The Evolution of Preterm Infant Care

 

They say that big things come in small packages, and preterm babies are no exception.  By definition, preterm birth is a birth that occurs before 37 weeks of gestation.  The number of complications rise drastically every week before 32 weeks of gestation as does the costs of care.  The article “A Preemie Revolution” by TIME Magazine explores the difficulties in development that preemies endure as well as the progress that neonatal care has made since the 1960s.

Every year, 1 million of the 15 million preterm babies born worldwide dies due to preterm complications.  At 22 weeks of gestation, the likelihood of survival is quite low, a mere 5%.  However, a preemie’s chance of survival increases exponentially with every additional week of gestation and by 32 weeks, preterm babies treated with proper care and updated technology are over 95% likely to survive.

Preemie01jpegNonetheless, those that survive still face a mountain of challenges before they are deemed mature enough to be released.  Preterm babies require vigilant medical attention and often their brains have difficulty tolerating all the stimuli.  Bright lights, cold air, tubes and needles are all necessary evils, yet can overwhelm the underdeveloped brain.  Improper approaches to necessary life functions, such as eating and breathing, can threaten the baby’s life due to partially developed systems.  For example, preemie lungs lack mature alveoli (which enable the change of carbon dioxide to oxygen) and do not produce surfactant (which prevent the lungs from collapsing), both of which can lead to infant asphyxia.  Additionally, preemies can develop necrotizing enterocolitis in their gut (intestinal tissue death) due to lack of beneficial bacteria, mucus and oxygen needed to fight infection.

However, new technologies are being developed every day to help save newborn lives.

Preterm babies born in developed countries can be treated using a number of sophisticated technologies, surgeries and specialists.  Neonatal units often employ nutritionists, pharmacologists, gastroenterologists, ophthalmologists, pulmonary specialists, surgeons, dieticians and even speech pathologists (to help babies with sucking and swallowing).  Until they develop the energy, coordination, and physical capability to synch their bodily processes, doctors employ a variety of techniques to help preterm babies survive.  To stimulate breathing, doctors may administer artificial surfactant to the trachea as well as use constant passive airway pressure (CPAP).  CPAP devices, typically used to aid sleep apnea, are now being used to help newborns breathe by increasing the air pressure in their throats which prevents airways from collapsing.  Doctors are also testing the benefits of giving infants low doses of probiotics in order to aid the preterm immune system to reaching maturity.

Preemie02jpeg1

The survival rates listed above are impressive, especially when compared to historic values.  In the United States, survival for babies under 3.3lbs has risen from 28% in 1960 to 78% in 2010.  Yet, as one can imagine, neonatal care isn’t cheap.  According to March of Dimes, it costs can costs up to $280,000 to care for babies born before 32 weeks of gestation in developed nations.  Currently, the limit of viability (the earliest gestational age in which the infant has 50% chance of survival) is 22-24 weeks in developed countries.

Not many can afford such a high cost of care and even fewer people can afford this figure in the developing world.  Fortunately, there are priceless rearing-practices and low-cost technologies which can greatly improve a baby’s chance of survival.

The article advocates for kangaroo care in which skin-to-skin contact between the mother and child provide a wealth of benefits to the newborn.  Not only can this help regulate the infant’s temperature, but also promote healthy brain development through longer and more natural sleep cycles and increased oxytocin.  Another positive practice is breastfeeding which is critical to a baby’s development in the neonatal period.  Breast milk has been shown to regulate low blood sugar, low body temperature and bolster the infant immune system.  Education is another priceless intervention that is helping save infant lives daily.  Dissemination of information about proper nutrition, hygiene and lifestyle by community health workers can markedly improve conditions for neonates.  For example, the negative effects of smoking and alcohol on the unborn fetus is still new information to some communities and quitting these behaviors can reduce the likelihood of birth complications.

Lastly, low-cost low-tech health solutions are constantly being developed and brought to scale in order to address the gap in healthcare.  Challenges such as Saving Lives at Birth and the Children’s Prize aim to the find the most effective and scaleable technologies and programs to reduce infant mortality.  Many programs, such as the one proposed by 2013 Children's Prize finalist World Medical Fund, aim to service community members within their communities using traveling rural clinics, thus low-tech, low-cost solutions are essential to aiding these populations.  Partnered with the University of Malawi, Rice 360° has developed a bubble CPAP system works as effectively as a standard $6,000 device, yet only costs $400.  The INSPIRE device proposed by Project HOPE for the Saving Lives at Birth Grand Challenge can detect abnormal breathing  rates in temperatures in newborns and is built to last in low resource environments.  The device has a hand-cranked battery and was designed to endure 5-10 years of use.

To read the full article, click here.

To see global preterm birth rates, click here.


Images scanned from the June 2, 2014 issue of TIME Magazine.  TIME graphics created by Emily Maltby and Lon Tweeten.


Innovations Abound at the Saving Lives at Birth Development XChange 2014

 

On August 1, 2014, hundreds of development professionals will convene in Washington D.C. for the Saving Lives at Birth Development XChange. The XChange showcases the 52 finalists and their proposals, widdled down from an initial 500 proposals. Additionally, the winner of the People’s Choice Award will be announced at the event.

The Saving Lives at Birth Grand Challenge for Development has been running since 2011, working to address the fact that, worldwide, a woman dies in childbirth every two minutes. The situation is even worse for women in the third world, 99% of all childbirth related deaths occur in developing countries.

Proposals could choose to tackle the issue through technology development and deployment, and/or by increasing service delivery and demand. In addition, all proposals were required to include monitored elements and a “review” or evaluation period in order to analyze efficacy. Overall, the competition aims to “accelerate substantial and sustainable progress against maternal and newborn deaths and stillbirths at the community level… [by] harness[ing] the collective imagination and ingenuity of experts across a broad range of disciplines and expertise.”1

IMG_2505The Saving Lives at Birth challenge addresses the growing concern over mortality in the postnatal and neonatal period and prompts applicants to develop solutions that can be utilized during the first 48 hours after delivery. Saving Lives at Birth is one of five Grand Challenges for Development run annually by USAID and its partner organizations. The Grand Challenges for Development focus on solving pressing global issues through the use of science and technology and critical analysis. The judges seek innovations that scalable, adoptable, sustainable and utilize modern infrastructure.

Instead of a single winner, Saving Lives at Birth awards seed grants and transition-to-scale grants to roughly one-fourth of the finalists. Common topics for finalists include treatment of post-partum hemorrhage, prevention of HIV transfer from mother to child, treatment of (pre)eclampsia, prevention of infection, empowering communities, jaundice, and the treatment of malnourishment. The most successful innovations contained elements of low-cost, point-of-care use, rapid results, nonintrusive, compactness, building demand, low or no-need for electricity, and novelty. Development of novel, low-electricity solutions is especially critical since ~20-25% of the world lacks access to electricity, and 80% of people in the third world have no electricity whatsoever.

This year’s finalists tackle a variety of issues and have an impressive geographic span; there are applications from 6 of the 7 continents. Two of our former finalists, Plan International and Rice University (a partner of the University of Malawi) have made it to the finalist stage and will be participating in the Development XChange. Plan International’s proposal will utilize community-based organizations to distribute calcium supplements to pregnant women in order to prevent preeclampsia. Rice University’s proposal seeks funding for the development of a “BreathAlert” device that can detect apnea in newborns as well as induce breathing through chest vibrations.

Follow #DevX2014 or @ChildrensPrize on Twitter for updates from the event or visit the Saving Lives at Birth website for more information.

 


1. Saving Lives at Birth: Challenge