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Neonatal period premature baby. Premature babies: consequences in the future, prognosis, development. What to do if anxiety symptoms occur

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

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

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

A premature baby is a baby born less than 37 completed weeks of gestation, i.e. before day 260 of pregnancy.

Determining prematurity by weight and height alone is not entirely correct, especially when the length of the pregnancy is difficult to ascertain. This method classification is used to standardize treatment and observation, for the needs of statistics. There are children born with large weight and height, but with clear signs immaturity, which is characteristic of premature babies. In practice, in addition, it is necessary to take into account a wider range of positions for assessing the actual age of the child.

Signs of prematurity: weak cry of the child, shallow, weakened irregular breathing, insufficient development of the subcutaneous fat layer, in connection with which the skin is red, dry, wrinkled, abundantly covered with fluff; the small and lateral fontanels are open, the auricles are soft and fit snugly to the head, > the nails do not reach the edge of the phalanges of the fingers, the umbilical cord is located below the middle of the body length, the genitals are underdeveloped - in boys, the testicles are not lowered into the scrotum, in girls, the labia minora are not covered large; scanty movements, hypotension (reduced tone) of the muscles, physiological reflexes are reduced, even sucking and swallowing reflexes may be absent.

Maturation of the sense organs in preterm infants.

Touch: The system of somatic sensitivity (senses of touch, temperature and pain) develops between 8 and 15 weeks of pregnancy. At 32 weeks of gestation, the fetus always reacts to changes in ambient temperature, touch and pain.

Taste: Taste buds are morphologically mature by the 13th week of pregnancy. At 24 weeks of pregnancy, the fetus already reacts to taste stimuli.

Hearing in the fetus appears at 20 weeks of gestation. At 25 weeks pregnant, the fetus responds to intense vibrational and sound stimuli. Sensitivity and the ability to distinguish sounds in height reach an adult level by the 30th week of pregnancy. In a full-term newborn, they are no different from those in an adult.

Vision. By 24 weeks of gestation, all structures of vision are formed. The reaction of the pupils of the fetus to light appears at a gestational age of 29 weeks. At 32 weeks, it becomes stable. At 36 weeks of gestation, the vision of the fetus is no different from that of a full-term baby. It must be remembered that the vision of even full-term children is 20 times worse than that of adults; it is still fuzzy, vague. The child sees only the outlines of objects (moving and stationary) located at a distance of only 25-30 cm from his eyes. A full-term baby distinguishes between shiny and red objects.

Smell: By 28-32 weeks of gestation, premature babies begin to react to strong odors.

Features of the course of the neonatal period in premature babies.

The course of the neonatal period in premature babies has some features and depends on the degree of physiological maturity.

In premature newborns, lethargy, drowsiness, a weak cry, physiological erythema is pronounced.

Physiological jaundice is usually detected somewhat later due to the bright color of the skin and is often delayed up to 3-4 weeks of life.

The umbilical cord in premature babies is thick, juicy, disappears later (by the 8-14th day of life), the healing of the umbilical wound is slow.

Many preterm infants in the 1st-2nd week of life have edema, which are located mostly on lower limbs and belly.

Thermoregulation is not stable enough, a naked child quickly cools, body temperature can drop below 36 °, and at elevated ambient temperatures, overheating quickly sets in ("couvez fever").

Respiratory rate in premature babies is unstable, during movements it reaches 60-80 per 1 min., at rest and during sleep it decreases significantly, prolonged apnea (breathing stops) can be observed, especially during feeding. In preterm infants, pulmonary atelectasis is often observed in the first days of life.

Heart sounds may be muffled, and the heart rate varies depending on the conditions and condition of the child (120-140). With anxiety and an increase in ambient temperature, the heart rate can reach up to 200 beats per 1 minute.

Physiological weight loss is restored by the 2-3rd week of life. Weight gain in the first month is insignificant (100-300 g).

At the 2-3rd month of life, when an intensive weight gain begins, premature babies often develop anemia. At proper nutrition with a sufficient introduction of protein and vitamins, it gradually passes. Decrease in hemoglobin below 50 units. requires special treatment.

A premature baby requires close attention, since a number of problems often arise in the process of nursing it. First of all, this applies to children born with a body weight of 1500 g or less (“deeply premature”) and, especially, less than 1000 g (“extremely premature”).

In developed countries, premature babies are usually cared for in wards. intensive care. Pediatricians who specialize in nursing children up to the 28th day of life are called neonatologists.

Particularly worth mentioning is the feeding of premature babies. Children born before 33-34 weeks of gestation, as a rule, are fed through a tube inserted into the stomach, because their sucking and swallowing reflexes are either reduced or completely absent. In addition, coordination of these reflexes is necessary, which develops only by 33-34 weeks of gestational age. The food used is expressed breast milk and / and infant formula specially adapted for such babies. That part of the food that children do not absorb in the digestive tract due to the reduced activity of digestive enzymes and other functional and morphological features of premature babies is administered in the form of separate solutions of proteins, fats and carbohydrates intravenously (parenteral nutrition).

Modern neonatal intensive care includes the most sophisticated methods of temperature control, respiration, heart activity, blood oxygenation and brain function.

Conditions for nursing premature babies.

The low birth weight group is particularly affected by exposure to external factors. They demand ideal conditions nursing, in order to achieve not only their survival, but also a favorable further development.

One of the most important conditions for nursing premature babies is the optimal temperature regime. Most often, children weighing up to 1500 g are placed in incubators. If a child does not retain its own heat well, then even if it is more than 1500 grams, it can be placed in an incubator.

Immediately after the birth of the child, they are placed in an incubator with an air temperature of 34 to 35.5 degrees (the smaller the weight of the child, the higher the temperature), by the end of the month the temperature is gradually reduced to 32 degrees. The temperature regime in the couveuse is selected individually. To control the child's body temperature, special temperature sensors can be used, connected to the monitor on one side, and attached to the child's body with a patch on the other.

Also, the thermal regime can be maintained using special changing tables with a source of radiant heat.

Another important condition for nursing is air humidity and in the first days it should be 70-80%. For this purpose, there are special humidifiers in incubators.

The purpose of creating conditions favorable for the development of a child receiving intensive care is associated with minimizing adverse effects, as a result of which the prognosis of psychomotor development improves.

Creating favorable conditions for the development of newborns in intensive care units (optimal light regimen, noise elimination, minimizing painful manipulations, tactile stimulation) has a positive effect on the subsequent development of children with serious illnesses.

Newborns are very vulnerable. Their reaction to damaging factors is common, that is, it involves the response of several body systems at once. The elimination of pain and anxiety reduces the need for oxygen in the blood (and, consequently, in the correction of the mode artificial ventilation lungs), reduces its energy costs, improves food tolerance, reduces the duration of hospitalization.

The inclusion of parents in the treatment process reduces in newborns pain and stress reactions and favorably affects subsequent development.

Newborns in intensive care units continue to develop sensory organs. Negative and positive environmental factors affect the conduction of excitation along the nerve pathways.

Critical changes occur in the brain of a premature baby during the period when he is in the intensive care unit (22-40 weeks of gestation):

Environmental influences influence the formation of the important processes listed above during this critical period. If these effects are inadequate, they can irreparably disrupt the process of formation of the nervous system.

A neonate receiving intensive care is exposed to light and sound. The very medical procedures necessary to save his life are a great burden for a premature and seriously ill child. These treatments include airway debridement, chest vibration massage, gastric tube insertion and feeding, venous catheterization, chest x-ray, ultrasound, ophthalmoscopy, daily physical examination, vital signs, hygiene procedures, weighing.

According to rough estimates, a seriously ill newborn is shifted and subjected to various manipulations for care, treatment and condition control more than 150 times a day. Thus, periods of continuous rest do not exceed 10 minutes.

What can reduce this kind of stress?

  • Creation of comfortable conditions, elimination of noise and bright light, convenient placement in an incubator (incubator) or in a bed.
  • Cooperation with parents, strengthening their attachment to the child.
  • Use of natural soothing and self-regulating factors: pacifiers, kangaroo care, twins in the same bed (incubator).
  • Laying in the midline in a flexor position, swaddling, simulating a limited space in the uterus.
  • Conducting several care manipulations in the same period of time to provide the child with longer periods of rest.

Eliminate noise and glare. Prematurity itself is a risk factor for sensorineural hearing loss and deafness. It is detected in 10% of those born prematurely and only in 5% of those born full-term. Noise disrupts the formation of auditory pathways in the central nervous system necessary for the development of speech.

Light levels of less than 6 foot-candles (60 lux) and noise levels of less than 50 decibels (calm, low speech) recommended in intensive care units reduce the risk of hearing loss and improve the subsequent development of seriously ill children. In the intensive care unit, therefore, only calm speech without raising the voice is allowed. It must be remembered that the doors of the incubator must be closed carefully quietly, do not knock on the incubator and other nearby surfaces.

Eyelids do not protect the eyes of newborns. At least 38% white light passes through the eyelids and irritates the child.

Elimination of pain and congestion:

Premature babies are very sensitive to rough touch. They react to such touches with tachycardia, agitation, increased blood pressure, apnea and a drop in hemoglobin saturation with oxygen, disorders of the regulation of physiological processes, insomnia.

However, preterm infants are not able to respond to pain with changes over a long period of time. physiological indicators and behaviour. Their reactions are quickly depleted, so it is difficult to notice them. The scales for assessing the intensity of pain, developed for full-term newborns, are not applicable to preterm infants.

According to one study, three out of four episodes of hypoxia and a drop in hemoglobin oxygen saturation are associated with care and treatment procedures. In addition, in response to them, stress hormones are released. A premature baby who covers his face with his hands gives us a signal that he is experiencing discomfort.

It is very important to try to reduce stress and pain effects.

Non-drug methods for minimizing pain and overload in newborns include using a pacifier and nipple with a bottle of water, swaddling to simulate an enclosed womb, reducing exposure to light and noise, and performing several manipulations at the same time in order to widen the gaps between them and allow the baby to rest.

Correct placement of premature babies:

When a baby is in the neonatal intensive care unit, it is important to create an environment that mimics the closed space of the uterus (“nest” made of soft materials).

Neural connections are strengthened by repeated stimulation and weakened by its absence. After birth, a premature baby, having left the closed space of the uterus, ceases to receive constant tactile stimulation from its walls, which supports muscle development. The weak muscles of a premature baby cannot resist gravity. He takes a sprawled pose with limbs extended, abducted and turned outward. Gradually, this posture leads to the formation of an abnormal muscle tone and postural (associated with the forced position of the body) deformations.

Thus, the increasing flattening of the skull from the sides leads to a narrowing and lengthening of the head (the so-called scaphocephaly and dolichocephaly). It is due to the thinness and softness of the bones of the skull, which is why it is easily deformed. This deformity of the head apparently does not affect the development of the brain, but makes the child outwardly unattractive and interferes with his socialization. However, with good care, the deformation can be significantly reduced.

Prolonged stay in the same position leads to muscle and skeleton deformities that disrupt subsequent motor development and the ability to learn about the world around, play, master social and other skills.

Giving the newborn the correct posture prevents deformations of the skull, trunk and pelvis, which disrupt and slow down subsequent development. Newborns themselves cannot turn, so attention should be paid to the correct posture. The child should be laid in a collapsed position in the "nest" and regularly turned from one side to the other. It is allowed to lay out premature babies on the stomach, but only under the control of monitoring supervision and personnel.

Premature is considered a baby born between 22 and 37 weeks of gestation (or between 154 and 259 days, counting from the first day of the woman's last cycle) with a body weight in the range of 500 grams to 2.5 kg and a body length of less than 45 cm (according to the recommendations WHO 1977).

Currently, in our country, the main criterion for the period of prematurity is considered to be gestational age or age. According to this, a premature baby is a baby born at a period of intrauterine development, which is less than 37 completed weeks of gestation (pregnancy). A full-term baby is called when its gestational age is between 37 weeks and 42 weeks.

Epidemiology

Among the total mass of children who have a body weight of less than 2500 g at birth, about 30% are full-term babies, the remaining 70% are premature newborn babies. Average weight a child at 37 weeks of gestation is usually about 3 kg. In some countries, those children who were born before 28 weeks of gestation are not counted as newborns, so the statistics on the frequency of birth of premature babies differ significantly from country to country (from 5% to 15%). In our country, there is an order of the Ministry of Health “On the transition to the criteria for live birth and stillbirth recommended by the World Health Organization (WHO). According to him, the period of perinatal development begins its countdown from the 28th week of pregnancy. Premature babies born between 28 and 36 weeks of gestation occur with a frequency of 5.5 to 8%. Among them, about 75% are babies born between 32 and 36 weeks of gestation.

Main groups

Premature small babies previously divided into the following degrees of prematurity, based on the figure of body weight at the time of birth:

  • 1 degree - body weight is from 2001 to 2500 gr.,
  • Grade 2 - body weight within 1501-2000 gr.,
  • 3 degree - from 1500 gr. up to 1001 gr. This group is called children with very low body weight;
  • Grade 4 - it is made up of newborns with extremely low weight, less than 1 kg.

However, there is also the WHO (World Health Organization) 10th revision classification, in which there is a heading for disorders associated with a decrease in pregnancy and low birth weight. According to it, it becomes generally accepted to divide premature babies both by body weight and by gestational age. When both gestational age and birth weight are known, preference should be given to the child's body weight. Depending on it, three groups of prematurity are distinguished:

  1. With extremely (extremely) low body weight - birth weight is up to 1 kg (999 grams or less);
  2. Very low birth weight - birth weight less than 1.5 kg (from 1000 grams to 1499);
  3. With low body weight - weight up to 2.5 kg (from 1500 grams to 2499).

Based on gestational age very premature babies, according to the WHO criteria of the 10th revision, are divided into two groups:

  1. With extreme immaturity - this includes babies born before 28 weeks of gestation;
  2. Other cases of prematurity - this group includes all children whose gestational age is 28 weeks or more, but less than 37.

The frequency of morbidity and mortality, the likelihood of their disability increases as the child's gestation period decreases, and therefore the prevention of a possible probability premature birth is a very important issue.


Reasons for having a premature baby

All etiological factors can be divided into the following groups:

  1. Social, economic and demographic factors: the presence of occupational hazards and the nature of the work of parents; bad habits(the effect of alcohol, nicotine and drugs); family living conditions (income level and place of residence, quality of food); the state of the level of education; the quality of medical care; the presence of mental and physical injuries;
  2. Biological factors: parental age(less than 18 years or more than 35); short stature, previous abortions and childbirth, the number of previous pregnancies and their outcomes, the presence of an interval between pregnancies and childbirth, etc .;
  3. Clinical reasons:
  • the presence of anomalies in the development of the genital organs (infantilism) in the mother;
  • in a woman;
  • an abortion preceding this pregnancy, which causes trauma to the uterus (leads to a violation of the structure of the endometrium, cervical insufficiency);
  • the presence of somatic pathology in the mother (heart disease, a, (lead to hypoxia, impaired placental blood flow and changes in the structure of the placenta);
  • existing infections that are sexually transmitted;
  • the presence of complications of this pregnancy (preeclampsia);
  • the occurrence of incompatibility of the blood of the mother and fetus (according to the Rh factor and group);
  • chromosomal diseases of the child;
  • endocrine pathology in the mother (, etc.).

With what premature newborn baby different from full-term?

A mature newborn is such a child who, based on his morphofunctional development, is ready for life outside the womb in conditions of optimal care and feeding. Such a baby is able to maintain body temperature well, has basic reflexes (sucking, swallowing), stable heart and respiratory rates, and normal motor activity.

External anatomical features of a premature baby:

  1. Disproportion in physique: the size of the head is up to a third of the height; the brain part of the skull is larger than the front; the bones of the skull are supple and thin, all sutures and fontanelles are open; no ossification nuclei in the epiphyses of bones; short legs and neck;
  2. The skin is bright, dark red, thin, glossy, as if translucent, the skin folds on the soles are weakly expressed;
  3. Lanugo (abundant and thick fluff) is found on the skin of the back, shoulders, face (forehead and cheeks), extensor surfaces of the limbs (often thighs);
  4. The subcutaneous fat layer is reduced or absent altogether, it remains only in the cheek area, there is a tendency to the rapid development of edema;
  5. Low-lying umbilical ring;
  6. The cartilages of the auricles are soft to the touch, tightly fitting to the head;
  7. The nail plate is thin, the tip of the nail does not reach the edge of the finger;
  8. The mammary glands are underdeveloped;
  9. The external genitalia are open, the gaping of the genital slit (the small lips are not covered by the large ones), the boys have no testicles in the scrotum.


Signs of immaturity on the part of organs and their systems

Premature babies differ from mature babies in neurological status, which is explained by the anatomical and functional immaturity of the CNS:

  • Weaker, lethargic, lethargic, drowsy, motor activity is reduced, the cry may be very weak or absent altogether;
  • The tone of the flexor muscles prevails over the tone of the extensor muscles, there is no physiological increased muscle tone and appears, as a rule, by two months after birth;
  • A decrease in all reflexes that a full-term baby has, including sucking and swallowing. premature baby with a body weight of more than 1.5 kg, it becomes able to suck no earlier than 2 weeks after birth, with a body weight of less than 1500 and more than 1000, this reflex occurs by 3 weeks, in children less than 1 kg at birth - not earlier than a month of life:
  • Imperfect thermoregulation is characteristic. All preterm infants typically have a reduced ability to generate heat due to low fat stores and low muscle tone. At the same time, high heat transfer is due to the large surface area of ​​the body and superficially located skin vessels. All this leads to rapid hypothermia, and immature thermoregulation centers in the central nervous system can cause the baby to overheat.

From the side respiratory system a feature will be the presence of primary atelectasis of the lungs, the variability of the respiratory rate (than less baby, the more often he breathes), his depths, stops or long pauses between breaths. The degree of maturity of the lung tissue depends on the gestational age: in those born before 28 weeks, the alveoli and capillaries are poorly developed, extensibility is reduced, and there is no surfactant, which leads to respiratory failure after birth.

The cardiovascular system is characterized by variability in the frequency of heart contractions, low blood pressure in the first two days after birth, and reduced vascular tone. The change in hemodynamics associated with birth occurs slowly with a short gestational age.

On the part of the digestive organs, a feature of a premature baby is a small volume of the stomach, a decrease in the tone of the sphincters, a decrease in intestinal motility, which causes a tendency to bloating and regurgitation. The activity of all enzymes also decreases with a decrease in gestational age.

The urinary system is characterized by a decrease in the ability of the kidneys to concentrate urine (due to low filtration volume in the glomeruli and reabsorption in the tubules), renal regulation of urination, and the ability to maintain a stable acid-base state of the blood. This causes significant fluctuations in the frequency and volume of urination.

The metabolism of a premature baby is characterized by a tendency to decrease in blood protein, glucose, calcium, and an increase in bilirubin.

Features of the physiology of a premature baby

They are due to the immaturity of all organs and their systems and are as follows:

  • Weight loss after birth is maximum during the first 7 days, can be up to 15% and is restored by 3 weeks;
  • Jaundice will manifest itself in 95% of premature babies, its character is longer and more pronounced;
  • Much less often, signs of a hormonal crisis and toxic erythema can be observed, in contrast to mature children; Share with friends!

The determining criterion for prematurity is gestational age. The parameters of physical development and even the degree of morphological and functional maturity are not criteria for diagnosing prematurity, since they may not correspond to gestational age. Premature babies often weigh more than 2500 g at birth.

Currently, there are no degrees of prematurity. When formulating a diagnosis, the gestational age (in days or weeks) and the nature of body weight at birth (low - 2499-1500 g, very low - 1499-1000 g, extremely (extremely) low - 999-500 g) are indicated.

Assessment of indicators of physical development.

Assessment of indicators of physical development of premature, full-term and post-term infants is carried out using percentage tables or average statistical indicators (stigmal deviations). Such parameters of physical development as weight and length of the body, circumference of the head, chest, and abdomen are evaluated.

Assessment of the degree of morphological and functional maturity. The maturity of a newborn child is determined by the totality of morphological (clinical) and functional signs in relation to gestational age.

Maturity is understood as the readiness of the organs and systems of the child to ensure its extrauterine existence.

A healthy full-term baby is considered mature, in which the morphological and functional state of organs and systems corresponds to his gestational age. All premature babies are immature compared to term babies. At the same time, they may be functionally mature enough for their gestational age, but their organs and systems are unable to ensure existence in extrauterine life. There may also be immature infants among full-term newborns. These are children whose morphological and functional maturity is below their gestational age. Gestational age is determined by obstetricians-gynecologists during an objective examination of a pregnant woman (fetal movement, height of the fundus of the uterus, term last menstrual period, ultrasound diagnostics).

The degree of morphological maturity of the baby is determined by a set of external signs:

body proportions, the density of the bones of the skull and the size of the fontanelles, the presence of original lubrication at birth, the development of the mammary glands, the shape of the auricles, the condition of the skin, the performance nail plate nail bed etc.



In 1971, Petruss proposed an assessment table for the degree of maturity, which includes five external morphological features: 1) auricle; 2) the diameter of the areola of the nipples; 3) striation of the feet; 4) external genitalia; 5) skin color (table). Each of these signs is estimated from 0 to 2 points. The resulting score is added to 30. The final result corresponds to the degree of morphological maturity of the newborn child. If it matches the gestational age, then the baby is mature for its gestational age. All premature babies are immature, while they may be functionally mature enough for their gestational age, but incapable of extrauterine life.

Evaluation table of the degree of maturity of the newborn

signs
Leather Red, edematous, red, Pink
thin pasty
Auricle shapeless, Availability solid,
soft curl and off formalized
the absence of anti-
whorl
striation 1-2 lines in the distal 1/2 distal Nearly
stop department department fully
Breast pink dot Diameter Diameter
areola nipple areola nipple
less than 5 mm more than 5 mm
outdoor Testicles in the inguinal Testicles at the entrance testicles in
sexual organs channels into the scrotum scrotum
in boys
outdoor Small genital isometric Large
sexual organs lips predominate big and labia
in girls over the big small genital cover
genital gaping lips small
gaps, hypertrophy
ripped clitoris

The functional maturity of a newborn child is determined by the maturity of vital systems:

CNS - the presence and severity of sucking, swallowing and other reflexes of the neonatal period, the maintenance of one's own body temperature at an adequate temperature regime of the environment;

Respiratory organs - the correct rhythm of breathing, the absence of apnea and cyanosis;

cardiovascular system - the correct rhythm of heart contractions, there is no microcirculation disorder, the normal functioning of other organs and systems

Functional Features premature baby

System Functional Features
Nervous Respiratory Circulatory Digestive Urinary Immune Oppression syndrome: lethargy, drowsiness, weak cry, decreased muscle tone and physiological reflexes; imperfection of thermoregulation Primary atelectasis of the lungs, lability of the frequency and depth of breathing, frequent apnea Heart rate lability, vascular dystonia, noises due to the functioning of fetal communications Decreased food tolerance, increased permeability of the intestinal mucosa Low filtration, reabsorption, concentration and secretory functions Low level of cellular and non-specific protective factors

Features of the course of the neonatal period in premature babies.

Premature babies have features of manifestation of some borderline conditions. The maximum physiological loss of body weight is observed by the 4-7th day of life and can be 5-12%, the restoration of body weight occurs by 2-3 weeks of life. Physiological jaundice may persist for up to 3-4 weeks. The manifestation of a sexual crisis for premature babies is uncharacteristic. Toxic erythema is possible in preterm gestation from 35 to incomplete 37 weeks. The neonatal period in premature babies lasts more than 28 days (up to 1.5-3 months). If a baby was born at 32 weeks gestation, then at 1 month of life, his gestational age will be 32 + 4 = 36 weeks.

The rate of development of premature babies is very high. In most of them, weight and height indicators by the end of the 1st year of life are compared with those of full-term peers, in very premature babies (less than 1500 g) - by 2-3 years. V neuropsychic development by 1.5 years of life, premature babies catch up with full-term peers, provided that they are healthy. It should be borne in mind that in 60-80% of very premature babies there are organic lesions CNS (cerebral palsy, hydrocephalus, schizophrenia, epilepsy), damage to hearing, vision, etc.

Stages of nursing of premature babies.

Nursing of premature babies is carried out in institutions where special conditions are created. It can be 2-stage: maternity hospital - home. Premature infants with a body weight of 2300 (2200) g or more are cared for in 2 stages, whose condition by the time of discharge is satisfactory, infants stably gain weight and maintain body temperature. The discharge of such children from the maternity hospital is carried out on the 7-8th day of life.

Less mature and sick premature babies are nursed according to a 3-stage system: maternity hospital - specialized departments for nursing premature babies - home.

Transfer to specialized departments is carried out on the 3rd day without infectious and acute surgical pathology. The duration of nursing in two stages is from 1 to 3 months.

Care of premature newborns at stage I (maternity hospital):

1) creating an optimal temperature regime. In the children's ward, where premature babies are nursed, it is necessary to maintain a temperature of 24-26 (28) ° C. Body temperature premature newborn should be in the range of 36.4-37.0 ° C. Methods of nursing premature babies - bed, heating pad or incubator. Children born in asphyxia, with a birth injury, with a body weight of 2000 g or less, unable to maintain their own body temperature, with edematous and aspiration syndromes, with respiratory distress syndrome (RDS) II-III stage, in severe conditions are placed in the incubator due to various pathologies of the neonatal period;

2) ensuring rational feeding. Premature babies are breastfed, from a horn, through a tube, parenterally. Indications for feeding through a tube are: regurgitation, slow weight gain, RDS 5 points, mechanical ventilation, extensive congenital defects of the hard and soft palate, low sucking and swallowing reflexes or their absence.

Parenteral nutrition is prescribed for vomiting, a flat or negative weight curve, intestinal paresis, if the residual volume of food before feeding is more than 1 ml / kg, with surgical pathology Gastrointestinal tract, etc. To calculate the amount of food for premature babies when fed from a horn or through a tube, the following formulas are used:

· Romel: (and + 10) x mass, g: 100; 4 for one feeding: 3 x m x p, where m is body weight; and - a day of life. The above formulas are used until the 14th day of life;

Khazanov: from 0 to 2 weeks - 1/7 body weight, g, from 2 to 4 weeks - 1/6 body weight, from 4 weeks - 1/5 body weight, g;

If premature babies are on artificial or mixed feeding, the following infant formulas are recommended: "Robolakt" or "Linolak" in the 1st week of life for premature babies weighing 1500 g or less, with a subsequent transition to adapted mixtures("Prepilti", "Pregumana", "Novolakt-MM", "Enfalakt"). From 1.5-2 months, it is necessary to include sour-milk mixtures (up to 40%) in the diet of premature babies. With a weight of a premature baby of 2000 g or more, the 1st complementary foods are administered 1-2 weeks earlier than for full-term ones; with a weight of less than 1500 g, the first complementary foods are introduced 1-2 months later in relation to their full-term peers. According to WHO recommendations, premature babies under 6 months of age should only be breastfed;

3) prevention of infection. Measures to prevent infection include: compliance with the sanitary and epidemiological regime, giving colostrum in delivery room, sowing on the flora from the external auditory canal, sowing blood and meconium for sterility, feeding with native or breast milk with the addition of lysozyme, prescribing eubiotics. Premature babies with a high risk group for the development of infectious pathology are prescribed antibiotic therapy and immunoglobulin.

human. Change of oxygen tents, nasal catheters, breathing circuits is carried out every 12 hours, incubators - 72 hours.

Tasks of the II stage (specialized department):

1) provision of medical and preventive care; 2) carrying out sanitary and educational work; 3) rehabilitation (medical, orthopedic, speech therapy, social).

Tasks of stage III (polyclinic):

1) clinical examination; 2) rehabilitation; 3) sanitary and educational work.

Medical examination. Examination of a premature baby is carried out within 1 day from the date of discharge. At the 1st month of life, a premature baby is examined by the local pediatrician weekly, 1 time is examined by the head of the department. During the first six months of life, a premature baby is examined twice a month at home. From the 2nd half of the year - once a month in a polyclinic. During dispensary observation an assessment of physical and neuropsychic development is carried out.

Weight gain:

1st month I-II stage - 400 g III-IV stage - 300 g;

2-10th I-II - 700 g III-IV - 600 g;

11-12th month 141 stages - 500 g INU stage - 400 g.

body height:

I quarter 3-5 cm;

II quarter 3-2.5; W-D/quarter 1-1.5cm.

Increase in head circumference: up to 3 months 1.5-2 cm;

from the 4th month no more than 1 cm. Rehabilitation:

maintaining breastfeeding;

4 increase in the immunological reactivity of the body (gymnastics, massage, walks on fresh air, hardening);

prevention of rickets and iron deficiency anemia;

prevention of infections (individual vaccination calendar);

Premature babies are those born between the 28th and 38th weeks of intrauterine development with a body weight of 2500 g or less and a length of 35-45 cm.

What is the weight of a premature baby?

A fetus weighing less than 1000 g, born at a gestational age of less than 28 weeks, is regarded as a miscarriage.

When determining the signs of prematurity, indicators of physical development and gestational age (length of pregnancy) are taken into account, since newborns, premature and full-term, can be born with a body weight that does not correspond to gestational age. For example, body weight may be reduced due to intrauterine malnutrition or intrauterine growth retardation (small children for this period pregnancy), as well as increased, which is observed in those born to mothers, patients diabetes. Given the large range of indicators characterizing prematurity, for practical purposes, the latter is divided into four degrees. The degree of prematurity reflects the maturity of the newborn, the possibility of adapting it to the external environment, the frequency and characteristics of pathology, and the likelihood of survival. So, they make a diagnosis of prematurity:

degree of prematurity - body weight of the child at birth 2500 - 2001

degree of prematurity - body weight of the child at birth 2000-1501

degree of prematurity - body weight of the child at birth 1500-1000 g.

degree of prematurity - body weight of a child at birth up to 1000 g.

Frequency premature birth v different countries varies widely (from 3.1 to 16.6%). There is no downward trend in this indicator. Among prematurely born children, there is the highest morbidity (birth trauma of the central nervous system, sepsis, pneumonia, rickets, anemia, malnutrition) and the highest mortality. Up to 75% of all newborn deaths are premature. Therefore, the priority medical workers in the fight to reduce morbidity and infant mortality is the prevention of prematurity. And in the event of its occurrence, the provision of proper care for premature newborns.

Reasons for the birth of premature babies

The main causes of premature birth of children are as follows:

Socio-biological factors. Parents too young or too old. If advanced age has a negative effect on gestation due to biological changes in the aging body, then the birth of premature babies in young mothers is due to unplanned pregnancies.

Miscarriage is influenced by the low level of parental education and related unhealthy image life during pregnancy and a lack of understanding of the importance of ongoing medical supervision. Among children born to women who were not observed during the entire pregnancy in antenatal clinic, level perinatal mortality higher by 5 times.

play an important role in miscarriage occupational hazards, bad habits, hard physical labor. Negative influence Smoking affects the health of the child not only for the mother, but also for the father. Severe malformations in children from men who smoke for many years and / or smokers a large number of cigarettes occur 2 times more often than in children from non-smoking fathers.

Causes of prematurity in children

The causes of prematurity can be various factors that violate intrauterine development fetus and physiological course of pregnancy. Premature children are often born to mothers with infectious diseases, including latent ones. Premature birth can be caused by mycoplasma infection, cytomegaly, diseases caused by herpes viruses, adenoviruses and other pathogens that pass through the placental barrier, damage the placenta and disrupt its function.

Often preterm birth occurs as a result of severe somatic diseases, vegetative dystonia, anemia of the pregnant woman. Infantilism and anomalies in the development of the female genital area, neuro-endocrine pathology, immunological incompatibility in antigenic systems also predispose to this. Babies are born prematurely multiple pregnancy.

Great importance have previous medical abortions, which cause functional and morphological changes in the endometrium and an increase in uterine contractility, chromosomal aberrations, the age of the pregnant woman and her bad habits, occupational hazards.

Signs of premature newborns

Clinical signs of a premature baby

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

Signs of very premature babies

A very premature baby (weighing less than 1500 g) has the following signs: thin wrinkled skin dark red, abundantly covered with cheese-like grease and fluff (lanugo). Simple erythema lasts up to 2-3 weeks.

The subcutaneous fat layer is not expressed, nipples and areola mammary glands barely noticeable; auricles are flat, shapeless, soft, pressed against 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, the 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 lowered into the scrotum.

Signs of more mature premature babies

In more mature premature babies, the appearance and signs of prematurity are different. Here are their signs: pink skin, no fluff on the face (at birth at the 33rd week of gestation), and later on the trunk. The navel is located slightly higher above the womb, the head is approximately 1/4 of the body length. Babies born at more than 34 weeks' gestation show the first curves at the auricles, the nipples and areola are more visible, in boys the testicles are located at the entrance to the scrotum, in girls the genital slit is almost closed.

Premature babies are characterized by such signs as muscle hypotonia, decreased physiological reflexes, decreased motor activity, impaired thermoregulation, and a weak cry. A deeply premature baby (less than the 30th week of gestation) lies with outstretched arms and legs, sucking, swallowing and other reflexes are absent or weakly expressed. Body temperature is unstable (it can drop to 32-34 ° C and rises easily). At birth after the 30th week of gestation, a premature baby is found to have partial flexion of the legs at the knee and hip joints; sucking reflex is good.

In a child born at a period of 36-37 weeks. gestation, flexion of the limbs is complete, but unstable, a distinct grasping reflex. A premature baby in the first 2-3 weeks of life may have a non-permanent tremor, non-rough and non-permanent strabismus, horizontal nystagmus with a change in body position.

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

Peculiarities internal organs in premature babies

Morphological and functional immaturity of the internal organs is also in line with the degree of prematurity and is especially pronounced in very preterm infants.

Breathing in premature babies is superficial 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 at less than 35 weeks of gestation, the formation of surfactant is impaired, which prevents the collapse of the alveoli on exhalation. They develop SDR more easily.

Heart rate in premature babies is characterized by high lability (from 100 to 180 per minute), vascular tone is reduced, systolic blood pressure does not exceed 6070 mm Hg. Increased permeability vascular walls can lead to cerebrovascular accident and cerebral hemorrhage.

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

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

In preterm infants, there is no relationship between the intensity of jaundice and the degree of transient hyperbilirubinemia, which often leads to an underestimation of the latter. The immaturity of the liver and the associated insufficient activity of the enzyme glucuronyl transferase, increased permeability of the blood-brain barrier (BBB), as well as the 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 studies of a premature baby

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 ones, 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 indicators change at a faster pace than in full-term ones, and at the age of 6-8 weeks, a typical deviation in the hemogram appears for premature babies - early anemia of prematurity. The leading cause of anemia is considered to be low production of erythropoietin.

Features of the development of premature babies

Physical development is characterized by a higher rate of increase in body weight and length during the first year of life. The lower the body weight and length of a premature baby at birth, the more intense the increase in these indicators during the year. By the end of the first year of life, the body weight of a premature baby increases as follows:

with a newborn weighing 800-1000 g - 8-10 times

"" "" 1001 - 1500 g "6-7"

"" "" 1501-2000 "5-7"

"" "" 2001-2500 "4-5"

In the same age period, the growth of a premature baby is 65–75 cm, i.e., it increases by 30–35 cm.

Body weight increases unevenly. The first month of life is the most difficult period of adaptation, especially for a very premature baby. His initial body weight decreases (for a full-term one by 5-7%); recovery is slow: in preterm infants with signs of III-IV degree, body weight often reaches the initial figures only by the end of the 1st month of life and begins to increase more intensively from the 2nd month.

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 in terms of body weight and height. In the future, in children born prematurely, asthenia and infantility are more often observed, but a number of children have indicators of physical development corresponding to full-term peers.

Children with II - III degree of 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 their full-term peers and catch up with them during the 2nd year of life (children with 1 degree of prematurity to end of year 1).

What does a premature baby look like?

Eyes. If your baby was born before the 26th week of pregnancy, his eyes may be tightly closed.

Genitals. Your child may have underdeveloped genitals. In boys, this will show up in the presence of testicles; in girls, that the labia majora (the outer labia of the vulva) will not be large enough to cover the labia minora (the inner labia of the vulva) and the clitoris, and a patch of skin may be visible from the vagina (don't worry, it will disappear over time) .

Extreme thinness. Your premature baby may look shriveled and skinny because his body lacks the layers of fat that usually accumulate towards the end of pregnancy (after 30-32 weeks). When he starts to gain weight, this fat will appear, and he will begin to look more like a normal full-term baby.

Transparent skin. Accumulations of fat also affect the skin color of a premature baby. Veins and arteries are clearly visible through the skin, and the skin has a pinkish-purple hue regardless of the child's race. (This is because skin pigmentation usually appears after the eighth month of pregnancy.)

Lack of hair. Severely premature babies may not have any body hair at all, except for a soft fluff. On the other hand, babies who were not born much prematurely may be covered - with a thin fluff that covers the body. This down can be especially abundant on the back, upper arms, and shoulders.

Lack of nipples. Usually, nipples appear after the 34th week of pregnancy, so your baby may not have nipples if he was born before this time. However, some babies have fully formed circles, the dark circles that usually surround the nipples.

Low muscle tone. Premature babies are less able to control their bodies than full-term babies. If you put the child on his back), his limbs may tremble or sag. Severely premature babies sometimes hardly move at all: their movements are limited to slight stretching or clenching of fists. Babies who are born before the 35th week of pregnancy may lack the muscle tone needed to assume the fetal position that is common for full-term babies.

Underdeveloped lungs. Premature babies have more breathing problems than full-term babies because their lungs aren't fully developed. Fortunately, as a baby's lungs mature, they can continue to develop outside of the mother's uterus.

Comment: If your baby is born between the 22nd and 25th weeks of pregnancy, you should be prepared for the fact that he will look more like a fetus in the womb than normal newborn. His eyes may still be tightly closed, his skin may look shiny, translucent, and too tender to touch. His ears may be soft and folded in places where the cartilage has not yet hardened. You will notice how much your baby will change in the coming weeks, how his skin will become thicker and how his eyes will open for the first time. He will begin to resemble a normal newborn.

Assessing the Development of Premature Babies

When analyzing the development of a premature infant in the first year of life, the period of prematurity is subtracted from the age of the child (if the period of prematurity is 2 months, then the development of a 7-month-old child is estimated as 5-month-old). When assessing the development of a premature child of the second year of life, half of the prematurity period is subtracted from the child's age (if the period of prematurity is 2 months, then the development of a 14-month-old child is estimated as 13-month-old). After a premature baby reaches the age of 2 years, its development is assessed without adjusting for prematurity.

Let's find out how the development of premature babies is assessed.

Signs of speech impairment and delayed language development in children preschool age

  • 6 months - does not respond or responds inadequately to sound or voice;
  • 9 months - does not respond to the name;
  • 12 months - cessation of babbling or no babbling at all;
  • 15 months - does not understand the words "no" and "bye-bye", does not respond to them;
  • 18 months - does not pronounce other words, except for "mom" and "dad";
  • 2 years - does not make two-word phrases;
  • after 2 years - still uses "childish" jargon and imitates sounds excessively;
  • 2.5 years - the child's speech is incomprehensible even to family members;
  • 3 years - does not amount to simple sentences;
  • 3.5 years - the child's speech is understandable only to family members;
  • 4 years - persistent articulation errors (in addition to the sounds R, S, L, W);
  • 5 years - has difficulty compiling structured sentences;
  • after 5 years - a noticeable permanent violation of the fluency of speech (stuttering);
  • 6 years - Unusual shyness, permutation of words, difficulty finding the right words when talking.

At any age - monotony of pronounced sounds or hoarseness of voice.

Signs of impaired cognitive function

  • 2-3 months - does not show much interest in relation to the mother;
  • 6-7 months - does not turn his head towards the fallen object;
  • 8-9 months - does not show interest when they try to play hide and seek with him;
  • 12 months - does not look for a hidden object;
  • 15-18 months - does not show interest in cause-and-effect games;
  • 2 years - does not divide surrounding objects into categories (for example, animals are one thing, cars are another);
  • 3 years - does not know his full name;
  • 4 years - can't tell which of the two lines is shorter and which is longer;
  • 4.5 years - does not know how to consistently count;
  • 5 years - does not know the names of letters, colors of objects;
  • 5.5 years - does not know the date of his birth and home address.

Caring for premature newborns

Features of feeding and care

Feeding premature babies has significant features. These features are due to the increased need for nutrients due to intensive physical development, as well as morphological and functional immaturity of the gastrointestinal tract, requiring careful introduction of food.

The beginning of feeding a child is determined by the state and degree of his prematurity. The method of feeding is determined depending on the severity of the condition.

With I degree of prematurity, a child can begin to feed with breast milk or its substitutes after 6-9 hours, with II degree - after 9-12 hours, with III degree- after 12-18 hours, the fetus - after 24 - 36 hours. During this period, 5% glucose solution is injected in 3 - 5 ml every 2-3 hours. Longer "starvation" is undesirable, as it leads to hypoglycemia, hyperbilirubinemia, hypoproteinemia , enhances metabolic acidosis.

Children with III-IV degree prematurity, as well as all premature infants with respiratory distress syndrome, asphyxia, a weak sucking reflex, receive breast milk through a gastric tube, permanent or disposable (the permanent tube is changed every 3-4 days for sterilization and prevention of bedsores). In a satisfactory general condition and sufficiently pronounced sucking reflex feeding the first 3 - 4 days is done through the nipple. Before this period, it is not advisable to apply to the breast, since breastfeeding is difficult. physical activity and secondary asphyxia or intracranial hemorrhage may occur.

Premature babies weighing less than 1500 g are applied to the breast from the 3rd week of life. Nutrition calculations are made in accordance with the need of the child's body per 1 kg of body weight per day: 1-2nd day of life - 30 kcal, 3rd day - 35 kcal, 4th day - 40 kcal and then daily 10 kcal more up to 10th day; on the 14th day - 120, from the 21st day - 140 kcal. During the care of premature newborns and when determining the amount of nutrition, the individual characteristics of the newborn should be taken into account: very premature babies from the 2nd month of life sometimes absorb the amount of breast milk corresponding to 150-180 kcal / kg. Most preterm infants, being breastfed, develop well.

Children with insufficient weight gain at the end of the 1st month are sometimes prescribed a concentrated supplement in the form of cottage cheese, whole kefir with 5% sugar. In addition, most preterm infants receive parenteral solutions of glucose and albumin. From the 2nd month of life, instead of drinking, they give vegetable broth, as well as fruit and vegetable juices. Instead of breast milk during nursing premature baby milk mixtures can be used.

Care of premature babies

Nursing of premature babies is carried out in 2 stages: maternity hospital and in a specialized neonatal unit. Then the child comes under the supervision of the clinic. In the maternity hospital, mucus is aspirated from the upper respiratory tract in order to prevent aspiration from the upper respiratory tract. In the first days and weeks of life, very premature babies or premature babies in serious condition contained in cuveuses ("incubators"). They maintain a temperature of 30 to 35 ° C (taking into account individual characteristics child), humidity on the first day up to 90%, and then up to 60 - 55%, oxygen concentration is about 30%. The body temperature of a premature baby can also be maintained in a heated crib or using heating pads in a regular crib. Optimum temperature the air in the room should be about 24 C.

Oxygen therapy is carried out, correction of the balance of acids and bases by introducing glucose solutions with ascorbic acid and cocarboxylase. The elimination of hypoglycemia, hypoproteinemia is provided with the help of glucose and albumin solutions. In case of urgent need, plasma transfusions and blood transfusions are carried out.

Most babies with grade III-IV prematurity receive antibiotics during nursing. The indications for their appointment are the severe general condition of the child, purulent-inflammatory diseases in the mother, premature effusion amniotic fluid, childbirth outside a medical facility.

What should be the care of a premature baby?

The main features of the body of a premature baby are very poor thermoregulation and shallow breathing. The first can lead to a drop in the child's body temperature to 35 degrees or a rise to 40, the second to oxygen starvation or even respiratory arrest.

As soon as the doctors decide that the baby's condition is satisfactory, the mother and baby are discharged home, having previously provided important instructions on hygiene, clothing, walking and bathing the premature baby.

It is very important to protect such a child from people who are carriers colds, ARI and SARS. For premature babies, both overheating and hypothermia are vitally dangerous. The temperature in the room where the child is located should not fall below 22 degrees, under the covers - at least 33 degrees. The temperature of the water for bathing should be higher than for a full-term baby (not lower than 38 degrees), while the bathroom should also be warm enough - not lower than 24 degrees.

From the foregoing, it is clear that caring for a premature baby includes constant monitoring of his body temperature. He needs warmer clothes than his full-term counterpart. It is very important to constantly change the air in the room, while airing it is worth taking the child out of the room.

The child is gaining weight

As soon as the weight of the child exceeds three kilograms, it can be taken out for walks. You should not go outside if the air temperature in the street is below minus 5 - for a child up to a month, below minus 10 - for a child up to a year. Walks should be started from 5-10 minutes, and gradually increase the walk time to 2-3 hours (leave immediately after feeding and walk until the next feeding).

Another problem is that the baby simply cannot suckle at the breast, and therefore is forced to eat from a bottle (and sometimes there is no strength for this). As soon as the child is strong enough to suckle, you should completely switch to breastfeeding. This will help you get faster desired weight and catch up with peers in development.

Only 8-10% of premature babies are discharged home from the maternity hospital - these are healthy children with a birth weight of more than 2000 g. The rest are transferred to specialized institutions for the second stage of nursing. In these institutions, children receive necessary treatment, hygienic baths, they are prevented from rickets and anemia. The complex of therapeutic measures includes massage and gymnastics. A healthy premature baby can be discharged home when he reaches a body weight of more than 2000 g, its positive dynamics and a good sucking reflex.

Proper development premature babies are facilitated by timely care for a premature newborn, a favorable home environment, individual sessions, games, massage and gymnastics, balanced diet.

Long-term consequences prematurity

Children born prematurely usually grow up healthy and become full members of society. It is known that I. Newton, Voltaire, Rousseau, Napoleon, C. Darwin, Anna Pavlova were born prematurely. However, among such a contingent of children, the percentage of mentally and physically handicapped children is higher than among those born on time. Severe neuropsychiatric disorders in the form of cerebral palsy, intellectual decline, hearing and vision impairment, epileptic seizures are observed in 13-27% of prematurely born. These indicators are especially high in the group of those born very prematurely, among them later restless children suffering from uncertainty, night terrors are more often observed. In preterm births, a disproportionate development of the skeleton is more often noted, mainly with a deviation towards asthenia.

In recent years, doctors of various specialties have been studying the developmental features of children born prematurely. It has been established that in women who were born very preterm, violations are more often observed menstrual cycle, defective generative function, signs of sexual infantilism, threatened miscarriage and premature birth.

Prevention of premature birth of children includes:

  • Protecting the health of the expectant mother from the very early childhood;
  • Prevention of medical abortions, especially in women with menstrual disorders and neuroendocrine diseases;
  • Creation of favorable conditions for a pregnant woman in the family and at work;
  • Timely detection of pregnant women with the threat of preterm birth and monitoring the course of pregnancy in them.