Is 37 weeks a preemie
Premature infant: MedlinePlus Medical Encyclopedia
A premature infant is a baby born before 37 completed weeks of gestation (more than 3 weeks before the due date).
At birth, a baby is classified as one of the following:
- Premature (less than 37 weeks gestation)
- Full term (37 to 42 weeks gestation)
- Post term (born after 42 weeks gestation)
If a woman goes into labor before 37 weeks, it is called preterm labor.
Late preterm babies who are born between 35 and 37 weeks gestation may not look premature. They may not be admitted to a neonatal intensive care unit (NICU), but they are still at risk for more problems than full-term babies.
Health conditions in the mother, such as diabetes, heart disease, and kidney disease, may contribute to preterm labor. Often, the cause of preterm labor is unknown. Some premature births are multiple pregnancies, such as twins or triplets.
Different pregnancy-related problems increase the risk of preterm labor or early delivery:
- A weakened cervix that begins to open (dilate) early, also called cervical incompetence
- Birth defects of the uterus
- History of preterm delivery
- Infection (a urinary tract infection or infection of the amniotic membrane)
- Poor nutrition right before or during pregnancy
- Preeclampsia: high blood pressure and protein in the urine that develop after the 20th week of pregnancy
- Premature rupture of the membranes (placenta previa)
Other factors that increase the risk for preterm labor and a premature delivery include:
- Age of the mother (mothers who are younger than 16 or older than 35)
- Being African American
- Lack of prenatal care
- Low socioeconomic status
- Use of tobacco, cocaine, or amphetamines
The infant may have trouble breathing and keeping a constant body temperature.
A premature infant may have signs of the following problems:
- Not enough red blood cells (anemia)
- Bleeding into the brain or damage to the brain's white matter
- Infection or neonatal sepsis
- Low blood sugar (hypoglycemia)
- Neonatal respiratory distress syndrome, extra air in the tissue of the lungs (pulmonary interstitial emphysema), or bleeding in the lungs (pulmonary hemorrhage)
- Yellow skin and whites of the eyes (newborn jaundice)
- Problems breathing due to immature lungs, pneumonia, or patent ductus arteriosus
- Severe intestinal inflammation (necrotizing enterocolitis)
A premature infant will have a lower birth weight than a full-term infant. Common signs of prematurity include:
- Abnormal breathing patterns (shallow, irregular pauses in breathing called apnea)
- Body hair (lanugo)
- Enlarged clitoris (in female infants)
- Less body fat
- Lower muscle tone and less activity than full-term infants
- Problems feeding due to trouble sucking or coordinating swallowing and breathing
- Small scrotum that is smooth and has no ridges, and undescended testicles (in male infants)
- Soft, flexible ear cartilage
- Thin, smooth, shiny skin that is often transparent (can see veins under skin)
Common tests performed on a premature infant include:
- Blood gas analysis to check oxygen levels in the blood
- Blood tests to check glucose, calcium, and bilirubin levels
- Chest x-ray
- Continuous cardiorespiratory monitoring (monitoring of breathing and heart rate)
When premature labor develops and can't be stopped, the health care team will prepare for a high-risk birth.
The mother may be moved to a center that is set up to care for premature infants in a NICU.
After birth, the baby is admitted to the NICU. The infant is placed under a warmer or in a clear, heated box called an incubator, which controls the air temperature. Monitoring machines track the baby's breathing, heart rate, and level of oxygen in the blood.
A premature infant's organs are not fully developed. The infant needs special care in a nursery until the organs have developed enough to keep the baby alive without medical support. This may take weeks to months.
Infants usually cannot coordinate sucking and swallowing before 34 weeks gestation. A premature baby may have a small, soft feeding tube placed through the nose or mouth into the stomach. In very premature or sick infants, nutrition may be given through a vein until the baby is stable enough to receive all nutrition through the stomach.
If the infant has breathing problems:
- A tube may be placed into the windpipe (trachea).
A machine called a ventilator will help the baby breathe. - Some babies whose breathing problems are less severe receive continuous positive airway pressure (CPAP) with small tubes in the nose instead of the trachea. Or they may receive only extra oxygen.
- Oxygen may be given by ventilator, CPAP, nasal prongs, or an oxygen hood over the baby's head.
Infants need special nursery care until they are able to breathe without extra support, eat by mouth, and maintain body temperature and body weight. Very small infants may have other problems that complicate treatment and require a longer hospital stay.
There are many support groups for parents of premature babies. Ask the social worker in the neonatal intensive care unit.
Prematurity used to be a major cause of infant deaths. Improved medical and nursing techniques have increased the survival of premature infants.
Prematurity can have long-term effects. Many premature infants have medical, developmental, or behavioral problems that continue into childhood or are permanent.
The more premature the baby is and the smaller their birth weight is, then the risk is greater for complications. However, it is impossible to predict a baby's long-term outcome based on gestational age or birth weight.
Possible long-term complications include:
- Long-term lung problem called bronchopulmonary dysplasia (BPD)
- Delayed growth and development
- Mental or physical disability or delay
- Vision problem called retinopathy of prematurity, resulting in low vision or blindness
The best ways to prevent prematurity are to:
- Be in good health before getting pregnant.
- Get prenatal care as early as possible in the pregnancy.
- Continue to get prenatal care until the baby is born.
Getting early and good prenatal care reduces the chance of premature birth.
Premature labor can sometimes be treated or delayed by a medicine that blocks uterine contractions. Many times, however, attempts to delay premature labor are not successful.
Betamethasone (a steroid medicine) given to mothers in premature labor can make some prematurity complications less severe.
Preterm infant; Preemie; Premie; Neonatal - premie; NICU - premie
- Newborn jaundice - discharge
Brady JM, Barnes-Davis ME, Poindexter BB. The high-risk infant. In: Kliegman RM, St. Geme JW, Blum NJ, Shah SS, Tasker RC, Wilson KM, eds. Nelson Textbook of Pediatrics. 21st ed. Philadelphia, PA: Elsevier; 2020:chap 117.
Parsons KV, Jain L. The late preterm infant. In: Martin RJ, Fanaroff AA, Walsh MC, eds. Faranoff and Martin's Neonatal-Perinatal Medicine. 11th ed. Philadelphia, PA: Elsevier; 2020:chap 40.
Simhan HN, Romero R. Preterm labor and birth. In: Landon MB, Galan HL, Jauniaux ERM et al, eds. Gabbe's Obstetrics: Normal and Problem Pregnancies. 8th ed. Philadelphia, PA: Elsevier; 2021:chap 36.
Updated by: Neil K. Kaneshiro, MD, MHA, Clinical Professor of Pediatrics, University of Washington School of Medicine, Seattle, WA.
Also reviewed by David Zieve, MD, MHA, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.
Premature baby | Pregnancy Birth and Baby
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What is a premature baby?
Most pregnancies last 40 weeks. A baby born before the 37th week is known as a premature or pre-term baby. Medical advances have meant that more than 9 out of 10 premature babies survive, and most go on to develop normally.
In Australia, almost 1 in every 10 babies is born prematurely. Most Australian premature babies are born between 32 and 36 weeks and don't have any serious long-term problems.
Very premature babies are at a higher risk of developmental problems.
It is possible for babies born at 23 to 24 weeks to survive, but they are at a greater risk of health complications.
Many babies born before 32 weeks, and those weighing 2.5 kg or less, may need help breathing. They will usually be cared for in a neonatal intensive care unit (NICU) until they have developed enough to survive on their own. Babies born between 32 and 37 weeks may need care in a special care nursery (SCN).
Why are babies born prematurely?
Often the cause of premature birth is not known. However, some of the reasons babies are born prematurely include:
- problems with the cervix, when it is too weak to hold the weight of the baby and uterus so it starts to open prematurely (your doctor may call this ‘cervical incompetence’)
- multiple pregnancy (twins or more)
- birth parent has a medical condition that means the baby must be induced early, such as pre-eclampsia
- problems with the placenta such as placental insufficiency, placenta praevia, placenta accreta or placental abruption
- preterm (premature) rupture of membranes, when the amniotic sac spontaneously ruptures (also known as ‘waters breaking’)
- the birth parent has a health condition like diabetes, or an infection
- the birth parent has a history of premature labour
Signs of premature labour include:
- contractions
- your waters breaking
- a 'show' of mucus from your vagina, or a change in your vaginal discharge, or mucous, blood or fluid leaking from your vagina
- a sudden decrease in your baby's movements
- pressure in the pelvis, as if the baby is pushing down
- cramping in the lower part of the belly, diarrhoea, nausea or vomiting
- constant lower back pain
You should also contact your midwife or doctor if you experience swelling in your face, hands or feet, or double vision, blurred vision or other eye disturbances.
These are signs of pre-eclampsia, which is a common cause of pre-term births.
Find out more about the signs of labour.
What should I do if I experience signs of premature labour?
If you are less than 37 weeks pregnant and you experience any of the signs of premature labour, contact your doctor or nearest birthing centre immediately. It may be possible to slow down or stop the labour. Each day your baby stays inside your womb, the better their outcomes are likely to be.
If your labour starts prematurely, it’s best to go to a hospital that can care for your newborn, such as a hospital with a neonatal intensive care unit (NICU) or special care nursery (SCN). You can find your nearest suitable hospital on the Miracle Babies Foundation website.
How is a premature labour managed?
At the hospital, you will probably have a pelvic examination or an ultrasound. The medical team will check whether your cervix has started to open for labour and monitor your baby.
If the hospital where the baby is born does not have an NICU, you and your baby may be transferred to another hospital.
When you are in labour, you may be given medicines to stop the contractions for a while. This allows you to be transferred to another hospital if necessary. You may also receive injections of corticosteroids 12 to 24 hours before the birth. Steroids will reduce your baby’s risk of some of the complications of being born very early (for example, breathing difficulties).
Premature babies can be born very quickly. They will usually be born through the vagina. However, in some cases the doctor may decide it is safest for you to give birth to your baby by caesarean section. Your doctor will discuss this decision with you.
A medical team from the neonatal (newborn) unit will be there for the birth. As soon as your baby is born, they will care for the baby in your room. The health team might use some specialised equipment, for example, your baby may need a neonatal resuscitation bed.
The team will keep your baby warm and may help them to breathe with an oxygen mask or breathing tube, and possibly medicine. Some babies need help to keep their heart beating with cardio-pulmonary resuscitation (CPR) or an injection of adrenalin.
Once your baby is stable, they may be transferred to the NICU or SCN.
Will I be able to hold my baby?
How soon you are able to hold your baby will depend on their medical condition. You may be able to hold them on the day they are born, but you might need to wait a few days or weeks until they are stable enough.
Holding your baby, known as kangaroo care, is an important part of your baby’s health and wellbeing, and the maternity staff will support you to do this as soon as you are able to.
Will my baby be able to breast feed?
After your baby is born, you’ll be asked to start expressing breastmilk. Maternity staff, lactation consultants and Australian Breastfeeding Association counsellors can help you.
Breastmilk is full of antibodies and nutrients that will be very important for your baby’s health and growth. Your baby may be given breast milk through a feeding tube initially because if they aren’t able to breastfeed. However, there are things you can do to help your baby learn to breastfeed:
- Holding your baby skin-to-skin, as soon as it is safe to do so, can help your baby feel secure and can help to stimulate your milk supply. Skin-to-skin feeding can be a good way to help prepare both you and your baby for breastfeeding.
- When your baby is held skin-to-skin you may notice them becoming more alert, sucking their fingers or lips, and moving closer towards your breast. These are signs that your baby may be ready to feed.
- Babies in the NICU usually progress through several stages when starting to breast feed. They may start by nuzzling and licking your nipple. They may then move towards your breast and take a few sucks. With time they will take more sucks and start to swallow, and will do so for longer periods of time.
Eventually they will be looking to breastfeed with every feed. - If your baby is very premature or sick it may take time for your baby to breastfeed well. It may take weeks – this is very normal. Hold your baby skin-to-skin when you can, and always go at their pace. With time your baby will start to feed better.
- If you do not want to breastfeed or don't produce enough milk, the staff will discuss formula feeding with you.
What will my premature baby look like?
Babies born at 36 to 37 weeks usually look like small full-term babies. Very premature babies will be small (perhaps fitting in your hand) and look very fragile.
Skin: Your baby’s skin might not be fully developed, and may appear shiny, translucent, dry or flaky. Your baby may not have any fat under the skin to keep them warm.
Eyes: The eyelids of very premature babies may be fused shut at first. By 30 weeks they should be able to respond to different sights.
Immature development: Your baby might not be able to regulate their body temperature, breathing or heart rate. They may twitch, become stiff or limp or be unable to stay alert.
Hair: Your baby may have little hair on its head, but lots of soft body hair (called 'lanugo').
Genitals: Your baby's genitals may be small and underdeveloped.
Will my premature baby's development be delayed?
Some common issues for premature babies include:
- breathing problems
- heart problems
- problems in their digestive tract
- jaundice
- leukaemia and anaemia
- infections
Most premature babies will develop normally, but they have a higher risk of developmental problems and will need regular health and developmental checks at the hospital or with a paediatrician. If you are worried about your child's development, talk to your doctor.
Problems that may occur later in children who were born prematurely include:
- language delays
- growth and movement problems
- problems with teeth
- problems with vision or hearing
- thinking and learning difficulties
- social and emotional problems
How do I calculate my baby's ‘corrected age’?
When you're considering whether your premature baby is developing normally, it is important to understand their 'corrected age'.
The corrected age is your baby's chronological age (how long ago they were born) minus the number of weeks or months they were born early. For example, a 6-month-old baby who was born 2 months early would have a corrected age of 4 months. That means they might be doing the things that other 4-month-olds do. Most paediatricians recommend correcting age when assessing growth and development until your child is 2 years old.
When will my baby be able to come home?
The hospital will not send your baby home until they are confident both you and your baby are ready. Staff will make sure you understand how to care for your baby at home. They will also show you how to use any equipment you may need.
You will need appointments to see a neonatologist (newborn baby doctor) or paediatrician. Your local child health nurse will also see you regularly.
It is normal to feel a little worried when you are looking after your baby yourself after a while in hospital. Take it slowly, and try to create a calm and quiet environment, until you both become confident being at home.
How do I cope with the stress of having a premature baby?
Having a premature baby can be an overwhelming and stressful experience for many parents. If you have a baby in the NICU or special care nursery you may feel distant from your baby and feel that it is difficult to bond with your baby. You may feel anxious about your baby’s health, now and in the future.
It might be helpful for you to think about other times in your life when you were feeling stressed or anxious and consider the different things you did to help you cope. Talking to close family and friends, speaking to people in similar situations to you, seeking professional help and writing down your feelings, may be useful ways to cope during this challenging time.
Who can I talk to for advice and support?
If you need support, contact the Miracle Babies Foundation's website 24-hour support line on 1300 622 243.
The Australian Breastfeeding Association can provide advice and support on feeding your baby on 1800 686 268.
Speak to a maternal child health nurse
Call Pregnancy, Birth and Baby to speak to a maternal child health nurse on 1800 882 436 or video call. Available 7am to midnight (AET), 7 days a week.
Sources:
Miracle babies foundation (What is prematurity), Miracle babies foundation (Causes of prematurity), Royal Women's (Stages of labour), Miracle babies foundation (Corrected and chronological age), The Royal Women’s Hospital (The Royal Women’s Hospital), Miracle Babies Foundation (Going home), South Australian Perinatal Practice Guidelines (Preterm Labor and Birth), Miracle babies foundation (Kangaroo care), The Royal Women\u2019s Hospital (Helping your baby to breast feed in the NICU), The parent infant research institute (Having a premature baby), Miracle Babies Foundation (Understanding your feelings)Learn more here about the development and quality assurance of healthdirect content.
Last reviewed: August 2022
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Related pages
- Neonatal intensive care unit (NICU)
- Special care nursery (SCN)
- What is kangaroo care?
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Features of adaptation and development of premature babies. Doctor Plus Medical Center
The first year of a child's life is characterized by the most intensive growth and rapid development. But during this period, the body is extremely vulnerable, the defenses are weak and imperfect. This is especially true for children who were born prematurely and are considered premature.
Premature are children born at gestational age from 28 to 37 completed weeks, weighing from 1000 - 2500 grams, height 35 - 45 cm. nine0003
The reasons for their premature birth are varied: too young age and, accordingly, the mother's body; hemolytic disease of the fetus, which develops as a result of Rhesus conflict; pathological (not normal) course of pregnancy; previous abortions, illness, physical and mental trauma; harmful working conditions, the use of nicotine and alcohol.
What a premature baby looks like. Anatomical and physiological signs. nine0010
There are 4 degrees of prematurity, depending on the weight of the child:
Grade 1: 2500 -2001 grams Grade 3: 1500 - 1001 grams
Grade 2: 2000 – 1500 grams Grade 4: 1000 grams or less.
Since body weight may or may not correspond to the gestational age at the time of birth, premature babies are divided into 2 groups also according to these signs nine0003
• children whose physical development corresponds to the gestational age at the time of birth;
In premature babies, the subcutaneous fat layer is not sufficiently developed, i.
e. they suffer more from overheating and hypothermia. The skin is thin, dry, wrinkled, abundantly covered with fluff. Insufficient maturity of blood vessels is manifested by the Harlequin symptom. If you put the baby on its side, the skin acquires a contrasting pink color. nine0003
The bones of the skull are malleable, not only a large, but also a small fontanel is open.
The auricles are soft - the cartilage in them has not yet formed, they are pressed to the head, and not separated from it, as in full-term ones.
The nails do not reach the edge of the phalanges of the fingers, the umbilical cord is located below the middle of the body, and not in the center.
The underdevelopment of the genital organs is indicative: in girls, the labia minora are not covered by the large ones. In boys, the testicles are not descended into the scrotum. nine0003
The child sucks badly, swallows with difficulty. The cry is weak, breathing is not rhythmic. Physiological jaundice often lasts up to 3-4 weeks.
The umbilical cord falls off much later, and the umbilical wound heals more slowly.
It has its own characteristics and physiological weight loss. It is restored only by 2-3 weeks of life, and the timing of weight recovery is directly dependent on the maturity of the child, i.e. not only the date of his birth, but also the degree of adaptation of the baby to environmental conditions. nine0003
In premature babies, the nerve centers that regulate the rhythm of breathing are not fully formed. The formation of lung tissue has not been completed, in particular, a substance that prevents the “falling off” of the lungs - Surfactant. Therefore, their respiratory rate is not constant. With anxiety, it reaches 60-80 in 1 minute, at rest and during sleep it becomes less frequent, respiratory arrests may even be observed. The expansion of the lungs due to an insufficient amount of Surfactant is slowed down, and respiratory failure may occur. nine0003
The heart rate also depends on the condition of the child and environmental conditions.
With an increase in the ambient temperature and the child's anxiety, the heart rate increases to 200 beats per minute.
In premature newborns, asphyxia and cerebral hemorrhage occur more often. They are more likely to suffer from acute respiratory diseases, intestinal infections, which is due to weak immunity and insufficient development of many adaptive reactions. nine0003
These babies are more likely than full-term babies to develop anemia (anemia).
Especially during the period when intensive growth and weight gain begins (2-3 months). With proper nutrition of the child and the mother, if she breastfeeds, these phenomena quickly pass. In the case when anemia is of a protracted nature, it is necessary to prescribe iron preparations.
The further development of the child is determined not only by the degree of prematurity, but also in many respects, by the state of his health for a given period of time. nine0003
If the child is practically healthy, from the 2nd month of life, he gains weight and height in the same way as full-term ones.
By the end of the 1st year, the weight increases by 5-10 times compared to the weight at birth.
The average height is 70-77 cm.
The nervous system of premature babies is also more immature. The development of various skills, their intellectual development lags behind by 1-2 months.
These children sit down later, start walking later, they may have anomalies in the structure of the foot, curvature of the legs, and spine. If children are born very premature and often get sick, their development slows down by about a year. In the future, it levels off, approximately to preschool age. nine0003
If you have suffered intrauterine malnutrition, i.e. the nutrition of the fetus was disturbed for some reason - diseases of the mother, anomalies in the development of the child itself, anomalies in the development of the umbilical cord and placenta, then its central nervous system can recover for a long time (therefore, the observation of a neurologist is very important).
There may be lability of the nervous system (mood changes easily, often gives in to emotions, conflicts with other people are not uncommon), night terrors, enuresis (urinary incontinence), lack of appetite, a tendency to nausea. nine0003
However, in general, premature babies grow up as quite normal people.
Care of a premature baby after discharge from the maternity hospital.
For a child born prematurely, dispensary observation is established at the place of residence up to 7 years.
Periodic consultations of specialists are obligatory, first of all - a neurologist, as well as a surgeon, an otolaryngologist, an ophthalmologist nine0003
From the age of 2-4 weeks, rickets is prevented (ultraviolet
irradiation - quartzization, the addition of vitamin D to food, massage, hardening).
The most adequate type of nutrition for a premature baby is breastfeeding. But given that the baby can suck out an insufficient amount of breast milk, you can supplement it with expressed milk or adapted mixtures.
From 4 months - vegetable purees, 5 months. - porridge, 6 months. - give meat soufflé.
Correction of protein and fat deficiency is carried out by adding the required amount of kefir and cottage cheese, starting with 5 ml, gradually increasing the dosage.
The room in which a premature baby lives should be bright, dry and thoroughly ventilated. The optimum room temperature is 20-22 *. S. Walks are very important. Sufficient exposure to fresh air prevents the development of pathological conditions. nine0003
In winter, walks start from the age of 2 months at an air temperature not lower than -8, -10*C. The duration of the walk is from 15 minutes to 2 hours. In summer, a child can spend all the intervals between feedings during the day in the fresh air. On windy, rainy and very hot days (more than 30*C), it is better for children to sleep indoors with windows open or on the veranda.
Daily warm baths are helpful. When bathing premature babies, the water temperature should be at least 37*C.
nine0003
Vaccination of premature babies is carried out strictly according to an individual schedule, it depends on the state of health, physical and neuropsychic development of the child.
When organizing care for a child born prematurely, one should take into account the functional characteristics of the organism.
In conclusion, let us say: as long-term observations show, despite all the peculiarities, with good care, due attention of parents and doctors, premature babies develop successfully and after a year they catch up with their peers. nine0099
Premature babies. What are Premature Babies?
IMPORTANT
The information in this section should not be used for self-diagnosis or self-treatment. In case of pain or other exacerbation of the disease, only the attending physician should prescribe diagnostic tests. For diagnosis and proper treatment, you should contact your doctor.
Premature babies are babies born before the due date, functionally immature, with a weight below 2500 g and a body length of less than 45 cm.
underdevelopment of the genital organs, weakness or absence of reflexes, weak cry, intense and prolonged jaundice, etc. Nursing premature babies involves the organization of special care - temperature, humidity, oxygenation level, feeding, and, if necessary, intensive care. nine0003
- Causes of prematurity
- Classification of prematurity
- External signs of prematurity
- Anatomical and physiological features of premature babies
- Specific care for premature babies
- Medical examination of premature babies
- Prices for treatment
General
Premature children are those born between the 28th and 37th weeks of pregnancy, having a body weight of 1000-2500 g and a body length of 35-45 cm. The gestational age is considered the most stable criterion; anthropometric indicators, due to their significant variability, are conditional criteria for prematurity. Every year, as a result of spontaneous premature birth or artificially induced termination of pregnancy in the later stages, 5-10% of children from the total number of newborns are born prematurely.
nine0003
According to the WHO definition (1974), a fetus is considered viable with a gestational age of more than 22 weeks, a body weight of 500 g, a body length of 25 cm. length less than 35 cm is regarded as a late miscarriage. However, if such a child was born alive and lived after birth for at least 7 days, he is registered as premature. The level of neonatal mortality among premature babies is much higher than that among full-term babies, and largely depends on the quality of medical care in the first minutes and days of a child's life. nine0003
premature babies
Causes of prematurity
All the reasons leading to the birth of premature babies can be grouped into several groups. The first group includes socio-biological factors, including too young or old age of parents (under 18 and over 40), bad habits of a pregnant woman, malnutrition and unsatisfactory living conditions, occupational hazards, unfavorable psycho-emotional background, etc.
Risk of premature delivery and birth premature babies are higher in women who did not plan a pregnancy and neglect medical support for pregnancy. nine0003
The second group of reasons is burdened obstetric and gynecological history and the pathological course of this pregnancy in the expectant mother. Here, a history of abortion, multiple pregnancy, gestosis, hemolytic disease of the fetus, and premature detachment of the placenta are of the greatest importance. The reason for the birth of premature babies can be short (less than 2 years) intervals between births. Premature babies are often born to women who resort to in vitro fertilization, but this is not due to the very fact of using ART, but rather to the “female” factor that prevents natural fertilization. Gynecological diseases and malformations of the genitals adversely affect pregnancy: cervicitis, endometritis, oophoritis, fibroma, endometriosis, bicornuate saddle uterus, uterine hypoplasia, etc. nine0003
The third group of causes that disrupt the normal maturation of the fetus and cause an increased likelihood of the birth of premature babies include various extragenital diseases of the mother: diabetes mellitus, hypertension, heart defects, pyelonephritis, rheumatism, etc.
Often, premature births are provoked by acute infectious diseases suffered by a woman in late gestation periods.
Finally, the birth of premature babies may be associated with pathology and abnormal development of the fetus itself: chromosomal and genetic diseases, intrauterine infections, severe malformations. nine0003
Classification of prematurity
Taking into account the indicated criteria (gestational age, body weight and length), 4 degrees of prematurity are distinguished:
I degree of prematurity - delivery occurs at a period of 36-37 weeks of gestation; the body weight of the child at birth is 2500-2001 g, length - 45-41 cm.
II degree of prematurity - delivery occurs at a period of 32-35 weeks of gestation; the body weight of the child at birth is 2001-2500 g, length - 40-36 cm. nine0003
III degree of prematurity - delivery occurs at a period of 31-28 weeks of gestation; the body weight of a child at birth is 1500-1001 g, length - 35-30 cm.
IV degree of prematurity - delivery occurs before 28 weeks of gestation; the birth weight of the child is less than 1000 g, the length is less than 30 cm. The term "premature with extremely low body weight" is used in relation to such children.
External signs of prematurity
Premature babies are characterized by a number of clinical signs, the severity of which correlates with the degree of prematurity.
Severely preterm infants weighing <1500 are born with thin wrinkled skin richly covered with cheesy grease and vellus hair (lanugo). The skin has a bright red color (the so-called simple erythema), which turns pale by 2-3 weeks of age. The subcutaneous fat layer is absent (hypotrophy II-II degree), the child's physique is disproportionate (the head is large and is approximately 1/3 of the body length, the limbs are relatively short). The abdomen is large, flattened with a clearly visible divergence of the rectus muscles, the navel is located in the lower abdomen.
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In very premature babies, all fontanelles and sutures of the skull are open, the cranial bones are supple, the brain skull prevails over the facial one. Characterized by underdevelopment of the auricles, poor development of the nails (nail plates do not reach the fingertips), weak pigmentation of the nipples and areola. The genital organs in premature babies are underdeveloped: in girls there is a gaping of the genital slit, in boys - undescended testicles into the scrotum (cryptorchidism).
Premature babies born at 33-34 weeks of gestation and later are characterized by greater maturity. Their appearance is distinguished by the pink color of the skin, the absence of fluff on the face and torso, a more proportional physique (smaller head, higher navel, etc.). In premature babies of I-II degree, the bends of the auricles are formed, the pigmentation of the nipples and areola circles is pronounced. In girls, the large labia almost completely cover the genital gap; in boys, the testicles are located at the entrance to the scrotum.
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Anatomical and physiological features of premature babies
Prematurity is determined not so much by anthropometric indicators as by morphological and functional immaturity of vital organs and body systems.
Characteristic features of the respiratory organs in premature infants are the narrowness of the upper respiratory tract, the high position of the diaphragm, the compliance of the chest, and the perpendicular arrangement of the ribs relative to the sternum. These morphological features of premature babies cause superficial, frequent, weakened breathing (40-70 per minute), a tendency to apnea lasting 5-10 seconds (apnea of prematurity). Due to the underdevelopment of the elastic tissue of the lungs, the immaturity of the alveoli, and the reduced content of surfactant in premature babies, a syndrome of respiratory disorders easily occurs (congestive pneumonia, respiratory distress syndrome). nine0003
The immaturity of the cardiovascular system is characterized by pulse lability, tachycardia 120-180 per minute, muffled heart tones, arterial hypotension (55-65/20-30 mm Hg).
In the presence of congenital heart defects (open ductus arteriosus, open foramen ovale), murmurs may be heard. Due to the increased fragility and permeability of the vascular walls, hemorrhages easily occur (subcutaneous, into internal organs, into the brain).
Morphological signs of CNS immaturity in premature infants are weak differentiation of gray and white matter, smoothness of the brain sulci, incomplete myelination of nerve fibers, and poor vascularization of the subcortical zones. Muscle tone in premature babies is weak, physiological reflexes and motor activity are reduced, the reaction to stimuli is slowed down, thermoregulation is impaired, and there is a tendency to both hypo- and hyperthermia. In the first 2-3 weeks, a premature baby may experience transient nystagmus and strabismus, tremors, shudders, stop clonus. nine0003
In premature babies, functional immaturity of all parts of the gastrointestinal tract and low enzyme-excretory activity are noted.
In this regard, premature babies are prone to regurgitation, the development of flatulence, dysbacteriosis. Jaundice in premature babies is more intense and lasts longer than in full-term newborns. Due to the immaturity of the liver enzyme systems, the increased permeability of the blood-brain barrier, and the rapid breakdown of red blood cells, premature infants can easily develop bilirubin encephalopathy. nine0003
Functional immaturity of the kidneys in premature infants leads to changes in the electrolyte balance (hypocalcemia, hypomagnesemia, hypernatremia, hyperkalemia), decompensated metabolic acidosis, a tendency to edema and rapid dehydration with inadequate care.
The activity of the endocrine system is characterized by a delay in the formation of the circadian rhythm of hormone release, rapid depletion of the glands. In premature babies, there is a low synthesis of catecholamines, transient hypothyroidism often develops, and a sexual crisis rarely occurs in the first days of life (physiological mastitis, physiological vulvovaginitis in girls).
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In premature babies, early anemia develops more rapidly than in full-term babies, there is an increased risk of developing septicemia (sepsis) and septicopyemia (purulent meningitis, osteomyelitis, ulcerative necrotic enterocolitis).
During the first year of life, the increase in body weight and length in premature babies occurs very intensively. However, according to anthropometric indicators, premature babies catch up with their peers born at term only by 2-3 years (sometimes by 5-6 years). The lag in psychomotor and speech development in premature babies depends on the degree of prematurity and comorbidities. In a favorable scenario for the development of a premature baby, alignment occurs in the 2nd year of life. nine0003
Further physical and psychomotor development of premature babies may be on par with their peers or be delayed.
Among premature babies, neurological disorders are more common than among full-term peers: astheno-vegetative syndrome, hydrocephalus, convulsive syndrome, vegetative-vascular dystonia, cerebral palsy, hyperactivity, functional dyslalia or dysarthria.
Almost a third of premature babies have a pathology of the organ of vision - myopia and astigmatism of varying severity, glaucoma, strabismus, retinal detachment, optic nerve atrophy. Premature babies are prone to frequent repeated SARS, otitis media, against which hearing loss may develop. nine0003
Women born prematurely in adulthood often suffer from menstrual irregularities, signs of sexual infantilism; they may be at risk of spontaneous abortion and premature birth.
Specific care for premature babies
Babies born prematurely need special care. Their phased nursing is carried out by neonatologists and pediatricians, first in the maternity hospital, then in the children's hospital and polyclinic. The main components of caring for premature babies are: ensuring optimal temperature and humidity conditions, rational oxygen therapy and metered feeding. In premature babies, constant monitoring of the electrolyte composition and CBS of the blood, monitoring of the gas composition of the blood, pulse and blood pressure is carried out.
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Very premature babies are placed immediately after birth in incubators, where, taking into account the condition of the child, a constant temperature (32-35 ° C), humidity (in the first days about 90%, then 60-50%), oxygenation level (about 30%) are maintained. Premature babies of I-II degree are usually placed in heated beds or in ordinary beds in special boxes, where the air temperature is maintained at 24-25°C.
Premature babies who are able to independently maintain normal body temperature, who have reached a body weight of 2000 g, with good epithelization of the umbilical wound, can be discharged home. The second stage of nursing in specialized departments of children's hospitals is indicated for premature infants who have not reached 2000 g in the first 2 weeks, and for children with perinatal pathology. nine0003
Feeding premature babies should begin in the first hours of life. Children with absent sucking and swallowing reflexes are fed through a gastric tube; if the sucking reflex is sufficiently pronounced, but the body weight is less than 1800 g, the child is fed through the nipple; children weighing over 1800 g may be breastfed.
The frequency of feeding premature babies I-II degree 7-8 times a day; III and IV degree - 10 times a day. Calculation of food is made according to special formulas. nine0003
Premature babies with physiological jaundice should receive phototherapy (general UV). As part of the rehabilitation of premature babies at the second stage, communication between the child and the mother, skin-to-skin contact, is useful.
Medical examination of premature babies
After discharge, children born prematurely need constant monitoring by a pediatrician during the first year of life. Examinations and anthropometry are carried out weekly in the first month, once every two weeks - in the first half of the year, once a month - in the second half of the year. In the first month of life, premature babies should be examined by a pediatric surgeon, pediatric neurologist, pediatric orthopedic traumatologist, pediatric cardiologist, pediatric ophthalmologist.
