Survival rates for extremely premature babies, born before 28 weeks of gestation, has improved a lot thanks to advances in neonatology and prenatal care and is currently around 75 % and 80 % in the first world. And, in turn, 75 % of these extreme premature babies that survive do so free of moderate or severe disability.
However, the figures are still not optimal among those born closer to the limits of viability, before six months of gestation, something that happens in more than 25,000 births in Europe every year. In the most extreme cases of prematurity, births with 26 weeks or less, survival rates are between 25 and 75 % depending on weeks of gestation. And a high percentage of babies that survive may have sequelae that can seriously affect their brain, cardiovascular and respiratory development, among other things.
According to the latest WHO data, complications related to prematurity are the main cause of mortality in children under five, with a million deaths a year worldwide. The reason for these data is that, in the first six months of pregnancy, the lungs, intestines and brain of the foetus are poorly developed.
Why does prematurity occur? Why has prematurity not decreased in the world and remains stagnant in most developed countries (besides being a very important problem in developing countries)? What can we be done from maternal-foetal medicine to predict or prevent prematurity?
In fact, an extremely premature newborn is a foetus that needs to survive in a highly anti-natural environment outside the mother’s womb. What matters is that these infants survive without serious sequelae or, at least, with the fewest impairments possible so that they can enjoy maximum autonomy as they grow.
How does current maternal-foetal medicine approach the birth of an extremely premature baby? How is its monitoring and treatment addressed? What sequelae may affect the baby and how can we alleviate them? What tools are currently available to doctors and families? What tools could be incorporated to manage these infants better in the near future and to reduce the sequelae of an extremely premature birth? What research and innovations are being employed in this area? Could an artificial placenta be a solution?
Dr Eduard Gratacós, Director of BCNatal of Hospital Clínic and Hospital Sant Joan de Déu, Professor of the Barcelona University and Head of the research groups of Foetal Medicine IDIBAPS and CIBERER, in Barcelona.
Dr Adelina Pellicer, Head of the Neonatology Service of the La Paz University Hospital and Head of the Neonatology Research Group of the Research Institute of the La Paz University Hospital (IdiPAZ), in Madrid.
Cristina Sáez, journalist specialised in science, health, environment and digital culture.