Caring for premature babies. Proper care of premature newborns

The birth of a premature baby is a difficult test for parents, and besides, in this case, the risk of developing various diseases increases. The frequency of birth of premature babies is approximately 6-10%. This article will be useful to mothers who want to find the answer to the question of why some babies are born prematurely and how a premature baby is cared for in hospitals and at home.

Signs of immaturity and weight of a premature baby

At 37-38 weeks of pregnancy, the baby in the womb is already quite ready for life. Children born before this term are considered premature. The period of 35-37 weeks of pregnancy is the 1st degree of prematurity (the weight of the baby can be from 2 to 2.5 kg). Doctors determine the second degree of prematurity at 32-34 weeks, the weight of a premature baby is one and a half to two kilograms.

The period of 29-31 weeks is the 3rd degree of prematurity, newborns weigh one to two kilograms. And finally, the 4th degree of prematurity - the birth of a baby for a period of less than 29 weeks and weighing less than one kilogram.

Sometimes it happens that a premature baby was born with a normal weight, but at the same time the following signs immaturity:

weak cry;
irregular or weak breathing;
underdeveloped subcutaneous fat layer;
wrinkled and dry skin, covered with fluff;
open small and lateral fontanelles;
soft auricles, tightly fitting to the head;
muscle hypotension;
absent or significantly reduced physiological reflexes.

When these factors are identified, a newborn child requires special medical supervision.

Problems and causes of the birth of a premature baby

Doctors call the following reasons the birth of a premature baby:

intrauterine diseases of the fetus and malformations;
extragenital pathology in the mother;
isthmic-cervical insufficiency;
gestoses;
premature detachment of the placenta;
professional hazards and bad habits mothers;
anomalies in the structure of the uterus.

How less term pregnancy, the higher the likelihood of developing characteristic diseases that are associated with the incomplete development of the systems and organs of the baby. We list the most frequent problems premature babies:

Underdeveloped lungs due to the lack of surfactant, a substance that prevents the alveoli from collapsing and provides correct work organs. To prematurely born babies, physicians inject drugs containing surfactant, then the lungs adapt to spontaneous breathing.
Retinopathy is damage to the retina of the eye that can lead to blindness.
High susceptibility to infections, including opportunistic pathogens due to underdevelopment immune system.
An open ductus arteriosus requiring surgical or medical treatment.
Problems with digestion of food due to insufficient amount of hemoglobin.

So, main feature premature baby - the immaturity of all systems of the baby and the unpreparedness for life outside the mother's body, so he needs special care.

Caring for a premature baby in a hospital setting

In the early days, babies need to be provided the necessary conditions for further development. First of all, in a hospital setting, an optimal temperature regime is created for the baby, since children's body hard to keep warm.

When children weigh up to one and a half kilograms, they are placed in an incubator, where a constant air temperature is maintained (34-35.5 degrees Celsius). As the baby adapts, the temperature is reduced. The skin of a premature baby is dry, and the mucous membranes and lungs are not prepared, so a device is operating in the incubator that maintains air humidity at 75-80%.

The medical care of a premature baby requires a huge amount of medical procedures Therefore, doctors try to minimize or compensate for stress in the following ways:

Eliminate excess noise. 10% of premature babies are born with deafness and sensorineural hearing loss. Noise disrupts the formation of the auditory pathways, and lowering the noise level reduces the likelihood of hearing loss.
Eliminate bright light. To do this, the incubators are covered with opaque diapers.

Caring for a premature baby at home

If a premature baby was born in the family, the program for nursing an immature baby must necessarily include the following items:

Air humidity and temperature conditions. The room where the baby is located should be warm (at least 25 degrees Celsius). The humidity in the room should be around 50%. This indicator can be monitored using a hygrometer.
Feeding - It is important to feed a premature baby with breast milk, as it provides him with the necessary substances, protecting him from infections. Immature babies need to be fed every three hours, day and night. If the baby is sleeping, you need to wake him up by lightly tickling his nose or ear.
Close contact with mother. In caring for a premature baby, closeness with the mother is important. In order for the early peanut to develop faster and get sick less, it is necessary to spread it as often as possible on mother's belly and cover with a warm blanket on top.
If the weight of a premature baby does not exceed one and a half kilograms, you can take it out to fresh air two weeks after birth, if the weather is warm and the air temperature is not lower than 22 degrees Celsius. The first time it is allowed to walk for no more than ten minutes, daily increasing the duration of the walk by 5 minutes.
Bathing. If a premature baby was born with a weight of more than one and a half kilograms, doctors recommend bathing him only 10 days after birth. For water procedures you need to use boiled water (temperature 38 degrees Celsius).

But in general, mother's love- this is the most important point in caring for a premature baby. If the mother loves the baby with all her heart and believes that everything will be fine with him, then most likely it will be so.

A newborn is considered premature if he was born at a gestational age of 28-37 weeks, has a weight of up to 2.5 kg and a height of up to 45 cm.

The weight of the child is from 2 to 2.5 kg and the height is from 36 to 37 cm.
The weight of the child is from 1.5 to 2 kg and the height is from 32 to 35 cm.
The weight of the child is from 1 to 1.5 kg and the height is from 28 to 31 cm.
Child weight up to 1 kg and height up to 28 cm.

Caring for a premature baby in the first months after birth requires a special approach from parents. Most parents of such a baby, faced with a problem premature birth They don't know how to take care of him. There are certain rules that will help to cope with such a problem.

Features of premature babies

Premature babies differ from babies born at term, not only in appearance, but also in their physiological and psychological state, namely:

Respiratory system. In a baby born at term, the lungs straighten out during the first cry and remain in this form. In a premature baby, the lungs do not expand well and may collapse again. Therefore, such babies have uneven and shallow breathing, which is not always able to provide the child's body with oxygen. Often happens congestion, which provoke the development of disorders in the respiratory system and can lead to pneumonia. To prevent such phenomena, you should carry the child in your arms and turn it over during sleep.
Thermoregulation. In premature babies, the subcutaneous layer of fat is not formed, such children quickly cool down and overheat. Therefore, body temperature must be maintained artificial methods. At 1 and 2 degrees of prematurity, heating pads, blankets and warm clothes, and at 3 and 4 degrees - the baby is placed in a special incubator, in which he can stay from several days to several weeks.
Digestive system. The baby can often spit up, as he has a poorly developed sphincter that compresses the entrance to the stomach. He also suffers from bloating due to incompletely formed stomach muscles. The intestines function sluggishly, which leads to gas stagnation and painful distension. In turn, this leads to compression of the lower parts of the lungs and difficulty breathing. Through the walls of the intestine, which have increased permeability, toxic substances and pathogenic microflora can enter the body. The liver also performs poorly, which is manifested by "jaundice of the newborn", which may not go away within a month.
The nervous system is poorly developed. Long sleep is replaced long periods wakefulness. The baby may have seizures. He reacts sharply to light, loud or unexpected sounds.
The baby has reduced immunity and can easily become infected with SARS or an intestinal infection.

Feeding a premature baby

Premature babies may not show signs of hunger. This is due to the fact that they nervous system not fully formed, and they simply may not feel hungry. In this case, the baby should be fed every 1.5–2 hours, since his stomach is very small.

When feeding, difficulties may arise associated with a poorly developed sucking reflex. In addition, such a child has weak muscles that help suck and swallow.

It will be easier for the child to eat if he has completely moved away from sleep, so you should help him focus on feeding. Until he can suckle well, you should feed him in silence and with dim lighting. If he starts to fall asleep while eating, you can wake him up.

Lactation

Breastfeeding has undoubted advantages: breast milk contains all the nutrients required for the development of the child, and breast milk contributes to the development and strengthening of the immune system. At first, the baby may not be able to completely suck out all the milk from the breast, so to improve milk production, you should express any remaining milk. If necessary, they can be fed to the child. When feeding, support the head and shoulders of the baby.

Apart from breast milk, a baby may need a children's supplement containing many useful substances. If such an additive is required, its use will be recommended to you by a specialist. Your doctor will help you plan your baby's feeding schedule. To find out how well your baby eats, you should regularly weigh him: thanks to the results of changes in the baby’s body weight, the doctor will be able to find out adequate nutrition the child receives or not.

Artificial feeding

If there are reasons why you can't breastfeed your baby, your doctor will recommend a formula meant for premature babies. This mixture contains significantly more nutrients than formulas for full-term babies.

The feeding bottle will require a soft nipple specifically designed for premature babies. With its help, the baby will be much easier to suck.

At the maternity ward, you will receive information about the amount of formula your baby needs throughout the day.

Premature babies are prone to iron deficiency, so you should take this into account when compiling a child's diet or give the baby iron supplements (as prescribed by a doctor). If this is not taken care of, an infant may run out of iron stores by two months of age, leading to anemia.

Premature baby room

Caring for a premature baby involves a specially prepared room for him, the creation of which requires compliance certain rules, namely:

1) Temperature regime. The most suitable air temperature in a child's room is between 22 and 24 degrees. The room should be ventilated periodically. At this time, it is better to take the baby out of there to avoid hypothermia. In summer, you can leave the window in the ventilation mode, but make sure that the newborn is not in a draft.

2) The body temperature of the baby should be monitored regularly. The optimal temperature for a premature baby is between 36.6 and 37.4 degrees. If the baby has cold hands or feet that have become bluish, he does not have enough warmth. To maintain the temperature of the baby's body, you can use heating pads, putting them under the covers.

However, the temperature under the blanket should not exceed 32 degrees, and the temperature of the heating pad should not exceed 65 degrees. Body temperature should be measured in the morning and evening, as well as when swaddling. If the skin is warm and red, the baby should be dressed in lighter clothing.

The child must not be exposed to direct Sun rays because his skin is very sensitive. In addition, you should not create cold drafts and dry air in the room.

For a newborn, the presence of a mother is important, so periodically lay the undressed baby on your stomach, covering it with a blanket.

3) The humidity in the room is also an important component. It should correspond to an indicator from 50 to 70%. To do this, you can use a humidifier, which has a humidity control sensor. With its help, the air will always be humid enough for a comfortable stay for the baby.

The most relevant air humidification is in winter period when the heating is on. Instead of a humidifier, you can use various water containers or hang wet towels around the room. This requires constant monitoring of humidity, which can be carried out using a hygrometer.

4) Bed. For the safety of the baby, the gaps between the bars should not exceed 6.5 cm. The mattress should be sufficiently rigid and fit snugly against the frame of the crib to avoid getting the baby's limbs between the frame and the mattress.

The mattress should be tightly covered with a sheet. It is not recommended to put any objects in the crib, they can make it difficult for the baby to breathe.

5) A premature baby should not be swaddled tightly, as it can become supercooled from squeezing the limbs. Also, do not wrap it too tightly, this can lead to overheating. The most comfortable for him will be special clothes designed for premature babies.

If the body weight of the newborn is less than 2 kg, then the clothes should be 1-2 layers more than in children born on time. Use diapers designed for premature babies.

6) You should bathe a premature baby only a week after arriving home. You need to do this very quickly, as he has a tendency to hypothermia. It is recommended to use boiled water for bathing during the first three months.

The bathroom temperature should be between 25 and 28 degrees and the bathing water should be around 38 degrees.

The baby should be bathed carefully, making gentle, caressing movements. After bathing, it should be wrapped in a soft towel.

If the baby's birth weight was less than 1.5 kg, then it should not be bathed for the first 2-3 weeks of being at home. In such a case it is possible to use wet wipes and baby milk, which cleanses the skin.

7) Walking with a premature baby should be done with caution, as he is susceptible to temperature changes. If at birth the baby weighed more than 1.5 kg, you can take him out for a walk 14 days after birth, but only on condition that the temperature outside is at least 22 degrees Celsius. The first walk should not exceed 10-15 minutes, every day you should increase the walk time by 5 minutes, thus reaching 1-1.5 hours.

If the temperature outside is below 10 degrees Celsius, it is recommended to take a baby weighing at least 2.5 kg and 1-1.5 months old for a walk.

8) For a premature baby, medical supervision is mandatory. To avoid infection various diseases, the first months of a baby's life, crowds in the house should be avoided. Control by a doctor should be carried out at home.

The baby should be examined by a pediatrician and a neurologist. During the first two years of life, the baby needs the supervision of a cardiologist, who must periodically do an ECG at 2, 4, 6 and 12 months. It is also required to conduct an ultrasound of the heart at 2, 6, 12 and 24 months. When the child is 14 days old, vitamin D should be started to prevent rickets. Also for these purposes, massage sessions, hardening and ultraviolet irradiation are carried out.

Vaccination of premature babies is also carried out according to a special schedule, which is compiled by a pediatrician.

An important point in the development of a child is to carry out gymnastics and massage with him, however, in order not to harm the baby with such activities, you should consult a doctor on how to properly perform such procedures.

Try to carry the child in your arms more often, talk to him and sing songs to him. All this has a beneficial effect on the development of the baby and his health.

In this article:

If the baby was born before the 37th week of pregnancy, then it is considered premature. And today you can save and go out even babies born at week 28. If the baby is healthy, there are no other developmental deviations, then he has every right to fight for his life. There are some features of care for premature babies. They must be observed, otherwise the life of the baby may be in danger. This includes conditions in the apartment, food, bathing and walking. Yes, it will be possible to walk with him, but only after the baby gains 2800 g of weight.

His life is completely in the hands of his parents. The baby needs your care, touch and care all 24 hours a day. Then he has good chances on normal life. By the age of 3-5, he will be able to catch up with his peers in height, weight and development.

Birth before 37 weeks

Babies born before 37 weeks of gestation are considered premature. Of course, the closer to this deadline it was possible
be born, the better for the baby. The minimum gestation period here is 28 weeks. Of course, this is very little, but thanks to the care of doctors, even seriously premature babies often survive.. When giving birth as early as 28-30 weeks, the baby will have to spend a lot of time in the hospital before you can take him home. But if the baby was born at 35-36 weeks, then this is not bad: he is strong, quite developed. The kid has the right to live, and parents must fight for his life.

Of course, such a baby needs special care. He will spend the first time in the hospital. The peculiarity of such children is underdeveloped lungs. They are not yet mature enough, so special equipment may be needed at first. But very soon the baby will be able to breathe on its own.

The usual parameters of a premature baby are as follows: weight less than 2.5 kg, height less than 45 centimeters. He seems tiny compared to a full-term baby. However, even these sizes are still considered large.
There are several types of prematurity:

weight 2500 g, height up to 36 cm;
weight 2000 g, height up to 35 cm;
weight 1500 g, height up to 27 cm;
weight up to 1000 g, height up to 26 cm.

Today, in most cases, all these babies have a chance. Especially if they do not have developmental defects or malformations. Only 15 years ago, a baby weighing up to 1000 was generally considered a miscarriage. No one fought for his life: there were no opportunities, no skills for doctors, and no suitable medicines.

Causes of preterm birth

Pregnancy can proceed normally, and childbirth begins
prematurely. Why is this happening? There are many options.

If a woman feels discomfort, attempts even for such a short period as 28 weeks, then you should immediately call an ambulance. This can save the life of the baby, and sometimes the mother. Premature births must be done in a hospital. No experiments with home births can be carried out here.

Some features of premature babies

Care in the hospital

After birth, the baby will be provided special conditions. It all depends on how early
term he was born. He will be placed in an incubator where the optimum temperature for him will be maintained.

And a prerequisite is a sterile zone, where viruses and infections do not penetrate, which are now deadly for crumbs. He seems to be sleeping all the time. In fact, the baby has to exert all his strength in order to develop faster, adapt to life. He also wants to live and fights for life with every breath he takes.

home care

If the doctors have allowed you to take the baby home, this is a great sign. Now there is no threat to his life. It will take very careful care of him all 24 hours a day. It is best if mom and dad do this, without involving nannies and nurses. It is dangerous for him to contact different people, so for the first couple of months, limit any contact. He must gain strength.

The necessary conditions

We create the necessary conditions at home. Most importantly, keep the temperature at 22-24C.
The baby must be warm all the time. It is very useful to take him in your arms: mom can warm him with her warmth, and he will also hear the sound of her heartbeat. So the baby is much calmer. He does not yet understand that he was born into the world - for him, gradual development continues. It is necessary to make his life in the first 2-4 weeks resemble intrauterine development.

Heat in the room and bed.
Dimmed light, no bright bulbs.
Do not turn on the TV in the room, make loud sounds and strong vibrations.
Humidity must be maintained.

So he will gradually adapt to life in the new conditions. Pick it up more often, but be very careful. His bones are still very weak - you can easily damage them. He will sleep and eat most of the time. The life of a baby is not much different from a full-term baby in the first weeks.

Do
wet cleaning every day. Dust harms such children. She can carry staphylococcus on herself, which will simply kill such small child. And the dust makes it hard to breathe. For a healthy, full-term baby, it is not as scary as for a premature baby.. Especially in summer time, when it's hot. It's best to put a humidifier in his room.

You will definitely be visited by a doctor to check the condition of the child. If the baby is unwell, has a too strong heartbeat and difficulty breathing, immediately call an ambulance. Now it is important to react correctly and in time if his condition worsens.

Lactation

Premature babies have a very weak sucking reflex. If at 34-36 weeks it is still there, then earlier it may simply not be. The baby is not yet able to eat. Mom has to stimulate sucking so that he can eat milk. Mom's milk is now the best medicine for him, the opportunity to gain weight and gain immunity. Feeding can be hard, but you can't give it up. Of course, for premature babies there are
special mixtures rich in vitamins and everything you need. But they should only be used as a last resort.

It happens that the woman herself has too little or no milk. This happens, especially if the baby was born early. Then you should consult with your doctor.. He will prescribe you drugs that will stimulate the flow of milk. If there is such a need, the mixture can be used as complementary foods: it will help you gain weight faster. But still, the main food of the baby is mother's milk.

Bathing

Bathing a newborn is essential. Many mothers think that such a procedure can harm the baby. This is not so, but quite the opposite: he is used to the aquatic environment and he even lacks that cozy state. Bathing your baby is best in the evening. Can be left
it in the bath for 5-10 minutes. This will help him:

relax, feel more comfortable;
learn to regulate body temperature;
adapt to changes in the external environment.

Water should be pleasant, warm. Optimum temperature for a bath - 37C. Be sure to support the baby on your arm when you bathe. Now he needs only warm boiled water. No soap or baby shampoo: the skin is very thin, and even baby soap might dry it out. Dry skin - wounds appear. And this is a direct path for dangerous infections.

Walks in the open air

Walking with the baby is possible and even necessary. But only when his body weight is at least 2800 g, the doctor let you walk. Fresh air, sounds, light will help the baby to better adapt. In such children, the brain does not yet fully understand that the birth has occurred. He behaves as if the baby is in his mother's tummy. Meeting
with new sounds, images, temperature changes will help him adapt and understand more quickly: he was born, his independent life began.

If the baby was born in winter, then it is better not to take him outside in the cold. Then just ventilate the room often. It is quite possible to walk up to -10C, but the walk time will be limited to 10 minutes. You can’t catch a cold now: because of weak immunity it is very dangerous for the baby. In the heat, it is also better not to take him outside for a long time.

Vaccinations

Immunizations for a premature baby will not be given according to the usual plan. Everything is transferred to next year when he grows up and gains enough mass.

Further development

The development of a premature baby will go a little slower than a full-term baby.
Parents should not be afraid of lagging behind in weight gain or height. Your baby is developing on his own schedule, and not like other babies. It is best to listen to the advice of a doctor, and not "knowledgeable" neighbors and relatives. Overfeeding such a crumb so that he gains weight is a bad idea. His gastrointestinal tract can not cope with the increased load. It is best to wait, gradually increase the dose of feeding.

When will the baby catch up with peers?

Don't worry here: it will catch up, and very soon. At 3-5 years old, there will no longer be any difference between babies.. IN kindergarten no one will even guess that your baby was born prematurely. Especially if the period was minimal - 2-4 weeks earlier.

Does he need vitamins?

Likely extra vitamins and useful material baby will need. Such children are more likely to suffer from rickets, and this should not be allowed. Vitamins and doses should be determined by the doctor, based on weight and general condition. Most often, these are supplements with calcium and vitamin D, E.

Do you need a massage?

In order for the muscles of the crumbs to tone up faster, it is advisable to give him a massage.. It is best to contact a professional children's massage therapist. The specialist knows how to quickly bring the baby into good shape.

Will prematurity affect mental development?

If from the first days the child was necessary care and it develops normally, then no- his mental development will be no worse than that of full-term children. And in some cases even a little ahead of them, because premature baby much earlier I encountered information about the world: sounds, smells, sensations. This stimulates the brain to work harder.

A newborn baby, regardless of birth weight, is considered premature if born between the 22nd and 36th weeks prenatal development(for full-term, this period is 37-40 weeks). The degree of maturity of the newborn depends on its ability to live outside the womb and adapt to the conditions of the external environment. The concept of maturity is most closely associated with gestational age (the period of intrauterine development). This indicator is the main one in assessing the nature of intrauterine development of the fetus. Based on gestational age, there are four degrees of prematurity: I degree - term gestation 36-35 weeks, II degree - 34-32 weeks, III degree - 31-29 weeks, IV degree - 28-22 weeks. Birth weight is not an absolute indicator of prematurity: premature babies are often born weighing more than 2500 g. low body weight (less than 1000 g).

The reasons for preterm birth of children are numerous and sometimes difficult to identify. Usually they are not isolated, but combined with each other. The main groups of causes and provoking factors of preterm birth are distinguished: 1) data of aggravated obstetric history(three or more previous abortions, short intervals between births, multiple pregnancy, breech presentation, surgical intervention); 2) severe somatic and infectious diseases of the mother; 3) fetal diseases ( intrauterine infections, chromosomal diseases, immunological conflict between the pregnant woman and the fetus); 4) socio-economic factors (primiparas under the age of 18 and over 30 years, height less than 150 cm, body weight 45 kg, low social status, genetic predisposition). Provoking moments include physical and mental trauma, lifting weights, falling and bruising a pregnant woman. Anatomical and physiological features (AFO) of a premature baby. Morphological signs of prematurity. The appearance of premature babies has a number of signs that are directly dependent on the gestational age. The lower the gestational age of the child, the brighter they are expressed and the more there are. Some signs are used to determine the gestational age. These include: skin, auricles, areolas of the nipples, furrows on the feet, sexual characteristics. A very premature baby has thin wrinkled skin of dark red color, abundantly covered with fluff (lanugo). auricles soft, adjacent to the skull, with a short gestation period, they are devoid of relief, shapeless due to underdevelopment of cartilage tissue. The areolas of the nipples are underdeveloped, less than 3 mm, with deep prematurity they may not be determined. The furrows on the feet are rare, short, shallow, appear at the 37th week of pregnancy, at the 40th week of gestation they become numerous. The scrotum in boys is often empty, the testicles are in the inguinal canals or in abdominal cavity. For girls, the gaping of the genital slit is characteristic - the large labia do not cover the small ones, the hypertrophied clitoris is clearly visible. A premature baby has a small size, a disproportionate physique (relatively large head and torso, short neck and legs, low position umbilical ring). The brain skull prevails over the facial. The sutures of the skull and fontanelles are open. The subcutaneous fat layer is not expressed. Functional signs of prematurity. Preterm infants are characterized by immaturity of all organs and systems, the severity of which depends on the duration of pregnancy. Neurological signs of prematurity are muscle hypotension, decreased physiological reflexes and motor activity, violation of thermoregulation, weak cry of the child. Children are periodically restless, there is an intermittent tremor of the chin and limbs. Breathing is 40-90 breaths per 1 min, uneven in rhythm and depth, interrupted by convulsive breaths and pauses (apnea) lasting up to 10-15 s, which is more often observed in very preterm infants with hypoxic lesions of the central nervous system. With a longer cessation of breathing, asphyxia (suffocation) may develop. The pulse is labile, from 100 to 180 in 1 min. Arterial pressure does not exceed 60-70 mm Hg. Art. Thermoregulation in a premature baby is imperfect. Children quickly cool down and just as quickly overheat. The peculiarity of the temperature reaction is manifested in the fact that when overheated, the body temperature can rise to 40 ° C, and in response to the introduction of infection, premature babies may not respond with an increase in temperature. Sucking and swallowing reflexes are underdeveloped. Often there is a violation of the coordination of sucking and swallowing. There is a tendency to regurgitation, vomiting, flatulence, constipation. The absence of a cough reflex contributes to the aspiration of food. Due to the imperfection of the immune system, premature babies are prone to infectious diseases. Increased permeability and fragility blood vessels contribute to violations cerebral circulation and hemorrhages. Peculiar in preterm infants borderline physiological states: more pronounced and prolonged physiological erythema, loss of initial body weight, jaundice. Mild jaundice may be accompanied by severe bilirubin encephalopathy. The umbilical cord falls off later than in full-term ones (on the 5-7th day of life), umbilical wound heals by the 12-15th day, with a weight of less than 1000 g - 1-2 weeks later.

Organization medical care. The problem of nursing premature babies is extremely difficult, since children are not yet ripe for existence outside the mother's body. To preserve the viability of premature babies, it is necessary to create special conditions both at the time of birth and during the subsequent adaptation of the child. To this end, assistance to premature babies is provided in stages: providing intensive care and treatment in the maternity hospital (I stage of nursing); nursing in a specialized department (stage II); dynamic monitoring in a children's clinic ( Stage III). The main goal of stage I is to save the life of the child. In the first hours and days after birth, if necessary, intensive care is provided, careful care and supervision are provided. Not later than 1 hour after birth, the child is transported to the neonatal unit (to the ward for premature babies) or, in case of serious condition, to the intensive care and resuscitation unit. Healthy babies with a birth weight of more than 2000 g are discharged home from the maternity hospital, all other premature babies are transferred to a specialized department for the second stage of nursing.

The main direction of work of the specialized department is treatment and rehabilitation. Therapeutic measures are aimed at eliminating hypoxia, preventing anemia, rickets, malnutrition. important means rehabilitation of children with CNS lesions are therapeutic exercises, massage and exercises in the water. The discharge from the department of the II stage of nursing is approached individually. The main criteria for resolving the issue of discharge are the absence of diseases, the restoration of the original body weight and its satisfactory increase, normal level hemoglobin, favorable home furnishings. All information about the child is transferred on the day of discharge to the pediatric site. Features of care. Premature babies are cared for physiological characteristics: imperfections in thermoregulation, reduced tolerance (endurance) to food, inclination to asphyxia, insufficient resistance to infection, immaturity of organs and systems. When nursing premature babies, it is necessary to create comfortable microclimatic conditions. Cooling a premature baby in the delivery room often dooms the whole, further care behind him, the temperature in the ward should be 24-26˚С; humidity -60%. In the first days and weeks of life, very premature babies or premature babies in serious condition are nursed in incubators. The temperature is maintained in them from 36˚С to 32˚С, the air humidity in the first day is up to 90%, then - 60-55%, the concentration of humidified oxygen is about 30%. Optimal temperature regime is a mode in which it is possible to maintain body temperature within 36.5-37˚С and exclude overheating and cooling of the child. The level of oxygenation is selected individually: it is advisable to provide a minimum excess oxygen concentration, at which the signs of hypoxemia disappear (cyanosis skin and mucous membranes, low motor activity, rare breathing with prolonged apnea, bradycardia). It is not recommended to create an oxygen concentration of more than 38% in the incubator because of the possibility of damage to the lungs, retina and central nervous system. The duration of oxygen supply should also be controlled. Disinfection and change of incubators are carried out for 2-3 days. A child in need of incubation is transferred to a clean incubator. Transfer to the crib is carried out in the absence of respiratory disorders, maintaining a constant body temperature, the ability of a premature baby to manage with minimal oxygenation. For additional heating, heated beds, thermal mattresses, thermal protective film, heating pads are used. When performing procedures that are short in time, heated changing tables and radiant heat lamps (“Ameda”) are used. Children nursed in cribs are dressed in undershirts with sewn up sleeves. Special attention should be given to monitoring the condition of the child, control the temperature and humidity of the room, the parameters of work and processing of the incubator, observe the strictest measures of sanitary and anti-epidemic regimes. Great importance has a protective regime: limiting pain stimuli, protecting the child's sleep, careful toileting and manipulation, strict adherence to the order of diagnostic and therapeutic procedures. The mother must follow the rules of personal hygiene and maintain proper sanitary conditions when caring for the child. The feeding of premature babies has a number of peculiarities. They are due to the high need of the child for nutrients, the immaturity of his gastrointestinal tract, requiring careful introduction of food. The composition of breast milk varies depending on the duration of pregnancy. That's why mother's milk best suited to the needs of the child and ensures maximum success in nursing. The newborn should receive it, even if the amount of milk is minimal. To stimulate milk production, frequent pumping is recommended (at least 8 times a day). In the absence of milk, premature babies provide donor milk, in exceptional cases, they use adapted milk formulas intended for feeding premature babies (“Enfalact”, “Nenatal”, “Pretutteli”, “Prenutrilon”, “Prepilti”, “TreHiPP”, “SMA-Premi”, “Novolakt-MM” , “Detolakt-MM”, “Humana O”, etc.), as well as “Alesya-1”, mixtures enriched with biological additives. The time of the first feeding of the child is determined individually. Depending on the severity of the condition, the premature baby is breast-fed, with a spoon or from a cup, through a tube. The frequency of eating depends on the type of feeding, the ability of the child to retain milk in the stomach and the activity of suckling. Babies with a weak sucking reflex receive milk through a stomach tube. The multiplicity of feeding through a tube is usually 7-8 times per sudki. With prolonged tube feeding using a syringe dispenser or infusion system, the time for introducing milk should not exceed 3 hours. Children with a swallowing reflex and a weak sucking reflex are fed from a spoon or cup. The spoon is partially filled and controlled so that the milk is poured over the tongue and swallowed without accumulating under the tongue. Feeding from a nipple makes breastfeeding difficult in the future. As the general condition improves and the sucking reflex appears, the child is applied to the breast. Breastfeeding and close contact with the mother is even more important for premature babies than for term babies. If the condition allows, it is recommended to lay the naked baby on the mother’s chest as early and often as possible (the “kangaroo” method). A premature baby cannot suckle effectively and is supplemented with expressed milk. Babies with active suckling are breastfed. While breastfeeding, help your baby find correct position and warn the mother that milk should not remain in the newborn's mouth because of the danger of aspiration. In case of aspiration, it is necessary to stop feeding immediately, suck the contents from the upper respiratory tract, place the child in a raised head position, provide oxygen and notify the doctor. The amount of food per feeding on the first day of life is usually 5-10 ml of milk, on the second - 10-15 ml, on the third - 15-20 ml. The daily amount of food in the first 10 days of life can be calculated using the Romell formula: (10 + n) x m: 100, where n is the number of days of life, m is the weight of the child in gamma. For example, on the 4th day for a child weighing 1600 g, the daily amount of milk is: (10 + 4) x 16 \u003d 224 (ml). Every day its amount increases and by the 15th day of life daily requirement milk is 1/7 of body weight, by the end of the 1st month - 1/5 of the mass. The daily amount of food can be determined using the caloric method. The need for calories up to the 10th day of life is (10hp) kcal x kg of body weight per day, where n is the number of days of life; by the 15th day -120 kcal/kg, at the age of 1 month - 140 kcal/kg, by the age of 1 year - 120 kcal/kg. Calorie content of 100 ml of breast milk is 70 kcal (colostrum - 140 kcal). For example, a child at the age of 1 month has a weight of 2500 g and, therefore, needs 3500 kcal / day. The daily volume of food is 350 kcal x 100 ml: 70 kcal = ml. To meet the increased need of premature babies for vitamins and mineral salts, more early introduction corrective additives and complementary foods.

Nursing at home. When nursing premature babies, it is necessary to ventilate the room more often, maintain the air temperature in the room at 20-22 ° C, while bathing - 22-26 ° C, depending on the maturity of the child. Bathe children daily at a water temperature of 38-39˚С. In the warm season, walks begin immediately after discharge, in the cold - from 1-2 months of age with a body weight of at least 2500-3000 g and an air temperature of at least 1-3 ° C. Most premature babies no longer need special heating by the end of the 1st month. The child needs a sparing sleep and wakefulness regimen. Training hardening methods ( air baths, contrast douche after bathing, etc. e) are carried out in the second half of life. From exercise until the disappearance of physiological muscle hypertension, only stroking and reflex exercises are allowed. Proper development premature babies contribute to a favorable home environment, individual sessions, games, rational nutrition, the strictest observance of the sanitary and hygienic regime.

Features of the development of premature babies. Physical development premature infants is characterized by a higher rate of increase in body weight and length during the first year of life compared to children born at term. The exception is the first month of life, when there is a low weight gain due to a greater loss of initial weight than in full-term ones. Growth for the first year increases by 27-38 cm. Despite the high rates of development, in the first 2-3 years of life, premature babies lag behind their peers who were born full-term in terms of body weight and height. During the first 1.5 years of life, the rate psychomotor development premature babies are delayed, the formation of the leading lines of neuropsychic development is shifted in time to a later age stage. This delay depends on the gestational age of the baby. Most premature babies have normal mental development, but may be unstable mental state, reactions of negativism, anxiety, insomnia, appetite disorders, difficulty in taking solid food.

Forecast. Behind last years There has been an improvement in survival rates and quality of life in surviving preterm infants, including those with very low birth weight. There are many problems associated with nursing and subsequent neurodevelopment in infants weighing less than 1000 g and less than 29 weeks' gestation. Mortality in these children continues to be high, as well as the frequency of disorders of the nervous system and disability (cerebral palsy, visual and hearing defects, delayed mental development). Prevention of premature birth of children. It provides for the following: protecting the health of the expectant mother, starting from the very early childhood; warning medical interruption pregnancy; creation of favorable conditions for a pregnant woman in the family and at work; timely detection of pregnant women with the threat of preterm birth and monitoring them during pregnancy.

Care premature baby the same as for full-term. Only more careful, gentle, attentive. And there are good reasons for this: all the organs and systems of the baby are just beginning to mature, and therefore they are not yet working in the “regular mode”, but in a special one.

In a premature baby, the nervous system is still being formed, and for the first weeks the baby may not even understand whether he is full or hungry. And even with severe discomfort, he does not scream, but only cries quietly or silently opens his mouth.

Born premature. What to do?

Room - prepare!

Living conditions are very important for a premature baby. Of course, you need to select the brightest room, constantly ventilate it, maintaining the air temperature within 22-25 degrees, that is, two degrees higher than recommended for ordinary children. Humidity is another important indicator to be controlled. It should be more than 50 and less than 70%. It is better to purchase a humidifier with a built-in hygrometer that turns on automatically when needed.

Crib choose stable with frequent rods of the sidewalls. In the first months, while the baby is not able to roll over, he is more comfortable in the cradle.

Remember: soft toys there is no place next to the baby! As soon as the baby is placed in the crib - all foreign objects are removed from it.

Temperature - control!

A baby born prematurely cannot maintain body temperature, so you need to be extremely careful when dressing it. In the first days after discharge, it is recommended to measure body temperature three times a day in order to understand when the little one is comfortable and when not. The normal spread of indicators is in the range from 36.6 to 37.4 degrees. You can also refer to appearance: if the baby's limbs are bluish or pale - it freezes, if the face is red - it's hot.

In the event that your little miracle is constantly freezing, you can use the “dry heating pads” method. In one and a half liter plastic bottles pour water at a temperature of about 60 degrees. Wrap them in several layers of diapers and put: one in the legs of the crumbs under the blanket, and two on the blanket, on the sides. In this case, the temperature under the blanket should be 32 degrees.

Please note: thermoregulation is imperfect and you can overheat the baby. Make sure that he is comfortable, and the bottles do not come into contact with the baby's skin, even through the fabric. They need to be changed in an hour and a half, in turn, so that the "nest" is always warm.

It is better not to use electric heating pads - they, according to statistics, often lead to overheating and burns.

It is best to buy clothes and diapers in a specialized store - strictly in size. Swaddling is not recommended - their body is too tender and the little ones suffer greatly from the slightest squeezing - blood circulation and thermoregulation are disturbed. choose the softest clothes corresponding to the size of the crumbs.

Feed - by the hour

Feeding is the most important task of the mother of a premature baby. There is something to work on: the baby does not scream, and cannot suckle for a long time, and the breast takes badly ...

Therefore, we feed:

breast;
by the hour (every 1.5 - 2 hours);
in a shaded quiet room, where nothing distracts the baby from such an important activity;
periodically waking up if he dozed off at the chest.

If breast-feeding impossible, the baby needs to be fed with a special formula for premature babies. It is more concentrated, gives the baby more energy with the same “labor”. You need to put on the bottle the softest nipple with a hole of sufficient diameter so that the baby spends as little energy as possible on sucking and does not get tired.

On hand - wear!

It's amazing, but babies, which mothers often take in their arms, grow and develop faster. For those born prematurely, contact with the skin of the parents is necessary. The more and more often, the better. It is usually recommended that mom or dad bare their torso, put the undressed baby on their stomach or chest and cover with a blanket. If there is no time to lie down, a sling helps out.

Hygiene - observe!

There are problems with this item too. The skin of the crumbs should be clean, however, it is not advisable to bathe and wash it in the first days - water (even warm!) Can quickly overcool the baby, and if you make it a little hot, you will burn it. Therefore, actively use baby wipes, resort to water in exceptional cases, and after water procedures, be sure to warm the baby with your body heat.

You can bathe in the bath after the baby has begun to weigh 2.0 kg, using boiled water for the first 2-3 months without foams, shampoos and herbal decoctions.

The bathing room should be warm (25-28), and the water temperature should be 38 degrees. This must be monitored with thermometers.

The duration of bathing is no more than two minutes, rinsing is not necessary. After the procedure, wrap the wet baby in a super soft towel and warm.

Walking is right!

You need to walk with a premature baby in any weather, except for excessively frosty and windy. Choose a stroller for walking with high sides to prevent the penetration of cold air. In summer, do not allow even a short-term exposure of direct sunlight to the skin of the crumbs - it will instantly burn, and you will not even notice.

Diseases - warn!

Premature babies easily get sick with all kinds of infections, so in the first months after discharge - no guests! If the guests still came - let them be in the next room, they will look at the baby when he grows up.

By two months, almost all newborns develop Iron-deficiency anemia. But, since the mother and the doctor know about this in advance, they take action - they look for a special mixture with a high iron content or give iron supplements.

Small children are more prone to rickets. You need to remember about this and take vitamin D at the dose prescribed by the pediatrician.

As soon as vaccinations are allowed, the doctor will draw up an individual vaccination schedule, which must be strictly adhered to. Children's infections, even grown-up children born prematurely, endure extremely hard.

Pediatrician - listen!

The pediatrician will come to your home quite often, and even more often you will meet with your district nurse. Be sure to contact them and listen to their advice. In the first year of life, the baby needs frequent examinations by a neurologist, ophthalmologist, cardiologist and additional methods research: ECG, ultrasound of the heart, examination of the fundus - in order to suspect something was wrong in a timely manner, make the correct diagnosis and immediately take action.

As soon as the baby weighs 2.5 kg, care for him will be the same as for a normal newborn.

And your child was born with what weight and height?