Good practice recommendations for term and preterm infants: A call for global cooperation

Worldwide, about 2.4 million neonatal deaths are reported annually, even though two-thirds of these infant deaths are preventable. Therefore, the International Federation of Gynecology and Obstetrics (FIGO) published a guidline of good practice recommendations for the care of term and preterm infants. The aim is to reduce neonatal mortality through better care and prevention of possible difficulties. FIGO supports the 2030 target of the Sustainable Development Goals to lower neonatal mortality to less than 12 deaths per 1,000 live births globally. This demand is made to both countries of the global south as well as countries in the global north. The guidelines include the implementation of important practices such as the consequent use of the Apgar score for postpartum rapid triage, early essential newborn care and Kangagoo Mother Care.

Neonatal mortality remains a global challenge, especially in low- and middle-income countries (LMICs). In 2019, the neonatal mortality was at 17 infant deaths out of 1,000 live births. The global target, defined by the Sustainable Development Goals, aims to reduce neonatal mortality to less than 12 deaths per 1,000 live births by 2030. Even though the overall numbers decreased during the past thirty years, there is still a long way to go and a lot of potential to lower neonatal mortality.

The leading cause for neonatal mortality is preterm birth. In 2020, studies indicated that about 35% of neonatal deaths are caused by preterm birth. This is due to the higher risks for hypothermia, infections, and breathing and feeding difficulties associated with preterm birth. The numbers differ between countries. Whilst countries in the global north experience higher preterm birth rates, LMICs show higher mortality rates. Therefore these numbers are a call for the global community to work together to ensure the survival of newborns in the global south and the global north.

Two-thirds of neonatal deaths can be prevented

There are different approaches to reduce neonatal mortality. The International Federation of Gynecology and Obstetrics (FIGO) released good practice recommendations and newborn care measures for the care of both term and preterm infants. Designed to work effectively regardless of cultural background or national context, the recommended approaches can be implemented in any neonatal care setting worldwide.

To improve good care and timely decision making, the Apgar score is recommended for immediate postpartum rapid triage. This measure allows to identify which subsequent management steps are required and helps to prevent hypothermia, hypoglycemia, and infections in the newborn.

In addition, FIGO released guidelines for the management of neonates with spontaneous breathing and nonbreathing, for the transfer to an intensive care unit or higher level facilities if necessary, for early essential newborn care (EENC). The guidelines also introduce steps to reduce morbidity and mortality.

Kangargoo Mother Care is one of the most effective measures to prevent infant mortality

FIGO explicitly recommends Kangaroo Mother Care because it reduces preterm mortality by up to 50%, protects the newborn from infections, decreases the risk for neonatal sepsis by almost half, decreases hypothermia and hypoglycemia, and increases breastfeeding rates. The practice of Kangaroo Mother Care includes prolonged and continuous skin-to-skin contact where the mother is keeping her newborn close to her breast, so the baby is warm and able to breastfeed. This also encourages the next steps of exclusive breastfeeding, early hospital discharge and home care support.

All FIGO recommendations, and especially Kangaroo Mother Care, meet the need of high effectiveness and low additional work for healthcare professionals and are therefore implementable in every setting. In LMICs, these recommendations are the optimal way to improve the knowledge on standards of care in order to reach the 2030 goal of the Sustainable Development Goals on reduced neonatal mortality.

Paper available at: FIGO good practice recommendations

Ful list of authors: Simonetta Costa, Nicoletta Menzella, Giovanni Vento, Eytan Barnea

DOI: https://doi.org/10.1002/ijgo.15116

More information on Kangaroo Mother Care (KMC)