1 month premature

Premature birth - Symptoms and causes

Overview

A premature birth is a birth that takes place more than three weeks before the baby's estimated due date. In other words, a premature birth is one that occurs before the start of the 37th week of pregnancy.

Premature babies, especially those born very early, often have complicated medical problems. Typically, complications of prematurity vary. But the earlier your baby is born, the higher the risk of complications.

Depending on how early a baby is born, he or she may be:

Late preterm, born between 34 and 36 completed weeks of pregnancy
Moderately preterm, born between 32 and 34 weeks of pregnancy
Very preterm, born at less than 32 weeks of pregnancy
Extremely preterm, born at or before 25 weeks of pregnancy

Most premature births occur in the late preterm stage.

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Symptoms

Your baby may have very mild symptoms of premature birth, or may have more-obvious complications.

Some signs of prematurity include the following:

Small size, with a disproportionately large head
Sharper looking, less rounded features than a full-term baby's features, due to a lack of fat stores
Fine hair (lanugo) covering much of the body
Low body temperature, especially immediately after birth in the delivery room, due to a lack of stored body fat
Labored breathing or respiratory distress
Lack of reflexes for sucking and swallowing, leading to feeding difficulties

The following tables show the median birth weight, length and head circumference of premature babies at different gestational ages for each sex.

Weight, length and head circumference by gestational age for boys
Gestational age	Weight	Length	Head circumference
40 weeks	7 lbs. , 15 oz. (3.6 kg)	20 in. (51 cm)	13.8 in. (35 cm)
35 weeks	5 lbs., 8 oz. (2.5 kg)	18.1 in. (46 cm)	12.6 in. (32 cm)
32 weeks	3 lbs., 15.5 oz. (1.8 kg)	16.5 in. (42 cm)	11.6 in. (29.5 cm)
28 weeks	2 lbs., 6.8 oz. (1.1 kg)	14.4 in. (36.5 cm)	10.2 in. (26 cm)
24 weeks	1 lb., 6.9 oz. (0.65 kg)	12.2 in. (31 cm)	8.7 in. (22 cm)

Weight, length and head circumference by gestational age for girls
Gestational age	Weight	Length	Head circumference
40 weeks	7 lbs. , 7.9 oz. (3.4 kg)	20 in. (51 cm)	13.8 in. (35 cm)
35 weeks	5 lbs., 4.7 oz. (2.4 kg)	17.7 in. (45 cm)	12.4 in. (31.5 cm)
32 weeks	3 lbs., 12 oz. (1.7 kg)	16.5 in. (42 cm)	11.4 in. (29 cm)
28 weeks	2 lbs., 3.3 oz. (1.0 kg)	14.1 in. (36 cm)	9.8 in. (25 cm)
24 weeks	1 lb., 5.2 oz. (0.60 kg)	12.6 in. (32 cm)	8.3 in. (21 cm)

Special care

If you deliver a preterm baby, your baby will likely need a longer hospital stay in a special nursery unit at the hospital. Depending on how much care your baby requires, he or she may be admitted to an intermediate care nursery or the neonatal intensive care unit (NICU). Doctors and a specialized team with training in taking care of preterm babies will be available to help care for your baby. Don't hesitate to ask questions.

Your baby may need extra help feeding, and adapting immediately after delivery. Your health care team can help you understand what is needed and what your baby's care plan will be.

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Risk factors

Often, the specific cause of premature birth isn't clear. However, there are known risk factors of premature delivery, including:

Having a previous premature birth
Pregnancy with twins, triplets or other multiples
An interval of less than six months between pregnancies
Conceiving through in vitro fertilization
Problems with the uterus, cervix or placenta
Smoking cigarettes or using illicit drugs
Some infections, particularly of the amniotic fluid and lower genital tract
Some chronic conditions, such as high blood pressure and diabetes
Being underweight or overweight before pregnancy
Stressful life events, such as the death of a loved one or domestic violence
Multiple miscarriages or abortions
Physical injury or trauma

For unknown reasons, black women are more likely to experience premature birth than are women of other races. But premature birth can happen to anyone. In fact, many women who have a premature birth have no known risk factors.

Complications

While not all premature babies experience complications, being born too early can cause short-term and long-term health problems. Generally, the earlier a baby is born, the higher the risk of complications. Birth weight plays an important role, too.

Some problems may be apparent at birth, while others may not develop until later.

Short-term complications

In the first weeks, the complications of premature birth may include:

Breathing problems. A premature baby may have trouble breathing due to an immature respiratory system. If the baby's lungs lack surfactant — a substance that allows the lungs to expand — he or she may develop respiratory distress syndrome because the lungs can't expand and contract normally.

Premature babies may also develop a lung disorder known as bronchopulmonary dysplasia. In addition, some preterm babies may experience prolonged pauses in their breathing, known as apnea.
Heart problems. The most common heart problems premature babies experience are patent ductus arteriosus (PDA) and low blood pressure (hypotension). PDA is a persistent opening between the aorta and pulmonary artery. While this heart defect often closes on its own, left untreated it can lead to a heart murmur, heart failure as well as other complications. Low blood pressure may require adjustments in intravenous fluids, medicines and sometimes blood transfusions.
Brain problems. The earlier a baby is born, the greater the risk of bleeding in the brain, known as an intraventricular hemorrhage. Most hemorrhages are mild and resolve with little short-term impact. But some babies may have larger brain bleeding that causes permanent brain injury.
Temperature control problems. Premature babies can lose body heat rapidly. They don't have the stored body fat of a full-term infant, and they can't generate enough heat to counteract what's lost through the surface of their bodies. If body temperature dips too low, an abnormally low core body temperature (hypothermia) can result.

Hypothermia in a premature baby can lead to breathing problems and low blood sugar levels. In addition, a premature infant may use up all of the energy gained from feedings just to stay warm. That's why smaller premature infants require additional heat from a warmer or an incubator until they're larger and able to maintain body temperature without assistance.
Gastrointestinal problems. Premature infants are more likely to have immature gastrointestinal systems, resulting in complications such as necrotizing enterocolitis (NEC). This potentially serious condition, in which the cells lining the bowel wall are injured, can occur in premature babies after they start feeding. Premature babies who receive only breast milk have a much lower risk of developing NEC.
Blood problems. Premature babies are at risk of blood problems such as anemia and newborn jaundice. Anemia is a common condition in which the body doesn't have enough red blood cells. While all newborns experience a slow drop in red blood cell count during the first months of life, the decrease may be greater in premature babies.

Newborn jaundice is a yellow discoloration in a baby's skin and eyes that occurs because the baby's blood contains excess bilirubin, a yellow-colored substance, from the liver or red blood cells. While there are many causes of jaundice, it is more common in preterm babies.
Metabolism problems. Premature babies often have problems with their metabolism. Some premature babies may develop an abnormally low level of blood sugar (hypoglycemia). This can happen because premature infants typically have smaller stores of stored glucose than do full-term babies. Premature babies also have more difficulty converting their stored glucose into more-usable, active forms of glucose.
Immune system problems. An underdeveloped immune system, common in premature babies, can lead to a higher risk of infection. Infection in a premature baby can quickly spread to the bloodstream, causing sepsis, an infection that spreads to the bloodstream.

Long-term complications

In the long term, premature birth may lead to the following complications:

Cerebral palsy. Cerebral palsy is a disorder of movement, muscle tone or posture that can be caused by infection, inadequate blood flow or injury to a newborn's developing brain either early during pregnancy or while the baby is still young and immature.
Impaired learning. Premature babies are more likely to lag behind their full-term counterparts on various developmental milestones. Upon school age, a child who was born prematurely might be more likely to have learning disabilities.
Vision problems. Premature infants may develop retinopathy of prematurity, a disease that occurs when blood vessels swell and overgrow in the light-sensitive layer of nerves at the back of the eye (retina). Sometimes the abnormal retinal vessels gradually scar the retina, pulling it out of position. When the retina is pulled away from the back of the eye, it's called retinal detachment, a condition that, if undetected, can impair vision and cause blindness.
Hearing problems. Premature babies are at increased risk of some degree of hearing loss. All babies will have their hearing checked before going home.
Dental problems. Premature infants who have been critically ill are at increased risk of developing dental problems, such as delayed tooth eruption, tooth discoloration and improperly aligned teeth.
Behavioral and psychological problems. Children who experienced premature birth may be more likely than full-term infants to have certain behavioral or psychological problems, as well as developmental delays.
Chronic health issues. Premature babies are more likely to have chronic health issues — some of which may require hospital care — than are full-term infants. Infections, asthma and feeding problems are more likely to develop or persist. Premature infants are also at increased risk of sudden infant death syndrome (SIDS).

Prevention

Although the exact cause of preterm birth is often unknown, there are some things that can be done to help women — especially those who have an increased risk — to reduce their risk of preterm birth, including:

Progesterone supplements. Women who have a history of preterm birth, a short cervix or both factors may be able to reduce the risk of preterm birth with progesterone supplementation.
Cervical cerclage. This is a surgical procedure performed during pregnancy in women with a short cervix, or a history of cervical shortening that resulted in a preterm birth.

During this procedure, the cervix is stitched closed with strong sutures that may provide extra support to the uterus. The sutures are removed when it's time to deliver the baby. Ask your doctor if you need to avoid vigorous activity during the remainder of your pregnancy.

By Mayo Clinic Staff

Associated Procedures

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Premature babies | March of Dimes

Premature babies may have more health problems than babies born later. These include problems with their brain, lungs, heart, eyes and other organs.

Some premature babies have to spend time in a hospital’s newborn intensive care unit (also called NICU) to get special medical care.

Premature birth can lead to long-term challenges for some babies, including intellectual and developmental disabilities.

After they leave the hospital, premature babies get regular checkups to monitor their health and development.

If you’re worried about your baby’s health or development at any time, tell your baby’s provider right away.

What is a premature baby?

A premature baby is one who is born too early, before 37 weeks of pregnancy. Each year, about 1 in 10 babies in the United States is born prematurely. Premature babies may not be fully developed at birth. They may have more health problems and may need to stay in the hospital longer than babies born later. Thanks to advances in medical care, even babies born very prematurely are more likely to survive today than ever before.

Your baby’s health care provider may use these terms to describe your baby’s birth:

Late preterm: Your baby is born between 34 and 36 completed weeks of pregnancy.
Moderately preterm: Your baby is born between 32 and 34 weeks of pregnancy.
Very preterm: Your baby is born at less than 32 weeks of pregnancy.
Extremely preterm: Your baby is born at or before 25 weeks of pregnancy.

Some health problems related to premature birth can last a lifetime. Other problems, like intellectual or developmental disabilities, can show up as your baby grows and later in childhood. These are problems with how the brain works that can cause a person to have trouble or delays in physical development, learning, communicating, taking care of himself or getting along with others.

The earlier in pregnancy a baby is born, the more likely he is to have health problems. Babies born before 34 weeks of pregnancy are mostly likely to have health problems, but babies born between 34 and 37 weeks of pregnancy are also at increased risk of having health problems related to premature birth. Some premature babies need to spend time in a hospital’s newborn intensive care unit (also called NICU). This is the nursery in a hospital where sick newborns get medical care. Premature babies stay in the NICU until their organs develop enough to stay alive without medical support. Some babies need NICU care for weeks or months until they can breathe on their own, eat by mouth and maintain their body temperature and body weight.

Do premature babies need special medical care?

Talk to your baby’s health care providers about any health conditions your baby has. He may be healthy enough to go home soon after birth, or he may need to stay in the NICU for special care. Your baby can probably go home from the hospital when he:

Weighs at least 4 pounds
Can keep warm on his own, without the help of an incubator. An incubator is a clear plastic bed that helps keep your baby warm.
Can breastfeed or bottle-feed
Gains weight steadily
Can breathe on his own

Your baby may need special medical equipment, medicine or other treatment after he leaves the hospital. Your baby’s provider and the staff at the hospital can help you with these things and teach you how to take care of your baby at home. They may recommend that you bring your baby to a neonatologist for checkups after your baby leaves the hospital. A neonatologist is a doctor who specializes in caring for premature babies and children. Talk to your baby’s provider if you have any questions about your baby’s health or long-term effects of premature birth. Hospital staff also can help you find parent support groups and other resources in your area that may be able to help you care for your baby.

What kinds of health problems can premature babies have?

Health problems that may affect premature babies include:

Anemia. This is when a baby doesn’t have enough healthy red blood cells to carry oxygen to the rest of the body. Anemia can cause low levels of oxygen and glucose (sugar) in a baby’s blood and make it hard for a baby’s organs to work properly. Premature babies in the NICU may have anemia because they get regular blood tests to check their health. They often can’t make new blood cells quickly enough to replace the blood cells they lose during blood tests. This can lead to anemia.

Breathing problems. These include:

Apnea of prematurity (also called AOP). This is a pause in breathing for 15 to 20 seconds or more. It may happen together with a slow heart rate called bradycardia.
Bronchopulmonary dysplasia (also called BPD). This is a lung disease that can develop in premature babies as well as babies who have treatment with a breathing machine. Babies with BPD have a higher risk of lung infections than other babies and BPD sometimes leads to lung damage.
Respiratory distress syndrome (also called RDS). If a baby has RDS, her lungs can’t make enough of a substance called surfactant. Surfactant is a slippery substance that keeps small air sacs in a baby's lungs from collapsing.

Infections or neonatal sepsis. Premature babies can get infections more easily than other babies because their immune systems aren’t fully developed. The immune system protects your body from infection. Infection in premature babies can lead to sepsis, when the body has an extreme response to infection. Sepsis can be life-threatening.

Intraventricular hemorrhage (also called IVH). This is bleeding in the fluid-filled spaces (also called ventricles) in the brain. The more premature a baby is, the more likely he is to have IVH.

Newborn jaundice. This is when your baby’s skin and the white parts of his eye look yellow. It’s caused by the build-up of a substance called bilirubin in your baby’s blood. Jaundice happens when a baby’s liver isn't fully developed or isn't working well.

Necrotizing enterocolitis (also called NEC). This is a common, but very serious problem that can affect a newborn baby’s intestines. Intestines are long tubes that are part of your digestive system. Your baby’s digestive system helps his body break down food, take in nutrients and remove waste. NEC happens when the tissue of the intestine is injured (damaged) or begins to die.

Patent ductus arteriosus (also called PDA). This is a heart condition that happens when a blood vessel called the ductus arteriosus doesn’t close properly. The ductus arteriosus helps blood go around a baby’s lungs before birth. Once a baby’s born and her lungs fill with air, the ductus arteriosis isn’t needed anymore and usually closes on its own a few days after birth. If it doesn’t close properly, too much blood may flow into the lungs. This can cause heart and breathing problems.

Retinopathy of prematurity (also called ROP). This is an eye disease that happens when a baby’s retina’s don’t fully develop in the weeks after birth. The retina is the nerve tissue that lines the back of the eye. ROP usually affects both eyes. Most babies with ROP have a mild case and don’t need treatment. But babies with severe ROP can have vision problems or blindness.

Last reviewed: October, 2019

If menses started early.

Possible causes

Every woman's cycle is different. The cycle is counted from the first day of menstrual bleeding and ends on the first day of the next menstruation. The typical cycle of an adult woman lasts 21-39 days, with an average of 28 days. The duration of menstruation for different women is also different, on average it is 2-7 days.

The duration of the cycle can vary throughout life and even from month to month, so most likely the early onset of menstruation is not a reason for excitement and panic. nine0003

Sometimes the menstrual cycle may last a couple of days longer or less than usual, start earlier or later, or be more or less heavy. It also happens that you can have two periods in a month. In women with a short cycle, the cycle may coincide with the calendar month so that menstruation will come at the beginning and at the end, and this is completely normal. Please remember that the calendar length of the month does not affect the length of the cycle.

If a short cycle is uncharacteristic for you, the first thing you need to understand is menstruation or intermenstrual bleeding. nine0003

How to distinguish between menstruation and intermenstrual bleeding?

If you have periods, they are heavy enough to soak a pad or tampon in a couple of hours. The blood is usually dark red, scarlet, brown or pink.

If you have intermenstrual bleeding, the amount of blood produced will be small: it will not be enough to soak a pad or tampon. Usually such blood is dark red or brown. nine0003

What can cause early periods?

They may not have started early

The normal cycle can be any number of days from 21 to 45, averages 28 days and does not depend on calendar dates. Usually menstruation occurs 2 weeks after ovulation and most often early menstruation is due to the fact that ovulation occurred earlier than usual. Our body is not a clock, and failures lasting up to a week are most often not caused by pathological processes. nine0003

Puberty (puberty)

Puberty usually begins in girls between the ages of 8 and 12 years and is affected by changes in the levels of reproductive hormones.

In the early years, levels of these hormones can vary greatly from cycle to cycle, which can cause inconsistent cycle length. This means that the number of days elapsed between one cycle and the next can be different.

Premenopausal

Premenopause - the period when the body prepares for the last menstruation and the further cessation of the cycle. Most often, premenopause begins around the age of 45 and lasts about 4 years.

Premenopause can also cause: insomnia, delayed menses, vaginal dryness, more or less menstrual periods than usual, irritability, hot flashes (waves of heat).

Lifestyle changes and stress

nine0002 Any change in lifestyle can cause cycle changes. Factors such as long-distance travel, frequency and level of physical activity, and night shift work can influence.

Acute stress can upset your body's hormonal balance and cause menstrual irregularities. Stress can also cause unexpected weight loss or gain, insomnia, and difficulty concentrating.

Significant weight changes and strenuous exercise

nine0002 The functioning of the reproductive system is strongly influenced by factors such as nutrition, metabolism and energy availability.

When there is a shortage of incoming calories, the body enters starvation mode and distributes energy differently, providing primarily such vital functions as breathing and heartbeat and stops producing reproductive hormones.

Oral contraceptives and other types of hormonal contraception

Oral contraceptives (OCs) are hormonal preparations used for contraception that suppress ovulation. nine0003

If you started taking OC, the start of your next period will depend on which cycle day you started the pack.

Emergency methods of contraception

Emergency hormonal contraception—hormonal drugs taken by women after unprotected penetrative sex with a man to reduce the risk of pregnancy. Emergency contraceptive pills contain hormones that interfere with the natural process of ovulation, which can lead to early or late periods. As the name suggests, these pills should only be taken in an emergency and should NOT be taken all the time. nine0003

Blood-thinning drugs (anticoagulants)

During menstruation, the body secretes anticoagulants to facilitate the flow of blood during menstruation and thin the uterine lining. Additional intake of such drugs can speed up this process and increase the intensity of bleeding.

Possible pathological causes of early menses:

Sexually transmitted infections (STIs)

Some of the most common STIs are chlamydia and gonorrhea. These are bacterial infections that are most often asymptomatic, but can sometimes cause spotting between periods, as well as abdominal pain, pain during sex, and during urination.

Take care of yourself and only have safe sex with a condom if you are not planning on getting pregnant. Not only will this help you avoid unwanted pregnancies, but it will also protect you from most STIs, including HIV. Remember that there is an HIV epidemic in Russia, and most of the new infections in recent years are heterosexual people who simply did not use a condom. nine0003

Polycystic ovarian syndrome

Polycystic disease occurs in approximately 10% of women of reproductive age. Many women only find out they have PCOS when they have difficulty conceiving. Polycystic disease can cause the following symptoms: menstrual irregularities and delays, weight gain, acne, excess hair growth on the face and body, and voice changes.

Thyroid disorders

Thyroid disorders are very common, in about 12% of women. Such disorders lead to insufficient or excessive production of thyroid hormones by the body. These hormones keep several body systems running, including metabolism and the menstrual cycle. nine0003

The symptoms of this condition depend on whether the amount of these hormones is excessive or insufficient.

Other symptoms include: unusually heavy or scanty periods, weight gain or loss, drowsiness or insomnia.

Endometriosis

In endometriosis, the uterine epithelium begins to grow outside the uterus. This is a fairly common health condition, occurring in about 11% of women of reproductive age. In addition to unexpected bleeding, the following symptoms occur: extremely painful cramps during menstruation, pain during and after sex. nine0003

When should I see a doctor for early periods?

Usually early menstruation is not a sign of any serious or dangerous changes in the body, but if you experience severe discomfort, pain or just fear, you need to seek medical advice.

You need to see a doctor if:

Menstrual pain worse than usual
nine0002 Menstrual pain is so severe that it interferes with your daily life
If menstruation is so heavy that tampons or pads have to be changed every hour
If the pulling pain in the lower abdomen does not go away after a couple of days after the start of menstruation
You experience pain during penetrative sex
Pain or burning during urination
Spotting spotting not related to ovulation

If you suspect or are certain that you are pregnant and you are bleeding, you should contact your doctor immediately.

Be sure to keep track of cycle length, period length, and any unusual discharge between and during cycles. This can be done in a regular paper calendar or in dedicated smartphone app. If the cycle does not become regular for 2-3 months, then you need to see a doctor. Information about your cycle will be needed when making a diagnosis. nine0003

Your baby was born prematurely | Regional Perinatal Center

Premature babies

If your baby is born too early, the joy of having a baby can be overshadowed by health concerns and thoughts about the possible consequences.

Instead of returning home with the baby, holding him and caressing him, you will have to stay in the department, learn to cope with the fear of touching the baby, realize the need for treatment and various manipulations, get used to the complex equipment that surrounds him. nine0003

In this situation, not only your baby needs help, you need it too! The best assistants are your loved ones, their love and care, as well as professional advice and recommendations from doctors and psychologists. This section of articles will help you improve your knowledge of preterm infant care, development and nutrition.

Your help for the baby

Previously, parents were often not allowed into the department for newborns and, especially, into the intensive care unit because of the fear of infection of the baby, but now the contact of the parent with the child is recognized as desirable and is prohibited only in exceptional cases (for example, if parents have acute infections)

Close communication between you and your baby is very important from the first days of his life. Even very immature premature babies recognize the voices and feel the touch of their parents.

The newborn needs this contact. Studies have shown that it greatly contributes to the faster adaptation of an immature child to new conditions and the stabilization of his condition. The baby's resistance to therapy increases, he absorbs large amounts of food and quickly begins to suck on his own. Contact with the child is important for parents. Taking part in the care of the baby, they feel their involvement in what is happening and quickly get used to a new role, especially when they see how he reacts to their presence. nine0003

By constantly and attentively observing the baby, parents can notice the smallest changes in his condition before others. In addition, communication in the hospital is a good practice that will undoubtedly come in handy after discharge. For parents, early physical contact with the baby is very valuable, because it allows them to feel him, despite the incubator and other obstacles, and show him their love.

Treatment in the neonatal intensive care unit requires parents to have full confidence in all medical staff. nine0003

Care of premature babies in the hospital

Many premature babies cannot breathe, suckle and regulate their body temperature sufficiently after birth. Only in the last weeks of pregnancy is the maturation of the lungs, gastrointestinal tract, kidneys, brain, which regulates and coordinates the work of all organs and systems.

Constant attention requires fluid loss due to the immaturity of the skin of premature babies and the insufficiency of thermoregulation processes. Modern approaches focused on nursing premature babies help to cope with these problems. nine0003

Heat regulation incubator

Premature babies are very sensitive to temperature fluctuations. At the same time, clothing can interfere with the monitoring of the baby's condition and its treatment. That is why an incubator is used to provide the conditions necessary for premature babies. It maintains a certain temperature and humidity, which change as the child grows. When the body weight of a premature infant reaches 1500-1700 g, he can be transferred to a heated bed, and after reaching a weight of 2000, most premature babies can do without this support. There are no strict rules here: when nursing children with low body weight, doctors are guided by the severity of the condition of each premature baby and its degree of maturity. nine0003

In incubators, very young premature babies are placed in special "nests" - soft hemispheres in which the baby feels comfortable and assumes a position close to intrauterine. It must be protected from bright lights and loud noises. For this purpose, special screens and coatings are used.

Critical treatments during the first days of life of preterm infants with low and very low birth weight:

Use of an incubator or heated bed. nine0003

Oxygen supply for respiratory support.

If necessary, artificial ventilation of the lungs or breathing using the CPAP system.

Intravenous administration of various drugs and fluids.

Carrying out parenteral nutrition with solutions of amino acids, glucose and fat emulsions.

Don't worry: not all premature babies need such extensive treatment!

Mechanical ventilation and CPAP for respiratory support

When it comes to nursing, oxygen supply is of the utmost importance for premature babies. In a child born before the 34-35th week of pregnancy, the ability of the lungs to work independently is not yet sufficiently developed. The use of a constant flow of air with oxygen, which maintains a positive airway pressure (CPAP), leads to an increase in blood oxygen saturation.

This new method made it possible to dispense with the majority of even very immature children without mechanical ventilation. The need for intubation of children has disappeared: during treatment with CPAP, oxygen is supplied through short tubes - cannulas that are inserted into the nasal passages. CPAP or mechanical ventilation is continued until the lungs can function at full capacity on their own. nine0003

In order for the lungs to expand and remain in this state in the future, a surfactant is needed - a substance that lines the alveoli from the inside and reduces surface tension. Surfactant is produced in sufficient quantities starting from the 34-35th week of pregnancy. Basically, it is by this time that the formation of the lungs is completed. If the baby was born earlier, modern technologies allow the introduction of surfactant into the lungs of premature babies immediately after their birth.

Parenteral nutrition - administering nutrient solutions by vein

Premature babies, especially those born weighing less than 1500 g, are not able to get and absorb enough nutrients, even when fed through a tube. For the rapid growth of the baby, a large amount of nutrition is needed, and the size of the stomach is still very small, and the activity of digestive enzymes is also reduced. Therefore, such children are given parenteral nutrition.

Special nutrients are injected into a vein using infusion pumps that deliver solutions slowly at a predetermined rate. In this case, amino acids necessary for building proteins, fat emulsions and glucose, which are sources of energy, are used. These substances are also used for the synthesis of a number of hormones, enzymes and other biologically active substances. Additionally, minerals and vitamins are introduced. nine0003

Gradually, the volume of enteral nutrition increases, and parenteral nutrition decreases until it is completely canceled.

Premature infants with gastrointestinal disease require parenteral nutrition for a longer period of time.

By the time your grown baby is discharged from the hospital, everything should be well prepared at home. And this applies not only to the environment, clothes and means of caring for the child.

All family members must be ready to receive the baby. Of course, the main care will fall on the shoulders of the parents. Although you have already gained some experience in the hospital, it is important to feel the support of others, especially in the early days.

Older children can also help. The discharge of your baby is a great joy that you want to share with all your relatives.

While you are getting used to your new role, it is important that nothing distracts you from communicating with your child. Now all the care and responsibility for the baby lies entirely with you. Everything you need to take care of him should be at hand. nine0003

Getting ready to be discharged from the hospital

Before you are discharged, you must make sure that:

The bed, bath and changing area are prepared. A crib should be placed in the parents' bedroom, the child should not be left alone even at night. A stroller is also required. you have baby milk that was recommended by the doctor before discharge (if the child is on mixed or artificial feeding). As a rule, this is a specialized medical product. You need a certain number of small bottles and teats of the appropriate size, as well as a sterilizer. All premature babies will need pacifiers. nine0124
You have fully mastered breastfeeding or bottle feeding.
If your baby is not sucking all the necessary milk volume from the breast and is supplementing from a bottle, you have purchased a breast pump that you have learned to use; you may also need it if you have a lot of breast milk.
You have asked your doctor how often your child's weight should be monitored.
If your baby still needs medicines, you have enough medicines at home. And you know exactly how and when to give them to your child. nine0124
You know which warning signs to look out for.
After the baby is discharged, a pediatrician and a neonatologist will look after the baby, to whom you will give the discharge summary from the hospital.
You know how the hospital from which your child is being discharged will provide follow-up care after discharge.
You know which specialists and how often should examine your baby (oculist, neuropathologist, etc.). nine0124
All the emergency phone numbers you need are at your fingertips.

When can a child go home

This question is very difficult to answer because all children are different. The stay in the hospital can last from 6 days to 6 months, depending on the degree of prematurity of the child, the severity of his condition, as well as the presence of certain complications.

Of course, all parents look forward to the moment when the baby can be brought home. Long-term nursing of a premature baby is often a difficult test for you. But we must not forget that safety comes first, and the baby can be discharged home only when the doctors are confident in the stability of his condition. It is certainly in your interest as well. nine0003

The rate of increase in body weight and length

Weight gain is the main indicator of the growth of the baby and the adequacy of the treatment. The weight of the child, especially in the first days and weeks of life, is influenced by a number of factors: the presence of milk in the stomach (immediately after feeding), the time of bowel movement, the degree of filling of the bladder, the presence of edema. Therefore, if an edematous child does not gain weight for several days, and perhaps even loses it, do not worry. It should be remembered that children grow unevenly and periods of high weight gain alternate with lower ones. It is better to focus not on weight gain per day, but on the dynamics of this indicator over several days or a week. nine0003

It is currently accepted that in the interval corresponding to 28-34 weeks of pregnancy, the normal weight gain of the child is 16-20 g/kg per day. Then it is reduced to 15 g/kg.

It is also important to take into account the rate of increase in body length. With malnutrition, at first the child gains less weight (or even loses it), and with a more pronounced deficiency of nutrients, his growth is also disturbed.

The weight must not only increase at a certain rate, but must also correspond to the length of the baby. An important parameter characterizing the development of the baby is an increase in the circumference of the head. The brain most actively increases in size during the first 12–18 months of life. But an excessively rapid increase in head circumference, as well as a slowdown in its increase, indicate neurological disorders. nine0003

A premature baby can be discharged from the hospital if:

he is able to independently maintain the required body temperature;
does not need breathing support and constant monitoring of the work of the respiratory and cardiovascular systems;
can suck out the required amount of nutrition on its own;
does not need round-the-clock monitoring and frequent determination of biochemical or other indicators; nine0124
maintenance treatment can be done at home;
he will be under the supervision of a local pediatrician and neonatologist at the place of residence.

The decision to discharge home is made for each patient individually. In addition to the state of health of the baby, the degree of preparedness of parents, their ability to provide high-level care for a premature baby is also taken into account.

Feeding a premature baby after discharge

Breastfeeding is the ideal way to feed premature babies.

However, if the baby was born much premature and his birth weight did not exceed 1800-2000 g, his high nutritional requirements cannot be met by breastfeeding. The growth rate will be insufficient. Moreover, over time, the content of many nutrients, including protein, in milk decreases. And it is the main material for building organs, and primarily brain tissue. Therefore, proteins must be supplied to the body of a premature infant in the optimal amount. nine0003

In addition, premature babies have a significantly increased need for calcium and phosphorus, which are essential for bone formation.

In order for the baby's nutrition to be complete even after being discharged from the hospital, special additives - "enrichers" are introduced into breast milk in a certain amount, already less than in the hospital. They make up for the lack of protein in it, as well as some vitamins and minerals. As a result, the child receives them in the optimal amount. The duration of their use will be determined by your doctor. If there is not enough milk or it does not exist at all, children born prematurely should be transferred to artificial feeding. Complementary feeding of premature babies is carried out with special children's dairy products designed for children with low birth weight. This baby milk is ideally suited to both the ability of immature children to digest and assimilate nutrients, and their needs. nine0003

Premature infant milk contains more protein, fat and carbohydrates than term infant milk, resulting in a higher calorie content. In specialized baby milk, the concentration of many minerals is higher, especially iron, zinc, calcium, phosphorus, as well as vitamins, including vitamin D. Long-chain polyunsaturated fatty acids of the Omega-3 and Omega-6 classes are introduced into such products, which are necessary for proper development of the brain and organ of vision, as well as nucleotides that contribute to the optimal development of immunity. However, when the child reaches a certain weight (2000-2500 g), you should gradually switch to feeding with standard baby milk, but not completely. Specialized baby milk can be present in the diet of a premature baby for several months. This time, as well as the volume of the product, will be determined by the doctor. He will answer all your questions about how to feed your baby. nine0003

At present, specialized children's dairy products have been developed and used to feed premature babies after discharge from the hospital. In its composition, it occupies an intermediate position between a specialized product for premature babies and regular baby milk. Your baby will be transferred to such baby milk while still in the hospital. You will continue to give it to your child at home, and the doctor, watching him, will tell you when it will be possible to switch to regular standard baby milk. If the baby was born with a very low body weight or is not gaining weight well, special baby milk can be used for a long time - up to 4 months, 6 or even 9months. The beneficial effect of such children's dairy products on the growth and development of the child has been proven in scientific studies.

Feeding needs for premature babies

Higher caloric intake because they need to gain weight faster than term babies.

More protein as premature babies grow faster.

More calcium and phosphorus for bone building.

More trace elements and vitamins for growth and development. nine0003

A premature baby grows faster than a term baby. Nutrition for such children is calculated taking into account body weight at birth, the age of the baby and its growth rate. As a rule, the calorie content of the daily diet is about 120-130 calories per 1 kg of body weight.