To objectively estimate weight of a condition of the newborn child very difficult. It is connected with anatomo-physiological features of children of different gestational age, existence of tranzitorny states and various compensatory opportunities depending on prenatal development. And always the significant share of subjectivity in assessment of a state is contributed by specialization, an experience and experience of the doctor performing inspection of the newborn person.
On the standard terminology the condition of the patient can be satisfactory, moderate severity, heavy and critical. By classics of the general practice the condition of the patient is determined how satisfactory if "functions of vitals are rather compensated. It is, as a rule, noted at easy forms of disease". At once there is a question: whether the general condition of the sick newborn child can even if the disease proceeds benign to be satisfactory?
Speak about the general moderately severe state in a case, "if the disease leads to a decompensation of functions of vitals, however does not pose direct hazard to life of the patient". Whether you saw the newborn child with a decompensation at least of one vital function that it did not constitute danger to his life?
The general condition of the patient is defined how heavy in case the decompensation of functions of vitals which developed as a result of a disease poses direct hazard to life of the patient or can result in disability. I think that any neonatolog by this definition would estimate the newborn's condition as critical which "… is characterized by sharp disturbance of the main vital functions of an organism. Without urgent and intensive treatment of the patient can die during the next few hours or minutes".
Then so that a neonatology are inclined to exaggerate severity of the patients? Yes, because we know how fast the condition of the child and what sometimes a fatal role is played by underestimation of weight of a state can change.
Attempts to objektivizirovat, create quantitative assessment of weight of a condition of patients are undertaken already more half a century. The scales of assessment of weight used in a neonatology:
PIM II — The Pediatric Index of Mortality for Children Receiving Intensive Care (Slater A. et al., 2003);
PRISM III — Pediatric Risk of Mortality (Pollack M.M., et al., 1996);
SNAP — Score for Neonatal Acute Physiology (1993 O.K.Richardson at al);
SNAPPE — Score for Neonatal Acute Physiology-Perinatal Extension (R.C. Silveria et al of 2001);
CRIB — Clinical Risk Index for Babies (2000, 2003 G.Pany et al);
NEOMOD — Neonatal Multiple Organ Dysfunction Score (Janota J. et al., 2001);
It should be noted that these scales differ in high validity, but only concerning the short-term forecast of lethality while the child is in ORITN. One of important shortcomings of these scales is the inability to differentiate influence of an intensive care on weight of a disease. And any of the offered scales of assessment of weight of a state does not answer a question: what weight of a condition of the specific child at the time of survey.
The exception is made by a scale of NTISS — Neonatal Therapeutic Intervention Scoring System (Gray J.E., Ricahardson D.K., et al., 1992) which estimates weight of a condition of the patient by quantity and complexity of methods of a research and the treatment necessary for the patient. Use of this scale dictates strict implementation of clinical protocols and standards that is not always possible in connection with the different level of delivery of health care.
Criteria for evaluation of weight of a state at newborn children
Nevertheless, the developed neonatologichesky scales of assessment of weight can and have to be used as the effective tool of comparative assessment of risk of a failure and also for the purpose of identification of potentially good practice since "… lethality is defined not by the body weight and gestational age more precisely that is often used for evaluation of the work of various ORITN, and weight of a condition of the patient defined by the standardized scales". Besides, objectification of weight of a condition of patients allows to define correctly routing of patients, to place priorities in personnel policy, is material – hardware of the medical organizations.
Practically the description of survey of the patient has to begin with assessment of the general state. Whether it is possible to make this assessment objective? Returning to the academic definition, weight of a condition of the patient is defined by degree of functional insufficiency of life support systems, i.e. weight of disease. For objective assessment of weight of a state clinical classifications of nosological forms and rank scales of quantitative assessment of functional insufficiency of this or that system of an organism are used.
It is conditionally accepted to allocate five life support systems.
Respiratory system.
When determining severity of respiratory insufficiency at newborn children scales of Silverman-Anderson (1956) and Downes are applied (in modification of 1970);
Cardiovascular system.
The severity of disturbance of blood circulation at newborns is determined by A.S. Sharykin's scale (2000) or it is possible to use less known scale of R.D. Ross et al (1992) in modification of NTsSSH of Bakulev;
Central nervous system.
Assessment cerebral insufficiency is carried out on neonatal scales of a coma Glasgow/St. Petersburg (2005) or Raymondi A.J., Hirschane J. (1984r.). Will be applied to assessment of weight of cerebral ischemia classification of H.B. Sarnat and M.S. Sarnat (1976);
Digestive tract. The main criterion of weight of intestinal insufficiency is the tolerance to an enteroalimentation;
Urinary system.
Weight of acute injury of kidneys at newborn children is estimated according to a neonatal scale of AKIN (2011) or nRIFLE (2013).
Criteria for evaluation of weight of a state at newborn children
With surgical pathology very well told H. Selye (1950) about assessment of a condition of children "… critical states of the operated patients are defined by the operation in not smaller degree, than insufficiency of any functional system. Besides consequences of such powerful aggression as surgical intervention, always affect all organism".
Still is special a nosology of the perinatal period which can cause weight of a condition of newborn children. For example, asphyxia of the newborn. Since 1952 pediatricians and a neonatology of the whole world use Virginia Apgar's scale at assessment of a condition of the newborn child the first minutes of life. This scale is the cornerstone of screening of weight of asphyxia.
Weight of a condition of the newborn child can be caused by the course of a hemolitic disease, at the same time the main criteria, according to the clinical recommendations of RON and RASPM (2017), clinical laboratory data are.
It is clear, that in case of a course of a disease all organism suffers, but not some single system, but always even at multiorgan insufficiency it is possible to allocate the leading pathological syndrome which will define weight of a condition of the sick child.
So, we will try to give definitions to weight of a condition of the newborn child.
The state can be satisfactory, when there is no dysfunctions of vitals. These are tranzitorny conditions of the period of a neonatality, prematurity, children with a delay of weight and growth, children with small anomalies of development (without dysfunction of body).
We speak about a condition of moderate severity in case functional insufficiency of the compromised life support systems is compensated by an organism on autoregulyation mechanisms.
Criteria for evaluation of weight of a state at newborn children
Treat criteria of serious condition:
Decompensation of functions of vitals
Multiorgan insufficiency
Risk of a lethal outcome or invalidism
There is an effect of the carried-out intensive care.
The efficiency of an intensive care distinguishes serious condition from critical which is characterized by prosthetics of two and more vital functions of an organism and a progressive aggravation of symptoms, despite the carried-out treatment. Thus, today the problem of creation of integrated scales of assessment of weight of the general condition of newborn children does not lose the relevance. Practically, the main criterion of weight of a condition of the patient is degree of clinical expressiveness of the leading pathological syndrome. It is important to understand that severity of a state — size non-constant and has to be estimated in dynamics.