The seventh sense in pediatrics, or How preterm babies are cared for in Gomel

"How are our babies?" - every day, every duty of the head of the pediatric department for newborns of the Gomel Regional Children's Clinical Hospital, Olga Tselekhovich, begins with this question. Even on the weekend, she does not change this tradition, let's say more - the call of the heart. Just can not help but know how the condition of those who struggle with all their might for life. The regional hospital has introduced a full cycle of neonatal care, nursing newborns weighing less than 500 g. BelTA learned how the clinic helps the smallest fighters for life, who are only a few hours or days old, to gain strength.

Patients of this department cannot show or suggest where, what and how they hurt. These are babies from zero to 3 months. The pediatric department for newborns is designed to provide specialized medical and diagnostic care to children from the first day to five months of life. These babies are sent from maternity hospitals, city and district hospitals, polyclinics of the city and the region. Reanimobiles that deliver newborns are also equipped with everything necessary.

The state has eight doctors, most of whom have the highest qualification category, as well as 27 nurses who love children and do not see themselves in another area. They feel their patients, understanding even without "agu".

Babies with somatic and infectious pathology of the neonatal period are hospitalized in the department, excluding intestinal dysfunctions of infectious genesis and perinatal lesions of the nervous system. Here, modern methods of laboratory and instrumental diagnostics are used, complex treatment and rehabilitation are carried out, including medical and physiotherapeutic methods, massage, physiotherapy exercises. If necessary, patients are consulted by doctors of all specialties represented in the hospital and from other hospitals in the city. Close contact has also been established with the staff of the Department of Pediatrics of the Gomel State Medical University. Colleagues from metropolitan hospitals and medical centers are always in touch. Telemedicine is widely practiced.

More than 1,000 newborns pass through the department every year. These are babies with various pathologies from all regions of the region. Most often, this is a perinatal pathology - about 70% of children with diagnoses such as congenital pneumonia, neonatal jaundice, malformations of various systems.

“Something happened - and even hundreds of kilometers away, newborns a few hours old are delivered to us. Honestly, there are children and 6-11 months. In fact, we know best babies up to a year. on duty in our department. Someone openly says that they are afraid of our children. We just feel them. Yes, there is experience, professionalism and, to some extent, intuition - the seventh sense, "Olga Tselekhovich smiles.

"Our main task is for children to get better so that they can continue to live and develop without any consequences. This is important for us. Therefore, our work does not end after we leave the hospital. We still worry, think about little patients Everyone is just crazy about children, otherwise it is impossible in our profession, "the doctor admits.

In fact, intensive care children are cared for in the department. The only difference is that they breathe on their own, not on machines. At the same time, everyone in the department is striving to establish breastfeeding as soon as possible. “We try to start this natural process as early as possible. This is the prevention of colitis and other complications that may be in premature babies. It is also important to get away from tube feeding as soon as possible, we teach to the nipple,” says Olga Tselekhovich.

Also, the still tiny person is being examined in full. "Thanks to our optometrist Tatyana Adamovna, who helps to see or prevent the pathology of the organs of vision in time, so that our children see this world, where they were in such a hurry, having been born prematurely," the doctor notes.

A full-fledged ultrasound diagnostics is also to help neonatologists. Ultrasound of the heart, brain and other organs. The sooner the pathology is detected and treatment begins, the more chances the child has. "Sometimes we are asked if we do not do too many examinations. I will immediately answer: in no case. It is during this period that all the nuances are visible that can later be veiled. Of course, we are glad when nothing is found and the child develops as expected" - say in the department.

"I will never forget one more case - the child did not digest food. They diagnosed intestinal sepsis. And then collectively they began to think in a different direction - and they diagnosed Hirschsprung's disease. This is an anomaly in the development of the large intestine of congenital etiology. The child was operated on in Minsk. Everything is fine with him "And now his mother sends photos every year on the baby's birthday. It's so nice. The best reward for our work. Also in my practice there were two triplets - excellent children," the doctor emphasizes.

Olga Tselekhovich has been working in the department since 2001. I came here right after the institute, after clinical residency. Then Oleg Anatolyevich Lozhechko was in charge of the department. Olga Petrovna headed the department in 2020. The doctor of the highest category notes that every child is remembered in the team. “It’s not without reason that the motto of our hospital is: “Every child is in our heart.” This is true. All the doctors in our department are one. three years have passed since the twins were discharged, they sent a photo, etc. I repeat, this is the greatest value for us," the doctor smiles.

The post of intensive care and nursing of premature and sick newborns with various pathologies on the basis of the department was created and opened in October 2018. There are six places and maximum possible attention and care. Speaking in the language of administrative documents - highly qualified neonatological care for full-term and premature newborns with different gestation periods and a variety of somatic pathologies. Plus, rehabilitation and training of parents in the skills of caring for premature babies at home.

“Our work is based on the principles of a protective regimen and individual care. Efforts are directed not only to the treatment of the disease, but also to the development of the child. We try to create conditions for a premature baby as close as possible to those in utero, where it was quiet, warm and dark. babies are nursed in incubators with the use of special capes-screens for the incubator. Babies with normal birth weight are in cribs on special heated mattresses," says neonatologist Elena Kozik.

If in 2019 89 children passed through ICU, then in 2021 - 140, of which 10 with extremely low birth weight (up to 1 kg) and 30 babies with very low birth weight from 1 to 1.5 kg.

The smallest patient is from twins. Weighed only 480 gr. His brother is slightly larger - 900 gr. Now they are 3 years old, they are developing well, mom sends photos, is proud and shares their achievements and successes. Share family joy and doctors.

“The smaller the child, the more he needs to maintain the intrauterine position, which is physiological for him. Therefore, we try to provide the baby with pastural support using various devices: nests, bolsters, mattresses,” doctors dedicate to the intricacies of their work.

The necessary medical support is provided in full. But there is a medicine that works flawlessly, it does not need to be injected. During the stay of a premature baby in a hospital, biological and psychological contact with parents is very important. This is exactly what the doctor ordered. "The sooner parents realize that they can help their baby and are included in the process, the more likely it is that everything will turn out favorably," they say in the department.

At the intensive care post, the kangaroo method is widely and successfully practiced. “This is daily close skin-to-skin contact between mother and child. Of course, the best medicine for our babies is their mother. In pre-Covid times, dads were also attracted. I think we will return this practice,” doctors of the smallest patients explain.

Such contact gives a visible effect from the discharge is unbelievable, but understandable from a scientific point of view. The baby feels the mother's warmth. And the body temperature is maintained at the proper level, the frequency of episodes of apnea - breath holding is reduced. "In addition, when exposed to stimulation that comes from the mother's breast, the sucking and swallowing reflexes improve in children. The mother also stimulates the lactation process. The psychomotor and emotional development of children improves," says Elena Kozik.

The department has a full-fledged parenting school for mothers of babies who were in a hurry to be born. The medical staff necessarily teaches stimulating massage on the arms, hands and fingers. This contributes to the development of auditory concentration, reduces the tone of the hand, and also positively affects the dynamics of the development of motor skills and speech.

At one time, the know-how of the staff of the department was the use of natural knitted things - hats, vests, socks, special octopus toys. "The friction of the woolen fibers warms the skin of the child, also, tingling and irritating with its fibers, acts on the delicate reflex endings. There is such a natural massage with a warming and tonic effect, the frequency of breath-holding episodes decreases," explains Elena Kozik.

A separate story - octopus toys. Everything is simple and deep at the same time: their knitted tentacles remind a child of an umbilical cord. When the baby is in the incubator and the mother cannot be with him, she will hold the toy on her chest and put it to the baby. "You know, the baby calms down - he smells his mother," Elena Kozik explains.

"A premature baby is a little hasty who is born prematurely, a small steadfast tin soldier. Everything is read in his movements, facial expression: anxiety, joy, anxiety. How to understand that he is unwell and what exactly is the matter? Everything comes with experience. Work experience allows you to better see the condition of the baby. Of course, he still does not say anything, but even by his crying, by his movements, we see that he has some kind of problem. And we begin to solve it. Believe me, you don’t even need to ask anything. We pay attention to the smallest things that allow you to say about the condition of the baby," Olga Tselekhovich shares her professional secrets.

Another point - sometimes it is not easy for mothers to accept that a premature baby was born. Every woman dreams of a rosy-cheeked toddler who is gaining weight every hour on breast milk, the harder it is to see how the baby cannot breathe on his own, feeds through a tube. And in such cases, the doctors of the department are not just attending physicians for children, but also psychologists for mothers. “It is important to reassure, tune in to positive emotions. After all, there is such a close connection between the baby and the mother that he instantly reacts when the mother cries or is nervous, and cries himself. It turns out a vicious circle: the mother does not understand why he is crying, and gets even more upset. The baby responds to all the emotions of the mother," Elena Kozik explains the possible reasons for the excitement of the kids.

For the recovery of the baby, the mood of the mother is important. “Moms and I always conduct individual conversations on the developmental features of such babies, on feeding, on home care. We tell mothers about the problems they may encounter in the future. The sooner we teach mothers to care for a child, the sooner they are transferred "Mothers can come to the intensive care post at least around the clock: for each feeding, change diapers, get a massage. After the child is stabilized, they are transferred to a joint ward," the doctors say.

Mothers with small patients lie in the hospital for a long time. Sometimes it's 2-3 months. You can understand their morale. The mini-stories of the recovery of the kids of the department, which are collected on a stand in the corridor, help not to lose heart and cheer up. The photographs show an obvious progress in the state and development of "steady tin soldiers" from lying in jugs and breathing with the help of an apparatus to restless naughty ones. Mom looks at the photos and understands that her baby can achieve a lot, that she is not alone in this situation.

In October 2019, the Republican Public Association of Parents of Premature Babies "Rano" and the Children's Fund UNICEF Belarus, with the support of the Ministry of Health, launched a training program on quality care, upbringing and development of premature babies "School of Parenthood". Together with the doctors of the department, they acted as a team. A nurse, a pediatrician, a breastfeeding specialist gave lectures for mothers, taught nursing skills. Mothers shared their experiences. The support of mothers who have gone through such difficult situations cannot be overestimated.

Tangible support for the staff of the department and patients was from another voluntary organization "28 loops". Volunteers delivered knitted woolen items for babies to the hospital.

A blog with this name is known to many families, or rather mothers. Olga Tselekhovich, a pediatrician of the highest category, and other doctors, parents show and talk about their own and not only children, but also give recommendations on how to take care of children. Family life, rest, psychology of relationships, useful tips and much more that is useful for parents to know.

They do not leave mom alone with the newborn and outside the hospital. Even at a distance, including through a blog, they will always prompt, support, recommend, remind. Each video is dedicated to a different topic. They simply and clearly explain and show how to massage the hands of tiny hands and fingers, whether there is enough milk for the baby, what sweets to pamper a child up to a year old, whether it is worth worrying about infant jaundice, talk about differences in the development of boys and girls. Everything about the colic of babies, the diet of a nursing mother, allergic reactions, the appearance of the first and other teeth, from agu and a reciprocal smile to long-awaited words - these and many other questions at any time of the day - at a distance of the phone in hand. There are tips for moms of growing up naughty

Discharge is the happiest moment not only for families, but also for doctors and medical staff. "We are always glad to see a smiling mother, a happy baby. Mothers are confident in their abilities. It's nice when, after being discharged from the hospital, mothers and their children visit us and talk about their achievements. This is very important for us, because this is how we see the results of our work. Back communication is only welcome," emphasizes Elena Kozik.

After discharge, doctors do not lose sight of their babies. If necessary, rehabilitation after a while is recorded for planned hospitalization. They ask families to send photos of growing babies, come to the hospital more often, but only to visit.

Nursing premature babies is one of the most expensive and high-tech areas of medicine. The use and introduction of modern non-invasive technologies into wide practice makes it possible to create conditions for a favorable outcome, development and maximum compensation for the condition of premature babies, and improve their quality of life. For doctors and nurses, this is daily, hourly, every minute work.

“It’s so great when you hold this little lump in your arms, from which a big person will grow over time, it’s an incomparable pleasure. I want all our kids to get better and go to discharge. We can’t say that it’s easy for everyone. once and give the little patients themselves.After all, these are such sunny children, they give so much positive energy that you can’t help but feel.And every time you come on duty and see that the baby is recovering in small steps, you understand that all the efforts are not in vain ", - summarizes the neonatologist Elena Kozik.

BELTA.