Researcher at Stanford Medicine helps update WHO guidelines for early care

The World Health Organization He updated Guidelines To care for premature and low birth weight babies, recommending, among other practices, more involvement of families, oil massage, and wider use of skin-to-skin contact.

Eleven of the 25 recommendations, published this week by the World Health Organization and Commented on in scalpel, is new, driven by recent developments in neonatology as well as social science research. The recommendations will be used everywhere, in low-, middle- and high-income countries around the world.

“When these recommendations are put into practice, the evidence is overwhelming that the changes will save many children’s lives and improve global health and development, as well as save healthcare resources,” said the global health expert. Gary DarmstadtMD, professor of pediatrics and co-principal investigator in the Prematurity Research Center at Stanford Medicine.

Darmstadt co-chaired the group of international experts who developed the new guidelines. When I heard he was leading this project, I was curious: How does a huge body of scientific literature boil down to succinct advice that doctors and families can use to care for millions of newborns around the world?

meet a need

About 11% of babies born each year (15 million babies worldwide) arrive prematurely, three or more weeks before their due date. About 20 million babies a year, including most premature babies, are low birth weight, weighing less than 5 pounds, 5 ounces at birth. Both premature and low birth weight infants can face medical challenges, including increased risks of breathing, gastrointestinal problems, infection, poor growth, jaundice, and difficulty regulating their body temperature. Some don’t survive: prematurity leads to nearly a million deaths annually.

The good news is that in the past several years, researchers have conducted many experiments on simple, low-cost medical technologies Improve results These newborns are at high risk. New WHO recommendations summarize this body of research into actionable guidelines. Among other changes, they endorsed the central and central role of families, especially parents, in every aspect of caring for their children and making medical decisions; Emollient treatment, or gentle massage with certain types of oils that protect children’s skin; using probiotic supplements for gut health; using caffeine for the prevention and treatment of a breathing problem known as apnea; use of CPAP (continuous positive airway pressure) immediately after birth; and wider use of Kangaroo mother careDuring which parents skin-to-skin touch newborn babies to keep them warm, promote breastfeeding and protect them from infection.

Darmstadt said getting a vulnerable baby to care for his first few days, weeks and months of life can make a huge difference. “In some cases, long-term benefits have been documented for children who receive interventions such as kangaroo mother care — things like better school performance and adult earning potential when they’re older,” he said. “The potential for impact is really deep.”

From scientific data to helpful guidelines

Darmstadt and neonatologist Vinod Paul, MD, with National Transformation Institute of India, New Delhi, India, co-chaired the guideline development group selected by WHO officials, including pediatricians, neonatologists, obstetricians, nurses, epidemiologists, and sociologists , midwives, parents of premature babies, and actors. From parent groups and experts in global healthcare. Panel members were drawn from more than 20 countries on every continent except Antarctica, including low-, middle- and high-income countries.

“People from all over the world want to know that the committee included someone who understands their situation,” said Darmstadt. The group had to make sure the guidelines would work everywhere, he said, adding that “the discussions were very rich; we tried to take a comprehensive set of considerations into account.”

In late 2020, the team began reviewing scientific developments, including evidence that had emerged since the publication of the last round of WHO guidelines for high-risk preterm infants in 2015. They looked for medical practices that improved the well-being of preterm and low-risk infants. Babies with low birth weight, have few risks, and could fit into every one of those babies born around the world. The team discussed all the medical evidence in detail, evaluating 28 potential interventions for the care of premature or low birth weight infants and ultimately recommending 25 of them to the World Health Organization.

“We filled out a framework to assess the strength of the evidence: How certain are we of the recommendation? What is the balance between potential benefits and harms? What are the costs and equity implications? How feasible and acceptable is it to families and health workers? What is the precise wording that makes the recommendation understandable and actionable?” Darmstadt said.

Better integration of families

The new guidelines expand existing recommendations for Kangaroo mother care, now states that it should be started immediately after birth, worldwide, for all very ill premature babies or those with a low birth weight, such as those who need ventilators. This has important implications for keeping mother and child together at all times.

A particularly relevant groundbreaking addition to the Guidelines was a new recommendation that parents and other family members be actively involved in the care of sick children and newborns, which was accompanied by a recommendation that families should be actively supported, through home visits and others. I mean, in this role, Darmstadt said. This extends recommendations beyond a focus on medical interventions to the way care is delivered. “There are now statements from the World Health Organization that say, ‘You have to make room for families,'” he said. They are the caregivers of premature babies.”

The guidelines state that parents should assist in providing routine care directly at the bedside – not currently standard practice in all neonatal intensive care units – and should be part of all medical decisions for their baby. They also recommend culture and infrastructure changes in hospitals, such as providing rooms where mothers and babies can stay together, and visits from trained medical providers after high-risk children go home from the hospital.

The recommendations make doctors and nurses accountable to the children’s parents: “You have to involve them in all the decision-making and care of their children, respecting that they are the parents and that you do it together,” said Darmstadt.

The new approach to family care is 180 from what it was 60 years ago, when parents were excluded from hospital nurseries for sick children. decades ago, Stanford team He was among the first to publish Research On the benefits of involving parents in childcare, such as improving early bonding between mothers and children.

When the recommendation to include the families was finalized, Darmstadt said, the experts all clapped and cheered. He’s excited that many months of painstaking filtering of research results will improve the lives of real people—newborns born too young and too soon, and their parents—around the world.

“This operation showed us that we need to rethink the medical system,” he said, adding that this applies to every iteration of the medical system, from rural villages in developing countries where medical care may be limited to a skilled midwife to high-tech hospitals with intensive care units. advanced newborn. “The system needs to shape itself to deliver what we know works for vulnerable children and their families.”

Image from photography xreflex

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