A.D. Tsaregorodcev) Ministry of Health of the Russian Federation, Moscow; I.M. Sechenov First Moscow State Medical University, Moscow Ключевые слова: тератома, плод в плоде, новорожденный, хирургия новорожденных.
Цель исследования: изучить подходы врачей к профилактике и лечению болевого синдрома у новорожденных детей, в том числе выбору поведенческих и медикаментозных средств, что позволило оценить их опыт, знания, а также на метить пути улучшения качества помощи новорожденным в стационаре. Материалы и методы: проведено аноним ное анкетирование среди 86 врачей из пяти городов России, с последующей статистической обработкой полученных данных. Результаты: анализ используемых лекарственных средств показал, что основу лечения болевого синдро ма у новорожденных составляют промедол (37,2%), анальгин (33,7%) и новокаин (33,7%): каждый третий врач ис пользует их для обезболивания во время кратковременных и болезненных процедур. При манипуляциях, сопровож дающихся сильной болью, ряд врачей считают возможным не вводить анальгетики или используют их редко и не во всех случаях (от 1,1% до 11,6% врачей), что является недопустимым. Профилактика не тяжелой боли с помощью мер комфорта, особенно применение глюкозы через соску, недостаточно часто используется респондентами. По данным опроса высокая оценка дана контакту с матерью во время болезненных манипуляций (74,4%). Заключение: проведенное исследование показало недостаточную информированность врачей, работающих с новорожденными детьми с современной тактикой профилактики и лечения болевого синдрома в неонатальном периоде. Ключевые слова: новорожденные дети, болевой синдром, анкетирование врачей, обезболивание, анальгетики, меры комфорта.Objective: to study physicians' approaches to preventing and treating the neonatal pain syndrome, including those to choosing behavioral measures and drugs, which could assess their experience, knowledge, and to direct ways of improv ing the quality of neonatal inpatient care. Subjects and methods. Anonymous questionnaire surveys were made among 85 physicians from five towns of Russia, which were followed by the statistical processing of the findings. Results. Analysis of used drugs has indicated that treatment for the neonatal pain syndrome is based on promedol (37.2%), analgin (33.7%), and novocaine (33.7%): every third physician prescribes them to relieve short term and painful procedures. It is inadmis sible that a number of physicians consider it impossible to administer analgesics during manipulations accompanied by severe pain or, possibly, to use them rarely and in not all cases (from 1.1% to 11.6% of the physicians). The respondents rather infrequently employ comfort measures, including nipple glucose use, for the prevention of mild pain. According to the survey data, maternal neonatal bonding is highly evaluated during painful manipulations (74.4%). Conclusion. The investigation has shown that pediatricians treating the newborns are unaware of the current treatment and prevention policy for the neonatal pain syndrome.
Commentary to the article by Yu.V. Zhirkova, R.F. Tepaev and Yu.I. Kucherov "Prevention of catheter-related infection in neonates"Rustem Faridovich Tepaev, PhD, head of the resuscitation and intensive care department at the Scientific Center of Children's Health, Professor of the pediatrics department with a course of pediatric rheumatology at the First Sechenov Moscow State Medical University Dear colleagues, we would like to call attention to an article dedicated to one of the most important sections of intensive care -prevention of catheter-related infectious complications. Infection is one of the most widespread causes of complications associated with central venous catheters (CVC); it is associated with the reduction in survival rate values at resuscitation and intensive care units (RICU). Observance of guidelines of aseptics and antiseptics is the basis of prevention of infectious complications. It is well known that the "horizontal" infection transmission route is the primary for the development of purulent-septic complications. Therefore, solutions for infusion therapy, assembly and connection of infusion lines to CVC must be conducted in aseptic conditions using sterile gloves. Symptoms of catheter-related sepsis must be daily checked in the event of parenteral feeding. In the event of development of such clinical symptoms as fever (body temperature over 38.0 o C), metabolic acidosis, thrombocytopenia, unstable blood glucose level and hyperlactatemia in a child, infectious process shall be suspected. It is necessary to inoculate CVC blood immediately upon detection of the listed symptoms. In compliance with the recommendations of international organization "The Surviving Sepsis Campaign" (SSC), cultural trials require sampling of CVC and peripheral vein blood and other biological fluids, which may serve as a source of infection before an antiinfection therapy has begun. Fungal CVC infections and stable hyperthermia with positive blood culture inoculations are indications for CVC removal. CVC-related infection must be monitored regularly. Operative measures must be taken upon slightest suspicion as one hour of delayed anti-infection therapy in patients with sepsis is associated with a 9% lethality increase. Prevention of catheter-related infection in neonatesRustem Faridovich Tepaev, PhD, head of the resuscitation and intensive care department at the Scientific Center of Children's Health, Professor of the pediatrics department with a course of pediatric rheumatology at the First Sechenov Moscow State Medical UniversityThe article is dedicated to an urgent issue of intensive therapy in neonatology -prevention of catheter-related blood flow infections. The article dwells upon etiological factors, formation mechanisms and modern methods of preventing colonization of central venous catheters and catheter-related infections.
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