Premature baby

Parents of babies born prematurely are forced to face various problems, including the difficulties of nursing crumbs in a maternity hospital and creating the necessary conditions at home, establishing breastfeeding or choosing a suitable formula, regular visits to the doctor and worries about the future health of the baby. However, they should always remember that with increased attention to the baby and proper care, they will be able to help the baby more quickly "catch up" with his peers and grow up as a healthy and cheerful baby, which is confirmed by the popular "Before and After" photographs.

You can see more such photos in the photo gallery at the end of the article.

Which baby is considered premature?

Official medicine classifies babies as premature if they were born less than 37 weeks of gestation. Such children have lower growth and weight indicators, and their organs are immature.

Causes

Factors causing premature birth are:

Neglect of medical care for pregnancy.
The presence of bad habits in a pregnant woman.
Insufficient or unbalanced nutrition of a woman during gestation.
The age of the future mother or future father is less than 18 and more than 35 years old.
Work of a pregnant woman in hazardous conditions.
Low pregnancy weight (less than 48 kg).
Living of the expectant mother in poor living conditions.
Bearing in an unfavorable psychological environment.

Abortion in the past.
Multiple pregnancy.
The onset of gestosis during pregnancy.
Premature detachment of the placenta.
Short interval between births (less than two years have passed since the previous birth).
Incompatibility of the blood of the baby and the mother for the Rh factor.
Gynecological inflammatory diseases in the mother.
Malformations of the female genital organs.
Extragenital diseases in a pregnant woman, for example, hypertension, pyelonephritis or diabetes mellitus.
Operations and injuries in the expectant mother.
Acute infections during pregnancy.
Genetic or chromosomal diseases in the fetus.
Infant infection during intrauterine development.
Severe malformations of the baby.

Prematurity classification

The division into the degree of prematurity is based on the gestational age at which the baby was born, as well as on such physical parameters of the toddler as weight and body length. There are such degrees of prematurity:

The first - the child is born at 36-37 weeks of pregnancy with body weight from 2 to 2.5 kg and body length from 41 to 45 cm.
The second - the baby appears at a period of 32 to 35 weeks, his body weight is less than 2 kg, but more than 1.5 kg, and the body length is from 36 to 40 cm.
The third - the baby is born at 28-31 weeks of gestation with weight from 1 to 1.5 kg and body length from 30 to 35 cm.
Fourth - an infant is born before 28 weeks of pregnancy with a mass less than one kilogram and body length less than 30 cm.

The most unusual and truly magical stories about the survival of premature babies are here:

Signs

Appearance

Compared to babies born at term, premature babies differ:

Thinner skin.
Less or no subcutaneous fat.
Large head size in relation to the body.
Large belly and low navel.
An unclosed small fontanel.
Very soft auricles.
Thin nails that may not completely cover the phalanges of the fingers.
Open genital slit in infant girls.
The testicles that did not have time to descend into the scrotum in boys.
Later loss of the umbilical cord.

These signs are more pronounced, the higher the degree of prematurity, and in infants with the first or second degree, many of them may be absent.

Anatomical and physiological features

The functioning of the organ systems of a premature baby is affected by the degree of prematurity, because the smaller the fetus was in the mother's womb, the more its organs did not have time to form to a state that allows them to quickly adapt to life after childbirth.

Respiration in premature babies is more frequent, than in term-born babies, which is associated with narrow upper airways, a more pliable rib cage and a higher location of the diaphragm. In addition, the lungs of the toddler are not mature enough, which leads to the frequent occurrence of pneumonia and apnea attacks.
Due to premature birth, the baby's circulatory system may not be fully formed. The result is various heart pathologies that worsen the condition of the crumbs. And since the vascular walls are more fragile and permeable, the baby often has hemorrhages.
The brain, even with deep prematurity, is fully formed, but the pathways in the last stages of pregnancy are still developing, therefore, in children born prematurely nerve impulses are poorly conducted to different tissues. If the baby's nervous system is affected, its motor activity will be reduced, as will muscle tone. Reflexes in such a child may be depressed or absent altogether, tremors are often observed.

The mechanisms that regulate the production and waste of heat in the body are poorly developed in a premature baby. Prematurely born babies lose heat faster, and it is produced in their body with great difficulty... In addition, babies can easily overheat due to underdeveloped and dysfunctional sweat glands.
The digestive tract of a premature toddler also works worse than that of babies born at term. This is primarily due to insufficient production of enzymes and gastric juice, as well as dysbiosis of the intestinal microflora. Besides, the motor function of the gastrointestinal tract suffers from impaired conduction of nerve impulses, which leads to a slowdown in the movement of food through the intestines.
In the bones of premature babies after childbirth, mineralization processes continue, which is the reason for the additional administration of calcium to babies. Such babies increased tendency to develop rickets and dysplasia of the pelvic joints.
Immature kidney function in a premature baby quickly shows signs of dehydration or swellingif caring for the baby is inadequate.
The endocrine system in case of prematurity does not work properly, which is why hormones are released in insufficient quantities, and the glands are quickly depleted.

Consequences of prematurity and vitality

The survival rate of premature babies depends on the duration of the pregnancy and the reasons that provoked the birth. If those born at a period of 23 weeks survive only in 20-40% of cases, then babies with a gestational age of 24-26 weeks survive in 50-70% of cases, and the survival rate of babies whose developmental period is more than 27 weeks exceeds 90%.

Babies born earlier than expected gain weight and grow in length very intensively... Many of them catch up with their full-term peers in these indicators by the age of 1-2, but there are babies, the difference between which with their peers is smoothed out only by the age of 5-6.

Anemia with prematurity develops more rapidly. The risk of sepsis and purulent infections of the bones, intestines, or meninges is increased in premature babies. At an older age, children born prematurely are more likely to have neurological pathologies, problems with vision or hearing, frequent ARVI and problems with the genitals.

Jaundice in children born prematurely, it is more pronounced and lasts longer. This physiological condition, resulting from the breakdown of fetal hemoglobin, usually resolves by 3 weeks of age, but in many premature infants requires treatment, for which phototherapy is primarily used.

Extreme prematurity

This is the name of the condition of babies weighing less than 1 kilogram. They are born in less than 5% of prematurity cases, often cannot breathe on their own, and require artificial and medical support. Even if such babies are nursed, the percentage of disability and the occurrence of various complications in these children is very high.

Deep prematurity

This condition is noted in infants whose body weight during preterm birth is 1-1.5 kg. To leave such babies, it is required to use mechanical ventilation, give them oxygen, inject food into a vein and through a tube. In order for the baby to grow and develop faster, amino acids, glucose, hormonal agents and other substances are injected into it.

7 months

At this stage of pregnancy, babies are born with a weight of 1.5-2 kg, but most of them cannot function independently. The little ones are placed in incubators with the required temperature and humidity, they carry out the necessary examinations and provide drug support. After gaining weight up to 1.7 kg, the baby is transferred to the crib, which is heated. When a child gains weight up to 2 kg, he no longer needs thermal support.

8 months

Babies born at this time, as a rule, weigh 2-2.5 kg, can suck and breathe on their own. They have an increased risk of apnea attacks, so the babies are observed for some time in the hospital, but in the absence of complications and rapid weight gain to normal, the baby is sent home with newly-made parents.

Clinical examination

Premature babies discharged home should be constantly monitored by a pediatrician.

Measurements and examinations during the first month after discharge are carried out once a week, then up to 6 months of age - once every two weeks, and from 6 months to a year - monthly. The kid is prescribed examinations by a surgeon, neurologist, cardiologist, orthopedist and ophthalmologist, and at the age of over a year - by a psychiatrist, as well as a speech therapist.

With what weight are they discharged?

As a rule, the mother returns home with the newborn baby after the weight of the baby has increased to at least 2 kg... It is also important for discharge that the baby does not have complications, that thermoregulation is established and that the baby does not need heart and breathing support.

Care features

Babies who are born prematurely require special care. They are gradually nursed with the help of neonatalists and pediatricians, first in the maternity hospital, then in the hospital, and then at home under the supervision of specialists. The most important components of baby care:

Provide optimal temperature and humidity in the room.
Provide rational treatment.
Provide feeding adequate to needs.
Provide contact with the mother using the kangaroo method.
After discharge, limit contact with strangers.
Bathing and walking with the baby after the permission of the doctor.
Perform gymnastics with the baby and conduct massage courses after the permission of the pediatrician.

What if there are alarming symptoms?

If mom is worried about something, she should definitely seek medical help. A specialist will be needed when:

Unwillingness of the baby to breastfeed or to eat from a bottle.
Vomiting attacks.
Prolonged jaundice.
Constant loud crying.
Stop breathing.
Great pallor.
A child's painful reaction to sounds, looks or touch over the age of 1.5 months.
Lack of reciprocal gaze at the age of more than 2 months.

Vaccination: when should you get vaccinated?

It is permissible to vaccinate a premature baby only when the baby is strong enough and his body weight increases.

BCG vaccination in the maternity hospital for children weighing less than 2 kg is not done. It is indicated for weight gain up to 2500 g, and if there are contraindications, it can be postponed for 6-12 months. The timing of the introduction of other vaccines should be determined by the pediatrician, taking into account the health and development of the toddler.

E. Komarovsky's opinion

As you know, a popular pediatrician recommends raising children in the first year of life so that the babies do not overheat. Komarovsky always focuses on frequent ventilation, humidification of the air up to 50-70% in the nursery and maintaining the temperature in the room not higher than + 22 ° С.

However, for premature babies, his recommendations are changing significantly. Komarovsky supports colleagues in the opinion that thermoregulation in such babies is poorly developed, therefore, a higher air temperature in the room immediately after discharge (not lower than + 25 ° C), in his opinion, is a necessity.

Until the baby gains weight up to 3000 g, and its age is not 9 months after conception, all extreme experiments (in this case, lowering the air temperature to the recommended Komarovsky indicators for full-term babies) are prohibited.

Tips for parents

You should not look to blame for the fact that the baby was born prematurely, it is better focus on current problems and help the baby adapt to a new life, supporting other family members.
Try to communicate more with the baby as soon as the doctor allows you to take the baby in his arms. Be aware of the high need of premature babies for close bodily contact with their parents. This will help the baby gain weight faster and accelerate mental development.
Take photos and keep a diary of the baby's life. It will be an interesting family value in the future.
Remember that each baby develops individually, therefore, do not compare the prematurely born baby either with other premature babies, or with babies born on time.
Ask doctors about all the points of interest, ask them to clarify the terms and explain what diagnoses were made to the baby... This will help you organize the regimen, care, and activities for your growing baby after discharge.