Dr Khoo Poh Choo, Organising Chairperson, World Prematurity Day 2019
Parents and families of ex-premies
Ex-premies who have grown up
Ladies and Gentlemen
A very good morning to you.
1. I would like to welcome all of you for joining us in commemorating World Prematurity Day. As the name suggests, this is a globally celebrated awareness day, and for good reasons. I was previously with KK Hospital as a paediatric opthamlogist and I won’t be surprised if many of the children here would have been seen by me, one way or another, when they were admitted to the ICU. Because we always screen the eyes of premature babies to look out for ROP (retinopathy of prematurity). But once they are cleared to be alright, then they do not follow up with us. But if they are found to have ROP, then we will continue to see them and monitor them very closely.
Prematurity – A Global Problem
2. Prematurity is on the rise and the World Health Organization estimates that every year, 15 million babies are born preterm. Babies born preterm are at increased risk of serious illness or death, and it is known that there is an increased risk of lifelong disability and chronic medical conditions for preterm babies. Without appropriate treatment, the probability of survival actually declines dramatically. But I must say that the healthcare system in Singapore, especially at the nenonatal services, is in fact one of the best in the world. Even children sometimes as young as 22, 23 weeks premature, born at gestational age at 23, can also survive with relatively good outcome. The risk for babies to be born prematurely may be reduced through measures such as eating healthily, stop smoking, regular obstetric follow-ups, and timely management of other risk factors like infections for the expectant mothers.
3. In Singapore, our expectant mothers have very good access to quality obstetrics care that enables appropriate foetal assessment for early detection and treatment of any pregnancy complications.
4. However, more women are having babies at a later age. The median age of mothers with first order births increased from about 27.5 in 1990[1] to 30.6 years in 2018[2]. That is also because Singaporeans are getting married at a later age nowadays. The prevalence of maternal health problems such as gestational diabetes and high blood pressure rises with a higher maternal age. The increased prevalence of maternal health conditions also leads to an increase in the risk of pregnancy related complications, including pre-term birth. Hence, there is a crucial need for regular follow-up of these mothers and for treatment to control these maternal medical conditions.
5. We are very well equipped with appropriate resources and expertise to support premature infants. Indeed, Singapore has good outcomes for neonatal care. The neonatal mortality rate[3] fell from 17.7 neonatal deaths per thousand live births in 1960 to 1.3 per thousand live births in 2018[4], probably one of the lowest in the world.
Family Integrated Care
6. Over the past few years, our public hospitals have stepped up on the development of a robust care model called the Family Integrated Care (FIC). The FIC supports the full integration of families in the care of their infants in Neonatal Intensive Care Unit (NICU). The goal of FIC is to promote parent-infant interactions and build parent confidence at a very, very early stage. This is achieved by a close collaboration between parents and the NICU staff. Over there, parents are taught to be involved in all possible aspects of their infant’s care including feeding, diaper changes, bathing as well as tracking growth and progress while their infant is in the NICU. Early involvement in their infant’s care will help them ease into their care provider roles subsequently when they are being discharged.
7. The FIC model is supported by research which shows that greater parental involvement translates to better outcomes for both NICU babies and their parents. Positive outcomes include better infant growth, more frequent breast feeding when they return home as well as an encouraging effect on the parents who report lower stress levels[5].
Singapore’s First Pasteurised Donor Milk Bank
8. In line with providing the best care for preterm babies and their families, Singapore’s first Pasteurised Donor Milk Bank was launched in 2017 at KK Women’s and Children’s Hospital (KKH). The milk bank follows stringent international guidelines to ensure a supply of ready, safe, pasteurised donor breast milk to vulnerable babies whose mothers’ have an inadequate supply of breast milk. This is based on the well-known benefits of breast milk in vulnerable infants and the recognition that donors’ milk is preferential to premature infant formula if a mother is unable to provide an adequate supply of breast milk[6].
9. I am encouraged to learn that we have had more than 450 donors since the bank’s opening in 2017 and that it has also extended the provision of donors’ milk to other hospitals, other than just KK Hospital. More than 1,000 babies nationwide have since benefited from this valuable resource.
Closing
10. The difficulties experienced by preterm babies and their families may not be apparent to all. I am delighted that for the fifth year running, support groups from KKH, NUH, SGH, have come together to organise this event to raise awareness of the challenges faced by premature children and their families as well as sharing best practices for the care of premature babies. I want to salute all of you for demonstrating amazing tenacity, determination and perseverance. I understand the journey that the baby was in ICU was not an easy one I can imagine that it is very tough, not just for the mother, the father, but the entire family, so I salute you for that. I hope you have an enjoyable and fruitful day ahead.
Thank you so much.
[1] Yap, MT. Fertility and Population Policy: the Singapore Experience. Journal of Population and Social Security (Population), supplement to Volume 1.
[2] ICA Report on Registration of Births and Deaths 2018
[3] Neonatal mortality rate is the number of babies dying before reaching 28 days of age for every one thousand live births per year.
[4] Trends in Infant Mortality Rate and Related Indicators. Statistics Singapore Newsletter Issue 1. 2019.
[5] O-Brien, K et al. Effectiveness of Family Integrated Care in neonatal intensive care units on infant and parent outcomes: a multicenter, multinational, cluster-randomised controlled trial. The Lancet Child & Adolescent Health. 7 February. 2018.
[6] American Academy of Paediatrics SoB. Breastfeeding and the use of Human Milk. Pediatrics. 2012; 129:e827-e841