• Are present the local palliative care protocol for children in institutions ?
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Are present the local palliative care protocol for children in institutions ?


Are present the local palliative care protocol for children in institutions ?

R. Marabyan, A. Penkov, O. Riga, T. Gavrysh, N. Konovalova, O. Kizenko 
Kharkiv Regional Specialized Orphanage No 1
Inyurpolis Law Firm (Kharkiv)

Nowadays the mechanisms of palliative care for children are without regulated documents, especially with regard to children deprived of parental care. The aim and methods. an analysis of children (38) without parental care who require palliative care. The children were aged 1.5 months to 4 years old from Kharkiv Regional Orphanage No 1.

Results. Kharkiv Regional Orphanage No 1 – an institution for orphans and children left without parental care, with the central nervous system and mental disorders. Among the 38 children – 17 (44.7%) under the age of 1 year, all children have the status of disabled children. Children who are temporarily held in the institution 28 (73.8%) have serious medical problems as a result of which 4 (10.5%) died: birth defects – 3 cases (75%) , blood disorders (hemorrhagic stroke) – 1 case (25%). Most children are 34 (89.4%) lag behind in physical development. Severe pathology leads to the impossibility of returning children to their biological families and preventing their adoption. This raises the question of medical management of children, especially palliative care, which begins with the diagnosis of disease and continues regardless of whether the child receives appropriate treatment. All pupils in the orphanage are on the records; majority of pupils have a 2–3 disease and more. For most classes of diseases recorded birth defects, respiratory diseases and diseases of the nervous system. Proportion of acute respiratory infection is 33.3% of all acute diseases. The incidence of acute bronchitis and pneumonia accounted for 1.5% and 3.1% respectively, which can be explained by the fact that children with diseases of the central nervous system respiratory problems arising due to the presence of swallowing disorders, decreased cough reflex, decreased chest excursion, resulting in the emergence of recurrent pneumonia and bronchitis. Among the 38 children 5 (13.1%) had surgery: removal of liver tumors, correction of congenital heart disease and three liquorshunting operation. Pathology of the central nervous system accompanied in 27 (71%) of the 64 children seizures seizures attacks even with the use of psychotropic substances. Therefore, on the one hand, children with central nervous system lesions requiring long-term recovery treatment and rehabilitation, on the other hand, they are limited in number and quality of rehabilitation process under frequent acute respiratory diseases and the risk of seizures carried out surgery. The use of individual rehabilitation has allowed the improvement of only 1 (2.6%), child, other children of coarse organic disorders of the central nervous system develop without speakers.

Conclusions. Severe organic pathology of the central nervous system in young children is a major cause of failure of parents to children, which leads to child abandonment, long-term treatment, rehabilitation and restrictions fatal consequences. This situation requires the development of local protocols palliative care, which would regulate the provision of child and her parent’s qualitative painless existence, along with the ethical health and social care.

Key words: palliative care, children, orphanage, regulation.