In 2023 the World Health Organization and UNICEF report, ‘Born Too Soon, Decade of Action’ was released highlighting the global burden of preterm birth. Nearly one million pēpi die due to complications of preterm birth every year and millions more survive with impacts that follow them and their whānau throughout their lives. The report also notes that little has changed in the rates or impact of preterm birth for many decades.

Here in Aotearoa, we are fortunate that most pēpi survive and do well after preterm birth. However, we have also seen little or no change in the rates of preterm birth, and some pēpi and their whānau continue to be significantly impacted as a result of it.

For Individuals 

Preterm birth remains a leading cause of pēpi death in Aotearoa with the chance of pēpi dying after preterm birth being greatest for those few born at the limits of survival (23⁺⁰ to 24⁺⁶ weeks), about 50-65% of these pēpi survive. The chance of survival then increases dramatically with each week of pregnancy gained, to about 80% by 25 weeks, about 90% by 26 weeks and more than 97% by 28 weeks.

The majority of pēpi survive preterm birth but need extra care in the newborn period. For those born very early, this will include many months of intensive care. During this time pēpi may have significant complications including brain bleeding (known as intraventricular haemorrhage), gut/intestine problems (known as necrotising enterocolitis) and eye disease (known as retinopathy of prematurity). They are also likely to need help with breathing and feeding and are very susceptible to infection.

As a consequence of preterm birth, the complications it leads to and some of the treatment required, some tamariki/children will have longer-term effects. This includes neurodevelopmental impacts such as cerebral palsy (about 7% after birth at less than 28 weeks), intellectual challenges and developmental delay (when measured at 2-3 years of age about 20% will have cognitive delay, 30% language delay and 20% motor delay after birth at less than 28 weeks). Those born very early (less than 28 weeks) may also experience visual and hearing impairments and possibly need to use glasses or hearing aids as they grow up. By the time tamariki/children who were born preterm are ready to go to school they have more chance of experiencing challenges with their behaviour, attention ability, visual processing and academic achievements. However, the majority live very happy, ‘normal’ and fulfilling lives. 

It is also known that preterm birth may have life-long effects on cardiometabolic function including high blood pressure (called hypertension) and weight problems (obesity). These in turn increase the chance of heart disease and stroke in later life.

It is important for people who are born preterm and their whānau to have an understanding about these potential impacts on their health and wellbeing. It can provide opportunity for preventative strategies, early or additional screening and timely treatment.

For whānau, community, healthcare services and society

The impact of preterm birth reaches beyond the individual with significant psychological and economic costs to whānau, community, healthcare systems and society. Prolonged neonatal intensive care stays result in time away from home and whānau (often in a different city especially for those living rurally) with impact on whānau relationships and household incomes. The longer-term effects in caring for tamariki/children with additional health and wellbeing needs also takes a toll on siblings, parent relationships and household finances.

Significant resource is required to serve our over-stretched neonatal units with an overall impact on healthcare costs. These have not been estimated in Aotearoa. In Australia in 2016, the incremental cost of preterm birth to government was estimated at AU$1.413 billion; with additional health and education-related cost for each preterm baby relative to a term birth estimated at AU$236,036, AU$89,709 and AU$25,471 for preterm birth at less than 28, 28-31 and 32-36 weeks respectively.