Health groups of newborns

The health group of the newborn is evaluated at discharge from the maternity ward.

• I-st group - healthy children from healthy mothers, gestosis of 1 half of pregnancy.
• 2nd group:
  • "A" subgroup - children from mothers with a narrow pelvis, children with physiological immaturity, grade I prematurity, toxic erythema, edematous I degree syndrome, degree I hypersensitivity.
  • "B" group is a complicated somatic anamnesis of the mother: chronic respiratory diseases, endocrinopathies, diseases of the cardiovascular system, allergic diseases, diseases of the urinary system. Complicated obstetric-gynecological history of the mother: acute and chronic diseases of the genitalia, labor in the breech presentation, vacuum extraction, application of obstetric forceps, caesarean section. Hypogalactia in the mother. Asphyxia of mild degree (grade Apgar score 6-7 points), child from multiple pregnancies, intrauterine growth retardation, skewness of grade II, children weighing less than 2000 g or more 4000 g, multiple small anatomical abnormalities (more than 4-5), transient fever, pathological loss of body weight (more than 8%).
• 3rd group - moderate and severe asphyxia, birth trauma, cephalothorem, umbilical vein catheterization, grade III prematurity, embryopathopathies, hemorrhagic disease, hemolytic disease of the newborn, intrauterine infections.
• The 4th and 5th group of health is appropriated in the presence of congenital malformations with signs of pronounced decompensation.

[1],

Dispensary observation of healthy newborns

[2], [3],

Observation by the district pediatrician

1st group of health:

• in the first 3 days after discharge from the maternity hospital:
• on the 18-20th day of life;
• on the 28th and 30th day of life - a visit to a polyclinic by a child, at the 2nd month of life a healthy child visits the polyclinic 2 times, then monthly.

2nd group of health:

• in the first 3 days after discharge from the maternity hospital:
• 14th day of life:
• 21st day of life;
• on the 28-30th day of life - a visit to a polyclinic by a child, at 1 month of age a healthy child visits the polyclinic 2 times, and monthly.

3rd group of health:

• in the first day after discharge from the maternity hospital;
• Newborns are inspected by the head of the department;
• Every 5 days during the first month of life the children are examined by a pediatrician. Further, the observation is conducted on the underlying disease together with the narrow specialists.
• The 4th and 5th group are observed for the main disease in the hospital.

Clinical examination and rehabilitation of newborns from different risk groups at the pediatric site

Risk groups of newborn children (methodological recommendations of the USSR from 1984)

• 1st group - newborns with a risk of developing CNS pathology.
• 2 nd group - newborns at risk of intrauterine infection.
• 3rd group - newborns with a risk of developing trophic disorders and endocrinopathies.
• 4-th group - newborns with the risk of developing congenital organs and systems sometimes.
• 5-th group - newborns from the group of social risk.

There are also additional groups (according to the order of the M3 RF No. 108 of 29.03.96 and the methodological recommendations of the city of Ivanovo from 1988.

• group of risk for deafness and deafness;
• a risk group for anemia;
• risk group for the development of sudden death syndrome;
• risk group for the development of allergic diseases.

Dispensary observation of newborns from different risk groups in the pediatric area is carried out in a differentiated manner.

[4], [5], [6],

1 st group - newborns with a risk of developing the pathology of the central nervous system

Risk factors:

• the mother's age is less than 16 and more than 40 years;
• bad habits and occupational hazards of the mother;
• extragenital pathology of the mother;
• pathology of pregnancy and childbirth (toxicosis, threat of interruption, miscarriages, polyhydramnios, multiple pregnancies in the history, prolonged or rapid delivery);
• toxoplasmosis and other infectious diseases;
• the child's mass is more than 4000 g;
• endurance, asphyxia, stigma.

Observation plan

• Inspection of the district pediatrician at least 4 times during the first month of life, then monthly.
• Examination with the participation of the head of the department no later than 3 months and is mandatory for every illness of the child.
• An examination by a neurologist at 1 month, then every quarter; a surgeon, an oculist - according to the testimony.
• Strict control of the district pediatrician, aimed at detecting the increase in the size of the head, the definition of neuropsychic development.
• Prophylactic vaccinations under the individual plan after the permission of the neuropathologist.
• On reaching the year in the absence of changes from the side of the central nervous system, the child is removed from the register.

[7], [8], [9], [10], [11], [12], [13], [14],

2nd group - newborns at risk of intrauterine infection

Risk factors:

• extragenital pathology of the mother;
• inflammatory gynecological diseases;
• pathology of labor (long anhydrous interval, placental pathology);
• transferred in the III trimester of pregnancy infectious (rubella,
• toxoplasmosis, cytomegal, ARVI) and bacterial diseases;
• prematurity, intrauterine growth retardation (FARM).

Observation plan

• Inspection by the district pediatrician at least 4 times during the first month, then monthly; nurse - 2 times a week.
• Early laboratory examination at 1 and 3 months (blood, urine) and after each disease.
• Compulsory examination with the head of the department no later than 3 months and after each disease.
• Measures for prevention, early diagnosis and treatment of dysbiosis.
• In the absence of symptoms of intrauterine infection, the child is removed from the clinic at 3 months of age.

[15], [16], [17], [18], [19]

3rd group - newborns with a risk of developing trophic disorders and endocrinopathy

Risk factors:

• extragenital pathology of the mother (diabetes, hypothyroidism,
• obesity, hypertension);
• prior abortion;
• pathology of pregnancy (severe toxicosis);
• childbirth from the fourth or more pregnancy;
• large birth weight, hypotrophy, immaturity, children from twins;
• hypogalactia in the mother, early artificial feeding, malabsorption syndrome;
• children with unstable stools;
• bad habits of the mother (smoking).

Observation plan

• Inspection of the district pediatrician at least 4 times during the first month, then monthly.
• The head of the department examines the child no later than 3 months of age.
• Inspection by an endocrinologist at least 2 times during the first year of life (in the first quarter and 12 months).
• Struggle for natural feeding up to 1,5-2 years.
• Clinical examination during the first year of life. In the absence of pathology, the child is removed from the register.

[20], [21], [22], [23]

4-th group - newborns with the risk of developing congenital malformations of the first organs and systems

Risk factors:

• presence of congenital malformations in spouses or their relatives;
• previous birth of children with congenital malformations;
• bloodbearing marriage;
• age of mother over 35;
• professional harmfulness of parents;
• bad habits of parents;
• use of medicines in the first half of pregnancy;
• pathology of pregnancy (toxicosis of the first half of pregnancy multiple threat of interruption, ARVI in 1 trimester of pregnancy;
• diabetes mellitus in pregnant women;
• the transferred rubella or contact with the patient in the first trimester of pregnancy;
• spontaneous abortions in the anamnesis;
• the number of stigmas is more than five;
• acutely developing polyhydramnios.

Observation plan

• Survey by the district pediatrician 4 times during the first month of life, then monthly.
• Urine analysis at 1 month, then quarterly and after each disease.
• Consultations of narrow specialists (oculist, cardiologist, geneticist) in the early period at the slightest suspicion of the possibility of pathology in the child.
• Withdrawal from dispensary registration at the age of 1 year in the absence of clinical symptoms of the disease.

[24], [25], [26], [27], [28],

5 th group - newborns from the social risk group

Risk factors:

• unsatisfactory social and living conditions;
• incomplete and large families;
• families with poor psychological climate;
• student families.

Observation plan

• Inspection of the district pediatrician 4 times during the first month of life, then monthly 1-2 times.
• Control by the district nurse for the actual place of residence of the child.
• Participation of the head of the department in the preventive supervision of the child.
• Mandatory hospitalization in case of illness.
• Earlier registration in the DDU (in the first year of life), preferably with a round-the-clock stay.
• In necessary cases - depriving the mother of parental rights.

[29], [30], [31],

Hearing and deafness risk group

Risk factors:

• infectious viral diseases of the mother during pregnancy (rubella, influenza, cytomegalovirus or herpesvirus infection, toxoplasmosis); toxicosis of pregnancy;
• asphyxia;
• intrauterine birth injury;
• Hyperbilirubinemia (more than 200 μmol / l);
• hemolytic disease of the newborn;
• birth weight less than 1500 g;
• prematurity;
• ototoxic drugs taken by the mother during pregnancy;
• gestational age more than 40 weeks;
• hereditary diseases in the mother, accompanied by a lesion of the auditory analyzer.

Observation plan

• Newborns from this group of risk are watched by a pediatrician in conjunction with an otorhinolaryngologist who examines it at 1, 4, 6 and 12 months, and performs a sound proof test.
• On the recommendation of the otorhinolaryngologist - impedanceometry with acoustic reflex, consultation of the audiologist.
• Careful monitoring of the development of the auditory analyzer.
• Avoid the appointment of aminoglycosides, ototoxic drugs (furosemide, quinine, ear drops, sfradex, anauran, garazon).
• Supervision up to 18 years.

Risk group for the development of anemia

Risk factors:

• violation of utero-placental blood circulation, placental insufficiency (toxicosis, threat of interruption, pregnancy retention, hypoxia, exacerbation of somatic and infectious diseases):
• fetomaterinsky and fetoplacental hemorrhages;
• multiple pregnancies;
• intrauterine melena;
• prematurity;
• multiple fertility;
• deep and prolonged iron deficiency in the body of a pregnant woman;
• premature or late ligation of the umbilical cord;
• intrapartum hemorrhages;
• prematurity;
• large children;
• children with anomalies of the constitution;
• malabsorption syndrome, chronic intestinal diseases.

Observation plan

• Pediatrician up to 3 months 2 times a month.
• The general or common analysis of a blood in 3, 6. 12 months. In earlier time by indications.
• Study of serum iron, total iron binding capacity of serum (OZHSS).
• Electrocardiography (ECG).
• Consultations of narrow specialists (cardiologist, gastroenterologist) according to indications.
• Early introduction of food additives (juice, fruit puree, minced meat).
• For artificial feeding, adapted mixtures containing iron are recommended.
• Purpose of ferrotherapy after confirmation of iron deficiency.
• Supervision up to 1 year.
• Risk group for the development of sudden death syndrome.

Risk factors:

• negative attitude of mother to child;
• adverse housing conditions;
• single parent family;
• unregistered marriage;
• alcoholism, parents' smoking:
• low educational level of the family;
• young age of mother;
• prematurity, birth with a weight less than 2000 g;
• sibbs;
• children of the first 3 months of life who suffered acute diseases;
• children with intrauterine infection;
• children with congenital malformations of vital organs.

Observation plan

• When prenatal or primary patronage of the newborn, find out all possible addresses of the child's residence.
• Observation of the pediatrician at least once a week during the first month of life, 1 time per 2 weeks before the year.
• Ill children under 1 year of age are observed daily until recovery.
• Inform the head of the pediatric department about children from this risk group.
• Consultations of the assistants of the Medical Academy.
• Sanitary and educational work with the family.
• Do not spread the baby to sleep on your stomach.
• Do not apply a tight swaddling, do not overheat the baby.
• Do not smoke in the room where the child is.
• The cot should be in the same room as the parents.
• Preservation of natural feeding in the first 4 months of life.
• Dynamic observation of a child under 1 year of age in the form of epicrisis at 3, 6, 9, 12 months and provide the history for examination to the head of the pediatric department.

Risk groups for the development of allergic diseases

Risk factors:

• exhausted allergic family history;
• acute infectious diseases and exacerbations of chronic diseases during pregnancy;
• reception of the mother during pregnancy antibiotics, sulfonamides, blood transfusion;
• abortion of pregnancy;
• complications of pregnancy (toxicosis, threat of interruption);
• abuse of pregnant obligate allergens;
• occupational hazards during pregnancy;
• dysbiosis of the intestine and vagina in pregnant women;
• malnutrition of the child, early transition to artificial feeding;
• frequent and irrational use of antibiotic therapy.

Observation plan

• Inspection pediatrician at least 4 times during the first month of life, then on a decree.
• Inspection by narrow specialists (including an allergist, immunologist, gastroenterologist) according to indications.
• Laboratory tests on the decreed dates, including the analysis of feces for dysbiosis.
• Hypoallergenic diet of mother and child.
• Timely sanation of foci of infection.
• Struggle for natural feeding.
• Elimination of household allergens.
• The use of antibacterial drugs is strictly according to the indications
• Duration of observation up to 2-3 years.

Standard of dispensary (prophylactic) observation of the child during the first year of life

The tasks of a pediatrician on antenatal care:

• Collection and evaluation of genealogical history.
• Collection and evaluation of biological history data.
• Collection and evaluation of social history data.
• Identification of risk groups.
• Making a prognosis of the state of health and development of the child.
• Definition of risk orientation.

Preparation of recommendations, including the following sections:

• sanitary and hygienic conditions;
• mode;
• feeding and nutrition.

The tasks of the district pediatrician on the primary patronage of the newborn:

• Collection and evaluation of genealogical history.
• Collection and evaluation of biological history data.
• Collection and evaluation of social history data.
• Identification of risk groups.
• Prognosis of the state of health and development of the child.
• Definition of risk orientation.
• Assessment of information for the period preceding the inspection.
• Evaluation of physical development. 

Diagnosis and evaluation of neuropsychic development, including:

• diagnosis of neuropsychic development;
• assessment of neuropsychic development with the definition of a variant of the development group;
• identification of risk groups.

Evaluation of resistance, including:

• analysis of the frequency, duration and severity of acute diseases.

Diagnosis and assessment of the functional state of the body, including:

• identification of complaints;
• inspection of organs and systems:
• assessment of the heart rate (HR), respiratory motion frequency (BHD) and blood pressure (BP);
• collecting information and assessing the behavior of the child;
• the allocation of risk groups for behavioral abnormalities.

Conclusion on the state of health, including:

• risk orientation, risk group;
• assessment of physical development:
• evaluation of neuropsychological development;
• evaluation of resistance;
• assessment of the functional state and behavior;
• adaptation forecast;
• diagnosis, group of health.

Recommendations, including the following sections:

• sanitary and hygienic conditions;
• mode;
• feeding and nutrition;
• physical education and tempering;
• educational impact;
• recommendations on immunoprophylaxis of infectious diseases;
• recommendations for the prevention of borderline conditions and their progression;
• laboratory and other research methods, including audiological screening, ultrasound (including ultrasound of the hip joints).

Inspection by medical specialists

1 month

• Neurologist.
• Children's surgeon.
• Traumatologist-orthopedist.
• Ophthalmologist.
• Otorhinolaryngologist.

2 month

• Neurologist.

3-4 month

• Otorhinolaryngologist.

5-6 months

• Otorhinolaryngologist.

7-9 months

• Children's dentist.
• Children's surgeon.

In 12 months

• Neurologist.
• Children's surgeon.
• Traumatologist-orthopedist.
• Ophthalmologist.
• Otorhinolaryngologist.
• Children's dentist.

Laboratory methods of examination

1 month

• Audiological screening.
• Ultrasound of the brain.
• Ultrasound of the hip joints.

3 months

• A general blood test, a general urine test.

12 months

• The general analysis of a blood, the general analysis of urine, an electrocardiogram.

At the 2nd year of life, the district pediatrician examines the child quarterly, at the end of the year of observation, a healthy child is assigned a general blood test, a general urine test and a study of feces for helminth eggs.

At the 3rd year of life, the district pediatrician examines the child 1 time in the first half of the year, at the end of the year of observation, a healthy child is given a general blood test, a general urine test and a study of feces for helminth eggs.

Inspection of the child by narrow specialists is mandatory before admission to a children's preschool (orthopedic surgeon, ophthalmologist, neurologist, dentist, speech therapist, otorhinolaryngologist, psychologist).