Prematurity: Impact on Neurodevelopmental and Behavioral Outcomes

2010 ◽  
Author(s):  
Betty R. Vohr
Keyword(s):  
Birth Weight ◽  
Preterm Birth ◽  
Low Birth Weight ◽  
Birth Rate ◽  
Very Low Birth Weight ◽  
Public Health Problem ◽  
Multiple Births ◽  
Major Public Health Problem ◽  
Neurodevelopmental Outcomes ◽  
Antenatal Steroids

Prematurity continues to be a major public health problem and, despite advances in antenatal care, prematurity rates continue to rise in the United States. Preterm and low-birth-weight (LBW) rates increased in 2006 to 12.8% and 8.3%, respectively. The very low birth weight (VLBW) (<1500 g) rate rose to 1.46% (62,283 of 4,265,996 births in 2006). In addition, the birth rate for women aged 40–44 years rose 3% to 9.4 per 1,000 between 2005 and 2006 (Martin et al. 2008). A component of the increase in the preterm birth rate remains attributed to older maternal childbearing, multiple births, and increasing rates of assisted reproductive technology (Heck et al. 1997). The increase in the number of multiple births is a concern because of the associated increased risk of death, preterm birth, low birth weight, and long-term adverse neurodevelopmental outcomes. Major therapeutic advances in perinatal and neonatal care in the past 20 years, including surfactant therapy, antenatal steroids for both pulmonary maturation and central nervous system protection, improved ventilation techniques, and parenteral nutritional support have resulted in a significant improvement in survival of extremely low-birth-weight infants (ELBW) (<1000 g) (National Institutes of Health [NIH] 1995; El-Metwally, Vohr, and Tucker 2000; Fanaroff, Hack, and Walsh 2003; Fanaroff et al. 2007; Hintz et al. 2005a; Hintz et al. 2005b). These infants have increased complex neonatal medical morbidities affecting all organ systems including lungs, gastrointestinal tract, kidneys, and brain, and increased growth, neurological, developmental, and behavioral morbidities both in the neonatal intensive care unit (NICU) and after discharge (Blakely et al. 2005; Ehrenkranz, 2000; Ehrenkranz et al. 2005; Laptook et al. 2005; Shankaran et al. 2004; Schmidt et al. 2003; Vohr et al. 2003; Vohr et al. 2004;Vohr et al. 2005; Walsh et al. 2005). Predicting the survival and neurodevelopmental outcomes of preterm infants becomes a challenge since outcomes are dependent on a combination of biologic factors including gender, gestational age, birth weight, singleton versus multiple, neonatal morbidities, neonatal interventions, and post-discharge environment.

scholarly journals Reduction in preterm births during the COVID-19 lockdown in Ireland: a natural experiment allowing analysis of data from the prior two decades

2020 ◽  
Author(s):  
RK Philip ◽  
H Purtill ◽  
E Reidy ◽  
M Daly ◽  
M Imcha ◽  
...  
Keyword(s):  
Birth Weight ◽  
Preterm Birth ◽  
Low Birth Weight ◽  
Rate Ratio ◽  
Birth Rate ◽  
Very Low Birth Weight ◽  
Preterm Births ◽  
List Type ◽  
Live Births ◽  
New Findings

AbstractBackgroundAetiology of preterm birth (PTB) is heterogeneous and preventive strategies remain elusive. Socio-environmental measures implemented as Ireland’s prudent response to the SARS-CoV-2 virus (COVID-19) pandemic represented, in effect, a national lockdown and have possibly influenced the health and wellbeing of pregnant women and unborn infants. Cumulative impact of such socio-environmental factors operating contemporaneously on PTB has never been assessed before.MethodsRegional PTB trends of very low birth weight (VLBW) infants in one designated health area of Ireland over two decades were analysed. Poisson regression and rate ratio analyses with 95% CI were conducted. Observed regional data from January – April 2020 were compared to historical regional and national data and forecasted national figures for 2020.ResultsPoisson regression analysis found that the regional historical VLBW rate per 1000 live births for January to April, 2001-2019 was 8.18 (95% CI: 7.21, 9.29). During January to April 2020, an unusually low VLBW rate of just 2.17 per 1000 live births was observed. The rate ratio of 3.77 (95% CI: 1.21, 11.75), p = 0.022, estimates that for the last two decades there was, on average, 3.77 times the rate of VLBW, compared to the period January to April 2020 during which there is a 73% reduction. National Irish VLBW rate for 2020 is forecasted to be reduced to 400 per 60,000 births compared to the historical 500-600 range.ConclusionAn unprecedented reduction in PTB of VLBW infants was observed in one health region of Ireland during the COVID-19 lockdown. Potential determinants of this unique temporal trend reside in the summative socio-environmental impact of the COVID-19 dictated lockdown. Our findings, if mirrored in other regions that have adopted similar measures to combat the pandemic, demonstrate the potential to evaluate these implicated interdependent behavioural and socio-environmental modifiers to positively influence PTB rates globally.Key QuestionsWhat is already known?Premature birth is an important contributor for under-five mortality globally.Currently there is no broadly accepted and effective strategy to prevent the birth of premature very low birth weight infants.Impact of socio-environmental and maternal behavioural modifications on the incidence of preterm birth has not been assessed.What are the new findings?COVID-19-triggered national lockdown in Ireland created an opportunity to study the cumulative influence of socio-environmental modifications on pregnant mothers.An unprecedented 73% reduction in the rate of very low birth weight deliveries was noted in one designated health region of Ireland during January to April of 2020 in comparison to the preceding 20 year timeframe.Our observations, if nationally mirrored, indicate that birth rate of very low birth weight premature infants in Ireland is forecasted to decrease considerably in 2020.What do the new findings imply?Socially rooted modifiers such as family support, work related stress and commuting, environmental pollution, infection avoidance, sleep and nutritional support, adequate exercise, reduced exposure to tobacco and illicit drugs, avoidance of financial strain, all cumulatively could contribute to reduce preterm birth rate.Our observations, if reflected in other countries that adopted COVID-19-prompted lockdown measures, would redefine the antecedents that trigger the yet poorly understood pathways leading to preterm births.Prematurity rate would be the most important ‘curve to bend’ in the context of reducing infant mortality globally and thus promote the achievement of sustainable development goals for children.

scholarly journals Pregnancy Outcome during the First COVID 19 Lockdown in Vienna, Austria

2021 ◽  
Vol 18 (7) ◽  
pp. 3782
Author(s):  
Sylvia Kirchengast ◽  
Beda Hartmann
Keyword(s):  
Birth Weight ◽  
Preterm Birth ◽  
Low Birth Weight ◽  
Pregnancy Outcome ◽  
Gestational Age ◽  
Very Low Birth Weight ◽  
Extremely Low Birth Weight ◽  
Negative Effects ◽  
Gestational Length ◽  
Live Births

The COVID 19 pandemic represents a major stress factor for non-infected pregnant women. Although maternal stress during pregnancy increases the risk of preterm birth and intrauterine growth restriction, an increasing number of studies yielded no negative effects of COVID 19 lockdowns on pregnancy outcome. The present study focused on pregnancy outcome during the first COVID 19 lockdown phase in Austria. In particular, it was hypothesized that the national lockdown had no negative effects on birth weight, low birth weight rate and preterm birth rate. In a retrospective medical record-based single center study, the outcome of 669 singleton live births in Vienna Austria during the lockdown phase between March and July 2020 was compared with the pregnancy outcome of 277 live births at the same hospital during the pre-lockdown months of January and February 2020 and, in addition, with the outcome of 28,807 live births between 2005 and 2019. The rate of very low gestational age was significantly lower during the lockdown phase than during the pre-lockdown phase. The rate of low gestational age, however, was slightly higher during the lockdown phase. Mean birth weight was significantly higher during the lockdown phase; the rates of low birth weight, very low birth weight and extremely low birth weight were significantly lower during the lockdown phase. In contrast, maternal gestational weight gain was significantly higher during the lockdown phase. The stressful lockdown phase in Austria seems to have no negative affect on gestational length and newborn weight among non-infected mothers.

Lack of Effects of Oral Probiotics on Growth and Neurodevelopmental Outcomes in Preterm Very Low Birth Weight Infants

2010 ◽  
Vol 156 (3) ◽  
pp. 393-396 ◽  
Author(s):  
I-Ching Chou ◽  
Haung-Tsung Kuo ◽  
Jeng-Sheng Chang ◽  
Shu-Fen Wu ◽  
Hsiao-Yu Chiu ◽  
...  
Keyword(s):  
Birth Weight ◽  
Low Birth Weight ◽  
Very Low Birth Weight ◽  
Low Birth Weight Infants ◽  
Neurodevelopmental Outcomes

Regional Birth Outcomes after the 2011 Great East Japan Earthquake and Tsunami in Miyagi Prefecture

2018 ◽  
Vol 33 (2) ◽  
pp. 215-219 ◽  
Author(s):  
Junichi Sugawara ◽  
Noriyuki Iwama ◽  
Tetsuro Hoshiai ◽  
Hideki Tokunaga ◽  
Hidekazu Nishigori ◽  
...  
Keyword(s):  
Birth Weight ◽  
Preterm Birth ◽  
Low Birth Weight ◽  
Risk Analysis ◽  
Birth Outcomes ◽  
Birth Rate ◽  
Great East Japan Earthquake ◽  
Miyagi Prefecture ◽  
Preterm Birth Rate ◽  
Regional Risk Analysis

AbstractObjectivesThis study was aimed to analyze post-disaster birth outcomes in coastal and inland regions of Miyagi Prefecture, Japan.MethodsPrimary data sets were compiled from birth records of obstetric facilities and 12,808 patients were analyzed for baseline birth outcomes by region. Regional risk analysis of the low-birth-weight rate and premature birth rate were conducted using multi-level logistic regression analysis.ResultsFrom overall baseline birth outcomes, a preterm birth rate was 4.6% and low-birth-weight rate was 8.8%. Regional analysis revealed that a preterm birth rate was 3.2% (coastal) and 5.0% (inland), respectively, and the rate of low birth weight was 6.5% in the coastal and 8.5% in the inland region. In the risk analysis of low-birth-weight rate and preterm birth rate, the risk in the coastal region could not be considered any higher than in the inland region (adjusted odds ratio 0.91 [0.73-1.14] and 0.85 [0.46-1.59], respectively).ConclusionsThe incidence of preterm birth and low birth weight were not adversely affected by the disaster. Early transfer and intensive medical intervention may have led to those findings. Further survey will be necessary to determine the long-term effects in both mothers and children.SugawaraJ, IwamaN, HoshiaiT, TokunagaH, NishigoriH, MetokiH, OkamuraK, YaegashiN. Regional birth outcomes after the 2011 Great East Japan Earthquake and tsunami in Miyagi Prefecture. Prehosp Disaster Med. 2018;33(2):215–219.

Polymorphisms of haemostasis genes as risk factors for preterm delivery

2005 ◽  
Vol 94 (07) ◽  
pp. 88-92 ◽  
Author(s):  
Christoph Härtel ◽  
Sören von Otte ◽  
Julia Koch ◽  
Peter Ahrens ◽  
Evelyn Kattner ◽  
...  
Keyword(s):  
Risk Factors ◽  
Birth Weight ◽  
Preterm Birth ◽  
Low Birth Weight ◽  
Preterm Delivery ◽  
Factor Xiii ◽  
Very Low Birth Weight ◽  
Factor V Leiden ◽  
Factor Vii ◽  
Factor V

SummaryClinical trials evaluating the potential benefit of anticoagulant treatment in pregnant women with inherited thrombophilia are based on the observation that a genetic predisposition to thrombosis is associated with frequent abortions and preterm birth. It was the aim of our study to delineate the impact of genetic polymorphisms with prothrombotic and antithrombotic effects on the occurrence of preterm birth in a large cohort of very-low-birth-weight (VLBW)-infants and their mothers. We examined the factor V Leiden and the prothrombin G20210A mutation, the factor VII 121del/ins and the factor XIII Val34Leu polymorphism in preterm very-low-birth-weight (VLBW, n=593) and term-born-infants (n=278) and their mothers (n=785).The primary outcome was preterm vs. term birth. From all polymorphisms tested, the maternal factor VII-121del/ins polymorphism (26.2 vs. 17.6 %; p=0.009) and the infant’s factor VII-121del/ins polymorphism (29.0 vs. 20.0 %; p=0.009) were more frequent in singletonVLBW and their mothers compared to term infants and their mothers. Furthermore, the frequency of the factor XIII-Val34Leu polymorphism was significantly lower in singleton VLBW than in term infant controls (5.1 vs. 9.6%, p=0.025). In a multivariate regression analysis, previous preterm delivery (OR=3.8, 95% CI: 1.7–8.4), the maternal carrier status of the factor-VII-121del/ins polymorphism (OR=1.7, 95% CI: 1.12–2.5, p=0.007) and the lower frequency of infant’s factor-XIII-Val34Leu polymorphism (OR=0.53; 95% CI: 0.29–0.96; p=0.038) were found to be independently associated with preterm delivery. InVLBW mothers with pathological CTG as cause of preterm delivery, the frequency of factor V Leiden mutation was significantly increased compared to VLBW mothers without pathological CTG (14.1 vs. 6.1%, p=0.01).The investigated haemostasis gene polymorphisms have a much lower impact on subsequent preterm delivery than known risk factors such as previous preterm birth. The reported association of the factor-VII-121del/ins polymorphism on preterm delivery and its clinical relevance needs to be further elucidated.

P1-77 Does preterm birth change circadian rhythmicity in young adulthood? The Helsinki Study of very low Birth Weight Adults

2007 ◽  
Vol 83 ◽  
pp. S104
Author(s):  
S. Strang-Karlsson ◽  
K. Räikkönen ◽  
E. Kajantie ◽  
S. Andersson ◽  
P. Hovi ◽  
...  
Keyword(s):  
Birth Weight ◽  
Preterm Birth ◽  
Low Birth Weight ◽  
Young Adulthood ◽  
Very Low Birth Weight ◽  
Circadian Rhythmicity
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