2 weeks Ago By Kelly Ho
A team of maternity and paediatric care experts at Hong Kong’s Queen Mary Hospital (QMH) has said it successfully raised the survival rate of premature infants by devising treatment and emergency care strategies with parents ahead of delivery. Premature babies born at 23 weeks of pregnancy in QMH between 2021 and 2023 had a 50 per cent chance of survival, Mabel Wong, consultant of the Department of Paediatrics and Adolescent Medicine, said during a press conference on Tuesday. The survival rate was significantly higher than that recorded among 23-week-old babies delivered in QMH between 2005 and 2014, when it was 27 per cent, Wong said, citing a study by her department released in 2017.
“A lot of factors affect the survival rate. From the proactive preparation by the obstetrics and gynaecology department to after the baby was born, every step is important,” the doctor said in Cantonese. Formed in June 2021, the multidisciplinary team has served more than 20 parents of “periviable gestations,” referring to infants born between 23 weeks and 25 weeks of pregnancy.
A full-term pregnancy is typically around 40 weeks. Mimi Seto, associate consultant at QMH’s Department of Obstetrics and Gynaecology, estimated that about 7 per cent of deliveries handled by public hospitals were at 37 weeks of gestation or before. Wong told the press on Tuesday that international research showed that babies born at 23 weeks only had around 40 per cent chance of survival.
Those born at 24 weeks saw a survival rate of around 60 per cent. If the birth of extremely preterm babies could be delayed to 25 weeks, their chance of survival could rise to 70 per cent, she said. The QMH team had assisted parents in choosing a suitable treatment method based on clinical evaluation of the condition of the expectant mother and her infant.
Some parents may opt for “active obstetric and neonatal management,” Seto said, which included taking medications to strengthen the lungs of the baby before delivery and prevent preterm contractions. Doctors may also prescribe magnesium sulphate to lower the risk of brain paralysis in the infant, and delay umbilical cord clamping after birth to supply more blood to the infant. The team would guide parents to decide on the delivery method, as performing a caesarean section on expectant mothers with extremely premature babies may not always be ideal.
“Some people may think performing a surgery to get the baby out means there will be better prospects, but it is different in every case,” Seto said in Cantonese. According to Wong, an infant’s prospects may be affected by their gender, with female infants having better chances of surviving. It also depended on whether there was a single infant or a pair of twins.
If the mother had been prescribed steroids to help with the lung development, the preterm infant may also see a higher chance of survival. Even if the premature infants survived, one out of seven infants born at 24 or 25 weeks of pregnancy would have severe disabilities. The risk was even higher for babies born at 23 weeks – one in four may be born with severe disabilities.
Paediatric expert Wong said the cross-department team would formulate emergency care policies ahead and maintain close communication with parents during the critical care period. If the baby survived, they would be sent to the intensive care unit for newborns, where the staff members would provide nutrition care, medication, respiratory support, infection prevention, body temperature monitoring and other medical assistance. A woman surnamed Yip, 39, had two premature births at QMH, in 2021 and earlier this year.
During her first pregnancy, Yip was admitted to the hospital after experiencing stomach pain at 25 weeks of gestation. It was then when she discovered that she was at risk of having a preterm delivery. With the team’s assistance, she and her husband decided to undertake proactive measures to save the infant.
After staying in the hospital for around 10 hours, Yip successfully gave birth to her daughter, who is now three years old. In April, Yip had a son at 31 weeks of pregnancy, after being sent to hospital at 23 weeks of gestation. The eight-week delay marked a “successful case” in helping premature infants survive, Seto said.
Recalling her two deliveries, Yip said at the Tuesday press conference that the QMH team had helped her stay calm by explaining the survival rate of her babies and their risk of being born with severe disabilities. The medics’ professional opinions and the statistics they provided made her understand that there was still a chance of survival for extremely premature infants. “Without this team, if I had looked up very general information [on preterm pregnancy] on my own online, I would have been really scared,” she said in Cantonese.
When asked if the multidisciplinary team would be extended to other public hospitals in the city, Seto said several hospitals had asked for their protocols after the team shared their work at some medical conferences. The doctor added that communication between departments was key, and that they had to be “on the same page” and have the same objectives to run the cross-unit team successfully. Support HKFP | Policies & Ethics | Error/typo? | Contact Us | Newsletter | Transparency & Annual Report | Apps Help safeguard press freedom & keep HKFP free for all readers by supporting our team.
