November 17 is observed as the World Prematurity Day to create awareness of preterm birth and the concerns of preterm babies and their families. The infants born before the completion of 37 weeks of pregnancy are referred as premature babies. In India, out of 26 million live births annually, 3.5 million are preterm, and globally the figure is around 15 million.
India is at the top of 10 countries contributing 60 per cent of the premature babies in the world (WHO report: Born too soon). A European parent organisation initiated the programme to mark November 17 as international awareness day for preterm birth in 2008, which got recognised as World Prematurity Day since 2011.
At present, more than 200 countries, government and non-government organisations, UN agencies, medical and health organisations have come together to stand with the family of lives that lost to preterm birth to create an environment for better care for premature babies and to adopt every possible strategy to eradicate preterm births.
A study published in reputed scientific journal lancet claims premature birth as the prime killer of young children, accounting for 1.1 million deaths out of 6.3 million deaths of children under the age of 5.
The increasing rates of preterm births are associated with various societal and medical factors. The age of mother, if she is below 17 or above 37 years, enhances the risk of preterm delivery, poor nutrition, heavy physical work load, short period between pregnancies, infertility treatments, smoking, alcohol or drug abuse, all contribute to this phenomenon.
In addition, history of second-trimester abortion or more than two first-trimester abortions or previous premature delivery also increases the risk of preterm delivery. Clinically relevant is the positive correlation with medical conditions like preeclampsia (elevated blood pressure and protein in the urine after the 20th week of pregnancy), HEllP syndrome (hemolysis, elevated liver enzymes, low platelet count), uterine or cervical abnormalities, recurring vaginal infections, kidneys, bladders and urinary tracts or chronic diseases like obesity, high blood pressure, diabetes, inflammatory bowel disease (IBS), kidney disease, lupus or thrombophilia. Hereditary factors as well play a significant role in increasing risk of preterm delivery.
Medical advancement and new obstetrician techniques have improved the scenario of pregnancy and delivery worldwide. However, sufficient research and technological innovation is lacking in the precise prediction of ‘at risk’ pregnant women and the effective interventions to prevent prematurity. If the risk can be accessed and interventions are implemented, the preterm labour can be delayed. The increase in the gestation period is directly proportional to the survival chances of the newborn with approximately 50% at 25 weeks gestation to 90% at 28 weeks and over 97% at 33 weeks gestation period.
The babies born preterm can be saved with timely interventions such as administration of steroid injections to mother with preterm labour to speed up the development of baby lungs. The baby after birth should be kept warm, clean and well-fed. Kangaroo mother care is where the infant is kept in skin-to-skin contact with the mother to keep the baby warm and facilitate breastfeeding.
In addition, appropriate administration of basic antibiotics can also save lives, such as amoxicillin to treat pneumonia and injection antibiotics to fight serious infections. It is also important to educate the families of premature babies for proper postnatal care of the mother and child. The family should be vigilant about the activity of the child, like weight and height gain, neuromuscular coordination, vision, hearing ability. If, God forbid, parents observe some abnormality, they should take medical aid without delay. It can be improved only with proper and timely therapy.
In observing the World Prematurity Day, we need to understand the struggle of these tiny treasures go through. They have to fight against all odds, be it low birth weight, fragile underdeveloped skin, poor immune system, breathing trouble, etc. Though many of them come out strong, like Sir Isaac Newton, Albert Einstein, Charles Darwin, Napoleon Bonaparte, many lose the battle leaving their families in tears. We should all pledge our support for creating a healthy, happy and nutritious life for would-be mothers so that a major preventable fraction of preterm deliveries can be avoided.
(Dr Sumona Karjee Mishra is a Social Innovation Immersion Programme Fellow, DBT-BIRAC KIIT-TBI. Email: sumonakarjee@gmail.com)