Premature babies: nursing and feeding in the first days of life. Premature baby

Principles of nursing a premature baby.

Nursing of a premature baby is carried out in a complex, both in stationary conditions and at home. Conditionally represented by 3 stages:

Stage 1. Intensive care in the maternity hospital.

Stage 2. Observation and treatment in a specialized department for premature babies.

Stage 3. Dynamic observation in a children's clinic, at home.

Stage 1. Intensive care in the maternity hospital.

When caring for premature babies, you must follow all the rules of asepsis and antisepsis. The first treatment and preventive measures are carried out in the delivery room. To prevent aspiration of amniotic fluid, all premature babies after birth are suctioned off the mucus from the upper respiratory tract, and for children born in cephalic presentation, this procedure is carried out in the early stages - immediately after the removal of the child's head.

All manipulations must be carried out in conditions that exclude the cooling of the child (the air temperature in the delivery room must be at least 25 C, humidity 66-60%, changing table with a source of radiant heat). Additional heating from the moment of birth is an important condition for its successful nursing!

If the child was born in a state hypoxia, a mixture is injected into the umbilical cord vein, including a 10% glucose solution, a cocarboxylase solution, a 5% ascorbic acid solution, a 10% calcium gluconate solution.

After initial treatment and ligation of the umbilical cord, premature babies weighing more than 2000 grams, wrapped in diapers and an envelope from a flannel blanket, are placed in beds at an ambient temperature of 24-26 C, since they are able to maintain a normal temperature balance themselves.

Premature babies weighing more than 1500 g can be effectively nursed in special beds "Bebitherm" with heating and additional oxygenation (the temperature in the ward is initially maintained within 26-28 C, then gradually decreases to 25 C, according to indications, warm, humidified oxygen is supplied, concentration within 30%).

Premature babies with a birth weight of 1500 g or less, as well as children in serious condition, are placed in incubators.

Nursing a premature baby in an incubator.

The temperature in the incubator is regulated taking into account the child's body temperature (when measured in the rectum, it should be 36.6-37.1 C). Oxygen is supplied to the incubator at the rate of 2 l/min. Humidity is set to 80%, by the end of the 1st week of life it is reduced to 50-60%. An open incubator or bed is used for children born with a body weight (or reaching a body weight) of more than 1500 g.

Optimal temperature- this is such a regimen in which the child manages to maintain a rectal temperature within 36.6-37.1C. The air humidity in the incubator should be 80-90% on the first day, and 50.60% on the next days. The level of oxygenation is selected individually. It is necessary to provide the child with optimum oxygen concentration, in which the signs of hypoxemia disappear (cyanosis of the skin and mucous membranes, decreased motor activity, bradypnea with apnea).

The change of the incubator and its disinfection is carried out every 2-3 days. A long stay of a premature baby in an incubator is undesirable. Depending on the condition of the child, it can be from several hours to 7-10 days.

On the 7th-8th day, healthy premature babies are transported from the maternity hospital to the department for nursing small children in specialized machines and in incubators.

Stage 2. Observation and treatment in a specialized department for premature babies.

Purpose of stay in these departments:

Observation and further nursing of the child;

Creation of comfortable microclimatic conditions (additional warming and oxygenation);

Providing adequate nutrition;

Teaching parents how to care for a child at home, etc.

A child in the department for nursing small children is transferred from the incubator to a heated bed only if this does not lead to a change in his condition.

If the child in the crib does not “keep” body temperature well, then additional warming is applied with the help of heating pads.

The mother is taught the exercise therapy complex. Classes in the absence of contraindications are carried out from the age of 3-4 weeks. Before feeding for 5-10 minutes 5-7 times a day. At the age of 4-6 weeks. The complex includes massage of the anterior abdominal wall. Bathe healthy premature babies from 2 weeks of age; the water temperature is 36C with a gradual decrease to 32 C. Walks with premature babies in the warm spring-autumn period and summer are carried out from 2-3 weeks of age, and with very premature babies - from 2 months of age. In winter, walks are allowed at the age of at least 3 months at a temperature not lower than -10C, they are carried out with a heating pad under a blanket.

During oxygen therapy it is necessary to ensure the optimal concentration of oxygen. It is recommended to inhale a gas mixture containing no more than 30% oxygen, the duration of oxygenation is selected individually. The mixture should be moistened to 80-100%, heated to a temperature of 24C. Oxygen therapy is carried out using nasal catheters, cannulas, a mask or an oxygen tent.

Peculiarities of feeding premature babies.

Human milk is the optimal food for a premature baby.

The choice of feeding method depends on the gestational age of the baby. It is important to ensure that the baby does not overwork, spit up or aspirate food during feeding.

1. Premature babies with a long gestational age, with a pronounced sucking, swallowing reflex and a satisfactory condition, can be fed 3-4 hours after birth.

2. With the severity of the swallowing reflex and the absence of a sucking reflex, the child can be fed from a spoon.

3. In the absence of breast milk from the mother, you can apply specialized adapted mixtures (Humana-O, Frisopre, Enfalak, Nepatal, Alprem, Detolakt-MM, Novolakt, etc.) during the first 2-3 months.

4. Children with low body weight and gestational age less than 32 weeks are fed through a naso - or orogastric tube. The introduction of milk must be carried out by drip, through special syringe perfusors, in their absence, sterile syringes and droppers can be used.

5. Deeply premature babies with respiratory disorders, circulatory disorders, depression of the central nervous system are prescribed parenteral nutrition. On the first day of life, they receive a 10% glucose solution, from the 2nd day they switch to a 5% glucose solution with the addition of amino acids, electrolytes, potassium, vitamins, microelements, fat emulsions.

Principles of medical treatment of premature infants.

Excessive stimulation of such children in the first days and weeks of life, intensive and infusion therapy can lead to a deterioration in the condition. Do not administer to premature babies with intramuscular injections of more than 0.5 ml of the drug solution.

Criteria for discharge of a premature baby from the hospital.

Body weight must be at least 2000 g with constant dynamics.

The ability to maintain a constant body temperature.

The presence of pronounced physiological reflexes.

Stability of all vital functional systems.

Stage 3. Dynamic observation in a children's clinic.

The next day after discharge from the hospital, the local doctor and nurse visit the child at home. They "actively" observe the child. At least once he is examined by a neuropathologist, an ophthalmologist, once every 6 months - by an otorhinolaryngologist, at the age of 1 and 3 months - by a pediatrician and a neuropathologist, attenuated vaccines are used for vaccinations. Premature, born weighing up to 2000 g, BCG vaccination in the maternity hospital is not carried out. It is prescribed when the child reaches the average indicators of physical and neuropsychic development of children born on time.

Prevention of prematurity:

1) Protecting the health of the future mother, starting from early childhood.

2) Timely rehabilitation of chronic foci of infection of the girl - the future mother.

4) Creation of favorable conditions for the course of pregnancy.

5) Regular monitoring of the pregnant woman in the antenatal clinic.

6) Refusal of a pregnant woman from bad habits.

7) With the threat of miscarriage, mandatory inpatient treatment of a pregnant woman.

ORGANIZATION OF THE WORK OF THE DEPARTMENTIISTAGE

NURSING OF NEWBORN

Departments or hospitals intended for the II stage of nursing premature babies are planning at the rate of 40-45 beds per 1000 premature births per year.

Examination of a premature baby is carried out immediately after admission directly to the department, which avoids its cooling and, if necessary, urgent medical measures can be taken.

The chambers are filled cyclically for 1-3 days. The principles of maintaining a sanitary and anti-epidemic regime in departments of the second stage of nursing are the same as for departments of newborns in maternity hospitals.

Chambers should be fully boxed, designed for 2-4 premature babies. The nursing station is usually located outside the ward, in a place convenient for monitoring all children (4-6 premature babies, depending on condition, body weight and feeding method).

The department should have free clean rooms for isolating sick children. The departments planned according to the “mirror” type can be considered optimal for preventing nosocomial infection, i.e. having a complete double set of rooms, half of which is ventilated. The change of premises is carried out at intervals of 2-4 weeks under the systematic control of their bacteriological control.

Discharge of healthy children from the department of the II stage of nursing of premature babies is possible when the child reaches a weight of 1700 g without vaccination against tuberculosis.

Nursing and necessary treatment of a premature baby in SPECIALIZED DEPARTMENT II THE STAGE OF NURSING THE NEWBORN is built individually and is a continuation of the activities started in the neonatal pathology department of the maternity hospital. The first 2-3 days after the transfer, the child adapts to new conditions, which can be expressed by a change in behavior (it is necessary to exclude the appearance of neurological symptoms provoked by transportation), the absence of gains or weight loss, the appearance of regurgitation, apnea. The child requires a special attitude - breastfeeding, sometimes with a decrease in the amount of food and a change in the method of feeding, placement in an incubator, additional oxygenation.

Premature babies weighing 1700 g or less need to be heated, they are placed in an open type incubator (warmer bed). Additional warming of such children usually stops by the end of the 2-3rd week of life. Children with ENMT are often in open incubators up to 1.5-2 months of life. Incubators (closed type incubators) at the second stage of nursing are used for sick premature babies.

The air temperature in the neonatal unit is the same as in the neonatal pathology unit of the maternity hospital. In the ward where there are premature babies weighing over 2500 g, the air temperature is 23-24°C.

Anthropometry of preterm infants is carried out on the day of admission (the circumference of the head, chest, height, weight are measured), and then repeated monthly. Weigh children daily. Head circumference is measured once a week.

Laying out premature babies on the stomach begins as early as possible. Manipulation is carried out on a hard surface (mattress) without a pillow, since some premature babies, even at the age of one month, may not have a protective reflex of turning the head in the prone position.

Massage of the anterior abdominal wall is carried out daily, starting from the age of one month, when the child reaches a weight of 1700-1800 g. Premature, suffering from flatulence, periodic abdominal massage is indicated even with a body weight of 900-1000 g.

Walks with premature babies are carried out on walking verandas or on the street in the warm spring-autumn period and in summer. They begin at the age of 3-4 weeks when the body weight reaches 1700-1800 g. severe anemia of prematurity, walks are also shown in the winter on the walking veranda at an air temperature of at least +5 ° C.

A healthy premature baby who is able to maintain a normal body temperature without additional heating can be discharged home. The conditions for discharge are: regular and sufficient weight gain, the mother correctly attaches the baby to the breast and knows the principles of successful breastfeeding, has the skills to care for the umbilical residue and skin; aware of the danger signs in the newborn. Most often, a premature baby is discharged home from the maternity hospital no earlier than 8-10 days of life, when the child reaches a weight of 1700g. The child's discharge is reported to the children's polyclinic for urgent patronage.

A full-term newborn is born defenseless and requires vigilant care. If we are talking about a baby who saw the world much earlier than the time allotted by nature, then the risks and troubles increase many times over. According to statistics, 8-12% of children are born long before the expected date. Nursing them is a complex process that involves a number of specialists. A positive attitude and the right actions of parents are of great importance. Consider the features of the condition of premature babies and the main recommendations for caring for them.

A newborn is considered premature if it was born before the 37th week of pregnancy, that is, before the 260th day of intrauterine development (gestation). At the same time, its weight is in the range from 0.5 to 2.5 kg, and its height is from 25 to 40 cm. Depending on the term of birth and body weight, 4 degrees of prematurity are distinguished:

• 1st - term - 35-37 weeks, weight - 2.001-2.5 kg, the child is mature and viable, in some cases treatment is required (with jaundice, birth trauma);
• 2nd - term - 32-34 weeks, weight - 1.501-2.0 kg, when assisted, the baby quickly adapts to external conditions;
• 3rd - term -29-31 weeks, weight - 1.001-1.5 kg, most children survive, but they need long-term rehabilitation;
• 4th - term - less than 29 weeks, weight - up to 1.0 kg, the baby is not ready for independent life, the prognosis is unfavorable - 60-70% of babies die within 30 days.

Nursing a premature baby in a medical facility

According to WHO standards, newborns with a body weight of at least 500 g and the presence of a heartbeat are subject to nursing. The earlier the child was born, the more difficult his condition. Prematurity of the first and second degree is called moderate, the third and fourth - deep. In addition to the above parameters, when developing nursing tactics, doctors pay attention to the severity of signs of immaturity of the body, the main ones are:

1. irregular weakened breathing;
2. dry wrinkled skin with a reddish tint due to underdevelopment of subcutaneous fat;
3. weak cry;
4. lanugo (fluff) on the body;
5. nail plates do not completely cover the phalanges;
6. umbilical cord below the center of the abdominal wall;
7. all fontanelles are open;
8. the genitals are underdeveloped;
9. meager movements due to reduced muscle tone;
10. disproportionate sizes of body parts - a large head, short limbs;
11. physiological reflexes are not expressed.

In the case of moderate prematurity, some of these signs are absent. It also happens that the baby's body weight is more than 2.5 kg, but there are manifestations of immaturity of the body.

The main causes of preterm birth:

• nutritional deficiencies in the mother's diet;
• lack of medical care;
• stress factors;
• bad habits and addictions of a woman;
• exposure to toxic substances, including in the workplace;
• the age of the mother is under 18 and over 35, the father is under 18 and over 50;
• more than three abortions in history;
• pregnancy earlier than one year after childbirth;
• chronic diseases of the mother;
• physical injury;
• immunological conflict;
• infections and chromosomal abnormalities of the fetus, and so on.

Condition features

A child born prematurely is not ready for independent life. The rate of adaptation depends on the maturity of the organism and the severity of the course of childbirth. In most cases, such babies, up to a certain age, lag behind their peers in development and show an increased tendency to certain diseases.

nervous system

By the 28th week of pregnancy, all the nerve endings and nodes, as well as the brain, are formed in the baby. But myelin, the substance responsible for the transmission of impulses, does not fully cover them. In a full-term baby, the process of myelination of fibers takes 3-5 months.

In a child born prematurely, the maturation of the nervous system may be delayed. As a result, there are difficulties with sucking, swallowing, breathing, reacting to external stimuli, and so on.

The stronger the degree of prematurity, the weaker the unconditioned reflexes.

The cerebral cortex in premature babies is poorly formed. Some structures are underdeveloped, such as the cerebellum, which is responsible for coordinating movements. The walls of the brain vessels are weakened, so there is a risk of ischemia (lack of oxygen) and hemorrhages.

thermoregulation

In children born prematurely, the processes of preserving and dissipating heat are imperfect. They are easily supercooled (body temperature drops below 36°) and overheated under the influence of external conditions. Reasons for this:

• lack of subcutaneous fat;
• immaturity of the thermoregulation center in the brain;
• immaturity of the sweat glands.

The increased risk of overheating/hypothermia persists for up to 6 months. The mechanism of thermoregulation is finally formed by the age of 8.

System digestion

The digestive system of premature newborns is characterized by some features:

1. reduced motor activity of the gastrointestinal tract, food passes slowly;
2. enzymes are not produced enough, products are poorly digested, and fermentation occurs;
3. due to the low acidity of digestive juices, the intestinal microflora is disturbed;
4. the stomach has a small volume;
5. sphincter at the border with the esophagus is weak.

As a result, babies suffer from bloating, intestinal colic, defecation disorders, frequent, profuse regurgitation, lack of vitamins and minerals.

The nutrition of such a child in the first days of life is carried out through a special probe.

Hearing and vision

With deep prematurity, the child reacts to sound stimuli only by blinking and moving the limbs. He begins to turn his head to the sound in about 1-1.5 months.

The vision of these children is poorly developed. Most of the time they lie with their eyes closed. Babies born at 30-32 weeks of gestation can hold their eyes on bright objects and turn towards a light source.

The vascular network of the retina is formed in the last month of pregnancy. Premature babies are at high risk of retinopathy, a retinal lesion that can lead to visual impairment and blindness. With timely treatment, the condition is corrected.

Respiratory system

Narrow airways, immaturity of the respiratory center of the brain, a highly located diaphragm - these and other factors make it impossible for a premature baby to fully breathe independently. In the waking state, he breathes very often (60-80 times per minute), but not deeply. In sleep, the frequency decreases, sometimes there are episodes of apnea - respiratory arrest, while the nasolabial triangle and fingers turn blue.

With deep prematurity, atelectasis (falling) of individual sections of the lungs can be observed. This is due to an insufficient amount of surfactant - a substance that is formed from 23 to 36 weeks of gestation and is designed to open the pulmonary vesicles during the first breath. As a result, respiratory disorders occur, which are often accompanied by an infection (pneumonia).

Some children have bronchopulmonary dysplasia after being connected to a ventilator. In the future, this is fraught with frequent acute respiratory infections.

Cordially — vascular system

Normally, after the first spontaneous breath, the shunts between the heart chambers and large vessels are closed in the child, thanks to which blood circulation was ensured during fetal development. In babies born prematurely, the process of restructuring the circulatory system occurs in the first months of life. In addition, the heart and blood vessels experience increased stress due to ongoing rehabilitation measures. Quite often congenital malformations are found.

The baby's heart sounds are muffled, the average heart rate is 120-140 beats per minute. The body reacts to any external influence with a jump in pressure and an increase in the frequency of contractions - up to 200.

Endocrine system

When born prematurely, all elements of the endocrine system do not function fully:

1. Adrenals. Cortisol deficiency leads to a decrease in the adaptive capabilities of the body and an inadequate response to stress factors. With severe adrenal insufficiency, the baby's body temperature decreases and blood pressure drops.
2. Thyroid. There is transient hypothyroidism (decreased activity of the organ). As a result, the metabolism slows down, swelling occurs, jaundice is prolonged, and so on.
3. Ovaries and testicles. Due to the lack of hormones, the sexual crisis is mild.
4. Pancreas. Excess insulin synthesis and meager glycogen stores lead to low blood sugar levels. Hypoglycemia is a dangerous violation of the maturation of the nervous tissue.

Bone system

In premature babies, the bones are fully formed, but the process of their mineralization is incomplete. For this reason, the risk of hip dysplasia is high.

Due to the deficiency of calcium and phosphorus, early prevention of rickets is advisable. It consists in the appointment of vitamin D from the age of 2 weeks.

urinary system

The immaturity of the renal tissue and the instability of water-salt metabolism predispose children to the formation of edema. Usually they appear in the first days of life and disappear in 1-2 weeks. Later firm swelling in the lower body may indicate nutritional problems or disease. In addition, it should be borne in mind that the baby can quickly develop dehydration.

hematopoietic system

The tendency to anemia in preterm infants is associated with the rapid destruction of fetal hemoglobin and the immaturity of the bone marrow. In addition, there is an increased risk of bleeding due to a lack of vitamin K and a decrease in the ability of platelets to stick together.

immune system

Most of the antibodies and immunoglobulins the child receives from the mother at 32-35 weeks. Premature babies have a marked lack of protective factors. Their immune system functions poorly: immunoglobulins and lymphocytes are almost not produced.

In the first weeks of life, the baby is defenseless against pathogenic microorganisms, while there is a tendency to generalize infectious processes. Vaccination of children is carried out according to a special schedule starting from 6 or 12 months.

In children born prematurely, a prolonged course of jaundice, increased intracranial pressure, and motor disorders are often observed. In addition, the risk of cerebral palsy, epilepsy and developmental delay is high.

Dynamics masses body

Weight loss occurs in all children after birth, but in full-term babies it is 5-8% of the initial weight, and in premature babies it is 5-15%. The subsequent dynamics depends on the general condition of the body and living conditions. Approximate rates:

• the initial weight is restored for 2-4 weeks of life, weight gain in the first month - 100-300 g;
• by 2-3 months, the mass doubles, and by 12 - increases by 4-8 times;
• growth during the first year of life becomes more by 27-38 cm, then 2-3 cm is added every month.

Specificity behavior

The degree of activity of the baby depends on the maturity of his body. If the baby was born before 28 weeks, then he sleeps most of the day. When touched, he may wake up and begin to move, grimace, but after a few minutes he falls asleep again. In the first degree of prematurity, the child is able to wake up on his own and stay awake for a longer time, as well as scream clearly and loudly.

In the first months of life, children cry a lot and are easily excited under the influence of stimuli, it is difficult for them to calm down. Hypo- or hypertonicity of the muscles is often observed.

The pace of neuropsychic development of premature babies is slowed down: later they begin to sit down, crawl, walk, talk. In the absence of serious pathologies, they "catch up" with their peers by 18-24 months. But fatigue and emotional instability may persist.

nursing

The process of nursing a premature baby can be divided into two stages: stay in the hospital and at home.

Hospital

Neonatologists are responsible for nursing babies. Immediately after birth, the child enters the intensive care unit or intensive care unit. If he cannot breathe on his own, he is put on a ventilator and injected with surfactant to open his lungs. Oxygenation can be performed, as well as the introduction of fluids and medications through catheters. Constant monitoring of vital signs is carried out.

The baby is placed in an incubator (incubator), where the air temperature is 33-35 ° and humidity is 70-95%. Indicators are selected individually depending on the degree of prematurity. As the condition improves, they decrease. Air parameters in the ward: temperature - 25°, humidity - 55-60%. The baby loses heat very easily. When changing clothes, heated changing tables and warm diapers are used. In the incubator, the child can spend from 3-4 days to 7-8 weeks.

In the process of nursing, it is very important to create the most favorable environment, minimizing stressful and traumatic factors, since premature babies are very sensitive. They react violently to any stimulus by several body systems at once, which negatively affects their condition. Main directions:

1. noise reduction;
2. protection from intense light sources;
3. careful conduct of all medical procedures;
4. tactile contact with the mother, if possible - laying on the chest, touching, stroking;
5. soft swaddling, simulating being in the uterus;
6. periodic change in body position to prevent bone deformities and abnormal muscle tone.

The period of stay in the hospital, as a rule, is equal to the period that the baby did not have enough for the full completion of intrauterine development.

House

Basic conditions for discharge of a child:

• the possibility of self-sucking;
• the ability to maintain body temperature;
• weight more than 2 kg and constant weight gain;
• healing of the umbilical wound;
• compliance with blood counts.

A premature baby needs careful handling, but do not be too zealous: be afraid to touch him and wrap him up carefully. It is better to practice loose swaddling so that the baby can move his arms and legs. Warm and heavy blankets are not needed, it is better to use lightweight textiles.

It has been scientifically proven that if you wear a premature baby in a sling, then he quickly adapts to new conditions.

The optimum air temperature in the room where the child is located is 25 °. Do not leave him naked for longer than 3-4 minutes. Gradually, the duration of air baths can be increased to 10-12 minutes, spending them 3-4 times a day.

The water environment is ideal for the baby. It needs to be bathed every day, especially if there is diaper rash. In the first weeks, the desired water temperature is 36-37 °. Then it can be gradually reduced to 32 °. This will encourage hardening.

Very useful massage for children. In the first weeks, this may be a slight stroking of the abdomen. When the baby's weight reaches 3 kg, you can move on to a general massage, adding elements of gymnastics to it. Sessions should be conducted by an experienced specialist.

Walking is allowed provided that the weight of the crumbs is more than 2.1 kg. The duration of the first promenade is 5-10 minutes. Then the duration can be increased to 30-40 minutes 2-3 times a day. In bad weather, it is worth "walking" on the balcony by opening the window. It is important to properly dress the baby so that he does not overheat and does not freeze.

Monthly with the baby it is necessary to go to the pediatrician. During the first year, 2-3 times you need to visit an orthopedist, surgeon, ENT, ophthalmologist. The child's neuropathologist should be shown every 3 months. It is very important to visit doctors in a timely manner in order to detect the slightest deviations at the initial stage.

Food

Proper nutrition is a key point in nursing premature babies. If the baby does not have swallowing and sucking reflexes, he is fed through a tube. In some cases, these automatisms are present, but there are problems with coordination of movements. The way out of the situation is feeding from a syringe without a needle, bottle or spoon. Children weighing 1.8-2 kg are applied to the mother's breast, which are able to actively suck. In any case, in the first days, saline, glucose and vitamins (K, C, E, group B) are administered intravenously to babies. Nutrient solutions may also be given.

The ideal food for premature babies is mother's milk. If direct attachment to the breast is not possible, then the woman should express herself. In case of shortage or absence of milk, special mixtures with an increased level of protein and increased energy value are used. Almost every baby food manufacturer has products designed for premature babies. It is necessary to buy the mixture on the recommendation of a doctor.

After discharge from the hospital, it is advisable to purchase an electronic scale and clearly monitor the amount of milk / formula eaten at each feeding, as well as the dynamics of the baby's weight. Children quickly get tired of sucking, it is worth giving them the opportunity to rest. They should be applied to the chest on demand. With artificial feeding, it is necessary to maintain intervals of 3 hours. The input of complementary foods is carried out according to an individual scheme.

The first months of the life of a child born prematurely is a difficult period for his parents. At this time, it is extremely important to trust the professionalism of doctors, as well as give your baby your love by talking to him and touching him. Modern technologies allow to nurse very premature babies. Up to 2-3 years, they may lag behind their peers in development, but over time, all problems are smoothed out. The main thing is to take care of the child and pay maximum attention to his needs.

A premature baby is a baby born before 37 completed weeks of pregnancy. Four years ago, our country began to nurse children who were born at a gestational age of 22 weeks or more. The weight of newborns born at such a short term is from 500 g. Previously, such children had no chance of survival, because they were not provided with resuscitation care at birth. A fetus born between 22 and 28 weeks of gestation was considered a miscarriage. He was registered as a premature baby if he lived for 7 days or more.

Now nursing very premature babies has become a routine practice. Birth weights between 1000 and 1500 g are considered very low, while those under 1000 g are considered extremely low. MedAboutMe will share in this article with its readers how to care for premature babies born weighing less than 1500 g.

Goals of nursing a premature baby

With the introduction of modern technologies for nursing extremely premature babies, they began to survive much more often than before. But to survive does not mean to be healthy. The extreme immaturity of children born before 28 weeks of gestation contributes to the formation of chronic diseases in them. Some of them lead to disability, severe retardation of physical and mental development.

Therefore, it is very important to create such nursing conditions for the child in order to bring them as close as possible to intrauterine. In order for a child to grow up healthy or with minimal health problems, more than just drug therapy and resuscitation equipment is required. Doctors and nurses working in neonatal intensive care units are constantly sharing their experience. These people are true professionals who strive to give every child a chance for a decent future.

Regardless of which way a premature baby is born, they are carefully prepared for his birth. There is an intensive care unit in the delivery room, where the child is given first aid, adequate breathing is established. It is very important to properly retain heat in a premature baby, because he himself cannot regulate the processes of heat transfer.

Babies who were born before 28 weeks of gestation are placed in a heat-resistant plastic bag or wrapped in a special film. This helps to maintain not only normal body temperature, but also skin moisture. Babies of older gestational age are dried after birth and wrapped in warm diapers. It is very important to put a hat on the child, because the heat loss from the scalp is very intense.

In the neonatal intensive care unit, the child is carried on his hands or transported in a transport incubator. Doctors try to show the child to the mother before they are separated. The doctor can not always immediately tell parents about what is happening with the baby. It takes time to optimize his condition, make appointments, provide assistance. After that, the pediatrician can talk with parents about the baby and answer disturbing questions.

Children with very low body weight (VLBW) and extremely low body weight (ELBW) are nursed in an incubator. In another way it is called an incubator. A special microclimate for the baby is created in the incubator. Temperature and humidity are kept at the right level. “Nests” are created from diapers and tissue rollers, in which the baby fits into the fetal position. This is very important - to recreate the position of the child in which he was in utero. Nurses regularly change the position of the child's body, spread it on the tummy.

In some incubators, you can even weigh the baby without taking him out of there. This is very convenient, because with premature babies you need to carry out a minimum of manipulations. They need peace, warmth, the absence of unnecessary irritants. In order to disturb the baby less, the staff tries to carry out maximum actions immediately. For example, treat the skin, feed, administer medicine, change position, and then let the child rest for a longer time.

The lungs of a deeply premature baby are immature. To ensure normal breathing for such an infant, he needs additional help. There is special equipment for this. Some children require mechanical ventilation (ALV). Others can breathe on their own, but positive pressure must be maintained in the lungs so that the alveoli do not stick together on inspiration.

The respiratory mixture is given to the child through an endotracheal tube, which is inserted into the trachea through the nose or mouth. If the child breathes on his own, then plastic cannulas are installed in the nose, through which air is supplied to him under the necessary pressure. The staff carefully monitors the child's breathing parameters on a breathing apparatus monitor. Children who receive respiratory therapy take blood for gases several times a day. This is necessary to monitor his condition and how he copes with breathing.

As the child grows and the lungs mature, he moves away from respiratory support. Sometimes premature babies take very long pauses between breaths, which is life-threatening. In this case, they are placed on a special panel, which will emit a sound signal that the child has stopped breathing, and he will be given the necessary assistance.

In addition, in order to monitor the parameters of the work of breathing and the cardiovascular system, the necessary sensors are installed on the skin of the child. Information from them is transmitted to the monitor, where you can see the heart rate, the degree of blood oxygen saturation. A cuff is put on the arm or leg of the baby, with the help of which blood pressure is regularly measured.

Breast milk is the best food for a baby. It not only nourishes the child, but also helps his weak immune system fight the viruses and bacteria to which he is so sensitive. In situations where there is no or little breast milk, special formulas are used to feed premature babies. They may also be required for certain diseases. Prematurity formulas contain degraded protein for better absorption.

Until the baby learns to suck from the nipple or from the breast, food is supplied to him through the tube. The probe is a thin plastic tube that is passed into the stomach through the nose or mouth. Sometimes nutrition is supplied to the baby around the clock with the help of a syringe pump, which delivers it to the baby at a low speed. Some babies are fed small meals every 2-3 hours.

As the nutrition is assimilated and the crumbs mature, the amount of milk or mixture supplied increases. This happens until the baby can fully absorb the required amount of nutrition. Unlike full-term babies, pacifiers are recommended for premature babies. This helps develop the sucking reflex and makes it easier to endure painful manipulations.

Premature babies usually receive a lot of drugs. This is due to the fact that the organs and systems of premature babies are very immature. They need medical support. This applies to both breathing and the work of the heart. Many are treated with antibiotics and antiviral agents for the course of intrauterine or stratified nosocomial infections.

Very premature babies need a lot of fluid, which they receive intravenously. It includes solutions of glucose, salts, vitamins and microelements. Venous catheters are installed in premature babies for several days. They allow you to inject different drugs at once into one vein.

Danger of noise and light

In utero, the child is protected from the influence of light and excessively strong sound stimuli. When born prematurely, babies are very sensitive to such influences. Bright light increases the excitement of the child, and the eyelids cannot protect the eyes from the light. Irritation with sound also excites the child, interferes with the proper development of the central nervous system. The main sources of noise in the intensive care unit are: mobile phones, staff conversations, equipment noise, closing of the incubator doors.

In order to reduce the harmful effects of noise and light on premature babies, a special protective regime is established in the department. The staff is trained in the rules of silence. In the department, periods of light and darkness alternate, and the incubators are closed with protective thick capes.

It has been proven that the participation of parents in nursing the crumbs increases the chances of success. The kangaroo method is a very common technique that can reduce the death rate of premature babies. When using the "kangaroo" method, the child is laid naked on the mother's or father's chest, covered with a blanket on top. In this position, they are for some time, depending on the condition of the child.

In order to make everyone as comfortable as possible, special chairs for parents are installed in the intensive care units, where they spend time with their baby. The use of this technique helps to reduce the incidence of children, gain weight faster and recover faster.

Recently, a lot of attention has been paid to the developmental care of premature infants: these are tactile touches to the baby, affectionate conversations of parents, quiet lullabies and fairy tales during the “kangaroo” technique, the use of toys as the baby grows up.

Nursing children born prematurely is a long process. After resuscitation of newborns, such children go to the nursing unit for premature babies, where they undergo further examination, learn to suckle, gain weight and are treated for concomitant diseases. After being discharged home, premature babies are observed by many specialists. This helps to identify health problems as early as possible and start treating them in a timely manner.

The first stage of nursing is children's resuscitation. In the case of significant immaturity of the vital systems of the newborn, he immediately after birth enters the pediatric intensive care unit. Here, the babies lie in special incubators covered with transparent caps with four holes - two on each side (for medical manipulations). All incubators are equipped with artificial lung ventilation devices. Children who do not have or have a weak sucking reflex receive food for the first few weeks (optimally - warmed mother's milk, sometimes with specially selected additives) through a nasogastric tube. The incubator maintains a constant temperature and air humidity (about 60%) so that the child's mucous membranes do not dry out. Sometimes incubators are equipped with water mattresses, which bring conditions closer to being in amniotic fluid. With the help of numerous tubes and wires, the child is connected to monitors, droppers and other devices that control his pulse, temperature and breathing, regularly conduct blood tests, administer the necessary medications and perform many other important functions. If the indicators registered by these devices deviate dangerously from the norm, an alarm sounds. Resuscitation procedures are not limited to artificial ventilation of the lungs and the supply of food through a tube.

The second stage of nursing is intensive care for newborns. When the baby is able to breathe on its own and there is no need for mechanical ventilation, the second stage of nursing begins, which is usually carried out in the neonatal intensive care unit. Here, premature babies are also placed in incubators. Unlike intensive care units, intensive care units are not equipped with ventilators. Nevertheless, it provides an additional supply of humidified and heated oxygen to the incubators, as well as optimal humidity and temperature conditions. The child is in the incubator until he can independently maintain body temperature and do without additional oxygen supply. Today it is considered proven that during a stay in a hospital, a premature baby needs to communicate with his mother. The baby must hear the mother's voice, feel her warmth, which is achieved using the so-called kangaroo method.

The third stage of nursing is follow-up observation. Relative normalization of the main vital functions of the body does not always, unfortunately, mean that a premature baby has finally caught up with peers in psycho-physical development. In follow-up rooms, not only observation of children is carried out, but also systematic correction of deviations revealed in them.

Primary care of newborns

After the newborn is discharged from the maternity hospital, information is transferred by telephone to the children's clinic, where the full name of the mother, the address and date of birth of the child are recorded in the newborn visit log. During the first three days after discharge from the maternity hospital, the local doctor and nurse perform the first patronage of the newborn. Children with risk factors, congenital anomalies and diseases, premature or overdue children, as well as the first child in the family, should be examined on the first day after discharge from the maternity hospital.

During the first patronage of a newborn, the doctor gets acquainted with the living conditions of the family. Finds out the presence of risk factors in the anamnesis, conducts a thorough examination of the child and, based on a comprehensive assessment, determines the infant's health group. Gives recommendations on the daily routine of the child, feeding the child and caring for the newborn, nutrition of the nursing mother, determines the timing of subsequent patronage visits, taking into account the state of health of the child. The nurse treats the umbilical wound and shows the mother all the manipulations for caring for the child.

At the first visit of a newborn, it is necessary to tell the mother about the conditions that require urgent medical attention, and to tell where to go for help with illnesses. Instruct parents on child care, feeding and upbringing.

Purulent-septic diseases of the neonatal period

Main questions:

General information about purulent-septic infection in children

Etiology, pathogenesis, risk factors for sepsis and localized forms of purulent infection

Classification, clinic, diagnostic criteria for sepsis

Purulent-inflammatory diseases of the skin and subcutaneous tissue in newborns (vesiculopustulosis, pemphigus, pseudofurunculosis, phlegmon, etc.)

Diseases of the umbilical wound (weeping navel, omphalitis, thrombophlebitis of the umbilical vein)

Treatment and prevention of purulent-septic diseases

Features of pharmacotherapy

A purulent infection is understood as the introduction and reproduction in the body of pathogenic pyogenic microorganisms with the formation of purulent foci.

Sepsis of the newborn. Etiology and pathogenesis. Risk factors

Etiology. The diversity of pathogens is one of the main characteristics of sepsis, which determines the characteristics of the course of the septic process, since the pathogenicity of various strains of microorganisms can vary. The etiology depends on the period of infection, the maturity of the child, the state of his immune system, the source of infection, the epidemiological situation in the region and the particular medical institution. So, with early-onset sepsis - up to 5 days of life - the pathogens are group B streptococci, E. coli, Klebsiella, enterococci, group A streptococci, Haemophilus influenzae, anaerobes. With late-onset sepsis - older than 5 days - causative agents are more often Staphylococcus aureus, Escherichia coli, Klebsiella, Staphylococcus epidermidis, Pseudomonas aeruginosa. It is believed that with an early onset of sepsis, gram-negative microbes are more often the causative agents, and with a late one, gram-positive microbes. With nosocomial infection, Staphylococcus aureus, Staphylococcus aureus, Enterococcus, Klebsiella, and Pseudomonas aeruginosa are more often isolated.

Risk factors

Risk factors for nosocomial infection are: the age of the child, underweight, severity of the condition, immunosuppression, previous antibiotic therapy (more than 10 days), the child's stay in the intensive care unit and parenteral nutrition. In recent years, there has been an increase in the frequency of intrauterine infection of the fetus and newborn with herpes simplex viruses, cytomegalovirus, chlamydia, mycoplasma. An infectious agent that persists in the body of a pregnant woman and fetus has an immunopathological effect on the body of a developing fetus and its immune system.