How is the development of a premature baby up to a year by months? For parents, who have had to take care of such a crumb, it is often a matter of life and death. The health and development of a child born prematurely depends largely on the degree of prematurity. The level of medical care provided is of paramount importance. However, the love and steadfastness of the parents is equally important.

From premature babies, healthy, strong, intelligent boys and girls grow up. They do not lag behind in mastering skills, but only develop according to their own scheme. The weight and length of the body in premature infants during the first year of life increases rapidly in comparison with full-term infants. Nature has set them the task of "catching up", and in some cases, "overtaking".

Groups of premature babies

Group	Pregnancy period, in weeks	Newborn weight, in grams	Increase in body weight by the year, at times
1	36-37	2000-2500	4-5
2	32-35	1500-2000	5-7
3	28-31	1000-1500	6-7
4	Less than 28	Less than 1000	8-10

• If a baby is born with a body weight below 1000 g, it is called "extremely premature"... Children with this weight make up less than 5% of all premature newborns. For the life of such a child, one has to fight hard and for a long time. All vital functions of his body require artificial support. With modern advances in neonatology, even children weighing 500 g are nursed, but in these cases there is a high percentage of complications and disabilities. By the way, in Russia since 2012 there has been a law on compulsory nursing and registration of children weighing 500 g. There are many discussions around this topic, including those of a moral nature.
• Particular attention is paid to babies born with a body weight of 1000 g to 1500 g... They are called "deeply premature", but they have many chances not only to survive, but also to be full-fledged, healthy people. Such children need artificial ventilation, oxygen supply, enteral (through a tube in the stomach) and parenteral (through a vein) nutrition. Hormones, amino acids, enzymes, glucose are added to special nutritional mixtures, which contribute to the rapid growth and development of the baby.
• Special conditions... Children weighing less than 1500 g are not prepared for independent functioning. For their nursing, it is necessary to create conditions adequate for intrauterine ones. Babies are placed in incubators (incubators) for premature babies. The required air temperature and humidity are maintained here, the necessary research and support are carried out. Children weighing up to 1700 g are kept in the incubator, then they are placed in a heated bed. With a weight of 2000 g, a baby, as a rule, no longer needs special thermal support.
• Features of the development of a premature baby at 34 weeks... The baby is able to suck independently. This is an important indicator when nursing premature babies. Babies in this group are at risk of apnea - sudden and involuntary cessation of breathing, most often during sleep. Therefore, they need to undergo additional examinations. The causes of apnea are poorly understood. They are associated with muscular, respiratory, and neurological disorders. If there are no complications, the baby quickly gains weight and goes home with the happy parents.
• Development of a premature baby born at 36 weeks... Such children, as a rule, do not have any complications. They can breathe and suck on their own. They may not need intensive care. However, such babies must undergo additional examinations and, after discharge, are under the close supervision of a pediatrician.
• The degree of prematurity is associated not only with the indicator of weight, but also with the general maturity of the body.... It happens that babies are born with a weight of 2500 g, but in terms of the maturity of organs, systems and functions they are inferior to those who have 2000.

What does a premature baby look like?

Babies born prematurely have a number of characteristics. External signs appear to varying degrees.

• Small weight and height... The length and weight of the baby's body can impress with their tinyness.
• Disproportion in the body... The baby has a big head. It is 1/3 of the body length (for comparison, in a full-term baby - 1/4). The cerebral part of the skull is larger than the facial one. The abdomen is also large and spread over its entire length. The navel is significantly lower than that of term babies. Neck, legs and arms are short.
• The softness and pliability of the bones of the skull... The fontanelle is open. Bones can move, cranial sutures can be pulled apart.
• The softness of the auricles... The ears are so soft that they can bend inward, stick together.
• Fluff on the body. The back, shoulders, hips, forehead, cheeks are covered with soft hair. In medicine, this phenomenon is called lanugo.
• Lack of subcutaneous fat... The skin of the baby is as if transparent. Under it you can see the blood vessels.
• Weakness and lethargy... Reduced motor activity, weak cry, lack of hunger, hypotonia, undeveloped sucking reflex - all these signs in medicine are called adynamia. They are only found in deeply premature babies.
• Weak and short nails... The symptom is less common than the rest.
• Ophthalmic eyes. It does not appear immediately, but two weeks after birth. Typical for children with a high degree of prematurity.
• Genital underdevelopment... Girls may have a gaping genital opening with underdeveloped labia majora. In severely premature boys, the testicles did not descend into the scrotum.
• No swelling of the mammary glands... It happens in deeply premature babies.

The listed signs can be manifested in a complex or partially. Some of them can even occur in full-term babies.

When the baby gets home

It depends on the degree of prematurity. In the hospital, he can spend from a week to six months. The stages of nursing premature babies are as follows: first aid in the hospital; transfer to the children's intensive care unit; then to the intensive care unit; already from here, with good dynamics, the baby is discharged home. Mom can be next to the baby in the hospital, help the nursing staff with care, and bring it in. And even take the baby in your arms. By the way, this is one of the most unique and effective ways of nursing. It is called the kangaroo method. Under what conditions is the baby discharged home?

• No complications, steady progress in overall development.
• Well-established thermoregulation.
• The child does without support and control of breathing, cardiovascular system.
• She knows how to suckle a breast or a bottle on her own, weight gain increased up to 2000 g.

And one more, no less important condition: parents know how to feed a premature baby, how to provide the baby with proper care and where to turn if necessary.

Development by months

Table - Weight gain and height of premature babies by months and per year

Age (months)	4 group (up to 1000 g)		Group 3 (up to 1500 g)		2nd group (up to 2000 g)		1st group (up to 2500 g)
	Weight, g	Length, cm	Weight, g	Length, cm	Weight, g	Length, cm	Weight, g	Length, cm
1	180	3,9	190	3,7	190	3,8	300	3,7
2	400	3,5	650	4	700-800	3,9	800	3,6
3	600-700	2,5	600-700	4,2	700-800	3,6	700–800	3,6
4	600	3,5	600-700	3,7	600-900	3,8	700-900	3,3
5	650	3,7	750	3,6	800	3,3	700	2,3
6	750	3,7	800	2,8	700	2,3	700	2
7	500	2,5	950	3	600	2,3	700	1,6
8	500	2,5	600	1,6	700	1,8	700	1,5
9	500	1,5	600	1,6	700	1,8	700	1,5
10	450	2,5	500	1,7	400	0,8	400	1,5
11	500	2,2	300	0,6	500	0,9	400	1,0
12	450	1,7	350	1,2	400	1,5	300	1,2
Weight and height gain per year	≈ 7080	≈ 33,7	≈ 8450	≈ 31,7	≈ 8650	≈ 27,5	≈ 9450	≈ 25,3

Table - Comparative characteristics of motor skills of full-term and premature babies

Skills	Child weighing up to 1500 g	Child weighing up to 2000 g	A child weighing up to 2500 g	A full-term baby weighing up to 3500 g
Visual and auditory concentration	3 months	2-2.5 months	1-1.5 months	2-4 weeks
Holds his head confidently while lying on his stomach	5 months	4 months	3.5-4 months	2.5-3 months
Rolls over from back to stomach	7-8 months	6-7 months	5.5-6 months	5-6 months
Starts to crawl	11-12 months	10-11 months	9-10 months	8-9 months
Sits down on his own	10-11 months	9-10 months	8-9 months	7-8 months
Stands alone	12-14 months	11-12 months	10-11 months	9-11 months
Walks on his own	14-16 months	12-15 months	12-13 months	11-12 months

What to look for when looking at the table?

• There is no group of "urgently premature" babies... The birth rate of such children is low. The methods of nursing them are comparable to space technologies, and the stages of development can be greatly delayed.
• The figures are averaged by months.... It is necessary to take into account individual development, genetic predisposition, general health.
• After six months, the indicators of premature babies gradually level out to the level of full-term... Psychomotor skills develop at about the same time, if the baby has no complications.

The difference in skill acquisition versus mature newborns is 1–3
months. It depends on the degree of prematurity of the baby.

• 1 month . Unlike full-term babies, a baby does not gain weight well during the first month. This is due to weak sucking activity, undeveloped swallowing reflex. If the baby is at home, the parents' task is to protect him from the effects of cold, pathogenic microbes, viruses. Contact with the outside world should be limited.
• 2 months . Strength is increasing, but it is still difficult for the baby to suck. During this period, there is a tangible weight gain, which is the main indicator of the healthy development of a premature baby. From the beginning of the second month, the baby can be.
• 3 months . Sleep and food are two basic things for a baby at this age. You just need to make sure that the baby does not turn his head to one side, and change his position. Also at this age, mimic reactions appear, the baby fixes his gaze on his mother's face, tries to raise his head. He does not smile yet, but reacts to tactile contact. The grasping reflex, visual and auditory attention develops. Body weight doubles.
• 4 month. The kid raises and confidently holds his head, makes sounds. Grabs the toy with his hand. During this period, an increase in muscle tone is possible, which is well removed by massage and gymnastics.
• 5 month. Holds a toy in his hand. He smiles, begins to show a keen interest in the world around him. Sound and visual responses are greatly improved. The child turns his head towards the sound and accurately identifies its source.
• 6 month. Body weight triples. The child makes attempts to roll over from back to stomach. When communicating, he noticeably revives, recognizes relatives, jerks his legs and arms, walks. If you hold the crumb under the armpits, rests his feet on the surface, slightly squats. After six months, caring for a premature baby is no different from caring for babies born on time.
• 7 month. Shows activity, easily, on bellies, holds a toy well in his hand. At this age, if the baby was born at 35–37 weeks.
• 8 month. He makes his first attempts, stands on all fours, tries to swing. All motor skills are conscious and skillful. At this age, he shows interest not only in his business, but also in communication. Understands when asked to show an object. The kid is interested in verbal contact - words, intonation, songs, nursery rhymes, fairy tales.
• 9 month. Sits more confidently, tries to crawl. The need for communication increases even more. The first teeth are cut if the baby is born at 32–34 weeks. Pronounces the first syllables.
• 10 month. Stands confidently, moves, holding on to the support. But for now he gives preference to crawling. Likes to watch moving objects. Reacts quickly to sounds, listens to them, knows his name. At this age, the first teeth are cut if the baby is born before 31 weeks.
• 11 month. The period of active crawling continues. Although the baby is already able to confidently stand up and sit down. Can stand without support for a long time and even take several steps without support. During this period, he is attracted by cubes, pyramids, all moving toys. He has good contact with loved ones.
• 12 month. The baby can go on its own. This once again confirms that premature babies "catch up" with their peers in development by the year. Sometimes this happens later - in a year and a half. Pediatricians note that premature babies do better in physical development than in neuropsychic development. The age maturity of neuropsychic processes in such children can be formed by the age of 2-3 years. These indicators are within the normal range.

What you need to know about the peculiarities of medical supervision of premature babies? Required: weekly supervision by a pediatrician for 1 month, then twice a month up to six months; monthly determination of the level of hemoglobin to prevent anemia; prevention, starting from 2 weeks; quarterly consultation with an orthopedist and neuropathologist. Additionally, in the first year of life, you will need consultations with a physiotherapist, ophthalmologist, otolaryngologist, cardiologist, endocrinologist.

Features of care: 6 important points

A premature baby requires more care and care. Which ones?

Parents need to stock up on not only knowledge and skills, but also patience, love and faith in their baby.

Separately about feeding

Feeding premature babies has a number of features that parents need to be aware of.

• ... After discharge, the baby should be able to pick up and suckle on his own. In the first months, the baby still has little strength, and the energy costs when sucking are high. Therefore, it is recommended to spoon-feed it with expressed milk. The main task of the mother is to feed the baby as long as possible.
• Artificial feeding... If breastfeeding is not possible, adapted formulas for premature babies with a high content of protein, vitamins, and fatty acids are used. It is imperative to consult a pediatrician when choosing a formula for a child.
• How many times should I feed my baby? Depending on the degree of prematurity: 10 to 20 times a day, in divided portions. When the baby begins to gain weight from the second month of life, 8 feeds per day will be enough.
• ... It is introduced only after 7 months, this is due to the immaturity of the digestive system. It is also impossible to delay with complementary foods, since the baby's body needs vitamins and minerals. The first in complementary foods should be cereals (,), then and, fresh juices and the very last -. Sugar and sweet fruits should be avoided. After each complementary feeding, you need to feed the baby with breast milk or formula.

For a baby born prematurely, each added gram is already a victory. Weight control is strictly enforced. It is advisable to purchase electronic scales for newborns and carry out weighing daily.

At discharge, parents receive a number of recommendations from neonatologists and pediatricians. It is important to comply with the care requirements and not engage in amateur activities. It is also important to know: the development of a premature baby by months depends on the degree of prematurity. The higher it is, the more time it will take for the baby to develop psychomotor skills.

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A premature baby is a baby born at less than 37 completed weeks, that is, before the 260th day of pregnancy.

Determining prematurity only by weight and height cannot be considered absolutely correct, especially when the duration of pregnancy is difficult to establish. This classification method is used to standardize treatment and observation, for the needs of statistics. There are children born with great weight and height, but with clear signs of immaturity, which is characteristic of premature babies. In practice, in addition, it is necessary to take into account a wider range of positions to assess the actual age of the child.

Signs of prematurity: weak cry of a child, shallow, weakened irregular breathing, insufficient development of the subcutaneous fat layer, and therefore the skin is red, dry, wrinkled, abundantly covered with fluff; the small and lateral fontanelles are open, the auricles are soft and tight to the head,> the nails do not reach the edge of the phalanges of the fingers, the umbilical cord is located below the middle of the body length, the genitals are underdeveloped - in boys the testicles are not descended into the scrotum, in girls the labia minora are not covered large; movements are scanty, hypotension (decreased tone) of the muscles, physiological reflexes are reduced, even sucking and swallowing reflexes may be absent.

The maturation of the senses in premature babies.

Tactile sensation: The system of somatic sensations (feelings of touch, temperature and pain) develops between 8 and 15 weeks of gestation. At 32 weeks gestation, the fetus always reacts to changes in ambient temperature, touch and pain.

Taste: Taste buds morphologically mature by 13 weeks of gestation. At 24 weeks of gestation, the fetus already reacts to taste stimuli.

Fetal hearing appears at 20 weeks of gestation. At 25 weeks gestation, the fetus responds to intense vibrational and sound stimuli. Sensitivity and the ability to distinguish sounds in pitch reach adult levels by 30 weeks of gestation. In a full-term newborn, they are no different from those in an adult.

Vision. By 24 weeks of gestation, all structures of vision are formed. The reaction of the pupils of the fetus to light appears at a gestational age of 29 weeks. At 32 weeks, it becomes stable. At 36 weeks gestation, the vision of a fetus is no different from that of a full-term baby. It must be remembered that the eyesight of even full-term babies is 20 times worse than that of adults; it is still indistinct, indistinct. The child sees only the outlines of objects (mobile and motionless), located at a distance of only 25-30 cm from his eyes. A full-term baby can distinguish between shiny and red objects.

Smell: By 28-32 weeks gestation, premature babies begin to react to strong odors.

Features of the course of the neonatal period in premature babies.

The course of the neonatal period in premature babies has some peculiarities and depends on the degree of physiological maturity.

Premature newborns have lethargy, drowsiness, weak cry, physiological erythema is pronounced sharply.

Physiological jaundice is usually detected a little later due to the bright color of the skin and often lasts up to 3-4 weeks of life.

The umbilical cord in premature babies is thick, juicy, disappears later (by the 8-14th day of life), the healing of the umbilical wound is slow.

In many premature babies, edema is observed at 1-2 weeks of life, which are located mostly on the lower limbs and abdomen.

Thermoregulation is not stable enough, a naked child cools quickly, the body temperature can drop below 36 °, and at elevated ambient temperatures, overheating quickly sets in ("kuvez fever").

The respiratory rate in premature babies is inconsistent, with movements it reaches 60-80 per minute, at rest and during sleep it is significantly hardened, prolonged apnea (respiratory arrest) can be observed, especially during feeding. In premature infants in the first days of life, atelectasis of the lungs is often observed.

Heart sounds can be muffled, heart rate changes depending on the conditions and condition of the child (120-140). With anxiety and an increase in ambient temperature, the heart rate can reach up to 200 beats per minute.

Physiological weight loss is restored by 2-3 weeks of life. Weight gain in the first month is insignificant (100-300 g).

In the 2-3rd month of life, when intensive weight gain begins, anemia often develops in premature babies. With proper nutrition with a sufficient intake of protein and vitamins, it gradually goes away. Decrease in hemoglobin below 50 units. requires special treatment.

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 or less ("deeply premature") and, especially less than 1000 g ("extremely premature").

In developed countries, premature babies are usually cared for in intensive care units. Pediatricians who specialize in caring for children up to 28 days old are called neonatologists.

It is especially worth mentioning about feeding premature babies. Children born before 33-34 weeks of gestation, as a rule, are fed through a tube inserted into the stomach, because their sucking and swallowing reflexes are either reduced or completely absent. In addition, coordination of these reflexes is necessary, which develops only by 33-34 weeks of gestational age. Expressed breast milk and / or infant formula specially adapted for these babies are used as food. That part of the food that children do not assimilate in the digestive tract due to the reduced activity of digestive enzymes and other functional and morphological characteristics of premature babies, is administered in the form of separate solutions of proteins, fats and carbohydrates intravenously (parenteral nutrition).

Modern neonatal intensive care includes sophisticated methods of controlling temperature, respiration, cardiac activity, blood oxygen saturation and brain function.

Conditions for nursing premature babies.

The group of low birth weight children is especially dependent on the influence of external factors. They require ideal nursing conditions in order to achieve not only their survival, but also a favorable further development.

One of the most important conditions for nursing premature babies is the optimal temperature regime. Most often, children weighing up to 1500 g are placed in incubators. If the child does not retain its own heat well, then even if it is more than 1500 grams, he can be placed in an incubator.

Immediately after birth, the child is placed in an incubator with an air temperature of 34 to 35.5 degrees (the smaller the weight of the child, the higher the temperature), by the end of the month the temperature is gradually reduced to 32 degrees. The temperature regime in the incubator is selected individually. To control the temperature of the child's body, special temperature sensors can be used, connected to the monitor on the one hand, and attached to the child's body with a plaster on the other.

Also, the thermal regime can be maintained using special changing tables with a source of radiant heat.

Another important condition for nursing is air humidity and in the first days it should be 70-80%. There are special humidifiers for this purpose in incubators.

The purpose of creating conditions favorable for the development of a child receiving intensive care is associated with minimizing adverse effects, as a result of which the prognosis of psychomotor development is improved.

The creation of favorable conditions for the development of newborns in intensive care units (optimal light regime, elimination of noise, minimization of painful manipulations, tactile stimulation) favorably affects the subsequent development of children with severe illnesses.

Newborns are very vulnerable. They have a common reaction to damaging factors, that is, it involves the response of several body systems at once. Elimination of pain and anxiety reduces the need for oxygen in the blood (and, consequently, in the correction of the mode of artificial ventilation of the lungs), reduces its energy costs, improves food tolerance, and shortens the duration of hospitalization.

The inclusion of parents in the treatment process reduces painful sensations and stress reactions in newborns and has a beneficial effect on subsequent development.

Newborns in intensive care units continue to develop their senses. Negative and positive environmental factors affect the conduction of excitation along the nerve pathways.

In the brain of a premature baby during the period when he is in the intensive care unit (22-40 weeks of gestation), critical changes occur:

Environmental influences affect the formation of the important above processes during this critical period. If these influences are inadequate, then they can irreparably disrupt the process of formation of the nervous system.

A newborn in intensive care is exposed to light and sound. The very medical procedures necessary to save his life are a great burden for a premature and seriously ill child. These treatments include airway sanitation, vibrating chest massage, tube insertion and feeding, venous catheterization, chest x-ray, ultrasound, ophthalmoscopy, daily physical examination, vital signs, hygiene, and weighing.

According to rough estimates, a seriously ill newborn is transferred and subjected to various manipulations for the care, treatment and control of the condition more than 150 times a day. Thus, periods of continuous rest do not exceed 10 minutes.

What can reduce this stress?

• Creation of comfortable conditions, elimination of noise and bright light, comfortable placement in an incubator (incubator) or in a bed.
• Cooperation with parents, strengthening their attachment to the child.
• Use of natural calming and self-regulating factors: pacifiers, kangaroo care, twins stay in the same bed (incubator).
• Midline positioning in a flexor position, swaddling that mimics the limited space in the uterus.
• Performing multiple nursing treatments at the same time frame to provide the child with longer periods of rest.

Eliminate noise and glare... Prematurity itself is a risk factor for sensorineural hearing loss and deafness. It is detected in 10% of those born prematurely and only in 5% of those born full-term. Noise disrupts the formation of the auditory pathways in the central nervous system, which are necessary for the development of speech.

Recommended illumination levels in ICUs of less than 6 ft-candles (60 lux) and noise levels of less than 50 decibels (calm, quiet speech) reduce the risk of hearing loss and improve the subsequent development of critically ill children. In the intensive care unit, therefore, only calm speech is allowed without raising the voice. It must be remembered that the doors of the incubator must be closed carefully and quietly, without knocking on the incubator and other nearby surfaces.

The eyelids of newborns are not protective. At least 38% of white light passes through the eyelids and irritates the baby.

Elimination of pain and congestion:

Premature babies are very sensitive to rough touch. They react to such touches with tachycardia, agitation, increased blood pressure, apnea and a drop in hemoglobin oxygen saturation, dysregulation of physiological processes, and insomnia.

However, premature babies are not able to respond to pain over a long period of time with changes in physiological parameters and behavior. Their reactions are quickly depleted, so it is difficult to notice them. Pain rating scales developed for term infants are not applicable to preterm infants.

According to one study, three out of four episodes of hypoxia and a drop in hemoglobin oxygen saturation are associated with manipulation of care and treatment procedures. In addition, stress hormones are released in response to them. A premature baby who covers his face with his hands gives us a signal that he is experiencing unpleasant sensations.

It is very important to try to reduce stress and pain.

Non-drug methods of minimizing pain and overload in newborns include using a pacifier and nipple with a bottle of water, swaddling to simulate a closed uterine space, reducing exposure to light and noise, and performing several manipulations at the same time in order to increase the gaps between them and give the baby rest.

Correct placement of premature babies:

When the baby is in the neonatal intensive care unit, it is important to create an environment that mimics the closed space of the uterus (a “nest” of soft materials).

Neural connections are strengthened with repeated stimulation and weakened in the absence of it. After birth, a premature baby, leaving the closed space of the uterus, ceases to receive constant tactile stimulation from its walls, which supports muscle development. The weak muscles of a premature baby cannot withstand the force of gravity. He assumes a sprawled posture with limbs extended, abducted and outwardly deployed. Gradually, this posture leads to the formation of abnormal muscle tone and postural (associated with a forced position of the body) deformations.

So, the increasing flattening of the skull from the sides leads to a narrowing and lengthening of the head (the so-called scaphocephaly and dolichocephaly). It is due to the thinness and softness of the bones of the skull, which is why it is easily deformed. Such a deformation of the head, apparently, does not affect the development of the brain, but makes the child outwardly unattractive and interferes with his socialization. However, with good care, deformation can be significantly reduced.

Prolonged stay in the same position leads to deformations of the muscles and skeleton, disrupting subsequent motor development and the ability to cognize the world around, play, master social and other skills.

Giving the newborn the correct posture prevents deformities of the skull, trunk and pelvis, which disrupt and slow down subsequent development. The newborns themselves cannot turn, therefore, attention should be paid to the correct posture. The child should be laid in a folded position in the "nest" and regularly turned from one side to the other. It is allowed to lay out premature babies on the stomach, but only under the supervision of monitoring supervision and personnel.

The main risk groups in the development of pathological conditions at birth. Organization of observation of them in the maternity hospital

The main risk groups in the development of pathological conditions in newborns, their causes and management plan

Primary and secondary toilet of the newborn. Skin care, the remainder of the umbilical cord and the umbilical wound in the children's ward and at home

Organization of feeding of full-term and premature newborns. Calculation of food. Benefits of breastfeeding

Organization of nursing, feeding and rehabilitation of premature babies in the maternity hospital and in specialized departments of the 2nd stage

Small and low birth weight newborn: leading clinical syndromes in the early neonatal period, principles of nursing and treatment

Health groups for newborns. Features of dispensary observation of newborns in outpatient settings, depending on health groups

Pathology of the neonatal period Borderline conditions of the neonatal period

Physiological jaundice of newborns: frequency, causes. Differential diagnosis of physiological and pathological jaundice

Jaundice of newborns

Classification of jaundice in newborns. Clinical and laboratory criteria for the diagnosis of jaundice

Treatment and prevention of neonatal jaundice caused by the accumulation of unconjugated bilirubin

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Hemolytic disease of the fetus and newborn: definition, etiology, pathogenesis. Clinical course options

Hemolytic disease of the fetus and newborn: the main links in the pathogenesis of edematous and icteric forms of the disease. Clinical manifestations

Hemolytic disease of the fetus and newborn: clinical and laboratory diagnostic criteria

Features of the pathogenesis and clinical manifestations of hemolytic disease of newborns with group incompatibility. Differential diagnosis with Rh-conflict

Principles of treatment for hemolytic disease of the newborn. Prophylaxis

Kernicterus: definition, causes of development, clinical stages and manifestations, treatment, outcome, prevention

Dispensary observation in a polyclinic for a newborn who has had hemolytic disease Syndrome of respiratory distress (SDR) in newborns

Causes of respiratory disorders in newborns. Share of SDR in the structure of neonatal mortality. Basic principles of prevention and treatment

Respiratory distress syndrome (hyaline membrane disease). Predisposing causes, etiology, links of pathogenesis, diagnostic criteria

Hyaline membrane disease in newborns: clinical manifestations, treatment. Prophylaxis

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Neonatal sepsis: definition, frequency, mortality, underlying causes and risk factors. Classification

III. Medical and diagnostic manipulations:

IV. Presence of various foci of infection in newborns

Sepsis of newborns: the main links of pathogenesis, variants of the clinical course. Diagnostic criteria

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Neuro-arthritic diathesis. Diagnostic criteria. Treatment. Prophylaxis

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Chronic eating disorders (dystrophies). The concept of normotrophy, malnutrition, obesity, kwashiorkor, marasmus. Classic manifestations of dystrophy

Hypotrophy. Definition. Etiology. Pathogenesis. Classification. Clinical manifestations

Hypotrophy. Treatment principles. Organization of diet therapy. Medical treatment. Criteria for the effectiveness of treatment. Prevention. Rehabilitation

Obesity. Etiology. Pathogenesis. Clinical manifestations, severity. Treatment principles

Rickets and rickets

Rickets. Predisposing factors. Pathogenesis. Classification. Clinic. Options for the course and severity. Treatment. Rehabilitation

Rickets. Diagnostic criteria. Differential diagnosis. Treatment. Rehabilitation. Antenatal and postnatal prophylaxis

Spasmophilia. Predisposing factors. Causes. Pathogenesis. Clinic. Flow options

Spasmophilia. Diagnostic criteria. Urgent care. Treatment. Prevention. Outcomes

Hypervitaminosis e. Etiology. Pathogenesis. Classification. Clinical manifestations. Flow options

Hypervitaminosis e. Diagnostic criteria. Differential diagnosis. Complications. Treatment. Prophylaxis

Bronchial asthma. Clinic. Diagnostics. Differential diagnosis. Treatment. Prevention. Forecast. Complications

Status asthmaticus. Clinic. Emergency therapy. Rehabilitation of patients with bronchial asthma in the polyclinic

Bronchitis in children. Definition. Etiology. Pathogenesis. Classification. Diagnostic criteria

Acute bronchitis in young children. Clinical and radiological manifestations. Differential diagnosis. Flow. Outcomes. Treatment

Acute obstructive bronchitis. Predisposing factors. Pathogenesis. Features of clinical and radiological manifestations. Emergency therapy. Treatment. Prophylaxis

Acute bronchiolitis. Etiology. Pathogenesis. Clinic. Flow. Differential diagnosis. Emergency treatment of respiratory distress syndrome. Treatment

Complicated acute pneumonia in young children. Types of complications and doctor's tactics for them

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Chronic pneumonia. Definition. Etiology. Pathogenesis. Classification. Clinic. Clinical course options

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Biliary dyskinesia. Etiology. Pathogenesis. Classification. Clinic and options for its course

Biliary dyskinesia. Diagnostic criteria. Differential diagnosis. Complications. Forecast. Treatment. Rehabilitation at the clinic. Prophylaxis

Chronic cholecystitis. Etiology. Pathogenesis. Clinic. Diagnostics and differential diagnosis. Treatment

Cholelithiasis. Risk factors. Clinic. Diagnostics. Differential diagnosis. Complications. Treatment. Forecast. Prevention of blood diseases in children

Deficiency anemias. Etiology. Pathogenesis. Clinic. Treatment. Prophylaxis

Acute leukemia. Etiology. Classification. The clinical picture. Diagnostics. Treatment

Hemophilia. Etiology. Pathogenesis. Classification. The clinical picture. Complications. Laboratory diagnostics. Treatment

Acute glomerulonephritis. Diagnostic criteria Laboratory and instrumental studies. Differential diagnosis

Chronic glomerulonephritis. Definition. Etiology. Pathogenesis. Clinical forms and their characteristics. Complications. Forecast

Chronic glomerulonephritis. Treatment (regimen, diet, drug treatment depending on clinical options). Rehabilitation. Prophylaxis

Acute renal failure. Definition. Age related reasons. Classification. Clinic and its options depending on the stage of the OPN

Acute renal failure. Treatment depending on the cause and stage. Indications for hemodialysis

1. Premature babies: frequency and causes of premature birth. Anatomical, physiological and neuropsychic characteristics of premature babies

Premature babies- children born in relation to the due date of the end of gestation prematurely.

Premature birth- This is the birth of a child before the end of the full 37 weeks of pregnancy or earlier than 259 days, counted from the first day of the last menstrual cycle (WHO, 1977). A premature baby is premature.

Preterm birth statistics .

Preterm birth rate = 3-15% (on average - 5-10%). Premature birth in 2002 - 4.5%. There is no downward trend in this indicator.

The highest morbidity and mortality rates are observed among children born prematurely. They account for 50 to 75% of infant mortality, and in some developing countries - almost 100%.

Causes of premature birth

socio-economic (salary, living conditions, nutrition of a pregnant woman);

socio-biological (bad habits, age of parents, occupational hazards);

clinical (extragenital pathology, endocrine diseases, threat, preeclampsia, hereditary diseases).

Factors contributing to fetal growth retardation and premature birth (prematurity) can be divided into 3 groups :

socio-economic:

1. lack or inadequacy of medical care before and during pregnancy;

   level of education (less than 9 grades) - affect the level and way of life, personality traits, material well-being;

   low standard of living and, accordingly, material security, and as a result, unsatisfactory living conditions, inadequate nutrition of the expectant mother;

   occupational hazards (physically hard, prolonged, monotonous, standing work of a pregnant woman);

   extramarital birth (especially with an unwanted pregnancy);

   unfavorable ecological situation;

socio-biological:

1. young or old age of a pregnant woman (less than 18 years old) and first childbirth over 30 years old);

   the father's age is under 18 and over 50 (in Europe);

   bad habits (smoking, alcoholism, drug addiction) of both the expectant mother and the father;

   short stature, infantile physique of a pregnant woman;

clinical:

1. infantilism of the genitals, especially in combination with hormonal disorders (insufficiency of the corpus luteum, hypofunction of the ovaries, isthmic-cervical insufficiency) - up to 17% of all premature births;

   previous abortions and miscarriages - lead to defective endometrial secretion, stromal collagenization, isthmic-cervical insufficiency, increased contractility of the uterus, the development of inflammatory processes in it (endometritis, synechia);

   mental and physical injuries of a pregnant woman (fright, shock, falling and bruising, lifting weights, surgical interventions during pregnancy - especially laparotomy);

   inflammatory diseases of the mother of an acute and chronic nature, acute infectious diseases (childbirth at the height of fever, as well as in the next 1-2 weeks after recovery);

   extragenital pathology, especially with signs of decompensation or exacerbation during pregnancy: rheumatic heart disease, arterial hypertension, pyelonephritis, anemia, endocrine diseases (hypothyroidism, thyrotoxicosis, diabetes mellitus, hyperfunction of the adrenal cortex, etc.), etc. cause disturbance of the uteroplacental blood flow, degenerative changes in the placenta;

   genital pathology;

   pathology of pregnancy: late gestosis, nephropathy, immunological conflict in the mother-placenta-fetus system;

   anomalies in the development of the placenta, umbilical cord;

   in vitro fertilization;

   multiple pregnancies (about 20% of all premature babies);

   fetal diseases: IUI, hereditary diseases, fetal malformations, isoimmunological incompatibility;

   the interval between births is less than 2 years.

Causes of prematurity can be divided according to another principle:

external,

coming from the mother;

associated with the characteristics of the course of pregnancy;

from the side of the fetus.

Prematurity classification

In the ICD X revision in the heading R 07 " Disorders associated with a shortened gestation period, as well as low birth weight " the division of premature newborns is accepted both by weight and by gestational age. The note says: When both birth weight and gestational age have been established, birth weight should be preferred.

Depending on the indicators of gestational age and the body weight of a premature baby, 4 degrees of prematurity (3 weeks for each of the first three degrees):

Prematurity		by gestation	by body weightat birth
I degree		35 weeks - incomplete 37 weeks (up to 259 days)	2500-2000 grams	low
II degree		32-34 weeks	1999-1500 grams
III degree	deeply premature	29-31 weeks	1499-1000 grams very low body weight
IV degree		22-28 weeks	999-500 grams extremely low weight (extremely low weight)

Extreme prematurity- gestational age less than 22 complete weeks (154 complete days).

The line between miscarriage and premature at 22 full weeks (154 full days) of gestation is determined by weight: 499 g - miscarriage, 500 g - premature newborn.

Anatomical, physiological and neuropsychic characteristics of premature babies

Anatomical features of premature babies (external signs of immaturity):

the skin is thin and glossy, dark red, as if translucent;

on the face, back, extensor surfaces of the limbs there is a plentiful primordial fluff - lanugo;

the subcutaneous fat layer is thinned, as a result of which the skin is wrinkled, there is a tendency to swelling of the subcutaneous fat;

body length from 25 cm to 46 cm;

disproportionate physique (the head is relatively large: the large vertical size of the head ranges from ¼ to ⅓ body length, the cerebral skull prevails over the facial one; the neck and lower limbs are short);

low hair growth on the forehead,

the skull is more round, its bones are malleable - the cranial sutures are not closed, the small and lateral fontanelles are usually open;

the auricles are soft, close to the skull;

nails often do not reach the fingertips, the nail plates are soft;

the low-lying place of the umbilical cord discharge, below the midpoint of the body;

underdevelopment of the genitals: in girls, the genital gap gapes, that is, the labia minora are not covered by the labia majora (due to underdevelopment of the labia majora and relative hypertrophy of the clitoris), in boys the testicles are not descended into the scrotum (in extremely immature children, the scrotum is generally underdeveloped) ...

Physiological characteristics of the premature body (functional signs of immaturity):

from the sidenervous and muscular systems - depression syndrome:

muscle hypotension, lethargy, drowsiness, delayed reaction to stimuli, weak quiet cry or squeak,

the predominance of subcortical activity (due to the immaturity of the cerebral cortex): movements are chaotic, tremors, hand tremors, clonus of the feet may be noted,

imperfection of thermoregulation (reduced heat production and increased heat transfer: children are easily cooled and overheated, they do not have an adequate temperature rise for the infectious process),

weak expression, rapid extinction or absence of physiological reflexes of the neonatal period,

weak sucking intensity;

from the siderespiratory system :

great lability of the frequency and depth of breathing with a tendency to tachypnea (36 - 72 per minute, on average - 48 - 52), its superficial nature,

frequent respiratory pauses (apnea) of varying duration (5 - 12 seconds);

gasps (convulsive respiratory movements with shortness of breath);

during sleep or rest can be observed: breathing biota type(correct alternation of periods of apnea with periods of respiratory movements of the same depth), breathing Cheyne-Stokes type(periodic breathing with pauses and a gradual increase and then a decrease in the amplitude of respiratory movements);

primary atelectasis;

cyanoticity;

from the sideof cardio-vascular system :

lower blood pressure in the first days of life (75/20 mm Hg with an increase in the following days up to 85/40 mm Hg;

lability of heart rate with a tendency to tachycardia (up to 200 per minute, on average - 140 - 160 beats / min);

the phenomenon of embryocardia (heart rhythm characterized by pauses of the same duration between I and II tone and between II and I tone);

muffled heart tones, in the first days of life, noises are possible due to the frequent functioning of embryonic shunts (botalle duct, oval window);

vascular dystonia - the predominance of the activity of the sympathetic part of the autonomic nervous system - any irritation causes an increase in heart rate, an increase in blood pressure;

Harlequin's symptom (or Finkelstein's symptom): in the position of the child on the side, an uneven color of the skin is observed: the lower half is pink, the upper half is white, due to the immaturity of the hypothalamus, which controls the state of the skin capillary tone;

from the sidedigestive system :

reduced food tolerance: low proteolytic activity of gastric acid enzymes, insufficient production of pancreatic and intestinal enzymes, bile acids,

increased permeability of the intestinal wall;

predisposition to flatulence and dysbiosis;

underdevelopment of the cardiac part of the stomach (gaping of the cardia - a tendency to regurgitate);

from the sideurinary system :

low filtration and osmotic function of the kidneys;

from the sideendocrine system :

decreased reserve capacity of the thyroid gland - a tendency to transient hypothyroidism;

from the sidemetabolism and homeostasis - a tendency to:

hypoproteinemia,

hypoglycemia,

hypocalcemia,

hyperbilirubinemia,

metabolic acidosis;

from the sideimmune system :

low level of humoral immunity and nonspecific protective factors.

Morphological signs of prematurity:

large vertical size of the head (⅓ from body length, in full-term - ¼),

predominance of the size of the cerebral skull over the facial one,

open small and lateral fontanelles and sutures of the skull,

low hair growth on the forehead,

soft auricles,

abundant lanugo,

thinning of subcutaneous fat,

the location of the umbilical ring below the midpoint of the body,

underdevelopment of nails

Functional signs of prematurity:

low muscle tone (frog pose);

weak reflexes, weak cry;

a tendency to hypothermia;

max body weight loss by 4-8 days of life and is 5-12%, is restored by 2-3 weeks;

prolonged physiological (simple) erythema;

physiological jaundice - up to 3 weeks. - 4 weeks;

early adaptation period = 8 days. -14days,

late adaptation period = 1.5 months. - 3 months;

the pace of development is very high: the mass-growth rate is compared by 1 year (compared with full-term), in deeply premature (<1500 г) - к 2-3 годам;

in neuropsychic development, by 1.5 years they catch up with full-term ones, provided that they are healthy. In 20% of cases with a weight of 1500 g and< - поражается ЦНС (ДЦП, эпилепсия, гидроцефалия).

Features of the course of the neonatal period in premature infants

The period of early adaptation in premature babies is 8-14 days, the neonatal period lasts more than 28 days (up to 1.5-3 months). For example, if a baby was born at 32 weeks of gestation, then in 1 month of life his gestational age will be 32 + 4 = 36 weeks.

Physiological loss of body weight lasts longer - 4 - 7 days and is up to 10 - 14%, its recovery occurs by 2 - 3 weeks of life.

90 - 95% of premature babies have neonatal jaundice of prematurity, more pronounced and longer than in full-term (can be kept up to 3-4 weeks).

Hormonal crisis and toxic erythema are less common than in full-term patients.

An increase in muscle tone in the flexors usually appears at 1 - 2 months of age.

In healthy premature infants weighing up to 1500 g, the ability to suck appears within 1 - 2 weeks of life, with a weight of 1500 to 1000 g - at 2 - 3 weeks of life, less than 1000 g - by the month of life.

The rate of development of premature babies is very high. Most premature babies catch up with their peers by the age of 1-1.5 years. Children with very low birth weight (less than 1500 grams - deeply premature) usually lag behind in physical and neuropsychic development up to 2-3 years. Organic lesions of the central nervous system (cerebral palsy, hearing, vision, etc.) occur in 20% of very premature infants. At 5-7 years old and 11-14 years old, there may be violations of the harmony of development (growth retardation).

Prevention of premature birth consists of:

socio-economic factors;

family planning;

treatment of extragenital pathology before pregnancy;

treatment of urogenital infections;

consultation in polyclinics “marriage and family”;

infusion of lymph suspension (150ml) during pregnancy or outside of it;

culture of sex life.

A baby is considered premature if it is born earlier than 37 weeks after conception. There can be many reasons for giving birth to a child ahead of schedule:

1. Social and biological factors.

1.1. The age of the parents (too young or old).

1.2. No matter how trite it sounds, but, nevertheless, the fact remains: many mothers with bad habits and / or neglecting medical examination and doctor's recommendations during pregnancy give birth ahead of schedule.

1.3. The risk of having a premature baby is several times higher in single women. This is due to psychological, emotional and social factors.

2. Abortions that preceded this conception.

3. Frequent childbirth, the period between which is less than two years.

4. Various diseases of the parents.

5. Pathological course of pregnancy.

6. Anomalies in the development of the female reproductive system.

7. Multiple pregnancies.

In any case, do not despair, there is nothing particularly terrible in the birth of a premature baby, and the chances of raising him as a full-fledged person are very high, you just have to put a little effort and patience in the first years of a baby's life.

In total, 4 degrees of prematurity are distinguished, based on the weight of the premature baby and its height

1 degree. The baby was born at 35-37 weeks, and the weight of the premature baby is from 2001 grams to two and a half kilograms.

2nd degree. Term: 32-34 weeks, and weight from 1501 grams to two kilograms.

3 degree. Term: 29-31 weeks, weight - from 1001 grams to one and a half kilograms.

4 degree. The gestation period is less than twenty-nine weeks, and the baby's weight is less than one kilogram.

The complexity of nursing a child depends on the degree of prematurity. The higher it is, the more difficult it is. It should be borne in mind that the main problem of premature babies is not low weight, as some believe, but an insufficient level of development of vital organs and body systems. In other words, a child, being born earlier, simply does not have time to "mature" for life outside the womb.

For newborns born prematurely, some external signs are characteristic.

Features of premature babies and their signs

1. Small size. Small growth is directly proportional to the degree of prematurity.

2. Lack of subcutaneous fat layer. Premature babies do not look emaciated. External exhaustion is inherent in children with second or third degree hypotrophy.

3. Low muscle tone, lethargy, weak cry, lack of hunger. That is, adynamia.

4. The physique is disproportionate, with a large head and small short limbs.

5. Large and flattened abdomen with obvious divergence of the rectus muscles.

6. The predominance of the cerebral skull over the facial one.

7. Compliance of the cranial bones.

8. Soft auricles.

9. Soft furry hair, which is located mainly on the back and shoulders, is also especially common in premature babies.

10. Empty scrotum in boys and gaping of the genital fissure in girls, that is, the labia majora do not overlap the small ones.

11. Lack of swelling of the mammary glands.

12. Exophthalmos (bulging eyes).

13. Poor development of nails. Nails may not reach the fingertips.

Separately, these signs cannot be indicative of prematurity. Too many factors affect the maturity of the child and the functional capacity of the newborn's body. You should not be guided only by the weight of the baby after birth. The main criteria that determine the characteristics of each individual newborn are the causes of premature birth, the degree of prematurity, the age and weight of the child.

The birth of a premature baby and the first weeks of life

In the delivery room ... Clothes for premature babies in the first moments of life

Doctors working in maternity wards know that obstetric care for premature babies should be provided with care so as not to injure the baby and not accidentally put pressure on the baby's skull. After separation from the mother, the child, who was born prematurely, is transferred to a prepared, warmed to the required temperature, changing table, which is illuminated by the rays of an electric reflector. All manipulations with the baby are carried out with caution, clearly and quickly. After that, the child is wrapped in sterile warm diapers, and heated portable jugs are placed in the blankets, then taken to a special ward for babies born prematurely. Clothing for premature babies, most often, consists of soft flannel blouses with long sleeves and a hood. A hat is put on the head, and warm socks on the legs.

Not all babies who were born earlier than the "usual" term end up in the department of the delivery room, which specializes in nursing premature babies. When deciding on the need to place a premature baby in an intensive care unit or intensive care unit, doctors take into account not only the gestational age at which the birth occurred, but also the proportional ratio of height and weight, the presence of malformations, congenital anomalies, breathing problems, and many other factors. If the opinion of experts agrees that the condition of the newborn does not pose a threat to his health, then the child is discharged home at the usual time.

If resuscitation is needed ...

If the vital systems of the child's body are too poorly developed, for example, a premature baby is unable to breathe on its own, then even in this case, the baby has a chance to survive! In such cases, the child is admitted to the pediatric intensive care unit immediately after birth. Here, babies are in special jugs, which are closed transparent domes with caps and four holes for various medical manipulations, two pieces from different sides. All these jugs are equipped with ventilators.

A certain temperature is constantly maintained in the incubator, since the danger for the baby is not only hypothermia, but also overheating, and a certain air humidity, approximately 60%, which is due to avoiding the risk of drying out the mucous membranes. In rare cases, water mattresses are installed in the incubators, the purpose of which is to maintain the conditions in which the baby is located, as close as possible to the conditions of the amniotic fluid. With the help of numerous sensors, a premature baby is connected to automatic monitoring systems that monitor all his vital processes, and, if necessary, signal an alarm to doctors. Resuscitation procedures consist not only of artificial ventilation of the lungs and feeding through a tube. Babies born prematurely are at risk of complications, the vast majority of which can be prevented and even cured!

When the baby is able to breathe on its own and when there is no need for ventilation, the next phase of survival begins, usually in neonatal intensive care units. There are also incubators here, but, unlike the incubators in the intensive care units, they are not equipped with devices for artificial ventilation of the lungs. But, nevertheless, these incubators also maintain the necessary temperature and humidity. The baby is kept in the intensive care unit until he is able to do without additional oxygen supply and maintain his body temperature on his own.

Feeding premature babies in an incubator

Those babies who have little or no sucking reflex receive, in the first few weeks, warmed mother's milk, to which, sometimes, special additives are added, through a tube. The probe is a thin tube that is inserted directly into your baby's stomach.

Features of the development of a premature baby after birth

Depending on the gestational age at which the birth occurred, the baby has certain developmental features.

If a premature baby was born earlier than 29 weeks after conception

Children born at this time are distinguished by their low weight, which is less than a kilogram. A distinctive feature of such a child is the absence of breathing, swallowing and sucking reflexes. That is why life support is carried out with the help of special medical equipment. Often, a child born at such a time does not know how to cry and spends most of the time in a dream, and due to weak muscle tone, his movements are sluggish and rare. The external differences between premature babies and babies born on time are in the red-purple color of the skin with folds, lanugo (the fluff that covers the baby's face and body), the absence of eyelashes and closed eyes. Due to the absence of a layer of subcutaneous fat, the child appears outwardly thin, but not emaciated. Exhaustion is a sign of malnutrition. Babies born before 29 weeks are at risk of various complications and may face problems in parenting and learning in preschool age. Fortunately, the birth of children at such a time is very rare.

Premature baby 29 weeks

Outwardly, it is very similar to a child born at an earlier date. However, there are significant differences: its weight is greater, and the likelihood of subsequent complications is lower. Often, these children are placed in an incubator with a constant temperature and humidity, as well as providing additional oxygen.

Premature baby 30 weeks

The baby can be fed with breast milk through a tube. The first movements appear, there may even be cases when a child grabs an adult's finger.

Premature baby 31 weeks of birth

Some babies already know how to cry and open their eyes, and the movements are more intense than babies born earlier. But, nevertheless, such babies are still at risk and need medical supervision.

Premature baby 32 weeks

As a rule, it can breathe on its own, and its weight is, on average, over one and a half kilograms.

Premature baby 33 weeks

Can be breastfed or bottle fed, of course, if there is no breathing problem in the newborn.

Premature baby 34 weeks

They have a higher chance of survival, and their weight is more than two kilograms. There are fewer possible health problems and the overall health of the newborn is better.

Premature baby 36 weeks

Weight comes gradually to optimal levels, and possible health risks are such ailments as: jaundice and poor thermoregulation, which is relatively easy to treat without consequences for later life.

A 36 weeks premature baby is in relatively good health and is usually discharged home as soon as possible.

Features of premature babies at different times after discharge from the hospital

In terms of term babies, babies born prematurely have a slightly delayed development of mental, emotional and motor skills.

Development of a premature baby by months (general information)

A premature baby weighing up to one kilogram.

The child begins to focus on the sources of sound and attention at the age of 2–3 months.

The ability to sit down on its own appears after 9 months.

The first steps appear after 14 months.

A premature baby weighing from a kilogram to 1500 g.

The child begins to focus on the sources of sound and attention at the age of 2-2.5 months.

The ability to keep the head upright appears at the age of three to four months.

The child begins to make coups from the back to the stomach at 6-7 months, and from the abdomen to the back at 7-8.

The ability to sit down on its own appears after 8 months.

The child begins to get up on his own at the age of 11-12 months.

The first steps appear after 14 months of life.

The child begins to pronounce the first words after a year of life.

A premature baby with a body weight of 1500 to 2 kilograms.

The child begins to focus on the sources of sound and attention at the age of 1.5-2 months.

The ability to keep the head upright appears at the age of two months.

The child begins to make coups from the back to the stomach at 5-6 months, and from the abdomen to the back at 6-7

The ability to sit down on its own appears after 7 months.

The child begins to get up on his own at the age of 9-10 months.

A premature baby with a body weight of two to two and a half kilograms.

The child begins to focus on the sources of sound and attention at the age of 1-1.5 months.

The ability to keep the head upright appears at the age of one and a half to two months.

The child begins to make coups from the back to the stomach at 5-5.5 months, and from the stomach to the back at 6-7

The ability to sit down independently appears after six months of life.

The child begins to get up on his own at the age of 9 months.

The first steps appear after 11 months of life.

The child begins to pronounce the first words after 11 months.

Development of a premature baby by months (valid for the first degrees of prematurity)

Premature baby 1 month

The child is gaining weight and raises his head.

Premature baby 2 months

The child, lying on his stomach, learns to keep his head in a horizontal position.

Premature baby 3 months

Attempts to fix the gaze at one point, the development of facial expressions.

Premature baby 4 months

The kid already knows how to smile, focuses his gaze and keeps his head upright without much effort.

Premature baby 5 months

The baby turns his head to the sounds, movements of his arms and legs appear in response to the appeal of the parents and makes so far indistinct sounds.

Premature baby 6 months

Children grab hanging toys, find invisible sound sources, and babble.

Premature baby 7 months

Rapid mental and emotional development takes place. The child already knows how to distinguish close from strangers, picks up various objects, babbles. Various long humming appears.

Premature baby 8 months

Movements develop in a horizontal position. Children begin to roll over onto their stomachs from the back and back. They begin to crawl and try to sit down.

Premature baby 9 months

The child begins to pronounce individual syllables, tries to repeat after adults. Attempts are being made to stand up. Sits down calmly, holding onto the barrier.

Premature baby 10 months

The range of manipulations with objects is expanding, the child can already stand, leaning on the barrier.

Premature baby 11 months

Psychoemotional and motor development begins to improve.

Premature baby 12 months

The child is standing relatively confidently. Has a strong interest in the environment, reacts to adults, actively manipulates objects.

Self-reliance skills when eating, such as holding a spoon, bread, spoon manipulation, begin to appear in premature babies between six months and ten months. Neatness skills - from nine months to a year.

Home care for premature babies

A premature baby has a number of characteristics and requires special conditions for its full development. Such conditions can be easily created at home, you just need to follow a few recommendations.

Firstly, caring for premature babies is in the temperature regime.

For a premature baby, at home, it is necessary to create optimal temperature conditions. The air temperature should be 22-25 degrees Celsius. Ventilation of the premises should be carried out every three hours for fifteen to twenty minutes. Near the child, directly under the blanket with which he is covered, the temperature should be maintained at twenty-eight to thirty-two degrees Celsius. Often, especially in the winter season, there is a need for additional heating of the newborn. For this, it is convenient to use rubber heating pads with hot (60-65 degrees) water. It should be remembered that electrical appliances cannot be used to heat the baby. Depending on the degree of prematurity and the temperature conditions in the room, 1 to 3 heating pads can be used. Heating pads are wrapped in cloth (towels, nappies or special bags) and placed under the blanket at the feet and on top of the blanket on the sides at the distance of the adult's palm from the child. For constant monitoring of the temperature and for convenience in general, you can put the thermometer next to the child.

It is important not to put heating pads under the child, to avoid burns, and put it on top, as this will make breathing difficult. You also need to change the heating pads one by one every one and a half to two hours and make sure that the child does not remain unheated, even for short periods of time. The newborn's face should always be open.

By the end of the first month, the baby will begin to "keep" the body temperature on its own, and, as a result, it will be possible to completely abandon artificial heating. Measurements of the child's body temperature should be made twice a day, in the morning and in the evening, unless, of course, the doctor gave otherwise. The body temperature is measured without undressing the baby.

Clothes for premature babies

A baby who was born with a body weight of over two kilograms does not need to be wrapped up. He is dressed in the same way as full-term babies. Children weighing less than two kilograms need a lot more things. The most optimal is clothing for premature babies, which consists of items such as knitted caps, knitted blouses with a hood and sewn-on sleeves, romper suit and diapers. A child dressed in this manner should be wrapped in a flannel blanket, placed in a woolen envelope and covered with a flannel blanket on top. By the end of the first month, you should gradually give up the blanket and envelope. It should be remembered that tight swaddling constrains the baby's breathing, which is categorically contraindicated. For uniform breathing in all parts of the newborn's lungs, it is necessary to regularly turn the baby from one side to the other.

Bathing a premature baby

Babies whose birth weight was less than one and a half kilograms should not be bathed in the first two to three weeks of being at home. Children whose birth weight was more than 1500 grams are allowed to bathe in 7-10 days. In the first three months of a child's life, bathing is carried out in boiled water. The temperature in the bathing room should be twenty-five degrees Celsius, and the water temperature should be 38 C.

Nutrition for premature babies. Feeding methods

Breast-feeding.

Feeding premature babies with probes using infusion pumps.

Portion feeding with a probe (food is injected with a syringe)

Mixed or artificial feeding, using special formulas for premature babies.

Feeding premature babies

When babies are able to feed on their mother's breast on their own, then they should be provided with the most comfortable feeding of premature babies.

It is often difficult for a baby to hold the nipple in his mouth. In this case, the most effective position of the baby in the arms will be the position "from under the arm" or "cradle", when the child is located along the forearm, and the mother's hand supports the child by the shoulders.

If the child swallows air, then it is worth taking a reclining position, for example, placing several pillows under the back.

In order for the baby to hold the nipple, you can use the so-called dancer's hand method, which consists in supporting the baby's cheeks and chin with the mother.

Walking

Care should be taken when walking, as sudden changes in temperature can adversely affect the health of the baby. Premature babies who were born with a body weight of more than one and a half kilograms are allowed to be taken for walks from two weeks of age at an air temperature outside the window of 25-26 degrees Celsius. The first walk should not be long, only ten to fifteen minutes, then the duration can be increased each time by 10-20 minutes, thereby bringing up to one to one and a half hours. In the autumn and spring seasons, at temperatures below ten degrees Celsius, it is allowed to walk with babies over one month old and weighing two and a half kilograms. If the air temperature is below eight degrees, walks with children are allowed when they reach the age of two months and body weight over 2800 grams.

The child is very dependent on the mother, moreover, not only on her physical health, but also on the psychological state. In order for the child to grow and develop normally, it is necessary to create favorable conditions for him, and in order to create them, first of all, you need to start with the mother herself. The most important thing is not to despair and look to the future with optimism. Even when the baby was born prematurely and was sent to the children's ward, the mother can still take care of him and take care of him. Maternal care will have a positive effect not only on the health of the child, but also on the psychological state of the parents. There are some simple yet extremely effective rules that will help the whole family.

First, the mother should spend as much time with the baby as possible. Even eye contact with the baby will have a beneficial effect on the psychological state of the mother.

Tactile contact also plays an important role; simple maternal touch is very important for premature babies.

Perhaps the most important factor is minimizing stress. Of course, the birth of a premature baby brings a lot of unpleasant sensations and stress, but you need to learn to cope with them, and only then will your baby grow up healthy and happy.

It is important to conserve breast milk. By the way, the absence of stressful situations will greatly facilitate the maintenance of lactation. Even if your baby is too weak to breastfeed, try offering breastmilk instead of tube feeding.

Get involved in caring for your baby. Ask your neonatologist what steps you can take to care. It could be feeding, swaddling or something else. If you have any questions, you can always contact the staff for help. All this will allow you to overcome the depressed state, improve the mood of the mother, and, of course, will have a beneficial effect on the child.

Premature babies are those born before the date of the last menstrual period and weighing less than 2500 grams. There are 4 degrees of prematurity depending on the gestational age and weight of the child at birth:

I degree- premature babies born at 35-37 weeks with a birth weight of 2000-2500 grams;

II degree- premature babies born at 32-34 weeks with a weight of 1500-2000 grams;

III degree- deeply premature babies born at 29-31 weeks with a weight of 1000-1500 grams;

IV degree- extremely premature babies born before 29 weeks with a weight of less than 1000 grams.

Of course, for such children, weight gain is one of the determining factors in the physical development and health of the child. A good weight gain can only be ensured with a well-established healthy nutrition of the child that satisfies his energy costs, when the baby receives all the nutrients, trace elements, and protective complexes he needs. Difficulties with feeding can arise due to the immaturity of the child's gastrointestinal tract, low enzymatic activity, rejection of food by the stomach, lack of swallowing and sucking reflexes. Depending on the problem, doctors feed the baby through a tube, use parenteral nutrition, when nutrient solutions are given intravenously to the baby.

The best thing is mother's breast milk... Scientists have proven that milk adapts to the needs of the baby, because the milk of a woman who gave birth ahead of time has its own unique composition, adapted for a premature baby. While the baby cannot suckle at the breast, he is fed with expressed milk, after the baby learns to suck and swallow (usually, when he gains 1.6 kg, these reflexes appear), he is gradually transferred, first to partial, and then to full breastfeeding. If it is impossible to breastfeed, the child is transferred to donor milk or a special adapted mixture for premature babies. Indicators of weight gain determine the quality and completeness of nutrition, the need to introduce or cancel supplementary feeding.

For premature babies, doctors divide into 3 main stages, which differ in the child's nutritional needs and weight gain.

At the 1st stage, the newborn does not gain, but loses weight... This is a physiological feature of all children, but if a full-term baby usually loses 5-6% of its weight, then a premature baby with a weight of more than 1.5 kg - 10%, and a deeply premature baby with a weight of up to 1.5 kg - 15%. This period usually lasts the first 7 days from birth. Despite the fact that during this period the amount of food is minimal, it must provide the body of the crumbs with all the necessary nutrients.

At the 2nd stage, constant weight gain is achieved, at least at the level of the intrauterine period... When the baby's condition stabilizes, he can independently suckle a breast or a bottle, has reached a weight of 2.5 kg, the mother and her baby are discharged from the department for premature babies. Weight gain per week should be 125-200 grams, depending on the baby's weight at birth. The calculation of the increase is as follows: + 15 g / kg daily.

At the 3rd stage, the child's weight is normalized, the period lasts up to a year(for deeply premature babies longer). The task of parents in this period is to provide the child with adequate nutrition with a sufficient amount of calories and all the nutrients that are needed for the growth of the child, because a premature baby needs to develop more intensively in order to catch up with peers. Usually, if a baby was born 1 month ahead of schedule, then he catches up with peers in development by 1 year, 2 months ahead of schedule - by 2 years, and 3 months - by 3 years, respectively.

Below is a table of weight gain for premature babies, depending on age and degree of prematurity.

The table gives an approximate result for children who are in full, the numbers may differ, both up and down. Every month the child should be examined by a pediatrician, who will assess the physical development and health of the child. Correction of nutrition, calculation of the rate of supplementation, recommendations for the introduction of complementary foods, vitamin supplements should be carried out only by a doctor.

Calculate the approximate weight gain of a premature baby under one year old online

Indicate the weight of the baby at birth (g)

Indicate the child's height at birth (cm)

Premature baby

Age, months	Weight gain	Your baby's weight
1	600
2	800
3	800
4	750
5	700
6	650
7	600
8	550
9	500
10	450
11	400
12	350