Friday, November 15, 2013

World Prematurity Day and the need for accelerated action

Mothers and infants in a waiting area at Queen Sirikit National Institute
© UNICEF EAPRO/2013/Andy Brown
17 November is World Prematurity Day. This is a great opportunity for UNICEF and our partners to focus much-needed global attention on the issue of premature births. Full term babies (born at 40 weeks of gestation) are physically equipped to adapt to the environment outside their mother’s womb. On the other hand, pre-term babies (delivered before 37 weeks) have to cope with additional stresses of breathing, infections and inability to maintain body temperature. These can all cause preventable deaths.

Gone are the days when parents and societies gave up on premature babies and thought all efforts to save them were futile. Now a majority of these babies can be saved with low–cost, effective interventions, often without expensive neonatal intensive care units, although some babies will still need this support.

A few weeks ago, I was invited to visit Queen Sirikit National Institute of Child health in Bangkok. This prestigious institute was founded in 1954 and is the only hospital in Thailand dedicated to the treatment of pediatric patients. The neonatal centre caters to complicated referral cases, mostly from a nearby obstetric facility at Ratchawithi hospital.

Kangaroo care

Visiting the in-patients, I was privileged to meet Supatra, a first time mother whose baby boy  was born at 30 weeks. Recalling her pregnancy and pre-term birth, she said:

“I love children and was so excited to have a positive pregnancy test, meaning I can have a child of my own. But I developed a urinary tract infection during the pregnancy and was so scared and nervous when it caused early contractions. My husband was also away - he had to go to another town for his work.

“The baby was born in a private hospital but we sought admission here as we could not afford the cost of treatment at the private hospital. My baby was kept in the Newborn Intensive Care Unit in the beginning and I could not hold him. However, I was encouraged to express breastmilk which was refrigerated and stored. To start with, nurses tube fed my baby, but now after one month and five days, he is able to suckle and I can feed him myself.”

A nurse helps Supatra hold her baby in the Kangaroo position
© UNICEF EAPRO/2013/Andy Brown
Supatra finds consolation in talking to other mothers and holding her baby skin-to-skin in the Kangaroo mother care position  or ‘Ching chow’ care (in Thai language). This is a special technique for caring for pre-term and low-birth weight babies adapted from kangaroos whose babies are born earlier than they are able to live independently and are snuggled into the mother’s pouch for warmth and milk feeding.

In kangaroo care practice, the baby is placed in direct skin to skin contact of the mother or father, under a shirt or arapped in cloth for several hours a day. It allows both physiological and psychological warmth and bonding; the position facilitates breastfeeding ( or the feeding with expressed breast milk). The parent’s stable body temperature helps regulate the neonate’s temperature more smoothely than an incubator.

When I asked Supatra about her hopes for her son’s future, she remarked: “I want him to be a good boy and get along with other kids, but at the moment I just wish for the day when we leave the hospital to go home.”

I asked her if she had a message for other mothers with pre-term babies. She replied: “It is hard but don’t give up. Be patient and hope for the best!”

A mother expressing milk with a breast pump for her premature baby
© UNICEF EAPRO/2013/Andy Brown
Professor Uraiwan Chotigeat working at the hospital, specializes in neonatology and is a strong advocate for kangaroo care. She is promoting Kangaroo care by fathers, too as it helps in father-infant bonding and ensures a greater involvement of both parents. Professor Uraiwan  feels  this technique has multiple benefits for the pre-term baby including more normalized temperature, heart rate and respiratory rate, frequent feeding and increased weight gain, fewer hospital acquired infections and reduced risk of respiratory problems.

Breastfeeding support

Professor Uraiwan Chotigeat
© UNICEF EAPRO/2013/Kritsada Jirathun
Breastfeeding is another important way to improve the health of babies – both premature and full term. In Thailand, the rates of breastfeeding are low.  Although fifty percent of all mothers initiated breastfeeding in the first hour after birth, only 5.4% exclusively breastfed their babies till the age of 6 months (MICS 2005-06). Raising awareness among mothers and their families is required as well as ensuring supportive environment at home and the workplace as 45% adult women are in paid employment.

The hospital Director Dr Siraporn Sawasdivorn is committed to promote breastfeeding among sick and pre-term newborns, as they have successfully done for healthy and full-term babies. The hospital runs a round-the-clock call centre to provide support and guidance on breastfeeding to new mothers. In this video, she tells me more:


I was really impressed with everything I saw at the hospital, the dedication of the staff and the quality of care offered.

The regional picture
Prematurity is a big problem across East Asia and the Pacific. It constitutes two-thirds of all newborn deaths. According to the global ranking of total annual number of pre-term births, China ranks second, Indonesia fifth and the Philippines eighth in the world. In addition, many countries in the region including Cambodia, Laos, Malaysia, Mongolia, and Timor Leste have pre-term birth rates greater than one in ten.

Meeting these country’s Millenium Development Goals by 2015, particularly Goal 4 to reduce child mortality, and “A Promise Renewed Goal” by 2020 will require intensive efforts to improve the services for newborn babies generally, and pre-term babies specifically. Even in a well-developed health setting like Thailand, about 40 percent of all newborn deaths are due to prematurity.

The Government of Thailand is aware of the importance of this issue and has framed strategies to address this problem. At a recent event, I spoke to Dr Nippunporn Voramongkol, Senior Advisor in Bureau of technical advisors, Ministry of Health Thailand.. In this video, she explains what they are doing:


The way forward

Now, with recent advocacy efforts and literature documenting the success of Kangaroo care in saving lives, there is an opportunity for countries to do more. The priority is to help countries quickly scale up capacity building efforts to introduce Kangaroo Mother Care practice for premature and low birth weight babies.

UNICEF is working with country governments, partners, professional associations and parent groups across the region to spread awareness about prematurity. We are supporting countries to develop plans for inclusion of cost-effective strategies to reduce pre-term deaths.

Efforts for ending prematurity related deaths will never be premature. We have to blast the myth that saving premature babies is a luxury only affordable for parents living in developed countries. Seventy five percent of all preterm babies can be saved with low cost interventions like antenatal corticosteroids and kangaroo care. It is up to us to spread the word and act now!

Supatra strokes her baby as she holds him in the Kangaroo position
© UNICEF EAPRO/2013/Andy Brown
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