The first child is premature and the second. Vaccinations in premature babies

A premature baby is a newborn born before 37 weeks and weighing less than 2.5 kg.

8 month. He tries to sit up himself, gets on all fours, tries to sway. He understands when he is asked to show something, and is interested in audible speech, its tone and tempo.

9 month. At this age, the baby sits more confidently, tries to crawl, speaks the first syllables, and the need for communication increases. The first teeth appear if the baby was born at 32–34 weeks.

10 month. The ten-month-old baby still prefers to crawl, but he can already stand well and walk, holding onto support. He likes to watch moving objects. He already knows his name. Babies born before 31 weeks begin to develop their first teeth.

11 month. The child is actively crawling. He has been standing for a long time without support, takes his first steps without support, and has good contact with familiar people. He is interested in cubes, pyramids, and any moving toys.

12 month. The baby can begin to walk, sometimes this happens a little later - at 18 months.
Such children reach neuropsychic maturity by 2–3 years. All this is a variant of the norm.

Features of care

Caring for a premature baby has a number of features:

1. Cloth. It should be made of natural materials, with snap fasteners, so that medical devices can be easily secured.
2. Care products. Must be hypoallergenic and selected depending on the degree of prematurity of the child. Skin The premature baby is very tender and sensitive. In the hospital department and later at home you will need diapers for premature babies. They come in “zero” sizes up to 1 kg, and from 1 to 3 kg.
3. Temperature conditions. The air temperature in the room should be 23-24 degrees, around the child’s body - approximately 28 degrees. If necessary, you can use heating pads. Optimal air humidity is 70%. This temperature regime must be maintained throughout the first month.
4. Bathing. Must not be sharp jumps temperature. To avoid this, you need to wrap the baby in a thin diaper, place it in the bathtub, unfold the cloth and wash the baby. The temperature in the room should be at least 25 degrees, water - at least 36 degrees. You need to wrap the baby in a warm towel. It is better if both parents bathe the child.
5. 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 go for a 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 weighs 2.5 kg. When a child is born in winter, going outside is allowed with a body weight of 3 kg and an air temperature of a maximum of -10 degrees.
6. Massage and physical education. All premature babies need them. It is advisable if they are done by a specialist. Physical education and massage normalize the musculoskeletal system, improve metabolism and digestion. With their help, the child will sit up, stand up, crawl and walk on time.

Features of feeding

Breastfeeding is the best thing for such children. The mother needs to breastfeed her baby for as long as possible. It is difficult for a premature baby to suckle at the breast, so he needs to be fed with expressed milk.

There are special formulas for sale for premature babies; if, due to various circumstances, natural feeding is impossible, then you will have to feed the baby with them, but you need to buy the formula after consultation with a specialist.

In the first month, you need to feed your baby 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 diet of premature babies should be varied and complementary foods should be introduced. This cannot be done before, since the digestive organs are not yet ready to digest any food other than breast milk or mixtures.

But you can’t delay complementary feeding: the baby needs vitamins and minerals. You need to start with cereals, then add vegetables and meat, fresh juices, and at the very end - dairy products. Sweet fruits and sugar should not be given.

Having a premature baby is stressful for parents. But we must remember that today medicine has stepped far forward and today it is possible to care for premature babies born even before 28 weeks.

Useful video about premature newborn babies

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A premature baby is a newborn child like others, differing from a mature newborn in underdeveloped body functions.

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

Degrees of prematurity

Premature babies belong to a separate group of newborns.

The group of premature babies is divided into a number of subgroups, but most often they are divided into two main ones: immature up to 1,500 g in weight and immature from 1,500 to 2,500 g.

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

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

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

Basically, a premature baby has all the characteristics of a newborn baby, it is just less mature. And yet, certain parts of the body lag behind others in size and development. This incommensurability in children born after fewer lunar months appears due to the fact that the formation of individual organs and systems was incomplete. For example, the skull has a round or ovoid shape and only before the end of pregnancy (10 lunar months) does it lengthen somewhat. The subcutaneous fat layer is much less pronounced, since it is mainly created before the end of pregnancy, so the premature baby has a somewhat specific appearance.

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

Causes of having a premature baby

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

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

• I would like to put ordinary negligence first expectant mother: to travel far away in a shaking train or car because “I want to”, to do general cleaning or repairs, and in all cases she believes that no one can move her closet, to fall while climbing a tree “behind that red cherry tree” or jogging on the ice... Dear expectant mothers, take care of yourself and your belly from the first days until the very birth, do not risk your baby by saying “and my friend flew to Turkey in her seventh month, and everything was fine.” There is no place for risks here!
• chronic diseases of mothers (tuberculosis, syphilis, joint diseases, anemia, etc.);
• congenital tendency to premature birth;
• injuries to working women (constant exposure to subtle but harmful influences, such as shocks, vibration, etc.);
• multiple pregnancies (twins, triplets);
• acute mental shocks of the mother;
• difficult social conditions mother’s life (illegitimate, unemployment, etc.);
• Seasons ( early spring, late fall);
• undesirable changes in the mother’s diet during pregnancy (lack of proteins and vitamins);
• attempt to have an abortion, previous abortions;
• drinking alcohol and smoking;
• too young or vice versa elderly age parents;
• non-compliance with medical instructions;
• psychological, everyday and emotional factors that negatively affect the course of pregnancy;
• period less than 2 years between births;
• difficult pregnancy;

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

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

Development of a premature baby by month

Premature baby up to 29 weeks.

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

Delivery before 29 weeks is extremely rare.

Development of a baby born at 29 weeks

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

Having a baby at 30 weeks

Children born at this stage can already be fed breast milk through a tube. They begin to develop movements.

Features of the development of a child born at 31 weeks

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

Baby born at 32 weeks

These babies weigh more than 1500 grams and can breathe on their own.

Week 33

If the child has no problems with respiratory system, then he can be bottle-fed or breastfed.

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

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

Birth of a child - 36 weeks

To the risks of birth in given period This may include imperfect thermoregulation and jaundice. The weight of such children is close to normal, and there are practically no health problems.

Development of premature babies by month depending on birth weight

The child was born weighing up to 1000 grams

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

The child was born weighing 1000-1500 grams

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

At 4 months, the head is held in an upright position.

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

Starting from 9 months, they try to sit up independently.

As children approach one year of age, they try to get up.

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

After a year, the first words are spoken.

The birth of a child weighing 1500-2000 grams.

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

Starting from 7 months, they try to sit up independently.

At 10 months, children try to stand up.

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

After 11 months, the first words are spoken.

Premature baby weighing 2000-2500 grams - development by month

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

At 2 months, the head is held in an upright position.

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

Starting from 6 months, they try to sit up independently.

Closer to 9 months, children try to get up.

Starting from 11 months, children try to take their first steps.

At 11 months the first words are spoken.

Features of the development of premature babies by month

Development of a premature baby - 1 month

High probability of infection infectious diseases which can lead to complications. Weight gain is minimal. The increase in height is on average 2-5 cm. The head circumference increases to 4-5 cm. If the development of the baby proceeds normally, a sucking-swallowing reflex should occur. If it is absent, feeding should be done using a tube. If the respiratory reflex is poorly developed, you should resort to artificial oxygen supply.

2 months of life of a premature baby

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

Premature baby and its development at 3 months

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

4 months of life of a premature baby

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

What can a premature baby do at 5 months?

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

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

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

7 months - development of a premature baby

The increase in height is on average 1-3 cm. The head circumference increases to 0.5-1 cm. The game becomes more active. The toddler turns over from his stomach to his back.

Premature baby - 8 months

The increase in height is on average 1-3 cm. The head circumference increases to 0.5-1 cm. Turning over is already easy for the baby. Attempts to crawl appear.

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

The increase in height is on average 1-3 cm. The head circumference increases to 0.5-1 cm. Picks up pieces of food without outside help, gets to his feet, holding onto the support, plays actively.

10-11 months of life of a premature baby

The increase in height is on average 1-3 cm. The head circumference increases to 0.5-1 cm. Children actively crawl, play, utter all sorts of sounds, and actively respond to their name.

A child born at a gestational age of 22-37 weeks (154-259 days from the first day of the last menstrual period) with a body weight of less than 2,500 g and a length of less than 45 cm is considered premature. A newborn with a birth weight of 500 g who has made at least just one breath. Depending on body weight at birth, there are 4 degrees of prematurity:

I degree – 2001-2500;

II degree – 1501-2000;

III degree – 1001-1500 g;

IV degree – 1000 g or less.

Birth weight is not an absolute indicator of prematurity. Thus, 1/3 of newborns weighing less than 2500 g are born full-term, and in 4-5% of premature infants their body weight exceeds 2500 g.

The main criterion for prematurity is gestational age (term intrauterine development, gestatio – pregnancy, wearing). Based on gestational age, there are 4 degrees of prematurity:

I degree – gestation period 37-35 weeks;

II degree – gestation period 34-32 weeks;

III degree – gestation period 31-29 weeks;

IV degree – gestation period 28-22 weeks.

Prematurity is a concept that relates exclusively to the neonatal period. The frequency of birth of premature babies in various regions of the country is 5-12%. The mortality rate of premature babies is 20 times higher than the mortality rate of full-term babies.

To decide whether the birth was urgent or premature, you cannot use only one of the indicators (gestational age or weight of the newborn), since they are not equivalent. The final diagnosis is made only after comparing the obstetric gestational age with the weight and maturity of the newborn.

In the postnatal period, gestational age is calculated using the Dubovich scale, which includes an assessment of the condition of the newborn based on 11 somatic signs (Table 1). Each of the signs is scored in points from 0 to 4. The resulting sum of points corresponds to a certain stage of pregnancy. Accurate knowledge of gestational age makes it possible to divide premature infants into two groups: developmentally corresponding to the gestational age and developmentally delayed (in relation to the gestational age); take a differentiated approach to resolving the issue of methods of nursing, prevention and treatment of pathological conditions in premature infants.

Grade. The amount of points corresponding to the period of intrauterine development

Note. Each indicator is given a maximum score.

Babies born before 37 weeks are considered premature. Such babies need extra care and special attention, and caring for them becomes significantly more difficult. Parents may be frightened by the size of the baby, because their further actions depend on the weight of the premature baby. If you follow all the doctors’ recommendations, you can overcome any difficulties, and after a few months all the hardships will be forgotten.

Many babies are now born premature. There is no need to panic: with proper care, doctors promise a gradual equalization of the pace of development to that of their peers and full-fledged healthy life

Main stages of development

Children born prematurely develop differently from their mature peers. On average, there is a lag of 1-3 months, depending on the period at which the child was born. Important parameters are displayed in the table of increase in height and weight of children during the first year of life:

Age by month	1 group (up to 2500 g)		Group 2 (up to 2000)		Group 3 (up to 1500 g)		Group 4 (up to 1000 g)
	Weight, g	Height, cm	Weight, g	Height, cm	Weight, g	Height, cm	Weight, g	Height, cm
1	300	3,7	190	3,8	190	3,7	180	3,9
2	800	3,6	700-800	3,9	650	4	400	3,5
3	700-800	3,6	700-800	3,6	600-700	4,2	600-700	2,5
4	700-900	3,3	600-900	3,8	600-700	3,7	600	3,5
5	700	2,3	800	3,3	750	3,6	650	3,7
6	700	2	700	2,3	800	2,8	750	3,7
7	700	1,6	600	2,3	950	3	500	2,5
8	700	1,5	700	1,8	600	1,6	500	2,5
9	700	1,5	700	1,8	600	1,6	500	1,5
10	400	1,5	400	0,8	500	1,7	450	2,5
11	400	1,0	500	0,9	300	0,6	500	2,2
12	300	1,2	400	1,5	350	1,2	450	1,7
Annual increase in height and weight	9450	25,3	8650	27,5	8450	31,7	7080	33,7

The information is provided based on long-term observations of the growth and weight of premature babies. More detailed development of a premature baby by month is presented below.

• 1 month

Parents may be concerned about the weight of their premature baby. Despite well-established nutrition, the baby does not gain the first grams well due to reduced sucking activity and a difficult swallowing reflex.

In a hospital ward it is easier to provide children with proper care in the first month, but parents can do this at home. It is enough to limit contact with the outside world and protect the baby from cooling or overheating.

• 2 months

When establishing nutrition for premature babies, the only obstacle is their weakness. In the second month there is more strength, but sucking is given to the baby with great difficulty. With healthy development, there is an increase in the weight of the premature baby, so pediatricians allow it gradually - this will allow you to start training the back muscles and will be an excellent prevention of colic in children.

• 3 months

In terms of basic needs, premature babies are no different from normal newborns. They also need food and restful sleep. For proper formation of the skull and prevention of torticollis, you need to monitor the position of the child’s head. Parents will be pleased with the appearance of the first facial reactions. The baby is not yet able to smile, but he will react to touch: he tries to raise his head and keeps his gaze on his mother’s face. The development of premature babies at this stage concerns auditory and visual attention, as well as the grasping reflex. The baby's weight from the moment of birth should double during this period.

A three-month-old premature baby does not yet know how to smile, but will be able to please his mother with his first emotional reactions, and is actively mastering the grasping reflex

• 4 months

The child can not only raise his head, but holds it quite confidently. He gurgles and is able to grab a toy with his hand. Some children may experience muscle tone, which only a specialist can diagnose. It is easy to get rid of increased tone with a course of massage or simple exercises. It is advisable to entrust all procedures to a professional.

• 5 months

The toy is not just grabbed reflexively, but is held well in the child’s hand. The first smile and interest in everything that surrounds the baby appears. Visual and auditory reactions increase noticeably. If no abnormalities are detected in the child, then at this age the baby already turns his head in the right direction towards the sound.

• 6 months

The child’s weight increases 3 times in 6 months. The toddler makes his first attempts to roll over onto his stomach from his back. As they grow, communication becomes more active, which is facilitated by recognition of relatives. At sight loved one the child makes sounds, waves his legs and arms. With support in the armpit area, he can rest his legs on the surface, squatting a little.

Komarovsky notes that after 6 months, premature babies require the same care and nutrition as their mature peers. At this stage, the baby’s development gradually levels out and reaches the pace of his peers in most cases.

• 7 months

By the 7th month, the baby becomes even more active, turning from back to stomach and back is easy. The toy rests confidently in the hand, and the child takes his first journey, trying to crawl funny, pushing off with his legs. If the baby was born at 35-37 weeks and receives all the important microelements from food, at 7 months his first teeth erupt.

• 8 months

The toddler tries to sit without the help of adults, gets on all fours and tries to swing. Thanks to proper development movements are skillful and performed consciously. The child is interested in his own activities, simple games and communication with loved ones. Responds to a request to show a certain object, listens with pleasure to fairy tales and poems, lullabies and nursery rhymes, catching changes in intonation.

At 8 months, the baby will be happy to listen to a fairy tale or a story invented by his mother, and will be able to distinguish the voices of different characters if read by role

• 9-10 months

Sits confidently, begins to crawl, requires more communication. Teeth appear if the baby is born between 32 and 34 weeks. Repeats sounds and syllables after adults. He stands more confidently, he can move with support, but for now he thinks that crawling is easier and faster. Obsessively watches moving objects. Instantly reacts to sound, recognizes its own name, listens to the world around it. The first teeth appear in those born before 31 weeks.

• 11 months

The period of active crawling and exploration by children of the surrounding world continues, despite the acquired ability to sit down and stand up. Without support, the baby is able to stand for a very long time and even takes the first steps without holding on to support. Pyramids, cubes and all toys that move are useful for development. He makes good contact with family and recognizes familiar faces.

After one year of age, the toddler can walk on his own. This is proof that premature babies are able to catch up with their peers in development. In some cases, the process drags on for up to 1.5 years, but physical development is easier than neuropsychic development. Full maturity is usually formed by 2-3 years, so parents have nothing to worry about before this period.

At the age of one year, the baby is able to learn to walk, like most of his peers. By this time, the mother will practically cease to remember that her child was born. ahead of schedule

Nutrition after birth

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It is very problematic to establish feeding a baby at first. The baby needs to receive nutrients, but his body is not able to fully absorb them. The best way Feeding for premature babies is selected by a specialist, taking into account the period at which the baby was born, assessment of condition and weight.

If a baby was born with a body weight of 2000 g or more, then doctors may allow him to be put to the breast immediately. The mother is required to carefully monitor the baby while breastfeeding. The slightest signs of fatigue and the appearance of shortness of breath indicate that breastfeeding you need to allocate less time and feed with the remaining amount.

When a newborn's body weight is from 1500 to 2000 g, he is offered breast milk in a bottle. Test feeding allows you to determine the baby’s readiness for independent feeding. If sucking activity is unsatisfactory, then tube feeding is prescribed.

For children weighing up to 1500 g, only tube feeding is allowed for weight gain. Feeding premature babies is possible in two ways:

• portioned;
• by long-term infusion.

Portioned meals mean 7-10 feedings per day. Due to the small volume of the premature baby's stomach, parenteral administration of nutrients is often carried out.

If the mother does not have milk or the baby is intolerant to it, he is on artificial feeding. Formula milk must have its own characteristics that allow it to be used in the diet of a premature baby.

First introduction to new food

Complementary feeding is introduced into the diet of babies born prematurely after six months. Digestive system ripens later, metabolic processes are not stable, so earlier introduction of new products may end sadly. Calculating the correct age for complementary feeding is simple: the starting point is the date when the baby should be born. If the baby came into this world a month earlier, then complementary foods should be introduced 1 month later.

Some mothers decide to play it safe and hold off on complementary feeding, which is also wrong. Premature babies have a meager supply of nutrients, so they cannot do without enriching the diet. After introducing complementary foods, breast milk cannot be excluded from the daily menu. Feeding new foods should be completed by latching on to the breast or offering a bottle of formula.

First, porridge appears in the diet, and then you can add fruit and vegetable purees. The order is explained by underweight, which is often found in babies born prematurely. It is better to use hypoallergenic cereals in the menu of premature babies:

• buckwheat;
• corn;
• rice

Porridges are diluted with mixtures or mother's milk so that the baby gets used to the new taste. In the absence of allergic reactions, the following is introduced into complementary foods:

• vegetables;
• meat;
• dairy products.

When feeding premature babies, you cannot do without consulting a pediatrician. It can determine the optimal period to begin introducing new products.

Since the baby needs to gain weight as quickly as possible, complementary feeding does not begin with fruit purees, and with cereals that have a higher nutritional value

Proper care

The harmonious development of a premature baby directly depends on the conditions in which he grows. It is important to provide him with appropriate care at home:

• Temperature

It is necessary to set a suitable temperature in the room within 23-25 ​​C. Next to the baby it should reach 28-32 C. You can use heating pads with water at 60-65 C. The heating pads are first wrapped in a diaper or towel to eliminate the risk of burns. It is better to place them in the legs under the blanket and on top of the blanket on the sides at a palm's distance. It is necessary to change the water every 1.5-2 hours. Additional heating will not be required after the first month of life, as the baby will learn to regulate its body temperature on its own. Acceptable humidity level is 50-70%.

• Bathing

If the baby is at risk and was born weighing less than 1500 g, pediatricians do not recommend bathing him for another 3 weeks. It is enough to carry out daily hygiene. The rest of the toddlers are allowed water treatments 7-10 days after birth. During the first 3 months, premature babies should only be bathed in boiled water at a temperature of 38 C. The bathroom must be heated to at least 25 C for the baby to feel comfortable.

• Walks

If the baby weighs more than 1500 g, you can start walking with him 2 weeks after birth (we recommend reading:). This recommendation concerns summer period, when the air temperature has risen to +25-26 C. The duration of the first “outing” should not exceed 10-15 minutes. With each walk, the time spent on fresh air gradually increases until it reaches 1-1.5 hours. In the spring-autumn period, it is allowed to walk with babies aged 1-1.5 months at an outside temperature of +10 C. The weight of the baby must be at least 2500 g. If the thermometer drops below +8-10 C, you can take walks with babies aged from 2 months and weighing 2800-3000 g. In the future, walks are planned according to the same scenario as for ordinary children.

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. National statistics of Russia on miscarriage (spontaneous termination of pregnancy at less than 37 full weeks) takes full account of these recommendations. 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.

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. Bad influence Smoking not only affects the mother's health, but also the father's. Severe developmental defects in children of men who have smoked 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

Appearance premature baby depends on the degree of prematurity.

Deep 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, nipples and areola mammary glands 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.

In more mature premature babies appearance other. 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, violation of thermoregulation, 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 on last month pregnancy (full-term boys are larger than girls).

Peculiarities 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 disruption 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: maternity hospital and a specialized department. Then the child comes under the supervision of the clinic.

All over the world, great importance is attached to “gentle nursing of premature infants” with the limitation of intensive care, stressful situations, 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 proper use of all modern methods care and treatment. 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 individual characteristics 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, warmed diapers, prolonged stay on the mother’s breast (kangaroo type), and a calm voice. nurse, stroking movements of her hands.

Only 8-10% of healthy premature babies with a birth weight of more than 2000 g 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 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. With a satisfactory general condition, a sufficiently pronounced sucking reflex and a body weight at birth of 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 who were born very prematurely often develop disorders in the future. menstrual cycle, signs of sexual infantilism, threat of miscarriage and premature birth.

Despite the above, when proper care and proper 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.