Preventable Disabilities: How Neonatal Care Can Prevent Severe Neurological Sequelae

In Brazil, living with some type of disability is a reality for 18.6 million people. Approximately 4% of this group are between 2 and 9 years old, which equates to 741,000 children. The data comes from the Brazilian Institute of Geography and Statistics (IBGE), in the People with Disabilities module of the Continuous National Household Sample Survey (Pnad 2022). According to specialists, many of these cases could have been prevented, especially in situations related to pregnancy, childbirth, or care shortly after birth.

Among the most common situations that can occur, such as premature and cardiac babies, is perinatal asphyxia, or hypoxic-ischemic encephalopathy, a condition that can occur shortly before, during, or immediately after birth and can compromise the child's neurological functions, cause severe sequelae, and lead to death. According to the World Health Organization (WHO), this is the third leading cause of death in newborns worldwide. In Brazil, 20,000 to 30,000 children are born annually with some brain oxygenation problem.

Among the main potentially preventable neurological sequelae in newborns are cerebral palsy, cognitive, motor, and sensory deficits, such as blindness and deafness. This is stated by neonatologist Gabriel Variane, founder and president of the healthtech Protecting Brains and Saving Futures (PBSF), which aims to reduce to zero the number of people with preventable disabilities worldwide.

"These conditions can result in significant challenges for families, as they require continuous care, specialized therapies, and have a major impact on the quality of life of the individual and their families. The Pnad survey itself shows, for example, the low enrollment of young people with disabilities in college, with less than 15% of the group attending higher education," comments the doctor.

PREVENTION AND ACTION

One of the basic strategies to avoid such situations is proper neonatal care, as well as continuous monitoring of the baby. Various problems can occur between pregnancy and childbirth, so it is important for healthcare teams to have adequate training to act when necessary. In the case of perinatal asphyxia, there are already technologies capable of detecting clinical situations that may pose a risk to the newborn's brain more quickly and effectively.

"One of the experiences we have is the neuromonitoring and neuroprotection system in neonatal ICUs. With it, we can detect seizures more accurately and diagnose other adverse events in advance. In some cases, critical situations can be alerted hours in advance. Such information can save the patient's life," he highlights.

If this occurs, one of the emergency treatments for newborns is therapeutic hypothermia. This procedure lowers the baby's body temperature to about 33°C to 34°C, reducing brain metabolism and inflammatory processes. "Studies show that when this action is initiated within 6 hours of birth, there is a reduction in mortality and improvement in neurological outcomes," the specialist details.

OTHER CAUSES

In addition to perinatal asphyxia, other cases may occur, such as intraventricular hemorrhage; congenital or neonatal infections (such as cytomegalovirus, toxoplasmosis, and bacterial meningitis); severe neonatal jaundice (kernicterus); neonatal stroke; persistent neonatal hypoglycemia; and hereditary metabolic disorders, which can also cause disabilities.

THE ROLE OF BREAST MILK

In addition to monitoring and continuous care, babies also have a great ally in brain protection: breast milk. Recommended as one of the healthiest and most important foods for development in the first months of life, it also plays a significant role in preventing neurological sequelae.

"Breast milk contains neuroprotective factors that promote brain development and reduce the chances of sequelae in premature and at-risk newborns. And when they are ready, with gastrointestinal maturity and the ability to suckle, breastfeeding also becomes a moment of emotional bonding between mother and child," says the neonatologist.

BRAZIL ON THE RIGHT PATH

The country has made positive strides with neuroprotection strategies that benefit the Public Health System (SUS), such as the kangaroo method and the Neonatal Resuscitation Program, promoted by the Brazilian Society of Pediatrics (SBP), which trains thousands of professionals to intervene quickly and effectively in the first moments of life. Variane emphasizes that these strategies are of fundamental importance and that medicine will evolve even further.

"Complications in neonatal ICUs, such as respiratory difficulties, heart problems, and central nervous system conditions, are still common and can lead to death or long-term sequelae. The development and implementation of well-structured public policies and protocols are essential to provide quality care that promotes the reduction of these rates," he concludes.