November 17th is World Prematurity Day and the entire month of November is Prematurity Awareness Month in the United States. One in ten babies arrive before 37 weeks.  A baby born before 37 weeks is considered a preterm infant and may require additional care and support.  As expected, the more premature an infant is, the more assistance they will require after birth.  The possibility of long-term adverse health outcomes and life-long disabilities also increases.  World Prematurity Day hopes to raise awareness for the challenges of preterm birth and shine a light on the risks and consequences faced by preterm infants and their families worldwide.

The impact of the COVID-19 pandemic has caused neonatal units worldwide to adopt strict safety measures that unfortunately often separated parents from their preterm babies in the neonatal unit, with detrimental consequences for babies and parents alike.  The theme of the 2021 World Prematurity Day is Zero Separation - Act Now! Keep parents and babies born too soon together.  Every parent should have the right to unrestricted access to their babies in hospital, no matter where and when.  Healthcare systems need to find ways to balance the needs of babies born too soon, too small, or too sick and their families with the requirements to keep hospitals running and the staff safe during the pandemic. Research indicates already that the risks caused by separation of parents and infants in NICUs effectively cancel out any gains in safety and security from a possible infection with COVID-19.

Here are some definitions from the World Health Organization (WHO) that you may find helpful:

• Late preterm identifies a baby born between 32 and 37 weeks of pregnancy
• Very preterm refers to babies born between 28 and 32 weeks of pregnancy
• Extremely preterm indicates the baby was born before 28 weeks of pregnancy

Globally, more than 15 million babies are born prematurely.  The long-term health outcomes of each premature baby are very dependent on where they were born.  Babies born early in low or under-resourced countries have much lower rates of survival than those premature babies born in high-resource countries. More than 90% of extremely preterm babies (less than 28 weeks) born in low-income countries die within the first few days of life; yet less than 10% of extremely preterm babies die in high-income settings.

The rates of preterm birth are increasing globally.  In the 184 countries with adequate data collection the rates of preterm birth ranges from 5% to 18% of all babies born.  It is thought that the possible reasons for this increase include better measurement, increases in maternal age and underlying maternal health problems such as diabetes and high blood pressure, greater use of infertility treatments leading to increased rates of multiple pregnancies, and changes in obstetric practices such as more cesarean births before term.

For children under the age of five, premature birth is the leading cause of death.  More than one million deaths are attributed to premature birth annually. 75% of those deaths could be prevented if current interventions were available to all facilities.

Feasible, cost-effective care that can be provided to the newborn or the parent or both can help reduce the number of deaths.  This care includes:

• Administration of antenatal steroid injections for people at risk of preterm labor
• Kangaroo care for the premature baby with their birth parent
• Frequent breast/chestfeeding or access to human milk
• Antibiotics to treat newborn infections

It has also been shown that access to effective midwifery services across the globe could reduce the risk of prematurity by 24%.  Effective midwifery led care includes:

• counseling on healthy diet and optimal nutrition, and tobacco and substance use
• fetal measurements including use of ultrasound to help determine gestational age and detect multiple pregnancies
• a minimum of eight contacts with health professionals throughout pregnancy to identify and manage other risk factors, such as infections
• Increased and more accessible access to contraceptives and increased empowerment could also help reduce preterm births

The World Health Organization has issued recommendations for perinatal professionals to assist them in improving preterm birth outcomes that can be accessed here.

Childbirth educators and other perinatal professionals can encourage pregnant people to receive regular prenatal care, and encourage them to ask their providers of any risks they may have for premature birth.  Also, encourage families to seek help if they suspect that something has changed during their pregnancy that may increase their risk of having a premature baby or if they notice signs of labor or other concerns before term.

References

Blencowe H, Cousens S, Oestergaard M, Chou D, Moller AB, Narwal R, Adler A, Garcia CV, Rohde S, Say L, Lawn JE. National, regional and worldwide estimates of preterm birth. The Lancet, June 2012. 9;379(9832):2162-72. Estimates from 2010.

Liu L, Oza S, Hogan D, Chu Y, Perin J, Zhu J, et al. Global, regional, and national causes of under-5 mortality in 2000-15: an updated systematic analysis with implications for the Sustainable Development Goals. Lancet. 2016;388(10063):3027-35.

Kostenzer J, Hoffmann J, von Rosenstiel-Pulver C, Walsh A, Zimmermann LJI, Mader S; COVID-19 Zero Separation Collaborative Group. Neonatal care during the COVID-19 pandemic - a global survey of parents' experiences regarding infant and family-centred developmental care. EClinicalMedicine. 2021 Aug 6;39:101056. doi: 10.1016/j.eclinm.2021.101056. PMID: 34401688; PMCID: PMC8355909.

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