)одне з найбільш небезпечних захворювань неонатального періоду. Захворюваність на НЕК у немовлят, за даними різних авторів, коливається в межах 0,3 -3,0 на 1000 дітей, у недоношених ця патологія зустрічається в 10-25% випадків та є зворотно пропорційною до маси тіла при народженні та гестаційного віку. Найбільший ризик для дітей, народжених в терміні <30 тижнів та з масою <1000 г [1,2,3].Загальна смертність у пацієнтів з НЕК коливається від 10 до 50%, але наближається до 100% у немовлят з швидко прогресуючим захворюванням. Крім того, діти, які перенесли НЕК, зазвичай вимагають тривалої госпіталізації через пов'язані з ним ускладнення, такі як кишкова непрохідність, синдром «короткого кишечника» і печінкова недостатность внаслідок повного парентерального харчування. На даний час не існує доказів, які підтверджують, що рання діагностика і втручання у пацієнтів з НЕК можуть змінити результати захворювання [3,4].НЕК та спонтанна перфорація кишечника у дітей із надзвичайно малою масою тіла (НММТ) часто має зв'язок із грибковою інфекцією та сепсисом, зумовленим коагулазонегативними стафілококами. За даними Corinne J. Ragouilliaux et al., частота спонтанної перфорації кишечника у дітей із НММТ становить 4,6% [4].Факторами ризику перфорації кишечника є тривалий безводний період, інфекція матері під час пологів, антибактеріальна терапія у пологах із застосуванням ампіциліну або пеніциліну з метою профілактики стрептококової інфекції, хоріоамніоніт, плацентит, грибкова інфекція у матері та новонародженого, пізній початок ентерального харчування, нестабільність гемодинаміки, метаболічний ацидоз, сепсис, зумовлений коагулазонегативним стафілококом, тривале перебування у стаціонарі. Для своєчасного встановлення інфекції плаценти та внутрішньоутробної інфекції у дитини з ризиком НЕК доцільно проводити гістологічне та мікробіологічне дослідження плаценти. Головними чинниками НЕК є ішемія та гіпоксія, внутрішньоутробна та нозокоміальна інфекції [5].Досягнення допологової та неонатальної допомоги призвели до збільшення виживання вкрай недоношених новонароджених. Проте, зростає й ризик розвитку НЕКу, що вимагає нових пошуків щодо стратегії ефективної профілактики даної патології.
Cystic fibrosis (CF) is an autosomal recessive, life-shortening disease in which generalized exocrine gland involvement occurs with predominantly pancreatic insufficiency, airway obstruction, and progressive lung involvement. Due to pancreatic insufficiency, malabsorption and malnutrition are observed in patients. The close attributive association of CF with nutritional status and adverse clinical outcomes determines a thorough assessment of the nutritional status, individual management and monitoring of all children with CF. Attainment of optimal physical development and adequate nutrition in patients with CF is currently possible through early diagnosis and aggressive nutritional medical therapy. Medical dietary interventions are aimed at ensuring normal growth and preventing of malnutrition, thus will upgrade the prognosis and quality of life of pediatric patients with CF. The reasons for the development of malnutrition in CF, specific screening tools for monitoring the growth of ill children, criteria for stratifying children into nutritional risk groups are reviewed in the lection. The procedure for calculating energy needs, taking into account activity, the severity of the disease and pancreatic insufficiency is presented. Attention is drawn to the ratio of macronutrients and the need to consume energy-dense and nutrient-rich foods. The prescription of medical nutritional therapy with the inclusion of special foods for medical purposes (clinical nutrition) to meet increased energy requirements and avoid the consumption of energy-dense but nutrient-poor foods also is discussed. It is meaningful to involve into a multidisciplinary team of a psychologist who can on a regular basis correct eating behavior and promote compliance with nutritional recommendations in order to achieve optimal physical development of patients. The research was carried out in accordance with the principles of the Helsinki Declaration. The informed consent of the patient was obtained for conducting the studies. No conflict of interests was declared by the authors. Key words: cystic fibrosis, children, malnutrition, medical nutrition therapy.
Teratomas are tumors which are composed of tissues derived of more than one germ cell layer; they appear between 3-6 weeks of pregnancy and are present more often in females. A prognosis for life depends on the timely diagnosis of the mass and a possibility of surgical treatment. An article presents a case of a female neonate born with severe respiratory insufficiency. Antenatal ultrasound at 19-20 and 30-31 weeks exposed the myoma of the uterus and a probability of large birth weight. Immediately after birth a neonate requested urgent intubation, artificial lung ventilation, intensive therapy for hemodynamic stabilization. The thoracic surgeon suspected the presence of cystic adenomatous malformation upon the chest X-ray and clinical observation data and defined expectant management and prolongation of intensive therapy. Autoptical evidence is a large mediastinal teratoma 10×8×5 cm, weight 135.0 gram, moderate secondary hypoplasia of lungs. Histological processing revealed mass lesion of the anterior mediastinum in a capsule, which was presented with immature discohesive mesenchyme with lymphoid assembly, brain tissue and multiple cysts of different size with inclusions of cartilage tissue. Effective correct and precise antenatal visualization, which can defined the type of maternity hospital, postnatal MRT and timely provided therapy intervention surgical mass removal including — these are key factors of successful management newborns suffering from anterior mediastinal teratomas. The research was carried out in accordance with the principles of the Helsinki Declaration. The study protocol was approved by the Local Ethics Committee of these Institutes. The informed consent of the patient was obtained for conducting the studies. No conflict of interest was declared by the authors. Key words: newborn, mediastinal teratoma, diagnostics, therapy.
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