As prematurity is responsible for 35 per cent of neonatal deaths with an estimated one million neonatal deaths annually and is also an important contributor to child and adult morbidities, the Indian Council of Medical Research (ICMR) will soon begin research in this area to address the issues of prevention and management of prematurity.
The research activity will focus on priority areas such as Effective interventions for prediction or prevention of preterm birth (fetal fibronetin, progesterone based screening tests, their indigenous innovations); Role of medical foods in prevention of prematurity; Prevention of infection in preterm babies such as necrotising enterocolitis; Treatment for lung damage in premature babies; Components of packages for care and support of parents and families of premature infants; and Optimum milk feeding strategy and guidance (including quantity and speed of feeding and use of donor and formula milk) of premature babies.
Besides, the priority areas of the research include: Role of emotional and practical support on improvement of attachment and bonding; Effective treatments for preterm premature rupture of membranes; Effective treatment interventions for necrotising entercolitis in premature infants; Effect of optimal environment (such as light and noise) on outcomes for premature babies; and Effect of early intervention on survival and development in preterm infants.
The ICMR's initiative in this regard is significant as globally, every 10th baby is born preterm and India contributes to a quarter of all preterm burden. It is a major risk for mortality and morbidity. Those who survive without proper intervention end up having long-term disabilities. A higher risk of adult chronic disease in those born preterm also leads to a major problem.
Complications from preterm births are the leading cause of neonatal mortality. The recently launched India Newborn Action Plan (INAP) programme by the health ministry has included antenatal corticosteroids for prevention of respiratory distress syndrome in prematurely born infants. Antibiotics for premature rupture of membranes have also been included in the programme. However, further research efforts are needed to better understand context-specific mechanisms leading to preterm birth; survival of neonates born prematurely.
Globally, there are research leads pointing towards ways to prevent contractions that begin the labour process, anti-inflammatory agents useful in protecting the fetus from the adverse effects of infection induced preterm birth (Epi-lipoxin), antimicrobial peptides (Cathelicidin) important in the pathophysiology of preterm rupture of the fetal membranes and spontaneous preterm labour. Corticotrophin releasing hormone (CRH) has been strongly implicated in the initiation of labour. Antagonists of CRH need to be investigated as therapeutic agents to prevent preterm labour. The Kv 7 subclass of potassium channel activators can profoundly inhibit uterine contractions in vitro. Role of supplements such as vitamin D and amino acids available as medical foods needs to be investigated. Additionally use of Arabian pessaries has been suggested for prevention of preterm birth.