By Lydia Di Stefano, B Theme student liaison (MSc Reproductive & Sexual Health Research Candidate)
November 17 marks World Prematurity Day, a parent-led movement to generate awareness of preterm birth and the impact it has on millions of families globally. November 17 serves as a reminder to reflect on the seriousness of this public health crisis, which is the leading cause of death in children under the age of five (WHO 2018).
Globally, prematurity affects more than one in ten babies. It not only contributes to preventable deaths but is also a cause of significant health consequences in survivors, including learning and motor disabilities, as well as visual and hearing problems. The huge burden of prematurity is recognised by the World Health Organization, and must be targeted in order to achieve Sustainable Development Goal 3.2 to end preventable deaths of newborns and children under 5 by 2030.
In high-income countries such as the UK, new technologies and procedures are facilitating an increase in survival of extremely premature infants (Santhakumaran et al., 2018). However, these advances are not seen in all settings within the UK, let alone in low- and middle-income countries which account for the vast majority of the world’s births. Global inequalities in neonatal care are stark, with half of babies born at or below 32 weeks in low-income settings dying due to a lack of simple and cheap care such as warmth and breastfeeding support. In middle-income countries, suboptimal use of technology has led to an increase in the burden of disability amongst surviving preterm infants (WHO 2018). It is clear that despite technological advances, the problem of prematurity is not going away.
In fact, in almost all countries with reliable data, rates of preterm birth appear to be rising (Chawanpaiboon et al., 2018). However, there is a significant “data gap” in both quantity and quality, particularly from low-income settings. In an article for The Lancet ‘Small babies, big numbers: global estimates of preterm birth’, MARCH Centre members Dr Hannah Blencowe and Professor Joy Lawn, along with Professor Anne CC Lee from Harvard Medical School, identified some reasons behind this gap. They suggested that one contributing factor is the frequent failure by health professional to record gestational age or enter relevant data into health systems. Another challenge lies in the difficulty of determining accurate gestational age, and the variation in the accuracy of various methods. For example, early ultrasound is by far the most accurate method (+/- 5-7 days) compared to last menstrual period, fundal height and newborn examination. Finally, variation in definitions of live birth means that many premature livebirths are misclassified as stillbirths.
In the article, the authors suggest that we should strive to:
1) Count all births, including vital status of the neonate;
2) Always record birthweight and gestational age; &
3) Develop novel methods to increase the accuracy of estimates for gestational age.
Premature infants are amongst the world’s most vulnerable citizens. Innovations in primary prevention and interventions after birth will help to improve the outcomes for these small babies and their families. But before we can begin to realise the true scale of this problem, improvements in data are desperately needed.