Why Don’t We Talk About Premature Birth?

Preterm birth is the leading cause of death in children under the age of five. Each year, about 15 million babies worldwide are born prematurely, that is about 1 in 10 children.

Preterm birth complications are the leading cause of death among children under 5 years of age, responsible for approximately 1 million deaths.

What is Prematurity?

A baby is termed ‘preterm’ when it is born ahead of 37 weeks of pregnancy. There are subcategories of preterm birth, based on gestational age, with risk of death, morbidity, and disability proportionate to the level of prematurity: moderate to late preterm (32 to 37 weeks), very preterm (28 to 32 weeks), and extremely preterm (less than 28 weeks).

Incidence and Trends of Prematurity

Preterm birth is the leading cause of death in children under the age of five; each year, about 15 million babies worldwide are born prematurely, that is about 1 in 10 children. Out of 15 million 3.5 million babies are born every year in India. Countries with the largest numbers of preterm births include India, China, Nigeria, Pakistan, and the United States, demonstrating that preterm birth is a problem in all settings and an increase in preterm birth rates over the past 20 years.

Causes of Prematurity

Common causes of preterm birth include multiple pregnancies, infections, and chronic conditions such as diabetes and high blood pressure; however, often no cause is identified. There could also be a genetic influence.

Burden of Prematurity

Preterm birth complications are the leading cause of death among children under 5 years of age, responsible for approximately 1 million deaths. In low-income settings, most of the babies die due to a lack of feasible, cost-effective care, such as warmth, breastfeeding support, and basic care for infections and breathing difficulties. In high-income countries, only extremely premature babies may have some forms of impairment, while in low-and middle-income countries a large number of moderately preterm babies survive with disability due to suboptimal quality of care and challenges in access and use of technology for care, rehabilitation, and support.

Short and long-term problems of prematurity

Short-term problems are breathing-related, ventilatory support, Heart (PDA), apnoea (cessation of breathing), Infections, gut-related (NEC), eye-related (Retinopathy). Long-term problems depend on how delivery room management was done and the level of NICU care. These include developmental, social, and language, growth-related problems and oxygen-dependent lungs, etc.

Hope and the future

If we are treating a middle-aged person with a life-threatening disease, we are extending his/her life for the next 15-20 years, but here we are treating newborns and giving their whole life. Moreover, three-quarters of these deaths because of prematurity can be prevented with current, cost-effective measures and interventions which include essential care during childbirth and in the postnatal period to every mother and baby, with the provision of antenatal steroid injections (given to pregnant women at risk of preterm labor and under set criteria to strengthen the babies’ lungs), by providing kangaroo mother care (the baby is carried by the mother with skin-to-skin contact and frequent breastfeeding) and antibiotics to treat newborn infections.

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In India, preterm baby outcomes have been improved over the last decade. The neonatal mortality rate of India fell gradually from 84.4 deaths per thousand live births in 1970 to 21.7 deaths per thousand live births in 2019. In Rainbow Children’s Hospital, an extremely premature baby who was born at 24 weeks gestation, weighing 350 grams suffering from breathing difficulty and many other complications like feeding difficulties, multiple blood transfusions, and chronic lung disease was on a ventilator for almost 105 days. Finally, the baby was successfully managed and saved from all the emergencies with the help of a highly qualified and skilled team. It takes a lot to treat a little but still we don’t have to lose our hope as many of these conditions are treatable.