Premature babies. Premature end of pregnancy: why are premature babies born? Potential long-term effects of extremely low birth weight

Pregnancy usually lasts 38-42 weeks. Children born at this time are called full-term, and childbirth is called timely, or urgent. However, about 25% of births start early (before 38 weeks of gestation).

Such babies are considered premature, and childbirth is considered premature.

During pregnancy, which lasts 9 months for a person (apparently, wise Nature has not in vain established such a period!), The baby manages to form and develop so much that it is born ready for a physiologically autonomous life.

Compared to full-term babies, the initial life potential at the time of birth in premature babies is much lower and therefore the newborn period (from the moment of 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 term of childbirth.

For "additional development" to go well, premature babies need some time to stay in conditions similar to those in which the fetus grew in the mother's womb; they are handled by experienced neonatologists (pediatricians dealing with neonatal pathologies), doctors and nurses.

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

A low-birth-weight baby born on time 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. He will lag behind in weight and height for a long time from children born on time. A baby born before 35 weeks weighs less than 2 kg.

What is he, a premature baby?

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

Physiological changes in body weight after birth

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

In a premature baby, the period of loss of the initial mass lasts about 4-7 days, and the "rate" of its decrease (intensity) is not the same: at first it grows, then it is maximum for 2 or 3 days, and then it gradually decreases.

Weight loss is mainly due to 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 at the time of delivery the fetus was healthy or had any disturbances.

In a healthy premature baby, the rate of recovery of the initial mass depends on the degree of prematurity and the higher, the less weight the child had at birth. But if the baby developed in utero with maturational impairment, then the rate of recovery is difficult to predict.

As soon as the initial (at birth) body weight is recruited, the body of a premature baby proceeds 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, the body retains the hairline that covers the fetus in the womb. Large blood vessels can be seen through very thin skin.

A premature newborn differs significantly from a full-term newborn in external signs, which are in direct proportion to 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, a low position of the navel. This is because the growth rate of the limbs increases in the second half of pregnancy.

Many children are not quite ordinary facial features- the forehead is steep and high, unusually bulging eyes (these features can disappear with the age of children), sometimes squint can be observed.
Rib cage and the abdominal muscles of a premature baby are soft. Breathing is shallow, its rhythm is unstable. The ribs are perpendicular to the sternum. A small tummy now and then pulls in and out. When you exhale, the ribs and sternum sink. The nipples and areola of the mammary glands are poorly expressed.

Bones overly 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.

Boys testicles often not omitted, and the scrotum does not have such an uneven folded appearance as in a full-term baby; often there are an increase in the size of the scrotum (dropsy of the testicle) and inguinal-scrotal hernia.

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

Important feature of the skin premature babies - intensive development of lanugo - vellus hair - not only on the shoulders and back, as 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 gentle. Looks wrinkled as it wrinkles easily. The skin normally has a red or hot pink color, but very often it has an icteric or bluish tint. The subcutaneous fat layer is poorly developed, or almost completely absent.

To correctly assess the compliance of a child's maturity with the period of his intrauterine development (gestational age), in addition to morphological signs, the state of his neuromuscular system is also taken into account.

Muscle tone The premature baby is noticeably reduced, therefore, at rest (in the supine position), his arms and legs are "flaccid", only slightly bent at the joints and pulled apart.

The longer the period of intrauterine life of the child, the better his legs are bent in the knee and hip joints.

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

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

The state of systems and organs

In premature babies, violations are often recorded at once according to several parameters, for example, according to the state of muscle tone and congenital reflexes, according to skin color, heart rate, respiratory rate, etc. systems work closely together. Disturbances in the work of one of them cause changes in the functioning of the whole organism. Therefore, it would be unreasonable to expect that any organs or physiological systems of a premature baby will work “perfectly”.

Note that there are practically no premature newborns without disturbances in the activity of the nervous system. 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 the slow growth of the masticatory muscles. Therefore, at first, such babies are fed through a tube, gradually transferring them to breastfeeding or bottle or spoon feeding. 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.

Such distressing signs of prematurity for parents are clearly visible up to about six months. Then, if the parents have carried out a thorough supportive therapy, "late" babies by 1-1.5 years old 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 in development from their "full-term" peers in other parameters - later they begin to walk, roll over, stand on their feet, take a toy.

Violation of thermoregulation- a common phenomenon for premature babies, arising from the immaturity of the body as a whole 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 rather poorly independently maintaining a normal body temperature. Without special external conditions, such a baby can quickly die from overheating or hypothermia.

Congenital reflexes in premature babies, as a rule, they are too weak or even absent. Naturally, conditioned reflexes in such babies will be developed much later than in full-term babies.

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

Respiratory system

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

If a child is born before this time, then the amount of matured surfactant is so small that it is not enough for independent lung function. The baby's breathing becomes difficult, he turns blue, suffocates. Therefore, the first thing such a child needs is a ventilator. Unfortunately, high doses of oxygen can burn your baby's lungs. Such a "burn" leads to spasm of the bronchi, to hyperproduction of mucus (bronchopulmonary dysplasia).

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

Parents of such children should remember that the baby's bronchi after such a "burn" remain vulnerable and prone to spasm for a long time - even with a common cold, a short-term cessation of breathing may occur. Therefore, you must warn the local doctor that the child was on apparatus breathing. Modern pharmaceuticals offer enough remedies for the prevention and rapid relief of pulmonary spasms.

The cardiovascular system

After the baby is born, a restructuring of the blood circulation system occurs - the blood flow stops its course 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, such a restructuring occurs much more slowly.

The baby's heart is relatively large - about 0.8% of the 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 shape 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 fast - from 90 to 160 beats per minute; with crying and states of anxiety, anxiety and discomfort, it can reach 200 beats per minute or more.

Premature newborns are more likely to develop heart murmurs. 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 detailed examination.

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

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

The body of a premature baby is fighting with all its might to preserve life, therefore, the blood supply to the brain and liver is best for the baby, and its arms, legs, etc. are provided with blood much less. As the baby matures and develops, the blood supply to all organs and tissues gradually increases.

The walls of the vessels of the brain Premature babies have increased permeability, as a result of which not only cerebral circulation disorders, but also local hemorrhages are possible.

Digestive system

The functional maturity of individual organs and the entire digestive system as a whole is highly dependent 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 central nervous system of a child leads to a significant "unwillingness" of its nerve centers to "lead" the regulation of digestion and sucking and swallowing reflexes. Therefore, despite the fact that the composition of digestive juices may include all the necessary enzymes for the digestion of breast milk, their activity can be very low.

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

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

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

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

Liver fetus and newborn - one of the main organs of his life.

Liver weight at birth can be up to 4.4% of a 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" of bilirubin (with the breakdown of fetal hemoglobin) and antitoxic (protective). The maturation of all other functions occurs gradually with the growth and development of the entire body of the baby.

General intestine length can be 3.3-3.6 m. Usually, in such babies, muscle and elastic tissue in the intestine is not sufficiently formed.

For newborns, first of all, proper nutrition is needed, corresponding to the degree of its prematurity. It is it that is able to support the favorable course of all metabolic processes, "heal" 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 the vitality of a 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

In premature babies, the organs of the 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 move to normal functioning as early as the ninth week. It was found that in the first few days of life in premature babies, the kidneys work more intensively than in full-term babies. At the same time, they remove a larger volume of fluid from the body. There are a number of kidney features in premature babies: low concentration capacity, low filtration level, decreased phosphate filtration, etc. Urine is poorly concentrated, and the frequency of urination is higher than in full-term babies (due to the high rate of metabolic processes in the body).

Skeletal system and joints

Dislocation of the hip joints can be one of the serious consequences of improper care of a baby with immaturity of his musculoskeletal system. An orthopedic consultation is mandatory for all newborn babies, but for small premature babies it is especially relevant.

Features of the immune system

In newborns, it is mainly congenital and passive acquired immunity that 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 and risky art. They accept such a child in a warmed up sterile diaper, covering it with a blanket. Then transferred to a warmed changing table, under the rays of an electric reflector. The baby's legs (and with a very low weight - and the head) are wrapped with cotton wool. After that, 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 maintaining optimal temperature and humidity. The simplest of these look like a double-walled tub with an open top. Hot water circulates between the walls (50-60 ° C).

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

The air temperature in the ward for premature babies should be high enough: 22-24 ° C, and even higher in the baby's crib: 26-30 "C. For control, a thermometer is placed next to the baby (over the blanket).

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

A premature baby really needs the feeling of “mother is near”. In many maternity hospitals, the "kangaroo method" is now practiced - the baby is placed on the mother's belly for a few minutes, and then again placed in the incubator. With a regular communication procedure, the baby's breathing and pulse improve.

A premature baby requires special care because:

• vellus hair prevents normal sweating, therefore 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 (flaccid muscles);
• the walls of the blood vessels are weak, there are not enough red cells in the blood, moreover, there is poor blood coagulation;
• low resistance to infectious diseases;
• immature nervous system. Stimulation of the senses is required for the development of the brain. Despite prematurity, they are already laid down in him. In particular, the child reacts to sounds. Therefore, it is very important to treat him like a full-term baby, while showing increased attention. To bridge the gap between the child's birthday and the day the child is discharged, it is necessary to contact the child with the parents as early as possible. It is advisable for the father to come to the child's hospital every day, as well as to the mother after discharge.

A premature baby is artificially fed from the first birthday. However, his stomach has too small a capacity, from 5 to 6 cm3, 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 injected with glucose through the head vein. When the reflexes reach the required level of development, it is transferred to breastfeeding through the nipple. The mother expresses milk at home and brings it to the 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 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 severely premature babies to a simpler device - a jug. Parents are given a child who has gained at least 2.5 kg.

Most preterm newborns who are 26 weeks old 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 in a special incubator. The incubator is a plastic box made of polymer plastic, in which a constant air temperature, the most acceptable for the baby (22-25 ° C), is maintained. The constancy of the ambient temperature contributes to the preservation of 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 the digestive system has not matured, and the sucking and swallowing reflexes have not developed. For this purpose, the child is fed through the tube or intravenously until the development of the basic reflexes of the newborn. Sometimes (when 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) airing the children's room, where the air temperature should be at least 22 ° C. Near 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 the winter season. Heating pads are placed in the legs and on the sides of the baby, and a thermometer can be placed in the crib for regular temperature control. The heating pads should be wrapped with a soft-touch cloth and placed at the palm's distance from the child. Heating pads should be changed every 2 hours, in turn. In no case should the child's face be covered with a blanket, it should always be open. It is also strictly forbidden to put heating pads under the child (in order to avoid burns) and put them on top, as this greatly complicates breathing and interferes with chest excursions.

Bathing premature babies

In the event that a child was born with a body weight of less than 2 kg, it is necessary to refuse bathing for at least a week and a half. 10-12 days after the birth of the child, they begin 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 of the child with strangers, since with frequent visits, the child can become infected with an infectious disease or ARVI, which will adversely affect his health. It is advisable not to give a premature newborn to a nursery during the first year of life and refrain from walking, 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 in order to catch up with his peers. The interval between feedings should not be more than 4 hours, as otherwise dehydration of the body may develop. You need to feed the child at least 8-10 times a day, slowly, making sure that he does not spit up (since if the child spits up frequently and profusely, it will be difficult for him to gain the required body weight). Premature babies need more sleep than term babies. The child should sleep not on a soft, but on a hard mattress in the supine position, since when lying on the stomach, sudden death may occur in sleep due to difficulty breathing.

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

A warm bed for a child at home can be made by putting feather beds and warm blankets on top and bottom of the baby, and heating pads with hot water on the sides and legs. Wrap them in a few diapers or a large piece of flannel. This is necessary in order not to burn the baby. You can make heating pads from 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. Bottles should also be wrapped in flannel and ensure that the caps are tightly closed. Otherwise, the child could be scalded. Do 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 is maintained in the room, heating pads and bottles can be dispensed with.

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

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

Premature babies must be protected from painful irritants, 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 ordinary heating pads with a water temperature of 60-65 ° C. Having wrapped them in diapers or towels, put them on the sides and at the feet of the baby, 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 "С

When you swaddle your baby, iron the diapers first to keep them warm. The room temperature should be kept at 22-24 ° C.
For signs of overheating(rapid breathing, fever, redness of the skin) you need to take the baby out of the crib, swaddle, give water or breast milk to drink. You can bathe the baby in a bath for 5-7 minutes at a temperature of 37 ° C.

When chilling a child(cold, pale, even bluish skin; lethargy) it is best to warm it with your body, press your naked baby to your chest, turning it with different sides. Say something nice to him. You can also warm your baby in a bathtub at a water temperature of 38-39 ° C for 5-7 minutes. Then swaddle him in warm swaddling clothes, put him in the crib and cover 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 has given birth prematurely has a higher protein content and a reduced fat content. And this is exactly what a premature baby needs: his body is not yet able to cope with the complete breakdown and absorption of dietary fats, but he needs a lot of "building material" - protein. But if your mother does not have enough milk, your doctor will prescribe food for you.

Daily toilet for a premature baby, including bathing, is very different from the toilet and bathing of 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 be bathed in 7-10 days. Carefully keep your baby cool while bathing. Gradually, toilet procedures become the same as those of ordinary (full-term) babies.

For walks premature babies are taught gradually.

In winter, it is advisable to start walking if the air temperature is not below minus 8 ° C and if the baby's weight is not less than 3000 g. The duration of the walk at the beginning 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 is overheated.

Medical incubator (kuvez)

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

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

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

Feeding in the hospital

Babies with an initial weight of about 1500 g at first most often have to be fed from a bottle or even through a tube. 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, actively suckle 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 breastfeeding yet. Express every 2-3 hours, preferably even at night. However, you should not specially wake up for this - you must rest and gain strength;
• If you cannot express enough milk with your hands, try to find a convenient breast pump;
• the milk you have expressed can be frozen for later use. Write the date of pumping on the bottle.

Massage and gymnastics for premature babies

Nature cares about her children: she has presented newborns with enormous potential for the restoration of organs and systems that have been damaged or delayed in their development. And if you, in addition, begin to stimulate natural opportunities with various developing and strengthening activities, you will undoubtedly achieve good results.

Basic requirements for massage and gymnastics

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

So, stick to the following rules:

• If possible, eliminate loud music, conversations of strangers and other distractions in the practice room;
• focus all your attention on the child, talking calmly with him and encouraging the correct implementation of the exercises with a smile and affectionate words;
• the duration of the first lessons should be no more than 5-6 minutes, while performing only breathing and simple reflex exercises, alternating them. Each exercise is repeated 3-4 times;
• start classes with breathing exercises (see below), repeating them several times throughout the entire procedure;
• gradually (as the child masters these exercises), introduce stroking;
• exercise gymnastics with children who have a birth weight of 1700 g or more, spend from one and a half months, and less than 1700 g a month later. Exercises during this period mainly consist of passive movements (i.e. they are performed not by the child himself, but by the parent, bending and unbending the baby's limbs);
• precede each gymnastic exercise with massage of the corresponding part of the body;
• in the first lessons, do not undress the child completely. When doing exercises for the muscles of the arms, cover the lower half of the baby's body with a diaper, and do not take off the undershirt while doing gymnastics for the legs; if you notice that your baby gets tired or cools quickly, carry out a set of exercises in two stages (for example, two breathing exercises at the beginning and at the end and one reflex between them; the next time the baby is awake, do other exercises from the complex);
• start classes no earlier than 45-60 minutes after feeding, and better - half an hour before it; before a night's sleep - we think you will agree - massage and gymnastics are simply not recommended: here it would be to lull, not cheer up!
• to really help the baby to overcome the lag in physical development, do not just do it every day, but repeat the whole 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 fundamentally wrong to blame each other for any shortcomings. Keep in mind - the past is gone. From now on, only you, your family and your child exist. He especially needs your love and help. Do not succumb to despondency, fears and doubts, believe in yourself and in your child, carefully follow the doctor's orders and carefully observe your baby. Only your love and patience can help him now!

Therefore, start communicating with your child from the very birth. Usually doctors limit visits because the premature baby needs rest and sleep, but you can watch him through the glass wall of the room. Observe the facial expressions of the newborn. As soon as the doctor permits you, swaddle and feed your baby, put on socks to keep him warm (if they are too big, attach them with a band-aid). Even the smallest and weakest toddlers see and hear much more than we imagine. They react to the sound of a voice, intonation, touch, even if they do not 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's listen to music, stroke his arms and legs. Up to 3-5 weeks, a child may be outwardly indifferent to such communication, but do not be alarmed - he simply accumulates impressions and is still too weak to actively react physically. Place a beautiful bright rattle next to your baby. This will help him to quickly begin to distinguish the colors, pitch and timbre of the sound. Vivid impressions stimulate the active psycho-emotional development of the child.

When you come to a child, you should not abuse decorative cosmetics and perfumes, especially smoking.

At the very first responses of the baby to your communication with him (revival, eye contact, smile), let him feel with words and touches that it is pleasant for you and that you love him. It would be useful to keep a diary about the child's behavior (diary of early development). It is interesting and useful not only as a family heirloom, but also in order to acquaint other family members with the baby in advance, to prepare them for the peculiarities of his development. Moreover, this diary enables specialists to help you and your child if later they have any difficulties with health or adaptation. You can take photos and videos of your baby (no flash!). Keep in mind that the development process is always individual. Before asking if your child is normally developed, compare his health status and character traits with this. For some, the norm is to read at 3 years old, for some it is easier to run quickly and jump high, and about others, parents say: "If only you were healthy!" And even if he learns rather weakly, he is kind and accommodating. It is true that there are no children without talent. Therefore, observe the abilities of your child, discover his (and only his!) Talents and develop them.

The main signs and features of the development of premature babies

If a baby is born between 28 and 37 weeks of gestation, it is considered premature. As a rule, the body weight in this case is from 1 to 2.5 kg, and the height is from 34 to 45 cm.However, the main sign of prematurity is precisely the date of birth of the child, since children born on time can also have a small body weight ( for example, children born of 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 prematurity.

The main signs of prematurity are:

1. poor development of subcutaneous adipose tissue (it is practically absent both due to the reduced nutrition of the child 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 conditional line dividing the child's body in half is located above the navel (if normal, at the level of the navel);
4. the cartilage of the auricles is not sufficiently developed, which is why the ears are easily wrapped and tightly pressed against 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 - an increase), and in boys, the testicles do not have time to descend into the scrotum;
6. normally, vellus hair is preserved only on the shoulders and back, and in children born before the term, they cover the entire body (arms, face, legs);
7. the size of the cerebral section of the skull significantly exceeds the size of the facial section, due to which the fontanelles are greatly enlarged, and the seams between the cranial bones are wide. The opening of the small fontanelle is quite often observed. By the third month of the 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 babies

Along with the underdevelopment of all vital organs and systems, most of all, the inferiority of the child's nervous system (both central and peripheral) attracts attention. The nervous system is weak, the reaction to external stimuli is slowed down. 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 in feeding the child), the regulation of the temperature of one's own body (autothermoregulation) is impaired, therefore premature babies often freeze quickly at low temperatures and overheat at high temperatures. In addition, perspiration is impaired in premature babies (which is also a component of the regulation of 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 cramps of the feet can be observed).

The respiratory system of children born prematurely is also insufficiently developed. 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 above normal, the ribcage is quite pliable, and the ribs are at right angles to the sternum. Due to the 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 systems of the body, the cardiovascular system is quite well developed, since its establishment and development occurs not in the last, but in the first trimester of pregnancy. Premature babies have a frequent pulse of weak filling, muffled heart sounds, a third tone is heard, blood pressure is reduced (up to 50-80 and 30-35 mm Hg), heart rate is about 120 per minute. The electrocardiogram also has a number of features.

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

The underdevelopment of the child's endocrine system is most often associated with a violation of the connection between the pituitary gland, the thyroid gland and the adrenal glands, since the direct and feedback mechanisms are not strong enough. Hypothyroidism develops quite often, since the immature thyroid gland is not able to fully perform its main 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 very quickly depleted (rarely, this process is irreversible, malignant). There is a relative insufficiency of the sex glands.

Premature babies are prone to the formation of edema and slight tissue pastiness, since there is an underdevelopment of systems that control water-salt metabolism, but this condition is reversible. In addition to edema, the opposite condition is less often observed - dehydration of the body due to the elimination of a large amount of fluid (combined with polyuria - frequent and profuse 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 the underdevelopment of the kidneys, their concentration ability sharply decreases, as a result of which a large amount of residual nitrogen is found in the blood, and urine is of weak concentration.

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

Starting from the age of a child from 3 to 4 weeks, it is recommended to lay him on his stomach, as this helps to strengthen the muscles of the occiput, shoulder girdle and back (for 2-3 minutes 2-3 times a day). Patting and stroking the child, basic massage and gymnastics are also recommended. Starting from the age of six months, the exercises need to be complicated - squatting, turning 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", "BBC", "wow-wow", etc.), they remember new words and names poorly. However, by one year, the child's mental development reaches the proper level.

How should a premature baby be born?

If preterm birth 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 outside, is it better for your baby to be born vaginally or caesarean?

If your case of premature birth is easy, then these questions will not be difficult to answer, but it can 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 the premature birth is known - rupture, infection, etc. It is only premature birth, which formally occurs for an unknown reason, lends itself well to tocolytics and other measures to combat them, because all other reasons that can really interfere with the continuation of pregnancy are already excluded.

If your baby is happier on the inside, then - at full speed to treatment, to "ward off the blow" of birth. If your child is feeling better outside, your doctor will see if you have enough time for the steroids to take effect - this usually happens within 24 hours. If so, he will pull as long as necessary in order to get the most out of their use, all the while watching the child closely. If there is no time for steroids, and the birth must be carried out immediately as an emergency measure, then the fastest way must be chosen. If the situation is unstable, displacement or caesarean section if things get worse and worse, such as with bleeding. If your condition is stable, you can try to give birth vaginally, using induction.

Feeding premature babies

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

It is 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 (six to eight), but in smaller portions. After a few days, you are likely to have too much milk, because premature babies suckle very little. Excess milk can be frozen and stored for future use.

In the past, premature babies were not breastfed until they learned to drink calmly from a bottle. We now know that this was a mistake. Sucking on the breast is much easier than using a bottle, and when a premature baby is breastfeeding, his heart rate, respiration and blood oxygen levels become closer to normal, so it is best to start breastfeeding these babies as soon as possible. In many hospitals (I hope that one day they will start doing this everywhere), the "kangaroo method" is practiced: the baby is taken out of the incubator and placed with the mother - skin on skin. This method has been used successfully even with babies born before the 26th week and weighing less than 600 grams. By skin contact with the mother, premature babies become warmer, they breathe easier, gain weight faster, are less prone to infections, and their psychomotor skills develop better. Mothers feel much more confident and have more milk.

If this is not the practice in your hospital, insist on it and bring the necessary information to the staff. Set achievable, short-term goals: "I'm not suggesting you start caring for all premature babies in a new way, just let me hold my baby for a couple of hours today."

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

Update: October 2018

A child born at 37 weeks of gestation and earlier is considered to be premature. The most common cause of premature birth is infection, maternal illness, or abnormalities in the placenta. This also affects the health of the baby, therefore, care for such a child should be treated with special attention. All children born prematurely are divided into groups depending on body weight:

• Extremely low weight: less than 1000g
• Very low weight: 1000g to 1500g
• Low weight: from 1500 to 2500g (more often at 34-37 weeks)

How to estimate the age of premature babies?

The age of a prematurely born baby is assessed in the same way as for a one born on time. That is, from the first birthday. But to assess the psychomotor development of a premature baby by months, the so-called prematurity corrections are used. For example, a one year old baby born 3 months ahead of schedule (at 28 weeks) would be scored as a 9 month old baby. Requirements for mental and physical development will be presented to him precisely at the age of 9 months, and not 12. Such a system is used until the child reaches the age of 2 years.

Possible health problems in premature newborns

Respiratory Disorders

• Respiratory distress syndrome
• Congenital pneumonia
• Underdevelopment of the lungs
• Periodic respiratory arrest (apnea)

Immaturity of the respiratory system with prematurity is a common occurrence. Lack of surfactant - a special substance that lines the lungs - leads to clumping and inability to breathe. Children lighter than 1000 g, in principle, are not able to breathe on their own after childbirth and require connection to a ventilator. Often, babies have episodes of apnea - long breaks in breathing. They usually pass by the age of 36 weeks of pregnancy, and before that they require increased monitoring.

Blood changes

• Anemia
• Jaundice
• Hemorrhages in the skin, liver, adrenal glands
• Vitamin K deficiency

Common jaundice of newborns, associated with the breakdown of fetal hemoglobin, lasts a little longer in premature babies. The maximum falls on the 5th day, by the 10th day, the yellowness of the skin normally disappears. If this condition is physiological, then it does not pose a danger to the baby. If the level of bilirubin that causes jaundice is higher than the acceptable level, then there is a risk of brain damage. In such cases, doctors use phototherapy.

Another common problem with hurried babies is anemia. It develops at the age of 1-3 months. Its manifestations are diverse: pallor, poor weight gain, decreased activity, disruption of the heart. In some severe cases, children require a blood transfusion. But for most newborns, it is enough to give iron supplements up to 1-1.5 years.

Gastrointestinal pathology

• Dyskinesias
• Necrotizing enterocolitis

One of the most dangerous and rapid conditions of low birth weight premature babies is necrotizing enterocolitis. It is based on the death of a part of the intestine with inflammation of the peritoneum. Most often, the disease develops in the first 2 weeks of life, manifested by blood in the stool and a general deterioration of the condition. Depending on the volume of the dead intestine, the outcome may be different. With extensive necrosis, removal of this part of the intestine is required, which is associated with high mortality and health problems in the future. Mild cases do not cause serious complications.

Nervous system problems

• Intraventricular hemorrhage (in the brain)
• Hypoxic-ischemic brain damage
• Convulsions
• Retinal pathology
• Deafness
• Muscle weakness

Immaturity of blood vessels in "early" children leads to an increased risk of cerebral hemorrhage. The lower the birth weight, the higher the risk. Most of this bleeding occurs in the first few days of life. The child becomes lethargic, like a "rag doll", sleepy, there are respiratory arrests, even coma. For diagnostics, ultrasound of the brain is used, if necessary, computed tomography. Treatment is possible only symptomatic. Prognosis for hemorrhage ranges from death and severe brain damage to mild developmental delay or complete recovery.

Oxygen starvation during prematurity also has a detrimental effect on the brain. Depending on the time and severity of hypoxia, the result may be cerebral palsy, dementia, a slight delay in psychomotor development or a complete absence of consequences.

Cardiovascular disorders

• Functioning ductus arteriosus
• Blood pressure instability

Other problems

• Tendency to low body temperature
• Vulnerability to infections
• Edema

Maintaining temperature conditions

Immediately after birth, special conditions are created for a premature baby with low body weight. They are placed in jugs where the optimum temperature and humidity are maintained. It has been proven that the survival rate of such children increases if they do not have to spend their energy on warming up. Discharge home usually occurs after the child reaches a certain weight and, accordingly, the ability to regulate temperature. But all the same, the room where the baby will be should be comfortable: not hot or cold, and the humidity should reach 60%.

Newborn nutrition

The earlier the baby is born, the more likely it is that at first he will not be able to suckle milk on his own. If premature babies with extremely low body weight have bowel surgery, infection with diarrhea and vomiting, then the only way to support the body is parenteral nutrition. In such cases, all the necessary substances are administered to the child through a vein. After improvement, breastfeeding begins with a tube. When the baby is strong enough, to learn to coordinate the sucking movements, it is the turn of the nipples or even latching on to the breast. Milk volumes must be controlled to avoid spitting up excess milk and entering the lungs. The frequency of feeding is usually 8-10 times a day. If the baby "spends" 6-8 diapers per day, then he has enough milk.

Breast-feeding

The importance of breastfeeding for premature babies cannot be overstated. Protective antibodies and digestible proteins found in colostrum and milk help babies to grow stronger and fight off infections. But since the need for some elements and vitamins in such babies is greater than in healthy ones, they have to be added to the child's diet additionally.

Milk mixtures

If it is impossible to breastfeed for various reasons due to the immaturity of the digestive tract, frequent regurgitation and special needs, premature babies are fed with special mixtures:

• Bellakt PRE
• Nutrilak Pre
• Pre Nan
• Pre-Nutrilon
• Similac NeoSure
• Similak SpecialCare
• Frisopre
• Humana 0-HA liquid

Complementary foods for premature babies

The introduction of complementary foods also has its own characteristics. If ordinary babies are advised to introduce vegetables or cereals from 6 months, then for babies from premature birth, an adjustment for prematurity is taken into account. That is, a child born 1.5 months ahead of schedule is injected with complementary foods at 7.5 months from birth. But there is no need to comply with these deadlines with an accuracy of the week. It is much more important to focus on the baby's readiness and desire to try new food (see).

Signs of readiness for complementary foods:

• The submission of the pushing reflex (the baby does not push out with the tongue any object that has fallen into the mouth)
• Triple weight from the moment of birth (while doubling is enough for those born on time)
• Lack of breastfeeding
• Active interest in adult food

The rest of the rules for complementary feeding are similar to those at birth on time. The introduction of new products begins with cereals (if the weight is poorly gained) or vegetables (if everything is in order with the weight).

Calcium and Vitamin D

Babies born with low and extremely low birth weight are also exposed to vitamin D in their blood. The result can be rickets, osteoporosis and pathological fractures. For the prevention of such conditions, children are prescribed vitamin D preparations (Aquadetrim at a dose of 300-500 IU per day), and often calcium with phosphorus.

Vitamin D deficiency symptoms:

• rickety rosary (thickening on the ribs, similar to oval rosary)
• small weight gain
• decreased blood calcium
• curvature of the legs

Iron preparations

Almost all premature babies are recommended to be given iron supplements (Aktiferrin, Ferrum-lek and others) until they reach 1-1.5 years. The dosage is calculated according to the formula: 2 mg of the drug per kilogram. The amount of iron can be adjusted by the doctor depending on the condition of the baby.

Baby weight

If the baby does not have serious health problems, then upon reaching the weight of 1800-2000g he can be discharged home. It is best to purchase a newborn baby scale in advance to monitor weight gain once every 1 to 2 weeks (but not every day). On average, daily weight gain should be 15-30g per kg per day. This is especially important for babies who do not breastfeed well. In the case of a normal diet, low gains can indicate anemia or digestive problems. As the baby gets older, weekly gains decrease.

Weight, height and head circumference graph

Age on the chart is counted in weeks from conception (up to 40 weeks), and then from birth in months, just like in babies born on time. The bold black line indicates the mean value. The dark area around the line is close to the mean. The dash-dot line marks the boundaries of the norm. But even when going beyond these boundaries, it is necessary to take into account the individual data of the child: his state of health, dietary habits and the opinion of the doctor.

Baby sleep

The total sleep duration of a premature baby is longer than that of a term born. But at the same time, the "early" child is more sensitive to external influences, so he often wakes up. It is important that after a brightly lit intensive care unit and the noise of medical devices, the child can react to darkness and silence at home for several weeks. Therefore, for the first time after discharge, it can be useful to turn on quiet, calm music and leave dim lights at night so that the baby gradually adapts.

The best sleeping position for your baby is supine. Premature babies are at higher risk of apnea and are less sensitive to low oxygen levels. Therefore, sleeping on your stomach can lead to sudden infant death syndrome. For the same reason, the baby's bed should be moderately rigid, without bulky blankets and toys.

Now on sale there are special cradles and cocoons for such special newborns. Many parents note that babies sleep better in these beds. But at the same time, no research has been carried out on the safety of such cocoons, so experts rarely recommend buying them.

When are they discharged from the premature ward?

• The baby should be attached to the breast / transferred to feeding through the nipple
• The weight gain per day should be at least 10-30g
• The toddler should be able to retain heat well enough while lying in the crib.
• There should be no episodes of stopping or sudden slowing down of breathing
• Vein feeding should be discontinued by the time of discharge
• Eyesight and hearing tests should take place before discharge
• The baby's weight should be 1800 grams and above.

Forecast for newborns

Thanks to modern methods of pediatric intensive care, the survival rate of premature babies weighing 1.5 to 2.5 kg exceeds 95%. If they have no concomitant malformations and severe brain damage, then by the age of 2 they catch up with their peers who were born on time in all respects. With severe concomitant pathology, there may be a developmental delay of varying degrees.

The earlier the child is born, and the less its weight, the lower the chances of survival and recovery. So, birth at 22 weeks of gestation brings the chances of survival closer to 0. At 23 weeks, they rise to 15%. At 24 weeks, half of the newborns survive, at 25 weeks - 70%.

Potential long-term consequences of extremely low birth weight:

• Dementia
• Epilepsy
• Hearing disorders and (from myopia to complete blindness and deafness)
• Frequent pneumonia
• Hepatic and renal failure
• Anemia, vitamin deficiency, growth retardation
• Low school performance
• Decreased social adaptation

All of the above long-term consequences in premature babies are found mainly with an extremely low weight - less than 800 g. But with proper therapy and careful parenting, there are chances to avoid these consequences.

Vaccinations in premature babies

There is a widespread belief that prematurely born babies have a “medication” from vaccinations due to weak immunity. But experts around the world agree that it is the high susceptibility to infectious diseases that makes such children the first candidates for vaccination. Because the risk of dying from commonplace measles, diphtheria, whooping cough and other diseases is high precisely during premature birth (see).

The first vaccine children receive is the hepatitis B vaccine. E is usually given on the first day after birth. After all, these children often require surgery, blood transfusions and other risk factors for the transmission of hepatitis. For babies with extremely low body weight, it makes sense to wait up to 30 days, because the optimal response to vaccination occurs with a weight of 2 kg or more.

In the absence of serious health problems (congenital immunodeficiency, progressive brain disease), the rest of the vaccinations are also done according to the general schedule. It is advisable to choose the pertussis component acellular (Pentaxim, Infanrix vaccines).

• Small babies who are born prematurely gain weight faster and get stronger when in contact with their mother. In the departments where such children lie, visits to parents are allowed, since this has a beneficial effect on the well-being of the kids.
• Premature babies are more likely than full-term babies to become left-handed or use both hands equally
• and hypoxia during childbirth (oxygen starvation) is more typical for those born at 34-37 weeks. Those born at 25-34 weeks of age tolerate it better, although their long-term consequences are worse.

FAQ

A boy, 1.5 months old, weight 1800g, was born at 35 weeks with stunted growth, weighing 1300g. It is not possible to achieve daily bowel movements, even with laxatives. Usually, there is a chair every 2-3 days. What can be done?

A stool frequency of once every 2-3 days is completely normal for any newborn. The main thing is that it is soft and does not bother the child.

A 6-month-old premature baby does not gain weight well, may not gain at all in a whole week. How to get a child to eat?

At this age, it is not the weekly gains that are important, but the weight trend. It is necessary to note on the graph the curve of age in months and body weight, compare it with the normal one (indicated in the article). If the graph goes up, then everything is in order with the increments. In no case should you force a baby to eat.

The daughter was born at 33 weeks, weighing 1700g. Now she is 2.5 years old, she has caught up with her peers in physical and psychomotor development. Problems began with a trip to the kindergarten. Almost constantly sick, every week. Does it make sense to postpone the visit to the kindergarten, because the child was born prematurely?

Almost all children begin to actively get sick with ARVI in the first year in the garden. This has nothing to do with prematurity. If the child does not mind attending a preschool institution, and parents have the opportunity to often take sick leave, then you can go to kindergarten.

Psychomotor development of a child

The earlier a baby is born, the higher the risk of neurological complications. Therefore, it is important to find a competent specialist who will periodically assess the development of the baby and give the right recommendations. Important steps are checks at 9, 18, 24 and 30 months from birth.

Many pediatricians use a convenient development diary from 0 to 3 years old, published in the book by A. M. Kazmin. This diary lists the critical timing for the emergence of skills. That is, in most children, they will appear earlier, and only 5% later. It must be remembered that the terms for premature babies are calculated with an amendment (for example, a baby born a month ahead of schedule should be able to do in six months what 7-month-old babies can do).

Motor development

Reaction
Lying on your back, bending your arms and legs randomly	1.5 months
Lying on his stomach, raises his head	2 months
Lying on the stomach, raises the head in the midline at 45 degrees and holds it (unstable)	3 months
Lying on your stomach, raises your head 45-90 degrees (the chest is raised, rests on the forearms, elbows at or in front of the shoulders)	4 months
When pulling on the handles, trying to sit down	4.5 months
Sitting with lower back support, keeping head straight	5 months
Lying on his back, touching his knees with his handles	5.5 months
Lying on your back, unbending your neck and back, rolls onto your side	6 months
Lying on his stomach, rests on outstretched arms (hands open, chest raised, chin lowered)	6 months
Sits (if seated) with support on his hands, freely turns his head to the sides	6 months
Lying on your back, lifts your legs up and touches your feet	7 months
Lying on his stomach, rests on the forearm of one hand, the other reaches for the toy	7 months
The seated person sits with a straight back without support, hands free. Can lean forward, backward, and sideways, but easily loses balance	7.5 months
Lying on your stomach, unbending, raises the legs and arms outstretched to the side ("swallow")	8 months
Sits stably without support, while being free to play with the toy	8 months
Stands with support for the chest, trying to "spring" on the legs (the body is slightly tilted forward)	8 months
Rolls over from back to stomach by rotating torso	8.5 months
Sitting without support, turns the torso to the side and takes the object, turns around and looks back	9 months
Rolls over from the abdomen to the side, leaning on one forearm, looks back	9.5 months
Rolls over from the abdomen to the back (the pelvic girdle rotates relative to the shoulder girdle)	9.5 months
Crawls on belly	9.5 months
Gets down on all fours (knees and hands) from a prone position, can swing on all fours back and forth	10 months
From a position on all fours, raises one hand high to reach an object	10 months
Sitting unsupported, does not fall when pulled to the side	10 months
Get on all fours from a sitting position	10 months
Stands up, holding on to the support	11 months
Standing, holding on to the support and swinging, shifting from foot to foot	11 months
Sits down on all fours	11 months
Sits down and / or bends over while holding on to the support	11 months
Crawls on all fours	1 year 1 month
Steps sideways along furniture (walls)	1 year 1 month
Kneels down from a standing position, holding the furniture with his hand	1 year 1 month
Stands unsupported for a few seconds	1 year 1 month
Walks independently, arms raised, legs wide apart	1 year 1 month
Sits down on his haunches from a standing position, stands up again	1 year 2 months
Gets up from the floor without support	1 year 3 months
Walks independently, hands are free and relaxed	1 year 3 months
Sits down on his haunches and plays in this position	1 year 6 months
Climbs on the sofa, armchair	1 year 6 months
From a standing position, bends over and straightens up again	1 year 6 months
Gets up from a small chair (with support)	1 year 6 months
Runs, looking at his feet	1 year 6 months
Walks, can suddenly stop and turn	2 years
Sits on a small chair	2 years
Climbs the stairs with an added step, holding onto the railing and the hand of an adult	2 years
Kicks the ball on the move	2 years
Walks backwards	2 years

Hand movements

Reaction	Approximate age at onset of the reaction
Lying on his back, brings his hands to his mouth	3 months
Grips an object that touches the palm or fingers	3 months
Looks at the movements of his hand	3 months
Reaches the object seen with one or two hands, hands open	3.5 months
Pulls the handles along the midline, pulls them up, looks at them, plays with them	3.5 months
Shakes a rattle in her hand	4 months
Lying on your back, reaches for the object seen, grabs it with both hands and pulls it into your mouth	4.5 months
Lying on his back, reaches for the object he sees with one hand and grabs it	4.5 months
Pulls an object in the hand into the mouth	5 months
Hands are open most of the time	5 months
Lying on his stomach, leans with one hand, with the other - reaches for a toy	5 months
Begins to adjust the brush to the shape and size of the object being grabbed	6 months
Lying on your back, holding a toy in one hand, with the other reaching for the other toy and grabbing it	6 months
Shifts the object from hand to hand	6 months
Reaches out for a distant object	7 months
Looks at a small object and tries to grab it with all his fingers	7 months
Rotates the brush with a held toy	7 months
Considers first one object in his hands, then another	8 months
Picks up an object with both hands	8 months
Takes a small object seen with three to four fingers (pinch)	8 months
Pushes the ball in a random direction	8 months
Knocks object on object	9 months
Claps her hands	9 months
Feels people and objects	10 months
Takes a small object with 2 fingers: the thumb and the lateral surface of the index finger (imprecise "tweezers grip")	10 months
The taken object does not immediately pull into the mouth, but first manipulates it (5-10 seconds): shakes, feels, hits something with it, examines	11 months
Drops items in the game	11 months
Takes a small object with two fingers (the tips of the thumb and forefinger) - precise "tweezers grip"	1 year
Separates objects under the control of vision (a board with a hole - a peg, a ring - a rod, etc.)	1 year 1 month
Repeats for adults actions with objects (pushes a toy car, tries to comb his hair with a comb, brings the telephone receiver to his ear, etc.)	1 year 1 month
Trying to draw doodle	1 year 2 months
Dice on dice	1 year 4 months
Connects objects (rod - ring, cap - pen, etc.) under visual control	1 year 4 months
Unscrews small screw caps under vision control	1 year 4 months
Unfolds a paper-wrapped item	1 year 6 months
Puts 3 dice on top of each other	1 year 8 months
Turns the pages of a book one by one	1 year 8 months
Lowers a small object into a small hole	1 year 9 months
Grabs a moving object (such as a ball)	2 years

Vision

Reaction name	Approximate age at onset of the reaction
Looks at the light source.	1 month
Fixes the gaze on the face of an adult.	1 month
Attempts to track a slowly moving face or bright object at a distance of 20-40 cm.	1 month
Fixes a stable gaze in the eyes of an adult.	1.5 months
He prefers to look at contrasting simple shapes: black and white stripes, circles and rings, etc., as well as contrasting moving objects.	2 months
Prefers to look at new items	2 months
Examines the details of an adult's face, objects, patterns.	2 months
Shifts the gaze to the object that appears in the field of view: from the side, from above, from below.	2 months
Smiles when he sees something familiar.	3 months
Keeps track of an adult's face or object moving in all directions at a distance of 20 to 80 cm.	3 months
Examines objects in the room.	3 months
Looks at his hand	3 months
Looks at the object in his hand.	3 months
Smiles more when he sees his mother than others.	3.5 months
Prefers bulky toys	4 months
Blinks when an object is quickly approaching.	4 months
Looks at himself in the mirror.	5 months
Recognizes the bottle (and / or breast).	5 months
Reacts to the mask	5 months
Examines the surroundings on the street	6 months
Selects a favorite toy with a glance.	6 months
In a new place - looking around, maybe frightened.	6 months
Facial expression changes depending on the adult's facial expression	6 months
Draws attention to small objects (bread crumbs, poppy seeds) at a distance of 20-40 cm	8 months
Distinguishes "friends" from "strangers" in appearance.	8 months
Follows the ball game	9 months
Examines small patterns, pictures, photographs, small objects with clear outlines	1 year
Observes how an adult writes or draws with a pencil.	1 year
Understands 2-3 gestures ("bye", "not allowed", etc.).	1 year 1 month
Avoids high obstacles when walking.	1 year 2 months
Mimics the seen actions of an adult	1 year 3 months
Recognizes himself and loved ones in photographs	1 year 4 months
Shows multiple named items or pictures.	1 year 4 months
Recognizes several objects by their realistic drawing.	1 year 4 months
Avoids obstacles on the surface on which he walks (pits, bumps ...).	1 year 6 months
Remembers where some items or toys are	1 year 6 months
He recognizes his things, clothes	2 years

Hearing

Reaction name	Approximate age at onset of the reaction
Listens to the sound of the rattle	2 months
Listens to the voice of an adult	2 months
Smiles when he hears the voice of an adult	2 months
Freezes when a new sound appears on the background of others.	2.5 months
Listens to music.	3 months
Gulps in response to sound stimulation.	3 months
Distinguishes the voices of loved ones (highlights the voice of the mother).	3 months
Highlights your favorite music	4 months
Selectively attentive to certain sounds, which depends on the nature of the sound, and not on its intensity.	4 months
Sometimes turns the head towards the sound source (lying on the back) if it is at ear level	4 months
Shakes the rattle, pauses and shakes again	4 months
Listens to the speaker and reacts to the termination of the conversation.	4 months
Shifts gaze from one speaking person to another	5 months
Looks closely at the object that makes sound.	5 months
Reacts emotionally to familiar voices.	6 months
He clearly finds the source of the sound with his eyes (lying down).	6 months
Listens to whispers and other quiet sounds	6 months
Laughs in response to some sounds	6 months
In a sitting position, turns to the sound source.	7 months
Attempts to reproduce the "melody" of the speech heard	7 months
Interested in objects that produce sound.	8 months
Attempts to reproduce the new sounds he heard	9 months
Looking at a person or object, expects to hear a familiar sound and is surprised if he hears another	10 months
Freezes when he is told "no", "wait", etc.	10 months
Performs movements at the request (for example, on the word "okay" begins to clap his hands)	11 months
Turning, he finds the sound source with his eyes, if he is in the immediate environment and even behind his back.	11 months
Sometimes he repeats familiar two-syllable words, consisting of the same syllables ("mom", "dad", "baba" ...).	1 year
Begins to "dance" to the sound of music.	1 year 2 months
Looks at familiar objects, family members, body parts that are named.	1 year 2 months
Attempts to reproduce a series of speech sounds with a specific intonation and rhythm, which resembles the speech of adults.	1 year 2 months
Performs a familiar action with an object upon request (rolls the car, "combes", "shakes" or "feeds" the doll, etc.). The request should be expressed only in words, without prompting with gestures or glances, without demonstrating what is being asked.	1 year 4 months
Repeats short words heard in conversation of adults (or reproduces them after a few hours).	1 year 4 months
Of 2-3 familiar objects, he looks at the one that was named.	1 year 4 months
From 2-3 familiar pictures he looks at the one that was named	1 year 4 months
Knows several short poems, inserts separate words into them.	1 year 6 months
Understands 20-50 words (names of loved ones, names of body parts, objects and some actions).	1 year 6 months
Likes to play with an adult in the "voices of animals" (for example: "How does the ladybug moo?" - "My-oo-oo").	1 year 6 months
Names objects that are out of sight when he hears sounds coming from them.	2 years
Understands 100 words or more.	2 years 3 months
Repeats sentences of 2-3 words after an adult (or reproduces them several hours later).	2 years 3 months
Trying to sing	2 years 6 months
Repeats couplets or quatrains after an adult (or reproduces them after a few hours)	3 years

For many years, who have been working at the Center for Correction of the Development of Premature Infants of the Research Clinical Institute of Pediatrics and engaged in scientific research on the growth and development of these children, they are currently consulting at the Chaika clinic. Elena Solomonovna has released a manual for parents about what the family of a premature baby has to go through and how to maintain love and friendship. We publish its sequel.

Physical development of a premature baby (weight gain and height)

The first concern of parents of a premature baby is the problem of weight gain. Indeed, it is of paramount importance as a primary indicator of a baby's physical well-being.

It should be noted that the growth rates of physical indicators (body weight, length, head and chest circumference) in a premature baby will differ significantly from those of his full-term peers. At least up to 6-9 months, your baby will be "smaller", and at this time mandatory weight control becomes essential: in the first weeks and months of life, daily at the same time, preferably before the first morning feed or in the evening before bathing), and then monthly.

What should worry you in the first place? This is a drop in body weight or lack of weight gain (the baby "stands" in weight).

The reasons can be both serious enough and due to feeding errors, insufficient amount of breast milk in the mother. Naturally, in any case, you need to consult with the child's leading doctor in order to clarify the causes and eliminate them. I repeat, with a one-time consultation with a pediatrician, the condition of a child born prematurely and very different from full-term peers can be assessed as more severe than it actually is

Digestive problems in a premature baby

The main problems with the digestive system in a premature baby, which almost all parents face, are:

Intestinal colic

Colic - comes from the Greek colicos, which means pain in the colon. Colic - paroxysmal pain in the abdomen, accompanied by severe anxiety in the child. The attack, as a rule, begins suddenly, the child screams loudly and more or less for a long time, reddening of the face or pallor of the nasolabial triangle may be noted. The abdomen is swollen and tense, the legs are pulled up to the abdomen and can instantly straighten, the feet are often cold to the touch, the arms are pressed to the body. The attack sometimes ends only after the child is completely exhausted. There is often noticeable relief after stool and flatulence have passed.

Premature babies are especially prone to colic, while some infants have frequent and intense attacks, which can be compared in intensity to labor pain, and certainly require medical intervention. Apparently, the main reason for this suffering of the baby is the immaturity of the neuromuscular apparatus and the enzymatic system of the intestine and, therefore, the tendency to increased gas production. As a result, the pressure on the intestinal wall increases and muscle spasm occurs.

Irrational feeding can also be the cause of discomfort and bloating. Certain foods, especially those high in carbohydrates, can contribute to excessive fermentation in the intestines. Intestinal allergies also cause the baby to cry due to abdominal discomfort.

But the causes of kolik are not limited to these states. It is important to timely diagnose diseases requiring surgical intervention. Therefore, in the absence of the effect of the usual measures aimed at eliminating colic (special carminative herbal teas, preparations of simethicone Sub / Simplex, Espumisan, a cleansing enema, the use of a gas outlet tube, massage of the abdomen, dry heat on the abdominal area), the child should be carefully examined in a medical institution.

Regurgitation syndrome

Regurgitation syndrome can also be troubling for parents of a premature baby. The most common reason for this is immaturity and temporary (passing) hypotonia of the smooth muscles of the stomach - the so-called "duodeno-gastric reflux". Most often this occurs in premature babies who have been fed for a long time through a tube. Aerophagia (when an infant greedily swallows air along with food) can also be a possible cause of regurgitation. The masses during regurgitation look abundant due to their binding to the air and usually do not change the baby's well-being in any way. In this case, you need to be patient and wait for the baby's stomach to "mature", while observing the recommendations for proper feeding, keeping the baby upright after feeding for 10-15 minutes. It is best to give medications to the baby before feeding. However, there are situations in which urgent consultation with a specialist is necessary: ​​if there are streaks of blood in the regurgitated masses, if the regurgitation is so profuse that the child does not gain weight well, if the baby does not feel well during regurgitation, do not hesitate, contact a doctor!

Diarrhea and constipation

Dyspepsia (diarrhea and constipation), changes in stool structure, the appearance of mucus and impurities in a premature baby is a frequent and exciting phenomenon for parents and pediatricians. It is necessary to determine what should not be of concern to parents.

When breastfeeding, the baby may have a stool after each feeding, along with gas (frothy) and quite liquid. In children receiving formula, stool is more rare - 3-4 times a day. Changes in stool quality and color also occur with late formation of intestinal enzymes in a premature baby, difficulty in digesting fats or carbohydrates.

The most common problem in a premature baby is a temporary lack of stool or delayed stool evacuation. There is no stool for several days, the child is pushing to no avail. When defecation occurs, the stool as a whole is not changed in consistency, which does not allow calling it constipation in the conventional sense of the word.

It will take some time to make it easier for the child to defecate, there is nothing to worry about if you do it with the knowledge and under the supervision of a doctor.

Immaturity is the cause of all disorders of the functional state of the gastrointestinal tract.

However, proper feeding is the best and natural treatment. Breast milk is perhaps the best thing a mother can give her baby. At the birth of a premature baby, milk, as it were, adapts to the immature intestine, so that the hormones necessary and coming from the mother, and active metabolites, protective substances and enzymes, contribute to the more rapid maturation of all organs.

Therefore, breast milk and the possibility of natural feeding should be tried with all our might. However, if there is still not enough milk, and you were forced to replace it with a formula, then it is most advisable to use a special formula for premature babies. In any case, it is important to coordinate the use of mixtures with your pediatrician.

The main criterion that all the changes you observe on the part of the gastrointestinal tract are not diseases requiring urgent medical measures, is a sufficient increase in the child's body weight and the absence of a pronounced pain syndrome in the child

Premature anemia

Almost all premature babies have a drop in hemoglobin, which is called anemia. The cause of anemia is the same immaturity. In premature babies, the so-called "fetal" hemoglobin is determined for a long time, which is destroyed faster, and the ability to form a new one is reduced. At the same time, hemoglobin carries oxygen, which is necessary for the functioning of all cells and their maturation. Controlling hemoglobin levels is very important.

A premature baby should be prevented from anemia and treated on time if hemoglobin drops to 100 g / l.

Rickets of prematurity

Rickets is a deficiency in the formation of vitamin D in the body and the entry of calcium into cells, which is necessary for the growth of bone tissue and the formation of neuromuscular regulation.

Deficiencies in vitamin D production and calcium absorption are associated with immaturity. This slows down the development of the child. The baby becomes more irritable, sweating, sleep is disturbed, hair falls out, growth and weight gain slow down. Bones become "weak" and may bend. A premature baby requires mandatory prophylactic use of vitamin D preparations, and in case of clinically obvious manifestations of rickets, treatment with vitamin D and calcium preparations.

The condition of the skeletal system and joints

The phenomena of morphofunctional immaturity in a premature baby often extend to the musculoskeletal system. Imperfection of neuromuscular regulation, ligament weakness, excessive joint mobility can lead to changes in the correct position of the limbs, head and spine of the child.

Often, the infant holds the head in a fixed position to one side. The reason for this may be a congenital shortening of the neck muscle on one side, a traumatic injury to the spine or cervical muscles during the removal of the head during childbirth, or just a "usual" position of the head, that is, the child "lay" in this position most of the time in the uterus. The correct diagnosis is always made by a doctor, and the sooner this happens, the more effective the treatment will be.

Prematurity, especially in combination with an incorrect intrauterine position of the fetus, is usually accompanied by underdevelopment of the hip joints or "dysplasia". The most severe variant of this pathology is dislocation of the hip joint. The diagnosis is established shortly after the baby is born and requires early treatment based on abduction of the hip joints. Currently, an effective method in identifying abnormalities in the development of joints is ultrasound scanning, which is mandatory for all children in the first months of life.

For premature infants, the most diagnostically reliable period is 3-4 months of corrected age to assess the condition of the hip joints. At an earlier date, there is a very high risk of error due to their natural immaturity.

Premature eye disease

Retinopathy of prematurity (ROP) is a disease of the eyes of premature babies, which can even lead to irreversible loss of visual functions.

The possibility of developing ROP is associated with the timing and weight at birth, the presence of severe changes in the respiratory, circulatory and nervous systems, as well as the adequacy of the measures taken to nurture the baby.

This disease was first diagnosed in a premature baby in 1942. Then it was called as retrolental fibroplasia. Until now, the causes of the onset, progression and spontaneous regression of the disease are not completely clear and are only being studied.

At this stage in the development of ophthalmology, the fact that the development of retinopathy occurs precisely in an immature baby is considered indisputable, as a violation of the normal formation of retinal vessels (which ends by the 40th week of intrauterine development, i.e. by the time of the birth of a full-term baby). It is known that up to 16 weeks of intrauterine development, the retina of the fetus has no vessels. Their growth into the retina begins from the point of exit of the optic nerve towards the periphery. By the 34th week, the formation of the vasculature in the nasal part of the retina is completed (the optic nerve disc, from which the vessels grow, is closer to the nasal side). In the temporal part, the growth of blood vessels continues up to 40 weeks. Based on the foregoing, it becomes clear that the earlier the child is born, the smaller the area of ​​the retina covered with blood vessels, i.e. during ophthalmological examination, more extensive avascular, or avascular, zones are revealed (if the child was born before the 34th week, then, accordingly, the avascular zones of the retina are detected on the periphery from the temporal and nasal sides). After the birth of a premature baby, various pathological factors act on the process of vascular formation: the external environment, light, oxygen, which can lead to the development of retinopathy.

The main manifestation of ROP is stopping the normal formation of blood vessels, their germination directly into the eye into the vitreous body. The growth of vascular and after it young connective tissue causes tension and retinal detachment.

As mentioned earlier, the presence of avascular zones on the periphery of the fundus is not a disease. This is only evidence of retinal vascular underdevelopment, and, accordingly, the possibility of retinopathy development in the future. Therefore, starting from the 34th week of development (or from the 3rd week of life) of the child, it is necessary that your child is examined by an ophthalmologist, a specialist in retinopathy of prematurity, who has special equipment for examining the retina of the eye. Such monitoring is necessary for all children born before 35 weeks of age and with a birth weight of less than 2000 g.

When signs of ROP are detected, examinations are carried out every week (at the so-called "plus" stage of disease - every 3 days) until the development of the threshold stage (at this stage the issue of preventive surgical treatment is being decided) or complete regression of the disease. With regression of the pathological process, examination can be carried out 1 time in 2 weeks. The examination is carried out with the obligatory dilation of the pupil, using special children's eyelid dilators, so as not to put pressure on the eyes with fingers.

Most often, the threshold stage of ROP develops by 36-42 weeks of development (1-4 months of life), therefore, parents of a premature baby should know that during this period he should be examined by a specialist (an ophthalmologist who has special equipment and knows about the signs of active retinopathy ).

Active retinopathy is a staged pathological process that can end in regression with the complete disappearance of the manifestations of the disease or cicatricial changes.

According to the international classification, active retinopathy is subdivided according to the stages of the process, its localization and length:

Stage 1. The appearance of a dividing line at the border of the vascular and avascular retina.

Stage 2. The appearance of a shaft (volume line) at the place of separation.

It should be emphasized that in 70-80% of cases at stages 1-2 of ROP, spontaneous cure of the disease with minimal residual changes in the fundus is possible.

Stage 3 is characterized by the appearance of retinal vascular growth in the vitreous body in the area of ​​the shaft. With a short duration of the process, as in the first two stages, spontaneous regression is possible, but the residual changes are more pronounced.

When the growth of blood vessels inside the eye has spread over a fairly wide area, this condition is considered to be the threshold stage of ROP, when the process of ROP progression becomes almost irreversible and requires urgent preventive treatment.

The effectiveness of prophylactic laser and cryocoagulation of the avascular retina ranges from 50-80%. Timely treatment can significantly reduce the number of adverse outcomes of the disease. If the operation is not performed within 1-2 days after the diagnosis of the threshold stage of retinopathy, then the risk of developing retinal detachment increases sharply. It should be noted that with the development of retinal detachment, cryo-, laser coagulation is not possible. Further prognosis for the development of vision in such an eye is extremely unfavorable.

The operation is often performed under anesthesia (less often local anesthesia is used) in order to avoid ophthalmic-cardiac and ophthalmic-pulmonary reactions. Evaluation of the results of treatment is carried out in a few days to resolve the issue of repeating the procedure. The effectiveness of preventive treatment can be judged 2-3 weeks after the formation of scars at the site of the shaft. If the treatment was not carried out or the effect was not achieved after the treatment (severe ROP), terminal stages develop.

Stage 4. Partial retinal detachment.

Stage 5. Complete retinal detachment.

Even if the process has reached stages 4 and 5, it is necessary to carry out a whole range of therapeutic and surgical measures aimed at preventing severe cicatricial changes.

The "plus" disease, as the most unfavorable form of active retinopathy, is distinguished separately. The disease begins early, has no clearly defined stages, progresses rapidly and leads to retinal detachment, not reaching the threshold stage. The pathological process is characterized by a sharp expansion of the retinal vessels, pronounced edema of the vitreous body, hemorrhages along the vessels, dilation of the vessels of the iris, often with the impossibility of dilating the pupil. The effectiveness of treatment for "plus" disease is still low.

If the active process has reached 3 or more stages in its development, then after its completion (with or without preventive treatment), cicatricial changes of varying severity are formed in the fundus.

1 degree - minimal changes in the periphery of the fundus;

Grade 2 - dystrophic changes in the center and periphery, remnants of scar tissue;

3 degree - deformation of the optic nerve head, with a displacement of the central parts of the retina;

4 degree - the presence of retinal folds, combined with changes characteristic of the 3rd stage;

Grade 5 - complete, often funnel-shaped, retinal detachment.

At the first and second degrees, a sufficiently high visual acuity can remain, with the development of thirds or more degrees, a sharp, often irreversible decrease in visual acuity occurs.

Indications for surgical treatment of cicatricial stages of ROP are strictly individual, determined by the degree and localization of retinal detachment, as well as the general somatic condition of the child. In any case, the functional and anatomical efficiency of operations is noticeable only up to 1 year of age, when it is possible to obtain an increase in visual acuity and create conditions for the growth of the eye.

However, upon reaching the 5th stage of cicatricial ROP, the pathological process can continue and lead to the development of complications in the form of corneal opacity and secondary glaucoma. Therefore, with the development of contact between the cornea and the iris, urgent surgical treatment is necessary in order to preserve the eye (in this case, we are not talking about increasing visual acuity).

It should be noted that if a child has undergone even mild stages of active ROP or has unexpressed cicatricial changes, then it is believed that such children do not develop a full-fledged retina. In the future, such children have a high risk of developing myopia, dystrophy and secondary retinal detachments. Based on this, children who have undergone ROP should be observed by an ophthalmologist at least 2 times a year until they reach the age of 18.

Successful nursing and subsequent development of premature babies, including the preservation of visual functions, is a difficult, but quite feasible task. Achieving a good rehabilitation result depends on the joint efforts of neonatologists, ophthalmologists and psychologists.

Hearing and speech formation

There is no evidence that premature babies are more likely to have severe hearing impairment than full-term babies. However, in many of them, the formation of auditory function is delayed. The presence of hearing can be assessed by a hardware technique, which is now widely used and is called otoacoustic emission or audio test. Taking into account the characteristics of a premature baby, it is possible to reliably judge the passing of the test only at the age of 4 months of the corrected age. Until that time, there will be many false negative results, which are explained by the same immaturity of the child, but cause a huge number of unnecessary worries. The later development of the auditory function also leads to a later onset of humming, difficulty with the child's speech in the future. Complex features lead to the fact that the child begins to speak later and many sounds are pronounced incorrectly (perhaps the child hears them this way). All this is gradually normalizing, but most premature babies will need the help of a speech therapist and it is advisable to start classes earlier than recommended for full-term babies, for example, at 2.5-3 years old, depending on the general development of the child.

What happens to the immune system of a premature baby?

Will he often have colds?

Numerous studies in our country and abroad have dispelled the prejudice about the "weakness" of the immune system of a premature baby. Just like in full-term babies, it is formed in the first three years of life and differs insignificantly in terms of indicators. Just like full-term babies, when breastfeeding, the formation of the immune system takes place more quickly and its activity is higher, but not enough to say that without breast milk your baby is not at all protected.

Why do premature babies get sick more often and more severely? There are several explanations here: premature babies are more likely to visit medical facilities where the risk of infection is high. Parents are very protective of premature babies, they often overheat and thus inhibit the development of the immune system. Premature babies with diseases often develop bronchospasm, respiratory failure, they are more often hospitalized and more often prescribed antibiotics, which also weakens the formation of immune defense. All this determines the approaches and tactics that parents of a premature baby should follow, and a doctor who knows the characteristics of the baby and, most importantly, is not afraid that he was born prematurely, should teach this.

Should premature babies be vaccinated?

It is necessary and necessary! Actually, vaccinations are just for them. Since a strong and strong child is likely to easily endure any infection, but for an "immature" and poorly protected premature baby, any serious infection can become fatal.

Previously, neonatologists made a diversion for a premature baby up to one year old. Today this concept has been revised all over the world. It has been proven that the immune system is more ready to produce antibodies in the first months of life. Judge for yourself: any child is born completely "sterile" and from the very first seconds is faced with a variety of viruses that are common around us, and with bacteria that inhabit surfaces and our bodies. However, he defends himself with sufficient ease, except for a situation of over-massive influences (intensive care unit, significant accumulations of sick children and adults).

However, there are still limitations - these are acute conditions, which are temporary, but absolute contraindications to vaccination, and some chronic conditions: and this is, first of all, damage to the central nervous system. These include absolute contraindications - decompensated hydrocephalus and seizures.

And yet, only the attending physician can tell whether your child is ready for vaccinations, explain in detail to you what vaccinations and from what diseases your baby is required, whether any examinations are needed, for example, an ECG or EEG. This is a very important decision that requires great knowledge of the doctor, self-confidence and confidence in your child. On the other hand, the importance of this decision is to protect your baby as much as possible from possible severe infections, which, unfortunately, are abundant in any society, realizing how difficult it will be for a premature baby to tolerate these diseases.

What is prevention of respiratory syncytial viral infection and why should it be done?

One of the most serious diseases of a premature baby in the 1st year of life is RSV infection. This is a very common condition. In fact, almost all children under 2 years of age carry this viral infection at least once.

This infection proceeds like a cold, but its peculiarity is the defeat of the lower respiratory tract, like pneumonia or, terminologically, alveolitis. Alveolitis is an inflammation of the most terminal parts of the respiratory tract - the alveoli, where gas exchange takes place. Thus, if the alveoli become inflamed, then the person begins to suffocate from the lack of oxygen and the accumulation of carbon dioxide in the body. This infection is especially difficult in premature babies, who already have a very immature broncho-alveolar tree, many have signs of broncho-pulmonary dysplasia. In severe cases, children require hospitalization, resuscitation, mechanical ventilation, antibiotic therapy, etc., not to mention severe psychological trauma for the baby and the whole family.

Over time, when faced with this virus, the child develops antibodies and after 2-3 years the virus becomes practically not dangerous and the disease proceeds like a common ARVI.

But! You have to live these 2 years. In recent years, a drug has been developed, created and widely distributed, which is a purified antibody to the respiratory syncytial virus. The introduction of these antibodies protects the child from the disease, but not only with this virus, but also with other similar viruses, and the child as a whole begins to get sick less.

Today in the country there is a drug SINAGIS, which is very expensive in price, as it is a superpurified monoclonal antibody. For effective protection from the virus, 3-4 injections are required with an interval of 30 days in the most dangerous epidemiological period - from about November to March. The introduction of the drug is not a vaccination, but a passive immunization: when it is not the child's body that produces antibodies, but they are injected ready-made. Therefore, repeated administration is required during the first year at strictly regular intervals.

In the near future, it is possible that there will be other drugs of a similar effect in the country, most likely cheaper and more accessible. But this still requires verification.

We tried to tell in an accessible form about the most common problems of the first year of a premature baby's life. All of them require attention, observation and timely treatment.

Once again, we repeat why you need to monitor a premature baby in the first year of life:

• The development of a child, the formation of his psycho-motor functions requires a monthly assessment by one specialist. You should carefully observe the baby in order to tell the doctor as truthfully and objectively as possible about the child's behavior.
• Weight gain, which indicates sufficient absorption and assimilation of nutrients. Premature babies tend to have a decrease in appetite, and sometimes it is a big problem to feed such a baby. The more the baby is not full-term, the more pronounced the violation of the digestibility of nutrients and the worse the weight gain. In this case, the use of special drugs that improve the energetic state of cells can help to cope with this.
• Prevention or, if necessary, treatment of rickets.
• Prevention and, if necessary, treatment of anemia.
• Relief of the child's "intestinal colic", control over the state of the gastrointestinal tract, correction of regurgitation. Rational feeding. Mandatory consultation to resolve the issue of the timeliness of the introduction of complementary foods.
• Monitoring the state of the nervous system, timely carrying out special examinations to determine the maturation of brain structures, to control the manifestation of hypoxic-ischemic encephalopathy (if your baby had hemorrhage or periventricular leukomalacia, if he had meningitis or encephalitis).
• Monitoring the state of the respiratory system, especially if the child has been on a ventilator for more than 3 days. Remember that if a child develops broncho-pulmonary dysplasia, it is necessary to carefully observe the color of the child's skin and his breathing (the child begins to breathe "heavily" and often), as periods of exacerbations are possible (for every doubt, it is better to consult your doctor watching) ... If such a baby falls ill, he often develops "obstructive syndrome", which requires urgent treatment.
• Monitoring the state of the heart, especially in children with broncho-pulmonary dysplasia. It is especially important for such children to control physical activity, to prescribe dosed massage and physical methods of rehabilitation.
• Monitoring the condition of the musculoskeletal system, in particular the hip joints, since a violation of the development of these joints will not allow the child to sit, stand and walk correctly.
• Monitoring the state of the organs of vision
• Monitoring the condition of the hearing organs.

Thus, there are a lot of problems. It is almost impossible to treat everything at the same time - the baby simply cannot withstand such a load. Therefore, when assessing the condition of the child, it is necessary to determine the primary task, which to a greater extent disrupts the normal development of the baby and requires urgent correction. Only a specialist can solve this.

Happiness, health and good luck to you and your kids!

Premature babies are considered children born in the period from 22nd to 37th week of gestation with a body weight of less than 2500-2700 g and a body length of less than 45-47 cm. The most stable indicator is the gestational age.

The fetus is viable (as defined by the WHO) with a body weight of 500 g or more, a body length of 25 cm or more, and with a gestational age of more than 22 weeks. Russian national statistics on miscarriage (spontaneous abortion at a gestational age of less than 37 full weeks) fully takes these recommendations into account. The statistics on prematurity (spontaneous or induced termination of pregnancy from the time when the fetus is considered viable) among live births takes into account only children from the 28th week of gestation weighing 1000 g and above and body length 35 cm or more. Of those born alive with a body weight of 500-999 g, newborns who have lived 7 days after birth are subject to registration.

The number of premature babies in different countries ranges from 3 to 17%, in Russia - 3-7%. Among prematurely born children, the highest morbidity and mortality are observed. They account for about 75% of infant mortality in our country; in the most economically developed countries - 100%.

REASONS FOR PREMATURE BIRTH OF CHILDRENThe main reasons for the premature birth of children are as follows.

Socio-biological factors.

The parents are too young or too old. If old age has a negative effect on bearing due to biological changes in the aging body, then the birth of premature babies in young mothers is due to unplanned pregnancies.

Miscarriage is influenced by the low educational level of the parents and the associated unhealthy lifestyle during pregnancy and the lack of understanding of the importance of constant

medical supervision. Among children born to women who have not been observed during the entire pregnancy in antenatal clinics, the level of perinatal mortality is 5 times higher.

An important role in miscarriage is played by occupational hazards, bad habits, and hard physical labor. Smoking not only for the mother, but also for the father has a negative effect on the health of the child. Severe malformations in children from men who smoke for many years and / or smoke a large number of cigarettes occur 2 times more often than children from non-smoking fathers.

Even with the desired pregnancy, the risk of miscarriage in single women is higher than in women who are married, which is due to social, everyday and psychoemotional factors.

Previous abortions. The complete elimination of abortion with effective contraception can reduce the incidence of preterm birth by 1/3.

Short intervals between births (less than 2 years) can cause premature delivery.

Diseases of the mother.

Pathological course of pregnancy.

DEGREES OF PREGNANCY

There are four degrees of prematurity (Table 4-1).

Table 4-1.Prematurity

Currently, the diagnosis usually indicates not the degree of prematurity, but the gestational age in weeks (a more accurate indicator).

SYMPTOMS OF PREPARATION Clinical signs

The appearance of a premature baby depends on the degree of prematurity.

A deeply premature baby (body weight less than 1500 g) has thin, wrinkled skin of a dark red color, abundantly covered with cheese-like lubricant and fluff (lanugo). Simple erythema

lasts up to 2-3 weeks. The subcutaneous fat layer is not pronounced, the nipples and areola of the mammary glands are barely noticeable; auricles are flat, shapeless, soft, pressed to the head; nails are thin and do not always reach the edge of the nail bed; the navel is located in the lower third of the abdomen. The head is relatively large and is 1/3 of the body length; limbs are short. The sutures of the skull and fontanelles (large and small) are open. The bones of the skull are thin. In girls, the genital gap gapes as a result of underdevelopment of the labia majora, the clitoris protrudes; in boys, the testicles are not descended into the scrotum.

In more mature premature babies, the external appearance is different. The skin is pink, there is no cannon on the face (at birth at the 33rd week of gestation), and later on the trunk. The navel is located slightly higher above the bosom, the head is about 1/4 of the body length. In children born more than 34 weeks of gestation, the first bends appear on the auricles, the nipples and areola are more noticeable, in boys the testicles are at the entrance to the scrotum, in girls the genital slit is almost closed.

Premature babies are characterized by muscle hypotonia, decreased physiological reflexes, motor activity, impaired thermoregulation, and a weak cry. A deeply premature baby (less than 30 weeks gestation) lies with outstretched arms and legs; sucking, swallowing and other reflexes are absent or poorly expressed. Body temperature is unstable (it can drop to 32-34? C and rise easily). At birth after the 30th week of gestation in a premature baby, partial flexion of the legs in the knee and hip joints is revealed; the sucking reflex is good. In a child born at 36-37 weeks of gestation, flexion of the limbs is complete, but unstable; a distinct grasping reflex is evoked. In the first 2-3 weeks of life, a premature baby may have an unstable tremor, a mild and unstable squint, horizontal nystagmus with a change in body position.

Premature boys and girls do not differ in anthropometric indicators, since these differences are formed in the last month of pregnancy (full-term boys are larger than girls).

Features of internal organs

The morphological and functional immaturity of internal organs is also in accordance with the degree of prematurity and is especially pronounced in deeply preterm infants.

Breathing in premature infants is shallow with significant fluctuations in NPV (from 36 to 76 per minute), with a tendency to tachypnea and apnea lasting 5-10 seconds. In children born at less than 35 weeks gestation, the formation of a surfactant is impaired, which

ryy prevents the collapse of the alveoli on exhalation. They develop SDD more easily.

The heart rate in premature infants is characterized by high lability (from 100 to 180 per minute), the vascular tone is reduced, the systolic blood pressure does not exceed 60-70 mm Hg. Increased permeability of the vascular walls can lead to impaired cerebral circulation and cerebral hemorrhage.

Due to insufficient maturity of the renal tissue, its function to maintain acid base balance is reduced.

All gastrointestinal enzymes necessary for the digestion of breast milk are synthesized, but they are characterized by low activity.

In premature babies, there is no relationship between the intensity of jaundice and the degree of transient hyperbilirubinemia, which often leads to an underestimation of the latter. Immaturity of the liver and the associated insufficient activity of the enzyme glucuronyltransferase, increased permeability of the blood-brain barrier (BBB), as well as rapid breakdown of erythrocytes can lead to the accumulation of indirect bilirubin in the blood in the first days of life and the development of bilirubin encephalopathy even with a relatively low concentration of bilirubin (170-220 μmol / L).

Laboratory research

In the first days of life, premature babies, to a greater extent than full-term babies, are characterized by hypoglycemia, hypoproteinemia, hypocalcemia, hypomagnesemia, hyperkalemia, and decompensated metabolic acidosis. The content of erythrocytes and Hb at birth is practically the same as in full-term, but the content of HbF is higher (up to 97.5%), which is associated with intense hemolysis. From the second day of life, red blood counts change at a faster pace than in full-term, and at the age of 6-8 weeks, a deviation in the hemogram, typical for premature babies, appears - early anemia of premature babies. Low erythropoietin production is believed to be the leading cause of anemia. The content of leukocytes is the same as in term babies, but the presence of young forms up to promyelocytes is characteristic. The first intersection of granulocytes and lymphocytes occurs the later, the greater the degree of prematurity (at grade III - by the end of the first month of life).

DEVELOPMENT FEATURES OF PREMATURE CHILDREN Physical development

Physical development of premature babies is characterized by a higher rate of increase in body weight and length during the first year

life. The less weight and body length of a premature baby at birth, the more intensively these indicators increase during the year.

By the end of the first year of life, body weight increases as follows: with IV degree prematurity, 8-10 times, III degree - 6-7 times, II degree - 5-7 times, I degree - 4-5 times. Body weight increases unevenly. The first month of life is the most difficult period of adaptation, especially for a deeply premature baby. The initial body weight is reduced by 8-12% (in term infants by 3-6%); recovery is slow. With a gestational age of less than 32 weeks, body weight often reaches its initial values ​​only by the end of the first month of life and begins to increase more intensively from the 2nd month.

The body length of a premature baby by the end of the first year of life is 65-75 cm, i.e. increases by 30-35 cm, while the full-term body length increases by 25 cm.

Despite the high rates of development, in the first 2-3 years of life, premature babies lag behind their peers who were born full-term. Alignment occurs after the third year of life, often at 5-6 years. In the future, in children born prematurely, asthenia and infantilism are often observed, but indicators of physical development characteristic of full-term peers are also possible.

Psychomotor development

In psychomotor development, healthy premature babies are compared with their full-term peers much earlier than in physical development. Children with II-III degree prematurity begin to fix their gaze, hold their head, roll over, get up and walk on their own, pronounce the first words 1-3 months later than full-term babies. Premature babies "catch up" with full-term peers in psychomotor development in the second year of life; with prematurity of I degree - by the end of the first year.

FEATURES OF PREMATURE HATCHINGNursing premature babies is carried out in two stages: in the maternity hospital and in a specialized department. Then the child is taken under the supervision of a polyclinic.

All over the world, great importance is attached to "gentle nursing of premature babies" with limited intensive therapy, stressful situations, and pain. After the birth of a premature baby, it should be placed in a sterile, warm diaper (“optimal comfort”). Chilling immediately after birth, while still in the delivery room, often dooms all further care to failure. So, if the body temperature of a premature baby only once dropped to 32? C

and below, the mortality rate reaches almost 100%, even with the correct use in the future of all modern methods of care and treatment. In the first days of life, deeply premature babies or premature babies in serious condition are kept in incubators. They maintain a constant temperature (from 30 to 35 ° C, taking into account the individual characteristics of the child), humidity (up to 90% on the first day, and then up to 60-55%), oxygen concentration (about 30%). The child's body temperature can also be maintained in a heated crib or in a regular crib with heating pads, since the longer you stay in the incubator, the more likely the child is to become infected. The optimum room temperature is 25 ° C. It is necessary to support the adaptive reactions of the child with the help of instilling native mother's milk into the mouth from a pipette, heated diapers, prolonged stay on the mother's breast (like "kangaroo"), the calm voice of a nurse, stroking movements of her hands.

Only 8-10% of healthy premature babies with a birth weight of more than 2000 are discharged from the maternity hospital. The rest are transferred to specialized institutions for the second stage of nursing.

FEATURES OF FEEDING PREMATURE

Features of feeding premature babies are due to their increased need for nutrients in connection with intense physical development, as well as functional and morphological immaturity of the gastrointestinal tract, and therefore food should be administered carefully. Even deeply premature babies should be fed already in the first hours of life due to the catabolic orientation of metabolism, hypoproteinemia and hypoglycemia.

With parenteral nutrition, the intestines of the child are quickly colonized with conditionally pathogenic microflora. At the same time, the permeability of the mucous membranes of the gastrointestinal tract increases, which contributes to the generalization of the infectious process. Parenteral nutrition is resorted to only in extremely serious conditions in deeply premature babies and for a limited period of time. It is more advisable for such children to prescribe a round-the-clock drip of native mother's milk.

Children with a gestational age of more than 28 weeks, as well as all premature babies with SDR, a weak sucking reflex, are injected breast milk through a gastric tube. With a satisfactory general condition, a sufficiently pronounced sucking reflex and a birth weight of more than 1800 g, it is possible to apply to the breast after 3-4 days. Premature babies weighing less than 1500 g at birth are applied to the breast from the third week of life. In the absence of milk from the mother, specialized mixtures for premature babies are prescribed

(for example, "Nenatal", "preNAN", etc.) When the body weight reaches 2500-3000 g, the child is gradually transferred to conventional breast milk substitutes.

Calculations of nutrition are made in accordance with the needs of the child's body per 1 kg of body weight per day: 1-2 day of life - 30 kcal, 3rd day - 35 kcal, 4th day - 40 kcal, then daily by 10 kcal more before the 10th day of life; on the 14th day - 120 kcal, from the 21st day of life - 140 kcal.

When determining the amount of food, the individual characteristics of the child should be taken into account: deeply premature babies from the 2nd month sometimes assimilate the volume of breast milk corresponding to 150-180 kcal / kg.

LONGER CONSEQUENCES OF PREGNANCYAmong premature babies, the risk of mental and physical disability is higher than among full-term babies.

Gross neuropsychiatric disorders in the form of infantile cerebral palsy, decreased intelligence, impaired hearing and vision, epileptic seizures occur in 13-27% of premature babies.

In premature babies, malformations are detected 10-12 times more often. They are characterized by a disproportionate development of the skeleton, mainly with deviations towards asthenization. Many of them have a further increased risk of “school maladjustment”. Among those born prematurely, attention deficit hyperactivity disorder is more often observed.

In women who were born deeply premature, in the future, menstrual irregularities, signs of sexual infantilism, the threat of termination of pregnancy and premature birth are often observed.

Despite the above, with proper care and balanced nutrition, premature babies usually grow up healthy and become full members of society.

PREVENTION OF PREMATURE BIRTH OF CHILDRENPrevention of premature birth of children provides for the protection of the health of the expectant mother; prevention of medical abortion, especially in women with menstrual irregularities and neuroendocrine diseases; creating favorable conditions for pregnant women in the family and at work; timely identification of risk groups and active monitoring of the course of pregnancy in these women.

Parents of babies born prematurely are forced to face various problems, including the difficulties of nursing crumbs in a maternity hospital and creating the necessary conditions at home, establishing breastfeeding or choosing a suitable formula, regular visits to the doctor and worries about the future health of the baby. However, they should always remember that with increased attention to the baby and proper care, they will be able to help the baby quickly "catch up" with his peers and grow up as a healthy and cheerful baby, which is confirmed by the popular "Before and After" photographs.

You can see more similar photos in the photo gallery at the end of the article.

Which baby is considered premature?

Official medicine classifies babies as premature if they were born less than 37 weeks of gestation. Such children have lower growth and weight indicators, and their organs are immature.

Causes

Factors causing premature birth are:

• Neglect of medical care for pregnancy.
• The presence of bad habits in a pregnant woman.
• Insufficient or unbalanced nutrition of a woman during gestation.
• The age of the future mother or future father is less than 18 and more than 35 years old.
• Work of a pregnant woman in harmful conditions.
• Low weight of a pregnant woman (less than 48 kg).
• Living of the expectant mother in poor living conditions.
• Carrying in an unfavorable psychological environment.

Prematurity classification

The division into the degree of prematurity is based on the gestational age at which the baby was born, as well as on such physical parameters of the toddler as weight and body length. There are such degrees of prematurity:

• The first- the child is born at 36-37 weeks of gestation with body weight from 2 to 2.5 kg and body length from 41 to 45 cm.
• The second- the baby appears at a period of 32 to 35 weeks, his body weight is less than 2 kg, but more than 1.5 kg, and the body length is from 36 to 40 cm.
• The third- the baby is born at -31 weeks of gestation with weight from 1 to 1.5 kg and body length from 30 to 35 cm.
• Fourth- an infant is born before 28 weeks of pregnancy with a mass less than one kilogram and body length less than 30 cm.

Signs

Appearance

Compared to babies born at term, premature babies differ:

• Thinner skin.
• Less or no subcutaneous fat.
• Large head size in relation to the body.
• Large abdomen and low navel.
• An unclosed small fontanel.
• Very soft auricles.
• Thin nails that may not completely cover the phalanges of the fingers.
• Open genital slit in infant girls.
• The testicles that did not have time to descend into the scrotum in boys.
• Later falling off of the umbilical cord.

These signs are the more pronounced, the higher the degree of prematurity, and in infants with the first or second degree, many of them may be absent.

Anatomical and physiological features

The functioning of the organ systems of a premature baby is affected by the degree of prematurity, because the smaller the fetus was in the mother's womb, the more its organs did not have time to form to a state that allows them to quickly adapt to life after childbirth.

• Respiration in premature babies is more frequent, than in term-born babies, which is associated with a narrow upper airway, a more pliable rib cage and a higher diaphragm position. In addition, the lungs of the toddler are not mature enough, which leads to the frequent occurrence of pneumonia and apnea attacks.
• Due to premature birth, the baby's circulatory system may not be fully formed. The result is various heart pathologies that worsen the condition of the crumbs. And since the vascular walls are more fragile and permeable, the baby often has hemorrhages.
• The brain, even with deep prematurity, is fully formed, but the pathways in the last stages of pregnancy are still developing, therefore, in children born prematurely nerve impulses are poorly conducted to different tissues. If the baby's nervous system is affected, his motor activity will be reduced, as will the muscle tone. Reflexes in such a child may be depressed or absent altogether, tremors are often observed.

• The mechanisms regulating the production and waste of heat in the body are poorly developed in a premature baby. Prematurely born babies lose heat faster, and it is produced in their body with great difficulty... In addition, babies can easily overheat due to underdeveloped and dysfunctional sweat glands.
• The digestive tract of a premature toddler also works worse than that of babies born at term. This is primarily due to insufficient production of enzymes and gastric juice, as well as dysbiosis of the intestinal microflora. In addition, the motor function of the gastrointestinal tract suffers from impaired conduction of nerve impulses, which leads to a slowdown in the movement of food through the intestines.
• In the bones of premature babies after childbirth, mineralization processes continue, which is the reason for the additional administration of calcium to babies. Such babies increased tendency to develop rickets and dysplasia of the pelvic joints.
• Immature kidney function in a premature baby quickly shows signs of dehydration or swelling if caring for the baby is inadequate.
• The endocrine system in case of prematurity does not work properly, which is why hormones are released in insufficient quantities, and the glands are quickly depleted.

Consequences of prematurity and vitality

The survival rate of premature babies depends on the duration of the pregnancy and the reasons that provoked the birth. If those born at a period of 23 weeks survive only in 20-40% of cases, then babies with a gestation period of 24-26 weeks survive in 50-70% of cases, and the survival rate of babies whose developmental period is more than 27 weeks exceeds 90%.

Babies, whose birth occurred earlier than the expected date, gain weight and grow in length very intensively. Many of them catch up with their full-term peers in these indicators by the age of 1-2, but there are babies, the difference between which with their peers is smoothed out only by the age of 5-6.

Anemia with prematurity develops more rapidly. The risk of sepsis and purulent infections of the bones, intestines or meninges in premature babies is increased. At an older age, children born prematurely are more likely to have neurological pathologies, problems with vision or hearing, frequent SARS and problems with the genitals.

Jaundice in children born prematurely, it is more pronounced and lasts longer. This physiological condition, resulting from the breakdown of fetal hemoglobin, usually resolves by 3 weeks of age, but in many premature infants requires treatment, for which phototherapy is primarily used.

Extreme prematurity

This is the name of the condition of babies weighing less than 1 kilogram. They are born in less than 5% of prematurity cases, often cannot breathe on their own and require artificial and medical support. Even if such babies are nursed, the percentage of disability and the occurrence of various complications in these children is very high.

Deep prematurity

This condition is noted in infants whose body weight during premature birth is 1-1.5 kg. To leave such babies, it is required to use mechanical ventilation, give them oxygen, inject food into a vein and through a tube. In order for the baby to grow and develop faster, amino acids, glucose, hormonal agents and other substances are injected into it.

7 months

At this stage of pregnancy, babies are born with a weight of 1.5-2 kg, but most of them cannot function independently. The little ones are placed in incubators with the required temperature and humidity, the necessary examinations are carried out to them and they are provided with medication. After gaining weight up to 1.7 kg, the baby is transferred to the crib, which is heated. When a child gains weight up to 2 kg, he no longer needs thermal support.

8 months

Babies born at this time, as a rule, weigh 2-2.5 kg, can suck and breathe on their own. They have an increased risk of apnea attacks, so the babies are monitored for some time in the hospital, but in the absence of complications and rapid weight gain, the baby is sent home with new parents.

How premature babies live and develop after birth in modern perinatal centers is described in the video:

Clinical examination

Premature babies discharged home should be constantly monitored by a pediatrician.

Measurements and examinations during the first month after discharge are carried out once a week, then up to 6 months of age - once every two weeks, and from 6 months to a year - monthly. The kid is prescribed examinations by a surgeon, neurologist, cardiologist, orthopedist and ophthalmologist, and at the age of over a year - by a psychiatrist, as well as a speech therapist.

With what weight are they discharged?

As a rule, the mother returns home with the newborn baby after the weight of the baby has increased to at least 2 kg. Also, for discharge, it is important that the baby has no complications, thermoregulation is established and the baby does not need heart and breathing support.

Care features

Babies who are born prematurely require special care. They are gradually nursed with the help of neonatalists and pediatricians, first in the maternity hospital, then in the hospital, and then at home under the supervision of specialists. The most important components of baby care:

• Provide an optimal temperature and humidity in the room.
• Provide rational treatment.
• Provide feeding adequate to needs.
• Provide contact with the mother using the kangaroo method.
• After discharge, limit contact with strangers.
• Bathing and walking with the baby after the permission of the doctor.
• Perform gymnastics with the baby and conduct massage courses after the permission of the pediatrician.

A few tips on how to avoid problems in the development of babies born prematurely are described in the video:

What if there are alarming symptoms?

If mom is worried about something, she should definitely seek medical help. A specialist will be needed when:

• Unwillingness of the baby to breastfeed or to eat from a bottle.
• Vomiting.
• Prolonged jaundice.
• Constant loud crying.
• Stop breathing.
• Great pallor.
• Painful reaction of a child to sounds, looks or touch over the age of 1.5 months.
• Lack of reciprocal gaze at the age of more than 2 months.

Vaccination: when should you get vaccinated?

It is permissible to vaccinate a premature baby only when the baby is strong enough and his body weight increases.

BCG vaccination in the maternity hospital for children weighing less than 2 kg is not done. It is indicated for weight gain up to 2500 g, and if there are contraindications, it can be postponed for 6-12 months. The timing of the introduction of other vaccines should be determined by the pediatrician, taking into account the health and development of the toddler.

E. Komarovsky's opinion

As you know, a popular pediatrician recommends raising children in the first year of life so that the babies do not overheat. Komarovsky always focuses on frequent ventilation, humidifying the air up to 50-70% in the nursery and maintaining the temperature in the room no higher than + 22 ° C.

However, his recommendations for premature babies are changing significantly. Komarovsky supports his colleagues in the opinion that thermoregulation in such babies is poorly developed, therefore, a higher air temperature in the room immediately after discharge (not lower than + 25 ° C), in his opinion, is a necessity.