Some aspects of the art of nursing premature babies. Premature baby: signs, degrees, causes, nursing, illness. How long do premature babies stay in the hospital, with what weight are they discharged
Often in life there are situations when a child is born prematurely. The baby in this case needs special conditions.
Body weight of premature babies
What is the average weight of a premature newborn?
< 2500 г
- low body weight
< 1500 г
- very low body weight
< 1000 г
– extremely low body weight
A baby born between 22 and 38 weeks of gestation is considered premature. Of course, the longer the gestation period after which the baby is born, the more likely it is that the baby will not have serious health problems and will quickly catch up with his peers. But even if the baby was born much prematurely and with extremely low body weight, doctors will do everything possible to get him out. Now in our country even babies with a body weight of 500 g or more are being nursed.
A newborn who was born on time, a few days after birth, is sent home from the maternity hospital with his mother. But the way home of a premature baby is longer.
Nature provides that the child spends 40 weeks in the mother's womb (plus or minus two weeks). If the baby is born ahead of time, then his organ systems have not yet fully matured; many children are not yet ready for life outside the womb. Therefore, many premature babies immediately after their birth end up in children's intensive care. This is the first stage of nursing premature newborns. Here the baby will be under the constant supervision of doctors.
Immediately after resuscitation, the child is not discharged, but sent to the perinatal center or children's hospital for the second stage of nursing premature babies. As a rule, the baby spends as much time in the hospital as he did not have enough to complete the intrauterine period. So, if a child was born six months old, then under the supervision of doctors in a hospital, he can stay up to three months. The baby is discharged from the hospital when he has fully adapted to the outside world and shows a positive trend.
Many people have a question - what about mom? Where is she while the baby is in the hospital? Firstly, now there are hospitals where mothers can constantly stay with their premature babies. Secondly, even if the hospital does not provide for a permanent joint stay of mother and baby, she can come to the hospital in the morning and stay with the child during the day, and go home at night. It is simply necessary for a child to communicate with his mother, because he is so used to her during those months while he was in her stomach.
How long after birth the baby will spend in the hospital or perinatal center - it depends on the degree of prematurity of the child. Sometimes the baby is re-admitted to the hospital for a while for examination and treatment.
Children born prematurely have an imperfect system of thermoregulation, they have immature respiratory, cardiovascular, nervous and other body systems, so they require special conditions in the first days, and sometimes even weeks. At birth, they are deficient in surfactant, a substance that helps the lungs absorb oxygen. To ensure that children can breathe normally, at birth, doctors must inject them with a surfactant. Some children require artificial lung ventilation (ALV) for a certain time - they cannot breathe on their own yet.
Premature babies are not yet able to maintain normal body temperature - they easily get supercooled and overheated, so special conditions are created for them, similar to those that surrounded the fetus in the mother's stomach: the children are placed in an incubator, where the temperature is maintained at 31-37 ° and remains high humidity.
Nutrition for premature babies
Certain difficulties are observed with the nutrition of premature babies. Of course, the most optimal nutrition for a premature baby is breast milk. It is best absorbed by the body of the crumbs. But direct breastfeeding of such a child can be problematic, because the baby is in the incubator. Therefore, mothers of such babies are advised to express regularly. We must try to save breast milk, because it is extremely useful for premature babies.
If the baby has a sucking reflex, then he can receive mother's milk from a bottle. In the absence of a sucking reflex, feeding of premature babies at first occurs through a tube.
Weight gain and height in preterm infants
- The smallest weight gain in the 1st month, the largest - in the 3rd-4th months.
- Children born with a body weight of 1500-2000 g double their weight by three months, and by the year they increase it by 4-6 times.
- Deeply premature babies double their weight by 2-3 months, and by the year it increases by 6-8 times.
- Body length in the first year of life increases by 27-38 cm, and in the second - by 2-3 cm monthly.
Finally home!
So, the difficult period is over, and your baby was discharged home. Now you will need to take care of the child on your own, but doctors will also monitor the baby's condition from time to time. The very next day after discharge from the hospital, the pediatrician from the district children's clinic will visit the baby. During the first month, the doctor will visit you once a week, then you will go with the baby to the clinic yourself.
At the age of 1 month, the baby needs to be shown to the surgeon, orthopedist, ophthalmologist, laura. Then it will be necessary to visit these specialists 2-3 more times during the first year. You need to go with the baby to a neurologist at the age of 1, 3, 6 and 12 months. Visits to the ophthalmologist are especially important in order not to miss such a disease as retinopathy, which occurs in premature babies. Premature babies require special attention of doctors up to 3 years, and sometimes up to 7. In some cases, children are recommended special classes with psychologists, speech therapists.
Mothers of premature babies are advised to buy electronic scales for newborns - they can be used to track changes in the baby's body weight, which is very important for children born with insufficient weight.
You need to prepare for the fact that the child in the first years of life will have to pay a lot of attention. Babies who are in a hurry to be born benefit from massage, therapeutic exercises, and swimming. In a clinic or hospital, doctors teach the mother how to do gymnastics with the child, what exercises to do. Gymnastics and massage stimulate the development of the crumbs, help the development of new motor skills.
Possible problems of premature babies
Prematurity of the baby and the difficult first months of adaptation - all this can affect the health of the child at an older age.
- Nervous system. If a child was born prematurely, then he still has an immature nervous system. Such babies are easily excitable, cry a lot, they have a delay in neuropsychic development. Many children have decreased or increased muscle tone. But if there is no serious damage to the nervous system, then usually everything returns to normal with time. If the child had any complications, for example, hemorrhages in the ventricles of the brain, then the situation is not so simple. Unfortunately, some premature babies develop cerebral palsy, convulsions, etc.
- Vision. Children require special attention from an ophthalmologist. Very premature babies are at risk of developing retinopathy, a damage to the retina of the eye that can lead to blindness. If the doctor notices changes that threaten vision in time, then the child will need coagulation of the retina.
- Frequent SARS. If the child was on a ventilator, he may develop bronchopulmonary dysplasia, which in the future may be manifested by frequent SARS, bronchitis, pneumonia.
- Disruptions in the digestive system. In those born prematurely in the first months, colic, constipation, dysbacteriosis are more often observed, enzyme deficiency is noted - all this is associated with the immaturity of the gastrointestinal tract, as well as with the still imperfect nervous regulation of the digestive organs. But over time, digestion tends to improve.
- The immune system. Immunity in children born prematurely may be lowered, so they are more susceptible to infectious diseases. Vaccinations for premature babies should be carried out according to a special scheme, which is compiled by an immunologist.
Features of the development of a premature baby
The pace of neuropsychic development of children born prematurely is usually slowed down - babies later than their peers begin to roll over on their stomach, sit down, crawl, walk. The degree of developmental delay depends on the degree of prematurity of the child - the earlier he was born, the longer he will have to catch up with his peers. It is noticed that at 6 months in such children there is usually a jump in psychomotor development.
In the absence of damage to the nervous system, even very premature babies by the age of 2-3 do not differ in terms of the level of psychomotor development from their peers born at term. Comparison in motor development occurs by 18-20 months, in cognitive - by 20 months, in speech - by 24 months. At the same time, many children remain emotionally unstable and easily fatigued.
A premature newborn requires special care and maintenance. None of the organs of a prematurely born baby is able to work properly, so the baby needs due attention from both doctors and parents. These babies have health complications, depending on the gestational age. In this article, we will analyze the question of what kind of care for premature newborns will be correct and complete. 
Babies who were born at 37-38 weeks quickly gain weight and adapt to environmental conditions more quickly. Such babies are born alive and viable. If the baby was born earlier, he is provided with medical supervision in a hospital. More often, babies born at week 26 are placed in an incubator for the further formation of all organs and systems, since he still has no chances for a natural life.
The kids are talking! My son is watching Friday. Shop, hosted by Alexander Molochko.
- Mom, give me milk! Please.
She brought him a mug. He looked at it for a long time and whispered a little audibly:
- Hey, Sasha, get out!
In the box for parents! In no case do not harden a premature baby. Such a procedure is dangerous and is associated with the progression of various diseases in crumbs.
Please note that a premature baby must pass, as a result of which the medical staff decides what measures to take to save the child's life.
How to massage a premature newborn, see the video.
Care of a premature newborn
From the moment the child is discharged from the hospital, the pediatrician and nurse must visit the baby on the same day, depending on what degree of prematurity the child has received. In the future, visits to the nurse during the first month will be at least 5 times a week. The pediatrician is required to visit the baby three times within 7 days. 
Please note: the child's condition must be analyzed and assessed. All information is recorded in the baby's medical record. If necessary, the medical staff interviews new parents about what procedures can be gradually included in the newborn regimen.
Smile! - You don't have money on your mobile?
- There is.
Why are you calling me from home?
- Well ... it's kind of easier to find.
Prematurity of children is classified into four groups:
Attention! Nursing a premature newborn is an extremely difficult procedure, as the wrong approach can adversely affect the baby's condition.
Stages of nursing premature newborns
There are three main stages that characterize the nursing of a newborn in certain conditions.
Nursing in a maternity hospital. It is planned to place children in a special incubator that supports the normal development of the child up to the positive indicators of his adaptation. For such purposes, there are special maternity hospitals and children's departments.
In this case, a similar hygiene of the newborn is performed, as well as a child born on time. Prematurely born babies are given intensive care and artificial ventilation of the lungs, and an injection of vitamin K is also administered.
Nursing in children's institutions. Similar care for an underdeveloped newborn is carried out in special wards-boxes. Here the child is provided with heating, optimal conditions for primary adaptation to the outside world. If necessary, they resort to medical massage, if the indicators of the development of the baby allow. 
Important! Ideal for the speedy adaptation of a premature baby is his joint stay in the ward with his mother. This reduces the risk of infection of a weakened body and improves the mental state of the child.
Nursing infants in clinics and at home. A child who was born earlier than the allotted time should be regularly examined by doctors. Parents should follow the recommendations given by pediatricians after discharge from the maternity hospital.
Among the celebrities there are those who were born prematurely, these are: Issac Newton, Napoleon Bonaparte, Adolf Hitler.
Unhealthy optimism and a 30 percent deficit
Nobody ever plans or expects this. But, alas, you can't get away with this. I also thought that I was healthy, young and in general ... Until, at the next scheduled appointment, the doctor suddenly measured the pressure of 150, which I did not feel, but with which, as it turned out, I had been walking for two weeks, or even three. Yana developed one of the varieties of late toxicosis - preeclampsia. All over the world, the causes of its occurrence have not yet been precisely established. But until the 29th week everything went well: life on the sea coast, no stress, no need to run to work, good food, and regular walks. The diagnosis was like thunder. On a clear sky.
I was urgently hospitalized, and after the ultrasound, the verdict was announced: the child already has a 30 percent lack of body weight. Several days of therapy, listening to my daughter's heart every two hours, regularly measuring my blood pressure. The doctors already knew the outcome of everything, but they pulled the child's lungs to prepare for a new life. To do this, they injected me with a special drug that accelerated the development of small lungs. But I was sure that I would lie down in the hospital for a week, return home and calmly reach my term. Well, what mother did not lie on conservation? Therefore, I brushed aside when the caring staff offered me an excursion to the department where premature babies lie.
Photo source: heroine's archive
In fact, I was just psychologically prepared ...
skin to skin
The first hour after the birth, the baby was seen by her father, whom the doctors called at night immediately after the operation and called to the hospital. The next day, when I was transferred from intensive care to a regular ward, my daughter was shown to me. More precisely put on the chest. Nobody asked Jana about what she wants. She, lying on a gurney, was simply rolled up to the incubator, they took out her daughter and with the words Congratulations! This is your daughter! placed on the chest.
- Now I understand that this is right, because you simply do not have time to think about something bad. I did not have time to get scared, to understand that she was too small and not like other children. No, I have an ordinary child and I am an ordinary happy mother - after all, everyone congratulates and rejoices around. The question that she might not survive was not even close to being in the air. And this is not some kind of self-hypnosis - all the medical staff around me spoke only about the happy ending.
The fact that not all such children survive, and most of those who survived receive either disability or a solid bouquet of illnesses, I learned only after reading an article about the Belarusian organization “Rano”. The first public association of parents of premature babies "Rano" has only recently appeared in Belarus. Moms and dads literally came together to support each other in a difficult situation and help in word and deed. But the approach to nursing children with extremely low body weight in Belarus and Sweden is significantly different.
Such collages hang throughout the department of the Swedish hospital. They tell the stories of premature babies
I sincerely sympathize with mothers who, finding themselves in the same situation, see their children in wires and tubes only through glass, not being able to even touch them. Already in the hospital, from acquaintances raising a 4-year-old daughter, I learned that their child was born at the 31st week weighing 990 grams. Almost our story, but it was in Minsk. Their girl spent a month and a half in intensive care in an incubator, where her lungs and stomach were helped to form and nutrition was gradually introduced. Mom and dad were waiting for her at home, not even being able to pick up their child. When the girl grew to 1450 grams, she was transferred to the ward for premature babies, where her mother was already placed. Another month and with a weight of 2450 they were discharged home. We also had an incubator, three sensors on the chest and another one on the leg for every second control of the heartbeat, respiration and pressure. And also catheters, which were removed after a couple of days, and a feeding tube: a tube was inserted through the nose into the stomach, through which breast milk and its substitute were poured with a syringe. Only without a ventilator
- Stefania breathed on her own from the first day of her life, and I even heard her first cry in the operating room.
Photo source: archive of the heroine. Jug with premature babies
Next to the incubator there was a bed for me, on which I lay with the baby on my chest for 7-8 hours a day. So from the first days she, all in wires, continued to grow on me. This method is called "skin to skin" or the kangaroo method. Today it is becoming more and more popular all over the world. Doctors are convinced that the most important thing for a child in this situation is to feel his mother and continue to hear her heart. That is why he is placed on his mother's tummy on his chest, and so the baby gradually gets used to the new world. Of course, a child cannot lie on his mother 24 hours a day. A woman needs to eat and sleep, so the incubator is also used with this method. I had my own room where I could rest, eat, sleep, express milk. In the morning, after breakfast, I went to Stesha, got her out of the couveuse, and we lay together for several hours. Then she went to have lunch, have a little rest, again returned to the child and lay with her until 9-10 pm.
While lying down, it was not necessary to move, so as not to disturb the child. Yana thought or read at a time when her daughter, feeling her mother nearby, was gaining strength to live confidently. But the monitor with data from the sensors still squeaked sometimes: it was a warning that the heart began to beat slowly or breathing stopped. Periodically, these children actually forget to breathe. They are tormented, reminded that you need to try - and everything is getting better.
Only now I began to understand how scary it is that something squeaks above your head several times a day because your child is not breathing! At the time, you don't think about it. It's a paradox, but then it was not thought at all about the bad. I remember a friend called and asked: “You probably cry all the time?” But I didn't understand why I should cry? After all, my child is alive and nothing threatens his life. You just need to lie down in the hospital for a while, where, by the way, it was quite comfortable and cozy, although it was hard from a busy schedule. But from time to time I still teased the doctors with questions about whether everything would be all right, whether there would be any deviations in development. The doctors didn't understand why I was asking about this. In the end, they decided that it was all about our language barrier, that I, apparently, did not understand them well, and ordered an interpreter who repeated all the words that the child was healthy, there were no deviations, and it was generally strange that I was asking about this.
Photo source: heroine's archive
New weekdays
Maternal everyday life for Yana began from the first day of a new life on the principle of "skin to skin". Feeding, pumping milk and changing diapers - everything was on the clock. Periodically, the baby was weighed and an ultrasound was done.
Weighing was in a day. Each time I waited with bated breath for the numbers on the scales. When two days later they showed 860 grams, I was scared. But they reassured me, saying that this is a normal situation when a baby loses weight in the first days of life. But it is one thing to lose 100 grams from a weight of 3-4 kilograms, and quite another when every gram counts! And here's a hundred! The first days the staff did everything themselves. Then I was politely asked if I would like to feed my child. I was frightened and refused: it was scary to pour milk into a small spout with a syringe through a tube. But the very next day I was told that I had to do it myself. Later they taught me how to change the probe on their own. Every hour and a half I fed my daughter with 4 milliliters of milk. Then portions and intervals increased. At the hospital, they gave me a breast pump and told me to bring my own milk to the baby. When there was not enough or not enough, she was given the milk of another mother. Later, formula milk was introduced to replace breast milk. A week later, they tried to apply the baby to the breast. Naturally, no feeding came out of this. But it was necessary to try for her peace of mind. By the month of her life, Stephanie began to take the breast well. The medical staff taught me how to change diapers, wash and even bathe a child. For the first time, my daughter bathed in a hospital ward in a basin.
Life with dad
Dad came to his family every day. And he did not sit in the hospital corridor, but every time he went into the incubator department. Shoe covers and a white coat were not required from him. Dad was given a bathrobe when it was necessary to replace Yana and lie down with little Stephanie on her chest.
Photo source: heroine's archive
My room was designed for a family, that is, for mom, dad and a child. There were two beds pushed together - a kind of imitation of a family bed. There was another folding one at the opposite wall, in case there is an older child in the family and there is no one to leave him with, or if dad is now more comfortable sleeping separately. When work issues were resolved, dad moved to our hospital. From that moment on, we took turns feeding Stephanie, taking turns lying with her. In a word, they lived as a family. These were not exceptional conditions of stay. In the department, besides Yana, several other families lived like this. Together and with all the conditions in the form of a separate shower and toilet. The only thing shared was the kitchen, which had several refrigerators, coffee makers, kettles, microwaves and all the necessary utensils. In the incubator department, parents of newborns could talk.
During such communication, I learned that a girl in the ward was born a girl even earlier than ours with a weight of 350 grams. When she reached 500, she underwent heart surgery. At the time of our acquaintance, their daughter was already three months old, she weighed almost two kilograms and nothing threatened her life, although there were still some health issues.
Way home
About a month later, Stephanie moved into our ward. She was given a cot with a heated mattress, so the incubator was no longer needed.
Photo source: archive of the heroine. The chamber in which Yana lay
But young parents, for obvious reasons, were afraid to stay with their daughter at night, so they took her to the doctors. Until they were asked, when will the girl begin to spend the night with mom and dad, and not in a lonely couveuse?
We promised to think about it, but the very next day we were confronted with the fact that now she lives permanently with us. An almost domestic life began with regular feedings and bathing. Once we were even offered a stroller and a walk with the child in the fresh air. I was almost shocked that this was possible, because by that time I had already read that such children were kept in incubators for months and not released from the hospital until they gained 2.5 kilograms. When Stephanie was one and a half months old, and her weight reached 1800 grams, the whole family went home. The girl was discharged. At first, twice a week, doctors from the hospital came home, the child was weighed and interested in health. No one left the young family to the mercy of fate.
For a while we fed the baby through a tube, but we started trying to give a bottle. When Stefania once again pulled it out for herself, I just didn’t put it on her anymore and continued to bottle feed. Breastfeeding after that, of course, had to be abandoned. But at that moment, it was more important for me to get this tube out of her nose as soon as possible. Doctors did not swear for such independence. After a couple of weeks, we were finally discharged and given to the care of the local clinic, where we first went once a week, and now only once a month for weighing and control.
No diagnoses. Usual life
Stephanie is almost 10 months old today. She is already sitting confidently and crawling quite quickly throughout the apartment. Doctors have not given her any diagnoses and do not distinguish her from other children. Only weight can give out a birth story: now it’s only the seventh kilogram with a height of 68 cm. - We don’t aspire to become heroes, but for ballet we’ll do it for ourselves, so we think about weight only in minutes of weighing. Yana understands that her daughter was lucky. After all, each such child has his own story and his own limit of strength to fight for this life. But the fact that the doctors did everything not only for the health of the baby, but also for the confident life of the mother, no one will deny. - From a month and a half of stay in the hospital, I have only good memories. There were not all those horrors of the maternity hospital, about which they write on many forums. In addition to the comfort provided, the hospital saved us from a lot of other worries, for which the parents of early children had not yet had time to prepare. Both me and the child were provided with all hygiene products (diapers, napkins, etc.).
Photo source: archive of the heroine. This set was given to little Stephanie by the hospital.
When the sensors were removed and the child could finally be dressed, the hospital gave us clothes that you definitely cannot find in sizes in ordinary stores. For citizens of Sweden, all this is free. Only food for parents at their own expense. But it seems that the most important thing that the doctors could do for Yana was to show her that her daughter is a healthy little person. The person who will live.
Does Belarusian medicine do everything possible to care for premature babies?
Principles of nursing a premature baby.
Nursing of a premature baby is carried out in a complex, both in stationary conditions and at home. Conditionally represented by 3 stages:
Stage 1. Intensive care in the maternity hospital.
Stage 2. Observation and treatment in a specialized department for premature babies.
Stage 3. Dynamic observation in a children's clinic, at home.
Stage 1. Intensive care in the maternity hospital.
When caring for premature babies, you must follow all the rules of asepsis and antisepsis. The first treatment and preventive measures are carried out in the delivery room. To prevent aspiration of amniotic fluid, all premature babies after birth are suctioned off the mucus from the upper respiratory tract, and for children born in cephalic presentation, this procedure is carried out in the early stages - immediately after the removal of the child's head.
All manipulations must be carried out in conditions that exclude the cooling of the child (the air temperature in the delivery room must be at least 25 C, humidity 66-60%, changing table with a source of radiant heat). Additional heating from the moment of birth is an important condition for its successful nursing!
If the child was born in a state hypoxia, a mixture is injected into the umbilical cord vein, including a 10% glucose solution, a cocarboxylase solution, a 5% ascorbic acid solution, a 10% calcium gluconate solution.
After initial treatment and ligation of the umbilical cord, premature babies weighing more than 2000 grams, wrapped in diapers and an envelope from a flannel blanket, are placed in beds at an ambient temperature of 24-26 C, since they are able to maintain a normal temperature balance themselves.
Premature babies weighing more than 1500 g can be effectively nursed in special beds "Bebitherm" with heating and additional oxygenation (the temperature in the ward is initially maintained within 26-28 C, then gradually decreases to 25 C, according to indications, warm, humidified oxygen is supplied, concentration within 30%).
Premature babies with a birth weight of 1500 g or less, as well as children in serious condition, are placed in incubators.
Nursing a premature baby in an incubator.
The temperature in the incubator is regulated taking into account the child's body temperature (when measured in the rectum, it should be 36.6-37.1 C). Oxygen is supplied to the incubator at the rate of 2 l/min. Humidity is set to 80%, by the end of the 1st week of life it is reduced to 50-60%. An open incubator or bed is used for children born with a body weight (or reaching a body weight) of more than 1500 g.
Optimal temperature- this is such a regimen in which the child manages to maintain a rectal temperature within 36.6-37.1C. The air humidity in the incubator should be 80-90% on the first day, and 50.60% on the next days. The level of oxygenation is selected individually. It is necessary to provide the child with optimum oxygen concentration, in which the signs of hypoxemia disappear (cyanosis of the skin and mucous membranes, decreased motor activity, bradypnea with apnea).
The change of the incubator and its disinfection is carried out every 2-3 days. A long stay of a premature baby in an incubator is undesirable. Depending on the condition of the child, it can be from several hours to 7-10 days.
On the 7th-8th day, healthy premature babies are transported from the maternity hospital to the department for nursing small children in specialized machines and in incubators.
Stage 2. Observation and treatment in a specialized department for premature babies.
Purpose of stay in these departments:
Observation and further nursing of the child;
Creation of comfortable microclimatic conditions (additional warming and oxygenation);
Providing adequate nutrition;
Teaching parents how to care for a child at home, etc.
A child in the department for nursing small children is transferred from the incubator to a heated bed only if this does not lead to a change in his condition.
If the child in the crib does not “keep” body temperature well, then additional warming is applied with the help of heating pads.
The mother is taught the exercise therapy complex. Classes in the absence of contraindications are carried out from the age of 3-4 weeks. Before feeding for 5-10 minutes 5-7 times a day. At the age of 4-6 weeks. The complex includes massage of the anterior abdominal wall. Bathe healthy premature babies from 2 weeks of age; the water temperature is 36C with a gradual decrease to 32 C. Walks with premature babies in the warm spring-autumn period and summer are carried out from 2-3 weeks of age, and with very premature babies - from 2 months of age. In winter, walks are allowed at the age of at least 3 months at a temperature not lower than -10C, they are carried out with a heating pad under a blanket.
During oxygen therapy it is necessary to ensure the optimal concentration of oxygen. It is recommended to inhale a gas mixture containing no more than 30% oxygen, the duration of oxygenation is selected individually. The mixture should be moistened to 80-100%, heated to a temperature of 24C. Oxygen therapy is carried out using nasal catheters, cannulas, a mask or an oxygen tent.
Peculiarities of feeding premature babies.
Human milk is the optimal food for a premature baby.
The choice of feeding method depends on the gestational age of the baby. It is important to ensure that the baby does not overwork, spit up or aspirate food during feeding.
1. Premature babies with a long gestational age, with a pronounced sucking, swallowing reflex and a satisfactory condition, can be fed 3-4 hours after birth.
2. With the severity of the swallowing reflex and the absence of a sucking reflex, the child can be fed from a spoon.
3. In the absence of breast milk from the mother, you can apply specialized adapted mixtures (Humana-O, Frisopre, Enfalak, Nepatal, Alprem, Detolakt-MM, Novolakt, etc.) during the first 2-3 months.
4. Children with low body weight and gestational age less than 32 weeks are fed through a naso - or orogastric tube. The introduction of milk must be carried out by drip, through special syringe perfusors, in their absence, sterile syringes and droppers can be used.
5. Deeply premature babies with respiratory disorders, circulatory disorders, depression of the central nervous system are prescribed parenteral nutrition. On the first day of life, they receive a 10% glucose solution, from the 2nd day they switch to a 5% glucose solution with the addition of amino acids, electrolytes, potassium, vitamins, microelements, fat emulsions.
Principles of medical treatment of premature infants.
Excessive stimulation of such children in the first days and weeks of life, intensive and infusion therapy can lead to a deterioration in the condition. Do not administer to premature babies with intramuscular injections of more than 0.5 ml of the drug solution.
Criteria for discharge of a premature baby from the hospital.
Body weight must be at least 2000 g with constant dynamics.
The ability to maintain a constant body temperature.
The presence of pronounced physiological reflexes.
Stability of all vital functional systems.
Stage 3. Dynamic observation in a children's clinic.
The next day after discharge from the hospital, the local doctor and nurse visit the child at home. They "actively" observe the child. At least once he is examined by a neuropathologist, an ophthalmologist, once every 6 months - by an otorhinolaryngologist, at the age of 1 and 3 months - by a pediatrician and a neuropathologist, attenuated vaccines are used for vaccinations. Premature, born weighing up to 2000 g, BCG vaccination in the maternity hospital is not carried out. It is prescribed when the child reaches the average indicators of physical and neuropsychic development of children born on time.
Prevention of prematurity:
1) Protecting the health of the future mother, starting from early childhood.
2) Timely rehabilitation of chronic foci of infection of the girl - the future mother.
4) Creation of favorable conditions for the course of pregnancy.
5) Regular monitoring of the pregnant woman in the antenatal clinic.
6) Refusal of a pregnant woman from bad habits.
7) With the threat of miscarriage, mandatory inpatient treatment of a pregnant woman.
Several factors come into play:
1.
The gestational age at which the premature birth occurred.
2.
The presence in a medical institution of optimal conditions for the provision of qualified medical care in full and nursing, starting from the moment the child is born. The first 20 minutes are the most important, on which the life and health of the crumbs in the future depend.
3.
Complete and correct feeding.
Not all children born before the "official" term need specialized medical care and nursing. With a moderate degree of prematurity, good health and the absence of diseases, the child with recommendations is discharged home a few days after birth.
Necessary creation of special conditions for children with a deep degree of prematurity or with a moderate degree, but with diseases or congenital malformations.
The chances of a successful outcome are higher when a baby is born in a specialized perinatal center equipped with the necessary medical equipment and staffed by trained medical workers.
With preterm birth in a conventional maternity hospital, there is no opportunity to create optimal conditions for survival, which significantly worsens the prognosis.
The first stage of nursing - children's resuscitation
In fact, it begins in the delivery room:
- After birth, the child is taken in heated sterile diapers and dried.
- Medical manipulations after cutting off the umbilical cord, including revitalization, are carried out in conditions of heat preservation - on a heated table.
A deeply premature baby spends the first days or weeks of life in an incubator designed to simulate intrauterine conditions. With a moderate degree of prematurity, the child is usually placed on a heated table.
Kuvez, or incubator for newborns
This is a device for medical purposes, the upper part of which is a chamber or cap made of transparent organic glass.
The incubator chamber has windows through which:
- Medical manipulations and feeding are carried out.
- Humidified oxygen is supplied.
- The child is connected to a ventilator.
- Sensors are brought to the baby from devices for measuring indicators: body temperature, blood pressure, blood oxygen saturation and some others.
Devices are used to create a "nest" - the conditions for a comfortable and convenient location of the child: on the side, stomach, back. Arms and legs are in a bent position, pressed to the body and move less - the baby saves his own energy.
Thermal conditions and humidity
Inside the incubator chamber is created:
- Optimum air temperature to avoid overheating or hypothermia. Usually for children with a birth weight of up to 1000 grams, the temperature is set at 34 o C, more than 1000-1500 grams - 32 o C.
- Humidity - about 60-70% to prevent drying of the mucous membranes and evaporation of water from the surface of the skin.
- When connected to a ventilator.
- When given through an oxygen mask or nasal cannula.
The importance of thermal management
In order for the baby to produce its heat, it needs more oxygen and energy.
However, there is a vicious circle:
- On the one hand, nutrients and oxygen are initially poorly supplied to the organs and tissues of a premature baby, and carbon dioxide is difficult to remove from them.
- On the other hand: under conditions of hypothermia, these processes are even more disrupted, leading to the development of hypoxia (lack of oxygen) and acidosis (increased acidity of tissues).
Respiratory distress syndrome or breath control
There are several approaches, depending on the degree of prematurity and the well-being of the crumbs.
With a moderate degree of prematurity, the baby usually breathes on its own, but sometimes the baby receives humidified and heated oxygen through an oxygen mask or nasal cannulas.
With a deep degree, it is often necessary to introduce an endotracheal tube into the trachea (a hollow organ - a continuation of the larynx). Through it, the baby is connected to the artificial lung ventilation (ALV).
In fact, the ventilator "breathes" for the child with the given parameters in accordance with the gestational age and general condition. A certain frequency of respiratory movements per minute, inhalation depth, airway pressure and others are set.
Modern devices for standard ventilation operate in the trigger ventilation mode, thanks to which the small patient is "taught" to breathe. What does this mean? A special built-in sensor detects the baby's attempt to take a breath and automatically synchronizes hardware breathing with the baby's breath.
Non-invasive ventilation
It is used when the child breathes on his own, but it is given to him with difficulty.
Through nasal prongs or a small mask, a constant positive pressure oxygen-air mixture is delivered to keep the lungs inflated. Exhalation occurs on its own.
Some models of this type of ventilator operate in a two-phase mode: against the background of forcing an oxygen-air mixture, several breaths are taken. 
High-frequency oscillatory IVL
As such, the usual inhalation and exhalation is not performed. The exchange of oxygen and carbon dioxide occurs due to fluctuations of the chest - oscillations that the apparatus creates.
The method is ideal for use in very preterm infants with very immature lungs or already developed pneumonia.
A baby with a birth weight of 1000 grams or less is often on a ventilator for up to two to three weeks of life. Transfer to spontaneous breathing is carried out after stabilization of the child's condition.
The most common possible complications of mechanical ventilation are barotrauma (rupture of lung tissue with air bubbles entering the bloodstream) and infection.
Skin care
The outer skin is thin and immature, quickly gives off heat and is damaged, does not sufficiently protect the baby from loss of water and proteins.
Substances are administered intravenously, slowly, at a predetermined rate using a liniamat or an infusion pump - a medical device with a syringe.
The introduction of solutions and / or drugs is possible using two methods: 
Fluid replenishment
A premature baby, due to the immaturity of the kidneys, is equally prone to fluid retention with the formation of edema, and to the loss of water with salts.
With a moderate degree and a stable condition of the child, it is possible to "drink" inside with a 5% glucose solution. In severe condition - intravenous infusion.
With a deep degree, the fluid is always replenished by intravenous administration of solutions.
Mostly, a 5% glucose solution is used, less often - 0.9% saline. In addition, glucose, in addition to replenishing the volume of fluid, reduces the risk of developing hypoglycemia (lowering blood sugar), which is especially important in the first hours and days of a baby's life.
If necessary, potassium, sodium and calcium are administered under the control of the level in the child's blood. With a moderate degree of prematurity, the content of electrolytes is determined twice a day, with a deep degree - every 6-8 hours. Both deficiency and excess can be harmful: dehydration or edema, heart rhythm disturbances, and others.
Increased bilirubin
The permissible level of bilirubin in the blood of a premature baby is 171 µmol / l.
The main method of treatment of uncomplicated neonatal jaundice is phototherapy in combination with "drinking" glucose or intravenous infusion of solutions. A child without clothes is placed under a special lamp with ultraviolet radiation, which destroys bilirubin in the skin and promotes its removal. Special goggles are worn to protect the eyes. One session can last several hours, with breaks for feeding.
With an indicator of 205.2 µmol / l, the issue of replacement blood transfusion is being considered.
Correctly and timely phototherapy in many cases helps to avoid blood transfusion.
Infection control
Many babies become infected in utero or during childbirth from their mother. Often the infection joins after birth. What are the consequences? Due to insufficient activity of the immune system, any pathogen can lead to the development of serious diseases. For example, pneumonia (pneumonia), sepsis (spread of infection with blood throughout the body), osteomyelitis (purulent focus in the bone) and others.
Therefore, as a rule, deeply premature babies are prescribed antibiotics from the first day of life. With a moderate degree of prematurity - according to indications: pneumonia, the implementation of intrauterine infection, and others.
It is advisable to collect blood and urine with inoculation on nutrient media before the start of treatment. The study is performed to identify a pathogen in a baby and select an antibiotic that acts specifically on this bacterium.
Prevention:
- Before giving birth. Treatment of identified infectious diseases before and / or during pregnancy: colpitis, pyelonephritis, sinusitis, tonsillitis and others.
- After childbirth. In the room where the baby is located, wet cleaning is carefully carried out, the incubator and oxygen supply tanks are treated with antiseptic solutions. You must follow the rules of personal hygiene.
Lines the inside of the alveoli, contributing to:
- Reducing tension and reducing the risk of collapse (atelectasis) of the lung sacs.
- Removal of sputum and involvement in breathing of other additional parts of the lungs.
Hemorrhages in the brain
Significantly worsen the prognosis and condition of the child: convulsions, swelling of brain tissues (excessive accumulation of fluid), short-term breath holding (apnea), minor twitching of facial muscles and others are possible.
It is believed that with moderate prematurity and hemorrhages of the I-II degree, the foci in most children resolve, sometimes even without a trace.
With hemorrhages of III-IV degree, the prognosis is unfavorable: about 30-50% of children die by the end of the first month of life.
The approach to treatment depends on the severity of bleeding:
- With rapidly progressive hemorrhage over a large area and the risk to the life of the child, the hematoma is often removed surgically.
- With I-II degree or multiple petechial hemorrhages, the treatment is conservative.
- Complete rest is ensured, light and sound stimuli are limited, drying and washing is carried out carefully and without unnecessary movements, painful procedures are minimized.
- After birth, all children are given vitamin K for prevention, which is involved in the production of prothrombin (blood protein) and promotes blood clotting. When a hemorrhage occurs, vitamin K is prescribed for three days.
- At a hemoglobin level below 80 g/l, intravenous administration of erythrocyte mass is recommended.
The second stage of nursing - the department of premature babies
Conditions are being created for recovery or rehabilitation, which is needed by almost every child born before the expected date. The duration of stay in the hospital, the amount of medical care and procedures depends on the degree of prematurity and the adaptive capabilities of the baby.
Therefore, mentally prepare for a long stay in the department for premature babies: from several weeks to two or three months.
If your birth took place in a specialized perinatal center, then there are no problems and delays with the transfer from one department to another. When childbirth takes place in an ordinary maternity hospital, the mother and baby are transported from one medical institution to another in an equipped ambulance.
In the neonatal unit, you are next to the baby all the time - in the "mother and child" ward. This approach allows you to independently care for the baby, feed on demand, support emotionally during medical manipulations and procedures. The child constantly feels your warmth and hears your voice, which, of course, contributes to its faster recovery.
Thermal regime
A baby with a moderate degree of prematurity usually retains heat well, so it is not always additionally heated. However, if necessary, it is sometimes placed on a heated table.
A different approach is applied to a child with a deep degree of prematurity, who does not retain heat on his own. For some time it remains in the incubator chamber, in which the air temperature gradually decreases. If necessary, humidified and heated oxygen is supplied to the incubator chamber. As soon as the baby begins to better retain heat, it is transferred to a heated table.
However, this is not enough: it is necessary to help the baby adapt to the conditions of life outside the womb.
Method "Kangaroo"
Based on the contact of the mother with the baby - "skin to skin". Dad can also take part in the process: replace mom in case of illness or poor health.
The main idea of the method: daily laying out the crumbs with a naked body on the skin of the mother's chest for several hours. The child is placed in the supine position with the face facing the mother, which resembles the "frog" position. To maintain the temperature, a hat is put on the baby’s head, and covered with a warm blanket on top.
In the first days, the child is laid out on the mother's breast for 20-40 minutes twice a day. Then the duration of the "session" is gradually increased to several hours. After discharge home, you can continue to apply the method at home.
It has been proven that the "Kangaroo" method not only warms the baby, but also has a positive effect on his physiology and psyche.
Positive impact on the child:
- Does not waste energy on the formation of its own heat and crying.
- Sleep and wakefulness are normalized, as well as their alternation.
- Improves breathing and heart function, blood oxygen saturation.
- The close proximity of the mother's breast and the smell of milk contributes to the development and coordination of innate reflexes: sucking, swallowing and search.
- The maturation of the cerebral cortex, recovery, restoration and adaptation to new living conditions are accelerated.
- Gaining weight better and faster.
The "Kangaroo" method is good, but it is used only after the child's condition improves, in the absence of convulsions and stabilization of the main indicators (respiration, heart rate, blood pressure).
A variation of this method are "slings", with which you can wear a crumb for several hours.
Prematurity care
If necessary, monitoring and recording of some indicators continues for some time: blood pressure, respiratory rate, heart rate, blood oxygen saturation.
And here your help is invaluable. You can take part in some simple procedures and manipulations. After all, it is not difficult to learn how to use a heated table, a phototherapy lamp or an incubator.
The approach has the advantage that the baby feels that you are near and care for him with warmth. Undoubtedly, this helps the baby to quickly adapt to new living conditions.
Drug treatment
Appointed depending on the disease:
- Jaundice of prematurity: continued phototherapy and "drinking".
- Improving the functioning of the brain: from the third week of life - nootropics (Cortexin, Piracetam).
- Mild sedative and brain enhancement: Glycine.
- Fighting seizures: Phenobarbital (the main drug), Convulex or Depakine.
- Vasodilatation and improvement of blood circulation: Cinnarizine.
- Improvement of metabolism, nutrition of the heart muscle, hemoglobin production: vitamin E.
Rehabilitation of premature babies
In the first year of life, the body of an immature baby has great potential for restoring and accelerating the maturation of damaged organs and tissues. You and the doctors will have to help the baby together.
Massage for premature babies
The procedure is quite effective, but, unfortunately, the skin of premature babies is thin and dry, so there are some limitations. In addition, remember that massage is usually prescribed by a pediatrician or neurologist with the permission of an ophthalmologist, since there is a risk of developing retinopathy of prematurity.
Basic principles
Usually the first massage sessions begin from 1-1.5 months of life.
A premature baby has disorders in the functioning of the nervous system, which leads either to an increase or decrease in muscle tone. In the first case, excitation processes predominate, in the second - inhibition.
With an increased tone, only light stroking is allowed, with a reduced tone, rubbing, kneading, tapping is performed. Massage at this stage is combined with passive gymnastics: bending the arms and legs, turning the head, and others.
As the child grows older, active exercises are added: with a birth weight of less than 1500 grams - from the age of six months, more than 2000 grams - from two to three months of life.
The kid is forced to perform certain simple actions. For example, turning the torso first on one side, then on the other, the urge to crawl, and others. From 7-8 months of life, exercises become more complicated, taking into account the individual characteristics and skills of the baby by this age. The child is taught to turn from back to stomach, from stomach to back, get on all fours, sit down and other actions.
Conditions for gymnastics and massage:
- The room must be ventilated and have an air temperature of 20-24 o C.
- The baby quickly supercools, so only that part of the body that is being massaged is exposed.
- Classes are held either 30-40 minutes before meals, or two hours after it.
- Gymnastics and exercises are not performed before bedtime, as the child comes into a state of excitement.
- Passive gymnastics is carried out daily 2-3 times a day, at the same time. At first, its duration is about 5 minutes, since the baby quickly gets tired. Then the duration of classes gradually increases.
Gymnastics in the water
It is carried out in a moderately premature baby about 7-10 days of life, in a deeply premature baby - from the third or fourth week of life.
The temperature of the water in the bath is not lower than 37 o C. The duration of the procedure at first should not exceed 5-7 minutes, then you can gradually increase its duration to 8-10 minutes.
Treatment of the oral cavity in a child
If the baby's oral mucosa is clean, you do not need to take care of it additionally.
However, a premature baby is prone to thrush, which is caused by a fungus of the Candida genus that lives in the body of each of us. Normally, its reproduction is restrained by the immune system. With insufficient activity of the immune system, the fungus is activated, leading to the development of the disease.
With thrush, it is better to consult a doctor for prescriptions. Usually, the doctor prescribes to treat the oral cavity with an aqueous solution of methylene blue, and take lactobacilli inside.
It is recommended to refrain from treating the oral cavity with a solution of baking soda - burns are possible. 
Bathing a premature baby
It starts taking into account the degree of prematurity: with moderate - from 7-10 days of life, with deep - from the third or fourth week of life.
Conditions for comfortable swimming:
- Bathe your baby 40 minutes before feeding or two hours after.
- Preheat the room to 24-26 o C.
- At first, it is recommended to bathe premature babies in clean boiled water or a decoction of herbs, the temperature of which is 37-38 o C. As soon as the baby gets a little stronger, it is not necessary to boil water.
- Before pouring water, pour boiling water over the bath.
- Use soap no more than once or twice a week.
- Keep your ears away from water. For safety, before bathing, soak two cotton balls in sunflower or baby oil, and insert shallowly into the external auditory canal.
- Perform the first water procedures for 5-7 minutes, gradually increasing the duration of bathing.
- At first, bathe your baby without adaptive stands. In order not to frighten the baby, immerse it in water gradually, starting from the legs and reaching the shoulders. The head is not immersed in water, but is located on your elbow or palm. In this case, the ring finger and little finger hold the head on one side, the thumb on the other, and the middle and index fingers are located along the back under the neck. You can first practice on a doll or enlist the help of household members.
- Bathe the baby, starting from the upper body, gradually descending to the legs, not missing the skin folds (armpits, neck, perineum).
- Before washing your hair, tilt it back slightly, and draw water with your palm.
- After bathing, transfer your baby to a warm towel and dry gently (do not dry!). Dry the ears with cotton swabs with a limiter, and clean the nose with cotton swabs. Then dress your baby in clothes.
- In the first year of life, bathe the baby daily in the summer, in winter - every other day.
Walking with a premature babyFresh air has a positive effect on the body as a whole. However, regarding premature crumbs, do not rush with walks.
After discharge from the hospital, refrain from walking for 1.5-2 weeks so that the child gets used to the new living conditions and does not experience stress.
The first walk lasts 10-15 minutes, then the time spent outdoors gradually increases by 15 minutes, reaching 1-1.5 hours a day.
Before going out, dress your baby according to the weather, but leave his face open.
At an air temperature of +25 +26 o C, you can walk with a child born with a weight of 1500 grams, two weeks after discharge from the hospital.
At an air temperature of +10 o C, walks are allowed if the baby has reached the age of 1-1.5 months and weighs at least 2500 grams.
At an air temperature of less than +10 o C, they walk when the baby reaches the age of two months with a body weight of 2500-3000 grams.
At an air temperature of -10 o C, it is advisable to postpone walking for one month after discharge from the hospital.
Premature babies: what kind of baby is considered premature, rehabilitation and nursing, developmental features, the opinion of a pediatrician - video
Rehabilitation of premature babies: doctors use hammocks - video
Feeding premature babies
The body of a baby born much earlier than the expected date needs an increased intake of vitamins, nutrients, and minerals.
The first two weeks of life are the most important. Lack of nutrients leads to a delay in the maturation of organs and systems - for example, nervous tissue with a lack of carbohydrates.
Feeding takes into account several key points:
1.
When and how to feed for the first time?
2.
Can the baby be put on the mother's breast?
3.
What is the amount of food for one feeding?
4.
What to feed: mother's milk or formula?
The approach depends on the gestational age and birth weight of the baby.
First feeding
First-degree prematurity and good health
The baby is applied to the mother's breast in the delivery room during the first 20-30 minutes of life or two to three hours after birth.
With a period of less than 33-34 weeks of gestation and a child's body weight at birth up to 2000 grams
Formula for premature babies
Comparative characteristics of the most commonly used mixtures:
| Mixture | Composition and benefits | Flaws |