Having a premature baby

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

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Caring for a Premature Baby: What Parents Need to Know

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Premature birth occurs in about 11 to 13 percent of pregnancies in the US.
Almost 60 percent of twins, triplets, and other multiple deliveries result in preterm births.

It is important to recognize that preterm deliveries, even if late preterm, should never be done for the convenience of the mother or obstetrician. Research has shown that late preterm babies have significantly greater risk for negative outcomes, and all efforts should be made to have babies reach full term. See Let Baby Set the Delivery Date: Wait until 39 Weeks if You Can.

Characteristics of Babies Born Premature

While the average full-term baby weighs about 7 pounds (3.17 kg) at birth, a premature newborn might weigh 5 pounds (2.26 kg) or even considerably less. But thanks to medical advances, children born after twenty-eight weeks of pregnancy, and weighing more than 2 pounds 3 ounces (1 kg), have almost a full chance of survival; eight out of ten of those born after the thirtieth week have minimal long-term health or developmental problems, while those preterm babies born before twenty-eight weeks have more complications, and require intensive treatment and support in a neonatal intensive care unit (NICU).

How Your Premature Baby Looks

The earlier your baby arrives, the smaller she will be, the larger her head will seem in relation to the rest of her body, and the less fat she will have.
With so little fat, her skin will seem thinner and more transparent, allowing you actually to see the blood vessels beneath it. She also may have fine hair, called lanugo, on her back and shoulders.
Her features will appear sharper and less rounded than they would at term, and she probably won't have any of the white, cheesy vernix protecting her at birth, because it isn't produced until late in pregnancy. Don't worry, however; in time she'll begin to look like a typical newborn.
Because she has no protective fat, your premature baby will get cold in normal room temperatures. For that reason, she'll be placed immediately after birth in an incubator (often called an isolette) or under a special heating device called a radiant warmer. Here the temperature can be adjusted to keep her warm.
After a quick examination in the delivery room, she'll probably be moved to the NICU.

How Your Premature Baby Acts

You also may notice that your premature baby will cry only softly, if at all, and may have trouble breathing. This is because her respiratory system is still immature.
If she's more than two months early, her breathing difficulties can cause serious health problems, because the other immature organs in her body may not get enough oxygen. To make sure this doesn't happen, doctors will keep her under close observation, watching her breathing and heart rate with equipment called a cardio-respiratory monitor.
If she needs help breathing, she may be given extra oxygen, or special equipment such as a ventilator; or another breathing assistance technique called CPAP (continued positive airway pressure) may be used temporarily to support her breathing.

Additional Information:

Preemie Milestones
Health Issues of Premature Babies
Challenges Faced by Parents of Children with Congenital Heart Disease
Depression During & After Pregnancy: You Are Not Alone

Last Updated: 10/31/2019

Source: Adapted from Caring for Your Baby and Young Child: Birth to Age 5, 6th Edition (Copyright © 2015 American Academy of Pediatrics)

The information contained on this Web site should not be used as a substitute for the medical care and advice of your pediatrician. There may be variations in treatment that your pediatrician may recommend based on individual facts and circumstances.

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.

The first weeks of a premature baby: what to prepare for

What is the difference between caring for a newborn if he was born prematurely and how to help him "catch up" with other babies

You were not ready for the fact that the baby will be born ahead of schedule? No one, unfortunately, is immune from preterm birth. The reasons are varied, from multiple pregnancy to infection and severe stress. Fortunately, modern medicine is able to nurse most premature babies. Neonatologist Milana Basargina talks about special care rules.

A baby is considered premature if he was born at a gestational age of 36 weeks or less. Most premature babies are born with a body weight of less than 2500 g and a height of less than 45 cm. According to the State Statistics Committee of the Russian Federation, the frequency of birth of children with low body weight in Russia is 4.0-7.3% in relation to the number of births. Among premature babies, about 80% are children born at a gestational age of 32-36 weeks. Babies born less than 32 weeks of age and weighing less than 1500 g are considered profoundly preterm.

The birth of a premature baby is always a cause for special worries and worries for parents. Doctors, relatives and the child himself have a lot of work to make up for lost weeks or even months of intrauterine development.

Often a prematurely born child causes parents to feel fear, guilt and hopelessness - and then there is increased overprotection, anxiety, disappointment. But modern medicine copes well with such situations, and with proper home care and a properly selected rehabilitation course (specialists will take care of this!) Even very premature babies not only survive, but by the age of 1. 5–3 years they catch up with their peers.

An object of increased attention

Every newborn needs the attention of visiting nurses and pediatricians, but in case of premature birth, the baby is constantly monitored by several specialists: a pediatrician, a cardiologist, a neurologist, an ophthalmologist, and, if indicated, a pulmonologist, an orthopedist, an immunologist. Such children can be registered at the dispensary for up to 7 years. This does not mean that all premature babies will necessarily have health problems, but since the risk is high, it is better for parents to be on the lookout and remember that any little things can matter. Do not be afraid to ask the doctor absolutely any questions, no matter how ridiculous they may seem to you!

The first weeks in the maternity hospital are a very difficult period, when in no case should you let feelings of guilt, anxiety and fear take over all your thoughts. It is necessary to maintain a positive attitude in order to convey your calmness to the baby. For support, you can contact a psychologist who is in the perinatal center or maternity hospital.

It is very dangerous for a premature baby to meet with infections. Therefore, after the child is discharged home, it is better to ask strangers to refrain from visiting for the time being. But it’s better for a child to get to know all the pets better so that he can get used to their microflora and develop immunity.

Sleep and temperature

In the first month, a premature baby will sleep a lot. Some of these babies sleep up to 22 hours a day. In a dream, they gain strength. Many parents worry, but this amount of sleep is nothing to worry about. In a month, the baby will get stronger, will be more awake, will, like all other babies, worry about colic, be capricious and behave more actively.

Watch the temperature! A premature baby has poorly developed subcutaneous tissue and a completely immature thermoregulation system, so he needs more heat. The air in the room should be warmed up to 22-25ºС. The baby himself is additionally heated with heating pads with water at 60-65ºС. You can use from one to three heating pads, depending on the degree of prematurity of the child and the temperature in the room. Warmers should be wrapped in towels or diapers and placed under the blanket at the feet, as well as on top of the blanket on the sides of the child, at a palm's distance from him. No direct contact of heating pads with the baby's skin! To constantly monitor the temperature under the blanket next to the baby, you can put a thermometer. You need to change the heating pads every one and a half to two hours, alternately, in order to maintain constant heating. But the face of a newborn must be left open (without covering it with a blanket).

By the end of the first month, the baby will begin to “keep” body temperature on his own and gradually it will be possible to refuse artificial heating. The body temperature of a premature baby should be measured in the morning and in the evening. According to the doctor's recommendations - more often, sometimes with each swaddling. This must be done without undressing the baby.

Meals by the hour

A child, even a sleeping one, also needs food, so at first it is better to feed not on demand, but at the frequency indicated by the doctor.

The only person who definitely needs breastfeeding is a baby in a hurry to be born. Breast milk prevents a number of neurological problems, improves immunity. Breast milk is living tissue in the body that adapts to the needs of the baby. There are no analogues of such food!

The immature intestine perceives food very poorly, but iron, for example, from breast milk is absorbed by the child by 70% (from mixtures - only 10%). The mother of a premature baby needs to make every effort to maintain lactation by the time the baby is discharged from the hospital. If this fails, you can seek help from a lactation consultant. If the baby does not have the strength to suck, milk must be expressed and given from a pipette or from a nipple.

Daily care

Clothes

If the baby is born weighing more than 2 kg, it does not need to be wrapped up. He will fit the same clothes as other (term) babies. Another thing is crumbs weighing less than 2 kg. They need a lot more things. The wardrobe should have a knitted cap, a knitted blouse with a hood and sewn-in sleeves, and sliders. A child dressed in this way can be wrapped in a flannel blanket or put in a woolen envelope, and covered with a flannel blanket on top. Only the face remains open! By the way, there are special sliders with natural wool lining in the area of the feet, which stimulates reflex zones, providing not only a warming, but also a tonic and restorative effect.

By the end of the first month, you can gradually give up the envelope and blanket. Since in such babies special attention should be paid to the development of the respiratory system, they should not be constrained by tight swaddling. In order for all parts of the lungs of a newborn to breathe evenly, it must be regularly shifted from one side to the other.

Bathing…by weight

Babies under 1500g do not need daily bathing for the first 2-3 weeks. For the rest of the newborns with low body weight, it is enough to wait 7-10 days with a bath. The temperature of the water in the bath should be 38ºС, and in the room where bathing takes place - at least 25ºС.

Short walks

Be very careful with walks: a sudden change in temperature can adversely affect your baby's health. Premature babies born with a body weight of more than 1500 g can be taken out for walks for 10–15 minutes, starting from the age of two weeks (during the warm season at an air temperature of 25–26ºС). The time spent outdoors can be gradually increased to 1–1.5 hours.

In autumn and spring (at air temperatures up to 10ºС), you can only walk with babies aged 1–1.5 months weighing at least 2500 g. At air temperatures below 8–10ºС, you can walk with premature babies only from 2 months when they reach a body weight of 2800–3000 g.

Life under observation

Premature babies are observed by doctors at the place of residence. Periodic consultations of specialists, primarily a neurologist, are mandatory. At the age of 1-2 weeks and beyond, to prevent rickets, vitamin D is added to food as prescribed by a doctor, massage and hardening are prescribed.

Vaccinations for premature babies require an individual approach. Each of them has their own vaccination schedule. For those who are healthy and were born with a body weight of more than 2000 g, the vaccination schedule will not differ from full-term children. Babies born weighing less than 2000 g are not vaccinated with BCG at the maternity hospital. It will be done when the baby weighs at least 2500 g within the time frame individually determined by the doctor.

During the first two years, a premature baby is under the supervision of a cardiologist. At 2, 4, 6 and 12 months of a child's life, electrocardiography (ECG) is necessary to assess the work of the heart muscle. At 2, 6, 12 and 24 months, it is advisable to conduct an ultrasound examination of the heart (echocardiography - ECHO-KG).

Although all these procedures may take a long time, do not refuse such services. The most difficult thing for families with premature babies is to admit that some problems still remain, because you really want to forget all the difficulties of the first weeks. But regular monitoring is the surest way to avoid complications.

Warm environment

Not only the ambient temperature is important for the baby. He just needs your warmth. Try to press the baby to your own body as much as possible - skin-to-skin contact is very important for him now. A sling is very good for these purposes. After all, a premature baby needs to be conveyed in the literal sense! In one American hospital, a volunteer named David Deutschman has been helping to nurse newborns in the intensive care unit for more than 12 years. He is exactly what "nourishes" babies. He just holds and wears it on his hands. David comes to the hospital and spends time with premature babies whose parents cannot always be near them.