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A normal delivery takes place between weeks 37 and 42 of a pregnancy. By that time, the foetus is fully formed and sufficiently developed to be able to adapt to extra-uterine life. Sometimes delivery takes place before the 37th week. In that case, the baby is considered to be premature, with the degree of organ development dependent on the gestational age. Maturation and functionality of the lungs is critical for survival. Depending on the gestational age, lungs can be completely or partially immature, and thus unable to ensure an adequate respiratory function. Particularly pronounced pulmonary impairment is seen among extremely premature infants, i.e. those born before the 28th week of pregnancy.


Improved care, increased survival of premature infants

Chiesi has long been conducting researching in collaboration with medical expertise to improve the care of premature infants. This collaboration has made Chiesi a global partner for neonatology and it supplies drugs to more than 80 countries. We are endeavouring to increase international exchange of knowledge so that information about the best clinical methods is more widely disseminated. In recent years, enhanced obstetric and neonatal care has increased survival at low gestational age. A dedicated focus on knowledge within paediatric care has also contributed to the improved results.


PRIMARY APNOEA                        

The respiratory system and the areas in the brain that regulate breathing are incompletely developed in premature infants and this can lead to breathing disruptions, primary apnoea. When the gestational age is low and occurs in combination with a low birth weight, there is an increased  risk of spontaneous apnoea, which usually emerges two to three days after the delivery.


Respiratory arrest that lasts for more than 20 seconds

An apnoeic episode is defined as a respiratory arrest of more than 20 seconds. Clinically, such a respiratory arrest can be linked with slower heart rate and/or reduced oxygenation of the blood. In infants experiencing an apnoeic episode, the skin can be pale or cyanotic (blue), together with a reduction in muscle tone. Milder episodes can be resolved by tactile stimulation, while more severe episodes need pharmacological intervention with stimulant drugs, such as caffeine.


Causes of primary apnoea and respiratory arrest?

Adenosine is a signal substance which affects the nerve cells' activity and reduces the breathing effort. It is known that adenosine and caffeine, despite having the opposite effect, bind to the same receptors in the central nervous system. Caffeine can therefore be used to directly counteract the effect of adenosine by blocking the interaction of adenosine with the receptors, which leads to an enhanced breathing rate.



Neonatal respiratory distress syndrome is a common condition in preterm infants. RDS is a generic term for a complex clinical picture caused by under-development in the respiratory system. Severity and incidence of the disease are directly linked with the degree of prematurity, with infants born before the 28th week of gestation at greater risk of developing RDS.


Shortage of pulmonary surfactant

Respiratory failure caused by RDS in preterm infants is due to a shortage of pulmonary surfactant, which leads to the lungs collapsing during exhalation. Surfactant is needed to create a biofilm which covers the internal walls of the alveoli, making it possible for the lungs to expand and avoid collapse (atelectasis) during the expiratory phases.  Lack of surfactant results in difficulty in breathing, with low oxygenation, increased breathing effort and the need for respiratory support. RDS can lead to lasting damage or in the worst case to infant mortality.

Compared with full term babies, premature infants usually have a smaller pool of available surfactant, which further decreases as a result of RDS. Surfactant can be supplemented, thus alleviating the symptoms of RDS and enabling the endogenous pool of surfactant to increase. 



Chiesi initiated the collaborative project, Help a Little, together with the Swedish Federation for Preterm Infants so that it could help families with premature babies. People who wish to can use a smart phone to take a picture of what they have at home and want to donate, for example, a buggy. The information is then available for the social workers at Karolinska University Hospital's Neonatal Department. When they meet a needy family, they can match what they need to the items that people have donated. It might involve newly arrived families or families suffering financial difficulties because a parent has been off work for several months in succession.