How does being born at 25 weeks gestation affect long-term health. What are the risks and outcomes for extremely premature babies. Can adults born prematurely overcome health challenges. How is research improving care for preterm infants.

The Miracle of Extremely Premature Survival

The story of Camille Girard-Bock, born at just 26 weeks gestation in 1992, exemplifies the remarkable progress made in neonatal care for extremely premature infants. Despite initial fears for her survival, Camille not only lived but thrived, growing up to pursue a PhD in biomedical sciences. Her journey from a 920-gram (2-pound) newborn to a accomplished young adult showcases the potential for positive outcomes in cases of extreme prematurity.

Extremely premature births, defined as those occurring before 25-28 weeks of gestation, pose significant challenges for both infants and medical professionals. These tiny babies face numerous health risks due to their underdeveloped organs, particularly their lungs. The introduction of surfactant treatment in the early 1990s marked a turning point in premature infant care, dramatically improving survival rates.

Understanding Long-Term Health Implications

As the first generation of extremely premature survivors reaches adulthood, researchers are gaining unprecedented insights into the long-term effects of early birth. Contrary to expectations, health concerns may extend beyond childhood and adolescence, manifesting in adulthood.

Cardiovascular Risks in Adulthood

Recent studies have identified an increased risk of cardiovascular disease among young adults born extremely prematurely. This discovery highlights the need for ongoing health monitoring and preventive care throughout the lifespan of these individuals.

Cognitive and Neurological Outcomes

While many extremely premature infants grow up to lead healthy lives, cognitive deficits and conditions such as cerebral palsy remain significant concerns. Understanding these potential outcomes is crucial for parents making difficult decisions about their premature infant’s care.

Advancements in Neonatal Care

The field of neonatal medicine has seen remarkable progress since the late 20th century. Key developments include:

• Introduction of ventilators in the 1970s
• Use of corticosteroids to mature fetal lungs before early delivery
• Surfactant treatment in the early 1990s

These advancements have significantly improved survival rates for extremely premature infants, allowing babies born as early as 25 weeks to have a fighting chance at life.

Ongoing Research and Clinical Trials

Scientists are actively working to further improve outcomes for extremely premature infants and address long-term health concerns. Current areas of focus include:

1. Novel interventions to boost survival rates
2. Compounds aimed at improving lung, brain, and eye function
3. Parent-support programs
4. Exercise regimens to minimize cardiovascular risks in adulthood

These research efforts aim to not only increase survival rates but also enhance the quality of life for individuals born extremely prematurely.

The Role of Cohort Studies in Understanding Prematurity

Long-term cohort studies, such as the Victorian Infant Collaborative Study (VICS) in Australia, play a crucial role in understanding the lifelong impacts of extreme prematurity. These studies provide valuable data on health outcomes, allowing researchers to identify potential risks and develop targeted interventions.

How do cohort studies contribute to our understanding of prematurity? By following participants from birth into adulthood, these studies offer a comprehensive view of the developmental trajectory and health challenges faced by individuals born extremely prematurely. This longitudinal approach enables researchers to identify late-onset conditions and develop strategies for early intervention and prevention.

Navigating Adulthood After Extreme Prematurity

For adults like Camille Girard-Bock who were born extremely prematurely, the journey continues beyond childhood. While aware of potential health risks, many maintain a positive outlook, drawing strength from their early survival against the odds.

What challenges do adults born prematurely face? Some may need to be vigilant about cardiovascular health, while others might contend with cognitive or physical disabilities. However, with appropriate medical care and support, many lead fulfilling lives and contribute significantly to their fields, as exemplified by Girard-Bock’s pursuit of a PhD focused on the very condition she experienced.

The Ethical Dimensions of Extreme Prematurity

The increasing survival rates of extremely premature infants raise important ethical questions for healthcare providers and parents. Decisions about continuing intensive care for these fragile newborns must balance the potential for survival against the risk of severe disability.

How do medical professionals approach these ethical dilemmas? They consider factors such as gestational age, birth weight, and the presence of complications. Transparent communication with parents about potential outcomes and available support is crucial. As research progresses, these conversations become more nuanced, incorporating new data on long-term outcomes and quality of life.

Innovations in Supportive Care for Premature Infants

Beyond medical interventions, researchers are exploring holistic approaches to support the development of extremely premature infants. These include:

• Kangaroo care (skin-to-skin contact)
• Optimized nutrition strategies
• Developmental care practices in the NICU
• Early intervention programs for cognitive and motor development

How do these supportive care practices benefit premature infants? They can promote better bonding between parents and infants, support optimal growth and development, and potentially mitigate some of the long-term health risks associated with extreme prematurity.

The Global Perspective on Extreme Prematurity

While advancements in neonatal care have improved outcomes in many developed countries, the challenges of extreme prematurity remain significant in resource-limited settings. Addressing this disparity is a crucial aspect of global health efforts.

What strategies can help improve outcomes for premature infants worldwide? Potential approaches include:

1. Technology transfer and training programs for healthcare providers
2. Development of low-cost, sustainable interventions
3. Implementation of standardized care protocols
4. Increased funding for neonatal care in low-resource settings

By addressing these global disparities, researchers and healthcare providers can work towards ensuring that all extremely premature infants have the best possible chance at survival and long-term health, regardless of where they are born.

The Future of Premature Infant Care

As research continues to unveil the long-term impacts of extreme prematurity, the field of neonatal care is poised for further advancements. Emerging areas of study include:

• Personalized medicine approaches based on genetic profiles
• Advanced imaging techniques to guide interventions
• Stem cell therapies for organ development and repair
• Artificial womb technology for supporting the most premature infants

How might these advancements shape the future of premature infant care? They could potentially push the boundaries of viability even further, improve long-term outcomes, and provide new hope for infants born at the earliest gestational ages.

The Importance of Multidisciplinary Care

As our understanding of the long-term impacts of extreme prematurity grows, it becomes increasingly clear that a multidisciplinary approach to care is essential. This approach involves collaboration among various healthcare specialists, including:

• Neonatologists
• Pediatricians
• Neurologists
• Cardiologists
• Developmental specialists
• Psychologists
• Occupational and physical therapists

Why is a multidisciplinary approach crucial for individuals born extremely prematurely? It ensures comprehensive care that addresses the complex and interconnected health challenges these individuals may face throughout their lives. By coordinating care across specialties, healthcare providers can offer more targeted interventions and support, potentially improving long-term outcomes.

The Role of Technology in Monitoring and Care

Advancements in technology are playing an increasingly important role in the care and monitoring of extremely premature infants, both in the NICU and beyond. Some key technological innovations include:

1. Advanced monitoring systems for vital signs and organ function
2. Telemedicine platforms for remote consultations and follow-up care
3. Wearable devices for long-term health tracking
4. AI-assisted decision support tools for healthcare providers

How does technology enhance care for premature infants and adults born prematurely? These tools enable more precise monitoring, early detection of potential complications, and improved coordination of care. For adults, technology can facilitate ongoing health management and provide valuable data for research into long-term outcomes.

Empowering Families and Individuals

Support for families of extremely premature infants and for individuals born prematurely is a crucial aspect of care that extends far beyond the NICU. Empowerment strategies include:

• Parent education programs
• Peer support networks
• Transition support for adolescents entering adult healthcare systems
• Career and life skills coaching for adults born prematurely

How do these support systems benefit individuals and families affected by extreme prematurity? They provide essential emotional support, practical guidance, and a sense of community. By empowering families and individuals with knowledge and resources, these programs can help improve quality of life and long-term outcomes.

The Impact of Environmental Factors

Research is increasingly focusing on the role of environmental factors in shaping long-term outcomes for individuals born extremely prematurely. Areas of interest include:

1. The impact of early nutrition on long-term health
2. The effects of environmental toxins on developing organs
3. The influence of socioeconomic factors on health outcomes
4. The role of stress and trauma in long-term health trajectories

Why is understanding environmental influences important? It can help identify modifiable risk factors and inform interventions to improve outcomes. By addressing environmental challenges, healthcare providers and policymakers can work towards creating more supportive conditions for the healthy development of extremely premature infants.

Celebrating Resilience and Success

While research often focuses on the challenges faced by those born extremely prematurely, it’s equally important to recognize and celebrate the resilience and achievements of this population. Many individuals, like Camille Girard-Bock, go on to lead fulfilling lives and make significant contributions to society.

How can highlighting success stories benefit the premature birth community? These narratives can provide hope and inspiration to families facing the challenges of extreme prematurity. They also help shift public perception, emphasizing the potential for positive outcomes and the value of investing in care and support for this population.

As research continues and medical advancements progress, the outlook for extremely premature infants continues to improve. While challenges remain, the combination of scientific innovation, comprehensive care, and the inherent resilience of these tiny fighters offers hope for even better outcomes in the future. The story of extreme prematurity is one of ongoing discovery, challenge, and triumph—a testament to the power of medical science and the human spirit.

the long-term impacts of being born extremely early

Scientists are watching out for the health of adults born extremely premature, such as these people who took part in a photography project.Credit: Red Méthot

They told Marcelle Girard her baby was dead.

Back in 1992, Girard, a dentist in Gatineau, Canada, was 26 weeks pregnant and on her honeymoon in the Dominican Republic.

When she started bleeding, physicians at the local clinic assumed the baby had died. But Girard and her husband felt a kick. Only then did the doctors check for a fetal heartbeat and realize the baby was alive.

The couple was medically evacuated by air to Montreal, Canada, then taken to the Sainte-Justine University Hospital Center. Five hours later, Camille Girard-Bock was born, weighing just 920 grams (2 pounds).

Babies born so early are fragile and underdeveloped. Their lungs are particularly delicate: the organs lack the slippery substance, called surfactant, that prevents the airways from collapsing upon exhalation. Fortunately for Girard and her family, Sainte-Justine had recently started giving surfactant, a new treatment at the time, to premature babies.

After three months of intensive care, Girard took her baby home.

Today, Camille Girard-Bock is 27 years old and studying for a PhD in biomedical sciences at the University of Montreal. Working with researchers at Sainte-Justine, she’s addressing the long-term consequences of being born extremely premature — defined, variously, as less than 25–28 weeks in gestational age.

Families often assume they will have grasped the major issues arising from a premature birth once the child reaches school age, by which time any neurodevelopmental problems will have appeared, Girard-Bock says. But that’s not necessarily the case. Her PhD advisers have found that young adults of this population exhibit risk factors for cardiovascular disease — and it may be that more chronic health conditions will show up with time.

Camille Girard-Bock, born at 26 weeks of gestation, is now studying the effects of prematurity for a PhD. Credit: Red Méthot

Girard-Bock doesn’t let these risks preoccupy her. “As a survivor of preterm birth, you beat so many odds,” she says. “I guess I have some kind of sense that I’m going to beat those odds also.”

She and other against-the-odds babies are part of a population which is larger now than at any time in history: young adults who are survivors of extreme prematurity. For the first time, researchers can start to understand the long-term consequences of being born so early. Results are pouring out of cohort studies that have been tracking kids since birth, providing data on possible long-term outcomes; other studies are trialling ways to minimize the consequences for health.

These data can help parents make difficult decisions about whether to keep fighting for a baby’s survival. Although many extremely premature infants grow up to lead healthy lives, disability is still a major concern, particularly cognitive deficits and cerebral palsy.

Researchers are working on novel interventions to boost survival and reduce disability in extremely premature newborns. Several compounds aimed at improving lung, brain and eye function are in clinical trials, and researchers are exploring parent-support programmes, too.

Researchers are also investigating ways to help adults who were born extremely prematurely to cope with some of the long-term health impacts they might face: trialling exercise regimes to minimize the newly identified risk of cardiovascular disease, for example.

“We are really at the stage of seeing this cohort becoming older,” says neonatologist Jeanie Cheong at the Royal Women’s Hospital in Melbourne, Australia. Cheong is the director of the Victorian Infant Collaborative Study (VICS), which has been following survivors for four decades. “This is an exciting time for us to really make a difference to their health.”

The late twentieth century brought huge changes to neonatal medicine. Lex Doyle, a paediatrician and previous director of VICS, recalls that when he started caring for preterm infants in 1975, very few survived if they were born at under 1,000 grams — a birthweight that corresponds to about 28 weeks’ gestation. The introduction of ventilators, in the 1970s in Australia, helped, but also caused lung injuries, says Doyle, now associate director of research at the Royal Women’s Hospital. In the following decades, doctors began to give corticosteroids to mothers due to deliver early, to help mature the baby’s lungs just before birth. But the biggest difference to survival came in the early 1990s, with surfactant treatment.

“I remember when it arrived,” says Anne Monique Nuyt, a neonatologist at Sainte-Justine and one of Girard-Bock’s advisers. “It was a miracle.” Risk of death for premature infants dropped to 60–73% of what it was before^1,2.

Marcelle Girard looks in at baby Camille, born weighing just 920 grams (2 pounds).Credit: Camille Girard-Bock

Today, many hospitals regularly treat, and often save, babies born as early as 22–24 weeks. Survival rates vary depending on location and the kinds of interventions a hospital is able to provide. In the United Kingdom, for example, among babies who are alive at birth and receiving care, 35% born at 22 weeks survive, 38% at 23 weeks, and 60% at 24 weeks³.

For babies who survive, the earlier they are born, the higher the risk of complications or ongoing disability (see ‘The effects of being early’). There is a long list of potential problems — including asthma, anxiety, autism spectrum disorder, cerebral palsy, epilepsy and cognitive impairment — and about one-third of children born extremely prematurely have one condition on the list, says Mike O’Shea, a neonatologist at the University of North Carolina School of Medicine in Chapel Hill, who co-runs a study tracking children born between 2002 and 2004. In this cohort, another one-third have multiple disabilities, he says, and the rest have none.

“Preterm birth should be thought of as a chronic condition that requires long-term follow-up,” says Casey Crump, a family physician and epidemiologist at the Icahn School of Medicine at Mount Sinai in New York, who notes that when these babies become older children or adults, they don’t usually get special medical attention. “Doctors are not used to seeing them, but they increasingly will.”

Outlooks for earlies

What should doctors expect? For a report in the Journal of the American Medical Association last year⁴, Crump and his colleagues scraped data from the Swedish birth registry. They looked at more than 2.5 million people born from 1973 to 1997, and checked their records for health issues up until the end of 2015.

Source: Ref. 4

Of the 5,391 people born extremely preterm, 78% had at least one condition that manifested in adolescence or early adulthood, such as a psychiatric disorder, compared with 37% of those born full-term. When the researchers looked at predictors of early mortality, such as heart disease, 68% of people born extremely prematurely had at least one such predictor, compared with 18% for full-term births — although these data include people born before surfactant and corticosteroid use were widespread, so it’s unclear if these data reflect outcomes for babies born today. Researchers have found similar trends in a UK cohort study of extremely premature births. In results published earlier this year⁵, the EPICure study team, led by neonatologist Neil Marlow at University College London, found that 60% of 19-year-olds who were extremely premature were impaired in at least one neuropsychological area, often cognition.

Such disabilities can impact education as well as quality of life. Craig Garfield, a paediatrician at the Northwestern University Feinberg School of Medicine and the Lurie Children’s Hospital of Chicago, Illinois, addressed a basic question about the first formal year of schooling in the United States: “Is your kid ready for kindergarten, or not?”

To answer it, Garfield and his colleagues analysed standardized test scores and teacher assessments on children born in Florida between 1992 and 2002. Of those born at 23 or 24 weeks, 65% were considered ready to start kindergarten at the standard age, 5–6 years old, with the age adjusted to take into account their earlier birth. In comparison, 85.3% of children born full term were kindergarten-ready⁶.

Despite their tricky start, by the time they reach adolescence, many people born prematurely have a positive outlook. In a 2006 paper⁷, researchers studying individuals born weighing 1,000 grams or less compared these young adults’ perceptions of their own quality of life with those of peers of normal birthweight — and, to their surprise, found that the scores were comparable. Conversely, a 2018 study⁸ found that children born at less than 28 weeks did report having a significantly lower quality of life. The children, who did not have major disabilities, scored themselves 6 points lower, out of 100, than a reference population.

As Marlow spent time with his participants and their families, his worries about severe neurological issues diminished. Even when such issues are present, they don’t greatly limit most children and young adults. “They want to know that they are going to live a long life, a happy life,” he says. Most are on track to do so. “The truth is, if you survive at 22 weeks, the majority of survivors do not have a severe, life-limiting disability.”

A nurse uses electroencephalography (EEG) to carry out a check of brain development on a baby born at 25 weeks.Credit: BSIP/Universal Images Group via Getty

Breathless

But scientists have only just begun to follow people born extremely prematurely into adulthood and then middle age and beyond, where health issues may yet lurk. “I’d like scientists to focus on improving the long-term outcomes as much as the short-term outcomes,” says Tala Alsadik, a 16-year-old high-school student in Jeddah, Saudi Arabia.

When Alsadik’s mother was 25 weeks pregnant and her waters broke, doctors went so far as to hand funeral paperwork to the family before consenting to perform a caesarean section. As a newborn, Alsadik spent three months in the neonatal-intensive-care unit (NICU) with kidney failure, sepsis and respiratory distress.

The complications didn’t end when she went home. The consequences of her prematurity are on display every time she speaks, her voice high and breathy because the ventilator she was put on damaged her vocal cords. When she was 15, her navel unexpectedly began leaking yellow discharge, and she required surgery. It turned out to be caused by materials leftover from when she received nutrients through a navel tube.

That certainly wasn’t something her physicians knew to check for. In fact, doctors don’t often ask if an adolescent or adult patient was born prematurely — but doing so can be revealing.

Charlotte Bolton is a respiratory physician at the University of Nottingham, UK, where she specializes in patients with chronic obstructive pulmonary disease (COPD). People coming into her practice tend to be in their 40s or older, often current or former smokers. But in around 2008, she began to notice a new type of patient being referred to her owing to breathlessness and COPD-like symptoms: 20-something non-smokers.

Quizzing them, Bolton discovered that many had been born before 32 weeks. For more insight, she got in touch with Marlow, who had also become concerned about lung function as the EPICure participants aged. Alterations in lung function are a key predictor of cardiovascular disease, the leading cause of death around the world. Clinicians already knew that after extremely premature birth, the lungs often don’t grow to full size. Ventilators, high oxygen levels, inflammation and infection can further damage the immature lungs, leading to low lung function and long-term breathing problems, as Bolton, Marlow and their colleagues showed in a study of 11-year-olds⁹.

Treatments for premature babies have improved in recent decades, but survival rates vary by age and country.Credit: Mohammed Hamoud/Getty

VICS research backs up the cardiovascular concerns: researchers have observed diminished airflow in 8-year-olds, worsening as they aged¹⁰, as well as high blood pressure in young adults¹¹. “We really haven’t found the reason yet,” says Cheong. “That opens up a whole new research area.”

At Sainte-Justine, researchers have also noticed that young adults who were born at 28 weeks or less are at nearly three times the usual risk of having high blood pressure¹². The researchers figured they would try medications to control it. But their patient advisory board members had other ideas — they wanted to try lifestyle interventions first.

The scientists were pessimistic as they began a pilot study of a 14-week exercise programme. They thought that the cardiovascular risk factors would be unchangeable. Preliminary results indicate that they were wrong; the young adults are improving with exercise.

Girard-Bock says the data motivate her to eat healthily and stay active. “I’ve been given the chance to stay alive,” she says. “I need to be careful.”

From the start

For babies born prematurely, the first weeks and months of life are still the most treacherous. Dozens of clinical trials are in progress for prematurity and associated complications, some testing different nutritional formulas or improving parental support, and others targeting specific issues that lead to disability later on: underdeveloped lungs, brain bleeds and altered eye development.

For instance, researchers hoping to protect babies’ lungs gave a growth factor called IGF-1 — which the fetus usually gets from its mother during the first two trimesters of pregnancy — to premature babies in a phase II clinical trial reported¹³ in 2016. Rates of a chronic lung condition that often affects premature babies halved, and babies were somewhat less likely to have a severe brain haemorrhage in their earliest months.

Another concern is visual impairment. Retina development halts prematurely when babies born early begin breathing oxygen. Later it restarts, but preterm babies might then make too much of a growth factor called VEGF, causing over-proliferation of blood vessels in the eye, a disorder known as retinopathy. In a phase III trial announced in 2018, researchers successfully treated 80% of these retinopathy cases with a VEGF-blocking drug called ranibizumab¹⁴, and in 2019 the drug was approved in the European Union for use in premature babies.

Some common drugs might also be of use: paracetamol (acetaminophen), for example, lowers levels of biomolecules called prostaglandins, and this seems to encourage a key fetal vein in the lungs to close, preventing fluid from entering the lungs¹⁵.

But among the most promising treatment programmes, some neonatologists say, are social interventions to help families after they leave the hospital. For parents, it can be nerve-racking to go it alone after depending on a team of specialists for months, and lack of parental confidence has been linked to parental depression and difficulties with behaviour and social development in their growing children.

At Women & Infants Hospital of Rhode Island in Providence, Betty Vohr is director of the Neonatal Follow-Up Program. There, families are placed in private rooms, instead of sharing a large bay as happens in many NICUs. Once they are ready to leave, a programme called Transition Home Plus helps them to prepare and provides assistance such as regular check-ins by phone and in person in the first few days at home, and a 24/7 helpline. For mothers with postnatal depression, the hospital offers care from psychologists and specialist nurses.

The results have been significant, says Vohr. The single-family rooms resulted in higher milk production by mothers: 30% more at four weeks than for families in more open spaces. At 2 years old, children from the single-family rooms scored higher on cognitive and language tests¹⁶. After Transition Home Plus began, babies discharged from the NICU had lower health-care costs and fewer hospital visits — issues that are of great concern for premature infants¹⁷. Other NICUs are developing similar programmes, Vohr says.

With these types of novel intervention, and the long-term data that continue to pour out of studies, doctors can make better predictions than ever before about how extremely premature infants will fare. Although these individuals face complications, many will thrive.

Alsadik, for one, intends to be a success story. Despite her difficult start in life, she does well academically, and plans to become a neonatologist. “I, also, want to improve the long-term outcomes of premature birth for other people.”

Micro Preemie Survival Rates and Health Concerns

A micro preemie is a baby who is born weighing less than 1 pound, 12 ounces (800 grams), or before 26 weeks gestation. Since micro preemies are born months before their due dates, they face long stays in the neonatal intensive care unit (NICU). Although many extremely premature babies grow up with no long-term effects of premature birth, some face severe health problems throughout life.

Premature Baby vs. Micro Preemie

To give you some context, any baby who is born before 37 weeks gestation is considered to be premature (also known as preterm).

Stages of Prematurity

Babies who are born between 34 and 37 weeks gestation are named “late preterm. ” Those who are born between 31 weeks and 34 weeks gestation are labeled “moderately premature,” while babies who are born between 27 weeks and 30 weeks gestation are called “very premature.”

Micro Preemies

Micro preemies are the most premature babies of all, born on or before 26 weeks. Many people are surprised by how small micro preemies are. Their skin is thin, with visible veins, and it may look sticky or gelatinous. If you are visiting a micro preemie in the NICU, you can expect to see the following:

• Respiratory support: Micro preemies usually have endotracheal tubes (ET Tubes) coming from their mouths. The tube is attached to a ventilator that helps your baby breathe. Some micro preemies can breathe on their own and will be on continuous positive airway pressure (CPAP) instead. These babies will have CPAP masks strapped firmly over their noses.
• Intravenous lines (IVs): If a micro preemies’ digestive system is too immature to absorb nutrition, they will be fed intravenously. Most will have lines in their umbilical cord stumps (called umbilical lines) for the first week or two of life, and a PICC line or peripheral IV later.
• Monitoring equipment: All NICU patients are closely monitored. Micro preemies may have wired stickers on their chests, feet, wrists, arms, and legs. They’re used to check blood pressure, breathing rates, and oxygen levels in the blood.
• NG/OG tube: Because micro preemies are too immature to eat from a bottle or from the breast, a tube will go from their mouths (OG tube) or noses (NG tube) into the stomach.

Micro Preemie Health Concerns

When a baby is born very prematurely, they are at risk for a number of health conditions. Some of the health concerns are short-term, while others may impact them for the rest of their lives.

Short-Term Health Concerns

Immediately after birth and during a micro preemie’s NICU stay, doctors and nurses watch closely for several serious medical conditions, such as these, below.

• Respiratory distress syndrome (RDS): Most micro preemies (about 85%) have difficulty breathing after birth. RDS is treated with respiratory support and medication.
• Patent ductus arteriosus (PDA): Just over half of micro preemies have a PDA. A PDA is a persistent connection between the large blood vessels near the heart. The connection is normal for a fetus but should close when a baby is born and begins to breathe. PDAs are treated with medication or surgery.
• Sepsis: Premature babies are prone to infection for several reasons. Micro preemies have immature immune systems and face many invasive procedures in the NICU, each of which can allow bacteria to enter the body. About 40% of micro preemies need antibiotics to treat bacterial infections.
• Intraventricular hemorrhage (IVH): IVH is bleeding into parts of the brain. Micro preemies have fragile blood vessels in their brains, and these vessels can rupture easily. About a quarter of micro preemies have serious IVH. Most cases of IVH resolve on their own, but some babies may need surgery to help drain the extra fluid.
• Retinopathy of Prematurity (ROP): The blood vessels in a micro preemie’s eyes are not fully formed at birth. When the vessels develop, they may grow so rapidly that they damage the retina. Just under 15% of micro preemies develop ROP, which usually resolves on its own. Surgery may be required in severe cases.
• Necrotizing Enterocolitis (NEC): Since micro preemies have immature digestive systems, their intestines are susceptible to infection. In NEC, the linings of the bowels become infected and begin to die. About 7% of micro preemies develop NEC, which can be extremely serious. NEC is treated with IV fluids and medication. Surgery may be required.

Long-Term Health Concerns

Many micro preemies show no long-term effects of prematurity. In fact, by age 8, about 60% have normal IQs. However, other micro preemies may have lifelong health issues, including the ones listed below.

• Cognitive problems: Developmental delays, trouble in school, and other cognitive problems are common effects of prematurity. About 20% of micro preemies have severe cognitive disabilities by age 8, and another 20% have mild to moderate cognitive problems.
• Cerebral palsy: About 10% of micro preemies have moderate to severe cerebral palsy.
• Chronic lung disease: About half of micro preemies need oxygen at NICU discharge. Micro preemies may also have asthma or other respiratory problems, including bronchopulmonary dysplasia, or BPD.
• Digestive problems: Micro preemies are prone to digestive problems such as gastroesophageal reflux disease (GERD), food refusal, or poor feeding.
• Vision or hearing loss: Between 2% and 3% of micro preemies have permanent vision or hearing problems due to complications of prematurity.

Survival Rate for Micro Preemies

Micro preemies are very fragile, and every day that you spend pregnant increases your baby’s chance of survival.

Improve Your Baby’s Chances

Although micro premies may face serious health problems, there are many things that you can do as a parent to give your baby the best possible start.

• Get early prenatal care: When you become pregnant, talk to your doctor early about how to minimize your risk of premature birth. Early prenatal care can help you avoid early delivery.
• Have your baby in a hospital with a NICU: If you know that your baby will be premature, delivering in a hospital with a level 3 NICU with 24-hour neonatology coverage can give your baby the best possible start.
• Learn the signs of preterm labor: While you’re pregnant, make sure that you understand the signs of preterm labor, and seek medical care immediately if you develop any of them.
• Seek early intervention: Babies born early may qualify for state-run early intervention programs. Starting these programs as soon as possible can help minimize any cognitive effects of prematurity.

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Verywell Family uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.

• Hoekstra, R et al. “Survival and Long-Term Neurodevelopmental Outcome of Extremely Premature Infants Born at 23-26 Weeks’ Gestational Age at a Tertiary Center.” Pediatrics Jan 2004; 113, c1-c7.
• Qiu, X et al. “Comparison of Singleton and Multiple-Birth Outcomes of Infants Born at or Before 32 Weeks of Gestation.” Obstetrics & Gynecology Feb 2008; 111, 365-371.
• Vohr, B et al. “Neurodevelopmental Outcomes of Extremely Low Birth Weight Infants <32 Weeks’ Gestation Between 1993 and 1998.” Pediatrics Sept 2005; 116, 635-643.

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Long-Term Impact of Being Born Premature

Whether an infant is born weeks or months early, parents worry about the long-term health effects of prematurity. They want to know what to expect, and how to prevent the problems caused by being born too soon.

Possible Long-Term Problems

The list of possible long-term problems of prematurity can terrify parents. But the news isn’t all bad. Even among micro-preemies, weighing less than 800 grams (about 1 lb 12 oz) at birth, most (60%) have normal neurological exams at 20 months of age. As weight and gestational age increase, the risks decrease.

Risks include:

• Learning problems: The most common long-term effect of prematurity is some form of learning disability. Disabilities may be mild, severe, or somewhere in between, and often don’t become apparent until children begin school. Math is most commonly affected; vocabulary and reading are least commonly affected. Early intervention and programs like Head Start can help minimize learning problems to encourage school success. 
• Vision and hearing problems: Micro-preemies are at risk for an eye condition called retinopathy of prematurity (ROP), a condition that can cause vision impairment or blindness. Because ROP is easiest to treat when it’s caught early, premature infants are screened early, often while they are still in the hospital. The condition is treated with freezing or with laser surgery, and most infants recover completely.
• Feeding and digestive problems: Premature infants often cannot drink from the breast or a bottle at birth, and may be fed with IV fluids or through a tube in the nose or mouth for several weeks. These early feeding challenges can cause long-term feeding difficulties, including food refusal and slow growth. Severe cases of necrotizing enterocolitis (NEC) may require bowel surgery, which can contribute to difficulty in feeding and digestion. Gastroesophageal reflux disease, also called GERD or reflux, is another problem that premature babies may have as they grow. Reflux may be mild or severe and may need to be treated by a doctor.
• Respiratory problems: Asthma, croup, and bronchiolitis are all more common in children who were born early than in children born at term. A more serious complication, bronchopulmonary dysplasia (BPD), is another possible risk of prematurity. Infants with BPD may need extra oxygen for longer periods of time, even after hospital discharge.
• Cerebral palsy: As many as 12% of micro-preemies develop cerebral palsy, a condition that affects movement and coordination. The condition may be mild or severe, and cognitive impairment may or may not be present. Many children with cerebral palsy use braces, wheelchairs, or other assistive devices to get from place to place.

What Can Parents Do to Lessen the Potential Long-Term Effects of Prematurity?

Most NICUs offer follow-up clinics for parents of premature infants, from the time they leave the NICU until they are in their second or third year of life. Attending all follow-up clinic appointments helps assure that any long-term effects of prematurity are caught early and treated promptly.

Preschool is critical for children who were born early. Head Start programs and traditional preschools can help smooth the transition into kindergarten, enhancing preemies’ academic preparation and allaying some of the schooling challenges preemies may face.

When premature infants enter school, parents will need to take an active role in their education to ensure that any challenges to learning are identified quickly. Early intervention can help prevent minor problems from becoming major ones and can help these tiny infants to maximize their abilities.

Premature birth statistics | Tommy’s

A preterm birth is one that happens before 37 completed weeks of pregnancy.

The World Health Organisation gives the following definitions for the different stages of preterm birth:

• Extremely preterm: before 28 weeks
• Very preterm: from 28 to 31 weeks
• Moderate to late preterm: from 32 to 37 weeks.

General UK premature birth statistics

• Around 8% of births in the UK are preterm. That is around 60,000 babies each year.
• This is higher than many countries in Europe and higher than Cuba and Iran

Of the births that were preterm in the UK:

• 5% were extremely preterm (before 28 weeks)
• 11% were very preterm (between 28 and 32 weeks)
• 85% were moderately preterm (between 32 and 37 weeks).

In 2019, live births where gestational age was under 24 weeks increased to 0.15% compared with 0.13% in 2018 and 0.11% in 2010.

Chances of survival following preterm birth

Medical advances mean that we are getting better at treating preterm babies but the chances of survival still depend on gestational age (week of pregnancy) at time of birth.

• Less than 22 weeks is close to zero chance of survival
• 22 weeks is around 10%
• 24 weeks is around 60%
• 27 weeks is around 89%
• 31 weeks is around 95%
• 34 weeks is equivalent to a baby born at full term.

Preterm birth and neonatal death

Complications arising from premature birth is the leading cause of neonatal death (death in the first few weeks after birth) in the UK. 

Preterm birth and multiple pregnancies

Having more than one baby is a risk factor for preterm birth. On average, most singleton pregnancies last 39 weeks, twin pregnancies 37 weeks and triplets 33 weeks.

• Risk of prematurity with singleton pregnancy: 7%
• Risk of prematurity with multiple pregnancy: 57%

Risk of disability in preterm children

Generally, the earlier the birth, the higher the risk of problems. However these are only statistics and cannot predict how an individual child will do; some extremely premature babies do very well and develop into healthy children.

• 1 in 10 of all premature babies will have a permanent disability such as lung disease, cerebral palsy, blindness or deafness.
• 1 in 2 of premature babies born before 26 weeks of gestation will have some sort of disability (this includes mild disability such as requiring glasses).

In one study of 241 children born before 26 weeks’ gestation the following was found:

• 22% severe disability (eg cerebral palsy + not walking, low cognitive scores, blindness, profound deafness)
• 24% moderate disability (eg cerebral palsy + walking, IQ/cognitive scores in the special needs range, lesser degree of visual or hearing impairment)
• 34% mild disability (defined as low IQ/cognitive score, squint, requiring glasses)
• 20% no problems.

Preterm birth by ethnicity

The risk of preterm birth is highest for Black Caribbean women and lowest for White British and White Other.

• Bangladeshi: 8%
• Indian: 7%
• Pakistani:7%
• Black African: 8%
• Black Caribbean: 10%
• White British: 7%
• White Other: 6%

Causes of preterm birth

In some cases a cause of preterm birth can be shown but more often it is unknown or unclear.

In 1 in 4 preterm births, the birth is planned (induced labour or c-section) to save the life of mother or baby from pregnancy complications such as pre-eclampsia, fetal growth restriction, waters breaking early (PPROM) or infection

Preventing premature birth

Too often health professionals are not able to tell women why they have had a premature birth. This area of research is underfunded, with many taking an unhelpful (and unique to pregnancy) approach of ‘It was not meant to be’.

Research into why premature birth happens is the only way we can save lives and prevent future loss. Tommy’s funds more than £400k of research into premature birth every year. We are focused on predicting early which women will have a premature birth and treating them to prevent it happening.

Read about our research into prematurity here.

Prediction of survival for preterm births

BMJ. 2000 Mar 4; 320(7235): 647.

Survival table was not easy to understand

T H H G Koh, neonatologist

Kirwan Hospital, Thuringowa, Queensland 4817, Australia

H Harrison, mother of a child born at 28 weeks

1144 Sterling Avenue, Berkeley CA 94708, USA

A Casey, mother of a baby born at 27 weeks

Seaholme, Victoria 3018, Australia

This article has been cited by other articles in PMC.

Editor—The article by Draper et al deserves further comment. ¹ The objective of the study was to produce current data on survival of preterm infants, yet theirs was a retrospective study for 1994-7. Since it is now 1999 we believe that their data, albeit useful, are recent rather than current. Antenatal administration of steroids to the mothers was not mentioned as one of the additional factors affecting infants’ survival.

As a neonatologist and two mothers of extremely premature babies we do not find the tables described in the paper easy to understand. Draper et al may be interested in our paper published last month, which describes a table giving outcome for parents of babies at less than 28 weeks of gestation.² This table contains information on survival rates, and also short term complications and treatment of the most recent cohort of such babies. This table could be unit based, updated annually, and be made available to the parents and each member of the perinatal team to promote consistency in the information given to the parents. We also suggest that parents be informed of 11 points, four of which are:

• Outcome for the baby depends on many factors, not all obvious and including infection and maternal and fetal health.

• A reasonably easy to remember guide is that the survival rate is about 40% for all babies born at 24 weeks’ gestation, 50% for those born at 25 weeks, 60% for those born at 26 weeks, 70% for those born at 27 weeks, and 80% for those born at 28 weeks.³

• Every baby is an individual, and the parents need to realise that their baby may be different from the average. The table is designed to share with parents risk factors that need to be understood within the unique context of the child and family.

• Babies born at 25 weeks and less are at high risk of death, a long, tortuous journey through life, and disability. Some babies born at 24 and 25 weeks do, however, seem to be developing normally.

The views of doctors, nurses, and parents with respect to such information must be sought out. We have just completed a study of 71 perinatologists, 35 neonatal nurses, and 48 parents of extremely premature babies, seeking their views of our outcome table. We found that parents were the most positive and accepting of the table, followed by nurses in second position, and finally by doctors.

References

1. Draper ES, Manktelow B, Field DJ, James D. Prediction of survival for preterm births by weight and gestational age: retrospective population based study. BMJ. 1999;319:1093–1097. [PMC free article] [PubMed] [Google Scholar]2. Koh THHG, Harrison H, Morley C. Gestation vs morbidity chart for parents in NICU. J Perinatol. 1999;19:452–453. [PubMed] [Google Scholar]3. Koh THHG. Simplified way of counselling parents about outcome of extremely premature babies. Lancet. 1996;348:963. [PubMed] [Google Scholar]

Premature Baby Categories, Outlooks and Complications Based on the Week of Birth

First, the good news: Advances in medical care mean the outcomes for preterm babies have improved in recent decades, and even the smallest of premature babies have a greater chance of surviving and living healthy lives.

Nevertheless, giving birth early can feel overwhelming. Will your preemie baby be okay? How long will he stay in the neonatal intensive care unit (NICU)? What’s the long-term outlook?

While the answer to these questions depends on a number of factors, arming yourself with general knowledge of outlooks by birth date can help you to feel more in control and better prepared to handle your baby’s hospital stay.

How preemies are categorized

Your preemie’s care, length of stay in the NICU and chances of complications depend on the category of preemie he is. In general, the earlier your baby is born, the longer and more complicated the stay in the NICU. The general categories include:

• Extremely preterm. Babies born at or before 28 weeks of pregnancy.
• Very preterm. Babies born between 28 and 32 weeks of pregnancy.
• Moderate preterm. Babies born between 32 to 34 weeks of pregnancy.
• Late preterm. Babies born between 34 to 36 weeks of pregnancy.
• Early term. Babies born between 37 to 39 weeks of pregnancy.

Premature babies aren’t only categorized by gestational age. A preterm baby’s health and treatment in the NICU also has a lot to do with size at birth — usually the smaller the baby, the greater the chances for a longer hospital stay and possibility for complications:

• Low birth weight is considered less than 5 pounds, 8 ounces.
• Very low birth weight is less than 3 pounds, 5 ounces.
• Extremely low birth weight is less than 2 pounds, 3 ounces.
• Micro preemies are the smallest and youngest babies, born weighing less than 1 pound, 12 ounces (800 grams) or before 26 weeks gestation.

Babies born before 28 weeks

The outlook for very extreme preemies born before 28 weeks has improved significantly over the years thanks to medical advances.

Some studies have found that more than 50 percent of babies born at 23 weeks survive, more than three-quarters of babies born at 25 weeks survive and more than 90 percent of babies born at 26 weeks survive.

What happens in the NICU?

Because their respiratory systems aren’t fully developed, these tiny babies need help breathing. And since the ability to coordinate reflexes like sucking and swallowing doesn’t kick in until around 34 weeks gestation, they aren’t able to eat on their own.

Most receive nutrition and fluids intravenously (through an IV) or feeding tube. Because of their extremely low birth weight, they’ll need to gain a few pounds.

Additionally, extreme preemies are at an increased risk of complications, including respiratory distress syndrome (RDS, a lung disorder), hypoglycemia (low blood sugar), hypothermia (difficulty staying warm), jaundice, urinary tract infections and pneumonia. All of these can increase the amount of time a baby needs to stay in the hospital.

How long before your baby can go home?

Extreme preemies without complications are typically ready for discharge two to three weeks before their due date. But babies who have endured health complications as a result of their preterm status, such as breathing problems or difficulty gaining weight, may have to stay in the NICU well after their anticipated birth date.

Generally speaking, the earlier the baby is born, the more likely he will have to stay past his due date. But new parents shouldn’t get their hopes dashed when baby has to stay a little longer. Soon enough, your little bundle will be ready to go home.

Babies born between 28 and 32 weeks

Babies born after 28 weeks of pregnancy have almost a full (94 percent) chance of survival, although they tend to have more complications and require intensive treatment in the NICU than babies born later, according to experts at the American Academy of Pediatrics (AAP).

Babies born after week 30 tend to have little to no long-term health or developmental problems. Most babies born before 32 weeks, however, tend to have breathing difficulties.

What happens in the NICU?

Babies who have breathing difficulties will likely need to use a respirator (ventilator) for a while. Some have trouble feeding and may initially receive their meals through a tube that’s inserted into the nose or mouth and passed down to the stomach. This is called gavage feeding.

Because their immune systems are still developing, they’re also at a greater risk of infection, and they’re more prone to hypoglycemia and hypothermia.

How long before your baby can go home?

Babies born at this age usually go home a couple of weeks before or right around their original due date, as long as they don’t experience any serious complications or illnesses.

Babies born between 32 and 36 weeks

Moderate and late-term (or near-term) preemies have spent quite a bit of time in Mom’s womb, so they have nearly full odds of survival.

What happens in the NICU?

Most babies in this category are less likely to have severe breathing problems (thanks to some development of lung-maturing surfactant in utero), but they may need help with breathing for a few hours or days.

Some may require gavage feeding, but most will be able to nipple-feed. As with any preterm baby, they’re still at risk for infections and problems like jaundice, hypoglycemia and hypothermia.

How long before your baby can go home?

It depends on the baby’s gestational age at delivery and may be anywhere from just after birth to a few days or a few weeks. If all checks out with your baby, he may be able to go home right away. But if there are any issues, your baby will have to stay for a (likely very short) while.

Babies born between 37 and 38 weeks

For decades, “full-term” described any pregnancy that lasted until 37 weeks up to 42 weeks. But a few years ago, the American College of Obstetricians and Gynecologists (ACOG) changed the definition. Now a full-term pregnancy is considered between 39 weeks of pregnancy through 40 weeks and 6 days.

That means a delivery that occurs between 37 weeks and 38 weeks, 6 days is referred to as an “early-term” delivery. These early-term babies still have a risk of infections and other problems, but the odds of serious complications are very low.

What happens in the NICU?

At this point, babies are usually right on track developmentally, so any treatment will be minimal.

How long before your baby can go home?

Many babies in this category don’t have to spend any time at all in the NICU. At most, it will likely be a couple of weeks tops.

Going home with your baby

No matter your baby’s gestational age at birth, he must meet a few requirements before his doctors will determine it’s safe to take him home. He must:

• Breathe on his own
• Maintain a stable temperature
• Feed by breast or bottle
• Reach a certain weight and be gaining weight steadily
• Have no unresolved acute medical concerns such as apnea (when preemies stop breathing for short periods of time while they’re sleeping)

Until your baby meets these requirements, he’ll have to stay in the NICU for monitoring and care. But once your baby meets all these criteria and barring any other complications, you’ll be able to bundle him up, take him home and enjoy your new life together.

Our Daughter Was Born at 25 Weeks

At 23 weeks gestation, we were given some devastating news about our sweet baby girl. She is a twin, but her sister hadn’t had a heartbeat since eight weeks. My wife, Laura, and I were sent to a specialist who told us we had TRAP sequence. Basically, one twin was trying to share blood with her sister, who had no heart, thus putting great strain on her own little heart. She was trying to do the work of two babies.

We decided to name her Whitney, which means protected, and we believed God would protect her life, just as he had so far.

November 9: A Difficult Decision

Our options were limited. We could go in for a procedure to try to cut off the blood supply to the other baby, but this was risky in that it could put Laura into labor immediately. We could wait things out and hope that Whitney could put up a fight and not tire out while in utero, or we could choose to deliver knowing that delivering early came with countless risks. We chose to let Whitney show us the way.

November 22: Born at 25 Weeks

Just two weeks later, we were set up to go in for the procedure to tie off Whitney’s twin’s umbilical cord. While being monitored before surgery, Laura’s water broke. In a moment of chaos, Laura’s heart rate skyrocketed and the nurses couldn’t find Whitney’s on the monitor. Whitney was breech and her feet were clamping the umbilical cord. An emergency C-section was performed, and it was the scariest thing we had ever been through. We welcomed Whitney Parke Linebarger into the world, weighing just 1 pound, 12 ounces. She was immediately taken to the NICU. 

November 23: Harrowing Early Days

We could visit Whitney in the NICU, and I was even able to hold her hand that night. Those crucial first few days were a mix of emotions. We were so elated to have our second daughter here in the world, but scared for the long, difficult road ahead. A brain ultrasound showed a level three brain bleed, her heart was in distress after working so hard in utero for such a long time, and many of her systems were underdeveloped.

November 28: Finally Holding Her

Laura got to hold Whitney on her sixth day of life. She could fit in one hand. It was terrifying to see such a tiny baby, but we were so grateful for the strides she had already made in her short time. This was the first moment I remember feeling like Whitney was real and that she was ours. The look on my wife’s face was the exact one she had the first time she held our older daughter, Claire. It was such an encouragement to see a familiar look in her eyes, and I knew we would all get through this together.

November 29: How I Could Help

One of the main things I could do as a dad during those early days is what the NICU staff calls oral care. I dipped a cotton swab in breastmilk and rubbed it onto Whitney’s mouth. This stimulated her while also offering her some nutrition. With a baby so fragile, knowing I could bond and help Whitney in this way was such a gift. She would move her tiny lips and almost lap up the milk!

December 2: In My Arms at Last

I got to hold Whitney for the first time on December 2. Her vitals remained stable, which Laura said was a sign she loves her daddy. We spent that day, as with many others, feeling overwhelmed by the love and support we’d received. A simple thank you doesn’t seem adequate to express our gratitude for everyone who has prayed for us, checked in and just been with us in this. 

December 8: The Fight of Her Life

Whitney’s biggest early challenges were her brain bleed and her heart function. Not only had her heart worked so hard in utero, she had what is called an open PDA, which is a large hole. Twice the doctors wanted to go in for surgery, but both times Whitney’s condition was stable enough to avoid operating. Eventually, her PDA shrunk in size with the help of medication and time.

December 15: Tiny But Tough

Whitney continued to be the sweetest, tiniest thing, and all of her nurses would comment on her feistiness. She had beaten so many odds. The brain bleed was the most frightening issue for us to digest, but ultrasounds had shown it stabilized and even retreated some, so we became hopeful for her future. Throughout our time in the NICU, we became accustomed to watching the numbers — to understand her condition but trying to not obsess over them. It was exhausting, and you had to try not to get overwhelmed with the fear of the unknown. But we believed God held us tightly every step of the way, and that helped us cope.

December 20: One Month Old!

Her first month of life is almost a blur of progress and declines. She would make two great strides forward and then take a step back, which we quickly learned was normal for life in the NICU. Around her one month birthday she was able to move off the CPAP machine to help her breathe and onto a nasal cannula. To be able to see her face without a giant mask covering it was such a joy!

December 24: First Family Photo

Our first picture as a family of four came on Christmas Eve and will forever be the best gift we’ve ever received. Whitney was doing well enough for us to hold her and our 2-year-old daughter, Claire, was able to visit several times. Taking this photo was heartwarming for us; it allowed us to envision our lives together in the future. 

December 25: Happy Holidays

We spent several holidays in the NICU. While it was difficult, the staff made things so special for Whitney and for us. One of Whitney’s nurses made her a festive Christmas skirt for when Santa came to visit. We knew our baby was getting so much love from them when we were away. Each person who entered Whitney’s room during her time in the NICU will forever hold a special place in our hearts.

January 5: Bath Time

Her first bath, on January 5, was so sweet. You quickly forget how wonderful the normal things can be when your baby is in the hospital, but we loved giving her a bath ourselves — and she loved the water. She got her hair washed, and her strawberry blonde hair has shocked her parents, who assumed she’d have dark hair. Whitney surprises us all the time!

January 7: Sisters Bonding

We didn’t really have time to prepare our older daughter, Claire, for Whitney’s quick arrival. But Claire was able to visit the hospital several times and thankfully didn’t think much of all the machines and wires. 

Balancing time at work, at the hospital and at home was challenging and exhausting, but Laura and I always kept the mindset that this phase was temporary. There were also sweet moments sprinkled throughout: Quiet snuggles with Whitney, letting Claire “play” with Whitney by putting stickers on her isolette, and really making the most of time with Claire before Whitney came home. Claire has served as a nice distraction at times of stress and despair, and Whitney has already taught us so much about determination. These two girls are the loves of our life, and we’re so grateful they have each other as they grow up. 

January 13: A Turning Point

The day Whitney moved from an isolette into an open crib in the hospital was a real milestone. It meant that she was truly headed home soon. On one particular day, Whitney made so much progress: She took a bottle, moved to a crib and was able to start wearing clothes. All of those big things happened in such quick succession that it was almost overwhelming. It wasn’t until this time that we realized Whitney had been naked for two months!

February 4: Planning to Leave

On February 4, Whitney’s condition had drastically improved and doctors told us she could be home within a week. We were thrilled — and terrified. I got to bottle feed her for the first time too, which went well. Feeding a preemie can be complicated but we learned each time. It helped us prepare for having her home. 

February 15: Finally Home

After 86 days in the NICU, on February 15, Whitney came home! It was such a joy-filled day for our family. Everyone at the hospital was thrilled and surprised because it was still a couple weeks before her due date. She had come so far. 

March 1: Passing Her Due Date

Whitney was due on March 1, and celebrating this day — at home — was a gift. We’d never anticipated the road that would have led here or that she’d be three months old instead of just days. She has overcome so many obstacles, and we thank God for his mercy and provision in her life. We can’t wait to see the person she grows into!

March 12: Settling Into a Routine

Life at home has been wonderfully exhausting. Whitney’s main goal is to gain weight, so she is on a strict feeding schedule. While the schedule feels rigid, it’s incredible to have the family all under one roof. As a dad, my best moments these days are seeing all of my girls together, whether it be Claire offering Whitey pacifiers constantly or everyone snuggled into Claire’s bed for nightly stories. We are soaking up this fleeting time.

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90,000 “His organs and systems are not ready” Why are they trying to save children in Russia who have almost no chance of surviving and being healthy: Society: Russia: Lenta.ru

In Russia, it was proposed only from the seventh day to register babies who were born at a very early age term (less than 22 weeks) and with extremely low weight (less than 500 grams). This happened after a series of criminal cases that the Investigative Committee opened against obstetricians. For example, neonatologist Elina Sushkevich from Kaliningrad was accused of killing a 22-week-old boy.Why in general today in Russia they are trying to save 500-gram children, what are their chances of surviving and whether they can grow up healthy – “Lenta.ru” learned from the doctor of medical sciences, head of the scientific department of neonatology and pathology of young children of the Scientific Research Clinical Institute of Pediatrics named after Yu.E. Veltischeva Elena Keshishyan.

“Lenta.ru”: Now the minimum criteria for saving premature babies is 22-23 weeks and 500 grams of weight. Why?

Elena Keshishyan : In order to understand what is the limit of possibilities both in technical terms (creating an environment close to intrauterine), and in terms of the maturity of the child’s brain, which is capable of developing extrauterinely, attempts have been made in the world to leave premature babies of different ages.The Japanese have achieved the greatest success in this. They tried to leave babies born at 20 weeks. That is, the approximate gestational age was five months. The Japanese succeeded, but in isolated cases. And they saw that in children born at this age, there is no differentiation of the brain, division into gray and white matter. Roughly speaking, this process determines the ability to think and feel. This is called higher nervous activity. It is this ability that distinguishes humans from animals.

Therefore, guided by research data and on the basis of a humanistic idea, the World Health Organization established this limit of human live birth – 23 weeks, which corresponds to approximately 500 grams of weight. This is the minimum age at which the brain can differentiate into gray matter and white matter. And, accordingly, there is hope that it will already be a human person with mental abilities.

Countries with technological capabilities, including Russia, have agreed that those born at this stage of pregnancy can legally be considered human.That is, they have all human rights, including medical care.

Russia has switched to the WHO criteria for nursing premature babies since 2012. How many such children have been saved during this time?

As a percentage of all those born, this is minuscule. I don’t have exact numbers. But I want to say that the body of children born almost half ahead of time is very immature. And their survival rate, conditionally, is one in a hundred. Still, 22-23 weeks is not childbirth in the full sense. From the point of view of nature, this is a miscarriage, this is a critical situation that may be associated with the health of the mother or the sick child himself.Therefore, the readiness for independent existence in such fruits is close to zero. Even if we assume that the maximum efforts of doctors have been thrown to save the child, all the necessary equipment is connected, the chance that he will get out is very small. In such a baby, kidneys, gastrointestinal tract, heart and other organs may not work. This is a very, very difficult, jewelry work of doctors.

One of the smallest surviving premature babies in the world. Amila Taylor was born in 2006 in Miami, USA.She spent only 22 weeks in the womb and was born with a weight of 284 grams and a height of 24 centimeters.

Photo: Baptist Health South Florida / Reuters

And honey?

Of course. A day in a well-equipped neonatal intensive care unit costs several thousand dollars. And it takes months to get out of such a child. But I want to emphasize that the number of survivors in this period is minimal. And it is minimal in almost all countries where the WHO criteria apply.

If these children are not viable, cost too much, why then were these criteria established?

The medical problem here is not at all about saving all children born at five months.It is clear that there is not a single person who does not understand that this child is at risk of being blind, deaf and immobilized. The task of medicine in this situation is to acquire knowledge and experience.

Obstetricians learn to prolong pregnancy as much as possible. There is a whole range of measures: prenatal diagnosis of genetic chromosomal diseases, various fetal malformations, identification of risk groups among pregnant women, their special observation, prenatal logistics and routing. They also hone the ability to correctly deliver at this time.This must be done as carefully as possible and do not forget about the “golden hour”. You need to have time to give the child, without waiting for his condition to worsen, what he could not get from his mother. That is, even if the child screamed, you need to understand that soon he will stop doing this and will not be able to breathe. The Golden Hour essentially determines whether or not there will be damage to brain cells. This means whether or not the child will have a full life.

And the qualifications of resuscitators working with such children are growing today.All this led to an important point: the quality of nursing children born a little later, at 26-28 weeks, became much better. I regularly see these babies. And I can say that over time, many of them are no different from their peers.

And before?

About 30 years ago, about six to seven children out of ten would have become severely disabled. And today I had three 26-week-old babies at my appointment. And everyone is developing quite well, there is a slight lag, but they will catch up.These children no longer have those possible developmental defects that, unfortunately, would have necessarily arisen in the past.

And this became possible thanks to experience, the accumulation of knowledge about how such babies develop. There are no trifles. This applies to everything – how to assess the heartbeat, how to interpret blood tests, and so on. Keeping a premature baby both in the neonatal period and later, in the first or second year of life, is not the same as a normal, full-term baby. But knowledge makes it possible to correct development in time, without even waiting for problems.

Photo: Science Photo Library / East News

It is important to understand that a premature baby is not a miniature copy of a normal baby. This is a child who is forced to adapt to extrauterine life when, physiologically, he should not do this. Its organs and systems are not prepared to function in the new conditions.

What do these children suffer from most often?

One of the typical pathologies is retinopathy of prematurity. Children have not yet matured a mechanism that protects the eye from light.And they experience a real shock when they suddenly find themselves in our bright world. The photons of light and the flow of oxygen begin to act on the retina, its vessels begin to grow rapidly, penetrate all the environments of the eye, and, ultimately, exfoliate the retina, leading to total blindness. Earlier, even when I was just starting to work, although we knew about such a disease as retinopathy of prematurity, there were few children born and survived less than 30 weeks of pregnancy. Therefore, no one knew how to treat this disease.It’s scary to remember, but premature babies lay in wards with round-the-clock lighting. The light was needed so that doctors and nurses could observe the baby’s condition and notice changes in time. At the time, six out of ten babies weighing less than a kilogram at the time of birth were blind. It was then that the borders were opened in Russia, and we were amazed that in Europe, blindness was at most two out of ten newborns.

But we started to learn very quickly. Now in the perinatal centers in all intensive care units for premature babies – it is twilight.The incubators are completely covered with dark bedspreads. The staff does not need to watch the baby all the time – all readings are automatically written by special devices. In good resuscitation, nurses who approach babies have a headlight. This is in order not to disturb other children. In many intensive care units, a large “ear” hangs. If the decibel level in the room begins to exceed the permissible limit, the device lights up red.

After the birth of the child, every week they begin to look at the eyes using a special method.If there is a proliferation of blood vessels, laser coagulation of the retina is performed. There are specialists in such operations in almost every major city.

About 400-600 babies born at 26-28 weeks pass through me every year. Over the past few years, not a single blind person has been among them. Although earlier in hospitals for such newborns it was necessary to open entire departments.

There is data on how many premature babies subsequently became healthy?

Now among premature babies born at five to six months (25-26 weeks of pregnancy), 25-30 percent become disabled.In developed countries, it is about the same. And even 20-30 years ago there were 75-80 percent of them.

The risks for these children are still very high. They require long-term observation and treatment. But still, today they have an incommensurably better chances of and than before.

Do parents who are unlucky regret insisting on resuscitation at any cost?

As a doctor, no one ever told me that. Naturally, families had very different hopes for childbirth. They cry in the doctor’s office, but they don’t moan.These children are madly in love. But this is painful love at the level of deep depression. Probably, some of these mothers at night may think what would happen if they knew in advance how everything would turn out. Perhaps they voice this to their mothers, husbands, girlfriends … But not to doctors. Here people prefer to hold on.

When a child is one or two years old – from a moral point of view, the situation is more difficult than at three days. Newborns are all wonderful little bags, it is only then that children begin to differ from each other. These families have a very specific and difficult life.When a child lies in your house, does not move, does not swallow, never looks at you, does not speak – it is very difficult. And you need to help parents turn their lives into at least a relatively social one, not make them outcasts.

What kind of family help can I count on now?

When Russia switched to WHO standards, doctors began to say that if we began to take care of such children, there would be a high frequency of cerebral palsy, mental retardation and other pathologies leading to severe disability.Without the development of a specialized service that will help such children, we will cause enormous damage to a society that will not accept such an increase in the number of disabled people. Then a system of follow-up of premature babies began to develop, which leads them up to three years. Because in the usual polyclinic network, there are not always doctors who understand how a child born with a low or extremely low body weight grows and develops. In parallel with this, the system of medical rehabilitation is developing quite rapidly.

We have the worst situation with social services. Help for these children is minimal. How to care for such a child, how to develop it, how to maintain motor skills – few explain to families. If in large cities at least some miserable amount can be achieved, then what can we say about the province? All this excludes one of the parents from social life. There are no places where it would be possible to transfer such a child for at least a week, a month so that the parents could have a little rest. Since the state has taken such a step, since we have legally recognized the 500-gram fruit as a human being, then they themselves also need to act humanly in the future with his family.

Is there a support system in other countries?

I know that in Europe and in the USA it is built very well. There, the emphasis is not on medical rehabilitation, but on social one. They have social workers who come and relieve these families of a significant part of their worries. Somewhere there are social centers where a child can be brought as to a kindergarten. Moreover, they are zoned – parents do not need to go to the other end of the city.

Photo: Alexander Kondratyuk / RIA Novosti

You say that some time ago, kilogram premature babies were also considered “non-living”, and now they are quite promising.Is it possible that in 30-40 years the same can be said about 500 grams?

Indeed, even 30-40 years ago, when it was not possible to maintain breathing, children born before seven months of age survived very rarely.

Then, when some of the first mechanisms appeared, the bar rose to the 28th week of pregnancy – that’s about six months. But technological progress is always moving forward, this made it possible to further gradually reduce the age of survival. We can now at least partially simulate intrauterine conditions.For example, when a child is born late, he does not yet have a substance in his lungs thanks to which he can breathe – surfactants. They can be brought in immediately at birth, artificial ventilation of the lungs can be started and, due to this, gas exchange can be maintained. Also, it became possible to give food subsidies not through the gastrointestinal tract, but through a vein with special substances that are already ready to be included in the metabolism. There are many other adaptations: the creation of a thermal regime, humidity, close to intrauterine.

Technologically, the border could be moved away indefinitely. If desired, you can simulate a situation when a woman is not needed at all to carry a child. But I have already said that scientists have established that the age of 22-23 weeks is the minimum period at which the cells of the cerebral cortex can develop postnatally. Still, the main criterion for the normal development of a child is not technological advances, but the capabilities of the brain.

Is it true that they are trying to save all 500-gram children only in Russia and Turkey, and in other countries – only if the child has high chances for a normal life?

This is not the case.In all countries where the WHO concept is adopted, these children are subject to compulsory medical care. But there are nuances. If the child was born between the 23rd and 25th weeks, the parents can refuse resuscitation. To do this, many countries have a legal regulation that resembles the law on euthanasia.

There is a special service in the perinatal centers. When it becomes clear that premature birth has begun, representatives approach relatives – the father and, if possible, the mother. “We assume that a baby with such and such parameters will be born.In this case, there are such and such risks of development … You have the right to choose – either full resuscitation or palliative care. ” And depending on what parents decide, doctors and act.

Photo: Sergey Pyatakov / RIA Novosti

In Russia, you can also choose a palliative today?

This is not legally spelled out in any way. Today, even if it is clear that the child has pathologies incompatible with life, they must be rescued to the last. It happens that parents can independently sign a paper that they would not like resuscitation, but this has no legal force.Parents can say: “Look, he breathes, breathes. He opened his eyes. Let’s revive him now! ” And we lost time, which in this case is very significant. This child initially has little chance, but it has become even less. And a situation may arise when the parents accuse the doctors that their child was not specially treated, “they spoke their teeth.”

The medical community is very concerned about this ambiguous position of doctors. And we have a number of proposals for solving the problem of their protection.

What exactly is on offer?

Legislative initiative so that parents can independently decide on the advisability of resuscitation assistance to a child born between the 23rd and 25th weeks. Naturally, all this should be discussed. It is necessary to involve the public in the discussion: these are lawyers, doctors, patient communities, representatives of religious confessions.

The Ministry of Health has now prepared new criteria for newborns born too early.In particular, it is proposed not to register such a child until he has lived for seven days. Maybe this will fix the situation, protect doctors from murder charges?

There are a lot of pitfalls here. In Russia, there was a similar law on kilogram children. They were helped from birth, but until the age of seven days, the baby was considered a fetus. If he died, then his mortality was already in other criteria, it was not considered the death of a newborn.

There are not many children with extremely low rates, they simply cannot influence the demographic structure in any way.But if there is such a provision that it is possible not to register for up to seven days, it seems to me that there may be even more claims to doctors about not providing assistance.

These are very difficult questions. On the one hand, parents may say: you did not save the child. And others, on the contrary, will say: why are you torturing him in vain? Imagine a resuscitator facing an ethical choice: he has only one ventilator in the hospital, and a 23-week-old baby has been on it for 40 days. And then a 32-week-old is born in the hospital.He needs help, he needs to keep him on the apparatus for three days, and then the baby will cope on his own. In the first case, there will probably be a disabled person. And in the second – practically healthy. And what should a doctor do?

Are you speaking theoretically now, or do such situations occur?

We cannot have this in federal centers. We have a sufficient amount of equipment. I just illustrated with an example that the issue of nursing such children is the most difficult one, all aspects echo in it – from medical to ethical and religious.

Photo: Sergey Krasnoukhov / RIA Novosti

The issue of infant mortality has recently become a political issue. Perhaps that is why patient scandals related to maternity hospitals are developing so sharply?

The issue of infant mortality has always been a political one. This is a socially significant parameter that determines the position of the country in terms of development. In our country as a whole, infant mortality has significantly decreased over ten years. However, in the past two years, the rate of decline has slowed down.Our government says this is bad. From the point of view of doctors, this is not entirely true. There are objective reasons that cannot be overcome with a swoop.

The primary decrease in mortality was due to the high-quality saturation of hospitals with equipment, due to the construction of perinatal centers. This gave immediate results. And now these indicators have reached a plateau. Another thing is that a plateau, say in Kaliningrad, St. Petersburg, is one thing. There, mortality rates are at the European level. That is, very low.And there are regions where mortality is high – Altai Territory, Jewish Autonomous Region, Magadan. There is a shortage of doctors, a shortage of equipment, very long distances, and difficulties in routing. And it is very difficult to do something about it.

We are not compact Switzerland. We have a huge country with difficult geographic conditions. There are regions from where we cannot even deliver a woman by helicopter. At one time I spent a lot of time in Chukotka, watching the obstetric service. Often, if a premature baby is born there, you will not help him in any way.

Are there no good hospitals?

Everything is there, but in one city – in Anadyr. And if a woman gave birth elsewhere, then often she can be cut off from the world. There are periods when even airplanes do not fly: a blizzard, something else. And you can’t guess with routing either. Because when you are expecting your first child, you are not going to give birth at 24 weeks. If the situation with childbirth repeats itself, then you can plan something, come at a “dangerous” time closer to specialized care …

Is it true that recently there have been more premature births?

No, their number is stable.This is approximately 7-10 percent of all newborns. Their survival rate has increased significantly.

One of the most “kindling” topics on parent Internet forums is that children who have been “culled” by nature have a bad effect on the quality of the gene pool. Is there any reason to think so?

In order for the “survivors” to influence the population, there must be a lot of them in percentage terms. For example, there are very few 26-week-olds – no more than two percent of all births. This can in no way affect anything.

I know that at one time they were discussing: what will happen if my child marries in the future someone who was once premature, will the gene pool suffer? Firstly, I can say that with regard to children born after the 30th week – they are completely healthy, adapted and do not differ from others. They themselves give birth to beautiful healthy children, we have already seen many generations. The danger of premature birth is not inherited. And usually they shake over premature babies, they do a lot of them.So in terms of development, these children can give a head start to others.

As for children born 5-6 months old, when they catch up with their peers, it is important that the parents continue an active life with them, and not engage in a protective regime. We need songs, dances, sports. These children have behavioral characteristics. But now there are centers that supervise such families. If you take care of children, everything will be fine. I look at these children regularly. And I have a much more optimistic outlook.For example, the frequency of chronic diseases among them is approaching the norm. That is, it is not higher than in the population. Everyone, even the seemingly most hopeless child, has a chance for a full life.

The term “prematurity” should not be tied to weight – Rossiyskaya Gazeta

It is customary to devote a special day to almost every disease. There is even a day of premature babies. Only once a year is it necessary to address this or that health problem? I address the question to one of the leading specialists in the field of neonatology, Deputy Director of the National Medical Research Center for Obstetrics, Gynecology and Perinatology named after V.I. Kulakov, professor Dmitry Degtyarev.

Dmitry Degtyarev: No, of course. This is just a pretext for summing up some results, exchange of the latest information, the latest experience, analysis of the prospects for the development of the industry. By the way, the day of premature babies is held at the initiative of the parents of such children.

Dmitry Nikolaevich, I will quote a certificate from the Internet: The term “prematurity” is used when a baby is born before the 37th week of pregnancy, and his body weight does not exceed 2.5 kilograms.With a weight of less than 1.5 kilograms, a newborn is considered deeply premature. And with a weight of less than a kilogram – a fetus. I think this information is outdated?

Dmitry Degtyarev: This information is not just hopelessly outdated. It is unacceptable in our time. It is not necessary to tie the term “prematurity” to weight. As practice shows, it is not so much a matter of weight, but of the gestational age at which the baby was born. And, of course, a baby weighing less than 1000 grams cannot be considered a fetus.There are many examples when babies with extremely low weight survive, even five hundred grams. This is by no means fruit! These are kids.

Do they grow up to be normal people? Or are they accompanied all their lives by various diseases precisely because of their low birth weight?

Dmitry Degtyarev: World statistics show that the percentage of healthy children and children who grew up disabled depends on three main factors. This is the exact gestational age at the time the baby is born.This is the mother’s initial state of health. This is the level of medical technology that is used to nurture extremely low weight children. Children born at 22-24 weeks of pregnancy, if they manage to get out, unfortunately, in many cases become disabled.

At risk are those women who, before the desired pregnancy, had more than one abortion

What is most affected in them?

Dmitry Degtyarev: Vision and hearing are the first to suffer.Such a child may even have cerebral palsy. And if a child was born between 25-27 weeks, then 80-90 percent of children are healthy. The health status of “late” premature babies (34-36 weeks) is comparable to full-term babies.

At least one of the terrible pathologies before the birth of a child can be determined?

Dmitry Degtyarev: You will definitely not like my answer: alas, no. If during pregnancy the fetus does not reveal obvious malformations, then it is almost impossible to determine the scenario of his life before the birth of this child.In any case, at this stage in the development of medical science and practice. A more accurate prognosis of life can be given only after birth. Based on an objective assessment of the reaction of the baby’s body during nursing in specialized departments.

Are there such branches all over Russia?

Dmitry Degtyarev: They are in every large region of the Russian Federation and, as a rule, they are subdivisions of perinatal centers.

What about the health of your parents? Agree, because the fact that the number of sick newborns does not decrease is often the fault of both mothers and fathers.They sometimes start thinking about having a baby too late. Moreover, thanks to new technologies, even in adulthood, even in old age, the birth of a child is possible. And they do not think about the fact that it takes years to put a child on his feet. True, this does not depend on the doctors. Everyone decides for himself. But about diseases that can lead to prematurity, it must be said.

Dmitry Degtyarev: Most women who give birth in early pregnancy, that is, extremely premature babies, have either chronic infections or endocrine disorders, or cardiovascular diseases, liver and kidney diseases.Women who have had abortions more than once before the desired pregnancy are in the zone of particular risk. And at the same time I will say now about the third factor: the level of perinatal technologies. Even 5-10 years ago, in our country, the methods used for nursing premature babies lagged behind the leading foreign clinics.

Now, in your opinion, are not lagging behind?

Dmitry Degtyarev: In recent years, thanks to the implementation of the state program for the modernization of the health service, the technologies we use are practically not inferior to the best foreign ones.But … Even with all this, we cannot guarantee that a prematurely born child will be absolutely healthy. Moreover, even with the use of modern technologies, no one can give a 100% guarantee that such a child will survive.

Not everything depends on the listed factors. There is another very important point: I mean the teamwork of doctors, nurses and the parents themselves. It is no coincidence that the “day of premature babies” was proposed by the parents of such children. Those who themselves have gone through the difficult path of saving their child and are now trying to do everything to make it as possible as possible for others who find themselves in a similar situation.

A woman is usually ready for a normal delivery on time. Including psychologically. But to give birth ahead of schedule …

Dmitry Degtyarev: Premature birth in most women causes psychological stress. This stress usually spreads to all family members. Sometimes even a loving husband becomes so depressed that he leaves the family. Although, as my personal experience shows, recently this happens less often than ten – fifteen years ago.To a large extent, this is also because psychologists work with the parents of premature babies.

A scientific and educational congress “Anesthesiology and resuscitation in obstetrics and neonatology” has just been held in Moscow. It discussed how to care for premature babies, including those born with extremely low birth weight. I remember, a very long time ago, for the first time I saw in a Moscow clinic an incubator for nursing such children. It was then a miracle inspiring hope. Now such “dwellings” for such children are practically everywhere where children are born.However, the fate of premature babies, the fate of those born with low birth weight does not change rapidly. Why?

Dmitry Degtyarev: In short, any of the most advanced medical equipment cannot fully recreate the conditions for the development of a child that would be provided for him by staying in the womb. Therefore, improving the quality of life of such children in the future will depend on the success of the development of biomedical technologies. You mentioned one of the first kuvezes that you saw years ago.Despite the fact that modern jugs even outwardly look completely different, they have microcomputers on board, the principle of their operation has practically remained unchanged. We hope that in the foreseeable future there will be technologies that are as close as possible to those created by nature.

Do you track the fate of premature babies, children with extremely low weight?

Dmitry Degtyarev: Yes. They are on an outpatient basis by the center’s specialists.

Recently, more and more people are talking about the need for physicians to work in conjunction with physicists, chemists, molecular biologists.This connection has always existed. But in our time, when biotechnology comes to the fore, it is more relevant than ever.

Dmitry Degtyarev: You are absolutely right. For example, in our center, there are 35 clinical departments in 20 fundamental scientific laboratories, in which graduates of Moscow State University, Phystech, and other leading universities of the country work. Physicists, molecular biologists are staff members of our center. And we are no exception to the rule. This kind of community becomes the rule.

Business card

Photo: Alexander Korolkov / RG

Dmitry Nikolaevich Degtyarev was born in Moscow. Graduated from the Second Moscow Medical Institute. His Ph.D., doctoral dissertations, more than 150 scientific papers are devoted to the most acute problems of pediatrics, in particular, neonatology.

Doctor of Medical Sciences Professor Degtyarev heads the Department of Neonatology at the I.M. Sechenov of the Ministry of Health of Russia, Dmitry Nikolaevich Deputy Director of the National Medical Research Center for Obstetrics, Gynecology and Perinatology named after V.I. Kulakova. Degtyareva’s wife Anna Vladimirovna is a pediatrician. Dmitry Nikolaevich is the father of four children.

“Children are not always saved, but we are blamed for it.” Perm doctors – why the new criteria for live birth in Russia lead to criminal prosecution of doctors

In 2012, the Russian Federation switched to the criteria of live birth recommended by the World Health Organization. Children who were born prematurely began to be cared for, starting from the 22-week gestation period – until 2012, premature birth was considered to be delivery at 28 weeks.The frequency of preterm birth in developed countries is 5-7%, annually 15 million premature babies are born in the world.

Western countries, having accumulated sufficient experience and having analyzed the results of neonatal survival and the health status of children born at 22-24 weeks, decided to shift this border from 22 weeks to 25. This is due to the high mortality of newborns at 22-24 weeks, more 90% of them have a body weight of only 500-700 grams.

Reference

In November 2018, special departments for the investigation of crimes in the field of medicine appeared in the Investigative Committee.

According to the Investigative Committee of the Russian Federation in the Perm Territory, in 2017-2019, nine criminal cases were initiated for crimes related to medical errors and inappropriate provision of medical care, under the following articles: 109 of the Criminal Code of the Russian Federation (Causing death by negligence), and 238 of the Criminal Code RF (Production, storage, transportation or sale of goods and products, performance of work or provision of services that do not meet safety requirements).

We are equated with murderers and rapists

Photo: Maxim Artamonov

Obstetrician-gynecologist at Hospital No. 6 and the chairman of the Alliance of Doctors Union Anastasia Tarabrina:

– All doctors in our country are absolutely unprotected.I find the criminal prosecution that healthcare providers face today outrageous! The entire medical community is now hearing the name of a neonatologist Neonatology is a branch of medicine that studies babies and newborns, their growth and development, their diseases and pathological conditions. The main patients of neonatologists are newborn infants with respiratory distress syndrome who are sick or require special medical care due to prematurity, low birth weight, intrauterine growth retardation, congenital malformations (birth defects), sepsis, or congenital asphyxia from Kaliningrad Elina Sushkevich, which the Investigative Committee brought charges under the article “murder of a minor, knowingly being in a helpless state.”She is accused of killing a newborn who was born prematurely at 23 weeks.

Babies born at 23 weeks and, for example, 27 weeks, have a huge difference in terms of future health prospects, because each week significantly increases the chances of life and health. Those of them who survive remain severely and moderately disabled degree, they cannot eat and move independently, have severe neurological disorders, including cerebral palsy, some of them turn out to be blind or deaf.Therefore, they require constant careful maintenance.

Surviving children, after long months in the Perinatal Center, are discharged home and get into the general network, where they should be dealt with by district pediatricians, who already have two areas. And such a child requires every second participation. As a rule, such families are left with their problem one on one: a huge psychological load, considerable financial costs – all this falls on the parents! Many of them can’t stand it. Disabled children in such families must undergo serious rehabilitation, which is not developed in our country.

That is why Western countries have abandoned nursing such children and moved the timeline: it is too expensive, and the prospects are very vague. The leadership of our country has invested huge sums of money in the development of the network of Perinatal centers, their equipment, but did not think about what to do next with such children.

The Russian Society of Obstetricians and Gynecologists has repeatedly appealed to the Ministry of Health, warning that the country is not ready to switch to the WHO criteria, but they were not heard. I think this is happening because there is a political aspect of this issue: we cannot be worse than the Western countries and must catch up and overtake them; we must increase fertility rates by any means possible to address the demographic crisis.Earlier there were many more births. Now women born in the 90s, when there was a demographic failure, give birth. Therefore, there are fewer women themselves capable of giving birth, and they themselves do not always decide to have a child due to the economic situation in the country.

The ethical and moral aspects of this issue still cause heated discussion in the medical environment: which is better: to save, condemning the family and such children to a painful life, or not to help, while having good intentions? But the main trouble is that obstetricians-gynecologists and neonatologists become hostages of such situations: children are not always saved, but doctors are accused of this, while initiating criminal cases.

Reference

In 2018, 4763 children were born alive in the Perm Regional Perinatal Center. 32 children died. 31 cases (97%) – premature babies and 1 case (3%) – full-term baby, died of congenital heart disease.

Of the premature babies who died, 25 (78%) are babies born with an extremely low body weight of up to 1000 grams. Of these, three children weighing up to 500 grams, 16 children weighing from 500 grams to 750 grams, and six children weighing up to 1000 grams.More than half of the babies were born before 25 weeks of gestation.

The main share were deaths from intrauterine sepsis and intrauterine pneumonia of 19 children (59%), congenital malformations – 3 cases (9%) and other causes.

Immaturity of tissues, organs and systems

Photo: From the personal archive of Olga Likh

Chief obstetrician-gynecologist of Perm Olga Likh, head of the Perm Regional Perinatal Center:

– Pregnancy period 22-24 weeks is an unfavorable period for health and survival children.Parents should be aware that in this group of children there is an extremely low survival rate (6-20% depending on the gestational age) and a high percentage of child disability, which is due to the deep immaturity of all organs and systems of a child born prematurely. The chances of survival for babies over 24 weeks of gestation increase by 2-3% every day. The prognosis for the survival of children in the period of 25-26 weeks is already more than 50%.

The main cause of infant mortality in early preterm birth is intrauterine infection and congenital pneumonia.In these cases, intrauterine infection is also the cause of premature birth. Children are born deeply premature, with respiratory failure, with cardiovascular failure, and require intensive care. At birth, the newborn receives the full range of resuscitation measures and further receives treatment in accordance with the identified pathology, but this cannot serve as a guarantee of the survival of such a child.

In the overwhelming majority of cases, premature birth and intrauterine infection of children is associated with chronic extragenital pathology in pregnant women (diseases of the cardiovascular system, diseases of the genitourinary system, genital tract, endocrine pathology, anemia), the presence of chronic foci of infection before pregnancy and during pregnancy ( infection of the genitals, urinary tract, ENT organs, oral cavity), lack of pregravid preparation, lack of sanitation of chronic foci of infection before pregnancy.Taking into account the above, women planning a pregnancy should pay attention to the need to contact a local obstetrician-gynecologist before pregnancy for pregravid preparation (correction of extragenital pathology, sanitation of chronic foci of infection, taking medications that reduce the risk of congenital malformations in the fetus).

Women must understand: in order to bear a healthy child, pregnancy must be planned, examined for infections, treated, corrected extragenital pathology, but this is not always the case.Some women require early delivery for medical reasons due to their serious illness. Increasingly, women with extremely severe extragenital pathology become pregnant. There is an order No. 736 of the Ministry of Health and Social Development of the Russian Federation “On the approval of the list of medical indications for artificial termination of pregnancy”, this order identifies diseases that threaten a woman’s life during pregnancy. Pregnancy is contraindicated in these patients, but patients ignore it.Despite the colossal health risk, they are trying to bear the baby.

We provide medical care to patients with severe diseases of the cardiovascular system, kidney diseases with renal failure, endocrine diseases, oncological diseases, diseases of the gastrointestinal tract, systemic diseases potentially threatening the patient’s life. Against the background of pregnancy, these diseases progress, the condition of the patients worsens. For medical reasons, if the patient’s condition worsens, early delivery is indicated, otherwise the woman may die.Accordingly, children are born prematurely, and the prognosis for such children is unfavorable.

European countries switched to 25 weeks of gestation due to high infant mortality and high disability rates among these children. These children are distinguished by deep immaturity of all organs and systems. One of the formidable complications is the immaturity of the bronchopulmonary system in a newborn. The lung tissue is immature, respiratory distress develops, these children suffer from severe respiratory failure, require mechanical ventilation (ALV), they are characterized by a high frequency of infectious complications, and therefore children need antibiotic therapy.An immature immune system reduces the ability to resist an infectious agent, septic complications and multiple organ failure occur.

After the intensive care unit, children are transferred to the second stage of nursing (neonatal pathology unit). Children born from very early premature births are in the perinatal center for quite a long time, until they reach at least two kilograms of weight, they need round-the-clock supervision of doctors and a hospital stay.After discharge, they are observed in the Department of Follow-up and Early Rehabilitation Treatment, specially created for children who have undergone severe perinatal pathology. Children requiring rehabilitation measures continue their treatment in specialized centers.

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Read also:

Obstetrician-gynecologist. How the Permians “reduce debit to credit” today.

The regional trade union of doctors “Alliance of Doctors” was established in Perm.

Chairman of the independent trade union Alliance of Doctors in Perm: “I am under pressure. Fear is their normal reaction. ”

How it works. Nursing premature babies in Voronezh. Latest news from Voronezh and region

The Voronezh Perinatal Center celebrated the White Petals Day for the seventh time, timed to coincide with the International Day of Premature Babies – November 17. In the perinatal center, about 400 babies are born prematurely per year – this is more than 62% of all premature babies in the region.Specialists of the perinatal center spoke about how the “hurry-ups” are nursed.

Which newborns are considered premature?

Normally, pregnancy lasts 38-40 weeks. Premature babies are considered to be born between the 22nd week and the end of the 37th week. In 2012, Russia switched to the live birth criteria approved by the World Health Organization. According to these parameters, a premature newborn baby weighs at least 500 g. If its weight is even lower, it is considered a fetus.

– Children born prematurely are divided into several groups: with a birth weight of less than a kilogram (extremely low body weight), from 1 to 1.5 kg (very low body weight) and more than 1.5 kg (low body weight) … Powerful resuscitation allows us to take care of children from the age of 500, – said Sergey Khots, deputy chief physician for obstetrics and gynecology at the Voronezh Perinatal Center.

Every year, about a hundred babies weighing less than a kilogram are nursed in the perinatal center, and in just eight years of the center’s work, about 600 of them were born.

What is the cause of premature birth?

There are many reasons: it can be stress, hormonal disorders, problems with the placenta, and intrauterine infection.

– Unfortunately, not only in the Voronezh region, but in Russia as a whole, the number of premature births is not decreasing. This is a world-class problem: in the world, premature births are 5-10%. During pregnancy, the load on the mother’s body increases, all chronic diseases of the cardiovascular system, kidneys, and endocrine system become aggravated.Therefore, I would like to wish future parents, during pregnancy planning, to undergo a thorough examination for the so-called dormant infections and somatic pathologies, said Sergey Hotz.

Experts noted that the thesis that premature babies are born more often in dysfunctional families is incorrect. This can, on the contrary, happen in a prosperous family, where parents are very much expecting a child and during pregnancy the expectant mother has high anxiety.

How are babies born prematurely different from normal newborns?

There are external signs: height and weight are below normal, the head looks larger in relation to the body, the navel is low, the fontanelle on the back of the head is open, the nails are not developed, thin skin.But the main problem is the immaturity of all organs and systems. Premature babies retain heat worse, they have decreased muscle tone, may have breathing problems, and the sucking reflex is absent or poorly expressed.

How are premature babies cared for?

If a newborn has breathing problems, he is referred to the intensive care unit. The baby is placed in a high-tech incubator, where the intrauterine environment is recreated with maximum accuracy: a certain temperature and humidity are maintained, there is the possibility of an additional supplement of oxygen.The incubators are equipped with artificial respiration devices and even scales so that the baby can be weighed without taking it out again and without disturbing it.

Newborns are protected from stress, therefore, in the intensive care unit, a quiet regime is observed, you cannot walk in heels here, and bright light is prohibited.

– We put the twins, brother and sister, weighing 800 g each, in one incubator: they feel the presence of each other, and this helps them to survive. They were born within 24 weeks with a weight of 700 g.The boy is breathing on his own, the girl is still using a ventilator. The kids are conscious, there are no neurological abnormalities at the moment. They have every chance of a full life, but they must go through all the stages of development. It’s just that in this case it does not happen in utero, ” said Konstantin Panichev, head of the neonatal intensive care unit of the perinatal center.

An important part of nursing premature babies is developmental care.Babies lie in so-called nests, babies wear warm hats and socks made of pure wool, which are knitted by both mothers and volunteers. In addition to tiny clothes, toys for babies are knitted – octopuses with long tentacles, carrots with tops. As it turned out, such objects also help to recreate the intrauterine environment: squeezing all these strings in the handles, babies seem to touch the umbilical cord and feel calmer, natural wool activates receptors and improves blood circulation.

If there are no signs of the course of the infectious process and the baby no longer needs an oxygen supplement, he is transferred from intensive care to the second stage of nursing. There, babies also lie in incubators, but they are no longer equipped with ventilators. However, the required temperature and humidity are maintained there. Then the child is sent to the ward of a joint stay with his mother.

How are premature babies fed?

The best nutrition for all babies is breast milk.It contains all the nutrients a newborn needs in an easily digestible form and antibodies that protect against infections. Mothers express milk, and babies in intensive care are fed them through special small nipples. If necessary, milk is enriched with microelements. Children can also receive additional food by tube or intravenous.

Are mothers allowed in intensive care?

Parents can visit children in intensive care at any time, but they are usually asked to coordinate the time of visits so that it does not coincide with the procedures.

Each ward has a chair on which the mother can sit and lay the baby on her chest, skin to skin. This kangaroo method strengthens the mother-baby bond, calms the baby and helps him develop better.

Olga every morning sees her older child to school and hurries to the perinatal center to see her daughter Stephanie. The baby was born with a weight of 875 g, but from the day of birth – October 3 – she actually doubled her weight. She has already been transferred to the second stage of nursing.

– Tactile contact is very important. This is what the doctors say, but I myself see that the child behaves in a completely different way when you touch her. My daughter takes my hand and smiles. She even feels an emotional state, so you can’t come to her in a bad mood, – said Olga.

What health complications threaten premature babies?

There is a whole group of special diseases of premature babies. It can be anemia, rickets, osteopenia – diseases that are not typical for ordinary newborns.

– For example, where does anemia come from? The laying of iron in the baby’s liver occurs in the third trimester from the mother, and if he was born earlier, he does not have this depot. Osteopenia is a metabolic bone disease because premature babies have little calcium and phosphorus in them. Prematurity is also a risk factor for the development of neurological disorders. Chronic lung diseases, serious vision problems are possible. But the creation of conditions for the intrauterine environment for “hurry-ups” and special therapy allow for prevention and prevent the development of diseases.Fortunately, nursing technologies and, accordingly, the prognosis of premature babies are improving every year, and most children born prematurely go to school with their peers, ” said Lyudmila Ippolitova, chief neonatologist of the Voronezh region.

What are the “hurry” parents being taught?

A school for such parents was opened in 2018. Doctors and nurses tell mothers and fathers in detail about the condition of their children, about the therapy they receive, about the intricacies of nursing and rehabilitation, about breastfeeding.Moms share their happy stories on the rush.36 website and support parents who are at the beginning of this journey.

– Parents who went through this school are calmer, they become one team with the medical staff and help specialists to care for their children at all stages. First, the question of life and death is decided, then – the quality of life. Although we officially created the school last year, we have been conducting classes for about three years now and have noticed that during this time the number of divorces in families of premature babies has decreased three times.After all, the birth of such a baby is a great physical and mental stress, and often the dad leaves the family, unable to bear this burden. And here many dads come to classes even without their mothers, giving them a rest, and ask how they can help. When we began to conduct such classes also in the ward of pathologies, where women enter with the threat of termination of pregnancy, we noticed that there were fewer preterm births: the expectant mother received information, calmed down, and the pregnancy was preserved, ” said Lyudmila Ippolitova.

Stories about children who were released at the perinatal center

Three years ago Natalia gave birth to triplets. Stephanie, Veronica and Arina. One girl weighed 1.8 kg, two – 1.4 kg each.

– They were nursed for a month, they gained weight well. They also paid special attention because they are triplets. Now the girls are three years old, they have no health problems, – Natalia shared.

The daughter of Marina and Sergei was born at the 25th week and at that time was the smallest newborn of the perinatal center: she weighed only 550 g.

– She had a cerebral hemorrhage, neurological problems. Only 25% of children survive with such diagnoses. But after a month, spent in intensive care, the daughter’s condition stabilized, and after two she began to breathe on her own. At two years old, she was removed from the register of a neurologist, – said the mother.

Sergei was the first to see his daughter 20 minutes after giving birth, while Marina was still under anesthesia after the operation.

– It was scary! – he admitted.- But the doctors are great, they supported us all the time. Two months later, I took my daughter in my arms for the first time.

The “smallest girl” weighed only 7 kg a year. Now she is five years old, she goes to kindergarten and, as her mother says, is no longer even the smallest in the group.

– My daughter attends a speech therapy kindergarten. Her English is good. But now we are preparing for school, the doctors advised not to overstrain with additional classes. And in the future we plan to sign up for the fight: a girl must be able to stand up for herself! – said Marina.

Anastasia saw her son only on the third day after birth, when his condition improved slightly. The baby was born weighing 1650 g, 48 cm tall, did not breathe himself.

– The doctors did not give any predictions, you just had to wait. I expressed milk, fed starting from 2 ml – first through a tube, then I learned it myself. For a month we lived in a state of obscurity. Fedor was discharged at the age of one and a half months with a weight of 3 kg. He is now five years old. He is dancing.Not everything is working out yet, but he is trying very hard. He loves music and socializing with children. We come to the holiday of white petals every year, we correspond with whom we were lying with, we communicate with doctors.

Lily had a difficult pregnancy, and then she had a premature birth.

Lilya:

– I myself work in the perinatal center and I know that our specialists can be trusted. But I was still very worried. The daughter was born at the beginning of the 32nd week, weight 1660 g.I spent five days in intensive care, breathed with the help of a ventilator, but thanks to our specialists, everything worked out. We were transferred to the second stage of nursing, we began to gain weight through breastfeeding and were discharged from 2200. Now Latika is one year old, she is very inquisitive, she is interested in everything, especially technology. It was impossible to tear her away from the ultrasound machine, she kept trying to pull out the sensors. Probably will be a doctor!

Yana:

– Alice’s weight was 1270 g.She spent five days in intensive care. A month later, we were discharged with a weight of 2050 g. Many thanks to all the doctors who support these babies! Now Alice is one and a half years old, she is a lively, cheerful girl, develops like an ordinary child.

Maria:

– Sergey was born on March 8, six months old, weighing 1120 g. The day before that he stopped moving, I went to an ultrasound scan – they told me to go to preservation. And in the perinatal center they immediately sent me to the operating table.The baby had a 1 on the Apgar scale (a system for quick assessment of the state of a newborn, a good result is from seven to ten points. in reanimation. It is difficult to explain what we have experienced, sometimes we thought that there was no hope. Several times he let us and the doctors get worried. Now Seryozha is two and a half years old, he is a very active fidget. Probably, if not for such an energetic character, he would not have scrambled out.

Help RIA “Voronezh”

The threshold weight for nursing premature babies in the period from the 1930s to the early 1950s was about 2 kg, then the indicator began to decline: in the 1960s – already 1.5 – 1.8 kg, in the late 1970s – in the early 1980s, they learned relatively well to care for newborns weighing 1 kg, but children weighing 500 g began to be saved relatively recently.

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“Daughter was born weighing 550 grams”

Moms who survived premature birth say that the most important thing is not to cry and not even think that something will go wrong

November 17 Since 2009, it has been declared the Day of Premature Babies all over the world.In the perinatal center of the Voronezh Regional Hospital, the only institution in the region where children born from 22 weeks of gestation and weighing 500 grams or more, they do not like the word “premature”.

– It seems to indicate the inferiority of the child, and in fact many of these children are absolutely in no way inferior to their “full-term” peers, – says the chief neonatologist of the regional health department Lyudmila Ippolitova, – Therefore, they are “in a hurry”, “fry” , “Miracle” …

Especially for the “hurry-ups” and their relatives, a holiday is organized in the perinatal center, the day of “White Petals” – this is how the children who hastened to be born are also affectionately called.It’s like a big shared birthday party, with animators, artists, songs and dances.

When, in 2012, by order of the Ministry of Health, they began to register children who were born not on the 28th, as before, but at 22 weeks of pregnancy with a weight of 500 grams – that is, to consider them not as miscarriages, but as newborns who need to be saved – this caused controversy … Opponents of the law said, they say, why should the state spend huge amounts of money on nursing children who were doomed in advance either to death or to profound disability.It’s a pity these opponents did not see how three-year-old Nastya Skrylnikova was dancing at the festival! The girl, who boldly ran out onto the stage for the company with the artists, instantly became the star of the matinee. Nasty Nastya was born four months ahead of schedule with a weight of 550 grams.

– From 20 weeks I started to have edema, preeclampsia, poor blood counts, – recalls Nastina’s mother, Marina, – I was admitted to the hospital, tried to save, but at 25 weeks I had to do an urgent cesarean. We spent more than three months in the perinatal center.Every day my husband Sergei and I repeated like a prayer: everything will be fine. It is very important in such a situation not to quarrel, to support each other. I tried to preserve milk – and as a result, I fed my daughter for up to a year and three months. I remember that the baby was still in the incubator, but the doctors had already allowed her to be pulled out and put on her chest for a short time. It was so scary – red, small, fragile with a tube in her mouth … And some “good” friends said, they say, that you are fiddling with her, she will be disabled, blind! Supported, in general …

Of course, Nastya was not without complications at all, but now she is an absolutely healthy, active child.And he even gets sick much less often than full-term peers!

The mother of two children, Lena Arapova, has a completely different story. Her youngest, Vova (now he is two and a half years old), was born at a good time, at 34 weeks. But in intensive care, he was the most difficult – he could not breathe, there were heart problems.

– Every day I came to the intensive care unit and sang him songs, all the children I knew, – says Lena, – The nurses and doctors still use me as an example! Of course, no one expected that I would have such difficulties.The pregnancy was proceeding calmly, well, all the indicators were like in the textbook. When suddenly both me and the baby started tachycardia, the doctors decided to urgently deliver! The son spent about a month in intensive care. But I have not shed a single tear during this time. Because strength and nerves were needed to help the baby. I know for sure, he reacted when I sang to him, communicated with him. And I also took care of milk, expressed and passed it on to the child. As a result, we are still feeding! I am very grateful to all the medical staff – both doctors and nurses.They are just amazing! For the entire period of our stay here, we did not pay a penny, nor did we buy a single thing or medicine – even diapers were given to us for free.

One-year-old twins Andrey and Vika Lysenko recently learned to walk and are happy to conquer more and more territories. As you know, multiple pregnancy itself has a risk of premature birth. The babies were born to their mother Irina at the 27th week and each weighed just over 900 grams.

– They breathed very badly, then he, then she – says their aunt and godmother, Elena, – Especially Vika was difficult.But do you know what’s interesting? When they were laid next to them, the babies began to breathe! They are still very friendly. I have two boys, 5 kg each were born, and these are 980 grams – but now there is no difference at all!

We talked to Natalia Pozdnyakova in the ward of the second stage of nursing. Talking to us, she continually stroked the head of her little son Denis, and he peacefully snoozed for himself in the cradle. Natalya was happy to see her first child and felt good. But when at 30 weeks the doctors measured her blood pressure, they were horrified – 110 to 190.The girl was directly told that urgent childbirth was needed, otherwise the child would die and her kidneys would fail.

– Well, they brought me here in an ambulance, otherwise I’m afraid everything would be really bad, – the young mother almost cries, – He was born seven months old, but due to problems with my pregnancy, he developed poorly and weighed only 860 grams!

First, the boy spent 24 days in intensive care, then a month in intensive care.

– My husband and I really waited for him to gain at least a kilogram, then two hundred, one and a half kilos.We already weighed 1975 grams yesterday! – Natalya rejoices, – Many thanks to the doctors! Of course, I had both fear and tears. But the doctors’ words make us happy. Dad once already held his son in his arms and now he is all exhausted – he is waiting for us! I know that I will soon take the baby home. And everything will be fine with us.

Since 2011, when the regional perinatal center was opened, four hundred babies weighing less than a kilogram have been rescued here – the smallest one weighed only 490 grams. According to statistics from the perinatal center, out of a hundred children born with a weight of less than a kilogram, 87 survive.

About how doctors today care for children with extremely low body weight, which is why expectant mothers have a risk of premature birth and after what week of pregnancy the chances of giving birth to a healthy baby dramatically increase – read in the issue “MY!” dated November 21

90,000 The story of how I gave birth at 25 weeks

According to the WHO, every tenth childbirth occurs prematurely; 15 million premature babies are born in the world every year.But when this happens to us, we get lost and absolutely do not know what to do. Our author Yulia Evstigneeva talks about her experience of preterm birth. “I went through this and I know this is not the end, this is the beginning: the beginning of a new, very difficult path to happiness.”

Each step was difficult. Half bent, I clung to the railing and crawled up the steps to the children’s intensive care unit. In the box – a bright room with transparent walls – among babies in three incubators (a device with automatic oxygen supply and maintaining an optimal temperature, in which a premature newborn is placed – Note.ed.), I immediately recognized her: firstly, she was the smallest – exactly how a girl of 740 grams should have looked in my mind, and secondly, mine: tiny, red, wrinkled, helpless and very similar to husband.

The sensors squeaked and howled in unison with my bursting heart, and I held on to the incubator and did not know how to help my baby. And why, why did it happen? After all, this is not what I wanted and was waiting for!

Pending

My husband and I dreamed of her for two years.I can’t say that it didn’t work out, no. I dreamed of being a child, and the doctor constantly found excuses not to allow planning. But I just really needed a daughter, I dreamed of her. For a year and a half, I put my tests in order, underwent an operation to remove a polyp, tightened up my hormones and spent an incredible amount of nerves waiting for it to be possible. And then six months of unsuccessful attempts.

Two stripes on the test showed up when I was on vacation abroad.I was happy, and my vacation was irretrievably lost, because now, instead of swimming in the sea, rushing on a hydro scooter and trying exotic food, I thought about not getting cold, not “shaking” the child and not being thrown into the infectious diseases department of the local hospitals. And the sudden threat of miscarriage forced the whole family to pack their bags and return to their homeland. But it was all nonsense. The stomach gradually grew, the threat was behind, the tests were normal, I felt great, there was only a month left before the decree, and the doctor, making measurements, happily predicted the baby’s weight at birth 3700, no less.

© Photo by Yulia Evstigneeva

Your daughter was born, 740 grams

The water flowed exactly on the day that my smartphone app announced that my pregnancy “turned” 25 weeks old. Right at work, at the computer. I didn’t immediately realize that it was water, but I tensed in my soul. She asked to go home, and from there called an ambulance. They brought me to the hospital with a noticeably smaller belly, and the doctor calmly announced during the examination: “Miscarriage! There’s nothing you can do! Give birth in the evening! Forget you were pregnant! ” I was in a state of shock and did not believe that this was happening to me.

I tried to object, but the nurse standing next to me stopped all my attempts with the words: “You are still young. Give birth to another in a year. ”

I was lucky, according to the law, all babies over 22 weeks old and weighing more than 500 grams should be kept, and if the hospital does not have the equipment and personnel for this, the woman in labor must be sent to another institution. I was taken by ambulance to the perinatal center, and I am grateful to our city doctors – for not seeing them again.

What should expectant mothers who are 22 weeks or more pregnant with a real threat of premature birth to know? They urgently need dexamethasone injections to help open the fetus’s lungs. This significantly increases the survival rate of premature babies. Ideally, three injections should be given 8-10 hours apart.

In the perinatal center, they immediately put me on a gurney, did an ultrasound scan, gave me an injection of dexamethasone, put on an IV, reassured me and assured me that they would keep it for as long as possible.Well, then they will have a cesarean section – this is so that the child does not “break” about the birth canal. It was possible to survive for only three days, then the temperature rose, the tests deteriorated, the baby stopped knocking.

Caesarean section took place in silence. Only once did the renimatologist ask the doctors: “What are the points there?”, And I heard a disappointing one: “What are the points!” There was no slap on the ass, the excitement of crying of the child, the statement of the fact “you have a girl” with all the details and even the predictions that she will live.

In silence, the incubator was driven past me, asked not to ask about anything, and only a few hours later, a doctor came down to me, already in the intensive care unit, and through my mind, clouded with medication, I heard: “Your daughter was born, 740 grams. Itself does not breathe, under mechanical ventilation. ”

Rescue milk

Everyone has their own reaction to such an event. One young mother, after a premature birth, cried constantly for about a week, the other was sure that everything would be fine and did not shed a single tear.But we all have what is vital for our children – milk.

They are premature, find themselves in a difficult situation, they are stuffed with a lot of drugs, instead of spontaneous breathing – pipes, and at least the food that is given to them drop by drop must be that given by nature. And it depends on us.

© Photo by Yulia Evstigneeva

When, four hours after the cesarean, I was allowed to get up and leave the intensive care unit, I began to look for my child. It was not easy to crawl to her to another floor, it was hard to look at this tiny child, no bigger than a doll’s doll.But a nurse came up to me and held out a cone: “Squeeze a couple of drops here, please.” I did what they asked and saw how these drops were poured into my daughter through a tube. She didn’t even budge, but I fed her, fed her! “In three hours, come back for feeding,” the doctor asked.

Then my daughter’s struggle for life began, and mine – for her health and preservation of milk. My husband brought a breast pump, every three hours I expressed 100-150 ml of milk, the child drank only a few milliliters of them, but I believed someday the entire volume would be needed, and I would definitely attach my baby to my breast.

Advice to those who gave birth ahead of time: Express regularly, do not feel sorry for yourself. To do this, get up even at night, it is in the dark that prolactin is produced, which promotes milk production.

What is this number?

Mothers of premature babies in our country face a great lack of information. The doctors themselves speak little, dosed, they swear a lot when they ask them about the forecasts, and in between times reproach: “You took the child for only half a term, what do you want ?!”.

No, I am grateful to these people, they are real workers and do an unrealistically good and kind deed, and yet they are all superstitious and afraid to make plans. But what should moms do? From the standpoint of my experience I will say:

• Deal with symptoms and sensors on your own. A child’s blue complexion is a reason to call a doctor. For example, I figured out what mechanical ventilation is only after three days, when my daughter was already transferred to another, lighter breathing support called CPAP. Normal saturation on the monitor (breathing sensor) should be within 100 (these numbers constantly flash on the monitor next to the breathing diaphragm), and the better your baby breathes himself, the less support: with the help of ventilation, oxygen is supplied through the tubes directly to the lungs, and CPAP uniformly delivers oxygen to the child’s body, but the child breathes on its own.If you have been transferred from a ventilator to a CPAP, that is very good. And if on the “antennae” – tubes, in which the air is simply more saturated with oxygen than the one we breathe – then you can jump for joy, the baby breathes himself;
• Do not listen to “well-wishers”. For example, I met one woman in labor who, upon learning about my case, exclaimed: “I don’t want to scare you, but such children don’t survive!”;
• Read forums. These are the sites that are dedicated to premature babies. There is a lot of information in them, and many similar stories.Of course, there may appear “ill-wishers”. Fortunately, I did not meet, and if I came across something negative, I did not pay attention. As you set yourself up, so everything will be.

© Photo by Yulia Evstigneeva

Second stage

When the risks to life are minimized, the premature baby is transferred to stage 2. This is no longer intensive care, but a hospital where the premature baby gains weight and is discharged home.

In the department where my daughter was lying, they let me go home with a weight of 1800 grams or more.My daughter switched to stage 2 at the age of 17 days, by that time she was already breathing on her own, but there was a tube with oxygen next to her. She weighed 800 grams and still needed an incubator. She was put in alone, without me, for about a month I had to visit her only twice a week (alas, these are the rules of the hospital) and bring milk every day.

The doctors explained that there was little I could help her, and there were only places for mothers in the common ward with children (my girl was not ready to move there).

But every day, with trepidation, I found her name on the list and rejoiced at the collected grams.When I was allowed to lie with her, she already weighed as much as 1300 grams, and when she gained another 100, I put her to my chest.

What helped me to get over the separation from my child?

• Preparing for hospitalization. In order to lie with a baby, tests and fluorography are required (even for nursing mothers). You are preparing, and it is morally easier for you.
• Knitting. Premature babies are very cold, and they need socks made of pure wool (without acrylic), hats, and knitted octopus toys (psychologists believe that the tentacles of these animals remind children of the umbilical cord, so babies calm down).If you know how to knit, the hospital doctors will be grateful, and the children will be kept warm thanks to your care.

Lying down at the second stage is also somewhat difficult: you have to follow all the instructions of the nurses, feed the baby every three hours, and do various manipulations for an hour before feeding – washing, swaddling, sterilizing the breast pump, pumping and feeding the baby from a bottle. Why a bottle? Not all babies breastfeed, and not everyone is allowed to breastfeed, because it takes strength.

Nursing babies are not at all like ordinary newborns: they are weak, sleep a lot, and cry so that they can hardly be heard.

I was overjoyed to tears when a neighbor came running to me in the dining room during lunch and said that my daughter was crying loudly and could wake up other children. And also stage 2 is a very long time: I lay for a whole month, and during this time my child underwent eye surgery (unfortunately, premature babies often suffer from vision).

It is simply necessary to be patient, but you should know, all this is temporary: these three months – from the moment the waters left to discharge – seemed to me a nightmare, but it passed and now it remains only in my memories.

We were discharged when the child weighed almost 2 kilograms. The developmental delay in age was three months – exactly as long as she did not sit in the tummy. In order to tighten up the child, in the first year I went to rehabilitation several times with massages and other procedures in the hospital, I did three massage courses at home.

Now my daughter is two years old. She is cheerful, lively and does not differ at all from her peers who were born on time. She wears glasses, but this is such nonsense compared to what was given to survive.And I know we went through all this with her to be happy – like now!

Special project “Born prematurely: stories and facts about premature babies”

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90,000 Interview with Olga Ksenofontova – Specialist advice – Patients

Yekaterinburg Clinical Perinatal Center

The parents of our patients do not forget us “like a bad dream”, but on the contrary – they share good news!

International Premature Baby Day was held on November 17th.This date is special for doctors of the City Perinatal Center. After all, they take care of babies born prematurely every day, prepare them for a new, not always simple, but inappropriately happy life.

Olga Ksenofontova – Deputy Chief Physician for the Medical Department, told what the parents of the baby should remember after he was discharged from the hospital.

Premature birth is a very common phenomenon today. Tell us about its main reasons. What can provoke an early birth of a child?

Among the main causes of premature birth, infectious diseases, pathology of the placenta, preeclampsia can be distinguished.A special group is also made up of smoking, alcohol, psychotropic and narcotic substances, and not only during, but also before pregnancy. But the exact cause of premature birth can not always be indicated.

Is it possible to “predict” premature birth?

Currently, there are methods for identifying the threat of premature birth. One of them is determining the length of the cervix during ultrasound screening in the second trimester. For treatment with the threat of premature birth, there are drugs that are used in outpatient practice and in the hospital.But nevertheless, not in all cases it is possible to prolong the pregnancy.

Is there any way to prepare for premature birth?

All women should remember that the antenatal clinic for registration for pregnancy must be contacted early, since the first and most important perinatal screening (ultrasound and blood test) must be carried out within 12 weeks. The antenatal clinic must be visited regularly and all the doctor’s prescriptions must be followed.

If the threat of developing premature birth still occurs and treatment at the outpatient stage in the antenatal clinic is ineffective, the pregnant woman is hospitalized in a hospital where various methods are used.

First of all, methods are used aimed at prolonging pregnancy (tocolysis, maintaining pregnancy with premature rupture of amniotic fluid, prescribing antibiotics). The prognosis for the life and development of a child directly depends on the duration of pregnancy in which he was born: the longer this period, the better the outcomes. And the account here goes not by months, but by weeks and days, so all our efforts are aimed at maintaining pregnancy for as long a period as possible.

Another group is made up of technologies aimed at preparing the fetus.These include, for example, the administration of hormones to a pregnant woman, magnesium sulfate. These techniques effectively reduce the incidence of complications such as respiratory distress syndrome, intraventricular hemorrhage, and some others in premature infants.

The possibilities of modern medicine in this direction are quite high today. But what are the real prospects for a baby born prematurely?

As I already said, the prognosis for the life and development of a child largely depends on the duration of pregnancy in which he was born (gestational age).The higher this age, the better the prognosis. Thus, the survival rate of children born at 28 weeks or more reaches 95-100%, while in children born at 25 weeks, it is only 30-50%. The same applies to predictions for the quality of life of children. Children with a lower gestational age are more likely to develop severe lung or central nervous system damage, which is often the cause of the child’s disability.

Much also depends on how much attention will be paid to the premature baby after discharge from the hospital.By the way, many of the great people were born prematurely. Among them: Napoleon, Newton, Mendeleev, Byron, Suvorov, Darwin, Rousseau, Mozart, Goethe, Schiller.

What is the first thing to remember for the parents of a premature baby?

Well, probably, first of all, that they are parents. That their child is special and, of course, it will take a lot of attention and strength, and patience, while he grows up and catches up with the development of his peers.

What are the main health problems faced by children and their parents?

The most common medical problems in premature infants are: pathology of the respiratory system caused by immaturity of the lung tissue and a lack of surfactant (a substance that keeps the lungs open).In premature infants (especially infants weighing less than 1000 grams at birth), immaturity of the lung tissue and the need for prolonged mechanical ventilation can lead to the development of broncho-pulmonary dysplasia, characterized by oxygen dependence, recurrent obstructive conditions and other symptoms. Also, the pathology of the organs of vision – retinopathy of premature babies. This serious disease requires observation by a specially trained ophthalmologist (in the city of Yekaterinburg, this type of assistance is carried out in the NGO “Bonum”) and even surgical treatment.Another problem is the pathology of the central nervous system: intraventricular hemorrhage, leukomalatory lesions of the white matter of the brain. In severe cases, this can lead to the development of hydrocephalus or various movement disorders.

Such a baby usually develops along its own “trajectory”. Tell us about its main points.

The development of a premature baby is assessed by the so-called postconceptual age (PCA). What does it mean?

For example, a baby was born at 33 weeks gestation and lived for 4 weeks.In this case, his PCV will be 37 weeks, that is, the term of full-term pregnancy.

A newborn full-term baby should open his eyes, fix his gaze, and have a certain set of physiological reflexes. Likewise, our prospective preterm patient at 37 weeks of PCV should have all these skills and reflexes. And in this case, it is not considered as a developmental delay, despite the fact that the child is actually one month old. Gradually, the difference between PCV and actual age decreases and premature babies “catch up” with their full-term peers.The higher the degree of prematurity, the longer it will take.

Such a baby needs a special approach: tell us about the peculiarities of caring for him.

When caring for a premature baby, it must be remembered that many functions and systems of his body are immature. It has less pronounced reserves of nutrients, while its growth rate should be high enough. Therefore, the nutrition of such a child should be enhanced and contain more protein and calories. For this purpose, specialized mixtures and enhancers (fortifiers) of breast milk have been invented.

It is more difficult for such a child to adapt to the conditions of the external environment: he quickly overheats and overcooles, therefore, it is necessary to monitor the temperature regime of the premises in which the premature baby is located. An immature immune system and a lack of a supply of maternal antibodies transmitted to the fetus in the last trimester of pregnancy make such a baby susceptible to infectious diseases. That is why breastfeeding is especially important for such children (after all, breast milk contains a whole set of protective substances) and timely vaccination.

Vaccination and the introduction of complementary foods are the main questions for many parents. If everything is standard with a full-term baby, then there are some peculiarities. Tell us about them.

In answer to the previous question, I have already mentioned the special susceptibility of premature babies to infectious diseases. That is why these babies need to be vaccinated in the first place! There is a completely wrong, but very widespread opinion: “He is small, weak, and then there is vaccination.”The purpose of vaccination is to protect against infections. And first of all, it is just the little and weak ones who need it, since they get sick more often and more heavily. Vaccinations for premature babies are given according to their actual age. Aside from some weight restrictions (for example, when deciding whether to vaccinate against hepatitis B and tuberculosis), these babies should be vaccinated on the same schedule as term babies. Complementary feeding for such babies, if they develop normally and do not get sick, is also introduced according to their actual age.

Are there any special methods for the development of these babies? What is the best way to deal with children at home?

There are massage and gymnastics techniques that require specially trained instructors – doctors and equipment. But there are also exercise techniques adapted for premature babies that parents can do on their own. They can be found in special reference literature. It is important to remember that none of the most modern drugs stimulating the nervous system will have its effect if the child is not given massage courses, and if the parents do not work with the child every day.The more they will contact their child, devote time to him, the better the result will be.

An office has been organized today, in which it is precisely premature babies that are observed. Tell us a little about this.

Yes, a follow-up room has been opened in the city. It works on the basis of the children’s city polyclinic №13 at the address: st. Weavers, 16a, phone: 384-48-13.

In the office, the reception of all narrow specialists, as well as a neonatologist, is organized. In it, premature babies from all parts of the city can be observed in the age of up to 2 years.There you can also get advice when deciding on vaccination.

Do you follow the fate of the babies you once left? Are you happy with the results?

The doctors of our departments keep in touch with many patients. When checking out, we always indicate the e-mail address of the neonatal pathology department and the parents of our “graduates” send photographs of their grown children and tell about them. There is a branch page on the Vkontakte social network. And in October this year, our perinatal center turned three years old, and we arranged a small meeting with patients who at different periods were treated in the department of pathology of premature babies.It was very joyful to see that the children are growing and developing well and have already caught up with their peers.

In fact, it is not only very pleasant for a doctor, but also very important to see the results of his work, as this helps him to maintain faith in the usefulness of what he is doing, gives him confidence. This is the best prevention of the so-called “burnout syndrome”.

We are very grateful to the parents of our patients for the fact that they do not forget us “like a bad dream”, but share with us their good news, such as “We are sitting”, “We are walking” or “We are already talking” mom “.Parents always say “we” about the child. And the doctors of our departments, when they remember discharged patients or discuss the treatment of some patient, they say “ours”. I often hear something like this: “They called from the clinic, at our Ivanov’s …” and then, depending on the situation. This is wonderful, because only with close interaction between doctors and parents and trust in each other, a good result can be achieved.

From the staff of the City Perinatal Center, I wish health to all children, regardless of the gestational age at which they were born.Let them grow big, strong, smart, please their parents and go to doctors only for preventive examinations and vaccinations!

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