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Zapalenie pępka u noworodka – jak mu zapobiegać?

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Na zapalenie pępka szczególnie narażone są noworodki hospitalizowane, w tym zwłaszcza wcześniaki. Może się ono wiązać z groźnymi dla dziecka powikłaniami. Jakie są objawy zapalenia pępka i jaką pielęgnację należy stosować, aby mu zapobiec?

Jakie są objawy zapalenia pępka?

Zapalenie pępka to zakażenie, które rozwija się w obrębie kikuta pępowiny u noworodków. Wśród jego objawów można wymienić: obrzęk i silne zaczerwienienie u nasady pępka, miejscową tkliwość, krwawienie, obfitą ropną wydzielinę o nieprzyjemnym zapachu. Należy jednak zwrócić uwagę, że nieprzyjemny zapach oraz występująca w niewielkich ilościach śluzowa wydzielina nie świadczą o procesie chorobowym. To zjawisko prawidłowe, świadczące o lizie tkanek.

Wraz z rozprzestrzenianiem się infekcji wzdłuż ścian jamy brzusznej zaczynają występować kolejne objawy: wybroczyny, pęcherze. W przypadku kiedy w wyniku zapalenia pępka dojdzie do uogólnionego zakażenia, występuje wysoka gorączka, tachykardia, spadek ciśnienia tętniczego, zaburzenia oddechu, senność i zanik odruchów wrodzonych. Upośledzeniu ulega również perystaltyka. Jeżeli zakażenie obejmie wątrobę, może dojść do rozwoju żółtaczki.

Jakie mogą być powikłania zapalenia pępka?

Zapalenie pępka może się wiązać z poważnymi powikłaniami. Należą do nich:

  • posocznica,
  • martwicze zapalenie powięzi,
  • martwica mięśni,
  • rozlane zapalenie otrzewnej,
  • ropień,
  • uszkodzenia wątroby i dróg żółciowych,
  • spontaniczne wytrzewienie.

Powikłania te mogą stanowić bezpośrednie zagrożenie życia noworodka.

Jak zapobiegać zapaleniu pępka?

Kluczową rolę w profilaktyce zapalenia pępka odgrywa odpowiednia pielęgnacja kikuta pępowiny u noworodków. Według zaleceń Światowej Organizacji Zdrowia w warunkach szpitalnych zaleca się stosowanie środków dezynfekujących na bazie oktenidyny, która jest dobrze tolerowana przez skórę noworodków, nie powoduje alergii i wykazuje skuteczność wobec szerokiego spektrum drobnoustrojów. Antyseptyki powinny być nakładane raz na dobę na całą powierzchnię kikuta, ze szczególnym uwzględnieniem nasady.

Zdecydowanie nie zaleca się natomiast stosowania alkoholu etylowego, który w wyniku przeniknięcia przez skórę może mieć działanie neurotoksyczne i podrażniające, a dodatkowo może wpłynąć na wydłużenie czasu odpadnięcia kikuta pępowiny, co zwiększa ryzyko zapalenia pępka.

W warunkach domowych zalecane jest natomiast stosowanie tzw. suchej pielęgnacji kikuta. Polega ona na myciu kikuta za pomocą wody z mydłem w przypadku zabrudzenia go moczem lub kałem. Następnie kikut powinien zostać osuszony i pozostawiony bez przykrycia pieluszką, aby zachować swobodny dostęp powietrza. Do czasu, kiedy kikut odpadnie, dziecko powinno być kąpane w niewielkiej ilości wody, by kikut nie ulegał długotrwałemu moczeniu.

Źródła:

  1. E. Kamińska, „Pielęgnacja pępka noworodka – nowe zalecenia”, „Biblioteka Faktów” 2010, 1, s. 2-4.
  2. https://www.mp.pl/

Przeczytaj także: Jak pandemia koronawirusa wpłynęła na opiekę nad pacjentami z cukrzycą?

Przeczytaj bezpłatnie pokrewny artykuł w czasopiśmie „Pielęgniarstwo w Anestezjologii i Intensywnej Opiece”:

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