Usually, the body weight of a child is very dependent on the gestational age. A premature baby looks very different from a full-term baby. For premature babies, in addition to low weight and height, a disproportionate physique is characteristic, skin he is more hyperemic (red), the bones are soft, there may be non-closure of cranial sutures. In girls, the labia majora are underdeveloped (they do not cover the labia minora), and in boys, the testicles are not lowered into the scrotum.

If a child was born with a body weight of less than 1.5 kg, then he is considered very premature, and with a body weight of less than 1 kg, the child is considered a fetus. To determine the severity of prematurity, in addition to weight and gestational age, other signs are taken into account, such as the presence of pathological conditions, compliance with the degree of maturity, the presence of diseases in the mother, etc. Determining the degree of maturity is a very important feature.

Modern medicine improves specialized care for such children, and even in the most severe cases, there is every chance that even a very premature baby will come out.

Maturity determined by the reaction of the child, the presence of reflexes, the state of muscle tone, motor activity, the ability to retain heat, etc. Even premature babies weighing about 2 kg, if they are healthy, can be quite active, have good tone, reflexes, be able to suck, etc. Children born with a body weight of about 1.5 kg can suck from the horn by the first week of life.

The situation in children is much more difficult if the woman's pregnancy period proceeded with complications and the child could suffer, for example, from intrauterine hypoxia. Such children are born, as a rule, in a more serious condition. The most difficult babies are those born with a body weight of 900 g or less. Despite the apparent severity of the health of these children, doctors have experience in nursing children even with such a body weight. Because of the immaturity of many internal organs and the risk of developing pathological conditions, the child is immediately carried out a set of measures in order to create the most optimal conditions. After birth, the mucus from the upper respiratory tract is immediately aspirated to the child, and the mucus from the stomach can also be suctioned. If the child is not breathing or is not breathing well on his own, he is given artificial ventilation. Also, the baby is given the necessary medications to maintain his health.

The child, depending on his condition, is in a specially designed incubator (incubator). The design of the incubator allows you to realize inside it a suitable microclimate for a premature baby. The temperature is set depending on the degree of prematurity of the child, and the humidity of the air is also necessarily regulated. The incubator allows you to monitor the condition of the child and carry out many manipulations without taking him out of it. The duration of the stay of the baby also depends on the body weight of the child, then the child is transferred to an open incubator, and then transferred to a specialized department.

• Your child is not yet the same as everyone else, but with time and with your help, he will be able to catch up with his peers in his development.
• Fight for breast-feeding this is very important for these kids.
• Special attention to nutrition, such children eat more slowly and usually in smaller portions, but somewhat more often than full-term children. The interval between feedings should not exceed 4 hours.
• Premature babies are easily exposed to infections, so you should carefully monitor the cleanliness of the room and limit the number of people who want to visit the baby at first.
• At first, doctors do not recommend putting such weakened babies to sleep on their tummy, it is better to put the child on the back.
• During swimming, the water temperature should be at least 37 ° C
• In the room where the premature baby is located, the temperature should be about 23-25 ​​° C. - Sterilization of bottles and nipples for such children is mandatory, try to follow this rule, especially in the first months of a baby's life.
• Premature babies are very useful special massage, which can be carried out by an experienced specialist. Simple tricks massage after consultation, parents can perform on their own.
• Complementary foods and vaccinations are prescribed strictly on the recommendation of a doctor, after assessing the condition of the baby.
• Be sure to follow all the recommendations of the doctor, if necessary, immediately call the doctor at home or an ambulance.

Premature baby weight and degree of prematurity

Approximate body weight of the child at various stages of pregnancy:

Depending on the body weight, the child is assigned a certain degree of prematurity:

Discussion

And my son was born at 36 weeks weighing 2200. But he was so weak. I couldn’t suck myself, I had to teach him))) We were even prescribed an Elkar so that he began to eat more actively, gain weight. By 2 months, following all the instructions of the doctors, we managed not only to catch up with our peers in skill, but even to overtake them. We put on weight well and learned to hold our heads. The process of learning about the surrounding world was so interesting that we even got interesting sounds. probably out of excitement! Mothers who have babies born with low birth weight or ahead of schedule, love your kids, maternal affection and care work wonders.

my boy was born at 36 weeks with a weight of 3200g is it considered not full term or not?

Comment on the article "Premature baby"

The Ministry of Health of the Russian Federation will expand the risk group during vaccination. It will be supplemented by premature and underweight children, who will also need to receive a vaccination against Haemophilus influenzae. Thus, the Ministry of Health of the Russian Federation will change the National calendar of preventive vaccinations. The draft order provides for an increase in the number of children who are at risk - namely, with an anomaly in the development of the intestine, oncological diseases, premature and underweight children. For this...

I want to tell you about our assistant wi-fi video baby monitor Angelcare AC 1200 with a breathing and movement monitor. We bought it not by chance, our daughter was born prematurely, so we decided to play it safe. Since premature babies are more likely to have breathing problems, they are more likely to spit up. The meaning of the breath and movement monitor is this if the child does not breathe or move for 20 seconds. it will give a strong signal. You can connect to the baby monitor itself from any device...

November 17 for babies born before 37 weeks (before 260 days of pregnancy) is a special date. On this day, the whole world celebrates the International Day of Premature Babies. The European Foundation for the Care of Newborns established the date for this event back in 2009. According to the report "Born too early - a report on global action on preterm birth" on our planet every year 15 million children are born prematurely (that's one in 10 children born). 1 million of them are not...

Premature babies often have trouble breathing because their lungs are not fully formed yet (respiratory distress syndrome). Babies born prematurely need a ventilator so they can breathe. A premature baby has very fragile blood vessels in the brain, and if these blood vessels rupture (intraventricular hemorrhage), then this can lead to brain damage. Often premature babies are fed through a drip or ...

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

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

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

Nursing a premature baby in a medical facility

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

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

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

The main causes of preterm birth:

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

Condition Features

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

nervous system

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

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

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

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

thermoregulation

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

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

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

System digestion

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

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

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

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

Hearing And vision

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

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

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

Respiratory system

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

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

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

Cordially — vascular system

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

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

Endocrine system

At birth before term, all elements endocrine system not fully functional:

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

Bone system

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

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

urinary system

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

hematopoietic system

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

immune system

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

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

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

Dynamics masses body

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

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

Specificity behavior

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

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

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

nursing

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

Hospital

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

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

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

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

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

House

Basic conditions for discharge of a child:

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

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

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

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

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

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

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

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

Nutrition

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

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

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

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

Babies born between the 28th and 37th weeks of pregnancy are considered premature. Their weight is 1000-2500 g, height - 35-46 centimeters. Body weight up to 2.5 kg is also often found in full-term newborns with malformations or when a pregnant woman uses alcohol, drugs, or tobacco. Signs of prematurity are soft ears, shorter legs, lack of subcutaneous fat, increased growth of vellus hair on certain parts of the body, big sizes anterior fontanel, enlarged frontal and parietal tubercles of the child. So, what are the features of the development of different categories of premature babies? What are the consequences of prematurity? Let's figure it out.

Premature babies: statistics

Today premature birth occur frequently. In most developed countries, this indicator is relatively stable and amounts to 5-10% of total number newborns.

If we talk about progress in the field of survival of premature babies, then medicine has taken a significant step forward. In the 1950s, three-quarters of babies weighing less than 1300 grams died as newborns. Half of the survivors grew up mentally retarded or had developmental disabilities. By the age of 80, 80% of babies weighing less than 1,500 grams at birth have survived. Less than 15% of them subsequently suffered from growth and development disorders. Today, 90% of premature babies grow up without complications.

You should know that in our time, doctors state such causes and risks of prematurity: short intervals between pregnancies, the age of the woman giving birth is up to 20 years, miscarriages or stillborn children in previous pregnancies, multiple abortions, multiple pregnancies.

Premature babies: 28-30 weeks

The term of a premature baby 28-30 weeks of pregnancy is the average degree of prematurity. Of course, compared to a birth before 28 weeks, such a newborn has a greater chance of survival.

But in these babies, the lungs are not fully ripe for independent breathing. In most cases, they need help in the form of ventilation or a steady flow of air that is enriched with oxygen. Most children born with an average degree of prematurity require such medical and respiratory assistance for a short period.

When a child is on a ventilator, he is fed through an intravenous catheter. If the child breathes on its own, then it is fed with mother's milk through a tube until the period until it learns to suck on its own.

With proper care and medical supervision in the future, babies born at a period of 28-30 weeks successfully survive and develop. Modern medicine today is able to save the lives of babies weighing less than a kilogram. Such crumbs are placed in specialized departments, incubators and are discharged only when the body weight reaches 2000-2300 grams, and the threat to life and health disappears.

Premature babies: after cesarean

In premature infants, the unpreparedness of the respiratory system for independent functioning of breathing can be manifested by a syndrome of respiratory disorders. The lungs of a child simply cannot cope with providing the body with the right amount of oxygen. This is manifested in shallow and irregular breathing, which is fraught with the development of respiratory diseases.

A caesarean section does not always go smoothly. The reason is those changes in health, which became indications for the operation. During a caesarean section, a newborn may be injured when removed from the uterus. And trauma is a possible damage to the nervous system with disruptions in motor activity and muscle tone, which can result in the development of paresis and paralysis. Similar consequences arise as a result of the hypoxia that the infant experiences during surgery. That is why such a child can sit down and crawl, walk and talk later than their peers. IN adolescence premature babies, born the way caesarean section, are more prone to vegetovascular dystonia and sensitivity to weather changes, headaches and fainting. But there is no need to be scared too early. Sometimes C-section is an the only way saving a premature baby, so the risks are always justified.

Premature babies: development

A healthy premature baby develops rapidly. He seems to be catching up with his peers. Babies born weighing 1500-2000 grams double their body weight by three months. And in a year their weight increases by 4-6 times. Similar healthy shifts occur with growth. So, for the first year, growth increases by 27-38 centimeters, during the second year - every month by 2-3 cm. When such a baby turns one year old, his height is usually up to 77 cm.

As for the development of psychomotor, at birth up to 2 kg it lags behind compared to full-term babies. In the first or second month of their lives, premature babies sleep a lot, move little, and get tired quickly. After 2 months, their activity increases, as does the tension of the limbs. Their fingers are constantly clenched into a fist and straighten with difficulty, and thumb almost not given away. To correct the problem, you should deal with such a child, do exercises. A premature baby has an immature nervous system. He can often be frightened and startle at sharp sounds and even for no reason. The main feature of premature babies is a decrease in immunity, which means low resistance to any disease. In such children, there is a predisposition to diseases of the gastrointestinal tract and otitis, respiratory infections and viral diseases.

Communication with premature babies is an important part of their development. Doctors limit communication and generally visiting such a child in the first days after birth, because he needs peace. But the mother has the right to be nearby, to watch her child through the glass wall. After some time, when the condition is stable, the doctors allow the mother to take her child in her arms, because this contact is very important. This is how the pre-interrupted intrauterine development of the child continues. You need to talk to him, stroke him, sing songs, talk about how you love him. This is the basis for the development of such a baby. Emotional contact between the baby and the mother accelerates the physical and mental development of the child. And even if the child does not respond to such actions, this does not mean that everything is useless. He's just too weak to react. You can notice the fruits of your efforts after a month of constant communication and emotional contact with the child.

The development of premature babies is accelerated by quiet calm music, bright toys in bed, special exercises.

Premature babies: consequences

It is natural for a mother to carry a child for 40 weeks. And it is clear that children born prematurely have much more developmental problems. How less term gestation to birth, the greater the risk of developing diseases characteristic of premature babies. So let's learn about possible consequences prematurity:

1. Underdeveloped lungs. They pose the greatest danger. It takes a lot of effort for a baby to breathe. These babies need artificial breathing support. Their respiratory center is not fully formed in the brain. Therefore, respiratory arrest (apnea) can often occur.
2. Features of the heart. The heart of the embryo in the womb pushes blood not into the pulmonary artery, but into the aorta through the ductus arteriosus. After the baby is born full-term, this duct overgrows, and in premature babies it can remain open, which is fraught with increased stress on the lungs and heart. This condition needs medical treatment.
3. Infections, metabolism, blindness. Infections are much more common in premature babies, because the immaturity of the immune system contributes to this. Viral infections are especially dangerous for such children. Premature babies often have metabolic problems and a lack of hemoglobin. In addition, this category of babies is prone to the development of retinal lesions, that is, retinopathy of prematurity. If it is not cured in early age, it can lead to blindness.

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

Especially for - Diana Rudenko

Every tenth birth, according to statistics, is early or premature, as a result of which a premature baby is born. He is born before the 37th week of pregnancy, with a weight of less than 2500 grams and a height of up to 45 cm. These parameters of prematurity are conditional, since they can fluctuate in different children. The focus is still on the maturity of the cardiovascular and respiratory systems, as well as thermoregulation.

Premature babies are weaker than those born at term. Therefore, their development differs from the established physiological norms of full-term babies. This difference will disappear by 2.5 - 3 years, not earlier. In addition, the development of a child born at the 32nd and 34th week will also have many differences.

What does a premature baby look like?

His weight is much less than the norm (less than 2.5 kg). It has been scientifically proven that babies born after 30 weeks are more likely to grow up healthy and catch up with their peers in development than those born before 28 weeks. The latter require more intensive care, long-term treatment, and a stay in a neonatal intensive care unit.

The earlier a child was born, the less subcutaneous fat layer he has. Because of this, the skin seems transparent, the vascular pattern is clearly visible through it.

Prematurity is noticeable by body proportions, a large head, insufficiently formed auricles, an umbilical fossa located too low. Downy thin hair can also be seen on the body.

Immediately after childbirth, there will be no original lubrication on the body of such a child, since normally it appears in the last weeks of gestation. The large fontanelle is sometimes displaced to the side because the skull is not fully formed. Facial features are pointed, but over time they will acquire the same appearance as in a healthy newborn.

Note:due to the lack of subcutaneous fat, such children quickly and easily become hypothermic, even at room temperature. Therefore, after birth, they are immediately placed in an incubator, in which a certain temperature regime is set.

Such children cry very quietly, sometimes even inaudibly. This is due to the immature respiratory apparatus.

Degrees of prematurity

Prematurity is distinguished taking into account when and with what weight the child was born. The presence of a lag in the development of some organs and systems is also taken into account.

In this case, there are several degrees of prematurity:

1. 1 degree- the baby was born at the 35-37th week with a weight of 2-2.5 kg.
2. 2 degree- the child was born with a weight of 1.5 to 2 kg for a period of 32-34 weeks of pregnancy.
3. 3 degree- the weight of a premature baby at birth at 29-31 weeks of gestation is from 1 to 1.5 kg.
4. 4 degree- children born weighing up to 1 kg and up to 29 weeks of pregnancy.

Note:the physical condition of premature babies will approach normal at the age of 12 months, the lag before this period is considered the norm.

The development of a premature baby after its birth is influenced by a number of factors:

• nutrition;
• high-quality, proper and regular care for the baby;
• understanding of parents and their adequate attitude to the problem of the birth of a premature baby;
• the social status of the family itself.

To ensure the full development of such children, it is necessary to carefully care for them and pay attention to the work of each system and organ. It should be borne in mind that children who were born before 30 weeks are 3-4 months behind their peers in development, so they learn all the necessary skills a little later.

The level of development of a premature baby at 1 month

During this month, the baby will gain very little weight due to an underdeveloped swallowing reflex and sluggish sucking activity. That is why often food comes through the probe.

During this period, there is a very high risk of joining infectious diseases that give serious complications, so it is very important to protect the child. There is also a pronounced instability of the nervous system, which lasts up to 4 months.

From birth, it is necessary to maintain vocal and tactile contact with the baby. He must feel the voice of his mother, feel her smell, body heat. If possible, it should be ensured that he stays in the arms of his mother for as long as possible.

The level of development of preterm at 2 months

The child becomes stronger, begins to gain weight better. Positive weight gain in the 2nd month is the main criterion healthy development premature baby.

By the second month of a baby's life, it is allowed to lay it on the stomach. But the baby still does not know how to hold his head in this position on his own, like his full-term peers.

A well-developed sucking-swallowing reflex also becomes noticeable. But in the process of natural breastfeeding, 2-month-old premature babies quickly become tired, so they need to be supplemented with expressed milk. It is important to consider that the interval between feedings will be less than 3 hours.

How does a premature baby develop at 3 months

At this age, the baby is already trying to fix his eyes on the face of his mother, to raise his head on his own. You need to provide him with proper sleep and food. At the 3rd month of life, a grasping reflex begins to form, the child actively reacts to tactile contact, he has mimic reactions.

During this period, the mass of the child increases by 1.5-2 times. Begins to develop more actively auditory and visual attention. It is necessary to carefully monitor the physiological state of the child. It is important not to overcool it, and not overheat. Between feedings, the premature baby sleeps most of the time, so the wakefulness period is short.

You should not forget about the frequent change in body position. It is better if the light source is dimmed rather than bright, with it the non-born will feel more comfortable.

What should a premature baby be able to do at 4 months

The baby learns to confidently raise and hold his head. He tries to make sounds, grab the toy with his palm, more confidently fixes his gaze on an object or face.

An increase in muscle tone is likely, which is easily corrected with the help of special gymnastics and massage for premature babies. Air baths and water procedures are very useful.

How does a premature baby develop at 5 months

Now the baby can already independently hold a rattle in his hand or grab a suspended toy with his hand.

He often smiles, he has an interest in everything that surrounds him. He reacts much better to light and sound, turns his head in his direction.

Also, at the 5th month, premature babies begin to walk.

Sixth month of life premature

Now the weight of the child is 2-2.5 times more than at birth. The baby is trying to roll over on his stomach from the back.

The psycho-emotional development of a premature baby is also accelerated. Not all children, but most of them, can already distinguish native people from strangers. When communicating with them, they come to life, become active, walk, move their arms and legs.

With the support of the child's armpit, he tries to rest his feet on the surface.

Development of a premature baby at 7 months

The activity of the baby becomes more and more, he already knows how to roll over onto his stomach from his back and vice versa. Can make the first attempts to crawl in a plastunsky way.

At 7 months old, the baby already holds a toy in his hand confidently. If a baby is born at the 35th week, then his first teeth may begin to erupt.

What can a premature baby at 8 months

Starting from this age, the baby shows an interest in communicating with others, and not just in what he does himself. He likes verbal contact with others (reading fairy tales, singing songs, changing the intonation of words, etc.).

The movements of the child become more skillful and confident. He tries to stand on all fours on his own, knows how to sway and sit.

The baby understands and knows some objects well, can show them if asked. Starting from 8 months, a premature baby learns to eat from a spoon.

How does a baby develop at 9 months

The first attempts to crawl appear, and the child sits much more confidently. He constantly needs the attention of his relatives, as the need for communication increases even more than before.

At this time, he most often pronounces the first words in the form of separate syllables. The child is already playing with toys . He makes attempts to stand up, holding on to something, and sits down from a position, standing on his side, while leaning on his arm.

While eating, he can put a piece of food in his mouth himself. Babies born at 32-33 weeks of gestation may have their first teeth.

10th month: what a premature baby can do

At the 10th month of life, a premature baby already knows how to stand and does it quite confidently. But still, to stand on his feet, he needs support.

Important:no need to overdo it and force the baby to stand if he does not want to. Doctors do not recommend doing this for both full-term and premature babies.

Holding onto a support, the baby can move around, but still prefers crawling. Shows great interest in objects that move, make sounds. The child already knows his name and responds to it. Those born before the 31st week of pregnancy may have their first teeth.

Prematurity at 11 months

The child already knows how to independently and confidently sit down, stand up, take the toy with his hand and put it in place. This is a period of active knowledge of the surrounding world, by crawling and standing, holding on to a support.

The kid is very active in contact with his family.

12th month of life

Some premature babies (not all) can take their first steps towards 12 months of age. But it's too early for them to walk on their own. Approximately at this time physical development premature babies catch up with their peers. At the same time, neuropsychic immaturity still persists. Finally, the difference will disappear by 2-3 years (depending on the degree of prematurity).

A child born at a gestational age of 22-37 weeks (154-259 days from the first day of the last menstrual period) with a body weight of less than 2,500 g and a length of less than 45 cm is considered premature. one breath. Depending on body weight at birth, 4 degrees of prematurity are distinguished:
I degree - 2001-2500;
II degree - 1501-2000;
III degree - 1001-1500 g;
IV degree - 1000 g or less.
Birth weight is not an absolute indicator of prematurity. So, 1/3 of newborns weighing less than 2500 g are full-term, and in 4-5% of premature babies, body weight exceeds 2500 g. The main criterion for prematurity is gestational age (prenatal development, gestatio - pregnancy, wearing). Based on gestational age, there are 4 degrees of prematurity:
I degree - gestational age 36-35 weeks;
II degree - gestational age 34-32 weeks;
III degree - gestational age 31-29 weeks;
IV degree - gestational age 28-22 weeks.
prematurity- a concept related exclusively to the neonatal period. The frequency of birth of premature babies in different regions of the country is 5-12%. The death rate of premature babies is 20 times higher than the death rate of full-term babies.
Anatomical and physiological features(AFO) premature baby
 Morphological signs of prematurity: Appearance premature babies has a number of signs that are directly dependent on the duration of pregnancy. The shorter the gestational age of the child, the brighter they are expressed and the more there are. Some
signs are used to determine gestational age. These include: skin, auricles, areolas of the nipples, furrows on the feet, sexual characteristics.
A very premature baby has thin wrinkled skin of dark red color, richly covered with fluff (lanugo). The auricles are soft, adjacent to the skull, with a short gestation period, they are devoid of relief, shapeless due to underdevelopment of cartilaginous tissue. The areolas of the nipples are underdeveloped, less than 3 mm, with deep prematurity they may not be determined. The furrows on the feet are rare, short, shallow, appear at the 37th week of pregnancy, at the 40th week of gestation they become numerous. The scrotum in boys is empty, the testicles are in the inguinal canals, or in the abdominal cavity. For girls, the gaping of the sexual
gaps - the large labia do not cover the small ones, the hypertrophied clitoris is clearly visible.
A premature baby has a small size, a disproportionate physique. The weight-height coefficient is 30-50. Relatively large head (1/3 of the body), short neck and legs, the umbilical ring is located closer to the womb. The brain skull prevails over the facial. The sutures of the skull and fontanelles are open. The subcutaneous fat layer is not expressed. The nails do not reach the fingertips.
 Functional signs of prematurity. For preterm infants, the immaturity of all organs and systems is characteristic, the severity of which depends on the duration of pregnancy. Neurological signs of prematurity are muscle hypotension, decreased
physiological reflexes (sucking, swallowing, sucking movements slow down breathing, cause respiratory pauses, cyanosis) and motor activity, imperfection of thermoregulation (reduced heat production and increased heat transfer), weak cry of the child, decreased activity of digestive enzymes. Children are periodically restless, there is an inconsistent tremor of the chin and limbs, a tendency to convulsions. Breathing is 40-90 breaths per minute, uneven in rhythm and depth, interrupted
convulsive sighs and pauses (apnea) lasting up to 10-15 seconds, which is more often observed in very premature babies with hypoxic lesions of the central nervous system. With a longer cessation of breathing, asphyxia (suffocation) may develop (insufficient development of the alveoli, the capillary network of the lungs, reduces the content surfactant a, which leads to insufficient expansion of the lungs, the preservation of fetal atelectasis, the development of hemodynamic disorders in the lungs, which cause breathing patterns. Therefore, premature babies make up the main percentage of newborns who develop respiratory distress syndrome).
The cardiovascular system. The pulse is labile from 100 to 180 beats per minute. Any irritants cause an increase in heart rate, increased sonority of tones, an increase in blood pressure (due to the predominant influence of the sympathetic department). Arterial pressure does not exceed 60-70 mm Hg. Thermoregulation in a premature baby is imperfect. Children quickly cool down and also quickly overheat. In children with low body weight, heat loss is increased due to the relatively large body surface, too thin subcutaneous fat layer and the immaturity of thermoregulatory centers. The peculiarity of the temperature reaction is manifested in the fact that when overheated, the body temperature can rise to 40 degrees, and in response to external infections, premature babies may not respond with an increase in temperature.
Digestive system. The volume of the stomach in the first 10 days in a premature baby is 3 ml / kg
multiplied by the number of days. Proteins are well digested, but fats are poorly digested. The permeability of the intestinal wall is significantly increased, and the enzyme excretory function of the intestine is reduced. The liver is functionally even more immature than full-term. small volume of the stomach, decreased secretion and activity of digestive enzymes, poor development of the muscular wall of the intestine, decreased immunoglobulin A contributes to the development of dysbacteriosis.
Sucking and swallowing reflexes are poorly developed. Often there is a violation of the coordination of sucking and swallowing. There is a tendency to regurgitation, vomiting, flatulence, constipation. The absence of a cough reflex contributes to the aspiration of food.
Kidneys. Reduced filtration function, increased urinary sodium excretion and weak water reabsorption, limited ability to remove excess water from the body. Daily diuresis by the end of the first week ranges from 60 to 145 ml, the frequency of urination is 8-15 times a day.
The hematopoietic system. Lower hemoglobin and red blood cells, fetal hemoglobin long time maintained at a high level. Nearly all preterm infants less than 30 weeks' gestational age are anemic. Increased permeability and fragility of blood vessels (due to vitamin K deficiency) contribute to the occurrence of cerebrovascular accidents and hemorrhages.
Due to the imperfection of the immune system, premature babies are prone to infectious diseases.
Borderline physiological states are peculiar in preterm infants: physiological erythema, loss of initial body weight, and jaundice are more pronounced and prolonged. Mild jaundice may be accompanied by severe bilirubin encephalopathy. The sexual crisis is much less common than in full-term ones, it is less pronounced. Primary leukocytic decussation later for 7-15 days. Transient fever easily occurs when non-compliance with the drinking regimen and overheating. The umbilical cord falls off later than in full-term ones (on the 5th-7th day of life), umbilical wound heals by 12-15 days, with weight
less than 1000 kg - 1-2 weeks later.

Features of the development of premature babies
I. Physical development of preterm infants
1. Characterized by a higher rate of weight gain during the first year of life compared to children born at term. The exception is the first month of life, when there is a low weight gain due to a greater loss of initial weight than in full-term ones. In preterm infants, the initial weight loss is 9-14% of birth weight. They double their body weight by 2-3.5 months, triple by 4-6 months, and by the year their weight increases by 4-7 times.
2. The monthly increase in height in premature babies is on average 2.5-3 cm. Growth for the first year increases by 27-38 cm. Despite the high growth and development rates, in the first 2-3 years of life, premature babies in terms of body weight and growth lag behind their peers who were born full-term. And only by the age of 3, the body weight and length of these children approach the corresponding indicators for full-term ones.
3. In children with prematurity of I-II degree, teeth erupt at 6-9 months, III-IV degree - at 8-10 months.
4. The circumference of the head at birth is 3-4 cm larger than the circumference of the chest. By 3-5 months, sizes
are compared, in the future the circumference of the chest is greater than the circumference of the head.
5. In the future, the periods of the 1st and 2nd stretching in premature babies begin 1-2 years later than in full-term ones.
II.Neuropsychic development of preterm infants
During the first years of life, the rate of psychomotor development of children is delayed, the formation of the leading lines of neuropsychic development is shifted in time to a later age stage. This lag depends on the degree of prematurity and is more pronounced in children with III-IV degree of prematurity. In these children, the appearance of psychomotor skills at 1-2 years is delayed by 2-3 months.
 In children with II degree of prematurity for 1-1.5 months
 By the end of the 1st year of life, the majority of children with I degree of prematurity in psychomotor development catch up with their full-term peers, and by the age of 2, very premature ones are compared with them. A delay in the mental development of a child born prematurely may be due to a violation of the function of the sense organs. So, the pathology of the organs of vision (myopathy, astigmatism, strabismus) occurs in 25%, hearing loss varying degrees in 4% of children born prematurely.
In preterm infants (due to unfavorable intrauterine conditions, fetal hypoxia, etc.), often
there are neuropsychiatric disorders in the form of neuropathic psychopathic personality traits. Neurological changes are more common: vegetative-vascular disorders, hypertension-hydrocephalic syndrome, convulsive syndrome, cerebral palsy. By the age of 4-7 years, the manifestation of neuropsychiatric symptoms may disappear or remain in the form of mild clinical signs of CNS damage: an unstable mental state, negative reactions, anxiety, fussiness, insomnia, impaired appetite, difficulty in eating solid food. Perhaps an unfavorable course with the formation of persistent and complex psychopathological syndromes. However, most premature babies have normal mental development. There are many famous people among premature babies: Darwin, Newton, Voltaire, Hugo, Napoleon, Yesenin, Mironov, etc.

Organization of medical care for premature babies
The problem of nursing premature babies is extremely complex, since children are not yet ripe for existence outside the mother's body. To preserve the viability of premature babies, it is necessary to create special conditions both at the time of birth and during the subsequent adaptation of the child. To this end, assistance to premature babies is provided in stages:
I stage of nursing - providing intensive care and treatment in the maternity hospital;
Stage II - nursing in a specialized department;
Stage III of nursing - dispensary observation in a children's clinic.
The main goal of stage I is to save the life of the child. In the first hours and days after birth, if necessary, intensive therapy is carried out, careful care and supervision is provided. Particular attention is paid to compliance with the sanitary epidemiological regime. Healthy babies with a birth weight of more than 2000 g are discharged home from the maternity hospital, all other premature babies are transferred to a specialized department for the second stage of nursing.
The main direction of work of the specialized department is treatment and rehabilitation. Therapeutic measures are aimed at eliminating hypoxia, cerebrovascular accidents, jaundice, pneumopathy, prevention of anemia, rickets, malnutrition.
The discharge from the department of the II stage of nursing is approached individually. The main criteria are:
- absence of diseases;
- restoration of the initial body weight and its satisfactory increase;
- normal hemoglobin level;
- good home environment.
All information about the child is transferred on the day of discharge to the children's clinic.