klinikuri praqtikis erovnuli rekomendacia (gaidlaini)

avSvis janmrTelobaze 

zedamxedvelobis ZiriTadi 

principebi 

klinikuri praqtikis erovnuli rekomendacia 

(gaidlaini) 

1

klinikuri praqtikis erovnuli rekomendacia (gaidlaini) `bavSvis 

janmrTelobaze zedamxedvelobis ZiriTadi principebi~ 

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 # 154/o brZanebiT. 

2

avSvis janmrTelobaze zedamxedvelobis ZiriTadi 

principebi 

definicia 

janmrTelobis msoflio organizacia janmrTelobas ganmartavs, rogorc 

daavadebebisa da paTologiuri procesebis ar arsebobas sruli fizikuri, 

sulieri da socialuri keTildReobis fonze (WHO). 

bavSvze zedamxedveloba (meTvalyureoba) - Tanamimdevruli RonisZiebebis 

erTobliobaa, romlis mizania bavSvis janmrTelobis mdgomareobisa da 

ganviTarebis monitoringi, ganviTarebis xelSewyoba, arsebuli problemebis 

identificereba da marTva, daavadebebis gamovlena da drouli referali. 

gaidlaini gankuTvnilia 

⇒ pirveladi jandacvis rgolis samedicino personalisTvis - ojaxis 

eqimi, eqimi-pediatri, eqTani. 

⇒ gaidlaini aseve SeiZleba gamoyenebuli iyos umaRlesi da saSualo 

samedicino dawesebulebis pedagogebis mier uwyveti samedicino 

ganaTlebisaTvis. 

gaidlainis samizne jgufi: 

⇒ bavSvebi dabadebidan 15 wlamde 

bavSvis janmrTelobaze uwyveti meTvalyureobis miznebi: 1,2,3,4,5,6 

• bavSvis janmrTelobis mdgomareobis Sefaseba; 

• drouli imunizaciis uzrunvelyofa; 

• kvebiTi statusis Sefaseba da jansaRi kvebis xelSewyoba; 

• bavSis ganviTarebis monitoringi da xelSewyoba; 

• bavSvis ganviTarebaze moqmedi risk-faqtorebis identificireba; 

• saskolo mzaobis Sefaseba; 

• ganviTarebis CamorCenis gansazRvra da koreqcia; 

• memkvidruli daavadebebis gamovlena; 

• daavadebis sawyis stadiaze gamovlena da saWiroebis SemTxvevaSi 

drouli referali; 

• ojaxuri garemos Sefaseba (higiena, bavSvisTvis aucilebeli 

moTxovnilebebis dakmayofilebis unari da SesaZlebloba, bavSvis 

ganviTarebisaTvis aucilebeli asakTan Sesabamisi nivTebis - 

saTamaSoebis, wignebis, saxatavi da saZerwi masalis arseboba); 

3

• bavSvze Zaladobisa da ugulebelyofis niSnebis Sefaseba; 

• ojaxis konsultireba (Zili, disciplina, TamaSi, usafrTxo garemo, 

dazianebebis prevencia, daavadebis saSiSroebis niSnebi da sxv.) 

janmrTel bavSvze zedamxedveloba pirveladi jandacvis rgolis 

mniSvnelovani komponentia. meTvalyureobas axorcielebs eqimi da eqTani 

rogorc binaze, ise samedicino dawesebulebaSi dadgenili standartis 

mixedviT. uwyveti meTvalyureoba uzrunvelyofs bavSvis ganviTrebis 

Sefasebis mdgradobas da saukeTeso pirobebs qmnis bavSvis 

janmrTelobisadmi erTiani midgomis CamoyalibebisTvis 7 . 

zedamxedvelobis sixSire da raodenoba 7,8,9,10,11,12 

sxvadasxva qveynaSi janmrTel bavSvze zedamxedvelobis sixSire da Sinaarsi 

gansxvavebulia. ar arsebobs sakmirisi mtkicebulebebi janmrTel bavSvze 

meTvalyureobis vizitebis zusti cifris Sesaxeb. 

0-1 wlamde asakSi sapatronaJo vizitebis raodenoba msoflios mraval 

qveyanaSi iseTivea, rogorc saqarTveloSi: eqimis 7 da meddis 10 viziti. 

pediatrTan erTi damatebiTi viziti tardeba orsulobis III trimestrSi. 

2 wlamde janmrTel bavSvze meTvalyureobis maRali sixSire ganisazRvreba 

am asakisTvis damaxasiaTebeli fiziologiuri TaviseburebebiT: 

axalSobilTa adaptacia, bavSvis zrda-ganviTarebis SedarebiT swrafi tempi, 

kvebis Tavisebureba, bavSvis ganviTarebis xelSewyobis aucilebloba, 

imunizacia da sxv. 

2 wlidan 16 wlamde rekomendebulia bavSvze zedamxedveloba erTi wlis 

intervaliT. 

ufro xSiri meTvalyureoba tardeba Semdeg SemTxvevaSi: 

⇒ dRenakluloba; 

⇒ perinataluri paTologia; 

⇒ Tandayolili mankebi; 

⇒ qronikuli daavadebebi; 

⇒ ganviTarebis Seferxeba; 

⇒ ojaxis mZime socialuri mdgomareoba. 

janmrTeli bavSvis gasinjva da Sefaseba SesaZlebelia mSoblis moTxovniT 

damatebiT ganxorcieldes 5,7 . 

bavSvis ganviTarebis istoria 

pirveladi jandacvis sistemis mniSvnelovani komponentia erTiani aRricxvis 

sistema da samedicino dokumentacia, romelic warmodgenilia bavSvis 

ganviTarebis istoriiT. bavSvis registraciis safuZvels jandacvis 

4

pirvelad rgolSi warmoadgens mSoblis mimarTva an bavSvis dabadebis 

Sesaxeb samSobiaros Setyobineba. 

bavSvis ganviTarebis istoriaSi Canaweri keTdeba yvela vizitis dros. eqimis 

an eqTnis mier fiqsirdeba bavSvis ganviTarebis Sefasebis, skriningis da 

laboratoriuli gamokvlevis yvela maCvenebeli, vaqcinaciis saxeoba 

da vadebi, sxvadasxva specialistebis konsultaciis Sedegebi, D 

mSobelTan konsultaciis Temebi (rekomendacia D) 13 . 

im SemTxvevaSi, Tu bavSvi gadadis aRricxvaze sxva pirveladi jandacvis 

dawesebulebaSi, ganviTarebis istoria igzavneba aRniSnul dawesebulebaSi. 

erTiani aRricxvis sistema da bavSvis ganviTarebis istoria, erTi mxriv 

SesaZleblobas iZleva Camoyalibdes erTiani xedva konkretuli bavSvis 

ganviTarebasa da janmrTelobis mdgomareobaze, meore mxriv satatistikur 

monacemTa bazis mniSvnelovan safuZvels qmnis. 

vizitis aRwera 5 

vizitebis dros aucilebelad unda ganxorcieldes: 

⇒ bavSvis sruli gasinjva (anamnezis Segroveba, risk-faqtorebis 

Sefaseba, ganviTarebis monitoringi); 

⇒ ojaxis konsultireba bavSvis asakis Sesabamisi TematikiT. 

vizitis warmatebiT ganxorcielebis erT-erT aucilebel instruments, 

samedicino personalis dedasTan da bavSvTan komunikacia warmoadgens. 

janmrTeli bavSvis ganviTarebis Sefaseba da gasinjva vizitis dros unda 

moxdes mosaxerxebel, Tbil, kargad ganaTebul garemoSi. 

samedicino personali aRWurvili unda iyos bavSvis gasinjvisa da 

SefasebisTvis saWiro inventariT. 

sasurvelia vizitis dros bavSvis saTamaSoebis gamoyeneba, misi yuradRebis 

gadarTvis mizniT. 

vizitis periodSi aucilebelia samedicino personalis mier garkveuli 

Tanamimdevrulobisa da sistematurobis dacva, rac saSualebas miscems eqims 

Caataros yvela saWiro manipulacia. 

yvela vizitis Sedegi unda dafiqsirdes bavSvis ganviTarebis istoriaSi. 

janmrTelobaze meTvalyureobisas mizanSewinilia eqimi mozards mSoblis 

gareSec daelaparakos. am SemTxvevaSi ufro maRalia albaToba, rom igi 

Tavisuflad ilaparakebs sqesobriv momwifebasTan dakavSirebul 

problemebze, SesaZlo mavne Cvevebze, Casaxvis sawinaaRmdego saSualebebze 

da sxv. eqimTan gulaxdili urTierToba SesaZlebelia gaxdes problemis 

Tavidan acilebis sawindari 2 . 

komunikaciis instrumenti 2,5 

vizitis dros eqimi urTierTobas amyarebas, rogorc bavSvTan ise dedasTan 

da/an aRmzrdelTan. 

5

avSvis nebismier asakSi viziti sasurvelia daiwyos mSoblis gamamxnevebeli 

frazebiT, rac mas waaxalisebs Semdgom urTierTobaze da daexmareba eqims 

anamnezis SegrovebaSi. 

ufrosTan saubris procesSi eqimi unda ijdes mis pirispir, umjobesia 

mSobelTan da bavSvTan axlos Camojdoma, maTTan “Tvali TvalTan” 

kontaqti. 

yuradReba fokusirebuli unda iyos mSobelsa da bavSvze, Canawerebi unda 

gakeTdes gamokiTxvis procesSi. 

vizitis dros mizanSewonilia mSobels bavSvi xelSi ekavos an muxlebze 

ejdes. ufrosTan saubris procesSi eqimi akvirdeba bavSvis qcevas, ufrosisa 

da baSvis urTierTobas. dakvirveba bavSvze unda warmoebdes mSvid garemoSi. 

eqimi mSobels unda esaubrebodes mSvidi auRelvebeli da damajerebeli 

toniT. dedis Civilebis mimarT eqimi unda gamoxatavdes dainteresebasa da 

TanagrZnobas. 

gamokiTxvisas bavSvi sasurvelia iyos mSvidad da ar tirodes, raTa 

mSobeli iyos maqsimalurad koncentrirebuli da zustad pasuxobdes eqimis 

mier dasmul kiTxvebs. eqimma unda scados bavSvis yuradRebis mipyroba 

saTamaSoTi. 

gasinjvis drosEeqimma unda gaiTvaliswinos, rom adreuli asakis bavSvebi 

xSirad tirian fonendoskopis danaxvisas, amitom sasurvelia maTi 

yuradRebis fokusireba saTamaSoze. 

Sefasebis instrumenti - bavSvis sruli gasinjva 

1. anamnezis Segroveba – yvela viziti iwyeba detaluri anamnezis 

SegrovebiT. 

2. fizikuri ganviTarebis Sefaseba - yvela vizitis dros 

C 

aucilebelia bavSvis wonisa da sigrZis, agreTve wlamde asakSi 

Tavis garSemowerilobis gansazRvra. miRebuli monacemebis 

Sefaseba ix. fizikuri ganviTarebis rekomendaciaSi (ix. gaidlaini - 

bavSvis fizikuri ganviTarebis Sefaseba) (rekomendacia C) 6 . 

3. janmrTelobis mdgomareobis Sefaseba - sxvadasxva organosa da 

sistemis gamokvleva. 

4. ganviTarebis monitoringi - igulisxmeba uxeSi da natifi motorikis, 

socialur-emociuri, kognituri sferos Sefaseba (ix. gaidlaini _ 0-6 

wlis bavSvis ganviTarebis Sefaseba). 

5. kvebis Sefaseba - (ix. gaidlaini - 2 wlamde asakis bavSvis C 

kveba) 6 . (rekomendacia C) 6 . 

6. skrining testebiT Sefaseba – tardeba mxedvelobis, smenis, menjbarZayis 

saxsaris skrininguli kvleva, rac darRvevebis 

identificirebis da specialistTan referalis saSualebas C 

iZleva (rekomendacia C) 6 . 

6

gasinjva/janmrTelobis mdgomareobis Sefaseba 

sruli gasinjva janmrTel bavSvze meTvalyureobis vizitis mTavari 

komponentia. 

gasinjvis pirvel etapze umjobesia, iseTi manipulaciebis ganxorcieleba, 

romlebic ar aris Semawuxebeli bavSvisTvis da vizitis mimdinareobis 

procesSi eqims ar uqmnis bavSvTan urTierTobis problemas. bavSvis 

simSvidis dros tardeba sunTqvis sixSiris da xasiaTis Sefaseba. 

mniSvnelovania dedisa da eqimis maqsimaluri TanamSromloba. 

gasinjvis dros sxeuli mTlianad unda daTvalierdes, Sefasdes kanis, Zvalsaxsovani 

da kunTovani sistemebis mdgomareoba. Semdeg xdeba sasunTqi, gulsisxlZarRvTa, 

nervuli da saWmlis momnelebeli sistemis gamokvleva - 

palpacia, perkusia da auskultacia. Semdgom etapze xdeba genitaliebis 

daTvaliereba. 

gasinjvis dros eqimis xeli da fonendoskopi unda iyos Tbili. muclis 

Rrus organoebis palpaciis dros bavSvi aucileblad unda iwves 

mosaxerxebel gasasinj magidaze (Tbili, kargad ganaTebuli magida). eqims 

SesaZlebelia dasWirdes mSoblis daxmareba. gasinjvis procesSi mSobels 

SeiZleba ekavos bavSvis xeli, eferebodes da elaparakebodes mas. 

yurisa da pir-xaxis daTvaliereba gasinjvis damamTavrebeli safexuria. 

vizitis dros rekomendebulia bavSvis ugulvebelyofis da masze 

Zaladobis niSnebis arsebobis gamovlena (rekomendacia D) 13 . D 

Zaladoba SeiZleba iyos fizikuri, seqsualuri da emociuri, masze 

miuTiTebs rogorc fizikuri niSnebi (mag.: sisxlnaJRenTebi, Calurjebebi, 

Zvlis motexiloba, movlis deficiti da sxv.), ise bavSvis qcevis cvlilebebi 

(agresiuloba, undobloba da sxv.). 

vizitebi, romlebic imunizaciis kalendars emTxveva unda daiwyos 

temperaturis gazomviT 5 . 

mSobelTa konsultirebis instrumenti 13,14 

yvela vizitis aucilebel komponents mSoblis konsultireba warmoadgens. 

eqimi konsultirebas atarebs bavSvis asakis Sesabammis sakiTxebze (ix. 

gaidlaini – mSoblisKkonsultireba bavSvis movlisa da ganviTarebis 

sakiTxebze) 

janmrTel bavSvze meTvalyureobis vizitebis aRwera 

prenataluri viziti 

orsulis viziti pediatrTan an ojaxis eqimTan sasurvelia ganxorcieldes 

orsulobis III trimestrSi. 13 

prenataluri vizitis komponentebi 

• momavali mSoblebis ndobis mopoveba da maTTan urTierTobis damyareba; 

7

• momavali mSoblebisTvis informaciis miwodeba axalSobilobis 

periodis Sesaxeb; 

• mSoblebis informireba ZuZuTi kvebis sargeblianobaze da misi 

motivireba, bavSvis kvebis Sesaxeb swori gadawyvetilebis misaRebad. 

gansakuTrebuli yuradReba unda daeTmos Semdeg sakiTxebs: 

• ZuZuTi kvebis upiratesobas dedisa da bavSvisTvis; 

• kani-kanTan kontaqtisa da kvebis adreuli dawyebis mniSvnelobas; 

• samSobiaro saxlSi dedisa da bavSvis erTad yofnis 

upiratesobas 15 .NTHS 

I postnataluri viziti 

pirveli vizitis efeqtur Catarebas didi mniSvneloba aqvs bavSvze Semdgomi 

dinamiuri meTvalyureobis xarisxianad ganxorcielebisaTvis. 

vizitis CatarebisAadgili da vada – viziti tardeba binaze ojaxis eqimis an 

pediatris mier axalSobilis samSobiarodan gamoweridan pirveli sami dRis 

ganmavlobaSi. 

I postnataluri vizitis komponentebi 

anamnezis Segroveba 

• prenataluri anamnezi – orsulobis jeradoba, mimdinareoba, 

problemebi orsulobis periodSi, orsulze meTvalyureoba, 

Catarebuli mkurnaloba; 

• intranataluri anamnezi – mSobiarobis jeradoba, mimdinareoba, 

garTuleba, samedicino Careva; 

• postnataluri anamnezi – samSobiaro blokSi pirveladi adaptacia, 

dabadebis wona da sigrZe, disadaptaciuri sindromebis arseboba, 

axalSobilis wona samSobiarodan gawerisas, kvebis xasiaTi, reJimi, 

teqnika. 

axalSobilis sruli gasinjva: 

axalSobilis gasinjvis dros fasdeba: 

• saSiSroebis niSnebi (ix. danarTi 1); 

• anTropometruli monacemebi (wona, sigrZe, Tavis garSemoweriloba); 

• axalSobilTa disadaptaciuri sindromebis arseboba – fiziologiuri 

siyviTle, wonis kleba, orsulobis reaqciebi, SardmJava infarqti da 

sxva; 

• ganviTarebaze moqmedi risk-faqtorebi; 

• mSoblisa da axalSobilis urTierToba; 

• mSoblebis unari gauwion bavSvs Sesatyvisi movla. 

8

fasdeba: 

• zogadi mdgomareoba: sxeulis poza, moZraoba, kanis feri, gamonayris 

arseboba, Wipis Wrilobis mdgomareoba; 

• Zval-saxsrovani da kunTovani sistema: Tavis forma, didi yiflibandi, 

kunTTa tonusi; 

• sasunTqi da gul-sisxlZarRvTa sistema; 

• nervuli sitema - axalSobilTa refleqsebi (wovis, Ziebis, avtomaturi 

dgomis da siarulis, cocvis, moros, tacebis, xelis gul nikapis); 

• muclis Rrus organoebi; 

• genitaliebi; 

• defekacia da diurezi; 

• ZuZuTi kvebis teqnika da efeqturoba. 

skriningi 

• smena; 

• mxedveloba; 

• menj-barZayis displazia (ix. skriningis protokoli). 

gasinjvis procesSi fasdeba garemo, sadac bavSvi imyofeba. 

mSoblis konsultirebis Tematika 

• 

Tu bavSvi ZuZuTi kvebazea, eqimma unda aswavlos dedas ZuZuTi 

kvebis principebis dacva da problemebis arsebobis SemTxvevaSi 

A 

moaxdinos maTi adekvaturi marTva (rekomendacia A) 13 . 

• 

Tu bavSvi xelovnur kvebazea, mSobels unda gaewios konsultacia 

xelovnuri kvebis principebis, sakvebis momzadebisa da 

D 

usafrTxoebis wesebis dacvis Sesaxeb (rekomendacia D) 13 

• 

ganviTarebis xelSewyoba (fizikuri ganviTareba, gonebrivi ganviTareba, 

bavSvTan urTierToba, “holdingi” – xelSi daWera); 

• 

tirili, misi mizezebi da marTva; 

• 

axalSobilis movla (Wipis damuSaveba, kanis, Tvalis, yuris, cxviris 

tualeti da sxv.); 

• 

usafrTxoebis wesebi (bavSvis sawolis da etlis SerCeva, gaTbobis 

sistema, pozicia Zilis dros da sxv.); 

• 

mSoblis damokidebuleba bavSvTan; 

• 

saSiSroebis niSnebi, romlis drosac aucilebelia eqimTan 

dauyovnebeli viziti; 

• 

dedis reproduqciuli janmrTeloba. 

konsultirebis Temebze nabeWdi sainformacio masalis arsebobis 

SemTxvevaSi aucilebelia mSoblis uzrunvelyofa Sesabamisi literaturiT. 

vizitis mimdinareobis procesSi eqimi avsebs bavSvis ganviTarebis istorias. 

vizitis dasrulebisas unda dafiqsirdes Semdegi vizitis TariRi. 

9

II viziti 

vizitis CatarebisAadgili da vada – viziti tardeba ambulatoriaSi ojaxis 

eqimis an pediatris mier 1 Tvis asakSi. 

II vizitis komponentebi 

anamnezis Segroveba - kvebis xasiaTi, kvebiTi statusi, reJimi, teqnika, dedis 

Civilebi; 

bavSvis sruli gasinjva 

gasinjvis dros yuradReba unda gamaxvildes: 

• saSiSroebis niSnebis arsebobaze; 

• anTropometruli monacemebis Sefasebaze (wona, sigrZe, Tavis 

garSemoweriloba), gansakuTrebuli yuradReba eqceva wonis namats, 

rac saSualebas iZleva Sefasdes kvebis efeqturoba. 

• gonebrivi ganviTarebis Sefasebaze. 

tardeba bavSvis sruli gasinjva (ix. I viziti) da skriningi 

• smena, 

• mxedveloba, 

• menj-barZayis displazia (ix. skriningis protokoli). 

mSoblis konsultireba 

• kvebis teqnika da principebi; 

• ganviTarebis xelSewyoba (fizikuri da gonebrivi ganviTareba, bavSvTan 

urTierToba, TamaSi); 

• usafrTxoebis wesebi; 

• Zili; 

• saSiSroebis niSnebi, romlis drosac aucilebelia eqimTan 


• momavali imunizacia da misi mniSvneloba bavSvis janmrTelobisTvis, 

SesaZlo garTulebebi; 

• dedis reproduqciuli janmrTeloba; 



10

III viziti 



III vizitis komponentebi 

tardeba imunizacia acris kalendris mixedviT, rasac win uswrebs anamnezis 

Segroveba, ganviTarebis Sefaseba, sruli gasinjva, skrinigi, konsultireba. 

imunizaciis Catarebamde aucilebelia temperaturis gasinjva da 

dafiqsireba bavSvis ganviTarebis istoriaSi. 


• kvebis ZiriTadi principebi; 

• ganviTarebis xelSewyoba; 

• usafrTxo garemo; 




SesaZlo garTulebebi. 



bunebriv kvebaze myofi yvela bavSvi saWiroebs D vitamins daniSvnas 

Sesabamisi profilaqtikuri dozebiT. (ix. gaidlaini - mikronutrientebis 

deficitis prevencia da marTva) 

IV viziti 



IV vizitis komponentebi 


Segroveba, ganviTarebis Sefaseba, sruli gasinjva, skriningi, konsultireba. 




• kvebis ZiriTadi principebi; 



• saTamaSos SerCeva; 

11







V viziti 



V vizitis komponentebi 


Segroveba, ganviTarebis Sefaseba, sruli gasinjva, skriningi, konsultireba. 







• damatebiTi kvebis mniSvneloba, daniSvnis vadebi. sakvebis saxeoba, 

damatebiTi kvebis teqnika; 







VI viziti 



VI vizitis komponentebi 

tardeba anamnezis Segroveba, ganviTarebis Sefaseba, sruli gasinjva, 

mxedvelobis, smenisa da menj-barZayis saxsris skriningi, mSoblis mier 

bavSvis ganviTarebis Sefaseba specialuri kiTxvaris gamoyenebiT (PEDS; ix. 

12

gaidlaini – O0-6 wlis bavSvis ganvTarebis Sefaseba, danarTi mSoblis mier 

bavSvis ganviTarebis Sefasebis kiTxvari) da mSoblis konsultireba. 

bavSvis fizikuri da gonebrivi ganviTarebis Sefaseba dabadebidan 6 Tvis 

CaTvliT aisaxeba bavSvis ganviTarebis istoriaSi etapuri epikrizis saxiT. 





• sxvadasxva sakvebis daniSvnis vadebi, damatebiTi kvebis teqnika; 

• kbilebis amoWrasTan dakavSirebuli problemebi; 

• piris Rrus higiena; 


dauyovnebeli viziti. 

vizitis dasrulebisas unda dafiqsirdes Semdegi vizitis TariRi. vizitis 

mimdinareobis procesSi eqimi avsebs bavSvis ganviTarebis istorias. 

VII viziti 



VII vizitis komponentebi 

tardeba anamnezis Segroveba, ganviTarebis Sefaseba, mSoblis mier bavSvis 

ganviTarebis Sefaseba specialuri kiTxvaris gamoyenebiT, sruli gasinjva, 

konsultireba. 





• sxvadasxva sakvebis daniSvnis vadebi, damatebiTi kvebis teqnika; 

• kbilebis amoWrasTan dakavSirebuli problemebi; 






13

VIII viziti 



VIII vizitis komponentebi 


Segroveba, ganviTarebis Sefaseba, mSoblis mier bavSvis ganviTarebis 

Sefaseba specialuri kiTxvaris gamoyenebiT, sruli gasinjva, konsultireba. 




• ganviTarebis xelSewyoba 

• usafrTxo garemo 

• saTamaSos SerCeva 

• sxvadasxva sakvebis daniSvnis vadebi, damatebiTi kvebis teqnika 

• kbilebis amoWrasTan dakavSirebuli problemebi 

• piris Rrus higiena 

• Zilis problemebi, SiSebi da maTi daZlevis gzebi 





meTvalyureoba 12 Tvis Semdeg 

12-24 Tvemde – rekomendebulia 3 viziti. 

IX viziti 



vizitis komponentebi – anamnezis Segroveba, sruli gasinjva, ganviTarebis 

Sefaseba da konsultireba. xdeba bavSvis fizikuri da gonebrivi 

ganviTarebis Sefaseba 6 Tvidan 12 Tvis CaTvliT, rac aisaxeba bavSvis 

ganviTarebis istoriaSi etapuri epikrizis saxiT. 

14

konsultireba: 

• kvebis teqnika, sakvebis saxeoba – “ojaxis” sakvebi 

• ganviTarebis xelSewyoba (fizikuri ganviTareba, globaluri 

ganviTareba, bavSvTan urTierToba, TamaSi, disciplina, 

damoukedeblobis Cvevebis gamomuSavebis xelSewyoba); 

• bavSvis piradi higienis Cvevebis xelSewyoba; 


• dRis reJimi da Zilis Cvevebi; 

• tualetis Cvevis Camyalibebis principebi; 






X viziti 




Sefaseba da konsultireba 17,18,19 . tardeba imunizacia acris kalendris 

mixedviT. imunizaciis Catarebamde aucilebelia temperaturis gasinjva da 

dafiqsireba bavSvis ganviTarebis istoriaSi. xdeba bavSvis fizikuri da 

globaluri ganviTarebis Sefaseba 12 Tvidan 18 Tvis CaTvliT, rac aisaxeba 

bavSvis ganviTarebis istoriaSi etapuri epikrizis saxiT. 

damatebiT tardeba autizmis skriningi - autizmis savaraudo niSnebis 

gamovlena mSoblis kiTxvaris meSveobiT (ix. gonebrivi ganviTarebis 

gaidlaini) 

konsultireba: 

• ganviTarebis xelSewyoba (fizikuri ganviTareba, gonebrivi 

ganviTareba, bavSvTan urTierToba, TamaSi) 

• disciplina, damoukideblobis Cvevebis gamomuSavebis xelSewyoba 

• dRis reJimi da Zilis Cvevebi 

• tualetis Cvevis Sefaseba da Camoyalibebis principebi 




15



XI viziti 




Sefaseba, mSoblis mier bavSvis ganviTarebis Sefaseba specialuri kiTxvaris 

gamoyenebiT da konsultireba. 

saWiroebis SemTxvevaSi damatebiT tardeba autizmis skriningi. 

konsultireba: 

• racionaluri kvebis principebi, sakvebis saxeoba, “ojaxis sakvebi” 

• ganviTarebis xelSewyoba (fizikuri ganviTareba, globaluri 


damoukideblobis Cvevebis gamomuSavebis xelSewyoba) 

• bavSvis piradi higienis xelSewyoba 

• piris Rrus higiena 

• dRis reJimi da Zilis Cvevebi 


• mSoblis damokidebuleba bavSvTan 





XII, XIII, XIV viziti 


eqimis an pediatris mier Sesabamisad 3, 4 5 wlis asakSi. 

vizitis komponentebi – anamnezis Segroveba, sruli gasinjva, globaluri 

ganviTarebis Sefaseba, mSoblis mier bavSvis ganviTarebis Sefaseba 

specialuri kiTxvaris gamoyenebiT, smenis, mxedvelobis skriningi da 

konsultireba. mocemuli asakidan rekomendebulia arteriuli wnevis 

gasinjva. 

16

5 wlis asakSi tardeba imunizacia. imunizaciis Catarebamde aucilebelia 

temperaturis gasinjva da dafiqsireba bavSvis ganviTarebis istoriaSi. 

konsultireba: 

• racionaluri kvebis principebi; 



damoukideblobis Cvevebis gamomuSavebis xelSewyoba); 

• piradi higienis xelSewyoba; 


• mSoblis damokidebuleba bavSvTan; 

• usafrTxo garemo (ojaxSi, gareT _ seirnobis, dasvenebis, 

ardadegebis dros); 



XV, XVI, XVII, XVIII, XIX, XX - viziti 

vizitebis CatarebisAadgili da vada – viziti tardeba ambulatoriaSi 

ojaxis eqimis an pediatris mier Sesabamisad 6, 7, 8, 9, 10, 11 wlis asakSi. 

vizitebis komponentebi – anamnezis Segroveba, sruli gasinjva, ganviTarebis 



fasdeba 

⇒ kveba; 

⇒ fizikuri ganviTareba- anTropometruli monacemebi (wona, sigrZe, 

sxeulis masis indeqsi); 

⇒ globaluri ganviTareba; 

⇒ smena, mxedveloba; 

⇒ mSoblebisa da bavSvis urTierToba; 

⇒ saskolo moswreba da urTierToba skolis megobrebTan da 

bavSvebTan; 

⇒ bavSvze Zaladobisa da ugulebelyofis niSnebi; 

⇒ vaqcinaciis kalendri; 

sruli gasinjva damatebiT tardeba arteriuli wnevis gazomva yvela 

vizitis dros. 

17

konsultireba: 

• racionaluri kvebis principebi, sakvebis saxeoba; 


ganviTareba, bavSvTan urTierToba, Ffizikuri aqtivoba, disciplina, 

damoukideblobis Cvevebis gamomuSavebis xelSewyoba); 

• bavSvis piradi higienis xelSewyoba; 



• televizori da/an kompiuteri da bavSvi; 


• mSoblis damokidebuleba bavSvTan ; 

• usafrTxoebis wesebi manqanaSi, quCaSi moZraobisas, skolaSi 

usafrTxoeba. 



XXI, XXII, XXIII, XXIV viziti 

vizitebis CatarebisAadgili da vada – viziti tardeba ambulatoriaSi 

ojaxis eqimis an pediatris mier 12, 13, 14, 15 wlis asakSi. 

XXIV viziti emTxveva vaqcianaciias erovnuli kalendris mixedviT. 

vizitebis komponentebi – anamnezis Segroveba, sruli gasinjva, ganviTarebis 



damatebiT fasdeba 

⇒ biologiuri simwifis niSnebi rogorc vaJebTan aseve gogonebTan; 

⇒ mSoblebisa da mozardis urTierToba; 

⇒ damatebiT aucilebelia arteriuli wnevis gazomva yoveli vizitis 

dros 

⇒ saskolo moswreba da urierToba skolis maswavleblebTan da 

megobrebTan; 

⇒ mozardze Zaladobisa da ugulebelyofis niSnebi; 

bavSvebi romelTac mSoblis gadmocemiT aReniSnebaT TviTrwmenis 

daqveiTeba, SiSebi, depresia, Zilis darRvevebi, agresiuli qceva, ar yavT 

megobrebi, xSirad ityuebian da mavnebloben, agreTve avlenen 

cxovelebisadmi sastik damokidebulebas saWiroeben damatebiTi fsiqologis 

konsultirebas; 

18

konsultireba: 

• racionaluri kvebis principebi, sakvebis saxeoba; 

• Tambaqo, narkotikebi – maTi mavne zemoqmedeba mozardze zrdaganviTarebis 

procesSi; 

• sqesobrivi gziT gadamdebi infeqciebi da maTi prevencia, Casaxvis 

sawinaaRmdego saSualebebi; 

• piradi higienis xelSewyoba; 




• mSoblis damokidebuleba bavSvTan; 



• usafrTxoebis wesebi manqanaSi, quCaSi moZraobisas, skolaSi 

usafrTxoeba. 



superviziis vizitebze Casatarebeli skriningebis Sesaxeb detaluri 

informacia ixileT danarTSi. 

eqTnis viziti 21,22,23,24 

eqTnis vizitebis raodenoba pirveli wlis manZilze Seadgens 10-s. 

vizitebis vada – sasurvelia pirveli viziti Catardes 2 kviris asakSi, 

Semdegi vizitebi daemTxves vaqcinaciis Semdgom periodebs, rac Seexeba sxva 

vizitebis vadas isini SesaZlebelia gansazRvros individualurad, eqimTan 

da mSobelTan SeTanxmebiT. 

I viziti 

ACatarebis adgili - binaze 

vada - 2 kvira. 

mizani - axalSobilis fizikuri ganviTarebis Sefaseba, misi wonis 

kontroli. kvebis Sefaseba, kvebis problemebis identificireba da 

mSoblis konsultireba kvebis sakiTxebze. 

II, III, IV viziti 

vada - 2 Tve, 3 Tve, 4Tve 

igegmeba da tardeba pirveli, meore da mesame vaqcinaciis Semdgom. acris 

Semdgomi garTulebis Sefasebis mizniT. amave dros fasdeba mSoblis 

19

mier bavSvis movlis xarisxi da aRniSnul sakiTxebze mSoblTa 

informirebulobis done. eqTani atarebs konsultacias bunebrivi kvebis, 

usafrTxoebis principebis, ganviTarebis xelSewyobis Sesaxeb. 

V viziti 

adgili - binaze 

vada - 5 Tve 

fasdeba wonis namati da kvebis xasiaTi. eqTani atarebs konsultirebas 

aZlevs rCevas mSobelTan bavSvis ganviTarebas xelSewyobasTan 

dakavSirebiT. 

V- X vizitebi 

adgili - binaze 

vada – tardeba Sesabamisad 7, 8, 9,10, 11, 12 Tveze. 

bolo viziti emTxveva vaqcinaciis Semdgom periods da Sesabamisad 

fasdeba vaqcinaciis Semdgomi garTulebis arseboba. 

yvela vizitis dros fasdeba bavSvis fizikuri ganviTareba, misi wonis 

namati, kvebis xasiaTi. mniSvnelovania agreTve eqTnis dakvirveba 

mSoblisa da bavSvis urTierTobaze, bavSvze Zaladobis an 

ugulvebelyofis niSnebis arsebobaze. 

yvela vizitis Semdgom eqTani akeTebs Canawers bavSvis ganviTarebis 

istoriaSi, igegmeba Semdgomi vizitis TariRi 5, 25 . 

aucilebeli inventari 

janmrTel bavSvze meTvalyureobis ganxorcielebisaTvis aucilebelia eqims 

hqondes: fonendoskopi, Spadeli, otoskopi, gamanaTebeli kalami an patara 

fanari, saswori, sigrZisa da simaRlis sazomi, fizikuri ganviTarebis 

Sesafasebeli diagramebi. sasurvelia nabeWdi informacia konsultirebis 

Temebis mixedviT, romelsac eqimi gaatans mSobels an mozards saxlSi. 

gaidlainis miRebis xerxi/wyaro 

gaidlainis SemuSavebis meTodologia 

• zedamxedvelobis principebis Sesaxeb arsebobs samecniero 

mtkicebulebis safuZvelze Seqmnil rekomendaciaTa sakmaod 

mcire 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 iTvaliswineba saqarTvelos samedicino dawesebulebaTa 

rogorc adamianur, ise teqnikur resursebs. 

20

• rekomendaciaTa moZieba xorcieldeboda klinikuri 

rekomendaciebis saerTaSoriso reestrebSi eleqtronuli 

monacemTa bazebis gamoyenebiT internetSi. 

cxrili 2 

qveyana da resursis 

dasaxeleba 

internet-misamarTi 

aSS 

US National Guideline 

Clearinghouse (NGC) 

Centers for Disease Control and 

Prevention (CDC) 

Agency for Healthcare 

Research and Quality (AHRQ) 

Health Services Technology 

Assessment Text (HSTAT) and 

National Library of Medicine 

(NLM) 

Institute of Clinical Systems 

Improvement (ICSI) 

American Medical Association 

Canadian Medical Association 

(CMA) 

Health Canada – Population and 

Public Health Branch (PPHB) 

didi britaneTi 

National Institute for Clinical 

Excellence (NICE) 

Sheffield Evidence for 

Effectiveness and Knowledge 

(SEEK) 

National electronic Library for 

Health (NeLH) 

PRODIGY Clinical Guidance 

Scottish Intercollegiate 

Guidelines Network (SIGN) 

German Guideline Information 

Service (GERGIS) 

http://www.guideline.gov 

http://www.phppo.cdc.gov/CDCRecommends/Adv 

SearchV.asp 

http://www.ahrq.gov/clinic/cpgsix.htm 

http://hstat.nlm.nih.gov 

http://www.icsi.org 

http://www.ama-assn.org 

http://mdm.ca/cpgsnew/cpgs/index.asp 

http://www.hc-sc.gc.ca/pphb-dgspsp/dpg_e.html 

http://www.nice.org.uk 

http://www.shef.ac.uk/seek/guidelines.htm 

http://www.nelh.nhs.uk/guidelinesfinder 

http://www.prodigy.nhs.uk/ClinicalGuidance 

http://www.sign.ac.uk 

http://www.leitlinien.de/english/english/view; 

21

avstralia 

Australian National Health and 

Medical Research Council (NHMRC) 

axali zelandia 

New Zealand Guidelines Group 

(NZGG) 

mtkicebiTi medicinis 

specialistTa 

regionTaSorisi 

sazogadoeba 

http://www.health.gov.au/hfs/nhmrc/publicat/cphome.htm 

http://www.nzgg.org.nz/library.cfm 

http://www.osdm.org 

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 bavSvze zedamxedvelobis 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 pediatrTa akademia 

⇒ janmrTelobis msoflo organizacia 

⇒ nelsonis saxelmZRvanelo “pediatria” 

22

• rekomendaciebis mtkicebulebaTa doneebis gansazRvrisas gamoyenebuli 

iyo saqarTvelos Sromis janmrTelobisa da socialuri dacvis 

saministros mier mowodebuli mtkicebulebebis donisa da 

rekomendaciebis xarisxis sqema. 

mtkicebulebaTa doneebisa da rekomendaciebis xarisxis sqema 

done 

I 

II 

III 

IV 

Va 

Vb 

mtkicebulebis siZlieris 

done (Muir Gray) 

Zlieri mtkicebuleba, 

eyrdnoba minimum erT 

sistemur mimoxilvas, 

romelic efuZneba swori 

dizainis mqone 

randomizebul 

kontrolirebad kvleva 

Zlieri mtkicebuleba, 

eyrdnoba minimum erTi 

swori dizainis mqone 

randomizebul 

kontrolirebad kvleva 

klinikuri kvleva 

randomizaciis gareSe, 

kohortuli da SemTxvevakontrolis 

kvlevebi 

araeqsperimentuli 

multicentruli kvlevebi 

avtoritetul 

profesionalTa mosazreba 

klinikuri gamocdileba, 

aRwerilobiTi kvlevebi an 

eqspertTa angariSi 

xarisxi 

A 

B 

C 

D 

rekomendaciis xarisxi 

(Cook et al) 

eyrdnoba I donis 

mtkicebulebas da 

Sesabamisad mtkiced 

rekomendebulia 

eyrdnoba II donis 

mtkicebulebas da 

Sesabamisad mtkiced 

rekomendebulia 

eyrdnoba III donis 

mtkicebulebas SeiZleba 

CaiTvalos Sesabamisad 

eyrdnoba IV da V donis 

mtkicebulebas saWiroebs 

konsesuss 

gaidlainis ganaxlebis vada – 5 weli. 

alternatiuli gaidlani ar arsebobs 

23

gamoyenebuli literatura: 

1. Rethinking Well-Child Care in the United States: An International Comparison. Kuo A., , 

Inkelas,. Lotstein Debra S, ,. Samson Kyra M, Schor Edward L., Halfon,. PEDIATRICS 

Volume 118, Number 4, October 2006 1692-1702 

2. American Academy of Pediatrics. Guidelines for Health Supervision II. Elk Grove Village, 

IL:American Academy of Pediatrics; 2000 

3. Kogan MD, Alexander GR, Jack BW, Allen MC. The association between adequacy of 

prenatal care utilization and subsequent pediatric care utilization in the United States. 

Pediatrics. 1998; 

4. Grossman LK, Humbert AJ, Powell M. Continuity of care between obstetrical and pediatric 

preventive care: indicators of nonattendance at first well-child appointment. Clin 

Pediatr.2003 563–569 

5. Behrman, Kleigman, Jenson. Nelson Test Book of Pediatrics 17-th edition.2004 

6. Nutrition Assessment – pediatrics.JPEN2002 jan-feb;26(1suppl):13 SA-17SA. 

7. 

8. Green M, Palfrey JS, eds. Bright Futures: Guidelines for Health Supervision of Infants, 

Children, and Adolescents. 2nd ed. Arlington, VA: National Center for Education in 

Maternal and Child Health; 2000 

9. Dinkevich E, Hupert J, Moyer V,.BMJ V.323. 2001 Oct. 846-849. Committee on 

Psychosocial Aspects of Child and Family Health 

10. .Gilbert JR, Feldman W, Siegel LS, Mills DA, Dunnett C, Stoddart G. How many well-baby 

visits are necessary in the first 2 years of life Can Med Assoc J 1984;130:857-61. 

11. Canadian Task Force on the Periodic Health Examination. The Canadian guide to clinical 

preventive health care. Ottawa: Canadian Government Publishing, 1994. 

12. Feldman W. Well-Baby care in the firs 2 yeats of life.Canadian task force on preventive 

health care. www.ctfphc.org 

13. Van Doorninck WJ,Casldwell BM, Wright C, Frankerburg WK. The relationship between 

twelve month home stimulation and school achivment. Child Dev.1981, 52: 1080-3. 

14. Full guideline Second draft for consultation, National Collaborating Centre for Primary Care 

February 2006 

15. Guiding Principles for Complementary Feeding of the Breastfeed Child. WHO Global 

Consultation on Complementary Feeding, December 10-13, 2001. 

16. American Academy of Pediatrics, Work Group on Breastfeeding. 1997.Breastfeeding and the 

use of human milk. Pediatrics100(6):1035–1039. 

17. Green M, Palfrey JS, eds. Bright Futures: Guidelines for Health Supervision of Infants, 

Children, and Adolescents. 2nd ed. Arlington, VA: National Center for Education in 

Maternal and Child Health; 2000 

18. Leduc D, Rourke L, Rourke J, Constantini E, Health supervision from zero to five years 

using the 2006 Rourke Baby Record. Paediatric Child Health Vol 11 No 8 Oct 2006. 

19. Canadian Task Fotce on Preventive Health Care History and Methodology. www.ctfphc.org 

( Version current at Septambre 19, 2006), Expert Panel on the 18-th month Well Baby Visit. 

Getting it right fot lifetime. www.ctfphc.org (Version current at Septambre 19, 2006) 

20. Macinko J, Starfield B, Shi L. The contribution of primary care systems to health outcomes 

within Organization for Economic Cooperation and Development (OECD) countries, 1970– 

1998. Health Serv Res. 2003;38:831–865 

21. Leslie L, Rappo P, Abelson H, et al. Final report of the FOPE II Pediatric Generalists of the 

Future Workgroup. Pediatrics. 2000; 106:1199–122 

22. Hall DMB, Elliman D. Health for All Children. 4th ed. Oxford, 

24

England: Oxford University Press; 2003 

23. Newacheck PW, Hochstein M, Marchi KS, Halfon N. Access to health care for young 

children in the United States. In: Halfon N, McLearn KT, Schuster MA, eds. Child Rearing 

in America. New York, NY: Cambridge University Press; 2002:293–319 

24. Healthy Development of Young Children Enrolled in Medicaid. New York, NY: The 

Commonwealth Fund; 2002 

25. Bethell C, Reuland CP, Halfon N, Schor EL. Measuring the quality of preventive and 

developmental services for young children: national estimates and patterns of clinicians’ 

performance. Pediatrics. 2004; 113(suppl):1973–1983 

26. Pediatric Clinical Practice Giudelines for Nurses in Primary care. www. hc-sc.gc.ca.org 

27. Eye examination and vision Screening in infants, children and young adults. Pediatrics 

Vol.98 no1 July 1996 

28. Clinicalal practice guidelines : Early detection of developmental Dysplazia of the 

hip.Pediatrics Vol 105 No.4 April 2000 

29. WHO - www.who.org 

30. q. nemsaZe - janmrTel bavSvze zedamxedvelobis principebi 2000 

avtorTa jgufi: 

pediatrTa da neontologTa kavSiri àlternativa~ 

samuSao jgufi: 

⇒ eka kandelaki – medicinis doqtori, Tbilisis saxelmwifo 

samedicino universitetis zogadi pediatriis departamentis 

asistent-profesori. pediatrTa da neontologTa kavSiri 

àlternativa~-s wevri; 

⇒ 

⇒ 

⇒ 

maia xerxeuliZe – medicinis doqtori, Tbilisis saxelmwifo 




nani yavlaSvili – medicinis doqtori Tbilisis saxelmwifo 




Tamar manjaviZe – medicinis doqtori, saqarTvelos Sromis, 

janmrTelobisa da socialuri dacvis saministro. pediatrTa 

da neontologTa kavSiri àlternativa~-s wevri. 

eqspertebi: 

⇒ medea zarnaZe _ Sps #10 bavSvTa poliklinikis direqtori; 

⇒ qeTevan nemsaZe – m.m.d. Tbilisis saxelmwifo samedicino 

universitetis zogadi pediatriis departamentis profesori; 

25

⇒ lela woworia _ saqarTvelos Sromis, janmrTelobisa da 

socialuri dacvis saministros jandacvis departamenti; 

⇒ 

Tea TavidaSvili _ saqarTvelos Sromis, janmrTelobisa da 

socialuri dacvis saministros jandacvis departamenti. 

26

klinikuri praqtikis erovnuli rekomendacia (gaidlaini)

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