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Preterm Births and Neonatal Mortality


6 March 2020 12:46 pm - 0     - {{hitsCtrl.values.hits}}


When talking about birth defects, one might attribute it to various environmental and genetic factors. However, premature birth (preterm birth) and birth defects are also connected, studies conducted have shown that birth defects are more common in preterm babies. The World Health Organization (WHO) defines preterm birth as all births before 37 completed weeks of gestation. According to the WHO, out of 15 million preterm births, 1.1 million die annually. Thus, preterm birth is the leading cause of neonatal mortality. At a plenary session held at the 9th International Conference on Birth Defects & Disabilities (ICBD) in the Developing World, the panellists revealed that most preterm birth survivors face complications in their lifetime including learning disabilities, visual and hearing issues.

Causes and current interventions for preterm births

Dr. Kelle H. Moley, Vice President and Chief Scientific Officer at March of Dimes, USA, shared that the causes can be divided into following categories:
Premature preterm rupture of membranes:
  • Spontaneous leakage of amniotic fluid without contractions
  • Unknown mechanism
  • Provider indicated:
  • Late preterm
  • Early Term scheduled deliveries
  • Medically indicated:
  • Pre eclampsia
  • Eclampsia
  • Fetal distress


Spontaneous onset of contractions

She also added that preterm births are also caused due to maternal characteristics during pregnancy. These causes are:
  • Age (less than 17 and more than 25)
  • Low/ High BMI
  • Poor nutrition
  • Stress
  • Depression
  • Smoking, alcohol and drugs (including second hand smoking)
  • Long working hours
  • Hard physical labour
  • Thyroid and asthma related medical conditions
  • Vaginal bleeding
  • Short cervix


Assistive Reproductive Technology (ART)
“Provider indicated preterm births can be prevented as they usually occur due to misjudgement of gestational age or poorly times deliveries carried out via c-section deliveries,” Dr. Moley stated. She shared that an increased incidence of ART such as IVF and ICSI contributed to an increase in preterm births due to multiple gestation and history of infertility of the mother.
She also revealed that waiting for delivery after 39 weeks resulted in fewer preterm births and 15% reduction in babies wanting neonatal intensive care. 
Dr. Moley also shared some of the measures taken to minimize preterm births. These were:
  • Progesterone supplementation
  • Cervical cerclage- the surgical closure of the dilated cervix during gestation
  • Tobacco cessation
  • Cautious fertility treatments
Preterm birth prevention clinics which include a group of medical health professionals who work with the mother prior and during pregnancy.
But she opined that the existing therapies and measures weren’t effective. She suggested that new strategies such as treatment of intrauterine infections, nutritional interventions should be introduced whilst also empowering women to be aware of their reproductive health. Dr. Moley also shared that poor social security of women, especially in low and middle income countries (LMICs) and cancerous growths during pregnancies also resulted in preterm deliveries. 

Preterm deliveries demographically

Dr. Razia Pendse, WHO Representative to Sri Lanka stated that according to WHO, in 2014 80% of preterm births were in South Asia and Sub-Saharan Africa. She also revealed that survival rates were unequal globally. “30% born between 28- 32 weeks will survive and almost all those born below 28 weeks may not survive in LMICs but in high income countries (HICs) 95% of those born between 28- 32 weeks will survive with almost 90% surviving with no impairment,” she said. The unequal survival rates are a result of lack of quality care for preterm babies in LMICs. 
Due to extreme preterm births, high neonatal intensive care treatment has to be provided to the babies and the cost of the care can be a challenge to many families especially in LMICs. “When ensuring survival of a preterm baby, financial security of the baby too should be considered. In some cases, the preterm birth survivor might need lifelong care and it should be seen that this could be facilitated,” she shared. 
She stated that to minimize neonatal and infant mortality due to preterm births, quality care should be provided and received by those who are in need for it. She stated that WHO is committed to researching causes, prevention methods and treatments for preterm births, enhancing clinical guidelines and quality of care provided for preterm births, working with relevant stakeholders for availability and quality of data, effectively treating complications that occur, increasing home-based follow-up care, and educating health workers on the necessary skills to provide quality care.

Why is it important to discuss about preterm births?

“7000 neonatal deaths occur every day due to preterm births,” stated Dr. Ornella Lincetto from WHO, Switzerland. She revealed that that 20 million new-borns required secondary care due to complications and 10 million required neonatal intensive care due to severe complications but 50% of such new-borns had no access to any form of care. “Therefore, it is vital we discuss the issue and make people aware of this, thereby being able to increase quality of care and survival rate,” she said.
She noted that to increase survival rate, three phases of quality care should be introduced and carried out, as was done in the past century. They are:
  • Phase 1
Public health approaches which are do-able  at home (observing healthy hygienic practices)
  • Phase 2
Improved pregnancy and providing birth and essential new born care
  • Phase 3
Providing special and intensive neonatal care
She revealed that these resulted to 75% relative reduction in the past. “We are also looking into changing from conventional care to a family centred care, because even the family undergoes trauma during a preterm birth. We are looking into a quality care without separation from birth to discharge,” she informed. 
Under Goal 3 of Sustainable Development Goals (SDGs)- Good Health, countries have aimed to reduce neonatal mortality rate to at least 12 per 1000 live births by 2030 and Dr. Lincetto stated that this could be achieved through educating health workers and universal health coverage, saving 1.7 million new-born lives annually. And due to preterm births being the leading cause for neonatal mortality, it is critical to minimize preterm births through minimizing risk factors and raising awareness on preventive measures and preventable factors while stakeholders invest in women’s, maternal, neonatal health care and innovation and research.
Pix by Kushan Pathiraja 

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