The resuscitation and children’s departments of the hospital№ 24, Moscow, Russia.


The children hospital №24 is situated at the capital of Russia, Moscow. Today this hospital is the major Moscow perinatal center. It specializes in aiding women who have noncarrying of pregnancy. The doctors of this hospital assist in childbirth, take care and treat low-birth-weight infants and help children with born defects.

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The obstetrician-gynecologists try to preserve pregnancy to carry a baby to the term, but, sometimes the doctors delivery a baby before a due date with a view to save child and/or woman’s lives. In this case just prematurely born children come into the world.

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 They are not able to breathe, keep body temperature without assistance and digest breast milk. The neonatologists start struggling for babies’ lives from the beginning of their first minutes. The child, who was born on the 25th week of gestation, has the birth weight about 500 grams and the doctor’s palm can be a room for such a baby due to his small size.

 

 Practically all prematurely born children require different sorts of respiratory therapy. The endotracheal introduction of special medicinal substance (the artificial surfactant) is often necessary for them because the immature lungs do not produce natural surfactant. The natural surfactant, a lung secretion is vital to normal pulmonary function because it keeps the lungs from collapsing after each breath. The artificial surfactant serves as a substitute for the missing substance until the babies' lungs mature and they begin to produce surfactant normally.
Prematurely born children need to have special conditions of temperature and humidity; they require carrying out of fluid therapy. That is why these children are transported to a resuscitation unit №1 of our hospital from a delivery room.

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An incubator is already warm and a respirator is ready when a child is being transported to the resuscitation department.  From this time onward a hard and long way for a child, his parents and doctors starts. They overcome difficulties together. This way requires the continual participation of the personnel and also the usage of about ten types of vital equipment for one child at the same time.
Incubators are vital for the new-born. When a baby is born before term it does not have sufficient forces to adapt to external conditions. Until it gains a normal weight it needs a fixed temperature of 37 Celsius degrees like in the mother’s body. This temperature can be maintained only with the help of equipment.

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If a child doesn’t have serious infectious disease, if it starts to breathe itself, digest the necessary volume of milk then it is transferred to the children’s unit from the resuscitation unit №1 for further patient's management with due respect to both medical treatment and general care.

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 However there are prematurely born children with associated illnesses who require the continuation of fluid therapy, observation by specialists of narrow background such as a neurologist, a pulmonologist and an oculist. Such children continue the treatment at the resuscitation unit №2. A prematurely born child, who suffers from pneumonia or has the other pathology of the respiratory system, is not able to breathe efficiently. In this case a respirator helps him.

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 Neonatologists try to teach a child to breathe on its own. The best respirator for this aim is a respirator which has a trigger mode of assisted pulmonary ventilation.  The trigger is a special sensor for catching of patient’s respiratory attempts. It synchronizes child’s breathing with a respirator. The trigger ventilation reduces length of artificial pulmonary ventilation. However a part of respirators doesn’t have a trigger sensor. Reduction of length of artificial pulmonary ventilation provides children with reduction of such diseases as broncho-pulmonary dysplasia and retinopathy which are typical for prematurely born children.

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In our department we use different methods of trigger ventilation, for example AC (assist control), SIMV (Synchronized Intermittent Mandatory Ventilation) and PAV (proportional assist ventilation). The mode CMV (controlled mechanical ventilation) describes a method that does not enable patient triggered breaths. This mode is used if a patient doesn’t have attempts of independent breaths. Besides at our department we use such modes of assisted ventilation as CPAP (Continuous Positive Airway Pressure) and High-frequency ventilation. All these methods are individual for every child and in the course of time one child can have several variants of assisted pulmonary ventilation.

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 The most necessary thing for a resuscitation specialist is a calculator. Every day he figures out a vital dropping medicine. The calculation accuracy has to be within tenth part of a milliliter, because an infant gets the most part of nutrients and trace elements intravenously. This method of treatment can last for a long period of time with the help of lineomates. They provide intravenous introduction of drug uninterruptedly at a certain speed.

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 Little by little the volume of breast milk for a child (which it gets with the help of a gastric tube) increases and the volume of intravenous medicine reduces. One or two months pass when a child starts breathing independently and infusion therapy cancels. Such a baby is ready for transport to the children department. There its mother will have learnt to care it and a child will have learnt to drink her milk at first from a bottle, after a while from her breast. When it gains the certain weight the parents will be able to take it home.
The long and difficult way spent at hospital is over!

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Not every parent believes that his child will be alive and healthy. Sometimes a resuscitation specialist, who is standing nearby an incubator for twenty-four hours, can start having his doubts about the child’s future. In this case he feels not only tiredness but sorrow as well… But, look! Two-year-old child is running up to meet you not as a patient, but, as a guest at the hospital! Our doctors’ team and its parents start discussing old times: how small the child was, and how it lay on a doctor’s palm, and what little chances of survival it had.

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Modern neonatology is a young and developing part of medicine. Today specialists can save a prematurely born child’s life practically in every case. Nowadays doctors fight for QUALITY of a baby’s life. The package of doctor’s deep knowledge and modern methods of treatment gives a child a chance for the further life of full value!

 

 

P.S. World Prematurity Awareness Day (on the 17th of November) was established in 2009. On this day parents, families, parents’ groups and activists gather together to raise awareness about prematurity and highlight all the problems associated with it. World Prematurity Awareness Day is celebrated in different countries annually. 

 

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