ABSTRACT
The development of neonatal surgery is an important task of health care system, because birth defects have been the 2nd most prevalent cause of infant mortality for many years. In order to improve the quality of care for neonates with surgical diseases we studied the main causes of neonatal deaths during the period from 1995 to 2014, on the basis of data from the Children's Surgery Department of Yakutsk. In 77% of cases, the causes of lethal outcomes in neonates with surgical pathology were conditionally preventable. We singled out the basic organizational problems, the solution of which led to a 3.5 times reduction in mortality of infants with surgical pathology during the second period of the study (2005-2014). The main organizational aspects of the regional model of improving medical care of infants with surgical pathology are: antenatal diagnosis of malformations and prenatal consultation with children's surgeon, competent and timely transportation of newborns from district hospitals, the centralization of aid at level 3 hospitals, the introduction of modern diagnostic and treatment algorithms, methods of minimally invasive endosurgery.
Subject(s)
Cause of Death/trends , Congenital Abnormalities/mortality , Congenital Abnormalities/surgery , Infant Mortality/trends , Arctic Regions/epidemiology , Bayes Theorem , Humans , Infant , Infant, Newborn , Population Groups/statistics & numerical data , Retrospective Studies , Russia/epidemiologyABSTRACT
The article presents our experience of treatment of congenital diaphrogmatic hernia at newborns and hernia of an esophageal opening of a diaphragm among children of early age. Since 2010 surgical tactics has been changed: the prolonged preoperative preparation with use of the device of high-frequency ventilation of lungs, correction of symptoms of pulmonary hypertensia is carried out, operation is carried out according to plan after stabilization of the patient in parameters of oxygenation and an acid-base state, operative treatment is executed by method of low-invasive endosurgery. Over the last 5 years 25 children with good functional and cosmetic results have been operated. The lethality in the case of congenital diaphragmatic hernia at newborns decreased to 12%, it was noted generally among patients with the expressed hypoplasia of lungs which died during preoperative preparation. In recent years we place emphasis on antenatal diagnosis of pathology and prenatal diagnostics of degree of a hypoplasia of a lung on indicators of a pulmonary and head index at a fetus. It wasn't noted a postoperative lethality.
Subject(s)
Hernias, Diaphragmatic, Congenital/diagnosis , Hernias, Diaphragmatic, Congenital/surgery , Herniorrhaphy/methods , Female , Humans , Infant, Newborn , Male , Survival RateABSTRACT
The actual stage of development of public health rendering of specialized medical care is based on principles of generality, accessibility, addressness, qualitativeness, and effectiveness. However, the problem of rendering specialized medical care to population is one of most critical targets in district centers and requires immediate solution. The main mean of resolving this problem is re-hospitalization of patient in more large-scale medical institutions. The rendering of high-tech medical care, surgery care included, to newborns in the Republic of Sakha (Yakutia) is possible only in conditions of metropolitan health institutions i.e. medical institutions of third level. Annually, almost half of newborns with surgical pathology is transported from central district hospital. The organization of reanimation counseling center, maintenance of remote monitoring of newborns and development of telemedicine and means of sanitary aviation play main role in supporting accessibility of high-tech medical care in conditions of this region.
Subject(s)
Health Services Accessibility/standards , Infant Mortality , Infant, Newborn, Diseases/surgery , Transportation of Patients/standards , Cold Climate , Humans , Infant , Infant, Newborn , Infant, Newborn, Diseases/epidemiology , Russia/epidemiology , Transportation of Patients/statistics & numerical dataABSTRACT
The endoscopic examination of 293 patients has shown that the incidence and character of diseases of the gastric stump (ulcer, polyps, carcinoma) were dependent on the underlying disease, time after the operation and severity of the duodenogastric reflux. The authors substantiate necessity of a refluxing anastomoses in gastric resection.
