axalSobilTa hipoTermia

klinikuri praqtikis erovnuli rekomendacia

(gaidlaini)

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klinikuri praqtikis erovnuli rekomendacia (gaidlaini)
`axalSobilTa hipoTermia~ miRebulia klinikuri praqtikis
erovnuli rekomendaciebis (gaidlainebi) da daavadebaTa marTvis
saxelmwifo standartebis (protokolebi) SemuSavebis, Sefasebis
da danergvis erovnuli sabWos 2007 wlis 21 martis #1 sxdomaze
da damtkicebulia saqarTvelos Sromis, janmrTelobisa da
socialuri dacvis ministris 2007 wlis 27 agvistos # 257/o
brZanebiT.

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axalSobilTa hipoTermia

1. daavadebis definicia, sinonimebi, klasifikacia da

terminologia
gaidlaini gankuTvnilia
⇒ samedicino personalisaTvis, romelic muSaobs axalSobilTan,
rogorc samSobiaro saxlSi, ise stacionarSi – neonatologi,
pediatri, mean-ginekologi, bebia-qali, axalSobilis eqTani.

gaidlainis samizne jgufi:

⇒ axalSobilebi, romlebsac aReniSnebaT hipoTermia an hipoTermiis
ganviTarebis riski.

Termoregulacia - organizmis unari daicvas balansi siTbos

warmoqmnasa da gacemas Soris, raTa SeinarCunos sxeulis temperatura
“normis” farglebSi.
axalSobilis sxeulis normaluri temperaturaa1-3:
• aqsilaruli - 36.5-37.50C
• oraluri - 37.0-37.50C
• reqtaluri - 37.5-38.00C
hipoTermia ewodeba sxeulis temperaturis daqveiTebas 36.50C-ze dabla.
• siciviTi stresi (msubuqi hipoTermia) – axalSobilis sxeulis
temperatura 36.0-36.40C.
• saSualo simZimis hipoTermia – axalSobilis sxeulis
0
temperatura 32.0-35.9 C.
• mZime hipoTermia – axalSobilis sxeulis temperatura < 32.00C.
hiperTermia ewodeba sxeulis temperaturis matebas 37.50C-ze metad.
Termoneitraluri garemo – garemos temperatura, romelzec sxeulis
normaluri temperaturis SesanarCuneblad saWiroa energiis da Jangbadis
minimaluri danaxarji. Termoneitraluri garemo damokidebulia gestaciur
asakze, wonasa da postnatalur asakze.

2. epidemiologia
janmos monacemebiT ganviTarebad qveynebSi hipoTermia axalSobilTa
80%-Si viTardeba. neonataluri hipoTermiiis SemTxvevebi ufro xSiria,
vidre amis aRricxva xdeba1.

3. etiologia
hipoTermiis ZiriTadi mizezia siTburi reJimis ugulebelyofa:
• samSobiaro blokis temperatura < 250C-ze
• “Tbili jaWvis” principebis ugulebelyofa - axalSobilebis
gvian gamSraleba, civi safenebis gamoyeneba, dabadebidan mcire
droSi higienuri abazanis Catareba da sxv.
axalSobilTa hipoTermia ufro xSirad gamowveulia samedicino
personalis codnis da yuradRebis deficitiT, vidre aparaturis simciriT1.

hipoTermiis ganviTarebis riskis jgufis axalSobilebi1,3:

• yvela axalSobili sicocxlis pirveli 8-12 saaTis ganmavlobaSi;

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 • dRenaklulebi – mura cximovani qsovilis mcire maragi, meti siTbos
dakargva (wonasTan SedarebiT didi sxeulis zedapiri, hipotoniis
gamo kanis farTobis gazrda);
• gestaciur asakTan SedarebiT mcire wonis axalSobilebi - mura
cximis maragis moxmareba dabadebamde, meti siTbos dakargva (wonasTan
SedarebiT didi sxeulis zedapiri);
• axalSobilebi, Tandayolili anomaliebiT, romeleTa drosac
vlindeba sxeulis zedapiris farTobis gazrdra - nervuli Reros
ganviTarebis darRveva, omfalocele, gastroSizi;
• axalSobilebi nevrologiuri darRvevebiT;
• axalSobilebi, romelTac dasWirdaT xangrZlivi reanimacia;
• axalSobilebi infeqciiT an hipoqsiiT – generalizebuli infeqcia an
mZime hipoqsia aferxebs mura cximis metabolizms da Sesabamisad
siTbos warmoqmnas. aseT axalSobilebSi ufro xSiria temperaturis
daqveiTeba, vidre mateba.
• axalSobilebi hipotoniiT – kanis farTobis gazrda

paTogenezi
axalSobilis Tavisi anatomiur-fiziologiuri Taviseburebebis gamo
xasiaTdeba poikoloTermiiT. misi unari _ moaxdinos reagireba siciveze
metabolizmis gaZlierebiTa da siTbos produqciiT, xolo gadaxurebis
SemTxvevaSi siTbos gaZlierebuli gacemiT - SezRudulia. siTbos
produqciis 3 gzidan (kunTTa nebiTi, kunTTa tonuri an riTmuli uneblie
aqtivoba da arakunTovani Termogenezi) axalSobilebSi yvelaze
mniSvnelovania siTbos produqciis arakunTovani Termogenezis (mura
cximovani qsovilis daSlis) gza. mura cximis Calageba ZiriTadad xdeba
gestaciis 28 kviris Semdeg – mxris midamoSi, Tirkmelebis da Tirkmelzeda
jirkvlis garSemo, kisris da iRliis areSi. mura cximovani qsovilis
raodenoba axalSobilis organizmSi mcirea, ris gamoc mas uWirs sxeulis
temperaturis regulireba.
siTbos gacemis 4 ZiriTadi meqanizmia1,3:
• aorTqleba: siTbos dakargva kanidan da sasunTqi gzebidan wylis
aorTqlebis xarjze. axalSobili aorTqlebiT kargavs siTbos
dabadebisas, svel safenSi gaxvevis da banaobis Semdeg.
• konveqcia: siTbos gadacema haerisTvis (damokidebulia haeris
temperaturasa da moZraobaze). am gziT axalSobili siTbos kargavs
oTaxis haeris dabali temperaturis dros da orpiri qaris pirobebSi.
• konduqcia: siTbos gadacema civ sagnebze maTTan uSualo Sexebisas. es
SeiZleba iyos civi safeni, saswori, rentgenis firi an nebismieri
civi sagani.
• gamosxiveba: siTbos gacvla im sagnebTan, romlebic daSorebulia
sxeulidan garkveuli manZiliT da ar xdeba maTTan uSualo Sexeba,
mag.: civi fanjara, inkubatoris kedlebi.

siciviTi stresiT gamowveuli Sedegebi1,3:

• metabolizmis gaZliereba - zrdis Jangbadis moxmarebas da iwvevs
hipoqsiasa da hipoqsemias;
• kaloriebze moTxovnilebis gazrda da glikogenis maragis Semcireba,
glukozis utilizaciis zrda - iwvevs hipoglikemias;
• filtvis vazokonstriqcia;

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 • metaboluri acidozis ganviTareba;
• surfaqtantis produqciis Semcireba;
• respiraciul distresis gaZliereba;
• Tirkmlis dazianeba (dabali perfuziis gamo);
• wonis matebis Semcireba (qronikuli hipoTermia);
• Termuli Soki da sisxlZarRvTaSida Sededebis sindromi (mZime
hipoTermiis dros), rac sabolood iwvevs sikvdils.

4. klinikuri simptomatika1,3:
• kanis sifermkrTale an cianozi;
• civi kidurebi (<10 centralur temperaturasTan SedarebiT);
• daTrgunva da moZraobiTi aqtivobis daqveiTeba;
• ariTmuli zerele sunTqva, apnoe, taqipnoe;
• bradikardia;
• sakvebze uaris Tqma da sustad wova;
• refleqsebis daqveiTeba dahipotonia;
• susti xmiT tirili;
• SeSupeba;
• sklerema.
mZime hipoTermiis dros SesaZlebelia gamoixatos saxis da kidurebis
hiperemia.
hipoTermia xSir SemTxvevaSi sefsisis, Tavis tvinis sisxlCaqcevis da
hipoglikemiis erT-erTi pirveli niSania.

5. diagnostika1-3
hipoTermiis diagnostika xdeba axalSobilis sxeulis temperaturis
gasinjviT.
blokSi axalSobilis aqsilaruli temperatura unda gaizomos
dabadebidan 30 wT-Si.
aqsilaruli temperatura unda gaizomos minimum 5 wuTis
ganmavlobaSi.
reqtaluri temperaturis gazomva ar aris rekomendebuli, radgan is
SeiZleba mogvianebiT daqveiTdes da xSirma gasinjvam SeiZleba gamoiwvios
swori nawlavis tramva da vagusis stimulacia. Tu temperatura izomeba
reqtalurad saWiroa Termometris 2 sm siRrmeze moTavseba swor nawlavSi
minimum 3 wuTiT.
hipoTermiis gansazRvrisTvis saWiroa specialuri Termometris
gamoyeneba, romelic temperaturas zomavs 250C-dan, radgan Cveulebrivi
TermometriT 350C-ze dabali temperatura ar izomeba. SesaZlebelia
eleqtroTermometris gamoyeneba.

6. gamokvlevis sqema
yvela axalSobili, romelsac aqvs hipoTermia unda gamokvleul iqnas
infeqciis arsebobaze1,2.
saWiroa sisxlSi glukozis donis da mJava-tutovani wonasworobis
kontroli.

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7. mkurnalobisa da prevenciis principebi
msoflio jandacvis organizaciis rekomendaciaa “Tbili jaWvis”
principis dacva yvela axalSobilTan, raTa Tavidan iyos acilebuli
hipoTermia1,2:
1. Tbili samSobiaro bloki (25-28°C), bavSvis magida da sawoli
unda iyos fanjaras mocilebuli;
2. swrafi gamSraleba – gamSraleba da sveli safenis
moSoreba; Tavze mizanSewonilia qudis daxureba, radgan
swored Tavidan xdeba yvelaze meti raodenobiT siTbos
dakargva;
3. kaniT-kanTan kontaqti - SiSveli janmrTeli axalSobilis
dedis sxeulze moTavseba (zemodan sabnis dafareba), siTbos
dakargvis prevenciis idealuri meTodia (rekomendacia A)4; A
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 done I)5-7. awonvis gadavadeba – bavSvis I
awonva mizanSewonilia dabadebidan 2 sT-Si, sasworze unda
moTavsdes winaswar SemTbari safeni;
6. saTanado tansacmlisa da sabnis SerCeva;
7. deda-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; II
Tavze qudis daxureba; reanimaciisaTvis Tbili teniani
Jangbadis gamoyeneba.
Zlier mcire wonis dRenaklulebi (<1500g) siTbos dakargvis
tradiciuli prevenciuli RonisZiebebis Catarebis
miuxedavad imyofebian hipoTermiis ganviTarebis riskis qveS
W210A,W210B
(mtkicebulebis done IV)8,9, amitom damatebiT IV
rekomendebulia gaxveva “plastikur” saxvevSi (haergaumtari
specialuri qaRaldi) da sxivuri gamaTboblis qveS
moTavseba (rekomendacia B, mtkicebulebis done II)9-14, II/B
saxvevi unda moscildes ganyofilebaSi gadayvanis Semdeg
(mtkicebulebis done I)7. saWiroa temperaturis mkacri I
kontroli, raTa ar ganviTardes hiperTermia (mtkicebulebis
done II)11, radgan hiperTermiam SeiZleba gamoiwvios tvinis
dazianeba (rekomendacia B)9. II/B
10. medpersonalis ganaTleba

samSobiaro blokSi hipoTermiis ganviTarebis Tavidan asacileblad

efeqturi meTodia gasaTbobi wylis leibebis gamoyeneba15.

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marTva hipoTermiis SemTxvevaSi:

msubuqi hipoTermia – Tu axalSobilis mdgomareoba

damakmayofilebelia, gaTboba SeiZleba kaniT-kanTan kontaqtis
saSualebiT1,2.

saSualo simZimis da mZime hipoTermia _ axalSobilis gaTboba

SeiZleba:
⇒ sxivuri gamaTbobliT
⇒ kuveziT
⇒ gasaTbobi wylis leibiT
⇒ Tu sxva saSualeba ar aris, kaniT-kanTan kontaqtiT.
sadReisod mainc ar aris naTeli sxeulis temperaturis SenarCunebis,
romeli meTodia upiratesi sxivuri gamaTbobeli, Tu inkubatori16.
sxivuri gamaTbobeli1,2
upiratesoba - bavSvze uSualo meTvalyureobis da Tavisufali midgomis
saSualeba. meTodi efeqturia, Tu oTaxis temperatura 250C-ze metia.
nakli - sxivuri gamaTbobeli iwvevs wylis damatebiT dakargvas
gansakuTrebiT mcire wonis axalSobilebSi, ramac SeiZleba gamoiwvios
dehidratacia. siTxis aRniSnuli danakargi gaTvaliswinebuli unda iyos
yoveldRiuri siTxis moTxovnilebis gaangariSebisas16.
janmo iZleva sxivuri gamaTboblis xanmokle droiT gamoyenebis
rekomendacias. sxivuri gamaTboblis gamoyenebisas axalSobilis
temperatura unda Sefasdes 30 wT-Si erTxel gadaciebis an gadaxurebis
Tavidan asacileblad.

gasaTbobi wylis leibi _ leibi unda moTavsedes sawolSi, wylis

temperatura unda iyos 35-380C. bavSvs unda ecvas tansacmeli da
II
zemodan unda exuros sabani (mtkicebulebis done II).

kuvezi1,2
gamoiyeneba: Zlier mcire wonis axalSobilebisTvis (<1500g), da nebismieri
wonis axalSobilebisTvis, romelTac aReniSnebaT saSualo simZimis an
mZime hipoTermia an sicocxlisaTvis saSiSi mdgomareoba (sefsisi, sunTqvis
mZime ukmarisoba da sxva)
upiratesoba – SeiZleba temperaturis, tenianobis da Jangbadis
koncentraciis kontroli, iZleva bavSvze (saWiroebis SemTxvevaSi SeiZleba
axalSobilis gaSiSvleba) uSualo meTvalyureobis saSualebas
nakli – Zviria, saWiroa medpersonalis treningi, barieria dedasa da bavSvs
Soris, SeiZleba moxdes baqteriebis kolonizacia.

saSualo simZimis da mZime hipoTermiis marTva:

• hipoTermuli axalSobilis gaTboba xdeba TandaTan 1 sT-Si 10C-is
siswrafiT. Tu masa <1200 gr, gestaciuri asaki <28 kv, xolo sxeulis
temperatura <320C-ze, gaTboba xdeba ufro dabali siswrafiT, 1 sT-Si
0,50C-iT. hipoTermuli bavSvis swrafma gaTbobam SeiZleba gamoiwvios
apnoe, metaboluri acidozi, hipotenzia da krunCxva.
• axalSobili unda moTavsdes kuvezSi romelSic temperatura 1-1,50–iT
metia axalSobilis temperaturaze3. dauSvebelia axalSobilis civ
inkubatorSi moTavseba.

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 • axalSobilis temperaturis stabilizaciamde kuvezis temperatura unda
gaizardos saaTSi erTxel 10–iT. rodesac sxeulis temperatura
miaRwevs 340C gaTbobis procesi unda Seneldes. temperaturis
stabilizaciis Semdeg SesaZlebelia cxrilSi mocemuli
temperaturebis gamoyeneba.
• sxeulis temperaturis kontroli saWiroa inkubatorSi moTavsebidan 30
wT-Si; Semdegi 4 saaTis ganmavlobaSi saaTSi erTxel, da Semdeg 4
saaTSi erTxel. aucilebelia kuvezSi haeris temperaturis kontroli.
• sasurvelia 40% tenianobis Seqmna kanis gamoSrobis Tavidan
asacileblad (mtkicebulebis done II)7. II
• aucilebelia vitaluri funqciebis da sisxlSi Saqris donis
kontroli.

kuvezis gamoyenebisas gaTvaliswinebuli unda iyos Semdegi

1,2
rekomendaciebi :
• inkubatoris fanjrebi yovelTvis daketili unda iyos. minimumamde unda
iyos dayvanili inkubatoris gaxsna, SeZlebisdagvarad yvela
manipulacia unda Catardes inkubatoris fanjrebidan.
• erTkedlian inkubatorSi ar aris mizanSewonili SiSveli bavSvis
moTavseba.
• Tu saWiroa infuzuri Terapia, sainfuzio xsnari unda SeTbes
specialuri aparatiT an inkubatorSi misi winaswar moTavsebiT
• inkubatori unda gaiwmindos yovel 2-5 dReSi erTxel. wylis
rezervuarSi wyali unda gamoicvalos yovel 24 sT-Si da winaswar
SeTbes.

kuvezis temperaturis dasaSvebi meryeoba

kuvezis optimaluri temperatura 0C

asaki/ dabadebis < 1000g 1000-1500g 1500-2000g 2000-2500g 2500g

wona
0-6 sT 36.7-36.2 36.2-35.4 35.7-34.2 34.8-33.6 34.8-32.7
6-12 sT 36.7-36.0 36.2-35.4 35.7-34.1 34.8-33.0 34.8-32.0
12-24 sT 36.6-35.9 36.0-35.2 35.6-34.1 34.7-32.5 34.7-31.6
24-36 sT 36.5-35.9 35.9-35.1 35.5-34.0 34.7-32.3 34.4-31.2
36-48 sT 36.5-35.9 35.9-35.0 35.4-33.9 34.6-32.0 34.2-31.0
48-72 sT 36.4-35.8 35.9-34.8 35.2-33.6 34.4-31.8 34.1-30.6
72-96 sT 36.3-35.7 35.8-34.7 35.1-33.5 34.2-31.7 33.6-30.2
4-5 dRe 36.3-35.6 35.7-34.4 35.0-33.3 34.1-31.6 33.4-29.9
5-6 dRe 36.2-35.5 35.6-34.3 34.9-33.2 33.9-31.6 33.1-29.8
6-8 dRe 36.0-35.2 35.5-34.1 34.8-33.0 33.8-31.6 32.5-29.3
8-10 dRe 35.9-35.1 35.2-34.0 34.6-32.8 33.5-31.6 32.5-29.3
10-12 dRe 35.8-34.9 35.0-33.9 34.4-32.7 33.4-31.6 32.0-29.3
12-14 dRe 35.7-34.7 35.0-33.4 34.3-32.6 33.3-31.6 31.4-29.3
2-3 kvira 35.6-34.1 35.0-33.0 34.2-32.4 33.2-31.0 -
3-4 kvira 35.2-33.6 34.6-32.3 34.1-32.0 33.0-30.4 -

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mcire wonis da avadmyofi Cvilebis kuvezSi haeris temperatura
mizanSewonilia iyos cxrilSi mocemuli asakis Sesabamisi temperaturis
zeda zRvris toli.

cxrilSi mocemuli temperatura gamoiyeneba Semdeg SemTxvevebSi17:

1. erT kedliani inkunatori
2. inkubatori, romlis tenianoba 50%
3. inkubatori, romlis haeris temperatura izomeba uSualod bavSvis
gulmkerdis zemoT
4. oTaxis temperatura daaxloebiT 26,50C

mdgomareoba, romelmac SeiZleba gamoiwvios inkubatoris temperaturis

cvlilebis aucilebloba:

1. inkubatoris Termometri moTavsebulia minus 0.5-1.00C

kuTxeSi
2. tardeba fotoTerapia minus 1.0-1.50C
3. oTaxis temperatura _ 300C minus 0.50C
_ 230C plius 0.50C
4. inkubatoris tenianiba 100% minus 0.50C

mcire wonis axalSobilebi

• mcire wonis axalSobilebi mizanSewonilia moTavsdnen ormag
kedlian inkubatorSi (mtkicebulebis done II)3,6. II
• mdgomareobis stabilizaciamde, sanam “bevri Carevaa” saWiro
umjobesia sxivuri gamaTboblis gamoyeneba, radgan inkubatoris
xSirma gaxsnam SeiZleba gamoiwvios temperaturis daqveiTeba.
• mcire wonis axalSobilebi minimum I kviris ganmavlobaSi unda
imyofebodnen Termoneitralur garemoSi. aseT SemTxvevaSi
inkubatorSi myofi mcire wonis axalSobilebSi muclis wina
zedapirze kanis temperatura minimum 360C unda iyos18.
• winaswar unda SeTbes yvelaferi, rasac mcire wonis axalSobili
exeba – saswori, stetoskopi, TeTreuli da sxva 6.

rodis unda moxdes axalSobilis inkubatoridan gamoyvana17,32:

axalSobilis gadayvana sawolSi, SesaZlebelia, Tu
⇒ bavSvis mdgomareoba stabiluria;
⇒ dRenaklulis masam miaRwia 1700-1800 grams;
⇒ sxeulis temperatura stabiluria, rodesac haeris temperatura
inkubatorSi aris 320C.

axalSobilis sawolSi gadayvanis win mizanSewonilia:

• inkubatoris haeris temperaturis dayeneba 280C-ze, Cvilis (unda ecvas
maisuri, erTjeradi higienuri safeni) Sexveva erT safenSi;
• saWiroa sxeulis temperaturis kontroli 30 wT-Si; Semdegi 4 saaTis
ganmavlobaSi saaTSi erTxel.

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 • Tu axalSobilis sxeulis temperatura ecema 36,50C-ze qvemoT, unda
moxdes misi gaTboba (2-3 dRis Semdeg meordeba inkubatoridan
gamoyvanis mcdeloba).
• Tu axalSobilis sxeulis temperatura stabiluria 8 saaTis
ganmavlobaSi, is unda Seixves damatebiT safenebSi da gadayvanil iqnas
sawolSi.
• saWiroa sxeulis temperaturis kontroli 30 wT-Si; Semdegi 4 saaTis
ganmavlobaSi saaTSi erTxel. Tu axalSobilis sxeulis temperatura
ecema 36,50C-ze qvemoT, unda moxdes misi dabruneba inkubatorSi,
mcdeloba unda gameorde 2-3 dReSi.

kenguris meTodi
dRenaklulTa da mcire masis mqone axalSobilTa gamozrdisas
rekomendebulia "kengurus meTodis" gamoyeneba. kengurus meTodiT
gamozrdis SemTxvevaSi bavSvi Tavsdeba vertikalurad dedis
A
mkerdze. es meTodi gamoiyeneba, Tu (rekomendacia A)4:
⇒ dRenaklulis mdgomareoba damakmayofilebelia,
⇒ ar aReniSneba sunTqvis darRveva an mZime nevrologiuri
dazianebis niSnebi,
⇒ dabadebis wona 1100 gr-ze metia
⇒ aqvs wovis unari.
kvlevebis safuZvelze dadginda, rom mocemuli meTodis gamoyeneba
hipoTermiis riskis SemcirebasTan erTad, amcirebs aspiraciis ganviTarebis
risks (bavSvis sxeulis vertikaluri poziciis gamo) da xels uwyobs
fsiqomotoruli ganviTarebas (neirosensoruli stimulaciis gamo).
marTalia, ukanasknel wlebSi warmoebuli kvlevebis monacemebiT
kengurus meTodi amcirebs axalSobilTa sikvdilobas, mainc ar arsebobs
sakmarisi mtkicebuleba mcire wonis axalSobilebSi am meTodis rutinili
gamoyenebis Sesaxeb19.

Terapiuli hipoTermia W211A,W211B

dabadebamde da dabadebisas Jangbadis nakleboba iwvevs axalSobilis

tvinis ujredebis dazianebas da es dazianeba grZeldeba dabadebis
Semdegac. erT-erTi gza am dazianebis Sesamcireblad aris bavSvis Tavis an
sxeulis gacieba, ramac SeiZleba Seamciros dazianebuli tvinis ujredebis
raodenoba.
sxeulis temperaturis daqveiTeba 2-30C (zomieri hipoTermia)
tvinis hipoqsia-iSemiis Semdeg amcirebs tvinis dazianebas da
aumjobesebs gamosavals eqsperimentul kvlevaSi (mtkicebulebis IV
20-22
done IV) . axalSobilebze Catarebuli kvlevebi mwiria da
urTierTgamomricxavi Sedegebi aqvs (mtkicebulebis done II)9.
arsebobs monacemebi, rom hipoTermia im axalSobilebSi, romelTac II
aqvT hipoqsiur-iSemiuri encefalopaTia sikvdilianibisa da
invalidobis xarisxis Semcirebas iwvevs. es kvlevebi Catarebulia,
1800 g-ze meti wonis axalSobilebSi, radgan ufro mcire wonis
bavSvebSi sxeulis temperaturis stabilizaciis miRweva sakmaod
rTulia. hipoTermiis misaRwevad gamoiyeneba specialuri aparati.
aRsaniSnavia, rom mniSvnelovania hipoqsiur-iSemiuri

10
encefalopaTiis mqone bavSvebSi hiperTermiis Tavidan acileba23-28.
mZime hipoTermiam SeiZleba gamoiwvios ariTmia, sisxldena,
Trombozi da sefsisi, Tumca es garTulebebi ar gamovlenila
zomieri hipoTermiis dros (mtkicebulebis done II)25,29,30.
II
jer ar aris sakmarisis mtkicebuleba sistemuri Tu seleqtiuri
cerebruli hipoTermiis (zomieri) rutinuli gamoyenebisaTvis9,31.

8. gaidlainis gadasinjvisa da ganaxlebis vada – 3 weli

9. gaidlainis miRebis xerxi/wyaro

gaidlainis SemuSavebis meTodologia
• axalSobilTa hipoTermiis prevenciis da marTvis principebis
Sesaxeb ar arsebobs samecniero mtkicebulebis safuZvelze
Seqmnil rekomendaciaTa sakmarisi raodenoba. mocemuli
gaidlainis Semqmnis 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 iTvaliswinebs
saqarTvelos samedicino dawesebulebaTa rogorc adamianur, ise
teqnikur resursebs.
• rekomendaciaTa moZieba xorcieldeboda eleqtronuli
monacemTa bazis gamoyenebiT.
cxrili 2
qveyana da resursis internet-misamarTi
dasaxeleba
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)

11
 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;
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
• jandacvis msoflio organizaciis reproduqciuli janmrTelobis
biblioTeka

publikaciebis CarTvis/gamoricxvis kriteriumebi

• gamoyenebul iqna kvlevebi Semdegi dizainiT: randomizirebuli

kontrolirebadi kvlevebi, sistemuri 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.
12
 moZiebuli klinikuri rekomendaciebisa da mtkicebulebebis analizi

• samuSao jgufis mier tardeboda moZiebuli wyaroebis analizi.

Catarebuli Ziebis Sedegad miRebuli iyo ramdenime klinikuri
meToduri rekomendacia axalSobilTa hipoTermiis marTvis
sakiTxebze, romlebic Seicavda jgufis miznis Sesaferis saWiro
informacias. am rekomendaciebis Sefasebisas gamoyenebuli iyo
rekomendaciaTa atestaciisa da eqspertizis kiTxvari - AGREE (94,96-
98). samuSao jgufi xelmZRvanelobda saqarTvelos Sromis
janmrTelobisa da socialuri dacvis saministros samedicino
standartebisa da normebis sammarTvelos mier mier SemuSavebuli
nacionaluri gaidlainebis gzamkvleviT. Sefasebis Sedegad
amorCeuli iyo qvemoT CamoTvlili organizaciebis gaidlainebi:
⇒ msoflo jandacvis organizacia
⇒ britaneTis reproduqciuli janmrTelobis programa
⇒ amerikis pediatriis akademia
• rekomendaciebis mtkicebulebaTa doneebis gansazRvrisas
gamoyenebuli iyo saqarTvelos Sromis janmrTelobisa da socialuri
dacvis saministros samedicino standartebisa da normebis
sammarTvelos 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 kvlevas
II Zlieri mtkicebuleba, B eyrdnoba II donis
eyrdnoba minimum erTi swori mtkicebulebas da
dizainis mqone randomizebul Sesabamisad mtkiced
kontrolirebad kvlevas rekomendebulia
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
multicentruli kvlevebi donis mtkicebulebas
saWiroebs konsesuss
Va avtoritetul
profesionalTa mosazreba
Vb klinikuri gamocdileba,
aRwerilobiTi kvlevebi an
eqspertTa angariSi

10. alternatiuli gaidlaini ar arsebobs

13
11. gamoyenebuli literatura:
1. Thermal protection of the newborn: a practical guide World Health Organization, 1997
2. World Health Organization - Managing Newborn Problems – A Guide for doctors, nurses
and midwives – 2003
3. British Columbia Reproductive Care Program – Newborn guideline 2, Neonatal
termoregulation – orifinal 1993, revised 2003
4. JBI Management of asymptomatic hypoglycaemia in healthy term neonates for nurses and
midwives Best Practice 10 (1) 2006
5. 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]
6. Weber R. - Neonatal Thermoregulation -www.continuingeducation.com/nursing/thermoreg/
thermoreg.pdf 1999
7. Association of Women's Health, Obstetric and Neonatal Nurses - Evidence-based clinical
practice guideline. Neonatal skin care. 2001 Jan. 54 p http://www.guideline.gov
8. Costeloe K, Hennessy E, Gibson AT, Marlow N, Wilkinson AR. The EPICure study:
outcomes to discharge from hospital for infants born at the threshold of viability. Pediatrics.
2000;106:659–671.
9. American Heart Association in collaboration with International Liaison Committee on
Resuscitation. Guidelines 2005 for Cardiopulmonary Resuscitation and Emergency
Cardiovascular Care: International Concensus on Science, Part 11: Neonatal Resuscitation.
Circulation. 2005;112 91-99. 188-195
10. Vohra S, Frent G, Campbell V, Abbott M, Whyte R. Effect of polyethylene occlusive skin
wrapping on heat loss in very low birth weight infants at delivery: a randomized trial. J
Pediatr. 1999;134:547–551.
11. Vohra S, Roberts RS, Zhang B, Janes M, Schmidt B. Heat Loss Prevention (HeLP) in the
delivery room: a randomized controlled trial of polyethylene occlusive skin wrapping in
very preterm infants. J Pediatr. 2004;145:750 –753.
12. Lyon AJ, Stenson B. Cold comfort for babies. Arch Dis Child Fetal Neonatal Ed.
2004;89:F93–F94.
13. Lenclen R, Mazraani M, Jugie M, Couderc S, Hoenn E, Carbajal R, Blanc P, Paupe A. [Use
of a polyethylene bag: a way to improve the thermal environment of the premature newborn
at the delivery room]. Arch Pediatr. 2002;9:238 –244.
14. Bjorklund LJ, Hellstrom-Westas L. Reducing heat loss at birth in very preterm infants. J
Pediatr. 2000;137:739 –740.
15. Boo NY, Selvarani S. Effectiveness of a simple heated water-filled mattress for the
prevention and treatment of neonatal hypothermia in the labour room. Singapore Med J.
2005 Aug;46(8):387-91 PMID: 16049607, PubMed - indexed for MEDLINE
16. Flenady VJ, Woodgate PG. Radiant warmers versus incubators for regulating body
temperature in newborn infants. The Cochrane Database of Systematic Reviews 2003, Issue
4. Art. No.: CD000435. DOI: 10.1002/14651858.CD000435
17. Edward F. Bell, MD - Iowa Neonatology Handbook: Detection and Management of
Abnormal Body Temperature, Last modification date: Wed Jun 21 16:00:45 2006 URL:
http://www.uihealthcare.com/depts/med/pediatrics/iowaneonatologyhandbook/temperature/
abnormaltemp.html
18. Sinclair JC. Servo-control for maintaining abdominal skin temperature at 36C in low birth
weight infants. The Cochrane Database of Systematic Reviews 2002, Issue 1. Art. No.:
CD001074. DOI: 10.1002/14651858.CD001074.
19. Conde-Agudelo A, Diaz-Rossello JL, Belizan JM. Kangaroo mother care to reduce
morbidity and mortality in low birthweight infants. The Cochrane Database of Systematic
Reviews 2003, Issue 2. Art. No.: CD002771. DOI: 10.1002/14651858.CD002771.

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 20. Gunn AJ, Gunn TR, de Haan HH, Williams CE, Gluckman PD. Dramatic neuronal rescue
with prolonged selective head cooling after ischemia in fetal lambs. J Clin Invest.
1997;99:248 –256.
21. Laptook AR, Corbett RJ, Sterett R, Burns DK, Garcia D, Tollefsbol G. Modest hypothermia
provides partial neuroprotection when used for immediate resuscitation after brain ischemia.
Pediatr Res. 1997;42: 17–23.
22. Thoresen M, Bagenholm R, Loberg EM, Apricena F, Kjellmer I. Posthypoxic cooling of
neonatal rats provides protection against brain injury. Arch Dis Child Fetal Neonatal Ed.
1996;74:F3–F9.
23. Compagnoni G., Pogliani L., Lista G., Castoldi F., Fontana P., Mosca F. Hypothermia
Reduces Neurological Damage in Asphyxiated Newborn Infants, Biology of the Neonate
2002;82:222-227
24. Bernard SA, Gray TW, Buist MD, et al. Treatment of comatose survivors of out-of-hospital
cardiac arrest with induced hypothermia. N Engl J Med. 2002;346 :557 –563
25. Gluckman PD, Wyatt JS, Azzopardi D, Ballard R, Edwards AD, Ferriero DM, Polin RA,
Robertson CM, Thoresen M, Whitelaw A, Gunn AJ. Selective head cooling with mild
systemic hypothermia after neonatal encephalopathy: multicentre randomised trial. Lancet.
2005;365:663–670.
26. Eicher DJ, Wagner CL, Katikaneni LP, Hulsey TC, Bass WT, Kaufman DA, Horgan MJ,
Languani S, Bhatia JJ, Givelichian LM, Sankaran K, Yager JY. Moderate hypothermia in
neonatal encephalopathy: efficacy outcomes. Pediatr Neurol. 2005;32:11–17.
27. Thoresen M, Whitelaw A. Cardiovascular changes during mild therapeutic hypothermia and
rewarming in infants with hypoxic-ischemic encephalopathy. Pediatrics. 2000;106:92–99.
28. Donovan EF, Fanaroff AA, Poole WK, Wright LL, Higgins RD, Finer NN, Carlo WA,
Duara S, Oh W, Cotten CM, Stevenson DK, Stoll BJ, Lemons JA, Guillet R, Jobe AH.
Whole-body hypothermia for neonates with hypoxicischemic encephalopathy. N Engl J
Med. 2005;353:1574–1584.
29. Eicher DJ, Wagner CL, Katikaneni LP, Hulsey TC, Bass WT, Kaufman DA, Horgan MJ,
Languani S, Bhatia JJ, Givelichian LM, Sankaran K, Yager JY. Moderate hypothermia in
neonatal encephalopathy: safety outcomes. Pediatr Neurol. 2005;32:18–24.
30. Shankaran S, Laptook A, Wright LL, Ehrenkranz RA, Donovan EF, Fanaroff AA, Stark
AR, Tyson JE, Poole K, Carlo WA, Lemons JA, Oh W, Stoll BJ, Papile LA, Bauer CR,
Stevenson DK, Korones SB, McDonald S. Whole-body hypothermia for neonatal
encephalopathy: animal observations as a basis for a randomized, controlled pilot study in
term infants. Pediatrics. 2002;110:377–385.
31. Jacobs S, Hunt R, Tarnow-Mordi W, Inder T, Davis P -Cooling for newborns with hypoxic
ischaemic encephalopathy (Cochrane Review) From The Cochrane Library, Issue 3, 2006
32. New K, Flenady V, Davies MW. Transfer of preterm infants from incubator to open cot at
lower versus higher body weight. The Cochrane Database of Systematic Reviews 2004,
Issue 2. Art. No.: CD004214. DOI: 10.1002/14651858.CD004214.pub2.

Worksheets Cited

W210A. http://circ.ahajournals.org/cgi/content/full/CIRCULATIONAHA. 105.170522/DC360

W210B. http://circ.ahajournals.org/cgi/content/full/CIRCULATIONAHA . 105.170522/DC361

15
12. avtorTa jgufi:
⇒ merab maWaraSvili _ neonatologi, SaraSiZis samedicino
centri generaluri direqtoris moadgile neonatologiasa da
pediatriaSi; pediatrTa da neonatologTa kavSiri
`alternativa~.
⇒ maia xerxeuliZe – medicinis doqtori, Tbilisis saxelmwifo
samedicino universitetis pediatriis departamentis asistent-
profesori; pediatrTa da neonatologTa kavSiri
`alternativa~.
⇒ nani yavlaSvili – medicinis doqtori, Tbilisis saxelmwifo
samedicino universitetis pediatriis departamentis asistent-
profesori; pediatrTa da neonatologTa kavSiri
`alternativa~; pediatrTa da neonatologTa kavSiri
`alternativa~.
⇒ eka kandelaki – medicinis doqtori, Tbilisis saxelmwifo
samedicino universitetis pediatriis departamentis asistent-
profesori; pediatrTa da neonatologTa kavSiri
`alternativa~; pediatrTa da neonatologTa kavSiri
`alternativa~.
⇒ Tamar manjaviZe _ medicinis doqtori, saqarTvelos Sromis,
janmrTelobisa da socialuri dacvis saministro;

eqspertebi:
⇒ qeTevan nemsaZe – medicinis mecnierebaTa doqtori, Tbilisis
saxelmwifo samedicino universitetis pediatriis
departamentis profesori.
⇒ dimitri abelaSvili - medicinis doqtori, Tbilisis
saxelmwifo samedicino universitetis diplomis Semdgomi da
uwyveti samedicino ganaTlebis instituti, m. iaSvilis
saxelobis bavSvTa centraluri klinikuri saavadmyofos
reanimaciisa da gadaudebeli daxmarebis samsaxuris ufrosi,
axalSobilTa reanimaciis ganyofilebis gamge; pediatrTa da
neonatologTa kavSiri `alternativa~;
⇒ lela woworia _ saqarTvelos Sromis, janmrTelobisa da
socialuri dacvis saministros janmrTelobis dacvis
departamenti;
⇒ Tea TavidaSvili _ saqarTvelos Sromis, janmrTelobisa da
socialuri dacvis saministros janmrTelobis dacvis
departamenti.

16