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WHO launches new guidance to improve outcomes in premature births

Published:Tuesday | November 17, 2015 | 12:00 AM
A premature baby

As Jamaica continues to grapple with the tragic death of 19 premature babies, after they were infected during a bacteria outbreak at two of the island's major public hospitals, yesterday the world observed World Prematurity Day.

Each year on World Prematurity Day, countries around the world seek to raise awareness of the devastating consequences of preterm birth. Preterm is when a baby is born before 37 completed weeks of pregnancy.

According to the World Health Organization (WHO), approximately 15 million babies are born prematurely every year - that is one in 10 babies born worldwide. Of those, approximately one million babies died in 2013 from complications due to prematurity.

But WHO is convinced that more than three quarters of these babies could be saved through better access to quality care and medicines for both mother and baby.

WHO said complications of preterm births are the leading cause of death among children under five years of age. Without appropriate treatment, those who survive often face lifelong disabilities, including learning, visual and hearing problems, and their quality of life is greatly affected.

In an effort to improve preterm birth outcomes, WHO has published recommendations for managing preterm births that are designed to save lives and improve the health of preterm infants.

Adding to efforts worldwide to further reduce child mortality, the guidance offers recommendations on interventions which can be provided to the mother when preterm birth is imminent and to the preterm infant after birth, with the aim of improving outcomes for preterm infants. Many of the recommendations are simple, proven and cost-effective measures.

A set of key interventions are included in the new guidance, available on WHO's website, which can improve the chance of survival and health outcomes for preterm infants. It includes interventions provided to the mother - for example, steroid injections before birth, antibiotics when her water breaks, and magnesium sulphate to prevent future neurological impairment of the child - as well as interventions for the baby - for example, thermal care (keeping the baby warm), safe oxygen use, and use of surfactant (a specific medicine) to help infants breathe more easily.

"We can save many more babies with effective interventions. We must focus our efforts on how to improve the outcomes for babies that are born preterm," said Dr Femi Oladapo, Department of Reproductive Health and Research, WHO.

WHO said it is committed to reducing the health problems and lives lost as a result of preterm birth.




- More than three quarters of premature babies can be saved with feasible, cost-effective care, for example, essential care during childbirth and in the postnatal period for every mother and baby, antenatal steroid injections (given to pregnant women at risk of preterm labour and under set criteria to strengthen the babies' lungs), kangaroo mother care (the baby is carried by the mother with skin-to-skin contact and frequent breastfeeding) and antibiotics to treat newborn infections.

- To help reduce preterm birth rates, women need improved care before, between and during pregnancies. Better access to contraceptives and increased empowerment could also help reduce preterm births.

- WHO recommends working with partners around the world to conduct research into the causes of preterm birth, and test effectiveness and delivery approaches for interventions to prevent preterm birth and treat babies that are born preterm.

- WHO recommends regularly updating clinical guidelines for the management of pregnancy and mothers with preterm labour or at risk of preterm birth, and those on the care of preterm babies, including kangaroo mother care, feeding babies with low birth weight, treating infections and respiratory problems, and home-based follow-up care.

- WHO recommends developing tools to improve health workers' skills and assess the quality of care provided to preterm babies.




- Every year, an estimated 15 million babies are born preterm (before 37 completed weeks of gestation), and this number is rising.

- Globally, preterm birth complications are the leading cause of death -among children under five years of age, responsible for nearly one million deaths in 2013.

- Three quarters of them could be saved with current, cost-effective interventions.

- Across 184 countries, the rate of preterm birth ranges from five per cent to 18 per cent of babies born.

- More than 60 per cent of preterm births occur in Africa and South Asia, but preterm birth is truly a global problem. In the lower-income countries, on average, 12 per cent of babies are born too early compared with nine per cent in higher-income countries. Within countries, poorer families are at higher risk.

- There is a dramatic difference in survival of premature babies, depending on where they are born. For example, more than 90 per cent of extremely preterm babies (<28 weeks) born in low-income countries die within the first few days of life; yet less than 10 per cent of babies of this gestation die in high-income settings.

- Induction or caesarean birth should not be planned before 39 completed weeks unless medically indicated.

- Inequalities in survival rates around the world are stark. In low-income settings, half of the babies born at or below 32 weeks (two months early) die due to a lack of feasible, cost effective care, such as warmth, breastfeeding support, and basic care for infections and breathing difficulties. In high-income countries, almost all of these babies survive.

- Preterm birth occurs for a variety of reasons. Most preterm births happen spontaneously, but some are due to early induction of labour or caesarean birth, whether for medical or nonmedical reasons.

- Common causes of preterm birth include multiple pregnancies, infections and chronic conditions such as diabetes and high blood pressure; however, often no cause is identified. There could also be a genetic influence. Better understanding of the causes and mechanisms will advance the development of solutions to prevent preterm birth.