Pediatric resuscitation, emergencies in pediatrics. Various infusion methods for children
Background. Medical care for premature babies in Germany is divided into two levels. Perinatal centers of the first level provide care for infants with body weight at birth <1500 g. Perinatal centers of the second level provide care for children whose body weight exceeds 1500 g. In order to be included in the list of first level institutions, the hospital must, among other, be able to pick up children from other institutions in the surrounding region. Mobile incubators are used for this purpose. Such an incubator is a kind of a mobile intensive care unit. In some cases, the incubator is delivered to the desired location by helicopter, but in most cases, specialized road transport is used.
Objective. To describe neonatological medical care in Germany.
Materials and methods. Analysis of own experience and available literature data on this issue.
Results and discussion. In recent years, Germany experiences a decrease in the number of births, which causes the problem of professional training of doctors. Hospitals with the fewest births are closed due to lack of efficiency. Although there are some fluctuations from year to year, in general, the number of premature babies with extremely low birth weight remains approximately constant. Prematurity remains one of the most important problems of modern medicine, as it is accompanied by high mortality rates. The earlier the premature birth is and the lower the body weight is, the higher these rates are. Prematurity is caused by numerous risk factors. Multiple pregnancies are accompanied by the highest risk of premature birth. The presence of twins or triples increases this risk by 7.7 times. Other risk factors include vaginal bleeding in late pregnancy, preeclampsia, and a history of preterm birth. Over the past 20 years, the survival of children born before 32 weeks of pregnancy or weighing <1500 g has increased by almost 20 %. The smallest premature baby born in our clinic is a baby born at 24 weeks of gestation with a body weight of 350 g. Nowadays in Germany, the survival rate of infants born after 24 weeks of gestation is almost 80 %, and after 29 weeks – almost 100 %. It should be noted that maintaining the life of a premature baby from birth to discharge costs 250-300 thousand euros. Bronchopulmonary dysplasia is an important problem of premature infants, especially in case of mechanical lung ventilation (MLV) or joining infections. Up to 40 % of children who die from complications of bronchopulmonary dysplasia can be saved. If possible, MLV and infections should be avoided, premature births should be prevented, so-called neuroprotective ventilation and nasal or mask devices that do not require intubation should be used. Surfactants have made great progress in the management of premature infants. The modern LISA (less invasive surfactant administration) method allows to inject a surfactant into a child’s lungs without intubation. In the early 20th century, 100 % oxygen was used in the resuscitation of newborns, but now we use air (21 % oxygen) or a mixture containing up to 30 % oxygen. To prevent necrotizing enterocolitis, premature infants are prescribed probiotics based on lyophilized lactic acid bacteria and bifidobacteria. Breast milk is an another way to prevent this complication of prematurity. There is a breast milk bank in Potsdam.
Conclusions. 1. Prematurity remains one of the most important problems of modern medicine, as it is accompanied by high mortality rates. 2. Multiple pregnancies are accompanied by the highest risk of premature birth. 3. Nowadays in Germany, the survival rate of children born after 24 weeks of gestation is almost 80 %, and after 29 weeks – almost 100 %. 4. Surfactants and the LISA method have made great progress in the management of premature infants. 5. Probiotics and breast milk are prescribed to premature babies to prevent necrotizing enterocolitis.
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