According to WHO estimates, each year, as a result of preterm birth, intrauterine growth restriction or both, several million babies are born prematurely (before the end of the 37th week of pregnancy), and more than 20 million with low birth weight (LBW), less than 2.5 kg. In 2020, 13.4 million of them were born (22,510 in Poland in 2022, according to the Central Statistical Office), and about 1 million died from complications. Premature birth rates worldwide have not changed over the past decade. Armed conflicts, climate change and COVID-19 are increasing the risk of prematurity. According to the Born Too Soon report (publ. June 2023), the number of babies born too soon between 2010 and 2020, as estimated by WHO and UNICEF, in collaboration with the London School of Hygiene and Tropical Medicine - is 152 million.
Extremely immature premature babies require comprehensive care, including modern technology, to survive. Most often - long-term specialized care and rehabilitation to compensate for developmental differences, including: delayed speech development, cognitive dysfunction. In a premature baby, immaturity of organs and systems can be associated with the occurrence of complications: bronchopulmonary dysplasia, retinopathy of prematurity, hearing loss, cardiac or neurological problems. Researchers from the British Universities of York, Leeds and Leicester, in a meta-analysis of data on some 8 million children from more than 75 studies from around the world, found that each pregnancy shortening by a week increases the risk of developmental disorders, most commonly with: speech delay and learning difficulties. Infants born between 32 and 33 weeks have a 14 times higher risk of cerebral palsy than those born on time. Researchers speculate that disruption of central nervous system (CNS) development leads to this type of disorder. Developmental difficulties in children born between the 32nd and 38th weeks of pregnancy can persist throughout childhood.
Standards
To reduce neonatal mortality associated with preterm birth and/or low birth weight, various interventions are used. Guidelines for the care of these babies are issued by the World Health Organization, the Union of European Neonatal & Perinatal Societies (UENPS), one of the partners in the European Standards of Care for Newborns, among others. The European Foundation for the Care of Newborn Infants (EFCNI), the first pan-European organization representing the interests of preterm and newborn infants and their families, bringing together parents, experts from various health care fields and researchers to improve the health of preterm and newborn infants, reducing the number of preterm births. Also, The European Standards of Care for Newborn Health (ESCNH) project, an EFCNI initiative, provides reference standards in the care of preterm and newborn babies. In 2021. EFCNI revised 20 ESCNH standards according to the latest scientific evidence, and updated several according to new guidelines. Standards of care for preterm infants are also created by pediatric and neonatal societies, such as the European Society for Pediatric Research (ESPR), Europe's oldest pediatric scientific society, the Union of Neonatal and Perinatal Societies and the Polish Neonatal Society. Their implementation is supported by non-governmental organizations, such as the European Foundation for the Care of Newborn Infants (EFCNI - a society representing the broad interests of premature infants and their families) and the Great Orchestra of Christmas Charity.
Every two years, the Congress of Joint European Neonatal Societies brings together clinicians and researchers in neonatology and pediatrics from around the world. It is co-organized by, among others: ESPR, the Union of European Neonatal & Perinatal Societies (UENPS), a union of European neonatal and perinatal societies including PTN, and EFCNI. The standardization of management concerns, among other things, the management of postnatal stabilization of the newborn. A member of the scientific committee of the 5th jENS Congress in 2023 in Rome was Prof. Tomasz Szczapa, who clinically deals with issues such as optimization of respiratory support, monitoring and resuscitation of the newborn. As a member of the "Newborn Life Support Science & Education Committee" of the European Resuscitation Council, he co-wrote the latest edition of the guidelines for neonatal resuscitation. As national director of NLS (Newborn Life Support) courses and Head of the NLS Working Group of the Polish Resuscitation Council, he has been organizing and supervising the implementation of NLS training for more than 10 years. In the care of premature infants, thanks to scientific evidence, resuscitation technique, treatment of respiratory distress syndrome have been improved, and elements of so-called FCC Family Centered Care have been introduced in many hospitals.
Resuscitation canon: establish an airway, provide ventilation/breathing, stabilize the cardiovascular system, medications
For the purposes of the European Resuscitation Council guidelines, the recommendations of ILCOR (International Liaison Committee on Resuscitation) were supplemented with issues not included in the 2020 consensus with data from literature reviews conducted by the European Resuscitation Council's Guidelines Group on neonatal resuscitation procedures. Guideline 2021 - current resuscitation recommendations in Europe - premature infants born ≤32 weeks of gestation: the baby should be covered completely (except for the face) without dryinǵ with polyethylene sheeting and placed́ under a radiant warmer (maintaining optimal body temperature reduces mortality); with delayed clamping of the umbilical cord, if the use of a radiant warmer is not possible, it is necessary to implement other methods to maintain the normal temperature of the neonate remaining connected to the placenta; babies born ≤32. weeks of gestation may̨ requiré e.g. increasing the temperature of the room, covering with warm blankets, putting on a cap and using a heated mattress; those of lower maturity or birth weight are placed in direct contact with the mother, under supervision to avoid hypothermia; with respiratory support, one must consideŕ the use of humidified and heated respiratory gases. In premature infants born < 32 weeks gestation, an initial pressure of 25 cm H2O is suggested. It is recommended that the initial concentration of oxygen in the breathing mixture should be 21% in infants born at 32 weeks of gestation and above, 21-30% in those born between 28 and 31 weeks, and 30% in those born < 28 weeks of gestation. This concentration should be titrated so that the saturation at the 5th minute of life is ≥80%. Failure to achieve this value is an unfavorable prognostic factor.
Treatment of respiratory distress syndrome
Updated "European guidelines for the management of HCAI "2, include protocols for protecting the lungs: starting to support the patient's own breathing with CPAP (continuous positive airway pressure) technique and adequate oxygen supplementation after birth. Early treatment and avoidance of mechanical ventilation is a key element in the treatment of HCAI. Conducting non-invasive respiratory support reduces the risk of bronchopulmonary dysplasia, among others, while better mechanical ventilation technology and minimizing its duration reduce the risk of lung damage and CNS complications. Protocols for optimizing the care of infants with FMS also include temperature control, nutrition, optimization of perfusion and judicious use of antibiotics.
Family centered care - family centered care (FCC)
Complications of prematurity are the leading cause of death in the neonatal period. Premature babies have an increased likelihood of disability and developmental delays. To survive, grow and thrive, they require special care. Social activism around the prevention of preterm birth by families, health professionals, academia and civil society - the CLP/WR (CLP Network for Surveillance and Research in Women's, Maternal and Neonatal Health) - creates a network for surveillance and research on women's, maternal and newborn health. The FCC promotes unrestricted admission of families to neonatal intensive care units. "Breastfeeding and early attachment have a positive impact on babies, especially premature infants, and have lifelong benefits," says Pan American Health Organization (PAHO/WHO) Regional Perinatal Health Advisor Pablo Durán. "The involvement of families is fundamental and is a perspective that all health centers caring for newborns should adopt," he believes.
Source: "Health Service"
