Babies born prematurely need constant attention and special treatment. Caring for them is significantly different from caring for regular newborns. Most often, premature babies are transferred from the hospital to the neonatal intensive care unit. There, the mother has the opportunity to get the first skills in childcare. But after discharge, when a young mother is at home alone with her baby, she may become confused. Let's look at the main nuances that mom will have to adhere to until the baby gets stronger.

Feeding
Feeding is one of the most important moments in caring for a premature baby, so the doctor gives recommendations regarding feeding the baby, based on his individual characteristics. And it is important for a young mother to follow them clearly.
Now let's move on to general, but rather important points.

As doctors note, in our time, parents practice feeding their children not on time, but on demand. This system cannot be applied to premature babies, because they are still too weak to show that they are hungry.

Usually, the baby is advised to feed every three hours without taking a break for the night. However, if he is too weak and does not eat well, the doctor may recommend that the intervals between feedings be shortened.

It is imperative to make sure that the child eats the portion assigned to him. If during feeding the baby falls asleep, you need to gently wake him up and try to feed him. It can be difficult to wake up such a baby, but this is normal, do not be afraid that something is wrong with him. Doctors advise to lightly twitch the ear and nose of the child. This is what annoys the newborn most of all, and he wakes up.

There is also another important point that many parents overlook. From the first days of life, a child should be given water to drink in addition to milk. He should drink 100 grams of water per 1 kg of weight per day. That is, if a child weighs 2 kg, he must drink 200 grams of water per day.

Dressing up
Dressing up a premature baby is also an important nuance. It must be remembered that heat exchange has not yet developed in children weighing less than 3 kg. They need constant warmth, otherwise hypothermia can occur very quickly.

The temperature in the room where the child is located should be 25-27 0 С, and the air humidity - 50-70%. To monitor this, you can hang a thermometer and hygrometer at a level of 1.5 m from the floor near the crib.

To maintain the necessary humidity in the room, it is necessary to often do wet cleaning, and you can also use a special air humidifier. In addition, do not forget about airing. It is advisable to ventilate the room every 3-4 hours for 15-20 minutes. At this time, the baby needs to be taken to another (warm) room.

So that the baby does not freeze and does not experience unnecessary stress, try to change his clothes one by one: first a vest, then a diaper and pants. You can cover open areas of the body with a diaper, so the baby will be calmer.

Each time a newborn should be dressed in clean and ironed linen on both sides. Do not neglect this nuance, because the baby still has practically no immunity, and he can easily get sick.

Bathing
For the first time after the birth of premature babies, they do not bathe. A child born with a weight of more than 1.5 kg is allowed the first bathing in 7-10 days. If the baby was born with a lower weight, then you should start bathing him in 2-3 weeks. Before the first bathing, it is better to consult a doctor, if you decided to do it early.

A newborn should be bathed in a separate baby bath, and in the first three months only in boiled water. The water temperature should be 38 0 С, and the premises should be at least 25 0 С.

The first bathing should not last long - 4-5 minutes. After the child should be wrapped in a heated towel, allowed to dry, warm up, and only then change clothes.

At the first bath, the child may cry. This is not familiar and scary for him. Over time, bathing will become one of his favorite activities.

Dream
Premature babies sleep a lot. Sometimes even 20 hours a day. This is due to the fact that the child is not yet ripe, and in a dream he develops more quickly. A few months will pass and the baby will begin to be more awake and show interest in the world around him.

Causes, signs and consequences of the development of premature babies. Special care and nutritional system.

The birth of a baby is perhaps the most important and responsible task in a woman's life. You are preparing, planning, dreaming of a comfortable pregnancy, childbirth without complications, breastfeeding crumbs from the first minutes after birth.

But besides your dreams, there are the desires of the little man. He also decides when, how and why to be born.

At what date of birth is a baby considered premature?

In the mid-70s of the last century, the World Health Organization determined the minimum indicators for the term, weight and height of a child after birth - 22 weeks, 500 g, 25 cm, respectively.

In practice, they fluctuate in the following ranges:

• 28-37 weeks gestation
• 1000-2500 kg
• 35-45 cm

The degree of a premature baby

A child born prematurely with the indicators approved by the WHO in the post-Soviet countries is regarded as a late miscarriage.

According to the degree of prematurity, babies are distinguished:

• Grade 4 - with extremely low weight - less than 1 kg, delivery occurred earlier than 28 weeks, growth up to 30 cm
• Grade 3 - low weight - less than 1.5 kg, born before 31 weeks of gestation with a body length of less than 35 cm
• 2 degree - parameters of weight, weeks of gestation and growth of the baby - up to 2 kg, 35 and 40 cm, respectively
• 1 degree - more than 2 kg, 37 weeks, 45 cm

A child can be born on time, but with insufficient weight. He will be recognized by doctors as premature too. Therefore, we note that the main feature of an "early" child is his weight.

Signs of a premature baby

A premature baby is very different from a baby born on time and with good weight. It is even more fragile and vulnerable to environmental irritants.

Signs of a child born prematurely, depending on his state of health and the degree of prematurity, are called:

• disproportionate body size - a large head is one third of its total length, limbs are short
• face, back and chest covered with hairy down
• skin color varies from deep red to pink depending on the week of birth
• crying low, voice thin
• wrinkled skin
• subcutaneous fat is absent or very thin
• poor body thermoregulation
• the bones of the skull are soft, the fontanelles are open
• the face is small compared to the size of the brain
• eyes closed
• the ears are soft or not fully formed
• the marigolds on the fingers have not grown to the tips
• the navel is located closer to the groin area
• rounded or sunken belly
• ribs perpendicular to the spine
• breathing too fast for up to 70 breaths a minute with signs of prolonged freezing (apnea) up to 10 seconds
• weak pulse, hypotension
• the genitals are underdeveloped - in boys, the testicles have not descended into the scrotum or the latter is in the stage of formation, in girls the large labia do not cover the small ones, there is a gaping gap
• nipples and areola without pigment
• muscle activity is weak, either hypo- or hypertonicity is observed
• delayed response to external stimuli

Causes of the birth of premature babies

As the mother herself, her diseases, lifestyle, heredity, and environmental factors can provoke the early birth of a baby.

Among the most likely reasons for the birth of premature babies are noted:

• the social and living conditions of the mother - food, the emotional background of the house, the presence of harmful factors at work, the age of the mother, the desirability of the unborn child
• obstetric and gynecological - mother's female diseases; abortions and miscarriages prior to pregnancy; a break of less than two years between pregnancies; lack of medical support during pregnancy, premature placental abruption, IVF
• specific diseases in the mother that interfere with the normal bearing of the child - for example, heart disease, diabetes mellitus, rheumatism

pathologies of the development of the fetus itself, intrauterine infectious diseases

Premature babies: consequences in the future

Stage 1 of nursing premature babies

• It begins from the moment the crumbs are transferred from the intensive care unit to the ward or to a special children's hospital for nursing premature babies
• He is placed in an incubator, in a special box or in an ordinary crib with heating pads.
• It is important to provide the baby with a stable air temperature of 23-26 ℃, humidity 40-60% and oxygen flow
• The clinic maintains a strict sanitary access regime. Staff and moms must wear gauze bandages when in contact with babies

Stage 2 nursing premature babies

• This is the start of the adaptation of the crumbs to new environmental conditions.
• Water treatments, massage, communication with mom, practice of the kangaroo method help him learn to control his body and communicate with the world
• Therefore, the presence of bathrooms, rooms for expressing milk, massage is mandatory for hospitals nursing premature babies.
• Additional advantages are the possibility of training a young mother there to take care of the baby, to correctly perform gymnastics in the water, massage

Stage 3 nursing premature babies

• From the first hours of a newborn's life, doctors and mothers determine and provide the optimal way of feeding. Ideal if it is breast milk or freshly expressed
• Alternative options are defrosted and warmed donor milk or special formulas. For premature babies with a reduced sucking reflex, it is administered parenterally or through a tube, which is replaced every 2 hours
• The nasogastric tube is used until the second month of individual babies' lives. Diet up to 10 times a day by infusion, or up to 6 times by long-term instillation.
• The latter option is relevant for children with frequent regurgitation.
• Since the size of the stomach in such crumbs is very small, the medical staff strictly controls the portions. On the first day, they are up to 10 ml, on the second - up to 15 ml, and on the third - up to 20 ml at a time.
• The calorie content of food for a premature baby is also important. For example, in the first month, one-time feeding should be 30-40 kcal / kg, and by the end of the first year of life - 140 kcal / kg
• Baby food is enriched with vitamins, trace elements and enzymes as prescribed by the doctor
• After birth in a maternity hospital or clinic, children are additionally given a glucose solution as a drink
• With artificial feeding, earlier feeding may be recommended, starting at 4 weeks of age

Breastfeeding premature babies

The most valuable and optimal nutrition for a newborn baby is breast milk. Studies of its composition have shown that it is more nutritious and contains more protein.

• Unfortunately, in premature babies, sucking and / or swallowing reflexes are sometimes poorly developed or even absent. Then use the introduction of food through the nasogastric tube, parenteral nutrition, feeding from a spoon, bottle
• A young mother is pumped to preserve breastfeeding in the future. If it is impossible to stay with him permanently, she creates a milk supply at home and brings it to the hospital
• Often, medical personnel add essential vitamins and minerals to the food of a premature baby. It depends on the condition, the presence or absence of pathologies and diseases in him
• If doctors allow at least short-term meetings with the baby, when you can pick him up, then practice latching on to the breast.

Why does a premature baby spit up?

• The gastrointestinal tract of a premature baby is not fully formed, all its parts are in the developmental stage. They are smaller than full-term babies. Therefore, regurgitation is the norm.
• The stomach is small and vertical. It is not yet inhabited by microflora for normal digestion and assimilation of food. The pancreas produces insufficient acid concentration. The motor activity of the gastrointestinal tract muscles is weak, that is, food is poorly promoted and excreted
• Due to the low resistance to pathogenic bacteria, the stomach of a premature baby is quickly colonized by them. Dysbacteriosis, dysbiosis, flatulence, constipation, regurgitation, violation of the internal flora accompany the baby in the first months of his life

What can a nursing mother of a premature baby eat?

• Like the mother of a full-term baby, the mother of a premature baby should eat well, rest and maintain a positive attitude.
• Her diet should be dominated by fresh vegetables, fruits, greens of the area in which she lives and where the pregnancy took place.
• She is also shown in small quantities butter and sunflower oil, whole grain bread, porridge cooked in water. Dairy products are allowed in a limited amount - maximum 500 ml per day
• As prescribed by a doctor, a nursing mother of a premature baby can be shown additionally pharmaceutical vitamin complexes

Special formulas for premature babies

Children born prematurely differ from their peers who appeared on time, and in terms of the need for nutrients in food. This is especially true for bottle-fed babies.

Well-known manufacturers of baby food have in their product line special mixtures for premature babies, enriched whitened and more high-calorie. There are lesser known firms though.

For example, Humana, Nan, Baby, Nutrilon, Prepilti, Nenatal, Novolak, Ladushka, Alesya.

Complementary feeding of premature babies by months

• In addition to a small volume, a premature baby in the stomach does not have enough microflora for full-fledged work. Therefore, strict adherence to portioned doses of his food is mandatory.
• From the 4th day, they give up to 40 ml at a time, increasing in each subsequent day, 10 ml to 140 ml, and from the 21st day - 160 ml. By the end of the first year of life, the baby easily assimilates up to 180 ml.
• A bottle-fed baby can receive complementary foods from 2 months of age according to an individual plan. He is given fresh apple, pomegranate juices, an egg
• To introduce other foods, young parents follow a standard baby food schedule and track allergic reactions. To do this, it is recommended to select an interval between new products of 5-7 days.

The needs of a premature baby

The most basic needs of an early-born baby are warmth, moisture, adequate nutrition, care and love.

From the first days, he is provided with optimal environmental conditions:

• stable temperature 24-26 ℃
• humidity 40-50%
• fresh air supply
• adequate nutrition
• the absence of too loud sounds
• care and love

The baby eats 6 to 10 times a day in the first months of life, and after being discharged home, the mother establishes an optimal individual diet for him.

Babies, surrounded by the care and love of loved ones, develop faster, grow and cope with ailments. Therefore, if possible, take them on the pens more often, communicate with them, sing songs and talk.

Complementary feeding for premature babies according to Komarovsky

The well-known children's doctor Komarovsky in his approach to the introduction of complementary foods differs from other schemes. He argues that the first product should be as similar as possible to mom's milk. Its consistency is reminiscent of kefir and cottage cheese.

• Then add pure cottage cheese or mix with kefir 1 tsp
• At 7 months, the baby should cook cereal porridge in milk. Reception scheme - for several days we give only liquid from porridge a few tablespoons, then add the porridge itself
• At 8 months, believe in vegetable soups and enter according to the milk porridge scheme. And continue to give cottage cheese in a volume of 50 ml
• At 9 months, diversify the menu with first courses with meat in broth. The feeding scheme is similar to vegetable soups
• From 10 months Komarovsky recommends giving fish and yolk

So, we examined the causes and consequences, external signs, features of feeding and caring for premature babies. We got acquainted with the recommended nutritional standards and schemes for introducing complementary foods, including Dr. Komarovsky.

And remember that the health and prosperous development of your baby depends on your care, love and tranquility.

Video: features of caring for premature babies

Magazine> complementary feeding for premature babies

Proper feeding of premature babies is critical to their development - not only physically, but also emotionally and intellectually. Adequate nutrition is the main condition for the normal functioning of virtually all life-supporting organs and systems.

The main distinguishing feature of premature babies is low birth weight (in most cases, less than 2.5 kg). Babies who appear ahead of time grow faster than full-term newborns, therefore, they need a more intensive supply of energy and plastic material with food. But this process is complicated by the limited ability of their digestive system to assimilate food. In many premature babies, the sucking and swallowing reflexes are reduced, because the mechanisms of regulation on the part of the nervous system are not developed enough, and the sucking muscles are not fully formed.

Salivation, necessary for normal digestion, in premature babies begins with the first feedings, but it is still lower than in full-term newborns. In addition, their stomach capacity is relatively small, and they regurgitate more often than full-term ones. The secretion of gastric juice and the activity of intestinal enzymes are reduced. Based on this, premature babies have such a low resistance to various pathogenic microbes, often accompanied by dysbiosis. The colonization of the intestine by different microbes largely depends on the nature of feeding - natural or unnatural.

The activity of the digestive system is possibly impaired and under the influence of some pathologies that the child suffered before birth.

Based on this, food for premature babies is prescribed personally, not forgetting that a child who appears with a weight of 1.5 kg differs from an infant who weighed more than two kilograms at birth.

At the time when to start feeding

The timing of the first feeding of a premature baby depends on its condition at the end of the birth. Overly delayed - it promotes weight loss. However, it is not required to insist on immediate attachment to the breast (according to Nikitin's method), this can lead to the formation of various diseases.

A preterm infant who appears in a satisfactory condition can take the first colostrum feeding in a couple of minutes. at the end of birth, after 4-6 hours, or a couple later. In most cases, doctors try to ensure that the hunger period at the end of birth does not exceed 24 hours. But from time to time, a long delay in the appointment of nutrition is needed if the child has suffered hypoxia or there is a suspicion of intracranial hemorrhage.

If the child has not eaten 12 hours after the end of the birth, doctors inject him with a nutrient solution of glucose - using a probe or intravenously.

How to feed quite often

It depends on a number of events, among which stand out:

* birth weight;

* degree of maturity or, on the contrary, immaturity.

Most premature babies are able to tolerate 7-8 feedings at intervals of 3 hours. Only with deep prematurity and some pathological conditions, the frequency of feedings is increased to 10 daily.

Children with reduced sucking and swallowing reflexes begin to feed with the use of special probes inserted through the nose into the stomach, dosing the food with a sterile syringe or a special device - an infusomat. Later, at a time when reflexes are formed, they move on to bottle feeding.

At the time when to apply to the chest

The question of breastfeeding a premature baby is decided personally. The main conditions are the presence of a sucking reflex and a general satisfactory condition.

Sparing the strength of the baby, who has appeared with a body weight of more than two kilograms, it is applied to the breast first for 1-2 feedings, and the rest are carried out from the nipple. When indicators of fatigue appear (blue near the mouth, lethargy sucking, etc.), breastfeeding is stopped and fed with expressed milk from a bottle. When breastfeeding, doctors control the amount of milk sucked up by weighing the baby before and after feeding.

In the first days of life, the amount of each feeding forms from 5 ml (in the first days) to 15-20 ml (by the 3rd day of life). The amount of food is also determined by the pediatrician. To ensure that they are getting enough essential nutrients (proteins, fats, and carbohydrates) and energy on a regular basis, doctors use the calorie method. In accordance with it, by the end of the 1st month of life, the calorie content of the diet of a premature baby increases to 130-140 kilocalories (kcal) per kilogram of weight per day (for a full-term baby at this age, 115 kcal / kg is enough). The gap of 10-15 kcal is explained by how the baby is fed - by breastfeeding, expressed or donor breast milk, standard or specialized formulas.

Starting from the 2nd month of life, children born with a weight of more than 1.5 kg, the calorie content is reduced by 5 kcal / kg per day (when compared with the high energy value in the 1st month of life). In children with a birth weight of 1-1.5 kg, the caloric content of the diet remains unchanged until 3 months of age. In the future, the calorie content of the diet (5-10 kcal / kg any month) is systematically reduced until it becomes equal to that of full-term babies. Along with this, the children's doctor takes into account the child's condition, food tolerance, weight gain over the past month, etc.

Other methods of calculating food, of which there are many, do not give the desired accuracy, only very approximate, often overestimated, results.

Breastfeeding full-term newborns will be able to do without additional drinking, because the fluid content in breast milk (about 87.5%) covers the need for it. Premature babies need additional fluid administration. In the first days of life, lightly sweetened boiled water is often used as a drink. From the age of one month, only unsweetened boiled water is offered for drinking.

It is believed that premature babies receiving breast milk do not need additional vitamin supplementation. But the vitamin composition of breast milk is highly dependent on the nutrition of the mother. Based on this, a nursing lady needs to pay special attention to her diet. In particular, vitamin D in breast milk is contained in a very small amount, completely insufficient for the prevention of rickets. Based on this, premature babies are recommended early (from the 10-14th day of life) the appointment of this vitamin. In addition, the use of modern adapted breast milk substitutes containing vitamin D in the diet of premature babies does not negate the specific prophylaxis of rickets. The use of fish oil, popular in the past, for this purpose is completely unacceptable!

Iron is more responsible than gold

Iron reserves in the body of premature babies are very scarce and can be depleted by the end of the 1st month. Based on this, the need for it is covered by fruit, berry and vegetable juices and purees. There is relatively little iron in breast milk, but it is well absorbed. Unfortunately, mother's iron, like iron in mixtures, does not fully cover the need for this element in premature babies, which often leads to the formation of iron deficiency anemia. In addition to the intake of iron with food, such children require the appointment of iron preparations in drops or syrups.

Most formulas for premature babies contain relatively low levels of iron (less than 1 mg per 100 ml). For premature babies suffering from anemia, at the age of 3-4 months, it is advisable to give mixtures additionally fortified with iron (for example, the American product Enfamil with iron).

the most optimal for meeting the needs of a premature baby is mother's milk. The protein composition of maternal colostrum and milk is most consistent with the nature of the protein metabolism of a premature baby. Breast milk fats are easily digested, and lactose (milk sugar, its main carbohydrate) is well broken down and absorbed. Mother's milk contains many beneficial protective factors that provide protection to the intestinal mucous membranes and interfere with the harmful effects of bacteria and viruses and food allergens. All this, combined with a balanced vitamin and mineral composition, explains the unique properties of breast milk, making its benefits obvious. Basically, breast milk is both a food and a medicine.

In women who have given birth prematurely, breast milk differs from mature milk. In premature milk, the protein content is increased, and the percentage of fat is lower, which corresponds to the zest of the assimilation of food by premature babies. Its calorie content is also higher.

But in many cases, breastfeeding of a premature baby is unrealistic due to:

* insufficient amount of breast milk or its complete absence in the mother;

* the presence of antibodies in milk during Rh-conflict;

* disorders of the reflexes of sucking and / or swallowing in a child;

* his serious condition (intracranial hemorrhage, etc.);

* intolerance to newborns of breast milk proteins;

* lactase deficiency (lack of an enzyme that breaks down milk sugar), etc.

In these circumstances, donor breast milk or breast milk substitutes are needed.

With unnatural feeding of premature babies, specialized adapted formulas are used. Their composition best suits the needs of a premature baby. These mixtures are prescribed only by the doctor!

If it is not possible to provide the baby with these food products, it is possible to resort to feeding with standard breast milk substitutes. At dairy kitchens, free of charge - in the direction of the district pediatrician - is issued the domestic acidophilic (fermented milk) mixture Malyutka, which has recently been actively replaced by Agu-1. From foreign acidophilic mixtures for feeding premature babies, Aci-Mileks, Pelargon and Lactofidus are suitable. It is completely unacceptable to use second formulas when feeding (on the packaging of which there is a number 2 at the end of the name). These products are not adapted to breast milk, but to cow's milk, the introduction of which into the diet of premature babies should be carried out with extreme caution.

In the past, when feeding children who appeared prematurely, kefir was used. But it is based on whole cow's milk, therefore, its inclusion in the diet of premature babies in the first months of life is not recommended.

When premature babies are transferred to mixed and unnatural feeding in the first 2-3 days of introducing a new mixture, its amount forms approximately 10 ml per feeding (1-3 times a day) before breast milk. Then the amount of the mixture in the diet is slowly - in 3-5 days - increased until 1-2 feedings are completely replaced. After 7 days, the introduced product can make up 50% of the diet. If necessary, within the next week, it is possible to completely transfer the premature baby to unnatural feeding with satisfactory tolerance of the product, the physiological nature of the stool, adequate sucking and the absence of regurgitation. The simultaneous administration of drugs such as bifidumbacterin has a beneficial effect on the transition to unnatural feeding.

At the time when to introduce complementary foods

For premature babies, the timely introduction of complementary foods is no less, if not more, fundamentally important than for full-term babies.

Fruit or vegetable juices are introduced into the diet of babies aged 1 to 3 months, depending on which week of pregnancy the birth took place, what was the weight of the baby at birth and how well the baby tolerates non-dairy food. Juices are introduced slowly, starting with a few drops to the required amount, which is easy to find out by multiplying the month of life by 10. So, for example, a 4-month-old child should take 40 ml or 8 teaspoons of juice a day. It is possible to give juices at the end of feeding or in the intervals between meals, both in pure and diluted form.

It is possible to recommend apple juice as the main juice, although it is possible to use pear, cherry and blackcurrant juice. Carrot juice should be conceived no earlier than a child of 3-4 months of age, and preferably mixed with apple juice (1: 1 ratio). It is better to abstain from tomato, grape and citrus juice during the first six months of life. And it is not at all necessary to give preterm babies strawberry, strawberry and beet juices during the first year of life - they can lead to allergies.

Fruit purees (apple, banana, etc.) begin to give by 2-3 months of life 2-3 weeks after the end of the introduction of juices, starting with half a teaspoon and bringing to the volume of juices in the daily diet of full-term babies.

Hard-boiled egg yolk is injected from 3 to 3.5 months of age, pre-chopping and rubbing in a small amount of breast milk or mixture. The daily consumption of the yolk is slowly increased to half a piece per day. In case of allergic reactions and indicators of intolerance, the yolk of a chicken egg can be replaced with a quail.

At the same age, cottage cheese is introduced so that a couple of prematurely introducing this product to healthy full-term children. The amount of cottage cheese forms approximately 10 g during the first month after the end of the introduction, after a month it increases to 20 g, and then increases by 5 g any month until it reaches 50 g.

It is prescribed from 4-4.5 months of age. Unlike full-term babies, for whom the first complementary food is vegetable puree, premature babies are given porridge (rice, oatmeal, buckwheat), which is cooked in vegetable broth or in water, adding a small amount of breast milk or mixture. be directed to carry out a phased increase in the concentration of cereals introduced into the diet, starting with 5% (5 g or 1 teaspoon of flour per 100 ml of water). Then they give 7-8% porridge (1.5 teaspoons per 100 ml of water), and then 10% porridge (2 teaspoons per 100 ml of water). First, vegetable (sunflower or olive) is added to the porridge, and then butter in the amount of 3-4 g per serving. It is not necessary to add oil to instant cereals of factory production.

At 5 months, they begin to give a second complementary food in the form of vegetable puree with the addition of vegetable oil. Meat puree (beef, lean pork or liver) - for the prevention of anemia - can be administered from 5 months of age, but at the same time it is given no more than 10 g and no more than 2-3 times a week. No later than 7 months of age, a premature baby should receive meat puree every day, the amount of which increases from 10 g to 50 g by one year of age. From 8 months it is advisable to supplement the diet with bread or unsweetened cookies. At the same age, vegetable soup is introduced, and then meat broth (from one teaspoon to 3-4 tablespoons).

Kefir and / or whole cow's milk - is administered at the age of 8-9 months, replacing breast milk or formula. In most cases, one feeding with milk or kefir during the day is enough.

Is everything true

Regular monitoring is needed for the correctness of the calculation and purpose of nutrition, and for the indicators of the physical development of a baby who appears prematurely. When assessing his physical development, the main attention is paid to the weight gain in any month, and to the average daily weight gain. Along with this, one must not forget that the processes of development of premature babies are more intensive. Most of the prematurely appeared babies by the age of 2 reach a level of physical development comparable to those of their full-term peers. At 1-2 months of life, an increase in body weight is considered normal at the rate of 10-15 g / kg of birth weight.

Feeding a premature baby is the most significant event. Based on this, a children's doctor must invariably give advice on its implementation and monitor their effectiveness.

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The preterm birth rate in the United States is between 11% and 13% of all pregnancies. Almost 60% of multiple pregnancies end in premature birth. Labor is considered “premature” if the baby is born before the full 37 weeks of pregnancy. Premature birth can be late - premature (34-36 weeks), moderately premature (32-36 weeks), and very premature (less than 32 weeks).

It should be noted that even late preterm birth is carried out only according to indications, and these babies are at greater risk than full-term babies: everything must be done to preserve the pregnancy.

A premature newborn outwardly differs significantly from babies born on time. While the average full-term birth weight is 3.17 kg, a premature newborn can weigh 2.26 kg or less. Thanks to the development of modern medicine, babies born after 27 weeks of pregnancy, weighing 1 kg, have almost every chance of survival; Eight out of ten babies born after 30 weeks have minimal health and developmental problems, while premature babies born before 28 weeks have more complications and require intensive treatment and care in the neonatal intensive care unit.

The earlier a baby is born, the thinner the subcutaneous fat layer is, so the skin appears transparent and the blood vessels underneath are visible. The proportions of the body are different from that of full-term babies: the head is larger in relation to the rest of the body. On the back and shoulders, thin hair may remain - lanugo. There is no original lubricant, because she was supposed to appear at the end of pregnancy, before birth. Facial features are sharper than those of full-term babies. Over time, the baby will look exactly like a normal newborn. Due to the lack of subcutaneous fat, a premature baby can easily get hypothermic and get sick even at room temperature. That is why premature babies are placed immediately after birth in incubators (incubators), under a source of radiant heat, where the temperature can be regulated and maintained. After a quick examination in the delivery room, the baby is usually transferred to the neonatal intensive care unit.

You may notice that the premature baby is crying very quietly or even inaudibly. Due to the immaturity of the respiratory system, he may have breathing problems. If the baby is born more than two months ahead of schedule, breathing difficulties can cause serious health problems because other organs, which are also immature, will not be supplied with sufficient oxygen. To ensure that this does not happen, doctors will monitor breathing and heart rate with special equipment and perform artificial ventilation of the lungs with constant positive pressure. These procedures are essential for the survival of the child. Transferring a child to the intensive care unit can be difficult for you: you cannot yet take the baby in your arms or touch him when you want, you cannot take him with you to the ward.

When worried about the health of your baby, do not forget about establishing breastfeeding.

To cope with stress, ask to be shown your baby as soon as possible after birth, and try to be actively involved in childcare whenever possible. If you are allowed to be near the child, be near. If you cannot take the child in your arms until his condition stabilizes, touch him more often. Many intensive care units allow parents to implement the Kangaroo method, which maximizes the physical skin-to-skin contact of the baby and the mother, but only after the support of the main organ systems of the child is not needed.

As soon as the doctor permits, you can feed the baby. The nursing staff will tell you about breastfeeding or bottle feeding, depending on your options and what is best for your baby. Some premature babies are first fed intravenously or with a tube that goes through the mouth or nose into the stomach. But the best nutrition is breast milk, which contains antibodies and other substances that boost the immune response and help the baby fight infections. In some cases, if breastfeeding is difficult, you have to express breast milk for tube or bottle feeding. Once you start full breastfeeding, breastfeed your baby as often as possible to increase milk supply. However, mothers of premature babies sometimes use a breast pump in addition to frequent breastfeeding to help them produce enough milk.

Your desire to return home as soon as possible is understandable, but the newborn may not yet be ready for this. Remember that your child is in good hands and you can visit as often as you can. While your baby is in the hospital, take a break, get your home and family ready for their arrival, and read parenting information on caring for premature babies. If you master the basic principles of caring for a baby while still in the hospital, you will feel more confident when you return home. As soon as the doctor permits, touch the baby, stroke him, sing lullabies to him.

You will be discharged and can take your baby home as soon as he can breathe on his own, maintain body temperature, be breastfed or formula-fed, and gain weight steadily. The local pediatrician will be informed about your child's discharge from the hospital, you can contact him with all questions and for advice.

28 days from the moment of birth, more precisely - from the moment of cutting the umbilical cord and separating the fetus from the mother.

It is clear that newborns are very different from each other and this is determined by both the state of health and the degree of maturity. Talking about the skills of a newborn without specifying what kind of newborn we are talking about is a thankless job, because there is a huge distance between a healthy full-term baby and a baby born seven months old. Therefore, we will agree right away - the subject of our discussion will be precisely a healthy newborn, born on time, since the physiological characteristics of premature babies is a specific topic that requires an emphasis not so much on “skills” as on the differences from the norm and the resulting features of care.

The initial assessment of the skills, and, accordingly, the state of health of the newborn is carried out by medical workers directly in the delivery room. Each parent will be able to find the result of this assessment in the documents received upon discharge from the hospital, where he will read, for example: "Born 8-9 points according to Apgar"... Not everyone knows who or what “Apgar” is, many are sure that this is some kind of abbreviation and are unsuccessfully trying to decipher it. Let us explain: Apgar is a surname such with an emphasis on the first letter "A", it belongs to (surname) a woman, an American anesthesiologist. Apgar proposed a scale, according to which 5 main signs of health (ill health) of a newborn, namely: heartbeat, breathing, muscle tone, reflexes and skin color, are assessed on a three-point system - get 0, 1 or 2 points. So in total, a maximum of 10 is recruited.

But evaluating by Apgar is the business of people in white coats. And what about the average average parent? Here we have arrived home from the hospital, here we have gathered for a family council. We have a newborn. The doctors said everything was fine. But doubts are oppressive. Some kind of red, eyes in different directions, waving its little hands in a strange way, twitching its legs, sticking out its lips, turning its head and generally yelling ... The relatives crowding around the crib put forward the most diverse and completely disappointing versions, plunging young parents into despondency and by no means contributing to normal lactation at the mother.

And taking into account the above and very typical situation, we will try to talk about how it should be, because the most reliable way to avoid stress is to get information on time. There is also a second way - to ask relatives to refrain from commenting so as not to create unnecessary stress, but within the framework of the domestic mentality, this task is practically unrealistic.

Let's start with the senses. In fact, according to the long established rules, the doctor finishes the examination of the child by assessing the work of the senses, but this is what worries the parents most of all - what the child sees, what he hears, what he feels.

Vision

Both the optic nerve and the muscles that move the eyeball in a newborn are not fully formed. The child feels only the light itself as such, that is, it distinguishes day from night, but it is not in a position to understand that it is the grandmother who is waving her arms in front of him. The aforementioned immaturity of the oculomotor muscles forms a physiological, that is, completely normal, strabismus for the neonatal period.

The specificity of the newborn is the blinking reflex. The bottom line: no matter how much you swing objects near the eye, it does not blink, but reacts to a bright and sudden beam of light.

Hearing

Slightly reduced immediately after birth(the ear cavity fills with air gradually) , but by the time he is at home - he hears almost like adults. But he does not understand and therefore does not react. If the sound is loud enough, it shudders, while the depth and frequency of breathing may change, the mimic muscles of the face react.

Smell

He clearly reacts to strong odors (as a rule, by changing the breathing rate), but he is not able to distinguish dad's cologne from mom's perfume.

Taste

With this - it's certainly all right. Sweet has a calming effect, licks lips, makes swallowing movements. Doesn't like salty and bitter things. Stops sucking, grimaces, cries.

Since the taste and smell are developed very well, it is quite possible, and this must be taken into account, negative reactions to the “tasteless” medicines and hygiene products used by a nursing mother.

Touch

Well developed, but unevenly, since the nerve endings are unevenly distributed. He perceives touching the face and limbs more actively than stroking the back. Well, he reacts in a completely civilized manner - cries from cold and hard, calms down from soft and warm.

So, we have dealt with the senses. Now a little about everything else, no less important.

Leather

Excellent blood supply the smallest vessels (capillaries) are wider than in adults (relatively, of course). Sweat glands are significantly underdeveloped. These two factors are associated with significant sensitivity to damaging factors, especially overheating. But there is also a noticeable plus - a very high restorative ability - everything heals very quickly, naturally if the damaging factor is eliminated.

Muscle

A specific feature is an increase in muscle tone, but themselves muscles are underdeveloped, especially the muscles of the limbs. And the total muscle mass is noticeably different from that of an adult and is only 22-25% of the body weight, while for dad and mom it is at least 40%.

Respiratory system

Pulmonary respiration, as is known, is absent in the fetus, in principle, the exchange of gases is carried out by means of the so-called. placental circulation. Immediately after birth, the baby takes the first breath, the upper respiratory tract and lungs are filled with air, - the baby begins to breathe like a human. An important feature of a newborn is the narrowness of the nasal passages, the larynx, and the trachea, and the mucous membranes covering them from the inside are very delicate and are actively supplied with blood. The mucous membranes of the upper respiratory tract can be easily damaged by picking the nose, it is easy to dry out. When the air is dry and dusty, protective mucus is produced in large quantities, and since all the passages are narrow, then problems often arise when mucus accumulates in the respiratory tract. A newborn can sneeze, but he can't blow his nose. It is important to know this precisely because the baby, of course, can breathe humanly (that is, with a nose and without grunting), but only if loving relatives create human conditions for him - so that there is less dust, so as not to overdo it with heaters to ventilate the nursery in time.

The normal respiratory rate for a newborn baby ranges from 40-60 breaths per minute.

The cardiovascular system

Placental circulation stops immediately after birth. The work of the heart and blood vessels changes significantly. The lungs are filled with blood, some vessels and openings cease to function and close(through them, the fetus carried blood flow bypassing the lungs). The heart of a newborn is one of the healthiest organs, it is very resistant to stress and a lack of oxygen. The heart rate ranges from 110 to 140 beats per minute, and these fluctuations occur constantly - almost any external influence seriously changes the pulse rate.

Digestive system

The baby is born with very well developed chewing muscles and a relatively large tongue. This makes prolonged and active sucking possible. But the salivary glands are still immature and there is little saliva itself. The digestive organs grow very quickly. So, on the first day of life, the stomach contains about 20 ml of milk, after a week already 50 ml, and by the end of the neonatal period more than 100. milk. In the first 10-20 hours of life, the intestinal tract is practically sterile, but it fills up with microbes very quickly. Bacteria multiplying in the intestine change the appearance of feces - at first it is brown, then greenish-yellow, after a few days - light yellow, mushy with a sour smell.

Allocation system

Already at birth, there is a small amount of urine in the bladder. In the first 3 days of life, urination is relatively rare - 4-5 times a day - this is quite normal. But the number of small-time walks is rapidly increasing and in the second week of life it ranges from 15 to 25 times. The volume of the bladder in a newborn is from 50 to 80 ml, but the child does not know how to accumulate urine in such an amount - 10-15 ml is "gathered" and it is enough - it's time to change the diapers. As for the kidneys themselves, although they are able to quite successfully perform their functions, they are underdeveloped by the time of birth. In this regard, the characteristics of a newborn's urine (specific gravity, reaction, protein content) are different from those of an adult.

Nervous system

The nervous system of a newborn has a number of features; this is perhaps the very system of the body that undergoes the greatest changes precisely during the first months of life. Reflexes, excitability, and reactions to the environment are constantly changing. Muscle tone is more pronounced in the muscles that flex the arms and legs. Some signs that are completely abnormal in adults are quite natural in newborns. For example, tremors of limb muscles(the so-called tremor) is very undesirable for agitated grandmothers, but for a newborn, this is the norm. Tendon reflexes (those that a neuropathologist determines with a hammer) are not constant in a newborn, well, except that the knee is determined almost always and in everyone.

But there are also very special reflexes, and they are called “physiological reflexes of newborns”. These reflexes are due to the immaturity of the brain, they are present in all healthy newborns, but as the brain “matures”, they fade away and disappear by 4-5 months. Each parent can find these reflexes in their child and thereby be convinced of his (child's) normality. Examples:

Grasp reflex.

If you bring an adult's finger to the inner side of the baby's palm, the child grabs it and holds firmly. So firmly that the child can be easily lifted up above the table surface.

Hug reflex.

Occurs when the child is lying on the table, when there is a sudden loud sound, when the buttocks or thighs are tapped. The reflex consists of two phases. In the first, the child leans back, the shoulders are unbent, and the arms are spread apart. In the second phase of the reflex, the arms converge on the chest.

Crawl reflex.

If the baby is laid on the tummy and the palms of an adult are placed on the feet, the child is repelled.

Stance reflexes and automatic walking.

In an upright position (the child is held under the armpits), the child rests his legs against the changing table. And if you tilt it forward a little, movements resembling walking appear.

The list is not limited to the above reflexes, but the above list is quite sufficient for parental experiments.
This information allows us to form a very definite impression of the skills of a newborn baby. The kid, although it seems weak and helpless, actually knows a lot. The main skill is the ability to distinguish good from bad and inform relatives about it. Cry and call for help when hungry, when in discomfort, when something hurts, calm down and behave pretty well when everything suits you. He knows how to suck and swallow, knows how to relieve himself, distinguish day from night, silence from noise, tasty from bitter, soft from hard - not so little for a person whose age is determined by days.