Causes of prematurity. The main signs of a premature baby. Differences from a baby born at term. Nursing premature babies

Premature babies are children born between the 28th and 38th weeks of intrauterine development with a body weight of 2500 g or less and a length of 35-45 cm.

At what weight is a premature baby?

A fetus weighing less than 1000 g and born at less than 28 weeks of gestation is considered a miscarriage.

When determining signs of prematurity, indicators of physical development and gestational age (duration of pregnancy) are taken into account, since newborns, premature and full-term, can be born with a body weight that does not correspond to gestational age. For example, body weight can be reduced due to intrauterine malnutrition or intrauterine growth retardation (small children for a given stage of pregnancy), as well as increased, which is observed in those born to mothers with diabetes. Given the wide range of indicators characterizing prematurity, for practical purposes the latter is divided into four degrees. The degree of prematurity reflects the maturity of the newborn, its ability to adapt to the external environment, the frequency and characteristics of the pathology, and the likelihood of survival. So, a diagnosis of prematurity is made:

degree of prematurity - child’s body weight at birth 2500 - 2001

degree of prematurity - the child’s body weight at birth is 2000-1501 g.

degree of prematurity - the child’s body weight at birth is 1500-1000 g.

degree of prematurity - the child’s body weight at birth is up to 1000 g.

The incidence of preterm birth in different countries varies widely (from 3.1 to 16.6%). There is no downward trend in this indicator. Among prematurely born children, the highest morbidity (birth injury of the central nervous system, sepsis, pneumonia, rickets, anemia, malnutrition) and the highest mortality are observed. Up to 75% of all newborn deaths are premature. Therefore, the primary task of health workers in the fight to reduce morbidity and infant mortality is to prevent prematurity. And if it occurs, providing proper care for premature newborns.

Reasons for the birth of premature babies

The main reasons for premature birth of children are as follows:

Socio-biological factors. The parents are too young or too old. 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.

Causes of prematurity in children

The causes of prematurity can be various factors that disrupt the intrauterine development of the fetus and the physiological course of pregnancy. Premature children are often born to mothers with infectious diseases, including latent ones. Premature birth can be caused by mycoplasma infection, cytomegaly, diseases caused by herpes viruses, adenoviruses and other pathogens that pass through the placental barrier, damage the placenta and disrupt its function.

Often premature birth occurs as a result of severe somatic diseases, vegetative-vascular dystonia, and pregnant anemia. Infantilism and developmental anomalies of the female reproductive system, neuro-endocrine pathology, and immunological incompatibility of antigenic systems also predispose to this. Babies born prematurely in multiple pregnancies.

Previous medical abortions are of great importance, which cause functional and morphological changes in the endometrium and increased contractility of the uterus, chromosomal aberrations, the age of the pregnant woman and her bad habits, and occupational hazards.

Signs of premature newborn babies

Clinical signs of a premature baby

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

Signs of very premature babies

A very premature baby (body weight less than 1500 g) has the following signs: 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 ears 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, the limbs are short. The sutures of the skull and fontanels (large and small) are open. The bones of the skull are thin. In girls, the genital gap gapes as a result of underdevelopment of the labia majora, the clitoris protrudes, in boys the testicles are not lowered into the scrotum.

Signs of more mature premature babies

In more mature premature babies, the appearance and signs of prematurity are different. Here are their signs: pink skin, 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 babies are characterized by signs such as muscle hypotonia, decreased physiological reflexes, decreased motor activity, impaired thermoregulation, and weak cry. A very premature baby (less than 30 weeks of gestation) lies with outstretched arms and legs, sucking, swallowing and other reflexes are absent or weakly expressed. Body temperature is unstable (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. gestation, flexion of the limbs is complete, but unstable, a distinct grasping reflex is evoked. In the first 2-3 weeks of life, a premature infant may have intermittent tremor, severe 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 in the last month of pregnancy (full-term boys are larger than girls).

Features of internal organs in premature babies

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, which prevents the collapse of the alveoli during exhalation, is impaired. 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 6070 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 tests of a premature baby

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.

Features of development of premature babies

Physical development is characterized by higher rates of increase in body weight and length during the first year of life. The smaller the body weight and length of the premature infant at birth, the more intense the increase in these indicators throughout the year. By the end of the first year of life, the body weight of a premature baby increases as follows:

with a newborn’s body weight 800-1000 g - 8-10 times

" " " " 1001 - 1500 g " 6-7 "

" " " " 1501-2000 " 5-7 "

" " " " 2001-2500 " 4-5 "

In the same age period, the growth of a premature baby is 65 - 75 cm, i.e. it increases by 30 - 35 cm.

Body weight increases unevenly. The first month of life turns out to be the most difficult period of adaptation, especially for a very premature baby. His initial body weight decreases (in a full-term baby by 5 - 7%); recovery occurs slowly: in premature infants with signs of degrees III - IV, body weight often reaches the initial figures only by the end of the 1st month of life and begins to increase more intensively from the 2nd month.

Despite the high rates of development, in the first 2 - 3 years of life, premature babies lag behind their peers born full-term in terms of body weight and height. In the future, asthenia and infantility are more often observed in children born prematurely, but a number of children have physical development indicators corresponding to their full-term peers.

Children with II - III degrees of prematurity begin to fix their gaze, hold their heads, roll over, stand up and walk independently, pronounce their first words 1 - 3 months later than their full-term peers and catch up with them during the 2nd year of life (children with 1 degree of prematurity to end of 1st year).

What does a premature baby look like?

Eyes. If your baby was born before the 26th week of pregnancy, his eyes may be tightly closed.

Genitals. Your baby may have underdeveloped genitals. In boys this will manifest itself in the presence of testicles; in girls, this is that the labia majora (outer labia of the vulva) will not be large enough to cover the labia minora (inner labia of the vulva) and clitoris, and a patch of skin may be visible from the vagina (don't worry, this will disappear over time) .

Extreme thinness. Your premature baby may look wrinkled and skinny because his body lacks the layers of fat that typically accumulate toward the end of pregnancy (after 30 to 32 weeks). As he begins to gain weight, this fat will appear and he will begin to look more like a normal full-term baby.

Transparent skin. Accumulations of fat also affect the skin color of a premature baby. Veins and arteries are clearly visible through the skin, and the skin has a pinkish-purple hue, regardless of the child's race. (This is because skin pigmentation usually appears after the eighth month of pregnancy.)

Lack of hair. Severely premature babies may not have any hair at all on their body, except for soft fuzz. On the other hand, children who were born slightly prematurely may be covered with a thin down covering the body. This fuzz may be especially abundant on the back, upper arms, and shoulders.

Lack of nipples. Nipples typically appear after the 34th week of pregnancy, so your baby may not have nipples if he was born before then. However, some babies have fully formed circles - dark circles that usually surround the nipples.

Low muscle tone. Premature babies have less control over their body than full-term babies. If you place your baby on his back, his limbs may shake or sag. Severely premature babies sometimes hardly move at all: their movements are limited to light stretching or clenching their fists. Babies born before the 35th week of pregnancy may lack the muscle tone needed to assume the fetal position common to full-term babies.

Underdeveloped lungs. Premature babies have more breathing problems than full-term babies because their lungs are not fully developed. Fortunately, a baby's lungs can continue to develop outside the mother's uterus as they mature.

Comment: If your baby is born between 22 and 25 weeks of pregnancy, you should be prepared for it to look more like a fetus in the womb than a normal newborn. His eyes may still be tightly closed, and his skin may appear shiny, translucent, and too tender to touch. His ears may be soft and folded in places where the cartilage has not yet hardened. You will notice how much your baby changes in the coming weeks, as his skin becomes thicker and his eyes open for the first time. He will begin to resemble a normal newborn.

Assessment of the development of premature infants

When analyzing the development of a premature infant in the first year of life, the period of prematurity is subtracted from the age of the child (if the period of prematurity is 2 months, then the development of a 7-month-old child is assessed as 5 months). When assessing the development of a premature child in the second year of life, half the period of prematurity is subtracted from the child’s age (if the period of prematurity is 2 months, then the development of a 14-month-old child is assessed as 13 months). Once a preterm infant reaches 2 years of age, development is assessed without adjustment for prematurity.

Let's find out how the development of premature babies is assessed.

Signs of speech impairment and delayed language development in preschool children

6 months - does not respond or responds inadequately to sound or voice;
9 months - does not respond to name;
12 months - cessation of babbling or no babbling at all;
15 months - does not understand the words “no” and “bye-bye”, does not react to them;
18 months - does not say other words except “mom” and “dad”;
2 years - does not form two-word phrases;
after 2 years - still uses "baby" slang and imitates sounds excessively;
2.5 years - the child’s speech is incomprehensible even to family members;
3 years - does not write simple sentences;
3.5 years - the child’s speech is understandable only to family members;
4 years - persistent articulation errors (in addition to the sounds R, S, L, Sh);
5 years - has difficulty writing structured sentences;
after 5 years - a noticeable constant disturbance in the fluency of speech (stuttering);
6 years old - unusual shyness, rearranging words, difficulty finding appropriate words when speaking.

At any age - monotony of spoken sounds or hoarseness of voice.

Signs of cognitive impairment

2-3 months - does not show much interest in relation to the mother;
6-7 months - does not turn his head towards a fallen object;
8-9 months - does not show interest when they try to play hide and seek with him;
12 months - does not look for a hidden object;
15-18 months - shows no interest in cause-and-effect games;
2 years - does not divide surrounding objects into categories (for example, animals are one thing, cars are another);
3 years - does not know his full name;
4 years old - cannot tell which of two lines is shorter and which is longer;
4.5 years - cannot count consistently;
5 years old - does not know the names of letters, the colors of objects;
5.5 years old - does not know his date of birth and home address.

Care of premature newborns

Features of feeding and care

Feeding premature babies has significant features. These features are due to the increased need for nutrients due to intensive physical development, as well as the morphological and functional immaturity of the gastrointestinal tract, requiring careful introduction of food.

The beginning of feeding a child is determined by the state and degree of prematurity. The method of feeding is determined depending on the severity of the condition.

With I degree of prematurity, the child can begin to be fed with breast milk or its substitutes after 6 - 9 hours, with II degree - after 9 - 12 hours, with III degree - after 12-18 hours, the fetus - after 24 - 36 hours. During this period a 5% glucose solution is administered in 3-5 ml doses every 2-3 hours. A longer “fast” is undesirable, as it leads to hypoglycemia, hyperbilirubinemia, hypoproteinemia, and increases metabolic acidosis.

Children with grade III - IV prematurity, as well as all premature infants with respiratory distress syndrome, asphyxia, and a weak sucking reflex, receive breast milk through a gastric tube, permanent or disposable (the permanent tube is changed every 3 - 4 days for sterilization and prevention of bedsores). If the general condition is satisfactory and the sucking reflex is sufficiently pronounced, feeding for the first 3 to 4 days is done through a pacifier. It is not advisable to breastfeed before this period, since breastfeeding is a heavy physical activity and secondary asphyxia or intracranial hemorrhage may occur.

Premature babies weighing less than 1500 g are put to the breast from the 3rd week of life. Nutrition calculations are made in accordance with the needs of the child’s body per 1 kg of weight per day: 1-2 days of life - 30 kcal, 3rd day - 35 kcal, 4th day - 40 kcal and then daily 10 kcal more until 10th day; on the 14th day - 120, from the 21st day - 140 kcal. When caring for premature newborns and when determining the amount of nutrition, the individual characteristics of the newborn should be taken into account: very premature babies from the 2nd month of life sometimes absorb a volume of breast milk corresponding to 150-180 kcal/kg. Most premature babies develop well when breastfed.

Children with insufficient weight gain at the end of the 1st month are sometimes prescribed a concentrated supplement in the form of cottage cheese, whole kefir with 5% sugar. In addition, most premature infants receive parenteral solutions of glucose and albumin. From the 2nd month of life, instead of drinking, they give vegetable broth, as well as fruit and vegetable juices. Instead of breast milk, formula milk can be used when caring for a premature baby.

Nursing premature babies

Nursing of premature babies is carried out in 2 stages: in the maternity hospital and in a specialized department for newborns. Then the child comes under the supervision of the clinic. In the maternity hospital, mucus is sucked out of the upper respiratory tract to prevent aspiration in a premature baby. In the first days and weeks of life, very premature babies or premature babies in serious condition are kept in incubators ("incubators"). They maintain a temperature of 30 to 35 ° C (taking into account the individual characteristics of the child), humidity in the first day up to 90%, and then up to 60 - 55%, oxygen concentration about 30%. The body temperature of a premature baby can also be maintained in a heated crib or with heating pads in a regular crib. The optimal room temperature should be about 24 C.

Oxygen therapy is carried out, correction of the balance of acids and bases by introducing solutions of glucose with ascorbic acid and cocarboxylase. Elimination of hypoglycemia and hypoproteinemia is achieved using solutions of glucose and albumin. In case of urgent need, plasma transfusions and blood transfusions are performed.

Most children with stage III-IV prematurity receive antibiotics during care. Indications for their use are the severe general condition of the child, purulent-inflammatory diseases in the mother, premature rupture of amniotic fluid, and childbirth outside a medical facility.

What should be the care for a premature baby?

The main features of the body of a premature baby are very poor thermoregulation and shallow breathing. The first can lead to a drop in the child’s body temperature to 35 degrees or a rise to 40, the second can lead to oxygen starvation or even respiratory arrest.

As soon as the doctors decide that the child’s condition is satisfactory, the mother and baby are discharged home, having previously provided important instructions on hygiene, clothing, walking and bathing the premature baby.

It is very important to protect such a child from people who are carriers of colds, acute respiratory infections and acute respiratory viral infections. For premature babies, both overheating and hypothermia are life-threatening. The temperature in the room where the child is located should not fall below 22 degrees, under the blanket - not below 33 degrees. The water temperature for bathing should be higher than for a full-term baby (not lower than 38 degrees), while the bathroom should also be warm enough - not lower than 24 degrees.

From the above it is clear that caring for a premature baby includes constant monitoring of its body temperature. He needs warmer clothing than his full-term counterpart. It is very important to constantly change the air in the room; during ventilation it is worth taking the child out of the room.

The child is gaining weight

As soon as the child's weight exceeds three kilograms, he can be taken for walks. You should not go outside if the air temperature outside is below minus 5 for a child up to a month old, below minus 10 for a child up to a year. You should start walking for 5-10 minutes, and gradually increase the walking time to 2-3 hours (go out immediately after feeding and walk until the next feeding).

Another problem is that the baby simply cannot suckle, and therefore is forced to eat from a bottle (and sometimes there is no strength for this). As soon as the baby is strong enough to suckle, you should completely switch to breastfeeding. This will help you quickly gain the desired weight and catch up with your peers in development.

Only 8-10% of premature babies are discharged home from the maternity hospital - these are healthy children with a birth weight of more than 2000. The rest are transferred to specialized institutions for the second stage of nursing. In these institutions, children receive the necessary treatment, hygienic baths, and are prevented from rickets and anemia. The complex of therapeutic measures includes massage and gymnastics. A healthy premature baby can be discharged home when he reaches a body weight of more than 2000 g, its positive dynamics and a good sucking reflex.

The proper development of premature babies is facilitated by timely care for a premature newborn, a favorable home environment, individual classes, games, massage and gymnastics, and a balanced diet.

Long-term consequences of prematurity

Children born prematurely usually grow up healthy and become productive members of society. It is known that I. Newton, Voltaire, Rousseau, Napoleon, Charles Darwin, Anna Pavlova were born prematurely. However, among such a contingent of children, the percentage of mentally and physically disabled children is higher than among those born at term. Severe psychoneurological disorders in the form of cerebral palsy, decreased intelligence, hearing and vision impairment, and epileptic seizures are observed in 13 - 27% of premature births. These indicators are especially high in the group of those born very prematurely; among them, restless children suffering from uncertainty and night terrors are more often observed later. In prematurely born children, disproportionate development of the skeleton is more often observed, mainly with a deviation towards asthenia.

In recent years, doctors from various specialties have been studying the developmental features of children born prematurely. It has been established that women born very prematurely are more likely to experience menstrual irregularities, defective generative function, signs of sexual infantilism, threatened miscarriage and premature birth.

Prevention of premature birth of children includes:

Protecting the health of the expectant mother from early childhood;
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 pregnant women at risk of premature birth and monitoring the course of their pregnancy.

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

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

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 economically developed countries - 100%.

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

Socio-biological factors.

The parents are too young or too old. 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.

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 fontanels (large and small) are open. The bones of the skull are thin. In girls, the genital gap gapes as a result of underdevelopment of the labia majora, the clitoris protrudes; In boys, the testicles are not descended into the scrotum.

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

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

Premature boys and girls do not differ in anthropometric indicators, since these differences are formed in the last month of 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.

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.

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

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

Psychomotor development

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

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

All over the world, great importance is attached to “gentle nursing of premature infants” with the limitation of intensive care, stressful situations, and 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 the individual characteristics of the 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 greater the likelihood of the child becoming infected. 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. If the general condition is satisfactory, the sucking reflex is quite pronounced and the body weight at birth is 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 born very prematurely often subsequently experience menstrual irregularities, signs of sexual infantilism, the threat of miscarriage and premature birth.

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

PREVENTION OF PREMATURE BIRTH OF CHILDRENPrevention of premature birth of children involves protecting the health of the expectant mother; prevention of medical abortions, especially in women with menstrual irregularities and neuroendocrine diseases; 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.

Parents of babies born prematurely are forced to face various problems, including the difficulties of caring for the baby in the maternity hospital and creating the necessary conditions at home, establishing breastfeeding or selecting the appropriate formula, regular visits to the doctor and worries about the future health of the little one. However, they should always remember that with increased attention to the baby and proper care, they will be able to help the baby “catch up” with his peers faster and grow up to be a healthy and cheerful baby, which is confirmed by the popular “Before and After” photographs.

You can see more similar photos in the photo gallery at the end of the article.

Which baby is considered premature?

Official medicine classifies babies as premature if they were born at less than 37 weeks' gestation. Such children have lower height and weight, and their organs are immature.

Causes

Factors that cause premature birth are:

Neglect of medical support during pregnancy.
Presence of bad habits in a pregnant woman.
Insufficient or unbalanced nutrition of a woman during pregnancy.
The age of the future mother or father is less than 18 and more than 35 years.
Working as a pregnant woman in hazardous conditions.
Low pregnancy weight (less than 48 kg).
The expectant mother lives in poor living conditions.
Gestation in an unfavorable psychological environment.

Classification of prematurity

The division into degrees of prematurity is based on the gestational age at which the baby was born, as well as on such physical parameters of the toddler as weight and body length. The following degrees of prematurity are distinguished:

First– the child is born at 36-37 weeks of pregnancy with a body weight from 2 to 2.5 kg and body length from 41 to 45 cm.
Second– the baby appears at a period of 32 to 35 weeks, his body weight is less than 2 kg, but more than 1.5 kg, and body length - from 36 to 40 cm.
Third– the baby is born at -31 weeks of gestation with weight from 1 to 1.5 kg and body length from 30 to 35 cm.
Fourth– the baby is born before 28 weeks of pregnancy with a weight less than one kilogram and body length less than 30 cm.

Signs

Appearance

Compared to full-term babies, premature babies are different:

Thinner skin.
Less or no subcutaneous fat.
Large head size in relation to the body.
Large belly and low navel.
Unclosed small fontanel.
Very soft ears.
Thin nails that may not completely cover the phalanges of the fingers.
Open genital cleft in female infants.
In boys, the testicles do not have time to descend into the scrotum.
Later loss of the umbilical cord.

These signs are more pronounced the higher the degree of prematurity, and in infants with the first or second degree, many of them may be absent.

Anatomical and physiological features

The functioning of the organ systems of a baby born prematurely is affected by the degree of prematurity, because the smaller the fetus was in the mother’s womb, the more its organs did not have time to form to a state that allows them to quickly adapt to life after childbirth.

Premature babies breathe more frequently than in babies born at term, which is associated with narrow upper respiratory tracts, a more pliable chest and a higher position of the diaphragm. In addition, the toddler’s lungs are not mature enough, which causes the frequent occurrence of pneumonia and attacks of apnea.
Due to premature birth, the baby's circulatory system may not be fully developed. The result is various heart pathologies that worsen the condition of the baby. And since the vascular walls are more fragile and permeable, The baby often develops hemorrhages.
Even with deep prematurity, the brain is fully formed, but the pathways in the last stages of pregnancy are still developing, so babies born prematurely have nerve impulses are poorly conducted to different tissues. If a baby’s nervous system is damaged, its motor activity will be reduced, as will muscle tone. Reflexes in such a child may be depressed or absent altogether, and tremors are often observed.

The mechanisms that regulate the production and loss of heat in the body are poorly developed in a premature baby. Prematurely born babies lose heat faster, and it is produced in their body with great difficulty. In addition, due to underdeveloped and dysfunctional sweat glands, babies can easily overheat.
The digestive tract of a premature toddler also works worse than that of full-term babies. This is primarily due to insufficient production of enzymes and gastric juice, as well as dysbiosis of the intestinal microflora. In addition, the motor function of the gastrointestinal tract suffers due to deteriorated transmission of nerve impulses, which leads to a slowdown in the movement of food through the intestines.
Mineralization processes continue in the bones of premature babies after birth, which is the reason for the additional administration of calcium to babies. In such babies increased tendency to develop rickets and pelvic joint dysplasia.
Due to immature kidney function, a premature baby will quickly develop signs of dehydration or swelling if caring for the baby is inadequate.
The endocrine system does not work fully during prematurity, which is why hormones are released in insufficient quantities, and the glands are quickly depleted.

Consequences of prematurity and viability

The survival rate of prematurely born infants depends on the duration of pregnancy and the reasons that triggered the birth. If those born at 23 weeks survive only in 20-40% of cases, then babies with a gestation period of 24-26 weeks survive in 50-70% of cases, and the survival rate of babies whose development period is more than 27 weeks exceeds 90%.

Babies born earlier than expected gain weight and grow in length very rapidly. Many of them catch up with their full-term peers in these indicators by 1-2 years, but there are babies whose differences with their peers are smoothed out only by 5-6 years of age.

Anemia during prematurity develops more quickly. The risk of sepsis and purulent infections of the bones, intestines or meninges in premature babies is increased. At an older age, children born prematurely are more likely to have neurological pathologies, problems with vision or hearing, frequent acute respiratory viral infections and problems with the genital organs.

Jaundice in babies born prematurely it is more pronounced and lasts longer. This physiological condition, which occurs due to the breakdown of fetal hemoglobin, usually resolves by 3 weeks of age, but in many preterm infants requires treatment, for which phototherapy is mainly used.

Extreme prematurity

This is the name given to the condition of babies weighing less than 1 kilogram. They are born in less than 5% of cases of prematurity, often cannot breathe on their own and require artificial and drug support. Even if such babies are cared for, the percentage of disability and various complications in these children is very high.

Extreme prematurity

This condition is observed in infants whose body weight during premature birth is 1-1.5 kg. In order to deliver such babies, it is necessary to use mechanical ventilation, give them oxygen, and administer nutrition into a vein and through a tube. In order for the baby to grow and develop faster, he is given amino acids, glucose, hormonal agents and other substances.

7 months

At this stage of pregnancy, babies are born weighing 1.5-2 kg, but most of them cannot function independently. The little ones are placed in incubators with the required temperature and humidity, they undergo the necessary examinations and are provided with medicinal support. After gaining weight up to 1.7 kg, the baby is transferred to a crib, which is heated. When the child gains weight up to 2 kg, he no longer requires thermal support.

8 months

Babies born at this stage, as a rule, weigh 2-2.5 kg and can suck and breathe independently. They have an increased risk of apnea attacks, so the babies are observed in the hospital for some time, but in the absence of complications and rapid weight gain to normal, the baby is sent home with the new parents.

How premature babies live and develop after birth in modern perinatal centers is described in the video:

Clinical examination

Premature babies discharged home should be constantly monitored by a pediatrician.

Measurements and examinations during the first month after discharge are carried out once a week, then until 6 months of age - once every two weeks, and from 6 months to a year - monthly. The baby is prescribed examinations by a surgeon, neurologist, cardiologist, orthopedist and ophthalmologist, and at the age of over a year - by a psychiatrist, as well as a speech therapist.

At what weight are they discharged?

As a rule, the mother returns home with her newborn baby after the baby’s weight has increased to at least 2 kg. It is also important for discharge that the baby has no complications, that thermoregulation has improved, and that the baby does not require heart and respiratory support.

Features of care

Babies born prematurely require special care. They are cared for step by step with the help of neonatologists and pediatricians, first in the maternity hospital, then in the hospital, and then at home under the supervision of specialists. The most important components of baby care:

Ensure optimal temperature and humidity in the room.
Carry out rational treatment.
Ensure feeding adequate to needs.
Provide contact with the mother using the kangaroo method.
After discharge, limit contact with strangers.
Bath and walk with the baby after the doctor's permission.
Perform gymnastics with the baby and conduct massage courses after the permission of the pediatrician.

Some tips on how to avoid problems in the development of babies born prematurely are described in the video:

What to do if there are alarming symptoms?

If anything worries the mother, she should definitely seek medical help. A specialist will be needed when:

The child's reluctance to breastfeed or eat from a bottle.
Attacks of vomiting.
Long-term jaundice.
Constant loud crying.
Stopping breathing.
Severe pallor.
Painful reaction of a child to sounds, sights or touches over the age of 1.5 months.
Absence of reciprocal gaze at the age of more than 2 months.

Vaccination: when should you get vaccinated?

It is permissible to vaccinate a premature baby only when the baby is strong enough and his body weight has increased.

BCG vaccination in the maternity hospital is not given to children weighing less than 2 kg. It is indicated for weight gain up to 2500 g, and if there are contraindications, it can be postponed for 6-12 months. The timing of the start of the administration of other vaccines should be determined by the pediatrician, taking into account the health and development of the toddler.

Opinion of E. Komarovsky

As you know, a popular pediatrician recommends raising children in their first year of life so that the babies do not overheat. Komarovsky always focuses on frequent ventilation, air humidification up to 50-70% in the nursery and maintaining the temperature in the room no higher than +22°C.

However, for premature infants, his recommendations change significantly. Komarovsky supports his colleagues in the opinion that thermoregulation in such babies is poorly developed, so a higher air temperature in the room immediately after discharge (not lower than +25°C), in his opinion, is a necessity.

A premature baby is a newborn born before 37 weeks and weighing less than 2.5 kg.

8 month. He tries to sit up himself, gets on all fours, tries to sway. He understands when he is asked to show something, and is interested in audible speech, its tone and tempo.

9 month. At this age, the baby sits more confidently, tries to crawl, speaks the first syllables, and the need for communication increases. The first teeth appear if the baby was born at 32–34 weeks.

10 month. The ten-month-old baby prefers to crawl for now, but he can already stand well and walk, holding onto support. He likes to watch moving objects. He already knows his name. Babies born before 31 weeks begin to develop their first teeth.

11 month. The child is actively crawling. He has been standing for a long time without support, takes his first steps without support, and has good contact with familiar people. He is interested in cubes, pyramids, and any moving toys.

12 month. The baby can begin to walk, sometimes this happens a little later - at 18 months.
Such children reach neuropsychic maturity by 2–3 years. All this is a variant of the norm.

Features of care

Caring for a premature baby has a number of features:

Cloth. It should be made of natural materials, with snap fasteners, so that medical devices can be easily secured.
Care products. Must be hypoallergenic and selected depending on the degree of prematurity of the child. The skin of a premature baby is very delicate and sensitive. In the hospital department and later at home you will need diapers for premature babies. They come in “zero” sizes up to 1 kg, and from 1 to 3 kg.
Temperature conditions. The air temperature in the room should be 23-24 degrees, around the child’s body - approximately 28 degrees. If necessary, you can use heating pads. Optimal air humidity is 70%. This temperature regime must be maintained throughout the first month.
Bathing. There should be no sudden temperature changes. To avoid this, you need to wrap the baby in a thin diaper, place it in the bathtub, unfold the cloth and wash the baby. The temperature in the room should be at least 25 degrees, water - at least 36 degrees. You need to wrap the baby in a warm towel. It is better if both parents bathe the child.
Walks. The child must be protected from hypothermia and sudden changes in temperature. If the baby was born in the summer and his body weight is more than 2 kg, then you can go for a walk right away. Walks last a maximum of a quarter of an hour, the air temperature outside should be 25 degrees. If the baby was born in spring or autumn, then walking is allowed at 1.5 months, when he weighs 2.5 kg. When a child is born in winter, going outside is allowed with a body weight of 3 kg and an air temperature of a maximum of -10 degrees.
Massage and physical education. All premature babies need them. It is advisable if they are done by a specialist. Physical education and massage normalize the musculoskeletal system, improve metabolism and digestion. With their help, the child will sit up, stand up, crawl and walk on time.

Features of feeding

Breastfeeding is the best thing for such children. The mother needs to breastfeed her baby for as long as possible. It is difficult for a premature baby to suckle at the breast, so he needs to be fed with expressed milk.

A newborn baby is classified as premature if its birth occurred in the period from 22 to 37 weeks of gestation. At the same time, there is a low weight - no more than 2.5 kg, and a height of up to 45 cm. Such children require special care and provision of certain conditions in the first days of life by medical personnel. This article describes in detail what premature termination of pregnancy is and what its consequences are. Considered why premature babies are born.

Types of prematurity

The degree of prematurity of the baby is determined depending on the number of completed weeks of gestation at the time of birth and its weight.

Why was the baby born prematurely?

There are a number of reasons that provoke the premature birth of a child., divide them into 4 groups.

Socio-biological reasons

The age of the expectant mother is too old (over 40 years old) or too young (under 18 years old).
Bad habits of a pregnant woman - drinking alcohol, smoking tobacco products (both before conception and during pregnancy).
Poor nutrition.
Unsatisfactory living conditions.
Occupational hazards or heavy physical labor.
Unfavorable and unstable psycho-emotional state.

Attention! Women who did not plan a child, and who are not observed by medical specialists during pregnancy, give birth to premature babies much more often.

Severe obstetric and gynecological history

Diseases of the expectant mother

Rheumatism.
Diabetes.
Pyelonephritis.
Hypertonic disease.
Viral diseases suffered in the third trimester of pregnancy.
Heart disease.

Abnormal development and pathologies of the fetus

Genetic and/or chromosomal diseases.
Intrauterine infections.
Development of severe defects.

Even if there are several factors that can trigger preterm labor, it can be prevented by regular monitoring by medical professionals. Timely provision of assistance to the expectant mother will allow her to carry the fetus for up to 37-40 weeks.

Factors leading to the problem

Important! In addition to the causes of preterm birth, there are risk factors that should also be considered. They can manifest themselves on both the mother’s and the child’s sides.

On the maternal side, the following factors are distinguished:

From the child's side:

Multiple births. Each woman’s uterus has its own “limits” for extensibility. As soon as the walls of the uterus stretch to a critical point, spontaneous contractions begin, leading to the onset of labor.
Polyhydramnios.
Placenta previa - it is located so that the exit from the uterine cavity is closed.
Breech presentation of the fetus.
Infection of a child in utero.

Risk group

When a woman finds out that she is pregnant, she should be very careful about the issue of premature birth and find out if she is at risk. Women in this group are most likely to go into labor prematurely. Among such expectant mothers, a special place is occupied by women who have used the IVF procedure or are carrying several babies.

Important! Women who encounter this problem during their first birth automatically fall into the risk group. The presence of infectious diseases in the mother or defects of the internal genital organs is also a reason for being at risk. The gender of the unborn child also plays a role.

It is noted that Boys are much more likely to be born prematurely. An explanation for this phenomenon has not yet been found, but the expectant mother should remember this.