Age, month

I degree prematurity

II degree prematurity

length

weight

length

weight

for 1 month

Total

for 1 month

Total

for 1 month

Total

for 1 month

Total

1

2

1100

3

10,9

1850

11,3

1650

4

14,2

2600

15,1

2540

5

16,5

3400

18,4

3340

6

18,5

4100

20,7

4040

7

20,1

4800

23,0

4640

8

21,6

5500

24,8

5340

9

22,8

6200

25,8

5790

24,3

6600

26,6

6190

11

25,5

7000

27,5

6690

26,5

7350

29,0

7090

Table 3-26. Length and body weight of premature infants in their first year of life

Age, month

III degree prematurity

IV degree prematurity

length

weight

length

weight

for 1 month

Total

for 1 month

Total

for 1 month

Total

for 1 month

Total

1

3,7

2

3

11,9

1490

9,9

1230

4

15,6

2140

13,4

1830

5

19,2

2890

17,1

2380

6

22,0

3690

UDC 616-053.32

Ivanova I.E., 2014

Received February 12, 2014

I.E. IVANOVA

Physical development of premature babies

(Lecture)

Institute for Advanced Medical Studies, Cheboksary

The basic laws of the physical development of premature babies born at different gestational periods are presented, the dynamics of increase in height, body weight, head and chest circumferences, as well as the forecast of “catching up” growth to 17 years of age are shown.

Keywords: physical development, premature, overtaking growth

Prematurely born children account for 3-16% of all newborns. According to the State Statistics Committee of the Russian Federation (2009), the birth rate of children with low body weight in Russia is 4.0-7.3% in relation to the number of all born. According to the Department of Monitoring Public Health, in 2008-2010. the birth rate of children with extremely low body weight at birth (ENMT) in Moscow was 0.1-0.3%, with very low body weight (ONMT) - 0.8-0.9%. In the USA (2006), low birth weight was observed in 8.3% of newborns, and ONMT in 1.48% of newborns. In European countries (2008), 1.1 to 1.6% of babies are born prematurely (<33 недель гестации).

Over the past years, the number of premature infants born in the Chuvash Republic has remained constant and makes up 5.1-5.4% of all births. Children with ENMT account for 0.9-1.2% of the total number of births (in the Russian Federation - 0.35%) and 6.6% of the number of births premature (in the RF 5%).

Back in the 60s. of the last century, it was believed that premature babies with a body weight at birth of less than 1,500 g were not viable. Since 2012, in Russia, in accordance with the WHO criteria, the registration standards for infants born at gestational age 22 weeks or more and weighing 500 g or more have changed, and conditions for their nursing have been created in the leading perinatal centers of the country. Thanks to the development of intensive care technologies, optimization of perinatal care in last years the survival rates of children with ONMT and ENMT improved (Table 1), which made the problem of further nursing of these children relevant not only for neonatologists, but also for the primary pediatric unit - the district service.

Table 1

Survival of children with ENMT in weight groups according to

obstetric hospitals in 2009 (per 1000 live births weighing 500-999 g)

It should be borne in mind that deeply premature babies do not adapt well to extrauterine conditions of existence, almost half of them show damage to the central nervous system (CNS) in the form of intraventricular hemorrhages of varying severity, ischemic foci, and periventricular leukomalacia. Their treatment and nursing require large material costs and moral stress from the staff. At the same time, literature data show that only in 10-15% of children the neurological pathology already in the neonatal period is so serious that an unfavorable outcome of its development and disability can be established at this age. The rest of the children after somatic adaptation can and should be at home, although during almost the entire first year of life, they may persist changes in the bronchopulmonary system, the consequences of perinatal damage to the central nervous system, hemodynamic instability with the functioning of fetal communications, vision and hearing problems, tendency to viral and bacterial infections, a high incidence of rickets, anemia, gastrointestinal dysfunction, fermentopathy. Thus, deeply premature babies have a number of specific problems associated, on the one hand, with immaturity and underlying pathology, and on the other, with the consequences of intensive therapy (in particular, mechanical ventilation).

Premature babies have a number of anatomical and physiological features, which, along with the above pathological conditions, cannot but affect the features of their physical and morphofunctional development. The physical development (RF) of a premature baby cannot be evaluated by the criteria of their full-term peers, since this will always lead to an underestimation of its parameters and an artificial aggravation of the condition of the baby. Sufficient experience in assessing the growth and development of premature babies has already been accumulated in world and domestic pediatrics, which we used in preparing this lecture.

FR - a set of morphological and functional properties of the organism, characterizing the process of its growth and maturation. Children's RF has great social and medical significance. World Health Organization experts define RF indicators as one of the fundamental criteria in a comprehensive assessment of a child’s health status. In addition, the harmonious RF of the child is a measure of the child’s legal capacity and endurance. Numerous modern studies show that the long-term cognitive development of the child is directly dependent on the growth rate in the early neonatal period and after discharge from the perinatal center. The parameters of FR are of various clinical diagnostic value. The length of the body characterizes the growth processes of the child's body, the mass indicates the development of the musculoskeletal system, subcutaneous fat, internal organs. The increase in head circumference in the first months of life, reflecting the active growth of the brain, is of great prognostic value for the further mental development of preschool and adolescence. If the child does not grow skeletally, does not add to the mass the correspondingly laid down genetic development program, then during this period there is no increase in the mass of the brain, like any other organ. A delay in development may turn out to be unrehabilitated by intellect in the future.

When evaluating RF in preterm infants, concepts such as gestational, postnatal, post conceptual and corrected age should be considered. Gestational age is understood to mean the number of full weeks elapsed between the first days of the last menstruation and the date of birth. Postnatal age is the actual (calendar) age, i.e. the number of months that have passed since the birth of the baby. Postconceptual (postmenstrual) age is calculated as the sum of the gestational age and postnatal age of the child. To calculate the corrected age, it is necessary to take from the calendar age those weeks for which prematurely born prematurely. RF of premature infants should be evaluated only by corrected age. This is especially important for children born before the 32-33rd week of pregnancy and weighing less than 1500 g. For children born at 32-33 weeks or later, the correction of gestational age can be completed at the age of 1 year. Corrected age in premature infants should be calculated in the first two years of life. Some authors suggest correcting up to 3 or 7 years. The moment of completion of the age adjustment must be recorded.

To assess growth in neonatology, growth curves of the fetus and premature baby are used. Growth curves are a graphical representation of the dynamics of anthropometry indicators depending on gestational age. Growth curves, as a rule, contain 3 dimensions: mass, height and head circumference. The mass measurement, according to experts of the World Health Organization, is an accurate measurement, because it uses electronic scales. The head circumference can also be measured with a high degree of accuracy. The growth of the child, according to experts, can be measured less accurately due to positioning issues.

Modern Fenton growth curves (2013) can be used to monitor the growth of the fetus and premature baby (Figs. 1 and 2).

Fig. 1. Centile curves of girls' developmental parameters depending on gestational age (Fenton T.R., 2013)

Fig. 2. Centile curves of developmental parameters of boys depending on gestational age (Fenton T.R., 2013)

Fenton's curves include the 3rd, 10th, 50th, 90th and 97th percentiles of weight, height, and circumference of the head, which are applied to the grid. In the zone from the 10th to the 90th percentile, average RF indicators are characteristic of 80% of premature infants. In the zones from the 10th to the 3rd and from the 90th to the 97th percentile there are values \u200b\u200bindicating the level of development below or above the average, peculiar to only 7% of conditionally healthy premature infants. Values \u200b\u200bbelow the 3rd and above the 97th percentile are areas of very low and very high rates that are found in healthy premature infants no more than in 3% of cases. Fenton's growth graph is large-scale, which provides high accuracy. The baby’s weight step is 100 g, the growth step and head circumference is 1 cm. A time interval of 1 week is used. The graph allows you to compare the growth of a premature baby with the growth of the fetus, starting from 22 weeks of gestation and up to 10 weeks of postnatal age. The chart is deliberately extended to 50 weeks, as most premature babies are discharged home by that age. At the bottom of the diagram there is a space for marking measurement data.

After stabilization and discharge from the hospital, premature babies experience accelerated growth, the so-called catch-upgrowth, which requires appropriate nutritional support at the outpatient nursing stage. Children who “caught up” their centile corridor by 6–9 months of adjusted age have a better prognosis of neuropsychic development than did not reach the required weight-growth indicators. Significantly better neurological prognosis is for children who have “caught up” with the corresponding normative indicators of RF by 2–3 months of adjusted age. The most beneficial for further development is the growth spurt in the first 2 months of the corrected age.

FR indicators and their dynamics include the length, weight and circumference of the head and chest. One of the practically significant features in assessing the physical status of a premature baby is a deviation from the synchronism of the increase in various physical parameters, the uneven growth processes of different structures in subsequent periods of development. FR of prematurely born children depends on the initial data, weight and body length “at the start”. Although most premature babies in the RF catch up to full-term newborns during the first year of life, some of the children with BDCs at birth and children with severe chronic lung diseases can remain small forever. Slow head growth may be an early sign of abnormalities in neuropsychic development.

For RF premature babies are characterized by higher growth rates of weight and body length in the first year of life (with the exception of the first month). By 2-3 months they double the initial body weight, by 3-5 they triple, by the year they increase 4-7 times. At the same time, extremely immature children in absolute terms of growth and body weight are significantly behind (“miniature” children) - the 1-3rd corridor of centile tables. In subsequent years of life, premature babies can maintain a peculiar harmonic delay in the RF.

Most babies born with a body weight of less than 2000 g double it by 2.5-3.5 months, triple it by 5-6 months. Basically, premature babies catch up with their full-term peers in terms of weight and height by 2-3 years of life, and children with body weight less than 1000 g - only by 6-7 years. Children with intrauterine growth retardation (IUGR) and congenital short stature syndromes lag behind in growth in subsequent age periods.

The initial weight loss in premature infants is 4-12%. The maximum decrease is observed on the 4-7th day, then for several days it does not change (2-3-day plateau) and subsequently begins to slowly increase. Permissible transient loss of body weight after birth in premature infants:

body weight at birth\u003e 1500 g - 7-9%;

body weight at birth from 1500 to 1000 g - 10-12%;

birth weight< 1000 г - 14-15%.

After frequent and profuse regurgitation, with serious illnesses and a decrease in edema, pathological weight loss (more than 15%) is noted, which develops faster than the initial weight loss. The restoration of body weight in premature infants (average 15 g / kg / day) depends on the degree of prematurity and occurs the faster, the less body weight at birth. The initial body weight is restored by the 2-3rd week of life. Children with greater body weight at birth and with a longer gestation period also have higher weight gain. A flat weight curve is often observed in premature patients, as well as in children with ONMT at birth and low gestational age (later, some of them show CNS damage). Children with body weight up to 1000-1200 g and gestational age up to 28 weeks restore their initial weight by 1 month.

Normal weight gain for the 1st month of life in children of the first degree of prematurity will fluctuate within 300-450 g, II degree - 450-675 g, III - 600-900 g. Approximately the same rate of increase in body weight remains at 2 -th month of life. In the future, when assessing the state of RF of premature babies, one can roughly focus on the average monthly increases in body weight of a full-term baby, which are 800 g at the 3rd month of life, 750 g at the 4th month, 700 g at the 5th month, etc. . (tab. 2).

The growth rate in children with body weight at birth\u003e 1000 g in the first 6 months of life is 2.5-5.5 cm per month, in the second half of the year - 0.5-3 cm per month. In the first year of life, the body length increases by 26.6-38 cm. Deeply premature babies grow faster. Average length the body of a premature baby by 1 year reaches 70.2-77.5 cm.

table 2

Physical development of premature babies in their first year of life

The daily increase in head circumference in premature infants in the first 3 months is 0.07-0.13 cm (measurement is carried out every 5 days). On average, an increase in head circumference in the 1st half of the year is 3.2-1 cm, in the 2nd half of the year - 1-0.5 cm per month. By the end of the 1st year of life, the head circumference increases by 15-19 cm and reaches 44.5-46.5 cm. The “cross” of the head and chest circumference in healthy premature infants occurs between the 3rd and 5th months after birth ( tab. 3, 4).

Table 3

Head circumference in premature infants in the first 3 months of life, cm

Table 4

Head circumference in preterm infants with birth weight

less than 1500 g

The rate of increase in chest circumference in premature infants is approximately 1.5-2 cm monthly.

First teething in premature babies begins:

1. with a body weight at birth of 800-1200 g - in 8-12 months;
2. with a body weight at birth of 1000-1500 g - in 10-11 months;
3. with a body weight at birth of 1501-2000 g - in 7-9 months;
4. with body weight at birth 2001-2500 g - at 6-7 months.

The study of the level of RF of prematurely born children in remote periods of life seems to be extremely important and relevant in connection with the fact that this is one of the most important indicators of a child’s health. In some children (especially those prematurely born with IUGR), manifestations of heterochrony of growth of deviations from a given program may be observed, when some parts of the body or organs grow faster than others or, conversely, are characterized by slow growth, while the coordination, synchronism of growth of different structures is violated. Studies in Russia have confirmed this fact, showing that almost every third premature baby with IUGR (27.0%) had a low growth in the future. When evaluating the RF of deeply premature infants, it was found that by the year it was normal only in 24.0-44.7% of the examined.

As a rule, children with ENMT do not grow well in early childhood, and often this problem persists in the future. By the age of 5 years, 30% of the weight deficit may occur, and 50% of children born before the 30th week of gestation may have a growth deficit. By 8–9 years, about 20% are still behind in growth. Periods of “stretching” in this group of children begin 1-2 years later. In children born with a body weight of less than 800 g, by 3 years the body length and head circumference is below the 5th percentile, and body weight is about the 10th percentile. Most often, growth disorders (growth retardation) are detected in children with cardiorespiratory problems, gastroesophageal reflux disease, CNS pathology (swallowing disorder), anemia, short bowel syndrome, and other chronic diseases.

Moreover, a decrease in the size of the head circumference (less than the third percentile) is associated with impaired cognitive function in school age (compared to children who had normal growth heads in the first two years of life, children with a slow increase in head circumference had a mental development index significantly lower).

However, it must be emphasized that, given even the most pessimistic forecasts of some studies, with a favorable medical and social environment of the child RF indicators in preterm infants almost always reach the norm by the age of 17. With age, prematurely born children experience a decrease in the dependence of physical indicators on the effects of biological factors.

Prior to the end of the age correction, when formulating a conclusion on RF in the individual history of the development of a premature baby, the following expressions are used: “Physical development corresponds to the gestational age” or “Physical development does not correspond to the gestational age” indicating the excess or deficiency of any parameter (weight, height, circles head and chest).

Impaired growth (stunting) and its correction in premature babies with IUGR

Most babies born with IUGR have a period of rapid growth and an increase in growth-weight indicators in the first 6-24 months of life. In the literature, this phenomenon is called "postnatal growth spurt", or "catching up with growth rates." The growth leap allows children to return to their genetic trajectory after a period of intrauterine growth retardation. Nevertheless, approximately 10-15% (6 thousand annually in Russia) of children with IUGR continue to have low growth rates in the postnatal period. As a result of inadequate rates of postnatal growth in such children, growth retardation is already noted by the age of 2 years. Growth deficiency is observed throughout childhood and adolescence, which ultimately leads to stunting in adults. The greater the IUGR of a child, the more likely it is to remain a stunted adult. In the absence of spontaneous growth acceleration, children remain stunted, accounting for 14-22% of adults whose height is less than 150 cm in women and less than 160 cm in men. Small babies are 5-7 times more likely to become stunted adults compared to babies with normal body sizes at birth. This significantly affects their social status.

The determination of the level of hormones in newborns or children with IUGR is not shown in everyday clinical practice, since neither the concentration of growth hormone (STH) nor the values \u200b\u200bof IRF-I or IRF-binding protein-3 in the circulating blood in children of the first year of life are predictors of the subsequent growth. Current recommendations come down to the fact that in a child born with low weight / height, it is necessary to measure height, body weight and head circumference every 3 months during the 1st year of life and then every 6 months. In those children who do not have a pronounced and reliable catch-up of growth during the first 6 months of life, or in children remaining stunted (growth below -2SD for the corresponding age) by 2 years, it is necessary to identify the reasons limiting growth and prescribe the appropriate treatment.

In connection with the existing anomalies in the secretion of STH, IRF-I in various countries of the world, attempts are being made to treat undersized children with IUGR in the history of drugs of recombinant growth hormone (rGR). The effectiveness of this treatment has been actively studied for over 15 years. The data of large multicenter studies indicate a dose-dependent effect of rGR therapy in this category of patients. With long-term continuous treatment (average duration of 6 years), most children (about 85%) achieve a final growth that is within the normal range for a healthy population or within the target growth (average 95%), i.e. comparable to their biological parents. Therefore, it is recommended to carry out early detection of stunted children born with low weight / height, and in order to establish an accurate diagnosis, send them to a consultation with an endocrinologist. Factors affecting the effectiveness of rGR therapy during the first 2–3 years include the following: age and SDS of growth at the time of initiation of therapy, average parental growth, and dose of rGR. The average increase in growth after 3 years of treatment with rGR varies from 1.2 to 2 SD at a dose of rGR of 0.035-0.070 mg / kg / day.

Currently, recommendations have been developed for the treatment of rGR of this category of children. RGR therapy can be prescribed for short-aged children with IUGR history of 2-6 years old, with growth below -2.5 SD. During the first years of rGR therapy, most children experience a quick catch-up increase in growth and its normalization (growth indicators reach a genetically determined curve). In the future, against the background of treatment, a normal growth rate is maintained until the final growth is achieved. The phase of maintenance treatment for rGR is less dose dependent. During the first years of rGR therapy, most children experience a quick catch-up increase in growth and its normalization (growth indicators reach a genetically determined curve). In the future, against the background of treatment, a normal growth rate is maintained until the final growth is achieved. The phase of maintenance treatment for rGR is less dose dependent.

A positive response to treatment for rGR is considered to be a change in SDS growth of more than +0.5 in the first year of therapy. If the response to therapy is inadequate, an additional examination is necessary to identify factors affecting the effect of treatment, assess compliance, dose rGR. In most stunted children with IUGR who received rGR in childhood, pubertal development began on time and went well.

LIST OF REFERENCES

1. Alyamovskaya G.A. Features of the physical development of deeply premature infants in the first year of life / G.A. Alyamovskaya, E.S. Keshishyan, E.S. Sakharova // Bulletin of modern clinical medicine. - 2013 .-- T. 6, issue 6. - S. 6-14.
2. Vinogradova I.V.Modern technologies for the treatment of premature infants / I.V. Vinogradova // Fundamental research. - 2013. - No. 9 (part 3). - S. 330-334.
3. Hypotrophy and intrauterine growth retardation in children: textbook. allowance / comp. I.E. Ivanova, V.A. Rodionov, T.V. Zolnikova. - Cheboksary, 2011 .-- 100 p.
4. Children's diseases: a textbook / ed. N.N. Volodina, Yu.G. Mukhina. - M.: Dynasty, 2011.- Vol. 1. Neonatology - 512 s.
5. Observation of deeply premature babies in the first year of life / T.G. Demyanova [et al.]. - M .: Medpraktika, 2006 .-- 148 p.
6. Observation of premature babies in a children's clinic: textbook / ed. I.E. Ivanova. - Cheboksary: \u200b\u200bAU of Chuvashia "IUV", 2014. - 650 p.
7. Neonatology: national leadership / ed. N.I. Volodina. - M.: GEOTAR-Media, 2013 .-- 886 p.
8. Features of the provision medical care children born in gestational age 22-27 weeks / D.O. Ivanov [et al.]. - SPb .: Inform-Navigator, 2013 .-- 132 p.
9. The principles of staged nursing of premature babies / Union of Pediatricians of Russia, FSBI "Scientific. Children's Health Center "RAMS; under the editorship of L.S. Namazova-Baranova. - M.: Pediatric, 2013 .-- 240 p.
10. Timoshenko V.N. Premature newborn babies: Textbook. allowance / V.N. Tymoshenko. - Rostov n / A: Phoenix; Krasnoyarsk: Publishing projects, 2007. - 192 p.
11. Physiology of the growth and development of children and adolescents (theoretical and clinical issues) / ed. A.A. Baranova, L.A. Shcheplyagina. - M., 2000 .-- 584 p.
12. Shabalov N.P. Neonatology: textbook. allowance: in 2 vol. T. 1 / N.P. Shabalov. - 4th ed., Rev. and add. - M .: MEDpress-inform, 2006 .-- 656 p.
13. Fenton T. R. / T. R. Fenton, J.H. Kim // A systematic review and meta-analysis to revise the Fenton growth chart for preterm infants. - BMC Pediatrics, 2013. - URL: http://www.biomedcentral.com/1471-2431/13/59.

It is generally accepted that physical development is an informative indicator of the level of health of a population.
There is a direct correlation between morbidity and mortality of children and their body weight. The lower the body weight of the child, the more susceptible it is to infectious diseases, more often suffers from anemia and impaired mental and motor development. A significant excess of the indicators of physical development relative to the norm also adversely affects the child's body and can be a manifestation of severe endocrine, genetic disorders; such children are also more likely to get sick. In most cases, a deviation from the normal rate of increase in length and body weight is the first sign of disease. It is necessary to analyze a similar situation and examine the child.
Thus, physical development is one of the main characteristics of health, which requires special control during critical periods of life, and especially in the first year of life, when the most intensive growth and development of the child occurs.
There is still no single approach to assessing physical development. In recent years, normative tables and graphical curves are increasingly used, which allow to unify the methodology for assessing the most important anthropometric indicators.

Definition of physical development and methods for its assessment

Physical development - This is a set of anthropometric indicators that characterize the health of the body, its endurance and resistance.
Anthropometric indicators include body weight and length, head and chest circumference. When examining a child, it is mandatory to measure body weight, body length and head circumference. The circumference of the chest is of secondary importance. It is advisable to measure the circumference of the chest only in a special group of children with an excess increase in the circumference of the head, compare them with each other and evaluate in dynamics.
The term "physical development" refers to the process of increasing the length of the body, mass, the development of individual parts of the body and the biological maturation of the child in different periods of time.
Currently, it is recommended to use the centile method to assess physical development. It is easy to operate, since it eliminates the need for calculations. Tsentilnye tables (graphs) allow you to compare individual anthropometric indicators with standard - tabular (graphical) obtained by mass screening (100 people of each age). The data of the 3rd, 10th, 25th, 50th, 75th, 90th, 97th examinees are entered into the tables in which the body weight indicators (or body length, or head circumference, or chest circumference) are vertically laid down, and horizontally - the age of the child. In the table. and in fig. keep the specified order - it is called the percentage, or percentile, or just centile (indicated by the symbol P: P25, P75, etc.).

Table. Assessment of anthropometric indicators of a child using centile graphs

Thus, if the anthropometric indicator of the child is between the P25 - P50 - P75 curves, then this corresponds to the average norm for a given age, if between the P25 - P10 and P75 - P90 curves, it is lower and higher than the average norm, but still within normal fluctuations . The values \u200b\u200bof anthropometric indicators below P10 and above P90 should be considered as low and high.
The physical development curve during normal development of the child should be fairly smooth and evenly arriving, so any change (especially a sharp slowdown) is most likely due to some kind of trouble. This can be a physical illness, malnutrition or psychosocial problems. However, a child may also have a rather large range of fluctuations in normal monthly changes in parameters.
Physical development is considered harmonious if all the studied anthropometric indicators correspond to the same centile interval. A large difference in centile indicators, when they are within different intervals, indicates the inharmonious development of the child.
For example, separately each anthropometric indicator can correspond to the norm: body weight corresponds to 25 centiles, body length corresponds to 50-75 centiles. However, the gap in the value of these indicators is more than one interval. In this case, the physical development of the child should be considered appropriate for age (average), but inharmonious - a lack of body weight relative to body length (height).
If the child is full-term, healthy, then at 28 days of life (1 month) his physical development can be determined using centile graphs. Evaluation of premature babies is carried out according to other schedules of physical development, in accordance with their gestational age, and cannot be carried out according to schedules for full-term babies.
Assessment of physical development can be static and monitoring.
Static evaluation. The data of anthropometric measurements are recorded at a particular point in time. For example, during a visit of a mother with her child to health worker it is possible to measure body weight and length, the circumference of the child’s head, determine centile values \u200b\u200band their correspondence with each other. This will approximately judge the norm or deviations from the norm in physical development. this child at the current time. This score is relative.
Monitoring assessment. Determination of indicators of body weight, body length, head circumference and their correspondence in dynamics, i.e. for a certain period of time. This allows you to evaluate the physical development and its harmony in the process of growth of the child. Monitoring data are a more important characteristic of development than static indicators. The assessment of anthropometric indicators as a result of monitoring has absolute diagnostic value in determining the norm or pathology of the child’s physical development.
For example, with a static assessment, all indicators can be normal. However, during monitoring, a constant decrease in the values \u200b\u200bof indicators can be detected, the centile curve can have a negative dynamics (decrease), which indicates a possible disadvantage and the need for a mandatory special examination of the child.

Measurement of anthropometric indicators

Body weight is determined by weighing the newborn.
Currently, electronic medical scales are widely used. The scales are mounted on a fixed surface and are included in the network. To check the balance, you should press with your hand, with a little effort in the center of the tray - the indications corresponding to the force of the hand will be displayed on the indicator; release the tray - zeros appear on the indicator. Next, the nurse should wash and dry her hands, put the diaper on the weighing tray - its weight will appear on the indicator. Reset the diaper weight to the balance memory by pressing the “T” button - zeros will appear on the indicator. After that, proceed to weigh the child: undress him, put on the tray. After a while, the indicator will show the value of the child’s body weight, which is fixed on the display for 30-40 seconds. After that, remove the child from the balance (the balance is automatically set to zero).
If weighing is carried out on a mechanical balance, then in preparation for the child’s weighing procedure, the balance is checked for adjustment (with the shutter closed, weights are set to zero; the shutter is opened and the balance is balanced by rotating the counterweight). When weighing a child, the balance is balanced by the movement of weights, which determine kilograms and grams of weight.
Height is measured in centimeters, from the crown of the head to the heels, in the position of the child on the back with legs straightened as far as possible in the knee joints and feet bent at right angles on the height meter or on a changing table with a centimeter tape.
The horizontal height meter is installed on a flat, stable surface with a “to you” scale. Nurse he washes and dries his hands, puts a diaper on the stadiometer, puts the child’s head on it to the fixed bar. The baby's legs straightens with a light pressure on her knees, she moves the movable level of the stadiometer to the feet.
When determining the head circumference, the centimeter tape passes through the superciliary arches and the occipital protuberance, the chest circumference at the lower corners of the shoulder blades and the lower third of the areola of the mammary glands.

Assessment of physical development at birth

Assessment of the physical development of newborns at birth includes:
- determination of body weight, body length, head and chest circumference, body proportionality and comparing them with indicators corresponding to / appropriate to the gestational age (GV) of the child;
- the maturity of the newborn is estimated by the totality of clinical and functional indicators. Assessment of morphofunctional maturity can be made only during the first 7 days of life, according to special maturity tables; includes condition assessment skin integument, the development of the hairline, mammary glands and genitals, the shape of the auricles, the position of the body and the child’s posture.
The gestational age (GV) of the baby is considered the gestational age at which he was born.
Currently, a child born at a gestational age of at least 28 weeks is considered to be a live-born child, respectively, this HB is determined starting from the 28th week of pregnancy. Upon the transition of Russia to the registration of live births from the 22nd week of pregnancy, HB will be calculated from this gestational age. Thus, in preterm pregnancy, HB will be 22-37 weeks.
When assessing the physical development of the child at his birth, centile graphs vertically postpone the indicators of body weight, body length, circumference of the head or chest of the child, and horizontally - his GV.
Along with individual parameters of physical development, the proportionality of the child’s physique is evaluated, i.e. ratio of individual parts of the body. Features of the external proportions of the baby at birth are:
- a relatively large head with a predominance of the brain over the facial;
- short neck;
- a shortened chest, narrowed in the upper and expanded in the lower half;
- a long protruding belly;
- relatively short lower limbs.
The smaller the child's HS, the more obvious are these physique features.
Based on a differentiated assessment of the state of physical development of newborns, the following clinical forms of growth and developmental disorders are distinguished:
- children with a large body weight;
- Children with low body weight (with congenital / intrauterine or prenatal malnutrition);
- children with intrauterine growth retardation (IUGR) - small relative to gestational age.
As a rule, children with a large body weight at birth are children with a mass of more than 4000 g.
Congenital (prenatal) malnutrition is an acute or chronic malnutrition of the fetus, accompanied by a lag in physical development, impaired functional state of the central nervous system, metabolic disorders and decreased immunological reactivity. Intrauterine hypotrophy can be an independent pathology and can accompany various diseases of the fetus and newborn. Children with intrauterine hypotrophy can be premature, full-term and long-term.
Children with IUGR (small by gestational age) are children who are not physically fit for gestational age.
Initial weight loss is a phenomenon that is observed in all newborns immediately after birth. This is due to the displacement of fluid from the respiratory tract during the formation of pulmonary breathing, evaporation amniotic fluid from the skin, loss of the "original stool" - meconium. Normally, a child can lose no more than 10% of body weight without serious consequences. Better - about 5%. In order for the child to lose weight as little as possible, it is necessary that
from the first minutes of his life he was near his mother and, upon first request, he was put on his chest. Let mother think that she does not have milk, but even a few drops of colostrum are important for the child to obtain the necessary energy and the formation of the correct metabolism. If the child loses more than 10% of the initial body weight, it is necessary to look for the cause - illness, malnutrition or malnutrition. However, in any case, therapeutic measures are required.
Evaluation should be carried out in the hospital and at the first visit to the newborn by a health care provider at home.

Assessment of the physical development of the newborn during the first month of life

At the age of the month, a regular assessment of physical development is carried out using centile graphs, based on the magnitude of the changes in anthropometric data.
The tables show the ranges of fluctuations in body weight, body length, and head circumference of full-term babies, which coincide with a range of 25-75 centiles and are considered normal.

Body Weight Table

Postnatal (acquired) hypotrophy - deficit of body weight relative to body length and postnatal paratrophy - excess of weight over body length are considered to be violations of the child’s physical development in the first month of life.
Postnatal malnutrition may be:
- primary - as a rule, alimentary hypotrophy caused by a shortage of milk in the mother or unsustainable artificial feeding of the baby, as well as states of milk intolerance due to fermentopathy;
- secondary - develops due to acute and chronic diseases of the child, congenital malformations (pyloric stenosis, intestinal stenosis), immunodeficiency diseases, severe CNS pathology.
Signs of malnutrition are important clinical signs of malnutrition:
- thinning of the subcutaneous fat layer;
- reducing the thickness of the skin folds, circumference of the thigh and shoulder;
- reduction of tissue turgor;
- an increase in the number of skin folds on the limbs, neck, their appearance on the face, buttocks, around the joints;
- clear outlines of ribs and other bone protrusions. Symptoms of undernutrition cause distinct
imbalances in the physique of newborns: children look thin, long, with a relatively large head.
A characteristic feature of children with intrauterine malnutrition is a decrease in non-specific defense factors, which leads to a high incidence of infectious and inflammatory diseases.
In case of insufficient weight gain in the first month of life, in the absence of threatening symptoms in the form of persistent, increasing in frequency and volume of spitting up and vomiting, it is necessary to conduct a consultation on feeding, check whether the mother correctly applies the baby to her breast and the effectiveness of sucking.

Assessment of the circumference and shape of the head

Measuring the head circumference in a child of the first year of life is of particular importance. In the first half of the year, the average increase in head circumference is 1-1.5 cm. Head circumference indicators should also be estimated from centile tables.
The circumference of the head in the newborn exceeds the circumference of the chest by 1-2 cm. The increase in the difference, especially persistent, makes the development of hydrocephalus suspected. An increase in head circumference may not be the only sign of hydrocephalus. In this case, there are usually other signs characteristic of this pathology.
If the head circumference is less than the circumference of the chest, then microcephaly must be excluded.
Head may be different shapes, which is not a pathology, but only a feature of the child.

Physical Fitness Advice

An insufficient increase or decrease in body weight relative to age may indicate acute infectious, surgical pathology (pyloric stenosis). In the absence of these diseases, mothers should be advised on nutrition.
With excessive weight gain, it is necessary to exclude endocrine pathology, in particular hyperglycemia and hypothyroidism. In their absence, paratrophy is considered constitutional, i.e. the child is not shown a restriction of nutrients, a decrease in the multiplicity and duration breast feeding etc.
Children with constitutional paratrophy require:
- control of hemoglobin level and prevention of anemia;
- control of calcium levels and prevention of vitamin D-dependent rickets.

Nursing care for a newborn in an outpatient setting. Ed. DI. Zelinsky. 2010

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