Why premature. Potential long-term consequences of extremely low birth weight. What happens to the immune system of a premature baby
All babies who are born between 28 and 37 weeks are considered premature. Parents of seven-month-old and eight-month-old babies, naturally, are worried about how to properly care for the baby, feed him, what kind of rehabilitation he needs so that the seven-month-old baby will not lag behind in development and have normal health in the future. You need to understand that all children who are born in the period of 7-8 months require special, rather difficult, but quite doable, competent care. Medical patronage, comprehensive and regular observation, as well as professional counseling of such babies, combined with the sincere desire of parents to help their child, significantly reduce the resonance picture from premature birth. Of course, the birth at 7 months changes the beginning of the child's development, but a little time will pass and with proper care, all the differences of such a baby in comparison with those who were born on time will surely become a thing of the past.
Description
The fetus at 7 months is almost fully formed, which allows it to live outside the mother's womb. However, its organs are not yet fully developed, and the life support systems are not yet functioning at full capacity. In this period, only the baby's stomach and intestines were fully formed. His kidneys are almost fully developed, but they begin to work only when the child is born. Also, during this period, the baby's lungs are actively developing. By the age of 7 months, the fetus almost completely occupies all the free space that is in the mother's uterus. The head of a seven-month-old baby is proportional to the body, this is the period that is the peak moment in the development of his cerebral cortex. A seven-month-old baby may already react to pain in the same way as an adult, i.e. fully-term fetus. In addition, a child at 7 months can already taste food.
The skin of a seven-month-old baby is still wrinkled and reddish, nevertheless, adipose tissue is already developing under it with might and main. At this stage of pregnancy, the fetal brain increases in size. The child creates nerve connections, i.e. his nerve cells are turned on to full work.
Reasons for the birth of seven-month-old children
It is quite difficult to determine the exact reason for the birth of children at 7 months, because for the most part it is not isolated, but complex. However, gynecologists and obstetricians who have been practicing for decades have identified some basic prerequisites for this. The reasons for the birth of seven-month-old children can be both clinical and biological, as well as socio-economic factors. The main causes of preterm birth by the mother are:
- inadequate living conditions of a woman expecting a child - her untimely appeal for medical care, an incorrectly balanced diet of her food, the absence of normal conditions in everyday life;
- harmful / hard work - a pregnant woman must remember that according to the labor code of our country, she has every right to contact her higher management and ask to be transferred to lighter work;
- habits dangerous for the health of a pregnant woman and the fetus - smoking, alcohol abuse, especially her use of drugs;
- too late pregnancy or too young age of the expectant mother;
- the presence of a pregnant woman in the past, spontaneous or medical abortion;
- various clinical factors, including chronic diseases of the expectant mother;
- problems in the endocrine system of a pregnant woman;
- constant nervous shocks.
In addition to the above, there are also factors of premature birth on the part of the fetus - these include genetic or chromosomal pathologies, as well as the immunological conflict between the fetus and the mother's body.
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What is the normal weight for a seven-month-old baby
According to modern experts in obstetrics and gynecology, normally the weight of a seven-month-old child should be 1.5 kilograms, and his body length should be 41 cm.
In general, all those children who are born between 28-37 weeks weigh no more than 2.5 kilograms. Despite the norms, a seven-month-old baby can have completely different weights within these limits - it depends on many factors. Modern experts classify four levels of prematurity for a baby who was born prematurely. It must be borne in mind that the care and development of such babies should take place in accordance with that specific level to which he belongs in terms of his birth weight:
- Level I: 2000-2500 grams;
- Level II: 2000-1500 grams;
- Level III: 1500-1000 grams;
- IV level: less than 1000 grams.
Nutrition for a seven month old baby
Babies that are seven months old are naturally lower in body weight than those born at term. Accordingly, the body of such children should develop at a faster pace. But on the other hand, in seven-month-old babies, the digestive system is still immature. In addition, they have insufficiently developed swallowing and sucking reflexes.
In addition, insufficient saliva production is an obstacle to the normal functioning of the digestive system - this is quite typical for seven-month-old babies. Also, the capacity of the stomach of a premature baby is less than that of children who are born on time - accordingly, they spit up much more often. In addition, breast milk is not fully digested by the child due to the decreased secretion of gastric juice.
In some modern maternity hospitals, they practice complementary feeding of seven-month-old babies with artificial mixtures. You should discuss this issue with your pediatrician in advance. But when deciding how to feed a seven-month-old baby, his mother needs to remember that the most complete and healthy food is her breast milk!
Therefore, the mother of a seven-month-old baby should try to maintain breastfeeding in all possible ways. Even in the case when the baby was born extremely weak and cannot eat on its own, but feeds through a tube, it is still possible to feed him with expressed breast milk.
When can you pick up from the hospital
It should be noted that at birth at any time, absolutely all babies lose weight. It is clear that this is much more noticeable when the child is born prematurely. A seven-month-old baby can lose about 15% of its body weight at birth. Weight loss seriously affects the thermoregulation of his body, therefore, such a child needs special conditions for heating. For these purposes, the incubator method is used today in maternity hospitals, which is quite effective, because it makes it possible to create absolutely those physiological conditions that are necessary for the life and normal development of a seven-month-old child.
Of course, a pregnant woman who is threatened with premature birth has the opportunity to contact a specialized maternity hospital for help, which specializes specifically in carrying out such childbirth, then you need to do this. In medical institutions of this kind, nursing seven-month-old children is the most common event, and the medical staff of such an institution has all the practical skills necessary for this. If this is not possible, then you should not panic anyway, since any modern maternity hospital has an incubator for premature babies, so the survival rate of seven-month and eight-month-old babies is quite high today.
In the incubator, there is the most suitable environment for the baby, which helps him not to waste a lot of energy when breathing. In addition, competent specialists working in incubators will help the child gain weight, he will be under constant supervision, etc.
If we talk about when you can take a seven-month-old baby home from the hospital, then in this matter you should definitely obey the doctor who deals with the premature baby. When the baby, in a hurry to be born, gains the body weight necessary for him, acquires absolutely all the skills necessary for a normal life (i.e., learn to breathe, cry and suck fully), then a competent doctor will write the mother and baby home only after that!
Rehabilitation of a child who was born at seven months after discharge from the hospital
Parents of seven-month-old babies are concerned with the question of the rehabilitation of such children at home, i.e. how to care for him after the child is at home. It should be noted that, as a rule, no special rehabilitation program is required in uncomplicated cases - over time, nature and maternal care will do their job. In addition, upon discharge from the hospital, a real qualified specialist will definitely give the mother of a prematurely born baby basic detailed recommendations and advice on how to properly care for such a child. The main conditions that must be observed are to follow these recommendations exactly, as well as timely and regularly observe the baby in the clinic. In this case, a child born at seven months in the future will grow up absolutely healthy, full-fledged and will not differ in any way from those children who were born right on time.
Due to various circumstances, premature babies are born. The development of such crumbs is different, compared to full-term babies. With the correct observance of all conditions by twelve months, such crumbs correspond in development to babies born at term.
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External characteristics of premature babies
How do premature babies grow?
Before embarking on the study of the characteristics of infants born earlier than the due date, one should study their characteristic signs.
For babies of the specified group stands out clearly:
- manifestation of lethargy and weakness;
- tiny growth;
- small values of mass;
- lack of skin on fontanelles;
- pronounced redness of the body;
- a thin layer of the auricles;
- displacement of the large fontanelle;
- the presence of "lanugs" - soft hair bundles;
- lack of formation of the external genital organs;
- disproportionately big head;
- a huge belly with a low navel;
- transparent thin nail plates;
- short arms, legs and neck.
The described signs indicate the incomplete development of the baby and the need to create comfortable conditions for its further formation. Most often, the weight of a premature baby does not exceed two kilograms.
Important! The prematurity of the toddler is not a pathology, but only a consequence of early labor.
In such a situation, parents should concentrate all efforts on the timely development of the baby.
Development features
How do premature babies develop? Premature babies are considered to be born from twenty-four weeks of pregnancy. The development of the children of this group has its own nuances, which are manifested in the following:
- A special type of functioning of the nervous system. The functioning of the nervous system differs from the functioning of the nervous system of normal newborns. Therefore, babies born ahead of schedule are demanding attention, especially from the mother. You should create maximum comfort in the house, and surround the baby with care and affection.
- Late development of behavioral skills. Children born ahead of time learn behavioral skills later than their peers. For example, when a baby appeared at thirty-two weeks of pregnancy, the duration of his lag behind his peers is at least three months.
- The use of couveses. If the weight of the crumbs born does not exceed one and a half kilograms, then for its further development, it is definitely required use of jugs... Komarovsky believes that only the conditions of the kuvezes allow the baby to grow to a healthy weight, since they are as close as possible to the intrauterine ones. An increase in body weight up to two kilograms causes the baby to move to a crib with a special heating.
The use of thermoregulatory conditions for premature babies is very significant, since it directly affects the further development of the baby.
Premature babies should be kept in a room where the thermal regime does not drop. below twenty degrees Celsius, and the humidity is below fifty percent.
The features of the development of premature babies have been studied in detail using numerous examples.
Mothers of such crumbs should familiarize themselves with the special literature and monitor the development in the development of their baby.
A deviation or a long delay in the development of a premature infant is a signal of immediate visiting a pediatrician. This will avoid the appearance of undesirable consequences, and sometimes it saves the life of the baby.
How are they developing by months
Premature babies develop somewhat differently after birth than their peers. At first, their body is trying to gain the prescribed weight and "re-form" organs. The development of a premature baby by months to a year can be clearly seen in the following table.
| Baby age from birth |
From birth | |||
| weighs less than 1 kg | weighs 1.5 kg | weighs 2 kg | weighs 2.5 kg | |
| Weight gain in grams | ||||
| Monthly | 180 | 190 | 190 | 300 |
| Two-month | 400 | 650 | 750 | 800 |
| Three month | 650 | 650 | 750 | 750 |
| Four month | 600 | 650 | 850 | 750 |
| Five month | 650 | 750 | 800 | 700 |
| Six month (half year old) |
750 | 800 | 700 | 700 |
| Seven month | 500 | 950 | 600 | 700 |
| Eight month | 500 | 600 | 700 | 700 |
| Nine month | 500 | 600 | 700 | 700 |
| Ten month | 450 | 500 | 400 | 400 |
| Eleven month | 500 | 300 | 500 | 400 |
| One year old | 450 | 350 | 450 | 300 |
The table illustrates the development by months in the form of a monthly increase in body weight. The given data are average and may vary in individual cases.
Depending on the weight of the newborn at early birth, the following are distinguished prematurity categories:
- Body weight ranges from two thousand grams to two and a half thousand grams. The first category includes babies born between thirty-sixth and thirty-seventh weeks of gestation. By the age of twelve months, the mass of such children increases. at least four times.
- Weight from one and a half thousand grams to two thousand grams. This category includes babies born from thirty-two to thirty-five weeks of gestation. In a year, the weight of the described crumbs increases at least five times.
- The mass of babies is from one thousand grams to one and a half thousand grams. "Deeply premature babies" - babies in this category. They are born before thirty weeks of pregnancy. By the age of twelve months, their body weight increases at least six times compared to the original.
- Children weighing less than a thousand grams. Infants who are six months old have extreme body weight. With proper care, they increase in weight eight times by the year.
Every premature baby is the result of the wrong behavior of a pregnant woman or the presence of pathologies in her. Therefore, you should not complain about others, but pull yourself together and start taking proper care of the newborn, if this did not work out while he was in the womb.
Your child's development
It is important to understand that the development of premature babies is somewhat different from that of full-term babies.
A child who developed in the mother's body for only 6-8 months cannot be compared with a child who had as much as 9 months to grow and develop.
When assessing the development of a baby, it is necessary to focus on his “corrected age”. This age can be determined by subtracting the number of months the child was born earlier from his actual age.
Estimating the corrected age gives parents and healthcare providers a realistic idea of the rate of development of a premature baby. A 5 month old baby who was born 3 months ahead of schedule should be considered 2 months old from a developmental point of view.
If a child has been in a serious condition for a sufficiently long time, then during the first months of life he may lag behind in his physical development or the development of motor skills and from his corrected age.
How premature babies behave
Most premature babies are discharged home about two weeks before their expected date of birth. But even if the child has reached this date, he still has something to "catch up". Perhaps he:
- Shows no clear signs of being hungry or tired
- still weak and has difficulty eating;
- sleeps or screams all day, or goes from one state to another within a few seconds.
The child will begin to better express his needs, and you will learn to understand what these or those signals mean. Like all babies, a premature baby will have stages of rapid development followed by long periods when nothing seems to be happening.
- You cannot force or "push" a child to develop if he is not yet ready for this. You should not try to stimulate him to activity if he is tired or actively resists. The violence will only lead to the fact that both the child and the mother will be upset.
- You need to focus on your baby's progress. The child began to walk at 12 or 20 months, after a few years it will no longer make any difference.
- When observing the neuropsychic development of a baby, when assessing his abilities, it is always necessary to take into account the adjusted age.
Uncoordinated movements are often observed in premature babies. It is difficult to predict how your child will react to you and the world around them.
- His reactions can be impulsive, sudden, as he tries to adapt to changes in the world around him and even to his own physical needs.
- The child may suddenly tense arms or legs, or pull them towards him.
- At times, he becomes lethargic, and then quickly goes into a state of tension.
- keep his arms and legs pressed to the body;
- When moving the child, try to keep your movements slow and smooth.
Breath
The breathing pattern and skin color of a premature baby can change quickly and unexpectedly. It is necessary to observe the child and try to catch the characteristic features of breathing and the "normal" color of the skin.
- Observe the baby's chest as it breathes.
- Count his usual number of breaths per minute.
- Listen for the sounds it makes when breathing normally.
The newborn baby sleeps most of the day. A full-term baby can sleep 15 to 22 hours a day. Premature babies have longer periods of sleep and shorter periods of wakefulness. When a child arrives home from the hospital, his perception of day and night is impaired.
It must be remembered that a familiar environment during sleep is important for a child. While some babies who have just been discharged from the neonatal unit learn to sleep in a dark, calm room, others lack noise and light. If your child is having trouble sleeping:
- turn on the night light. Give him the opportunity to hear background sounds, such as quiet piano playing or other quiet melodic music;
- gradually eliminate additional noise and light to help the child adapt to the home;
- resist the urge to play with your baby during the night feed. During this time, try to keep the child's attention focused on the food.
Cry
At first, a premature baby will not scream a lot. His ability to express his emotions by crying seems to develop as his expected date of birth approaches.
The first episodes of crying may be short. The baby can be easily soothed by gentle stroking or by letting him suck on the breast or nipple. As he grows, he will start screaming more often. The ability to cry is a good sign of normal infant development.
Crying signals to the mother that the baby is hungry, uncomfortable, or tired. If they react to his crying, it helps to develop in the child a sense of trust and a feeling that he can already communicate with other people.
During these first months, the baby should be picked up as often as possible, as soon as there is time and "free" hands for this. It will not spoil the child. The more attention is paid to the child, the more they communicate with him, the better he develops and the faster he "catches up" with his peers.
In some cases, it can be difficult to calm down a crying child. Prolonged episodes of crying can signal that the baby is unwell or in pain.
If the child cries for an unusually long time, a doctor should be called. As a rule, nothing bad will be found, however, it is necessary that a specialist confirms this.
- Full-term newborns in the first months of life can cry for 2-3 hours.
- Some premature babies, especially the smallest ones, are very moody and may cry 6 hours a day or more.
Whims and crying usually peak at the adjusted age of 3-4 months. As the child gets older, they will cry less and sleep more regularly.
How to calm a crying child
First, make sure that the baby is not hungry and does not need to change his diaper.
- Place your child so that he can see you. Talk to him affectionately.
- Bring your baby's hand to his mouth or give him a dummy.
- Keep your baby's arms close to his chest.
- Swaddle your baby. His shoulders should be free, and his torso should not be tight, but tightly wrapped in a baby blanket.
- Pick up the baby. The movement is usually calming, so try to rock your child rhythmically or walk around with him.
- Resist the urge to entertain your child. Maybe he doesn't tolerate stimulation well. Instead, give him peace.
- Give your baby a warm bath (unless the baby doesn't like water).
- If all of these methods are ineffective, put your baby back in the crib and let him cry. Sometimes this is exactly what a crying child needs to calm down.
- Never shake your baby to stop crying. This can lead to brain damage or even death of the baby.
When premature babies are hungry, they may not cry, unlike full-term babies. Due to the immaturity of the nervous system, the child may not know that he is hungry. And since his stomach is very small, he should be fed a little, but often (approximately every 2.5-3 hours, and sometimes more often).
As the baby grows, when he becomes more physically developed and can better coordinate his sucking, swallowing and breathing, he will take longer to saturate.
A premature baby needs a lot of energy to suckle. Its mouth is small and the muscles used to suck are weak.
If the baby is breastfed, you need to provide additional support for his head and shoulders. If your baby is bottle fed, you may need a specially designed soft teat designed for premature babies to make sucking less tiring. The child will eat better if fully awake, so help him focus on eating.
Until the baby is able to suckle properly, it should be fed in a calm room with no bright lights, minimizing distractions, even talking and motion sickness. Make eye contact with the baby by supporting the head and neck with your hand or forearm. The baby should be comfortable, he should not stretch out too much or shrink. Feeding should be a pleasant and relaxing pastime for both the baby and the mother.
It is very important to keep track of how often your baby has bowel movements, as many feeding problems occur when the baby does not have to empty his bowels regularly. The chair can be after each meal, or maybe just once in 1 or 2 days. If the baby is breastfed, the stool will be soft, yellowish in color, similar in consistency to cottage cheese.
If the baby is receiving formula, the stool may also be soft and yellow to brownish green in color.
Track your child's normal stool frequency and consistency for signs of constipation or diarrhea.
If your child's stool is difficult to move, or you suddenly have frequent watery stools, you should call your doctor.
Also pay attention to how often the baby's diaper gets wet. The number of micturitions should be at least equal to the number of feedings. Fewer wet diapers can be a sign that the baby is not getting enough milk or formula.
Breast-feeding
Breastfeeding has many special benefits. Several components of breast milk help protect your baby from infection. Breast milk is the optimal source of nutrients for a premature baby.
After discharge, a premature baby may tire quickly during feedings and may not fully suckle the breast. To ensure adequate milk supply during the first weeks, it may be necessary to express and feed or store expressed milk.
In addition to breast milk, some premature babies need an additive to help them grow, such as a breast milk fortifier, vitamin and mineral supplement, or a special formula. Your doctor will tell you if your child needs any of these products.
- Before you leave the hospital, make sure you are familiar with all aspects of breastfeeding.
- Work with your doctor or breastfeeding specialist to make a plan of how often you will need to feed your baby and if any supplements are needed.
- An early checkweigh, done at home or in your doctor's office, will give you the information you need to make sure your baby is getting the right amount of food for adequate growth and development.
Bottle feeding
If for some reason the mother does not breastfeed and cannot express milk, the doctor will prescribe a special infant formula. The ESPGHAN (European Society of Pediatric Gastroenterology, Hepatology and Nutritionists) Nutrition Committee recognizes that after hospital discharge, it is better to use special formulas for premature babies, which have a higher concentration of nutrients than standard formulas for full-term babies. *
Usually, premature babies and low birth weight babies are discharged from the hospital when their condition is stable. However, even after discharge, these children still have special nutritional needs. Adequate nutrition plays a large role throughout the first year of life, when the baby grows especially quickly. While in the hospital with the child or visiting him, parents must learn special feeding techniques and learn to determine how much formula the child needs in 24 hours.
Due to the fact that a premature baby has a risk of developing iron deficiency, iron should be present in his diet: either in the food itself, or in the form of an iron preparation in drops. This is due to the fact that by the age of 2 months, the child's iron stores may be depleted, which can lead to the development of anemia.
Upon discharge from the hospital, the doctor will give the necessary recommendations not only on feeding, but also on the use of vitamins.
It should be remembered that vitamins are also medicines, therefore, these drugs can be given to a child only on the recommendation of a doctor.
Development of the senses
Vision
At the corrected age, corresponding to 0 months, premature babies can see objects at a distance of 20-30 cm, which is approximately the distance from their eyes to the face of the person who feeds or holds them in their arms.
By the corrected age of about 6 months, premature babies can see almost as far as adults.
All children distinguish between dark and light.
- At first, they like simple black and white designs such as diagonal stripes.
- As children get older, they become attracted to more intricate and subtle patterns and vibrant colors.
- Like adults, children become bored if they look at the same object for a long time.
- Most of all, children love to look at faces.
- The constantly changing expression of a human face is a subject of continuous interest for them.
- During the first weeks and months at home, your face-to-face contact with your child, at first briefly, will be an important source of learning.
- At the adjusted age of 0 months, the baby is able to mimic smiles, frowns, and other facial expressions. He may even try to imitate you if you stick out your tongue!
- You will become the main object of interest and attention of your baby. Your smile, the sound of your voice and the comfort you provide play a key role in a child's development. The increasing frequency of his reactions to you can be seen as an important indicator of progress.
Children seem to hear sounds that change, such as voice or music, better than sounds that stay the same.
- The easiest way for your child to “tune in” to the sound of your voice and enjoy it.
- Children like quiet music, especially the singing of a person, even if he is out of tune.
Even a child with normal hearing may not respond to some loud noises. However, a persistent lack of reaction to sound should serve as a signal for concern and should be brought to the attention of a specialist.
Touch
Naturally, you touch and pet your child. Touch is a calming force that makes him feel safe.
Children who love to be hugged (which is most children) tend to relax and cuddle up against the person holding them. Enjoy these minutes.
Children love to touch everything. Let your child feel for the things they encounter every day: a towel, a diaper, water, clothes and your skin.
Taste and smell
The baby can taste and smell. Of course, newborns prefer the taste and aroma of breast milk. They often wrinkle their noses when offered stale expressed milk or formula.
Communication
One of the first achievements of a child is a smile, which appears at the corrected age of 2–3 months.
- To inspire your little one to smile, smile at him yourself. Smile at your child when you talk to him or take him out of the crib, and always when he smiles at you.
- Although in the first months the child does not understand words, he learns to "maintain" a conversation.
- It is very important to talk to your child.
- This helps him learn the language and serves as the basis for many other skills.
- Feel free to talk to your little one about everything you do.
- Express your love for him in words without hesitation.
Signs indicating a comfortable state of the baby
In the process of communication, premature babies give signals of "readiness", which show others that they are in the mood for communication or play. When a child is ready to interact, he is characterized by the following:
- pink skin color
- cheerful, cheerful expression
- eyes are wide open, eye contact is maintained
- arms folded crosswise on the chest
- fist in the mouth
- the arms and legs are relaxed.
Children also have signs of fatigue, which indicate when the child needs a break. If too many things happen, the child may:
- look away
- be capricious and cry
- hiccup
- spit up (be careful if vomiting occurs! This is a reason to consult your doctor)
- arch your back
- squeeze your arms and legs.
Interaction with the pediatrician
It is important that the doctor you are talking to knows that your baby is premature and is being treated in the neonatal intensive care unit (NICU).
The fullest contact is established with the pediatrician who is best able to understand and share the feelings of fear, confusion and love that are natural for you in the process of caring for a child.
First doctor visits
Find out in advance the number and telephone number of your children's polyclinic so that the medical staff from the hospital can inform the local doctor about your discharge. The local pediatrician should examine the child at home within the first two days after discharge. Give the pediatrician all recommendations and results of examinations carried out in the hospital. Be sure to keep all copies for yourself, which you will need to provide to other consultants if necessary. You should create a special folder where you will put all the child's medical documents.
For the first month, all examinations of the child are carried out at home. In the future, a visit to the doctor is recommended only on the "baby" day, in order to reduce contacts with sick children in the children's clinic. When the child grows up, it will be easier to visit places where there are congestions of children, since the baby's immune system will mature and he will be able to more easily transfer the disease.
When visiting a doctor, you need to discuss the progress in the development of the child and ask about everything that worries you. We recommend that you write your questions down in advance using the free space at the back of this brochure. What a mother tells the doctor about her child is very important. Be sure to discuss issues related to activity, attention level, sleep, nutrition, and personality. Don't let baby's weight and stool be the only issues discussed with your doctor. You should ask the doctor or nurse to explain everything that you do not understand, and also that they write down their recommendations.
Vaccinations
In the Russian Federation, a system has been established for the initiation of vaccination of premature babies in accordance with the adjusted age. Usually, preterm babies are vaccinated when their body weight reaches 2200 grams.
It is necessary to discuss the child's vaccination schedule with the pediatrician and not to miss the scheduled visits. Vaccinations are very important for a premature baby, as severe infections (from which vaccinations are carried out) most often affect weakened children.
World practice insists that premature babies, more than others, require vaccinations, and as early as possible, especially if the child is forced to often visit a children's clinic or hospital. However, remember that vaccination is not a neutral procedure for the body of any baby, especially a premature baby. It is necessary to ask what kind of vaccinations will be given to the child, how to prepare him for them, what to observe, what side effects may be, and what to do in this situation.
On the day of vaccination, the child may experience a slight discomfort, a painful reaction, eat worse and be capricious, he may have a fever. All this is normal, but requires careful observation and understanding. On the first day after vaccination, it is advisable to create a "protective" regime, reduce contact with other children and protect the baby from excessive fatigue. Typically, a reaction to a vaccine can last 1–2 days.
Cosmetic problems
Often, premature babies have congenital spots at birth, which are called hemangiomas. These "strawberry patches" are soft, red-colored protruding patches of dilated blood vessels (capillaries). By the end of the first year of life, they begin to gradually disappear and usually disappear by the age of 4.
In the case when hemangiomas begin to grow ahead of the general growth of the child, or if the spot becomes bumpy and rises above the surface of the body, it is necessary to consult a doctor to resolve the issue of cryocoagulation of these areas, which is not only of cosmetic importance, but also prevents pathological vascular growth in place of hemangioma.
Another cosmetic feature can be scars after operations and procedures, which in some tiny children look very large and ugly. In most cases, over time, as the child grows, they become less noticeable.
Cardiopulmonary resuscitation
A feature of the development of a premature baby is its tendency to viral infections. Swelling of the mucous membrane of the respiratory tract and nasopharynx associated with a viral infection, impaired airway patency and difficulty in implementing an effective cough can lead to severe respiratory failure, up to and including stopping it. In this regard, it is desirable to have an idea of how to provide first aid to a child before an ambulance arrives. Such knowledge will allow parents to achieve the resumption of the work of the heart and lungs of the child in the event of an emergency.
Cardiopulmonary resuscitation is a skill that every parent and everyone who cares for a child must master. It consists in freeing the airways by sucking mucus, reflex action (slaps on the chest, back, cheeks), conducting mouth-to-mouth breathing, and indirect heart massage.
The sequence and technique of carrying out these events must be learned in a calm atmosphere, preferably by trying to do all the actions yourself on a special children's dummy.
Most likely, this knowledge will not be needed, but if something happens, the parents will not be confused and will not waste precious minutes to save the baby.
Does the child need examination?
Metabolic screening of newborns
All newborn babies must be tested for some rare hereditary diseases. If left untreated, these conditions can have a serious adverse effect on a child's development. For testing, a few drops of blood are taken from the heel area or from the baby's finger. Although testing is done in a hospital for all children, in some cases retesting is necessary after being discharged home. At discharge or at the first visit, check with your doctor that your child has been screened for these rare but serious conditions.
Follow-up vision assessment
All premature babies weighing less than 1,500 grams at birth and babies who have had medical complications during their hospital stay should be seen by an ophthalmologist.
If the child underwent an eye examination in the hospital, the results and recommendations should be noted in an extract from the medical history, which is given to the parents.
Follow-up hearing assessment
Before leaving the hospital, the child undergoes a hearing assessment. Repeated examinations are often recommended. The test results and recommendations should also be in the discharge from the medical history.
Practical advice
Safety seats in the car
Always place your child in an approved child seat in the back seat of the car before going anywhere by car. Even the smallest children need to be transported in a child seat. Use a 5-point child car seat or a 5-point safety foldable seat.
Do not use hard or slippery plastic underlays. Remember that a child seat should never be placed on an airbag-protected seat. A premature baby in a car seat will need extra support to keep his torso straight and breathe easier. Rolled up blankets and diaper clothes can serve as extra padding to keep your baby from slipping and moving.
Diapers and clothing
There are diapers designed specifically for premature babies.
As the child will soon grow out of these garments, one should not buy too many of them. Nowadays, ready-made clothing for premature babies is sold in specialized stores and on Internet sites, but you need to make sure that it meets the required safety standards.
Crib
Never use a spring net in a baby's crib; make sure that the distance between the bars of the cot is no more than 6.5 cm. If this distance is greater, the baby's head may get stuck between the bars.
- The mattress should be firm and fit snugly against the crib frame.
- There should be only a thin, tight sheet between the mattress and the baby.
- Do not place soft, bulky objects in the crib that might interfere with your baby's breathing.
It is necessary to maintain a comfortable temperature in the children's room within the range of 22-24 ° С.
As a precaution, baby's skin temperature should be monitored. A temperature of 36.6–37.4 ° C is considered normal for a premature baby.
- If your baby has cool, pale, or bluish hands and feet, keep him warm.
- If your baby's skin is warm and overly red, the baby may be dressed too warmly.
Infection control
In some countries, colds and respiratory diseases are common in autumn and winter, or during the rainy season. Common and severe respiratory infections in premature babies are usually caused by respiratory syncytial virus (RSV).
Before leaving the hospital, you should consult with your doctor about how to protect your child from the development of severe respiratory diseases caused by the respiratory syncytial virus (pneumonia, bronchospasm, shortness of breath and choking).
Currently, in the world and in the Russian Federation, there is an opportunity to protect a child from severe RSV infection by injecting him with protective antibodies.
After the child has been taken home, you need to give him and yourself a few weeks to adapt before inviting relatives and friends.
Anyone should wash their hands with warm water and soap before touching a child. It must be remembered that a respiratory syncytial viral infection can be transmitted by kissing.
No one should be allowed to smoke near the child. Newborns and children who come into contact with tobacco smoke are more likely to have respiratory infections.
Bathing time
Bathing time should be as short as possible: premature babies are characterized by rapid heat loss.
- Check the water temperature with your wrist or elbow before placing your baby in the bath. The bathroom should be warm and free of drafts.
- Wash your baby with gentle, caressing movements. After bathing, wrap it in a soft towel.
Whenever possible, try to sleep when your baby falls asleep. Caring for a premature baby is a real job and not for one person, so feel free to ask for help if you need it. Take turns taking care of your baby.
- While family and friends may initially be asked to refrain from visiting so you and your child have time to adjust, do not refuse their help with cooking, cleaning, and running errands if they offer it.
- Parents need to spend some time apart from their child. Take timeouts. You need personal life and rest.
- According to many parents, their anxiety and stress are reduced when they talk to other parents of premature babies.
- You are probably worried about whether the premature birth will affect the mental development of your child. Most premature babies develop normally. Few babies born prematurely have serious and long-term problems.
- Many famous people were born prematurely. These are, for example, Mark Twain, Albert Einstein, Anna Pavlova and Winston Churchill.
- One of the most important factors in the development of premature babies is the home environment. Love, attention and care will help to develop your child's full potential.
- Parents are often overprotective of their premature baby, even if the doctor reassures them that everything is okay. In such families, the child can become dependent and demanding. As a parent of a premature baby, you must help your baby to develop both emotionally and physically. As your child grows, you can help him adapt by setting a schedule and norms.
- Continue to contact your pediatrician. He will confirm whether your baby is developing normally and give useful recommendations. Everyday life plays an important role in creating the right parent-child relationship that you both need.
I.I. Ryumina, MD, DSc, Head. Department of Pathology of Newborns and Premature Babies of N.N. IN AND. Kulakova, Ministry of Health and Social Development of the Russian Federation,
E.S. Keshishyan, Doctor of Medical Sciences, Professor, Head of the Scientific Department of Neonatology and Pathology of Young Children, Head of the Center for Correction of the Development of Premature Infants.
The expectation and birth of a child is a period of joyful, but also exciting events. Of course, I really want the pregnancy to proceed without problems, and the baby was born full-term and healthy. However, for many reasons, childbirth can occur prematurely, and then the baby is born prematurely.
Which baby is considered premature?
Babies born before the 38th week of pregnancy are considered premature. In most cases, premature babies weigh less than 2500 g and less than 45 cm in length.At the same time, a small weight of a child is not an absolute sign of prematurity, since in utero some children gain insufficient weight for various reasons, forming intrauterine growth retardation syndrome. Although, of course, the overwhelming majority (more than 70%) of newborns born with a weight of less than 2500 g are premature.
Depending on the body weight at birth, it is customary to allocate several groups of premature babies:
children with low birth weight (less than 2500 g);
children with very low body weight (less than 1500 g);
children with extremely low birth weight (less than 1000 g).
What is the difference between premature babies and those born on time?
It is not for nothing that nature has come up with a 9-month gestation period in humans. At this time, the baby is formed and develops enough to be ready for extrauterine life by the time of birth. If for some reason the baby is born prematurely, then it will be more difficult for him to adapt to an unknown and complex life outside his mother’s tummy. Of course, a lot depends on how early the baby is not full-term. If childbirth occurred at 35–36 weeks, then the baby is already mature enough, and if at 28–30 weeks, then much more effort will be required to nurture him.
Premature babies usually have a disproportionate build with short lower limbs and short necks. The head looks larger in relation to the body. The skin of a premature baby is thinner and more delicate, covered with delicate vellus hair. The auricles are very soft. The subcutaneous fat layer in premature babies is not sufficiently formed, and even the fatty lumps on the cheeks are poorly expressed. All these signs can have varying degrees of manifestation, depending on the date of birth of the baby.
But not only external signs make it possible to distinguish a premature baby. The most important feature is the functional immaturity of all organs and systems of the premature newborn. So, premature babies retain heat worse, they are more lethargic and sleepy, they are characterized by a decrease in muscle tone and sluggish sucking. Of course, the smaller the child, the more pronounced these functional features.
What is nursing premature babies?
After birth, a premature baby requires special attention from doctors. Regardless of the degree of maturity and prematurity, the child needs to provide first aid - to warm, suck amniotic fluid from the mouth, provide additional oxygen, and in more severe cases, carry out a full range of resuscitation measures.
The severity of the condition of a premature baby can be associated with several reasons. First of all, pediatricians pay attention to the development of the respiratory function. In the lungs of a premature baby, not enough special substance is produced - a surfactant, which helps them to function fully: it prevents the alveoli from collapsing and ensures normal gas exchange. Lack of surfactant can cause various breathing disorders - from mild respiratory distress syndrome to severe illness in which spontaneous breathing is impossible, and artificial ventilation is required.
Respiratory failure aggravates the child's metabolic changes caused by birth stress and problems with the circulatory systems, digestion, and excretion.
To create a comfortable thermal regime for a premature baby, the baby is placed in an incubator. In parallel with this, all existing violations are being corrected. After the premature baby begins to better retain heat, is able to breathe on its own, and does not require intensive care, he can be transferred from the maternity hospital to the 2nd stage of nursing in a specialized department for premature babies. If preterm birth occurred in a specialized maternity hospital, then such a department is included in its composition. Such a department can be part of a maternity hospital, if a maternity hospital specializes in preterm birth, or at a children's hospital.
Nursing a premature baby at this stage is a logical continuation of the activities started in the departments of the maternity hospital. The period of adaptation to extrauterine life in a premature baby also has some differences compared to a full-term baby. So, weight loss in premature babies is usually more than in babies born on time. The restoration of the original body weight occurs over a longer period: full-term babies usually regain birth weight by 7-10 days of life, and in premature babies this period can stretch for 2-3 weeks.
Another condition that occurs in newborn babies is physiological jaundice. But in premature babies, jaundice is more pronounced and its duration is longer than in full-term babies, which in some cases requires treatment. This is due to the functional characteristics and immaturity of liver enzymes. Feeding a premature baby can also cause some problems, as babies born prematurely do not absorb nutrition well. Feeding small newborns begins literally drop by drop, gradually increasing the volume. Optimal for premature babies is breastfeeding by the mother. As you know, the composition of the milk of a woman who gave birth prematurely differs from the milk of a mother whose birth occurred on time. It contains more protein, electrolytes, polyunsaturated fatty acids and less lactose, better meeting the needs of a low birthweight baby. In the event that breastfeeding is not possible, the baby should receive a specialized formula for premature babies.
When is a premature baby discharged home?
This question worries many many parents whose babies were born prematurely. Of course, such decisions are made by doctors based on the condition of the child. Usually, if the child's weight has reached 2000 g, the baby is actively sucking and gaining weight, he can be discharged subject to active supervision at home by a pediatrician and a visiting nurse. In addition, after being discharged from the hospital, the baby may need additional help from an ophthalmologist, neuropathologist, masseur and some other specialists.
In conclusion, it should be added that a baby born prematurely needs not only experienced and competent doctors and nurses, but also the love and care of mom and dad. Nursing a premature baby is a laborious and long process. But a premature baby has every chance to catch up with his peers over time, and in the future will not differ from them in mental and motor development.
Premature babies are considered children born as a result of premature birth with a weight of less than 2500 grams and a height of less than 45 cm. These criteria are conditional, since many full-term babies are born with a weight of less than 2500 grams, and some premature babies weigh more than 2500 grams. The main feature of premature babies is the immaturity of the main body systems - respiratory, cardiovascular and thermoregulatory. Premature babies require special care and medical supervision. Low birth weight babies born on time are considered to be children with intrauterine growth retardation.
How long is it possible to leave a newborn baby?
According to the WHO definition, children born no earlier than 22 weeks of pregnancy and weighing more than 500 grams are considered potentially viable. Nursing deeply premature babies is possible only in specialized departments of hospitals or perinatal centers. The longer the gestation period at the time of the onset of premature birth, the lower the risk to the baby. Babies born between 32 and 37 weeks have significantly fewer problems than premature babies born between 22 and 32 weeks of gestation. The doctor takes into account the baby's weight when deciding whether to place the baby in an incubator, prescribe phototherapy, when choosing the type of feeding a premature baby, and in other cases.
What does a premature baby look like?
As a rule, his head is disproportionately large in comparison with the body. The skin is very thin, sometimes even translucent, softer than usual to the touch, covered with fluff and grease. The subcutaneous fat layer is insignificant or absent, the skin is wrinkled. The small and large fontanelles are larger than usual. The nails are very thin and often do not reach the fingertips. In boys, the testicles may not descend into the scrotum, and in girls, the labia are underdeveloped. The limbs are thinner and longer, the auricles are soft and pressed against the skull, the navel is low.
What is the immaturity of a premature baby?
Premature babies are usually poorly expressed, and in some cases, basic reflexes are absent. Muscle tone is reduced, the thermoregulatory system is undeveloped, so the newborn cannot independently maintain a constant body temperature. The rest of the body's systems can also be immature - respiratory, digestive, cardiovascular, visual, nervous, and bone. In the absence of vital reflexes (breathing or swallowing), the child is placed in the intensive care unit or intensive care unit.
Why is the child placed in an incubator?
The incubator is a device with transparent walls, allowing you to observe the child, and an optimal artificial microclimate (temperature - 33–38º, humidity - 85–100%, oxygen content - 25–40%). A special opening or special sleeves are provided for caring for a child inside the incubator. Premature babies are placed in the incubator for warming and further protection from cooling the body, as well as to improve blood oxygen saturation. Oxygen can be supplied without interruption if necessary. It should be remembered about the danger of the toxic effects of oxygen on the retina, which can lead to complete loss of vision, especially in deeply premature babies with prolonged maintenance in an oxygen-supplied incubator (with timely diagnosis and treatment, this situation is reversible).
What is kangaroo nursing?
How long does a premature baby need to stay in the hospital?
Premature babies need help to maintain a constant normal body temperature. Being in the incubator allows the child not to waste energy on thermoregulation, quickly adapt and gain weight. The duration of a child's stay in the "incubator" depends on the weight of the child at birth and the general dynamics of his condition. Children with a low degree of prematurity can be in the incubator from several hours to 4 days, children weighing up to 1750 grams. - about a week, and with a weight of up to 1500 gr. - from a week to two. Usually a child is discharged from a maternity hospital or a specialized children's hospital when he steadily gains weight, maintains a constant body temperature, he has no breathing problems and his weight is 2500 g and more.
Will a premature baby subsequently differ from its full-term peers?
In premature babies, the pace of physical development is accelerated, and the less their body weight at birth, the faster it will increase. The neuropsychic development of such children is somewhat slower than usual, premature babies need more attention, special classes (massage, gymnastics). At first, when assessing the psychomotor development of a premature baby, it is necessary to focus on the period in which he should have been born, and count all the milestones from this moment. For example, if a child was born at 32 weeks, that is, 2 months ahead of schedule, one should expect that he will begin to turn not at 3.5-4 months after birth, but at 5.5-6. On average, by one and a half to two years, a healthy premature baby is practically no different from full-term peers.
Is it true that premature babies are more prone to disease?
On average, premature babies get sick more often than ordinary children, the healing process takes longer. Premature babies are more prone to respiratory diseases (bronchitis, pneumonia). Jaundice, which is common in newborns, can pose a serious risk to premature babies. Also, premature babies often have problems with the development of the central nervous system, gastrointestinal tract, and the skeletal system and joints may suffer.