Preterm is defined as babies born alive before 37 weeks of pregnancy are completed. There are sub-categories of preterm birth, based on gestational age:
- Extremely preterm (less than 28 weeks)
- Very preterm (28 to 32 weeks)
- Moderate to late preterm (32 to 37 weeks)
We are not classifying here as LBW, VLBW OR ELBW, because that will complicate an issue ,And that is the management issue when sent for SNCU or NICU.
Extent of Prematurity:
An estimated 15 million babies are born too early every year which corresponds TO 10-12% of all babies born. Out of these, approximately 1 million children die each year due to complications of preterm birth (1). Globally, prematurity is the leading cause of death in children under the age of 5 years. Survivors also suffer from a lifetime of disability, including, organ system complications, learning disabilities and visual and hearing problems.
In developed countries, preterm birth rates are increasing because of reasons which are not common in developing world like infertility. Inequalities in survival rates around the world are stark. In low-income settings, half of the babies born at or below 32 weeks (2 months early) die due to a lack of feasible, cost-effective care.. In highincome countries, almost all of these babies survive. For better survival of these tiny tots, warmth, breastfeeding support, and basic care for infections and breathing difficulties management is cornerstone.
Need of hour
More than three quarters of premature babies can be saved with feasible, cost-effective care, such as essential care during child birth and in the postnatal period for every mother and baby, provision of antenatal steroid injections (given to pregnant women at risk of preterm labor 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. Obstetrics community also plays important role in prevention of prematurity. Effective midwifery services have been shown to reduce the risk of prematurity by around 24%.
Preventing deaths and complications from preterm birth starts with a healthy pregnancy. Quality care before, between and during pregnancies will ensure all women have a positive pregnancy experience.
Why does preterm birth happen?
Preterm birth occurs for a variety of reasons. Most preterm births happen spontaneously, but some are due to early induction of labor or caesarean birth, whether for medical or nonmedical reasons. Who advices caesarian section or induction of labor after 39 completed weeks, however there is no scientific reason why 39 week as a cutoff.
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. understanding of the causes and mechanisms remain still unclear and solutions to prevent preterm birth requires genuine data and multicentre studies.
Where and when does preterm birth happen?
More than 60% 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% of babies are born too early compared with 9% in higher-income countries. Within countries, poorer families are at higher risk.
The 10 countries with the greatest number of preterm births(2):
- India: 3 519 100
- China: 1 172 300
- Nigeria: 773 600
- Pakistan: 748 100
- Indonesia: 675 700
- United States of America: 517 400
- Bangladesh: 424 100
- Philippines: 348 900
- Democratic Republic of the Congo: 341 400
- Brazil: 279 300
The 10 countries with the highest rates of preterm birth per 100 live births (2):
- Malawi: 18.1 preterm births per 100 births
- Comoros: 16.7
- Congo: 16.7
- Zimbabwe: 16.6
- Equatorial Guinea: 16.5
- Mozambique: 16.4
- Gabon: 16.3
- Pakistan: 15.8
- Indonesia: 15.5
- Mauritania: 15.4
Most of the countries with reliable data are showing increase in preterm birth rate. Possible reasons for this include better measurement, increases in maternal age and underlying maternal health problems such as diabetes and high blood pressure, greater use of infertility treatments leading to increased rates of multiple pregnancies, and changes in obstetric practices such as more caesarean births before term.
More than 90% of extremely preterm babies (less than 28 weeks) born in low-income countries die within the first few days of life; yet less than 10% of extremely preterm babies die in highincome settings.
Important interventions to help prevent preterm birth, are
- Counseling on healthy diet and optimal nutrition,
- Tobacco and substance use;
- Fetal measurements including use of ultrasound to help determine gestational age and detect multiple pregnancies;
- Minimum of 8 contacts with health professionals throughout pregnancy to identify and manage other risk factors, such as infections.
- Better access to contraceptives and increased empowerment could also help reduce preterm births.
WHO recommendations on interventions to improve preterm birth outcomes
WHO is currently coordinating two clinical trials, first one called the WHO ACTION Trials (Antenatal Corticosteroids for Improving Outcomes in preterm Newborns) for women at risk of preterm birth .The trials will assess how steroid injections can be used safely and effectively for women and preterm newborns in low- and middleincome countries.
And second trial is Immediate kangaroo mother care (KMC) multi-country trial (compared with the current recommendations of initiating KMC when baby is stable) in Ghana, India, Malawi, Nigeria and the United Republic of Tanzania.
- Implementation research to scale-up KMC in India and Ethiopia. Are also important component of this trial.
- UNICEF India and its state branches are helping governments and non government organizations in organizing and implementing standard KMC care at various places.
PEDIATRIC ASSOCIATION OF INDIA can take active part in activities related to kangaroo mother care and publish valuable data in this venture. Most of the members of PAI have background of community which represents the resourse limited part of India. The hand in glove cooperation with obstetric and community medicine will help preterm of future in improving quality of life.
Issue: October-December 2017 [Volume 6.4]