How many lie with a premature baby. stage of nursing premature babies. Features of the rehabilitation of babies with extremely low weight

30.04.2019

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 considered 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 these babies is underdevelopment. internal organs, and the earlier the birth occurs, the more thorough care the baby 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 permission 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 love her baby? 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 round, with clearly visible fontanelles and sutures;
the auricles are pressed tightly 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, marigolds may be underdeveloped, 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 intricacies 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, 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.

V 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 a baby if it is poorly developed sucking reflex, carried out with a syringe.

A baby with a well-developed reflex is given a bottle. If the child's weight is so small that he cannot even swallow, a nasogastric tube is used or nutrients 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

At the first stages, care is taken by the hospital staff. Most often, immediately after birth, the baby falls into children's department resuscitation, and it's good if in maternity hospital it is there. 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 equipped necessary equipment for the care of premature babies, there is a ventilator, a incubator, and special preparations designed to support the life of a 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. 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 ward. 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, vitamin K and E are necessarily introduced, vitamin C, thiamine. 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 monitored. nurses and doctors, the necessary procedures and examinations 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 care is possible premature baby at home, then they let him go home with his mother. If there is no need for resuscitation, but there is any health risk, 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 pediatric 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. More than full examination, it is aimed at detecting pathologies and genetic diseases... The baby is examined by narrow specialists, required analyzes and procedures.

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. Keep in mind 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 soft towel and they dress 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 mother's milk - essential element nutrition in the first year of life. If you do not have enough milk or it has completely disappeared 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 children 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 for necessary doctor and it will need to be visited regularly, without missing any appointments.

If your little one is completely healthy, then you only need monthly inspection in the polyclinic and bypasses of narrow specialists, which are carried out in the "Days of Healthy Children". During the month, the district nurse will visit you to make sure well-being child.

Development of premature babies

If 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 premature babies weak, so the baby can flinch for no reason, get scared sharp 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!

We are continuing the conversation, as well as about the rules of nursing, the pace of development and possible problems in health, which may arise as a result of the fact that the baby hastened to the light. To begin with, almost all children who were born earlier than the due date are placed immediately after childbirth in a special unit for premature babies or wards. intensive care with specially trained personnel and modern equipment allowing for complete care for the children.

What is special about intensive care units?

Almost all of the premature babies at birth will need to be admitted, even for a short time, to the intensive care unit and special wards for premature babies. In the conditions of these wards, special conditions for nursing are created for premature babies and the entire volume of medical procedures is fully carried out, which will help babies to accumulate weight and strength, mature and in the future they can already exist fully. Intensive care wards are conditionally divided into two different sections - a section of increased intensity, where special children with deep prematurity or babies born with any diseases are placed, as well as a section for completely viable children who are under special supervision until they will be able to fully breathe on their own and will be able to assimilate and consume food on their own. For premature babies, there are mechanical ventilation systems that allow babies to breathe until their lungs and respiratory center in the brain mature.

In these wards, children are connected to special electronic monitors that will control them. heartbeat, the level of blood oxygen saturation and the frequency of respiratory movements, which reflects their general state and the degree of maturity. With any slightest signals of ill health or problems, an alarm is immediately sounded, and the medical staff immediately takes a set of necessary actions for the baby to normalize the condition. Children are given IVs in these wards so that they can receive intravenous required amount liquid or medicines, the necessary food. If the child does not have sucking and swallowing reflexes, then a gastric tube is placed for the child, which is inserted through the nose and esophagus directly into the stomach. The tube will give your baby breast milk or formula feed for premature babies until he can feed on his own. In many intensive care units, constant contact between babies and their parents is created, which is especially important in nursing premature babies. This is the skin contact of a naked baby with the skin of the mother or father. Premature babies are placed special devices- kangaroos, and parents carry them on themselves. In many studies, it has been proven that when children are with their parents in this way, they begin to gain weight more actively and recover faster.

Features of medical care

For children who were premature, it is necessary to create special conditions and the presence of specially trained medical personnel. All doctors and nurses in the ICU for premature babies have high professional skills and will do their best to help your premature baby grow and develop as much as possible. Basically, all work in these wards is supervised by special pediatric doctors - neonatologists, these are pediatricians with special professional training. They give instructions for the care of nurses and themselves carry out a number of manipulations and procedures. Nurses monitor the condition, the work of monitors and the administration of medications, nutrition and care. All these specialists have extensive experience working with such babies and know how to handle them.

Nurses of the pediatric department will help you take care of your premature toddler, and will try to involve you as much as possible in all the basic procedures with the baby. In the premature wards at grave condition For babies, individual nurses can also be assigned to them, who will relentlessly monitor the condition of the child. The midwife of the maternity ward will closely monitor the condition and well-being of the mother after the birth and will then help the mother to breastfeed the baby in the future. If the baby is born too weak to breastfeed and suckle on his own, then midwives teach the mothers how to express breast milk, and it is transferred to the nursery to feed the infants. In addition to these specialists, there are also other doctors - physiotherapists, neurologists, therapists, who, if necessary, are called for advice on the treatment and rehabilitation of infants. Nurses in the area of the intensive care unit must fully provide all types of professional help mothers of seriously ill children or premature babies.

What will be the prognosis for later life?

For the parents of such a child, this will be one of the main issues that disturb from the very birth of the baby. Of course, when premature babies are born, a whole gamut of feelings arises that are associated with difficult experiences or with a strong fear for the life and health of children. However, in most cases, the birth of a child prematurely does not at all affect the further physical or mental development of the toddler, he quickly recovers and makes up for lost time. Due to super-modern technologies, significant advances have been made in the nursing and survival of such children who have extremely low body weight and are deeply premature. Today babies are cared for, starting from a weight of about 500 grams, and from about 25-26 weeks of pregnancy. Once premature babies will reach a certain body weight and get stronger, will be able to exist independently with adequate parental care, they are discharged from maternity hospital under the supervision of a local pediatrician and other specialists. The less the weight of the child at birth, the first time he will lag behind his peers in weight and growth, and may also lag slightly behind his peers in development. But it is also impossible to compare such children with those children that were full-term and born on time. But gradually, by the age of two or three, all the differences are erased and the kids catch up with their peers in height and weight, as well as in pace psychomotor development... Therefore, you need to monitor the dynamics of the development of your child and consult a doctor, and not be guided by the neighbor's full-term toddlers.

Key questions for parents who have premature babies

The first question parents ask is is it true that all premature babies have health problems? This question is controversial, since the period itself intrauterine development a premature baby will have much less than it should be, and the baby simply does not have time to go through all the stages of development assigned to it. Therefore, premature babies may actually have certain health problems. However, even premature babies will be completely different - some were born a couple of weeks earlier, and some eight or ten. It will be impossible to accurately predict what the very first months or even years in the extrauterine life of the baby will be like. Quite a lot of children who were born earlier than the due date will grow and develop fully in the future. But according to statistics, children who are born at an almost full term from 37th to 40th weeks may have health problems much less often than those children who were in a hurry to be born.

Anyway, premature baby will require special care for himself both from the medical staff and from his parents - he needs a lot of love and affection, care and patience. Such children are more susceptible to different kinds infectious diseases, especially for various pustular lesions of the skin, eye area or umbilical wound... If your baby is born earlier than the due date, you, as a parent, usually face a period of rather difficult life. But if you are as aware as possible about what problems in the health of premature babies are possible, this will help you cope with difficult situation, and qualified doctors and nurses will help you in all matters of care and treatment at all stages.

Tomorrow we will discuss the main deviations in the state of health of children born before the term, and talk about how to cope with these problems.

When a premature baby is born with deep degree immaturity, the process of nursing it takes many weeks, and sometimes months. You need to be mentally prepared for this. After all, this is a miracle: such a baby was born alive and is fighting for his right to be in this world. You just have to wait for him to be next to you. Everyone has their own path, but three stages are clearly traced in it.

Stage one: nursing in the maternity hospital (perinatal center)

If the risk of premature birth is high, then it is best to "attach" to a large perinatal center, where there is a neonatal intensive care unit. There, your baby will have more chances to survive and subsequently grow into a full-fledged person.

Immediately after birth, they interact with the baby only with warm hands, on a heated changing table and wrapped in sterile heated diapers. It is very important at this stage to exclude hypothermia.
Only those babies who weigh more than two kilograms are bathed. The original lubricant is hardly removed so as not to damage the skin.
All crumbs that have not reached a weight of two kilograms are placed in closed incubators, where they are created optimal conditions resembling those in which they were in utero.
Management tactics depend on the degree of maturity and prematurity of the baby.

Where and when will they be discharged?

Healthy children who have gained two kilograms are discharged home.
Those who do not collect the coveted "kopeck piece" on the 7-8th day are sent to the department of pathology of newborns, to the second stage of nursing.
Sick premature babies are transferred to the second stage of nursing as soon as the diagnosis is established and the conditions for safe transportation are provided.

Stage two: nursing in the pediatric ward / neonatal pathology ward of the children's hospital

Modern departments of the II stage of nursing premature babies are equipped for the stay of children with their mothers. In this case, one box-type ward usually accommodates from two to four children. Each ward (less often two) has a special nurse supervising the care of mothers for their children and performing medical procedures and manipulation.

At the end of the article, you can download pestoval gymnastics exercises for toddlers 6 weeks old and older.

Children weighing up to 1700 g are in incubators, from where they are taken (if there is permission from a neonatologist) to feed, weigh and change clothes. A toy is hung at a distance of 60-70 cm from the baby's chest, even if the baby is still very weak.

Bathing children:

after two weeks of age, if their weight is more than 1700 grams;
at the age after two months, if their weight has reached one kilogram.

Weighing is carried out as needed, but at least once a day.

Height and head circumference are measured weekly.

As soon as it becomes possible, premature babies are often laid out on the tummy. And when the body weight reaches 1800 grams, they begin to massage the tummy (according to indications earlier, even up to 1000 grams).

Even in the hospital with premature babies weighing 1700 grams, they start walking around the age of two weeks.

Healthy premature babies who have gained weight from 1700 to 2000 g are discharged home. If there are any deviations, then they are left in the hospital until complete recovery.

Stage three: observation at home by a doctor of the children's polyclinic

On the first day after arriving home, the child should be examined by a nurse and a doctor. Then the nurse will come twice a week for a month, and the pediatrician - two more times. Up to six months the nurse will come weekly, and from six months to a year twice a month.

Doctors will monitor the health and development of a premature baby, and parents are obliged to do everything possible to organize suitable conditions for crumbs to live, adjust its regime, nutrition, hardening and developmental actions.

A premature baby requires milder climates. Recommended:

room temperature 20-22 degrees Celsius;
humidity 60-70%.

The room should have Fresh air, airing is required.

They bathe the baby every day, in a room where the air temperature is not lower than 22 degrees, optimally 26. They use clean water heated to 38-39 degrees for bathing. Bathing is carried out with a hygienic and restorative purpose. Tempering issues in the first months for premature babies are not relevant.

Walking is allowed:

with a weight of 2500 grams in any weather (clothes are one layer warmer than ordinary newborns);
with a weight of up to 2500 grams - only in warm weather.

Food is preferably breastfeeding, if it is not possible - use adapted mixtures for premature babies. They are more concentrated and contribute to the speedy weight gain and growth of the baby.

For premature babies, educational games and activities are of particular importance. Constant tactile proximity is also important. They need to be handled often, and it is better to always wear them in a sling. So they grow faster and develop better.

It is advisable to start hardening procedures from the second half of life, if there are no contraindications to this.

For mothers of babies born prematurely, it is especially important to establish a relationship of trust with the local pediatrician and nurse. There are many questions and they need to be solved with the help of specialists, reasonedly and in accordance with the modern positions of official medicine.

If everything is done correctly, after a year or two, no one will even remember that the baby was somewhat different from his peers.

And when did your baby catch up with his peers in height, weight and development?

Download pestoral gymnastics exercises for toddler 6 weeks and older

Do you want your little one to be healthy, active and vigorous? Are you planning to take the most direct role in teaching crumbs to gymnastics? Download practical exercises from pestoval gymnastics for babies from 6 weeks to 3 months and give your baby health from birth!

What is the difference between a premature baby and other babies and how to help him “catch up” with his peers?

Premature babies

What is a "premature baby"? This is not just a baby who was born underweight.

Prematurity presupposes, first of all, the "immaturity" of all organs and systems, the inability of the baby to a separate existence from the mother.

According to the criteria The World Organization Healthcare (WHO), a child born earlier than 37–38 weeks of gestation with a body weight of less than 2.5 kg is considered premature. Expectant mothers should know some of the anatomical and physiological characteristics of such babies, which will allow them to understand some of the mechanisms of adaptation and behavior of the child.

Premature babies: appearance

A premature baby even outwardly differs significantly from a baby born on time. His skin is thin, dark red, and subcutaneous fat is very weakly expressed or completely absent. This leads to high risk trauma skin, therefore, any procedures and manipulations for such a baby should be carried out as carefully as possible.

The baby's head is large in relation to the size of the body, the seams between the bones of the skull and the small fontanel are open, that is, between the bones of the skull and in the region of the small fontanel there are areas not covered by bone tissue. Large fontanelle small due to the displacement of the bones of the skull. The auricles are very soft. Nails are thin, do not reach the edges of the nail phalanges. In girls, the labia majora do not cover the small ones, so you can see a wide open crimson-red genital slit. In boys, the testicles have not yet descended into the scrotum, the scrotum itself bright red. Umbilical cord in such children, it disappears later, by about 10 days, and in full-term babies it occurs by 5 days of life.

The functioning of all organs and systems of a premature baby is also associated with the absence of a certain period of intrauterine development and the characteristics of the maturation and development of the organism in a new environment... Due to the immaturity of all organs and systems: central nervous, cardiovascular, respiratory, digestive, adverse effects are especially acutely tolerated by premature babies. Consequently, diseases that do not pose a danger to other babies can be more severe in premature babies.

Respiratory system

In premature babies, the respiratory rate usually exceeds the norm and depends on the degree of prematurity: the less the baby's body weight, the more often he breathes.

After the baby is discharged from the hospital or children's hospital in order to reduce the likelihood of inflammatory diseases of the respiratory system, one should try to protect him from a large number of contacts with potentially infected relatives and friends, limiting his social circle only to family members. To maintain a normal microclimate, you should ventilate the room where the baby is, while, however, not forgetting about the favorable temperature regime.

The cardiovascular system

The fetus has a specific circulatory system, which is fully formed by the time of birth in full-term babies. Premature babies, due to the fact that they were born prematurely, they may have various cardiac abnormalities that cause changes in heart parameters and worsen the general condition of the child. Insofar as the cardiovascular system premature babies are sensitive to external stimuli, you need to try to protect the baby from harsh and loud sounds, for example, from screaming, loud music.

Nervous system

The laying of brain structures occurs on early stage intrauterine development. Therefore, even a deeply premature baby is born with well-formed divisions. nervous system, but the process of maturation of the pathways is not yet complete, therefore, the conduction of nerve impulses to various bodies and fabrics.

In children with lesions of the nervous system, motor activity and muscle tone are reduced, reflexes are weak or absent, there may be an inconsistent small twitching of the limbs and chin - tremor.

In addition, the mechanisms of thermoregulation are imperfect in premature babies: they easily give off heat, but they produce it with difficulty. For babies born prematurely sweat glands do not function, there is no sweating, as a result of which these children easily overheat. Therefore, they should be in the most comfortable temperature conditions in order to avoid both hypothermia and overheating. The temperature regime must be maintained even after discharge from the clinic, avoiding hypothermia and overheating of the baby.

Given the above features of the nervous system, premature newborns are carefully monitored by pediatric neuropathologists, and in the clinic, these children are prescribed several courses of preventive or therapeutic massage. But the mother herself can engage in gymnastics and massage with a premature baby using simple techniques that a pediatrician will teach her; this will help the baby not only develop physically correctly, but also establish psychological contact with her mother, which will provide positive influence on the formation of the nervous system.

Digestive system

A number of features have and digestive system immature children. This is primarily expressed in immaturity. enzyme system... The glands of the gastrointestinal tract do not produce the required amount of gastric juice and enzymes. When colonizing the gastrointestinal tract with microorganisms, even a small amount of pathogenic bacteria in premature babies causes the phenomenon of dysbiosis - an incorrect ratio of certain microorganisms in the gastrointestinal tract. Also, due to the immaturity of the nervous system and the transmission of nerve impulses, the motor, or motor, function of the gastrointestinal tract suffers, the movement of food slows down. As a result, there are problems with the flow of food into different parts of the stomach and intestines and its excretion.

It must be remembered that the best and most necessary food for a premature baby is mother's milk. Therefore, in cases where the baby is immediately after birth in the intensive care unit and receives food through a dropper or is so weak that he cannot suckle, the mother needs to do everything possible measures to preserve breast milk.

Skeletal system

Even in deeply premature babies by the time of birth skeletal system sometimes formed, but the mineralization of bones is not yet complete, in connection with which they are additionally prescribed calcium and, in order to prevent rickets, an aqueous solution of vitamin D is additionally introduced.

Often premature babies are born unformed hip joints- dysplasia. Underdevelopment of the joints threatens in the future with various disorders of motor function, up to the deprivation of the ability to move independently. Therefore, it is necessary to diagnose this pathology in time and prescribe treatment. To detect dysplasia, an ultrasound examination of the joints is performed, which allows the correct diagnosis to be made. For treatment, depending on the degree of maturity of the joints, either wide swaddling, or wearing spacers, or - in severe cases - immobilization with plaster casts.

Health care

Not all babies born before the "official" term will certainly end up in departments specializing in nursing premature babies. When deciding on the need to place a child born prematurely in the intensive care unit or neonatal intensive care unit, doctors take into account not only his gestational age, that is, the period of pregnancy at which the baby was born, but also the state of health. If, according to doctors, the condition of the newborn does not pose a threat to his life and health, the child is discharged home, providing the mother with all the necessary recommendations for caring for him.

If a premature baby needs medical supervision, he has to go through various stages of assistance and nursing.

First step - children's resuscitation. In the case of significant immaturity of vital systems, the child immediately after birth goes to the children's intensive care unit. There is a device for every baby. artificial ventilation lungs that can be used when needed. In the intensive care unit, children are kept in special incubators, in which the temperature regime that is optimal for a given gestational age is maintained. All babies are connected to monitors displaying basic vital signs. If the indicator, for example, the heart rate, changes below the acceptable level, the monitor starts emitting alarms. The medical staff immediately fixes them and provides the child with the necessary assistance.

Children who have no or poorly expressed sucking reflex receive food for the first few weeks through a nasogastric tube, which is inserted into the stomach through the nasal passages. Then breast milk or formula is poured into the tube.

The baby receives the necessary treatment - antibiotics, antiviral drugs, drugs that prevent the development of dysbiosis, etc. At the same time, diagnostics and treatment of concomitant pathology is carried out, the child is examined by various specialists - an ophthalmologist, neurologist, cardiologist, etc., who are prescribed to him preventive treatment that prevents the development of formidable complications of prematurity.

Second phase - intensive therapy newborns. The child is in the intensive care unit until his lungs are capable of spontaneous breathing... As soon as the baby begins to breathe completely on his own, or if he needs an additional supply of oxygen, he is transferred to the next stage - in the intensive care unit for newborns. Here, a premature baby is also placed in an incubator, in which he remains until he can independently maintain body temperature and do without additional oxygen supply.

Today, it is considered a proven fact that during a hospital stay, a premature baby needs communication with its mother. The baby should hear the mother's voice, feel her warmth, which is achieved using the so-called kangaroo method. Its essence lies in the fact that the child is nursed, being in direct contact with the mother's skin - on her chest and abdomen. Mom puts on loose, front-opening clothes, the baby is wearing a diaper and sometimes a hat. The baby is placed between the breasts of the mother, her clothes are fastened to prevent heat loss. The baby's temperature is monitored by a nurse or monitors. Studies have shown that mother's warmth is great for keeping babies warm and their body temperature is maintained. Breathing also becomes more correct and stable, as does the heartbeat and oxygenation of the blood. Moreover, the baby's skin is colonized by the mother's microflora, which contributes to the healing process. You can switch to this nursing method when, in a relatively satisfactory condition, the child still needs artificial thermoregulation and monitoring of the heartbeat and breathing.

The third stage is follow-up observation... Now, in many cities of Russia, follow-up rooms are opening for children born with extremely low body weight. Follow-up in medicine is information about the patient, collected after the end of the initial observation, in in this case- after discharge from the intensive care unit or nursing premature babies. In some clinics with large regional or regional hospitals there are catamnesis rooms. The doctor working in this office has information about every child born prematurely, treated in the intensive care unit, and the pathology of premature babies. All this is necessary in order to track the health of the baby, determine the need for referral to a particular specialist, depending on the pathology identified, and improve the quality of life of a premature baby.

What awaits the baby who has "hurried" to be born? The prognosis depends on the degree of prematurity. Deeply premature babies receive treatment and continue to be "nursed" in an intensive care unit or intensive care unit. If the child was born after 33 weeks and did not suffer during childbirth, then in 7-10 days he can be discharged home under the supervision of a local pediatrician.

Do not forget that your child is still a little different from everyone else, but over time and with your help, he will be able to catch up with his peers in development.

Breast-feeding

The optimal nutrition for a premature baby is breast milk. If, for some reason, the mother cannot breastfeed the baby, then she needs to keep lactation as long as possible, because breast milk contains a number of protective factors, including immunoglobulins, vitamins, immunologically active substances, bifidus factor, lactoferrin, prostaglandins, etc. It is important that class A secretory immunoglobulins present in breast milk, provide local protection of the intestinal mucous membranes and prevent the influence of pathogenic bacteria and viruses, as well as food allergens. All this combined with a balanced vitamin and mineral composition explains unique properties breast milk, making its benefits apparent.

The timing of the appointment of the first feeding of a premature newborn is determined by his condition after birth. A delayed first feed increases initial loss body weight, and can also lead to a number of unwanted pathological conditions... A premature baby born in a relatively satisfactory condition can receive the first feed within a few minutes after birth (in this case, the baby will suck up a few drops of colostrum) or after 4-6 hours. Maximum duration The "hungry" period after birth should in no case exceed 24 hours. Sometimes such a long delay in the appointment of nutrition is necessary if the child has suffered severe antenatal asphyxia, or intrauterine hypoxia, as well as if you suspect the presence of intracranial hemorrhage, with frequent regurgitation after trying to carry out the first feeding.

A premature baby sleeps a lot and does not feel hungry. He should be fed every 2 hours or as directed by a doctor. Feeding such a baby is difficult, sometimes it takes a long time, since he sucks poorly and sluggishly. The mother needs to be patient and attentive, but breastfeeding for too long, if he is weakly sucking, should not be: it tires the baby. Express milk and feed your baby with expressed breast milk. It should be remembered about the small capacity of the stomach in premature babies. Therefore, in the first days of life, the volume of one feeding can range from 5 ml per day to 15–20 ml per day 3 of life.

As a rule, premature babies receiving breast milk do not need additional administration of vitamins, however, breast milk contains little vitamin D, so sufficient attention must be paid rational nutrition nursing mothers. At present, it is recommended to prescribe vitamin D in the form of an aqueous solution early, on the 10-14th day of life.

Sanitary and hygienic standards

The nursery must be kept perfectly clean, diapers and other linen must be boiled thoroughly. Even with seemingly insignificant changes in the child's condition, you should immediately consult a doctor. At first, the number of those wishing to visit the baby should be limited, since premature babies are easily exposed to infections.

Bathing a baby

Bathing should be started only after the doctor permits it.
Bathing a premature baby in the first months is possible only in boiled water... Pour into the bath first hot water, and then gradually dilute it with cold to a temperature of 37–38 ° C, but not less than 37 ° C.
When swimming, only the baby's head should be above the water. You should wash your baby with soap no more than 1-2 times a week.
After the end of the procedure, the child is poured warm water and immediately wrapped in a heated diaper or towel. You need to wipe the baby very carefully, gently, without sipping the skin. The armpits, groin area and cervical folds are lubricated with vegetable oil.

Temperature regime

The temperature regime should take into account the imperfection of thermoregulation and the special danger of cooling the baby. The air temperature in the delivery room should be at least 22–23 ° С. The transfer of a premature baby from a maternity hospital to a hospital for subsequent nursing can be carried out already in the first hours of life in the absence of obvious contraindications to transportation, such as intracranial hemorrhages, hemolytic disease.

In specialized departments, premature babies are placed in boxed wards, 2-3 babies in a box. Children born with a body weight of less than 1500 g, as well as more mature, but seriously ill premature babies are nursed in incubators - incubators, in which, depending on the degree of immaturity and age of the child, the temperature of 32–36 ° C is maintained. During the first week of a child's life, the relative humidity in incubators is gradually reduced from 90% to 60–70%. The length of the child's stay in the incubator depends on his individual characteristics. All medical procedures are carried out, if possible, in an incubator. The position of the child's body is periodically changed, turning him over on the other side or on his stomach.

The air temperature in the wards ranges from 24 to 26 ° C, the premises are ventilated 3–6 times a day. In the department of stage 2, it is necessary to observe a strict medical-protective and sanitary-epidemiological regime - to carry out wet cleaning, air quartzization, and cyclic filling of the chambers. Clear monitoring of the health of nursing mothers is required; wearing by staff and mothers gauze masks with a change every 4 hours; hygienic baths for children, which are prescribed individually.

At home, you should also observe the required temperature regime. To prevent hypothermia of the child, the temperature in the room should be at least 25 ° C, since when the body temperature of a premature baby drops below 36 ° C, there is a risk of joining or activating a latent infection.

Place heating pads or hot water bottles in the crib where your baby will sleep, wrapping them in several layers of fabric to prevent the baby from getting burnt. The water must be changed as it cools. It is necessary to measure temperature and change clothes of a premature baby quickly so that heat loss is minimal.

It is impossible to leave the baby undressed for a long time. Dressing a premature baby should be warm. If the baby was born a few months ahead of schedule, he needs to prepare special clothes: good warm will do blouse or jumpsuit with a hood. The sleeves must be sewn up to keep the baby's arms from freezing.

In the room where the premature baby is located, it is necessary to support high humidity air so that the mucous membranes of the eyes, mouth and nose of the baby do not dry out. You can increase the humidity by placing several containers of water in the room or hanging wet towels, or it is better to use a special humidifier that maintains a constant set humidity.

Special massage

Muscular weakness is characteristic of premature babies, and a competent specialist's massage courses can improve the condition of the baby's muscular system. Simple tricks after consultation with a doctor, parents can perform massage on their own.

Walking mode

Walking with a premature baby should only be done in warm weather with the permission of a doctor. If the baby was born in summer, it should be taken out for a walk only if the temperature outside is not lower than 24 ° C and the weather is calm. You should walk with your child no earlier than 2 weeks old. For premature babies born in autumn or spring, walks are allowed no earlier than 1.5 months after birth. In this case, the child's body weight must be at least 2.5 kg, and the air temperature must be at least 10 ° C. V winter months you should not take a premature baby out into the street, since he is not yet able to endure such sharp drop temperatures.

Contact with mother

Over the past 15 years, Western neonatologists have been actively using and promoting the kangaroo method. As already mentioned, this method involves close communication between mother and child on a skin-to-skin basis. The child is laid undressed on the mother's naked breast, and both are covered with diapers and a warm blanket. This procedure carried out for an hour to several times a day. The rest of the time, the baby is in the incubator or maintains the temperature with the help of other heating devices.

If possible, the mother should be with the child as much as possible. The baby should hear the voice of the mother, feel her smell, touch. Talk to your baby as often as possible - when you feed him, change a diaper or diaper, massage, wash, rock. Sing lullabies or just songs you know. Hearing mother's voice, feeling her, the child will understand that mother is near, he is safe and there is no reason for concern. This will help him accumulate all his strength for a speedy correction.

As long-term observations show, despite all the described features, at good care and due attention of parents and doctors, premature babies develop successfully and after 1 year they catch up with their peers.

Premature babies. Pathology of premature babies

Efimova Margarita, 5 course

About two out of ten babies are born prematurely. A premature infant is a baby born before the end of 37 weeks of pregnancy. Most premature babies are born with a body weight of less than 2500 g.

Prematurity:

I degree 35-37 weeks weight about 2001-2500 g

II degree 32-34 weeks weight approximately 1501-2000 g

III degree 29-31 weeks weight about 1001-1500 g

IV degree less than 29 weeks weight less than 1000 g.

A premature baby requires close attention, since in the process of nursing it, a number of problems often arise. First of all, this applies to children born with a body weight of 1500 g and less "deeply premature" and, especially less than 1000 g "extremely premature". It should be remembered that the division by the degree of prematurity, taking into account the weight parameters, does not always correspond to the true conceptual age of the child. This method classification is used to standardize treatment and observation, for the needs of statistics. In practice, in addition, it is necessary to take into account a wider range of positions to assess the actual age of the child.

The causes of undermaturity can be divided into three large groups:

1. Socio-economic and demographic. Absence or insufficiency medical care, poor nutrition of a pregnant woman, occupational hazards(work on the assembly line, availability physical activity, standing position for most of the working day), bad habits, unwanted pregnancy etc.

2. Socio-biological. Premature birth is more common in primiparous women under the age of 18 and over 30 years old, the father's age is over 50 years old. The obstetric history is important: artificial termination of pregnancy (especially criminal or proceeding with complications), pregnancy that occurred soon after childbirth (less than 2-3 years).

3. Clinical. The presence of chronic somatic, gynecological, endocrinological diseases in a pregnant woman. Pathology of pregnancy: late gestosis, acute infectious diseases suffered during pregnancy, surgery, physical injuries, especially the abdomen.

On the part of the fetus, the causes of premature birth can be chromosomal pathology and intrauterine infection. A premature baby can be distinguished externally from a baby born on time. In premature babies, the physique is disproportionate. The head is large relative to the body, the bones of the skull are pliable, the seams and the small fontanel are open. The skin is thin, dark red, subcutaneous tissue practically undeveloped, the skin is abundantly covered with a delicate fluff, the auricles are soft, the nails are very thin. The navel is located below the middle of the abdomen.

Internal organs and systems are also immature. In premature and "low birthweight" children, the body's defenses are weaker and imperfect. The period of adaptation to outside world their course is more intense than that of full-term ones. In this regard, adverse effects are especially acutely tolerated by babies. Pathology often develops against this background. Diseases that do not pose a danger to other children are more severe in premature and "low birthweight" babies.

As you know, the laying of brain structures occurs at an early stage of intrauterine development. And even a deeply premature baby is born with formed parts of the nervous system, but the nervous system is immature and often unable to carry out the correct regulation of all organs and systems. It takes time to build these relationships. So, in the early days, the baby does not know how to suck independently, because the nerve impulse is not transmitted correctly to the muscles that are involved in sucking. The baby is fed through a tube for a long time until the sucking reflex is formed. Very often, such children, having already learned to suck, swallow badly.

Children, whom doctors were forced to feed through a tube for a long time and who were on artificial ventilation for a long time, usually start talking late, pronounce sounds incorrectly, because reflexes that regulate the tone of the muscles involved in the pronunciation of sounds take a very long time to form. Therefore, almost all deeply premature babies need the help of a speech therapist. And speech therapy classes are necessary even before the child begins to speak, in order to normalize the tone of the muscles of the tongue, to form the correct development of the speech muscles.

During childbirth, even without complications, the baby's brain is under great stress. The pressure on the membranes can be so strong that circulatory disorders develop, this can lead to hemorrhages in the brain. In premature babies, immaturity of the brain is often accompanied by hypoxia, traumatic childbirth, a lack of hematopoietic vitamin K, which also often leads to hemorrhages and cerebral strokes. Violation cerebral circulation can lead to damage to the structures of the brain. Against this background, the formation of infantile cerebral palsy is possible.

In case of mild hemorrhages, the walls "burst" small vessels and this can lead to increased intracranial pressure. Intracranial pressure increases due to the excess formation of fluid in the ventricles of the brain, which presses on the surrounding tissue. With minor hemorrhages, the condition in most cases is quickly compensated, the outflow of fluid from the ventricles is normalized, and the hemorrhages dissolve without a trace. In other words, grade 1 and 2 hemorrhages can pass without a trace for the child, however, this does not mean that he does not need to be observed and treated at 1-2 years of age.

Severe hemorrhages, when large vessels "break" and blood fills all cerebral ventricles, cause much more serious consequences, lead to hydrocephalus, seizures, developmental delay, movement disorders... Such children need constant help from a neonatologist, neuropathologist and other specialists, in particular, control from the neurosensory organs (hearing and vision), since these areas of the brain can be damaged.

An orthopedic surgeon examines all newborns at least 4 times (at 1, 3.6 and 13 months). Such control allows early detection of pathology, which is often found in premature babies, such as dysplasia (underdevelopment) of the joints.

In children with damage to the nervous system, motor activity and muscle tone are reduced, reflexes are poorly expressed. Conversely, there may be excitement. Often in premature babies there is convulsive syndrome... For the diagnosis of neurological disorders in babies, the method of ultrasound of the brain (NBG) is widely used. If the child has risk factors for severe pathology of the central nervous system, he needs active treatment and follow-up by a neuropathologist. In premature babies, the respiratory system is also immature. Observed underdevelopment lung tissue and its blood supply.

More often premature babies develop anemia, rickets. Children are susceptible to infectious diseases, often suffer from colds, otitis media, etc. Anemia is one of the most common pathologies in children. early age... About 20% of full-term babies suffer from this disease, and among premature babies in the first year of life, almost all develop anemia. At the same time, the lower the gestational age of the child, the higher the severity of the anemia. In the first months of life in premature babies with very low birth weight (less than 1500 g) and gestational age less than 30 weeks severe anemia requiring red blood cell transfusion is up to 90%.

All premature babies undergo audiological screening, as the risk of hearing impairment is increased due to damage to the nervous system.

Also, all premature babies in mandatory examined by an ophthalmologist. The first examination is carried out at the age of 4-6 weeks, and then once every three months. Observation of an ophthalmologist is necessary to detect retinopathy of prematurity. Retinopathy of premature babies is a disease of the eyes of premature babies, often leading to irreversible loss of visual function.

This disease was first identified in a premature baby in 1942 (then it was called as retrolental fibroplasia), until now the causes of the onset, progression and spontaneous regression of the disease are not completely clear and are only being studied.

Since the beginning of the 90s, research in this area has moved to a new qualitative level. This was largely due to the sharp increase in surviving deeply premature babies in developed countries and, accordingly, the appearance of a large number of children with terminal stages of retinopathy. Over the past 10 years, scientists from many countries have come to consensus on the multifactorial nature of the onset of the disease (i.e., the presence of many risk factors), developed a unified classification of the disease and proved the effectiveness of prophylactic laser and cryosurgical treatment.

Development is still underway surgical operations in active and cicatricial stages of the disease. On this stage In the development of ophthalmology, it is considered indisputable that the development of retinopathy of prematurity occurs precisely in an immature infant, as a violation of the normal formation of retinal vessels (which ends by 40 weeks of intrauterine development, i.e. by the time of the birth of a full-term baby). It is known that up to 16 weeks of intrauterine development, the retina of the fetus has no vessels. Their growth into the retina begins from the point of exit of the optic nerve towards the periphery. By the 34th week, the formation of the vasculature in the nasal part of the retina is completed (the optic nerve disc, from which the vessels grow, is closer to the nasal side). In the temporal part, the growth of blood vessels continues up to 40 weeks. Based on the foregoing, it becomes clear that the earlier the child is born, the smaller the area of the retina covered with blood vessels, i.e. an ophthalmological examination reveals more extensive avascular, or avascular zones (if the child was born before 34 weeks, then, accordingly, the avascular retinal zones are detected on the periphery from the temporal and nasal sides). After birth in a premature baby, various pathological factors - external environment, light, oxygen, which can lead to the development of retinopathy.