Take care of low birth weight and preterm children

2021-03-21 12:00 AM

For the development of children's physiological abilities such as regulating body temperature, respiratory function, digestion, circulation, immunity

A century ago, even in Europe, underweight and preterm babies did not have a chance to live, the death of low-birth-weight babies and premature birth was always infinite pain for mothers and families.

Since 1900, Boudin in France was the first to have proven that premature babies can save lives under three conditions: keeping warm, good nutrition and clean hygiene. Up to now, these three conditions are still fundamental and also of great significance.

Define

Low weight children

Are children whose birth weight is less than 2500g despite full term.

Preterm baby

Are babies born before 37 weeks gestation from the first day of their last menstrual cycle.

Malnutrition or growth delay in the uterus

Infants whose birth weight was below the 10th percentile of antenatal development chart for gestational age. This type is often a combination of preterm, malnutrition and growth retardation in the uterus.

Growth retardation once: only lose weight while the child's length and head circumference develop normally.

Overall retardation: loss of both weight and length of the child.

Why do we need to distinguish? Because the child's physiological development such as adjusting body temperature, respiratory function, digestive function, circulation, immunity ... are all related to gestational age, regardless of birth weight. Malnourished children often suckle well, can breastfeed well, meals are divided many times, can be eaten with cups and spoons easily even at very low weight, the main problems in these babies are:

Neonatal hypoglycemia.

Vaginal inhalation and neonatal asphyxia, caused by chronic intrauterine fetal failure.

Reason

Mother side

Pregnancy poisoning and high blood pressure.

Uterine, fetal and placenta abnormalities such as uterine malformation, placenta, poly amniotic fluid.

Gynecological diseases: ovarian cyst, uterine fibroids ...

Acute infections: malaria, dengue fever, pneumonia, hepatitis ...

Chronic infections such as tuberculosis, genital - urinary infections or diseases of the heart, kidneys, diabetes.

Surgical injuries during pregnancy: appendix surgery, traffic accident, falls ...

Risk factor:

Mother's age under 18 or over 35 years old.

Mother is addicted to cigarettes, alcohol and drugs.

Layed many times.

Low socio-economic conditions.

There is a major mental injury.

Environmental factors.

Child side

Multiple pregnancy.

Abnormal pregnancy.

Underdeveloped pregnancy in the uterus.

Assess gestational age

Signs of a premature baby

Weight <2500g.

Length <45cm.

Skin: The thinner, redder the skin is borne, the more visible blood vessels are from the skin, underdeveloped subcutaneous fat, fluffy skin on the skin, undeveloped breast and nipple organization.

Hair: short, soft <2cm.

The limbs are soft, not clusters of fingers.

Soft skeletal system, large head relative to body ratio (1/4), unbroken cranial grooves, broad fontanel, flat chest, soft ears, undeveloped coronary cartilage.

The limbs are always in the stretching posture, soft and muscular tone.

External genitals:

Boys: testicles have not descended to the cyst, the skin of the scrotum is swelling.

Girls: large, undeveloped lips, unable to conceal baby lips and clitoris, no genital fluctuations such as physiological menstruation or breast swelling.

Neurological: lethargy, inhibitory, weak crying, weak or absent primary reflex.

Determine gestational age

Neurological maturity:

Table: Neurological standards of maturity (from c. Amiel)

Passive muscle tone

 

Week 28

Week 30

Week 32

Week 34

Week 36

Week 38

Week 40

Posture

Completely hypotonic

Begin to fold the lower extremities

Shape "frog"

4 limbs

Intense strength

Very energetic

Slump posture

Horizontal leaning face

The chin touches the tip of the shoulder

Chin at the front of the shoulder

The chin is at the front very much above the tip of the shoulder

The chin is very close to the sternum

Foot angle - lower leg

40 - 50°

40°

30°

30°

10°

Creased corners

180°

150°

130°

110°

90°

90°

90°

Bored heels - ears

Crickets

Against lightweight

Against lightweight

Against

It is almost impossible to do it

Can't do it

 

Return to the grip of the forearm

 

 

 

 

Positive, except after stretching for 3 seconds

Positive, regardless of stretching time

 

Shoulder promo signs

There was absolutely no resistance

Limit

The elbow is above the midline

The elbow does not reach the mid lane

Evaluate gestational age according to the transcript

Table: Determination of gestational age (Finstron - Sweden)

Score

1

2

3

4

Nipple

Hard to see

Clearly determined

Prominent breast pigmentation ring

 

Breast organization

5mm

5-1 Omm

10mm

 

Blood vessels under the skin

Clear blood vessels in the skin of the abdomen

Several branches are visible

Very few see

Can not see

Hair properties

Thin and soft

Thick and smooth

 

 

Thin hands

Not covered

Covered up

Concealed and hard

 

Coronary cartilage

Not available

There is cartilage in the lower part of the ear

Cartilage in the outer ear

Cartilage of the entire ear rim

Sticky liver is boring

Not available

There are 1/3 on the foot

2/3 upper

Total

The number of diems equivalent to the fetus is as follows:

Point

7

8

9

10

11

12

13

14

15

16

17

18

19

20

21

22

23

Week

27

28

29

30

31

32

33

34

34

35

36

37

38

39

40

41

42

If reliable data on last menstrual date is not available, the maturity scoring system can be used to determine gestational age. Accuracy is not wrong more than ± 2 weeks.

Physiological characteristics

All premature babies exhibit more or less immature body system maturity characterized by a lack of reserves and immature biological function, depending on the cause and degree of preterm delivery. . So the ability to adapt to the environment outside the uterus of premature babies is very difficult.

Respiratory

Respiratory function of preterm infants is still very weak, goat children suffer from respiratory failure because:

The ribcage is flat, the ribs are soft, and the ribs are easy to shape, the intercostal muscles are underdeveloped and poorly dilated.

Immature lungs, alveolar cells are cylindrical, less elastic, accompanied by a lack of surfactant of group II cells in the production embryo (due to inadequate production), so the alveoli is difficult to expand. oxygen exchange is more difficult.

The respiratory center is immature, so premature babies often have delayed postpartum crying or weak crying, scheyne-stock irregular breathing, long pause time (7-10 seconds), arrhythmias can be 2-3 weeks postpartum or longer depending on gestational age (according to J. Laugier and F. Gold). Preterm breathing has two main features:

Abdominal breathing: abdomen swells up when inhaled, then flattens when rabbits come out.

Periodic breathing rate: successive sequence of inhalation and exhalation with increasing and descending intensity, apnea of ​​different frequency and duration may occur, breathing stops less than 15 seconds is not pathologically significant, may persist for several weeks, when attaining a breath of 50-60 beats / min is a sign of prognostic maturity.

Circulation and blood

Heart area enlarged - round, heart-chest ratio> 0.55, right ventricle is larger than left ventricle, so electrocardiogram has right axis.

The Botal artery and hole noise closes slowly so that systolic murmur can be detected in the early days, after which it is naturally gone but not pathological.

Heart rate ranges from 100-200 times / minute. Because the nerve center is incomplete, the heartbeat depends on respiration, so it is also irregular.

The capillaries are small, the cell wall has not yet developed, are fragile, and are prone to edema due to the escape of the esophagus, especially in the area around the ventricles because of little buffering organization.

Blood: both blood cells and coagulation factors are reduced than in term babies, with more premature red blood cells in peripheral blood in the first few weeks. Deficiency coagulation factors such as fibrinolysis, reconverting ... Especially prothrombin, decreased <30%, so premature babies are prone to bleeding, especially brain hemorrhage.

Conditioning your body temperature

At birth, due to the lower outside temperature in the uterus, babies are more susceptible to heat loss, poor thermoregulation, and premature babies often lose heat than term babies because:

The body temperature center is not complete.

In early months, the motor is weak so it is less heat generating.

Thin skin, underdeveloped fat layer.

The skin area is relatively large compared to weight, so the evaporation of water leads to a lot of heat loss in the child (lml of water evaporates 0.58Kcal).

If the child's body temperature drops below 35.5 ° C, it will cause a series of complications in the respiratory and nervous system, especially brain hemorrhage and pulmonary bleeding. Therefore, the operation of drying and warming the baby right after birth is a very necessary job, must be respected with preterm infants. Silverman therefore recommends ensuring optimal ambient humidity and temperature to limit children's energy consumption, dehydration and oxygen consumption.

Digestive function

The digestive system of preterm infants is underdeveloped, the digestive enzymes are generally not activated, the suckling reflexes are weak or not available in too young children, the stomach is small, horizontal, and the bowel movement is weak. Eat little, many times a day, the absorption of food is poor, so the child is prone to vomiting, bloating and digestive disorders.

Liver: Right lobe is not bigger than left lobe, immature liver function, little storage of glycogen in the liver because glycogen is accumulated in the liver from 35 weeks of pregnancy, liver has not produced some metabolic enzymes like enzymes glucuronyl-trans- íerase, carbonic anhydrase ... so premature babies often have dark, long-lasting jaundice, easy to lower blood sugar, easy to dissolve blood.

Metabolic - endocrine function

Protid and lipid metabolism is poor because of the lack of necessary enzymes while the demand for protids and lipids is high for weight gain to catch up with term babies and keep body temperature, so preterm babies need more breast milk to make it easier to absorb and transport. chemical.

The requirement for Na + and K + is similar to that of a term child, while the water rate of preterm infants is higher, the kidney's filtration and elimination function is incomplete, potassium excretion is very slow, water and salt retention is high, so it is prone to edema.

Vitamins: In general, premature babies lack most of their vitamins, and should be supplemented from the beginning to the end of the neonatal period.

Most of the endocrine glands are incomplete and function very weakly, only glands, although active immediately after birth, mainly only secrete insulin, so preterm infants are susceptible to hypoglycemia due to lack of reserves, supply. acute incineration, but also due to increased insulin secretion in medical cases.

Immunity

The body's defenses against infection of preterm infants are either underdeveloped or underdeveloped.

The skin is thin, the acidity is low, so it has little antibacterial effect.

The cellular immune system is weak, phagocytic and bactericidal is incomplete.

The amount of humoral immunoglobulin (IgG) from mother to placenta is very small (due to preterm delivery).

Weak autoimmune ability.

Because of the above reasons, premature babies are susceptible to infection, and the death rate of the population is high.

Care and nurture

The development of low birth weight and preterm babies depends a lot on the nurture, care and environmental conditions around babies right from birth with the basic principles of keeping warm, breast milk and disobey.

Take care of

Keep warm: infants should be placed in a warm environment to avoid being cold :

Once born, low birth weight and preterm babies need to be dried, incubated, and located in a room with a temperature of 28-35 ° C. If the child is under 1800g, it should be placed in the bristles to help us observe the goat easily, convenient in care such as injection, feeding, and cleaning the child on the spot and to maintain a stable temperature, but pay attention to the incubator. ensure hygiene, sterility and use the correct parameters for each child (temperature, humidity, oxygen ...).

Need to maintain the temperature of the glass cage between 33-34 ° C for children <2000g, and between 34-35 ° C for children <1500g.

In the following days, it is necessary to maintain the temperature in the child's room at 28-30 ° C and daily monitoring of the child's temperature in order to change the temperature around the child appropriately.

If the incubator is not used, it is necessary to warm the baby according to the kangaroo method (put the baby against the mother's chest to skin to skin) or warm with a compressive pad, a warm crib. The child's body is unable to generate the heat needed to maintain body temperature, the chemical composition of the infant's subcutaneous fat layer consists of layers of saturated fatty acids (palmatic and stearic), low in unsaturated fatty acids ( obic). Therefore, if the child is cold, the child is prone to scleroderma edema, the more likely the child will be aggravated by a common illness in the child.

Skin care and baby bathing: It is necessary to keep the skin hygienic, so daily bathing with warm water, soap for children, quick baths and dry with soft towels, winter should bathe the baby in the incubator and rub a paraíin oil layer to keep skin moisture from losing heat. Wear soft, laminated cotton clothes when warm

Take care of the navel, eyes, and mouth like a full-term baby.

nutritional support

Breast milk should be given to premature and low weight babies as soon as possible because this type of baby has the risk of hypoglycemia, hypothermia, dehydration, and weight loss than full term babies. The biggest conflict of children is between supply and demand, the child cannot suckle or suckle weakly, the amount of reserves in the body is low, while the body needs are high. So by all means we must provide children with a calorie serving of 130-150 calories / kg / day. Of which, 50% of the energy is from sugar, 40% is from protein, and 10% is from fat. Depending on the situation of each child, depending on the weight and age of the fetus, there is an appropriate management.

If the premature infant is> 34 weeks old, weighing> 2300g with a suckling reflex will breastfeed early and lie with the mother, taking care of like a full-term baby.

If preterm babies are <32 weeks old, have no suckling reflexes, they must feed them with a gastrostomy tube (8-10 times / day), duodenal catheter or spoon, drip breast milk into the baby's mouth, monitor the amount milk every meal.

If the child is too young, weighing less than 1500g, it is necessary to coordinate intravenous feeding and drip of the stomach or mouth according to the principle of gradually reducing the amount of intravenous infusion (glucose 10% + electrolytes) gradually increasing, progressing to fed by the gastrointestinal tract completely.

For example: the amount of milk and infusion for children under 1500g

Infusion                                       Amount of milk

Day 1: 60ml / kg / 24 hours 20ml / kg / 24 hours

Day 2: 50ml 40ml

Day 3: 40ml 60ml

Day 4: 30ml 80ml

Day 5: 20ml 100ml

Day 6: 20ml 120ml

Day 7: 10ml 140ml

From the second week onwards, increase gradually from 150ml to 200ml / kg / day if the child eats without rest.

Needs of preterm and low weight babies

Because the energy requirement of preterm infants is 130-140 Kcal / day, higher than full term children (100-120 Kcal / day), when the baby does not eat enough, it is necessary to add 10% glucose and electrolytes.

Energy:

60-110 Kcal / kg / day: the first 3 days.

110-140 Kcal / kg / day: the following days.

Country:

80-100 ml / kg / first day.

100-140 ml / kg / day during the first week.

Second week increase from 150-180 ml / kg / day.

From the following week increase up to 200 ml / kg / day.

Protid:

2.5-3 g / kg / day, when gaining weight rapidly, the need can increase to 3.5-4 g / kg / day.

Lipid:

2-3 g / day.

Glucid:

12-15 g / kg / day, dextrene maltose can be added.

Vitamin:

Vitamins A, D: 800-1000 units / day.

Vitamin c: 50 mg / day.

Vitamin E: 5-10 mg / day.

Vitamin KI: 2-5 mg / time after delivery (intramuscularly or oral).

Also added vitamins Bl, B6, B12.

Mineral salts:

NaCl: 4 mmol / kg / day.

KC1: 2-4 mmol / kg / day.

Calcium: 50-100 mg / kg / day.

Phosphorus: 30-60 mg / kg / day.

Magnesium: 10-20 mg / kg / day.

Conclude

Low birth weight and preterm babies are susceptible to infections, high mortality rates (accounting for 80% of total perinatal deaths). It is very difficult and costly to nurture, the care must be very meticulous, attentive, requiring technology, experience and expertise.

Some babies can become healthy and develop almost like full-term babies. But for extremely young children, whose birth weight is less than 1500g or whose gestational age is less than 32 weeks, it is easy to leave defects in physical development (45%), mental (40%), other senses such as mute. deafness, astigmatism, visual impairment ... Therefore, it is necessary to pay attention to do well in reproductive health care to strengthen measures to prevent babies from being born ahead of time, and at the same time pay attention to good resuscitation. in the delivery room to reduce complications for children in the future.