NICE publishes new guideline to reduce premature birth rates
Preterm or premature birth is the leading cause of death in newborn babies and the second most common cause of death in children under the age of five . In 2012, over 52,000 babies in England and Wales, about 1 in 10, were born preterm. 
As well as the risk to their lives, infants who are born early are more prone to serious long-term health problems like heart defects, lung disorders and neurological conditions such as cerebral palsy . They may also reach developmental milestones later and can struggle at school.
The new NICE guideline sets out the best treatment pathways for women at risk of, or in suspected or confirmed, preterm labour. Its intention is to prevent or delay early labour and reduce the associated risks to the baby. The guideline is aimed at healthcare professionals working in community settings including home and free-standing midwifery units, and hospital settings including alongside midwifery units and obstetric units.
Key recommendations include:
- Women at increased risk of preterm labour, with suspected, diagnosed or established preterm labour, or having a planned preterm birth (and their family members or carers as appropriate) should be given information and support (both oral and written) as early as possible, taking into account the likelihood of preterm birth and the status of labour. This should include information on the symptoms and signs of preterm labour and explanations of the care that may be offered.
- Women who are having a planned preterm birth should be provided with information and support that includes information about:
- the likelihood of the baby surviving and other outcomes (including long-term outcomes) and risks for the baby,
- the neonatal care of preterm babies, including location of care,
- the immediate problems that can arise when a baby is born preterm, and
- the possible long-term consequences of prematurity for the baby (how premature babies grow and develop).
- There should also be ongoing opportunities for women who are having a planned preterm birth to talk about and state their wishes about resuscitation of the baby, and an opportunity to speak to a neonatologist or paediatrician.
- Intravenous magnesium sulfate for neuroprotection  of the baby should be offered to women between 24+0 and 29+6 weeks of pregnancy, and considered for women between 30+0 and 33+6 weeks of pregnancy who are:
- in established preterm labour or
- having a planned preterm birth within 24 hours.
Other important recommendations include:
- When to offer progesterone (given as a vaginal suppository) or a cervical ‘stitch’ (cerclage) to prevent or delay the onset of preterm labour
- How to diagnose if a woman’s waters have broken prematurely before labour has begun and which antibiotics to offer to avoid infection
- Which drugs will help to delay labour and to whom they should be offered
- When to safely clamp and cut a premature baby’s umbilical cord
Christine Carson, NICE clinical practice programme director, said: “Most babies born prematurely thrive and do well, but many can be at greater risk of long-term developmental problems. These risks are greater the earlier a baby is born.
“This new guideline outlines the very best care for women at risk of, or in suspected or diagnosed preterm labour, in order to improve outcomes both for women and preterm babies.”
Jane Plumb, member of the committee which developed the guideline, said: “Almost twenty years ago, my premature baby son, Theo, died because of a Group B Strep (GBS) infection. Most GBS infections are preventable, and babies born preterm are more at risk of developing these infections.
“This new NICE guideline is important and clearly outlines the steps healthcare professionals need to take in order to prevent or delay early labour, and ensure all women, right across the NHS, receive excellent care at this crucial time.”
Jane Norman, Professor of Maternal and Fetal Health, Director of the Tommy’s Centre for Maternal and Fetal Health, University of Edinburgh, and chair of the committee which developed the guideline, said: “Preterm birth is a common condition, affecting around 10 pregnant women in every hundred. Preterm babies are at greater risk for conditions such cerebral palsy and delayed development. This new NICE guideline describes the strategies that have been shown to be effective in reducing adverse outcomes, and which should be offered to all pregnant women at risk of preterm birth”.
Caroline Davey, Chief Executive of Bliss, the premature and sick baby charity, said: “It is vital that every baby born early receives the best care before, during and after birth to minimise complications and increase their chances of survival and healthy development. Bliss wholeheartedly supports this new NICE guideline, which will be instrumental in improving outcomes for babies born prematurely and their mothers.”
- World Health Organisation fact sheet on preterm birth. http://www.who.int/mediacentre/factsheets/fs363/en/
- According to the Office for National Statistics, 52,160 babies – 7.3 per cent of live births – in England and Wales were born prematurely during 2012: http://www.ons.gov.uk/ons/rel/child-health/gestation-specific-infant-mortality-in-england-and-wales/2012/index.html
- Henderson C, Macdonald S. Mayes midwifery: a textbook for midwives. Philadelphia: Bailliere Tindall, 2011.
- Antenatal magnesium sulfate therapy given to women at risk of preterm birth reduces the risk of neurological disorders in their infants.