janmrTeli drouli

axalSobilis movla
samSobiaro saxlSi

klinikuri praqtikis erovnuli rekomendacia

(gaidlaini)

1
klinikuri praqtikis erovnuli rekomendacia (gaidlaini)
`janmrTeli drouli axalSobilis movla samSobiaro saxlSi~
miRebulia klinikuri praqtikis erovnuli rekomendaciebis
(gaidlainebi) da daavadebaTa marTvis saxelmwifo
standartebis (protokolebi) SemuSavebis, Sefasebis da
danergvis erovnuli sabWos 2008 wlis 5 noembris #1 sxdomaze
da damtkicebulia saqarTvelos Sromis, janmrTelobisa da
socialuri dacvis ministris 2009 wlis 14 aprilis # 146/o
brZanebiT.

2
janmrTeli drouli axalSobilis movla
samSobiaro saxlSi

definicia 1,2
axalSobilis movlis procedurebis erToblioba, romelic bavSvis
dabadebidan xorcieldeba rutinulad, gansazRvruli TanmimdevrobiT.
axalSobilis adekvaturi movlis principebis dacva mSobiarobis pirveli
wuTebidanve minimumamde amcirebs axalSobilTa avdobisa da mokvdaobis
risks.
axalSobilis movlis ZiriTadi miznebi:
⇒ axalSobilis normaluri adaptaciis xelSewyoba;
⇒ janmrTelobis mdgomareobis xelSewyoba da daavadebaTa
prevencia;
⇒ mSoblebTan urTierTobis daregulireba.

gaidlaini gankuTvnilia
• samedicino personalisTvis, romelic muSaobs axalSobilebTan
samSobiaro saxlSi (ganyofilebaSi) – neonatologi, mean-ginekologi,
ojaxis eqimi, pediatri, bebia-qali, axalSobilis eqTani.

gaidlainis samizne jgufi:

• drouli janmrTeli axalSobili adreul neonatalur periodSi.

samSobiaro saxlSi axalSobilis movlis aucilebeli pirobebi da

standartuli procedurebi

garemo 3-5,86,87

axalSobilis pirveladi movlis procedurebis warmatebiT

ganxorcielebisaTvis aucielebelia Sesabamisi garemo pirobebis
uzrunvelyofa:
• siTbo da kargi ganaTeba - samSobiaro blokSi temperatura ar unda
iyos 250 C-ze naklebi, ar unda iyos orpiri haeris nakadi,
kondicioneri;
• samSobiaro bloki uzrunvelyofili unda iyos axalSobilis movlisa
da pirveli daxmarebisaTvis saWiro aRWurvilobiTa da medikamentebiT;
• mSobiarobamde 0,5-1 sT adre aucilebelia, sxivuri gamaTboblis
samuSao reJimSi moyvana, romelic uzrunvelyofs Sesabamis
temperaturas im areSi, sadac saWiroebis SemTxvevaSi tardeba
axalSobilis pirveladi reanimaciis (movlis) procedurebi;
• safeni, romelSic xdeba axalSobilis miReba unda iyos Tbili, siTbos
dakagvis prevenciis mizniT;
3
• axalSobilis mdgomareobis Sefaseba da movlis procedurebi
sicocxlis pirvel wuTebSi unda ganxorcieldes dedis sxeulze (kani
kanTan kontaqti) an sxivuri gamaTboblis qveS (reanimaciis
saWiroebis SemTxvevaSi);
• samedicino personals, romelic monawileobs axalSobilis miRebis,
Seafasebisa da movlis procedurebis ganxorcielebaSi unda ecvas
xelTaTmanebi.

axalSobilis movlisTvis aucilebeli aRWurviloba samSobiaro

blokSi 3-5
• axalSobilis magida sxivuri gamaTbobliT;
• Tbili safenebi;
• Tbili qudi, windebi da dasafarebeli;
• kedlis saaTi wamzomiT;
• oTaxis haeris Termometri;
• aRWurviloba zeda sasunTqi gzebis sanaciisTvis;
• aRWurviloba axalSobilis reanimaciisaTvis (ix. axalSobiliTa
reanimaciis gaidlaini);
• eleqtroTermometri an vercxliswyliani Termometri, romelzec
SesaZlebelia dafiqsirdes 350 C–ze dabali temperetura;
• ZiriTadi preparatebi (medikamentebi reanimaciisaTvis, vitamini K da
Tvalis malamo, antiseptikuri xsnari).

axalSobilis Sefaseba 3,5

yvela axalSobilTan dabadebisTanave, Wiplaris gadaWramde,

aucilebelia reanimaciis saWiroebis Sefaseba.
axalSobilTa reanimaciis saWiroeba ganisazRvreba mSobiarobisTanave 4
ZiriTad SekiTxvaze pasuxiT:
• axalSobili droulia?
• sanayofe siTxe sufTaa?
• sunTqavs an tiris?
• kunTTa tonusi kargia?
oTxive kiTxvaze dadebiT pasuxis SemTxvevaSi axalSobili ar saWiroebs
reanimacias da tardeba standartuli movlis procedura. 4 kiTxvidan,
Tundac erT kiTxvaze uaryofiTi pasuxi reanimaciis saWiroebaze
miuTiTebs. (ix. gaidlaini - axalSobilTa reanimacia samSobiaro blokSi).

movlis procedurebi samSobiaro blokSi

⇒ sasunTqi gzebis gamavlobis uzrunvelyofa;
⇒ siTbos dakargvis prevencia;
⇒ Wiplaris gadaWra;
⇒ apgaris SkaliT Sefaseba;
⇒ kani-kanTan kontaqti da I moWideba;

4
 ⇒ koniuqtivitis profilaqtika;
⇒ hemoragiuli daavadebis profilaqtika;
⇒ anTropometria.
samSobiaro blokSi sasuTqi gzebis gamavlobis uzrunvelyofisa da
siTbos dakargvis prevenciis TiToeuli safexuri erTmaneTis
monacvleobiT tardeba (ix. protokoli).

sasunTqi gzebis gamavlobis uzrunvelyofa 4,5

sasunTqi gzebis gamavlobis uzrunvelyofa damokidebulia sekretis

raodenobaze. sasunTqi gzebis sanaciis rutinulad Catareba yvela
SemTxvevaSi ar aris aucilebeli.
• Tu sekretis raodenoba umniSvneloa, umjobesia, bavSvis gverdiT
poziciaSi moTavseba ramdenime wuTiT, sekreti grovdeba loyis
midamoSi da Tavisuflad gadmoedineba piris Rrudan, aseT SemTxvevaSi
ar aris aucilebeli sanaciis Catareba;
• Tu bavSvi dabadebisTanave Tavsdeba dedis gulmkerdze, bunebrivad
xdeba lorwos drenireba (sekreti TviTon gadmoedineba);
• Warbi sekretis SemTxvevaSi SesaZlebelia saWiro gaxdes zerele
sanacia:
⇒ zerele sanaciis dros bavSvis Tavi gverdiT unda iyos gadaweuli.
sanacia tardeba Semdegi TanmimdevrobiT: jer piri, Semdeg cxviri.
⇒ sanacia tardeba steriluri rezinis baloniT an meqanikuri
aspiratoris 8-10 Fr kaTeteriT. uaryofiTi wneva ar unda
aRematebodes 100 mm vwy.sv; im SemTxvevaSi, rodesac sanayofe siTxe
sufTaa upiratesoba eniWeba sanaciisaTvis steriluri rezinis
balonis gamoyenebas. Tu gamoiyeneba kaTeteri sanaciis dro ar
unda iyos 5 wm-ze meti.
ar aris rekomendebuli Rrma sanaciis Catareba. Rrma sanacia iwvevs xaxis
ukana kedlis gaRizianebas, cTomili nervis aRgznebas, rasac SeiZleba
mohyves bradikardiisa da apnoes ganviTareba5.

siTbos dakargvis prevencia 3-9,86-87

janmrTelobis msoflio organizaciis rekomendaciiT hipoTermiis riskis

Semcirebis mizniT, yvela axalSobilTan aucilebelia “Tbili jaWvis” 10
safexuris dacva:
1. Tbili samSobiaro bloki (25-28°C), bavSvis magida da sawoli unda
iyos fanjaras mocilebuli;
2. swrafi gamSraleba da sveli safenis moSoreba; Tavze
mizanSewonilia qudis daxurva, radgan swored Tavidan xdeba
yvelaze meti raodenobiT siTbos dakargva;
3. kani-kanTan kontaqti - SiSveli janmrTeli axalSobilis dedis
sxeulze moTavseba (zemodan sabnis dafareba), siTbos
dakargvis prevenciis idealuri meTodia (rekomendacia A)9; A
5
 4. ZuZuTi kveba – adreuli dawyeba da moTxovnilebiTi kveba
uzrunvelyofs bavSvs saTanado kaloriebiT, raTa man moaxerxos
siTbos warmoqmna;
5. abazanis gadavadeba – bavSvis dabana dabadebisTanave iwvevs misi
sxeulis temperaturis mkveTr daqveiTebas, amitom saWiroa
abazanisgan Tavis Sekaveba, sanam ar moxdeba axalSobilis sxeulis
temperaturis stabilizacia (minimum 6 saaTi, an
temperaturis stabilizaciidan 2-4 saaTi) (mtkicebulebis I
done I)9. awonvis gadavadeba – bavSvis awonva mizanSewonilia
dabadebidan 2 sT-Si, sasworze unda moTavsdes winaswar SemTbari
safeni;
6. saTanado tansacmlisa da sabnis SerCeva;
7. dedis da bavSvis erTad yofna;
8. Tbili transporti – Tu bavSvs sWirdeba transportireba,
aucilebelia am dros siTbos uzrunvelyofa;
9. siTbo reanimaciis dros - bavSvis miReba winaswar SemTbar safenSi,
misi moTavseba 0,5-1 saaTiT adre CarTuli sxivuri gamaTboblis
qveS, gamSraleba da sveli safenis moSoreba, Tavze qudis daxureba,
reanimaciisaTvis Tbili teniani Jangbadis gamoyeneba;
10. medpersonalis ganaTleba.

Wiplaris damuSaveba12-20,87
janmos mier rekomendebulia janmrTel axalSobilebTan Wiplaris
gadaWra sicocxlis pirvel wuTze apgaris SkaliT Sefasebamde4, 14.
Wiplaris gadaWra pirvel wuTze xels uwyobs placentidan damatebiTi
sisxlis gadasvlas axalSobilis organizmSi da icavs mas sicocxlis
pirvel wels rkinadeficituri anemiis ganviTarebisagan3.4. Tu
axalSobils esaWiroeba pirveladi reanimacia Wiplari iWreba pirvel 10
wm-Si5. Wiplaris erT wuTze ufro gvian gadaWris SemTxvevaSi maRalia
hipervolemiisa ganviTarebis riski, rac Tavis mxriv iwvevs sasunTqi da
gul-sisxlZarRvTa sistemis funqcionirebis darRvevas.
• Wiplars gadaWramde edeba 2 qirurgiuli momWeri. pirveli - Wipis
rgolidan 2 TiTis (3-4sm) zemoT unda moTavsdes, xolo meore –
Wipis rgolidan 4 TiTis daSorebiT4;
• Wiplars exveva marlis safeni, rom gadaWrisas ar moxdes sisxliT
dasvra;
• ukanaskneli monacemebiT rekomendebulia plastmasis momWeris
gamoyeneba. misi ararsebobis SemTxvevaSi SesaZlebelia elastiuri
ligaturas gamoyeneba;
• Wiplaris gadakvanZisaTvis ar SeiZleba araelastiuri masalis
gamoyeneba, vinadan daaxloebiT 1 sT-is Semdeg Wiplaris qsovili
mcirdeba moculobaSi, ligatura eSveba da maRalia sisxldenis
ganviTarebis da inficirebis riski;
• gadaWra xdeba steriluri lancetiT an makrateliT;

6
 • janmrTelobis msoflio organizaciis rekomendaciiT
mizanSewonilia Wiplaris mSrali movla, sapniTa da wyliT
gasufTaveba saWiroa mxolod misi SardiT da ganavliT
dabinZurebisas (mtkicebulebis done I)4,14. Tumca im qveynebSi
sadac maRalia Wiplaris baqteriuli kontaminaciis riski
dasaSvebia misi damuSaveba antiseptiuri xsnariT. am mizniT
gamoiyeneba qlorheqsidini an povidon-iodinis xsnari 12-20.
• ar aris rekomendebuli Wiplaris takvze naxvevis dadeba,
axalSobilis inficirebis riskis Semcirebisa da Wiplaris takvis
swrafi mumifikaciis xelSewyobis mizniT4,14. Wiplaris takvi ar
unda moxvdes bavSvis erTjeradi safenis qveS4,14. Tavisuflad unda
moTavsdes tansacmlis qveS.

Sefaseba apgaris SkaliT4,5

apgaris Skala mravali welia gamoiyeneba axalSobilis adaptaciis
Sesafaseblad sicocxlis pirvel wuTebSi. apgaris SkaliT Sefaseba
tardeba sicocxlis pirvel da mexuTe wuTze. normis SemTxvevaSi apgariT
Sefaseba unda iyo 7-10 qula. I wuTze apgaris qula gviCvenebs
axalSobilis sawyis statuss. xolo Semdegi Sefasebis qulebi
miuTiTeben Tu ramdenad adeqvaturad pasuxobs axalSobili samedicino
personalis mier Catarebul qmedebebs da SesaZlebelia gamoyenebuli
iyos nevrologiuri gamosavlis Sesafaseblad.
apgaris Skala ar gamoiyeneba reanimaciis saWiroebis Sesaxeb
gadawyvetilebis misaRebad. Tumca im SemTxvevaSi, Tu tardeba
axlSobilis pirveladi reanimacia apgariT Sefaseba iwyeba 1 wuTze da
meordeba yovel 5 wuTSi erTxel 20 wT-is ganmavlobaSi.

apgaris Skala

vitaluri qulebi
funqciebi
0 1 2
sunTqva ar aris araregularuli, regularuli
iSviaTi

guliscemis ar aris < 100 >100

sixSire
kunTTa tonusi hipotonia kidurebis susti aqtiuri
fleqsia (moxra) moZraoba
kanis feri sifermkrTale/ akrocianozi vardisferi
cianozi
reaqcia cxvirSi reaqcia ar aris saxis grimasi Zlieri tirili,
kaTeteris xvela, cemineba
Seyvanaze

7
kani kanTan kontaqti da ZuZuTi kvebis adreuli dawyeba (ix. ZuZuTi kvebis
gaidlaini)
kani-kanTan kontaqti gulisxmobs SiSveli axalSobilis (axalSobils
Tavze unda exuros qudi da ecvas windebi) moTavsebas dedis
gulmkerdze, aucilebelia dedas da bavSvs efaros sabani. janmrTeli,
drouli axalSobilis kani-kanTan kontaqti dedasTan unda
ganxorcieldes fiziologiuri mSobiarobisTanave da gagrZeldes
aranakleb 30 wuTisa, janmos rekomendaciiT sasurvelia janmrTeli
axalSobili dedis sxeulze iwves 2 sT-is ganmavlobaSi4,21,86-87.
kani-kanTan kontaqtis dros ar aris mizanSewonili deda-Svilis
uyuradRebod datoveba. SesaZlebelia Tavdgmuri ojaxis wevri iyos.
sakeisro kveTis Semdeg SesaZlebelia ganxorcieldes axalSobilis
kani-kanTan kontaqti mamasTan.
• kani-kanTan kontaqtis procesSi aucilebelia axalSobilis
ZuZuze pirveli moWidebis xelSewyoba, roca bavSvs D
gamouvlindeba ZuZuTi kvebis Sesabamisi mzaobis niSnebi
(rekomendacia - D) 22;
• ZuZuTi kveba unda daiwyos fiziologiuri mSobiarobidan 1 saaTis
ganmavlobaSi. ar aris rekomendebuli bavSvis iZulebiT an
daCqarebuli wesiT ZuZuze moWidebis ganxorcieleba;
• zogadi narkoziT sakeisro kveTis SemTxvevaSi ZuZuTi kveba unda
ganxorcieldes dedisa da bavSvis sruli gamofxizlebis Semdeg
(daaxloebiT 2-3 saaTSi).

kani kanTan kontaqti da ZuZuTi kvebis adreuli dawyeba xels uwyobs: 4,21:
• efeqturi woviTi refleqsebis Camoyalibebas (mtkicebulebis II
done II) 23,24
• axalSobilis sxeulis normaluri temperaturis SenarCunebas I
(mtkicebulebis done I) 25-27

• dedisa da axalSobilis mSobiarobis stresis moxsnas;

• bavSvis kanze dedis mikrobuli floris kolonizacias;
• laqtaciis procesis stimulirebas (mtkicebulebis done II) II
28-32

• oqsitocinis gamomuSavebas, saSvilosnos SekumSvas da qalis

dacvas mSobiarobis Semdgomi sisxldenisagan (mtkicebulebis II
done II) 33
• dedasa da bavSvs Soris mWidro fsiqoemociuri kavSiris
II
damyarebas (mtkicebulebis done II) 33,34
• xsenis miRebas pirveli erTi saaTis ganmavlobaSi da
B
axalSobilis infeqciebisgan dacvas (rekomendacia B) 31,34-37

8
axalSobilis monitoringi samSobiaro blokSi4,14,38
sicocxlis pirveli 2 sT-is ganmavlobaSi yvela axalSobili, maT Soris
janmrTelic aucileblad saWiroebs periodul meTavlyureobas. 15-30 wT-
Si erTxel unda Sefasdes, vitaluri niSnebi:
• sunTqvis sixSire
• guliscemis sixSire
• kanis feri
sxeulis temperatura unda gaizomos dabadebidan 30 wT-Si da 2 sT-Si. Tu
pirveli gasinjvis Semdeg fiqsirdeba dabali temparatura saWiroa
bavSvis gaTboba da temperaturis SedarebiT xSiri kontroli (ix.
hipoTermiis marTvis gaidlaini).

koniunqtivitis profilaqtika4,38,39,87
axalSobilTa ofTalmiis (gonokokuri da qlamidiuri koniunqtiviti)
profilaqtikis mizniT mSobiarobidan erTi saaTis ganmavlobaSi
erTjeradad gamoiyeneba tetraciklinis 1% an eriTromicinis 0,5%
malamo. malamos 0,5 sm unda moTavsdes Tvalis qveda quTuTos
koniunqtivis garsze, quTuToze TiTebis nazi moZraobiT malamo
nawildeba koniunqtivaze. 1 wuTis Semdeg malamos narCeni SeiZleba
moiwmindos steriluri tamponiT.
Tvalis damuSavebamde unda ganxorcieldes kani-kanTan kontaqti, raTa
axalSobils mieces SesaZlebloba dainaxos da aRiqvas deda.

hemoragiuli daavadebis profilaqtika 3,4,41-53,87

• axalSobilTa hemoragiuli daavadebis prevenciis mizniT

rekomendebulia K vitaminis gamoyeneba. K vitamini maRali
efeqturobiT xasiaTdeba da sarwmunod icavs axalSobils
hemoragiuli daavadebisagan;
• K vitaminis gamoyeneba mizanSewonilia dabadebidan 1-2 sT-is
ganmavlobaSi.
SesaZlebelia K vitaminis oraluri formis gamoyeneba, romlis micema
iwyeba samSobiaro saxlSi da aucileblad unda gagrZeldes binaze,
dozireba da sqema insazRvreba mwarmoeblis instruqciis mixedviT.
saqarTveloSi registrirebulia K1 vitaminis oraluri forma - "ka-vit"
(fitomenadioni), romelic janmrTel droul axalSobilSi gamoiyeneba
dozirebis reJimiT:
I doza - sicocxlis I dRes - "ka-vit"-is 2mg (anu 2 wveTi)
II doza – sicocxlis III dRes – 2 mg (anu 2 wveTi)
III doza _ sicocxlis me-4 kviridan me-6 kviramde periodSi - 2 mg (anu 2
wveTi).

9
ukanaskneli wlebis monacemebiT upiratesoba eniWeba vitaminis Seyvanis
parenterul gzas41-53, radgan is icavs axalSobils rogorc adreuli
aseve gviani hemoragiuli daavadebis ganviTarebisgan, gansxvavebiT
oraluri formisgan romlis gamoyenebisas maRalia gviani hemoragiuli
daavadebis ganviTarebis riski.
amerikis pediatriis akademia upiratesobas aniWebs K1 vitaminis
parenterul gamoyenebas (doza – 0,5-1,0mg), vinaidan igi uSualod miitaneba
da deponirdeba RviZlSi. saqarTveloSi aRniSnuli medikameti ar aris
registrirebuli, gamoiyeneba vikasoli (vitamini K3) 2 mg. misi Seyvanis
adgilia barZayis kunTis wina lateraluri mxare. ar aris rekomendebuli
K vitaminis dunduloSi gakeTeba, rac zrdis nervis an sisxlZarRvis
dazianebis risks. amasTan aRsaniSnavia, rom vikasolis maRalma dozebma
SeiZleba gamoiwvios hemolizi42,49,50.

axalSobilis markireba
axalSobilis markireba tardeba samSobiaro blokSi movlis
procedurebis msvlelobisas. dabadebisas samajurze iwereba ded-mamis
gvari, istoriis nomeri, dabadebis dro, sqesi. tyupebis SemTxvevaSi
samajurze unda daeweros I tyupi, II tyupi da a.S. anTropometriis Semdeg
samajurze damatebiT fiqsirdeba Sesabamisi maCveneblebi.

anTropometria
dabadebidan 2 saaTSi aucilebelia axalSobilis anTropometruli
monacemebis Sefaseba:
• sxeulis masa
• sxeulis sigrZe
• Tavis garSemoweriloba
(ix. protokoli - anTropometriis teqnika)4,54-56.
axalSobilis sxeulis masis Sefaseba unda moxdes gestaciur asakTan
mimarTebaSi, es gansakuTrebiT mniSvnelovania 2500 gramze naklebi wonis
axalSobilebisaTvis (ix. protokoli - axalSobilis fizikuri
4
ganviTarebis Sefaseba) .

axalSobilis Cacma4,57
axalSobili unda iyos Cacmuli, rom man Tavi komfortulad igrZnos.
tansacmeli unda iyos Tavisufali, naturaluri bambis qsovilis. Tavze
unda exuros Txeli qudi. ar aris mizanSewonili axalSobilis mWidrod
Sexveva, radgan:
• izRudeba diafragmis moZraoba;
• qveiTdeba sisxlis cirkulacia;
• izRudeba axalSobilis Tavisufali moZraoba;
• safensa da kans Soris arsebuli haeris Txeli fena ver
uzrunvelyofs siTbos SenarCunebas.

10
axalSobilis pirveli sruli gasinjva 4,38,39,87

axalSobilis sruli gasinjva mizanSewonilia Catardes sicocxlis 2 sT-

is Semdeg, kargad ganaTebul, Tbil oTaxSi. pirvel rigSi fasdeba
axalSobilobis periodis zogadi saSiSroebis niSnebi:
⇒ gulyra;
⇒ taqipnoe > 60-ze;
⇒ bradipnoe < 30-ze;
⇒ siyviTle ganviTarebuli pirvel dRes an siyviTle nebismier
dRes, romelic vrceldeba terfsa da mtevanze;
⇒ leTargia;
⇒ cxviris nestoebis vibracia;
⇒ gulmkerdis mkveTri retraqcia;
⇒ sxeulis temperaturis momateba 380C da meti;
⇒ sxeulis temperatura < 350C–ze;
⇒ kanis feris cvlilebebi: silurje an siyviTle, gamoxatuli
sifermkrTale;
⇒ sisxldena Wiplaris Wrilobidan.
saSiSroebis nebismieri niSnis arseboba miuTiTebs sxvadasxva
paTologiuri mdgomareobis arsebobaze, rac saWiroebs damatebiT
gamokvlevas da saWiroebisas referalis ganxorcielebas.
gasinjvisas unda Sefasdes ante da intranataluri anamnezi,
axalSobilis gestaciuri asaki da simwife, vitaluri funqciebi,
inspeqciis, palpaciis, perkusiis da auskultaciis gamoyenebiT yvela
organo da sisitema. axalSobili unda daTvalierdes mTlianad,
yuradReba unda mieqces disembriogenezuli stigmebis da anomaliebis
arsebobas. gasinjvis monacemebi unda dafiqsirdes axalSobilis
istoriaSi, anTropometruli monacemebi masa, sigrZe Tavis
garSemoweriloba gadatanili unda iyos Sesabamis diagramaze.

yoveldRiuri movlis procedurebi samSobiaro saxlis postnatalur

palataSi:
⇒ saxis, Tvalis, yuris, cxviris da kanis tualeti;
⇒ Wiplaris takvis damuSaveba;
⇒ awonva;
⇒ dabana, Cabanva;
⇒ imunizacia;
⇒ skriningi.

axalSobili vitaluri funqciebis Sefaseba da gasinjva postnatalur

palataSi4,38,39,87
TiToeul axalSobils yoveldRiurad utardeba sasicocxlo funqciebis
martivi monitoringi. fasdeba guliscemisa (norma 120-160) da sunTqvis
sixSire (norma 40-60), temperatura (36,50-37,50C), kanis feri. yoveldRiurad
tardeba gasinjva da fasdeba axalSobilobis zogdi saSiSroebis niSnebi
(garda im niSnebisa rac fasdeba I gasinjvis dros damatebiT unda

11
Sefasdes, xom ar aris gamoxatuli Semdegi niSnebi - sisxli ganavalSi,
Seupovari Rebineba, Wipis rgolis garSemo siwiTle da SeSupeba, romelic
vrceldeba 1 sm da met diametrze, Cirqi, usiamovno suni, ver iRebs
sakvebs).
gaweris win aucilebelia axalSobilis sruli gasinjva.
mniSvnelovania samSobiaroSi axalSobilis diurezisa da defekaciis
kontroli.

axalSobilis diurezi38
• dabadebidan pirveli sami dRis ganmavlobaSi Sardvis sixSire 6-ze
naklebia fiziologiuri anuriis gamo;
• axalSobilis Sardvis sixSire 3-4 dRis Semdeg unda iyos minimum 6-
jeradi 24 saaTSi;
• Tu Sardvis sixSire 6-jerze naklebia, savaraudoa araefeqturi
ZuZuTi kveba (ix ZuZuTi kvebis gaidlaini);
• Tu 24 saaTis ganmavlobaSi ar gamoiyo Sardi saWiroa:
⇒ muclisa da genitaliebis ganmeorebiT gasinjva;
⇒ kvebis efeqturobis Sefaseba;
⇒ Sardis buStis kaTeterizacia da Sardis analizis Catareba;
⇒ specialistis konsultacia da referali hospitalSi.

axalSobilis defekacia38
• mekoniumis gamoyofa unda daiwyos 24 sT-s ganmavlobaSi. dabadebidan
ramdenime dRe axalSobili gamoyofs mekoniums, romelsac muqi mwvane
feri da webovani konsistencia aqvs. me-4-5 dRisTvis ganavlis mwvane
Seferiloba icvleba moyviTalo SeferilobiT. nawlavTa moqmedeba
ZuZuTi kvebaze myof zogierT axalSobils aqvs yvela kvebis Semdeg,
zogierTs ki dReSi erTxel an ramdenjerme.
• Tu ganavlis gamoyofa ar xdeba saWiroa:
⇒ muclisa da genitaliebis ganmeorebiT gasinjva;
⇒ kvebis efeqturobis Sefaseba;
⇒ Tu 48 sT-is Semdeg kvlav ar gamoiyofa ganavali, saWiroa
damatebiTi kvlevis Catareba;
⇒ specialistis konsultacia da referali hospitalSi.

saxis, Tvalis, yuris, cxviris da kanis tualeti postnatalur

palataSi 38,39,56,58-68
axalSobilis yoveldRiuri tualeti tardeba diliT kvebis win:
• saxis dabana da Tvalebis tualeti - TiToeuli Tvalis dasa-
muSaveblad gamoiyeneba sterilur wyalSi dasvelebuli tamponi;

12
• yuris gawmenda bambis fTiliT - dauSvebelia am mizniT bambadaxveuli
Cxiris gamoyeneba;
• cxviris gasufTaveba bambis tamponis brunviTi moZraobiT, qerqebis
arsebobisas tamponi dasvelebuli unda iyos vazelinis zeTSi. Tu
axalSobils aReniSneba cxviris gaWedva da Zneldeba sunTqva,
mizanSewonilia Tbili fiziologiuri xsnaris an natriumis
bikarbonatis 2%-iani xsnaris gamoyeneba (2 wveTi);
• safenebiT gamowveuli dermatitis prevenciis mizniT saWiroa I,II
(mtkicebulebis done I-II) 10,65-68:
⇒ safenebis xSiri gamocvla;
⇒ bavSvis Cabana yvela defekaciis Semdeg. Cabanva saWiroa
yoveli safenis gamocvlis Semdeg. gogona Caibaneba I,II
winidan-ukana mimarTulebiT. Cabanvis Semdeg aucilebelia
kanis saguldagulod gamSraleba (mtkicebulebis done I, II-2)
58-62
. Tu ar aris Cabanis saSualeba SesaZlebelia kanis
gawmenda specialuri sveli xelsaxociT.
⇒ bavSvis pudris rutinuli gamoyeneba kanis
dasamuSaveblad ar aris rekomendebuli mtkicebulebis I,III
(

done I – III) 63-64.

⇒ safenebis dermatitis dros saWiroa mizezis dadgena,
III
kanis dacva TuTiis oqsidis Semcveli malamoTi
(mtkicebulebis done III)10.
⇒ Tu safenebis dermatiti ganpirobebulia Candida albicans-
iT, saWiroa antifungaluri malamos gamoyeneba, III
efeqturia haeris da sinaTlis zemoqmedebac (mtkicebulebis
done III)10.
⇒ safenebis dermatitis dros antibiotikis Semcveli malamos
rutinuli gamoyeneba ar aris rekomendebuli.

Wiplaris damuSaveba postnatalur palataSi 12-20

metad mniSvnelovania:
• Wipis aris sisufTavis da simSralis uzrunvelyofa, Tu Wipi
dabinZurda SardiT da ganavliT, SesaZlebelia misi gasufTaveba
I,II
steriluri wyliT an sapniani wyliT. (mtkicebulebis done I,II,)10
• janmos rekomendaciiT saWiroa Wiplaris mSrali movla, Wiplaris
takvi ar unda moxvdes bavSvis erTjeradi safenis qveS4,14. ganviTarebad
qveynebSi sadac maRalia omfalitis ganviTarebis riski Wiplaris
dasamuSaveblad SesaZlebelia gamoyenebuli iyos antispetikuri
xsnarebi (qlorheqsidini da povidon iodini) (mtkicebulebis II
done II)54,65.
• ar aris rekomendebuli Wipis aris Sexveva an masze
plastiris dawebeba66.

13
mizanSewonilia personalis da ojaxis wevrebis informireba Wiplaris
Sexorcebis meqanizmis Sesaxeb da Wipis movlis principebze
(mtkicebulebis done I)10,66:
1. Wipis damuSavebamde xelebis dabana;
2. Wipis sisufTavis da simSralis uzrunvelyofa;
3. Wipis takvis dacva Sardisa da ganavlis nawilakebisgan.
msoflios mraval qveyanaSi bavSvi ewereba binaze Wiplaris takviT.
kvlevebi adastureben, rom aRniSnuli taqtika mkveTrad amcirebs
inficirebis risks4,14. Tumca, aseTi bavSvebis binaze movla pirveladi
jandacvis rgolis specialistebis informirebasa da Sesabamis
momzadebas saWiroebs.

axalSobilis dabana4,14,69-73
• ar aris rekomendebuli axalSobilis dabana dabadebisTanave, es
zrdis hipoTermiis risks4,14
• axalSobilis pirveli dabana unda ganxorcieldes, mxolod mas
Semdeg, rac moxdeba axalSobilis sxeulis temperaturis
stabilizacia, dabadebidan 6-24 saaTis Semdeg (mtkicebulebis I
done I).8,10,72-73 personalis da axalSobilis usafrTxoebis mizniT
axalSobilis pirveli dabana unda ganxorcieldes
xelTaTmanebiT (mtkicebulebis done I) 38 I

• ar aris rekomendebuli sacxis mTlianad mocileba, sacxi icavs

bavSvs infeqciebisgan da siTbos dakargvisagan. (mtkicebulebis III
done III) 10,69-70
• axalSobilis dabanisas ar aris rekomendebuli sapnis rutinuli
gamoyeneba. umjobesia gamoyenebuli iyos neitraluri pH is mqone
dasabani geli 60,65,71
• wylis temperatura unda iyos 37-380C: (mtkicebulebis done I – I,II
II)10
• dabanis Semdeg axalSobili maSinve kargad unda gamSraldes,
Semoexvios 2 safeni, daexuros qudi daaxloebiT 5-10 wT-Si mas
unda Caacvan da Seucvalon qudi (mtkicebulebis done I) 10 I
• dedas unda aswavlon rogor dabanos axalSobili samSobiarodan
gaweris Semdeg da daicvas usafrTxeobis wesebi. mSoblebs unda
miewodos informacia, rom vertikaluri abazana (bavSvi mTeli
sxeuliT Tavsdeba wyalSi, dafarulia mxrebi _ specialuri
I
abazana) aris bavSvis komfortis da higienis dacvis usafrTxo
da efeqturi meTodi (mtkicebulebis done I)10,69

awonva 38,39

samSobiaro saxlSi mizanSewonilia bavSvis yoveldRiuri awonva masis

fiziologiuri klebis kontrolis mizniT (ix. fizikuri ganviTarebis
gaidliani da protokoli).

14
imunizacia4
saqarTvelos Sromis, janmrTelobisa da socialuri dacvis saminsitros
mier damtkicebuli imunizaciis erovnuli kalendris Sesabamisad
samSobiaro saxlSi axalSobils dabadebidan 12 sT-Si utardeba B
hepatitis, sicocxlis me-2-5 dRes ki _ tuberkulozis sawinaaRmdego
vaqcinacia (ix. imunizaciis brZaneba).

B hepatitis sawinaaRmdego vaqcinacia

axalSobilebSi maRalia B hepatitiT inficirebis sixSire (70-90 %-mde)
vertikaluri transmisiis gziT. Tu inficirebuli dedis axalSobili
dabadebisTanave ar miiRebs B hepatitis sawinaaRmdego vaqcinas da
specifikur imunoglobulins igi 90%-Si xdeba B hepatitis virusis
qronikuli mtarebeli da maTgan SemTxvevaTa 50-70 %-Si viTardeba
RviZlis cirozi da ciroz-kibo.
Tu inficirebuli dedis axalSobils dabadebisTanave gaukeTdeba B
hepatitis sawinaaRmdego imunoglobulini da Cautardeba hepatitis
sawinaaRmdego vaqcinaciis sruli kursi (3 acra), 95-98% viTardeba myari
imuniteti.
Tu orsuls antenataluri vizitis dros (12-13 kvira) Catarebuli aqvs
skriningi B hepatitze da skriningis pasuxi dadebiTia tardeba
konfirmaciuli testi.
• Tu testi uaryofiTia – axalSobils dabadebidan pirvel 12 saaTSi
utardeba mxolod B hepatitis sawinaaRmdego vaqcinacia HB-VAX II
doza - 5 mkg (0.5 ml);
• Tu testi dadebiTia axalSobils vaqcinaciasTan erTad ukeTdeba
specifiuri imunoglobulini (doza 40 se/kg-ze. maqsimum 200 se).
B hepatitis sawinaaRmdego vaqcinacia da imunoglobulinis Seyvana xdeba
erTdroulad sxvadasxva fexis barZayis wina lateralur zedapirze,
dabadebidan pirvel 12 saaTSi (ixile imunizaciis brZaneba da danarTi).

BCG vaqcinacia
tuberkulozis prevenciis saukeTeso saSualebaa axalSobilis BCG
vaqcinacia. vaqcinacia tardeba saqarTvelos acris kalendris Sesabamisad
sicoclis me-2-5 dRes, bavSvis samSobiaro saxlidan gaweramde.
vaqcinacia tardeba tuberkulinis SpriciT doziT 0,05 ml, kanSi, mxris
zeda mesamedSi. dauSvebelia saineqcio aris damuSaveba antiseptikiT
(ixile imunizaciis brZaneba da danarTi).

skriningi
axalSobilis sicocxlis me-4-5 dRes samSobiaro saxlSi tardeba
skriningi fenilketonuriasa da hipoTireozze. sisxlis aReba xdeba
quslidan specialur saSrob qaRaldze. masala igzavneba Sesabamis
laboratoriaSi sadiagnostikod. sisxlis mocemul vadaze adre aRebis
semTxvevaSi maRalia cru dadebiTi pasuxebis riski.
15
dedis da axalSobilis erTad yofna 4,38

samSobiaro saxlSi deda da axalSobili (maT Soris sakeisro kveTis

SemTxvevaSi) dRisiT da RamiT erT palataSi unda imyofebodes, garda im
periodisa, romelic saWiroa sxvadasxva higienuri, Tu samedicino
procedurebis CatarebisaTvis.

deda-bavSvis erTad yofna 4:

• saSualebas aZlevs dedas kvebos bavSvi roca igi amJRavnebs SimSilis
niSnebs, misi moTxovnilebis Sesabamisad (ix. ZuZuTi kvebis da baksis
gaidlaini);
• xels uwyobs dedisa da bavSvis mWidro fsiqo-emociuri kavSiris
damyarebas, dedobrivi grZnobis Camoyalibebas 74-79;
• dadebiTad aisaxeba dedis damokidebulebaze ZuZuTi kvebisadmi 65

• aumjobesebs ZuZuTi kvebis process 80-81

• amcirebs bavSvTan infeqciis ganviTarebis risks 82-83

• xels uwyobs ZuZuTi kvebis xangrZlivobis gazrdas da ZuZuTi kvebis

efeqtur ganxorcielebas zrdis ZuZuTi kvebis sixSires da amcirebs
qalis rZis Semcvlelebis damatebis saWiroebas;
• SesaZlebelia mxolod umnSivnelod dairRves dedis Zili,
magram umjobesdeba bavSvis Zili, bavSvebi ufro mSvidad II
arian da naklebad tirian (mtkicebulebis done II);
• dedisa da bavSvis erTad yofna warmoadgens aucilebel
pirobas moTxovnilebiTi ZuZuTi kvebis warmatebiT I
ganxorcilebisTvis (mtkicebulebis done I).

garemo 4,38,84

postnatalur palataSi temperatura ar unda iyos 250 C-ze naklebi.

palataSi unda iyos magida movlis sxvadasxva proceduris Casatareblad.
sasurvelia palataSi iyos sveli wertili. bavSvis leibi unda iyos
magari. ar SeiZleba baliSis gamoyeneba.

axalSobilis istoriaSi fiqsirdeba informacia Semdeg sakiTxebze 38:

1. blokSi Catarebuli yvela manipulacia da movlis procedura;

2. pirveli gasinjvis da yvela Semdgomi Sefasebisas miRebuli
monacemebi;
3. anTropometruli monacemebi: masa, sigrZe da Tavis
garSemoweriloba da masis cvlilebis dinamika;
4. kvebis xasiaTi da reJimi;
5. Sardis da ganavalis gamoyofa;
6. imunizacia, skriningi da Catarebuli gamokvleva.
16
axalSobilis gawera samSobiaro saxlidan (ganyofilebidan) 4,38,85

gaweris kriteriumebia:
• aqtiuri da janmrTeli axalSobili;
• efeqturi kveba;
• wonaSi klebis SeCereba an matebis dawyeba;
• sxeulis temperaturis SenarCuneba;
• drouli imunizacia;
• axalSobili wona > 2000 g;
• dedas/bavSvis momvlels SeuZlia axalSobilis movla.
samSobiarodan binaze axalSobili ewereba sicocxlis me-4–5 dRes.

ra unda icodes dedam gawerisas 4,38,84-85

• rogor kvebos axalSobili (ZuZuTi kvebis principebi - ix. bunebrivi

kvebis gaidlaini);
• rogor mouaros da Caacvas axalSobils;
• rodis mimarTos eqims (saSiSroebis niSnebi):
⇒ sunTqvis gaxSireba
⇒ mkvnesare sunTqva
⇒ krunCxva
⇒ sxeulis temperaturis momateba 380C da meti
⇒ sxeulis temperatura < 350C–ze
⇒ kanis feris cvlilebebi: silurje an siyviTle, gamoxatuli
sifermkrTale
⇒ Wipis rgolis garSemo siwiTle da SeSupeba, romelic
vrceldeba 1 sm da met diametrze, Cirqi, usiamovno suni
⇒ sisxldena Wiplaris Wrilobidan
⇒ Rebineba, sisxli ganavalSi
• rodis da sad aiyvanos aRricxvaze Semdgomi meTvalyureobisTvis -
gawerisas (axalSobilis dedas xelze eZleva amonaweri
axalSobilis ganviTarebis istoriidan, romlis safuZvelze
pirveladi jandacvis rgolis Sesabamis dawesebulebaSi ixsneba
janmrTelobis baraTi axalSobilisaTvis);
• Semdgomi imunizaciis aucilebloba5;
• bavSvisTvis usafrTxo garemos Seqmna da ganviTarebis xelSewyoba;
• Cvilis uecari sikvdilis sindromis prevencia (bavSvs unda eZinos
calke sawolSi, magram mSoblebis oTaxSi, mSoblebma ar unda
mowion Tambaqo bavSvis oTaxSi, bavSvs unda eZinos zurgze da magar
zedapirze, bavSvi ar unda gadaxurdes).

gaidlainis ganaxlebis vada – 4 weli.

17
gaidlainis miRebis xerxi/wyaro
gaidlainis SemuSavebis meTodologia
• axalSobilis movlis Sesaxeb arsebobs samecniero
mtkicebulebis safuZvelze Seqmnil rekomendaciaTa sakmaod
mcire raodenoba. mocemuli gaidlainis Seqmnis procesSi
samuSao jgufis gadawyvetilebiT moZiebuli da Sefasebuli
iqna ukve arsebuli praqtikuli rekomendaciebi. moxda
arsebuli rekomendaciebis adaptirebuli variantis SemuSaveba,
romelic erTis mxriv pasuxebs saerTaSoriso moTxovnebs,
xolo meore mxriv iTvaliswineba saqarTvelos samedicino
dawesebulebaTa rogorc adamianur, ise teqnikur resursebs.
• rekomendaciaTa moZieba xorcieldeboda klinikuri
rekomendaciebis saerTaSoriso reestrebSi eleqtronuli
monacemTa bazebis gamoyenebiT internetSi.

qveyana da resursis internet-misamarTi

dasaxeleba
WHO http://www.who.int/
aSS
US National Guideline http://www.guideline.gov
Clearinghouse (NGC)
Centers for Disease Control and http://www.phppo.cdc.gov/CDCRecommends/Adv
Prevention (CDC) SearchV.asp
Agency for Healthcare http://www.ahrq.gov/clinic/cpgsix.htm
Research and Quality (AHRQ)
Health Services Technology http://hstat.nlm.nih.gov
Assessment Text (HSTAT) and
National Library of Medicine
(NLM)
Institute of Clinical Systems http://www.icsi.org
Improvement (ICSI)
American Medical Association http://www.ama-assn.org
Canadian Medical Association http://mdm.ca/cpgsnew/cpgs/index.asp
(CMA)
Health Canada – Population and http://www.hc-sc.gc.ca/pphb-dgspsp/dpg_e.html
Public Health Branch (PPHB)
didi britaneTi
National Institute for Clinical http://www.nice.org.uk
Excellence (NICE)
Sheffield Evidence for http://www.shef.ac.uk/seek/guidelines.htm
Effectiveness and Knowledge
(SEEK)
National electronic Library for http://www.nelh.nhs.uk/guidelinesfinder
Health (NeLH)
PRODIGY Clinical Guidance http://www.prodigy.nhs.uk/ClinicalGuidance
Scottish Intercollegiate http://www.sign.ac.uk
Guidelines Network (SIGN)
German Guideline Information http://www.leitlinien.de/english/english/view;

18
 Service (GERGIS)
avstralia
Australian National Health and http://www.health.gov.au/hfs/nhmrc/publicat/cp-
Medical Research Council (NHMRC) home.htm
axali zelandia
New Zealand Guidelines Group http://www.nzgg.org.nz/library.cfm
(NZGG)
mtkicebiTi medicinis http://www.osdm.org
specialistTa
regionTaSorisi
sazogadoeba

klinikuri rekomendaciebis da mtkicebulebebis moZiebis damatebiTi

wyaroebi da meTodebi

• koxreinis biblioTeka - The Cochrane Library 2006, Issue 2,

• amerikis samedicino biblioTekis mier Seqmnil eleqtronul
bibliografiul monacemTa baza - medlaini – MEDLINE

publikaciebis CarTvis/gamoricxvis kriteriumebi

• kvlevebi Semdegi dizainiT: randomizirebuli sakontrolo
kvlevebi, sistematuri mimoxilvebi da meta-analizi,
erTmomentiani, kohortuli kvlevebi;
• rekomendaciis momzadebisas ZiriTadad dadgenili iyo drois 12
wliani SezRudva. Tumca zogjer gamoyenebuli iyo ufro
adreuli publikaciebi, romlebic dResac aqtualuria da
safuZvlad udevs sxva Tanamedrove mtkicebulebebs;
• dadgenili iyo enobrivi SezRudvebi, radganac samuSao jgufs
SesaZlebloba hqonda literaturis wyaroebi Seeswavla
mxolod inglisur da rusul enebze.

moZiebuli klinikuri rekomendaciebisa da mtkicebulebebis analizi

• samuSao jgufis mier tardeboda moZiebuli wyaroebis analizi.
Catarebuli Ziebis Sedegad miRebuli iyo ramdenime klinikuri
meToduri rekomendacia axalSobilis movlis Sesaxeb romlebic
Seicavda jgufis miznis Sesaferis saWiro informacias. am
rekomendaciebis Sefasebisas gamoyenebuli iyo rekomendaciaTa
atestaciisa da eqspertizis kiTxvari - AGREE (94,96-98). Sefasebis
Sedegad amorCeuli iyo qvemoT CamoTvlili organizaciebis
gaidlainebi:
⇒ amerikis pediatriis akademia;
⇒ janmrTelobis msoflo organizacia;
⇒ kanadis nayofisa da axalSobilis komiteti.
• rekomendaciebis mtkicebulebaTa doneebis gansazRvrisas
gamoyenebuli iyo saqarTvelos Sromis janmrTelobisa da

19
 socialuri dacvis saministros mier mowodebuli mtkicebulebebis
donisa da rekomendaciebis xarisxis sqema.

mtkicebulebaTa doneebisa da rekomendaciebis xarisxis sqema

done mtkicebulebis siZlieris xarisxi rekomendaciis xarisxi

done (Muir Gray) (Cook et al)
I Zlieri mtkicebuleba, A eyrdnoba I donis
eyrdnoba minimum erT mtkicebulebas da
sistemur mimoxilvas, Sesabamisad mtkiced
romelic efuZneba swori rekomendebulia
dizainis mqone
randomizebul
kontrolirebad kvleva
II Zlieri mtkicebuleba, B eyrdnoba II donis
eyrdnoba minimum erTi mtkicebulebas da
swori dizainis mqone Sesabamisad mtkiced
randomizebul rekomendebulia
kontrolirebad kvleva
III klinikuri kvleva C eyrdnoba III donis
randomizaciis gareSe, mtkicebulebas SeiZleba
kohortuli da SemTxveva- CaiTvalos Sesabamisad
kontrolis kvlevebi
IV araeqsperimentuli D eyrdnoba IV da V donis
multicentruli kvlevebi mtkicebulebas saWiroebs
konsesuss
Va avtoritetul
profesionalTa mosazreba
Vb klinikuri gamocdileba,
aRwerilobiTi kvlevebi an
eqspertTa angariSi

alternatiuli gaidlani ar arsebobs

gamoyenebuli literatura:

1. Doenges, M. E. Moorhouse M. F. - Maternal/Newborn Plans of Care; Guidelines for

Individualizing Care. Philadelphia: F. A. Davis Company, 1999;
2. Encyclopedia of Nursing & Allied health - Neonatal Care – 2006
http://health.enotes.com/nursing-encyclopedia/neonatal-care;
3. WHO - Hospital Care for Children – 2005;
4. WHO - Managing newborn problems: A guide for doctors, nurses and midwives 2003;
5. American Heart Association in collaboration with International Liaison Committee on
Resuscitation. Guidelines 2005 for Cardiopulmonary Resuscitation and Emergency
Cardiovascular Care: International Consensus on Science, Part 11, 7: Neonatal Resuscitation.
Circulation 2005;112:91-9;
6. Thermal protection of the newborn: a practical guide World Health Organization, 1997;

20
7. British Columbia Reproductive Care Program – Newborn guideline 2, Neonatal
termoregulation – orifinal 1993, revised 2003;
8. Bergstrom A, Byaruhanga R, Okong P The impact of newborn bathing on the prevalence of
neonatal hypothermia in Uganda: a randomized, controlled trial Acta Paediatr. 2005
Oct;94(10):1462-7 PMID: 16299878 [PubMed - in process];
9. JBI Management of asymptomatic hypoglycaemia in healthy term neonates for nurses and
midwives Best Practice 10 (1) 2006;
10. Association of Women's Health, Obstetric and Neonatal Nurses (AWHONN). Neonatal skin
care. Evidence-based clinical practice guideline. Washington (DC): Association of Women's
Health, Obstetric and Neonatal Nurses (AWHONN); 2001 Jan. 54 p
http://www.guideline.gov;
11. Campbell JR, Zaccaria E, Baker CJ. Systemic candidiasis in extremely low birth weight
infants receiving topical petrolatum ointment for skin care: a case-control study.
Pediatrics 2000 May;105(5):1041-5;
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avtori:
pediatrTa da neontologTa kavSiri `alternativa~

samuSao jgufi:
• eka kandelaki – medicinis doqtori, Tbilisis saxelmwifo
samedicino universitetis pediatriis departamentis asistent-
profesori. pediatrTa da neontologTa kavSiri `alternativa~-s
wevri;
• merab maWaraSvili _ neonatologi, m.SaraSiZis samedicino
centri generaluri direqtoris moadgile neonatologiasa da
pediatriaSi. pediatrTa da neontologTa kavSiri
`alternativa~-s wevri;
• Tamar manjaviZe – medicinis doqtori, saqarTvelos Sromis,
janmrTelobisa da socialuri dacvis saministro. pediatrTa da
neontologTa kavSiri `alternativa~-s wevri;
• maka mSvildaZe _ neonatologi, CaCavas sax. mean ginekologiisa
da perinatologiis instituti.dimitri toklikiSvili –
neonatologi, samSobiaro saxli “bibida”, neonataluri
samsaxuris xelmZRvaneli. pediatrTa da neontologTa kavSiri
`alternativa~-s wevri;
• qeTevan nemsaZe – medicinid mecnierebaTa doqtori, profesori,
Tbilisis saxelmwifo samedicino universitetis pediatriis
departamentis sruli-profesori; m. iaSvilis sax. bavSvTa
centraluri saavadmyofos klinikuri direqtori;
• dimitri toklikiSvili – neonatologi, samSobiaro saxli
“bibida”, neonataluri samsaxuris xelmZRvaneli. pediatrTa da
neontologTa kavSiri `alternativa~-s wevri;
• nani yavlaSvili – medicinis doqtori, Tbilisis saxelmwifo
samedicino universitetis pediatriis departamentis asistent-
profesori. pediatrTa da neontologTa kavSiri `alternativa~-s
wevri;
• maia xerxeuliZe – medicinis doqtori, Tbilisis saxelmwifo
samedicino universitetis pediatriis departamentis asistent-
profesori. pediatrTa da neontologTa kavSiri `alternativa~-s
wevri.

eqspertebi:

• ia daviTaia – med. Mmecn. Ddoqtori, CaCavas sax. perinataluri

medicinisa da meanoba ginekologiis s/k institutis axalSobilTa
ganyofilebis xelmZRvaneli, saqarTvelos neonatologTa
asociaciis prezidenti;
• irakli favleniSvili - profesori, neonataluri mimarTulebis
xelmZRvaneli, Tssu diplomis Semdgomi da uwyveti samedicino
ganaTlebis institutis direqtori;

25
• lela woworia _ saqarTvelos Sromis, janmrTelobisa da
socialuri dacvis saministros jandacvis departamenti;
• Tea TavidaSvili _ saqarTvelos Sromis, janmrTelobisa da
socialuri dacvis saministros jandacvis departamenti.

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