Causes of prematurity. Premature babies: frequency and causes of preterm birth

- these are children born before the due date, functionally immature, with a weight below 2500 g and a body length of less than 45 cm. Clinical signs of prematurity include disproportionate physique, open sutures of the skull and small fontanel, lack of expression of the subcutaneous fat layer, hyperemia skin, underdevelopment of the genital organs, weakness or absence of reflexes, weak cry, intense and prolonged jaundice, etc. Nursing premature babies involves organizing special care - temperature regime, humidity, oxygenation level, feeding, and, if necessary, intensive care.

General information

Premature children are considered to be those born between the 28th and 37th weeks of pregnancy, with a body weight of 1000-2500 g and a body length of 35-45 cm. The most stable criterion is the gestational age; anthropometric indicators, due to their significant variability, are considered conditional criteria for prematurity. Every year as a result of spontaneous premature birth or artificially induced termination of pregnancy later 5-10% of the total number of newborns are born prematurely.

According to the WHO definition (1974), a fetus is considered viable at a gestational age of more than 22 weeks, a body weight of 500 g, and a body length of 25 cm. In domestic neonatology and pediatrics, the birth of a fetus before the 28th week of gestation, weighing less than 1000 g and a length of less than 35 cm is regarded as a late miscarriage. However, if such a child was born alive and lived after birth for at least 7 days, he is registered as premature. The neonatal mortality rate among preterm infants is much higher than that among full-term infants, and depends largely on the quality of care medical care in the first minutes and days of a child’s life.

Causes of prematurity

All the reasons leading to the birth of premature babies can be combined into several groups. The first group includes socio-biological factors, including being too young or elderly age parents (under 18 and over 40 years old), bad habits pregnant woman, insufficient nutrition and unsatisfactory living conditions, occupational hazards, unfavorable psycho-emotional background, etc. The risk of premature delivery and the birth of premature babies is higher in women who did not plan pregnancy and neglect medical support for pregnancy.

The second group of reasons is a burdened obstetric-gynecological history and pathological course real pregnancy at expectant mother. Here, a history of abortion, multiple pregnancy, gestosis, hemolytic disease of the fetus, and premature placental abruption are of greatest importance. The reason for the birth of premature babies can be short (less than 2 years) intervals between births. Often, premature babies are born to women who resort to in vitro fertilization, but this is not due to the very fact of using ART, but rather to the “female” factor that prevents natural fertilization. Gynecological diseases and genital malformations have an adverse effect on pregnancy: cervicitis, endometritis, oophoritis, fibroma, endometriosis, bicornuate saddle uterus, uterine hypoplasia, etc.

The third group of reasons that disrupt the normal maturation of the fetus and cause an increased likelihood of having premature babies includes various extragenital diseases of the mother: diabetes mellitus, hypertension, heart defects, pyelonephritis, rheumatism, etc. Often premature birth provoked by acute infectious diseases suffered by a woman in late gestation.

Finally, the birth of premature babies may be associated with pathology and abnormal development of the fetus itself: chromosomal and genetic diseases, intrauterine infections, severe malformations.

Classification of prematurity

Taking into account the indicated criteria (gestational age, weight and body length), 4 degrees of prematurity are distinguished:

I degree of prematurity– delivery occurs at 36-37 weeks of gestation; The child’s body weight at birth is 2500-2001 g, length – 45-41 cm.

II degree of prematurity- delivery occurs at 32-35 weeks of gestation; The child’s body weight at birth is 2001-2500 g, length – 40-36 cm.

III degree prematureness- delivery occurs at 31-28 weeks of gestation; The child’s body weight at birth is 1500-1001 g, length – 35-30 cm.

IV degree of prematurity- delivery occurs before 28 weeks of gestation; The child’s body weight at birth is less than 1000 g, length is less than 30 cm. For such children, the term “premature with extremely low body weight” is used.

External signs of prematurity

Premature babies are characterized by a number of clinical signs, the severity of which correlates with the degree of prematurity.

Extremely premature infants who are overweight<1500, рождаются с тонкой морщинистой кожей, обильно покрытой сыровидной смазкой и пушковыми волосами (лануго). Кожные покровы имеют ярко-красный цвет (т. н. простая эритема), который бледнеет к 2-3 неделе жизни. Подкожно-жировой слой отсутствует (гипотрофия II-II степени), телосложение ребенка непропорциональное (голова большая и составляет примерно 1/3 от длины тела, конечности относительно короткие). Живот большой, распластанный с явно заметным расхождением прямых мышц, пупок расположен в нижней части живота.

In extremely premature infants, all fontanelles and sutures of the skull are open, the cranial bones are pliable, and the cerebral skull predominates over the facial skull. Characterized by underdevelopment of the ears, poor development of nails (nail plates do not reach the fingertips), weak pigmentation of the nipples and areola. The genital organs of premature babies are underdeveloped: girls have a gaping genital opening, and boys have undescended testicles into the scrotum (cryptorchidism).

Premature babies born at 33-34 weeks of gestation and later are characterized by greater maturity. Their appearance is distinguished by the pink color of the skin, the absence of fuzz on the face and body, and a more proportional physique (smaller head, higher navel, etc.). In premature infants of degrees I-II, the auricles are curved, and the pigmentation of the nipples and parapapillary circles is pronounced. In girls, the labia majora almost completely cover the genital opening; In boys, the testicles are located at the entrance to the scrotum.

Anatomical and physiological characteristics of premature babies

Prematurity is determined not so much by anthropometric indicators as by morphofunctional immaturity of vital organs and systems of the body.

Characteristic features of the respiratory system in premature infants are the narrowness of the upper respiratory tract, the high position of the diaphragm, the compliance of the chest, and the perpendicular position of the ribs relative to the sternum. These morphological features of premature babies cause shallow, frequent, weakened breathing (40-70 per minute), a tendency to apnea lasting 5-10 seconds (apnea of prematurity). Due to underdevelopment of the elastic tissue of the lungs, immaturity of the alveoli, and reduced surfactant content, respiratory distress syndrome (congestive pneumonia, respiratory distress syndrome) easily occurs in premature infants.

Immaturity of the cardiovascular system is characterized by pulse lability, tachycardia 120-180 per minute, muffled heart sounds, arterial hypotension (55-65/20-30 mm Hg). In the presence of congenital heart defects (patent Botallov duct, patent oval window), murmurs may be heard. Due to the increased fragility and permeability of vascular walls, hemorrhages easily occur (subcutaneous, in internal organs, in the brain).

Morphological signs of central nervous system immaturity in premature infants are poor differentiation of gray and white matter, smoothness of the sulci of the brain, incomplete myelination of nerve fibers, and poor vascularization of the subcortical zones. Muscle tone in premature babies is weak, physiological reflexes and motor activity are reduced, the reaction to stimuli is slow, thermoregulation is impaired, and there is a tendency to both hypo- and hyperthermia. In the first 2-3 weeks, a premature baby may experience transient nystagmus and strabismus, tremor, flinching, and foot clonus.

Premature babies have functional immaturity of all parts of the gastrointestinal tract and low enzyme secretion activity. In this regard, premature babies are prone to regurgitation, flatulence, and dysbacteriosis. Jaundice in premature infants is more intense and persists longer than in full-term newborns. Due to the immaturity of liver enzyme systems, increased permeability of the blood-brain barrier and rapid breakdown of red blood cells, bilirubin encephalopathy can easily develop in premature infants.

Functional immaturity of the kidneys in premature infants leads to changes in electrolyte balance (hypocalcemia, hypomagnesemia, hypernatremia, hyperkalemia), decompensated metabolic acidosis, a tendency to edema and rapid dehydration with inadequate care.

The activity of the endocrine system is characterized by a delay in the formation of the circadian rhythm of hormone release and rapid depletion of glands. Premature babies have low synthesis of catecholamines, often develop transient hypothyroidism, and in the first days of life a sexual crisis rarely occurs (physiological mastitis, physiological vulvovaginitis in girls).

Premature babies develop early anemia at a faster rate than full-term babies, and there is an increased risk of developing septicemia (sepsis) and septicopyemia (purulent meningitis, osteomyelitis, necrotizing ulcerative enterocolitis).

During the first year of life, the increase in body weight and length in premature infants occurs very intensively. However, according to anthropometric indicators, premature children catch up with their peers born at term only by 2-3 years (sometimes by 5-6 years). The lag in psychomotor and speech development in premature infants depends on the degree of prematurity and concomitant pathology. In a favorable scenario for the development of a premature baby, leveling occurs in the 2nd year of life.

Further physical and psychomotor development of premature infants may be on par with peers or delayed.

Among premature children, neurological disorders are more common than among full-term peers: astheno-vegetative syndrome, hydrocephalus, convulsive syndrome, vegetative-vascular dystonia, cerebral palsy, hyperactivity, functional dyslalia or dysarthria. Almost a third of premature babies have vision pathology - myopia and astigmatism of varying severity, glaucoma, strabismus, first in the maternity hospital, then in the children's hospital and clinic. The main components of caring for premature babies are: ensuring optimal temperature and humidity conditions, rational oxygen therapy and dosed feeding. In premature infants, constant monitoring of the electrolyte composition and ABS of the blood, monitoring of the gas composition of the blood, pulse and blood pressure is carried out.

Very premature babies immediately after birth are placed in incubators, where, taking into account the child’s condition, a constant temperature (32-35°C), humidity (in the first days about 90%, then 60-50%), and oxygenation level (about 30%) are maintained. Premature babies I-II degrees are usually placed in heated cribs or in regular cribs in special boxes where the air temperature is maintained at 24-25°C.

Premature babies who are able to independently maintain normal body temperature, have reached a body weight of 2000 g, and have good epithelization of the umbilical wound can be discharged home. The second stage of nursing in specialized departments of children's hospitals is indicated for premature babies who have not reached a body weight of 2000 g in the first 2 weeks, and for children with perinatal pathology.

Feeding premature babies should begin in the first hours of life. Children with absent sucking and swallowing reflexes receive nutrition through a gastric tube; if the sucking reflex is sufficiently expressed, but the body weight is less than 1800 g, the child is fed through a pacifier; children weighing over 1800 g can be breastfed. The frequency of feedings for premature infants of stage I-II is 7-8 times a day; III and IV degrees - 10 times a day. Nutrition calculations are made using special formulas.

speech therapist and child psychiatrist.

From 2 weeks of age, premature babies need prevention of iron deficiency anemia and rickets. Preventive vaccinations for premature babies are carried out according to an individual schedule. In the first year of life, repeated courses of baby massage, gymnastics, and individual health and hardening procedures are recommended.

It is not uncommon for the baby to be born not at the fortieth week of pregnancy, but earlier. Fortunately, modern medicine has not considered this a serious problem for a long time, and the survival rate of premature babies is increasing every year. From a medical point of view, a premature baby is a child born before the 37th week of pregnancy. Such a baby comes into the world very tiny, with little weight and height.

Brief characteristics of prematurity

A premature baby is born unable to exist outside the mother's womb. As a rule, he cannot breathe, eat, or adapt to temperature changes on his own. How quickly the baby adapts to new conditions depends on the period of prematurity. There are two degrees of prematurity, which we will talk about below.

Moderate degree

The structural features of internal organs and morphological characteristics at this degree of prematurity are as follows:

Deep degree

It has the following qualities:

With a moderate degree, the survival prognosis is more positive than with a deep degree, since such children have numerous developmental defects, as well as several serious diseases. It is very difficult to deliver such babies.

Important! It sometimes happens that premature babies born in the same week differ in their level of development. Therefore, it should be noted that the criteria for degrees of prematurity are conditional.

Table of differences from a full-term newborn

There is such a thing as fetal maturity. She assumes that the baby inside the womb has already formed enough to ensure its existence outside of it. In the table below you can see the criteria by which you can understand how a full-term baby differs from one born prematurely.

Index	Premature baby	Full term baby
Date of birth	up to 37 weeks	after 37 weeks
Weight	800-2500 gr	2501-6000 gr
Height	40-46 cm	46-60 cm
Color of the skin	Dark red	pink
Body proportions	the head is larger relative to the body, the limbs are smaller	the head and limbs are proportional to the body
Reflexes	undeveloped or poorly expressed	there are conditioned and unconditioned reflexes
Thermoregulation	imperfect or absent	optimal response to changes in ambient temperature
Activity	weak or absent	actively moves limbs
Hairline	there is thick fluff	sometimes there is sparse fluff, more often the hair at birth remains only on the head
Genitals	almost always underdeveloped	developed in accordance with age norms
Subcutaneous fat layer	may be slightly developed on the face, in the fatty corpuscles of the cheeks	fatty tissue is present on the face, limbs, chest, back
Nails	soft, not grown to the end of the finger	formed
Scream	weak or absent	clear and loud

Premature babies are children born between the 28th and 38th weeks of intrauterine development with a body weight of 2500 g or less and a length of 35-45 cm.

At what weight is a premature baby?

A fetus weighing less than 1000 g and born at less than 28 weeks of gestation is considered a miscarriage.

When determining signs of prematurity, indicators of physical development and gestational age (duration of pregnancy) are taken into account, since newborns, premature and full-term, can be born with a body weight that does not correspond to gestational age. For example, body weight can be reduced due to intrauterine malnutrition or intrauterine growth retardation (small children for a given stage of pregnancy), as well as increased, which is observed in those born to mothers with diabetes. Given the wide range of indicators characterizing prematurity, for practical purposes the latter is divided into four degrees. The degree of prematurity reflects the maturity of the newborn, its ability to adapt to the external environment, the frequency and characteristics of the pathology, and the likelihood of survival. So, a diagnosis of prematurity is made:

degree of prematurity - child’s body weight at birth 2500 - 2001

degree of prematurity - the child’s body weight at birth is 2000-1501 g.

degree of prematurity - the child’s body weight at birth is 1500-1000 g.

degree of prematurity - the child’s body weight at birth is up to 1000 g.

The incidence of preterm birth in different countries varies widely (from 3.1 to 16.6%). There is no downward trend in this indicator. Among prematurely born children, the highest morbidity (birth injury of the central nervous system, sepsis, pneumonia, rickets, anemia, malnutrition) and the highest mortality are observed. Up to 75% of all newborn deaths are premature. Therefore, the primary task of health workers in the fight to reduce morbidity and infant mortality is to prevent prematurity. And if it occurs, providing proper care for premature newborns.

Reasons for the birth of premature babies

The main reasons for premature birth of children are as follows:

Socio-biological factors. The parents are too young or too old. If old age has a negative impact on pregnancy due to biological changes in the aging body, then the birth of premature babies in young mothers is due to unplanned pregnancies.

Miscarriage is influenced by the low level of education of parents and the associated unhealthy lifestyle during pregnancy and lack of understanding of the importance of constant medical supervision. Among children born to women who were not observed at the antenatal clinic throughout pregnancy, the perinatal mortality rate is 5 times higher.

Occupational hazards, bad habits, and hard physical labor play a big role in miscarriage. Smoking not only of the mother, but also of the father has a negative impact on the health of the child. Severe developmental defects in children of men who smoke for many years and/or smoke a large number of cigarettes occur 2 times more often than in children of non-smoking fathers.

Causes of prematurity in children

The causes of prematurity can be various factors that disrupt the intrauterine development of the fetus and the physiological course of pregnancy. Premature children are often born to mothers with infectious diseases, including latent ones. Premature birth can be caused by mycoplasma infection, cytomegaly, diseases caused by herpes viruses, adenoviruses and other pathogens that pass through the placental barrier, damage the placenta and disrupt its function.

Often, premature birth occurs as a result of severe somatic diseases, vegetative-vascular dystonia, and pregnant anemia. Infantilism and developmental anomalies of the female reproductive system, neuro-endocrine pathology, and immunological incompatibility of antigenic systems also predispose to this. Children born prematurely in multiple pregnancies.

Previous medical abortions are of great importance, which cause functional and morphological changes in the endometrium and increased contractility of the uterus, chromosomal aberrations, the age of the pregnant woman and her bad habits, and occupational hazards.

Signs of premature newborns

Clinical signs of a premature baby

The appearance of a premature baby depends on the degree of prematurity.

Signs of very premature babies

A very premature baby (body weight less than 1500 g) has the following signs: thin, wrinkled skin of a dark red color, abundantly covered with cheese-like lubricant and fluff (lanugo). Simple erythema lasts up to 2-3 weeks.

The subcutaneous fat layer is not expressed, the nipples and areola of the mammary glands are barely noticeable; the ears are flat, shapeless, soft, pressed to the head; nails are thin and do not always reach the edge of the nail bed; The navel is located in the lower third of the abdomen. The head is relatively large and makes up 1/3 of the body length, the limbs are short. The sutures of the skull and fontanelles (large and small) are open. The bones of the skull are thin. In girls, the genital gap gapes as a result of underdevelopment of the labia majora, the clitoris protrudes, in boys the testicles are not lowered into the scrotum.

Signs of more mature premature babies

In more mature premature babies, the appearance and signs of prematurity are different. Here are their signs: pink skin, no fuzz on the face (at birth in the 33rd week of gestation), and later on the body. The navel is located slightly higher above the womb, the head is approximately 1/4 of the body length. In children born at more than 34 weeks of gestation, the first curves appear on the ears, the nipples and areola are more visible, in boys the testicles are located at the entrance to the scrotum, in girls the genital slit is almost closed.

Premature babies are characterized by signs such as muscle hypotonia, decreased physiological reflexes, decreased motor activity, impaired thermoregulation, and weak cry. A very premature baby (less than 30 weeks of gestation) lies with outstretched arms and legs, sucking, swallowing and other reflexes are absent or weakly expressed. Body temperature is unstable (can drop to 32-34 ° C and easily rises). At birth after the 30th week of gestation, a premature infant is found to have partial flexion of the legs at the knee and hip joints; sucking reflex is good.

In a child born at 36-37 weeks. gestation, flexion of the limbs is complete, but unstable, a distinct grasping reflex is evoked. In the first 2-3 weeks of life, a premature infant may have intermittent tremor, severe and unstable strabismus, and horizontal nystagmus when changing body position.

Premature boys and girls do not differ in anthropometric indicators, since these differences are formed in the last month of pregnancy (full-term boys are larger than girls).

Features of internal organs in premature babies

Morphological and functional immaturity of internal organs also corresponds to the degree of prematurity and is expressed especially sharply in very premature infants.

Breathing in premature babies is shallow with significant fluctuations in respiratory rate (from 36 to 76 per minute), with a tendency to tachypnea and apnea lasting 5-10 s. In children born at less than 35 weeks of gestation, the formation of surfactant, which prevents the collapse of the alveoli during exhalation, is impaired. They develop SDR more easily.

Heart rate in premature babies is characterized by great lability (from 100 to 180 per minute), vascular tone is reduced, systolic blood pressure does not exceed 6070 mm Hg. Increased permeability of vascular walls can lead to impaired cerebral circulation and cerebral hemorrhage.

Due to the insufficient maturity of the renal tissue, its function to maintain acid-base balance is reduced.

All gastrointestinal enzymes necessary for the digestion of breast milk are synthesized, but are characterized by low activity.

In premature infants, there is no relationship between the intensity of jaundice and the degree of transient hyperbilirubinemia, which often leads to underestimation of the latter. Immaturity of the liver and the associated insufficient activity of the enzyme glucuronyltransferase, increased permeability of the blood-brain barrier (BBB), as well as rapid breakdown of red blood cells can lead to the accumulation of indirect bilirubin in the blood in the first days of life and the development of bilirubin encephalopathy even with a relatively low concentration of bilirubin (170-220 µmol/l).

Laboratory tests of a premature baby

In the first days of life, premature infants are more likely than full-term infants to experience hypoglycemia, hypoproteinemia, hypocalcemia, hypomagnesemia, hyperkalemia, and decompensated metabolic acidosis. The content of erythrocytes and Hb at birth is almost the same as in full-term infants, but the HbF content is higher (up to 97.5%), which is associated with intense hemolysis.

From the second day of life, red blood counts change at a faster rate than in full-term infants, and at the age of 6-8 weeks, a deviation in the hemogram typical of premature infants appears - early anemia of prematurity. The leading cause of anemia is considered to be low production of erythropoietin.

Features of development of premature babies

Physical development is characterized by higher rates of increase in body weight and length during the first year of life. The smaller the body weight and length of the premature infant at birth, the more intense the increase in these indicators throughout the year. By the end of the first year of life, the body weight of a premature baby increases as follows:

with a newborn’s body weight 800-1000 g - 8-10 times

" " " " 1001 - 1500 g " 6-7 "

" " " " 1501-2000 " 5-7 "

" " " " 2001-2500 " 4-5 "

During the same age period, the height of the premature infant is 65–75 cm, i.e., it increases by 30–35 cm.

Body weight increases unevenly. The first month of life turns out to be the most difficult period of adaptation, especially for a very premature baby. His initial body weight decreases (in a full-term baby by 5 - 7%); recovery occurs slowly: in premature infants with signs of degrees III - IV, body weight often reaches the initial figures only by the end of the 1st month of life and begins to increase more intensively from the 2nd month.

Despite the high rates of development, in the first 2 - 3 years of life, premature babies lag behind their peers born full-term in terms of body weight and height. Subsequently, asthenia and infantility are more often observed in children born prematurely, but a number of children have indicators of physical development that correspond to their full-term peers.

Children with II - III degrees of prematurity begin to fix their gaze, hold their heads, roll over, stand up and walk independently, pronounce their first words 1 - 3 months later than their full-term peers and catch up with them during the 2nd year of life (children with 1 degree of prematurity to end of 1st year).

What does a premature baby look like?

Eyes. If your baby was born before the 26th week of pregnancy, his eyes may be tightly closed.

Genitals. Your baby may have underdeveloped genitals. In boys this will manifest itself in the presence of testicles; in girls, this is that the labia majora (outer labia of the vulva) will not be large enough to cover the labia minora (inner labia of the vulva) and clitoris, and a patch of skin may be visible from the vagina (don't worry, this will disappear over time) .

Extreme thinness. Your premature baby may look wrinkled and skinny because his body lacks the layers of fat that typically accumulate toward the end of pregnancy (after 30 to 32 weeks). As he begins to gain weight, this fat will appear and he will begin to look more like a normal full-term baby.

Transparent skin. Accumulations of fat also affect the skin color of a premature baby. Veins and arteries are clearly visible through the skin, and the skin has a pinkish-purple hue, regardless of the child's race. (This is because skin pigmentation usually appears after the eighth month of pregnancy.)

Lack of hair. Severely premature babies may not have any hair at all on their body, except for soft fuzz. On the other hand, children who were born slightly prematurely may be covered with a thin down covering the body. This fuzz may be especially abundant on the back, upper arms, and shoulders.

Lack of nipples. Nipples typically appear after the 34th week of pregnancy, so your baby may not have nipples if he was born before then. However, some babies have fully formed circles - dark circles that usually surround the nipples.

Low muscle tone. Premature babies have less control over their body than full-term babies. If you place your baby on his back, his limbs may shake or sag. Severely premature babies sometimes hardly move at all: their movements are limited to light stretching or clenching their fists. Babies who are born before the 35th week of pregnancy may lack the muscle tone needed to assume the fetal position common to full-term babies.

Underdeveloped lungs. Premature babies have more breathing problems than full-term babies because their lungs are not fully developed. Fortunately, a baby's lungs can continue to develop outside the mother's uterus as they mature.

Comment: If your baby is born between 22 and 25 weeks of pregnancy, you should be prepared for the baby to look more like a fetus in the womb than a normal newborn. His eyes may still be tightly closed, and his skin may appear shiny, translucent, and too tender to touch. His ears may be soft and folded in places where the cartilage has not yet hardened. You will notice how much your baby changes in the coming weeks, as his skin becomes thicker and his eyes open for the first time. He will begin to resemble a normal newborn.

Assessment of the development of premature infants

When analyzing the development of a premature infant in the first year of life, the period of prematurity is subtracted from the age of the child (if the period of prematurity is 2 months, then the development of a 7-month-old child is assessed as 5 months). When assessing the development of a premature child in the second year of life, half the period of prematurity is subtracted from the child’s age (if the period of prematurity is 2 months, then the development of a 14-month-old child is assessed as 13 months). Once the preterm infant reaches 2 years of age, his or her development is assessed without adjustment for prematurity.

Let's find out how the development of premature babies is assessed.

Signs of speech impairment and delayed language development in preschool children

6 months - does not respond or responds inadequately to sound or voice;
9 months - does not respond to name;
12 months - cessation of babbling or no babbling at all;
15 months - does not understand the words “no” and “bye-bye”, does not react to them;
18 months - does not say other words except “mom” and “dad”;
2 years - does not form two-word phrases;
after 2 years - still uses "baby" slang and imitates sounds excessively;
2.5 years - the child’s speech is incomprehensible even to family members;
3 years - does not write simple sentences;
3.5 years - the child’s speech is understandable only to family members;
4 years - persistent articulation errors (in addition to the sounds R, S, L, Sh);
5 years - has difficulty writing structured sentences;
after 5 years - a noticeable constant disturbance in the fluency of speech (stuttering);
6 years old - unusual shyness, rearranging words, difficulty finding appropriate words when speaking.

At any age - monotony of spoken sounds or hoarseness of voice.

Signs of cognitive impairment

2-3 months - does not show much interest in relation to the mother;
6-7 months - does not turn his head towards a fallen object;
8-9 months - does not show interest when they try to play hide and seek with him;
12 months - does not look for a hidden object;
15-18 months - shows no interest in cause-and-effect games;
2 years - does not divide surrounding objects into categories (for example, animals are one thing, cars are another);
3 years - does not know his full name;
4 years old - cannot tell which of two lines is shorter and which is longer;
4.5 years - cannot count consistently;
5 years old - does not know the names of letters, the colors of objects;
5.5 years old - does not know his date of birth and home address.

Care of premature newborns

Features of feeding and care

Feeding premature babies has significant features. These features are due to the increased need for nutrients due to intensive physical development, as well as the morphological and functional immaturity of the gastrointestinal tract, requiring careful introduction of food.

The beginning of feeding a child is determined by the state and degree of prematurity. The method of feeding is determined depending on the severity of the condition.

With I degree of prematurity, the child can begin to be fed with breast milk or its substitutes after 6 - 9 hours, with II degree - after 9 - 12 hours, with III degree - after 12-18 hours, the fetus - after 24 - 36 hours. During this period a 5% glucose solution is administered in 3-5 ml doses every 2-3 hours. A longer “fast” is undesirable, as it leads to hypoglycemia, hyperbilirubinemia, hypoproteinemia, and increases metabolic acidosis.

Children with grade III - IV prematurity, as well as all premature infants with respiratory distress syndrome, asphyxia, and a weak sucking reflex, receive breast milk through a gastric tube, permanent or disposable (the permanent tube is changed every 3 - 4 days for sterilization and prevention of bedsores). If the general condition is satisfactory and the sucking reflex is sufficiently pronounced, feeding for the first 3 to 4 days is done through a pacifier. It is not advisable to breastfeed before this period, since breastfeeding is a heavy physical activity and secondary asphyxia or intracranial hemorrhage may occur.

Premature babies weighing less than 1500 g are put to the breast from the 3rd week of life. Nutrition calculations are made in accordance with the needs of the child’s body per 1 kg of weight per day: 1-2 days of life - 30 kcal, 3rd day - 35 kcal, 4th day - 40 kcal and then daily 10 kcal more until 10th day; on the 14th day - 120, from the 21st day - 140 kcal. When caring for premature newborns and when determining the amount of nutrition, the individual characteristics of the newborn should be taken into account: very premature babies from the 2nd month of life sometimes absorb a volume of breast milk corresponding to 150-180 kcal/kg. Most premature babies develop well when breastfed.

Children with insufficient weight gain at the end of the 1st month are sometimes prescribed a concentrated supplement in the form of cottage cheese, whole kefir with 5% sugar. In addition, most premature infants receive parenteral solutions of glucose and albumin. From the 2nd month of life, instead of drinking, they give vegetable broth, as well as fruit and vegetable juices. Instead of breast milk, formula milk can be used when caring for a premature baby.

Nursing premature babies

Nursing of premature babies is carried out in 2 stages: in the maternity hospital and in a specialized department for newborns. Then the child comes under the supervision of the clinic. In the maternity hospital, mucus is sucked out of the upper respiratory tract to prevent aspiration in a premature baby. In the first days and weeks of life, very premature babies or premature babies in serious condition are kept in incubators ("incubators"). They maintain a temperature of 30 to 35 ° C (taking into account the individual characteristics of the child), humidity in the first day up to 90%, and then up to 60 - 55%, oxygen concentration about 30%. The body temperature of a premature baby can also be maintained in a heated crib or with heating pads in a regular crib. The optimal room temperature should be about 24 C.

Oxygen therapy is carried out, correction of the balance of acids and bases by introducing solutions of glucose with ascorbic acid and cocarboxylase. Elimination of hypoglycemia and hypoproteinemia is achieved using solutions of glucose and albumin. In case of urgent need, plasma transfusions and blood transfusions are performed.

Most children with stage III-IV prematurity receive antibiotics during care. Indications for their use are the severe general condition of the child, purulent-inflammatory diseases in the mother, premature rupture of amniotic fluid, and childbirth outside a medical facility.

What should be the care for a premature baby?

The main features of the body of a premature baby are very poor thermoregulation and shallow breathing. The first can lead to a drop in the child’s body temperature to 35 degrees or a rise to 40, the second can lead to oxygen starvation or even respiratory arrest.

As soon as the doctors decide that the child’s condition is satisfactory, the mother and baby are discharged home, having previously provided important instructions on hygiene, clothing, walking and bathing the premature baby.

It is very important to protect such a child from people who are carriers of colds, acute respiratory infections and acute respiratory viral infections. For premature babies, both overheating and hypothermia are life-threatening. The temperature in the room where the child is located should not fall below 22 degrees, under the blanket - not below 33 degrees. The water temperature for bathing should be higher than for a full-term baby (not lower than 38 degrees), while the bathroom should also be warm enough - not lower than 24 degrees.

From the above it is clear that caring for a premature baby includes constant monitoring of its body temperature. He needs warmer clothing than his full-term counterpart. It is very important to constantly change the air in the room; during ventilation it is worth taking the child out of the room.

The child is gaining weight

As soon as the child's weight exceeds three kilograms, he can be taken for walks. You should not go outside if the air temperature outside is below minus 5 for a child up to a month old, below minus 10 for a child up to a year. You should start walking for 5-10 minutes, and gradually increase the walking time to 2-3 hours (go out immediately after feeding and walk until the next feeding).

Another problem is that the baby simply cannot suckle, and therefore is forced to eat from a bottle (and sometimes there is no strength for this). As soon as the baby is strong enough to suckle, you should completely switch to breastfeeding. This will help you quickly gain the desired weight and catch up with your peers in development.

Only 8-10% of premature babies are discharged home from the maternity hospital - these are healthy children with a birth weight of more than 2000. The rest are transferred to specialized institutions for the second stage of nursing. In these institutions, children receive the necessary treatment, hygienic baths, and are prevented from rickets and anemia. The complex of therapeutic measures includes massage and gymnastics. A healthy premature baby can be discharged home when he reaches a body weight of more than 2000 g, its positive dynamics and a good sucking reflex.

The proper development of premature babies is facilitated by timely care for a premature newborn, a favorable home environment, individual classes, games, massage and gymnastics, and a balanced diet.

Long-term consequences of prematurity

Children born prematurely usually grow up healthy and become productive members of society. It is known that I. Newton, Voltaire, Rousseau, Napoleon, Charles Darwin, Anna Pavlova were born prematurely. However, among such a contingent of children, the percentage of mentally and physically disabled children is higher than among those born at term. Severe psychoneurological disorders in the form of cerebral palsy, decreased intelligence, hearing and vision impairment, and epileptic seizures are observed in 13 - 27% of premature births. These indicators are especially high in the group of those born very prematurely; among them, restless children suffering from uncertainty and night terrors are more often observed later. In prematurely born children, disproportionate development of the skeleton is more often observed, mainly with a deviation towards asthenia.

In recent years, doctors from various specialties have been studying the developmental features of children born prematurely. It has been established that women born very prematurely are more likely to experience menstrual irregularities, defective generative function, signs of sexual infantilism, threatened miscarriage and premature birth.

Prevention of premature birth of children includes:

Protecting the health of the expectant mother from early childhood;
Prevention of medical abortions, especially in women with menstrual irregularities and neuroendocrine diseases;
Creating favorable conditions for pregnant women in the family and at work;
Timely identification of pregnant women at risk of premature birth and monitoring the course of their pregnancy.

Even babies born at full term often cause their parents to worry a lot about their health. What can we say about those little “hurry-ups” who rushed to “go out into the world” ahead of schedule. Indeed, parents of premature babies face serious potential childhood diseases and complications, which they should at least be aware of. As in that beautiful and accurate saying: “Aware, means already armed”...

Often, premature babies are placed in special incubator incubators, where special temperature, humidity and oxygen conditions are maintained.

Features of premature babies

Babies born before the 37th week of pregnancy are considered premature. Such children will have a very difficult time in the first months of their “early” life - after all, they will have to not only intensively catch up with their peers, but also bravely resist many potentially dangerous pathologies. We will tell you in detail about the most common of them.

Often, after birth, premature babies are placed for some time in a hospital, in intensive care units, where neonatologists closely monitor their health, and also take measures to care for premature babies.

The time that a baby born prematurely will spend in the hospital growing and nursing directly depends on how “small” he was born. On average, in Russian clinics, in intensive care units for premature babies, babies spend from 15 to 45 days.

Many premature babies lack the sucking reflex for some time; such babies are fed using a special tube. Some cannot breathe on their own - they are connected to appropriate equipment.

To the most important features of premature babies relate:

immature central nervous system (CNS), which is expressed in the child’s lethargy, chaotic movements of the arms and legs, and the absence of a sucking reflex;
an unformed gastrointestinal tract system, an excessively small volume of the stomach and underdeveloped intestinal muscles;
immature ability to thermoregulate (this is why most premature babies need to stay in warm and humid incubators);
an undeveloped respiratory system (in very premature babies, as a rule, at the time of birth the lungs are not able to open and fill with air on their own), which is expressed in shallow “ragged” breathing and in breathing stops when overloaded (for example, due to crying);
immature skin, which is very vulnerable to microbes and is easily injured even by normal touch.

The premature baby is under constant supervision of neonatologists in the intensive care unit until his vital and physical indicators approach the norms of a child born at term.

And, of course, along with nursing and raising premature babies in hospitals, they also undergo a thorough medical examination to identify serious diseases. So, the following pathologies most often appear in premature babies:

Underdeveloped lungs and breathing pathologies

Most babies develop lungs by 36 weeks of pregnancy. Although there are exceptions, because each child develops individually. If the mother already knows that the baby will be born prematurely, she can order an amniocentesis procedure (taking a sample of amniotic fluid for laboratory testing), which can check the level of maturity of the fetus's lungs. In some cases, the mother may be given a steroid injection before birth to help the fetus develop lungs faster. A premature baby whose lungs have not yet developed is at risk of experiencing the following complications:

Respiratory distress syndrome which causes sharp, irregular breathing in the child. In this case, nursing a premature baby is carried out by supplying additional oxygen to the lungs (with a respiratory support device), or using a respirator, or creating constant positive pressure in the respiratory tract, or tracheal intubation. In severe cases, the baby is given doses of a surfactant that the lungs lack.
Transient tachypnea of newborns, that is, fast shallow breathing. This condition can occur in both premature and full-term infants. Nursing a premature baby in this case, as a rule, takes place without medical intervention and takes up to several days. Until the newborn's breathing returns to normal, intravenous feeding is used.
Bronchopulmonary dysplasia of the lungs occurs when a newborn's lungs are damaged. Unfortunately, when premature babies are treated with a ventilator, their lungs, due to their weakness, cannot always withstand the constant pressure generated by the device. Premature babies who have been placed on a ventilator for more than twenty-eight days are at high risk of developing BPD.

Pneumonia of premature babies

Another serious consequence that premature babies often face is pneumonia. It is caused by an infection in the area of the lungs that is involved in the exchange of carbon dioxide and oxygen. The resulting inflammation reduces the amount of space available for air exchange. This can lead to the child’s body not receiving oxygen in the required quantity.

In this case, treatment for premature babies will include antibiotics, as well as supplemental oxygen and intubation. If pneumonia is not treated promptly, it can develop into a fatal infection or lead to sepsis or.

Apnea and bradycardia

Very common diseases of premature babies also include apnea and bradycardia. Apnea is short-term cessation of breathing. In hospitals, specialists are always prepared for this situation: if a premature baby develops irregular breathing and pauses reach 10-15 seconds, an alarm will sound in the intensive care unit, where he is being nursed, calling for medical help.

Bradycardia is a decrease in heart rate. The scenario is the same: if the premature baby’s heart rate drops below 100 beats per minute, the alarm also goes off.

Special equipment in the departments for nursing premature babies monitors all vital signs of babies around the clock.

Typically, lightly patting your newborn's back will help "remind" him to start breathing again and will also increase his heart rate. But sometimes the baby needs more serious specialized help.

Infections in premature babies

Ordinary babies born at term are protected from most infections not only by mother's breast milk and partial mother's immunity, but also by two vital organs - the skin and the respiratory system. Both normally prevent the penetration of many viruses and bacteria into a vulnerable organism. But a premature baby has a certain underdevelopment - both the respiratory system and the maturity of the skin.

The high risk of developing infections in premature babies is the second reason why these babies are kept in incubators for some time. These incubator beds not only create a favorable climate around the children, but also protect them from infections.

Intraventricular hemorrhage (IVH)

Babies born before 34 weeks face an increased risk of intraventricular hemorrhage in the brain. The fact is that during childbirth, the pressure in the blood vessels changes so dramatically that weak vessels may not be able to cope with it. In the future, IVH can lead to complications such as cerebral palsy, mental retardation, and learning difficulties.

Intracranial hemorrhage occurs in approximately every third child born at 24-26 weeks of pregnancy. If preterm labor is unavoidable, a doctor may prescribe medications to the pregnant woman to reduce the risk of severe intracranial hemorrhage in newborns.

Retinopathy of prematurity

This is an extremely dangerous disease that affects underdeveloped blood vessels and capillaries in the eyes of premature babies. Retinopathy of prematurity can be mild, without visible defects, or it can be severe, with the formation of new blood vessels (neovascularization) and lead to retinal detachment, and even sometimes blindness.

Retinopathy, which in the future may develop into high myopia in a child, is one of the most dangerous and common diseases among premature babies.

In the maternity hospital, the mother will immediately know if she has a premature baby. Over the subsequent weeks of her stay in medical institutions, she will acquire much more information on this issue than can be obtained from this article. Everything that the mother learns in the hospital will pass through her heart. Still, even if your baby was born on time, don't skip this article.

Premature babies are those who were not carried to the generally defined normal gestational age of 37-42 weeks, which is why they are most often born with a weight of less than 2500 g and a body length of less than 45 cm, as well as with a certain set of signs of immaturity.

It must immediately be said that none of these signs in themselves, nor the birth of a child before the 37th week, serves as a basis for recognizing the child as premature.

Immaturity can also be the lot of those whose birth fits into the specified dates and is even delayed in relation to them.

Signs of immaturity are divided into two large groups:

on the so-called morphological, relating to the structure of the body,
and functional, describing the work and interaction of organs.

Morphological signs of immaturity

Pay attention to the signs from the first category that are accessible to external observation.

Wrinkled “senile” skin is a consequence of underdevelopment of the subcutaneous fat layer; its color is not pale pink as normal, but pink or red, and the deeper the immaturity, the darker the color. If the skin is gathered into a fold, it will not straighten out immediately - you will have time to notice how this will happen.
Thick vellus hair grows everywhere on the body and arms; the navel is located just above the pubis (in full-term babies it is located in the middle of the body length).
The nipples and areola are difficult to distinguish.
A full-term newborn has a normal head proportion - 1/4 of the length of the entire body; in children born prematurely, the head is relatively large - up to a third of the height, and the hair on the head has not yet grown to two centimeters.
The appearance of the ears is characteristic - they are soft and shapeless, pressed tightly to the skull, and the skull itself is compressed from the sides and seems very high.
Nails are soft, transparent, and may not reach the fingertips.
In premature girls, the labia majora are underdeveloped; they do not cover the labia minora, which is why the labia gapes.

Morphological immaturity, of course, is not limited to these external, clearly visible signs, since all organs and systems are underdeveloped.

Functional signs of immaturity

Here is a short list of signs from the second group - functional:

underdevelopment or complete absence of sucking and swallowing reflexes;
irregular breathing, sometimes reaching a half-minute stop;
faint cry; paucity of movements and emotional manifestations.

The body of a premature baby is poorly adapted to maintaining a constant body temperature, constant blood composition and other internal environments.

The pose of such a child is also characteristic: the arms lie sluggishly along the body, the legs are widely spread and slightly bent at the hip joints. Mandatory weight loss in the first 2 days of life is most often 10-12%.