TABLE 1.

WHO Interventions and Recommendations to Improve Preterm Birth Mortality, With MANDATE Model Assumptions of Intervention Penetration, Utilization, and Efficacy in Sub-Saharan Africa, 2015

InterventionRecommendation SummaryWHO Strength of Recommendation for ImplementationQuality of EvidenceBaseline Penetration in MANDATE Home/Clinic/Hospital, %Baseline Utilization in MANDATE Home/Clinic/Hospital, %Efficacy in MANDATE Model, %Key References
Prenatal interventions for preterm
Antenatal corticosteroidsFor women at risk of preterm birth (24–34 weeks gestation) under specific conditionsStrongModerate0/10/500/5/25RDS: 50
IVH: 42
NEC: 54
16–18,28
Antibiotics for preterm laborFor women with preterm prelabor rupture of membranesStrongModerateNot included in model
Postnatal care
Cord careDaily CHX application to the umbilicus for newborns born at home in settings with high neonatal mortality. Clean, dry cord care for newborns born in health facilities and at home in low neonatal mortality settings.StrongModerate0/0/00/0/05529–32
Care of the preterm/LBW neonate
Thermal care for preterm newbornsKMC for the routine care of newborns weighing ≤2,000 g at birth, and should be initiated in health care facilities as soon as the newborns are clinically stable.StrongModerate95/95/950/0/25115,33
Unstable newborns weighing ≤2,000 g or stable newborns weighing ≤2,000 g who cannot be given KMC should be cared for in a thermo-neutral environment either under radiant warmers or in incubators.StrongVery low0/0/500/0/306034–36
FeedingLBW infants, including those with very low birth weight, should be fed mother's own milk.StrongModerate99/99/9920/40/55Sepsis: 55
LBW: 18
37–39
Management: newborn resuscitation
Immediate drying and additional stimulationNewly born babies who do not breathe spontaneously after thorough drying should be stimulated by rubbing the back 2–3 times before cord clamping and PPV initiation.WeakNot graded50/85/9050/70/851540–42
PPVIn newly born term or preterm (>32 weeks of gestation) babies requiring PPV, ventilation should be initiated with air.StrongModerate5/50/9520/40/604042–45
Oxygen therapy for preterm newbornsVentilation of preterm babies born at or before 32 weeks of gestation with oxygen therapy with 30% oxygen or air (if blended oxygen is not available).StrongVery low0/15/600/50/75RDS: 25
Asphyxia: 25
46,47
Management: RDS
Continuous positive airway pressure for newborns with RDSContinuous positive airway pressure therapy is recommended for the treatment of preterm newborns with RDS.StrongLow0/2/200/50/70RDS: 50
Asphyxia: 50
46,47
Surfactant administration for newborns with RDSSurfactant replacement therapy is recommended for intubated and ventilated newborns with RDS.Conditional (health care facilities only with intubation, ventilator care, blood gas analysis, newborn nursing care and monitoring)Moderate0/1/50/50/753546,48
Management: neonatal sepsis
Prophylactic antibiotics for prevention of sepsisA neonate with risk factors for infection (i.e., membranes ruptured > 18 hours before delivery, maternal fever > 38°C before delivery or during labor, or foul-smelling or purulent amniotic fluid) should be treated with the prophylactic antibiotics ampicillin and gentamicin for at least 2 days and reassessed if signs of sepsis or positive blood culture.WeakVery lowNot modeled
Empirical antibiotics for suspected neonatal sepsisNeonates with signs of sepsis should be treated with antibiotic treatment for at least 10 days.StrongLow10/85/9520/65/757249,50
Management: NEC
Antibiotics for treatment of NECYoung neonates with suspected NEC should be treated with intravenous or intramuscular ampicillin (or penicillin) and gentamicin as first-line antibiotic treatment for 10 days.StrongLowNot modeled
  • Abbreviations: CHX, chlorhexidine; KMC, kangaroo mother care; IVH, intraventricular hemorrhage; LBW, low birth weight; MANDATE, Maternal and Neonatal Directed Assessment of Technology; NEC, necrotizing enterocolitis; PPV, positive pressure ventilation; RDS, respiratory distress syndrome; WHO, World Health Organization.