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How to care for premature newborn. Bathing of premature babies. Development by month

By barely learning about pregnancy, we can already calculate the estimated date of the appearance of your baby. But sometimes it happens that the baby is in a hurry to be born. Why is this happening? What awaits the baby, not yet quite ready for a new world for him? How to help him adapt?

Causes of premature birth

Here are the most frequent causes of premature births:

1. First of all, infection. Any inflammatory process makes the wall of the uterus defective, so the pregnancy continues until the uterus wall can be stretched, and then the body is trying to get rid of the embryo.
2. Eastic-cervical insufficiency, that is, the inferiority of the muscular layer of the cervix, holding the fruit inside.
3. Endocrinopathy - non-abrupt disorders of the function glands of the inner secretion - thyroid gland, adrenal glands, ovaries, pituitary glands (with gross violations of a woman, as a rule, cannot become pregnant at all on their own).
4. Coloring the uterus caused by multiple pregnancy, multi-way, large fruit.
5. Acute infectious disease (influenza, ORZ, angina, pyelonephritis, especially with an increase in body temperature, etc.)
6. Toxicosis of various severity, especially nephropathy.
7. Incorrect or insufficient nutrition (deficiency of vitamins A, C, E).
8. Chronic diseases (hypertension, diabetes mellitus, hormonal disorders, heart and kidney disease).
9. Heavy physical work, chronic stressful situation at work or at home, injury during pregnancy.
10. Using the future mom of alcohol, nicotine and narcotic drugs.
11. Risk factors also include the age of a future mother less than 18 or more than 35 years.

4 degree of presence are isolated:

I. The weight of the kid 2000-2500g, the growth is 36-37 cm.
II. The weight of the kid is 1500-2000g, the growth is 32-35 cm.
III. The weight of the kid 1000-1500g, the growth is 31-28 cm.
IV. The weight of the kid is less than 1000g, height is less than 28 cm.

Just 15 years ago, there were practically no chance of such kids. At that time, the newborn with a weight of less than 1000g was considered miscarriage and no one struggled for his life. Nowadays, thanks to the purchase of the latest equipment and trained professionals, "Children-Toropups" appeared a significant chance to survive. In order to exit the baby, it is necessary to make up the maximum of professional knowledge and forces from a qualified medical staff. We are also important for patience and faith from parents of Baby, because he was not yet ready for the emergence of the world.

Physiological and psychological features of premature

For the first time for the first time after childbirth, the premature babies can notice the external differences from the children born on time. It is not necessary to scare this, you just need to remember that this is all temporary and soon your baby, to the end formed, will become the most beautiful lump of happiness. In the meantime, his skin is thin, wrung and seems transparent, because there is no subcutaneous fat, but the time will pass, the baby will get in weight, and will not differ from the rest of the children. He can have a light gun, not only on the back and shoulder, but even on the face and other parts of the body, this is also a temporary phenomenon. The size of the head may seem overly large compared to handles and legs. The ears are still completely soft, they can be frozen or tightly lay down to the head. And the palms and foot are absolutely smooth, as doctors say - without allocated. The activity of the kid is reduced, the muscle tone and reflexes are not well developed.

It is only external differences that will disappear over time, but there are other differences that carry a threat to another rapid child, namely:

1. Respiratory system. At the ended healthy child with the first cry, lungs straightened and remain in such a state, the premature babe they straightened harder, and sometimes straightening, decay again. In this regard, their breathing is uneven, superficial, sometimes not capable of providing the body with a sufficient amount of oxygen. There are often congestive phenomena, which can lead to respiratory disorders and lung diseases, for example, pneumonia. Therefore, for the prevention of stagnant phenomena, it is necessary to take a child to the hands and change the positions during sleep.

2. Thermoregulation. Due to the unfinished formation of the body, the baby does not have a subcutaneous fat layer, therefore, such children are quickly overheated, but also quickly cooled. Depending on the degree of presence, various options for maintaining the optimal temperature for the baby are used. At the first and second degree of prematurity, heights, additional clothes and blankets, at the third and fourth degree of presence of kids are placed in a special cuvez, where the optimal microclimate, both temperature and humidity, is created. There he can dwell from four days to several weeks.

3. Digestive system. Due to the weakly developed muscle, which squeezes the entrance to the stomach in the baby, frequent joins are possible. And frequent bloatings occur due to the recently formed muscles of the stomach walls. The loss of the intestines and the still weak abdominal muscles often lead to poor gases in a natural way, while tensile tummy tummy occurs, causing pain. Through the diaphragm, it takes up upwards of the lower lungs, which prevents normal breathing. The intestinal walls have an increased permeability, so the kid easily absorbs any microbes and toxins. Not quite formed liver does not cope with the "Justice Newborn", which can hold over to the month.

4. The nervous system is also not fully formed and makes itself felt. The baby sleeps for a long time, then a few hours awake. Cramps may occur. Krochu reacts with a sharp plan for switching on light, an unexpected knock or a loud conversation.

5. Due to all these factors, the baby has very weak immunity. It is predisposed to intestinal and respiratory infections, otita.

As a rule, the baby separately from the mother for several months is in the hospital under the permanent control of the medical staff. But during this period, the presence of the mother is very important for him. It is necessary that he at least a few minutes or hours a day felt your warmth, love and care.

We are together - "Mom Plus Child"

For the normal development of a premature child and a close relationship between mom and baby, children's psychologists advise the so-called Kangaroo method. It lies in the constant corporal contact of the mother and the child, of course, if there is no heavy complications with health from the kid.

The baby's premature babe put your mother on the stomach or chest and cover with a blanket, so he spends most of the time. The baby feels Mamino's heartbeat and respiratory rhythm, feels its smell and, as it may return to the usual conditions of the intrauterine stay. And Mamino warmly helps the baby do not waste additional energy to warm up. This method is good not only to maintain the toddler body temperature, reducing the risk of infection with infections, but also for the overall development of the baby. Its heart works better, breathing becomes calmer and smooth, a good sleep and activity during wakefulness are being built. He recruits faster in weight and earlier ready for discharge. And moms have more active milk generation.

During his stay in the hospital, Mom should not forget to dechat the milk. According to the observations of the doctors, those of the kids who received released milk were faster on the amendment and added in weight, because it provides the best protection against infection and contains a plurality of vitamins and nutrients, so necessary to a small organism.

Feeding our kid

When the crumb will be able to suck the chest independently, it will be necessary to provide him as comfortable conditions, for example:

1. Because of the weak muscles, the baby is difficult to keep the nipple in the mouth. The most efficient position for feeding will be the so-called, in which the child is easier to capture the nipple. The position of the "cradle" is also convenient: the crumb is located along the mother's forearm, and her hand supports her shoulders.
2. It happens that, because of another imperfect regulation of breathing and swallowing and low muscular tone in children, there is a swallowing of air, while they begin to choke and cough. To prevent this, take the position of the middle trip, rejected back and putting several pillows for convenience. In this position, the head of milk will be reduced and the kid itself will be able to adjust its stream.
3. Since the crumbs have not yet developed special sucking structures, namely the ribbies in the sky and fat pads on the cheeks, the mother can use the "Dancer's Hand" method. He lies in maintaining the mother's hand of cheeks and the chin's chin (a child's cheeks hold big and index fingers, the middle-chin, and the two remaining chest adheres to). With this feeding, the baby will not get sick so often from the nipple.
When the kid's body is finally formed and he will strengthen, he is discharged home, where all the concern and responsibility goes to her parents. At home, the premature babe requires much attention and especially careful care.

Several important moments for care for premature at home

1. There should be no drafts in the house. The optimal temperature in the room is 22-25 degrees of heat. The baby should wear warm and soft linen, and then wrapping in a bike knob, while it is necessary to constantly control the temperature under the blanket, the thermometer should show 30-33 degrees, while the temperature of the kid itself should be 36.5-36.6.6 degrees. In the future, the temperature in the room can be reduced to 20 degrees. If the body temperature in crumbs is poorly held, it should be placed in the bed wrapped in a diaper heating, placing at a safe distance from the kid. There should be an obligatory, while the child should be taken out of the room. It is also necessary to take care of maintaining normal humidity in the room, as dryness and dampness are destructive on the health of the kid.

2. Feeding and sleep premature babies depends on the degree of their prematurity. When I and II degrees of crumbs under the age of two months should be breeding 7 times a day, and there should be 4 day sleep for 2-2.5 hours each; from two to five months should be fed 6 times a day, while 3 day sleep for 2 hours each; And from five months to a year to feed 5 times a day, with 3 day sleep for 1.5-2 hours.
With III and IV degrees, kids up to three months should be breeding 7 times a day, with 4 day sleep for 2.5 hours; From three to six months, feeding occurs 6 times a day, with 3 day sleep for 2.5 hours; From six months before a year, crumbling five-volume foods, 3 day sleep for 2.15 hours.

3. Bathing babies born with weight of less than 1.8 kg, in the first three weeks after discharge is not recommended. If he was born with weight more than 1.8 kg, then the first bathing can be carried out on the seventh day after the discharge. The water temperature must be 38 degrees. In the first three months, water for swimming should be boiled. It is necessary to constantly monitor the water temperature, for this it is necessary to purchase a special thermometer to control the temperature, it is also necessary to prepare water for rinsing and hot water, which can be added as needed. The temperature in the room should not be very different from the temperature in the bathroom. It is advisable not to carry the baby immediately into the room, open the door of the bathroom and give the crumb to smoothly go from one thermal mode to another.

4. Walks for "special" babes are dangerous primarily by a sharp change of temperature, so in the first month it is better to do the air ventilation. From the second month, the walks should be started from 5-10 minutes, while the air temperature on the street must be at least +25 degrees, gradually increasing the duration of staying in the fresh air to 2-3 hours a day. At a minus temperature, the walk is not recommended.

5. In premature kids, with whom they were engaged in gymnastics and massage, respiratory viral infections were less common, muscular tone normalized faster, an emotional state improved. While the kid has muscle hypertension, stroking is allowed, which is very useful for crumbs, as it helps to relax muscles. So, in the first month, a gentle massage is performed - stroking. With 1.5-2 months, massage can be combined with gymnastics, which will contribute to motor skills. In three or four months, the crumb can be encouraged to turn over from one side to another. From four to five months, start learning the crumb to consciously reach to toys and take them into hand. In five to six months, begin to encourage the baby to actively crawl. If a child in seven or eight months already holds a straight back, then you can begin to encourage him to seat and standing. From the nine-ten months, the baby may already be up with the help of a support and, holding it for her, get up and try to walk. In the year, start learning independent walking.

Very important at the massage session not only physical contact, but also psychological. Communicate with your baby, affectionately talk to him, sneak him.

For premature babies, to seven years there is a dispensary observation at the place of residence. Periodic consultations of the neuropathologist and other specialists are required. And in the first two weeks of life, the prevention of Rakhit is necessarily carried out.

Do not worry that your special crocha in the first year of life is lagging behind in the development of docking babies. By two years, this difference will disappear. It is possible that over time it will become no less famous than the French commander Napoleon Bonaparte, English poet Byron, physicist and mathematician Isaac Newton, or Russian Chemist Dmitry Mendeleev and the commander Alexander Suvorov.

+

2. The body of the body is at least 45 cm.

5. Hyperthonus muscles.

9.To proportionately.

2. Rhythmic breathing.

scale apg . Scale apg

Cardiac activity;

Breath;

Muscular tone;

Reflexes;

Skin painting.

Well expressed 2 points;

Not enough 1 point;

There is no 0 points.

Features of organs and systems.

The cardiovascular system.

Extractuous blood circulation is installed, two circle circles begin to function. Battles are closed duct, oval window, Aranians duct (residues of navel vessels). The heart is relatively large and occupies 0.8% of the body weight. The frequency of heartbreaks in a newborn 120-140 beats per minute.

Respiratory system.

Empty breathing is installed. Lights are not enough formed.

The interstitial fabric is loose, contains little elastic fibers, rich in vessels and fiber. The newborn often arises emphysema and atelectase. The tendency to the atelectasam is enhanced due to a shortage of a surfactant (a surfactant coating the inner surface of the alveoli and prevents them in exhalation).

Breathing in newborns superficial and frequent. Frequency of breathing per minute 40-60. Characterized arrhythmia. Inhaling shorter exhalation. Sometimes breathing can be intermittent (imperfect respiratory center). Abdominal breathing type.

Leather.

The skin is smooth, velvety, blood vessels are wide, easily permeable.

Protective function It is not well developed, the skin is easily raw, is easily infected, often the entrance gate of infection.

Thermoregulatory function is imperfect . Children easily overheat or transferred. Sweet glands do not function (the immaturity of the sweating center).

The respiratory function is well developed.

Vitamin-forming function.

To perform this feature, it is necessary to observe the mode of the day with a sufficient stay in the air (vitamin D) is formed under the action of UFO.

The skin is covered with primary lubrication, which includes the secret of sebaceous glands. The hair is well developed, but by 6-8 weeks they fall out. The subcutaneous fat layer is uniformly developed.

Muscular system.

The tone of the flexors prevails over the tone of the extensors.

Bone system.

The skeleton base is cartilaginous fabric. The head relative to large sizes is ¼ of body lengths. The brain department is more developed than facial. The seams are easily told. Small spring has a triangular shape, is between dark and occipient bones. Large spring has a diamond shape, located between the frontal and dark bones. Closes by 12-16 months of life. Spine straight.

Urinary system.

The kidneys are relatively more than adults. Lohanks and ureters are wide, walls are hypotonic. The bladder is located higher than in adults (at the level of the navel in the filled state). Capacity 50 ml. The urethra of the boys 5-6 cm, in girls 1-1.5 cm. Reabsorption, secretion and diffusion processes are imperfect, therefore the possibility to concentrate urine in newborns is limited. In the first days, the child highlights 10-20 ml. urine, the amount of urination is 4-6 times. Then quantity is 20-25 times a day in the first month of life. The urine reaction sharply acidic, relative density is 1003-1005.

Blood.

Increased hemoglobin and erythrocyte content (ER.6-10x10 / l, hemoglobin 170-240 g / l). 60-80% Fetal hemoglobin. This hemoglobin binds oxygen faster than hemoglobin adults. Color indicator 1.3. Erythrocytes of various sizes (anisocytosis), various colors (polychromatophilia). Increased content of reticulocytes. SE 2-3 mm / h. In the leukocyte formula, neutrophils predominate (60-65%), lymphocytes 16-34%, by 5-6 day neutrophils are compared with lymphocytes (first crosses), by the end of the month the number of neutrophils decreases, and the lymphocytes are increasing. In 5-6 years, their number is again compared (the second crossroads). And after 6 years neutrophils again prevail over lymphocytes.

Physiological (border, transient states).

Mekonia (original feces) -it stands out in the first days of life and is a thick smell thick, a viscous mass of dark-green color. It consists of the discharge of an embryonic digestive tract, epithelium, swallowed sprinkled waters. Later, it becomes more frequent, inhomogeneous consistency and coloring (watery, dark green, with yellow and whitish lumps). Such calories is called transition. After 2-3 days, it becomes crawling and yellow, up to 8 times a day depending on feeding.

Transient, physiological loss of the initial body weight.

In the first 3-4 days of life, all newborns occur the body weight loss and it constitutes 10%, in a premature 12-14%. The mass recovery occurs to 7-10 days of life. In premature, large-scale children -

The reasons:

Malnutrition;

Water loss with urine, with feces;

Swelling;

Drying the umbilical residue.

Need:

Early applying to the chest;

Feeding on demand;

Compliance with the optimal drinking mode.

Transient skin changes.

1)simple erythema -Gypemia of the skin, sometimes with light cyanosis in the area of \u200b\u200bthe brushes and stop. The reason is the expansion of the capillaries of the skin environmental conditions. It keeps from several hours to 2-3 days. The prematurendicable is brighter, it is saved 5-7 days. When erythema is fading, a small or large-perch peeling is noted, especially pronounced in premature babies.

Necessary Lubricate the skin with sterile vegetable oil.

2)toxic erythema.

It occurs in 20-30% of newborns for 2-5 days. Red spots appear on the skin, sometimes with a papule or vesicle, are located on the extensive surface of the limbs, around the joints, on the chest, buttocks, less often on the face, torso. After 2-3 days of rash, the child's condition is not disturbed.

Necessary abundant drinking.

3)transient jaundice.

It is associated with accumulation in the blood and tissues of free bilirubin, which is formed during the decay of fetal hemoglobin. Since a functionally immature liver of a child cannot translate bilirubin to non-toxic shape and allocate from the body, bilirubin stains the skin and sclera into yellow color. Observed in 2/3 newborns. It occurs on 2 day of life and disappears to 7-10 days, prematurely persists 2-3 weeks. The general condition is not violated.

Necessary Abundant drink, activated carbon.

Milia (White Uchri).

There are 60% of newborns on 3-4 days of life. White-yellow-colored nodules of 1-2 mm in size, towering above the skin and are localized on the wings of the nose, bridge, in the forehead, chin. Pass 1-2 weeks without treatment.

Transient hyperthermia.

Increased body temperature up to 39-40 degrees (17%) occurs on 3-4 days of life, it lasts a few hours. Children can be restless. The main reason Insufficient flow of fluid into the body.

Necessary Drink a child, to appoint a doctor to introduce antipyretic means.

Care for newborns.

In the maternity hospital, care is performed by midwife. This work includes:

The first toilet of the newborn;

Anthropometry;

Warding.

In the maternity hospital, a healthy newborn is 2 hours. Then the medical sister of the branch of the newborns comes after the child, the documents (text of the bracelet, medallion, the history of the child's development), notes in the history of development the exact time of the toddle of the baby, its condition and transfers to the children's office. Healthy children are in the ward together with mom.

The following requirements should be performed in the children's office:

The temperature in the ward should be 22-24 gr.;

Before starting work, all medical personnel must take a shower and change daily bathrobe;

Replaceable shoes should wash and wipe away;

The change of masks spend every 4 hours:

It is forbidden to work with long covered with varnish nails.

The work of nurses in the children's office includes:

1.Look the child.

2.Thertyometry (twice a day - in the morning and evening).

3.Antropometry (before the first feed).

4rily newborn toilet.

5. The way for the umbilical cord is the residue and the umbilical wound.

6. Decoration and laying in bed.

7.Vaccination of the BCG and the passage of hepatitis V.

8. Baby children.

Care features.

Premature children are taking into account the physiological features: imperfections of thermoregulation, reduced tolerance (endurance) to food, inclinations to asphisic states, insufficient resistance to infection, immaturity of organs and systems.

When charging premature children, it is necessary to create comfortable microclimatic conditions. Cooling prematurely in Rodzale is often concerned about the whole further care for it. Temperature in the ward must be installed 24- 26 ° C, humidity - 60%. In the early days and weeks of life, deep children or prematurely in serious condition are keen in the clusters. It supports the temperature from 36 ° C to 32 ° C, air humidity in the first day is up to 90%, then 60-55%, the concentration of moisturized oxygen is about 30%: the optimal temperature mode is the mode in which the body temperature can be maintained. Within 36.5-37 ° C and exclude overheating and cooling of the child. OK-sgenation level is selected individually: it is advisable to provide a minimum excess concentration of oxygen, which disappears signs of hypoxemia (canose of skin and mucous membranes, low motor activity, rare breathing with a long apnea, bradycardia). The concentration of oxygen is more than 38% of the kouvez, it is not recommended to create due to the possibility of lung damage, the retina of the eyes and the CNS. The duration of the oxygen supply should be monitored.

Disinfection and change of delices is carried out in 2-3 days. A child who needs a deadline content is shifted into a clean incubator. Translation into the crib is carried out in the absence of respiratory disorders, maintaining a constant body temperature, the ability of a premature child to manage the minimum oxygenation. For additional heating, thermomatrays, thermal protective film, and heels are used. When performing procedures, short-circuit, apply changing tables with heating, lamps of radiant heat ("Amunda"). Children who are leaning in cribs are dressed in dispensers with sewn sleeves.

Special attention should be paid to the observation of the child's condition, control the temperature and humidity of the room, the work parameters and processing of the Kuvez, observe the strictest measures of sanitary and hygienic and anti-epidemic regimes. The security regime is of great importance: restriction of pain irritants, child sleep protection, careful holding of the toilet and manipulations, strict adherence to the order of diagnostic and therapeutic procedures. Mother must fulfill personal hygiene rules and maintain a proper sanitary condition when careing child.

Breeding premature children has a number of features.

They are due to the high need of a child in nutrients, the immaturity of the gastrointestinal tract, requiring cautiously introducing food. Depending on the period of pregnancy, breast milk changes in composition. Therefore, maternal milk is most suitable for the needs of the child and ensures maximum success in sticking. The newborn should receive it, even if the amount of milk is minimal. For stimulation of milk generation, frequent dimming is recommended (at least 8 times a day). In the absence of milk, premature children provide donor milk, in exceptional cases, adapted milk mixtures are used, designed to feed premature children ("Novolact-MM", "Children's MM", "Human O", etc.), as well as "Baby", "Alesa-1", mixtures enriched with biological additives.

The time of the first feeding of the child is determined individually. Depending on gravity; The states are prematched breastfeeding, spoon or from a cup, through the probe. The frequency of food is depends on the method of nutrition, the child's ability to hold in the stomach, milk and sucking activity. Children with a weak sucking and lack of swallowing reflexes are obtained by milk through the gastric probe. Multiplicity of feeding through the probe is usually 7-8 times a day. With prolonged probation feeding with a syringe dispenser or an infusion system, the milk administration time should not exceed 3 hours.

Children with swallowing reflex and weakly pronounced sucking reflex are fed from a spoon or cup. The spoon is filled in part and control so that the milk is poured over the tongue and swallowed without accumulating under the tongue. Feeding from the nipple makes it difficult for breastfeeding in the future.

As it improves. "The general condition and appearance: a sucking reflex of a child applied to the chest. Breastfeeding and close contact with the mother for prematurely is even more important than for children born on time. If the condition allows, it is recommended that as early as possible and more often to lay out a naked child on the mother's chest ("Kangaroo Method") to effectively suck premature and it cannot be reconciled by the milk. Children with active sucking breastfeeding. During breastfeeding, a child should help find the right position and warn the mother that milk should not remain in the oral cavity of the newborn due to the danger of aspiration.

In the case of aspiration, it is necessary to stop feeding immediately, to suck the content from the upper respiratory tract, to give the child with an elevated headboard, ensure the supply of oxygen and inform the doctor.

The amount of food for one feeding in-first day of life is usually 5-10 ml of milk, in the second - 10--15 ml, the third - 15-20 ml. The daily amount of food in the first 10 days of life can be calculated by romelle's formula:

(10 + n) x t: 100, where p -The day of life, t- Mass of a child in grams.

For example, on the 4th day, a child with a mass of 1600 g is a daily amount of milk. (10 + 4) x 16 \u003d\u003d 224 (ml)

Every day, his quantity increases and by the 15th day of life, the daily need of milk is 1/7 mass of the body, by the end of the 1st month - 1/5 of the mass.

The daily amount of food can be determined using the Caloric Method. The need for calories until the 10th day of life is (10 x p) kcal x kg body weight per day where p -number of days of life; By the 15th day - 120 kcal / kg, at the age of 1 month - 140 kcal / kg, by 1 year - 120 kcal / kg. Caloriciness 100 ml of breast milk is 70 kcal (colostrum - 140 kcal). For example, a child at the age of 1 month has a mass of 2500 g and, therefore, needs 350 kcal / day. The daily feed volume is 350 kcal x 100 ml: 70 kcal \u003d 500 ml.

To meet the increased need of premature children in vitamins and mineral salts, it is recommended to be an earlier introduction of corrective additives and. Pringistic.

Homework.

When charging premature babies, it should often air the room,. Maintain the air temperature of 20-22 ° C in the room, when bathing - 22-26 ° C, depending on the maturity of the child. Battle children daily at a water temperature of 38-39 ° C. In the warm season, walks begin immediately after discharge, in the cold - from 1-2 months of age with a body weight of at least 2500-3000 g and air temperature not lower than 1-3 ° C. In a special heating, most premature ceases need to need an end of 1 month. The child needs sparing mode of sleep and wakefulness. Training methods of hardening (air baths, contrast downturn after bathing, etc.) are held in the second half of life. Of the exercise, only stroking and exercises of a reflex character are allowed to disappear from physiological muscular hypertension.

The correct development of premature children contributes to a favorable home furnishings, individual classes, games, rational food, strict observance of the sanitary and hygienic regime.

Organization of nursing care for a dead and premature newborn baby

Healthy newborn baby boy - This is a child born on a pregnancy 40 + 2 week, having external signs of inquiry and functional maturity.

The maturity of the fetus and the newborn is a state that is characterized by the readiness of the organs and systems to ensure its outtitic existence.

External signs of a duddy child:

1. The mass of the body is at least 2500 gr.

2. The body of the body is at least 45 cm.

3. Products of head 34-36 cm and chest 32-34 cm.

4. Rowing smooth, elastic, velvety, brightly pink color.

5. Hyperthonus muscles.

6.Roflexes are alive, well called.

7. Pool hair only on the shoulders and the upper spins.

8. Present ring in the middle point of the body (mid-distance from the sword-shaped process to the navel).

9.To proportionately.

10.Shings of the nose, elastic elastic sinks, hold the form.

11. Large spring is open 2x2 cm, 3x3 cm, in 15% of newborns can be opened by small springs to 0.5 cm.

12. The skulls are closed, dense.

13.Nogti reach the edge of the phalange.

14.yachki omitted in the scrotum in boys, girls have big sex lips cover small lips.

Signs of functional maturity:

1.Cric is loud, demanding, emotional.

2. Rhythmic breathing.

3. Supply to maintain body temperature at the time of inspection.

4. Dulculate motor activity.

Immediately after birth, the child is assessed by scale apg . Scale apg - Ballery system for assessing the condition of the child. It is based on the definition of the most important clinical signs:

Cardiac activity;

Breath;

Muscular tone;

Reflexes;

Skin painting.

Each sign is estimated in points:

Well expressed 2 points;

Not enough 1 point;

There is no 0 points.

An assessment on the Angar scale is carried out at the end of the 1st and 5th minutes of life.

A healthy newborn on the hangar scale is estimated at 8-10 points.


Children, born ahead of time, need special attention and care. Caring for a premature child in the maternity hospital carries out specially trained personnel, and after discharge, the baby is transferred to the hands of his parents. How is the churching of children born before the laid time?

Physiology of premature children

By definition of WHO, children who have previously appeared to the light of the 37th week of pregnancy are considered premature. Such kids are usually born with weight of less than 2500. All organs and systems of premature children are immature, and that is why special care is required for such newborns. All the achievements of modern neonatology are aimed at helping these children to adapt to the existence in the new world.

Physiological features of premature babies

  • Appearance: weakly developed fatty tissue, thin leather, thin guns throughout the body, open springs, soft-eared sinks, underdevelopment of genital organs.
  • Nervous system: underdevelopment of reflexes, weak muscle tone.
  • Respiratory system: Surfactant lack and various respiratory disorders.
  • Cardiovascular system: high frequency of heart development anomalies.
  • Digestive system: enzyme immaturity, poor digestion of food.
  • Bone-muscular system: high risk of displays of hip joints.
  • Thermoregulation: inability to save heat independently.

Department care

Calculation of premature babies is possible since 22 weeks of gestation. Children born after this period have a body weight of more than 500 g and are considered viable. If the baby is born on a period of 22 to 32 weeks, it is transferred to the specialized department for the care of deeply premature children. In the usual maternity hospital there are no conditions for long-term lying in such kids.

In the specialized department, the newborn is in a cuvez, where optimal temperature and humidity are supported. Medical staff is constantly watching the baby's condition. The newborn is powered through the probe. The health status of the baby appreciates neonatologist, oculist, neurologist and other specialists. Such an integrated approach allows to achieve optimal results and prevent the development of complications after premature genera.

Children born on time from 32 to 37 weeks and able to breathe independently, are in the separation of intensive therapy. Here the baby is also in a cuvez, but quite often, next to the baby, his mother can be. If the newborn takes the chest, breastfeeding is allowed.

In recent years, "Kangaroo Method" has been successfully used in many hospitals. The kid spreads out the mother's belly and wonders with warm diapers. Such an approach improves the work of the lungs, lines the breath and heartbeat of the baby and settles the skin of the baby with the maternal microflora. "Kangaroo Method" is recognized in many countries an optimal way to enjoy the premature newborns.

What weight is the little patient home? Usually, the extract occurs when weighing the weight of 2000-2500 g. At the same time, the baby adds consistently in weight, knows how to maintain body temperature and does not have problems with breathing. Such a baby can be at home under the supervision of the precinct pediatrician.

Care home

And the care of it is a difficult topic, talking about which is almost infinite. After the baby is discharged from the hospital, he gets from the hands of caring parents. What needs to be done in order to help the baby adapt to new conditions of existence?

Microclimate

The room where the baby is located, should be fairly light and spacious. Optimal air temperature - 25 ° C. The room must be regularly ventilated. In summer, you can leave windows open throughout the day, provided that drafts are not created.

Some children require additional warming. For this purpose, you can wrapped with cloth. The water temperature in the heating should not exceed 60 ° C. The heights are placed in the legs, as well as on the sides and change every 2 hours.

Do not remove the baby from the bed all the heels at the same time, otherwise the child can freeze.

The optimal humidity for the room is 50-70%. To create favorable conditions, a wet room cleaning should be carried out. It will be useful to purchase a special humidifier. Alternatively, you can arrange the vessels with water vessels or cheer the wet diapers.

Feeding

Calculation of premature babies is impossible without the right nutritional organization. The best food for a premature baby is maternal milk. This product contains all important nutrients, enzymes and antibodies necessary for the normal development of the infant. Even if the baby is on artificial feeding, it is not necessary to completely deprive his breast milk. You can feed the baby from a spoon. With properly organized feeding, the baby must add in weight according to regulations.

Bathing

Children with weight less than 2000 g are not recommended to bathe in the first month of life. Baby skin care is carried out with wet napkins. You can neatly wipe the skin with a cotton swab, moistened in warm water. After all the procedures, it is worth using hypoallergenic moisturizing cream.

Children weighing 2 kg can be bathed in a children's bath. The optimal water temperature is 37-38 ° C. Many experts recommend boiling water before bathing. If you wish, you can add a decoction of chamomile or calendula into the water.

Walk

Walking with the baby you can walk 3-4 weeks of his stay at home. In the summer you should not be on the street in the peak of solar activity (from 11 to 15 hours). In the fall and winter can be walking at a temperature not lower than minus 10 ° C. Winter walks begin with a child's weight 3 kg and are allowed at air temperature not lower than 15 ° frost.

Use for walking quiet places. Avoid places of large cluster of people in the first months of the life of the baby.

The duration of walks should increase gradually. For the first time, it is enough 15 minutes of finding outdoors. With good health, you can gradually increase the duration of walks to 2-3 hours every day.

clothing

Dressing the children who have reached the weight of 2.5 kg, you can also like their diligent peers. It is impossible to connect a baby too much - this can lead to a thermal blow as a result of the immaturity of thermoregulation systems.

Children weighing less than 2.5 kg should be put on a little warmer. 1-2 additional layers of clothing are allowed compared to domestic children. The head and legs of the baby should always be warm. Clothes should be made of natural fabrics and not to cause any anxiety.

Medical observation

Care for a premature child provides for continuous monitoring of the precinct pediatrician. With any deviations in a state of health, it is necessary to consult a doctor. Children, born ahead of time, are sick more often than their diligent peers, so they need special control from all specialists.

Up to 2 years, premature children are registered with the cardiologist, eyepiece and neurologist. According to indications, it may be necessary to help other doctors. The regular passage of ECG and echocardiography is recommended to control the condition of the heart.

Preventive vaccinations premature children are put on individual graphics. Vaccination against tuberculosis is carried out only when the weight is reached 2.5 kg. The question of the rest of vaccinations is solved with a district pediatrician. Vaccination is allowed only with good health of the infant and the absence of serious diseases.

With properly organized care, premature children catch up with their peers in development. Compliance with all the recommendations of the doctor will help adapt the baby to the existence in an unfamiliar world for him and will avoid the emergence of serious health problems.

What is the difference in a premature child from other babies and how to help him "catch up" of his peers?

Premature children

What is a "premature child"? This is not just a kid who was born with insufficient weight.

Prematurity implies primarily the "immaturity" of all organs and systems, the inaptability of the baby to a separate existence of Mom.

According to the criteria of the World Health Organization (WHO), the child who was previously born earlier than 37-38 weeks of pregnancy with a mass mass of less than 2.5 kg is considered premature. Futive mothers worth knowing some anatomy-physiological features of such kids, which will allow to understand some mechanisms for adaptation and child behavior.

Premature children: appearance

The premature child even externally differs significantly from the baby born on time. His skin is thin, dark red, and subcutaneous fat fiber is very weakly expressed or there is no no. This leads to a high risk of traumatization of the skin, so any procedures and manipulations of such a baby should be carried out as careful as possible.

The head of the baby is great relative to the size of the body, the seams between the bones of the skull and the small springs are open, that is, between the bones of the skull and in the field of small springs there are areas that are not closed with bone tissue. Large Spring is small due to the displacement of the bones of the skull. Own sinks are very soft. Nails are thin, do not reach the edges of the nail phalange. Girls have big sex lips cover small, so you can see widely open gender harvester of crimson-red. The boys the testicles have not yet lowered in the scrotum, the scrotum is bright red. The umbilical residue in such children disappears later, about 10 days, and the docking it happens to 5 days of life.

The functioning of all organs and systems of the premature child is also associated with the lack of a certain period of intrauterine development and the peculiarities and the development of the body in the new environment. Due to the immaturity of all organs and systems: the central nervous, cardiovascular, respiratory, digestive, - unfavorable impacts are transferred to premature children especially acute. Consequently, there are no danger of diseases for other kids, prematurely can proceed.

Respiratory system

In premature babies, the respiratory frequency usually exceeds the norm and depends on the degree of presence: the less weight of the child's body, the more often his breathing.

After the discharge of the baby from the hospital or child hospital in order to reduce the likelihood of inflammatory diseases of the respiratory system, you must try to protect it from a large number of contacts with potentially infected relatives and acquaintances, limiting the circle of communication only by family members. To maintain a normal microclimate, it is necessary to air the room where the baby is located, however, not forgetting the favorable temperature mode.

The cardiovascular system

The fetal has a specific circulatory system, which by the time of birth in the docking children is fully formed. Premature children, due to the fact that they were born ahead of time, they may have various abnormalities of the hearts that cause changes in heartlights and worsen the overall condition of the child. Since the cardiovascular system is prematurely reacts to the external stimuli, you need to try to protect the child from sharp and loud sounds, for example, screaming, loud music.

Nervous system

The laying of brain structures occurs at an early stage of intrauterine development. Therefore, even a deeply premature child is born with the formed departments of the nervous system, but the process of maturation of conductive paths has not yet been completed, therefore, nerve pulses are disturbed to various organs and tissues.

In children with damage to the nervous system, motor activity and muscle tone are reduced, weakly expressed or there are no reflexes, a non-permanent fine twitching of the limbs and chin - tremor can be observed.

In addition, the premature children are imperfect thermoregulation mechanisms: they easily give warmly, but it is hard to produce it. In the kids born ahead of time, sweat glands do not function, there is no sweating, as a result of which such children are easily overheated. Therefore, they must be in the most comfortable temperature conditions to avoid both supercooling and overheating. The temperature regime needs to be maintained and after discharge from the clinic, not allowing the supercooling and overheating of the baby.

Given the above features of the nervous system, child neuropathologists carefully observe the premature newborns, and in the clinic these children are prescribed several courses of preventive or therapeutic massage. But mom and herself can do with a premature baby gymnastics and massage with simple techniques, which a pediatrician will teach it; This will help the crumb not only correctly develop physically, but also to establish a psychological contact with mom, which will have a positive effect on the formation of the nervous system.

Digestive system

A number of features have a digestive system of immature children. First of all, this is expressed in the immaturity of the enzyme system. The glands of the gastrointestinal tract do not produce the desired amount of gastric juice and enzymes. When the gastrointestinal tract is seized with microorganisms, even a small number of pathogens in premature bacteries causes the phenomena of dysbiosis - the incorrect relationship between certain microorganisms in the gastrointestinal tract. Also because of the immaturity of the nervous system and the transfer of nerve impulses, the motor, or the motor, the function of the gastrointestinal tract suffers, slows down. As a result, problems arise with food intake in different areas of the stomach and intestines and its elimination.

It must be remembered that the best and necessary food for a premature child is maternal milk. Therefore, in cases where the baby immediately after birth is in the intensive care unit and gets food through a dropper or so weak that it cannot suck the chest, mom needs to take all possible measures to preserve breast milk.

Bone system

Even in deeply premature children by the time of birth, the bone system is formed, but the mineralization of the bones is not yet completed, and in connection with which it is additionally prescribed by calcium and in order to prevent Rakhita, an aqueous solution of vitamin D is additionally introduced.

Often, premature children are born with non-deformed hip joints - dysplasia. The underdevelopment of the joints threatens in the future different violations of the motor function, up to the deprivation of the possibilities independently move. Therefore, it is necessary to diagnose this pathology on time and prescribe treatment. To detect dysplasia, a ultrasound examination of the joints is carried out, which allows you to correctly diagnose. For treatment, depending on the degree of maturity of the joints, either wide swarenia is prescribed, or wearing struts, or - in severe cases - immobilization with gypsum bandages.

Health care

Not all children born earlier than the "official" period will certainly fall into the branches specializing in premature charging. Deciding on the need for the premises of the child born ahead of time to the branch of resuscitation or intensive therapy of newborns, doctors take into account not only its gestational age, i.e. the term of pregnancy on which the baby was born, but also a state of health. If, according to doctors, the state of the newborn does not represent the threats to his life and health, the child is discharged home, providing mom with all the necessary recommendations for the care of it.

If a premature baby requires medical observation, he will have to go through various stages of assistance and adhering.

First stage - children's resuscitation.In the event of a significant immaturity of vital systems, the child immediately falls into the department of children's resuscitation. For each kid there is an artificial ventilation unit of the lungs, which can be used if necessary. In the intensive care unit, children lie in special lines, in which the temperature regime is optimal for this gestational age. All kids are connected to monitors displaying the basic parameters of life. In case of changes in the indicator, for example, heart rate, the monitor begins to issue alarm signals below the permissible norm. Medical personnel immediately records them and provides the child to the child.

Children who are missing or poorly expressed sucking reflex, the first few weeks are used through the nasogastric probe, which is introduced into the stomach through the nasal moves. Then in the probe poured breast milk or milk mixture.

The baby receives the necessary treatment - antibiotics, antiviral drugs, drugs that impede the development of dysbacteriosis, etc. At the same time, diagnosis and treatment of related pathology is carried out, the child is examined by various specialists - an oculist, a neurologist, cardiologist, etc., who are prescribed to him Preventive treatment that prevents the development of terrible complications of prematurity.

Second phase - intensive therapy Newborn. In the resuscitation department, the child is as long as its lungs are capable of independent breathing. As soon as the baby begins to breathe completely itself or if it requires an additional oxygen supply, it is translated into the next stage - to the separation of intensive therapy of newborns. Here, the premature child is also placed in the kouvez, in which it is as long as he can independently maintain the body temperature and do without additional oxygen supply.

Today it is considered proven by the fact that during the hospital stay in a premature child it is necessary to communicate with the mother. The baby must hear mom's voice, feel it warm, which is achieved with the help of the so-called kangaroo method. His essence is that the child is walking around, being in direct contact with the skin of the mother - she has a chest and stomach. Mom puts on a free, unbuttoned in front of clothes, a diaper will be put on the child and sometimes - a hat. The baby is placed between the breasts of the mother, its clothes are fastened to avoid heat loss. The child's temperature is monitored by nurse or monitors. Studies have shown that maternal warmth warms the child well, and its body temperature is maintained at the proper level. Breathing also becomes more correct and stable, as well as heartbeat and blood saturation with oxygen. Moreover, the skin of the kid is settled by the microflora of the mother, which contributes to the processes of recovery. It is possible to switch to this method of sticking, when, with a relatively satisfactory condition, the child still needs artificial thermoregulation and observation of heartbeats and breathing.

Third stage - catamnestic observation. Now in many cities of Russia, the cabins of katamnestic observation of children, born with an extremely low body weight, open. Catamnesis in medicine is called information about the patient collected after the end of the initial observation, in this case, after discharge from the department of intensive therapy or the imposition of premature. In some polyclinics with large edge or regional hospitals, there are caatnase cabinets. A physician working in this office has information about each child born prematurely, receiving treatment in the resuscitation department, the pathology of premature babies. All this is necessary in order to track the health status of the baby, determine the need for its direction to one or another specialist depending on the identified pathology, improve the quality of life of the premature child.

What awaits a baby who "hurried" to be born? The forecast depends on the degree of prematurity. Deep premature children receive treatment and continue to "leaving" in the conditions of the intensive care unit or separation of intensive therapy. If the child was born after 33 weeks and did not suffer in childbirth, he could be discharged home under the supervision of a precipitated pediatrician after 7-10 days.

Do not forget that your child is still not a bit like everyone else, but over time and with your help he will be able to catch up in the development of his peers.

Breast-feeding

Optimal nutrition for premature babe is maternal milk. If for some reason, mom cannot feed the child with breasts, then it needs to preserve lactation as long as possible, because breast milk contains a number of protective factors, including immunoglobulins, vitamins, immunologically active substances, bifidus factor, lactoferrin, Prostaglandins, etc. It is important that class A secretory immunoglobulins present in breast milk provide local protection of the intestinal mucous membranes and prevent the effects of pathogenic bacteria and viruses as well as food allergens. All this, in combination with a balanced vitamin and mineral composition, explains the unique properties of breast milk, making its advantages obvious.

The destination of the first feeding of the premature newborn is determined by its state after birth. Deferred first feeding contributes to an increase in the initial loss of body weight, and can also lead to a number of unwanted pathological conditions. A premature child, born in a relatively satisfactory condition, can get the first feeding after a few minutes after birth (in this case, the baby will squilt a few drops of colosure) or after 4-6 hours. The maximum duration of the "hungry" period after birth in no case should not exceed 24 hours. Sometimes such a long delay in power assignment is necessary if the child moved a pronounced antenatal asphyxia, or intrauterine hypoxia, as well as at suspected of the presence of intracranial hemorrhage, with frequent joins after an attempt to carry out first feeding.

The premature child sleeps a lot and does not feel hunger. It should be fed every 2 hours or at the instructions of the doctor. Feeding such a baby is difficult, sometimes takes a lot of time, as it is bad and sluggish sucks. Mothers need to be patient and attention, but too long to feed the baby with breasts, if it sucks weakly, it should not: it tires the baby. It is necessary to send milk and pectinate the child with satellite breast milk. It should be remembered about the small capacity of the stomach in premature babies. Therefore, in the first days of life, the volume of one feeding can be from 5 ml in 1 day to 15-20 ml per day of life.

As a rule, premature children receiving maternal milk do not need additional administration of vitamins, but there is little vitamin D in breast milk, so it is necessary to pay sufficient attention to the rational nutrition of nursing mothers. It is currently recommended early, for 10-14 days of life, the purpose of vitamin D in the form of an aqueous solution.

Sanitary and hygienic standards

Children's room must be kept in perfect cleanliness, diapers and other underwear should be thoroughly boiled. Even with insignificant at first glance, changes in the state of the child need to immediately contact the doctor. At first, it should be limited to the number of people who want to visit the baby, since premature babies are easily subjected to infections.

Swimming baby

  • Bathing should be started only after the doctor is allowed.
  • Bathing a premature child in the first months is possible only in boiled water. In the bath, the hot water is poured first, and then gradually dilute it with cold to a temperature of 37-38 ° C, but not less than 37 ° C.
  • During swimming over the water, there should be only a child's head. Wash the baby with soap should not be more often 1-2 times a week.
  • After the completion of the procedure, the child is powered by warm water and immediately wrapped in a heated diaper or towel. To wipe the crumb to be very neat, gently, without sipping the skin. Armpits, inguinal area and cervical folds are lubricated with vegetable oil.

Temperature mode

Temperature regime should take into account the imperfection of thermoregulation and the particular danger of cooling the baby. The air temperature in the generic hall must be at least 22-23 ° C. The translation of the premature child from the maternity hospital in the hospital for subsequent adhering can be carried out already in the first hours of life in the absence of obvious contraindications to transportation, such as intracranial hemorrhages, hemolytic disease.

In specialized departments of premature children are placed in the bauxated chambers of 2-3 children in boxing. Children born with a body weight of less than 1500 g, as well as more mature, but severely ill prematurely find out in incubators - Cruise, in which they support, depending on the degree of immaturity and age of the child, the temperature is 32-36 ° C. Relative humidity in incubators during the first week of the child's life is gradually reduced from 90?% To 60-70?%. The duration of the child's stay in the goosezew depends on his individual characteristics. All medical manipulations are carried out if possible in the closet. The position of the child's body is periodically changed by turning it onto another side or on the stomach.

The air temperature in the ward ranges from 24 to 26 ° C, 3-6 times a day are ventilated. In separation of the 2 stage, it is necessary to observe a strict medical and security and sanitary-epi-demiological regime - carry out wet cleaning, quartzing of air, cyclical filling of the chambers. Clear control over the state of health of nursing mothers; Wearing staff and mothers of gauze masks with a shift every 4 hours; Hygienic baths for children who are prescribed individually.

At home, the necessary temperature regime should also be observed. To prevent the child's hypothermation, the temperature in the room should be at least 25 ° C, since with a decrease in the body temperature in a premature baby below 36 ° C, there is a risk of attachment or activation of a hidden flowing infection.

In the crib, where your baby will sleep, you should put the heating pads or bottles with hot water, wrapped them with several layers of the fabric so that the child does not dive. Water must be changed as it is cooled. Measure the temperature and change the premature child, it is necessary to quickly so that the heat loss is minimal.

It is impossible to leave the baby to leave the kid. Daring a premature child should warm. If Kroch was born a few months ahead of time, he needs to cook special clothes: a warm blouse or a hood overalls fit well. The sleeves need to be sewed so that the chick's handles do not freeze.

In the room where the premature baby is located, it is necessary to maintain high air humidity, so that the mucous membranes of the eyes, the mouth and the baby's nose did not swap. You can increase moisture, putting several tanks with water or having wetted wet towels, and it is better to use a special air humidifier that supports constant specified humidity.

Special massage

For premature children, muscle weakness is characterized, and conducting massage courses with a competent specialist makes it possible to improve the condition of the muscular system of the baby. Simple massage techniques after consulting a doctor, parents can do themselves.

Walk mode

Walking with a premature baby follows only in warm weather by the permission of the doctor. If the baby was born in the summer, it should be carried out for a walk only if the temperature on the street is not lower than 24 ° C and there is a windless weather. Walking with the child follows no earlier than he will be 2 weeks. For premature babes born in autumn or spring, walks are allowed not earlier than 1.5 months after birth. The child's body mass should be at least 2.5? Kg, and the air temperature is not lower than 10 ° C. In the winter months, it is not necessary to endure a premature child to the street, as it is not yet able to transfer such a sharp difference in temperatures.

Contact with Mother

Over the past 15 years, Western neonatologists are actively used and promoted the kangaroo method. As already mentioned, this method suggests close communication of the mother and the child according to the principle of "skin to the skin." The child is spreaded by laid out on the naked mother's chest and both are covered with diapers and a warm blanket. This procedure is carried out throughout the hour to several times a day. All the rest of the time the baby is in a goal or maintains the temperature with other heating devices.

If possible, mom is as much time as possible should be with a child. Kroch must hear the voice of the mother, feel its smell, touch. Speak with the baby as often as possible - when feeding it, change the diaper or diaper, make a massage, wash, rans. Sing the lullabies or just songs that you know. I hearing mother's voice, feeling her, the child will understand that mom is near, he is safe and no reason for concern. This will help him accumulate all his strength for the speedy correction.

As perennial observations show, despite all the features described, with good care and proper attention of parents and doctors, premature children are successfully developing and after 1 year catch up with their peers.

A premature child is considered to be a child born earlier than the 38th week of pregnancy, having a body weight of less than 2500 grams, the length of the body is less than 45 centimeters.

The viability of the premature child depends not only on the mass of the body and the deadline for the appearance of the world, but also from the mother's pregnancy flowed.

The premature child appears more weakened if the mother suffers from cardiovascular, gynecological, endocrine diseases, kidney disease, suffered during pregnancy infectious diseases, smoked, saw alcoholic beverages.

The frequency of premature births among smoking women is twice as high as among non-smoking. Smoking causes oxygen starvation of the fetus, slows its growth in such women can be born a premature child.

The first days of life - a critical period for a premature child. As a rule, a premature child requires special conditions, and it is transferred to hospital from the maternity hospital. But here is a child, and you can pick up home. Now it all depends on the care of him!

It is clear that the premature child is more susceptible to any diseases than children born on time. Therefore, it is immediately necessary to protect the baby from contact with adults or children who have at least a hint of cough, runny nose, throat pain.

The highest requirements are presented to the cleanliness of the room - cleaning must be carried out by a wet method, since the dust often happens the carrier of the staphylococcus We use the vacuum cleaner more often, try to remove excess furniture, curtains, curtains from the room, bringing dust.

Do not cool and not overlay!

One of the features of the premature child is the imperfection of thermoregulation mechanisms, such children are very sensitive to cooling, and to overheating. Therefore, in hospitals the weakest, deeply premature babies are keen in special soupes, where constant temperature and humidity are supported.

By the time of statement, thermoregulation is usually settled, but still remains imperfect. The most suitable for the child room temperature is plus 20 - 22 °. Do not be afraid - it is necessary! In the summer you can keep the window open almost all the time, check the room in the winter at least three times a day to 10 - 15 minutes. A child at this time should be taken out of the room.

Gradually teach the child to change temperatures. Bat the baby every day, preferably in the same clock - this is also a hardening procedure. At first, the water should be warm enough (37 °); By the end of the first half of the year, its temperature should be reduced to 36 °, and when the child is six months to 35 °. We need and walks. If the premature child was discharged from the hospital in May - August, it is possible to bring it the next day to the air for 15 to 20 minutes, and, every day, increasing the duration of the walk, bring it within a week to one and a half or two hours 3-4 times in day.

In winter, it is allowed to walk at a temperature not lower than -10 °, in windless days, but provided that the body's mass of the child reached 2800 - 3000 grams. The duration of a walk in the winter to lengthen carefully, gradually: starting from 15 minutes, walk every day for 5 - 10 minutes more, but not more than one hour 2 - 3 times a day.

In the spring and autumn, when the outdoor temperature is above 0 ° and no wind, walks can be started if the baby's body has more than 2500 grams.

How to feed?

Of course, the best food for a premature baby - maternal milk, it provides a growing organism not only with full nutrition, but also in dire protective substances, enzymes, hormones in this situation. But the trouble is that after premature births, some women have hygogalactium - insufficient milk generation. We must try to strengthen it. But if milk is still not enough, you have to translate the child to mixed or artificial feeding.

You can give a premature child a mixture of "Robolt", specially intended for weakened and premature children. A composophil mixture of "Baby" is sufficiently full, the dry milk mixture of the same name, a mixture "Kid". "Children's", Lynolac.

To replenish the diet of the premature baby with vitamins and mineral salts, from three weeks - you begin to give him fruit and vegetable juices (apple, lemon, carrot, blade, black, the first portions of juice - 3 - 4 drops. Every day, add several drops to several times and gradually bring the amount of juice to 30 - 50 milliliters.

From 2 to 3 months, fruit purees should already be given - from a quarter of a teaspoon to one - two spoons 3 - 5 times a day.

The dust of the premature child is recommended from 4 months, and a vegetable puree is preferable as the first dust. If a premature child has no tendency to allergic diathesis, add yellow-boiled eggs in a puree, loss in a small amount of milk. Yeah should be put at first completely crumb, then 1/8, then 1/4 and only gradually bring to half. At the age of 5 - 5.5 months, they add second lures - porridge, buckwheat or oatmeal. These cereals are more complete in their composition than manna.

From 7 months, a premature child is given by a vegetable soup. It can be included in the Menu Menu, and then the rubbed meat minced meat (1 teaspoon per day), by 8 months the child must receive up to 2 tablespoons of the minced meat together with a vegetable puree. By 10 months, meat minced meatballs are replaced by meatballs, they begin to give the child dry cookies, crackers.

Gymnastics, massage, mode.

A premature child appears to be larger, worse than developed than the docking children. To overcome this lag, it is necessary to specifically engage in its physical development.

Complexes of gymnastics and massage a premature child will be appointed in a children's clinic. Their carrying out! And besides, you need to lay out a child before feeding for 2 - 3 minutes on the belly, first - 1 - 2 times a day, and then 3 - 4, this situation strengthens the muscles of the nape, abdomen and limbs, it contributes to the relief of abdominal pain Due to the accumulation of gases, from which the children of the first months of life often suffer.

Premature children are especially predisposed to anemia and rickets. The precinct pediatrician, taking into account such a threat, is usually prescribed preventive tools - vitamin 0, iron preparations. His recommendations must be accurately performed.

The doctor decides both the issue of conducting preventive vaccinations. Children who were born with body weight below 1500. Preventive vaccinations in the first year, as a rule, do not, are transferred to the second year.

With well-organized care and upbringing, the correct mode of the day, the premature child is developing even more intense rates than its diligent peers, as if deficiently missed. Studies of specialists held in recent years have been established that more than half of the deep children whose body has a body at birth within 1000 grams, by 3-5 years, were completely equal to the indicators of physical and mental development with domestic peers. Children with a higher body weight at birth reach normal indicators by year or even earlier, if they have not transferred in a period of newborns or later than any severe diseases.

But this alignment, we repeat once again, is achieved with unrepreneurial parental attention, careful, reasonably gentle, but also a reasonably ordinary and training regime.

G.V. Yatsyk, Doctor of Medical Sciences. S.G. Gribakin, Candidate of Medical Sciences.