WHO today launched new guidelines to improve the survival and health of babies born early (before 37 weeks of pregnancy) or small (less than 2.5 kg at birth).
The guidelines advise that skin-to-skin contact with a caregiver – known as kangaroo mother care – should begin immediately after birth, with no initial period in an incubator. This marks a significant shift from previous advice and common clinical practice, reflecting the immense health benefits of ensuring caregivers and their premature babies can stay close, not separated, after birth.
The guidelines also provide recommendations for ensuring emotional, financial and professional support for families of very small and premature babies, who may face extraordinary stress and hardship due to intensive care demands and health anxieties. of their babies.
“Premature babies can survive, thrive and change the world – but every baby should have that chance,” said Dr Tedros Adhanom Ghebreyesus, Director General of WHO. “These guidelines show that improving outcomes for these tiny babies is not always about providing the most advanced solutions, but rather about ensuring access to essential health care centered around the needs of families.”
Prematurity is an urgent public health problem. Each year, approximately 15 million babies are born prematurely, accounting for more than 1 in 10 of all births worldwide, and an even higher number – over 20 million babies – are born with low birth weight. This number is increasing and prematurity is now the leading cause of death for children under 5 years old.
Depending on where they were born, there remain significant disparities in a premature baby’s chances of survival. While most people born at or after 28 weeks in high-income countries survive, in poorer countries survival rates can be as low as 10%.
Most premature babies can be saved with feasible and cost-effective measures, including quality care before, during and after birth, prevention and management of common infections, and Kangaroo Mother Care – combining skin-to-skin contact in a sling or special wrap for as many hours as possible with a primary caregiver, usually the mother, and exclusive breastfeeding.
Because premature babies lack body fat, many have problems regulating their own temperature at birth, and they often need medical assistance to breathe. For these babies, previous recommendations called for an initial period of separation from their primary caregiver, with the baby first stabilized in an incubator or warmer. It would take about 3-7 days on average. However, research has now shown that starting kangaroo mother care immediately after birth save many more livesreduces infections and hypothermia and improves nutrition.
“The first hug with a parent is not only emotionally important, but also absolutely essential to improving survival chances and health outcomes for small and preterm babies,” said Dr Karen Edmond, Medical Officer for Newborn Health at WHO. “During the time of COVID-19, we know that many women have been unnecessarily separated from their babies, which could be catastrophic for the health of babies born early or small. These new guidelines underscore the need to care for families and premature babies together as a unit, and to ensure that parents receive the best possible support during what is often a particularly stressful and anxious time.
While these new recommendations are particularly relevant in poorer settings that may not have access to high-tech equipment, or even a reliable supply of electricity, they are also relevant for high-income settings. This calls for a rethink of how neonatal intensive care is provided, according to guidelines, to ensure parents and newborns can be together at all times.
Throughout the guidelines, breastfeeding is strongly recommended to improve health outcomes for preterm and low birth weight babies, with evidence showing it reduces infection risks compared to infant formula. When breast milk is not available, donor breast milk is the best alternative, although fortified ‘premature formula’ can be used if donor milk banks are not available.
Incorporating family feedback gathered from more than 200 studies, the guidelines also call for increased emotional and financial support for caregivers. Parental leave is needed to help families care for the infant, the guidelines say, while government and regulatory policies and rights should ensure that families of premature and low birth weight babies receive financial and sufficient professional.
Earlier this year, WHO issued related recommendations on prenatal treatments for women at high risk of preterm birth. These include antenatal corticosteroids, which can prevent breathing difficulties and reduce health risks for premature babies, as well as tocolytic treatments to delay labor and allow time to complete a course of corticosteroids. Together, these are the first updates to WHO’s guidelines on preterm and low birth weight infants since 2015.
The guidelines were released ahead of World Prematurity Day, which is celebrated annually on November 17.