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Teacher G.G. Fomenko Nursing care for premature babies. GB POU NMK PM 02. PARTICIPATION IN TREATMENT, DIAGNOSTIC AND REHABILITATION PROCESSES Nursing care in pediatrics Specialty: 02.34.01 Nursing MDK 02.01 Nursing care for various diseases and conditions
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Plan: Features of the structure and functioning of the newborn’s body at various degrees of prematurity. Stages of nursing. Nursing process when caring for a premature baby (features of feeding, warming and oxygen therapy). Prevention of miscarriage.
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Gestational age of premature babies Premature birth (birth of a premature baby) is a birth that occurs before the end of the full 37 weeks of pregnancy. Pregnancy period (gestational age) is conventionally counted from the first day of the last menstrual cycle.
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Gestational age is the age of the baby from conception to birth. This is the most important indicator of assessing the degree of maturity of a newborn and his ability to adapt to environmental conditions. The degree of maturity of preterm infants depends on gestational age and birth weight.
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Premature baby According to the WHO definition, a premature baby is a child born alive, before the 37th week of intrauterine development, with a body weight of less than 2500 g and a length of less than 45 cm. A newborn with a birth weight of more than 500 g who has made at least one breath.
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According to the order of the Ministry of Health of Russia No. 318 dated December 4, 1992, the following terminology is recommended: all children with body weight<2500 г - это новорожденные с малой массой. Среди них выделяют группы: 2500- 1500 г - дети с низкой массой тела при рождении (НМТ); 1500- 1000 г-с очень низкой массой тела (ОНМТ); 1000 г - с экстремально-низкой массой тела (ЭНМТ).
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Health care institutions must register all children born alive and stillborn, who have a birth weight of 500 g or more, a length of 25 cm or more, with a gestational age of 22 weeks. and more (industry indicators). However, state statistics of live births only take into account children from 28 weeks. gestation or more (body weight 1000 g or more, length 35 cm or more). Of those born alive with a body weight of 500-999 g, only those newborns who lived 168 hours (7 days) are subject to registration with the registry office. In order for domestic statistics to be comparable with international criteria in the field of perinatology, Russia, taking into account WHO recommendations, switched to new criteria (order No. 318 of the Ministry of Health of the Russian Federation).
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When diagnosing a “premature newborn,” the gestational age in weeks at which the birth occurred (gestational age of the newborn) is indicated. Based on the ratio of body weight and gestational age, both full-term and premature infants are divided into three groups: large for gestational age (BGA); appropriate for gestational age (GAA); small for gestational age (SGA).
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Risk factors leading to increased mortality in premature infants: maternal bleeding before birth; multiple pregnancy; breech birth; lack of steroid therapy in the mother (prevention of SDR); perinatal asphyxia; male gender; hypothermia; type I respiratory distress syndrome (RDS, RDS - respiratory distress syndrome, hyaline membrane disease).
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1. Socio-economic factors: occupational hazards (work in hazardous industries, with computers, with salts of heavy metals, chemicals, etc.); level of education of parents (the lower the level of education of the mother and father, the higher the likelihood of prematurity); a woman’s attitude towards pregnancy: in cases of unwanted pregnancy, especially in unmarried women, premature birth of a child is observed 2 times more often; smoking of both mother and father. Typical complications of pregnancy in smokers - placenta previa, premature placental abruption and rupture of the membranes - contribute to miscarriage. Heavy paternal smoking reduces the likelihood of conception and is a risk factor for having a low birth weight child; Alcohol and/or drug use leads to a high incidence of premature births. Causes of miscarriage
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2. Socio-biological factors: age of the mother (primiparas under 17 years old and over 30 years old) and father (under 17 years old); subclinical infection and bacterial carriage; previous abortions; i “deficient” nutrition of a pregnant woman. Causes of miscarriage 3. Clinical factors: extragenital diseases of the mother (especially if they worsen or decompensate during pregnancy); antiphospholipid syndrome in the mother (in 30-40% of cases of recurrent miscarriage - for more details, see Chapter III); chronic diseases of the genitourinary system in the mother; surgical interventions during pregnancy; psychological and physical trauma and other pathological conditions; gestosis lasting more than 4 weeks.
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4. In vitro fertilization. Multiple pregnancy. Causes of miscarriage
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Risk factors for the birth of a premature baby: 1. On the maternal side: age of the pregnant woman (primigravidas under the age of 18 and over 30 years); severe somatic and infectious diseases suffered during pregnancy; genetic predisposition; abnormalities in the development of the reproductive system; burdened obstetric history (frequent previous terminations of pregnancy or surgical intervention, pathology of pregnancy, recurrent miscarriages, stillbirths, etc.); mental and physical trauma; uncontrolled use of medications.
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Risk factors for the birth of a premature baby: 2. From the fetus: chromosomal aberrations; developmental defects; immunological conflict; intrauterine infection.
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Criteria for prematurity Degree of prematurity Gestational age Body weight I 37 - 35 weeks 2500 - 2000 g II 34 - 32 weeks 2000 - 1500 g III 31 - 29 weeks 1500 - 1000 g IV 28 - 22 weeks less than 1000 g
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Signs of prematurity The appearance of a premature baby differs from a full-term baby in its disproportionate physique, significant predominance of the cerebral skull over the facial skull, relatively large body, short neck and legs.
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Signs of prematurity: the skin is red, thin, wrinkled, abundantly covered with fluff (lanugo), the subcutaneous fat layer is not expressed, muscle tone is reduced; the bones of the skull are soft, pliable, mobile, sometimes overlap each other, the sutures are not closed, the large, small and lateral fontanelles are open; the ears are soft, shapeless, pressed closely to the head; the areolas and nipples of the mammary glands are underdeveloped or absent; fingernails and toenails are thin and do not reach the edges of the nail bed; plantar folds are short, shallow, sparse or absent; the stomach is spread out like a frog, the umbilical ring is located in the lower third of the abdomen; in girls, the labia majora do not cover the labia minora, the genital slit gapes, the clitoris is enlarged; in boys, the testicles are not descended into the scrotum and are located in the inguinal canals or in the abdominal cavity.
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From the side of the central nervous system: decrease or absence of sucking, swallowing and other physiological reflexes (Moro, Bauer, Robinson, etc.), uncoordinated movements of the limbs, strabismus, nystagmus (horizontal floating movement of the eyeballs), muscle hypotonia, adynamia, disturbance of processes thermoregulation (due to insignificant energy intake from food, a thin subcutaneous fat layer with a low content of brown adipose tissue, a relatively large body surface compared to mass), lack of ability to maintain normal body temperature, which manifests itself in hypothermia (severe hypothermia - body temperature 35.9 -32°C, in severe cases - below 32°C, hypothermia can cause swelling of the subcutaneous fatty tissue - sclerema). AFO of organs and systems of a premature baby
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From the side of peripheral analyzers: visual and hearing impairment (with severe prematurity). On the part of the respiratory system: uneven breathing in rhythm and depth (pathological breathing), respiratory rate varies from 40 to 90 per minute, tendency to apnea, absent or weak cough reflex. There is no surfactant in the alveoli or its content is insufficient, which causes the development of atelectasis and respiratory disorders. From the cardiovascular system: decreased blood flow speed (bluish discoloration of the feet and hands), “harlequin” syndrome (in the child’s position on its side, the skin of the lower half of the body becomes red-pink, and the upper half becomes white). Blood pressure is low, pulse is labile. AFO of organs and systems of a premature baby
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From the immune system: functional immaturity and a decrease in the number of T-lymphocytes, a decrease in the ability to synthesize immunoglobulins (high risk of infections). From the digestive organs: low activity of the secretory function of digestive enzymes (lipase, amylase, lactase, etc.) and food absorption, small stomach capacity, which does not allow holding the required amount of food at once, increased tendency to regurgitate due to insufficient development of the cardiac sphincter, monotonous the nature of intestinal motility (lack of increase in response to food intake). AFO of organs and systems of a premature baby
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From the liver: immaturity of enzyme systems, which causes a decrease in the synthesis of protein, prothrombin (hemorrhagic syndrome), impaired bilirubin metabolism, accumulation of indirect bilirubin in the blood and brain tissue (bilirubin encephalopathy). On the part of the kidneys: reduced ability to concentrate urine, almost complete reabsorption of sodium and insufficient reabsorption of water, imperfect maintenance of urine output. Daily diuresis by the end of the first week is 60-140 ml, the frequency of urination is 8-15 times a day. AFO of organs and systems of a premature baby
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Stage III. Dynamic observation in a children's clinic. System of nursing a premature baby, stage I. Intensive care in the maternity hospital, stage II. Observation and treatment in a specialized department for premature babies
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OBIECTIVELE lECŢIEI: O1 - Să caracterizeze perioada de nou –născut
O2 – Să definească noţiune de nou-nascut
prematur
O3 – Să numească gradele prematurităţii
O4 – Să enumere factorii de risc
O5 – Să numească semnele nou-născutului
prematur.
O6 – Să enumere criterii de externare
O7 – Să efectueze toaleta matinală, intimate, băiţa
igienică.
linguriţa, cănuţa.
O9 – Să expună tehnica vaccinării BCG, HVB.
O10 – Să efectuieze proba suptului.
DEFINITION
70-75% of child mortality ispremature babies are therefore the main thing
medical task workers is
preventing premature births
children.
According to WHO child
is considered premature if the baby
born alive, with a gestational age of up to 37
weeks (less than 258 days), with weight at
birth less than 2500 grams.
Degrees of prematurity
1st degree (2500-2001; 36-34 weeks)2nd degree (2000-1501; 34-30 weeks)
3 degree (1500-1001; 30-28 weeks)
Grade 4 (less than 1000; less than 28 weeks)
Risk factors for the birth of premature and low birth weight infants.
I. Risk factors (social):1.Low social level
2.Occupational diseases of parents
3. Inadequate nutrition
4. Bad habits of parents
(substance abuse, alcoholism, drug addiction,
smoking)
Risk factors associated with the mother:
Abortion before this pregnancyInfertility before this pregnancy
Arterial hypertension in pregnant women is more
140/90
The mother's body weight before pregnancy is less than 50 kg.
Hormonal dysfunctions
Emotional stress during pregnancy Sexually transmitted diseases during pregnancy
Risk of miscarriage
Infectious diseases in mother
Decompensated cardiopathy
Severe anemia in pregnancy
Bleeding during pregnancy
Age under 18 and over 35 years
Risk factors associated with the fetus:
Abnormal presentationGenetic factors
Chromosomal diseases
Congenital anomalies
Hormonal dysfunctions
Multiple pregnancy
Premature rupture of amniotic sac
shell
Incompatibility of mother and fetus by blood type
ABO and Rhesus.
Factors related to the placenta:
Morphological abnormalities in the structurePlacental hypoplasia
Placenta with calcifications
Uteroplacental insufficiency.
Determination of gestational age:
Mom's menstrual dataUltrasound
Clinical examination
newborn
Anatomical and physiological characteristics of a premature baby.
Body disproportionate, limbs and neckshort
The head is large, 1/3 of the length, bones
the skulls are soft, the sutures are open, the fontanelles are open
lateral.
The face is small, triangular, the mouth is large,
sharp chin
The neck is thin
The chest is narrow The abdomen is larger than the chest
The umbilical cord is thinner and located lower
The skin is red, thin, shiny, swollen, covered
“lanugo” on the back, limbs, forehead, cheeks.
Subcutaneous fat tissue is poorly developed
Thin nails do not cover the nail bed
The auricles are soft, with underdeveloped cartilage
cloth
The external genitalia are underdeveloped
girls do not cover the labia majora
small.
in boys the scrotum is underdeveloped, small,
The testicles are not descended into the scrotum.
Functional characteristics of a premature baby.
Premature is drowsy, hypodynamic,weak cry, decreased muscle tone,
reflexes are weak or absent.
Breathing is irregular, shallow,
abdominal type, with apnea crises.
The respiratory muscles are underdeveloped, therefore
VC in premature babies is very
small. Lower segments weakly
ventilated. Due to lack
surfactant. SSS. BP is very low 45/20 mm. rt. Art. first
10 days, then grows 70/45.
Heart rate is 120-160 per minute, and pulse is 60 per minute,
therefore the extremities are cold and cyanotic
touch
Gastrointestinal tract. Swallowing and sucking reflexes are weak
developed. Saliva secretion is reduced, therefore
the oral mucosa is very dry. Cardiac part
poorly developed, so they often occur
regurgitation.
Liver function is underdeveloped. Glycogen depot
in the liver is reduced, therefore in premature infants
Hypoglycemia occurs quickly. The secretion of prothrombin is also reduced, which
leads to hemorrhagic syndrome in
premature babies.
In premature infants, the system is also imperfect
thermoregulation, which leads to rapid
hypothermia.
Kidney function is also imperfect and reduced
filtration function.
The immune system is underdeveloped, therefore
susceptibility to infections is high.
Infectious diseases are more severe in them
Features of caring for premature babies.
Air temperature 26-28%, humidity60%
Warm clothes
Resuscitation table
Oxygen flow
Warm incubator
Electric heater.
Advantages of incubators:
Provide a clean, warm environment withmonitoring temperature, humidity.
Provides thermal comfort,
strict control of humidity and feed
oxygen.
Incubators are used to care for
premature and with a small birth weight
birth while maintaining optimal
temperature.
The required temperature is set
for age and weight. Vaccination.
Premature babies are vaccinated only when
when their weight reaches 2500 grams.
Conditions for discharge of a premature baby:
The child breathes well and without other pathologies
Body temperature 36.5-37.5
Baby sucks well at the breast
Gaining weight well (at least 15 mg/kg per
day)
The mother is able to care for the child.
Nutrition of premature babies.
If the child's weight is between 1.75-2.5 kg.The child is allowed to breastfeed if he is not
can breastfeed, use expressed milk.
If the child's weight is from 1.5-1.749 kg. feed
expressed milk using a mug and spoon.
If the child weighs from 1.2-1.49 kg. feeding the baby
expressed milk using a nasogastric tube
probe.
Nursing is carried out in 2 stages:
- the first - in the maternity hospital;
- the second - in a specialized department for premature babies. Then the child comes under the supervision of the clinic.
The first stage of nursing
Ensuring optimal temperature conditions:
the air temperature in the department should be 25°C;
immediately after birth, suction of mucus from the upper respiratory tract and primary treatment of the umbilical cord are carried out on a warm tray with warm diapers;
children weighing less than 1500g are placed in a closed incubator (temperature 30-34°C, humidity 90%, oxygen supply). Children are in an incubator from 2-7 to 14 days.;
The body temperature of premature infants can also be maintained in a heated crib.
Drug therapy
It is carried out for the prevention of pathological conditions and for children with a high risk of disease (extremely premature, with intrauterine hypoxia and asphyxia during childbirth)
- for the prevention of hemorrhagic syndrome: 1% Vicasol for 3 days;
- for the prevention of kernicterus: phototherapy, intravenous administration of albumin, choleretic drugs;
- at 3.4 tbsp. prematurity - correction of PCP: 4% solution of sodium bicarbonate with 10% glucose, ascorbic acid, KKB;
- to eliminate hypoglycemia, hypoproteinemia, hypocalcemia – 10% glucose solution, albumin, calcium preparations.
On days 7-8, premature babies are transferred to a specialized department, where they are nursed and treated until complete recovery and achievement of body weight.
Second stage of nursing
1. Temperature maintenance: in in box wards the temperature d.b. 22-24°C, humidity 60%, airing the rooms 6 times a day.
2. Depending on body weight, the temperature regime is set and maintained using an incubator, heated beds, and heating pads.
3. If necessary, continue drug therapy started on
first stage.
Features of feeding premature babies
- the choice of feeding method depends on the severity of the child’s condition, body weight at birth, and gestational age;
- early start of nutrition, regardless of the method (during the first 2-3 hours after birth and no later than 6-8 hours);
- children with a body weight of more than 2000 g with an Apgar score of 7 points or more - are put to the breast on the first day, feeding frequency 7-8 times. If you get tired easily, supplement with expressed breast milk from a bottle.
Children weighing 1500-2000 g are given a trial bottle feeding. In case of unsatisfactory sucking activity - tube feeding in full or partial volume;
- children weighing less than 1500 g are fed through a tube using the method of long-term infusion of native breast milk.
Nutrient and energy requirements
In the 1st month of life 120-140 kcal/kg/day.
2-3 months life – reduction in calorie content to 115 kcal/kg/day. B – 3.8-3.0 g/kg/day.
F – 6.0-6.5 g/kg/day. U – 10-14 g/kg/day.
In order to ensure the high nutritional needs of premature infants in the diet of breastfed children, specialized milk formulas for premature and low birth weight infants based on highly hydrolyzed proteins (Alfare, Nutrilak Peptidi MCT, etc.) are introduced in a volume of up to 20- thirty%.
If the mother does not have milk, children receive full amounts of formula for
feeding premature babies.
Complementary feeding for premature babies is introduced from 4-5 months: fruit purees, vegetable purees or porridge. Meat puree from 5.5 months.
Juices – after 5-6 months.
Premature children represent a special group of patients who are characterized by signs of physiological immaturity. Due to premature birth, the child is born insufficiently mature and has problems associated with adaptation to the conditions of extrauterine life.
Certain difficulties in feeding premature babies are caused by the following features of the immature body: decreased or absent sucking and swallowing reflexes; small volume of the stomach and slow evacuation of its contents; decreased intestinal motility
There are several approximate formulas for calculating the volume of nutrition for premature babies of 1-3 degrees: Volumetric method up to the 10th day - 3 x m x n per feeding or 1/7 of the mass per day. On the first day - 1/6 of the mass per day from the end of the first month and in the second - 1/5 of the mass per day.. Formula G.I. Zaitseva - 2% x m x n (ml per day).. Rommel's formula - from the 3rd to the 10th day: n x (m/100) + 10 (ml per day).. Energy method: (n x) kcal/ kg per day, max kcal/kg by the 14th day.
On average, the amount of milk per feeding is: - 1st day of life - 5-10 ml, - 2nd day of life - ml, - 3rd day of life - ml. “calorie” method, which involves the following calculation of nutrition depending on the age of the child: 1st day 30 kcal/kg; 2nd day 40 kcal/kg; 3rd day 50 kcal/kg; 4th day 60 kcal/kg; 5th day 80 kcal/kg; 6th day 80 kcal/kg; 7th day 90 kcal/kg; days 10–14 100–120 kcal/kg; Day 30 130 kcal/kg (artificial), 140 kcal/kg (breast) milk
Nasogastric tube feeding Infants born before one week of gestation are typically tube fed to avoid the risk of aspiration resulting from a lack of coordination between sucking and swallowing. Feeding through a tube can be intermittent - bolus or continuous - drip, and it can be carried out at a given speed using an infusion pump.
Feeding from a spoon or from a pipette If there is a swallowing reflex and a weak sucking reflex, the child should be fed slowly from a spoon and try to feed from a nipple. The first feeding of a premature baby should be carried out 610 hours after birth, depending on its general condition. The prepared dose of milk is introduced slowly into the child’s mouth with a spoon, and the spoon is only partially filled each time. The sister makes sure that the milk pours over the top of the tongue and is swallowed, and does not accumulate under the tongue.
Bottle feeding Infants with a body weight of g, whose condition after birth corresponds to moderate severity, are given a trial feeding from a bottle.
Attachment to the breast Children with a body weight of more than 2000 g with an Apgar score of 7 points or higher can be attached to the mother's breast in the first day of life. For premature babies, free feeding is unacceptable. When breastfeeding, it is necessary to closely monitor the appearance of signs of fatigue, cyanosis, shortness of breath, etc.
The presentation presents the definition of prematurity, causes, characteristics according to the degree of prematurity, stages of nursing, features of feeding, physical and neuropsychic development of a premature baby. The material can be used in theoretical and practical classes.
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Anatomical and physiological characteristics of a premature baby and organization of care for him. Prepared by: Pediatrics teacher Olga Borisovna Veselova
The problem of prematurity is one of the most pressing in modern pediatrics. Over the past decade, the prevention of prematurity and the organization of nursing of premature babies have become more advanced. In specialized departments, high-tech diagnostic and treatment methods are used. Nurses play a significant role in caring for premature babies. Therefore, when studying this topic, we will devote a special role to the formation of professional competencies and the cultivation of a caring, kind attitude towards children.
OK 1; OK 2; OK 6; OK 7; OK 11; OK 12 PC 2.2; PC 2.3; PC 2.4; PC 2.5; PC 2.6; PC 2.7 Veselova Olga Borisovna
Premature babies - children born between 28 and 37 weeks of intrauterine development and having a body weight below 2500 g, a length of 45 cm or less Olga Borisovna Veselova
Children are registered in the registry office departments: Children born alive and stillborn from the 28th week of gestation, weighing 1000 g or more and body length 35 cm or more. Also, children from twins weighing less than 1000 g. Of those born alive with a body weight of 500-999 g, newborns who survived 7 days after birth are subject to registration.
The percentage of births of premature babies in different regions of Russia fluctuates, on average 5-14%. 1 . Socio-economic: Lack of or insufficient medical care; Poor nutrition (lack of minerals and vitamins), even several months before the expected birth; Presence of bad habits (smoking, drug addiction, alcohol); Severe stress over several weeks, or lack of desire for the child; Harmful or dangerous workplace (dust, radiation, monotonous work, heavy lifting, irregular working hours or weeks). Working seven days a week for several weeks in a row; Insufficient education of parents. Veselova Olga Borisovna
2. Socio-biological: The age of a pregnant woman (before 18 or after 35) can cause the child to be premature; The father's age (before 18 or after 45) can cause the child to be premature; Complicated obstetric and gynecological history (termination of pregnancy, miscarriage, criminal abortion several months before, IVF); Genetic predisposition or diseases of parents; Marriage between relatives. Veselova Olga Borisovna
3. Various diseases: The presence of chronic diseases of the mother, which could worsen during pregnancy; Past acute infectious diseases, possible complications after ARVI, influenza, severe colds, rubella, chicken pox, and so on; On the part of the fetus, there may also be various anomalies in the development of the cardiovascular system, internal organs, and its position; hormonal dysfunctions, premature rupture of water, chromosomal defects; The presence and development of intrauterine infections: chlamydia, mycoplasma, ureplasma, cytomegalovirus. Or other, undetected or untreated sexually transmitted diseases; Insufficient maternal weight (less than 48 kg); Complications after vaccination; A premature baby may be born due to constant stress. Veselova Olga Borisovna
Veselova Olga Borisovna
Prematures of the 1st and 2nd degrees have pink skin, no fuzz on the face (at birth at 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. Veselova Olga Borisovna
A very premature baby of the III-IV degree (body weight less than 1500 g) has 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; limbs are short. The sutures of the skull and fontanels (large and small) are open. The bones of the skull are thin. In girls, the genital slit gapes as a result of underdevelopment of the labia majora, the clitoris protrudes; In boys, the testicles are not descended into the scrotum. Veselova Olga Borisovna
Premature infants are characterized by: muscle hypotonia, decreased physiological reflexes, motor activity, impaired thermoregulation, weak cry; sucking, swallowing and other reflexes are absent or weakly expressed. in the first 2-3 weeks of life there may be intermittent tremor, mild and unstable strabismus, horizontal nystagmus when changing body position. Veselova Olga Borisovna
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. 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 60-70 mm Hg. Increased permeability of vascular walls can lead to impaired cerebral circulation and cerebral hemorrhage. 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. Veselova Olga Borisovna
Features of physical development. The physical development of premature infants is characterized by higher rates of increase in body weight and length during the first year of life. The smaller the weight and body length of a premature infant at birth, the more intensely these indicators increase throughout the year. By the end of the first year of life, body weight increases as follows: with IV degree prematurity by 8-10 times, III degree - by 6-7 times, II degree - by 5-7 times, I degree - by 4-5 times. Body weight increases unevenly. The first month of life is the most difficult period of adaptation. Initial body weight decreases by 8-12%; recovery is slow. The body length of a premature baby by the end of the first year of life is 65-75 cm, i.e. increases by 30-35 cm, while the body length of a full-term child increases by 25 cm. Despite the high rates of development, in the first 2-3 years of life, premature children lag behind their peers born full-term. Leveling occurs after the third year of life, often at 5-6 years. Veselova Olga Borisovna
Veselova Olga Borisovna
In psychomotor development, healthy premature infants are compared with their full-term peers much earlier than in physical development. Children with degree II-III prematurity begin to fix their gaze, hold their head up, roll over, stand up and walk independently, and pronounce their first words at 1-3 months. later than full term. Premature children “catch up” with their full-term peers in terms of psychomotor development in the second year of life; with stage I prematurity - by the end of the first year. Veselova Olga Borisovna
Nursing of premature babies is carried out in three stages: in the maternity hospital; specialized department; then the child comes under the supervision of the clinic. Veselova Olga Borisovna
After birth, the premature baby should be placed in sterile, warm diapers (“optimal comfort”). Veselova Olga Borisovna
In the first days of life, very premature babies or premature babies in serious condition are kept in incubators. They maintain a constant temperature (from 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%). Veselova Olga Borisovna
The child’s body temperature can be maintained in a heated crib or in a regular crib using heating pads, since the longer the stay in the incubator, the greater the likelihood of the child becoming infected. The optimal indoor air temperature is -25 C. Veselova Olga Borisovna
It is necessary to support the child’s adaptive reactions by dropping native mother’s milk into the mouth from a pipette, heated diapers, a long stay on the mother’s chest (like a “kangaroo”), the calm voice of a nurse, and stroking movements of her hands. Veselova Olga Borisovna
FEATURES OF FEEDING PREMATURES Features of feeding premature infants are due to their increased need for nutrients due to intensive physical development, as well as the functional and morphological immaturity of the gastrointestinal tract, and therefore food should be administered carefully. Veselova Olga Borisovna
For children with a weak sucking reflex, breast milk is administered through a gastric tube. Veselova Olga Borisovna
If the general condition is satisfactory, the sucking reflex is quite pronounced and the body weight at birth is more than 1800 g, breastfeeding can be done after 3-4 days. In the absence of milk from the mother, specialized formulas for premature infants are prescribed Olga Borisovna Veselova
In the absence of milk from the mother, specialized formulas for premature infants are prescribed Olga Borisovna Veselova
LONG-TERM CONSEQUENCES OF PREMATURE Severe psychoneurological disorders in the form of cerebral palsy, decreased intelligence, hearing and vision impairment, and epileptic seizures occur in 13-27% of premature infants. In premature infants, developmental defects are 10-12 times more likely to be detected. They are characterized by disproportionate development of the skeleton, mainly with deviations towards asthenia. Many of them subsequently have an increased risk of “school maladjustment.” Attention deficit hyperactivity disorder is more common among those born prematurely. Women born very prematurely often subsequently experience menstrual irregularities, signs of sexual infantilism, the threat of miscarriage and premature birth. Veselova Olga Borisovna
PREVENTION OF PREMATURE BIRTH OF CHILDREN Prevention of premature birth of children includes: protecting the health of the expectant mother; 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 risk groups and active monitoring of the course of pregnancy in these women. Veselova Olga Borisovna
Thank you for your attention! Veselova Olga Borisovna