Neonatal death, like Cristiano Ronaldo’s son, can be avoided with proper prenatal care

Last Monday (18), Portuguese soccer player Cristiano Ronaldo shared the news that one of the babies he and his wife were expecting died. Georgina Rodríguez, who already has four children with the Manchester United star, was pregnant with twins.

The circumstances of the child’s death were not disclosed. “Only the birth of our little girl gives us the strength to live this moment with some hope and happiness”, wrote Ronaldo to more than 430 million followers on Instagram. “Our boy, you are our angel. We will love you forever.”

The fatality is called by specialists early neonatal death, as death occurred between birth and the sixth day of life. This classification, in turn, belongs to the group of perinatal deaths, which occur between the 28th week of pregnancy and the 7th day after the child’s birth.

An analysis published in January of this year in the journal “Cadernos de Saúde Pública” revealed that, in 2018, there were 45,875 perinatal deaths. Among them, 18,866 are early neonatal cases and 27,009 are fetal cases. The study is signed by scientists from the Health Surveillance Secretariat of the Ministry of Health.

“The main risk factors for perinatal death are those related to prematurity, whether spontaneous or caused by some type of fetal or maternal pathology”, explains Paulo Roberto Nassar de Carvalho, a gynecologist who is a member of the National Committee Specialized in Perinatology of the Brazilian Federation of Gynecology and Obstetrics Associations (Febrasgo).

Although problems such as fetal malformation still cannot be solved by specialists, several pathologies associated with prematurity can be controlled. The hypertensive disease of pregnancy is the most common among them and interferes with the flow of blood to the baby at the time of delivery, which can have serious consequences.

This and other maternal pathologies, such as pregnancy diabetes, which can influence the normal growth of the baby, are easily detected during routine examinations of the pregnant woman. That’s why, for Linus Pauling Fascina, medical manager of the Maternal and Child Department at Hospital Albert Einstein, in São Paulo, “everything comes back to prenatal care.”

Monitoring is crucial because, if there is a risk to the baby, measures can be taken in time. “You can advance the period of hospitalization before delivery, for example”, says the doctor.

In multiple pregnancies, as was the case with Georgina Rodríguez, Cristiano Ronaldo’s wife, the risks for babies are naturally higher, as they are more likely to be born prematurely. “In singleton pregnancies this rate is approximately 11% of the total, while in twins [múltiplas] this rate is around 50%”, points out Carvalho.

In fact, to reduce the risks of births in general, vaginal deliveries are preferable to cesarean sections – especially if more than one child is arriving in the world. “[O método natural] takes advantage of the babies’ maturation process and makes respiratory complications difficult”, says Fascina.

The role of health professionals is even more important in cases of perinatal deaths caused by asphyxia, according to a study led by scientists at the Escola Paulista de Medicina at the Federal University of São Paulo. The analysis, published in 2013 in Paulista Journal of Pediatricshighlights that, with adequate care for mother and baby, deaths of fetuses and newborns due to lack of oxygen can be avoided.

Adequate medical follow-up is also essential for the diagnosis of infections that may affect the child. The main one, as the Ministry of Health researchers point out, is syphilis, which can be easily treated.

“When offered in a timely manner, it can ensure complete remission of the disease in the mother and prevent vertical transmission to the baby, thus making deaths from this cause avoidable,” the scientists wrote in the study published earlier this year.

Furthermore, individual and circumstantial factors cannot be ignored. According to the report, in 2018, perinatal deaths were more common in mothers over 34 and under 20. Meanwhile, a higher level of education was shown to be associated with lower chances of fatality.

For Fascina, the problem is not the capacity of the SUS (Unified Health System). “SUS has a well-assembled structure for prenatal care”, he says. “However, accessing it regularly is often difficult due to other issues, such as the distance.”

The country, even so, has seen considerable advances in the area: data from the Brazilian Institute of Geography and Statistics (IBGE) reveal that the infant mortality rate was 71.3 per thousand live births in 1982, to 14 per thousand in 2015 – a drop of 80.4%. In the same period, neonatal mortality reduced by 63.4%, and went from 33.4 to 8.2 per thousand in the same period.

The pace of this improvement is also considerable, according to research published in the February this year issue of the journal Science & Public Health. The study, which investigated data from 2007 to 2017, found a reduction of 2.15% per year in the number of neonatal deaths.