Premature babies. Premature babies - degrees and signs of prematurity in a newborn baby, features of the body and behavior Norms of blood pressure in premature babies
The norms of such particles in the blood are determined by a general analysis, and depend on the time of day, as well as the age of the patient. In the morning, in the evening and at night, their number may increase due to changes in the work of the adrenal glands.
What does it mean if the rate is increased
Shift of the leukocyte formula from high level eosinophils (eosinophilia) indicates that an inflammatory process is taking place in the body.
A severe degree is considered a rather dangerous condition for a person, since in this case damage to internal organs is often noted due to oxygen starvation of tissues.
When diagnosing cardiovascular disease
By itself, an increase in eosinophils in the blood cannot speak of damage to the heart or vascular system, but pathologies, the symptom of which is an increase in the number of this type of leukocytes, can cause cardiovascular diseases.
The fact is that in the place of their accumulation over time, inflammatory changes are formed that destroy cells and tissues. For example, prolonged, severe allergic reactions and bronchial asthma can cause eosinophilic myocarditis, a rare myocardial disease that develops as a result of exposure to eosinophil proteins.
The main reasons for the increase
An excess of eosinophils can have a number of different causes, including:
A decrease in the level of eosinophils in the patient's blood (eosinopenia) is no less a dangerous condition than their increase. It also indicates the presence of an infection in the body, a pathological process or tissue damage, as a result of which protective cells rush to the focus of danger and their number in the blood drops sharply.
What does it say in diseases of the heart and blood vessels
The most common cause of a decrease in blood eosinophils in heart disease is the onset of acute myocardial infarction. On the first day, the number of eosinophils can decrease until they disappear completely, after which, as the heart muscle regenerates, the concentration begins to increase.
What causes the downgrade
Low levels of eosinophils are observed in the following cases:
- severe purulent infections and sepsis - in this case, the leukocyte form shifts towards young forms of leukocytes;
- in the first stages inflammatory processes and in pathologies requiring surgical intervention: pancreatitis, appendicitis, exacerbation of cholelithiasis;
- strong infectious and painful shocks, as a result of which the blood cells stick together into tin-like formations that settle inside the vessels;
- dysfunction of the thyroid gland and adrenal glands;
- poisoning with lead, mercury, arsenic, copper and other heavy metals;
- chronic emotional stress;
- an advanced stage of leukemia, when the concentration of eosinophils can drop to zero.
Change in number in childhood
High eosinophils in the blood of a child is a fairly common phenomenon. In premature babies, this condition is considered a variant of the norm, and disappears when normal body weight is reached.
In other cases, the most common causes of increased cell levels are:
Eosinophils in children are reduced in the presence of viral or bacterial infections in the body and a general decrease in immunity. In addition, it can be caused by prolonged physical exercise, severe psycho-emotional overwork, as well as previous injuries, burns or surgical interventions.
In any case, a decrease or increase in the level of eosinophils in the blood is not an independent disease, but a symptom that a pathological process is taking place in the body. To identify the problem and prescribe adequate treatment, the patient needs to undergo a set of additional studies and get expert advice.
Open ductus arteriosus (OAP) in children: what is this pathology
Children are not immune from congenital anomalies, so it is important for parents to know what signs may indicate certain malformations. For example, about such a pathology as an open ductus arteriosus in newborns.
The ductus arteriosus is a small vessel that connects the pulmonary artery to the fetal aorta, bypassing the pulmonary circulation. This is normal before birth as it provides the fetal circulation needed for a fetus that does not breathe air in the womb. After the birth of a child, a small duct closes in the first two days after birth and turns into a strand of connective tissue. In premature babies, this period can last up to 8 weeks.
But there are times when the duct remains open and leads to disruption of the lungs and heart. More often this pathology is observed in premature babies and is often combined with other congenital malformations. If the ductus arteriosus remains open for 3 or more months, we are talking about such a diagnosis as PDA (open ductus arteriosus).
By what signs can one suspect that the duct has remained open?
The main symptoms in children under one year old are shortness of breath, palpitations, slow weight gain, pale skin, sweating, difficulty feeding. The reason for their appearance is heart failure, which occurs due to congestion of the vessels of the lungs, to which blood returns with an open duct, instead of rushing to the organs.
The severity of symptoms depends on the diameter of the duct. If it has a small diameter, an asymptomatic course of the disease is possible: this is due to a slight deviation from the normal pressure in pulmonary artery. With a large diameter of the open vessel, the symptoms are more severe and are characterized by several more signs:
- hoarse voice;
- cough;
- frequent infectious diseases respiratory organs (pneumonia, bronchitis);
- weight loss
- poor physical and mental development.
Parents should know that if a child is slowly gaining weight, gets tired quickly, turns blue when crying, breathes frequently and holds his breath when crying and eating, then you need to urgently contact a pediatrician, cardiologist or cardiac surgeon.
If a patent ductus arteriosus has not been diagnosed in a newborn, the symptoms tend to get worse as they grow. In children from one year old and adults, the following signs of PDA can be observed:
- frequent breathing and lack of air even with minor physical exertion;
- frequent respiratory infections, persistent cough;
- cyanosis - blue discoloration of the skin of the legs;
- weight deficit;
- quick fatigue even after short outdoor games.
What are the reasons why the ductus arteriosus does not close?
Until now, doctors can not give an exact answer to this question. It is assumed that risk factors for abnormal development include:
- a number of other congenital heart diseases (congenital heart defects);
- premature birth;
- insufficient body weight of the newborn (less than 2.5 kg);
- hereditary predisposition;
- oxygen starvation of the fetus;
- genomic pathologies, such as Down syndrome;
- diabetes mellitus in a pregnant woman;
- rubella infection during childbearing;
- chemical and radiation effects on a pregnant woman;
- the use of pregnant alcoholic beverages and drugs;
- taking medication during pregnancy.
Moreover, statistics show that in girls this pathology occurs twice as often as in boys.
How do doctors make a diagnosis?
First of all, the doctor listens to the newborn's heart with a stethoscope. If the noise does not stop after two days, the examination is continued by other methods.
On the chest radiograph, changes in the lung tissue, expansion of the cardiac borders and the vascular bundle are visible. High load on the left ventricle is detected by ECG. To detect an increase in the size of the left ventricle and atrium, echocardiography or ultrasound of the heart is performed. Doppler echocardiography is needed to determine the volume of the discharged blood and the direction of its current.
In addition, probing of the pulmonary artery and aorta is performed, while the probe passes through the open duct from the artery into the aorta. During this examination, the pressure in the right ventricle is measured. Before aortography, a contrast agent is injected into the aorta with a catheter, which enters the pulmonary artery with blood.
Early diagnosis is very important because the risk of complications and severe consequences is very high, even in asymptomatic cases.
Spontaneous closure of an abnormal ductus arteriosus can occur in children under 3 months of age. In a later period, self-healing is almost impossible.
Treatment is carried out depending on the age of the patient, the severity of symptoms, the diameter of the pathological duct, the existing complications and concomitant congenital malformations. The main methods of treatment: medication, catheterization, ligation of the duct.
Conservative treatment is prescribed in case of unexpressed symptoms, in the absence of complications and other congenital malformations. Treatment of the open ductus arteriosus with various drugs is carried out at the age of up to a year under constant medical supervision. For treatment, drugs can be used: anti-inflammatory non-steroidal (ibuprofen, indomethacin), antibiotics, diuretics.
Catherization is performed for adults and children over the age of one year. This method is considered effective and safe in terms of complications. The doctor performs all actions using a long catheter, which is inserted into a large artery.
Often, an open ductus arteriosus is treated surgically - bandaged. If a defect is detected while listening to extraneous heart sounds in a newborn, the duct is closed by surgery when the child reaches the age of 1 year to avoid possible infectious diseases. If necessary (with a large diameter of the duct and heart failure), the operation can also be performed on a newborn, but it is optimal to do them at the age of up to three years.
Don't Forget About Prevention
In order to protect the unborn child from the development of PDA, during gestation, one should avoid taking medications, stop smoking and drinking alcohol, and be wary of infectious diseases. In the presence of congenital heart defects in family members and relatives, you need to turn to genetics even before the moment of conception.
What is the prognosis?
Vice is dangerous because the risk of death is high. An open ductus arteriosus can be complicated by a number of diseases.
- Bacterial endocarditis is an infectious disease that affects the heart valves and can lead to complications.
- Myocardial infarction, in which necrosis of a section of the heart muscle occurs due to impaired blood circulation.
- Heart failure develops with a large diameter of an open ductus arteriosus in the absence of treatment. Among the signs of heart failure, which is accompanied by pulmonary edema, should be called: shortness of breath, rapid breathing, high pulse, low blood pressure. This condition poses a threat to the life of the child and requires hospitalization.
- Aortic rupture is the most severe complication of PDA, leading to death.
DEFINITION OF PREMATURE. CAUSES OF PREMIUM
Prematurity includes children born before the end of 37 weeks of pregnancy and having a body weight of less than 2500 g and a height of less than 45 cm. g, while a premature baby can weigh more than 2500 g.
Conventionally, 4 degrees of prematurity are distinguished by body weight: I - 2001-2500 g, II - 1501-2000 g, III - 1001-1500 g, IV - less than 1000 g.
Most often, premature births are caused by diseases of the mother (chronic somatic pathology: diseases of the kidneys, cardiovascular system, endocrine disorders; acute infectious diseases; gynecological pathology); complications of pregnancy (especially late toxicosis); aggravation of the obstetric history with previous abortions and miscarriages (isthmic-cervical insufficiency); injuries (including mental) and intoxication (smoking, alcohol); immunological incompatibility in the mother-fetus system (Rhesus conflict and group conflict). Too young (under 18 years old) and old (over 30 years old) age of the mother also matters; the influence of age and the state of health of the father is less pronounced.
On the part of the fetus, the causes of prematurity can be genetic diseases (including chromosomal pathology) and intrauterine infections. In recent years, the socio-economic causes of prematurity (industrial hazards, out-of-wedlock births, environmental degradation, the “sexual revolution”, hidden starvation of women due to the impoverishment of the population, etc.) have acquired particular importance.
ANATOMO-PHYSIOLOGICAL FEATURES
Premature babies have a peculiar physique - a relatively large head with a predominance of the brain skull, sometimes - open cranial sutures, small and lateral fontanelles, a low location of the umbilical ring; poor development of subcutaneous adipose tissue. Premature babies are characterized by abundant vellus hair (lanugo), with a significant degree of prematurity - underdevelopment of nails. The bones of the skull are malleable due to insufficient mineralization, the auricles are soft. In boys, the testicles are not descended into the scrotum (in extremely immature children, the scrotum is generally underdeveloped); in girls, the genital gap gapes due to underdevelopment of the labia and relative hypertrophy of the clitoris. Based on the external examination of the child, it is possible to draw a conclusion about the degree of prematurity (gestational age) according to the totality of morphological criteria, for which evaluation tables of these signs in points have been developed.
The nervous system of premature babies is characterized by weakness and rapid extinction of physiological reflexes (in very premature babies, including sucking and swallowing); slow response to stimuli; imperfection of thermoregulation; muscle hypotension.
The morphology of the brain of a premature baby is characterized by smoothing of the furrows, poor differentiation of gray and white matter, incomplete myelination of nerve fibers and pathways.
The reactions of premature babies to various stimuli are characterized by generalization, weakness of active inhibition, and irradiation of the excitation process. The immaturity of the cortex determines the predominance of subcortical activity: movements are chaotic, shudders, hand tremors, and stop clonus may be noted.
Due to the immaturity of thermoregulatory mechanisms, premature babies are easily cooled (reduced heat production and increased heat transfer), they do not have an adequate increase in body temperature for an infectious process, and they easily overheat in incubators. Overheating contributes to the underdevelopment of sweat glands.
The respiratory system in a premature baby, like the nervous system, is characterized by immaturity (a predisposing background for pathology). The upper respiratory tract in preterm infants is narrow, the diaphragm is located relatively high, the chest is pliable, the ribs are located perpendicular to the sternum, in very preterm infants the sternum sinks. Breathing is shallow, weakened, the frequency is 40-54 per minute, the volume of breathing is reduced compared to full-term children. The rhythm of breathing is irregular, with occasional apneas.
The cardiovascular system of a premature baby, compared with other functional systems, is relatively mature, as it is formed at the early stages of ontogenesis. Despite this, the pulse in premature babies is very labile, of weak filling, the frequency is 120-160 per minute. The most immature children are characterized by a rhythmic pulse pattern of the type of embryocardia. On auscultation, heart sounds may be relatively muffled; with the persistence of embryonic shunts (botallian duct, oval window), the presence of noise is possible. Blood pressure in premature babies is lower compared to full-term babies: systolic 50-80 mm Hg. Art., diastolic 20-30 mm Hg. Art. Average pressure 55-65 mm Hg, Art.
Due to the increased load on the right side of the heart, the electrocardiogram of preterm infants is characterized by signs of a rightogram and a high wave R combined with relatively low voltage and smooth interval S - T.
The gastrointestinal tract of premature infants is characterized by the immaturity of all departments, a small volume and a more vertical position of the stomach. Due to the relative underdevelopment of the muscles of the cardial part of it, premature babies are prone to regurgitation. The mucous membrane of the alimentary canal in preterm infants is tender, thin, easily vulnerable, and richly vascularized. There is a low proteolytic activity of gastric juice, insufficient production of pancreatic and intestinal enzymes, as well as bile acids. All this complicates the processes of digestion and absorption, contributes to the development of flatulence and dysbacteriosis. In 2/3 of premature babies, even those who are breastfed, there is a deficiency of intestinal bifidoflora in combination with the carriage of opportunistic flora. The nature of the child's stool is determined by the characteristics of feeding; as a rule, preterm infants have a lot of neutral fat in the coprogram.
Features of the functioning of the endocrine system of a premature baby are determined by the degree of its maturity and the presence of endocrine disorders in the mother, which caused premature birth. As a rule, the coordination of the activity of the endocrine glands is impaired, primarily along the axis of the pituitary gland - thyroid gland - adrenal glands. The process of reverse development of the fetal zone of the adrenal cortex in newborns is inhibited, the formation of circadian rhythms of hormone release is delayed. Functional and morphological immaturity of the adrenal glands contributes to their rapid depletion.
In premature babies, the reserve capacity of the thyroid gland is relatively reduced, and therefore they may develop transient hypothyroidism. The gonads in premature babies are less active than in full-term babies, so they have a so-called sexual crisis much less often in the first days of life.
The processes of metabolic adaptation in premature babies are slowed down. At the age of 4-5 days, they often have metabolic acidosis in the blood plasma in combination with a compensatory shift towards intracellular alkalosis; on the 2nd-3rd week of life, extracellular acidosis is compensated by intracellular normative reactions. In premature babies (even in conditionally healthy ones), hypoglycemia, hypoxemia, and hyperbilirubinemia are more common.
Renal regulation of acid-base balance and electrolyte composition in preterm infants is imperfect; water-salt metabolism is labile, which manifests itself as a tendency to edema and rapid dehydration in pathological conditions or inadequate care. The immaturity of the kidneys causes relatively high levels of residual nitrogen in the blood of preterm infants in the first 3 days of life (up to 34.4 mmol / l), in the following days this figure decreases; a premature baby has a relatively stable diuresis. Urine is weakly concentrated (due to the low concentration ability of the kidneys), the frequency of urination usually exceeds that of full-term babies (relatively high metabolic rate and water-nutrient load).
FEATURES OF CARE AND ORGANIZATION OF NURSING
The period of postnatal adaptation to the environment in premature babies stretches for 1-2 months. Due to the immaturity of organs and systems under inadequate conditions, severe failures of adaptation are possible. Therefore, the organization of optimal nursing conditions is extremely important for premature babies.
The temperature regime must take into account the imperfection of thermoregulation and the special danger of cooling. It is advisable to create specialized maternity hospitals for receiving preterm births (perinatal centers), in which fetal monitoring is carried out. The air temperature in the maternity hospital should be at least 22-23; the child is taken in warm sterile diapers or immediately after birth and cutting off the umbilical cord is placed on a special heated table (in an incubator). Premature babies in some countries are wrapped in metallic diapers to prevent heat loss. The transfer of a premature baby from the maternity hospital to the hospital of the 2nd stage of nursing (as a rule, on the basis of clinical children's hospitals) in the presence of specially equipped resuscitation machines (with an incubator and an oxygen cylinder) can be carried out already in the first hours of life in the absence of obvious contraindications to transportation ( intracranial hemorrhage, hemolytic disease). In specialized departments, premature babies are placed in boxed wards (2-3 children in a box). Children born weighing less than 1500 g, as well as more mature, but seriously ill premature babies, are nursed in incubators (couveuses), in which they maintain a temperature of 32-36 ° C, depending on the degree of immaturity and age of the child (in intensive care incubators, the air temperature is automatically regulated according to the indicators of skin sensors to maintain the child's body temperature of 36-37 ° C).
Relative humidity in incubators during the first week of a child's life is gradually reduced from 90% to 60-70%; oxygen concentration depends on the condition of the child and averages 35-40%. When oxygen is supplied to the incubator, to prevent its toxic effects, it is most advisable to use the intensity of oxygenation depending on the Po 2 indicators in the child's blood (transcutaneous monitoring), which should not exceed 60%.
The duration of the child's stay in the incubator depends on his individual characteristics. All medical manipulations are carried out, if possible, in an incubator. The position of the child in the incubator is periodically changed by turning it on the other side or on the stomach.
The air temperature in the wards ranges from 23 to 25 °C, the wards are regularly ventilated (3-6 times a day). In the department of the 2nd stage, it is necessary to observe strict sanitary and epidemiological (wet cleaning, air quartzization, cyclical filling of the wards) and medical and protective regimes. Careful monitoring of the health status of nursing mothers is necessary; wearing gauze masks by staff and mothers (with a change every 4 hours); hygienic baths for children (assigned individually); introduction of micro-methods and non-invasive examination methods; special rooms for the collection and processing of breast milk, for the collection of linen; the use of disposable care items and tools (needles, syringes).
The second stage of nursing a premature baby is the initial stage of rehabilitation. Almost all premature babies need physical rehabilitation: massage, exercises in the water, which require a special room with baths and trained staff. It is necessary to involve parents in the rehabilitation of immature children, especially the mother (communication in the ward, "kangaroo" - contact "skin to skin"). Children who are in the department for the purpose of rehabilitation need to organize walks on the veranda or in the garden in the summer.
The discharge of a premature baby from the hospital to the pediatric site is carried out in the presence of stable adaptation to the external environment: independent sucking, regular weight gain (at discharge 2200-2300 g or more), sufficient thermoregulation. Shortly before discharge, the mother is taught care techniques, massage and water exercises. Continuity between the hospital and the clinic is ensured by the transfer of detailed medical documentation (extract) with recommendations for the next 1-3 months.
FEATURES OF FEEDING
When determining the method of feeding and prescribing its volume and composition, it is necessary to take into account the individual characteristics of an immature child, reduced food tolerance and an increased need for energy substrates. Enteral feeding, in the absence of contraindications, usually begins 2-6 hours after birth (expressed breast milk of the mother; more mature, conditionally healthy preterm infants can be breastfed).
Extremely immature and critically ill children usually receive only parenteral nutrition for the first 24-48 hours of life.
The optimal food for a premature baby is mother's native breast milk. In the absence of milk from the mother, pasteurized donor breast milk is used (heated to 68-70 ° C for 30 minutes), since pasteurization less than sterilization denatures milk proteins, but still partially destroys its protective factors. Therefore, breast milk banks are created in large clinics - expressed breast milk is pasteurized in a gentle mode (62.5 "C for 30 minutes) and then frozen at a temperature of -18 ... -20 ° C. Frozen breast milk can be stored for 3 months
Premature babies with a well-formed sucking reflex, without severe pathology, are usually bottle-fed for 1-2 weeks (sometimes breastfeeding and bottle sucking alternate); milk is administered to immature and seriously ill children through a nasogastric tube, sometimes until the end of the 1st - the beginning of the 2nd month of life. As the general condition improves, some tube feedings are replaced with nipple feedings. Attachment to the breast of a premature baby is carried out according to individual indications, with active sucking and a body weight of 1800-2000 g.
The frequency of feeding is also selected individually. For children fed through a tube, 2 feeding options are possible: fractional portioned (7 or 10 times a day, with a 6-hour night break) or prolonged introduction of milk using syringe pumps (introduction of a portion of milk for 2-3 hours, usually 5-6 times a day with short breaks). The latter method of feeding is especially indicated for children with regurgitation syndrome, with symptoms of partial intestinal paresis or with respiratory failure, and also, if it is necessary to increase the calorie content of food, for small and hypotrophic children.
Due to the fact that in the first days after birth, the capacity of the stomach in premature babies is small, the volume of one feeding on the 1st day is 5-10 ml, on the 2nd - 10-15 ml, on the 3rd - 15-20 ml. ml.
The calculation of nutrition for premature babies should be carried out by caloric content. In the first 3-5 days, the child receives 30-60 kcal/kg per day, by the 7th-8th day - 60-80 kcal/kg, by the end of the 1st month - 135-140 kcal/kg. From the age of two months, children born with a body weight of more than 1500 g are reduced to 130-135 kcal / kg; for small children, the calorie content is kept at the level of 140 kcal / kg for up to 3 months.
The daily requirement of preterm infants for food ingredients depends on the type of feeding. With natural feeding (breast native or pasteurized milk), the child should receive 2.2-2.5 g / kg of proteins in the 1st half of the year, 6,5- 7 g/kg of fat, 12-14 g/kg of carbohydrates; in the 2nd half of the 1st year of life 3-3.5 g/kg of proteins and 5.5-6 g/kg of fats.
With mixed and artificial feeding, the need for proteins is 3-3.5 and 3.5-4 g/kg, respectively; caloric content is increased by 10-15 kcal/kg.
A premature baby needs enough fluids. As a drink, use a mixture of Ringer's solution from 5% glucose solution (1:1). The total daily fluid volume (87.5% of milk volume + drinking + intravenous infusions) by the end of the 1st week is 70-80 ml / kg for children weighing less than 1500 g and 80-100 ml / kg for more mature children ; at the age of 10 days - 125-130 ml / kg, by the 15th day - 160 ml / kg, by the 20th - 180 ml / kg, by the end of the 1st and on the 2nd month - 200 ml / kg ( options are possible depending on the loss of fluid during phototherapy, exicosis, or, conversely, with a tendency to edema).
As a rule, premature babies need additional administration of vitamins. In the first 2-3 days of life, all premature babies are given vitamin K (Vikasol) due to its insufficient synthesis in the body to prevent hemorrhagic disorders, 0.001 g 2-3 times a day orally or intramuscularly, 0.1-0.3 ml.
Ascorbic acid is used in the first months of life at a dose of 30-100 mg per day, depending on the type of feeding, thiamine and riboflavin - 2-3 mg per day (with the exception of children receiving kefir). Premature babies also have a higher need for vitamin E due to increased lipid peroxidation of membranes. Therefore, usually children who do not have dyspeptic disorders are given orally a 5% solution of tocopherol, 2-3-5 drops per day for 10-12 days; To seriously ill children, tocopherol is administered intramuscularly.
Specific prevention of rickets in premature babies is carried out strictly individually, depending on the condition of the child, type of feeding, season of the year. Different prophylaxis schemes are possible: compacted method using a 0.5% alcohol solution of ergocalidiferol up to 10,000-12,000 IU per day for 20 days (course dose 200,000-300,000 IU); fractional dose method - 500-2500 IU of an oily solution of vitamin D3 (0.0625% or 0.125%) per day for several months, for a course of 200,000-400,000 IU.
Other vitamins are prescribed to premature babies according to clinical indications. For children with severe immaturity or seriously ill, a complex of vitamin metabolites, including vitamins Be, BS, Bi5 and lipoic acid, is used in the form of rectal suppositories.
Premature babies are very sensitive to the mineral composition of the diet. As a rule, due to a violation of the absorption processes, immature children during breastfeeding experience a relative deficiency of calcium, with mixed and artificial - a deficiency of phosphorus and some trace elements (iron, zinc, copper). Most trace elements are optimally absorbed when fed with native breast milk. When prescribing calcium preparations, it is advisable to focus on the level of ionized calcium in the child's blood plasma.
In the absence of mother's or donor milk, specially adapted milk formulas can be used to feed premature babies from the 2nd week of life, which have a higher energy value (81 kcal per 100 ml) and a higher protein content, which is important for feeding immature children. These are the domestic mixture "No-volakt-MM", imported mixtures "Prepiltti", "Pretugteli", "Premalalak", "Nenatal". In addition to fresh mixtures, the acidophilic mixture "Baby" is used, after 2 months - kefir.
Starting from the 3-4th week, a premature baby is given fresh fruit juices (usually apple or pomegranate); from 2.5-3 months - grated apple and yolk (in the absence of contraindications). The age and order of introduction of complementary foods is determined individually.
If enteral feeding is impossible (necrotizing ulcerative enterocolitis, congenital anomalies in the development of the gastrointestinal tract, persistent vomiting and exsicosis against the background of various diseases), the child is transferred to partial or complete parenteral feeding. There are 2 schemes of parenteral nutrition: Scandinavian (using intravenous infusion of amino acids, glucose and lipid emulsions such as lipofundin, etc.) and the hyperalimentation method (only glucose and amino acid solutions). For premature babies, the latter method is recommended, as they do not tolerate fat emulsions. Parenteral nutrition requires an accurate calculation of the amount of proteins, carbohydrates and liquids to be administered, constant monitoring of the electrolyte composition of the blood and CBS, monitoring of the gas composition of the blood, blood pressure and pulse.
FEATURES OF DEVELOPMENT AND DISPENSARY SUPERVISION
The physical development of premature babies is characterized by higher rates of weight gain and body length in the first year of life (with the exception of the first month). By 2-3 months, they double the initial body weight, by 3-5 - triple, by the year - increase by 4-7 times. At the same time, extremely immature children absolute indicators growth and body weight are significantly behind (“miniature” children), 1-3 “corridor” of centile tables. In subsequent years of life, very premature babies may retain a kind of harmonic "delay" of physical development.
The pace of neuropsychic development of premature babies in the first 1.5 years is usually slow, and the degree of this delay depends on the degree of prematurity - this is a kind of "norm" for immature children. In the absence of damage to the nervous system, even extremely immature children by the age of 2-3 years do not differ from full-term ones in terms of the level of psychomotor development, although many of them retain emotional lability, fatigue, and rapid exhaustion of nervous processes. The full development of premature babies largely depends on socio-economic and medical-organizational factors.
Dispensary observation of premature babies in a polyclinic involves differentiated monitoring of their physical and neuropsychic development, peripheral blood indicators, as well as systematic examinations by specialists (neurologist, orthopedist, ophthalmologist, surgeon, allergist, etc., according to indications), individual health-improving and tempering procedures, depending on the presence of developmental disorders, the selection of adequate prevention of rickets and anemia, an individual vaccination calendar.
Premature babies in the first year of life are usually observed according to the scheme provided for children of the 2nd and 3rd health groups. In their rehabilitation, physical methods are of primary importance: various massage complexes, gymnastics, exercises in water. Due to the high risk of developing early (hyporegenerative) and late (iron deficiency) anemia in premature babies, a monthly analysis of red blood counts is necessary.
Most premature babies do not receive the BCG vaccine at the maternity hospital. The issue of starting vaccination is decided strictly individually, starting from 2 months of age. As a rule, due to perinatal CNS lesions and the frequent development of anemia, premature babies receive the BCG vaccine (or BCG-M) after 6 months; subsequent vaccinations, depending on the state of health of the child, are carried out in combination (anti-polio + ADS-M) or separately; the pertussis component (DTP vaccine) in premature infants is used extremely rarely due to the greatest reactogenicity.
The start time of vaccinations is determined with the participation of a neurologist. Considering possible risk allergic reactions, assess the usefulness of the immune response. Vaccinations for children with altered reactivity are often carried out "under the protection" of antihistamines, calcium preparations (with exudative diathesis) or against the background of vitamin and metabolic correction (benfotiamine, riboflavin, calcium pantothenate and lipoic acid) - children with reduced immune response capabilities.
At all stages of monitoring a premature baby, active joint work of the doctor and parents is necessary. In the first days and weeks of his life, the mother, as a rule, needs psychotherapeutic correction, "removal" of postpartum stress. To do this, a psychologist or psychotherapist (individual or group sessions of psychotherapeutic correction) should work in the department of the 2nd stage. The mother (sometimes the father) must be in contact with the child in the hospital (“kangaroo”, communication with the child in the incubator, lullabies), at the final stage of nursing, the mother learns care, massage, exercises in the water. The doctor of the children's polyclinic and the patronage nurse control the conditions of the child's home life, the timeliness of medical interventions (visits to specialists, tests, vaccinations), classes to stimulate psycho-emotional and speech development. Appropriate gentle home environment and regular activities with parents, sensory stimulation (toys, lullabies), training of elementary skills are indispensable conditions for the full development of premature babies.
Pathological processes in premature babies have features due to the immaturity of their body. These features are outlined in the relevant disease-specific sections.
Since 1961, according to WHO recommendations, all newborns weighing less than 2500 g have been designated as "low birth weight" newborns. At present, this position is not shared by many researchers, since it eliminated the concepts of "prematurity" and "prenatal development" in assessing the condition of the child. Many researchers divide newborns with low body weight into three groups:
- newborns whose intrauterine growth rate was normal until birth (body weight corresponds to gestational age);
- children born at term or overdue, but having a body weight that is insufficient for a given gestational age, due to a slowdown in intrauterine growth;
- premature, who, in addition, noted a slowdown in fetal growth, i.e. their body weight is insufficient due to both prematurity and impaired intrauterine development.
Cause of premature babies
In most observations, the phenomena of intrauterine growth retardation in primigravidas were due to the morphofunctional features of the placenta and the development of placental insufficiency. A comparative analysis of qualitative indicators and quantitative characteristics showed that at birth at 28-32 weeks, half, and at birth at 33-36 weeks - only one third of the placenta had anomalies in the shape and attachment of the umbilical cord. In those cases when the pregnancy proceeded with the threat of termination in the first trimester, changes in the placenta were more pronounced. Thus, the index of the resorption surface of the placenta decreased to 3.1 m 2 at a gestational age of 28-32 weeks and to 5.7 m 2 at a period of 33-36 weeks.
When using general survey methods of morphological studies in the placenta in women who gave birth prematurely, a number of changes were revealed, which include massive fibrinoid deposits in the decidual plate and intervillous space with the presence of single X-cells, areas of calcification, an increase in the number of altered terminal villi (sclerosed, edematous, fibrinoid-altered), narrowing of the intervillous space. All these changes characterized dystrophic processes and were more often found in the placentas of women who gave birth before 32 weeks. At the same time, a large number of unchanged terminal villi with syncytial "nodules" of the proliferative type, with dilated, full-blooded and subepithelially located capillaries were determined. These villi determined compensatory-adaptive reactions in the placenta. These features were more often detected in the placentas of women who gave birth later than 33 weeks of gestation. Stereometric analysis of the placenta confirmed the predominance of dystrophic processes in the placenta during childbirth up to 32 weeks and compensatory and adaptive changes during childbirth at a later date. In women who had acute respiratory viral diseases during pregnancy, histological examination of the placentas, in addition to these changes, showed severe disorders of the uteroplacental circulation in the form of extensive hemorrhages in the decidua, intervillous space and stroma of the villi.
When analyzing the morphometric data of the placenta and comparing them with data on the state of premature babies at birth and in the early neonatal period, it was found that the body weight of newborns, the weight and morphometric parameters of the placenta, depending on the gestational age, are reduced in cases where children were born with signs of intrauterine development. The condition of children born with signs of malnutrition was assessed on the Apgar scale, as a rule, below 5 points. In the morphological analysis of the placenta, dystrophic processes more pronounced in intensity and prevalence were observed in those women whose children were born with signs of malnutrition and before 32 weeks of pregnancy. These data were confirmed by a stereometric analysis of the structural elements of the terminal villi, where a decrease in the relative areas of the intervillous space was observed. If during histological examination, compensatory changes in the placentas prevailed over dystrophic ones, then the physical data of the children were normal and corresponded to the gestational age.
Electron microscopic examination of the placenta revealed changes in all cellular structures of the villous chorion: syncytiotrophoblast, villus stroma and capillaries. The microvilli covering the syncytiotrophoblast were absent in places or unevenly located on the altered terminal villi. The ultrastructure of sclerosed villi was characterized by an increase in the number of collagen fibers in the stroma running in different directions, while edematous villi were characterized by a decrease in the number of cellular components with large electron-optically transparent formations of various shapes and numerous septa. The amount of collagen fibers around the capillary confirmed the presence of vascular sclerosis. At the same time, endothelial cells lining the inner surface of the capillary were changed. Their nuclei were elongated, nuclear chromatin was located compactly along the periphery, sometimes with destruction of the cytoplasm. All these changes in the cellular elements of the terminal villus confirmed the presence of a dystrophic process in the placenta. An electron microscopic examination of the placenta also showed an increase in subepithelial vessels and hyperplastic capillaries, changes in the density of microvilli, and the appearance in syncytium of grouped nuclei of syncytiotrophoblast with swollen mitochondrial rists.
As a result of the study of the enzymatic activity of ATPase and 5 "-nucleotidase in placentas during preterm birth, the dependence of the reaction product on changes in various structures of the terminal villus was established. Thus, high enzymatic activity was observed on microvilli secreting pinocytic vesicles, nuclei of syncytium, cytotrophoblast and endothelial cells , i.e., unchanged terminal villi, where more often the processes were of a compensatory nature.So, where destruction was detected during ultrastructural examination of the placenta, the enzymatic activity of ATPase and 5 "-nucleotidase was reduced. This was especially true of edematous, sclerosed and fibrinoid-altered villi. Electron microscopic examination made it possible to once again determine the predominance of dystrophic or compensatory processes in the placentas in women who gave birth prematurely. The results of ultrastructural and ultracytochemical studies confirmed that the changes occurring in the placenta indicate the development of placental insufficiency.
Thus, morphofunctional studies of placenta in preterm birth, carried out using morphometric and electron microscopic methods, made it possible to detect the phenomena of placental insufficiency. In cases of predominance of compensatory-adaptive processes in the placentas over dystrophic ones, the pregnancy proceeded favorably and premature babies were born with physical parameters corresponding to the gestational age. With pronounced dystrophic changes in the placentas, the development of placental insufficiency led to intrauterine growth retardation of the fetus, a complicated course of the neonatal period in premature babies and was one of the indications for early termination of pregnancy.
The main signs of a premature baby
A baby born before 38 weeks of gestation is considered premature. According to the international nomenclature (Geneva, 1957), children with a birth weight of more than 2500 g are diagnosed with prematurity if they were born earlier than 37 weeks.
Classification of prematurity based on gestational age at birth
- I degree - 35-37 weeks of pregnancy.
- II degree - 32-34 weeks of pregnancy.
- III degree - 29-31 weeks of pregnancy.
- IV degree - less than 29 weeks of pregnancy.
The physical development of premature babies is characterized by a higher rate of weight gain and body length in the first year of life (with the exception of the first month). By 2-3 months, they double the initial body weight, by 3-5 - triple, by the year - increase by 4-7 times. At the same time, extremely immature children are significantly behind in terms of absolute indicators of height and body weight (“miniature” children), 1-3 “corridor” of centile tables. In subsequent years of life, very premature babies may retain a kind of harmonic "delay" of physical development. The assessment of physical development is carried out according to the scale of G.M. Dementieva, E.V. Short and according to the method of E.A. Usacheva, taking into account gestational age.
The neuropsychic development of premature babies in the first 1.5 years is usually slowed down, the degree of this delay depends on the severity of prematurity, this is a kind of "norm" for immature children. In the absence of damage to the nervous system, even extremely immature children by the age of 2-3 years do not differ from full-term ones in terms of the level of psychomotor development, although many of them retain emotional lability, fatigue, and rapid exhaustion of nervous processes.
Anatomical and physiological features of premature babies
Features of the neurological status of preterm infants of the 1st degree (35-38 weeks) without factors aggravating the neurological status do not differ from full-term children. In children with II-IV degree of prematurity, the morphological status depends on the degree of brain maturity. Children with II-III degree of prematurity are characterized by respiratory failure (rhythmic shallow breathing), which persists up to 2-3 months of life. Di 1.5-2 months of life, the syndrome of "heat transfer" is expressed, the marble pattern of the skin, cyanosis, rapid cooling, and edematous syndrome.
Children are lethargic, motor reactions are reduced. Reactions of concentration and initial tracking begin to form with a satisfactory increase in body weight and the absence of somatic diseases, appear from 1.5-2 months of life. Characterized by muscle hypotonia up to 2-4 weeks, then replaced by increased tone in the flexors of the limbs.
Unconditioned reflexes from the group of spinal automatisms (reflexes of support, automatic gait, crawling, etc.) begin to appear from 1-2 months of age. In prematurity III-IV degree, it is difficult to objectively assess the neurological status up to 1.5-2 months, since the leading syndrome is general lethargy, which is also characteristic of CNS depression.
It must be remembered that with improper rehabilitation, even meager clinical manifestations before the age of 3-4 months of life can subsequently progress.
Features of the neurological status in premature babies
Premature babies are identified as a risk group for neuropsychiatric pathology. The pediatrician should pay attention to the clinical manifestations of neuropsychiatric status. In a premature baby, the syndrome of increased neuro-reflex excitability proceeds according to one of three options.
In the first case, the clinical picture in the acute period is similar to that of a full-term baby, subsequently decreases and gradually disappears by 6-12 months. In the second variant, after a year of life, an asthenoneurotic syndrome is formed. In the third variant of the course, minimal manifestations of the syndrome of increased neuro-reflex excitability are transformed into a convulsive syndrome (regardless of age). Such conditions practically do not occur in full-term children with neuro-reflex excitability syndrome.
Thus, minimal clinical changes in the nervous system in a premature baby can have irreversible severe consequences, which requires constant dynamic monitoring by a pediatrician, narrow specialists using instrumental research methods.
Most often, premature babies develop hypertensive hydrocephalic syndrome, which occurs in two ways. Favorable course - at first, hypertensive symptoms disappear, in the future there are no signs of hydrocephalus. Unfavorable course - outcome in cerebral palsy, hydrocephalic and convulsive syndromes.
CNS depression syndrome is typical for children with III-IV degree of prematurity. It indicates not only neurological, but also somatic ill-being, is characteristic of subarachnoid and parenchymal hemorrhages, bilirubin brain damage that occurs with conjugative jaundice in immature premature babies.
Convulsive syndrome can be observed in the first days of life. His clinic is typical. Sometimes in the recovery period, after 4-6 months of life, there are apnea attacks, a sharp reddening or cyanosis of the face, a marbled skin pattern, a Harlequin symptom, increased sweating, regurgitation, nodding movements of the head or bending the body back and forth. These prognostically unfavorable symptoms may first occur against the background of intercurrent diseases, indicating irreversible changes occurring in the central nervous system. All premature babies are characterized by a syndrome of vegetative-visceral dysfunctions, the severity of which depends on the degree of prematurity, the timeliness and volume of rehabilitation measures.
A child born prematurely shows signs of immaturity: body weight less than 2500 g, body length less than 45 cm, a lot of cheese-like lubricant, insufficient development of subcutaneous adipose tissue, fluff on the body (normally it is noted only on the shoulder girdle), short hair on the head , soft ear and nasal cartilages, nails do not go beyond the fingertips, the umbilical ring is located closer to the womb, in boys the testicles are not lowered into the scrotum, in girls the clitoris and labia minora are not covered by large ones, the child's cry is thin (squeaky).
Maturity is assessed using a special scale (WHO, 1976). At the same time, the period of intrauterine development of a newborn can be estimated with an accuracy of 2 weeks. When assessing the degree of maturity, the gestational age at which the birth occurred should be taken into account.
The Apgar score has been proposed for the full-term newborn, but this scale can also be used with success in prematurity. An increased frequency of depression of vital parameters in a premature baby is correlated with low status scores at birth. According to many researchers, with a body weight of up to 1500 g, the condition is assessed on the Apgar scale from 0 to 3 points in about 50%, while with a weight of 3000 g - only in 5-7% of newborns. Of great prognostic value is the assessment of the child's condition on the Apgar scale 5 minutes after birth. If it remains low, then the prognosis is poor.
In recent years, it has been established that in utero the fetus makes respiratory movements that can be recorded using ultrasound equipment. If these movements are absent or significantly weakened, then newborns often develop hyaline membrane disease. With nephropathy or diabetes in the mother, the frequency of episodes of respiratory movements in the fetus decreases. Intrauterine respiration is a new parameter, which, apparently, will make it possible to more accurately assess the readiness of the fetal body for extrauterine respiration. The mechanism of the first breath is quite complex, and the role of stimuli in this process is not well understood, especially in children born at different gestational dates. Of great importance in the excitation of the respiratory center at the time of birth is asphyxia, which can be observed as a short episode at the time of birth. A decrease in PO2 and pH, an increase in PCO2 stimulate respiratory movements, causing impulses from carotid and aortic chemoreceptors. Such short episodes of asphyxia, which are observed during normal childbirth, are characterized by the absence of metabolic acidosis. Protracted asphyxia is accompanied by the appearance of metabolic and respiratory acidosis and leads to depression of the respiratory center.
Another important stimulus to start breathing is a sharp drop in the temperature of the environment surrounding the baby at birth. Decrease in temperature stimulates the nerve endings in the child's skin, these stimuli are transmitted to the respiratory center. They are an intense breath stimulant. However, excessive cooling of the newborn leads to a deep depression of the child's life. The tactile stimulation created by normal touching of the baby at the time of birth also stimulates the onset of breathing. The end result of the extrauterine activity of the respiratory muscles is the creation of more low pressure than in the atmosphere. Negative intrathoracic pressure promotes the flow of air into the lungs. The diaphragm plays a major role in the normal functioning of the lungs.
Adaptation of the cardiovascular system to extrauterine life occurs simultaneously with the adaptation of the lungs. The expansion of the lungs and adequate oxygenation, which occur in a child with the onset of respiratory movements, cause a decrease in blood pressure in the pulmonary circulation due to the expansion of the pulmonary arterioles. At this time, arterial pressure in the systemic circulation increases significantly due to the shutdown of placental blood flow. Due to the change in the ratio of blood pressure values, conditions are created for the elimination of mixing of venous and arterial blood, the oval window and the arterial, and then the venous duct close. .
To assess the respiratory function at the time of birth and subsequent days, the Silverman scale is increasingly being used, according to which the respiratory function of the newborn is characterized by:
- movement of the chest and retraction of the anterior abdominal wall on inspiration;
- retraction of intercostal spaces;
- retraction of the sternum;
- the position of the lower jaw and the participation of the wings of the nose in the act of breathing;
- the nature of breathing (noisy, with a groan).
Each of these symptoms is scored from 0 to 2 points as its severity increases. The sum of points gives an idea of the respiratory function of the newborn. The lower the score on the Silverman scale, the less pronounced manifestations of pulmonary insufficiency. When nursing premature babies, it is necessary to maintain adequate breathing and normal functioning of the lungs. It is especially important not to disrupt the mechanism of the first breath, so all manipulations to suction mucus from the upper respiratory tract should be carried out with extreme caution.
Maintaining the optimal temperature environment is one of the most important aspects of effective care for a premature baby. The anatomical features of premature babies are such that they predispose to heat loss, and their heat balance is less stable than in children with a larger body weight.
In newborns with low body weight, its surface is relatively large. Large surface body causes more extensive contact with the external environment, increasing heat loss. Heat loss per unit mass in a premature baby weighing 1500 g is 5 times greater than in an adult. Another anatomical obstacle to the preservation of heat is too thin a layer of subcutaneous fatty tissue, as a result of which heat is quickly transferred from the internal organs to the surface of the skin.
The posture of the child is also reflected in the rate of heat loss. With bent limbs, the surface of the body and, accordingly, heat transfer decrease. The tendency to bend the limbs increases with the increase in the period of intrauterine development. The smaller it is, the more heat the newborn loses. These factors significantly affect the newborn's ability to survive, the rate of recovery after asphyxia, the effectiveness of treatment of respiratory disorders, and the rate of weight gain.
Under the influence of cold, due to the activation of the metabolism in a newborn, the rate of return increases. This phenomenon is observed in both full-term and premature newborns, although the latter have a slightly lower rate of heat transfer. The main metabolic disorders in newborns exposed to cold include hypoxemia, metabolic acidosis, rapid depletion of glycogen stores, and low blood sugar levels. An increase in metabolism leads to an increase in oxygen consumption. If at the same time the oxygen content in the inhaled air is not increased, then the blood PO2 drops. In response to hypothermia, norepinephrine is released, which leads to pulmonary vasoconstriction. In this regard, the efficiency of lung ventilation decreases, which leads to a decrease in the partial pressure of oxygen in arterial blood. In this case, the breakdown of glycogen and its conversion into glucose occur under hypoxic conditions, and with anaerobic glycolysis, the rate of glycogen breakdown is many times higher than with aerobic, resulting in hypoglycemia. In addition, in the process of anaerobic glycolysis, a large amount of lactic acid is formed, which leads to an increase in metabolic acidosis.
These disorders occur the sooner the more premature the child is, since his glycogen stores are insignificant, and are especially reduced in newborns with insufficient oxygenation with atelectasis due to lung immaturity and other respiratory disorders. For these newborns, maintaining a warm environment is vital. Body temperature drops immediately after birth. To a certain extent this physiological process, since stimulation of the skin receptors is necessary to stimulate the first breath. In a normal delivery room, the temperature of a full-term newborn decreases by 0.1 ° C in the rectum and 0.3 ° C on the skin per minute. In a premature baby, these losses are even more significant, especially if respiratory distress is observed at the same time.
A significant amount of heat is lost when the amniotic fluid evaporates from the baby's body. In order to reduce these losses, a premature baby should be taken in warm diapers, wiped and placed on a table heated from above by a heat source, or in an incubator heated to 32-35 ° C. Maintaining a thermal regime in the first days of life is a top priority when nursing premature babies.
Premature newborns do not tolerate stressful situations that arise in connection with the onset of extrauterine life. Their lungs are not mature enough to carry out gas exchange, the digestive tract cannot absorb 20-40% of the fat contained in milk. Their resistance to infection is low, and an increase in the rate of heat loss disrupts thermoregulation. Increased fragility of capillaries predisposes to hemorrhage, especially in the ventricles of the brain and cervical region spinal cord. The most common diseases to which premature newborns are predisposed are hyaline membrane disease, intracranial hemorrhage, infection, and asphyxia.
Complications in premature babies
The most severe complication of the postnatal period of life in a premature baby is hyaline membrane disease, or respiratory distress syndrome. Most often, this disease is observed in children with a birth weight of 1000-1500 g or less. In most cases, newborns have surfactant in their lungs to help them breathe efficiently. A small amount of it is produced with the participation of methyltransferase from 22-24 weeks of intrauterine life. After birth, the production of surfactant l in this way stops under the influence of hypoxia. Surfactant synthesis by a more stable system involving phosphocholine transferase begins at 34-35 weeks of intrauterine life; this system is more resistant to acidosis and hypoxia. At birth and shortly thereafter, a premature baby can breathe without difficulties, but due to the fact that the surfactant is consumed, and the new system synthesizes it in small quantities, normal functional residual lung capacity is not established. The alveoli, which expand during inhalation, collapse during exhalation. Each subsequent breath requires incredible effort from the child.
As the child weakens, atelectasis increases, which entails the development of hypoxia and hypercapnia. Since the anaerobic pathway of glycolysis predominates, metabolic acidosis occurs. Hypoxia and acidosis increase vasospasm, resulting in a decrease in blood flow to the lungs. Hypoxia and acidosis lead to capillary damage and alveolar necrosis. In the alveoli and terminal respiratory bronchioles, hyaline membranes are formed from the products of cell necrosis, which by themselves, without causing atelectasis, significantly reduce the elasticity of the lungs. These processes further disrupt the production of surfactant. Insufficient expansion of the lungs and the preservation of high resistance of the pulmonary vessels lead to an increase in blood pressure in the pulmonary circulation, as a result of which the intrauterine type of blood circulation (foramen ovale, arterial duct) is preserved. The action of these extrapulmonary shunts is expressed in the removal of blood from the lungs, and: the child's condition progressively worsens. With the threat of premature birth and at the time of birth, it is necessary to prevent the disease of hyaline membranes in a child (maintaining the temperature regime, sufficient oxygenation, combating acidosis). Modern methods of intensive care can significantly reduce mortality in this disease. In the neonatal period, premature babies show signs of intrauterine growth retardation. Such conditions are most typical for children born to mothers with extragenital pathology and toxicosis in the second half of pregnancy. At the same time, as our studies have shown), children with malnutrition are often born even in primigravida without any other complications during pregnancy. Hypotrophy is detected more often in preterm birth at 28-32 weeks of gestation (67%). At birth at 33-36 weeks, the frequency of birth of children with signs of intrauterine growth retardation is only 30%.
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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, a 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 flow 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.
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 side to this work. immune system: Some babies have a slightly reduced risk of developing allergic reactions after birth.
However, as they grow older, on the contrary, the child becomes more susceptible to
- Reduced levels of vitamin K, which is involved in the formation of proteins and some blood factors (for example, prothrombin) responsible for normal blood clotting.
- Reduced ability of platelets (blood cells) to stick together and form blood clots.
Jaundice in premature babies
In utero, the fetus develops fetal hemoglobin, carrying more oxygen to organs and tissues, which is necessary in conditions of mixed circulation.
After birth, fetal hemoglobin is rapidly degraded to form bilirubin- a toxic pigment that spreads throughout the body with blood, staining the skin and mucous crumbs yellow. Bilirubin binds to special proteins that are produced in the liver, then excreted from the body.
In a full-term baby the level of bilirubin rarely reaches high numbers and is excreted from the body within a few days or two weeks.
In a premature baby this process is delayed due to the immaturity of the liver, insufficient production of bile acids, narrow bile ducts of the liver and gallbladder.
An increase in the level of bilirubin is dangerous because, being a toxic substance, it leads to impaired respiration in cells and the formation of proteins. Most of all, bilirubin "loves" fat cells and nervous tissue.
Physiological weight loss
After birth, all babies "lose weight" for several reasons:
- During childbirth, the body's metabolism and energy consumption by tissues increase.
- Childbirth is stressful for the baby, leading to fluid loss through sweat and breathing.
- The original stool passes - meconium.
The child has nothing to compensate for the losses from the outside, since not enough colostrum and energy enter the body. The baby begins to consume its own "reserves" of brown fat accumulated during fetal development.
Weight recovery takes place at different times. In full-term children - by 7-10 days of life. With a moderate degree of prematurity - usually after the second week of life, with a deep - the third or fourth week. Numerous factors influence the process: the conditions of nursing and feeding, the presence or absence of diseases, and some other points.
urinary system
The exchange of salts and water in premature babies is unstable, so they are equally prone to both the formation of edema and dehydration. In addition, the kidney tissue in which urine is formed is also immature, further contributing to water retention in the body.
Therefore, premature babies often develop early swelling- even during fetal development, in the first hours or days of life. They are soft, spread throughout the body and disappear in the first or second week of life.
Late swelling occur in the second or third week of life, indicating nutritional problems, a decrease in the amount of protein in the body, or the presence of a disease in the child. Edema is dense to the touch, located in the lower third of the abdomen, feet, legs and pubis.
Given the characteristics of organs and tissues, a premature baby needs help to adapt to new living conditions and survive.
Few parents are prepared for the birth of their child. ahead of time. Most often, the birth of a premature baby becomes a difficult test for the whole family. This is because everyone is waiting for the birth of a plump, rosy-cheeked toddler, expecting to return from the maternity hospital in a maximum of 5 days, and in general, as a rule, they make optimistic plans for the future. A huge amount of information for future and young parents, including the Internet, television, print media, is devoted to a normal pregnancy, childbirth without complications, and caring for a healthy newborn. When something starts to go wrong, parents find themselves in an information vacuum, which sometimes exacerbates an already difficult situation.
For the first time in Russia, a resource has been created that is completely devoted to the problem of premature birth and prematurity. This resource was created by parents for parents who are expecting or have already given birth to a child prematurely. From our own experience, we have experienced a lack of information during the period of maintaining a pregnancy, nursing a baby in a maternity hospital and a perinatal center. We felt an acute shortage of funds for specialized care, which is so necessary for the full physical and mental maturation of the child outside the womb. Behind him is more than one month spent at the incubator, then at the crib in endless expectation, fear and hopes for recovery. As the baby grew, more and more information was needed about the care, development, education of a child born prematurely, which would be adapted to our situation and which is very difficult to find. Such experience gives us reason to believe that the information posted on our website will help young mothers and fathers be more prepared for the birth of their dearest baby, which means it is easier and more peaceful to survive this difficult period in life. Knowledge and experience will make you more confident and help you focus on the most important thing - the health and development of your baby.
As materials for creating the site, we used medical and pedagogical literature, reference books, practical guides, opinions of specialists in the field of obstetrics, gynecology and neonatology, child psychology and pedagogy, materials from foreign resources, as well as the invaluable experience of parents whom we met and became close friends thanks to our children.
We draw your attention to the fact that the materials presented here are not a “recipe” for you and your child, but are only intended to help you deal with the situation, dispel some doubts and orient yourself in your actions. mention of any medicines, equipment, brands, institutions, etc. is not an advertisement and cannot be used without the consent of experts.
We hope that we will be useful to you from the moment your baby is born and we will grow with you. If you have any questions, wishes or suggestions, This e-mail address is being protected from spambots. You need JavaScript enabled to view it !
Sincerely yours,