November 17 is the International Day of the Premature Baby, which was established in 2009 at the initiative of the European Foundation for the Care of Newborn Patients.

Pregnancy is behind us - a time of joyful and, at the same time, anxious anticipation. Finally, the long-awaited baby was born, but, alas, earlier than expected. Of course, you are worried and ask a lot of questions.

After all, you will have to face many problems, since the baby will be in a hurry to be born, and his body is not ready for independent life. Therefore, the baby requires increased attention and careful care.

Premature baby: basic concepts

Immediately after birth, it is determined how premature the baby is, since further treatment tactics and the creation of conditions for nursing depend on this.

This takes into account two main criteria: birth weight and gestational age or age (the number of completed weeks of pregnancy at the time of birth).

Degrees of prematurity

First degree of prematurity- birth at 34-36 weeks and six days. Birth weight is from 2001 to 2500 grams. The prognosis is favorable, as a rule, without creating special conditions for nursing. Except in cases where there are other conditions or diseases - for example, infection, birth injury, a long period of waterlessness.

Second or moderate degree of prematurity- early birth at 31-33 weeks and 6 days. Birth weight is from 1501 to 2000 grams. The prognosis is favorable if timely medical care is provided, as well as in conditions of optimal feeding and care.

Third or severe degree of prematurity- very early birth at 28-30 weeks. Body weight at birth is from 1001 to 1500 grams. The prognosis is not entirely favorable, although many of these children survive. However, subsequently they spend a long time in nursing and receive treatment for various diseases.

Fourth degree or deep prematurity- extremely early birth at up to 28 weeks. Birth weight - up to 1000 grams (extremely low weight). According to statistics, every fifth baby is born alive during this period.

However, the prognosis is unfavorable. Babies who were born alive before 26 weeks, unfortunately, in 80-90% of cases die by the age of one month, and of those born at 27-28 weeks - about 60-70%.

In addition, a very premature baby, due to the immaturity of all organs and systems, may develop numerous pathological conditions and diseases. Therefore, it is recommended to decide the future fate of the baby together with an obstetrician-gynecologist, neonatologist and the child’s mother. At the same time, parents are explained all the consequences and the need for long-term care.

"Post-conceptual age" or "post-conceptual period"

In medicine, these concepts are used when the age of the child or the period after birth is indicated according to the duration of pregnancy, if it were still ongoing.

Therefore, characterizing a premature baby ( appearance, developmental features and other signs), weeks are usually given in accordance with gestational age.

Born prematurely: what does a premature baby look like?

Of course, a premature baby is different in appearance from a full-term baby, but much depends on the gestational age.

The main external distinctive signs of premature babies

Moderate prematurity: I-II degree

* Muscle tone is somewhat reduced, but the baby is generally active.
* The skin is pink and the subcutaneous fat layer is moderately thin.
* Vellus hair (lanugo) is absent from the skin on the face from 32-33 weeks, and starting from 35-37 weeks - usually on the entire surface of the skin.
* The nipples and peripapillary areas (the skin around the nipples) are clearly visible and pigmented (colored).
* The first bends in the ears appear at 35-37 weeks.
* Usually the physique is proportional: the size of the head and the length of the limbs (arms, legs) relative to the body are of normal size.
* The navel is located closer to the center of the abdomen, but still slightly lower than in full-term babies.
* Nails typically extend to the edges of the toes (nail bed).
* The external genitalia are well developed. In girls, the genital slit is almost closed. In boys, the testicles are located at the entrance to the scrotum (in the upper third), but sometimes there is unilateral cryptorchidism (one testicle does not descend into the scrotum).

Deep prematurity: III-IV degree

* Due to decreased muscle tone, the child lies with his arms and legs extended.
* The skin is dark red, thin and wrinkled (like an old man’s), often swollen, and abundantly covered with vellus hair.
* The subcutaneous fat layer is thinned.
* The baby has a somewhat disproportionate physique: the size of the head is large in relation to the length of the body, and the limbs are short compared to the body.
* The navel is located in the lower third of the abdomen.
* The nipples and parapapillary areas are poorly pigmented and difficult to see.
* The ears are soft, have no convolutions and are shapeless, pressed to the head and located low.
* Baby's nails are underdeveloped and usually do not reach the fingertips.
* Cranial sutures are open, small, large and lateral fontanelles have large sizes, and the bones of the skull are soft.
* External genitalia are underdeveloped. In girls, the labia majora do not cover the labia minora, so the genital slit is gaping (open). In boys, the testicles usually have not yet descended into the scrotum.

However, it should be remembered that the same baby does not always show all the signs of prematurity equally clearly and clearly in accordance with the gestational age. It often happens that some of them are more pronounced and others less.

Life against all odds...

Regarding premature babies, there is general trend: The incidence of morbidity, mortality and disability increases as gestational age decreases.

However, the forecast remains just a forecast and is not guarantee or sentence. Because some premature babies, despite all the gloomy assessments, fight, survive and grow up as healthy children. While other babies have a hard time being nursed, and sometimes even die, although, it would seem, they initially have more favorable characteristics.

Why is this happening? The question is better addressed to Mother Nature. Alas, we most likely will not get an answer to it. However, perhaps this phenomenon can be explained by the desire of some children to cling to life by any means.

Hence the conclusion: with each passing day, the baby’s chances of survival increase significantly.

Therefore, in the next material we will talk about the physiological features of a premature baby depending on the gestational age at the time of birth. Successful nursing, adaptation to life outside the womb and the health of the premature baby are directly related to them.

resident doctor of the children's department

- children born between 28 and 37 weeks of intrauterine development and having a body weight below 2500 g and a length of 45 cm or less. Depending on body weight at birth, there are 4 degrees of prematurity: I degree - premature, born with a body weight of 2001-2500 g; II degree - with a weight of 1501-2000 g; III degree - with a mass of 1001-1500 g, IV degree - 1000 g or less. A premature infant with a birth weight of more than 500 g and who has taken at least one breath is considered viable. The frequency of birth of premature babies in various regions of our country ranges from 6 to 14%.

Etiology. The most common causes of prematurity: isthmic-cervical insufficiency, uterine malformations, extragenital pathology, infectious diseases in a pregnant woman; pathology of the fetus (malformations, antenatal pathology, congenital diseases), pathology of pregnancy and childbirth (toxicosis, immunological incompatibility of the pregnant woman and the fetus, premature placental abruption, premature effusion amniotic fluid), as well as factors such as occupational hazards, the age of the pregnant woman is younger than 20 and older than 35 years, bad habits(alcoholism, drug addiction, smoking).

Anatomical and physiological features. Morphological characteristics. The physique of a premature baby is disproportionate, the head is relatively large (1/3 of the body length), the size of the cerebral skull is larger than the facial one. The bones of the skull are pliable, the sutures and the small fontanel are often open, the ears are soft. The umbilical ring is located closer to the pubic symphysis. The skin is thin, subcutaneous tissue is practically absent (Fig. 1), the skin is abundantly covered with original fluff - lanugo (Fig. 2), the nail plates do not reach the fingertips. In girls, the labia majora do not cover the labia minora, which is why the genital slit is gaping; in boys, the testicles are not lowered into the scrotum (Fig. 3).

Functional signs of a premature baby are decreased muscle tone, lethargy, weak cry or squeak, insufficient expression or absence of swallowing and sucking reflexes. The number of respiratory movements varies from 36 to 82 per minute, breathing is shallow, of uneven depth, there is a prolongation of individual inhalations and exhalations, respiratory pauses of varying lengths, convulsive respiratory movements with difficulty exhaling (so-called gasps).

Heart rate 140-160 beats/min, blood pressure 75/20 mmHg. Art. Any irritating factor causes increased heart rate and increased blood pressure. In the first days of life, functional closure of fetal communications (ductus arteriosus and foramen ovale) is noted; anatomical closure of these formations occurs only at 2-8 weeks of life. During this period, there may be a discharge of blood both from left to right (usually) and from right to left (less often) - transient circulation syndrome. Clinically, it manifests itself as cyanosis of the lower extremities in some completely healthy newborns. N.d. prone to hypothermia, which is due to a decrease in heat production and an increase in heat transfer. Low heat production is due to a low intake of energy from food, limited lipolysis, and brown fat, the amount of which in premature infants is approximately 2% of body weight, which is significantly less than in full-term infants. High heat transfer is associated with a relatively large surface of the skin (about 0.15 m2 per 1 kg of body weight), a thin layer of subcutaneous tissue.

The gastric capacity in the first 10 days of a premature baby is 3 ml/kg multiplied by the number of days. So, in a child of 3 days of life, born with a weight of 1500 g, the stomach capacity is 3x1, 5x3 = 13.5 ml. This determines the small amount of prescribed nutrition in the first days of life. The volume of gastric juice secreted in them is almost 3 times less than that of full-term peers, the pH at the height of digestion reaches 4.4-5.6. The enzyme secretory function of the intestine is reduced, as evidenced by the low concentration of enterokinase, alkaline phosphatase, lactase, up to 21/2 months. Pancreatic enzymes (amylase, lipase, trypsin) are absent or their content is sharply reduced.

At the time of birth of a premature baby, the endocrine glands are structurally differentiated, but their functionality during the period of adaptation to new environmental conditions is limited.

Functional characteristics of the kidneys in N.d. are low glomerular filtration volume (19.4 ml/min?m2), reduced tubular reabsorption of water (95.9-96.4%), almost complete sodium reabsorption, weak response to the administration of osmodiuretics, imperfect renal osmoregulation and maintenance of acid-base balance balance. Daily diuresis by the end of the first week of life ranges from 58 to 145 ml, the frequency of urination is 8-13 times a day.

The severity of innate reflex reactions depends on the degree of prematurity. The predominance of subcortical activity is manifested by a tendency to chaotic movements and general tremors. This is explained by the morphological and functional immaturity of the central nervous system. Thus, at birth, smoothness of the sulci of the cerebral cortex, weak differentiation of gray and white matter, and relatively poor vascularization of the subcortical zones are noted. Rapid exhaustion of the processes of higher nervous activity is also characteristic. In cerebrospinal fluid N.d. - pronounced xanthochromia, high cytosis (up to 80 cells in 1 μl) of a predominantly lymphocytic nature.

Features of adaptation to new environmental conditions. The shortening of the period of intrauterine development and the associated morphological and functional immaturity of many vital organs and systems determine the characteristics of the period of adaptation to the conditions of extrauterine life and have a significant impact on the level of perinatal morbidity and mortality. The concept of “maturity” is closely related to the concept of “gestational age” - the true age of the child from the moment of conception to birth. Knowing the gestational age allows us to assess the nature of intrauterine development of the fetus. It can be installed both in the antenatal and postnatal periods. In the antenatal period, information about gestational age is obtained by examining amniotic fluid, the composition of which reflects the degree of development of individual systems of the fetal body. The degree of maturity of the respiratory system is especially important; it is established based on the content of surfactant in the alveoli. Its decrease leads to the development of respiratory distress syndrome (see Respiratory distress syndrome in newborns). The size of the fetus is also determined using ultrasound examination followed by calculation using special tables.

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

Perinatal and neonatal mortality and morbidity in newborns “small for term” are 3-8 times higher than those in children born at term with normal body weight. The younger the child’s gestational age, the more intense and longer the process of adaptation to the conditions of extrauterine life takes place. Clinically, it is characterized by disorder syndromes cerebral circulation I—II—III degree, breathing, icteric and edematous; The detection rate of these syndromes ranges from 67 to 100%. More often there is a combination of syndromes, each of which aggravates the course of the other. Towards the end of the first - on the second day of life, jaundice appears, the intensity of which increases by the 5-8th day of life and persists until 2-3 weeks. The hourly increase in bilirubin in a premature baby should not exceed 1.7 µmol/l. There is no correlation between the intensity of jaundice and the degree of hyperbilirubinemia, as well as between the latter and the likelihood of damage to the brain nuclei by indirect bilirubin. N.d. prone to swelling of the subcutaneous tissue, and against the background of the development of pathological conditions (for example, hypothermia), sclerema and (or) scleredema may occur. Physiological erythema, which is characterized by the intensity of skin coloring, may appear; toxic erythema (see Toxic erythema of newborns) is rarely found. Transient fever is not observed, but if the nursing regime is violated, hyperthermia due to overheating is possible. Sexual crisis and uric acid infarction are much less common than in full-term babies and their severity is weaker. Transient dysbiosis is observed in premature infants who do not receive breast milk, as well as those on antibacterial therapy. Due to the immaturity of the surfactant system of the lungs in N.d. there is a high incidence of pneumopathy-atelectasis, hyaline membrane disease, edematous-hemorrhagic syndrome (see Respiratory distress syndrome of newborns). An unfavorable course of the antenatal period, leading to intrauterine hypoxia, complications during childbirth, and vitamin K deficiency in premature infants contribute to the occurrence of intracranial hemorrhages, and their frequency increases in proportion to the decrease in gestational age. Due to the limited functionality of the endocrine system in N.d. Adrenal insufficiency, transient hypothyroidism and hypoparathyroidism are more common. For N.d. physiological metabolic acidosis is characteristic, from 4-5 days. In life, multidirectional reactions of acid-base balance appear: extracellular acidosis and intracellular alkalosis. Normalization of acid-base balance occurs slowly, and metabolic acidosis easily occurs with any damaging effect. For N.d. characterized by shifts in the electrolyte composition of the blood serum - hypocalcemia, hypo- or hypermagnesemia, the sodium level is higher than in full-term children, and is 140-155 mmol/l. In the first 3-4 days of life, hypoglycemia remains within 2-2.5 mmol/l. Only by 2 weeks of age does the glucose level stabilize at 3 mmol/l.

Features of physical and nervous mental development . Loss of body weight in premature babies in the first days of life is 5-12% in relation to body weight at birth, body weight is restored by the 12-14th day of life. Average weight gain in N.d. with a relatively favorable course of the adaptation period during the first month of life depends on the degree of prematurity (for prematurity I-II degrees - 250-350 g, for III-IV degrees - 180-200 g). Subsequently, the intensity of body weight gain increases: by 3 months. it doubles; by 5 months - triples, by 1 year - increases 4-10 times. Head circumference in the first 3 months. life increases by 11/2-3 cm monthly, then by 1-11/2 cm per month. and by 1 year it becomes 12-19 cm larger. In the first year of life N.d. grow more intensively than full-term babies (monthly increase in height is 2.5-4 cm). However, during the first year of life, height increases by 25-44 cm and reaches an average of 73 cm by 1 year, i.e., it lags somewhat behind the growth of full-term children. Only by approximately 2-3 years, almost all children born prematurely catch up with their full-term peers in the main parameters of physical development (body weight and height), and at the age of 8-10 years, the differences in these indicators of physical development between these groups of children, as usually not at all. In children with I-II degrees of prematurity, teeth erupt at 6-9 months, and with III-IV degrees of prematurity - at 8-10 months.

Features of neuropsychic development N.d. determined by the nature of the antenatal and postnatal periods, the volume of corrective therapy carried out during this period. Due to the polymorphism of factors that have a pathological effect in the antenatal and postnatal periods of fetal and newborn development, N.d. neurological changes of varying severity may be observed. The main syndromes include; vegetative-vascular disorders, asthenoneurotic conditions, hypertensive-hydrocephalic and convulsive syndromes (Fig. 4), cerebral palsy.

Intellectual development N.d. does not always correlate with the severity of neurological pathology. This indicates the need for a more careful differentiated approach to these children by both neurologists and child psychiatrists. Medical and pedagogical correction must be carried out based on average indicators of neuropsychic development. For N.d. Characterized by a significant delay, compared with full-term peers, in the development of static and motor functions: tries to hold his head while lying on his stomach at 2-4 months, holds his head upright well at 4-6 months, rolls over onto his stomach, stands steadily with support at 6 ,5-7 months, rolls over from stomach to back at 7-81/2 months, sits up and lies down on his own, stands up holding a barrier at 9-12 months, stands independently at 11-13 months. In premature babies, there is also a delay in the development of speech, both babbling and phrasing: the beginning of humming is at 31/2-5 months, and there is a long period of humming from 51/2-71/2 months; the beginning of babbling - at 61/2-8 months, babbles for a long time at 8-10 months, pronounces syllables loudly at 91/2-12 months, repeats various syllables after adults from 10-121/2 months, pronounces the first words at 11—141/2 months. Often there may be a lack of appetite, repeated regurgitation and vomiting are observed, and the rhythm of sleep and wakefulness is disrupted.

Delayed mental development of a child born prematurely may be aggravated by dysfunction of sensory organs. Thus, pathology of the organ of vision (myopia of varying severity, astigmatism, strabismus, glaucoma) occurs in 21-33% of premature infants; 3-4% of N.D. have hearing loss of varying degrees; Hearing loss may increase due to frequent repeated acute respiratory viral infections and other diseases (for example, otitis media, grade II-III adenoids). With age, clinical manifestations of psychoneurological symptoms may disappear or undergo a reduction, remaining by 4-7 years only in the form of mild residual organic signs of damage to the central nervous system. However, their unfavorable course with the formation of persistent and complex psychopathological syndromes is also possible.

Features of care. The air temperature in the room where N.D. is located should be 25°, humidity 55-60%. If necessary, closed incubators are used for nursing (Fig. 5). The temperature in the incubator depends on the child’s body weight and is 34.8-32°. In the first days of life, humidity is maintained within 90-95%; from the 3rd-4th day it is gradually reduced, reaching 50-60% by the end of the 1st week. The level of oxygenation is selected individually. Transfer of a premature baby to other hospitals should be carried out by a special machine equipped with an incubator with oxygen supply and everything necessary equipment for carrying out resuscitation measures. Children are discharged from the hospital when the child reaches a body weight of 2500 g. It is advisable to transfer children with encephalopathy to a specialized rehabilitation department.

Breastfeeding. The timing of the first feeding depends on the condition of the child and gestational age; it is carried out after 6-9 hours if the child was born between 32 and 37 weeks, and after 12-36 hours if the child was born at less than 32 weeks. In the latter case, from the first hours of life, children are given a 10% glucose solution parenterally. Children weighing more than 1800 g can be breastfed; children weighing less than 1800 g are fed through a nipple, and in the absence of sucking and swallowing reflexes, through a tube. The physiological frequency of feedings is 7-8 times a day, and for very premature infants of III and IV degrees of prematurity - 10 times. The amount of milk required for feeding in the first 10 days of life is calculated by the formula: 10 kcal x body weight (kg) x day of life. Up to 14 days. During life, a child receives 100-120 kcal/kg, by the 1st month and older (up to 1 year) - 135-140 kcal/kg. The protein requirement for natural feeding is 2.5 g/kg, for mixed and artificial feeding 3.5-4 g/kg. Juices are administered from the 14th day of life. The daily amount of fluid in the liquid is determined by the age of the child, amounting to 30 ml/kg in the first two days, on the third day - 60 ml/kg of weight, on the 4-6th day - up to 80 ml/kg, on the 7th-8th - 100 -200 ml/kg, by 2 weeks of age - 140-160 ml/kg. Supplementary feeding N.d. with mixed and artificial feeding carried out with adapted milk formulas “Semilak”, “Detolakt”, “Linolakt” and fermented milk formulas “Malyutka”, “Malysh”. Mixtures “Biolact” and “Narine” are also used. Protein deficiency is corrected by adding the required amount of whole kefir, and after 4 months. life - cottage cheese. Translation to mixed feeding carried out gradually from 3-31/2-4 months. The sequence of introducing one or another type of complementary feeding is the same as for full-term babies - vegetable puree, porridge, hashish meat, etc. (see Infant).

Features of the course of various diseases. More often in N.d. pneumonia, rickets, anemia, and sepsis are observed. Pneumonia develops, as a rule, against the background of pneumopathy, and therefore it is necessary to identify risk factors indicating intrauterine infection. Pneumonia is not characterized by hyperthermia, physical data are scant, symptoms of respiratory failure and toxicosis increase gradually and are especially pronounced in the bacterial-viral nature of the disease.

Clinical manifestations of rickets in N.d. can be observed as early as 11/2-2 months; In this case, bone changes are characteristic - the severity of the frontal and parietal tubercles, thickening of the ends of the ribs (rosary), expansion of the lower opening of the chest, at the age of 2-3 months. Harrison's groove appears, the time and order of teeth eruption is disrupted. Somewhat later than in full-term infants, gross deformation of the tubular bones and a rachitic hump are noted. Extremely premature babies are characterized by an acute course of rickets, in which the initial period very quickly turns into the period of the height of the disease. Symptoms of damage to the central nervous system rapidly increase. and other systems. The subacute course of rickets is characterized by a slow and gradual development of the disease with a predominance of symptoms of osteoid hyperplasia. A relapsing course of rickets is often observed, which may be associated with frequent illnesses, poor nutrition, and violation of care and regimen.

Anemia in N.d. in the first 2-3 months. life (early anemia) is caused by increased hemolysis of red blood cells and functional failure of the hematopoietic apparatus. Development of anemia in N.d. over 3 months (late anemia) is almost always iron deficiency. Deficiency of protein, vitamins, and microelements is also important. The clinical manifestations of anemia are determined by the degree of its severity.

For N.d. characterized by a high frequency of purulent-septic diseases, and with decreasing gestational age the likelihood of developing sepsis increases; in this case, the main etiological factor is gram-negative opportunistic microflora; the process is sluggish. Along with septicemia, septicopyemia is often detected (purulent meningitis, osteomyelitis, necrotizing ulcerative enterocolitis).

Prevention of rickets in N.D. start at 8-10 days. life. An alcohol solution of vitamin D is prescribed (0.5% solution of ergocalciferol in alcohol); 1 ml of solution contains 200,000 IU, 1 drop - about 4000 IU of vitamin D. Prescribe 1 drop 2 times a day. The course prophylactic dose is 250,000 - 300,000 IU. Calcium levels in the body are monitored using the Sulkovich test once every 10 days. Prevention of anemia is no different from that in full-term infants.

In the complex of preventive measures, a special place belongs to physical therapy and hardening procedures. Mothers of all N.D. should be instructed about the need for constant physical therapy (5-7 times a day) before feeding for 5-10 minutes, which, in the absence of contraindications, should begin at the age of 3-4 weeks. At the age of 4-6 weeks. begin to massage the anterior abdominal wall. Bathing healthy N.D. start at 2 weeks of age; water temperature 36° followed by a gradual decrease to 32°. Walks with N.d. in the warm spring-autumn period and summer, they are carried out from 2-3 weeks of age, and with very premature children - from 2 months of age. In winter, walks are allowed at the age of at least 3 months. at a temperature not lower than 7-10°.

Medical care for premature babies in a clinic. The local pediatrician examines N.D. 1 time every 2 weeks. in the first half of the year and 1 time per month in the second half of life. A neurologist examines a child born prematurely after discharge from the hospital, and subsequently, depending on the nature of clinical manifestations on the part of the central nervous system. from 1 to 3 times per quarter during the first year of life. In each specific case, the question of the advisability of hospitalizing the child in a specialized rehabilitation department is decided. Consultative examinations by an ophthalmologist are carried out once every 3 months, by an otolaryngologist - once every 6 months, a surgeon and an orthopedist examine all N.D. at the age of 1 and 3 months. In the second half of life, consultation with a speech therapist and a child psychiatrist is necessary.

It is advisable to carry out preventive vaccinations in the second year of life after consultation with a pediatrician and neurologist; weakened vaccines are used for vaccinations.

When assessing the physical development of a child born prematurely, if a growth deficiency is detected, a consultation with an endocrinologist is required, and a deficiency in body weight with a gastroenterologist is required. At all age periods (1-3 years, 4-5 years, 6-8 years), an assessment of psychophysical health indicators is necessary, which makes it possible to resolve the issue of the harmonious development of the child, the adequacy of the medication, psychological and socio-pedagogical correction. It is very important to assess the child’s capabilities when entering school. If there are contraindications for studying in a general education school, a conclusion is given to send him to a specialized school.

Premature children are considered children born as a result of premature birth with a weight of less than 2500 g and a height of less than 45 cm. These criteria are arbitrary, since many full-term children are born weighing less than 2500 g, and some premature babies weigh more than 2500 g. The main feature of premature babies is the immaturity of the main body systems - respiratory, cardiovascular and thermoregulatory. Premature babies require special care and medical supervision. Low birth weight newborns born at term are considered children with intrauterine growth retardation.

At what age is it possible to deliver a newborn baby?

According to the WHO definition, children born no earlier than 22 weeks of pregnancy and weighing more than 500 grams are considered potentially viable. Nursing very premature babies is possible only in specialized departments of hospitals or perinatal centers. The longer the pregnancy is at the time of premature birth, the lower the risk for the baby. Babies born between 32 and 37 weeks have significantly fewer problems than preemies born between 22 and 32 weeks of pregnancy. The doctor takes into account the weight of the child when deciding whether to place the child in an incubator, prescribe phototherapy, when choosing the type of feeding of a premature baby, and in other cases.

What does a premature baby look like?

As a rule, his head is disproportionately large compared to his body. The skin is very thin, sometimes even translucent, softer to the touch than usual, covered with fluff and grease. The subcutaneous fat layer is insignificant or absent, the skin is wrinkled. The small and large fontanelles are larger than usual. The nails are very thin and often do not reach the tips of the fingers. In boys, the testicles may not descend into the scrotum, and in girls, the labia are underdeveloped. The limbs are thinner and longer, the ears are soft and pressed to the skull, the navel is low.

What is the immaturity of a premature baby?

Premature babies usually have weak, and in some cases absent, basic reflexes. Muscle tone is reduced, the thermoregulation system is undeveloped, so the newborn cannot independently maintain a constant body temperature. Other systems of the body may also be immature - respiratory, digestive, cardiovascular, visual, nervous, bone. If vital reflexes (breathing or swallowing) are absent, the child is placed in the intensive care unit or intensive care unit.

Why is a child placed in an incubator?

An incubator is a device with transparent walls that allow you to observe the child, and an optimal artificial microclimate (temperature - 33–38º, humidity - 85–100%, oxygen content - 25–40%). To care for a child inside the incubator, a special hole or special sleeves are provided. Premature babies are placed in an incubator to warm them up and further protect them from cooling the body, as well as to improve blood saturation with oxygen. Oxygen, if necessary, can be supplied uninterruptedly. One should remember the danger of the toxic effects of oxygen on the retina of the eye, which can lead to complete loss of vision, especially in very premature infants when they are kept in an incubator with oxygen for a long time (with timely diagnosis and treatment, this situation is reversible).

What is kangaroo care?

How long does a premature baby need to stay in the hospital?

In order to maintain a constant normal body temperature, premature babies need help. Being in an incubator allows the child not to waste energy on thermoregulation, adapt faster and gain weight. The length of a child’s stay in the “incubator” depends on the child’s weight at birth and the general dynamics of his condition. Children with a low degree of prematurity can be in an incubator from several hours to 4 days, children weighing up to 1750 grams. - about a week, and with a weight of up to 1500 grams. - from a week to two. Typically, a child is discharged from a maternity hospital or a specialized children's hospital when he steadily gains weight, maintains a constant body temperature, has no breathing problems and his weight is 2500 grams or more.

Will a premature baby subsequently be different from his full-term peers?

In premature babies, the pace of physical development is accelerated, and the lower their body weight at birth, the faster it will increase. The neuropsychic development of such children is somewhat slower than usual; premature children require more attention and special activities (massage, gymnastics). At first, when assessing psychomotor development For a premature baby, it is necessary to focus on the time at which he should have been born, and count all milestones from this moment. For example, if a child was born at 32 weeks, that is, 2 months ahead of schedule, you should expect that he will begin to turn not at 3.5-4 months after birth, but at 5.5-6. On average, by the age of one and a half to two years, a healthy premature baby is practically no different from its full-term peers.

Is it true that premature babies are more prone to illness?

On average, premature babies get sick more often than normal children, and the recovery process takes longer. Premature babies are more susceptible to respiratory diseases (bronchitis, pneumonia). Jaundice, which is common in newborns, can be a serious danger for premature babies. Also, premature babies are more likely to have problems with the development of the central nervous system, gastrointestinal tract, and the skeletal system and joints may suffer.

It happens when even a normally proceeding pregnancy ends in birth ahead of schedule. If the baby was born before 37 weeks weighing less than 2.5 kg, he is premature. Such children require special care.

In the first months of life, the development of premature babies differs from normal full-term babies. However, with proper care, by the age of one year, these children are almost no different from children born in accordance with the norms.

What is a “premature baby”, degrees of prematurity

Depending on the age and weight at which the baby was born, the following degrees of prematurity are distinguished.

• Extremely premature babies– these are babies born before 28 weeks, weighing less than 1 kg. Such children are not ready for life outside the womb, so the operation of all its systems requires artificial support. One must fight hard and for a long time for his future life. However, there are cases where premature babies born with extremely low body weight (about 500 g) were cared for. There is a high risk of complications and possible disability.
• Extremely premature babies are born weighing between 1 kg and 1.5 kg at 28 to 31 weeks. These children have a high probability of normal development. They require artificial ventilation and cannot feed themselves (feeding is given through a gastric tube or through a vein). The food is enriched with amino acids, enzymes, glucose and other substances that accelerate the growth and development of the baby.
• Premature babies requiring special conditions content. These are children born at 32-35 weeks weighing from 1.5 kg to 2 kg. Children weighing up to 1.7 kg are placed in special incubators for premature newborns (incubators), where they are provided with optimal temperature and humidity, and the necessary studies are carried out. For babies weighing from 1.7 kg to 2 kg, special heated cots are used.

When the child’s weight reaches 2 kg, there is no need to provide a special temperature regime. Babies born at 34 weeks are at risk of apnea (sudden stoppage of breathing). The reasons for this phenomenon are not known; they are associated with imperfect functioning of the respiratory and nervous systems.

• Babies born at 36 weeks. As a rule, they can breathe and suck on their own, but at birth they undergo mandatory additional examinations. In the future, they are under the supervision of a pediatrician.

It should be borne in mind that mass does not play a decisive role. When assessing a premature baby, the maturity of systems, organs and functions is taken into account. It may happen that a baby weighing 2 kg will be superior in development and prognosis to a baby weighing 2.5 kg.

Signs of a premature baby

A premature baby is defined by the following characteristic features:

• small height and weight;
• disproportionate body: the head makes up about a third of the total height; the brain part of the head is noticeably larger than the facial part; the navel is located lower than in normal-term babies; neck, arms, legs short;
• , the bones of the skull are soft, mobile;
• Extremely premature babies may have weak muscle tone, lack of a sucking reflex and feeling of hunger, and bulging eyes;
• the ears are so soft that they can stick together and curl inward;
• girls may have a gaping genital cleft due to underdevelopment of the labia majora, and a boy may have an empty scrotum due to undescended testicles;
• the whole body is covered with soft hair;
• absence of a layer of fat under the skin - the skin is so thin that blood vessels are visible through them.

What premature babies look like, look at the photo:

Premature babies - development by month

• In the first month of life, a premature baby hardly gains any weight. c, very susceptible to infections, may require mechanical ventilation and feeding tubes.
• If in the second month the child begins to gain weight well, then this is a sign good development And proper care. At this age, the sucking reflex is poorly developed, so the mother needs to supplement the baby with expressed milk from a spoon.
• In the third month, weight increases by 1.5 times compared to birth weight. The baby sleeps a lot. Therefore, temperature conditions and air humidity must be optimal.
• At 4 months, when placed on the stomach, the baby tries to hold its head and holds it for a short time.
• At 5 months, mothers will be given their first smile. Interest in toys increases, the baby tries to grab and hold them.
• At six months they react well to the adults around them, distinguish their own from strangers, walk around, confidently hold their head upright and in a position on their stomach. The weight of the babies increases 2.5-3 times.
• A premature baby at 7 months has already fully mastered turning over from back to stomach and vice versa; games and toys are of increasing interest to him.
• At 8 months, he tries to crawl, learns to sit without support, and closer to 9 months, along with peers born at term, he tries to stand on his legs; at this time, the first teeth usually appear.
• By 10-11 months, premature babies are usually already actively crawling, responding to their name, and pronouncing individual syllables.

By the age of one year they are not much different from their peers. It should be noted that physical development Premature children at this age correspond to the development of normally full-term children, but the neuropsychic processes are slightly delayed and “catch up” with their normally full-term peers by 2-3 years.

Medical assistance and hospital care

Whether a premature baby needs special medical care depends on the degree of prematurity of the baby.

• If the baby was born very premature, then he is placed in a pediatric intensive care unit, where he is provided with artificial ventilation and nutrition is supplied through a gastric tube. In addition, they are connected to monitors that record basic vital parameters; in case of deviations from the norms, the medical staff quickly responds. If necessary, the baby receives treatment and is also observed by specialized specialists: an ophthalmologist, a cardiologist, a neurologist, whose task is to prevent the development of complications.
• If the baby's lungs are ready for independent breathing and the baby has a sucking reflex, he is provided with intensive care. The baby will remain in the incubator until his body learns to independently thermoregulate. Today it has been proven that the rate of development and growth of a baby increases when in contact with his mother. The so-called kangaroo method is used. The baby in a diaper and a hat is placed between the mother's breasts and the clothes are fastened. Mother's body temperature ideally warms the baby. At the same time, he inhales native smells, hears his mother’s familiar heartbeat, his skin is populated with maternal microflora, which increases the baby’s immunity and helps a speedy recovery. The method gives excellent results when the baby still needs control of breathing and heartbeat.
• Follow-up observation is carried out by a doctor after discharge from the maternity hospital. All data on the baby’s health condition is recorded, and taking into account the degree of prematurity and the current condition of the child, additional examination may be recommended.

Babies born before 33 weeks will be cared for in the intensive care unit and then in the intensive care unit. If the baby was born at 34 weeks and was not injured during childbirth, then on the 7-10th day he can be discharged from the maternity hospital under the supervision of a local pediatrician.

Caring for a premature baby at home

Differs from caring for normal term babies. What you need to pay special attention to.

• Clothes for premature babies should be made only from natural fabrics. All seams are only external; it is desirable that holes are provided for medical equipment.
• Buttons and fasteners must be plastic. None of the clothing items should damage the baby's delicate skin.
• Microclimate in the room. The optimal humidity in the room is at least 70%, the temperature is 25°, around the baby’s body is 28°.
• . Water temperature 36°. Before bathing, wrap your baby in a diaper, and after bathing, pat his body dry with a warm towel.
• Buy special skin care products, for premature babies, they must be hypoallergenic.
• Diapers We also need special ones, made taking into account the fact that the skin of premature babies is very thin and delicate.
• Walks. If you are born in the summer and if the baby’s weight has already reached 2 kg, you can walk immediately after being discharged from the hospital, but the first walks are no more than 15 minutes at an outside temperature of at least 25°.

If the baby was born in winter, then the first exit to the street is possible when the baby reaches 3 kg of weight and the temperature outside the window is not lower than 10 degrees below zero. In the off-season, you can walk if you weigh at least 2.5 kg and reach 1.5 months.

• Massage is very necessary for premature babies. Let the professionals show you the basic principles and techniques.
• Vaccinations. If the baby is healthy and his birth weight is more than 2 kg, then he is vaccinated in the same way as normal full-term children. Otherwise, the doctor creates an individual vaccination plan for premature babies.

Feeding the baby

When discharged from the hospital, the baby can suck independently. However, he is very weak and gets tired quickly, so his mother should supplement him with expressed milk from a spoon. It is very important to maintain breastfeeding at this difficult and difficult moment, because it is the best food for a premature newborn baby.

If for some reason natural feeding is not possible, the baby is fed. Under no circumstances should you choose formula for feeding a premature baby on your own; your doctor should recommend it.

Feeding premature babies in the first month of life is carried out in fractional portions. The number of feedings per day can reach 20 times. By approximately the third month of life, when weight gain is stable, the number of feedings is reduced to 8.

They begin to administer it from the 7th month of life. Porridge is the first food, since weight gain for a premature baby is a top priority. In addition, it is necessary to ensure that the nutrition of premature babies is complete: they really need vitamins and minerals.

Development of a premature baby - video

When caring for premature babies, it is important to monitor not only weight gain, but also the improvement of the baby’s skills at a given age. You will learn how to correctly calculate the baby’s age, taking into account his prematurity, what reactions and stages of development you need to pay attention to. Watch the video about the features of psychomotor maturation of premature babies.

IN modern world Children born prematurely have good chances for a full life. If you work with premature babies, develop their psychomotor skills, talk to them, surround them with attention and love, provide them with proper care, then you will avoid all negative consequences, and in the future your baby will be no different from other children. This is not an easy task, but it can be done.

Working for many years at the Center for Correction of the Development of Premature Children of the Clinical Research Institute of Pediatrics and engaged in scientific research on the growth and development of these children, they are currently consulting at the Chaika clinic. Elena Solomonovna has released a guide for parents about what the family of a premature baby will have to endure and how to maintain love and friendship. We are publishing its continuation.

Physical development of a premature baby (weight and height gain)

The first concern of parents of a premature baby is problems with weight gain. And indeed this is of paramount importance as the main indicator of the baby’s physical well-being.

It should be taken into account that the rate of growth of physical indicators (body weight, length, head and chest circumference) in a premature baby will differ significantly from those of his full-term peers. At least until 6-9 months, your baby will be smaller, and mandatory weight control becomes of primary importance at this time: in the first weeks and months of life, daily (it is necessary to take into account the correctness of daily weighing of the child, which must be carried out in at the same time, preferably before the first morning feeding or in the evening before bathing), and then monthly.

What should be your first concern? This is a drop in body weight or lack of weight gain (the baby is “standing” in weight).

The reasons can be either quite serious or due to feeding errors, insufficient quantity mother's breast milk. Naturally, in any case, you need to consult with the child’s doctor to clarify the causes and eliminate them. I repeat, during a one-time consultation with a pediatrician, the condition of a child born prematurely and very different from his full-term peers may be assessed as more severe than it actually is.

Digestive problems in a premature baby

The main problems from digestive system in a premature baby, which almost all parents face are:

Intestinal colic

Colic comes from the Greek kolikos, which means pain in the colon. Colic is paroxysmal pain in the abdomen, accompanied by severe anxiety in the child. The attack, as a rule, begins suddenly, the child screams loudly and more or less continuously, redness of the face or pallor of the nasolabial triangle may be noted. The abdomen is swollen and tense, the legs are pulled up to the stomach and can instantly straighten, the feet are often cold to the touch, the arms are pressed to the body. The attack sometimes ends only after the child is completely exhausted. Often noticeable relief occurs after the passage of stool and gases.

Premature babies are especially predisposed to colic, and some infants experience frequent and intense attacks, which in terms of severity can be compared to labor pain, and certainly require medical intervention. Apparently, the main reason for this baby’s suffering is the immaturity of the neuromuscular system and the intestinal enzymatic system and, therefore, a tendency to increased gas formation. As a result, pressure on the intestinal wall increases and muscle spasm occurs.

The cause of discomfort and bloating can also be irrational feeding. Some foods, especially those high in carbohydrates, can promote excessive fermentation in the intestines. Intestinal allergies also cause the baby to cry due to a feeling of discomfort in the abdomen.

But the causes of colic are not limited to these conditions. It is important to promptly diagnose diseases that require surgical intervention. Therefore, if there is no effect from the usual measures aimed at eliminating colic (special carminative herbal teas, simethicone preparations Sub/Simplex, Espumisan, cleansing enema, use of a gas tube, abdominal massage, dry heat on the abdominal area), the child should be carefully examined in a medical institution.

Regurgitation syndrome

Spitting syndrome can also be a concern for parents of a premature baby. Most common cause This is due to immaturity and temporary (passing) hypotension of the smooth muscles of the stomach - the so-called “duodeno-gastric reflux”. Most often this occurs in premature babies who have been fed through a tube for a long time. Also possible reason regurgitation may be aerophagia (when the baby greedily swallows air along with food). The masses when regurgitated look abundant due to their binding with air and usually do not change the baby’s well-being in any way. In this case, you need to be patient and wait until the baby’s stomach “ripens”, while following the recommendations for proper feeding and holding the baby upright for 10-15 minutes after feeding. Medicines It is better to give to the child before feeding. However, there are situations in which urgent consultation with a specialist is necessary: ​​if there are streaks of blood in the regurgitated masses, if the regurgitation is so profuse that the child does not gain weight well, if the baby’s well-being is disturbed during regurgitation - do not hesitate, consult a doctor!

Diarrhea and constipation

Dyspepsia (diarrhea and constipation), changes in stool structure, the appearance of mucus and impurities in a premature baby are a frequent and worrying phenomenon for parents and pediatricians. It is necessary to determine what should not cause concern to parents.

When breastfeeding, the baby may have stools after each feeding along with gases (foamy) and quite liquid. In children receiving formula, stools are rarer - 3-4 times a day. A change in the quality and color of stool also occurs when the development of intestinal enzymes in a premature baby is late, and difficulty digesting fats or carbohydrates.

Most common problem a premature baby is a temporary absence of stool or delayed evacuation of stool. There is no stool for several days, the child pushes to no avail. When defecation occurs, the stool as a whole is not changed in consistency, which does not allow us to call it constipation in the generally accepted sense of the word.

You will have to make it easier for the child to defecate for some time; there is nothing wrong with this if you do this with the knowledge and under the supervision of a doctor.

The cause of all disorders of the functional state of the gastrointestinal tract is immaturity.

However, proper feeding is the best and natural treatment. Breast milk is perhaps the best thing a mother can give to her baby. At the birth of a premature baby, milk, as it were, adapts to the immature intestine, so that the necessary hormones received from the mother, and active metabolites, protective substances and enzymes contribute to a more rapid maturation of all organs.

Therefore, breast milk and the possibility natural feeding You must try to preserve it with all your might. However, if there is still not enough milk, and you were forced to replace it with a mixture, then it is most advisable to use special mixtures for premature babies. In any case, it is important to coordinate the use of mixtures with your pediatrician.

The main criterion for the fact that all the changes you observe in the gastrointestinal tract are not diseases requiring urgent treatment is a sufficient increase in the child’s body weight and the absence of severe pain in the child

Anemia of prematurity

Almost all premature babies experience a drop in hemoglobin, which is called anemia. The cause of anemia is the same immaturity. In premature babies, the so-called “fetal” hemoglobin takes longer to be determined, which is destroyed more quickly, and the ability to form new one is reduced. At the same time, hemoglobin carries oxygen, which is necessary for the functioning of all cells and their maturation. Monitoring your hemoglobin level is very important.

Premature baby It is necessary to prevent anemia and carry out timely treatment if hemoglobin decreases to 100 g/l.

Rickets of prematurity

Rickets is a deficiency in the formation of vitamin D in the body and the supply of calcium to cells, which is necessary for the growth of bone tissue and the formation of neuromuscular regulation.

Deficiencies in vitamin D production and calcium absorption are associated with immaturity. At the same time, the child’s development slows down. The baby becomes more irritable, sweats, sleep is disturbed, hair falls out, growth and weight gain slow down. Bones become “weak” and may become twisted. A premature baby requires mandatory prophylactic use of vitamin D preparations, and in case of clinically obvious manifestations of rickets, treatment with vitamin D and calcium preparations.

Condition of the skeletal system and joints

The phenomena of morphofunctional immaturity in a premature baby often extend to the musculoskeletal system. Imperfect neuromuscular regulation, ligament weakness, excessive joint mobility can lead to changes correct position limbs, head and spine of the child.

Often the baby holds his head in a fixed position to one side. The reason for this may be congenital shortening of the neck muscle on one side, traumatic damage to the spine or cervical muscles during the removal of the head during childbirth, or just the “habitual” position of the head, that is, the child “lay” in this position most of the time in the uterus. The correct diagnosis is always made by a doctor, and the sooner this happens, the more effective the treatment will be.

Prematurity, especially in combination with abnormal intrauterine position of the fetus, is usually accompanied by underdevelopment of the hip joints or “dysplasia”. The most severe variant of this pathology is dislocation of the hip joint. The diagnosis is made soon after the birth of the child and requires early treatment based on abduction of the legs at the hip joint. Currently effective method in identifying abnormalities in the development of joints is ultrasound scanning, which is mandatory for all children in the first months of life.

For premature babies, the most diagnostically reliable period is 3-4 months of corrected age for assessing the condition of the hip joints. In more early dates the risk of error is very high due to their natural immaturity.

Premature eye disease

Retinopathy of prematurity (ROP) is an eye disease of premature babies that can even lead to permanent loss of visual function.

The possibility of developing ROP is related to the age and weight at birth, the presence of severe changes in the respiratory, circulatory and nervous systems, as well as the adequacy of the measures taken to care for the baby

This disease was first identified in a premature baby in 1942. Then it was called retrolental fibroplasia. Until now, the causes of the onset, progression and spontaneous regression of the disease are not completely clear and are only being studied.

At this stage of development of ophthalmology, it is considered indisputable that the development of retinopathy occurs precisely in an immature baby, as a violation of the normal formation of retinal vessels (which ends by the 40th week of intrauterine development, i.e. by the time of birth of a full-term baby). It is known that until 16 weeks of intrauterine development, the retina of the fetal eye does not have blood vessels. Their growth into the retina begins from the exit point of the optic nerve towards the periphery. By the 34th week, the formation of the vascular network in the nasal part of the retina is completed (the optic disc from which the vessels grow is located closer to the nasal side). In the temporal part, vascular growth continues up to 40 weeks. Based on the above, it becomes clear that the earlier the child was born, the smaller the area of ​​the retina covered with blood vessels, i.e. an ophthalmological examination reveals more extensive avascular, or avascular, zones (if the child was born before the 34th week, then, accordingly, avascular zones of the retina are detected on the periphery on the temporal and nasal sides). After birth in a premature baby, the process of vascular formation is affected by various pathological factors: external environment, light, oxygen, which can lead to the development of retinopathy.

The main manifestation of ROP is the stopping of the normal formation of blood vessels, their growth directly into the eye into the vitreous body. The growth of vascular tissue and, subsequently, young connective tissue causes tension and retinal detachment.

As mentioned earlier, the presence of avascular zones in the periphery of the fundus is not a disease. This is only evidence of underdevelopment of retinal vessels, and, accordingly, the possibility of developing retinopathy in the future. Therefore, starting at 34 weeks (or 3 weeks of life) of your baby, it is necessary to have your baby examined by an ophthalmologist who specializes in retinopathy of prematurity and who has special equipment to examine the retina. Such control is necessary for all children born before 35 weeks and with a birth weight of less than 2000 g.

When signs of ROP are detected, examinations are carried out every week (in the so-called “plus” stage of the disease - every 3 days) until the threshold stage develops (at this stage the issue of preventive surgical treatment is decided) or complete regression of the disease. In case of regression of the pathological process, examination can be carried out once every 2 weeks. The examination is carried out with the obligatory dilation of the pupil, using special children's eyelid dilators, so as not to put pressure on the eye with fingers.

Most often, the threshold stage of ROP develops by the 36-42nd week of development (1-4 months of life), so parents of a premature baby should know that during this period he should be examined by a specialist (an ophthalmologist who has special equipment and is aware of the signs of active retinopathy ).

Active retinopathy is a staged pathological process that can result in regression with complete disappearance of disease manifestations or scar changes.

According to the international classification, active retinopathy is divided according to the stages of the process, its localization and extent:

Stage 1. The appearance of a dividing line at the border of the vascular and avascular retina.

Stage 2. The appearance of a shaft (volumetric line) at the site of separation.

It should be emphasized that in 70-80% of cases with stages 1-2 of ROP, spontaneous cure of the disease is possible with minimal residual changes in the fundus.

Stage 3 is characterized by the appearance of growth of retinal vessels into the vitreous body in the shaft area. With a short duration of the process, as in the first two stages, spontaneous regression is possible, but residual changes are more pronounced.

When the growth of blood vessels inside the eye has spread over a fairly wide area, this condition is considered to be the threshold stage of ROP, when the process of progression of ROP becomes almost irreversible and requires urgent preventive treatment.

The effectiveness of preventive laser and cryocoagulation of the avascular retina ranges from 50-80%. Timely treatment can significantly reduce the number of adverse outcomes of the disease. If the operation is not performed within 1-2 days after diagnosing the threshold stage of retinopathy, then the risk of developing retinal detachment increases sharply. It should be noted that with the development of retinal detachment, cryo- or laser coagulation is not possible. The further prognosis for the development of vision in such an eye is extremely unfavorable.

The operation is often performed under general anesthesia (local anesthesia is used less frequently) to avoid oculocardiac and oculopulmonary reactions. The treatment results are assessed after a few days to decide whether to repeat the procedure. The effectiveness of preventive treatment can be judged 2-3 weeks after the formation of scars at the site of the shaft. If treatment was not carried out or no effect was achieved after treatment (severe ROP), terminal stages develop.

Stage 4. Partial retinal detachment.

Stage 5. Complete retinal detachment.

Even if the process has reached stages 4 and 5, it is necessary to carry out a whole range of therapeutic and surgical measures aimed at preventing severe scarring.

“Plus” disease is highlighted separately as the most unfavorable form of active retinopathy. The disease begins early, has no clearly defined stages, progresses rapidly and leads to retinal detachment without reaching the threshold stage. The pathological process is characterized by a sharp dilation of the retinal vessels, pronounced vitreous edema, hemorrhages along the vessels, dilation of the iris vessels, often with the impossibility of dilating the pupil. The effectiveness of treatment for “plus” disease remains low.

If the active process has reached 3 or more stages in its development, then after its completion (with or without preventive treatment), scar changes of varying severity form in the fundus.

Grade 1 – minimal changes in the periphery of the fundus;

2nd degree – degenerative changes in the center and periphery, remnants of scar tissue;

3rd degree – deformation of the optic nerve head, with displacement of the central parts of the retina;

4th degree – the presence of retinal folds, combined with changes characteristic of the 3rd stage;

Grade 5 – complete, often funnel-shaped, retinal detachment.

With the first and second degrees, fairly high visual acuity can be maintained; with the development of third or more degrees, a sharp, often irreversible decrease in visual acuity occurs.

Indications for surgical treatment of the cicatricial stages of ROP are strictly individual, determined by the degree and location of retinal detachment, as well as the general somatic condition of the child. In any case, the functional and anatomical effectiveness of operations is noticeable only up to 1 year of life, when it is possible to improve visual acuity and create conditions for eye growth.

However, when reaching the 5th stage of cicatricial ROP, the pathological process can continue and lead to the development of complications in the form of corneal opacification and secondary glaucoma. Therefore, if contact between the cornea and iris develops, immediate surgical treatment is necessary in order to preserve the eye (in this case we are not talking about increasing visual acuity).

It should be noted that if a child has suffered even mild stages of active ROP or has unexpressed scar changes, then it is believed that in such children the formation of a full-fledged retina does not occur. In the future, such children have a high risk of developing myopia, dystrophy and secondary retinal detachments. Based on this, children who have suffered ROP should be observed by an ophthalmologist at least 2 times a year until they reach the age of 18.

Successful nursing and subsequent development of premature infants, including the preservation of visual functions, is, although difficult, a completely feasible task. Achieving a good rehabilitation result depends on the joint efforts of neonatologists, ophthalmologists and psychologists.

Formation of hearing and speech

There is no evidence that premature infants are more likely than full-term infants to have severe forms of hearing impairment. However, in many of them the development of auditory function is slow. The presence of hearing can be assessed using a hardware technique that is now widespread and called otoacoustic emission or audio test. Taking into account the characteristics of a premature baby, it is possible to reliably judge the test’s passing only at the age of 4 months of the corrected age. Until this time, there will be many false negative results, which are explained by the same immaturity of the child, but cause a huge number of unnecessary worries. The later development of auditory function also leads to a later onset of humming and difficulty with the child’s speech in the future. Complex features lead to the fact that the child begins to speak later and many sounds are pronounced incorrectly (perhaps the child hears them that way). All this is gradually returning to normal, but most premature children will require the help of a speech therapist and it is advisable to start classes earlier than recommended for full-term children, for example, at 2.5-3 years, depending on general development child.

What happens to the immune system of a premature baby?

Will he have to get colds often?

Numerous studies in our country and abroad have dispelled the prejudice about the “weakness” of the immune system of a premature baby. Just like in full-term children, it is formed in the first three years of life and differs slightly in terms of indicators. Just like full-term babies, when fed with breast milk, the formation of the immune system occurs more quickly and its activity is higher, but not so much as to say that without breast milk your baby is not at all protected.

Why do premature babies get sick more often and more severely? There are several explanations: premature babies are more likely to visit health care facilities where the risk of infection is high. Premature babies are very protective of their parents; they often overheat and thereby inhibit the development of the immune system. Premature babies with illnesses often develop bronchospasm and respiratory failure, they are more often hospitalized and are more often prescribed antibiotics, which also weakens the formation of immune defense. All this determines the approaches and tactics that parents of a premature baby should follow, and this should be taught by a doctor who knows the characteristics of the child and, most importantly, is not afraid of the fact that he was born premature.

Should premature babies be vaccinated?

It is necessary and mandatory! Actually, vaccinations are just for them. Since it is strong and strong child, most likely, will easily survive any infection, but for an “immature” and poorly protected premature baby, any severe infection can be fatal.

Previously, neonatologists made an allotment for a premature baby up to one year old. Today this concept has been revised all over the world. It has been proven that immune system It is in the first months of life that the baby is more ready to produce antibodies. Judge for yourself: any child is born completely “sterile” and from the first seconds is faced with many viruses that are common around us, and even with bacteria that inhabit surfaces and our bodies. However, he protects himself with sufficient ease, except in situations beyond massive influences (intensive care unit, significant concentrations of sick children and adults).

However, there are still limitations - these are acute conditions, which are temporary but absolute contraindications to vaccination, and some chronic conditions: and this is, first of all, damage to the central nervous system. These include absolute contraindications – decompensated hydrocephalus and convulsions.

And yet, only the attending physician can tell whether your child is ready for vaccinations, explain in detail to you what vaccinations and against what diseases your baby needs, and whether any examinations are needed, for example, an ECG or EEG. This is a very important decision that requires great knowledge of the doctor, confidence in yourself and your child. On the other hand, the importance of this decision is to protect your child as much as possible from possible severe infections, which, unfortunately, abound in any society, understanding how difficult it will be for a premature baby to endure these diseases.

What is prevention of respiratory syncytial virus infection and why do it?

One of the most serious diseases of a premature baby in the 1st year of life is RSV infection. This is a very common disease. In fact, almost all children under 2 years of age experience this viral infection at least once.

This infection occurs like a cold, but its peculiarity is that it affects the lower respiratory tract, like pneumonia or, terminologically, alveolitis. Alveolitis is an inflammation of the final parts of the respiratory tract - the alveoli, where gas exchange occurs. Thus, if the alveoli become inflamed, the person begins to suffocate from lack of oxygen and the accumulation of carbon dioxide in the body. This infection is especially severe in premature infants, who already have a very immature broncho-alveolar tree, and many have signs of bronchopulmonary dysplasia. In severe cases, children require hospitalization, resuscitation, mechanical ventilation, antibiotic therapy, etc., not to mention severe psychological trauma for the baby and the entire family.

Over time, when faced with this virus, the child produces antibodies and after 2-3 years the virus becomes practically harmless and the disease proceeds like a normal ARVI.

But! You have to live these 2 years. In recent years, a drug has been developed, created and widely distributed, which is purified antibodies to the respiratory syncytial virus. The introduction of these antibodies protects the child from getting sick, not only with this virus, but also with other similar viruses, and the child generally begins to get sick less.

Today, the country has the drug SYNAGIS, which is very expensive in price, as it is a highly purified monoclonal antibody. For effective protection against the virus, 3-4 injections are required with an interval of 30 days during the most dangerous epidemiological period - approximately from November to March. The administration of the drug is not vaccination, but passive immunization: when the child’s body does not produce antibodies, but they are administered ready-made. Therefore, repeated administration is required during the first year at strictly maintained intervals.

In the near future, there may be other drugs with similar effects in the country, most likely cheaper and more accessible. But this still requires verification.

We tried to talk in an accessible way about the most common problems in the first year of life of a premature baby. All of them require attention, observation and timely treatment.

Let us repeat once again why you need to monitor the first year of life of a premature baby:

• The development of a child, the formation of his psycho-motor functions requires a monthly assessment by one specialist. You must carefully observe the baby in order to tell the doctor as truthfully and objectively as possible about the child’s behavior.
• Weight gain, which indicates sufficient absorption and assimilation of nutrients. Premature babies tend to have a decrease in appetite, and sometimes this big problem feed such a child. The more premature the baby is, the more pronounced is the disturbance in the absorption of nutrients and the worse the weight gain. In this case, the use of special drugs that improve the energy state of cells can help cope with this.
• Prevention or, if necessary, treatment of rickets.
• Prevention and, if necessary, treatment of anemia.
• Relieving the child of “intestinal colic”, monitoring the state of the gastrointestinal tract, correcting regurgitation. Rational feeding. Mandatory consultation to resolve the issue of timely introduction of complementary foods.
• Monitoring the state of the nervous system, timely conduct of special examinations to determine the maturation of brain structures, to monitor the manifestation of hypoxic-ischemic encephalopathy (if your baby had hemorrhage or periventricular leukomalacia, if he suffered meningitis or encephalitis).
• Monitoring the condition of the respiratory system, especially if the child has been on a ventilator for more than 3 days. Remember that if a child develops bronchopulmonary dysplasia, it is necessary to carefully monitor the color of the child’s skin and his breathing (the child begins to breathe “hard” and often), since periods of exacerbations are possible (if in any doubt, it is better to contact the doctor who is observing your baby) . If such a baby gets sick, he often develops “obstructive syndrome”, which requires urgent treatment.
• Monitoring heart condition, especially in children with bronchopulmonary dysplasia. It is especially important for such children to control physical activity, prescribe massage in doses and physical methods rehabilitation.
• Monitoring the condition of the musculoskeletal system, in particular the hip joints, since impaired development of these joints will not allow the child to sit, stand and walk correctly.
• Monitoring the condition of the visual organs
• Monitoring the condition of the hearing organs.

So there are a lot of problems. It is almost impossible to treat everything at the same time - the baby simply cannot withstand such a load. Therefore, when assessing the child’s condition, it is necessary to determine the priority task, which to a greater extent disrupts the normal development of the baby and requires urgent correction. Only a specialist can decide this.

Happiness, health and good luck to you and your kids!