Author: MD Ph.D Tetiana Kovtiukh
In this article, MD Ph.D Tetiana Kovtiukh discuss preterm birth, the potential struggles related to this, and the reason behind the complications. Additionally, the neonatal landscape in Sweden is highlighted and the need for future developments.
Preterm birth, defined as delivery before 37 complete weeks of pregnancy, remains a top priority of health care and a major problem around the world. The rate of preterm birth varies from 5 to 18% in different countries around the world and does not show a downward trend3. The perinatal mortality among preterm infants is 40 times higher than that in full-term children. This is due to the immaturity of the preterm newborn’s organs and systems. An adaptation to life after birth in the external environment is more difficult than for babies who were born full-term1.
The conditions in which the fetus develops during pregnancy (the fetal period ranges from the 10th week of pregnancy until birth) are significantly different in terms of temperature, the intensity of sounds and light, the level of air humidity. Most importantly however, is the need to breathe on its own, absorb nutrients, and function independently of the mother’s organism.
Sweden has a low rate of preterm birth
Sweden has a vast legacy of neonatal intensive care, and the rate of preterm birth is low compared to other countries such as the U.S. According to the Neonatal Care Register’s Annual Report 2021, about 6,6% preterm babies were born in Sweden 20214. A population-based study using data from the Swedish Medical Birth Register found that preterm birth rates could range from 1,73% to 6,31% depending on the region of Sweden3. Moreover, data shows that one-year survival among live-born extremely preterm infants (born between 22-26 weeks of pregnancy) in Sweden rose from 70% to 77% from 2004 to 20162,5. However, extremely preterm birth has continued to be an issue in terms of optimal care before and after birth, long-term health outcomes, and rate of survival without disabilities among such a vulnerable group of patients. Even though Sweden has a public health care system, free prenatal care with almost 100% involvement of pregnant women these problems still exist4.
Being born preterm is a struggle
The birth of a preterm baby can be a difficult trial for parents because everyone dreams of healthy and cheerful babies. The care for a child born preterm does not stop after discharge from the intensive care unit. For many parents, caring for their preterm born child will continue for not only months after birth, but for many years to come since many of the children suffer from long-term morbidities such as sight impairment, cognitive morbidities, and problems with their movement. Society does not know a lot about the features of these children. For instance, the influences on these children’s social connections in school, where there might be a lack of understanding of their capabilities which in turn creates exclusion as they are more often left behind.
Therefore, scientists and healthcare professionals should do everything possible not only to save the lives of such tiny patients, but also to find ways to get them out without further serious consequences for their health. After all, how fulfilling their life will be depends on this.
References:
1. Bell EF, Hintz SR, Hansen NI, et al. Mortality, In-Hospital Morbidity, Care Practices, and 2-Year Outcomes for Extremely Preterm Infants in the US, 2013-2018. JAMA. 2022 Jan 18; 327(3): 1–16. doi: 10.1001/jama.2021.23580
2. Fellman V, Hellström-Westas L, Norman M, et al. One-year survival of extremely preterm infants after active perinatal care in Sweden. JAMA. 2009 Jun 3;301(21):2225-33. doi: 10.1001/jama.2009.771.
3. Murray SR, Juodakis J, Bacelis J, Sand A, Norman JE, Sengpiel V, Jacobsson B. Geographical differences in preterm delivery rates in Sweden: A population‐based cohort study. Acta Obstet Gynecol Scand. 2019; 98:106–116. DOI: 10.1111/aogs.13455.
4. Neonatalvårdsregistrets Årsrapport 2021. Swedish Neonatal Quality Register. www.snq.se.
5. Norman M, Hallberg B, Abrahamsson T, et al. Association Between Year of Birth and 1-Year Survival Among Extremely Preterm Infants in Sweden During 2004-2007 and 2014-2016. JAMA. 2019;321(12):1188-1199. doi:10.1001/jama.2019.2021.
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