THE UKRAINIAN MINISTRY OF PUBLIC HEALTH Vinnitsa National Pirogov Memorial Medical University

METHODICAL RECOMMENDATIONS FOR INDIVIDUAL WORK OF STUDENTS WHILE PREPARING PRACTICAL CLASS

Discipline Basis of clinical medicine Theme of lesson Newborn baby. Мodern technology of medical care for newborn baby. Feeding the baby during neonatal period. Natural, artificial, mixed feeding Course 3 Faculty Pharmaceutical

1. Actuality of theme Neonatal period is about 0.5% of the total length of human life, but the course of this period determines the child's health in the years of life. In this period the child is adapting to new conditions beyond fetal life. The adaptation process usually is physiological in nature, but under certain conditions may be complicated by the development of pathological changes. Feeding children in the first year of life has always been a topical issue among pediatrics. From feeding depends on the development of all internal organs and systems, establishing physical and psychological development. The best for the baby and mother including a natural feeding. The question of feeding the baby often prone to significant changes, particularly marked in recent years. It is known that the priority is natural feeding children in the first year of life. However, there are situations, when a child has to be translated on the artificial rearing. Therefore task of every student, and then and doctor to know reasons of hypo- and agalaction, able to prevent them or liquidate. In the case of translation on the artificial rearing able to appoint the rational use of the modern adapted mixtures and food additions, systematic to control physical and neuro-psychical development of these children.

2. Aims of employment: 1. Acquire knowledge definition of early and late neonatal period. 2. Adaptation period and its manifestation. 3. Master the principles of evaluation newborn Apgar. 4. Be able to determine the physiological condition in a newborn baby. 5. Acquire knowledge notion distress syndrome. 6. Be able to conduct a primary toilet newborn, able to care for Cord and umbilical wound. 7. Know the basic principles and be able to spend caring for a newborn. 8. To collect anamnesis infant feeding and rate it. 9. Be able to calculate the daily, one-time amount of food child in a natural, artificial, mixed feeding (depending on age). 10. A calculation of natural, artificial and mixed feeding (before weaning). 11. Estimate the daily diet of the child and to adjust if necessary.

3. Base knowledge, abilities, skills necessary for the study of theme (interdisciplanary integration) Names of previous disciplines Got skills 1. Normal human anatomy To own knowledge about the anatomic features of organs and systems of newborn children. Anatomic features of gastro intestinal tract 2. Normal physiology To apply knowledge about the features of functioning of newborn children. To use knowledge about the phases of development of mammary glands and lactation. About physiological processes that take place in a digestive tract for children. 3. Phatophysiology To apply knowledge at influences of hormones on formations of milk and influence of diseases of the endocrine system on the secretion of milk.

4. Task for independent work during preparation to employment 4.1. List of basic terms, parameters, descriptions which a student must master at preparation to employment

Term Determination 1.Neonatal period Is a period from birth till 30 days of life : early and late 2. Transitory states Is adaptation of newborns to the external environment: transitory hyperventilation, physiological erythema, physiological jaundice, transitory hyperthermia, physiological body loss, uric acid infarct, desquamative vulvovaginitis, physiological dyspepsia 3. Definition of pre-term, Pre-term babies were born with gestational age less than 73 term, post-term babies weeks, term babies-between 37-42 weeks of gestation, post- term babies-over 42 weeks of gestation 4. Breast feeding Is the feeding when a child on the first year of life receive only maternal milk. 5.Artifitial feeding Type of feeding when the child on the life first half of the year at all doesn't receive maternal milk or it makes less than 1/5 daily allowances of volume of food. 6. Mixed feeding Type of feeding when the child on the first half of the first year of life receives maternal milk and an artificial mix.

4.2. Theoretical questions to employment: 1. Concept of neonatal period: early, late. 2. A concept is the term baby, preterm and post-term child. 3. Concept of period of adaptation. 4. Rating newborn Apgar 5. The concept of distres syndrome in newborns 6. Description of basic borderline states. 7. Modern rules of care of the healthy newborn child. 8. Types of feeding a child during the first-year of life 9. Advantages of natural feeding, importance of breast feeding for the health of the child and the mother. 10. Rules of writing the feeding sheet of a child, on natural feeding, for 1 day with the calculation of feeding (depending on the age, after the introduction of weaning). 11. Reasons of translation of children on the artificial feeding, technique of conducting of the artificial feeding. 12. Mix up for feeding children, their composition. 13. Reasons for mixed feeding, Methods and rules of mixed feeding.

4.3. Practical tasks which are executed on employment: 1. Work with the tests tasks. 2. Work of students in wards with newborns, with children of breast feeding age. 3. Decision of situational tasks.

Content of the topic- the content on the practical lessons outlined in the lecture material, tutorial chair, textbooks information, in the network of Internet.

Materials for self-control: Tests: 1. Color of skin at physiological erythema: a. skin has a pinky color b skin has an yellow color c. skin has a bright red color d. skin has a cyanotic color e. skin has a pale-grey color. 2. Reason of origin of physiological jaundice: a. physiologic destruction of erytrocytes b. physiologic destruction of leukocytes c. Dyspepsia d. Physiological erythema e. a mother’s hepatit 3. Color of urine at uric acid infarct: a. Light yellow b. bright yellow c. yellow-brick d. brown e. pink 4. Clinical signs of desquamativе vulvovaginitis: a. mastopathy b. metrorrhagia c. grey-white color secretion d. watery secretion e. hemorrhagia secretion 5. Frequency of defecating at newborn: a. 1-2 times per days b. 3-4 times per days c. 1 time per days d. 6-7 times per days e. 10 time per days 6. Signs of good lactation: a. Temperature of body under the pectoral gland should be 0.5-1oС below, that in the underarm; b. The venous network is well expressed on the breast; c. Upon pressing after feeding, milk flows in a trickle from the breast; d. Upon pressing after feeding milk is comes out in drops from the breast; e. Expressed pigmentation around the nipples 7. At what age and why is it necessary to strain off the remaining milk from the breast? a. During the whole of the 1st year of the life of the baby (massage promotes lactopoiesis); b. For duration of 1-2 months, as lactostase decreases further secretion of milk 8. Which lactose predominates in cow’s milk? a β-lactose; b α-lactose 9. The required amount of food a child 3 months - 850 ml. In the mother is 350 ml of breast milk. At what is feeding the child? a natural; b artificial; с. mixed 10. What is amount of pectoral milk can be named an artificial? а. pectoral milk makes ½ volume b. pectoral milk is 1/3 volume c. pectoral milk makes ¼ volume d. pectoral milk is 1/5 volume

Situational tasks. Task 1.The child is 4 days old, borned by term with of body weight 3 kg. On 3 days written from a maternity hospital. At patronage of district doctor a mother complains, that a child urinates little. How to define day's volume of urine?

Task 2. In a maternity hall the term baby must conduct the ophthalmic prophylaxis. When, by whom, sequence, what facilities conduct this manipulation?

Task 3. A midwife is going to dress on the wrists of newborn child of oil-cloth bracelets. What on them must be indicated? Task 4 A new-born child has a body weight of 3000 g and body leng this51cm. 1. How should a new-born befed after birth? 2. In what is itnot possible to breast feed a new-born? 3. What is the term of placing the new-born on the breast after birth? 4. What regime of feeding should be prefered? 5. Calculate the volume of food for a day and during each feeding for a new-born child of 3 days with strained off breast milk? Task 5 A new-born child born has a body weight of 2900 g and the body length is 49cm. At present the child is 2 days old. It is fed with the strained off mother milk due to the situation of the mother after operation. 1. What type of feeding is optimum for a new-born child after birth? 2. Which new-born children cannot be put to the breast? 3. What is the term of placing the new-born on the breast? 4. What regime of feeding do you recommend? 5. Calculate the volume of food for a day and during each feeding (by all of methods). 6. Make a sheet of feed for the 1st day if the child is fed on strained off breast milk.

Literature Main: 1. Lectures on propaedeutics of children’s diseases. 2. Kapitan T. Propaedeutics of children’s diseases and nursing of the child. – Vinnitsa, 2006. – Pg. 347-404. 3. Kapitan T. Propaedeutics of children’s diseases and nursing of the child. – Vinnitsa, 2011. – Pg. 385-453. 4. Kapitan T. Training manual «Fact issues of pediatrics». – Vinnitsa, 2009. – Pg. 27-54.

Additional: 1. Pediatric clinical methods. – New Delhi, 2004. – Pg. 49-65.