Born too soon

On Nov. 17 we observed “World Prematurity Day,” a global effort “to raise awareness of the deaths and disabilities due to prematurity and the simple, proven, cost-effective measures that could prevent them.”

When a baby is born at less than 37 weeks of gestational age, or when the birth occurs “before the developing organs are mature enough to allow normal postnatal survival,” that baby is what is known as a “preemie.” Sources say that premature infants are at greater risk for “short- and long-term complications, including disabilities and impediments in growth and mental development.” Indeed, preterm birth is, according to Unicef, “the world’s largest killer of babies, causing more than one million deaths each year,” this even if 75 percent can be saved without high-technology care.

The Philippines ranks eighth out of 184 countries for the number of babies born prematurely, and ranks 17th for the total number of deaths due to complications from preterm birth. Unicef says that in the Philippines, 48 percent of children who die under the age of five years are newborn, and 39 percent of these die from preterm complications, “making this the leading cause of newborn mortality.”

Last year, a total of 11,290 deaths were attributed to preterm complications—“the equivalent of 31 newborn deaths every day.”

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WHAT makes the tragedy of babies dying due to complications of being born too soon is that these deaths can be easily and even cheaply prevented.

“Late preterm babies,” those born between 32 and 37 weeks (eighth and ninth months) of pregnancy, “have a good chance of survival if the basic, low cost interventions are in place.” Unicef says that around 84 percent of the 350,000 preterm babies that are born annually in the Philippines fall into this category.

Dr. Mariela Castillo, a specialist on mother and child health for Unicef, says that it is “crucial” for preemies to receive “appropriate newborn care.” This means, says Castillo “ensuring that babies who have difficulty breathing get quick attention, and that all newborns are breastfed and kept warm, dry and clean.”

“Unang Yakap” (The First Embrace) is the name given to a protocol of “essential intrapartum and newborn care (EINC),” so-called because it calls for keeping infants warm and insulated, mainly by keeping them held close to the mother’s skin.

The Unang Yakap protocol contains guidelines for quality and safe birthing services that are mother- and newborn-friendly, “ensuring success of breastfeeding initiation at the health facility.” In addition, the recently published “DOH-WHO Guidelines on Intrapartum and Immediate Postpartum Care,” developed together with the Philippine Obstetrical and Gynecological Society, aims to complement the essential newborn care protocol guidelines, to ensure safer and more effective labor procedures.

Caring for one’s baby begins before birth, as the health department recommends that expectant mothers go for a minimum of four prenatal care visits, give birth in health facilities (birthing centers, clinics or hospitals), have their births attended by skilled and competent health professionals, and that mothers and babies receive postnatal care before they return home.

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DESPITE the high rates of preterm births and deaths, progress is being seen, Unicef says. Recently, there was a reduction in neonatal sepsis (infection) rates and neonatal death rates in government hospitals. These hospitals were part of the 11-hospital EINC scale-up initiative under a joint program of the DOH, the United Nations, and AusAID. Interventions that were proven to work included improving emergency obstetric and newborn care in hospitals; heightened awareness of the use of antenatal (before birth) steroids during preterm labor with imminent delivery of the baby; health facility infection control measures such as hand washing; and “kangaroo” mother care, and breastfeeding initiation practices.

Three “low-cost interventions” known to be especially effective for preterm babies, but are still not widely used despite documented success are steroid injections, kangaroo mother care, and infection control measures.

When given to mothers in preterm labor, dexamethasone, a steroid also used to treat asthma, helps speed up the development of the baby’s lungs while in the uterus, enabling the baby to breathe once it is born. It stops premature babies from going into respiratory distress when they are born and, in many cases, prevents deaths. And it only costs about a dollar for four shots!

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KANGAROO mother care calls for placing the infant “skin-to-skin upright between the mother’s breasts and then tied to the mother’s chest with a cloth.” This keeps the preterm baby warm and facilitates breastfeeding. Keeping preterm babies warm is especially important “because their tiny bodies lose heat rapidly, making them highly vulnerable to illness, infection and even death.”

Preterm babies are especially at risk of contracting life-threatening infections. Good hygiene and care help prevent these infections, and basic antibiotics fight infections when they occur.

The Philippine Society of Newborn Medicine in collaboration with PhilHealth is also completing a “Prematurity Package” that includes supplies of medicines for infants with breathing difficulties.

Warmth, hygiene, steroids, and early breastfeeding—these are just a few of the interventions that can be applied to ensure the survival and health of “preemies,” babies who face daunting challenges right after birth but who, with good and affordable care, can lead active, productive lives like other babies.