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World Health Organisation’s new report indicated that around the world, 15 million babies are born prematurely each year, and one million of them die. Experts, warning that the numbers of preterm births
had increased globally in the last 20 years stated that many of the deaths could have been prevented, reports Sade Oguntola.
The birth of a child, which ordinarily should be a joyous experience, too often ends in death if such a child is born prematurely. Premature birth is the second greatest killer of babies worldwide — after pneumonia. A new report about premature delivery called “Born Too Soon” shows that globally, one in 10 babies is born prematurely.
Unfortunately, 1.1 million of such babies born prematurely die every year, the majority occuring shortly after their birth. Others survive, but suffer disabilities for the rest of their lives, affecting their health, nervous system or ability to access education.
The report stating that the cost of babies being born too soon to families and society was huge, said that still yet many of the preterm babies who die could survive if they had access to existing, relatively inexpensive treatments.
More than 100 experts from 40 United Nations agencies, universities and other organisations contributed to the report, which was published by the March of Dimes. These are World Health Organisation, Partnership for Maternal, Newborn and Child Health and Save the Children. It stated what exactly is known about preterm birth, its causes, and the kinds of care that are needed.
According to the report, all but two of the 11 countries with the highest levels of premature birth of over 15 per cent are in sub-Saharan Africa. While 12 per cent of babies in low-income countries are born too soon, only nine per cent are in richer countries. But the United States and Brazil have similar levels of premature birth to many poorer countries.
More than one in nine of births in the United States are preterm, a rate of around 12 per cent. And that is even after preterm birth rates in the U.S. have declined for four consecutive years.
India has the highest number of premature births, at more than 3.5 million, while China recorded nearly 1.2 million, followed by Nigeria, Pakistan and Indonesia, with figures around 700,000. But calculating the rate of preterm births per 100 births instead of per country, the list was dominated by sub-Saharan African countries. It was topped by Malawi, Comoros and Congo and Zimbabwe. Malawi recorded 18.1 premature births per 100 live births. Kenya had 12 preterm births out of every 100 births, whereas Uganda recorded a rate of 13 preterm births out of every 100 births.
For the purpose of the report, preterm birth was considered as occurring before 37 weeks. But research continues to show that a healthy baby requires 39 weeks of gestation to ensure that the brain, liver and lungs are fully developed.
Although European countries featured on the list of countries with the lowest rates of preterm births, with some of the lowest rates recorded in Belarus, Latvia, and Lithuania and Estonia, experts alerted that in all but three countries, preterm birth rates increased in the last 20 years, an indication that the numbers of preterm births are increasing globally.
The report, which highlighted the dramatic survival gap between low-income and high-income countries for babies born before 28 weeks, indicated that in low-income countries, more than 90 per cent of extremely preterm babies die within the first few days of life, while less than 10 per cent die in high-income countries.
But preterm births in lower income countries are linked to health problems like malaria, HIV and high adolescent pregnancy rates. Those in richer countries are linked to higher number of older mothers, and the use of fertility treatments.
The United States, for example, had a unique combination of teenage pregnancies and women over 35 giving birth to twins, triplets or more after in-vitro fertilisation, with these babies deliberately delivered early by caesarean section according to the study. Added to the number are premature births due to complications from obesity, diabetes, high blood pressure, smoking and lack of early prenatal care.
Unfortunately, prematurity is not accorded much importance as other diseases such as breast cancer and AIDS. Yet more than 40 per cent of deaths of children less than five years of age are associated with preterm birth and why it happens remains a mystery in many cases.
Conversely, research has it that being born prematurely may carry some risk on cognitive abilities such as memory and attention. Researchers found that when tested in early adulthood, people who were born extremely premature — with a birth weight of less than 3.3 lbs. — generally scored lower on tests of executive function than babies born full-term. On IQ tests, adults who were born premature scored 8.4 points lower on average than those who were born full-term.
No doubt, preterm infants have a higher risk of dying in the first few years of life. But their risk of dying does not wane over time. A research published in the Journal of the American Medical Association, which looked at 674,000 Swedish babies born between 1973 and 1979 and tracked them until they were between 29 and 36 years old, indicated that preterm infants had a 59 per cent increased risk of death in early childhood (between ages one and five), compared with babies born later. They succumbed to congenital anomalies, mostly heart defects as well as respiratory and endocrine problems.
Nonetheless, medical experts suggested that women can reduce their risk of complications associated with pregnancy, including premature delivery by starting her prenatal care early and attend all of her prenatal care visits. This allows close monitoring of the progress of her pregnancy, and any problem that may arise can be addressed timely.
A woman who previously had a preterm delivery, who reports early for prenatal care can avail herself medical treatments that are appropriate for her to consider during her current pregnancy, such as progesterone, to prevent a repeat premature birth.
In addition, pregnant women should also attempt to manage the stress in their lives. Pregnant women can cope better with their stress if they are healthy and fit.
Eating a healthy diet, getting plenty of sleep and avoidance of alcohol, cigarettes and drugs are equally important to ensure a healthy pregnancy and baby. Exercise helps to keep pregnant women fit, prevent some common discomforts of pregnancy, such as backache, fatigue and constipation and relieves stress.
However, the report’s recommendations to prevent preterm birth include provision of family planning to all women universally because teen pregnancy and improper birth spacing are risk factors for preterm birth; strengthening of health services before and between pregnancies to ensure that mothers enter pregnancy as healthy as possible and the need to improve basic care for pregnant women worldwide, with better-trained birth attendants and access to antibiotics and emergency obstetric care.
While stating the need for increased investment in research into the causes of preterm birth, to ensure reduction in deaths of babies born too early, they advocated for the skin-to-skin kangaroo care, which helps newborns stay warm and the promotion of breast-feeding.
In addition, it stated that universal availability of corticosteroids to women in preterm labour would help their babies’ lungs mature. Corticosteroids are very cheap and cost effective intervention that can ensure that no less than 400,000 babies are saved by 2015.