HNN brings together partner organisations and individuals working in newborn health to share key resources, data, experiences, and lessons and helps increase global commitment to the advancement of newborn health. It also provides a platform for stakeholders to engage in discussions and working group activities on the vast range of newborn and maternal health topics.
World Prematurity Day is a key moment to focus global attention on the leading cause of child deaths under age 5 – complications from preterm birth – which account for nearly 1 million deaths each year (UNICEF). Without a major push to reduce these deaths, we will not reach the Global Goal, endorsed by 193 countries, to end all preventable newborn and child deaths by 2030.
Preterm births rising globally
An estimated 15 million babies are born preterm every year – more than 1 in 10 babies around the world and this number is rising. Preterm birth complications are the leading cause of death for children under 5, causing an estimated 1 million deaths in 2015 globally. Many survivors of preterm birth face a lifetime of disability, including learning disabilities and visual and hearing problems.
Preterm birth (born before 37 weeks of pregnancy) and being small for gestational age, which are the reasons for low-birth-weight (LBW), are also important indirect causes of neonatal deaths. LBW contributes to 60% to 80% of all neonatal deaths. The global prevalence of LBW is 15.5%, which amounts to about 20 million LBW infants born each year, 96.5% of them in developing countries.
Countries can reduce their neonatal and infant mortality rates by improving the care for the mother during pregnancy and childbirth and of LBW infants. Experience from developed and low- and middle-income countries has clearly shown that appropriate care of LBW infants, including their feeding, temperature maintenance, hygienic cord and skin care, and early detection and treatment of infections and complications including respiratory distress syndrome can substantially reduce mortality.
Here, WHO strongly advocates for skilled care at every birth, which is the foundation for all good care for preterm babies. WHO also promotes essential newborn care for all babies, and has developed clinical guidelines and training tools for this purpose. In addition, WHO promotes basic newborn resuscitation, which has helped to make resuscitation broadly available in developing countries.
WHO’s recommendations focus on 3 areas
The WHO Recommendations on antenatal care for a positive pregnancy experience (2016) recommend midwife-led continuity of care (MLCC) models, where one midwife, or a group of midwives working together, provides care to a woman, newborn and her family throughout the antenatal, intrapartum and postnatal continuum. This differs from “medical-led” care, or care that is “shared” between medical staff and midwives.
MLCC is associated with improved outcomes for the majority of women and babies at low risk of developing complications and has been shown to reduce the risk of prematurity by around 24%.
Women are more likely to experience spontaneous vaginal birth; experience fewer interventions including episiotomies and instrumental births and are more likely to be satisfied with their care.
MLCC requires a well-functioning midwifery programme and should be provided by midwives who are educated, trained, licensed, and regulated. Access to emergency obstetric and neonatal care, either at the health facility or though transport to a referral centre, is prerequisite.
Kangaroo Mother Care
Kangaroo Mother Care is a method of care of preterm infants, particularly those weighing less than 2 kg. It includes exclusive and frequent breastfeeding in addition to skin-to-skin contact and support for the mother-infant dyad, and has been shown to reduce mortality in hospital-based studies in low- and middle-income countries. The WHO document Kangaroo mother care: a practical guide provides guidance on how to organise services in health facilities and on what is needed to provide effective Kangaroo Mother Care. WHO is currently coordinating clinical trials on Kangaroo Mother Care.
Specific clinical interventions
WHO recommendations on interventions to improve preterm birth outcomesprovides specific recommendations for interventions during pregnancy, labour and during the newborn period that are aimed at improving outcomes for preterm infants. The guidelines include interventions provided to the mother – for example steroid injections before birth, antibiotics when her water breaks before the onset of labour, and magnesium sulfate to prevent future neurological impairment of the child, as well as interventions for the newborn baby – for example thermal care, feeding support, (e.g. kangaroo mother care, when babies are stable), safe oxygen use, and other treatments to help babies breathe more easily.