The outcomes of preterm birth remain concerning in many countries: Approximately 11% of infants worldwide are born preterm, and preterm birth complications are still the leading cause of death among children under five years of age. This is why, in 2020 the WHO convened a Guideline Development Group (GDG) to examine evidence and formulate recommendations for the care of preterm or low birth-weight (LBW) infants. The 25 new WHO recommendations confirm the pivotal role of preventive and promotive care for preterm and LBW infants. They particularly emphasise the promotion of family involvement in the care for their preterm/LBW infant. In addition, the GDG generated research questions that will be critical for optimising the effectiveness and delivery of new WHO recommendations for the care of preterm/LBW infants in the future. The research questions (RQs) include unanswered research priorities for preterm/LBW infants from previous prioritisation processes.
Since preterm birth and LBW remain the top cause for under-five mortality, WHO felt obliged to act on this evidence. The last WHO recommendation on the care of preterm birth or LBW infants was made in 2015. Therefore, the Guideline Development Group (GDG) was engaged in 2020 to update the recommendations. Experts from all parts of the world and all interest groups were invited, including representatives for maternal and child health, governmental and non-governmental organisations, healthcare institutions, and parent groups. In November 2022, the GDG successfully defined 25 new recommendations and a good practice statement. Nearly half of the recommendations are new, highlighting the need and topicality of the recommendations update. The ultimate goal behind the new guidelines is to improve the newborns’ survival, health, and development.
WHO launched 25 updated recommendations for the care of preterm and low birth-weight infants
The 25 new recommendations focus on preventive and protective care, management of complications as well as family involvement and support. This includes guidelines for Kangaroo Mother Care, feeding and nutrition, continuous positive airway pressure (CPAP), family support, and parental leave. If you would like to find out more about the 25 new recommendations, you can find them here. Through this thematic focus, WHO acknowledges the importance of infant-parent bonding and family involvement in the care of preterm and LBW infants.
Defined research questions help to implement WHO recommendations
In order to support the implementation of the WHO recommendations, research questions (RQs) were developed by the GDG. They aim to optimise the effectiveness of the new recommendations and will make it easier to transfer the recommendations into praxis. Above all, the RQs serve as a basis to identify future research priorities in order to further influence and actualise the WHO guidelines.
The RQs were prioritised and ranked according to the likelihood that answering this question would impact change. Accordingly, the highest priority is given to questions that help close knowledge gaps, promote equity, improves the care of preterm or LBW infants, or influence public health. In addition, feasibility of implementation was also taken into account. A total of 36 priority RQs were identified.
The highest priority was given to the following questions:
- Which strategies can be used to increase family participation in the care for preterm/LBW infants?
- How can exclusive breastfeeding be promoted for preterm/LBW babies?
- What is the effectiveness of emollients on the infant’s development and mortality in low- and middle- income countries?
- What is the effectiveness of CPAP and other forms of non-invasive ventilation in improving mortality and morbidity of preterm/LBW infants?
Other high priority questions include the effectiveness of Kangaroo Mother Care and family support, probiotics, human milk banks and other forms of feeding, as well as home visits. This demonstrates the heavy orientation towards efficacy of interventions for preterm infants. Overall, the WHO recommendations and implementation with help of the RQs require adaptation at regional and country levels and training for healthcare professionals to ensure an expansion of evidence-based interventions for preterm/LBW infants.
Corresponding author: Department of Maternal, Newborn, Child and Adolescent Health and Ageing, World Health Organization
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