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Saving Premies from Death or Disability

Three-day-old premature baby Jessica Thelusma is carried by her mother Silvie Estain in the emergency room at General Hospital in Port-au-Prince, Saturday, May 8, 2010. (AP Photo/Esteban Felix)
Three-day-old premature baby Jessica Thelusma is carried by her mother Silvie Estain in the emergency room at General Hospital in Port-au-Prince, Saturday, May 8, 2010. (AP Photo/Esteban Felix)

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Joe DeCapua

It’s estimated about 15-million babies are born prematurely each year. About one million of them die, while many others suffer life-long disabilities.  A major study says half the women at risk of pre-term deliveries are not receiving simple, low cost treatments that could help prevent death or disabilities in newborns.

De Capua report on pre-term delivery risk
De Capua report on pre-term delivery riski
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The study of more than 300,000 births in 29 low and middle income countries appears in The Lancet.

The World Health Organization’s Dr. Joshua Vogel, who led the research, said, “It’s a very big problem and a global one. Our best estimates are that over one in ten births worldwide actually occur before 37-weeks. So occur pre-term before the baby is fully grown and that’s in the region of about 15-million births annually.”

Most of the pre-term births occur in sub-Saharan Africa and South Asia. Why pre-term births occur, he said, is a complex question.

“Many conditions can actually cause it, for example, infections. But often we don’t know the reason. They just occur and we need to do the best we can to manage them.”

Besides the nearly one million deaths each year among pre-term babies, many of those who survive have serious health issues. These include cardiovascular problems, visual and hearing difficulties and learning disabilities.

“And of course we need to consider how this can have an impact on the family, not just the individual baby or child, but also the economic consequences as well,” he said.

Vogel -- who‘s with the WHO’s Reproductive Health and Research Department – said there are simple, effective and inexpensive treatments that can prevent many of these problems.

“We have the antenatal corticosteroids that can help develop the lungs a bit quicker. And we also have another group of medications called tocolytics. And tocolytics can actually slow down or even in some cases temporarily stop a woman’s contractions. And this can buy us a little bit of time, not just in terms of helping to deliver, but more to give time for us to administer antenatal corticosteroids – for those drugs to work – or indeed to transfer the woman to a facility where she can get access to the best newborn care for the premature newborn when it is born,” he said.

But many women simply are not receiving these treatments.

Vogel said, “Of the women that are eligible for those drugs only just over half of them are actually receiving it. And in the case of the tocolytics medications, we found most women who are eligible were not receiving tocolytics medication or an antenatal corticosteroid. We also found that instead of tocolytics drugs women were often being treated with regimens that we know don’t really make much of a difference in this particular clinical situation.”

About a third of the women studied received ineffective treatments for pre-term risk, such as bed rest, hydration and magnesium sulfate. And many who did receive the tocolytics were not getting the best form known as calcium channel blockers. Instead, they were given the more risky beta-agonists, which can increase the risk of cardiovascular problems, nausea and vomiting.

Vogel said the precise reasons why women are not getting proper treatments are unclear. Further study is needed on that. But he gives a few possibilities.

“It can be misunderstanding on the behalf of health staff or a lack of information. It can be a fear amongst women or the doctors or health care providers themselves. And of course it can be a lot of economic and financial barriers -- not just for hospitals and getting access to the drugs, but in the case of women and their families being able to afford it,” he said.

Vogel said to reduce the risk of pre-term births the medications should be given to eligible women between 26 and 34 weeks into pregnancy.  The WHO official agreed with those who say the drugs are not a panacea and that a comprehensive approach is needed to reduce deaths and disabilities associated with pre-term births.

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