Critical condition of the 3rd degree in premature babies. Classification of premature babies
premature babies: frequency and causes premature birth. Anatomical, physiological and neuropsychic features of premature babies
premature babies- children born in relation to the established end of gestational age prematurely.
premature birth- is the birth of a child before the end of the full 37 weeks of pregnancy or earlier than 259 days counted from the first day of the last menstrual cycle (WHO, 1977). A prematurely born child is premature.
premature birth statistics .
The frequency of preterm birth = 3–15% (average − 5–10%). Premature births in 2002 - 4.5%. There is no downward trend in this indicator.
Among prematurely born children, the highest morbidity and mortality are observed. They account for 50 to 75% infant mortality, and in some developing countries - almost 100%.
Causes of preterm birth
socio-economic (salary, living conditions, nutrition of a pregnant woman);
socio-biological ( bad habits, parent's age, prof. harmfulness);
clinical ( extragenital pathology, endocrine diseases, threat, preeclampsia, hereditary diseases).
Factors contributing to fetal growth retardation and preterm labor (prematurity) can be divided into 3 groups :
absence or insufficiency medical care before and during pregnancy;
level of education (less than 9 classes) - affect the level and lifestyle, personality traits, material well-being;
low standard of living and, accordingly, material security, and as a result, unsatisfactory living conditions, malnutrition of the expectant mother;
occupational hazards (physically difficult, prolonged, monotonous, standing work of a pregnant woman);
extramarital birth (especially with unwanted pregnancy);
unfavorable ecological situation;
young or elderly age pregnant (less than 18 years old) and first birth over 30 years old);
father's age is under 18 and over 50 (in Europe);
bad habits (smoking, alcoholism, drug addiction) of both the future mother and father;
short stature, infantile physique of a pregnant woman;
infantilism of the genital organs, especially in combination with hormonal disorders (insufficiency corpus luteum, hypofunction of the ovaries, isthmic-cervical insufficiency) - up to 17% of all preterm births;
previous abortions and miscarriages - lead to inadequate secretion of the endometrium, collagenization of the stroma, isthmic-cervical insufficiency, an increase in the contractility of the uterus, the development of inflammatory processes(endometritis, synechia);
mental and physical injuries of a pregnant woman (fright, shocks, falls and bruises, weight lifting, surgical interventions during pregnancy - especially laparotomy);
inflammatory diseases of the mother of an acute and chronic nature, acute infectious diseases (delivery at the height of fever, as well as in the next 1-2 weeks after recovery);
extragenital pathology, especially with signs of decompensation or exacerbation during pregnancy: rheumatic heart disease, arterial hypertension, pyelonephritis, anemia, endocrine diseases (hypothyroidism, thyrotoxicosis, diabetes mellitus, hyperfunction of the adrenal cortex, etc.), etc. cause a violation of the uteroplacental blood flow, degenerative changes in the placenta;
genital pathology;
pathology of pregnancy: late gestosis, nephropathy, immunological conflict in the mother-placenta-fetus system;
anomalies in the development of the placenta, umbilical cord;
in vitro fertilization;
multiple pregnancy (about 20% of all premature babies);
fetal diseases: IUI, hereditary diseases, defects fetal development, isoimmunological incompatibility;
the interval between births is less than 2 years.
socio-economic:
socio-biological:
clinical:
Causes of prematurity can be divided according to another principle:
environmental,
coming from the mother;
associated with the peculiarities of the course of pregnancy;
from the side of the fetus.
Classification of prematurity
In ICD X revision under heading P 07 " Disorders associated with the shortening of pregnancy, as well as low birth weight" The division of premature newborns is accepted both by weight and by gestational age. The note says: When both birth weight and gestational age are established, birth weight should be preferred.
Depending on the indicators of gestational age and body weight of a premature baby, 4 degrees of prematurity (3 weeks for each of the first three degrees):
|
Degrees of prematurity |
by gestation |
by body weightat birth |
||
|
I degree |
35 weeks - incomplete 37 weeks (up to 259 days) |
2500−2000 grams |
low |
|
|
II degree |
32-34 weeks |
1999−1500 grams |
||
|
III degree |
deeply premature |
29-31 weeks |
1499−1000 grams− very low weight body |
|
|
IV degree |
22-28 weeks |
999-500 grams extremely low mass (extremely low mass) |
||
Extreme prematurity− gestational age less than 22 completed weeks (154 completed days).
The line between miscarriage and premature at 22 full weeks(154 full days) of gestation is determined by weight: 499 g - miscarriage, 500 g - premature newborn.
Anatomical, physiological and neuropsychic features of premature babies
Anatomical features of premature babies (external signs of immaturity):
the skin is thin and glossy, dark red, as if translucent;
on the face, back, extensor surfaces of the limbs there is an abundant primordial fluff − lanugo;
the subcutaneous fat layer is thinned, as a result of which the skin is wrinkled, there is a tendency to edema of the subcutaneous fat;
body length from 25 cm to 46 cm;
disproportionate physique (head relatively large: large vertical dimension the head varies from ¼ to ⅓ of the body length, the brain skull predominates over the facial one; neck and lower limbs short);
low forehead hair growth
the skull is more round, its bones are pliable - non-closure of cranial sutures, small and lateral fontanelles are usually open;
auricles are soft, close to the skull;
nails often do not reach fingertips, nail plates are soft;
low-lying place of discharge of the umbilical cord, below the midpoint of the body;
underdevelopment of the genital organs: in girls, the genital slit gapes, i.e., the labia minora is not covered by the labia majora (due to underdevelopment of the labia majora and relative hypertrophy of the clitoris), in boys, the testicles are not lowered into the scrotum (in extremely immature children, the scrotum is generally underdeveloped) .
Physiological features of the body of a premature baby (functional signs of immaturity):
from the sidenervous and muscular systems - depression syndrome:
muscle hypotension, lethargy, drowsiness, delayed response to stimuli, a weak, quiet cry or squeak,
the predominance of subcortical activity (due to the immaturity of the cerebral cortex): movements are chaotic, shudders, hand tremors, stop clonus may be noted,
imperfection of thermoregulation (reduced heat production and increased heat transfer: children easily cool and overheat, they do not have an adequate temperature increase for an infectious process),
weak expression, rapid fading or absence physiological reflexes neonatal period,
weak sucking intensity;
from the siderespiratory system :
great lability of the frequency and depth of breathing with a tendency to tachypnea (36 - 72 per minute, on average - 48 - 52), its superficial nature,
frequent respiratory pauses (apnea) of varying duration (5-12 seconds);
gasps (convulsive respiratory movements with difficulty inhaling);
during sleep or rest may be observed: breathing Biot type(correct alternation of periods of apnea with periods of respiratory movements of the same depth), breathing Cheyne-Stokes type(periodic breathing with pauses and a gradual increase, and then a decrease in the amplitude of respiratory movements);
primary atelectasis;
cyanosis;
from the sideof cardio-vascular system :
lower blood pressure in the first days of life (75/20 mm Hg with an increase in the following days to 85/40 mm Hg;
frequency lability heart rate with a tendency to tachycardia (up to 200 per minute, on average - 140 - 160 beats / min);
the phenomenon of embryocardia (heart rhythm, characterized by pauses of equal duration between I and II tone and between II and I tone);
muffled heart tones, in the first days of life, noises are possible due to the frequent functioning of embryonic shunts (botall duct, oval window);
vascular dystonia - the predominance of the activity of the sympathetic department of the autonomic nervous system- any irritation causes an increase in heart rate, an increase in blood pressure;
Harlequin symptom (or Finkelstein symptom): in the position of the child on the side, uneven skin coloration is observed: the lower half Pink colour, upper - white, which is due to the immaturity of the hypothalamus, which controls the state of skin capillary tone;
from the sidedigestive system :
reduced food tolerance: low proteolytic activity of gastric juice enzymes, insufficient production of pancreatic and intestinal enzymes, bile acids,
increased permeability of the intestinal wall;
predisposition to flatulence and dysbacteriosis;
underdevelopment of the cardiac part of the stomach (gaping of the cardia - a tendency to regurgitation);
from the sideurinary system :
low filtration and osmotic function of the kidneys;
from the sideendocrine system :
decrease in the reserve capacity of the thyroid gland - a tendency to transient hypothyroidism;
from the sidemetabolism and homeostasis − propensity to:
hypoproteinemia,
hypoglycemia,
hypocalcemia,
hyperbilirubinemia,
metabolic acidosis;
from the sideimmune system :
low level of humoral immunity and nonspecific protective factors.
Morphological signs of prematurity:
large vertical size of the head (⅓ of the body length, in full-term ones - ¼),
the predominance of the size of the brain skull over the facial,
open small and lateral fontanelles and sutures of the skull,
low forehead hair growth
soft ears,
plentiful lanugo,
thinning of subcutaneous fat,
the location of the umbilical ring below the midpoint of the body,
underdevelopment of nails
Functional signs of prematurity:
short muscle tone(frog pose);
weakness of reflexes, weak cry;
tendency to hypothermia;
max weight loss by 4-8 days of life and is 5-12%, is restored by 2-3 weeks;
prolonged physiological (simple) erythema;
physiological jaundice - up to 3 weeks. - 4 weeks;
period early adaptation= 8days -14 days,
period of late adaptation = 1.5 months. - 3 months;
the rates of development are very high: the mass-growth index is compared to 1 year (compared to full-term ones), in very preterm infants (<1500 г) - к 2-3 годам;
in neuropsychic development, by the age of 1.5, they catch up with full-term ones, provided that they are healthy. In 20% of cases with a mass of 1500 g and< - поражается ЦНС (ДЦП, эпилепсия, гидроцефалия).
Features of the course of the neonatal period in preterm infants
The period of early adaptation in premature babies is 8-14 days, the neonatal period lasts more than 28 days (up to 1.5 - 3 months). For example, if a child was born at a gestational age of 32 weeks, then at 1 month of life his gestational age will be 32 + 4 = 36 weeks.
Physiological weight loss lasts longer - 4 - 7 days and amounts to 10 - 14%, its recovery occurs by 2 - 3 weeks of life.
90-95% of preterm babies have neonatal jaundice of prematurity, more pronounced and longer than full-term (can be held up to 3-4 weeks).
Hormonal crisis and toxic erythema are less common than in term infants.
An increase in muscle tone in the flexors usually appears in 1-2 months of life.
In healthy premature babies weighing up to 1500 g, the ability to suckle appears within 1–2 weeks of life, with a weight of 1500 to 1000 g – at 2–3 weeks of life, less than 1000 g – by the month of life.
The rate of development of premature babies is very high. Most premature babies catch up with their peers by 1-1.5 years in terms of weight and height. Children with very low birth weight (less than 1500 grams - very premature) usually lag behind in physical and neuropsychic development up to 2-3 years. In 20% of very premature babies, there are organic lesions of the central nervous system (cerebral palsy, hearing, vision, etc.).
Prevention of preterm birth consists of:
socio-economic factors;
family planning;
treatment of extragenital pathology before pregnancy;
treatment of urogenital infection;
consultation in polyclinics “marriage and family”;
transplantation of lymph suspension (150 ml) during or outside of pregnancy;
sex culture.
A premature baby is a newborn born before 37 weeks of gestation weighing less than 2.5 kg.
8 month. He tries to sit down himself, gets on all fours, tries to swing. Understands when asked to show something, is interested in audible speech, its tone and pace.
9 month. At this age, the baby sits more confidently, tries to crawl, says the first syllables, and the need for communication increases. The first teeth appear if the baby was born at 32–34 weeks.
10 month. A ten-month-old baby prefers to crawl for now, but he already stands well, walks, holding on to a support. He likes to watch moving objects. He already knows his name. Babies born before 31 weeks have their first teeth.
11 month. The child is actively crawling. He has been standing without support for a long time, taking his first steps without support, and making good contact with familiar people. He is interested in cubes, pyramids, any moving toys.
12 month. The baby can start walking, sometimes it happens a little later - at 18 months.
Such children reach neuropsychic maturity by the age of 2-3 years. All of this is normal.
Features of care
Caring for a premature baby has a number of features:
- clothing. Should be made of natural materials, with snap fasteners to easily secure medical devices.
- Care products. Should be hypoallergenic and selected depending on the degree of prematurity of the child. The skin of a premature baby is very delicate and sensitive. In the hospital department and later at home, you will need diapers for premature babies. They come in "zero" size up to 1 kg, as well as from 1 to 3 kg.
- Temperature regime. The air temperature in the room should be 23-24 degrees, around the child's body - approximately 28 degrees. Heating pads can be used if necessary. The optimum air humidity is 70%. This temperature regime must be maintained during the first month.
- Bathing. There should be no sudden changes in temperature. To avoid this, the child must be wrapped in a thin diaper, placed in a bath, unfold the cloth and wash the baby. The temperature in the room should be at least 25 degrees, water - at least 36 degrees. Wrap the baby in a warm towel. It is better if both parents bathe the child.
- Walks. The child must be protected from hypothermia and sudden changes in temperature. If the baby was born in the summer and his body weight is more than 2 kg, then you can walk right away. Walks last a maximum of a quarter of an hour, the air temperature outside should be 25 degrees. If the baby was born in spring or autumn, then walking is allowed at 1.5 months, when he will weigh 2.5 kg. When a child appeared in winter, then going outside is allowed with a body weight of 3 kg and an air temperature of a maximum of -10 degrees.
- Massage and exercise. All premature babies need them. It is desirable if they are done by a specialist. Physical education and massage normalize the musculoskeletal system, improve metabolism, digestion. With their help, the child will sit down, get up, crawl and walk in time.
Features of feeding
Breastfeeding is the best thing for these babies. Mom needs to breastfeed her baby as long as possible. It is difficult for a premature baby to suckle at the breast, so he must be supplemented with expressed milk.
There are special mixtures for premature babies on sale, if due to various circumstances natural feeding is not possible, then you will have to feed the baby with them, but you need to buy the mixture after consulting a specialist.
Feed the baby in the first month you need from 10 to 20 times a day, in small portions. When the baby gains weight from the 2nd month, it will be enough to feed 8 times a day.
Starting from the 7th month, the nutrition of premature babies should be varied, complementary foods should be introduced. Previously, this cannot be done, since the digestive organs are not yet ready to digest any food other than breast milk or formula.
But you can’t delay with complementary foods either: the child needs vitamins and minerals. You need to start with cereals, then introduce vegetables and meat, fresh juices, and at the very end - fermented milk products. Sweet fruits and sugar should not be given.
The birth of a premature baby is stressful for parents. But we must remember that today medicine has stepped far forward and today it is possible to nurse premature babies born even before 28 weeks.
Useful video about premature newborns
Answers
Today we will list and briefly characterize the signs of a full-term newborn. In addition, we will focus on the issues of postmaturity or prematurity. How can this be determined by the child and how do children differ? What threatens this newborn?
For this reason, it is necessary to know not only the signs of full-term and maturity of the newborn, but also be able to correctly diagnose and be aware of possible problems. If we consider the child as an object of childbirth, then this must be done based on the size of the head, since this is the most voluminous part of the fetal body, which experiences the greatest difficulties during movement through the birth canal. Now we propose to talk in more detail about the signs of a full-term newborn.
full-term baby
What is fetal maturity? This is a certain state of the child, which characterizes the readiness of the internal organs to ensure the life of the baby outside the womb. After the birth of a child, a neonatologist must necessarily examine.
The doctor needs to evaluate three things:
- determination of the term of a newborn child, the signs of which we will consider in this section;
- assess the degree of physical development;
- morphological and functional maturity.
Which baby is considered full term? These signs include:
- birth date - from thirty-eight to forty-two weeks;
- body weight must be more than two and a half kilograms;
- body length - from forty-six centimeters or more.
It is very important to note that there are a number of other signs of a full-term newborn. We are talking about morphological and functional maturity. We will talk about this in detail later. Summing up everything said in this section, we can highlight the main signs of a full-term newborn:
- gestational age;
- body mass;
- body length.
External signs
Let's start with the main features that are visible to the naked eye. The first item on this list is to highlight a loud and demanding voice. Second - the skin should be pink and velvety. Be sure to pay attention to the fact that the skin of the newborn should be clean, and the fat layer should be uniform. The third is the presence of an open large fontanel. However, according to statistics, in fifteen percent of cases, a small one is also open. The fourth external sign is the formation of the auricle, all arcs must be clearly expressed. The fifth sign - the navel is located in the center of the abdomen, the nail plates should completely cover the nail phalanges. The sixth sign is that girls have a closed genital slit, and boys have testicles lowered into the scrotum.
Functional features
In this section, we list the functional signs of a full-term newborn. These include the following:
- the limbs of the baby should be bent at the joints;
- movements are chaotic and quite active;
- children are characterized by increased muscle tone;
- body temperature is stable, deviations within the normal range up to six tenths of degrees Celsius are possible;
- the breathing of the newborn is also stable - from forty to sixty breaths per minute;
- the heartbeat is heard well, rhythmic (the norm is from one hundred twenty to one hundred and forty beats per minute);
- in a full-term baby, all reflexes are symmetrical, it is possible to cause specific ones.
Specific reflexes of newborns:
- sucking;
- search;
- prehensile;
- trunk and others.
prematurity
Now let's turn to the issue of criteria for prematurity, postmaturity of the baby. A premature baby is born before the end of intrauterine development, that is, before the thirty-seventh week of pregnancy. Such babies have a small body weight, weight less than two and a half kilograms, and their height does not reach forty-five centimeters. Newborns have problems with thermoregulation and lack of response to external stimuli. It is important to note the statistical information: such babies are born in about 10% of cases.
It is worth knowing that there is a term "extreme prematurity" if the baby is born for up to twenty-two weeks. This condition is the line between a miscarriage and a premature baby. Body weight in this case is a decisive factor: if it reaches half a kilogram, then this is a premature baby, and just one gram less is a miscarriage.
Prematurity is usually classified according to the body weight of the newborn.
Prematurity problems can be both in mom or dad, and in the child. They are briefly listed in the table below.
Manifestation of prematurity
The signs of full-term, prematurity and postmaturity of a newborn considered by us in the article are reflected in the behavior and development of the baby. We invite you to talk about how prematurity in newborns manifests itself. Now we will give a general clinical picture. Firstly, the newborn has a disproportion of the body (a very large head). In addition, the sutures of the skull are open, so the bones are malleable. Secondly, the auricles are soft. Thirdly, the child is in the frog position, as muscle hypotension is noted. The fourth sign is that the testicles of the boys have not yet descended into the scrotum, and the large labia of the girls have not yet fully developed. Fifth, specific reflexes are extremely weakly expressed. Sixth - shallow and weak breathing (up to 54), low blood pressure (about 55-65). Seventh - frequent urination and regurgitation.
Postmaturity
What are the features of a post-term newborn baby? Signs of postmaturity in the mother should be diagnosed by a doctor with the help of CTG and ultrasound. These symptoms include:
- lack of labor activity;
- reduction in abdominal circumference;
- rather large fruit;
- compaction of the child's skull;
- meconium in amniotic fluid;
- reduced concentration of glucose in the amniotic fluid;
- urinalysis shows low levels of estriol.
It is worth noting that there are two types of post-term pregnancy:
With true postmaturity, the child is in serious danger, because hypoxia develops.
What are the causes of postmaturity and how do they affect the child?
How does a post-term pregnancy affect the baby? The baby has the following symptoms:
- thin body;
- dry and wrinkled skin;
- peeling on the skin;
- lack of fetal lubrication;
- long nails and hair;
- open eyes;
- increased activity.
Pay attention to the fact that the skin of postterm newborns acquires a yellowish tint. To prevent a post-term pregnancy, it is very important to undergo a CTG procedure three times a week (after 40 weeks). The baby's heartbeat and movements will help determine exactly how the baby is feeling.
The causes of this phenomenon are unknown, but doctors distinguish two large groups:
Note that there is also a psychological factor. If the expectant mother is afraid of childbirth and is not psychologically ready for them, then the pregnancy may be delayed. In this case, you need the support of loved ones or a consultation with a psychologist.
Differences between a full-term and premature baby
A full-term baby is distinguished by a number of features. He is ready for life outside the womb, has certain reflexes, the skin is able to maintain a certain temperature regime, the heart rate is stable, normal breathing and activity. A premature baby is the exact opposite: he is not ready for life outside the womb, he is not able to maintain a temperature regime, the heart rate and breathing are unstable, low blood pressure, and the reflexes of newborns are poorly developed.
Perhaps, nowhere did I find such a good article about premature babies. I took it from here
She once gave birth to a premature son. Oh, and we got it ... Now everything is fine
November 17 is the International Day of the Premature Baby, which was established in 2009 at the initiative of the European Foundation for the Care of Newborn Patients.
The pregnancy is left behind - it's time for a joyful and, at the same time, anxious expectation. Finally, the long-awaited baby was born, but, alas, ahead of schedule. Of course, you are worried and ask a lot of questions.
Premature baby: basic concepts
Immediately after birth, it is determined how premature the baby is, since further treatment tactics and the creation of conditions for nursing depend on this.
This takes into account two main criteria: body weight at birth and gestational age or age (the number of completed weeks of pregnancy at the time of birth).
Degrees of prematurity
First degree prematurity- childbirth for a period of 34-36 weeks and six days. Birth weight - from 2001 to 2500 grams. The prognosis is favorable, as a rule, without creating special conditions for nursing. Except when there are other conditions or diseases - for example, an infection, a birth injury, a long anhydrous period.
Second or medium degree of prematurity- early birth at 31-33 weeks and 6 days. Birth weight - from 1501 to 2000 grams. The prognosis is favorable with the provision of timely medical care, as well as in conditions of optimal feeding and care.
Third or severe prematurity- very early birth at 28-30 weeks. Body weight at birth - from 1001 to 1500 grams. The prognosis is not entirely favorable, although many of these children survive. However, in the future they are long-term nursing and receive treatment in connection with various diseases.
Fourth degree or profound prematurity- extremely early childbirth for up to 28 weeks. Birth weight - up to 1000 grams (extremely low weight). According to statistics, at this time, every fifth baby is born alive.
However, the prognosis is poor. Babies who were born alive before 26 weeks, unfortunately, in 80-90% of cases die by the age of one month, and of those born at 27-28 weeks - about 60-70%.
"Post-conceptual age" or "post-conceptual period"
In medicine, these concepts are used when the age of the child or the period after birth is indicated according to the gestational age, if it were still ongoing.
Therefore, when characterizing a premature baby (appearance, developmental features and other signs), weeks are usually given in accordance with gestational age.
Prematurely born: what does a premature baby look like?
Of course, a premature baby looks different from a full-term baby, but a lot depends on gestational age.
The main external distinguishing features of premature babies
Moderate prematurity: I-II degree
* Muscle tone is somewhat lowered, but basically the baby is active.
* The skin is pink, and the subcutaneous fat layer is moderately thinned.
* Vellus hair (lanugo) is absent from the skin on the face from 32-33 weeks, and from 35-37 weeks - usually already on the entire surface of the skin.
* Nipples and peripapillary areas (skin around the nipples) are clearly visible and pigmented (colored).
* The first bends on the auricles occur at 35-37 weeks.
* Usually the physique is proportional: the size of the head and the length of the limbs (arms, legs) relative to the body are of normal size.
* The navel is located closer to the center of the abdomen, but still somewhat lower than in full-term babies.
* Nails, as a rule, reach the edges of the fingers (nail bed).
* The external genital organs are well developed. In girls, the genital slit is almost closed. In boys, the testicles are located at the entrance to the scrotum (in the upper third), but sometimes there is unilateral cryptorchidism (one testicle does not descend into the scrotum).
Deep prematurity: III-IV degree
* Due to reduced muscle tone, the child lies with outstretched arms and legs.
* The skin is dark red, thin and wrinkled (like an old man), often swollen, abundantly covered with vellus hair.
* The subcutaneous fat layer is thinned.
* The baby has a somewhat disproportionate physique: the size of the head is large in relation to the length of the body, and the limbs are short compared to the body.
* The navel is located in the lower third of the abdomen.
* Nipples and peripapillary areas are poorly pigmented and poorly visible.
* The auricles are soft, without convolutions and shapeless, pressed against the head and located low.
* The nails of the crumbs are underdeveloped and usually do not reach the fingertips.
* The cranial sutures are open, the small, large and lateral fontanelles are large, and the bones of the skull are soft.
* The external genitalia are underdeveloped. In girls, the labia majora do not cover the labia minora, so the genital slit gapes (opened). In boys, the testicles usually have not yet descended into the scrotum.
Life against all odds...
For premature babies, there is The general trend: the incidence of morbidity, mortality and disability increases as the gestational age decreases.
However, the forecast remains just a forecast and is not guarantee or warrant. Because some premature babies, against all gloomy estimates, fight, survive and grow up as healthy children. While other babies are hard to nurse, and sometimes even die, although, it would seem, they initially have more favorable data.
Why is this happening? The question is better addressed to Mother Nature. Alas, we most likely will not receive an answer to it. However, perhaps this phenomenon can be explained by the desire of some babies to cling to life by any means.
Hence the conclusion: with each passing day, the chances of survival for a baby increase significantly.
Therefore, in the next article we will talk about the features of the physiology of a premature baby, depending on the gestational age at the time of birth. Successful nursing, adaptation to life outside the womb and the health of a premature baby are directly related to them.
Nine months of pregnancy… In anticipation of the baby, the expectant mother is counting the days, but here's a surprise - the baby decided to be born earlier!
Fortunately, for modern medicine, the birth of premature babies is not such a problem as it used to be. What are they, premature babies, and what are their features?
According to WHO criteria, a baby born after 22 weeks of pregnancy and with a body weight above 500 g is viable, while nursing premature babies is possible.
Which babies are considered premature?
A premature baby is a baby born between 22 and 37 weeks gestation, weighing less than 2500g and less than 45cm long.
Guided by these indicators, different degrees of severity of prematurity are determined:
Newborns weighing 900-500g are premature babies with extremely low body weight, most often these are very premature babies in terms of gestational age. For such children, most likely, health problems and consequences in the future are possible.
Even if the weight of a premature baby is more or less normal, the gestational age is considered a more reliable and stable indicator.
Why is the baby born prematurely
The question of why premature babies are born and how to care for them is one of the most discussed in obstetric and neonatological practice.
The main etiological factors of prematurity include:
- the age of a pregnant woman is under 18 or the first birth in a woman over 30;
- oddly enough, this is also influenced by the age of the father - under 18 or over 50 years old (in European countries);
- the interval between births is less than 2 years;
- inflammatory acute or exacerbation of chronic diseases of the mother;
- emotional stress;
- pathological course of pregnancy;
- malnutrition or unbalanced diet of the expectant mother;
- bad habits of both the future mother and father - smoking, alcoholism, drug addiction);
- occupational hazards - physically hard work, monotonous stay in a forced position, standing work, the influence of toxic substances;
- unsatisfactory material and living conditions of a pregnant woman;
The absence or inferiority of medical care before and during pregnancy also plays a significant role.
External manifestations of prematurity
In addition to the fact that the premature baby differs in weight and gestational age, there are also external manifestations.
Weight gain and height.
So, the main signs of a premature baby:
- the baby's skin is wrinkled, dark red;
- subcutaneous fat is almost completely absent (its absence just explains the color of the baby's skin);
- auricles are soft, supple;
- a lot of vellus hair that covers the face, limbs and back;
- low location of the navel;
- underdevelopment of the genital organs - in girls, the small labia are not covered by the large ones, in boys - the testicles are not lowered into the scrotum;
- non-closure of cranial sutures;
- large, small and side crowns are open.
The norms of a premature baby, of course, differ from those with which children are usually born, but over time this difference decreases, and then completely disappears.
Features of early children
The physical condition of premature newborns.
In children who were born prematurely, all organs and systems lag behind in development. Therefore, the treatment of premature babies takes into account all age characteristics.
Since the formation of the lung tissue has not been completed, the introduction of Surfactant is mandatory - a drug that prevents the collapse of the pulmonary alveoli and helps them straighten out. If the dose of Surfactant is insufficient, the child may have respiratory failure.
Since natural surfactant begins to be produced in a child weighing at least 500 g, accordingly, there is a dosage for each degree of prematurity. The lower the gestational age of the newborn, the higher the surfactant deficiency, which means the higher the likelihood of pulmonary pathology.
Also, the following features are often found in practice:
- Inconsistent respiratory rate in premature babies. When the baby is restless, he may have tachypnea (rapid breathing) - about 60-80 breaths per minute, at rest the baby breathes less often. It is so unstable that it can sometimes stop.
- Babies born prematurely do not know how to adapt to environmental changes, so the temperature of a premature baby is unstable, they are prone to hypothermia or overheating.
- The baby's cardiac activity also depends on the environment - in a too hot room, the child becomes restless, heart contractions become more frequent, tachycardia can increase up to 200 beats / min. If the baby is cold, the heart also slows down.
- The imperfection of the nervous system leads to the appearance of various neurological symptoms. If the baby develops well in the future, neurological symptoms gradually disappear. The development of premature babies lags behind by about 1-2 months from full-term peers.
- Weight gain in premature babies is also different. Physiological weight loss recovers more slowly, this process can take 2-3 weeks, since in such children the unconditioned swallowing and sucking reflexes are poorly developed or may even be absent. In the future, children also gain weight more slowly than their "urgent" peers.
- In addition, due to the immaturity of the digestive system, its violations often occur, which is manifested by dyspepsia, colitis, and intestinal dysbiosis. Food is digested slowly, so babies suffer from constipation and flatulence.
- The retina of the eye in premature babies is also immature and completes its formation only by the 4th month of life. Due to a number of reasons, the normal development of the retina can be disrupted, in which case a serious disease occurs - retinopathy or retrolental fibroplasia of prematurity.
- Violations of the normal blood supply to the retina contribute to the formation of new vessels, which are not entirely complete and have very thin walls that tend to rupture. Because of this, hemorrhages often occur in the eye, both small and extensive. In addition, insufficient nutrition of the retina causes the growth of fibrous tissue in its thickness and on the surface, which leads to detachment and, in severe cases, the child may lose sight. Therefore, all babies who were born at a gestational age of less than 30 weeks must be examined by an ophthalmologist.
- On the body of premature babies, hemangiomas are sometimes present - these are dark red spots that consist of dilated blood capillaries. Hemangiomas are not dangerous, but they should still be monitored by a pediatrician and an oncologist. Such spots become less intense by the age of 12 months, then gradually disappear. This usually happens by 4-5 years of age.
Features of premature babies are that they are much more likely to have cerebral hemorrhages and asphyxia, anemia often develops.
Diseases of premature babies are directly dependent on the environment and care.
These children are the most susceptible, due to the imperfection of the immune system, therefore, they require more careful care and close attention.
Why does the baby turn yellow
Especially premature babies should be considered separately, since most mothers, seeing that the baby's skin has turned yellow, begin to panic and immediately blame the doctors, they say, they overlooked it.
In fact, jaundice can be physiological, i.e. occurs normally in absolutely healthy children, and may be pathological, which indicates the presence of diseases.
The liver of a newborn is not fully developed, it is characterized by significant vascularization, inferior differentiation of parenchymal tissue, poor development of connective tissue. Histologically mature (such as in adults) the liver becomes only by the age of 8 years.
Since the liver has not yet “learned” to perform all its functions as it should, on the 2-3rd day of life, the baby begins to turn yellow. This is physiological jaundice - an increase in the amount of bilirubin in the body, which normally disappears after a few days.
If the child's skin began to turn yellow on the first day and this condition continues for more than 10 days, jaundice is regarded as pathological, which means it is a symptom of some disease and requires careful diagnosis.
Physiological jaundice occurs in more than 80% of premature babies and in about 60% of full-term babies. Visually, it manifests itself when the value of bilirubin in the blood of a premature baby is 85-100 μmol / l.
Why is jaundice more common in premature babies? Everything is very simple - the organs of such a child are very underdeveloped and they need more time to adapt and correct their work.
The main thing is to keep the crumbs alive
Caring for premature babies is a difficult, long and emotionally intense process. The lower the birth weight of a child, the more difficult and dangerous the situation. The stages of nursing babies depend on the gestational age, weight and individual adaptive characteristics of a tiny newborn organism.
Immediately after birth, the baby is placed in a closed incubator (“incubator”), in which the optimum temperature is maintained to prevent hypothermia or overheating of the baby. Then the airways are cleared and breathing is restored.
If the situation requires it, then they carry out resuscitation measures - artificial ventilation of the lungs and excitation of cardiac activity.
After that, the child is transferred to the intensive care unit, where he is in an incubator with constant, round-the-clock monitoring. Here the baby is until his body needs to restore and correct vital functions.
When the vital signs of the crumbs are normal, the child begins to gain weight, he can be transferred to a regular neonatal unit. Impatient grandparents and other relatives are waiting to meet a new family member, constantly wondering when, finally, you can take your mother and baby home. It depends on how the child reacts to the environment, eats and gets better.
With what weight are premature babies discharged? You can discharge a premature newborn when he gains 2500 g of weight. However, if the child feels well, he has no pathological abnormalities, then he can be discharged with a weight of 2000.
This happens quite often if the pregnancy was multiple and the mother had twins or triplets on time, just the babies at birth were smaller than their peers from a singleton pregnancy.
If a newborn premature baby is not gaining weight well, he can spend several weeks or even more within the walls of a medical institution. Children with IV degree of prematurity after 3-4 weeks can only restore physiological weight loss, and only then begin to add.
Most babies born prematurely develop absolutely normally, they just need more time.
When, finally, the child is at home, it is still worthwhile to postpone the frequent visits of relatives and give him the opportunity to calmly adapt to the new environment.
Premature care at home
Since the nervous system of such children is immature, it is natural that they are late from their peers in motor development by about 6-8 weeks. It depends on when premature babies begin to hold their heads, walk, coo, roll over, be interested in toys, crawl, walk. No need to push and rush the child, all skills will come in due time.
With patronage, a doctor or nurse must control how quickly premature babies gain weight.
As a rule, weight gain in a premature baby begins at two months, at three he learns to hold his head and his weight increases by almost one and a half times.
At this time, it is still very important to maintain the optimal room temperature for the baby (air temperature +24).
At the fourth month of life, the baby already holds his head well, fixes his eyes and begins to make sounds. Just at this time it will be useful to start a course of light massage, air baths.
At five months, the baby learns to smile, pay attention to toys, try to grab them with his hands.
After six months, the immaturity of the child is less pronounced, and by the age of 2 they can no longer be distinguished from full-term ones.
Quite often, premature babies "confuse" motor skills - they start crawling late, first they get up, and then they learn to sit down, they walk on tiptoe for a long time.
Firming treatments
Water procedures perfectly strengthen all body systems of a premature baby, so daily bathing of these children is not only desirable, but also necessary. Depending on the situation, the first bathing can be carried out by a neonatologist, the procedures are necessarily carried out under a reflector. Then the parents learn to bathe the baby.
The temperature of the bathing water should not be lower than 37, but it should not be made very high either.
From the first weeks of life, the child begins to prevent rickets: UV irradiation, vitamin D, then massage and gradual hardening.
From the age of two months, premature babies are allowed winter walks if the air temperature outside the window is not lower than -8. In summer, you can start walking earlier. At first, walks last for 15 minutes, then their duration gradually increases to 1-2 hours in winter and 2-3 hours in summer.
The local pediatrician necessarily establishes dispensary observation for premature babies up to 7 years with periodic consultations of a neuropathologist, as well as other narrow specialists.
Premature diet
Premature babies have their own feeding habits. At first, they do not know how to suckle and swallow milk, then, when they learn to do this, they get very tired, even in the second or third month of life. And since feeding during this period should be frequent, they must be supplemented with expressed breast milk.
Of course, mother's milk is the most optimal product for a newborn. But in the case of agalactia of the mother or the presence of any contraindications to breastfeeding, they begin feeding the premature baby with a mixture that is adapted to the immature body, for example, Prepilti, Prenutrilon, Alprem, Nenatal, Pre-NAN and others.
The rules for the first feedings depend on the gestational age of the baby:
* the baby receives breast milk only if there was no regurgitation after taking a 5% glucose solution.
If feeding is artificial, then how much the mixture should be eaten by a premature baby must be determined by a neonatologist or pediatrician. On average, the baby should receive 150 ml of the mixture per 1 kg of body weight per day. The result obtained must be divided into 8 feedings (one feeding every three hours), then a single dose will become known.
A baby who weighed less than 2500 g at birth should eat 60 ml of milk or mixture on the first day. Then the total volume of the serving is increased daily by 20 ml, until the daily norm of 200 ml is reached. These are the average nutritional standards. Since each child is individual, consultation with a neonatologist is required.
When the baby's weight reaches 3.5 kg, you can gradually switch to a six-time feeding regimen.
When to introduce complementary foods to a premature baby? What are the best foods to start with?
It is very easy to calculate the timing of the introduction of complementary foods to a premature baby - add to the actual age the period for which he was born earlier.
For example, if a child was born prematurely by 2 months, we introduce complementary foods not at 6, but at 8 months, and so on.
In principle, feeding premature babies is no different from feeding full-term babies. First, cereals from cereals rich in iron, zinc and vitamins are gradually introduced into the baby's diet. This is rice, buckwheat, corn. Sunflower or olive oil can be added to the porridge.
After the introduction of cereals, vegetable puree is gradually added. Exotic vegetables and fruits should not be abused. It is better to use seasonal fruits typical for your region. Zucchini, broccoli, cauliflower, carrots are perfect.
Two months after the start of complementary foods, the baby can be offered kefir and gradually introduce the yolk and meat products.
As for drinking, a breastfed baby does not need additional drinking. The need to drink does not arise until 10 months, when the baby is already receiving a sufficient amount of complementary foods.
However, it will still be better if the parents discuss the child's drinking regimen with the doctor. If a premature baby is also artificial, it is imperative to give some water, but you can only use boiled water.
Separately about vaccinations
Recently, there has been a tendency for parents to refuse to vaccinate even full-term children. What can we say about the reactions to the word "vaccination" of the parents of children born earlier! But still, vaccinations for premature babies are needed to protect the already weakened body from external infections.
Even children with very low weight are able to tolerate the vaccine well, forming a sufficient amount of antibodies that can protect the children's body.
BCG vaccination, prescribed for full-term babies on the 3rd day of life, is possible after a premature baby gains a body weight of more than 2 kg. A comprehensive vaccination of DTP + OPV + Hib at 2-3 months is better for premature babies in a hospital.
Rehabilitation of premature babies is not only medical supervision and constant medical care, it is a whole range of activities in which parents should take an active role.
Creating optimal conditions for the baby, a comfortable external environment, psycho-emotional connection with mom and dad from the first minutes after birth, are the key to the success of nursing and development of the baby, who decided to be born ahead of time.
