posts: 27256

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    "id": "wp-27256",
    "slug": "untitled-reusable-block-136",
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                        "text": "There are two ways to reduce preterm mortality rates: trying to reduce the prevalence of preterm births and providing better care for babies who are born prematurely.",
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                "text": [
                    {
                        "text": "Reducing the prevalence of preterm births\u00a0",
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                        "text": "Approximately 70% of preterm births are spontaneous.{ref}Spontaneous preterm births include those that occur as a result of spontaneous preterm labour (40-45%) and those that occur as a result of preterm premature rupture of the membranes (30-35%). The non-spontaneous preterm births are provider initiated (e.g. cesarean sections).",
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                "value": [
                    {
                        "text": "Goldenberg, R. L., Culhane, J. F., Iams, J. D., & Romero, R. (2008).",
                        "spanType": "span-simple-text"
                    },
                    {
                        "url": "https://www.sciencedirect.com/science/article/pii/S0140673608600744",
                        "children": [
                            {
                                "text": " Epidemiology and causes of preterm birth.",
                                "spanType": "span-simple-text"
                            }
                        ],
                        "spanType": "span-link"
                    },
                    {
                        "children": [
                            {
                                "text": "The Lancet",
                                "spanType": "span-simple-text"
                            }
                        ],
                        "spanType": "span-italic"
                    },
                    {
                        "text": ", ",
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                        "children": [
                            {
                                "text": "371",
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                            }
                        ],
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                        "text": "(9606), 75-84{/ref} While the list of factors associated with spontaneous preterm delivery is long,{ref}\u00a0A list of factors ",
                        "spanType": "span-simple-text"
                    },
                    {
                        "children": [
                            {
                                "text": "associated",
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                            }
                        ],
                        "spanType": "span-italic"
                    },
                    {
                        "text": " with preterm birth is long; for many of these factors we don\u2019t have a generalizable effect size. A non-exhaustive list includes, external factors such as maternal nutrition, smoking, drug use, air-pollution, infection with HIV, chlamydia, malaria, hepatitis C or syphilis; as well as innate factors such as gestational diabetes, short cervical length, pre-eclampsia, maternal anemia, genetic predisposition. Ethnicity, socioeconomic status, and the number of previous pregnancies are also important.{/ref} the literature provides relatively few interventions that have been reliably assessed for their effectiveness in reducing preterm birth rates. A recent systemic review of the literature by the Cochrane Library has identified four interventions that had a positive effect on reducing preterm births:{ref}Medley, N., Vogel, J. P., Care, A., & Alfirevic, Z. (2018). ",
                        "spanType": "span-simple-text"
                    },
                    {
                        "url": "https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD012505.pub2/full",
                        "children": [
                            {
                                "text": "Interventions during pregnancy to prevent preterm birth: an overview of Cochrane systematic reviews.",
                                "spanType": "span-simple-text"
                            }
                        ],
                        "spanType": "span-link"
                    },
                    {
                        "children": [
                            {
                                "text": "Cochrane Database of Systematic Reviews",
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                            }
                        ],
                        "spanType": "span-italic"
                    },
                    {
                        "text": ", (11).",
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                "value": [
                    {
                        "text": "Delnord, M., & Zeitlin, J. (2019, February). ",
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                    },
                    {
                        "url": "https://www.sciencedirect.com/science/article/pii/S1744165X18301069#sec4",
                        "children": [
                            {
                                "text": "Epidemiology of late preterm and early term births\u2013An international perspective.",
                                "spanType": "span-simple-text"
                            }
                        ],
                        "spanType": "span-link"
                    },
                    {
                        "text": " In ",
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                    },
                    {
                        "children": [
                            {
                                "text": "Seminars in Fetal and Neonatal Medicine",
                                "spanType": "span-simple-text"
                            }
                        ],
                        "spanType": "span-italic"
                    },
                    {
                        "text": " (Vol. 24, No. 1, pp. 3-10). WB Saunders.",
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                    }
                ],
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            {
                "type": "text",
                "value": [
                    {
                        "text": "Adams, M. M., Elam-Evans, L. D., Wilson, H. G., & Gilbertz, D. A. (2000). ",
                        "spanType": "span-simple-text"
                    },
                    {
                        "url": "https://jamanetwork.com/journals/jama/fullarticle/192523",
                        "children": [
                            {
                                "text": "Rates of and factors associated with recurrence of preterm delivery.",
                                "spanType": "span-simple-text"
                            }
                        ],
                        "spanType": "span-link"
                    },
                    {
                        "text": " Jama, 283(12), 1591-1596.{/ref}",
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                    }
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                                "text": "Providing a regular midwife-led care during pregnancy {ref} The review compared different models of care. It found that midwife-led continuous care during pregnancy can reduce preterm birth risk by 24% compared to other types of hospital care. Other models of care include physician-led care or shared care between several healthcare professionals.\u00a0",
                                "spanType": "span-simple-text"
                            },
                            {
                                "spanType": "span-newline"
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                            {
                                "spanType": "span-newline"
                            },
                            {
                                "text": "Sandall\u00a0 J, Soltani\u00a0 H, Gates  S, Shennan\u00a0 A, Devane  D. ",
                                "spanType": "span-simple-text"
                            },
                            {
                                "url": "https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD004667.pub5/full",
                                "children": [
                                    {
                                        "text": "Midwife\u2010led continuity models versus other models of care for childbearing women.",
                                        "spanType": "span-simple-text"
                                    }
                                ],
                                "spanType": "span-link"
                            },
                            {
                                "text": " Cochrane Database of Systematic Reviews 2016, Issue 4. Art. No.: CD004667. DOI: 10.1002/14651858.CD004667.pub5 ",
                                "spanType": "span-simple-text"
                            },
                            {
                                "spanType": "span-newline"
                            },
                            {
                                "text": "{/ref}",
                                "spanType": "span-simple-text"
                            },
                            {
                                "spanType": "span-newline"
                            }
                        ],
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                                "text": "Screening for genital tract infections{ref}Screening pregnant women during the first 20 weeks gestation can reduce the risks of preterm birth by 45% compared to the group that receives the screening but is not informed of its results.",
                                "spanType": "span-simple-text"
                            },
                            {
                                "spanType": "span-newline"
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                                "spanType": "span-newline"
                            },
                            {
                                "text": "Sangkomkamhang\u00a0 US, Lumbiganon  P, Prasertcharoensuk\u00a0 W, Laopaiboon  M. ",
                                "spanType": "span-simple-text"
                            },
                            {
                                "url": "https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD006178.pub3/abstract",
                                "children": [
                                    {
                                        "text": "Antenatal lower genital tract infection screening and treatment programs for preventing preterm delivery",
                                        "spanType": "span-simple-text"
                                    }
                                ],
                                "spanType": "span-link"
                            },
                            {
                                "text": ". Cochrane Database of Systematic Reviews 2015, Issue 2. Art. No.: CD006178. DOI: 10.1002/14651858.CD006178.pub3.{/ref}",
                                "spanType": "span-simple-text"
                            }
                        ],
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                                "text": "Zinc supplementation{ref}The review study found that zinc supplementation reduces preterm birth risk by 14%.",
                                "spanType": "span-simple-text"
                            },
                            {
                                "spanType": "span-newline"
                            },
                            {
                                "spanType": "span-newline"
                            },
                            {
                                "text": "Ota\u00a0 E, Mori\u00a0 R, Middleton\u00a0 P, Tobe\u2010Gai  R, Mahomed\u00a0 K, Miyazaki  C, Bhutta  ZA. ",
                                "spanType": "span-simple-text"
                            },
                            {
                                "url": "https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD000230.pub5/full",
                                "children": [
                                    {
                                        "text": "Zinc supplementation for improving pregnancy and infant outcome",
                                        "spanType": "span-simple-text"
                                    }
                                ],
                                "spanType": "span-link"
                            },
                            {
                                "text": ". Cochrane Database of Systematic Reviews 2015, Issue 2. Art. No.: CD000230. DOI: 10.1002/14651858.CD000230.pub5.{/ref}",
                                "spanType": "span-simple-text"
                            }
                        ],
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                                "text": "Cervical stitch for women at high-risk of preterm delivery{ref}High-risk is defined as previous preterm deliveries, short cervix or prior cervical surgery.",
                                "spanType": "span-simple-text"
                            },
                            {
                                "spanType": "span-newline"
                            },
                            {
                                "spanType": "span-newline"
                            },
                            {
                                "text": "Alfirevic\u00a0 Z, Stampalija\u00a0 T, Medley  N.",
                                "spanType": "span-simple-text"
                            },
                            {
                                "url": "https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD008991.pub3/full",
                                "children": [
                                    {
                                        "text": " Cervical stitch (cerclage) for preventing preterm birth in singleton pregnancy",
                                        "spanType": "span-simple-text"
                                    }
                                ],
                                "spanType": "span-link"
                            },
                            {
                                "text": ". Cochrane Database of Systematic Reviews 2017, Issue 6. Art. No.: CD008991. DOI: 10.1002/14651858.CD008991.pub3.{/ref}",
                                "spanType": "span-simple-text"
                            }
                        ],
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                        "text": "We should note that zinc supplementation was found to be effective in studies based on low-income populations. Therefore, the study authors suggest that this may be a consequence of a general maternal ",
                        "spanType": "span-simple-text"
                    },
                    {
                        "url": "https://ourworldindata.org/hunger-and-undernourishment#world-map-of-the-prevalence-of-undernourishment",
                        "children": [
                            {
                                "text": "undernutrition",
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                        "text": ". Indeed, multiple observational studies have indicated that maternal nutrition may have an impact on the length of pregnancies.{ref}Data from historical famines also provides valuable case studies on the relationship between maternal nutrition and preterm delivery. For example, during the siege of Leningrad (a blockade of Soviet city of Leningrad by the Nazis between 1941 and 1944, that resulted in prolonged famine in the region) there was a 41% increase in preterm births among mothers who conceived during the famine period.",
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                "value": [
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                        "text": "A review by Bloomfield (2011) discusses many aspects of maternal nutrition and their relationship to preterm birth.\u00a0",
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                "value": [
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                        "text": "Bloomfield, F. H. (2011). ",
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                    },
                    {
                        "url": "https://www.annualreviews.org/doi/full/10.1146/annurev-nutr-072610-145141#_i5",
                        "children": [
                            {
                                "text": "How is maternal nutrition related to preterm birth?",
                                "spanType": "span-simple-text"
                            }
                        ],
                        "spanType": "span-link"
                    },
                    {
                        "text": ". ",
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                    },
                    {
                        "children": [
                            {
                                "text": "Annual review of nutrition",
                                "spanType": "span-simple-text"
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                        ],
                        "spanType": "span-italic"
                    },
                    {
                        "text": ", ",
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                        "children": [
                            {
                                "text": "31",
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                    {
                        "text": ", 235-261.",
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                "value": [
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                        "text": "Antonov, A. N. (1947). ",
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                    },
                    {
                        "url": "https://www.sciencedirect.com/science/article/abs/pii/S002234764780160X",
                        "children": [
                            {
                                "text": "Children born during the siege of Leningrad in 1942.",
                                "spanType": "span-simple-text"
                            }
                        ],
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                    {
                        "children": [
                            {
                                "text": "The Journal of pediatrics",
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                            }
                        ],
                        "spanType": "span-italic"
                    },
                    {
                        "text": ", ",
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                        "children": [
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                                "text": "30",
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                        "text": "(3), 250-259.{/ref} This factor is particularly important in Africa and Southeast Asia, where both the ",
                        "spanType": "span-simple-text"
                    },
                    {
                        "url": "https://ourworldindata.org/grapher/deaths-from-preterm-birth-complications",
                        "children": [
                            {
                                "text": "mortality due to preterm complications",
                                "spanType": "span-simple-text"
                            }
                        ],
                        "spanType": "span-link"
                    },
                    {
                        "text": " and ",
                        "spanType": "span-simple-text"
                    },
                    {
                        "url": "https://ourworldindata.org/grapher/prevalence-of-undernourishment",
                        "children": [
                            {
                                "text": "undernutrition",
                                "spanType": "span-simple-text"
                            }
                        ],
                        "spanType": "span-link"
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                    {
                        "text": " are most common.\u00a0\u00a0",
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                "text": [
                    {
                        "text": "Providing care for preterm newborns\u00a0\u00a0",
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                        "text": "In the right settings, most premature babies can be taken care of with simple interventions.\u00a0",
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                        "text": "According to a study by Saifon Chawanpaiboon and others, the majority (85%) of premature births fall into moderate or late preterm period, defined as being born between 32 and less than 37 weeks of gestation.{ref}Chawanpaiboon, S., Vogel, J. P., Moller, A. B., Lumbiganon, P., Petzold, M., Hogan, D., ... & Lewis, C. (2019). ",
                        "spanType": "span-simple-text"
                    },
                    {
                        "url": "https://www.thelancet.com/journals/langlo/article/PIIS2214-109X(18)30451-0/fulltext#seccestitle170",
                        "children": [
                            {
                                "text": "Global, regional, and national estimates of levels of preterm birth in 2014: a systematic review and modelling analysis.",
                                "spanType": "span-simple-text"
                            }
                        ],
                        "spanType": "span-link"
                    },
                    {
                        "children": [
                            {
                                "text": "The Lancet Global Health",
                                "spanType": "span-simple-text"
                            }
                        ],
                        "spanType": "span-italic"
                    },
                    {
                        "text": ", ",
                        "spanType": "span-simple-text"
                    },
                    {
                        "children": [
                            {
                                "text": "7",
                                "spanType": "span-simple-text"
                            }
                        ],
                        "spanType": "span-italic"
                    },
                    {
                        "text": "(1), e37-e46.{/ref} These are the babies for whom availability of minimal interventions will be the most effective.",
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                    }
                ],
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                "value": [
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                        "text": "A 2014 study published in the journal ",
                        "spanType": "span-simple-text"
                    },
                    {
                        "children": [
                            {
                                "text": "The Lancet",
                                "spanType": "span-simple-text"
                            }
                        ],
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                    },
                    {
                        "text": " has estimated that if available interventions would reach high coverage rates (90-99%), by 2025, we could reduce deaths due to prematurity by 58% from their levels in 2012.{ref}Of course that means that 42% of deaths from of preterm birth are still left. As discussed previously, we still don\u2019t understand all the causes of preterm birth, which makes it difficult to provide the right interventions. As we learn more about the causes we can provide new and improve the current treatments. The study authors also suggest that we currently don\u2019t have good assessments for a number of interventions that are used to reduce preterm mortality rates. Such interventions were therefore not included in the model used to estimate by how much the preterm complication mortality rates could be reduced.\u00a0",
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                ],
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            {
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                "value": [
                    {
                        "text": "Bhutta, Z. A., Das, J. K., Bahl, R., Lawn, J. E., Salam, R. A., Paul, V. K., ... & Walker, N. (2014). ",
                        "spanType": "span-simple-text"
                    },
                    {
                        "url": "https://www.thelancet.com/pdfs/journals/lancet/PIIS0140-6736(14)60792-3.pdf#%20",
                        "children": [
                            {
                                "text": "Can available interventions end preventable deaths in mothers, newborn babies, and stillbirths, and at what cost?",
                                "spanType": "span-simple-text"
                            }
                        ],
                        "spanType": "span-link"
                    },
                    {
                        "text": ". ",
                        "spanType": "span-simple-text"
                    },
                    {
                        "children": [
                            {
                                "text": "The Lancet",
                                "spanType": "span-simple-text"
                            }
                        ],
                        "spanType": "span-italic"
                    },
                    {
                        "text": ", ",
                        "spanType": "span-simple-text"
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                    {
                        "children": [
                            {
                                "text": "384",
                                "spanType": "span-simple-text"
                            }
                        ],
                        "spanType": "span-italic"
                    },
                    {
                        "text": "(9940), 347-370.{/ref} This means reducing the total number of deaths from prematurity from more than 900,000 in 2012 to below 400,000 by 2025.\u00a0",
                        "spanType": "span-simple-text"
                    }
                ],
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                        "text": "Here you see a table of interventions from",
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                    {
                        "children": [
                            {
                                "text": " ",
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                        "text": "the same study, which summarises the measures which would help us to reach the 58% reduction. The simplest intervention \u2014 hospital and kangaroo care \u2014 would be responsible for 50% of averted deaths. Providing mothers with antenatal steroids,{ref}Antenatal steroids are given to help the fetal lung development.{/ref} would be responsible for additional 31% of reduction.\u00a0",
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                        "text": "The key care required for preterms is provision of thermal insulation and feeding, both of which can usually be provided by the mother through kangaroo care. Kangaroo care involves early breastfeeding and 24-hour skin-to-skin contact between the mother and newborn. Research reviews have shown that kangaroo care can reduce neonatal mortality risk by as much as 51%.{ref}Conde\u2010Agudelo\u00a0 A, D\u00edaz\u2010Rossello\u00a0 JL. ",
                        "spanType": "span-simple-text"
                    },
                    {
                        "url": "https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD002771.pub4/full",
                        "children": [
                            {
                                "text": "Kangaroo mother care to reduce morbidity and mortality in low\u00a0birthweight infants.",
                                "spanType": "span-simple-text"
                            }
                        ],
                        "spanType": "span-link"
                    },
                    {
                        "text": " Cochrane Database of Systematic Reviews 2016, Issue 8. Art. No.: CD002771. DOI: 10.1002/14651858.CD002771.pub4.",
                        "spanType": "span-simple-text"
                    }
                ],
                "parseErrors": []
            },
            {
                "type": "text",
                "value": [
                    {
                        "text": "Lawn, J. E., Mwansa-Kambafwile, J., Horta, B. L., Barros, F. C., & Cousens, S. (2010). ",
                        "spanType": "span-simple-text"
                    },
                    {
                        "url": "https://academic.oup.com/ije/article/39/suppl_1/i144/702431/#12354934",
                        "children": [
                            {
                                "text": "\u2018Kangaroo mother care\u2019 to prevent neonatal deaths due to preterm birth complications.",
                                "spanType": "span-simple-text"
                            }
                        ],
                        "spanType": "span-link"
                    },
                    {
                        "text": " International journal of epidemiology, 39(suppl_1), i144-i154.{/ref} However, globally, the current predicted coverage of kangaroo care is expected to be extremely low.{ref}Even though targets for kangaroo care coverage ",
                        "spanType": "span-simple-text"
                    },
                    {
                        "url": "https://www.sciencedirect.com/science/article/pii/S0140673614607509",
                        "children": [
                            {
                                "text": "have been proposed",
                                "spanType": "span-simple-text"
                            }
                        ],
                        "spanType": "span-link"
                    },
                    {
                        "text": ", countries do not collect the coverage data and accurate global estimates are not available. Most research literature predicts global coverage to be very low, perhaps ",
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                    },
                    {
                        "url": "https://www.sciencedirect.com/science/article/pii/S0140673614607923#tbl1",
                        "children": [
                            {
                                "text": "as low as 10%",
                                "spanType": "span-simple-text"
                            }
                        ],
                        "spanType": "span-link"
                    },
                    {
                        "text": ".{/ref}",
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                "text": [
                    {
                        "text": "Effect of interventions that can reduce neonatal mortality due to preterm complications. Expressed as percentage reduction in child mortality due to preterm complications.{ref}Bhutta, Z. A., Das, J. K., Bahl, R., Lawn, J. E., Salam, R. A., Paul, V. K., ... & Walker, N. (2014). ",
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                    },
                    {
                        "url": "https://www.thelancet.com/pdfs/journals/lancet/PIIS0140-6736(14)60792-3.pdf#",
                        "children": [
                            {
                                "text": " Can available interventions end preventable deaths in mothers, newborn babies, and stillbirths, and at what cost?",
                                "spanType": "span-simple-text"
                            }
                        ],
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                    },
                    {
                        "text": ". The Lancet, 384(9940), 347-370.{/ref}",
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                    }
                ],
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                "value": "<div class=\"raw-html-table__container\"><table><thead><tr><th scope=\"col\" colspan=\"1\">Intervention</th><th scope=\"col\" colspan=\"1\">Effect size (%)</th></tr></thead><tbody><tr><td colspan=\"1\" rowspan=\"1\">Hospital care of preterm babies including kangaroo mother care</td><td colspan=\"1\" rowspan=\"1\">50</td></tr><tr><td colspan=\"1\" rowspan=\"1\">Antenatal steroids for preterm labour</td><td colspan=\"1\" rowspan=\"1\">31</td></tr><tr><td colspan=\"1\" rowspan=\"1\">Neonatal resuscitation</td><td colspan=\"1\" rowspan=\"1\">8</td></tr><tr><td colspan=\"1\" rowspan=\"1\">Labour and delivery managenment</td><td colspan=\"1\" rowspan=\"1\">5</td></tr><tr><td colspan=\"1\" rowspan=\"1\">Balanced energy supplementation</td><td colspan=\"1\" rowspan=\"1\">2</td></tr><tr><td colspan=\"1\" rowspan=\"1\">Micronutrient supplementation</td><td colspan=\"1\" rowspan=\"1\">2</td></tr><tr><td colspan=\"1\" rowspan=\"1\">Antibiotics for premature rupture of membranes</td><td colspan=\"1\" rowspan=\"1\">2</td></tr></tbody></table></div>",
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        "type": "article",
        "title": "How to reduce preterm deaths",
        "authors": [
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        "dateline": "November 7, 2019",
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    "createdAt": "2019-11-07T14:31:26.000Z",
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    "updatedAt": "2020-04-30T14:00:12.000Z",
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    "publishedAt": "2019-11-07T14:31:16.000Z",
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