Premature newborn 34 weeks. Physical development of premature babies. Feeding premature babies

Usually pregnancy lasts 38-42 weeks. Children born at this time are called full-term, and births are called timely, or urgent. However, about 25% of births begin prematurely (before 38 weeks of gestation).

Such children are considered premature, and childbirth is considered premature.

During pregnancy, which lasts 9 months for a person (apparently, the wise Nature set such a period for a reason!), the baby manages to form and develop so much that it is born ready for a physiologically autonomous life.

Compared with full-term children, the initial life potential at the time of birth in premature babies is much lower, and therefore the newborn period (from the moment of birth to 28 days) is much more difficult for them. Such babies first have to, as it were, "complete" intrauterine development, its systems and organs must reach a level corresponding to the normal term of childbirth.

In order for “development” to proceed normally, premature babies need to stay for some time in conditions similar to those in which the fetus grew in the mother’s womb, so all babies immediately after birth are placed in equipped intensive care units of maternity hospitals and children’s medical centers, where care they are followed by experienced neonatologists (pediatricians dealing with newborn pathologies), doctors and nurses.

A premature baby requires special conditions for nursing and constant monitoring by doctors, on whom his life depends.

A baby born at term with low weight differs from a premature one in that the internal organs of the latter are underdeveloped. He will need another two months for all his organs and systems to reach functional maturity. He will lag behind in weight and height from children born at term for a long time to come. A baby born before the 35th week weighs less than 2 kg.

What is he, a premature baby?

The birth of a baby earlier than expected is always accompanied by feelings and anxiety of parents. And this is quite understandable - both for them and for the doctors, a serious struggle begins for the life of the newborn.

Physiological changes in body weight after birth

Almost all newborns from the moment of birth begin to lose body weight: full-term babies by about 5-6%, and premature babies - up to 12-14% of body weight at birth. This is a normal, physiologically justified phenomenon.

In a premature baby, the period of loss of the initial mass lasts about 4-7 days, and the “speed” of its decrease (intensity) is not the same: first it grows, then it is maximum for 2 or 3 days, and then it gradually decreases.

Weight loss is mainly due to malnutrition of a premature baby in the first days of life, as well as large fluid losses through the lungs and skin. Recovery depends on whether the fetus was healthy at the time of birth or whether it had any disorders.

In a healthy premature baby, the rate of recovery of the initial weight depends on the degree of prematurity and the higher, the lower the weight was in the child at birth. But if the baby developed in utero with impaired maturation, then the recovery rate is difficult to predict.

As soon as the initial (at birth) body weight is gained, the body of a premature infant proceeds to the next stage: he needs to adapt to extrauterine life, and he begins to grow and gain weight with all his might.

Appearance

The appearance of such a child is very characteristic. The skin is reddish in color, the body retains the hairline, which covers the fetus in the womb. Large blood vessels show through very thin skin.

A premature newborn differs significantly from a full-term one in external signs, which are directly dependent on the time of intrauterine development of the baby. The smaller it is, the more pronounced these signs are.

First of all, a disproportionate physique is striking: a relatively large head and torso, short legs and neck, and a low navel. This is due to the fact that the growth rate of the limbs increases in the second half of pregnancy.

Many children have not quite normal facial features- the forehead is steep and high, unusually bulging eyes (these features may disappear with the age of children), sometimes strabismus can be observed.
Rib cage and the abdominal muscles of a premature baby are soft. Breathing is shallow, its rhythm is unstable. The ribs are perpendicular to the sternum. The little tummy is continually drawn in and out. When exhaling, the ribs and sternum sink. The nipples and areolas of the mammary glands are weakly expressed.

Bones excessively soft, flexible (they still have little calcium).

Nails thin and often may not reach the edge of the nail bed; with a significant degree of prematurity, underdevelopment of the nails is observed.

Boys testicles often not drooping and the scrotum does not have the uneven, folded appearance of a full-term baby; often there is an increase in the size of the scrotum (hydrocele) and inguinal-scrotal hernia.

When the baby cries, then swelling of the muscles appears in the umbilical ring.

Important feature of the skin premature babies - intensive development of lanugo - vellus hair - not only on the shoulders and back, like a full-term baby, but also on the cheeks and buttocks.

The skin is dry and thin. Despite the reduced elasticity, it can be considered tender. Appears wrinkled because it folds easily. Normally, the skin is red or bright pink, but very often it has an icteric or bluish tint. The subcutaneous fat layer is poorly developed, or almost completely absent.

In order to correctly assess the compliance of the child's maturity with the period of its intrauterine development (gestational age), in addition to morphological features, the state of its neuromuscular system is also taken into account.

Muscle tone a premature baby is noticeably reduced, therefore, at rest (in the supine position), his arms and legs are “sluggish”, only slightly bent at the joints and spread apart.

The longer the period of intrauterine life of the child, the better his legs are bent at the knee and hip joints.

A deeply premature baby in a normal position lies simply with outstretched arms and legs.

The sternum is an oblong flat bone that is located in the middle of the human chest and is connected to the ribs with the help of cartilage, forming the chest.

The state of systems and organs

In premature babies, violations are often recorded in several parameters at once, for example, in the state of muscle tone and innate reflexes, in skin color, heart rate, respiratory rate, etc. This is not surprising, since in the body of even an adult, all organs and physiological systems work closely together. Violations in the work of one of them cause changes in the functioning of the whole organism. Therefore, it would be unreasonable to expect that any organs or physiological systems of a premature baby will work “perfectly”.

Note that there are practically no premature newborns without disturbances in the activity of the nervous system. Differences can only be in the degree of pathology. The most commonly observed disorders caused by the immaturity of the central nervous system (CNS) are the absence of sucking and swallowing reflexes, as well as slow growth of masticatory muscles. Therefore, at first, these babies are fed through a tube, gradually transferring them to breastfeeding or feeding from a bottle or spoon. Premature babies usually swallow food poorly - they keep it in their mouth for a long time, as if remembering what to do with it next.

Such upsetting signs of prematurity for parents are clearly visible until about six months. Then, if the parents conducted a thorough maintenance therapy, "late" babies by the age of 1-1.5 years become practically indistinguishable from their peers born at term. But in severe advanced cases, some children up to two or three years old eat only liquid food. As a rule, they lag behind in development from their "full-term" peers in other ways - later they begin to walk, roll over, stand up, take a toy.

Violation of thermoregulation- a common phenomenon for premature babies, arising from the immaturity of the body as a whole and certain nerve regulatory centers in particular. This leads to the fact that the baby's body in the initial period of life is still quite poorly independently maintains normal body temperature. Without special external conditions, such a baby can quickly die from overheating or hypothermia.

innate reflexes in premature babies, as a rule, they are too weakly manifested or even absent. Naturally, conditioned reflexes in such babies will be developed much later than in full-term ones.

In the first days and weeks of life, the motor activity of a premature newborn is limited: drowsiness or severe lethargy follows occasional spontaneous movements.

Respiratory system

Your baby's lungs develop gradually, preparing for the first breath immediately after birth. Inside the mother, they still do not fully function.

If a child is born before this time, then the amount of matured surfactant is so small that it is not enough for the independent work of the lungs. The baby's breathing becomes difficult, he turns blue, suffocates. Therefore, the first thing such a child needs is a ventilator. Unfortunately, large doses of oxygen can "burn" the baby's lungs. Such a “burn” leads to bronchospasm, to hyper-production of mucus (bronchopulmonary dysplasia).

But the baby is alive! Of two evils, as they say ...

Parents of such children should remember that the baby’s bronchi after such a “burn” remain vulnerable and predisposed to spasm for a long time - even with a common cold, short-term respiratory arrest may occur. Therefore, you must warn the local doctor that the child was on machine breathing. Modern pharmaceuticals offer enough funds for the prevention and rapid removal of pulmonary spasms.

The cardiovascular system

After birth, the baby undergoes a restructuring of the circulatory system - the blood flow stops its course through the placenta, the heart becomes four-chambered (in the fetus it is three-chambered), the large and small circles of blood circulation are included in the work; the baby's cardiovascular system begins its extrauterine life. In a child born prematurely, such a restructuring occurs much more slowly.

The baby's heart is relatively large - about 0.8% of body weight (in adults 0.4-0.5%); its shape is close to spherical.

The volume of a child's heart relative to the volume of his chest is much larger than that of an adult. Later, until adolescence, the heart will move and rotate in the chest; its mass will begin to increase; the form and device will also undergo changes.

The heart muscle (myocardium) of a premature infant is characterized by too thin muscle fibers and insufficient development of connective tissue.

The pulse is weak, but frequent - from 90 to 160 beats per minute; with crying and states of anxiety, anxiety and discomfort, it can reach 200 beats per minute or more.

Premature newborns are more likely to have a heart murmur. They can occur for various reasons: either as a result of premature restructuring of the physiology of the cardiovascular system, excessive load on it, or due to other disorders of varying severity. Heart murmurs require detailed examination.

Without exception, all tests and procedures must be agreed with the cardiologist observing the baby. Violations in the activity of the cardiovascular system are very insidious and can be "masked", that is, not manifested by any symptoms that are noticeable to parents.

Parents of a premature baby need to regularly monitor the state of his blood: red blood cells, hemoglobin, hematocrit.

The body of a premature baby is fighting with all its might to save life, so the child has the best blood supply to the brain and liver, and his arms, legs, etc. are provided with much less blood. As the baby matures and develops, the blood supply to all organs and tissues gradually increases.

Vessel walls of the brain of a premature baby have increased permeability, as a result of which not only cerebrovascular accidents are possible, but also local hemorrhages.

Digestive system

The functional maturity of individual organs and the entire digestive system as a whole depends very much on the degree of prematurity of the newborn. At the same time, its work is largely related to the state and activity of other body systems.

For example, the immaturity of the child's central nervous system leads to a significant "unreadiness" of its nerve centers to "lead" the regulation of digestion and sucking-swallowing reflexes. Therefore, despite the fact that the digestive juices may contain all the necessary enzymes for the digestion of mother's milk, their activity can be very low.

Although the production of saliva is already in the first feeding, the salivary glands are poorly developed, the volume of saliva is small. Therefore, in the digestion of a premature infant, the role of saliva is very insignificant.

Esophagus short in premature babies. Its contractile function may be practically absent, or be poorly developed.

Stomach in a premature newborn, it is round and small - from 10 to 30 ml. Different parts of the stomach are underdeveloped. The production of gastric juice and its enzymatic activity is reduced. Peristalsis is weakly expressed, and motor activity is characterized by a too low rhythm. All this is the cause of abundant regurgitation of food.

Pancreas in premature babies, it functions, although there are very few enzymes in the cells of its tissues.

Liver fetus and newborn - one of the main organs of his life support.

Liver weight at birth can be up to 4.4% of the baby's body weight. In a premature baby, the immune and hematopoietic functions of the liver are especially active; less mature are the functions of "binding" bilirubin (during the breakdown of fetal hemoglobin) and antitoxic (protective). The maturation of all other functions occurs gradually with the growth and development of the entire body of the baby.

General intestine length can be 3.3-3.6 m. Usually, in such babies, the muscle and elastic tissues in the intestines are not sufficiently formed.

For newborns, first of all, you need a full-fledged proper nutrition, corresponding to the degree of its prematurity. It is it that is able to support the favorable course of all metabolic processes, “improve” the intestinal microflora and thereby create conditions for the successful development of the child.

Sufficient and reasonably balanced nutrition, as a rule, helps to increase the vitality of a premature baby, improves the condition of his blood, immune, bone and other systems. This ensures the gradual growth and development of his entire body.

excretory system

In premature babies, the organs of the excretory system are also functionally immature.

The kidneys are the main organ of the excretory system. They begin to form from the third week of fetal development and begin to function normally as early as the ninth week. It has been established that in the first few days of life in premature babies, the kidneys work more intensively than in full-term babies. At the same time, they remove more fluid from the body. A number of features of the kidneys in premature babies are noted: low concentration ability, low filtration level, reduced filtration of phosphates, etc. Urine is weakly concentrated, and the frequency of urination is higher than in full-term children (due to the high rate of metabolic processes in the body).

Skeletal system and joints

One of the severe consequences of improper care of the baby with the immaturity of his musculoskeletal system can be a dislocation of the hip joints. Consultation with an orthopedist is mandatory for all newborns, __but for small premature babies, it is especially relevant.

Features of the immune system

In newborns, mainly innate and passive acquired immunity works (the child is partially protected only from those infections that the mother encountered during pregnancy).
A premature baby in this situation is especially difficult. The most dangerous time for him is the first 20 days of life, when resistance to infections is very limited.

Care

Obstetric care for premature babies is a complex art, with great risks. They take such a child in heated sterile diapers, covering them with a blanket. Then they are transferred to a warmed changing table, under the rays of an electric reflector. The baby's legs (and with a very small weight, and the head) are wrapped with cotton wool. After that, the baby is placed in a separate, specially equipped children's ward.

Children with very low weight are placed in incubators - containers with automatic oxygen supply and maintaining optimal temperature and humidity. The simplest of them look like a double-walled tub, open at the top. Hot water circulates between the walls (50-60 °C).

The duration of stay in the incubator is determined individually and depends on the weight and general condition of the child. On average, it is from 2-4 to 8-14 days.

The air temperature in the ward for premature babies should be high enough: 22-24 ° C, and even higher in the baby's crib: 26-30 "C. For control, a thermometer is placed next to the baby (over the blanket).

Since the immunity of premature babies is very weak, special attention is paid to the prevention and prevention of infectious diseases in the department where they are. Careful sterilization of linen, personal hygiene of personnel (work in masks, gloves, etc.) and the mother - all this must be strictly observed.

A premature baby really needs the feeling of "mother is nearby." In many maternity hospitals, the "kangaroo method" is now practiced - the baby is placed on the mother's stomach for several minutes, and then placed again in the incubator. With a regular communication procedure, the baby's breathing and pulse improve.

Premature babies require special care because:

• vellus hair prevents normal sweating, so it is necessary to maintain constant air humidity;
• the air must be saturated with oxygen because the capacity of the lungs is insufficient;
• it is necessary to maintain a constant air temperature (36 ° C), since there is no self-regulation of body temperature;
• the muscular system is underdeveloped (flaccid muscles);
• the walls of the blood vessels are weak, there are not enough red cells in the blood, in addition, poor blood clotting;
• low resistance to infectious diseases;
• immature nervous system. The development of the brain requires stimulation of the sense organs. Despite the prematurity, he already has them. In particular, the child reacts to sounds. Therefore, it is very important to treat him as a full-term baby, while showing increased attention. To bridge the gap between the day of birth and the day of discharge of the child, the earliest possible contact of the child with the parents is necessary. It is desirable for the father to come to the maternity hospital to the child every day, as well as for the mother after discharge.

A premature baby is bottle-fed from the first day of birth. However, his stomach has too little capacity, from 5 to 6 cm3, sucking and swallowing reflexes are still poorly developed. Therefore, he is fed with milk mixtures through a tube passing into the stomach through the nasal opening. In addition, glucose is administered to the child through the head vein. When the reflexes reach the required level of development, it is transferred to breastfeeding through the nipple. The mother expresses milk at home and brings it to the hospital. Mother's milk is vital for a premature baby. In addition, it helps to establish a kind of emotional connection between mother and child. If the mother does not have milk, it is delivered from the lactaria (an institution that collects and preserves women's milk for feeding newborns).

As soon as this becomes possible, the child is transferred from the incubator for severely premature babies to a simpler device - an incubator. Parents are given a child who has gained weight of at least 2.5 kg.

Most premature newborns who were born at 26 weeks or less need special care. In order to avoid the development of such severe postpartum complications as hearing loss, dementia, and others, immediately after birth, the child is placed in the neonatal intensive care unit, where he is in a special incubator. The incubator is a plastic box made of polymer plastic, in which a constant, most acceptable air temperature for the baby (22-25 ° C) is maintained. The constancy of the ambient temperature contributes to the preservation of fluid, in addition, incubators prevent the penetration of infectious agents to a child with an absolutely weak immune system.

In addition to the special temperature regime, children born prematurely need special nutrition, since the digestive system has not matured, and the sucking and swallowing reflexes have not developed. For this purpose, through-tube or intravenous nutrition of the child is carried out until the moment of development of the main reflexes of the newborn. Sometimes (when the baby is born from 28 to 35 weeks), you can feed the baby through a tube, but with breast milk, which will significantly accelerate the growth and development of the baby, and also protect him from infectious diseases.

Maintaining the temperature regime at home is achieved by regular (every 2-3 hours) ventilation of the children's room, where the air temperature should not be lower than 22 ° C. Next to the child (in his crib), the air temperature should not be lower than 28 ° C, which is achieved by wrapping the child with heating pads filled with water (water temperature 60-65 ° C), especially in the winter season. Heating pads are placed at the feet and sides of the child, and a thermometer can be placed in the crib to regularly monitor the temperature. Warmers must be wrapped in a soft-touch cloth and placed at a distance of the palm from the child. The change of heating pads must be carried out every 2 hours, in turn. In no case should the child's face be covered with a blanket, it should always be open. It is also strictly forbidden to put heating pads under the child (to avoid burns) and put them on top, as this greatly complicates breathing and interferes with chest excursions.

Bathing premature babies

In the event that a child was born with a body weight of less than 2 kg, it is necessary to refuse bathing for at least a week and a half. 10-12 days after the birth of the child, they begin to bathe in boiled water (water temperature is about 38 ° C).

Features of caring for a premature baby at home

It is necessary to reduce the number of contacts of the child with strangers, since with frequent visits the child may become infected with an infectious disease or SARS, which will adversely affect his health. It is advisable not to give a premature newborn to a nursery during the first year of life and to refrain from walking, especially in winter, until the age of three months.

A premature baby needs more frequent feeding, as his body must grow several times faster in order to catch up with his peers. The interval between feedings should not be more than 4 hours, otherwise dehydration may develop. You need to feed the child at least 8-10 times a day, slowly, making sure that he does not spit up (because if the child spit up often and profusely, it will be difficult for him to gain the necessary body weight). Premature babies need more sleep than term babies. The child should sleep not on a soft, but on a hard mattress in the supine position, since when positioned on the stomach, sudden death in sleep due to difficulty in breathing can occur.

At home, child care is provided in a very heated room (25-30 °C), depending on the doctor's instructions, with a humidity of 60%. Humidity is necessary so that the mucous membranes of the child do not dry out and to facilitate breathing. The necessary humidity is achieved by hanging wet towels and diapers in the room. Buckets, basins and large pots of water specially placed on the floor in the corners of the room will also help. Evaporating from them, the water will sufficiently humidify the air.

A warm crib for a baby at home can be made by putting duvet covers and warm blankets on top and bottom of the baby, and heating pads with hot water on the sides and legs. Wrap them in several diapers or a large piece of flannel. This is necessary in order not to burn the baby. You can make heating pads from hermetically sealed water bottles. The water temperature should be 50 °C. Water must be changed every hour around the clock so that it does not have time to cool. Bottles should also be wrapped in flannel and the corks should be tightly closed. Otherwise, you can scald the child. Do not place the baby's crib near a window or open it when the baby is in the room. If the room maintains the required temperature and humidity, you can do without heating pads and bottles.

Previously, premature babies immediately after birth, having been wiped with warm oil, were wrapped in several strips of cotton wool. Each limb of the baby was also wrapped in cotton wool to avoid heat loss. If necessary, the contaminated cotton wool could be changed without fully opening the baby. A separate strip of cotton is applied to the anus and urethra to make it easy to change. From above, a shirt and a woolen blouse were put on the child. The head is also wrapped in cotton wool and a woolen cap lined with cotton fabric was put on top. Sometimes they put on 2 bonnets, and the bottom one was cotton, not woolen, as wool irritates the skin.

As a rule, when a baby gains weight in 2000, you will be discharged home. This will be reported to the children's polyclinic for urgent patronage. The local doctor and nurse will take the baby under their control and teach you how to care for him.

Premature babies must be protected from painful stimuli, including injections of drugs and blood sampling - these procedures must be strictly justified.

To maintain body temperature a premature baby at home, you can use ordinary heating pads with a water temperature of 60-65 ° C. Wrapping them in diapers or towels, wrap them around the baby on the sides and at the feet, but not close to his body - the distance between the heating pads and the child's body should be 7-8 cm. Cover the baby with a blanket from above.

Heating pads must be changed approximately every 1.5-2 hours, maintaining the temperature under the blanket within 26-30 "C

When you swaddle your baby, iron the diapers first to keep them warm. The room temperature should be maintained at 22-24 °C.
For signs of overheating(frequent breathing, fever, reddening of the skin) you need to take the baby out of the crib, untie it, give it water or breast milk. You can bathe the baby in the bath for 5-7 minutes at a temperature of 37 ° C.

When the child is cold(cold, pale, even bluish skin; lethargy) it is best to warm it with your body, Press the naked baby to your chest, turning it with different sides. Say something nice to him. You can warm the baby in the bath at a water temperature of 38-39 ° C for 5-7 minutes. Then swaddle him in warm diapers, put him in a crib and cover him with heating pads.

About strict feeding mode premature babies need not be said - they need to be fed as many times as they wish. Everyone knows that it is best to feed premature babies with mother's milk. The milk of a woman who gave birth prematurely is characterized by a high protein content and a reduced fat content. And this is exactly what a premature baby needs: his body still cannot cope with the complete breakdown and absorption of dietary fats, but he needs a lot of “building material” - protein. But if your mother does not have enough milk, the doctor will prescribe food for you.

Daily toileting for a premature baby, including bathing, is very different from toileting and bathing a full-term baby. It is enough to carry out regular wiping and washing. Babies with a birth weight of 1500 g or more should begin to bathe after 7-10 days. While bathing, carefully protect the baby from cooling. Gradually, toilet procedures become the same as in normal (full-term) children.

For walks premature babies are taught gradually.

In winter, it is advisable to start walking if the air temperature is not lower than minus 8 ° C and if the weight of the baby is not less than 3000 g. The duration of the walk at first is 10-15 minutes.

If during a walk the child begins to behave uneasily, you must immediately return home and find out the reason. Most often, the baby is overheated.

Medical incubator (kuvez)

An incubator is an apparatus that holds premature or low birth weight babies until they are old enough and gain weight to live with their parents and be fed normally from breast or bottle.

The device has the appearance of a large transparent box made of plexiglass, which allows you to maintain the baby's temperature and monitor him. The air is heated depending on the needs of the newborn (mostly the temperature is 30 ° C), the air is also humidified. The baby's temperature is taken with a thermal catheter attached to the baby's skin.

If the baby was born prematurely, it is placed in an incubator, as it is highly susceptible to infections. His breathing and digestion, as well as the regulation of temperature, cannot yet function normally. This explains the need for a forced supply of oxygen, feeding through a dropper, as well as the use of phototherapy (direct blue light to the child to destroy bilirubin, which provokes Botkin's disease in the newborn).

Feeding in the hospital

Babies with an initial weight of about 1500 g at first most often have to be fed from a bottle or even through a tube. Children weighing less than 1 kg are fed only through a tube.

Those babies with an initial weight of 2 kg or more usually take the mother's breast well, actively suck and even suck out the required amount of milk.

Tips for moms:

• Start expressing milk as early as possible, even if your baby is not breastfeeding yet. Pump every 2-3 hours, preferably even at night. However, you should not wake up specifically for this - you must rest and gain strength;
• if you can’t express enough milk with your hands, then try to find a comfortable breast pump;
• milk that you have expressed can be frozen for later use. Write the date of pumping on the bottle.

Massage and gymnastics for premature babies

Nature takes care of its children: it gave newborns enormous potential for the restoration of damaged or delayed in their development of organs and systems. And if, in addition, you begin to stimulate natural abilities with various developmental and strengthening activities, then you will undoubtedly achieve good results.

Basic requirements for massage and gymnastics

The methodology for conducting massage and gymnastics with premature babies is carried out taking into account their physiological characteristics. It is better to have your baby massaged by a specialist. If this is not possible, you can learn massage techniques and do it yourself, but at the initial stage, always under the supervision of a doctor!

So, stick to the following rules:

• if possible, exclude loud music, conversations of strangers and other distractions in the study room;
• focus all your attention on the child, talking calmly with him and encouraging the correct implementation of the exercises with a smile and affectionate words;
• the duration of the first lessons should be no more than 5-6 minutes, while only breathing and simple reflex exercises are performed, alternating them. Each exercise is repeated 3-4 times;
• start classes with breathing exercises (see below), repeating them several times during the entire procedure;
• gradually (as the child masters these exercises), introduce strokes;
• gymnastics with children who have a birth weight of 1700 g or more, spend from one and a half months, and less than 1700 g a month later. Exercises during this period mainly consist of passive movements (that is, they are performed not by the child himself, but by the parent, bending and unbending the baby's limbs);
• precede each gymnastic exercise with a massage of the corresponding part of the body;
• do not undress the child completely during the first lessons. When performing exercises for the muscles of the arms, cover the lower half of the baby's body with a diaper, and do not remove the vest when doing gymnastics for the legs; if you notice that your baby quickly gets tired or cools down, do a set of exercises in two stages (for example, two breathing exercises at the beginning and at the end and one reflex between them; the next time the baby is awake, do other exercises from the complex);
• start classes no earlier than 45-60 minutes after feeding, and preferably half an hour before it; before a night's sleep - we think you will agree - massage and gymnastics are simply not recommended: it would be to lull, not to invigorate!
• to really help the baby overcome the lag in physical development, do not just do it daily, but repeat the whole set of exercises 2-3 times a day for 5-6 minutes, and in some cases more often (up to 4-6 times).

Caring for a premature baby

Remember: no one is to blame for the fact that your baby was born prematurely. Neither you nor your loved ones. Therefore, it would be fundamentally wrong to reproach each other for any shortcomings. Keep in mind - the past is gone. From this moment on, only you, your family, and your child exist. He especially needs your love and help. Do not give in to despondency, fears and doubts, believe in yourself and in your child, carefully follow the doctor's instructions and carefully monitor your baby. Only your love and patience can help him now!

Therefore, start communicating with the child from the very birth. Doctors usually limit visits because a premature baby needs rest and sleep, but you can watch him through the glass wall of the room. Observe the facial expressions of the newborn. As soon as the doctor allows you, swaddle and feed the baby, put on socks to keep him warm (if they are too big, attach them with a band-aid). Even the smallest and weakest babies see and hear much more than we imagine. They react to the sound of the voice, intonation, touch, even if they do not show it outwardly. No matter how strange it may seem to you, talk to the child (you already did this during pregnancy), sing to him or let's listen to music, stroke his hands and feet. Up to 3-5 weeks, the child may be outwardly indifferent to such communication, but do not be alarmed - he is simply accumulating impressions and is still too weak to actively respond physically. Put a beautiful bright rattle next to the baby. This will help him quickly begin to distinguish colors, pitch and timbre of sound. Vivid impressions stimulate the active psycho-emotional development of the child.

It is not necessary, coming to the child, to abuse decorative cosmetics and perfumes, especially to smoke.

At the very first responses of the baby to your communication with him (revival, eye contact, smile), let him feel with words and touch that you are pleased and you love him. It would be useful to keep a diary about the child's behavior (early development diary). It is interesting and useful not only as a family heirloom, but also in order to introduce other family members to the baby in advance, to prepare them for the peculiarities of its development. Moreover, this diary provides an opportunity for specialists to help you and your child if he subsequently has any difficulties with health or adaptation. You can take photos and videos of your baby (no flash!). Keep in mind that the development process is always individual. Before asking if your child is normally developed, compare his state of health and character traits with this. For some, it’s normal to read at the age of 3, for some it’s easier to run fast and jump high, and about the third parents say: “If only you were healthy!”. And let him study rather weakly, but he is kind and accommodating. It is true what they say that there are no children without talent. Therefore, observe the abilities of your child, discover his (and only him!) Talents and develop them.

The main signs and features of the development of premature babies

If a baby is born between 28 and 37 weeks of gestation, it is considered premature. As a rule, body weight is from 1 to 2.5 kg, and height is from 34 to 45 cm. However, the main sign of prematurity is precisely the date of birth of the child, since children born at term may also have a small body weight ( for example, children born from twins, or in the presence of any intrauterine disease, smoking, alcoholism of a pregnant woman, etc.) - in this case, they speak of intrauterine growth retardation, and not prematurity.

The main signs of prematurity are:

1. poor development of subcutaneous adipose tissue (it is practically absent both due to the reduced nutrition of the child and due to underdevelopment);
2. the ratio of the child's body weight to his height is reduced to 30-50, while the norm is 60-80;
3. violation of the proportionality of the body: the legs, as a rule, are short, and the conditional line dividing the child's body in half is located above the navel (at the norm - at the level of the navel);
4. the cartilages of the auricles are not sufficiently developed, which is why the ears are easily wrapped and tightly pressed to the head;
5. in girls, the labia minora does not completely close the entrance to the vagina, the genital slit is open, and the clitoris is on the surface (sometimes its relative hypertrophy is observed - an increase), and in boys, the testicles do not have time to descend into the scrotum;
6. normally, vellus hair is preserved only on the shoulders and back, and in children born before term, they cover the entire body (handles, face, legs);
7. the size of the brain region of the skull significantly exceeds the size of the facial region, which is why the fontanelles are greatly enlarged, and the sutures between the cranial bones are wide. Quite often there is an opening of a small fontanelle. By the third month of a child's life, a sharp increase in the parietal tubercles becomes quite noticeable.

Features of the development of internal organs and functional systems of premature babies

Along with the underdevelopment of all vital organs and systems, the inferiority of the child's nervous system (both central and peripheral) attracts the most attention. The nervous system is weak, the reaction to the action of external stimuli is slowed down. Physiological reflexes quickly fade away (if a child was born between 28 and 30 weeks, then, as a rule, the sucking and swallowing reflexes are not yet developed, which causes great difficulties in feeding the child), the regulation of own body temperature (autothermoregulation) is disturbed, therefore, premature babies often freeze quickly at low temperatures and overheat at high temperatures. In addition, in premature babies, sweating is impaired (which is also a component of the regulation of the temperature of the internal environment of the body). There is a sharp decrease in muscle tone (children are inactive, their movements are chaotic, slight trembling of the hands and clonic spasms of the feet may be observed).

The respiratory system of children born prematurely is also underdeveloped. The immaturity of the respiratory system is a very good background for the development of various infectious diseases, both the upper respiratory tract and pneumonia. The diaphragm is located above the normal level, the chest is quite pliable, and the ribs are at right angles to the sternum. Due to the anatomical features in such children, shallow breathing is observed with a frequency of 45-50 breaths per minute, breathing is irregular, the volume of inhaled air is reduced, and periods of respiratory arrest are observed.

Unlike other body systems, the cardiovascular system is quite well developed, since its formation and development occur not in the last, but in the first trimester of pregnancy. Premature babies have a frequent pulse of weak filling, muffled heart tones, a third tone is heard, blood pressure is reduced (up to 50-80 and 30-35 mm Hg), the heart rate is about 120 per minute. The electrocardiogram is also characterized by a number of features.

In second place after the nervous system in terms of underdevelopment is the digestive system, since there is an underdevelopment of all its departments. The stomach of premature babies has a small volume, is located almost vertically. The sphincter (obturator sphincter) between the esophagus and the stomach is poorly developed, which is why regurgitation is often observed. The mucous membrane of the upper parts of the digestive tract is very well supplied with blood, it is thin and pliable (there is a high risk of injury by foreign objects when swallowed). All digestive enzymes (both the stomach, pancreas, and bile acids) are produced in insufficient quantities, which significantly slows down the processes of digestion of foods and the absorption of nutrients. Diarrhea, flatulence, and disruption of the intestinal microflora (dysbacteriosis) often develop.

The underdevelopment of the endocrine system of a child is most often associated with a violation of the connection between the pituitary gland, thyroid gland and adrenal glands, since the mechanisms of direct and feedback are not strong enough. Quite often, hypothyroidism develops, since the immature thyroid gland is not able to fully perform its basic functions. In most cases, hypothyroidism resolves as soon as the child catches up with their peers in development. Due to the immaturity of the adrenal glands, they are very quickly depleted (rarely this process is irreversible, malignant). There is a relative insufficiency of the sex glands.

Premature babies are prone to the formation of edema and slight pastosity of tissues, since there is an underdevelopment of the systems that control water-salt metabolism, but this condition is reversible. In addition to edema, the opposite condition is less often observed - dehydration of the body due to the excretion of a large amount of fluid (combined with polyuria - frequent and profuse urination).

Due to metabolic disorders, an increase in the amount of bilirubin in the blood and a decrease in the concentration of glucose are often observed. Due to the underdevelopment of the kidneys, their concentration ability is sharply reduced, as a result of which a large amount of residual nitrogen is found in the blood, and urine is of low concentration.

The most accelerated rates of growth and development of premature babies are observed at the age of 3-5 months (in full-term babies 1-2 months) and by the year. As a rule, the body weight of the child increases by 7-8 times, and the average height at the age of 1 year is approximately 75 cm.

Starting from the age of the child from 3 to 4 weeks, it is recommended to lay him on his stomach, as this helps to strengthen the muscles of the neck, shoulder girdle and back (for 2-3 minutes 2-3 times a day). Patting and stroking the child, elementary massage and gymnastics are also recommended. Starting from the age of six months, the exercises need to be complicated - squatting, turning from the tummy to the back and vice versa, crawling, etc.

The mental development of premature babies also has a number of characteristic features. A little later, children begin to speak simplified words (“give”, “bi-bi”, “bow-wow”, etc.), they do not remember new words and names well. However, by one year the mental development of the child reaches the proper level.

How should a premature baby be born?

If preterm labor is still complicating your pregnancy, your doctor should answer the following questions:

First, where is your child safer - inside you or outside?

Second, if the answer is outside, is it better for your baby to be delivered vaginally or by caesarean?

If your case of preterm birth is simple, then these questions will not be difficult to answer, but it can also be difficult, so your doctor should answer these questions as soon as possible. Usually the answer to the first question is "outside" if the cause of preterm labor is known - rupture, infection, etc. These are only premature births that formally occur for an unknown reason, respond well to tocolytics and other measures to combat them, because all other causes that can really prevent the continuation of pregnancy have already been excluded.

If your baby is safer on the inside, then full speed ahead to treatment to "beat back" the birth. If the baby is better outside, your doctor will see if you have enough time for the steroids to work - this usually happens within 24 hours. If so, he will pull for as long as it takes to get the maximum benefit from their application, all the while closely watching the child. If there is no time left for steroids, and the birth must be carried out immediately as an emergency measure, then the fastest route should be chosen. In an unstable situation, transfer or caesarean section if things are getting worse and worse, such as bleeding. If your condition is stable, you can try to give birth vaginally by induction.

Feeding premature babies

If a woman gives birth prematurely, her milk is different from normal. For several weeks on end, it contains more fat, calcium, sodium and other nutrients than others. This milk is specially adapted to the needs of the prematurely born baby.

It is wise to start expressing milk a few hours after giving birth, as soon as you are physically able to do so. It is better to express it several times a day (from six to eight), but in smaller portions. After a few days, you will most likely even have too much milk, because premature babies suckle very little. Excess milk can be frozen and stored for the future.

In the past, premature babies were not allowed to breastfeed until they were comfortable drinking from a bottle. We now know that this was a mistake. Breastfeeding is much easier than a bottle, and when a premature baby is breastfeeding, their heart rate, breathing, and blood oxygen levels become closer to normal, so it is best to start breastfeeding such babies as early as possible. In many hospitals (I hope one day they will start doing this everywhere) the “kangaroo method” is practiced: the baby is taken out of the incubator and put to the mother - skin on skin. This method has been successfully used even with babies born before the 26th week and weighing less than 600 grams. By skin contact with the mother, premature babies become warmer, breathe easier, gain weight faster, are less susceptible to infections, and their psychomotor development is better. Mothers feel much more confident and have more milk.

If this is not practiced in your hospital, insist on it and convey the necessary information to the staff. Set achievable, short-term goals: "I'm not suggesting that all premature babies start nursing in a new way, just let me hold my baby for a couple of hours today."

In Germany, Dr. Sontheimer and colleagues have managed, by placing premature babies skin on mother's skin, to transport them over distances of up to four hundred kilometers without the use of incubators - with excellent results. One of the advantages of this method of transportation is that mothers can travel with their babies: otherwise, too often they had to stay alone somewhere in a rural hospital and worry about how her sick baby would get to a hospital in a large city.

Premature babies are those born as a result of premature birth with a weight of less than 2500 grams and a height of less than 45 cm. These criteria are conditional, since many full-term babies are born weighing less than 2500 grams, and some premature babies weigh more than 2500 grams. The main feature of premature babies is the immaturity of the main body systems - respiratory, cardiovascular and thermoregulatory. Premature babies require special care and medical supervision. Newborns with low body weight, born at term, are considered children with intrauterine growth retardation.

How long is it possible to leave a newborn baby?

According to the WHO definition, children born not earlier than 22 weeks of gestation and weighing more than 500 g are considered potentially viable. Nursing of very premature babies is possible only in specialized departments of hospitals or perinatal centers. The longer the gestational age at the time of the onset of preterm birth, the lower the risk to the baby. Babies born between 32 and 37 weeks of gestation have significantly fewer problems than premature babies born between 22 and 32 weeks of gestation. The doctor takes into account the weight of the child when deciding whether to place the child in an incubator, prescribe phototherapy, when choosing the type of feeding of a premature baby, and in other cases.

What does a premature baby look like?

As a rule, his head is disproportionately large compared to his body. The skin is very thin, sometimes even translucent, softer to the touch than usual, covered with fluff and grease. The subcutaneous fat layer is insignificant or absent, the skin is wrinkled. Small and large fontanelles are larger than usual. The nails are very thin and often do not reach the fingertips. In boys, the testicles may not descend into the scrotum, and in girls, the labia may be underdeveloped. The limbs are thinner and longer, the auricles are soft and pressed against the skull, the navel is low.

What is the immaturity of a premature baby?

In premature babies, the main reflexes are usually mild, and in some cases absent. Muscle tone is reduced, the thermoregulation system is undeveloped, so the newborn cannot independently maintain a constant body temperature. Other systems of the body can also be immature - respiratory, digestive, cardiovascular, visual, nervous, bone. In the absence of vital reflexes (breathing or swallowing), the child is placed in the intensive care unit or intensive care unit.

Why is a child placed in an incubator?

The incubator is an apparatus with transparent walls that allow you to observe the child, and an optimal artificial microclimate (temperature - 33-38º, humidity - 85-100%, oxygen content - 25-40%). To care for a child inside the incubator, a special hole or special sleeves are provided. Premature babies are placed in the incubator for warming and further protection from body cooling, as well as to improve blood oxygen saturation. Oxygen, if necessary, can be supplied uninterruptedly. It should be remembered about the danger of toxic effects of oxygen on the retina of the eye, which can lead to complete loss of vision, especially in very premature babies with prolonged keeping in an incubator with oxygen supply (with timely diagnosis and treatment, this situation is reversible).

What is kangaroo nursing?

How long does a premature baby need to stay in the hospital?

In order to maintain a constant normal body temperature, premature babies need help. Being in an incubator allows the child not to waste energy on thermoregulation, adapt faster and gain weight. The duration of the child's stay in the "incubator" depends on the weight of the child at birth and the general dynamics of his condition. Children with a small degree of prematurity can be in an incubator from several hours to 4 days, children weighing up to 1750 gr. - about a week, and with a weight of up to 1500 gr. - from a week to two. Typically, a child is discharged from a maternity hospital or a specialized children's hospital when he is gaining weight steadily, maintains a constant body temperature, has no breathing problems, and weighs 2500 grams or more.

Will a premature baby subsequently be different from their full-term peers?

In premature babies, the pace of physical development is accelerated, and the less their body weight was at birth, the faster it will increase. The neuropsychic development of such children is somewhat slower than usual, premature babies need more attention, special classes (massage, gymnastics). At first, when assessing the psychomotor development of a premature baby, it is necessary to focus on the period in which he should have been born, and count all the milestones from this moment. For example, if a child was born at 32 weeks, that is, 2 months ahead of schedule, you should expect him to start turning not at 3.5-4 months after birth, but at 5.5-6. On average, by the age of one and a half to two years, a healthy premature baby is practically no different from full-term peers.

Is it true that premature babies are more prone to illness?

On average, premature babies get sick more often than normal babies, and the recovery process takes longer. Premature babies are more susceptible to respiratory diseases (bronchitis, pneumonia). Jaundice, common in newborns, can be a serious danger for premature babies. Also, premature babies often have problems with the development of the central nervous system, the gastrointestinal tract, and the skeletal system and joints may suffer.

Today, premature births are common. In most developed countries, this indicator is relatively stable and amounts to 5-10% of the total number of children born.

The prognosis for life in premature babies depends on many factors. First of all, from the gestational age and birth weight. In the case of the birth of a child in the period of 22-23 weeks, the prognosis depends on the intensity and quality of therapy.

Long-term consequences of prematurity (the likelihood of these complications again depends on many factors; under other favorable conditions, these complications are quite rare). Among premature babies, the risk of mental and physical disability is higher than among full-term babies.

The concept of prematurity.

A premature baby is a baby born before the end of the normal gestational age.

Usually, it is customary to refer to premature babies whose birth weight is less than 2500 g. However, the definition of prematurity only by birth weight does not always correspond to reality. Many children born prematurely have a body weight of more than 2500 g. This is more often observed in newborns whose mothers have diabetes.

At the same time, among full-term infants born at 38-40 weeks of gestation, there are children whose birth weight is less than 2000 g and even 1500 g. These are primarily children with congenital malformations and intrauterine diseases, as well as from multiple pregnancies and sick mothers. Therefore, it is more correct to consider the duration of pregnancy as the main criterion for determining prematurity. On average, as you know, a normal pregnancy lasts 270-280 days, or 38-40 weeks. Its duration is usually calculated from the first day after the last menstruation until the onset of childbirth.

A baby born before 38 weeks of gestation is considered premature. According to the International Nomenclature (Geneva, 1957), children with a birth weight of more than 2500 g are diagnosed with prematurity if they were born before 37 weeks.

Babies born at 38 weeks' gestation or more, regardless of birth weight (more or less than 2500 g), are full-term. In controversial cases, the issue of full-term is decided on the basis of a combination of signs: gestational age, body weight and height of the child at birth.

Childbirth before 28 weeks of gestation is considered a miscarriage, and a newborn with birth weight less than 1000 g (from 500 to 999 g) is considered a fetus. The concept of "fetus" persists until the 7th day of life.

The degree of prematurity of children (intrauterine malnutrition)

The degree of intrauterine malnutrition is determined by the lack of body weight. For normal body weight, we conditionally accept the lower limit of the limit corresponding to the given gestational age indicated above. The ratio of body weight deficit to the minimum body weight for this gestational age in percent shows the degree of intrauterine malnutrition.

We single out 4 degrees of intrauterine malnutrition: with I, the body weight deficit is 10% or less; with II - from 10.1 to 20%; with III - from 20.1 to 30% and with IV - over 30%. Here are some examples:

1. A child weighing 1850 g was born at 35 weeks. The mass deficit is (2000-1850): 2000 X 100=7.5%. Diagnosis: prematurity of the 1st degree, intrauterine malnutrition of the 1st degree.
2. A child weighing 1200 g was born at 31 weeks. The mass deficit is (1400-1200): 1400 X 100 = 14.3%. Diagnosis: prematurity III degree, intrauterine malnutrition II degree.
3. A child weighing 1700 g was born at 37 weeks. The mass deficit is (2300-1700): 2300 X 100 = 26%. Diagnosis: prematurity of the 1st degree, intrauterine malnutrition of the 3rd degree.
4. A child weighing 1250 g was born at 34 weeks. The mass deficit is (1800-1250): 1800 X 100 = 30.5%. Diagnosis: prematurity II degree, intrauterine malnutrition IV degree.

Features of premature babies

The appearance of premature babies has distinctive features that are directly dependent on the gestational age. The lower the gestational age, the more such signs and the more pronounced they are. Some of them can be used as additional tests to estimate gestational age.

1. Small sizes. Low growth and reduced nutrition are characteristic of all premature infants, with the exception of children born weighing over 2500 g. corresponds to the length of the body, they just look petite. The presence of wrinkled, flabby skin at birth is typical for children with intrauterine malnutrition, and later observed in premature patients who, for various reasons, gave a large weight loss or have a flat weight curve.
2. Disproportionate physique. A premature baby has a relatively large head and torso, short neck and legs, and a low navel. These features are partly due to the fact that the growth rate of the lower extremities increases in the second half of pregnancy.
3. Severe hyperemia of the skin. More characteristic of fruits.
4. Expressed lanugo. Small premature babies have soft fluffy hair not only on the shoulders and back, but abundantly cover the forehead, cheeks, thighs and buttocks.
5. Gaping of the genital slit. In girls, due to the underdevelopment of the labia majora, the genital gap gapes and the clitoris is clearly visible.
6. Empty scrotum. The process of lowering the testicles into the scrotum occurs in the 7th month of uterine life. However, for various reasons, it may be delayed. In very premature boys, the testicles are often not descended into the scrotum and are located in the inguinal canals or in the abdominal cavity. Their presence in the scrotum indicates that the gestational age of the child exceeds 28 weeks.
7. Underdevelopment of fingernails. By the time of birth, the nails, even in the smallest children, are quite well formed and completely cover the nail bed, but often do not reach the fingertips. The latter is used as a test to assess the degree of nail development. According to foreign authors, the nails reach the fingertips at 32-35 weeks of gestation, and at more than 35 weeks they protrude beyond their edges. According to our observations, the nails can reach the tips of the fingers as early as the 28th week. Assessment is carried out in the first 5 days of life.
8. Soft ear shells. Due to the underdevelopment of cartilage tissue in small children, the auricles often tuck inward and stick together.
9. The predominance of the brain skull over the facial.
10. The small spring is always open.
11. Underdevelopment of the mammary glands. Premature babies do not have physiological breast engorgement. The exception is children whose gestational age exceeds 35-36 weeks. Breast engorgement in children weighing less than 1800 g indicates intrauterine malnutrition.

Characteristics of premature babies.

When evaluating any premature baby, it should be noted to what extent it corresponds to its gestational age, which can only be attributed to the prematurity itself, and which is a manifestation of various pathological conditions.

The general condition is assessed on a generally accepted scale from satisfactory to extremely severe. The severity criterion is primarily the severity of pathological conditions (infectious toxicosis, CNS damage, respiratory disorders). Prematurity itself in its "pure" form, even in children weighing 900-1000 g, in the first days of life is not a synonym for a serious condition.

The exception is fruits with a body weight of 600 to 800 g, which on the 1st or 2nd day of life can produce quite a favorable impression: active movements, good tone of the limbs, a rather loud cry, normal skin color. However, after some time, their condition deteriorates sharply due to respiratory depression, and they die rather quickly.

Comparative characteristics are carried out only with premature babies of a given weight category and gestational age. If preterm infants of IV-III degree do not have depression syndrome, severe neurological symptoms and significant respiratory disorders, their condition can be regarded as moderate or a more streamlined wording can be used: “the condition corresponds to the degree of prematurity”, “the condition basically corresponds to the degree prematurity."

The latter means that the child, in addition to prematurity, has moderate manifestations of atelectasis or a mild form of encephalopathy.

Premature babies tend to worsen their condition as the clinical manifestation of pathological syndromes occurs several hours or days after birth. Some doctors, in order to avoid reproach for underestimating the child, indiscriminately regard almost all premature babies as severe, which is reflected in the stencil entry: “The condition of the child at birth is severe. The severity of the condition is due to the degree of prematurity and its immaturity. Such a record, on the one hand, does not contribute to clinical thinking, and on the other hand, does not provide sufficient information for an objective assessment of the child at the subsequent stages of nursing.

The maturity of the newborn means the morphological and functional correspondence of the central nervous system to the gestational age of the child. The standard of maturity is a healthy full-term baby. Compared to him, all premature babies are considered immature. However, each gestational age of a premature baby has its own degree of maturity (gestational maturity). When a developing fetus is exposed to various damaging factors (infectious and somatic diseases of the mother, toxicosis of the pregnant woman, criminal intervention, etc.), the maturity of the child at birth and in subsequent days may not correspond to his age. In these cases, we should talk about gestational immaturity.

The concepts of "mature" and "healthy" newborn are not identical. The child may be sick, but his maturity is to match his true age. This applies to pathological conditions that are not accompanied by CNS depression. In severe pathology, it makes no sense to determine the maturity of a child.

The determination of maturity is carried out not only at the birth of a child, but also in the following days, during the 1-3rd week of life. However, during this period, functional CNS depression is often due to postnatal pathology (infectious toxicosis), therefore, in our presentation, the concept of "gestational immaturity" is interpreted more broadly. It reflects the morphological underdevelopment of the brain, as well as the functional damage to the central nervous system of intrauterine and postnatal origin. More precisely, we determine not so much gestational maturity as the correspondence of a given child to premature babies of similar body weight and age.

For comparative characteristics, motor activity, the state of muscle tone and reflexes of the newborn, the ability to maintain body temperature, and the severity of the sucking reflex can be used. Under equal conditions, they can also start sucking earlier and more actively.

In addition to immaturity, severe hypoxia, various CNS lesions, and infectious toxicosis have a depressing effect on the sucking reflex. The combination of these factors leads to the fact that many premature babies are unable to suck from the horn for a long time. The duration of this period in children weighing 1800 g or more usually does not exceed 2.5-3 weeks, in children weighing 1250-1700 g - 1 month and in children weighing 800-1200 g - 1'/ 2 months.

A more prolonged absence of suckling, which cannot be explained by a generalized or indolent infection, goes beyond mere gestational immaturity and should be alert for organic CNS damage, even if there are no neurological symptoms at this time.

Inhibition of sucking in children who have previously actively sucked is almost always associated with the appearance of a focus of infection.

According to our data, children weighing up to 1200 g in the first 2 months of life increase their height by 1-2 cm per month, children with a larger weight - by 1-4 cm.

The increase in head circumference in premature babies of all weight categories in the first half of the year averages 3.2-1 cm per month, and in the second half of the year - 1-0.5 cm. During the first year of life, the head circumference increases by 15-19 cm and in at the age of 1 year, on average, it is 44.5-46.5 cm [Ladygina V. E., 1972].

Physical development of premature babies

Of interest is the physical development of the smallest children with a birth weight of 800 to 1200 g. According to our data, the average body weight of these children at the age of one year is 8100 g, with the most frequent fluctuations from 7500 to 9500 g. Comparing weight indicators at the age of one year Depending on the gender, we did not observe in children with a birth weight of up to 1200 g a difference between the body weight of boys and girls.

The average weight gain for the 2nd year of life in children with a birth weight of 800 to 1200 g, according to our data, is 2700 g, and at 2 years of age their weight is on average 11000 g with the most frequent fluctuations from 10,000 up to 12,000

The average body weight for boys at the age of 2 years is 11,200, and for girls, 10,850 g.

The rate of increase in height in children with a birth weight of 800 to 1200 g is also quite high. According to our data, children in this weight category increase their initial height by 2-2.2 times by a year, reaching an average of 71 cm with fluctuations from 64 to 76 cm. During the first year of life, they grow on average by 38 cm with fluctuations from 29 to 44 cm.

In contrast to weight indicators, the average height of boys with a birth weight of up to 1200 g at the age of one year was higher than that of girls - 73 and 69.5 cm, respectively.

During the 2nd year of life, children with a birth weight of 800 to 1200 g, according to our data, increase their height by an average of 11 cm and reach 81 cm at 2 years of age, with fluctuations from 77 to 87 cm.

Interesting data were obtained by R. A. Malysheva and K. I. Kozmina (1971) in the study of the physical development of preterm infants at an older age. Examining children aged 4 to 15 years, they found that after 3-4 years of life, premature babies are compared in body weight and height with full-term peers, at 5-6 years of age, i.e. in the period of the first " stretching”, they again, according to these indicators, especially in body weight, begin to lag behind full-term children. By the age of 8-10 years, growth rates level off again, but the difference in body weight between full-term and premature boys remains.

With the approach of puberty, the same pattern repeats itself: the second "stretching" in premature babies occurs 1-2 years later. In full-term boys, growth between 11 and 14 years increases on average by 20 cm, in girls - by 15 cm, in premature babies, these figures are respectively less - 16 and 14.5 cm. Full-term boys increase body weight during this period by an average of 19 kg, girls - 15.4 kg, premature babies - by 12.7 and 11.2 kg, respectively.

Teething in premature babies, it starts at a later date. There is a correlation between body weight at birth and the time when the first teeth appear. According to some data, in children with a birth weight of 2000 to 2500 g, the eruption of the first teeth begins at 6-7 months, in children weighing from 1501 to 2000 g - at 7-9 months and in children weighing from 1000 to 1500 g - at 10-11 months. According to our data, in children with a birth weight of 800 to 1200 g, the first teeth appear at the age of 8-12 months, on average - at 10 months.

In conclusion, let's touch on a question that often arises among doctors of children's clinics: should all premature babies be considered as children with malnutrition in the first year of life.

The physical development of premature babies has its own characteristics and depends on body weight at birth, previous diseases and constitutional features of the child. Assessment of body weight indicators should be carried out only in comparison with those in healthy premature babies of this weight category. Therefore, it is completely wrong to regard a child born with a weight of 950 g, in which at the age of one year it is equal to eight kg, to regard as a patient with malnutrition. Diagnosis: prematurity in such a child explains the temporary lag in physical and psychomotor development.

Psychomotor development of premature babies: consequences

Basic psychomotor skills in most premature babies appear later than in full-term babies. The lag in psychomotor development depends on the degree of prematurity and is more pronounced in children weighing up to 1500 g. bodies from 1501 to 2000 - for 1 - 1 1/2 months.

By the end of the first year, most children with a birth weight of 2001 to 2500 g catch up with their full-term peers in psychomotor development, and by the age of 2, deeply premature ones are compared with them.

Data on the psychomotor development of premature babies by months are presented in Table. 1.

Table 1 Some indicators of psychomotor development in premature babies in the 1st year of life, depending on body weight at birth (data from L. 3. Kunkina)

Time of onset in months based on birth weight visual-auditory concentration Keeps head upright Turn from back to stomach Turn from belly to back On one's own: Starts to say words

Thus, in terms of psychomotor development, premature babies are compared with their full-term peers earlier than in terms of height and body weight.

However, in order for a child to develop well, a lot of individual work must be done with him (massage, gymnastics, display of toys, colloquial speech).

In long-term ill preterm infants and in children who were deprived of the necessary individual care, the lag in psychomotor development is more pronounced.

Consequences of prematurity, prognosis (catamnesis)

The prospect of nursing premature babies largely depends on their further psychomotor development. In this regard, early and long-term prognosis is of great importance.

The literature on this issue is contradictory. This is primarily due to the unequal contingent of the examined children, the difference in the tests used to determine the usefulness of the child, as well as the number of specialists (neurologist, psychiatrist, ophthalmologist, speech therapist) involved in the examination.

Some authors are very pessimistic about the neuropsychic development of premature babies. As an example, let us cite the statement of the prominent Finnish scientist Ilppö: “The mental development of premature babies in the first years of life lags behind the norm. Unfortunately, a significant proportion of these intellectual defects persist for life. Premature babies are much more likely to show more or less severe mental disability. Intellectual disorders are often combined with hemiplegia, paraplegia, Little's disease ”(Fanconi G, Valgren A, 1960). In the studies of many authors, there is a large percentage of severe CNS lesions in non-term infants.

R. A. Malysheva et al., examining 255 premature babies aged 3-4 years, 32 of them (12.6%) had severe organic lesions of the central nervous system and 50% had slight deviations in neuropsychic development.

According to S. Drillien, almost 30% of premature babies born weighing up to 2 kg have moderate or severe impairments in psychomotor and physical development.

A. Janus-Kukulska and S. Lis, in a study of 67 children with a birth weight of up to 1250 g, aged 3 to 12 years, half of them found a lag in physical and mental development, 20.9% were found to have severe CNS lesions .

Attention is drawn to the frequency of various lesions of the organ of vision. In studies by A. Janus-Kukulskaya and S. Lis, 39% of children weighing up to 1250 g at birth were found to have various visual defects: myopia, strabismus, astigmatism, optic nerve atrophy, retinal detachment. Other researchers also point to a high percentage of congenital myopia (30%) in premature babies [Grigorieva VI et al., 1973].

K. Rare et al. (1978), studying the follow-up of 43 children born weighing up to 1000 g, 12 of them were found to have severe eye damage, including 7 - retrolental fibroplasia (RLF) and 2 - complete loss of vision.

S. Saigal et al. (1982) in a study of 161 children with a birth weight of up to 1500 g, RLF was found in 42 children, in 12 of them it proceeded in a severe form.

At the same time, other authors note a more favorable outcome in the follow-up examination of premature babies. In the observations of N. R. Boterashvili, the frequency of CNS lesions varied depending on the degree of prematurity from 3.8 to 8.5%. L. 3. Kunkina, studying together with a neurologist 112 premature babies aged 3 years, 4 of them (3.6%) found a delay in neuropsychic development, 7 (6.2%) had neurotic reactions in the form anxiety, sleep disorders, logoneurosis, and in 2 (1.7%) - epileptiform seizures [Kunkina L. 3., 1970].

J. Hatt et al. (1972), observing 26 children with a birth weight of 1250 g or less at the age of 2 to 12 years, 77.8% of them noted normal mental development.

S. Saigal et al. (1982) studied follow-up for 3 years in 184 children born weighing up to 1500 g. 16.8% had neurological disorders, including 13% - cerebral palsy.

According to A. Teberg et al. (1977) and K. Rare et al. (1978), among children with a birth weight of 1000 g or less, 67.5-70% had no deviations in the neurological status.

Analyzing the literature data and our own material, we can note the following:

1. Premature infants are significantly more likely than full-term infants to have organic lesions of the central nervous system.

They are caused by the pathology of the prenatal period, complications in childbirth and damaging factors in the early postnatal period (hyperoxemia, hyperbilirubinemia, hypoglycemia);

1. preterm infants with a gestational age of less than 29 weeks and a body weight of less than 1200 g, due to underdevelopment of the retina, have a greater predisposition to the development of RLF. It is in this contingent of children that this pathology is mainly observed;
2. in recent years, premature babies have a tendency to increase the incidence of cerebral palsy. By the way, this is typical for full-term children. This trend can be explained by two reasons: firstly, there are now more opportunities to save a pregnancy that occurs with the threat of termination; secondly, progress in organizing specialized care for newborns and the creation of resuscitation services in maternity hospitals contribute to the survival of children with asphyxia. - this and intracranial hemorrhages;
3. The prospects for the psychophysical development of premature babies largely depend on how pathogenetically substantiated and sparing (iatrogenic factors) the therapy was at the 1-2nd week of life and how early and consistently rehabilitation assistance was provided at subsequent stages.

Due to the fact that mild forms of cerebral palsy are not detected immediately, and often only in the second half of the first year of life, and some pathology of vision is not diagnosed by pediatricians at all, after discharge from the department of premature babies with a burdened anamnesis and weighing up to 1500 g should be observed by a neurologist, as well as undergo an examination by an ophthalmologist.

Based on the above, premature babies should remain under the systematic supervision of neonatologists from the moment of birth until the period when their health is out of danger, and the body becomes ready for independent life.

Doctor of Medical Sciences, Alexander Ilyich Khazanov(Saint Petersburg)

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.

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

The birth of a child is a process well thought out by nature: the body is quite ready for new living conditions. Another thing is a child born prematurely. What systems of the body of a premature baby suffer in the first place and why?

Why, when talking about a woman's pregnancy, they call the figure 40 weeks - after all, the prenatal period (the so-called gestational age) is 265-270 days, i.e. 38 weeks. What is the reason for this difference?

Since the exact date of fertilization cannot usually be determined, the calculation of the gestational age is carried out from the first day of the last menstruation. However, it is known that, on average, the process of fertilization is possible from the 14th day. Therefore, the age of the embryo, i.e. gestational age child, and it turns out to be two weeks less than the gestational age.

According to the timing of the birth of a child, they judge full-term or prematurity. Doctors distinguish four degrees of prematurity, depending on the gestational age and weight of children at birth.

To the first group children are included, whose gestational age at the time of birth was 35-37 weeks. These are children with low birth weight (2-2.5 kg).

second group are children whose gestational age at the time of birth was 32-34 weeks. They also have low birth weight (1.5-2 kg).

Third group- These are children whose age at the time of birth was 29-31 weeks. These are children with very low birth weight (1-1.5 kg).

And finally, to fourth group includes children with a gestational age of less than 29 weeks at birth (i.e., born in the 7th month of pregnancy). These children are characterized by extremely low birth weight (less than 1 kg).

Premature baby: respiratory and immune problems

Having just left the cozy "mother's environment", which reliably protected him from any adversity and supplied him with everything necessary, the newborn must adapt to other conditions of existence. This preparation of the organism for life in the new world begins long before the birth of the child.

Many systems - respiratory, cardiovascular, digestive and others - are fully formed even in the prenatal period of development of the organism. By the time the baby is born, they are ready to go to work.

Why does the nervous system of premature babies suffer?

The second circumstance concerns the degree of maturity nervous system. Observations of very preterm infants show that they have a rapid extinction of vital physiological reflexes, such as sucking and swallowing; chaotic movements, tremor of the hands, which indicates the immaturity of the cerebral cortex. What is it connected with?

Subcortical structures are the first to form in the process of intrauterine development and provide rigid, genetically stable programs for the development of the organism. The highest part of the brain - the cerebral cortex - is laid as early as the 7th week of intrauterine development, however, the process of differentiation of cell layers and specialization of cortical fields is much longer. Only at the 5th month of intrauterine life, the formation of furrows on the surface of the telencephalon begins - thereby increasing the surface of the cortex. In addition, there are processes of qualitative transformation and cortical brain tissue, processes of reorganization of cellular brain tissue. By 6 months, the fetus already has all the fields of the cortex characteristic of an adult.

Anatomically, structurally, everything seems to be mature. Now you need to install the necessary connections between different cortical regions, between the cortex and the subcortex. The system is ready to move on to "functioning", all the "cubes" are in place - but you still need to master the "rules of the game".

What affects the timing of the birth of premature

You can often hear that the adaptation of a child born at the 6-7th month is much easier than, for example, a child born at the 8th month of pregnancy. There are reasons for this observation.

If premature birth takes place at the 6-7th month, the brain is still at the “zero” level, connections have not yet begun to be established, and it is much easier for the body to switch to a new adaptation algorithm imposed by the external environment: the brain, at the same time, builds its connections into in accordance with the requirements of the environment, and therefore, shows greater adaptability.

If a child is born at 8 months, then the process of functional reorganization is already in full swing, and along a rather rigid, programmed path, and the very premature entry into other conditions simply “knocks down” this mechanism, introduces a disintegrating principle into it. Hence the decrease in the adaptive capabilities of the body.

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