Premature baby 35 weeks development and behavior. Psychological problems of development of premature babies. Should premature babies be vaccinated?

Usually pregnancy lasts 38-42 weeks. Children born at this time are called full-term, and births are called timely, or urgent. However, about 25% of births begin prematurely (before 38 weeks of gestation).

Such children are considered premature, and childbirth is considered premature.

During pregnancy, which lasts 9 months for a person (apparently, the wise Nature set such a period for a reason!), the baby manages to form and develop so much that it is born ready for a physiologically autonomous life.

Compared with full-term children, the initial life potential at the time of birth in premature babies is much lower, and therefore the newborn period (from the moment of birth to 28 days) is much more difficult for them. Such babies first have to, as it were, "complete" intrauterine development, its systems and organs must reach a level corresponding to the normal term of childbirth.

In order for “development” to proceed normally, premature babies need to stay for some time in conditions similar to those in which the fetus grew in the mother’s womb, so all babies immediately after birth are placed in equipped intensive care units of maternity hospitals and children’s medical centers, where care they are followed by experienced neonatologists (pediatricians dealing with newborn pathologies), doctors and nurses.

A premature baby requires special conditions for nursing and constant monitoring by doctors, on whom his life depends.

A baby born at term with low weight differs from a premature one in that the internal organs of the latter are underdeveloped. He will need another two months for all his organs and systems to reach functional maturity. He will lag behind in weight and height from children born at term for a long time to come. A baby born before the 35th week weighs less than 2 kg.

What is he, a premature baby?

The birth of a baby earlier than expected is always accompanied by feelings and anxiety of parents. And this is quite understandable - both for them and for the doctors, a serious struggle begins for the life of the newborn.

Physiological changes in body weight after birth

Almost all newborns from the moment of birth begin to lose body weight: full-term babies by about 5-6%, and premature babies - up to 12-14% of body weight at birth. This is a normal, physiologically justified phenomenon.

In a premature baby, the period of loss of the initial mass lasts about 4-7 days, and the “speed” of its decrease (intensity) is not the same: first it grows, then it is maximum for 2 or 3 days, and then it gradually decreases.

Weight loss is mainly due to malnutrition of a premature baby in the first days of life, as well as large fluid losses through the lungs and skin. Recovery depends on whether the fetus was healthy at the time of birth or whether it had any disorders.

In a healthy premature baby, the rate of recovery of the initial weight depends on the degree of prematurity and the higher, the lower the weight was in the child at birth. But if the baby developed in utero with impaired maturation, then the recovery rate is difficult to predict.

As soon as the initial (at birth) body weight is gained, the body of a premature infant proceeds to the next stage: he needs to adapt to extrauterine life, and he begins to grow and gain weight with all his might.

Appearance

The appearance of such a child is very characteristic. The skin is reddish in color, the body retains the hairline, which covers the fetus in the womb. Large blood vessels show through very thin skin.

A premature newborn differs significantly from a full-term one in external signs, which are directly dependent on the time of intrauterine development of the baby. The smaller it is, the more pronounced these signs are.

First of all, a disproportionate physique is striking: a relatively large head and torso, short legs and neck, and a low navel. This is due to the fact that the growth rate of the limbs increases in the second half of pregnancy.

Many children have not quite normal facial features- the forehead is steep and high, unusually bulging eyes (these features may disappear with the age of children), sometimes strabismus can be observed.
Rib cage and the abdominal muscles of a premature baby are soft. Breathing is shallow, its rhythm is unstable. The ribs are perpendicular to the sternum. The little tummy is continually drawn in and out. When exhaling, the ribs and sternum sink. The nipples and areolas of the mammary glands are weakly expressed.

Bones excessively soft, flexible (they still have little calcium).

Nails thin and often may not reach the edge of the nail bed; with a significant degree of prematurity, underdevelopment of the nails is observed.

Boys testicles often not drooping and the scrotum does not have the uneven, folded appearance of a full-term baby; often there is an increase in the size of the scrotum (hydrocele) and inguinal-scrotal hernia.

When the baby cries, then swelling of the muscles appears in the umbilical ring.

Important feature of the skin premature babies - intensive development of lanugo - vellus hair - not only on the shoulders and back, like a full-term baby, but also on the cheeks and buttocks.

The skin is dry and thin. Despite the reduced elasticity, it can be considered tender. Appears wrinkled because it folds easily. Normally, the skin is red or bright pink, but very often it has an icteric or bluish tint. The subcutaneous fat layer is poorly developed, or almost completely absent.

In order to correctly assess the compliance of the child's maturity with the period of its intrauterine development (gestational age), in addition to morphological features, the state of its neuromuscular system is also taken into account.

Muscle tone a premature baby is noticeably reduced, therefore, at rest (in the supine position), his arms and legs are “sluggish”, only slightly bent at the joints and spread apart.

The longer the period of intrauterine life of the child, the better his legs are bent at the knee and hip joints.

A deeply premature baby in a normal position lies simply with outstretched arms and legs.

The sternum is an oblong flat bone that is located in the middle of the human chest and is connected to the ribs with the help of cartilage, forming the chest.

The state of systems and organs

In premature babies, violations are often recorded in several parameters at once, for example, in the state of muscle tone and innate reflexes, in skin color, heart rate, respiratory rate, etc. There is nothing surprising in this, since in the body of even an adult, all organs and physiological systems work closely together. Violations in the work of one of them cause changes in the functioning of the whole organism. Therefore, it would be unreasonable to expect that any organs or physiological systems of a premature baby will work “perfectly”.

It should be noted that there are practically no premature newborns without disturbances in the activity of the nervous system. Differences can only be in the degree of pathology. The most commonly observed disorders caused by the immaturity of the central nervous system (CNS) are the absence of sucking and swallowing reflexes, as well as slow growth of masticatory muscles. Therefore, at first, these babies are fed through a tube, gradually transferring them to breastfeeding or feeding from a bottle or spoon. Premature babies usually swallow food poorly - they keep it in their mouth for a long time, as if remembering what to do with it next.

Such upsetting signs of prematurity for parents are clearly visible until about six months. Then, if the parents conducted a thorough maintenance therapy, "late" babies by the age of 1-1.5 years become practically indistinguishable from their peers born at term. But in severe advanced cases, some children up to two or three years old eat only liquid food. As a rule, they lag behind in development from their "full-term" peers in other ways - later they begin to walk, roll over, stand up, take a toy.

Violation of thermoregulation- a common phenomenon for premature babies, arising from the immaturity of the body as a whole and certain nerve regulatory centers in particular. This leads to the fact that the baby's body in the initial period of life is still quite poorly independently maintains normal body temperature. Without special external conditions, such a baby can quickly die from overheating or hypothermia.

innate reflexes in premature babies, as a rule, they are too weakly manifested or even absent. Naturally, conditioned reflexes in such babies will be developed much later than in full-term ones.

In the first days and weeks of life, the motor activity of a premature newborn is limited: drowsiness or severe lethargy follows occasional spontaneous movements.

Respiratory system

Your baby's lungs develop gradually, preparing for the first breath immediately after birth. Inside the mother, they still do not fully function.

If a child is born before this time, then the amount of matured surfactant is so small that it is not enough for the independent work of the lungs. The baby's breathing becomes difficult, he turns blue, suffocates. Therefore, the first thing such a child needs is a ventilator. Unfortunately, large doses of oxygen can "burn" the baby's lungs. Such a “burn” leads to bronchospasm, to hyper-production of mucus (bronchopulmonary dysplasia).

But the baby is alive! Of two evils, as they say ...

Parents of such children should remember that the baby’s bronchi after such a “burn” remain vulnerable and predisposed to spasm for a long time - even with a common cold, short-term respiratory arrest may occur. Therefore, you must warn the local doctor that the child was on machine breathing. Modern pharmaceuticals offer enough funds for the prevention and rapid removal of pulmonary spasms.

The cardiovascular system

After birth, the baby undergoes a restructuring of the circulatory system - the blood flow stops its course through the placenta, the heart becomes four-chambered (in the fetus it is three-chambered), the large and small circles of blood circulation are included in the work; the baby's cardiovascular system begins its extrauterine life. In a child born prematurely, such a restructuring occurs much more slowly.

The baby's heart is relatively large - about 0.8% of body weight (in adults 0.4-0.5%); its shape is close to spherical.

The volume of a child's heart relative to the volume of his chest is much larger than that of an adult. Later, until adolescence, the heart will move and rotate in the chest; its mass will begin to increase; the form and device will also undergo changes.

The heart muscle (myocardium) of a premature infant is characterized by too thin muscle fibers and insufficient development of connective tissue.

The pulse is weak, but frequent - from 90 to 160 beats per minute; with crying and states of anxiety, anxiety and discomfort, it can reach 200 beats per minute or more.

Premature newborns are more likely to have a heart murmur. They can occur for various reasons: either as a result of premature restructuring of the physiology of the cardiovascular system, excessive load on it, or due to other disorders of varying severity. Heart murmurs require detailed examination.

Without exception, all tests and procedures must be agreed with the cardiologist observing the baby. Violations in the activity of the cardiovascular system are very insidious and can be "masked", that is, not manifested by any symptoms that are noticeable to parents.

Parents of a premature baby need to regularly monitor the state of his blood: red blood cells, hemoglobin, hematocrit.

The body of a premature baby is fighting with all its might to save life, so the child has the best blood supply to the brain and liver, and his arms, legs, etc. are provided with much less blood. As the baby matures and develops, the blood supply to all organs and tissues gradually increases.

Vessel walls of the brain of a premature baby have increased permeability, as a result of which not only cerebrovascular accidents are possible, but also local hemorrhages.

Digestive system

The functional maturity of individual organs and the entire digestive system as a whole depends very much on the degree of prematurity of the newborn. At the same time, its work is largely related to the state and activity of other body systems.

For example, the immaturity of the child's central nervous system leads to a significant "unreadiness" of its nerve centers to "lead" the regulation of digestion and sucking-swallowing reflexes. Therefore, despite the fact that the digestive juices may contain all the necessary enzymes for the digestion of mother's milk, their activity can be very low.

Although the production of saliva is already in the first feeding, the salivary glands are poorly developed, the volume of saliva is small. Therefore, in the digestion of a premature infant, the role of saliva is very insignificant.

Esophagus short in premature babies. Its contractile function may be practically absent, or be poorly developed.

Stomach in a premature newborn, it is round and small - from 10 to 30 ml. Different parts of the stomach are underdeveloped. The production of gastric juice and its enzymatic activity is reduced. Peristalsis is weakly expressed, and motor activity is characterized by a too low rhythm. All this is the cause of abundant regurgitation of food.

Pancreas in premature babies, it functions, although there are very few enzymes in the cells of its tissues.

Liver fetus and newborn - one of the main organs of his life support.

Liver weight at birth can be up to 4.4% of the baby's body weight. In a premature baby, the immune and hematopoietic functions of the liver are especially active; less mature are the functions of "binding" bilirubin (during the breakdown of fetal hemoglobin) and antitoxic (protective). The maturation of all other functions occurs gradually with the growth and development of the entire body of the baby.

General intestine length can be 3.3-3.6 m. Usually, in such babies, the muscle and elastic tissues in the intestines are not sufficiently formed.

For newborns, first of all, you need a full-fledged proper nutrition, corresponding to the degree of its prematurity. It is it that is able to support the favorable course of all metabolic processes, “improve” the intestinal microflora and thereby create conditions for the successful development of the child.

Sufficient and reasonably balanced nutrition, as a rule, helps to increase the vitality of a premature baby, improves the condition of his blood, immune, bone and other systems. This ensures the gradual growth and development of his entire body.

excretory system

In premature babies, the organs of the excretory system are also functionally immature.

The kidneys are the main organ of the excretory system. They begin to form from the third week of fetal development and begin to function normally as early as the ninth week. It has been established that in the first few days of life in premature babies, the kidneys work more intensively than in full-term babies. At the same time, they remove more fluid from the body. A number of features of the kidneys in premature babies are noted: low concentration ability, low level of filtration, reduced filtration of phosphates, etc. Urine is weakly concentrated, and the frequency of urination is higher than in full-term children (due to the high rate of metabolic processes in the body).

Skeletal system and joints

One of the severe consequences of improper care of the baby with the immaturity of his musculoskeletal system can be a dislocation of the hip joints. Consultation with an orthopedist is mandatory for all newborns, __but for small premature babies, it is especially relevant.

Features of the immune system

In newborns, mainly innate and passive acquired immunity works (the child is partially protected only from those infections that the mother encountered during pregnancy).
A premature baby in this situation is especially difficult. The most dangerous time for him is the first 20 days of life, when resistance to infections is very limited.

Care

Obstetric care for premature babies is a complex art, with great risks. They take such a child in heated sterile diapers, covering them with a blanket. Then they are transferred to a warmed changing table, under the rays of an electric reflector. The baby's legs (and with a very small weight, and the head) are wrapped with cotton wool. After that, the baby is placed in a separate, specially equipped children's ward.

Children with very low weight are placed in incubators - containers with automatic oxygen supply and maintaining optimal temperature and humidity. The simplest of them look like a double-walled tub, open at the top. Hot water circulates between the walls (50-60 °C).

The duration of stay in the incubator is determined individually and depends on the weight and general condition of the child. On average, it is from 2-4 to 8-14 days.

The air temperature in the ward for premature babies should be high enough: 22-24 ° C, and even higher in the baby's crib: 26-30 "C. For control, a thermometer is placed next to the baby (over the blanket).

Since the immunity of premature babies is very weak, special attention is paid to the prevention and prevention of infectious diseases in the department where they are. Careful sterilization of linen, personal hygiene of personnel (work in masks, gloves, etc.) and the mother - all this must be strictly observed.

A premature baby really needs the feeling of "mother is nearby." In many maternity hospitals, the “kangaroo method” is now being practiced - the baby is placed on the mother’s stomach for several minutes, and then placed again in the incubator. With a regular communication procedure, the baby's breathing and pulse improve.

Premature babies require special care because:

• vellus hair prevents normal sweating, so it is necessary to maintain constant air humidity;
• the air must be saturated with oxygen because the capacity of the lungs is insufficient;
• it is necessary to maintain a constant air temperature (36 ° C), since there is no self-regulation of body temperature;
• the muscular system is underdeveloped (flaccid muscles);
• the walls of the blood vessels are weak, there are not enough red cells in the blood, in addition, poor blood clotting;
• low resistance to infectious diseases;
• immature nervous system. The development of the brain requires stimulation of the sense organs. Despite the prematurity, he already has them. In particular, the child reacts to sounds. Therefore, it is very important to treat him as a full-term baby, while showing increased attention. To bridge the gap between the day of birth and the day of discharge of the child, the earliest possible contact of the child with the parents is necessary. It is desirable for the father to come to the maternity hospital to the child every day, as well as for the mother after discharge.

A premature baby is bottle-fed from the first day of birth. However, his stomach has too little capacity, from 5 to 6 cm3, sucking and swallowing reflexes are still poorly developed. Therefore, he is fed with milk mixtures through a tube passing into the stomach through the nasal opening. In addition, glucose is administered to the child through the head vein. When the reflexes reach the required level of development, it is transferred to breastfeeding through the nipple. The mother expresses milk at home and brings it to the hospital. Mother's milk is vital for a premature baby. In addition, it helps to establish a kind of emotional connection between mother and child. If the mother does not have milk, it is delivered from the lactaria (an institution that collects and preserves women's milk for feeding newborns).

As soon as this becomes possible, the child is transferred from the incubator for severely premature babies to a simpler device - an incubator. Parents are given a child who has gained weight of at least 2.5 kg.

Most premature newborns who were born at 26 weeks or less need special care. In order to avoid the development of such severe postpartum complications as hearing loss, dementia, and others, immediately after birth, the child is placed in the neonatal intensive care unit, where he is in a special incubator. The incubator is a plastic box made of polymer plastic, in which a constant, most acceptable air temperature for the baby (22-25 ° C) is maintained. The constancy of the ambient temperature contributes to the preservation of fluid, in addition, incubators prevent the penetration of infectious agents to a child with an absolutely weak immune system.

In addition to the special temperature regime, children born prematurely need special nutrition, since the digestive system has not matured, and the sucking and swallowing reflexes have not developed. For this purpose, through-tube or intravenous nutrition of the child is carried out until the moment of development of the main reflexes of the newborn. Sometimes (when the baby is born from 28 to 35 weeks), you can feed the baby through a tube, but with breast milk, which will significantly accelerate the growth and development of the baby, and also protect him from infectious diseases.

Maintaining the temperature regime at home is achieved by regular (every 2-3 hours) ventilation of the children's room, where the air temperature should not be lower than 22 ° C. Next to the child (in his crib), the air temperature should not be lower than 28 ° C, which is achieved by wrapping the child with heating pads filled with water (water temperature 60-65 ° C), especially in the winter season. Heating pads are placed at the legs and sides of the child, and a thermometer can be placed in the crib to regularly monitor the temperature. Warmers must be wrapped in a soft-touch cloth and placed at a distance of the palm from the child. The change of heating pads must be carried out every 2 hours, in turn. In no case should the child's face be covered with a blanket, it should always be open. It is also strictly forbidden to put heating pads under the child (to avoid burns) and put them on top, as this greatly complicates breathing and interferes with chest excursions.

Bathing premature babies

In the event that a child was born with a body weight of less than 2 kg, it is necessary to refuse bathing for at least a week and a half. 10-12 days after the birth of the child, they begin to bathe in boiled water (water temperature is about 38 ° C).

Features of caring for a premature baby at home

It is necessary to reduce the number of contacts of the child with strangers, since with frequent visits the child may become infected with an infectious disease or SARS, which will adversely affect his health. It is advisable not to give a premature newborn to a nursery during the first year of life and to refrain from walking, especially in winter, until the age of three months.

A premature baby needs more frequent feeding, as his body must grow several times faster in order to catch up with his peers. The interval between feedings should not be more than 4 hours, otherwise dehydration may develop. You need to feed the child at least 8-10 times a day, slowly, making sure that he does not spit up (because if the child spit up often and profusely, it will be difficult for him to gain the necessary body weight). Premature babies need more sleep than term babies. The child should sleep not on a soft, but on a hard mattress in the supine position, since when positioned on the stomach, sudden death in sleep due to difficulty in breathing can occur.

At home, the child is cared for in a very heated room (25-30 ° C), depending on the doctor's instructions, with a humidity of 60%. Humidity is necessary so that the mucous membranes of the child do not dry out and to facilitate breathing. The necessary humidity is achieved by hanging wet towels and diapers in the room. Buckets, basins and large pots of water specially placed on the floor in the corners of the room will also help. Evaporating from them, the water will sufficiently humidify the air.

A warm crib for a baby at home can be made by putting duvet covers and warm blankets on top and bottom of the baby, and heating pads with hot water on the sides and legs. Wrap them in several diapers or a large piece of flannel. This is necessary in order not to burn the baby. You can make heating pads from hermetically sealed water bottles. The water temperature should be 50 °C. Water must be changed every hour around the clock so that it does not have time to cool. Bottles should also be wrapped in flannel and the corks should be tightly closed. Otherwise, you can scald the child. Do not place the baby's crib near a window or open it when the baby is in the room. If the room maintains the required temperature and humidity, you can do without heating pads and bottles.

Previously, premature babies immediately after birth, having been wiped with warm oil, were wrapped in several strips of cotton wool. Each limb of the baby was also wrapped in cotton wool to avoid heat loss. If necessary, the contaminated cotton wool could be changed without fully opening the baby. A separate strip of cotton is applied to the anus and urethra to make it easy to change. From above, a shirt and a woolen blouse were put on the child. The head is also wrapped in cotton wool and a woolen cap lined with cotton fabric was put on top. Sometimes they put on 2 bonnets, and the bottom one was cotton, not woolen, as wool irritates the skin.

As a rule, when a baby gains weight in 2000, you will be discharged home. This will be reported to the children's polyclinic for urgent patronage. The local doctor and nurse will take the baby under their control and teach you how to care for him.

Premature babies must be protected from painful stimuli, including injections of drugs and blood sampling - these procedures must be strictly justified.

To maintain body temperature a premature baby at home, you can use ordinary heating pads with a water temperature of 60-65 ° C. Wrapping them in diapers or towels, wrap them around the baby on the sides and at the feet, but not close to his body - the distance between the heating pads and the child's body should be 7-8 cm. Cover the baby with a blanket from above.

Heating pads must be changed approximately every 1.5-2 hours, maintaining the temperature under the blanket within 26-30 "C

When you swaddle your baby, iron the diapers first to keep them warm. The room temperature should be maintained at 22-24 °C.
For signs of overheating(frequent breathing, fever, reddening of the skin) you need to take the baby out of the crib, untie it, give it water or breast milk. You can bathe the baby in the bath for 5-7 minutes at a temperature of 37 ° C.

When the child is cold(cold, pale, even bluish skin; lethargy) it is best to warm it with your body, Press the naked baby to your chest, turning it with different sides. Say something nice to him. You can warm the baby in the bath at a water temperature of 38-39 ° C for 5-7 minutes. Then swaddle him in warm diapers, put him in a crib and cover him with heating pads.

About strict feeding mode premature babies need not be said - they need to be fed as many times as they wish. Everyone knows that it is best to feed premature babies with mother's milk. The milk of a woman who gave birth prematurely is characterized by a high protein content and a reduced fat content. And this is exactly what a premature baby needs: his body still cannot cope with the complete breakdown and absorption of dietary fats, but he needs a lot of “building material” - protein. But if your mother does not have enough milk, the doctor will prescribe food for you.

Daily toileting for a premature baby, including bathing, is very different from toileting and bathing a full-term baby. It is enough to carry out regular wiping and washing. Babies with a birth weight of 1500 g or more should begin to bathe after 7-10 days. While bathing, carefully protect the baby from cooling. Gradually, toilet procedures become the same as in normal (full-term) children.

For walks premature babies are taught gradually.

In winter, it is advisable to start walking if the air temperature is not lower than minus 8 ° C and if the weight of the baby is not less than 3000 g. The duration of the walk at first is 10-15 minutes.

If during a walk the child begins to behave uneasily, you must immediately return home and find out the reason. Most often, the baby is overheated.

Medical incubator (kuvez)

An incubator is an apparatus that holds premature or low birth weight babies until they are old enough and gain weight to live with their parents and be fed normally from breast or bottle.

The device has the appearance of a large transparent box made of plexiglass, which allows you to maintain the baby's temperature and monitor him. The air is heated depending on the needs of the newborn (mostly the temperature is 30 ° C), the air is also humidified. The baby's temperature is taken with a thermal catheter attached to the baby's skin.

If the baby was born prematurely, it is placed in an incubator, as it is highly susceptible to infections. His breathing and digestion, as well as the regulation of temperature, cannot yet function normally. This explains the need for a forced supply of oxygen, feeding through a dropper, as well as the use of phototherapy (direct blue light to the child to destroy bilirubin, which provokes Botkin's disease in the newborn).

Feeding in the hospital

Babies with an initial weight of about 1500 g at first most often have to be fed from a bottle or even through a tube. Children weighing less than 1 kg are fed only through a tube.

Those babies with an initial weight of 2 kg or more usually take the mother's breast well, actively suck and even suck out the required amount of milk.

Tips for moms:

• Start expressing milk as early as possible, even if your baby is not breastfeeding yet. Pump every 2-3 hours, preferably even at night. However, you should not wake up specifically for this - you must rest and gain strength;
• if you can’t express enough milk with your hands, then try to find a comfortable breast pump;
• milk that you have expressed can be frozen for later use. Write the date of pumping on the bottle.

Massage and gymnastics for premature babies

Nature takes care of its children: it gave newborns enormous potential for the restoration of damaged or delayed in their development of organs and systems. And if, in addition, you begin to stimulate natural abilities with various developmental and strengthening activities, then you will undoubtedly achieve good results.

Basic requirements for massage and gymnastics

The methodology for conducting massage and gymnastics with premature babies is carried out taking into account their physiological characteristics. It is better to have your baby massaged by a specialist. If this is not possible, you can learn massage techniques and do it yourself, but at the initial stage, always under the supervision of a doctor!

So, stick to the following rules:

• if possible, exclude loud music, conversations of strangers and other distractions in the study room;
• focus all your attention on the child, talking calmly with him and encouraging the correct implementation of the exercises with a smile and affectionate words;
• the duration of the first lessons should be no more than 5-6 minutes, while only breathing and simple reflex exercises are performed, alternating them. Each exercise is repeated 3-4 times;
• start classes with breathing exercises (see below), repeating them several times during the entire procedure;
• gradually (as the child masters these exercises), introduce strokes;
• gymnastics with children who have a birth weight of 1700 g or more, spend from one and a half months, and less than 1700 g a month later. Exercises during this period mainly consist of passive movements (that is, they are performed not by the child himself, but by the parent, bending and unbending the baby's limbs);
• precede each gymnastic exercise with a massage of the corresponding part of the body;
• do not undress the child completely during the first lessons. When performing exercises for the muscles of the arms, cover the lower half of the baby's body with a diaper, and do not remove the vest when doing gymnastics for the legs; if you notice that your baby quickly gets tired or cools down, do a set of exercises in two stages (for example, two breathing exercises at the beginning and at the end and one reflex between them; the next time the baby is awake, do other exercises from the complex);
• start classes no earlier than 45-60 minutes after feeding, and preferably half an hour before it; before a night's sleep - we think you will agree - massage and gymnastics are simply not recommended: it would be to lull, not to invigorate!
• to really help the baby overcome the lag in physical development, do not just do it daily, but repeat the whole set of exercises 2-3 times a day for 5-6 minutes, and in some cases more often (up to 4-6 times).

Caring for a premature baby

Remember: no one is to blame for the fact that your baby was born prematurely. Neither you nor your loved ones. Therefore, it would be fundamentally wrong to reproach each other for any shortcomings. Keep in mind - the past is gone. From this moment on, only you, your family, and your child exist. He especially needs your love and help. Do not succumb to despondency, fears and doubts, believe in yourself and in your child, carefully follow the doctor's instructions and carefully monitor your baby. Only your love and patience can help him now!

Therefore, start communicating with the child from the very birth. Doctors usually limit visits because a premature baby needs rest and sleep, but you can watch him through the glass wall of the room. Observe the facial expressions of the newborn. As soon as the doctor allows you, swaddle and feed the baby, put on socks to keep him warm (if they are too big, attach them with a band-aid). Even the smallest and weakest babies see and hear much more than we imagine. They react to the sound of the voice, intonation, touch, even if they do not show it outwardly. No matter how strange it may seem to you, talk to the child (you already did this during pregnancy), sing to him or let's listen to music, stroke his hands and feet. Up to 3-5 weeks, the child may be outwardly indifferent to such communication, but do not be alarmed - he is simply accumulating impressions and is still too weak to actively respond physically. Put a beautiful bright rattle next to the baby. This will help him quickly begin to distinguish colors, pitch and timbre of sound. Vivid impressions stimulate the active psycho-emotional development of the child.

It is not necessary, coming to the child, to abuse decorative cosmetics and perfumes, especially to smoke.

At the very first responses of the baby to your communication with him (revival, eye contact, smile), let him feel with words and touch that you are pleased and you love him. It would be useful to keep a diary about the child's behavior (early development diary). It is interesting and useful not only as a family heirloom, but also in order to introduce other family members to the baby in advance, to prepare them for the peculiarities of its development. Moreover, this diary provides an opportunity for specialists to help you and your child if he subsequently has any difficulties with health or adaptation. You can take photos and videos of your baby (no flash!). Keep in mind that the development process is always individual. Before asking if your child is normally developed, compare his state of health and character traits with this. For some, it’s normal to read at the age of 3, for some it’s easier to run fast and jump high, and about the third parents say: “If only you were healthy!”. And let him study rather weakly, but he is kind and accommodating. It is true what they say that there are no children without talent. Therefore, observe the abilities of your child, discover his (and only him!) Talents and develop them.

The main signs and features of the development of premature babies

If a baby is born between 28 and 37 weeks of gestation, it is considered premature. As a rule, body weight is from 1 to 2.5 kg, and height is from 34 to 45 cm. However, the main sign of prematurity is precisely the date of birth of the child, since children born at term may also have a small body weight ( for example, children born from twins, or in the presence of any intrauterine disease, smoking, alcoholism of a pregnant woman, etc.) - in this case, they speak of intrauterine growth retardation, and not prematurity.

The main signs of prematurity are:

1. poor development of subcutaneous adipose tissue (it is practically absent both due to the reduced nutrition of the child and due to underdevelopment);
2. the ratio of the child's body weight to his height is reduced to 30-50, while the norm is 60-80;
3. violation of the proportionality of the body: the legs, as a rule, are short, and the conditional line dividing the child's body in half is located above the navel (at the norm - at the level of the navel);
4. the cartilages of the auricles are not sufficiently developed, which is why the ears are easily wrapped and tightly pressed to the head;
5. in girls, the labia minora does not completely close the entrance to the vagina, the genital slit is open, and the clitoris is on the surface (sometimes its relative hypertrophy is observed - an increase), and in boys, the testicles do not have time to descend into the scrotum;
6. normally, vellus hair is preserved only on the shoulders and back, and in children born before term, they cover the entire body (handles, face, legs);
7. the size of the brain region of the skull significantly exceeds the size of the facial region, which is why the fontanelles are greatly enlarged, and the sutures between the cranial bones are wide. Quite often there is an opening of a small fontanel. By the third month of a child's life, a sharp increase in the parietal tubercles becomes quite noticeable.

Features of the development of internal organs and functional systems of premature babies

Along with the underdevelopment of all vital organs and systems, the inferiority of the child's nervous system (both central and peripheral) attracts the most attention. The nervous system is weak, the reaction to the action of external stimuli is slowed down. Physiological reflexes quickly fade away (if a child was born between 28 and 30 weeks, then, as a rule, the sucking and swallowing reflexes are not yet developed, which causes great difficulties in feeding the child), the regulation of own body temperature (autothermoregulation) is disturbed, therefore, premature babies often freeze quickly at low temperatures and overheat at high temperatures. In addition, in premature babies, sweating is impaired (which is also a component of the regulation of the temperature of the internal environment of the body). There is a sharp decrease in muscle tone (children are inactive, their movements are chaotic, slight trembling of the hands and clonic spasms of the feet may be observed).

The respiratory system of children born prematurely is also underdeveloped. The immaturity of the respiratory system is a very good background for the development of various infectious diseases, both the upper respiratory tract and pneumonia. The diaphragm is located above the normal level, the chest is quite pliable, and the ribs are at right angles to the sternum. Due to the anatomical features in such children, shallow breathing is observed with a frequency of 45-50 breaths per minute, breathing is irregular, the volume of inhaled air is reduced, and periods of respiratory arrest are observed.

Unlike other body systems, the cardiovascular system is quite well developed, since its laying and development occur not in the last, but in the first trimester of pregnancy. In premature babies, there is a frequent pulse of weak filling, muffled heart tones, a third tone is heard, blood pressure is reduced (up to 50-80 and 30-35 mm Hg), the heart rate is about 120 per minute. The electrocardiogram is also characterized by a number of features.

In second place after the nervous system in terms of underdevelopment is the digestive system, since there is an underdevelopment of all its departments. The stomach of premature babies has a small volume, is located almost vertically. The sphincter (obturator sphincter) between the esophagus and the stomach is poorly developed, which is why regurgitation is often observed. The mucous membrane of the upper parts of the digestive tract is very well supplied with blood, it is thin and pliable (there is a high risk of injury by foreign objects when swallowed). All digestive enzymes (both the stomach, pancreas, and bile acids) are produced in insufficient quantities, which significantly slows down the processes of digestion of foods and the absorption of nutrients. Diarrhea, flatulence, and disruption of the intestinal microflora (dysbacteriosis) often develop.

The underdevelopment of the endocrine system of a child is most often associated with a violation of the connection between the pituitary gland, thyroid gland and adrenal glands, since the mechanisms of direct and feedback are not strong enough. Quite often, hypothyroidism develops, since the immature thyroid gland is not able to fully perform its basic functions. In most cases, hypothyroidism resolves as soon as the child catches up with their peers in development. Due to the immaturity of the adrenal glands, they are very quickly depleted (rarely this process is irreversible, malignant). There is a relative insufficiency of the sex glands.

Premature babies are prone to the formation of edema and slight pastosity of tissues, since there is an underdevelopment of the systems that control water-salt metabolism, but this condition is reversible. In addition to edema, the opposite condition is less often observed - dehydration of the body due to the excretion of a large amount of fluid (combined with polyuria - frequent and profuse urination).

Due to metabolic disorders, an increase in the amount of bilirubin in the blood and a decrease in the concentration of glucose are often observed. Due to the underdevelopment of the kidneys, their concentration ability is sharply reduced, as a result of which a large amount of residual nitrogen is found in the blood, and urine is of low concentration.

The most accelerated rates of growth and development of premature babies are observed at the age of 3-5 months (in full-term babies 1-2 months) and by the year. As a rule, the body weight of the child increases by 7-8 times, and the average height at the age of 1 year is approximately 75 cm.

Starting from the age of the child from 3 to 4 weeks, it is recommended to lay him on his stomach, as this helps to strengthen the muscles of the neck, shoulder girdle and back (for 2-3 minutes 2-3 times a day). Patting and stroking the child, elementary massage and gymnastics are also recommended. Starting from the age of six months, the exercises need to be complicated - squatting, turning from the tummy to the back and vice versa, crawling, etc.

The mental development of premature babies also has a number of characteristic features. A little later, children begin to speak simplified words (“give”, “bi-bi”, “bow-wow”, etc.), they do not remember new words and names well. However, by one year the mental development of the child reaches the proper level.

How should a premature baby be born?

If preterm labor is still complicating your pregnancy, your doctor should answer the following questions:

First, where is your child safer - inside you or outside?

Second, if the answer is outside, is it better for your baby to be delivered vaginally or by caesarean?

If your case of preterm birth is simple, then these questions will not be difficult to answer, but it can also be difficult, so your doctor should answer these questions as soon as possible. Usually the answer to the first question is "outside" if the cause of preterm labor is known - rupture, infection, etc. These are only premature births that formally occur for an unknown reason, respond well to tocolytics and other measures to combat them, because all other causes that can really prevent the continuation of pregnancy have already been excluded.

If your baby is safer on the inside, then full speed ahead to treatment to "beat back" the birth. If the baby is better outside, your doctor will see if you have enough time for the steroids to work - this usually happens within 24 hours. If so, he will pull for as long as it takes to get the maximum benefit from their application, all the while closely watching the child. If there is no time left for steroids, and the birth must be carried out immediately as an emergency measure, then the fastest route should be chosen. In an unstable situation, transfer or caesarean section if things are getting worse and worse, such as bleeding. If your condition is stable, you can try to give birth vaginally by induction.

Feeding premature babies

If a woman gives birth prematurely, her milk is different from normal. For several weeks on end, it contains more fat, calcium, sodium and other nutrients than others. This milk is specially adapted to the needs of the prematurely born baby.

It is wise to start expressing milk a few hours after giving birth, as soon as you are physically able to do so. It is better to express it several times a day (from six to eight), but in smaller portions. After a few days, you will most likely even have too much milk, because premature babies suckle very little. Excess milk can be frozen and stored for the future.

In the past, premature babies were not allowed to breastfeed until they were comfortable drinking from a bottle. We now know that this was a mistake. Breastfeeding is much easier than a bottle, and when a premature baby is breastfeeding, their heart rate, breathing, and blood oxygen levels become closer to normal, so it is best to start breastfeeding such babies as early as possible. In many hospitals (I hope one day they will start doing this everywhere) the “kangaroo method” is practiced: the baby is taken out of the incubator and put to the mother - skin on skin. This method has been successfully used even with babies born before the 26th week and weighing less than 600 grams. By skin contact with the mother, premature babies become warmer, breathe easier, gain weight faster, are less susceptible to infections, and their psychomotor development is better. Mothers feel much more confident and have more milk.

If this is not practiced in your hospital, insist on it and convey the necessary information to the staff. Set achievable, short-term goals: "I'm not suggesting that all premature babies start nursing in a new way, just let me hold my baby for a couple of hours today."

In Germany, Dr. Sontheimer and colleagues have managed, by placing premature babies skin on mother's skin, to transport them over distances of up to four hundred kilometers without the use of incubators - with excellent results. One of the advantages of this method of transportation is that mothers can travel with their babies: otherwise, too often they had to stay alone somewhere in a rural hospital and worry about how her sick baby would get to a hospital in a large city.

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 growth 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 circumference of the head increases to 0.5-1 cm. He picks up pieces of food without outside help, gets to his feet, holding on to a support, and 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. The children actively crawl, play, pronounce all kinds of sounds, and 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.

Nursing premature babies is a complex process, it is carried out by the best neonatologists. And after the discharge of premature babies from the maternity hospital, all worries fall on caring parental shoulders. The warmth and love of loved ones can work wonders: being aware of all the features of caring for premature babies and following all the prescriptions of doctors, after a few months, parents can ensure that their babies catch up with their peers in development.

Why are premature babies born and what are the features of nursing such babies?

The reasons for the birth of premature babies are very diverse and are divided into several groups:

• of the socio-economic most common: low standard of living, poor nutrition for pregnant women, poor living conditions, lack of medical care, occupational hazards, drug addiction, alcohol consumption, smoking;
• there are also socio-biological reasons for the birth of premature babies: the mother's age is under 18 and after 35, the father's age is younger than 18 and over 50 years, three or more medical abortions in the mother, spontaneous abortions, pregnancy that occurred earlier than 1 year after the previous birth;
• the cause of the birth of premature newborns may be clinical factors: chronic diseases of the mother, the pathological course of pregnancy, physical trauma, immunological conflict between mother and fetus, fetal diseases (intrauterine infections, chromosomal diseases).

Any newborn needs vigilant attention and touching care. And if a child was born prematurely, parents and doctors have an increased responsibility for his further development and health.

Nature determined the period of gestation of a human life at 280 days (40 weeks), but did not take care of maintaining pregnancy throughout its entire duration. Premature births occur with enviable constancy both in countries with a low standard of living and in highly developed ones. From 8 to 12% of newborns are born prematurely, and along with them, anxiety is born for their fragile life and future fate.

A premature newborn automatically falls into a high-risk group. It requires treatment, attention and care at all stages of nursing: in the maternity hospital, in the neonatal pathology department of the children's hospital, in the rehabilitation department, and after discharge home - in-depth medical examination in the clinic.

Degrees of prematurity of a newborn baby

There are four degrees of prematurity in newborns in accordance with body weight in grams:

• 1st degree 2001-2500;
• 2nd degree 1501-2000;
• 3rd degree 1001-1500;
• 4th degree 1000 or less.

At the initiative of the World Health Organization, a fetus weighing at least 500 grams and having a heartbeat is considered a live birth.

Even a healthy newborn does not immediately adapt to new living conditions, but what is it like for a prematurely born child with its immature systems: respiratory, digestive, thermoregulation, etc.?

It is enough to say only about the sharp change in temperature during the transition from the mother's tummy (37 ° C) to the new world (20 ° C) to make it clear how uncomfortable and anxious the baby feels.

The inability of the central nervous system to coordinate the activity of vital organs, the immaturity of the digestive system, the decrease in reflexes, primarily sucking (and often its absence), are the main barriers to life.

Some thirty years ago, a newborn child of the fourth degree of prematurity weighing one and a half kilograms was doomed, today even a deeply premature infant weighing 500 grams has a chance to survive.

A premature baby is one born at 37 weeks or earlier, weighing less than 2500 grams and less than 45 cm long.

These photos show premature babies with varying degrees of prematurity:

However, body weight alone is not a determinant of prematurity. Often a child born at term has a mass less than the borderline, but other indicators of its development indicate that the child is healthy. In other cases, the weight and height of the newborn correspond to the average values, but in other respects it lags behind the norm. Then it is called immature. Perhaps his mother had the flu during pregnancy or suffered from high blood pressure. Sometimes the weight of a premature baby is 300-600 grams higher than the weight of a full-term newborn, especially from mothers with diabetes and obesity.

The severity of the newborn’s condition is determined by the degree of prematurity and its functional immaturity: is it able to maintain a constant body temperature, does it have sucking and swallowing reflexes, does it experience short-term respiratory arrest and bouts of cyanosis (cyanosis), is muscle hypotonia expressed, poverty of motor and emotional reactions, how often spitting up.

Nursing methods for premature babies: incubator and "kangaroo"

It is clear that for nursing premature babies of such low weight with depressed or absent reflexes in the maternity hospital, one desire is not enough. It is necessary to have a specialized department equipped with modern equipment that allows you to monitor the condition of the child around the clock, provided with the latest medications, including antibacterial ones.

But even the most modern advances in medicine cannot replace the kind and gentle hands of neonatologists and nurses who provide gentle, gentle care for premature babies.

In large cities, there are special maternity hospitals for women with premature births and perinatal centers, where all conditions have been created to help premature babies.

The inability of a premature baby to maintain a constant body temperature is taken into account from the moment of birth: all manipulations with the baby are performed on a table with additional heating, on a warm mattress, heated diapers are used when dressing.

In specially equipped wards for premature babies, the air temperature is 25 ° C and the humidity is 55-60%.

The baby is placed in an incubator or crib with additional heating, depending on its weight and condition. Incubators are used for preterm infants weighing less than 2000 grams.

Couveuse means "incubator" in French. This device, which has saved many infant lives, has its own microclimate: air temperature from 29 °C to 34 °C and humidity from 90-95% in the first 3-4 days, followed by a gradual decrease to 55-60%, as in the surrounding air .

The duration of stay in the incubator for newborns is individual. A child weighing more than 1500 grams usually needs 3-4 days of "incubator" maintenance. With a smaller weight in the incubator for newborns, children can stay from 7-8 days to several weeks.

A premature baby needs to create conditions that mimic the closed space of the uterus, where he was in the fetal position. For this, there is a special “nest” made of soft materials, in which the premature baby feels very comfortable.

At present, it is possible to create “weightlessness” for a premature baby by placing him in a bath with warm water on a special medical film that envelops the baby and creates the conditions in which he was in the womb.

A heated water mattress can be placed in the crib, on which the baby is comfortable to lie, and thus it is protected from hypothermia.

There are other methods of nursing premature babies in the hospital. Sometimes the "kangaroo" method is used, in which a premature baby is placed on the mother's chest "skin to skin". He is warm and comfortable, he smells his mother, her heartbeat and rhythmic breathing. the kangaroo method in nursing premature babies allows the child to grow and develop.

All newborns in the first days lose body weight (the so-called physiological weight loss). But in preterm infants, this process is more intense, and often the physiological loss turns into a pathological one, if the losses are more than 15%. The recovery of the initial indicator is slow, and only by the age of three weeks the premature baby acquires its original weight.

Therefore, during the first month of life, weight gain in premature babies is insignificant - from 180 to 300 grams. But in the future, with proper feeding and proper care, premature babies double by the age of three months, and by 4-5 months they triple the weight at birth. By his first birthday, the baby has a body weight that is 6-7 times greater than the original.

Breastfeeding and artificial feeding of premature newborns

Among all activities for nursing premature babies, the main attention is paid to properly organized feeding. The method of feeding premature babies is determined by the condition of the baby, its weight, the presence or absence of sucking and swallowing reflexes.

A very premature baby with absent reflexes will receive milk through a tube inserted into the stomach. And a child weighing more than 2000 g, in a satisfactory condition, with active sucking activity, can be attached to the mother's breast on the first day, first for one feeding a day, then for 2-3 feedings, and then for each feeding.

It is important to remember that suckling is a physical activity for a newborn, and not every premature baby can cope with it. Therefore, during breastfeeding of premature babies, it is necessary to monitor the condition of the babies, and at the slightest sign of fatigue, wean them from the breast and supplement them with a bottle or a teaspoon. In the first days, breastfeeding of preterm infants should be alternated with bottle feeding or applied to the breast, and then supplemented with a bottle. It is recommended before and after feeding to allow the baby to breathe humidified oxygen for 5-10 minutes.

Imperfection of the digestive system: a small volume of the stomach, low activity of digestive enzymes - dictate the tactics of feeding. On the first day of life, a premature baby should receive 10-15 ml of milk per feeding, on the second day - 15-20 ml, on the third - 25-30 ml. In the future, the amount of milk per feeding is given at the rate of 15-30 ml per kilogram of weight. For example, when feeding premature newborns, a baby weighing 1800 g should receive from 27 to 54 ml per feeding (1.8 x 15 \u003d 27 ml, 1.8 x 30 \u003d 54 ml) depending on condition and body weight.

For such an amount of milk, a standard bottle is not needed, you can get by with a small bubble with a regular rubber nipple. With a needle annealed on fire, make a hole so that the milk from the inverted bottle flows out in frequent drops, and not in a stream. Having become accustomed to the easy flow of milk from the nipple, the baby may refuse the breast when the happy moment of reunion with the mother comes.

It is easy to control the amount of milk in formula-fed premature babies, and if the baby is breastfeeding, you need to weigh him before and after each feeding to prevent malnutrition.

The frequency of feeding is set individually. But if the baby is on artificial feeding from the first day, then the pauses between feedings should be at least 3 hours, with a six-hour night break.

In a sluggish infant with poor weight gain, feeding is acceptable after 1.5-2 hours without a night break.

If attachment to the breast does not cause negative consequences in the child, he actively sucks and does not spit up, then you can feed "on demand". This method of feeding strengthens the bond between the mother and the child, has a beneficial effect on the baby, who has an increased need for care and affection, and stimulates the production of milk.

The key to successful nursing of a premature baby is natural feeding!

Wise nature arranged so that the milk of a woman who gave birth prematurely contains more protein, polyunsaturated fatty acids (PUFAs), mineral salts and less lactose.

An increased protein content is necessary for a premature baby in order to provide a rapidly flowing process of building cells and tissues with plastic material. The accelerated pace of development of the central nervous system requires an increased amount of PUFAs to improve the conduction of impulses along the nerve fibers and maturation of the retina. The limited content of milk sugar is justified by the low activity of the lactase enzyme in a premature baby.

Dairy fats are dominated by short chain fatty acids, which break down faster and provide more of the energy required to ensure a high growth rate for the child. The increased content of minerals helps to strengthen the bone, muscle and other body systems.

Mother's milk is the best and healthiest food for a premature baby, as well as the best way to protect against various diseases and allergic reactions. If the mother has little milk, one should try to maintain lactation for the maximum possible period, following all the recommendations for the treatment of hypogalactia.

If the mother does not have milk from a premature baby, it is necessary to provide donor milk, at least for the first time. This issue is easily resolved in the maternity hospital or in the pathology department of newborns at the expense of other "dairy" mothers, and after being discharged home, the child is often transferred to artificial feeding.

The event is undesirable, but forced, and it should be carried out carefully and gradually. On the first day, the child should receive an artificial mixture of no more than 1/8 of the daily volume of food, and the rest - with women's milk.

On the second day, the amount of the mixture increases to 1/4 part of the volume, on the third day - up to 1/2 part, and within 5-6 days they completely switch to artificial feeding.

Special mixtures for prematurely born children have been developed and produced. What infant formula is recommended by pediatricians? These are Prepiltti, Humana 0, Novolact MM, Bona. You can also use adapted mixtures for premature babies, approved for use from the first days of life: Similak, Piltti, Detolact, Baby, etc. It is possible to use such adapted fermented milk formulas for premature babies, such as acidophilic Baby ”, “Bifilin”, “Bifilakt”, “Atsi-Maileks”, “Pelargon”.

The introduction of nutritional supplements as complementary foods to premature babies should begin earlier than those born at term. Natural fruit and vegetable juices can be given to children aged 2-3 months, at 3-5 drops per day, increasing this amount to 40 ml by four months and to 60 ml by five months of age (divided into two doses).

The baby will begin to receive fruit puree from 3.5 months. First, half a teaspoon once a day, with a gradual increase in portions to 60 grams by six months and up to 100 grams by the year. Cottage cheese as an additional source of protein and calcium is offered to a premature baby in the third month of life, egg yolk - from three months.

The first complementary foods are prescribed at four months in the form of porridge (rice, oatmeal, buckwheat, cooked in diluted breast milk or a mixture). At five months, a second complementary food is prescribed in the form of vegetable puree. It is recommended to use a variety of vegetables: potatoes, carrots, beets, zucchini, pumpkin, green peas, spinach, etc. At the same time, iron-rich foods are introduced to prevent anemia: pureed liver, minced meat as an additive to soup or mashed potatoes . At first, the child receives meat dishes 2-3 times a week, and from 7 months on a daily basis. At 8 months, the child receives vegetable soup with crackers, a slice of bread, unsweetened cookies, and at 9 months you can give kefir. All new products are introduced gradually, taking into account their individual tolerance.

Caring for a premature newborn after discharge from the hospital at home

Premature babies are discharged from the hospital if the baby is able to maintain normal body temperature, actively sucks, regularly gains weight and has already reached 2000 grams, his umbilical wound has healed, and the blood test corresponds to the age norm.

Sick children, regardless of body weight, and healthy premature babies who have not reached the required 2000 grams in the first 2 weeks of life are transferred to the neonatal pathology department of the children's hospital for further nursing and treatment.

The length of stay in the hospital for each child is individual and depends on the state of his health. The criteria for discharge are the same as for discharge from the maternity hospital: retains heat, dispenses with additional oxygen, actively sucks and gains weight.

Premature babies are not vaccinated against tuberculosis in the maternity hospital, and this circumstance should be taken into account when the child is discharged to unfavorable living conditions: living in the apartment of a tuberculosis patient.

You were so eager to go home, and, left alone with the baby, you suddenly became confused and did not know what to do and how to approach him. Premature babies are still weak after discharge. “He's so small, I'm afraid to touch him. Suddenly I’ll break something, ”the young mother cries.

Tears and sobs are bad helpers in important matters. Doctors and nurses have fulfilled their duty, caring for a premature baby after discharge, the main responsibility for the life and health of the "hurry" lies with his mother. It depends only on her whether the baby will cope with the problems of the neonatal period, how soon he will catch up with his full-term peers, whether prematurity will not have an impact on his future fate.

Your baby came into the world prematurely. Otherwise, he is no different from other children. Unless the care of a premature baby, attention and care, such a baby needs a little more than a baby born on time.

Once again, it is worth emphasizing how important natural feeding is for a premature baby. Try to do everything possible to provide the baby with mother's milk. When caring for a premature baby at home after breastfeeding, it should be weighed daily to prevent malnutrition.

Having unwadded your baby at home for the first time, you may be worried when you find the “marbling” of the skin: bluish-pink stains all over the body, indicating the immaturity of vascular reactions and thermoregulation. Turning the baby on its side, you will find that the lower half of the body has become a rich red color, and the upper one has become pale. This picture can also scare young parents. Do not worry, this is a symptom of Harlequin, indicating the immaturity of the autonomic nervous system and vasomotor center in a premature baby. After a couple of weeks, with proper care for a premature newborn, your baby will gain weight, acquire subcutaneous fat, and his skin will become smooth and pink.

Bathing, massage and gymnastics of a premature newborn baby (with video)

Increased care for a prematurely born baby is justified, but should not go beyond acceptable limits. Keeping in mind the imperfection of thermoregulation, when caring for a premature baby at home, young mothers try to wrap their treasure in several diapers, and even cover it with a cotton blanket on top. The muscle tone of a premature baby is lowered, the respiratory muscles work with effort, and tight swaddling restricts breathing movements, besides, pressed down by a heavy blanket, he can simply suffocate. During home care for a premature baby, use the grandmother's downy shawl to warm the baby: warm, light and cozy.

Start bathing your premature baby as soon as the umbilical wound has healed. The aquatic environment for him is his native element. First, the water temperature should be 36-37 ° C, then gradually reduce it to 32-34 ° C. Bathing a premature newborn should be done every other day or every day, especially if diaper rash is present.

A baby born weighing less than 1 kg will start swimming only from the 4th week. Until then, he will have to do with gentle washing of problem areas.

Another feature of caring for premature babies is limited exposure to the air. Air baths during dressing and changing diapers in the first month of life should not exceed 3-4 minutes. Be aware of the imperfection of the thermoregulation system in a premature baby. You can have 3-4 such sessions per day. Gradually increasing the time of "naked floundering", you can bring the air bath to 10-12 minutes.

A child who has reached a weight of 1300 grams at the age of 1 month can be laid out on the stomach. First for a few minutes, gradually increasing the time to 10 minutes 3-4 times a day 15-20 minutes before feeding.

Light massage for premature babies begins to be done when the baby reaches the age of one month, when he reaches a weight of 1800 grams .. First, it will be a massage of the anterior abdominal wall. With flatulence, stroking the abdomen is shown to the baby even with a weight of 900 g.

General massage for premature newborns can begin when they reach a weight of 3 kg. It should be performed by an experienced massage therapist. The first sessions last 3-5 minutes, as the baby's nervous system gets tired quickly.

From 3-4 months, add elements of gymnastics for premature babies to the massage, constantly expanding the set of exercises. There are special complexes designed for weak and premature babies, which you can learn from an instructor in physical therapy. In the first year of life, a premature baby must undergo three courses of general massage and gymnastics. This is the most effective tool for accelerating psychomotor development, contributing to the achievement of the age level.

Watch a video of massage for premature babies and simple gymnastic exercises:

Outdoor walks begin in the warm season with a weight of 2100 grams from 2-3 weeks of age. In winter, the first walk with a premature baby should take place at an air temperature of at least -5 ° C, its duration should not exceed 5-10 minutes. In the future, it will be possible to walk at a temperature of -10-12 ° C for 30-40 minutes 2-3 times a day.

If the winter is frosty, arrange walks on a closed veranda or in a room with an open window. Make sure that during the walk the baby does not overheat and does not freeze, but feels comfortable.

Features of immunity in premature babies

While in the womb, the child receives antibodies from many diseases through the placenta, which reliably protect him in the first six months of life. The greatest amount of antibodies and immunoglobulins enters the child's body at a gestational age of 32 to 35 weeks. Consequently, a prematurely born child did not receive a significant amount of protective bodies, which undoubtedly affects the state of his immunity.

The own immunity of premature babies functions very poorly: it is almost unable to produce immunoglobulins, few B-lymphocytes are produced, and the functional activity of T-lymphocytes is low. Secretory immunoglobulins, which are located in the mucous membranes of the respiratory tract and digestive tract and are the first to meet the invasion of the "enemy", are almost absent in premature babies. Therefore, pathogens of respiratory and intestinal diseases easily penetrate through the mucous membranes into the internal environment of the body.

The production of macroglobulins, which should be the first to appear after immunization, is difficult in preterm infants. Therefore, there is no point in preventive vaccinations in the first six months of life.

Non-specific protection is also imperfect: the level of lysozyme is reduced, interferon is produced little, complement activity is insignificant, digestive enzymes are inactive, intestinal wall permeability is increased, and the neutralizing function of the liver is almost not expressed.

All these facts testify to the imperfection of immunity in a premature baby and emphasize the need to increase it by all means.

Preventive vaccinations for children born with a weight of 1500 or less are carried out after the first year of life, taking into account the state of health.

Premature 1-2 degree vaccinations are allowed from 5-6 months, subject to stable weight gain and good physical development. Due to the high incidence of rickets in preterm infants due to calcium and phosphorus deficiency in the skeletal system, specific prevention of rickets with vitamin D begins at 2 weeks of age.

All premature babies should be regularly observed by a pediatrician, and at the age of 2 months they need to consult a neurologist, surgeon and orthopedist.

Psychological problems of development of premature babies

The birth of a premature baby makes the mother feel guilty about him and the desire to do everything possible to raise the baby healthy and strong.

But good intentions often collapse when faced with reality: the long-term separation of mother and child does its dirty work, and the formation of a psychological bond between them is much more complicated. The presence of a weak and fragile baby in an incubator, the presence of a large amount of medical equipment, the inability to press the baby to the chest make it difficult to establish physical contact between mother and child. All this creates problems in the development of premature babies, which are purely psychological in nature.

These circumstances can lead to reduced feelings of motherhood and attachment to one's own child. And anxious thoughts and despondency contribute to the development of postpartum depression. Unfortunately, there are times when parents, after a long separation, abandon the baby without seeing him and without experiencing tender feelings for him.

“There is no evil without good,” says folk wisdom. Look at the problems of premature newborns from a different angle. While your baby is in the care of medical professionals, take care of yourself. The recovery period after childbirth will be faster and more efficient for you, because you do not have to get up several times a night to the baby and take care of him all day without rest. The birth took place before the appointed time, and you did not have time to prepare the dowry? Now you have time to calmly and without fuss prepare the nursery and clothes for the baby. And on the day the child is discharged from the hospital, he will be met by a strong, healthy and self-confident mother.

Recently, great attention has been paid to the presence and constant active participation of parents in the care of the child. In some maternity hospitals and hospitals, parents are allowed into the wards of premature babies. This picture no longer surprises anyone: near the couveuse, in which the baby is entangled in wires and tubes, his mother is standing, stroking her tiny hand and whispering kind words.

The baby feels the presence of the mother, and this has a beneficial effect on his nervous system, stimulates growth and development. The communication of a mother with a child forms in her a sense of affection and responsibility for his life, stimulates the production of milk.

In addition, this is the best motherhood school: constantly watching how skillfully the nurses manage the baby, the mother will stop being afraid of him and will take all possible part in the care, and when she comes home, she will not stand in confusion in front of the crib, but will calmly and confidently deal with the baby .

A premature baby is in great need of affectionate and caring attitude. Take him in your arms more often, hug him to you, say gentle words and sing songs. Do not be afraid to take him "by the side" in your bed. Feeling the presence of loving parents, the child becomes calmer and grows better.

Your care and attention will not go unnoticed: problems in premature babies will disappear and in a few months the baby will catch up with their peers, and you will forget that it once fit in the palm of your hand.

A baby is considered premature if he was born earlier than 37 weeks after conception. There are many reasons for having a baby early:

1. Social and biological factors.

1.1. Age of parents (too young or too old).

1.2. No matter how trite it may sound, but, nevertheless, the fact remains: many mothers with bad habits and / or neglecting medical examinations and doctors' recommendations during pregnancy give birth prematurely.

1.3. The risk of having a premature baby is many 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 illnesses of parents.

5. Pathological course of pregnancy.

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

7. Multiple pregnancy.

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 need 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 child was born at a period of 35-37 weeks, and the weight of a premature baby ranges from 2001 grams to two and a half kilograms.

2 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 weighs less than one kilogram.

The difficulty of nursing a child depends on the degree of prematurity. The higher it is, the harder 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 “ripen” for life outside the womb.

For newborns who were born ahead of time, 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 malnourished. External exhaustion is inherent in children with malnutrition of the second or third degree.

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

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

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

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

7. Compliance of cranial bones.

8. Soft ear shells.

9. Soft fluffy hairline, which is located mainly on the back and shoulders, is also a feature of premature babies.

10. An empty scrotum in boys and a gaping genital gap in girls, that is, the large labia do not overlap the small ones.

11. Lack of swelling of the mammary glands.

12. Exophthalmos (bulging eyes).

13. Weak development of nails. Nails may not reach to the fingertips.

Individually, these signs cannot serve as an indicator of prematurity. Too many factors affect the maturity of the child and the functionality of the body of the newborn. Do not focus only on 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.

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 delivery rooms know that obstetric care for premature babies must be done carefully so as not to injure the child 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 changing table prepared ahead of time, warmed to the desired temperature, which is illuminated by the rays of an electric reflector. All manipulations with the baby are carried out with care, clearly and quickly. After that, the child is wrapped in sterile warm diapers, and warmed portable incubators are placed in blankets, then they are 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 are put on the feet.

Not all children who were born earlier than the “usual” term end up in the department of the maternity ward, which specializes in nursing premature babies. When deciding whether 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 his own, then even in this case, the baby has a chance to survive! In such cases, the child enters the pediatric intensive care unit immediately after birth. Here, the babies are in special incubators, which are closed transparent domes with caps and four holes for various medical manipulations, located on different sides in two pieces. All these incubators are equipped with artificial lung ventilation devices.

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 humidity of the air, approximately 60%, which is due to avoiding the risk of drying of 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 control all the processes of his life, and, if necessary, give 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 developing 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 stage of survival begins, usually carried out in neonatal intensive care units. There are also incubators here, but, unlike the incubators located in intensive care units, they are not equipped with artificial lung ventilation devices. But, nevertheless, in these couveuses the necessary temperature and humidity are also maintained. In the intensive care unit, the baby is kept until he is able to do without additional oxygen supply and independently maintain body temperature.

Feeding premature babies in an incubator

Those babies who have a weak or no sucking reflex at all 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 the 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 before 29 weeks from the moment of conception

Children born at this time are characterized by low weight, which is less than a kilogram. A distinctive feature of such a child is the absence of respiratory, 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 his time in a dream, and due to weak muscle tone, his movements are sluggish and rare. External differences between premature babies and babies born on time are red-violet skin color with folds, lanugo (fluff that covers the face and body of the baby), the absence of eyelashes and closed eyes. Due to the absence of a layer of subcutaneous fat, the child looks thin, but not emaciated. Exhaustion is a sign of malnutrition. Babies born before 29 weeks of age are at risk of various complications and may face problems in raising and teaching at preschool age. Fortunately, cases of children being born at such times are 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 constant temperature and humidity, as well as providing supplemental 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 children already know how to cry and open their eyes, and the movements are more intense than in children born at an earlier date. 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, unless, of course, there are problems with the breathing of 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 general condition of the newborn is better.

Premature baby 36 weeks

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

A premature baby of 36 weeks has relatively good health, and, as a rule, he is discharged home as soon as possible.

Features of premature babies at different time periods after discharge from the hospital

In relation to full-term babies, babies born prematurely have somewhat 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 sources of sound and attention at the age of 2-3 months.

The ability to sit up independently appears after 9 months.

The first steps appear after 14 months.

A premature baby with a body weight from a kilogram to 1500 g.

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

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

The child begins to roll over from back to stomach at 6-7 months, and from stomach to back at 7-8.

The ability to sit up independently appears after 8 months.

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

The first steps appear after 14 months of life.

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

Premature baby weighing from 1500 g to 2 kg.

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

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

The child begins to roll over from back to stomach at 5-6 months, and from stomach to back at 6-7 months.

The ability to sit up independently appears after 7 months.

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

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

The child begins to roll over from back to stomach at 5-5.5 months, and from stomach to back at 6-7 months.

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

The child begins to stand up independently at the age of 9 months.

The first steps appear after 11 months of life.

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

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

Premature baby 1 month

The child gains mass 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 on one point, the development of facial expressions.

Premature baby 4 months

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

Premature baby 5 months

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

Premature baby 6 months

Children grab hanging toys, find invisible sources of sounds, and begin to babble.

Premature baby 7 months

There is a rapid mental and emotional development. The child already knows how to distinguish relatives from strangers, picks up various objects, babbles. A variety of long hums appear.

Premature baby 8 months

Movements develop in a horizontal position. Children begin to roll over on their stomach from their backs and back. They start to crawl and try to sit up.

Premature baby 9 months

The child begins to pronounce individual syllables, tries to repeat after adults. Efforts are being made to get up. Calmly sits down, holding on to the barrier.

Premature baby 10 months

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

Premature baby 11 months

Psycho-emotional and motor development begin to improve.

Premature baby 12 months

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

Self-reliance in eating, such as holding a spoon, bread, manipulation of a spoon, in premature babies begin to appear at the age of six months to ten months. Neatness skills - from nine months to a year.

Caring for premature babies at home

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

First, care for premature babies is temperature control.

A premature baby needs to create optimal temperature conditions at home. The air temperature should be 22-25 degrees Celsius. Airing 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. To do this, it is convenient to use rubber heating pads with hot (60-65 degrees) water. It should be remembered that electrical appliances should not 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 fabric (towels, diapers or in special bags) and placed under the blanket at the feet and over the blanket on the sides at a distance of the palm of an adult from the child. For constant monitoring of the temperature and for convenience in general, you can put a thermometer next to the child.

It is important not to put heating pads under the child, to avoid burns, and to put it on top, as this will make it difficult to breathe. You also need to change the heating pads alternately every one and a half to two hours and make sure that the child does not remain without heating, even for short periods of time. The face of a newborn 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 instructed otherwise. Body temperature is measured without undressing the baby.

Clothes for premature babies

A baby who was born with a body weight of more than two kilograms does not need to be wrapped up. He is dressed in the same way as full-term babies. Children who weigh less than two kilograms need a lot more things. The most optimal is clothing for premature babies, which consists of such elements as knitted bonnets, knitted blouses with a hood and sewn-in sleeves, sliders and diapers. A child dressed in this way 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, the blanket and envelope should be gradually abandoned. It should be remembered that tight swaddling restricts the baby's breathing, which is categorically contraindicated. For uniform breathing by all parts of the lungs of a newborn, 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 above 1500 grams are allowed to bathe after 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 of premature babies. Feeding methods

Breast-feeding.

Feeding premature babies with probes using infusion pumps.

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

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

Feeding premature babies

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

It is often difficult for a child to keep a nipple in his mouth. In this case, the most effective position of the baby in the arms will be the “under the arm” or “cradle” position, 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 his 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.

walks

During walks, care should be taken, 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 take out for walks from the age of two weeks 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 it up to one to one and a half hours. In autumn and spring, at temperatures below ten degrees Celsius, it is allowed to walk with babies aged one month and weighing more than 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, and not only on her physical health, but also on the psychological state. In order for a 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 impact not only on the health of the child, but also on the psychological state of the parents. There are some simple but 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 child will favorably affect 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 discomfort and stress, but you need to learn how 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 preservation of lactation. Even if your baby is too weak to breastfeed, try offering to breastfeed instead of formula.

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

How does the development of a premature baby up to a year proceed by months? For parents who have fallen to nurse such a crumb, it is often a matter of life and death. The health and development of a prematurely born child largely depends on the degree of prematurity. The primary role is played by the level of medical care provided. However, the love and resilience of parents is no less important.

Healthy, strong, intelligent boys and girls grow up from premature babies. 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 babies during the first year of life increases rapidly in comparison with full-term newborns. Nature has set them the task of "catching up", and in some cases "overtaking".

Groups of premature babies

Group	Gestational age, in weeks	Newborn weight in grams	Increase in body weight per year, in 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 weighing less than 1000 g, it is called "extremely preterm". Children with this weight make up less than 5% of all premature newborns. For the life of such a child, one has to fight stubbornly and for a long time. All vital functions of his body require artificial support. With modern achievements in neonatology, even children weighing 500 g are nursed. But in these cases, a high percentage of complications and disability. By the way, in Russia, since 2012, a law has been in force on the mandatory nursing and registration of children weighing 500 g. There are many discussions around this topic, including a moral one.
• Particular attention is paid to children 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 mechanical 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 up to 1500 g are not prepared for independent functioning. For their nursing, it is necessary to create conditions adequate to those in utero. Babies are placed in incubators (cuveuses) - incubators for premature babies. The necessary temperature and humidity are maintained here, the necessary research and support are carried out. Babies weighing up to 1700 g are kept in the incubator, then they are placed in a heated bed. At a weight of 2000 g, the baby, as a rule, no longer needs special thermal support.
• Features of the development of a premature baby for a period of 34 weeks. The baby is able to suck on its own. This is an important indicator when nursing children born prematurely. Babies in this group are at risk of apnea - a sudden and involuntary stoppage of breathing, most often during sleep. Therefore, they need to undergo additional examinations. The causes of sleep apnea are poorly understood. They are associated with muscular, respiratory, neurological disorders. If there are no complications, the baby quickly gains weight and goes home with happy parents.
• Development of a premature baby born at 36 weeks. In these children, as a rule, there are no 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 an 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 features. External signs appear with varying degrees.

• Small weight and height. The length and weight of the baby's body can impress with its 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 brain part of the skull is larger than the front. The belly is also large and flattened relative to its entire length. The navel is much lower than in full-term babies. The neck, legs and arms are short.
• Softness and suppleness of the bones of the skull. The spring is open. The bones can move, the cranial sutures diverge.
• The softness of the ears. 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.
• Absence of subcutaneous fat. The skin of the baby, as if transparent. Under it you can see the blood vessels.
• Weakness and lethargy. Motor activity is reduced, weak cry, lack of hunger, hypotension, undeveloped sucking reflex - all these signs are called adynamia in medicine. They occur only in very premature babies.
• Weak and short nails. The symptom is less common than the others.
• Puffy eyes. It does not appear immediately, but two weeks after birth. It is typical for children with a high degree of prematurity.
• Underdevelopment of the genital organs. Girls may have a gaping genital slit with underdeveloped labia majora. In very preterm boys, the testicles did not descend into the scrotum.
• No swelling of the mammary glands. Happens in very premature babies.

These symptoms may appear in combination or in part. Some of them can even occur in full-term children.

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 maternity 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 medical staff care, bring. And even take the baby in your arms. By the way, this is one of the most unique and effective ways of nursing. It's called the kangaroo method. Under what conditions is the baby discharged home?

• No complications, stable progress in overall development.
• Well-established thermoregulation.
• The child does without the support and control of breathing, the cardiovascular system.
• Able to breastfeed or bottle independently, weight gain increased until 2000.

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 (in months)	4 group (up to 1000 g)		3 group (up to 1500 g)		2 group (until 2000)		1 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 gain and height per year	≈ 7080	≈ 33,7	≈ 8450	≈ 31,7	≈ 8650	≈ 27,5	≈ 9450	≈ 25,3

Table - Comparative characteristics of the 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	Full-term baby weighing up to 3500 g
visual and auditory focus	3 months	2-2.5 months	1-1.5 months	2-4 weeks
Confidently holds his head, 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
Sitting up on his own	10-11 months	9-10 months	8-9 months	7-8 months
stand alone	12-14 months	11-12 months	10-11 months	9-11 months
Walks independently	14-16 months	12-15 months	12-13 months	11-12 months

What to look for when considering a table?

• There is no group of "emergency premature" babies. The birth rate of such children is low. The methods of their nursing are comparable to space technologies, and the stages of development can be very late.
• Monthly averages are given.. It is necessary to take into account individual development, genetic predisposition, general health.
• After six months, the indicators of premature babies gradually level off to the level of full-term ones.. Psychomotor skills develop at about the same time, if the crumbs do not have any complications.

The difference in skill acquisition compared to mature newborns is 1–3
month. 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 task of parents is to protect him from the effects of cold, pathogenic microbes, and viruses. Contact with the outside world must be limited.
• 2 months . Forces are added, but it is still difficult for the baby to suckle. During this period, there is a noticeable weight gain, which is the main indicator of the healthy development of a premature baby. From the beginning of the second month, the baby is possible.
• 3 months . Sleep and food are two basic things for a baby at this age. It is only necessary to ensure that the baby does not turn its head to one side, and change its position. Also at this age, mimic reactions appear, the baby fixes his gaze on his mother's face, tries to raise his head. While not smiling, but responding to tactile contact. The grasping reflex, visual and auditory attention develops. Doubling body weight.
• 4 month . The baby raises and confidently holds his head, makes sounds. Grabs a toy. During this period, it is possible to increase muscle tone, which is well removed by massage and gymnastics.
• 5 month . Holds a toy in hand. He smiles, begins to show a keen interest in the world around him. Sound and visual reactions are much improved. The child turns his head to the sound and accurately determines its source.
• 6 month . Body weight is tripled. The child makes attempts to roll over from his back to his stomach. When communicating, he noticeably perks up, recognizes his relatives, jerks his legs and arms, hums. If you hold the baby under the armpits, rests your feet on the surface, crouches slightly. After six months, caring for a premature baby is no different from caring for babies born at term.
• 7 month. Shows activity, easily, in a plastunsky way, well holds a toy in a hand. At this age, if the baby was born at 35–37 weeks.
• 8 month. Makes the 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 affairs, but also in communication. Understands when asked to show an object. The kid is interested in verbal contact - words, intonations, 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 was born at 32–34 weeks. Pronounces the first syllables.
• 10 month. Confidently stands, moves, holding on to a support. But preference is still given to crawling. Likes to watch moving objects. Quickly reacts to sounds, listens to them, knows his name. At this age, the first teeth are cut if the baby was born before 31 weeks.
• 11 month. The period of active crawling continues. Although the baby is already able to confidently get up and sit down. Can stand for a long time without support and even take a few steps without support. During this period, he is attracted to cubes, pyramids, all moving toys. He communicates well with loved ones.
• 12 month. The baby can walk on its own. This once again confirms that premature babies “catch up” with their peers in development by the age of one. Sometimes this happens later - in a year and a half. Pediatricians note that premature babies succeed more in physical development than in neuropsychic development. The age maturity of neuropsychic processes in such children can be formed by 2-3 years. These figures are within the normal range.

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

Care features: 6 important points

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

Parents need to stock up not only with knowledge and skills, but also with 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 independently take and suck the breast. In the first months, the baby still has little strength, and the energy consumption during sucking is high. Therefore, it is recommended to supplement it with expressed milk from a spoon. The main task of the mother is to feed the child as long as possible.
• Artificial feeding. If breastfeeding is not possible, adapted mixtures for premature babies with a high content of protein, vitamins, fatty acids are used. It is imperative to consult with a pediatrician when choosing a mixture for a child.
• How many times to feed the baby? Depending on the degree of prematurity: from 10 to 20 times a day, in fractional portions. When the baby begins to gain weight from the second month of life, 8 feedings 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, because the baby's body needs vitamins and minerals. The first in feeding should be cereals (,), then and, fresh juices and the latest -. Sugar and sweet fruits should be avoided. After each feeding, you need to supplement the baby with breast milk or formula.

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

Upon discharge, parents receive a number of recommendations from neonatologists and pediatricians. It is important to comply with the requirements for care 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 the baby will need to develop psychomotor skills.

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