The National Commission for Women’s, Children’s, and Adolescents’ Health (CNSMCM) stated that preterm babies born before 26 weeks of gestation present a demanding clinical reality. However, Portugal has responded in a robust, organized, and humane manner. With progressively improving survival rates and neonatal mortality among the lowest in the OECD, the country ranks highly in perinatal care.
This public statement follows a premature baby being born last Thursday in an ambulance operated by the Volunteer Firefighters of Nazaré, Leiria district, who died after being admitted to the Obstetric Emergency at the Hospital of Leiria.
The commission also considers that such births, when occurring outside a specialized center and without preparation time, require resource mobilization and real-time decision-making that no health structure can guarantee infallibly.
“What can and should be guaranteed is a coordinated, ethical, and evidence-based response, which our neonatal network has sought to ensure,” it adds.
The CNSMCM document indicates that a recent case involving a newborn of 26 weeks’ gestation during an inter-hospital transfer drew media attention. “This episode warrants a thoughtful and informed reflection on how Portugal systematically and organizedly responds to clinical situations at the limits of neonatal viability.”
The statement emphasizes understanding the phenomenon of extreme prematurity, what is clinically at stake at these gestational ages, and the ethical, technical, and organizational stance of Portugal in this area.
According to the National Registry of Very Low Birth Weight Newborns, between 2019 and 2024, 479 babies were born in Portugal with a gestational age of less than 26 weeks, representing less than 0.3% of all births, yet showcasing considerable clinical and ethical complexity.
The overall mortality rate in this group is 56.3%, reflecting the challenges of extreme immaturity, even in contexts of excellent intensive care, and “still, Portugal presents care results comparable to the best international centers.”
The CNSMCM also notes that the Portuguese perinatal network is a model of health organization. “Portugal has a highly structured national perinatal network, comprised of differentiated perinatal support hospitals, with dedicated neonatology teams, technologically equipped neonatal intensive care units, and national protocols for in-utero transfer to ensure delivery in a specialized environment.”
This organization allows a specialized response to extreme prematurity and constitutes one of the pillars of the Portuguese neonatal health system, enabling internationally recognized excellence results.
However, it is considered that recognition is necessary “when the birth of an extreme preterm occurs unexpectedly, in a location without adequate differentiation, or without sufficient time for in-utero transfer, the complexity levels increase exponentially,” and “in these situations, even experienced teams face logistical obstacles, resource limitations, and biological conditions.”
This organization allows a specialized response to extreme prematurity and constitutes one of the pillars of the Portuguese neonatal health system, enabling internationally recognized excellence results, it states.
On this matter, the National Institute of Medical Emergency (INEM) assured that its actions were “the most appropriate.”
In a response to the Lusa agency, the entity coordinating emergency medical care in Portugal stated that its “actions (…) and those of all participants in this incident were the most appropriate.”
