Every year 15 million children are born preterm (before the 37th week of gestation) and this number is increasing. Complications of preterm deliveries were responsible for about 1 million deaths in 2015.
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Premature children often die or suffer from serious illnesses in the neonatal period. Without appropriate treatment, survivors have an increased risk of permanent disability and poor quality of life. Complications of preterm birth are the leading cause of neonatal death and the second most common cause of death in children under the age of 5.
Death and morbidity related to preterm birth can be reduced through interventions on the mother, before or during pregnancy, and on the premature infant after birth. Interventions can be directed at all women and included in primary prevention programmes to reduce the risk of preterm births (e.g. tobacco control and healthy eating programmes) or adopted to minimize possible complications in pregnant women with known risk factors.
The most effective interventions that could improve the chances of survival of newborns and the long-term outcomes of preterm delivery are those on the mother when preterm delivery seems inevitable. These include the prophylaxis of the antenatal corticosteroid, the administration of magnesium sulfate for fetal neurological protection, the use of antibiotics in case of labor with rupture of membranes. These interventions focus on pregnancy and the situation of imminent childbirth, with the aim of overcoming the immediate and future difficulties of the premature infant.
Specific support for premature infants is essential to avoid or treat potential complications and avoid chronic disabilities. The most common interventions concern the use of thermal cradle, positive pressure ventilation in case of respiratory distress, oxygen therapy.
The World Health Organization (WHO) has long been committed to reducing child mortality. One of the objectives is to urgently address the problems associated with preterm births at a global level. The WHO has published some guidelines on the subject, including WHO recommendations on interventions to improve preterm birth outcomes and Managing complications in pregnancy and childbirth: a guide for midwives and doctors - 2nd ed.
The WHO is currently coordinating two clinical studies, called WHO ACTION Trials (Antenatal Corticosteroids for Improving Outcomes in preterm Newborns) for women at risk of preterm delivery. The research will assess whether steroid administration can be used safely and effectively for women and premature infants in low and middle-income countries.