Premature baby information

Premature babies | March of Dimes

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

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

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

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

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

What is a premature baby?

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

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

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

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

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

Do premature babies need special medical care?

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

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

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

What kinds of health problems can premature babies have?

Health problems that may affect premature babies include:

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

Breathing problems. These include:

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

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

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

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

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

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

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

Last reviewed: October, 2019

Premature birth - Symptoms and causes

Overview

A premature birth means a baby is born too early. The birth takes place before the 37th week of pregnancy. A typical pregnancy lasts about 40 weeks.

Premature babies often have serious health problems, especially when they're born very early. These problems often vary. But the earlier a baby is born, the higher the risk of health challenges.

A newborn can 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 between 28 and 32 weeks of pregnancy.
Extremely preterm, born before 28 weeks of pregnancy.

Most premature births happen in the late preterm stage.

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Symptoms

Your baby may have very mild symptoms of premature birth or more-serious health problems.

Some signs of being born too early include:

Small size, with a head that's large compared with the body.
Features that are sharper and less rounded than a full-term baby's features due to a lack of cells that store fat.
Fine hair that covers much of the body.
Low body temperature, mainly right after birth in the delivery room.
Trouble breathing.
Feeding problems.

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 give birth to a preterm baby, your baby will likely need to stay in a special nursery unit at the hospital. Some infants need to spend time in a unit that cares for them and closely tracks their health day and night. This is called a neonatal intensive care unit (NICU).

A step down from the NICU is an intermediate care nursery, which provides less intensive care. Special nursery units are staffed with health care providers and a team that's trained to help preterm babies.

Your baby may need extra help feeding and adapting right after delivery. Your health care team can help you understand what's needed and what your baby's care plan will be. Feel free to ask them questions.

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Risk factors

Often, the exact cause of premature birth isn't clear. But certain things can raise the risk.

Some risk factors linked to past and present pregnancies include:

Pregnancy with twins, triplets or other multiples.
A span of less than six months between pregnancies. It's ideal to wait 18 to 24 months between pregnancies.
Treatments to help you get pregnant, called assisted reproduction, including in vitro fertilization.
More than one miscarriage or abortion.
A previous premature birth.

Some health problems can raise the risk of premature birth, such as:

Problems with the uterus, cervix or placenta.
Some infections, mainly those of the amniotic fluid and lower genital tract.
Ongoing health problems such as high blood pressure and diabetes.
Injuries or trauma to the body.

Lifestyle choices also can raise the risk of a preterm pregnancy, such as:

Smoking cigarettes, taking illicit drugs or drinking alcohol often or heavily while pregnant.
Being underweight or overweight before pregnancy.
Becoming pregnant before the age of 17 or after 35.
Going through stressful life events, such as the death of a loved one or domestic violence.

For unknown reasons, Black and Native people in the United States are more likely to have premature births than are women of other races. But premature birth can happen to anyone. In fact, many preterm births have no known risk factors.

Complications

Not all premature babies have health complications. But being born too early can cause short-term and long-term medical problems. In general, the earlier a baby is born, the higher the risk of complications. Birth weight plays a key role too.

Some problems may be clear at birth. Others may not show up 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 being born with lungs that aren't fully developed. If the baby's lungs lack a substance that allows the lungs to expand, the baby may have trouble getting enough air. This is a treatable problem called respiratory distress syndrome.

It's common for preterm babies to have pauses in their breathing called apnea. Most infants outgrow apnea by the time they go home from the hospital. Some premature babies get a less common lung disorder called bronchopulmonary dysplasia. They need oxygen for a few weeks or months, but they often outgrow this problem.
Heart problems. Some common heart problems that premature babies have are patent ductus arteriosus (PDA) and low blood pressure. PDA is an opening between two important blood vessels, the aorta and the pulmonary artery. This heart defect often closes on its own. But without treatment it can lead to problems such as heart failure. That's when the heart can't pump blood as well as it should. Low blood pressure may need to be treated with fluids given through a vein, medicines and sometimes blood transfusions.
Brain problems. The earlier a baby is born, the greater the risk of bleeding in the brain. This is called 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 quickly. They don't have the stored body fat of a full-term infant. And they can't make enough heat to counter what's lost through the surface of their bodies. If body temperature drops too low, it can lead to a dangerous problem called hypothermia.

Hypothermia in a premature baby can lead to breathing problems and low blood sugar levels. A preterm infant also may use up all of the energy gained from feedings just to stay warm. That's why smaller premature babies need extra heat from a warmer or an incubator at first.
Digestive problems. Premature infants are more likely to have digestive systems that aren't fully developed. This can lead to problems such as necrotizing enterocolitis (NEC). With NEC, the cells lining the bowel wall are injured. This problem can happen in premature babies after they start feeding. Premature babies who receive only breast milk have a much lower risk of getting NEC.
Blood problems. Premature babies are at risk of blood problems such as anemia and newborn jaundice. With anemia, the body doesn't have enough red blood cells. All newborns have a slow drop in red blood cell count during the first months of life. But that drop may be greater in premature babies. With newborn jaundice, the skin and eyes look yellow. It happens because the baby's blood contains too much of a yellow-colored substance from the liver or red blood cells. This substance is called bilirubin. Jaundice has many causes, but it is more common in preterm babies.
Metabolism problems. Premature babies often have problems with metabolism. That's the process by which the body changes food and drink into energy. Some premature babies may have a very low level of blood sugar. This can happen because premature infants often have smaller amounts of stored blood sugar than do full-term babies. Premature babies also have more trouble turning their stored sugar into more-usable, active forms of blood sugar.
Immune system problems. It's common for premature babies to have immune systems that aren't fully developed. This can lead to a higher risk of illnesses. An infection in a premature baby can quickly spread to the bloodstream and cause a life-threatening problem called sepsis.

Long-term complications

Over the long term, premature birth may lead to health problems such as:

Cerebral palsy. This group of disorders can cause problems with movement, muscle tone or posture. It can be due to an infection or poor blood flow. It also can stem from an injury to a newborn's brain, either early during pregnancy or while the baby is still young.
Trouble learning. Premature babies are more likely to lag behind full-term babies on different milestones. A school-age child who was born too early might be more likely to have learning disabilities.
Vision problems. Premature infants may get an eye disease called retinopathy of prematurity. This happens when blood vessels swell and grow too much in the light-sensing tissue at the back of the eye, called the retina. Sometimes these overgrown vessels slowly scar the retina and pull it out of place. When the retina is pulled away from the back of the eye, it's called retinal detachment. Without treatment, this can harm vision and cause blindness.
Hearing problems. Premature babies have a higher risk of losing some hearing. All babies should have their hearing checked before they go home from the hospital.
Dental problems. Preterm babies may be more likely than full-term babies to have defects with the hard outer covering of the teeth, called enamel. Infants born very or extremely early also may be more likely to have teeth that take longer to develop.
Behavior and mental health problems. Children who were born early may be more likely than kids born full term to have certain mental health troubles, as well as delays in development.
Ongoing health issues. Premature babies are more likely to have long-term health issues than are full-term infants. Illnesses, asthma and feeding problems are more likely to develop or linger. Premature infants also are at higher risk of sudden infant death syndrome (SIDS). That's when an infant dies for unclear reasons, often while asleep.

Prevention

The exact cause of preterm birth is often unknown. But some things can be done to help lower the risk of preterm birth, including:

Taking progesterone supplements. Progesterone is a hormone that plays a role in pregnancy. A lab-made version of it may be able to lower the risk of preterm birth if you've had a premature baby before. It also may lower the risk of preterm birth if you have a short cervix. The cervix is the lower end of the uterus, which opens during labor so a baby can be born.
Cervical cerclage. This is a surgery that's done during pregnancy. Your provider may suggest it if you have a short cervix and you've had a preterm birth before.

During this procedure, the cervix is stitched closed with a strong suture. This may give the uterus extra support. The suture is removed when it's time to have the baby. Ask your provider if you need to stay away from vigorous activity during the rest of your pregnancy.

One thing that doesn't help prevent preterm birth is staying in bed. Bed rest can raise the risk of blood clots, weaker bones and less muscle strength. It might even make preterm birth more likely.

By Mayo Clinic Staff

Associated Procedures

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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.

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.

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

• 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.

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.

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.

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, the 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, breathing stops may even be observed. The expansion of the lungs due to an insufficient amount of Surfactant is slowed down, and respiratory failure may occur.

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.

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.

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.

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.

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

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.

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.

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 body.

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.

What are the features of managing premature babies?

A newborn baby is not a miniature baby, and a premature baby is not a newborn who is just small.

Which babies are considered premature

A premature newborn is a baby born prematurely between 22 and 37 weeks of gestation. An interesting fact is that the weight of the child will not affect the status of “term”, because even if the baby was born small, with a weight of, for example, 2500 g, but at 37.5 weeks of gestation, then such a child will no longer have the status of “premature”, after all, most often all organs and systems have already matured, and for some reason he did not have time to gain weight. Such a newborn will be considered “low birth weight” and will have special care different from that of a premature baby.

In a premature newborn, almost all organs and systems are immature, because he still had to live in the womb and develop. However, for various reasons, what happens is what happens, and the child must adapt to the new conditions of life. Of course, the further nursing of a premature baby and its development will depend primarily on the gestational age at which the baby was born - the earlier the gestation period, the more immature the child will be, and his treatment and nursing will take many months or even years.

The weight of a premature baby, sufficient for survival, to carry out more successful measures to save the life of a baby after birth, according to experts, starts from 500 g, however, in life there are cases of children being born with much lower weight, who survived and successfully developed thanks to the professionalism of doctors and careful care of premature newborns for many months.

Causes of prematurity

The causes of prematurity can be different, but if they are divided into two main groups, then these are the reasons associated either with the mother or with the fetus.

The mother of the child may have various conditions that require early delivery, both against the background of a disease not associated with pregnancy and the upcoming birth (these can be chronic diseases of the heart, kidneys, etc.), and caused by the current condition (preeclampsia, eclampsia, placental abruption, inflammatory diseases, etc.)

The state of health of the fetus in utero can also cause early birth. These can be various syndromic conditions, Rh factor incompatibility, etc. There are cases of spontaneous delivery ahead of time, sometimes this is due to mother's stress.

Degrees of prematurity

In order not to load the reader with a lot of medical terminology, we single out 4 degrees of prematurity

1 – lightest when both due date and weight are close to term (35-37 weeks, preterm newborn weight over 2000 g)

2 - 32-34 weeks, body weight approximately 1500-2000g. The child is still immature, but will quickly be able to catch up with their full-term peers in development

3 - 29-31 weeks of gestation and weight between 1000 and 1500g

4 - 22-28 weeks, weight less than 1000g

Obviously, grades 3 and 4 of prematurity are the most difficult for both the baby and neonatologists. Often, the prognosis for the development of premature babies with this term at birth is unclear, because. at first, such a newborn will be assisted in the intensive care unit, supporting the functions of vital organs. And only over time, when the baby's condition stabilizes, when we can carefully evaluate the dynamics of the development of a premature baby by months, it will be possible to make assumptions about what the baby will be like.

Signs of prematurity

A premature newborn baby has both external features that indicate its immaturity, and internal ones.

First of all, attention is drawn to the large head with the predominance of the brain region of the skull of the relatively small body of the child. The sutures on the head are either soft or not yet completely closed, the fontanelles are large.

Also, the signs of a premature baby include the so-called lanugo - upon examination, the child's body is covered as if with fluff, especially pronounced on the back and limbs. Your baby's nails can be very soft.

Next, we examine the stomach - it often has a “frog shape” (with the lower extremities bent at the knees and hip joints, the abdomen seems to be flattened, the abdominal muscles are not yet able to hold the shape).

When examining the genital organs in boys, there may be a so-called. cryptorchidism, when the testicles have not yet had time to descend into the scrotum. This phenomenon is most often temporary and with age everything falls into place.

Features of the development of a premature newborn and the structure of its systems and organs

Cardiovascular system

The most mature system in a prematurely born is the cardiovascular system, because it begins to be laid from the 2nd week of pregnancy, and by the 3rd month the placental circulation is already established. By the time of birth, both full-term and premature infants can have functioning fetal communications (heart structures that function at the time of intrauterine development of the child, and must close after birth), such as the foramen ovale or ductus arteriosus. This requires long-term observation by a pediatrician in order to evaluate the functioning of a small heart and, if necessary, refer to a cardiologist and a cardiac surgeon to decide on a surgical intervention to close these communications if they affect the health of the baby.

Often, these defects close themselves, and only timely examinations by a pediatrician and the performance of control ultrasound examinations of the heart within the time schedule scheduled by the observing doctor can help in choosing the right tactics for managing the baby.

Enteral nutrition and gastrointestinal tract

As we said earlier - the more premature the child, the more immature organs and systems he has. This statement did not bypass the digestive system. And everything would be fine for a premature baby with digestion, because all the structures for proper digestion have already been formed, but there is one thing. But, which can become critical for the child. Digestion is regulated by the nervous system, which is formed and matures even after birth, then what can we say if the child was born prematurely, and the nervous system is just gaining momentum in development.

After birth, the baby is ready to receive its first drops of milk, and it is necessary to start feeding as early as possible, and the opportunity to breastfeed should not be missed if the condition of the baby allows it. However, due to the immaturity of the nervous system, a child, especially a very premature one, may not have a sucking reflex, and then feeding through the mouth is not possible. In this case, doctors install a nasogastric tube to continue feeding the baby with breast milk and specialized milk formulas through a special tube that delivers food directly to the stomach, bypassing the oral cavity and esophagus. And as soon as, over time, the baby is ready to take the mother’s breast again or suck on the nipple of the bottle, the probe will be removed, and the newborn will be transferred to “per os” nutrition, i.e. through the mouth so that he can enjoy the sweet taste of milk and feel even closer to his mother.

Nervous system

It is one of the most immature systems of a premature baby. Often, after discharge from the hospital, the diagnosis of the baby may be - Perinatal damage to the Central nervous system (CNS). You should not be scared right away, because there are different degrees of brain damage, and in view of the high plasticity of the cells of a newborn, with proper monitoring of the child and timely rehabilitation measures started, serious consequences can be avoided. However, there are more global problems with the nervous system, especially in very immature babies, or in more mature ones who have had a difficult birth. Here you need a sensitive view of a neurologist who will guide your child for at least the first year of life and determine the entire tactics of examination and treatment together with a pediatrician.

Disorders of the central nervous system are captured as the work of internal organs, which can lead, as we have already indicated above, to disruption of the gastrointestinal tract (prolonged regurgitation, constipation, feeding the child through a tube when it is impossible to suck on the breast or bottle with the mixture), breathing (premature baby can give pauses in breathing during sleep, often accompanied by an independent restoration of respiratory movements, but so frightening for parents), as well as to general neurological disorders in the form of developmental delays. We live in the 21st century, and now there are a lot of programs and centers for the rehabilitation of such babies. Some children will take years to recover from a difficult birth, some will require only mild correction of neurological disorders. In any case, you should not despair, you just need to find "your" specialists who will be with you throughout the entire recovery period of the baby.

Organs of vision

Parents of a premature baby may face such a diagnosis as "retinopathy of prematurity". This is an eye disease that occurs in premature babies due to incomplete maturation of the retinal vessels, i.e. there are zones on the retina where the vascular network has not yet had time to germinate due to the early birth of the baby (normally, the full maturation of the eye occurs just in time for full term, i.e. by the 40th week of gestation). After a baby is born prematurely, the vessels of the eye continue to grow, but they do not grow as they should - the vessels can grow inside the eye, which can lead to retinal detachment and complete loss of vision. The conditions of nursing the child will also affect this process. A premature baby should be nursed in semi-darkness, because the eye has not yet got used to the light, the baby still had to mature in the womb in the dark. Therefore, incubators with premature babies are covered with special covers to protect them from light and create more physiological conditions.

A child with this diagnosis should be seen by an ophthalmologist who specializes in premature babies and has special equipment to check the fundus. Inspection will be required weekly, and even more often, so as not to miss retinal detachments. The doctor may prescribe special drugs that can prevent the development of blindness. However, there are cases when it is not possible to avoid surgical treatment on the child's manholes (laser surgery). All this is aimed at preserving the baby's vision and requires well-coordinated work between parents and specialists.

Respiratory organs

Another immature system in preterm infants is the respiratory system, which is one of the last to mature as the fetus grows in the womb. Most often, problems with the lungs are associated with the fact that by the time of premature birth, a special substance (surfactant) has not been produced in a child in sufficient quantities, which prevents the alveoli from collapsing (sticking together) and normal breathing. Surfactant begins to be produced from 20-24 weeks of gestation and completes its synthesis by term (approximately 37 weeks). Thus, at birth, premature babies are given external surfactant to minimize the complications of lung immaturity, but this is not always 100% successful. Often the child cannot breathe on his own and he is transferred to breathing with the help of artificial lung ventilation (ALV). On the one hand, this is helping the child, because otherwise it is simply impossible to ensure adequate breathing. On the other hand, mechanical ventilation and oxygen supply can have a negative effect on the maturing lungs and lead to the development of bronchopulmonary dysplasia (BPD), which is characterized by a change in the structure of the lung parenchyma and long-term dependence on oxygen. In the vast majority of cases, this condition resolves within the first year of life, however, there are children who require supervision by a pediatrician and pulmonologist for a sufficiently long period of time.

Another problem for the respiratory system of the premature is the RS (respiratory syncytial) virus. In full-term and healthy infants, it can cause runny nose, cough, mild bronchial obstruction, but in immature lungs, it can cause severe bronchiolitis, as a result of which gas exchange in the lungs is disturbed and the child needs additional oxygen. For children at risk, there is a drug (palivizumab - Synagis), which will avoid severe forms of the course of the RS-virus infection, and the indications for the administration of the drug will be determined by the doctor observing the baby.

Care of premature babies

Nursing of premature babies is carried out, as a rule, in large perinatal centers by a team of medical specialists - resuscitators, neonatologists, neurologists, ophthalmologists, cardiologists. Of course, this is not the work of one specialist, because such a child requires the attention of a large number of doctors and the implementation of a multidisciplinary approach.

As we said above, nursing can last a very long time, because. the process of maturation of the child is not fast. Parents often need to be patient, and in some cases seek psychological help from specialists who will help them survive such a difficult period in the life of the family.

Possible consequences of prematurity

After analyzing the section with the features of the development of internal organs, we can summarize that the most important problems faced by premature babies are problems with the nervous system. The earlier the baby was born, the higher the risk of developing cerebral palsy.

Visual problems fade into the background due to the development of effective methods for the treatment of retinopathy, but still remain acute in relation to the most "early" preterm infants.

The respiratory system will also require special control due to the frequent development of bronchopulmonary dysplasia in such babies. Here you need to find a competent specialist who will tell you about the vaccination of a premature baby, because it can and should be protected from vaccine-preventable infections, which often affect the lung tissue.