Morphofunctional characteristics of premature infants. B) big open. Cardiovascular system disorders

The course of the newborn period largely depends on the degree of maturity of the child, which is inextricably linked with the maturity of the fetus. Fetal maturity is a state characterized by the readiness of the organs and systems of the body to ensure its extrauterine existence. It is largely due to the nature of the pregnancy.

During the initial examination of a newborn, a neonatologist should evaluate him according to three parameters:

• gestational age (determining term/prematurity criterion );
• indicators physical development;
• degree of morphological and functional maturity.

Currently, parameters of physical development and even the degree of morphological and functional maturity are not criteria for diagnosing prematurity, because they may not be appropriate for gestational age (gestational age). Thus, premature babies often have a birth weight of more than 2500 g, and approximately 1/3 of newborns born weighing less than 2500 g are full-term. The degree of morphological and functional maturity of the newborn also does not always correspond to the gestational age. Various deviations in the woman’s health, complicated pregnancy, bad habits and others can lead to the birth of a child that is immature for its gestational age.

This means that the determining criterion for full term is gestational age..

• Gestational age - quantity full weeks between the first day of the last menstrual period and childbirth.

Gestational age is determined by obstetricians-gynecologists during an objective examination of the pregnant woman (date of the last menstruation, according to ultrasound, fetal movement, height of the uterine fundus, alpha-fetoprotein (α-FP) parameters).

According to gestational age, newborns may be (and may have the listed anthropometric features):

• full-term – born at 37 weeks - 42 weeks = 260 days - 294 days of gestation (regardless of birth weight; usually at full term, body weight = 2500 g - 4000 g, body length = 45 cm - 53 cm, head circumference = 32 - 38 cm);

• post-term – those born at a gestational age > 42 weeks = 295 days or more (regardless of birth weight);
• premature – born between 22 and<37 недель гестации = со 154 дня до 259-го дня гестации включительно (масса тела = 2500г − 500 г, длина тела = 44см − 25 см).

Extreme prematurity− gestational age is less than 22 full weeks (154 full days). The line between miscarriage and prematurity at 22 full weeks (154 full days) of gestation is determined by weight: 499 g - miscarriage, 500 g - premature newborn.

• Indicators of physical development of a newborn :
  • body mass;
  • body length;
  • Head circumference;
  • chest circumference;
  • proportionality to the above indicators.

The main indicators of the physical development of a newborn are body mass and length.

Birth weight maybe (in ascending order):

• extremely (extremely, extremely) low= 500 g − 999 g;
• very low= 1000 g − 1499 g;
• low= 1500 g − 2499 g;
• sufficient= 2500 g - 4000 g (on average = 3500 g - for m., 3350 g - for d.);
• big= 4000 g − 4500 g;
• extremely large= more than 4500 g.

Newborn body length on average varies from 45 to 53 cm.

Head circumference newborn ranges from 32 to 38 cm.

Newborn chest circumference− 32−34 cm.

To assess the indicators of physical development of full-term, premature and post-term infants, use percentile tables(tables by G.M. Dementieva) or average statistical indicators. According to the scoring tables, newborns can be divided into 4 groups of physical development:

• − newborns with normal for their gestational age, physical development - their body weight and length range from P10 to P90 and fluctuate within ±2σ deviations;
• − newborns with low weight and length in relation to gestational age (due to impaired intrauterine growth of the fetus, IUGR) - their body weight and length are below P10 and with fluctuations outside the limits of 2σ, i.e. from −3σ to −2nd sigmal deviation. Newborns will be included in this group:
  • small for gestational age - weight and length less than P10 (IUGR of the hypoplastic type);
  • light weight for gestational age - weight below P10, length greater than P10, i.e. normal (IUGR of the hypotrophic type);
  • undersized for gestational age - weight greater than P10, i.e. normal, and length below P10;
• − newborns malnourished(congenital malnutrition): weight and length greater than P10 and fluctuating within Me−2σ, but there are trophic disorders in the form of underdevelopment or absence of subcutaneous fat, decreased elasticity and turgor of tissues, dryness and flaking of the skin;
• − with large mass, exceeding that required for gestational age by more than P90 and with their fluctuation within the limits of Me+2σ.

Moreover, heavy-weight newborns may be with harmonious or disharmonious development, which is determined using harmonicity coefficient (CH), (Quettel index, body mass index− for adults):

KG=22.5−25.5 children are harmonious − large,

KG>25.5 - disharmonious with a predominance of weight over body length - heavy-weight,

KG<22,5 − дисгармоничные с преобладанием длины тела по отношению к массе − large-growing.

• Morpho-functional maturity − readiness of the child’s organs and systems for extrauterine existence.

In 1971, Petruss (Petruss ) , was proposed maturity rating scale, which includes 5 external morphological characteristics:

• skin condition;
• Auricle;
• nipple areola diameter;
• external genitalia;
• striation of the feet.

Petrousse Maturity Rating Scale

Each of these characteristics is scored from 0 to 2 points, the resulting sum of points is added to 30.

The final result corresponds to the degree of morphological maturity of the newborn. If it matches the gestational age, then the baby is mature for its gestational age.

All premature babies are immature; at the same time, they may be quite functionally mature, but are incapable of extrauterine life.

If the Petruss score is less than the baby's gestational age, the baby is immature for its gestational age. Only newborns who have reached 30 weeks of intrauterine development can be assessed using this table..

For a more detailed assessment of the degree of maturity and also at the birth of a child before 30 weeks of pregnancy Ballard (1991) and Dubovich (1970) tables are used, which take into account not only external, but also functional signs of immaturity, namely neuromuscular maturity.

Dubovich (Dubovich ) was proposed system for assessing maturity and gestational age(accuracy - ± 2 weeks), consisting of 11 morphological and 10 functional characteristics, each of which is assessed according to a 4- and 5-point system, respectively.

Mature full term baby

The maturity of a full-term newborn baby is determined by a set of external signs.

The baby's skin is pink and evenly colored. “Fluff” (vellus hair, lanugo) is preserved only on the shoulder girdle and in the upper back. The hair on the head is at least 2-3 cm long. The cartilage of the ears and nose is dense. The origin of the umbilical cord is located approximately in the middle of the body or slightly lower. In boys, the testicles are lowered into the scrotum; in girls, the labia minora are covered by the labia majora. Such a child screams loudly, has active movements, pronounced muscle tone, and physiological reflexes are detected.

Physiological jaundice of newborns - appears on the 2-3rd day of life and disappears by the 5th day; if it does not disappear, then it is necessary to exclude hemolytic disease of the newborn, hereditary blood diseases, malformations of the biliary tract, sepsis, etc.

The bones of the skull in the vast majority are not fused, a large fontanelle is open (its dimensions are 1-2 cm), the sutures can be closed, slightly diverge, or overlap each other. Depending on the characteristics of the birth, the shape of the head can be: dolichocephalic (extended from front to back), brachycephalic (extended upward) or irregular (asymmetrical). In the first days the eyes are closed almost all the time. The child opens them when changing body position. There may be postpartum hemorrhages on the sclera, and the eyelids are swollen. The pupils must be symmetrical and responsive to light from birth. The eyeballs are “floating”; in the first days of life, horizontal nystagmus (small-amplitude involuntary twitching of the eyeballs) may be normally observed. The chest is barrel-shaped, the ribs are located horizontally, breathing is shallow, with a frequency of 40-50 breaths per minute, when the child screams, feeds, or is restless, shortness of breath easily occurs due to the narrow nasal passages, possible swelling of the nasal mucosa. Heart rate is 130-150 beats per minute, heart sounds are loud and clear. The abdomen is usually actively involved in the act of breathing and has a rounded shape. With overfeeding and illness, bloating easily occurs. The liver protrudes from under the edge of the costal arch no more than 2 cm. In full-term girls, the labia majora cover the labia minora; in boys, the testicles should be lowered into the scrotum.

Post-term pregnancy

Signs of overripeness

• dark green skin color
• dense skull bones
• narrow seams and fontanelles
• dry skin
• lack of cheese-like lubricant
• maceration of the skin of the feet, palms
• thinning of the pancreas
• placenta with symptoms of calcenosis.

Assessment of overripeness according to Clifford

1st degree - the newborn is dry, but of normal skin color. The cheese-like lubricant is poorly expressed. The amniotic fluid is light, but its quantity is reduced. The general condition of the newborn is satisfactory.

2nd degree - dry skin is more pronounced, there are symptoms of malnutrition. Approx. water, the umbilical cord and skin of the newborn are colored green by meconium. Perinatal mortality is high.

3rd degree - The water around the body is yellow, the skin and nails are yellow. These are signs of deeper hypoxia, the mortality rate is lower.

To the clinical symptoms of postmaturity

detected after birth include signs of overmaturity (postmaturity) of the fetus and macroscopic changes in the placenta.

Signs of postmaturity include:

dark green coloring of the skin, membranes, umbilical cord, maceration of the skin (in a living child), especially on the arms and legs (“bath” feet and palms);

reduction or absence of cheese-like lubricant; reduction of subcutaneous fatty tissue and formation of folds; decreased skin turgor (“senile” appearance of the child), large size of the child (less often malnutrition);

long fingernails; poorly defined head configuration, dense skull bones, narrow sutures and small fontanelles.

Signs of prematurity:

• disproportionate body, large head
• umbilical ring low
• the skull bones are pliable, the sutures and fontanelles are open
• ears are soft
• a lot of vellus hair
• nails do not reach fingertips
• genital slit gapes
  The labia majora do not cover the male
  testicles are not descended into the scrotum
• weakness, drowsiness, weak cry, underdevelopment of reflexes, poor thermoregulation

A child born between 22 and 37 weeks of pregnancy (or from 154 to 259 days, counting from the first day of a woman’s last cycle) with a body weight ranging from 500 grams to 2.5 kg and a body length of less than 45 cm (according to recommendations) is considered premature. WHO from 1977).

Currently, in our country, the main criterion for the period of prematurity is considered to be gestational age or age. According to this, a premature baby is a baby born at a period of intrauterine development that is less than 37 completed weeks of gestation (pregnancy). A full-term baby is called when its gestational age ranges from 37 to 42 weeks.

Epidemiology

Among the total mass of children who have a body weight of less than 2500 g at birth, about 30% are full-term babies, the remaining 70% are premature newborn babies. The average weight of a baby at 37 weeks of gestation is usually about 3 kg. In some countries, those children born before 28 weeks of gestation are not counted as newborns, so statistics on the incidence of premature births vary significantly across different countries (from 5% to 15%). In our country, there is an order of the Ministry of Health “On the transition to the criteria for live births and stillbirths recommended by the World Health Organization (WHO”). According to it, the period of perinatal development begins at the 28th week of pregnancy. Premature babies born between 28 and 36 weeks of gestation occur with an incidence of 5.5 to 8%. Among them, about 75% are babies born between 32 and 36 weeks of gestation.

Main groups

Premature low birth weight babies were previously divided into the following degrees of prematurity, based on body weight at the time of birth:

• 1st degree – body weight is from 2001 to 2500 g.,
• 2nd degree – body weight within 1501-2000 g.,
• 3rd degree – from 1500 gr. up to 1001 gr. This group is called children with very low body weight;
• Grade 4 – it consists of newborns with extremely low weight, less than 1 kg.

However, there is also the WHO (World Health Organization) 10th revision classification, which includes a category for disorders associated with a decrease in gestational age and low birth weight. According to it, it is becoming generally accepted to divide premature babies by both body weight and gestational age. In cases where both gestational age and birth weight are known, preference should be given to the baby's body weight. Depending on it, three groups of prematurity are distinguished:

1. With extremely (extremely) low body weight – birth weight is up to 1 kg (999 grams or less);
2. Very low weight – birth weight less than 1.5 kg (from 1000 grams to 1499);
3. With low body weight - weight up to 2.5 kg (from 1500 grams to 2499).

Based on gestational age very premature babies, according to the WHO 10 revision criteria, are divided into two groups:

1. With extreme immaturity - this includes babies born before 28 weeks of pregnancy;
2. Other cases of prematurity - this group includes all children whose gestational age is 28 weeks or more, but less than 37.

The frequency of morbidity and mortality, the likelihood of their disability increases as the child's gestational age decreases, and therefore the prevention of the possible likelihood of premature birth is a very important problem.

Causes of having a premature baby

All etiological factors can be divided into the following groups:

1. Social, economic and demographic factors: the presence of occupational hazards and the nature of the parents’ work; bad habits (the effects of alcohol, nicotine and drugs); family living conditions (income level and place of residence, quality of nutrition); state of education level; quality of medical care; presence of mental and physical injuries;
2. Biological factors: parental age (less than 18 years or more than 35); short stature, previous abortions and childbirth, the number of previous pregnancies and their outcomes, the presence of an interval between pregnancies and births, etc.;
3. Clinical reasons:

• the mother has abnormal development of the genital organs (infantilism);
• in a woman;
• an abortion preceding a given pregnancy, which causes trauma to the uterus (leads to disruption of the structure of the endometrium, cervical insufficiency);
• the presence of somatic pathology in the mother (heart disease, a, (lead to hypoxia, disruption of placental blood flow and changes in the structure of the placenta);
• existing infections that are sexually transmitted;
• the presence of complications of this pregnancy (preeclampsia);
• the occurrence of incompatibility between the blood of mother and fetus (by Rh factor and group);
• chromosomal diseases of the child;
• endocrine pathology in the mother (, etc.).

With what premature newborn baby different from full-term?

A mature newborn is a child who, based on his morphofunctional development, is ready for life outside the womb under conditions of optimal care and feeding. Such a baby is able to maintain body temperature well, has basic reflexes (sucking, swallowing), stable heart and breathing rates, and normal motor activity.

External anatomical features of a premature baby:

1. Disproportion in physique: head size is up to a third of height; the cerebral part of the skull is larger than the facial part; the bones of the skull are pliable and thin, all seams and fontanelles are open; there are no ossification nuclei in the epiphyses of bones; short legs and neck;
2. The skin is bright, dark red, thin, glossy, as if translucent, the skin folds on the soles are weakly expressed;
3. Lanugo (abundant and thick fluff) is present on the skin of the back, shoulders, face (forehead and cheeks), extensor surfaces of the limbs (usually the hips);
4. The subcutaneous fat layer is reduced or absent altogether, remaining only in the cheek area, there is a tendency to rapid development of edema;
5. Low-lying umbilical ring;
6. The cartilages of the auricles are soft to the touch, fitting tightly to the head;
7. The nail plate is thin, the tip of the nail does not reach the edge of the finger;
8. The mammary glands are underdeveloped;
9. The external genitalia are open, the genital slit is gaping (the labia minora are not covered by the labia majora), boys have no testicles in the scrotum.

Signs of immaturity on the part of organs and their systems

Premature babies are distinguished by their neurological status from mature babies, which is explained by the anatomical and functional immaturity of the central nervous system:

• Weaker, lethargic, lethargic, drowsy, active motor activity is reduced, the cry may be very weak or absent altogether;
• The tone of the flexor muscles predominates over the tone of the extensors; physiological increased muscle tone is absent and appears, as a rule, by two months after birth;
• A decrease in all reflexes that a full-term baby has, including sucking and swallowing. A premature baby with a body weight of more than 1.5 kg becomes able to suck no earlier than 2 weeks after birth, with a body weight of less than 1500 and more than 1000, this reflex occurs by 3 weeks, in children less than 1 kg at birth - no earlier than a month of life:
• Characterized by imperfect thermoregulation. All premature babies typically experience a decreased ability to produce heat due to low fat reserves and low muscle tone. At the same time, high heat transfer is due to the large surface area of ​​the body and superficially located skin vessels. All this leads to rapid hypothermia, and immature thermoregulation centers in the central nervous system can cause the baby to overheat.

On the part of the respiratory system, the peculiarity will be the presence of primary atelectasis of the lungs, variability in the respiratory rate (the smaller the child, the more often he breathes), its depth, stops or long pauses between breaths. The degree of maturity of the lung tissue depends on the gestational age: in those born before 28 weeks, alveoli and capillaries are poorly developed, distensibility is reduced, and there is no surfactant, which leads to respiratory failure after birth.

The cardiovascular system is characterized by variability in heart rate, low blood pressure in the first two days after birth, and decreased vascular tone. Changes in hemodynamics associated with birth occur slowly at short gestational ages.

On the part of the digestive system, the peculiarities of a premature baby are a small volume of the stomach, decreased sphincter tone, decreased intestinal motility, which causes a tendency to bloating and regurgitation. The activity of all enzymes also decreases with decreasing gestational age.

The urinary system is characterized by a decrease in the ability of the kidneys to concentrate urine (due to low glomerular filtration volume and reabsorption in the tubules), renal regulation of urine formation, and the ability to maintain a stable acid-base state of the blood. This causes significant fluctuations in the frequency and volume of urination.

The metabolism of a premature baby is characterized by a tendency to decrease protein, glucose, calcium in the blood, and increase bilirubin.

Features of the physiology of a premature baby

They are caused by the immaturity of all organs and their systems and are as follows:

• Weight loss after birth is maximum during the first 7 days, can be up to 15% and is restored by 3 weeks;
• Jaundice will appear in 95% of premature babies, its nature is longer and more pronounced;
• It is much less common to observe signs of hormonal crisis and toxic erythema, in contrast to mature children; Share with your friends!

Today we will list and briefly describe the signs of a full-term newborn. In addition, we will dwell on the issues of postmaturity or prematurity. How is it possible to determine this from a child and how do children differ? What does this mean for a newborn?

For this reason, it is necessary to know not only the signs of full term and maturity of the newborn, but also to be able to correctly diagnose and be aware of possible problems. If we consider the child as an object of birth, then this must be done based on the size of the head, since this is the most voluminous part of the fetal body, which experiences the greatest difficulties during movement along the birth canal. Now we propose to talk in more detail about the signs of a full-term newborn.

Full term baby

What is fetal maturity? This is a certain state of the child, which characterizes the readiness of the internal organs to ensure the life of the baby outside the womb. After birth, the child must be examined by a neonatologist.

The doctor needs to assess three parameters:

• determination of full-term birth of a newborn baby, the signs of which we will consider in this section;
• assess the degree of physical development;
• morphological and functional maturity.

Which baby is considered full-term? These signs include:

• birth time - from thirty-eight to forty-two weeks;
• body weight must be more than two and a half kilograms;
• body length - from forty-six centimeters or more.

It is very important to note that there are a number of other signs that a newborn is full-term. We are talking about morphological and functional maturity. We will talk about this in detail further. To summarize everything that has been said in this section, we can highlight the main signs of a full-term newborn:

• gestational age;
• body mass;
• body length.

External signs

Let's start with the main signs that are visible to the naked eye. The first item on this list should be a loud and demanding voice. Secondly, the skin should be pink and velvety. Be sure to pay attention to the fact that the newborn’s skin should be clean and the fat layer should be even. Third, the presence of an open large fontanel. However, according to statistics, in fifteen percent of cases the small one is also open. The fourth external sign is the formation of the auricle; all arches must be clearly expressed. The fifth sign is that the navel is located in the center of the abdomen, the nail plates should completely cover the nail phalanges. The sixth sign is that girls have a closed genital opening, and boys have testicles descended into the scrotum.

Functional signs

In this section we list the functional signs of a full-term newborn. These include the following:

• the baby’s limbs should be bent at the joints;
• movements are chaotic and quite active;
• Children are characterized by increased muscle tone;
• body temperature is stable, deviations within the normal range of up to six tenths degrees Celsius are possible;
• the newborn's breathing is also stable - from forty to sixty breaths per minute;
• the heartbeat can be heard well, rhythmically (the norm is from one hundred twenty to one hundred and forty beats per minute);
• in a full-term baby, all reflexes are symmetrical, it is possible to cause specific ones.

Specific reflexes of newborns:

• sucking;
• search;
• prehensile;
• proboscis and others.

Prematurity

Now let's turn to the issue of criteria for prematurity, postmaturity of the baby. A premature baby is born before the end of intrauterine development, that is, before the thirty-seventh week of pregnancy. Such babies have a small body weight, weighing less than two and a half kilograms, and their height does not reach forty-five centimeters. Newborns have problems with thermoregulation and insufficient response to external stimuli. It is important to note statistical information: such children are born in approximately 10% of cases.

It is worth knowing that there is a term “extreme prematurity” if the baby is born before twenty-two weeks. This condition is the line between a miscarriage and a premature baby. Body weight in this case is a decisive factor: if it reaches half a kilogram, then it is a premature baby, and just one gram less is a miscarriage.

Prematurity is usually classified according to the body weight of the newborn.

Problems of prematurity can lie in both the mother or father and the baby. They are briefly listed in the table below.

Manifestation of prematurity

The signs of full term, prematurity and postmaturity of a newborn that we consider in the article are reflected in the behavior and development of the baby. We invite you to talk about how prematurity in newborns manifests itself. We will now present the general clinical picture. Firstly, the newborn has body disproportion (a very large head). In addition, the sutures of the skull are open, so the bones are pliable. Secondly, the ears are soft. Third, the child is in the frog position, as muscle hypotonia is noted. The fourth sign is that boys’ testicles have not yet descended into the scrotum, and girls’ labia majora have not yet fully developed. Fifth, specific reflexes are extremely weakly expressed. Sixth - shallow and weak breathing (up to 54), low blood pressure (approximately 55-65). Seventh - frequent urination and regurgitation.

Postmaturity

What features does a post-term newborn baby have? Signs of postmaturity in the mother should be diagnosed by a doctor using CTG and ultrasound. These symptoms include:

• absence of labor;
• reduction in abdominal circumference;
• quite large fruit;
• compaction of the child’s skull;
• meconium in amniotic fluid;
• reduced concentration of glucose in amniotic fluid;
• A urine test shows low estriol levels.

It is worth noting that there are two types of post-term pregnancy:

In case of true postmaturity, the baby is in serious danger, because hypoxia develops.

What are the causes of postmaturity and how do they affect the baby?

How does a post-term pregnancy affect the child? The baby has the following signs:

• thin body;
• dry and wrinkled skin;
• peeling of the skin;
• lack of fetal lubrication;
• long nails and hair;
• open eyes;
• increased activity.

Please note that the skin of post-term newborns acquires a yellowish tint. To prevent post-term pregnancy, it is very important to undergo a CTG procedure three times a week (after 40 weeks). Your baby's heartbeat and movements will help determine exactly how your baby is feeling.

The reasons for this phenomenon are unknown, but doctors distinguish two large groups:

Please note that there is also a psychological factor. If the expectant mother is afraid of childbirth and is not psychologically ready for it, then the pregnancy may be delayed. In this case, you need the support of loved ones or consultation with a psychologist.

Differences between a full-term and premature baby

A full-term baby has a number of characteristics. He is ready for life outside the womb, has certain reflexes, the skin is able to maintain a certain temperature regime, the heart rate is stable, normal breathing and activity. A premature baby is the exact opposite: he is not ready for life outside the womb, he is unable to maintain temperature, his heart rate and breathing are unstable, his blood pressure is low, and newborn reflexes are poorly developed.

Premature newborns are characterized by certain external signs. These include:

1. Small sizes. All premature newborns are small in stature. Their length is proportional to the degree of prematurity. The larger the latter, the smaller the child's height.

2. Reduced nutrition. Extremely premature infants are characterized by significantly reduced nutrition with an almost complete absence of the subcutaneous fat layer (Fig. 1). At the same time, they do not give the impression of being emaciated, as is observed in infants with degree II-III malnutrition. The nutrition of premature babies is in complete harmony with their growth. Sharp emaciation with wrinkled skin in the form of folds, which immediately catches the eye, is observed only in premature patients and in children with congenital malnutrition.

3. Adynamia. This sign is typical for very premature babies. Adynamia manifests itself in general lethargy, decreased muscle tone, weak cry, underdevelopment of the sucking reflex, and lack of hunger.

Rice. 1. Extremely premature baby. A large head and short legs are visible.

4. Disproportional physique. A premature baby is characterized by a relatively large head, a relatively large body (in relation to its own height), a short neck, short legs and a low navel. If in a full-term baby the head is 1/4 of the body length, then in a premature baby this ratio is one third. In absolute terms, the head and torso of a premature baby are much smaller in size than those of full-term babies.

5. Large, flat stomach with separation of the rectus muscles.

6. Predominance of the cerebral skull over the facial skull.

7. The small fontanelle is always open. There is non-fusion, and often divergence of cranial sutures. The bones of the skull are pliable, mobile and can overlap each other.

8. The ears are soft. They wrinkle easily, curl inward and often stick together.

9. Pronounced lanugo. Lanugo is the soft vellus hair characteristic of newborns and is located mainly on the shoulders and back. In premature babies, the lanugo is more abundantly developed and covers not only the shoulders and back, but is also well expressed on the forehead, cheeks and hips.
10. Gaping of the genital slit. In premature girls, the labia majora do not cover the labia minora, as a result of which the genital slit gapes and the clitoris is clearly visible.
11. Empty scrotum. In boys, the testicles are located in the abdominal cavity or in the inguinal canals. This sign is not observed in all premature babies and is more typical for children weighing up to 1200 g, although in some of them the testicles may already be descended into the scrotum at birth.
12. Lack of physiological swelling of the mammary glands. Swelling of the mammary glands in premature infants is observed very rarely and only in children with a low degree of prematurity (birth weight over 2000 g).
13. Exophthalmos. Protruding eyes are not expressed in all premature babies and usually do not appear immediately, but in the 2-3rd month of life. It can be combined with megacephaly (enlargement of the frontal and parietal tubercles).
14. Underdevelopment of nails. Fingernails and toenails are poorly developed and may not extend to the tips of the fingers. This symptom is the most variable and is extremely rare.

Most of the above signs, taken individually, cannot serve as an absolute criterion for determining prematurity. They can also occur in some full-term infants (absence of testicles in the scrotum, open small fontanelle, non-fusion of cranial sutures, etc.) and at the same time absent in some premature infants (presence of testicles in the scrotum, absence of exophthalmos, normal development of nails, etc. .d.). Premature babies are characterized by a combination of most of these signs, and the greater the degree of prematurity, the more pronounced they are.
* * *
Each premature baby is unique. Many factors influence the maturity of a newborn and the functionality of his body. You can't rely on birth weight alone. The cause of premature birth and its nature, the pathology of the mother during pregnancy, the condition of the child at birth, his weight and age and, finally, the degree of prematurity - these are the main criteria that determine the characteristics of each premature child and are necessary when comparing different premature children.

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 is during this period that all the internal systems and organs of the baby finally develop and strengthen 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 are in good health, and do not have any physical or mental disabilities. 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 practices, that children born with a body weight of at least 500 g and a term of at least 22 weeks should be considered viable. 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 hours or weeks). 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, influenza, 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 differ greatly from healthy ones not only in appearance, but also in the structure of internal organs. Especially at birth 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. The ears have soft cartilage and are 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).
Premature babies have poor development of 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 in a healthy baby, after inhaling, the lungs straighten and remain in this position, then 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.

Special vaccinations may be used for such children.

A premature baby may sleep 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 the body's 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 the vital functions of the 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 carrying children through maximum physical contact between baby and mother (skin to skin). This method allows a premature baby to quickly adapt to the environment, in a few weeks or months, and has a positive effect on the baby’s development. It also compensates for heat loss.

The larger the contact area, 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 period 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. You should not panic if your child behaves this way. This may last for several weeks or months.

What to do if alarming symptoms arise?

It is imperative to contact medical professionals who 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, you should take immediate action - cardiac massage), severe pallor.

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

Useful video about premature babies