Features of diagnosis and development of premature babies. Nutritional regimen for premature infants. Endocrine system of a premature baby

Prematurity is considered to be the birth of a child before the end of the gestational period, that is, between 22 and 37 weeks, with a body weight of less than 2500 g and a length of less than 45 cm.

Premature babies have disorders of thermoregulation, breathing with a tendency to apnea (cessation of respiratory movements), weak immunity and obvious anthropometric and clinical signs.

Degrees

The classification of premature babies by degree is related to the child’s body weight (gestational age is conditional):

1st degree - body weight 2001-2500g. (the period corresponds to 35-37 weeks);

2nd degree - body weight 1501-2000g. (the period corresponds to 32-34 weeks);

3rd degree - 110-1500g. (gestational age 29-31 weeks);

Grade 4 - the baby’s weight is less than 1000g, which corresponds to a gestational age of less than 29 weeks (extremely premature).

Reasons for the birth of premature babies

Causes premature birth numerous and presented on three sides:

Maternal factors:

• chronic diseases of women (pathology of cardio-vascular system, endocrine diseases, kidney pathology):
• acute infections during pregnancy;
• gynecological diseases;
• complicated obstetric history (abortion, cesarean section);
• intrauterine device;
• injuries;
• age (under 17 and over 30);
• Rhesus conflict pregnancy;
• bad habits;
• pathology of the placenta (previa, abruption);
• harmful working conditions;
• complications of pregnancy (preeclampsia).

Paternal factors:

• age (over 50 years);
• chronic diseases.

Fruit factors:

• intrauterine malformations;
• multiple pregnancy;
• erythroblastosis (hemolytic disease);
• intrauterine infection.

Signs

Premature babies have a pronounced clinical picture. There is a disproportion of body parts, the cerebral skull predominates over the facial one. The bones of the skull are soft; in addition to the fontanelles, non-fusion of the cranial sutures is observed. Soft ears are also characteristic.

In premature babies, the subcutaneous fat layer is poorly developed; they cannot “hold” their temperature (instability of thermoregulation). Underdevelopment of the lungs during prematurity is due to the lack of surfactant, which ensures the opening of the pulmonary alveoli during inspiration, which is manifested by respiratory failure and periodic apneas (stopping breathing).

Skin wrinkled, have a bright red color on the first day, weak muscle tone or its complete absence.

Physiological reflexes (sucking, searching and others) are weakly expressed.

In premature boys, the testicles are not descended into the scrotum, and in girls, the labia majora are underdeveloped. Hypertensive and hydrocephalic syndromes are typical for premature babies.

Due to underdevelopment of the eyelids, bulging eyes (exophthalmos) are pronounced.

There is insufficient liver function, which is manifested by kernicterus. Due to underdeveloped immune system Premature babies are at high risk of infection. Premature babies are prone to spitting up. In addition, in such children, the nail plates are underdeveloped and can only reach the middle of the fingertips.

Therapy for premature babies

A neonatologist is involved in the management and treatment of premature babies.

Children born prematurely require certain living conditions. The ambient temperature should be 25°C and the humidity at least 55-60%. For this purpose, premature babies are kept in incubators (special incubators).

The incubators contain babies weighing less than 2000g. Healthy premature babies are discharged on days 8-10, provided their body weight reaches 2 kg.

If premature baby within 14 days has not reached a weight of 2000 g, he is transferred to the second stage of nursing (carried out in the intensive care unit of the children's department/hospital). Such children are placed in incubators where oxygen is supplied.

Premature babies begin to be bathed at 2 weeks of age (subject to the healing of the umbilical cord). They walk with children when they are 3-4 weeks old and weigh 1700-1800g.

Healthy premature babies are discharged when they reach a weight of 1700g.

Feeding

Feeding your baby with pumped milk breast milk begin 2-6 hours after birth, provided there are no contraindications and the pregnancy is long (34-37 weeks).

Babies who are critically ill or very premature are given parenteral nutrition through a tube (through the mouth or nose) for the first 24-48 hours of life.

They begin to put a baby weighing 1800-2000g to the breast. in the presence of active sucking. On day 1, the volume of one feeding is 5-10 ml, on day 2 10-15 ml, and on day 3 - 15-20 ml.

In addition, premature babies are advised to administer vitamins:

• vikasol (vitamin K) to prevent intracranial hemorrhage;
• ascorbic acid (vitamin C), vitamins B1, B2;
• vitamin E (tocopherol);
• prevention of rickets (vitamin D);
• vitamins B6 and B5, lipoic acid for extreme prematurity;

Consequences of prematurity and developmental prognosis

The prognosis for life in premature babies depends on many factors. Primarily on gestational age and birth weight. If a baby is born at 22-23 weeks, the prognosis depends on the intensity and quality of therapy. The risk of death increases in the following cases:

• antepartum hemorrhage;
• breech birth;
• multiple pregnancy;
• asphyxia during childbirth;
• low temperature of the child;
• respiratory distress syndrome.

Long-term consequences of prematurity (the likelihood of these complications again depends on many factors; under other favorable conditions, these complications are quite rare):

• retardation in mental and physical development;
• cerebral palsy;
• convulsive and hydrocephalic syndromes;
• myopia, astigmatism, glaucoma, retinal detachment;
• tendency to frequent infections;
• hearing impairment;
• violation menstrual cycle, genital infantilism and problems with conception in girls.

A child born at a gestational age of 22-37 weeks (154-259 days from the first day of the last menstrual period) with a body weight of less than 2,500 g and a length of less than 45 cm is considered premature. A newborn with a birth weight of 500 g who has made at least just one breath. Depending on body weight at birth, there are 4 degrees of prematurity:
I degree – 2001-2500;
II degree – 1501-2000;
III degree – 1001-1500 g;
IV degree – 1000 g or less.
Birth weight is not an absolute indicator of prematurity. Thus, 1/3 of newborns weighing less than 2500 g are full-term, and in 4-5% of premature infants their body weight exceeds 2500 g. The main criterion for prematurity is gestational age (term intrauterine development, gestatio – pregnancy, wearing). Based on gestational age, there are 4 degrees of prematurity:
I degree – gestation period 36-35 weeks;
II degree – gestation period 34-32 weeks;
III degree – gestation period 31-29 weeks;
IV degree – gestation period 28-22 weeks.
Prematurity- a concept that relates exclusively to the neonatal period. The frequency of birth of premature babies in various regions of the country is 5-12%. The mortality rate of premature babies is 20 times higher than the mortality rate of full-term babies.
Anatomical and physiological features(AFO) premature baby
 Morphological signs of prematurity: Appearance premature babies have a number of signs that are directly dependent on the duration of pregnancy. The shorter the child’s gestational age, the more pronounced they are and the more of them there are. Some
signs are used to determine gestational age. These include: skin, ears, nipple areolas, furrows on the feet, sexual characteristics.
A very premature baby has thin, wrinkled skin of a dark red color, abundantly covered with fluff (lanugo). The auricles are soft and adjacent to the skull; at a short gestation period, they lack relief and are shapeless as a result of underdevelopment of cartilage tissue. The areolas of the nipples are underdeveloped, less than 3 mm, and with severe prematurity they may not be detected. The furrows on the feet are sparse, short, shallow, appear at the 37th week of pregnancy, and at the 40th week of gestation they become numerous. The scrotum in boys is empty, the testicles are located in the inguinal canals, or in abdominal cavity. Girls are characterized by genital gaping
gaps - the labia majora do not cover the labia minora, the hypertrophied clitoris is clearly visible.
A premature baby is small in size and has a disproportionate build. The weight-height ratio is 30-50. Relatively large head (1/3 of the body), short neck and legs, umbilical ring located closer to the womb. The brain skull predominates over the facial skull. The sutures of the skull and fontanels are open. The subcutaneous fat layer is not expressed. Nails do not reach fingertips.
 Functional signs of prematurity. Premature babies are characterized by immaturity of all organs and systems, the severity of which depends on the duration of pregnancy. Neurological signs of prematurity are muscle hypotonia, decreased
physiological reflexes (sucking, swallowing, sucking movements inhibit breathing, cause respiratory pauses, cyanosis) and motor activity, imperfect thermoregulation (reduced heat production and increased heat transfer), weak cry of the child, decreased activity of digestive enzymes. Children are periodically restless, there is intermittent tremor of the chin and limbs, and a tendency to convulsions. Breathing is 40-90 respiratory movements per minute, uneven in rhythm and depth, interrupted
convulsive sighs and pauses (apnea) lasting up to 10-15 seconds, which is more often observed in very premature infants with hypoxic lesions of the central nervous system. With a longer cessation of breathing, asphyxia (suffocation) may develop (insufficient development of the alveoli, the capillary network of the lungs, reduces the content surfactant and, which leads to insufficient expansion of the lungs, the persistence of fetal atelectasis, and the development of hemodynamic disorders in the lungs, which determine breathing patterns. Therefore, premature babies make up the main percentage of newborns who develop respiratory distress syndrome).
The cardiovascular system. The pulse is labile from 100 to 180 beats per minute. Any irritants cause increased heart rate, increased sonority of tones, and increased blood pressure (due to the predominant influence of the sympathetic department). Blood pressure does not exceed 60-70 mm Hg. Thermoregulation in a premature baby is imperfect. Children quickly cool down and also quickly overheat. In children with low body weight, heat loss is increased due to a relatively larger body surface, a too thin subcutaneous fat layer and immaturity of thermoregulation centers. The peculiarity of the temperature reaction is manifested in the fact that when overheated, the body temperature can rise to 40 degrees, and in response to external infections, premature infants may not respond with an increase in temperature.
Digestive system. The volume of the stomach in the first 10 days of a premature infant is 3 ml/kg
multiplied by the number of days. Proteins are well absorbed, but fats are poorly absorbed. The permeability of the intestinal wall is significantly increased, and the enzyme-secreting function of the intestine is reduced. The liver is functionally even more immature than that of full-term infants. small stomach volume, decreased secretion and activity of digestive enzymes, poor development of the intestinal muscle wall, decreased immunoglobulin A promotes the development of dysbacteriosis.
Sucking and swallowing reflexes are poorly developed. There is often a lack of coordination between sucking and swallowing. There is a tendency to regurgitation, vomiting, flatulence, and constipation. The absence of a cough reflex promotes aspiration of food.
Kidneys. Reduced filtration function, increased urinary sodium excretion and poor water reabsorption, limited ability to remove excess water from the body. Daily diuresis by the end of the first week ranges from 60 to 145 ml, the frequency of urination is 8-15 times a day.
Hematopoietic system. Lower levels of hemoglobin and red blood cells, fetal hemoglobin remains for a long time high level. Almost all preterm infants less than 30 weeks' gestational age are anemic. Increased permeability and fragility of blood vessels (due to vitamin K deficiency) contribute to the occurrence of cerebrovascular accidents and hemorrhages.
Due to imperfect immunity, premature babies are prone to infectious diseases.
Borderline physiological states are unique in premature infants: physiological erythema, loss of initial body weight, and jaundice are more pronounced and prolonged. Mild jaundice may be accompanied by severe bilirubin encephalopathy. Sexual crisis is much less common than in full-term babies and is less pronounced. Primary leukocyte crossover is 7-15 days later. Transient fever easily occurs due to non-compliance with drinking regime and overheating. The umbilical cord remnant falls off later than in full-term babies (on the 5th-7th day of life), umbilical wound heals by 12-15 days, with mass
less than 1000 kg - 1-2 weeks later.

Features of development of premature babies
I. Physical development of premature infants
1. Characterized by higher rates of increase in body weight during the first year of life compared to children born at term. The exception is the first month of life, when there is a low increase in body weight due to a greater loss of initial weight than in full-term infants. In premature infants, initial weight loss is 9-14% of birth weight. They double their body weight by 2-3.5 months, triple by 4-6 months, and by one year their weight increases 4-7 times.
2. The monthly increase in height in premature infants is on average 2.5-3 cm. Growth in the first year increases by 27-38 cm. Despite the high rates of growth and development, in the first 2-3 years of life, premature infants in terms of body weight and growth lag behind their peers born full-term. And only by the age of 3, the body weight and length of these children approach the corresponding indicators for full-term children.
3. In children with grades I-II prematurity, teeth erupt at 6-9 months, grades III-IV - 8-10 months.
4. Head circumference at birth is 3-4 cm larger than chest circumference. By 3-5 months sizes
are compared, then the chest circumference is greater than the head circumference.
5. Subsequently, the periods of the 1st and 2nd extension in premature infants occur 1-2 years later than in full-term infants.
II. Neuropsychic development of premature infants
During the first years of life, the rate of psychomotor development of children is delayed, the formation of leading lines of nervous mental development shifted in time to a later age stage. This lag depends on the degree of prematurity and is more pronounced in children with degrees III-IV prematurity. In these children, the appearance of psychomotor skills at 1-2 years is delayed by 2-3 months.
 In children with II degree of prematurity for 1-1.5 months
 By the end of the 1st year of life, the majority of children with degree I prematurity catch up with their full-term peers in psychomotor development, and by the age of 2 years, extremely preterm children are compared with them. Delayed mental development of a child born prematurely may be due to dysfunction of the sensory organs. Thus, pathology of the visual organs (myopathy, astigmatism, strabismus) occurs in 25%, hearing loss of varying degrees in 4% of children born prematurely.
In premature infants (due to unfavorable intrauterine conditions, fetal hypoxia, etc.)
psychoneurological disorders in the form of neuropathic psychopathic personality traits are observed. Neurological changes are more common: vegetative-vascular disorders, hypertensive-hydrocephalic syndrome, convulsive syndrome, cerebral palsy. By the age of 4-7 years, the manifestation of neuropsychiatric symptoms may disappear or remain in the form of mild clinical signs of central nervous system damage: unstable mental condition, negativism reactions, anxiety, fussiness, insomnia, loss of appetite, difficulty in eating solid food. An unfavorable course with the formation of persistent and complex psychopathological syndromes is possible. However, most premature babies have normal mental development. Among the premature there are many famous people: Darwin, Newton, Voltaire, Hugo, Napoleon, Yesenin, Mironov, etc.

Organization medical care premature babies
The problem of caring for premature babies is extremely complex, since children are not yet mature enough to exist outside the mother’s body. To preserve the viability of premature babies, it is necessary to create special conditions both at the time of birth and during the subsequent adaptation of the child. For this purpose, assistance to premature babies is provided in stages:
Stage I of nursing – providing intensive care and treatment in the maternity hospital;
Stage II – nursing in a specialized department;
III stage of nursing – dispensary observation in a children's clinic.
The main goal of stage I is to save the child’s life. In the first hours and days after birth, intensive therapy is provided, if necessary, and careful care and monitoring are provided. Special attention is paid to compliance with the sanitary and epidemiological regime. Healthy babies with a birth weight of more than 2000 g are discharged home from the maternity hospital, all other premature babies are transferred to a specialized department for the second stage of nursing.
The main area of ​​work of the specialized department is treatment and rehabilitation. Therapeutic measures aimed at eliminating hypoxia, cerebrovascular accidents, jaundice, pneumopathy, preventing anemia, rickets, malnutrition.
Discharge from the department of the second stage of nursing is approached individually. The main criteria are:
– absence of diseases;
- restoration of initial body weight and its satisfactory increase;
— normal level hemoglobin;
- favorable home environment.
All information about the child is transferred to the children's clinic on the day of discharge.

A premature baby is a newborn child like others, differing from a mature newborn in underdeveloped body functions.

Any newborn born weighing less than 2,500 g and height less than 48 cm is considered premature. It is usually born before the end of the 37th week of pregnancy.

Degrees of prematurity

Premature babies belong to a separate group of newborns.

The group of premature babies is divided into a number of subgroups, but most often they are divided into two main ones: immature up to 1,500 g in weight and immature from 1,500 to 2,500 g.

There are 4 degrees, which are based on the height and weight of the premature baby.

1. First. Date of birth: 35-37 weeks, weight 2000-2500 grams.
2. Second. Term: 32-34 weeks, weight 1500-2000 grams.
3. Third. Term: 29-31 weeks, weight 1000-1500 grams.
4. Fourth. Less than 20 weeks, weight less than 1000 grams.

The higher the degree of prematurity, the more difficult it will be for the baby to emerge. The main problem of such babies is not lack of weight, but too low development of vital systems and organs of the body.

Basically, a premature baby has all the characteristics of a newborn baby, it is just less mature. And yet, certain parts of the body lag behind others in size and development. This incommensurability in children born after fewer lunar months appears due to the fact that the formation of individual organs and systems was incomplete. For example, the skull has a round or ovoid shape and only before the end of pregnancy (10 lunar months) does it lengthen somewhat. The subcutaneous fat layer is much less pronounced, since it is mainly created before the end of pregnancy, so the premature baby has a somewhat specific appearance.

The percentage of births of premature babies is variable and not the same in all countries of the world. Basically it ranges from 8 to 12% of the total number of children born...

Causes of having a premature baby

The causes of prematurity in approximately 50% of cases are unknown.

It is believed that of all possible reasons The following have a special impact on the birth of premature babies:

• in the first place I would like to put the usual negligence of the expectant mother: to go far away in a shaking train or car because “I want”, to do general cleaning or repairs, and in all cases she believes that no one can move her closet, she falls while climbing up the tree “for that red cherry” or running on the ice... Dear expectant mothers, take care of yourself and your belly from the first days until birth, don’t risk your baby by saying “and my friend flew to Turkey in her seventh month, and that’s all.” it was nice". There is no place for risks here!
• chronic diseases of mothers (tuberculosis, syphilis, joint diseases, anemia, etc.);
• congenital tendency to premature birth;
• injuries to working women (constant exposure to subtle but harmful influences, such as shocks, vibration, etc.);
• multiple pregnancies (twins, triplets);
• acute mental shocks of the mother;
• difficult social conditions mother’s life (illegitimate, unemployment, etc.);
• Seasons ( early spring, late fall);
• undesirable changes in the mother’s diet during pregnancy (lack of proteins and vitamins);
• attempt to have an abortion, previous abortions;
• drinking alcohol and smoking;
• too young or vice versa elderly age parents;
• non-compliance with medical instructions;
• psychological, everyday and emotional factors that negatively affect the course of pregnancy;
• period less than 2 years between births;
• difficult pregnancy;

We have already said that about 50% of the reasons have not yet been sufficiently studied. There are also new interpretations according to which the causes of prematurity may also come from fathers. It is believed that for successful childbirth it is important when the sperm are completely mature and capable of fertilization.

As mentioned above, a premature baby is born with less mature organs, the maturity of which is achieved in parallel with weight gain. Such a child is poorly prepared for life in the external environment, it is difficult to adapt and quickly succumbs to various diseases. The development of a premature baby by month is worth talking about in more detail.

Development of a premature baby by month

Premature baby up to 29 weeks.

Such children typically weigh less than 1 kilogram and have a red-violet skin color. The skin is folded and covered with fluff (lanugo). Externally, the babies are thin, but not emaciated. If there are signs of exhaustion, this indicates the presence of malnutrition. Due to the lack of sucking, swallowing and breathing reflexes, life support for babies is provided by medical equipment. Often such children do not know how to cry, but sleep most of the time. Their movements are rare and sluggish due to decreased muscle tone.

Delivery before 29 weeks is extremely rare.

Development of a baby born at 29 weeks

Outwardly, these babies resemble babies born more early stages, however, there are differences that subsequently reduce the likelihood of negative manifestations early birth. Most often, children are placed in an incubator in which constant temperature and humidity conditions are maintained, and oxygen is additionally supplied.

Having a baby at 30 weeks

Children born at this stage can already be fed breast milk through a tube. They begin to develop movements.

Features of the development of a child born at 31 weeks

Despite the fact that children born at this time can already open their eyes, cry and move more actively, they still need constant medical supervision.

Baby born at 32 weeks

These babies weigh more than 1500 grams and can breathe on their own.

Week 33

If the baby does not have problems with the respiratory system, then he can be bottle-fed or breastfed.

Childbirth at 34 weeks - features of the birth of a child

The likelihood of developing health problems decreases, the condition of children who were born during this period improves.

Birth of a child - 36 weeks

Risks of birth at this time include imperfect thermoregulation and jaundice. The weight of such children is close to normal, and there are practically no health problems.

Development of premature babies by month depending on birth weight

The child was born weighing up to 1000 grams

At 3 months they begin to concentrate their attention on sound sources.

The child was born weighing 1000-1500 grams

At 2.5 months they begin to concentrate their attention on sound sources.

At 4 months, the head is held in an upright position.

At 7 months they roll over from back to stomach, and at 8 months from stomach to back.

Starting from 9 months, they try to sit up independently.

As children approach one year of age, they try to get up.

Starting from 1 year 2 months, children try to take their first steps.

After a year, the first words are spoken.

The birth of a child weighing 1500-2000 grams.

At 2 months they begin to concentrate their attention on sound sources.

Starting from 7 months, they try to sit up independently.

At 10 months, children try to stand up.

Starting at 11, children try to take their first steps.

After 11 months, the first words are spoken.

Premature baby weighing 2000-2500 grams - development by month

At 1.5 months they begin to concentrate their attention on sound sources.

At 2 months the head is held in an upright position.

At 6 months they roll over from back to stomach, and at 7 months from stomach to back.

Starting from 6 months, they try to sit up independently.

Closer to 9 months, children try to get up.

Starting from 11 months, children try to take their first steps.

At 11 months the first words are spoken.

Features of the development of premature babies by month

Development of a premature baby - 1 month

High probability of infection infectious diseases which can lead to complications. Weight gain is minimal. The increase in height is on average 2-5 cm. The head circumference increases to 4-5 cm. If the development of the baby proceeds normally, a sucking-swallowing reflex should occur. If it is absent, feeding should be done using a tube. If the respiratory reflex is poorly developed, you should resort to artificial oxygen supply.

2 months of life of a premature baby

Weight gain accelerates. This good indicator, as it indicates that the child is developing. The increase in height is on average 2-5 cm. The head circumference increases to 2-3 cm. Breastfeeding is a difficult test for fragile children, so they need to be supplemented with expressed milk using a spoon.

Premature baby and its development at 3 months

The weight should increase by 1.5 times. The increase in height is on average 2-5 cm. The head circumference increases to 2.5 cm. The main task of parents during this period is to control the climate in the room where the baby sleeps and change the position of the child’s body during wakefulness and sleep.

4 months of life of a premature baby

The baby is already raising his head, holding it, fixing his gaze and making sounds. The increase in height is on average 2-5 cm. The head circumference increases to 1.5 cm.

What can a premature baby do at 5 months?

He begins to smile and grabs objects that interest him with his hands. The increase in height is on average 2-5 cm. The head circumference increases to 1.5 cm.

Features of the physical and psychological development of a premature baby - 6 months

By this age, premature babies catch up with their peers in development. Their weight should double. The increase in height is on average 2-5 cm. The head circumference increases to 1.5 cm. They are able to distinguish their family from strangers, play with toys and turn their heads.

7 months - development of a premature baby

The increase in height is on average 1-3 cm. The head circumference increases to 0.5-1 cm. The game becomes more active. The toddler turns over from his stomach to his back.

Premature baby - 8 months

The increase in height is on average 1-3 cm. The head circumference increases to 0.5-1 cm. Turning over is already easy for the baby. Attempts to crawl appear.

9 months of life of a premature baby - his skills, developmental features

The increase in height is on average 1-3 cm. The head circumference increases to 0.5-1 cm. He picks up pieces of food without outside help, gets to his feet, holding onto a support, and actively plays.

10-11 months of life of a premature baby

The increase in height is on average 1-3 cm. The head circumference increases to 0.5-1 cm. Children actively crawl, play, utter all sorts of sounds, and actively respond to their name.

Premature baby - development at 1 year - 12 months

The increase in height is on average 1-3 cm. The head circumference increases to 0.5-1 cm. They begin to pronounce syllables. The main thing for parents during this period is not to rush and not teach the child to walk.

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 a woman’s health, complicated pregnancy, bad habits, etc. 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

I don’t think I’ve found such a good article anywhere about premature babies. I took it from here

She herself once gave birth to a premature son. Oh, and we got it... Now everything is fine

November 17 is the International Day of the Premature Baby, which was established in 2009 at the initiative of the European Foundation for the Care of Newborn Patients.

Pregnancy is behind us - a time of joyful and, at the same time, anxious anticipation. Finally, the long-awaited baby was born, but, alas, earlier than expected. Of course, you are worried and ask a lot of questions.

Premature baby: basic concepts

Immediately after birth, it is determined how premature the baby is, since further treatment tactics and the creation of conditions for nursing depend on this.

This takes into account two main criteria: birth weight and gestational age or age (the number of completed weeks of pregnancy at the time of birth).

Degrees of prematurity

First degree of prematurity- birth at 34-36 weeks and six days. Birth weight - from 2001 to 2500 grams. The prognosis is favorable, as a rule, without creating special conditions for nursing. Except in cases where there are other conditions or diseases - for example, infection, birth trauma, a long anhydrous period.

Second or moderate degree of prematurity- early birth at 31-33 weeks and 6 days. Birth weight is from 1501 to 2000 grams. The prognosis is favorable if timely medical care is provided, as well as under conditions of optimal feeding and care.

Third or severe degree of prematurity- very early birth at 28-30 weeks. Body weight at birth is from 1001 to 1500 grams. The prognosis is not entirely favorable, although many of these children survive. However, subsequently they spend a long time in nursing and receive treatment for various diseases.

Fourth degree or deep prematurity- extremely early birth at up to 28 weeks. Birth weight - up to 1000 grams (extremely low weight). According to statistics, every fifth baby is born alive during this period.

However, the prognosis is unfavorable. Babies who were born alive before 26 weeks, unfortunately, in 80-90% of cases die by the age of one month, and of those born at 27-28 weeks - about 60-70%.

"Post-conceptual age" or "post-conceptual period"

In medicine, these concepts are used when the age of the child or the period after birth is indicated according to the duration of pregnancy, if it were still ongoing.

Therefore, when characterizing a premature baby (appearance, developmental features and other signs), weeks are usually given in accordance with gestational age.

Born prematurely: what does a premature baby look like?

Of course, a premature baby is different in appearance from a full-term baby, but much depends on the gestational age.

The main external distinctive signs of premature babies

Moderate prematurity: I-II degree

* Muscle tone is somewhat reduced, but the baby is generally active.
* The skin is pink and the subcutaneous fat layer is moderately thin.
* Vellus hair (lanugo) is absent from the skin on the face from 32-33 weeks, and starting from 35-37 weeks - usually on the entire surface of the skin.
* The nipples and peripapillary areas (the skin around the nipples) are clearly visible and pigmented (colored).
* The first bends in the ears appear at 35-37 weeks.
* Usually the physique is proportional: the size of the head and the length of the limbs (arms, legs) relative to the body are of normal size.
* The navel is located closer to the center of the abdomen, but still slightly lower than in full-term babies.
* Nails typically extend to the edges of the toes (nail bed).
* The external genitalia are well developed. In girls, the genital slit is almost closed. In boys, the testicles are located at the entrance to the scrotum (in the upper third), but sometimes there is unilateral cryptorchidism (one testicle does not descend into the scrotum).

Deep prematurity: III-IV degree

* Due to decreased muscle tone, the child lies with his arms and legs extended.
* The skin is dark red, thin and wrinkled (like an old man’s), often swollen, and abundantly covered with vellus hair.
* The subcutaneous fat layer is thinned.
* The baby has a somewhat disproportionate physique: the size of the head is large in relation to the length of the body, and the limbs are short compared to the body.
* The navel is located in the lower third of the abdomen.
* The nipples and parapapillary areas are poorly pigmented and difficult to see.
* The ears are soft, have no convolutions and are shapeless, pressed to the head and located low.
* Baby's nails are underdeveloped and usually do not reach the fingertips.
* The cranial sutures are open, the small, large and lateral fontanelles are large, and the bones of the skull are soft.
* External genitalia are underdeveloped. In girls, the labia majora do not cover the labia minora, so the genital slit is gaping (open). In boys, the testicles usually have not yet descended into the scrotum.

Life against all odds...

Regarding premature babies, there is The general trend: The incidence of morbidity, mortality and disability increases as gestational age decreases.

However, the forecast remains just a forecast and is not guarantee or sentence. Because some premature babies, despite all the gloomy assessments, fight, survive and grow up as healthy children. While other babies have a hard time being nursed, and sometimes even die, although, it would seem, they initially have more favorable characteristics.

Why is this happening? The question is better addressed to Mother Nature. Alas, we most likely will not get an answer to it. However, perhaps this phenomenon can be explained by the desire of some children to cling to life by any means.

Hence the conclusion: with each passing day, the baby’s chances of survival increase significantly.

Therefore, in the next material we will talk about the physiological features of a premature baby depending on the gestational age at the time of birth. Successful nursing, adaptation to life outside the womb and the health of the premature baby are directly related to them.