Born Too Soon: Care for the preterm baby

Abstract

As part of a supplement entitled "Born Too Soon", this paper focuses on care of the preterm newborn. An estimated 15 million babies are born preterm, and the survival gap between those born in high and low income countries is widening, with one million deaths a year due to direct complications of preterm birth, and around one million more where preterm birth is a risk factor, especially amongst those who are also growth restricted. Most premature babies (>80%) are between 32 and 37 weeks of gestation, and many die needlessly for lack of simple care. We outline a series of packages of care that build on essential care for every newborn comprising support for immediate and exclusive breastfeeding, thermal care, and hygienic cord and skin care. For babies who do not breathe at birth, rapid neonatal resuscitation is crucial. Extra care for small babies, including Kangaroo Mother Care, and feeding support, can halve mortality in babies weighing <2000 g. Case management of newborns with signs of infection, safe oxygen management and supportive care for those with respiratory complications, and care for those with significant jaundice are all critical, and are especially dependent on competent nursing care. Neonatal intensive care units in high income settings are de-intensifying care, for example increasing use of continuous positive airway pressure (CPAP) and this makes comprehensive preterm care more transferable. For health systems in low and middle income settings with increasing facility births, district hospitals are the key frontier for improving obstetric and neonatal care, and some large scale programmes now include specific newborn care strategies. However there are still around 50 million births outside facilities, hence home visits for mothers and newborns, as well as women's groups are crucial for reaching these families, often the poorest. A fundamental challenge is improving programmatic tracking data for coverage and quality, and measuring disability-free survival. The power of parent's voices has been important in high-income countries in bringing attention to preterm newborns, but is still missing from the most affected countries.DeclarationThis article is part of a supplement jointly funded by Save the Children's Saving Newborn Lives programme through a grant from The Bill & Melinda Gates Foundation and March of Dimes Foundation and published in collaboration with the Partnership for Maternal, Newborn and Child Health and the World Health Organization (WHO). The original article was published in PDF format in the WHO Report "Born Too Soon: the global action report on preterm birth" (ISBN 978 92 4 150343 30), which involved collaboration from more than 50 organizations. The article has been reformatted for journal publication and has undergone peer review according to Reproductive Health's standard process for supplements and may feature some variations in content when compared to the original report. This co-publication makes the article available to the community in a full-text format.

Critical analyses of the implications of Kangaroo Mother Care on a preterm infant

“…There are many causes, but all have the same result. These tiny fragile babies all need specialist care in a highly technical environment in order to survive and grow to reach the weight and maturity they would have had as full term babies (Lawn et al 2013). …”

“Empeng” Efektif Menurunkan Nyeri Bayi saat Pengambilan Darah Vena

“…BBLR terpapar berbagai stressor selama perawatan di ruang intensif seperti prosedur yang menimbulkan nyeri dan ketidaknyamanan, kebisingan, pencahayaan yang berlebih, perpisahan dengan ibu, dan gangguan tidur. Lingkungan perawatan tersebut akan berkontribusi terhadap kualitas kehidupan BBLR di masa depan (Lawn, Davidge, Paul, Xylander, Johnson, et al, 2013).…”

Neurodevelopment, Nutrition, and Inflammation: The Evolving Global Child Health Landscape

“…28 Although multifactorial in origin, prematurity risks include maternal undernutrition, micronutrient deficiencies, as well as subclinical infections and inflammation; these risks may vary in different populations and are affected by genetic influences. Given the prevalence of prematurity in the United States and globally, it is fortunate that some progress on solutions to the health care of such children worldwide has been made, 29 such as with recently developed nutritional guidelines for preterm infants. 30 • Nutrition: Malnutrition, including both undernutrition and overnutrition, clearly has implications for all aspects of child development.…”