Millions born too soon, die too soon
October 5, 2009
Lauran Neergaard
ASSOCIATED PRESS
WASHINGTON–They call it kangaroo care: A premature baby nestles skin-to-skin against mom's bare, warm chest. In Malawi, mothers' bodies take the place of too-pricey incubators to keep these fragile newborns alive.
Nearly one in 10 of the world's babies is born premature, and about a million infants die each year as a result, says a startling first attempt to measure a toll that is hidden in much of the world. Of four million deaths soon after birth, 28 per cent are attributed to prematurity.
It's a problem concentrated in poor countries, with the vast majority of nearly 13 million preemies born each year in Africa and Asia, according to the report released Sunday by the March of Dimes.
Preterm birth rates are highest in Africa, but followed closely by North America, concludes the first part of a collaboration with the World Health Organization to tackle the growing problem.
How? "That's the 13-million-baby question," said March of Dimes epidemiologist Christopher Howson, who headed the project.
Different factors fuel prematurity in rich countries and poor ones.
Wealthy nations such as the United States have sophisticated neonatal intensive care units for the tiniest, youngest preemies. That produces headlines about miracle babies and leads to a false sense that modern medicine conquers prematurity – without acknowledging lifelong problems such as cerebral palsy, blindness and learning disabilities that often plague survivors.
Scientists don't know all the triggers for preterm birth or how to stop early labour once it starts, one reason the report urges major new research.
"These are conservative estimates," Howson said. "As shocking as this toll is, that toll will only rise." Next year, the WHO finishes an in-depth, country-by-country count.
Yet even in very poor countries, there are steps to improve preemies' survival, if only more mothers knew, said Dr. Joy Lawn, a pediatrician-turned-policy director for Save the Children in South Africa.
"Even in educated families, there's a sense of fatalism if a baby is born preterm. There's no expectation they can do anything," Lawn said.
"With pretty simple solutions, these deaths could be halved, but it doesn't seem to be a priority."
She points to Malawi, where traditionally, new mothers have tied babies to their backs as they go about their day. Today, mothers of preemies are taught to tie them in front, under their clothes, kangaroo care-style, she said. The skin-to-skin contact keeps the infants' body temperature stable, a key to survival, and they can nurse at will, promoting weight gain.
Babies are premature if they're born before 38 weeks of pregnancy. Being born a few weeks early can cause breathing problems, jaundice and learning or behavioural delays.
Among risk factors:
- Lack of prenatal care.
- Smoking or alcohol use.
- Pregnancy before age 16 or after 35, or pregnancies spaced less than two years apart.
- Carrying twins or more.
- In wealthy nations, early elective inductions and Caesarean sections.
"What leads to a healthy outcome or adverse outcome are factors that begin far before that third trimester," Howson said, stressing care for infections and chronic conditions, good diet and family planning so the mother is healthy before she conceives.
Toronto Star