Today, premature births are common. In most developed countries, this indicator is relatively stable and amounts to 5-10% of the total number of children born.

The prognosis for life in premature babies depends on many factors. First of all, from the gestational age and birth weight. In the case of the birth of a child in the period of 22-23 weeks, the prognosis depends on the intensity and quality of therapy.

Long-term consequences of prematurity (the likelihood of these complications again depends on many factors; under other favorable conditions, these complications are quite rare). Among premature babies, the risk of mental and physical disability is higher than among full-term babies.

The concept of prematurity.

A premature baby is a baby born before the end of the normal gestational age.

Usually, it is customary to classify children as premature if their birth weight is less than 2500 g. However, the definition of prematurity only by birth weight does not always correspond to reality. Many children born prematurely have a body weight of more than 2500 g. This is more often observed in newborns whose mothers have diabetes.

At the same time, among full-term infants born at 38-40 weeks of gestation, there are children whose birth weight is less than 2000 g and even 1500 g. These are primarily children with congenital malformations and intrauterine diseases, as well as from multiple pregnancies and sick mothers. Therefore, it is more correct to consider the duration of pregnancy as the main criterion for determining prematurity. On average, as you know, a normal pregnancy lasts 270-280 days, or 38-40 weeks. Its duration is usually calculated from the first day after the last menstruation until the onset of childbirth.

A baby born before 38 weeks of gestation is considered premature. Children with a birth weight of more than 2500 g are diagnosed with prematurity, according to the International Nomenclature (Geneva, 1957), if they were born before 37 weeks.

Babies born at 38 weeks' gestation or more, regardless of birth weight (more or less than 2500 g), are full-term. In controversial cases, the issue of full-term is decided on the basis of a combination of signs: gestational age, body weight and height of the child at birth.

Childbirth before 28 weeks of gestation is considered a miscarriage, and a newborn with birth weight less than 1000 g (from 500 to 999 g) is considered a fetus. The concept of "fetus" persists until the 7th day of life.

The degree of prematurity of children (intrauterine malnutrition)

The degree of intrauterine malnutrition is determined by the lack of body weight. For normal body weight, we conditionally accept the lower limit of the limit corresponding to the given gestational age indicated above. The ratio of body weight deficit to the minimum body weight for this gestational period as a percentage shows the degree of intrauterine malnutrition.

We single out 4 degrees of intrauterine malnutrition: with I, the body weight deficit is 10% or less; with II - from 10.1 to 20%; with III - from 20.1 to 30% and with IV - over 30%. Here are some examples:

1. A child weighing 1850 g was born at 35 weeks. The mass deficit is (2000-1850): 2000 X 100=7.5%. Diagnosis: prematurity of the 1st degree, intrauterine malnutrition of the 1st degree.
2. A child weighing 1200 g was born at 31 weeks. The mass deficit is (1400-1200): 1400 X 100 = 14.3%. Diagnosis: prematurity III degree, intrauterine malnutrition II degree.
3. A child weighing 1700 g was born at 37 weeks. The mass deficit is (2300-1700): 2300 X 100 = 26%. Diagnosis: prematurity of the 1st degree, intrauterine malnutrition of the 3rd degree.
4. A child weighing 1250 g was born at 34 weeks. The mass deficit is (1800-1250): 1800 X 100 = 30.5%. Diagnosis: prematurity II degree, intrauterine malnutrition IV degree.

Features of premature babies

The appearance of premature babies has distinctive features that are directly dependent on the gestational age. The lower the gestational age, the more such signs and the more pronounced they are. Some of them can be used as additional tests to estimate gestational age.

1. Small sizes. Low growth and reduced nutrition are characteristic of all premature infants, with the exception of children born weighing over 2500 g. corresponds to the length of the body, they just look petite. The presence of wrinkled, flabby skin at birth is typical for children with intrauterine malnutrition, and later observed in premature patients who, for various reasons, gave a large weight loss or have a flat weight curve.
2. Disproportionate physique. A premature baby has a relatively large head and torso, short neck and legs, and a low navel. These features are partly due to the fact that the growth rate of the lower extremities increases in the second half of pregnancy.
3. Severe hyperemia of the skin. More characteristic of fruits.
4. Expressed lanugo. Small premature babies have soft fluffy hair not only on the shoulders and back, but abundantly cover the forehead, cheeks, thighs and buttocks.
5. Gaping of the genital slit. In girls, due to the underdevelopment of the labia majora, the genital gap gapes and the clitoris is clearly visible.
6. Empty scrotum. The process of lowering the testicles into the scrotum occurs in the 7th month of uterine life. However, for various reasons, it may be delayed. In very premature boys, the testicles are often not descended into the scrotum and are located in the inguinal canals or in the abdominal cavity. Their presence in the scrotum indicates that the gestational age of the child exceeds 28 weeks.
7. Underdevelopment of fingernails. By the time of birth, the nails, even in the smallest children, are quite well formed and completely cover the nail bed, but often do not reach the fingertips. The latter is used as a test to assess the degree of nail development. According to foreign authors, the nails reach the fingertips at 32-35 weeks of gestation, and at more than 35 weeks they protrude beyond their edges. According to our observations, the nails can reach the tips of the fingers as early as the 28th week. Assessment is carried out in the first 5 days of life.
8. Soft ear shells. Due to the underdevelopment of cartilage tissue in small children, the auricles often tuck inward and stick together.
9. The predominance of the brain skull over the facial.
10. The small spring is always open.
11. Underdevelopment of the mammary glands. Premature babies do not have physiological breast engorgement. The exception is children whose gestational age exceeds 35-36 weeks. Breast engorgement in children weighing less than 1800 g indicates intrauterine malnutrition.

Characteristics of premature babies.

When evaluating any premature baby, it should be noted to what extent it corresponds to its gestational age, which can only be attributed to the prematurity itself, and which is a manifestation of various pathological conditions.

The general condition is assessed on a generally accepted scale from satisfactory to extremely severe. The severity criterion is primarily the severity of pathological conditions (infectious toxicosis, CNS damage, respiratory disorders). Prematurity itself in its "pure" form, even in children weighing 900-1000 g, in the first days of life is not a synonym for a serious condition.

The exception is fruits with a body weight of 600 to 800 g, which on the 1st or 2nd day of life can make a very favorable impression: active movements, good tone of the limbs, a rather loud cry, normal skin color. However, after some time, their condition deteriorates sharply due to respiratory depression, and they die rather quickly.

Comparative characteristics are carried out only with premature babies of a given weight category and gestational age. If preterm infants of IV-III degree do not have a syndrome of depression, severe neurological symptoms and significant respiratory disorders, their condition can be regarded as moderate or a more streamlined wording can be used: “the condition corresponds to the degree of prematurity”, “the condition basically corresponds to the degree prematurity."

The latter means that the child, in addition to prematurity, has moderate manifestations of atelectasis or a mild form of encephalopathy.

Premature babies tend to worsen their condition as the clinical manifestation of pathological syndromes occurs several hours or days after birth. Some doctors, in order to avoid reproach for underestimating the child, indiscriminately regard almost all premature babies as severe, which is reflected in the stencil entry: “The condition of the child at birth is severe. The severity of the condition is due to the degree of prematurity and its immaturity. Such a record, on the one hand, does not contribute to clinical thinking, and on the other hand, does not provide sufficient information for an objective assessment of the child at the subsequent stages of nursing.

The maturity of the newborn means the morphological and functional correspondence of the central nervous system to the gestational age of the child. The standard of maturity is a healthy full-term baby. Compared to him, all premature babies are considered immature. However, each gestational age of a premature baby has its own degree of maturity (gestational maturity). When a developing fetus is exposed to various damaging factors (infectious and somatic diseases of the mother, toxicosis of the pregnant woman, criminal intervention, etc.), the maturity of the child at birth and in subsequent days may not correspond to his age. In these cases, we should talk about gestational immaturity.

The concepts of "mature" and "healthy" newborn are not identical. The child may be sick, but his maturity is to match his true age. This applies to pathological conditions that are not accompanied by CNS depression. In severe pathology, it makes no sense to determine the maturity of a child.

The determination of maturity is carried out not only at the birth of a child, but also in the following days, during the 1-3rd week of life. However, during this period, functional CNS depression is often due to postnatal pathology (infectious toxicosis), therefore, in our presentation, the concept of "gestational immaturity" is interpreted more broadly. It reflects the morphological underdevelopment of the brain, as well as the functional damage to the central nervous system of intrauterine and postnatal origin. More precisely, we determine not so much gestational maturity as the correspondence of a given child to premature babies of similar body weight and age.

For comparative characteristics, motor activity, the state of muscle tone and reflexes of the newborn, the ability to maintain body temperature, and the severity of the sucking reflex can be used. Under equal conditions, they can also start sucking earlier and more actively.

In addition to immaturity, severe hypoxia, various CNS lesions, and infectious toxicosis have a depressing effect on the sucking reflex. The combination of these factors leads to the fact that many premature babies are unable to suck from the horn for a long time. The duration of this period in children weighing 1800 g or more usually does not exceed 2.5-3 weeks, in children weighing 1250-1700 g - 1 month and in children weighing 800-1200 g - 1'/ 2 months.

A more prolonged absence of suckling, which cannot be explained by a generalized or indolent infection, goes beyond mere gestational immaturity and should be alert for organic CNS damage, even if there are no neurological symptoms at this time.

Inhibition of sucking in children who have previously actively sucked is almost always associated with the appearance of a focus of infection.

According to our data, children weighing up to 1200 g in the first 2 months of life increase their height by 1-2 cm per month, children with a larger weight - by 1-4 cm.

The increase in head circumference in premature babies of all weight categories in the first half of the year averages 3.2-1 cm per month, and in the second half of the year - 1-0.5 cm. During the first year of life, the head circumference increases by 15-19 cm and in at the age of 1 year, on average, it is 44.5-46.5 cm [Ladygina V. E., 1972].

Physical development of premature babies

Of interest is the physical development of the smallest children with a birth weight of 800 to 1200 g. According to our data, the average body weight of these children at the age of one year is 8100 g, with the most frequent fluctuations from 7500 to 9500 g. Depending on the gender, we did not observe in children with a birth weight of up to 1200 g a difference between the body weight of boys and girls.

The average weight gain for the 2nd year of life in children with a birth weight of 800 to 1200 g, according to our data, is 2700 g, and at 2 years of age their weight is on average 11000 g with the most frequent fluctuations from 10,000 up to 12,000

The average body weight for boys at the age of 2 years is 11,200, and for girls, 10,850 g.

The rate of increase in height in children with a birth weight of 800 to 1200 g is also quite high. According to our data, children in this weight category increase their initial height by 2-2.2 times by a year, reaching an average of 71 cm with fluctuations from 64 to 76 cm. During the first year of life, they grow on average by 38 cm with fluctuations from 29 to 44 cm.

In contrast to weight indicators, the average height of boys with a birth weight of up to 1200 g at the age of one year was higher than that of girls - 73 and 69.5 cm, respectively.

During the 2nd year of life, children with a birth weight of 800 to 1200 g, according to our data, increase their height by an average of 11 cm and reach 81 cm at 2 years of age, with fluctuations from 77 to 87 cm.

Interesting data were obtained by R. A. Malysheva and K. I. Kozmina (1971) in the study of the physical development of preterm infants at an older age. Examining children aged 4 to 15 years, they found that after 3-4 years of life, premature children in terms of body weight and height are compared with full-term peers, at 5-6 years of age, i.e., in the period of the first " stretching”, they again, according to these indicators, especially in body weight, begin to lag behind full-term children. By the age of 8-10 years, growth rates level off again, but the difference in body weight between full-term and premature boys remains.

With the approach of puberty, the same pattern repeats itself: the second "stretching" in premature babies occurs 1-2 years later. In full-term boys, growth between 11 and 14 years increases on average by 20 cm, in girls - by 15 cm, in premature babies, these figures are respectively less - 16 and 14.5 cm. Full-term boys increase body weight during this period by an average of 19 kg, girls - 15.4 kg, premature babies - by 12.7 and 11.2 kg, respectively.

Teething in premature babies, it starts at a later date. There is a correlation between body weight at birth and the time when the first teeth appear. According to some data, in children with a birth weight of 2000 to 2500 g, the eruption of the first teeth begins at 6-7 months, in children weighing from 1501 to 2000 g - at 7-9 months and in children weighing from 1000 to 1500 g - at 10-11 months. According to our data, in children with a birth weight of 800 to 1200 g, the first teeth appear at the age of 8-12 months, on average - at 10 months.

In conclusion, let us touch upon a question that often arises among doctors of children's clinics: should all premature babies be considered as children with malnutrition in the first year of life.

The physical development of premature babies has its own characteristics and depends on body weight at birth, previous diseases and constitutional features of the child. Assessment of body weight indicators should be carried out only in comparison with those in healthy premature babies of this weight category. Therefore, it is completely wrong to regard a child born with a weight of 950 g, in which at the age of one year it is equal to eight kg, to regard as a patient with malnutrition. Diagnosis: prematurity in such a child explains the temporary lag in physical and psychomotor development.

Psychomotor development of premature babies: consequences

Basic psychomotor skills in most premature babies appear later than in full-term babies. The lag in psychomotor development depends on the degree of prematurity and is more pronounced in children weighing less than 1500 g. bodies from 1501 to 2000 - for 1 - 1 1/2 months.

By the end of the first year, most children with a birth weight of 2001 to 2500 g catch up with their full-term peers in psychomotor development, and by the age of 2, deeply premature ones are compared with them.

Data on the psychomotor development of premature babies by months are presented in Table. one.

Table 1 Some indicators of psychomotor development in premature babies in the 1st year of life, depending on body weight at birth (data from L. 3. Kunkina)

Time of onset in months based on birth weight visual-auditory concentration Keeps head upright Turn from back to stomach Turn from belly to back On one's own: Starts to say words

Thus, in terms of psychomotor development, premature babies are compared with their full-term peers earlier than in terms of height and body weight.

However, in order for a child to develop well, a lot of individual work must be done with him (massage, gymnastics, display of toys, colloquial speech).

In long-term ill preterm infants and in children who were deprived of the necessary individual care, the lag in psychomotor development is more pronounced.

Consequences of prematurity, prognosis (catamnesis)

The prospect of nursing premature babies largely depends on their further psychomotor development. In this regard, early and long-term prognosis is of great importance.

The literature on this issue is contradictory. This is primarily due to the unequal contingent of the examined children, the difference in the tests used to determine the usefulness of the child, as well as the number of specialists (neurologist, psychiatrist, ophthalmologist, speech therapist) involved in the examination.

Some authors are very pessimistic about the neuropsychic development of premature babies. As an example, let us cite the statement of the prominent Finnish scientist Ilppö: “The mental development of premature babies in the first years of life lags behind the norm. Unfortunately, a significant proportion of these intellectual defects persist for life. Premature babies are much more likely to show more or less severe mental disability. Intellectual disorders are often combined with hemiplegia, paraplegia, Little's disease ”(Fanconi G, Valgren A, 1960). In the studies of many authors, there is a large percentage of severe CNS lesions in non-term infants.

R. A. Malysheva et al., examining 255 premature babies aged 3-4 years, 32 of them (12.6%) had severe organic lesions of the central nervous system and 50% had slight deviations in neuropsychic development.

According to S. Drillien, almost 30% of premature babies born weighing up to 2 kg have moderate or severe impairments in psychomotor and physical development.

A. Janus-Kukulska and S. Lis, in a study of 67 children with a birth weight of up to 1250 g, aged 3 to 12 years, half of them found a lag in physical and mental development, 20.9% were found to have severe CNS lesions .

Attention is drawn to the frequency of various lesions of the organ of vision. In the studies of A. Janus-Kukulskaya and S. Lis, 39% of children weighing up to 1250 g at birth were found to have various visual defects: myopia, strabismus, astigmatism, optic nerve atrophy, retinal detachment. Other researchers also point to a high percentage of congenital myopia (30%) in premature babies [Grigorieva VI et al., 1973].

K. Rare et al. (1978), studying the follow-up of 43 children born weighing up to 1000 g, 12 of them were found to have severe eye damage, including 7 - retrolental fibroplasia (RLF) and 2 - complete loss of vision.

S. Saigal et al. (1982) in a study of 161 children with a birth weight of up to 1500 g, RLF was found in 42 children, in 12 of them it proceeded in a severe form.

At the same time, other authors note a more favorable outcome in the follow-up examination of premature babies. In the observations of N. R. Boterashvili, the frequency of CNS lesions varied depending on the degree of prematurity from 3.8 to 8.5%. L. 3. Kunkina, studying together with a neurologist 112 premature babies aged 3 years, 4 of them (3.6%) found a delay in neuropsychic development, 7 (6.2%) had neurotic reactions in the form anxiety, sleep disorders, logoneurosis, and in 2 (1.7%) - epileptiform seizures [Kunkina L. 3., 1970].

J. Hatt et al. (1972), observing 26 children with a birth weight of 1250 g or less at the age of 2 to 12 years, 77.8% of them noted normal mental development.

S. Saigal et al. (1982) studied follow-up for 3 years in 184 children born weighing up to 1500 g. 16.8% had neurological disorders, including 13% - cerebral palsy.

According to A. Teberg et al. (1977) and K. Rare et al. (1978), among children with a birth weight of 1000 g or less, 67.5-70% had no deviations in the neurological status.

Analyzing the literature data and our own material, we can note the following:

1. Premature infants are significantly more likely than full-term infants to have organic lesions of the central nervous system.

They are caused by the pathology of the prenatal period, complications in childbirth and damaging factors in the early postnatal period (hyperoxemia, hyperbilirubinemia, hypoglycemia);

1. preterm infants with a gestational age of less than 29 weeks and a body weight of less than 1200 g, due to underdevelopment of the retina, have a greater predisposition to the development of RLF. It is in this contingent of children that this pathology is mainly observed;
2. in recent years, premature babies have a tendency to increase the incidence of cerebral palsy. By the way, this is typical for full-term children. This trend can be explained by two reasons: firstly, there are now more opportunities to save a pregnancy that occurs with the threat of interruption; secondly, progress in organizing specialized care for newborns and the creation of resuscitation services in maternity hospitals contribute to the survival of children with asphyxia. - this and intracranial hemorrhages;
3. The prospects for the psychophysical development of premature babies largely depend on how pathogenetically substantiated and sparing (iatrogenic factors) the therapy was at the 1-2nd week of life and how early and consistently rehabilitation assistance was provided at subsequent stages.

Due to the fact that mild forms of cerebral palsy are not detected immediately, and often only in the second half of the first year of life, and some pathology of vision is not diagnosed by pediatricians at all, after discharge from the department of premature infants with a burdened anamnesis and weighing up to 1500 g should be observed by a neurologist, as well as undergo an examination by an ophthalmologist.

Based on the above, premature babies should remain under the systematic supervision of neonatologists from the moment of birth until the period when their health is out of danger, and the body becomes ready for independent life.

Doctor of Medical Sciences, Alexander Ilyich Khazanov(St. Petersburg)

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What are the consequences for premature babies in the future?

Premature babies - what should parents prepare for, what do they need to know? features of these children. What consequences await in the future? Caring for extremely premature babies.

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Premature babies - the consequences of premature birth in the future, what complications await these babies, what parents are preparing for - we will tell in this article. Every year, the birth rate of premature babies increases, which were born at 5, 6, 7, 8 months. The longer the child develops in the womb, the higher the chance of his survival. In the conditions of modern medicine, it is possible to save the life of even the smallest children born at 23-24 weeks. Cases have been recorded when they saved the life of a 22-week-old newborn.

Premature babies: accompanying disorders

No one can predict with certainty what future consequences await premature babies. Some babies born earlier than term develop as full-term, others are slightly or significantly behind their peers. The prognosis of development largely depends on how early the baby was born.

As a result of premature birth, the child is deprived of the opportunity to achieve full development in the mother's womb. In addition to problems at birth, premature babies may face the consequences of prematurity in the future. Such babies often grow weak and painful.

Depending on the degree of prematurity, children born prematurely have a number of disorders that limit the child's ability to survive without modern medical care:

low body weight;

underdevelopment of the lungs (pulmonary insufficiency);

visual impairment (retinopathy) and hearing;

prolonged jaundice in newborns;

neurological disorders;

developmental disorder.

These disorders can cause complications such as: patent ductus arteriosus (which should close after birth), necrotizing enterocolitis, intracranial hemorrhage, bronchopulmonary dysplasia, mental retardation. All these complications require prompt diagnosis in order to help a small patient.

Babies born between 24 and 26 weeks of age have an increased risk of mental and motor retardation. The most common movement disorder in premature babies is cerebral palsy. The later the child is born, the less likely it is.

Another consequence of prematurity can be retinopathy, a disease in which vision is affected. It usually occurs in babies born before 28 weeks.

A newborn who was born prematurely should be regularly observed by a doctor until the age of 3 years. It is advisable to do this during the primary school age. This will allow you to control the development of the child and respond to possible complications in time.

Caring for extremely premature babies

These babies are called extremely premature, with very low body weight up to 1500 g. They are too weak, their body is not able to perform its vital functions without medical help. Having virtually no immunity, the body of these children cannot protect itself from infection. Any infection can lead to serious illness, therefore, very premature babies are prescribed antibiotics immediately after birth.

At first, extremely premature babies are in a special medical incubator, in which artificial intrauterine conditions are created. In the incubator (as this incubator is called), the baby is connected to a ventilator. The required temperature is also maintained there, feeding is provided, and many other manipulations are performed that are necessary for nursing extremely premature babies.

Parents need to be prepared for a long-term nursing of such a child. Often these children later have deviations in physical and mental development and require medical supervision by many specialists.

Premature baby 7 months - consequences

Children, months old, usually weigh less than 2000 g. They are still weak and often nursed in the intensive care unit. If the baby is not capable of independent breathing, then first it is placed in intensive care, where it is connected to a ventilator.

At this age, the child often does not have a sucking reflex, and accordingly, he cannot take mother's milk in a natural way or receive nutrition through the nipple. In such cases, feeding is carried out intravenously or through a tube.

Seven-month-old premature babies, the consequences in the future for them are ambiguous. Their immune system is usually weakened. This contributes to frequent bacterial infections. Infections are one of the main causes of high mortality among premature babies.

The body of a prematurely born baby is not fully formed, therefore it is vulnerable to the development of many diseases and disorders. Due to its immaturity, it is not able to perform its functions, like the body of a full-term baby. In this regard, problems of the respiratory system, heart defects, intellectual disorders may appear later in the child's life.

In this article:

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

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

Which babies are considered premature

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

How long can such a child leave

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

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

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

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

Causes of prematurity

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

Social and economic:

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

Social and biological:

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

Various diseases:

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

What is the immaturity of a premature baby

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

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

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

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

For such children, special vaccinations may be used.

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

Care

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

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

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

Nursing premature babies using the kangaroo method

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

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

How long will mom and baby stay in the hospital?

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

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

feeding

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

Vaccinations

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

Criteria, development and norms of behavior

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

What to do if anxiety symptoms occur?

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

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

Useful video about premature babies

Retinopathy of prematurity: description of the disease, consequences, which children have, risk factors, prevention - video

Premature babies: what kind of baby is considered premature, rehabilitation and nursing, developmental features, the opinion of a pediatrician - video

Rehabilitation of premature babies: doctors use hammocks - video

The site provides reference information for informational purposes only. Diagnosis and treatment of diseases should be carried out under the supervision of a specialist. All drugs have contraindications. Expert advice is required!

Did you have a premature baby? Of course, you are worried and ask a lot of questions, the answers to which, alas, you do not always get in a timely manner. Meanwhile, knowing the "weak" places of the baby, you can more easily cope with many situations - for example, feeding or bathing. Yes, and a small weight gain or some lag behind the crumbs in development from their peers will not cause concern.

In addition, remember that any medical forecast is by no means the final "verdict". Quite often, babies with seemingly favorable data die or lag behind in development, while children with gloomy prospects survive and grow up healthy against all odds.

So you want to know everything about premature babies? We will tell you about the features of physiology, development, nursing, feeding and restorative treatment of babies born much earlier than expected.

As defined by the World Health Organization (WHO)

A child is considered premature if he was born between 22 and 37 weeks of gestation (gestation) with a weight of 500 to 2500 grams and a height of 25 to 40 centimeters.

premature baby day

It is celebrated on November 17, which was established in 2009 by the European Foundation for the Care of Newborn Patients.

Degrees of prematurity

They are determined depending on the weight and the number of complete weeks of pregnancy (gestation) at the time of delivery.

I degree

The baby is born at 34-36 weeks and 6 days with a weight of 2001 to 2500 grams. The child is fully mature and self-sufficient. Therefore, as a rule, no special conditions are required. However, sometimes treatment and nursing is necessary - for example, with prolonged jaundice, trauma during childbirth, and some other conditions.

II degree

The baby is born at 31-33 weeks and 6 days with a weight of 1501 to 2000 grams. Usually, the baby quickly adapts to new living conditions with the provision of timely medical care, as well as the creation of appropriate conditions for care and feeding.

III degree

Very early delivery at 28-30 weeks of gestation with a baby weighing 1001 to 1500 grams. Many of these children survive, but in the future they need long-term rehabilitation treatment and observation by doctors of various specialties. Sometimes some babies have various diseases, congenital malformations or genetic abnormalities.

IV degree

Childbirth before 28 weeks of pregnancy with an extremely low birth weight of a child up to 1000 grams. The baby is immature and completely unprepared for new conditions. Every fifth baby is born alive, but the chance of survival is extremely low. Unfortunately, many children die before reaching the age of one month: of those born before 26 weeks - 80-90% of babies, at 27-28 weeks - 60-70%.

Moreover, such children usually have numerous severe diseases and / or congenital malformations, which significantly worsens the prognosis. Parents are explained the further probable fate of the crumbs and the need for long-term nursing. The final decision on the management of a very premature baby is recommended to be made jointly with an obstetrician-gynecologist, neonatologist and parents.

Signs of prematurity

Depend on the number of completed weeks of pregnancy (gestational age) at the time of birth.

Moderate, or I-II degree of prematurity

Baby is mostly active, moves arms and legs, but his muscle tone is somewhat reduced.

Cardiovascular system of premature babies

In utero, the fetus has a special blood circulation. The fact is that the lungs do not participate in breathing, and oxygen enters the blood from the vessels of the placenta. Arterial blood, once in the blood vessels of the baby, mixes with venous blood and is again distributed throughout the body.

This process is possible due to holes, or shunts, between the chambers of the heart and large vessels.

In a full-term baby, after the first breath, auxiliary openings are closed. This is how the blood circulation of the newborn is established, ensuring the supply of arterial blood to the organs and tissues.

Due to the incomplete maturation of tissues in a premature baby, such a restructuring occurs much later. In addition, this process is also delayed due to an increase in the load on the heart and blood vessels: resuscitation (revival) in the delivery room, artificial lung ventilation, intravenous infusion of solutions.

A premature baby often has congenital heart defects that significantly worsen his condition.

A child born before the expected date is sensitive to external stimuli (touch, loud sound) with an increase in heart rate and an increase in blood pressure.

Endocrine system of a premature baby

Cortisol is insufficiently produced by the adrenal cortex, a hormone necessary to adapt the baby to life outside the womb and ensure an adequate response to stress (birth). With adrenal insufficiency, the child's condition deteriorates rapidly: blood pressure drops sharply and the amount of urine decreases, body temperature drops.

The function of the thyroid gland is temporarily reduced (transient hypothyroidism), which leads to a slowdown in the metabolism of the baby. The condition is manifested by a tendency to edema, prolonged jaundice, poor weight gain, and various respiratory disorders.

The sex glands produce hormones in insufficient quantities, so the sexual crisis is not pronounced:

• In girls, the mammary glands moderately enlarge and the labia swell, and spotting from the genitals is not pronounced or absent.
• In boys, the scrotum and penis may swell slightly.

Low blood sugar (hypoglycemia)

Often occurs in the first 3-5 days of life, due to several factors:

• Insufficient stores of glycogen - a form of storage of glucose in cells.
• Reduced production of enzymes by the pancreas, which reduces the breakdown and absorption of glucose from the intestines and stomach.
• Increased synthesis in the pancreas of insulin - a hormone that promotes the penetration of glucose into cells.

The norm of glucose for newborns is from 2.8 to 4.4 mmol / l.

What is the danger of hypoglycemia? The maturation of the nervous tissue is disturbed, in the future, epileptic seizures (convulsions) and mental retardation may occur.

The immune system of preterm infants

There is also a positive moment in such work of the immune system: in some babies, the risk of developing allergic reactions after birth is somewhat reduced.

However, as they grow older, on the contrary, the child becomes more susceptible to

We have already talked about premature babies, but we still have a lot of questions that we want to get an answer to. First of all, how does a premature baby grow and develop, what are the differences between his physical and neuropsychic development, will he lag behind his peers? Let's talk about this in more detail.

How he develops physically.
If the baby hurried to be born ahead of time, it is natural that he will differ from his peers at birth and beyond, his growth and development will be carried out according to a different plan. But, this does not mean that they will be ill or hypotrophic (with low stature and weight). Usually there is a pattern that a premature baby grows faster than their peers born on time, that is, they are trying to quickly catch up with what they could not sit out in the tummy. But this rule only works with a slight prematurity of 32 weeks or more. With a deep degree of prematurity, when the child is on hardware and incubator nursing, his development proceeds at a different pace. Then the increase in weight and height in the first weeks will be small, because premature babies lose a lot of weight initially, they can’t immediately absorb food - they need to first restore what they lost, and then start to add.

Another difficulty in weight gain and growth is the difficulty with nutrition - while children with a little prematurity can usually suckle or bottle feed, then very premature babies are fed through a tube or even parenterally (that is, they are given nutrients through the umbilical vessels directly into blood). As the sucking and swallowing reflex matures in children, they begin to breastfeed or use a nipple, then weight gain improves. The most difficult thing in feeding and nursing a baby is the first month, this month all enzyme systems are set up and digestion matures for an extrauterine method of nutrition, if the baby begins to assimilate food - usually things quickly go smoothly, and he begins to add and grow, round and accumulate subcutaneous fat.

Such a pattern is noted - by the second or third month, children double their weight from birth, triple by six months, and by the age of one - increase their weight from four to eight times, and the smaller they were born, the more significant the increase will be. But, this does not mean that a kilogram baby by the year should catch up with someone who was born on time with a weight of 3.5 kg. Of course, premature babies will be smaller, and it is very good for them to weigh 7-8 kg per year. If there is more - excellent, if a little less - we will try to eat more calories.

On average, the dynamics of gains in premature babies is as follows:
In the first month it is 150-300 grams,
The second - 400-800 grams,
Third - 500-700 grams,
Fourth - 500-800 grams,
Fifth - 500-700 grams,
The sixth - 500-600 grams, and then they add according to the laws of children born on time, by the year having an addition in weight in the plus from 5500 to 7500 g to the initial body weight.

In any case, do not compare your premature baby with a neighbor's full-term one, his growth and weight patterns will be different, you should focus on the dynamics of your baby's development. on average - the greater the degree of prematurity, the later he will catch up with his peers in height and weight - doctors set this period at the border from 3 to 7 years, in any case, absolutely everything will be equal to school. But at 12-17 years old, children, according to research results, do not differ in any way, whether they were born with a weight of 1000 or 4000.

Patterns of growth.
The growth and body weight of the baby are interdependent processes, and the growth of the child is determined by his age and body weight. Growth dynamics will depend on how the baby begins to gain weight. In the first months, up to about six months, the baby will grow rapidly, its growth will remain 3-6 cm per month, by the year this figure will be from 25 to 38 cm, and by the year babies usually have about 70-80 cm in height. In the second year of life, they grow more slowly, about 1-2 cm per month.

The circumference of the body grows no less intensively, and it is very important to monitor the growth of the head especially so as not to miss the development of pathologies that are more characteristic of premature babies. The child's head in size should be larger than the chest in the first six months, the increase in size on average arrives by 1-2 cm, grows up to 12 cm in six months, the second half of the year is not so intensive in growth. The breast should also grow by 1-2 cm every month, and by six months the chest and head should be equal in size.

In addition, in premature babies, the timing of teething is shifted - they will linger for about so many months. how much the baby did not sit in the mother's tummy, that is, according to the gestational age, the appearance of teeth should also be calculated.
That is - if the baby was born after 35 weeks - his teeth can be expected after 7-8 months,
During childbirth from 30 to 34 weeks, teeth can be expected closer to 9 months, with deep prematurity and a period of less than 30 weeks, teeth have the right to appear after 10-12 months.
In addition, the timing of teething is affected by the presence of rickets, anemia and calcium deficiency, which are much more common in premature babies and should be taken into account. Therefore, do not worry and do not be afraid - there will definitely be teeth, but later.

In addition, development always follows its own patterns and small deviations do not mean pathology at all. However, the physical development of premature babies requires more attention from pediatricians.

What about skills?
Very often, parents of premature babies hear horror stories about deep mental retardation and inferiority of babies. Only these stories are not true, or the truth is very partial. Certainly. nursing premature babies is a complex thing and the nervous system of babies is more vulnerable, but this does not mean that a premature baby is equivalent to being disabled. A sick child can be born both full-term and premature. Prematurity in itself is only a feature of the baby, it is not a diagnosis and not a sentence.

How is development different?
Of course, there will be differences in neuropsychic development - after all, the baby was in a hurry and did not finish the prescribed intrauterine stages. So he needs to catch up with them first. They master skills by age a little later, compared to full-term babies, but they go through all the same stages - first they hold their heads, then they crawl and turn over, sit, stand up and walk. But they will definitely start doing it - usually the skill is shifted by the number of weeks that the baby is premature.

Your baby will later focus on auditory and visual stimuli, later he will begin to hold his head, cooing will begin later, the smile will also be delayed. But it will definitely appear, like all other skills.
If the child was born for more than 32 weeks, the skills will be delayed for a month and a half, if he was born even earlier, the delay can reach up to three months. but children with short periods of prematurity catch up with their peers by the end of the year, a deeply premature baby is slightly behind and will catch up with their peers by the age of two or three years, these are those who were born weighing 500-1000 g. If a child was born painful, he has malformations or there is no proper care for the baby (in a baby house, for example), neuropsychic development will be more inhibited. Therefore, how your premature baby will develop depends on you - your classes with him are an incentive for development.

To control the neuropsychic development of a baby with prematurity. They use special tables for the development of NPR in such babies. They usually indicate the boundaries for the emergence of a particular skill in comparison with the age for full-term babies, and also outline the boundaries for fluctuations in the emergence of new skills - that is, when parents need to start worrying.

How to know if development is normal?
The doctor, when evaluating the development of the baby, compares his skills in fact, with those that he should be able to according to his age criteria. Moreover, the ability is considered what the baby does confidently, for example, holds his head well and hums. Then the individual rate of development is determined - whether development is slow, normal, accelerated or discoordinated. It is considered a problem if the baby is behind the deadline for 1-2 or more months, and more than 2-3 skills.

Naturally, we never equate babies who are premature with children who are born on time - they will differ greatly in development. But the general patterns of development of mom and dad of babies, of course, should be known. This will help parents understand that something is going wrong and seek medical help.

The terms of development in the card usually indicate - the passport term and the term adjusted for prematurity, that is, the gestational age and how many weeks. Gradually, the skills will begin to approach those of full-term babies, and then the corrections will no longer be relevant. By the time of 12-15 months, they are moving to the landmark of ordinary full-term children.

If a child makes you suspicious or you are worried about his development - do not hesitate and do not try to look for advice on the Internet or from your friends, ask a doctor better - early identification of problems in health and development will allow you to quickly and correctly correct all deviations. Then your baby will be strong and healthy, even though he is premature.