It may happen that a pregnancy must end before the canonical 37 weeks for several reasons. The path then shifts to intensive care
Wrens. They are born before the others and born uphill, as a mother says. They couldn’t do it alone. They need special assistance, in a special place, with special people and machinery. They need to have their parents around, like and more than any other child. I am premature babies, those who come into the world before the canonical 37 weeks of pregnancy: 6.7 shares per hundred are pre-termHealth Ministry’s Cedap (Childbirth Assistance Certificates) data for 2019 said.
Italy, one of the countries in the world where people are born better
The Neonatal Intensive Care Unit (Tin) can become their home, even for months. A special place where life or death is decided. Fairly contained event, the latter: Italy among the countries in the world where people are born better, with very low neonatal mortality rates (2.1 per thousand live births compared to 2.9 in Germany; 2.6 in Denmark; 2.7 in Holland and 2.9 in England, Eurostat data 2018) recalled the Professor Fabio Mosca, past president of the Italian Society of Neonatology (Sin) at the opening of the last National Congress, in Rome last October. Of course there is still ample room for improvement, above all to reduce the gap between neonatal mortality rates in Northern and Central Italy compared to Southern Italy and the Islands, but the network of our birth centers among the best in Europe.
Parents: be in front of the door
The numbers are comforting, true. But what does it mean, today, to be born first in Italy? How is the network of Neonatology centers organized? What are the forces in the field and what resources can they rely on? And a parent? How does it feel when you arrive at the door of a NICU? Start from here. You find yourself plunged into a world you do not know, moreover in an emergency situation. An extremely sophisticated, technological, very cold environment, with a feeling of great fear because you are afraid every day that something might happen. But also with a great sense of protection, he says the lawyer Martina Bruscagnin, mother of a girl born at 27 weeks and president of Vivere (viveonlus.com), a non-profit organization that coordinates 50 associations of parents of premature or hospitalized children at birth.
The neonatal network
Let’s open those doors, then. In our country there are 118 intensive therapies for 418 birth points (White paper on neonatology just presented by Sin, data from 2019). Each of these neonatal ICUs the hub of a series of birth points that refer to them when a newborn is in critical condition. Fortunately, the number of child transfers is decreasing over time, because the transfer of the mother directly to a second-level center, equipped with all the characteristics to be able to assist a pathological pregnancy, explains Dr. Luigi Orfeo, new president of Sin. Hub and spoke, like the hub and spokes of a wheel: this is how Italian neonatology is organized. We actually have two levels: the first level is a birth point that is able to assisting a minor disease, that is, babies with small problems that can occur immediately after birth, metabolic alterations such as hypoglycemia or hypocalcemia or particularly high jaundice. The second level, on the other hand, is capable of assisting premature babies with organ failure which can be caused by, among other things, prematurity. But also from previous situations such as congenital malformations which will then require surgery. For example, heart disease, which is probably the most common type of congenital malformation in our newborns.
What happens in intensive care
We enter a Tin. There is a baby on the way. When in need of intensive care, the baby is taken to the ward for the most part assisted in a thermal cot, an incubator. One of the main problems of newborns, especially premature babies who need a constant temperature because they tend to lose heat very easily. Respiratory failure is another problem. These children often require respiratory assistance and are connected to a mechanical ventilator. Today, however, non-invasive ventilation methods are much more frequent, therefore without endotracheal intubation but simply with nasal cannulas that favor breathing, explains Orfeo. And how do mom and dad come into play? According to the indications of our scientific society, but also the European standards, they should be present without time limitations. Because in our case parents are not considered visitors but an integral part of the therapeutic path.
In many centers, the doors remain closed
The active presence of the parent next to the child foreseen in the
Charter of the Rights of the premature child
, recognized by the Italian Senate in December 2010 (see the factsheet). The opening of intensive care 24 hours a day, loudly demanded by parents, however, it collides with a different reality: guaranteed, according to Sin, in almost 90% of the structures in the North, a percentage that drops to 56% in Central Italy and 34% in the centers of the South. The reasons for so much disparity? Cultural, in my opinion. We need to broaden our horizons. The presence of the parent can create new realities rather than problems. The parent can indeed be involved in caring for the childsays Orpheus. Right. C
he what can they do in the muffled and confined space of an intensive care unit? In some cases some trivial care operations even in very young children, that is of 800-900 grams: change the diaper, feed it, clean it, massage it. For guidance to involve parents more and more. And with the parent ever more present, the way of communicating with operators also changes. The most open communication continues.
The return home
The admission of a child to intensive care is not always a story with a happy ending. We said it. And in these cases (but not only), parental associations become a lifeline. For the majority of children and parents, however, the day of the you can go home tomorrow. For many mothers a bit like cutting an umbilical cord, as Elide Esposito writes, co-author of the book with her husband Peter Durante
420 grams. Story of a difficult birth
(Feltrinelli, 288 pg, 11 euros), a two-entry diary that tells directly the experience of having a premature child. But we do not abandon them, assures Orpheus. We continue to follow them. Preterm newborn follow-up clinics are operational throughout the national territory. Generally, most of these assistance programs are interrupted for around three years, while they should instead be prolonged at least until the age of school.
Assistance after admission
We need to be able to extend the assistance up to at least 5-6 years, dice Luigi Orfeo, who is also director of the UOC of Pediatrics, Neonatology and Neonatal Intensive Care, San Giovanni Calibita Fatebenefratelli Hospital – Isola Tiberina in Rome. Why? a period of time long enough to be able to identify a whole series of problems. In the early years we basically see the serious ones. Of course many of these children may have other problems related to learning disabilities over time. Obviously, we cannot notice all these things in the first three years of life, instead a slightly prolonged follow-up at least up to 5-6 years of life could also intercept the problems that appear later on. And would you be able to do it? Yes, if we had adequate medical and nursing staff and means, naturally with the support of other specialists, psychologists, physiotherapists, child neuropsychiatrists because the follow-up is in any case multidisciplinary. But our strengths hardly allow us to continue up to the child’s three years. Not to mention that these activities are not always part of a Pdta (Diagnostic Therapeutic Assistance Path). This is another claim of the Sin: c
hwe provide specific pathways for the follow-up of the newborn.
Zero Separation. Act now! Keep parents and babies born too soon together, which in Italian becomes Zero separation. Let’s act now! Keep parents and children born too early together, the claim chosen by the European Foundation for the Care of Newborns (Efcni) for the World Day of Prematurity which is celebrated on November 17. For the occasion, many monuments are illuminated in purple, the color of the event, synonymous with sensitivity and exceptionalism. Symbol of World Day, on the other hand, the thread with the socks spread over it. The tiny pair of purple socks – amidst nine full-size baby socks – means: 1 in 10 babies is born premature. Worldwide. More information can be found on www.efcni.org and viveonlus.com.
November 24, 2021 (change November 24, 2021 | 19:30)