Nursing is carried out in 2 stages:

- the first - in the maternity hospital;

- the second - in a specialized department for premature babies. Then the child comes under the supervision of the clinic.

The first stage of nursing

Ensuring optimal temperature conditions:

the air temperature in the department should be 25°C;

immediately after birth, suction of mucus from the upper respiratory tract and primary treatment of the umbilical cord are carried out on a warm tray with warm diapers;

children weighing less than 1500g are placed in a closed incubator (temperature 30-34°C, humidity 90%, oxygen supply). Children are in an incubator from 2-7 to 14 days.;

The body temperature of premature infants can also be maintained in a heated crib.

Drug therapy

It is carried out for the prevention of pathological conditions and for children with a high risk of disease (extremely premature, with intrauterine hypoxia and asphyxia during childbirth)

- for the prevention of hemorrhagic syndrome: 1% Vicasol for 3 days;

- for the prevention of kernicterus: phototherapy, intravenous administration of albumin, choleretic drugs;

- at 3.4 tbsp. prematurity - correction of PCP: 4% solution of sodium bicarbonate with 10% glucose, ascorbic acid, KKB;

- to eliminate hypoglycemia, hypoproteinemia, hypocalcemia – 10% glucose solution, albumin, calcium preparations.

On days 7-8, premature babies are transferred to a specialized department, where they are nursed and treated until complete recovery and achievement of body weight.

Second stage of nursing

1. Temperature maintenance: in in box wards the temperature d.b. 22-24°C, humidity 60%, airing the rooms 6 times a day.

2. Depending on body weight, the temperature regime is set and maintained using an incubator, heated beds, and heating pads.

3. If necessary, continue drug therapy started on

first stage.

Features of feeding premature babies

- the choice of feeding method depends on the severity of the child’s condition, body weight at birth, and gestational age;

- early start of nutrition, regardless of the method (during the first 2-3 hours after birth and no later than 6-8 hours);

- children with a body weight of more than 2000 g with an Apgar score of 7 points or more - are put to the breast on the first day, feeding frequency 7-8 times. If you get tired easily, supplement with expressed breast milk from a bottle.

Children weighing 1500-2000 g are given a trial bottle feeding. In case of unsatisfactory sucking activity - tube feeding in full or partial volume;

- children weighing less than 1500 g are fed through a tube using the method of long-term infusion of native breast milk.

Nutrient and energy requirements

In the 1st month of life 120-140 kcal/kg/day.

2-3 months life – reduction in calorie content to 115 kcal/kg/day. B – 3.8-3.0 g/kg/day.

F – 6.0-6.5 g/kg/day. U – 10-14 g/kg/day.

In order to ensure the high nutritional needs of premature infants in the diet of breastfed children, specialized milk formulas for premature and low birth weight infants based on highly hydrolyzed proteins (Alfare, Nutrilak Peptidi MCT, etc.) are introduced in a volume of up to 20- thirty%.

If the mother does not have milk, children receive full amounts of formula for

feeding premature babies.

Complementary feeding for premature babies is introduced from 4-5 months: fruit purees, vegetable purees or porridge. Meat puree from 5.5 months.

Juices – after 5-6 months.

Premature baby: A premature baby is characterized by a disproportion of individual parts of the body: a relatively large head and torso in relation to height, a short neck and legs, a low navel. The brain skull predominates over the facial skull. The fontanelles (anterior, posterior, often mamillary and sphenoid) are open, the cranial sutures diverge. The bones of the skull are soft, pliable, and move one on top of the other. The ears are underdeveloped and soft. The nasal cartilages are also underdeveloped.

Diagnostic signs of prematurity: body weight from 1000 g to 2500 g, height cm, head circumference - cm, chest circumference - cm; functional and morphological immaturity of the main organ systems; decreased lecithin/sphingomyelin ratio in amniotic fluid, bronchial and gastric aspirates; external signs of immaturity (thin skin, underdeveloped ear cartilage, etc.); high indicators (fetoprotein; late start of maturation of protective morpho-functional structures); high frequency of edema syndrome in the first days of life (40%), SDR (60-70%), intracranial hemorrhages, prolonged conjugative hyperbilirubinemia.

Features of the subcutaneous fat layer: There is no subcutaneous fat layer. The skin is thin, wrinkled, bright or dark red, sometimes glossy, shiny; covered with down (lanugo) on the forehead, cheeks, shoulders, back, and thighs. Because the skin is thin, the network of saphenous veins is visible, and the movement of the intestines can be seen through the abdominal wall. Cheese-like lubricant covers not only areas of physiological folds, but also the entire surface of the body. The nails on the fingers of the extremities are poorly developed and do not extend beyond the edge of the nail bed.

Premature baby: In girls, due to insufficient development of the labia majora, the genital slit is gaping, the clitoris is clearly visible, in boys the scrotum is bright red, empty, the testicles are contained in the inguinal canals or even in the abdominal cavity. The child is sleepy, muffled, and has a weak cry. Movements are uncoordinated and chaotic. Muscle tone is reduced. Physiological reflexes are weakened. Very premature babies may lack swallowing and sucking reflexes.

Activities to provide medical care to premature babies: 1. Hospitalization of women with premature birth in specialized maternity homes. 2. Application of careful delivery methods. 3. Creating optimal conditions for caring for a premature baby in the maternity hospital (stage I). 4. Creation of optimal conditions for nursing healthy premature babies (stage II) and treatment of sick premature babies. 5. Clinical observation of premature babies in a children's clinic.

Features of caring for a premature baby: In the delivery room, a woman with premature birth requires careful care. Childbirth is usually carried out naturally, carefully, without protection of the perineum, always by an obstetrician and neonatologist. Particular attention should be paid to the prevention, timely diagnosis and treatment of intrauterine hypoxia, as well as to prevent the child from cooling down. The temperature in the delivery room should be 2224 °C. It is imperative to prevent asphyxia for Nikolaev. The fetal heartbeat in the first period is listened to every 15 minutes, in the second period every 5 minutes.

Caring for a premature baby: Children who were born with asphyxia undergo a complex of resuscitation measures (suction of mucus, mechanical ventilation, chest compressions, injection into the umbilical cord vein of a 20% glucose solution, 10% calcium chloride solution, cocarboxylase, etimizol, ATP, analeptic mixture, prednisolone). Manipulations related to the revival of a premature baby, ligation of the umbilical cord, prevention of gonoblenorrhea, primary toileting, are carried out with mandatory additional heating with a heat lamp, on a heated changing table. The diapers and midwife's hands should also be warm. After spontaneous breathing is restored, the child is immediately transferred to the neonatal department.

Wards for premature babies: In the wards of the maternity hospital for nursing premature babies (stage I), the temperature should be 2326 °C. Functionally immature children, whose weight is less than 1800 g, are placed in a closed incubator such as “Inka”, “Medicor”, where it is possible to maintain the required temperature, humidity (6570%) and, if necessary, use oxygen. Children whose birth weight is less than 1200 g are kept in an incubator, the temperature in which during the first week becomes 36 °C, from the 7th to the 12th day 35 °C, from the 12th to the 15th day 34 °C, from the 15th to the 20th day 33 °C, after the 20th day 32 °C. For children whose weight reaches 1 g, the temperature should accordingly be 35°, 34, 33, 32 °C; for children whose weight is more than 1500 g, the temperature from the first days should not exceed °C. The length of stay of a premature baby in an incubator depends on its ability to adapt to environmental conditions and is indicated by its ability to maintain a constant body temperature. On average, children who weigh more than 1200 g stay in the incubator for 314 days, and those weighing less than 1200 g from 14 to 30 days. Children weighing more than a gram are kept in open incubators with additional heating with heating pads (water temperature in the heating pads is 5060 °C) for the first 56 days.

Caring for premature babies: Manipulations, swaddling, examination of premature babies in the ward should be carried out with mandatory additional heating and strict adherence to the rules of asepsis and antiseptics. Much attention is paid to the prevention of attacks of secondary asphyxia and respiratory distress syndrome. A significant role is played by proper gentle swaddling of the child, ensuring maximum rest, prescribing mustard plasters on the chest 23 times a day, using oxygen at 4050% concentration, etimizol, inhalation with substances that stabilize surfactant (glycerin 1 ml, heparin 50 units/kg body weight, isotonic sodium chloride solution 3 ml) 3 4 times throughout the day. If premature babies are diagnosed with a disease, they are treated at the first stage and in specialized departments.

Stage II of nursing for premature babies: Children whose weight on the 7-10th day of life is less than 2000 are transferred to Stage II of nursing. The main tasks of this stage are: 1) creating optimal environmental conditions; 2) rational nutrition; 3) prevention of rickets and anemia; 4) massage, exercise therapy; 5) treatment of various pathological conditions.

Care for premature babies: Particular attention is paid to the sanitary and hygienic regime and care for premature babies. The temperature in the rooms is 2425 °C, they do wet cleaning and ventilation. Premature babies are bathed in boiled water (temperature 3840 °C) for 5 minutes. After the bath, the child is wiped with a dry diaper, swaddled in warm, clean linen, and swaddled again after a minute. Very premature babies stay in incubators until they independently maintain a constant body temperature. To warm children in regular wards, heating pads are used; the water temperature in them should not exceed 60 °C. One heating pad is placed under the blanket on the legs and two heating pads are placed along the child’s body on both sides on top of the blanket.

Prevention of rickets and anemia in premature infants: To prevent rickets, from the 810th day of life, ergocalciferol (vitamin D) in an oil or alcohol solution is prescribed, IU per day for 25 days (per course of IU) and calcium supplements. Instead of using ergocalciferol, ultraviolet radiation can be performed (25 sessions). To prevent anemia, it is advisable to introduce microelements into the child’s diet from three weeks of age. Midi sulfate (0.01% solution, 1 ml/kg body weight) and cobalt sulfate (0.001% solution, 0.2 ml/kg body weight) are added to breast milk or formula once a day for 610 weeks. Iron supplements (hemostimulin, iron lactate, etc.) are prescribed from eight weeks of age for 35 months.

Nursing premature babies: When nursing premature babies, one should consider their characteristic deficiency of iron and vitamins. From the first days of life, they need to be prescribed retinol, tocopherol, thiamine, riboflavin, pyridoxine, rutin, ascorbic and nicotinic acids. Premature babies are discharged home when they have reached body weight g and are in satisfactory general condition.

Caring for premature babies in the area: Monitoring of premature babies in the area should be carried out by a local pediatrician with the help of a visiting nurse. Children whose birth weight is below 1700 g are visited by a nurse 4 times a month by the age of 7 months, children with a body weight of more than 1700 g twice a month by 4 months, and then once a month.

Basic principles of clinical examination of premature infants: 1) dynamic monitoring of physical and psychomotor development; 2) control over rational feeding; 3) prevention, early diagnosis and treatment of rickets, anemia; 4) timely detection and treatment of neurological and orthopedic disorders.

Nutrition of premature infants: Nutrition of premature infants depends on age, body weight at birth, degree of maturity, and general condition. The first feeding of healthy premature babies is prescribed after an hour; for children with manifestations of respiratory distress syndrome (RDS)

Nutrition of premature infants: Feeding technique is indicated by the presence of sucking and swallowing reflexes and the general condition of the child. The weakest children need to be fed through a permanent factory-made polyethylene tube with a rounded smooth end or through rubber catheters 9 and 10. The polyethylene tube is inserted through the nasal passages, the rubber tube only through the mouth. When inserting the probe into the stomach, fix it above the upper lip and leave it on the face with an adhesive plaster for 4872 hours, pull it out, boil it and, if necessary, insert it again. Milk is introduced into the stomach in drops, after introducing the entire amount, the probe is washed with 12 ml of 10% glucose solution. This feeding method is used in the first or second week of life until the sucking reflex appears, after which they combine a one-time insertion of a tube with bottle feeding, gradually switching to bottle feeding, and then breastfeeding.

Feeding premature babies: Children with well-defined sucking and swallowing reflexes, whose body weight is less than 1700 g, should be bottle-fed. If the baby actively sucks, does not spit up and does not get tired when feeding, he can be applied to the breast 12 times a day with a gradual transition to breastfeeding.

Feeding premature babies: Healthy premature babies weighing more than 1700 g should be placed on the mother's breast as early as possible. Breastfeeding is carried out with mandatory control weighing. If the baby does not suck enough breast milk, then you need to supplement with breast milk from a bottle. It is most rational to feed a premature baby every 3 hours, initially 8 times a day (without a night break), and later 7 times a day (with a 6-hour night break). The daily amount of milk is best determined using this method: on the first day of feeding, children who weigh less than 1500 g should receive ml of milk; children whose weight is more than 1500 g ml. In the following days, the daily amount of milk for children whose body weight is less than 1500 g is increased by 1530 ml every day, and for children whose body weight is more than 1500 g per ml. On the 1st day of life, the amount of milk a child needs per day should be 1/5 of his body weight.

Feeding premature babies: Human milk is an ideal food for a premature baby, but it cannot replace the need for protein, and sometimes fat, in children born with a body weight of less than 2000. In these cases, nutrition is corrected with formula. If there is no breast milk, premature babies can be given adapted formulas (Nan, Nutrilon, Detolakt). 24

Educational educational institution of secondary vocational education "Kursk Basic Medical College"
Specialty: Nursing
PM 02. PARTICIPATION IN TREATMENT AND DIAGNOSTIC
AND REHABILITATION PROCESS
MDK 02.01 Nursing care for various diseases and conditions
Nursing care in pediatrics
Nursing care for premature babies.
Teacher T. V. Okunskaya

Plan:
1. Features of the structure and functioning of the body
newborn with varying degrees of prematurity.
2. Stages of nursing.
3. Nursing process when caring for a premature baby
(features of feeding, warming and oxygen therapy).
4. Prevention of miscarriage.

Gestational age of premature babies
Premature birth (birth of a premature baby) -
is a birth that occurs before the end of the full 37 weeks
pregnancy.
Pregnancy period (gestational age) is conventionally counted from
the first day of the last menstrual cycle.

Gestational age is the age of the baby from
from conception to birth.
This is the most important indicator of degree assessment
maturity of the newborn and his abilities
adapt to environmental conditions.
The degree of maturity of premature babies depends on
gestational age and birth weight.

Premature baby
According to WHO definition, a premature baby is
baby born alive before 37 weeks
intrauterine development, with body weight less than 2500 g and
less than 45 cm long.
A newborn with a body weight of
birth over 500 g, having taken at least one breath.

According to the order of the Russian Ministry of Health No. 318 dated December 4, 1992
The following terminology is recommended:
all overweight children<2500 г - это новорожденные с малой
mass. Among them there are groups:
2500-1500 g - children with low birth weight (LBW);
1500-1000 g with very low body weight (VLBW);
1000 g - with extremely low body weight (ELBW).

In order for domestic
statistics were comparable to
international criteria in the field
perinatology, Russia, considering
WHO recommendations, switched to new
criteria (order No. 318 of the Ministry of Health of the Russian Federation).
Health care institutions must register
all children, born alive and stillborn, who have a mass
body at birth 500 g or more, length - 25 cm or more, at term
22 weeks pregnant and more (industry indicators).
However, government statistics from live births
takes into account only children from 28 weeks. gestation or more (body weight 1000 g
or more, length 35 cm or more). Of those born alive with body weight
500-999 g are subject to registration with the registry office only those
newborns who lived 168 hours (7 days).

When a diagnosis of prematurity is made
newborn" indicates the gestational age in
weeks in which the birth occurred
(gestational age of the newborn).
According to the ratio of body weight and gestational age
both full-term and premature babies are separated
into three groups:
large for gestational age (LGA);
appropriate for gestational age (GAA);
small for gestational age (SGA).

Risk factors leading to increased mortality
premature babies:
bleeding in the mother before childbirth;
multiple pregnancy; pelvic birth
presentation;
absence of steroid therapy in the mother (prevention
HAPPY BIRTHDAY);
perinatal asphyxia;
male gender;
hypothermia;
type I respiratory distress syndrome (RDS, RDS -
respiratory distress syndrome, hyaline disease
membranes).

1. Socio-economic factors:
occupational hazards (work in hazardous industries, with
computers, with salts of heavy metals, chemicals, etc.);
level of education of parents (the lower the level of education
mother and father, the higher the likelihood of prematurity);
woman’s attitude towards pregnancy: in cases of unwanted
pregnancy, especially in unmarried women,
premature birth of a child is observed 2 times more often;
smoking of both mother and father. Typical complications
pregnancy in smokers - placenta previa,
premature placental abruption and rupture of the membranes,
contribute to miscarriage. Father's heavy smoking reduces
the likelihood of conception and is a risk factor for the birth of a child
with low body weight;
alcohol and/or drug use leads to high
frequency of birth of a premature baby.

Causes of miscarriage
2. Socio-biological factors:
maternal age (primiparas under 17 years and over 30 years) and
father (under 17 years old);
subclinical infection and bacterial carriage;
previous abortions; i
"deficient" nutrition of a pregnant woman.
3. Clinical factors:
extragenital diseases of the mother (especially with
exacerbation or decompensation during pregnancy);
antiphospholipid syndrome in the mother (in 30-40% of cases
recurrent miscarriage - for more details, see Chapter.
III);
chronic diseases of the genitourinary system in the mother;
surgical interventions during pregnancy;
psychological and physical trauma and other pathological
conditions;
gestosis lasting more than 4 weeks.

Causes of miscarriage
4. In vitro fertilization.
5. Multiple pregnancy.

1. On the mother's side:
age of the pregnant woman (primiparas under the age of 18
years and over 30 years old);
severe somatic and infectious diseases,
transferred during pregnancy;
genetic predisposition;
abnormalities in the development of the reproductive system;
complicated obstetric history (frequent
previous terminations of pregnancy or
surgery, pathology of pregnancy,
habitual miscarriages, stillbirths, etc.);
mental and physical trauma;
uncontrolled use of medications.

Risk factors for having a premature baby:
2. From the fetus:
chromosomal aberrations;
developmental defects;
immunological conflict;
intrauterine infection.

Criteria for prematurity
Degree
prematurity
I
II
III
IV
Gestational
age
37 - 35 weeks
34 - 32 weeks
31 - 29 weeks
28 - 22 weeks
Body mass
2500 - 2000 g
2000-1500 g
1500-1000 g
less than 1000 g

Signs of prematurity
The appearance of a premature baby differs from
full-term with a disproportionate physique,
significant predominance of the brain skull over
facial, relatively large body, short
neck and legs.

Signs of prematurity
skin is red, thin, wrinkled,
abundantly covered with fluff (lanugo), subcutaneous fat layer is not expressed, muscular
tone is reduced;
the bones of the skull are soft, pliable, mobile, sometimes overlap each other, the sutures are not closed,
the large, small and lateral fontanelles are open;
ears are soft, shapeless, crowded
pressed to the head;
the areolas and nipples of the mammary glands are underdeveloped or absent;
fingernails and toenails are thin and do not reach the edges of the nail bed;
plantar folds are short, shallow, sparse or absent;
the stomach is spread out "frog", the umbilical ring is located in
lower third of the abdomen;
in girls - the labia majora do not cover the labia minora, labia
the slit is gaping, the clitoris is enlarged;
in boys - the testicles are not lowered into the scrotum, they are located in the inguinal
canals or in the abdominal cavity.

From the side of the central nervous system:
reduction or absence of sucking, swallowing and other physiological reflexes (Moro,
Bauer, Robinson, etc.),
uncoordinated movements of the limbs,
strabismus, nystagmus (horizontal floating
movement of the eyeballs)
muscle hypotonia, adynamia, disruption of processes
thermoregulation (due to slight
energy intake from food, thin subcutaneous fat layer with
low in brown adipose tissue, relatively large
body surface compared to mass),
lack of ability to maintain normal temperature
body, which manifests itself in hypothermia (severe hypothermia body temperature is 35.9-32°C, with severe hypothermia - below 32°C, hypothermia can cause swelling of the subcutaneous fatty tissue of the sclera).

AFO of organs and systems of a premature baby
From peripheral analyzers: blurred vision and
hearing (with severe prematurity).
From the respiratory system:
uneven breathing in rhythm and depth (pathological
breath),
breathing rate varies from 40 to 90 per minute,
tendency to apnea,
the cough reflex is absent or weakly expressed.
There is no surfactant in the alveoli or its content is
is not enough, which causes the development of atelectasis and
respiratory disorders.
From the SSS side:
decreased blood flow (bluish discoloration of the feet and
brushes),
"harlequin" syndrome (in the child's position on his side, the skin of the lower
half of the body becomes red-pink in color, and the upper half is white).
Blood pressure is low, pulse is labile.

AFO of organs and systems of a premature baby
From the immune system:
functional immaturity and a decrease in the number of T-lymphocytes,
decreased ability to synthesize immunoglobulins (high risk
occurrence of infections).
From the digestive organs:
low activity of the secretory function of digestive
enzymes (lipase, amylase, lactase, etc.) and food absorption,
small stomach capacity, which does not allow one to simultaneously hold
required amount of food,
increased tendency to regurgitate due to insufficient
development of the cardiac sphincter,
monotonous nature of intestinal peristalsis (lack of
increase in response to food intake).

AFO of organs and systems of a premature baby
From the liver:
immaturity of enzyme systems, which causes a decrease
protein synthesis, prothrombin (hemorrhagic syndrome),
violation of bilirubin metabolism, accumulation of indirect
bilirubin in the blood and brain tissue (bilirubin
encephalopathy).
From the kidneys:
decreased ability to concentrate urine, almost complete
sodium reabsorption and insufficient water reabsorption,
imperfection of WWTP maintenance.
Daily diuresis by the end of the first week is 60-140 ml,
frequency of urination 8-15 times a day.

Premature baby nursing system
Stage I. Intensive
therapy
in the maternity hospital
Stage II. Observation and treatment
in a specialized department
for premature babies
Stage III. Dynamic observation in a children's clinic

Stage I. Intensive care in the maternity hospital
Goal: save the child's life
All manipulations must be performed under conditions
excluding cooling of the child (air temperature in
the delivery room should be at least 25° C, humidity 5560%, changing table with a radiant heat source).
Additional heating from birth.
Additional oxygenation 15 minutes before and after
feeding. Oxygenation level is adjusted
individually.
For body weight over 1500 g - nursing in special
Baby-therm cots with heating.
With a birth weight of 1500 g and below, as well as for
children in serious condition - incubation.

Couvez is a device, inside of which
a certain temperature is automatically maintained (from 36 to 32°C).
Optimal
temperature regime is the regime at which
which the child has
manages to maintain
rectal temperature
within 36.6-37.1°C.
Changing the incubator and its
disinfection
held every
2-5 days

for 7-8 days depending on his condition
carried out by a sanitary machine
transport equipped with a coupe, or
specialized ambulance team
medical care.

Transfer of a premature baby to an acute care unit
Body temperature measurement is mandatory
premature baby when transferred from the maternity hospital to
transportation time and at the time of admission to the second stage
nursing
Medical personnel transporting a premature baby
child, recorded in the extract from the maternity hospital or on
special card transportation conditions and condition information
child during the observation period.

1. Assess the stability of the condition:
established adequate mechanical ventilation (air, oxygen),
respiratory support;
infusion therapy (through a venous catheter);
control of blood pressure and body temperature.
2. Inform the mother about the transfer of the child, show the child (if
impossibility - to take a Polaroid photograph of a child in
maternity hospital for parents).

Transfer of a premature baby to an acute care unit
Basic transportation rules:
3. Official consent of the mother for possible surgical
interventions.
4. The accompanying documents must contain an extract from
history of the newborn baby and all examination data
mother (preferably a copy) and the medications administered to her.
5. Careful monitoring of the child during transport.

Stage II. Observation and treatment in a specialized
department for premature babies
Goal: satisfaction of basic vital needs
premature babies.
Main goals:
provision of highly qualified medical care;
organization of nursing care with the strictest adherence
rules of asepsis;
creating comfortable microclimatic conditions
(additional warming and oxygenation);
provision of adequate nutrition;
condition monitoring;
teaching parents how to care for their baby at home
conditions, etc.

Features of caring for a premature baby at home
For a premature baby, the air temperature in the room should be 22-
24; bathing water 38.
Questions about the first walk, massage, gymnastics are decided by the doctor in
individually for each premature infant.
The premature baby is fed according to the regimen selected in the department
nursing (7-9 times a day).
If the mother is still lactating, breastfeeding is carried out
premature with a good sucking reflex, weighing more than 1900 g.

First, let’s find out which baby is considered premature. A premature baby is a child born at less than 37 completed weeks, that is, before the 260th day of pregnancy. There are four degrees of prematurity: 1. degree 35 -37 weeks weight approximately 2001-2500 g 2. degree 32 -34 weeks weight approximately 1501-2000 g 3. degree 29 -31 weeks weight approximately 1001-1500 g 4. degree less than 29 weeks weight less than 1000 g.

The reasons for the birth of a premature baby can be: genetic abnormalities of the embryo and malformations of its development; late toxicosis; immunological incompatibility of mother and fetus (Rh conflict); mother's age is under 18 and over 35 years; insufficient or malnutrition of the mother before and during pregnancy; maternal diseases of a general nature, chronic (diseases of the cardiovascular and endocrine systems, kidneys), acute infectious diseases (ARVI, influenza); gynecological diseases of the mother, including sexually transmitted infections, most often syphilis, gonorrhea, cytomegalovirus infection, herpes, ureaplasmosis, trichomoniasis; changes in the uterus (scars after operations, including cesarean section, uterine fibroids, chronic endometritis); bad habits of the mother (smoking, alcohol abuse); occupational hazards; mother's injuries, including psychological ones.

A premature baby requires close attention, since a number of problems often arise in the process of nursing it. First of all, this applies to children born with a body weight of 1500 g or less, “very preterm” (with very low body weight) and, especially less than 1000 g, “extremely premature” (with extremely low body weight). It should be remembered that the division into degrees of prematurity taking into account weight parameters does not always correspond to the true conceptual age of the child. This classification method is used to standardize treatment and observation, for statistical purposes. In practice, in addition, it is necessary to take into account a wider range of positions to assess the actual age of the child.

Due to early, lack of weight and underdevelopment, the child’s AFO differs from the AFO of normal full-term children. Let's consider these differences: Features of thermoregulation AFO of the cardiovascular system AFO of the respiratory system AFO of the digestive system AFO of the genitourinary system

Features of thermoregulation Thermoregulation of premature babies is ineffective; their body temperature completely depends on the ambient temperature. They overheat and cool easily. This is especially pronounced in the first month after birth. According to some authors, in very premature infants, inferior thermoregulation is observed for a longer period (up to 3–4 months). The main reason for thermolability is the immaturity of the thermoregulation center and thermoregulatory mechanisms. A large body surface, very thin skin, an almost complete absence of subcutaneous fat, and low metabolism are also important. Heat generation processes are insufficient (low muscle activity, small amount of food intake, weak oxidative processes). At the same time, heat transfer processes are enhanced and occur more intensely than in full-term infants due to the larger body surface, very thin skin, expansion of the skin capillary network and poor development of subcutaneous tissue. All this explains the frequency of hypo- and hyperthermic conditions in premature infants, as well as the absence of a temperature reaction in them due to infection. Knowledge of the features of thermoregulation of a premature baby poses an important task for clinicians - to create such temperature conditions so that the child does not cool down or overheat. An important criterion for the correct thermal regime is a constant body temperature above 36° with fluctuations during the day of no more than 0.4–0.8°. In recent years, foreign authors have proposed the widespread use of hormones and neuroplegic substances in the fight against hypothermia of prematurity. These treatments for hypothermia are unlikely to be physiological and require careful experimental and clinical testing.

Respiratory system Asphyxial conditions and bouts of cyanosis occur quite often in premature infants. They are explained by the immaturity of the entire respiratory apparatus, ranging from the functional inferiority of the respiratory center to the structural underdevelopment of the lung tissue: thick interalveolar septa, insufficient amount of elastic tissue in the lung, underdevelopment of the alveoli, the presence of more or less areas of “germinal” atelectasis. The horizontal position of the ribs, their softness and pliability, the narrowness of the respiratory tract, the weakness of the respiratory muscles are factors favoring the appearance of breathing disorders. Intrauterine respiratory movements, which the fetus produces in the last months of pregnancy with the glottis closed, help improve blood circulation and nutrition of the fetus. Intrauterine respiratory movements of the fetus are a kind of breathing training that a prematurely born child is deprived of. The average respiratory rate of premature infants is 34–39 per minute. Shallow breathing and difficulty in taking a deep breath in children with particularly low initial weight are mainly a consequence of weak excitability of the respiratory center and low tone of the respiratory muscles. Uneven breathing is apparently due to the physiological immaturity and low excitability of the respiratory center, as well as, possibly, difficulties in conducting impulses along the centripetal fibers of the vagus nerve. Thus, the breathing of a healthy premature baby is characterized by greater frequency, unevenness and less depth compared to full-term children. Resistance to hypoxia in premature infants is due to the ability to use anaerobic sources of metabolism, as well as the lower sensitivity of the child’s body to oxygen starvation. In the majority of premature babies, from the 4th to 5th day of life during sleep, periodic breathing is observed, reminiscent of Cheyne-Stokes type breathing, due to the immaturity of the central respiratory mechanisms.

Cardiovascular system In premature infants, the cardiovascular system is relatively well developed; it begins to function at an early stage of intrauterine development of the fetus. Nevertheless, in comparison with full-term children, they exhibit functional inferiority of the cardiovascular system due to imperfect regulation of blood circulation and incomplete development of the vascular wall. Heart sounds in most children are distinct, sonorous, and the first sound is often amplified. Often, in the 1st–2nd month of life, a systolic murmur is heard, which can be light, subtle and sharp, blowing, even whistling. The frequency of occurrence of such noises (almost 50%), the complete disappearance of noises by 2.5–3 months of life indicate their functional origin. Apparently, poor expansion of the lungs, non-closure of some embryonic circulatory tracts, and anemia are important. Therefore, one should not rush to diagnose “congenital heart disease” in a premature baby in the presence of even pronounced systolic murmur.

The pulse in premature infants is accelerated compared to full-term infants (on average 120–160 beats/min), often arrhythmic, and labile. Blood pressure is significantly lower than in full-term infants, its value is directly proportional to the degree of prematurity of the child. Low blood pressure, significant individual fluctuations and a slow increase, significant fluctuations in pulse rate characterize the inferiority of the cardiovascular system in premature infants. The walls of the blood vessels of a premature baby have an insufficient number of elastic fibers. In extremely premature babies (birth weight up to 1500 g), due to atelectasis and hypoxia, congestion in the pulmonary circulation often develops and severe cardiopulmonary failure occurs - “pulmonary” heart. Such patients die due to decompensation of the right heart. The electrocardiogram in a premature baby is characterized by a lower voltage and deviation of the electrical axis to the right. Changes in the electrocardiogram are caused by the anatomical and physiological characteristics of the heart of a premature baby, as well as, possibly, influences from the autonomic apparatus and electrolytes of blood and tissues. Severe respiratory arrhythmia in premature infants in the first 3 months of life indicates a close relationship between the cardiovascular and respiratory centers. The heart of a premature baby is stable and hardy in terms of automatism and contractile function of the myocardium. Thus, during an asphyxial attack, cardiac activity does not stop, and in the fatal condition of a premature infant, the activity of the heart “outlasts” breathing.

Urogenital system. In premature newborns, phenomena of sexual crisis (engorgement of the mammary glands, swelling and hyperemia in the area of ​​the external genitalia) are almost never observed due to the fact that maternal hormones that cause this condition enter the child’s body only in the last weeks of pregnancy. Premature babies have very little urine in the first days after birth; Most of them have albuminuria. Due to the functional inferiority of the kidneys, the release of chlorides and Na ions is significantly reduced, and therefore water is retained in the tissues, and edema easily occurs. It is possible that the retention of sodium ions in tissues also depends on the functional underdevelopment of the adrenal cortex. Rest, warmth, oxygen therapy, administration of large amounts of liquid orally (but not saline solutions), injections of adrenaline (0.15 ml under the skin of a 0.1% solution) are effective in combating edema of this origin. Central nervous system. Cerebral cortex , subcortical formations, vital centers of the brain (cardiovascular, respiratory, digestive) are underdeveloped in premature babies to varying degrees (depending on the period of intrauterine development and the influence of the pathological course of pregnancy and childbirth in the mother).The swallowing reflex, as phylogenetically the most ancient, is usually present Even in the smallest premature babies, the sucking reflex may be absent for a long time.Even in very premature babies, if they are healthy, the Robinson grasping reflex, the Bauer crawling reflex and the proboscis reflex are observed.

Due to the immaturity of the central nervous system, a number of premature infants experience some motor restlessness (monotonous, sweeping movements of the upper and lower extremities, contractions of the facial muscles, usually during sleep). Such phenomena must always be differentiated from intracranial birth trauma. Sucking strength increases very slowly in premature infants; They often suck “in vain,” that is, they externally produce vigorous sucking movements, but suck out very little milk, since their suction force and pressure force are very small. Therefore, it is necessary to weigh the baby every time before and after feeding to accurately determine the amount of milk sucked. The period of normalization of sucking function has very wide limits and depends on the child’s maturity, care, and feeding conditions. The appearance of conditioned reflexes (food, defensive) is possible already in the 1st–3rd month of life and depends on the degree of prematurity and state of health. The electroencephalogram of a very premature baby in the first 2 months of life records the bioelectrical activity of the brain in a state of complete rest in the form of irregular, low-amplitude, slow oscillations and periodically repeated outbreaks of paroxysmal oscillations against the background of complete electrical rest, which mainly reflects the vital processes of subcortical structures. Clinically, the predominance of subcortical reflexes (fetal posture, automatic movements, generalized reactions to external stimuli) is also clearly revealed.

Digestive organs The digestive system in very premature infants is functionally immature. The gastrointestinal tract of premature infants is characterized by immaturity of all sections, small volume and a more vertical position of the stomach. The sucking reflex is absent or insufficiently developed, and some children do not have a swallowing reflex. Due to the relative underdevelopment of the muscles of the cardiac part, premature babies are predisposed to regurgitation. The mucous membrane of the digestive canal in premature infants is tender, thin, and easily vulnerable. All this complicates the processes of digestion and absorption, contributes to the development of flatulence and dysbacteriosis. In 2/3 of premature babies, even those who are breastfed, there is a deficiency of intestinal bifid flora in combination with the carriage of opportunistic flora. The nature of a child's stool is determined by feeding characteristics; As a rule, premature babies have a lot of neutral fat in their coprogram. Thus, the features of the gastric tract in premature infants are: Poor development of the sphincter at the entrance to the stomach, which leads to frequent regurgitation; Poor development of longitudinal muscle bundles of the stomach wall, which causes lethargy and bloating due to overfeeding and exposure to air; Slow evacuation of stomach contents (130 - 140 min); High viscosity of original feces (lack of trypsin). In premature newborns, the functional inferiority of the liver is expressed; as a result, an insufficient amount of the enzyme glucurone transferase is produced, and this predisposes to the development of prolonged jaundice. A low level of prothrombin causes increased bleeding. Premature babies are prone to intestinal dysfunction. The intestinal wall has increased permeability, so microbes and toxins in the intestines are absorbed through the intestinal wall into the blood. Due to hypotension of the intestines and the anterior abdominal wall, flatulence is often observed; as a result, the diaphragm rises upward, squeezing the lower parts of the lungs and disrupting their normal ventilation.

Endocrine system. Features of the functioning of the endocrine system of a premature baby are determined by the degree of its maturity and the presence of endocrine disorders in the mother that caused premature birth. As a rule, the coordination of the activity of the endocrine glands is impaired, primarily along the axis of the pituitary gland - thyroid gland - adrenal glands. The process of reverse development of the fetal zone of the adrenal cortex in newborns is inhibited, and the formation of circadian rhythms of hormone release is delayed. Functional and morphological immaturity of the adrenal glands contributes to their rapid depletion. In premature babies, the reserve capacity of the thyroid gland is relatively reduced, and therefore they may develop transient hypothyroidism. The gonads in premature babies are less active than in full-term babies, so they are much less likely to experience the so-called sexual crisis in the first days of life.

Conclusion A premature baby needs special, complex, expensive and technologically advanced care. A premature baby is kept in an incubator until he can independently maintain body temperature and do without additional oxygen supply. The length of stay in the incubator depends on the body weight at birth, maturity and general condition of the child. Children with a low degree of prematurity are in the incubator for 2-4 days or several hours, very premature children with a body weight of up to 1500 g - 8-14 days, and with a body weight of up to 1750 g - 7-8 days. Today it is considered proven that during a hospital stay a premature baby needs communication with its mother. The baby should hear the mother's voice and feel her warmth. Studies have shown that maternal warmth perfectly warms the child and his body temperature is maintained at the proper level. Breathing also becomes more regular and stable, as does the heartbeat and oxygen saturation of the blood. Moreover, the newborn’s skin is populated with the mother’s microflora, which promotes healing processes.

OBIECTIVELE lECŢIEI: O1 - Să caracterizeze perioada de nou –născut
O2 – Să definească noţiune de nou-nascut
prematur
O3 – Să numească gradele prematurităţii
O4 – Să enumere factorii de risc
O5 – Să numească semnele nou-născutului
prematur.
O6 – Să enumere criterii de externare
O7 – Să efectueze toaleta matinală, intimate, băiţa
igienică.

O8 – Să alimenteze copii prematuri prin gavaj, cu
linguriţa, cănuţa.
O9 – Să expună tehnica vaccinării BCG, HVB.
O10 – Să efectuieze proba suptului.

DEFINITION

70-75% of child mortality is
premature babies are therefore the main thing
medical task workers is
preventing premature births
children.
According to WHO child
is considered premature if the baby
born alive, with a gestational age of up to 37
weeks (less than 258 days), with weight at
birth less than 2500 grams.

Degrees of prematurity

1st degree (2500-2001; 36-34 weeks)
2nd degree (2000-1501; 34-30 weeks)
3 degree (1500-1001; 30-28 weeks)
Grade 4 (less than 1000; less than 28 weeks)

Risk factors for the birth of premature and low birth weight infants.

I. Risk factors (social):
1.Low social level
2.Occupational diseases of parents
3. Inadequate nutrition
4. Bad habits of parents
(substance abuse, alcoholism, drug addiction,
smoking)

Risk factors associated with the mother:

Abortion before this pregnancy
Infertility before this pregnancy
Arterial hypertension in pregnant women is more
140/90
The mother's body weight before pregnancy is less than 50 kg.
Hormonal dysfunctions
Emotional stress during pregnancy

Sexually transmitted diseases during pregnancy
Risk of miscarriage
Infectious diseases in mother
Decompensated cardiopathy
Severe anemia in pregnancy
Bleeding during pregnancy
Age under 18 and over 35 years

Risk factors associated with the fetus:

Abnormal presentation
Genetic factors
Chromosomal diseases
Congenital anomalies
Hormonal dysfunctions
Multiple pregnancy
Premature rupture of amniotic sac
shell
Incompatibility of mother and fetus by blood type
ABO and Rhesus.

Factors related to the placenta:

Morphological abnormalities in the structure
Placental hypoplasia
Placenta with calcifications
Uteroplacental insufficiency.

Determination of gestational age:

Mom's menstrual data
Ultrasound
Clinical examination
newborn

Anatomical and physiological characteristics of a premature baby.

Body disproportionate, limbs and neck
short
The head is large, 1/3 of the length, bones
the skulls are soft, the sutures are open, the fontanelles are open
lateral.
The face is small, triangular, the mouth is large,
sharp chin
The neck is thin
The chest is narrow

The abdomen is larger than the chest
The umbilical cord is thinner and located lower
The skin is red, thin, shiny, swollen, covered
“lanugo” on the back, limbs, forehead, cheeks.
Subcutaneous fat tissue is poorly developed
Thin nails do not cover the nail bed
The auricles are soft, with underdeveloped cartilage
cloth
The external genitalia are underdeveloped
girls do not cover the labia majora
small.
in boys the scrotum is underdeveloped, small,
The testicles are not descended into the scrotum.

Functional characteristics of a premature baby.

Premature is drowsy, hypodynamic,
weak cry, decreased muscle tone,
reflexes are weak or absent.
Breathing is irregular, shallow,
abdominal type, with apnea crises.
The respiratory muscles are underdeveloped, therefore
VC in premature babies is very
small. Lower segments weakly
ventilated. Due to lack
surfactant.

SSS. BP is very low 45/20 mm. rt. Art. first
10 days, then grows 70/45.
Heart rate is 120-160 per minute, and pulse is 60 per minute,
therefore the extremities are cold and cyanotic
touch
Gastrointestinal tract. Swallowing and sucking reflexes are weak
developed. Saliva secretion is reduced, therefore
the oral mucosa is very dry. Cardiac part
poorly developed, so they often occur
regurgitation.
Liver function is underdeveloped. Glycogen depot
in the liver is reduced, therefore in premature infants
Hypoglycemia occurs quickly.

The secretion of prothrombin is also reduced, which
leads to hemorrhagic syndrome in
premature babies.
In premature infants, the system is also imperfect
thermoregulation, which leads to rapid
hypothermia.
Kidney function is also imperfect and reduced
filtration function.
The immune system is underdeveloped, therefore
susceptibility to infections is high.
Infectious diseases are more severe in them

Features of caring for premature babies.

Air temperature 26-28%, humidity
60%
Warm clothes
Resuscitation table
Oxygen flow
Warm incubator
Electric heater.

Advantages of incubators:

Provide a clean, warm environment with
monitoring temperature, humidity.
Provides thermal comfort,
strict control of humidity and feed
oxygen.
Incubators are used to care for
premature and with a small birth weight
birth while maintaining optimal
temperature.
The required temperature is set
for age and weight.

Vaccination.
Premature babies are vaccinated only when
when their weight reaches 2500 grams.
Conditions for discharge of a premature baby:
The child breathes well and without other pathologies
Body temperature 36.5-37.5
Baby sucks well at the breast
Gaining weight well (at least 15 mg/kg per
day)
The mother is able to care for the child.

Nutrition of premature babies.

If the child's weight is between 1.75-2.5 kg.
The child is allowed to breastfeed if he is not
can breastfeed, use expressed milk.
If the child's weight is from 1.5-1.749 kg. feed
expressed milk using a mug and spoon.
If the child weighs from 1.2-1.49 kg. feeding the baby
expressed milk using a nasogastric tube
probe.