Organization of nursing care for full-term and premature newborns. Caring for a premature baby: the first month at home Recommendations for caring for premature newborns
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Nursing premature babies
When considering nursing premature baby Several factors come into play:
1.
The gestational age at which premature birth occurred.
2.
Availability in a medical institution of optimal conditions for the provision of qualified medical care in full and nursing, starting from the moment of birth of the child. The most important are the first 20 minutes, on which the future life and health of the baby depends.
3.
Complete and proper feeding.
Not all children born before the “official” due date require specialized medical care and nursing. With a moderate degree of prematurity, good health and absence of diseases, the child is discharged home with recommendations a few days after birth.
Necessary creation of special conditions for children with a severe degree of prematurity or with a moderate degree, but with diseases or congenital malformations.
The chances of a successful outcome are higher if the baby is born in a specialized perinatal center, equipped with the necessary medical equipment and staffed by trained medical workers.
With premature birth in a regular maternity hospital, there is no opportunity to create optimal conditions for survival, which significantly worsens the prognosis.
The first stage of nursing - pediatric intensive care
In fact, it starts in the delivery room:
- After birth, the baby is taken into heated sterile diapers and dried.
- Medical procedures after cutting off the umbilical cord, including resuscitation, are carried out in conditions of maintaining heat - on a heated table.
A very premature baby spends the first days or weeks of life in an incubator designed to simulate intrauterine conditions. With moderate prematurity, the baby is usually placed on a heated table.
Kuvez, or incubator for newborns
This is a device for medical purposes, the upper part of which is a chamber or cap made of transparent organic glass.
The incubator chamber has windows through which:
- Medical manipulations and feedings are carried out.
- Humidified oxygen is supplied.
- The child is connected to a ventilator.
- Sensors from devices are connected to the baby to measure indicators: body temperature, blood pressure, blood oxygen saturation and some others.
Devices are used to create a “nest” - conditions for a comfortable and convenient positioning of the child: on the side, stomach, back. The arms and legs are in a half-bent position, pressed against the body and move less - the baby saves his own energy.
Thermal conditions and humidity
Inside the incubator chamber the following is created:
- Optimal air temperature to avoid overheating or hypothermia. Typically, for children with a birth weight of up to 1000 grams, the temperature is set at 34 o C, more than 1000-1500 grams - 32 o C.
- Air humidity is about 60-70% to prevent drying out of the mucous membranes and evaporation of water from the surface of the skin.
- When connected to a ventilator.
- When supplied through an oxygen mask or nasal cannulas.
The importance of thermal conditions
In order for a baby to produce its heat, it needs more oxygen and energy.
However, there is a vicious circle:
- On the one hand: nutrients and oxygen initially poorly reach the organs and tissues of the premature baby, and carbon dioxide is difficult to remove from them.
- On the other hand: under conditions of hypothermia, these processes are further disrupted, leading to the development of hypoxia (lack of oxygen) and acidosis (increased tissue acidity).
Respiratory distress syndrome or breathing control
There are several approaches depending on the degree of prematurity and the baby’s well-being.
With moderate prematurity, the baby usually breathes on his own, but sometimes the baby receives humidified and heated oxygen through an oxygen mask or nasal cannulas.
With a deep degree, it is often necessary to insert an endotracheal tube into the trachea (a hollow organ - a continuation of the larynx). Through it, the baby is connected to an artificial lung ventilation device (ALV).
In essence, the ventilator “breathes” for the child with specified parameters in accordance with the gestational age and general condition. A certain frequency of respiratory movements per minute, inhalation depth, pressure in the respiratory tract and others are set.
Modern devices for standard mechanical ventilation operate in trigger ventilation mode, thanks to which a small patient is “taught” to breathe. What does this mean? A special built-in sensor detects the baby’s attempt to take a breath and automatically synchronizes the breathing apparatus with the baby’s inhalation.
Non-invasive ventilation
It is used when the child breathes on his own, but finds it difficult.
Through nasal cannulas or a small mask, an oxygen-air mixture is supplied under constant positive pressure, which maintains the lungs in an expanded state. Exhalation occurs independently.
Some models of this type of ventilator operate in a two-phase mode: several breaths are taken while the oxygen-air mixture is pumped. 
High-frequency oscillatory ventilation
As such, the usual inhalation and exhalation are not performed. The exchange of oxygen and carbon dioxide occurs due to vibrations of the chest - oscillations that the device creates.
The method is ideal for use in very premature infants with very immature lungs or already developed pneumonia.
A baby with a birth weight of 1000 grams or less is often on a ventilator for up to two to three weeks of life. Transfer to independent breathing is carried out after the child’s condition has stabilized.
The most common possible complications of mechanical ventilation: barotrauma (rupture of lung tissue with air bubbles entering the blood) and infection.
Skin care
The outer skin is thin and immature, quickly gives off heat and is damaged, and does not sufficiently protect the baby from loss of water and proteins.
Substances are administered intravenously, slowly, at a given speed using a lineamate or an infusion pump - a medical device with a syringe.
The administration of solutions and/or medications is possible using two methods: 
Fluid replacement
Due to the immaturity of the kidneys, a premature baby is equally prone to both fluid retention with the formation of edema and loss of water and salts.
With a moderate degree and stable condition of the child, it is possible to “drink” orally with a 5% glucose solution. In severe conditions - intravenous infusions.
With a deep degree, fluid is always replenished by intravenous administration of solutions.
Mostly a 5% glucose solution is used, less often a 0.9% saline solution is used. In addition, glucose, in addition to replenishing fluid volume, reduces the risk of developing hypoglycemia (low blood sugar), which is especially important in the first hours and days of a baby’s life.
If necessary, potassium, sodium and calcium are administered under monitoring the level in the child's blood. With a moderate degree of prematurity, the electrolyte content is determined twice a day, with a deep degree - every 6-8 hours. Both deficiency and excess can cause harm: dehydration or edema, heart rhythm disturbances and others.
Increased bilirubin
The permissible level of bilirubin in the blood of a premature baby is 171 µmol/l.
The main method of treating uncomplicated jaundice in newborns is phototherapy in combination with glucose feeding or intravenous infusion of solutions. A naked child is placed under a special lamp with ultraviolet radiation, which destroys bilirubin in the skin and promotes its excretion. Special glasses are worn to protect the eyes. One session can last several hours, with breaks for feeding.
At a level of 205.2 µmol/l, the issue of replacement blood transfusion is considered.
Correctly and timely phototherapy in many cases helps to avoid blood transfusions.
Fighting infection
Many babies become infected in utero or during childbirth from their mother. Often the infection occurs after birth. What are the consequences? Due to insufficient activity of the immune system, any pathogenic microorganism can lead to the development of serious diseases. For example, pneumonia (pneumonia), sepsis (spread of infection with blood throughout the body), osteomyelitis (purulent focus in the bone) and others.
Therefore, as a rule, very premature babies are prescribed antibiotics from the first day of life. In case of moderate degree of prematurity - according to indications: pneumonia, intrauterine infection and others.
It is advisable to collect blood and urine with culture media before starting treatment. The study is performed to identify a pathogenic microorganism in the baby and select an antibiotic that acts specifically on this bacterium.
Prevention:
- Before giving birth. Treatment of identified infectious diseases before and/or during pregnancy: colpitis, pyelonephritis, sinusitis, tonsillitis and others.
- After childbirth. In the room where the baby is, wet cleaning is thoroughly carried out, the incubator and oxygen supply tanks are treated with antiseptic solutions. You must maintain good personal hygiene.
Lines the alveoli from the inside, promoting:
- Reducing tension and reducing the risk of collapse (atelectasis) of the pulmonary sacs.
- Removing sputum and involving other additional parts of the lungs in breathing.
Brain hemorrhages
The prognosis and condition of the child are significantly worsened: convulsions, swelling of brain tissue (excessive accumulation of fluid), short-term holding of breath (apnea), small twitching of facial muscles and others are possible.
It is believed that with moderate prematurity and grade I-II hemorrhages, the lesions in most children resolve, sometimes even without a trace.
With grade III-IV hemorrhages, the prognosis is unfavorable: about 30-50% of children die by the end of the first month of life.
The approach to treatment depends on the severity of bleeding:
- With rapidly progressing hemorrhage over a large area and a risk to the child’s life, the hematoma is often removed surgically.
- For grades I-II or multiple pinpoint hemorrhages, treatment is conservative.
- Complete rest is ensured, light and sound stimuli are limited, drying and washing are carried out carefully and without unnecessary movements, painful procedures are minimized.
- After birth, all children are given vitamin K for prevention, which is involved in the production of prothrombin (blood protein) and promotes blood clotting. If hemorrhage occurs, vitamin K is prescribed for three days.
- When hemoglobin levels are below 80 g/l, intravenous administration of red blood cells is recommended.
The second stage of nursing - separation of premature babies
Conditions are created for recovery or rehabilitation, which almost every child born earlier than expected needs. The length of hospital stay, the amount of medical care and procedures depend on the degree of prematurity and the baby’s adaptive capabilities.
Therefore, prepare yourself mentally for a long stay in the department for premature babies: from several weeks to two to three months.
If your birth took place in a specialized perinatal center, then there will be no problems or delays in transferring from one department to another. When childbirth occurs in a regular maternity hospital, mother and baby are transported from one medical facility to another in an equipped ambulance.
In the department for premature babies, you are close to the baby all the time - in the “mother and child” ward. This approach allows you to independently care for the baby, feed on demand, and provide emotional support during medical manipulations and procedures. The child constantly feels your warmth and hears your voice, which certainly contributes to a faster recovery.
Thermal mode
A baby with moderate prematurity usually retains heat well, so he is not always warmed up additionally. However, if necessary, it is sometimes placed on a heated table.
A different approach is used for a child with severe prematurity who has poor heat retention on his own. For some more time he remains in the incubator chamber, in which the air temperature gradually decreases. If necessary, humidified and heated oxygen is supplied to the incubator chamber. As soon as the baby begins to retain heat better, he is transferred to a heated table.
However, this is not enough: it is necessary to help the baby adapt to living conditions outside the womb.
Kangaroo Method
Based on contact between mother and baby - “skin to skin”. Dad can also take part in the process: replace mom in case of illness or poor health.
The main idea of the method: daily laying of the baby's naked body on the skin of the mother's breast for several hours. The child is placed in a prone position on his stomach with his face turned towards the mother, which resembles the “frog” position. To maintain the temperature, a cap is put on the baby's head and covered with a warm blanket on top.
In the first days, the baby is placed on the mother's breast for 20-40 minutes, twice a day. Then the duration of the “session” gradually increases to several hours. After discharge home, you can continue to use the method at home.
It has been proven that the Kangaroo method not only warms the baby, but also has a positive effect on his physiology and psyche.
Positive impact on the child:
- Does not waste energy on generating its own heat and crying.
- Sleep and wakefulness, as well as their alternation, are normalized.
- Breathing and heart function, blood oxygen saturation improves.
- The close proximity of the mother's breast and the smell of milk contributes to the development and coordination of innate reflexes: sucking, swallowing and searching.
- The maturation of the cerebral cortex, recovery, restoration and adaptation to new living conditions are accelerated.
- Gains weight better and faster.
The Kangaroo method is good, but is used only after the child’s condition improves, in the absence of seizures and stabilization of the main indicators (respiration, heart rate, blood pressure).
A variation of this method are “slings”, with which you can carry the baby on you for several hours.
Monitoring the premature baby
If necessary, monitoring and recording of some indicators continues for some time: blood pressure, respiratory rate, heart rate, blood oxygen saturation.
And here your help is invaluable. You can take part in some simple procedures and manipulations. After all, it’s not at all difficult to learn how to use a heated table, phototherapy lamp or incubator.
The approach has the advantage: the baby feels that you are nearby and take care of him with warmth. Undoubtedly, this helps the baby quickly adapt to new living conditions.
Treatment with drugs
Prescribed depending on the disease:
- Jaundice of prematurity: phototherapy and watering continues.
- Improving brain function: from the third week of life - nootropics (Cortexin, Piracetam).
- Mild sedative and improvement of brain function: Glycine.
- Fighting seizures: Phenobarbital (main drug), Convulex or Depakine.
- Vasodilation and improved blood circulation: Cinnarizine.
- Improving metabolism, nutrition of the heart muscle, hemoglobin production: vitamin E.
Rehabilitation of premature babies
In the first year of life, the body of an immature baby has great potential for restoration and acceleration of maturation of damaged organs and tissues. You and the doctors will have to work together to help the baby.
Massage for premature babies
The procedure is quite effective, but, unfortunately, the skin of premature babies is thin and dry, so there are some limitations. In addition, remember that massage is usually prescribed by a pediatrician or neurologist with the permission of an ophthalmologist, since there is a risk of developing retinopathy of prematurity.
Basic principles
Usually the first massage sessions begin at 1-1.5 months of life.
A premature baby has disturbances in the functioning of the nervous system, which leads to either an increase or decrease in muscle tone. In the first case, excitation processes predominate, in the second - inhibition.
With increased tone, only light stroking is allowed; with decreased tone, rubbing, kneading, and effleurage are performed. Massage at this stage is combined with passive gymnastics: bending arms and legs, turning the head and others.
As the child grows up, active exercises are added: with a body weight at birth of less than 1500 grams - from six months of age, more than 2000 grams - from two to three months of life.
The baby is forced to perform certain simple actions. For example, turning the body first on one side, then on the other, encouraging crawling, and others. From 7-8 months of life, the exercises become more complicated, taking into account the individual characteristics and skills of the baby at this age. The child is taught to turn from back to stomach, from stomach to back, get on all fours, sit down and other actions.
Conditions for gymnastics and massage:
- The room should be ventilated and have an air temperature of 20-24 o C.
- The baby quickly becomes hypothermic, so only the part of the body that is being massaged is exposed.
- Classes are held either 30-40 minutes before meals, or two hours after it.
- Gymnastics and exercises are not performed before bedtime, as the child becomes excited.
- Passive gymnastics is carried out daily 2-3 times a day, at the same time. At first, its duration is about 5 minutes, since the baby gets tired quickly. Then the duration of classes gradually increases.
Gymnastics in water
It is carried out in a moderately premature baby approximately 7-10 days of life, in a very premature baby - from the third to fourth week of life.
The temperature of the water in the bath should not be lower than 37 o C. The duration of the procedure at first should not exceed 5-7 minutes, then you can gradually increase its duration to 8-10 minutes.
Treatment of the child's oral cavity
If the baby's oral mucosa is clean, there is no need to take additional care of it.
However, a premature baby is prone to thrush, which is caused by a fungus of the genus Candida, which lives in the body of each of us. Normally, its reproduction is controlled by the immune system. If the immune system is insufficiently active, the fungus becomes more active, leading to the development of the disease.
If you have thrush, it is better to consult a doctor for prescriptions. Usually the doctor prescribes treating the oral cavity with an aqueous solution of methylene blue, and taking lactobacilli internally.
It is recommended to refrain from treating the oral cavity with a solution of baking soda - burns are possible. 
Bathing a premature baby
It begins taking into account the degree of prematurity: with moderate prematurity - from the 7-10th day of life, with deep prematurity - from the third to fourth week of life.
Conditions for comfortable swimming:
- Bathe your baby 40 minutes before or two hours after feeding.
- Pre-warm the room to 24-26 o C.
- At first, it is recommended to bathe premature babies in clean boiled water or a decoction of herbs, the temperature of which is 37-38 o C. Once the baby gets a little stronger, it is not necessary to boil the water.
- Before pouring water, pour boiling water over the bath.
- Use soap no more than once or twice a week.
- Protect your ears from water. To be safe, before bathing, soak two cotton balls in sunflower or baby oil and insert shallowly into the outer ear canal.
- Perform the first water procedures for 5-7 minutes, gradually increasing the duration of bathing.
- At first, bathe your baby without a bathing device. In order not to scare the baby, immerse him in the water gradually, starting from the legs and reaching the shoulders. The head is not immersed in water, but is located on the bend of your elbow or palm. In this case, the ring finger and little finger hold the head on one side, the thumb on the other, and the middle and index fingers are located along the back under the neck. You can first practice on a doll or seek the help of members of your household.
- Bathe your baby, starting from the upper body, gradually moving down to the legs, not missing the skin folds (armpits, neck, perineum).
- Before washing your hair, tilt it back slightly and scoop up water with your palm.
- After bathing, transfer the baby to a warm towel and dry with gentle movements (do not dry!). Dry your ears with cotton swabs and clean your nose with cotton swabs. Then put clothes on your baby.
- In the first year of life, bathe the baby daily in the summer, in winter - every other day.
Walking with a premature baby
Fresh air has a positive effect on the body as a whole. However, regarding the premature baby, do not rush into walks.
After discharge from the hospital, refrain from walking for 1.5-2 weeks so that the child gets used to the new living conditions and does not experience stress.
The first walk lasts 10-15 minutes, then the time spent in the air gradually increases by 15 minutes, reaching 1-1.5 hours a day.
Before going outside, dress your baby according to the weather, but leave his face uncovered.
At an air temperature of +25 +26 o C, you can walk with a child born weighing 1500 grams two weeks after discharge from the hospital.
At an air temperature of +10 o C, walks are allowed if the baby has reached the age of 1-1.5 months and weighs at least 2500 grams.
When the air temperature is less than +10 o C, they walk when the baby reaches two months of age with a body weight of 2500-3000 grams.
At an air temperature of -10 o It is advisable to postpone walking for one month after discharge from the hospital.
Premature babies: which child is considered premature, rehabilitation and nursing, developmental features, opinion of a pediatrician - video
Rehabilitation of premature babies: doctors use hammocks - video
Feeding premature babies
The body of a baby born much earlier than expected needs an increased supply of vitamins, nutrients, and minerals.
The first two weeks of life are the most important. Lack of nutrients leads to a delay in the maturation of organs and systems - for example, nervous tissue with a lack of carbohydrates.
Several key points are taken into account when organizing catering:
1.
When and how to feed for the first time?
2.
Is it possible to put a baby on the mother's breast?
3.
What is the amount of food per feeding?
4.
What to feed: mother's milk or formula?
The approach depends on the gestational age and birth weight of the child.
First feeding
In the first degree of prematurity and good health
The baby is placed on the mother's breast in the delivery room during the first 20-30 minutes of life or two to three hours after birth.
With a period of less than 33-34 weeks of gestation and the child’s body weight at birth is up to 2000 grams
Formula for premature babies
Comparative characteristics of the most commonly used mixtures:
| Mixture | Composition and benefits | Flaws |
A baby born before 37 weeks and weighing less than 2500 grams is considered premature. Such a baby is born weak and requires special attention and care. Every 10th baby in Russia is born prematurely.
The chances of survival for such children are high, because the capabilities of modern medicine make it possible to care for newborns weighing less than 500 grams. In this article we will talk about how to implement care of premature newborns in the hospital and at home .
Causes of premature birth
- Infections.
- Hormonal problems.
- Viral and other diseases contracted during pregnancy.
- Consumption of alcohol, nicotine.
- Genetic predisposition.
- Mechanical impact on the abdomen.
- Frequent abortions and other operations on the reproductive organ.
- Age at risk (less than 18 years and more than 35 years), etc.
REFERENCE! To assess the development of an infant born prematurely, it is necessary to know two dates: the actual date of birth and the expected one. For example, if your child is already 7 months old, then his development will approximately correspond to the age of 4 months.
Physiological characteristics of premature babies
Premature babies are different from babies born at term and have the following features.
- The skin is very thin, wrinkled and has a dark red color.
- There is very little or almost no fat layer.
- Poor thermoregulation.
- Short limbs.
- The fontanelles (small and lateral) are large in size.
- The bones of the skull are malleable.
- Ears are pressed to the head.
- The genitals are underdeveloped (in boys, the testicles are not descended into the scrotum; in girls, the labia majora do not cover the labia minora).
- Breathing is shallow.
- Increased risk of apnea.
- Weak pulse and low blood pressure.
- Prolonged jaundice due to elevated bilirubin levels.
- Dysbacteriosis.
- Presence of vellus hair on the body and face.
- Possible trembling of the arms and chin.
- Poorly developed reflexes or their complete absence.
- Anemia.
- Weak immune system and so on.
The organs of such babies are immature, the body systems are poorly developed. After all, the baby has not gone through all the stages of intrauterine development, as provided for in a full-term pregnancy. Caring for low birth weight newborns both in the hospital and at home, must correspond to the physiological characteristics of such babies.
Hospital care for premature newborns
Which department the little one will go to depends on its condition and gestational age. If he was not born during a dangerous period and has a weight slightly below normal, his tests are good, then doctors can discharge such a child after he reaches the required level. body weight (2500 grams) and carrying out the necessary examinations.
A newborn is ready to leave the hospital if he can independently maintain body temperature, his sucking and swallowing reflexes are fully developed, and there are no respiratory arrests or other pathologies requiring observation. In other cases, he is treated in the following departments before being discharged.
Reanimation
REFERENCE! If the maternity hospital does not have an intensive care unit, the baby is taken in a special car to a hospital with the necessary equipment. Then placed in an incubator, which creates the necessary conditions for maintaining and developing the functioning of body systems.
Using medical devices monitored around the clock heart rate and other vital signs. The intensive care unit is equipped with devices for the rehabilitation of such infants, including a ventilator. Attached to the baby's body sensors A special sound signal warns of the need for emergency medical assistance.
Visits in the intensive care unit are permitted at certain times. Mom can watch the baby through the incubator. To feed such children, it is used, which is introduced into the stomach through the nasal openings. Very weak infants are provided with nutrients using.
The newborn is prescribed antiviral drugs, as well as medications to prevent dysbiosis, infections and other complications. In addition, in order to take timely measures when pathologies are detected, examination by highly specialized specialists(neurologist, cardiologist and others) and the necessary examinations are performed.
IMPORTANT! After discharge, to monitor the heartbeat at home, you can use special sensors that signal the need for first aid.
Intensive therapy
At this stage, many hospitals allow mother and child to stay together, but in some it is possible to visit the baby only temporarily.
As soon as the baby's lungs are able to function independently, he is sent to the intensive care unit. The newborn is again placed in the incubator to maintain the desired temperature and additional oxygen supply. Communication between the baby and mother is allowed in the department. During this period, her voice and touch are especially important for the baby; they will help him recover faster and improve his well-being. Mom can bring expressed milk to the baby for feeding.
Caring for a premature newborn at home
After discharge, care for a newborn premature baby is carried out at home. Such children require increased attention, which is why mothers should know all the features of caring for premature newborns. Do the following recommendations.
- Maintain the required temperature in the room (not lower than 25 °C).
- Ventilate the room frequently.
- Take some time with the air baths. Such a child must be changed quickly to prevent exposure to temperature changes.
- Don't let the baby freeze. After all, his thermoregulation mechanisms are poorly developed.
- Sterilize bottles thoroughly before use.
IMPORTANT! For many babies born prematurely, a mixed feeding regimen is used. Gradually you can switch to exclusively. Use specialized ones for low birth weight and premature babies.
- If necessary, place a heating pad in. In order not to burn the little one, place it at a palm’s distance from the baby, having previously wrapped it in a diaper.
- Support optimal humidity level (70-80%).Also, there should be no drafts in the room.
- Try to maintain lactation, because mother's milk is the best food for a baby. Breastfeed on demand. Do not rush feeding; the baby takes a long time to eat due to immature reflexes.
- To improve and further develop muscle tone use the services of a professional massage therapist.
- Caring for a premature newborn must include walks in the fresh air. Walk with your baby in comfortable weather without wind, rain or snowfall. The outside temperature should be no lower than 10°C and no higher than 25°C. Usually for low birth weight babies walks are allowed 2 weeks after discharge, after doctor’s approval. The first promenades should be short-term. Gradually increase your stay time to 2 hours a day. It is better to postpone visits to crowded places until later.
- Make physical contact with your baby more often.
- carry out 2-3 weeks after discharge.
ATTENTION! Open the door to the bathroom during water procedures. Avoid sudden temperature changes when moving from one room to another!
- Bathe in boiled water.
- Every day should include examining the newborn’s skin for diaper rash, rashes and other suspicious elements.
- Consult your pediatrician to create a personalized vaccination schedule.
- Start introducing complementary foods after 7 months.
Babies born prematurely are considered special children. With proper care and the absence of congenital pathologies, by the age of one year a premature baby is no different from his peers.
Caring for a newborn premature baby: useful video
After watching this video, you will learn what difficulties parents of premature babies may encounter and learn how to properly care for such babies.
Premature babies are not only short in height and weight. Their organs and systems are immature, so such babies require special attention and careful care.
Elena DOLGIKH,
Chief freelance neonatologist of the Ministry of Health of the Sverdlovsk Region, pediatric neonatologist of the highest category, expert doctor of the quality control department of medical care of the State Budgetary Institution of Healthcare of the Collective Clinical Hospital No. 1, assistant of the Department of Hospital Pediatrics of the Pediatric Faculty of the USMU, Candidate of Medical Sciences
The baby is discharged home when his weight reaches 2000 g, he actively sucks and gains weight. When caring for a premature baby at home, a number of factors should be taken into account: air temperature and humidity, frequency of meals, walks, clothing, etc.
Climate in the children's room
For the health of newborns born prematurely, the temperature and humidity in the nursery are of great importance. The optimal humidity level in a nursery is 50-70%. A device called a hygrometer helps control these parameters. It is necessary to humidify the dry air in the room during the period when the central heating radiators are operating. To do this, you can purchase a humidifier. Alternatively, you can use cups of water placed around the room or clean, wet diapers hung up.
The optimal air temperature for a premature baby is 23-25 degrees Celsius. A room thermometer will help you control the numbers. It is necessary to regularly ventilate the room. During the hot season, you can keep the window slightly open at all times, avoiding drafts.
Near the child (under the blanket) the temperature should be slightly higher - about 32 degrees. Additional warming of the baby may be required as prescribed by the doctor. In such cases, heating pads wrapped in soft cloth help. The water temperature in them should not exceed 65 degrees. According to the doctor's recommendation, heating pads are placed at the child's feet under the blanket, and on the sides - on top of the blanket. The heating pads are changed one by one every 1-1.5 hours. It is not recommended to change all heating pads at the same time.
Electric heating pads and blankets should not be used to warm premature newborns. It is strictly forbidden to place heating pads under or on top of a child.
How to control your baby's body temperature
By the end of 1 month of life, the baby's thermoregulation is gradually improving. After the doctor's permission, you can gradually abandon additional heat sources.
It is necessary to monitor the body temperature of a premature baby. This allows you to detect hypothermia or overheating of a child in time. Measure your temperature in the morning and evening, or more often as recommended by your doctor. The ideal device for this purpose is a non-contact thermometer. It measures the temperature by holding it over a child's forehead in 5 seconds. When measuring temperature, the baby must be dressed, otherwise hypothermia will occur.
Cloth
A child born prematurely has an unexpressed subcutaneous fat layer (it may be completely absent), and therefore needs warm clothes that will effectively retain body heat. In addition, clothing intended for premature babies must meet a number of requirements:
- made exclusively from natural fabrics;
- all seams should be only on the outside, no buttons or buttons should touch the baby’s skin;
- It is advisable that the rompers have special insulating pads in the foot area (for example, made of camel hair) - they not only additionally warm the child, but also provide massage to the reflexogenic zones on the child’s feet;
- It is unacceptable to put clothes on premature babies over their heads.
Today, most manufacturers of children's clothing comply with these standards, and therefore finding such models is not particularly difficult - it is only important to contact a specialized store with a wide selection of children's clothing.
Bathing
For a newborn baby, including low birth weight ones, it is necessary to take daily hygienic baths. Bath water does not have to be boiled; the temperature is approximately 36-37 degrees.
The bathing procedure can be carried out at any time of the day, preferably in the evening, before the penultimate feeding, but if the mother notices that bathing has an exciting effect on the baby, it can be done after lunch.
The air temperature in the bathroom should be 25 degrees. The child should be in the water for no more than 2-3 minutes (every day the time can be increased by 1 minute), soap or bathing foam should be used no more than twice a week.
Walks
Walking for premature babies is a very serious issue. Sudden temperature changes are unacceptable. In the warm season, you can go for short walks starting from the 3rd week of staying at home. In winter, it is necessary to let the baby get stronger.
In spring and autumn, walks for children 1-1.5 months old weighing more than 2.5 kg are allowed at temperatures of 10 degrees and above. At temperatures below 8 degrees, you can walk with 3-month-old children weighing 3 kg or more.
Feeding
The feeding regimen for a low birth weight baby is established by a pediatrician. Make sure your baby doesn't spit up milk or formula. After feeding, hold him upright to release any swallowed air. If regurgitation occurs regularly, consult a doctor.
The lower the child's initial weight, the slower it increases. During the first 2 weeks, the baby usually even loses weight, but, as a rule, begins to gain weight from 3-4 weeks, 100-200 g per week. By about 3-4 months he will double his weight.
Limiting guest visits
Premature babies have weak immunity; therefore, it is recommended to limit the number of visitors and guests in the first months of the baby’s life.
Doctors' supervision
Premature babies require not only high-quality home care, but also constant medical supervision.
The doctor at the children's clinic and the visiting nurse monitor the conditions of the child's home life and the timeliness of medical interventions (visits to specialists, tests, vaccinations).
Dispensary observation is established at the place of residence for up to 7 years. Premature babies require constant monitoring by a pediatrician and regular consultations with a neurologist.
During the first 2 years of life, a premature baby is under the supervision of a cardiologist. An electrocardiogram should be performed regularly (at 2, 4, 6 and 12 months of life). An ECG allows you to assess the condition and functioning of the heart muscle. An ultrasound examination of the heart (echocardiography) is also performed. This study allows you to identify congenital heart defects, developmental anomalies and anatomical defects. Echocardiography is performed 4 times during the first 2 years of life (at 2, 6, 12 and 24 months).
Preventive vaccinations
Premature babies are vaccinated according to an individual vaccination schedule drawn up by a pediatrician. The guidelines are the child’s health status and psychomotor development.
Children born weighing less than 2 kg are not given the BCG vaccination (vaccine against tuberculosis) that is usual for all healthy newborns in the maternity hospital. It is performed later, when the child gains weight up to 2.5 kg, in a clinic at the place of residence.
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As soon as we learn about pregnancy, we can already calculate the approximate date of birth of our baby. But sometimes it happens that the baby is in a hurry to be born. Why is this happening? What awaits a baby who is not yet quite ready for a new world? How can I help him adapt?
Causes of premature birth
Here are the most common causes of premature birth:
1. First of all, infection. Any inflammatory process makes the uterine wall defective, so pregnancy continues as long as the uterine wall can stretch, and then the body tries to get rid of the embryo.
2. Isthmic-cervical insufficiency, that is, the inferiority of the muscular layer of the cervix that holds the fetus inside.
3. Endocrinopathies - mild dysfunctions of the endocrine glands - the thyroid gland, adrenal glands, ovaries, pituitary gland (with severe disorders, women, as a rule, cannot become pregnant on their own).
4. Overdistension of the uterus caused by multiple pregnancies, polyhydramnios, and large fetuses.
5. Acute infectious disease (influenza, acute respiratory infections, tonsillitis, pyelonephritis, especially with increased body temperature, etc.)
6. Toxicosis of varying severity, especially nephropathy.
7. Improper or insufficient nutrition (deficiency of vitamins A, C, E).
8. Chronic diseases (hypertension, diabetes, hormonal disorders, heart and kidney diseases).
9. Heavy physical work, chronic stressful situations at work or at home, injuries during pregnancy.
10. The expectant mother’s use of alcohol, nicotine and drugs.
11. Risk factors also include the age of the expectant mother being less than 18 or more than 35 years old.
There are 4 degrees of prematurity:
I. Baby’s weight is 2000-2500g, height - 36-37 cm.
II. The baby's weight is 1500-2000g, height - 32-35 cm.
III. The baby's weight is 1000-1500g, height - 31-28 cm.
IV. The baby's weight is less than 1000g, height is less than 28 cm.
Just 15 years ago, such kids had virtually no chance. At that time, a newborn weighing less than 1000 g was considered a miscarriage and no one fought for his life. Nowadays, thanks to the purchase of the latest equipment and trained specialists, “children in a hurry” have a significant chance to survive. In order to deliver the baby, it is necessary to apply maximum professional knowledge and effort on the part of qualified medical staff. Patience and faith on the part of the baby’s parents are also important, because he was not yet ready to be born.
Physiological and psychological characteristics of the premature infant
Already for the first time moments after birth, premature babies can notice external differences from children born on time. Don’t be afraid of this, you just need to remember that this is all temporary and soon your baby, once fully formed, will become the most beautiful bundle of happiness for you. In the meantime, his skin is thin, wrinkled and seems transparent, because there is no subcutaneous fat, but as time passes, the baby will gain weight and will not differ from other children. He may have light fluff, not only on the back and shoulders, but even on the face and other parts of the body; this is also a temporary phenomenon. The size of the head may appear excessively large compared to the arms and legs. The ears are still very soft, they can wrinkle or fit tightly to the head. And the palms and feet are absolutely smooth, as doctors say - without striations. The baby's activity is reduced, muscle tone and reflexes are not sufficiently developed.
These are only external differences that will disappear over time, but there are other differences that pose a threat to a still fragile child, namely:
1. Respiratory system. In a full-term healthy baby, with the first cry, the lungs straighten and remain in this state; in a premature baby, they straighten more difficult, and sometimes, having straightened, they collapse again. In this regard, their breathing is uneven, superficial, and sometimes unable to provide the body with sufficient oxygen. Congestion often occurs, which can lead to respiratory disorders and lung diseases such as pneumonia. Therefore, to prevent congestion, it is necessary to pick up the child more often and change positions during sleep.
2. Thermoregulation. Due to the incomplete formation of the body, the baby does not have a subcutaneous fat layer, therefore, such children quickly overheat, but also quickly cool down. Depending on the degree of prematurity, various options are used to maintain the optimal temperature for the baby. In the first and second degrees of prematurity, heating pads, additional clothing and blankets are used; in the third and fourth degrees of prematurity, babies are placed in a special incubator, where an optimal microclimate is created, both temperature and humidity. There he can stay from four days to several weeks.
3. Digestive system. Due to a poorly developed muscle that compresses the opening to the baby’s stomach, frequent regurgitation is possible. Frequent bloating occurs due to incompletely formed muscles of the stomach walls. Lethargy of the intestines and still weak abdominal muscles often lead to poor conduction of gases naturally, and the baby’s tummy is stretched, causing pain. Through the diaphragm, the lower parts of the lungs are pressed upward, preventing normal breathing. The intestinal walls have increased permeability, so the baby easily absorbs any microbes and toxins. A liver that is not fully formed does not cope well with “newborn jaundice,” which can last up to a month.
4. The nervous system is also not fully formed and makes itself felt. The baby either sleeps for a long time or stays awake for several hours. Convulsions may occur. The baby reacts with sharp crying to the turning on of the light, an unexpected knock or loud conversation.
5. Due to all these factors, the baby has a very weak immune system. He is predisposed to intestinal and respiratory infections, otitis media.
As a rule, the baby is separated from his mother in the hospital for several months under the constant supervision of medical staff. But during this period, the presence of his mother is very important for him. It is necessary that he feels your warmth, love and care for at least a few minutes or hours a day.
We are together - “mother plus child”
For the normal development of a premature baby and a close relationship between mother and baby, child psychologists recommend the so-called “kangaroo” method. It consists of constant physical contact between mother and child, of course, provided there are no serious health complications on the part of the baby.
The premature baby is placed naked on his mother’s stomach or chest and covered with a blanket, where he spends most of his time. The baby feels the mother’s heartbeat and breathing rhythm, smells her smell and, as it were, returns to the usual conditions of intrauterine stay. And mother’s warmth helps the baby not waste additional energy to keep warm. This method is good not only for maintaining the baby’s body temperature and reducing the risk of infection, but also for the overall development of the baby. His heart works better, breathing becomes calmer and more even, good sleep and activity while awake are established. He is gaining weight faster and is ready to be discharged sooner. And mothers experience more active milk production.
During her stay in the hospital, the mother should not forget to express milk. According to medical observations, those babies who received expressed milk recovered faster and gained weight, because it provides the best protection against infection and contains many vitamins and nutrients that are so necessary for a small body.
Feeding our baby
When the baby is able to suckle on his own, you will need to provide him with the most comfortable conditions, for example:
1. Due to still weak muscles, it can be difficult for the baby to hold the nipple in his mouth. The most effective position for feeding will be the so-called one, in which it is easier for the baby to latch onto the nipple. The “cradle” position is also convenient: the baby is located along the mother’s forearm, and her hand supports the shoulders.
2. It happens that, due to still imperfect regulation of breathing and swallowing and decreased muscle tone in children, swallowing of air is observed, and they begin to choke and cough. To prevent this, take a reclining position, leaning back and placing several pillows for comfort. In this position, the pressure of the milk will be reduced and the baby himself will be able to regulate its flow.
3. Since the baby has not yet developed special sucking structures, namely the ribbing on the palate and the fat pads on the cheeks, the mother can use the “dancer’s hand” method. It consists of supporting the baby’s cheeks and chin with the mother’s hand (the thumb and forefinger hold the baby’s cheeks, the middle finger holds the chin, and the remaining two fingers hold the chest). With this feeding, the baby will not slip off the nipple so often.
When the baby’s body is fully formed and he gets stronger, he is discharged home, where all care and responsibility for him falls on the parents. At home, a premature baby requires a lot of attention and especially careful care.
Several important points for caring for premature babies at home
1. There should be no drafts in the house. The optimal temperature in the room is 22-25 degrees Celsius. The baby should be dressed in warm and soft underwear, and then wrapped in a flannelette blanket, while the temperature under the blanket must be constantly monitored, the thermometer should show 30-33 degrees, while the temperature of the baby itself should be 36.5-36.8 degrees. In the future, the temperature in the room can be reduced to 20 degrees. If the baby’s body temperature is poorly maintained, you should place a heating pad wrapped in a diaper in the crib, placing it at a safe distance from the baby. Ventilation must be mandatory, and the child should be taken out of the room. You also need to take care to maintain normal humidity in the room, since dryness and dampness have a detrimental effect on the baby’s health.
2. Feeding and sleeping for premature babies depends on their degree of prematurity. In grades I and II, babies under two months of age should be fed 7 times a day, with 4 daytime naps of 2-2.5 hours each; from two to five months you should feed 6 times a day, with 3 daytime naps of 2 hours each; and from five months to a year, feed 5 times a day, with 3 daily naps of 1.5-2 hours each.
In grades III and IV, babies up to three months should be fed 7 times a day, with 4 daily naps of 2.5 hours each; from three to six months, feeding occurs 6 times a day, with 3 daily naps of 2.5 hours each; from six months to a year, the baby has five meals a day, 3 daily naps of 2.15 hours each.
3. Bathing babies born weighing less than 1.8 kg in the first three weeks after discharge is not recommended. If he was born weighing more than 1.8 kg, then the first bath can be carried out on the seventh day after discharge. The water temperature should be 38 degrees. In the first three months, bathing water must be boiled. You need to constantly monitor the temperature of the water, for this you need to purchase a special thermometer to control the temperature, you also need to prepare water for rinsing and hot water, which can be added as needed. The temperature in the room should not be much different from the temperature in the bathroom. It is advisable not to carry the baby straight into the room; open the bathroom door and allow the baby to smoothly transition from one thermal mode to another.
4. Walking for “special” babies is dangerous primarily due to a sharp change in temperature, so in the first month it is better to ventilate the room. From the second month, walks should begin with 5-10 minutes, while the air temperature outside should be at least +25 degrees, gradually increasing the duration of stay in the fresh air to 2-3 hours a day. At sub-zero temperatures, walking is not recommended.
5. Premature babies with whom they did gymnastics and massage experienced respiratory viral infections less frequently, muscle tone normalized more quickly, and their emotional state improved. While the baby still has muscle hypertension, stroking is allowed, which is very useful for the baby, as it helps relax the muscles. So, in the first month, a gentle massage is performed - stroking. From 1.5-2 months, massage can be combined with gymnastics, which will promote motor skills. At three to four months, the baby can be encouraged to roll over from one side to the other. From four to five months, start teaching your baby to consciously reach for toys and pick them up. At five to six months, begin to encourage your baby to actively crawl. If a child at seven or eight months already holds his back straight, then you can begin to encourage him to sit and stand. From nine to ten months, the baby can already rise independently with the help of a support and, holding on to it, stand up and try to walk. At one year, start learning to walk independently.
During a massage session, not only physical contact, but also psychological contact is very important. Communicate with your baby, talk to him affectionately, sing songs to him.
For premature babies up to seven years of age, dispensary observation is established at the place of residence. Periodic consultations with a neurologist and other specialists are required. And in the first two weeks of life and in the future, prevention of rickets is mandatory.
Don’t worry that your special baby in the first year of life lags behind in development compared to full-term babies. By two years this difference will disappear. It is possible that over time he will become no less famous than the French commander Napoleon Bonaparte, the English poet Byron, the physicist and mathematician Isaac Newton, or the Russian chemist Dmitry Mendeleev and commander Alexander Suvorov.
A baby is considered premature if born before its due date - before 37 weeks. He was born small, with tiny weight and height, such a baby requires special care from his parents.
In most cases, the first months of caring for a premature baby for parents are a lot of difficulties that arise due to fears, lack of experience and ignorance of the developmental features of such babies. We will help you and tell you how to properly care for premature babies at home.
Nutrition of a premature baby
When a premature baby wants to eat, he may not cry, unlike full-term babies, because his nervous system is still immature, and the baby may not even know that he is hungry. And since his stomach is still too small, it is worth feeding the baby a little, but every 1.5–2 hours.
The muscles used for sucking and swallowing are too weak in a premature baby, and the sucking reflex is poorly developed, so problems can occur.
Your baby will eat better if he is fully awake, so help him focus on eating. Until the baby learns to suck properly, feed him in a room with dim lighting, in silence; if the baby begins to doze off during feeding, “wake him up.”
Breast-feeding
Breastfeeding has a number of benefits. Most importantly, breast milk helps strengthen your baby's immune system and is an ideal source of all essential nutrients. After discharge from the hospital, the baby may become tired during feeding and may not suck the breast completely. In order to ensure good milk production at first, express the remainder after feeding; if necessary, they can be used for supplementary feeding. The baby will need additional support for the head and shoulders during feeding.
In addition to mother's milk, some premature babies need a special supplement fortified with essential nutrients, but if this is really required, your doctor will tell you about it. Also discuss with him how to feed the child correctly, and make a feeding plan together. To understand whether the baby is eating well enough, have a check weighing first, then your doctor will be able to determine whether the baby has enough food.
Bottle feeding
If for some reason you cannot breastfeed your baby, your doctor will prescribe you a special formula for premature babies. They contain much higher concentrations of nutrients than regular infant formulas.
For the jar from which you will feed the baby, you will need a special soft nipple, designed specifically for premature babies; it will make sucking less tiring for the baby.
While you are in the hospital, you will have time to find out how much formula your baby needs during the day.
Because premature babies are at risk of developing iron deficiency, make sure you get enough iron in your diet or give your baby the medicine your doctor prescribes. This is due to the fact that by the age of two months a child’s iron reserves may be depleted, and this can lead to anemia.
Premature baby's room
Air temperature
The most comfortable temperature in a children's room is 22–24˚С. Do not forget to ventilate the room, but at this time it is better to leave it with your child so that he does not get sick. In summer, you can keep the window slightly open, the most important thing is that there are no drafts.
Body temperature
Also monitor the baby’s body temperature; 36.6–37.4˚C is considered normal for a premature baby. If you notice that your child has cool, pale or bluish hands and feet, warm him up. Since the child’s thermoregulation does not work well, doctors advise making warm, dry heating pads, wrapping them in cloth and placing them at the baby’s feet under the blanket and on the sides on the blanket. But be careful, the temperature under the blanket should not exceed 32˚C, and the temperature of the heating pad itself should not exceed 65˚C. Measure your baby's body temperature in the morning, evening and, if possible, during swaddling. If your baby's skin is warm and excessively red, he may be dressed too warmly.
Avoid exposing your baby to direct sunlight, as the skin of premature babies is very sensitive. Also, try to avoid cold drafts and excessively dry air.
The closeness of a premature baby to its mother is very important. To keep your baby's body temperature normal and help him grow faster, place your naked baby on your stomach and cover him with a warm blanket as often as possible.
Humidity
Monitor the humidity in the baby's room; its level should be from 50 to 70% so that the premature baby feels comfortable. It is best to buy a humidifier with a humidity control sensor; it will turn on automatically when the air becomes too dry. This is especially true in the cold season, when the central heating is turned on. An alternative humidifier is to use vessels with water in the room or hanging wet fabrics. Be sure to buy a hygrometer to monitor humidity levels.
Crib
The distance between the bars of the crib was no more than 6.5 cm, this will protect the baby as much as possible. Make sure the mattress fits snugly against the bed frame so that your child's arm or leg doesn't get caught in the gap. By the way, the mattress should be firm enough.
There should only be a thin, tightly stretched sheet between the mattress and the baby. And do not place soft bulky objects in the baby’s crib; they can interfere with the baby’s breathing.
Premature baby clothes
You should not swaddle the baby, as due to the tight fixation of the limbs the child may become hypothermic, and you should not wrap the baby either, otherwise he may overheat. It is better to buy him special small-sized clothes for premature babies, they are sold in specialized stores. Don’t overdo it, the child will grow out of these clothes in just a month and will switch to the dowry that you have prepared for him.
If the child weighs less than 2 kg, then he needs to be dressed in 1-2 layers more than children born on time. Buy diapers specifically for premature babies.
Bathing
Bathing a premature baby should be as short as possible, since the baby quickly cools down, and only after a week of staying at home. For the first three months, bathe your baby in boiled water.
Before putting your child in the bath, check the water temperature, it should be 38˚C. There should be no drafts in the bathroom itself, and the optimal air temperature is 25–28˚C.
The child needs to be bathed very carefully with soft and caressing movements. After bathing, wrap him in a soft towel.
But if your child was born less than 1.5 kg, then do not bathe him at home for the first 2-3 weeks, it is better to wipe him with wet wipes and special baby cleansing milk.
Walks
Be careful when walking, as sudden temperature changes are dangerous for a premature baby. If your child weighed more than 1.5 kg at the time of birth, then you can start walking with him 2 weeks after his birth, but only on the condition that the weather outside is warm and not lower than +22⁰C. The first time the walk can last 10-15 minutes, then adding 5 minutes every day, increase it to 1-1.5 hours.
If the temperature outside is up to +10⁰С, then you can only walk with a 1-1.5 month old baby who weighs at least 2.5 kg.
Control by doctors
Since a premature baby has a very weak immune system, in the first months of life, make sure that there are as few guests in the house as possible, and so that the doctor examines the child, invite him home if possible.
The baby needs constant monitoring by a pediatrician and regular consultations with a neurologist. Also, for the first two years of his life, a premature baby should be observed by a cardiologist, who will do an electrocardiogram at 2, 4, 6 and 12 months of life. It is necessary to perform ultrasound of the heart 4 times during the first 2 years of life - at 2, 6, 12 and 24 months. And when the child is two weeks old, it is worth starting to prevent rickets - vitamin D, massage, hardening, ultraviolet irradiation.
With vaccinations for premature babies, everything is also special. The pediatrician will draw up an individual vaccination schedule.
It is also very important to give the baby a massage and perform simple gymnastics with him, but before that, consult a doctor on how to do them correctly so as not to harm the baby, since a premature baby is too fragile.
Carry your baby in your arms more often, talk to him and sing. This has a positive effect on the baby's health.