Approximately 11% of infants are born preterm, and complications of prematurity are the most common cause of death in children aged under five years. Almost one million preterm infants die each year across low, high and middle-income countries.
According to Dr N. Varsha Monica Reddy, Consultant Pediatric Neurologist, Yashoda Hospitals Hyderabad, new recommendations included preventive and promotive care (e.g., community and immediate KMC, probiotics, emollient therapy) as well as care for complications (continuous positive airway pressure and caffeine for respiratory support) and family involvement and support.
- Preterm or LBW infants should be exclusively breastfed (EBF) until 6 months of age.
- Kangaroo mother care (KMC) is recommended as routine care for all preterm or LBW infants. KMC can be initiated in facilities or at home and should be given for 8–24 hours per day (as many hours as possible).
- Mother’s own milk is recommended for feeding preterm or LBW infants, including those <32 weeks gestation.
- When the mother’s own milk is not available, donor human milk may be considered for feeding preterm or LBW infants, including those <32 weeks gestation.
- When the mother’s own milk and donor human milk are not available, preterm formula may be considered for babies <32 weeks gestation.
- Preterm and LBW infants, including those <32 weeks’ gestation or <1.5 kg at birth, should be fed as early as possible from the first day after birth. Infants who are able to breastfeed should be put to the breast as soon as possible after birth. Infants who are unable to breastfeed should be given an expressed mother’s own milk. If the mother’s own milk is not available, one can provide Micronutrients, Iron supplementation, Zinc supplementation, Vitamin D supplementation and Vitamin A supplementation.
- Calcium and phosphorous supplementation and multiple micronutrient supplementation: not recommended.
- Probiotics: Probiotics may be considered for human-milk-fed preterm infants <32 weeks’ gestation.
- Emollients: Application of topical oils to the body of preterm or LBW infants may be considered.
Families of preterm or LBW infants should be given extra support to care for their infants, starting in health-care facilities from birth, and continuing during follow-up post-discharge. The support may include education, counselling, discharge preparation from health workers, and peer support.
Home visits by trained health workers are recommended to support families in caring for their preterm or LBW infant.
Parental leave and entitlements should address the special needs of mothers and fathers of preterm or LBW infants.
Overall, the new WHO recommendations affirm the central role of family involvement and support and the importance of high-quality care for preterm term and LBW infants.
Parents should be able to:
Independently and confidently care for their infant; provide medications, nutritional supplements and any special medical care; recognize signs and symptoms of illness and respond appropriately, especially in emergency situations; and understand the importance of infection control measures and a smoke-free environment.
The discharge team must determine each family’s caregiving and psychosocial readiness for their infant’s discharge, including an assessment of the home environment. The family should receive predischarge education that includes safe sleep practices and SIDS prevention. Infant cardiopulmonary resuscitation training is highly desirable.
