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New WHO recommendations on interventions to improve preterm birth outcomes

World Prematurity Day 2015

Department of Reproductive Health and ResearchDepartment of Maternal, Newborn, Child and Adolescent Health

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• Preterm birth affected an estimated 11.1% ( 9.1%–13.4%) of live births globally in 2010

• Equates to approximately 15 million liveborn preterm babies

• 15% of the estimated 6.3 million under 5 child mortality in 2013 were due to complications of preterm birth (1 million deaths)

• Preterm birth is the leading cause of death in neonates (deaths before 28 days of life)

Preterm birth - a global problem

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WHO preterm birth guidelines (Aug 2015)

Management of women in preterm labour and management of preterm newborn

Mother:→ antenatal corticosteroids→ tocolytics → magnesium sulfate for neuroprotection → antibiotic prophylaxis→ optimal mode of birth

Preterm infant:→ Thermal care→ CPAP & Surfactant for respiratory

distress syndrome→ Oxygen therapy and concentration

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Use of antenatal corticosteroids

• Strong recommendation for ACS therapy for women at risk of preterm birth from 24 weeks to 34 weeks of gestation when the following conditions are met:

– GA assessment can be accurately undertaken;– preterm birth is considered imminent;– there is no clinical evidence of maternal infection;– adequate childbirth care is available (including the capacity to

recognize and safely manage preterm labour and birth);– the preterm newborn can receive adequate care if needed (including

resuscitation, thermal care, feeding support, infection treatment and safe oxygen use).

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Other maternal interventions• Tocolytic treatments (acute and maintenance treatments) are not

recommended for the purpose of improving newborn outcomes (Conditional recommendation)

• Magnesium sulfate is recommended before 32 weeks of gestation for prevention of cerebral palsy in the infant and child (Strong recommendation)

• Antibiotic administration is recommended for women with preterm prelabour rupture of membranes (Strong recommendation)

• Antibiotic administration is not recommended for women in preterm labour with intact amniotic membranes and no clinical signs of infection (Strong recommendation)

• Routine delivery by caesarean section is not recommended, regardless of cephalic or breech presentation (Conditional recommendation)

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Newborn interventions• Kangaroo mother care as routine care of

clinically stable newborns weighing ≤2000 g at birth (Strong recommendation)

• Unstable newborns weighing ≤ 2000 g at birth, or stable newborns weighing <2000 g who cannot be given KMC, should be cared for in a thermo-neutral environment either under radiant warmers or in incubators (Strong recommendation)

• CPAP therapy for care of preterm newborns with respiratory distress syndrome (Strong recommendation)

• Surfactant replacement therapy for intubated and ventilated newborns with respiratory distress syndrome (Conditional recommendation)

Photo: UNICEF/Asselin

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Newborn interventions

• Start with 30% oxygen or air (if blended oxygen is not available), rather than with 100% oxygen for ventilation of babies born before 32 weeks (Strong recommendation)

• Progressively higher concentrations of oxygen should only be considered for newborns undergoing oxygen therapy if their heart rate is less than 60 beats per minute after 30 sec of adequate ventilation with 30% oxygen or air (Strong recommendation)

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For more information, visit: http://www.who.int/reproductivehealth/publications/maternal_perinatal_health/preterm-birth-guideline/en/

http://www.who.int/reproductivehealth/publications/maternal_perinatal_health/preterm-birth-highlights/en/

Contact: reproductivehealth@who.int or mncah@who.int

Websites: who.int/reproductivehealth and www.who.int/maternal_child_adolescent