This literature review covers the pathophysiological features of water and sodium exchange in newborns. The main mechanisms regulating fluid and electrolyte balance in newborns are poorly studied. The volume and composition of the extracellular fluid are provided by the functional activity of the kidneys under the control of the neuroendocrine system. The antidiuretic hormone plays the main role in the regulation of water excretion by the kidneys. The volume of intracellular fluid depends on the passive water transport with the participation of aquaporins. Lability of water and electrolyte metabolism in newborns may be accompanied by hyponatremia. For various pathological conditions in the neonatal period, certain types of hyponatremias are characteristic. Correction of hyponatremia should be carried out taking into account its pathophysiological type. Hyponatremia is a common complication associated with severe neonatal brain damage. Hyponatremia contributes to brain damage as an independent factor. The study of indicators of water and electrolyte balance in the neonatal period has an important prognostic value for early detection of damage to the central nervous system.
Целью данного исследования было выявление различий бактериальной колонизации пупочного остатка у новорожденных при совместном пребывании с матерями и у новорожденных, получавших лечение отдельно от матерей. Материалы и методы: проведено исследование 180 новорожденных, родившихся в Перинатальном центре в период с октября 2014 г. по март 2019 г., и распределенных на 3 группы: 82 новорожденных, родившихся при вагинальных родах (ВР) и находившихся в режиме совместного пребывания с матерями; 60 новорожденных, родившихся путем кесарева сечения (КС) и находившихся совместно с матерями; 38 новорожденных, поступивших в ОРИТН и находившихся отдельно от матерей. Уход за пуповиной у всех новорожденных заключался в естественном высыхании пуповины. Учитывались способ родоразрешения, паритет беременности, пол ребенка, вес при рождении и гестационный возраст. Данные анализировались программой SPSS (версия 20.0). Определение нормальности распределение данных проводилось с использованием критерия χ-квадрат Колмогорова-Смирнова. Результаты. Анализ данных показал, что в исследуемых группах не выявлено существенных различий бактериальной обсемененности у детей разного пола и первородящих матерей, но отмечались различия в зависимости от сроков беременности и веса при рождении.
Dehydration is one of the most common disorders of water and electrolyte metabolism in young children. The reasons leading to the lack of water in the child’s body are very diverse. In clinical practice, a correct assessment of the pathophysiological mechanisms in various types of dehydration is necessary, which will allow timely identification of changes in various organ systems and conduct rational rehydration therapy. Water losses in children occur in a certain sequence. First of all, the intravascular subsector of the extracellular sector is subjected to water losses (clinical manifestations of dehydration in the child in this case are absent). If the pathological process continues, the intercellular subsector of the extracellular sector loses water, and then the patient first presents clinical symptoms: loss of body weight, dryness and brightness of the mucous membranes, reduction of subcutaneous fiber turgor, shrinkage of the mole in children of the first year of life, reduction of diuresis. Last of all, the intracellular sector loses its volume. Depending on the osmolarity of the extracellular fluid, isotonic, hypertonic and hypotonic dehydration are isolated. The most difficult in children is hypotonic dehydration, which is accompanied by a low osmolarity of the extracellular sector with predominant losses of sodium from the body. A retrospective analysis of a clinical case illustrates water-electrolyte disturbances in hypotonic dehydration. The child developed extracellular hypotonic dehydration because of sodium and water loss through the gastrointestinal tract. Hypotonic dehydration is characterized by an extreme degree of dissonance of the water-electrolyte balance, that is, the patient has severe extracellular dehydration and intracellular hyperhydration (edema, cell swelling). In this clinical case, violations of the waterelectrolyte balance led to the development of cerebral edema against the background of the existing cerebral deficiency, and death.
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