WHO advises urgent skin-to-skin care for the survival of small and premature infants

WHO launched today new guidelines to improve survival and health outcomes for babies born early (before 37 weeks’ gestation) or small (under 2.5 kg at birth).

The guidelines advise that skin-to-skin contact with the caregiver – known as kangaroo care – should begin immediately after birth, without any initial period in the incubator. This marks a significant change from earlier guidelines and common clinical practice, reflecting the enormous health benefits of ensuring that caregivers and their preterm infants can remain close, without separation, after birth.

The guidelines also make recommendations for providing emotional, financial and workplace support for families of very young and premature babies, who may face extreme stress and hardship due to intense caregiving demands and concerns about their babies’ health.

“Premature babies can survive, thrive and change the world – but every baby must be given that chance,” he said. WHO Director-General Dr. Tedros Adhanom Ghebreyesus. “These guidelines show that improving outcomes for these tiny babies is not always about providing the most advanced solutions, but about ensuring access to basic health care that is focused on the needs of the family.”

Premature birth is an urgent public health problem. It is estimated that every year around 15 million babies are born prematurely, which is more than 1 in 10 of all births in the world, and an even greater number – over 20 million babies – have a low birth weight. That number is growing, and prematurity is now the leading cause of death for children under the age of 5.

Depending on where they are born, there remain significant differences in a premature baby’s chances of survival. While the majority of those born at or after 28 weeks in high-income countries survive, in poorer countries survival rates can be as low as 10%.

Most premature babies can be saved with feasible, cost-effective measures including quality care before, during and after birth, prevention and treatment of common infections, and kangaroo-like maternal care – combining skin-to-skin contact in a special sling or wrap for as many hours as possible with the primary caregiver , usually by the mother, and exclusively by breastfeeding.

Because premature babies lack body fat, many have problems regulating their own temperature when they are born, and they often need medical help to breathe. For these babies, previous recommendations were for an initial period of separation from the primary caregiver, with the baby first being stabilized in an incubator or warmer. This would take about 3-7 days on average. However, research has now shown that initial care for the mother kangaroo immediately after birth saves many more livesreduces infections and hypothermia and improves feeding.

“The first hug with a parent is not only emotionally important, but absolutely critical to improving the chances of survival and health outcomes for infants and premature infants,” he said. dr. Karen Edmond, Medical Officer for Newborn Health at WHO. “We know that many women were unnecessarily separated from their babies during the time of COVID-19, which could be disastrous for the health of babies born early or small. These new guidelines emphasize the need to care for families and premature babies together as one unit, and to ensure that parents receive the best possible support through what is often a uniquely stressful and anxious time.”

While these new recommendations are particularly important in poorer communities that may not have access to high-tech equipment or even a reliable electricity supply, they are also relevant to high-income contexts. This requires rethinking the way neonatal intensive care is delivered, the guidelines say, to ensure parents and newborns can be together at all times.

Throughout the guidelines, breastfeeding is strongly recommended to improve health outcomes for preterm and low-birth-weight infants, with evidence showing that it reduces the risk of infection compared to infant formula. Where breast milk is not available, human donor milk is the best alternative, although fortified ‘premature formula’ can be used if no donor milk banks are available.

Integrating family feedback collected through more than 200 studies, the guidelines also advocate for increased emotional and financial support for caregivers. Parental leave is needed to help families care for the infant, the guidelines said, while government and regulatory policies and rights should ensure that families of premature and low-birth-weight babies receive sufficient financial and workplace support.

Earlier this year, the WHO published related recommendations on antenatal treatments for women with a high probability of premature birth. These include antenatal corticosteroids, which can prevent breathing difficulties and reduce health risks for premature babies, as well as tocolytic treatments to delay labor and allow time to complete the corticosteroid cycle. Together, these are the first updates to the WHO guidelines for preterm and low birth weight infants since 2015.

The guidelines were published ahead of World Prematurity Day, which is celebrated every year on November 17.