About 13.4 million babies — or one in 10 of all births — were born preterm (that is, before 37 weeks of pregnancy) in 2020, says a new study by the United Nations.
The study has been authored by researchers from the World Health Organization (WHO), the United Nations Children’s Fund (UNICEF) and the London School of Hygiene and Tropical Medicine.
“These numbers show an urgent need for serious investment in services available to support them and their families as well as a greater focus on prevention — in particular ensuring access to quality health care before and during every pregnancy,” Dr Anshu Banerjee, director of maternal, newborn, child and adolescent health and ageing at WHO, said in a press release.
Dr Suman Rao, professor and head, department of neonatology, St John’s Medical College, Bangalore, and part of the WHO’s Immediate Kangaroo Mother Care Study Group, told Happiest Health that while the incidence of prematurity has been high for a very long time, the biggest concern is that the decline in neonatal mortality rate (NMR) is very slow.
Regions with highest preterm births
According to the study, no significant stride has been made in reducing the number of premature births globally. Between 2010 and 2020, the annual global rate of reduction in preterm births was just 0.14%.
Out of the total number of premature births in 2020, about 65% occurred in sub-Saharan Africa and southern Asia. India recorded the highest number of preterm births (3.02 million), accounting for over 20% of total global figure.
The highest preterm birth rate in southern Asia was recorded in Bangladesh (16.2%) and Pakistan (14.3) — three to four times higher than the rates in least-affected countries like Serbia (3.8%), Moldova (4%) and Kazakhstan (4.7%).
Types of premature births
Dr Karthik Nagesh, head of department and consultant, neonatology pediatrics, Manipal Hospitals, Old Airport Road, Bangalore, told Happiest Health there are three categories of preterm births: late preterm (born between 34 and 37 weeks), moderate preterm (30-34 weeks) and extreme preterm (less than 30 weeks). The complications depend on the level of prematurity.
“Extreme premature babies face the worst complications,” he said, adding that one of the most common issues is severe breathing difficulty.
“Their lungs are not well-formed, and they experience respiratory distress syndrome. Unfortunately, they succumb if they are not given enough respiratory support. Their lungs are deficient in a substance known as surfactant which doesn’t allow the lungs to expand. Therefore, they may need ventilation and respiratory support soon after birth, including non-invasive ventilation modes like CPAP (continuous positive airway pressure). Sometimes, these babies may be administered surfactant through the windpipe so their lungs open up.”
Complications faced by preterm babies
Other complications faced by these babies include heart and kidney problems and a higher risk of infections.
“Because of the delicate nature of the blood vessels in their head, preterm babies can sometimes develop blood clots in the brain. Some of them also develop severe neonatal jaundice,” said Dr Nagesh.
He said that moderate preterm babies may have a lesser degree of these complications.
“Although their weight is higher, they may require respiratory support soon after birth and may also go through milder versions of the same problems,” he added. “Late-preterm babies, which is a very large number, may have fewer respiratory problems. But they can develop dehydration, don’t feed well and have jaundice.”
According to the study, preterm babies who survive are also more likely to suffer major illnesses, disability, developmental delays and chronic diseases such as diabetes and cardiovascular diseases later on.
Managing preterm births: Strengthen neonatal care
The authors of the study said that since preterm birth is the leading cause of death in children’s early years, there is an urgent need to strengthen neonatal care as well as improve maternal health and nutrition.
The study pointed to adolescent pregnancies, infections during pregnancies, poor nutrition during pregnancy and pre-eclampsia during pregnancy as some of the major maternal health risks linked to preterm births.
Dr Nagesh said, “If there is a high-risk pregnancy, which is likely to lead to a premature delivery, the mother should be given good antenatal care,”
Dr Rao added that it is possible to slightly bring down prematurity if one can identify high-risk pregnancies right at the beginning or give progesterone to mothers who are at risk for high-risk pregnancy, etc.
“However, the biggest intervention that will make a difference is dating early — as soon as you’ve missed a period, go and date your pregnancy so you’re clear on the gestational age,” she said. “Another big gamechanger when it comes to reducing neonatal mortality is antenatal corticosteroids. If there is a high possibility of delivering a premature baby, giving two shots of steroids to the mother reduces the risk of mortality tremendously.
“Another significant intervention is care at birth. These babies are fragile and require extra care, so ensure that you deliver at least in a secondary or a tertiary level healthcare facility with neonatal ICU.”
Dr Rao recommended kangaroo mother care, a form of skin-to-skin care for preterm and low birthweight babies. “It can reduce mortality straightaway by 40-50%,” she said.
According to a report by experts from the WHO, UNICEF and the London School of Hygiene and Tropical Medicine, one in 10 babies was born preterm in 2020. The report, which has been published in the Lancet, highlights poor maternal health and nutrition as major causes for the high number of preterm births.