The birth rate in the country is falling, while the number of complications and premature births is increasing. Although there are no publicly available nationwide statistics on such cases, doctors confirm this. Caring for “hurry-up babies” is a complex and usually lengthy process. Valeriia Tyshkevych, head of the pediatric intensive care unit at the Kyiv Perinatal Center, explained how it works in a comment to UNN.
The capital’s Perinatal Center is the facility to which women in labor with complications and those giving birth prematurely are referred. This is because it is specifically equipped to provide care for babies requiring special attention.
"We start caring for babies from 22 weeks’ gestation and weighing 500 grams or more, but sometimes they can be born at 22 weeks weighing 480 or even 370 grams. It is very difficult, but if the baby is born alive, we provide assistance and do everything possible to help the baby survive," Tyshkevych says.
After the baby is born, assistance is usually provided immediately in the delivery room. Such babies require medication, but as a rule, medications are not administered in the delivery room unless full resuscitation is being performed. According to Tyshkevych, babies born weighing less than 1,500 grams less often require such immediate resuscitation. If it is necessary, the baby is given adrenaline and saline solution.
"The baby is then taken to the intensive care unit. A polyethylene bag is then placed over the baby to prevent heat loss," the doctor said.
The bodies of prematurely born babies retain heat and moisture poorly, and polyethylene prevents their loss. This prevents the development of neonatal hypothermia, which can increase the risk of infections and other complications. Polyethylene is transparent, so doctors can see the baby’s skin color and perform the necessary procedures.
The baby is placed in an open resuscitation system, and a temperature sensor and pulse oximeter are connected.
"In the open resuscitation system, the baby receives the necessary assistance and is subsequently placed in a transport incubator. Even before being transferred to the intensive care unit, the baby is connected to a mechanical ventilator, because these babies have breathing problems," Tyshkevych explains.
Once in the intensive care unit, the baby is given surfactant—a lipid-protein complex that prevents the lungs from sticking together during exhalation. Such medication can be administered up to three times over a 72-hour period.
According to Tyshkevych, surfactants are expensive, and today the facility is forced to purchase them independently.
"And in accordance with national protocols, we обязательно administer surfactant to all babies under 32 weeks who require intubation and oxygen. The dose of surfactant is calculated according to weight. For example, if the baby weighs less than 1,000 grams, the dose is 200 milligrams per kilogram, while one vial contains 120 milligrams—so that is already one and a half vials," the doctor explains.
A central venous catheter is also inserted for prolonged parenteral nutrition.
"Then come antibacterial drugs and complete parenteral nutrition—there is a standardized mixture, or glucose, protein preparations, and a fat emulsion. We purchase all of this as well," Tyshkevych said.
Such babies often also require other medications, including caffeine citrate, antibacterial and anticonvulsant drugs, blood products, and more.
"Treatment for a baby born at 22–25 weeks’ gestation lasts 4–5 months, three of which are highly intensive," the doctor says.
Tyshkevych explains that the care of such babies is not fully covered by payments from the National Health Service, partly because the institution calculates tariffs based on an average level of expenses.
"At a facility where, as in ours, such babies are concentrated, the expenses are not fully covered," Tyshkevych says.
Today, up to 10% of babies born at the Perinatal Center are born prematurely.
"Our facility specializes in caring for them. Here, children can receive a full range of services up to the age of three. From the intensive care unit, the child is transferred to post-intensive care, followed by medical rehabilitation. After being discharged home, the child can continue receiving rehabilitation and follow-up care at our facility until the age of three," the doctor explains.
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Such babies often require open-heart surgery or intestinal surgery because they are unable to feed independently. Neurosurgical procedures are also not uncommon.
Immaturity of the gastrointestinal tract, electrolyte or metabolic disorders, respiratory dysfunction, hemorrhages, and cardiac problems are issues that, unfortunately, "preemies" face.
"Unfortunately, treatment is not fully covered by the state," Tyshkevych says.
According to calculations that Perinatal Center Director Dmytro Hovsyeiev announced at a Kyiv City State Administration commission meeting, on average, caring for such a child costs the facility approximately 35,000 hryvnias: depending on the infant's condition, the figure ranges from 20,000 to more than 100,000. A significant share of the expenses goes toward medications for treating respiratory disorders in such children, which are expensive.