It is not uncommon for the baby to be born not at the fortieth week of pregnancy, but earlier. Fortunately, modern medicine has not considered this a serious problem for a long time, and the survival rate of premature babies is increasing every year. From a medical point of view, a premature baby is a child born before the 37th week of pregnancy. Such a baby comes into the world very tiny, with little weight and height.

Brief characteristics of prematurity

A premature baby is born unable to exist outside the mother's womb. As a rule, he cannot breathe, eat, or adapt to temperature changes on his own. How quickly the baby adapts to new conditions depends on the period of prematurity. There are two degrees of prematurity, which we will talk about below.

Moderate degree

The structural features of internal organs and morphological characteristics at this degree of prematurity are as follows:

Deep degree

It has the following qualities:

With a moderate degree, the survival prognosis is more positive than with a deep degree, since such children have numerous developmental defects, as well as several serious diseases. It is very difficult to deliver such babies.

Important! It sometimes happens that premature babies born in the same week differ in their level of development. Therefore, it should be noted that the criteria for degrees of prematurity are conditional.

Table of differences from a full-term newborn

There is such a thing as fetal maturity. She assumes that the baby inside the womb has already formed enough to ensure its existence outside of it. In the table below you can see the criteria by which you can understand how a full-term baby differs from one born prematurely.

Typically 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 babies are considered premature, and the birth is considered premature.

During pregnancy, which lasts 9 months for a person (apparently, it was not for nothing that wise Nature set this particular period!), the baby manages to form and develop so much that it is born ready for a physiologically autonomous life.

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

In order for “pre-development” to proceed normally, premature babies need to spend 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 cared for by experienced neonatologists (pediatricians who deal with pathologies of newborns), doctors and nurses.

A premature baby requires special conditions of care and constant monitoring by doctors on whom his life depends.

A low-weight baby born at term differs from a premature baby in that the latter’s internal organs are underdeveloped. It will take him another two months for all his organs and systems to reach functional maturity. For a long time he will lag behind children born at term in weight and height. A baby born before the 35th week weighs less than 2 kg.

What is he like, a premature baby?

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

Physiological changes in body weight after birth

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

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

Weight loss is mainly explained by insufficient nutrition of the premature baby in the first days of life, as well as large losses of fluid through the lungs and skin. Recovery depends on whether the fetus was healthy at the time of birth or whether it had any abnormalities.

In a healthy premature baby, the rate of restoration of the original weight depends on the degree of prematurity and is higher, the smaller the child’s weight at birth. But if the baby developed in utero with impaired maturation, then the speed of recovery is difficult to predict.

As soon as the initial (at birth) body weight is gained, the body of the premature baby moves 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 hair that covers the fetus in the womb. Large blood vessels are visible through the 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.

The first thing that catches your eye is the disproportionate physique: a relatively large head and torso, short legs and neck, and a low navel. This is explained by the fact that the growth rate of the limbs increases in the second half of pregnancy.

Many children are not quite ordinary facial features- the forehead is steep and high, unusually bulging eyes (these features may disappear as children age), and sometimes squint may be observed.
Rib cage and the abdominal muscles of a premature baby are soft. Breathing is shallow, its rhythm is unstable. The ribs are located perpendicular to the sternum. The little tummy is constantly being pulled in and out. When exhaling, the ribs and sternum sink. The nipples and areola of the mammary glands are poorly 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.

In boys testicles often not drooping, and the scrotum does not have the same uneven folded appearance as in a full-term baby; An increase in the size of the scrotum (hydroxy testis) and inguinal-scrotal hernias are common.

When the baby cries, muscle swelling appears in the area of ​​the umbilical ring.

Important skin feature premature babies - intensive development of lanugo - vellus hair - not only on the shoulders and back, like in 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. It looks wrinkled because it wrinkles easily. Normally, the skin is red or bright pink, but very often it has a jaundiced or bluish tint. The subcutaneous fat layer is poorly developed or almost completely absent.

In order to correctly assess the correspondence of a child’s maturity to the period of its intrauterine development (gestational age), in addition to morphological characteristics, the state of its neuromuscular system is also taken into account.

Muscle tone a premature baby is noticeably reduced, so at rest (lying on his back) his arms and legs are “flaccid”, only slightly bent at the joints and spread apart.

The longer the child’s intrauterine life, the better his legs bend at the knee and hip joints.

A very 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 a person's chest and connects to the ribs with cartilage, forming the rib cage.

Condition of systems and organs

In premature babies, disorders are often recorded in several parameters at once, for example, in the state of muscle tone and innate reflexes, skin color, heart rate, breathing rate, etc. This is not surprising, since in the body of even an adult, all organs and physiological systems work in close interconnection. Disturbances in the functioning of one of them cause changes in the functioning of the entire organism. Therefore, it would be unreasonable to expect that any organs or physiological systems of a premature baby will function “perfectly.”

Let us note 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 immaturity of the central nervous system (CNS) are the absence of sucking and swallowing reflexes, as well as slow growth of the masticatory muscles. Therefore, at first, such babies are fed through a tube, gradually transferring them to breastfeeding or feeding from a bottle or spoon. Premature babies usually do not swallow food well - they hold it in their mouth for a long time, as if remembering what to do with it next.

These distressing signs of prematurity for parents are clearly visible until about six months. Then, if the parents have carried out thorough supportive therapy, “late” babies by the age of 1-1.5 years become practically indistinguishable from their peers born on time. But in severe advanced cases, some children up to two or three years old eat only liquid food. As a rule, they lag behind their “full-term” peers in development in other respects - later they begin to walk, roll over, stand on their feet, and pick up a toy.

Violation of thermoregulation- a common phenomenon for premature babies, arising due to the immaturity of the body in general 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 poor at maintaining normal body temperature on its own. 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 weak or even absent. Naturally, such babies will develop conditioned reflexes much later than full-term babies.

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

A baby's lungs develop gradually, preparing for the first breath immediately after birth. They are not yet fully functioning inside the mother.

If a child is born before this period, then the amount of mature surfactant is so small that it is not enough for the lungs to function independently. The baby's breathing becomes difficult, he turns blue, and 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 and hyperproduction of mucus (bronchopulmonary dysplasia).

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

Parents of such children need to remember that the baby’s bronchi after such a “burn” remain vulnerable and predisposed to spasms for a long time - even with a common cold, a short-term cessation of breathing may occur. Therefore, you must warn the local doctor that the child was on mechanical breathing. Modern pharmaceuticals offer sufficient means for the prevention and rapid relief of pulmonary spasms.

The cardiovascular system

After birth, the baby undergoes a restructuring of the circulatory system - the blood flow stops 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, this 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 structure will also undergo changes.

The heart muscle (myocardium) of a premature baby 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 restlessness, anxiety and discomfort, it can reach 200 beats per minute or more.

Premature newborns are more likely to develop a heart murmur. They can arise 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 a detailed examination.

Without exception, all tests and procedures must be agreed upon with the cardiologist observing the baby. Disturbances in the activity of the cardiovascular system are very insidious and can be “masked,” that is, not manifest themselves in any symptoms 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 struggles with all its might to preserve life, so the child has the best blood supply to the brain and liver, and to his arms, legs, etc. are provided with much less blood. As the baby matures and further develops, the blood supply to all organs and tissues gradually increases.

Walls of brain vessels premature babies have increased permeability, as a result of which not only cerebral circulation disorders are possible, but also local hemorrhages.

Digestive system

The functional maturity of individual organs and the entire digestive system as a whole very much depends on the degree of prematurity of the newborn. Moreover, 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 “unpreparedness” of its nerve centers to “manage” the regulation of digestion and sucking-swallowing reflexes. Therefore, despite the fact that digestive juices may contain all the necessary enzymes for digesting mother's milk, their activity can be very low.

Although saliva is produced already during the first feedings, the salivary glands are poorly developed and the volume of saliva is small. Therefore, in the digestion of a premature baby, the role of saliva is very insignificant.

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

Stomach in a premature newborn it is round and small - from 10 to 30 ml. Various parts of the stomach are underdeveloped. The production of gastric juice and its enzymatic activity is reduced. Peristalsis is poorly expressed, and motor activity has a too low rhythm. All this causes excessive regurgitation of food.

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

Liver the fetus and newborn is one of the most important organs of its life support.

The weight of the liver at birth can be up to 4.4% of the child’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 baby’s entire body.

General intestinal length can be 3.3-3.6 m. Typically, in such babies, the muscle and elastic tissue in the intestines are not sufficiently formed.

For newborns, first of all, it is necessary to have adequate nutrition that corresponds to the degree of prematurity. It is this that can support the favorable course of all metabolic processes, “healthy” 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 in the ninth week. It has been established that in the first few days of life, the kidneys of premature babies work more intensively than those of full-term babies. At the same time, they remove a larger volume of fluid from the body. A number of features of the kidneys in premature infants 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 infants (due to the high rate of metabolic processes in the body).

Skeletal system and joints

One of the serious consequences of improper care of a baby when his musculoskeletal system is immature can be dislocation of the hip joints. Consultation with an orthopedist is mandatory for all newborn babies, __but for low birth weight 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).
It is especially difficult for a premature baby in this situation. 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 that involves great risks. Such a child is received in warmed sterile diapers, covered with a blanket. Then they are transferred to a warm changing table, under the rays of an electric reflector. The baby's legs (and, if the weight is very low, the head) are wrapped in cotton wool. After this, 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 maintenance of optimal temperature and humidity. The simplest of them look like a double-walled bathtub, open at the top. Hot water (50-60 °C) circulates between the walls.

The length 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 quite high: 22-24 °C, and in the baby’s crib even higher: 26-30 °C. To control, place a thermometer next to the baby (on top of the blanket).

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

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

A premature baby requires 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 lung capacity 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 (flabby muscles);
• the walls of the blood vessels are weak, there are not enough red cells in the blood, and blood clotting is poor;
• low resistance to infectious diseases;
• immature nervous system. Brain development requires stimulation of the senses. Despite the prematurity, he already has them. In particular, the child reacts to sounds. Therefore, it is very important to treat him like a full-term baby, while showing increased attention. To smooth out the gap between the child’s birthday and the day the child is discharged, the child’s contact with the parents is necessary as early as possible. It is advisable for the father to come to the maternity hospital to see 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 small a capacity, from 5 to 6 cm3, and the sucking and swallowing reflexes are still poorly developed. Therefore, he is fed formula milk through a tube passing into the stomach through the nasal opening. In addition, the child is given glucose through the cephalic vein. When the reflexes reach the required level of development, he is transferred to feeding with mother's milk through a nipple. The mother expresses milk at home and brings it to the maternity 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 a lactarium (an institution that collects and preserves human milk for feeding newborns).

As soon as this becomes possible, the child is transferred from an incubator for very 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, those born at 26 weeks or less, require 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 kept 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 helps preserve fluid; in addition, incubators prevent the penetration of infectious agents to a child with a completely fragile 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, the child is fed through a tube or intravenously until the development of the newborn’s basic reflexes. Sometimes (if 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 at home is achieved by regularly (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 be at least 28 ° C, which is achieved by covering the child with heating pads filled with water (water temperature 60-65 ° C), especially in the winter season. Heating pads are placed at the feet and sides of the baby, and to regularly monitor the temperature, you can put a thermometer in the crib. The heating pads should be wrapped in a soft-touch cloth and placed at a palm's distance from the child. The heating pads must be changed every 2 hours, one at a time. The child's face should never be covered with a blanket; it should always be open. It is also strictly forbidden to place heating pads under the child (to avoid burns) and place them on top, as this significantly complicates breathing and interferes with chest excursions.

Bathing premature babies

If a child was born weighing less than 2 kg, it is necessary to refrain from bathing for at least a week and a half. 10-12 days after birth, the child begins 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 the child has with strangers, since with frequent visits the child may become infected with an infectious disease or ARVI, which will negatively affect his health. It is advisable not to send a premature newborn to a nursery during the first year of life and to refrain from walks, especially in winter, until the age of three months.

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

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 to ensure that the baby's mucous membranes do not dry out and to facilitate breathing. The required 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.

You can make a warm bed for a child at home by placing feather beds and warm blankets on top and bottom of the baby, and hot water bottles on the sides and legs. Wrap them in several diapers or a large piece of flannel. This is necessary so as not to burn the baby. You can make hot water bottles from hermetically sealed water bottles. The water temperature should be 50 °C. The water must be changed every hour around the clock so that it does not have time to cool down. The bottles should also be wrapped in flannel and ensure that the caps are tightly closed. Otherwise, the child may be scalded. You should not place the baby's crib near a window or open it when the baby is in the room. If the required temperature and humidity are maintained in the room, you can do without heating pads and bottles.

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

As a rule, when your baby reaches 2000 g, you will be discharged home. This will be reported to the children's clinic for urgent care. The local doctor and nurse will take control of the baby and teach you how to care for him.

Premature infants must be protected from painful stimuli, including drug injections and blood sampling - these procedures must be strictly justified.

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

Heating pads need to 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 swaddles first to keep them warm. The room temperature should be maintained at 22-24 °C.
If there are signs of overheating(frequent breathing, increased temperature, reddening of the skin) you need to take the baby out of the crib, undress him, give him water or breast milk. You can bathe your baby in the bath for 5-7 minutes at a temperature of 37°C.

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

About strict feeding mode There is no need to talk about premature babies - 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 has a high protein content and a reduced fat content. And this is exactly what a premature baby needs: his body cannot yet cope with the complete breakdown and absorption of dietary fats, but he needs a lot of “building material” - protein. But if your mother doesn’t have enough milk, your doctor will prescribe food for you.

Daily toileting of 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 start bathing after 7-10 days. During bathing, carefully protect your baby from getting cold. Gradually, toilet procedures become the same as for 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 baby’s weight 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 restlessly, you must immediately return home and find out the reason. Most often, the baby ends up overheated.

Medical incubator (incubator)

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

The device looks like a large transparent plexiglass box and allows you to maintain the baby’s temperature and monitor him. The air is heated depending on the needs of the newborn (generally the temperature is 30 ° C), the air is also humidified. The baby's temperature is measured using a thermal catheter attached to his skin.

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

Feeding in the maternity hospital

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

Those babies whose initial weight is 2 kg or more usually take the mother’s breast well, suck actively 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 yet latching. Express every 2-3 hours, preferably even at night. However, you shouldn’t wake up specifically for this - you should rest and gain strength;
• if you cannot express enough milk with your hands, then try to choose a convenient breast pump;
• The milk you express can be frozen for later use. Write the pumping date on the bottle.

Massage and gymnastics for premature babies

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

Basic requirements for massage and gymnastics

The methodology for conducting massage and gymnastics classes 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 perform it yourself, but at the initial stage, be sure to 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, calmly talking with him and encouraging him to perform the exercises correctly with a smile and gentle words;
• The duration of the first classes 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 your classes by doing breathing exercises (see below), repeating them several times throughout the procedure;
• gradually (as the child masters these exercises) introduce stroking;
• Conduct gymnastics classes with children with a birth weight of 1700 g or more 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 straightening the baby’s limbs);
• precede each gymnastic exercise with a massage of the corresponding area of ​​the body;
• During the first lessons, do not undress the child completely. When performing exercises for the arm muscles, cover the lower half of the baby’s body with a diaper, and do not take off the vest when performing gymnastics for the legs; if you notice that your baby is quickly tired or cold, perform a set of exercises in two stages (for example, two breathing exercises at the beginning and at the end and one reflex exercise between them; the next time your baby is awake, do other exercises from the complex);
• start classes no earlier than 45-60 minutes after feeding, or better yet, half an hour before it; before going to bed at night - we think you will agree - massage and gymnastics are simply not recommended: it would lull you to sleep, not invigorate you!
• To really help your baby overcome the lag in physical development, do not just do it every day, but repeat the entire set of exercises 2-3 times a day for 5-6 minutes, and in some cases more often (up to 4-6 times).

Monitoring a premature baby

Remember: it is no one’s fault that your baby was born prematurely. Neither you nor your loved ones. Therefore, it would be completely wrong to blame each other for any shortcomings. Keep in mind - the past is no more. From this moment on, only you, the family and your child exist. He especially needs your love and help. Do not give in 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 your child from the moment he is born. Doctors usually limit visits because the premature baby needs rest and sleep, but you can watch him through the glass wall of the room. Observe the newborn's facial expressions. As soon as the doctor gives you permission, swaddle and feed your baby, put socks on him to keep warm (if they are too big, attach them with a plaster). Even the smallest and weakest babies see and hear much more than we imagine. They react to the sound of a voice, intonation, touch, even if they don’t show it outwardly. No matter how strange it may seem to you, talk to your baby (you already did this during pregnancy), sing to him or let him listen to music, stroke his arms and legs. 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. Place a beautiful, bright rattle next to your 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.

When visiting your child, you should not overuse decorative cosmetics and perfumes, much less smoke.

At the baby’s first response to your communication with him (animation, visual contact, smile), let him feel with words and touches 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 and prepare them for the peculiarities of its development. Moreover, this diary allows specialists to help you and your child if he later has any difficulties with health or adaptation. You can take photos and videos of your baby (without flash!). Keep in mind that the development process is always individual. Before asking whether your child is normally developed, compare his health status and character traits with this. For some, the norm is to read at the age of 3, for others it is easier to run fast and jump high, and for others, parents say: “If only he were healthy!” And even if he studies poorly, he is kind and flexible. It is true what they say that there are no children lacking talent. Therefore, observe your child’s abilities, discover his (and only his!) talents and develop them.

Main signs and features of development of premature babies

If a baby is born between 28 and 37 weeks of pregnancy, it is considered premature. As a rule, body weight ranges from 1 to 2.5 kg, and height - from 34 to 45 cm. However, the main sign of prematurity is the timing of the child’s birth, since children born at term can also have a low 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 of prematurity.

The main signs of prematurity are:

1. poor development of subcutaneous fatty tissue (it is practically absent both due to the child’s reduced nutrition 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 conventional line dividing the child’s body in half is located above the navel (normally, at the level of the navel);
4. the cartilages of the auricles are not sufficiently developed, which is why the ears easily curl up and are pressed tightly to the head;
5. in girls, the labia minora do not completely cover the entrance to the vagina, the genital slit is open, and the clitoris is on the surface (sometimes its relative hypertrophy is observed - enlargement), and in boys the testicles do not have time to descend into the scrotum;
6. Normally, vellus hair remains only on the shoulders and back, but in children born before term, they cover the entire body (arms, face, legs);
7. the size of the cerebral part of the skull significantly exceeds the size of the facial part, which is why the fontanelles are greatly enlarged and the sutures between the cranial bones are wide. Quite often the opening of a small fontanel is observed. 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 infants

Along with the underdevelopment of all vital organs and systems, what most attracts attention is the inferiority of the child’s nervous system (both central and peripheral). The nervous system is weak, the reaction to external stimuli is slow. Physiological reflexes quickly fade (if a child was born at a period of 28 to 30 weeks, then, as a rule, the sucking and swallowing reflexes are not yet developed, which causes great difficulties when feeding the child), the regulation of one’s own body temperature (autothermoregulation) is impaired, so premature babies often freeze quickly at low temperatures and overheat at high temperatures. In addition, premature babies have impaired sweating (which is also a component of regulating 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 tremors 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 located at right angles to the sternum. Due to anatomical features, such children experience shallow breathing with a frequency of 45-50 breaths per minute, irregular breathing, 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 formation and development occur not in the last, but in the first trimester of pregnancy. Premature babies have a rapid, weakly filled pulse, muffled heart sounds, a third sound is heard, blood pressure is reduced (to 50-80 and 30-35 mm Hg), and a heart rate of 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 underdevelopment of all its departments. The stomach of premature babies has a small volume and is located almost vertically. The sphincter (obturator sphincter) between the esophagus and stomach is poorly developed, which is why regurgitation is often observed. The mucous membrane of the upper digestive tract is very well supplied with blood, it is thin and pliable (there is a high risk of injury from foreign objects when swallowed). All digestive enzymes (both stomach, pancreas, and bile acids) are produced in insufficient quantities, which is why the processes of digestion of foods and absorption of nutrients are significantly slowed down. Diarrhea, flatulence and disruption of intestinal microflora (dysbacteriosis) often develop.

Underdevelopment of the child’s endocrine system is most often associated with a disruption of the connection between the pituitary gland, thyroid gland and adrenal glands, since the direct and feedback mechanisms 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 goes away as soon as the child catches up with his peers in development. Due to the immaturity of the adrenal glands, they are depleted very quickly (rarely this process is irreversible, malignant). There is a relative deficiency of the gonads.

Premature babies have a tendency to develop edema and slight tissue pastiness, since there is underdevelopment of the systems that control water-salt metabolism, but this condition is reversible. In addition to edema, the opposite condition is less commonly observed - dehydration of the body due to the excretion of large amounts of fluid (combined with polyuria - frequent and copious urination).

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

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

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

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

How should a premature baby be born?

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

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

Second, if the answer is external, is it better for your baby to be born vaginally or by cesarean?

If your case of preterm labor is simple, these questions will not be difficult to answer, but they can also be difficult, so your doctor should answer these questions as early as possible. Usually the answer to the first question is “outside” if the cause of premature birth is known - rupture, infection, etc. It is only premature births, which formally occur for an unknown reason, that respond well to tocolytics and other measures to combat them, because all other reasons that can truly interfere with the continuation of pregnancy have already been excluded.

If your baby is happier inside, then go full speed ahead to treatment to "bounce back" the birth. If your baby is feeling better outside, your doctor will see if you have enough time for the steroids to work - usually within 24 hours. If so, he will take as long as necessary to get the maximum benefit from their use, all the while keeping a close watch on the child. If there is no time for steroids, and the birth must be carried out immediately as an emergency measure, then the fastest route must be taken. 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 through induction.

Feeding premature babies

If a woman gives birth prematurely, her milk will be different from normal. For several weeks in a row, it contains more fat, calcium, sodium and other nutrients than others. This milk is specially adapted for the needs of a 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 likely have too much milk because premature babies suck very little. Excess milk can be frozen and saved for future use.

Previously, premature babies were not given breastfeeding until they were comfortable drinking from a bottle. We now know that this was a mistake. Breastfeeding is much easier than bottle feeding, and when a premature baby is breastfed, his heart rate, breathing rate and blood oxygen levels are closer to normal, so it is best to start breastfeeding as early as possible for these babies. 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 placed next to the mother, skin to skin. This method has been used successfully even with babies born before the 26th week and weighing less than 600 grams. By having skin contact with their mother, premature babies become warmer, they breathe easier, they gain weight faster, they are less susceptible to infections, and their psychomotor skills develop better. Mothers feel much more confident and produce more milk.

If this is not the practice at your hospital, insist on it and convey the necessary information to employees. Set achievable, short-term goals: “I’m not suggesting that you all preemies start nursing in a new way, just let me hold my baby for a couple of hours today.”

In Germany, Dr. Sontheimer and his colleagues managed, by placing premature babies skin-on-mother, 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 would be left alone in a rural hospital somewhere and worry about how their sick little one would get to the hospital in a large city.

In the maternity hospital, the mother will immediately know if she has a premature baby. Over the subsequent weeks of her stay in medical institutions, she will acquire much more information on this issue than can be obtained from this article. Everything that the mother learns in the hospital will pass through her heart. Still, even if your baby was born on time, don't skip this article.

Premature babies are those who were not carried to the generally defined normal gestational age of 37-42 weeks, which is why they are most often born with a weight of less than 2500 g and a body length of less than 45 cm, as well as with a certain set of signs of immaturity.

It must immediately be said that none of these signs in themselves, nor the birth of a child before the 37th week, serves as a basis for recognizing the child as premature.

Immaturity can also be the lot of those whose birth fits into the specified dates and is even delayed in relation to them.

Signs of immaturity are divided into two large groups:

1. on the so-called morphological, relating to the structure of the body,
2. and functional, describing the work and interaction of organs.

Morphological signs of immaturity

Pay attention to the signs from the first category that are accessible to external observation.

• Wrinkled “senile” skin is a consequence of underdevelopment of the subcutaneous fat layer; its color is not pale pink as normal, but pink or red, and the deeper the immaturity, the darker the color. If you gather the skin into a fold, it will not straighten out immediately - you will have time to notice how this will happen.
• Thick vellus hair grows everywhere on the body and arms; the navel is located just above the pubis (in full-term babies it is located in the middle of the body length).
• The nipples and areola are difficult to distinguish.
• A full-term newborn has a normal head proportion - 1/4 of the length of the entire body; in children born prematurely, the head is relatively large - up to a third of the height, and the hair on the head has not yet grown to two centimeters.
• The appearance of the ears is characteristic - they are soft and shapeless, pressed tightly to the skull, and the skull itself is compressed from the sides and seems very high.
• Nails are soft, transparent, and may not reach the fingertips.
• In premature girls, the labia majora are underdeveloped; they do not cover the labia minora, which is why the labia gapes.

Morphological immaturity, of course, is not limited to these external, clearly visible signs, since all organs and systems are underdeveloped.

Functional signs of immaturity

Here is a short list of signs from the second group - functional:

• underdevelopment or complete absence of sucking and swallowing reflexes;
• irregular breathing, sometimes reaching a half-minute stop;
• faint cry; paucity of movements and emotional manifestations.

The body of a premature baby is poorly adapted to maintaining a constant body temperature, constant blood composition and other internal environments.

The pose of such a child is also characteristic: the arms lie sluggishly along the body, the legs are widely spread and slightly bent at the hip joints. Mandatory weight loss in the first 2 days of life is most often 10-12%.

- these are children born before the due date, functionally immature, with a weight below 2500 g and a body length of less than 45 cm. Clinical signs of prematurity include disproportionate physique, open sutures of the skull and small fontanel, lack of expression of the subcutaneous fat layer, hyperemia of the skin, underdevelopment of the genitals organs, weakness or absence of reflexes, weak cry, intense and prolonged jaundice, etc. Nursing premature babies involves organizing special care - temperature, humidity, oxygenation level, feeding, and, if necessary, intensive care.

General information

Premature children are considered to be those born between the 28th and 37th weeks of pregnancy, with a body weight of 1000-2500 g and a body length of 35-45 cm. The most stable criterion is the gestational age; Anthropometric indicators, due to their significant variability, are considered conditional criteria for prematurity. Every year, as a result of spontaneous premature birth or artificially induced termination of pregnancy in the later stages, 5-10% of the total number of newborns are born prematurely.

According to the WHO definition (1974), a fetus is considered viable at a gestational age of more than 22 weeks, a body weight of 500 g, and a body length of 25 cm. In domestic neonatology and pediatrics, the birth of a fetus before the 28th week of gestation, weighing less than 1000 g and a length of less than 35 cm is regarded as a late miscarriage. However, if such a child was born alive and lived after birth for at least 7 days, he is registered as premature. The neonatal mortality rate among premature infants is much higher than that among full-term infants, and largely depends on the quality of medical care in the first minutes and days of a child’s life.

Causes of prematurity

All the reasons leading to the birth of premature babies can be combined into several groups. The first group includes socio-biological factors, including too young or old age of parents (under 18 and over 40 years old), bad habits of the pregnant woman, insufficient nutrition and unsatisfactory living conditions, occupational hazards, unfavorable psycho-emotional background, etc. The risk of premature labor and birth The rate of premature babies is higher in women who did not plan pregnancy and neglected medical support for pregnancy.

The second group of reasons is a burdened obstetric-gynecological history and the pathological course of the current pregnancy in the expectant mother. Here, a history of abortion, multiple pregnancy, gestosis, hemolytic disease of the fetus, and premature placental abruption are of greatest importance. The reason for the birth of premature babies can be short (less than 2 years) intervals between births. Often, premature babies are born to women who resort to in vitro fertilization, but this is not due to the very fact of using ART, but rather to the “female” factor that prevents natural fertilization. Gynecological diseases and genital malformations have an adverse effect on pregnancy: cervicitis, endometritis, oophoritis, fibroma, endometriosis, bicornuate saddle uterus, uterine hypoplasia, etc.

The third group of reasons that disrupt the normal maturation of the fetus and cause an increased likelihood of having premature babies includes various extragenital diseases of the mother: diabetes mellitus, hypertension, heart defects, pyelonephritis, rheumatism, etc. Premature birth is often provoked by acute infectious diseases suffered by a woman in later life. terms of gestation.

Finally, the birth of premature babies may be associated with pathology and abnormal development of the fetus itself: chromosomal and genetic diseases, intrauterine infections, severe malformations.

Classification of prematurity

Taking into account the indicated criteria (gestational age, weight and body length), 4 degrees of prematurity are distinguished:

I degree of prematurity– delivery occurs at 36-37 weeks of gestation; The child’s body weight at birth is 2500-2001 g, length – 45-41 cm.

II degree of prematurity- delivery occurs at 32-35 weeks of gestation; The child’s body weight at birth is 2001-2500 g, length – 40-36 cm.

III degree prematureness- delivery occurs at 31-28 weeks of gestation; The child’s body weight at birth is 1500-1001 g, length – 35-30 cm.

IV degree of prematurity- delivery occurs before 28 weeks of gestation; The child’s body weight at birth is less than 1000 g, length is less than 30 cm. For such children, the term “premature with extremely low body weight” is used.

External signs of prematurity

Premature babies are characterized by a number of clinical signs, the severity of which correlates with the degree of prematurity.

Extremely premature infants who are overweight<1500, рождаются с тонкой морщинистой кожей, обильно покрытой сыровидной смазкой и пушковыми волосами (лануго). Кожные покровы имеют ярко-красный цвет (т. н. простая эритема), который бледнеет к 2-3 неделе жизни. Подкожно-жировой слой отсутствует (гипотрофия II-II степени), телосложение ребенка непропорциональное (голова большая и составляет примерно 1/3 от длины тела, конечности относительно короткие). Живот большой, распластанный с явно заметным расхождением прямых мышц, пупок расположен в нижней части живота.

In extremely premature infants, all fontanelles and sutures of the skull are open, the cranial bones are pliable, and the cerebral skull predominates over the facial skull. Characterized by underdevelopment of the ears, poor development of nails (nail plates do not reach the tips of the fingers), weak pigmentation of the nipples and areola. The genital organs of premature babies are underdeveloped: girls have a gaping genital opening, and boys have undescended testicles into the scrotum (cryptorchidism).

Premature babies born at 33-34 weeks of gestation and later are characterized by greater maturity. Their appearance is distinguished by the pink color of the skin, the absence of fuzz on the face and body, and a more proportional physique (smaller head, higher navel, etc.). In premature infants of degrees I-II, the auricles are curved, and the pigmentation of the nipples and parapapillary circles is pronounced. In girls, the labia majora almost completely cover the genital opening; In boys, the testicles are located at the entrance to the scrotum.

Anatomical and physiological characteristics of premature babies

Prematurity is determined not so much by anthropometric indicators as by morphofunctional immaturity of vital organs and systems of the body.

Characteristic features of the respiratory system in premature infants are the narrowness of the upper respiratory tract, the high position of the diaphragm, the compliance of the chest, and the perpendicular position of the ribs relative to the sternum. These morphological features of premature babies cause shallow, frequent, weakened breathing (40-70 per minute), a tendency to apnea lasting 5-10 seconds (apnea of ​​prematurity). Due to underdevelopment of the elastic tissue of the lungs, immaturity of the alveoli, and reduced surfactant content, respiratory distress syndrome (congestive pneumonia, respiratory distress syndrome) easily occurs in premature infants.

Immaturity of the cardiovascular system is characterized by pulse lability, tachycardia 120-180 per minute, muffled heart sounds, arterial hypotension (55-65/20-30 mm Hg). In the presence of congenital heart defects (patent Botallov duct, patent oval window), murmurs may be heard. Due to the increased fragility and permeability of vascular walls, hemorrhages easily occur (subcutaneous, in internal organs, in the brain).

Morphological signs of central nervous system immaturity in premature infants are poor differentiation of gray and white matter, smoothness of the sulci of the brain, incomplete myelination of nerve fibers, and poor vascularization of the subcortical zones. Muscle tone in premature babies is weak, physiological reflexes and motor activity are reduced, the reaction to stimuli is slow, thermoregulation is impaired, and there is a tendency to both hypo- and hyperthermia. In the first 2-3 weeks, a premature baby may experience transient nystagmus and strabismus, tremor, flinching, and foot clonus.

Premature babies have functional immaturity of all parts of the gastrointestinal tract and low enzyme secretion activity. In this regard, premature babies are prone to regurgitation, flatulence, and dysbacteriosis. Jaundice in premature infants is more intense and persists longer than in full-term newborns. Due to the immaturity of liver enzyme systems, increased permeability of the blood-brain barrier and rapid breakdown of red blood cells, bilirubin encephalopathy can easily develop in premature infants.

Functional immaturity of the kidneys in premature infants leads to changes in electrolyte balance (hypocalcemia, hypomagnesemia, hypernatremia, hyperkalemia), decompensated metabolic acidosis, a tendency to edema and rapid dehydration with inadequate care.

The activity of the endocrine system is characterized by a delay in the formation of the circadian rhythm of hormone release and rapid depletion of glands. Premature babies have low synthesis of catecholamines, often develop transient hypothyroidism, and in the first days of life a sexual crisis rarely occurs (physiological mastitis, physiological vulvovaginitis in girls).

Premature babies develop early anemia at a faster rate than full-term babies, and there is an increased risk of developing septicemia (sepsis) and septicopyemia (purulent meningitis, osteomyelitis, necrotizing ulcerative enterocolitis).

During the first year of life, the increase in body weight and length in premature infants occurs very intensively. However, according to anthropometric indicators, premature children catch up with their peers born at term only by 2-3 years (sometimes by 5-6 years). The lag in psychomotor and speech development in premature infants depends on the degree of prematurity and concomitant pathology. In a favorable scenario for the development of a premature baby, leveling occurs in the 2nd year of life.

Further physical and psychomotor development of premature infants may be on par with peers or delayed.

Among premature children, neurological disorders are more common than among full-term peers: astheno-vegetative syndrome, hydrocephalus, convulsive syndrome, vegetative-vascular dystonia, cerebral palsy, hyperactivity, functional dyslalia or dysarthria. Almost a third of premature babies have vision pathology - myopia and astigmatism of varying severity, glaucoma, strabismus, first in the maternity hospital, then in the children's hospital and clinic. The main components of caring for premature babies are: ensuring optimal temperature and humidity conditions, rational oxygen therapy and dosed feeding. In premature infants, constant monitoring of the electrolyte composition and ABS of the blood, monitoring of the gas composition of the blood, pulse and blood pressure is carried out.

Very premature babies immediately after birth are placed in incubators, where, taking into account the child’s condition, a constant temperature (32-35°C), humidity (in the first days about 90%, then 60-50%), and oxygenation level (about 30%) are maintained. Premature babies I-II degrees are usually placed in heated cribs or in regular cribs in special boxes where the air temperature is maintained at 24-25°C.

Premature babies who are able to independently maintain normal body temperature, have reached a body weight of 2000 g, and have good epithelization of the umbilical wound can be discharged home. The second stage of nursing in specialized departments of children's hospitals is indicated for premature babies who have not reached a body weight of 2000 g in the first 2 weeks, and for children with perinatal pathology.

Feeding premature babies should begin in the first hours of life. Children with absent sucking and swallowing reflexes receive nutrition through a gastric tube; if the sucking reflex is sufficiently expressed, but the body weight is less than 1800 g, the child is fed through a pacifier; children weighing over 1800 g can be breastfed. The frequency of feedings for premature infants of stage I-II is 7-8 times a day; III and IV degrees - 10 times a day. Nutrition calculations are made using special formulas.

speech therapist and child psychiatrist.

From 2 weeks of age, premature babies need prevention of iron deficiency anemia and rickets. Preventive vaccinations for premature babies are carried out according to an individual schedule. In the first year of life, repeated courses of baby massage, gymnastics, and individual health and hardening procedures are recommended.

Premature babies are considered children born between the 22nd and 37th weeks of gestation with a body weight of less than 2500-2700 g and a body length of less than 45-47 cm. The most stable indicator is gestational age.

The fetus is viable (according to WHO definition) with a body weight of 500 g or more, a body length of 25 cm or more, and a gestation period of more than 22 weeks. Russian national statistics on miscarriage (spontaneous termination of pregnancy at less than 37 completed weeks) fully take these recommendations into account. Statistics on prematurity (spontaneous or induced termination of pregnancy from a time when the fetus is considered viable) among those born alive takes into account only children from the 28th week of gestation weighing 1000 g or more and a body length of 35 cm or more. Of those born alive with a body weight of 500-999 g, newborns who survived 7 days after birth are subject to registration.

The number of premature babies in different countries ranges from 3 to 17%, in Russia - 3-7%. Preterm births have the highest morbidity and mortality rates. They account for about 75% of infant mortality in our country; in the most economically developed countries - 100%.

CAUSES OF PREMATURE BIRTH OF CHILDRENThe main reasons for premature birth of children are as follows.

Socio-biological factors.

The parents are too young or too old. If old age has a negative impact on pregnancy due to biological changes in the aging body, then the birth of premature babies in young mothers is due to unplanned pregnancies.

Miscarriage is influenced by the low level of education of parents and the associated unhealthy lifestyle during pregnancy and lack of understanding of the importance of constant

medical supervision. Among children born to women who were not observed at the antenatal clinic throughout pregnancy, the perinatal mortality rate is 5 times higher.

Occupational hazards, bad habits, and hard physical labor play a big role in miscarriage. Smoking not only of the mother, but also of the father has a negative impact on the health of the child. Severe developmental defects in children of men who smoke for many years and/or smoke a large number of cigarettes occur 2 times more often than in children of non-smoking fathers.

Even with a desired pregnancy, the risk of miscarriage in single women is higher than in married women, which is due to social, household and psycho-emotional factors.

Previous abortions. Complete elimination of abortions with the use of effective contraception can reduce the incidence of premature births by 1/3.

Short intervals between births (less than 2 years) can cause premature birth.

Mother's diseases.

Pathological course of pregnancy.

DEGREES OF PREMATURE

There are four degrees of prematurity (Table 4-1).

Table 4-1.Degrees of prematurity

Currently, the diagnosis usually indicates not the degree of prematurity, but the gestational age in weeks (a more accurate indicator).

SIGNS OF PREMATURE Clinical signs

The appearance of a premature baby depends on the degree of prematurity.

A very premature baby (body weight less than 1500 g) has thin, wrinkled skin of a dark red color, abundantly covered with cheese-like lubricant and fluff. (lanugo). Simple erythema

lasts up to 2-3 weeks. The subcutaneous fat layer is not expressed, the nipples and areola of the mammary glands are barely noticeable; the auricles are flat, shapeless, soft, pressed to the head; nails are thin and do not always reach the edge of the nail bed; The navel is located in the lower third of the abdomen. The head is relatively large and makes up 1/3 of the body length; limbs are short. The sutures of the skull and fontanels (large and small) are open. The bones of the skull are thin. In girls, the genital gap gapes as a result of underdevelopment of the labia majora, the clitoris protrudes; In boys, the testicles are not descended into the scrotum.

More mature premature babies have a different appearance. The skin is pink, there is no fuzz on the face (at birth in the 33rd week of gestation), and later on the body. The navel is located slightly higher above the womb, the head is approximately 1/4 of the body length. In children born at more than 34 weeks of gestation, the first curves appear on the ears, the nipples and areola are more visible, in boys the testicles are located at the entrance to the scrotum, in girls the genital slit is almost closed.

Premature infants are characterized by muscle hypotonia, decreased physiological reflexes, motor activity, impaired thermoregulation, and weak cry. A very premature baby (less than 30 weeks of gestation) lies with outstretched arms and legs; sucking, swallowing and other reflexes are absent or weakly expressed. Body temperature is not constant (can drop to 32-34? C and easily rises). At birth after the 30th week of gestation, a premature infant is found to have partial flexion of the legs at the knee and hip joints; sucking reflex is good. In a child born at 36-37 weeks of gestation, the flexion of the limbs is complete, but unstable; a distinct grasping reflex is evoked. In the first 2-3 weeks of life, a premature infant may have intermittent tremor, mild and unstable strabismus, and horizontal nystagmus when changing body position.

Premature boys and girls do not differ in anthropometric indicators, since these differences are formed in the last month of pregnancy (full-term boys are larger than girls).

Features of internal organs

Morphological and functional immaturity of internal organs also corresponds to the degree of prematurity and is expressed especially sharply in very premature infants.

Breathing in premature babies is shallow with significant fluctuations in respiratory rate (from 36 to 76 per minute), with a tendency to tachypnea and apnea lasting 5-10 s. In children born at less than 35 weeks of gestation, the formation of surfactant is impaired, which

This prevents the collapse of the alveoli during exhalation. They develop SDR more easily.

Heart rate in premature babies is characterized by great lability (from 100 to 180 per minute), vascular tone is reduced, systolic blood pressure does not exceed 60-70 mm Hg. Increased permeability of vascular walls can lead to impaired cerebral circulation and cerebral hemorrhage.

Due to the insufficient maturity of the renal tissue, its function to maintain acid-base balance is reduced.

All gastrointestinal enzymes necessary for the digestion of breast milk are synthesized, but are characterized by low activity.

In premature infants, there is no relationship between the intensity of jaundice and the degree of transient hyperbilirubinemia, which often leads to underestimation of the latter. Immaturity of the liver and the associated insufficient activity of the enzyme glucuronyltransferase, increased permeability of the blood-brain barrier (BBB), as well as rapid breakdown of red blood cells can lead to the accumulation of indirect bilirubin in the blood in the first days of life and the development of bilirubin encephalopathy even with a relatively low concentration of bilirubin (170-220 µmol/l).

Laboratory research

In the first days of life, premature infants are more likely than full-term infants to experience hypoglycemia, hypoproteinemia, hypocalcemia, hypomagnesemia, hyperkalemia, and decompensated metabolic acidosis. The content of erythrocytes and Hb at birth is almost the same as in full-term infants, but the HbF content is higher (up to 97.5%), which is associated with intense hemolysis. From the second day of life, red blood counts change at a faster rate than in full-term infants, and at the age of 6-8 weeks, a deviation in the hemogram typical of premature infants appears - early anemia of prematurity. The leading cause of anemia is considered to be low production of erythropoietin. The content of leukocytes is the same as in full-term infants, but the presence of young forms up to promyelocytes is characteristic. The first crossover of granulocytes and lymphocytes occurs the later, the greater the degree of prematurity (with degree III - by the end of the first month of life).

DEVELOPMENTAL FEATURES OF PREMATURE CHILDREN Physical development

The physical development of premature infants is characterized by higher rates of increase in body weight and length during the first year

life. The smaller the weight and body length of a premature infant at birth, the more intensely these indicators increase throughout the year.

By the end of the first year of life, body weight increases as follows: with IV degree prematurity by 8-10 times, III degree - by 6-7 times, II degree - by 5-7 times, I degree - by 4-5 times. Body weight increases unevenly. The first month of life is the most difficult period of adaptation, especially for a very premature baby. Initial body weight decreases by 8-12% (in full-term infants by 3-6%); recovery is slow. With a gestation period of less than 32 weeks, body weight often reaches its initial values ​​only at the end of the first month of life and begins to increase more intensively from the 2nd month.

The body length of a premature baby by the end of the first year of life is 65-75 cm, i.e. increases by 30-35 cm, while in a full-term baby the body length increases by 25 cm.

Despite the high rates of development, in the first 2-3 years of life, premature children lag behind their peers born full-term. Leveling occurs after the third year of life, often at 5-6 years. In the future, asthenia and infantility are often observed in children born prematurely, but indicators of physical development characteristic of full-term peers are also possible.

Psychomotor development

In psychomotor development, healthy premature infants are compared with their full-term peers much earlier than in physical development. Children with degree II-III prematurity begin to fix their gaze, hold their head up, roll over, stand up and walk independently, and pronounce their first words 1-3 months later than full-term children. Premature children “catch up” with their full-term peers in terms of psychomotor development in the second year of life; with stage I prematurity - by the end of the first year.

FEATURES OF CARE OF PREMATURE INFANTSNursing of premature babies is carried out in two stages: in the maternity hospital and in a specialized department. Then the child comes under the supervision of the clinic.

All over the world, great importance is attached to the “soft care of premature babies” with the limitation of intensive care, stressful situations, and pain. After birth, the premature baby should be placed in sterile, warm diapers (“optimal comfort”). Cooling immediately after birth, while still in the delivery room, often dooms all further care to failure. So, if the body temperature of a premature infant dropped only once to 32? C

and lower, mortality reaches almost 100%, even with the correct use of all modern methods of care and treatment in the future. In the first days of life, very premature babies or premature babies in serious condition are kept in incubators. They maintain a constant temperature (from 30 to 35? C, taking into account the individual characteristics of the child), humidity (in the first day up to 90%, and then up to 60-55%), oxygen concentration (about 30%). The child’s body temperature can be maintained in a heated crib or in a regular crib using heating pads, since the longer the stay in the incubator, the greater the likelihood of the child becoming infected. The optimal indoor air temperature is 25? C. It is necessary to support the child’s adaptive reactions by dropping native mother’s milk into the mouth from a pipette, heated diapers, a long stay on the mother’s chest (like a “kangaroo”), the calm voice of a nurse, and stroking movements of her hands.

Only 8-10% of healthy premature babies with a birth weight of more than 2000 are discharged home from the maternity hospital. The rest are transferred to specialized institutions for the second stage of nursing.

FEATURES OF FEEDING PREMATURES

The peculiarities of feeding premature infants are due to their increased need for nutrients due to intensive physical development, as well as the functional and morphological immaturity of the gastrointestinal tract, and therefore food should be administered carefully. Even very premature babies should begin to be fed in the first hours of life due to the catabolic nature of metabolism, hypoproteinemia and hypoglycemia.

With parenteral nutrition, the child’s intestines are quickly populated by opportunistic microflora. At the same time, the permeability of the mucous membranes of the gastrointestinal tract increases, which contributes to the generalization of the infectious process. Parenteral nutrition is used only in extremely severe conditions in very premature infants and for a limited period of time. For such children, it is more appropriate to prescribe round-the-clock drip administration of native mother's milk.

Infants with a gestational age of more than 28 weeks, as well as all premature infants with SDD and a weak sucking reflex, breast milk is administered through a gastric tube. If the general condition is satisfactory, the sucking reflex is quite pronounced and the body weight at birth is more than 1800 g, breastfeeding can be done after 3-4 days. Premature babies with a birth weight of less than 1500 g are put to the breast from the third week of life. If the mother does not have milk, specialized formulas for premature infants are prescribed

(for example, “Nenatal”, “preNAN”, etc.) When the child reaches a body weight of 2500-3000 g, the child is gradually transferred to regular breast milk substitutes.

Nutrition calculations are made in accordance with the needs of the child’s body per 1 kg of body weight per day: 1-2 days of life - 30 kcal, 3rd day - 35 kcal, 4th day - 40 kcal, then 10 kcal more daily up to the 10th day of life; on the 14th day - 120 kcal, from the 21st day of life - 140 kcal.

When determining the volume of food, the individual characteristics of the child should be taken into account: very premature babies from the 2nd month sometimes absorb a volume of breast milk corresponding to 150-180 kcal/kg.

LONG-TERM CONSEQUENCES OF PREMATUREAmong premature infants, the risk of developing mental and physical disabilities is higher than among full-term infants.

Severe psychoneurological disorders in the form of cerebral palsy, decreased intelligence, hearing and vision impairment, and epileptic seizures occur in 13-27% of premature infants.

In premature infants, developmental defects are 10-12 times more likely to be detected. They are characterized by disproportionate development of the skeleton, mainly with deviations towards asthenia. Many of them subsequently have an increased risk of “school maladjustment.” Attention deficit hyperactivity disorder is more common among those born prematurely.

Women born very prematurely often subsequently experience menstrual irregularities, signs of sexual infantilism, the threat of miscarriage and premature birth.

Despite the above, with proper care and nutrition, premature babies usually grow up healthy and become full-fledged members of society.

PREVENTION OF PREMATURE BIRTH OF CHILDRENPrevention of premature birth of children involves protecting the health of the expectant mother; prevention of medical abortions, especially in women with menstrual irregularities and neuroendocrine diseases; creating favorable conditions for pregnant women in the family and at work; timely identification of risk groups and active monitoring of the course of pregnancy in these women.