The author - Sozinova AV practicing obstetrician-gynecologist. Experience in the specialty since 2001.
Baby prematurity considered to closure gestational period, i.e. in a period of 22 to 37 weeks, weighing less than 2500g., A length of less than 45cm.
Premature babies are marked thermoregulation disorders, respiratory prone to apnea (cessation of breathing movements), poor immunity and explicit anthropometric and clinical signs.
degrees
Classification of premature children in powers associated with the child's weight (gestational age conditions):
1 degree - mass 2001-2500gr body. (Corresponds to a period of 35-37 weeks);
2 degree - mass 1501-2000gr body. (The period corresponding to 32-34 weeks);
3 degree - 110-1500gr. (Gestational age 29-31 weeks);
4 degree - the child weighing less than 1000g, which corresponds to less than 29 gestation weeks (extreme preterm)..
The causes of premature births
The causes of preterm labor are many and are presented on three sides:
Maternal factors:
- chronic diseases of women (pathology of the cardiovascular system, endocrine diseases, kidney disease):
- acute infections during pregnancy;
- gynecological disorders;
- burdened obstetrical history (abortion, cesarean section);
- intrauterine device;
- trauma;
- cervical incompetence;
- age (younger than 17 and older than 30);
- Rh-conflict pregnancy;
- bad habits;
- placental pathology (presentation, Detachment);
- harmful working conditions;
- complications of pregnancy (preeclampsia).
Paternal factors:
- age (over 50 years);
- chronic diseases.
Fruit factors:
- fetal malformations;
- multiple pregnancy;
- erythroblastosis (hemolytic disease);
- intrauterine infection.
evidence
Premature babies have a strong clinical picture. Marked disproportion of body parts, brain skull predominates over the facial. The bones of the skull soft fontanelle is observed in addition to cleft cranial sutures. soft ears are also characteristic.
Premature babies poorly developed subcutaneous layer, they can not "hold" temperature (thermoregulation instability). Maldevelopment light due to the absence of prematurity surfanktanta which provides Disclosure of pulmonary alveolar breath that appears disordered breathing and occasional apnea (stop breathing).
Wrinkled skin, have a bright red color in the first day, there is a weak muscle tone or no.
Physiological reflexes (sucking, search, etc.) are poorly expressed.
Preterm boys' testicles are not lowered into the scrotum, and the girls are underdeveloped labia. Characteristic of premature babies and hypertensive hydrocephalic syndromes.
Due to underdevelopment century expressed exophthalmia (exophthalmos).
It notes the lack of function of the liver, which is manifested kernicterus. Because of an underdeveloped immune system in premature infants at high risk of infection. Premature babies are prone to regurgitation. In addition, these children are underdeveloped nail plate and may reach only the middle toe.
Therapy in preterm infants
Management and treatment of premature infants has been doctor-neonatologist.
Babies born before term, a certain living conditions. The ambient temperature should be 25 ° C, and the humidity is not less than 55-60%. To this end, premature babies are kept in incubator (special incubators).
The incubator are infants with a weight less than 2000gr. Extract of healthy preterm infants carried out for 8-10 hours, subject to the achievement of their weight 2kg body.
If a premature baby for 14 days did not reach the weight 2000gr., He was transferred to the second stage of nursing (conducted in the intensive care unit children's department / hospital). Such children are placed in the incubator where oxygen is supplied.
Bathe premature babies begin with a 2-week age (provided healing umbilical residue). Walk with the children in the performance of 3-4 weeks and weighing 1700-1800gr.
Extract of healthy preterm infants carried out at a maximum weight of 1700gr.
Feeding
baby feeding expressed breast milk begin in 2-6 hours after birth in the absence of contraindications and large gestational age (34-37 weeks).
Children who are in serious condition, or very preterm appointed parenteral nutrition through a tube (through the mouth or nose) during the first 24-48 hours of life.
To begin to put the chest baby weight 1800-2000gr. if an active sucking. On day 1 the amount of feeding of 5-10 ml at 2 day 10-15 ml, and in the 3rd - 15-20 ml.
In addition, premature babies shows the introduction of vitamins:
- menadione (vitamin K) to prevent intracranial hemorrhage;
- ascorbic acid (vitamin C), vitamin B1, B2;
- Vitamin E (tocopherol);
- prevention of rickets (vitamin E);
- Vitamins B6 and B5, lipoic acid under deep prematurity;
The consequences of prematurity and development forecast
The prognosis for life in preterm infants depend on many factors. First of gestational age and birth weight. In the case of the child's birth at term 22-23 weeks prognosis depends on the intensity and quality of care. The risk of death is increased in the following cases:
- antepartum haemorrhage;
- breech delivery;
- multiple pregnancy;
- birth asphyxia;
- low temperature of the child;
- respiratory distress syndrome.
Long-term effects of prematurity (the likelihood of these complications, again depends on many factors; under other favorable conditions these complications are quite rare):
- lag in mental and physical development;
- cerebral palsy;
- convulsive and hydrocephalic syndromes;
- myopia, astigmatism, glaucoma, retinal detachment;
- tendency to frequent infections;
- hearing loss;
- menstrual disorders, genital infantilism and problems conceiving girls.
