Survival of premature babies by weeks. Premature baby: what is the danger of being born prematurely. Is it true that premature babies are more prone to disease?

26.09.2019

Update: October 2018

A baby born at 37 weeks of gestation or earlier is considered premature. The most common cause of preterm birth is an infection, illness of the mother, or pathology of the placenta. This also affects the health of the baby, so 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 1000 g
Very low weight: from 1000g to 1500g
Low weight: 1500 to 2500g (usually at 34-37 weeks)

How to estimate the age of premature babies?

The age of a prematurely born baby is estimated in the same way as that of a full-term baby. That is, from the first day of birth. But to assess the psychomotor development of a premature baby by months, the so-called corrections for prematurity are used. For example, a one-year-old baby born 3 months premature (at 28 weeks) would be counted 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
Intermittent pauses in breathing (apnea)

Immaturity of the respiratory system in prematurity is a common occurrence. Lack of surfactant - a special substance that lines the lungs - leads to sticking and inability to breathe. Children lighter than 1000 g are in principle unable to breathe on their own after childbirth and require connection to a ventilator. Often, babies experience episodes of apnea - long breaks in breathing. They usually pass by the age of 36 weeks of pregnancy, and before that they require increased control.

Blood changes

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

The usual jaundice of newborns, associated with the breakdown of fetal hemoglobin, takes 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 exceeds the permissible value, then there is a risk of brain damage. In such cases, doctors use phototherapy.

Another common problem of "hurried" kids 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 pathologies

Dyskinesia
Necrotizing enterocolitis

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

Problems of the nervous system

Intraventricular hemorrhages (in the brain)
Hypoxic-ischemic brain lesions
convulsions
Pathology of the retina
Deafness
Muscle weakness

The immaturity of blood vessels in "early" children leads to an increased risk of cerebral hemorrhage. This risk is higher the lower the birth weight. Most of these bleedings occur in the first few days of life. The child becomes lethargic, like a “rag doll”, sleepy, respiratory arrests occur, even coma. For diagnosis, ultrasound of the brain is used, if necessary, computed tomography. Treatment is possible only symptomatic. Hemorrhage prognosis 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 lack of consequences.

Cardiovascular disorders

Functioning ductus arteriosus
Blood pressure instability

Maintaining the temperature

Immediately after birth, special conditions are created for a premature baby with a low body weight. They are placed in couveuses, 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. Usually discharge home occurs after the child reaches a certain weight and, accordingly, the ability to regulate the temperature. But all the same, in the room where the baby will be, it should be comfortable: not hot and not cold, and the humidity should reach 60%.

Newborn nutrition

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

Breast-feeding

The importance of breastfeeding for preterm babies cannot be overstated. Protective antibodies and easily digestible proteins found in colostrum and milk help babies get stronger and resist infections. But since the need for certain elements and vitamins in such babies is greater than in healthy ones, you have to add them to the child's diet additionally.

Milk formulas

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
Similac 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 recommended to introduce vegetables or cereals from 6 months, then for children from premature birth, an adjustment for prematurity is taken into account. That is, a child born 1.5 months ahead of schedule is introduced complementary foods at 7.5 months from birth. But there is no need to comply with these deadlines up to a week. It is much more important to focus on the readiness and desire of the baby to try new food (see).

Signs of readiness to feed:

Subsidence of the ejection reflex (the baby does not push out any object that has fallen into the mouth with the tongue)
Tripling of weight since birth (whereas for those born at term, doubling is enough)
Lack of breastfeeding
Active interest in adult food

The rest of the feeding rules are similar to those at term birth. They begin the introduction of new products with cereals (if the weight is gaining poorly) or vegetables (if everything is in order with the weight).

Calcium and Vitamin D

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

Vitamin D deficiency symptoms:

rachitic rosary (thickness on the ribs, similar to an oval rosary)
small weight gain
decreased calcium in the blood
curvature of the legs

Iron preparations

Almost all premature babies are recommended to give iron preparations (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 for each 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 a weight of 1800-2000g, he can be discharged home. It is best to purchase a newborn scale in advance to monitor weight gain once every 1-2 weeks (but not every day). On average, daily weight gain should be 15-30g per kg per day. This is especially important for children who do not take the breast well. In the case of a normal diet, low gains can indicate anemia or digestive problems. As the baby grows older, weekly increases decrease.

Graph of weight, height and head circumference

Age in the graph is measured in weeks from conception (up to 40 weeks), and then from birth in months, as in children born at term. The bold black line indicates the mean value. The dark area around the line is close to the average values. Dash-dotted lines indicate the limits 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, nutritional characteristics and the opinion of the doctor.

Baby sleep

The total sleep duration of a premature baby is greater than that of a full-term baby. 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, a child can react to home darkness and silence for several weeks. Therefore, for the first time after discharge, it can be useful to turn on quiet, calm music and leave subdued lights at night so that the baby gradually adapts.

The best position for a baby to sleep is on the back. Premature babies are at higher risk of sleep apnea and are less sensitive to reduced 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 hard, without voluminous blankets and toys.

Now on sale there are special cradles and cocoons for such special newborns. Many parents note that the sleep of babies in such beds is stronger. But at the same time, no studies have been conducted on the safety of such cocoons, so experts rarely recommend buying them.

When are they discharged from the neonatal unit?

Baby to be breastfed/transferred to nipple feeding
Weight gain per day should be at least 10-30g
The baby should keep warm enough while lying in the crib
There should be no episodes of stopping or sudden slowing of breathing
Feeding through a vein by the time of discharge should be stopped
Vision and hearing tests must take place before discharge
The mass of the baby should be 1800 grams and above.

Prognosis for newborns

Thanks to modern methods of pediatric intensive care, the survival rate of premature babies weighing from 1.5 to 2.5 kg exceeds 95%. If they do not have 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 comorbidity, there may be a developmental delay of varying degrees.

The earlier the child was born, and the smaller its mass, the lower the chances of survival and recovery. So, a birth at 22 weeks of pregnancy 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%.

Possible long-term effects of extremely low birth weight:

Dementia
Epilepsy
Hearing disorders and (from myopia to complete blindness and deafness)
Frequent pneumonia
Liver and kidney failure
Anemia, vitamin deficiency, growth retardation
Poor school performance
Reduced social adaptation

All of the above long-term consequences in premature babies occur mainly at extremely low weight - less than 800 g. But with proper therapy and careful parental care, there is a chance to avoid these consequences.

Vaccines for premature babies

There is a widespread belief that prematurely born babies have a “medical exemption” 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 banal measles, diphtheria, whooping cough and other diseases is high precisely during premature birth (see).

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

In the absence of serious health problems (congenital immunodeficiency, progressive brain disease), other vaccinations are also given according to the general schedule. It is desirable to choose a cell-free pertussis component (vaccines Pentaxim, Infanrix).

Small babies born prematurely gain weight faster and get stronger when in contact with their mother. In the departments where such children lie, visits by parents are allowed, as 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 in childbirth (oxygen starvation) is more typical for those born at 34-37 weeks. Those born in the period of 25-34 weeks tolerate it better, although they have worse long-term consequences.

FAQ

Boy, 1.5 months, weight 1800g, born at 35 weeks with growth retardation, weight 1300g. Unable to achieve daily stools, even with laxatives. Usually the chair happens every 2-3 days. What can be done?

A stool frequency of once every 2-3 days is perfectly normal for any newborn. The main thing is that it should be of a soft consistency and not cause concern to the child.

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

At this age, it is not the weekly gains that are important, but the weight trend. It is necessary to mark 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 is on the rise, then everything is in order with the increase. Under no circumstances should a child be forced to eat.

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

The earlier a child 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 milestones are checks at 9, 18, 24 and 30 months from birth.

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

motor development

Reaction
Lying on back, randomly bending arms and legs	1.5 months
Lying on his stomach, raises his head	2 months
Lying on the stomach, raises the head in the midline by 45 degrees and holds it (unstable)	3 months
Lying on the stomach, raises the head 45-90 degrees (the chest is raised, resting on the forearms, elbows at or in front of the shoulders)	4 months
When they pull the handles, he tries to sit down	4.5 months
Sitting with support behind the lower back, keeping the head straight	5 months
Lying on your back, touching your knees with your hands	5.5 months
Lying on your back, straightening your neck and back, rolls on your side	6 months
Lying on his stomach, leaning on outstretched arms (hands open, chest raised, chin down)	6 months
Sits (if planted) with support on hands, freely turns his head to the sides	6 months
Lying on your back, lift your legs up and touch your feet	7 months
Lying on his stomach, leans on the forearm of one hand, the other reaches for a toy	7 months
The planted sits with a straight back without support, hands are free. Can lean forward, backward, and sideways, but loses balance easily	7.5 months
Lying on his stomach, unbends, raises his legs and arms outstretched to the side ("swallow")	8 months
Sits steadily without support, while being able to freely play with the toy	8 months
Standing with support behind the chest, trying to "spring" on the legs (torso slightly tilted forward)	8 months
Rolls from back to stomach, rotating the torso	8.5 months
Sitting without support, turns the body to the side and takes the object, turns around and looks back	9 months
From the stomach rolls over to the side, leaning on one forearm, looking back	9.5 months
Rolls over from stomach to back (pelvic girdle rotates relative to shoulder girdle)	9.5 months
Crawls on belly	9.5 months
Gets on all fours (on knees and hands) from a position on the stomach, can swing back and forth on all fours	10 months
From a pose on all fours, raises one hand high to reach an object	10 months
Sitting without support, does not fall when stretched to the side	10 months
Gets on all fours from a sitting position	10 months
Stand up holding on to a support	11 months
Standing, holding on to a support and swinging, shifting from foot to foot	11 months
Sits down from a position on all fours	11 months
Sits down and/or leans over while holding on to a support	11 months
Crawls on all fours	1 year 1 month
Steps sideways along furniture (walls)	1 year 1 month
From a standing position, he kneels down, holding his hand on the furniture	1 year 1 month
Standing unsupported for a few seconds	1 year 1 month
Walks independently with arms raised and legs wide apart	1 year 1 month
Squats down from a standing position, gets up again	1 year 2 months
Gets up off the floor without support	1 year 3 months
Walks independently, hands are free and relaxed	1 year 3 months
Squats down and plays in this position	1 year 6 months
Climbing on a sofa, chair	1 year 6 months
From a standing position, bend over and straighten up again	1 year 6 months
Gets up from a small chair (with support)	1 year 6 months
Runs looking down	1 year 6 months
Walks, may suddenly stop and turn	2 years
Sits on a small chair	2 years
Climbs the stairs with a side step, holding on to 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 of onset of reaction
Lying on your back, bring your hands to your mouth	3 months
Grabs an object that touches the palm or fingers	3 months
Looks at the movements of his hand	3 months
Reaches for the object he sees with one or two hands, the hands are open	3.5 months
Brings the handles in the middle line, pulls them up, looks at them, plays with them	3.5 months
Shaking a rattle in his hand	4 months
Lying on his back, reaches for the object he has seen, grabs it with both hands and pulls it into his mouth	4.5 months
Lying on his back, reaches for the object he has seen with one hand and grabs it	4.5 months
Pulls an object in the hand into the mouth	5 months
Most of the time the brushes are open	5 months
Lying on his stomach, one hand rests, the other reaches for a toy	5 months
Begins to adapt the brush to the shape and size of the object being gripped	6 months
Lying on his back, holding a toy in one hand, the other reaches for the second toy and grabs it	6 months
Transfers an item from hand to hand	6 months
Reaches for a distant object	7 months
Looks at a small object and tries to rake it with all fingers	7 months
Rotates brush with held toy	7 months
Considers one object that he holds in his hands, then another	8 months
Picks up an object with both hands	8 months
Takes a small object seen with three or four fingers (pinch)	8 months
Pushes the ball in a random direction	8 months
Hitting an object against an object	9 months
Claps hands	9 months
Feels people and objects	10 months
Takes a small object with 2 fingers: thumb and lateral surface of the index finger (inaccurate "tweezer 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 (tip of the thumb and forefinger) - precise "tweezer grip"	1 year
Separates objects under visual control (a board with a hole - a peg, a ring - a rod, etc.)	1 year 1 month
Repeats actions with objects after adults (pushing a toy car, trying to comb his hair with a comb, bringing the handset to his ear, etc.)	1 year 1 month
Tries to doodle	1 year 2 months
Puts a cube on a cube	1 year 4 months
Connects objects (rod - ring, cap - pen, etc.) under visual control	1 year 4 months
Unscrews small screw caps under visual control	1 year 4 months
Unwraps a paper-wrapped object	1 year 6 months
Places 3 dice on top of each other	1 year 8 months
Turns the pages of a book one at a time	1 year 8 months
Drops a small object into a small hole	1 year 9 months
Grabs a moving object (such as a ball)	2 years

Vision

Name of the reaction	Approximate age of onset of reaction
Looks at a light source.	1 month
Fixes the gaze on the face of an adult.	1 month
Attempts to follow a slowly moving face or a bright object at a distance of 20-40 cm.	1 month
Fixes a steady gaze on the eyes of an adult.	1.5 months
Prefers to look at contrasting simple shapes: black and white stripes, circles and rings, etc., as well as moving contrasting objects.	2 months
Prefers to look at new things	2 months
Examines the details of an adult's face, objects, patterns.	2 months
He shifts his gaze to the object that has appeared in the field of view: from the side, from above, from below.	2 months
He smiles when he sees something familiar.	3 months
Follows an adult 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 he is holding in his hand.	3 months
He smiles more when he sees his mother than others.	3.5 months
Prefers voluminous toys	4 months
Blinks when an object is quickly approaching.	4 months
Looks at his reflection in the mirror.	5 months
Recognizes the bottle (and/or breast).	5 months
Responds to the mask	5 months
Considers the surroundings on the street	6 months
He chooses his favorite toy with a glance.	6 months
In a new place - looks around, may be frightened.	6 months
Facial expression changes depending on the facial expression of an adult	6 months
Pays 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
Watching the ball game	9 months
Examines small patterns, pictures, photographs, small objects with clear contours	1 year
Watching an adult write or draw with a pencil.	1 year
Understands 2-3 gestures ("bye", "not", etc.).	1 year 1 month
Avoids high obstacles while walking.	1 year 2 months
Imitates the actions of an adult	1 year 3 months
Recognizes himself and loved ones in photographs	1 year 4 months
Shows several named objects or pictures.	1 year 4 months
Recognizes several objects by their realistic drawings.	1 year 4 months
Avoids obstacles on the surface it walks on (holes, bumps...).	1 year 6 months
Remembers where certain objects or toys lie	1 year 6 months
Recognizes his things, clothes	2 years

Hearing

Name of the reaction	Approximate age of onset of reaction
Listening to the sound of a rattle	2 months
Listening to the voice of an adult	2 months
Smiles when he hears an adult's voice	2 months
Freezes when a new sound appears in the background of others.	2.5 months
Listens to music.	3 months
Gut in response to sound stimulation.	3 months
Distinguishes the voices of close people (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 head towards sound source (lying on 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
Looks from one talking person to another	5 months
Looks closely at the object that makes the sound.	5 months
Reacts emotionally to familiar voices.	6 months
Clearly finds the source of the sound with his eyes (lying down).	6 months
Listens for whispers and other soft sounds	6 months
Laughs at certain sounds	6 months
In a sitting position, turns to the source of the sound.	7 months
Attempts to reproduce the "melody" of the speech heard	7 months
Interested in objects that produce sound.	8 months
Tries to reproduce new sounds 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 they say "no", "wait", etc.	10 months
Performs movements at the request (for example, the word "patties" begins to clap his hands)	11 months
Turning, he finds the source of the sound 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 ("mother", "dad", "woman" ...).	1 year
Begins to "dance" at 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 certain intonation and rhythm, which resembles the speech of adults.	1 year 2 months
Performs a familiar action with an object at the request (rolls the car, "combs", "shakes" or "feeds" the doll, etc.). The request should be expressed only in words, without prompting with gestures or a look, without demonstrating what is being asked.	1 year 4 months
Repeats short words heard in an adult conversation (or repeats 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 individual words into them.	1 year 6 months
Understands 20-50 words (names of relatives, names of body parts, objects and some actions).	1 year 6 months
He likes to play "animal voices" with an adult (for example: "How does a cow moo?" - "My-y-y").	1 year 6 months
Names objects that are out of sight when hearing 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 repeats them a few hours later).	2 years 3 months
Tries to sing	2 years 6 months
Repeats couplets or quatrains after an adult (or plays them several hours later)	3 years

Premature babies are those born as a result of premature birth with a weight of less than 2500 g and a height of less than 45 cm. These criteria are conditional, since many full-term babies are born weighing less than 2500 g, and some premature babies weigh more than 2500 g. The main feature of premature babies is the immaturity of the main body systems - respiratory, cardiovascular and thermoregulatory. Premature babies require special care and medical supervision. Newborns with low body weight, born at term, are considered children with intrauterine growth retardation.

How long is it possible to leave a newborn baby?

According to the WHO definition, children born not earlier than 22 weeks of gestation and weighing more than 500 g are considered potentially viable. Nursing of very premature babies is possible only in specialized departments of hospitals or perinatal centers. The longer the gestational age at the time of the onset of preterm birth, the lower the risk to the baby. Babies born between 32 and 37 weeks of gestation have significantly fewer problems than premature babies born between 22 and 32 weeks of gestation. The doctor takes into account the weight of the child when deciding whether to place the child in an incubator, prescribe phototherapy, when choosing the type of feeding of a premature baby, and in other cases.

What does a premature baby look like?

As a rule, his head is disproportionately large compared to his body. The skin is very thin, sometimes even translucent, softer to the touch than usual, covered with fluff and grease. The subcutaneous fat layer is insignificant or absent, the skin is wrinkled. Small and large fontanelles are larger than usual. The nails are very thin and often do not reach the fingertips. In boys, the testicles may not descend into the scrotum, and in girls, the labia may be underdeveloped. The limbs are thinner and longer, the auricles are soft and pressed against the skull, the navel is low.

What is the immaturity of a premature baby?

In premature babies, the main reflexes are usually mild, and in some cases absent. Muscle tone is reduced, the thermoregulation system is undeveloped, so the newborn cannot independently maintain a constant body temperature. Other systems of the body can also be immature - respiratory, digestive, cardiovascular, visual, nervous, bone. In the absence of vital reflexes (breathing or swallowing), the child is placed in the intensive care unit or intensive care unit.

Why is a child placed in an incubator?

The incubator is an apparatus with transparent walls that allow you to observe the child, and an optimal artificial microclimate (temperature - 33-38º, humidity - 85-100%, oxygen content - 25-40%). To care for a child inside the incubator, a special hole or special sleeves are provided. Premature babies are placed in the incubator for warming and further protection from body cooling, as well as to improve blood oxygen saturation. Oxygen, if necessary, can be supplied uninterruptedly. It should be remembered about the danger of toxic effects of oxygen on the retina of the eye, which can lead to complete loss of vision, especially in very premature babies with prolonged keeping in an incubator with oxygen supply (with timely diagnosis and treatment, this situation is reversible).

What is kangaroo nursing?

How long does a premature baby need to stay in the hospital?

In order to maintain a constant normal body temperature, premature babies need help. Being in an incubator allows the child not to waste energy on thermoregulation, adapt faster and gain weight. The duration of the child's stay in the "incubator" depends on the weight of the child at birth and the general dynamics of his condition. Children with a small degree of prematurity can be in an incubator from several hours to 4 days, children weighing up to 1750 gr. - about a week, and with a weight of up to 1500 gr. - from a week to two. Typically, a child is discharged from a maternity hospital or a specialized children's hospital when he is gaining weight steadily, maintains a constant body temperature, has no breathing problems, and weighs 2500 grams or more.

Will a premature baby subsequently be different from their full-term peers?

In premature babies, the pace of physical development is accelerated, and the less their body weight was at birth, the faster it will increase. The neuropsychic development of such children is somewhat slower than usual, premature babies need more attention, special classes (massage, gymnastics). At first, when assessing the psychomotor development of a premature baby, it is necessary to focus on the period in which he should have been born, and count all the milestones from this moment. For example, if a child was born at 32 weeks, that is, 2 months ahead of schedule, you should expect him to start turning not at 3.5-4 months after birth, but at 5.5-6. On average, by the age of one and a half to two years, a healthy premature baby is practically no different from full-term peers.

Is it true that premature babies are more prone to illness?

On average, premature babies get sick more often than normal babies, and the recovery process takes longer. Premature babies are more susceptible to respiratory diseases (bronchitis, pneumonia). Jaundice, common in newborns, can be a serious danger for premature babies. Also, premature babies often have problems with the development of the central nervous system, the gastrointestinal tract, and the skeletal system and joints may suffer.

A baby born before 38 weeks of gestation is considered premature. Premature birth can be provoked by many social factors, as well as the health of the expectant mother, her obstetric history. Newborn premature babies, regardless of the degree of underdevelopment, need special care, especially in the first weeks of life.

Who are premature babies

An infant born between 22 and 37 weeks of gestation, weighing 500 to 2500 grams and measuring 27 to 45 cm in length is considered premature. Such children differ from full-term newborns in insolvency, immaturity of almost all systems and organs of the body, as a result of which special care is required for premature babies.

Signs of prematurity

The main clinical external signs of an immature newborn include a disproportionate physique, open fontanelles (lateral and small) of the skull, undeveloped fatty tissue or its complete absence, hyperemia of the skin, underdevelopment of the external and internal genital organs, and physiological reflexes characteristic of full-term peers. In severe cases, apnea, weakness or lack of muscle tone occurs.

Anatomical and physiological features of the child

Depending on the severity, in a baby who was born prematurely, the following anatomical and physiological features are distinguished:

The cardiovascular system is characterized by the presence of tachycardia (150-180 beats / min), muffled tones, functional hypotension of the newborn. At the third and fourth degree, defects of the cardiac septum (open foramen ovale) are often present.
Respiratory system. Premature infants have narrow upper airways, a high standing diaphragm, which leads to apnea and respiratory failure. Children with the third and fourth degree of prematurity are on artificial lung ventilation for a long time, because. organs are not mature and cannot perform their function.
Skin and subcutaneous tissue. In newborns born prematurely, subcutaneous fat is almost completely absent, sweat and sebaceous glands do not function, as a result of which the body is not able to independently regulate body temperature.
Gastrointestinal tract. In preterm infants, there is a functional insufficiency of all parts of the gastrointestinal tract, low enzymatic activity of the pancreas and stomach.
excretory system. The immaturity of the urinary system leads to electrolyte imbalance in the body, decompensated metabolic acidosis and a tendency to edema, rapid dehydration.

Causes of prematurity

Several groups of risk factors are statistically distinguished, in the presence of which women have a high risk of giving birth to a baby prematurely:

Socio-biological factors. They suggest too early or late pregnancy (the age of the parents is less than 16-18 or more than 40-45 years), the presence of bad habits in a woman, poor living conditions, the presence of occupational hazards. In addition, the risk of having a premature baby is higher in those girls who are not observed in the antenatal clinic during pregnancy.
Unfavorable obstetric and gynecological history and pathological course of the present or past pregnancy. This includes a history of abortions, miscarriages, multiple pregnancy, placental abruption, etc. High risks of preterm birth may be in women whose interval between births is less than two years.
Chronic extragenital diseases of the mother: hypertension, endocrine disorders, chronic infections.

Degrees of prematurity

The clinical classification according to the ICD of premature infants according to three criteria (weight, height, gestational age) suggests four degrees of severity:

The first degree of prematurity is assigned to an infant if delivery occurs at 36-37 weeks of gestation; weight is at least 2000 g, and the length of the body is from 41 cm. At the same time, spontaneous breathing is observed, the possibility of breastfeeding. However, the baby needs the supervision of a pediatrician and control of the thermoregulation of the body.
The second degree of prematurity is assigned to a baby who was born at a period of 32 to 35 weeks with a weight of 1501 to 2000 g, a height of 36 to 40 cm. As a rule, such babies have a weak sucking reflex, so you have to feed the baby using a probe with special mixtures, there is low muscle tone, immaturity of the respiratory system.
The third degree in children born between 28 and 31 weeks of gestation, body weight is from 1001 to 1500 g, and height is from 30 to 35 cm. Such babies are considered very premature and need intensive care under the supervision of doctors. The baby is in a closed incubator, breast milk or formula is fed through a tube due to the complete absence of a sucking reflex.
The fourth degree of prematurity is assigned at birth before 28 weeks from the onset of pregnancy, body weight is less than 1000 g, body length is less than 30 cm. In relation to such children, the term “extremely low birth weight newborns” is used in neonatology.

Weight of a premature baby by month

The body weight of a premature baby maximizes in the first six months of life (from 500 to 700 grams per month). By the end of the first year, a healthy newborn should weigh 9-10 kg. The rate of weight gain depends on the degree of miscarriage, concomitant diseases, congenital pathologies of organs and systems, and, especially, on the type of nutrition of the baby.

Age, months	Average weight of a child with different degrees of prematurity, grams
Age, months

Development of premature babies by months

Modern medicine cannot accurately draw a line between the consequences of prematurity and pathological conditions that occur in a baby born prematurely. The frequency of neurological, mental and physical disorders is due to the harmful effects of the internatal period, their negative impact on the immature central nervous system. However, as babies grow and develop, birth defects are corrected. The table shows the development of a premature baby by months to a year.

Age of premature	neuropsychic development
1-3 months	During the first three months of life, the infant has increased drowsiness, rare, weak crying, lack of periods of activity, and decreased appetite. Children who were born with a body weight of more than 2000 g, in the second month of life, are actively awake after feeding, actively suck breast milk a lot.
4-6 months	At the age of 4-6 months, a premature infant further develops the functionality of the analyzer organs (the newborn looks for an object by sound, examines bright, multi-colored toys), manipulates objects (first they feel, grab suspended toys), they begin to rest with their feet. During this period, the baby lies on his stomach for a long time, responds to the voice of his parents with a long smile, actively moves his arms and legs.
7-9 months	During this period, the baby develops the first speech reactions (for a long time he hums, pronounces separate simple syllables). He rolls over from his back to his stomach and vice versa, tries to crawl. During wakefulness, the child does a lot of toys, examines, taps, and holds them in his hands for a long time. Children begin to eat from a spoon, drink from a cup held by an adult.
10-12 months	At the age of 10 to 12 months, the baby actively crawls, can sit down on his own, stand up to the barrier with support. As a rule, he walks freely, slightly holding on to objects. Children react to the speech of adults addressed to them, babble a lot, gurgle themselves, begin to pronounce simple monosyllabic words.

Survival of premature babies by week

The chances of surviving a baby who was born prematurely depend on how many weeks he developed in the womb. According to the World Health Organization, a viable fetus is considered to be born no earlier than 22-23 weeks and weighing at least 500 grams. The survival rate for this period is only 10-12%. Those born at 25-28 weeks recover in 60-70% of cases; at 29-30 weeks, this figure is already 90%. Babies who were born at 31 weeks or more have a 95% survival rate.

What is dangerous birth before 37 weeks

If a baby is born before 37 weeks of gestation, then he has a functional immaturity of all organs and systems. Seven-month-old children, as a rule, suffer from acute respiratory failure and failure of the central nervous system. Such children lag behind their peers not only in physical but also mental development. In addition, the underdevelopment of the excretory system can lead to the accumulation of toxins in the body, prolonged physiological jaundice.

Consequences in the future

The immaturity of the organs of children who are born prematurely can adversely affect their health in the future. The most common complications:

rickets;
heart failure;
hydrocephalus of the brain;
retinopathy of prematurity;
early anemia;
severe diseases of internal organs;
chronic renal failure;
psychomotor disorders;
failure of the endocrine glands.

Caring for premature newborns

Nursing of children born prematurely in the maternity hospital is carried out regardless of the degree of prematurity and is an additional heating of the newborn from the moment of birth, rational oxygen therapy, dosed feeding. In the delivery room, the baby is immediately dried with warm sterile diapers and immediately placed in an incubator to prevent heat loss. Preterm infants with a birth weight of less than 1800 g need additional heating for several weeks. The temperature in the room should be 24-25°C.

Bathing of children born prematurely begins from two weeks of age every other day. Weighing is carried out daily; height, head and chest circumference are measured at least once a week. Laying out a premature baby on the stomach begins as early as possible, which helps to increase the concentration of oxygen in the blood and helps to reduce regurgitation, normalize muscle tone.

A healthy premature baby, who is able to maintain normal body temperature without additional heating, constantly gaining weight and reaching 2000 g, can be discharged home in case of good healing of the umbilical wound, normal hemogram and other laboratory tests. As a rule, an extract is made no earlier than 7-9 days after birth.

incubator

At the initial stage of nursing a premature baby, an incubator or incubator is used to maintain a constant body temperature, optimal feeding with a probe. There are several types of incubators:

Resuscitation. Such an incubator, in addition to heating, a system for regulating the concentration of oxygen in the air, an ECG, an EEG, a heart rate monitor. Thanks to modern incubators of this type in the nursing departments, there is a therapy for newborns, even with minimal vital signs at birth.
Transport. Necessary for the transportation of a newborn, incl. and at low temperatures, equipped with heating, supplied with oxygen. Such an incubator is lightened due to the absence of a metal frame, while the baby is fixed with special belts.
Open. It is used for nursing children of the first degree of prematurity. Helps keep the newborn at a constant body temperature. In the absence of complications, constant weight gain, stay in such an incubator is 7-10 days.

Features of feeding

The first feeding depends on the degree of prematurity, birth weight and general health. In the absence of severe pathologies, a premature baby receives nutrition already on the first day of life: in the first degree, feeding begins 2-3 hours after birth, attaching them to the mother's breast. At 2-3 degrees, they are fed from a special horn or probe. A premature baby of the fourth degree with low weight is fed first parenterally, then with a special mixture using a probe.

Optimal is feeding with milk or colostrum of the mammary glands of a woman, because. it is distinguished by a high content of essential protein, electrolytes, polyunsaturated fatty acids (linolenic acid promotes high rates of myelination and prostaglandin synthesis), low lactose content, a huge amount of antibodies and immunoglobulins that protect newborns from infections.

Clinical examination

Premature babies should be especially carefully observed by doctors after discharge from the maternity hospital to reduce the risk of developing severe pathologies in the future, normalize the rate of weight gain in low-weight babies when formula-fed, and improve physical development. Examination of a pediatrician during the first month of life is carried out 1 r / week, from 2 to 12 - 1 r / month. Consultation of narrow specialists is necessary only in the first month of life, after only 2 r / year. Prophylactic vaccinations are carried out according to an individual plan.

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According to the concept adopted by the World Health Organization (1974), a live-born newborn child is considered to be “a product of conception, completely removed or removed from the mother (regardless of the course of pregnancy, separation of the placenta, ligation of the umbilical cord) weighing more than 500 grams, which, after separation, breathes, or has other signs life - heartbeat, pulsation of umbilical vessels or spontaneous movement of muscles.
Since January 1993, Russia has joined this definition of live birth (previously, the criterion for live birth was the presence of spontaneous breathing), which means the need for resuscitation of all children (fetuses) who at birth have any of the four signs of life: spontaneous breathing, heartbeat, umbilical cord pulsation and voluntary muscle movement .
A normal human pregnancy lasts approximately 40 weeks (9 lunar months): a full-term baby is considered if he was born at a gestational age of 37 to 42 weeks of intrauterine development, and premature - at birth less than 37 completed weeks of intrauterine development. Note, that there is no lower limit for prematurity, but only a weight limit (500 grams), which approximately corresponds to 20-22 weeks of intrauterine development (this is approximately 5-5.5 months of pregnancy).
In accordance with WHO recommendations (1977), the term "very low birth weight" (VLBW) implies a body weight of less than 1500 g and the term "extremely low birth weight" (ELBW) - a body weight of less than 1000 g. In accordance with the data of the medical and psychosocial study of the Union of Pediatricians of Russia, the majority of low birth weight newborns (71.3%) are very premature babies born at a gestational age of 24-30 weeks, 28.7% of children are premature and full-term with a discrepancy between body weight and gestational age.
What is the rate of preterm birth in the world? The frequency of preterm birth in developed countries is defined as 5%-12% of the total number of births (in the USA - 8.9%, in Australia - 5.9%, in Sweden - 5.9%, in France - 5.6%) , of which 80% occurred at a period of 32-37 weeks, 11% - 28-31 weeks, 9% - less than 28 weeks. In Russia, their number was 3.8% -4% in the period for 1991-1996.
According to M. Hack in 1995, the frequency of birth of children with low body weight in different countries ranged from 4.1% to 40%. In European countries, the lowest rates were noted (in Sweden, Finland, Norway) (6.8%), the highest - in Asia (more than 20%), the Middle East (10% -20%) and America (6% -13 %).
In our country, the number of children born with low birth weight increased from 5.7% in 1989 to 6.1% in 1996, and among them from 0.45% to 0.48% were newborns with body weight at birth 1000 g-1499 g and from 0.2% to 0.3% - less than 1000 g.
The achievements of neonatal medicine, which has been rapidly developing in our country in the last decade (and abroad since the 1970s), have led to a significant increase in the survival rate of premature babies with very low and extremely low birth weight.
According to H.C.A. Emsley (1998), among premature babies 23-25 weeks of gestation, survival increased from 27% in 1984 to 42% in 1990. Studies conducted at the Royal Victorian Center of England showed an increase in survival among children with a birth weight of up to 1000 g from 25.4% in 1980 to 37.9% in 85 and to 56.2% in 91.
In the 1995 La Pine study, among children born weighing less than 800 g, the survival rate in 1977-80 was 20%, in 83-85 - 36% and in 86-90 - 49%.
Currently, children born before 26 weeks of gestational age and weighing less than 500 g survive. The literature provides data on the unique nursing of infants weighing 390 g (Amato M., 1992), born with a weight of 354 g and having normal psycho-motor development by the age of 4 (Opitz J., 1993) and even a newborn weighing 280 g, developing according to age by the age of 2 (Muraskas JK, 1992). In Japan, among children with a birth weight of 400-499 g, 12% survive (Nishida H.A., 1992).
The data of the Institute of Obstetrics and Gynecology of the Russian Academy of Medical Sciences indicate that the viability of very premature newborns with a birth weight of less than 1000 g in 1964-1968 was 21.6% (Solomonova Z.A., 1971). Over a 12-year period, it increased from 45% in 1981-83 to 65% in 90-92, and in recent years, 54%, 73%, 56%, 60%, 81% of infants survived, respectively, with body weight at birth, less than 600 g, from 601 to 700 g, from 701 to 800 g, from 801 to 900 g and from 901 to 1000 g (Baranov A.A., 2001).
The development of technologies for nursing very premature babies has led to a decrease in mortality and survival of children with low and extremely low birth weight. According to the resuscitation department of the specialized hospital for premature babies in St. Petersburg - Children's hospital No. 17, mortality in the group of children with a birth weight of up to 1000 g decreased from 55% in 1995 to 22.5% in 2002, among children with body weight at birth from 1000 g to 1500 g - from 40.7% to 9.2%. At the same time, the introduction of new methods of intensive care and resuscitation of newborns, including the use of modern respiratory equipment, the use of invasive diagnostic and therapeutic procedures, "aggressive" drug therapy, along with an increase in survival, led to the emergence of a number of diseases that were not observed in the pre-resuscitation period. era until the middle of the 20th century. This applies to such a specific pathology of premature infants as bronchopulmonary dysplasia, retinopathy of prematurity, necrotizing enterocolitis, which significantly worsen the child's condition in the near and long term.

Official documents approved by the Ministry of Health of the Russian Federation on the recommendations of the World Health Organization determine the terms of preterm birth, during which it is possible to give birth to a viable child. The criteria governing the need for medical care for a newborn include the approximate gestational age at which the baby is born.

The birth of a baby at the 40th week is considered optimal, but only every tenth pregnant woman nurses. This is the ideal time for childbirth, and in life, something is rarely perfect. At 40 weeks, nature provides the necessary conditions for the birth of a healthy baby, and the birth process went without complications.

The development of the fetus in the mother's womb must be complete. Clinical studies have shown that small deviations from the pediatric norm do not have a significant impact on the condition of the newborn.

At what time can a viable baby be born? For a long time in modern pediatrics, full-term births are considered for a period from 37 to 42 weeks. The first obstetric week is counted from the 1st day of the last menstruation and is checked according to the ultrasound data in each trimester.

A full-term baby can be born from the 37th to the 40th week inclusive. At 36, he is still considered full-term, at 41 and 42 - post-term. In the last week, the issue of auxiliary measures to stimulate the labor process or early delivery by caesarean section is being decided.

In the WHO recommendations, taken as a basis in the regulatory documents of the Russian Federation, the main determining criterion for the physiological nature of the birth of a child at a time determined by nature, and its viability, was the gestational age, and not the weight and height of the newborn, although indicators are also taken into account. A woman gives birth to a full-term baby only at 37, 38, 39 and 40 weeks. From 22 to 36 he is considered premature, at 41 and 42 - overdue.

Degrees of prematurity and indicators

Life support medical assistance for preterm birth is undertaken from the 22nd week of pregnancy, provided that the baby weighs at least 500 g and its body length is 25 cm or more. The statistics include babies born viable, who have reached 1 kg and 35 cm of height since 28 weeks. From 22 to 27, medical assistance is provided and the necessary measures for nursing are taken. If such a child has lived for more than a week, he is registered alive.

The main criteria for exhibiting in the medical history by week of pregnancy:

22-27 - 4th degree of prematurity, weight from 0.5 to 0.999 kg;
28-31 - 3rd degree of prematurity, - 1 kg - 1.5 kg;
32-35 - 2nd degree of prematurity, - 1.501 kg–2.0 kg;
36 (sometimes 36-37) weeks - 1 degree of prematurity, - 2.001-2.5 kg;
37-40 - considered full-term;
41-42 - postponed.

According to WHO recommendations, births that occur between 22 and 37 weeks are considered premature. A child born at 37 weeks is already considered to be born in the minimum period for physiological childbirth, if the baby was born a week earlier - he is still not full-term to the lower limit of the norm.

Survival at every stage

4 degree of prematurity - the period when the child is not sufficiently prepared for life outside the mother's womb. The point is not only in low weight, but also in the underdevelopment of vital organs. If the maternity hospital has the necessary equipment and specially trained personnel, there is a minimal chance for the survival of the newborn. Therefore, registration, as a living one, is carried out only from the 28th week, or 7 days after birth.

At grade 3, approximately 50% survival is noted, the cause of high mortality in immature lungs. If they managed to prepare before birth, the baby survives.

At 2 and 1 degrees, in modern conditions, it is possible to save almost all children. Despite the 100% survival rate of infants with 1 and 2 degrees of prematurity, doctors are trying to extend the pregnancy at least to the minimum physiological period. No ultra-modern equipment can replace the supply, comfort and optimal natural conditions of the mother's womb.

In the weeks when the baby is still considered premature, there are processes of transition to the outside world. The body undergoes radical changes to ensure adaptation outside the mother, the implementation of independent breathing and nutrition.

In order to prevent premature birth, every woman must comply with medical prescriptions, take maximum care of her own body and the unborn child who is to be born. The baby's life and health depend on the mother.