Neonatal card: who saves premature babies in Russia
In the fall of 2026, the Ministry of Health said that Russia has reached a record low infant mortality rate — less than the average European and American. Izvestia talked with representatives of leading neonatal centers about how this was achieved, how modern neonatal care is organized in the country, what technologies help save babies born extremely early today, and from what age mothers get a chance at life, as well as about the prospects for the development of this area.
Extremely early
Infant mortality in Russia has reached a new historical low and amounted to 3.3 ppm, in some regions this figure is below 2 ppm, Dmitry Ivanov, chief freelance neonatologist at the Russian Ministry of Health, told Izvestia.
"Many factors have influenced the reduction in the mortality rate, including the training of specialists, the technological equipment of clinics, and decisions taken at the state level," the doctor noted.
Earlier, the head of the Ministry of Health, Mikhail Murashko, also announced the achievement of the historical mark.
According to the level of development of neonatal medicine, Russia has the best indicators among the major countries of the world, Dmitry Ivanov explained. In particular, in comparison with the USA (5.5 ppm), China (4.5), Argentina (8.2), Turkey (9.1), Brazil (12.5). The average European indicator is also higher than the Russian one today — 3.6 ppm.
Today, domestic doctors, as in most other developed countries of the world, will try to get a baby out of the 22 full weeks of the mother's pregnancy. The World Health Organization (WHO) set this deadline back in the 1970s, based on the anatomical features of the child's lung structure, Dmitry Degtyarev, Deputy Director for Scientific Work at the Kulakov National Medical Research Center for Obstetrics, Gynecology and Perinatology of the Russian Ministry of Health, MD, told Izvestia.
— But most countries joined this criterion of live birth gradually, because one thing is a potential opportunity, and another is its implementation in practice. Therefore, some, including developed countries, have been supporting the care of children from this age relatively recently," the source explained. — It practically took about 50 years for this to happen.
In Russia, the technological transition to this level began in 1993, and the Russian medical system was fully ready by 2012. Today, children born at this age are registered from the first days of life, despite their extremely small body weight.
Formally, there is another criterion — a weight of 500 g, explained Natalia Trifonova, Deputy Chief Physician for Science and Innovative Development at the Sechenov Center for Motherhood and Childhood, MD, Professor, to Izvestia. However, in reality, this does not play such a role.
— This does not mean at all that if a baby is born at 22-23 weeks, sometimes it happens for a longer period, but weighing less than 500 g, they will not carry out resuscitation with him. Of course they will," she said. — We have many cases when children weighing less than 500 g survived, even with very good results.
All births at 22-28 weeks of pregnancy are extremely early, but the prognosis for the baby improves significantly from about the 24th week, the specialist explained.
In recent decades, the percentage of premature births has remained unchanged, but the survival rate of premature babies has changed radically in 20-30 years, Dmitry Ivanov confirmed.
— If we take, for example, extremely premature newborns weighing less than 1 kg, born, say, at 22-24 weeks, then 30 years ago there was no question of their survival at all. Currently, almost 90% of children born at these dates are being cared for in our country," said the chief freelance neonatologist at the Ministry of Health.
At the same time, not only the survival rate has changed, but also the risks of disability of such infants, he stressed.
— Today, the absolute majority of prematurely born children develop completely normally in the future, — said the expert.
Using gene therapy and intrauterine surgery
Some pathologies or diseases today can be corrected even before childbirth as a result of intrauterine surgery, Natalia Trifonova explained.
— Even at the beginning of our century, this was only a dream, but now this area is developing very actively. An operation is performed, then the uterus heals, and the woman safely completes the term," explained the interlocutor of Izvestia. — Then the baby, who was operated on a few weeks earlier, is removed by caesarean section.
The development of technologies related to intrauterine intervention has also helped to cope with such a dangerous condition as hemolytic disease of newborns caused by incompatibility of blood factors between mother and child, Dmitry Degtyarev added.
— Such fetuses are given blood in utero. Due to this, it is possible to prolong pregnancy, and neonatologists have a more stable condition of the child at birth. As a result, the survival rate reached 97% even in severe cases," he stressed.
Another promising area remains gene therapy, in which the fetus receives therapy using gene drugs in utero. This allows the treatment of severe genetic diseases to begin at the earliest possible stages, which significantly increases the chances of successful correction of the child's condition and a prosperous life in the future, experts interviewed by Izvestia explained. The time during which a baby can be operated on after childbirth has also been reduced.
— If at the beginning of the century many congenital malformations were inoperable, now this has changed. The deadlines for performing operations have shifted to earlier ones with the development of technology and everything else," explained Natalia Trifonova. — That is, some defects are operated on literally immediately after birth, not even for vital reasons.
In particular, according to her, today children with cleft lip are successfully operated on in the first weeks, and not after a year of life, which greatly facilitates the process for the baby and his parents.
Multi-level system
One of the main features of the development of neonatal medicine in Russia is the specifics of the regions, which can vary greatly, said Dmitry Ivanov.
— Russia is a huge country with very diverse natural conditions, with different population densities, with pronounced regional differences, and with great distances. Therefore, the issue of patient routing is not always a simple issue, and the use of some kind of average approach does not always give good results," said the chief freelance neonatologist of the Ministry of Health.
The country has been building a system of neonatal care in its current form since the 2000s. The multi—level system, based on principles used back in the Soviet Union, involves assistance and support at various stages - from women's consultations to pediatric departments and specialized centers, the expert explained.
At the regional level, intensive care and consultation centers for newborns initially allowed for constant remote monitoring of patients requiring additional examination or therapy, competent routing and, if necessary, medical evacuation, said the deputy chief physician of the Morozovskaya Children's City Clinical Hospital, PhD. Rustam Mukhametshin.
—Intensive care and counseling centers have provided the appearance of "rules" for medical institutions in the region — the criteria for contacting the counseling center, the criteria for departure and evacuation, and the criteria for routing," he explained.
The development of educational programs made it possible to provide the necessary assistance even in first-level institutions, as a result, after stabilization and pre-transportation training, the patient could be evacuated to another medical institution.
However, with such a transportation-based system, children with extremely low body weight, critical malformations, and congenital heart defects are at risk. The creation of a system of regional perinatal centers allowed solving this problem.
"The idea is for childbirth to take place in a target—level medical organization, which will allow the required therapy to begin as early as possible, avoiding subsequent transportation and the risks associated with it," the Izvestia source explained.
As prenatal routing has developed, the number of births has shifted significantly in favor of second- and third-level medical organizations and, consequently, to the closure of some small first-level maternity hospitals. According to the expert, this is a clinically justified process — the results of any medical organization's work are determined by the number of patients receiving care there. Therefore, maternity hospitals with low capacity quickly lose their competencies.
"The creation of a network of perinatal centers has made it possible to "saturate" neonatology with the necessary medical equipment — incubators, intensive care systems, equipment for working in the delivery room, devices for invasive and non-invasive ventilation, patient monitors, dosing equipment, diagnostic devices, transportation equipment and many others," Rustam Mukhametshin listed.
The top of this pyramid is federal perinatal centers, such as the Kulakov Center or the Sechenov Center for Motherhood and Childhood. If necessary, their specialists can consult their colleagues remotely.
"If colleagues in both perinatal centers and maternity hospitals that are less equipped than perinatal centers have any problems, such as a woman's problematic pregnancy, a problematic birth, or a seriously ill newborn, they can get our advice directly in a few hours,— Dmitry Degtyarev said. — We have telemedicine consultations around the clock.
In case of serious complications, any federal center can also receive the patient.
— This is probably the advantage of pregnancy — it lasts a long time, 40 weeks, which allows you to identify various complications. So patients often have time for routing, and we understand that we can expect something in the near future or, conversely, in the distant future," explained Natalia Trifonova.
"Alone in the field is not a warrior"
In the near future, neonatology will continue to develop technologies, and the trend towards enlarging maternity hospitals will continue, Dmitry Ivanov is sure.
— It is impossible to install MRI or cardiac surgical operating rooms in every small village hospital. And it's not even about the cost of this equipment, but about the people who should be able to work on it," explained the chief freelance neonatologist at the Ministry of Health.
According to him, three components are important for the development of any medical field: medicines, medical technologies (domestic specialists managed to partially replace them with imports or to some extent compensate for them through cooperation with China), as well as personnel training.
— Equipment without people will not be effective anyway. Therefore, to some extent, we have an advantage related specifically to educational traditions," he said. — Despite the fact that Soviet neonatology was in its infancy, the system of training doctors for pediatric medicine created at that time is even better than in a number of Western countries.
At the same time, the interlocutor of Izvestia admitted, the technological nature of modern neonatal medicine tightens the requirements: to quickly train a good specialist who can confidently work on modern technology is a separate serious task.
Rustam Mukhametshin called situations in which a patient has diseases or pathologies that require the attention of several specialists the key and most difficult clinical challenge in modern neonatology.
— Multidisciplinary teams are formed to work with the most difficult patients, designed to find the optimal solution in the diagnosis and therapy of complex and rare combinations of diseases. These teams include not only clinicians, but also specialists in the field of instrumental diagnostics, clinical pharmacology, rehabilitation, and many others," the source explained.
Success in this case depends not so much on the complexity or high cost of treatment, but on the effectiveness of interaction within the clinical team. It is important to be able to think and have a dialogue beyond the scope of your specialty.
—A huge role in the process of helping comorbid patients belongs to the average medical staff, nurses, whose deep understanding of the disease, possible risks, features of therapy and care can take pediatrics to a new level," the doctor emphasized.
In addition, the complex structure of modern medicine requires active interaction, including with colleagues within the same specialty.
— Modern medicine is a collective effort. Now, more than ever before, one is not a warrior in the field," the source said.
Natalia Trifonova considers it important for biologists to develop an artificial uterus, a device that would allow a child born extremely early to be carried in as close to natural conditions as possible.
— This is a device where a prematurely born child can be placed, where conditions will be created that fully mimic its development in the womb. Such work is currently being carried out on animals, that is, on calves and lambs. And it seems to me, given how technology is accelerating, perhaps soon they will be able to be used to help neonatologists," she said.
It should be understood, the Izvestia interlocutor pointed out, that this is not about artificial gestation, but about a tool that can help a child born prematurely survive.
According to Rustam Mukhametshin, it is also important to create a full-fledged "medical digital ecosystem" based on AI, which can timely warn about risks and warn the doctor against mistakes.
"Artificial intelligence is certainly not a panacea or magic, it is mathematics that allows us to identify complex, nonlinear, implicit patterns on large amounts of data," he explained. — The next step is early prediction and identification of risk groups for certain conditions based on data from a medical electronic card, an intensive care card, data from a monitor and a ventilator.
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