Premature baby

A premature baby is a child born before 37 weeks of gestation.

The full term of gestation is 40 weeks. In children born before 37 weeks of gestation, there is an increased incidence of complications and mortality, which is approximately proportional to the degree of prematurity. Premature birth is one of the main causes of neonatal morbidity and mortality.

Previously, any child with a birth weight less than 2.5 kg was considered premature. This definition is not correct, since many newborns with birth weight less than 2.5 kg are full or born, but small by the gestation period; they have different appearance and different problems. Infants less than 2.5 kg at birth are considered low-birth newborns, and children less than 1500 g are considered to be infants with very low body weight.

[1], [2], [3], [4], [5], [6], [7]

What causes the birth of a premature baby?

The cause of premature births with a prior or premature rupture of the membranes is usually unknown. At the same time, the mother's anamnesis often shows a low socioeconomic status; inadequate prenatal care; poor nutrition; low education; unmarried status; preterm birth in history and intercurrent diseases or infections (eg, bacterial vaginosis). Other risk factors include placental abruption and preeclampsia.

Signs of a premature baby

The results of the physical examination correlate with the gestation period. Prenatal ultrasound, if it is performed, also determines the duration of gestation.

A premature baby is small, usually with a birth weight less than 2.5 kg, most often has a thin shiny pink skin, through which subcutaneous veins are easily visible. The child has little subcutaneous fat, hair, weak cartilage of the external ear. Spontaneous motor activity and muscle tone are reduced, and the limbs are not held in the flexion position, typical for full-term newborns. In boys, the folding of the scrotum may be mild, and the testicles may not be lowered into the scrotum. Girls have small labia lips yet not covered with large ones. The development of reflexes occurs at different times during intrauterine development. Reflection Moro begins to appear by the 28-32nd week of gestation and is well caused by the 37th week of pregnancy. The palmar reflex begins to be called at the 28th week and is well triggered by the 32nd week. On the 35th week begins to appear cervical tonic reflex, most clearly manifested in 1 month after birth.

Complications in premature infants

Most complications are associated with dysfunction of immature organs and systems.

[8], [9], [10], [11], [12]

Lungs

Surfactant products are often not sufficient to prevent the alveoli from falling off and the development of atelectasis, which leads to the development of a respiratory distress syndrome.

Central nervous system

Children born before 34 weeks of gestation have inadequate coordination of sucking and swallowing reflexes and require parenteral nutrition or probing feeding. The immaturity of the respiratory center at the base of the brain leads to episodes of apnea (central apnea). Apnea can also be a consequence of an adrenal obstruction (obstructive apnea). Two of these options can be combined (mixed apnea).

The periventricular embryonic matrix (embryonic cells located above the caudate nucleus on the lateral ventricular lateral wall, which is found only in the fetus) predisposes to hemorrhages that can spread into the ventricular cavity (intraventricular hemorrhage), white matter infarctions in the periventricular region (periventricular leukomalacia) can also arise from causes that are not fully understood. Hypotension, inadequate or unstable brain perfusion and blood pressure peaks (for example, when intravenously injected with fluid quickly) can contribute to heart attacks or cerebral hemorrhages.

[13], [14], [15], [16], [17], [18], [19]

Infections

Sepsis or meningitis occurs approximately 4 times more often. The increased likelihood of infection is the result of the use of permanent intravascular catheters and intubation of the trachea, the presence of a breach of the integrity of the skin and a significantly reduced level of immunoglobulins in the blood serum.

Thermoregulation

In premature infants, an exceptionally large ratio of body surface to mass. Therefore, if a child is in an environment with a temperature lower than neutral, he quickly loses heat and has difficulty maintaining body temperature.

Gastrointestinal tract

The small stomach and immaturity of the sucking and swallowing reflexes prevent feeding through the mouth or nasogastric tube and create the risk of aspiration. Necrotic enterocolitis develops very often.

Kidneys

The kidney function is reduced, including concentration. Late metabolic acidosis and dysplasia may result from the inability of immature kidneys to remove bound acids that accumulate when fed with high protein and bone growth mixtures. Na and HC03 are absent in the urine.

Metabolic problems

Hypoglycemia and hyperglycemia.

Hyperbilirubinemia develops more frequently, icteric sclera can develop even at this low serum bilirubin level, like 10 mg / dL (170 μmol / L) in small patients with immature neonates. A higher level of bilirubin may in part be due to the inadequate development of hepatic excretion mechanisms, including the inadequacy of bilirubin uptake from the blood, its conjugation from the liver to bilirubin digipicuronide and its excretion into the biliary tract. Decreased motor activity of the intestine contributes to the fact that more bilirubin diglyucuronide is deconjugated in the lumen of the intestine by the enzyme beta-glucuronidase, as a result of which the reabsorption of unbound bilirubin (intestinal hepatic circulation of bilirubin) increases. In contrast, early feeding increases the motor activity of the intestine and reduces the reabsorption of bilirubin and, consequently, can significantly reduce the frequency and severity of physiological jaundice. Seldom later, clamping the umbilical cord increases the risk of significant hyperbilirubinemia, as it facilitates the transfusion of a large number of red blood cells, thus increasing the destruction of red blood cells and the formation of bilirubin.

Treatment of diseases in premature infants

General supportive care is best provided in neonatal intensive care units or special care units and includes an attentive attitude to maintaining the appropriate temperature using servo controlled tubing; special attention is paid to washing hands before and after all contacts with patients. It is necessary to constantly monitor the patient for the presence of episodes of apnea, bradycardia, hypoxemia up to 34.5-35 weeks of gestation.

Parents should be encouraged to visit and interact with the child as much as the child's condition permits.

Feeding a premature baby

Feeding of the premature baby should be carried out through the nasogastric tube before the coordination of sucking, swallowing and breathing is established - about 34 weeks of gestation, when it is necessary to stimulate breastfeeding in every possible way. Most immature infants are well tolerated by breast milk, which provides them with nutrients and immune protection factors that are absent in cow's milk mixtures. At the same time, breast milk does not provide sufficient intake of calcium, phosphorus and protein for newborn babies with very low birth weight (ie, less than 1500 g), for which they should additionally be added to breast milk. As an alternative, special mixtures can be used for premature infants that contain 20-24 kcal / oz (2.8-3, ZJ / ml).

In the early days, if the child's condition does not allow enough fluid and calories to be given through the mouth or nasogastric tube, 10% glucose and electrolyte solution is used to prevent dehydration and malnutrition. Continuous ingestion of breast milk or a mixture through a nasogastric or nasoangiogenic probe can satisfactorily support consumption in small preterm infants, especially if there is a respiratory distress syndrome or in repetitive episodes of apnea. Feeding begins in small portions (for example, 1-2 ml every 3-6 hours) to stimulate the gastrointestinal tract. If tolerability is good, the volume and concentration slowly increase within 7-10 days. Very young or infants in critical condition may require completely parenteral nutrition through a peripheral intravenous catheter or central catheter (transcutaneous or surgical method of administration) until there is a good tolerance of enteral feeding.

[20], [21], [22]

How to prevent the birth of a premature baby?

The risk of preterm premature birth can be reduced by making sure that all women, especially those at high risk, have access to early and appropriate prenatal care, including advice on the importance of avoiding alcohol, smoking and illegal drugs.

What is the prognosis of a premature baby?

A premature baby has a different prognosis, which varies depending on the presence and severity of the complications, but usually the survival rate increases significantly with an increase in gestation and birth weight. In children with birth weight between 1250 g and 1500 g, the survival rate is about 95%.