How premature babies grow: development by month. Premature baby - definition, maturation, nursing conditions

There is still an opinion that premature babies will never become like everyone else and will be limited in physical and mental abilities. Because of such stereotypes, many babies born prematurely end up abandoned at birth. maternity hospital. Let's try to figure out how things really are.

Which babies are considered premature?

Nature has laid down the period intrauterine development the unborn baby, and it lasts 40 weeks. During this period, all internal organs and systems of the fetus develop in order to safely meet the outside world and function fully. Premature newborn the child is born from 22 to 37 weeks with a body weight of less than 2.5 kg and a body length of up to 45 cm. At the same time, WHO establishes the following criteria for fetal viability: gestational age 22 weeks, weight more than 0.5 kg, body length from 25 cm , at least one recorded breath.

Why can a baby be born prematurely?

If a child was born premature, it is not always possible to find out the reasons for this. According to research, there are a number of possible provoking factors, including:

• old or too young age of mother, father;
• mother's unhealthy lifestyle;
• influence of occupational hazards;
• previous abortions;
• conception after recent childbirth (less than 2 years);
• chronic pathologies in the mother;
• past infections;
• physical injuries;
• intrauterine abnormalities in the fetus.

Features of premature babies

There is no clear “bar” that determines at what age a baby can survive, and there is a lot of debate around the topic of the need for proper medical care for premature babies. In our country on this moment The life of such babies, born with a weight of 500 g or more, is protected by a law that provides for their mandatory registration and nursing.

Low birth weight premature babies are born without being prepared for the conditions of extrauterine existence. Their vital organs are not yet fully mature and are not ready to function independently. Such crumbs have many external features, distinguishing them from infants born at term:

• impressively short height and weight;
• severe disproportion of body parts;
• softness of the cranial bones;
• underdeveloped genitals;
• the presence of a fluff on the back and shoulders;
• dry and thin skin;
• lack of subcutaneous fat;
• tightly closed eyes;
• reduced physical activity etc.

The listed signs may be present partially or in combination in different premature babies. In addition, premature babies are characterized by undeveloped reflexivity, immaturity vascular system, lack of hunger. They have problems with straightening their lungs and producing digestive enzymes. It should be remembered that over time, if efforts are made, the baby will look like an ordinary newborn, and all organs will improve their functioning.

Premature baby weight

Depending on the weight of the premature baby at birth, several degrees of prematurity are distinguished:

• I – from 2001 to 2500 g (mild);
• II – from 1501 to 2000 g (moderate prematurity);
• III – from 1001 to 1500 g (severe prematurity);
• IV – less than 1000 g (extremely premature).

The degree of prematurity is associated not only with the weight indicator, but also with signs of the general maturity of the body. For example, it happens that babies are born weighing 2.5 kg, but in terms of maturity of organs and functions they are inferior to those who gained 2 kg at the time of birth. When the baby's condition stabilizes, he will begin to gain weight. On average, the increase can be 90-120 g in seven days, and by the fourth or fifth month of life, the child’s body weight triples.

Growth of a premature baby

A baby who was born prematurely often has a body length in the range of 45-35 cm. This indicator depends on the period of prematurity. In the future, one should expect the following increase in height: about 2.5-5.5 cm per month during the first half of life, about 0.5-3 cm during the second half of the year. So, after a year, body length increases by 26-38 cm per year.

Premature babies - consequences

Extremely premature infants have a high percentage of disability and complications, although there are cases where babies with critically low weight not only survived, but also did not have special problems with health. Those born weighing a kilogram or more have much more optimistic chances. When special conditions are created, such children after a few years are no different from those born at a normal time.

We list what pathologies of premature babies can be diagnosed:

• hydrocephalus;
• vegetative-vascular dystonia;
• speech defects;
• astigmatism;
• myopia;
• hearing impairment;
• mental retardation;
• increased susceptibility to infections, etc.

Development of a premature baby by month to year

It has been established that the development of premature infants under one year of age is determined not only by gestational age and body weight, but also general condition health, genetic factors. Often, in a favorable scenario, by the age of two they catch up with their peers in anthropometric, speech and psychomotor indicators, sometimes this happens by the age of 3-6.

Do not forget that a lot depends not only on the medical staff, but also on the parents of the baby. It’s worth making an effort, and the result will not be long in coming, and the baby will delight with more and more achievements. Premature babies whose development progresses according to months special schedule, in many cases they are not significantly behind the full-term ones, which can be tracked in the table with averaged data.

Caring for a premature baby

In order for a premature baby to develop normally, he needs to create special conditions, similar to those in the mother's womb. Many vital functions small organism require artificial support and the less premature babies weigh, the more equipment the medical institution needs, the more experienced the staff.

Nursing premature babies

When a premature baby is born, care is initially provided in the intensive care unit. The baby is placed in an incubator, where respiration, pulse and temperature are continuously monitored, artificial ventilation is provided, and nutrition is supplied. With moderate and mild prematurity, the baby can be placed in a heated crib. The period of postpartum adaptation is about one to two months, and in the presence of pathologies - longer.

In some medical institutions, kangaroo care is considered acceptable. This means that a child who can breathe and eat on his own is in constant physical contact with his mother - on her chest or stomach. Thanks to this, the baby quickly adapts to the new environment and develops better. After discharge from the maternity hospital, prematurely born babies should be regularly examined by doctors, especially in the first year.

Feeding premature babies

Feeding premature babies is special. In the absence of a swallowing-sucking reflex, a formula for premature babies, to which hormones, amino acids, enzymes, glucose and other components are added, is supplied through a gastric tube. In the most severe cases, parenteral intravenous nutrition is provided. When the baby learns to suck, he is fed from a bottle with a nipple, and a little later he is applied to the breast (with a weight of at least 1.8 kg).

The nutrition of premature babies from about the second week of life can be based on mother's milk, which in this case takes priority over artificial mixtures. Complementary feeding for premature babies begins no earlier than 7-8 months of age, i.e. 1-2 months later than in ordinary infants, which is explained by longer maturation digestive system.

Everything that can happen to the nervous system of a premature baby can be divided into 2 large and unequal groups. Firstly, even if nothing bad happened to the nerve cells and cerebral blood flow, all the same, the cells of the nervous system turn out to be very immature and sometimes not “capable” of carrying out the correct regulation of all organs and systems. These relationships take time to develop. So, in the first days the baby does not know how to suck independently, because the nerve impulse is not transmitted correctly to the muscles that are involved in sucking. The child is fed through a tube for a long time until the sucking reflex is formed. Very often, such children, having already learned to suck, swallow poorly. The child holds food in his mouth for a long time in a small volume and only then swallows it. Feeding takes a lot of time; usually parents adapt to feeding the baby from a pipette in small portions. In addition, such a child has to be fed liquid food for a long time, sometimes up to 2-3 years, due to the fact that the chewing muscles develop poorly. Due to the immaturity of the nervous system of the stomach and intestines, such children usually regurgitate profusely, intestinal colic sometimes continue until 5-6 months of age. Constipation often occurs because the nervous regulation of the intestines is very imperfect.

Children whom doctors were forced to feed through a tube for a long time, and who were on artificial ventilation, they usually start speaking late and pronounce sounds incorrectly, because the reflexes that regulate the tone of the muscles involved in the pronunciation of sounds take a very long time to form. Therefore, almost all very premature babies require the help of a speech therapist. Moreover speech therapy sessions are necessary even before the child begins to speak in order to normalize the tone of the tongue muscles and form the correct development of speech muscles.

Due to deep immaturity, premature babies are delayed in motor development; they begin to hold their head up, pick up a toy, and roll over late. After six months, immaturity is no longer as pronounced and the child develops faster. Often premature baby motor skills are “confused”: the child begins to first stand up, then sit down, he may learn to crawl late, he may walk on tiptoe for a long time. There are two cures for immaturity: time and your patience.

If your baby is less fortunate, then in addition to deep immaturity, the cells of the nervous system may suffer from the lack of oxygen that a premature baby experiences during severe pregnancy and childbirth. If oxygen starvation brain was not too severe and long-lasting, then the changes that occurred in the cells will be reversible and will not lead to further severe consequences. In the first months, such children may be more excitable and have sleep disturbances. Subsequently, they develop well and by the age of 1.5-2 years do not differ in level of development from their full-term peers. But if cell damage could not be avoided, this may result in “ruptures” of brain vessels and hemorrhages in the ventricles of the brain. At 1-2 months of life, the condition of such children is usually severe, and they need medical care and long-term nursing.

With mild hemorrhages, the walls of small vessels “burst,” which can lead to increased intracranial pressure. Intracranial pressure increases due to excess fluid formation in the ventricles of the brain, which puts pressure on surrounding tissues. With minor hemorrhages, the condition in most cases is quickly compensated, the outflow of fluid from the ventricles is normalized, and the hemorrhages resolve without a trace. In other words, hemorrhages of the 1st and 2nd degrees can pass without a trace for the child, however, this does not mean that he does not need to be observed and treated at 1-2 years of age.

Severe hemorrhages, when large vessels “rupture” and blood fills all the cerebral ventricles, cause much more serious consequences, leading to seizures, developmental delays, and motor disorders. Such children need constant help from a neonatologist, neurologist and other specialists, in particular monitoring of neurosensory organs (hearing and vision), since these areas of the brain can be damaged. If the baby is severely delayed in his development, you need to carefully observe whether he has seizures. The attacks are very different and sometimes do not resemble convulsions at all. The child may look away and freeze for a few seconds, stick out his tongue, or make unusual, elaborate movements with his arms and legs. You should be especially wary if the child bends or straightens too much, several times in a row. If there is any suspicion of convulsive seizures, the baby needs to consult a neurologist and conduct an electroencephalogram. If possible, make a video recording so that the neurologist can see the attacks that alert you.

In premature babies who have suffered severe oxygen deprivation, irreversible death of nerve cells directly in the brain tissue can occur. This is the most severe type of lesion, and it is called periventricular leukomalacia. With periventricular leukomalacia, cells of the white and sometimes gray matter of the brain are destroyed, and in their place are formed. This brain damage is diagnosed using ultrasound examination brain Over time, these cysts “close”, and after 6-8 months of age they are no longer visible on ultrasound. The outcome in such children can be different: from minimal motor impairment with motor clumsiness and normal development psyche, until the formation of paresis, paralysis with delayed psychomotor development.

The diagnosis of intracranial hemorrhage and periventricular leukomalacia is very serious, but is not a final verdict. No one knows what the outcome will be in this case in the first months of life. The brain cells of a premature baby continue to develop extrauterinely, the tissue is very plastic and it can partially take over the function damaged cells. Again and again we want to say: do not lose hope, treat the child, try to help him, develop him, follow the doctor’s orders. And you can get a fairly good result even in a very serious situation. Moreover, science moves forward, and new knowledge and methods of providing assistance appear every day.

Digestive problems in a premature baby

The main concern of parents of a premature baby is the problem of weight gain and, indeed, this is of paramount importance as the main indicator of the baby’s physical well-being. It should be taken into account that the rate of growth of physical indicators (body weight, length, head and chest circumference) in a premature baby will differ significantly from those of his full-term peers. At least until 6-9 months, your baby will be smaller, and mandatory weight control becomes of primary importance at this time: in the first weeks and months of life, daily (it is necessary to take into account the correctness of daily weighing of the child, which must be carried out at one and the same time). the same time, preferably before the first morning feeding or in the evening, before bathing), and then monthly. What should alarm you first of all is a drop in body weight or lack of weight gain (the baby is “standing” in weight). The reasons can be either quite serious or due to feeding errors, insufficient breast milk at the mother's. Naturally, in any case, you need to consult a pediatrician to clarify the causes and eliminate them.

The main problems with the digestive system in a premature baby, which almost all parents face, are intestinal colic. The word comes from the Greek kolikos, meaning pain in the colon. Colic is paroxysmal pain in the abdomen, accompanied by severe anxiety in the child. The attack, as a rule, begins suddenly, the child screams loudly and more or less continuously, redness of the face or pallor of the nasolabial triangle may be noted. The abdomen is swollen and tense, the legs are pulled towards the stomach (can instantly straighten), the feet are often cold to the touch, the arms are pressed to the body. The attack sometimes ends only after the child is completely exhausted. Often noticeable relief occurs after the passage of stool and gases.

Premature babies are especially prone to colic, with some infants experiencing frequent and intense attacks that can be compared in severity to labor pain, and certainly require medical intervention. Apparently, the main reason for this baby’s suffering may be the immaturity of the neuromuscular system and the intestinal enzymatic system. And because of this, the tendency to increased gas formation, resulting in increased pressure on the intestinal wall and muscle spasm.

The cause of discomfort and bloating can also be irrational feeding. Some foods, especially those high in carbohydrates, can promote excessive fermentation in the intestines. Intestinal allergies also cause the baby to cry due to a feeling of discomfort in the abdomen. But the causes of colic are not limited to these conditions. It is important to promptly diagnose diseases that require surgical intervention. Therefore, if there is no effect from the usual measures aimed at eliminating colic (special carminative herbal teas, simethicone preparations, cleansing enema, use of a gas tube, abdominal massage, dry heat on the abdominal area), the child should be carefully examined in a medical institution.

Dyspepsia (diarrhea, constipation) in a premature baby is a frequent and worrying phenomenon for parents and pediatricians. At breastfeeding The baby may have stools after each feeding along with gases (foamy) and quite liquid. In children receiving formula, stools are rarer - 3-4 times a day. The absence of stool in a baby for more than 1 day can be considered constipation. The cause of dyspepsia is the immaturity of the neuromuscular apparatus of the intestine, a violation of the formation of intestinal biocenosis, transferred bacterial infections, long-term antibacterial therapy, treatment with iron supplements, anticonvulsants (what was prescribed to your child for health reasons) can lead to disruption of the innervation of the intestine, as a result of inflammation of its mucous membrane, changes in the trophism of the colon mucosa occur.

Digestive disorders caused by increased fat content breast milk or milk substitutes; immaturity of enzymatic function. In all these cases, there are special corrective formulas - therapeutic breast milk substitutes, preventive drugs that can help your child, but it is very important to coordinate their use with your pediatrician.

Spitting syndrome can also be a concern for parents of a premature baby. The most common cause of this is immaturity and temporary (passing) smooth muscles of the stomach - the so-called “duodeno-gastric reflux”. Most often it occurs in premature babies who have been fed long time through a probe. Also, a possible cause of regurgitation may be aerophagia (when the baby greedily swallows air along with food). Masses during regurgitation look abundant due to their binding with air and usually do not change the baby’s well-being in any way. In this case, you need to be patient and wait until the baby’s stomach “ripens”, while following the recommendations for proper feeding and holding the baby upright for 10-15 minutes after feeding. Improvement occurs quite quickly with the introduction of thickener mixtures (Frisov, Nutrilon-antireflux) into the diet. It is better to give medications to the child before feeding. However, there are situations in which urgent consultation with a specialist is necessary. If there are streaks of blood in the regurgitated masses, if they are so abundant that the child does not gain weight well, if the baby’s well-being is disturbed during regurgitation - do not hesitate, consult a doctor!

Condition of the skeletal system and joints

The phenomena of morpho- functional immaturity in a premature baby they often spread to the musculoskeletal system. Imperfect neuromuscular regulation, weak ligaments, and excessive joint mobility can lead to changes in the correct position of the child’s limbs, head and spine.

Often the baby holds his head in a fixed position to one side. The reason for this may be congenital shortening of the neck muscle on one side, traumatic damage to the spine or cervical muscles when the head is removed during childbirth, or just the “habitual” position of the head, that is, the child “lay” in this position most of the time in the uterus. The correct diagnosis is always made by a doctor, and the sooner this happens, the more effective the treatment will be.

Prematurity, especially in combination with abnormal intrauterine position of the fetus, is usually accompanied by underdevelopment of the hip joints or “dysplasia”. The most severe variant of this pathology is dislocation of the hip joint. The diagnosis is made soon after the birth of the child and requires early start treatment based on leg abduction hip joint. Currently effective method in identifying abnormalities in the development of joints is ultrasound scanning, which is mandatory for all children at 1 and 3 months of life or more often if a disease is detected.

Considering that the described problems are especially common in premature babies, every baby should be examined by an orthopedist several times in the first year of life. As a rule, children receive their first consultation at 1 month of life, then at 3 and 12 months. If pathology is detected, there may be more consultations. Timely identification of abnormalities will help to quickly begin treatment and raise a healthy child.

We tried to talk in an accessible way about the most common problems of the 1st year of life of a premature baby. They all require attention, observation and timely treatment. We strongly recommend that you contact specialists who specifically deal with the health and development of such children - this will help you avoid mistakes and unnecessary worries.

We wish you and your kids happiness and health!

Skripets Petr Petrovich,
pediatric ophthalmic surgeon, candidate medical sciences

Comment on the article "A premature baby is not a death sentence for a family! Part 2"

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Discussion

Elena, hello! How did it all work out for you? I am now 38 weeks and we were given the same diagnoses..

Hang in there. You know, medicine is developing. Previously, a heart defect was a death sentence, but now it is operated on and the child leads a normal life. Our job is to hope, to believe in good things.

A premature baby is not a death sentence for a family! Part 2. If oxygen starvation of the brain was not too severe and prolonged, then the changes that occurred in the cells will be Intracranial pressure increases...

Currently the best way management of labor in infected women has not been fully determined. To make a decision, the doctor needs to know the results of a comprehensive virological study. Natural childbirth includes a whole range of measures aimed at adequate pain relief and prevention of fetal hypoxia and early rupture amniotic fluid reducing trauma to the birth canal in the mother and skin baby. Only if all preventive measures are followed does...

Discussion

I completely agree. Unfortunately, at the moment there is no consensus on the safest management of childbirth with hepatitis C. According to statistics, the likelihood of a child becoming infected with hepatitis is somewhat lower during a planned caesarean section than during a natural birth. However, none of these methods can guarantee the safety of a child from hepatitis infection. Therefore, the choice of method of obstetric care is based more on obstetric history than on knowledge of the presence of this infection.

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Name of examination Expiration date 1. Blood group, Rh factor 2. General analysis blood 14 days 3. General urine test 14 days 4. Glycosylated hemoglobin (only for patients with type I and II diabetes) 3 months 5. Biochemical analysis blood: total protein –. Urea, creatinine. K, Na–Blood sugar – Bilirubin (by fractions) 14 days 6. Blood clotting time: (Duke, or Sukharev) or coagulogram 14 days 7. HIV, RW, HbS, HCV (have your PASSPORT with you) 3 months 8. ECG 1 month 9...

Not only diarrhea can cause concern in mothers, but also fatty baby stool as a symptom of serious disorders in the body. U healthy baby feces, as a rule, have a uniform consistency, yellowish color, soft and without any admixtures of blood or other liquid. The emptying process should be painless. Constipation and diarrhea are not good, but isolated cases do not indicate any abnormalities in the baby’s body. But fatty stools can signal serious disturbances in the functioning of the pancreas...

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We went to Turkey with our children three times. Once we got sick with rotavirus. We called an ambulance for our youngest. We went on vacation in vain. Then I was taught prevention. A doctor of the highest category, an auntie came to the house for a fee. A few days before departure and on the day of departure, Arbidol and Viferon suppositories. I have a negative attitude towards immunomodulators and stimulants, but it works here. Before returning, the same is desirable. But I give up. Now the children are 8 and 13 years old with their grandmother in Bulgaria, the third week is ending. There are 2...

Discussion

Didn't he happen to be drunk when he wrote this???
1 - generally normal child. Where is he premature? For 1 week or what?
2. Since when was 3050 considered extremely low birth weight????????????????????
hydronephrosis - see a urologist. But it's not scary. In severe cases, it may not be an incredibly complicated operation, but most likely you will have to live with it.

healthy children!!

Extremely low birth weight - less than 1000 g, which means the second one was a little larger. And in 3-4 weeks before 3300 it is impossible to gain weight.
Typical diagnoses, hydronephrosis (unilateral? bilateral?) need to be looked at in dynamics, determine the cause, maybe. Both conservative treatment and surgical treatment are required; the prognosis is also determined by a combination of factors.

The other day, a post was published on the pages of livejournal magazine: “Is supernanny bad?” In her search for a nanny, Nastya found exactly the one that seemed to make any mother happy. ‘’ The nanny helped overcome all the problems that frighten young mothers so much - how to potty train, wean from a pacifier, teach to fall asleep on their own. And it was clear from the child that the nanny was a treasure. But there was a climax in the nanny-family relationship, and the child demanded the presence of a nanny. The question arises: to be good...

Nastya was born at 33-34 weeks. Prematurity, triple entanglement of the umbilical cord and difficult labor (induction, pressure on the abdomen, anhydrous period about 14 hours) led to serious consequences: 2 weeks in intensive care (of which 10 days on mechanical ventilation), a month in the neonatal pathology department and, as a result, at one and a half months, the child and mother finally went home with diagnoses: subacute intracerebral hematoma of the left parietal region and a subdural hematoma in the posteromedial surface of the left hemisphere...

A premature baby is not a death sentence for a family! Part 2. Answer who is raising very premature babies born weighing less than 600 grams.

Discussion

Absolutely, the interval may be different - my twins were fed after 2.5 hours. But some children frequent feeding Mine spit up too :(

Naturally, a weak child does not get enough to eat, not every full-term baby can withstand 3 hours, and in general a premature baby probably needs to be fed every hour. My daughter quickly got tired of sucking, she will suck for about 10 minutes, sleep for 10-15 minutes and finish sucking for another 10 minutes. Then I went without food for 2 hours. I counted all this as one feeding, although the doctor said that this was not correct. Is it right for her to scream for an hour afterwards? Or should we just go out for a walk and eat what we asked for?

Discussion

Here it is good example. Natalya, we just went to visit, Anyutka’s second cousin, she follows him with her tail, looks into his mouth, obeys in everything, almost prays))) A 9-year-old boy is in good health, in winter he runs with his father from the bathhouse into the snow, generally running half naked. It’s just a classic - he’s standing there, grimy, all bitten by mosquitoes, scratched, his knees are knocked down, “Well, maaaam...” he whines about being excused from garden work and a couple of friends are hesitating at the gate, while finishing the second grade according to Zinkov, (not according to Paterson lung, they would and it’s not necessary, but the simpler school is too far away and inconvenient) there are B grades, but in general he is considered an excellent student. Not a boy, but a dream. And my mother’s comments: “Oh, you know, just this year I sighed and relaxed a little.” And he was born with your parameters, very premature, 1300, intensive care, “let’s pray that he lives to see the 3rd day,” “let’s pray that he lives for a week,” the chances will be greater. At 3 years old “when will he start talking”, at 5 years old “oh my God, yesterday I understood everything, today I’m laying out the manuals to repeat, and again, as if for the first time, he sees that others from 1 time, mine remembers from 20-50, it’s just a memory bad." But there's MOM non-working MOM, an iron man-tank heading towards the goal. I envy her terribly, God did not give me such freedom. Goal, plan, regime, schedule, absolute faith in your son, self-discipline and not a day of doubt or “give up.” I couldn't do that. But she was also lucky, there were no specific strong pathologies or diagnoses, she was just overall premature, “immature.” I recovered 200%. And there are bad examples, so you can’t predict how things will go for your twins.

At 24 months old, my goddaughter didn’t say anything except mom, she walked, but at the same time she couldn’t climb onto the 40 cm high sofa. It’s difficult for me to say at all that she understood, because... out of 10 times she was approached, she reacted in about 4-5 cases, ate very little and very selectively. Now she is 2 years old and 10 months old, she runs, talks and talks very funny. although she still has little contact with strangers, she can switch off (in terms of reaction) at any moment. No one measured her head, but a 6-month-old baby’s hats fit on her without any problems (if you’re interested, I can try them on). At the age of 2 years, the neuropathologist prescribed hopantenate. Parents are not worried at all. And another case with a neighbor's child. The girl did not speak at all until she was 3.5 years old. She understood everything, then she began to speak very slowly. By the age of 4, the vocabulary of used words was approximately 30 to 40. Now he is finishing school and entering the polytechnic. Still not very talkative. So maybe you just need to take your time. After all, the children are still small.

A premature baby is not a death sentence for a family! Part 2. Answer who is raising very premature babies born weighing less than 600 grams.

Discussion

My son was born almost seven months old with a weight of 1.400, within a year he gained normal weight, just one year old, is developing normally, a very smart boy, but psychologically it is very difficult - a child with a pessimistic view of everything, comes to the point of thinking “it’s better for me not to live”, does not know how to empathize with others, and sometimes becomes aggressive.
In the first years of life, this could be attributed to the whims, characteristics of the child, then they did an MRI of the brain - it turned out to be organic lesions of the brain (some lesions do not work), as a consequence of prematurity, underdevelopment of the brain, although in terms of health in the first years there was A lot has been done: we were constantly treated by a neurologist, had massages 4 times a year, etc. Sometimes it is very difficult to communicate with your son, although he is already an adult boy, he understands how to behave, but nothing can be done. With two such children it will be difficult, to say the least.

A friend of mine gave birth to a girl before 7 months.
She has problems with her eyes and neurology; at 2 years old she cannot sit or walk... a very difficult child.
She says: they saved, but was it worth it?...

I think that those who are born less than 1,500 have more health problems, and that worse than that It’s not known at all how everything will be in a year or two. Alas =(