Babies born prematurely

General information regarding prematurity

Percentage prematuur geborenen per categorie van zwangerschapsduur (2022)gestational age category (2022)

Common diagnoses in babies born at a gestational age of below 32 weeks in Belgian hospitals are respiratory dysfunctions, immaturity of the autonomic nervous system, anaemia and neonatal jaundice.[5]

Worldwide, premature birth is the leading cause of death in children under 5. This high figure is largely explained by inadequate care in low-income countries[6]. In high-income countries, almost all babies born prematurely survive. However, the child will still be at a higher risk of complications and lasting effects. For example, more developmental and behavioural disorders, learning disabilities, social-emotional difficulties and poorer mental health later in life are observed when babies are born prematurely.[7][8][9][10]

Care pathway for babies born prematurely

Several services exist within a hospital to provide optimal care to newborns. In a maternity unit, babies are cared for with their mothers after birth has taken place. On 1/01/2025, there were 98 campuses in Belgium with a maternity unit that included a function for non-intensive, neonatal care. If the newborn needs extra care, he/she can be admitted to an N* service where he/she will be closely monitored. This function for non-intensive, neonatal care is available in every maternity unit in Belgium. The newborn can be cared for in this N* service from a gestational age of 32 weeks onwards. If a baby is born after a pregnancy of less than 32 weeks, or if he requires intensive care, it will be referred to an NIC service for specialised follow-up.

The specialist, supra-regional centres have a perinatal care function or P* function. This includes an MIC service, an NIC service, and a maternity unit with N* function. An MIC service is a service where women with at-risk (or high-risk) pregnancies are closely monitored. An NIC service is an intensive neonatal care service. If newborns are seriously ill or in specispecial illness conditions, they are cared for in an NIC service where specialist staff work. Campuses with an MIC unit must also have NIC beds to ensure the safe care of babies after high-risk pregnancies[11]. Conversely, a campus that has an NIC department can exist without an MIC department. In Belgium, there are 19 campuses with an MIC service and 19 with an NIC service.

Distribution of MIC and NIC services (01/01/2025)

The hospitals with a P* function enter into cooperation agreements with hospitals that only have a maternity unit and an N* function. Indeed, good cooperation between the various services is crucial when it comes to offering an optimal level of perinatal care in Belgium. If it is determined during a prenatal consultation that a pregnancy carries increased risks, a pregnant woman may receive additional follow-up at a supra-regional hospital with an MIC service. This will ensure close cooperation between the gynaecologists and paediatricians associated with the MIC and NIC services.

The collaboration agreements, also ensure that a newborn in need of intensive care can be transferred smoothly from an N* to an NIC service. The most common reasons for the external transfer of a newborn from a hospital without a NIC service to a NIC service are respiratory dysfunction, prematurity and oxygen deprivation at birth.[12]

Sick newborns remain in the NIC service until they have recovered sufficiently and can be transferred back to the referring hospital for further care without undue risk.

Activity in an NIC department

A total of 6,238 patients were admitted to NIC services in 2022. Their length of stay was very variable, but averaged 19 days. The median length of stay is 45 days for newborns after gestational age of less than 32 weeks and 8 days at gestational age of 32 weeks and above.

Both prematurity and low birth weight are indications for admission to an NIC service. In principle, whenever babies are born at a gestational age of less than 32 weeks, they will be referred to a NIC unit by default. We find that 55 - 61% of babies in 2022 with a gestational age of less than 32 weeks made a passage in a NIC service during their stay. Only half (52%) of newborns with a birth weight of less than 1,500 grams and with a gestational age of 32 weeks or more make a passage in a NIC service.[13]

Percentage of stays by birth weight and length of pregnancy with a transfer to a neonatal intensive care unit

Learn more? www.babyhospital.be

^{[1] Source: FPS Public Health (undated). Minimale Ziekenhuisgegevens (Minimum Hospital Data – MZG). [Dataset].}

^{[2] Source : Shaw, J., Steegers, E. A., & Verbiest, S. (2020). Preconception health and care: A life course approach. Springer.}

^{[3] Source : Vats, H., Saxena, R., Sachdeva, M. P., Walia, G. K., & Gupta, V. (2021). Impact of maternal pre-pregnancy body mass index on maternal, fetal and neonatal adverse outcomes in the worldwide populations: A systematic review and meta-analysis. Obesity Research & Clinical Practice, 15(6), 536-545.  https://doi.org/10.1016/j.orcp.2021.10.005}

^{[4] Bron: Cobo, T., Kacerovsky, M., & Jacobsson, B. (2020). Risk factors for spontaneous preterm delivery. International journal of gynaecology and obstetrics: the official organ of the International Federation of Gynaecology and Obstetrics, 150(1), 17–23. https://doi.org/10.1002/ijgo.13184}

^{[5] Source: FPS Public Health (undated). Minimale Ziekenhuisgegevens (Minimum Hospital Data – MZG). [Dataset].}

^{[6] Source: World Health Organization. (2023). Preterm birth. Consulted at https://www.who.int/news-room/fact-sheets/detail/preterm-birth}

^{[7] Twilhaar, E. S., De Kieviet, J. F., Van Elburg, R. M., & Oosterlaan, J. (2020). Neurocognitive processes underlying academic difficulties in very preterm born adolescents. Child Neuropsychology, 26(2), 274-287.}

^{[8] Roberts, G., Lim, J., Doyle, L. W., & Anderson, P. J. (2011). High rates of school readiness difficulties at 5 years of age in very preterm infants compared with term controls. Journal of Developmental & Behavioral Pediatrics, 32(2), 117-124.}

^{[9] Montagna, A., & Nosarti, C. (2016). Socio-emotional development following very preterm birth: Pathways to psychopathology. Frontiers in Psychology, 7, 80..}

^{[10] Johnson, S., O’Reilly, H., Ni, Y., Wolke, D., & Marlow, N. (2019). Psychiatric symptoms and disorders in extremely preterm young adults of 19 years of age and longitudinal findings from middle childhood. Journal of the American Academy of Child & Adolescent Psychiatry, 58(8), 820-826.}

^{[11] One hospital in the Brussels-Capital Region is an exception to this.}

^{[12] Source : Goemaes, R., Fomenko, E., Laubach, M., De Coen, K., Bogaerts, A. & Roelens, K. (2023). Perinatale gezondheid in Vlaanderen – Jaar 2022. Brussel: Studiecentrum voor Perinatale Epidemiologie.}

^{[13] In the case of 0.42% of newborn stays, the gestational age is unknown and in the case of 0.09% of stays, the birth weight is unknown.}

^{[14] Kuhn, P., Dufour, A., Zores, C. et al. (2017). The Auditory Sensitivity of Preterm Infants Toward Their Atypical Auditory Environment in the NICU and Their Attraction to Human Voices. In: Filippa, M., Kuhn, P., Westrup, B. (eds) Early Vocal Contact and Preterm Infant Brain Development. Springer, Cham. doi.org/10.1007/978-3-319-65077-7_7}

^{[15] Klemming, S., Lilliesköld, S & Westrup, B. (2021). Mother-Newborn Couplet Care from theory to practice to ensure zero separation for all newborns. Acta Paediatrica, 110:2951–2957. doi: 10.1111/apa.15997}

^{[16] Van Veenendaal, N.R., van Kempen, M.W., Birit B.F.P. et al. (2022). Association of a Zero-Separation Neonatal Care Model With Stress in Mothers of Preterm Infants. Journal of American Medical Association, 5(3):e224514. doi:10.1001/jamanetworkopen.2022.4514}