1. How important is premature birth in contributing to infant mortality in India and globally?
Premature birth is an extremely important case of mortality and morbidity both in India and the rest of the world. About 10-15% of all babies born in the world are born early and thus have higher risk of dying or surviving with life long disabilities.
In the US the prematurity rate is roughly about 10% whereas in India it varies a lot going from one state to another. The lowest prematurity rate and infant mortality rate is in Kerala. A large fraction of premature births occur at 34, 35, 36 weeks where there is great opportunity to improve the outcomes.
Most developed countries focus on babies that are born very early whereas in countries like India we need to focus on babies that are more mature but yet are born early.
2. What strategies are in place to improve outcomes of preterm babies?
About 75 % of all pre mature births occur at 34, 35, 36 weeks. A large number of such births occur because of maternal conditions, the mother goes into preterm labour or the mother ruptures the bag of water leading to premature rupture of membranes.
Preterm birth is inevitable to improve the outcome of the premature infant. One of the strategies which we are currently looking at is the role of anti natal betamethasone or antenatal steroids that is given to the mother who comes in preterm labour.
3. In low resource countries, what public health interventions would you recommend to reduce the impact of premature birth?
There are known low cost interventions that are grossly under utilised in much of the developing world. One example is the use of folic acid which is given in small doses before the mother becomes pregnant. It has dramatically reduced the birth defects and can also help impact prematurity and preeclampsia.
In the US and many other countries there has been a big push to add folic acid to food so that the fortified bread constantly provides the required amount of folic acid. There is no such programme in India but I wish there was a programme which would promote folic acid intake.
We recommend that mothers who are in the reproductive age group constantly take folic throughout their reproductive life as this is the simplest way in making it effective. Mothers who have had a birth defect in a baby require 10 times more dosage of folic acid. Second is giving the mother antenatal steroids and this is something that needs to be practised in every rural area.
4. Please tell us about your research and role in 'use of steroids' in late preterm pregnancies.
Many years ago there was very poor understanding as to what fills the lungs of the foetus. Remember, the foetus is in the uterus surrounded by a pool of fluid and is completely drowned in it. The lungs of the baby are full of fluid that needs to be completely cleared after birth so that normal air exchange can occur and the dependence of placenta for oxygen and nutrients goes away.
My research over the last 20 years has been focused on how the foetus clears the lung fluid. Now we have focussed on looking at what is that magic bullet at birth that indicates the mother or the baby that the time to be born has come. The second part of my own research is focussed on looking at the outcomes of late preterm babies.
We have done a lot of work why these babies began to have problems like learning disabilities, autistic behaviour or why there are bigger neurological problems when they start going to school.