V \u010cR se neust\u00e1le zvy\u0161uje po\u010det p\u0159ed\u010dasn\u00fdch porod\u016f, a to z p\u016fvodn\u00edch 6 procent v roce 2002 na sou\u010dasn\u00fdch 8,3 procenta. To znamen\u00e1, \u017ee v roce 2002 se p\u0159ed\u010dasn\u011b narodilo 5567 d\u011bt\u00ed, zat\u00edmco v roce 2014 u\u017e to bylo 9121 d\u011bt\u00ed. Asi 1,2 procenta je dokonce extr\u00e9mn\u011b nedono\u0161en\u00fdch, tedy p\u0159ijdou na sv\u011bt d\u0159\u00edve ne\u017e ve 28. t\u00fddnu t\u011bhotenstv\u00ed. Tato \u010d\u00edsla se neli\u0161\u00ed od z\u00e1padn\u00edho sv\u011bta. <\/p>\n
D\u00edky \u0161pi\u010dkov\u00e9 p\u00e9\u010di porodn\u00edk\u016f a specializovan\u00fdch neonatologick\u00fdch center maj\u00ed tito novorozenci, tj. p\u0159ed\u010dasn\u011b narozen\u00e9 d\u011bti, vysokou \u0161anci na norm\u00e1ln\u00ed \u017eivot bez zdravotn\u00edch komplikac\u00ed. <\/p>\n
P\u0159ed\u010dasn\u00fd porod je porod do konce 37.\u207a\u2070 t\u00fddne t\u011bhotenstv\u00ed. V naprost\u00e9 v\u011bt\u0161in\u011b se jedn\u00e1 o porod spont\u00e1nn\u00ed a jeho p\u0159\u00ed\u010diny nejsou dosud pln\u011b objasn\u011bn\u00e9. Existuj\u00ed n\u011bkter\u00e9 rizikov\u00e9 faktory, nap\u0159\u00edklad afroamerick\u00e1 rasa, v\u011bk rodi\u010dky m\u00e9n\u011b ne\u017e 18 a v\u00edce ne\u017e 40 let, n\u00edzk\u00e1 t\u011blesn\u00e1 hmotnost, \u0161patn\u00fd socioekonomick\u00fd status. Mezi ovlivniteln\u00e9 rizikov\u00e9 faktory pat\u0159\u00ed p\u0159edev\u0161\u00edm kou\u0159en\u00ed, drogy, kr\u00e1tk\u00fd interval mezi porody a dal\u0161\u00ed. <\/p>\n
\u201eTento trend ur\u010dit\u011b souvis\u00ed mimo jin\u00e9 i s posouv\u00e1n\u00edm mate\u0159stv\u00ed do vy\u0161\u0161\u00edho fertiln\u00edho v\u011bku, celkov\u00fdm sn\u00ed\u017een\u00edm plodnosti populace a ohromn\u00fdm rozvojem asistovan\u00e9 reprodukce. Sledujeme to v z\u00e1padn\u00edm sv\u011bt\u011b a \u010cesk\u00e1 republika nen\u00ed v\u00fdjimkou,\u201c konstatuje prim\u00e1\u0159 Neonatologick\u00e9ho odd\u011blen\u00ed Gynekologicko-porodnick\u00e9 kliniky VFN a 1. LF UK, prof. MUDr. Richard Plavka, CSc. <\/p>\n
Z\u00e1sadn\u00ed je, aby se dostala rodi\u010dka do specializovan\u00e9ho centra <\/p>\n
Pro zdrav\u00ed novorozenc\u016f a rodi\u010dek je z\u00e1sadn\u00ed, aby byly pacientky s po\u010d\u00ednaj\u00edc\u00edm p\u0159ed\u010dasn\u00fdm porodem transportov\u00e1ny do perinatologick\u00e9ho centra Vysoce specializovan\u00fdch center intenzivn\u00ed p\u00e9\u010de v perinatologii je v \u010cR celkem dvan\u00e1ct. T\u00edm, kter\u00e9 dlouhodob\u011b dosahuje nejlep\u0161\u00edch v\u00fdsledk\u016f je Perinatologick\u00e9 centrum VFN. <\/p>\n
K do\u010dasn\u00e9mu odd\u00e1len\u00ed p\u0159ed\u010dasn\u00e9ho porodu o dva a\u017e sedm dn\u00ed se vyu\u017e\u00edv\u00e1 tokolytick\u00e9 l\u00e9\u010dby. Neindikuje se p\u0159ed 24. a po 35. t\u00fddnu gravidity, jej\u00ed trv\u00e1n\u00ed nem\u00e1 p\u0159es\u00e1hnout 48 hodin a slou\u017e\u00ed p\u0159edev\u0161\u00edm k tomu, aby se z\u00edskal \u010das pro \u201etransport in utero\u201c do perinatologick\u00e9ho centra nebo \u010das na pod\u00e1v\u00e1n\u00ed kortikosteroid\u016f k indukci plicn\u00ed zralosti plodu. <\/p>\n
\u201eVeden\u00ed porodu jedno\u010detn\u00fdch t\u011bhotenstv\u00ed se v p\u0159\u00edpad\u011b polohy pod\u00e9ln\u00e9 hlavi\u010dkou neli\u0161\u00ed od veden\u00ed porodu v term\u00ednu. Zp\u016fsob veden\u00ed porodu mezi t\u00fddny 22.\u207a\u2070 a 25.\u207a\u2070 vol\u00edme v\u017edy p\u0159\u00edsn\u011b individu\u00e1ln\u011b a po p\u0159edchoz\u00edm rozhovoru s rodi\u010dkou a jej\u00edm partnerem. Oba by m\u011bli zn\u00e1t v\u00fdznamn\u00e1 rizika perinat\u00e1ln\u00ed mortality a morbidity, ale v\u011bd\u011bt i o riziku vy\u0161\u0161\u00ed mate\u0159sk\u00e9 \u00famrtnosti a d\u016fsledc\u00edch c\u00edsa\u0159sk\u00e9ho \u0159ezu pro p\u0159\u00edpadn\u00e1 dal\u0161\u00ed t\u011bhotenstv\u00ed,\u201c dod\u00e1v\u00e1 prof. MUDr. Anton\u00edn Pa\u0159\u00edzek, CSc., vedouc\u00ed l\u00e9ka\u0159 perinatologick\u00e9ho centra. <\/p>\n
\u201eTo znamen\u00e1, i d\u011bti s porodn\u00ed hmotnost\u00ed men\u0161\u00ed ne\u017e 500 g, ale ve st\u00e1\u0159\u00ed 22+0 t\u00fddn\u016f jsou na\u0161imi pacienty. Od roku 2010 jsme tyto d\u011bti evidovali. Obdob\u00ed mezi 22. \u2013 24. t\u00fddnem t\u011bhotenstv\u00ed se naz\u00fdv\u00e1 \u201e\u0161edou z\u00f3nou\u201c. Postup u t\u00e9to st\u00e1le prognosticky nejist\u00e9 skupiny pacient\u016f je individu\u00e1ln\u00ed a respektuje p\u0159\u00e1n\u00ed rodi\u010d\u016f. P\u0159i z\u00edsk\u00e1n\u00ed jejich souhlasu v\u011bnujeme novorozenc\u016fm plnou prenat\u00e1ln\u00ed a postnat\u00e1ln\u00ed p\u00e9\u010di jako u vy\u0161\u0161\u00edch gesta\u010dn\u00edch t\u00fddn\u016f, tedy pod\u00e1n\u00ed steroid\u016f matk\u00e1m k indukci dozr\u00e1v\u00e1n\u00ed plic plod\u016f, porod c\u00edsa\u0159sk\u00fdm \u0159ezem v p\u0159\u00edpad\u011b ohro\u017een\u00ed plodu, resuscitaci na s\u00e1le s n\u00e1slednou p\u00e9\u010d\u00ed na JIRP,\u201c vysv\u011btluje prof. Plavka. <\/p>\n
D\u016fle\u017eit\u00e9 minuty pro \u017eivot <\/p>\n
Prvn\u00ed minuty a hodiny bezprost\u0159edn\u011b po narozen\u00ed jsou pro dal\u0161\u00ed v\u00fdvoj nezral\u00fdch novorozenc\u016f velice d\u016fle\u017eit\u00e9. Stabilizuj\u00ed se na speci\u00e1ln\u00edm resuscita\u010dn\u00edm l\u016f\u017eku s vy\u0161\u0161\u00edm v\u00fdh\u0159evn\u00fdm potenci\u00e1lem, kompletn\u00ed monitorovac\u00ed panel a ventila\u010dn\u00ed p\u0159\u00edstroj usnad\u0148uj\u00ed provzdu\u0161n\u011bn\u00ed plic po porodu. <\/p>\n
JIRP: Hlavn\u00ed c\u00edl je d\u00fdch\u00e1n\u00ed a v\u00fd\u017eiva <\/p>\n
Snahou je udr\u017eet nezral\u00e9 novorozence na neinvazivn\u00ed podpo\u0159e d\u00fdch\u00e1n\u00ed. Z\u00e1rove\u0148 se okam\u017eit\u011b zahajuje stimulace za\u017e\u00edvac\u00edho traktu mate\u0159sk\u00fdm ml\u00e9kem. U extr\u00e9mn\u011b nezral\u00e9ho novorozence prob\u00edh\u00e1 postnat\u00e1ln\u00ed zr\u00e1n\u00ed a dozr\u00e1v\u00e1n\u00ed jeho org\u00e1nov\u00fdch funkc\u00ed v jin\u00e9m biologick\u00e9m \u201e\u010dasoprostoru\u201c ne\u017e u plodu, jen\u017e se vyv\u00edj\u00ed v d\u011bloze matky. Snahou neonatolog\u016f je, aby ne\u017e\u00e1douc\u00ed vlivy, kter\u00fdm se zat\u00edm nelze \u00fapln\u011b vyhnout, alespo\u0148 minimalizovaly. Hledaj\u00ed se fyziologi\u010dt\u011bj\u0161\u00ed metody l\u00e9\u010dby, je\u017e sni\u017euj\u00ed infekce, krv\u00e1cen\u00ed do postrann\u00edch komor mozku, v\u00fdvoj retinopatie nedono\u0161en\u00fdch. K tomu slou\u017e\u00ed krom\u011b nejlep\u0161\u00edch postup\u016f, je\u017e zlep\u0161uj\u00ed dlouhodobou progn\u00f3zu nezral\u00fdch novorozenc\u016f (nap\u0159\u00edklad pozdn\u00ed podvaz pupe\u010dn\u00edku, \u0159\u00edzen\u00e1 a c\u00edlen\u00e1 terapie kysl\u00edkem, neinvazivn\u00ed zp\u016fsoby podpory d\u00fdch\u00e1n\u00ed, \u010dasn\u00e1 v\u00fd\u017eiva mate\u0159sk\u00fdm ml\u00e9kem) i za\u010dlen\u011bn\u00ed maminek do o\u0161et\u0159ovatelsk\u00e9ho procesu. A to bezprost\u0159edn\u011b po porodu, od prvn\u00edch hodin tak, aby byla matka s d\u00edt\u011btem ve vz\u00e1jemn\u00e9m kontaktu. Jakmile nezral\u00fd novorozenec nepot\u0159ebuje intenzivn\u00ed p\u00e9\u010di, je p\u0159elo\u017een na odd\u011blen\u00ed intermedi\u00e1rn\u00ed p\u00e9\u010de (IMP) a tady u\u017e prob\u00edh\u00e1 n\u00e1sledn\u00e1 fyzioterapie a postupn\u00e9 pln\u00e9 zapojen\u00ed rodi\u010d\u016f. P\u00e9\u010de je zam\u011b\u0159ena na r\u016fst a v\u00fd\u017eivu, dozr\u00e1v\u00e1n\u00ed plic, neurologick\u00fd v\u00fdvoj. \u201eNa\u0161e p\u00e9\u010de o p\u0159ed\u010dasn\u011b narozen\u00e9ho novorozence se sna\u017e\u00ed co nejv\u00edc napodobit neru\u0161en\u00fd nitrod\u011blo\u017en\u00ed \u017eivot v t\u011ble matky a z\u00e1rove\u0148 poskytnout dostatek podn\u011bt\u016f ke spr\u00e1vn\u00e9mu fyzick\u00e9mu i psychick\u00e9mu v\u00fdvoji d\u00edt\u011bte,\u201c vysv\u011btluje prof. Plavka. O tom, \u017ee se to da\u0159\u00ed, sv\u011bd\u010d\u00ed v\u00fdsledky neonatologick\u00e9 p\u00e9\u010de o nezral\u00e9 novorozence v \u010cR, kter\u00e1 je na \u0161pi\u010dkov\u00e9 sv\u011btov\u00e9 \u00farovni. <\/p>\n
Psychick\u00e1 podpora rodi\u010d\u016f <\/p>\n
\u010casto zcela ne\u010dekan\u00fd p\u0159ed\u010dasn\u00fd porod, bez p\u0159edchoz\u00edch komplikac\u00ed, vede zvl\u00e1\u0161\u0165 u matek k akutn\u00edmu psychick\u00e9mu traumatu, kter\u00fd si mohou ve form\u011b posttraumatick\u00e9 stresov\u00e9 poruchy n\u00e9st \u017eivotem m\u011bs\u00edce a roky. Rodi\u010de p\u0159ed\u010dasn\u011b narozen\u00fdch a zvl\u00e1\u0161\u0165 extr\u00e9mn\u011b nezral\u00fdch novorozenc\u016f pot\u0159ebuj\u00ed speci\u00e1ln\u00ed psychologickou pomoc, dostate\u010dnou informovanost, mo\u017enost co nej\u010dast\u011bji pob\u00fdvat se sv\u00fdm potomkem, pod\u011blit se o sv\u00e9 obavy, \u00fazkost a strach. K tomu p\u0159isp\u00edvaj\u00ed krom\u011b psycholog\u016f, zdravotn\u00edk\u016f i dobrovolnick\u00e9 skupiny, nap\u0159\u00edklad rodi\u010dovsk\u00e1 organizace Nedoklubko. Ve VFN p\u016fsob\u00ed tak\u00e9 Centrum prov\u00e1zen\u00ed, kter\u00e9 velmi aktivn\u011b pom\u00e1h\u00e1 na Neonatologick\u00e9m odd\u011blen\u00ed Gynekologicko-porodnick\u00e9 kliniky. <\/p>\n","protected":false},"excerpt":{"rendered":"
V \u010cR se neust\u00e1le zvy\u0161uje po\u010det p\u0159ed\u010dasn\u00fdch porod\u016f, a to z p\u016fvodn\u00edch 6 procent v roce 2002 na sou\u010dasn\u00fdch 8,3 procenta. To znamen\u00e1, \u017ee v […]<\/a><\/p>\n<\/div>","protected":false},"author":1,"featured_media":0,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[9],"tags":[],"class_list":["post-30301","post","type-post","status-publish","format-standard","hentry","category-zpravy"],"_links":{"self":[{"href":"https:\/\/www.invarena.cz\/index.php?rest_route=\/wp\/v2\/posts\/30301","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.invarena.cz\/index.php?rest_route=\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/www.invarena.cz\/index.php?rest_route=\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/www.invarena.cz\/index.php?rest_route=\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/www.invarena.cz\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=30301"}],"version-history":[{"count":0,"href":"https:\/\/www.invarena.cz\/index.php?rest_route=\/wp\/v2\/posts\/30301\/revisions"}],"wp:attachment":[{"href":"https:\/\/www.invarena.cz\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=30301"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.invarena.cz\/index.php?rest_route=%2Fwp%2Fv2%2Fcategories&post=30301"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.invarena.cz\/index.php?rest_route=%2Fwp%2Fv2%2Ftags&post=30301"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}