When a couple has a child, mom and dad spend all their time on him, 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 cannot even breathe and eat without outside help.

More recently, doctors did not undertake to resuscitate and save the life of a baby whose birth weight was 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 the baby was born earlier than expected, then it is considered premature. The main problem of such babies is the underdevelopment of internal organs, and the earlier the birth occurred, 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 independently begin to take care of her child only after the permission of the pediatrician, but more on that later. So far, we are interested in the features of the physiology of an infant who was born prematurely. How fast can a mother hug her baby? It all depends on the degree of his prematurity. There are three degrees in total:

1. Extreme prematurity - weight less than a kilogram.
2. Deep prematurity - weight from a kilogram to one and a half.
3. Prematurity - weight from one and a half kilograms to two and a half.

The main features of a premature baby are:

• little weight;
• small stature (up to 46 cm);
• disproportionately folded body (large head, shortened legs, neck, navel displaced to the inguinal side);
• the shape of the skull is rounded, with a clearly visible fontanel and sutures;
• the auricles are pressed tightly against the head, very soft;
• the skin is very thin and wrinkled, all the veins can shine through;
• the surface of the body is covered with a small fluff;
• the fat layer is completely absent;
• nails may be underdeveloped on the arms and legs, or even absent;
• undescended testicles in boys and an open genital slit in girls.

It is worth noting that all the above features must be combined. Only in this case can we talk about the features of caring for premature babies. If one thing manifested itself, this indicates a pathology, and not prematurity.

Behavior of a premature baby

Newborns born at the wrong time also differ in behavior. They are inactive, there is a reduced muscle tone. Toddlers 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 randomly. Particularly complicating the care of premature babies is the lack of a sucking reflex. The little one is hungry but doesn't know how to eat.

Briefly about the care of premature babies

We suggest considering the intricacies of caring for a baby, and then we will 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 is done. This is the most important procedure. The baby's breathing can be disturbed or stop altogether, as an early-born baby does not produce enough surfactant, the 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, so thermoregulation is imperfect. Babies quickly overcool and overheat, as the ambient temperature varies greatly from that which was in the mother's womb.

In the old days, this problem was solved by wrapping the baby in cotton wool or placing it on a warm stove. 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 terms, an incubator. A sufficient amount of oxygen enters 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. Medical personnel take the expressed milk from the mother, add the necessary vitamins, proteins and minerals to it. If a woman does not have milk, then infant formulas are used, designed specifically for babies born prematurely. 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 weight of the child is so small that he cannot even swallow, a nasogastric tube is used or nutrients are administered 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. Organs are not yet developed enough to work fully. Nursing care for premature babies is essential. After all, the mother can overfeed.

Inpatient care for premature babies may not be possible at first if there are health complications. In this case, the baby is transferred to the intensive care unit.

resuscitation care

Care for the first stages is taken over by the medical staff of the maternity hospital. Most often, immediately after birth, the baby ends up in the children's intensive care unit, and it's good if there is one 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), if necessary, ultrasound of all internal organs. In addition, urine and blood samples are taken. After the procedures, the baby is placed in an incubator.

What happens if the maternity hospital does not have its own intensive care unit? Is there really no chance to "pull out" the child? Nothing like this. All are equipped with the necessary equipment for caring for premature babies, there is a lung ventilator, an incubator, and special preparations designed to keep the baby alive, and a neonatologist, a specialist trained to care for babies born at the wrong time.

But still there is a problem: neonatologists not only look after premature babies, but are also required 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 it suddenly becomes necessary to save the baby.

Nurses and neonatologists work in the intensive care unit, 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 there is none in the maternity hospital, then after stabilization of the condition, he will be transferred to another hospital where there is a necessary department. Transportation is carried out in a specialized car, where there are devices for ventilation of the lungs, an incubator 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 features 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 weight of the child reaches two kilograms and the sucking reflex is well developed, then there is the possibility of breastfeeding. Moms will often be able to hold the baby in their arms, feed and help the medical staff care for him. Only a nurse feeds from a bottle or syringe so that there are no problems with the esophagus. As already mentioned 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. Ringer's solution, diluted 1/1 with 5% glucose, is usually used to maintain the body. In addition, vitamins are needed, in the first days riboflavin, vitamin 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 nutrition of the baby will not be any different from the nutrition of peers. But at the first stages of nursing, special additives are needed so that the development and growth of the crumbs are accelerated.

As parents can see, there is no need to worry about nutrition. Soon your baby will take over and turn from a thin, weak baby into a cheerful, rosy-cheeked and active toddler.

Nursing in the maternity hospital

Care for premature babies in a hospital necessarily begins with the neonatal pathology department. Here the baby will be constantly under the supervision of nurses and doctors, the necessary procedures and examinations will be prescribed.

The transfer of an infant to a regular department can be made only when he gains a body weight of at least two kilograms, actively sucks milk, independently copes 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;
• the 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 maternity hospital, the child has already reached the minimum parameters under which it is possible to care for a premature baby at home, then he is allowed to go home with his mother. If the need for resuscitation is no longer there, but there is any risk to health, the baby is transferred to the children's department. The mother herself decides how to proceed further: go to the hospital with the baby or 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 fed through a tube and needs artificial respiration. All care for premature babies in this case is in the hands of the medical staff.

The child will be placed in a heated bed or incubator. A more complete examination is carried out in the hospital, 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 expected birth, that is, from the date when the child was supposed to be born on time. The length of stay in stationary conditions depends on how quickly the baby gains weight, learns to suck and swallow, and on the presence of identified pathologies. Treatment in the hospital can last from a week to several months.

At home

When the baby is finally ready to go home, the doctor provides detailed care for a premature baby after discharge is very difficult, especially for couples who have had their first child. The difficulties lie in the fact that only nursing staff nursed the baby and parents may not even have a clue about how and what to do.

In any case, if the baby was born prematurely, patronage must be conscientious. If for some reason the pediatrician did not arrive on the scheduled day, call the clinic and demand a visit. Now we will consider in detail all the subtleties of a premature baby, which all family members living in the same room must know.

1. The first thing to watch for is the air temperature in the baby's room, it should be about +22 degrees. Do not forget that premature babies may have problems with thermoregulation.
2. For the first time, bathing a baby at home is after the permission of the local doctor. The bathroom warms up to 24 degrees, and the water should be close to body temperature. After washing, the baby is thoroughly dried with a soft towel and dressed warmly, as children born out of time can quickly become supercooled.
3. Walks are no different from those prescribed for full-term babies. In the warm summer time, you can go out for a breath of air immediately after discharge, and in the cold season - after a month. The first walks last no more than half an hour, time is gradually added.
4. 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 the breast. Still, try to breastfeed or express milk as often as possible and feed it to your child, because mother's milk is the most important nutrient in the first year of life. If you don't have enough milk, or if it's completely gone after the stress of worrying about your baby's life, then buy formulas designed for premature babies.
5. Caring for premature babies at home necessarily includes constant monitoring! If the baby has become lethargic, weak, refuses to feed and spit up profusely, call the doctor immediately, these are very bad signs.

Caring for a premature baby in an outpatient setting

The plan for the examination of children born early is drawn up individually. Often premature babies suffer from diseases of the kidneys, eyes, neurological pathologies are observed. If there is any violation, then the baby is registered with the necessary doctor and he will need to be visited regularly, without missing the appointments.

If your little one is completely healthy, then only a monthly examination at the clinic and a round of narrow specialists, which are performed on the "Days of Healthy Children", will be required. Within a month, the district nurse will visit you to make sure that the child is well.

Development of premature babies

If a little man was born early, then in the first two months of his life he will sleep almost constantly, get tired quickly even with low activity. After the age of two months, the child will begin to develop faster, move more actively, which can lead to tension in the muscles of the limbs. It is easy to remove with special exercises.

We must not forget that the nervous system of premature babies is weak, so the baby can shudder for no reason, be frightened by 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 meeting strangers and a change of scenery.

If the baby does not have pathologies, then it will develop and grow quite quickly. By the age of three months, he will catch up and even possibly surpass his peers in height, weight and development!

Premature babies need special attention and care. Care for a premature baby in the maternity hospital is carried out by specially trained staff, and after discharge, the baby is transferred to the hands of the parents. How is the nursing of children born earlier than the term set by nature?

Physiology of premature babies

According to the WHO, babies born before the 37th week of pregnancy are considered premature. Such babies are usually born with a weight of less than 2500 g. All organs and systems of premature babies are immature, and that is why special care is required for such newborns. All the achievements of modern neonatology are aimed at helping these children adapt to existence in a new world for them.

Physiological features of premature babies

• Appearance: poorly developed adipose tissue, thin skin, thin fluff all over the body, open fontanelles, soft auricles, underdevelopment of the genital organs.
• Nervous system: underdevelopment of reflexes, weak muscle tone.
• Respiratory system: lack of surfactant and various respiratory disorders.
• Cardiovascular system: high incidence of cardiac anomalies.
• Digestive system: immaturity of enzymes, poor absorption of food.
• Musculoskeletal system: high risk of developing hip dysplasia.
• Thermoregulation: the inability to keep warm on its own.

Inpatient care

Nursing of premature babies is possible starting from 22 weeks of gestation. Children born after this period have a body weight of more than 500 g and are considered viable. If the baby is born between 22 and 32 weeks, he is transferred to a specialized department for the care of very premature babies. In an ordinary maternity hospital, there are no conditions for long-term nursing of such babies.

In a specialized department, the newborn is in an incubator, where the optimum temperature and humidity are maintained. Medical staff constantly monitors the condition of the baby. The newborn is fed through a tube. The health status of the baby is assessed by a neonatologist, oculist, neurologist and other specialists. Such an integrated approach allows you to achieve optimal results and prevent the development of complications after preterm birth.

Babies born between 32 and 37 weeks of age who can breathe on their own are in the intensive care unit. Here the baby is also in the incubator, but quite often his mother can be next to the baby. If the newborn takes the breast, breastfeeding is allowed.

In recent years, many hospitals have successfully applied the "kangaroo method". The baby, undressed, is laid out on the mother's stomach and wrapped in warm diapers. This approach improves lung function, evens out the breathing and heartbeat of the baby, and populates the baby's skin with maternal microflora. The "kangaroo method" is recognized in many countries as the best way to care for premature newborns.

With what weight is a small patient discharged home? Usually, discharge occurs when the weight reaches 2000-2500 g. At the same time, the baby is steadily gaining weight, is able to maintain body temperature and has no breathing problems. Such a baby can be at home under the supervision of a local pediatrician.

home care

And caring for him is a complex topic, which you can talk about almost endlessly. After the baby is discharged from the hospital, he falls into the hands of caring parents. What needs to be done in order to help the baby adapt to the new conditions of existence?

Microclimate

The room where the baby is located should be bright and spacious enough. The optimum air temperature is 25 °C. The room must be regularly well ventilated. In the summer, you can leave the windows open all day long, provided that there are no drafts.

Some children need extra warmth. To this end, you can wrapped in a cloth. The temperature of the water in the heating pads must not exceed 60 °C. Heating pads are placed at the legs as well as on the sides and are changed every 2 hours.

Do not remove all heating pads from the baby's bed at the same time, otherwise the baby may freeze.

The optimum humidity for the room is 50-70%. To create favorable conditions, you should regularly carry out wet cleaning of the room. It will be useful to purchase a special humidifier. Alternatively, you can arrange water bottles around the room or hang wet diapers.

Feeding

Nursing premature babies is impossible without proper nutrition. The best food for a premature baby is breast milk. This product contains all the important nutrients, enzymes and antibodies required for normal development of an infant. Even if the baby is bottle-fed, you should not completely deprive him of breast milk. You can feed your baby with a spoon. With properly organized feeding, the baby should gain weight according to the standards.

Bathing

Children weighing less than 2000 g are not recommended to bathe in the first month of life. Baby skin care is carried out using wet wipes. You can gently wipe the skin with a cotton swab dipped in warm water. After all procedures, it is worth using a hypoallergenic moisturizer.

Children who have reached a weight of 2 kg can be bathed in a baby bath. The optimum water temperature is 37-38 °C. Many experts recommend boiling water before bathing. If desired, you can add a decoction of chamomile or calendula to the water.

walks

You can walk with the baby after 3-4 weeks of his stay at home. In summer, you should not be outside during the peak of solar activity (from 11 am to 3 pm). In autumn and winter, you can walk at a temperature of at least minus 10 ° C. Winter walks begin when the child reaches a weight of 3 kg and are allowed at an air temperature of at least 15 ° below zero.

Use quiet places for walking. Avoid crowded places in the first months of a baby's life.

The duration of walks should increase gradually. For the first time, 15 minutes of being in the fresh air is enough. With good health, you can gradually increase the duration of walks up to 2-3 hours every day.

Cloth

Children who have reached a weight of 2.5 kg can be dressed in the same way as their full-term peers. You can not wrap the baby too tightly - this can lead to heat stroke as a result of the immaturity of the thermoregulation systems.

Children weighing less than 2.5 kg should be dressed slightly warmer. 1-2 extra layers of clothing are allowed compared to full-term babies. The head and legs of the baby should always be warm. Clothing should be made from natural fabrics and not cause any disturbance to the baby.

medical supervision

Caring for a premature baby provides for the constant supervision of a local pediatrician. In case of any deviations in the state of health, it is necessary to consult a doctor. Children born prematurely get sick more often than their full-term peers, so they need special monitoring from all specialists.

Up to 2 years of age, premature babies are registered with a cardiologist, ophthalmologist and neurologist. Assistance from other physicians may be required as indicated. Regular ECG and echocardiography is recommended to monitor the condition of the heart.

Preventive vaccinations for premature babies are given according to an individual schedule. Vaccination against tuberculosis is carried out only when the child reaches a weight of 2.5 kg. The issue of other vaccinations is decided with the local pediatrician. Vaccination is allowed only if the baby is in good health and there are no serious diseases.

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