Premature birth. Premature babies: consequences in the future, prognosis, development Psychomotor development of premature babies: consequences

Premature baby- a child born prematurely, i.e. in the range of 28-37 weeks. The concept of full term is determined solely by the duration of pregnancy. It should be distinguished from the concept of maturity, which is determined by a set of characteristics, the main of which are fetal length and body weight. A fruit with a body length of at least 47 cm and a body weight of more than 2500 grams is considered mature, skin mature fruit pink, the subcutaneous fat layer is well developed, the thickness of the skin fold on the abdomen is about 1 cm, there is a delicate fluff on the back, the fingernails reach the fingertips, the navel is located in the middle of the distance between the pubis and the xiphoid process, in girls the labia majora covers the labia minora, in boys the testicles are lowered into the scrotum, the small fontanelle is closed or barely visible. In most cases, it is acceptable to identify the concepts of full-term and maturity, but it must be borne in mind that a full-term fetus is not always mature and vice versa. If the fetus develops under unfavorable conditions (due to maternal illness, malnutrition, etc.), then a full-term baby may often be immature. And, conversely, when the fetus develops under favorable conditions, it often becomes mature even before the due date, i.e., before the 40th week of pregnancy. Yet almost always a premature baby (especially a significantly premature one) is born immature, that is, he does not have the signs of maturity mentioned above.

Childbirth before 28 weeks of pregnancy should be considered a late miscarriage. Children from such births with a body weight of up to 1000 g and a length of up to 35 cm are classified as fetuses; if they live for a week, they are classified as premature babies.

There are 4 degrees of prematurity: I degree - body weight 2001 - 2500 grams, period of intrauterine development 35 - 37 weeks, II degree - respectively, 1501 - 2000 grams, 32 - 34 weeks; III degree - 1000 - 1500 grams, 28 - 31 weeks; IV degree (fetus) - up to 1000 grams, less than 28 weeks.

Body weight does not always correspond to the degree of maturity of the child. Thus, with diabetes mellitus in the mother, premature children usually have a greater body weight than full-term children of healthy mothers. At late toxicosis During pregnancy, the child's body weight may be lower than normal, although other signs of maturity are quite pronounced. Children with low body weight are often born due to maternal hypertension, intrauterine infection and other unfavorable conditions of intrauterine development. Further development of premature (immature) children often proceeds without any pronounced features and in most cases does not differ from normal, although there are indications of possible deviations. However, in the newborn period, children constitute a high-risk group for morbidity, which is 5-6 times higher in them than in full-term children, which depends on a number of interrelated factors (immaturity, conditions intrauterine development, influence of the birth act).

The energy resources of a premature baby (mainly due to liver glycogen and fat) are much lower than those of full-term babies, and their replenishment through the digestive tract is significantly difficult due to its immaturity (imperfect digestion, reduced absorption, etc.). Therefore, to cover energy costs, the premature baby is forced to use tissue proteins. This leads to an increased content of protein breakdown products (residual nitrogen) in the body of a premature baby, which adversely affects its central nervous system and can cause cerebral disorders. Imperfection of activity gastrointestinal tract, associated with insufficiency of enzymatic function, slow motility, insufficiency of sphincters and elasticity of the stomach, leads to poor tolerance of fats, partly proteins, intestinal bloating, regurgitation (they are especially dangerous due to the possibility of aspiration of food), which makes feeding premature babies difficult. These difficulties increase even more in significantly premature infants due to imperfect coordination of the acts of sucking and swallowing, on the one hand, and breathing, on the other. In connection with these features, it is clear that there is a significant and longer-lasting decrease in body weight than in full-term infants and a slower recovery. There is a direct relationship between the degree of prematurity, weight loss and the duration of its recovery.

Respiratory function in premature infants develops slowly and is often impaired, especially in significantly premature infants, which is the main cause of illness and death in premature infants. The so-called hyaline membrane syndrome develops especially often. The initial stage of development of hyaline membranes is characterized by motor restlessness of the child and tachycardia. Then the most characteristic symptoms for this pathology develop: shortness of breath (up to 100 or more per minute), “groaning” breathing with prolonged exhalation, retraction of the intercostal spaces and a sharp retraction of the sternum when inhaling (insufficient expansion of the lungs). Hypotension, adynamia, trembling of the limbs (sometimes convulsions) are noted as a consequence of hypoxia of brain tissue. For hyaline membrane syndrome, early and active treatment is indicated, which can significantly reduce the high mortality rate of children from this disease.

The kidneys of a premature baby work in dilution mode, i.e. they remove waste products in large quantities of water. Therefore, an adequate fluid supply is particularly important for a premature baby.

Thermal regulation of a premature baby is imperfect due to insufficient development of the nervous mechanisms regulating this function and reduced energy reserves (fat, in particular the so-called brown fat, which has high energy productivity). Therefore, a premature baby does not tolerate both cooling and overheating.

Based on the above, the main requirements for nursing a premature baby are the regulation of external respiration, the creation of optimal temperature conditions and nutrition.

It is most advisable to feed a premature baby (as well as a full-term baby) breast milk mother (fresh, not pasteurized), which contains all the components necessary for the child. Early initiation of feeding is beneficial. 3-6 hours after birth, the baby is given a 5% glucose solution. If he does not regurgitate, then 6-12 hours after birth he can be given fresh breast milk. If a child regurgitates a glucose solution, then the time for introducing milk is postponed to 12-24 hours or even 48 hours, but the glucose solution is given to drink 3-6 ml every 2-3 hours. Premature babies are fed milk every 8 hours. In the first days of life, a premature baby is fed either from a bottle or through a tube. If such feeding is not possible, parenteral nutrition is performed, i.e. drip intravenous administration of nutrient solutions. Premature babies with a body weight of 2000 grams and above are fed initially from a bottle, and from 2-3 days of life they are applied to the mother’s breast and fed under weighing control, and if necessary, supplemented with expressed breast milk from a bottle. Children with a body weight below 1900 grams (up to 1600 grams) are fed from a bottle until they reach a weight of 1900-2000 grams, and then, with good sucking activity, they are applied to the mother's breast. Children with a body weight below 1600 grams are fed only through a tube inserted through the mouth into the stomach, and only after they are able to suck and swallow independently (usually when they reach a weight of 1700-1800 grams), they are fed from a bottle, and then put to the mother's chest. For children weighing up to 1750 grams, in the 1st week of life, 5-7 ml of milk (up to 50 kcal/kg) is administered per 100 grams of body weight, in 2 weeks - 7-12 ml (up to 90 kcal/kg), in 3 weeks weeks - 12-15 ml (100 kcal/kg), at 4 weeks - 16-18 ml (125 kcal/kg); if the child’s body weight is 1800 g or more, by the end of the 2nd week you can give milk in larger quantities (up to 1/5 of body weight per day).

It is necessary to calculate not only the amount of food introduced (proteins, fats and carbohydrates), but also its calorie content. By the 5-7th day of life, 1 kg of body weight per day should account for 80-90 kcal, with high energy costs (with respiratory distress syndrome) - up to 100 kcal or more. This amount of calories cannot be administered only orally; parenteral nutrition is also required. It has already been indicated that a premature baby should receive a sufficient amount of fluid: in the 1st week of life, including milk, 50-100 ml per 1 kg of body weight, in the 3rd - 150-170 ml, in the 4th - up to 200 ml .

Intravenous drip infusions (10% glucose solution in combination with isotonic sodium chloride solution in a ratio of 8:1, and then 2:1) as parenteral nutrition begin at the end of the 1st day, administering 30-40 ml per 1 kg of body fat, then, from the 3-4th day, the amount of solution is increased, taking into account the total amount of fluid the child receives. From the 2-3rd day, you can add protein and fat to glucose. Protein is administered in the form of hydrolysates or mixtures of amino acids, and fat in the form of emulsions (mainly from soybean oil). In the absence of such solutions, use a 5-20% albumin solution (at the rate of 0.5-1 g of albumin per 1 kg of body weight). The rate of intravenous fluid administration is low to avoid overloading the kidneys and for better absorption of the administered nutrition - 6-8 drops per minute.

The external temperature for a significantly premature baby should be at least 32-34 ° C, humidity - 90% or higher. Such conditions are most easily achieved in incubators, where it is advisable to place children weighing up to 1500-1600 grams immediately after birth for 7-14 days (sometimes for up to 4 weeks). Then the child is placed in a heating pad (open incubator), and later, when thermoregulation improves and the difference between morning and evening temperatures becomes minimal (no more than 0.3-0.5 ° C), he is transferred to a regular crib.

Treatment of respiratory failure in a newborn is aimed at eliminating pulmonary atelectasis, normalizing blood flow in them, eliminating hypoxemia and acidosis. Such children are placed in an incubator, providing constant oxygenation, but breathing high concentration oxygen should not be prolonged (more than 2-3 days) due to the risk of damage to the retina; medications are administered that normalize respiratory function (ethimizole at the rate of 1 ml per 1 kg of body weight 2-3 times a day), ensure constant warming of the child, high air humidity in the incubator (up to 80-100%).

Elimination of pulmonary atelectasis is facilitated by intravenous drip administration of fluid (initially 30-50 ml per 1 kg of body weight, after a few days its amount increases). Sometimes (in the presence of acidosis) sodium bicarbonate is added to the liquid. Albumin solutions are also administered. In the presence of hyaline membranes, the introduction of corticosteroids (prednisolone 0.5-2 mg/day/kg) is recommended. Measures are taken to facilitate inhalation and help eliminate atelectasis. To prevent pneumonia and combat frequent infections, antibiotics are administered. In case of respiratory failure, the child should be fed only through a tube.

The normal length of pregnancy for women ranges from 38 to 42 weeks. Babies born after a full 37 weeks of gestation, regardless of their birth weight, are called full-term newborns. Children who were born before the 37th week are so-called prematurely born or premature babies. Currently, modern medicine is able to keep alive babies born before the 27th and even before the 25th week of pregnancy. These newborns weigh much less than children should weigh at birth - they sometimes weigh just over 500 g. Despite their enormous immaturity at birth and the many dangers that await them, such children often grow up to be quite normal in appearance. Of course, such a fact of prematurity cannot pass completely without a trace. Most often, internal organs and the brain are affected in children. That is, children subsequently lag behind mentally, although this is not necessary and depends on many factors.

The stay in the ward for premature births is usually long. It may take several months until the child reaches a normal weight for his age and his organs begin to work independently. Subsequent care for such a child goes beyond routine preventive visits and infant vaccinations and often requires highly qualified counseling and developmental support. Diagnostic methods are also being undertaken to detect early detection of defects such as hearing and vision. Early diagnosis allows you to provide effective assistance V right time and in the required volume.

Required equipment

To save the life of a child born prematurely, modern equipment is needed. One such device is an incubator, which practically replaces the uterus. There the child is in conditions as close as possible to those in which children develop before their due date. The correct temperature and humidity must be maintained there. Unfortunately, the main technical problem is still that such an incubator is too loud in operation. For the child this does not matter, but for those who work nearby it causes a lot of inconvenience.

With the consequences of premature birth, it is often necessary to connect the child to a chamber, which for him is a substitute for the respiratory system. It is also connected to a vital organ management device. This device shows heart rate, respiration, blood oxygen saturation, and blood pressure. Its task is to prevent cardiac and respiratory arrhythmias and respiratory arrest.

During nursing prematurely born child a device is also used to provide nutrition, which can initially be administered parenterally, i.e. intravenously. This is how proteins, fats and carbohydrates are delivered to the child’s body to ensure proper development. A special technique is also used for this purpose using appropriate blood vessels (the general thin line cannot withstand such a large overload) and a pump that supplies nutritional ingredients under conditions of absolute sterility.

Learn more about the consequences of premature birth on a child's development

Breathing problems

Babies born prematurely almost always have breathing problems because their lungs are too underdeveloped. They still have a low content of surfactants, thus reducing the surface tension of the alveoli, which prevents them from sticking together during exhalation. In the lungs of a healthy fetus, all this is formed under physiological conditions around the 35th week of pregnancy. Prematurely born children (before the 35th week of pregnancy) are almost deprived of the ability to breathe normally. Surfactants are administered by inhalation through an intubation tube directly into the airways, thereby helping children with breathing problems. This also avoids many of the complications of prematurity (eg, neurological and infectious). The production of surfactants in the form of medicines was a turning point in saving premature babies. Unfortunately, some premature babies, especially the least mature ones, require mechanical ventilation for up to a month.

Sometimes such children develop chronic lung diseases, which is associated with the immaturity of the lung tissue. In such cases, the use of additional drugs is used to stimulate the growth of lung tissue. They are particularly vulnerable to the damaging effects of oxygen and are injected under pressure to save lives.

In the future, children. Those born prematurely often become special needs patients. The impact of chronic lung disease may result in an increased tendency to experience spasmodic bronchitis, shortness of breath during infection, or increased risk development of asthma.

Nervous tissue

Premature babies' brains are still very immature. There are good and bad sides to this. Unfavorable aspects are the very high sensitivity of immature nervous tissue to mechanical damage and the lack of sufficient oxygen. The upside, however, is that the more immature brain has greater plasticity and tissue can functionally replace areas that were damaged in early age. However, the damage caused to nerve tissue has a significant impact on further functioning. nervous system child.

Children born ahead of schedule, are more often prone to neuroses. They are more susceptible to emotions, more active, and require a special approach. Such children are often difficult to cope with; they often cry, eat poorly, and sleep little. Such unpleasant symptoms disappear over time, but the residue remains for life.

Premature birth - mother and child

Immediately after premature birth, a woman should breastfeed her baby. If the child is not able to feed on his own, he is given mother’s milk enterally, that is, forcibly. It is very important that in the first hours and days of life, milk enters the child’s body by any means. Thanks to this, the child’s gastrointestinal tract matures faster and learns to digest food. Mother's milk also provides the baby with antibodies that can fight bacteria and protect him from infection.

Although the mother does not initially breastfeed prematurely born child constantly, she still has to preserve the milk with all her might. Sooner or later the moment of direct contact between the child and the mother will come. If the mother managed to maintain milk production or stimulate it again, this will be the best help for the child’s adaptation. The baby is already able to coordinate sucking with swallowing, so you can try putting him to the breast. Premature babies do not lose the instinct to suck, so they quickly understand that they need it. If mother's milk is supplied in sufficient quantities, children quickly gain the proper weight and get better. They have fewer complications than those who are artificially fed.

The role of touch and tactile contact

Long before feeding begins, the mother is invited to various forms of contact with the baby: touching, stroking, hugging, transferring heat, listening to the sound of the heartbeat. Mothers are allowed to hug the baby for a while after being removed from the incubator, hold him close, and stroke him. This method of child care has proven to be very beneficial for premature babies. This has benefits for both the baby's development and the mother's.

The mother must touch her child, talk to him, sing to him. They just ask to delete it jewelry, roll up your sleeves to your elbows and wash your hands before placing them in the incubator. The mother thus transfers only “good” bacteria for the skin to the child, so that it becomes more resistant to nosocomial organisms.

Psychological connection

Many mothers who give birth prematurely suffer from depression. This is a little different from other mothers with postpartum depression. They have a huge sense of guilt. People often wonder why premature births occurred and what is to blame for this. And even if a woman does not speak out loud about her doubts, the neonatologist supports her and gives her hope that they can cope with many problems.

The presence of the child near the mother allows her to believe that she can do a lot for him. She can see the baby's heartbeat change when he touches her. He stops crying and then becomes calmer and falls asleep. His mother gains confidence that she can handle problems.

When can I be discharged home?

Often three or four months pass until a prematurely born child reaches a weight of 500 to 1800-1900 grams. The child can be discharged home only when the doctor is sure that he can breathe and eat independently, according to his weight, and the mother can cope with the child at home. During the hospital stay, staff are taught how to care for a premature baby. infant. It is also important to have the possibility of further contact with the hospital (for example by telephone) if the first difficulty arises.

A child’s weight at birth is one of the most important indicators of the baby’s health. Along with height, chest and head circumference parameters, skin condition and color, weight is very important role in the further speed of adaptation and development of the newborn.

A child’s growth is one of the most stable indicators and, as the child grows up, it maintains an upward trend. The same cannot be said about the weight of a newborn. In the first days after birth, babies tend to lose weight and by the third day of life the baby’s weight can decrease by as much as 10%. This feature should not unnecessarily worry a young mother, because weight loss after childbirth is a natural reaction of the baby’s body to the stress experienced and to the changed conditions of the surrounding reality. After birth, the processes of nutrition, blood circulation and breathing of the baby are transformed. In addition, the act of sucking the mother's breast requires constant physical effort from the baby. These features influence the fact that the newborn’s weight is lost in the first days of life.

Children also lose weight when fed artificial formula from birth. In this case, the child loses less weight and gains it faster. This is due to the stable composition of fats and carbohydrates in artificial nutrition. And the baby is on breastfeeding in the first days he receives extremely healthy colostrum, rich in proteins and vitamins. At the same time, the fat content in it is less than in mature milk, and the calorie content is correspondingly lower.

Premature babies and low birth weight babies also invariably lose weight. At the same time, these groups of children can lose more than ten percent in the first days after birth, gradually making up for the lost values ​​during the first month.

Leaving the maternity hospital, the baby’s weight remains fairly stable and begins to grow at a normal rate of 20–40 grams per day, gradually approaching the initial values. From the tenth day of life, the baby gains 150–300 grams per week and by the end of the first month can weigh a whole kilogram more than after birth. This trend of rapid weight gain will continue throughout the first three months.

Normal weight indicators in full-term infants at birth.

At birth, the average weight of full-term newborns is 2.5–4 kg. At the same time, these indicators, depending on many patterns, are quite difficult to predict. Method ultrasound diagnostics allows you to calculate the baby’s mass only approximately. Doctors note that firstborns, as a rule, weigh less than their brothers and sisters by an average of 500 grams, and the weight of boys exceeds the weight of girls by 100–300 g. Recently, the trend of the birth of “hero boys” has continued, when the weight and the baby’s growth is fixed at high rates. The maximum weight of a newborn, recorded in 1955 in the Guinness Book of Records, is 10.2 kg.

The main factors on which the baby’s weight depends:

• heredity indicators;
• duration of pregnancy (a premature baby has low weight, a newborn born later than expected has a high probability of exceeding the normal weight indicator);
• lifestyle, mother’s nutritional habits during pregnancy and her psychological comfort (stress and severe physical activity increase the likelihood of having a low birth weight baby);
• gender of the baby;
• chronic maternal diseases (large children are often born to women with diabetes or obesity);
• multiple pregnancy, etc.

Immediately after birth, doctors check the parameters of children with approved values. Table of the Research Institute of Pediatrics of the Russian Federation and normal weight According to WHO, they differ slightly.

Newborn weight chart (WHO)

Quetelet index

One of the most popular methods for assessing a child's birth weight is the Quetelet index. This value is determined by dividing the height of the newborn by his weight. At the same time, the resulting value, which is included in the range of values ​​from 60 to 70, is evidence of a normal indicator of the child’s weight at birth and one of the factors of full development.

Table of approximate calculation of the Quetelet index for infants

Example: Height - 51 cm, Weight - 3100 g.

Weight loss in newborns

Children weighing less than 2500 g are assigned the status of low birth weight. In this case, it is not so much the baby’s weight deficit that is important, but the condition and formation of his internal organs and vital systems. Therefore, babies born at 28–37 weeks are classified as premature babies. The weight of a premature seven-month-old baby is only 1500 grams with a height of 41 cm. Such babies are often not ready for independent breathing and feeding and need special care and close monitoring.

In some cases, with chronic diseases in a young mother (heart disease, hypertension, diabetes, etc.), a baby born at term is underweight. In such cases, the child is diagnosed with malnutrition. Treatment of such babies consists of individual selection of a special highly nutritious diet. Newborns diagnosed with melon have a slightly greater tendency, compared to other children, to be thin.

Multiple pregnancies can also cause underweight babies. If babies are born at term and their organ systems are developed, then medical intervention is limited to observation.

Excess weight in newborns

If a baby is born weighing more than 4000 grams, the doctor classifies him as a large child. Baby “heroes” are often born to tall and plump parents. Recently, the number of newborn babies with high birth weight has increased. Why is there still an increase in the birth rate of large children? There are several versions. The reasons for the birth of large babies include: diabetes mellitus and obesity in expectant mother, improper nutrition of a pregnant woman, hemolytic disease, etc. Often children with high weight are born to mothers who took certain vitamin complexes and some hormonal supplements during pregnancy medicines, drugs with high glucose content, etc.

Correction overweight the baby has artificial feeding consists of individual dosages of the mixture. When breastfeeding, children develop quite harmoniously and by the age of one year the problem disappears on its own. Sometimes a pediatrician may prescribe massage, swimming and other physical activities for children.

Preterm birth is considered to be between 22 and 37 weeks, when the baby is born premature but viable. All babies born alive weighing more than 500 grams should receive medical care in a neonatal intensive care unit. These requirements were established in Russia by the Ministry of Health in accordance with WHO recommendations.

What are the dangers of premature birth?

The number of complications during premature birth is much higher than during urgent labor. The most common of them:
premature rupture of membranes, early departure water;
hypoxia (oxygen starvation) of the child;
infection of the uterus and baby;
rapid labor activity, rapid labor.
injuries to mother and child, ruptures;
weakness of labor;
mother's bleeding.

One of the main reasons for the death of children in premature birth is the insufficient development of their organs, and especially the lungs, which is why they cannot breathe normally.

The timing of the birth is of decisive importance for the life of a premature baby.

Premature birth 22 – 27 weeks

The child's weight is from 500 to 1000 grams. Premature birth at these stages most often occurs due to the so-called isthmic-cervical insufficiency. This is a condition in which the cervix is ​​weakened, cannot support the weight of the growing baby and begins to dilate prematurely. This causes water to leak and may lead to bleeding and infection.

This is rare during the first pregnancy, more often in women after abortions, with inflammatory diseases of the pelvic organs, or in those who had severe cervical ruptures in a previous pregnancy.

If signs of premature birth appear at this time, it is necessary to try at all costs to prolong the pregnancy, since the child’s organs are still completely immature and are not ready for life outside the mother’s body.

The baby has a chance of survival only if the maternity hospital is equipped with modern intensive care equipment for caring for premature babies and qualified personnel.

Premature birth 28 – 33 weeks

The child's weight is 1000 - 1800 grams. Premature birth at this stage can occur for a variety of reasons. In this group there are already up to 30% of women with their first pregnancy. More than half manage to stop premature labor and prolong pregnancy with the help of medications.

Although the baby’s lungs are still immature, with modern means it is possible to prepare them for childbirth in two to three days, so he has a much greater chance of surviving during this period.

Premature birth 34 – 37 weeks

The child's weight is 1900 - 2500 grams or more. At this stage, premature birth is more common in women with their first pregnancy. They can also be caused by a variety of reasons, but infection no longer plays such an important role.

The child’s lungs are sufficiently developed and ready to breathe air, so almost all children born at this stage survive and develop normally. But still, if possible, you should try to extend the pregnancy to 38 - 40 weeks.

Signs of the onset of premature labor

Expert Nina Antonova, obstetrician-gynecologist
Signs of the onset of premature labor may include nagging pain and heaviness in the lower abdomen, spotting or leakage of clear fluid from the vagina, cramping pain lasting more than 30 seconds (it is important not to confuse them with Braxton-Hicks training contractions). At the same time, fetal movements are no longer felt.

If these signs appear, you should call ambulance and go to the maternity hospital, where you will receive qualified assistance.