New research revealing premature birth is the second biggest killer of children under five is "shocking" and "staggering", medical experts tell Channel 4 News.
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More than one in 10 babies is born too early, according to the first-ever report on premature births worldwide. Researchers now estimate that 15 million babies in the world are born too early and more than 1.1 million of those babies die shortly after birth.
But the report, based on research from more than 100 experts from 40 UN agencies, universities and charities, also reveals that as many as three-quarters of the preterm babies who die could actually survive without expensive care.
'Born Too Soon: The Global Action Report on Preterm Birth' looks at premature births - that is any baby born before 37 weeks - in 184 countries. It highlights not only the magnitude of the problem but the disparities between countries. Of the 11 countries with preterm birth rates over 15 per cent, all but two are in sub-Saharan Africa.
One of the surprises, however, was that the United States was number six for actual numbers of preterm births but number 37 for deaths because of the expensive and effective intensive care. The UK rates 46th out of the 184 countries with nearly 60,000 preterm births in 2010. In that same year there were 1,300 deaths from complications resulting from these births.
When you think that this is killing 1.1m babies, that is six times higher than HIV deaths in children. Dr Joy Lawn, report co-editor
The US was average, however, in percentage terms at 12 preterm births for every 100 births. The UK preterm rate was lower at 7.8 per cent but is rising at a rate of 1.5 per cent every year between 1990 and 2010. The researchers say this is related to lifestyle trends such as older women giving birth, obesity, smoking and adolescent pregnancy.
The lead authors of the report from the March of Dimes Foundation, the Partnership for Maternal, Newborn and Child Health, Save the Children and the World Health Organisation, highlight the fact that premature births are the second leading cause of death in children under five after pneumonia - more than both HIV deaths and malaria.
Shocking and staggering
Dr Joy Lawn, co-editor of the report and director, global evidence and policy for Save the Children, said the numbers of preterm births were increasing. "Being born too soon is an unrecognised killer," she said.
Speaking to Channel 4 News, Dr Lawn said: "When you think that this is killing 1.1m babies, that is six times higher than HIV deaths in children. It isn't that there should be a competition but then you should be hearing about it.
"This is the first report to put this out and maybe people have said that is because we didn't have data. We did have some data on the deaths but now it is even more shocking because preterm deaths has risen to number two cause of death."
The authors believe that there was a perception that nothing could be done to prevent the prebirths or reduce the deaths. But Dr Lawn said the report "coshes" that myth.
Research shows, for instance, that saving the lives of premature babies does not need to involve high-tech machinery or intensive care services. Inexpensive interventions include antenatal steroid injections for mothers in premature labour, which cost $1 an injection, "kangaroo care" in which the infant is held skin-to-skin on the mother's chest to keep warm; antiseptic cream for birth cord infection and antibiotics.
But in wealthier countries, experts believe there needs to be a greater focus on prevention, and the report calls for more research to identify the risk factors and reduce the death rates.
Professor Andy Shennan, consultant obstetrician for the baby charity Tommy's, said that even as someone who has worked in this field for a long time, he was "staggered" by the figures. In the preterm birth clinic at St Thomas's Hospital, London, his team sees more than 30 high risk pregnant women every week.
"My view is that prevention is the absolute key because even in richer countries the babies that used to die are now unwell. It is not because people don't care - it is lack of knowledge but if you look at statistics most would agree that needs more attention," he said.