In a significant advancement aimed at increasing survival rates and enhancing the well-being of premature and underweight infants, the World Health Organization (WHO) has introduced groundbreaking guidelines. These guidelines promote the immediate initiation of “kangaroo mother care,” which involves skin-to-skin contact between the newborn and a caregiver, right after birth for premature babies (born before 37 weeks of pregnancy) or those with a low birth weight (under 2.5kg). This marks a significant departure from previous practices that involved separating the infant and caregiver and placing the baby in an incubator.
These guidelines offer a comprehensive approach to neonatal care, including recommendations for emotional, financial, and workplace support for families caring for very small and premature babies. Such families often face extraordinary stress and challenges due to the demands of intensive caregiving and concerns about their infants’ health.
Addressing the Urgent Global Issue of Prematurity
Prematurity is a pressing global public health concern, with an estimated 15 million premature births occurring worldwide each year, representing more than 1 in 10 of all births. Furthermore, over 20 million babies are born with a low birth weight. This concerning trend is on the rise, with prematurity now being the leading cause of death among children under 5 years old.
Fortunately, many preterm infants can be saved through practical and cost-effective measures. These measures include comprehensive care before, during, and after childbirth, the prevention and management of common infections, and the practice of kangaroo mother care. Kangaroo mother care involves skin-to-skin contact between the infant and a primary caregiver, typically the mother, using a specialized sling or wrap, combined with exclusive breastfeeding.
Because preterm infants often have limited body fat and struggle to regulate their body temperature at birth, they often require medical assistance with breathing. Previous recommendations involved an initial period of separation from the primary caregiver, with the infant placed in an incubator or warmer for an average of 3-7 days. However, recent research has highlighted the significant benefits of initiating kangaroo mother care immediately after birth. This approach saves more lives, reduces the risk of infections and hypothermia, and improves feeding.
The Crucial Role of the First Embrace
The guidelines emphasize that the first embrace between a parent and their infant has not only emotional significance but also paramount importance in improving survival and health outcomes for small and premature babies. The COVID-19 pandemic underscored the risks of unnecessary separation between mothers and their babies, especially for those born prematurely or with a low birth weight. These new guidelines stress the need to provide care for families and preterm babies as a unit, ensuring that parents receive optimal support during this uniquely stressful and anxious period.
While these guidelines are particularly relevant in resource-constrained settings with limited access to advanced medical equipment and reliable electricity, they are also applicable in high-income contexts. This calls for a paradigm shift in the delivery of neonatal intensive care to facilitate the continuous presence of parents and newborns.
The Crucial Role of Breastfeeding
Throughout the guidelines, there is a strong endorsement of breastfeeding as a means to improve health outcomes for preterm and low birthweight babies. Research has shown that breastfeeding reduces the risk of infections compared to using infant formula. In cases where a mother’s milk is unavailable, donor human milk is considered the best alternative, although fortified “preterm formula” may be considered when donor milk banks are not accessible.
Comprehensive Support for Caregivers
The guidelines incorporate feedback from families gathered through more than 200 studies, advocating for increased emotional and financial support for caregivers. Parental leave is identified as a necessity to assist families in caring for their infants. Additionally, government policies and regulations should ensure that families of preterm and low birthweight babies receive adequate financial and workplace support.
A Holistic Approach to Addressing Prematurity
Earlier this year, WHO released complementary recommendations regarding antenatal treatments for women at high risk of preterm birth. These recommendations include the administration of antenatal corticosteroids, which can prevent breathing difficulties and reduce health risks for preterm infants. Additionally, tocolytic treatments that delay labor, providing time for a course of corticosteroids, are recommended. These collective recommendations represent the first updates to WHO’s guidelines for preterm and low birthweight infants since 2015.
In conclusion, WHO’s new guidelines represent a groundbreaking step towards revolutionizing the care of preterm and small babies. By advocating for immediate kangaroo mother care and emphasizing comprehensive support for families, these guidelines offer a holistic approach to address the urgent issue of prematurity. As the world grapples with the challenges posed by preterm births, these guidelines pave the way for a brighter, healthier future for our most vulnerable infants.