Guideline

WHO recommendations on interventions to improve preterm birth outcomes

Year of Publication

2015

Issuing Institution

World Health Organization

Links

WHO IRIS

Recommendations

31 included recommendations

Antenatal corticosteroid therapy is recommended for women at risk of preterm birth from 24 weeks to 34 weeks of gestation when the following conditions are met: . gestational age assessment can be accurately undertaken; . preterm birth is considered imminent; there is no clinical evidence of maternal infection; adequate childbirth care is available (including the capacity to recognize and safely manage preterm labour and birth); . the preterm newborn can receive adequate care if needed (including resuscitation, thermal care, feeding support, infection treatment and safe oxygen use)

Status

Retired

Recommended in favor

Strong

For eligible women, antenatal corticosteroid should be administered when preterm birth is considered imminent within 7 days of starting treatment, including within the first 24 hours

Status

Retired

Recommended in favor

Strong

Certainty of evidence

Low

Antenatal corticosteroid therapy is recommended for women at risk of preterm birth irrespective of whether a single or multiple birth is anticipated

Status

Retired

Recommended in favor

Strong

Certainty of evidence

Low

Antenatal corticosteroid therapy is not recommended in women undergoing planned caesarean section at late preterm gestations (34–36+6 weeks).

Status

Retired

Recommended in favor

Conditional

Certainty of evidence

Very low

Antenatal corticosteroid therapy is recommended in women with hypertensive disorders in pregnancy who are at risk of imminent preterm birth

Status

Retired

Recommended in favor

Strong

Antenatal corticosteroid therapy is recommended for women at risk of imminent preterm birth of a growth-restricted fetus.

Status

Retired

Recommended in favor

Strong

Certainty of evidence

Very low

Antenatal corticosteroid therapy is recommended for women with pre-gestational and gestational diabetes who are at risk of imminent preterm birth, and this should be accompanied by interventions to optimize maternal blood glucose control

Status

Retired

Recommended in favor

Strong

Certainty of evidence

Very low

Either intramuscular (IM) dexamethasone or IM betamethasone (total 24 mg in divided doses) is recommended as the antenatal corticosteroid of choice when preterm birth is imminent.

Status

Retired

Recommended in favor

Strong

Certainty of evidence

Low

A single repeat course of antenatal corticosteroid is recommended if preterm birth does not occur within 7 days after the initial dose, and a subsequent clinical assessment demonstrates that there is a high risk of preterm birth in the next 7 days.

Status

Retired

Recommended in favor

Conditional

The use of magnesium sulfate is recommended for women at risk of imminent preterm birth before 32 weeks of gestation for prevention of cerebral palsy in the infant and child.

Status

Maintained

Recommended in favor

Strong

Certainty of evidence

Moderate

Antibiotic administration is recommended for women with preterm prelabour rupture of membranes

Status

New

Recommended in favor

Strong

Certainty of evidence

Moderate

Erythromycin is recommended as the antibiotic of choice for prophylaxis in women with preterm prelabour rupture of membranes

Status

Maintained

Recommended in favor

Conditional

Certainty of evidence

Moderate

The use of a combination of amoxicillin and clavulanic acid (“co-amoxiclav”) is not recommended for women with preterm prelabour rupture of membranes.

Status

Maintained

Recommended against

Strong

Certainty of evidence

Moderate

Antenatal corticosteroid therapy is recommended in women with preterm prelabour rupture of membranes and no clinical signs of infection

Status

Retired

Recommended in favor

Strong

Antenatal corticosteroid therapy is not recommended in women with chorioamnionitis who are likely to deliver preterm

Status

Retired

Recommended against

Conditional

Certainty of evidence

Very low

Tocolytic treatments (acute and maintenance treatments) are not recommended for women at risk of imminent preterm birth for the purpose of improving newborn outcomes

Status

Retired

Recommended against

Conditional

Certainty of evidence

Very low

Routine antibiotic administration is not recommended for women in preterm labour with intact amniotic membranes and no clinical signs of infection

Status

New

Recommended against

Strong

Certainty of evidence

Moderate

Routine delivery by caesarean section for the purpose of improving preterm newborn outcomes is not recommended, regardless of cephalic or breech presentation.

Status

Maintained

Recommended against

Conditional

Certainty of evidence

Very low

Kangaroo mother care is recommended for the routine care of newborns weighing 2000 g or less at birth, and should be initiated in health-care facilities as soon as the newborns are clinically stable.

Status

Retired

Recommended in favor

Strong

Certainty of evidence

Moderate

Newborns weighing 2000 g or less at birth should be provided as close to continuous Kangaroo mother care as possible.

Status

Retired

Recommended in favor

Strong

Certainty of evidence

Moderate

Intermittent Kangaroo mother care, rather than conventional care, is recommended for newborns weighing 2000 g or less at birth, if continuous Kangaroo mother care is not possible.

Status

Retired

Recommended in favor

Strong

Certainty of evidence

Moderate

Unstable newborns weighing 2000 g or less at birth, or stable newborns weighing less than 2000 g who cannot be given Kangaroo mother care, should be cared for in a thermoneutral environment either under radiant warmers or in incubators.

Status

New

Recommended in favor

Strong

Certainty of evidence

Very low

There is insufficient evidence on the effectiveness of plastic bags/wraps in providing thermal care for preterm newborns immediately after birth. However, during stabilization and transfer of preterm newborns to specialized neonatal care wards, wrapping in plastic bags/wraps may be considered as an alternative to prevent hypothermia

Status

New

Recommended in favor

Conditional

Certainty of evidence

Low

Continuous positive airway pressure therapy is recommended for the treatment of preterm newborns with respiratory distress syndrome

Status

Retired

Recommended in favor

Strong

Certainty of evidence

Low

Continuous positive airway pressure therapy for newborns with respiratory distress syndrome should be started as soon as the diagnosis is made

Status

Retired

Recommended in favor

Strong

Certainty of evidence

Very low

Surfactant replacement therapy is recommended for intubated and ventilated newborns with respiratory distress syndrome.

Status

New

Recommended in favor

Conditional

Certainty of evidence

Moderate

Either animal-derived or protein-containing synthetic surfactants can be used for surfactant replacement therapy in ventilated preterm newborns with respiratory distress syndrome.

Status

New

Recommended in favor

Conditional

Certainty of evidence

Moderate

Administration of surfactant before the onset of respiratory distress syndrome (prophylactic administration) in preterm newborns is not recommended.

Status

New

Recommended against

Strong

Certainty of evidence

Low

In intubated preterm newborns with respiratory distress syndrome, surfactant should be administered early (within the first 2 hours after birth) rather than waiting for the symptoms to worsen before giving rescue therapy.

Status

New

Recommended in favor

Conditional

Certainty of evidence

Low

During ventilation of preterm babies born at or before 32 weeks of gestation, it is recommended to start oxygen therapy with 30% oxygen or air (if blended oxygen is not available), rather than with 100% oxygen.

Status

New

Recommended in favor

Strong

Certainty of evidence

Very low

The use of progressively higher concentrations of oxygen should only be considered for newborns undergoing oxygen therapy if their heart rate is less than 60 beats per minute after 30 seconds of adequate ventilation with 30% oxygen or air.

Status

New

Recommended in favor

Strong

Certainty of evidence

Very low