32 week old baby premature

Survival Rate, Time in Hospital, More

The final months of pregnancy are full of prepping and planning. And, of course, planning is important. But be prepared: Many births don’t go according to plan.

For example, you might end up having a cesarean delivery (C-section) or other interventions that you weren’t planning on. Or you may find yourself with much less time to prepare if your baby decides to show up to the party earlier than expected!

About 11 percent of babies worldwide are born early (premature). This means that they’re born more than 3 weeks before their estimated due date. About 85 percent of these are born between 32 and 36 weeks of pregnancy.

But if your baby is born even more prematurely — say, at 32 weeks — they still have very good odds at being healthy with some supportive medical care. Here’s what you need to know about a baby born at 32 weeks.

Yes, a baby can safely be born at 32 weeks, but they may need specialized care to help support their development as they navigate their early days in the world.

A baby who’s born before week 37 of pregnancy is considered to be premature. However, during pregnancy, every week — and even every day — makes a difference in a baby’s growth and development. This is why premature babies are grouped into four stages:

late preterm, born between 34 and 36 weeks
moderate preterm, born between 32 and 34 weeks
very preterm, born between 25 and 32 weeks
extremely preterm, born before 25 weeks

If your baby reaches 32 weeks of gestation (time in the womb) and is born at 32 weeks, they’re moderate preterm. Babies born at 32 weeks have a survival rate as high as 95 percent. They also have very good chances of growing into healthy babies and children without any complications.

Babies who are born very preterm and extremely preterm have a higher risk of complications and health problems than a baby born at 32 weeks.

How healthy and developed your baby is at 32 weeks also depends on what kind of pregnancy you have. If you’re carrying twins or other multiples they may be smaller than if you’re carrying a singleton baby.

At 32 weeks, babies still have a couple months to go before reaching their full birth weight, but they’re well developed. Your baby will look almost like a full-term baby, just smaller, thinner, and even more delicate.

They’ll have almost-there toenails and perhaps a few wisps of hair on their head. Most of the soft, downy hair (lanugo) that covered them earlier in the womb will have started falling off, but they’ll still be a little fuzzy.

They probably will not yet have fully formed fingernails. Their eyes, though developed, may be too sensitive to light to open just yet. By 32 weeks most babies are practicing breathing, and their lungs are in the final stages of development. Their skull and all their bones will still be very soft.

At 32 weeks, a baby may:

weigh almost 4 pounds
be between 16 and 17 inches long
have a head size (circumference) between 11 and 12 inches

How long your baby needs to stay in the hospital after they’re born at 32 weeks depends on several things.

After birth, your premature baby will be taken to a special care nursery or the neonatal intensive care unit (NICU) in the hospital where you gave birth.

Most babies born at 32 weeks of pregnancy have only a few temporary health issues and need to stay in the NICU for only a few days to a few weeks. After birth, your baby may need extra help learning and developing the skills needed for feeding, staying warm, and breathing on their own.

Babies born at 32 weeks will generally not yet be strong enough to breastfeed because their sucking muscles are still weak and uncoordinated. They’ll likely need to be tube-fed for a few weeks.

That said, receiving breast milk is especially important for preterm babies. Compared to preterm babies who receive formula, those who receive human milk typically have higher survival rates, shorter NICU stays, and fewer serious health complications.

Even if you weren’t planning to breastfeed, you may consider expressing milk to help nourish your premature baby. You may also consider donor milk.

Most babies born at 32 weeks don’t have breathing problems, but your doctors and nurses will make sure they’re breathing properly.

Before your baby can safely go home with you, your doctor will make sure they don’t have any other health problems and are growing and developing enough to do well without NICU care.

Before they’re discharged, your baby will be evaluated on their:

weight gain
ability to suck and swallow milk on their own
temperature regulation
eye development and sensitivity

Babies born at 32 weeks might have some temporary health problems such as:

low birth weight
jaundice
hypothermia
feeding difficulties

Some long-term issues in babies born at 32 weeks might show up months to years later. These are not common, but can include slower development. In most cases, babies with learning or developmental delays catch up later in childhood with a little bit of extra help.

A 2017 medical study in France that followed 5,170 babies who were born between 22 to 34 weeks of pregnancy found that babies born at 32 to 34 weeks had very low risks of long-term health problems.

The researchers found that about 1 percent of babies born at 32 to 34 weeks had the neuromotor disorder cerebral palsy.

The same study tested 2,506 2-year-olds who were born prematurely. In the group born at 32 to 34 weeks of pregnancy, 36.2 percent scored slightly lower than average on a questionnaire that was used to test brain development.

While this means that some babies born at 32 weeks may have delayed learning development and skills in early childhood, and early intervention can have a significant impact in improving skills.

If your baby is born at 32 weeks, they have very good chances of being born healthy and developing just fine.

They’ll be considered premature, specifically moderately preterm, and will need extra medical care to make sure they’re healthy and growing normally before they can go home. Your baby may be in the hospital or NICU for several days to weeks.

In rare cases, a baby born at 32 weeks may have neurodevelopmental (brain and learning) delays. In most cases, they’ll catch up with some extra help during early childhood.

Premature baby development: 26-36 weeks

Premature baby development: the basics

A premature baby’s development typically happens in the same order as it would have happened in the womb.

But premature babies might have some health challenges along the way. Sometimes premature babies also have delays in growth and development. Very premature babies and premature babies with medical challenges are more likely to have delays.

For example, a premature baby born at 32 weeks is likely to act differently from a baby born at 26 weeks, who has had many medical challenges by the time they get to 32 weeks. The baby born at 26 weeks might take extra time to put on weight, learn to feed and come out into the social world.

Here are the changes you can expect and watch in your premature baby during their time in hospital.

26 weeks

At 26 weeks, a baby in the womb is about 35 cm long and weighs about 760 gm. But premature babies are often small for their age. A baby born at 26 weeks would probably fit snugly into your hand.

At this age your premature baby’s main job is to grow, sleep and become medically stable.

Your baby might open their eyes occasionally, but they can’t focus. Light or other visual stimuli might stress their body’s systems. Your baby’s nurse might place a cover over your baby’s incubator, and some neonatal intensive care units (NICUs) dim the lights at night.

Your baby’s movements are often jerks, twitches or startles. Your baby doesn’t yet have good muscle tone and can’t curl up. Hospital staff will put your baby in a curled-up position, support their body with bedding and keep them warm. This helps your baby keep up their energy.

Your baby might also have apnoea. This is common for very premature babies. The breath triggering part of your baby’s brain hasn’t fully developed yet, so pauses between breaths are common. Your baby will grow out of it.

Your baby’s ears and hearing structures are already fully formed, but your baby might be sensitive to external sounds. Your baby might notice your voice but they can’t respond to you yet.

Your baby won’t be able to feed from your breast yet.

Your baby’s skin is fragile and sensitive, and they might get stressed if they’re handled or touched. The nurses will probably encourage you to ‘comfort hold’ your baby but not stroke them.

Our article on touching, holding and massaging your baby has more information on comfort holding and kangaroo care. And our article on premature baby body language explains what your premature baby’s behaviour is telling you.

26-28 weeks

At 26-28 weeks, babies in the womb continue to put on weight and grow longer. But if your premature baby is sick, their weight gain might not keep up with a baby in the womb. Also, hospitals use careful, staged feeding plans to protect your baby’s immature gut from infection, and this might slow weight gain.

At this age, babies start blinking. They also grow eyelashes and eyebrows.

Your baby still has low muscle tone and is likely to have twitches and tremors.

Your baby’s sleep and wake cycles aren’t clear yet, but your baby might have active and quiet periods and very brief alert times.

Your baby might open their eyes, but they probably still can’t focus or get their eyes moving together.

At this age, your baby’s responses to sound might change from hour to hour or day to day. Or they might respond to your voice but get stressed by other noises. Your baby’s responses will start to give you some clues to what they like and dislike.

Your baby might begin sucking, but they still can’t feed from your breast. To breastfeed, they need to know how to suck, swallow and breathe in the right order.

Your baby’s skin is still fragile and sensitive. But if your baby is medically stable, you might be able to start skin-to-skin contact by doing kangaroo care.

28-30 weeks

In the womb a baby keeps getting heavier and longer, starts to move more often, knows the difference between some sounds – for example, voices and music – starts to grasp with their hands, and opens and shuts their eyes.

At this age, your premature baby will still be well supported with bedding and positioning, but they might move and stretch more actively as their muscle tone gets better.

Your baby’s quiet deep sleep (when they don’t move) and light sleep (when they move their limbs and eyes) increase at about 30 weeks. You’ll also start to see short alert, eye-opening periods, but this can be affected by your baby’s health, the environment or the time of day.

Your baby is starting to close their eyelids tightly if it’s bright, but they still can’t move their eyes together very much. Their eyes wouldn’t usually get much stimulation at this age, so it might help to limit what they see.

Your baby keeps responding to pleasant sounds and is still sensitive to other sounds. They might be quiet and attentive to your voice and might even seem to ‘wake up’ when you come in. You can start to talk or sing to your baby during their short alert times. But keep stimulation to one thing at a time – for example, eye contact or talking, but not both at once.

Your baby’s rooting reflex – turning to a touch on the cheek – might start around this time. This means they’re getting ready for breastfeeding. Your baby might even start sucking, but they can’t feed at your breast yet.

Your baby might still be sensitive to touch, but they like steady, gentle, hands-on touch or skin-to-skin contact. You might be able to get involved in caring for your baby about now.

30-33 weeks

At this age, a baby’s organs are maturing. A baby born now might not need much medical help.

Your premature baby’s movement is smoother and more controlled, and they’ll start to bend their arms and legs for themselves.

Your baby’s deep sleep increases. Their alert periods come more often, especially if the room is dim. When they’re alert, your baby might focus on your face or another interesting object, and they might show an obvious response to your voice. Your baby might shut their eyes tightly if the room is bright.

Your baby might like eye contact, cuddling or talking during these times – but it’s still a good idea to keep it to one thing at a time. And you can also watch your baby’s body language for signs of stress.

Your baby might start to suck rhythmically and might show that they’re ready to suck to feed. Letting your baby smell and taste breastmilk gets their senses ready for breastfeeding. Gently rubbing around your baby’s lips and inside their mouth before feeds helps your baby get ready for the touch sensations of feeding from your breast.

If you see your baby putting their hands to their mouth, this means that they’re starting to soothe themselves.

Your baby might still be very sensitive to touch and handling. It’s helpful to tell them what you’re about to do so they can start associating your voice with what you’re doing. For example, ‘We’re going to change your nappy now’.

33-36 weeks

Your baby is now approaching the date they were due to be born. But even when they’ve reached 37 weeks, they aren’t necessarily like a full-term baby.

Your baby can now move more smoothly and bend their arms and legs. They can also move their head from side to side, and their muscle tone is stronger.

Your baby will be much less likely to experience apnoea.

Your baby’s states are clear – quiet sleep, active sleep, drowsy, quiet and alert, awake and fussy, or crying. Their alert states are still quite short, but they’re getting longer and happening more often. Your baby can have longer social times, and they can now turn away or close their eyes when they’ve had enough.

Your baby is more likely to respond to sounds and noises in the same way from day to day. You might even know how they’re going to react when you say something to them.

Your baby probably still doesn’t cry much. But as your baby gets closer to term, they’ll cry more often to let you know what they want.

Your baby can usually start breastfeeding around this time.

Your baby might still be sensitive to touch and handling, although telling your baby what you’re about to do will help them relax over time.

37 weeks and beyond

Your baby might be ready to go home before their expected birth date. But it might take longer if your baby has had surgery or an illness.

The hospital will have health, growth and development goals for your baby to meet before you can take them home. These might include steadily gaining weight, feeding from your breast or a bottle at all feeds, and having no problems with apnoea.

Our article on going home with your premature baby has more information on how to prepare for your baby’s homecoming.

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.

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 neonatal unit 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.

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.

Nursing 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.

Fluid loss due to the immaturity of the skin of premature babies and the insufficiency of thermoregulation processes require constant attention. Modern approaches focused on nursing premature babies help to cope with these problems.

Heat regulation incubator

Premature babies are very susceptible 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.

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 premature babies with low and very low birth weight:

Use of an incubator or heated bed.

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 for the majority of even very immature children to do 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.

In order for the lungs to expand and remain in such a 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.

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.

Preparing for discharge from the hospital

Before discharge, you must make sure that:

Prepared the crib, bath for bathing and a place for changing clothes, preferably a changing table. 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.
You have fully mastered breastfeeding or bottle feeding.
If your baby is not suckling all the required amount of milk 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 medication, you have the required amount at home. And you know exactly how and when to give them to your child.
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.).
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.

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.

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.

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;
supportive care can be provided 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 prematurely 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.

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.

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.

At present, specialized children's dairy products have been developed and are being 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.

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.

It is very important that your baby continues to gain weight quickly and grow in length after discharge. To do this, feeding premature babies must be carried out using a specialized fortified diet prescribed by a doctor.

“His organs and systems are not ready” Why in Russia they are trying to save children who have almost no chance to survive and be healthy: Society: Russia: Lenta.ru

at a very early stage (less than 22 weeks) and with extremely low weight (less than 500 grams). This happened after a series of criminal cases that the Investigative Committee initiated against obstetricians. So, neonatologist Elina Sushkevich from Kaliningrad was accused of killing a 22-week-old boy. Why are they trying to save 500-gram children in Russia at all today, what are their chances of surviving and whether they can grow up healthy - Lenta.ru learned from the doctor of medical sciences, head of the scientific department of neonatology and pathology of young children at the Research Clinical Institute of Pediatrics named after Yu. E. Veltishchev Elena Keshishyan.

***

Lenta.ru: Now the minimum criteria for saving premature babies are 22-23 weeks and 500 grams of weight. Why?

Elena Keshishyan : In order to understand the limit of possibilities both in technical terms (creation of an environment close to intrauterine), and in terms of the maturity of the child's brain, which is able to develop out of utero, attempts were made in the world to give birth to premature babies of different ages. The greatest successes in this were achieved by the Japanese. They tried out babies born at 20 weeks. That is, the approximate gestational age was five months. The Japanese succeeded, but in isolated cases. And they saw that in children born at this age there is no differentiation of the brain, division into gray and white matter. Roughly speaking, this process determines the ability to think, to feel. This is called higher nervous activity. It is this ability that distinguishes man from animals.

Therefore, guided by research data and on the basis of a humanistic idea, the World Health Organization has set this limit for human live birth - 23 weeks, which corresponds to approximately 500 grams of weight. This is the minimum age at which the brain can differentiate into gray and white matter. And, accordingly, there is hope that it will already be a human person with mental abilities.

Countries with technological capabilities, including Russia, have agreed that those born at this gestational age can legally be considered human. That is, they have all human rights, including medical care.

Since 2012, Russia has switched to the WHO criteria for nursing premature babies. How many of these children have been saved during this time?

As a percentage of all those born, this is minuscule. I don't have exact numbers. But I want to say that the body of children born almost half prematurely is very immature. And their survival rate, conditionally, is one in a hundred. Still, 22-23 weeks is not childbirth in the full sense. From the point of view of nature, this is a miscarriage, this is a critical situation that may be associated with the health of the mother or the sick child herself. Therefore, the readiness for independent existence in such fruits is close to zero. Even if we assume that the maximum efforts of doctors are thrown to save the child, all the necessary equipment is connected, the chance that he will get out is very small. In such an infant, the kidneys, gastrointestinal tract, heart and other organs may not work. This is a very, very complex, jewelry work of doctors.

One of the smallest surviving premature babies in the world. Amilya Taylor was born in 2006 in Miami, USA. She spent only 22 weeks in the womb and was born with a weight of 284 grams and a height of 24 centimeters.

Photo: Baptist Health South Florida / Reuters

And dear?

Of course. A day in a well-equipped neonatal intensive care unit costs several thousand dollars. And to leave such a child, months are needed. But I want to emphasize that the number of survivors in this period is minimal. And it is minimal in almost all countries where the WHO criteria apply.

If these children are not viable, cost too much, then why were these criteria established?

The medical task here is not at all to save without exception all children born at a term of five months. It is clear that there is not a single person who does not understand that this child is at risk of being blind, deaf and immobilized. The task of medicine in this situation is to acquire knowledge and experience.

Obstetricians learn how to prolong pregnancy as much as possible. There is a whole range of activities: prenatal diagnosis of genetic chromosomal diseases, various fetal malformations, identification of risk groups among pregnant women, their special monitoring, prenatal logistics and routing. They also hone the ability to properly take birth at this time. This must be done as carefully as possible and do not forget about the "golden hour". It is necessary to have time to give the child, without waiting until his condition worsens, what he could not get from his mother. That is, even if the child screamed, you need to understand that soon he will stop doing this and will not be able to breathe. The "golden hour" essentially determines whether or not there will be damage to brain cells. This means whether or not a child will have a full life.

And the qualifications of resuscitators working with such children are growing today. All this led to an important point: the quality of nursing of children born a little later, at 26-28 weeks, has become much better. I see these babies regularly. And I can say that over time, many of them are no different from their peers.

And before?

About 30 years ago, about six or seven out of ten children would have become severely disabled. And today I had three 26-week-old babies at my appointment. And everyone is developing quite well, there is a slight backlog, but they will catch up. These children no longer have those possible malformations that, unfortunately, would have necessarily arisen in past years.

And this became possible thanks to the experience, the accumulation of knowledge about how such babies develop. There are no small things. This applies to everything - how to evaluate the heartbeat, how to interpret blood tests, and so on. Caring for a premature baby, both in the neonatal period and later, in the first or second year of life, is not the same as managing a normal, full-term baby. But knowledge allows timely adjustment of development, without even waiting for problems.

Photo: Science Photo Library / East News

It is important to understand that a premature baby is not a small copy of a normal one. This is a child who is forced to adapt to extrauterine life, when physiologically he should not do this. Its organs and systems are not prepared to function in the new conditions.

"This is painful love at the level of deep depression"

What do such children most often suffer from?

One of the typical pathologies is retinopathy of prematurity. In children, the mechanism that protects the eye from light has not yet matured. And they experience a real shock, suddenly falling into our bright world. Photons of light and the flow of oxygen begin to act on the retina, its vessels begin to grow rapidly, penetrate all the media of the eye, and, ultimately, exfoliate the retina, leading to total blindness. Earlier, even when I was just starting to work, although we knew about such a disease as retinopathy of prematurity, there were few children born and surviving at gestational ages of less than 30 weeks. Therefore, no one knew how to treat this disease. It's scary to remember, but premature babies were in wards with round-the-clock lighting. The light was needed so that doctors and nurses could observe the baby's condition and notice changes in time. At that time, six out of ten children whose birth weight was less than a kilogram went blind. Just then, the borders were opened in Russia, and we were amazed that in Europe, a maximum of two out of ten newborns had blindness.

But we started learning very quickly. Now in perinatal centers in all intensive care units for premature babies - twilight. The cuveuses are completely covered with dark blankets. The staff does not need to watch the baby all the time - all readings are automatically recorded by special devices. In good ICUs, nurses who approach babies have headlights. This is to avoid disturbing other children. In many intensive care units, a large “ear” hangs. If the decibel level in the room begins to exceed the allowable limit, the device lights up red.

After the birth of the child, every week they begin to look at the eyes with a special method. If there is proliferation of blood vessels, laser coagulation of the retina is performed. There are specialists in such operations in almost every major city.

Approximately 400-600 babies pass through me every year, born at 26-28 weeks. Over the past few years, not a single blind person has been among them. Although earlier in hospitals for such newborns it was necessary to open entire departments.

Is there any data on how many premature babies subsequently became healthy?

Now, among premature babies born at five to six months (25-26 weeks of pregnancy), 25-30 percent become disabled. The same is true in developed countries. And even 20-30 years ago there were 75-80 percent of them.

The risks for these children are still very high. They require long-term observation and treatment. But still today they have incommensurably or better chances than before.

Photo: East News

Do unfortunate parents regret insisting on resuscitation at all costs?

As a doctor, no one has ever told me this. Naturally, the families had very different hopes for childbirth. In the doctor's office they cry, but they don't moan. These children are madly loved. But this is painful love at the level of deep depression. Probably, some of these mothers may think at night what would happen if they knew in advance how everything would turn out. Perhaps they voice this to their mothers, husbands, girlfriends . .. But not to doctors. This is where people prefer to stay.

When a child is one or two years old, from a moral point of view, the situation is more difficult than in three days. Newborns are all wonderful bags, it is only then that children begin to differ from each other. These families have a very specific and difficult life. When a child lies at home, does not move, does not swallow, never looks at you, does not speak - this is very difficult. And parents need to be helped to turn their life into at least a relatively social one, not to make them outcasts.

What family support can I expect now?

When Russia switched to WHO standards, doctors began to say that if we started caring for such children, there would be a high incidence of cerebral palsy, mental retardation and other pathologies leading to severe disability. Without the development of a specialized service that will help such children, we will inflict enormous damage on a society that will not accept such an increase in the number of people with disabilities. Then a follow-up system for premature babies began to develop, which leads them up to three years. Because in the usual polyclinic network there are not always doctors who understand how a child born with low or extremely low body weight grows and develops. In parallel with this, the system of medical rehabilitation is developing quite rapidly.

The worst situation is with the social services. Help for these children is minimal. Few people explain to families how to care for such a child, how to develop him, how to maintain motor skills. If in large cities at least some minuscule can be achieved, then what can we say about the province? All this turns one of the parents out of social life. There are no places where it would be possible to transfer such a child at least for a week, a month, so that the parents could have a little rest. Since the state has taken such a step, since we have legally recognized a 500-gram fetus as a person, then they themselves also need to act humanly in the future with his family.

Is there a support system in other countries?

I know that in Europe and in the USA it is built very well. The emphasis is not on medical rehabilitation, but on social rehabilitation. They have social workers who come and relieve these families of a significant part of their worries. Somewhere there are social centers where a child can be taken to a kindergarten. Moreover, they are zoned - parents do not need to go to the other end of the city.

Photo: Alexander Kondratyuk / RIA Novosti

“Even if it is clear that a child has pathologies that are incompatible with life, they must be saved to the last”

You say that some time ago, kilogram premature babies were also considered “non-residents”, but now they are quite promising. Is it possible that in 30-40 years the same can be said about 500-gram ones?

Indeed, even 30-40 years ago, when it was not possible to maintain breathing, children born before seven months of age survived very rarely.

Then, when some first mechanisms appeared, the bar was raised until the 28th week of pregnancy, which is about six months. But technological progress is always moving forward, and this has allowed us to further gradually reduce the age of survival. We can now at least partially simulate intrauterine conditions. For example, when a child is not born on time, he does not yet have a substance in his lungs, thanks to which he can breathe - surfactants. They can be introduced immediately at birth, start artificial ventilation of the lungs and thereby support gas exchange. It also became possible to give nutritional subsidies not through the gastrointestinal tract, but through a vein with special substances that are already ready for inclusion in metabolism. There are many other adaptations: the creation of a thermal regime, humidity close to intrauterine.

Technologically, the frontier could move indefinitely. If desired, you can simulate a situation where a woman is not needed at all to bear a child. But I have already said that scientists have established that the age of 22-23 weeks is the minimum period at which the cells of the cerebral cortex can develop postnatally. Still, the main criterion for the normal development of a child is not technological achievements, but the capabilities of the brain.

Is it true that they try to save all 500-gram children only in Russia and Turkey, and in other countries - only if the child has high chances for a normal life?

This is not true. In all countries where the WHO concept has been adopted, these children are subject to mandatory medical care. But there are nuances. If the baby was born between the 23rd and 25th weeks, parents can refuse resuscitation. To do this, in many countries there is a legal standard, reminiscent of the law on euthanasia.

There is a special service in perinatal centers. When it becomes clear that preterm labor has begun, representatives approach relatives - the father and, if possible, the mother. “We assume that a baby will be born with such and such parameters. In this case, there are such and such development risks ... You have the right to choose either full resuscitation or palliative care. And depending on what the parents decide, the doctors act.

Photo: Sergey Pyatakov / RIA Novosti

In Russia, you can also choose a palliative today, right?

This is not prescribed by law. Today, even if it is clear that a child has pathologies incompatible with life, they must be saved to the last. It happens that parents can sign a paper on their own that they would not like resuscitation, but this has no legal force. Parents can say, “Look, he is breathing, breathing. He opened his eyes. Let's revive him now!" And we lost time, which in this case is very important. This child initially has little chance, but it has become even less. And a situation may arise when parents accuse the doctors that their child was not specially treated, “talking teeth”.

The medical community is very concerned about this ambiguous position of doctors. And we have a number of proposals to solve the problem of their protection.

What exactly is offered?

Legislative initiative to allow parents to independently decide on the appropriateness of resuscitation care for a child born between the 23rd and 25th weeks. Naturally, all this should be discussed. It is necessary to involve the public in the discussion: these are lawyers, doctors, patient communities, representatives of religious denominations.

The Ministry of Health has now prepared new criteria for newborns born too early. In particular, it is proposed not to register such a child until he has lived seven days. Maybe this will fix the situation, protect doctors from murder charges?

There are a lot of pitfalls here. In Russia, there was a similar law on kilogram children. They were assisted from birth, but until the age of seven days the child was considered a fetus. If he died, then his mortality already went into other criteria, it was not considered the death of a newborn.

There are not many children born with extremely low rates, they simply cannot influence the demographic structure in any way. But if there is such a situation that you can not register for up to seven days, it seems to me that even more claims may arise against doctors regarding the failure to provide assistance.

These are very difficult questions. On the one hand, parents can say: you did not save the child. And others, on the contrary, will say: why are you torturing him in vain? And imagine a resuscitator who may be faced with an ethical choice: he has only one ventilator in the hospital, and a 23-week-old baby has been on it for the 40th day. And then a 32-week-old is born in the hospital. He needs help, hold him for three days on the device, and then the baby will cope on his own. In the first case, there will certainly be a disabled person. And in the second - almost healthy. And what should a doctor do?

Are you speaking theoretically now or do such situations occur?

We cannot have this in federal centers. We have enough equipment. I just illustrated with an example that the issue of nursing such children is the most difficult, all aspects are in common in it - from medical to ethical and religious.

Photo: Sergey Krasnoukhov / RIA Novosti

“The issue of infant mortality has always been political”

The issue of infant mortality has recently become political. Perhaps that is why patient scandals associated with maternity hospitals are developing so sharply?

The issue of infant mortality has always been political. This is a socially significant parameter that determines the position of the country in terms of development. In our country as a whole, infant mortality has significantly decreased over ten years. However, in the last two years the rate of decline has slowed down. Our government says it's bad. From the point of view of doctors, this is not entirely true. There are objective reasons that cannot be overcome with a swoop.

The primary decrease in mortality occurred due to the high-quality saturation of hospitals with equipment, due to the construction of perinatal centers. This gave immediate results. And now these figures have reached a plateau. Another thing is that a plateau, for example, in Kaliningrad, St. Petersburg, is one thing. There mortality rates are at the European level. That is very low. And there are regions where mortality is high - the Altai Territory, the Jewish Autonomous Region, Magadan. There is a lack of doctors, a lack of equipment, very long distances, routing difficulties. And it's very difficult to do anything about it.

We are not compact Switzerland. We have a huge country with difficult geographical conditions. There are regions where we cannot even deliver a woman by helicopter. At one time I spent a lot of time in Chukotka, watching the obstetric service. Often, if a premature baby is born there, you will not help him in any way.

There are no good hospitals there?

Everything is there, but in one city - in Anadyr. And if a woman gave birth in another place, then often she can be cut off from the world. There are periods when even planes do not fly: a snowstorm, something else. And with routing too you will not guess. Because when you are expecting your first child, you are not going to give birth at 24 weeks. This is if the situation with childbirth repeats, then you can plan something, come closer to specialized care at the “dangerous” time ...

Is it true that there have been more premature births lately?

No, their number is stable. This is approximately 7-10 percent of all newborns. Significantly increased their survival rate.

One of the most "inciting" topics on parenting Internet forums is that children who are "culled" by nature have a bad effect on the quality of the gene pool. Is there any reason to think so?

In order for the “survivors” to be able to influence the population, there must be a lot of them in percentage terms. For example, there are very few 26-week-olds - no more than two percent of all births. It can't affect anything in any way.

I know that at one time they discussed: what will happen if my child marries in the future someone who was once premature, will the gene pool suffer? Firstly, I can say that, as for children born after the 30th week, they are completely healthy, adapted and no different from others. They themselves give birth to beautiful healthy children, we have already seen many generations. The risk of preterm birth is not inherited. And usually premature babies are shaken, they are a lot of work. So in terms of development, these children can give odds to others.

As for children born 5-6 months old, when they catch up with their peers, it is important that parents continue an active life with them, and not engage in a protective regime. We need songs, dances, sports. These children have behavioral patterns. But now there are centers that supervise such families. If you take care of children, everything will be fine. I look at these kids regularly. And I have a much more optimistic outlook.