Professor Andrew Shennan and Dr Megan Hall, from Kings College London, were part of the Preterm birth committee who launched PremPrep-5 at the International Federation of Gynaecology and Obstetrics (FIGO) Conference in Paris in October.
Five impactful approaches to dealing with preterm birth challenges.
The 2023 World Health Organisation Born Too Soon Report highlights that around 13 million babies are born preterm every year. A baby dies every 40 seconds because of a complication of preterm birth, and those who survive carry a higher burden of disease than survivors of any other medical problem. While survival has improved, there has been no change in the rate of preterm birth in 30 years. Prevention is challenging and multi-factorial.
The burden of preterm birth is not shared equally across the globe – the highest incidences are found in low and middle-income countries (LMICs). Approximately 80% of preterm births occur in these countries, meaning that countries who are less financially able to manage the consequences of medically complex newborns are also having to manage the largest volume of cases. Furthermore, this compounds significant global disparities in neonatal outcomes: in high-income countries, up to 9 in 10 infants born before 28 weeks survive, with this number falling to 1 in 10 in low-income countries.
In recent years, there has been substantial evidence of specific actions that can improve outcomes. What is encouraging is that some of these interventions are simple and could be implemented anywhere across the globe and without high costs.
With this challenge in mind, the pre-term birth committee of the International Federation of Gynaecology and Obstetrics (FIGO), has selected 5 key interventions known to save lives, from which many preterm babies could benefit.
The 5 interventions are:
1. Prior to delivery, a course of antenatal corticosteroids given to the mother.
2. Magnesium sulphate given to the mother soon before delivery.
3. Delayed cord clamping practiced, for at least a minute postnatally at delivery.
4. Early feeding with breastmilk encouraged (within 1 hour of delivery)
5. Immediate kangaroo care strongly encouraged– involving other family members.
The FIGO preterm birth committee, which launched PremPrep-5 at the FIGO conference in Paris during October 2023, has made a commitment to implement this worldwide. These simple interventions with significant impact, can be easily taught, performed and disseminated in LMICs. One of them alone (administration of antenatal corticosteroids) has been estimated to be able to save 370 000 lives per year and it appears that some of the others could be even more effective in addressing preterm birth issues.
The outputs of the PremPrep-5 are simple:
A 4-minute video available in multiple languages outlining the 5 components; an infographic and a publication for professionals in a journal. The drive is to see this video and infographic distributed across the globe, at all levels. The aim is that these 5 interventions, which are cost effective and known to save lives, will spread to professionals, healthcare students and other birth attendants via professional networks, but also on social networks, where mothers and families will also be able to access the information and so be empowered to advocate for themselves and their babies.
At the end of the launch of PremPrep-5 in Paris, an audience participant, who works in the field of maternal health, stood up and said that if it hadn’t been for these 5 key interventions, she wouldn’t be alive today! Testament to the power of their impact!
The preterm birth committee from FIGO who conceptualised and drove this initiative are: Dr Catalina M Valencia, Maternal Fetal Medicine Specialist Department of Maternal Fetal Medicine at Clinica del Prado – Universidad CES, Medellín, Colombia; Professor Priya Soma-Pillay, Professor of Obstetrics and Gynaecology, Department of Obstetrics and Gynaecology, Faculty of Health Sciences, University of Pretoria, South Africa and Steve Biko Academic Hospital; Dr Megan Hall, Clinical Research Fellow, Department of Women and Children’s Health, St Thomas’ Hospital, King’s College London; Professor Andrew Shennan, Professor of ObstetricClinical Director South London CRN, Department of Women and Children’s Health, School of Life Course Sciences, FoLSM, Kings College London.
Professor Andy Shennan and Dr Megan Hall presenting the PremPrep-5 at the FIGO conference in Paris.