Preterm babies born soon, die sooner and demand our attention at the soonest.

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A preterm baby : As small as to fit on a palm!

Most recent global estimates places complications arising from preterm birth as the single most important direct cause of the world’s 3.6 million neonatal deaths (Black, Cousens et al. 2010; Liu L, Johnson HL et al. 2012). One third of preterm survivors suffer from severe long term neurological disabilities, such as cerebral palsy or mental retardation (Lawn, Cousens et al. 2005). Furthermore, preterm infants carry increased risk of behavioural problems, school learning difficulties, chronic lung disease, retinopathy of prematurity, hearing impairment, and lower growth attainment (Saigal and Doyle 2008). Preterm birth affects not only infants but also their families who may have to spend several months in hospital for ensuring care for preterm infants, and thus preterm birth has increasing cost implications for health services (Tucker and McGuire 2004).

Millennium Development Goal (MDG4) targets a two-thirds reduction of under-five deaths between 1990 and 2015 and achievement of MDG 4 is strongly dependent on progress in reducing neonatal deaths (Oestergaard, Inoue et al. 2011). Since preterm birth is the leading cause of neonatal deaths globally (Black, Cousens et al. 2010), progress towards achieving MDG target is much dependent on achieving high coverage of evidence-based interventions to prevent preterm birth and to improve survival for preterm newborns (Darmstadt, Bhutta et al. 2005).

Results from a community based study showing vulnerability of Preterm babies

Thus, effective planning and designing community based program and neonatal health intervention needs to focus on preterm births, specifically in low resource settings; such a focus will require a clearer understanding of associated risk factors, especially those which are can be intervened upon.

Investigating associated risks factors of preterm birth is important for several reasons. First, identification of at-risk women will allow initiation of risk-specific interventions and/or preventive measures. Second, identifying risk factors could help designing and studying specific interventions. Finally, associated risk factors might provide important insights into mechanisms leading to preterm birth which could provide critical contribution to existing knowledge base.

Reference

Black, R. E., S. Cousens, et al. (2010). “Global, regional, and national causes of child mortality in 2008: a systematic analysis.” The Lancet 375(9730): 1969-1987.

Darmstadt, G. L., Z. A. Bhutta, et al. (2005). “Evidence-based, cost-effective interventions: how many newborn babies can we save?” The Lancet 365(9463): 977-988.Lawn, J. E., S. Cousens, et al. (2005). “4 million neonatal deaths: when? Where? Why?” Lancet 365(9462): 891-900.

Liu L, Johnson HL, et al. (2012). “Global, regional, and national causes of child mortality: an updated systematic analysis for 2010 with time trends since 2000.” Lancet 379(9832)(Jun 9): 2151-2161.

Oestergaard, M. Z., M. Inoue, et al. (2011). “Neonatal Mortality Levels for 193 Countries in 2009 with Trends since 1990: A Systematic Analysis of Progress, Projections, and Priorities.” PLoS Med 8(8): e1001080.

Saigal, S. and L. W. Doyle (2008). “An overview of mortality and sequelae of preterm birth from infancy to adulthood.” Lancet 371(9608): 261-269.

Tucker, J. and W. McGuire (2004). “Epidemiology of preterm birth.” BMJ 329(7467): 675.

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3 Responses to “Preterm babies born soon, die sooner and demand our attention at the soonest.”

  1. carolynrodehau Says:

    I couldn’t agree more with Rashed, making preterm newborns apart of the global health agenda is critical to achieving MDG4. As more research is driven around this vulnerable population, we see not only how important the first year of life a child’s life, but most surprisingly the first hour of birth. Kangaroo Mother Care (KMC) is an innovative, affordable intervention that can prevent and manage complications associated with preterm birth. This life saving approach is rooted in the importance of skin-to-skin contact and exclusive breastfeeding. This evidence based intervention strategy has incredible potential for increasing both preterm and newborn survival especially in low resource settings. I would advocate for KMC to be availability in all low-income settings to be brought to scale.

    For more information on KMC: http://ije.oxfordjournals.org/content/39/suppl_1/i144.full

  2. mcdonsrun Says:

    I think Rasheed did a very good job presenting the problem of prematurity. It is the single most direct cause of neonatal death and it is often associated with adolescent pregnancy, maternal health problems (such as preeclampsia) and premature rupture of membranes.
    The question from the Darmstadt article is central to the issue: “How many newborn babies can we save?” For much of the world it is difficult if not impossible to support/sustain the lives of many premature newborns, especially the 26-32 week gestation neonates. These babies need so much more high level intensive and expensive care. There are ethical and resource issues regarding viability in some countries here but the truth is learning to prevent prematurity is the most sound strategy.
    Even in America there are so many more women giving birth to mildly premature babies because of glucose intolerance/gestational diabetes and polycystic ovary syndrome both associated with maternal obesity. These babies often need some extra hospital care and have increased morbidity.
    Prematurity of birth is a global problem. I am glad to see it presented here. Well done.

  3. cmorebmore Says:

    Thank you for the fascinating post. I agree that preterm births are the leading cause of neonatal death and as such, attention should be paid to this issue. One challenge is that preterm babies, once born, require expensive interventions – currently in the US, on average $49,000 in the first year of life (http://www.cnn.com/2009/HEALTH/03/17/premature.babies/index.html) compared to $4,551 for a newborn without complications. Therefore, whereas the more pricey care is essentially tertiary prevention, perhaps we can consider primary prevention, and build research capacity to investigate what are the potential contributing factors in each region including LMICs and address these factors to the extent possible.

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