Premature girl meh. "My crazy girls": the father creates funny photos of his daughters. Vaccination: when to get vaccinated

A premature girl was born with a body weight of 1500 g, a length of 40 cm, a head circumference of 29 cm, a chest circumference of 26 cm. Childbirth at the 32nd week, there was a prenatal outflow of water, a single tight entanglement of the umbilical cord around the neck. Apgar score 2/3 points. ALV was started in the delivery room, Kurosurf was introduced.

The child's condition is very serious. From the fourth day - attacks of clonic-tonic convulsions. Is on IVL with a frequency of 46 in 1 minute. She is fed with expressed milk through a tube. The skin is pale, clean. Breathing is carried out in all departments, there are no wheezing. Heart sounds are clear, rhythmic, 152 beats/min. The abdomen is soft, painless, the liver is +1 cm from under the edge of the costal arch. Stool with mucus. Diuresis is normal. Reflexes of the newborn are not called. Muscle tone is asymmetrical: higher on the right than on the left. Tendon reflexes on the right are animated, convulsive readiness is noted. The large fontanel is 3x3 cm, pulsates, there is a divergence of the sagittal suture by 0.2 cm, the small fontanel is open.

Hemogram on the 4th day: hemoglobin 90 g/l, erythrocytes 2.5xl0 12 /l, CP 1.0, leukocytes 9.8xl0 9 /l, n/nuclear 3%, s/nuclear 44%, eosinophils 0%, lymphocytes 47%, monocytes 6%.

General analysis of urine: clear, no protein and glucose, leukocytes 3-4 in p / c.

The study of cerebrospinal fluid (4th day of life): the color is bloody, cytosis is increased due to fresh erythrocytes (covering all fields of vision), counting is impossible.

Neurosonogram (4th day of life): the brain parenchyma is poorly differentiated. The left lateral ventricle is enlarged in all departments, the diameter is 12 mm, echopositive inclusions are present in the cavity. The right ventricle is expanded to 10 mm. The cavities of the transparent septum, the large cisternae, and the 3rd ventricle were dilated.

Exercise:

1. List the available syndromes, indicate the leading syndrome.

3. Carry out differential diagnostics.

4. Substantiate and formulate a clinical diagnosis in accordance with the modern classification.

5. What additional laboratory and instrumental research should be done for this child?

6. Etiology and pathogenesis of this disease.

7. What complications can occur in this disease, outcome?

8. Give treatment.

9. Make a plan for dispensary observation.

Answer: Hypoxic-hemorrhagic lesion of the central nervous system, bilateral intraventricular hemorrhage of the III degree, acute period; depression syndrome, convulsive syndrome. Osl.: Posthemorrhagic anemia. Sop.: Prematurity, gestational age 32-33 weeks, very low body weight.

19.11.2012, 21:29

Hello!
Daughter Zhenya was born 680g and 31cm, 28 weeks. natural childbirth. Diagnoses at discharge from home are cerebral, ischemia of the 2nd stage, IPVC of 2-3 degrees, hypertension syndrome, rough syndrome of general depression. Currently, she has a diagnosis of mild spastic tetraparesis, rougher in the legs, in the neurological status - convergent strabismus, against the background of diffuse hypotension, muscle tone is increased in the distal extremities, tendon reflexes of the arms and legs are spastic, equal,
Now we are 2 years old. Weight 8500, height 79cm.
Motor development:
-holds her head vertically from 6 months, but when tired up to a year, she approximately tilted forward. She did not hold her head on her stomach until she crawled on all fours - there was no support on her hands.
- flips from stomach to back - 10m, from back to stomach 11m.
- did not crawl on the plastunsky
- crawled on half-fours (head on the floor, hands either under him or on the sides, do not participate in crawling) in 1g.4m.
- got on all fours at 1g.5m.
- crawled on all fours at 1 year 5 months 2 weeks.
- got up, she went to the support at 1 year.5m.2 weeks.
- sat down from all fours at 1.6 m., from a prone position, she still cannot sit down. He sits mostly on his knees, buttocks between the feet. With straightened legs, he sits uncertainly, if the legs are bent, he can sit longer, sometimes he helps himself with one hand. The back is also not very straight in this pose.
At the moment, he crawls quickly and confidently, stands at any support, climbs and gets off the sofa, loves to climb obstacles - slides, steps, pillows, stands, holding on with one hand, can walk a couple of meters along the sofa or go around his crib, in the crib can move from one long side to the opposite (i.e. across), can walk by one handle, but not very confidently, often walks somehow sideways. Refuses to walk behind push gurneys, can quickly follow her on her knees, tries to walk on her knees without support, but it turns out to be practically marking time. Can quite confidently kneel without support, jumps on them.
The main problems are that she does not get up and does not stand without support. There were several times that, having played too much and not noticing that they were not supporting her, she stood for 20-30 seconds, once she stood up on the bed, pushing herself away from me. But these are isolated cases, she herself does not strive and is generally very timid and cautious. Recently, she has become even more afraid, although she has not fallen.

1) tell me how you can teach to squat? We don't have them at all. He descends from the support, putting his foot on his knee. On the ass, she slapped only a couple of times when she was not kept at the support. With great difficulty, he gets off the potty chair, overturning it (for now we are just getting to know him) And probably this also applies there - he can’t spring his legs when he jumps on the ball - his legs are straightened, feet are often on tiptoe.
2) when he sits down at the support, he brings his knees inward, the foot of the leg, which he lowers on his knee, also looks inward and somehow sideways. Stands up correctly - the foot is either straight or slightly outward, the knee is also outward. Is it a pathology? How can this be corrected? Chicks are also often present when standing at a support. As a rule, these are the first one or two movements, then it adapts and stands on a full foot.

And if I may, a few more questions on psycho-emotional development.
Zhenya speaks well (a lot of words, sentences of 2-3 words, sings short songs by Zheleznova), the pronunciation is poor. Names and correctly shows colors, shapes, animals, etc. Good imagination and memory. But there are a few things that bother me:
1) Games: does not play cubes, pyramid, sorter, puzzles. Fine motor skills are far behind us, as soon as it doesn’t work out, the daughter immediately loses interest. We have a maximum sorter - to shove a couple of figures in passing and crawl further, there is not even such interest in the rest. Tried to beat role-playing - to no avail. She plays practically only role-playing games alone or with a soft toy (she is a hamster, a kitten, goes to bed in a house, eats cutlets from a bowl, plays catch-up, etc.) - At one time she drew a lot, now she is not interested. I can't understand - is she not interested at all, or simply does not understand the meaning of such games? Is such a shift dangerous?
2) I just can’t teach you to play hide and seek, or rather hide yourself. She's only interested in looking for me. If I hide it and tell it to sit quietly while I look for it, it crawls out almost immediately. Similarly, catching up - does not run away, crawls a meter and smiles. It's chasing me.
3) Zhenya does not correlate well with his size and the size of the surrounding things - i.e. will try to climb into a box in which it obviously does not fit
4) Doesn't understand how to get out of bed. We removed a couple of rods, it climbs in on its own, but it crawls out where it wanted right now. In general, the problem with avoiding obstacles is trying to go directly, through the sofa, for example, or through your crib.
5) Zhenya stubbornly asks to get the item from the picture. I have been explaining to her for a very long time that these are painted objects and you cannot take and touch them, at the same time I showed real and painted toys. She knows this, she says that it’s drawn and that it’s impossible to take it, but there’s no realization or something, all the same, either the ball from the picture will ask, or the mouse. A couple of times this happened with the TV.
Tell me, please, is this really a problem or did I invent it myself and it's time to treat me?
Thank you very much! And sorry for such a large volume.

23.11.2012, 21:40

Good evening.
- sat down from all fours at 1.6 m., from a prone position, she still cannot sit down. and shouldn't :)
He sits mostly on his knees, buttocks between the feet. With straightened legs, he sits uncertainly, if the legs are bent, he can sit longer, sometimes he helps himself with one hand. The back is also not very straight in this pose. Here's what you need to do. try planting on a slight elevation, or better on a wedge-shaped pillow. In this position, you will sit confidently and your back will straighten. Toys are best offered at chest level, periodically from the side.
At the moment, he crawls quickly and confidently, stands at any support, climbs and gets off the sofa, loves to climb obstacles - slides, steps, pillows, stands, holding on with one hand, can walk a couple of meters along the sofa or go around his crib, in the crib can go from one long side to the opposite (i.e. across), This is wonderful.
Can walk by one hand, but not very confidently, often walks somehow sideways. Refuses to walk behind push gurneys, can quickly follow her on her knees, tries to walk on her knees without support, but it turns out to be practically marking time. Can quite confidently kneel without support, jumps on them. You can't lead by hand. Try to help walk by supporting the back of the pelvis.
The main problems are that she does not get up and does not stand without support. There were several times that, having played too much and not noticing that they were not supporting her, she stood for 20-30 seconds, once she stood up on the bed, pushing herself away from me. But these are isolated cases, she herself does not strive and is generally very timid and cautious. Recently, she has become even more afraid, although she has not fallen. Don't fixate on it just yet, her fear may be caused by your attention.
A few questions, if I may:
1) tell me how you can teach to squat? We don't have them at all. He descends from the support, putting his foot on his knee. On the ass, she slapped only a couple of times when she was not kept at the support. With great difficulty, he gets off the potty chair, overturning it (for now we are just getting to know him) So teach: plant on a raised platform, for example, a sofa cushion, a book and put toys in front. The game will sometimes fall on all fours.
And probably this also applies there - he does not know how to spring his legs when he jumps on the ball - his legs are straightened, feet are often on tiptoe. If there is a tendency to stand on toes, I would not force this side yet. It is too early
2) when he sits down at the support, he brings his knees inward, the foot of the leg, which he lowers on his knee, also looks inward and somehow sideways. Stands up correctly - the foot is either straight or slightly outward, the knee is also outward. Is it a pathology? How can this be corrected? This is an internal rotation. It is difficult to get rid of it in movements, but it should not be in postures.
Chicks are also often present when standing at a support. As a rule, these are the first one or two movements, then it adapts and stands on a full foot. It is not clear: when he gets up or when he stands or when he walks.
3) from time to time I notice Zhenya's hand tremor with an amplitude of approx. 5 mm, not fast - for example. when he catches the streams of the soul, when he brings a piece of bread to his mouth. The system is difficult to identify, but perhaps most often when very focused on the process. The neurologist said - problems with the cerebellum. But there were never any pathologies on the NSG. What can it
be? (probably, this is not quite your profile, but maybe you have come across?)
This is a medical issue.
1) Games: does not play cubes, pyramid, sorter, puzzles. Fine motor skills are far behind us, as soon as it doesn’t work out, the daughter immediately loses interest. We have a maximum sorter - to shove a couple of figures in passing and crawl further, there is not even such interest in the rest. Tried to beat role-playing - to no avail. She plays practically only role-playing games alone or with a soft toy (she is a hamster, a kitten, goes to bed in a house, eats cutlets from a bowl, plays catch-up, etc.) - At one time she drew a lot, now she is not interested. I can't understand - is she not interested at all, or simply does not understand the meaning of such games? Is such a shift dangerous? Fine motor skills need to be practiced.
2) I just can’t teach you to play hide and seek, or rather hide yourself. She's only interested in looking for me. If I hide it and tell it to sit quietly while I look for it, it crawls out almost immediately. Similarly, catching up - does not run away, crawls a meter and smiles. It's chasing me. This is fine.
3) Zhenya does not correlate well with his size and the size of the surrounding things - i.e. will try to get into a box in which it obviously does not fit. This may be a feature of visual perception. if you figured out the vision, then only motor experience can help you figure out the size.
4) Doesn't understand how to get out of bed. We removed a couple of rods, it climbs in on its own, but it crawls out where it wanted right now. In general, the problem with avoiding obstacles is trying to go directly, through the sofa, for example, or through your crib. The answer is similar to the previous one.
5) Zhenya stubbornly asks to get the item from the picture. I have been explaining to her for a very long time that these are painted objects and you cannot take and touch them, at the same time I showed real and painted toys. She knows this, she says that it’s drawn and that it’s impossible to take it, but there’s no realization or something, all the same, either the ball from the picture will ask, or the mouse. A couple of times this happened with the TV. Another question about vision.
A large volume does not allow you to answer in detail, so the choice is yours. Want to discuss - ask one question.

23.11.2012, 23:58

Polina Lvovna! Thank you very much for your answer! As for one question, I understand, I'm correcting it.

Here's what you need to do. try planting on a slight elevation, or better on a wedge-shaped pillow. In this position, you will sit confidently and your back will straighten. Toys are best offered at chest level, periodically from the side.

Got the idea, thanks! Here you can master both sitting and squatting. There is a suitable sofa cushion with an inclined surface of 10-15 cm high. Only it turns out that she sits on it like on a chair. legs are bent at the knees. Or legs d.b. fully extended? Zhenya more or less sits on low narrow benches, when the legs are bent, if you put him on a wide one, the whole thing is immediately clamped and begins to fall sideways.
There are slight shifts - the last couple of days I began to notice that after dropping an object at the support, it no longer falls on its knee as before, but tries to sit down.

24.11.2012, 18:32

The legs should be bent at the knees.

27.11.2012, 00:44

Hello Polina Lvovna!
Let's try the seat. While the longest time can be spent watching cartoons - min. 10-15. Then he rounds his back and falls to the left with support on his arm. Unfortunately, while picking up a game with toys at chest level for a more or less long time does not work, it quickly crawls away, but I'm experimenting.

Tell me more, please, is there any sense in the “spider” exercise according to Muromov (I don’t know if you are familiar with his methodology, but this is a variant of squats based on hands for 1-2 minutes, 5-7 approaches per day)?
We then rise from this position at the support, i.e. Kind of like training squats.

It is not clear: when he gets up or when he stands or when he walks.

I would like to return, if you will, to the chicks. It looks like this - Zhenya puts the supporting leg on a full foot, rises, the second leg, when it rises, is already leaning on the fingers. Then he either puts the second leg on the foot or puts the supporting leg on tiptoe. Stands a little and falls on full feet. The second option is more common. Also, in the process of moving along the support, it can suddenly rise on tiptoe and so take one or two steps. According to my observations, chicks appear with initial movements, fear or strong excitement. Paraffin and massage help a little, but then everything comes back. How serious is this? Is my daughter really late in walking because of the tone of her feet?

27.11.2012, 21:37

Increased tone, of course, to what extent interferes.
In this case, as you describe it, it's like an emotional tone. Try how you can walk barefoot on a prickly rug.
The spider exercise is not bad, but it does not have much significance. You can do it in a row with others, especially if this pose has become a transition to other poses.

01.12.2012, 00:49

01.12.2012, 19:20

Thank you! Will definitely try with a rug.
May I have another question about the seat? As I wrote, Zhenya often sits on her knees with her booty on the floor. As I understand it, it is better to stop this pose and teach it to sit down with legs forward? She still often sits one foot forward, the other back. So can you sit?
Many times I tried to find out the opinion about such a sitting (first position) from orthopedists - there is no single answer. I don't like it if I see internal rotation of the hips. This happens. if the knees are together, I'm feet apart. The second pose does not cause me any alertness.
Try to sit on a small elevation (book, suitcase, sofa cushion) so it's easier to get used to bringing your legs forward.

01.12.2012, 23:20

Polina Lvovna, can I express my opinion about the sitting position, when the pelvis is located between the heels from the point of view of biomechanics. The support area with such a sitting is much larger, which means that it is much easier to keep the body upright. But it is clear that you need to fight for verticalization. And as always, from simple (easy) to complex (difficult), that's why I support the proposal to put the child on a low "seat"
Excuse me if I had no right to get into someone else's topic .. and don't ban me, please ...

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Dream Interpretation - Mole

There is a well-known folk sign: "A mole is in such a place that you can see it yourself - for worse, but not visible - for good." Perhaps it was this folk wisdom that served as the basis for a mole to appear in your dream.

Or maybe a mole arose in a dream because in real life you thought about the symbolic meaning of each mole, because it’s not for nothing that people say: “The more moles, the more unhappy and sicker the person” or “A mole on the nose - to heart disease” , "A mole on the back - be pneumonia."

A mole may appear in your dream also because in reality you met with your relatives.

Examining a large mole on your body in a dream is a sign that you have a very influential and wealthy relative who is ready to come to your aid at any moment.

If you dreamed that you had moles all over your body, then such a dream is a bad omen. You will have a misfortune from which you will not be able to recover for a long time.

Perhaps such a dream indicates that you have many relatives with whom you should not forget to maintain relationships.

To remove a mole from your body in a medical way in a dream, then in real life you will be able to avoid the danger that threatens you and the evil gossip of your ill-wishers.

If you yourself remove a mole from yourself, then such a dream suggests that in reality you only contribute to circumstances not in your favor, and give food for gossip to your enemies.

If you dreamed that you had a large mole on your forehead, then in real life you will feel worse. Perhaps you will catch an infection from which you will not be able to recover for a long time. Be careful when talking to strangers.

Looking for moles on your body in a dream and not finding them is a sign that you yourself are to blame for the cool attitude of your relatives towards you. If you do not change your behavior, you will soon be left all alone.

If you accidentally ripped off your mole in a dream, then you will soon receive unpleasant news from your relatives, because of which your attitude towards them will noticeably worsen.

Watching how moles grow on your body before your eyes is evidence that in real life many people would like to make friends, and maybe even intermarry with you. Be careful in choosing friends!

Victoria Bradley, 37, was told her daughter would die - the girl was born weighing just 1lbs 6oz (0.623 kg). Francesca Bradley-Karan was born in April, just two days past what is considered acceptable in the UK for abortion. Doctors say that this is a real "miracle" - they had to go through serious difficulties in the course of the struggle for the life of the baby.
A premature baby girl whose feet were the size of a penny was born in the UK. Victoria Bradley, 37, was told her daughter was likely to die. But little Francesca Bradley Curran had a huge will to live. But if she had been born 48 hours earlier, she would not have received medical assistance. Under current UK law, babies born before an abortion is still eligible are not considered "viable" due to their low survival rate.
But although the survival rates of such children are low, and their bodies are often underdeveloped, there are exceptions. However, for nine months this "wonder baby" battled meningitis, sepsis and lung problems.

Ms Bradley, from Liverpool, received a memento cast of her daughter's tiny footprints - doctors made them because they didn't expect her to survive.
But now Francesca is alive and well, she was released from the hospital only 17 weeks after birth. Ms. Bradley said, "It's great to finally be home. I didn't think my daughter would be here. It's scary to think that if she had arrived just two days earlier, no one would have helped us save her."

The nurses allowed the mother to stay with her daughter for just a few hours, and then placed her in isolation in the intensive care unit. She added: “I thought the baby was still more like a fetus. Her skin was translucent and she had no eyebrows or eyelashes. Her eyes were not yet open. She was just unrealistically tiny, horror. We were told that she would not survive. She immediately picked up a bunch of infections."

Currently, abortions in the UK are performed until the 24th week of pregnancy, and only from the 25th week the fetus is considered human. However, under certain circumstances, the pregnancy may be terminated at this time if there is a risk to the mother or baby.
For those born before 24 weeks, doctors are not required to provide care and resuscitation, as they are not considered "viable". But a 2006 study suggested that 19% of babies born at 23 weeks of age survived, leading many to argue that this limit should be lowered.
Last year, the Royal College of Midwives argued that a woman should be able to terminate a pregnancy at any time without fear of criminal prosecution. This position has been heavily criticized, as there is reason to believe that some will want to terminate a pregnancy if the fetus is the "wrong" sex that they would like. The press campaign began after a 24-year-old woman was imprisoned for deliberately induced miscarriage while eight months pregnant.

Ms. Bradley was diagnosed with infertility and was sure that she would never be able to have children due to problems with the ovaries. She and her partner, Paul Karan, 46, were shocked to learn that she had become pregnant. The pregnancy was very difficult, the woman experienced back pain and severe toxicosis, and at 24 weeks she was taken to the Liverpool hospital on April 22, where she gave birth to her daughter naturally.
After placing the baby in an incubator in the intensive care unit, a team of 15 doctors and nurses fought to keep the girl alive. It took 11 minutes before she could take her first breath.

The girl underwent 15 blood transfusions and laser eye surgery to avoid going blind after the scan. In the first few weeks of life, she also had to overcome meningitis, sepsis, two cases of lung failure and kidney problems.
Ms Bradley added: "She just kept getting stronger every day." After eight weeks, she was able to live without an incubator, and this amazed the doctors - they do not stop repeating that it is a miracle that she survived. The proud mother tattooed Francesca's tiny footprints on her wrist to symbolically commemorate her daughter's battle for life.

- these are children born before the due date, functionally immature, with a weight below 2500 g and a body length of less than 45 cm. Clinical signs of prematurity include a disproportionate physique, open sutures of the skull and a small fontanel, a lack of expression of the subcutaneous fat layer, hyperemia of the skin, underdevelopment of the genital organs, weakness or absence of reflexes, weak cry, intense and prolonged jaundice, etc. Nursing premature babies involves the organization of special care - temperature, humidity, oxygenation level, feeding, and, if necessary, intensive care.

General information

Premature children are those born between the 28th and 37th weeks of pregnancy, having a body weight of 1000-2500 g and a body length of 35-45 cm. The gestational age is considered the most stable criterion; anthropometric indicators, due to their significant variability, are conditional criteria for prematurity. Every year, as a result of spontaneous premature birth or artificially induced termination of pregnancy in the later stages, 5-10% of children from the total number of newborns are born prematurely.

According to the WHO definition (1974), a fetus is considered viable with a gestational age of more than 22 weeks, a body weight of 500 g, a body length of 25 cm. a length of less than 35 cm is regarded as a late miscarriage. However, if such a child was born alive and lived after birth for at least 7 days, he is registered as premature. The level of neonatal mortality among premature babies is much higher than that among full-term babies, and largely depends on the quality of medical care in the first minutes and days of a child's life.

Causes of prematurity

All the reasons leading to the birth of premature babies can be grouped into several groups. The first group includes socio-biological factors, including too young or old age of parents (under 18 and over 40), bad habits of a pregnant woman, malnutrition and unsatisfactory living conditions, occupational hazards, unfavorable psycho-emotional background, etc. Risk of premature delivery and birth premature babies are higher in women who did not plan a pregnancy and neglect medical support for pregnancy.

The second group of reasons is burdened obstetric and gynecological history and the pathological course of this pregnancy in the expectant mother. Here, a history of abortion, multiple pregnancy, preeclampsia, hemolytic disease of the fetus, and premature placental abruption are of the greatest importance. The reason for the birth of premature babies can be short (less than 2 years) intervals between births. Often, premature babies are born to women who resort to in vitro fertilization, but this is not due to the very fact of using ART, but rather to the “female” factor that prevents fertilization in a natural way. Gynecological diseases and malformations of the genitals adversely affect pregnancy: cervicitis, endometritis, oophoritis, fibroma, endometriosis, bicornuate saddle uterus, uterine hypoplasia, etc.

The third group of causes that disrupt the normal maturation of the fetus and cause an increased likelihood of the birth of premature babies include various extragenital diseases of the mother: diabetes mellitus, hypertension, heart defects, pyelonephritis, rheumatism, etc. Often, premature birth is provoked by acute infectious diseases suffered by a woman in late gestation periods.

Finally, the birth of premature babies may be associated with pathology and abnormal development of the fetus itself: chromosomal and genetic diseases, intrauterine infections, severe malformations.

Classification of prematurity

Taking into account the indicated criteria (gestational age, body weight and length), 4 degrees of prematurity are distinguished:

I degree of prematurity- delivery occurs at a period of 36-37 weeks of gestation; the body weight of the child at birth is 2500-2001 g, length - 45-41 cm.

II degree of prematurity- delivery occurs at a period of 32-35 weeks of gestation; the body weight of the child at birth is 2001-2500 g, length - 40-36 cm.

III degree prematurenews- delivery occurs at a period of 31-28 weeks of gestation; the body weight of a child at birth is 1500-1001 g, length - 35-30 cm.

IV degree of prematurity- delivery occurs before 28 weeks of gestation; the birth weight of the child is less than 1000 g, the length is less than 30 cm. The term "premature with extremely low body weight" is used in relation to such children.

External signs of prematurity

Premature babies are characterized by a number of clinical signs, the severity of which correlates with the degree of prematurity.

Deeply premature babies with a body weight of II-II degree malnutrition), the child's physique is disproportionate (the head is large and is approximately 1/3 of the body length, the limbs are relatively short). The abdomen is large, flattened with a clearly visible divergence of the rectus muscles, the navel is located in the lower abdomen.

In very premature babies, all fontanelles and sutures of the skull are open, the cranial bones are supple, the brain skull prevails over the facial one. Characterized by underdevelopment of the auricles, poor development of the nails (nail plates do not reach the fingertips), weak pigmentation of the nipples and areola. The genital organs in premature babies are underdeveloped: in girls there is a gaping of the genital slit, in boys - undescended testicles into the scrotum (cryptorchidism).

Premature babies born at 33-34 weeks of gestation and later are characterized by greater maturity. Their appearance is distinguished by the pink color of the skin, the absence of fluff on the face and torso, a more proportional physique (smaller head, higher navel, etc.). In premature babies of I-II degree, the bends of the auricles are formed, the pigmentation of the nipples and areola circles is expressed. In girls, the large labia almost completely cover the genital gap; in boys, the testicles are located at the entrance to the scrotum.

Anatomical and physiological features of premature babies

Prematurity is determined not so much by anthropometric indicators as by morphological and functional immaturity of vital organs and body systems.

Characteristic features of the respiratory organs in premature infants are the narrowness of the upper respiratory tract, the high position of the diaphragm, the compliance of the chest, and the perpendicular arrangement of the ribs relative to the sternum. These morphological features of premature babies cause superficial, frequent, weakened breathing (40-70 per minute), a tendency to apnea lasting 5-10 seconds (apnea of ​​prematurity). Due to the underdevelopment of the elastic tissue of the lungs, the immaturity of the alveoli, and the reduced content of surfactant in premature babies, a syndrome of respiratory disorders easily occurs (congestive pneumonia, respiratory distress syndrome).

The immaturity of the cardiovascular system is characterized by pulse lability, tachycardia 120-180 per minute, muffled heart tones, arterial hypotension (55-65/20-30 mm Hg). In the presence of congenital heart defects (open Botall duct, open foramen ovale), murmurs may be heard. Due to the increased fragility and permeability of the vascular walls, hemorrhages easily occur (subcutaneous, into internal organs, into the brain).

Morphological signs of CNS immaturity in premature infants are weak differentiation of gray and white matter, smoothness of the brain sulci, incomplete myelination of nerve fibers, and poor vascularization of the subcortical zones. Muscle tone in premature babies is weak, physiological reflexes and motor activity are reduced, the reaction to stimuli is slowed down, thermoregulation is impaired, and there is a tendency to both hypo- and hyperthermia. In the first 2-3 weeks, a premature baby may experience transient nystagmus and strabismus, tremors, tremors, and stop clonus.

In premature babies, functional immaturity of all parts of the gastrointestinal tract and low enzyme-excretory activity are noted. In this regard, premature babies are prone to regurgitation, the development of flatulence, dysbacteriosis. Jaundice in premature babies is more intense and lasts longer than in full-term newborns. Due to the immaturity of the liver enzyme systems, the increased permeability of the blood-brain barrier, and the rapid breakdown of red blood cells, premature infants can easily develop bilirubin encephalopathy.

Functional immaturity of the kidneys in premature infants leads to changes in the electrolyte balance (hypocalcemia, hypomagnesemia, hypernatremia, hyperkalemia), decompensated metabolic acidosis, a tendency to edema and rapid dehydration with inadequate care.

The activity of the endocrine system is characterized by a delay in the formation of the circadian rhythm of hormone release, rapid depletion of the glands. In premature babies, there is a low synthesis of catecholamines, transient hypothyroidism often develops, in the first days of life a sexual crisis rarely occurs (physiological mastitis, physiological vulvovaginitis in girls).

Premature babies develop early anemia more rapidly than full-term babies, there is an increased risk of developing septicemia (sepsis) and septicopyemia (purulent meningitis, osteomyelitis, ulcerative necrotic enterocolitis).

During the first year of life, the increase in body weight and length in premature babies occurs very intensively. However, according to anthropometric indicators, premature babies catch up with their peers born at term only by 2-3 years (sometimes by 5-6 years). The lag in psychomotor and speech development in premature babies depends on the degree of prematurity and comorbidities. In a favorable scenario for the development of a premature baby, alignment occurs in the 2nd year of life.

Further physical and psychomotor development of premature babies may be on par with their peers or be delayed.

Among premature babies, neurological disorders are more common than among full-term peers: astheno-vegetative syndrome, hydrocephalus, convulsive syndrome, vegetative-vascular dystonia, cerebral palsy, hyperactivity, functional dyslalia or dysarthria. Almost a third of premature babies have a pathology of the organ of vision - myopia and astigmatism of varying severity, glaucoma, strabismus, retinal detachment, optic nerve atrophy. Premature babies are prone to frequent recurrent

Very premature babies are placed immediately after birth in incubators, where, taking into account the condition of the child, a constant temperature (32-35 ° C), humidity (in the first days about 90%, then 60-50%), oxygenation level (about 30%) are maintained. Premature babies of I-II degree are usually placed in heated beds or in ordinary beds in special boxes, where the air temperature is maintained at 24-25°C.

Premature babies who are able to independently maintain normal body temperature, who have reached a body weight of 2000 g, with good epithelization of the umbilical wound, can be discharged home. The second stage of nursing in specialized departments of children's hospitals is indicated for premature infants who have not reached 2000 g in the first 2 weeks, and for children with perinatal pathology.

Feeding premature babies should begin in the first hours of life. Children with absent sucking and swallowing reflexes are fed through a gastric tube; if the sucking reflex is sufficiently pronounced, but the body weight is less than 1800 g, the child is fed through the nipple; children weighing over 1800 g may be breastfed. The frequency of feeding premature babies I-II degree 7-8 times a day; III and IV degree - 10 times a day. Calculation of food is made according to special formulas.

At the age of 1 year, children need to consult a speech therapist and a child psychiatrist.

From 2 weeks of age, premature babies need the prevention of iron deficiency anemia and rickets. Preventive vaccinations for premature babies are carried out according to an individual schedule. In the first year of life, repeated courses of baby massage, gymnastics, individual wellness and tempering procedures are recommended.