Causes of prematurity. The ideal food for premature babies is. A) thymus gland
Update: October 2018
A baby born at 37 weeks of gestation or earlier is considered premature. The most common cause of preterm birth is an infection, illness of the mother, or pathology of the placenta. This also affects the health of the baby, so care for such a child should be treated with special attention. All children born prematurely are divided into groups depending on body weight:
- Extremely low weight: less than 1000 g
- Very low weight: from 1000g to 1500g
- Low weight: 1500 to 2500g (usually at 34-37 weeks)
How to estimate the age of premature babies?
The age of a prematurely born baby is estimated in the same way as that of a full-term baby. That is, from the first day of birth. But to assess the psychomotor development of a premature baby by months, the so-called corrections for prematurity are used. For example, a one-year-old baby born 3 months premature (at 28 weeks) would be counted as a 9-month-old baby. Requirements for mental and physical development will be presented to him precisely at the age of 9 months, and not 12. Such a system is used until the child reaches the age of 2 years.
Possible health problems in premature newborns
Respiratory disorders
- Respiratory distress syndrome
- congenital pneumonia
- Underdevelopment of the lungs
- Intermittent pauses in breathing (apnea)
Immaturity of the respiratory system in prematurity is a common occurrence. Lack of surfactant - a special substance that lines the lungs - leads to sticking and inability to breathe. Children lighter than 1000 g are in principle unable to breathe on their own after childbirth and require connection to a ventilator. Often, babies experience episodes of apnea - long breaks in breathing. They usually pass by the age of 36 weeks of pregnancy, and before that they require increased control.
Blood changes
- Anemia
- Jaundice
- Hemorrhages in the skin, liver, adrenal glands
- Vitamin K deficiency
The usual jaundice of newborns, associated with the breakdown of fetal hemoglobin, takes a little longer in premature babies. The maximum falls on the 5th day, by the 10th day the yellowness of the skin normally disappears. If this condition is physiological, then it does not pose a danger to the baby. If the level of bilirubin that causes jaundice exceeds the permissible value, then there is a risk of brain damage. In such cases, doctors use phototherapy.
Another common problem of "hurried" kids is anemia. It develops at the age of 1-3 months. Its manifestations are diverse: pallor, poor weight gain, decreased activity, disruption of the heart. In some severe cases, children require a blood transfusion. But for most newborns, it is enough to give iron supplements up to 1-1.5 years.
Gastrointestinal pathologies
- Dyskinesia
- Necrotizing enterocolitis
One of the most dangerous and rapid conditions of small premature babies is necrotizing enterocolitis. It is based on the death of part of the intestine with inflammation of the peritoneum. Most often, the disease develops in the first 2 weeks of life, manifesting itself as blood in the stool and a general deterioration in the condition. Depending on the volume of the dead intestine, the outcome may be different. Extensive necrosis requires removal of this part of the intestine, which is associated with high mortality and health problems in the future. Mild cases do not cause serious complications.
Problems of the nervous system
- Intraventricular hemorrhages (in the brain)
- Hypoxic-ischemic brain lesions
- convulsions
- Pathology of the retina
- Deafness
- Muscle weakness
The immaturity of blood vessels in "early" children leads to an increased risk of cerebral hemorrhage. This risk is higher the lower the birth weight. Most of these bleedings occur in the first few days of life. The child becomes lethargic, like a “rag doll”, sleepy, respiratory arrests occur, even coma. For diagnosis, ultrasound of the brain is used, if necessary, computed tomography. Treatment is possible only symptomatic. Hemorrhage prognosis ranges from death and severe brain damage to mild developmental delay or full recovery.
Oxygen starvation during prematurity also has a detrimental effect on the brain. Depending on the time and severity of hypoxia, the result may be cerebral palsy, dementia, a slight delay in psychomotor development, or a complete lack of consequences.
Cardiovascular disorders
- Functioning ductus arteriosus
- Blood pressure instability
Other problems
- Tendency to low body temperature
- Vulnerability to infections
- Edema
Maintaining the temperature
Immediately after birth, special conditions are created for a premature baby with a low body weight. They are placed in couveuses, where the optimum temperature and humidity are maintained. It has been proven that the survival rate of such children increases if they do not have to spend their energy on warming. Usually discharge home occurs after the child reaches a certain weight and, accordingly, the ability to regulate the temperature. But all the same, in the room where the baby will be, it should be comfortable: not hot and not cold, and the humidity should reach 60%.
Newborn nutrition
The earlier the baby was born, the more likely it is that at first he will not be able to suck milk on his own. If premature babies with extremely low body weight have intestinal surgery, infection with diarrhea and vomiting, then the only way to keep the body is parenteral nutrition. In such cases, all the necessary substances are administered to the child through a vein. After improvement, feeding with breast milk through a tube is started. When the child is strong enough to learn to coordinate sucking movements, it is the turn of the pacifier or even attachment to the breast. Milk volumes must be controlled to avoid regurgitation of excess milk and entry into the lungs. The frequency of feeding is usually 8-10 times a day. If the baby "consumes" 6-8 diapers per day, then he has enough milk.
Breast-feeding
The importance of breastfeeding for preterm babies cannot be overstated. Protective antibodies and easily digestible proteins found in colostrum and milk help babies get stronger and resist infections. But since the need for certain elements and vitamins in such babies is greater than in healthy ones, you have to add them to the child's diet additionally.
Milk formulas
If it is impossible to breastfeed for various reasons due to the immaturity of the digestive tract, frequent regurgitation and special needs, premature babies are fed with special mixtures:
- Bellakt PRE
- Nutrilak Pre
- Pre Nan
- Pre-Nutrilon
- Similac NeoSure
- Similac SpecialCare
- Frisopre
- Humana 0-HA liquid
Complementary foods for premature babies
The introduction of complementary foods also has its own characteristics. If ordinary babies are recommended to introduce vegetables or cereals from 6 months, then for children from premature birth, an adjustment for prematurity is taken into account. That is, a child born 1.5 months ahead of schedule is introduced complementary foods at 7.5 months from birth. But there is no need to comply with these deadlines up to a week. It is much more important to focus on the readiness and desire of the baby to try new food (see).
Signs of readiness to feed:
- Subsidence of the ejection reflex (the baby does not push out any object that has fallen into the mouth with the tongue)
- Tripling of weight since birth (whereas for those born at term, doubling is enough)
- Lack of breastfeeding
- Active interest in adult food
The rest of the feeding rules are similar to those at term birth. They begin the introduction of new products with cereals (if the weight is gaining poorly) or vegetables (if everything is in order with the weight).
Calcium and Vitamin D
Babies born with low and extremely low body weight are also susceptible to vitamin D in the blood. The result can be rickets, osteoporosis and pathological fractures. To prevent such conditions, children are prescribed vitamin D preparations (Aquadetrim at a dose of 300-500 IU per day), and often calcium and phosphorus.
Vitamin D deficiency symptoms:
- rachitic rosary (thickness on the ribs, similar to an oval rosary)
- small weight gain
- decreased calcium in the blood
- curvature of the legs
Iron preparations
Almost all premature babies are recommended to give iron preparations (Aktiferrin, Ferrum-lek and others) until they reach 1-1.5 years. The dosage is calculated according to the formula: 2 mg of the drug for each kilogram. The amount of iron can be adjusted by the doctor depending on the condition of the baby.
Baby weight
If the baby does not have serious health problems, then upon reaching a weight of 1800-2000g, he can be discharged home. It is best to purchase a newborn scale in advance to monitor weight gain once every 1-2 weeks (but not every day). On average, daily weight gain should be 15-30g per kg per day. This is especially important for children who do not take the breast well. In the case of a normal diet, low gains can indicate anemia or digestive problems. As the baby grows older, weekly increases decrease. 
Graph of weight, height and head circumference
Age in the graph is measured in weeks from conception (up to 40 weeks), and then from birth in months, as in children born at term. The bold black line indicates the mean value. The dark area around the line is close to the average values. Dash-dotted lines indicate the limits of the norm. But even when going beyond these boundaries, it is necessary to take into account the individual data of the child: his state of health, nutritional characteristics and the opinion of the doctor.
Baby sleep
The total sleep duration of a premature baby is greater than that of a full-term baby. But at the same time, the "early" child is more sensitive to external influences, so he often wakes up. It is important that after a brightly lit intensive care unit and the noise of medical devices, a child can react to home darkness and silence for several weeks. Therefore, for the first time after discharge, it can be useful to turn on quiet, calm music and leave subdued lights at night so that the baby gradually adapts.
The best position for a baby to sleep is on the back. Premature babies are at higher risk of sleep apnea and are less sensitive to reduced oxygen levels. Therefore, sleeping on your stomach can lead to sudden infant death syndrome. For the same reason, the baby's bed should be moderately hard, without voluminous blankets and toys.
Now on sale there are special cradles and cocoons for such special newborns. Many parents note that the sleep of babies in such beds is stronger. But at the same time, no studies have been conducted on the safety of such cocoons, so experts rarely recommend buying them.
When are they discharged from the neonatal unit?
- Baby to be breastfed/transferred to nipple feeding
- Weight gain per day should be at least 10-30g
- The baby should keep warm enough while lying in the crib
- There should be no episodes of stopping or sudden slowing of breathing
- Feeding through a vein by the time of discharge should be stopped
- Vision and hearing tests must take place before discharge
- The mass of the baby should be 1800 grams and above.
Prognosis for newborns
Thanks to modern methods of pediatric intensive care, the survival rate of premature babies weighing from 1.5 to 2.5 kg exceeds 95%. If they do not have concomitant malformations and severe brain damage, then by the age of 2 they catch up with their peers who were born on time in all respects. With severe comorbidity, there may be a developmental delay of varying degrees.
The earlier the child was born, and the smaller its mass, the lower the chances of survival and recovery. So, a birth at 22 weeks of pregnancy brings the chances of survival closer to 0. At 23 weeks, they rise to 15%. At 24 weeks, half of the newborns survive, at 25 weeks - 70%.
Possible long-term effects of extremely low birth weight:
- Dementia
- Epilepsy
- Hearing disorders and (from myopia to complete blindness and deafness)
- Frequent pneumonia
- Liver and kidney failure
- Anemia, vitamin deficiency, growth retardation
- Poor school performance
- Reduced social adaptation
All of the above long-term consequences in premature babies occur mainly at extremely low weight - less than 800 g. But with proper therapy and careful parental care, there is a chance to avoid these consequences.
Vaccines for premature babies
There is a widespread belief that prematurely born babies have a “medical exemption” from vaccinations due to weak immunity. But experts around the world agree that it is the high susceptibility to infectious diseases that makes such children the first candidates for vaccination. Because the risk of dying from banal measles, diphtheria, whooping cough and other diseases is high precisely during premature birth (see).
The first vaccine given to children is hepatitis B. E is usually given on the first day after birth. After all, such children often require surgery, blood transfusions and other risk factors for the transmission of hepatitis. In extremely low birth weight babies, it makes sense to wait up to 30 days, because the optimal response to the vaccine occurs at a weight of 2 kg or more.
In the absence of serious health problems (congenital immunodeficiency, progressive brain disease), other vaccinations are also given according to the general schedule. It is desirable to choose a cell-free pertussis component (vaccines Pentaxim, Infanrix).
- Small babies born prematurely gain weight faster and get stronger when in contact with their mother. In the departments where such children lie, visits by parents are allowed, as this has a beneficial effect on the well-being of the kids.
- Premature babies are more likely than full-term babies to become left-handed or use both hands equally
- and hypoxia in childbirth (oxygen starvation) is more typical for those born at 34-37 weeks. Those born in the period of 25-34 weeks tolerate it better, although they have worse long-term consequences.
FAQ
Boy, 1.5 months, weight 1800g, born at 35 weeks with growth retardation, weight 1300g. Unable to achieve daily stools, even with laxatives. Usually the chair happens every 2-3 days. What can be done?
A stool frequency of once every 2-3 days is perfectly normal for any newborn. The main thing is that it should be of a soft consistency and not cause concern to the child.
A 6-month-old premature baby does not gain weight well, may not gain weight at all for a whole week. How to make a child eat?
At this age, it is not the weekly gains that are important, but the weight trend. It is necessary to mark on the graph the curve of age in months and body weight, compare it with the normal one (indicated in the article). If the graph is on the rise, then everything is in order with the increase. Under no circumstances should a child be forced to eat.
The daughter was born at 33 weeks, weighing 1700g. Now she is 2.5 years old, she caught up with her peers in physical and psychomotor development. The problems began with a trip to the kindergarten. Almost constantly sick, every week. Does it make sense to postpone a visit to the kindergarten, because the child was born prematurely?
Almost all children begin to actively get sick with ARVI in the first year in the garden. It has nothing to do with prematurity. If the child does not mind attending a preschool institution, and parents have the opportunity to often take sick leave, then you can go to kindergarten.
Psychomotor development of the child
The earlier a child is born, the higher the risk of neurological complications. Therefore, it is important to find a competent specialist who will periodically assess the development of the baby and give the right recommendations. Important milestones are checks at 9, 18, 24 and 30 months from birth.
Many pediatricians use a convenient development diary from 0 to 3 years, published in the book by A. M. Kazmin. This diary lists the critical timeframes for the emergence of skills. That is, most children will have them earlier, and only 5% later. It must be remembered that the terms for premature babies are calculated with an adjustment (for example, a baby born a month ahead of schedule should be able to do in six months what 7-month-old children can do).
motor development
| Reaction | |
| Lying on back, randomly bending arms and legs | 1.5 months |
| Lying on his stomach, raises his head | 2 months |
| Lying on the stomach, raises the head in the midline by 45 degrees and holds it (unstable) | 3 months |
| Lying on the stomach, raises the head 45-90 degrees (the chest is raised, resting on the forearms, elbows at or in front of the shoulders) | 4 months |
| When they pull the handles, he tries to sit down | 4.5 months |
| Sitting with support behind the lower back, keeping the head straight | 5 months |
| Lying on your back, touching your knees with your hands | 5.5 months |
| Lying on your back, straightening your neck and back, rolls on your side | 6 months |
| Lying on his stomach, leaning on outstretched arms (hands open, chest raised, chin down) | 6 months |
| Sits (if planted) with support on hands, freely turns his head to the sides | 6 months |
| Lying on your back, lift your legs up and touch your feet | 7 months |
| Lying on his stomach, leans on the forearm of one hand, the other reaches for a toy | 7 months |
| The planted sits with a straight back without support, hands are free. Can lean forward, backward, and sideways, but loses balance easily | 7.5 months |
| Lying on his stomach, unbends, raises his legs and arms outstretched to the side ("swallow") | 8 months |
| Sits steadily without support, while being able to freely play with the toy | 8 months |
| Standing with support behind the chest, trying to "spring" on the legs (torso slightly tilted forward) | 8 months |
| Rolls from back to stomach, rotating the torso | 8.5 months |
| Sitting without support, turns the body to the side and takes the object, turns around and looks back | 9 months |
| From the stomach rolls over to the side, leaning on one forearm, looking back | 9.5 months |
| Rolls over from stomach to back (pelvic girdle rotates relative to shoulder girdle) | 9.5 months |
| Crawls on belly | 9.5 months |
| Gets on all fours (on knees and hands) from a position on the stomach, can swing back and forth on all fours | 10 months |
| From a pose on all fours, raises one hand high to reach an object | 10 months |
| Sitting without support, does not fall when stretched to the side | 10 months |
| Gets on all fours from a sitting position | 10 months |
| Stand up holding on to a support | 11 months |
| Standing, holding on to a support and swinging, shifting from foot to foot | 11 months |
| Sits down from a position on all fours | 11 months |
| Sits down and/or leans over while holding on to a support | 11 months |
| Crawls on all fours | 1 year 1 month |
| Steps sideways along furniture (walls) | 1 year 1 month |
| From a standing position, he kneels down, holding his hand on the furniture | 1 year 1 month |
| Standing unsupported for a few seconds | 1 year 1 month |
| Walks independently with arms raised and legs wide apart | 1 year 1 month |
| Squats down from a standing position, gets up again | 1 year 2 months |
| Gets up off the floor without support | 1 year 3 months |
| Walks independently, hands are free and relaxed | 1 year 3 months |
| Squats down and plays in this position | 1 year 6 months |
| Climbing on a sofa, chair | 1 year 6 months |
| From a standing position, bend over and straighten up again | 1 year 6 months |
| Gets up from a small chair (with support) | 1 year 6 months |
| Runs looking down | 1 year 6 months |
| Walks, may suddenly stop and turn | 2 years |
| Sits on a small chair | 2 years |
| Climbs the stairs with a side step, holding on to the railing and the hand of an adult | 2 years |
| Kicks the ball on the move | 2 years |
| Walks backwards | 2 years |
Hand movements
| Reaction | Approximate age of onset of reaction |
| Lying on your back, bring your hands to your mouth | 3 months |
| Grabs an object that touches the palm or fingers | 3 months |
| Looks at the movements of his hand | 3 months |
| Reaches for the object he sees with one or two hands, the hands are open | 3.5 months |
| Brings the handles in the middle line, pulls them up, looks at them, plays with them | 3.5 months |
| Shaking a rattle in his hand | 4 months |
| Lying on his back, reaches for the object he has seen, grabs it with both hands and pulls it into his mouth | 4.5 months |
| Lying on his back, reaches for the object he has seen with one hand and grabs it | 4.5 months |
| Pulls an object in the hand into the mouth | 5 months |
| Most of the time the brushes are open | 5 months |
| Lying on his stomach, one hand rests, the other reaches for a toy | 5 months |
| Begins to adapt the brush to the shape and size of the object being gripped | 6 months |
| Lying on his back, holding a toy in one hand, the other reaches for the second toy and grabs it | 6 months |
| Transfers an item from hand to hand | 6 months |
| Reaches for a distant object | 7 months |
| Looks at a small object and tries to rake it with all fingers | 7 months |
| Rotates brush with held toy | 7 months |
| Considers one object that he holds in his hands, then another | 8 months |
| Picks up an object with both hands | 8 months |
| Takes a small object seen with three or four fingers (pinch) | 8 months |
| Pushes the ball in a random direction | 8 months |
| Hitting an object against an object | 9 months |
| Claps hands | 9 months |
| Feels people and objects | 10 months |
| Takes a small object with 2 fingers: thumb and lateral surface of the index finger (inaccurate "tweezer grip") | 10 months |
| The taken object does not immediately pull into the mouth, but first manipulates it (5-10 seconds): shakes, feels, hits something with it, examines | 11 months |
| Drops items in the game | 11 months |
| Takes a small object with two fingers (tip of the thumb and forefinger) - precise "tweezer grip" | 1 year |
| Separates objects under visual control (a board with a hole - a peg, a ring - a rod, etc.) | 1 year 1 month |
| Repeats actions with objects after adults (pushing a toy car, trying to comb his hair with a comb, bringing the handset to his ear, etc.) | 1 year 1 month |
| Tries to doodle | 1 year 2 months |
| Puts a cube on a cube | 1 year 4 months |
| Connects objects (rod - ring, cap - pen, etc.) under visual control | 1 year 4 months |
| Unscrews small screw caps under visual control | 1 year 4 months |
| Unwraps a paper-wrapped object | 1 year 6 months |
| Places 3 dice on top of each other | 1 year 8 months |
| Turns the pages of a book one at a time | 1 year 8 months |
| Drops a small object into a small hole | 1 year 9 months |
| Grabs a moving object (such as a ball) | 2 years |
Vision
| Name of the reaction | Approximate age of onset of reaction |
| Looks at a light source. | 1 month |
| Fixes the gaze on the face of an adult. | 1 month |
| Attempts to follow a slowly moving face or a bright object at a distance of 20-40 cm. | 1 month |
| Fixes a steady gaze on the eyes of an adult. | 1.5 months |
| Prefers to look at contrasting simple shapes: black and white stripes, circles and rings, etc., as well as moving contrasting objects. | 2 months |
| Prefers to look at new things | 2 months |
| Examines the details of an adult's face, objects, patterns. | 2 months |
| He shifts his gaze to the object that has appeared in the field of view: from the side, from above, from below. | 2 months |
| He smiles when he sees something familiar. | 3 months |
| Follows an adult face or object moving in all directions at a distance of 20 to 80 cm. | 3 months |
| Examines objects in the room. | 3 months |
| Looks at his hand | 3 months |
| Looks at the object he is holding in his hand. | 3 months |
| He smiles more when he sees his mother than others. | 3.5 months |
| Prefers voluminous toys | 4 months |
| Blinks when an object is quickly approaching. | 4 months |
| Looks at his reflection in the mirror. | 5 months |
| Recognizes the bottle (and/or breast). | 5 months |
| Responds to the mask | 5 months |
| Considers the surroundings on the street | 6 months |
| He chooses his favorite toy with a glance. | 6 months |
| In a new place - looks around, may be frightened. | 6 months |
| Facial expression changes depending on the facial expression of an adult | 6 months |
| Pays attention to small objects (bread crumbs, poppy seeds) at a distance of 20-40 cm | 8 months |
| Distinguishes "friends" from "strangers" in appearance. | 8 months |
| Watching the ball game | 9 months |
| Examines small patterns, pictures, photographs, small objects with clear contours | 1 year |
| Watching an adult write or draw with a pencil. | 1 year |
| Understands 2-3 gestures ("bye", "not", etc.). | 1 year 1 month |
| Avoids high obstacles while walking. | 1 year 2 months |
| Imitates the actions of an adult | 1 year 3 months |
| Recognizes himself and loved ones in photographs | 1 year 4 months |
| Shows several named objects or pictures. | 1 year 4 months |
| Recognizes several objects by their realistic drawings. | 1 year 4 months |
| Avoids obstacles on the surface it walks on (holes, bumps...). | 1 year 6 months |
| Remembers where certain objects or toys lie | 1 year 6 months |
| Recognizes his things, clothes | 2 years |
Hearing
| Name of the reaction | Approximate age of onset of reaction |
| Listening to the sound of a rattle | 2 months |
| Listening to the voice of an adult | 2 months |
| Smiles when he hears an adult's voice | 2 months |
| Freezes when a new sound appears in the background of others. | 2.5 months |
| Listens to music. | 3 months |
| Gut in response to sound stimulation. | 3 months |
| Distinguishes the voices of close people (highlights the voice of the mother). | 3 months |
| Highlights your favorite music | 4 months |
| Selectively attentive to certain sounds, which depends on the nature of the sound, and not on its intensity. | 4 months |
| Sometimes turns head towards sound source (lying on back) if it is at ear level | 4 months |
| Shakes the rattle, pauses and shakes again | 4 months |
| Listens to the speaker and reacts to the termination of the conversation. | 4 months |
| Looks from one talking person to another | 5 months |
| Looks closely at the object that makes the sound. | 5 months |
| Reacts emotionally to familiar voices. | 6 months |
| Clearly finds the source of the sound with his eyes (lying down). | 6 months |
| Listens for whispers and other soft sounds | 6 months |
| Laughs at certain sounds | 6 months |
| In a sitting position, turns to the source of the sound. | 7 months |
| Attempts to reproduce the "melody" of the speech heard | 7 months |
| Interested in objects that produce sound. | 8 months |
| Tries to reproduce new sounds heard | 9 months |
| Looking at a person or object, expects to hear a familiar sound and is surprised if he hears another | 10 months |
| Freezes when they say "no", "wait", etc. | 10 months |
| Performs movements at the request (for example, the word "patties" begins to clap his hands) | 11 months |
| Turning, he finds the source of the sound with his eyes, if he is in the immediate environment and even behind his back. | 11 months |
| Sometimes he repeats familiar two-syllable words consisting of the same syllables ("mother", "dad", "woman" ...). | 1 year |
| Begins to "dance" at the sound of music. | 1 year 2 months |
| Looks at familiar objects, family members, body parts that are named. | 1 year 2 months |
| Attempts to reproduce a series of speech sounds with a certain intonation and rhythm, which resembles the speech of adults. | 1 year 2 months |
| Performs a familiar action with an object at the request (rolls the car, "combs", "shakes" or "feeds" the doll, etc.). The request should be expressed only in words, without prompting with gestures or a look, without demonstrating what is being asked. |
1 year 4 months |
| Repeats short words heard in an adult conversation (or repeats them after a few hours). | 1 year 4 months |
| Of 2-3 familiar objects, he looks at the one that was named. | 1 year 4 months |
| From 2-3 familiar pictures, he looks at the one that was named | 1 year 4 months |
| Knows several short poems, inserts individual words into them. | 1 year 6 months |
| Understands 20-50 words (names of relatives, names of body parts, objects and some actions). | 1 year 6 months |
| He likes to play "animal voices" with an adult (for example: "How does a cow moo?" - "My-y-y"). | 1 year 6 months |
| Names objects that are out of sight when hearing sounds coming from them. | 2 years |
| Understands 100 words or more. | 2 years 3 months |
| Repeats sentences of 2-3 words after an adult (or repeats them a few hours later). | 2 years 3 months |
| Tries to sing | 2 years 6 months |
| Repeats couplets or quatrains after an adult (or plays them several hours later) | 3 years |
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.
The pregnancy is left behind - it's time for joyful and, at the same time, anxious expectation. Finally, the long-awaited baby was born, but, alas, ahead of schedule. Of course, you are worried and ask a lot of questions.
After all, you have to face a lot of problems, because the baby will hurry to be born, and his body is not ready for independent life. Therefore, the baby requires increased attention and careful care.
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: body weight at birth and gestational age or age (the number of completed weeks of pregnancy at the time of birth).
Degrees of prematurity
First degree prematurity- childbirth for a period of 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 when there are other conditions or diseases - for example, an infection, a birth injury, a long anhydrous period.
Second or medium degree of prematurity- early birth at 31-33 weeks and 6 days. Birth weight - from 1501 to 2000 grams. The prognosis is favorable with the provision of timely medical care, as well as in conditions of optimal feeding and care.
Third or severe prematurity- very early birth at a period of 28-30 weeks. Body weight at birth - from 1001 to 1500 grams. The prognosis is not entirely favorable, although many of these children survive. However, in the future they are long-term nursing and receive treatment in connection with various diseases.
Fourth degree or profound prematurity- extremely early childbirth for up to 28 weeks. Birth weight - up to 1000 grams (extremely low weight). According to statistics, at this time, every fifth baby is born alive.
However, the prognosis is poor. 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%.
In addition, a deeply premature baby, due to the immaturity of all organs and systems, may develop numerous pathological conditions and diseases. Therefore, the question of the future fate of the baby is recommended to be decided together with the obstetrician-gynecologist, neonatologist and the mother of the child. At the same time, all the consequences and the need for long-term nursing are explained to parents.
"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 gestational age, 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.
Prematurely born: what does a premature baby look like?
Of course, a premature baby looks different from a full-term baby, but a lot depends on gestational age.
The main external distinguishing features of premature babies
Moderate prematurity: I-II degree
* Muscle tone is somewhat lowered, but basically the baby is active.
* The skin is pink, and the subcutaneous fat layer is moderately thinned.
* Vellus hair (lanugo) is absent from the skin on the face from 32-33 weeks, and starting from 35-37 weeks - usually already on the entire surface of the skin.
* Nipples and peripapillary areas (skin around the nipples) are clearly visible and pigmented (colored).
* The first bends on the auricles occur 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, as a rule, reach the edges of the fingers (nail bed).
* The external genital organs 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 reduced muscle tone, the child lies with outstretched arms and legs.
* The skin is dark red, thin and wrinkled (like an old man), often swollen, 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.
* Nipples and peripapillary areas are poorly pigmented and poorly visible.
* The auricles are soft, without convolutions and shapeless, pressed against the head and located low.
* The nails of the crumbs 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.
* The external genitalia are underdeveloped. In girls, the labia majora do not cover the labia minora, so the genital slit gapes (opened). In boys, the testicles usually have not yet descended into the scrotum.
However, it should be remembered that not always in the same baby all the signs of prematurity appear equally clearly and vividly in accordance with the gestational age. It often happens that some of them are more pronounced, while others are less.
Life against all odds...
For premature babies, there is The general trend: the incidence of morbidity, mortality and disability increases as the gestational age decreases.
However, the forecast remains just a forecast and is not guarantee or warrant. Because some premature babies, against all gloomy estimates, fight, survive and grow up as healthy children. While other babies are hard to nurse, and sometimes even die, although, it would seem, they initially have more favorable data.
Why is this happening? The question is better addressed to Mother Nature. Alas, we most likely will not receive an answer to it. However, perhaps this phenomenon can be explained by the desire of some babies to cling to life by any means.
Hence the conclusion: with each passing day, the chances of survival for a baby increase significantly.
Therefore, in the next article we will talk about the features of the physiology 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 a premature baby are directly related to them.
pediatric resident doctor
Premature babies: frequency and causes of preterm birth. Anatomical, physiological and neuropsychic features of premature babies
premature babies- children born in relation to the established end of gestational age prematurely.
premature birth- is the birth of a child before the end of the full 37 weeks of pregnancy or earlier than 259 days counted from the first day of the last menstrual cycle (WHO, 1977). A prematurely born child is premature.
premature birth statistics .
The frequency of preterm birth = 3–15% (average − 5–10%). Premature births in 2002 - 4.5%. There is no downward trend in this indicator.
Among prematurely born children, the highest morbidity and mortality are observed. They account for 50 to 75% of infant mortality, and in some developing countries - almost 100%.
Causes of preterm birth
socio-economic (salary, living conditions, nutrition of a pregnant woman);
socio-biological (bad habits, age of parents, prof. harmfulness);
clinical (extragenital pathology, endocrine diseases, threat, preeclampsia, hereditary diseases).
Factors contributing to fetal growth retardation and preterm labor (prematurity) can be divided into 3 groups :
lack or insufficiency of medical care before and during pregnancy;
level of education (less than 9 classes) - affect the level and lifestyle, personality traits, material well-being;
low standard of living and, accordingly, material security, and as a result, unsatisfactory living conditions, inadequate nutrition of the expectant mother;
occupational hazards (physically difficult, prolonged, monotonous, standing work of a pregnant woman);
extramarital birth (especially with unwanted pregnancy);
unfavorable ecological situation;
young or old age of the pregnant woman (less than 18 years old) and the first birth over 30 years old);
father's age is under 18 and over 50 (in Europe);
bad habits (smoking, alcoholism, drug addiction) of both the future mother and father;
short stature, infantile physique of a pregnant woman;
genital infantilism, especially in combination with hormonal disorders (corpus luteum insufficiency, ovarian hypofunction, isthmic-cervical insufficiency) - up to 17% of all preterm births;
previous abortions and miscarriages - lead to inadequate secretion of the endometrium, collagenization of the stroma, isthmic-cervical insufficiency, increased contractility of the uterus, the development of inflammatory processes in it (endometritis, synechia);
mental and physical injuries of a pregnant woman (fright, shocks, falls and bruises, weight lifting, surgical interventions during pregnancy - especially laparotomy);
inflammatory diseases of the mother of an acute and chronic nature, acute infectious diseases (delivery at the height of fever, as well as in the next 1-2 weeks after recovery);
extragenital pathology, especially with signs of decompensation or exacerbation during pregnancy: rheumatic heart disease, arterial hypertension, pyelonephritis, anemia, endocrine diseases (hypothyroidism, thyrotoxicosis, diabetes mellitus, hyperfunction of the adrenal cortex, etc.), etc. cause a violation of uteroplacental blood flow, degenerative changes in the placenta;
genital pathology;
pregnancy pathology: late gestosis, nephropathy, immunological conflict in the mother-placenta-fetus system;
anomalies in the development of the placenta, umbilical cord;
in vitro fertilization;
multiple pregnancy (about 20% of all premature babies);
fetal diseases: IUI, hereditary diseases, fetal malformations, isoimmunological incompatibility;
the interval between births is less than 2 years.
socio-economic:
socio-biological:
clinical:
Causes of prematurity can be divided according to another principle:
environmental,
coming from the mother;
associated with the peculiarities of the course of pregnancy;
from the side of the fetus.
Classification of prematurity
In ICD X revision under heading R 07 " Disorders associated with the shortening of pregnancy, as well as low birth weight" The division of premature newborns is accepted both by weight and by gestational age. The note says: When both birth weight and gestational age are established, birth weight should be preferred.
Depending on the indicators of gestational age and body weight of a premature baby, 4 degrees of prematurity (3 weeks for each of the first three degrees):
|
Degrees of prematurity |
by gestation |
by body weightat birth |
||
|
I degree |
35 weeks - incomplete 37 weeks (up to 259 days) |
2500−2000 grams |
low |
|
|
II degree |
32-34 weeks |
1999−1500 grams |
||
|
III degree |
deeply premature |
29-31 weeks |
1499−1000 grams− very low body weight |
|
|
IV degree |
22-28 weeks |
999-500 grams extremely low mass (extremely low mass) |
||
Extreme prematurity− gestational age less than 22 completed weeks (154 completed days).
The line between miscarriage and premature at 22 full weeks (154 full days) of gestation is determined by weight: 499 g - miscarriage, 500 g - premature newborn.
Anatomical, physiological and neuropsychic features of premature babies
Anatomical features of premature babies (external signs of immaturity):
the skin is thin and glossy, dark red, as if translucent;
on the face, back, extensor surfaces of the limbs there is an abundant primordial fluff - lanugo;
the subcutaneous fat layer is thinned, as a result of which the skin is wrinkled, there is a tendency to edema of the subcutaneous fat;
body length from 25 cm to 46 cm;
disproportionate physique (the head is relatively large: the large vertical size of the head ranges from ¼ to ⅓ of the body length, the brain skull prevails over the facial one; the neck and lower limbs are short);
low forehead hair growth
the skull is more round, its bones are pliable - non-closure of cranial sutures, small and lateral fontanelles are usually open;
auricles are soft, close to the skull;
nails often do not reach the fingertips, the nail plates are soft;
low-lying place of discharge of the umbilical cord, below the midpoint of the body;
underdevelopment of the genital organs: in girls, the genital slit gapes, i.e., the labia minora is not covered by the labia majora (due to underdevelopment of the labia majora and relative hypertrophy of the clitoris), in boys, the testicles are not lowered into the scrotum (in extremely immature children, the scrotum is generally underdeveloped) .
Physiological features of the body of a premature baby (functional signs of immaturity):
from the sidenervous and muscular systems - depression syndrome:
muscle hypotension, lethargy, drowsiness, delayed response to stimuli, a weak, quiet cry or squeak,
the predominance of subcortical activity (due to the immaturity of the cerebral cortex): movements are chaotic, shudders, hand tremors, stop clonus may be noted,
imperfection of thermoregulation (reduced heat production and increased heat transfer: children easily cool and overheat, they do not have an adequate temperature increase for an infectious process),
weak severity, rapid extinction or absence of physiological reflexes of the neonatal period,
weak sucking intensity;
from the siderespiratory system :
great lability of the frequency and depth of breathing with a tendency to tachypnea (36 - 72 per minute, on average - 48 - 52), its superficial nature,
frequent respiratory pauses (apnea) of varying duration (5-12 seconds);
gasps (convulsive respiratory movements with difficulty inhaling);
during sleep or rest may be observed: breathing Biot type(correct alternation of periods of apnea with periods of respiratory movements of the same depth), breathing Cheyne-Stokes type(periodic breathing with pauses and a gradual increase, and then a decrease in the amplitude of respiratory movements);
primary atelectasis;
cyanosis;
from the sideof cardio-vascular system :
lower blood pressure in the first days of life (75/20 mm Hg with an increase in the following days to 85/40 mm Hg;
lability of heart rate with a tendency to tachycardia (up to 200 beats per minute, on average - 140 - 160 beats / min);
the phenomenon of embryocardia (heart rhythm, characterized by pauses of equal duration between I and II tone and between II and I tone);
muffled heart tones, in the first days of life, noises are possible due to the frequent functioning of embryonic shunts (botall duct, oval window);
vascular dystonia - the predominance of the activity of the sympathetic division of the autonomic nervous system - any irritation causes an increase in heart rate, an increase in blood pressure;
Harlequin symptom (or Finkelstein symptom): in the position of the child on the side, uneven skin coloration is observed: the lower half is pink, the upper half is white, which is due to the immaturity of the hypothalamus, which controls the state of skin capillary tone;
from the sidedigestive system :
reduced food tolerance: low proteolytic activity of gastric juice enzymes, insufficient production of pancreatic and intestinal enzymes, bile acids,
increased permeability of the intestinal wall;
predisposition to flatulence and dysbacteriosis;
underdevelopment of the cardiac part of the stomach (gaping of the cardia - a tendency to regurgitation);
from the sideurinary system :
low filtration and osmotic function of the kidneys;
from the sideendocrine system :
decrease in the reserve capacity of the thyroid gland - a tendency to transient hypothyroidism;
from the sidemetabolism and homeostasis − propensity to:
hypoproteinemia,
hypoglycemia,
hypocalcemia,
hyperbilirubinemia,
metabolic acidosis;
from the sideimmune system :
low level of humoral immunity and nonspecific protective factors.
Morphological signs of prematurity:
large vertical size of the head (⅓ of the body length, in full-term ones - ¼),
the predominance of the size of the brain skull over the facial,
open small and lateral fontanelles and sutures of the skull,
low forehead hair growth
soft ears,
plentiful lanugo,
thinning of subcutaneous fat,
the location of the umbilical ring below the midpoint of the body,
underdevelopment of nails
Functional signs of prematurity:
low muscle tone (frog pose);
weakness of reflexes, weak cry;
tendency to hypothermia;
max weight loss by 4-8 days of life and is 5-12%, is restored by 2-3 weeks;
prolonged physiological (simple) erythema;
physiological jaundice - up to 3 weeks. - 4 weeks;
early adaptation period = 8 days. -14 days,
period of late adaptation = 1.5 months. - 3 months;
the rates of development are very high: the mass-growth index is compared to 1 year (compared to full-term ones), in very preterm infants (<1500 г) - к 2-3 годам;
in neuropsychic development, by the age of 1.5, they catch up with full-term ones, provided that they are healthy. In 20% of cases with a mass of 1500 g and< - поражается ЦНС (ДЦП, эпилепсия, гидроцефалия).
Features of the course of the neonatal period in preterm infants
The period of early adaptation in premature babies is 8-14 days, the neonatal period lasts more than 28 days (up to 1.5 - 3 months). For example, if a child was born at a gestational age of 32 weeks, then at 1 month of life his gestational age will be 32 + 4 = 36 weeks.
Physiological weight loss lasts longer - 4 - 7 days and amounts to 10 - 14%, its recovery occurs by 2 - 3 weeks of life.
90-95% of preterm babies have neonatal jaundice of prematurity, more pronounced and longer than full-term (can be held up to 3-4 weeks).
Hormonal crisis and toxic erythema are less common than in term infants.
An increase in muscle tone in the flexors usually appears in 1-2 months of life.
In healthy premature babies weighing up to 1500 g, the ability to suckle appears within 1–2 weeks of life, with a weight of 1500 to 1000 g – at 2–3 weeks of life, less than 1000 g – by the month of life.
The rate of development of premature babies is very high. Most premature babies catch up with their peers by 1-1.5 years in terms of weight and height. Children with very low birth weight (less than 1500 grams - very premature) usually lag behind in physical and neuropsychic development up to 2-3 years. In 20% of very premature babies, there are organic lesions of the central nervous system (cerebral palsy, hearing, vision, etc.).
Prevention of preterm birth consists of:
socio-economic factors;
family planning;
treatment of extragenital pathology before pregnancy;
treatment of urogenital infection;
consultation in polyclinics “marriage and family”;
transplantation of lymph suspension (150 ml) during or outside of pregnancy;
sex culture.
A premature baby is the same newborn baby as others, differing from a mature newborn in underdeveloped body functions.
Any newborn born weighing less than 2,500 g and measuring 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 of weight and immature from 1.500 to 2.500 g.
There are 4 degrees, which are based on the growth and weight of a premature baby.
- First. Date of birth: 35-37 weeks, weight 2000-2500 grams.
- Second. Term: 32-34 weeks, weight 1500-2000 grams.
- Third. Term: 29-31 weeks, weight 1000-1500 grams.
- Fourth. Less than 20 weeks, weight below 1000 grams.
The higher the degree of prematurity, the more difficult it will be for the baby to come out. 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, he is only less mature. And yet, individual parts of the body lag behind in size and development from others. This incommensurability in children born after a smaller number of lunar months is manifested due to the fact that the formation of individual organs and systems was incomplete. So, for example, the skull has a rounded or ovoid shape, and only before the end of the gestation period (10 lunar months) it lengthens somewhat. The subcutaneous fat layer is much less pronounced, since it is mainly created before the end of pregnancy, so a premature baby has a somewhat specific appearance.
The percentage of births of premature babies is not constant and is not the same in all countries of the world. Basically, it ranges from 8 to 12% of the total number of children born ...
Reasons for having a premature baby
The causes of prematurity in about 50% of cases are unknown.
It is believed that of all the possible causes, the following have a special impact on the birth of premature babies:
- in the first place I want to put the usual negligence of the expectant mother: to go to distant lands in a shaking train or car because I “want”, to do a general cleaning or repair, and in all cases she believes that no one can move her wardrobe better, fall, climbing on a tree “behind that red cherry” or running across the ice ... Dear future mothers, take care of yourself and your stomach from the first days until the very birth, do not risk the baby, telling “and my friend flew to Turkey in her seventh month, and that’s all it was nice". No risk here!
- chronic diseases of mothers (tuberculosis, syphilis, joint diseases, anemia, etc.);
- congenital tendency to premature birth;
- traumatism of working women (constant exposure to subtle, but harmful influences, such as shaking, vibration, etc.);
- multiple pregnancy (twins, triplets);
- acute mental shocks of the mother;
- difficult social conditions of the mother's life (illegitimacy, unemployment, etc.);
- seasons (early spring, late autumn);
- undesirable changes in the mother's diet during pregnancy (lack of proteins and vitamins);
- attempt to have an abortion, previous abortions;
- drinking and smoking;
- too young or vice versa old age of parents;
- non-compliance with medical prescriptions;
- psychological, domestic and emotional factors that adversely affect the course of pregnancy;
- a period of less than 2 years between births;
- severe pregnancy;
We have already said that about 50% of the causes have not yet been sufficiently studied. There are new interpretations, according to which the causes of prematurity can also come from fathers. It is believed that for successful childbirth it matters when the spermatozoa 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 succumb to various diseases. The development of a premature baby by months - this is worth talking about in more detail.
Development of a premature baby by months
Premature baby up to 29 weeks.
For such children, the weight is less than 1 kilogram, the skin color is red-violet. The skin is folded and covered with fluff (lanugo). Outwardly, the kids 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 respiratory reflexes, the life support of babies is provided by medical equipment. Often such children do not know how to cry, and most of the time they sleep. Their movements are rare and sluggish due to reduced muscle tone.
Cases of childbirth before 29 weeks are extremely rare.
Development of a baby born at 29 weeks
Outwardly, these babies resemble babies born at an earlier date, but there are differences that subsequently reduce the likelihood of a negative manifestation of early childbirth. Most often, children are placed in an incubator in which constant temperature conditions and humidity are maintained, oxygen is additionally supplied.
Having a baby at 30 weeks
Children born at this time can already be fed through a tube with breast milk. They start to move.
Features of the development of a child born at 31 weeks
Despite the fact that children born at this time already know how to open their eyes, cry and move more actively, they still need constant medical supervision.
Baby born at 32 weeks
The weight of these babies exceeds 1500 grams, they know how to breathe on their own.
33 week
If the child does not have problems with the respiratory system, then he can be bottle-fed or breast-fed.
Childbirth at 34 weeks - features of the birth of a child
The likelihood of health problems decreases, the condition of children who were born during this period improves.
Childbirth - 36 weeks
The risks of birth at this time include imperfection of thermoregulation and jaundice. The weight of such children is close to normal, there are practically no health problems.
Development of premature babies by months 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 with a weight of 1000-1500 grams
At 2.5 months, they begin to concentrate their attention on sound sources.
At 4 months, the head is held in a vertical 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 down on their own.
Closer to a year, children try to get up.
Starting from 1 year 2 months, children try to take their first steps.
After a year, the first words are pronounced.
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 down on their own.
At 10 months, babies try to get up.
Starting at 11, children try to take their first steps.
After 11 months, the first words are pronounced.
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 a vertical 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 down on their own.
Closer to 9 months, children try to get up.
From the age of 11 months, children try their best to take their first steps.
At 11 months, the first words are pronounced.
Features of the development of premature babies by months
Development of a premature baby - 1 month
High probability of contracting infectious diseases that can lead to complications. Weight gain is minimal. The increase in growth averages 2-5 cm. The head circumference increases to 4-5 cm. If the development of the crumbs proceeds normally, a sucking-swallowing reflex should occur. If it is absent, feeding should be carried out using a probe. If the respiratory reflex is poorly developed, artificial oxygen supply should be resorted to.
2 months of life of a premature baby
Weight gain is accelerating. This is a 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 must be supplemented with expressed milk using a spoon.
Premature baby and its development at 3 months
Weight should increase by 1.5 times. The increase in height averages 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 eyes 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
Premature babies by this age are catching up with their peers in development. Their weight should double. The increase in height is on average 2-5 cm. The circumference of the head increases to 1.5 cm. They are able to distinguish their relatives from strangers, play with toys and turn their heads.
7th month - development of a premature baby
The increase in height is on average 1-3 cm. The circumference of the head increases to 0.5-1 cm. The game becomes more active. The peanut rolls over from its stomach to its back.
Premature baby - 8 months
The increase in height is on average 1-3 cm. The circumference of the head increases to 0.5-1 cm. Coups are already easy for the baby. There are attempts to crawl.
9 months of life of a premature baby - his skills, features of development
The increase in height is on average 1-3 cm. The circumference of the head increases to 0.5-1 cm. He picks up pieces of food without outside help, gets to his feet, holding on to a support, and actively plays.
10-11 months of life of a premature baby
The increase in height averages 1-3 cm. The head circumference increases to 0.5-1 cm. Children actively crawl, play, pronounce all kinds of sounds, and actively respond to their name.
Premature baby - development in 1 year - 12 months
The increase in height averages 1-3 cm. The circumference of the head 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.
- these are children born before the due date, functionally immature, with a weight below 2500 g and a body length of less than 45 cm. Clinical signs of prematurity include a disproportionate physique, open sutures of the skull and a small fontanel, a lack of expression of the subcutaneous fat layer, hyperemia of the skin, underdevelopment of the genital organs, weakness or absence of reflexes, weak cry, intense and prolonged jaundice, etc. Nursing premature babies involves the organization of special care - temperature, humidity, oxygenation level, feeding, and, if necessary, intensive care.
The third group of causes that disrupt the normal maturation of the fetus and cause an increased likelihood of the birth of premature babies include various extragenital diseases of the mother: diabetes mellitus, hypertension, heart defects, pyelonephritis, rheumatism, etc. Often, premature birth is provoked by acute infectious diseases suffered by a woman in late gestation periods.
Finally, the birth of premature babies may be associated with pathology and abnormal development of the fetus itself: chromosomal and genetic diseases, intrauterine infections, severe malformations.
Classification of prematurity
Taking into account the indicated criteria (gestational age, body weight and length), 4 degrees of prematurity are distinguished:
I degree of prematurity- delivery occurs at a period of 36-37 weeks of gestation; the body weight of the child at birth is 2500-2001 g, length - 45-41 cm.
II degree of prematurity- delivery occurs at a period of 32-35 weeks of gestation; the body weight of the child at birth is 2001-2500 g, length - 40-36 cm.
III degree prematurenews- delivery occurs at a period of 31-28 weeks of gestation; the body weight of a child at birth is 1500-1001 g, length - 35-30 cm.
IV degree of prematurity- delivery occurs before 28 weeks of gestation; the birth weight of the child is less than 1000 g, the length is less than 30 cm. The term "premature with extremely low body weight" is used in relation to such children.
External signs of prematurity
Premature babies are characterized by a number of clinical signs, the severity of which correlates with the degree of prematurity.
Deeply premature babies with a body weight of II-II degree malnutrition), the child's physique is disproportionate (the head is large and is approximately 1/3 of the body length, the limbs are relatively short). The abdomen is large, flattened with a clearly visible divergence of the rectus muscles, the navel is located in the lower abdomen.
In very premature babies, all fontanelles and sutures of the skull are open, the cranial bones are supple, the brain skull prevails over the facial one. Characterized by underdevelopment of the auricles, poor development of the nails (nail plates do not reach the fingertips), weak pigmentation of the nipples and areola. The genital organs in premature babies are underdeveloped: in girls there is a gaping of the genital slit, in boys - undescended testicles into the scrotum (cryptorchidism).
Premature babies born at 33-34 weeks of gestation and later are characterized by greater maturity. Their appearance is distinguished by the pink color of the skin, the absence of fluff on the face and torso, a more proportional physique (smaller head, higher navel, etc.). In premature babies of I-II degree, the bends of the auricles are formed, the pigmentation of the nipples and areola circles is pronounced. In girls, the large labia almost completely cover the genital gap; in boys, the testicles are located at the entrance to the scrotum.
Anatomical and physiological features of premature babies
Prematurity is determined not so much by anthropometric indicators as by morphological and functional immaturity of vital organs and body systems.
Characteristic features of the respiratory organs in premature infants are the narrowness of the upper respiratory tract, the high position of the diaphragm, the compliance of the chest, and the perpendicular arrangement of the ribs relative to the sternum. These morphological features of premature babies cause superficial, frequent, weakened breathing (40-70 per minute), a tendency to apnea lasting 5-10 seconds (apnea of prematurity). Due to the underdevelopment of the elastic tissue of the lungs, the immaturity of the alveoli, and the reduced content of surfactant in premature babies, a syndrome of respiratory disorders easily occurs (congestive pneumonia, respiratory distress syndrome).
The immaturity of the cardiovascular system is characterized by pulse lability, tachycardia 120-180 per minute, muffled heart tones, arterial hypotension (55-65/20-30 mm Hg). In the presence of congenital heart defects (open Botall duct, open foramen ovale), murmurs may be heard. Due to the increased fragility and permeability of the vascular walls, hemorrhages easily occur (subcutaneous, into internal organs, into the brain).
Morphological signs of CNS immaturity in premature infants are weak differentiation of gray and white matter, smoothness of the brain sulci, incomplete myelination of nerve fibers, and poor vascularization of the subcortical zones. Muscle tone in premature babies is weak, physiological reflexes and motor activity are reduced, the reaction to stimuli is slowed down, thermoregulation is impaired, and there is a tendency to both hypo- and hyperthermia. In the first 2-3 weeks, a premature baby may experience transient nystagmus and strabismus, tremors, tremors, and stop clonus.
In premature babies, functional immaturity of all parts of the gastrointestinal tract and low enzyme-excretory activity are noted. In this regard, premature babies are prone to regurgitation, the development of flatulence, dysbacteriosis. Jaundice in premature babies is more intense and lasts longer than in full-term newborns. Due to the immaturity of the liver enzyme systems, the increased permeability of the blood-brain barrier, and the rapid breakdown of red blood cells, premature infants can easily develop bilirubin encephalopathy.
Functional immaturity of the kidneys in premature infants leads to changes in the electrolyte balance (hypocalcemia, hypomagnesemia, hypernatremia, hyperkalemia), decompensated metabolic acidosis, a tendency to edema and rapid dehydration with inadequate care.
The activity of the endocrine system is characterized by a delay in the formation of the circadian rhythm of hormone release, rapid depletion of the glands. In premature babies, there is a low synthesis of catecholamines, transient hypothyroidism often develops, in the first days of life a sexual crisis rarely occurs (physiological mastitis, physiological vulvovaginitis in girls).
Premature babies develop early anemia more rapidly than full-term babies, there is an increased risk of developing septicemia (sepsis) and septicopyemia (purulent meningitis, osteomyelitis, ulcerative necrotic enterocolitis).
During the first year of life, the increase in body weight and length in premature babies occurs very intensively. However, according to anthropometric indicators, premature babies catch up with their peers born at term only by 2-3 years (sometimes by 5-6 years). The lag in psychomotor and speech development in premature babies depends on the degree of prematurity and comorbidities. In a favorable scenario for the development of a premature baby, alignment occurs in the 2nd year of life.
Further physical and psychomotor development of premature babies may be on par with their peers or be delayed.
Among premature babies, neurological disorders are more common than among full-term peers: astheno-vegetative syndrome, hydrocephalus, convulsive syndrome, vegetative-vascular dystonia, cerebral palsy, hyperactivity, functional dyslalia or dysarthria. Almost a third of premature babies have a pathology of the organ of vision - myopia and astigmatism of varying severity, glaucoma, strabismus, retinal detachment, optic nerve atrophy. Premature babies are prone to frequent repeated acute respiratory viral infections, otitis media, against which background hearing loss may develop.
Women born prematurely in adulthood often suffer from menstrual irregularities, signs of sexual infantilism; they may be at risk of spontaneous abortion and premature birth.
Features of caring for premature babies
Babies born prematurely need special care. Their phased nursing is carried out by neonatologists and pediatricians, first in the maternity hospital, then in the children's hospital and polyclinic. The main components of caring for premature babies are: ensuring optimal temperature and humidity conditions, rational oxygen therapy and metered feeding. In premature babies, constant monitoring of the electrolyte composition and CBS of the blood, monitoring of the gas composition of the blood, pulse and blood pressure is carried out.
Very premature babies are placed immediately after birth in incubators, where, taking into account the condition of the child, a constant temperature (32-35 ° C), humidity (in the first days about 90%, then 60-50%), oxygenation level (about 30%) are maintained. Premature babies of I-II degree are usually placed in heated beds or in ordinary beds in special boxes, where the air temperature is maintained at 24-25°C.
Premature babies who are able to independently maintain normal body temperature, who have reached a body weight of 2000 g, with good epithelization of the umbilical wound, can be discharged home. The second stage of nursing in specialized departments of children's hospitals is indicated for premature infants who have not reached 2000 g in the first 2 weeks, and for children with perinatal pathology.
Feeding premature babies should begin in the first hours of life. Children with absent sucking and swallowing reflexes are fed through a gastric tube; if the sucking reflex is sufficiently pronounced, but the body weight is less than 1800 g, the child is fed through the nipple; children weighing over 1800 g may be breastfed. The frequency of feeding premature babies I-II degree 7-8 times a day; III and IV degree - 10 times a day. Calculation of food is made according to special formulas.
Premature babies with physiological jaundice should receive phototherapy (general UV). As part of the rehabilitation of premature babies at the second stage, communication between the child and the mother, skin-to-skin contact, is useful.
Clinical examination of premature babies
After discharge, children born prematurely need constant monitoring by a pediatrician during the first year of life. Examinations and anthropometry are carried out weekly in the first month, once every two weeks - in the first half of the year, once a month - in the second half of the year. In the first month of life, premature babies should be examined by a pediatric surgeon, pediatric neurologist, pediatric orthopedic traumatologist, pediatric cardiologist, pediatric ophthalmologist. At the age of 1 year, children need to consult a speech therapist and a child psychiatrist.
From 2 weeks of age, premature babies need the prevention of iron deficiency anemia and rickets. Preventive vaccinations for premature babies are carried out according to an individual schedule. In the first year of life, repeated courses of baby massage, gymnastics, individual wellness and tempering procedures are recommended.
