Department of resuscitation and intensive care for newborns of the City Clinical Hospital named after. M.P. Konchalovsky (formerly City Clinical Hospital No. 3) has 9 beds in the perinatal center. If necessary, can provide assistance to more children. Intensive care of newborns is one of the specialized areas of neonatal care.

The birth of a child is the most significant event in a woman’s life. But the baby may be born prematurely or be born with a problem that requires emergency, competent help. Complications that adversely affect the condition of the baby may arise during childbirth. In all these cases, the newborn is transferred to the intensive care unit.

Indications for transfer to this department are:

• respiratory, cardiovascular, renal, hepatic, adrenal failure in acute form
• severe intrauterine infections
• neurotoxicosis, toxicosis with exicosis grade 2-3
• prematurity with a weight of less than 2 kg, with very low (1000-1500 g) and extremely low (500-1000 g) body weight
• severe asphyxia
• hyperthermic, hemorrhagic or convulsive syndrome
• the need for complex procedures and examinations

The neonatal intensive care unit has everything necessary to accommodate children with the diagnoses listed above.

Immediate assistance and the treatment process are provided around the clock by qualified medical staff. The condition of each baby is monitored daily by the attending physician and the head of the department. If necessary, consultations with leading Moscow specialists are carried out promptly. Nurses provide proper care for newborn children with various perinatal pathologies.

Children in need of special care require special treatment. To carry out high-quality monitoring of their condition and development, the department is provided with the latest diagnostic and therapeutic equipment.

Each place in the intensive care unit is equipped with individual equipment:

• An incubator that maintains optimal temperature and humidity that are comfortable for the child
• Ventilator - a device for artificial ventilation of the lungs
• A monitor that monitors the vital functions of the body around the clock and gives indicators of respiration, pressure, degree of blood oxygen saturation, cardiac activity
• Perfusor - a device for administering medications intravenously
• A device that sanitizes the respiratory tract

All devices used are certified and connected to an autonomous station, which guarantees their uninterrupted operation.

The necessary studies (ultrasound diagnostics, express laboratory) allow us to quickly assess the level of important indicators and the need for treatment correction.

Children receive nutrition according to an individual scheme - in the absence of contraindications, expressed milk is given or the optimal formula is selected; in other cases, intravenous parenteral nutrition is provided.

The staff of the intensive care unit for newborns try to make the difficult period in the lives of the parents of their little patients as easy as possible, provide information about the health of the babies, providing the opportunity for daily communication between mother and child.

The very first examination which is performed on a child after birth is an assessment of the condition on the Apgar scale at 1, 5 and 10 minutes of life. A score below 6 points at 1 minute indicates asphyxia and, probably, acidosis; The exception is very low birth weight newborns - their low Apgar score is not necessarily associated with asphyxia. A score below 3 indicates severe asphyxia. These children require CPR.

The tactics should be as follows.
The child is wiped dry and warmed up.
The contents of the respiratory tract are aspirated and oxygen inhalation begins.
Ventilation is performed using a breathing bag, mask and air duct.
When the heart rate is less than 100 minutes, indirect cardiac massage is started. Heart rate is best determined by the pulse on the umbilical or axillary artery or by the cardiac impulse.
Subsequent measures include venous catheterization, administration of adrenaline, infusion of solutions (0.9% NaCl), and in case of hypoglycemia - glucose, as well as sodium bicarbonate to eliminate acidosis.

Basic resuscitation measures:
Call the resuscitation team.
Check airway patency, breathing, pulse.
Assess the reaction to external stimuli.

Restoring airway patency:
Throw back your head, push your lower jaw forward.
Aspirate the contents of the respiratory tract.

Artificial ventilation:
If there has not been a single breath within 10 seconds, begin mouth-to-mouth breathing (in infants, cover both the child’s mouth and nose with the mouth).
If possible, oxygen inhalation is started.

Indirect cardiac massage:
The pulse is determined on the carotid or brachial artery.
If the heart rate is less than 60 minutes or there are signs of insufficient tissue perfusion (cyanosis or severe pallor), chest compressions begin.

Video of cardiopulmonary resuscitation in children

Pediatric resuscitation equipment:
Suction.
Gödel mouth ducts and face masks come in a variety of sizes and types.
Self-inflating breathing bags, such as the Ambu bag. These bags come in three sizes:
- for newborns - 240 ml;
- for children from 1 year to 12 years - 500 ml;
- for adults - 1600 ml.

If necessary In infants, it is permissible to use bags for older patients, but then with each insufflation it is necessary to monitor the rise of the chest to avoid overinflating the lungs.
- Laryngoscopes.
- Laryngeal masks.
- A set of endotracheal tubes (for cardiopulmonary resuscitation, an endotracheal tube is taken, the outer diameter of which is equal to the diameter of the child’s little finger).
- Flexible bougie and conductor (stiletto).
- Venous catheters, infusion solutions.
- Needle for intraosseous administration of drugs.
- Syringes, alcohol wipes, nasogastric tubes.
- Electrocardiograph, pulse oximeter, tonometer, capnograph, thermometer.
- Emergency tracheostomy kit.

Hypothermia provides brain protection, but it is difficult to use for therapeutic purposes during cardiopulmonary resuscitation: it is difficult to control in infants and young children due to excessive heat transfer. In contrast, hypothermia is prevented by using forced air devices, heated mattresses, pendant reflectors, heated infusion solutions, and maintaining a high room temperature.
Children tolerate hypothermia better than adults. Cases of successful resuscitation after circulatory arrest due to hypothermia have been described.
Ribbon Broselow- a nomogram for determining the expected weight of a child according to body length: helps to select the correct dosage of drugs.
Algorithms cardiopulmonary resuscitation, such as the European Council for Cardiopulmonary Resuscitation Guidelines, and the Oakley nomogram (allows you to determine the expected weight of the child by age).

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Doctors divide young patients into three groups. The algorithm for resuscitation is different for them.

1. Sudden stoppage of blood circulation in a child. Clinical death throughout the entire period of resuscitation. Three main outcomes:

• CPR ended with a positive result. At the same time, it is impossible to predict what the patient’s condition will be after his clinical death, and how much the functioning of the body will be restored. The so-called post-resuscitation illness develops.
• The patient lacks the possibility of spontaneous mental activity, and brain cells die.
• Resuscitation does not bring a positive result; doctors declare the patient’s death.

1. The prognosis is unfavorable when performing cardiopulmonary resuscitation in children with severe trauma, in a state of shock, and purulent-septic complications.
2. Resuscitation of a patient with oncology, abnormal development of internal organs, or severe injuries is carefully planned whenever possible. Immediately proceed to resuscitation efforts in the absence of pulse and breathing. Initially, it is necessary to understand whether the child is conscious. This can be done by shouting or lightly shaking, while avoiding sudden movements of the patient’s head.

Indications for resuscitation - sudden cessation of blood circulation

The peculiarities of cardiopulmonary resuscitation in children are that it is necessary to use fingers or one palm to perform compression due to the small size of the patients and fragile physique.

• For infants, pressure is applied to the chest using only the thumbs.
• For children from 12 months to eight years old, massage is performed with one hand.
• For patients over eight years of age, both palms are placed on the chest. as for adults, but the force of pressure is proportional to the size of the body. The elbows of the hands remain straight during cardiac massage.

There are some differences in CPR of a cardiac nature in patients over 18 years of age and cardiopulmonary failure resulting from suffocation in children, therefore resuscitators are recommended to use a special pediatric algorithm.

What kind of poisoning can cause breathing and heartbeat to stop?

Death as a result of acute poisoning can happen from anything. The main causes of death in case of poisoning are cessation of breathing and heartbeat.

Arrhythmia, atrial and ventricular fibrillation and cardiac arrest can be caused by:

• drugs from the group of cardiac glycosides;
• “Obzidan”, “Isoptin”;

barium and potassium salts;

• some antidepressants;
• organophosphorus compounds;
• quinine;
• hellebore water;
• adrenergic blockers;
• calcium antagonists;
• fluorine.

In what cases is artificial respiration necessary? Respiratory arrest occurs due to poisoning:

• drugs, sleeping pills, inert gases (nitrogen, helium);
• intoxication with substances based on organophosphorus compounds used to control insects;

curare-like drugs;

• strychnine, carbon monoxide, ethylene glycol;
• benzene;
• hydrogen sulfide;
• nitrites;
• potassium cyanide, hydrocyanic acid;
• "Diphenhydramine";
• alcohol.

In the absence of breathing or heartbeat, clinical death occurs. It can last from 3 to 6 minutes, during which there is a chance of saving the person if you start artificial respiration and chest compressions. After 6 minutes, it is still possible to bring a person back to life, but as a result of severe hypoxia, the brain undergoes irreversible organic changes.

What to do if a person falls unconscious? First you need to identify signs of life. The heartbeat can be heard by placing your ear to the victim's chest or by feeling the pulse in the carotid arteries. Breathing can be detected by the movement of the chest, leaning towards the face and listening for inhalation and exhalation by holding a mirror to the victim’s nose or mouth (it will fog up when breathing).

If no breathing or heartbeat is detected, resuscitation should begin immediately.

How to do artificial respiration and chest compressions? What methods exist? The most common, accessible to everyone and effective:

• external cardiac massage;
• mouth-to-mouth breathing;
• breathing "from mouth to nose".

It is advisable to conduct receptions for two people. Cardiac massage is always carried out together with artificial ventilation.

1. Free the respiratory organs (oral, nasal cavity, pharynx) from possible foreign bodies.
2. If there is a heartbeat, but the person is not breathing, only artificial respiration is performed.
3. If there is no heartbeat, artificial respiration and chest compressions are performed.

The technique of performing indirect cardiac massage is simple, but requires the right actions.

1. The person is laid on a hard surface, the upper part of the body is freed from clothing.
2. To perform closed cardiac massage, the resuscitator kneels on the side of the victim.

The palm, with its base extended as far as possible, is placed in the middle of the chest, two to three centimeters above the sternal end (where the ribs meet).

1. Where is pressure applied to the chest during closed cardiac massage? The point of maximum pressure should be in the center, not on the left, because the heart, contrary to popular belief, is located in the middle.
2. The thumb should be facing the person's chin or stomach. The second palm is placed crosswise on top. The fingers should not touch the patient; the palm should be placed with the base and be extended as much as possible.
3. Pressure on the heart area is done with straight arms, the elbows do not bend. Pressure should be applied with your entire weight, not just your hands. The shocks should be so strong that the chest of an adult falls by 5 centimeters.
4. With what frequency of pressure is indirect cardiac massage performed? Press on the sternum at least 60 times per minute. You need to focus on the elasticity of the sternum of a particular person, precisely on how it returns to the opposite position. For example, in an elderly person the frequency of clicks may be no more than 40–50, and in children it can reach 120 or higher.
5. How many breaths and presses should you take during artificial respiration? When alternating chest compressions with artificial ventilation, 2 breaths are taken for 30 pushes.

Why is indirect cardiac massage impossible if the victim is lying on something soft? In this case, the pressure will be released not on the heart, but on the pliable surface.

Very often, ribs are broken during chest compressions. There is no need to be afraid of this, the main thing is to revive the person, and the ribs will grow together. But you need to take into account that broken ribs are most likely the result of incorrect execution and you should moderate the pressure.

If a poisoned person has secretions in the mouth that are dangerous to the resuscitator, such as poison, poisonous gas from the lungs, or an infection, then artificial respiration is not necessary! In this case, you need to limit yourself to performing an indirect cardiac massage, during which, due to pressure on the sternum, about 500 ml of air is expelled and again absorbed.

How to do mouth-to-mouth artificial respiration?

The victim should be placed in a horizontal position with his head thrown back. You can put a cushion or your hand under your neck. If there is a suspicion of a fracture of the cervical spine, then you should not throw your head back.

1. The lower jaw needs to be pushed forward and downward. Free your mouth from saliva and vomit.
2. Holding the injured person’s open jaw with one hand, with the other you need to tightly pinch his nose, inhale deeply and exhale as much as possible into his mouth.
3. The frequency of air injections per minute during artificial respiration is 10–12.

For your own safety, it is recommended that artificial respiration is best done through a napkin, while controlling the tightness of the pressure and preventing air “leakage”. Exhalation should not be sharp. Only strong but smooth (for 1–1.5 seconds) exhalation will ensure proper movement of the diaphragm and filling of the lungs with air.

Artificial respiration “mouth to nose” is performed if the patient is unable to open his mouth (for example, due to a spasm).

1. Having laid the victim on a straight surface, tilt his head back (if there are no contraindications for this).
2. Check the patency of the nasal passages.
3. If possible, the jaw should be extended.
4. After a maximum inhalation, you need to blow air into the injured person’s nose, tightly covering his mouth with one hand.
5. After one breath, count to 4 and take the next one.

In children, resuscitation techniques differ from those in adults. The chest of babies under one year old is very tender and fragile, the heart area is smaller than the base of the palm of an adult, so pressure during indirect cardiac massage is performed not with the palms, but with two fingers.

The movement of the chest should be no more than 1.5–2 cm. The frequency of compressions is at least 100 per minute. From 1 to 8 years of age, massage is done with one palm. The chest should move 2.5–3.5 cm. Massage should be performed at a frequency of about 100 pressures per minute.

The ratio of inhalation to compression on the chest in children under 8 years old should be 2/15, in children over 8 years old - 1/15.

How to perform artificial respiration for a child? For children, artificial respiration can be performed using the mouth-to-mouth technique. Since babies have a small face, an adult can perform artificial respiration by immediately covering both the mouth and nose of the child. The method is then called “mouth to mouth and nose.” Artificial respiration is given to children at a frequency of 18–24 per minute.

Signs of effectiveness when following the rules for performing artificial respiration are as follows.

When artificial respiration is performed correctly, you may notice the chest moving up and down during passive inspiration.

1. If the movement of the chest is weak or delayed, you need to understand the reasons. Probably a loose fit of the mouth to the mouth or nose, a shallow breath, a foreign body preventing the air from reaching the lungs.
2. If, when you inhale air, it is not the chest that rises, but the stomach, then this means that the air did not go through the airways, but through the esophagus. In this case, you need to press on the stomach and turn the patient's head to the side, as vomiting is possible.

The effectiveness of cardiac massage also needs to be checked every minute.

1. If, when performing an indirect cardiac massage, a push appears on the carotid artery, similar to a pulse, then the pressing force is sufficient for blood to flow to the brain.
2. If resuscitation measures are performed correctly, the victim will soon experience heart contractions, blood pressure will rise, spontaneous breathing will appear, the skin will become less pale, and the pupils will narrow.

All actions must be completed for at least 10 minutes, or better yet, before the ambulance arrives. If the heartbeat persists, artificial respiration must be performed for a long time, up to 1.5 hours.

If resuscitation measures are ineffective within 25 minutes, the victim has cadaveric spots, a symptom of a “cat” pupil (when pressure is applied to the eyeball, the pupil becomes vertical, like a cat’s) or the first signs of rigor - all actions can be stopped, since biological death has occurred.

The sooner resuscitation is started, the greater the likelihood of a person returning to life. Their correct implementation will help not only restore life, but also provide oxygen to vital organs, prevent their death and disability of the victim.

Purpose of CPR in children

CPR in a child includes three stages, which are also called ABC - Air, Breath, Circulation:

• Air way open. The airway must be cleared. Vomiting, tongue retraction, foreign body may be an obstacle to breathing.
• Breath for victim. Carrying out artificial respiration measures.
• Circulation his blood. Closed heart massage.

The first stage is considered the most important in the process of CPR in children. The algorithm of actions is as follows.

The patient is placed on his back, with the neck, head and chest in the same plane. If there is no skull injury, you need to tilt your head back. If the victim has an injury to the head or upper cervical region, it is necessary to move the lower jaw forward. If you are losing blood, it is recommended to elevate your legs. Violation of the free flow of air through the respiratory tract in an infant may increase with excessive bending of the neck.

The reason for the ineffectiveness of pulmonary ventilation measures may be the incorrect position of the child’s head relative to the body.

If there are foreign objects in the oral cavity that make breathing difficult, they must be removed. If possible, tracheal intubation is performed and an airway is inserted. If it is impossible to intubate the patient, breathing “mouth to mouth” and “mouth to nose and mouth” is performed.

Algorithm of actions for mouth-to-mouth ventilation

Solving the problem of the patient's head tilting is one of the primary tasks of CPR.

Airway obstruction causes the patient's heart to stop. This phenomenon is caused by allergies, inflammatory infectious diseases, foreign objects in the mouth, throat or trachea, vomit, blood clots, mucus, and a child’s sunken tongue.

The procedure for performing artificial respiration and indirect cardiac massage

If a person is found unconscious, it is necessary to check the pulse, breathing and degree of contact. In the absence of these indicators, artificial respiration and chest compressions begin.

You should not spend more than 15-20 seconds on assessing the condition: the later CPR is started, the worse the prognosis.

Until 2005, the International Anesthesiology Service recommended starting CPR with ventilation, only then doing chest compressions. However, during the analysis of hundreds of thousands of clinical cases, the instructions were reviewed and changed.

At the moment, the sequence of actions is as follows: chest compressions, and then mechanical ventilation.

This order is explained by the fact that at the moment of loss of consciousness, residual oxygen is still present in the bloodstream, which must be quickly delivered to the tissues suffering from hypoxia.

When providing first aid, the victim must be moved to a hard surface and remove any restrictive outer clothing. Straightened arms should be crossed on the lower third of the sternum. If you do not know the anatomical landmarks, it is permissible to begin chest compression in the center of a conventional line drawn between the nipples.

After the first 30 compressions, it is necessary to quickly perform the Safar maneuver, which ensures the patency of the oral cavity and larynx for air.

It consists of straightening the cervical spine (the head is thrown back), extending the lower jaw and opening the mouth. After opening the mouth, take two deep breaths of air.

Artificial respiration can be done using the mouth-to-mouth or mouth-to-nose methods.

A cycle of 30 compressions and two breaths is performed sequentially until the ambulance team arrives. Immediately after the appearance of a pulse and spontaneous breathing movements, the victim must be placed on his side. This will prevent asphyxia by the sinking tongue or stomach contents at the moment of restoration of consciousness.

When performing artificial respiration and external cardiac massage by two people, the functions performed are distributed. One of the rescuers massages the heart, the second performs pulmonary ventilation. In this case, the first one counts out loud the number of compressions made. After 30 compressions, the second rescuer takes 2 deep breaths.

Performing chest compressions requires great physical effort. The person providing assistance quickly gets tired, the frequency or force of compression of the sternum decreases. This negatively affects the effectiveness of resuscitation actions, so you need to massage the heart, replacing each other.

• use of a thermal mattress or radiant heater;
• body contact;
• wrapping in a blanket;
• increase in room temperature.

Following the triple dose of Safar, you need to take 5 breaths, then immediately begin compression of the sternum. For children over one year of age, the mouth-to-mouth technique should be used; for children one year old, the mouth-to-nose technique may be an alternative.

For a newborn, massage is done with the index finger, for an infant - with two (index and middle). For older children (weighing from 12 to 30 kg), compressions are performed with one hand.

The frequency of compressions is at least 100 per minute, the depth of compression is one third of the diameter of the chest. The ratio between air inhalations and chest compressions is 30:2.

The condition is assessed after 3-4 cycles of CPR.

• the appearance of pulsation in large arterial vessels;
• the occurrence of independent respiratory movements;
• restoration of consciousness;
• constriction of the pupils;
• disappearance of cyanotic (bluish-marbled) or pale coloration of the epithelial skin;
• rise in systolic blood pressure more than 65 mmHg.

The first three criteria are absolute; if they are present, resuscitation actions can be stopped. Any doubts about the effectiveness of CPR should be interpreted as a signal to continue closed cardiac massage and artificial respiration.

1. Waste of time on unnecessary diagnostic activities.
2. Untimely stopping of resuscitation efforts.

Methodological - incorrect order or technique of performing artificial ventilation of the lungs or chest compressions:

1. Providing assistance on uneven or soft surfaces.
2. Incorrect position of the rescuer's upper extremities: bending the arms at the elbow joint, lifting the palms from the sternum, applying the entire surface of the palm instead of its base.
3. Violation of the frequency or ratio of compressions and air inhalations: the pace of chest compressions is too slow, changing the recommended ratio of inhalations and compressions (30:2) up or down, breaks of more than 15 seconds for inhalations.
4. Changes in the depth of compression or incorrect ventilation technique: insufficient or excessive pressure on the chest, inhalation too short, massaging the heart at the moment of inhalation (occurs when performing mechanical ventilation by two rescuers).

Another common mistake is inadequate monitoring of the patient’s condition and one’s own actions immediately at the time of resuscitation. Thus, control over the expansion of the chest should always be carried out simultaneously with inhalation of air into the oral cavity.

If the lungs do not expand at the moment of inhalation, the rescuer is performing mechanical ventilation incorrectly or there is an obstruction to air flow in the airway.

During artificial cardiac massage, it is necessary to monitor both your hands (avoid bending your elbows or lifting them from the sternum) and the depth of compression.

Even after successful resuscitation measures, 90-100% of victims develop post-resuscitation illness. It is a cascade of pathophysiological processes resulting from temporary cessation of blood circulation and subsequent restoration of normal blood flow. Post-resuscitation illness includes several syndromes:

• signs of brain damage (coma, seizures, cognitive-mnestic disorders);
• decreased contractile function of the heart;
• activation of the immune and blood coagulation systems;
• exacerbation of existing chronic diseases;
• multiple organ failure.

It is the severity of the manifestations of post-resuscitation illness that determines further treatment and rehabilitation tactics.

In the early recovery period, mechanical ventilation and drugs that improve the trophism and contractility of the heart are used.

In the presence of convulsive syndrome, the use of anticonvulsants (anticonvulsants) is indicated. Metabolic correction is achieved by massive infusion-transfusion therapy.

An important role in the rehabilitation period is assigned to etiotropic and pathogenetic methods of therapy. They are aimed at eliminating the factor that contributed to cardiac arrest.

In case of heart pathology, percutaneous coronary interventions are performed, arterial stenting is performed, and medications are prescribed to correct blood pressure or stop arrhythmias.

Other causes of sudden cardiac arrest (increased potassium levels in the blood, acidotic conditions) are eliminated by metabolic correction and transfusion of blood replacement solutions.

• fibrillation (90%);
• asystole (4%);
• electromechanical dissociation (1%).

In these situations, the heart muscle loses its ability to contract, which leads to a stop in blood flow to organs and tissues. Due to lack of oxygen, the nervous system experiences hypoxia and the person loses consciousness. 1-1.5 minutes after the heartbeat stops, breathing stops, and before that, its pathological types (Chayne-Stokes, Kussmaul) can be observed.

Resuscitation begins immediately if the victim does not have one of the following criteria:

• palpitations and pulsations in large arterial vessels;
• respiratory movements or non-physiological types of breathing;
• consciousness.

Additional signs of clinical death may be a critical drop in pressure, bluish coloration or blanching of the skin and mucous membranes, and clonic-tonic convulsions due to acute cerebral hypoxia.

Resuscitation is carried out when a person is in critical condition in order to maintain the basic functions of the body.

The CPR procedure includes maintaining a clear airway, 30 chest compressions, and two deep breaths.

Resuscitation methods should be used if the victim experiences clinical death. In this state, the victim has no breathing or blood circulation. The cause of clinical death can be any injury in an accident: exposure to electric current, drowning, poisoning, etc.

• absence of pulse in the carotid artery;
• loss of consciousness;
• the appearance of seizures.

There are also late signs of circulatory arrest. They appear in the first 20–60 seconds:

• convulsive breathing, lack of it;
• dilated pupils, lack of any reaction to light;
• The skin color becomes earthy gray.

If no irreversible changes have occurred in the brain cells, the state of clinical death is reversible. After the onset of clinical death, the body’s viability continues for another 4–6 minutes.

Artificial respiration and indirect cardiac massage should be performed until the heartbeat and breathing are restored. For resuscitation to be effective, the rules of resuscitation must be followed.

Before starting chest compressions, the person providing assistance must perform a precordial blow, the purpose of which is to strongly shake the chest with the chest and activate the start of the heart.

The precordial blow must be delivered with the edge of the fist. The point of impact is located in the lower third of the sternum, or more precisely 2 - 3 cm above the xiphoid process. The blow is performed with a sharp movement, the elbow of the hand should be directed along the victim’s body.

Algorithm of actions for mechanical ventilation

When performing artificial ventilation, it is optimal to use an air duct or a face mask. If it is not possible to use these methods, an alternative course of action is to actively blow air into the patient’s nose and mouth.

To prevent the stomach from distending, it is necessary to ensure that there is no excursion of the peritoneum. Only the volume of the chest should decrease in the intervals between exhalation and inhalation when carrying out measures to restore breathing.

Air duct application

When carrying out the procedure of artificial ventilation of the lungs, the following steps are carried out. The patient is placed on a hard, flat surface. The head is slightly thrown back. Observe the child's breathing for five seconds. If there is no breathing, take two breaths lasting one and a half to two seconds. After this, wait a few seconds for the air to escape.

When resuscitating a child, you should inhale air very carefully. Careless actions can cause rupture of lung tissue. Cardiopulmonary resuscitation of a newborn and infant is carried out using the cheeks to blow air. After the second inhalation of air and its exit from the lungs, the heartbeat is felt.

It is necessary to carefully check for the presence of foreign objects in the oral cavity and upper respiratory tract. This kind of obstruction will prevent air from entering the lungs.

The sequence of actions is as follows:

• The victim is placed on the arm bent at the elbow, the baby’s torso is above the level of the head, which is held by the lower jaw with both hands.
• After the patient is placed in the correct position, five gentle blows are applied between the patient's shoulder blades. The blows should have a directed effect from the shoulder blades to the head.

If the child cannot be placed in the correct position on the forearm, then the thigh and bent leg of the person resuscitating the child are used as support.

Compression-ventilation ratio

Closed cardiac muscle massage is used to normalize hemodynamics. Not carried out without the use of mechanical ventilation. Due to an increase in intrathoracic pressure, blood is released from the lungs into the circulatory system. The maximum air pressure in a child's lungs occurs in the lower third of the chest.

The first compression should be a test, it is carried out to determine the elasticity and resistance of the chest. The chest is squeezed during cardiac massage by 1/3 of its size. Chest compression is performed differently for different age groups of patients. It is carried out by applying pressure to the base of the palms.

Closed heart massage

If only one physician is involved in resuscitation, he should perform two air injections into the patient's lungs for every thirty compressions. If two resuscitators are working at the same time, compression is performed 15 times for every 2 air injections. When using a special tube for ventilation, non-stop cardiac massage is performed. The ventilation rate ranges from eight to twelve beats per minute.

A heart blow or precordial blow is not used in children - the chest may be seriously damaged.

Remember that the child's life is in your hands

Resuscitation efforts should not be interrupted for more than five seconds. 60 seconds after resuscitation begins, the physician should check the patient's pulse. After this, the heartbeat is checked every two to three minutes when the massage stops for 5 seconds. The state of the pupils of the person being resuscitated indicates his condition.

The neonatal department has been part of the Central Clinical Hospital since 1989. The department organizes the joint stay of mothers and newborns from the first minutes of life. We provide support for breastfeeding, which is important from the first hours of a child’s life, and teach mothers the skills to care for their baby. Our caring and experienced nurses will help you care for your newborn, and qualified neonatologists will monitor him daily.

If you are expecting a baby, know that you are not the only one waiting for him! They are waiting for him in the newborn department, because people who love their profession work here.

The structure of the department includes a resuscitation and intensive care ward, a room for preparing baby food, as well as a room for storing vaccines and conducting vaccinations.

A neonatologist is the first doctor in your child’s life; he meets the little person who has been born, takes him in his arms, places him on the mother’s breast, and observes him in the first hours, days and weeks of his life. A neonatologist is always present during childbirth and is ready to help a weakened or premature baby. For this purpose, the neonatal department has everything necessary. After the child’s condition has stabilized, you will have the opportunity to be in the same room with the child.

The department is equipped with modern diagnostic and therapeutic equipment: incubators; breathing apparatus for artificial ventilation of the lungs; monitors to monitor blood pressure, oxygen saturation, temperature, respiratory rate and heart rate; heated resuscitation tables; electric pumps; perfusers for long-term infusion therapy; phototherapy lamps, as well as a centralized oxygen system; oxygen dosimeters; sets for puncture of the spinal canal; Brownule sets for puncture of peripheral veins; catheters for catheterization of the umbilical vein; replacement blood transfusion kits; intragastric probes.

Laboratory tests for newborns are carried out at the hospital laboratory: clinical blood test, acid-base balance, electrolyte composition, determination of blood group and Rh factor, Coombs reaction, bilirubin and its fractions, glucose level, biochemical blood test, blood coagulation factors, urinalysis, analysis cerebrospinal fluid, it is possible to conduct immunological and microbiological blood tests. The following examinations can also be performed: radiography, ECG, ECHO-CG, ultrasound of internal organs and neurosonography. If necessary, children in the department will be consulted by otolaryngologists, ophthalmologists, surgeons, dermatologists from other departments of the Central Clinical Hospital, cardiologists of the Scientific Center of the Cardiovascular Surgery named after. A.N. Bakuleva and consultant neurologist Professor A.S. Petrukhin. The department screens all newborns for phenylketonuria, hypothyroidism, adrenogenital syndrome, cystic fibrosis, and galactosemia. According to the national vaccination calendar, vaccination against tuberculosis with the BCG-M vaccine and vaccination against hepatitis B with the Engerix B vaccine, and audiological screening are carried out. Compliance with all requirements for the sanitary and epidemiological regime is the most important part of the department’s work. As a result of the measures taken, there were no nosocomial infections during the operation of the department. The greatest attention in our department is paid to breastfeeding and the joint stay of mother and child.