The Wehrmacht generals who managed to survive World War II without being hanged for war crimes devoted the rest of their lives to writing memoirs designed to explain the reasons for their defeat.

These memoirs are rather monotonous and represent an attempt to prove that “the brilliant Wehrmacht was destroyed exclusively by the Russian frost and a madman Hitler who made suicidal decisions."

One of the best German military leaders did not have to make excuses. Erwin Rommel, who has earned respect and recognition from himself Winston Churchill, did not live to see the defeat of Germany, becoming a victim of the regime that he served faithfully.

Teacher's son

He was born on November 15, 1891 in Heidenheim. His father was a simple teacher, who, however, succeeded in his personal life, marrying the daughter of the former president of the government of Württemberg, a kingdom that was part of the German Empire.

Erwin had two brothers and one sister. Karl Rommel became a successful dentist Gerhard Rommel- famous opera singer. Erwin's sister Helen, with whom he was very close, became an arts and crafts teacher.

Erwin grew up purposeful, ambitious and stubborn. True, he could not insist on his dream of becoming an aircraft engineer - his father, an equally stubborn man, rejected this idea.

Erwin was given a choice - either he becomes a teacher, like his father, or a military man. Rommel chose a military career.

In 1912, Erwin Rommel, a graduate of the Danzig Military School, received the shoulder straps of a lieutenant. But instead of a military career, the young officer began to think about marriage. He fell in love with a 20-year-old Walburga Stemmer. The problem was that, according to the laws of the German Empire, an officer had to pay a deposit of 10,000 marks when getting married. Erwin didn't have that kind of money.

The news of the affair angered the father, who demanded that his son get the nonsense out of his head. But Erwin showed character by refusing his father’s demand. The father, who died soon, never found out that Erwin’s beloved was already pregnant by that time.

The marriage between the young people was never consummated, and they separated. Rommel found solace in his military career.

Young hero

During the First World War, the young officer showed his best side. During the First Battle of the Marne in August 1914, Rommel, who was scouting an enemy-controlled village with three soldiers, came across a detachment of two dozen Frenchmen. The French were unable to detect the Germans due to thick fog, and then Rommel ordered to open fire on them. Rommel’s entire platoon approached the scene of the ensuing firefight, and the Germans occupied the village with a swift attack.

Rommel later fought in the Alpine Battalion, stationed in the mountainous region on the border with Italy. During the battles at Mount Caporetto, Rommel captured important strategic positions, forcing the surrender of superior Italian forces and capturing a large number of captured weapons. For this brave maneuver, the young officer received Germany's highest military award - the Order of Pour le Merite.

The war, a failure for Germany, turned out to be a successful period for Rommel. He received awards more than once, was promoted to the rank of captain, and in 1916 finally succeeded in his personal life, marrying Lucy Mollen, with whom he had a long affair by this time.

Erwin Rommel, 1917. Photo: www.globallookpress.com

Next to the Fuhrer

After Germany's defeat, Rommel remained in military service. Over time, he rose to the position of commander of an infantry regiment, taught at military schools, and published the book “The Infantry is Advancing.”

Rommel's book became very popular among the military, and Adolf Hitler, who came to power in Germany in 1933, drew attention to it. Rommel was appointed commander of the Fuhrer's guard battalion.

In 1938, Colonel Rommel became head of the Theresian Military Academy.

On the eve of the start of World War II, Rommel was one of the military men who enjoyed Hitler's special trust. Six days before the invasion of Poland, Erwin Rommel became commandant of the Fuhrer's headquarters.

Rommel left this post with the rank of Major General in February 1940, becoming commander of the 7th Panzer Division. In this position, he took a direct part in the defeat of France, for which he was awarded the Knight's Cross.

Mission to Africa

At the beginning of 1941, Hitler was forced to save his ally from complete military disaster Mussolini. The Italian army, which fought in North Africa against British forces, was on the verge of complete defeat. The British advance meant that within two months the Italians were driven back more than 600 miles and suffered 130,000 casualties.

Mussolini begged for help. Hitler sent General Rommel, who in February 1941 was appointed commander of the Afrika Korps, to save the situation.

The transfer of forces, however, took time, while it was necessary to act urgently. And here Rommel began to demonstrate his talent as a commander in all its glory.

To begin with, he ordered the construction of mock-ups of tanks in order to mislead the British about the forces that he had at his disposal. Then he completely abandoned attacks on the enemy, giving the British the impression that active hostilities had ended.

The British took the bait and began regrouping their troops, moving their best units to other areas. At the same time, many officers, including the commander of the British army "Nile", received leave.

Using the factor of surprise, Rommel launched a counteroffensive without waiting for the arrival of the main forces. The goals were initially modest - to prevent the complete defeat of the Italian units. However, the German attack was so successful that the British were driven back hundreds of miles.

Erwin Rommel in Africa, 1941. Photo: www.globallookpress.com

"Desert Fox"

Rommel throws new units of the Afrika Korps into battle, and the flight of the British becomes completely chaotic. Chaos reigned in the British units, and they managed to stop the retreat only at the end of 1941, gaining a foothold in Benghazi. Actually, the reason for this was rather the complete depletion of the reserves of the Afrika Korps, the already poor supplies of which became even more scarce with the outbreak of the war on the Eastern Front.

The British launch a counteroffensive, and Rommel has to retreat. He, however, successfully evades all attempts to be surrounded, retains his equipment and keeps his losses to a minimum. After this, the respectful nickname “Desert Fox” was assigned to him.

Winston Churchill himself, speaking in the British Parliament, says about Rommel: “We have before us a very experienced and brave enemy and, I must admit, despite this devastating war, a great commander.”

Rommel's name began to strike fear into British soldiers, so much so that Commander-in-Chief of the British Middle East Forces Claude Auchinleck issued a special order in which it was forbidden to mention Rommel’s name among the troops.

In January 1942, Rommel was promoted to colonel general, and a month later he was appointed commander of Panzer Army Africa. Despite the loud name, the tank army was actually just an army group - the vast majority of the units were Italian (with low combat value), and the Germans had only one tank division in the “army”.

Rommel's tanks in Africa, 1942. Photo: www.globallookpress.com

Rommel goes to the Nile

In June 1942 came the brightest moment in his military career. Having very limited forces, inferior to the British in numbers, he stormed the fortress of Tobruk. This citadel, considered the main Allied bridgehead in the African theater of operations, was considered impregnable until Rommel's tanks appeared at its walls.

For the capture of Tobruk, Rommel received the rank of Field Marshal. After the surrender of the fortress, the Germans launched a rapid offensive, reaching El Alamein in July 1942, from which there were no more than 100 kilometers to the Nile Delta. The threat of German capture of Alexandria and Cairo loomed.

The situation for British troops in Africa became critical. They were saved from military disaster by... Hitler. Rommel, who was squeezing everything he could and couldn't from his available forces, asked Hitler for reinforcements and increased supplies of fuel and ammunition, but was invariably refused. The Fuhrer of the Third Reich was concentrated on the Eastern Front, where even those forces that were specially trained for war in the African desert were transferred.

Taking advantage of this, the British hastily transferred new units to El Alamein, and American equipment began to arrive in Africa. The Allies were preparing a large-scale offensive.

Perhaps the “Desert Fox” would have managed to get out again, but just at that moment he was struck down by dysentery, and Rommel was urgently sent for treatment to Germany.

Erwin Rommel and Adolf Hitler, 1942. Photo: www.globallookpress.com

The collapse of Army Africa

With the beginning of the British offensive, he was called from the hospital, but by the time Rommel returned to Africa it was all over - the German forces at El Alamein were completely defeated.

In November 1942, the Americans landed in Morocco and Tunisia. Rommel, despite the desperate situation, continued to inflict damage on the enemy, but could not fundamentally change the situation.

In March 1943, Rommel went to Hitler's headquarters to ask him to order the evacuation of German forces from Africa. According to the Desert Fox, it was necessary to save the troops, since it was no longer possible to save the campaign.

But after the disaster in Stalingrad, Hitler did not want to hear about any new retreat. Rommel was removed from his post and never returned to Africa. The remaining German and Italian troops in Tunisia capitulated two months later.

Perhaps at this moment the Field Marshal General, who was considered Hitler’s favorite, was completely disillusioned with the leader of the Third Reich.

The rampart that Rommel built

However, the recall from Africa did not mean disgrace: Rommel was appointed commander of Army Group B in Northern Italy with the task of preventing the final defeat of the Italians and the advance of Anglo-American forces. “Desert Fox” coped with this quite well.

In January 1944, Rommel was appointed commander of German forces in Northern France. Anticipating the invasion of the allied forces, he is creating powerful fortifications on the coast. But Rommel’s ideas about the principles of defense of the Atlantic Wall do not find support among Field Marshal von Rundstedt, commander of all German forces in France. Not least of all, these contradictions were the reason why the Allied landing in Normandy on June 6, 1944 was successful.

Rommel in France, 1944. Photo: www.globallookpress.com

The war ended for Rommel on July 17, 1944, when a British plane fired on the field marshal's car. The seriously wounded Rommel was sent to the hospital, and then home to the city of Ulm to continue treatment.

Three days after Rommel was wounded, military conspirators launched an assassination attempt on Hitler, which ended in failure. Colonel Claus von Stauffenberg, who set off the explosive device, fought in Africa under Rommel.

Sentenced to suicide

Rommel himself, however, was not one of the conspirators, although he sympathized with their goals. Among the conspirators there were many who believed that the authoritative Rommel should enter the new German government, and possibly lead it.

After the plot failed, the arrested military men were subjected to severe torture, extracting testimony against their accomplices. During such interrogations, the name of Erwin Rommel was mentioned with passion.

Hitler, who was informed about this, decided to give his favorite “special honor.” On October 14, 1944, two officers were sent to the field marshal's home and told Rommel the Fuhrer's will - he would either stand trial or commit suicide.

The trial meant a death sentence, and subsequent repressions would also fall on members of the military leader’s family. In fact, the field marshal, who never recovered from his wound, was forced to take poison.

Four days later, Field Marshal General Erwin Rommel was buried as a national hero. On the day of his funeral, national mourning was declared in the Third Reich.

Funeral of Erwin Rommel. Photo: www.globallookpress.com

Six months later, Adolf Hitler would share the fate of his favorite, committing suicide. True, instead of honors and mourning, the Fuhrer was faced with a bomb crater in which his body was burned under the volleys of guns from the advancing Soviet troops.

When feeding premature babies, especially during the neonatal period, determining their quantitative need for human milk is of great importance. The formulas existing for these purposes do not justify themselves and therefore they have only approximate value.

Thus, Rommel’s formula, proposed for premature newborns in the first 10 days of life (V = n + 10, where V denotes the required amount of milk in milliliters for every 100 g of the child’s weight, n is the number of days of his life), often exceeds the actual need for milk .

The Reiche formula (V = x/y - X7) (V is the daily amount of milk in milliliters, X is the child’s weight, y is body length), intended for calculating the milk needs of children from 3 weeks of age, is also of little use in this sense. and older because it does not take age into account.

More practically justified is the principle of calculating the need for milk of a premature baby, proposed by Ilppo (1960); the daily amount in the first 10 days of a premature infant’s life should correspond to about 1/10, and in subsequent periods - 1/5 of its weight. The differentiated standards given in the manual by V. F. Shagan (1959) are convenient for implementation.

Daily amounts of milk for every 100 g of premature baby's weight

"Nutrition for a healthy and sick child"
S.A. Gil

It is characteristic that Ramstedt, after the first operation he performed in the modification that underlies the currently used operation, believed that preserving the mucous membrane when dissecting only the muscular layer of the pylorus frees the doctor from fear for the further feeding of the child. Unfortunately, this valuable idea was forgotten. Histological examination of various sections and layers of the stomach with congenital...

The industrial method of preparing canned fruits and vegetables preserves their nutritional value. The production of dry and canned products is completely mechanized, which, along with pasteurization of products and keeping all equipment clean, ensures that they are free from bacterial contamination. Powdered milk is prepared from cow's milk. The process of drying condensed milk sprayed into tiny droplets occurs at a temperature no higher than…

Our many years of experience have shown that in cases where during the operation there was no injury to the mucous membrane and other aggravating aspects (ligation of blood vessels in the stomach, difficulty in repositioning it after myotomy, etc.), especially if the operation was performed in the early stages of clinical detection diseases, children after it actively took the breast, often sucking already in the first 48...

When feeding children with powdered milk, earlier (than when feeding with whole cow's milk) correction of the diet with protein is necessary for infants. This necessity is dictated by its lower protein content. When reconstituting milk or its mixtures, a small amount of warm water is added to the dry powder, stirred until a creamy mass is thick, then the rest of the water is added and the resulting mixture...

The use of so-called nutritional enemas from breast milk (A.R. Shurinok, Yu.P. Kukuruza, E.I. Tretyakova, 1962) as food cannot replace natural feeding and is devoid of theoretical grounds from the point of view of the absorption of milk without the necessary enzymatic impact. Speaking about the physiological conditions of nutrition, the desire for which determines attempts to accelerate the food load in...

Babies weighing about 1500 g or less usually breastfeed poorly and become very tired, and it is advisable to bottle-feed them or put them to the breast not every feeding. When the first symptoms of fatigue appear (lethargy, cyanosis of the nasolabial triangle), the baby should be weaned from the breast and bottle-fed.

If the baby's body weight at birth is about 2000 g, then he usually takes the breast well and sucks out the required amount of milk.

The number of feedings of a premature baby is determined by its weight, condition, and degree of functional maturity. The most commonly prescribed feedings are 7 times a day with a 6-hour night break. Only if the child is severely ill and ill, the number of meals can be increased to 10. When the body weight of a premature baby reaches 3000-3500 g, at the age of 2-3 months he can be transferred to 6 meals a day. The subsequent feeding pattern is not much different from the physiological pattern of the first year of life.

When determining the amount of food needed by a premature baby, it is usually based on its individual characteristics, body weight at birth, and general condition. A premature baby has increased growth energy compared to a full-term baby, so he needs an amount of food that would satisfy his energy needs. At the same time, food tolerance in premature infants is reduced due to the functional immaturity of the gastrointestinal tract. The capacity of the gastrointestinal tract in such children is small, and the digestive activity of juices is significantly reduced. All this requires a very precise and precise determination of the amount of food.

Usually, on the first day of life, a premature baby receives 5-10 ml of milk per feeding, on the second day - 10-15 ml, on the third day - 15-20 ml. Over the next 10 days, the amount of food needed for a premature baby can be approximately calculated using Rommel's formula:
V=n+10,
where V is the amount of milk in ml for every 100 g of the child’s body weight, and n is the number of days of life.

For example, if a child’s body weight on the 5th day of life is 2000 g, then the amount of food per day should be (5 + 10) X 20 = 300 ml. Then, for one feeding with 7 meals a day, the child should receive 43 ml of milk (300:7).

However, when calculating nutrition using Rommel's formula, slightly overestimated amounts of food are obtained. Therefore, a more correct method is calculating nutrition by calorie content, which is mainly used in the domestic diet. According to these recommendations, a premature baby should receive 30-60 kcal/kg body weight in the first three days of life, 70-80 kcal/kg body weight by the 7-8th day of life, and 100-100 kcal/kg by the 10-14th day of life. 120 kcal/kg body weight, and at one month of age - 135-140 kcal/kg body weight. From 2 months of age, caloric intake is calculated taking into account body weight at birth. For children born weighing more than 1500 g, caloric intake is reduced to 130-135 kcal/kg body weight. In children born weighing 1000-1300 g, up to 3 months of age the caloric content of food should be 140 kcal/kg body weight, and at 4-5 months - 130 kcal/kg body weight. In this case, the general condition of the child, his ability to digest food, the intensity of weight gain, etc. are taken into account.

For example, a child’s body weight by the 8th day of life is 2300 g. At this age, he should receive 80 kcal per 1 kg of weight, which will be 184 kcal per day. This amount of calories is contained in 260 ml of breast milk, which has a calorie content of 70 kcal per 100 ml. With seven meals a day, the child should receive an average of 37 ml at each meal.

Zaitseva formula:

Daily milk volume= 2% of body weight at birth * day of life.

For example, a 3-day-old child with a birth weight of 3500 g should receive 2% * 3500 * 3 = 210 ml per day

Shabalov's formula:

= 3 ml * day of life * birth weight (in kg).

For example, a 3-day-old child weighing 3500 g sucks in one feeding:

3 ml * 3 (day) * 3.5 kg = 31.5 ml

Volumetric method:

Volume of milk per feeding can be calculated using the formula:

10 ml *day of life

For example, a child aged 3 days can suck 10 ml * 3 days = 30 ml.

Calculation of nutrition for a premature newborn baby (for the first 10 days of life)

Rommel's formula:

Daily amount of milk= (10 + day of life) * weight in grams: 100.

For example, a 3-day-old child weighing 2000 g should receive per day

(10 + 3)*2000: 100 = 260 ml.

After 10 days of life The daily amount of nutrition for a newborn is 1/5 of body weight (volume method).

For example, a child aged 18 days with a body weight of 4000 g will receive 800 ml per day (110 -120 ml per feeding).

Daily toilet of a newborn

Daily you need:

Wash the child’s face and hands with boiled water; hands should be washed with baby soap;

Gently clean the nasal passages using dry cotton wool (daily),

external auditory canals (no more than once a week);

Wipe eyes with a cotton swab moistened with boiled water, in the direction from the outer corner.

to the inner one (each eye with a separate cotton swab). Do not put it in the eyes of a child

breast milk!

The oral cavity should not be treated;

Skin folds must be treated with special baby creams and oils

and powders. At night, it is advisable to apply to the area of ​​the inguinal and gluteal folds.

dock "baby diaper cream" containing zinc oxide and panthenol, which creates

a protective layer on the surface of the skin that lasts for 12 hours.

Toilet of the umbilical wound is carried out with a 1% solution of brilliant green using

eye dropper 2 times a day until the 10th day and 1 time a day until 1 month.

III. Examples of situational tasks are given above.

IV. Self-control tasks.

Solve situational problems

1. Calculate the daily and one-time volume of nutrition using formulas known to you for a full-term baby weighing 4000 g at the age of 4 days; 6 days, 10 days.

2. Calculate the daily and one-time volume of nutrition using formulas known to you for a premature baby weighing 1800 g at the age of 4 days; 6 days, 10 days.

I. Tests

1. The minimum body weight of a full-term newborn is (in grams)

a) 2000 b) 2500 c) 3000 d) 3500

2. The minimum body length of a full-term newborn is (in cm)

a) 45 b) 47 c) 50 d) 55

3. The umbilical cord is separated from a full-term newborn at term (day of life)

a) 2 b) 3 c) 4-5 d) 6-7

4. To prevent ophthalmoblennorrhea, a solution is used

a) furatsilin b) sodium chloride c) sulfacyl sodium d) polyglucin

5. Feeding regimen for a newborn baby:

a) 7 times every 3 hours b) 6 times every 35 hours c) 5 times every 4 hours d) 3 times a day

6. The physiological decrease in body weight of a newborn is
a) up to 10% b) up to 20% c) up to 30% d) up to 40%

7. Sexual crisis manifests itself in a newborn

a) increased body temperature

b) increase in body weight

c) enlarged mammary glands

d) decrease in body temperature

8. Timing of the appearance of physiological jaundice in a newborn

a) immediately after birth b) on days 2-3 c) on day 5 d) on day 7 of life

9. Intensity of physiological jaundice over time

a) increases b) decreases

10. Condition of the newborn with physiological jaundice

a) worsens b) does not change

11. To prevent diaper rash, the folds of a newborn’s skin are treated

a) sterile vegetable oil b) saline solution

c) furacillin solution) d) polyglucin solution

12. The umbilical wound of a newborn is treated with a solution

a) 2% sodium bicarbonate b) 1% brilliant green c) 5% iodine

d) 5% sodium chloride

Standard answers to test control tasks

1b, 2 b, 3 c, 4 c, 5 a, 6 a, 7c, 8 b, 9 b, 10 b. 11 a 12 b

Premature babies are those born between the 28th and 37th weeks of pregnancy, with a body weight of 1000-2500 g and a body length of 35-45 cm.

Caring for premature babies involves organizing special care - temperature, humidity, oxygenation levels, feeding, and, if necessary, intensive care.

Organization of feeding of premature newborns

Difficulties Feeding premature babies has significant features due to

• weak expression or absence (not developed until 32–34 weeks of gestation) of sucking and swallowing reflexes and their coordination due to neuropsychic immaturity, which correlates with the degree of prematurity;
• increased need for nutrients due to intensive physical development,
• morphological and functional immaturity of the gastrointestinal tract, requiring careful introduction of food:
  • small stomach volume,
  • the predominance of the tone of the pyloric region over the poorly developed sphincter of the cardial part of the stomach,
  • enzyme deficiency: reduced secretion of gastric juice, the ability of acid formation and pepsinogen production, and as a result incomplete breakdown of proteins, reduced lactase activity(However, pancreatic function even in very premature infants is at a sufficient level). Intestinal enzymes involved in carbohydrate and protein metabolism are formed at earlier stages than lipolytic enzymes, and therefore it is often observed in premature infants increased excretion of fecal fat,
  • low activity of intestinal motility, which leads to bloating and intestinal overdistension.

When organizing feeding of premature infants, it is necessary to answer 4 questions:

1. When;
2. to what extent;
3. what method?

When?

For premature babies born at a long gestational age (35 or > weeks) in relatively satisfactory condition, it is advisable to start the first feeding no later than 2-3 hours after birth. In infants with a gestational age of less than 34 weeks and weighing less than 2000g, the basic principles are: caution and gradualism.

In relatively good condition

in case of stage I prematurity, you can start feeding breast milk or its substitutes 6-9 hours after birth,

in grade II - after 9-12 hours,

at III - after 12-18 hours,

at IV - after 36 hours.

Premature babies with a birth weight of less than 1500 g are put to the breast from the 3rd week of life.

Requirements for natural (breast or bottle) feeding of a premature infant : it should be sucking reflex.

If early (immediately after birth) breastfeeding is impossible, it is necessary to pipette a few drops of mother’s milk into the baby’s oral cavity to populate the gastrointestinal tract with normal microflora.

Feeding frequency depends on body weight, degree of maturity, condition. Feeding is 7-8 times a day, but according to indications, the frequency can be increased to 12 times a day.

How?

Product selection . For premature babies, as well as for full-term babies, the ideal food is breast milk without any correction. If breast milk is not available, use adapted milk formulas, preferably specialized for premature babies.

Infant formulas: “Robolact” or “Linolact” for the 1st week of life, then to adapted mixtures “Prepilti”, “Pregumana”, “Novolakt-MM”. From 1.5-2 months - fermented milk mixtures.

To what extent?

Calculation of nutrition for premature babies

By what method?

Types of feeding premature babies and methods of introducing nutrition :

• natural: breasts mother or nurse,
• natural, artificial and mixed: pacifier − expressed from his own mother or donor,
• probe: for each feeding − one-time− or permanent,
• parenteral nutrition (vomiting, flat or negative weight curve, intestinal paresis, surgical pathology of the gastrointestinal tract, etc.).

The method of feeding is determined depending on the severity of the condition and the degree of maturity.

Indications for breastfeeding :

• possible in premature newborns 35–37 weeks of gestation in satisfactory condition:
• when breastfeeding, systematic control weighings before and after feeding are necessary: ​​the loss should not be >1.5−2%, diuresis 1 ml/kg×hour.

Indications for pacifier feeding :

• used in premature infants born after 33–34 weeks of pregnancy or II degree of prematurity (the sucking reflex is reduced, but quite pronounced for the nipple), if they do not have any disturbances during postnatal adaptation - in the first 3-4 days. Before this period, it is not advisable to put the baby to the breast, since breastfeeding is a heavy physical activity for him and can lead to secondary asphyxia or intracranial hemorrhage;
• HDN - donor milk.

Indications for tube feeding:

breast milk through a disposable gastric tube:

• regurgitation;
• weakness or absence of sucking and swallowing reflexes;
• premature babies with asphyxia, RDS 5 points; during mechanical ventilation;
• deep prematurity - III-IV degree of prematurity, less than 32 - 33 weeks;
• slow weight gain;

through a permanent probe:

• with a mass of less than 1500 g;
• the sucking process interferes with breathing and hemodynamics:
  • the appearance of persistent cyanosis during sucking,
  • defects of the hard and soft palate;
• suspected birth intracranial injury.

The probe is inserted to a length equal to the distance from the bridge of the nose to the xiphoid process, or orogastric (preferred), or nasogastric(creates additional resistance to the passage of air, can provoke apnea and bradycardia).

Types of tube feeding :

A) bolus (intermittent). The probe is used for a single portion of milk, after which it is immediately removed. The milk is supplied effortlessly, slowly, under the influence of gravity. The method is more physiological than drip administration, because promotes the cyclic release of hormones, which stimulates the growth and development of the gastrointestinal tract.

b) prolonged (drip, micro-jet). The probe is inserted for up to 3 – 7 days. It is usually used in children weighing less than 1500 g, as well as in larger ones, in case of their severe general condition with a tendency to stagnation in the stomach. The adapted mixture is delivered to the stomach using an infusion pump. In this case, it is preferable to breast milk, because it is easier to maintain its sterility during the entire period of administration.

When feeding through a tube, it is necessary to check before each feeding residual gastric volume. If it is more than 10% of the volume of the previous feeding, the portion of milk is reduced by 50%, followed by a gradual increase in volume.

In order to correct lipid metabolism - lipofundin 10% 5ml/kg/day.

During premature birth, breast milk has special nutritional and energy properties. Thus, the milk of women who gave birth prematurely contains more protein and polyunsaturated fatty acids, which are necessary for the growth and development of the premature baby’s body, primarily for the maturation of the central nervous system. Also, breast milk during premature birth contains more carbohydrates, vitamins A, E, C compared to breast milk from women who gave birth at term. It is very important that breast milk in women with premature pregnancy contains more microelements necessary for the development of the child, namely: iron, chlorine, zinc, iodine. The milk of women who gave birth prematurely has a higher protein component and contains 1.8-2.4 g/100 ml.

According to the literature, the amount of fat in breast milk in women who gave birth prematurely does not differ from that in women who gave birth at term, the average level is 3.2-3.4 g/100 ml. Breast milk fats are completely digestible.

Lactose in the milk of women who gave birth prematurely is 5.96-6.95 g/100 ml. Calcium and phosphorus are slightly higher. The calcium/phosphorus ratio in breast milk is more physiological (1:2) than in formula; lower phosphorus levels lead to loss of calcium in the urine.

Thus, nature itself provided the physiological expediency of feeding prematurely born children with mother's milk.

The need of a premature baby for basic food ingredients (proteins, fats, carbohydrates)

The protein requirement of premature infants varies depending on the degree of maturity and age from 2.5-3.0 to 4.0 g/kg per day.

The fat requirement is approximately 6.5 g/kg per day.

The need for carbohydrates is 12-14 g/kg per day.

The energy needs of premature babies gradually increase: on the first day they are 20-25 kcal/kg, on the 2nd - 40, on the 3rd - 50, on the 5th - 70, on the 7th - 90, on the 10th. e – 110 kcal/kg per day. This need increases on the 20th day to 130 kcal/kg, by the 30th day – to 135-140 kcal/kg.

What should you consider when feeding a premature baby?

The rapid growth rate of a premature baby determines higher body needs for protein, microelements, and vitamins. Therefore, in order to satisfy the physiological needs of such a child, breast milk is used as a basis, to which nutrients that are in short supply are added.

Such additional provision of proteins, some microelements, vitamins, especially for children with a gestational age of less than 32 weeks and a body weight of 1,500 g or less, can be carried out through partial parenteral nutrition.

Infants who are 32–34 weeks gestational age can receive additional protein enterally by adding special protein-fortified supplements to breast milk. Newborns who received fortified breast milk have greater weight gain, linear growth, and significantly higher urea nitrogen levels.

Methods for calculating the amount of nutrition required for a premature newborn baby

They begin to feed premature babies with a body weight of 2,000 - 1,500 g with 5-7 ml with a gradual increase by 5 ml. In premature infants weighing 1,500 - 1,000 g, the volume of the first feeding is 2-4 ml with a gradual increase by 3-5 ml. Children weighing less than 1,000 g begin to be fed with 1-2 ml and gradually increase the volume by 1-2 ml.

When tube feeding children with very low and extremely low body weight, 3-hour injections of milk with one-hour breaks and a 5-hour night break are common. Thus, 5 infusions are performed per day. The initial rate of milk administration is 1.5-3 ml/kg per 1 hour. On the 6-7th day it gradually increases to 7-9 ml/kg per 1 hour.

The criteria for determining the date of the first feeding of a premature baby are gestational age, birth weight, and general condition of the child. In the absence of severe pathology, feeding can be done on the first day, depending on maturity, using different feeding methods.

Functionally mature newborns greater than 34 weeks' gestational age can begin feeding 2 to 3 hours after birth.

First feeding—enteral feeding tolerance test- held distilled water(because glucose aspiration causes inflammatory changes in the lungs similar to milk aspiration), then several injections of 5% glucose solution,after which they use breast milk (or formula).

In premature infants up to and including the 10th day of life, the daily volume of milk is determined using Rommel’s formula:

V=(n+10) x for every 100 g of the child’s weight, where n is the number of days of the child’s life;

or in a caloric manner in accordance with daily requirements.

Example: A child is 3 days old, body weight is 1,800 g. Calculate the daily and one-time volume of milk.

V= (3+10)x18=234 ml;

Number of feedings – 10.

Volume per feeding = 234:10 = 23.4 = 24 ml.

Taking into account the tolerance of the premature baby’s body to food, on the 1st day per feeding – 5-7 ml, on the 2nd – 10-12 ml, on the 3rd – 15-17 ml, on the 4th – 24 ml.

After the 10th day of life, the daily volume of food is determined by body weight using the volumetric method, as in full-term infants.

Monitoring the adequacy of feeding

Regurgitation, vomiting, and bloating are indications for refusal of the standard feeding regimen and require clarification of the reasons that caused these symptoms. The most effective criterion for proper feeding is daily positive weight changes (approximately 15 g/kg per day).