Newborn health groups

The health group of a newborn is assessed upon discharge from the maternity hospital.

• Group I - healthy children from healthy mothers, gestosis in the first half of pregnancy.
• 2nd group:
  • Subgroup "A" - children from mothers with a narrow pelvis, children with physiological immaturity, prematurity of the 1st degree, toxic erythema, edema syndrome of the 1st degree, postmaturity of the 1st degree.
  • "B" group - complicated somatic history of the mother: chronic respiratory diseases, endocrinopathies, cardiovascular diseases, allergic diseases, diseases of the urinary system. Complicated obstetric and gynecological history of the mother: acute and chronic diseases of the genitourinary organs, breech delivery, vacuum extraction, application of obstetric forceps, cesarean section. Hypogalactia in the mother. Mild asphyxia (score on the Apgar scale 6-7 points), child from multiple pregnancy, intrauterine growth retardation of the child, grade II distortion, children weighing less than 2000 g or more than 4000 g, multiple minor anatomical anomalies (more than 4-5), transient fever, pathological weight loss (more than 8%).
• Group 3 - moderate and severe asphyxia, birth trauma, cephalohematoma, umbilical vein catheterization, grade III prematurity, embryofetopathy, hemorrhagic disease, hemolytic disease of the newborn, intrauterine infections.
• The 4th and 5th health groups are assigned in the presence of congenital malformations with signs of severe decompensation.

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Outpatient observation of healthy newborns

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Observation by a local pediatrician

1st health group:

• in the first 3 days after discharge from the maternity hospital:
• on the 18-20th day of life;
• on the 28th-30th day of life - the child visits the clinic, in the 2nd month of life a healthy child visits the clinic 2 times, then monthly.

2nd health group:

• in the first 3 days after discharge from the maternity hospital:
• 14th day of life:
• 21st day of life;
• on the 28th-30th day of life - the child visits the clinic, at 1 month of life a healthy child visits the clinic 2 times, yes monthly.

3rd health group:

• within the first day after discharge from the maternity hospital;
• newborns are examined by the head of the department;
• Every 5 days during the first month of life, children are examined by a pediatrician. Then, observation is carried out on the main disease together with narrow specialists.
• The 4th and 5th groups are observed in hospital for the underlying disease.

Medical examination and rehabilitation of newborns from various risk groups in the pediatric area

Risk groups of newborn children (methodological recommendations of the USSR from 1984)

• Group 1 - newborns at risk of developing CNS pathology.
• Group 2 - newborns at risk of intrauterine infection.
• Group 3 - newborns at risk of developing trophic disorders and endocrinopathies.
• Group 4 - newborns with a risk of developing congenital defects of organs and systems.
• Group 5 - newborns from the social risk group.

Additional groups are also identified (according to the order of the Ministry of Health of the Russian Federation No. 108 of 29.03.96 and the methodological recommendations of the city of Ivanovo from 1988.

• risk group for hearing loss and deafness;
• risk group for anemia;
• risk group for developing sudden death syndrome;
• risk group for developing allergic diseases.

Outpatient monitoring of newborns from different risk groups in the pediatric area is carried out in a differentiated manner.

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Group 1 - newborns at risk of developing CNS pathology

Risk factors:

• mother's age is less than 16 and more than 40 years;
• bad habits and professional hazards of the mother;
• extragenital pathology of the mother;
• pathology of pregnancy and childbirth (toxicosis, threat of miscarriage, miscarriages, polyhydramnios, history of multiple pregnancies, prolonged or rapid labor);
• toxoplasmosis and other infectious diseases;
• the child's weight is more than 4000 g;
• postmaturity, asphyxia, stigma.

Observation plan

• Examination by a local pediatrician at least 4 times during the first month of life, then monthly.
• An examination with the participation of the head of the department no later than 3 months and is mandatory for each illness of the child.
• Examination by a neurologist at 1 month, then every quarter; audiologist, ophthalmologist - as indicated.
• Strict monitoring by the local pediatrician, aimed at detecting the increase in head size and determining neuropsychic development.
• Preventive vaccinations according to an individual plan after permission from a neurologist.
• Upon reaching one year of age, if there are no changes in the central nervous system, the child is removed from the register.

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Group 2 - newborns at risk of intrauterine infection

Risk factors:

• extragenital pathology of the mother;
• inflammatory gynecological diseases;
• pathology of childbirth (prolonged anhydrous period, pathology of the placenta);
• infectious diseases (rubella,
• toxoplasmosis, cytomegalovirus, acute respiratory viral infections) and bacterial diseases;
• prematurity, intrauterine growth retardation (IUGR).

Observation plan

• Examination by a local pediatrician at least 4 times during the first month, then monthly; by a nurse - 2 times a week.
• Early laboratory examination at 1 and 3 months (blood, urine) and after each illness.
• Mandatory examination with the participation of the head of the department no later than 3 months and after each illness.
• Measures for prevention, early diagnosis and treatment of dysbacteriosis.
• If there are no symptoms of intrauterine infection, the child is removed from the dispensary register at 3 months of age.

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Group 3 - newborns at risk of developing trophic disorders and endocrinopathies

Risk factors:

• extragenital pathology of the mother (diabetes mellitus, hypothyroidism,
• obesity, hypertension);
• previous abortions;
• pathology of pregnancy (severe toxicosis);
• childbirth from the 4th or more pregnancy;
• high birth weight, hypotrophy, immaturity, twins;
• hypogalactia in the mother, early artificial feeding, malabsorption syndrome;
• children with unstable stools;
• mother's bad habits (smoking).

Observation plan

• Examination by a local pediatrician at least 4 times during the first month, then monthly.
• The head of the department examines the child no later than 3 months of age.
• Examination by an endocrinologist at least 2 times during the first year of life (in the first quarter and at 12 months).
• The fight for natural feeding up to 1.5-2 years.
• Medical examination during the first year of life. If there is no pathology, the child is removed from the register.

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Group 4 - newborns with risk of developing congenital defects of organs and systems

Risk factors:

• the presence of congenital defects in the spouses or their relatives;
• previous birth of children with congenital defects;
• consanguineous marriage;
• mother's age is over 35 years;
• professional hazards of parents;
• bad habits of parents;
• use of drugs in the first half of pregnancy;
• pregnancy pathology (toxicosis of the first half of pregnancy, multiple threats of miscarriage, acute respiratory viral infection in the first trimester of pregnancy;
• diabetes mellitus in pregnant women;
• history of rubella or contact with a sick person in the first trimester of pregnancy;
• history of spontaneous abortions;
• the number of stigmas is more than five;
• acutely developing polyhydramnios.

Observation plan

• Examination by a local pediatrician 4 times during the first month of life, then monthly.
• Urine analysis at 1 month, then quarterly and after each illness.
• Consultations with specialists (ophthalmologist, cardiologist, geneticist) at an early stage at the slightest suspicion of the possibility of pathology in the child.
• Removal from dispensary registration at the age of 1 year in the absence of clinical symptoms of the disease.

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Group 5 - newborns from the social risk group

Risk factors:

• unsatisfactory social and living conditions;
• single-parent and large families;
• families with a poor psychological climate;
• student families.

Observation plan

• Examination by a local pediatrician 4 times during the first month of life, then 1-2 times monthly.
• Control by the district nurse over the child’s actual place of residence.
• Participation of the head of the department in preventive monitoring of the child.
• Mandatory hospitalization in case of illness.
• Earlier registration in a preschool educational institution (in the first year of life), preferably with round-the-clock stay.
• If necessary, deprivation of parental rights of the mother.

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Risk group for hearing loss and deafness

Risk factors:

• infectious viral diseases of the mother during pregnancy (rubella, influenza, cytomegalovirus or herpesvirus infection, toxoplasmosis); toxicosis of pregnancy;
• asphyxia;
• intrauterine birth trauma;
• hyperbilirubinemia (more than 200 µmol/l);
• hemolytic disease of the newborn;
• birth weight less than 1500 g;
• prematurity;
• ototoxic drugs taken by the mother during pregnancy;
• gestational age over 40 weeks;
• hereditary diseases in the mother, accompanied by damage to the auditory analyzer.

Observation plan

• Newborns from this risk group are observed by a pediatrician together with an otolaryngologist, who examines them at 1, 4, 6 and 12 months and conducts a sound reactotest.
• On the recommendation of an otolaryngologist - impedancemetry with acoustic reflex, consultation with an audiologist.
• Careful monitoring of the development of the auditory analyzer.
• Avoid prescribing aminoglycosides, ototoxic drugs (furosemide, quinine, ear drops sofradex, anauran, garazon).
• Observation until 18 years.

Risk group for developing anemia

Risk factors:

• violation of uteroplacental circulation, placental insufficiency (toxicosis, threat of miscarriage, post-term pregnancy, hypoxia, exacerbation of somatic and infectious diseases):
• fetomaternal and fetoplacental bleeding;
• multiple pregnancy;
• intrauterine melena;
• prematurity;
• multiple pregnancy;
• deep and prolonged iron deficiency in the body of a pregnant woman;
• premature or late ligation of the umbilical cord;
• intrapartum bleeding;
• prematurity;
• large children;
• children with constitutional abnormalities;
• malabsorption syndrome, chronic bowel disease.

Observation plan

• Pediatrician up to 3 months 2 times a month.
• Complete blood count at 3, 6, 12 months. Earlier if indicated.
• Study of serum iron, total iron-binding capacity of serum (TIBC).
• Electrocardiography (ECG).
• Consultations with specialists (cardiologist, gastroenterologist) as indicated.
• Early introduction of food supplements (juice, fruit puree, minced meat).
• When artificially feeding, adapted formulas containing iron are recommended.
• Prescribing ferrotherapy after confirmation of iron deficiency.
• Observation up to 1 year.
• Risk group for developing sudden death syndrome.

Risk factors:

• negative attitude of the mother towards the child;
• unfavorable housing conditions;
• single-parent family;
• unregistered marriage;
• alcoholism, smoking parents:
• low educational level of the family;
• young age of the mother;
• prematurity, birth weight less than 2000 g;
• sibs;
• children in the first 3 months of life who have suffered acute illnesses;
• children with intrauterine infection;
• children with congenital malformations of vital organs.

Observation plan

• During prenatal or primary care of a newborn, find out all possible addresses of the child’s residence.
• Observation by a pediatrician at least once a week during the first month of life, once every 2 weeks until the child reaches one year of age.
• Sick children under 1 year of age should be monitored daily until recovery.
• Inform the head of the pediatric department about children from this risk group.
• Consultations with assistants of the Department of Medical Academy.
• Health education work with the family.
• Do not put your baby to sleep on his stomach.
• Do not swaddle tightly or overheat the baby.
• Do not smoke in the room where the child is.
• The crib must be in the same room as the parents.
• Maintaining natural feeding during the first 4 months of life.
• Dynamic observation of a child up to 1 year of age should be drawn up in the form of medical reports at 3, 6, 9, 12 months and the records should be submitted for review to the head of the pediatric department.

Risk groups for the development of allergic diseases

Risk factors:

• poor family history of allergies;
• acute infectious diseases and exacerbations of chronic diseases during pregnancy;
• maternal use of antibiotics, sulfonamides, or blood transfusions during pregnancy;
• termination of pregnancy;
• complications of pregnancy (toxicosis, threat of miscarriage);
• abuse of obligate allergens by a pregnant woman;
• occupational hazards during pregnancy;
• intestinal and vaginal dysbiosis in pregnant women;
• improper nutrition of the child, early transition to artificial feeding;
• frequent and irrational use of antibacterial therapy.

Observation plan

• Examination by a pediatrician at least 4 times during the first month of life, then at the prescribed times.
• Examination by specialists (including an allergist, immunologist, gastroenterologist) as indicated.
• Laboratory tests within the prescribed timeframes, including stool analysis for dysbacteriosis.
• Hypoallergenic diet for mother and child.
• Timely sanitation of infection foci.
• The fight for natural breastfeeding.
• Elimination of household allergens.
• Use of antibacterial drugs strictly according to indications
• The observation period is up to 2-3 years.

Standard of dispensary (preventive) observation of a child during the first year of life

Tasks of a pediatrician during antenatal care:

• Collection and evaluation of genealogical anamnesis data.
• Collection and evaluation of biological history data.
• Collection and evaluation of social history data.
• Identification of risk groups.
• Preparing a prognosis for the child’s health and development.
• Determining the direction of risk.

Preparation of recommendations, including on the following sections:

• sanitary and hygienic conditions;
• mode;
• feeding and nutrition.

The tasks of the local pediatrician during the initial care of a newborn:

• Collection and evaluation of genealogical anamnesis data.
• Collection and evaluation of biological history data.
• Collection and evaluation of social history data.
• Identification of risk groups.
• Prognosis of the child's health and development.
• Determining the direction of risk.
• Evaluation of information for the period preceding the inspection.
• Assessment of physical development.

Diagnostics and assessment of neuropsychic development, including:

• diagnostics of neuropsychic development;
• assessment of neuropsychic development with determination of the development group variant;
• identification of risk groups.

Resistance assessment, including:

• analysis of the frequency, duration and severity of acute diseases.

Diagnostics and assessment of the functional state of the body, including:

• identification of complaints;
• examination of organs and systems:
• assessment of heart rate (HR), respiratory rate (RR) and blood pressure (BP);
• collecting information and assessing the child's behavior;
• identification of risk groups for behavioral deviations.

Health report, including:

• risk orientation, risk group;
• assessment of physical development:
• assessment of neuropsychic development;
• resistance assessment;
• assessment of functional status and behavior;
• adaptation forecast;
• diagnosis, health group.

Recommendations, including the following sections:

• sanitary and hygienic conditions;
• mode;
• feeding and nutrition;
• physical education and hardening;
• educational influences;
• recommendations for immunoprophylaxis of infectious diseases;
• recommendations for the prevention of borderline conditions and their progression;
• laboratory and other research methods, including audiological screening, ultrasound (including ultrasound of the hip joints).

Examination by medical specialists

1 month

• Neurologist.
• Pediatric surgeon.
• Traumatologist-orthopedist.
• Ophthalmologist.
• Otorhinolaryngologist.

2 month

• Neurologist.

3-4 month

• Otorhinolaryngologist.

5-6 month

• Otorhinolaryngologist.

7-9 months

• Children's dentist.
• Pediatric surgeon.

At 12 months

• Neurologist.
• Pediatric surgeon.
• Traumatologist-orthopedist.
• Ophthalmologist.
• Otorhinolaryngologist.
• Children's dentist.

Laboratory examination methods

1 month

• Audiological screening.
• Ultrasound of the brain.
• Ultrasound of the hip joints.

3 months

• Complete blood count, complete urine analysis.

12 months

• Complete blood count, complete urine analysis, ECG.

In the 2nd year of life, the local pediatrician examines the child quarterly; at the end of the year of observation, a healthy child is prescribed a general blood test, a general urine test, and a stool test for helminth eggs.

At the age of 3, the local pediatrician examines the child once every six months; at the end of the year of observation, a healthy child is prescribed a general blood test, a general urine test, and a stool test for helminth eggs.

Examination of a child by specialized specialists is mandatory before admission to a preschool institution (orthopedic surgeon, ophthalmologist, neurologist, dentist, speech therapist, otolaryngologist, psychologist).