New WHO guidance for mothers of preterm babies

Mothers who give birth to small or preterm babies should have skin-to-skin contact with their child immediately, according to new guidelines from the World Health Organization.

In the first updates to WHO’s preterm and low birth weight guidelines since 2015, it is a significant change from earlier guidance and means the baby would not be placed in an incubator initially.

WHO says its new recommendations to implement “kangaroo mother care” will improve survival and health outcomes for babies born before 37 weeks of pregnancy) or who are under 2.5kg at birth.

Its guidelines also include how to ensure emotional, financial and workplace support for families of very small and preterm babies.

Dr Tedros Adhanom Ghebreyesus, WHO director-general, said: “Preterm babies can survive, thrive, and change the world – but each baby must be given that chance.

“These guidelines show that improving outcomes for these tiny babies is not always about providing the most high-tech solutions, but rather ensuring access to essential healthcare that is centred around the needs of families.”

Every year, an estimated 15 million babies are born preterm, and more than 20 million babies have a low birthweight.

While most born at or after 28 weeks in high-income countries go on to survive, in poorer countries survival rates can be as low as 10%.

Most preterm babies can be saved through cost-effective measures including quality care before, during and after childbirth, prevention and management of common infections, and kangaroo mother care and exclusive breastfeeding, WHO says.

Previous recommendations for preterm babies were for an initial period of separation from their primary caregiver, with the baby first stabilised in an incubator or warmer, for between three to seven days.

However, research has now shown that starting kangaroo mother care immediately after birth saves many more lives, reduces infections and hypothermia, and improves feeding.

Dr Karen Edmond, WHO’s medical officer for newborn health, said: “The first embrace with a parent is not only emotionally important, but also absolutely critical for improving chances of survival and health outcomes for small and premature babies.

“Through COVID-19 times, we know that many women were unnecessarily separated from their babies, which could be catastrophic for the health of babies born early or small,” she said.

“These new guidelines stress the need to provide care for families and preterm babies together as a unit, and ensure parents get the best possible support through what is often a uniquely stressful and anxious time.”

WHO’s new guidance is relevant also for high-income countries, and the authors say it calls for a rethink of how neonatal intensive care is provided, to ensure parents and newborns can be together at all times.

It recommends breastfeeding to improve health outcomes for preterm and low birthweight babies, with evidence showing it reduces infection risks compared to infant formula. If mother’s milk is not available, donor human milk is the best alternative, but fortified ‘preterm formula’ can be used if there are no donor milk banks.

The guidelines were released for World Prematurity Day yesterday 17 November.

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