On November 17, 2009, the World Health Organization declared the World Day of Prematurity, and it was instituted by the European Foundation for the Care of Newborn Infants (EFCNI) and associated European organizations, which were joined by the American March of Dimes and the African Little Big Souls, and later the Premmie National Foundation (Australia) to expand this movement at an intercontinental level.
It is a day of each year to create collective awareness of the challenges that premature birth represents for society. It is symbolized with a small purple sock that represents the sensitivity and exceptionality. The small pair of purple socks, framed by nine full-term newborn-sized baby socks, symbolizing that 1 in 10 babies are born prematurely worldwide. In May 2012, the WHO and its partners published a report entitled Born too soon. Global Action Report on premature births, which includes the first estimates made on premature births by country.
It is said that every year, 15 million babies are born before having completed 9 months of gestation and worldwide, prematurity is the first cause of mortality in children under five years of age.
In high-income countries, where practically all of these babies survive, the pending task is that said survival occurs with fewer morbidities since premature babies run the risk of developing disabilities that will accompany them throughout their lives due to the fact that any injury that if it occurs in the premature brain, it will compromise a critical period of its development, given that it is a period of active cerebral myelination and neuronal connections. Technological advances and knowledge are essential for the survival of premature children, but not sufficient. Apart from the technology, there has to be a human part and it works in search of this balance ASPACE Catalonia Foundation.
Different studies confirm that the incidence of cerebral palsy is inversely proportional to the gestational age and that the cerebral palsy it affects 9 percent of babies born before 32 weeks, a percentage that rises to 18 percent in those born at 26 weeks. In comparison, the number of children with cerebral palsy after the normal gestation period it comprises between 1 and 2 percent.
The frequency of neurodevelopmental alterations in very low birth weight premature infants is very significant, being responsible for up to 50% of childhood neurological abnormalities, which include from mild alterations of cognitive functions to infantile cerebral palsy, delay in psychomotor development, deafness or sensorineural hearing loss, retinopathy of prematurity, etc.
Preterm children at birth show a wide range of neuromotor abnormalities which can sometimes persist and be accompanied by a delay and/or motor disorder as well as a fine motor disorder, visual-spatial deficit, alterations in executive function, visual-perceptual and problems with motor execution.
The motor disorders in these children can range from one cerebral palsy mild-severe, up to a mild functional motor disorder called neuromotor dysfunction (DN) or disorder in the development of coordination. For many of these children, the motor disorder is less disabling than the alterations associated with them (executive sphere, cognitive and fine motor disorders).
For example, the EPICURE study in 2010 (in the United Kingdom and Ireland) concluded that at 11 years of age boys and girls who were born extremely premature (< 26 weeks of gestation) had a greater risk of developing ADHD, emotional disorders and ASD .
With this wide range of possibilities for neurodevelopmental alterations in premature infants, our challenge as multipurpose center is to give an early response to every difficulty faced by families and parents who in turn also find themselves in the situation of premature fatherhood, having to pass all of them through moments of much fragility and vital risk facing challenges of survival and constant adaptation.
The specialized hospital units do an effective and efficient job in the care of premature children and their parents and units like ours Fundació ASPACE Catalonia we dedicate a large part of our efforts to creating bridges of joint work to receive premature children and their families with our multidisciplinary teams (CDIAP, Day Hospital, School, specialized ambulatory care, rehabilitation and occupational therapy centers, etc.) to start a path of accompaniment at all ages and stages of his life, to enhance his integral development, and ensure his best adaptation and achieve as much as possible his autonomy, seeking to improve his quality of life, respecting his times, enhancing his individual skills, strengthening the role of families and creating interconnections with their environment. Premature babies are tireless fighters and they are not alone.
Dr. Lydia Vargas (Neuropediatrist and Head of the Ambulatory Care Service - Aspace-)
BIBLIOGRAPHIC REFERENCES
1. March of Dimes, PMNCH, Save the Children, WHO. Born too soon: The Global Action Report on Preterm Birth. Howson CP, Kinney MV, Lawn JE, eds. Geneva: World Health Organization, 2012.
2. Blencowe H, Cousens S, Oestergaard MZ, Chou D, Moller AB, Narwal R, et al. National, regional, and worldwide estimates of preterm birth rates in the year 2010 with time trends since 1990 for selected countries: a systematic analysis and implications. Lancet. 2012; 379 (9832):2162-72.
3. Lawn J, Davidge R, Paul V, von Xylander S, de Graft Johnson J, Costello A, et al. Born too soon: care for the preterm baby. Reprod Health. 2013; 10(1):S5.
4. EganF, Quiroga A, ChattásG. Cuidado par aelneurodesarrollo.RevvEnfervNeo.2012;(14):1-14.2.
5. Pallás CR, Valls A, Perapoch J. Cuidados Centrados en Desarrollo Unidades de Neonatología ¿Quál es su situación en España?. Madrid: Ministry of Health and Social Policy; 2010.3.
6. Oskoui, M; Coutinho, F; Dykeman, J; Jette, N; Pringsheim, T. An update on the prevalence of cerebral palsy: a systematic review and meta-analysis. Dev. Med, Child, Neurol. 2013;6 (55): 509-519.
7. Johnson S, Hollis C, Kochhar P, Hennessy E, Wolke D, Marlow N. Autism spectrum disorders in extremely preterm children. Journal Pediatr. 2010; 156 (4): 525-531.
Available https://doi.org/10.1016/j.jpeds.2009.10.04129.
8. Hernández A, Canal R, Magán M, De la Fuente G, Ruíz-Ayúcar I, Bejarano A, Janicel C, Jenaro C. Autism spectrum disorder and prematurity: towards a prospective screening program. In F. Mulas. XX International Update Conference on Neurodevelopmental Disorders. Valencia: Illustrious Official College of Doctors of Valencia; 2018
