Preterm births in countries with a very high human development index – Authors' reply

Chang, Hsie-Chia; Larson, Jim; Blencowe, Hannah; Spong, C. Y.; Simpson, Joe Leigh; Lawn, Joy E

doi:10.1016/s0140-6736(13)60878-8

Cited by 7 publications

(6 citation statements)

References 4 publications

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“…This systematic analysis of ACS use in 11 high-burden countries, which together account for over half of maternal and newborn deaths, has identified commonly experienced health system bottlenecks to scaling up ACS for management of preterm birth. A comprehensive approach to preterm birth should include strategies for prevention as well as management; however, the menu for high-impact, evidence-based preterm birth prevention is currently limited [ 26 ]. In high-income settings, reductions in the burden of preterm birth can largely be traced to improved care of preterm infants, which has yet to achieve major traction or wide-scale use even for simpler care such as feeding support, kangaroo mother care and infection prevention and treatment [ 27 ].…”

Section: Discussionmentioning

confidence: 99%

Antenatal corticosteroids for management of preterm birth: a multi-country analysis of health system bottlenecks and potential solutions

Liu¹,

Segrè²,

Gülmezoglu

et al. 2015

BMC Pregnancy Childbirth

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BackgroundPreterm birth complications are the leading cause of deaths for children under five years. Antenatal corticosteroids (ACS) are effective at reducing mortality and serious morbidity amongst infants born at <34 weeks gestation. WHO guidelines strongly recommend use of ACS for women at risk of imminent preterm birth where gestational age, imminent preterm birth, and risk of maternal infection can be assessed, and appropriate maternal/newborn care provided. However, coverage remains low in high-burden countries for reasons not previously systematically investigated.MethodsThe bottleneck analysis tool was applied in 12 countries in Africa and Asia as part of the Every Newborn Action Plan process. Country workshops involved technical experts to complete the survey tool, which is designed to synthesise and grade health system "bottlenecks", factors that hinder the scale up, of maternal-newborn intervention packages. We used quantitative and qualitative methods to analyse the bottleneck data, combined with literature review, to present priority bottlenecks and actions relevant to different health system building blocks for ACS.ResultsEleven out of twelve countries provided data in response to the ACS questionnaire. Health system building blocks most frequently reported as having significant or very major bottlenecks were health information systems (11 countries), essential medical products and technologies (9 out of 11 countries) and health service delivery (9 out of 11 countries). Bottlenecks included absence of coverage data, poor gestational age metrics, lack of national essential medicines listing, discrepancies between prescribing authority and provider cadres managing care, delays due to referral, and lack of supervision, mentoring and quality improvement systems.ConclusionsAnalysis centred on health system building blocks in which 9 or more countries (>75%) reported very major or significant bottlenecks. Health information systems should include improved gestational age assessment and track ACS coverage, use and outcomes. Better health service delivery requires clarified policy assigning roles by level of care and cadre of provider, dependent on capability to assess gestational age and risk of preterm birth, and the implementation of guidelines with adequate supervision, mentoring and quality improvement systems, including audit and feedback. National essential medicines lists should include dexamethasone for antenatal use, and dexamethasone should be integrated into supply logistics.

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Section: Discussionmentioning

confidence: 99%

Antenatal corticosteroids for management of preterm birth: a multi-country analysis of health system bottlenecks and potential solutions

Liu¹,

Segrè²,

Gülmezoglu

et al. 2015

BMC Pregnancy Childbirth

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“…Preterm birth (PTB) (<37 weeks of gestation) is the leading cause of neonatal morbidity and mortality. In developed countries, the incidence of preterm delivery varies between 7 and 12% . This rate is higher in developing countries where there is limited availability of neonatal care and there are poorer clinical outcomes .…”

Section: Introductionmentioning

confidence: 99%

Prevention of preterm delivery with vaginal progesterone in women with preterm labour (4P): randomised double‐blind placebo‐controlled trial

Tejada

Karolinski

Ocampo

et al. 2014

BJOG

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Objective To evaluate the effectiveness of 200 mg of daily vaginal natural progesterone to prevent preterm birth in women with preterm labour.Design Multicentre, randomised, double-blind, placebo-controlled trial.Setting Twenty-nine centres in Switzerland and Argentina.Population A total of 385 women with preterm labour (24 0/7 to 33 6/7 weeks of gestation) treated with acute tocolysis.Methods Participants were randomly allocated to either 200 mg daily of self-administered vaginal progesterone or placebo within 48 hours of starting acute tocolysis.Main outcome measures Primary outcome was delivery before 37 weeks of gestation. Secondary outcomes were delivery before 32 and 34 weeks, adverse effects, duration of tocolysis, re-admissions for preterm labour, length of hospital stay, and neonatal morbidity and mortality. The study was ended prematurely based on results of the intermediate analysis.

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“…Preterm birth, defined as birth before 37 weeks gestation, is a major cause of death and significant morbidities in children [1,2]. Global studies show that approximately 10% of all newborns are born premature [3,4], with substantial developmental disorders and chronic diseases occurring in later life [5–7].…”

Section: Introductionmentioning

confidence: 99%

Intermittent hypoxia suppression of growth hormone and insulin-like growth factor-I in the neonatal rat liver

Cai

Ahmad

Valencia

et al. 2018

Growth Hormone & IGF Research

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Objectives Extremely low gestational age neonates with chronic lung disease requiring oxygen therapy frequently experience fluctuations in arterial oxygen saturation or intermittent hypoxia (IH). These infants are at risk for multi-organ developmental delay, reduced growth, and short stature. The growth hormone (GH)/insulin-like growth factor-I (IGF-1) system, an important hormonal regulator of lipid and carbohydrate metabolism, promotes neonatal growth and development. We tested the hypothesis that increasing episodes of IH delay neonatal growth by influencing the GH/IGF-I axis. Design Newborn rats were exposed to 2, 4, 6, 8, 10, or 12 hypoxic episodes (12% O2) during hyperoxia (50% O2) from P0-P7, P0-P14 (IH), or allowed to recover from P7-P21 or P14-P21 (IHR) in room air (RA). RA littermates at P7, P14, and P21 served as RA controls; and groups exposed to hyperoxia only (50% O2) served as zero IH controls. Histopathology of the liver; hepatic levels of GH, GHBP, IGF-I, IGFBP-3, and leptin; and immunoreactivities of GH, GHR, IGF-I and IGF-IR were determined. Results Pathological findings of the liver, including cellular swelling, steatosis, necrosis and focal sinusoid congestion were seen in IH, and was particularly severe in the P7 animals. Hepatic GH levels were significantly suppressed in the IH groups exposed to 6–12 hypoxic episodes per day and were not normalized during IHR. Deficits in the GH levels were associated with reduced body length and increase body weight during IHR suggesting increased adiposity and catchup fat. Catchup fat was also associated with elevations in GHBP, IGF-I, leptin. Conclusions IH significantly impairs hepatic GH/IGF-1 signaling during the first few weeks of life, which is likely responsible for hepatic GH resistance, increased body fat, and hepatic steatosis. These hormonal perturbations may contribute to long-term organ and body growth impairment, and metabolic dysfunction in preterm infants experiencing frequent IH and/or apneic episodes.

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Preterm births in countries with a very high human development index – Authors' reply

Cited by 7 publications

References 4 publications

Antenatal corticosteroids for management of preterm birth: a multi-country analysis of health system bottlenecks and potential solutions

Antenatal corticosteroids for management of preterm birth: a multi-country analysis of health system bottlenecks and potential solutions

Prevention of preterm delivery with vaginal progesterone in women with preterm labour (4P): randomised double‐blind placebo‐controlled trial

Intermittent hypoxia suppression of growth hormone and insulin-like growth factor-I in the neonatal rat liver

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