Born too soon: accelerating actions for prevention and care of 15 million newborns born too soon

Abstract

Preterm birth complication is the leading cause of neonatal death resulting in over one million deaths each year of the 15 million babies born preterm. To accelerate change, we provide an overview of the comprehensive strategy required, the tools available for context-specifi c health system implementation now, and the priorities for research and innovation. There is an urgent need for action on a dual track: (1) through strategic research to advance the prevention of preterm birth and (2) improved implementation and innovation for care of the premature neonate. We highlight evidence-based interventions along the continuum of care, noting gaps in coverage, quality, equity and implications for integration and scale up. Improved metrics are critical for both burden and tracking programmatic change. Linked to the United Nation’s Every Women Every Child strategy, a target was set for 50% reduction in preterm deaths by 2025. Three analyses informed this target: historical change in high income countries, recent progress in best performing countries, and modelling of mortality reduction with high coverage of existing interventions. If universal coverage of selected interventions were to be achieved, then 84% or more than 921,000 preterm neonatal deaths could be prevented annually, with antenatal corticosteroids and Kangaroo Mother Care having the highest impact. Everyone has a role to play in reaching this target including government leaders, professionals, private sector, and of course families who are aff ected the most and whose voices have been critical for change in many of the countries with the most progress.

Figure 1

Approaches to prevent preterm birth and reduce deaths among premature babies. Source: Born Too Soon, Chapter 6 [75]. Dean et al., 2013 [4]; Requejo et al., 2013 [5]; Lawn et al., 2013 [6].

Figure 2

Integrated service delivery packages for maternal, newborn and child health. Source: Born Too Soon, Chapter 6 [75]. Adapted from (Kerber et al., 2007; Lawn et al., 2012; PMNCH 2012) [22,23,51]. Note: interventions for preterm birth are bold. Acryomns used: ANC = Antenatal care; CPAP = Continuous positive airway pressure; HIV = Human Immunodeficiency Virus; IMCI = Integrated Management of Childhood Illnesses; IPTp = Intermittent presumptive treatment during pregnancy for malaria; pPROM = prelabour premature rupture of membranes; STI = Sexually Transmitted Illness.

Figure 3

Coverage along the continuum of care for 75 Countdown to 2015 priority countries. Source: Countdown to 2015 (Requejo et al., 2013) [29]. Note: Eight selected Commission on Information and Accountability for Women's and Children's Health indicators, showing median for Countdown priority countries. Acryomns used: ANC = Antenatal care; DTP3 = Three doses of diphtheria, tetanus and pertussis vaccine.

Figure 4

Historical phasing of reductions in neonatal mortality rates in the United Kingdom and United States during the 20th century. Source: Born Too Soon, Chapter 6 [75]. Data sources for UK and US historical data: (CDC, 2012, Office for National Statistics, 2012, NIH, 1985, Smith et al., 1983, Jamison et al., 2006, Lissauer and Fanaroff, 2006, Baker, 2000, Philip, 2005, Wegman, 2001) [54-62]. With thanks to Boston Consulting Group. Note: more information on history of neonatal mortality reduction in UK and USA available (Lawn et al, 2013) [6]. Data sources for Afghanistan, India, Brazil, and Russia from Child Health Epidemiology Reference Group/World Health Organization cause of death estimates for 2010 from Liu et al., 2012 [50].

Figure 5

Countries that have halved their deaths due to preterm birth in just one decade.

Figure 6

Well-preforming countries for preterm-specific neonatal mortality reduction by region. Source: Born Too Soon, Chapter 6 [75]. Analysis conducted using data from Liu et al., 2012 [50]. Credit: Boston Consulting Group with the Global Preterm Birth Mortality Reduction Analysis Group.

Figure 7

Targets for action by 2025.

Figure 8

Results of three scenarios of preterm-specific mortality reduction to 2025. Source: Born Too Soon, Chapter 6 [75]. Analysis conducted by Mortality Reduction Goal Group and Boston Consulting Group using multiple data sources (Liu et al., 2012; EIU GDP projections 2010 to 2030; World Population Prospects, 2010; UN Department of Economic and Social Affairs; LiST analysis) [50,52,53]. Note: Analysis is for countries with NMR of more than 5 per 1,000 live births; other countries are excluded. Interventions in the LiST analysis included KMC, antenatal corticosteroids, antibiotics for pPRoM, skilled birth attendance, and others.

Figure 9

Government - national integrated campaign for preterm births.

Figure 10

The United Nations - Life-saving Commodities for Women and Children-- potential for action to reduce preterm deaths.

Figure 11

Donors and philanthropic institutions - Helping Babies Breathe as an example of a public-private alliance to save newborns.

Figure 12

The business community - Industry partnership for innovative technology for preterm baby care in Asia.

Figure 13

Health care workers - Health care providers as champions of change for mothers and newborns.

Figure 14

Civil society - Chinese parents mobilising for their preterm babies.