Every year on November 17, the world unites to mark World Prematurity Day — a reminder that millions of babies arrive too soon, too fragile, and too often into systems that are not fully equipped to support them. The 2025 theme, “Give preterm babies a strong start for a hopeful future,” highlights the global shift from mere survival to intact survival — where every baby not only lives but thrives.
As a practising neonatologist for over three decades, I have witnessed the arc of change — from a time when preterm survival was uncertain to today, where technology and teamwork make miracles possible. Yet, the journey ahead is about systems, policy, and equity. Survival should not depend on where a baby is born, but on how well the system is prepared to care.
Understanding prematurity: Beyond a definition
Prematurity, defined as birth before 37 completed weeks of gestation, exists on a wide spectrum. A baby born at 35 weeks needs monitoring and feeding support; one born at 26 weeks needs continuous ventilatory care, infection control, and round-the-clock neonatology expertise. From a policy perspective, this means one size cannot fit all. India must move towards a tiered and regionalised neonatal care system, where hospitals are accredited for specific levels of prematurity they can safely manage. Not every facility should handle extremely preterm births. Instead, in-utero transfers — transferring expectant mothers to hospitals with advanced neonatal facilities before delivery — must become standard national practice. Evidence globally and in India has shown that such transfers significantly improve neonatal survival and reduce disability.
Redefining success: From survival to intact survival
For years, progress in neonatal care has been measured in survival rates. But true progress means more than keeping a baby alive — it means ensuring that child grows, learns, and lives without significant neurological or developmental impairment. This is what the 2025 theme truly calls for. India now needs national policy metrics that go beyond survival to measure intact survival. NICU accreditation must include developmental outcomes, not just infrastructure. Every preterm baby discharged from the hospital should be automatically linked to neurodevelopmental follow-up clinics and monitored through national longitudinal data systems that track their growth, cognitive milestones, and long-term health. This data-driven approach will help India align neonatal outcomes with global benchmarks and close the gap between urban and rural healthcare delivery.
Before birth: Preventing prematurity
A strong start for preterm babies doesn’t begin at birth; it starts before conception and continues through childhood into adulthood. Policies must therefore support this entire continuum of care. National preconception counselling programmes — especially for women with previous preterm deliveries or chronic illnesses — can significantly lower preterm risk. The government must ensure that antenatal corticosteroid protocols for women at risk of preterm labour are uniformly implemented, especially at district hospitals. Every birth should be attended by trained personnel capable of neonatal resuscitation. Hospitals must be equipped for temperature regulation, feeding support, and infection prevention. Tertiary centres should have 24/7 neonatology and obstetric teams, and referral networks should enable timely in-utero transfers to higher-level facilities when needed.
India’s weakest link is post-discharge care. We need national guidelines for follow-up on nutrition, growth monitoring, immunisation, and developmental screening. These services should be embedded into existing child health initiatives like the POSHAN Abhiyaan, ensuring every preterm baby continues to receive holistic care.
Research shows that preterm birth can predispose individuals to adult-onset diseases like diabetes, hypertension, and cognitive disorders. This connection — the foetal origins of adult disease — must be integrated into national health surveillance systems. Investing in long-term tracking and prevention is not just good healthcare policy, but smart economics.
Building infrastructure and workforce capacity
India’s neonatal network has grown tremendously, but progress remains uneven. Many district hospitals lack advanced NICUs or trained teams. To change this, we must focus on regional hubs of excellence and public–private partnerships.
Each state should have designated NICU hubs, digitally connected to smaller centres through tele-NICU systems, allowing remote guidance and monitoring. The government can collaborate with private hospitals to train nurses, respiratory therapists, and neonatal care specialists, ensuring standardised skills and outcomes nationwide.
In parallel, technology innovation must be encouraged — cost-effective CPAP devices, thermal care solutions, and remote monitoring systems can bridge the gap in resource-limited areas.
Empowering parents as partners
No neonatal policy can succeed without recognising parents as central partners. Parents of preterm babies need education, counselling, and emotional support from the very first day. Awareness campaigns must highlight kangaroo mother care, exclusive breastfeeding, and infection prevention, empowering parents to contribute actively to their child’s recovery.
Support groups, both online and within hospitals, can help families navigate the long journey of follow-up and rehabilitation. When parents are informed and engaged, compliance improves — and so do outcomes.
From advocacy to action
India has achieved remarkable progress in reducing neonatal mortality over the past decade. But the next leap forward must focus on the quality of survival. Every preterm baby deserves not only to live, but to live well — with dignity, potential, and opportunity.
To make that happen, India needs to:
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Establish a regionalised neonatal care network with tiered accreditation.
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Integrate intact survival metrics into national reporting systems.
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Mandate neurodevelopmental follow-up for all preterm babies.
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Build tele-NICU and mentorship models linking private and government facilities.
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Invest in training, research, and innovation focused on preterm health.
The time for fragmented efforts is over. This is the moment for unified policy action — where governments, hospitals, and professionals work together to give every preterm baby a strong, hopeful start. As I have often said, saving a preterm baby is not the end of care — it is the beginning of responsibility. When we invest in these tiny lives today, we are investing in the future health, productivity, and human capital of our nation.