Every week, a child is born in week 22 or 23 in Sweden, and almost always, efforts are made to save them. Sweden stands out internationally as one of the few countries that provides high-intensity care even for "22-ers", according to SVT's Uppdrag Granskning.
In Sweden, more than half of the children born before week 24 are saved, but 96 percent of the survivors suffer from problems, according to a Swedish study from last year.
Worse than expected
Ann Hellström, professor and senior physician at Sahlgrenska and Gothenburg University, tells UG that it's going worse for the children than previously thought.
We've become so much better at getting the children to survive. We have the opportunity to save children we couldn't before, she says to TT and continues:
But it also means that the children we save are much sicker than those we saved ten years ago.
Three out of four get some kind of functional impairment, such as language impairment or intellectual disability. The children often need oxygen at home, have difficulty getting nourishment, and a large proportion get visual and hearing impairments.
Since the children are so underdeveloped when they are born, Ann Hellström doesn't think it will get much better in the coming years.
It will take something quite revolutionary medically for us to also see fewer diagnoses.
"Very difficult"
Parents testify that they and the children receive the best possible neonatal care, but that there is a lack of support and follow-up when they leave the hospital.
It requires a lot for them to seek help and have knowledge about what they can get help with. One would have wished for a special reception for these children, or a BVC that had knowledge of everything that can affect them, says Hellström.
She believes it can have major consequences.
That it should depend on the parents' capacity and network is not reasonable. For these parents, it's already very difficult.
The National Board of Health and Welfare states that there is an idea about how to build a care chain around the children, but that it needs to be clarified.
There is an awareness that these problems exist, what the problems are, and how common they are. With that said, we have caught signals that a clear guidance is needed here, says department head Thomas Lindén to UG.
It looks different in Europe when it comes to deciding when to initiate intensive care for prematurely born children.
In Denmark, it happens from 22+5 days, Finland, France, and Norway from week 23, in Germany from week 24, and in Belgium from week 26. In the UK, an individual assessment is made.
Sweden stands out as a country where it almost always happens from week 22, and there are examples of attempts made from week 21.
Week 21 is also the last week it is allowed to perform late abortions in Sweden, but after week 18, special permission is required.
Sources: UG
A summary of four studies published in a report in Läkartidningen last year showed that 399 children born before week 24 in Sweden between 2007 and 2018 survived.
In total, more than half of the children born before week 24 survived, with the proportion increasing over the years.
But 96 percent have been affected by one or more diagnoses. Three out of four got some form of developmental neurological impairment. Common problems also include lung, gut, visual, and hearing impairments, as well as poor growth.
Source: Läkartidningen
