Baby boys at higher risk of death and disability due to preterm birth
New York, 15 November 2013 - Groundbreaking global studies on preterm birth and disability carried out by almost 50 researchers at 35 institutions and launched in association with World Prematurity Day finds baby boys are at a higher risk of death and disability due to preterm birth than baby girls. These disabilities range from learning problems and blindness to deafness and motor problems, including cerebral palsy.
The six major papers in Pediatric Research, published by Nature, show that boys are 14 percent more likely to be born preterm than girls.
“Baby boys have a higher likelihood of infections, jaundice, birth complications, and congenital conditions but the biggest risk for baby boys is due to preterm birth. For two babies born at the same degree of prematurity, a boy will have a higher risk of death and disability compared to a girl. Even in the womb, girls mature more rapidly than boys, which provides an advantage, because the lungs and other organs are more developed,” says Professor Joy Lawn, M.D., PhD, a neonatologist and epidemiologist at the London School of Hygiene & Tropical Medicine (LSHTM) and team leader of the new research.
“One partial explanation for more preterm births among boys is that women pregnant with a boy are more likely to have placental problems, pre-eclampsia, and high blood pressure, all associated with preterm births.”
However, after the first month of life, in some societies where girls receive less nutrition and medical care, the girls are more likely to die than boys, despite this biological survival advantage for girls.
Preterm birth-tiny babies, but a big global health problem
In the last three years, some $25 billion in new funds have been spent on maternal, newborn and child health, according to a 2013 report by The Partnership for Maternal, Newborn & Child Health (PMNCH). Low- and middle-income countries, as well as private foundations, non-government organizations, and the private sector have raised about 40 percent of this. However less than 1 percent is specifically directed at premature or newborn care.
Improving prematurity prevention and care is a key part of a wider drive to reduce newborn deaths and improve quality care at the time of birth, when risks are highest for both women and their babies.
“Three quarters of the 1 million babies who die each year from complications associated with prematurity could have been saved with cost-effective interventions, even without intensive care facilities,” says UN Secretary General Ban Ki-moon, whose Every Woman Every Child movement has provided major worldwide impetus for women and children. “World Prematurity Day is an opportunity to mobilize partners to improve the care available to all women and children.”
More than 50 partners, convened by UNICEF and WHO, are developing a major new global plan to improve newborn health. The plan will focus on improving the quality of care for women and children during labor and delivery, as well as the critical few days before and after birth, when risks are highest. The Every Newborn plan (www.everynewborn.org) will be launched during the World Health Assembly, in May 2014.
Outcomes for 15 million preterm babies
Risks for disabilities or impairments are affected by where a preterm baby is born:
Eye problems for preterm babies
“There is a risk of repeating the epidemic of blindness in preterm survivors seen in the US and Europe in the 1940s and 1950s,” says Professor Clare Gilbert, a physician at LSHTM and world expert on retinopathy of prematurity. “Much can be done to reduce blindness from retinopathy of prematurity by improving quality of neonatal care, including safer use of oxygen, and by detecting retinopathy early. Preterm infants must be followed up and their eyes must be checked.”
Important conditions causing deaths and disability for full term newborns
Better care needed at birth and especially for sick and small newborns
Most newborn deaths can be prevented without intensive care. Low-cost interventions that are very effective, but are not commonly used in the highest burden countries include:
“Using an essential package of pregnancy, childbirth, and postnatal care that includes these interventions will save more than three-quarters of preterm babies from death without expensive, high-tech intensive care,” says Carole Presern, PhD, Executive Director of PMNCH and a midwife. “Most of these infants can grow up healthy and without lifelong disabilities, but the message needs to get out there.”
This is especially true in the poorest countries. "We need to increase training and support for all those who are delivering the babies -- from obstetricians and pediatricians to midwives and nurses," said Mickey Chopra, M.D., PhD, UNICEF Chief of Health.
“Better access to family planning, particularly for adolescent girls, could save an estimated 230,000 babies, if family planning were scaled up to 60 percent coverage,” Dr. Presern says.
Better care for children with disability and their families
“For children with disabilities to count, they must be counted – at birth, at school and in life,” says Dr. Chopra.
In The State of the World’s Children 2013: Children with Disabilities, UNICEF urges governments to ratify and implement the Convention on the Rights of Persons with Disabilities and the Convention on the Rights of the Child, to save more newborn lives and to support families to meet the costs of caring for children with disabilities.
Differences for countries around the world
Of the 11.7 million births in high-income countries, including the United States, Canada, Australia and most of Europe, 40,035 preterm babies died due to birth complications and infections, and another 147,000 were impaired. Major disability is most common for babies born at less than 28 weeks, and especially in those born under 25 weeks.
A country-by country analysis shows that India (3,277,200) and China (1,315,000), because of their size, had the greatest numbers of preterm births, followed by Nigeria (831,100), Pakistan (757,900), Indonesia (748,500), United States (497,600), Bangladesh (435,500), Philippines (343,400), Democratic Republic of the Congo (323,100), Ethiopia (305,900), Brazil (266,500) and Tanzania (210,300).
Rates of preterm births differed from absolute numbers, with Malawi topping the list with a rate of 18.1 per thousand live births, followed by Comoros (16.7), Zimbabwe (16.6), Equatorial Guinea (16.5), Mozambique (16.4), Gabon (16.3), Pakistan (15.8), Indonesia (15.5), and Mauritania (15.4).
These studies, based on more than 1,000 data sources, reveal significant data gaps, especially in most low-income and many middle-income countries. For instance, basic information on the number of preterm births and deaths is missing in areas where many babies are delivered at home. Follow-up information does not exist for much of the world, a crucial deficiency because many disabilities -- cerebral palsy and learning difficulties among them -- may not be apparent for several years.
Leading researchers and global health organizations issued a new call-to-action on a consensus research agenda to address preterm birth. This “Solution Pathway” was developed by more than 30 scientific experts at a meeting convened by the Bill & Melinda Gates Foundation; the Eunice Kennedy Shriver National Institute of Child Health and Human Development; the Global Alliance to Prevent Prematurity and Stillbirth (GAPPS) and the March of Dimes Foundation.
“With this comprehensive, priority research agenda, we have the roadmap to advance discovery, find new solutions to the problem of preterm birth, and evaluate effective strategies to scale up what we know can save lives of newborns,” says Eve Lackritz, M.D., a pediatrician and a researcher at GAPPS.