Care for premature newborns in intensive care. Head of the department: Kyshtymov Mikhail Vladimirovich doctor of the highest category. Take care of yourself
Nursing of newborns with low and very low body weight in a hospital setting is one of the specialized areas of neonatal care provided in the Mother and Child clinics. We have all the technological resources to provide competent care for babies, our doctors are leading specialists in the field of neonatology in Russia.
Newborns with low, very low and extremely low body weight and who were born much earlier are admitted to the intensive care unit and intensive care of newborns, and then continue treatment in the department of pathology and nursing of low birthweight newborns.
A child who appears on time has developed all the senses - he is ready to interact with the world around him. It is more difficult for a premature baby - the environment, with its loud sounds and bright lighting, has a negative impact on such a baby. As a result, the baby may subsequently experience hearing, vision, and sleep disorders.
That is why such children need a special individual approach in treatment and care, which is provided first in the intensive care unit of newborns and continues in the department of pathology and nursing of low-birth-weight newborns at the Mother and Child clinic.
We provide treatment and care even for patients with extremely low body weight (less than 900 g). Babies are in conditions as close as possible to intrauterine conditions:
- deeply premature babies are kept in special incubators, in which temperature, humidity, light brightness, sound intensity are controlled and the necessary support for all vital functions is provided (nutritional, respiratory, hemodynamic);
- children with a larger body weight occupy cribs equipped with special heated mattresses. In order for the baby to take a pose as close as possible to the intrauterine one, we use special devices, rollers.
Our clinics use only modern certified equipment that works around the clock and without interruption:
- devices for non-invasive artificial ventilation of the lungs;
- devices for intravenous administration of fluids, parenteral nutrition;
- apparatus for monitoring vital signs;
- climate control devices;
- X-ray machine and ultrasound machine.
The staff of the nursing departments of premature clinics "Mother and Child" will always help!
We provide comprehensive support to children born both in our clinics and in other medical institutions. Highly qualified doctors (of the highest and first categories, candidates and doctors of sciences) and nurses apply all the experience gained over many years of practice for the benefit of the patient.
The health and development of the baby is monitored by the attending physician, the head of the department, and several nurses. If necessary, parents are consulted by specialized specialists of the Mother and Child clinics - neurologists, geneticists, ophthalmologists, cardiologists, otorhinolaryngologists, etc. Our staff provides detailed information about the child - his condition, the dynamics of treatment, care after discharge.
Knowing that tactile contact can be painful for a premature baby, our staff tries to minimize the number of procedures and manipulations, to find an option that will provide appropriate assistance with a minimum of touching.
Contact with mom is welcome!
We believe that minimizing parental contact with children is not worth it, because mothers' touch can have healing powers for the baby. Our staff in every possible way promotes early all-round communication between the mother and the baby, monitors his reaction, receiving valuable information about his condition and development dynamics.
We also support breastfeeding and provide mum with privacy to express when she is not hospitalized with her baby.
For a comfortable stay of patients' parents in the Mother and Child clinics, we have equipped one- and two-room wards with everything necessary. With us, a mother can concentrate only on her baby - food and cleaning are included in the price of the ward. Other relatives or a nanny can also be with the child.
The nursing units for children with low body weight at the Mother and Child clinics are an opportunity to preserve the health of the child and give him a full life.
The department is the first specialized department for newborn care in the country. It was created in 1962 on the basis of the Filatovskaya Hospital on the initiative of the staff of the hospital and the department of hospital pediatrics of the Second Moscow Medical Institute. Since its inception, the department has been an advanced scientific and medical base. All doctors of the department have the highest medical category and many years of work experience. The head of the department for decades has been an experienced neonatologist Mikhail Vladimirovich Kyshtymov. The nurses of the department also have vast experience and certificates of the first and highest categories. Patients are consulted by a neurologist, physiotherapist, ophthalmologist, ENT doctor and other specialists. Each child in the department has not only, but also a leading nurse.
What does the Department of Neonatal Pathology at Filatov Hospital specialize in?
Currently, the department specializes in the treatment of newborns who require resuscitation after birth. In comparison with other departments of newborns functioning at present in Moscow, the department annually takes care of the largest number of severe "reanimation" children. The department nurses both full-term and premature babies. The department has modern equipment to provide assistance at the highest level. The department closely cooperates with other departments of the hospital: the neonatal intensive care unit (neonatal center) and the neonatal surgery department, due to which all urgent measures are carried out as soon as possible. Specialists of the department, departments, as well as a specially created unit - the follow-up office, observe the patients of the department even after discharge.
On the basis of the department, employees of the departments of the Russian State Medical University advise children and conduct scientific work:
Department of Neonatology, Faculty of Advanced Training for Doctors of the Russian State Medical University.
Departments of Children's Diseases with a course of gastroenterology and dietetics FUV RSMU.
Scientific directions of the departments:
Perinatal gastroenterology
Perinatal immunology and neonatal infections
Perinatal neurology
Perinatal Nephrology.
Head of the department: Kyshtymov Mikhail Vladimirovich doctor of the highest category.
The patients of the department are daily consulted by assistants, associate professors, professors of departments,
also head of the department - academician of the Russian Academy of Medical Sciences - Volodin Nikolay Nikolaevich
Several factors play a role in the aggregate:
1.
The term of pregnancy at which the premature birth occurred.
2.
The presence in the 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 most important are the first 20 minutes, on which the life and health of the baby in the future depends.
3.
Complete and correct feeding.
Not all babies born before the "official" date need specialized medical care and nursing. With a moderate degree of prematurity, good health and the absence of diseases, the child is discharged home with recommendations 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 premature birth in a regular 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 starts back in the delivery room:
- After birth, the baby is taken into warmed up sterile diapers and dried.
- Medical manipulations after cutting off the umbilical cord, including revitalization, are carried out in conditions of preservation of heat - on a heated table.
A deeply premature baby spends the first days or weeks of life in an incubator designed to simulate intrauterine conditions. For moderate prematurity, the baby 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 hood 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 from devices for measuring indicators are brought to the baby: body temperature, blood pressure, blood oxygen saturation and some others.
Devices are used to create a "nest" - the conditions for a comfortable and convenient position of the child: on the side, abdomen, 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 chamber of the incubator 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 С, more than 1000-1500 grams - 32 o С.
- Air humidity is about 60-70% to prevent drying out of mucous membranes and evaporation of water from the skin surface.
- When connected to a ventilator.
- When given through an oxygen mask or nasal cannulas.
The importance of thermal conditions
For a child to generate its warmth, 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 disturbed, leading to the development of hypoxia (lack of oxygen) and acidosis (increased tissue acidity).
Breathing disorder or breath control
There are several approaches depending on the degree of prematurity and the state of health of the baby.
With a moderate degree of prematurity, the baby usually breathes on its own, but sometimes the baby receives moist and heated oxygen through an oxygen mask or nasal cannulas.
With a deep degree, the introduction of an endotracheal tube into the trachea (a hollow organ - an extension of the larynx) is often required. Through it, the baby is connected to a ventilator.
In fact, the ventilator "breathes" for the child with the specified parameters in accordance with the gestational age and general condition. A certain frequency of respiratory movements per minute, depth of inhalation, pressure in the airways and others are set.
Modern devices for standard ventilation work in the trigger ventilation mode, thanks to which the little patient is "taught" to breathe. What does this mean? A special built-in sensor catches the baby's attempt to inhale and automatically synchronizes the breathing apparatus with the baby's inhalation.
Non-invasive mechanical ventilation
It is used when the child breathes on his own, but it is given to him with difficulty.
Through nasal cannulas or a small mask, an oxygen-air mixture is supplied under constant positive pressure, which maintains the lungs in an expanded state. The exhalation occurs independently.
Some models of this type of ventilator operate in a two-phase mode: several breaths are taken against the background of the injection of an oxygen-air mixture. 
High-frequency oscillatory ventilation
As such, the usual inhalation and exhalation are not performed. The exchange of oxygen and carbon dioxide occurs due to oscillations of the chest - oscillations created by the apparatus.
The method is ideal for use in deeply premature infants with very immature lungs or already developed pneumonia.
A baby with a birth weight of 1000 grams or less is often on mechanical ventilation 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: barotrauma (rupture of lung tissue with air bubbles entering the blood) 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 the loss of water and proteins.
Substances are injected intravenously, slowly, at a predetermined rate using a lineamat or an infusion pump - a medical device with a syringe.
The introduction of solutions and / or drugs is possible in two ways: 
Fluid replacement
The 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 fluids.
Basically, 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 electrolyte content 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 treating uncomplicated neonatal jaundice is phototherapy in combination with "drinking" glucose or intravenous infusion of solutions. A child without clothes is placed under a special UV lamp, which destroys the bilirubin in the skin and promotes its elimination. Special glasses 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 on time phototherapy in many cases helps to avoid blood transfusions.
Fighting infection
Many babies become infected even in utero or during childbirth from their mother. Often, the infection joins after birth. What are the consequences? Due to insufficient immunity activity, any pathogenic microorganism can lead to the development of serious diseases. For example, pneumonia (inflammation of the lungs), sepsis (spread of infection with blood throughout the body), osteomyelitis (purulent focus in the bone) and others.
Therefore, as a rule, antibiotics are prescribed to deeply premature babies from the first day of life. With a moderate degree of prematurity - according to indications: pneumonia, intrauterine infection, and others.
It is advisable to collect blood and urine inoculated on nutrient media before starting treatment. The study is performed to identify a pathogenic microorganism in a baby and select an antibiotic that acts on this particular 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, wet cleaning is thoroughly carried out, the incubator and oxygen supply tanks are treated with antiseptic solutions. You must practice good personal hygiene.
Lines from the inside of the alveoli, contributing to:
- Reducing tension and reducing the risk of collapse (atelectasis) of the pulmonary sacs.
- Removal of phlegm and the involvement of other additional areas of the lungs in breathing.
Cerebral hemorrhage
Significantly worsen the prognosis and condition of the child: convulsions, edema of the brain tissue (excessive accumulation of fluid), short-term breath holding (apnea), minor twitching of the facial muscles, and others are possible.
It is believed that with moderate prematurity and hemorrhages of I-II degrees, the foci in most children dissolve, sometimes even without a trace.
With grade III-IV hemorrhages, the prognosis is poor: about 30-50% of children die by the end of the first month of life.
The approach to treatment depends on the severity of the bleeding:
- With rapidly progressing hemorrhage in a large area and the risk to the child's life, the hematoma is often surgically removed.
- With I-II degrees or multiple small-point hemorrhages, 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 prophylaxis, 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.
- When the hemoglobin level is below 80 g / l, intravenous administration of erythrocyte mass is recommended.
The second stage of nursing is the separation of premature babies
Conditions are created for recovery or rehabilitation, which is needed by almost every child born earlier than expected. The length of stay in the hospital, the amount of medical care and procedures depends on the degree of prematurity and the adaptive capacity of the baby.
Therefore, mentally prepare yourself for a long stay in the department for premature babies: from several weeks to two to three months.
If your childbirth took place in a specialized perinatal center, then there are no problems and delays in transferring 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 department for premature babies, you are with the baby all the time - in the "mother and child" ward. This approach allows you to take care of the baby on your own, feed on demand, support emotionally during medical procedures and procedures. The child constantly senses your warmth and hears your voice, which certainly contributes to a faster recovery.
Thermal conditions
A baby with a moderate degree of prematurity usually retains heat well, therefore 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, independently poorly retaining heat. For some more time, he remains in the chamber of the jail, in which the air temperature gradually decreases. If necessary, humidified and heated oxygen is supplied to the incubator chamber. As soon as the crumb begins to better retain heat, then it is transferred to a heated table.
However, this is not enough: it is necessary to help the baby to adapt to the conditions of life outside the womb.
Kangaroo method
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 feeling unwell.
The main idea of the method: daily laying out the crumbs with a naked body on the skin of the mother's breast for several hours. The child is placed in a prone position with the face facing the mother, which resembles the "frog" pose. 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 spread on her mother's breast for 20-40 minutes, twice a day. Then the duration of the "session" is gradually increased to several hours. After you are discharged home, you can continue using the method at home.
It is proved that the "Kangaroo" method not only warms up the baby, but also positively affects its physiology and psyche.
Positive impact on the child:
- Does not waste energy on the formation of its own warmth and crying.
- Sleep and wakefulness are normalized, as well as their alternation.
- Breathing and heart function improves, blood oxygen saturation.
- The close proximity of mother's breast and the smell of milk contributes to the development and coordination of innate reflexes: sucking, swallowing and searching.
- The maturation of the cerebral cortex, recovery, recovery and adaptation to new living conditions is accelerated.
- Gains weight better and faster.
The "Kangaroo" method is good, but it is used only after the child's condition has improved, in the absence of seizures and stabilization of the main indicators (respiration, heart rate, blood pressure).
A variation of this method is "slings", with the help of which you can wear a baby on yourself for several hours.
Monitoring a premature baby
If necessary, the monitoring and registration of some indicators continues for some time: blood pressure, respiration rate, heart rate, blood oxygen saturation.
And here your help is invaluable. You can take part in some simple procedures and manipulations. Learning how to use a heated table, phototherapy lamp or incubator is easy.
The approach has an advantage: the baby feels that you are near and takes care of him with warmth. Undoubtedly, this helps the baby to quickly adapt to new life conditions.
Drug treatment
Are prescribed depending on the disease:
- Preterm jaundice: continued phototherapy and "drinking".
- Improving brain function: from the third week of life - nootropics (Cortexin, Piracetam).
- Mild sedative and brain enhancer: Glycine.
- Fighting seizures: Phenobarbital (main drug), Konvulex or Depakine.
- Expansion of blood vessels and improvement of blood circulation: Cinnarizine.
- Improving metabolism, nutrition of the heart muscle, production of hemoglobin: vitamin E.
Rehabilitation of premature babies
In the first year of life, the body of an immature baby has great potential to restore and accelerate 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 at 1-1.5 months of age.
A premature baby has disturbances in the functioning of the nervous system, which leads either to an increase or decrease in muscle tone. In the first case, excitation processes prevail, in the second - inhibition.
With an increased tone, only light stroking is allowed, with a decreased 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 up, the performance of active exercises is 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 body 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 is quickly overcooled, so only the part of the body that is being massaged is exposed.
- Classes are held either 30-40 minutes before a meal, or two hours after it.
- Gymnastics and exercises are not done before bed as the child becomes aroused.
- Passive gymnastics is carried out every day, 2-3 times a day, at the same time. At first, its duration is about 5 minutes, since the baby gets tired quickly. Then the duration of the lessons 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 to 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.
Oral cavity treatment in a child
If the baby's oral mucosa is clean, it does not need additional care.
However, a premature baby is prone to the appearance of thrush, which is caused by a fungus of the genus Candida, which lives in the body of each of us. Normally, its reproduction is inhibited by the immune system. With insufficient immunity activity, the fungus is activated, leading to the development of the disease.
In case of 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 bathing:
- Bathe your baby 40 minutes before feeding or two hours after feeding.
- Preheat the room to 24-26 o C.
- At first, premature babies are recommended to be bathed in clean boiled water or a decoction of herbs, the temperature of which is 37-38 o C. As soon as the crumb gets a little stronger, it is not necessary to boil the water.
- Pour boiling water over the tub before pouring water.
- Use soap no more than once or twice a week.
- Protect your ears from water. For safety, before bathing, soak two cotton balls in sunflower or baby oil, and insert shallowly into the ear canal.
- Perform the first water procedures for 5-7 minutes, gradually increasing the duration of bathing.
- At first, bathe your baby without adaptive supports. In order not to frighten the baby, immerse it in water gradually, starting from the legs and reaching the shoulders. The head does not submerge in water, but is located at the bend of 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. Beforehand, you can practice on a doll or resort to the help of your household.
- Bathe your 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 the baby to a warm towel and pat dry with gentle movements (do not dry!). Dry the ears with cotton swabs with a stopper, and clean the nose with cotton swabs. Then put clothes on the baby.
- In the first year of life, bathe the baby every day in the summer, in winter - you can every other day.
Walking with a premature baby
Fresh air has a positive effect on the body as a whole. However, regarding the premature baby, do not rush to 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 in the air gradually increases by 15 minutes, reaching 1-1.5 hours a day.
Before going outside, 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 a baby reaches two months of age with a body weight of 2500-3000 grams.
At an air temperature of -10 o C, it is advisable to postpone walks 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 expected needs an increased intake of vitamins, nutrients, and minerals.
The first two weeks of life are 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.
In the organization of food, several key points are taken into account:
1.
When and how to feed for the first time?
2.
Can the baby be applied to the mother's breast?
3.
What is the amount of food per feeding?
4.
What to feed: mother's milk or milk formula?
The approach depends on the gestational age and birth weight of the child.
First feeding
At the first degree of 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
Mix for premature babies
Comparative characteristics of the most commonly used mixtures:
| Mixture | Composition and benefits | disadvantages |
There are situations when a woman does not reach the due date of pregnancy and she has a premature baby who needs special care. What are the health and nutritional characteristics of premature babies? Which maternity hospitals and children's hospitals in Moscow and St. Petersburg specialize in the problem of having a baby prematurely? Consulting professor Galina Yatsyk and neonatologist Antonina Volzhina.
A premature baby is considered to be born prematurely if the mother gave birth to him before 36 weeks of pregnancy. A few years ago, doctors took up nursing a child if he was born with a body weight of at least 1000 g.
Now there are new technologies that help save the lives of children with less body weight. Therefore, the World Health Organization proposed new assessment criteria: at least 22 weeks of intrauterine development and at least 500 g of weight.
The issue of changing the criteria is also being discussed in our country. Doctor of Medical Sciences, Professor, Head of the Department for Premature Babies of the Scientific Center for Children's Health of the Russian Academy of Medical Sciences Galina Yatsyk says: “We have a phased transition to new criteria from 2008 to 2012. My opinion and some more obstetricians-gynecologists and neonatologists is that the criterion of viability would be more correct to consider gestational age 25-26 weeks and body weight 750 g or more. Now in various media there are sensational reports about the birth of a microbe with a body weight of up to 300 g. My experience in neonatology indicates that up to 70% of children with extremely low birth weight become disabled in the future. The issue of nursing such children should be treated very carefully ”.
For your information
Depending on the initial weight of babies born prematurely, they are divided into three groups:
from 1500 g - premature baby,
from 1000 to 1500 g - a premature baby with low body weight,
up to 1000 g - a premature baby with extremely low body weight.
Difficulties at birth
If a child is born prematurely, his organs and systems are not yet developed to the same extent as those of a full-term one. Therefore, from the first minute he will need medical care, and its volume and duration will depend on how long and with what weight the baby was born.
- One of the serious problems in premature babies is the development of respiratory function. In the lungs of each person, a special substance is produced - a surfactant, which prevents the alveoli from collapsing and, thus, contributes to normal breathing. A premature baby does not have enough surfactant, therefore, his lung tissue cannot be completely straightened out and sometimes breathing disorders occur, even to the point of stopping it. It is important for doctors to improve the child's respiratory function. For this, artificial lung ventilation devices are used. Doctors have one more drug in service - an analogue of a surfactant produced in humans, which helps premature babies to improve their respiratory system.
- A premature baby is not yet physiologically ready for the conditions that await him in our world. The ambient temperature here is lower than in the mother's womb, and the baby's thermoregulation system is still imperfect - it quickly gets supercooled and overheated. In the old days, if a baby was born prematurely, it was wrapped in cotton wool or put on a stove to create a climate as similar as possible to the intrauterine one. “Now the child is being placed in an incubator (incubator),” says Galina Yatsyk. - It is isolated from noise and excess light, oxygen is supplied here, temperature and humidity are regulated. Sometimes so-called "nests" are used to simulate the intrauterine position of the baby.
- It is possible to reproduce not only the intrauterine position, but also the state of weightlessness. This is done through a method called dry immersion. The bath is filled with warm water, the temperature of which is maintained at 36.6 degrees. The surface of the water is covered with a medical film on which the baby is lowered. He is enveloped in this film, he is warm, he is in weightlessness and feels great ”.
- Premature babies often have nutritional problems. They are solved in different ways. If a child weighs about 1700 g and has a sucking reflex, then he is fed dosed through a special syringe, taking into account the milk flow rate. If the baby is already sucking himself, then an ordinary nipple and bottle are used. Of course, in this case, milk is still given fractionally, little by little. When the sucking reflex is absent, the baby is fed through a nasogastric tube, and the food gradually enters the baby's stomach.
The best food for a premature baby is breast milk. To maintain it while the baby is not breastfeeding, the woman needs to express regularly. The medical staff will feed the baby with breast milk, introducing additional supplements into it, because the need of premature babies for proteins, vitamins and minerals is very high. If a woman does not have enough milk, then artificial milk formulas are used for feeding, specially designed for premature babies.
Take your time home!
The first stage of nursing a premature baby is carried out in the maternity hospital. The best thing is if the premature birth takes place in a hospital where there is a children's intensive care unit - then the baby gets there immediately after birth. But children's intensive care is not available in all maternity hospitals.
In the hospital, the child must be examined by specialist doctors: a neuropathologist, an ophthalmologist, an orthopedist, a cardiologist, they do neurosonography - ultrasound of the brain, if necessary - ultrasound of internal organs, take urine and blood tests.
What happens to a baby if he was born in a hospital where there is no resuscitation? Can't he be saved?
Nothing like this. In maternity hospitals, there must be incubators, and ventilators, and drugs necessary to support the life of premature babies, and neonatologists who know how to "pull out" such children. Another thing is that, in addition to observing difficult premature babies, neonatologists must be present at the next birth, take new newborns. This means that the attention to premature babies will be less on the part of neonatologists, and they may miss some important moments when the child needs to be rescued. In the intensive care unit, neonatologists and nurses work, who deal directly with those children who are there - this is their direct responsibility, which means that the child will be constantly under medical supervision.
When a premature baby is in intensive care, the mother can visit him, but at certain hours, and "communicate" through the glass of the incubator (in some maternity hospitals and centers, round-the-clock visits are allowed).
- If there is no resuscitation in the maternity hospital, and the child needs it, then after the condition is stabilized, he can be transferred to the hospital where it is. The baby is transported in a car that is specially equipped for transporting premature babies (it has incubators, ventilators, etc.).
- If a child is born prematurely, but with a good weight (2400–2500 g), he is healthy and gains weight normally, then he can be discharged from the hospital with his mother at the usual time. If the baby is low in weight or has health problems, then 5-10 days after birth, he is transferred to the second stage of nursing - to the department of premature babies in a children's hospital or a children's medical center. Here, in the hospital, the baby has to spend some more time, how much depends on the condition and weight of the child.
As for the second stage, here in some medical institutions the baby is allowed to stay with the mother, in others the mother can come to the children's hospital in the daytime to feed the baby and help take care of him. Doctors usually welcome a mother's desire to feed her baby with her milk. If the mother is not constantly with the baby, the doctors ask her to express herself and bring milk to the children's hospital every day so that the baby can receive it.
Usually a child is discharged home when he has a positive dynamics, his weight reaches 2400-2500 g, he can suckle the breast or a bottle.
For your information
The main causes of premature birth:
- isthmic-cervical insufficiency (premature dilatation of the cervix),
- gestosis,
- premature placental abruption,
- genital infections
- hormonal disorders
- multiple pregnancy,
- serious diseases of the mother (diseases of the kidneys, cardiovascular system, etc.).
When a couple has a child, mom and dad spend all their time on it, because without proper care, the baby simply cannot develop normally, and maybe even survive. What if the baby was born prematurely? Care for premature babies should be special, because sometimes such crumbs can not even breathe and eat without help.
More recently, doctors did not undertake to resuscitate and save the life of a baby whose birth weight is less than a kilogram. Now everything has changed, and experts can give a chance to a baby who was born the size of a palm and weighs half a kilogram. We will talk about caring for premature babies in intensive care, after discharge and in other conditions in this article.
Premature babies: features
Full-term babies are those born between the 37th and 42nd weeks of pregnancy. If a child was born earlier than expected, then he is considered premature. The main problem of such babies is the underdevelopment of internal organs, and the earlier the birth occurs, the more thorough care the child will need. Nursing care for premature babies begins from the first minutes of his life, the mother will be able to start taking care of her child on her own only after the permission of the pediatrician, but more on that later. For now, we are interested in the physiological features of an infant born prematurely. How quickly can a mom get her baby to love? It all depends on the degree of its prematurity. There are three degrees in total:
- Extreme prematurity - less than a kilogram.
- Deep prematurity - weight from a kilogram to one and a half.
- Prematurity - weight from one and a half kilograms to two and a half.
The main features of a premature baby are:
- little weight;
- small growth (up to 46 cm);
- disproportionately folded body (large head, shortened legs, neck, navel displaced to the groin side);
- the shape of the skull is rounded, with clearly visible fontanelles and sutures;
- the ears are tightly pressed to the head, very soft;
- the skin is very thin and wrinkled, all wreaths can show through;
- the surface of the body is covered with a small fluff;
- the fat layer is completely absent;
- on the arms and legs there may be underdeveloped marigolds, or even absent;
- undescended testes in boys; and open genital slit in girls.
It is worth noting that all of the above features should be combined. Only in this case can we talk about the peculiarities of caring for premature babies. If one thing manifests itself, this indicates pathology, and not prematurity.
Premature baby behavior
Newborns born at the wrong time also differ in behavior. They are inactive, there is a reduced muscle tone. Babies are drowsy (this is noticeable even against the background of the fact that full-term babies sleep almost constantly), they shudder for no reason and begin to move chaotically. The lack of a sucking reflex complicates the care of premature babies. The baby is hungry, but does not know how to eat.
Briefly about caring for premature babies
We propose to consider the subtleties of caring for a baby, and then go through each item in more detail.
Nursing care for premature babies, as we have already written, begins from the first seconds of his life. First of all, it is taken in a warm diaper and, if necessary, ventilation of the lungs is done. This is the most responsible procedure. The baby's breathing may be impaired or even stop completely, since the early-born baby does not produce enough surfactant, a substance responsible for proper breathing. Therefore, the lung tissue cannot fully expand.
The second problem is that premature babies are completely unprepared for a physiological existence in this world, they have an insufficient layer of subcutaneous fat, therefore thermoregulation is imperfect. Babies quickly become hypothermic and overheat, since the ambient temperature differs greatly from that in the mother's womb.
In the old days, this problem was solved by wrapping the baby in cotton wool or putting it on a warm oven. Now the problem of regulating the body temperature of a newborn is solved differently: a premature baby is placed in an incubator, or, in simple words, an incubator. A sufficient amount of oxygen gets there, it is isolated from extraneous noise and light. The temperature and humidity in the incubator are regulated, creating conditions similar to those in utero.
There are no feeding problems either. Features of nursing care for premature babies are swaddling, monitoring the general condition and, of course, feeding. The medical staff collects the expressed milk from the mother and adds the necessary vitamins, proteins and minerals to it. If a woman does not have milk, then infant formulas are used, developed specifically for babies born ahead of schedule. Feeding the baby, if he has a poorly developed sucking reflex, is carried out with a syringe.
A baby with a well-developed reflex is given a bottle. If the baby's weight is so small that he cannot even swallow, a nasogastric tube is used or nutrients are injected intravenously. The probe is inserted through the nose of the crumbs, and milk in small doses enters his stomach. In any case, feeding a premature baby is fractional and in small portions, even if its weight is more than two kilograms. The organs are not yet developed enough to work fully. Nursing care for premature babies is a must. After all, a mother can overfeed.
At first, it may not be possible to care for premature babies in a hospital if there are health complications. In this case, the baby is transferred to the intensive care unit.
Resuscitation care
Care at the first stages is taken over by the hospital staff. Most often, immediately after birth, the baby enters the children's intensive care unit, and it's good if it is available in the maternity hospital. But it happens that the hospital does not have such a department.
First of all, the baby is examined by a cardiologist, neuropathologist, orthopedist, ophthalmologist, neurosonography (ultrasound of the brain) is performed, if necessary, ultrasound of all internal organs. In addition, urine and blood tests are taken. After the procedures, the baby is placed in an incubator.
What happens if the hospital does not have its own intensive care unit? Is there really no chance of "pulling out" the child? Nothing like this. All are equipped with the necessary equipment for caring for premature babies, there is a ventilator, and incubator, and special drugs designed to support the life of the baby, and a neonatologist - a specialist trained to care for babies born at the wrong time.
But there is still a problem: neonatologists not only look after premature babies, but also have to be present at each subsequent birth. And this means that there will be less monitoring of premature babies and the neonatologist may miss the moment if there is a need to save the baby.
In the intensive care unit, nurses and neonatologists work, whose duties include only nursing the children already in their department. In this case, the newborn will be constantly under vigilant medical supervision.
If the baby needs resuscitation, but it is not in the maternity hospital, then after stabilization of the condition, he will be transferred to another hospital where there is the necessary department. Transportation is carried out in a specialized car with ventilators, incubators and other necessary devices to support life.
When the baby is in intensive care, the mother can come to him at the appointed time, but "communicate" only through the glass of the incubator (incubator). There are departments where it is possible to visit the baby at any time of the day.
Feeding
Parents of babies born early need to know all the subtleties and peculiarities of caring for premature babies so as not to worry about the child. Many couples begin to worry too much about the life of the crumbs, they think that they will not be able to cope. Of course, it is very difficult to survive the period of such a difficult nursing, but progress does not stand still, and medical personnel are able to save even the smallest ones.
If the child's weight reaches two kilograms and the sucking reflex is well developed, then there is the possibility of breastfeeding. Mommies will often be able to hold the baby in their arms, feed and help the medical staff with caring for it. Only the nurse feeds from a bottle or syringe so that there are no problems with the esophagus. As already written earlier, if the sucking reflex is absent or poorly developed, then the digestive organs cannot fully cope with their task and feeding should be fractional.
Premature babies need plenty of fluids. Usually, Ringer's solution diluted 1/1 with 5% glucose is used to maintain the body. In addition, vitamins are needed, in the first days riboflavin, vitamins K and E, ascorbic acid, thiamine are necessarily introduced. Focusing on the individual condition of the newborn, the doctor may prescribe other vitamins.
After a while, the baby's nutrition will not be any different from the nutrition of their peers. But at the first stages of nursing, special additives are needed so that the development and growth of the baby is accelerated.
As parents can see, there is no need to worry about food. Soon, your baby will take its toll and turn from a thin, weak baby into a cheerful, rosy-cheeked and active toddler.
Nursing in the hospital
Care for premature babies in a hospital necessarily begins with the department of pathologies of newborns. Here the baby will be constantly under the supervision of nurses and doctors, the necessary procedures and examination will be prescribed.
The transfer of an infant to a regular department can be done only when he gains a body weight of at least two kilograms, actively sucks milk, independently cope with the regulation of body temperature, and breathes well. The duration of stay in the incubator depends on the severity of the degree of prematurity, there are four of them:
- first degree - childbirth occurred at a period of 37 to 35 weeks;
- second degree - from 34 to 32 weeks;
- third degree - 31-29 weeks;
- fourth degree - 28 or less.
If, by the time the mother is discharged from the hospital, the child has already reached the minimum parameters at which it is possible to care for a premature baby at home, then he is allowed to go home with his mother. If there is no need for resuscitation, but there is any risk to health, the baby is transferred to the children's department. The mother herself decides how to proceed further: to go to the hospital with the baby or to come to the hospital for feeding.
In the hospital
A baby born prematurely is transferred to a specialized children's department according to the prescription of a pediatrician and neonatologist. Such a move is possible even if the baby is still feeding through a tube and needs artificial respiration. In this case, all care for premature babies is in the hands of the medical staff.
The baby will be placed in a heated bed or incubator. In the hospital, a more complete examination is carried out, it is aimed at detecting pathologies and genetic diseases. The baby is examined by narrow specialists, the necessary tests and procedures are prescribed.
Positive dynamics usually begins to grow from the day of the previously expected birth, that is, from the date when the child was supposed to be born on time. The time spent in stationary conditions depends on how quickly the baby gains weight, learns to suck and swallow, on the presence of identified pathologies. Hospital treatment can last from a week to several months.
Houses
When the baby is finally ready to go home, the doctor issues detailed Care for a premature baby after discharge is very difficult, especially for couples who have their first child. The difficulty lies in the fact that only the nursing staff nursed the baby and the parents may not even have a clue of how and what to do.
In any case, if the baby was born prematurely, the patronage must be conscientious. If for some reason the pediatrician did not come on the set day, call the clinic and ask for a visit. Now we will consider in detail all the subtleties of a premature baby, which must be known to all family members living in the same room.
- The first thing worth watching is the air temperature in the crumbs room, it should be about +22 degrees. Do not forget that premature babies may have problems with thermoregulation.
- For the first time, it is worth bathing a baby at home after the permission of the district doctor. The bathroom heats up to 24 degrees, and the water should be close to body temperature. After washing, the baby is thoroughly wiped with a soft towel and dressed warmly, as babies who are not born on time can quickly become overcooled.
- Walks are no different from those prescribed for full-term babies. In the warm summer time, you can go out to breathe air immediately after discharge, and in the cold season - after a month. The first walks last no more than half an hour, the time gradually increases.
- Breastfeeding premature babies after discharge is most often impossible, since he will already be "spoiled" by the bottle and he will be too lazy to suckle. Still, try to breastfeed or express milk as often as possible and feed your child with it, because breast milk is the most important element of nutrition in the first year of life. If you do not have enough milk or it disappeared altogether after the stress of worrying about your baby's life, then buy formula developed for premature babies.
- In caring for premature babies at home, constant supervision must be included! If the baby becomes lethargic, weak, refuses to feed and spits up profusely, call a doctor immediately, these are very bad signs.
Outpatient care for a premature baby
The plan for the examination of babies born early is drawn up individually. Often premature babies suffer from kidney and eye diseases, neurological pathologies are observed. If there is any violation, then the baby is registered with the necessary doctor and it will be necessary to visit him regularly, without missing the appointed appointments.
If your little one is completely healthy, then you only need a monthly examination at the clinic and bypass narrow specialists, which are carried out in the "Days of Healthy Children". During the month, the district nurse will visit you to make sure your child is well-being.
Development of premature babies
If a little man was born early, then in the first two months of his life he will almost constantly sleep, get tired quickly even with low activity. After two months of age, the child will begin to develop faster, move more actively, which can lead to muscle tension in the limbs. It can be easily removed with special exercises.
We must not forget that the nervous system of premature babies is weak, so the baby can flinch for no reason, be afraid of sudden movements and sounds. Periods of restful sleep can change dramatically with bouts of arousal, again for no reason. Such children need peace and quiet, they do not tolerate meetings with strangers and a change of scenery.
If the baby does not have pathologies, then he will develop and grow rather quickly. By the age of three months, he will catch up and even, perhaps, surpass his peers in height, weight and development!