Care of the preterm and/or low-birth-weight newborn
Preterm birth is the most common direct cause of newborn mortality. Preterm birth and being small for gestational age (SGA), 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.
Interventions to improve care during pregnancy, childbirth and the postnatatal period as well as feeding are likely to improve the immediate and longer-term health and well-being of the individual infant and have a significant impact on neonatal and infant mortality at a population level. The series of documents on Integrated Management of Pregnancy and Childbirth (IMPAC) provide practice guidance to healthworkers, and the recent WHO guidelines Optimal feeding of low-birth-weight infant contain recommendations on what to feed, when to feed and how to feed a LBW newborn.
"Kangaroo mother care" is a method of care of preterm infants 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".
The Pocketbook for hospital care for children and Managing newborn problems aim to improve case management of severe complications of preterm birth in hospitals.
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.
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 to improve data on preterm births;
- analysing global preterm birth levels and trends every three to five years;
- working with partners to research the best ways of preventing preterm birth and caring for babies that are born preterm;
- updating clinical guidelines on the care of preterm babies, including kangaroo mother care, feeding babies with low birth weight, treating infections and breathing problems, and home-based follow-up care; and
- developing tools to improve health workers’ skills and assessing the quality of care provided to preterm babies.