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The importance of nutrition conditions of preschool children to make a menu in a kindergarten
No full textCilj: glavni cilj ovog istraživanja je utvrditi postoji li razlika u stupnju uhranjenosti po dobnim skupinama te postoji li potreba za preinakom kcal vrijednosti dnevnih jelovnika (koji su isti za sve 4 dobne skupine) uz prijedlog intervencije unutar institucijskih mogućnosti (u dječjem vrtiću).
Metode: za potrebe ovog istraživanja anketni upitnik je proveden tijekom dva tjedna kroz lipanj 2020. godine na 128 roditelja djece Dječjeg vrtića „Grigor Vitez“. Za izračun pokazatelja uhranjenosti odnosno pothranjenosti korištene su visina i težina djeteta te su dobiveni rezultati za indeks tjelesne mase (ITM) i percentilne krivulje indeksa tjelesne mase, definirane prema spolu i uzrastu, izračunati sa stranice CDC (https://www.cdc.gov/healthyweight/bmi/calculator.html). Ispitanici do 5. percentile svrstani su u skupinu pothranjene djece, od 5. do 85. percentile u grupu normalno uhranjenih, od 85. do 95. u grupu s povećanom tjelesnom težinom te iznad 95. percentile u grupu pretilih. Upotrebom metoda deskriptivne statistike prezentiraju se aritmetička sredina i standardna devijacija kao pokazatelj odstupanja od aritmetičke sredine. Razlika u numeričkim vrijednostima s obzirom na odabrane kategorije ispituje se ANOVA testom. Analiza je rađena u statističkom softveru STATISTICA 12.
Rezultati: u istraživanju je sudjelovalo 57,48 % ženske i 63,52 % muške djece. Najveći prosječan ITM je utvrđen kod djece starosne dobi 3,00 – 3,99 godina (15,91) te je za 0,37 bodova veći u odnosu na prosječan ITM djece starosne dobi 6,00 – 6,99 godina, dok testiranjem nije utvrđeno postojanje razlike (F = 0,25; p = 0,862). Najveći prosječni percentil je utvrđen kod djece starosne dobi 6,00 – 6,99 godina (60,30) te je za 12,89 bodova veći u odnosu na prosječnu vrijednost percentila djece starosne dobi 3,00 – 3,99 godina, a testiranjem nije utvrđeno postojanje razlike (F = 0,936; p = 0,426).
Zaključci: dobiveni rezultati ne upućuju na potrebu za preinakom kcal vrijednosti dnevnih jelovnika u Dječjem vrtiću „Grigor Vitez“ jer nije utvrđena razlika u stupnju uhranjenosti po dobnim skupinama ispitivane djece. Ovi rezultati mogu se koristiti pri izradi preventivnog edukacijskog zdravstvenog programa u cijeloj Republici Hrvatskoj u kojem bi sudjelovalo osoblje dječjih vrtića: ravnatelji, odgojitelji, pedagozi, psiholozi, zdravstveni voditelji – prvostupnici ili magistri sestrinstva, kuhari te nutricionisti i doktori medicine specijalisti pedijatrije kako bi se utvrdilo stvarno stanje uhranjenosti djece, mogućnosti unaprjeđenja jelovnika u dječjim vrtićima i stvaranje zdravih životnih navika od najranije dobi.Introduction and Aim: the main objective of this research is to determine if there is any difference in the level of nutrition in different age groups and is there any need for adjusting the caloric value for the daily menues (which are identic for all 4 age groups) with proposition of interventions within of institutional possibility (kindergarten).
Material and methods: for the purposes of this research, the questionnaire was conducted during two weeks in June 2020 on 128 parents of “Grigor Vitez” kindergarten children. The height and weight of the children were used to calculate the nutritional and malnutrition indicators, and the results of the body mass index (BMI) and percentile curves of the body mass index, defined by sex and age, calculated from the CDC page (https://www.cdc.gov/healthyweight/bmi/calculator.html), were obtained. Subjects up to the 5th percentile were classified in the group of malnourished children, from the 5th to the 85th percentile in the group of normally fed, from the 85th to the 95th in the group with increased body weight and above the 95th percentile in the group of obese. Using the methods of descriptive statistics, the arithmetic mean and standard deviation are presented as an indicator of deviation from the arithmetic mean. The difference in numerical values with respect to the selected categories is examined by the ANOVA test. The analysis was performed in the statistical software STATISTICA 12.
Results: 57.48 % of female and 63.52 % of male children participated in the study. The highest average BMI was found in children aged 3.00 - 3.99 years (15.91), and was 0.37 points higher than the average BMI of children aged 6.00 - 6.99 years, while testing did not determine the existence of a difference (F = 0.25; p = 0.862). The highest average percentile was found in children aged 6.00 - 6.99 years (60.30), and was 12.89 points higher than the average value of the percentile of children aged 3.00 - 3.99 years, and testing did not reveal any difference (F = 0.936; p = 0.426). Conclusion: the obtained results do not indicate the need to change the caloric value of daily menus in the kindergarten Grigor Vitez because no difference was found in the degree of nutrition by age groups of the examined children. These results can be used in creation of preventive educational health program throughout the Republic of Croatia in which the staff of kindergartens would participate; principals, educators, pedagogues, psychologists, health leaders-bachelors or masters of nursing, chefs, and nutritionists and medical doctors specializing in pediatrics to determine the actual nutritional status of children, opportunities to improve the menu in kindergartens and create healthy living habits from an early age
Procedures for improving sensory and motor outcomes in infants and young children with central hypotonia
No full textCentralna hipotonija je uzrokovana bolestima središnjeg živčanog sustava. Najčešći simptomi hipotonije uključuju probleme s pokretljivošću, držanjem tijela, disanjem, poteškoće s govorom. Smanjena je sposobnost održavanja posturalne kontrole i kretanja protiv gravitacije, što dovodi do kašnjenja u razvoju motorike s nenormalnim obrascima kretanja. Liječenje hipotonog djeteta zahtijeva individualan pristup multidisciplinarnog tima stručnjaka. Pristup liječenju centralne hipotonije prvenstveno ovisi o uzroku hipotonije. U većini slučajeva, neovisno o uzroku hipotonije, primjenjuju se vježbe stimulacije neuromotornog razvoja s ciljem postizanja pobuđivanja plastičnosti mozga, a time i poboljšanja neuromišićnog statusa. Fizikalna terapija je usmjerena na postizanje funkcionalnog pokreta, poboljšanje mišićne snage, koordinacije, ravnoteže i posturalne kontrole. Terapijom senzorne integracije postiže se aktivno i funkcionalno sudjelovanje djeteta u svakodnevnim aktivnostima. U re/habilitaciji djece s hipotonijom najčešće se primjenjuje neurorazvojna terapija po Bobathu, terapija po Vojti, terapija senzorne integracije i primjena ortoza. Zbog boljeg terapijskog uspjeha važno je hipotono dijete što ranije uključiti u re/habilitacijski program. Važan dio terapije je edukacija roditelja za provođenje vježbi kod kuće.Central hypotonia is caused by diseases of the central nervous system. The most common symptoms of hypotonia include problems with mobility, posture, breathing, and difficulty whit speaking. The ability to maintain postural control and anti-gravity movements is reduced, leading to delays in motor development with abnormal movement patterns. Treatment of a hypotonic child requires an individual approach by a multidisciplinary team of professionals. The approach to treating central hypotonia primarily depends on the cause of the hypotonia. In most cases, regardless of the cause of hypotonia, exercises to stimulate neuromotor development are applied in order to achieve the stimulation of brain plasticity, and thus improve neuromuscular status. Physical therapy is aimed at achieving functional movement, improving muscle strength, coordination, balance and postural control. Sensory integration therapy achieves the active and functional participation of the child in everyday activities. In the re / habilitation of children with hypotonia, neurodevelopment Bobath therapy, Vojta therapy, sensory integration therapy and the use of orthoses are most often used. For better therapeutic success, it is important to include a hypotonic child in the re / habilitation program as soon as possible. An important part of therapy is educating parents to conduct exercises at home
SIGNIFICANCE OF NURSES IN PRESERVATION OF MENTAL HEALTH IN YOUTH
No full textMentalno zdravlje je ključno za adekvatan razvoj i dobrobit pojedinca, zajednice i društva. Ono osigurava optimalan rast i napredak mladih te čini temelj za buduće naraštaje. Promocija i prevencija mentalnih poremećaja kod mladih je područje koje je i dalje u razvoju. Stoga se programi promocije mentalnog zdravlja i prevencije mentalnih poremećaja moraju provoditi sustavno i dosljedno. Medicinske sestre imaju iznimno veliku ulogu u edukaciju i uključivanju zajednice u sveobuhvatne strategije mentalnog zdravlja. Implementacija programa je zahtjevan i složen postupak, ali nosi sa sobom velike novčane uštede te isplativost za cijelu zajednicu.Mental health is key to the adequate development and well-being of the individual, the community and society. It ensures optimal growth and progress of young people and forms the basis for future generations. Promotion and prevention of mental disorders in young people is an area that is still developing. Therefore, mental health promotion and mental disorder prevention programs must be implemented systematically and consistently. Nurses have an extremely important role to play in educating and involve in the community in a comprehensive mental health strategy. The implementation of the program is a demanding and complex process, but it brings with it large financial savings and cost-effectiveness for the whole community
Midwifery care of a newborn with Treponema pallidum infection
No full textSažetak: Uvod. Sifilis je zarazna bolest uzrokovana spiralnom bakterijom zvanom Treponema pallidum.
Infekcija se najčešće prenosi spolnim putem, no može se prenijeti i transplacentarno.
Cilj. Cilj ovog rada je opisati mikrobiološka obilježja uzročnika, kliničku sliku, dijagnostičke postupke i
načine liječenja u odraslih osoba, trudnica, novorođenčadi i odabranih skupina, te istaknuti ulogu primalje
u skrbi za oboljelu trudnicu.
Rasprava. Treponema pallidum je Gram neodređena spiroheta složene antigenske strukture koja se može
vizualizirati mikroskopiranjem u tamnom polju, no klinički gledano najvažniju ulogu u dijagnosticiranju
sifilisa imaju serološki testovi; netreponemski (VDRL, RPR) i treponemski (IFA, TPHA, TPI).Klinička
slika sifilisa dijeli se na tri stadija; primarni, sekundarni i tercijarni. Također, uobičajeno je govoriti i o
ranom i kasnom stadiju sifilisa. Kongenitalni sifilis nastaje transplacentarnim prijenosom, uobičajeno
između 16. i 28. tjedna gestacije. Osim transplacentarno, novorođenče može akvirirati infekciju i u
kontaktu s lezijom u vaginalnom kanalu ili dojenjem. U slučaju transplacentarnog prijenosa infekcije,
mogu nastati različiti neželjeni ishodi trudnoće. Pri porođaju u novorođenčeta se ne moraju uočavati
kliničke manifestacije bolesti.Lijek izbora za liječenje sifilisa je penicilin, a duljina liječenja i način
primanja terapije ovise o stadiju bolesti i specifičnosti bolesnika. Uspješnost liječenja potrebno je pratiti
klinički i serološki.Primaljska skrb očituje se u edukaciji trudnice o simptomima, prijenosu i načinu
zaštite od spolno prenosivih bolesti. U trudnica s potvrđenom dijagnozom sifilisa, primalja sudjeluje u
primjeni liječenja koje je ordinirao liječnik specijalist. Primalja bi trebala uočiti rane znakove
kongenitalnog sifilisa, te pravovremeno prepoznati čimbenike koji doprinose povećanom riziku za lošije
ishode u novorođenčeta.
Zaključak. Kongenitalni sifilis može se prevenirati rutinskim probirom trudnica na sifilis. Sve trudnice
trebale bi prvi prvom pregledu biti podvrgnute istom, a dodatno testiranje trebalo bi obaviti između 28. i
32. tjedna gestacije. U slučaju postojanja dodatnih čimbenika rizika, testiranje bi trebalo ponoviti
neposredno prije ili po porodu. Liječenje kongenitalnog sifilisa uključuje i timski rad specijalista
infektologije, neonatologije, pedijatrije, ginekologije i opstetricije, te sestrinskog i primaljskog osoblja.Summary: Introduction. Sypfilis is an infectious disease caused by spirochetal bacteria named
Treponema pallidum. Infection is usually sexually transsmited, but could be also transplacentary
transmitted.
Aim. The aim of this work is to describe the microbiological features, clinical presentation, diagnostic
tools and available treatment in adults, pregnant women, newborns and other specific groups of patients.
Also, the goal of this work is to point out the role of midwifery care.
Discussion. Treponema pallidum is a Gram neutral spirohetal bacteria with complex antigene structure
that can be visualized by microscopy in the dark field. From the clinical aspect, serological tests are the
most important diagnostic tools in confirming the diagnosis. There are non-treponemal (VDRL, RPR) and
treponemal tests (IFA, TPHA, TPI).Cliniacl presentation of syphilis in traditionally divided into three
stages; primary, secondary and tertiary. Also, syphilis is divided into early and late onset. Congenital
syphilis appears after transplacental transmission usually between 16th and 28th gestation week. Besides
transplacentary, newborn may aquire this infection in direct contact with vaginal channel or while
breastfeeding. In casese of transplacentar transmission, various unfavorable pregnancy outcomes may
occur. At birth, newborns may not show the cliniacl manifestations of acute illness. Penicillin is the
medication of choice. The regime and the duration of the therapy are prescribed depending of the stage of
illness and the patient specificity. Effectivness of therapy should be monitored with clinical and serologic
features.Midwifery care is based on the education about symptoms, ways of transmission and protection
against sexually transmitted diseases. In pregnant women with syphilis, midwife participates in treatment
procedures proscribed by the specialists doctors. Midwife should be trained to recognize the early signs of
congenital syphilis, and to promptly notice the factors that contribute to the increased risk for negative
outcomes in newborns.
Conclusion. Congenital syphilis is preventable when routine serological tests are made on time in
pregnant women. All pregnant women should underwent serological testing at the first visit, and
additional testing is recommended to be done between 28th
and 32th gestation week. In case of other risk
factors, re-testing should be made near delivery or at delivery. Complete treatment process of congenital
syphilis is a result of multidisciplinary work of specialities in infectology, neonatology, gynecology and
obstetrics, and nursing and midewifery staff
Quality control of digital receptors in radiology
No full textSuvremena radiologija danas u potpunosti koristi digitalne sustave kao princip rada. Digitalni receptori koji mogu biti indirektni i direktni, temeljena su komponenta digitalnog sustava. Prednost digitalnih receptora je veća učinkovitost konverzije rtg zračenja u sliku (signal), bolja kontrastna rezolucija, manja doza zračenja, brža i lakša distribucija slike, s tim da pri tome dobar digitalni detektor mora postići prostornu rezoluciju što bližu film folijskim sustavima. Idealan digitalni receptor slike u radiologiji mora biti dovoljno velikog formata, visoke osjetljivosti, velikog dinamičkog raspona, veličina piksela mora omogućavati idealnu oštrinu slike, dok šum mora biti unutar granica kako bih se omogućila kvalitetna slika. Rad je baziran na prikazu kontrole kvalitete digitalnih receptora u radiologiji koji se temelje na ispitivanju kvalitete i postojanosti kontrastne i prostorne rezolucije te postojanju šum i artefakata na slici jer oni onemogućavaju kvalitetno očitavanje slike i ispravno postavljanje dijagnoze. Sam proces kontrole kvalitete za svaki uređaj je definiran pravilnicima o kontroli uređaja koji sadrže točna uputstva izvedbe testa, učestalost i osobu koja ga vrši jer u ispitivanju kvalitete digitalnih receptora sudjeluju uz radiološke tehnologe i medicinski fizičari. Protokoli su određeni vremenskim intervalima provedbe testiranja (dnevno, mjesečno i godišnje testiranje). Samo zajedničkim djelovanjem zaduženog osoblja i pravilnom te redovnom provedbom protokola mogu se ostvariti idealni radni uvjeti.Modern radiology today makes full use of digital systems as a working principle. Digital receptors, which can be indirect and direct, are a fundamental component of a digital system. The advantage of digital receptors is higher efficiency of X-ray to image conversion (signal), better contrast resolution, lower radiation dose, faster and easier image distribution, and a good digital detector must achieve a spatial resolution as close as possible to film foil systems. The ideal digital image receptor in radiology must be large enough format, high sensitivity, large dynamic range, pixel size must allow ideal image sharpness, while noise must be within limits to enable quality image. The master's thesis is based on the presentation of quality control of digital receptors in radiology based on testing the quality and consistency of contrast and spatial resolution and the existence of noise and artifacts in the image because they prevent quality image reading and correct diagnosis. on the control of devices that contain the exact instructions for performing the test, the frequency and the person performing it, because they participate in the examination of the quality of digital receptors with radiological technologists and medical physicists. Protocols are determined by the time intervals of testing (daily, monthly and annual testing). Only through the joint action of the staff in charge and the proper and regular implementation of the protocol can ideal working conditions be achieved
CREATIVE BEHAVIOR AND PROSPENSITY TO DDAYDREAM IN STUDENTS: ARE "DREAMERS" MORE CREATIVE?
No full textCiljevi: Ciljevi rada bili su ispitati razlike u kreativnom ponašanju, samoprocjeni kreativnosti i dnevnom
sanjarenju između studenata na Sveučilišnom odjelu zdravstvenih studija i studenata Filozofskog
fakulteta u Splitu, te ispitati mogućnost predviđanja kreativnog ponašanja na osnovi vrste studija,
poticanja kreativnosti, dnevnog sanjarenja i otvorenosti prema iskustvima.
Metode: U istraživanju je sudjelovao 121 student sa Sveučilišnog odjela zdravstvenih studija i
Filozofskog fakulteta u Splitu. Istraživanje se provodilo metodom anketiranja tijekom siječnja 2020.
Mjerni instrumenti koji su korišteni za dokazivanje hipoteza i specifičnih ciljeva jesu validirani anketni
upitnici, odnosno Upitnik općih podataka, Upitnik neprilagođenog dnevnog sanjarenja, Upitnik
kreativnog ponašanja, Pitanja o poticanju kreativnog ponašanja, Upitnik samoprocjene kreativnosti i
Upitnik otvorenosti. Istraživanjem je utvrđeno da među ispitanicima ne postoji razlika u spolu i dobi
prema fakultetu koji studenti pohađaju.
Rezultati: Provođenjem ankete pokazalo se da studenti Filozofskog fakulteta u Splitu imaju više razine
kreativnog ponašanja, više samoprocjene kreativnosti i više dnevnog sanjarenja od studenata Sveučilišnog
odjela zdravstvenih studija te da pripadnost studiju Filozofskog fakulteta, više razine dnevnog sanjarenja,
veća otvorenost prema iskustvima i poticanje kreativnosti predviđaju više razine kreativnog ponašanja.
Zaključci: Kreativno ponašanje i sklonost sanjarenju kod studenata povezana je s fakultetom koji
studenti pohađaju, pa su studenti ovisno o zahtjevima svoje profesije manje ili više skloni pragmatičnijem
pristupu životu, a samim time i manje, odnosno više sanjare te su posljedično, manje ili više kreativni.
Tako se kod studenata koji imaju više razine kreativnog ponašanja, više samoprocjene kreativnosti, više
dnevnog sanjarenja i veću otvorenost iskustvima predviđa viša razina kreativnog ponašanja. Provedeno
istraživanje je jedinstveno te bi rezultati istraživanja mogli unaprijediti spoznaje o sklonosti sanjarenju
kod studenata te povezanosti sanjarenja i kreativnog ponašanja. Međutim, nedostatak je istraživanja što je
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ono ograničeno samo na studente i što su ispitanici homogeni prema dobi, što bi moglo utjecati na
rezultate istraživanja. Osim toga, korištenje samoprocjenskih upitnika može utjecati na objektivnost
ispitanika.Aims: The aims of this paper were to examine differences in creative behavior, self-assessment of
creativity and daydreaming between students of the University Department of Health Studies and students
of the Faculty of Humanities and Social Sciences in Split, and to examine the possibility of predicting
creative behavior based on study type.
Methods: Altogether 121 students partcipated in this study, of which 80 were the students of the
University Department of Health Studies and 41 were the students of the Faculty of Humanities and
Social Sciences. The research was conducted by the survey method during January 2020. The measuring
instruments used to prove the hypotheses and specific objectives are the validated survey questionnaires
as follows: the General Data Questionnaire, the Maladaptive Daydreaming Questionnaire, the Creative
Behavior Questionnaire, the Creative Behavior Questions, the Creativity Self-Assessment Questionnaire
and the Openness Questionnaire.
Resultates: The research found that there was no gender and age differences among the respondents
according to the faculty that students attend. The results showed that students of the Faculty of
Humanities and Social Sciences had higher levels of creative behavior, higher self-assessment of
creativity and more daydreaming compared to students of the University Department of Health Studies.
Furher, encouriging creativity by authorities predicted higher levels of creative behavior.
Conclusiones: Creative behavior and a tendency to daydream in students was associated with the faculty
that students attend, so students were more or less inclined to a more pragmatic approach to life, and thus
less or more daydreamers, and consequently, more or less creative in daily life. Thus, for students who
have higher levels of creative behavior, higher self-assessment of creativity, more daily daydreaming and
greater openness to experiences, a higher level of creative behavior has been predicted. The conducted
research is unique and the results of the research could improve the knowledge about the tendency of
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daydreaming in students and the association between daydreaming and creative behavior. However, the
limitation of the research is that it is limited to students and that the respondents are homogenous by age,
which could affect the results of the research. In addition, the use of self-assessment questionnaires can
also affect the objectivity of the respondent
Quality of life of patients with acute myocardial infarction treated with primary percutaneous coronary intervention: a cross-sectional study
No full textTijekom 2021. godine, anketiranjem ispitanika u Kliničkom bolničkom centru Split, istražena je kvaliteta života u grupi bolesnika s akutnim infarktom miokarda koji su podvrgnuti perkutanoj koronarnoj intervenciji. Rezultati ukazuju na nižu kvalitetu života u usporedbi s kontrolnom grupom zdravih ispitanika. U odnosu na kontrolnu grupu ostalih kardioloških bolesnika nema statistički značajne razlike.In 2021, by surveying respondents at the Clinical Hospital Center Split, the quality of life in a group of patients with acute myocardial infarction who underwent percutaneous coronary intervention was investigated. The results indicate a lower life quality compared to the control group of healthy subjects. There is no statistically significant difference compared to the control group of other cardiac patients
Use of immunofluorescent techniques in routine histopathological diagnostics
No full textU radu je prikazana povijest razvoja imunofluorescentne tehnike u patohistologiji, od direktne imunofluorescence (DIF) do molekularne patologije (FISH). Imunofluorescentna metoda je osjetljiva i specifična. Uvjet za optimalni preparat je dobra predanalitička priprema tkiva i poštovanje analitičkog postupka. Suboptimalne preparate nije moguće točno interpretirati, te ih treba, ako je moguće, ponavljati što predstavlja trošak novca i vremena. Prikazan je način rada na imunofluorescentnom mikroskopu uz korištenje računalnog softvera za pohranu i analizu slike.The paper presents the history of the development of immunofluorescence techniques in pathohistology, from direct immunofluorescence (DIF) to molecular pathology (FISH). The immunofluorescent method is sensitive and specific. The condition for the optimal preparation is good pre-analytical tissue preparation and adherence to the analytical procedure. Suboptimal preparations cannot be interpreted accurately, and should be repeated, if possible, which is a cost of money and time. The method of working on an immunofluorescence microscope with the use of computer software for image storage and analysis is shown
HEALTH CARE OF INFANTS WITH HYPERBILIRUBINEMIA
No full textNakon rođenja djeteta uslijed pojave hiperbilirubinemije kao povećane koncentracije serumskog bilirubina najvažnije je razlučiti radi li se o fiziološkoj ili pak patološkoj hiperbilirubinemiji. Prisutnost hiperbilirubinemije razotkrivamo pojavom žućkastog obojenja kod djeteta koje prvo zahvaća bjeloočnice, a zatim se širi tijelom prema nogama. Kako bi se ustanovila vrsta i potrebno liječenje najbitniji parametar kojim se neonatolozi vode je vrijeme pojave žutice. Žuticu koja se javlja u prvih 24 sata ili traje više od tjedan dana u nedonešenog ili dva tjedna u donešenog djeteta potrebno je pomno pratiti i liječiti kako ne bi došlo do razvoja kernikterusa nakon prodiranja nekonjugiranog toksičnog bilirubina u bazalne ganglije i jezgre moždanog debla. Takva hiperbilirubinemija naziva se patološkom. Patološka hiperbilirubinemija može biti konjugiranu i nekonjugiranu. Konjugirane (direktne) hiperbilirubinemije za razliku od nekonjugiranih uvijek su patološke, a njihov uzrok nastanka su oštećenja hepatocita ili različite opstrukcije žučnih vodova. Nekonjugirane hiperbilirubinemije razlog su nastanka mnogih sindroma kao što je Gilbertov sindrom. Kernikterus kao najgori ishod koji može nastati iz patološke žutice rijedak je i nepredvidiv, a dovodi do mnogih neurorazvojnih poteškoća kod preživljene dojenčadi. S druge strane fiziološka žutica kao benigna prolazna pojava manifestira se nakon 72 sata života novorođenčeta i nestaje do kraja tjedna. Uz navedene vrste hiperbilirubinemije postoji još jedna karakteristična vrsta žutice koja se pojavljuje nakon poroda a naziva se laktacijska žutica. Dijelimo je na ranu i kasnu, a srž njenog nastanka smatra se nedostatak prisutnosti enzima glukuronidaze te pregnan-3α,20β-diola i neesterificirane masne kiseline u majčinom mlijeku. Dijagnoza hiperbilirubinemije obuhvaća TSB test kao zlatni standard i TcB test kao jednostavniju, bržu i neinvazivnu metodu koja koristi uređaj transkutani biliruinometar. Visoke vrijednosti TSB-a potrebno je umanjiti te spriječiti neurotoksičnost bilirubina standardnim metodama liječenja koje uključuju fototerapiju i eksangvinotransfuziju te popratnu farmakološku potporu fenobarbitolom. Uloga medicinske sestre kod hiperbilirubinemije proteže se od labaratorijskih pretraga preko edukacije majke do skrbi i njege za dijete kod postupaka snižavanja bilirubina. Ključna je i njena uloga pri planiranju i provođenju zdravstvene njege kroz sestrinske dijagnoze i intervencije.After the birth of a child due to the appearance of hyperbilirubinemia as an increased concentration of serum bilirubin, it is most important to distinguish whether it is physiological or pathological hyperbilirubinemia. The presence of hyperbilirubinemia is revealed by the appearance of a yellowish discoloration in a child that first affects the sclera and then spreads through the body towards the legs. In order to establish the type and treatment required, the most important parameter used by neonatologists is the time of onset of jaundice. Jaundice that occurs in the first 24 hours or lasts more than a week in a premature or two weeks in a preterm infant should be closely monitored and treated to prevent the development of kernicterus after unconjugated toxic bilirubin enters the basal ganglia and brainstem. Such hyperbilirubinemia is called pathological. Pathological hyperbilirubinemia can be conjugated or unconjugated. Conjugated (direct) hyperbilirubinemias, unlike unconjugated ones, are always pathological, and their cause is hepatocyte damage or various bile duct obstructions. Unconjugated hyperbilirubinemias are the cause of many syndromes such as Gilbert's syndrome. Kernicterus as the worst outcome that can result from pathological jaundice is rare and unpredictable, and leads to many neurodevelopmental difficulties in surviving infants. On the other hand, physiological jaundice as a benign transient occurs after 72 hours of life of the newborn and disappears by the end of the week. In addition to these types of hyperbilirubinemia, there is another characteristic type of jaundice that occurs after childbirth and is called lactational jaundice. It is divided into early and late, and the core of its occurrence is considered to be the lack of the presence of the enzyme glucuronidase and pregnan-3α, 20β-diol and non-esterified fatty acids in breast milk. The diagnosis of hyperbilirubinemia includes the TSB test as the gold standard and the TcB test as a simpler, faster, and noninvasive method using a transcutaneous biliruinometer device. High TSB levels should be reduced and bilirubin neurotoxicity prevented by standard treatments including phototherapy and exanguinotransfusion and concomitant pharmacological support with phenobarbitol. The role of the nurse in hyperbilirubinemia extends from laboratory tests through maternal education to child care and nursing in bilirubin lowering procedures. Its role in planning and implementing health care through nursing diagnoses and interventions is also crucial.
Conclusion: A form of hyperbilirubinemia in infants needs to be recognized in order to initiate timely treatment and avoid consequences such as kernicterus. In addition to neonatologists, nurses are also involved in this process
INCIDENCE OF INFECTIONS IN PRETERM INFANTS AT THE NEONATOLOGY OF CLINICAL HOSPITAL CENTER SPLIT AND THEIR IMPACT ON THE COMPLEXITY OF NURSING CARE
No full textCILJ ISTRAŽIVANJA:
Analizirati nedonoščad kod kojih se razvila infekcija i utvrditi utjecaj gestacijske dobi, rodne mase, Apgar indeksa, spola djeteta, dobi obrazovanja i pariteta majki na razvoj infekcija kod djece te utjecaj razvoja infekcije na složenost sestrinske skrbi. Prikazati vrste infekcija po organskim sustavima.
ISPITANICI I METODE:
Retrospektivno je pregledana medicinska dokumentacija nedonoščadi liječenih na odjelu neonatologije KBC-a Split, rođenih od 1. siječnja 2016. godine do 31. prosinca 2018. godine. U istraživanju je obrađeno 351 nedonošče kod kojih se razvila infekcija i njihove majke. Analizirani su podatci: rodna masa, gestacijska dob, Apgar indeks, spol djeteta, dob, paritet i obrazovanje majki.
REZULTATI:
Od ukupno 821 nedonoščeta rođenog tijekom trogodišnjeg razdoblja 351 nedonošče razvilo je infekciju (42,3%). Značajna je razlika kod nedonoščadi niže rodne mase i manje gestacijske dobi kod koje se razvila infekcija u odnosu na nedonoščad veće rodne mase i gestacijske dobi (p<0,001). Spol djeteta i dob majke nemaju utjecaja na razvoj infekcije kod djece. 51,6% djece koja su razvila infekciju imala su Apgar indeks u prvoj minuti od 8 do 10. Kod najvećeg broja nedonoščadi 41,6% zabilježena je nespecificirana perinatalna infekcija. Kod majki prvorotki je veća vjerojatnost za razvoj perinatalnih infekcija kod djece. Analizom podataka utvrđeno je kako od ukupnog broja djece koja su razvila infekciju 68,1% istih su djeca majki sa SSS, a 31,9% sa VŠS ili VSS. Sestrinska skrb kod nedonoščadi koja su razvila infekciju je kompleksnija te zahtjeva veći broj specifičnih sestrinskih postupaka.
ZAKLJUČCI:
Manja gestacijska dob i niža rodna masa utječu na razvoj infekcija kod nedonoščadi. Istraživanje je pokazalo kako redoslijed poroda ima utjecaj na razvoj infekcije kod djece, odnosno kod djece majki prvorotki veća je vjerojatnost za razvoj infekcije.
Spol djeteta i dob majki nemaju utjecaja na razvoj infekcije kod djece. Sestrinska skrb kod ovakve djece je kompleksnija te zahtjeva znanje i izuzetne vještine medicinske sestre.AIM:
To analyse preterm infants who have developed the infection and determine the impact of gestational age, birth weight, Apgar score, gender of the child, age, education and parity of mothers on the development of infection in children and the impact of infection on the complexity of nursing care. Show the types of infections by organ systems.
SUBJECTʼS AND METHODS:
The medical records of premature infants treated at the Department of Neonatology of the Clinical Hospital Center Split, born from 1 January 2016 to 31 December 2018, were retrospectively reviewed. The study looked at 351 premature babies who developed the infection and their mothers. Data about birth weight, gestational age, Apgar score, gender of the child and mother´s age, parity and education were taken into account.
RESULTS:
Out of a total of 821 premature infants born during the three – year period, there were 351 (42,3%) preterm infants who developed the infection. There was a significant difference in preterm infants of lower birth weight and lower gestational age who developed the infection compared to preterm infants of higher birth weight and gestational age (p<0.001). The gender of the child and the age of the mother have no influence on the development of infection in children. 51.6% of children who have developed an infection have an Apgar score between 8 and 10. The biggest number of preterm infants have developed a respiratory infection, 24.5% of them. Children of first-born mothers are more likely to develop the infection. The analysis of the data established that in 68.1% of cases mothers of the children who developed the infection completed secondary education and in 31,9% of cases they had higher or high expertise. Nursing care in preterm infants who have developed an infection is a more complex and requires more specific nursing procedures.
CONCLUSIONS:
Lower gestational age and lower birth weight significantly affect the development of infections in preterm infants. Research has shown that first – borns have a greater impact on the development of infection in children.
The gender of the child and the age of the mother did not show a statistically significant effect on the development of infections in children. Nursing care in preterm infants who have developed an infection is a more complex and requires nurses with knowledge and exceptional skills