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Premature birth (also known as a '''preterm birth''') is the Birth of a Baby before the standard period of Pregnancy is completed. In most systems of human pregnancy, prematurity is considered to occur when the Baby is born sooner than 37 weeks after the beginning of the last menstrual period (LMP). The standard length of a human Gestation is 266 days, however, for convenience most timing is based on the LMP, with Conception being assumed to occur approximately 14 days after the LMP, making a standard term pregnancy 280 days or 40 weeks. The opposite condition, Postmature Birth , is defined as birth more than 42 weeks after the LMP. OVERVIEW Premature or preterm birth is defined medically as , more than 490,000 babies in the U.S. were born prematurely. Worldwide rates of prematurity are more difficult to obtain as the lack of widespread professional Obstetric care in developing regions makes determination of Gestational Age less reliable. The World Health Organization instead tracks rates of low Birth Weight , which occurred in 16.5 percent of births in less developed regions in 2000.http://www.who.int/research/en/ It is estimated that one-third of these low birth weight deliveries are due to premature delivery. The shorter the term of pregnancy, the greater the risks of complications. Infants born prematurely have an increased risk of death in the first year of life ( as teenagers. The Age '' Depression Linked to Premature Birth .'' May 2004. Although there are several known risk factors for prematurity (see below), nearly half of all premature births have no known cause. When conditions permit, doctors may attempt to stop premature labor, so that the pregnancy can have a chance to continue to full term, thereby increasing the baby's chances of health and survival. However, there is currently no reliable means to stop or prevent preterm labor in all cases. In fact, the rate of preterm births in the United States has increased 30% in the past two decades.Mayo Clinic. '' Premature Birth .'' 6 Nov 2006. In developed countries premature infants are usually cared for in a Neonatal Intensive Care Unit (NICU). The physicians who specialize in the care of very sick or premature babies are known as Neonatologists . In the NICU, premature babies are kept under radiant warmers or in Incubator s (also called isolettes), which are Bassinet s enclosed in plastic with climate control equipment designed to keep them warm and limit their exposure to germs. Modern neonatal intensive care involves sophisticated measurement of temperature, respiration, cardiac function, Oxygenation , and Brain Activity . Treatments may include fluids and nutrition through Intravenous catheters, Oxygen supplementation, Mechanical Ventilation support, and medications. In developing countries where advanced equipment and even electricity may not be available or reliable, simple measures such as '' Kangaroo Care '' (skin to skin warming), encouraging Breastfeeding , and basic infection control measures can significantly reduce preterm Morbidity and mortality. FACTORS There are many different factors which may contribute to a preterm birth. Factors related to maternal disease or condition that have been shown to increase the risk of preterm birth, with associated odds ratio (OR) when known include:
Whether or not Urinary Tract infections directly cause preterm birth is uncertain, however, it is known that urinary tract infections increase pre-eclampsia which as stated above increases the risk of preterm birth. Sexually transmitted disease STD , Beta Strep , kidney disease, and uterine infections are also suspected of increasing the risk of preterm birth. Adequate maternal Nutrition is important to fetal development and a diet low in saturated fat and cholesterol may help reduce the risk of a preterm delivery. (BMJ: British Medical Journal) Factors related to pregnancy history that have been shown to increase the risk of preterm birth include:
Multiple pregnancies ( Twins , triplets, etc.) are another significant factor in preterm birth. The March of Dimes Multicenter Prematurity and Prevention Study found that 54% of twins were delivered preterm vs. 9.6% of singleton births. (Gardner) Women who have tried to conceive for more than a year before getting pregnant are at a higher risk for premature birth. A recent study done by Dr. Olga Basso of the University of Aarhus in Denmark and Dr. Donna Baird of the U.S. National Institute of Environmental Health Sciences suggests that women who had difficulty conceiving were about 40 percent higher risk of preterm birth than those who had conceived easily. Finally, the use of Tobacco and Alcohol during pregnancy also increases the chance of preterm delivery. Tobacco is the most commonly abused drug during pregnancy and also contributes significantly to low birth weight delivery.(Shino) (Parazzini) PREVENTION OF PRETERM BIRTH Recent research has identified possible methods to ''prevent'' preterm birth, pre-eclampsia/eclampsia, premature rupture of membranes, and preterm labor. These include self-care methods to reduce infections, nutritional and psychological interventions, and the control of preterm birth risk factors (eg. working long hours while standing on feet, carbon monoxide exposure, domestic abuse, and other factors). Injection with a form of progesterone (17 alpha-hydroxyprogesterone caproate), taking fish oil supplements, and self-monitoring vaginal PH followed by yogurt treatment or Clindamycin treatment if the PH was too high all seem to be effective at reducing the risk of preterm birth. Lamont RF and Jaggat AN. Emerging drug therapies for preventing spontaneous preterm labor and preterm birth. Expert Opin Investig Drugs. 2007 16:337-45. PMID 17302528 Hoyme UB and Saling E. Efficient prematurity prevention is possible by pH-self measurement and immediate therapy of threatening ascending infection. Eur J Obstet Gynecol Reprod Biol. 2004 115:148-53. PMID 15262346 This research is quite new; however, doctors using these newer strategies have obtained preterm birth rates as low as 1 to 2%, compared to the 11 to 16% currently in the US. SYMPTOMS AND INDICATIONS The symptoms of an imminent premature birth include:
MATERNAL TREATMENTS There are two tactics that can be used to deal with a potential premature birth: delay the arrival of birth as much as possible, or prepare the prospectively premature fetus for arrival. Both of these tactics may be used simultaneously. Delaying the premature birth from occurring is typically the most favored option. This gives the fetus or fetuses as much time as possible to mature in the womb. There are a number of techniques that can be used to try to accomplish this. The first resort is usually complete bed rest. Maintaining a horizontal position reduces pressure on the s), such as Ritodrine , Fenoterol , Nifedipine and Atosiban , although these do not appear to have more than a short-term effect on delaying delivery. Premature birth can not always be prevented. Severely premature infants may have underdeveloped lungs, because they are not yet producing their own Surfactant . This can lead directly to Respiratory Distress Syndrome , also called hyaline membrane disease, in the neonate. To try to reduce the risk of this outcome, pregnant mothers with threatened premature delivery prior to 34 weeks are often administered at least one course of Glucocorticoids , a steroid that crosses the placental barrier and stimulates growth in the lungs of the fetus. Typical glucocorticoids that would be administered in this context are Betamethasone or Dexamethasone , often when the fetus has reached viability at 23 weeks. In cases where premature birth is imminent, a second "rescue" course of steroids may be administered 12 to 24 hours before the anticipated birth. There is no research consensus on the efficacy and side-effects of a second course of steroids, but the consequences of RDS are so severe that a second course is often viewed as worth the risk. NEWBORN COMPLICATIONS Premature infants show physical signs of their prematurity and may develop other problems as well. These include, but are not limited to, the following: Neurologic
Cardiovascular
Respiratory
Gastrointestinal / metabolic
Hematologic Infectious The earliest controversies over the aggressiveness of the care rendered to such infants. The limit of viability has also become a factor in the Abortion debate. Some of the complications related to prematurity are not apparent until years after the birth. For example, children who were born prematurely (especially if born less than 1500 grams) have a higher likelihood of having behavioral problems, delays in motor development, and difficulties in school. Throughout life they are more likely to require services provided by physical therapists, occupational therapists or speech therapists. TREATMENT MEASURES FOR A PREMATURE INFANT The required care for premature infants differs greatly depending on the child's gestational age, birth weight, and overall maturity. Measures common among extremely premature infants include:
RECORDS James Elgin Gill (born on 20 May 1987 in Ottawa , Canada ) was the earliest premature baby in the world. He was 128 days premature (21 weeks and 5 days gestation) and weighed 1 lb. 6 oz. (624 g). He survived and is healthy.http://www.powells.com/biblio?show=0553587129&page=excerpt?Kennedy, John. (February 07, 2006). " Miracle child ." ''Canada.com.'' Retrieved June 23, 2007. Amillia Taylor is also often cited as the most-premature baby.1 She was born on and Respiratory problems, together with a Brain Hemorrhage . She was discharged from the Baptist Children's Hospital on 20 February 2007 . The record for the smallest premature baby to survive was held for some time by Madeline Mann, who was born at 26 weeks weighing 9.9 oz (280 g) and 9.5 inches (24 cm) longhttp://www.hindu.com/seta/2004/08/26/stories/2004082600411400.htm. This record was broken in surgery to correct visual problems, a common occurrence among premature babies. Historical figures who were born prematurely include Johannes Kepler (born in 1571 at 7 months gestation), Isaac Newton (born in 1643, small enough to fit into a Quart mug, according to his Mother ), Winston Churchill (born in 1874 at 7 months gestation), and Anna Pavlova (born in 1885 at 7 months gestation).Raju, T. N. K. (1980). Some Famous "High Risk" Newborn Babies . In ''Historical Review and Recent Advances in Neonatal and Perinatal Medicine''. Retrieved June 23, 2006. SEE ALSO
Notes Bibliography Jeffcoat, Marjorie K., Nico C. Geurs, Michael S. Reddy, Suzanne P. Cliver, Robert L. Goldenberg, and John C. Hauth. "Periodontal Infection and Preterm Birth." The Journal of the American Dental Association 132 (2001): 875-880. 25 Apr. 2007 Martius, J. A., T. Steck, M. K. Oehler, and K. H. Wulf. "Risk Factors Associated with Preterm (." Eruopean Journal of Obstetrics, Gynecology and Reproductive Biology (1998): 183-189. 1 May 2007 Parazzini, F, L. Chatenoud, M. Surace, L. Tozzi, B. Salerio, G. Bettoni, and G. Benzi. "Moderate Alcohol Drinking and Risk of Preterm Birth." European Journal of Clinical Nutrition 57 (2003): 1345. 1 May 2007 Hagan, R., H. Benninger, D. Chiffings, S. Evans, and N. French. "Very Preterm Birth--a Regional Study. Part 1 Maternal and Obstetric Factors." British Journal of Obstetrics and Gynaecology 103 (1996): 230-238. 1 May 2007 Gardner, M. O., R. L. Goldenberg, S. P. Cliver, J. M. Tucker, K. G. Nelson, and R. L. Copper. "The Origin and Outcome of Preterm Twin Pregnancies." Obstetrics and Gynecology 85 (1995): 553-557. 1 May 2007 Shiono, Patricia H., Mark A. Klebanoff, Robert P. Nugent, Mary F. Cotch, Diana G. Wilkins, Douglas E. Rollins, Christopher J. Carey, and Richard E. Behrman. "Fetus-Placenta-Newborn: the Impact of Cocaine and Marijuana Use on Low Birth Weight and Preterm Birth: a Multicenter Study." American Journal of Obsetrics and Gynecology 172 (1995): 19-27. 1 May 2007 "Cholesterol Lowering Diet for Pregnant Women May Help Prevent Preterm Birth." BMJ: British Medical Journal 331 (2005): 1093. 1 May 2007 EXTERNAL LINKS
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