Prevention of Preterm Birth and Complications outlines key definitions, numbers, and interventions related to preterm birth. It begins with defining preterm birth as babies born alive before 37 completed weeks of pregnancy. It then presents a strategic three-phase approach and discusses how preterm birth is connected to other maternal and child health outcomes. The document reviews evidenced-based interventions to manage preterm birth like antenatal corticosteroids and antibiotics for premature prelabor rupture of membranes. It also discusses interventions for caring for preterm newborns and ways to prevent preterm birth like birth spacing and treating infectious diseases.
Adolescent Sexual and Reproduction Health PresentationDeepak TIMSINA
ADRA worked to scale-up ASRH programme in Kalikot District through its Strengthening Reproductive Health (SRH) project. I worked as a 'Training Officer' in ADRA from 2012-2013.
If someone says the word “Herpes”, everyone cringes. Surprisingly, about 2/3 of you reading
this now, may have had HSV 1 (the type that causes cold sores), and about 20% of you may
have had the genital type of Herpes (HSV2).
In this ppt, I have discussed some special cases when a mother may be unsure if and how to breast feed her infant. In these special conditions, what should a doctor advise
Mother-to-child transmission of HIV (MTCT) is the main route by which infants acquire HIV infection globally. In 2010, children living with HIV in Nigeria contributed 15.3% to the 370,000 infected children worldwide, thus, the region with the highest number of unprotected childhood infection. This accounts for about 90% of HIV infection in children below 15 years of age.Most children below 15 years living with HIV contract diseases through MTCT (FMoH, 2010)
Overall incidence of MTCT without intervention is 20%-45% distributed over
-Antenatal period
-Labour & Delivery
-Breastfeeding
Without intervention,
About 30% of infants of HIV infected mothers will be infected during pregnancy and delivery
An additional 5-20% will also be infected through breastfeeding practices.
Adolescent Sexual and Reproduction Health PresentationDeepak TIMSINA
ADRA worked to scale-up ASRH programme in Kalikot District through its Strengthening Reproductive Health (SRH) project. I worked as a 'Training Officer' in ADRA from 2012-2013.
If someone says the word “Herpes”, everyone cringes. Surprisingly, about 2/3 of you reading
this now, may have had HSV 1 (the type that causes cold sores), and about 20% of you may
have had the genital type of Herpes (HSV2).
In this ppt, I have discussed some special cases when a mother may be unsure if and how to breast feed her infant. In these special conditions, what should a doctor advise
Mother-to-child transmission of HIV (MTCT) is the main route by which infants acquire HIV infection globally. In 2010, children living with HIV in Nigeria contributed 15.3% to the 370,000 infected children worldwide, thus, the region with the highest number of unprotected childhood infection. This accounts for about 90% of HIV infection in children below 15 years of age.Most children below 15 years living with HIV contract diseases through MTCT (FMoH, 2010)
Overall incidence of MTCT without intervention is 20%-45% distributed over
-Antenatal period
-Labour & Delivery
-Breastfeeding
Without intervention,
About 30% of infants of HIV infected mothers will be infected during pregnancy and delivery
An additional 5-20% will also be infected through breastfeeding practices.
Newborn survival and perinatal health in resource-constrained settings in Asia and the Pacific: Applying Global Evidence to Priorities Beyond 2015
12 April 2013
prophylactic encerclage for multiple pregnancy is always debated.in this presentation cerclage for MFG is favored as there was a debate in recently held KSOGA conference at manipal on 3-11-11.
Presented by Gunta Lazdane, Programme Manager, Sexual and Reproductive Health, WHO/Europ , at the 64th session of the WHO Regional Committee for Europe.
Delhi IVF Fertility & Research Centre in IndiaDelhi IVF
Delhi-IVF Fertility & Research Centre in India was established in the year 1994 by Dr. Anoop Gupta (an expert consultant and specialist in infertility management) together with a small and dedicated team committed to provide the best fertility care, IVF, Surrogacy, Egg Donation and Infertility Clinic in India.
This presentation is part of and education series to pediatric healthcare providers in Syria and it may be useful to all practitioners working in low resource settings.
Professor Soo Downe presenting at the Doctoral Midwifery Research Society Alcohol & Medication in Pregnancy Conferene about 'Which horse for which courses? The EBM Problem in studies of pharmacological substances in maternity care'.
Invited lecture by Dr Sujoy dasgupta in the Annual Conference of the "Academy of Clinical Embryologists" (ACE) held in October 2021 in "Hybrid mode" (Kolkata and Webinar)
Preterm labor is defined as the onset of labor before 37 weeks of gestation. It is a leading cause of neonatal morbidity and mortality, and can lead to long-term health problems for the baby. Risk factors for preterm labor include a history of preterm labor or delivery, multiple gestations, cervical incompetence, uterine anomalies, and infections.
Symptoms of preterm labor can include regular contractions, pelvic pressure or pain, backache, vaginal bleeding or discharge, and a change in vaginal discharge. If preterm labor is suspected, immediate medical attention is required. Treatment may include medications to stop or slow down labor, steroid injections to help speed up fetal lung development, and bed rest.
Prevention of preterm labor can be achieved through good prenatal care, including regular prenatal visits, proper nutrition, and management of underlying medical conditions. Avoiding certain risk factors, such as smoking and substance abuse, can also help reduce the risk of preterm labor.
In cases where preterm labor cannot be prevented, the goal is to delay delivery as long as possible to give the baby the best chance of survival and good health. This may involve hospitalization for bed rest, medication, and close monitoring of the mother and baby.
Preterm labor is a serious and potentially life-threatening complication of pregnancy, but with appropriate management and early intervention, the risk of morbidity and mortality can be minimized.
Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
Dr Sujoy Dasgupta presented the study on "Couples presenting to the infertility clinic- Do they really have infertility? – The unexplored stories of non-consummation" in the 13th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2024) at Manila on 24 May, 2024.
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
Anti ulcer drugs and their Advance pharmacology ||
Anti-ulcer drugs are medications used to prevent and treat ulcers in the stomach and upper part of the small intestine (duodenal ulcers). These ulcers are often caused by an imbalance between stomach acid and the mucosal lining, which protects the stomach lining.
||Scope: Overview of various classes of anti-ulcer drugs, their mechanisms of action, indications, side effects, and clinical considerations.
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
Evaluation of antidepressant activity of clitoris ternatea in animals
Preterm Birth Interventions_James Litch_10.16.13
1. Prevention of Preterm Birth and
Complications: Evidence for Interventions
and Opportunities for Action
James A. Litch, MD, DTMH
Director, Perinatal Interventions Program
Global Alliance for Prevention of Prematurity and Stillbirth (GAPPS)
Clinical Assistant Professor
Department of Global Health
Department of Epidemiology
University of Washington
jlitch@yahoo.com
2. Outline
•
•
•
•
Definitions and numbers
Strategic approach
Interventions to manage preterm birth
Interventions for care the preterm
newborn
• Interventions to prevent preterm birth
• Ready for Implementation?
4. Born Too Soon Report
What is preterm birth?
Definition of preterm birth:
Babies born alive before 37
completed weeks of
pregnancy
Source: Chap 5, Born Too Soon
erm
ret
p
te
era
od ks
m
nd wee
a
ate <37
L to
32
%
84
Very preterm
28 to <32 weeks
10%
Ex
< 2 trem
5% 8 w ely
ee pre
ks
ter
m
5. Born Too Soon Report
Annual births by gestation age
Source: Analysis using data from Blencowe et al., 2012; Cousens et al., 2011; Liu et
al., 2012
Source: Chap 5, Born Too Soon
7. Connected MNCH Outcomes
ConnectedMNCH Outcomes
Require aan Interdisciplinary Approach
Requires New, Interdisciplinary Approach
Preterm birth and stillbirth are
Maternal
Maternal
inextricably linked with maternal,
newborn, child and RH health.
Child
Prematurit
preterm births and stillbirths will
y&
accelerate efforts toward
Stillbirth
Interventions aimed at reducing
Child
Prematurity
& Stillbirth
Fetal
achieving MDGs 4 and 5.
Newborn
Newborn
Reproductive
Health
8. Three-phase Approach to
Preterm Birth
Image from Healthy Newborn Network Technical Guidance for Program Implementation
http://www.healthynewbornnetwork.org/resource/technical-guidance-program-implementation
9. Preterm Birth as a direct cause of neonatal deaths –
change between 2000 to 2010
10. Causes of Death Due to Preterm Birth
Underlying Pathology
Cause of Death
Lung immaturity
Hypoxia
Acute respiratory distress syndrome (ARDS)
Inability to tolerate labor
Birth asphyxia
Poor temperature regulation
Hypothermia
Infection
Sepsis
Pneumonia
Poor feeding
Hypoglycemia
Dehydration
Pour weight gain
11. Additional risks specific to preterm newborns
• Hypoglycemia/dehydration/under-nutrition from feeding difficulties - coordinated suck and
swallow process only starts at 34 weeks
• Thermal instability - surface area to mass and metabolic issues
• Severe infections more common, and higher risk of dying infection
• Respiratory Distress Syndrome due to lung immaturity and lack of surfactant
• Jaundice - immature liver cannot easily metabolize bilirubin, and brain is at higher risk since
their blood-brain barrier is less well developed.
• Brain injury is most commonly intraventricular hemorrhage, occurring in the first few days after
birth in about 1 in 5 babies <2,000 g.
• Necrotizing enterocolitis affecting the intestinal wall of very premature babies. Formula feeding
increases risk tenfold compared to BF milk alone (Schanler, 2001).
• Retinopathy of prematurity if given too high levels of oxygen.
17. Born Too Soon Report
Potential for lives saved through steroid injections for
women in preterm labor
Respiratory complications due to lung immaturity (RDS) are the
commonest cause of death in preterm babies.
Single course of antenatal steroids to women in preterm labour:
•31% Mortality reduction (RR 0.69, 95% CI 0.58 to 0.81) for babies in
settings where ventilation (+/-surfactant) is standard of care (Cochrane
review)
•53% reduction in mortality in 4 studies in middle income countries (RR 0.47,
95% CI 0.35 to 0.64)
Dexamethasone is low cost (<$1) and available in many
settings but low coverage in low and middle income
settings
One of the 13 priority medicines listed by UN Commodities
Commission
Could save about 400,000 babies each year if reached 95% of
women in preterm labor (LiST analysis)
Source: Chap 6 , Born too soon,
18. ACS: Clinical Guidelines
•
WHO recommended treatment
– Single dose for pregnant women who are:
• between 26 and 35 weeks gestational age, and
• At risk of preterm delivery within 7 days
– Dexamethasone 6 mg IM 4 doses 12 hours apart*
– Betamethasone 12 mg IM, 2 doses 24 hours apart
•
•
•
Insufficient evidence to justify multiple courses or a single
rescue course of ANC at this time
Partial or incomplete regimen may provide some benefit
Major barrier to implementation is identifying women at risk
or preterm labor in time to administer drug
Hofmeyer GJ. Antenatal corticosteroids for women at risk of preterm birth: RHL commentary. The WHO
Reproductive Health Library; Geneva, WHO.
Bonanno C, Wapner RJ. Antenatal Corticosteroids an the management of preterm birth: are we back where we
started? 2012 Obstet Gynecol Clin N Am; 39:47-3-62.
19. Born Too Soon Report
Potential for lives saved through antibiotics for premature
prelabor rupture of the membranes (pPROM)
- In high-income countries, it is standard practice to give antibiotics to women
with pre-term, pre-labour rupture of membranes (pPROM) to delay birth and
reduce the risk of infection.
- In LMICs use of antibiotic therapy for pPROM is not common
- Reviewed 18 RCTs (most from HIC) that provide strong evidence that
antibiotics for pPROM:
- Reduced risk of RDS [risk ratio (RR) = 0.88; confidence interval (CI)
0.80, 0.97],
- Reduced risk of early onset postnatal infection (RR = 0.61; CI 0.48,
0.77).
- Reduction in neonatal mortality (RR = 0.90; CI 0.72, 1.12).
- In LMICs where access to other interventions (antenatal steroids, surfactant
therapy, ventilation, antibiotic therapy) may be low, antibiotics for pPROM
could prevent 4% of neonatal deaths due to complications of prematurity
and 8% of those due to infection.
Could save about 12% of PT babies each year if reached 95%
of women in preterm labor (LiST analysis)
Cousens S, et al. Antibiotics for preterm pre-labor rupture of membranes. International Journal of
Epidemiology 2010;39:i134–i143.
20. Antibiotics for premature prelabor
rupture of the membranes (PROM)
Lack of data from low-income countries, where
newborns have less access to appropriate PT care.
In the absence advance PT interventions, the use of
antibiotics for pPROM will certainly prevent neonatal
deaths by preventing RDS.
Similarly, in settings with poor access to antibiotic
therapy for neonatal infections, the prevention of
sepsis cases through the use of antibiotics for
pPROM will certainly prevent infection deaths.
Cousens S, et al. Antibiotics for preterm pre-labor rupture of membranes. International Journal of
Epidemiology 2010;39:i134–i143.
21. Delayed chord clamping
Wait 2-3 minutes, or until chord stops pulsating,
while keeping baby below level of placenta
There are different potential comparative effects
of early rather than delayed cord clamping for
term and preterm infants.
In term infant, increasing placental transfusion by
delaying cord clamping may increase respiratory
morbidity after birth (Yao 1974).
What about for PTB less than 37 weeks?
Born Too Soon: The Global Action Report on Preterm Birth. World Health Organization. Geneva, 2012
Roberts d, Dalziel SR. Antenatal corticosteroids for accelerating fetal lung maturation for women at risk
of preterm birth. Cochrane Reviews 2006. 3.
22. Born Too Soon Report
Potential for decrease morbidity and transfusions
through delayed chord clamping for PTB < 37 weeks
Fifteen studies (738 infants) were eligible for inclusion. Participants were
between 24 and 36 weeks’ gestation at birth. The maximum delay in cord
clamping was 180 seconds. Delaying cord clamping, compared to
immediate clamping, was associated with:
- Fewer infants requiring transfusions for anaemia (seven trials, 392
infants; risk ratio (RR) 0.61, 95% confidence interval (CI) 0.46 to 0.81)
- Less intraventricular haemorrhage (ultrasound diagnosis all grades) 10
trials, 539 infants (RR 0.59, 95% CI 0.41 to 0.85)
- Lower risk for necrotising enterocolitis (five trials, 241 infants, RR 0.62,
95% CI 0.43 to 0.90)
For primary outcomes of infant death, severe intraventricular hemorrhage
and periventricular leukomalacia there were no clear differences identified
between groups
Decreased complications and reduced transfusion
needs if reached 95% of preterm newborns
Source: Effect of timing of umbilical cord clamping and other strategies to influence placental
transfusion at preterm birth on maternal and 15 infant outcomes (2012 Cochrane Review)
23. Delayed chord clamping for PTB < 37 weeks
•
•
•
Developing countries, with limited resources
and a high risk of transmitting infection through
blood transfusion
Potential value of a reduced need for blood
transfusion.
In more developed countries, 60% to 80% of
preterm infants less than 32 completed weeks’
gestation (Brune 2002; Ringer 1998) require
transfusion
Born Too Soon: The Global Action Report on Preterm Birth. World Health Organization. Geneva, 2012
Roberts d, Dalziel SR. Antenatal corticosteroids for accelerating fetal lung maturation for women at risk
of preterm birth. Cochrane Reviews 2006. 3.
24. Resuscitation for preterm baby
- Premature births have higher risk of hypoxic brain
injury and retinopathy from oxygen administration.
- Some 10% of newborns require assistance to begin
breathing, more for preterm babies
- ¾ of these require only basic resuscitation with bag
and mask or tube and mask to initiate breathing
- Assisted ventilation with room air is equivalent to
using oxygen (Saugstad et al, 2006)
- Premature babies at great risk for RDS and may
require ventilation support with CPAP
25. Emollient ointment for preterm newborn
- Topical application of emollient
ointment (sunflower oil or
Aquaphor/Petrolatum 41%)
- Reduces water loss, dermatitis and risk
of sepsis (Soll and Edwards, 2000)
- Limited hospital-based trials in Egypt
and Bangladesh (reduced mortality)
- High potential and has application in
facilities and homes
26. Chlorhexidine topical application
- Topical application of 7.1% chlorhexidine digluconate
solution/gel to chord before 24 hours of birth
(continue up to 7 days)
- Reduces chord stump infection and risk of sepsis
(Tielsch et al, 2007, Scoofi et al, 2012, Arifeen et al,
2012)
- Community trials in Asia and Africa
- Greater reduction of mortality among preterm
newborns (Arifeen et al 2012)
27. Clean birth practices for preterm newborn
- Consistent hand washing and maintaining a clean
environment
- Premature births have higher risk of sepsis.
- Included in:
- Continuous skin to skin care package (KMC)
- Clean birth kits
28. Born Too Soon Report
Potential for lives saved through continuous skin-to-skin care
Baby is tied skin to skin with mother 24 hours a day
for days/weeks providing:
•thermal care
•increased breastfeeding, better weight gain
•links to additional supportive care, if needed, and
•earlier discharge
Mortality reduction 51% for babies < 2000 gm, in
facilities, clinically stable and started within one week
compared to incubator care
Effective entry point for care of preterm babies
Could save about 450,000 babies each year
if reached 95% of preterm babies (LiST analysis)
Chap 5, Born too Soon.
Impact data from Lawn et al ‘Kangaroo mother care’ to prevent neonatal deaths due to preterm birth
complications. Int J Epid: 2010,
Conde Aguedelo Cochrane review 2011
29. Feeding Support
- Early initiation of breast feeding within one hour after birth
reduces (Edmond et al, 2006)
- Premature newborns benefit nutritionally, immunologically
and developmentally (Callen and Pinelli, 2005)
- Formula feeding increases risk of necrotizing enterocolitis
and improved neurodevelopmental outcome (Edmond et
al, 2007; Hurst, 2007)
- Extra feeding support with a cup, spoon or other device
(especially <34 weeks)
- Support mother expressing milk or provide donor milk
- Milk banking is option in some areas of Africa
30. Likely to work – but lacking evidence for preterm lives saved
-
Birth preparedness
Danger signs awareness
Monitoring of labor
Transportation / referral arrangements
Mother/Baby friendly care (patient centered respectful care)
Postnatal care vouchers
31. Prevention of preterm birth
Care before and between pregnancy
Implement:
• Family planning strategies, including birth
spacing and provision of adolescent-friendly
services
• Prevention and management of STIs and
NCDs
• Education and interventions for domestic
violence
• Promotion of healthy nutrition and addressing
life-style risks like smoking and substance
abuse
Source: Born Too Soon
34. Estimated Lives Saved of Premature Babies in Settings
with Universal Coverage of Basic Interventions (without
NICU)
520,000 lives (55%) of premature babies could be saved if adequate
management of preterm labor and birth.
760,000 lives (80%) saved if family planning included in model. 34
35. Thank you
Global Alliance to Prevent Prematurity
and Stillbirth (GAPPS) leads a
collaborative, global effort to increase
awareness and accelerate innovative
research and development to make
every birth a healthy birth.
jlitch@yahoo.com
james.litch@seattlechildrens.org
35
36. Important Resources
Global report on preterm birth & stillbirth: the
foundation for innovative solutions and
improved outcomes
www.biomedcentral.com/bmcpregnancychildbirth/supplements/
Born Too soon: The Global Action Report on
Preterm Birth
www.who.int/pmnch/media/news/2012/preterm_birth_report/en/index.html
Essential Interventions, Commodities and
Guidelines for Reproductive, Maternal,
Newborn and Child Health
www.who.int/pmnch/topics/part_publications/201112_essential_interventions/en/in
37.
38. Interventions for preterm birth and stillbirth
along the continuum of care
PTB Intervention
PREPREGNANCY
•Family planning/
birth spacing
•Prevent & treat
sexually transmitted
infections
•Nutrition
PREGNANCY
•Prevent & treat
sexually
transmitted
infections
•Nutrition
BIRTH
•Antenatal steroids
•Antibiotics for
pPROM
•Delayed chord
cutting
•Identify preterm
babies
POSTNATAL/
NEWBORN
CHILDHOOD
•Essential & Extra care
•Chlorhexidine
•Kangaroo Mother Care
•Management of sick
newborns
•Neonatal resuscitation
•Appropriate oxygen use
•Ventilation support
•Postnatal followup
Editor's Notes
"Prevention of Preterm Birth and Complications: So What? Evidence for interventions and opportunites for action"
This presentation will present a practical approach to the prevention of preterm birth and complication by focussing on the evidence that supports a priority list of ready interventions and approaches to implementation, that leverage existing program investments, policy environments and resources.
5, 10 and 85%
Maternal, fetal, newborn and child health are all linked. Prematurity and stillbirth interventions, many of which are directed toward the mother, will help improve all of these health outcomes. (click) These connected outcomes require a new, interdisciplinary approach.
The point of this slide - We’ve made great strides in improved management in NICU care in industrialized countries --- but basic services for late preterm deliveries would address the majority of preterm-related deaths
The point of this slide - We’ve made great strides in improved management in NICU care in industrialized countries --- but basic services for late preterm deliveries would address the majority of preterm-related deaths
Feeding difficulties since the coordinated suck and swallow process only starts at 34 weeks gestation. Preterm babies need help to feed and are more likely to aspirate.
Severe infections are more common, and premature babies are at higher risk of dying once they get an infection. The majority of babies who die from neonatal sepsis are preterm.
Respiratory Distress Syndrome due to lung immaturity and lack of surfactant in the alveoli, resulting in collapsing lungs that take extra pressure to inflate. Below 32 weeks gestation, the majority of babies develop RDS, although this risk can be reduced by antenatal corticosteroids injections to women at risk or preterm labor, or in preterm labor.
Jaundice is more common in premature babies since the immature liver cannot easily metabolize bilirubin, and once jaundiced, the preterm baby’s brain is at higher risk since their blood-brain barrier is less well developed to protect the brain.
Brain injury in preterm babies is most commonly intraventricular hemorrhage, occurring in the first few days after birth in about 1 in 5 babies under 2,000 g and is often linked to severity of RDS and hypotension. Less commonly, preterm babies may have hypoxic brain injury with white matter loss which differs from that seen in the brain of term babies (Volpe, 2009).
Necrotizing enterocolitis is a rarer condition affecting the intestinal wall of very premature babies, with a typical X-ray image of gas in the bowel wall. Formula feeding increases the risk tenfold compared to babies who are fed breast milk alone (Schanler, 2001).
Retinopathy of prematurity due to abnormal proliferation of the blood vessels around the retina of the eye, which is more severe if the baby is given too high levels of oxygen.
Anemia of prematurity, which often becomes apparent at a few weeks of age due to delay in producing red blood cells as the bone marrow is immature.
Feeding difficulties since the coordinated suck and swallow process only starts at 34 weeks gestation. Preterm babies need help to feed and are more likely to aspirate.
Severe infections are more common, and premature babies are at higher risk of dying once they get an infection. The majority of babies who die from neonatal sepsis are preterm.
Respiratory Distress Syndrome due to lung immaturity and lack of surfactant in the alveoli, resulting in collapsing lungs that take extra pressure to inflate. Below 32 weeks gestation, the majority of babies develop RDS, although this risk can be reduced by antenatal corticosteroids injections to women at risk or preterm labor, or in preterm labor.
Jaundice is more common in premature babies since the immature liver cannot easily metabolize bilirubin, and once jaundiced, the preterm baby’s brain is at higher risk since their blood-brain barrier is less well developed to protect the brain.
Brain injury in preterm babies is most commonly intraventricular hemorrhage, occurring in the first few days after birth in about 1 in 5 babies under 2,000 g and is often linked to severity of RDS and hypotension. Less commonly, preterm babies may have hypoxic brain injury with white matter loss which differs from that seen in the brain of term babies (Volpe, 2009).
Necrotizing enterocolitis is a rarer condition affecting the intestinal wall of very premature babies, with a typical X-ray image of gas in the bowel wall. Formula feeding increases the risk tenfold compared to babies who are fed breast milk alone (Schanler, 2001).
Retinopathy of prematurity due to abnormal proliferation of the blood vessels around the retina of the eye, which is more severe if the baby is given too high levels of oxygen.
Anemia of prematurity, which often becomes apparent at a few weeks of age due to delay in producing red blood cells as the bone marrow is immature.
34% reduction in respiratory distress syndrome
46% reduction in Intraventricular Hemorrhage
54% reduction in necrotilizing entercolitis
31% reduction in neonatal death
Near universal coverage of ACS across 75 priority countries may result in a 40% reduction of newborn deaths arising from complications of prematurity
*While both dexamethsaone and betamethasone are safe and effective, Dexamethasone is preferred as it is slightly safer overall, is associated with a greater reduction of IVH and is cheaper than betamethasone
n high-income countries, it is standard practice to give antibiotics to women with pre-term, pre-labour rupture of membranes (pPROM) to delay birth and reduce the risk of infection. In low and middle-income settings, where some 2 million neonatal deaths occur annually due to complications of pre-term birth or infection, many women do not receive antibiotic therapy for pPROM.
To review the evidence for and estimate the effect on neonatal mortality due to pre-term birth complications or infection, of administration of antibiotics to women with pPROM, in low and middle-income countries.
We performed a systematic review to update a Cochrane review. Standardized abstraction forms were used. The quality of the evi- dence provided by individual studies and overall was assessed using an adapted GRADE approach.
Eighteen RCTs met our inclusion criteria. Most were from high-income countries and provide strong evidence that antibiotics for pPROM reduce the risk of respiratory distress syndrome [risk ratio (RR)1⁄40.88; confidence interval (CI) 0.80, 0.97], and early onset postnatal infection (RR 1⁄4 0.61; CI 0.48, 0.77). The data are consistent with a reduction in neonatal mortality (RR 1⁄4 0.90; CI 0.72, 1.12).
Antibiotics for pPROM reduce complications due to pre-term deliv- ery and post-natal infection in high-income settings. There is mod- erate quality evidence that, in low-income settings, where access to other interventions (antenatal steroids, surfactant therapy, ventila- tion, antibiotic therapy) may be low, antibiotics for pPROM could prevent 4% of neonatal deaths due to complications of prematurity and 8% of those due to infection.
There is high-quality evidence that antibiotics for pPROM reduce the risk of complications due to pre- maturity and risk of neonatal infection in high-income settings. The evidence for a reduction in neonatal mortality is less strong. Our meta-analysis of 14 trials estimates a 10% reduction in all-cause neonatal mortality but with a wide CI that included no effect. However, there is a dearth of data from low-income countries, where newborns have less access to other forms of care including antenatal ster- oids, surfactant therapy, ventilation and even antibi- otic treatment for infection. In the absence of these other interventions, the use of antibiotics for pPROM will certainly prevent neonatal deaths by preventing RDS, which is the most common cause of death due to complications of prematurity. Similarly, in settings in which newborns do not have easy access to anti- biotic therapy for neonatal infections, the prevention of sepsis cases through the use of antibiotics for pPROM will certainly prevent infection deaths.
Common complications and conditions of preterm babies born before 33 weeks’ gestation include low blood pressure during the first days of life, the need for respiratory support due to immature lungs and the need for blood transfusions. Intraventricular haemorrhage (bleeding into the brain) and necrotising enterocolitis (severe infection of the bowel) can be life threatening events. Suggested advantages of delaying clamping of the umbilical cord and subsequent increased placental transfusion include larger blood volume for the preterm baby, better adaption to extrauterine life; higher haemoglobin for the baby; less anaemia for the baby and better iron stores, less need for blood transfusion, less respiratory distress (Linderkamp 1978), and less requirement for respiratory support (Holland 1991; Hudson 1990; Kinmond 1993).
Potential disadvantages include delay in resuscitation, hypothermia, poly- cythaemia, hyperbilirubinaemia needing treatment (Saigal 1972) and a possible risk of intraventricular haemorrhage (Hofmeyr 1988). If there are benefits for preterm infants in the first few days and weeks of life, it would also be important to assess whether these short-term benefits are reflected in improved long-term out- come.
There are different potential comparative effects of early rather than delayed cord clamping for term and preterm infants. For ex- ample, in term infants increasing placental transfusion by delaying cord clamping may increase respiratory morbidity after birth (Yao 1974). As a consequence the issue of timing of cord clamping is reviewed separately for preterm and term infants.
For developing countries, with limited resources and a high risk of transmitting infection through blood transfusion, the potential value of a reduced need for blood transfusion would be of particular interest. In more developed countries, 60% to 80% of preterm infants less than 32 completed weeks’ gestation (Brune 2002; Ringer 1998)
Common complications and conditions of preterm babies born before 33 weeks’ gestation include low blood pressure during the first days of life, the need for respiratory support due to immature lungs and the need for blood transfusions. Intraventricular haemorrhage (bleeding into the brain) and necrotising enterocolitis (severe infection of the bowel) can be life threatening events. Suggested advantages of delaying clamping of the umbilical cord and subsequent increased placental transfusion include larger blood volume for the preterm baby, better adaption to extrauterine life; higher haemoglobin for the baby; less anaemia for the baby and better iron stores, less need for blood transfusion, less respiratory distress (Linderkamp 1978), and less requirement for respiratory support (Holland 1991; Hudson 1990; Kinmond 1993).
Potential disadvantages include delay in resuscitation, hypothermia, poly- cythaemia, hyperbilirubinaemia needing treatment (Saigal 1972) and a possible risk of intraventricular haemorrhage (Hofmeyr 1988). If there are benefits for preterm infants in the first few days and weeks of life, it would also be important to assess whether these short-term benefits are reflected in improved long-term out- come.
There are different potential comparative effects of early rather than delayed cord clamping for term and preterm infants. For ex- ample, in term infants increasing placental transfusion by delaying cord clamping may increase respiratory morbidity after birth (Yao 1974). As a consequence the issue of timing of cord clamping is reviewed separately for preterm and term infants.
For developing countries, with limited resources and a high risk of transmitting infection through blood transfusion, the potential value of a reduced need for blood transfusion would be of particular interest. In more developed countries, 60% to 80% of preterm infants less than 32 completed weeks’ gestation (Brune 2002; Ringer 1998) require transfusion
Feeding difficulties since the coordinated suck and swallow process only starts at 34 weeks gestation. Preterm babies need help to feed and are more likely to aspirate.
Severe infections are more common, and premature babies are at higher risk of dying once they get an infection. The majority of babies who die from neonatal sepsis are preterm.
Respiratory Distress Syndrome due to lung immaturity and lack of surfactant in the alveoli, resulting in collapsing lungs that take extra pressure to inflate. Below 32 weeks gestation, the majority of babies develop RDS, although this risk can be reduced by antenatal corticosteroids injections to women at risk or preterm labor, or in preterm labor.
Jaundice is more common in premature babies since the immature liver cannot easily metabolize bilirubin, and once jaundiced, the preterm baby’s brain is at higher risk since their blood-brain barrier is less well developed to protect the brain.
Brain injury in preterm babies is most commonly intraventricular hemorrhage, occurring in the first few days after birth in about 1 in 5 babies under 2,000 g and is often linked to severity of RDS and hypotension. Less commonly, preterm babies may have hypoxic brain injury with white matter loss which differs from that seen in the brain of term babies (Volpe, 2009).
Necrotizing enterocolitis is a rarer condition affecting the intestinal wall of very premature babies, with a typical X-ray image of gas in the bowel wall. Formula feeding increases the risk tenfold compared to babies who are fed breast milk alone (Schanler, 2001).
Retinopathy of prematurity due to abnormal proliferation of the blood vessels around the retina of the eye, which is more severe if the baby is given too high levels of oxygen.
Anemia of prematurity, which often becomes apparent at a few weeks of age due to delay in producing red blood cells as the bone marrow is immature.
Feeding difficulties since the coordinated suck and swallow process only starts at 34 weeks gestation. Preterm babies need help to feed and are more likely to aspirate.
Severe infections are more common, and premature babies are at higher risk of dying once they get an infection. The majority of babies who die from neonatal sepsis are preterm.
Respiratory Distress Syndrome due to lung immaturity and lack of surfactant in the alveoli, resulting in collapsing lungs that take extra pressure to inflate. Below 32 weeks gestation, the majority of babies develop RDS, although this risk can be reduced by antenatal corticosteroids injections to women at risk or preterm labor, or in preterm labor.
Jaundice is more common in premature babies since the immature liver cannot easily metabolize bilirubin, and once jaundiced, the preterm baby’s brain is at higher risk since their blood-brain barrier is less well developed to protect the brain.
Brain injury in preterm babies is most commonly intraventricular hemorrhage, occurring in the first few days after birth in about 1 in 5 babies under 2,000 g and is often linked to severity of RDS and hypotension. Less commonly, preterm babies may have hypoxic brain injury with white matter loss which differs from that seen in the brain of term babies (Volpe, 2009).
Necrotizing enterocolitis is a rarer condition affecting the intestinal wall of very premature babies, with a typical X-ray image of gas in the bowel wall. Formula feeding increases the risk tenfold compared to babies who are fed breast milk alone (Schanler, 2001).
Retinopathy of prematurity due to abnormal proliferation of the blood vessels around the retina of the eye, which is more severe if the baby is given too high levels of oxygen.
Anemia of prematurity, which often becomes apparent at a few weeks of age due to delay in producing red blood cells as the bone marrow is immature.
Feeding difficulties since the coordinated suck and swallow process only starts at 34 weeks gestation. Preterm babies need help to feed and are more likely to aspirate.
Severe infections are more common, and premature babies are at higher risk of dying once they get an infection. The majority of babies who die from neonatal sepsis are preterm.
Respiratory Distress Syndrome due to lung immaturity and lack of surfactant in the alveoli, resulting in collapsing lungs that take extra pressure to inflate. Below 32 weeks gestation, the majority of babies develop RDS, although this risk can be reduced by antenatal corticosteroids injections to women at risk or preterm labor, or in preterm labor.
Jaundice is more common in premature babies since the immature liver cannot easily metabolize bilirubin, and once jaundiced, the preterm baby’s brain is at higher risk since their blood-brain barrier is less well developed to protect the brain.
Brain injury in preterm babies is most commonly intraventricular hemorrhage, occurring in the first few days after birth in about 1 in 5 babies under 2,000 g and is often linked to severity of RDS and hypotension. Less commonly, preterm babies may have hypoxic brain injury with white matter loss which differs from that seen in the brain of term babies (Volpe, 2009).
Necrotizing enterocolitis is a rarer condition affecting the intestinal wall of very premature babies, with a typical X-ray image of gas in the bowel wall. Formula feeding increases the risk tenfold compared to babies who are fed breast milk alone (Schanler, 2001).
Retinopathy of prematurity due to abnormal proliferation of the blood vessels around the retina of the eye, which is more severe if the baby is given too high levels of oxygen.
Anemia of prematurity, which often becomes apparent at a few weeks of age due to delay in producing red blood cells as the bone marrow is immature.
Feeding difficulties since the coordinated suck and swallow process only starts at 34 weeks gestation. Preterm babies need help to feed and are more likely to aspirate.
Severe infections are more common, and premature babies are at higher risk of dying once they get an infection. The majority of babies who die from neonatal sepsis are preterm.
Respiratory Distress Syndrome due to lung immaturity and lack of surfactant in the alveoli, resulting in collapsing lungs that take extra pressure to inflate. Below 32 weeks gestation, the majority of babies develop RDS, although this risk can be reduced by antenatal corticosteroids injections to women at risk or preterm labor, or in preterm labor.
Jaundice is more common in premature babies since the immature liver cannot easily metabolize bilirubin, and once jaundiced, the preterm baby’s brain is at higher risk since their blood-brain barrier is less well developed to protect the brain.
Brain injury in preterm babies is most commonly intraventricular hemorrhage, occurring in the first few days after birth in about 1 in 5 babies under 2,000 g and is often linked to severity of RDS and hypotension. Less commonly, preterm babies may have hypoxic brain injury with white matter loss which differs from that seen in the brain of term babies (Volpe, 2009).
Necrotizing enterocolitis is a rarer condition affecting the intestinal wall of very premature babies, with a typical X-ray image of gas in the bowel wall. Formula feeding increases the risk tenfold compared to babies who are fed breast milk alone (Schanler, 2001).
Retinopathy of prematurity due to abnormal proliferation of the blood vessels around the retina of the eye, which is more severe if the baby is given too high levels of oxygen.
Anemia of prematurity, which often becomes apparent at a few weeks of age due to delay in producing red blood cells as the bone marrow is immature.
Feeding difficulties since the coordinated suck and swallow process only starts at 34 weeks gestation. Preterm babies need help to feed and are more likely to aspirate.
Feeding difficulties since the coordinated suck and swallow process only starts at 34 weeks gestation. Preterm babies need help to feed and are more likely to aspirate.
The point of this slide - We’ve made great strides in improved management in NICU care in industrialized countries --- but basic services for late preterm deliveries would address the majority of preterm-related deaths