Premature baby signs and degrees of prematurity. Possible health problems in premature newborns. Premature babies - consequences

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, a baby who was born prematurely has the following anatomical and physiological features:

1. The cardiovascular system 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. It is assumed that it is too early or late pregnancy(parents' age is less than 16-18 or more than 40-45 years), availability bad habits the woman has bad living conditions, presence of occupational hazards. In addition, the risk of having a premature baby is higher in those girls who are not observed in antenatal clinic during pregnancy.
2. Unfavorable obstetric and gynecological history and pathological course current or past pregnancy. This includes a history of abortions, miscarriages, multiple births, placental abruption, etc. Women who have an interval between births of less than two years may have a high risk of premature birth.
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, it is observed spontaneous breathing, possibility of 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.

Development of premature babies by month

Modern medicine cannot accurately draw the line between the consequences of prematurity and pathological conditions, which occur in a baby born prematurely. The frequency of neurological, mental and physical disorders is due to the harmful effects of the internatal 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.

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 children typically suffer from acute respiratory failure and central nervous system failure. 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 consists of additional heating of the newborn from the moment of birth, rational oxygen therapy, and 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 good healing umbilical wound, normal hemogram indicators and others laboratory tests. As a rule, discharge is made no earlier than 7-9 days after birth.

Incubator

At the initial stage of 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. Reanimation. 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 is characterized by a high content of essential protein, electrolytes, polyunsaturated fatty acids (linolenic acid promotes high rates of myelination and prostaglandin synthesis), low lactose content, and 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 fed on artificial feeding, performance improvement physical development. 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.

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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. National statistics of Russia on miscarriage (spontaneous termination of pregnancy at less than 37 full weeks) takes full account of these recommendations. 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.

The 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 by the low level of education of parents and the 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. Smoking not only of the mother, but also of the father has a negative impact on the health of the child. 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 elimination of abortions with the use of 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 fontanelles (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, violation of thermoregulation, 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 grasp reflex. 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 impaired 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 greater the degree of 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. With a gestation period of less than 32 weeks, body weight often reaches its initial values ​​only at the end of the first month of life and begins to increase more intensively from the 2nd month.

The body length of a premature infant 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 infants” with the limitation of 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 the correct use of all modern methods of care and treatment in the future. 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

The peculiarities of feeding premature infants are due to their increased need for nutrients due to intensive physical development, as well as the 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. With a satisfactory general condition, a sufficiently pronounced sucking reflex and a body weight at birth of more than 1800 g, breastfeeding can be done 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 who were born very prematurely often develop disorders in the future. menstrual cycle, signs of sexual infantilism, 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; creating favorable conditions for pregnant women in the family and at work; timely identification of risk groups and active monitoring of the course of pregnancy in these women.

The gynecology staff on duty panicked. In the evening, they gave birth to a “filling” - an abortion was performed on a woman at 26 weeks for social reasons. The silent fetus was wrapped in a diaper and placed outside the window - no need to run to the morgue at night? The failed mother left immediately after the abortion - she had five years of age waiting for her at home. And suddenly, in the dark, dark silence, crying was heard outside the window. Plaintive, squeaky. The nurse and orderly, crossing themselves, approached the window - the bundle was moving...

I won’t bore you, I’ll tell you the continuation of the story right away. Nature has endowed newborn children with unprecedented vitality. The cold forced the baby to take his first breath and scream. With trembling hands, the nurse took out the package, unwrapped it and placed it on the changing table.

The baby squeaked, moved his thin arms and legs, and weighed only 800 grams. Women in white coats looked at this miracle as if spellbound.

But the “miracle” stopped moving, screaming and breathing. Sighing, the nurse wrapped him in a diaper again and put him out the window. It was night. I didn't want to sleep. The women listened intently and suddenly... yes, yes, again - a squeak! Here the pediatrician on duty was already called, who began to cast a spell on the baby, who did not want to leave this world. The child survived. And when he was 4 months old and gained 2.5 kg, his mother suddenly came running. She lived on a distant farm and rumors about the “surviving flood” did not reach her immediately. She hugged me, pressed her to her chest, and cried. She said that she decided to have an abortion under the influence of stress - her husband lost his job, and she already had a lot of children. I couldn’t forgive myself for this weakness later, I prayed. In general, this story has a good ending. “Baby” is now many years old and he, the only one of all the children in the family, graduated from college, returned to his native place as an agronomist and helps his parents a lot. This story is also unique in that the extremely premature baby survived without an incubator or a neonatologist.

Which children are viable?

The concepts of “viability” and “live birth rate” are different.

It is clear that children born prematurely at home, in a regular maternity hospital and in a modern perinatal center have completely different chances of survival. And this is a legal moment, affecting the concepts of “failure to provide assistance” and “premeditated murder.”

From a legal point of view: “viability is a state in which the development of tissues, organs and systems of a newborn ensures its independent life outside the womb.”

From the point of view of doctors: a live birth is a fetus that exhibits at least one sign of life: heartbeat, breathing, pulsation of the umbilical cord, muscle movements.

Previously, children were considered viable if they were born at 28 or more weeks, weighed a kilogram or more, and were 28 cm tall. Children born at an earlier stage and with lower height and weight indicators were considered nonviable and were registered in the registry office only if when they survived.

Since 1993 the situation has changed. Children born at a period of at least 22 weeks, weighing at least 500 grams and having a height of 25 cm or more are considered viable.

Among those born prematurely, children are distinguished:

• with extremely low weight (0.5 -1.0 kg);
• with very low weight (1.01 - 1.5 kg);
• with low weight (1.51 - 2.5 kg).

Very low birth weight babies are now called “potentially viable”.

Survival rate of children at different stages of birth

This factor largely depends on the conditions, but even average statistics show that medicine is developing and doctors are saving the lives of an increasing number of children with very low weight.

Do doctors save very low weight children?

Yes, in our country they save. This is determined by order of the Ministry of Health of the Russian Federation No. 372 dated December 28, 1995: “If even one sign of a live birth is noted, the baby must be provided with both primary and resuscitation care.” If premature birth is known in advance, the baby should be met in the delivery room by a neonatologist who will organize timely treatment and, if necessary, transport the baby to a specialized medical facility.

Other countries have different laws. So, in England, a child weighing from 500 to 999 grams will be saved only when his relatives insist on it. This is explained simply: the costs are high and the survival rate is low. In addition, among the surviving children with extremely low weight, many have serious pathology that requires further expensive treatment.

Did you know that children born weighing 1 kg are registered with the civil registry office immediately, but those born weighing 500-999 grams are registered only after they have lived for seven days?

Why are premature babies born?

There are many reasons. The most significant:

• cervical insufficiency (if the suture is not applied in time);
• anatomical features of the uterus;
• maternal infections;
• fetal malformations.

More often, premature birth occurs in pregnant women who are too young and those who give birth after 35 years, heavy smokers and those who are addicted to alcohol.

Are premature and immature the same thing?

No, these are different states.

• Premature a child born prematurely.
• Immature a child can be born at any stage, but his organs and systems are not yet mature enough for him to live independently.

Moreover, almost always a premature baby is immature. But not everyone who is immature is premature. Immature full-term babies need adequate medical care the same as premature babies.

Signs of prematurity:

• wrinkled red skin;
• the entire body is covered with hairs (lanugo) and abundant cheese-like lubricant;
• a weak cry resembling a squeak;
• intermittent breathing with a tendency to apnea (stopping breathing at the slightest exertion);
• imperfect thermoregulation - the baby easily overheats and becomes hypothermic;
• decreased or even absent sucking reflex;
• thin ears and fingers, actually “transparent”;
• gaping genital slit in girls, absence of testicles in the scrotum in boys.

My children were born full-term and mature. And your?

Working for many years at the Center for Correction of the Development of Premature Children of the Clinical Research Institute of Pediatrics and engaged in scientific research on the growth and development of these children, they are currently consulting at the Chaika clinic. Elena Solomonovna has released a guide for parents about what the family of a premature baby will have to endure and how to maintain love and friendship. We are publishing its continuation.

Physical development of a premature baby (weight and height gain)

The first concern of parents of a premature baby is problems with weight gain. And indeed this is of paramount importance as the main indicator of the baby’s physical well-being.

It should be taken into account that the rate of growth of physical indicators (body weight, length, head and chest circumference) in a premature baby will differ significantly from those of his full-term peers. At least until 6-9 months, your baby will be smaller, and mandatory weight control becomes of primary importance at this time: in the first weeks and months of life, daily (it is necessary to take into account the correctness of daily weighing of the child, which must be carried out in at the same time, preferably before the first morning feeding or in the evening before bathing), and then monthly.

What should be your first concern? This is a drop in body weight or lack of weight gain (the baby is “standing” in weight).

The reasons can be either quite serious or due to feeding errors or insufficient breast milk from the mother. Naturally, in any case, you need to consult with the child’s doctor to clarify the causes and eliminate them. I repeat, during a one-time consultation with a pediatrician, the condition of a child born prematurely and very different from full-term peers may be assessed as more severe than it actually is.

Digestive problems in a premature baby

The main problems from digestive system in a premature baby, which almost all parents encounter are:

Intestinal colic

Colic comes from the Greek kolikos, which means pain in the colon. Colic is paroxysmal pain in the abdomen, accompanied by severe anxiety in the child. The attack, as a rule, begins suddenly, the child screams loudly and more or less continuously, redness of the face or pallor of the nasolabial triangle may be noted. The abdomen is swollen and tense, the legs are pulled up to the stomach and can instantly straighten, the feet are often cold to the touch, the arms are pressed to the body. The attack sometimes ends only after the child is completely exhausted. Often noticeable relief occurs after the passage of stool and gases.

Premature babies are especially predisposed to colic, and some infants experience frequent and intense attacks, which in terms of severity can be compared to labor pain, and certainly require medical intervention. Apparently, the main reason for this baby’s suffering is the immaturity of the neuromuscular system and the intestinal enzymatic system and, therefore, a tendency to increased gas formation. As a result, pressure on the intestinal wall increases and muscle spasm occurs.

The cause of discomfort and bloating can also be irrational feeding. Some foods, especially those high in carbohydrates, can promote excessive fermentation in the intestines. Intestinal allergies also cause the baby to cry due to a feeling of discomfort in the abdomen.

But the causes of colic are not limited to these conditions. It is important to promptly diagnose diseases that require surgical intervention. Therefore, if there is no effect from the usual measures aimed at eliminating colic (special carminative herbal teas, simethicone preparations Sub/Simplex, Espumisan, cleansing enema, use of a gas tube, abdominal massage, dry heat on the abdominal area), the child should be carefully examined in a medical institution.

Regurgitation syndrome

Spitting syndrome can also be a concern for parents of a premature baby. The most common cause of this is immaturity and temporary (passing) hypotension of the smooth muscles of the stomach - the so-called “duodeno-gastric reflux”. Most often this occurs in premature babies who have been fed through a tube for a long time. Also possible reason regurgitation may be aerophagia (when the baby greedily swallows air along with food). Masses during regurgitation look abundant due to their binding with air and usually do not change the baby’s well-being in any way. In this case, you need to be patient and wait until the baby’s stomach “ripens”, while following the recommendations for proper feeding and holding the baby upright for 10-15 minutes after feeding. It is better to give medications to the child before feeding. However, there are situations in which urgent consultation with a specialist is necessary: ​​if there are streaks of blood in the regurgitated masses, if the regurgitation is so profuse that the child does not gain weight well, if the baby’s well-being is disturbed during regurgitation - do not hesitate, consult a doctor!

Diarrhea and constipation

Dyspepsia (diarrhea and constipation), changes in stool structure, the appearance of mucus and impurities in a premature baby are a frequent and worrying phenomenon for parents and pediatricians. It is necessary to determine what should not cause concern to parents.

When breastfeeding, the baby may have stools after each feeding along with gases (foamy) and quite liquid. In children receiving formula, stools are rarer - 3-4 times a day. A change in the quality and color of stool also occurs when the development of intestinal enzymes in a premature baby is late, and difficulty digesting fats or carbohydrates.

The most common problem of a premature baby is a temporary absence of stool or delayed evacuation of stool. There is no stool for several days, the child pushes to no avail. When defecation occurs, the stool as a whole is not changed in consistency, which does not allow us to call it constipation in the generally accepted sense of the word.

You will have to make it easier for the child to defecate for some time; there is nothing wrong with this if you do this with the knowledge and under the supervision of a doctor.

The cause of all disorders of the functional state of the gastrointestinal tract is immaturity.

However, proper feeding is the best and natural treatment. Breast milk is perhaps the best thing a mother can give to her baby. At the birth of a premature baby, milk, as it were, adapts to the immature intestine, so that the necessary hormones received from the mother, and active metabolites, protective substances and enzymes contribute to a more rapid maturation of all organs.

Therefore, breast milk and the possibility of natural feeding must be preserved with all our might. However, if there is still not enough milk, and you were forced to replace it with a formula, then it is most advisable to use special formulas for premature babies. In any case, it is important to coordinate the use of mixtures with your pediatrician.

The main criterion is that all the changes you observe in the gastrointestinal tract are not diseases that require urgent treatment therapeutic measures, is a sufficient increase in the child’s body weight and the absence of severe pain syndrome in the child

Anemia of prematurity

Almost all premature babies experience a drop in hemoglobin, which is called anemia. The cause of anemia is the same immaturity. In premature babies, the so-called “fetal” hemoglobin takes longer to be determined, which is destroyed more quickly, and the ability to form new one is reduced. At the same time, hemoglobin carries oxygen, which is necessary for the functioning of all cells and their maturation. Monitoring your hemoglobin level is very important.

A premature baby needs to be prevented from anemia and treated promptly if hemoglobin drops to 100 g/l.

Rickets of prematurity

Rickets is a deficiency in the formation of vitamin D in the body and the supply of calcium to cells, which is necessary for the growth of bone tissue and the formation of neuromuscular regulation.

Deficiencies in vitamin D production and calcium absorption are associated with immaturity. At the same time, the child’s development slows down. The baby becomes more irritable, sweats, sleep is disturbed, hair falls out, growth and weight gain slow down. Bones become “weak” and may become twisted. A premature baby requires mandatory prophylactic use of vitamin D preparations, and in case of clinically obvious manifestations of rickets, treatment with vitamin D and calcium preparations.

Condition of the skeletal system and joints

The phenomena of morphofunctional immaturity in a premature baby often extend to the musculoskeletal system. Imperfect neuromuscular regulation, weak ligaments, and excessive joint mobility can lead to changes in the correct position of the child’s limbs, head and spine.

Often the baby holds his head in a fixed position to one side. The reason for this may be congenital shortening of the neck muscle on one side, traumatic damage to the spine or cervical muscles when the head is removed during childbirth, or just the “habitual” position of the head, that is, the child “lay” in this position most of the time in the uterus. The correct diagnosis is always made by a doctor, and the sooner this happens, the more effective the treatment will be.

Prematurity, especially in combination with abnormal intrauterine position of the fetus, is usually accompanied by underdevelopment of the hip joints or “dysplasia”. The most severe variant of this pathology is dislocation of the hip joint. The diagnosis is made soon after the birth of the child and requires early treatment based on abduction of the legs at the hip joint. Currently effective method in identifying abnormalities in the development of joints is ultrasound scanning, which is mandatory for all children in the first months of life.

For premature babies, the most diagnostically reliable period is 3-4 months of corrected age for assessing the condition of the hip joints. In earlier periods, the risk of error is very high due to their natural immaturity.

Premature eye disease

Retinopathy of prematurity (ROP) is an eye disease of premature babies that can even lead to permanent loss of visual function.

The possibility of developing ROP is related to the age and weight at birth, the presence of severe changes in the respiratory, circulatory and nervous systems, as well as the adequacy of the measures taken to care for the baby

This disease was first identified in a premature baby in 1942. Then it was called retrolental fibroplasia. Until now, the causes of the onset, progression and spontaneous regression of the disease are not completely clear and are only being studied.

At this stage of development of ophthalmology, it is considered indisputable that the development of retinopathy occurs precisely in an immature baby, as a violation of the normal formation of retinal vessels (which ends by the 40th week of intrauterine development, i.e. by the time of birth of a full-term baby). It is known that until 16 weeks of intrauterine development, the retina of the fetal eye does not have blood vessels. Their growth into the retina begins from the exit point of the optic nerve towards the periphery. By the 34th week, the formation of the vascular network in the nasal part of the retina is completed (the optic disc from which the vessels grow is located closer to the nasal side). In the temporal part, vascular growth continues up to 40 weeks. Based on the above, it becomes clear that the earlier the child was born, the smaller the area of ​​the retina covered with blood vessels, i.e. an ophthalmological examination reveals more extensive avascular, or avascular, zones (if the child was born before the 34th week, then, accordingly, avascular zones of the retina are detected on the periphery on the temporal and nasal sides). After birth in a premature baby, the process of vascular formation is affected by various pathological factors: external environment, light, oxygen, which can lead to the development of retinopathy.

The main manifestation of ROP is the stopping of the normal formation of blood vessels, their growth directly inside the eye into the vitreous body. The growth of vascular tissue and, subsequently, young connective tissue causes tension and retinal detachment.

As mentioned earlier, the presence of avascular zones in the periphery of the fundus is not a disease. This is only evidence of underdevelopment of retinal vessels, and, accordingly, the possibility of developing retinopathy in the future. Therefore, starting at 34 weeks (or 3 weeks of life) of your baby, it is necessary to have your baby examined by an ophthalmologist who specializes in retinopathy of prematurity and who has special equipment to examine the retina. Such control is necessary for all children born before 35 weeks and with a birth weight of less than 2000 g.

When signs of ROP are detected, examinations are carried out every week (in the so-called “plus” stage of the disease - every 3 days) until the threshold stage develops (at this stage the issue of preventive surgical treatment is decided) or complete regression of the disease. In case of regression of the pathological process, examination can be carried out once every 2 weeks. The examination is carried out with the obligatory dilation of the pupil, using special children's eyelid dilators, so as not to put pressure on the eye with fingers.

Most often, the threshold stage of ROP develops by the 36-42nd week of development (1-4 months of life), so parents of a premature baby should know that during this period he should be examined by a specialist (an ophthalmologist who has special equipment and is aware of the signs of active retinopathy ).

Active retinopathy is a staged pathological process that can end in regression with the complete disappearance of the manifestations of the disease or scarring.

According to the international classification, active retinopathy is divided according to the stages of the process, its localization and extent:

Stage 1. The appearance of a dividing line at the border of the vascular and avascular retina.

Stage 2. The appearance of a shaft (volumetric line) at the site of separation.

It should be emphasized that in 70-80% of cases with stages 1-2 of ROP, spontaneous cure of the disease is possible with minimal residual changes in the fundus.

Stage 3 is characterized by the appearance of growth of retinal vessels into the vitreous body in the shaft area. With a short duration of the process, as in the first two stages, spontaneous regression is possible, but residual changes are more pronounced.

When the growth of blood vessels inside the eye has spread over a fairly wide area, this condition is considered to be the threshold stage of ROP, when the process of progression of ROP becomes almost irreversible and requires urgent preventive treatment.

The effectiveness of preventive laser and cryocoagulation of the avascular retina ranges from 50-80%. Timely treatment can significantly reduce the number of adverse outcomes of the disease. If the operation is not performed within 1-2 days after diagnosing the threshold stage of retinopathy, then the risk of developing retinal detachment increases sharply. It should be noted that with the development of retinal detachment, cryo- or laser coagulation is not possible. The further prognosis for the development of vision in such an eye is extremely unfavorable.

The operation is often performed under anesthesia (less commonly used local anesthesia) to avoid oculocardiac and oculopulmonary reactions. The treatment results are assessed after a few days to decide whether to repeat the procedure. The effectiveness of preventive treatment can be judged 2-3 weeks after the formation of scars at the site of the shaft. If treatment was not carried out or no effect was achieved after treatment (severe ROP), terminal stages develop.

Stage 4. Partial retinal detachment.

Stage 5. Complete retinal detachment.

Even if the process has reached stages 4 and 5, it is necessary to carry out a whole range of therapeutic and surgical measures aimed at preventing severe scarring.

“Plus” disease is highlighted separately as the most unfavorable form of active retinopathy. The disease begins early, has no clearly defined stages, progresses rapidly and leads to retinal detachment without reaching the threshold stage. The pathological process is characterized by a sharp dilation of the retinal vessels, pronounced edema of the vitreous body, hemorrhages along the vessels, dilation of the vessels of the iris, often with the impossibility of dilating the pupil. The effectiveness of treatment for “plus” disease remains low.

If the active process has reached 3 or more stages in its development, then after its completion (with preventive treatment or without it), scar changes of varying severity are formed in the fundus.

Grade 1 – minimal changes in the periphery of the fundus;

2nd degree – dystrophic changes in the center and periphery, remnants of scar tissue;

3rd degree – deformation of the optic nerve head, with displacement of the central parts of the retina;

4th degree – the presence of retinal folds, combined with changes characteristic of the 3rd stage;

Grade 5 – complete, often funnel-shaped, retinal detachment.

With the first and second degrees, fairly high visual acuity can be maintained; with the development of third or more degrees, a sharp, often irreversible decrease in visual acuity occurs.

Indications for surgical treatment of the cicatricial stages of ROP are strictly individual, determined by the degree and location of retinal detachment, as well as the general somatic condition of the child. In any case, the functional and anatomical effectiveness of operations is noticeable only up to 1 year of life, when it is possible to improve visual acuity and create conditions for eye growth.

However, when reaching the 5th stage of cicatricial ROP, the pathological process can continue and lead to the development of complications in the form of corneal opacification and secondary glaucoma. Therefore, if contact between the cornea and iris develops, immediate surgical treatment is necessary to save the eye (in in this case We are not talking about increasing visual acuity).

It should be noted that if a child has suffered even mild stages of active ROP or has unexpressed scar changes, then it is believed that in such children the formation of a full-fledged retina does not occur. In the future, such children have a high risk of developing myopia, dystrophy and secondary retinal detachments. Based on this, children who have suffered ROP should be observed by an ophthalmologist at least 2 times a year until they reach the age of 18.

Successful nursing and subsequent development of premature infants, including the preservation of visual functions, is, although difficult, a completely feasible task. Achieving a good rehabilitation result depends on the joint efforts of neonatologists, ophthalmologists and psychologists.

Formation of hearing and speech

There is no evidence that premature infants are more likely than full-term infants to have severe forms of hearing impairment. However, in many of them the development of auditory function is slow. The presence of hearing can be assessed using a hardware technique that is now widespread and called otoacoustic emission or audio test. Taking into account the characteristics of a premature baby, it is possible to reliably judge the test’s passing only at the age of 4 months of the corrected age. Until this time, there will be many false negative results, which are explained by the same immaturity of the child, but cause a huge number of unnecessary worries. The later development of auditory function also leads to a later onset of humming and difficulty with the child’s speech in the future. Complex features lead to the fact that the child begins to speak later and many sounds are pronounced incorrectly (perhaps the child hears them that way). All this is gradually normalizing, but most premature children will require the help of a speech therapist and it is advisable to start classes earlier than recommended for full-term children, for example, at 2.5-3 years, depending on the general development of the child.

What happens to the immune system of a premature baby?

Will he have to get colds often?

Numerous studies in our country and abroad have dispelled the prejudice about the “weakness” of the immune system of a premature baby. Just like in full-term children, it is formed in the first three years of life and differs slightly in terms of indicators. Just like full-term babies, when fed with breast milk, the formation of the immune system occurs more quickly and its activity is higher, but not so much as to say that without breast milk your baby is not at all protected.

Why do premature babies get sick more often and more severely? There are several explanations: premature babies are more likely to visit health care facilities where the risk of infection is high. Premature babies are very protective of their parents; they often overheat and thereby inhibit the development of the immune system. Premature babies with illnesses often develop bronchospasm and respiratory failure, they are more often hospitalized and are more often prescribed antibiotics, which also weakens the formation of immune defense. All this determines the approaches and tactics that parents of a premature baby should follow, and this should be taught by a doctor who knows the characteristics of the child and, most importantly, is not afraid of the fact that he was born premature.

Should premature babies be vaccinated?

It is necessary and mandatory! Actually, vaccinations are just for them. Since it is strong and strong child, most likely, will easily survive any infection, but for an “immature” and poorly protected premature baby, any severe infection can be fatal.

Previously, neonatologists made an allotment for a premature baby up to one year old. Today this concept has been revised all over the world. It has been proven that the immune system It is in the first months of life that the baby is more ready to produce antibodies. Judge for yourself: any child is born completely “sterile” and from the first seconds is faced with many viruses that are common around us, and even with bacteria that inhabit surfaces and our bodies. However, he protects himself with sufficient ease, except in situations beyond massive influences (intensive care unit, significant concentrations of sick children and adults).

However, there are still limitations - these are acute conditions, which are temporary but absolute contraindications to vaccination, and some chronic conditions: and this is, first of all, damage to the central nervous system. These include absolute contraindications – decompensated hydrocephalus and convulsions.

And yet, only the attending physician can tell whether your child is ready for vaccinations, explain in detail to you what vaccinations and against what diseases your baby needs, and whether any examinations are needed, for example, an ECG or EEG. This is a very important decision that requires great knowledge of the doctor, confidence in yourself and your child. On the other hand, the importance of this decision is to protect your child as much as possible from possible severe infections, which, unfortunately, abound in any society, understanding how difficult it will be for a premature baby to endure these diseases.

What is prevention of respiratory syncytial virus infection and why do it?

One of the most serious diseases of a premature baby in the 1st year of life is RSV infection. This is a very common disease. In fact, almost all children under 2 years of age experience this viral infection at least once.

This infection occurs like a cold, but its peculiarity is that it affects the lower respiratory tract, like pneumonia or, terminologically, alveolitis. Alveolitis is an inflammation of the final sections of the respiratory tract - the alveoli, where gas exchange occurs. Thus, if the alveoli become inflamed, the person begins to suffocate from a lack of oxygen and the accumulation of carbon dioxide in the body. This infection is especially severe in premature infants, who already have a very immature broncho-alveolar tree; many have signs of broncho-pulmonary dysplasia. In severe cases, children require hospitalization, resuscitation, mechanical ventilation, antibiotic therapy, etc., not to mention severe psychological trauma for the baby and the entire family.

Over time, when faced with this virus, the child produces antibodies and after 2-3 years the virus becomes practically harmless and the disease proceeds like a normal ARVI.

But! You have to live these 2 years. In recent years, a drug has been developed, created and widely distributed, which is purified antibodies to the respiratory syncytial virus. The introduction of these antibodies protects the child from getting sick, not only with this virus, but also with other similar viruses, and the child generally begins to get sick less.

Today, the country has the drug SYNAGIS, which is very expensive in price, as it is a highly purified monoclonal antibody. For effective protection against the virus, 3-4 injections are required with an interval of 30 days during the most dangerous epidemiological period - approximately from November to March. The administration of the drug is not vaccination, but passive immunization: when the child’s body does not produce antibodies, but they are administered ready-made. Therefore, repeated administration is required during the first year at strictly maintained intervals.

In the near future, there may be other drugs with similar effects in the country, most likely cheaper and more accessible. But this still requires verification.

We tried to talk in an accessible way about the most common problems in the first year of life of a premature baby. All of them require attention, observation and timely treatment.

Let us repeat once again why you need to monitor the first year of life of a premature baby:

• The development of a child, the formation of his psycho-motor functions requires a monthly assessment by one specialist. You must carefully observe the baby in order to tell the doctor as truthfully and objectively as possible about the child’s behavior.
• Weight gain, which indicates sufficient absorption and assimilation of nutrients. Premature babies tend to have a decrease in appetite, and sometimes it is a big problem to feed such a child. The more premature the baby is, the more pronounced the disturbance in the absorption of nutrients and the worse the weight gain. In this case, the use of special drugs that improve the energy state of cells can help cope with this.
• Prevention or, if necessary, treatment of rickets.
• Prevention and, if necessary, treatment of anemia.
• Relieving the child of “intestinal colic”, monitoring the state of the gastrointestinal tract, correcting regurgitation. Rational feeding. Mandatory consultation to resolve the issue of timely introduction of complementary foods.
• Monitoring the state of the nervous system, timely conduct of special examinations to determine the maturation of brain structures, to control the manifestation of hypoxic-ischemic encephalopathy (if your baby had hemorrhage or periventricular leukomalacia, if he suffered meningitis or encephalitis).
• Monitoring the condition of the respiratory system, especially if the child has been on a ventilator for more than 3 days. Remember that if a child develops bronchopulmonary dysplasia, it is necessary to carefully monitor the color of the child’s skin and his breathing (the child begins to breathe “hard” and often), since periods of exacerbations are possible (if in any doubt, it is better to contact the doctor who is observing your baby) . If such a baby gets sick, he often develops “obstructive syndrome”, which requires urgent treatment.
• Monitoring heart condition, especially in children with bronchopulmonary dysplasia. It is especially important for such children to control physical activity, prescribe massage in doses and physical methods rehabilitation.
• Monitoring the condition of the musculoskeletal system, in particular the hip joints, since impaired development of these joints will not allow the child to sit, stand and walk correctly.
• Monitoring the condition of the visual organs
• Monitoring the condition of the hearing organs.

So there are a lot of problems. It is almost impossible to treat everything at the same time - the baby simply cannot withstand such a load. Therefore, when assessing the child’s condition, it is necessary to determine the priority task that most violates normal development baby and requires urgent correction. Only a specialist can decide this.

Happiness, health and good luck to you and your kids!

Nursing premature babies is a complex process, it is handled by the best neonatologists. And after premature babies are discharged from the maternity hospital, all worries fall on the caring shoulders of parents. The warmth and love of loved ones can work wonders: by being aware of all the features of caring for premature babies and following all the doctors’ instructions, within a few months parents can ensure that their babies catch up with their peers in development.

Why are premature babies born and what are the features of caring for such babies?

The reasons for the birth of premature babies are very diverse and are divided into several groups:

• of the socio-economic ones, the most common are: low standard of living, poor nutrition of the pregnant woman, unsatisfactory living conditions, lack of medical care, occupational hazards, drug addiction, alcohol consumption, smoking;
• there are also socio-biological reasons for the birth of premature children: mother’s age under 18 years and after 35, father’s age under 18 and over 50 years, three or more medical abortions in the mother, spontaneous abortions, pregnancy occurring earlier than 1 year after the previous birth;
• The birth of premature newborns may be caused by clinical factors: chronic diseases mothers, pathological course of pregnancy, physical injuries, immunological conflict between mother and fetus, fetal diseases (intrauterine infections, chromosomal diseases).

Any newborn needs constant attention and touching care. And if a child was born premature, parents and doctors have increased responsibility for his further development and health.

Nature has determined the gestation period human life at 280 days (40 weeks), but did not take care of maintaining the pregnancy throughout its entire duration. Premature births occur with enviable regularity both in countries with a low standard of living and in highly developed ones. From 8 to 12% of newborns are born prematurely, and with them comes anxiety about their fragile life and future fate.

A premature newborn baby is automatically at high risk. It requires treatment, attention and care at all stages of nursing: in the maternity hospital, in the neonatal pathology department of the children's hospital, in the rehabilitation department, and after discharge home - in-depth medical examination in the clinic.

Degrees of prematurity of a newborn baby

There are four degrees of prematurity in newborn babies according to body weight in grams:

• 1st degree 2001-2500;
• 2nd degree 1501-2000;
• 3rd degree 1001-1500;
• 4th degree 1000 or less.

According to the initiative of the World Health Organization, a fetus weighing at least 500 grams and having a heartbeat is considered to be live born.

Even a healthy newborn does not immediately adapt to new living conditions, but what is it like for a prematurely born child with its immature systems: respiratory, digestive, thermoregulation, etc.?

Suffice it to say only about the sharp change in temperature during the transition from mother’s tummy (37 ° C) to new world(20 °C), so that it becomes clear how uncomfortable and anxious the baby feels.

The inability of the central nervous system to coordinate the activities of vital organs, immaturity of the digestive system, decreased reflexes, primarily sucking (and often its absence), are the main barriers to life.

Just thirty years ago, a newborn child of the fourth degree of prematurity weighing one and a half kilograms was doomed, but today even a very premature baby weighing 500 grams has a chance to survive.

A baby born at 37 weeks or earlier, weighing less than 2500 grams and length less than 45 cm is considered premature.

These photos show premature babies with varying degrees of prematurity:

However, body weight in itself is not a determining criterion for prematurity. Often a child born at term has a weight less than borderline, but other indicators of its development indicate that the child is healthy. In other cases, the weight and height of the newborn correspond to the average values, but in other respects it lags behind the norm. Then he is called immature. Perhaps his mother had the flu during pregnancy or suffered from high blood pressure. Sometimes the weight of a premature baby is 300-600 grams higher than the weight of a full-term newborn, especially from mothers with diabetes mellitus and obesity.

The severity of the newborn’s condition is determined by the degree of prematurity and his functional immaturity: is he able to maintain a constant body temperature, does he have sucking and swallowing reflexes, does he have short-term respiratory arrests and bouts of cyanosis (cyanosis), is there pronounced muscle hypotonia, poor motor and emotional reactions, such as frequent regurgitation.

Methods of caring for premature babies: incubator and kangaroo

It is clear that desire alone is not enough to care for premature babies of such low weight with suppressed or absent reflexes in the maternity hospital. It is necessary to have a specialized department equipped with modern equipment that allows round-the-clock monitoring of the child’s condition, provided with the latest medications, including antibacterial.

But even the most modern advances in medicine cannot replace the kind and gentle hands of doctors - neonatologists and nurses who provide gentle, gentle care for premature babies.

In large cities there are special maternity hospitals for women with premature births and perinatal centers where all conditions have been created to provide care to premature babies.

The inability of a premature baby to maintain a constant body temperature is taken into account from the moment of birth: all manipulations with the baby are performed on a table with additional heating, on a warm mattress, and heated diapers are used when dressing.

In specially equipped wards for premature babies, the air temperature is maintained at 25 ° C and humidity 55-60%.

The baby is placed in an incubator or crib with additional heating, depending on its weight and condition. Incubators are used for premature babies weighing less than 2000 grams.

Couveuse means "incubator" in French. This device, which saved many infant lives, has its own microclimate: air temperature from 29 ° C to 34 ° C and humidity from 90-95% in the first 3-4 days, followed by a gradual decrease to 55-60%, as in ambient air .

The length of stay in the incubator for newborns is individual. For a child weighing more than 1500 grams, 3-4 days of “incubation” are usually sufficient. With a lower weight, children can stay in an incubator for newborns from 7-8 days to several weeks.

A premature baby needs to create conditions that simulate the closed space of the uterus, where he was in the fetal position. For this purpose, there is a special “nest” made of soft materials, in which the premature baby feels very comfortable.

Currently, it is possible to create “weightlessness” for a premature baby by placing him in a bath of warm water on a special medical film that envelops the baby and creates the conditions in which he was in the womb.

You can put a heated water mattress in the crib, on which the baby can lie comfortably, and thus protect him from hypothermia.

There are other methods of caring for premature babies in the maternity hospital. Sometimes the kangaroo method is used, in which the premature baby is placed skin to skin on the mother's chest. He feels warm and comfortable, he feels the smell of his mother, her heartbeat and rhythmic breathing. The kangaroo method for caring for premature babies allows the child to grow and develop.

All newborns lose body weight in the first days (so-called physiological weight loss). But in premature babies this the process is underway more intense, and often the physiological decline turns into pathological if the losses are more than 15%. The restoration of the initial indicator occurs slowly, and only by the age of three weeks does the premature infant regain its original weight.

Therefore, during the first month of life, the weight gain in premature infants is insignificant - from 180 to 300 grams. But in the future, with proper feeding and proper care, premature babies double their birth weight by the age of three months, and triple their birth weight by the age of 4-5 months. By his first birthday, the baby has a body weight that is 6-7 times its original weight.

Breastfeeding and artificial feeding of premature newborns

Among all the activities for caring for premature babies, the main attention is paid to properly organized feeding. The method of feeding premature babies is determined by the condition of the baby, its weight, the presence or absence of sucking and swallowing reflexes.

A very premature baby with no reflexes will receive milk through a tube inserted into the stomach. A child weighing more than 2000 g, in satisfactory condition, with active sucking activity, can be attached to the mother’s breast on the first day, first for one feeding per day, then for 2-3 feedings, and then for each feeding.

It is important to remember that sucking is a physical activity for a newborn, and not every premature baby can cope with it. Therefore, while breastfeeding premature babies, it is necessary to monitor the condition of the babies, and at the slightest sign of fatigue, wean them from the breast and feed them with a bottle or teaspoon. In the first days, you should alternate between breastfeeding preterm infants and bottle feeding or attaching to the breast, and then supplementing with bottle feeding. It is recommended to allow the baby to breathe in humidified oxygen for 5-10 minutes before and after feeding.

Imperfections of the digestive system: small stomach volume, low activity of digestive enzymes - dictate feeding tactics. On the first day of life, a premature baby should receive 10-15 ml of milk per feeding, on the second day - 15-20 ml, on the third - 25-30 ml. In the future, the amount of milk per feeding is given at the rate of 15-30 ml per kilogram of weight. For example, when feeding premature newborns, a child weighing 1800 g should receive from 27 to 54 ml per feeding (1.8 x 15 = 27 ml, 1.8 x 30 = 54 ml) depending on condition and body weight.

For this amount of milk you don’t need a standard bottle; you can get by with a small bottle with a regular rubber nipple. Using a fire-heated needle, make a hole such that milk flows out of the inverted bottle in frequent drops and not in a stream. Having become accustomed to the easy flow of milk from the nipple, the baby may refuse the breast when the happy moment of reunification with the mother comes.

It is easy to control the amount of milk when artificially feeding premature babies, and if the baby is breastfeeding, it is necessary to weigh him before and after each feeding to prevent malnutrition.

The frequency of feedings is set individually. But if the baby is bottle-fed from the first day, then the pauses between feedings should be at least 3 hours, with a six-hour break at night.

In a sluggish infant with poor weight gain, feeding every 1.5-2 hours without an overnight break is acceptable.

If breastfeeding does not cause the baby negative consequences, he actively sucks and does not spit up, then you can feed “on demand.” This method of feeding strengthens the bond between mother and child, has a beneficial effect on the baby, who experiences an increased need for care and affection, and stimulates milk production.

The key to successful nursing of a premature baby is natural feeding!

Wise nature arranged it so that the milk of a woman who gave birth prematurely contains more protein, polyunsaturated fatty acids (PUFAs), mineral salts and less lactose.

An increased protein content is necessary for a premature baby to provide plastic material for the rapidly occurring process of building cells and tissues. The accelerated pace of development of the central nervous system requires an increased amount of PUFAs to improve the conduction of impulses along nerve fibers and the maturation of the retina. The limited milk sugar content is justified by the low activity of the lactase enzyme in a premature baby.

Among milk fats, short-chain fatty acids predominate, which break down faster and give more energy required to ensure a high growth rate of the child. The increased content of minerals helps strengthen bone, muscle and other body systems.

Mother's milk is the best and healthy diet for the premature baby, as well as The best way protection from various diseases And allergic reactions. If the mother has little milk, we must try to maintain lactation as much as possible. possible deadline, following all recommendations for the treatment of hypogalactia.

If the mother does not have milk, the premature baby must be provided with donor milk, at least for the first time. This issue is resolved without problems in the maternity hospital or in the neonatal pathology department at the expense of other “milk” mothers, and after discharge home the child is often transferred to artificial feeding.

This event is undesirable, but forced, and it should be carried out carefully and gradually. On the first day, the child should receive no more than 1/8 of the daily amount of food from artificial formula, and the rest from human milk.

On the second day, the amount of the mixture is increased to 1/4 of the volume, on the third - to 1/2 of the volume, and within 5-6 days they completely switch to artificial feeding.

Special formulas for prematurely born children have been developed and produced. Which prematurity formulas are recommended by pediatricians? These are “Prepiltti”, “Humana 0”, “Novolakt MM”, “Bona”. You can also use adapted formulas for premature babies, approved for use from the first days of life: “Similac”, “Piltti”, “Detolakt”, “Malyutka”, etc. It is possible to use such adapted fermented milk formulas for premature infants as acidophilus “Malyutka” ", "Bifilin", "Bifilakt", "Atsi-Milex", "Pelargon".

The introduction of nutritional supplements as complementary foods to premature infants should begin earlier than to full-term infants. Natural fruit and vegetable juices can be given to children aged 2-3 months, from 3-5 drops per day, increasing this amount to 40 ml by four months and to 60 ml by five months (divided into two doses).

The baby will begin to receive fruit puree at 3.5 months. First, half a teaspoon once a day, with a gradual increase in portions to 60 grams by six months and up to 100 grams by a year. Cottage cheese as an additional source of protein and calcium is offered to premature babies in the third month of life, egg yolk - from three months.

The first complementary foods are prescribed at four months in the form of porridge (rice, oatmeal, buckwheat, prepared with diluted breast milk or mixture). At five months, a second complementary feeding is prescribed in the form of vegetable puree. It is recommended to use a variety of vegetables: potatoes, carrots, beets, zucchini, pumpkin, green peas, spinach, etc. At the same time, foods rich in iron are introduced to prevent anemia: pureed liver, chopped meat as an additive to soup or puree. At first, the child receives meat dishes 2-3 times a week, and from 7 months daily. At 8 months, the child receives vegetable soup with crackers, a piece of bread, unsweetened cookies, and at 9 months, kefir can be given. All new products are introduced gradually, taking into account their individual tolerance.

Caring for a premature newborn baby after discharge from the hospital at home

Premature babies are discharged from the maternity hospital if the baby is able to maintain normal body temperature, actively sucks, regularly gains weight and has already reached 2000 grams, his umbilical wound has healed, and his blood test corresponds to the age norm.

Sick children, regardless of body weight, and healthy premature babies who have not reached the required 2000 grams in the first 2 weeks of life are transferred to the neonatal pathology department of the children's hospital for further nursing and treatment.

The length of stay in the hospital is individual for each child and depends on the state of his health. The criteria for discharge are the same as for discharge from the maternity hospital: retains heat, does without additional oxygen, actively sucks and gains weight.

Premature babies are not vaccinated against tuberculosis in the maternity hospital, and this circumstance should be taken into account when discharging a child into unfavorable living conditions: living in the apartment of a tuberculosis patient.

You were so eager to go home, but when you were left alone with the baby, you suddenly became confused and didn’t know what to do or how to approach him. Premature babies are still weak after discharge. “He’s so small, I’m afraid to touch him. “What if I break something,” the young mother cries.

Tears and sobs are bad helpers in important matters. Doctors and nurses have fulfilled their duty, caring for the premature baby after discharge, the main responsibility for the life and health of the “hurry baby” falls on his mother. It depends only on her whether the baby will cope with the problems of the newborn period, how soon he will catch up with his full-term peers, and whether prematurity will have an impact on his future fate.

Your baby came into the world ahead of schedule. Otherwise, he is no different from other children. Unless such a baby requires a little more care, attention and care than a premature baby born on time.

Once again, it is worth emphasizing how important natural feeding is for a premature baby. Try to do everything possible to provide your baby with breast milk. When caring for a premature baby at home after breastfeeding, the baby should be weighed daily to prevent malnutrition.

Having swaddled your baby for the first time at home, you may be concerned when you discover “marbling” of the skin: bluish-pink stains all over the body, indicating immaturity of vascular reactions and thermoregulation. Turning the baby onto its side, you will find that the lower half of the body has acquired a rich red color, and the upper half has become pale. This picture can also frighten young parents. Don’t worry, this is a Harlequin symptom, indicating the immaturity of the autonomic nervous system and vasomotor center in a premature baby. In a couple of weeks, with proper care for your premature newborn, your baby will gain weight, acquire subcutaneous fat, and his skin will become smooth and pink.

Bathing, massage and gymnastics of a premature newborn baby (with video)

Increased care for a prematurely born baby is justified, but should not go beyond acceptable limits. Remembering the imperfection of thermoregulation, when caring for a premature baby at home, young mothers try to wrap their treasure in several diapers, and even cover it with a cotton blanket on top. Muscle tone in a premature baby it is lowered, the respiratory muscles work with effort, and tight swaddling limits breathing movements, and besides, crushed by a heavy blanket, he can simply suffocate. During home care For a premature baby, use grandma's down shawl to keep the baby warm: warm, light and cozy.

Start bathing your premature baby as soon as the umbilical cord has healed. The water environment is his native element. First, the water temperature should be 36-37 °C, then gradually reduce it to 32-34 °C. Bathing a premature newborn should be done every other day or daily, especially if there is diaper rash.

A baby born weighing less than 1 kg will start swimming only from the 4th week. Until then, he will have to make do with gently washing the problem areas.

Another feature of caring for premature babies is limited exposure to air. Air baths during changing clothes and changing diapers in the first month of life should not exceed 3-4 minutes. Remember about the imperfection of the thermoregulation system in a premature baby. You can conduct 3-4 such sessions per day. Gradually increasing the time of “naked floundering”, you can bring the air bath to 10-12 minutes.

A child who has reached a weight of 1300 grams at the age of 1 month can be placed on his stomach. First for a few minutes, gradually increasing the time to 10 minutes 3-4 times a day 15-20 minutes before feeding.

A light massage for premature babies begins when the baby reaches one month of age, when he reaches a weight of 1800 grams.. First, this will be a massage of the anterior abdominal wall. In case of flatulence, stroking the abdomen is indicated for a baby even weighing 900 g.

General massage for premature newborns can begin when they reach a weight of 3 kg. It should be performed by an experienced massage therapist. The first sessions last 3-5 minutes, as the baby’s nervous system quickly gets tired.

From 3-4 months, add elements of gymnastics for premature babies to the massage, constantly expanding the range of exercises. Exist special complexes, designed for weak and premature babies, which you can get acquainted with from your physical therapy instructor. In the first year of life, a premature baby must undergo three courses of general massage and gymnastics. This is the most effective means for accelerating psychomotor development, helping to achieve the age level.

Watch a video of massage for premature babies and simple gymnastic exercises:

Walking in the fresh air begins in the warm season at a weight of 2100 grams from 2-3 weeks of age. In winter, the first walk with a premature baby should take place at an air temperature of at least -5 ° C, its duration should not exceed 5-10 minutes. In the future, it will be possible to walk at a temperature of -10-12 °C for 30-40 minutes 2-3 times a day.

If the winter is frosty, take walks on a closed veranda or in a room with open window. Make sure that during the walk the baby does not overheat or freeze, but feels comfortable.

Features of immunity in premature babies

While in the womb, the child receives antibodies from many diseases through the placenta, which reliably protect him in the first six months of life. The largest amount of antibodies and immunoglobulins enters the child’s body during pregnancy from 32 to 35 weeks. Consequently, a prematurely born child did not receive a significant amount of protective bodies, which undoubtedly affects the state of his immunity.

The own immunity of premature babies functions very weakly: it is almost incapable of producing immunoglobulins, few B-lymphocytes are produced, and the functional activity of T-lymphocytes is low. There are almost no secretory immunoglobulins, which are found in the mucous membranes of the respiratory tract and digestive tract and are the first to meet the invasion of the “enemy,” in premature infants. Therefore, pathogens of respiratory and intestinal diseases easily penetrate through the mucous membranes into the internal environment of the body.

The production of macroglobulins, which should be the first to appear after immunization, is difficult in premature infants. Therefore, there is no point in preventive vaccinations in the first six months of life.

Nonspecific protection is also imperfect: the level of lysozyme is reduced, little interferon is produced, complement activity is insignificant, digestive enzymes are inactive, the permeability of the intestinal wall is increased, the neutralizing function of the liver is almost not expressed.

All these facts indicate the imperfection of immunity in a premature baby and emphasize the need to improve it by all means.

Preventive vaccinations for children born weighing 1500 or less are carried out after the first year of life, taking into account their health status.

For premature infants of the 1st-2nd degree, vaccinations are allowed from 5-6 months, subject to stable weight gain and good physical development. Due to the high incidence of rickets in premature infants due to calcium and phosphorus deficiency in the skeletal system, specific prevention of rickets with vitamin D begins at 2 weeks of age.

All premature babies should be regularly monitored by a pediatrician, and at the age of 2 months they need consultation with a neurologist, surgeon and orthopedist.

Psychological problems of development of premature babies

The birth of a premature baby makes the mother feel guilty about him and the desire to do everything possible to raise the baby healthy and strong.

But good intentions often crumble when faced with reality: long-term separation of mother and child does its dirty work, and the formation of a psychological connection between them becomes much more difficult. The stay of the weak and fragile baby in the incubator, the presence large quantity medical equipment and the inability to hold the baby to the chest make it difficult to establish physical contact between mother and child. All this creates problems in the development of premature babies, which are purely psychological in nature.

These circumstances can lead to a decrease in the feeling of motherhood and attachment to one's own child. And anxious thoughts and despondency contribute to the development of postpartum depression. Unfortunately, there are cases when parents, after a long separation, abandon the baby without seeing him or feeling tender feelings for him.

“Every cloud has a silver lining,” says folk wisdom. Look at the problems of premature newborns from a different perspective. While your little one is in the care of medical professionals, take care of yourself. The recovery period after childbirth will be faster and more efficient for you, because you will not have to get up several times a night to see your baby and take care of him all day without rest. The birth occurred ahead of schedule, and you did not have time to prepare a dowry? Now you have time to calmly and without fuss to prepare the nursery and clothes for the baby. And on the day the child is discharged from the hospital, he will be greeted by a strong, healthy and confident mother.

Recently, great attention has been paid to the presence and constant active participation of parents in child care. In some maternity hospitals and hospitals, parents are allowed into the wards of premature babies. No one is surprised by this picture: near the incubator, in which lies a baby entangled in wires and tubes, his mother stands, stroking his tiny hand and whispering kind words.

The baby feels the presence of the mother, and this has a beneficial effect on his nervous system, stimulates growth and development. Communication between a mother and her child creates a sense of attachment and responsibility for his life, and stimulates milk production.

Moreover, this best school motherhood: constantly observing how deftly the nurses handle the baby, the mother will stop being afraid of him and will take part in her care as much as possible, and when she comes home, she will not stand at a loss in front of the crib, but will calmly and confidently work with the baby.

A premature baby really needs affectionate and caring treatment. Take him in your arms more often, hold him close, say tender words and hum songs. Don't be afraid to take him into your bed. Feeling the presence loving parents, the child becomes calmer and grows better.

Your care and attention will not go unnoticed: problems in premature babies will disappear and in a few months the baby will catch up with its peers, and you will forget that it once fit in the palm of your hand.