NIHR Signal Delayed umbilical cord clamping reduces hospital mortality for preterm infants

Delays to clamping the umbilical cord of about a minute can reduce hospital mortality for preterm infants by around 32%. Delayed clamping also reduced the proportion of infants needing a blood transfusion by 10%.


This review adds more precise data on survival from new trials including a large Australian trial (over 1,600 babies) to a previous Cochrane 2012 review of trails including 738 infants and provides new more precise data on the survival benefit.


From the NIHR Dissemination Centre

Families should feel supported when their child is born preterm, says NICE

Children born preterm should be offered developmental check-ups to help identify any problems or disorders early on, NICE has said in its latest draft quality standard. 

The draft standard aims to improve the follow-up care that is provided to families from when they start planning the discharge of their preterm child from hospital.

NIHR Signal Caesarean section is better for extremely premature breech babies but not necessarily for their mothers

Delivering extremely preterm breech babies (23 to 27 weeks) by caesarean reduced the risk of infant death or brain bleeds by around 40% compared with vaginal delivery.

Choice of delivery is a balance of risks for mother and baby. There are immediate risks to the mother associated with anaesthesia and surgery but also risks in subsequent pregnancies following surgery on the immature uterus. In this review, there was limited information on outcomes for the mothers.

From the NIHR Dissemination Centre

Children born prematurely have greater risk of cognitive, motor and behavioural difficulties

Babies born preterm – at any degree – have a greater risk of developing cognitive, motor and behavioural difficulties and these problems persist throughout school years, finds a new study published online in BJOG: An International Journal of Obstetrics and Gynaecologists.

The authors call for “organisations delivering healthcare, policy makers and educational institutions to take into account the additional academic, emotional and behavioural needs of children born preterm.”

In the UK, around 60,000 babies are born prematurely each year. Short term complications of preterm for the child include higher risk of respiratory complications, sepsis, and bleeding into brain. In addition, these children are at risk of cognitive, motor, and behavioural difficulties in the long-term.

However, there is little evidence on the effects of being born preterm at various points in subsequent years after birth. Therefore, UK based researchers carried out a systematic review to analyse the effect of preterm birth at various stages on the cognitive, motor, behavioural and academic performance of children born preterm versus those born at term.

Developmental follow-up of children and young people born preterm [NG72]

This new NICE guideline covers the developmental follow-up of babies, children and young people under 18 years who were born preterm (before 37+0 weeks of pregnancy). It explains the risk of different developmental problems and disorders, and specifies what extra assessments and support children born preterm might need during their growth and development.

It also says that neonatal physiotherapists should be helping to provide developmental support and surveillance assessments to prematurely born children, during the first two years of their lives.

Calcium and phosphorus supplementation of human milk for preterm infants

Review to determine whether addition of calcium and phosphorus supplements to human milk leads to improved growth and bone metabolism of preterm infants without significant adverse effects

Cochrane Database of Systematic Reviews

Antenatal corticosteroids reduce breathing problems in late preterm babies

Giving corticosteroids to women at risk of preterm birth at 34 weeks of pregnancy or later reduced the risk of severe breathing problems in the baby after birth from 1.9% to 1.1%. Steroids also reduced the risk for babies born by planned caesarean section after 37 weeks (so not premature).

From the NIHR Dissemination Centre

Antenatal corticosteroids reduce breathing problems in late preterm babies

Giving corticosteroids to women at risk of preterm birth at 34 weeks of pregnancy or later reduced the risk of severe breathing problems in the baby after birth from 1.9% to 1.1%. Steroids also reduced the risk for babies born by planned caesarean section after 37 weeks (so not premature).

From the NIHR Dissemination Centre

Preterm breech and caesarean delivery

Answer to the question, In women labouring at gestational ages of extreme prematurity, what is the evidence for delivering by Caesarean section if breech presentation?, posted to the RCOG Query Bank.

Very premature babies at risk of mental health problems – research

Children who are born very prematurely are at greater risk of developing mental health and social problems that can persist well into adulthood, according to one of the largest reviews of evidence.

Those with an extremely low birth weight, at less than a kilogram, are more likely to have attention disorders and social difficulties as children, and feel more shyness, anxiety and depression as adults, than those born a healthy weight.

World’s smallest MRI scans the brains of new-born babies

The Royal Hallamshire Hospital in Sheffield holds one of only two neonatal MRI scanners in the world. The compact MRI scanner was purpose-built for imaging the brains of premature babies.

Currently ultrasound is used to scan the brains of new-born babies, however, Professor Griffiths said that MRI scans show the structures of the brain and abnormalities more clearly.

Schedules for Pneumococcal Vaccination of Preterm Infants: An RCT

Pediatrics (PEDIATRICS), Sep2016; 138(3): 1-11. (11p)

Premature infants have a higher risk of invasive pneumococcal disease and are more likely to have lower vaccine responses compared with term infants. Increasingly, immunization schedules are including a reduced, 2-dose, pneumococcal conjugate vaccine priming schedule. Our goal was to assess the immunogenicity of 3 commonly used 13-valent pneumococcal conjugate vaccine (PCV13) priming schedules in premature infants and their response to a 12-month booster dose.

UHCW Research: P. Satodia

Supplementary feeding of preterm babies by cup rather than bottle helps breastfeeding success

For women who chose to breastfeed their preterm baby, supplementary feeds with a cup, compared with a bottle, led to improved breastfeeding rates at discharge and up to six months later.

From the NIHR Dissemination Centre

Some treatments for abnormal cervical cells increase risk of preterm birth

Women who receive the more radical treatments (like loop excisions) for abnormal cells on the cervix are more likely to experience preterm birth and other adverse pregnancy outcomes than those receiving more local treatments or those not needing treatment at all. Abnormal cells – termed cervical intraepithelial neoplasia (CIN) – can be picked up on cervical screening. These non-cancerous changes can develop into cancer in the future if left untreated. Various treatment options are available to either cut away or destroy the problem cells. The benefits of treatments need to be considered too.

From the NIHR Dissemination Centre

Preterm labour and birth

New quality standard from NICE on preterm labour and birth.

Delivery of non-cephalic second twin

Answer to the question, What is the best practice for delivery of 2nd twin in non cephalic presentations in a patient not under epidural anaesthesia in term and preterm labours?, posted to the RCOG Query Bank

Moderate exercise does not increase risk of preterm birth in healthy pregnant women

Women with an uncomplicated pregnancy who exercise are no more likely to have a preterm birth than those who don’t exercise.

This systematic review pooled the findings of nine trials including 2059 healthy pregnant women who were assigned to exercise for 35 to 90 minutes, three to four times a week, or to no exercise. Despite previous concerns that exercise may increase risk of preterm birth, the review found no evidence for this. It also found that exercise might increase a woman’s chance of a vaginal delivery and reduce risk of pregnancy complications such as diabetes and high blood pressure.

From the NIHR Dissemination Centre

National Neonatal Audit Programme: 2016 Annual Report

This RCPCH report outlines the result of a national audit of neonatal services and finds an improvement in rates of two year follow-up for premature babies but that there was an increase in risk of illness and that some units were still failing to record timely consultation with parents. The report urges neonatal units to form partnerships with neighbouring hospitals in order to reduce variation and drive up standards of care for very sick babies.

Little or no benefit from progesterone to prevent preterm birth

In this trial, vaginal progesterone given to women at high risk of preterm delivery did not reduce the risk of premature birth compared to a placebo. The consequences for the baby in the first 28 days of life, and children at two years’ old, were also similar when looked at as a whole.

From the NIHR Dissemination Centre

One type of drug for depression during pregnancy may be linked to a small increase in pre-term births

Women who are depressed during pregnancy and who take selective serotonin inhibitors (SSRIs) may be more likely to have a pre-term birth than those who do not take SSRIs. Pre-term birth occurred in 6.8% of women with depression during pregnancy treated with SSRIs compared to 5.8% of depressed women who were treated with talking therapies alone.

However, because this is a review of observational (cohort) studies rather than randomised controlled trials it is not possible to say that SSRIs cause pre-term birth. For example, it is possible that women who had worse depression were more likely to be prescribed SSRIs, and it may have been the greater severity of depression rather than the SSRIs that caused pre-term birth.

The benefits of drugs for depression during pregnancy need to be weighed against potential harms. This information does not suggest a change in practice, but may help the discussion between doctor and patient.

From the NIHR Dissemination Centre