A newborn baby is considered premature at the gestational age. Premature babies

Expectation and birth of a child is a period of joyful, but also exciting events. Of course, I really want the pregnancy to proceed without problems, and the baby to be born full-term and healthy. However, for many reasons, birth can occur ahead of schedule, and then the baby is born premature.

Which baby is considered premature?
Babies born before the 38th week of pregnancy are considered premature. In most cases, premature babies have a weight of less than 2500 g and a length of less than 45 cm. At the same time, a small child’s weight is not an absolute sign of prematurity, since some children in utero are various reasons do not gain enough weight, forming retention syndrome intrauterine development. Although, of course, the overwhelming majority (more than 70%) of newborns born weighing less than 2500 g are premature.

Depending on body weight at birth, it is customary to distinguish several groups of premature babies:

children with low birth weight (less than 2500 g);

children with very low body weight (less than 1500 g);

children with extremely low birth weight (less than 1000 g).

How are premature babies different from those born full term?
It was not for nothing that nature came up with a 9-month pregnancy period for humans. At this time, the baby is formed and develops so much that by the time of birth it is ready for extrauterine life. If for some reason the baby is born ahead of schedule, then it will be more difficult for him to adapt to the unknown and difficult life outside mom's tummy. Of course, much depends on how earlier baby not full term. If the birth occurred at 35-36 weeks, then the baby is already quite mature, and if at 28-30 weeks, then much more effort will be required to nurse him.

Premature babies usually have a disproportionate build with short lower limbs and neck. The head looks larger in relation to the body. The skin of a premature baby is thinner and more delicate, covered with delicate vellus hair. The ears are very soft. The subcutaneous fat layer in premature infants is not sufficiently formed, and even the fatty lumps on the cheeks are poorly expressed. All these signs can have varying degrees of manifestation depending on the baby’s due date.

But not only external signs make it possible to distinguish a premature baby. The most important feature is the functional immaturity of all organs and systems of a premature newborn. Thus, premature babies retain heat less well, they are more lethargic and drowsy, they are characterized by decreased muscle tone and sluggish sucking. Of course, these functional features are more pronounced the smaller the child.

What is nursing for premature babies?
After birth, a premature baby requires special attention from doctors. Regardless of the degree of maturity and prematurity, the child must be given first aid: warm, suction from the mouth amniotic fluid, provide additional oxygen, and in more severe cases, carry out a full range of resuscitation measures.

The severity of a premature baby's condition may be due to several reasons. First of all, pediatricians pay attention to the development of respiratory function. The lungs of a premature baby do not produce enough of a special substance, surfactant, which helps them function fully: it prevents the alveoli from collapsing and ensures normal gas exchange. Lack of surfactant can cause various breathing disorders, from mild respiratory distress syndrome to severe disease in which spontaneous breathing is impossible and artificial ventilation is required.

Respiratory failure aggravates the child’s existing metabolic changes caused by birth stress and problems with the circulatory, digestive, and excretory systems.

To create a comfortable thermal regime for a premature baby, the baby is placed in an incubator. In parallel with this, correction of all existing violations is carried out. After the premature baby begins to retain heat better, is able to breathe independently, and does not require intensive care, he can be transferred from the maternity hospital to the 2nd stage of nursing in a specialized department for premature babies. If premature birth occurred in a specialized maternity hospital, then such a department is necessarily included in its composition. Such a department may be part of a maternity hospital, if the maternity hospital specializes in premature birth, or at a children's hospital.

Nursing a premature baby at this stage is a logical continuation of the activities begun in the departments of the maternity hospital. The period of adaptation to extrauterine life in a premature baby also has some differences compared to a full-term baby. Thus, weight loss in premature babies is usually greater than in babies born at term. Restoration of initial body weight occurs over a longer period: full-term babies usually regain birth weight by 710 days of life, and in premature babies this period can last for 23 weeks.

Another condition that occurs in newborns is physiological jaundice. But in premature babies, jaundice is more pronounced and its duration is longer than in full-term babies, which in some cases requires treatment. This is due to functional features and immaturity of liver enzymes. Feeding a premature baby can also cause some problems, since babies born prematurely do not absorb nutrition well. Low birth weight newborns are started to be fed literally drop by drop, gradually increasing the volume. Feeding is optimal for premature babies breast milk mother. As is known, the composition of the milk of a woman who gave birth prematurely differs from the milk of a mother whose birth occurred at term. It contains more protein, electrolytes, polyunsaturated fatty acids and less lactose, better meeting the needs of a low birth weight baby. If breastfeeding is not possible, the child should receive a specialized formula for premature babies.

When is a premature baby discharged home?
This question worries many many parents whose babies were born prematurely. Of course, doctors make such decisions based on the child’s condition. Usually, if the child’s weight has reached 2000 g, the baby is actively sucking and gaining weight, he can be discharged subject to active monitoring at home by a pediatrician and a visiting nurse. In addition, after discharge from the hospital, the baby may need additional help an ophthalmologist, a neurologist, a massage therapist and some other specialists.

In conclusion, I must add that a baby born prematurely needs not only experienced and competent doctors and nurses, but also the love and care of mom and dad. Caring for a premature baby is a labor-intensive and long process. But a premature baby has every chance to catch up with his peers over time, and in the future will not differ from them in mental and motor development.

It so happened that he was born premature baby. There can be a lot of reasons for the birth of a premature baby, but since this has happened, you need to learn how to care for a premature baby.

At 31 weeks of pregnancy I had the procedure and a baby weighing 1230 was born.

With a weight of up to 2000g, after birth they are transferred to a special hospital in the department for nursing premature babies. In the hospital, the child is monitored, if necessary, necessary treatment. Low weight babies live in incubators. Kuvez- this is a special device in which the child is located, with an automatic supply of oxygen, maintaining optimal temperature and humidity.

The first months in the hospital

My son and I were admitted to the hospital; in the next room there were twins - a boy and a girl, they were born weighing 800g and 900g. They had been in the hospital for two months now. What a surprise I was when I saw rattles in their incubators, their room was very cozy, there were children’s toys around - everything was bright and beautiful. An ordinary hospital ward turned into a small children's room.

I know how hard it is to be in the hospital with a tiny baby. Perhaps you didn’t have time and bought absolutely nothing for your baby. But you need to pull yourself together, you simply have no other way! Now you only need to walk with your head held high and only upward, because the child feels his mother’s strength and becomes stronger himself.

Life in a box

I don't know what this is connected with, but different doctors are treated differently. For example, for the first three days in the hospital we slept with the light on; it was always light in the room and in the incubators, too. And on the fourth day the manager came and drew our attention to the fact that there should be twilight in the incubators, couvez It is advisable to cover it with a large pink cloth and at night there will be enough light from a night lamp in the room. In incubators are created comfortable conditions for the growth and development of the child, the illusion is created that he is still in the womb.

Doctors also differ on the subject of rattles in the incubator. In general, having visited hospitals, I came to the conclusion that each doctor has his own truth, so it is advisable to find exactly the doctor with whom you will be more comfortable.

Baby understands you

No matter how weak and defenseless your baby may seem. He is very good and he expects support, patience and love from you. Your contact with your child is very important. Try to talk to him as much as possible, sing him songs, recite rhymes, we had an iPod in our room and beautiful classical music played all the time. Every day I told my son what day it was, what the weather was like outside, who was coming to visit us today. And of course, I kept telling him how much my dad and I love him, how strong, healthy, beautiful he is, that soon he will grow up and we will go home, an incredibly interesting and multifaceted world awaits us.

It is very important to touch the baby often and stroke him. And what happiness I felt when they laid him on my stomach; our first skin-to-skin contact, which happens in babies immediately after birth, happened 2 weeks later. Such contacts should be arranged as often as possible. Firstly, it has a good effect on the baby, and secondly, the baby smells his mother’s smell, feels his mother’s warmth, which gives such a fragile creature a feeling of comfort and security. The child will develop better and faster.

IN couvez you can hang a couple of rattles, at first he may not notice them, you can show him and tell him what they are. Then the baby will become interested and will look at them.

The main thing is to believe and love. Everything will be fine. You can handle it. You will win. Trust your inner voice– he won’t deceive. Very soon your baby will get stronger and will delight you with his successes and achievements.

Here's yours premature baby gained the coveted 2000-2500 g and you are discharged home. The doctor will give you all the necessary recommendations, and on the pages of my blog I will write about our experience of bathing a premature baby, walking with him, about the first feeding and about his further development.

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

Such babies are considered premature, and the birth is considered premature.

During pregnancy, which lasts 9 months for a person (apparently, it was not for nothing that wise Nature set this particular period!), the baby manages to form and develop so much that it is born ready for a physiologically autonomous life.

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

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

A premature baby requires special conditions of care and constant monitoring by doctors on whom his life depends.

A low-weight baby born at term differs from a premature baby in that the latter’s internal organs are underdeveloped. It will take him another two months for all his organs and systems to reach functional maturity. For a long time he will lag behind children born at term in weight and height. A baby born before the 35th week weighs less than 2 kg.

What is he like, a premature baby?

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

Physiological changes in body weight after birth

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

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

Weight loss is mainly explained by insufficient nutrition of the premature baby in the first days of life, as well as large losses of fluid through the lungs and skin. Recovery depends on whether the fetus was healthy at the time of birth or whether it had any abnormalities.

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

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

Appearance

The appearance of such a child is very characteristic. The skin is reddish in color, the body retains the hair that covers the fetus in the womb. Large blood vessels are visible through the very thin skin.

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

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

Many children are not quite ordinary facial features- forehead is steep and high, unusual bulging eyes(these features may disappear as children age), and sometimes strabismus may occur.
Rib cage and the abdominal muscles of a premature baby are soft. Breathing is shallow, its rhythm is unstable. The ribs are located perpendicular to the sternum. Little belly every now and then it gets pulled in and out. When exhaling, the ribs and sternum sink. The nipples and areola of the mammary glands are poorly expressed.

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

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

In boys testicles often not drooping, and the scrotum does not have the same uneven folded appearance as in a full-term baby; An increase in the size of the scrotum (hydroxy testis) and inguinal-scrotal hernias are common.

When the baby cries, muscle swelling appears in the area of ​​the umbilical ring.

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

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

In order to correctly assess the correspondence of a child’s maturity to the period of its intrauterine development (gestational age), in addition to morphological characteristics, the state of its neuromuscular system is also taken into account.

Muscle tone a premature baby is noticeably reduced, so at rest (lying on his back) his arms and legs are “flaccid”, only slightly bent at the joints and spread apart.

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

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

The sternum is an oblong, flat bone that is located in the middle of a person's chest and connects to the ribs with cartilage, forming the rib cage.

Condition of systems and organs

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

Note that premature newborns without disturbances in activity nervous system Hardly ever. Differences can only be in the degree of pathology. The most commonly observed disorders caused by immaturity of the central nervous system (CNS) are the absence of sucking and swallowing reflexes, as well as slow growth of the masticatory muscles. Therefore, at first, such babies are fed through a tube, gradually transferring them to breastfeeding or feeding from a bottle or spoon. Premature babies usually do not swallow food well - they hold it in their mouth for a long time, as if remembering what to do with it next.

These distressing signs of prematurity for parents are clearly visible until about six months. Then, if the parents have carried out thorough supportive therapy, “late” babies by the age of 1-1.5 years become practically indistinguishable from their peers born on time. But in severe advanced cases, some children up to two or three years old eat only liquid food. As a rule, they lag behind their “full-term” peers in development in other respects - later they begin to walk, roll over, stand on their feet, and pick up a toy.

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

Innate reflexes in premature babies, as a rule, they are too weak or even absent. It is natural that conditioned reflexes Such babies will develop it much later than full-term babies.

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

Respiratory system

A baby's lungs develop gradually, preparing for the first breath immediately after birth. They are not yet fully functioning inside the mother.

If a child is born before this period, then the amount of mature surfactant is so small that it is not enough for the lungs to function independently. The baby's breathing becomes difficult, he turns blue, and suffocates. Therefore, the first thing such a child needs is a ventilator. Unfortunately, large doses of oxygen can “burn” the baby’s lungs. Such a “burn” leads to bronchospasm and hyperproduction of mucus (bronchopulmonary dysplasia).

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

Parents of such children need to remember that the baby’s bronchi after such a “burn” remain vulnerable and predisposed to spasm for a long time - even with common cold A short-term cessation of breathing may occur. Therefore, you must warn the local doctor that the child was on mechanical breathing. Modern pharmaceuticals offer sufficient means for prevention and quick removal pulmonary spasms.

The cardiovascular system

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

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

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

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

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

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

Without exception, all tests and procedures must be agreed upon with the cardiologist observing the baby. Disturbances in the activity of the cardiovascular system are very insidious and can be “masked,” that is, not manifest themselves in any symptoms noticeable to parents.

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

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

Walls of brain vessels premature babies have increased permeability, as a result of which not only violations are possible cerebral circulation, but also local hemorrhages.

Digestive system

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

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

Although saliva is produced already during the first feedings, the salivary glands are poorly developed and the volume of saliva is small. Therefore, in the digestion of a premature baby, the role of saliva is very insignificant.

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

Stomach in a premature newborn it is round and small - from 10 to 30 ml. Various parts of the stomach are underdeveloped. The production of gastric juice and its enzymatic activity is reduced. Peristalsis is poorly expressed, and motor activity has a too low rhythm. All this is the reason profuse regurgitation food.

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

Liver the fetus and newborn is one of the most important organs of its life support.

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

General intestinal length can be 3.3-3.6 m. Typically, in such babies, the muscle and elastic tissue in the intestines are not sufficiently formed.

For newborns, first of all, it is necessary to have adequate nutrition that corresponds to the degree of prematurity. It is this that can support the favorable course of all metabolic processes, “healthy” the intestinal microflora and thereby create conditions for the successful development of the child.

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

Excretory system

Premature babies have organs excretory system are also functionally immature.

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

Skeletal system and joints

One of the serious consequences is not proper care If the baby's musculoskeletal system is immature, there may be a dislocation of the hip joints. Consultation with an orthopedist is mandatory for all newborn babies, __but for low birth weight premature babies it is especially relevant.

Features of the immune system

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

Care

Obstetric care for premature babies is a complex art that involves great risks. Such a child is received in warmed sterile diapers, covered with a blanket. Then they are transferred to a warm changing table, under the rays of an electric reflector. The baby's legs (and, if the weight is very low, the head) are wrapped in cotton wool. After this, the baby is placed in a separate, specially equipped children's ward.

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

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

The air temperature in the ward for premature babies should be quite high: 22-24 °C, and in the baby’s crib even higher: 26-30 °C. To control, place a thermometer next to the baby (on top of the blanket).

Because immunity premature babies very weak, special attention in the department where they are located is paid to prevention and prevention infectious diseases. Thorough sterilization of linen, personal hygiene of staff (working in masks, gloves, etc.) and mothers - all this must be strictly observed.

A premature baby really needs the feeling of “mother is nearby.” Many maternity hospitals now practice the “kangaroo method” - the baby is placed on the mother’s stomach for a few minutes, and then again placed in the incubator. With regular communication, the baby's breathing and pulse improve.

A premature baby requires special care because:

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

The premature baby is on artificial feeding from the first birthday. However, his stomach has too small a capacity, from 5 to 6 cm3, and the sucking and swallowing reflexes are still poorly developed. Therefore, he is fed formula milk through a tube passing into the stomach through the nasal opening. In addition, the child is given glucose through the cephalic vein. When the reflexes reach the required level of development, he is transferred to feeding with mother's milk through a nipple. The mother expresses milk at home and brings it to the maternity hospital. Mother's milk is vital for a premature baby. In addition, it helps to establish a kind of emotional connection between mother and child. If the mother does not have milk, it is delivered from a lactarium (an institution that collects and preserves human milk for feeding newborns).

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

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

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

Maintaining the temperature at home is achieved by regularly (every 2-3 hours) ventilation of the children's room, where the air temperature should not be lower than 22 °C. Next to the child (in his crib), the air temperature should be at least 28 ° C, which is achieved by covering the child with heating pads filled with water (water temperature 60-65 ° C), especially in winter time of the year. Heating pads are placed at the feet and sides of the baby, and to regularly monitor the temperature, you can put a thermometer in the crib. Warmers should be wrapped in a soft-touch cloth and placed at a palm's distance from the child. The heating pads must be changed every 2 hours, one at a time. The child's face should never be covered with a blanket; it should always be open. It is also strictly forbidden to place heating pads under the child (to avoid burns) and place them on top, as this significantly complicates breathing and interferes with chest excursions.

Bathing premature babies

If a child was born weighing less than 2 kg, it is necessary to refrain from bathing for at least a week and a half. 10-12 days after birth, the child begins to bathe in boiled water (water temperature is about 38 ° C).

Features of caring for a premature baby at home

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

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

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

You can make a warm bed for a child at home by placing feather beds and warm blankets on top and bottom of the baby, and hot water bottles on the sides and legs. Wrap them in several diapers or a large piece of flannel. This is necessary so as not to burn the baby. You can make hot water bottles from hermetically sealed water bottles. The water temperature should be 50 °C. The water must be changed every hour around the clock so that it does not have time to cool down. The bottles should also be wrapped in flannel and ensure that the caps are tightly closed. Otherwise, the child may be scalded. You should not place the baby's crib near a window or open it when the baby is in the room. If the required temperature and humidity are maintained in the room, you can do without heating pads and bottles.

Previously, premature babies immediately after birth, wiping warm oil, wrapped in several strips of cotton wool. Each limb of the baby was also wrapped in cotton wool to prevent heat loss. If necessary, the contaminated cotton wool could be changed without completely exposing the baby. A separate strip of cotton wool is applied to the anus and urethra to make it easy to change. On top of the child they put a shirt and a woolen blouse. The head is also wrapped in cotton wool and a woolen cap lined with cotton fabric is put on top. Sometimes they wore 2 caps, with the bottom one made of cotton, not wool, since wool irritates the skin.

As a rule, when your baby reaches 2000 g, you will be discharged home. This will be reported to the children's clinic for urgent care. Local doctor and nurse will take control of the baby and teach you how to care for him.

Premature infants must be protected from painful stimuli, including drug injections and blood sampling - these procedures must be strictly justified.

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

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

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

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

About strict feeding mode There is no need to talk about premature babies - they need to be fed as many times as they wish. Everyone knows that it is best to feed premature babies with mother's milk. The milk of a woman who gave birth prematurely has a high protein content and a reduced fat content. And this is exactly what a premature baby needs: his body cannot yet cope with the complete breakdown and absorption of dietary fats, but he needs a lot of “building material” - protein. But if your mother doesn’t have enough milk, your doctor will prescribe food for you.

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

For walks Premature babies are taught gradually.

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

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

Medical incubator (incubator)

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

The device looks like a large transparent plexiglass box and allows you to maintain the baby’s temperature and monitor him. The air is heated depending on the needs of the newborn (generally the temperature is 30 ° C), the air is also humidified. The baby's temperature is measured using a thermal catheter attached to his skin.

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

Feeding in the maternity hospital

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

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

Tips for moms:

• Start expressing milk as early as possible, even if your baby is not yet latching. Express every 2-3 hours, preferably even at night. However, you shouldn’t wake up specifically for this - you should rest and gain strength;
• if you cannot express enough milk with your hands, then try to choose a convenient breast pump;
• The milk you express can be frozen for later use. Write the pumping date on the bottle.

Massage and gymnastics for premature babies

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

Basic requirements for massage and gymnastics

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

So, stick to the following rules:

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

Monitoring a premature baby

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

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

When visiting a child, you should not abuse decorative cosmetics and perfume, especially smoking.

At the baby’s first response to your communication with him (animation, visual contact, smile), let him feel with words and touches that you are pleased and you love him. It would be useful to keep a diary about the child’s behavior (diary early development). It is interesting and useful not only as a family heirloom, but also to introduce other family members to the baby in advance and prepare them for the peculiarities of its development. Moreover, this diary allows specialists to help you and your child if he later has any difficulties with health or adaptation. You can take photos and videos of your baby (without flash!). Keep in mind that the development process is always individual. Before asking whether your child is normally developed, compare his health status and character traits with this. For some, the norm is to read at the age of 3, for others it is easier to run fast and jump high, and for others, parents say: “If only he were healthy!” And even if he studies poorly, he is kind and flexible. It is true what they say that there are no children lacking talent. Therefore, observe your child’s abilities, discover his (and only his!) talents and develop them.

Main signs and features of development of premature babies

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

The main signs of prematurity are:

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

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

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

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

Unlike other body systems, the cardiovascular system is quite well developed, since its formation and development occur not in the last, but in the first trimester of pregnancy. In premature babies, a rapid pulse with weak filling, muffled heart sounds are observed, a third heart sound is heard, arterial pressure reduced (to 50-80 and 30-35 mm Hg), heart rate is about 120 per minute. The electrocardiogram is also characterized by a number of features.

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

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

Premature babies have a tendency to develop edema and slight tissue pastiness, since there is underdevelopment of the systems that control water-salt metabolism, but this condition is reversible. In addition to edema, the opposite condition is less commonly observed - dehydration of the body due to the excretion of large amounts of fluid (combined with polyuria - frequent and copious urination).

Due to metabolic disorders, an increase in the amount of bilirubin in the blood and a decrease in glucose concentration are quite often observed. Due to underdevelopment of the kidneys, their concentration ability sharply decreases, resulting in the presence of a large number of residual nitrogen, and urine - low concentration.

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

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

The mental development of premature babies also has a number of characteristic features. Children begin to speak simplified words a little later (“give”, “bee-bee”, “woof-woof”, etc.), and do not remember new words and names well. However, by one year mental development the child reaches the required level.

How should a premature baby be born?

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

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

Second, if the answer is external, is it better for your baby to be born vaginally or by cesarean?

If your case of preterm labor is simple, these questions will not be difficult to answer, but they can also be difficult, so your doctor should answer these questions as early as possible. Usually the answer to the first question is “outside” if the cause of premature birth is known - rupture, infection, etc. It is only premature births, which formally occur for an unknown reason, that respond well to tocolytics and other measures to combat them, because all other reasons that can truly interfere with the continuation of pregnancy have already been excluded.

If your baby is happier inside, then go full speed ahead to treatment to "bounce back" the birth. If your baby is feeling better outside, your doctor will see if you have enough time for the steroids to work - usually within 24 hours. If so, he will take as long as necessary to get the maximum benefit from their use, all the while keeping a close watch on the child. If there is no time for steroids, and the birth must be carried out immediately as an emergency measure, then the fastest route must be taken. In an unstable situation - move or C-section, if things get worse and worse, such as bleeding. If your condition is stable, you can try to give birth vaginally through induction.

Feeding premature babies

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

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

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

If this is not the practice at your hospital, insist on it and convey the necessary information to employees. Set achievable, short-term goals: “I’m not suggesting that you all preemies start nursing in a new way, just let me hold my baby for a couple of hours today.”

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

A full-term newborn is born defenseless and requires constant 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. Are of great importance positive attitude and the correct actions of parents. Let's consider the features of the condition of premature babies and basic recommendations for caring for them.

A newborn is considered premature when born before the 37th week of pregnancy, that is, before the 260th day of intrauterine development (gestation). Moreover, his weight ranges from 0.5 to 2.5 kg, and his height is from 25 to 40 cm. Depending on the due date and body weight, there are 4 degrees of prematurity:

• 1st – period – 35-37 weeks, weight – 2.001-2.5 kg, the child is mature and viable, in some cases treatment is required (for jaundice, birth trauma);
• 2nd – period – 32-34 weeks, weight – 1.501-2.0 kg, with assistance the baby quickly adapts to external conditions;
• 3rd – period – 29-31 weeks, weight – 1.001-1.5 kg, most children survive, but they require long-term rehabilitation;
• 4th – period – 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. How earlier child was born, the more serious his condition. Prematurity of the first and second degrees is called moderate, the third and fourth - deep. In addition to the listed parameters, when developing nursing tactics, doctors pay attention to the severity of signs of immaturity of the body, the main ones being:

1. irregular weakened breathing;
2. dry, wrinkled skin with a reddish tint due to underdevelopment of subcutaneous fat;
3. faint cry;
4. lanugo (fluff) on the body;
5. the nail plates do not completely cover the phalanges;
6. the umbilical cord is below the center of the abdominal wall;
7. all fontanelles are open;
8. genitals are underdeveloped;
9. poor movements due to decreased muscle tone;
10. disproportionate sizes of body parts - 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 signs of immaturity of the body.

The main causes of premature birth:

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

Features of the condition

A child born prematurely is not ready for independent life. The speed of adaptation depends on the maturity of the body and the severity of labor. In most cases, such children, until 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 transmitting 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, difficulties arise with sucking, swallowing, breathing, responding to external stimuli, and so on.

How stronger degree prematurity, the weaker the unconditioned reflexes are expressed.

The cerebral cortex of 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 before term, the processes of heat conservation and release are imperfect. They easily become hypothermic (body temperature drops below 36°) and overheat under the influence of external conditions. Reasons for this:

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

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

System digestion

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

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

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

In the first days of life, such a child is fed through a special tube.

Hearing And vision

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

The vision of such children is poorly developed. Most of the time they lie with their eyes closed. Babies born at 30-32 weeks of gestation may fixate their gaze on bright objects and turn toward a light source.

The retinal vascular network is formed in the last month of pregnancy. Premature babies have a high risk of retinopathy - damage to the retina, which can lead to blurred vision 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. While awake, he breathes very quickly (60-80 times per minute), but shallowly. During sleep, the frequency decreases, sometimes episodes of apnea occur - stopping breathing, while the nasolabial triangle and fingers turn blue.

With deep prematurity, atelectasis (collapse) of certain parts of the lungs may 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 intended to open the pulmonary vesicles during the first breath. As a result, respiratory disorders occur, which are often accompanied by infection (pneumonia).

Some children experience 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 child’s first independent breath, the shunts between the heart chambers and large vessels, which ensured blood circulation during intrauterine development, close. 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 rehabilitation activities. Congenital defects are often detected.

The baby's heart sounds are muffled, the average pulse rate is 120-140 beats per minute. For any external influence the body reacts 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. Adrenal glands. Cortisol deficiency leads to a decrease in the body's adaptive capabilities and an inadequate response to stress factors. With severe adrenal insufficiency, the baby’s body temperature decreases and blood pressure drops.
2. Thyroid. Transient hypothyroidism (decreased organ activity) is observed. As a result, metabolism slows down, swelling occurs, jaundice prolongs, and so on.
3. Ovaries and testicles. Due to the lack of hormones, the sexual crisis is mild.
4. Pancreas. Excessive insulin synthesis and poor glycogen stores lead to low blood sugar levels. Hypoglycemia is dangerous due to impaired maturation of 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 calcium and phosphorus deficiency, it is advisable early prevention rickets. It consists of prescribing vitamin D from the age of 2 weeks.

Urinary system

The immaturity of the kidney tissue and the instability of water-salt metabolism predispose children to the formation of edema. They usually appear in the first days of life and disappear within 1-2 weeks. Later hard swelling in the lower body may indicate nutritional problems or illness. In addition, it is worth considering that the baby can quickly develop dehydration.

Hematopoietic system

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

Immune system

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

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

Children born prematurely often experience a prolonged course of jaundice, increased intracranial pressure, motor disorders. In addition, the risk of cerebral palsy, epilepsy and developmental delays 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 those born prematurely - 5-15%. Subsequent dynamics depend on the general condition of the body and living conditions. Approximate norms:

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

Specifics 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 and grimace, but after a few minutes he falls asleep again. In the first degree of prematurity, the baby 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 muscles is often observed.

The pace of neuropsychic development of premature babies is slowed down: they later begin to sit up, crawl, walk, and talk. With absence 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: staying in the hospital and at home.

Hospital

Neonatologists are responsible for caring for babies. Immediately after birth, the baby is admitted to the intensive care unit or intensive care unit. If he cannot breathe on his own, he is put on a ventilator and given surfactant to open his lungs. Oxygenation may be administered, as well as fluids and medications administered through catheters. Vital signs are constantly monitored.

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 room: temperature – 25°, humidity – 55-60%. The baby loses heat very easily. When changing his clothes, heated changing tables and warm diapers are used. A child can spend from 3-4 days to 7-8 weeks in an incubator.

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

1. noise reduction;
2. protection from intense light sources;
3. careful implementation 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 of 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 was not enough for the baby to fully complete intrauterine development.

House

Basic conditions for the child’s discharge:

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

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

It has been scientifically proven that if you carry a premature baby in a sling, he will quickly adapt to new conditions

The optimal air temperature in the room where the child is is 25°. You should not leave him naked for more than 3-4 minutes. Gradually duration air baths can be increased to 10-12 minutes, performing them 3-4 times a day.

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

Massage is very useful for children. In the first weeks, this may include light stroking of the belly. 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 baby's weight 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 conditions, you should “walk” on the balcony with the window open. It is important to dress your baby correctly so that he does not overheat or freeze.

You should visit your pediatrician every month with your baby. During the first year, you need to visit an orthopedist, surgeon, ENT specialist, or ophthalmologist 2-3 times. The child should be seen by a neurologist every 3 months. It is very important to visit doctors in a timely manner to detect the slightest abnormalities at the initial stage.

Nutrition

Proper organization of nutrition - key moment when nursing premature babies. If the baby does not have swallowing and sucking reflexes, he is fed through a tube. In some cases, these automatisms exist, but problems arise 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, who are able to actively suck, are placed on the mother's breast. In any case, in the first days, babies are given intravenous saline, glucose and vitamins (K, C, E, group B). Nutrient solutions may also be prescribed.

The ideal food for premature babies is breast milk. If direct attachment to the breast is not possible, then the woman should express. If there is a shortage or absence of milk, special mixtures with increased level protein and increased energy value. Almost every baby food manufacturer has products intended for premature babies. You must buy the mixture on the recommendation of a doctor.

After discharge from the maternity hospital, it is advisable to purchase electronic scales and clearly monitor the amount of milk/formula consumed 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 breast on demand. When artificial feeding, you need to maintain intervals of 3 hours. Complementary feeding is introduced according to an individual scheme.

The first months of the life of a child born prematurely are a difficult period for his parents. At this time, it is extremely important to trust the professionalism of doctors, and also to give your baby your love by talking to him and touching him. Modern technologies allow you to care for very premature babies. Up to 2-3 years of age, 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.

It happens when even a normally proceeding pregnancy ends in birth ahead of schedule. If the baby was born before 37 weeks weighing less than 2.5 kg, he is premature. Such children require special care.

In the first months of life, the development of premature babies differs from normal full-term babies. However, with proper care, by the age of one year, these children are almost no different from children born in accordance with the norms.

What is a “premature baby”, degrees of prematurity

Depending on the age and weight at which the baby was born, the following degrees of prematurity are distinguished.

• Extremely premature babies– these are babies born before 28 weeks, weighing less than 1 kg. Such children are not ready for life outside the womb, so the operation of all its systems requires artificial support. For him future life you have to fight hard and for a long time. However, there are cases where premature babies born with extremely low body weight (about 500 g) were cared for. There is a high risk of complications and possible disability.
• Extremely premature babies are born weighing between 1 kg and 1.5 kg at 28 to 31 weeks. These kids are highly likely normal development. They require artificial ventilation and cannot feed themselves (feeding is given through a gastric tube or through a vein). The food is enriched with amino acids, enzymes, glucose and other substances that accelerate the growth and development of the baby.
• Premature babies requiring special conditions content. These are children born at 32-35 weeks weighing from 1.5 kg to 2 kg. Children weighing up to 1.7 kg are placed in special incubators for premature newborns (incubators), where they are provided with optimal temperature, humidity, and necessary research. For babies weighing from 1.7 kg to 2 kg, special heated cots are used.

When the child’s weight reaches 2 kg, there is no need to provide a special temperature regime. Babies born at 34 weeks are at risk of apnea (sudden stoppage of breathing). The reasons for this phenomenon are not known; they are associated with imperfect functioning of the respiratory and nervous systems.

• Babies born at 36 weeks. As a rule, they can breathe and suck on their own, but at birth they undergo mandatory additional examinations. In the future, they are under the supervision of a pediatrician.

It should be borne in mind that mass does not play a decisive role. When assessing a premature baby, the maturity of systems, organs and functions is taken into account. It may happen that a baby weighing 2 kg will be superior in development and prognosis to a baby weighing 2.5 kg.

Signs of a premature baby

A premature baby is defined by the following characteristic features:

• small height and weight;
• disproportionate body: the head makes up about a third of the total height; the brain part of the head is noticeably larger than the facial part; the navel is located lower than in normal-term babies; neck, arms, legs short;
• , the bones of the skull are soft, mobile;
• Very premature babies may have weak muscle tone, lack of sucking reflex and feeling of hunger, bulging eyes;
• the ears are so soft that they can stick together and curl inward;
• girls may have a gaping genital cleft due to underdevelopment of the labia majora, and a boy may have an empty scrotum due to undescended testicles;
• the whole body is covered with soft hair;
• absence of a layer of fat under the skin - skin so thin that blood vessels can be seen through them.

What premature babies look like, look at the photo:

Premature babies - development by month

• In the first month of life, a premature baby hardly gains any weight. c, very susceptible to infections, may require mechanical ventilation and feeding tubes.
• If in the second month the child begins to gain weight well, then this is a sign good development and proper care. At this age, the sucking reflex is poorly developed, so the mother needs to supplement the baby with expressed milk from a spoon.
• In the third month, weight increases by 1.5 times compared to birth weight. The baby sleeps a lot. Therefore, temperature conditions and air humidity must be optimal.
• At 4 months, when placed on the stomach, the baby tries to hold its head and holds it for a short time.
• At 5 months, mothers will be given their first smile. Interest in toys increases, the baby tries to grab and hold them.
• At six months they react well to the adults around them, distinguish their own from strangers, go for walks, confidently hold their head up vertical position and in the prone position. The weight of the babies increases 2.5-3 times.
• A premature baby at 7 months has already fully mastered turning over from back to stomach and vice versa; games and toys are of increasing interest to him.
• At 8 months, he tries to crawl, learns to sit without support, and closer to 9 months, along with peers born at term, he tries to stand on his legs; at this time, the first teeth usually appear.
• By 10-11 months, premature babies are usually already actively crawling, responding to their name, and pronouncing individual syllables.

By the age of one year they are not much different from their peers. It should be noted that physical development The development of premature children at this age corresponds to the development of normally full-term children, but the neuropsychic processes are slightly delayed and “catch up” with their normally full-term peers by 2-3 years.

Medical assistance and hospital care

Whether a premature baby needs special medical care depends on the degree of prematurity of the baby.

• If the baby was born very premature, then he is placed in a pediatric intensive care unit, where he is provided with artificial ventilation and nutrition is supplied through a gastric tube. In addition, they are connected to monitors that record basic vital parameters; in case of deviations from the norms, the medical staff quickly responds. If necessary, the baby receives treatment and is also observed by specialized specialists: an ophthalmologist, a cardiologist, a neurologist, whose task is to prevent the development of complications.
• If the baby's lungs are ready for independent breathing and the baby has a sucking reflex, he is provided with intensive care. The baby will remain in the incubator until his body learns to independently thermoregulate. Today it has been proven that the rate of development and growth of a baby increases when in contact with his mother. The so-called kangaroo method is used. The baby in a diaper and a hat is placed between the mother's breasts and the clothes are fastened. Mother's body temperature ideally warms the baby. At the same time, he inhales native smells, hears his mother’s familiar heartbeat, his skin is populated with maternal microflora, which increases the baby’s immunity and helps a speedy recovery. The method gives excellent results when the baby still needs control of breathing and heartbeat.
• Follow-up observation is carried out by a doctor after discharge from the maternity hospital. All data on the baby’s health condition is recorded, and taking into account the degree of prematurity and the current condition of the child, additional examination may be recommended.

Babies born before 33 weeks will be cared for in the intensive care unit and then in the intensive care unit. If the baby was born at 34 weeks and was not injured during childbirth, then on the 7-10th day he can be discharged from the maternity hospital under the supervision of a local pediatrician.

Caring for a premature baby at home

Differs from caring for normal term babies. What you need to pay special attention to.

• Clothes for premature babies should be made only from natural fabrics. All seams are only external; it is desirable that holes are provided for medical equipment.
• Buttons and fasteners must be plastic. None of the clothing items should be damaged delicate skin baby.
• Microclimate in the room. The optimal humidity in the room is at least 70%, temperature regime– 25°, around the baby’s body – 28°.
• . Water temperature 36°. Before bathing, wrap your baby in a diaper, and after bathing, pat his body dry with a warm towel.
• Buy special skin care products, for premature babies, they must be hypoallergenic.
• Diapers We also need special ones, made taking into account the fact that the skin of premature babies is very thin and delicate.
• Walks. If you are born in the summer and if the baby’s weight has already reached 2 kg, you can walk immediately after being discharged from the hospital, but the first walks are no more than 15 minutes at an outside temperature of at least 25°.

If the baby was born in winter, then the first time outside is possible when the baby reaches 3 kg of weight and the temperature outside the window is not lower than 10 degrees below zero. In the off-season, you can walk if you weigh at least 2.5 kg and reach 1.5 months.

• Massage is very necessary for premature babies. Let the professionals show you the basic principles and techniques.
• Vaccinations. If the baby is healthy and his birth weight is more than 2 kg, then he is vaccinated in the same way as normal full-term children. Otherwise, the doctor forms individual plan vaccinations for premature babies.

Feeding the baby

When discharged from the hospital, the baby can suck independently. However, he is very weak and gets tired quickly, so his mother should supplement him with expressed milk from a spoon. It is very important to maintain breastfeeding at this difficult and difficult moment, because it is the best food for a premature newborn baby.

If for some reason natural feeding impossible, the baby is being fed. Under no circumstances should you choose formula for feeding a premature baby on your own; your doctor should recommend it.

Feeding premature babies in the first month of life is carried out in fractional portions. The number of feedings per day can reach 20 times. By approximately the third month of life, when weight gain is stable, the number of feedings is reduced to 8.

They begin to administer it from the 7th month of life. Porridge is the first food, since weight gain for a premature baby is a top priority. In addition, it is necessary to ensure that the nutrition of premature babies is complete: they really need vitamins and minerals.

Development of a premature baby - video

When caring for premature babies, it is important to monitor not only weight gain, but also the improvement of the baby’s skills at a given age. You will learn how to correctly calculate the baby’s age, taking into account his prematurity, what reactions and stages of development you need to pay attention to. Watch the video about the features of psychomotor maturation of premature babies.

IN modern world children born prematurely have good chances For full life. If you work with premature babies, develop their psychomotor skills, talk to them, surround them with attention and love, provide them with proper care, then you will avoid all negative consequences, and in the future your baby will be no different from other children. This is not an easy task, but it can be done.