Why a premature baby. Development and consequences of premature babies

26.08.2019

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

Premature babies: statistics

Today, preterm birth is not uncommon. In most developed countries, this indicator is relatively stable and amounts to 5-10% of the total number of newborns.

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

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

Premature babies: 28-30 weeks

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

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

When the baby is on ventilator, it is fed through an intravenous catheter. If the baby breathes on its own, then it is fed with breast milk through a tube until it learns to suckle on its own.

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

Premature babies: after cesarean

In premature infants, the unpreparedness of the respiratory system for independent functioning of breathing can manifest itself as a syndrome of respiratory disorders. A child's lungs simply cannot cope with providing the body with the required amount of oxygen. This manifests itself in shallow and irregular breathing, which is fraught with the development of respiratory diseases.

Caesarean section does not always go smoothly. The reason is those changes in health, which became the indications for the operation. During a cesarean section, a newborn can be injured when removed from the uterus. And trauma is a possible damage to the nervous system with malfunctions of motor activity and muscle tone, which can result in the development of paresis and paralysis. Similar consequences arise as a result of the hypoxia that the infant experiences during the operation. That is why such a child can sit and crawl, walk and talk later than his peers. In adolescence, premature babies born by caesarean section are more likely to be susceptible to vegetative vascular dystonia and sensitivity to weather changes, headaches and fainting. But you don't need to be scared prematurely. Sometimes a cesarean section is the only way to save a premature baby, so the risks are always justified.

Premature babies: development

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

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

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

The development of premature babies is accelerated by soft calm music, bright toys in the crib, and special exercises.

Premature babies: consequences

The nature laid down the bearing of the child by the mother for 40 weeks. And it is clear that babies born prematurely have much more developmental problems. The shorter the gestation period before birth, the greater the risk of developing diseases characteristic of premature babies. So, let's find out about the possible consequences of prematurity:

Underdeveloped lungs. They pose the greatest danger. To inhale, the baby needs to make great efforts. Such babies need artificial respiration support. Their respiratory center is not fully formed in the brain. Therefore, respiratory arrest (apnea) can often occur.
Features of the heart. The heart of the embryo in the womb pushes blood not into the pulmonary artery, but into the aorta through the ductus arteriosus. After the birth of a full-term baby, this duct becomes overgrown, and in premature babies it can remain open, which is fraught with increased stress on the lungs and heart. This condition requires medication.
Infections, metabolism, blindness. Infections haunt premature babies much more often, because this is facilitated by the immaturity of the immune system. Viral infections are especially dangerous for such children. Premature babies often have metabolic problems and a lack of hemoglobin. In addition, this category of babies is susceptible to the development of retinal lesions, that is, retinopathy of premature babies. If not treated at an early age, it can lead to blindness.

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

Especially for - Diana Rudenko

Even term-born babies often make their parents very worried about their health. What can we say about those little "hurry-ups" who hastened to "go out" ahead of schedule. Indeed, parents of premature babies face serious potential childhood illnesses and complications that they should at least have an idea of. As in that beautiful and accurate saying: "Aware, then already armed" ...

Often, premature babies are placed in special incubators, where a special temperature, humidity and oxygen regime are maintained.

Features of premature babies

Babies born before the 37th week of pregnancy are considered premature. Such children will have a very difficult time in the first months of their "early" life - after all, they will not only have to intensively catch up with their peers, but also bravely resist many potentially dangerous pathologies. We will tell you in detail about the most common of them.

Often, after birth, premature babies are placed in a hospital for some time, in intensive care units, where neonatologists closely monitor their health, and also take measures to nurture premature babies.

The time that a baby, born prematurely, will spend in the hospital for growing and nursing, directly depends on how "small" he was born. On average, in Russian clinics, in intensive care units for premature babies, babies spend from 15 to 45 days.

Many premature babies do not have a sucking reflex for some time - such babies are fed with a special probe. Some cannot breathe on their own - they are connected to the appropriate equipment.

To the most important features of premature babies relate:

immature central nervous system (CNS), which is expressed in the lethargy of the child, chaotic movements of the arms and legs, the absence of the sucking reflex;
undeveloped gastrointestinal tract system, excessively small stomach volume and underdeveloped intestinal muscles;
immature ability for thermoregulation (which is why most premature babies need to stay in warm and moist jars);
undeveloped respiratory system (in very premature babies, as a rule, at the moment of birth, the lungs are not able to open up and fill with air on their own), which is expressed in shallow "ragged" breathing and in respiratory stops during overload (for example, due to crying);
immature skin, which is very vulnerable to germs and is easily injured even with normal touch.

Under the constant supervision of neonatologists of the intensive care unit, a premature baby is kept until his vital and physical indicators approach the norms of a child born at term.

And, of course, along with nursing and nursing premature babies in hospitals, a thorough medical examination is carried out to identify serious diseases. So, in premature babies, the following pathologies are most often manifested:

Underdeveloped lungs and respiratory pathologies

In most babies, the lungs form at 36 weeks of gestation. Although there are exceptions, every child develops individually. If the mother already knows that the baby will be born prematurely, she can order an amniocentesis procedure (taking a sample of amniotic fluid for laboratory research), with which you can check the level of maturity of the fetus's lungs. In some cases, to speed up the formation of lungs in the fetus, mothers may be injected with steroids before delivery. A premature baby, whose lungs have not yet formed, risks facing the following complications:

Respiratory distress syndrome which causes the child to breathe sharply, irregularly. In this case, nursing a premature baby is carried out by supplying additional oxygen to the lungs (a respiratory support apparatus), or using a respirator, or creating a constant positive pressure in the airways, or by intubating the trachea. In severe cases, the infant is given a dose of a surfactant that the lungs lack.
Transient tachypnea of newborns, that is, rapid shallow breathing. This condition can occur in premature babies as well as in full-term infants. Nursing a premature baby in this case, as a rule, takes place without medical intervention and takes up to several days. Until the newborn's breathing has returned to normal, intravenous feeding is used.
Bronchopulmonary dysplasia of the lungs occurs when the lungs of a newborn are damaged. Unfortunately, when premature babies are treated with a ventilator, their lungs, due to their weakness, cannot always withstand the constant pressure generated by the device. Premature babies who have been ventilated for more than twenty-eight days are at high risk of developing BPD.

Pneumonia of premature babies

Another difficult consequence that premature babies often face is pneumonia. It is caused by an infection in the area of the lungs that is involved in the exchange of carbon dioxide and oxygen. The resulting inflammation reduces the amount of space available for air exchange. This can lead to the fact that the child's body will not receive the required amount of oxygen.

In this case, treatment for premature babies will include antibiotics, supplemental oxygen and intubation. If pneumonia is not treated in time, it can develop into a fatal infection or lead to sepsis or.

Apnea and bradycardia

Apnea and bradycardia are also very common diseases of premature babies. Apnea is short-term respiratory arrest. In hospitals, specialists are always ready for this situation: if a premature baby develops irregular breathing and pauses reach 10-15 seconds, an alarm will sound in the intensive care unit, where he is nursing, calling on doctors for help.

Bradycardia is a decrease in heart rate. The scenario is the same: if the heart rate of a premature baby drops below 100 beats per minute, an alarm is also triggered.

Special equipment in the departments of nursing premature babies monitors all vital indicators of babies around the clock.

Typically, a gentle pat on the back of the newborn helps to "remind" him to breathe again and also increases the heart rate. But sometimes the baby also needs more serious specialized help.

Infections in premature babies

Ordinary babies born on time are protected from most infections not only by mother's breast milk and partial mother's immunity, but also by two vital organs - the skin and the respiratory system. Both that, and another normally prevent the penetration of many viruses and bacteria into the vulnerable organism. But in a premature baby, there is a certain underdevelopment - both of the respiratory system and the maturity of the skin.

The high risk of developing infections in premature babies is the second reason why these babies are kept in jails for some time. These incubator beds not only create a favorable climate around the children, but also protect them from infections.

Intraventricular hemorrhage (IVH)

Babies born before 34 weeks of age face an increased risk of intraventricular hemorrhage in the brain. The fact is that during childbirth, the pressure in the blood vessels changes so dramatically that weak vessels may not cope with it. In the future, IVH can lead to complications such as cerebral palsy, mental retardation, and learning difficulties.

Intracranial hemorrhage occurs in about every third child born at 24-26 weeks of gestation. If preterm birth is unavoidable, the doctor may prescribe medications to the pregnant woman to reduce the risk of severe intracranial hemorrhage in the newborn.

Retinopathy of prematurity

This is an extremely dangerous disease that affects underdeveloped blood vessels and capillaries in the eyes of premature babies. Retinopathy of prematurity can be mild, without visible defects, or it can be severe with the formation of new blood vessels (neovascularization) and lead to retinal detachment, and sometimes even blindness.

Retinopathy, which in the future may develop into high myopia in a child, is one of the most dangerous and common diseases among premature babies.

When treating mild retinopathy, the doctor may prescribe a course of special drops (vitamin or hormonal drugs). In difficult cases, they resort to surgical intervention, the purpose of which is to stop the retinal detachment. and .

There is no reason to sweeten the reality - in most cases, a premature baby and his parents will face serious trials in the first year of a baby's life. But this does not mean that a premature baby is doomed to a painful existence, chronically poor health and many pathologies.

With careful and reverent care, in the presence of patience and love, with the help of adequate and timely medical intervention, premature babies not only quickly "catch up" in the development of their peers, but also in the future are no different from them.

Judge for yourself: in modern Russia, there are 7 premature babies for every hundred newborns. And if you meet these children over the age of two, you probably will not be able to determine which of them was born on time, and who was a little rushed towards a new life ...

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

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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, you 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. The increase in body weight up to two kilograms causes the baby to move to the bed, 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 "complete" the organs. The development of a premature baby by months to a year can be clearly seen in the following table.

Age of the baby 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 has increased 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, by the year they increase in weight eight times.

Each 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.

Premature babies are called babies born before the date of the last menstrual period and weighing less than 2500 grams. There are 4 degrees of prematurity depending on the gestational age and weight of the child at birth:

I degree- premature babies born at 35-37 weeks with a birth weight of 2000-2500 grams;

II degree- premature babies born at 32-34 weeks with a weight of 1500-2000 grams;

III degree- deeply premature babies born at 29-31 weeks with a weight of 1000-1500 grams;

IV degree- extremely premature babies born before 29 weeks with a weight of less than 1000 grams.

Of course, for such children, weight gain is one of the determining factors in the physical development and health of the child. A good weight gain can only be ensured with a well-established healthy nutrition of the child that satisfies his energy costs, when the baby receives all the nutrients, trace elements, and protective complexes he needs. Difficulties with feeding can arise due to the immaturity of the child's gastrointestinal tract, low enzymatic activity, rejection of food by the stomach, lack of swallowing and sucking reflexes. Depending on the problem, doctors feed the baby through a tube, use parenteral nutrition, when nutrient solutions are administered intravenously to the baby.

The best thing is mother's breast milk... Scientists have proven that milk adapts to the needs of the child, because the milk of a woman who gave birth ahead of time has its own unique composition, adapted for a premature baby. While the baby cannot suckle at the breast, he is fed with expressed milk, after the baby learns to suck and swallow (usually, when he gains 1.6 kg, these reflexes appear), he is gradually transferred, first to partial, and then to full breastfeeding. If it is impossible to breastfeed, the child is transferred to donor milk or a special adapted mixture for premature babies. Indicators of weight gain determine the quality and completeness of nutrition, the need for the introduction or cancellation of supplementary feeding.

For premature babies, doctors divide into 3 main stages, which differ in the child's nutritional needs and weight gain.

At the 1st stage, the newborn does not gain, but loses weight... This is a physiological feature of all children, but if a full-term baby usually loses 5-6% of its weight, then a premature baby with a weight of more than 1.5 kg - 10%, and a deeply premature baby with a weight of up to 1.5 kg - 15%. This period usually lasts the first 7 days from birth. Despite the fact that during this period the amount of nutrition is minimal, it must provide the crumbs' body with all the necessary nutrients.

At the 2nd stage, constant weight gain is achieved, at least at the level of the intrauterine period... When the baby's condition stabilizes, he can independently suckle a breast or a bottle, has reached a weight of 2.5 kg, the mother and her baby are discharged from the department for premature babies. Weight gain per week should be 125-200 grams, depending on the weight of the baby at birth. The calculation of the increase is as follows: + 15 g / kg daily.

At the 3rd stage, the child's weight is normalized, the period lasts up to a year(for deeply premature babies longer). The task of parents in this period is to provide the child with adequate nutrition with a sufficient amount of calories and all the nutrients that are needed for the growth of the child, because a premature baby needs to develop more intensively in order to catch up with peers. Usually, if a baby was born 1 month ahead of schedule, then he catches up with peers in development by 1 year, 2 months ahead of schedule - by 2 years, and 3 months - by 3 years, respectively.

Below is a table of weight gain for premature babies, depending on age and degree of prematurity.

The table gives an approximate result for children who are in full, the numbers may differ, both up and down. Every month the child should be examined by a pediatrician, who will assess the physical development and health of the child. Correction of nutrition, calculation of the rate of supplementation, recommendations for the introduction of complementary foods, vitamin supplements should be carried out only by a doctor.

Calculate the approximate weight gain of a premature baby under one year old online

Indicate the weight of the baby at birth (g)

Indicate the height of the child at birth (cm)

Premature baby

Age, months	Weight gain	Your baby's weight
1	600
2	800
3	800
4	750
5	700
6	650
7	600
8	550
9	500
10	450
11	400
12	350

Premature babies are considered children born between the 22nd and 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 those born alive takes into account only children from the 28th week of gestation weighing 1000 g and above and a body length of 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 poor parenting education and associated unhealthy lifestyles during pregnancy and a lack of understanding of the importance of consistent

medical supervision. Among children born to women who have not been observed during the entire pregnancy in the antenatal clinic, 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 psycho-emotional 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 PREMATURE 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 expressed, 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 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, 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 called. A premature baby in the first 2-3 weeks of life may have an unstable tremor, a mild and unstable squint, horizontal nystagmus when the body position changes.

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 respiratory rate (from 36 to 76 per minute), with a tendency to tachypnea and apnea lasting 5-10 seconds. In children born less than 35 weeks of gestation, the formation of a surfactant is impaired, which

ry 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 the enzymes of the gastrointestinal tract 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 at a relatively low concentration of bilirubin (170-220 μmol / L).

Laboratory research

In the first days of life, premature babies are more likely than full-term babies to have 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 ones, 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 full-term babies, however, 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 the weight and length of the premature body 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 by 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 babies by 3-6%); recovery is slow. With a gestation period 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 the age of 5-6 years. Further, 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, stand 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 the limitation of 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 (such as "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 due to 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 by 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 nd 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, 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.