Maternal, newborn, child and adolescent health

Care of the preterm and low-birth-weight newborn

World Prematurity Day - "Let them thrive"

A preterm baby fed from a plastic cup by its mother.

17 November 2017 -- World Prematurity Day is an opportunity to call attention to the heavy burden of death and disability and the pain and suffering that preterm birth causes, as well as a chance to talk about solutions. This year the theme is "Let them thrive," focusing on quality, equity and dignity. On this day, WHO, UNICEF and PATH have released a policy statement on ensuring equitable access to human milk for all infants

Preterm births rising globally

An estimated 15 million babies are born preterm every year – more than 1 in 10 babies around the world and this number is rising. Preterm birth complications are the leading cause of death for children under 5, causing an estimated 1 million deaths in 2015 globally. Many survivors of preterm birth face a lifetime of disability, including learning disabilities and visual and hearing problems.

Preterm birth (born before 37 weeks of pregnancy) and being small for gestational age, which are the reasons for low-birth-weight (LBW), are also important indirect causes of neonatal deaths. LBW contributes to 60% to 80% of all neonatal deaths. The global prevalence of LBW is 15.5%, which amounts to about 20 million LBW infants born each year, 96.5% of them in developing countries.

Countries can reduce their neonatal and infant mortality rates by improving the care for the mother during pregnancy and childbirth and of LBW infants. Experience from developed and low- and middle-income countries has clearly shown that appropriate care of LBW infants, including their feeding, temperature maintenance, hygienic cord and skin care, and early detection and treatment of infections and complications including respiratory distress syndrome can substantially reduce mortality.

WHO's recommendations focus on 3 areas

Midwife-led continuity of care

The WHO Recommendations on antenatal care for a positive pregnancy experience (2016) recommend midwife-led continuity of care (MLCC) models, where one midwife, or a group of midwives working together, provides care to a woman, newborn and her family throughout the antenatal, intrapartum and postnatal continuum. This differs from “medical-led” care, or care that is “shared” between medical staff and midwives.

MLCC is associated with improved outcomes for the majority of women and babies at low risk of developing complications and has been shown to reduce the risk of prematurity by around 24%.

Women are more likely to experience spontaneous vaginal birth; experience fewer interventions including episiotomies and instrumental births and are more likely to be satisfied with their care.

MLCC requires a well-functioning midwifery programme and should be provided by midwives who are educated, trained, licensed, and regulated. Access to emergency obstetric and neonatal care, either at the health facility or though transport to a referral centre, is prerequisite.

Kangaroo Mother Care

Kangaroo Mother Care is a method of care of preterm infants, particularly those weighing less than 2 kg. It includes exclusive and frequent breastfeeding in addition to skin-to-skin contact and support for the mother-infant dyad, and has been shown to reduce mortality in hospital-based studies in low- and middle-income countries. The WHO document Kangaroo mother care: a practical guide provides guidance on how to organize services in health facilities and on what is needed to provide effective Kangaroo Mother Care.

WHO is currently coordinating clinical trials on Kangaroo Mother Care.

Specific clinical interventions

WHO recommendations on interventions to improve preterm birth outcomes provides specific recommendations for interventions during pregnancy, labour and during the newborn period that are aimed at improving outcomes for preterm infants. The guidelines include interventions provided to the mother – for example steroid injections before birth, antibiotics when her water breaks before the onset of labour, and magnesium sulfate to prevent future neurological impairment of the child, as well as interventions for the newborn baby – for example thermal care, feeding support, (e.g. kangaroo mother care, when babies are stable), safe oxygen use, and other treatments to help babies breathe more easily.

Optimal feeding of low-birth-weight infant contains recommendations on what to feed, when to feed and how to feed a LBW newborn.

What is WHO doing to improve the care of babies who are born preterm?

WHO strongly advocates for skilled care at every birth, which is the foundation for all good care for preterm babies. WHO also promotes essential newborn care for all babies, and has developed clinical guidelines and training tools for this purpose. In addition, WHO promotes basic newborn resuscitation, which has helped to make resuscitation broadly available in developing countries.

In May 2012, WHO and partners - The Partnership for Maternal, Newborn & Child Health, Save the Children, and the March of Dimes - published a report Born Too Soon: The global action report on preterm birth that included the first ever estimates of preterm birth by country. New estimates will be released by WHO in 2018. In 2014 WHO Member States endorsed the Every Newborn: An action plan to end preventable deaths.

WHO is working to reduce the health problems and lives lost as a result of preterm birth with the following specific actions:

  • working with countries and partners to implement the Every Newborn: An action plan to end preventable deaths adopted in May 2014 in the framework of the UN Secretary-General’s Global Strategy for Women’s, Children’s and Adoelscents' Health (2016-30);
  • working with countries to strengthen the availability and quality of data on preterm births;
  • providing updated analyses of global preterm birth levels and trends every 3 to 5 years;
  • working with partners around the world to conduct research into the causes of preterm birth, and test effectiveness and delivery approaches for interventions to prevent preterm birth and treat babies that are born preterm;
  • regularly updating clinical guidelines for the management of pregnancy and mothers with preterm labour or at risk of preterm birth, and those on the care of preterm babies, including Kangaroo Mother Care, feeding babies with low birth weight, treating infections and respiratory problems, and home-based follow-up care (see WHO Recommendations on interventions to improve preterm outcomes 2015);
  • developing tools to improve health workers’ skills and assess the quality of care provided to mothers at risk of preterm delivery and preterm babies; and
  • supporting countries to implement WHO's antenatal care guidelines, aimed at reducing the risk of negative pregnancy outcomes, including preterm births, and ensuring a positive pregnancy experience for all women.