The arrival of new life has brought hope and joy to countless families。But there are always special babies who can't wait to meet mom and dad before their organs are fully developed。

　　Some mischievous "early angels" came to earth after living in their mother's special "house" for only 37 weeks or less。They are separated from the mother in advance of the normal cycle required for fetal growth, just like the flowers in the winter, if they are not timely and effective care, they will face the risk of death at any time。However, when the "early arrival angel" met the neonatal medical team of the Provincial Hospital affiliated to Shandong First Medical University (Shandong Provincial Hospital), the gears of fate began to turn in a favorable direction。

　　October 22, 2022，The mother of Shang En (not her real name) from Linyi is only 24 weeks pregnant，Suffering from chronic hypertension, she developed severe preeclampsia and intrauterine growth restriction during pregnancy，Lack of blood flow in umbilical artery during diastolic period was complicated，The situation is urgent，The doctor recommended direct transfer to the provincial hospital for intrauterine referral。After receiving the news, the provincial hospital immediately opened a series of green channels for Shangen's mother, and the pediatric medical staff were ready to meet the "early angel".。

　　"Gold 1 Minute"

　　Is the first step to reducing the risk of complications

　　"Medically premature infants generally refer to newborns of less than 37 weeks of gestational age, of which premature infants of less than 28 weeks of gestational age are called 'super immature children', the smaller the gestational age, the more difficult the treatment, especially in the case of various complications such as intrauterine infections of pregnant mothers, the more difficult the treatment of premature infants.。Yu Yonghui, director of the neonatology department of the Provincial Hospital, said that Xiao Shangen developed in the mother for only 24 weeks, and the difficulty of treatment is self-evident。Every second of the little life after the birth of the mother to fight for every second of treatment is crucial to the healthy survival and high-quality growth of little Sean, and the one minute after birth is also known as the "golden minute".。

　　Operating room，The obstetricians and anesthesiologists prepared for the caesarean section in an orderly manner，Neonatal consultation staff "medical colleagues" rushed to the delivery room，Work with midwives to form a premature resuscitation team，Preheat the thermal table, blanket, velvet cap and plastic film in advance，Prepare resuscitators, tracheal intubation and other rescue equipment and rescue drugs，Specialized in the resuscitation and treatment of little Sean after delivery。

　　Shadowless lamp，Cesarean section after epidural anesthesia，A very young baby is born and immediately placed on an incubator，The whole body is wrapped in plastic film, wear a velvet cap, and bounce the sole to stimulate breathing，Complete this series of initial resuscitations in 30 seconds，And maintain the early postnatal body temperature stability;Doctors assessed Sean's breathing as unstable on his own，Intubation was performed immediately，Connect resuscitation airbags to assist breathing，To further maintain the stability of breathing and heart rate。

　　At this point, premature babies have won the "golden minute" after birth, which is a key step in reducing the risk of serious complications in super immature babies。The resuscitation team slowly injected lung maturation drugs via endotracheal intubation, then placed the baby in a preheated incubator and transferred the baby smoothly to the neonatal intensive care unit (NICU) with the assistance of a transport ventilator.。

　　With a gestational age of 24 weeks and a birth weight of only 410 grams, "pocket baby" Sean started his "delicate life" in this way.。

　　Scientific and refined management

　　Care for the smooth transition of small life

　　"The 410-gram little Sean is smaller than my palm, has almost no ability to suck on its own, and is injected every 3 hours through a nasal feeding tube.5 ml of breast milk is difficult to digest and absorb, we use his mother's colostrum for the baby within three days of birth to do oral care, start gastrointestinal peristalsis and basic digestion and absorption function。"Provincial hospital East hospital neonatology head nurse Li Minmin said。

　　The functional development of the body of this super immature infant is extremely immature，Any subtle fluctuations in basic vital signs, such as body temperature, blood pressure, blood sugar, acid-base balance, volume and internal environment，It is easy to induce serious complications, especially intracranial hemorrhage and pulmonary hemorrhage，So any care should be as gentle as possible - the incubator is adjusted to the most appropriate temperature and humidity;The specially designed "nest" allows the baby to stay in the same position as if it were in the mother's womb，Full of security;Keep the middle line of the head and the head of the bed raised by 300, a comfortable physiological position;All medical care operations are "clustered" at one time，Try to control unnecessary operations such as repeatedly opening the warm box，At the same time reduce sound and light stimulation，Help him adjust to the changing environment from uterine to outside the mother as quickly as possible。

　　In order to give the super immature children more gentle scientific fine management，His small body is connected to electrodes that can monitor vital signs in real time, ECG monitor and other instruments;Umbilical vein catheterization and peripherally inserted central vein catheterization uninterrupted intravenous infusion of energy and fluid needed to maintain the baby;When breathing through artificial ventilator under tracheal intubation, the basic oxygenation parameters required by the body should be maintained at the lowest possible ventilator parameters，And extubation as soon as possible within 1 to 2 weeks to shorten the time of mechanical ventilation，To avoid additional damage to young lung tissue;Early enteral microfeeding is carried out for preterm infants within 1 to 2 weeks after birth through a soft gastric tube，Drip 0 from every 3 hours.Start with 5 ml of breast milk, increase the amount of milk carefully to help the baby slowly start the gastrointestinal tract;In addition, there is always a need to be vigilant about the possibility of serious infections, and the use of antibiotics needs to be strictly limited。

　　"Seeing little Sean with all the tubes in his body, as a mother, I was heartbroken, but thinking about my difficult pregnancy, the pain of pregnancy, how precious he was to me.。Sean's mother choked as she recalled that difficult time。

　　Full family participation

　　Health management

　　After more than 2 weeks of careful treatment and care, little Sean successfully evacuated the tracheal tube, put on the non-invasive nasal congestion ventilator, and came to his mother's arms for kangaroo care。

Photo of medical staff in neonatology department

　　Under the careful guidance of the medical staff and the company of his mother, Xiao Sean finally withdrew from the nasal congestion ventilator and successfully stopped the intravenous nutrition to achieve total gastrointestinal feeding。At the same time, his weight increased rapidly and his cognitive function gradually improved.The comprehensive education of the specialist nurses to the mother also improved the mother's anxiety, improved the mother's nursing skills, and increased the confidence after discharge。

　　From October 22, 2022 to February 7, 2023，Lasted 108 days，This tenacious little life in the provincial hospital neonatology department NICU all the medical staff of scientific treatment and family participation of refined care，Keep growing，Finally, he was discharged successfully with a weight of more than 2000 grams and a standard of self-feeding，A new record was set in the neonatology department of provincial Hospital for the successful treatment of the lowest birth weight over immature infants。After discharge, Xiao Shang also needs to regularly go to the premature infant specialist clinic for regular review and health guidance to ensure the comprehensive and healthy development of physical, intellectual and cognitive functions and emotions。

　　Multidisciplinary healthcare collaboration

　　Help "early angel" break through difficulties

　　Xiao Shang En's adventure journey is the epitome of countless premature babies who have experienced difficulties in gaining a new life. In the process of pregnancy and growth, they are basically faced with four major difficulties: difficult conception, difficult abortion, difficult treatment, and difficult healthy survival。All nodes, such as before pregnancy, during pregnancy and the birth of the baby, during hospitalization of NICU and after discharge, are crucial. How to minimize the risk of serious complications and sequelae on the premise of ensuring the survival rate is still the focus and difficulty of neonatal clinical work。

　　The provincial hospital integrates the technical strength of multidisciplinary medical cooperation teams such as obstetrics and pediatrics to build a strong defense line for protecting the life safety of mothers and infants to the maximum extent。For high-risk infants and critically ill newborns，Effectively open 5G referral green channel，Gradually improve the intrauterine referral, intrauterine consultation, before and after delivery and post-discharge specialist outpatient follow-up prenatal and postpartum integrated treatment management system;In the treatment and management of premature infants，Neonatology is for infants with a gestational age of less than 28 weeks or a birth weight of less than 1000 grams，The whole process of standardized, scientific and refined management from prenatal to delivery room delivery resuscitation to NICU family participatory care and outpatient follow-up after discharge is adopted。At present, the healthy survival rate of super-immature infants aged 23-27 weeks is more than 80%;Among ultra-preterm infants who grow up healthily to more than 2 years old, the minimum gestational age is 23+4 weeks, the minimum birth weight is 410 grams, and the long-term healthy survival without serious complications or sequelae is achieved, reaching the leading level in China。

　　In the treatment and management of super immature infants, the neonatology department of provincial hospitals has gradually explored a new way of clinical management and clinical research Mosaic development。In 2016, the department established a single-center clinical research database;In 2018, Yu Yonghui, director of the Department, led the organization of the North China Newborn Collaboration Network, an online data platform covering 8 provinces, municipalities and autonomous regions in northern China (www.snn-med.com) and the preterm birth cohort，The application of scientific, information, digital real world research methods and health care big data-driven clinical quality improvement，The healthy survival rate of super immature infants was rapidly improved，And published high-quality clinical research papers in international academic journals，Greatly enhance academic influence，Strengthen the high-quality development of disciplines and the construction of talent echelons，Use modern scientific means to empower "early angels"，To ensure their long-term quality of life。