Inform Yourself

The preterm newborn is a miracle that came into the world at an earlier time, a fragile miracle, but which, with lots of attention, love and special care, can manage to evolve spectacularly. A baby born before Week 37 and weighing less than 2,500 grams is considered preterm and in most cases it needs a longer period of hospitalisation, during which the baby must be able to adapt to its new living environment. Significant growth and natural development continue during the last few weeks of intrauterine life, thus causing the preterm baby to encounter difficulties in certain functions, such as breathing, temperature control and feeding. A physiotherapist is an important partner during preterm recovery and the therapy should begin as soon as possible after birth, as soon as the child’s health permits it. In maternities, the physical therapist observes and assesses the baby’s preterm developmental needs and, together with the team from the Neonatology department, sets up the individualised recovery programmes. The assessment of the preterm newborn will always take into account their age of motor development rather than their chronological age. Rehabilitation therapy may consist of stimuli to improve respiratory function and swallowing, or to correct positioning so as to prevent vicious attitudes. Furthermore, the physical therapist helps and encourages the family to interact with the baby as much as possible, giving them information about how to transport, position and stimulate it. Sometimes the recovery process can be long and tedious, with the preterm child achieving a normal development around the age of 2 years, during which the family must pay more attention towards recovering the sensory-motor deficit.

Iulian Nicolae, Physical Therapist Paediatrician

Lifestyle Factors Medical Conditions Demographic Factors
Smoking Infections

(vaginal, urinary tract)

Aged under 17 or over 35 years of age
Alcohol consumption Increased blood pressure Lower class social standing
Drug consumption Diabetes Ethnics
Elevated stress levels and prolonged hours of work Coagulation disorders
Lack of self-care or poor self-care during pregnancy Subnutrition / Underweight
Lack of social support Obesity
Multiple pregancy
Women who went through previous preterm births
Malformations or abnormalities of the uterus or cervix

Preterm births occur when a child is born before gestation Week 37 (Table 1) and represents the singular major cause of infant mortality and morbidity in both developed and developing countries.

According to the data from national registries and the European Perinatal Health Report (2008), the preterm birth rate is between 5.5% (Ireland) and 11.4% (Austria), amounting to approximately 500,000 preterm babies in Europe every year. Existing data indicate an increase in preterm births in Europe. This is why preventive measures for preterm births, though much more carefully applied, proved elusive.

The definition of a preterm birth

The gravity of preterm births Gestational week
Extremely preterm Earlier than Week 28
Very preterm Weeks 28-31
Moderately preterm Weeks 32-33
Slightly preterm Weeks 34-36

 

In industrialised countries such as European ones, the proportion of women who give birth after the age of 35 has increased considerably, thus increasing the risk of preterm births. Pregnancy stress is also responsible for approximately 30% of preterm births.

Several studies have also demonstrated a link between complications during pregnancy and an increased risk of preterm birth, including low birth weight or poor neurological development, as well as psychological factors that may subsequently develop into anxiety and depression. Moreover, the social disadvantages suffered by the pregnant woman can play an important role.

Neonatal death occurs at least once per 100 births, accounting for 63% of all deaths in children up to 5 years of age throughout the European Union.

There are also large differences between the rate of neonatal mortality in so-called “new” countries and the older Europe. In 2004, for the countries that joined the European Union before 2004 (the first 15 Member States) and Norway, the average neonatal mortality rate was 2.7 per 1,000 births. This rate was much higher (4.4 per 1000 births) in the countries that joined the European Union in 2004 (the Czech Republic, Cyprus, Estonia, Hungary, Latvia, Lithuania, Malta, Poland, Slovenia and Slovakia) and three times higher in the countries that joined in 2007 (Bulgaria and Romania).

 

Surely, conclusive examples of other social costs owed to preterm birth are given by the incidence of cerebral palsy, with a rate of 2.3 per 10,000 newborns. Lifetime costs for this condition are estimated at a minimum of 750,000 € per child, totaling more than 7 million € per year. In the US, the estimated annual costs associated with preterm births were $26.2 million in 2005.

Another example of the associated social costs pertains to the labour force. Preterm-born members of society who have not received adequate care usually have fewer skills than an ordinary person who is fit to work, resulting in a labour shortage throughout the European market.

Up to 10% of babies born preterm suffer from medical disabilities that affect their work capacity by up to 50%. Analysing the long-term trend, preterm births equate to 20,000 children per year, each of whom is at risk of being totally unable to join the workforce.

Preterm births and babies with low birth weight also have an impact on their parents’ performance at work. Many preterm mothers are late to return to work, reduce their work schedule, or give up work for child care. This phenomenon is usually associated with a fall in family income by up to 32%.

Parents of children with neuro-sensory and cognitive disabilities generally need special services during the immediate period following their discharge from a neonatal care unit. At older ages, development services are used that include daily care programs, case management and counseling, temporary care and home care, as well as additional health services and educational services.

Furthermore, some costs include the emotional and mental energy needed to care for a preterm child, which may result in the isolation of their parents and the limitation of their social contact.

In the context of rising preterm birth numbers in Europe, all of the above issues represent an alarming sign for rapid action, especially when it comes to the ambitious priorities of the Europe 2020 strategy:

  1. Reducing school drop-out rates to less than 10%.
  2. Increasing the age of the population with tertiary education of at least 40% to 30-40 years.
  3. Reducing the poverty and social exclusion of 20 million people.
  4. Increase the employment rate of the population aged 20-64 to at least 75%.

Decision-makers should take into account the long-term economic effect of preterm births. Moreover, they need to be more receptive to the financial constraints that low-income parents encounter during critical moments of their parent-child relationship.

Pregnancy length Total Weight at birth
Under 500 500-999 1000-1499 1500-1999 2000-2499
Total 190238 9 488 1183 2786 10563
Under 28 449 9 366 67 2 2
28-31 1810 0 106 714 551 124
32-35 6891 0 7 274 1419 2703

The infant mortality rate in 2016 – 7.3 deaths under 1 year-old per 1,000 live births.

These data are not definitive and may be subject to later modifications. Data source: The National Institute of Statistics

Worldwide, 1 out of 10 children are born preterm. In Romania, there are 18,000 preterm births being registered every year.

These values change from year to year.

Thus, in 2017, according to weight and number of weeks were born:

  • 550 babies – with a weight of less than 1 kg (500 g – 999 g)
  • 3650 babies – under 2 kg
  • 12687 babies – under 3 kg
  • 1576 babies (Weeks 22-28, between months 5 and 6 of the pregnancy)
  • 2430 babies (Weeks 31-33, between months 6 and 7 of the pregnancy)
  • 12168 babies (Weeks 34-36, between months 7 and 8 of the pregnancy)

Statistical data* showed that natality recorded 191,694 live births out of which 16,177 were preterm babies.

“The phenomenon of preterm births remains a subject of great interest to the entire civil society. From the figures we have, there has been a slight decrease in preterm births over the last 5 years”:

  • 20,024 (year 2013)
  • 1,733 (year 2014)
  • 16,960 (year 2015)
  • 17,851 (year 2016)
  • 16,177 (year 2017)

With these figures, the abandonment of preterm babies in maternities has improved. This is due to the state subsidies for families with newborns, says Diana Gămulescu – President of the Preterm Association.

“In 2017, at the Cantacuzino maternity in the capital, the figures on preterm births were still high for the birth rate we are registering and we are, as a country, in the top. It is very important to have preventive programs and health policies to support the reduction of this phenomenon. In America, one 28-day-old preterm baby costs the maternity approximately $250,000. The lower the gestational age, the higher the costs. In Romania, estimates start at 25,000 €/preterm baby. The discrepancy is huge”, says Adrian Crăciun – Primary Neonatology Physician at the Cantacuzino maternity and the Center for Excellence in Prematurity.

The phenomenon of preterm births maintains its gravity and every year statistics show that the number of preterm babies is constant.

Their number varies by city and the latest figures show that Bucharest is among the top cities with the most preterm babies. In 2017, there were 1,842 babies born preterm.

On the map of Romania, the most recent data looks like this:

City Number of babies born preterm (2017)
Dolj

Iași

Vaslui

Ilfov

Brașov and Timiș

Constanța

736

703

691

553

550

535

Argeș

Suceava

Cluj

Mureș

Bacău

Prahova

Bihor

488

470

469

462

447

436

430

Sibiu and Dâmbovița

Galați and Neamț

Hunedoara

Olt

Botoșani

Teleorman

352

324

309

303

301

300

Brăila

Alba

Buzău and Vrancea

Gorj

Călărași

Satu-Mare

Harghita

Bistrița

Arad

Giurgiu

Maramureș

Caraș-Severin

Ialomița

267

265

262

259

255

242

239

238

230

229

226

207

202

Sălaj 194
Mehedinți 192
Covasna 151
Tulcea 92

 

“We have often been asked why do we not also reach Galați, Suceava, Cluj, Arad, Bistrița and so on. We are aware of the situation of each city, we know the shortcomings of the whole country, but we need forces, financial support to expand our services and reach all of the miniature neonatology heroes.

Preterm babies need months or years of recovery. In order for them to develop harmoniously, they need specialists in kinesiotherapy, psychology, speech therapy, ophthalmology and a close relationship with the neonatologist, even after discharge.

They need support and if you want to support them, you can make donations to the account: RO68BTRLRONCRT0411176001 with the mention PRETERM DONATION” – says Diana Gămulescu, the founder of the Preterm Association and the Center for Excellence in Prematurity.

Together we fight for our children!

* Data source: The National Institute of Statistics, Demographic Statistics