WHO recommendations on interventions to improve preterm birth outcomes.

Published by World Health Organization on Apr 4, 2025

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© World Health Organization 2015 

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PICOS

PICO 10.1

Population
Preterm newborns
Intervention
Kangaroo mother care (KMC)
Comparator
Conventional neonatal care
Outcomes

PICO 10.1

Population
Women at risk of preterm birth
Intervention
Antenatal corticosteroids (ACS)
Comparator
Placebo or no treatment
Outcomes

PICO 10.2

Population
Women at risk of preterm birth (subgroup by gestational age at first dose)
Intervention
Antenatal corticosteroids (ACS)
Comparator
Placebo or no treatment
Outcomes

PICO 10.2

Population
Preterm newborns
Intervention
Continuous kangaroo mother care (KMC)
Comparator
Conventional neonatal care
Outcomes

PICO 10.3

Population
Preterm newborns
Intervention
Intermittent kangaroo mother care (KMC)
Comparator
Conventional neonatal care
Outcomes

PICO 10.3

Population
Women at risk of preterm birth (subgroups by gestational age at birth)
Intervention
Antenatal corticosteroids (ACS)
Comparator
Placebo or no treatment
Outcomes

PICO 10.4

Population
Preterm newborns
Intervention
Radiant warmers
Comparator
Incubators
Outcomes

PICO 10.4

Population
Women at risk of preterm birth (subgroups by interval to delivery)
Intervention
Antenatal corticosteroids (ACS)
Comparator
Placebo or no treatment
Outcomes

PICO 10.5

Population
Preterm (and some term) newborns
Intervention
Plastic bags or wraps
Comparator
Conventional care
Outcomes

PICO 10.5

Population
Women at risk of preterm birth (subgroups by singleton/ multiple pregnancy)
Intervention
Antenatal corticosteroids (ACS)
Comparator
Placebo or no treatment
Outcomes

PICO 10.6

Population
Women at risk of preterm birth (subgroups by intact/ruptured membranes)
Intervention
Antenatal corticosteroids (ACS)
Comparator
Placebo or no treatment
Outcomes

PICO 10.7

Population
Women at risk of preterm birth (women with chorioamnionitis)
Intervention
Antenatal corticosteroids (ACS)
Comparator
No antenatal corticosteroids (ACS)
Outcomes

PICO 10.8

Population
Women undergoing elective caesarean section at late preterm (34—36+6 weeks)
Intervention
Antenatal corticosteroids (ACS)
Comparator
No antenatal corticosteroids (ACS)
Outcomes

PICO 10.9

Population
Women with hypertensive disorders in pregnancy
Intervention
Antenatal corticosteroids (ACS)
Comparator
Placebo or no treatment
Outcomes

PICO 10.10

Population
Women at risk of preterm birth (women with growth-restricted fetuses)
Intervention
Antenatal corticosteroids (ACS)
Comparator
No antenatal corticosteroids (ACS)
Outcomes

PICO 10.11

Population
Women at risk of preterm birth (pre-gestational and gestational diabetes)
Intervention
Antenata corticosteroids (ACS)
Comparator
Placebo or no treatment
Outcomes

PICO 10.12

Population
Women at risk of preterm birth (any regimen of dexamethasone and betamethasone)
Intervention
Dexamethasone (any regimen)
Comparator
Betamethasone (any regimen)
Outcomes

PICO 10.13

Population
Women at risk of preterm birth
Intervention
Repeat course(s) of antenatal corticosteroids (ACS)
Comparator
Single course of ACS
Outcomes

PICO 20.1

Population
Women in preterm labour
Intervention
All Betamimetics
Comparator
Placebo or no treatment
Outcomes

PICO 20.1

Population
Peterm newborns with respirtory distress syndrome
Intervention
Continuous positive airway pressure (CPAP)
Comparator
Oxygen by head box cannula
Outcomes

PICO 20.2

Population
Women in preterm labour
Intervention
Calcium channel blockers
Comparator
Placebo or no treatment
Outcomes

PICO 20.2

Population
Preterm newborns with respirtory distress syndrome
Intervention
Early CPAP therapy initiation
Comparator
Late CPAP therapy initiation
Outcomes

PICO 20.3

Population
Women in preterm labour
Intervention
Cyclo-oxygenase (COX) inhibitors
Comparator
Placebo or no treatment
Outcomes

PICO 20.3

Population
Preterm newborns with respiratory distress syndrome
Intervention
Surfactant replacement therapy
Comparator
No therapy or placebo
Outcomes

PICO 20.4

Population
Women in preterm labour
Intervention
Magnesium sulfate
Comparator
Placebo or no treatment
Outcomes

PICO 20.4

Population
Preterm newborns with respiratory distress syndrome
Intervention
Protein-free synthetic surfactant treatment prophylaxis
Comparator
Natural surfactant
Outcomes

PICO 20.5

Population
Women in preterm labour
Intervention
Oxytocin receptor antagonists
Comparator
Placebo or no treatment
Outcomes

PICO 20.5

Population
Preterm newborns with respiratory distress syndrome
Intervention
Protein-free synthetic surfactant
Comparator
Animal derived surfactant extract
Outcomes

PICO 20.6

Population
Women in preterm labour
Intervention
Nitric oxide donors
Comparator
Placebo or no treatment
Outcomes

PICO 20.6

Population
Preterm newborns with respirtory distress syndrome
Intervention
Protein containing synthetic surfactant therapy
Comparator
Animal derived surfactant therapy
Outcomes

PICO 20.7

Population
Women in preterm labour
Intervention
Progestational agents
Comparator
Placebo or no treatment
Outcomes

PICO 20.7

Population
Preterm newborns with respiratory distress syndrome
Intervention
Prophylactic surfactant therapy
Comparator
Selective surfactant therapy
Outcomes

PICO 20.8

Population
Women in preterm labour
Intervention
Relaxin
Comparator
Placebo or no treatment
Outcomes

PICO 20.8

Population
Preterm newborns with respiratory distress syndrome
Intervention
Prophylactic surfactant replacement therapy
Comparator
Rescue surfactant therapy without CPAP
Outcomes

PICO 20.9

Population
Preterm newborns with respiratory distress syndrome
Intervention
Prophylactic surfactant replacement therapy
Comparator
Rescue surfactant therapy with CPAP
Outcomes

PICO 20.9

Population
Women in preterm labour
Intervention
Hydratation
Comparator
No treatment/bed rest alone
Outcomes

PICO 20.10

Population
Preterm newborns with respiratory distress syndrome
Intervention
Early surfactant replacement therapy
Comparator
Late rescue surfactant therapy
Outcomes

PICO 20.10

Population
Women in preterm labour
Intervention
Any betamimetic
Comparator
Placebo/no treatment
Outcomes

PICO 20.11

Population
Women in preterm labour
Intervention
Magnesium
Comparator
Placebo or no treatment
Outcomes

PICO 20.12

Population
Women in preterm labour
Intervention
Calcium channel blocker
Comparator
Control
Outcomes

PICO 20.13

Population
Women in preterm labour
Intervention
Atosiban
Comparator
Placebo
Outcomes

PICO 30.1

Population
Women at risk of preterm birth (all women and babies)
Intervention
Magnesium sulphate
Comparator
No active treatment
Outcomes

PICO 30.2

Population
Women at risk of preterm birth (singleton and multiple pregnancy subgroup)
Intervention
Magnesium sulphate
Comparator
No active treatment
Outcomes

PICO 30.3

Population
Women at risk of preterm birth (gestational age at administration)
Intervention
Magnesium sulphate
Comparator
No active treatment
Outcomes

PICO 30.4

Population
Women at risk of preterm birth (intention to prevent preterm-birth related neurological complications)
Intervention
Magnesium sulfate
Comparator
No active treatment
Outcomes

PICO 30.5

Population
Women at risk of preterm birth (retreatments)
Intervention
Retreatment
Comparator
No retreatment
Outcomes

PICO 40.1

Population
Women in preterm labour with intact membranes
Intervention
Any antibiotics
Comparator
No antibiotics
Outcomes

PICO 40.2

Population
Women in preterm labour with intact membranes
Intervention
A particular type of antibiotic
Comparator
Placebo or no treatment
Outcomes

PICO 50.1

Population
Women at risk of preterm birth and ruptured of membranes
Intervention
Any antibiotic
Comparator
Placebo
Outcomes

PICO 50.2

Population
Women at risk of preterm birth and ruptured of membranes
Intervention
Antibiotic prophylaxis
Comparator
Placebo
Outcomes

PICO 50.3

Population
Women at risk of preterm birth and ruptured of membranes
Intervention
Erythromycin
Comparator
Co-amoxiclav
Outcomes

PICO 50.4

Population
Women at risk of preterm birth and ruptured of membranes
Intervention
3-day ampicilin regimen
Comparator
7-day ampicilin regime
Outcomes

PICO 60.1

Population
Women at risk of preterm birth
Intervention
Planned immediate caesarean section
Comparator
Planned vaginal delivery
Outcomes