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Seven month old newborn. In a premature newborn, it is noted. B) chromosomal disorder

For many years working at the Center for the Correction of the Development of Premature Babies of the Research Clinical Institute of Pediatrics and engaged in scientific research on the growth and development of these children, they are currently consulting at the Chaika Clinic. Elena Solomonovna released a guide for parents about what the family of a premature baby has to go through and how to maintain love and friendship. We publish its continuation.

Physical development of a premature baby (weight and height gain)

The first concern of the parents of a premature baby is the problem of weight gain. And indeed it is of paramount importance as the main indicator of the physical well-being of the baby.

It should be noted that the rate of growth of physical parameters (body weight, length, head and chest circumference) in a premature baby will differ significantly from those of his full-term peers. At least up to 6-9 months, your baby will be “smaller”, and at this time obligatory weight control becomes of primary importance: in the first weeks and months of life, daily (at the same time, it is necessary to take into account the correct daily weighing of the child, which must be carried out in the same time, preferably before the first morning feed or in the evening before bathing), and then monthly.

What should be your first concern? This is a drop in body weight or the absence of its increase (the baby "stands" in weight).

The reasons can be both quite serious and due to feeding errors, insufficient amount of breast milk in the mother. Naturally, in any case, you need to consult with the child's leading doctor to clarify the causes and eliminate them. I repeat, with a one-time consultation with a pediatrician, the condition of a child born prematurely and very different from full-term peers can be assessed as more severe than it actually is.

Digestive problems in a premature baby

The main problems of the digestive system in a premature baby, which almost all parents face, are:

Intestinal colic

Colic is derived from the Greek kolikos, which means "colon pain". Colic - paroxysmal pain in the abdomen, accompanied by severe anxiety of the child. The attack, as a rule, begins suddenly, the child screams loudly and more or less continuously, reddening of the face or pallor of the nasolabial triangle may be noted. The abdomen is swollen and tense, the legs are pulled up to the stomach and can instantly straighten up, the feet are often cold to the touch, the arms are pressed to the body. The attack sometimes ends only after the child is completely exhausted. Often noticeable relief comes after the passage of feces and gases.

Premature babies are particularly prone to colic, with some babies experiencing frequent and intense seizures that can be compared to labor pain in severity, and will certainly require medical intervention. Apparently, the main cause of these sufferings of the baby is the immaturity of the neuromuscular apparatus and the enzymatic system of the intestine and, therefore, the tendency to increased gas formation. As a result, pressure on the intestinal wall increases and muscle spasm occurs.

The cause of discomfort and bloating can also be irrational feeding. Some foods, especially those high in carbohydrates, can contribute to excessive fermentation in the intestines. Intestinal allergies also cause a baby to cry due to abdominal discomfort.

But the causes of colic are not limited to these conditions. It is important to diagnose diseases requiring surgical intervention in a timely manner. Therefore, in the absence of the effect of conventional measures aimed at eliminating colic (special carminative herbal teas, preparations of simethicone Sub / Simplex, Espumizan, cleansing enema, use of a gas vent tube, massage of the abdomen, dry heat on the abdomen), the child should be carefully examined in a medical institution.

regurgitation syndrome

The regurgitation syndrome can also bother the parents of a premature baby. The most common cause of this is immaturity and temporary (transient) hypotension of the smooth muscles of the stomach - the so-called "duodeno-gastric reflux". Most often this occurs in premature babies who have been fed for a long time through a tube. Aerophagia (when a baby greedily swallows air along with food) can also be a possible cause of regurgitation. Masses during regurgitation look plentiful due to their binding with air and usually do not change the baby's well-being in any way. In this case, you need to be patient and wait until the baby's stomach "ripens", while observing the recommendations for proper feeding, holding the baby vertically after feeding for 10-15 minutes. Medicines are best given to the child before feeding. However, there are situations in which an urgent consultation of a specialist is necessary: ​​if there are streaks of blood in the regurgitation masses, if the regurgitation is so abundant that the child does not gain weight well, if the baby’s well-being is disturbed during regurgitation - do not hesitate, consult a doctor!

Diarrhea and constipation

Dyspepsia (diarrhea and constipation), changes in the structure of the stool, the appearance of mucus and impurities in a premature baby is a frequent and exciting phenomenon for parents and pediatricians. It is necessary to determine what should not cause concern to parents.

When breastfeeding, a child's stool can be after each feeding, along with gases (foamy) and quite liquid. In children receiving mixtures, stools are rarer - 3-4 times a day. A change in the quality and color of the stool also occurs with the late formation of intestinal enzymes in a premature baby, the difficulty in digesting fats or carbohydrates.

The most common problem in a premature baby is the temporary absence of stool or delayed stool evacuation. There is no stool for several days, the child strains to no avail. When defecation occurs, the stool as a whole is not changed in consistency, which does not allow us to call it constipation in the generally accepted sense of the word.

It will take some time to make it easier for the child to defecate, there is nothing wrong with that if you do it with the knowledge and under the supervision of a doctor.

The cause of all violations of the functional state of the gastrointestinal tract is immaturity.

However, proper feeding is the best and natural cure. Breast milk is perhaps the best thing a mother can give to her baby. At the birth of a premature baby, milk, as it were, adapts to the immature intestines, so that the hormones necessary and coming from the mother, and active metabolites, protective substances and enzymes contribute to the faster maturation of all organs.

Therefore, breast milk and the possibility of natural feeding must be tried to preserve with all our might. However, if there is still not enough milk, and you were forced to replace it with formula, then it is most advisable to use special mixtures for premature babies. In any case, it is important to coordinate the use of mixtures with your pediatrician.

The main criterion that all the changes you observe in the gastrointestinal tract are not diseases that require urgent therapeutic measures is a sufficient increase in the child's body weight and the absence of a pronounced pain syndrome in the child

Anemia of prematurity

Almost all premature babies have a drop in hemoglobin, which is called anemia. The cause of anemia is the same immaturity. In premature babies, the so-called “fruit” hemoglobin is determined for a longer time, which is destroyed faster, and the ability to form a new one is reduced. At the same time, hemoglobin carries oxygen, which is necessary for the functioning of all cells and their maturation. Controlling hemoglobin levels is very important.

A premature baby needs to be prevented from anemia and treated in time if hemoglobin drops to 100g/l.

Rickets of prematurity

Rickets is a deficiency in the formation of vitamin D in the body and the entry of calcium into the cells, which is necessary for the growth of bone tissue and the formation of neuromuscular regulation.

Deficiencies in vitamin D formation and calcium absorption are associated with immaturity. This slows down the development of the child. The baby becomes more irritable, sweaty, sleep is disturbed, hair falls out, growth and weight gain slow down. The bones become "weak" and may twist. A premature baby requires mandatory prophylactic use of vitamin D preparations, and with clinically obvious manifestations of rickets, treatment with vitamin D and calcium preparations.

Condition of the skeletal system and joints

The phenomena of morphofunctional immaturity in a premature baby often extend to the musculoskeletal system. Imperfection of the neuromuscular regulation, weakness of the ligaments, excessive mobility of the joints can lead to changes in the correct position of the limbs, head and spine of the child.

Often the baby keeps his head in a fixed position on one side. The reason for this may be a congenital shortening of the neck muscle on one side, a traumatic lesion of the spine or cervical muscles during the removal of the head during childbirth, or just a “usual” position of the head, that is, the child “lyed” in this position most of the time in the uterus. The doctor always establishes the correct diagnosis, and the sooner this happens, the more effective the treatment will be.

Prematurity, especially in combination with an abnormal intrauterine position of the fetus, is usually accompanied by underdevelopment of the hip joints or "dysplasia". The most severe variant of this pathology is a dislocation of the hip joint. Diagnosis is established shortly after birth and requires early treatment based on hip abduction. Currently, an effective method in identifying abnormalities in the development of the joints is ultrasound scanning, which is mandatory for all children in the first months of life.

For premature babies, the most diagnostically reliable period is 3-4 months of the corrected age for assessing the condition of the hip joints. At earlier dates, the risk of error is very high due to their natural immaturity.

Premature eye disease

Retinopathy of prematurity (RP) is an eye disease of premature babies that can even lead to permanent loss of visual function.

The possibility of developing ROP is associated with the term and body weight at birth, the presence of severe changes in the respiratory, circulatory and nervous systems, as well as the adequacy of the measures taken to nurse the baby.

This disease was first identified in a premature baby in 1942. Then it was called 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.

At this stage in the development of ophthalmology, it is indisputable that the development of retinopathy occurs precisely in an immature infant, as a violation of the normal formation of retinal vessels (which is completed by the 40th week of intrauterine development, i.e. by the time a full-term baby is born). It is known that up to 16 weeks of intrauterine development, the fetal retina does not have blood vessels. Their growth into the retina starts 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 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 was born, the smaller the area of ​​the retina covered with vessels, i.e. an ophthalmological examination reveals more extensive avascular, or avascular, zones (if the child was born before the 34th week, then, accordingly, the avascular zones of the retina are detected on the periphery from the temporal and nasal sides). After the birth of a premature baby, various pathological factors act on the process of vascular formation: the external environment, light, oxygen, which can lead to the development of retinopathy.

The main manifestation of RH is the stoppage of the normal formation of blood vessels, their germination directly into the eye into the vitreous body. The growth of the vascular and, after it, the young connective tissue causes tension and detachment of the retina.

As mentioned earlier, the presence of avascular zones on the periphery of the fundus is not a disease. This is only evidence of underdevelopment of retinal vessels, and, accordingly, the possibility of developing retinopathy in the future. Therefore, from the 34th week of development (or from the 3rd week of life) of the child, it is necessary that your child is examined by an ophthalmologist, a specialist in retinopathy of prematurity, who has special equipment for examining the retina. Such monitoring is necessary for all children born before 35 weeks and with birth weight less than 2000 g.

If signs of ROP are detected, examinations are carried out every week (with the so-called "plus" stage of the disease - every 3 days) until the threshold stage develops (at this stage, the issue of preventive surgical treatment is decided) or the disease completely regresses. With the regression of the pathological process, the examination can be carried out 1 time in 2 weeks. The examination is carried out with the obligatory expansion of the pupil, using special children's eyelid dilators, so as not to put pressure on the eye with fingers.

Most often, the threshold stage of ROP develops by the 36-42nd week of development (1-4 months of life), so the parents of a premature baby should know that during this period he should be examined by a specialist (an ophthalmologist who has special equipment and is aware of the signs of active retinopathy ).

Active retinopathy is a staged pathological process that can end in regression with the complete disappearance of the manifestations of the disease or cicatricial changes.

According to the international classification, active retinopathy is divided into stages of the process, its localization and extent:

1 stage. The appearance of a dividing line at the border of the vascular and avascular retina.

2 stage. The appearance of a shaft (solid line) at the place of separation.

It should be emphasized that in 70-80% of cases with 1-2 stages of ROP, a spontaneous cure of the disease is possible with minimal residual changes in the fundus.

Stage 3 is characterized by the appearance of growth of retinal vessels into the vitreous body in the area of ​​the shaft. With a short duration of the process, as well as in the first two stages, spontaneous regression is possible, but the residual changes are more pronounced.

When the growth of vessels inside the eye has spread over a fairly large area, this condition is considered to be the threshold stage of ROP, when the progression of ROP becomes almost irreversible and requires urgent preventive treatment.

The effectiveness of prophylactic laser and cryocoagulation of the avascular retina ranges from 50-80%. Timely treatment can significantly reduce the number of adverse outcomes of the disease. If the operation is not performed within 1-2 days after the diagnosis of the threshold stage of retinopathy, then the risk of developing retinal detachment increases dramatically. It should be noted that with the development of retinal detachment, cryo-, laser coagulation is not possible. The further prognosis for the development of vision in such an eye is extremely unfavorable.

The operation is often performed under anesthesia (local anesthesia is less often used) in order to avoid oculocardial and oculopulmonary reactions. Evaluation of the results of treatment is carried out after a few days to decide whether to repeat the procedure. The effectiveness of preventive treatment can be judged 2-3 weeks after the formation of scars at the site of the shaft. If the treatment was not carried out or the effect was not achieved after the treatment (severe ROP), terminal stages develop.

4 stage. Partial retinal detachment.

5 stage. Complete retinal detachment.

Even if the process has reached stages 4 and 5, it is necessary to carry out a whole range of therapeutic and surgical measures aimed at preventing severe cicatricial changes.

Separately, the “plus” disease is singled out as the most unfavorable form of active retinopathy. The disease begins early, has no clearly defined stages, progresses rapidly and leads to retinal detachment before reaching the threshold stage. The pathological process is characterized by a sharp dilation of the retinal vessels, pronounced edema of the vitreous body, hemorrhages along the vessels, dilation of the vessels of the iris, often with the inability to expand the pupil. The effectiveness of treatment for "plus" disease is still low.

If the active process has reached 3 or more stages in its development, then after its completion (with or without preventive treatment), cicatricial changes of varying severity form on the fundus.

1 degree - minimal changes in the periphery of the fundus;

Grade 2 - dystrophic changes in the center and on the periphery, remnants of scar tissue;

Grade 3 - deformation of the optic disc, with displacement of the central parts of the retina;

4 degree - the presence of retinal folds, combined with changes characteristic of the 3rd stage;

Grade 5 - complete, often funnel-shaped, retinal detachment.

With the first and second degrees, a sufficiently high visual acuity can be maintained, with the development of third or more degrees, a sharp, often irreversible decrease in visual acuity occurs.

Indications for surgical treatment of cicatricial stages of ROP are strictly individual, determined by the degree and localization of retinal detachment, as well as the general somatic condition of the child. In any case, the functional and anatomical effectiveness of operations is noticeable only up to 1 year of life, when it is possible to improve visual acuity and create conditions for eye growth.

However, upon reaching the 5th stage of cicatricial ROP, the pathological process can continue and lead to the development of complications in the form of corneal clouding and secondary glaucoma. Therefore, with the development of contact between the cornea and the iris, urgent surgical treatment is necessary in order to save the eye (in this case, we are not talking about increasing visual acuity).

It should be noted that if a child has undergone even mild stages of active ROP or has unexpressed cicatricial changes, then it is considered that such children do not form a full-fledged retina. In the future, these children have a high risk of developing myopia, dystrophy and secondary retinal detachments. Based on this, children who have had ROP should be observed by an ophthalmologist at least 2 times a year until they reach the age of 18.

Successful nursing and subsequent development of premature babies, including the preservation of visual functions, is a difficult but quite feasible task, although it is difficult. Achieving a good rehabilitation result is the envy of the joint efforts of neonatologists, ophthalmologists and psychologists.

Formation of hearing and speech

There is no evidence that premature infants are more likely than full-term infants to have severe forms of hearing loss. However, in many of them, the formation of auditory function is slow. Hearing can be assessed by a hardware technique, which is now widely used and is called otoacoustic emission or an audio test. Taking into account the characteristics of a premature baby, it is possible to reliably judge the passing of the test only at the age of 4 months of the corrected age. Until that time, there will be many false negative results, which are explained by the same immaturity of the child, but cause a huge number of unnecessary worries. The late development of the auditory function also leads to a later onset of cooing, which makes it difficult for the child to speak in the future. Complex features lead to the fact that the child begins to speak later and many sounds are pronounced incorrectly (perhaps the child hears them that way). All this gradually normalizes, but most premature babies will need the help of a speech therapist and it is advisable to start classes earlier than recommended for full-term babies, for example, at 2.5-3 years, depending on the overall development of the child.

What happens to the immune system of a premature baby?

Will he often get sick with colds?

Numerous studies in our country and abroad dispelled the prejudice about the "weakness" of the immune system of a premature baby. Just like in full-term children, it is formed in the first three years of life and differs slightly in terms of indicators. Just like full-term babies, when breastfed, the formation of the immune system is faster and its activity is higher, but not so much as to say that without breast milk, your child is not at all protected.

Why do premature babies get sick more often and more severely? There are several explanations for this: Premature babies are more likely to visit healthcare facilities where the risk of infection is high. Premature babies are very guarded by their parents, they often overheat and this inhibits the development of the immune system. Premature babies with diseases often develop bronchospasm, respiratory failure, they are more often hospitalized and more often prescribed antibiotics, which also weakens the formation of immune defenses. All this determines the approaches and tactics that parents of a premature baby should follow, and this should be taught by a doctor who knows the characteristics of the child and, most importantly, is not afraid that he was born prematurely.

Should premature babies be vaccinated?

Must and must! Actually, vaccinations are for them. Since a strong and strong child is likely to easily endure any infection, but for an “immature” and poorly protected premature baby, any severe infection can be fatal.

Previously, neonatologists made a tap for a premature baby up to a year old. Today, this concept is being revised around the world. It has been proven that the immune system is more ready to produce antibodies in the first months of life. Judge for yourself: any child is born completely “sterile” and from the very first seconds is faced with many viruses that are common around us, and with bacteria that inhabit surfaces and our bodies. However, he defends himself with sufficient ease, except for the situation of super-massive impacts (intensive care unit, significant concentrations of sick children and adults).

However, there are still limitations - these are acute conditions, which are temporary, but absolute contraindications to vaccination, and some chronic conditions: and this is, first of all, damage to the central nervous system. These include absolute contraindications - decompensated hydrocephalus and convulsions.

And yet, only the attending physician can tell if your child is ready for vaccinations, explain in detail to you what vaccinations and against what diseases your baby is required, whether any examinations are needed, for example, an ECG or EEG. This is a very important decision that requires great knowledge of the doctor, self-confidence and your child. On the other hand, the importance of this decision is to protect your baby as much as possible from possible severe infections, which, unfortunately, abound in any society, realizing how difficult it will be for a premature baby to endure these diseases.

What is the prevention of respiratory syncytial virus infection and why should it be carried out?

One of the most serious diseases of a premature baby in the 1st year of life is RSV infection. This is a very common disease. In fact, almost all children under 2 years of age at least once suffer this viral infection.

This infection proceeds like a cold, but its peculiarity is the defeat of the lower respiratory tract, like pneumonia or, terminologically, alveolitis. Alveolitis is an inflammation of the most terminal parts of the respiratory tract - the alveoli, where gas exchange occurs. Thus, if the alveoli become inflamed, then the person begins to suffocate from a lack of oxygen and the accumulation of carbon dioxide in the body. This infection is especially severe in premature infants, who already have a very immature broncho-alveolar tree, many have signs of broncho-pulmonary dysplasia. In severe cases, children require hospitalization, resuscitation, mechanical ventilation, antibiotic therapy, etc., not to mention severe psychological trauma for the baby and the whole family.

Over time, when faced with this virus, the child develops antibodies and after 2-3 years the virus becomes practically not dangerous and the disease proceeds like a normal ARVI.

But! These 2 years must be lived. In recent years, a drug has been developed, created and widely distributed, which is a purified antibody to the respiratory syncytial virus. The introduction of these antibodies protects the child from the disease, not only with this virus, but also with other similar viruses, and the child as a whole begins to get sick less.

Today, the country has the drug SINAGIS, which is very expensive in price, as it is an ultra-purified monoclonal antibody. Effective protection against the virus requires 3-4 injections with an interval of 30 days during the most dangerous epidemiological period - approximately from November to March. The introduction of the drug is not a vaccination, but a passive immunization: when it is not the child's body that produces antibodies, but they are already administered. Therefore, repeated administration is required during the first year with strictly observed intervals.

In the near future, it is possible that there will be other drugs of similar action in the country, most likely cheaper and more affordable. But this still needs to be verified.

We tried to tell in an accessible form about the most common problems of the first year of a premature baby's life. All of them require attention, observation and timely treatment.

Let us repeat once again why you need to monitor a premature baby in the first year of life:

  • The development of the child, the formation of his psycho-motor functions requires a monthly assessment by one specialist. You should carefully observe the baby in order to tell the doctor about the child's behavior as truthfully and objectively as possible.
  • Weight gain, which indicates the sufficiency of absorption and assimilation of nutrients. Premature babies tend to have reduced appetite, and sometimes it is a big problem to feed such a child. The more premature the child is, the more pronounced the violation of the absorption of nutrients and the worse the weight gain. In this case, the use of special preparations that improve the energy state of the cells can help to cope with this.
  • Prevention or, if necessary, treatment of rickets.
  • Prevention and, if necessary, treatment of anemia.
  • Relief for the child of "intestinal colic", control of the state of the gastrointestinal tract, correction of regurgitation. Rational feeding. Mandatory consultation to resolve the issue of the timeliness of the introduction of complementary foods.
  • Control of the state of the nervous system, timely conduct of special examinations to determine the maturation of brain structures, to control the manifestation of hypoxic-ischemic encephalopathy (if your baby had a hemorrhage or periventricular leukomalacia, if he had meningitis or encephalitis).
  • Monitoring the state of the respiratory system, especially if the child has been on a ventilator for more than 3 days. Remember that in the case of the formation of broncho-pulmonary dysplasia in a child, it is necessary to carefully monitor the color of the child's skin and his breathing (the child begins to breathe "heavy" and often), since periods of exacerbations are possible (in case of any doubt, it is better to contact the doctor observing your baby) . If such a baby gets sick, he often develops an "obstructive syndrome", which requires urgent treatment.
  • Control of the state of the heart, especially in children with bronchopulmonary dysplasia. It is especially important for such children to control physical activity, prescribe massage and physical rehabilitation methods in a dosed manner.
  • Monitoring the condition of the musculoskeletal system, in particular the hip joints, as a violation of the development of these joints will not allow the child to sit down, stand up and walk properly.
  • Monitoring the state of the organs of vision
  • Hearing control.

Thus, there are a lot of problems. It is almost impossible to treat everything at the same time - the baby simply cannot withstand such a load. Therefore, when assessing the child's condition, it is necessary to determine the primary task, which to a greater extent disrupts the normal development of the baby and requires urgent correction. Only a specialist can decide this.

Happiness, health and good luck to you and your kids!

Even babies born at term often make their parents very worried about their health. What can we say about those little "hurry-ups" that hurried to "go out" ahead of schedule. Indeed, parents of premature babies face serious potential childhood illnesses and complications that they should at least be aware of. As in that beautiful and accurate saying: "Informed means already armed" ...

Often, premature babies are placed in special incubators, where a special temperature, humidity and oxygen regime are maintained.

Features of premature babies

Babies born before the 37th week of pregnancy are considered premature. Such children will have a very difficult time in the first months of their “early” life - after all, they will not only have to intensively catch up with their peers, but also bravely resist many potentially dangerous pathologies. Let's talk about the most common of them in detail.

Often, after birth, premature babies are placed in a hospital for some time, in intensive care units, where neonatologists closely monitor their health, and also take measures to nurse premature babies.

The time that a baby born prematurely will spend in the hospital for growing and nursing, directly depends on how "small" he was born. On average, in Russian clinics, in intensive care units for premature babies, babies spend from 15 to 45 days.

Many premature babies do not have a sucking reflex for some time - such babies are fed using a special probe. Some cannot breathe on their own - they are connected to the appropriate equipment.

To the most important features of premature babies relate:

  • immature central nervous system (CNS), which is expressed in the child's lethargy, chaotic movements of the arms and legs, and the absence of a sucking reflex;
  • unformed gastrointestinal system, excessively small volume of the stomach and underdeveloped intestinal muscles;
  • immature ability to thermoregulate (which is why most premature babies need to stay in warm and humid incubators);
  • undeveloped respiratory system (in very premature babies, as a rule, at the time of birth, the lungs are not able to open and fill with air on their own), which is expressed in superficial "torn" breathing and in respiratory arrest during overload (for example, due to crying);
  • immature skin that is very vulnerable to germs and easily injured even with normal touch.

A premature baby is under the constant supervision of neonatologists of the intensive care unit until his vital and physical indicators approach the norms of a child born on time.

And, of course, along with nursing and rearing premature babies in hospitals, they also undergo a thorough medical examination to identify serious diseases. So, in premature babies, the following pathologies are most often manifested:

Underdeveloped lungs and respiratory pathology

In most babies, lungs form at 36 weeks of gestation. Although there are exceptions, because the development of each child is individual. If the mother already knows that the baby will be born prematurely, she can order an amniocentesis procedure (taking a sample of amniotic fluid for laboratory testing), which can be used to check the level of maturity of the fetus's lungs. In some cases, mothers may be given steroid injections prior to delivery to speed up the formation of lungs in the fetus. A premature baby whose lungs have not yet formed is at risk of the following complications:

  • Respiratory distress syndrome, which causes the child to experience rapid, irregular breathing. In this case, nursing a premature baby is carried out by supplying additional oxygen to the lungs (by a respiratory support device), or by using a respirator, or by creating a constant positive pressure in the airways, or by tracheal intubation. In severe cases, the infant is given doses of a surfactant that the lungs lack.
  • Transient tachypnea of ​​the newborn, that is, rapid shallow breathing. This condition can be observed in both premature and full-term infants. Nursing a premature baby in this case, as a rule, passes without medical intervention and takes up to several days. Until the breathing of the newborn has returned to normal, intravenous feeding is used.
  • Bronchopulmonary dysplasia of the lungs occurs when the lungs of a newborn are damaged. Unfortunately, when preterm infants are treated with a ventilator, their lungs, due to their weakness, cannot always withstand the constant pressure generated by the ventilator. Premature babies who have been placed on a ventilator for more than twenty-eight days are at high risk of developing BPD.

Pneumonia in premature babies

Another serious consequence that premature babies often face is pneumonia. It is caused by an infection in the area of ​​the lungs that is involved in the exchange of carbon dioxide and oxygen. The resulting inflammation reduces the amount of space available for air exchange. This can lead to the fact that the child's body will not receive oxygen in the right amount.

In this case, the treatment of premature babies will include antibiotics, as well as the provision of additional oxygen to the body and intubation. If pneumonia is not treated on time, it can develop into a fatal infection or lead to sepsis or.

Apnea and bradycardia

Sleep apnea and bradycardia are also very common diseases of premature babies. Apnea is a short pause in breathing. In hospitals, specialists are always ready for this situation: if a premature baby develops irregular breathing and pauses reach 10-15 seconds, an alarm will sound in the intensive care unit where he is nursing, calling for doctors to help.

Bradycardia is a decrease in heart rate. The scenario is the same: if the pulse of a premature baby falls below 100 beats per minute, an alarm is also triggered.

Special equipment in the departments for nursing premature babies around the clock monitors all the vital signs of babies.

Usually, a light pat on the back of a newborn helps to “remind” him to start breathing again, and also increases the heart rate. But sometimes the baby needs more serious specialized help.

Infections in premature babies

Ordinary babies born on time are protected from most infections not only by mother's breast milk and partial mother's immunity, but also by two vital organs - the skin and the respiratory system. Both normally prevent the penetration of many viruses and bacteria into the vulnerable organism. But a premature baby has a certain underdevelopment - both the respiratory system and the maturity of the skin.

The high risk of infections in premature babies is the second reason why these babies are kept in incubators for some time. These incubator beds not only create a favorable climate around the children, but also protect them from infections.

Intraventricular hemorrhage (IVH)

Babies born before the 34th week face an increased risk of intraventricular hemorrhage in the brain. The fact is that during childbirth, the pressure in the blood vessels changes so dramatically that weak vessels can not cope with it. In the future, IVH can lead to complications such as cerebral palsy, mental retardation, and learning difficulties.

Intracranial hemorrhage occurs in about every third child born at 24-26 weeks of gestation. If preterm labor is unavoidable, the doctor may prescribe medication to the pregnant woman to reduce the risk of severe intracranial hemorrhage in newborns.

Retinopathy of prematurity

This is an extremely dangerous disease that affects underdeveloped vessels and capillaries in the eyes of premature babies. Retinopathy of prematurity can be mild with no visible defects, or it can be severe with new blood vessels (neovascularization) and lead to retinal detachment and sometimes even blindness.

Retinopathy, which in the future may develop into high myopia in a child, is one of the most dangerous and common diseases among premature babies.

When treating mild retinopathy, the doctor may prescribe a course of special drops (vitamin or hormonal preparations). In difficult cases, they resort to surgical intervention, the purpose of which is to stop retinal detachment. And .

There is no reason to sweeten reality - in most cases, a premature baby and his parents will face serious trials in the first year of a baby's life. But this does not mean that a premature baby is doomed to a painful existence, chronically poor health and many pathologies.

With careful and reverent care, in the presence of patience and love, with the help of adequate and timely medical intervention, premature babies not only quickly "catch up" in the development of their peers, but in the future they do not differ from them.

Judge for yourself: in modern Russia, for every hundred newborns, there are 7 premature babies. And if you meet these children over the age of two, you probably won’t be able to determine which of them was born on time, and which hurried a little towards a new life ...

In this article:

All over the world, including Russia, there is an increase in cases of premature birth of babies. According to statistics, every tenth child is premature, or, if translated into numbers, about 8-13 million babies worldwide are in a hurry to see the light a few weeks or months ahead of schedule. This includes "extremely premature" weighing up to 1kg. This child needs special care. Extremely premature babies in 86% of cases, despite the measures taken, die in their first few weeks of life. Of the remaining 14%, only 6 out of 100 have a chance of developing without any abnormalities, defects and future disability. The rest are doomed.

In developed countries, premature babies are nursed in 96% of cases, in Russia only in 28.

Which babies are considered premature

The program for the development of the intrauterine fetus provides for 280 days, or 40 weeks. It is during this period that all the internal systems and organs of the baby finally develop and grow stronger to meet the environment. Premature babies are considered to be those children who appeared a few weeks ahead of schedule: everyone who was born before the 37th week with a body weight of less than 2500 g. at 40 weeks. They develop well, they are in good health, they do not have any physical and mental abnormalities. The only thing is that such premature babies need special nutrition and vaccinations. Feeding premature babies at 38-39 weeks is supervised.

How long can such a child leave

To begin with, it should be said about the generally accepted stages of prematurity by body weight:

  1. 2001-2500
  2. 1501-2000
  3. 1001-1500
  4. Less than 1000g

Since 1974, the World Health Organization has proposed, on the basis of collected statistics and successful practice, that children born with a body weight of at least 500 g and a term of at least 22 weeks are considered viable. This is the minimum, which really does not guarantee a favorable outcome. You need to understand that a child born in a few months is weak in all vital parameters.

The shorter the term and the lower the body weight, the more experienced the center or department is required, the greater the risk associated with death. Premature babies are demanding in terms of conditions, care, nutrition.

Causes of prematurity

There are many factors that influence the fact that a child is born prematurely.

Social and economic:

  1. Lack or inadequate medical care;
  2. Poor nutrition (lack of minerals and vitamins), even a few months before the expected birth;
  3. Presence of bad habits (smoking, drug addiction, alcohol);
  4. Severe stress in a few weeks, or lack of desire for a child;
  5. Harmful or dangerous workplace (dust, radiation, monotonous work, heavy lifting, irregular working day or week). Work without days off for several weeks in a row;
  6. Insufficient education of parents.


Social and biological:

  1. The age of a pregnant woman (up to 18 or after 35) can cause a premature baby;
  2. The age of the father (before 18 or after 35) can cause a premature baby;
  3. The presence of a “bad” history (termination of pregnancy, miscarriage, criminal abortion in a few months);
  4. Genetic predisposition or diseases of parents;
  5. Marriage between relatives.

Various diseases:

  1. The presence of chronic diseases of the mother, which could worsen during pregnancy;
  2. Transferred acute infectious diseases, possible complications after SARS, influenza, severe colds, rubella, chickenpox, and so on;
  3. On the part of the fetus, there may also be various anomalies in the development of the cardiovascular system, internal organs, its position; hormonal dysfunctions, premature discharge of water, chromosomal defects;
  4. The presence and development of intrauterine infections: chlamydia, mycoplasma, ureplasma. Or other undiagnosed or untreated sexually transmitted diseases;
  5. Underweight mother (less than 48 kg);
  6. Complications after vaccination;
  7. A premature baby may be born due to constant stress.

What is the immaturity of a premature baby

Premature babies are very different from healthy ones not only in appearance, but also in the structure of internal organs. Especially at birth for 3, 6, 8 weeks. The skin is dry, thin, wrinkled. The body is covered with down. There are no grooves on the soles of the feet. The nails do not have a protrusion. The auricles have soft cartilage and are poorly formed.

The immaturity of the blood vessels is pronounced: if the child is placed on its side, the skin acquires a pinkish tint.

The general physique of the child: a relatively large head against the background of an underdeveloped skeleton (trunk).
Premature babies have poor development of sucking and other reflexes. This affects the feeding of premature babies. They are immobile. If in healthy children the umbilical cord heals quickly, then here the processes are much slower, including the falling off of the umbilical process.

Children born prematurely (a few weeks in advance), unlike healthy ones, have problems with the straightening of the lungs. If in a healthy baby, after inhalation, the lungs straighten and remain in this position, then in a premature baby, they can curl up again. There are problems with the production of digestive enzymes, so the feeding and nutrition of premature babies is carried out according to a special program.

For such children, special vaccinations may be used.

A premature baby can sleep for several months for a long time, cry a lot, react with convulsive movements. It affects the underdevelopment of the nervous system. In the first few weeks, there can be serious problems with the body's thermoregulation.

Care

The period of postpartum adaptation in premature babies: born in a few weeks, is about a month or two. Given the immaturity of all life support systems, disruptions or an increase in terms are possible.

After birth, a premature baby needs special care, including feeding. The child is placed in artificially created conditions - an incubator. It is in some way an incubator for maintaining the vital functions of the body. The couveuse is fully automated. Equipped with special sensors, in particular for monitoring the temperature of the baby's body. Since heat transfer is impaired, a drop in body temperature to 32 ° C is critical and can lead to death.

All data is transmitted to the software, which, depending on the indications and the development of the baby, makes certain decisions. In the event of a power outage, an emergency power supply is provided.

Nursing premature babies using the kangaroo method

Kangaroo care involves carrying children through maximum physical contact between the baby and mother (skin to skin). This method allows a premature baby to quickly adapt to the environment, in a few weeks or months, has a positive effect on the development of the baby. It also compensates for heat loss.

The larger the contact area, the better. Additionally, the baby is covered with a warm diaper and put on a hat. This is a kind of clothing for premature babies.

How long will mom and baby stay in the hospital?

This usually depends on the state of the mother and what category of prematurity the child belongs to. The terms for the mother can be from several weeks to a month, for the child about two months. Nursing premature babies depends on how many weeks before the due date the baby was born and how the vaccinations are tolerated.

Will a premature baby differ in development from other healthy ones when they grow up?
With proper care, despite the underweight and underdevelopment of the body, a premature baby will not differ from healthy peers in the future. The neuropsychic development of such children is slower, but in the end, with proper care, everything returns to normal. For example, if a child was born at 28 weeks, then on his own, with proper care, he will begin to roll over no earlier than 4-8 months.

feeding

Feeding premature babies takes place under the close supervision of medical professionals. Premature babies grow faster than their peers, they need more nutrients, but the digestive system is weak, so a special mixture is prepared.

Vaccinations

Vaccinations are given only after the child gets stronger and gains weight. Approximate time 6-8 months. Basic vaccinations: BCG, hepatitis. Any mother has the right to refuse them.

Criteria, development and norms of behavior

The norm is a long sleep, tearfulness, convulsive response to external stimuli, relatively inhibited development of reactions or its short absence, rapid fatigue, apathy. You should not panic if the child behaves in this way. This may take several weeks or months.

What to do if anxiety symptoms occur?

It is imperative to contact medical professionals who will help and provide proper care if: the child does not breastfeed for a long time, there is constant vomiting, the child turns yellow, emits a prolonged, painful cry, the child has stopped breathing (apnea), cardiac arrest (in this case, should take immediate action - heart massage), severe pallor.

In Russia, premature babies were neglected until the introduction of the standard. Now, if a child was born a few weeks earlier with a weight of up to 500 g, doctors are required to take such an infant out, provide him with all the necessary conditions and nutrition. Feeding premature babies is carried out only by qualified, experienced workers.

Useful video about premature babies

A premature baby is the same newborn baby as others, differing from a mature newborn in underdeveloped body functions.

Any newborn born weighing less than 2,500 g and measuring less than 48 cm is considered premature. It is usually born before the end of the 37th week of pregnancy.

Degrees of prematurity

Premature babies belong to a separate group of newborns.

The group of premature babies is divided into a number of subgroups, but most often they are divided into two main ones: immature up to 1.500 g of weight and immature from 1.500 to 2.500 g.

There are 4 degrees, which are based on the growth and weight of a premature baby.

  1. First. Date of birth: 35-37 weeks, weight 2000-2500 grams.
  2. Second. Term: 32-34 weeks, weight 1500-2000 grams.
  3. Third. Term: 29-31 weeks, weight 1000-1500 grams.
  4. Fourth. Less than 20 weeks, weight below 1000 grams.

The higher the degree of prematurity, the more difficult it will be for the baby to come out. The main problem of such babies is not lack of weight, but too low development of vital systems and organs of the body.

Basically, a premature baby has all the characteristics of a newborn baby, he is only less mature. And yet, individual parts of the body lag behind in size and development from others. This incommensurability in children born after a smaller number of lunar months is manifested due to the fact that the formation of individual organs and systems was incomplete. So, for example, the skull has a rounded or ovoid shape, and only before the end of the gestation period (10 lunar months) it lengthens somewhat. The subcutaneous fat layer is much less pronounced, since it is mainly created before the end of pregnancy, so a premature baby has a somewhat specific appearance.

The percentage of births of premature babies is not constant and is not the same in all countries of the world. Basically, it ranges from 8 to 12% of the total number of children born ...

Reasons for having a premature baby

The causes of prematurity in about 50% of cases are unknown.

It is believed that of all the possible causes, the following have a special impact on the birth of premature babies:

  • in the first place I want to put the usual negligence of the expectant mother: to go to distant lands in a shaking train or car because I “want”, to do a general cleaning or repair, and in all cases she believes that no one can move her wardrobe better, fall, climbing on a tree “behind that red cherry” or running across the ice ... Dear future mothers, take care of yourself and your stomach from the first days until the very birth, do not risk the baby, telling “and my friend flew to Turkey in her seventh month, and that’s all it was nice". No risk here!
  • chronic diseases of mothers (tuberculosis, syphilis, joint diseases, anemia, etc.);
  • congenital tendency to premature birth;
  • traumatism of working women (constant exposure to subtle, but harmful influences, such as shaking, vibration, etc.);
  • multiple pregnancy (twins, triplets);
  • acute mental shocks of the mother;
  • difficult social conditions of the mother's life (illegitimacy, unemployment, etc.);
  • seasons (early spring, late autumn);
  • undesirable changes in the mother's diet during pregnancy (lack of proteins and vitamins);
  • attempt to have an abortion, previous abortions;
  • drinking and smoking;
  • too young or vice versa old age of parents;
  • non-compliance with medical prescriptions;
  • psychological, domestic and emotional factors that adversely affect the course of pregnancy;
  • a period of less than 2 years between births;
  • severe pregnancy;

We have already said that about 50% of the causes have not yet been sufficiently studied. There are new interpretations, according to which the causes of prematurity can also come from fathers. It is believed that for successful childbirth it matters when the spermatozoa are completely mature and capable of fertilization.

As mentioned above, a premature baby is born with less mature organs, the maturity of which is achieved in parallel with weight gain. Such a child is poorly prepared for life in the external environment, it is difficult to adapt and quickly succumb to various diseases. The development of a premature baby by months - this is worth talking about in more detail.

Development of a premature baby by months

Premature baby up to 29 weeks.

For such children, the weight is less than 1 kilogram, the skin color is red-violet. The skin is folded and covered with fluff (lanugo). Outwardly, the kids are thin, but not emaciated. If there are signs of exhaustion, this indicates the presence of malnutrition. Due to the lack of sucking, swallowing and respiratory reflexes, the life support of babies is provided by medical equipment. Often such children do not know how to cry, and most of the time they sleep. Their movements are rare and sluggish due to reduced muscle tone.

Cases of childbirth before 29 weeks are extremely rare.

Development of a baby born at 29 weeks

Outwardly, these babies resemble babies born at an earlier date, but there are differences that subsequently reduce the likelihood of a negative manifestation of early childbirth. Most often, children are placed in an incubator in which constant temperature conditions and humidity are maintained, oxygen is additionally supplied.

Having a baby at 30 weeks

Children born at this time can already be fed through a tube with breast milk. They start to move.

Features of the development of a child born at 31 weeks

Despite the fact that children born at this time already know how to open their eyes, cry and move more actively, they still need constant medical supervision.

Baby born at 32 weeks

The weight of these babies exceeds 1500 grams, they know how to breathe on their own.

33 week

If the child does not have problems with the respiratory system, then he can be bottle-fed or breast-fed.

Childbirth at 34 weeks - features of the birth of a child

The likelihood of health problems decreases, the condition of children who were born during this period improves.

Childbirth - 36 weeks

The risks of birth at this time include imperfection of thermoregulation and jaundice. The weight of such children is close to normal, there are practically no health problems.

Development of premature babies by months depending on birth weight

The child was born weighing up to 1000 grams

At 3 months they begin to concentrate their attention on sound sources.

The child was born with a weight of 1000-1500 grams

At 2.5 months, they begin to concentrate their attention on sound sources.

At 4 months, the head is held in a vertical position.

At 7 months they roll over from back to stomach, and at 8 months from stomach to back.

Starting from 9 months, they try to sit down on their own.

Closer to a year, children try to get up.

Starting from 1 year 2 months, children try to take their first steps.

After a year, the first words are pronounced.

The birth of a child weighing 1500-2000 grams.

At 2 months they begin to concentrate their attention on sound sources.

Starting from 7 months, they try to sit down on their own.

At 10 months, babies try to get up.

Starting at 11, children try to take their first steps.

After 11 months, the first words are pronounced.

Premature baby weighing 2000-2500 grams - development by month

At 1.5 months, they begin to concentrate their attention on sound sources.

At 2 months, the head is held in a vertical position.

At 6 months they roll over from back to stomach, and at 7 months from stomach to back.

Starting from 6 months, they try to sit down on their own.

Closer to 9 months, children try to get up.

From the age of 11 months, children try their best to take their first steps.

At 11 months, the first words are pronounced.

Features of the development of premature babies by months

Development of a premature baby - 1 month

High probability of contracting infectious diseases that can lead to complications. Weight gain is minimal. The increase in height averages 2-5 cm. The head circumference increases to 4-5 cm. If the development of the crumbs proceeds normally, a sucking-swallowing reflex should occur. If it is absent, feeding should be carried out using a tube. If the respiratory reflex is poorly developed, artificial oxygen supply should be resorted to.

2 months of life of a premature baby

Weight gain is accelerating. This is a good indicator, as it indicates that the child is developing. The increase in height averages 2-5 cm. The head circumference increases to 2-3 cm. Breastfeeding is a difficult test for fragile children, so they must be supplemented with expressed milk using a spoon.

Premature baby and its development at 3 months

Weight should increase by 1.5 times. The increase in height averages 2-5 cm. The head circumference increases to 2.5 cm. The main task of parents during this period is to control the climate in the room where the baby sleeps and change the position of the child's body during wakefulness and sleep.

4 months of life of a premature baby

The baby is already raising his head, holding it, fixing his eyes and making sounds. The increase in height is on average 2-5 cm. The head circumference increases to 1.5 cm.

What can a premature baby do at 5 months

He begins to smile and grabs objects that interest him with his hands. The increase in height is on average 2-5 cm. The head circumference increases to 1.5 cm.

Features of the physical and psychological development of a premature baby - 6 months

Premature babies by this age are catching up with their peers in development. Their weight should double. The increase in height is on average 2-5 cm. The circumference of the head increases to 1.5 cm. They are able to distinguish their relatives from strangers, play with toys and turn their heads.

7th month - development of a premature baby

The increase in height is on average 1-3 cm. The circumference of the head increases to 0.5-1 cm. The game becomes more active. The peanut rolls over from its stomach to its back.

Premature baby - 8 months

The increase in height is on average 1-3 cm. The circumference of the head increases to 0.5-1 cm. Coups are already easy for the baby. There are attempts to crawl.

9 months of life of a premature baby - his skills, features of development

The increase in height is on average 1-3 cm. The head circumference increases to 0.5-1 cm. He picks up pieces of food without outside help, stands up, holding on to a support, actively plays.

10-11 months of life of a premature baby

The increase in height averages 1-3 cm. The head circumference increases to 0.5-1 cm. Children actively crawl, play, pronounce all kinds of sounds, actively respond to their name.

Premature baby - development in 1 year - 12 months

The increase in height averages 1-3 cm. The circumference of the head increases to 0.5-1 cm. They begin to pronounce syllables. The main thing for parents during this period is not to rush and not teach the child to walk.

Premature newborns are characterized by certain external signs. These include:

1. Small size. All premature newborns are small in stature. Their length is proportional to the degree of prematurity. The larger the latter, the smaller the growth of the child.

2. Reduced nutrition. Significantly reduced nutrition with an almost complete absence of the subcutaneous fat layer is characteristic of very preterm infants (Fig. 1). At the same time, they do not give the impression of being emaciated, as is noted in infants with malnutrition of the II-III degree. The nutrition of premature babies is in harmony with their growth. Sharp exhaustion with wrinkled skin in the form of folds, which immediately catches the eye, is noted only in premature patients and in children with congenital malnutrition.

3. Adynamia. This symptom is typical for very premature babies. Adynamia is manifested in general lethargy, decreased muscle tone, weak cry, underdevelopment of the sucking reflex, lack of hunger.

Rice. 1. Deeply premature baby. A large head and short legs are visible.

4. Disproportionate physique. A premature baby is characterized by a relatively large head, a relatively large torso (in relation to its own height), a short neck, short legs, and a low navel. If in a full-term baby the head is 1/4 of the body length, then in a premature baby this ratio is one third. In absolute terms, the head and torso of a premature baby are much smaller than those of full-term babies.

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

6. The predominance of the brain skull over the facial.

7. The small fontanel is always open. Non-fusion is noted, and often the divergence of the cranial sutures. The bones of the skull are malleable, mobile and can find each other.

8. Ears are soft. They are easily crumpled, tucked inward and often stick together.

9. Expressed lanugo. Lanugo is a soft fluffy hair characteristic of newborns and is located mainly on the shoulders and back. In preterm infants, lanugo are more abundant and cover not only the shoulders and back, but are also well expressed on the forehead, cheeks and thighs.
10. Gaping of the genital slit. In premature girls, the large labia do not cover the small ones, as a result of which the genital gap gapes and the clitoris is clearly visible.
11. Empty scrotum. In boys, the testicles are located in the abdominal cavity or in the inguinal canals. This symptom is not observed in all premature babies and is more typical for children weighing up to 1200 g, although in some of them, the testicles may already be descended into the scrotum at birth.
12. Lack of physiological swelling of the mammary glands. Swelling of the mammary glands in preterm infants is observed very rarely and only in children with a small degree of prematurity (birth weight over 2000 g).
13. Exophthalmos. Bulging is not expressed in all premature babies and usually does not appear immediately, but at the 2-3rd month of life. It can be combined with megacephaly (an increase in the frontal and parietal tubercles).
14. Underdevelopment of nails. Fingernails and toenails are poorly developed and may not reach to the fingertips. This sign is the most inconsistent and is extremely rare.

Most of the above signs, taken separately, cannot serve as an absolute criterion for determining prematurity. They can also occur in some full-term babies (absence of testicles in the scrotum, open small fontanelle, non-closure of cranial sutures, etc.) and at the same time be absent in some premature babies (presence of testicles in the scrotum, absence of exophthalmos, normal development of nails, etc.). d.). Premature babies are characterized by a combination of most of these signs, and the greater the degree of prematurity, the more pronounced they are.
* * *
Every premature baby is unique. Many factors affect the maturity of the newborn and the functionality of his body. You can not focus only on birth weight. The cause of premature birth and its nature, the pathology of the mother during pregnancy, the condition of the child at birth, his weight and age, and, finally, the degree of prematurity - these are the main criteria that determine the characteristics of each premature baby and are necessary when comparing different premature babies.