The anatomical and physiological features of the body of a newborn child, which determine the specificity of its reactions to various environmental influences in normal and pathological situations, are detailed in numerous, now classic, works of domestic and foreign researchers (N. P. Gundobin, 1906; F. I. Valker, 1938; I. A. Arshavsky, 1959; G. Fanconi and A. Valgren, 1960; D. Vobev and I. Ivanova, 1969; E. Ch. Novikova et al., 1971, etc.).

A new stage in the understanding of embryogenesis, the patterns of pre- and postnatal development of animal and human organisms was the teaching of P. K. Anokhin (1948) on systemogenesis, according to which the selective, non-simultaneous (heterochronous) development of the morphological structures of the body, united by the unity of a specific function, is the most important condition timely provision of the body with adaptive reactions aimed at its survival in a given time period. Systemogenesis, a harmonious system of normal development (pormogenesis) of the body was the starting point for the development (S. Ya. Doletsky, 1968) of the theory of relative immaturity, disproportions in the growth and development of organs and systems of a newborn child, contributing to understanding the characteristics of the course of pathological processes in them, substantiating the principles of therapy for various pathological conditions, evaluation of long-term prognosis.

Weight, height, proportions of body parts. V last years much attention is paid to the study of the anatomy and physiology of a growing organism (B. F. Shagan, 1959; A. Andronescu, 1970, etc.). Anatomical and physiological features are expressed the brighter, the younger the child's age. Knowledge of the age characteristics of the newborn is necessary for the timely and rational prevention of possible diseases, the creation of optimal conditions for the normal development of the newborn and the proper organization of care for him. The main criteria for assessing the maturity and maturity of a newborn are height and weight.

In recent years, indicators of the physical development of newborns have increased. The average height has increased by 0.8 cm and is currently 51 - 52 cm. The weight of boys reaches 3400 - 3500 g, and girls - 3250 - 3400 g (A. F. Tur, 1971). The ego is connected with the fact that among newborns children from the first births predominate, the weight of which, as you know, is less than the weight of children born from repeated births. According to R. B. Kogan, the proportion of first-borns in 1964 in Moscow was 77%. The minimum weight of a full-term newborn, according to most authors, is 2500 g, the maximum is 4000 - 4500 g. Weight fluctuations depend on the individual characteristics of the parents, their state of health, mother's nutrition during pregnancy, etc.

The proportions of the body parts of a newborn differ significantly from those of adults. The head is 1/4 of the body, reaching a circumference of 32-34 cm, which is 2 cm greater than the circumference of the chest. The newborn is characterized by an eight-fold predominance of the brain part of the skull over the front (in an adult, 2 times). The limbs of the newborn are relatively short. There is no difference between the length of the upper and lower limbs. Data on the size of body parts of the newborn are presented in table. one.

Table 1. The main dimensions (in centimeters) of newborns (according to A.F. Tour, 1967)

During the neonatal period, some of these indicators change significantly. In the first days of life, the so-called physiological weight loss occurs, mainly due to the loss of intestinal contents, the drying of the umbilical cord residue, the release of fluid through the nights, lungs, skin, etc. Physiological weight loss is 6 - 8% and even 10% of the initial . The maximum weight loss is noted on the 2nd - 3rd day. A weight loss of 500 g or more usually indicates a pathological condition associated with either undernutrition or a disease in the newborn. The initial weight is normally restored by the 7th - 10th day, and by the end of the neonatal period, the child adds 700 - 800 g.

The body length of a newborn during the first days of life may decrease due to the alignment of skull deformities resulting from childbirth. By the end of the neonatal period, the baby grows by 1 cm.

Thus, during the neonatal period, interconnected processes of increasing body weight, shaping, and development proper, or differentiation of organs and tissues, are intensively going on. Quantitative, qualitative and temporal disproportions of these processes determine the characteristics of some borderline conditions and diseases that are characteristic only for children in the first weeks of life.

Skin, mucous membranes, subcutaneous tissue. The total skin surface of a newborn is 6-8 times smaller than that of an adult and is 0.25 m 2 . characteristic appearance skin - it has a pale pink color, is juicy and even somewhat puffy due to the high water content, it seems tender and velvety due to the abundant blood supply. The skin of a newborn is smooth and soft, which is due to the loose structure of the epidermis and dermis, the more delicate structure of collagen and elastic fibers. The underdevelopment of the basement membrane and the weak development of the stratum corneum reduce the connection between the epidermis and the dermis, making the baby's skin easily vulnerable.

At birth, the skin is covered with a gray-whitish or yellowish cheesy lubricant called vernix caseosa. It is most pronounced on the face, ears, in the armpits and inguinal folds. The lubricant consists of soluble fats and altered epithelial cells, rich in cholesterol and glycogen. S. Ya. Golosovker, P. Pophristov and other authors point to the protective properties of the lubricant that protects the skin of the newborn from infection. After the first bath, the lubricant is removed, freeing the stratum corneum, as a result of which the skin acquires a pale cyanotic color. All possible thermal irritations cause expansion of capillaries, discoloration to bright red (physiological catarrh of the skin or erythema of newborns), disappearing by the 3rd day of life. Erythema is replaced by general peeling, which can last up to 2 weeks. Peeling of the skin of a newborn occurs as a result of its drying after birth, physiological parakeratosis and poor functioning of the glandular apparatus.

The sweat glands are underdeveloped, especially on the elbows, hands and ankles. In these areas, the skin is rough, dry and pale. It should be noted that in hemorrhagic disease, skin hemorrhages appear primarily in these areas. Well-functioning sebaceous glands sometimes become noticeable due to excessive accumulation of secretions in their ducts. They can be seen on the skin of the nose as yellow-white dots (milia).

Most of the newborn's skin, especially on the shoulders and back, is covered with soft hairs (lanugo) that usually fall out during the 1st week of life. The nails on the hands and feet are well developed and reach the end of the fingers in full-term babies. Weaker development of the nail plate is not a sign of immaturity. Congenital absence of nails (aponychia) is extremely rare.

On the head of newborns, red spots of various sizes and shapes are often observed, which are the result of the expansion of intradermal capillaries. These spots are located on the forehead, bridge of the nose, eyelids; they resemble flat hemangiomas, but unlike them, they disappear on their own.

The mucous membranes are bright and somewhat dry due to insufficient development of the glands. Weakly expressed epithelial cover makes them tender and easily vulnerable.

The subcutaneous fat layer in a newborn is well expressed throughout the body, in particular, on the extensor surface of the joints, where it is subsequently absent. Fatty tissue in a child at birth is 5 times more than in an adult, in relation to body weight. It does not have a differentiated structure, is functionally labile, and can transform into a blood-forming or fat-accumulating tissue. It has now been proven that the adventitial mesenchymal cells of the adipose tissue of the newborn have a blood-forming function. In some parts of the body, fiber has a completely embryonic character and is closely associated with the ramifications of blood vessels (Becker, 1954). Chemical composition fat is characterized by a high content of derivatives of saturated acids - stearic and palmitic, which is expressed in a greater density of subcutaneous adipose tissue and its easier hardening under cooling conditions. The latter explains the development in some cases of subcutaneous fat necrosis, scleroma, etc.

These features of the skin, mucous membranes and subcutaneous adipose tissue should be taken into account in all pathological processes in newborns.

Respiratory system, rib cage. The respiratory organs at the time of birth do not reach maturity. The nose of the newborn is short, with an underdeveloped bridge of the nose and narrow choanae. The mucous membrane of the nasal passages is tender, with a large number of blood and lymphatic vessels; adnexal sinuses are poorly developed. The maxillary sinuses are most pronounced, while the frontal and main sinuses are practically absent. The pharynx is narrow, small, with an underdeveloped lymphatic ring.

The larynx has a funnel-shaped shape with an expanded upper section and is located on the

2 - 3 vertebrae higher than in adults. The cartilages that form the larynx are thin, elastic and easily pliable. A small lumen of the larynx, an abundance of blood vessels and lymphoid tissue lead to a faster than in older children, the occurrence of stenosis during inflammation or injury.

The trachea in newborns is of different shapes - from wide and short to narrow and long. Cartilaginous rings are soft, freely compressed and displaced. The length of the trachea is 4-5 cm, its mucous membrane is rich in blood vessels, but somewhat dry due to the small number of mucous glands. At level III-IV of the thoracic vertebrae, the trachea divides into two main bronchi. The right main bronchus departs at an angle of 15 - 20 ° and is, as it were, a continuation of the trachea. The left main bronchus is longer and departs at an angle of 20 - 40 °. The lumens of segmental bronchi are narrow, there are few elastic fibers in their wall. The mucous membrane of the bronchial tree is loose, well supplied with blood and, when swollen, easily causes blockage of the bronchial lumen.

The lungs in the first hours after birth change shape, weight and position. With the first breath, their expansion begins, which lasts for several days. Separate alveoli, mainly in the posterior lower sections of the lungs, may remain unexpanded throughout the entire neonatal period, since the respiratory movements of the diaphragm initially occur predominantly in the anteroposterior direction. During the first breaths, most of the air enters the lower sections of the left lung, on the right, a relatively large liver limits the movement of the diaphragm. However, in the future, the right lung expands faster and better, because it is ventilated through a wider and shorter bronchus. The weight of the lungs reaches 50 g; the right lung is somewhat larger than the left. The lungs of a newborn are full-blooded due to wide capillaries and lymphatic slits. The interstitial tissue is well developed, but there are not enough elastic fibers, which causes a decrease in the airiness of the lungs, contributes to the occurrence of atelectasis and facilitates the development of inflammation.

These anatomical features determine the physiological changes in breathing. In the fetus, gas exchange occurs due to the placental circulation. With the birth of a child and the first breath, pulmonary respiration occurs. It is generally accepted that the cause of the first breath is an increased content of carbon dioxide in the blood, which stimulates the respiratory center (Yu. F. Dombrovskaya, 1957; A. F. Tur, 1967, etc.). Due to lack of differentiation nervous system in a newborn, its regulatory effect on the respiratory center is not enough, which explains the lability and some features of the indicative respiration.

The respiratory rate is 40 - 60 per minute. Such shortness of breath is not pathological and is associated with a shallow depth of breathing. Rapid and shallow breathing is caused by increased need newborn in oxygen. The minute volume of breathing is 800 - 900 ml. This indicator depends on the magnitude of the basal metabolism and changes not only with respiratory distress, but also with circulatory disorders. The vital capacity of the lungs is about 140 ml.

The anatomical and functional immaturity of the respiratory system of the newborn causes more frequent occurrence of generalized lung diseases, with severe respiratory failure.

The cardiovascular system. By the end of the 2nd month of intrauterine life, placental circulation develops, providing the fetus with everything necessary for development. There is no direct communication between the blood of the fetus and the mother. The transfer of oxygen and nutrients is carried out through the epithelium of the villi and the endothelium of the capillaries located inside the latter.

Arterial blood enters the fetus through the umbilical vein and is divided into two parts. A smaller part of the most oxygen-rich blood enters the liver, a large part flows through the duct of Arantia into the inferior vena cava, where it first mixes with the venous blood of the lower half of the body. Blood from the inferior vena cava enters the right atrium, where it combines with the venous blood of the superior vena cava. In the future, the blood of the right atrium is divided into two streams. One of them enters the right ventricle, from where the bulk is discharged through the arterial duct into the descending aorta, and a smaller part passes through the lungs and enters the left atrium. The second flow directly from the right atrium through the foramen ovale enters the left, mixes with blood coming from non-functioning lungs, and is sent to the left ventricle. The main part of the blood from the descending aorta returns through the umbilical arteries to the placenta (Fig. 1a).

Rice. 1. Scheme of intrauterine circulation of the fetus (a) and newborn (b).

Thus, in the process of embryonic circulation, repeated mixing of arterial and venous blood occurs. At the same time, organs that perform a more important function for the life of the fetus receive the most oxygen-rich blood. These include the liver, brain, and heart muscle. The pelvic organs and lower limbs receive blood that is relatively poor in oxygen. According to S. Ya. Doletsky (1968), among the reasons for the predominance of certain malformations in the zone of relative hypoxia, the latter can play a certain role in teratogenesis in general, as well as in the selectivity of damage to such, for example, suffering as calcification.

From the moment of the birth of the child, a sharp restructuring of the blood circulation occurs - the placental circulation stops and the small circle begins to function (Fig. 1, b). This leads to an increase in left atrial pressure (due to increased blood flow from the functioning lungs) and a decrease in right atrial pressure (due to the elimination of blood flow in the umbilical vein). This change in atrial pressure stops the discharge of blood through the foramen ovale and leads to its gradual closure. At the age of 6-8 months, it closes completely, and from that moment the large and small circles of blood circulation begin to function independently. The expansion of the lungs and the associated change in the position of the heart impede the movement of blood through the ductus arteriosus. The mixing of arterial and venous blood stops, the arterial duct becomes non-functioning and is subsequently obliterated, turning into lig. arteriosum   magnum.

The heart of a newborn has characteristic features. Compared to body weight, it is greater than that of an adult, and is 0.8% of a child's body weight (20-24 g). According to A. B. Volovik (1952), the length of the heart is 3.1 cm, width 4 cm, its thickness reaches 1.85 cm. The thickness of the walls of the right and left ventricles is almost the same - about 5 mm. The volume of the cavities of the heart reaches 20 cm 3.

There is an opinion that in a newborn the right ventricle prevails over the left (F. I. Valker, 1938). With age, the muscle of the left ventricle increases significantly in contrast to the right ventricle, which hardly changes. The atria and arteries are large in relation to the ventricles.

During the 1st month of life, the heart lags behind other organs in weight, but then it intensively increases. The growth of the heart is accompanied by a change in its topography. The newborn is characterized by a transverse position of the heart. As the ribs and diaphragm descend, it assumes an oblique position. The apex of the heart is usually formed by both ventricles. Less often, one of the ventricles takes part in the formation of the apex, more often the left one.

Histologically, cardiac muscle has a delicate structure. Muscle fibers are thin and short, arranged more compactly. Elastic fibers are poorly developed. A well-defined network of blood vessels, which have a large number of anastomoses.

The innervation of the heart muscle is embryonic. The centers of the sympathetic and vagus nerves at the time of birth appear to be morphologically developed. The peripheral endings of both nerves are well formed, but due to the fact that during embryogenesis the sympathetic nerve appears before the vagus one, its predominance continues after birth. This explains the frequent and labile pulse of the baby. The heart rate is 120 - 160 per minute. Blood pressure in a child on the 1st day of life is 67.7 ± 0.49 - 36.5 ± 0.43 mm Hg. Art. By the 10th day, it accordingly rises to 77.2 ± 0.75 mm Hg. Art. (V. P. Buyko, 1967; A. A. Makarov, 1973). Venous pressure is 70 - 90 mm of water. Art. The volume of circulating blood does not exceed 85 ml/kg, which should be taken into account when determining the amount of blood loss in various diseases and during surgery.

Features of the heart muscle of the newborn determine the characteristic x-ray picture, which is characterized by a small differentiation of the cardiac arches. There is not always a cardiovascular angle along the right edge, the lower arch appears to be more convex and is formed by the right atrium. The left ventricle and large vessels (aorta and pulmonary artery) form, respectively, the lower and upper arcs along the left edge of the shadow of the heart muscle (O. L. Tsimbal, 1968). The basal vascular pattern is barely visible, because the roots of the lungs are covered by the shadow of the heart. The size of the heart in most cases is due to the width of its cavities, and not to hypertrophy of the heart muscle.

Blood. The main hematopoietic organ in newborns, as well as in older children, is the bone marrow of flat and tubular bones. The presence of additional foci of hematopoiesis in the liver, spleen and reticuloendothelial system is characteristic. The blood of a newborn is thicker and more viscous, has a high specific gravity and increased osmotic resistance of erythrocytes (Table 2).

Table 2. Physical properties blood of a newborn (according to A. F. Tour, 1963)

The morphological composition of blood is characterized by a large number of erythrocytes, leukocytes and other uniform elements. The number of erythrocytes ranges from 5,000,000 to 7,000,000. There is no relationship between the number of erythrocytes and the weight of the child. Prominent anisocytosis, which

stored 5 - 7 days. In the first day of life, the number of red blood cells increases, then decreases. A high content of hemoglobin is characteristic - 20 - 24 g%. There are two types of hemoglobin: adult type (Hb A) and uterine (HbF). The latter is more stable and has a greater affinity for oxygen. By the time of birth, the child has both types of hemoglobin, for the most part it is HbF (80%).

The number of leukocytes is increased to 20,000 - 30,000. The leukocyte formula is peculiar, where neutrophils predominate until the 5th - 6th day. In the future, their number decreases, and the number of lymphocytes increases. Changes in the leukocyte formula are presented in table. 3.

Table 3. Leukocyte blood count of a newborn (according to A. F. Tour, 1963)

	Neutrophils	Eosinophils	Basophils	Monocytes	Lymphocytes

The morphological composition of the blood of a newborn is characterized not only by an increased content of formed elements, but also by a large number of young cells, which is due to the lability and immaturity of the hematopoietic organs.

The organs of the abdominal cavity. The position and size of the organ of the abdominal cavity of newborns are characterized by large individual fluctuations. This can be seen in the example of the length of various sections of the intestine (Table 4). Pockets and pits of the peritoneum are expressed quite clearly by the time of birth and deepen with the age of the child. The volume of the abdominal cavity is different, depending on the weight, degree of maturity and the height of the diaphragm.

Table 4. The length of different sections of the intestines of a newborn (according to the Department of Operative Surgery and Topographic Anatomy of the Leningrad Pediatric Medical Institute, 1970)

Sections of the intestine	Length (cm)
greater curvature
Small intestine
Thick »
appendix
cecum
ascending colon
transverse colon
descending colon
sigmoid colon

Stomach may have a different shape: bag-shaped, hook-shaped and in the form of a stocking (V. K. Sobolev, 1970). The greatest differences in the outline of the stomach appear in the fundus, where single or double protrusions resembling diverticula can occur. The pyloric part is long, has a cylindrical shape and is projected anterior to the gate of the liver. The physiological capacity of the stomach in the first day of life is 7 - 10 cm 3, by the 10th day it reaches 90 cm 3 (A. A. Deshin, 1929). The wall is thin, pliable, easily injured during various manipulations.

The mucous membrane is thicker than that of an adult, has a slightly pronounced folding. In the first week of life, the number of folds increases. The rate of growth of the mucous membrane in the neonatal period is accelerated, which, in combination with its loose fixation to the presenting layer, can lead to the prolapse of the membrane into the pyloric lumen and partial obstruction.

The muscular coat is poorly developed, the surface layer is very thin and may sometimes be absent; the middle layer is well expressed, forms a strong sphincter at the level of the pylorus; the deep layer is poorly developed by the time of birth. Cardiac sphincter is underdeveloped and gaping, which is the cause of frequent regurgitation.

Duodenum. The data of X-ray anatomical study of the duodenum in newborns (L. K. Zholobov, G. V. Petkevich, 1970) allow us to divide it according to the shape of pa: annular (34%), II-shaped (27%), U-shaped (17%) , horseshoe (14%) and V-shaped. In older children and adults, the U-shaped form is more common (41%). The place of transition of the duodenum to the jejunum is located at the level of I - II lumbar vertebra. Due to the lack of fiber in the retroperitoneal space and weak connection with other organs, the duodenum of a newborn is characterized by significant mobility. The mucous membrane has pronounced circular folds, which are easily straightened in the first weeks of life due to the underdevelopment of the muscle layer and connective tissue. The glands of the mucous membrane are better developed than in the rest of the intestine.

Small intestine in a newborn, in 54% of cases it begins at level II of the lumbar vertebra, in 41% - at level I, which is significantly higher than in adults. In the upper parts of the abdominal cavity, the loops of the small intestine are located under the liver, in the lower parts they are adjacent to the anterior abdominal wall. The blood supply to the small intestine is characterized by uneven distribution of vessels throughout (EM Margorin, 1970). In terms of saturation with arterial and venous vessels, the middle third of the small intestine occupies a leading position. The largest diameter of the vessels also corresponds to the middle section, the smallest - to the initial and final sections of the intestine.

The mucous membrane is highly permeable. Circular folds are located mainly in the initial section of the jejunum. The muscular layer is underdeveloped. The same thickness of all layers of the intestinal wall of the newborn is characteristic, while in adults half of it is the muscle layer.

Colon in the first weeks of life is variable in shape, size and position. As a rule, by the time of birth, the left half of the large intestine is more developed than the right. In newborns, signs that distinguish the small intestine from the large intestine are often absent or poorly expressed - fatty suspensions are barely marked, tenia and haustrae are poorly defined and are almost invisible on the swollen intestine.

Comparative characteristics of individual topographic and anatomical parameters of a newborn and an adult

The body of a newborn is characterized by a different proportion than that of an adult, the proportion of the size of the head and torso in comparison with the limbs. On fig. (a) and (b) shows the difference in the proportions of the body segments of a newborn and an adult (according to Startz).

In newborns, the pyramidal shape of the chest is more common (c). In contrast to the structure of the chest of an adult (d), the position of the ribs is almost horizontal, the configuration of the upper aperture is close to an oval extended forward. Expanded epigastric angle greatly facilitates access to the diaphragm and chest organs from the abdominal cavity.

The muscles and aponeurotic formations of the anterior abdominal wall of the newborn are poorly developed. In contrast to the structure of the abdominal wall of an adult, in newborns, wide aponeurotic bands stretch from the costal arch to the pupart ligament between the Spigelian line and the edge of the rectus abdominis muscles. The white line of the abdomen is distinguished by a significant width and small thickness. These zones, devoid of the muscle layer, are the weakest parts of the anterior abdominal wall. Laparotomy, performed by incisions in the mentioned zones, is most often complicated by eventration.

There are significant differences in the anatomy of the inguinal region of a newborn (e) and an adult (f). In newborns, the aponeurosis pedicles and fibrae   intercrura   les   are poorly developed. The inguinal gap is made m. cremaster. The inguinal canal is short and wide, its direction is almost straight. The subcutaneous inguinal opening is located at the level of the suprapubic arcuate fold.

General differences in size and location internal organs newborn and adult. The large thymus gland and the transversely located heart make the anterior mediastinum of the newborn relatively wide.

By the time of birth, the liver occupies more than half of the abdominal cavity. Its right and left lobes are almost the same size. The left lobe fills most of the left dome of the diaphragm, distancing the spleen from it for a considerable distance (g, h). When opening the abdominal cavity of a newborn, only a small part of the stomach is visible, its main mass is hidden under the left lobe of the liver. The greater omentum is poorly developed, short and covers only part of the intestine in the left half of the abdomen.

The cecum of the newborn (i) has a funnel-shaped shape and is located, in contrast to what occurs in adults (k), at the level of the iliac crest.

The bladder of a newborn (l) due to the underdevelopment of the small pelvis will stand high in the abdominal cavity. In contrast to the spherical shape in adults (m), it has a fusiform or pear-shaped shape. The peritoneum covers only the posterior surface of the organ, which makes it possible for extraperitoneal interventions on the bladder.

The heart of a newborn has an oval shape, which is associated with the relatively large size of the atria and the underdevelopment of the ventricles. When compared with the structure of the heart of an adult, the relatively narrow lumen of the venous trunks also attracts attention. Features of skeletopia and the shape of the heart are clearly visible when comparing the survey X-ray images: n - a survey radiograph of the chest of a newborn, o - a survey radiograph of the chest of an adult.

The stomach of a newborn is located more vertically than in adults. Cardiac and fundus are indistinct (p). The pyloric section has a cylindrical shape and is projected anterior to the gate of the liver. The muscular ring of the cardiac region is almost absent. Folding of the mucous membrane is weakly expressed.

The duodenum of newborns is more often ring-shaped. The upper horizontal part of the intestine in newborns (c) is located higher than in adults (t). Unlike adults, the liver covers in front not only the upper horizontal branch, but also the descending segment of the duodenum.

The kidneys of a newborn are relatively large and lobular. From above and in front they are covered for a large extent by large adrenal glands (y). The pelvis is more often located intrarenally. The ureters have a relatively large lumen width and a more tortuous course. In newborns, the kidneys are located lower (x) than in adults (c). A characteristic feature of the anatomy of newborns is the extremely weak development of retroperitoneal tissue (h), which determines the greater mobility of organs, the complexity of performing novocaine lumbar blocks and diagnostic procedures.

The skeleton of a newborn is characterized by underdevelopment of bone tissue. The epiphyses of bones are represented by cartilage, in which ossification nuclei appear at various times after birth.

The skull of a newborn is distinguished by significant features. Due to the rapid development of the brain and sensory organs, the difference in size between the brain and facial parts of the skull in a newborn (n) is even sharper than in an adult (e). The bones of the skull are thin, elastic and mobile, as they are connected by connective tissue layers. The frontal and main sinuses are practically absent.

The movable part of the spinal column of a newborn (s) is devoid of bends observed in adults (s) and is an adaptation of the human spinal column to the vertical position of the body. The almost straight axis of the spine causes a large protrusion of the kidneys into the abdominal cavity and the simplicity of their palpation.

Cecum. Distinguish high and low position of the intestine in relation to the superior anterior iliac spine. As a rule, the intestine is separated from it by 2-3 cm and occupies a middle position. The apex of the caecum can continue without clear boundaries into the appendix. Its lumen is relatively larger than that of an adult. The appendix communicates with the cecum with a large opening, which contributes to a good evacuation of the contents of the appendix and explains the rarity of acute appendicitis in newborns.

The Bauhinian valve is represented by a delicate fold of the mucous membrane, is located transversely and has a well-developed anterior lip.

The ascending colon is short and occupies either an extremely lateral position or approaches the midline.

The transverse colon is the longest part of the large intestine. Its position in the abdominal cavity of the infant is determined by its relationship with the liver: the intestine can lie under it only with the right edge, right and left simultaneously with the sagging of the middle section into the abdominal cavity or be completely covered with the liver (E. A. Alkhimovich, 1970). There is also a low position of the transverse colon, when it lies 1 cm above the symphysis, and a high position - up to 8.5 cm.

The descending colon and its splenic angle may occupy a lower or higher position.

The sigmoid colon is the most developed and variable section of the intestine in a newborn. It is characterized by relatively greater length and tortuosity. It is located high in the abdominal cavity, has a long mesentery and can easily be displaced up to the right iliac fossa.

Big omentum the newborn contains all the structural elements and is distinguished by pronounced plastic properties, which is explained high content in the tissue of the omentum cells of the histiocyte type and the presence of a well-developed lymphatic network by the time of birth. The dimensions of the gland are 2.5 - 8.5 cm long and 4 - 12.5 cm wide. This explains the large fluctuations in its area - from 28 to 115 cm 2 (E. M. Margorin, 1970). The gland consists of separate segments. The single-blade form of the stuffing box is more common, although two-blade and multi-blade configurations are possible. The number of segments depends on the distribution of intraorgan arteries. Anterior and posterior duplication in children early age not fused and have their own developed arterial vessels (V. I. Shifrin,

1970), which makes it possible to lengthen the omentum and use it in plastic surgery.

Liver is the largest internal organ. The weight of the organ is about 5% of the total weight of the child (F. I. Valker, 1938). The lower edge of the liver protrudes from under the costal arch by 2-3 cm. The baby's liver is easily displaced due to the underdevelopment of the fixing apparatus and the mobility of the diaphragm.

The elements of the hepatoduodenal ligament are arranged in the same order as in adults; from left to right - hepatic artery, portal vein, common bile duct. On the right, instead of the common bile duct, there may be a portal vein, cystic or hepatic arteries. Around the vessels and ducts lies a powerful hepatic nerve plexus. The total length of the ligament reaches 1-2 cm (G. A. Bairov, A. G. Pugachev, A. N. Shapkina, 1970).

gallbladder most often has a cylindrical shape. There are pear-shaped, spindle-shaped and S-shaped forms. The last two are characterized by a saccular protrusion of the wall in the cervical region, predisposing to stagnation of bile. The most typical for newborns is the “hidden” position of the gallbladder under the liver. Bubble length 1.5 - 5 cm, width 0.5 - 1.5 cm.

Pancreas has an elongated shape, reaches a length of 4.5 - 7 cm. It can be curved or have the form of a ring around the wall of the duodenum (annular pancreas). The position of the gland is horizontal. It is located at the level of the XII thoracic or I lumbar vertebra. On a cross section, the organ may look like an oval or a trihedron. In the first case, two surfaces are distinguished - anterior and posterior, in the second - anterior, posterior and inferior.

Spleen in newborns and children of the first months of life, it has a lobed structure, which smoothes out with age. By the time of birth, the spleen is a rounded movable organ with a diameter of about 5 cm and a weight of 7-10 g. It is located at the level of the IX-XI ribs and is separated from the diaphragm by the left lobe of the liver. In front, it is covered by the transverse colon and the fundus of the stomach.

Urogenital system. The kidneys of a newborn have pronounced structural and functional features that characterize them as an immature organ. The weight and volume of the kidneys is relatively larger than that of an adult. The kidneys of a newborn weigh about 11.5 g, which is approximately 0.76% of the total weight. The large development of the cranial part leads to the fact that the kidneys in the neonatal period take on a triangular shape, and not the shape of a bean, as in an adult. Located on the sides of the spine, they protrude into the abdominal cavity more than in older children. This makes the kidneys of a newborn easily accessible for palpation, especially with an increase in the size of the organ. The longitudinal axes of the kidneys run almost parallel to the spine.

The kidney of a newborn has a lobular structure. On average, each kidney has 14 lobules, separated from each other by furrows of various sizes and depths. The surface of the lobule corresponds to the renal pyramids, and the sulci correspond to the renal columns. The superficial division of the kidney into lobules disappears by the age of three (A. Andronescu, 1970). The kidneys are covered with a fibrous capsule, around which there is a thin fatty layer - the future fat capsule.

The hilum of the kidney is projected at the level of the II lumbar vertebra, the renal vessels often have an oblique direction. Their length is relatively greater than that of adults. The difference in the diameter of the adducting and efferent vessels is pronounced - the renal vein has a small caliber compared to the renal artery. The renal artery is divided into 2-3 trunks that give off vessels that supply strictly defined segments with blood. In most cases, one segmental artery enters the segment, very rarely two. Inside the organ, the arteries are divided into three known types of branching - main, loose and mixed. With age, there is an increase in the diameter and length of segmental vessels.

In the kidneys of newborns, as in adults, 4-5 segments can be distinguished (M. Kazartsev, 1969). It is important to note that the intersegmental boundaries on the surface of the organ do not correspond to the interlobular furrows.

The renal pelvis of the newborn is ampullar in shape and relatively wider than in subsequent periods of growth.

The cortical layer of the kidney is narrow (2 mm). The medulla is well developed. The ratio of the cortex - the medulla is 1:4 (in an adult - 1:2). Malpighian bodies are located directly on the fibrous capsule. The loops of Henle are short and do not extend beyond the cortical layer. The convoluted tubules are poorly developed and their diameter is 2 times smaller than in adults. The renal calyces are thin. The epithelium of the glomerular capsule is cuboidal.

The position of the kidneys in relation to other organs differs from that of an adult. Often, the caecum and appendix are adjacent to the lower pole of the right kidney. The left kidney can contact the spleen for a short distance; the tail of the pancreas approaches its upper pole.

The ureter is long, often curving. Its lumen is relatively wider due to the weak development of the muscle layer and elastic fibers. The bends of the ureter are well expressed at the place of its intersection with the iliac vessels and at the transition to the wall of the bladder. With age, the ureters become more rectilinear. Their length in newborn boys is about 6.5 cm, in girls 5.5 cm. When they enter the bladder, the baby's ureters adjoin the wall of the bladder for a longer distance than in older children.

Bladder. Connective and adipose tissue in the circumference of the bladder is poorly developed, which makes it easily displaced. In newborns, the bottom of the bladder is practically absent, since the triangle of the bladder is located vertically and is, as it were, a direct continuation of the posterior wall. The capacity of the bubble is 50 - 80 ml.

The bubble wall is thicker than that of an adult, and the density is the same. The mucous membrane is well developed and rich in folds of predominantly vertical direction. The connective tissue part of the mucous membrane is developed to a large extent. The muscle layer is weakly expressed, and the elastic tissue is practically absent.

The urethra in the neonatal period is relatively larger in size. In male infants, it reaches 5-6 cm. The urethra of girls is proportionally wider than in adults, has an oblique direction and reaches 1 cm in length. The internal opening of the urethra is round, with smooth walls. In the future, it becomes slit-like, acquires a pronounced folding. The outer opening is gaping. The urethra, like that of an adult, has narrow sections - an external opening and a transition point to the membranous part. The membranes of the urethra are poorly developed. The mucous membrane appears smooth, devoid of folds and transverse wrinkles, its glandular apparatus is not fully formed.

Functional features of the kidneys of the newborn. The main excretory organ in the prenatal period is the placenta. The transition to extrauterine existence is accompanied by an increased load on the kidneys of the newborn, since the excretory function of the placenta stops. Clinically, this can be expressed in the onset of transient renal failure in the form of the so-called physiological azotemia. It is possible that its manifestation is caused by dehydration and protein catabolism (Yu. E. Veltishchev, 1967).

Glomerular filtration in full-term newborns (calculated in relation to the body surface) averages 30-50% of its value in adults (Winberg, 1959). After the 1st week of life, the filtration function increases and, in relation to the total water content, approaches that of adults. The lower productivity of the glomerular apparatus in the neonatal period is explained by morphological features. The visceral sheet of the capsule is formed by high epithelium, which prevents filtration processes. The diameter of the glomeruli, especially in the outer cortical sections, is so small that up to 50 glomeruli can be seen in the field of view of the microscope, while in an adult there are only 5-6 (EP Semenova, 1950).

Due to these features, the total surface of the filtering apparatus per unit weight of the organ is much less in a newborn than in an older child.

The concentration function of the kidneys in the neonatal period is characterized by a low ability to osmotic concentration. The kidney of children in the first weeks of life secretes urine that is hypotonic in relation to blood plasma, which protects the infant's tissues from excess fluid content. With age, as the osmoregulatory function matures, the urine becomes more hypertonic. The instability of osmoregulation in newborns is due to a large range of fluctuations in blood osmotic pressure, depending on food intake and different protein content in the diet, while in adults this value is constant (E. A. Zaryanova, 1951; Keitel, 1958). The reasons for the limited concentration ability of the kidneys of newborns have not yet received a satisfactory explanation. A. G. Ginetsinsky (1952) believes that the renal tubules during the neonatal period are not sensitive to antidiuretic hormone, despite the fact that by the time of birth the amount of the hormone in the child is quite sufficient to produce concentrated urine and the system that regulates water-salt metabolism is close to state of functional maturity. Edelmann, Barnett   (1960) an important role in lowering the concentrating ability of the kidneys of infants is assigned to the low rate of glomerular filtration and insufficient intake of osmotically active substances into the tubules of the kidneys - sodium chloride and urea, which determine the osmotic pressure of urine.

The physiological characteristics of the kidneys also explain some of the features of urine: the first portions of it are light, with a low (1008 - 1013) specific gravity; during the period of the greatest drop in body weight, urine darkens, its specific gravity at this time increases; the urine of children in the first weeks of life is characterized by a high content of uric acid salts, which quickly precipitate, and the constant presence of protein. The latter was called "physiological albuminuria". It is caused by increased permeability of the epithelium of the urinary glomeruli and tubules, which increases with starvation and dehydration.

The daily amount of urine after the birth of a child is insignificant and reaches 25% of the volume of milk received. This also caused a small number of urination (4 - 5 per day). By the 7th - 8th day of life, the amount of urine excreted doubles and the number of urination reaches 15 - 25.

Central and peripheral nervous system. The transition from stable conditions of intrauterine development to continuously changing environmental conditions places increased demands on the nervous system of the newborn.

With normal intrauterine development and normal childbirth, a child is born with a sufficiently developed, but not differentiated, nervous system. Its further development continues in the extrauterine period. Abnormal childbirth, asphyxia can slow down the development of the nervous system, as irreversible changes occur or nerve cells die (BN Klosovsky, 1949).

The brain of a newborn is immature, its differentiation and myelination are not completed. On the surface of the cortical layer, only the main furrows are distinguished, which are less pronounced and less deep than in older children. Small, minor furrows appear only after birth. The weight of the brain of a newborn is about 350 g, which is a quarter of the weight of the brain of an adult (S. I. Nersesyants, 1968). In the future, a gradual increase in weight is noted, but not due to the multiplication of cellular elements of the medulla, the total number of which by the time of birth is about 16 billion, and does not change in the future (D. S. Futer, 1965). The brain of a newborn is rich in water. With age, the amount of fluid decreases in proportion to the increase in the dense substances of the cortex. The cerebral hemispheres are composed almost entirely of gray matter; white matter begins to appear after birth. The brain does not completely fill the cranial cavity, the free spaces filled with cerebrospinal fluid are wide.

The cerebellum is relatively less developed, almost completely located under the cerebral hemispheres that cover it.

The spinal cord in the early stages of embryonic development fills the spinal canal throughout. Starting from the 3rd month of intrauterine life, the rate of growth of the spine in length accelerates, part of the spinal canal remains free. The length of the spinal cord is 14 cm, its lower edge reaches

II lumbar vertebra or the upper edge of the III lumbar vertebra. This is important when performing a spinal tap on a newborn. As the end of the spinal cord moves upward, the angle of inclination of the roots from top to bottom increases, forming a ponytail. The spinal cord of a newborn has well-defined cervical and lumbar thickenings. There is relatively little cerebrospinal fluid in an infant, and it is under less pressure.

Peripheral nerves are anatomically formed by the birth of a child and provide the possibility of functioning of the organons innervated by them. Nerve fibers have numerous expansions due to the vessels passing through them and the accumulation of interstitial tissue.

An important morphological feature of the nervous system of a child in the neonatal period is the absence or insufficiency of myelination of nerve fibers. Along nerve fibers devoid of a myelin sheath, irritations to the cerebral cortex proceed much more slowly and can even pass to neighboring fibers, which leads to the impossibility of forming limited foci of excitation in the cortex. The latter is manifested in the predominance of general reactions in newborns over local ones.

According to the theory developed by P. K. Anokhin et al. (1933, 1948, 1966), with the growth of the child there is a consistent maturation of certain structural relationships of the central nervous system - the so-called heterochrony. It is the sequence of maturation that determines which form of adaptive actions will manifest itself earlier and which later. This concept is confirmed by neurophysiological analysis of the specific reactions of the newborn. The infant has only ancient spinal reflexes, which are possible due to the early myelination of the corresponding reflex systems. This is especially clearly revealed when considering the dynamics of myelination of the facial nerve (E. L. Golubeva, 1961). Its branches innervating the lip region are myelinated in the period from 21 to 24 weeks. intrauterine life, while the remaining branches acquire a myelin sheath much later. This fact indicates the early formation of the morphological basis of the sucking reflex, which is well expressed by the time the child is born. The older phylogenetic systems—the spinal cord, the medulla oblongata, and others—are more developed and richer in myelin by the beginning of extrauterine life than the young sections of the central nervous system—the cortex and the striatum.

The first contacts of the nervous system of the newborn with the environment are a tangible impetus for the onset of intense myelination, which is clearly expressed already by the age of two weeks. Further myelination is staged, heterochronous in nature and has a certain sequence: skin receptors, balance organs, olfactory and auditory analyzers, visual receptors.

In parallel with the development and functional maturation of the nervous system, the neuro-reflex activity of the growing organism arises, develops and becomes more complicated. In a newborn child, the influence on the life processes of the subcortical region is clearly visible. The movements of the baby are regulated mainly by subcortical centers (AF Tour, 1967). Continuous, uncoordinated movements gradually acquire a certain direction. The most specific reactions for a newborn are the Moro reflex, the grasping reaction, the primitive swimming reflex, postural adjusting reflexes, as well as reflexes associated with nutrition - sucking, palatine (D. S. Futer, 1965). In newborns, the formation of conditioned reflexes is possible. However, they are characterized by lability and low intensity, especially in the first 10 days of life (OP Zykova, 1967).

The autonomic nervous system has been functioning since birth. Previously, it was assumed that the tone of the sympathetic division of the autonomic nervous system predominates in a child in the first weeks of life (A. L. Epshtein, 1925). It has now been proven that some organs in the neonatal period are influenced by the parasympathetic nervous system, while others are influenced by the sympathetic one (A. Kh. Khamidullina, 1966; A. F. Tur, 1967).

Metabolism. The metabolism of a newborn child is characterized by high intensity and lability. During the neonatal period, enhanced plastic processes occur with increased synthesis of proteins, fats and carbohydrates.

Features of metabolism in the early stages of a child's development are related to the conditions of his life. Prolonged sleep, a small number of movements, abundant vascularization of organs, increased release of carbon dioxide during respiration contribute to the predominance of accumulation processes over cost processes. At the same time, the insufficiency of reflex and humoral mechanisms of regulation characteristic of this age causes a great dependence of metabolic processes on the external environment, and primarily on nutrition.

Protein exchange. In the intrauterine period, the mother's body is the supplier of protein for the fetus. In the last months of pregnancy, the fetus intensively deposits proteins in the liver. However, the total amount of proteins in the newborn remains less than in older children.

The protein composition of plasma depends on the degree of term of the child and is subject to significant fluctuations, as can be seen from Table. 5. In the regulation of plasma proteins, the main role in the infant is played by the liver. Under normal nutritional conditions, plasma proteins are synthesized in the liver from food amino acids. With a temporary lack of protein in food, maintaining the level of plasma proteins is carried out by a direct transition of proteins from the liver into it. With prolonged hypoproteinemia, the oxidative function of the liver cells rapidly decreases, which leads to depletion of amino acid deamination processes and sharply weakens the detoxification function of the liver.

Table 5 Age features normal values ​​of serum proteins (according to I. Todorov, 1963)

					Protein fractions (%)
	Total protein (g %)	albumins	α 1 -globulin	α 2 -globulin		β-globulin		y-globulin
umbilical
newborn
premature
On the 30th day of life

Nitrogen balance during the neonatal period undergoes a number of changes. First, there is a distinct retention of nitrogen in the body (up to 78%), and its content in the urine is the lowest. This is due to the lack of proteins in the small amount of food that the child receives in the first days of life. Subsequently, the nitrogen balance becomes positive (N. F. Tolkacheskaya, 1947).

The fat metabolism of the newborn is closely related to the metabolism of carbohydrates and is characterized by instability. The bulk of the fat is synthesized by the fetus itself. The source of fat formation in the prenatal period is the mother's carbohydrates and their metabolic products that can overcome the placental barrier. In recent years, there have been works indicating the possibility of penetration through the placenta and a small amount of lipoids (Dancis, 1962).

A special role in the neonatal period is played by the so-called brown adipose tissue (Fig. 2). It differs from white adipose tissue in a large number of mitochondria, coenzymes, cytochromes and is characterized by a high metabolism. Its weight in a newborn reaches 30 g. The works of E. Ch. Novikova et al. (1972) proved that the response of a newborn to cooling is always associated with the activation of heat production in brown adipose tissue.

Rice. 2. Localization of brown adipose tissue in a newborn. a - interscapular region; b - external cervical triangle; c - armpit; d - paravertebral tissue; e - perirenal fiber; e - fiber of the anterior mediastinum; g - fiber surrounding large vessels.

From the first day of life, that is, from the moment breastfeeding begins, an intensive intake of exogenous fat into the body of a newborn begins, which leads to an increase in the concentration of cholesterol, phospholipids and fatty acid esters in the blood. The lipid level reaches 531 ± 102.5 mg% in the first week of life. In the gastrointestinal tract, fats are broken down by lipolytic enzymes to glycerol and fatty acids, which are absorbed in the intestinal wall. In infants suffering from malnutrition, a significant part of the fat can be absorbed in an unsplit form. Fat is transported mainly by lymph and deposited in the liver, subcutaneous tissue, and lungs (Koldovsky, 1963).

The lipid metabolism of newborns is characterized by rapid depletion of fat depots. Because of this, in children with functional disorders of the central nervous system and liver, periodic acetonemia and acetonuria may occur, accompanied by vomiting.

carbohydrate metabolism. The processes of sugar breakdown in the organs and tissues of a newborn proceed more intensively than in older children, and are characterized by a great dependence on environmental conditions. In the last 1 - 2 months. Pregnancy in the liver, muscles and even kidneys of the fetus known reserves of glycogen are created, which before birth exceed the reserves of an adult by 2-3 times. Such an increase in carbohydrates is necessary to maintain energy balance in the first days of life. The child is born with a pretty high level blood sugar (up to 100 mg%). In cases of asphyxia, prolonged starvation, hypothermia, increased respiratory activity, glycogen stores are quickly depleted.

Thus, in children in the first days of life, there is a large instability in the level of blood sugar, due to the limited hormonal regulation, the predominance of glycolysis processes over the processes of glycogen synthesis. The subsequent formation of carbohydrate metabolism in the neonatal period is determined by the degree of full-term maturity, the course of the birth act, oxygen supply, ambient temperature, and the time of the first feeding.

A great influence on the regulation of carbohydrate and lipid metabolism in newborns has an increased content of growth hormone, catecholamines, changes in the concentration of corticosteroids (Yu. A. Baryshkov, 1970).

Energy exchange. In children of the neonatal period, the basal metabolism is low, proportional to weight and equal to 50-54 calories per 1 kg (AF Tur, 1967). The main energy costs are for growth and cytoplastic processes.

The period of childbirth and the first days of life require a significant expenditure of energy from the newborn. This is due to birth stress, the appearance of spontaneous breathing, changes in temperature, increased muscle activity and brain activity. Fasting after childbirth, increased consumption of glucose by tissues leads to the use of their own energy reserves, causes the breakdown of glycogen and the mobilization of fat.

Carbohydrates are used mainly in the first day after birth. In the future, glycemia is maintained at a level sufficient to provide glucose to the brain tissue. At this time, the splitting of brown adipose tissue is activated and non-esterified fatty acids are mobilized, the level of which in the blood serum in the first week of life is 1.5 - 1.8 meq / l, decreasing by the 7th - 10th day of life (Yu. A. Baryshkov, 1966).

Water-salt exchange. The total water content in newborns ranges from 75 - 80% of body weight and depends on the degree of maturity of the child. In premature babies weighing 1500 - 2500 g, the total water content reaches 81 - 85%. Water in the body of a newborn is distributed unevenly through the tissues, most of it falls on the intracellular fluid, the volume of which, when converted to 1 kg of weight, is 2 times greater than in adults.

An infant is born with symptoms of physiological hyperhydration and loses excess water in the first days of life. This process underlies physiological weight loss. Since this is mainly the loss of extracellular fluid (urine, meconium, etc.), there are no clinical signs of dehydration. Physiological weight loss is due to a negative water balance in the first days of life.

Water is excreted mainly by the lungs and skin (52-72%). This is determined by the functional immaturity of the kidneys, the relatively large surface of the body and a significant respiratory rate. In older children, 50% of the fluid taken is excreted by the kidneys, the rest is excreted through the skin, lungs and feces.

The water exchange of newborns is closely related to the electrolyte. Different levels of electrolytes make it possible to distinguish intracellular fluid from extracellular fluid (Fig. 3.4). The most important cations of the extracellular fluid are sodium, potassium, calcium and magnesium. These electrolytes correspond to the anions of chlorine, bicarbonate, orthophosphate and sulfate. Part of the cations in the extracellular fluid in children is associated with organic acids and protein (Yu. E. Veltishchev, 1967). The level of sodium and chlorine is approximately the same in all periods of life. The content of other electrolytes is a physiological constant, the change of which is hard to tolerate by the body.

Rice. 3. Ionogram of the extracellular fluid of the body (according to Fanconi).

Rice. 4. Ionogram of the intracellular body fluid (according to Fanconi).

The extracellular fluid of the newborn is characterized by two features. The first is an increased (up to 110 meq/l) chlorine content. In clinical practice, this must be taken into account, because the introduction of a large amount of solutions containing chlorine can cause intoxication hyperchloremia, and large losses of chlorine lead to a decrease in the osmotic pressure of the blood, which leads to the development of exsicosis due to the movement of intracellular fluid into the plasma. The second feature is that the intracellular fluid of an infant has weak buffering properties due to the low content of proteins and bicarbonates. The latter explains the rapid onset of acidosis in newborns with various diseases or with the introduction of a large amount of protein.

The mechanisms that regulate electrolyte balance during the neonatal period are imperfect, because they do not fully mature by the time of birth. In particular, in children in the first weeks of life, due to the immaturity of the renal tubules, the production of ammonia is limited, and therefore this most important mechanism for saving bases practically does not function (TO. E. Veltishchev, 1967).

Anabolic processes predominate in the body of a newborn, due to active glycolysis, the acid-base balance of the blood has the character of metabolic acidosis (pH 7.3; BE = -7.15; S B = 18.8).

Thus, the metabolism of a newborn child is characterized by variability in regulation, pronounced lability and a strong dependence on environmental conditions, which must be taken into account during preoperative preparation, surgical intervention and in the postoperative period.

Anatomical and physiological features of the newborn organism must be taken into account first of all when assessing the initial state of the child. For this purpose, the Apgar scale is used in everyday clinical practice (Table 6), which reflects the state of the respiratory, cardiovascular, and central nervous systems. The assessment is made on a ten-point system 1 and 5 minutes after birth. In normal children, the number of points should range from 8 to 10, a smaller number of points indicates a poor condition of the newborn.

Table 6. Apgar scale

heartbeat	Missing	Less than 100 per minute	Over 100 per minute
		Slow, irregular	Good, shout
Muscle tone		Reduced, not pronounced flexion of the limbs	active movements
Reflexes (checked when a catheter is inserted into the nose)		Grimaces or movements appear	Movement, screaming, coughing or sneezing
Skin coloration	white or cyanotic	Pink. Limbs are blue

In pathological conditions, the structural and functional features of the newborn determine the specificity of the clinical manifestations of various diseases and malformations, are the starting point for substantiating pathogenetic therapy, assessing the immediate and long-term results. Fundamental differences in the anatomical structure of organs and systems of a newborn and an adult, which determine the specificity of the choice of the method of surgical treatment, are presented in a series of illustrations (see atlas).

A practical guide to caring for a newborn Zhanna Vladimirovna Tsaregeradskaya

Physiological features of the newborn

Physiological features of the newborn

regurgitation

Spitting up in newborns is the result of the immaturity of the nervous system and the weakness of the cardiac sphincter, located between the stomach and esophagus. As a result of involuntary spasms of the diaphragm, the sphincter does not hold the contents of the stomach, and it pours out of the oral cavity.

The norm for the age of one to four months is regurgitation after each feeding or before feeding, when turning over on the stomach or changing the position of the body in the amount of one tablespoon and once a day with a “fountain”, i.e. vomiting in the amount of more than three tablespoons. To check exactly how much milk the baby has burped up, pour one tablespoon of water onto the diaper and compare the water stain with the size of the stain formed after spitting up. You should not worry that the baby burped up all the milk that he sucked. He can only regurgitate the milk in the stomach and esophagus. The milk evacuated to the intestines safely remained in his body. With normal spitting up, you should not put the baby in a column after each feeding in order to avoid them. If the child burps frequently and profusely, but at the same time urinates often, feels good and gains weight normally, there is no threat of dehydration. Normally, regurgitation can persist up to five to six months of age.

hiccup

The hiccups of newborns are associated with involuntary contractions of the diaphragm and, above all, are a legacy of intrauterine life. Being in the mother's stomach, the baby is accustomed to recurring hiccups, and this condition does not give him any negative experiences. In a mature child, hiccups are not a sign of hypothermia, because a well-warmed baby can also hiccup. Such hiccups, without signs of cooling, the parents probably observed themselves, but did not attach any importance to this. When cooling, only immature children begin to hiccup - premature or underweight.

Chair features

In an infant who is on a properly organized exclusively breastfeeding, up to six months of life, the chair can be of any frequency and type. It can be sour with lumps of curdled milk, green, frothy, with mucus and blood streaks (microtrauma of the rectum), yellow creamy, etc. It can be very frequent and appear during, after or between feedings, and also very rare - once every 2-7 days. Neither the amount, nor the type of stool, nor the frequency of its occurrence should worry parents until six months.

Urination

Urinary frequency. It is very important to monitor the frequency of urination of the baby. Periodically, about once a week, it is necessary to count the diapers or put a tick, noting each urination. Normally, the baby should have about 12-15 wet diapers per day. Alertness should cause a decrease in the number of wet diapers to 6-8 pieces per day. This is the lower limit of the norm, at which it can be said that there is no dehydration, but this does not mean that the baby's nutrition is sufficient.

Urination and sleep. During deep sleep, the baby does not urinate. Urination occurs before awakening, during or immediately after it.

Sleep features of a newborn

A newborn baby sleeps almost all the time. The total duration of a newborn's sleep is 18 hours. It has day and night rhythms. The daily rhythm starts at about 8-10 am and ends at about 11 pm. It is replaced by the night rhythm, which lasts from about 11 p.m. to 8-10 a.m. During the daily rhythm, the newborn wakes up every 1-1.5 hours to breastfeed, pee and fall asleep again. The night rhythm differs from the day rhythm in that the intervals between awakenings are lengthened.

The main feature of a newborn's sleep is a high percentage of paradoxical, i.e., superficial sleep - up to 80%. During REM sleep, a newborn behaves more restlessly than an adult. In addition, newborns and children under the age of three months do not have well-defined deep slow wave sleep. Expressed deep sleep appears in children only by six months. Precisely because the newborn sleeps superficially, it is extremely important to consider the following when organizing his sleep:

The baby falls into a deep sleep about 20 minutes after the start of falling asleep;

Immersion in deep sleep is evidenced by general relaxation, lack of eye movement, facial expressions, limb movements;

A newborn quickly transitions from deep sleep to superficial sleep, so it is worth trying to shift a sleeping baby from your arms to the bed, as his sleep will become restless. In order not to disturb the baby’s sleep, it is recommended to go to bed with him, and when he falls asleep, gently get up from him;

Sleep is most restful when the mother's scent is present;

When laying a newborn to sleep separately during the day, it is necessary to closely lay pillows or cushions on both sides of him in order to reproduce the conditions of pleasant tightness;

To reduce anxiety and provide tactile stimuli for the normal growth of the nervous system, it is necessary to organize a nightly joint sleep with the mother;

Co-sleeping with the mother is the prevention of spontaneous infant mortality as a result of respiratory arrest. The newborn breathes unevenly, he makes respiratory pauses. Resume breathing after a pause allows tactile stimulation. Sharing a night's sleep with the mother provides continuous tactile stimulation, and therefore even breathing of the baby.

The newborn, starting from the seventh day of life, has a pronounced long night's sleep, which lasts from about 23-24 hours to 8-10 in the morning. During a night's sleep, the child shows sucking activity three to four times. Showing a desire to attach to the breast, the baby does not wake up, the nursing mother has to wake up. The only time when a baby spends up to three months in a state of deep sleep is the first hours of the night, that is, from 23–24 to 3–4 in the morning.

Phenomena of the neonatal period

Mastitis of the newborn

In newborns, both girls and boys, during the first 14 days of life, hardening of the mammary glands may occur. Neonatal mastitis is a physiological phenomenon that does not pose a danger to the child and does not require special treatment. It is associated with high levels of the hormone prolactin in the mother's blood during childbirth and in the first days after them. Prolactin is responsible for the production of milk and, transmitted to the baby first through the umbilical cord during childbirth, and then through colostrum and milk, leads to swelling of the mammary glands. Most often, mastitis occurs in a child almost simultaneously with the flow of milk from the mother, 3-10 days after birth.

It is important to note that physiological forms of mastitis occur in children in the case of biologically normal childbirth and properly organized breastfeeding in the first days after them. In this case, the diameter of the induration does not exceed the size of the bean, and the induration spontaneously disappears approximately three to four weeks after delivery.

In the case of clinical childbirth, i.e. childbirth in a medical facility (especially during which various interventions were carried out and drugs were used), and improperly organized breastfeeding, neonatal mastitis can acquire pathological forms. The seal can be large sizes and can cause pain to the baby when touched. If the diameter of the lump exceeds three cm, then the child needs help, which can be provided by an instructor in teaching mothering art.

"Colic"

No newborn or infant did not complain to the doctor: “Doctor, my stomach hurts!”. So the diagnosis of "colic" is not abdominal pain, but the characteristic behavior of the child."Colic" is called the continuous incessant crying of a child at a certain time of the day, most often in the evening, and the baby at this time is very difficult to calm down. At the same time, the child can pull his legs up to his stomach and twist them, as if his stomach hurts. It may seem that the child wants to suck, but refuses the breast, making 2-3 sucking movements. Babies with this pattern of crying may have active digestion and gas. However, even in a calm state, they have seething in the stomach and the release of gases that do not cause crying. Usually, with a more detailed study of the condition of such a child, the cause of crying remains unclear. This condition is called "colic".

Parents always associate the child's behavior with colic (knocking his legs, starting to cry when passing gases, etc.) with abdominal pain. However, it should be borne in mind that a child, unlike an adult, does not have pain localization, therefore, with any pain, he behaves the same way - after all, he hurts all over. For example, when a child takes blood from a finger and his finger hurts, he cries, screams, kicks his legs and throws up his arms. He does the same when they take blood from his heel. In this regard, it can be argued that by the behavior of the child in response to a painful stimulus, which is hidden from the eyes of an adult, it is impossible to say with accuracy what exactly the baby hurts.

It is known that "colic" is more common in children diagnosed with PEP (perinatal encephalopathy) or increased intracranial pressure. Based on the clinical practice of psychiatrists and psychotherapists, it was found that "colic" is a manifestation of infantile migraine of vascular origin. Typical symptoms that accompany migraine are increased intestinal motility, nausea, lightheadedness, vomiting, and indigestion. During sucking and gurgling in the abdomen headache in infants it intensifies, it is with an increase in headache in response to any mechanical stimulus that the increase in crying is associated with the offer of the child to take the breast and the release of gases from him. For the same reason, during a migraine attack, children are extremely sensitive to changes in body position.

swelling

Swelling is called a painful condition of the child associated with disruption of the intestines, in which there is increased gas formation. The cause of swelling is poor holding, in which the baby does not receive enough maternal warmth in the literal sense of the word. The fact is that the normal functioning of the intestines of the child is ensured not only by the type of feeding, but also by warming the baby's tummy. When a mother carries a child in her arms in the correct position, hugging and warming his stomach with her biological heat, she thereby ensures the normal functioning of his intestines. If the mother does not warm the baby’s tummy enough, then the intestines malfunction, which leads to bloating. Therefore, the prevention of swelling is a full-fledged holding and properly organized breastfeeding.

Departure of natural needs: urination and defecation

The parent's decision to care for a child in relation to the administration of natural needs, which includes the wearing of diapers and other clothing, must be conscious. First of all, you should know that from the organization of the administration of the natural needs of the newborn and baby the following points depend:

Establishing control over sphincters;

Awareness of one's body;

Functional formation of the excretory system.

Successful and timely solution of these psychophysiological tasks provides the basis for human sexual health.

Each of these positions is a developmental task that the child solves in the first year of life with the participation of the mother. All these tasks are solved in several stages by organizing planting in accordance with the physiological needs and innate reflexes of the child. Disembarkation is the act of a mother or caregiver to assist in the emptying of an infant.

Urinary reflex and establishing control over the sphincters.

During childbirth, when the fetus passes through the birth canal, it develops a urination reflex, due to which, before urination and defecation, the newborn feels discomfort and begins to show anxiety or cry. This gives the mother the opportunity to disembark the baby at his signal and thus control the work of his sphincters. Thanks to maternal control, from the first days of life, the baby develops its own ability to control its sphincters. Gradually, the urination reflex fades away, and by three months it is replaced by the child's ability to independently control his sphincters.

Awareness of your body

The newborn does not know that he has a body. He does not know that he has a face, arms, legs, head, etc. At about two months, the child discovers that he has arms, which he begins to observe, and begins to listen carefully to his body at the moment when gas or when he empties his bowels. From this moment, the baby begins to understand: “This is happening to me!”. By three months, the child already controls the work of the sphincters, not understanding their exact location on his body, but already knowing for sure that this process is happening in him. Further, at about four months, the baby, feeling his body, discovers his stomach, legs and his genitals. Thanks to this new knowledge about his body, the child understands exactly where the sphincters are, which he already knows how to control.

At the stage of awareness of the genitals, it is extremely important that the baby grope for his genitals, and not for the clothes in which he can be dressed: a diaper or sliders. This is very important, because it is this first impression that will enter his consciousness for life. If, as a result of studying his body, the baby learns the fact that he does not have genitals, but has diapers or panties, this will not contribute to his mental and sexual health - it is very difficult to be adequate in relation to sexuality if you do not have genitals and, in fact, there is no gender.

Functional formation of the excretory system

In a newborn and infant, the excretory system is immature. Its final maturation and functional development occurs by the age of puberty, but the beginning of this process dates back to the neonatal period.

In humans, the work of the kidneys and bladder is not chaotic, but ordered in time and have well-defined daily rhythms. In their work, there are peaks and valleys of daily biological activity, there is a certain rhythm of urination in the wakeful phase and urination pauses during sleep. These rhythms are clearly seen already in the newborn. In the first three months of life, the baby urinates only in the awakening stage and during wakefulness. From the age of one month, during periods of wakefulness, urination occurs approximately every 15-20 minutes. During sleep, there is a urinary pause. It is present both during the day and during the night. Nighttime urination is closely related to breastfeeding. Whenever the baby wakes up to attach to the breast, emptying may also occur. Before urination, the baby necessarily gives the mother a signal, and only if the mother ignored this signal, does he empty himself on his own - simply from hopelessness.

The functional formation and regulation of the excretory system as a whole occurs in the presence of planting and maternal control. Nature expected that after the birth of the baby's immature excretory system, the mother would initially support it. Gradually, the child will take the initiative in his own hands and begin to independently control the work of the sphincters and the excretory system. For the normal functioning of the excretory system, as well as the urethral and anal sphincters, it is necessary that the child feels the processes of urination and defecation. If he does not feel these processes, then the work of the sphincters, and after them, the work of the entire system will be disrupted. This mechanism was developed by evolution, therefore, by violating it, we necessarily form certain deviations from the norm, which later may be noticeable to a greater or lesser extent. If the mother disembarks the child, she thereby ensures the normal development of the excretory and reproductive systems and helps to establish control over the sphincters. Normally, by the age of three months, the baby controls the work of the sphincters.

Using diapers and sliders

The current generation of mothers who use diapers find it convenient not to know exactly how their baby urinates and what is happening to him. However, mothers of ethnic groups who do not know diapers believe that the lack of information about the rhythm and quality of urination of their own child is extremely inconvenient, since it does not allow them to navigate in his condition. But the task of every mother, given to her from above, is to raise a healthy, full-fledged person. It is simply impossible to preserve the health of a baby by disrupting the work of any of its functional systems. If a mother understands the importance of planting for the future health of her baby, then she is ready to reconsider her social attitudes. The revision of socio-cultural attitudes towards caring for a newborn is not a victim on the part of a woman - she is absolutely adapted to physiologically based child care.

Due to the fact that the use of diapers and sliders is primarily associated with the formation of human sexual behavior, there are certain rules for their use. Pampers - a device for visits. Therefore, they can be used for visits, when receiving guests, for a walk, etc., so that the mother can show her child's beautiful costume. They cannot be used at home for constant wear, and even more so during sleep, both at night and during the day. Their use at bedtime is all the more pointless because the child, as a rule, sleeps completely dry and urinates only when waking up.

Both diapers and sliders will not give the child the opportunity to get to know his body, find his genitals, find out exactly where the discharge comes from, and establish control over the functions of urination and defecation. Therefore, the use of these items of clothing should be reasonable and not prevent the child from solving age-related developmental tasks. It is recommended under any circumstances from the age of six months to stop using diapers, sliders, shorts, etc.

Thermal adaptation and basics of hardening

Thermal adaptation

A child is born into the world from conditions of a relatively stable temperature regime that existed in the uterus. Therefore, a newborn, accustomed to the relative constancy of temperature, must adapt to new temperature conditions, depending on the climatic conditions in which he fell. Thermoadaptation is the adaptation of a newborn and infant to the temperature regime in the conditions of extrauterine existence.

Thermal adaptation of the newborn occurs due to contact with air, i.e. daily air baths, and contact with water during washing and bathing, subject to full holding and breastfeeding.

Initially, the thermoadaptation of the baby is provided by the mother. It is she who should gradually introduce the child into the world of new temperatures and help him adapt to them. On the one hand, it should extend the conditions of intrauterine comfort for the baby, and on the other hand, it should give him the opportunity to meet the new world, get to know him and safely adapt to new influences. To ensure intrauterine comfort, the mother carries the baby on herself, breastfeeds him, which lengthens the contact with the usual maternal warmth. Periodically, she sets the baby aside to treat or change clothes, whereby he takes short-term air baths, and regularly washes him, ensuring contact with water. In order for thermal adaptation to be complete, the child should be washed with water of different temperatures. This develops a calm reaction in the baby to water of any temperature.

Hypothermia and overheating

Providing an optimal opportunity for thermal adaptation, at the same time, the mother must protect the baby from strong influences. Adjustment of the condition of the child lies entirely on it. The newborn is immature and cannot independently maintain its body temperature, so it is extremely sensitive to overheating and hypothermia. The mother must warm the baby with her warmth so that cooling does not come, and save him from the heat so that there is no overheating. Insufficient warming of the baby's tummy disrupts the functioning of his intestines, which threatens to bloat. In addition, hypothermia adversely affects the functioning of the kidneys and adrenal glands.

Overheating is no less dangerous for the child's body than hypothermia, and can lead to heat stroke. Constant stay in the field of biological warmth of the mother due to unlimited carrying on the hands, co-sleeping and breastfeeding is necessary for the child for mild thermal adaptation and maintaining all the functions of his body. Thus, the mother monitors the ambient temperature and, if possible, regulates it in order to avoid adverse effects on the child.

How to understand that the child is cold?

The first guide is the feelings of the mother. We perceive the temperature of the environment subjectively. Moreover, the baby is always somewhat colder than an adult. Therefore, in order to control the sensations of the child, the mother should be dressed a little lighter than he is. If the clothes of mother and baby are aligned, i.e. the child is dressed slightly warmer than the mother, the following guidelines are:

- time, since the child, if he was lying separately from the mother, needs another portion of maternal warmth every 20 minutes;

- general skin color should be even pink, it should not become marbled or cyanotic. This landmark does not apply to the hands and feet of an infant, which may be bluish even in a warm baby;

- skin temperature should be warm or cool to the touch, but not cold. The tip of a baby's nose will always be cold, even if the baby is not cold, as it is the coldest point on the body. All flexion surfaces should be warm: under the knee, under the arm, at the elbow, in the groin. Cold in the elbow and under the knee indicates cooling.

hardening

Favorable thermal adaptation is the basis for further hardening of the child. Hardening is the formation of the body's resistance to environmental influences and, in particular, to the influence of temperatures.

In a child, the process of hardening is determined, first of all, by the conditions of life and occurs consciously, and its success depends on the stability of the child's psyche and timely, properly organized thermal adaptation.

If parents want to raise a hardy baby, they should not test his immature body with unbearable and unreasonable loads. Hardening, as a special procedure, is possible no earlier than the child is five or six years old, which will be successful only under the influence of the parents' example.

Swimming and diving for babies

Swimming babies, despite its wide popularity, is not a positive and safe procedure. For an infant, it is extremely dangerous, primarily due to the fact that water, entering the baby's nasopharynx, irritates the mucous membranes and leads to various inflammations. For example, small swimmers suffer from frequent otitis media (2-4 times a year), more often than other children they get sick with meningitis, suffer from chronic rhinitis, tonsillitis, sinusitis, etc. Here it is worth recalling waterfowl mammals such as walruses, fur seals, etc. These animals are much better than a man adapted to life in the water, but they give birth to their young on land and do not let them into the water until their skin changes and the muzzle is sufficiently extended. After all, small walruses and seals can also get otitis media and other unpleasant diseases of the nasopharynx. In addition to the nasopharynx, water, far from being of the best quality, also enters the child's digestive system, which leads to digestive disorders. Therefore, if the child is really exclusively breastfed, swimming is contraindicated for him.

In addition, swimming and diving babies affect the development of the vestibular apparatus. Immersing an infant in a large volume of water gives him the impression of floating in space without support. The constant experience of this feeling adversely affects the formation of the child's ability to navigate in space and evaluate distances. In addition, the experience of soaring is fixed at an unconscious level and subsequently leads to such a mental disorder as agoraphobia, which is expressed in a combination of fear of heights and open spaces with the desire to jump from a height to reproduce the impression of soaring. From a domestic point of view, the presence of such a disorder is very dangerous, since at an older age it can cause uncontrolled behavior of the child.

author O. V. Osipova

From the book Propaedeutics of childhood diseases author O. V. Osipova

From the book Propaedeutics of childhood diseases author O. V. Osipova

From the book Propaedeutics of childhood diseases author O. V. Osipova

From the book Propaedeutics of childhood diseases author O. V. Osipova

From the book Normal Physiology: Lecture Notes author Svetlana Sergeevna Firsova

author O. V. Osipova

From the book Propaedeutics of childhood diseases: lecture notes author O. V. Osipova

From the book Fundamentals of Intensive Rehabilitation. Spine and spinal cord injury author Vladimir Alexandrovich Kachesov

From the book Therapeutic Dentistry. Textbook author Evgeny Vlasovich Borovsky

author author unknown

From the book Children's Diseases. Complete reference author author unknown

From the book Children's Diseases. Complete reference author author unknown

From the book Children's Diseases. Complete reference author author unknown

From the book Children's Diseases. Complete reference author author unknown

From the book How to Balance Thyroid, Adrenal, Pancreatic Hormones author Galina Ivanovna Uncle

TICKET #16

Convulsive syndrome. Urgent care.

4. Purpose of the State Program "Health Development".

PHC reform at the present stage. Priority of PHC elements in the work of the medical assistant SVA, FAP.

Reforming the PHC system for the population:

- changing the system of rendering assistance to the rural population;

– modernization of existing institutions and their divisions;

– alignment of patient flows with the formation of uniform routing principles;

- development of new forms of medical care - hospital replacement and outreach methods of work;

– development of emergency care on the basis of outpatient departments;

Improving the principles of interaction with hospitals and ambulance units

Improving the efficiency of specialized care delivery:

– introduction of innovative methods of treatment into practice,

Development of infrastructure and resource support for healthcare, including financial, material, technical and technological equipment treatment and prophylactic institutions based on innovative approaches and the principle of standardization,

The federal law "On Compulsory Medical Insurance" provides for the inclusion of high-tech medical care in the system of compulsory medical insurance from 2015.

Improving the efficiency of obstetrics and childhood services:

* Development of the program "Birth Certificate";

* Development of a network of perinatal centers;

* Prenatal diagnosis of developmental disorders of the child;

*Early detection of hereditary and congenital diseases immediately after the birth of a child;

*Development of specialized medical care for children

AFO of the newborn. Care for him.

After the separation of the fetus from the mother, the first four weeks are called the neonatal period. At this time, the adaptation of the body to the environment begins.

Indicators of the physical development of a newborn depend on many reasons: the state of health of the mother, her nutrition, the course of pregnancy, the sex of the child. Therefore, the weight and length of the child's body have wide limits: from 2500 g and above (average 3200 g) and from 45 to 58-60 cm (average 52 cm). The circumference of the head (34-36 cm) is slightly larger than the circumference of the chest (32-34 cm).

Leather in a newborn, it is smooth, elastic, hyperemic and covered with a layer of cheesy oil. The connective tissue is poorly developed, the number of muscle fibers is insignificant, very vascularized. The sebaceous glands are well developed and the sweat glands are poorly developed. The skin has increased vulnerability, reduced protective function. It is a respiratory organ, excretory properties are well expressed.

Subcutaneous adipose tissue term children is well developed. Contains a large amount of dense fatty acids.

Muscular system underdeveloped, especially on the limbs. The tone of the flexors predominates, giving the child a characteristic posture.

Nervous system still immature, but under the influence of external conditions, it is constantly being improved. This affects the growth and development of the child.

Brain The baby is relatively large and heavy. Its mass is 350-400 g. The cerebral cortex is thin, the furrows are shallow, not always clearly defined. The gray matter of the brain is insufficiently demarcated from the white. The spinal cord, in comparison with other parts of the central nervous system, has a perfect structure and is functionally mature.

sense organs neonates are imperfect. However, they taste well. From sweet, the child calms down, makes swallowing movements, from bitter, salty and sour it becomes restless. The sense of smell is poorly developed. The touch feels good to the child. Uncoordinated eye movements cause physiological strabismus. Bright light triggers a protective blink reflex. Hearing is reduced, but it reacts to strong sounds, the muscles of the face contract, the frequency and depth of breathing change. The pain is somewhat relieved.

Respiratory system. The nose of newborns is small, the cartilage is soft, the passages are narrowed. The mucous membrane is tender, well vascularized, vulnerable and swells quickly. The paranasal sinuses are underdeveloped. The auditory tube is short and wide, located horizontally. The throat, larynx, trachea and bronchi are narrow, with soft cartilage, their mucous membrane is delicate, with good blood supply.

The chest is barrel-shaped, the ribs are soft, supple, placed horizontally. The trachea at the level of III-IV thoracic vertebrae is bifurcated. The lungs have a dense capillary network and little elastic tissue. Their lower border is located higher than in infants, due to the high location of the diaphragm

The volume of each breath is 15-20 cm3. Blood oxygen saturation on the first day of life is 64-92%, on the 7th day it increases to 87-97%.

The cardiovascular system. After the birth of a child and the ligation of the umbilical cord, the function of the cardiovascular system changes significantly. The placental circulation stops, the pulmonary circulation begins to work.

Blood circulation in newborns is carried out twice as fast as in adults, and lasts 11-12 seconds. The heart is placed high, and its dimensions relative to the chest are much larger than in adults. The pulse in the first days after birth is 140-160 for 1 minute. By the 4th week of life, it gradually slows down, reaching 125-140 in 1 min. It is characterized by arrhythmia.

Blood and hematopoietic organs. In the embryonic period, it occurs mainly in the liver, the hematopoietic function of which increases until the 5th month, and then weakens and almost stops at the birth of a child. From the 4th month of intrauterine development, along with the liver, the hematopoietic organs are the bone marrow, spleen and lymphatic tissue. In a newborn, the main hematopoietic organ is the red bone marrow.

The liver in newborns is large, full-blooded, poor in connective tissue. On palpation, its lower edge protrudes from under the costal arch by 1-2 cm.

Digestive system. The oral cavity is small. It has a delicate and well-vascularized mucosa, the protective function of which is reduced. The salivary glands are underdeveloped, the amount of saliva is reduced. With saliva, the enzymes amylase and ptyalin are released, which break down polysaccharides, and maltase - decomposes disaccharides into monosaccharides.

On the lips are hard rollers that contribute to a tight grip on the nipple. Fat formations (Bish's lumps) are located in the thickness of the cheeks, which improve the act of sucking.

The esophagus is 10-11 cm long. Its mucosa contains many vessels and few mucous glands. The mucous membrane is dry and vulnerable.

The contents of the stomach in the first days of life is 30-34 ml, on the 10th day - 70-80 ml. Newborns easily spit up and vomit.

The intestinal mucosa is highly permeable to microorganisms and toxins. Immediately after birth, the content of the intestines is sterile, but after a few hours, saprophytic microflora (bifidobacteria, non-pathogenic Escherichia coli, etc.) enters them. Under the condition of natural feeding, bifidobacteria predominate, artificial ones - Escherichia coli.

Gastric juice in newborns is characterized by low acidity and enzymatic activity, which leads to its insufficient protective function. In the first 2-3 days after birth, meconium passes during bowel movements, later - transitional feces, which subsequently becomes golden yellow. The frequency of stool in newborns is up to 3 times a day. If there is no meconium in the first days of life, infection (atresia) of the rectum should be suspected.

Urinary organs. The kidneys are larger in relation to body weight in newborns than in adults and can be palpated. The kidneys function from the first days of life, although they still have an embryonic structure (underdeveloped medulla and renal cortex).

In the first 2-4 days, physiological oliguria (little urine) is observed, due to insufficient intake of fluid into the body. Therefore, urination becomes more frequent up to 20-25 times a day, 10-15 ml of urine is excreted.

Similar information.

The direct connection of the child with the mother's body ceases from the moment of birth.

The newborn lets out a cry, and at the first breath air enters his lungs. From this moment, the child begins to breathe on his own, and later to eat on his own.

The first period of a child's life begins, the so-called neonatal period, which lasts 3-4 weeks. The child finds himself in a new, unusual environment for him.

External conditions can easily have a harmful effect on him. good care help the child to adapt to the new conditions of life.

Let us recall some anatomical and physiological features of the newborn.

Main Feature is the presence of a remainder umbilical cord. Usually, while the newborn is in the maternity hospital, the umbilical cord does not have time to fall off. The bandage applied to the umbilical wound should not be touched.

If the umbilical cord has fallen off, then nothing but bandaging with a sterile or cleanly washed and ironed linen bandage should be done. In extreme cases, it is recommended to sprinkle the place where the umbilical cord falls off - the umbilical wound - with white streptocide powder. Caring for an umbilical wound requires a lot of experience, so it is better if the patronage nurse of the children's clinic does it.

In children of the first two weeks of life, with poor care of the navel, a serious illness can occur - umbilical sepsis (blood poisoning).

Body type a newborn is outwardly different from the physique of an adult. The ratio of individual parts of his body is completely different: the length of the head of a newborn is equal to a quarter of the length of his entire body, while in an adult the length of the head is only 1/7 - 1/8 of the length of the body. The child has a short neck: the head, as it were, sits on the shoulders. Draw attention to the short lower limbs.

Leather newborns are very tender and thin, as a result of which she is extremely vulnerable. Diaper rash, abrasions, scratches easily appear on it, through which pathogenic microbes can penetrate and cause suppuration. On the shoulders and upper back, the skin is covered with fluff. In premature babies, this fluff is thicker and also covers the forehead and cheeks.

On the 2-3rd day of life, the skin becomes dry and begins to peel off. Peeling occurs in the form of thin scales, plates or grains resembling bran. It continues for about a week.

The skin of a child at birth is covered with a cheese-like lubricant secreted by the skin sebaceous glands. This lubricant in utero protects the skin from soaking the surface layer, protects against amniotic fluid, and during childbirth contributes to an easier passage of the child through the birth canal of the mother.

The skin of a newborn is bright pink. Its color depends on the fact that very close to the superficial layer, the stratum corneum, which is very thin, there is a dense network of blood vessels.

On the 2nd-3rd-4th day after birth, the bright pink color of the skin turns into yellowish. There comes the so-called physiological jaundice. It occurs in almost all children. This jaundice does not represent anything dangerous for the child, although it is sometimes very pronounced. After 3-4 days, the jaundice disappears, and the skin gradually returns to its normal pale pink color.

Sweat glands are poorly developed at birth and develop as the child grows.

The sebaceous glands are already well developed by the time of birth. There are many of them on the skin of the child, and they secrete abundant fat, which is especially noticeable in the scalp, where sometimes crusts form in the form of scales covering the entire head. This is nothing but dried fat mixed with dust, hairs and desquamated cells of the surface layer of the skin. When caring for a child, they must be cleaned, as due to the ingress of microbes, skin inflammation can begin.

The skin performs a very important protective function for the child, participates in the process of respiration - carbon dioxide and water are released through it. The thinnest branches are laid in the skin - the endings of sensory nerves, due to which tactile, pain and temperature sensations arise.

The skin is an important organ for a child's life. Therefore, skin care requires great care and due attention from both the mother and caregivers.

The mucous membranes are extremely delicate and easily vulnerable. The slightest, even imperceptible scratch or abrasion is enough for microbes or mold to penetrate there.

As a result, white plaques quickly appear on the oral mucosa, thrush develops, which sometimes mothers quite incorrectly consider mandatory and call "color".

Muscles in a child initially poorly developed. Despite this, the muscles of the newborn are in a tense, contracted state. As the child grows, this muscle tension weakens, movements become free, then the muscles increase in volume and become more elastic on palpation.

Body temperature in a newborn is unstable, since his body cannot produce enough heat and store it. Therefore, the child is very quickly exposed to cooling, even at normal ambient temperatures, and also quickly overheats if he is excessively wrapped.

Gradually, the newborn adapts and gets used to new conditions for him. His body temperature is set at 36.6-37 °.

Skeletal system the child, i.e., its skeleton, presents some features. His bones are softer and more elastic, as they have a lot of cartilage.

The newborn has not yet closed the cranial sutures, i.e., there is no complete fusion of the parietal and frontal bones of the head. Between them in front there is a soft spot, the so-called large fontanel. As the cartilage grows, it is replaced by dense bone tissue.

The head of the child, passing through the birth canal of the mother, is somewhat squeezed from the sides and pulled up or backwards, and the bones of the skull move one on top of the other. Therefore, in the first days after birth, the head of a newborn has an irregular shape. In the future, it gradually levels itself off. Don't try to straighten it out. Often during childbirth, a birth tumor forms on the baby’s head, which resolves by itself after a few days.

The legs of the newborn are slightly curved, this is due to the intrauterine position of the fetus. In a healthy child, the legs gradually straighten. Therefore, tight swaddling is unnecessary and harmful. The newborn, due to increased muscle tone, keeps his arms bent at the elbows, and his legs tucked up to his stomach. This position is the most comfortable and familiar for him even before birth. Only for a short time the newborn unbends his arms and legs, and then bends them again. These movements should not be hindered - they are necessary for the child. In addition, these movements contribute to the release of gases from the intestines, which sometimes bother the child.

The digestive organs of a newborn also have their own characteristics, which you need to know in order to properly care for a child. The oral mucosa is bright red and rather dry; it can be very easily damaged even by a gentle touch, so wiping the mouth of a newborn is by no means recommended. The salivary glands of the child begin to secrete saliva from the 3-4th month, while there is profuse salivation.

The stomach and intestines of the child in the first months are able to digest food natural for him, i.e. breast milk. Sometimes a child experiences various kinds of deviations from the normal process of digestion: regurgitation, vomiting after feeding or after some time not coagulated or coagulated milk, bloating due to accumulation of gases.

Milk digested in the stomach and intestines is absorbed through the walls of the intestines into the bloodstream and used to build new cells of a growing organism.

If the child spits up often, it is necessary to monitor his weight. If the weight decreases, the child should be shown to the doctor for advice. In healthy children, regurgitation resolves by 3 months.

The process of digestion and promotion of food gruel in the small and then in the large intestines, the formation of feces and their excretion through the rectum in a newborn child has not yet been established. There is an accumulation of gases and bloating of the intestines, which causes severe anxiety, as well as frequent or, conversely, rare bowel movements of various colors and types.

During the first year, the digestive organs acquire the ability to digest and assimilate cow's milk and other types of food - vegetables, berries, fruits, meat, bread, etc.

When feeding breast milk a child has stools 3-4 times a day, stools have yellow and sour smell. Gradually the chair becomes less frequent; in the second half of the year it happens 1-2 times a day. When fed with cow's milk, the stools are thicker, their color is darker. When switching to a general diet close to the general normal diet of an adult healthy person, the stool becomes darkish in color, thick consistency.

In an adult, the intestines are 4 times longer than its height, and in a child, 6 times. Such a relatively large length of the intestine is explained by the fact that a child needs relatively more food than an adult, given the amount of food per kilogram of weight.

For the same reason, the liver is relatively large in a child. In the liver, all nutrients from the intestines are neutralized, after which they enter the general bloodstream, are distributed throughout the body and used to build new cells, for complex metabolic processes in the child's body.

respiratory organs the newborn is still imperfect. The openings of the nostrils, nasal passages and other airways (larynx, trachea and bronchi) are relatively narrow. With a runny nose, the mucous membranes swell, and if drops of milk get into the nose or larynx (when regurgitation), breathing becomes difficult and the child cannot suckle normally.

Therefore, the correct position of the child during feeding, systematic nasal care is essential in order for the respiratory tract of the newborn to remain healthy.

The shape of the chest in a child is barrel-shaped, and not cone-shaped, as in an adult. The intercostal muscles are still weak and therefore the very breath of the child is superficial. The deeper a person breathes, the more oxygen he inhales, the better his lungs are ventilated. The child has shallow breathing, that is, when breathing, he inhales relatively little air in one breath, and in order to provide oxygen to the body, the child breathes more often than an adult.

The air that a child breathes must always be clean, so you need to ventilate the room where the child is located, be with him more in fresh, clean air. You can not tightly twist and swaddle a child with handles, as this squeezes the chest and makes breathing difficult. Improper breathing of a child also depends on the insufficient development of the respiratory center in the brain, they disappear gradually during the first months of life.

child's heart differs from the heart of an adult in that it does not work properly due to the imperfection of the nervous system, although a child may be completely healthy.

This irregularity of cardiac activity gradually disappears.

The heart of a young child is relatively larger than that of an adult. Vessels, especially large ones, are relatively wider than in an adult, which facilitates the work of the heart.

The contraction of the heart is determined by the pulse. The pulse in a newborn is up to 140 beats per minute, in the first year of life 130-110, at the age of 1-2 years - about 110 beats per minute; in an adult - 72-80 strokes. Under the influence of minor causes (movement, prolonged crying, anxiety, etc.), the pulse can sharply increase.

The amount of blood relative to body weight in an infant is almost twice that of an adult. In its composition, the blood differs little from the blood of an adult. The composition of the blood changes rapidly under the influence of diseases, but it is quickly restored upon recovery. The composition of the blood is affected by the lack of fresh air, nutrition, etc.

The weight and height of the newborn are different. A normal full-term baby weighs an average of 3200 grams (boys) and 3000 grams (girls) at birth. In individual children, birth weight can range from 2800 to 4500 grams, and sometimes even higher. Babies weighing between 1000 and 2500 grams are considered premature.

The height (body length) of a newborn is on average 48-50 centimeters (from 45 to 55 centimeters).

During the first 3-5 days, the initial weight of the child in most cases decreases by 100-200 grams or more.

From the 4-5th day of a child's life, the weight begins to increase and usually reaches its original value by the 9-12th day.

The initial weight loss depends on the characteristics of the neonatal period: drying and falling off of the umbilical cord, desquamation of the upper layer of the skin, excretion of the original feces. In the early days, the newborn sucks only a small amount of milk from the mother's breast. The less milk a puerperal has, the slower it is released, the more the baby loses weight. Therefore, first-born children lose more weight than subsequent ones, since usually primiparas have less milk in the first days than in subsequent births. For the same reason, children with a large initial weight lose more weight than small children who weigh little, since the former have a greater need for food.

It is very important to observe the child's weight during the first year of his life, since changes in weight, along with other signs that will be discussed below, make it possible to judge the normal physical development of the child and, in particular, the sufficient amount of food he receives.

By 6 months, the child doubles its weight, and by the end of the first year of life, triples it. On average, in the first half of the year, he adds 600 grams per month, in the second half of the year 400-500 grams; for the second year of life adds 2500 grams, an average of 200 grams per month; for the third year of life - 150 grams, i.e. about 150 grams per month.

The increase in the length of the child's body follows the same patterns. The greatest increase in growth occurs in the first year of life - 25 centimeters, in the second - 10 centimeters, in the third - 7-8 centimeters.

Development of motor functions and psyche occurs according to the development of the central nervous system. A newborn child does not hold his head, makes only erratic movements of his arms and legs. His movements are usually sluggish, slow. Sometimes the child flinches and makes quick movements with his arms and legs. This is normal. In the future, his movements become smoother. In the first days after birth, the baby sleeps a lot and wakes up only to eat. Tears in newborns do not stand out: the newborn screams, but does not cry. He cannot blink. The eyelids are swollen in the first days after birth, as a result of which the newborn usually keeps his eyes closed for a long time.

Occasionally, strabismus can be observed, which gradually disappears.

A newborn baby worries and cries only for any reason: usually if he lies in wet diapers, tightly wrapped, wrapped too warmly - overheated, and also in the presence of gases in the intestines. To eliminate these causes, it is necessary to follow the rules of caring for the child and feed him regularly.

Sometimes a perfectly healthy child starts crying without any external cause; this happens with improper care, when the child is accustomed to being constantly carried in his arms.

Development of the central nervous system, especially the brain, in the first year of life goes very quickly. From the environment and internal organs, the child's brain receives various stimuli through the sense organs, to which it responds by strengthening or weakening the activity of its organs. The more the brain develops, the more accurately and better it responds to irritation.

The first glimpses of conscious movements appear in the child towards the end of the first month. Simultaneously with the development of the brain, there is a rapid development of static motor and mental functions in a child in the first years of life.

During the first year of life, the child's body gradually more and more adapts to existence.

Simultaneously with the general development, the child can control his organs of movement. At the age of one month, he raises his head, by 2 months he holds it tightly, by 3 months he grabs objects with his hands, and at 4 months he holds them for a long time. By 6 months, the child sits, by 8 months - stands, holding on to some object, by 10 - stands freely, by 10-14 months begins to walk independently. By the age of 3, the child overcomes obstacles, walks up the stairs.

For a correct assessment physical development of the child you need to know the laws of growth of its weight and height.

Systematic observations of the weight of the child during the first year of life from the neonatal period are very important, since they give us the opportunity at any time to judge the course of the child's physical development.

These are brief information about the anatomical and physiological characteristics of a young child.

Knowledge of the child's body forces the mother to consciously follow many rules of care in order to ensure the child's proper development.

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During the neonatal period, which lasts 28 days, there is a significant restructuring in the body of the child. Some organs and systems were already functioning in utero. The heart, endocrine glands, kidneys and even the digestive system (as early as the 14th week, the fetus begins to swallow amniotic fluid, digest them, which then turns them into the original feces - meconium). Others, like the lungs, which begin to work only after birth, and the cardiovascular system dramatically changes its work due to the inclusion of the pulmonary circulation. The child from the endogenous method of nutrition, obtaining oxygen and liberation from metabolic products, passes to an autonomous endogenous method of nutrition, respiration and excretion. Therefore, during the neonatal period, some physiological features are noted. Due to the fact that the load on the kidneys increases sharply, since the newborn must independently excrete waste products, the mother will no longer help him here, the newborn may experience a urinary crisis. This is the physiological state of the newborn, and is characterized by a high specific gravity of urine (urine is very concentrated), so that even sandy crystals can precipitate. This usually occurs on the 2-5th day from birth and is associated with a large release of uric acid salts, which stain the sediment in the urine in a reddish color. In addition to a urinary crisis, a lack of fluid can also cause transient fever. It is characterized by an increase in temperature, sometimes up to 40 ° C, anxiety of the child and even convulsions. The child just needs to be soldered. One of the physiological conditions of the neonatal period is physiological weight loss. Normally, it should not exceed 5-7% of, and if the weight of a full-term baby is normally 3000-3200, then in the first 3 days the baby loses 200-250 g of weight. This is due to the fact that the first 3 days of life, the intestines of a newborn are freed from meconium - the original feces (meconium is a dark brown, viscous, odorless mass formed from the secretions of the digestive tract, epithelium and amniotic fluid during five months of intrauterine development) . And since the first food of a newborn - colostrum - is very concentrated and in very small quantities (from a few drops to five milliliters), it basically replenishes energy costs. And only with the advent of transitional milk, the newborn restores its original weight, subject to the presence of physiological maturity. And this usually happens by the 5-7th day from birth. The next feature of the neonatal period is physiological jaundice, it occurs in 40-45% of physiologically mature newborns (jaundice is mandatory in premature babies, and it lasts up to 3-4 weeks). This is due to the fact that in the liver there is an intensive restructuring of fetal (fetal) hemoglobin, which was necessary for the fetus for oxygen exchange through the placenta, to mature hemoglobin, which is used for gas exchange in the lungs. Jaundice, as a rule, is not very pronounced - it is a slight icteric staining of the skin, mucous membranes, and sclera of the eyes. It appears on the 2-3rd day of life and usually lasts 7-10 days. She does not require any treatment. Give more water to the child, if the weather is sunny, hold the child in the sun for five to seven minutes. Ultraviolet helps remove bilirubin, which turns the skin yellow (sunlight is effective, it passes through clean glass, although 60% of ultraviolet is retained by glass). But if the baby seems too yellow to you in good light. If the palms and soles of the child's feet are yellow, the child is lethargic and does not eat well, or if the temperature has risen, you should consult a doctor. You also need to know about sexual crises. In recent years, they have been found in almost all newborns, and this is due to a gross interference in the hormonal background of the woman in labor. Maternal hormones enter the blood of the baby during childbirth and later with mother's milk, causing intense breast engorgement in both boys and girls, sometimes with milk-like drops from the nipples. In addition, girls may experience bloody discharge from the genital slit, and boys may experience swelling of the scrotum. This usually happens in the first days of life and ends by the 8-10th day. Can't press on mammary glands, massage them, and even more so try to express drops of liquid from the nipples. Any manipulations with the mammary glands in infants are dangerous because they can lead to the development of mastitis in newborns, and this is a very serious disease and can only be treated surgically. To make you calm, just make a pad of cotton and gauze and put it on the mammary glands under the baby's vest. With vaginal discharge, the girl should be washed with a light pink, cool solution of potassium permanganate from front to back. The skin of a newborn baby is covered with a lubricant at birth, which helps him pass through the birth canal more easily and protects him from bacteria. Gradually, the lubricant is washed off, and you can see the physiological catarrh of the skin in the newborn. This is redness of the skin with a slight bluish tinge. It occurs due to a significant expansion of the skin capillaries, more often on the feet and hands, and lasts from several hours to 3-4 days, followed by peeling. In the old days they said: “The baby is blooming.” Often, newborns have a blockage of the sebaceous and sweat glands in the form of white seals the size of millet - on the nose, on the forehead and, less often, on the cheeks. They rise slightly above the level of the skin, without causing any discomfort to the baby. In children with ancestors of the Mongoloid race, more often in the region of the sacrum there is a gray-cyanotic spot that does not protrude above the surface of the skin, a spot of "Mongoloidness", which disappears with age. Telangiectasias are somewhat less common - expansion of skin capillaries, remnants of embryonic vessels. Usually they have the appearance of red or slightly bluish spots of irregular shape and size with a clear border from the surrounding normal skin. When pressed, they turn pale, but then the color is restored. More often they are located on upper eyelids, on the back of the head, on the forehead, on the border of the scalp. By the year, these spots turn pale, by 3-5 years they disappear, more often without medical intervention. People call them "birth spots". Often in the first days of newborns, whitish nodules appear on the whole body in the thickness of the skin, surrounded by a red rim. This is toxic erythema, it resembles traces of nettle burns. After two days, he disappears without a trace. The skin of the child takes a great part not only in thermoregulation, but also in gas exchange. Up to 70% of metabolic products are excreted through the skin, and therefore it is so important that it be clean and healthy. Considering that in infants, the subcutaneous fat has a special structure - there are few connective tissue partitions in it, and it has a very good blood supply, in connection with this, any inflammatory process of the skin very quickly passes to the underlying tissues, and this requires especially careful care for the skin of a newborn . The child must be washed, bathed, swim with him - every day. Make sure that diaper rash does not occur - they are an indicator that the child is overheating, or may be the first symptom of exudative-catarrhal diathesis. In this case, the mother needs to keep a food diary in order to identify foods that cause diaper rash, and the places of diaper rash (more often these are the neck folds, armpits, inguinal folds) should be processed or olive oil, or potato starch. But in no case should you combine one with the other, and most importantly, do not overheat the child. Transient intestinal catarrh (physiological dyspepsia of the newborn, transitional intestinal catarrh) is a kind of stool disorder that occurs in all newborns in the middle of the first week of life. During the first or second (less often up to the third) day, meconium leaves the intestines of the child - the so-called. original cal. Meconium is a viscous, thick, dark green, almost black mass. Later, the stool becomes more frequent, inhomogeneous both in consistency (lumps, mucus, liquid part can be seen) and in color (areas of dark green color alternate with greenish, yellow and even whitish). Often the stool becomes more watery, resulting in a water spot around the stool on the diaper. Such a chair is called transitional, and the condition associated with its appearance, as you may have guessed, is a transitional intestinal catarrh. After 2-4 days, the stool becomes physiological - homogeneous in texture and color. Simply put, it acquires a mushy, yellow appearance with a sour-milk smell. It reduces the number of leukocytes, fatty acids, mucin (mucus) and tissue protein. The severity of transient catarrh varies from child to child. In some, the frequency of bowel movements reaches six or more times a day, the stool is very watery, in other babies its frequency is up to three times and the consistency is not much different from the usual one. Be that as it may, the transitional catarrh of the intestine is a physiological phenomenon and can only frighten new mothers and dads, but don't harm the baby. Trying to influence the transitional catarrh of the intestine is an unjustified event. You just need to wait a bit - when the baby more or less "learns" to use his digestive system, the stool is normalized. Transient dysbacteriosis is a transitional state that naturally develops in all newborns. The normal course of pregnancy allows the fetus to develop in sterile conditions. The birth of a child willy-nilly marks his transition to the world of microorganisms. It seems possible to fight back pathogenic, "alien" microbes only thanks to the existence of the so-called autoflora - bacteria that naturally inhabit the human body in a physiological way. Starting from the moment a child is born, flora inhabits his skin and mucous membranes birth canal mother. Involuntary sources of additional introduction of microorganisms can be air, hands of medical staff, care items, mother's milk. At the same time, the primary bacterial flora of the intestines and skin, mucous membranes is represented not only by bifidobacteria, lactostreptococci and epidermal staphylococcus aureus, but also by opportunistic microbes: Escherichia coli with altered properties, Proteus, fungi, which in small quantities can also be natural companions of an adult. Therefore, it is no secret that from the end of the first and the entire second week of life, pathogenic staphylococci can be isolated from the skin, nasal mucosa, pharynx, and feces in most absolutely healthy newborns, in half - enterobacteria with reduced enzymatic properties, Candida yeast-like fungi, and in every tenth child to detect Proteus and hemolytic enterobacteria. In the nasopharynx of newborns, Staphylococcus aureus, Escherichia, Klebsiella also often settle down. Transient dysbacteriosis is also facilitated by the fact that the barrier function of the skin and mucous membranes at the time of birth is less perfect in a number of indicators than in children of the second week of life. Only by the third week of the newborn in the intestines do bifidobacteria gain their proper place. In accordance with this, the so-called. phases of the primary bacterial colonization of the intestines of newborns. The first phase, which takes twenty hours from the moment of birth, is called aseptic, that is, sterile. The second phase, the growing infection, can last up to three to five days. At this time, colonization of the intestine by bifidobacteria, Escherichia coli, strepto- and staphylococci, fungi occurs. By the second week, the displacement of all other microorganisms by bifidoflora (transformation stage) should begin. From this moment on, various E. coli, sarcins and staphylococci, whether they like it or not, are obliged to understand that bifidobacteria becomes the queen of the microbial landscape. It is well known that mother's milk is an important supplier of bifidoflora and inevitably leads to the displacement of pathogenic microorganisms or to a sharp decrease in their number. Help overcome transient dysbacteriosis and reaching 5.0 (or even 3.0!) pH of the skin by the sixth day, and increasing acidity of gastric juice. Nonspecific and specific factors of immune defense are actively synthesized, including local ones - on the skin, mucous membranes and in the intestinal wall. Transient dysbacteriosis is a physiological phenomenon, but if hygienic standards of care are not observed, artificial feeding- dysbacteriosis is delayed and can cause a child’s illness as a result of a layering of a secondary infection or activation of an endogenous pathogenic flora. Based on materials by I. Lazareva

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