In Spain, around 20,000 premature children are born every year, and of them, a considerable percentage, especially those born very prematurely, will have long-term consequences. Prematurity is, therefore, a risk factor for people developing a disability and, one of its main causes, either at the time of birth, or in the future in the form of developmental disorders such as ADHD, SLI or autism. In fact, of those born extremely prematurely (before 28 weeks of gestation), among a 5 and 15% have motor, cognitive, sensory or behavioral sequelae.
Taking into account that the number of very premature babies has doubled in the last two decades, thanks to the fact that advances in neonatology have increased survival, the number of new births at risk of having disabilities In the future it has also increased.
From the NeNe Foundationdedicated to the research and dissemination of neurological problems in newborns, consider that, with adequate investment and resources, disability rates among these children could be considerably reduced, “Taking care of children’s health is the best investment To improve the health of the general population, and to improve children’s health, it is essential to promote research in pediatrics“, emphasizes the vice president of the NeNe Foundation, Simón Lubián, “it is essential to know in depth the alterations in brain development that lead to these consequences,” explains the vice president of NeNe. “This way, we will be able to prevent them and, where appropriate, treat them. That is why we need to investigate the effect that being born early has on the brain development of these children,” he adds.
Less cerebral palsy, but developmental disorders prevail
Whether a premature baby develops a disability in the future depends on many factors. The first of them, as explained Juan Arnáez, Director of the Nene Foundationis the week in which they were born, because “although any prematurity has a certain risk, those who are close to term (34, 35 or 36 weeks) have less risk of having consequences than one of 26, 28 or 30. The child most at risk will always be the youngest child.” he warns.
Advances in neonatology have reduced the risk of some types of disabilities, but less of others, since, as Arnáez explains, the most common before was cerebral palsy, whose prevalence has decreased considerably in countries like Spain and its surroundings, “this indicates that things are getting better and better, but it is true that there is another type of more cognitive disabilitynot so much at the motor level, in which we have made less progress,” he warns.
Thus, for example, it is still very common for premature babies to develop problems in the learning areabecause “processing speed is different, abstract reasoning is different, attention is very difficult for them… It does not mean that all premature babies will have them, but that they are clearly more at risk, and that is a challenge.”
It does not mean that all premature babies will have disabilities, but that they are clearly more at risk, and that represents a challenge.
The disability of the premature baby, as explained by Dr. Arnáez, It is fundamentally associated with two things: to one brain injury and to its development. The first is usually caused by bleeding or lack of oxygen, which is more frequent the smaller the brain is, “this ultimately produces an injury, permanent damage to the brain. Unless it is very small and in an area that does not compromise, it usually leaves a sequel.
When brain damage of this type occurs, the most common thing is that an area that normally affects the motor pathwayThat is, they are usually “children who have mobility impairments, such as hemiparesis, but often their learning development is good.”
Others consequences occur due to being born prematurelyfor “everything that is added to living outside the mother’s womb, because in the end babies, instead of being in a liquid environment protected from an aggressive external environment, have noises, pain because things are done to them, with stress with discomfort…”, explains Arnáez.
Therefore, in recent years, in addition to avoiding damage to the brain, the focus has been placed on that the maturation of the premature baby’s brain is not affected to develop outside the womb, “to achieve this, at the NENE Foundation, we have established a series of minimum care that all neonatal units should have, such as regulating light, noise, doing skin-to-skin – which sensorially improves brain maturation -, the breastfeedingnot examining the child when he sleeps… all those things seem very silly, but They are essential for a developing brain“he warns.
If that is not done, the brain becomes inflamed and, although it is not damaged like when there is bleeding or lack of oxygen, it is not going to let it develop the same, “in the end, the volume of connections and development in these very early stages, which is when the brain is most plastic , It is what will most determine the futureand that is where the current focus of research and care of premature babies is being placed.
By focusing on these issues, we could minimize other consequenceswhich are not motor, but which also greatly condition the child’s future, such as ADHD, SLI, autism, learning problems, behavioral problemsetc., “their injuries are less visible, but their brain volume of connections is smaller and that affects the areas of learning and behavior, it is a bit difficult for them to use language, process information, attention, and the socio-emotional area…” .
The volume of connections and development in these very early stages, which is when the brain is more plastic, is what will most determine the future.
The importance of what happens after admission
Arnaéz assures that another thing that could be improved and that would also minimize disability of these children is the care after discharge from the hospital, and that involves, on the one hand, ensuring that all children, wherever they are born, have the attention they need and, on the other hand, due to the specialization of professionals, “although it may seem surprising, care in neonatal units is not always specialized. For example, in many hospitals, nursing staff rotate, and It is not the same to care for an adult patient as for a 900-gram baby.or physiotherapists, who in many hospitals are not children’s hospitals.
All premature children should be born, therefore, “in centers with the specialization to care for them.”. This, in general, is done well at the level of neonatal doctors, but they are not widespread at the nursing level. And nursing care is more than 70% of the success of a premature baby, much more so in medical care,” he acknowledges.
Discharge is also a key moment, “the transition is not done well. He goes home and we forget about the child. We give him consultations with a series of specialists, which may be a high-risk neonatology consultation or a neuropediatrician, but parents often comment that they feel a little abandoned because there is a sudden change from admission to going home. And that’s it. transition must be done wellit has to be planned, structured, individualizing the risks, because not all babies have the same risks. You have to spend time explaining to them what the process is going to be like, what type of specialists can intervene, etc.”
Furthermore, at NeNe they believe that it is essential that, after discharge, a doctor coordinates, but that the team is multidisciplinarybecause “not only do we have to monitor the neuroevolutionary part, these are babies who sometimes need nutritional, respiratory things… or other specialties. That’s why there are consultations for high risk neonatologywho have a coordinator who relies on other specialists. However, these units are not always available, especially in small cities, where there are usually no specialized children’s physiotherapists, children’s speech therapists who know how to handle, for example, the issue of food, etc. He multidisciplinary support that the baby needs after discharge and during the following years it has to be specialized.
On the other hand, there is the early careessential for these children, early care that, although in their case they access almost directly from the hospital, is very saturated in many communities and They do not have professionals specialized in premature babies“to minimize the risk of developing a disability by these children, early care professionals should also be specialized,” he insists.
And the same should happen in schools, where he Teachers should be trained and informed about the risks in the development of their learning that these children may have, “educators must know what the risks of premature babies are in terms of learning to make the necessary adaptations,” he says.
To minimize the risk of developing a disability, early care should also be specialized for premature babies.
And all these resources, both health, educational and social, should be available to all premature childrensomething that, today, does not happen, which produces a lot of inequality, “in the end, the socioeconomic or sociocultural level affects the evolution of the premature baby,” Arnáez laments, “and that is well studied, because if the support , despite being born very prematurely, is good after discharge, that is, if there is good stimulation, good interdisciplinary support… the baby is doing well, but If the support is not adequate, their evolution is worse. That’s why support must be universalizedbecause people with resources look for a life and go private. Those who don’t have them, can’t. Therefore, socioeconomic level is a fundamental factor to minimize disability.”
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