Medical examination plan for children. Topic: “Dispensary observation of children with various somatic pathologies”
The happy and exciting time of pregnancy has passed. Childbirth is over and now you are holding your miracle in your arms for the first time. Now the first thing you have to do is close observation by doctors in the first year of life.
Why is medical examination necessary for children in the first year of life?
This is a question many young parents ask. After all, now there is so much freely available information literally at your fingertips. It would seem that all you have to do is type a question into a search engine and get an answer. But it's not that simple. It is impossible to replace the knowledge acquired by a pediatrician by reading several articles. Only a doctor can determine whether changes in your baby’s health are normal or pathological. And critical changes in the child’s general condition do not always alarm parents.
A monthly visit to the doctor is necessary for monitoring proper development baby, receiving recommendations on nutrition and development. In addition to the standard, time-tested monitoring of children in the first year of life, 98% of babies undergo a dispensary examination according to “Birth Certification”.
Generic certification, what is it?
This is one of the sections of the large state project “Health”. Its main purpose is to increase opportunities for examination and treatment of all segments of the population.
What is being done for our children? The state obliges not only doctors, but also parents to conduct a certain list of examinations during the first year of life. The fact is that not all terrible pathologies in children at an early age can be seen with the naked eye or a phonendoscope.
For example, the terrible disease “” can be diagnosed with a simple screening test after the birth of a child. Without a screening test, such a diagnosis will be made only by the age of one year, and precious time will be lost.
Dispensary observation of children in the maternity hospital
Immediately after birth, the baby is examined by a neonatologist. He checks reflexes, assesses the condition of the mucous membrane, listens to breathing and heartbeat. All these activities are aimed at the early detection of any pathologies.
On the 4th day in healthy children and on the 7th day in premature babies, blood is taken from the heel for a screening test. It allows you to timely identify a number of severe genetic diseases:
- cystic fibrosis;
- phenylketonuria;
- congenital hypothyroidism;
- galactosemia;
- adrenogenital syndrome.
If the child is healthy, then the mother does not receive a notification. But if the baby is at risk for any of the listed diseases, the parents (sometimes the children's clinic) receive a notification about the need for a re-examination.
Dispensary observation of children 1 year of age in a children's clinic or first-aid post
Observation of generic certification is divided into 2 stages.
- I period: from 1 month. up to 6 months
- II period: from 6 months. up to 12 months
Examinations are carried out every 3 months.
Examination of a child at 1 month
Here is mother and newborn at home. During the first month of the child's life, the doctor and nurse came to your home, now it's time for a return visit to the pediatrician.
At the pediatrician's appointment:
- checks the baby's posture;
- palpates internal organs;
- checks the fontanel;
- controls the proper development of the senses;
- In boys, the scrotum is examined.
At the first appointment, the pediatrician informs the mother that the baby needs to undergo an examination and visit some specialized specialists, namely:
- surgeon;
- traumatologist-orthopedist;
- neurologist;
- ophthalmologist (to exclude dacryocystitis).
These specialists must rule out the presence of pathology in their area. You need to come to them with ultrasound results in five areas:
- Ultrasound of the brain;
- hearts;
- liver;
- kidney;
- hip joints.
Usually, parents do not have a question about why their child needs an ultrasound examination in the first 4 positions, because these organs are perhaps the most important in our body. But why do you need an ultrasound of the hip joints? The fact is that changes in the structure of the joints cannot always be noticed during examination, but if they are missed, adult life The child will face many problems (severe pain, changes in gait, impaired range of motion in a joint, even disability).
Examination of a child at 2 months
Don't forget to visit your pediatrician when your baby is 2 months old. This is done to monitor the baby’s weight and development in preparation for the 3-month examination.
Examination of a child at 3 months
The pediatrician assesses the degree of development of your child. Not only weight is measured, but also height, head and chest circumference. After all the manipulations, the doctor gives a referral for further examination as part of the Maternity Certification, which includes:
- visit to a neurologist
- taking an OAC (blood test)
- passing OAM (urinalysis).
There is no need to be afraid of taking an OAM - collecting urine from a 3-month-old baby is not difficult if you approach this issue without fear and wisely. By the time the baby reaches the age of 3 months, the mother already knows the time of his awakening in the morning. This is the best time to collect urine. The collection process itself takes place in several stages:
- In the morning before the child wakes up or in the evening, prepare a clean, large plastic bowl;
- as soon as the baby begins to wake up, carefully wash him;
- place a bowl on your lap and hold a child with a bare bottom over it - soon a small portion of urine will appear in the bowl.
If this option is difficult for you, you can use not a bowl, but a special children's urinal - this is a small special plastic bag with an adhesive surface. It attaches to the genitals of both girls and boys and collects urine. Just don’t forget that the little one needs to be washed first.
When visiting a neurologist, the child’s neuropsychic development is assessed. The neurologist evaluates muscle tone, ability to follow a moving object, and so on. All this is important, since at this age the time for further immunization (vaccination) is approaching. It should be done after visiting a neurologist and taking tests.
Examination of a child at 4-5 months
At this time, a standard appointment with the pediatrician takes place. Your baby is listened to (heart and lungs), internal organs are palpated, new skills are assessed (turning on his side, etc.), and in boys, the scrotum is examined. The mother receives recommendations on the further nutrition and development of the baby.
If everything is in order, you are invited to the next vaccinations.
Examination of a child at 6 months
Six months have already passed since the birth of the child, and it’s time for another series of examinations.
The pediatrician conducts a standard examination, weighs the baby, measures his height, head and chest circumference. This is necessary to monitor the proper development of your child.
Examination of a child at 7.8 months
This is the time of regular visits to the children's clinic, during which:
- Weight control is carried out to assess the correctness of the introduction of complementary foods;
- psychomotor development is assessed;
- Recommendations are given for feeding and expanding the toddler's diet;
- If a child does not have enough vaccinations and there are no contraindications for immunization, the missing vaccines are given.
Examination of a child at 9 months
The pediatrician weighs and completely measures the baby, assesses his physical and psychomotor development and sends him for further examination according to the Birth Certificate to a neurologist, surgeon, or dentist; a referral for an ECG (electrocardiogram) is issued.
Parents are already familiar with the neurologist and surgeon and questions usually do not arise. But why a dentist? It is worth noting that dentists treat not only teeth and gums, but also the tongue, uvula, lingual frenulum, etc. Oral diseases (for example, tongue tie, irregular or delayed teething) occur even at such a young age, so consultation with a dentist is necessary.
Examination of a child at 10, 11 months
Don't miss your pediatrician's appointments. At this age, children begin to crawl and walk, and from a doctor you can get competent advice on how to help your baby in these endeavors. New foods are introduced into the child’s diet. To assess the rationality of your diet, you should come for your next weigh-in.
Examination of a child at 12 months
Your baby is already very big and is ready to undergo the last stage of the Birth Certification examination, which includes:
- consultation with a neurologist;
- consultation with a surgeon;
- consultation with a traumatologist-orthopedist;
- appointment with an ophthalmologist;
- dentist appointment;
- visit to the ENT specialist;
- CBC (complete blood count);
- UAM (general urinalysis);
- Ultrasound (done if necessary).
Parents and children who have passed all the relevant examinations can proudly say: “We have passed not only the standard medical examination of children in the first year of life, but also the Birth Certification!”
Olesya Svichkareva, nurse in the pediatric department, especially for the site
Annotation
WITH RESPIRATORY DISEASES
Respiratory diseases occupy one of the first places among the child population. More than 30% of children are admitted to the hospital due to acute diseases of the bronchopulmonary system: acute bronchitis, pneumonia, bronchiolitis. The number of chronic bronchopulmonary diseases also remains high.
In children of the first year of life, acute pneumonia predominates in the structure of respiratory diseases, and in older children, recent years The incidence of respiratory allergies is increasing. The main role in the fight against bronchopulmonary diseases belongs to local doctors who carry out prevention, early diagnosis, timely hospitalization or treatment at home, medical examination (“D”)
The following are subject to dispensary observation:
1. children with recurrent bronchitis;
2. children who have suffered acute pneumonia;
3. patients with chronic nonspecific diseases of the bronchopulmonary system;
4. patients with bronchial asthma;
5. patients with respiratory allergies.
Medical examination of children with chronic bronchitis
Dispensary observation by specialists:
pediatrician - 2 times a year,
ENT and dentist - 2 times a year,
pulmonologist - once a year,
allergist and immunologist - according to indications,
TAM and OAC during exacerbation and after intercurrent illnesses.
Chest X-ray, sputum cultures, Mantoux test, spirography and FGS as indicated.
Schoolchildren are exempt from physical education for 1 month. after an exacerbation, then continue classes in the preparatory group.
“D” follow-up for 2 years.
Health group 3.
Lesson No. 16. Respiratory diseases in children.
Annotation
Clinical examination is an active method of dynamic monitoring of the health status of certain groups with the aim of early detection of the disease, registration, clinical observation, comprehensive treatment of patients, and carrying out measures to improve the health of these children. The organizer of dispensary observation of patients in his area is the local pediatrician. He is also responsible for regular visits by patients to the dispensary group of specialist doctors.
The role of specialist doctors in conducting medical examinations of the child population is very significant. Their task is to conduct in-depth examinations and follow-up of patients.
When children with a pathology that is an indication for dispensary observation are identified, a carefully in-depth examination is carried out in a clinic, diagnostic center or hospital.
According to the methodological recommendations of 1974, 14 groups of children are subject to dispensary observation. With the same principles of clinical examination, its specific content is different; it is dictated by the localization and characteristics of the pathological process. A large group of dispensary observations consists of children who have suffered acute diseases of the respiratory system. Rehabilitation includes three stages of treatment for a sick child: hospital - sanatorium - preventive outpatient treatment.
The first stage is hospital, the second stage of rehabilitation is sanatorium. The third stage of rehabilitation is adaptation. It is carried out in a children's clinic, in a family, or in the institution that the child attends (nursery, kindergarten, school). The necessary functional studies, as prescribed by a doctor at a children's institution, are carried out in a children's clinic. The completion of the third stage of rehabilitation is the restoration of all health parameters.
Registration at the dispensary is recorded in 2 medical documents: the history of the child’s development (F.112) and the control card of the dispensary patient (F.30/u), which are filled out for a child with a chronic disease.
Every year, the pediatrician draws up a monitoring plan for the child. At the end of the calendar year, an annual epicrisis is drawn up for each child who was under dispensary observation. Deregistration of a sick child is carried out with the obligatory participation of the pediatrician and the specialist who observed the child. If after a year the patient is not removed from the register, then a medical examination plan for the next year is drawn up.
One of the difficult issues of clinical examination of sick children is their treatment during intercurrent illnesses. There is no general scheme for the pediatrician to act in these cases. In each specific case, treatment should be individualized, taking into account the characteristics of the acute disease, the course of the underlying chronic disease and the background condition. However, there are a number of general recommendations. First of all, they relate to the need to avoid polypharmacy, especially since intercurrent diseases often require courses of anti-relapse therapy. Almost all chronic somatic diseases of inflammatory or infectious-allergic nature, systemic diseases, congenital anomalies require antibacterial therapy, anti-inflammatory, non-steroidal, sedative, immunostimulating drugs, and adaptogens in the treatment of intercurrent diseases. The specific range of drugs and the timing of treatment are determined by the underlying pathology.
A feature of the treatment of intercurrent diseases against the background of chronic pathology is the limitation of the use of a number of medications. In addition, against the background of intercurrent diseases, laboratory and instrumental monitoring of the course of the underlying disease is mandatory. Most acute illnesses in children with chronic diseases require hospital treatment. In this case, hospitalization will be carried out on an emergency basis. The need for planned hospitalization of children with chronic diseases is determined by the diagnostic and treatment capabilities of primary care and the conditions in the child’s family.
An important issue during clinical observation is the question of dosing physical activity in organized children. This issue is largely resolved by preschool and school pediatricians.
When conducting a medical examination, the local pediatrician, together with teachers and parents, resolves issues of social adaptation of the child, i.e., preparing and returning the sick child to the usual lifestyle for his peers.
Their parents must be informed about social benefits and restrictions, including professional ones, in case of illnesses in children. This is the responsibility of not only doctors of organized children's groups, but also local pediatricians who carry out medical examinations.
Rehabilitation treatment departments are organized in one or more clinics, which is determined by the needs of the child population and its size in the service area. The rehabilitation treatment department includes rooms for physiotherapy, physical therapy, massage, acupuncture, as well as for audiology and audiology classes. These departments treat children with diseases of the respiratory system, nervous system, musculoskeletal system, ENT organs, and heart and kidneys.
CHILDREN'S DISPANSERIZATION AND REHABILITATION
CHILDREN WITH CARDIOVASCULAR PATHOLOGY
The prevalence of cardio-rheumatological diseases among the child population continues to remain quite high. It is important to note the very high risk of disability for children in this group.
In recent years, the structure of cardiovascular diseases in children has changed significantly. The prevalence of rheumatism has noticeably decreased. Congenital heart defects in children have begun to occupy a leading place, and the number of non-rheumatic carditis, rhythm disturbances, and dystonic conditions has also increased significantly.
Dispensary observation of children with pathologies of the cardiovascular system in a polyclinic is carried out by a local doctor and a cardio-rheumatologist. The local doctor deals with the issues of primary prevention of cardiovascular diseases, primarily providing measures aimed at increasing the resistance of the child’s body. The pediatrician carries out a lot of work on the early identification of children at risk of developing cardiovascular pathology and sick children.
A cardio-rheumatologist carries out activities related to secondary prevention, prevention of relapses and complications in sick children, provides organizational and methodological management of clinical examination, improves the qualifications of medical workers, carries out sanitary educational work among the population, and provides advisory assistance in identifying patients.
Subject to dispensary observation
Patients with rheumatism in active and inactive form;
Children with chronic foci of infection and changes in side effects
heart problems (threatened by rheumatism);
Patients with nonspecific myocarditis;
Children with vegetative-vascular dystonia;
Children with congenital heart and vascular defects,
Patients with collagen diseases.
Clinical observation of children with rheumatism. Rheumatism is a infectious-allergic disease with a predominant
by the heart and blood vessels. Group A 3-hemolytic streptococcus plays a leading role in the etiology of this disease.
The developed complex therapy for rheumatism includes: inpatient treatment, follow-up treatment in a local cardio-rheumatology sanatorium, and clinical observation in a clinic.
The concept of primary prevention of rheumatism includes measures of a general sanitary and hygienic nature, reducing the streptococcal environment, combating overcrowding, ventilation and wet cleaning of premises, personal hygiene, and sanitation of foci of chronic infection.
Children with the active phase of rheumatism should be hospitalized for at least 1.5-2 months until the activity of the rheumatic process decreases. Before transferring a child to a local sanatorium, he should not show signs of circulatory failure.
In a local sanatorium, after-care for children with an inactive phase of rheumatism is carried out for 2 months, for patients with an active phase - 3 months. In some cases, the period of stay of children in the specified sanatorium is extended. Children are discharged from the sanatorium only after complete elimination of the activity of the rheumatic process, normalization of the functions of the circulatory and respiratory systems, achievement of high resistance to infectious diseases, and also after sufficient physical and psychological preparation.
Clinical observation of children who have had rheumatism includes secondary prevention of rheumatism, aimed primarily at preventing relapse of the disease and further normalizing altered reactivity.
For 3 months after returning from the sanatorium, the child is examined by a local pediatrician and cardio-rheumatologist monthly, then once a quarter, and then twice a year. In addition, the child should be examined by an ENT doctor and a dentist twice a year. Examination methods: blood and urine tests 2 times a year and after intercurrent diseases, biochemical indicators of inflammatory activity 2 times a year, ECG and PCG - 2 times a year, other studies - as indicated.
Children who have suffered primary rheumatic carditis without signs of heart disease or chorea without obvious heart damage are given year-round prophylaxis in the first 2 years after the attack, and seasonal in the next 3 years. In case of continuously relapsing course of the disease and the formation of heart disease, year-round prophylaxis is carried out for 5 years. Currently, the most widely used is bicillin-5, which is administered once every 3 weeks.
IM 750,000 units for children preschool age, 1,500,000 units once a month for school-age children.
Simultaneously with bicillin in spring and autumn, both for year-round and seasonal prevention, non-steroidal anti-inflammatory drugs (sachol syrup, ibuprofen, diclofenac sodium) are used in a dose equal to 4/2 of the therapeutic dose for 4 weeks. Imported drugs can be used for prevention: extencillin, retarpen. Quersalin is convenient for prevention. If you are intolerant to penicillins, you can prescribe macrolides in age-specific dosages.
If a child develops an intercurrent illness in complex therapy it is necessary to include penicillin or erythromycin, one NSAID, desensitizing agents, and multivitamins (vibovit) for at least 10 days. If prompt sanitation of foci of infection is necessary, the operation is performed no earlier than 2 months after the end of hormone therapy against the background of antibiotics and antihistamines.
Sanatorium-resort treatment can be carried out 6-12 months after an acute attack (Sochi, Kislovodsk).
Exemption from physical education for 6 months, then classes in a special group for 6 months, then permanently in the preparatory group.
Schoolchildren are given an additional day off, exemption from transfer exams for 6 months from the start of the attack, and in the event of a continuously relapsing course, exemption is given permanently. Final exams are conducted using a gentle methodology.
Dispensary observation of children stops 5 years after an acute attack of rheumatism, if there have been no relapses and no organic changes have occurred in the heart. Otherwise, patients are not deregistered until they are transferred to an adult clinic. Health group III-V.
Children with chronic foci of infection and chronic intoxication (threatened by rheumatism) are observed by a pediatrician and rheumatologist until the foci of infection are sanitized once a quarter, after sanitization - examination every month, then - 2 times a year. The main purpose of monitoring such children is to prevent the first attack of rheumatism. This is facilitated by careful treatment of intercurrent diseases and seasonal bicillin prophylaxis for at least two years. Dispensary observation can be stopped 2 years after the complete elimination of foci of chronic infection and associated intoxication.
Clinical observation of children with non-rheumatic carditis. Non-rheumatic carditis is one of the most difficult issues in the entire problem of myocardial damage in children. Carditis can be complicated by any infectious disease. In older children, the viral-bacterial association predominates. Carditis is divided into congenital and acquired. Congenital carditis can be early or late. Early congenital carditis is considered to be carditis that occurs in the fetus in the first half of pregnancy, late congenital carditis occurs in the last trimester of pregnancy.
Treatment is staged: hospital, sanatorium, clinic. The frequency of examination by a pediatrician is once a month for 3 months, then once every 6 months for the rest of the follow-up period. The cardiorheumatologist examines the child with the same frequency. Consultation with a dentist and ENT doctor - 2 times a year, other specialists - according to indications. Examination methods: blood and urine tests 2 times a year and after inter-current diseases. ECG 2 times a year, EchoCG and FCG - 1 time a year, other studies as indicated.
Anti-relapse treatment is carried out 2 times a year - in spring and autumn. Within a month, patients should receive one of the cardiotropic drugs: Riboxin, Panangin, calcium pantothenate, a multivitamin complex for up to 15 days. For intercurrent diseases, nonsteroidal anti-inflammatory drugs and adaptogens are prescribed.
The issue of preventive vaccinations should be decided together with a cardiologist and immunologist, after the ECG is normalized. In the absence of heart failure, after recovery and in the absence of changes on the ECG, preventive vaccinations are allowed after 1 month.
Exemption from physical education for 6 months, then classes in a special group, then in a preparatory group for 1 year.
Medical examination of children who have suffered acute myocarditis should be carried out for 3 years, patients with subacute and chronic myocarditis are observed for 5 years. Health group III-V.
Clinical examination of children with vegetative-vascular dystonia (VSD). Vegetative-vascular dystonia (VSD) is the most common pathology in children. This disease occurs in 20-25% of school-age children. VSD is not an independent nosological form, but a syndrome that occurs in many types of pathology. Therefore, when formulating a diagnosis, it is advisable to put the cause of VSD first. The most important etiological and predisposing factor of VSD is hereditary
But constitutional predisposition Psychoemotional stress associated with an unfavorable environment at home, conflicts at school, and mental fatigue can cause the development of VSD in children.
Depending on the prevalence of activity of one of the parts of the autonomic nervous system, sympathicotonic, vagotonic and mixed forms of VSD are distinguished.
The frequency of examinations by a pediatrician and cardio-rheumatologist is once every 3 months, by a neurologist, an ENT doctor, a dentist 2 times a year, and by other specialists - according to indications. Examination methods: blood pressure 2 times a week at school, blood and urine tests 2 times a year, ECG 2 times a year, other studies as indicated.
Anti-relapse treatment 2 times a year for 1-1.5 months. Treatment includes drug and non-drug measures. Normalization of work and rest, physical education are of great importance. Often children with VSD are unreasonably exempted from physical education. Nutrition is of particular importance, do not overeat, limit salt, fat, strong tea, coffee, spicy foods (pepper, mustard, smoked meats). Physiotherapy is indicated: ultrasound, electroson, paraffin applications on the cervical-collar region, electrophoresis of medicinal substances with calcium, caffeine, phenylephrine, drotaverine for a course of 10-12 procedures, repeated after 1.5-2 months. Acupuncture and all types of massage, from general to acupressure, are recommended, at least 3 courses per year. Water procedures give a good effect: swimming, Charcot shower, contrast, fan and circular showers, pine and salt-pine baths
Herbal medicine is widely used in the treatment of VSD. Sedative herbs are recommended (valerian, motherwort, peony, horsetail, kidney tea); medicinal plants of the cardiac type (hawthorn, adonis, rose hips, viburnum, rowan); herbs with an antispasmodic effect (peppermint, fennel, parsley, dill, birch mushroom, carrots, quince), tonic herbs (tinctures of ginseng, leuzea, zamanikha, eleutherococcus, lemongrass, golden root, pantocrine). Herbal medicine for all types of VSD is prescribed for a period of at least 4-6 months with breaks every 1-1.5 months for 7-10 days. After 2-3 months of use, the dose and frequency may be reduced.
Drug therapy is carried out in combination with non-drug drugs or after their ineffectiveness. Due to long-term treatment, many drugs are not prescribed at once. For sympatho-cotonia, benzodiazepine derivatives are prescribed in courses of up to 4-6 weeks. You can use “daytime” tranquilizers: tofisopam, pipo-
fesia. Other drugs for sympathicotonia include potassium preparations (panangin, orotic acid), vitamins V b E et al. Hypersymchaticotonia requires the prescription of reserpine, proroxan, propranolol.
Children with vagotonia are prescribed benactizine, sindofen, caffeamine, calcium preparations (glycerophosphate, gluconate), vitamins (pyridoxine, pyridoxal, ascorbic acid).
For mixed forms, meprobamate, phenibut, and bellata-minal are used. To improve microcirculation, vincamine, actovegin, dipyridamole, and cinarizine are used.
Taking into account the prevailing topic of cerebrovascular insufficiency, differentiated use is recommended medicines. If the hemispheric formations are unfavorable, piracetam, aminalon, pyriditol, vinpocetine are prescribed; if the hypothalamic-pituitary formations are affected, acephen, pantogam, cleregil are prescribed; reticulo-stem formations are prescribed cerebrolysin, glutamic acid. All these drugs are prescribed for a long time, 6-12 months, in intermittent courses of 2-4 weeks.
Nootropic drugs are contraindicated when the threshold for convulsive readiness on the EEG is reduced. For intracranial hypertension syndrome, courses of diuretic herbs (bearberry, juniper, pine needles, kidney tea, lingonberry), acetazolamide, spironolactone, hydrochlorothiazide are prescribed.
Physical education classes in the preparatory group are ongoing, exercise therapy - according to indications.
Follow-up for 3 years after the disappearance of clinical signs of eetovascular dystonia. Health group II.
Clinical observation of children with congenital heart defects (CHD). The clinical picture of congenital heart defects and great vessels is varied. An important point should be considered the presence of certain phases during congenital heart disease:
Phase 1 - primary adaptation, during which in the first months of life
no child is adapting his body to unusual conditions
blood circulation;
2 (times - relative compensation;
3 (times - terminal, in which symptoms of severe
timoy decompensation.
Children with congenital malformations of the heart and blood vessels should be under the supervision of a cardiologist. The specific content of clinical observation depends on the syndrome of congenital heart disease, the anatomical variant of the defect and the phase of its progression.
During the first phase of toroca, the frequency of examination by a pediatrician of children with congenital heart disease without hemodynamic disturbances is 2 times a year; after hospital treatment 6 months monthly, then 1 time 1 V 2 months to a year. Children in the first year of life are examined every 3 months for mild cases and monthly for severe adaptation phases. In the second phase of the defect, children are examined 2 times a year. A cardiorheumatologist examines the child 2-4 times a year, in case of severe cases (blue type defect, pulmonary hypertension, etc.) once every 1-2 months. Consultation with a dentist and ENT doctor 2 times a year, other specialists - as indicated. The cardiac surgeon consults the child when making a diagnosis, then according to indications. Children who have undergone operations for congenital heart disease, including palliative ones, are examined once every 2-3 months in the first year after the intervention, then 1-2 times a year. Children who have undergone dry heart surgery are considered at risk of developing subacute bacterial endocarditis during the first year of observation.
Examination methods: blood and urine tests 2 times a year, X-ray examination 1 time a year, EchoCG, ECG 1 time every 6 months. Other studies according to indications.
Indications for hospitalization: clarification of the diagnosis of congenital heart disease, the appearance of symptoms of decompensation, severe hypoxemic crises, the development of complications, intercurrent diseases. Surgical debridement of foci of chronic infection no earlier than 6 months after surgery for heart disease. Contraindications for surgical debridement of foci of infection are the presence of symptoms of decompensation, hemorrhagic diathesis in children with the third phase of blue defect, and complications from the central nervous system.
One of the leading tasks of rehabilitation of congenital heart disease is compensation of heart failure. The regimen of a child with congenital heart disease includes extensive use of fresh air both at home and outdoors. The temperature should be maintained between 18-20 °C with frequent ventilation.
A child’s participation in outdoor games with other children should be determined not by the nature of the defect, but by its compensation and the child’s well-being. Children suffering from congenital heart disease themselves limit their physical activity. In the presence of congenital heart disease with unimpaired hemodynamics, children engage in physical education in kindergarten in weakened groups, at school - in preparatory groups. If there are hemodynamic disturbances, a special group is permanently assigned, exercise therapy. After heart surgery, exemption from physical education for 2 years, permanent exemption for symptoms of heart or pulmonary failure.
Twice a year (in spring And in the fall) they conduct a course of treatment with cardiotropic drugs: riboxin, cocarboxylase, ATP, corhormone, orotic acid, glutamic acid, vitamin therapy. When a hypoxemic attack develops without loss of consciousness, oxygen is given, sedative therapy and cordiamine are prescribed. If necessary, according to indications, the child receives cardiac glycosides. An important point in rehabilitation and clinical observation is determining the timing of surgical treatment of defects with the participation of a cardiac surgeon, which is carried out in stage 2 of the disease.
Clinical observation before transfer to an adult clinic, after surgical treatment, the issue of medical examination is resolved individually. Health group III-V.
Clinical examination of children with systemic connective tissue lesions (collagenosis). These diseases are based on an immunopathological autoimmune process, manifested by systemic lesions, recurrent nature and progression. These include juvenile rheumatoid arthritis, systemic lupus erythematosus, dermatomyositis, scleroderma and neriarteritis nodosa.
The principles of monitoring children with collagenosis are almost the same. Observation objectives: prevention of relapses, prevention or reduction of functional disorders of organs and systems. One of the basic principles of outpatient observation is the constant, long-term use of selected treatment regimens.
Frequency of examinations by a pediatrician and cardio-rheumatologist: monthly for the first 3 months of the acute period, then once every 3 months. An ENT doctor and a dentist examine children 2 times a year, an ophthalmologist - 2 times a year (examination with a slit lamp is required), an orthopedic surgeon for severe functional disorders in the joints, and other specialists as indicated. Examination methods: clinical blood and urine tests once every 3 months and after intercurrent diseases, ultrasound of internal organs, ECG, radiography of joints 2 times a year, biochemical blood tests as indicated.
Anti-relapse measures are carried out over a long period of time (months and years), the selection of therapy in a specialized hospital is considered optimal, and the use of basic therapy drugs is carefully monitored in the clinic. Immunosuppressive drugs (cyclosporine A, methotrexate) are prescribed for at least 2 years against the background of clinical and laboratory remission for a year, in combination with no more than one NSAID drug or oral glucocorticoids (maintenance dose for at least 6 months). According to indications, antibiotics, antihypertensive drugs, diuretics and pre-
parathas prescribed for the prevention and treatment of osteoporosis. Local therapy is indicated using intra-articular injections of glucocorticoids, both fast-acting (metipred, deio-medrol) and long-acting (diprostan, kenalog, lederlon), applications of anti-inflammatory ointments (indovazin, voltarene gel, dol-git) in combination with dimexide.
In outpatient settings, it is especially difficult to manage patients receiving basic therapy when intercurrent diseases occur. In such cases, broad-spectrum antibiotics are prescribed. When using NSAIDs as basic therapy, their dose is increased by 1.5 times, and a return to the original dose is carried out 3-5 days after body temperature normalizes. If immunoregulatory drugs were used as basic therapy, they are discontinued from the first day of the onset of an acute disease and returned to them 7-10 days after the body temperature has normalized, while simultaneously reducing the dose of NSAIDs by half. In the absence of signs of exacerbation of the underlying disease, NSAIDs are discontinued after 7-10 days, the total duration of NSAID treatment is thus 2-3 weeks. Hormonal therapy, if the child has received it, is carried out in the same dose, however, in the presence of hormone dependence, the dose must be increased by 1.5-2 times; a return to the original level is carried out after the temperature has normalized against the background of NSAIDs after 3-5 days. In case of severe intercurrent diseases, the patient is hospitalized even without signs of exacerbation of the underlying disease.
Rehabilitation measures include massage and exercise therapy constantly, physical factors to improve joint trophism are prescribed regularly for 3-4 weeks at least 2-4 times a year: paraffin and ozokerite applications in combination with massage; electrophoresis with ascorbic acid, nicotinic acid, heparin, 5% lithium chloride solution, lidase and other antifibrinous agents; laser therapy; mud therapy; hydromassage; mechanotherapy; balneotherapy At home exercises physical exercise to train the affected joints (bicycle, skiing, skating, volleyball) should be carried out constantly.
Physical education group - depending on the degree of functional disorders of the joints, it is important to use the maximum possible loads, but it is necessary to avoid overload and hypothermia. The main physical education group is not assigned.
Clinical examination effectiveness criteria:
No relapses,
Reduction or absence of functional disorders in the joint
vah and internal organs;
No foci of chronic infection.
Clinical observation before transfer to an adult clinic. Health group III-V.
Career guidance children with diseases of the cardiovascular system. The problems of career guidance for children suffering from chronic diseases of the cardiovascular system should be dealt with by local doctors, doctors of general education and special educational institutions, and specialist doctors of narrow profiles.
For rheumatism in the inactive phase, without clinical manifestations, factors of the working environment and the labor process are contraindicated: unfavorable meteorological and microclimatic factors, significant physical stress, toxic substances.
Chronic diseases of the joints, often exacerbating or progressing, are contraindications for professions in the presence of unfavorable meteorological and microclimatic conditions, toxic substances, increased risk of infection of the body, significant physical stress, prolonged forced position of the body, a large range of movements in the affected joints, the risk of injury, the presence general and local vibration.
Cardiac variants of connective tissue dysplasia also require solving issues of career guidance for schoolchildren; they are contraindicated in professions that require significant physical effort, exposure to the open air, in hot workshops and cold rooms.
In case of organic lesions of the valves, heart muscles, including congenital heart defects with circulatory disorders of stages I-II, significant physical stress, severe neuropsychic stress, the prescribed pace of work, long walking, unfavorable meteorological and microclimatic factors, exposure to toxic substances and dust, forced body position.
In the presence of VSD, severe physical stress, significant neuropsychic stress, the prescribed pace of work, work at height, unfavorable meteorological and microclimatic conditions, severe noise and vibration, and contact with toxic substances are contraindicated.
^ Topic/element/sub-element index O.I.01.2.4.1
Approved at the department meeting
Head of the department
Compiled by:
Doctor of Medical Sciences, Associate Professor Galaktionova M.Yu.
Candidate of Medical Sciences, Associate Professor Gordiets A.V.
Krasnoyarsk
Lesson No. 2
2. Form of organization of the lesson: seminar lesson.
3. Importance of studying the topic(the relevance of the problem being studied). Over the past decade, stable negative trends have formed in the health of children and adolescents - the prevalence of risk factors for health and development, an increase in morbidity and disability. Solving the problem of preserving and strengthening the health of children from 0 to 18 years of age is possible only with the organization of constant monitoring of their health and development, regular implementation of comprehensive health-improving and rehabilitation measures.
^4. Learning Objectives:
- general: the student must have general cultural (OK-1, OK-2, OK-3, OK-4) and professional competencies (PC-1, PC-2, PC-3, PC-4, PC-5, PC-6, PC -7, PK-8, PK-9, PK-10, PK-11).
- educational:
the student must know: regulatory framework and principles for organizing dispensary observation of children and adolescents, dynamic monitoring of the health status of children, rules for processing medical documents.
the student must be able to: assess the physical and neuropsychic development of the child, collect anamnesis, conduct an objective examination of the child, maintain the necessary medical documentation.
the student must own: principles of preventive work in a children's clinic, dynamic monitoring of the health status of children.
^ 5. Topic study plan:
5.1. Control of the initial level of knowledge:individual oral or written survey, frontal survey.
5.2. Basic concepts and provisions of the topic.
Purpose of medical examination sick children is to reduce morbidity, prevent relapses of the disease, disability, medical and social adaptation to work.
The local pediatrician carries out clinical observation of “disorganized” children and older children at preventive appointments in the clinic at decreed (regulated) dates. After a detailed clinical examination, anthropometry, diagnostics of the level of neuropsychic development, study of the child’s behavioral characteristics, analysis of existing risk factors, information over the past period, data from laboratory and other research methods, and consultation with specialists, the pediatrician gives an opinion on the child’s health status. It includes:
diagnosis (main and concomitant diseases, morphofunctional abnormalities);
assessment of physical development;
assessment of neuropsychic development;
behavior assessment;
establishing a health group.
further observation;
nutritional characteristics;
physical education;
hardening;
educational influences;
carrying out preventive vaccinations;
further dispensary observation;
laboratory and instrumental research methods;
treatment-and-prophylactic and health-improving and rehabilitation measures;
sanatorium-resort treatment.
Rheumatism
For 3 months after hospitalization, the child is examined by a pediatrician and cardio-rheumatologist monthly, then once a quarter, and then twice a year. ENT and dentist twice a year. KLA and OAM 2 times a year and after intercurrent illnesses. Used blood 2 times a year. ECG and FCG 2 times a year and other studies as indicated. For rheumatic carditis without defect and chorea, year-round prophylaxis is carried out for the first 2 years, and seasonal for the next 3 years. When a defect develops, year-round prophylaxis is carried out for 5 years with bicillin-5 intramuscularly at 750,000 units for preschool age, 1,500,000 units once a month for school age. Sanitary resort treatment 6-12 months after an acute attack. Exemption from physical education for 6 months, then special group for 6 months, then permanently in the preparatory group. “D” monitoring of children stops 5 years after the acute attack. If there is a defect, they are not deregistered until they are transferred to an adult clinic. Health group 3-5.
Non-rheumatic carditis
Pediatrician and cardio-rheumatologist 1 time per month for 3 months, then 1 time every 6 months for the rest of the time. ENT and dentist twice a year. KLA and OAM 2 times a year and after intercurrent illnesses. Used blood 2 times a year. ECG 2 times a year and EchoCG, FCG 1 time a year and other studies as indicated. Exemption from physical education for 6 months, then special group, then preparatory group for a year. “D” observation for acute myocarditis 3 years, subacute and chronic 5 years. Health group 3-5.
VSD
Pediatrician and cardio-rheumatologist 1 time every 3 months. Neurologist, ENT specialist and dentist twice a year. BP 2 times a week, UAC and OAM 2 times a year. ECG 2 times a year. Physical education in the preparatory group is ongoing. “D” follow-up 3 years. Health group 2.
Congenital defects
Children of the first year are examined every 3 months for mild and monthly for severe cases. Cardio-rheumatologist 2-4 times a year, in severe cases 1 time every 1-2 months. After surgery, once every 2-3 months, then 1-2 times a year. ENT and dentist twice a year. KLA and OAM 2 times a year, X-ray examination 1 time a year. EchoCG, ECG once every 6 months. “D” observation is not deregistered until transfer to an adult clinic. Health group 3-5.
Clinical examination of children with bronchopulmonary diseases
Acute pneumonia
The task of “D” observation is the complete morphological and functional restoration of the respiratory system, elimination of pathological reflexes and psychomotor abnormalities that arose in the child during the acute period of the disease, increasing the child’s immunological reactivity, and eliminating foci of chronic infection.
They are under “D” observation in the clinic for 1 year. In the first year of life, they attend school. pediatrician for the first time 3 days after discharge. Children of the first 3 months. are observed for 6 months after recovery 2 times a month, then once a month. At the age of 3-12 months, they are observed once every month throughout the year. From one year to 3 years are observed once every 2 months, over 3 years once a quarter. Schoolchildren are exempt from physical education for 3 months.
In case of repeated pneumonia during the “D” observation period, a consultation with a pulmonologist or immunologist is carried out. Prof. Vaccinations are allowed after 3-4 weeks. after recovery.
Recurrent bronchitis
Recurrent bronchitis is bronchitis without obstructive symptoms, episodes of which appear 2-3 times a year. “D” observation: pediatrician - 2 times a year, ENT and dentist - 2 times a year, pulmonologist - 1 time a year, allergist and immunologist - according to indications, OAM and OAC during exacerbation. Chest X-ray, sputum cultures, Mantoux test, spirography and FGS as indicated. Schoolchildren are exempt from physical education for 1 month after an exacerbation, then continue to attend classes in the preparatory group. “D” follow-up for 2 years. Health group 2.
Chronic pneumonia
Chronic pneumonia is a chronic recurrent inflammatory nonspecific process, the pathomorphological basis of which is pneumosclerosis and deformation of the bronchi.
“D” observation: pediatrician for mild cases - 2 times a year, moderate cases - 4 times a year, for severe cases 6 times a year, ENT and dentist - 2 times a year, pulmonologist - 1 time a year, phthisiatrician and thoracic surgeon - according to indications. OAM and UAC before each “D” examination. Spirography 2 times a year, sputum cytology, culture for flora and sensitivity to antibiotics 1 time a year. Chest X-ray according to indications. Anti-relapse courses of treatment 2 times a year in the absence of bronchial deformation, if present - 4 times a year. Physical education classes for schoolchildren are constantly in a special group, exercise therapy. For chronic pneumonia, stage 3. Children are provided with individual education at home without attending school. Exemption from transfer exams is permanent with frequent exacerbations and the presence of cardiopulmonary failure. “D” observation before transfer to an adult clinic. Health group 3-5.
Bronchial asthma
Bronchial asthma is an allergic disease that occurs as a result of sensitization by allergens, characterized by the periodic occurrence of bronchial obstruction as a result of bronchospasm, swelling of the bronchial wall and accumulation of secretions. The diagnosis is clarified by performing skin tests, examining the titer of immunoglobulins to significant allergens, and performing specific hyposensitization.
A pediatrician and an allergist examine patients with severe asthma once a month. With mild and severe cases, once every 3 months, with a long interictal period, 2 times a year, ENT and dentist - 2 times a year, allergist - 2 times a year. OAM and UAC 1 time in 3 months, feces for I/g and Giardia 2 times a year, spirography 2 times a year, chest radiography as indicated.
For mild and severe st. BA children attend school. In case of severe cases, study at home. Exemption from transfer exams is permanent with frequent attacks. Exemption from physical education for schoolchildren for 1 month after an attack, then permanently in a special group for severe forms of exercise in a physical therapy group. Disability in severe forms of asthma for a period of 2 years, in case of a hormone-dependent form - for up to 18 years. “D” observation before transfer to an adult clinic. Health group 3-5.
Gastrointestinal diseases
Diseases of the biliary tract (cholecystitis, cholecysto-cholangitis, biliary dyskinesia).
A pediatrician every 2-3 months for 1 year after an exacerbation, every 6 months for subsequent years, an otolaryngologist, a dentist as indicated. If necessary, consult a gastroentrologist. Feces for Giardia cysts and worm eggs. Duodenal intubation at least once every 3 months. During the first year after discharge from the hospital. In the future, according to indications. Functional liver tests (bilirubin, cholesterol, proteinogram, isthrombin, transaminase). Deregistration in the absence of exacerbation, liver enlargement, pain in the right hypochondrium and epigastrium, with normal duodenal contents for 1.5 -2 years.
^ Chronic hepatitis and the initial stage of liver cirrhosis, inactive phase.
Pediatrician once a quarter. Functional liver tests (bilirubin, cholesterol, proteinogram, prothrombin, transaminase, aldolase). Duodenal intubation once every 3-6 months. Clinical blood test with platelets once every 3 months. Feces for Giardia cysts and worms. Urine for bile pigments and urobilin once a month. Deregistration in the absence of enlargement of the liver, spleen, absence of jaundice, hemorrhages, normalization of liver function tests, duodenal contents and blood tests, i.e. no exacerbations for 2 years.
^ Chronic hepatitis and the initial stage of liver cirrhosis, active phase.
Pediatrician at least 2 times a month. The same as in the inactive phase, but liver function tests once every 10-14 days, other tests as indicated. Deregistration is the same as during the inactive phase.
^ Liver cirrhosis: mature and terminal stage.
Pediatrician at least once a month. Liver function tests and complete blood count (platelet counts are required) as indicated - at least once a month. X-ray of the esophagus once a year. Duodenal intubation is contraindicated. Do not remove from the register, systematic monitoring of the general condition (size of the liver, spleen, jaundice, ascites, etc.), functional liver tests and blood tests.
^ Chronic gastritis and duodenitis.
A pediatrician every 3 months during the first year after an exacerbation and every 6 months during the subsequent year; otolaryngologist, dentist – 2 times a year. Blood test, fractional study of gastric juice, duodenal intubation; fluoroscopy of the stomach (according to indications), coprogram, feces for I/g and lamblia; sowing for flora (according to indications). Normalization of weight, absence of complaints, normalization of gastric secretion; deregistration no earlier than 2 years after the disappearance of the main symptoms.
^ Peptic ulcer of the stomach and duodenum.
A pediatrician every 3 months during the first year after an exacerbation and every 6 months during the subsequent year; otolaryngologist, dentist – 2 times a year. Blood test, feces for occult blood, x-ray of the stomach and duodenum, fractional study of gastric juice (in the absence of food in the stomach). Weight restoration, absence of exacerbations and complications, normalization of acidity, x-ray data. They are not deregistered and at the age of 15 they are transferred for observation to a clinic for adults.
^ Clinical examination of children with diseases of the urinary organs
The conditions for dispensary observation and rehabilitation of patients with kidney diseases are reflected in the order of the Ministry of Health Russian Federation No. 380 of October 22, 2001.
When organizing clinical monitoring of children with kidney diseases, it is extremely important and necessary to adhere to the following principles:
1. Stages of observation in a clinic, hospital (specialized or somatic), local sanatorium and resort;
2. Consistency in resolving issues of diagnosis and prognosis with a medical geneticist (if there is a family history of kidney disease, metabolic disorders, pathology of the cardiovascular system);
3. Continuity of conservative and replacement therapy for chronic renal failure.
The task of clinical examination in a clinic for kidney diseases is to continue treatment recommended by the hospital, seasonal prevention, treatment during intercurrent diseases, identification and sanitation of foci of chronic infection, treatment in case of exacerbation of a chronic process.
Patients are subject to dispensary observation:
Pyelonephritis,
Glomerulonephritis,
Children with dysmetabolic nephropathies.
Acute pyelonephritis - N 10 - observation period 3 years (acute secondary pyelonephritis - 5 years)
frequency of examination by specialists - pediatrician 1st year once a month; 2nd year 1 time every 2-3 months; then once every 3 months. Nephrologist – 1st year, once every 3 months, then 1-2 times a year. Dentist - once a year, otolaryngologist - once a year, gynecologist - once every 6 months, urologist - once a year.
Symptoms that require attention are general condition, blood pressure, clinical signs of pyelonephritis, urinary syndrome (leukocytes, red blood cells), bacteriuria, renal function (endogenous creatinine clearance, Zimnitsky test), changes in kidney size on ultrasound.
Additional research methods - urine analysis: the first 6 months - once every 15 days, then once a month; quantitative urine tests (Amburger or Nechiporenko) – once every 3 months. Clinical blood test once a year. Zimnitsky test – once every 6 – 12 months. Urine culture once every 6 months, then once a year. Renal function test – once a year (for secondary renal failure). Instrumental examination (ultrasound, urography, nephroscintigraphy - according to indications). Daily excretion of oxalates and urates according to indications.
The criteria for the effectiveness of dispensary observation are deregistration one year after complete clinical and laboratory remission after examination in a hospital setting.
frequency of examination by specialists - pediatrician 1st year once a month; 2nd year 1 time every 2 months; then once every 3 months. Nephrologist – for chronic primary 1st year 1 time every 3 months, then 1-2 times a year; at chr. secondary 1 year once every 3 months, 2nd year once every 6 months, then once a year. If kidney function decreases, once every 3 months. Ophthalmologist - if kidney function decreases - once every 6 months. Dentist - once every 6 months. Otolaryngologist - once every 6 months, gynecologist - once every 6 months, urologist - once every 6 months.
Symptoms that require attention are general condition, blood pressure, clinical signs of pyelonephritis, urinary syndrome (leukocytes, red blood cells, protein), bacteriuria, renal function (endogenous creatinine clearance, Zimnitsky test), biochemical changes in the blood (increased creatinine and urea). Clinical signs of renal failure. Changes in kidney size on ultrasound.
Additional research methods - urine analysis: chronic primary - once every 10 days, then once a month; quantitative urine tests (Amburger or Nechiporenko) – once a month. Chronic secondary – 1st year once every 10 days, then once a month. Nechiporenko test once every 2 months, urine culture once every 3 months. Zimnitsky test once every 6 months. Clinical blood test once every 6 months. and for intercurrent diseases. Biochemical blood test (creatinine, urea) for chronic first Once a year, on Tue. chronic – 1 time every 6 months. Renal function test – once every 6 months. Instrumental examination (ultrasound, urography, nephroscintigraphy) – once a year. Urine testing for oxalates and urates as indicated, but at least once a year. Urine culture for intravenous blood and examination by a phthisiatrician once a year.
The criteria for the effectiveness of dispensary observation are deregistration after 5 years of complete clinical and laboratory remission after examination in a hospital for primary chronic pyelonephritis, in the absence of signs of chronic renal failure. Children with chronic secondary pyelonephritis are not removed from the register.
frequency of examination by specialists - pediatrician for the first 3 months, once a month; then once every 3 months; . Nephrologist – 1st year, once every 3 months, then 1-2 times a year. Gynecologist - once every 3-6 months, other specialists according to indications.
Symptoms that require attention are general condition, low-grade fever, abdominal or lower back pain, dysuria. Urinary syndrome (leukocytes, erythrocytes, protein), bacteriuria. Changes in an. blood - leukocytes, erythrocytes, platelets, ESR. Clinical manifestations of vulvitis.
Additional research methods - clinical blood test - once every 6-12 months General urine analysis: the first 3 months - once every 15 days, then once a month, for 1 year, then as indicated; Biochemical urine analysis according to indications; quantitative urine tests (Amburger or Nechiporenko) - once a month for 3 months and for intercurrent diseases, then once every 3 months. Urine culture once every 3 months, then once a year. Renal function test – once a year (for secondary renal failure). Instrumental examination (ultrasound, urography, nephroscintigraphy - according to indications). Daily excretion of oxalates and urates according to indications.
The criteria for the effectiveness of dispensary observation are deregistration after 6 months in the absence of clinical and laboratory signs of the disease in a clinic or hospital.
frequency of examination by specialists - pediatrician once a month during the first year of observation, then once every 3 months; . Nephrologist – 2 times a year, urologist 1 time every 2 years. Other specialists according to indications.
Symptoms that require attention are general condition, low-grade fever, abdominal or lower back pain, dysuria. Urinary syndrome (leukocytes, erythrocytes, protein), bacteriuria. Changes in an. blood - leukocytes, erythrocytes, ESR.
Additional research methods - General urine analysis monthly, preferably with determination of the morphology of urinary sediment, Zimnitsky test, determination of daily salt excretion and the level of these indicators in the blood, study of the anti-crystal-forming ability of urine, ultrasound of the kidneys, tests of the functional state of the kidneys, biochemical studies (ammonia, titratable acids , 24-hour urine, phospholipase activity, lactate dehydrogenase, creatine kenase) 2 times a year. According to indications, X-ray examination.
Acute glomerulonephritis – N 00 -08 – observation period 5 years
frequency of examination by specialists - pediatrician for the first 3 months, 2 times a month, from 3 to 12 months, 1 time per month; then once every 2-3 months. Nephrologist – 1st year, once every 3 months, then 1-2 times a year. Dentist - once every 6 months, otolaryngologist - 1-2 times a year.
Symptoms that require attention - general condition, blood pressure, diuresis, edema; urinary syndrome (leukocytes, red blood cells, protein); state of kidney function (endogenous creatinine clearance, Zimnitsky test); changes in blood tests (leukocytes, platelets, ESR); disturbance of mineral metabolism (hypoglycemia, hypocalcemia).
Additional research methods - urine analysis: the first 6 months - once every 15 days, then once a month; quantitative urine tests (Amburger or Nechiporenko) – once every 3 months. Daily urine for protein 1 time per month, during remission 1 time every 6 months. Clinical blood test once a year. Zimnitsky test – once every 6 months. Urine culture once every 6 months, then once a year. Kidney function test – once a year.
The criteria for the effectiveness of dispensary observation are deregistration after 5 years of complete clinical and laboratory remission after examination in a hospital setting.
frequency of examination by specialists - pediatrician 1-2 years, once a month; then once every 2-3 months. If kidney function decreases - monthly. Nephrologist – once every 2-3 months. Dentist, otolaryngologist, ophthalmologist once every 6 months.
Symptoms that require attention - general condition, blood pressure, diuresis, edema; urinary syndrome (leukocytes, red blood cells, protein); state of kidney function (endogenous creatinine clearance, Zimnitsky test); changes in blood tests (leukocytes, platelets, ESR); disturbance of mineral metabolism (hypoglycemia, hypocalcemia, hypokalemia, glucosuria, hyponatremia). Clinical signs of renal failure. State of the gastrointestinal tract, bone and endocrine systems in children receiving corticosteroid and cytostatic therapy.
Additional research methods - urine analysis during exacerbation: once every 15 days, then once a month; Daily urine test for protein and Addis once every 15 days, during remission - once every 6 months. Biochemical blood test (proteinogram, creatinine, urea, cholesterol) once every 6 months. Kidney function tests – once every 6 months. Urine culture for BC and examination by a TB specialist once a year.
The criteria for the effectiveness of clinical observation are the achievement of long-term remission and the absence of signs of chronic renal failure.
^ Medical examination of children with blood diseases
Leukemia C 91.0 - C95.0
Leukemia is the general name for malignant tumors arising from hematopoietic cells. Acute leukemia is diagnosed when more than 30% blast cells are present in a bone marrow smear.
“D” observation: pediatrician during remission once every 2 weeks, hematologist once a month, other specialists as indicated. Pay attention to hemorrhagic syndrome, peripheral lymph nodes, liver and spleen, testicles, state of the nervous system syndrome, urine color. CANCER at least once every 2 weeks, with platelet determination, myelogram according to indications, B/C once every 3 months and if an exacerbation is suspected. Changes in climatic conditions are not recommended for children. The child is exempt from school visits, professional vaccinations, and physical education classes. Home training is provided. Disability is assigned for a period of 5 years. Children are not removed from the “D” register.
^ Iron deficiency anemia –
"D" - observation by a pediatrician in the acute period 1-2 times a month, during remission 1 time in 3 months. Hematologist according to indications. Pay attention to the general condition, the condition of the liver, spleen, gastrointestinal tract, and cardiovascular system. OBC 1 time in 2 weeks, during the period of remission 1 time in 3 months, determination of serum iron. They are removed from the register after a year if the hemogram is normal. Professional vaccinations after 6 months when blood counts are normalized.
^ Thrombocytopenic purpura - D69
Thrombocytopenic purpura is a clinical and hematological syndrome that belongs to hemorrhagic diathesis. The diagnosis is established on the basis of a decrease in the number of platelets (the lower limit of normal platelets in children ranges from 100 10 9 / l).
“D” observation: pediatrician and hematologist in the first year once a month, then once every 3 months up to 2 years, then once every 6 months. CANCER with platelet counting, bleeding time in the first 3 months every 2 weeks, then 9 months once a month, then once every 2-3 months, more often if indicated. Exemption from physical education classes for schoolchildren for 1 month after recovery, then a permanent special group. Medical examination for acute cases is 3 years, and for chronic cases – up to 18 years. Preventive vaccinations according to the situation.
^ Hemorrhagic vasculitis - D69.0
Hemorrhagic vasculitis - Henoch-Schönlein disease (anaphylactoid purpura, capillary toxicosis) is an immune complex disease.
“D” observation: pediatrician and hematologist once a month in the first year of observation, then 2 times a year, by an allergist and other specialists according to indications. CANCER and OAM monthly in the first 3 months, then once every 3 months, for abdominal syndrome - feces for occult blood, coagulogram according to indications.. Exemption from physical education for schoolchildren for 3 months, then preparatory group for 1 year. Disability is issued in case of pathological conditions arising from hemorrhagic vasculitis with a duration of more than 2 months, for a period of 6 months to 2 years. Dispensary observation for 3 years.
^ Hemophilia D66
Hemophilia "D" observation by a pediatrician during the period of remission once a month, a hematologist 2 times a year, an orthopedist according to indications. Pay attention to the presence of hemorrhagic syndrome and the functional state of the joints. CANCER with determination of the blood coagulation system, OAM once every 2 months, coagulogram according to indications. Physical education classes at school are contraindicated. Disability is issued for severe forms of coagulopathies for up to 18 years. Children are not removed from the dispensary register.
^ Hemolytic anemia D 55 - D 59
Hemolytic anemia is a disease in which there is a shortening of the lifespan of red blood cells.
Minkowski-Shafar hemolytic anemia is a hereditary disease based on a qualitative and quantitative defect in erythrocyte membranes.
D" observation: pediatrician once a month, hematologist 2 times a year, other specialists as indicated. CANCER with counting of reticulocytes, microspherites 1 time per month, B/C (bilirubin, transaminases) 1 time per 3 months. Physical education classes at school are contraindicated. Disability occurs during anemic crises more than once a year with a decrease in HB of less than 100 g/l. With Minkowski-Shafar anemia, children can be removed from the “D” register 4 years after splenectomy in the absence of relapses. Vaccinations according to the situation.
^ Aplastic anemia D60 – D 64
Aplastic anemia is anemia caused by inhibition of the hematopoietic function of the bone marrow. “D” observation: pediatrician and hematologist once a month, other specialists as indicated. Pay attention to pallor, hemorrhagic syndrome, condition of the liver, spleen, cardiovascular system, dysfunction of the gastrointestinal tract. CANCER with platelet count once a month. Physical education classes at school are contraindicated. Disability is issued for congenital and acquired aplastic anemia and hypoplastic conditions against the background of changes in peripheral blood (HB below 100 g/l, platelets below 100 10 9 / l, leukocytes less than 4 10 9 / l) for a period of up to 18 years. Preventive vaccinations according to the situation. Children are not removed from the “D” register.
Lymphogranulomatosis –
“D” observation – pediatrician and hematologist during the period of remission once a month. Pay attention to the general condition, temperature, size of the lymph nodes, liver, spleen, peripheral blood parameters. During the period of remission, a blood test is performed once a month, a chest x-ray is taken twice a year. They are not deregistered; preventive vaccinations are required depending on the situation; they are not deregistered from “D”.
^ Medical examination of children with endocrine diseases
Diabetes mellitus E 10-E14
Diabetes mellitus is insulin deficiency. The diagnosis is made on the basis of a glucose tolerance test at a dose of 1.75 g/kg (no more than 75 g).
D" observation: pediatrician and endocrinologist once a month, ophthalmologist, neurologist and dentist 2 times a year, ENT specialist 1 time a year. When examining, pay attention to: the general condition of the child, the condition of the skin and liver. Monitor weight, body length, and rate of sexual development. Determination of blood and urine glucose, blood and urine acetone once every 3 months. Determination of microalbuminuria once every 3 months, visual acuity and fundus once every 3 months, ECG, rheoencephalography, rheovasography once every 6 months, CBC and OAM once every 6 months, chest x-ray once a year. Preventive vaccinations are carried out in a state of compensation. Children are not removed from the “D” register.
Hypothyroidism E 03
Hypothyroidism is caused by decreased production of thyroid hormones or lack of sensitivity to them in tissues. Clinical examination is carried out by a pediatrician and an endocrinologist. It involves two stages. Stage 1 – maternity hospital. A screening test for hypothyroidism is performed. Stage 2 – pediatric section. Examination and examination at age: 14 days, after 4-6 weeks, then quarterly in the first year of life, up to 3 years, once every 6 months, then once a year. Attention is paid to the condition of the skin, blood pressure, pulse, timing of teething, body length, mental development. Neurologist at 1 and 2 years, psychiatrist at 3 years, ophthalmologist at 2 and 3 years, audiologist at 2 years. Bone radiography is performed once a year to monitor the dynamics of bone age. Then specialists examine the child annually. TSH, T3 and T4 at 14 days, after 4-6 weeks, then quarterly for up to a year. TSH, T3 and T4, CBC, lipid profile once every 6 months. Preventive vaccinations are not contraindicated. Children are not removed from the “D” register.
^ Endemic goiter E 01.0
Endemic goiter is a manifestation of iodine deficiency.
^ Toxic diffuse goiter –
D" observation: pediatrician and endocrinologist once every 6 months. TSH, T3 and T4, B/C, fasting blood sugar, lipidogram, KBC, BAM, ECG, blood pressure, pulse counting. Physical development is assessed by ultrasound. Preventive vaccinations are not contraindicated for compensation. Children are not removed from the “D” register.
^ Adrenal diseases -
( chronic adrenal insufficiency, acute adrenal insufficiency, congenital adrenal hyperplasia (adrenogenital syndrome), Itsenko-Cushing syndrome, pheochromocytoma)
Observation by a pediatrician and endocrinologist once a month in the acute period, in the compensation stage once every 3 months. According to indications, consultation with an ophthalmologist, neurologist, and phthisiatrician. Monitoring blood pressure, sexual development, body weight and length, fat deposition, and general condition. Additional examinations: general blood test, blood and urine sugar, determination of 17-OX in the blood and urine, electrolytes (sodium, potassium, chlorides, calcium). Tuberculin tests according to indications, radiography according to indications (hands, lungs). Other examinations depending on the situation.
Obesity E 66
Obesity is a pathological excess of triglycerides in the body, leading to an increase in body weight by 10% or more from the average normal value.
D" observation: pediatrician and endocrinologist once every 3 months, then once every 6-12 months. Oculist, neurologist once a year. Monitor the condition of the skin and cardiovascular system, blood pressure, body weight and length Determination of fasting blood and urine glucose, cortisol, ACTH, sex hormones, sugar curve, lipid profile, ultrasound of the abdominal organs, fundus and visual fields 1 time in 6-12 months Deregistered due to weight normalization.
^ 5.3. Independent work
