title: Preventing newborn deaths due to prematurity.
abstract: Preterm births (PTBs), defined as births before 37 weeks of gestation account for the majority of deaths in the newborn period. Prediction and prevention of PTB is challenging. A history of preterm labour or second trimester losses and accurate measurement of cervical length help to identify women who would benefit from progesterone and cerclage. Fibronectin estimation in the cervicovaginal secretions of a symptomatic woman with an undilated cervix can predict PTB within 10 days of testing. Antibiotics should be given to women with preterm prelabour rupture of membranes but tocolysis has a limited role in the management of preterm labour. Antenatal corticosteroids to prevent complications in the neonate should be given only when gestational age assessment is accurate PTB is considered imminent, maternal infection and the preterm newborn can receive adequate care. Magnesium sulphate for fetal neuroprotection should be given when delivery is imminent. After birth, most babies respond to simple interventions essential newborn care, basic care for feeding support, infections and breathing difficulties. Newborns weighing 2000 g or less, benefit from KMC. Babies, who are clinically unstable or cannot be given KMC may be nursed in an incubator or under a radiant warmer. Treatment modalities include oxygen therapy, CPAP, surfactant and assisted ventilation.
authors.affiliation: Perinatal Care Project, Diabetic Association of Bangladesh, 122 Kazi Nazrul Islam Avenue, Dhaka 1000, Bangladesh. Electronic address: kishwar.azad@gmail.com.
authors.forename: Kishwar
authors.initials: K
authors.lastname: Azad
authors.affiliation: Department of Obstetrics & Gynaecology, Christian Medical College, Ida Scudder Road, Vellore 632 004, India.
authors.forename: Jiji
authors.initials: J
authors.lastname: Mathews
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D001942:Breast Feeding; D045422:Continuous Positive Airway Pressure; D005260:Female; D005322:Premature Rupture of Fetal Membranes / Q000628:therapy*; D006801:Humans; D007035:Hypothermia / Q000517:prevention & control; D007186:Incubators, Infant; D007231:Infant, Newborn; D007234:Infant, Premature; D060127:Kangaroo-Mother Care Method; D008278:Magnesium Sulfate / Q000627:therapeutic use*; D007752:Obstetric Labor, Premature / Q000628:therapy*; D010102:Oxygen Inhalation Therapy; D066087:Perinatal Death / Q000209:etiology / Q000517:prevention & control*; D011247:Pregnancy; D047928:Premature Birth / Q000517:prevention & control*; D011663:Pulmonary Surfactants / Q000627:therapeutic use; D015149:Tocolytic Agents / Q000627:therapeutic use*
chemical_list: D000900:Anti-Bacterial Agents; D011663:Pulmonary Surfactants; D015149:Tocolytic Agents; D008278:Magnesium Sulfate
keywords: KMC; antenatal corticosteroids; cerclage; essential newborn care; preterm birth; surfactant