A new report from the World Health Organisation highlights the importance of prematurity as a major health problem around the world. http://www.who.int/pmnch/media/news/2012/preterm_birth_report/en/index.html Fifteen million babies are born prematurely in the world each year, and the number is increasing everywhere. You can use an interactive map on the following page to find out how various countries are doing. http://www.marchofdimes.com/mission/globalpreterm.html?utm_source=Healthy%2BNewborn%2BNetwork%2BNewsletter%26utm_campaign=10505b16f0-HNN_express_May%2B4%26utm_medium=email The report points out that prematurity is a huge problem in low-resource countries as well as middle and high resource countries. Millennium development goal 4, reducing child deaths by 2/3 is far from being realized. Much of the failure has been because newborn babies are not considered to be of much value, and the loss of human life, when it is newborn babies, is never considered to be as serious as when it is older children or ‘productive’ adults.
The majority of neonatal deaths in the world are due to lack of access to basic medical care. Many millions of those deaths could be prevented with simple inexpensive interventions: breast feeding, basic temperature management, early treatment of infections and more importantly, education. This includes preterm babies, most preterm babies are only slightly preterm, and they do not need expensive intensive care to survive, but kangaroo care, assistance with feeding and knowledge of simply treated complications could make a difference to millions of babies.
Simple interventions also make a difference to full term babies, Five percent of term babies need a little help to start breathing on their own. In many countries, babies who don’t breathe immediately after birth are left to die. A new program for such babies ‘heliping babies breathe’ holds great potential to improve survival and decrease long term handicap. http://www.helpingbabiesbreathe.org/
This program has been developed with careful evaluation of the skills gained by providers and evaluation of how to best institute it.
Singhal N, Lockyer J, Fidler H, Keenan W, Little G, Bucher S, et al. Helping Babies Breathe: Global neonatal resuscitation program development and formative educational evaluation. Resuscitation. 2012;83(1):90-6.
With programs like Helping Babies Breathe and simple ways to improve outcomes of preterm babies, we have a chance to make a dent in the millennium goals.
It must be recognized that neonatal resuscitation not only reduces death but also reduces long term handicap.
It has sometimes been difficult in the past to start resuscitation programs because people worry that resuscitating babies who do not breathe at birth is to risk resuscitating babies who will have serious long term brain injury. It has even been difficult to get funds to start programs to train people.
The reality is exactly the opposite. Neonatal resuscitation programs reduce death AND reduce disability. Wally Carlo and his colleagues have shown this very clearly, Carlo WA, Goudar SS, Pasha O, Chomba E, McClure EM, Biasini FJ, et al. Neurodevelopmental outcomes in infants requiring resuscitation in developing countries. J Pediatr. 2012;160(5):781-5 e1. http://www.jpeds.com/article/S0022-3476(11)01046-8/abstract
Teaching neonatal resuscitation in low resource countries reduces the numbers of babies who are classified as stillborn, and reduces the numbers of babies who have long term neurological and developmental problems.