Interventions for Pre-Term Infants

Neonatal mortality and illness remains a significant public health issue, especially in the Global South: as recently as 2019, neonatal mortality rates stood at 27 deaths per 1,000 live births in sub-Saharan Africa and 24 deaths per 1,000 live births in Central and Southern Asia. Children born in these countries are ten times more likely to die in their first month of life than children born in high-income countries.1  A recent multi-country prospective cohort study conducted by the Alliance for Maternal and Newborn Health Improvement (AMANHI) found that pre-term birth complications are the third most-common cause of newborn deaths in south Asia (19 percent of neonatal deaths) and sub-Saharan Africa (24 percent).2 There are promising interventions for pre-term infants. Antenatal steroids accelerate fetal maturity and have been shown to reduce respiratory distress syndrome by 34 percent, cerebroventricular hemorrhage by 46 percent, and the risk of neonatal deaths by 31 percent. The administration of these steroids is also associated with reduced need for ventilation, making them a promising option for settings where intensive care is not accessible. A Lancet article from 2014 estimates that deaths caused by prematurity could be reduced by 58 percent by 2025 with the use of multiple interventions.3

 

One promising strategy for reducing pre-term infant mortality is “kangaroo mother care,” defined as continuous skin-to-skin contact with the chest of the mother or other caregiver along with feeding exclusively from breast milk.4 The 2014 Lancet article estimated that kangaroo mother care could decrease pre-term mortality by as much as 50 percent,3 and recent analyses have further emphasized the utility of the strategy. A study conducted in Ghana, India, Malawi, Nigeria, and Tanzania published in May 2021 compared strategies of delivering kangaroo mother care in infants with low birthweights (among them pre-term infants), who account for 70 percent of all neonatal deaths. WHO guidelines currently recommend that kangaroo mother care only be initiated in short, intermittent sessions until the infant’s condition has been stabilized, but the new study demonstrated that providing continuous kangaroo mother care soon after birth improved neonatal survival by 25 percent when compared to a control group that initiated kangaroo mother care after stabilization. The trial was stopped early by the data and safety monitoring board because the evidence of reduced mortality among infants receiving immediate kangaroo mother care proved to be so compelling.4

 

It is notable that the 2018 AMANHI study found that the leading causes of neonatal death in south Asia and sub-Saharan Africa are perinatal asphyxia and severe neonatal infections. This stands in contrast to reports from the previous 15 years indicating that these two conditions have been decreasing while deaths due to pre-term births have proportionally increased. The authors hypothesize that these differences could be due to incorrectly assigning “pre-term birth” as the cause of death for many infants who are born pre-term but do not actually die because of pre-term birth complications.2

 

The complications faced by newborns, especially in low-resource countries, are multifaceted and overlapping. Certain strategies can address multiple concerns: for example, antibiotics administered for pre-term, premature rupture of membranes have been shown to also reduce the risk of respiratory distress syndrome by 12 percent and early-onset postnatal infection by 39 percent.3 While the mortality rates for pre-term births can be reduced through multiple interventions, it is also important to promote efforts that reduce pre-term births overall. Maternal healthcare and education are especially important, as pregnancies in adolescents are more prevalent in many low-income countries and are associated with increased risks of pre-term birth.3 Achieving UN Sustainable Development Goals for reducing neonatal mortality will depend on a truly holistic approach to reproductive health, one incorporating both maternal and infant care.

 

References

 

  1. SDG Target 3.2. World Health Organization. https://www.who.int/data/gho/data/themes/topics/indicator-groups/indicator-group-details/GHO/sdg-target-3.2-newborn-and-child-mortality
  2. Alliance for Maternal and Newborn Health Improvement (AMANHI) mortality study group. Population-based rates, timing, and causes of maternal deaths, stillbirths, and neonatal deaths in south Asia and sub-Saharan Africa: a multi-country prospective cohort study. Lancet Glob Health. 2018;6(12):e1297-e1308.
  3. Bhutta ZA, Das JK, Bahl R, et al. Can available interventions end preventable deaths in mothers, newborn babies, and stillbirths, and at what cost? Lancet. 2014;384(9940):347-370.
  4. WHO Immediate KMC Study Group, Arya S, Naburi H, et al. Immediate “kangaroo mother care” and survival of infants with low birth weight. N Engl J Med. 2021;384(21):2028-2038.