How long is a premature baby. What to do if anxiety symptoms occur? Deep prematurity: III-IV degree

28.06.2019

Prematurity is the birth of a child before the end of the gestational period, that is, in the period from 22 to 37 weeks, with a body weight of less than 2500 g., And a length of less than 45 cm.

Premature infants have disorders of thermoregulation, breathing with a tendency to apnea (cessation of respiratory movements), weak immunity, and obvious anthropometric and clinical signs.

Degrees

The classification of premature babies by degrees is related to the weight of the child (gestational age is conditional):

1st degree - body weight 2001-2500g. (the term corresponds to 35-37 weeks);

2nd degree - body weight 1501-2000gr. (the term corresponds to 32-34 weeks);

3 degree - 110-1500gr. (gestational age 29-31 weeks);

Grade 4 - the weight of the child is less than 1000g, which corresponds to a gestation period of less than 29 weeks (extremely premature).

Causes of the birth of premature babies

The causes of premature birth are numerous and presented from three sides:

Maternal factors:

chronic diseases of a woman (pathology of the cardiovascular system, endocrine diseases, kidney pathology):
acute infections during pregnancy;
gynecological diseases;
burdened obstetric history (abortion, cesarean section);
intrauterine device;
trauma;
age (under 17 and over 30);
Rh-conflict pregnancy;
bad habits;
pathology of the placenta (presentation, detachment);
harmful working conditions;
complications of pregnancy (gestosis).

Paternal factors:

age (over 50);
chronic diseases.

Fruit factors:

intrauterine developmental defects;
multiple pregnancy;
erythroblastosis (hemolytic disease);
intrauterine infection.

Signs

Premature babies have a pronounced clinical picture. There is a disproportion of body parts, the cerebral skull prevails over the facial one. The bones of the skull are soft; in addition to the fontanelles, there is a non-closure of the cranial sutures. Soft auricles are also characteristic.

Premature babies have a poorly developed subcutaneous fat layer, they cannot “keep” the temperature (instability of thermoregulation). Underdevelopment of the lungs with prematurity is due to the lack of surfactant, which ensures the opening of the pulmonary alveoli on inspiration, which is manifested by impaired breathing and periodic apnea (respiratory arrest).

The skin is wrinkled, has a bright red color on the first day, there is a weak muscle tone or its complete absence.

Physiological reflexes (sucking, searching and others) are poorly expressed.

In premature boys, the testicles are not descended into the scrotum, and in girls, the labia majora are underdeveloped. Hypertensive and hydrocephalic syndromes are characteristic of premature babies.

Due to the underdevelopment of the eyelids, bulging (exophthalmos) is expressed.

Insufficient liver function is noted, which is manifested by nuclear jaundice. Because of the underdeveloped immune system, premature babies are at high risk of infection. Premature babies are prone to regurgitation. In addition, these children have underdeveloped nail plates and can only reach the middle of the fingertips.

Therapy for premature babies

A neonatologist is involved in the management and treatment of premature babies.

Children born before their term require certain living conditions. The ambient temperature should be 25 ° C, and the humidity should be at least 55-60%. For this purpose, premature babies are kept in incubators (special incubators).

Babies weighing less than 2000g are kept in the jail. Discharge of healthy premature babies is carried out on the 8-10th day, provided that their body weight reaches 2kg.

If a premature baby within 14 days has not reached a weight of 2000g, he is transferred to the second stage of nursing (carried out in the intensive care unit of the pediatric department / hospital). Such children are accommodated in jugs where oxygen is supplied.

Bathing premature babies begins at 2 weeks of age (subject to healing of the umbilical cord). They walk with children when they are 3-4 weeks old and weigh 1700-1800g.

Discharge of healthy premature babies is carried out when they reach a weight of 1700g.

Feeding

Feeding the baby with expressed breast milk begins 2-6 hours after birth, provided that there are no contraindications and a long gestation period (34-37 weeks).

Children who are in serious condition or deeply premature are prescribed parenteral nutrition through a tube (through the mouth or nose) during the first 24-48 hours of life.

A baby weighing 1800-2000g is applied to the breast. in the presence of active sucking. On the 1st day the volume of one feeding is 5-10 ml, on the 2nd day 10-15 ml, and on the 3rd - 15-20 ml.

In addition, the introduction of vitamins is shown to premature babies:

vikasol (vitamin K) to prevent intracranial hemorrhage;
ascorbic acid (vitamin C), vitamins B1, B2;
vitamin E (tocopherol);
prevention of rickets (vitamin D);
vitamins B6 and B5, lipoic acid with deep prematurity;

Consequences of prematurity and development prognosis

The prognosis for life in premature babies depends on many factors. First of all, on the duration of pregnancy and birth weight. In the case of a baby being born within 22-23 weeks, the prognosis depends on the intensity and quality of therapy. The risk of death increases in the following cases:

prenatal bleeding;
breech delivery;
multiple pregnancy;
asphyxia in childbirth;
low temperature of the child;
respiratory distress syndrome.

Long-term consequences of prematurity (the likelihood of these complications, again, depends on many factors; other favorable conditions, these complications are quite rare):

lag in mental and physical development;
cerebral palsy;
convulsive and hydrocephalic syndromes;
myopia, astigmatism, glaucoma, retinal detachment;
tendency to frequent infections;
hearing impairment;
violation of the menstrual cycle, genital infantilism and problems with conception in girls.

Due to various circumstances, premature babies are born. The development of such crumbs is different, compared to full-term babies. With the correct observance of all conditions by twelve months, such crumbs correspond in development to babies born at term.

In contact with

External characteristics of premature babies

How do premature babies grow?

Before embarking on the study of the characteristics of infants born earlier than the due date, one should study their characteristic signs.

For babies of the specified group stands out clearly:

manifestation of lethargy and weakness;
tiny growth;
small values of mass;
lack of skin on fontanelles;
pronounced redness of the body;
a thin layer of the auricles;
displacement of the large fontanelle;
the presence of "lanugs" - soft hair bundles;
lack of formation of the external genital organs;
disproportionately big head;
a huge belly with a low navel;
transparent thin nail plates;
short arms, legs and neck.

The described signs indicate the incomplete development of the baby and the need to create comfortable conditions for its further formation. Most often, the weight of a premature baby does not exceed two kilograms.

Important! The prematurity of the toddler is not a pathology, but only a consequence of early labor.

In such a situation, parents should concentrate all efforts on the timely development of the baby.

Development features

How do premature babies develop? Premature babies are considered to be born from twenty-four weeks of pregnancy. The development of the children of this group has its own nuances, which are manifested in the following:

A special type of functioning of the nervous system. The functioning of the nervous system differs from the functioning of the nervous system of normal newborns. Therefore, babies born ahead of schedule are demanding attention, especially from the mother. You should create maximum comfort in the house, and surround the baby with care and affection.
Late development of behavioral skills. Children born ahead of time learn behavioral skills later than their peers. For example, when a baby appeared at thirty-two weeks of pregnancy, the duration of his lag behind his peers is at least three months.
The use of couveses. If the weight of the crumbs born does not exceed one and a half kilograms, then for its further development, it is definitely required use of jugs... Komarovsky believes that only the conditions of the kuvezes allow the baby to grow to a healthy weight, since they are as close as possible to the intrauterine ones. An increase in body weight up to two kilograms causes the baby to move to a crib with a special heating.

The use of thermoregulatory conditions for premature babies is very significant, since it directly affects the further development of the baby.

Premature babies should be kept in a room where the thermal regime does not drop. below twenty degrees Celsius, and the humidity is below fifty percent.

The features of the development of premature babies have been studied in detail using numerous examples.

Mothers of such crumbs should familiarize themselves with the special literature and monitor the development in the development of their baby.

A deviation or a long delay in the development of a premature infant is a signal of immediate visiting a pediatrician. This will avoid the appearance of undesirable consequences, and sometimes it saves the life of the baby.

How are they developing by months

Premature babies develop somewhat differently after birth than their peers. At first, their body is trying to gain the prescribed weight and "re-form" organs. The development of a premature baby by months to a year can be clearly seen in the following table.

Baby age from birth	From birth
	weighs less than 1 kg	weighs 1.5 kg	weighs 2 kg	weighs 2.5 kg
	Weight gain in grams
Monthly	180	190	190	300
Two-month	400	650	750	800
Three month	650	650	750	750
Four month	600	650	850	750
Five month	650	750	800	700
Six month (half year old)	750	800	700	700
Seven month	500	950	600	700
Eight month	500	600	700	700
Nine month	500	600	700	700
Ten month	450	500	400	400
Eleven month	500	300	500	400
One year old	450	350	450	300

The table illustrates the development by months in the form of a monthly increase in body weight. The given data are average and may vary in individual cases.

Depending on the weight of the newborn at early birth, the following are distinguished prematurity categories:

Body weight ranges from two thousand grams to two and a half thousand grams. The first category includes babies born between thirty-sixth and thirty-seventh weeks of gestation. By the age of twelve months, the mass of such children increases. at least four times.
Weight from one and a half thousand grams to two thousand grams. This category includes babies born from thirty-two to thirty-five weeks of gestation. In a year, the weight of the described crumbs increases at least five times.
The mass of babies is from one thousand grams to one and a half thousand grams. "Deeply premature babies" - babies in this category. They are born before thirty weeks of pregnancy. By the age of twelve months, their body weight increases at least six times compared to the original.
Children weighing less than a thousand grams. Infants who are six months old have extreme body weight. With proper care, they increase in weight eight times by the year.

Every premature baby is the result of the wrong behavior of a pregnant woman or the presence of pathologies in her. Therefore, you should not complain about others, but pull yourself together and start taking proper care of the newborn, if this did not work out while he was in the womb.

The degree of prematurity is determined by taking into account the number of weeks of pregnancy and the weight of the newborn.

Effects

It is impossible to determine exactly what problems await a premature baby in the future. Some develop no worse than ordinary children, others - partially or greatly lag behind their peers.

The prognosis is strongly influenced by how early the baby was born.... Due to premature birth, the baby cannot achieve the necessary development in the womb.

In addition to possible troubles at birth, the child faces consequences in the future life. They are often accompanied by soreness and weakness. Depending on the degree of prematurity, disorders may occur that limit the ability to live and develop without the help of doctors:

These violations can cause a number of complications that require quick diagnosis and timely assistance:

open arterial duct (in normal babies, it closes at the time of birth);
retarded mental development, intracranial hemorrhage, necrotizing enterocolitis, etc.

Babies born at 24-26 weeks are more prone to delayed motor and mental development... Cerebral palsy is common. Babies born less than 28 weeks old are often prone to retinopathy (vision impairment).

Most of the psychomotor skills in premature babies appear with a lag, which is more often expressed in children born with a body weight of less than 1500 grams.

Indicators of psychomotor development are more quickly compared with full-term babies than indicators of weight and height. For more effective development, an individual set of classes is needed (gymnastics, speech, massages, etc.).

7 months (27-31 weeks)

At this time (27-31 weeks) babies weigh 1500-2000 grams most of them also need help.

A child of 7 months is in an incubator with a certain humidity and temperature, where the necessary tests are carried out and medication support is provided.

When the baby reaches a weight of 1,700 grams, he is transferred to a specially heated bed. With a weight of 2000 grams or more, a child does not need special conditions.

7 month old babies born prematurely can expect problems such as:

nutritional deficiencies, stunted growth, sepsis;
distress syndrome, hemolytic diseases;
impaired cerebral status, kernicterus, etc.

6 months (22-26 weeks)

Premature babies born at 6 months usually have a body weight of 1 to 1.5 kilograms.

To care for a 6-month-old child, mechanical ventilation is used, oxygen is given artificially, food is administered with a probe and into a vein.

For early development, hormones, amino acids, glucose, etc. are introduced.

Six month old babies born prematurely can expect problems such as:

frequent somatic disorders;
deformities and congenital developmental abnormalities;
diseases of the respiratory and hematopoietic organs;
diseases of the endocrine and digestive systems, impaired metabolism.

5 months (18-21 weeks)

The baby weighs less than 1000 grams, such premature babies are born in less than 5% of all cases. They often require medical attention and artificial respiration support.

Even with careful nursing, many of them become disabled and have a large number of complications.

5-month-old babies born prematurely can expect problems such as:

endocrine diseases, eating disorders, rickets;
hypotrophy, acute bronchitis, pneumonia;
diseases of the respiratory system, circulatory system.

We watch a video about what chances a premature baby has to mature, as well as the consequences of premature birth:

Problems in the future

If the newborn is underweight, it returns to normal when it reaches 1-2 years... Mental health will develop normally in 2-3 years, in some cases in 5-6 years.

In this article:

All over the world, including Russia, there is an increase in cases of premature birth of babies. According to statistics, every tenth baby is premature, or, if translated into numbers, about 8-13 million babies around the world are in a hurry to see the light of day several weeks or months ahead of schedule. This includes “extremely premature babies” weighing up to 1kg. Such a child needs special care. Extremely premature babies in 86% of cases, despite the measures taken, die in their first few weeks of life. Of the 14% of the remaining, only 6 out of 100 have a chance of developing without any deviations, defects and future disabilities. The rest are doomed.

In developed countries, premature babies are nursed in 96% of cases, in Russia only in 28.

What babies are considered premature

The fetus development program provides for 280 days, or 40 weeks. It is during this period that all the internal systems and organs of the baby finally develop and grow stronger to meet the environment. Premature babies are those children who appeared several weeks earlier than the due date: everyone who was born before the 37th week with a body weight of less than 2500 g. A child born at 38-39 weeks weighs, looks and does not differ from children born at the 40th week. They are developing well, they are in good health, and do not have any physical or mental disabilities. The only thing is that such premature babies need special nutrition and vaccinations. Feeding premature babies at 38-39 weeks is supervised.

How long can you leave such a child?

To begin with, it should be said about the generally accepted stages of prematurity by body weight:

2001-2500
1501-2000
1001-1500
Less than 1000g.

Since 1974, the World Health Organization has proposed, on the basis of collected statistics and good practice, to consider viable children born with a body weight of at least 500 g and a period of at least 22 weeks. This is the minimum, which truth does not guarantee a favorable outcome. You need to understand that a child born in a few months is weak in all vital parameters.

The shorter the period and less body weight, the more experienced the center or department is required, the greater the risk associated with death. Premature babies are demanding in terms of conditions, care, nutrition.

Causes of prematurity

There are many factors that contribute to the premature birth of a baby.

Social and economic:

Lack or inadequate medical care;
Poor nutrition (lack of minerals and vitamins), even several months before the expected birth;
The presence of bad habits (smoking, drug addiction, alcohol);
Severe stress for several weeks, or lack of desire for a child;
Harmful or hazardous workplace (dust, radiation, repetitive work, heavy lifting, irregular working day or week). Work without days off for several weeks in a row;
Insufficient parental education.

Social and biological:

The age of a pregnant woman (under 18 or over 35) can cause the baby to be premature;
The father's age (before 18 or after 35) can cause a prematurity of the child;
The presence of a “bad” history (termination of pregnancy, miscarriage, criminal abortion in a few months);
Genetic predisposition or diseases of the parents;
Marriage between relatives.

Various diseases:

The presence of chronic diseases of the mother, which could be exacerbated during pregnancy;
Postponed acute infectious diseases, possible complications after acute respiratory viral infections, influenza, severe colds, rubella, chickenpox, and so on;
On the part of the fetus, there may also be various anomalies in the development of the cardiovascular system, internal organs, and its position; hormonal dysfunctions, premature effusion of water, chromosomal defects;
Presence and development of intrauterine infections: chlamydia, mycoplasma, ureplasma. Or other, undetected or untreated sexually transmitted diseases;
Underweight mother (less than 48 kg);
Complications after vaccination;
A premature baby can be born due to constant stress.

What is the immaturity of a premature baby

Premature babies are very different from healthy ones not only in appearance, but also in the structure of internal organs. Especially at birth for 3, 6, 8 weeks. The skin is dry, thin, wrinkled. The body is covered with fluff. There are no grooves on the soles of the feet. The nails do not have a protrusion. The auricles have soft cartilage and are poorly formed.

The immaturity of the blood vessels is pronounced: if the child is put on its side, the skin becomes pinkish.

The general physique of the child: a relatively large head against the background of an underdeveloped skeleton (trunk).
Premature babies have poor development of sucking and other reflexes. This affects the feeding of premature babies. They are inactive. If in healthy children the umbilical cord heals quickly, then here the processes are much slower, including the loss of the umbilical cord.

Children born prematurely (several weeks before), in contrast to healthy children, have problems with straightening their lungs. If in a healthy child, after inhalation, the lungs straighten and remain in this position, then in a premature baby they may curl up again. There are problems with the production of digestive enzymes, so the feeding and nutrition of premature babies is carried out according to a special program.

For these children, special vaccinations can be applied.

A premature baby can sleep for a long time for several months, cry a lot, react with convulsive movements. The underdevelopment of the nervous system affects. In the first few weeks, there can be serious problems with the thermoregulation of the body.

Care

The period of postpartum adaptation in premature babies: those born in a few weeks is about a month or two. Given the immaturity of all life support systems, disruptions or an increase in terms are possible.

After birth, a premature baby needs special care, including feeding. The child is placed in an artificially created environment - incubator. It is a kind of incubator for maintaining the vital functions of the body. The cuvez is fully automated. Equipped with special sensors, in particular for monitoring the baby's body temperature. Since heat exchange is impaired, a drop in body temperature to 32 ° C is critical and can lead to death.

All data is transferred to the software, which, depending on the indications and development of the baby, makes certain decisions. In the event of a power outage, an emergency power supply is provided.

Nursing premature babies using the kangaroo method

Kangaroo care involves carrying children through maximum physical contact between the baby and the mother (skin to skin). This method allows the premature baby to quickly adapt to the environment, in a few weeks or months, has a positive effect on the development of the baby. And also compensates for heat loss.

The larger the contact area, the better. Additionally, the baby is covered with a warm diaper and a hat is put on. This is a kind of clothing for premature babies.

How long will mom and baby stay in the hospital?

This usually depends on the state of the mother and what category of prematurity the baby belongs to. Terms for a mother can range from several weeks to a month, for a baby about two months. Nursing premature babies depends on how many weeks before the due date the baby was born and how it tolerates vaccinations.

Will a premature baby differ in development from other healthy ones when it grows up?
With proper care, despite the underweight and underdevelopment of the body, a premature baby will not differ from healthy peers in the future. The neuropsychic development of such children is slower, but in the end, with proper care, everything will return to normal. For example, if a child was born at 28 weeks, then independently, with proper care, he will begin to roll over no earlier than 4-8 months.

Feeding

Feeding premature babies takes place under the close supervision of medical professionals. Premature babies grow faster than their peers, they need more nutrients, but the digestive system is weak, so a special mixture is prepared.

Vaccinations

Vaccinations are done only after the child gets stronger and gains weight. Approximate term 6-8 months. Basic vaccinations: BCG, hepatitis. Any mother has the right to refuse them.

Criteria, development and norms of behavior

The norm is long sleep, tearfulness, convulsive response to external stimuli, relatively inhibited development of reactions or its short absence, rapid fatigue, apathy. You should not panic if a child behaves this way. This can last for weeks or months.

What to do if anxiety symptoms occur?

It is imperative to contact medical professionals who will help and provide proper care if: the child does not breastfeed for a long time, there is constant vomiting, the child turns yellow, publishes a prolonged, painful cry, the child has stopped breathing (apnea), cardiac arrest (in this case, take immediate action - heart massage), severe pallor.

In Russia, premature babies were neglected before the introduction of the standard. Now, if a child was born a few weeks earlier with a weight of up to 500 g, doctors are obliged to leave such a baby, to provide him with all the necessary conditions and food. Feeding premature babies is carried out only by qualified, experienced workers.

Useful video about premature babies

If the baby is born prematurely - up to 37 weeks of gestation- it is considered premature.

There are several degrees of prematurity in newborns. Light, as a rule, does not pose a danger to the health of the baby, heavy - requires serious medical attention.

Mild prematurity

If a baby is born between 32 and 36 weeks of pregnancy, modern medical care allows him to avoid health problems.

Breast milk for premature babies

Adequate breastfeeding is not always available. So, premature babies, as a rule, do not have a sucking reflex - they are fed through a tube. Does not necessarily transfer the infant to artificial feeding. Expressing is the way out.

In some cases, in children with a mild degree of prematurity, the lungs do not have time to finally mature. They need additional assistance with breathing: artificial ventilation of the lungs or additional oxygen supply in the first days of life.

Many mild prematurity babies have nutritional problems. Babies born before 34-35 weeks are not able to suckle on their own - they have to be fed with a tube.

Therefore, babies born at this time are forced to stay in the children's department of a hospital or maternity hospital for several more weeks until they can start self-feeding.

In addition, all premature babies may have problems maintaining their body temperature for several weeks. In this case, they are left in jug- a special box for newborns - to maintain an optimal temperature and monitor cardiac activity and respiration.

In the future, after discharge, parents should carefully monitor the child's body temperature... Premature babies can easily overheat or catch colds.

Moderate prematurity

A baby is born at 28-31 weeks of gestation. In children born at this time, the lungs are not yet fully ripe for breathing. They usually require assistance with mechanical ventilation or a constant stream of oxygen-enriched air to maintain positive airway pressure.

Most babies with moderate prematurity need such help within a fairly short time.

If the child is on mechanical ventilation, food is supplied through an intravenous catheter. Children who breathe on their own can feed on breast milk through a tube until they learn to suck independently.

Severe prematurity

The baby is born before 28 weeks of pregnancy. Previously, such children survived extremely rarely, but modern medicine allows you to take care of such babies.

Almost all children who have appeared at this time have not yet developed lungs - most of them require artificial ventilation of the lungs or the supply of an oxygen-enriched air stream.

The lungs can maintain respiratory function from 22-24 weeks of intrauterine development, but the alveoli, necessary for normal absorption of oxygen, develop only at 28-30 weeks of gestation.

In addition, severely premature babies cannot feed on their own and maintain their body temperature. Parents of such babies need to understand that a child will stay in the children's department for a long time.

Why is it dangerous for children to be born before the deadline?

Babies who are born before 37 weeks of pregnancy may experience problems related not only to the lack of a sucking reflex.

The shorter the period for which a child was born, the higher his risk of developing various diseases characteristic of premature babies.

Undeveloped lungs

The most dangerous are pulmonary disorders. For example, shortness of breath syndrome in newborns, in which the baby's immature lungs cannot fully expand. The child has to make significant efforts to inhale.

Such children need artificial respiration support.

Stop breathing

Premature babies have not yet fully formed the respiratory center of the brain. If the person does not breathe often enough, the command from the brain stem compensates for this by breathing deeper.

Newborn babies, on the other hand, breathe shallowly and unevenly, they have periods of too slow breathing. If they occur too often, doctors talk about the development of respiratory arrest, or apnea.

A baby with such a violation needs constant supervision in the first weeks of life. As the child grows, the risk of sleep apnea decreases.

Features of the heart

During intrauterine development, the child's blood practically does not pass through his lungs due to the structural characteristics of the heart. The heart of the embryo pushes blood from the right ventricle not into the pulmonary artery, but into the aorta through an opening called the ductus arteriosus.

Soon after birth, in full-term babies, it overgrows, and in premature babies, it can remain open. This puts an increased strain on the lungs and heart. This condition requires medical or even surgical treatment.

Infections, exchange problems and blindness

Infections affect premature babies more often than babies born on time. One of the reasons for this vulnerability is immaturity of the immune system, in which antibodies in the child's blood are produced in insufficient quantities.

Also dangerous for premature babies and viral infections, which in other babies cause only mild symptoms of a cold.

In addition, premature babies may experience problems with absorption of nutrients, as well as a lack of hemoglobin associated with a low rate of formation of red blood cells - erythrocytes.

Premature babies can also develop retinal damage - retinopathy of prematurity without early treatment leading to blindness.

That is why premature babies should remain under the supervision of neonatologists from birth to the moment when their body is ready for independent life.

The most important

A child born even before the 28th week of pregnancy can not only survive, but eventually catch up with full-term babies in the development.

All premature babies require careful care and supervision of doctors in order to avoid diseases caused by the immaturity of their body.