According to modern definition of the World Health Organization (WHO), the child born on pregnancy term till 37 full weeks and having all signs of immaturity about which we will tell below is considered premature. Growth and weight of premature babies, naturally, as a rule, are less than growth also of the weight of the children who were born in time, however today refer the body weight and growth to conditional criteria of prematurity as many full-term children for a variety of reasons can have body weight less than 2500 and height less than 45 cm
there are two extremes in the attitude towards the premature child: some are inclined to consider it as the reduced copy of the child who was born in time others refuse to it at all the right to be called the person and consider nearly as the germ, will of destiny which came to be out of a maternal womb. Both incorrectly. Premature children, of course, children, but - special, needing the special relation and special leaving. For example, 24 - the week premature child normal would have to spend 16 more weeks in a uterus where the placenta provides it with food and oxygen, relieving of need to eat and breathe independently; temperature is constant; it is protected from all injuries and damages; gravity is not felt in any way; its nervous system should not react to strong irritants (visual, acoustical, tactile). Having lost this habitual and comfortable environment before term, the kid is forced to adapt in process of forces to new, in general hostile, habitat. It is clear, that without the assistance of doctors it in most cases is impossible.
Chances to survive
C of 1979 the Russian health care proceeds from the international standards accepted by WHO according to which the children who were born with body weight more than 500 g at pregnancy term not less than 22 weeks are considered potentially viable. Let`s note that the forecast is the forecast, but not a guarantee and not a sentence: some premature children suddenly die, despite favorable forecasts, others - survive counter to gloomy estimates. The Japanese scientists described even a case of successful nursing of the child who was born weighing 396 g and after some time it did not concede to peers neither in mental, nor in physical development! One is undoubted: chances of the premature kid to survive increase with everyone lived in the afternoon.
As the premature child looks and behaves?
Appearance and behavior of the newborn premature child, of course, depend on his gestational age (number of full weeks of pregnancy by the time of the birth). The constitution of the premature child is very peculiar. The head is rather big, cranial seams are often open, small and lateral fontanels have the big sizes. Bones of a skull are pliable. Hypodermically - fatty cellulose is developed poorly. Often skin of the premature child is covered with pushkovy hair, nails can be underdeveloped. Auricles are soft, the umbilical ring is located low. At boys testicles can be not lowered in a scrotum, and at girls vulvar lips are underdeveloped.Reflexes at premature children are weak
and die away very quickly, and at deeply premature often are absent vital - swallowing and sucking. The muscular tone is, as a rule, lowered. Owing to immaturity of the center of thermal control, premature cannot maintain the body temperature therefore they are easily cooled and do not react rise in temperature to infectious diseases. Respiratory, digestive, it is warm - vascular, nervous and other systems at them are underdeveloped (in comparison with the full-term babies) and have a number of features which define the course of diseases at this group of children. The visual system ripens approximately between 22 and 34 gestational age. Therefore first premature kids spend not enough time with open eyes and do not focus a look. By 30 weeks of gestational age they already react to bright light, blinking or narrowing eyes, and at soft lighting open eyes, consider surrounding objects and focus on them a look, however, focusing of a look takes them more time, than the full-term children and adults.
That expects a premature baby right after the birth
Not all children born before “official“ term by all means get to the offices specializing in nursing of premature. Making the decision on need of the placement of the kid who was born before term to the intensive care unit or intensive therapy of newborns, doctors consider not only its gestational age, but also a ratio the weight/growth, existence of trouble breathing, congenital anomalies or malformations, diseases, especially infectious, and many other factors. If, according to doctors, the condition of the newborn does not pose threat of his life and to health, the child is written out home, having supplied mother with all necessary recommendations about care of it.
the First stage of nursing - children`s reanimation. In case of considerable immaturity of the vital systems of the newborn (for example if the premature child is not able to breathe independently), he right after the birth gets to office of children`s reanimation. Here kids lie in the special couveuses closed by transparent caps with four openings - on two from each party (for medical manipulations). All couveuses are supplied with medical ventilators. Children at whom is absent or the sosatelny reflex is poorly expressed, the first several weeks receive food (optimum - the warmed-up maternal milk, sometimes with specially picked up additives) through a nazogastralny probe. Constant temperature (danger is constituted not only by overcooling, but also an overheat) and humidity of air (about 60%) that at the child mucous membranes did not dry is maintained in the couveuse. Sometimes couveuses are supplied with water mattresses which bring closer conditions to stay in amniotic liquid. By means of numerous tubes and wires the child is connected to the monitors, droppers and other devices which are controlling his pulse, temperature and breath, regularly carrying out blood tests, entering necessary drugs and carrying out a set of other important functions. If the indicators registered by these devices dangerously deviate norm, the alarm signal is distributed. Resuscitation procedures are not limited to artificial ventilation of lungs and giving of food through a probe. The children who were born prematurely are endangered developments of various complications, the majority of which at modern development of neonatal reanimation can be prevented or cured. Let`s give only one example. In lungs, as we know, there is a process, major for human life, - gas exchange: oxygen of air passes into blood, and carbon dioxide - from blood in air. The tiny bubbles braided with a network of capillaries - alveoluses are responsible for it. And so, the substance counteracting subsidence of alveoluses in lungs during an exhalation, so-called surfactant is formed only on 22 - 24 week of pregnancy, and deeply premature children need introduction of artificially synthesized surfactant. Such examples it is possible to give a set, however the detailed description of all procedures which are carried out with premature children in the intensive care unit, will take too much place and it will be hardly clear and interesting to the people far from medicine.
the Second stage of nursing - intensive therapy of newborns. When the child is able to breathe independently and need for artificial ventilation of lungs disappears, the second stage of nursing which is usually carried out in an intensive care unit of newborns begins. Here premature children are located in couveuses too. Unlike intensive care units, intensive care units are not equipped with medical ventilators. Nevertheless, additional supply of the moistened and warmed up oxygen in couveuses, and also optimum moisture and temperature condition is provided here. The child is in the couveuse until is able independently to maintain body temperature and to do without additional supply of oxygen. Today the fact that during stay in a hospital the premature child needs communication with mother is taken for granted. The kid has to hear a maternal voice, feel its heat that he is reached by means of a so-called method of a kangaroo. This method of nursing of premature children was for the first time applied in that poor and underdeveloped countries where on purely economic means to provide all premature children with the couveuses equipped with all the equipment, necessary for maintenance of constant temperature, were not the reasons. The essence of a method consists that the child is nursed, being in direct contact with mother`s skin - at it on a breast and a stomach. Mother puts on the free, undone in front clothes, the diaper is put on the child (and, maybe, a hat). The kid is located between breasts, the clothes are clasped in order to avoid loss of heat. Temperature of the child is controlled by the nurse or monitors. Researches showed what maternal warmly perfectly warms the child and temperature of his body is maintained up to standard. Breath also becomes more correct and stable, as well as heartbeat and saturation of blood oxygen. Besides, skin of the child becomes populated by microflora of mother that promotes recovery processes. It is possible to pass to this method of nursing when at rather satisfactory condition the child still needs artificial thermal control and supervision over heartbeat and breath.
the Third stage of nursing - katamnestichesky supervision. Relative normalization of the main vital functions of an organism not always, unfortunately, means that the premature child was finally made even to peers in psychophysical development. Now in many cities of Russia offices of katamnestichesky supervision over the children who were born with extremely low body weight open. Katamnez in medicine is called information on the patient collected after the end of initial supervision (in this case - after an extract from an intensive care unit or nursing premature). Of course, in katamnestichesky offices not only observation over children, but also systematic correction of the deviations revealed at them is made. Methods of such correction - a subject for separate conversation.
the Child of the house
Certainly, writing out the child home, the doctor will make to mother all necessary recommendations about further care of it. We within article will be limited only to the most general reasons.
- to you should be supported also at home a certain temperature condition - in the room of the child has to be around 22 - 23 ° Page. Though by the time of an extract thermal control of the child usually already works, he all the same should spend a lot of own energy for heating of the body therefore you have to create it comfortable conditions, otherwise all calories taken from hardly the got food will leave on maintenance of body temperature, but not on an increase in weight. But do not forget - the child can and be overheated that is not less dangerous.
- Sterilize small bottles and nipples which you use for feeding of the child. Try that at least at first the child did not contact to all relatives and friends who cannot wait to visit you, - its resilience to an infection is weak, and there is no need to hurt to him at all. you Feed with
- the child often, do not worry if it long remains at a breast, - premature children suck not so actively, and they should give time to be sated. If you see that the child was tired, interrupt feeding, let`s it have a rest a little, finish feeding the decanted milk. Surely consult to the doctor whether it is necessary to receive to the child in addition to your breast milk the special mix containing all substances and polyvitamins necessary for it. There are such additives which are dissolved in breast milk and reduce risk of development of a vitamin deficiency in the premature child. the Feeding up can be begun with
- only with permission of the doctor. Usually the feeding up is entered when the child weighs 6 - 7 kg, eats about 1000 ml of breast milk or mix a day, however if necessary the feeding up is appointed earlier. be not frightened by
- if the child from the very first days does not begin to put on weight promptly. The first two weeks the child usually even loses flesh, begins to add, as a rule, with the third - the fourth week. The increase in weight for a week of the premature child first averages 100 - 200. On the third or fourth month it will double the weight (the full-term child doubles weight on the fifth month), and will treble on the sixth (the full-term child - only at the end of the first year).
- Should not torment itself with sense of guilt from - for the fact that the child was born before term and in this regard to show excessive care, to too indulge the kid. The premature child - the being unusual and demanding the special relation to himself is valid. It is the best of all to consult with the good children`s psychologist, the methodologist owning skills of the various developing games and techniques. They will allow you to create an optimum environment for harmonious development of the child and to compensate all those difficulties which your tiny little son or the daughter had to face, having hardly come to this world. Medical practice demonstrates that at due leaving and correctly picked up rehabilitation course even deeply premature children catch up with the peers on the key psychophysical parameters by 1,5 - 3.