How are newborns saved? Report from pediatric intensive care
“Little clumps, some the size of a palm, vulnerable to infections and complications, but extraordinarily resilient, ready to fight for their lives from the first second of their birth. The other day we visited the intensive care unit for premature babies and want to tell you how this unit works, ”writes Stanislav Dvoeglazova.
1. The department receives the heaviest children from all maternity hospitals in Moscow. Transportation of these children is carried out by a mobile resuscitation neonatal team.
A call comes in from the maternity hospital, and a team consisting of a doctor and a paramedic leaves the place and brings the child to the intensive care unit. Here the children lie until their condition stabilizes.
Children are on mechanical ventilation, as their lungs are not fully expanded, and also when there is a manifestation of severe respiratory failure. Restoration of respiratory function occurs just in this department.
2. Recently, medicine has made serious progress in the treatment of respiratory failure, a lot of new equipment has appeared, and for children, especially premature ones, with extremely low body weight, doctors are trying to carry out non-invasive artificial ventilation of the lungs, that is, without intubation (without inserting a tube into the larynx) of the child . Doctors use a technique called "nasal sipap" that creates the same pressure in the lungs as when intubating the trachea during complete mechanical ventilation.
The specialization of this resuscitation is premature babies, since the entire children's corps is designed to care for them, but also full-term babies with birth injuries, swallowed water during childbirth, or those who have a convulsive syndrome.
There are several similar departments of the second stage in Moscow: the department at the 7th (from where, in fact, we are reporting), the 13th, at Filatovskaya, at the 70th and 8th City Clinical Hospital.
3. On the basis of the 7th City Clinical Hospital there is a single dispatch center where calls are received from all maternity hospitals in Moscow, and then the dispatcher directs the children to the intensive care unit of a particular hospital, depending on the distance from the maternity hospital and the workload of beds.
4. In total, 3 reanimobiles are on duty in Moscow, two of them are attached to the 7th city hospital and one to the 8th.
5. Modern medicine allows you to nurse children weighing 500 grams, from the 22nd week of gestation. The size of such a child is approximately 32-33 centimeters from the top of the head to the heels.
6. When parents ask what are the chances of their child surviving, the doctors say that it is 50/50, but in fact, thanks to the good equipment and qualifications of doctors, the mortality rate this year was 0.3 percent. When it comes to life, words like "just something" are completely inappropriate. You need to understand that doctors here are fighting for every child, for every day of his life, for every gram of his weight.
7. On average, 1100-1200 children enter this department per year, this is 2-3, maximum 4 children per day. They are in intensive care from 5 to 30 days, but if we are talking about very small children, then they can stay in the department for up to 3 months. The cost of nursing such a child can reach half a million rubles. But this does not mean at all that parents need to be millionaires in order to pay for treatment. Everything is provided within the framework of state guarantees under the policy of compulsory medical insurance, which is available to all citizens of the Russian Federation.
8. As far as I know, the other day the Moscow City Compulsory Medical Insurance Fund announced an increase in expenses for the provision of a number of types of medical care, including the direction of nursing children, in particular, 122,000 hospitals will receive 122,000 instead of the 61,000 due today. Previously, not all tariffs covered the cost of treatment, especially if children weighing 600-800 grams were nursed, and a child is discharged only when the mother is able to cope with it, that is, the child must be able to breathe on his own, keep warm and suck on a nipple.
And here, if I may, I will deviate a little from the topic and stay a boring teacher, remembering my teaching experience at the university. So, the compulsory medical insurance policy is not just a piece of paper, but such a thing, according to which every citizen of the Russian Federation is entitled to free medical care in the system of compulsory medical insurance. At the same time, it doesn’t matter at all that you received the policy in Uryupinsk, for example, you were registered in Vladivostok at all, and you or your child needed medical care in Moscow. So, if suddenly they refused to provide you with this same medical assistance, arguing that you are not a resident of the capital, or even demanded money for treatment, then do this: 1. Write an application addressed to the head physician of the medical institution, where you state the situation, and 2. send the same letter of happiness to the insurance company that issued your policy, as well as to the Compulsory Medical Insurance Fund, and believe me, you will be happy, and those who tried to refuse treatment or demanded money - atata in the soft spot.
9. Let's go back to the department.
All children in the department lie in special cuveuses, in which a certain temperature and humidity are maintained.
10. All flasks are covered with blankets. This is not done for aesthetics, but due to the fact that the eyes of premature babies react painfully to daylight, and in order not to irritate them and aggravate the development of retinopathy, incubators are covered all over the world.
11. Monitors with sensors are connected to each child, and if the parameters go beyond the norm, then an alarm is given, which is also duplicated on the monitor, which is located at the nurse's station.
Alla Lazarevna, a neonatologist, head of the perinatal center at GBUZ GKB No. 7 DZM, proudly told us that the department that is in her department is better than those that she saw in foreign clinics where she and her employees traveled to exchange experience. Yes, the incubators there are exactly the same, of the same manufacturers and modifications, but they have more crowding of children in boxing, which does not correspond to Russian SanPins. In our country, children are placed in one box from one maternity hospital, in another box - from another, so as not to mix the flora of maternity hospitals. They do it all at the same time.
12. Parents come to the intensive care unit every day, and they are given information about the child's condition, they can also go to the intensive care unit and sit next to the child. If the child is on independent breathing, then mothers are allowed into the department, they express milk and begin to feed the children with this milk.
13. Two laboratories for express diagnostics work around the clock in the department. One of the main tests is the determination of the acid-base state of children, blood gases are taken for analysis every four hours in all children who are on artificial lung ventilation, to determine the correctness of the selected parameters.
14. A biochemical blood test is done in another laboratory, it is located on the third floor of the department.
15. If there is a need to take an x-ray, then the child is not taken anywhere, the radiologist is called, and he carries the x-ray machine to the incubator. Everything is close to the child. Resuscitation children cannot be moved anywhere else, all assistance is provided on the spot.
16. If you need to put a catheter or intubate, then the child is transferred from the incubator to a special heated table. It is correctly called "Open resuscitation system".
17. After the children are removed from the apparatus, they are transferred to the intensive care unit. This is the next stage, bringing her discharge home and reunion with her parents closer.
18. Before entering the children's box, you must wash your hands.
19. Reminders of this hang in front of every door.
20. After discharge, children under three years of age are observed not only in polyclinics at the place of residence, but also in the polyclinic at the department.
And finally, I would like to express my deep gratitude personally to Erlikh Alla Lazarevna and her staff for doing such a great and bright work, as well as for the tour.
Special thanks to my beloved husband for the photos
Keywords: Newborns | Resuscitation