Premature babies. The right to live. The second stage of nursing - the department for premature babies: an inside view The system of nursing a premature baby

The nursing process takes from several weeks to a couple of months.. The final time is affected by the degree of prematurity, the general condition of the baby, the presence of pathologies. Newborns who are in perinatal centers have high chances for survival and full development.

Much of what is needed to properly care for a premature baby is often missing in conventional maternity hospitals.

First: nursing in intensive care

This is the most important and critical stage in a baby's life. An important role at this stage is played by the speed of decision-making. The purpose of the first stage of nursing is to exclude the development of complications and life-threatening situations. After the baby is removed from the womb and the umbilical cord is cut, it is placed on warm diapers and dried. All medical manipulations are carried out on a warm table, which maintains a certain temperature similar to intrauterine heat.

The child is sent to the intensive care unit for medical reasons. Here the child is placed in a jugs. This is a kind of incubator for newborns, which is shaped like a glass box with holes. The set temperature and humidity are always maintained inside the incubator.

The child in the incubator is connected to sensors that support and control the functioning of the lungs, the digestive system, and these devices also measure blood pressure.

REFERENCE! The temperature and humidity in the incubator depends on the weight of the baby. So, with a mass of 1 kg, the temperature is +34 degrees, the humidity is 60%. With a weight of 1.5 kg - +32 degrees and 70% humidity.

Medical care for a premature baby in the intensive care unit includes:

• Breath control. Premature babies often develop lung pathology - hyaline membrane disease (in children weighing up to 1 kg). To eliminate the problem, a ventilator is connected - the device is designed to supply a gas mixture to the lungs.
• The skin of preterm babies is thin, and the risk of moisture loss is high. In the incubator, babies are only wiped with wet swabs. All equipment is hung with clips or attached to the fingers or earlobes, since pressure tapes cause severe chafing.
• Medicines. Medicines are given through the umbilical vein or through a vein in the arms.

Second: intensive care

The child is transferred to this stage after the normalization of body weight. The purpose of the second stage of nursing is the fastest growth and weight gain, the normalization of psychosomatic functions. In intensive care, mother and baby are together in the ward. Each ward is assigned 1-2 nurses who monitor the condition of the newborn.

In this department, you can spend from several weeks to months. In the ward, monitoring of the baby's body temperature continues. According to the dynamics of state improvements, a method such as the “kangaroo method” is assigned. It implies direct contact between mother and child.

1. The baby is placed on the mother’s chest for about 20 minutes, covered with a blanket on top, and a hat is put on her head.
2. The method allows you to stabilize heat transfer, has a beneficial effect on the mental state.
3. In the future, the time interval is increased. Pediatricians advise continuing to perform the "kangaroo method" at home.

IMPORTANT! The kangaroo method should only be used after the newborn's medical parameters have stabilized (no seizures, stable breathing, blood pressure, and heart rate).

Third: at home under the supervision of doctors

Stage 3 is possible if there is no threat to the life of the child and critical weight indicators are defeated. The purpose of the third stage of nursing is the addition of mass in a natural way. On the first day after discharge, a nurse and a doctor come home. Further, during the month, the nurse will come 2 times a week, the pediatrician 2 times a month.

At home, it is also important to observe the thermal regime and control the humidity of the air. The temperature in the room should not be 20 degrees, ideal indicators: 20-22 degrees. Air humidity 60-70%.

Rehabilitation of newborns with low body weight

You can save and leave a newborn if he was born for a period of 28 weeks. This is considered a deep prematurity, but such children are already viable. With proper care, they quickly gain weight and adapt. Advanced medical equipment allows you to nurse children weighing 500 g or more.

Saving a premature baby begins already in the delivery room. Resuscitators and neonatologists carry out the prevention of asphyxia: with a special device, the child's organs are cleared of mucus.

If there is no breathing, the baby is connected to a ventilator. After normalization of breathing and heart rate, the child is placed in an incubator.

General initial steps for caring for a low birth weight baby:

1. Rubbing and drying the skin.
2. Wrapping in sterile heated film.
3. Additional head protection against heat loss.

Features of the rehabilitation of babies with extremely low weight

So how many weeks can a premature newborn go out? You can go from 28 weeks and above. If the child was born before 28 weeks, and his body weight is less than 1 kg, special conditions are created. In the first minutes of life, the baby is immediately placed in an airtight bag (the whole body except for the head). The head remains on the surface, it is additionally wrapped for warming.

Before being placed in a bag, sensors for measuring pressure, pulse, and temperature are attached to the right wrist of the child.

Attention! In the incubator later, a set of measures aimed at stabilizing breathing and heart rhythm is carried out. This is the creation of a suitable temperature regime.

Also carried out:

• additional oxygen supply through a mask, nasal cannulas or endotracheally;
• parenteral nutrition (with weak sucking activity) or with a probe;
• replenishment of fluid losses;
• antibiotic therapy.

Premature babies have high chances for life and full development with timely and proper assistance. If there is a risk of preterm birth, "attach" to the perinatal center in advance. The condition of the baby largely depends on the health and mood of the mother, take your condition seriously.

The first treatment and preventive measures begin in the delivery room. All manipulations are carried out in conditions that exclude the cooling of the child (air temperature not less than 25 ° C, humidity 55-60%, changing table with a source of radiant heat).

An important condition for the successful nursing of a premature baby is additional heating from the moment of birth!

Immediately after removing the head, suction of mucus from the oral cavity and upper respiratory tract (to prevent aspiration).

Reception of the child in warm, sterile diapers.

Re-sanation of the tracheobronchial tree.

Then the head and body of the child are carefully wiped with diapers. Soft (sparing) stroking of the head, torso, limbs is one of the methods of tactile stimulation of respiration, in response to these manipulations, as a rule, the frequency and depth of respiration increase.

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

After the initial treatment and bandaging of the umbilical cord, a child weighing more than 2000 g, wrapped in diapers and a flannelette blanket, is placed in a crib at an environmental temperature of 24-26 ° C, tk. he is able to maintain a normal temperature balance himself.

Children weighing more than 1500 g are nursed in special beds "Bebiterm" with heating and additional oxygenation (T about the air in the ward at first 26-28 ° C, then gradually decreases to 25 ° C, according to indications, warm, humidified oxygen is supplied, the concentration is within thirty%).

Premature babies with a birth weight of 1500 g or less, as well as children in serious condition, are placed in incubators (an apparatus inside which a certain T o C is automatically maintained - from 36 o C to 32 o C). In the incubator, the child is provided with an optimal temperature regime (the child's rectal temperature is maintained within 36.6 o -37.1 o C).

Humidity in the incubator on the first day should be 80-90%, and in the following days - 50-60%. The level of oxygenation is selected individually - the oxygen concentration should be optimal, at which cyanosis of the skin and mucous membranes, bradypnea, apnea, and reduced motor activity disappear. But it is not recommended to maintain an oxygen concentration of more than 38% due to the possibility of its toxic effects on the central nervous system, lungs and retina. The change of the incubator and its disinfection are carried out every 2-5 days (increased temperature and humidity create favorable conditions for the rapid reproduction of pathogenic microorganisms). Prolonged stay of the child in the incubator is undesirable. Depending on the condition of the child, it can be from several hours to 7-10 days.

On the 7th-8th day, a premature baby is transported in specialized vehicles and in incubators from the maternity hospital to the department for nursing premature babies.

Stage II - observation and treatment in a specialized department for premature babies.

Target: meeting the basic vital needs of premature babies.

Main goals:

Providing highly qualified medical care;

Organization of nursing care with the strictest observance of asepsis rules;

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

Providing adequate nutrition;

Status monitoring;

Teaching parents how to care for a child at home.

The child in the department is transferred from the incubator to a heated bed only if this does not lead to a change in his condition (T about the body, color of the skin, etc.). If the child in the crib does not “keep” the body temperature well, additional warming is applied with the help of rubber heating pads (from one to three degrees of water at 60 ° C, placing two on the sides and one at the legs at a palm-width distance from the child’s body). As soon as the child begins to "keep" T about the body in the range of 36.5-37 ° C, the number of heating pads is gradually reduced. It must be remembered that inept warming of the child can lead to overheating or hypothermia.

3. Regular assessment of the functional state of organs and systems (skin, mucous membranes, musculoskeletal system, organs of vision and hearing, etc.).

4. Control and correction of the child's nutrition according to the functional capabilities and age.

5. Timely prevention of rickets, anemia.

6. Education and counseling of parents on hardening.

7. Training of parents in massage and gymnastics complexes.

8. Vaccination according to an individual vaccination schedule.

9. Examination of the child by a pediatrician and specialists (ophthalmologist, otolaryngologist, neuropathologist, orthopedist, dentist) at the decreed time and according to indications.

10. Laboratory studies of blood and urine tests at the decreed time and as needed.

Ekaterina Morozova

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The term "prematurity" is used when the baby is born earlier, and his body weight does not exceed 2.5 kg. With a weight of less than 1.5 kg, a newborn is considered very premature. And with a weight of less than a kilogram - a fetus.

What are the signs of prematurity, and how to take care of babies born prematurely?

Premature newborns: signs of a premature baby

In addition to weight, premature babies have other characteristic signs of preterm birth.

These include:

• Small growth. It will be the smaller, the higher the degree of prematurity.
• Almost complete absence of subcutaneous fat(in very preterm infants).
• Decreased muscle tone.
• Underdeveloped sucking reflex.
• Body disproportion: low position of the navel, shorter legs, large flattened belly, large head (1/3 in relation to height).
• open small and, often, divergence of the cranial sutures.
• Soft, easy to fold ear shells.
• Abundant vellus hair expressed not only on the back / shoulders, but also on the forehead, hips, cheeks.
• Underdeveloped marigolds(not reaching the fingertips).

The maturity of the baby is affected many factors . Each organism is individual, and of course, it is impossible to focus only on body weight at birth.

The key criteria by which the status and characteristics of a premature baby are determined are condition, degree of prematurity and body weight of the baby at birth, and the nature of childbirth, the cause of preterm labor and the presence of pathologies during pregnancy.

Degrees of prematurity in newborns, height and weight in newborns

The weight of the crumbs directly depends on the gestational age, on the basis of which they are classified degree of prematurity baby:

• At birth at 35-37 weeks and body weight equal to 2001-2500 g - 1st degree .
• At birth at 32-34 weeks and body weight equal to 1501-2000 g - 2nd degree .
• At birth at 29-31 weeks and body weight equal to 1001-1500 g - 3rd degree.
• At birth at a term of less than 29 weeks and a body weight of less than 1000 g - 4th degree .

Stages of nursing premature babies, pathology of premature newborns

• Resuscitation. The first stage, at which babies are placed in an incubator ("incubator" with a ventilator) in the absence of the ability to breathe on their own and with the immaturity of important body systems. If there is no sucking reflex, then milk is given to the child through a special probe. Control of breathing, pulse and temperature is mandatory.
• Intensive therapy. If it is possible to breathe on its own, the baby is transferred to the incubator, where they continue to maintain his body temperature and carry out additional oxygen supply.
• follow-up observation. Observation of specialists until the full normalization of all vital functions of the body and to identify deviations with their subsequent correction.

The duration and difficulties of nursing directly depend on the degree of prematurity . But the main problem is not the lack of weight, but underdevelopment of important systems and organs crumbs. That is, the fact that the baby was born before he had time to ripen for life outside the womb.

That is why the task of doctors is comprehensive examination for the presence of pathologies that develop against the background of imperfection of the protective forces, a tense period of adaptation and acute reactions to adverse effects.

Possible pathologies of premature babies:

• Inability to spontaneously breathe.
• Lack of sucking reflex, poor swallowing of food.
• Long-term formation of reflexes that are responsible for the regulation of muscle tone (at an older age - incorrect pronunciation of sounds, late onset of the first coherent speech, etc.).
• Circulatory disorders, hypoxia, risk of developing cerebral palsy.
• Increased intracranial pressure.
• Developmental delays and movement disorders.
• Joint dysplasia.
• Immaturity of the respiratory system, underdevelopment of lung tissue.
• The development of rickets and anemia.
• Susceptibility to colds, otitis, infectious diseases.
• development of anemia.
• Hearing and vision disorders (development of retinopathy), etc.

Nursing of premature babies: feeding, treatment of premature newborns

Key baby care rules born prematurely are reduced to the following points:

• Creation of comfortable conditions : rest, proper feeding and drinking, sparing examination and treatment, air humidity, etc.
• Strict maintenance of the desired temperature in the ward (24-26 gr.) and incubator (with a weight of 1000 g - 34.5-35 gr., with a weight of 1500-1700 g - 33-34 gr.). The baby is not yet able to warm himself, so even changing clothes takes place in the incubator.
• Additional oxygenation (increase in oxygen concentration).
• The correct position of the baby in the incubator , if necessary - the use of a cotton bagel, a regular change of position.

Feeding premature babies is a separate part of the nursing program:

• Immature babies (in severe condition) are shown parenteral nutrition (intravenously and through a probe), in the presence of a sucking reflex and in the absence of severe pathologies - fed from a bottle, with active sucking and a weight of 1800-2000 g - applied to the chest (according to individual indications).
• Sufficient liquid A must for every premature baby. Ringer's solution is usually used, mixed 1:1 with 5% glucose solution.
• Additional vitamins are added : during the first 2-3 days - vikasol (vitamin K), riboflavin and thiamine, ascorbic acid, vitamin E. The remaining vitamins are prescribed according to indications.
• In the absence of mother's milk, from the 2nd week, premature babies may be prescribed nutrition with mixtures with a high level of protein and energy value .

Severely premature babies special treatment is required, which depends on individual health problems.

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

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

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

Nursing a premature baby in a medical facility

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

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

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

The main causes of preterm birth:

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

Condition features

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

nervous system

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

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

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

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

thermoregulation

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

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

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

System digestion

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

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

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

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

Hearing And vision

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

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

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

Respiratory system

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

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

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

Cordially — vascular system

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

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

Endocrine system

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

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

Bone system

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

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

urinary system

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

hematopoietic system

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

immune system

Most of the antibodies and immunoglobulins the child receives from the mother at 32-35 weeks. In premature babies, there is a pronounced lack of protective factors. Their immune system functions poorly: immunoglobulins and lymphocytes are almost not produced.

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

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

Dynamics masses body

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

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

Specificity behavior

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

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

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

nursing

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

Hospital

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

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

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

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

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

House

Basic conditions for discharge of a child:

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

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

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

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

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

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

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

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

Nutrition

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

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

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

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