Enneaegse sünnituse ja enneaegse vastsündinu perinataalperioodi käsitlus (ajakohastatud)

Ravijuhendi töörühma liikmed (2026)

Pille Andresson (juht)	Lastearst, neonatoloogia osakonna juhataja, AS Ida-Tallinna Keskhaigla; Eesti Perinatoloogia Selts
Liis Toome	Lastearst, ravijuht, SA Tallinna Lastehaigla; Eesti Perinatoloogia   Selts
Tuuli Metsvaht	Anestesioloog, lastekliiniku juht, SA Tartu Ülikooli Kliinikum; laste ja vastsündinute intensiivravi ja farmakoteraapia professor, Tartu Ülikool; Eesti Anestesioloogide Selts, Eesti Perinatoloogia  Selts
Mari-Liis Ilmoja	Anestesioloog, AS Ida-Tallinna Keskhaigla; Eesti Anestesioloogide   Selts
Aune Siller	Naistearst-õppejõud, SA Tartu Ülikooli Kliinikum; naistearst, AS Medita Baltics; õppejõud, Tartu Ülikool; Eesti Naistearstide Selts; STILEÜ; töörühma liige kuni juuli 2023
Anne Rohtmets	Arst-õppejõud sünnitusabi ja günekoloogia alal, SA Tartu Ülikooli Kliinikum; (õppejõud) assistent, Tartu Ülikooli Naistekliinik; naistearst, AS LEH Võru Haigla; Eesti Naistearstide Selts; Eesti Arstide Liit; töörühma liige alates juuli 2023
Kadi Ploom	Naistearst-juhtivarst,  AS Ida-Tallinna  Keskhaigla;  Eesti Perinatoloogia Selts
Roksolana Goshka	Naistearst, naistehaiguste ja sünnitusabiosakonna vanemarst, SA Ida-Viru Keskhaigla; Eesti Naistearstide Selts; Eesti Perinatoloogia  Selts
Birgit Suits	Lastearst, SA Pärnu Haigla, AS Ida-Tallinna Keskhaigla; Eesti Perinatoloogia Selts, Eesti Lastearstide Selts
Merilin Lumpre	Lastearst, SA Pärnu Haigla; Eesti Perinatoloogia Selts; Eesti Lastearstide  Selts
Irena Bartels	Ämmaemandusjuht, AS Lääne-Tallinna Keskhaigla; Eesti Ämmaemandate  Ühing
Svetlana Müürsepp	Vastutav õde, SA Tallinna Lastehaigla; Eesti Õdede  Liit
Kristel Kukk	Patsientide esindaja, MTÜ Enneaegsed Lapsed

Ravijuhendi sekretariaadi liikmed (2026)

Liina Süvari (juht)	Lastearst, neonatoloog, AS Lääne-Tallinna Keskhaigla; Helsingi Ülikooli   Haigla
Maarja Hallik	Anestesioloog, anestesioloogia ja intensiivravi keskuse juhataja, AS Ida-Tallinna Keskhaigla; anestesioloog, SA Tallinna  Lastehaigla
Kadri Mägi	Arst-õppejõud sünnitusabi ja günekoloogia alal, SA Tartu Ülikooli Kliinikum; naistearst, Viljandi Haigla
Kristel Soonets	Arst-resident pediaatria erialal, SA Tartu Ülikooli  Kliinikum
Triin Laaneleht	Naistearst, AS Ida-Tallinna Keskhaigla; naistearst, Tallinna Eriarstikeskus  OÜ
Berit Lomp	Arst-resident pediaatria erialal, SA Tartu Ülikooli  Kliinikum
Jana Rojak	Lastearst, neonatoloog, Päijät-Häme Keskhaigla, SA Tallinna Lastehaigla, AS Ida- Tallinna Keskhaigla
Anna Vesper	Metoodikanõunik, Tartu Ülikool; sekretariaadis kuni märts  2026
Kadi Kallavus	Metoodik, Tartu Ülikool; sekretariaadis alates märts 2026

Ravijuhendi töörühma liikmed (2017)
 

Pille Andresson (juht)	lastearst, EPS-i esindaja, TTK, ELS
Pille Vaas	naistearst, EPS-i esindaja, ENS
Aune Siller	naistearst, ENS-i esindaja, EPS
Kadi Ploom	naistearst, EPS-i esindaja
Jana Klementsov	naistearst, EPS-i esindaja, ENS
Ena Volmer	naistearst, EPS-i esindaja, ENS
Liis Toome	lastearst, ELS-i esindaja, EPS
Heili Varendi	lastearst, ELS-i esindaja, EPS
Birgit Suits	lastearst, EPS-i esindaja, ELS
Tuuli Metsvaht	anestesioloog, EAS-i esindaja, EPS,  ELS
Vivian Arusaar	ämmaemand, EPS-i esindaja, TTK
Svetlana Müürsepp	õde, EÕL-i esindaja, EPS
Triinu Kalle	patsientide esindaja, MTÜ Enneaegsed Lapsed
Pille Teesalu	ämmaemand, EÄÜ esindaja, EPS

Ravijuhendi sekretariaadi liikmed (2017)
 

Anette Aija (juht)	neonatoloogia eriala arst-resident, EPS,  ELS
Valeria Angioni	naistearst, EPS, ENS
Imbi Eelmäe	lastearst-anestesioloog,  EPS,  ELS, EAS
Reet Moor	lastearst, anestesioloogia eriala arst-resident, EPS,  ELS
Anne Antson	lastearst, EPS, ELS
Maie Veinla	lastearst, EPS, ELS
Liisa Perk	günekoloogia ja sünnitusabi eriala arst-resident,  ENS
Annemai Jallai (Noorkõiv)	günekoloogia ja sünnitusabi eriala arst-resident,  ENS
Anna Vesper	metoodiline tugi

Keeletoimetaja:  Merily Šmidt
 
Tervisekassa esindaja: Silja  Vanaisak

Lühendid

AAP	American Academy of Pediatrics
ACOG	American College of Obstetricians and Gynecologists
AGA	gestatsioonivanusele vastav, ingl appropriate for gestational age
BiPAP	mitteinvasiivse ventilatsiooni režiim, kus opereeritakse kahe erineva rõhuga, st sissehingamisel on kasutusel kõrgem rõhk kui väljahingamisel, ingl Bi-level Positive Airway Pressure
BPD	bronhopulmonaalne düsplaasia, ingl bronchopulmonary dysplasia
CLD	krooniline kopsuhaigus, ingl chronic lung disease
CP	laste tserebraalparalüüs, ingl cerebral palsy
CPAP	pidev positiivne rõhk hingamisteedes, ingl continuous positive airway pressure
CRT	kapillaartäitumus, ingl capillary refill time
CRP	C-reaktiivne valk
EhhoKG	ehhokardiograafia, südame ultraheliuuring
ELBW	erakordselt väike sünnikaal, ingl extremely low birth weight
ELGA	erakordselt väike gestatsioonivanus, ingl extremely low gestational age
ERS	erütrotsüütide suspensioon
EvSu	tõendusmaterjali kokkuvõte, ingl evidence  summary
FiO2	hapniku osakaal sissehingatavas õhus, ingl fraction of inspired oxygen
GBS	B-grupi streptokokk, ingl group B  streptococcus
GKS	glükokortikosteroid
GN	gestatsiooninädal ehk rasedusnädal
HF	mitteinvasiivne hingamistoetus, mida rakendatatakse suure peavooluga soojendatud ja niisutatud õhuga ja/või hapnikulisaga, ingl high-flow
IGFBP-1	insuliinisarnast kasvufaktorit siduv proteiin 1, ingl insulin-like growth factor binding protein-1
INSURE	INSURE meetod (intubatsioon, surfaktandi manustamine, ekstubatsioon), ingl INtubation-SURfactant- Extubation

IUGR	üsasisene kasvupeetus, ingl intrauterine growth restriction
IVH	intraventrikulaarne hemorraagia, ingl intraventricular hemorrhage
KKV	kopsude kunstlik ventilatsioon
KNS	kesknärvisüsteem
LBW	väike sünnikaal, ingl low birth weight
LISA	vähem invasiivne surfaktandi manustamine, ingl less invasive surfactant administration
MAP	keskmine arteriaalne vererõhk, ingl mean arterial blood pressure
NAVA	mitteinvasiivne sünkroniseeritud ventilatsioonimeetod, kus hingamistoetust reguleerib vahelihase elektriline impulss ja sissehingamine on abistatud reguleeritud rõhuga, ingl neurally adjusted ventilatory assist
NEK	nekrotiseeriv enterokoliit, ingl necrotizing enterocolitis
NHFOV	nina kaudu vahendatav kõrgsagedusventilatsioon, ingl nasal high frequency oscillatory ventilation
NICE	National Institute for Health and Care Excellence
NICU	vastsündinute intensiivravi osakond, ingl neonatal intensive care unit
NIDCAP	enneaegsete vastsündinute individuaalset arengut ja vajadusi arvestav hooldus, ingl newborn individualised developmental care and assessment programm
NIPPV	mitteinvasiivne positiivse rõhuga ventilatsioon, ingl nasal intermittent/non-invasive positive pressure ventilation
NIV	mitteinvasiivne ventilatsioon, ingl noninvasive ventilation
NSAID	mittesteroidsed põletikuvastased ravimid, ingl non-steroidal anti-inflammatory drugs
PAMG-1	platsenta alfa-1-mikroglobuliin, ingl placental alphamicroglobulin-1
PDA	avatud arterioosjuha, ingl patent ductus  arteriosus
PEEP	positiivne ekspiratoorne lõpprõhk; positiivne rõhk hingamisteedes väljahingamise lõpul, ingl positive end- expiratory pressure

PICO	patsiendi-/sihtrühma-sekkumisvõrdluse  tulemusnäitaja, ingl population/patient-intervention-comparison-outcome
PIP	inspiratoorne tipprõhk; maksimaalne rõhk hingamisteedes sissehingamisel, ingl peak-inspiratory pressure
PMV	postmenstruaalvanus
PPROM	lootevee puhkemine ajavahemikul 22+0–36+6 rasedusnädalat, ingl preterm premature rupture of membranes
PROM	lootevee puhkemine pärast 37. rasedusnädalat (alates 37+0),  ingl premature rupture of membranes
PVL	periventrikulaarne leukomalaatsia, ingl periventricular leucomalacia
RCOG	Royal College of Obstetricians and Gynaecologists
RCT	juhuslikustatud kontrolluuring, ingl randomized controlled  trial
RDS	respiratoorse distressi sündroom, ingl respiratory distress- syndrome
ROP	enneaegsuse retinopaatia, ingl retinopathy of  prematurity
SGA	gestatsioonivanuse kohta väike, ingl small for gestational age
SI	prolongeeritud ehk pikendatud sissehingamisaeg, ingl sustained inflation
SoKo	soovituse kokkuvõtte tabel, ingl evidence to decision table
SpO2	saturatsioon – perifeerse vere hemoglobiini hapnikuga küllastatus
TõKo	tõenduse kokkuvõtte tabel, ingl summary of findings table
VLBW	väga väike sünnikaal, ingl very low birth weight
VLGA	väga väike gestatsioonivanus, ingl very low gestational age

Mõisted

Apgari hinne	ühtlustatud hinnang vastsündinu seisundile esimesel, viiendal ja kümnendal eluminutil
Antenataalne periood	ajavahemik alates raseduskestusest 22+0 nädalat kuni sünd
Enneaegne sünnitus	regulaarsete emaka kokkutõmmete teke enne 37. rasedusnädala lõppu koos samaaegsete muutustega emakakaelas
Enneaegne vastsündinu (ingl preterm infant)	ajavahemikul 22+0–36+6 rasedusnädalat sündinud laps
Enneaegse vastsündinu mõiste sünnikaalu järgi
Väikese sünnikaaluga (LBW) vastsündinu	vastsündinu sünnikaaluga alla 2500 g
Väga väikese sünnikaaluga (VLBW) vastsündinu	vastsündinu sünnikaaluga alla 1500 g
Erakordselt väikese sünnikaaluga (ELBW) vastsündinu	vastsündinu sünnikaaluga alla 1000 g
Enneaegse vastsündinu mõiste gestatsioonivanuse järgi sünnil
Hilisenneaegne vastsündinu	raseduskestuse korral 34+0–36+6 nädalat sündinud laps
Mõõdukalt enneaegne vastsündinu	raseduskestuse korral 32+0–33+6 nädalat sündinud laps
Väga väikese gestatsioonivanusega (VLGA) vastsündinu	raseduskestuse korral 28+0–31+6 nädalat sündinud laps
Erakordselt väikese gestatsioonivanusega (ELGA) vastsündinu	raseduskestuse korral 22+0–27+6 nädalat sündinud laps
Äärmiselt ebaküps vastsündinu	raseduskestuse korral 22+0–23+6 nädalat sündinud laps

Gestatsioonivanus	raseduskestus (loote vanus), mida arvutatakse ema viimase menstruatsiooni esimesest päevast nädalates ja päevades (nt 22 nädalat ja 0 päeva, väljendatakse 22+0)
Hiline surfaktantravi	surfaktandi manustamine kaks või enam tundi pärast sündi
Hingamistoetus	invasiivne – hingamistoetus, mida viiakse läbi alumistesse hingamisteedesse ulatuva hingamistee (intubatsioonitoru, trahheostoomia kanüüli) kaudu
	mitteinvasiivne – hingamistoetus, mida viiakse läbi invasiivset hingamisteed (intubatsioonitoru, trahheostoomia kanüüli) kasutamata
Inotroopne ravi	südamelihase jõudlust parandav ravi
Intranataalne periood	periood sünnitegevuse algusest kuni lapse sünnini
Kofeiinravi	kofeiintsitraat on valikravim enneaegsete apnoe farmakoloogiliseks raviks
Koorionamnioniit	lootekestade põletik
Känguruhooldus, ingl Kangaroo Mother Care	terviklik hooldusviis peamiselt enneaegsetele ja/või väikese sünnikaaluga imikutele, mis seisneb pikaajalises lapse-vanema nahakontaktis ning rinnapiimaga lapse toitmisel (ema oma või doonorpiim) ja lapse-vanema sideme tugevdamisel
Nabaväädi hiline sulgemine, ingl delayed cord clamping	nabaväädi sulgemine alates 60 sekundit pärast sündi
Nabaväädi  lüpsmine	protseduur, mille käigus haaratakse õrnalt pöidla ja nimetissõrmega kinni kas sulgemata või läbilõigatud nabaväädist ning kaks kuni neli korda õrnalt surudes suunatakse veri kuni 25 cm pikkusest nabaväädist 15–20 sekundi jooksul vastsündinu poole
Nabaväädi varajane sulgemine, ingl early cord clamping	nabaväädi sulgemine kohe sünni järel, enne 30 sekundi möödumist

Nahakontakt, ingl skin-to-skin contact	riieteta või mähkmega lapse asetamine vähemalt üheks tunniks lapsevanema paljale rindkerele või kõhule
Neonataal- ehk vastsündinuperiood	lapse 0.–28. elupäev
Normotermia	kehatemperatuur 36,5–37,5 °C
Oksügenisatsioon	kudede varustatus hapnikuga
Perekeskne ravi	vanemate kaasamine ja nende aktiivne osalemine lapse hooldus- ja raviprotsessis sünnijärgsel haiglaperioodil
Perinataalperiood	ajavahemik alates raseduskestusest 22+0 nädalat kuni vastsündinu esimese sünnijärgse elunädala lõpuni
Postmenstruaalvanus, ingl  postmenstrual age	gestatsioonivanusele sünnil liidetud lapse sünnijärgne vanus
Preduktaalne saturatsiooninäit	perifeerne hemoglobiini hapnikuga küllastatuse näit mõõdetuna vastsündinu paremal käel
Proaktiivne ravi	aktiivne sekkumine perinataalperioodis, eesmärk on vastsündinu parem tervisetulem. Proaktiivse ravi all mõistetakse üldiselt antenataalset GKS-ravi, tokolüüsi, antibakteriaalset ravi, neuroprotektsiooni, keisrilõiget lootepoolsetel näidustustel, vastsündinu elustamist ja intensiivravi
Profülaktiline surfaktantravi	surfaktandi manustamine enneaegsele vastsündinule kohe sünnil, et vältida RDS-i teket või selle süvenemist
Prolongeerimine	sünnituse edasilükkamine
Prolongeeritud ehk pikendatud sissehingamisaeg, ingl sustained inflation	esimestel hingetõmmetel kontrollitud rõhuga (20 cm H2O) pikem sissehingamisaeg, mida kasutatakse sünnil kopsude kiirema avanemise saavutamiseks
Perepalat vastsündinute intensiivravi osakonnas	palat, kus haiglasoleku ajal saab pere ööpäev läbi koos olla

Sünnituse induktsioon	sünnituse esilekutsumine vähemalt 22+0 GN-i kestnud raseduse korral ema- või lootepoolsetel näidustustel
T-kontuur	T-kujuline hingamiskontuur, mis võimaldab vastsündinu elustamisel rakendada kontrollitud rõhuga hingamistoetust
Toidutaluvus/ maojääk	kliiniliste sümptomiteta maojääk alla 4 ml/kg või alla 50% viimasest toidukorrast kolme tunni jooksul, ei ole vajadust vähendada toidukogust ega katkestada toitmist
Tokolüüs	sünnitustegevuse pärssimine ravimitega
Troofiline toitmine	enteraalne toitmine väikestes kogustes (10–15 ml/ kg päevas) ilma toidukoguseid suurendamata
Varajane enteraalne toitmine	enteraalse toitmise alustamine enne 6. elutundi
Varajane neonataalperiood	lapse 1.–7. elupäev
Varajane surfaktantravi	surfaktandi manustamine RDS-iga vastsündinule 1.–2. elutunnil
Vastsündinu	laps vanuses 0–28 elupäeva
Väljaõppe saanud meeskond	vastavat aparatuuri omav, intensiivravi väljaõppe ja kogemustega meeskond, kes osutab abi enneaegselt sündinud lapsele
Väga enneaegne vastsündinu	enne 32. GN-i sündinud laps
Üsasisene transport, ingl in utero transport	raseda transport enne lapse sündi kõrgema etapi haiglasse, et vältida vastsündinu sünnijärgset transporti

ANTENATAALNE PERIOOD

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