World leading experts from Sheffield Teaching Hospitals NHS Foundation Trust and the University of Sheffield have received a £2 million Global Health grant from the National Institute for Health Research to help transform the management and prevention of preterm birth in some of the world’s poorest countries.
Around 15 million babies are born prematurely each year, a number which is rising globally. Three-quarters of these births occur in lower income countries. Complications arising from preterm birth are the leading cause of death in children under five, with survival rates and outcomes much poorer in lower income countries.
However, research into the optimal neonatal and maternal management and care of preterm babies in lower income countries is limited, with few clinical guidelines in place to support healthcare professionals in poorer countries with their care.
There is a dramatic difference in survival of premature babies depending on where they are born, and in lower income countries preterm babies are routinely sent home at a gestational age of 32 or 34 weeks, which leaves them at greater risk of life-threatening conditions such as sepsis and dehydration. Often preterm babies born in lower income countries are poor feeders, too, and many will die due to a lack of basic care, infections and breathing difficulties.
Led by Professor Dilly Anumba, a consultant in obstetrics and gynaecology at Sheffield Teaching Hospitals NHS Foundation Trust, and professor of obstetrics and gynaecology at the University of Sheffield’s Academic Unit of Reproductive and Developmental Medicine, the team of researchers will undertake the first ever in-depth study investigating why the incidence of preterm birth is much higher in lower income countries.
The research will look at what global guidelines exist on neonatal and maternal care for preterm babies and what the barriers are to introducing simple cost-effective interventions which are known to give significant neonatal and maternal benefit in countries such as Africa. This includes the use of delayed umbilical cord clamping and kangaroo or skin-to-skin care.
As well as conducting medical research as to how mothers with preterm babies look after babies with low birth weight, the team will visit slum communities to gather first-hand views from both women and men about their knowledge of preterm birth, what they think of care they may have received and what they feel should have been done to prevent complications arising from preterm birth in their communities.
Professor Dilly Anumba, whose team is also leading on the development of a new device which could accurately predict a woman’s risk of preterm birth at the 20-week antenatal scan, said: “Preterm birth is a global health problem, and in the lower income countries many preterm babies weighing less than 5lbs will die at home simply from a lack of basic care. We are hugely honoured to have been awarded this Global Health grant which could change so much for so many underprivileged people.
“Our research will focus on the communities in countries with limited resources where there are highest rates of preterm birth but the least expertise, and as well as providing training to medical counterparts in how to care for neonatal babies we will be informing new research and the development of context-specific guidelines for preterm birth in deprived areas by exploring lifestyle interventions that can be given to women who suffer with preterm births while still caring for a child who is under six months old.”
The team will also investigate the placentas of mothers who have delivered preterm babies in lower income countries and compare them with those born at Sheffield’s Jessop Maternity Wing. This will enable them to find out what specific infections may contribute to the higher chance of preterm birth in the lower income countries, and recommend vaccinations and treatments to improve child survival rates as well as reduce preterm birth risk.
In low-income settings, half of the babies born at or below 32 weeks (two months early) die due to a lack of feasible, cost-effective care, such as warmth, breastfeeding support, and basic care for infections and breathing difficulties. In high-income countries, almost all of these babies survive.
The research is due to be completed by 31 March 2021, with the team expected to visit and work in collaboration with hospitals and universities in South Africa, Bangladesh and Nigeria.
