Advances in medicine and the role of parents impact the survival of preterm infants

Manuella was 23 days old and just over 700 grams when she felt the lap of public servant Stephanie Molina Diener, 32, for the first time. There were wires attached to her body and tubes in her nose, but no equipment stopped her from exchanging a look with her mother.

The chubby, nickname Manuella has received since she gained weight and was discharged, is an example of how advances in medicine and in the work of mothers and fathers allow the survival and quality of life of increasingly premature babies.

“In the 1980s, children weighing less than 1 kg did not survive because we had no knowledge of the newborn’s physiology. We did not know, for example, how and when the lung matured. Another factor that advanced was the creation of neonatal intensive care units” , comments Licia Maria Oliveira Moreira, president of the Scientific Department of Neonatology of the Brazilian Society of Pediatrics.

Graduated in medicine at UFBA (Federal University of Bahia) in January 1976, she closely followed the changes in the area, including better training of the multidisciplinary team, advances in physical therapy, use of corticosteroids in prenatal care for lung and artificial surfactants for the correct functioning of the lungs after birth.

“We currently have a very good survival rate in the country for babies from 26 weeks and, in some places, 24 weeks”, says Moreira, in line with the improvement in survival rates pointed out in international studies. Babies below 37 weeks of gestation are considered premature and those born at less than 28 weeks are considered extremely premature.

Extreme preterm infants have greater difficulty regulating their own temperature and controlling breathing, so they require a special incubator and a suitable respirator, innovations in recent decades. Another strong point was the establishment of protocols for the moment immediately after birth, the Golden Minute, for the team to be prepared to receive and, if necessary, resuscitate the baby.

“It is necessary to have this infrastructure to not harm the baby. He was born early and the external environment is aggressive. We see that thin and delicate skin on the outside, imagine on the inside. Everything we use needs to be delicate”, says neonatologist Filomena Bernardes de Mello, head of the neonatal ICU at Hospital e Maternidade Santa Joana.

With more than 30 years of career, she also witnessed the changes in neonatology and learned that the premature is a box of surprises. “You look at the baby all cute, but he doesn’t have all the functions 100%. This is deceiving and we have an obligation to tell the parents that his path will require patience. It doesn’t mean that the best outcome won’t happen, but I can’t help but say that the risks are high”.

Patience was something that Stephanie and her husband, attorney Giulliano Naccarati Marcon, 28, began to develop while they were pregnant. It was the second pregnancy – they lost Helena at ten weeks – and at the beginning there were two bleedings. Afterwards, they discovered a small detachment of the placenta and were told that Manuella was very underweight.

Due to the risk, Stephanie was admitted to the semi-intensive ICU when she was 27 weeks and a day old, and at 4:22 am on August 17, after two weeks of follow-up in the hospital, she gave birth by an emergency cesarean section.

Manuella was hospitalized for 75 days. It was enough time for the parents to live with the most different feelings: guilt, grief for the babies they saw die, joy for every ounce conquered.

“There are many ups and downs in the NICU. The other parents gave us a lot of strength, as did our parents, the hospital staff and religion”, says the couple.

Stephanie remembers, for example, the speech therapist’s care so that Manuella started to breastfeed and Giulliano, the authorization to stay an hour with her daughter on her lap. “I was completely stuck. I wondered if she was saturating, if I was pulling any threads, if the lip color was good. These are concerns of an ICU parent. I’ll never forget it.”

The active participation of the mother and father was another progress registered in recent years. Even so, it is necessary to encourage the practice, hence the motto for this year’s Purple November, awareness month on care and prevention of prematurity, being “Ensure skin-to-skin contact with parents from the moment of birth”.

“We had many achievements in the prematurity scenario, but we still have many challenges”, highlights Denise Leão Suguitani, president of the NGO Prematuridade.com. According to the Ministry of Health, Brazil annually records the birth of about 340,000 premature babies, equivalent to 38 births per hour.

Suguitani lists, within the scope of prematurity prevention, adolescent sex education, family planning and the adequacy of prenatal care, both in terms of the quantity of consultations and in relation to the quality of care. The pregnant woman needs to know, among other points, which are the signs of risk and which hospital is her referral so as not to go on pilgrimage at the time of delivery. She still needs to understand the risks of needlessly scheduled cesareans before the child is fully mature.

The president of the NGO also emphasizes the need to put the Kangaroo Method into practice in all its dimensions. “These are very complete and thorough guidelines for humanized care. It’s not just skin-to-skin contact. It ranges from care before delivery to the stay in the ICU, with parents having 24-hour access because they are part of the baby’s treatment. are visits”.

In the case of Stephanie and Giulliano, maternity leave and working from home allowed them to accompany Manuella for more than 12 hours a day, every day. And they will allow the continuation of care, since, as indicated by Mello, premature infants must be accompanied by a multidisciplinary team, including a neuropediatrician, physical therapist, speech therapist and ophthalmologist.

“There are different possible sequelae, so we say that prematurity is not just being born prematurely and that’s it. After discharge, the story continues.”