The Swedish Experience
A story of reaching world leading standard
Improvements in preterm care
The care of preterm infants has improved rapidly during the last 20-30 years. As a result of improved intensive care, the survival rates of extremely preterm infants has increased considerably, even at very low gestational ages and birth weights well below 1000 g. However, these infants are still at high risk of short-term and long-term morbidities, including retinopathy of prematurity, bronchopulmonary dysplasia and later cognitive and behavioural problems. The remaining challenge in preterm care is now how to improve the health outcomes for these ”new survivors”. Early nutrition has been identified as a key target for quality improvement, since it has been shown to reduce the risk of poor health outcomes.
Sweden has since the 1990’s been the leading country with respect to individualized nutrition for preterm infants.
From substandard nutritional care to world leading
Due to a pro-active approach, Sweden has excellent survival rates of preterms even at 22 and 23 weeks of gestation. In the national EXPRESS study, based on extremely preterm infants born between 2004-2007, it was shown that nutrient intakes during the first weeks of life were much lower than recommended and that these infants showed severe postnatal growth failure. This has subsequently led to significant improvements in preterm nutrition in Swedish neonatal intensive care units. The Nutrium system was developed and is now used at the vast majority of Swedish neonatal units for daily nutrition prescriptions as well as for nutrition and growth monitoring.
Sweden has a well-developed system of milk banks, facilitating the use of donor milk when the mother’s own milk is not available. Since the fat and protein content of breast milk is highly variable among individuals and over time, Sweden has a long tradition of analysing breast milk for macronutrient content and using this information to guide breast milk fortification. The feedback from the Nutrium system has led to improved practice with regard to enteral nutrition, including earlier fortification of breast milk, as well as parenteral nutrition, including more concentrated parenteral nutrition solutions. The system has also resulted in greatly improved interest and knowledge about preterm nutrition among neonatologists, neonatal nurses and dieticians. Studies have shown that these improvements have resulted in improved nutrient intakes and improved growth of preterm infants in Sweden.