Transient (transitional) states of newborns during the adaptation period. Physiological weight loss

03.08.2019

Borderline conditions of newborns.

Adaptation to extrauterine life causes significant changes in the newborn's body. The external manifestations of these changes can be the so-called borderline conditions of newborns, which are not diseases and do not require treatment. And nevertheless, newborns with borderline conditions require more careful attention and some additional measures when organizing care for them.

The most common borderline conditions in newborns.

It occurs in 100% of newborns by 3 - 4 days of life and makes up a maximum of 10% of the initial body weight. Recovery occurs by 7-10 days of life.

Causes:

* malnutrition in the first days of life;

· Excretion of water through the skin and lungs;

• loss of water in urine and stool;

· Insufficient fluid intake;

Regurgitation of amniotic fluid;

· Drying of the umbilical residue.

Tactics:

· Early attachment to the breast;

· Feeding at the request of the child;

· Fight against hypogalactia;

· Control of the child's weight.

Transient erythema of the skin.

It manifests itself as a simple, less often toxic erythema.

Simple erythema- reactive redness of the skin, sometimes with a bluish tinge of the hands and feet.

Cause- reflex vasodilation of the skin due to the powerful effect of environmental factors on the skin receptors of the newborn. In mature full-term newborns, it lasts for several hours, less often for 1 - 2 days.

Toxic erythema is a kind of allergic reaction of the skin of a newborn. In contrast to simple erythema does not occur immediately after birth, but on the 2nd - 5th day of life. It manifests itself in the form of hyperemic spots, papules, vesicles on the entire skin, except for the palms and feet. The rash fades away after 2 to 3 days.

Erythema, as it fades, turns into peeling (often small, sometimes large).

Tactics:

· Thorough skin care;

· Hygienic bath with potassium permanganate solution.

Transient fever

It develops as a result of instability of water exchange and imperfection of thermoregulation. It manifests itself on the 3rd - 5th day of life in the form of fever with a temperature of 38 - 39 degrees, anxiety, thirst, dry skin and mucous membranes. After 1 - 2 days, the temperature will return to normal.

Causes:

· Insufficient amount of fluid intake into the body;

Overheating of the child;

· Ingestion of E. coli endotoxins during the initial colonization of the intestine with microflora.

Tactics:

Transient jaundice

The appearance of icteric coloration of the skin and mucous membranes without disturbing the state of health. It manifests itself on the 3rd day, reaches a maximum by the 4th - 5th day and disappears by the 7th - 10th day of life.

Cause- a combination of underdevelopment of the enzymatic functions of the liver, in which the death and processing of erythrocytes occurs, as well as the massive destruction of fetal erythrocytes (the number of which in the fetus is very large). As a result of this combination of factors, the pigment of erythrocytes that did not have time to be processed accumulates in the skin and mucous membranes, staining them yellow.

Tactics:

· Control over the condition of the child;

· Additional drink of 5% glucose.

Hormonal crisis

It is caused by the transition of mother's estrogens into the fetal blood in the antenatal and intrapartum periods and their entry to the newborn with mother's milk.

It can manifest itself as:

1. Physiological mastopathy in boys and girls. In this case, there is a symmetrical engorgement of the mammary glands without signs of inflammation. There may be a grayish discharge from the nipples. It manifests itself on 3 - 4 days, reaches a maximum by 7 - 8 days and disappears by the end of 2 - 3 weeks.

2. Swelling of the scrotum in boys, which is also symmetrical and goes away without treatment.

3. Desquamative vulvovaginitis girls. At the same time, discharge from the genital fissure appears of a grayish-white, and sometimes brownish color. It manifests itself in the same way as the edema of the scrotum in boys, disappears in the 1st days of life and the 3rd day.

Tactics:

· Careful child care.

Uric acid renal infarction

This is the deposition of uric acid in the form of crystals in the lumen of the urinary tubules.

Causes:

· Increased decay of a large number of cells;

· Features of protein metabolism.

It is manifested by a change in urine. It becomes cloudy, yellowish brown in color. After such urine dries, brown spots and sand remain on the diapers. It is found on the 3rd - 4th day of life against the background of physiological oliguria (a decrease in the daily volume of urine). As the urine output increases and the crystals are washed out (within 7 - 10 days), it disappears.

Tactics:

· Additional drink of 5% glucose.

The listed conditions are called borderline, since all systems of the newborn are characterized by a state of unstable equilibrium, therefore, even minor changes in environmental conditions can lead to the development of diseases.

Hence, necessary:

· implementation of special careful care of the newborn in compliance with the rules of asepsis and antiseptics;

· observance of special hygienic conditions for its maintenance;

· correct organization of feeding a newborn.

What can a mother overshadow the joy of having a baby and waiting for discharge from the hospital? News that her baby is losing weight!

This phenomenon seems unnatural and dangerous. Is it worth worrying? But how, after all, all the attention of parents and their relatives is riveted to the two most important numbers - the height and weight of the child!

Some moms, worried about the baby's weight loss and believing that it is a lack of milk, refuse to breastfeed before they can properly establish it. Is it worth talking about the harm from actions caused by far-fetched fears?

What is physiological weight loss

In the first 3-5 days after giving birth, your baby loses weight - there is a so-called physiological loss of body weight.

And this is a completely natural phenomenon if the weight loss does not exceed the norm.

The norm is considered to be a decrease in body weight by 5-8% of the weight with which the child was born. For example, if your baby was born 3500 g, then a physiological loss of up to 280 g is considered normal. A critical weight loss occurs on the 3-5th day of a baby's life, and already 6-12 days after birth, body weight is gradually restored.

In premature babies, physiological loss lasts longer, and such newborns lose more - from 9 to 14%. Weight is restored only in the second, or even in the third week of life.

If the baby does not experience a physiological loss of body weight, this is where you need to worry!

This indicates fluid retention in the child's body, which is most likely associated with the pathology of the urinary system. You cannot do without a consultation with a doctor!

Three Degrees of Newborn Weight Loss

First degree.
Weight loss is less than 6%. The baby suffers from mild dehydration, which can manifest as mild anxiety and greed during feeding. This group includes the majority of newborns who were born healthy.
Second degree.
Weight loss in the range of 6-10%. At the same time, the child behaves restlessly, shows thirst. He has a bright mucous membrane, pale skin, rapid heart rate and breathing.

Third degree.

Loss of body weight by more than 10%. The child feels strong thirst, he has dry mucous membranes and skin, palpitations, shortness of breath and even fever. He can be both restless and sluggish.

In this case, the doctor identifies the reasons for the sharp weight loss and gives recommendations for their elimination.

Causes of weight loss in a newborn in the first days of life

During birth, the metabolism of a child increases, and a large amount of energy is expended. The baby needs time to get used to the extrauterine existence.
In his mother’s tummy, he received everything he needed through the umbilical cord. After birth, he has to learn a lot - to breathe with his lungs, to adapt to a new type of digestion.

For a small organism, this is an additional load that takes an incredible amount of energy into the baby. And this is not an exaggeration, sucking is serious work for a child. Observant mothers may notice beads of sweat on the skin of a newborn during feeding.
Insufficient replenishment of the body with fluid.
Mom's lactation is just getting better. In addition, in the first two days, the baby sucks sluggishly and, accordingly, receives little milk.

In some maternity hospitals, in order to prevent dehydration, newborns are additionally watered, but this preventive measure prevents the normal formation of lactation and is criticized by breastfeeding specialists.
The body of a newborn loses a lot of water in the first days of life:

Most of the fluid is lost through the skin (about 60-70% of the mass lost). If there is dry air or high temperatures in the room, this aggravates the situation.
The newborn begins to breathe on its own, and during breathing, as you know, moisture is released from the body.
The umbilical cord remains dry little by little.
Promotes the loss of fluid urination and excretion of meconium (original feces).
The minus in weight is complemented by regurgitation.

Which babies lose more weight?

Overweight babies.

Children born by caesarean section or due to prolonged labor.

Premature and immature newborns.

It is much more difficult for such crumbs to adapt to new living conditions, therefore, weight loss and its recovery take much longer.

How to help your baby regain weight faster

Do not neglect the early attachment of the baby to the breast. After childbirth, the mammary glands produce colostrum, a viscous yellow liquid that contains a huge amount of nutrients.
Even a few drops of this valuable substance fills the newborn's body with the necessary energy, helps him quickly adapt to the new environment.

For the mother herself, early attachment ensures stable lactation, since the emptying of the mammary gland is the most important component of lactation, and stagnation of secretions in the alveoli and ducts causes its depression.
Choose a free breastfeeding regimen for your newborn. In this mode, you feed the child not strictly according to the clock, but when he himself asks.
And it is useful for mommy - frequent attachment supports lactation, relieves the feeling of fullness in the breast.
Provide your child with the optimal temperature regime.
In the children's room, keep the temperature no more than 22-24 ° C, and dress the child in accordance with the air temperature.
Do not overdry the indoor air. Moisten it with special devices or place a bowl of water near the baby's bed.
The most common cause of dry air can be an oil heater.

Have you made sure that there is no reason to panic because of the weight loss in a newborn in the first days of his life? If the answer is YES, then great, because a calm mom is a calm and healthy baby!

When your baby finally comes into this world, then you, along with the news of his birth, happily inform all relatives and friends of two important numbers - the baby's height and body weight (or, as usual for most, weight). However, by the time of discharge from the hospital, the baby's weight in most cases decreases slightly. This means that there was a physiological loss of body weight characteristic of the neonatal period. What is it and is it worth worrying if the baby has lost a little weight?
Normally, the decrease in body weight should not exceed 5-8% of the birth weight of the child. That is, if the baby weighed 3000 g at birth, then the physiological loss of up to 240 g is quite acceptable. If you lose more weight, your doctor should take all the necessary steps to prevent further weight loss. The maximum weight loss is observed in the majority of full-term newborns on the 3-5th day of life, the restoration of body weight occurs 6-12 days after birth. In premature babies, weight loss also depends on birth weight, but it is restored only by the second or third week of life, and even then not in all newborns.
There are three degrees of loss of the initial body weight of the newborn:

first degree (weight loss is less than 6% of birth weight). In this case, the child does not show signs of dehydration, but greed during feeding, anxiety may be present. At the cellular level, laboratory studies reveal minor signs of intracellular hypohydration. Most newborns belong to this group.
second degree (weight loss of a newborn within 6-10%). In this case, some signs of dehydration may appear: thirst, brightness of mucous membranes, pallor of the skin, increased heart rate, shortness of breath, irritability is noticeable in the child's behavior. In laboratory conditions, there are signs of intracellular hypohydration and extracellular dehydration.
third degree (weight loss over 10%). In this case, signs of dehydration are more pronounced: severe thirst, dry mucous membranes and skin, shortness of breath, severe tachycardia, fever, the child behaves restlessly or inhibited. In the laboratory, pronounced signs of intracellular and extracellular hypohydration are observed.

Loss of more than 10% of body weight can lead to a significant deterioration in the child's condition, therefore, the doctor individually decides on the need for additional supplementation or supplementation with a mixture.
Let's see what can cause weight loss: dehydration due to significant energy expenditure of the body. Indeed, in the first days of life, a child receives a very small amount of colostrum - from a few drops to several milliliters, while spending significantly more energy. In addition, some children suck very sluggishly in the first days, which also contributes to a longer development of lactation and, accordingly, slows down the rate of weight gain in the baby; loss of fluid associated with evaporation through the skin; fluid loss associated with the excretion of urine and meconium (this is the original feces - a dark mass formed from the amniotic fluid and secretions of the digestive system swallowed by the baby); preconditions for a more pronounced loss of weight can be prematurity of the baby, birth weight more than 4 kg, difficult or prolonged childbirth, early discharge of amniotic fluid, the presence of birth trauma.
Prevention of excessive weight loss of a newborn can be early attachment to the breast, a free mode of breastfeeding, a rational temperature regime in the room where the child is.

The body weight of a healthy full-term baby is on average 3400-3500 g for boys and 3200-3400 g for girls. But there can be significant fluctuations in the direction of both its decrease and increase. With multiple pregnancies, the body weight of newborns is much lower - 1200-2000 g. Children of multiparous women are usually larger in weight and height than children of primiparous. The individual characteristics of the parents, their age, health, social and living factors are important. In recent years, the indicators of the physical development of children have significantly increased, children with a body weight of 4000 g or more are often born.

PERIOD OF NEWBIRTH.
Physiological weight loss

In the first days after birth, the weight of the child decreases by about 150-200 g. This decrease in body weight, as a rule, is natural and is not considered pathological; it is called physiological weight loss.

Depending on the individual characteristics of the child and a number of external factors, the initial weight loss in individual newborns can fluctuate within fairly wide limits, but it is relatively rarely less than 100-150 g. A weight loss of 500-700 g should be considered outside the normal range; it is usually caused by prolonged malnutrition or some illness in the newborn.

Weight loss continues for 3-4 days, its greatest loss occurs on the 1-2nd day of a child's life. After 4-5 days, body weight increases again and reaches the initial level by 7-10 days of life, and more often by 12-15 days of life.

Physiological weight loss and subsequent restoration of the original weight occur in newborns in two main types.

Nutrition of the newborn has a decisive influence on the reduction of the weight curve. A strong drop and late recovery of weight are largely the results of some underfeeding of children in the first days of their life, which is associated with the characteristics of the mother's lactation, and with the characteristics of the child himself.

Approximately 70-75% of the initial weight loss should be attributed to the loss of water excreted by the kidneys, intestines, and mainly the lungs and skin, that is, by respiratio insensibilis. The newborn loses tissue water, water from the body's reserve depots and water, partially formed as a result of tissue breakdown. First of all, the reserves of glycogen in the liver are consumed, fats are partially destroyed; the possibility of decay and a certain amount of tissue proteins is not excluded.

The loss of 10-20% of the total weight loss can be explained by the excretion of urine and original feces (meconium), which are still formed in utero and are usually taken into account at the first weighing.

About 3-5% of the total weight loss should be attributed to vomiting by amniotic fluid swallowed during childbirth, blood and other secretions of the mother's birth canal. To an even lesser extent, weight loss occurs due to the drying out of the remainder of the umbilical cord.

The size of weight loss in the first days of life and the time it returns to its original level, if, of course, do not go beyond normal fluctuations, do not affect the further physical development of the newborn.

BREAST AGE.
(period from 1 month to a year)

The weight of the child at the end of the neonatal period continues to grow: by six months, more often 5-5.5 months, it doubles, by the end of the year it triples. The energy of weight gain gradually weakens with each month of life.

Weight gain for each month of life can be roughly calculated using the following formula:

Monthly weight gain = 800 g - (50 x number of months of life).

For example, in the 2nd month of life, the child should put on weight by 800 - (50 x 2) = 700 g, for the 7th month - by 800 - (50 x 7) = 450 g, etc.

To determine the absolute weight of a child of any month of the 1st year of life, you can use the following simple, but, of course, also only a very rough calculation:

Baby weight (in g) = baby's weight at birth + (600 or 500 x per number of months of life)

For children of the first half of the year, the number of months of life is multiplied by 600 (the average monthly weight gain in grams during the first half of the year), for children older than 6 months - by 500 (the average monthly weight gain in grams of children of the 1st year of life).

For example, a baby with an initial weight of 3250 g at the age of 4 months should weigh: 3250 + (600 x 4) = 5650 g. The weight of the same child at the age of 8 months will be: 3250 + (500 x 8) = 7250 g.

In fact, the increase in weight in infants is far from always distinguished by such a pattern, and rather significant deviations from the indicated average norms are possible, which depends on the individual characteristics of the child and a number of external factors. Children with an initial low weight usually give relatively large weight gain, and it doubles and triples in them earlier than in larger children.

The infant's weight gain is particularly affected by the way the infant is fed: babies who are artificially fed from the day of birth double their weight about a month later than babies who are breastfeeding; the latter by the end of the 1st year of life weigh about 250 g more than the former. The greatest increase in weight is observed in late summer and autumn, the smallest - in spring and early summer, average gains - in the winter season.

Table 1 shows the average weight of children 1 year of life according to the data of S.M. Leviant.

Table 1. Weight of a child of the 1st year of life (in g)
(according to S.M. Leviant; Leningrad, 1958)

Age	Boys	Girls	Age	Boys	Girls
Newborn	3501	3376	6 months	8209	7692
1 month	4131	3914	7 months	8735	8196
2 months	5198	4805	9 months	9663	9062
3 months	6049	5613	10 months	9963	9424
4 months	6832	6412	11 months	10269	9789
5 months	7634	7095	12 months	10556	10088

There is no doubt that the initial weight of the newborn and subsequent weight gain of children during the first year of life may give some deviations from the average figures given in Table. 1.

PERIOD OF MILK TEETH.
(period from 1 year to 6-7 years)

From table. 2 shows that in children over the age of 1 year, the energy of weight gains is significantly weakened. For the 2nd year of life, the child's weight increases by 2.5 - 3.5 kg, from the 3rd year, the annual weight gain is about 2 kg. By about 6-7 years, the weight of a one-year-old child doubles, and by 13-14 years, it increases 4 times.

Table 2. Weight of children (average for boys and girls) over 1 year old
(according to different authors)

Age	Weight in kg	Age	Weight in kg	Age	Weight in kg
1 year	10,1	7 years	21,5	13 years	39,5
2 years	12,5	8 years	24,5	14 years old	45,0
3 years	14,5	9 years	26,0	15 years	50,0
4 years	16,0	10 years	28,0	16 years	53,0
5 years	17	11 years	31,0	17 years	55,0
6 years	19	12 years	35,5	18 years	58,0

The rate of weight gain in children over 1 year old does not remain strictly uniform in different periods of life; weight gain in prepubertal and pubertal periods is especially vigorous.

PERIOD of adolescence and puberty.
(period from 7 to 18 years old)

In boys aged 14-15 years, the annual weight gain rises to 3-5 kg, and by the age of 16-17 it reaches 5.5 - 8 kg. In girls, this increase in body weight gain is detected earlier; at the age of 9-12 years, their annual weight gain reaches 2.5 - 4.5 kg, at the age of 13-15, there are maximum gains of up to 5-8 kg and again a significant decrease in the energy of accumulating body weight by the age of 16-17.

From fig. 3 it can be seen that up to 11-12 years old the weight of boys is slightly more than the weight of girls; with the onset of puberty, girls overtake boys in weight, and from the age of 16, the weight of boys again exceeds the weight of girls of the same age.

Rice. 3. Curves of weight and body length for boys (blue line) and girls (pink line).

The weight of a child of any age after a year (in kg) can be approximately calculated using the following formula:

Child's weight (in kg) = 9.5 kg + (2 kg x for the number of years),

that is, to the weight of a one-year-old child (9.5 kg), add 2 kg (average annual weight gain), multiplied by the number of years of the child at the moment.

Quantitatively and qualitatively, malnutrition, insufficient use of air and light, unfavorable living conditions, unfavorable sanitary conditions, lack or excess of physical and mental stress, diseases, etc., affect, to a greater or lesser extent, the normal weight gain in children. The weight of children of the same age can fluctuate quite widely.

The most intensive development of the child occurs in the prenatal period and during his first year of life.

Newborn children have some peculiarities of weight gain, since they have a physiological loss of body weight during the first week of life.

What is this physiological loss or loss of body weight in a newborn and what is it associated with? Here are the common questions that young mothers worry about. Let's talk about this in more detail.

Weight gain in newborns

The loss of the initial body weight in newborns occurs mainly due to slight starvation in the first days of life (since the mother's milk is just beginning to come) and due to imperceptible water loss with breathing and sweat. Discharge of urine, meconium, prolapse of the umbilical cord are also attributed to the reasons for the decrease in the body weight of the newborn.

Physiological loss of body weight is observed in all newborns and does not depend on body weight at birth.

The maximum loss of the initial body weight of the child usually falls on the 3-5th day. It is measured as a percentage of birth weight.

Normally, the maximum loss of body weight should not exceed 10%. In healthy full-term newborns, it is usually no more than 6%. Losses of more than 10%, in a full-term newborn, indicate the presence of any diseases or disorders in nursing the child.

Factors contributing to large values of maximum body weight loss:

Prematurity;
Large body weight at birth (over 4 kg);
Birth injury;
Prolonged labor;
Hypogalactia in the mother;
High temperature in the newborn ward;
Insufficient humidity in the newborn ward.

Smaller values of physiological loss of body weight are usually:

Girls;
In children with clinical manifestations of a hormonal crisis;
In children born with repeated childbirth;
Attached to the mother's breast in the first 2 hours of life;
In newborns on the "free feeding" regimen.

In healthy full-term newborns, there are 3 degrees of maximum body weight loss.

I degree - with a weight loss of less than 6%. At this degree, there are no clinical manifestations of dehydration. There may be some greed when sucking. But in laboratory parameters, there may be signs of intracellular hypohydration (dehydration). This is an increase in the concentration of sodium in plasma, potassium in erythrocytes, high values of the potassium-nitrogen ratio of urine. But, as a rule, in healthy newborns, these indicators are not determined, therefore, these changes in the body remain unnoticed. Do not worry, as they do not affect the health of the baby.

II degree - with a loss of body weight 6-10%. Clinical manifestations may either be absent, or the child has thirst, anxiety, irritable cry. Other symptoms are the brightness of the mucous membranes, slow straightening of the skin fold, tachycardia, and shortness of breath. Laboratory data indicate intracellular and extracellular hypohydration - this is an increase in the hematocrit number, total serum protein, oliguria (decrease in the amount of urine), an increase in the relative density of urine.

III degree - weight loss of more than 10%. Clinically, the child has thirst, severe dryness of the mucous membranes and skin, the skin fold straightens very slowly, the large fontanelle sinks, tachycardia, shortness of breath, there may be an increase in body temperature, anxiety, tremor. In some children, on the contrary, weakness (decreased motor activity), decreased reflexes, up to their complete extinction, and marbling of the skin are noted. Laboratory data indicate pronounced signs of intracellular and extracellular hypohydration - a significant increase in the level of sodium in the blood, thickening of the blood (increase in the hematocrit number), an increase in total plasma protein. Oliguria and an increase in the relative density of urine are also noted.

Prevention of dehydration with physiological loss of body weight

Rational organization of newborn care and breastfeeding- early attachment to the breast, followed by attachments every 2-2.5 hours (or free feeding mode);

Temperature regime(prevent the child from overheating);

With the appearance of clinical manifestations, with a daily loss of body weight of more than 4%, with overheating of the child, if laboratory signs of dehydration are detected, it is advisable give a child a drink between feedings with 5% glucose (or 5% glucose in half with Ringer's solution).

Restoring body weight in a newborn

After a transient (physiological) loss, the restoration of body weight at birth in healthy newborns usually occurs by 6-7 days of life. In some children, the necessary increase in body weight can be delayed until the second week of life.

In premature babies, especially those with grade 3-4, as well as in children with large body weight at birth, body weight recovery is slower.

Optimal thermal regime, timely detection and elimination of hypogalactia, early attachment to the breast, proper care for the baby, these are the main factors that contribute to the rapid restoration of normal body weight.