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Data from the Department of Information and Informatics of the Unified Health System, called Datasus, an acronym for the IT department of the Unified Health System of Brazil, reveals worrying data regarding the future of Acre: the period from 2017 to 2021 (the last year with available information) shows that Acre has the highest prematurity rate of births in the country – 14.02%, a worrying scenario in the view of doctors and nutritionists involved with the cause.
The infant mortality rate – the biggest cause of which is premature birth – in Acre is 17.2 per thousand live births in 2022, the latest data available – a rate much higher than the rest of the Legal Amazon region and higher than the rest of Brazil, which is 13.2 per thousand live births and, the following year, 13.8 in 2021.2 – also the latest figures available.
Acre is the national leader in the birth of premature children/Photo: Reproduction
Still based on the Primary Health Care Observatory, in 2020, the rate was 13.2 per thousand live births and, in the following year, 13.8 in 202, but Acre was always above this.
The percentage of prematurity in Acre is higher than the national average. In an average of the 5 years analyzed, Acre leads the highest prematurity rate in the country, with 14.02%, while the national average is around 11.57%. Next come Roraima (13.98%); Amapá (13.82%); Rio Grande do Norte (12.79%), and, finally, Rio Grande do Sul (12.04%).
Purple November is the month to intensify the campaign to combat the problem around the world
The numbers emerged this week, in mid-November, a month identified in Brazil by the Ministry of Health as a milestone for the “Purple November” campaign, when, at a global level, there is international mobilization that aims to raise awareness and sensitize the population about prematurity and the importance of caring for premature babies. Premature is any child born before 37 weeks of gestation.
Due to this worrying proportion, World Prematurity Day, celebrated on November 17th, brings together a series of actions regarding the challenges of the topic. With the theme “Small actions, big impact: immediate skin-to-skin contact for all babies, everywhere”, the global campaign for the month of November reinforces the importance of ensuring this practice. Studies have shown that extremely premature babies, the most vulnerable, benefit even more from this contact when done early. In view of this, the WHO and the institutions that make up the Global Alliance for Newborn Care (GLANCE), including the NGO Prematuridade.com, chose to emphasize the issue again in 2024. At this time of year, everyone comes together in favor of take the debate to civil society.
In Brazil, the campaign will have a broad program, including public hearings, symposiums, lives, actions in hospitals, walks and picnics, among other activities. In the actions promoted by the NGO, the participation of representatives from the Pan American Health Organization (PAHO), Ministry of Health, Brazilian Society of Pediatrics and other important institutions in the context of prematurity are confirmed, as well as families of premature babies, health professionals, celebrities and opinion makers.
Currently, around 12% of babies born on national soil are affected by the syndrome, which is the main cause of infant mortality in children under five years of age. Globally, according to the World Health Organization (WHO), around 15 million children are affected by the condition and more than a million babies die due to prematurity.
Not everything is lost: rates can be reduced, says experienced nutritionist from Acre
Despite this alarming condition, the good news is that this may end or drop to reasonable levels. This will be possible with broad access to quality maternal and newborn care everywhere, when many cases can be prevented. In fact, this is precisely the theme of the “Purple November” campaign in 2024, marking one of the strategic axes of action of the agents involved, recalls nutritionist Janilda Moraes, 39 years old.
An Acre native from Brasiléia, Janilda Moraes is a nutrition specialist who has worked as a nutritionist for premature babies in the ICU (Intensive Care Unit) for 15 years. She is part of the NGO Prematuridade in João Pessoa, Paraíba, and back in her homeland wants to use her knowledge to help combat the high rates of premature births in Acre. She is a representative of the Brazilian association of parents and caregivers of premature babies linked to the Ministry of Health.
Janilda Moraes is a nutrition specialist who has worked as a nutritionist for premature babies in the ICU for 15 years/Photo: Reproduction
The professional points out the causes. There are at least ten causes, which, if treated and controlled, do not represent a serious risk. Below are the ten causes:
- Hypertension – Even if a woman’s pressure has always been normal, it can change during pregnancy. When the maximum is above 140 and the minimum above 90, it is a reason for concern and constant medical monitoring.
- Previous prematurity – Pregnant women who have already had other cases of prematurity are three times more likely to give birth to a premature baby again than women who gave birth on time.
- Fetal malformation – It is the only factor that apparently will determine prematurity. And complications can contribute to a forced birth early.
- Uterine pathologies – Fibroids, uterine malformation, short cervix and problems with the cervix are some causes of prematurity. If the issue is a short cervix, for example, the muscles cannot contain the pregnancy. Transvaginal ultrasound is the best way to predict the risk of a premature baby. In cases related to the uterus, the doctor will probably order complete rest.
- Maternal infections – A urinary infection may seem simple, but if left untreated it will pose a risk to pregnancy, just like any other vaginal infection. Furthermore, systemic infections (which affect the body) are a serious risk, which can cause premature labor.
- Pregnancy of multiples – Today, with pregnancy treatments, it is easier to become pregnant with not just two, but three or four embryos. It is very likely that the pregnancy will come early. For triplets, for example, pregnancy is usually terminated before 33 weeks.
- Maternal age – In general, women over the age of 35 already have an established profession and, in many cases, occupy positions of high responsibility. Stress and everyday problems are associated with low baby weight or premature labor. And adolescents, with an immature uterus and without essential nutritional care, are also part of the risk group for prematurity.
- High incidence of cesarean section – With scheduled birth, there is a risk of error when counting the gestational age. Any mistake could make doctors remove your premature baby from your belly. Today, in Brazil, the number of cesarean sections is above 35%, while the World Health Organization considers 15% to be the maximum.
- Placenta positioning – In some cases, the placenta, instead of being inserted into the wall of the uterus, lies on top of the cervix. This can lead to bleeding and then premature birth.
- Bad prenatal care – The crucial point to avoid prematurity is good medical monitoring. It is at this stage that it is possible to identify the problems that could lead to preterm birth. The minimum is five consultations and two ultrasound exams, but the ideal is monthly follow-up.
In a lecture to Mexican doctors, Janilda Moraes will explain ways to improve neonatal health
Janilda Moraes’ experience in the area is such that she will participate, online, on Saturday (17), in the 1st Mexican Symposium on Nutritional Therapy in Premature Infants: A Milestone in Neonatal Health. Mexico faces high infant mortality rates, especially among premature babies, with rates much higher than Brazil. One of the main causes identified is the failure to provide adequate nutrition during the period of hospitalization in neonatal ICUs in the country. Another alarming fact: The entire country does not have nutritionists specialized in neonatal nutrition for premature babies, revealing a critical gap in the care of these vulnerable babies.
According to medical advice on the subject, in order for death rates to be reduced to reasonable levels, the solution is pervention. Preventing prematurity begins even before a woman becomes pregnant, with adequate family planning. Next, prenatal care is essential to ensure the health of the maternal-fetal binomial. This is the safest and most effective way to guarantee the development of a healthy pregnancy and reduce the risks involved, including premature birth.
There are also, after the baby is born and leaves the neonatal ICU, some recommendations. They are:
- Put the premature baby to sleep on his or her back;
- Do not smoke inside or near the house;
- Avoid closed and crowded places;
- Keep away from people with respiratory infections (cough or runny nose, for example). If unavoidable, wear an N95 mask;
- Wash your hands frequently and use 70% alcohol;
- Prioritize breastfeeding;
- Keep your vaccination card up to date;
- Change diapers every two to three hours;
- When taking a shower, cleanse gently, with neutral soap, without rubbing;
- Kisses? Only from mom, dad and anyone who already lives in the same house (if it’s on the forehead, the better).
