Table dementieva and short assessment of physical development. Newborn baby. Signs of prematurity and prematurity. Determining the degree of maturity. To the clinical symptoms of overmaturity

The child is growing every day. In order to assess his physical growth, to understand whether he is developing correctly, there are centile tables. Pediatricians, observing the baby, regularly evaluate its weight and size, advise parents what to do if the child's parameters differ significantly in one direction or another from the average. Proper physical development is important for the subsequent life of a small person.

What are centiles and centile tables in pediatrics

The principle of these tables is that centiles divide the values ​​into 100 intervals, most often used: 3, 10, 25, 50, 75, 90 and 97th. Centiles are data on values ​​(height, weight, head and chest circumference) that a certain number of examined children have. They are used in order to quickly assess how the child is developing, whether his data correspond to the norm (the average value characteristic of most children at a particular age). The norm is the number of signs characteristic of half of healthy boys and girls, that is, an interval from 25 to 75 centiles. The standard is considered to be physical development, defined as the 50th centile.

How to use, knowing the height and weight of the child

Using tables is simple and convenient. You need to weigh and measure the baby, find his age and see which corridor his data fell into. The centile corridor is the interval on the centile scale that corresponds to your child's performance. For convenience, the centile corridors are marked with numbers from 1 to 8, and the columns indicating the norm are highlighted in color. The indicators on the left (1–3) and on the right (6–8) are rated as below and above the average. Corridors 2 and 7 are areas of focus that may require further consultation. Corridors 1 (very low) and 8 (very high) - there is a possibility of developmental pathology. Under the corridor numbers, the quantitative boundaries of the trait are indicated for a certain proportion (percentage, centile) of children of a given age and gender.

Example: boy, age 3 months. Determine the level of his physical development from the tables:

• body length - 60 cm, average (corridor 5);
• weight - 5600 g, average (corridor 4);
• chest circumference - 39 cm, average (corridor 5);
• head circumference - 40 cm, average (corridor 4).

The meaning of centiles and compliance with the norms - table

standard deviation

The standard deviation "σ" (usually denoted by the Greek letter sigma) allows you to estimate how much the values ​​from the set can differ from the average value. Estimation of body length/height using "σ" is made by calculating standard deviations from 50% of the values ​​of growth indicators for this age group.

Indicator score:

• within ± 1 σ - average growth;
• from ± 1 σ to ± 2 σ - growth below/above average;
• from ± 2 σ to ± 3 σ - low/high growth;
• going beyond +/- Зσ - growth is very high (gigantism) / very low (dwarfism).

Failure of the child's indicators to return to normal

Very low and highest rates are sometimes found in healthy children. They may be related to weight at birth, parameters of mom and dad, or metabolism.

Centile tables are never diagnosed. Failure to meet the norm of any of the indicators does not mean anything. To assess the physical size of the child, you need to determine the corridor into which his data falls. If they remain within the boundaries of one corridor or differ by one or two, then the child develops proportionally. When the difference in indicators is more than two corridors, this indicates an inharmonious formation. If the pediatrician reveals this difference, there is no need to be afraid, in such cases the baby may be sent for an additional examination or consultation to find out the cause. It is possible that the baby is healthy, he just has such features or hereditary signs.

Breastfed babies often develop unevenly. In one month there may be a lack of weight, and the next vice versa. Parents need to record their child's performance and compare them so as not to worry once again. At the age of one year, children need to be shown to the pediatrician monthly in order to monitor the health of the child and understand whether he is growing properly.

There are different charts for boys and girls, as boys tend to grow, gain weight and develop faster. For children, height is key. Everything else is considered in conjunction with it, that is, with an increase in body length, other indicators (weight, head and chest girths) increase.

WHO centric tables for assessing the physical development of girls - photo gallery

Height and weight of girls Chest and head circumference of girls Proportionality of height and weight of girls

It is generally recognized that physical development is an informative indicator of the level of health of the population.
There is a direct correlation between morbidity and mortality in children and their body weight. The smaller the body weight of the child, the more susceptible he is to infectious diseases, more often he suffers from anemia and disorders of mental and motor development. A significant excess of physical development indicators relative to the norm also adversely affects the child's body and may be a manifestation of severe endocrine, genetic disorders; these children are also more likely to get sick. In most cases, a deviation from the normal rate of increase in body length and weight is the first sign of disease. It is necessary to analyze this 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.
Until now, there is no single approach to assessing physical development. In recent years, normative tables and graphic curves have been increasingly used, which make it possible 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 chest circumference parameter is of secondary importance. It is advisable to measure the chest circumference only in a special group of children with an excessive increase in head circumference, compare them with each other and evaluate them in dynamics.
The term "physical development" refers to the process of increasing the length of the body, weight, the development of individual parts of the body and the biological maturation of the child in different periods of time.
Currently, to assess physical development, it is recommended to use the centile method. It is easy to use, as it eliminates the need for calculations. Centile tables (graphs) allow you to compare individual anthropometric indicators with standard tabular (graphic) indicators obtained during mass surveys (100 people of each age). The data of the 3rd, 10th, 25th, 50th, 75th, 90th, 97th subject are entered into tables in which body weight indicators (or body length, or head circumference, or chest circumference) are plotted vertically, and the age of the child horizontally. In table. and in fig. keep the specified order - it is called a percentage, or percentile, or just a centile (indicated by the symbol P: P25, P75, etc.).

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

Thus, if the anthropometric indicator of a 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, then it is below and above the average norm, but still within normal fluctuations . The values ​​of anthropometric indicators below P10 and above P90 should be considered as low and high.
The curve of physical development during the normal development of the child should be quite smooth and evenly rising, so any change (especially a sharp slowdown) is most likely due to some kind of trouble. It can be a physical illness, malnutrition or psychosocial problems. However, a child may also have a fairly 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 age-appropriate (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. Premature babies are assessed on different growth charts according to their gestational age and cannot be done on full term charts.
Assessment of physical development can be static and monitoring.
Static evaluation. Data of anthropometric measurements are recorded at a specific point in time. For example, during a visit of a mother with a child to a health worker, you can measure the weight and length of the body, the circumference of the child's head, determine the centile values ​​and their correspondence with each other. This will allow you to approximately judge the norm or deviations from the norm in the physical development of this child at the current time. This rating 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 is a more important characteristic of development than static indicators. The assessment of anthropometric indicators as a result of monitoring has an absolute diagnostic value in determining the norm or pathology of the child's physical development.
For example, with a static assessment, all indicators may correspond to the norm. However, during monitoring, a constant decrease in the values ​​of indicators can be detected, the centile curve may have a negative trend (decrease), which indicates a possible trouble 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. Scales are installed on a fixed surface and are connected to the network. To check the scales, press with a hand, with a slight effort, in the center of the tray - the indicator will show the readings corresponding to the effort of the hand; release the tray - zeros will appear on the indicator. Next, the nurse should wash and dry her hands, put the diaper on the scale tray - her weight will be displayed on the indicator. Reset the weight of the diaper to the memory of the scale by pressing the "T" button - zeros will appear on the indicator. After that, start weighing the child: undress him, put him 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 scales (the scales are automatically set to zero).
If weighing is performed on a mechanical scale, then in preparation for the weighing procedure of the child, the balance adjustment is checked (when the shutter is closed, the weights are set to zero; the shutter is opened and the balance is balanced by rotating the counterweight). When weighing a child, the scales are balanced by the movement of weights that determine kilograms and grams of weight.
Height is measured in centimeters, from the top of the head to the heels, in the position of the child on his back with legs straightened as far as possible in the knee joints and feet bent at right angles on a height meter or on a changing table with a centimeter tape.
The horizontal height meter is installed on a flat, stable surface with the scale “towards you”. Nurse washes and dries his hands, spreads a diaper on the stadiometer, puts the child on it with his head to the fixed bar. The baby's legs are straightened by lightly pressing on the knees, and the movable bar of the stadiometer is moved to the feet.
When determining the circumference of the head, the centimeter tape passes through the superciliary arches and the occipital protuberance, the circumference of the chest - under the lower angles 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 the time of birth includes:
- determination of body weight, body length, head and chest circumference, body proportions and their comparison with indicators corresponding / due to the gestational age (GA) of the child;
- the maturity of the newborn is assessed by a combination of clinical and functional indicators. An assessment of morphofunctional maturity can only be made during the first 7 days of life, according to special tables of maturity; includes an assessment of the condition of the skin, the development of hairline, mammary glands and genital organs, the shape auricles, body position and posture of the child.
The gestational age (GA) of a baby is the gestational age at which it was born.
Currently, a child born at a gestational age of at least 28 weeks is considered a live birth, according to this, BW is determined starting from the 28th week of pregnancy. With the transition of Russia to the registration of live births from the 22nd week of pregnancy, GW will be calculated from this gestational age. Thus, with a premature pregnancy, the GV will be equal to 22-37 weeks.
When assessing the physical development of a child at birth, centile graphs show the indicators of body weight, body length, head or chest circumference of the child, and horizontally - his GV.
Along with individual parameters of physical development, the proportionality of the child's physique is assessed, i.e. ratio of individual parts of the body. Features of the external proportions of the child at birth are:
- a relatively large head with a predominance of the brain over the facial;
- short neck;
- shortened chest, narrowed in the upper half and expanded in the lower half;
- long protruding belly;
- Relatively short lower limbs.
The smaller the GV of the child, the more obvious these features of the physique.
Based on a differentiated assessment of the state of physical development of newborns, the following clinical forms of growth and development disorders are distinguished:
- children with 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 weighing more than 4000 g.
Congenital (intrauterine) malnutrition is an acute or chronic malnutrition of the fetus, accompanied by a lag in physical development, a violation of the functional state of the central nervous system, metabolic disorders and reduced immunological reactivity. Intrauterine malnutrition may be an independent pathology and may accompany various diseases fetus and newborn. Children with intrauterine malnutrition can be premature, full-term and post-term.
Children with IUGR (small for gestational age) are children who do not correspond in physical development to gestational age.
Initial weight loss is a phenomenon that occurs in all newborns immediately after birth. This is due to the displacement of fluid from the respiratory tract during the formation of a pulmonary type of breathing, evaporation amniotic fluid from the skin, the loss of the "original stool" - meconium. Normally, a child can painlessly lose no more than 10% of body weight. Better - about 5%. In order for the child to lose as little weight as possible, it is necessary that
from the first minutes of his life he was near his mother and, at the first request, he was applied to the breast. It may seem to the mother that she does not have milk, but even a few drops of colostrum are important for the child to obtain the necessary energy and form the correct metabolism. If the child loses more than 10% of the original body weight, it is necessary to look for the cause - illness, improper or malnutrition. However, in any case, therapeutic measures are required.
The assessment should be carried out at the maternity hospital and at the first visit of the newborn by a health worker at home.

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

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

Table Body weight

The violations of the physical development of the child in the first month of life include postnatal (acquired) malnutrition - a lack of body weight relative to body length and postnatal paratrophy - excess weight over body length.
Postnatal malnutrition may be:
- primary - as a rule, alimentary malnutrition caused by a lack of milk in the mother or irrational artificial feeding infant, as well as states of milk intolerance due to fermentopathy;
- secondary - develops as a result of acute and chronic diseases of the child, congenital malformations (pyloric stenosis, intestinal stenosis), immunodeficiency diseases, severe pathology of the central nervous system.
Important clinical signs of malnutrition are symptoms of undernutrition.:
- thinning of the subcutaneous fat layer;
- reduction in the thickness of the skin fold, the circumference of the thigh and shoulder;
- decrease in 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 bony protrusions. Symptoms of malnutrition cause distinct
disproportions in the physique in newborns: children look thin, long, with a relatively large head.
A characteristic of children with intrauterine malnutrition is a decrease in nonspecific protective factors, which leads to a high incidence of infectious and inflammatory diseases in them.
With insufficient weight gain in the first month of life, in the absence of threatening symptoms in the form of constant, increasing in frequency and volume of regurgitation and vomiting, it is necessary to conduct a consultation on feeding, check whether the mother is putting the baby to the breast correctly and the effectiveness of sucking.

Evaluation of the circumference and shape of the head

The measurement of 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 evaluated according to centile tables.
The circumference of the head in a newborn exceeds the circumference of the chest by 1-2 cm. An increase in the difference, especially persistent, makes one suspect the development of hydrocephalus. 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 circumference of the head less than a circle chest, it is necessary to exclude microcephaly.
The head can be of different shapes, which is not a pathology, but only a feature of the child.

Counseling in violation of physical development

Insufficient weight gain or decrease in body weight relative to age may indicate an acute infectious, surgical pathology (pyloric stenosis). In the absence of these diseases, the mother should be counseled 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 nutrient restriction, a decrease in the frequency and duration breastfeeding etc.
Children with constitutional paratrophy require:
- control of hemoglobin levels and prevention of anemia;
- control of calcium levels and prevention of vitamin D-dependent rickets.

Nursing care of a newborn in outpatient conditions. Ed. DI. Zelinskaya. 2010

UDC 616-053.32

Ivanova I.E., 2014

Received on February 12, 2014

I.E. IVANOV

Physical development of premature CHILDREN

(Lecture)

Institute for Postgraduate Medical Education, Cheboksary

The main regularities of the physical development of premature babies born on different terms gestation, shows the dynamics of increase in height, body weight, head and chest circumferences, as well as the forecast of "catching up" growth up to 17 years of age.

Keywords: physical development, prematurity, catch-up growth

Prematurely born children account for 3-16% of all newborns. According to the State Statistics Committee of the Russian Federation (2009), the frequency of birth of children with low body weight in Russia is 4.0-7.3% in relation to the number of all births. According to the data of the Population Health Monitoring Department, in 2008-2010. the frequency of birth of children with extremely low birth weight (ELBW) in Moscow was 0.1-0.3%, with very low birth weight (VLBW) - 0.8-0.9%. In the USA (2006), low birth weight was noted in 8.3% of newborns, VLBW - in 1.48% of newborns. In European countries (2008) from 1.1 to 1.6% of children are born very preterm (<33 недель гестации).

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

Back in the 60s. of the last century, it was believed that premature babies with a birth weight of less than 1500 g are not viable. Since 2012, in Russia, in accordance with the WHO criteria, the registration standards for infants born at a gestational age of 22 weeks or more and weighing 500 g or more have changed, and conditions for their care have been created in the country's leading perinatal centers. Thanks to the development of intensive care technologies and the optimization of perinatal care, the survival rates of children with VLBW and ELBW have improved in recent years (Table 1), which made the problem of further nursing of these children relevant not only for neonatologists, but also for the primary pediatric link - 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 taken into account that very premature babies do not adapt well to extrauterine conditions of existence, almost half of them have damage to the central nervous system (CNS) in the form of intraventricular hemorrhages of varying severity, ischemic foci, 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, neurological pathology is so serious already in the neonatal period 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 for almost the entire first year of life they may have changes in the bronchopulmonary system, the consequences of perinatal damage to the central nervous system, hemodynamic instability with the functioning of fetal communications, problems with vision and hearing, a tendency to to viral and bacterial infections, a high incidence of rickets, anemia, dysfunction of the gastrointestinal tract, fermentopathy. Thus, very preterm infants have a number of specific problems associated, on the one hand, with immaturity and underlying pathology, and, on the other hand, with the consequences of ongoing intensive care (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 (PD) of a premature baby cannot be assessed according to the criteria of their full-term peers, since this will always lead to an underestimation of its parameters and an artificial aggravation of the child's condition. In world and domestic pediatrics, sufficient experience has already been accumulated in assessing the growth and development of children born prematurely, 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. The RF of children is of great social and medical importance. Experts from the World Health Organization define risk factors as one of the fundamental criteria in a comprehensive assessment of a child's health status. In addition, the harmonious PR of the child is a measure of the child's capacity and endurance. Numerous modern studies show that the long-term cognitive development of a child is directly dependent on growth rates in the early neonatal period and after discharge from the perinatal center. FR parameters are of different clinical and diagnostic value. Body length characterizes the growth processes of the child's body, weight indicates the development of the musculoskeletal system, subcutaneous fat, and internal organs. The increase in head circumference in the first months of life, reflecting the active growth of the brain, has an important prognostic value for the further mental development of preschool and adolescence. If the child does not grow skeletal, does not add mass according to the genetic development program laid down, then during this period there is no increase in the mass of the brain, like any other organ. A developmental delay may turn out to be unrehabilitated in terms of intelligence in the future.

When assessing RF in preterm infants, such concepts as gestational, postnatal, postconception, and corrected age should be taken into account. Gestational age is usually understood as the number of complete weeks that have elapsed between the first day of the last menstruation and the date of birth. Postnatal age is the actual (calendar) age, i.e. the number of months since the birth of the child. Postconceptional (postmenstrual) age is calculated as the sum of the gestational age and the postnatal age of the child. To calculate the corrected age, it is necessary to subtract from the calendar age those weeks for which ahead of schedule was born prematurely. The risk factors for preterm infants should only be assessed by corrected age. This is especially important for children born before 32-33 weeks of gestation and weighing less than 1500 g. For children born at 32-33 weeks or later, gestational age correction may be completed at the age of 1 year. Corrected age in preterm 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 display of the dynamics of anthropometric indicators depending on the gestational age. Growth curves usually contain 3 measurements: mass, height and head circumference. Weight measurement, according to experts from the World Health Organization, is an accurate measurement, since electronic scales are used for this. Head circumference can also be measured with a high degree of accuracy. A child's height, according to experts, may be measured less accurately due to positioning issues.

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

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

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

Fenton's curves include the 3rd, 10th, 50th, 90th, and 97th percentiles of weight, height, and head circumference, which are plotted on a grid. In the zone from the 10th to the 90th percentile, there are average indicators of RF, characteristic of 80% of premature babies. In the zones from the 10th to the 3rd and from the 90th to the 97th percentile there are values ​​indicating a level of development below or above the average, characteristic of only 7% of apparently healthy preterm infants. Values ​​below the 3rd and above the 97th percentile are areas of very low and very high rates that occur in healthy preterm infants no more than 3% of cases. The Fenton Growth Plot is on a large scale for high accuracy. The step of the child's weight is 100 g, the step of growth and head circumference is 1 cm. The time interval is 1 week. The graph allows you to compare the growth of a premature baby with the growth of the fetus, starting at 22 weeks of gestation and up to 10 weeks of postnatal age. The chart is deliberately extended to 50 weeks, since most premature babies are discharged home at this age. A space is made at the bottom of the diagram for marking measurement data.

After stabilization of the condition and discharge from the hospital, premature infants show an acceleration of growth, the so-called catch-up growth (catch-upgrowth), which requires appropriate nutritional support at the outpatient stage of nursing. Children who "catch up" with their centile corridor by 6-9 months of corrected age have a better prognosis for neuropsychic development than those who have not reached the proper weight and height indicators. A significantly better neurological prognosis is observed in children who “catch up” with the corresponding normative indicators of RF by 2–3 months of corrected age. The most beneficial for further development is a growth spurt in the first 2 months of corrected age.

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

The RF of premature babies is characterized by higher rates of weight gain and body length in the first year of life (except for the first month). By 2-3 months, they double the initial body weight, by 3-5 - triple, by the year - increase by 4-7 times. At the same time, extremely immature children are significantly behind in terms of absolute indicators of height and body weight (“miniature” children) - the 1st-3rd corridor of centile tables. In subsequent years of life, very preterm infants may retain a kind of harmonic delay in RF.

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

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

body weight at birth> 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 severe illness and a decrease in edema, a pathological loss of body weight (more than 15%) is noted, which develops faster than the initial loss of body weight. Restoration of body weight in preterm infants (average 15 g/kg/day) depends on the degree of prematurity and occurs faster, the lower the body weight at birth. The initial body weight is restored by the 2-3rd week of life. Children with higher birth weight and longer gestational age also have higher weight gain. A flat weight curve is often observed in preterm patients, as well as in children with VLBW at birth and low gestational age (later, CNS damage is detected in some of them). Children with a body weight of up to 1000-1200 g and a gestational age of up to 28 weeks restore their original weight by 1 month.

Normal weight gain for the 1st month of life in children of I degree of prematurity will fluctuate within 300-450 g, II degree - 450-675 g, III - 600-900 g. th month of life. In the future, when assessing the state of the risk factor of premature babies, one can roughly focus on the average monthly weight gain of a full-term baby, which is 800 g at the 3rd month of life, 750 g at the 4th month, 700 g at the 5th month, etc. . (Table 2).

The growth rate in children with birth weight > 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. During the first year of life, body length increases by 26.6-38 cm. Very premature babies grow faster. Average length the body of a premature baby reaches 70.2-77.5 cm by the age of 1 year.

table 2

Physical development of premature babies in the first year of life

The daily increase in head circumference in premature babies in the first 3 months is 0.07-0.13 cm (measurement is carried out every 5 days). On average, the 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 head and chest circumference indicators in healthy preterm infants occurs between the 3rd and 5th months after birth ( Tables 3, 4).

Table 3

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

Table 4

Head circumference growth in preterm infants with birth weight

less than 1500 g

The rate of increase in chest circumference in premature babies is approximately 1.5-2 cm per month.

The eruption of the first teeth in premature babies begins:

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

The study of the level of risk factors in prematurely born children in the remote periods of life is extremely important and relevant due to the fact that this is one of the most important indicators of a child's health. Some children (especially those born prematurely with IUGR) may experience manifestations of growth heterochrony deviations from a given program, when some parts of the body or organs grow faster than others or, on the contrary, are characterized by slow growth, while the consistency and synchronism of the growth of different structures are disturbed. Studies in Russia have confirmed this fact, showing that almost one in three premature baby with IUGR (27.0%) had a low growth in the future. When assessing the FR of very preterm infants, it was found that only 24.0-44.7% of those examined had normal by the year.

As a rule, children with ELMT do not grow well in early childhood, and often this problem persists into the future. By the age of 5, 30% of children born before the 30th week of gestation may have a weight deficit, and 50% of growth - 50%. By the age of 8-9, about 20% are still lagging behind in growth. The periods of "stretching" in this group of children begin 1-2 years later. In children born weighing less than 800 g, by the age of 3, body length and head circumference are 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.

At the same time, 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 with normal growth heads in the first two years of life, children with a slow increase in head circumference had a significantly lower mental development index).

However, it must be emphasized that, taking into account even the most pessimistic forecasts of some studies, with a favorable medical and social environment for the child FR indicators in premature babies by the age of 17 almost always reach the norm. With age, prematurely born children show a decrease in the dependence of physical parameters on the impact of biological factors.

Until the end of age correction, when formulating a conclusion about the 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, circumference head and chest).

Growth disorder (short stature) and its correction in premature infants with IUGR

In the majority of children born with IUGR, in the first 6-24 months of life, there is a period of rapid growth and an increase in height and weight indicators. In the literature, this phenomenon is called "postnatal growth spurt", or "catch-up growth rates". The growth spurt allows children to return to their genetic trajectory after a period of intrauterine growth retardation. Nevertheless, approximately 10-15% (6 thousand in Russia annually) of children with IUGR maintain low growth rates in the postnatal period. As a result of inadequate rates of postnatal growth, these children are already stunted by the age of 2 years. Growth deficit is observed throughout childhood and adolescence which ultimately leads to short stature in adults. The more IUGR a child had, the more chances he had to remain a short adult. In the absence of spontaneous growth acceleration, children remain short, making up 14-22% of adults whose height is less than 150 cm in women and less than 160 cm in men. Underweight babies are 5 to 7 times more likely to become short adults than babies with normal birth sizes. This significantly affects their social status.

Determining the level of hormones in newborns or children with IUGR in everyday clinical practice is not shown, since neither the concentration of somatotropic hormone (STH), nor the values ​​of IGF-I or IGF-binding protein-3 in the circulating blood in children of the first year of life are predictors of subsequent growth. Current recommendations boil 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 every 6 months thereafter. In those children who do not show significant and significant catch-up during the first 6 months of life, or who remain stunted (less than -2SD for age) by 2 years of age, the causes of growth limitation should be identified and appropriate treatment instituted.

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

Currently, recommendations have been developed for the treatment of rGH in this category of children. rGH therapy can be administered to short children with a history of IUGR at the age of 2-6 years, with growth below -2.5 SD. During the first years of rGH therapy, most children experience a rapid catch-up increase in growth and its normalization (growth rates reach a genetically determined curve). In the future, against the background of treatment, the normal growth rate is maintained until the final growth is reached. The maintenance phase of rGH therapy is less dose dependent. During the first years of rGH therapy, most children experience a rapid catch-up increase in growth and its normalization (growth rates reach a genetically determined curve). In the future, against the background of treatment, the normal growth rate is maintained until the final growth is reached. The maintenance phase of rGH therapy is less dose dependent.

A positive response to rGH treatment is considered to be a change in height SDS 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, and dose of rGH. In the majority of short children with IUGR who received rGH in childhood, pubertal development began in a timely manner and proceeded normally.

BIBLIOGRAPHY

1. Alyamovskaya G.A. Features of the physical development of very premature children in the first year of life / G.A. Alyamovskaya, E.S. Keshishyan, E.S. Sakharova // Bulletin of modern clinical medicine. - 2013. - V. 6, issue 6. - S. 6-14.
2. Vinogradova I.V. Modern technologies for the treatment of premature newborns / I.V. Vinogradova // Basic 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. Zolnikov. - Cheboksary, 2011. - 100 p.
4. Children's diseases: textbook / ed. N.N. Volodina, Yu.G. Mukhina. - M.: Dynasty, 2011.- Vol.1. Neonatology. - 512 p.
5. Observation of very premature children in the first year of life / T.G. Demyanova [i dr.]. - M.: Medpraktika, 2006. - 148 p.
6. Monitoring of premature babies in a children's clinic: textbook / ed. I.E. Ivanova. - Cheboksary: ​​AU Chuvashia "IUV", 2014. - 650 p.
7. Neonatology: national guide / ed. N.I. Volodin. - M.: GEOTAR-Media, 2013. - 886 p.
8. Rendering Features medical care children born at 22-27 weeks gestation / D.O. Ivanov [i dr.]. - St. Petersburg: Inform-Navigator, 2013. - 132 p.
9. Principles of staged nursing of premature babies / Union of Pediatricians of Russia, FGBU “Nauch. children's health center" RAMS; ed. L.S. Namazova-Baranova. - M.: Pediatr, 2013. - 240 p.
10. Timoshenko V.N. Premature newborns: textbook. allowance / V.N. Timoshenko. - Rostov n / a.: Phoenix; Krasnoyarsk: Publishing projects, 2007. - 192 p.
11. Physiology of growth and development of children and adolescents (theoretical and clinical issues) / ed. A.A. Baranova, L.A. Scheplyagina. - M., 2000. - 584 p.
12. Shabalov N.P. Neonatology: textbook. allowance: in 2 vols. T.1 / N.P. Shabalov. - 4th ed., Rev. and additional - 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.

Centile tables for boys

Central tables of physical development of children

When you bring your son to see the pediatrician, who will weigh him and measure his height, chest and head circumference, you hear an assessment of these indicators: a four, or another number from one to eight. What are these points? This centile corridor, which contains the indicators of your boy according to the table. Centile tables are given below.

physical development of the child

An example of assessing the physical development of a newborn boy

Height-length - 50 cm, corresponds to the "average" indicators. Weight - 3800 g, corresponds to the assessment of "above average". Chest circumference - 37 cm, corresponds to the assessment of "wide". Head circumference - 36 cm, corresponds to the "average" values. Correspondence of weight to the length of the child's body - a moderate excess of weight relative to length, "above average".

When you bring your baby to an appointment with a pediatrician who will weigh her and measure her height, chest and head circumference, you hear an assessment of these indicators: a four, or another number from one to eight. What are these points? This centile corridor, which contains the indicators of your girl according to the table.

From the tables, you can find out if your child's height and weight are normal at a given age (from birth to 17 years). Centile tables are given below.

Dental tables for assessing the physical development of a child represent a kind of “mathematical photograph” of the distribution of a large number of children according to increasing indicators of height, weight, chest and head circumference. The practical use of these tables is extremely simple and convenient, combined with a good logical understanding of the evaluation results.

The columns of the centile tables show the quantitative boundaries of the trait in a certain proportion (percentage, centile) of children of a given age and gender. At the same time, the values ​​typical for half of healthy children of a given sex and age are taken as average or strictly normal values, which corresponds to an interval of 25-50-75%. In our tables, this interval is shaded. Intervals that are close to the average are rated as below and above the average (respectively 10-25% and 75-90%). These indicators parents can also be regarded as normal. If the indicator falls into the zone of 3-10 or 90-97%, you should be alert and point this out to the doctor. This is an area of ​​attention that requires additional consultations and examination. If the child’s indicator goes beyond 3 or 97%, it is very likely that the child has some kind of pathology that affects the indicators of his physical development.
distribution of children by head circumference

You can understand what a dental scale, for example, growth, is in the following example. Imagine 100 children of the same age and gender, lined up in order from smallest to tallest. The growth of the first three children is assessed as very low, from 3rd to 10th - low, 10-25th - below average, 25-75th - average, 75-90th - above average, 90-97 - tall and the last three guys are very tall.

The indicator of height, weight, etc. of a particular child can be placed in its own “corridor” of the centile scale of the corresponding table. Depending on which "corridors" the child's anthropometric data fell into, a value judgment is formulated and an appropriate tactical medical decision is made.

According to the same principle, the correspondence of body weight to the length-height of the child is assessed, while the distribution is built using the weight indicators of children with the same height.

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Few parents are prepared to have their child prematurely. Most often, the birth of a premature baby becomes a difficult test for the whole family. This is because everyone is waiting for the birth of a plump, rosy-cheeked toddler, expecting to return from the maternity hospital in a maximum of 5 days, and in general, as a rule, they make optimistic plans for the future. Great amount information for future and young parents, including the Internet, television, printed publications, is dedicated to a normal pregnancy, childbirth without complications and caring for a healthy newborn. When something starts to go wrong, parents find themselves in an information vacuum, which sometimes exacerbates an already difficult situation.

For the first time in Russia, a resource has been created that is completely devoted to the problem premature birth and prematurity. This resource was created by parents for parents who are expecting or have already given birth to a child prematurely. From our own experience, we have experienced a lack of information during the period of maintaining a pregnancy, nursing a baby in a maternity hospital and a perinatal center. We felt an acute shortage of funds for specialized care, which is so necessary for the full physical and mental maturation of the child outside the womb. Behind him is more than one month spent at the incubator, then at the crib in endless expectation, fear and hopes for recovery. As the baby grew, everything was required more information about the care, development, education of a child born prematurely, which would be adapted to our situation and which is very difficult to find. Such experience gives us reason to believe that the information posted on our website will help young mothers and fathers be more prepared for the birth of their dearest baby, which means it is easier and more peaceful to survive this difficult period in life. Knowledge and experience will make you more confident and help you focus on the most important thing - the health and development of your baby.

As materials for creating the site, we used medical and pedagogical literature, reference books, practical guides, opinions of specialists in the field of obstetrics, gynecology and neonatology, child psychology and pedagogy, materials from foreign resources, as well as the invaluable experience of parents whom we met and became close friends thanks to our children.

We draw your attention to the fact that the materials presented here are not a “recipe” for you and your child, but are only intended to help you deal with the situation, dispel some doubts and orient yourself in your actions. Mention of any medicines, equipment, trademarks, institutions, etc. is not an advertisement and cannot be used without the consent of experts.

We hope that we will be useful to you from the moment your baby is born and we will grow with you. If you have any questions, wishes or suggestions, This e-mail address is being protected from spambots. You need JavaScript enabled to view it !

Sincerely yours,