He was born about 55 000 children prematurely each year in the hexagon Prematurity and reached more than 6% of births.
A premature baby is a child born before the 37th week after the first day of last menstrual period (eight months or 259 days). Extreme prematurity (less than 33 weeks) for 9,000 children.
A newborn whose size and weight are too low relative to gestational age, has a "delayed intrauterine growth" or IUGR It is also called "hypotrophic". Premature babies can also be hypotrophic.
Multiple causes
The causes of prematurity are many and often intricate. There are obstetrical factors (multiple gestation, placenta previa, placental abruption, growth retardation intrauterine etc.), maternal (B streptococcal infections, listeriosis, diabetes, toxemia, etc..), Fetal (chromosomal abnormalities or not etc..) and socioeconomic (multiparity, mothers under 18 or over 35 years, etc..). Since 1985, the number of multiple pregnancies has increased dramatically due to the rise of assisted reproductive techniques. Moreover, the percentage of pregnancies in women over 35 increased from 6 to 14%. Finally, premature or medically induced granted (maternal illness, progressive hypotrophy) is at least 30% of hospitalizations for neonatal prematurity.
Characteristics of prematurity
- The premature infant is one which all major functions are immature.
- The respiratory system is immature: breathing is irregular and premature interspersed with "breaks" that require intensive monitoring.
- The lung immaturity is reflected in the absence of an essential substance in the lung surfactant. The instillation of artificial surfactant has revolutionized the treatment of hyaline membrane disease as there is risk of delivery before 33 weeks, the injection of corticosteroids to the mother and transfer to a facility with maternity and neonatal resuscitation .
- The liver is immature explaining the high incidence of jaundice.
- The digestive system is immature: the premature infant must be force-fed by stomach tube or duodenal because it does not have the strength to suck, does not have the sucking reflex or the swallowing reflex.
- The immune system is immature, which explains the frequency and severity of infections in preterm infants. The latter must therefore be isolated and handled with great care aseptic
- Thermoregulation is immature: the premature is very sensitive to cold and heat. It should therefore be placed at birth in an incubator (incubator) with a temperature of about 34 ° to 35 ° C., is set several times a day. The atmosphere of the incubator should be moist with a humidity of 80%. Children are out of incubator to 2 kg. The early returns to his parents' home to 2,300 g if its feeding behavior allows.
Disease of prematurity
During the first days of life: three major hazards threatening the prematurity: respiratory distress (hyaline membrane disease), intracranial hemorrhage and infection.
After the first week of life is the period "breeding" is going smoothly in general. The premature remains a victim of choice for the infection that doctors are trying to prevent by draconian aseptic precautions: isolation of prematurity in boxes, masks and the cap, using a special gown to each boxing , frequent hand washing before and after handling each infant, aseptic care, levies and feedings ...
What future?
Through better monitoring of pregnancy and modern techniques, mortality has dropped dramatically but remains a function of birth weight:
- Growth in height and weight of prematurity following manner different from that of the term infant. It is more rapid during the first year that birth weight was low. Head circumference reflects brain growth and should be carefully monitored.
- When comparing a psychomotor premature to those of a term infant, the pediatrician considers "corrected age" and not the actual age. When a premature baby is born after 7 months of pregnancy, we can say that it has 2 months in advance. When it is 10 months old civilly, he will in fact only 8 months corrected age. It is therefore necessary to compare the performance of an infant born at term 8 months and not those of an infant of 10 months.
- Relationships between parents, caregivers and child in a specialized are arranged so that parents can enter the unit and be kept informed of developments. Parents are invited (but not required of course) to return the units to participate in the care of the baby, talking to him, to caress, etc.. Breastfeeding is encouraged. The hospital stay is as short as possible. The role of hospital staff is to demystify and explain to parents the role of instruments and pipes often frightening