A detailed study from Malawi, published in this week's PLoS Medicine, shows that during the first 2 years of life, infants who were born prematurely (before 37 weeks gestation) continue to have a higher risk of death than infants born at term and are also more likely to have poorer growth and developmental delay.
The authors, led by Nynke Van Den Broek from the Liverpool School of Tropical Medicine, and Melissa Gladstone, from the University of Liverpool say that their findings show that in addition to interventions in the immediate neonatal period, a focus on early childhood is needed to improve outcomes for infants born prematurely in low-income settings.
In their study of 2,297 pregnant women in southern Malawi, the authors compared 247 infants born preterm with 593 infants born at term and found that premature infants were 1.79 times more likely to die than term infants: 27 (10.9%) preterm babies died compared to 37/593 (6.2%) term babies. Furthermore, at 12, 18, and 24 months follow up, the authors found that surviving preterm infants were more likely to be underweight and have higher rates of disability and developmental delay.
The authors say: "To date, interventions in low-income settings to reduce neonatal morbidity and mortality have targeted the perinatal period. Our data show that, for preterm babies who survive the immediate neonatal period, there is ongoing disadvantage with increased risk of death, growth retardation, and developmental delay. "
They continue: "Further detailed qualitative and longitudinal studies to assess the causal mechanisms for these problems would be extremely beneficial. Along with these studies, post-neonatal interventions need to be trialled that might improve outcomes in this group of preterm born children."
Funding: This study was funded by the Wellcome Trust (project grant 065810/Z/01/Z) http://www.wellcome.ac.uk/Funding/International/Global-health-research/index.htm. No funding bodies had any role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.
Competing Interests: The authors have declared that no competing interests exist.
Citation: Gladstone M, White S, Kafulafula G, Neilson JP, van den Broek N (2011) Post-neonatal Mortality, Morbidity, and Developmental Outcome after Ultrasound-Dated Preterm Birth in Rural Malawi: A Community-Based Cohort Study. PLoS Med 8(11): e1001121. doi:10.1371/journal.pmed.1001121
CONTACT:
Melissa Gladstone
University of Liverpool
Institute of Child Health, School of Reproductive and Developmental Medicine
Alder Hey Children's NHS Foundation Trust
Eaton Road
Liverpool, Merseyside L12 2AP
United Kingdom
M.J.Gladstone@liverpool.ac.uk; mgladstone@btinternet.com
Nynke Van Den Broek
Maternal & Newborn Health Unit
Liverpool School of Tropical Medicine
Pembroke Place
Liverpool, L35QA
United Kingdom
vdbroek@liverpool.ac.uk
Journal
PLoS Medicine