In a premature newborn, it is noted. In deeply premature babies, the state of the fontanelles. The child is gaining weight

A child born at 22–37 weeks of gestation (154–259 days from the first day of the last menstrual period) with a body weight of less than 2,500 g and a length of less than 45 cm is considered premature. one breath. Depending on body weight at birth, 4 degrees of prematurity are distinguished:

I degree - 2001-2500;

II degree - 1501-2000;

III degree - 1001-1500 g;

IV degree - 1000 g or less.

Birth weight is not an absolute indicator of prematurity. So, 1/3 of newborns weighing less than 2500 g are full-term, and in 4-5% of premature babies, body weight exceeds 2500 g.

The main criterion for prematurity is gestational age prenatal development, gestatio - pregnancy, wearing). Based on gestational age, there are 4 degrees of prematurity:

I degree - gestational age 37-35 weeks;

II degree - gestational age 34-32 weeks;

III degree - gestational age 31-29 weeks;

IV degree - gestational age 28-22 weeks.

Prematurity is a concept that refers exclusively to the neonatal period. The frequency of birth of premature babies in different regions of the country is 5-12%. The death rate of premature babies is 20 times higher than the death rate of full-term babies.

To decide whether the birth was urgent or premature, only one of the indicators (gestational age or newborn weight) cannot be used, since they are not equivalent. The final diagnosis is made only after comparison obstetric period pregnancy with the weight and maturity of the newborn.

In the postnatal period, gestational age is calculated using the Dubovich scale, which includes an assessment of the state of the newborn based on 11 somatic signs (Table 1). Each of the signs is evaluated in points from 0 to 4. The resulting amount of points corresponds to a certain period pregnancy. Accurate knowledge of gestational age makes it possible to divide preterm infants into two groups: corresponding in development to the gestational age and lagging behind in development (in relation to the gestational age); differentiated approach to the solution of the issue of methods of nursing, prevention and treatment pathological conditions in premature babies.

Grade. The amount of points corresponding to the period of intrauterine development

Note. Each indicator is given a maximum score.

Premature is considered a baby born between 22 and 37 weeks of gestation (or between 154 and 259 days, counting from the first day of the woman's last cycle) with a body weight in the range of 500 grams to 2.5 kg and a body length of less than 45 cm (according to the recommendations WHO 1977).

Currently, in our country, the main criterion for the period of prematurity is considered to be gestational age or age. According to this, a premature baby is a baby born at a period of intrauterine development, which is less than 37 full weeks gestation (pregnancy). A full-term baby is called when its gestational age is between 37 weeks and 42 weeks.

Epidemiology

Among the total mass of children who have a body weight of less than 2500 g at birth, about 30% are full-term babies, the remaining 70% are premature newborn babies. The average weight of a baby at 37 weeks of gestation is usually about 3 kg. In some countries, those babies born before 28 weeks of gestation are not counted as newborns, so the statistics on the frequency of birth of premature babies differ significantly according to various countries(from 5% to 15%). In our country, there is an order of the Ministry of Health “On the transition to the criteria for live birth and stillbirth recommended by the World Health Organization (WHO). According to him, the period of perinatal development begins its countdown from the 28th week of pregnancy. Premature babies born between 28 and 36 weeks of gestation occur with a frequency of 5.5 to 8%. Among them, about 75% are babies born between 32 and 36 weeks of gestation.

Main groups

Premature small babies previously divided into the following degrees of prematurity, based on the figure of body weight at the time of birth:

• 1 degree - body weight is from 2001 to 2500 gr.,
• Grade 2 - body weight within 1501-2000 gr.,
• 3 degree - from 1500 gr. up to 1001 gr. This group is called children with very low body weight;
• Grade 4 - it is made up of newborns with extremely low weight, less than 1 kg.

However, there is also a WHO classification ( World Organization Health) 10th revision, which includes a heading for disorders associated with reduced pregnancy and low birth weight. According to it, it becomes generally accepted to divide premature babies both by body weight and by gestational age. When both gestational age and birth weight are known, preference should be given to the child's body weight. Depending on it, three groups of prematurity are distinguished:

1. With extremely (extremely) low body weight - birth weight is up to 1 kg (999 grams or less);
2. Very low birth weight - birth weight less than 1.5 kg (from 1000 grams to 1499);
3. With low body weight - weight up to 2.5 kg (from 1500 grams to 2499).

Based on gestational age very premature babies, according to the WHO criteria of the 10th revision, are divided into two groups:

1. With extreme immaturity - this includes babies born before 28 weeks of gestation;
2. Other cases of prematurity - this group includes all children whose gestational age is 28 weeks or more, but less than 37.

The frequency of morbidity and mortality, the likelihood of their disability increases as the child's gestation period decreases, and therefore prevention possible probability premature birth is very important issue.

Reasons for having a premature baby

All etiological factors can be divided into the following groups:

1. Social, economic and demographic factors: the presence of occupational hazards and the nature of the work of parents; bad habits(the effect of alcohol, nicotine and drugs); family living conditions (income level and place of residence, quality of food); the state of the level of education; the quality of medical care; the presence of mental and physical injuries;
2. Biological factors: parental age(less than 18 years or more than 35); short stature, previous abortions and childbirth, number previous pregnancies and their outcomes, the presence of an interval between pregnancies and childbirth, etc.;
3. Clinical reasons:

• the presence of anomalies in the development of the genital organs (infantilism) in the mother;
• in a woman;
• an abortion preceding this pregnancy, which causes trauma to the uterus (leads to a violation of the structure of the endometrium, cervical insufficiency);
• the presence of somatic pathology in the mother (heart disease, a, (lead to hypoxia, impaired placental blood flow and changes in the structure of the placenta);
• existing infections that are sexually transmitted;
• the presence of complications of this pregnancy (preeclampsia);
• the occurrence of incompatibility of the blood of the mother and fetus (according to the Rh factor and group);
• chromosomal diseases of the child;
• endocrine pathology in the mother (, etc.).

With what premature newborn baby different from full-term?

A mature newborn is such a child who, based on his morphofunctional development, is ready for life outside the womb in conditions of optimal care and feeding. Such a baby is able to maintain body temperature well, has basic reflexes (sucking, swallowing), stable heart and respiratory rates, and normal motor activity.

External anatomical features premature baby:

1. Disproportion in physique: the size of the head is up to a third of the height; the brain part of the skull is larger than the front; the bones of the skull are supple and thin, all sutures and fontanelles are open; no ossification nuclei in the epiphyses of bones; short legs and neck;
2. The skin is bright, dark red, thin, glossy, as if translucent, skin folds on the soles are weakly expressed;
3. Lanugo (abundant and thick fluff) is found on the skin of the back, shoulders, face (forehead and cheeks), extensor surfaces of the limbs (often thighs);
4. The subcutaneous fat layer is reduced or absent altogether, it remains only in the cheek area, there is a tendency to the rapid development of edema;
5. Low-lying umbilical ring;
6. The cartilages of the auricles are soft to the touch, tightly fitting to the head;
7. The nail plate is thin, the tip of the nail does not reach the edge of the finger;
8. The mammary glands are underdeveloped;
9. The external genitalia are open, the gaping of the genital slit (the small lips are not covered by the large ones), the boys have no testicles in the scrotum.

Signs of immaturity on the part of organs and their systems

Premature babies differ from mature babies in neurological status, which is explained by the anatomical and functional immaturity of the CNS:

• Weaker, lethargic, lethargic, drowsy, motor activity is reduced, the cry may be very weak or absent altogether;
• The tone of the flexor muscles predominates over the tone of the extensor muscles, physiological muscle increased tone is absent and appears, as a rule, by two months after birth;
• A decrease in all reflexes that a full-term baby has, including sucking and swallowing. A premature baby weighing more than 1.5 kg becomes able to suck no earlier than 2 weeks after birth, with a body weight of less than 1500 and more than 1000 this reflex occurs by 3 weeks, in children less than 1 kg at birth - not earlier than a month life:
• Imperfect thermoregulation is characteristic. All preterm infants typically have a reduced ability to generate heat due to low fat stores and low muscle tone. The high heat transfer is due to large area surface of the body and superficial vessels of the skin. All this leads to rapid hypothermia, and immature thermoregulation centers in the central nervous system can cause the baby to overheat.

On the part of the respiratory system, the feature will be the presence of primary atelectasis of the lungs, the variability of the respiratory rate (than less baby, the more often he breathes), his depths, stops or long pauses between breaths. The degree of maturity of the lung tissue depends on the gestational age: in those born before 28 weeks, the alveoli and capillaries are poorly developed, extensibility is reduced, there is no surfactant, which leads to respiratory failure after birth.

For of cardio-vascular system variability in heart rate, low blood pressure in the first two days after birth, reduced vascular tone are characteristic. Birth-related hemodynamic changes occur slowly with short term gestation.

On the part of the digestive organs, a feature of a premature baby is a small volume of the stomach, a decrease in the tone of the sphincters, a decrease in intestinal motility, which causes a tendency to bloating and regurgitation. The activity of all enzymes also decreases with a decrease in gestational age.

The urinary system is characterized by a decrease in the ability of the kidneys to concentrate urine (due to low filtration volume in the glomeruli and reabsorption in the tubules), renal regulation of urination, and the ability to maintain a stable acid-base state of the blood. This causes significant fluctuations in the frequency and volume of urination.

The metabolism of a premature baby is characterized by a tendency to decrease in blood protein, glucose, calcium, and an increase in bilirubin.

Features of the physiology of a premature baby

They are due to the immaturity of all organs and their systems and are as follows:

• Weight loss after birth is maximum during the first 7 days, can be up to 15% and is restored by 3 weeks;
• Jaundice will manifest itself in 95% of premature babies, its character is longer and more pronounced;
• Much less often, signs of a hormonal crisis and toxic erythema can be observed, in contrast to mature children; Share with friends!

Today we will list and briefly characterize the signs of a full-term newborn. In addition, we will focus on the issues of postmaturity or prematurity. How can this be determined by the child and how do children differ? What threatens this newborn?

For this reason, it is necessary to know not only the signs of full-term and maturity of the newborn, but also be able to correctly diagnose and know about possible problems. If we consider the child as an object of childbirth, then this must be done based on the size of the head, since this is the most voluminous part of the fetal body, which experiences the greatest difficulties during movement through the birth canal. Now we propose to talk in more detail about the signs of a full-term newborn.

full-term baby

What is fetal maturity? This is a certain state of the child, which characterizes the readiness internal organs ensure the life of the baby outside the womb. After the birth of a child, without fail see a neonatologist.

The doctor needs to evaluate three things:

• determination of the term of a newborn child, the signs of which we will consider in this section;
• assess the degree physical development;
• morphological and functional maturity.

Which baby is considered full term? These signs include:

• birth date - from thirty-eight to forty-two weeks;
• body weight must be more than two and a half kilograms;
• body length - from forty-six centimeters or more.

It is very important to note that there are a number of other signs of a full-term newborn. It's about about morphological and functional maturity. We will talk about this in detail later. Summing up everything said in this section, we can highlight the main signs of a full-term newborn:

• gestational age;
• body mass;
• body length.

External signs

Let's start with the main features that are visible to the naked eye. The first item on this list is to highlight a loud and demanding voice. Second - the skin should be pink and velvety. Be sure to pay attention to the fact that the skin of the newborn should be clean, and the fat layer should be uniform. The third is the presence of an open large fontanel. However, according to statistics, in fifteen percent of cases, a small one is also open. Fourth outward sign- this is the formation of the auricle, all arcs should be clearly expressed. Fifth sign - the navel is located in the center of the abdomen, nail plates should completely cover the nail phalanges. The sixth sign is that girls have a closed genital slit, and boys have testicles lowered into the scrotum.

Functional features

In this section, we list the functional signs of a full-term newborn. These include the following:

• the limbs of the baby should be bent at the joints;
• movements are chaotic and quite active;
• children are characterized by increased muscle tone;
• body temperature is stable, deviations within the normal range up to six tenths of degrees Celsius are possible;
• the breathing of the newborn is also stable - from forty to sixty breaths per minute;
• the heartbeat is heard well, rhythmic (the norm is from one hundred twenty to one hundred and forty beats per minute);
• in a full-term baby, all reflexes are symmetrical, it is possible to cause specific ones.

Specific reflexes of newborns:

• sucking;
• search;
• prehensile;
• trunk and others.

prematurity

Now let's turn to the issue of criteria for prematurity, postmaturity of the baby. Premature baby is born before the end of intrauterine development, that is, before the thirty-seventh week of pregnancy. Such babies have a small body weight, weight less than two and a half kilograms, and their height does not reach forty-five centimeters. Newborns have problems with thermoregulation and lack of response to external stimuli. It is important to note the statistical information: such babies are born in about 10% of cases.

It is worth knowing that there is a term "extreme prematurity" if the baby is born for up to twenty-two weeks. This condition is the line between a miscarriage and a premature baby. Body weight in this case is a decisive factor: if it reaches half a kilogram, then this premature baby, and just one gram less - a miscarriage.

Prematurity is usually classified according to the body weight of the newborn.

Prematurity problems can be both in mom or dad, and in the child. They are briefly listed in the table below.

Manifestation of prematurity

The signs of full-term, prematurity and postmaturity of a newborn considered by us in the article are reflected in the behavior and development of the baby. We invite you to talk about how prematurity in newborns manifests itself. We will now give a general clinical picture. Firstly, the newborn has a disproportion of the body (a very large head). In addition, the sutures of the skull are open, so the bones are malleable. Secondly, auricles soft. Thirdly, the child is in the frog position, as muscle hypotension is noted. The fourth sign is that the testicles of the boys have not yet descended into the scrotum, and the large labia of the girls have not yet fully developed. Fifth, specific reflexes are extremely weakly expressed. Sixth - shallow and weak breathing (up to 54), low arterial pressure(about 55-65). Seventh - frequent urination and regurgitation.

Postmaturity

What are the features of a post-term newborn baby? Signs of postmaturity in the mother should be diagnosed by a doctor using CTG and ultrasound. These symptoms include:

• lack of labor activity;
• reduction in abdominal circumference;
• rather large fruit;
• compaction of the child's skull;
• meconium in amniotic fluid;
• reduced concentration of glucose in the amniotic fluid;
• urinalysis shows low levels of estriol.

It is worth noting that there are two types of post-term pregnancy:

With true postmaturity, the child is in serious danger, because hypoxia develops.

What are the causes of postmaturity and how do they affect the child?

How does a post-term pregnancy affect the baby? The baby has the following symptoms:

• thin body;
• dry and wrinkled skin;
• peeling on the skin;
• lack of fetal lubrication;
• long nails and hair;
• open eyes;
• increased activity.

Pay attention to the fact that the skin of postterm newborns acquires a yellowish tint. To prevent a post-term pregnancy, it is very important to undergo a CTG procedure three times a week (after 40 weeks). The baby's heartbeat and movements will help determine exactly how the baby is feeling.

Causes this phenomenon unknown, but doctors distinguish two large groups:

Please note that there is psychological factor. If future mom is afraid of childbirth and is not psychologically ready for them, then the pregnancy may be delayed. In this case, you need the support of loved ones or a consultation with a psychologist.

Differences between a full-term and premature baby

A full-term baby is distinguished by a number of features. He is ready for life outside the womb, has certain reflexes, the skin is able to maintain a certain temperature regime, heart rate is steady, normal breathing and activity. A premature baby is the exact opposite: he is not ready for life outside the womb, he is not able to maintain a temperature regime, the heart rate and breathing are unstable, low blood pressure, and the reflexes of newborns are poorly developed.

The course of the neonatal period largely depends on the degree of maturity of the child, which is inextricably linked with the maturity of the fetus. The maturity of the fetus is a state characterized by the readiness of the organs and systems of the body to ensure its extrauterine existence. It is largely due to the nature of the course of pregnancy.

At the initial examination of a newborn, a neonatologist should evaluate him according to three options:

• gestational age (determining term/prematurity criterion );
• indicators of physical development;
• degree of morphological and functional maturity.

Currently, the parameters of physical development and even the degree of morphological and functional maturity are not criteria for diagnosing prematurity, because. they may not correspond to gestational age (gestational age). Thus, premature babies often have a birth weight of more than 2500 g, and approximately 1/3 of newborns born weighing less than 2500 g are full-term. The degree of morphological and functional maturity of the newborn also does not always correspond to the gestational age. Various deviations in a woman's health status, complicated pregnancy, bad habits, etc. can lead to the birth of a child who is immature for her gestational age.

This means that the determining criterion for term is gestational age..

• Gestational age is the number of completed weeks elapsed between the first day of the last menstrual period before delivery.

Gestational age is determined by obstetrician-gynecologists at objective examination a pregnant woman (date of the last menstruation, according to ultrasound, fetal movement, height of the uterine fundus, alpha-fetoprotein (α-FP) parameters.

According to gestational age, newborns may be (and may have the listed anthropometric features):

• full-term - born at 37 weeks - 42 weeks = 260 days - 294 days of gestation (regardless of birth weight; usually at term, body weight = 2500g - 4000g, body length = 45cm - 53cm, head circumference = 32 - 38cm);

• overdue - born at gestational age > 42 weeks = 295 days or more (regardless of birth weight);
• premature - born between 22 and<37 недель гестации = со 154 дня до 259-го дня гестации включительно (масса тела = 2500г − 500 г, длина тела = 44см − 25 см).

Extreme prematurity− gestational age less than 22 completed weeks (154 completed days). The line between miscarriage and premature at 22 full weeks (154 full days) of gestation is determined by weight: 499 g - miscarriage, 500 g - premature newborn.

• Indicators of the physical development of the newborn :
  • body mass;
  • body length;
  • Head circumference;
  • chest circumference;
  • proportionality of the above indicators.

The main indicators of the physical development of the newborn are the mass and length of the body.

Birth weight maybe (in ascending order):

• extremely (extremely, extremely) low= 500 g - 999 g;
• very low\u003d 1000 g - 1499 g;
• low\u003d 1500 g - 2499 g;
• sufficient\u003d 2500 g - 4000 g (on average \u003d 3500 g - at m., 3350 g - at d.);
• big= 4000 g - 4500 g;
• extremely large= more than 4500 g.

Newborn body length on average varies from 45 to 53 cm.

Head circumference newborn is from 32 to 38 cm.

Chest circumference of a newborn- 32-34 cm.

To assess the indicators of physical development of full-term, premature and post-term infants, use percentile tables(tables by G.M. Dementieva) or medium statistical indicators. According to the evaluation tables, newborns can be divided into 4 groups of physical development:

• − newborns with normal for their gestational age by physical development - their body weight and length are from P10 to P90 and fluctuate within ±2σ deviations;
• − newborns with low weight and length in relation to gestational age (due to impaired intrauterine growth of the fetus, IUGR) - their body weight and length are below P10 and fluctuate outside 2σ, i.e. from -3σ to -2nd sigma deviation. This group will include newborns:
  • small for gestational age - weight and length less than P10 (IUGR of the hypoplastic type);
  • lightweight for gestational age - weight below P10, length more than P10, i.e. normal (IUGR of hypotrophic type);
  • undersized for the gestation period - the weight is more than P10, i.e., normal, and the length is below P10;
• − newborns malnourished(congenital malnutrition): weight and length are greater than P10 and fluctuate within Me−2σ, but there are trophic disorders in the form of underdevelopment or absence of subcutaneous fat, decreased elasticity and turgor of tissues, dryness and peeling of the skin;
• − with large mass, exceeding the due to gestational age more than P90 and with their fluctuation within Me + 2σ.

Moreover, large-weight newborns may be harmonious or disharmonious development, which is determined using coefficient of harmony (KG), (Kettle index, body mass index− for adults):

CG=22.5−25.5 harmonious children − large,

CG>25.5 - disharmonious with predominance of mass over body length - large-weight,

KG<22,5 − дисгармоничные с преобладанием длины тела по отношению к массе − tall.

• Morpho-functional maturity − readiness of organs and systems of the child for extrauterine existence.

In 1971 Petruss (Petrus ) , was proposed maturity rating scale, which includes 5 external morphological features:

• skin condition;
• Auricle;
• diameter of the areola of the nipples;
• external genitalia;
• stop striation.

Appraisal scale for the degree of maturity of Petrus

Each of these features is evaluated from 0 to 2 points, the resulting amount of points is added to 30.

The final result corresponds to the degree of morphological maturity of the newborn. If it matches the gestational age, then the baby is mature for its gestational age.

All premature babies are immature, at the same time, they may be functionally mature enough, but incapable of extrauterine life.

If the Petruss score is less than the child's gestational age, then he is immature for his gestational age. Only newborns who have reached 30 weeks of fetal development can be evaluated according to this table..

For a more detailed assessment of the degree of maturity and at the birth of a child before 30 weeks of pregnancy tables of Ballard (1991) and Dubovich (1970) are used, which take into account not only external, but also functional signs of immaturity, namely, neuromuscular maturity.

Dubovich (Dubovich ) was proposed maturity and gestational age assessment system(accuracy - ± 2 weeks), consisting of 11 morphological and 10 functional features, each of which is evaluated according to a 4- and 5-point system, respectively.

Mature term baby

The maturity of a full-term newborn child is determined by a complex of external signs.

The skin of the baby is pink, evenly colored. "Fluff" (vellus hair, lanugo) is preserved only on the shoulder girdle and in the upper back. The hair on the head is at least 2-3 cm long. The cartilages of the auricles and nose are dense. The place of origin of the umbilical cord is located approximately in the middle of the body or slightly lower. The testicles in boys are lowered into the scrotum, in girls the small labia are covered with large ones. Such a child screams loudly, he has active movements, pronounced muscle tone, and physiological reflexes are determined.

Physiological jaundice of newborns - appears on the 2nd-3rd day of life and disappears by the 5th day; if it does not disappear, then it is necessary to exclude hemolytic disease of the newborn, hereditary blood diseases, malformations of the biliary tract, sepsis, etc.

The bones of the skull in the vast majority are not fused, a large fontanel is open (its size is 1-2 cm), the sutures can be closed, slightly diverge or find each other. Depending on the characteristics of the course of childbirth, the shape of the head can be: dolichocephalic (stretched from front to back), brachycephalic (stretched upwards) or irregular (asymmetrical). Eyes in the first days are almost always closed. The child opens them when changing the position of the body. There may be postpartum hemorrhages on the sclera, the eyelids are swollen. Pupils should be symmetrical, respond to light from birth. The eyeballs are "floating", in the first days of life, horizontal nystagmus (small-amplitude involuntary twitching of the eyeballs) may be normal. The chest is barrel-shaped, the ribs are located horizontally, breathing is superficial, with a frequency of 40-50 breaths per minute, when a child screams, feeds, and worries, shortness of breath easily occurs due to narrow nasal passages, possible swelling of the nasal mucosa. Heart rate 130-150 beats per minute, heart sounds are loud, clear. The abdomen is usually actively involved in the act of breathing, has a rounded shape. With overfeeding and diseases, bloating easily occurs. The liver protrudes from under the edge of the costal arch by no more than 2 cm. In full-term girls, the large labia cover the small ones; in boys, the testicles should be lowered into the scrotum.

Postterm pregnancy

Signs of overripe

• dark green skin color
• hard bones of the skull
• narrow sutures and fontanelles
• dry skin
• lack of cheese lubrication
• maceration of the skin of the feet, palms
• thinning of the pancreas
• placenta with symptoms of calcification.

Maturity score according to Clifford

Grade 1 - newborn dry, but normal skin color. Raw lubrication is poorly expressed. Amniotic fluid is light, but their amount is reduced. The general condition of the newborn is satisfactory.

Grade 2 - dry skin is more pronounced, there are signs of malnutrition. Approx. water, the umbilical cord and the skin of the newborn are stained green with meconium. Perinatal mortality is high.

Grade 3 - Near the water is yellow, skin and nails are yellow. These are signs of deeper hypoxia, mortality is less.

To the clinical symptoms of overmaturity

detectable after childbirth include signs of overmaturity (maturity) of the fetus and macroscopic changes in the placenta.

Signs of a preterm baby include:

dark green coloration of the skin, membranes, umbilical cord, maceration of the skin (in a living child), especially on the arms and legs (“bathing” feet and palms);

reduction or absence of cheese lubrication; reduction of subcutaneous adipose tissue and the formation of folds; decrease in skin turgor ("senile" appearance of the child), the large size of the child (less often malnutrition);

long fingernails; poorly expressed configuration of the head, dense bones of the skull, narrow sutures and small fontanelles.

Signs of prematurity:

• disproportionate body, big head
• umbilical ring low
• skull bones are pliable, sutures and fontanelles are open
• ear shells are soft
• a lot of vellus hair
• nails do not reach fingertips
• gaping sex slit
  large labia do not cover male
  testicles are not descended into the scrotum
• weakness, drowsiness, weak cry, underdevelopment of reflexes, inconsistent thermoregulation

A full-term newborn is born defenseless and requires vigilant care. If we are talking about a baby who saw the world much earlier than the time allotted by nature, then the risks and troubles increase many times over. According to statistics, 8-12% of children are born long before the expected date. Nursing them is a complex process that involves a number of specialists. A positive attitude and the right actions of parents are of great importance. Consider the features of the condition of premature babies and the main recommendations for caring for them.

A newborn is considered premature if it was born before the 37th week of pregnancy, that is, before the 260th day of intrauterine development (gestation). At the same time, its weight is in the range from 0.5 to 2.5 kg, and its height is from 25 to 40 cm. Depending on the term of birth and body weight, 4 degrees of prematurity are distinguished:

• 1st - term - 35-37 weeks, weight - 2.001-2.5 kg, the child is mature and viable, in some cases treatment is required (with jaundice, birth trauma);
• 2nd - term - 32-34 weeks, weight - 1.501-2.0 kg, when assisted, the baby quickly adapts to external conditions;
• 3rd - term -29-31 weeks, weight - 1.001-1.5 kg, most children survive, but they need long-term rehabilitation;
• 4th - term - less than 29 weeks, weight - up to 1.0 kg, the baby is not ready for independent life, the prognosis is unfavorable - 60-70% of babies die within 30 days.

Nursing a premature baby in a medical facility

According to WHO standards, newborns with a body weight of at least 500 g and the presence of a heartbeat are subject to nursing. The earlier the child was born, the more difficult his condition. Prematurity of the first and second degree is called moderate, the third and fourth - deep. In addition to the above parameters, when developing nursing tactics, doctors pay attention to the severity of signs of immaturity of the body, the main ones are:

1. irregular weakened breathing;
2. dry wrinkled skin with a reddish tint due to underdevelopment of subcutaneous fat;
3. weak cry;
4. lanugo (fluff) on the body;
5. nail plates do not completely cover the phalanges;
6. umbilical cord below the center of the abdominal wall;
7. all fontanelles are open;
8. the genitals are underdeveloped;
9. meager movements due to reduced muscle tone;
10. disproportionate sizes of body parts - a large head, short limbs;
11. physiological reflexes are not expressed.

In the case of moderate prematurity, some of these signs are absent. It also happens that the baby's body weight is more than 2.5 kg, but there are manifestations of immaturity of the body.

The main causes of preterm birth:

• nutritional deficiencies in the mother's diet;
• lack of medical care;
• stress factors;
• bad habits and addictions of a woman;
• exposure to toxic substances, including in the workplace;
• the age of the mother is under 18 and over 35, the father is under 18 and over 50;
• more than three abortions in history;
• pregnancy earlier than one year after childbirth;
• chronic diseases of the mother;
• physical injury;
• immunological conflict;
• infections and chromosomal abnormalities of the fetus, and so on.

Condition features

A child born prematurely is not ready for independent life. The rate of adaptation depends on the maturity of the organism and the severity of the course of childbirth. In most cases, such babies, up to a certain age, lag behind their peers in development and show an increased tendency to certain diseases.

nervous system

By the 28th week of pregnancy, all the nerve endings and nodes, as well as the brain, are formed in the baby. But myelin, the substance responsible for the transmission of impulses, does not fully cover them. In a full-term baby, the process of myelination of fibers takes 3-5 months.

In a child born prematurely, the maturation of the nervous system may be delayed. As a result, there are difficulties with sucking, swallowing, breathing, reacting to external stimuli, and so on.

The stronger the degree of prematurity, the weaker the unconditioned reflexes.

The cerebral cortex in premature babies is poorly formed. Some structures are underdeveloped, such as the cerebellum, which is responsible for coordinating movements. The walls of the brain vessels are weakened, so there is a risk of ischemia (lack of oxygen) and hemorrhages.

thermoregulation

In children born prematurely, the processes of preserving and dissipating heat are imperfect. They are easily supercooled (body temperature drops below 36°) and overheated under the influence of external conditions. Reasons for this:

• lack of subcutaneous fat;
• immaturity of the thermoregulation center in the brain;
• immaturity of the sweat glands.

The increased risk of overheating/hypothermia persists for up to 6 months. The mechanism of thermoregulation is finally formed by the age of 8.

System digestion

The digestive system of premature newborns is characterized by some features:

1. reduced motor activity of the gastrointestinal tract, food passes slowly;
2. enzymes are not produced enough, products are poorly digested, and fermentation occurs;
3. due to the low acidity of digestive juices, the intestinal microflora is disturbed;
4. the stomach has a small volume;
5. sphincter at the border with the esophagus is weak.

As a result, babies suffer from bloating, intestinal colic, defecation disorders, frequent, profuse regurgitation, lack of vitamins and minerals.

The nutrition of such a child in the first days of life is carried out through a special probe.

Hearing And vision

With deep prematurity, the child reacts to sound stimuli only by blinking and moving the limbs. He begins to turn his head to the sound in about 1-1.5 months.

The vision of these children is poorly developed. Most of the time they lie with their eyes closed. Babies born at 30-32 weeks of gestation can hold their eyes on bright objects and turn towards a light source.

The vascular network of the retina is formed in the last month of pregnancy. Premature babies are at high risk of retinopathy, a retinal lesion that can lead to visual impairment and blindness. With timely treatment, the condition is corrected.

Respiratory system

Narrow airways, immaturity of the respiratory center of the brain, a highly located diaphragm - these and other factors make it impossible for a premature baby to fully breathe independently. In the waking state, he breathes very often (60-80 times per minute), but not deeply. In sleep, the frequency decreases, sometimes there are episodes of apnea - respiratory arrest, while the nasolabial triangle and fingers turn blue.

With deep prematurity, atelectasis (falling) of individual sections of the lungs can be observed. This is due to an insufficient amount of surfactant - a substance that is formed from 23 to 36 weeks of gestation and is designed to open the pulmonary vesicles during the first breath. As a result, respiratory disorders occur, which are often accompanied by an infection (pneumonia).

Some children have bronchopulmonary dysplasia after being connected to a ventilator. In the future, this is fraught with frequent acute respiratory infections.

Cordially — vascular system

Normally, after the first spontaneous breath, the shunts between the heart chambers and large vessels are closed in the child, thanks to which blood circulation was ensured during fetal development. In babies born prematurely, the process of restructuring the circulatory system occurs in the first months of life. In addition, the heart and blood vessels experience increased stress due to ongoing rehabilitation measures. Quite often congenital malformations are found.

The baby's heart sounds are muffled, the average heart rate is 120-140 beats per minute. The body reacts to any external influence with a jump in pressure and an increase in the frequency of contractions - up to 200.

Endocrine system

When born prematurely, all elements of the endocrine system do not function fully:

1. Adrenals. Cortisol deficiency leads to a decrease in the adaptive capabilities of the body and an inadequate response to stress factors. With severe adrenal insufficiency, the baby's body temperature decreases and blood pressure drops.
2. Thyroid. There is transient hypothyroidism (decreased activity of the organ). As a result, the metabolism slows down, swelling occurs, jaundice is prolonged, and so on.
3. Ovaries and testicles. Due to the lack of hormones, the sexual crisis is mild.
4. Pancreas. Excess insulin synthesis and meager glycogen stores lead to low blood sugar levels. Hypoglycemia is a dangerous violation of the maturation of the nervous tissue.

Bone system

In premature babies, the bones are fully formed, but the process of their mineralization is incomplete. For this reason, the risk of hip dysplasia is high.

Due to the deficiency of calcium and phosphorus, early prevention of rickets is advisable. It consists in the appointment of vitamin D from the age of 2 weeks.

urinary system

The immaturity of the renal tissue and the instability of water-salt metabolism predispose children to the formation of edema. Usually they appear in the first days of life and disappear in 1-2 weeks. Later firm swelling in the lower body may indicate nutritional problems or disease. In addition, it should be borne in mind that the baby can quickly develop dehydration.

hematopoietic system

The tendency to anemia in preterm infants is associated with the rapid destruction of fetal hemoglobin and the immaturity of the bone marrow. In addition, there is an increased risk of bleeding due to a lack of vitamin K and a decrease in the ability of platelets to stick together.

immune system

Most of the antibodies and immunoglobulins the child receives from the mother at 32-35 weeks. Premature babies have a marked lack of protective factors. Their immune system functions poorly: immunoglobulins and lymphocytes are almost not produced.

In the first weeks of life, the baby is defenseless against pathogenic microorganisms, while there is a tendency to generalize infectious processes. Vaccination of children is carried out according to a special schedule starting from 6 or 12 months.

In children born prematurely, a prolonged course of jaundice, increased intracranial pressure, and motor disorders are often observed. In addition, the risk of cerebral palsy, epilepsy and developmental delay is high.

Dynamics masses body

Weight loss occurs in all children after birth, but in full-term babies it is 5-8% of the initial weight, and in premature babies it is 5-15%. The subsequent dynamics depends on the general condition of the body and living conditions. Approximate rates:

• the initial weight is restored for 2-4 weeks of life, weight gain in the first month - 100-300 g;
• by 2-3 months, the mass doubles, and by 12 - increases by 4-8 times;
• growth during the first year of life becomes more by 27-38 cm, then 2-3 cm is added every month.

Specificity behavior

The degree of activity of the baby depends on the maturity of his body. If the baby was born before 28 weeks, then he sleeps most of the day. When touched, he may wake up and begin to move, grimace, but after a few minutes he falls asleep again. In the first degree of prematurity, the child is able to wake up on his own and stay awake for a longer time, as well as scream clearly and loudly.

In the first months of life, children cry a lot and are easily excited under the influence of stimuli, it is difficult for them to calm down. Hypo- or hypertonicity of the muscles is often observed.

The pace of neuropsychic development of premature babies is slowed down: later they begin to sit down, crawl, walk, talk. In the absence of serious pathologies, they "catch up" with their peers by 18-24 months. But fatigue and emotional instability may persist.

nursing

The process of nursing a premature baby can be divided into two stages: stay in the hospital and at home.

Hospital

Neonatologists are responsible for nursing babies. Immediately after birth, the child enters the intensive care unit or intensive care unit. If he cannot breathe on his own, he is put on a ventilator and injected with surfactant to open his lungs. Oxygenation can be performed, as well as the introduction of fluids and medications through catheters. Constant monitoring of vital signs is carried out.

The baby is placed in an incubator (incubator), where the air temperature is 33-35 ° and humidity is 70-95%. Indicators are selected individually depending on the degree of prematurity. As the condition improves, they decrease. Air parameters in the ward: temperature - 25°, humidity - 55-60%. The baby loses heat very easily. When changing clothes, heated changing tables and warm diapers are used. In the incubator, the child can spend from 3-4 days to 7-8 weeks.

In the process of nursing, it is very important to create the most favorable environment, minimizing stressful and traumatic factors, since premature babies are very sensitive. They react violently to any stimulus by several body systems at once, which negatively affects their condition. Main directions:

1. noise reduction;
2. protection from intense light sources;
3. careful conduct of all medical procedures;
4. tactile contact with the mother, if possible - laying on the chest, touching, stroking;
5. soft swaddling, simulating being in the uterus;
6. periodic change in body position to prevent bone deformities and abnormal muscle tone.

The period of stay in the hospital, as a rule, is equal to the period that the baby did not have enough for the full completion of intrauterine development.

House

Basic conditions for discharge of a child:

• the possibility of self-sucking;
• the ability to maintain body temperature;
• weight more than 2 kg and constant weight gain;
• healing of the umbilical wound;
• compliance with blood counts.

A premature baby needs careful handling, but do not be too zealous: be afraid to touch him and wrap him up carefully. It is better to practice loose swaddling so that the baby can move his arms and legs. Warm and heavy blankets are not needed, it is better to use lightweight textiles.

It has been scientifically proven that if you wear a premature baby in a sling, then he quickly adapts to new conditions.

The optimum air temperature in the room where the child is located is 25 °. Do not leave him naked for longer than 3-4 minutes. Gradually, the duration of air baths can be increased to 10-12 minutes, spending them 3-4 times a day.

The water environment is ideal for the baby. It needs to be bathed every day, especially if there is diaper rash. In the first weeks, the desired water temperature is 36-37 °. Then it can be gradually reduced to 32 °. This will encourage hardening.

Very useful massage for children. In the first weeks, this may be a slight stroking of the abdomen. When the baby's weight reaches 3 kg, you can move on to a general massage, adding elements of gymnastics to it. Sessions should be conducted by an experienced specialist.

Walking is allowed provided that the weight of the crumbs is more than 2.1 kg. The duration of the first promenade is 5-10 minutes. Then the duration can be increased to 30-40 minutes 2-3 times a day. In bad weather, it is worth "walking" on the balcony by opening the window. It is important to properly dress the baby so that he does not overheat and does not freeze.

Monthly with the baby it is necessary to go to the pediatrician. During the first year, 2-3 times you need to visit an orthopedist, surgeon, ENT, ophthalmologist. The child's neuropathologist should be shown every 3 months. It is very important to visit doctors in a timely manner in order to detect the slightest deviations at the initial stage.

Nutrition

Proper nutrition is a key point in nursing premature babies. If the baby does not have swallowing and sucking reflexes, he is fed through a tube. In some cases, these automatisms are present, but there are problems with coordination of movements. The way out of the situation is feeding from a syringe without a needle, bottle or spoon. Children weighing 1.8-2 kg are applied to the mother's breast, which are able to actively suck. In any case, in the first days, saline, glucose and vitamins (K, C, E, group B) are administered intravenously to babies. Nutrient solutions may also be given.

The ideal food for premature babies is mother's milk. If direct attachment to the breast is not possible, then the woman should express herself. In case of shortage or absence of milk, special mixtures with an increased level of protein and increased energy value are used. Almost every baby food manufacturer has products designed for premature babies. It is necessary to buy the mixture on the recommendation of a doctor.

After discharge from the hospital, it is advisable to purchase an electronic scale and clearly monitor the amount of milk / formula eaten at each feeding, as well as the dynamics of the baby's weight. Children quickly get tired of sucking, it is worth giving them the opportunity to rest. They should be applied to the chest on demand. With artificial feeding, it is necessary to maintain intervals of 3 hours. The input of complementary foods is carried out according to an individual scheme.

The first months of the life of a child born prematurely is a difficult period for his parents. At this time, it is extremely important to trust the professionalism of doctors, as well as give your baby your love by talking to him and touching him. Modern technologies allow to nurse very premature babies. Up to 2-3 years, they may lag behind their peers in development, but over time, all problems are smoothed out. The main thing is to take care of the child and pay maximum attention to his needs.