An approximate 15 million premature babies are born each year – more than 1 in 10 preterm babies worldwide and this statistic is increasing. Preterm birth defects remain the leading cause of death for children under 5 years of age, with approximately 1 million deaths worldwide in 2015. Most preterm birth survivors experience life-long disability, including learning disorders and sight and hearing difficulties. Premature birth (born before 37 completed weeks of gestation) and being too small for gestational age, which are the reasons for low birth weight (LBW), are both significant indirect causes of neonatal mortality. LBW accounts for between 60% and 80% of all deaths in neonatal care. The global prevalence of LBW is 15.5 percent, accounting for around 20 million LBW babies born each year, 96.5 percent of them in developed nations. Countries can decrease their neonatal and baby mortality by improving treatment for mothers during pregnancy and delivery and LBW babies. Experience from developing and low-and middle-income countries has demonstrated that proper care for LBW babies, including nursing, temperature control, hygienic cord, and skincare, and early diagnosis and treatment of infections and disorders, including respiratory distress syndrome, will greatly reduce mortality. The recommendations of WHO focus on three main areas:
1. Midwife-Led Continuity of Care (MLCC)
WHO Guidelines on antenatal treatment for healthy pregnancy suggest midwife-led continuity of care (MLCC) models where a midwife, or a group of midwives working collectively, offers support for mothers, newborns, and their families along with the antenatal, intrapartum, and postnatal period. This varies from “medical-led” treatment or “shared” care between medical personnel and midwives. MLCC is considered to be more effective for the majority of mothers and children at low risk of developing complications and has been shown to decrease the risk of prematurity by about 24 percent. Women tend to experience natural vaginal birth; they undergo fewer interventions, like episiotomies and instrumental deliveries, and are more likely to be pleased about their care. MLCC provides a well-functioning midwifery curriculum that should be offered to midwives who are qualified, trained, licensed, and supervised. Access to emergency obstetric and neonatal care, either at a health clinic or by travel to a referral center, is a requirement.
2. Kangaroo Mother Care
Kangaroo Mother Care is a system of care for premature infants, especially those weighing less than 2 kilograms. It requires exclusive and consistent breastfeeding in the neonatal intensive care unit, in addition to skin-to-skin touch and maternal-infant-dyad care, and has been shown to minimize death in hospital-based trials in low-and middle-income countries.
3. Specific Clinical Interventions
WHO guidelines for interventions to improve preterm birth outcomes include detailed recommendations for interventions during pregnancy, labor, and in the newborn phase to improve outcomes for premature infants. The recommendations include treatments given to the mother – for example, pre-birth steroid injections, antibiotics once the water breaks before the start of labor, and magnesium sulfate to avoid potential neurological deterioration of the infant, as well as interventions for the newborn infant – for example, thermal support, feeding assistance (e.g., kangaroo mother care, when the baby is stable), healthy oxygen use, and other care processes to ease the baby’s respiration process.
4. Risk Factors
Risk factors for Low birth-weight and prematurity involve the fetus, maternal wellbeing, and the condition where the parent lives. Doctors at a NICU Hospital in Coimbatore think that gender, the order of birth, and the prevalence of more than one gestation are risk factors for Low birth-weight.
Maternal Risk Factors
Maternal risk factors for LBW and preterm births in NICU hospital in Coimbatore include socio-demographic factors (<18 and >35 years of age, lower socioeconomic status, rural residency, and close to zero maternal education); dietary and anthropometric factors (insufficient parental diet, insufficient gestational weight gain, small stature, and inadequate nutrition); lifestyle throughout pregnancy (alcohol and cigarette smoking) and preterm pregnancy diseases (hypertension, malaria, syphilis, and anemia).
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Obstetric Risk Factors
Obstetric risk factors for low birth-weight and preterm delivery involve having a recent history of LBW/preterm baby, inadequate obstetric history involving past stillbirth or sudden neonatal death, a brief interval of birth, placental abruption, previous placenta, and lack of adequate prenatal treatment. In addition, mothers living in poor socio-economic environments, mothers engaging in physically stressful practices, and mothers suffering from physical and/or psychological trauma are more likely to give birth to LBW and/or premature infants.
Low Birth Weight
Globally, LBW is a big public health concern. In India, every third newborn in a neonatal intensive care unit is an LBW that contributes around 40% of the global burden. Birth weight is a significant measure of a newborn’s wellbeing and is a key influence that influences the child’s life, physical and mental development, and is also a predictor of the mother’s state of health. Low birth weight remains one of the most serious problems for maternal and infant wellbeing in both developing and developed countries. It is an important indicator of infant and child mortality, morbidity, and disease and also has a long-term effect on health outcomes in adult life. Low birth weight infants in the developing world are born in India. The birth weight of an infant is the most significant determinant of its probability of survival, stable growth and development, and depends on several maternal influences. It is widely accepted that children of reduced birth weight would remain unhealthful throughout their lives. These babies are at greater risk of developing lung, cardiac and intestinal disorders and may also be prone to diabetes later in life.
In this regard, the World Health Organization is:
- Collaborating with countries to improve the accessibility and accuracy of data on premature births;
- Providing revised analyses of worldwide premature birth levels and patterns every 3 to 5 years;
- Working with stakeholders around the globe to conduct studies into causes of premature births and assess feasibility and delivery methods for strategies to reduce preterm birth and to treat preterm births;
- Frequently revising medical recommendations for the control of preterm pregnancy and mothers with or at risk of preterm delivery and for the care of preterm children, like Kangaroo Mother Care, the nursing of low birth weight infants, the treatment of infections and pulmonary disorders, and home-based follow-up care.