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A child born before 38 weeks of pregnancy is considered premature. Premature birth can be caused by many social factors, as well as the health status of the expectant mother, her obstetric history. Newborn premature babies, regardless of the degree of underdevelopment, need special care, especially in the first weeks of life.

Who are premature babies?

A baby born between 22 and 37 weeks of pregnancy, weighing from 500 to 2500 grams and body length from 27 to 45 cm is considered premature. Such children differ from full-term newborns in the incompetence and immaturity of almost all systems and organs of the body, as a result of which special care is required for premature infants.

Signs of prematurity

Basic clinical external signs immature newborns include disproportionate physique, open fontanels (lateral and small) of the skull, undeveloped fatty tissue or its complete absence, hyperemia of the skin, underdevelopment of the external and internal genital organs, physiological reflexes characteristic of full-term peers. In severe cases, apnea, weakness or lack of muscle tone occurs.

Anatomical and physiological characteristics of the child

Depending on the severity, the baby who is born ahead of schedule, the following anatomical and physiological features are distinguished:

1. The cardiovascular system is characterized by the presence of tachycardia (150-180 beats/min), muffled tones, and functional hypotension of the newborn. In grades three and four, cardiac septal defects (patent foramen ovale) are often present.
2. Respiratory system. Premature infants have narrow upper respiratory tracts and a high diaphragm, which leads to apnea and respiratory failure. Children with third and fourth degrees of prematurity long time are on artificial ventilation, because organs are not mature and cannot perform their function.
3. Skin and subcutaneous tissue. In newborns born prematurely, subcutaneous fat is almost completely absent, sweat and sebaceous glands do not function, as a result of which the body is not able to independently regulate body temperature.
4. Gastrointestinal tract. In premature infants, there is functional insufficiency of all parts of the gastrointestinal tract, low enzymatic activity of the pancreas and stomach.
5. Excretory system. Immaturity of the urinary system leads to an imbalance in the electrolyte balance in the body, decompensated metabolic acidosis and a tendency to edema and rapid dehydration.

Causes of prematurity

Statistically, there are several groups of risk factors, in the presence of which women have a high risk of giving birth to a baby prematurely:

1. Socio-biological factors. Presumably too early or late pregnancy (parents' age is less than 16-18 or more than 40-45 years), the presence bad habits a woman has poor living conditions, the presence of occupational hazards. In addition, the risk of having a premature baby is higher for those girls who are not observed in the antenatal clinic during pregnancy.
2. Unfavorable obstetric and gynecological history and pathological course of the current or past pregnancy. This includes a history of abortions, miscarriages, multiple births, placental abruption, etc. High risks Preterm birth can occur in women whose birth interval is less than two years.
3. Chronic extragenital diseases of the mother: hypertension, endocrine disorders, chronic infections.

Degrees of prematurity

Clinical classification according to the ICD of premature infants according to three criteria (weight, height, gestational age) involves four degrees of severity:

1. The first degree of prematurity is assigned to the baby if delivery occurs at 36-37 weeks of pregnancy; the weight is at least 2000 g, and the body length is from 41 cm. In this case, independent breathing is observed, the possibility breastfeeding. However, the baby needs observation by a pediatrician and monitoring of body thermoregulation.
2. The second degree of prematurity is assigned to a baby who was born at a period of 32 to 35 weeks with a weight of 1501 to 2000 g and a height of 36 to 40 cm. As a rule, such babies have a weak sucking reflex, so the baby has to be fed using a tube with special mixtures, there is low muscle tone, immaturity of the respiratory system.
3. The third degree in children born between 28 and 31 weeks of pregnancy, body weight ranges from 1001 to 1500 g, and height from 30 to 35 cm. Such babies are considered very premature and require intensive care under the supervision of doctors. The baby is in a closed incubator; breast milk or formula is fed through a tube due to the complete absence of the sucking reflex.
4. The fourth degree of prematurity is assigned at birth earlier than 28 weeks from the start of pregnancy, body weight is less than 1000 g, body length is less than 30 cm. In relation to such children, neonatology uses the term “newborns with extremely low body weight.”

Weight of a premature baby by month

The body weight of a premature baby increases maximum in the first six months of life (from 500 to 700 grams per month). By the end of the first year, the weight of a healthy newborn should be 9-10 kg. The rate of weight gain depends on the degree of miscarriage, concomitant diseases, congenital pathologies of organs and systems, and, especially, on the type of nutrition of the baby.

Age, months	Average weight of a child at various degrees of prematurity, grams

Development of premature babies by month

Modern medicine cannot accurately draw the line between the consequences of prematurity and the pathological conditions that arise in a baby born prematurely. Frequency of neurological, mental and physical disorders due to harmful effects during the internation period, their negative impact on the immature central nervous system. However, as babies grow and develop, birth defects are corrected. The table shows the development of a premature baby by month up to a year.

Premature age	Neuropsychic development
1-3 months	During the first three months of life, the baby experiences increased drowsiness, rare, weak crying, lack of periods of activity, and decreased appetite. Children who were born with a body weight of more than 2000 grams, in the second month of life, are actively awake after feeding, actively sucking breast milk a lot.
4-6 months	At the age of 4-6 months, a premature infant experiences further development the functionality of the analyzer organs (the newborn looks for an object by sound, examines bright, multi-colored toys), manipulates objects (first they feel, grabs hanging toys), and begins to rest their feet. During this period the baby for a long time lies on his stomach, responds to his parents' voice with a long smile, actively moves his arms and legs.
7-9 months	During this period, the baby develops the first speech reactions (weeps for a long time, pronounces individual simple syllables). He rolls over from his back to his stomach and vice versa, trying to crawl. While awake, the child plays with toys a lot, examines them, taps them, and holds them in his hands for a long time. Children begin to eat from a spoon and drink from a cup held by an adult.
10-12 months	At the age of 10 to 12 months, the baby actively crawls, can sit down on his own, and stands up to the barrier with support. As a rule, he walks freely, slightly holding on to objects. Children react to adults’ speech addressed to them, babble a lot, coo themselves, and begin to pronounce simple monosyllabic words.

Survival rate of premature babies by week

The chances of survival of a baby born prematurely depend directly on how many weeks it has been developing in the womb. According to the World Health Organization, a fetus is considered viable if it is born no earlier than 22-23 weeks and weighs at least 500 grams. The survival rate at this period is only 10-12%. Those born at 25-28 weeks recover in 60-70% of cases; at 29-30 weeks this figure is already 90%. Babies born at 31 weeks or older have a 95% survival rate.

What are the dangers of being born before 37 weeks?

If a baby is born before 37 weeks of gestation, then he has functional immaturity of all organs and systems. Seven-month-old infants typically suffer from acute respiratory failure and central insufficiency. nervous system. Such children lag behind their peers not only in physical but also mental development. In addition, underdevelopment of the excretory system can lead to the accumulation of toxins in the body and prolonged physiological jaundice.

Future consequences

The immaturity of the organs of children who are born prematurely can negatively affect their health in the future. The most common complications:

• rickets;
• heart failure;
• hydrocephalus of the brain;
• retinopathy of prematurity;
• early anemia;
• serious illnesses internal organs;
• chronic renal failure;
• psychomotor disorders;
• insufficiency of the endocrine glands.

Care of premature newborns

Nursing of children born prematurely in the maternity hospital is carried out regardless of the degree of prematurity and represents additional heating of the newborn from the moment of birth, rational therapy oxygen, dosed feeding. In the delivery room, the baby is immediately dried with warm, sterile diapers and immediately placed in an incubator to prevent heat loss. Premature infants weighing less than 1800 g at birth require supplemental heating for several weeks. The temperature in the room should be 24-25°C.

Bathing of children born prematurely begins every other day at two weeks of age. Weighing is carried out daily; height, head and chest circumference are measured at least once a week. Placing a premature baby on his stomach begins as early as possible, which helps increase the concentration of oxygen in the blood and helps reduce regurgitation and normalize muscle tone.

A healthy premature baby, who is able to maintain normal body temperature without additional heating, is constantly gaining weight and reaches 2000 g, can be discharged home if the umbilical wound is well healed, normal indicators hemogram and other laboratory tests. As a rule, discharge is made no earlier than 7-9 days after birth.

Incubator

On initial stage When nursing a premature baby, an incubator or incubator is used to maintain a constant body temperature and optimal feeding using a tube. There are several types of incubators:

1. Resuscitation. Such an incubator, in addition to heating, has a system for regulating the concentration of oxygen in the air, an ECG, an EEG, and a heart rate monitor. Thanks to modern incubators of this type in nursing departments, it is possible to carry out therapy for newborn children even with minimal vital signs at birth.
2. Transport. Necessary for transporting a newborn, incl. and at low temperatures, equipped with heating, supplied with oxygen. This incubator is lightweight due to the absence of a metal frame; the baby is secured with special belts.
3. Open. Used for nursing children of the first degree of prematurity. Helps maintain a constant body temperature for the newborn. In the absence of complications and constant weight gain, the stay in such an incubator is 7-10 days.

Features of feeding

The first feeding depends on the degree of prematurity, birth weight and general health. In the absence of severe pathologies, a premature baby receives nutrition already on the first day of life: in the first degree, feeding begins 2-3 hours after birth, placing them on the mother’s chest. For grades 2-3, feed from a special horn or tube. A premature baby of the fourth degree with low weight is fed first parenterally, then using a tube with a special mixture.

It is optimal to feed milk or colostrum to a woman’s mammary glands, because it's different high content essential protein, electrolytes, polyunsaturated fatty acids (linolenic acid promotes high rates of myelination and prostaglandin synthesis), low lactose content, a huge amount of antibodies and immunoglobulins that protect newborns from infections.

Clinical examination

Premature babies should be especially carefully observed by doctors after discharge from the maternity hospital to reduce the risk of developing severe pathologies in the future, normalize the rate of weight gain in low-birth-weight infants when bottle-fed, and improve physical development indicators. Examination by a pediatrician during the first month of life is carried out 1 time per week, from 2 to 12 - 1 time per month. Consultation narrow specialists necessary only in the first month of life, after only 2 r/year. Preventive vaccinations are administered according to individual plan.

Video

There is still an opinion that premature babies will never become like everyone else and will be limited in physical and mental abilities. Because of such stereotypes, many babies born prematurely end up abandoned in the maternity hospital. Let's try to figure out how things really are.

Which babies are considered premature?

Nature has laid down the period intrauterine development the unborn baby, and it lasts 40 weeks. During this period, all internal organs and systems of the fetus develop in order to safely meet the outside world and function fully. A premature newborn baby is born from 22 to 37 weeks with a body weight of less than 2.5 kg and a body length of up to 45 cm. At the same time, WHO establishes the following criteria for fetal viability: gestational age 22 weeks, weight more than 0.5 kg, body length from 25 cm, at least one recorded breath.

Why can a baby be born prematurely?

If a child was born premature, it is not always possible to find out the reasons for this. According to research, there are a number of possible provoking factors, including:

• old or too young age of mother, father;
• mother's unhealthy lifestyle;
• influence of occupational hazards;
• previous abortions;
• conception after recent childbirth (less than 2 years);
• chronic pathologies in the mother;
• past infections;
• physical injuries;
• intrauterine abnormalities in the fetus.

Features of premature babies

There is no clear “bar” that determines at what age a baby can survive, and there is a lot of debate around the topic of the need for proper medical care for premature babies. In our country on this moment The life of such babies, born with a weight of 500 g or more, is protected by a law that provides for their mandatory registration and nursing.

Low birth weight premature babies are born without being prepared for the conditions of extrauterine existence. Their vital organs are not yet fully mature and are not ready to function independently. Such crumbs have many external features, distinguishing them from infants born at term:

• impressively short height and weight;
• severe disproportion of body parts;
• softness of the cranial bones;
• underdeveloped genitals;
• the presence of a fluff on the back and shoulders;
• dry and thin skin;
• lack of subcutaneous fat;
• tightly closed eyes;
• decreased physical activity, etc.

The listed signs may be present partially or in combination in different premature babies. In addition, premature babies are characterized by undeveloped reflexivity, immaturity of the vascular system, and lack of hunger. They have problems with straightening their lungs and producing digestive enzymes. It should be remembered that over time, if efforts are made, the baby will look like an ordinary newborn, and all organs will improve their functioning.

Premature baby weight

Depending on the weight of the premature baby at birth, several degrees of prematurity are distinguished:

• I – from 2001 to 2500 g (mild);
• II – from 1501 to 2000 g (moderate prematurity);
• III – from 1001 to 1500 g (severe prematurity);
• IV – less than 1000 g (extremely premature).

The degree of prematurity is associated not only with the weight indicator, but also with signs of the general maturity of the body. For example, it happens that babies are born weighing 2.5 kg, but in terms of maturity of organs and functions they are inferior to those who gained 2 kg at the time of birth. When the baby's condition stabilizes, he will begin to gain weight. On average, the increase can be 90-120 g in seven days, and by the fourth or fifth month of life, the child’s body weight triples.

Growth of a premature baby

A baby who was born prematurely often has a body length in the range of 45-35 cm. This indicator depends on the period of prematurity. In the future, one should expect the following increase in height: about 2.5-5.5 cm per month during the first half of life, about 0.5-3 cm during the second half of the year. So, after a year, body length increases by 26-38 cm per year.

Premature babies - consequences

Extremely premature infants have a high percentage of disability and complications, although there are cases where babies with critically low weight not only survived, but also did not have any special health problems. Those born weighing a kilogram or more have much more optimistic chances. When special conditions are created, such children after a few years are no different from those born at a normal time.

We list what pathologies of premature babies can be diagnosed:

• hydrocephalus;
• vegetative-vascular dystonia;
• speech defects;
• astigmatism;
• myopia;
• hearing impairment;
• mental retardation;
• increased susceptibility to infections, etc.

Development of a premature baby by month to year

It has been established that the development of premature infants under one year of age is determined not only by gestational age and body weight, but also by general health and genetic factors. Often, in a favorable scenario, by the age of two they catch up with their peers in anthropometric, speech and psychomotor indicators, sometimes this happens by the age of 3-6.

Do not forget that a lot depends not only on the medical staff, but also on the parents of the baby. It’s worth making an effort, and the result will not be long in coming, and the baby will delight with more and more achievements. Premature babies, whose monthly development follows a special schedule, in many cases are not significantly behind full-term babies, which can be tracked in a table with averaged data.

Skill type	Children weighing up to 1500 g, months.	Children weighing up to 2000 g, months.	Children weighing up to 2500 g, months.	Full-term babies, months
Concentration on visual and auditory objects	3	2,5	1,5	0,5
Keeping your head on your stomach	5	4	3,5	2,5
Rollovers from back to tummy	7-8	6-7	5-6	5-6
Crawl	11-12	10-11	8-9	7-8
Independent sitting	10-11	9-10	8-9	6-7
Standing on legs without support	12-14	11-12	10-11	9-11
First steps	14-16	12-15	12-13	11-12

Caring for a premature baby

In order for a premature baby to develop normally, he needs to create special conditions, similar to those in the mother's womb. Many vital functions of a small body require artificial support, and the less premature babies weigh, the more equipment is needed medical institution, the more experienced the staff.

Nursing premature babies

When a premature baby is born, it is first cared for intensive care unit. The baby is placed in an incubator, where respiration, pulse and temperature are continuously monitored, artificial ventilation is provided, and nutrition is supplied. With moderate and mild prematurity, the baby can be placed in a heated crib. The period of postpartum adaptation is about one to two months, and in the presence of pathologies - longer.

In some medical institutions, kangaroo care is considered acceptable. This means that a child who can breathe and eat on his own is in constant physical contact with his mother - on her chest or stomach. Thanks to this, the baby quickly adapts to new environment, develops better. After discharge from the maternity hospital, prematurely born babies should be regularly examined by doctors, especially in the first year.

Feeding premature babies

Feeding premature babies is special. In the absence of a swallowing-sucking reflex, a formula for premature babies, to which hormones, amino acids, enzymes, glucose and other components are added, is supplied through a gastric tube. In the most severe cases, parenteral intravenous nutrition is provided. When the baby learns to suck, he is fed from a bottle with a nipple, and a little later he is applied to the breast (with a weight of at least 1.8 kg).

The nutrition of premature babies from about the second week of life can be based on mother's milk, which in this case is a priority over artificial mixtures. Complementary feeding for premature babies begins no earlier than 7-8 months of age, i.e. 1-2 months later than in ordinary infants, which is explained by the longer maturation of the digestive system.

Premature babies are considered children born between the 22nd and 37th weeks of gestation with a body weight of less than 2500-2700 g and a body length of less than 45-47 cm. The most stable indicator is gestational age.

The fetus is viable (according to WHO definition) with a body weight of 500 g or more, a body length of 25 cm or more, and a gestation period of more than 22 weeks. Russian national statistics on miscarriage (spontaneous termination of pregnancy at less than 37 completed weeks) fully take these recommendations into account. Statistics on prematurity (spontaneous or induced termination of pregnancy from a time when the fetus is considered viable) among those born alive takes into account only children from the 28th week of gestation weighing 1000 g or more and a body length of 35 cm or more. Of those born alive with a body weight of 500-999 g, newborns who survived 7 days after birth are subject to registration.

Number of premature babies in different countries ranges from 3 to 17%, in Russia - 3-7%. Preterm births have the highest morbidity and mortality rates. They account for about 75% of infant mortality in our country; in the most economical developed countries - 100%.

CAUSES OF PREMATURE BIRTH OF CHILDRENThe main reasons for premature birth of children are as follows.

Socio-biological factors.

Too young or too elderly age parents. If old age has a negative impact on pregnancy due to biological changes in the aging body, then the birth of premature babies in young mothers is due to unplanned pregnancies.

Miscarriage is influenced low level parental education and associated unhealthy lifestyle during pregnancy and lack of understanding of the importance of constant

medical supervision. Among children born to women who were not observed at the antenatal clinic throughout pregnancy, the perinatal mortality rate is 5 times higher.

Occupational hazards, bad habits, and hard physical labor play a big role in miscarriage. Bad influence Smoking not only affects the mother's health, but also the father's. Severe developmental defects in children of men who smoke for many years and/or smoke a large number of cigarettes occur 2 times more often than in children of non-smoking fathers.

Even with a desired pregnancy, the risk of miscarriage in single women is higher than in married women, which is due to social, household and psycho-emotional factors.

Previous abortions. Complete liquidation abortions using effective contraception can reduce the incidence of premature births by 1/3.

Short intervals between births (less than 2 years) can cause premature birth.

Mother's diseases.

Pathological course of pregnancy.

DEGREES OF PREMATURE

There are four degrees of prematurity (Table 4-1).

Table 4-1.Degrees of prematurity

Currently, the diagnosis usually indicates not the degree of prematurity, but the gestational age in weeks (a more accurate indicator).

SIGNS OF PREMATURE Clinical signs

The appearance of a premature baby depends on the degree of prematurity.

A very premature baby (body weight less than 1500 g) has thin, wrinkled skin of a dark red color, abundantly covered with cheese-like lubricant and fluff. (lanugo). Simple erythema

lasts up to 2-3 weeks. The subcutaneous fat layer is not expressed, the nipples and areola of the mammary glands are barely noticeable; the auricles are flat, shapeless, soft, pressed to the head; nails are thin and do not always reach the edge of the nail bed; The navel is located in the lower third of the abdomen. The head is relatively large and makes up 1/3 of the body length; limbs are short. The sutures of the skull and fontanels (large and small) are open. The bones of the skull are thin. In girls, the genital gap gapes as a result of underdevelopment of the labia majora, the clitoris protrudes; In boys, the testicles are not descended into the scrotum.

In more mature premature babies appearance other. Leather Pink colour, there is no fuzz on the face (at birth in the 33rd week of gestation), and later on the body. The navel is located slightly higher above the womb, the head is approximately 1/4 of the body length. In children born at more than 34 weeks of gestation, the first curves appear on the ears, the nipples and areola are more visible, in boys the testicles are located at the entrance to the scrotum, in girls the genital slit is almost closed.

Premature infants are characterized by muscle hypotonia, decreased physiological reflexes, motor activity, impaired thermoregulation, and weak cry. A very premature baby (less than 30 weeks of gestation) lies with outstretched arms and legs; sucking, swallowing and other reflexes are absent or weakly expressed. Body temperature is not constant (can drop to 32-34? C and easily rises). At birth after the 30th week of gestation, a premature infant is found to have partial flexion of the legs at the knee and hip joints; sucking reflex is good. In a child born at 36-37 weeks of gestation, the flexion of the limbs is complete, but unstable; a distinct grasping reflex is evoked. In the first 2-3 weeks of life, a premature infant may have intermittent tremor, mild and unstable strabismus, and horizontal nystagmus when changing body position.

Premature boys and girls do not differ in anthropometric indicators, since these differences are formed on last month pregnancy (full-term boys are larger than girls).

Features of internal organs

Morphological and functional immaturity of internal organs also corresponds to the degree of prematurity and is expressed especially sharply in very premature infants.

Breathing in premature babies is shallow with significant fluctuations in respiratory rate (from 36 to 76 per minute), with a tendency to tachypnea and apnea lasting 5-10 s. In children born at less than 35 weeks of gestation, the formation of surfactant is impaired, which

This prevents the collapse of the alveoli during exhalation. They develop SDR more easily.

Heart rate in premature babies is characterized by great lability (from 100 to 180 per minute), vascular tone is reduced, systolic blood pressure does not exceed 60-70 mm Hg. Increased permeability of vascular walls can lead to disruption cerebral circulation and cerebral hemorrhage.

Due to the insufficient maturity of the renal tissue, its function to maintain acid-base balance is reduced.

All gastrointestinal enzymes necessary for the digestion of breast milk are synthesized, but are characterized by low activity.

In premature infants, there is no relationship between the intensity of jaundice and the degree of transient hyperbilirubinemia, which often leads to underestimation of the latter. Immaturity of the liver and the associated insufficient activity of the enzyme glucuronyltransferase, increased permeability of the blood-brain barrier (BBB), as well as rapid breakdown of red blood cells can lead to the accumulation of indirect bilirubin in the blood in the first days of life and the development of bilirubin encephalopathy even with a relatively low concentration of bilirubin (170-220 µmol/l).

Laboratory research

In the first days of life, premature infants are more likely than full-term infants to experience hypoglycemia, hypoproteinemia, hypocalcemia, hypomagnesemia, hyperkalemia, and decompensated metabolic acidosis. The content of erythrocytes and Hb at birth is almost the same as in full-term infants, but the HbF content is higher (up to 97.5%), which is associated with intense hemolysis. From the second day of life, red blood counts change at a faster rate than in full-term infants, and at the age of 6-8 weeks, a deviation in the hemogram typical of premature infants appears - early anemia of prematurity. The leading cause of anemia is considered to be low production of erythropoietin. The content of leukocytes is the same as in full-term infants, but the presence of young forms up to promyelocytes is characteristic. The first crossover of granulocytes and lymphocytes occurs the later the more degree prematurity (with degree III - by the end of the first month of life).

DEVELOPMENTAL FEATURES OF PREMATURE CHILDREN Physical development

The physical development of premature infants is characterized by higher rates of increase in body weight and length during the first year

life. The smaller the weight and body length of a premature infant at birth, the more intensely these indicators increase throughout the year.

By the end of the first year of life, body weight increases as follows: with IV degree prematurity by 8-10 times, III degree - by 6-7 times, II degree - by 5-7 times, I degree - by 4-5 times. Body weight increases unevenly. The first month of life is the most difficult period of adaptation, especially for a very premature baby. Initial body weight decreases by 8-12% (in full-term infants by 3-6%); recovery is slow. At a gestational age of less than 32 weeks, body weight often reaches initial values only towards the end of the first month of life and begins to increase more intensively from the 2nd month.

The body length of a premature baby by the end of the first year of life is 65-75 cm, i.e. increases by 30-35 cm, while in a full-term baby the body length increases by 25 cm.

Despite the high rates of development, in the first 2-3 years of life, premature children lag behind their peers born full-term. Leveling occurs after the third year of life, often at 5-6 years. In the future, asthenia and infantility are often observed in children born prematurely, but indicators of physical development characteristic of full-term peers are also possible.

Psychomotor development

In psychomotor development, healthy premature infants are compared with their full-term peers much earlier than in physical development. Children with degree II-III prematurity begin to fix their gaze, hold their head up, roll over, stand up and walk independently, and pronounce their first words 1-3 months later than full-term children. Premature children “catch up” with their full-term peers in terms of psychomotor development in the second year of life; with stage I prematurity - by the end of the first year.

FEATURES OF CARE OF PREMATURE INFANTSNursing of premature babies is carried out in two stages: in the maternity hospital and in a specialized department. Then the child comes under the supervision of the clinic.

All over the world, great importance is attached to “gentle nursing of premature babies” with limited intensive care, stressful situations, pain. After birth, the premature baby should be placed in sterile, warm diapers (“optimal comfort”). Cooling immediately after birth, while still in the delivery room, often dooms all further care to failure. So, if the body temperature of a premature infant dropped only once to 32? C

and lower, mortality reaches almost 100%, even with proper use of all modern methods care and treatment. In the first days of life, very premature babies or premature babies in serious condition are kept in incubators. They maintain a constant temperature (from 30 to 35? C, taking into account individual characteristics child), humidity (in the first day up to 90%, and then up to 60-55%), oxygen concentration (about 30%). The child’s body temperature can be maintained in a heated crib or in a regular crib using heating pads, since the longer the stay in the incubator, the more likely child infection. The optimal indoor air temperature is 25? C. It is necessary to support the child’s adaptive reactions by dropping native mother’s milk into the mouth from a pipette, heated diapers, a long stay on the mother’s chest (like a “kangaroo”), the calm voice of a nurse, and stroking movements of her hands.

Only 8-10% of healthy premature babies with a birth weight of more than 2000 are discharged home from the maternity hospital. The rest are transferred to specialized institutions for the second stage of nursing.

FEATURES OF FEEDING PREMATURES

Features of feeding premature infants are due to their increased need for nutrients ah due to the intense physical development, as well as functional and morphological immaturity of the gastrointestinal tract, and therefore food should be administered carefully. Even very premature babies should begin to be fed in the first hours of life due to the catabolic nature of metabolism, hypoproteinemia and hypoglycemia.

With parenteral nutrition, the child’s intestines are quickly populated by opportunistic microflora. At the same time, the permeability of the mucous membranes of the gastrointestinal tract increases, which contributes to the generalization of the infectious process. Parenteral nutrition is used only in extremely severe conditions in very premature infants and for a limited period of time. For such children, it is more appropriate to prescribe round-the-clock drip administration of native mother's milk.

Infants with a gestational age of more than 28 weeks, as well as all premature infants with SDD and a weak sucking reflex, breast milk is administered through a gastric tube. If satisfactory general condition, a sufficiently pronounced sucking reflex and a body weight at birth of more than 1800 g can be applied to the breast after 3-4 days. Premature babies with a birth weight of less than 1500 g are put to the breast from the third week of life. If the mother does not have milk, specialized formulas for premature infants are prescribed

(for example, “Nenatal”, “preNAN”, etc.) When the child reaches a body weight of 2500-3000 g, the child is gradually transferred to regular breast milk substitutes.

Nutrition calculations are made in accordance with the needs of the child’s body per 1 kg of body weight per day: 1-2 days of life - 30 kcal, 3rd day - 35 kcal, 4th day - 40 kcal, then 10 kcal more daily up to the 10th day of life; on the 14th day - 120 kcal, from the 21st day of life - 140 kcal.

When determining the volume of food, the individual characteristics of the child should be taken into account: very premature babies from the 2nd month sometimes absorb a volume of breast milk corresponding to 150-180 kcal/kg.

LONG-TERM CONSEQUENCES OF PREMATUREAmong premature infants, the risk of developing mental and physical disabilities is higher than among full-term infants.

Severe psychoneurological disorders in the form of cerebral palsy, decreased intelligence, hearing and vision impairment, and epileptic seizures occur in 13-27% of premature infants.

In premature infants, developmental defects are 10-12 times more likely to be detected. They are characterized by disproportionate development of the skeleton, mainly with deviations towards asthenia. Many of them subsequently have an increased risk of “school maladjustment.” Attention deficit hyperactivity disorder is more common among those born prematurely.

Women born very prematurely often subsequently experience menstrual irregularities, signs of sexual infantilism, the threat of miscarriage and premature birth.

Despite the above, with proper care and nutrition, premature babies usually grow up healthy and become full-fledged members of society.

PREVENTION OF PREMATURE BIRTH OF CHILDRENPrevention of premature birth of children involves protecting the health of the expectant mother; prevention of medical abortions, especially in women with menstrual irregularities and neuroendocrine diseases; Creation favorable conditions for pregnant women in the family and at work; timely identification of risk groups and active surveillance over the course of pregnancy in these women.

In this article:

All over the world, including Russia, there is an increase in cases of premature birth of babies. According to statistics, every tenth child is premature, or, if translated into numbers, about 8-13 million babies around the world are in a hurry to see the world several weeks or months ahead of schedule. This includes “extremely premature” babies weighing up to 1 kg. Such a child needs special care. Extremely premature babies in 86% of cases, despite measures taken, die in their first few weeks of life. Of the remaining 14%, only 6 out of 100 have a chance of development without any deviations, defects or future disabilities. The rest are doomed.

In developed countries, premature babies are nursed in 96% of cases, in Russia only in 28.

Which babies are considered premature

The intrauterine fetus development program provides for 280 days, or 40 weeks. It was during this period that everything internal systems and the baby’s organs finally develop and become stronger to meet the environment. Premature babies are those children who were born several weeks ahead of schedule: everyone who was born before the 37th week with a body weight of less than 2500 g. A child born at 38-39 weeks weighs, looks and is no different in health from children born at 40 weeks. They are developing well, they have good health, do not have any physical and mental disorders. The only thing is that such premature babies need special nutrition and vaccinations. Feeding premature babies at 38-39 weeks is carried out under supervision.

At what age can such a child be born?

To begin with, we should say about the generally accepted stages of prematurity by body weight:

1. 2001-2500
2. 1501-2000
3. 1001-1500
4. Less than 1000g.

Since 1974, the World Health Organization has proposed, based on collected statistics and successful practice, consider as viable children born with a body weight of at least 500 g and a period of at least 22 weeks. This is the minimum, which however does not guarantee a favorable outcome. You need to understand that a child born within a few months is weak in all vital parameters.

The shorter the period and the lower the body weight, the more experienced the center or department is required, the greater the risk associated with death. Premature babies are demanding in terms of conditions, care, and nutrition.

Causes of prematurity

There are many factors that influence a baby to be born premature.

Social and economic:

1. Lack or insufficient medical care;
2. Poor nutrition (lack of minerals and vitamins), even several months before the expected birth;
3. Presence of bad habits (smoking, drug addiction, alcohol);
4. Severe stress over several weeks, or lack of desire for the child;
5. Harmful or dangerous workplace(dust, radiation, monotonous work, heavy lifting, irregular working day or week). Working seven days a week for several weeks in a row;
6. Insufficient education of parents.

Social and biological:

1. The age of a pregnant woman (before 18 or after 35) can cause the baby to be premature;
2. The father's age (before 18 or after 35) can cause the child to be premature;
3. The presence of a “bad” history (termination of pregnancy, miscarriage, criminal abortion within a few months);
4. Genetic predisposition or diseases of parents;
5. Marriage between relatives.

Various diseases:

1. The presence of chronic diseases of the mother, which could worsen during pregnancy;
2. Past acute infectious diseases, possible complications after ARVI, flu, severe colds, rubella, chickenpox, and so on;
3. On the part of the fetus, there may also be various anomalies in the development of the cardiovascular system, internal organs, and its position; hormonal dysfunctions, premature rupture of water, chromosomal defects;
4. The presence and development of intrauterine infections: chlamydia, mycoplasma, ureplasma. Or other, undetected or untreated sexually transmitted diseases;
5. Insufficient maternal weight (less than 48 kg);
6. Complications after vaccination;
7. A premature baby may be born due to constant stress.

What is the immaturity of a premature baby?

Premature babies are very different from healthy ones not only appearance, but also the structure of internal organs. Especially at birth at 3, 6, 8 weeks. The skin is dry, thin, wrinkled. The body is covered with fluff. There are no grooves on the soles of the feet. The nails do not have a protrusion. Ears have soft cartilage, poorly formed.

The immaturity of the blood vessels is clearly expressed: if the child is placed on his side, the skin takes on a pinkish tint.

The general physique of the child: a relatively large head against the background of an underdeveloped skeleton (torso).
In premature babies poor development sucking and other reflexes. This affects the feeding of premature babies. They are inactive. If in healthy children the umbilical cord heals quickly, then here the processes proceed much more slowly, including the falling off of the umbilical cord.

Children born prematurely (several weeks before), unlike healthy ones, have problems with straightening their lungs. If healthy child After inhalation, the lungs straighten and remain in this position, but in a premature baby they can collapse again. There are problems with the production of digestive enzymes, so feeding and nutrition of premature babies follows a special program.

For such children, special vaccinations may be used.

A premature baby may sleep for a long time for several months, cry a lot, and react with convulsive movements. The underdevelopment of the nervous system affects. In the first few weeks there may be serious problems with body thermoregulation.

Care

The period of postpartum adaptation in premature babies: those born several weeks in advance, is about a month or two. Considering the immaturity of all life support systems, failures or increased deadlines are possible.

After birth, a premature baby needs special care, including feeding. The child is placed in artificially created conditions - an incubator. This is in some way an incubator for maintaining vital important functions body. The incubator is fully automated. Equipped with special sensors, in particular for monitoring the baby’s body temperature. Since heat exchange is impaired, a drop in body temperature to 32°C is critical and can lead to death.

All data is transferred to the software, which, depending on the indications and development of the baby, makes certain decisions. In the event of a power outage, an emergency power supply is provided.

Caring for premature babies using the kangaroo method

Kangaroo care involves childbearing through maximum physical contact baby and mother (skin to skin). This method allows a premature baby to quickly adapt to environment, over several weeks or months, has a positive effect on the baby’s development. It also compensates for heat loss.

How larger area contact, the better. Additionally, the baby is covered with a warm diaper and put on a hat. This is a kind of clothing for premature babies.

How long will mother and baby stay in the hospital?

This usually depends on what condition the mother is in and what category of prematurity the baby falls into. The period for the mother can range from several weeks to a month, for the child about two months. Caring for premature babies depends on how many weeks before the due date the baby was born and how well he tolerates vaccinations.

Will a premature baby be different in development from other healthy ones when he grows up?
With proper care, despite the underweight and underdevelopment of the body, a premature baby will not differ from healthy peers in the future. The neuropsychic development of such children is slower, but eventually, with proper care, everything returns to normal. For example, if a baby was born at 28 weeks, then on his own, with proper care, he will begin to roll over no earlier than 4-8 months.

Breastfeeding

Feeding of premature babies occurs under the close supervision of medical workers. Premature babies grow faster than their peers, they require more nutrients, but the digestive system is weak, so a special formula is prepared.

Vaccinations

Vaccinations are given only after the child has grown stronger and gained weight. Approximate time 6-8 months. Basic vaccinations: BCG, hepatitis. Any mother has the right to refuse them.

Criteria, development and norms of behavior

The norm is long sleep, tearfulness, convulsive response to external stimuli, relatively inhibited development of reactions or its short absence, rapid fatigue, apathy. Don't panic if your child behaves In a similar way. This may last for several weeks or months.

What to do if alarming symptoms arise?

It is imperative to contact medical workers which will help and provide proper care if: the child does not take the breast for a long time, there is constant vomiting, the child has turned yellow, emits a prolonged, painful cry, the child has stopped breathing (apnea), cardiac arrest (in this case, immediate measures should be taken - cardiac massage ), severe pallor.

In Russia, premature babies were neglected before the standard was introduced. Now, if a child was born a few weeks earlier with a weight of up to 500 g, doctors are obliged to take such a baby out and provide him with everything the necessary conditions and nutrition. Feeding of premature babies is carried out only by qualified, experienced workers.

Useful video about premature babies

There are children with deep prematurity up to 22-23 weeks, and sometimes with mild prematurity. Of course, the success of nursing depends on how early the baby was born.

We have summarized the data and will tell you what every parent of a premature baby faces. They are somewhat subjective and emotional. We hope this will help mothers who have had a premature birth and have to care for a tiny baby, and will give everyone else knowledge about what and how such children and their parents live. So, 10 facts about premature babies

1. He does not know how to suck, swallow, or breathe.

It sounds simple, doesn't it? But if the baby cannot do at least something from this list, then you will not be allowed to go home after childbirth.

2. Parents quickly learn to read medical devices.

When you sit at the incubator day and night with your baby, you can distinguish every sound signal of the device connected to the tiny body no worse than the hospital medical staff. You can tell by the sound whether the baby is yawning or whether you urgently need to press the button to call a nurse. You will never forget these sounds and will not confuse them with any others. Even when everything is over, and you hear such a squeak on TV, your heart will skip a beat and everything inside will turn over.

3. Always in touch

The nurse and doctor's phone number should be on speed dial on your phone.

A mother cannot sit with her baby forever. Someday there comes a time when she needs to go home to take a shower, eat, sleep, or needs to pay attention to her older child... Then she cannot do without the phone number of the nurse who is looking after the baby at that moment.

4. Breast milk is worth its weight in gold.

Breast milk is ideal for feeding a premature baby. And a mother who plans to feed her baby knows how to save him. A breast pump can help. She has to follow the same schedule day after day as if she were feeding the baby at home, in special containers for the baby, who is in intensive care.

5. He must be kept warm at all times.

It would seem that there is nothing unusual here. But mom needs to constantly monitor this process. And all because, trying to regulate its body temperature, the baby burns too many calories. This means that he is gaining weight poorly, risks his health and may develop complications.

6. Clothes for a premature baby are always too big.

Premature babies are most often very small. Therefore, you cannot rely on age indicators when buying clothes. Usually you have to buy two sizes smaller.

7. The common cold becomes dangerous.

There is nothing strange in the fact that parents of children who were born prematurely become germaphobes (fear of bacteria). They understand that even one sneeze towards their child can cause an unpredictable reaction in him.

8. All stages of development of a premature baby occur somewhat later.

The ability to hold up the head, roll over, sit, crawl and walk in all premature babies develops a little later than in normal babies. But every achievement of the baby is a holiday.

9. Nothing prevents a premature baby from sleeping.

Many children wake up at the slightest disturbance during sleep, and it is simply unrealistic to put them back to sleep. The regime that a prematurely born child endured (hourly feeding, constant checks of the operation of devices, health checks, etc.) makes him indifferent to light and unnecessary sounds. That is why such children sleep peacefully even in a thunderstorm.

10. Prematurely born babies are bullies.

These little ones came into the world with a struggle. Fighting for every breath and every gram they gain. And there is nothing strange in the fact that in the future they try to achieve everything through struggle. Therefore, these little ones grow up strong-willed and ready to show the world who’s boss.