Report outlines ways to reduce preemie deaths
Worldwide, 1 in 11 babies is born too early, a proportion that rises to 1 in 9 births in the United States. More than a million of the 15 million babies born too soon die shortly after birth and others face long-term medical problems tied to prematurity.
A new report from an international coalition of child health advocacy organizations suggests those grim numbers could be drastically reduced if just a few proven and inexpensive treatments and preventive measures were available around the globe.
While the underlying causes of and treatment for premature birth differ between less developed nations and high-income nations like the U.S., there are some common solutions that can work across cultures.
“There are some interventions that benefit babies whether they're in Africa, Asia or Silicon Valley, like Kangaroo mom care (swaddling an infant skin-to-skin at the mother's chest to keep it warm),” said Christopher Howson, vice president for global programs at the March of Dimes Foundation and a co-editor of the report. “It's a low-tech innovation that could save more than 450,000 babies a year in poor countries, but is readily adopted in a culture like ours.”
With more than 500,000 preterm births a year, the United States ranks sixth out of 184 countries for total numbers, but 37th for preterm deaths, due to the availability of effective but costly neonatal intensive care.
Although the causes of many preterm births is uncertain, researchers say the chief drivers of the increase in wealthy nations seem to be an increasing number of older women having babies, more use of fertility drugs that result in multiple pregnancies and a rise in medically unnecessary labor induction and Caesarean deliveries before full-term.
The leading factors in poorer countries are maternal infections, high adolescent pregnancy rates and a lack of prenatal medical care and nutrition, including drugs to delay premature labor. Having those steroids widely available could save 400,000 infants a year.
Even in the United States, some populations still have less access to medical care and higher teen birthrates that put them at higher risk for premature birth. The prematurity rate for black Americans was 17.5 percent compared to 10.9 percent for whites in 2009.
A full-term birth is 39 weeks of gestation. More than 80 percent of all preterm births occur between 32 and 37 weeks — late preterm — and most babies in this group can survive with supportive care.
Those born between 28 and 32 weeks are considered “very preterm” and most will survive if they get extra medical care. Any baby born earlier than 28 weeks is considered “extremely preterm” and requires the most intensive hospital care to live.
The “extremely preterm” babies born in developed countries have a 90 percent chance of survival, which drops to 10 percent in low-income nations. But all of the earliest infants have a great risk for lifelong physical and neurological deficits.
The best way to protect infants is to find ways to ensure most pregnancies last 39 weeks. “We are now looking closely at what can be done before a woman gets pregnant to help her have an optimal outcome,” said Dr. Elizabeth Mason, a World Health Organization official who oversees newborn health and was a major contributor to the report.
Howson said culturally appropriate programs to educate women about healthy pregnancy are important to reaching high-risk groups.
“There are a lot of programs for women in prenatal care, but there's not much being done toward helping women be healthy before they become pregnant,” he added.
“Making that happen requires full health insurance coverage and good access to health care.”