Every mother wants her pregnancy to go on without pathologies, and the baby was born on time. However, it is not uncommon for cases when, for a number of reasons, labor takes place before the due date. Than it can threaten the child? How to cope with the problems that lie in wait for the mother of a premature baby? Can these problems be avoided? The development and health of premature babies is the topic of conversation for today.
A premature baby with a body weight of less than 2.5 kg at birth is considered to be premature. The World Health Organization identifies preterm infants as having been born before 37 weeks from the first day of the last menstrual period. Malignant is a premature baby with a birth weight of less than 1.5 kg. Recently, a category of extremely low body weight was added, which is less than 1 kg. Previously, children with similar weight simply did not survive.
There are two different problems in premature babies. One of them is the child's unwillingness to live outside the womb - underdevelopment of organs, unformed tissues. Another problem is a small weight, which is a delay in the child's further development. In the first type of babies there is a big feeding problem in the future - they do not want to eat, they should be constantly encouraged, while the last children are always hungry and insatiable, they have an excellent appetite. Unfortunately, it is not uncommon to give birth prematurely to a child with a low birth weight.
Risk factors for premature delivery
There are several risk factors for premature birth:
- Caesarean section, used in severe unfavorable internal conditions of the fetus. This may include pre-eclampsia or placental abruption. The decisions to be taken are, first of all, an assessment of the circumstances and maturity of the child and the answer to the question: "Which environment is the most safe for the child - outside or inside the uterus?". It's just a matter of balancing risks.
- Several pregnancies in a row often lead to premature birth, especially if it is a multiple pregnancy. This can provoke premature birth, since there is a maximum increase in the uterus.
- The classic case is the inadequacy of the development of the cervix before, pregnancy with premature rupture of the membranes and at the beginning painlessly stretching the cervix. Usually it causes rupture of the muscular fibers of the cervix. This is dangerous for the mother. For a child, it carries all the risks that accompany the development and health of premature babies.
- Low socioeconomic status, lack of or insufficient care during pregnancy and poor nutrition of the mother - all this in the bosom predisposes to premature birth. Smoking and excessive alcohol consumption are also risk factors.
- Refusal of heroin or too rapid reduction of methadone in the first trimester of pregnancy can lead to premature birth. Women who abuse drugs before pregnancy should strictly adhere to a special methadone reduction regime. It can not be done quickly - it will just kill your child! Cocaine can also lead to premature birth. It creates a compression effect in the uterus, which can have a devastating effect on the function of the placenta.
- Children with low body weight, as a rule, are born in women younger than 17 or older than 35 years.
- Bacterial vaginosis predisposes to the birth of premature babies.
Distinctive features of development of premature infants
A prematurely born child seems a little "inappropriate" under external conditions. A child born before the term usually has very little subcutaneous fat, and his skin looks wrinkled. A premature baby faces many problems, which are even more pronounced in the case of delayed fetal development.
Hypothermia is the main risk factor, especially if the child has little subcutaneous fat. A premature baby is difficult to regulate the temperature of his body. It is easier to freeze or, on the contrary, overheat.
Hypoglycemia is also a risk, especially for very young children who are lagging behind in development. They can also cause hypocalcemia. Both conditions can cause seizures, which, in turn, can lead to long-term brain damage.
The earlier the child was born before the term, the greater the risk of developing respiratory distress syndrome. Taking mothers of steroids before delivery can reduce the risk, but it is still real. If a child needs oxygen, you need to closely monitor this, because if his level is too high - a premature baby is prone to fibroplasia and blindness.
Premature babies are susceptible to jaundice. Their liver requires special care and development conditions. First of all - special food. Preterm infants also have a high risk of infection and accumulation of pus in the intestines. They are susceptible to intraventricular hemorrhage in the brain with serious consequences in the future.
Neonatologists face similar problems all the time. The saddest thing is that even when the child is finally discharged from the hospital and goes home with his mother, the problems do not end there. Often, they are just beginning. Birth before the term never passes for the child without a trace. The only question is how much damage and how much effort will be needed to adapt the child to the outside world. Sometimes premature babies, with all the efforts made by specialists, do not catch up with the development and health of their peers born in the due time.
Support for parents
When a child is in a specialized ward for premature babies - this is a very emotional and traumatic period for both the mother and the whole family. You should encourage and support each other, and stay close to your child for as long as possible. Breastfeeding is very difficult, but it should also be supported as much as possible. Breast milk is the best food for any child, especially for the born prematurely. Mothers, who produce more milk than the child needs, should encourage the production of milk in the future. When the child gains weight, he will eat better and milk will be required more.
The child is tied to monitors and tubes protruding from his body. It's scary, but you have to stay calm. Believe me, the child feels everything. Unfortunately, it is not always possible to hold a child, but this should be encouraged at least occasionally. Trying to keep optimism, parents should also get used to the fact that a child can die. You must be prepared to make difficult decisions about the child's further quality of life if he survives. Doctors are not always correct in communicating with parents, and sometimes it is very difficult to immediately accept the facts told them at such an emotional moment. You can discuss your situation with someone you know well and trust. It is desirable that he was a good specialist or someone could advise you.
Immunization
Premature babies should be protected by immunization, like all other children. The fact of premature birth is not a contraindication for vaccination, even if the immune system is not sufficiently developed. The time for immunization is based on the chronological age of the child from the moment of birth, and not on the estimated age, if he was born on time.
Future problems with the development and health of premature babies
The figures regarding the results of the study of preterm infants should be interpreted with caution to ensure that similar cases are compared. Interest should be calculated very carefully. It is quite clear that the more prematurely a child is born, the greater the risk of death or disability of those who have survived. There is a risk grading. If your child is premature and small, another danger is automatically added.
The study shows that 300 children born before 26 weeks of pregnancy and earlier, survived during childbirth and were placed in wards for newborns. Of these, only 30 children were reported as completely normal. The rest either died before the age of two, or stayed for life with severe disabilities. Children born before 26 weeks of pregnancy have approximately 12% chance of surviving to two years. A slightly smaller percentage of children survive with a significant degree of disability.
Sight and hearing
Serious problems such as cerebral palsy, blindness and deafness can affect between 10% and 15% of extremely premature babies. Every fourth baby weighing less than 1.5 kg has peripheral or central auditory disorders, or both.
Birth weight below 1.5 kg, as well as giving birth up to 33 weeks of pregnancy, lead to a risk of development of refractive errors and strabismus. And there is still no official policy for the subsequent treatment and care of such children. Although most critically preterm infants develop retinopathy, serious damage occurs relatively rarely. According to the results of the study, 66% of children weighing up to 1.25 kg were subject to retinopathy, but only 18% reached the third stage, and only 6% needed treatment.
Intelligence
Studies have affected the development of 1000 children who were born at least 15 weeks before the term (25 weeks of pregnancy or less) during the first 10 months of 2009. Of these, 308 children survived, 241 underwent formal psychological testing using standard cognitive, language, phonetic and speech tests that could assess their future achievements in school. Of these, 40% of children had a moderate and severe learning difficulty (while boys were about 2 times more affected than girls). The percentage of severe, moderate and mild disabilities is 22%, 24% and 34%. Full cerebral palsy was found in 30 children, which is 12%. Among them were also children with severe disabilities, who developed up to 30 months. Overall, 86% of surviving children had a number of moderate and severe violations before the age of 6 years.
According to another study, in critically premature babies, mental abilities only deteriorate over time, rather than improve. Specialists compared children aged 8 to 15 years and found that their IQ dropped an average of 104 to 95 percentage points, and the number of children in need of additional activities increased by 24%. The results show that at the age of 8 to 15 years, there was an actual decrease in the development of nerve cells in premature infants.
Psychomotor and behavioral problems
Studies of children 7 and 8 years old, who were born before 32 weeks, showed that their development is enough to attend secondary school. However, the problems could be hidden, therefore a wider range of tests was used. The drop in mobility - the main problem in premature babies - was the most frequent. This influenced their success in school, mostly negative ones. More than 30% of these children suffered disruption in the development of coordination, compared to their classmates. Unnared children are much more active, they are easily distracted, they are impulsive, disorganized, chaotic. Hyperactivity due to lack of attention was detected in 49% of premature infants.
Development of the brain
Delay in development in the womb can be important for early brain development, which in turn leads to a low IQ score and a lag in the development of skills. For children born before 33 weeks of pregnancy, a significant reduction in brain volume and an exceptional increase in the size of the skull during adolescence are frequent.
Emotional development and puberty
Survey of adolescents in general schools that were born before the 29th week of pregnancy showed that these children have more emotional problems, problems with concentration and relationships with other children. They, according to teachers and parents, are more "clamped" and lag behind in terms of puberty. Despite these problems, they do not show any more serious behavioral disorders, such as suicidal tendencies, drug use or depression.
The study of preterm infants who reached the age of 19 to 22 years showed that they on average have lower growth rates than their peers, they are more often ill and less likely to enter higher education.
The most safe place for the development of the child is the womb of the mother. And it is important to try hard to prevent premature births and complications inherent in any birth before the term. There are situations when the intrauterine environment is so unfavorable that the child will be more safe outside. However, such situations are rare. Postpartum care is also very important. Social and domestic problems, maternal malnutrition, and alcohol and drug use are the most common risk factors. Smoking should be stopped, the consumption of alcoholic beverages should be extremely moderate, since there is no safe lower limit for it. In the foreground should be a healthy lifestyle. Only in this case the probability of birth before the term decreases by several times.