The Preterm Problem

Health Promotion Update No. 3 – Series 2012
Health Promotion and Advocacy Working Group
World Prematurity Day Primer

Premature birth means a baby is born too early. Babies aren’t fully developed until at least 39 weeks of pregnancy. It is known that the development of the brains, lungs and eyes occur in the last few weeks of pregnancy. Worldwide, one baby in ten is born premature: Every year, about 15 million children are born too early.  Thus, preterm babies represent the largest child patient group and their number continues to increase (1).

In order to promote awareness about preterm births, as well as the problems and risks on the development of the premature infant, various international organizations such as the March of Dimes and European Foundation for the Care of Newborn Infants (EFCNI) have declared November 17 as the World Prematurity Day.

The Preterm Problem

Key Facts

• Every year, an estimated 15 million babies are born preterm (before 37 completed weeks of gestation), and this number is rising.
• An estimated 1.1 million babies die annually from preterm birth complications.
• Preterm birth is the leading cause of newborn deaths (babies in the first four weeks of life) and the second leading cause of death after pneumonia in children under five years.
• Three-quarters of them could be saved with current, cost-effective interventions, even without intensive care facilities.
• Across 184 countries, the rate of preterm birth ranges from 5% to 18% of babies born.

Preterm Birth and Associated Risks

• Preterm is defined as babies born alive before 37 weeks of pregnancy are completed. Over one million children die each year due to complications of preterm birth. 

• Many survivors face a lifetime of disability, including learning disabilities and visual and hearing problems.As these infants grow, they have a higher risk of learning and behavioural disabilities, cerebral palsy, sensory and motor deficits, infections, chronic respiratory and cardiovascular diseases or diabetes compared to their full term counterparts.

Causes

• Preterm birth occurs for a variety of reasons. Most preterm births happen spontaneously, but some are due to early induction of labor or caesarean birth, whether for medical or non-medical reasons.

• Common causes of preterm birth include multiple pregnancies, infections and chronic conditions, such as diabetes and high blood pressure; however, often no cause is identified. There is also a genetic influence. 

• Better understanding of the causes and mechanisms will advance the development of solutions to prevent preterm birth.   

Preterm Births: The Global Situation

• Over 60% of preterm births occur in Africa and south Asia, but preterm birth is truly a global problem.

• Preterm births are higher in low-income countries. In the poorest countries, on average, 12% of babies are born too soon compared with 9% in higher-income countries. 

•  Within countries, poorer families are at higher risk.

• Inequalities in survival rates around the world. In low-income settings, half of the babies born at 32 weeks (two months early) die due to a lack of feasible, cost-effective care, such as warmth, breastfeeding support, and basic care for infections and breathing difficulties. In high-income countries, almost all of these babies survive.

The 10 countries with the greatest number of preterm births:

    India: 3 519 100
    China: 1 172 300
    Nigeria: 773 600
    Pakistan: 748 100
    Indonesia: 675 700
    The United States of America: 517 400
    Bangladesh: 424 100
    The Philippines: 348 900
    The Democratic Republic of the Congo: 341 400
    Brazil: 279 300

Preterm Births in the Philippines

The preterm birth problem in the Philippines  is alarming. Our country was listed in the Top 10 countries with the greatest number of preterm births (Rank #8) in the Global Action Report on Preterm Birth. The preterm birth rate in the country is almost 15% which correspond to 348,900 preterm newborns. Deaths from complications were more than 12,000 annually.

The Status of the Philippines on the Global Action Report on Preterm Birth
http://www.marchofdimes.com/mission/globalpreterm.html

What can we do?

Solutions

• More than three-quarters of premature babies can be saved with feasible, cost-effective care.
• antenatal steroid injections (given to pregnant women at risk of preterm labour to strengthen the babies’ lungs)
• kangaroo mother care (the baby is carried by the mother with skin-to-skin contact and frequent breastfeeding)
• antiseptic cream for the umbilical cord, and antibiotics to treat newborn infections – even without the availability of neonatal intensive care.

 

Born Too Soon: Kangaroo Mother Care Saves Preterm Babies from Save the Children on Vimeo.

• Over the past decade, some countries have halved deaths due to preterm birth by ensuring that health workers are skilled in the care of premature babies and by improving supplies of life-saving commodities and equipment.

•  To reduce preterm birth rates, women – especially adolescents – need better access to family planning and increased empowerment, as well as improved care before, between and during pregnancies.

• If a pregnancy is healthy, it’s best to let labor begin on its own instead of scheduling a delivery.  Induction or caesarean birth should not be planned before 39 completed weeks unless medically indicated. Babies born after 39 weeks have fewer health problems than babies born early.

• Mom’s health is the best indicator of her baby’s health. Early and regular prenatal care is very important to monitor mom and baby to identify problems before they become serious.

• Every mom-to-be should know the signs of preterm labor and what to do if they occur.  

Raise Awareness. Despite the high number and the risks involved, the public is only hardly aware of the prevention of preterm birth and the problems and risks involved in the development of a preterm infant.

The following are the recommended status updates by March of Dimes:

• I honor the million babies born too soon worldwide who died this year and the 12 million more struggling to survive. Join me on World Prematurity Day at http://on.fb.me/j8AcLi

• On World Prematurity Day, I honor the 1 million babies born too soon worldwide who died this year.

References:

[1] European Foundation for the Care of Newborn Infants (EFCNI) website. www.efcni.org 

[2] WHO Fact Sheet No. 363 . May 2012. Preterm Births.http://www.who.int/mediacentre/factsheets/fs363/en/index.html

[3] Global Action Report on Preterm Birth. http://www.marchofdimes.com/mission/globalpreterm.html