Every November 17, Prematurity Day is celebrated around the world. For this reason, the Spanish Society of Neonatology (SeNeo) analyzes the change in the profile of babies born prematurely in our country, the causes of prematurity in Spain, and insists on the importance of prevention measures and a national strategy for care for their proper health and survival.
At present, we are witnessing a worrying decrease in the birth rate in our country, a decrease that is due to multiple causes and that is not accompanied by a decrease in prematurity, remaining at a percentage close to seven percent of premature births ; that is, those babies born before 37 weeks of gestation.
Added to this problem is a change in the profile of premature babies, as the survival of those babies born with less than 28 weeks , or less than 1000 grams, increases more and more.
It is in this population where the greatest risk of problems in the medium and long term is concentrated. “For them we have to have a national care strategy that not only has to be applied from the moment of birth, but later during their hospital stay, and even more so when these little ones leave the hospital and join family life. ” , Explains Dr. Manuel Sánchez Luna, president of the Spanish Society of Neonatology.
The causes of prematurity
The causes of prematurity are multiple, some of them related to acute problems during pregnancy, maternal diseases or anatomical disorders .
However, more and more, and especially in recent years, there has been a progressive increase in prematurity associated with the delay in maternal age to gestation -which in Spain has already reached 32 years on average for the first child-, the need to resort to assisted reproductive techniques and the problems associated with these, such as multiple pregnancies.
Some of these factors have recently been corrected, such as the twinning rate, but other factors such as the delay in the age of mothers to gestation is becoming more and more pronounced.
In addition, the biological conditions of couples who require assisted reproductive techniques increase the risk of prematurity. It is estimated that assisted reproductive techniques are associated with an increase of up to three times the risk of having a child weighing less than 1500 grams at birth.
The impact of prematurity
The impact of prematurity is great, both from a health and socioeconomic point of view. The greatest number of premature newborns affects those born between weeks 32 and 37 , however, it is fundamentally those born before week 28 (with less than 1000 grams at birth) who require much more specialized care and who also present an increased risk of complications. Every year in our country between 1,000 and 1,100 babies are born before week 28.
“Extreme prematurity” is that of those children who are born at the limit of viability, between week 22 and week 25 . They do it too early in their development, in a very limiting situation to survive outside the mother’s womb.
In this group, the most frequent problems are: chronic respiratory problems; bronchopulmonary dysplasia; neurological, where there has been some risk to normal brain development; brain injuries from the preterm birth itself or from the circumstances surrounding preterm birth. Less frequently: infection problems, because these children have very compromised immunity and defend themselves very poorly from infections, metabolic problems and digestive problems.
The problems of the “latest preterm” , those born closer to 37 weeks gestation, are different. They are more related to adaptation to birth. They do not usually leave sequelae and, in general, in most cases, they are overcome well. The balance to achieve the best survival with the least number of sequelae is that these children are born in centers where neonatal medicine is very advanced.
“ The first thing we have to do, when we are born, is breathe with our lungs. Therefore, it has traditionally been believed that survival depends on the degree of lung development. It is obvious. But we cannot forget that adequate brain development is essential. Like that of the kidneys, that of the metabolic systems and that of the immune systems. If a baby, when it is born, is so immature that it is unable to breathe, its brain is just as immature. It is your kidney, it is your pancreas, it is your liver. Neonatal professionals aim in these cases to mature the fetus , not just the lungs, by administering corticosteroids to the mother before birth. This reduces the risk of intracranial hemorrhage, increases the survival of premature infants and prepares the fetus for a situation of intense stress that is very premature birth ”, argues the president of the SeNeo, Manuel Sánchez Luna.
However, much progress has been made in the respiratory management of premature infants, in the prevention of infection; neurological sequelae have been reduced and nutritional aspects have been innovated.
The problems, however, do not stop when they go home, but rather a long process of care and specialized attention after discharge follows, complex and very expensive, which in most cases includes occupational therapy, physical therapy and stimulation. early, metabolic and nutritional controls and controls and immunizations for the prevention of common respiratory infectious problems.
The guarantee of the success of the care of these so fragile patients goes through the recognition of the specialty of Neonatology and the consequent organization of neonatal care in centers that have the appropriate units with accredited personnel and sufficient resources.
In Babies and more | Every year 15 million premature babies are born in the world
