INTERGROWTH-21st: A Tool for Carrying Out the Every Newborn Action Plan

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By: Katie Millar, Technical Writer, Women and Health Initiative, Harvard T.H. Chan School of Public Health

babies from around the worldOn May 24th, 2014 a critical commitment was made to newborn health: All 194 member states endorsed the Every Newborn Action Plan (ENAP)at the 67th annual World Health Assembly (WHA). In order to set the stage for making newborn health a global priority, The Lancet released their Every Newborn series on May 20th, 2014 during the WHA convening. This series is critical to next steps for newborn health as it provides data on global estimates and causes of neonatal mortality and morbidities, weaknesses in health systems to address these causes, and priority actions for mitigating death and ensuring health.

One of these priority actions is to have maternal and newborn health converge in research, policy, and programming. Adequate maternal care, health and nutrition from before conception through the first 1,000 days of life are essential to fetal and newborn outcomes. This key integration is evident in the ENAP strategic objectives:

  1. Strengthen and invest in care during labour, birth and the first day and week of life
  2. Improve the quality of maternal and newborn care
  3. Reach every woman and every newborn; reduce inequities
  4. Harness the power of parents, families, and communities
  5. Count every newborn—measurement, programme-tracking and accountability

In order to translate ENAP’s goals into reality, the Every Newborn series identified proven interventions and tools to recommend for scale-up, including new fetal growth standards developed by International Fetal and Newborn Growth Consortium for the 21st Century (INTERGROWTH-21st).

We learn in the Every Newborn series paper, “Progress priorities potential beyond survival” that small babies have the greatest risks of death in utero, during the newborn period, and into childhood. Addressing adequate growth and weight in both fetuses and newborns is essential for decreasing fetal and newborn deaths. Unfortunately there are no global growth standards and the variety of standards we do have is based on live birth data from 1991 in the United States. In order to address this gap, INTERGROWTH-21st is producing evidence-based growth standards for fetal, preterm and newborn growth, as well as a classification system to phenotype preterm, intrauterine growth restricted, macrosomic and stillborn babies according to level of risk. These tools have strong implications for more effectively managing and preventing preterm and small for gestational age (SGA) births.

Developing these tools is one thing, but often countries face challenges in timely implementation of new tools and interventions. As such, INTERGROWTH-21st is also producing supportive resources to aid in the effective implementation of the new growth standards, like a new international equation for estimating gestational age through ultrasound.

With the research and tools INTERGROWTH-21st is creating, we can join with the ENAP to help make this world a better and healthier place for newborns and their mothers.