Every tenth earthling is born premature. Premature baby - chances of survival

According to the UN Declaration of the Rights of the Child, the state is obliged to ensure the protection of the life and health of children, regardless of the economic situation of society. The implementation of this provision from the first minutes of life of a premature newborn baby directly depends on the work of medical personnel.

The annual decline in infant mortality (by about 5%) that began in the late 1980s stopped in 1990. Since 1991, its increase began. Premature babies make a significant contribution to the growth of this indicator.

According to the Ministry of Health and Medical Industry, in 1985, every 11th baby was born sick or became ill in the neonatal period, in 1989 - every 8th, in 1992-1993 - every 5th. By 2013, the proportion of healthy newborns in the Russian population may decrease to 15-20% while the birth rate remains low.

The relevance of this topic in modern conditions

Prematurity is one of the leading causes of death among newborns. Surviving preterm infants have a significantly increased likelihood of developing acute or chronic illness and various neurological disorders later in life. These facts make us treat the epidemiology of prematurity as a problem of exceptional importance. Statistics show a disproportionately high number of premature babies among the total number of surviving newborns who suffer from physical, intellectual and emotional disabilities. Prematurity leads to ethical problems related to the cost and effectiveness of treatment, family relationships, difficulties in education and future employment. All this gives reason to believe that prematurity is not only a medical, but also a serious social problem.

The term “premature babies” was adopted in 1929 and is recognized throughout the world.

If you strictly follow the medical terminology, prematurity is not always a special problem: the term itself means that the baby was born before spending 38 weeks in the mother’s tummy. Sometimes it even happens that a baby born after the 36th week has completely normal health and good weight, sucks well at the breast and is actively developing. But, alas, it happens differently: most often, prematurely born babies have signs of immaturity and require special care.

The incidence of preterm birth is highly variable. In most industrialized countries, over the past two decades it has been quite stable and amounts to 5-10% of the number of children born. The frequency of premature births in St. Petersburg is 7.4-6.7% (1999-2002). In the United States, of the 3.7 million babies born annually, 10.8% are children born weighing less than 2500 g, and 1.1% are born before 32 weeks and weighing less than 1250 g.

Survival of preterm infants is directly related to gestational age and birth weight. Children with a body weight of 1500 g and below (less than 30-31 weeks of gestation) account for only 1% of all live births, but at the same time, 70% of deaths in the neonatal period (excluding children with congenital anomalies) occur in children with birth weight bodies up to 1500. With the accumulation of experience in intensive treatment of newborn premature babies, a progressive decrease in the mortality rate is noted.

In 1975, the World Health Organization recommended that babies be considered viable if they were born no earlier than the 22nd full week and their body weight reached 500 g, and a child born before 37 completed weeks of pregnancy and having all the signs is considered premature. immaturity. Today, body weight and height are considered conditional criteria for prematurity, since many full-term children, for a number of reasons, may have a body weight of less than 2500 g and a height of less than 45 cm.

Russia joined the countries implementing WHO recommendations on January 1, 1993. Of course, children with extremely low body weight, according to statistics, are rarely born: 0.01% of all premature babies. If you look at the numbers, this, of course, is negligible, but behind the numbers lies the fate of the little man and his parents. Out of ten very premature children, four become disabled, but we can leave six, and they adapt socially.

A prognosis is a prognosis, not a guarantee or a death sentence: some premature babies die suddenly, despite favorable prognoses, others survive despite gloomy estimates. Japanese scientists have described a case of successful nursing of a premature baby born weighing 396 g. Moreover, after some time, he was not inferior to his peers either in mental or physical development!

One thing is certain: the chances of a premature baby to survive increase with each passing day.

The degree of development of this topic

Currently, in developed countries, a fetus born at a gestation period of 22-25 weeks can survive if nursing conditions are created that correspond to its anatomical and physiological characteristics. Today, in maternity hospitals with well-equipped neonatal intensive care units, babies weighing from 500 g are cared for. And the smallest child to survive after premature birth was Amilia Taylor from the USA: she was born at the 22nd week of pregnancy and at the time of birth weighed only 280 grams! At the WHO Assembly, and then in the order of the Ministry of Health of the Russian Federation No. 318 (dated December 4, 1992), the following definition of live birth was adopted: “A live birth is the complete expulsion or extraction of the product of conception from the mother’s body, regardless of the duration of pregnancy, and the fetus after such separation breathes or exhibits other signs of life, such as heartbeat, pulsation of the umbilical cord, or voluntary muscle movements, regardless of whether the umbilical cord is cut or whether the placenta is separated.”

According to the order of the Ministry of Health of Russia No. 318 dated December 4, 1992, the following terminology is recommended: all children weighing less than 2500 g are low birth weight newborns.

Among them there are groups:

b 2500-1500 g - children with low birth weight (LBW)

b 1500-1000 g - with very low body weight (VLBW)

b less than 1000 g - with extremely low body weight (ELBW)

In order for domestic statistics to be comparable with international criteria in the field of perinatology, Russia, taking into account WHO recommendations, switched to new criteria, which is reflected in the above-mentioned order. Health care institutions must register all children born alive and stillborn, who have a birth weight of 500 g or more, a length of 25 cm or more, with a gestational age of 22 weeks or more (industry indicators). However, as before, state statistics of live births only take into account children from the 28th week of gestation or more (body weight 1000 g or more, length 35 cm or more). Of those born alive with a body weight of 500-999 g, only those newborns who lived 168 hours (7 days) are subject to registration with the registry office. The neonatal mortality rate of premature infants is much higher than that of full-term infants and is largely dependent on the effectiveness of medical care.

A nationwide study showed that the proportion of surviving babies among those born at 22-23 weeks is 1%, and among those born at 25-26 weeks the figure is already 44%. Severe and moderate developmental disorders are observed in two out of three surviving 23-24 week old infants.

There are two extremes in attitude towards a premature baby: some are inclined to consider him a smaller copy of a child born at term, others completely deny him the right to be called a person and consider him almost an embryo, who, by the will of fate, found himself outside the mother’s womb. Both are wrong. Premature babies are, of course, children, but they are special ones, requiring special treatment and special care. For example, a 24-week premature baby would normally have to spend another 16 weeks in the uterus, where the placenta provides him with nutrition and oxygen, eliminating the need to eat and breathe on his own; temperature is constant; it is protected from all injuries and damage; gravity is not felt at all; his nervous system does not have to react to strong stimuli (visual, auditory, tactile). Having been deprived of this familiar and comfortable environment ahead of schedule, the baby is forced to adapt to the best of his ability to a new, generally hostile environment. It is clear that in most cases this is impossible without the help of doctors.

Ethical features of nursing premature babies

In recent years, various aspects of the problem of depopulation in Russia have been actively discussed in the scientific and public press. Since 1991, the country began a process of natural population decline; currently, in many regions of Russia, the mortality rate is 2-3 times higher than the birth rate. Currently, the birth rate in Russia does not ensure simple reproduction of the population.

Declining birth rate in the 1990s. was so significant that analogies with the Great Patriotic War are appropriate. Currently, in terms of fertility, Russia is in the group of economically developed countries (such as Italy, Spain, Greece, Germany, the Czech Republic), whose total fertility rate is consistently 1.5-1.6.

Another reason for the decline in the birth rate is the change in reproductive attitudes under the influence of the media, the introduction of foreign models of family, reproductive and sexual behavior into the consciousness of Russian youth.

In total, 1.789 million people were born in January-December, which is almost 28 thousand more than in 2009. The birth rate increased by 1.6%. At the same time, in Russia in 2010, mortality also increased.

Mortality continues to outweigh the birth rate, and Russia's population decreased by 241.4 thousand people in 2010.

In Russia, the mortality rate of newborns in obstetric institutions still remains very high. It should be noted here that, according to the current “Instructions on determining the criteria for live birth, the perinatal period”, approved by order of the Ministry of Health of Russia No. 318 dated December 4, 1992, the perinatal period begins only from 28 weeks of pregnancy, when the normal body weight of the fetus is 1000 g and more, and not from 22 weeks, as recommended by WHO and as is customary in most countries of the world. Therefore, in Russia there are virtually no official regulatory documents obliging the care of newborns born with a body weight of less than 1000 g (EBW), which in practice results in a very large death of newborns with EBW.

In addition, according to the above-mentioned order of the Russian Ministry of Health, a newborn with a body weight from 500 to 1000 is subject to official registration with the civil registry office only if he lived more than 168 hours (7 days) after birth. If such a child lived less than 168 hours, he is considered a “late miscarriage,” just like one born with a body weight of less than 1000 g without signs of life. Therefore, neither the birth nor the death of such a child is officially registered by the civil registry office. Information about such cases can only be found in the medical documentation of maternity institutions and annual reports on their activities (forms No. 32 and No. 13), but this information cannot be considered completely reliable. Since there is no official control over so-called late miscarriages, maternity institutions often “dump” children born with a body weight of more than 1000 g into this weight group in order to avoid their official registration and thus not worsen their performance indicators. In the weight group itself, 500-999 grams. the majority of children born with any signs of life (breathing, heartbeat, pulsation of the umbilical cord) and who died for the first time minutes and hours of life are classified as stillborn, so as not to apply expensive resuscitation measures to them.

The main efforts should be aimed at preventing miscarriage, since nursing and subsequent rehabilitation of children born with low body weight require large economic and material costs. Thus, according to the US National Center for Health Statistics, caring for 1 premature baby costs $60 thousand, while the cost of treating full-term babies averages $4,300. In general, the United States spends on caring for children born before 37 weeks of pregnancy 11 .9 billion dollars annually and 25 billion dollars for the provision of medical care for all other births. It is unlikely that such expenses will be within the power of the Russian budget in the foreseeable future. Now no more than 2.2-2.9% of GDP is allocated to all healthcare, while in the USA the total contribution to healthcare is more than 12% of their GDP, in the UK - 7%, and the Czech Republic - up to 8%. Therefore, the development of a preventive direction is more realistic and will cost much less.

At the same time, with the order to switch to the WHO-recommended criteria for providing care to children No. 380 of 1992 and the responsibilities of the neonatologist in carrying out the entire complex of resuscitation and treatment measures, in 1993, order No. 302 of the Ministry of Health of the Russian Federation dated December 28, 1993 No. 302 “ON APPROVAL OF THE LIST OF MEDICAL INDICATIONS” was issued FOR ARTIFICIAL INTERRUPTION OF PREGNANCY" (ALONG WITH INSTRUCTIONS "ON THE PROCEDURE FOR AUTHORIZING THE OPERATION OF ARTIFICIAL INTERRUPTION OF PREGNANCY FOR MEDICAL INDICATIONS"). This order, referring in accordance with the Fundamentals of the legislation of the Russian Federation on the protection of the health of citizens (Article 36), establishes that every woman has the right to independently decide the issue of motherhood. Artificial termination of pregnancy for medical reasons is carried out with the consent of women, regardless of the stage of pregnancy (!). The order provides a large list of medical indications for which a woman has the right to terminate a pregnancy after 22 weeks, i.e. with a viable fetus. Among such indications are indicated, for example, the state of decline of the function of the woman’s reproductive system - age 40 years or more, as well as the state of physiological immaturity - minority. In most cases, at a period of more than 22 weeks, the child is born alive, and often has no other diseases except extremely low weight and the associated immaturity of organs and systems, which will subsequently lead to his death. The rights of a newborn and the actions of medical personnel in such a situation are not regulated in any way by the order. With timely and highly qualified assistance, these children survive, and the situation when delivery was carried out with the aim of getting rid of an unwanted pregnancy and a child becomes practically insoluble in the moral aspect. Even more confusing is the situation when termination of pregnancy after 22 weeks was carried out due to an intrauterine disease of the child, for example, developmental defects, which, during resuscitation measures, in some cases turn out to be compatible with life. As a result, the neonatologist receives a child that is viable, but in addition to the congenital disease, also morpho-functionally immature. The legal aspects of such cases are unclear, and the situation when termination of pregnancy was carried out with the main purpose of preventing the birth of a sick child becomes absurd.

Unfortunately, the great perinatal revolution bypassed Russia. Yes, there are centers for caring for premature babies in large cities, but they don’t make the weather. For the vast majority of the population, high technologies of perinatal care are still inaccessible.

For more than half a century, Soviet doctors worked according to the 1937 instructions of the People's Commissariat of Health of the USSR. This archaic document delayed the development of neonatal resuscitation and intensive care for decades. According to him, children who did not take an independent breath, but showed other signs of life, were considered stillborn.

Only in 1992 did we finally recognize that heartbeat, pulsation of the umbilical cord and movements of the child’s voluntary muscles, along with breathing, are signs of life,” says Rimma Ignatieva, Doctor of Medical Sciences, Professor, Head of the Laboratory of the Scientific Center for Children’s Health of the Russian Academy of Medical Sciences.

If we use international criteria, the statistics of infant mortality in Russia will take on a completely different, terrible look. Professor Ignatieva carefully names the real figure - about 25 deaths per thousand newborns, which is six to eight times higher than in many countries of Europe and North America.

Goal of the work:

to study the medical and social aspects of nursing premature babies with extremely low body weight

Research objectives:

b to study risk factors for the birth of children with extremely low body weight

ь to consider organizing assistance to premature children of the Leningrad region

l analyze the features of the work of a nurse when caring for premature babies

b to study the attitude of nurses in the intensive care unit to the problem of caring for premature babies with extremely low body weight

l analyze complications arising in premature infants

Scope and subject of research: The study was carried out at the intensive care unit, the emergency and planned advisory medical care department and the neonatal pathology department of the Children's Clinical Hospital. Data for the study were taken for 2005, 2006, 2007, 2008, 2009 and 20010. For the study, we used data from the logs of patient admission to departments (number of bed days spent by the child in the hospital, the diagnosis of the child upon admission to the hospital and upon discharge from it, etc.), data from medical records of premature newborns (child’s weight at birth, weight child upon discharge, medical history data, etc.), data from the logs of on-site resuscitation teams. A survey of nurses working with newborn children was also conducted.

Every year, approximately 15 million babies are born premature worldwide, according to the World Health Organization (WHO). Premature birth is considered to be a birth that occurs before the 37th week of pregnancy.

They are divided into three groups according to the child’s body weight: 2.5-1.5 kilograms - low body weight; 1.5-1 kilogram - very low body weight; less than 1 kilogram - extremely low body weight. Also, in connection with the transition to new criteria for live birth (gestational age more than 22 weeks, birth weight more than 500 grams), early premature births are distinguished, at a period of less than 25 weeks.

Such babies require special care, which is most often provided by a neonatologist - a specialist who deals with the health of newborn children. The Social Navigator correspondent asked the most common questions to the head of the neonatal resuscitation and intensive care unit of the perinatal medical center of the Mother and Child Group of Companies, Sergei Nikolaevich Volkov.

— What are the statistics on the birth of premature babies in Russia now? What is she talking about?

— Every tenth birth in the world occurs prematurely. In percentage terms, there are more of them in developing countries, and less in developed countries. Russian statistics in this case are at the level of developed countries.

The number of premature births is increasing - there is such a trend. But medicine is constantly developing, and now those women who in the past would not have been able to conceive or bear a child on their own have a chance to become a mother.

Many women put off having a child because they are building a career and personal life, which means that by the time they get pregnant, they have a baggage of some diseases. The environmental situation, chronic stress - all this leads to a deterioration in a woman’s health and, of course, affects the course of pregnancy.

— There is an opinion that a child born prematurely is always a child with pathologies. Is this a true statement?

- No, this is a false statement.

Yes, indeed, there are a lot of problems that can be caused precisely by prematurity, but due to the fact that all their organs and systems are in the stage of growth and development, these children have great compensatory capabilities, that is, they solve many of their problems, in simple terms language, outgrow.

— There is a widespread belief that supposedly children born at seven months are better cared for than those born a little later, at eight months. Is it so?

— There is such an opinion, but it is not clinically confirmed.

Each term has its own specific moments, some problems are replaced by others. The earlier a child is born, the greater the likelihood of immature lungs and, as a result, respiratory failure - the first problem we face.

— What is the main thing mothers need to pay attention to in the baby’s condition in the first days after discharge from the hospital?

— The most basic indicator of a child’s well-being, which reflects how comfortable the child is, is his weight gain and how he eats.

— Newborn babies are assessed on the Apgar scale. How realistic is this scale about the baby’s condition?

— This scale was invented back in the 50s of the 20th century, and primarily it is intended to assess the condition of full-term children.

Since our main patient population in pediatric intensive care is now premature babies, it is not entirely correct for assessing the severity of such a child’s condition due to the specific immaturity of his body and other reasons.

— Vaccinations are a sore subject for young mothers and doctors. In what cases is it really better not to do them for newborns?

— In our country, the attitude towards vaccinations is more wary than abroad; there they are more open to it.

In my practice, there was a case when we were nursing a very premature baby with extremely low body weight, who, after discharge, went to France to “finish nursing”, as it happened. So there, before being discharged from the hospital, he was vaccinated against seven infections. They treat them more calmly and don’t see any consequences.

Now the situation with polio and the spread of the virus is again very difficult, so, of course, if possible, we must do it.

As for vaccinations for children born prematurely: they, of course, should be done according to an individual schedule, which will be determined by the pediatrician observing the child.

Interviewed by Alina Semenova

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 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 in the same way 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?

The probability of survival of the baby is directly dependent on these two factors:

Gestation period.
Birth weight.

Gestational age, also called the gestational age of the fetus, is an indicator that indicates the number of completed weeks of a woman’s pregnancy.

Reference! Gestational age is counted from the first day of the last menstrual cycle, for the reason that in most cases a woman cannot name the exact date of conception.

The higher the gestational age of a premature fetus, the greater the chance that the baby will survive. According to statistics, a baby born weighing more than 1.5 kg has a greater chance of survival. Infants weighing up to 1.5 kg make up only 1% of live births.

Degrees of fetal development

A premature baby is born before the 37th week of pregnancy. Such children have smaller weight and size indicators than usual, as well as insufficient development of the body as a whole. There are four degrees of fetal prematurity:

An infant is considered to have a chance of survival if its body weight is more than 500 grams.

Let's look in detail at how long a baby can survive:

Important! The activity of a premature baby directly depends on the number of weeks; the longer the baby is carried, the more active it will be.

There is no clearly defined boundary between the degrees, everything depends on the individual development of the child, so one child may have all the signs of prematurity, while another may not have them at all.

How long can a baby be saved?

Premature baby leaves mother's womb early, so the conditions he finds himself in are unsuitable for him:

different temperature;
pressure;
space;
air, etc.

Before answering the question of how many weeks babies survive, you need to know that the longer the gestation period, the better the baby adapts to changes.
Each pregnancy case is unique and there is always hope to save the premature baby.

Statistics on premature births show the following:

What measures to take?

Premature birth can occur for various reasons, many of which cannot be controlled, but there are still several rules for parents who want to take care of the health of their unborn baby.

Check with a doctor. Ideally, this should be done before conception, for both women and men. Even if everything seems to be in order, it’s worth being safe. After all, various infections can harm the baby in the womb.
In a timely manner register for consultation and talk to your doctor about all your medical conditions.
Costs avoid direct contact with sick people during pregnancy, so as not to endanger the fetus.
Avoid stressful situations throughout the entire pregnancy. If a woman has a very stressful job, it is worth consulting a doctor about taking sedatives.
Avoid strenuous physical activity and under no circumstances lift heavy objects. If a woman wants to keep herself in shape, she should do only those exercises that are recommended for pregnant women, and only under supervision, for example, sign up for a fitness class for expectant mothers. It would be better if the trainer draws up an individual program, taking into account the duration of pregnancy and the doctor’s instructions.
Costs the same watch your diet so that the baby receives enough nutrients.

First of all, you need to consult a doctor, because each situation is unique in its own way and requires an individual approach.