WHO issues guidelines on interventions to improve preterm birth outcomes (November 2015)

The World Health Organization (WHO) has issued guidelines on interventions to improve preterm birth outcomes.

Key Messages:

Maternal Interventions

1. Antenatal corticosteroids to improve preterm outcomes

Antenatal corticosteroid therapy is recommended for women at risk of preterm birth from 24 weeks to 34 weeks of gestation when the following conditions are met:

  • gestational age assessment can be accurately undertaken;
  • preterm birth is considered imminent;
  • there is no clinical evidence of maternal infection;
  • adequate childbirth care is available (including the capacity to recognize and safely manage preterm labour and birth);
  • the preterm newborn can receive adequate care if needed (including resuscitation, thermal care, feeding support, infection treatment and safe oxygen use).

For eligible women, antenatal corticosteroid should be administered when preterm birth is considered imminent within 7 days of starting treatment, including within the first 24 hours.

Antenatal corticosteroid therapy is recommended for women at risk of preterm birth irrespective of whether a single or multiple birth is anticipated.

Antenatal corticosteroid therapy is recommended in women with

  • preterm prelabour rupture of membranes and no clinical signs of infection.
  • hypertensive disorders in pregnancy who are at risk of imminent preterm birth.
  • at risk of imminent preterm birth of a growth restricted fetus.
  • pre-gestational and gestational diabetes who are at risk of imminent preterm birth, and this should be accompanied by interventions to optimize maternal blood glucose control.

Either intramuscular (IM) dexamethasone or IM betamethasone (total 24 mg in divided doses) is recommended as the antenatal corticosteroid of choice when preterm birth is imminent.

A single repeat course of antenatal corticosteroid is recommended if preterm birth does not occur within 7 days after the initial dose, and a subsequent clinical assessment demonstrates that there is a high risk of preterm birth in the next 7 days.

Antenatal corticosteroid therapy is NOT recommended in women

  • with chorioamnionitis who are likely to deliver preterm.
  • undergoing planned caesarean section at late preterm gestations (34–36+6 weeks)

2. Tocolytics for inhibiting preterm labour

Tocolytic treatments (acute and maintenance treatments) are NOT RECOMMENDED for women at risk of imminent preterm birth for the purpose of improving newborn outcomes.

3. Magnesium sulfate for fetal protection against neurological complications

The use of magnesium sulfate is recommended for women at risk of imminent preterm birth before 32 weeks of gestation for prevention of cerebral palsy in the infant and child.

4,5. Antibiotics for preterm labour

Routine antibiotic administration is NOT RECOMMENDED for women in preterm labour with intact amniotic membranes and no clinical signs of infection.

Antibiotic administration is RECOMMENDED for women with preterm prelabour rupture of membranes:

  • Erythromycin is the recommended antibiotic of choice
  • The use of a combination of amoxicillin and clavulanic acid (“co-amoxiclav”) is NOT RECOMMENDED for women with preterm prelabour rupture of membranes.

6. Optimal mode of delivery

Routine delivery by caesarean section for the purpose of improving preterm newborn outcomes is NOT RECOMMENDED, regardless of cephalic or breech presentation.

7. Thermal care for preterm newborns

Kangaroo mother care is recommended for the routine care of newborns weighing 2000 g or less at birth, and should be initiated in health-care facilities as soon as the newborns are clinically stable.

Newborns weighing 2000 g or less at birth should be provided as close to continuous Kangaroo mother care as possible.

Intermittent Kangaroo mother care, rather than conventional care, is recommended for newborns weighing 2000 g or less at birth, if continuous Kangaroo mother care is not possible.

Unstable newborns weighing 2000 g or less at birth, or stable newborns weighing less than 2000 g who cannot be given Kangaroo mother care, should be cared for in a thermoneutral environment either under radiant warmers or in incubators.

10. Oxygen therapy and concentration for preterm newborns

During ventilation of preterm babies born at or before 32 weeks of gestation, it is recommended to start oxygen therapy with 30% oxygen or air (if blended oxygen is not available), rather than with 100% oxygen.

The use of progressively higher concentrations of oxygen should only be considered for newborns undergoing oxygen therapy if their heart rate is less than 60 beats per minute after 30 seconds of adequate ventilation with 30% oxygen or air.

NOTE: Recommendations 8 and 9 have been omitted from this article. They concern Positive pressure ventilation and surfactant therapy, respectively.

Useful Links:

Link to the guideline document (PDF):

http://apps.who.int/iris/bitstream/10665/183037/1/9789241508988_eng.pdf?ua=1

Link to the evidence base for the recommendations (PDF):

http://apps.who.int/iris/bitstream/10665/183038/1/WHO_RHR_15.17_eng.pdf?ua=1

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