Health problems as a result of being born too early are the biggest cause of death for children under age 5, a global report on preterm births has found.
It’s the first time in history that premature birth has outranked other killers of young children such as pneumonia, diarrhea and other diseases, according to findings published Monday in the journal the Lancet.
Part of the shift is because of international success treating infectious diseases through immunization, antibiotics and prevention of HIV transmission, which has brought those death rates down dramatically, noted the research team from Johns Hopkins Bloomberg School of Public Health, the World Health Organization and the London School of Hygiene and Tropical Medicine.
At the same time, however, “we have an epidemic of preterm and newborn deaths that represents one of the greatest health challenges of the 21st century,” Dr. Andres de Francisco of the global Partnership for Maternal, Newborn and Child Health, said in a statement.
The Lancet study found that in Canada, 29 per cent of deaths under age 5 were a result of preterm birth complications, placing it among the 20 worst countries in the list of 162. The rate was 28 per cent in the United States.
However, Canadian physicians cautioned the numbers don’t paint a full picture because of variations in how births are registered around the world and lack of reliable data in many countries.
“The temptation is to flag Canada as one of the worst countries but in fact, that’s not how these tables should be interpreted,” said Dr. Dorothy Shaw, vice-president of medical affairs at B.C. Women’s Hospital and a leading advocate for global maternal and infant health.
Statistics for deaths under 5 are based only on estimates in many countries, she said. And even among developed countries, live births are measured differently. Some countries only include infants who breathe spontaneously. In Canada, any sign of life is considered a live birth.
Earlier studies have also suggested that Canada’s poor rankings on international child health indexes by organizations such as the OECD are a result of the absence of standardized measurements.
However, the upward trend in premature births is worrisome, said Toronto neonatologist Dr. Shoo Lee, a scientific director with the Canadian Institutes of Health Research.
“In Canada preterm birth, like elsewhere in the world, is becoming an increasingly important issue.”
The rate has jumped 30 per cent in the past 20 years, he said, driven primarily by the fact that women are having babies at older ages and assisted reproduction has exploded. Both boost risks of premature birth and related complications.
Currently one in every 12 babies born in Canada is premature, and it is the leading cause of infant mortality (death in the first 12 months). Preterm birth is also the leading cause of cerebral palsy, said Lee.
The health and economic implications of this trend are huge because, along with immediate medical needs, many of those babies have long-term conditions such as developmental or physical disabilities that require care and resources for them and their families for many years.
In the last three years, the number of babies born at 25 weeks gestation or less has increased by 50 per cent, Lee said.
“The good news is that our ability to treat these babies has improved and outcomes have improved a lot.”
Over the past three years, neonatal intensive care units across the country have adopted new standards of care that have resulted in 25 per cent fewer deaths, said Lee.
But there are still major gaps in the system, according to the Canadian Premature Babies Foundation.
“It’s important to find out why (the increase) is happening, and can we reverse the trend,” says founder and president Katharina Staub of Edmonton.
Six years ago at age 42, Staub went through the trauma of delivering twins at 27 weeks pregnancy. Her son and daughter, now in Grade 1, spent their first 10 weeks of life in hospital.
She launched the non-profit two years ago to advocate for more research and education and to give a voice to families. It recently released an extensive report with recommendations to address prematurity in Canada and gaps in care for infants and their families.
Monday’s Lancet report noted that globally, two-thirds of preterm deaths could be prevented without intensive care.
A few basic steps can make a significant difference in developing countries, says Dr. Dorothy Shaw of B.C. Women’s, who is also a former president of the International Federation of Gynecology and Obstetrics.
Those include: ensuring the umbilical cord is cut with sterilized equipment; keeping babies warm through skin-to-skin contact with the mother or father, known as “kangaroo care;” and encouraging early and exclusive breastfeeding.
“Those are really easy low-tech, low-cost interventions that can be made in the community,” Shaw said in an interview from Vancouver, noting that the Canadian Network for Maternal, Newborn and Child Health has been instrumental in promoting these strategies.
Encouraging intervals of roughly two years between pregnancies for women under 35 and focusing on nutrition not just for pregnant women but all girls and women would also reduce risks of preterm birth, she said.