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Encyclopedia > Premature infants
Premature birth
Classifications and external resources
ICD-10 O60.1
ICD-9 659.0

Premature birth (also known as preterm birth) is defined medically as childbirth occurring earlier than 37 completed weeks of gestation. Most pregnancies last about 40 weeks. About 12 percent of babies in the United States — or 1 in 8 — are born prematurely each year. [1] In 2003, more than 490,000 babies in the U.S. were born prematurely. The shorter the term of pregnancy is, the greater the risks of complications. Infants born prematurely have an increased risk of death in the first year of life; prematurity itself is the leading cause of newborn death within one month of birth at 25%.[2] They are also at a greater risk for developing serious health problems such as: cerebral palsy, chronic lung disease, gastrointestinal problems, mental retardation, vision and hearing loss.[3] The International Statistical Classification of Diseases and Related Health Problems (commonly known by the abbreviation ICD) is a detailed description of known diseases and injuries. ... The following codes are used with International Statistical Classification of Diseases and Related Health Problems. ... // O00-O99 - Pregnancy, childbirth and the puerperium (O00-O08) Pregnancy with abortive outcome (O00) Ectopic pregnancy (O01) Hydatidiform mole (O02) Other abnormal products of conception (O03) Spontaneous abortion (O04) Medical abortion (O05) Other abortion (O06) Unspecified abortion (O07) Failed attempted abortion (O08) Complications following abortion and ectopic and molar pregnancy... The International Statistical Classification of Diseases and Related Health Problems (commonly known by the abbreviation ICD) is a detailed description of known diseases and injuries. ... The following is a list of codes for International Statistical Classification of Diseases and Related Health Problems. ... Image File history File links Gnome-globe. ... Childbirth (also called labour, birth, partus or parturition) is the culmination of a human pregnancy with the emergence of a newborn infant from its mothers uterus. ... Gestation is the carrying of an embryo or fetus inside a female viviparous animal. ... A pregnant woman near the end of her term Pregnancy is the carrying of one or more embryos or fetuses by female mammals, including humans, inside their bodies. ... 2003 (MMIII) was a common year starting on Wednesday of the Gregorian calendar. ... Cerebral palsy (CP) is an umbrella term encompassing a group of non-progressive neurological physical disabilities in the development of human movement and posture. ... In medicine, pulmonology is the specialty that deals with diseases of the lungs and the respiratory tract. ... For the Physics term GUT, please refer to Grand unification theory The gastrointestinal or digestive tract, also referred to as the GI tract or the alimentary canal or the gut, is the system of organs within multicellular animals which takes in food, digests it to extract energy and nutrients, and... Mental retardation (also called mental handicap[1]) is a term for a pattern of persistently slow learning of basic motor and language skills (milestones) during childhood, and a significantly below-normal global intellectual capacity as an adult. ... Blindness is the condition of lacking visual perception due to physiological or psychological factors. ... An editor has expressed a concern that the topic of this article may be unencyclopedic. ...


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 actually increased 30% in the past two decades.[4]


After being born, a premature baby is cared for in a special section of the hospital known as the NICU (Neonatal Intensive Care Unit). The physicians who specialize in the care of very sick or premature babies are known as neonatologists. In the NICU, babies are kept in incubators (or isolettes), a bassinet enclosed in plastic with climate control equipment designed to keep babies warm and limit their exposure to germs. In some cases, an oxygen-enriched atmosphere may be used, although this is avoided where possible, as it can cause damaging side effects. Premature babies may be released from the hospital when they no longer need the constant hospital care the NICU provides. A newborn infant sleeping in his incubator. ... The word incubation (from Latin incubare, to lie upon - cf. ... Modern reproduction of a medieval cot and rattle, c. ... General Name, Symbol, Number oxygen, O, 8 Chemical series Nonmetals, chalcogens Group, Period, Block 16, 2, p Appearance colorless (gas) very pale blue (liquid) Atomic mass 15. ...

Contents

Factors

There are many known factors related to premature births. However, the nature of the relationship between these factors and premature births are unclear.

  • A woman's previous history of preterm birth, or pregnancies that ended in miscarriage.
  • Multiple pregnancies (twins, triplets, etc.) are at a higher risk for premature birth.
  • Uterine or cervical abnormalities.
  • Certain chronic disease such as high blood pressure, kidney disease and diabetes.
  • Infections of the cervix, uterus or urinary tract. Certain STDs, Beta Strep.
  • Substance abuse of tobacco, alcohol and other drugs.
  • 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.
  • Women under 18 or over 35 are at a higher risk for premature birth.
  • Inadequate nutrition during pregnancy.
  • Antepartum hemorrhage
  • Pre-eclampsia
  • Stress

Miscarriage or spontaneous abortion is the natural or accidental termination of a pregnancy at a stage where the embryo or the fetus is incapable of surviving, generally defined at a gestation of prior to 20 weeks. ... Fraternal twin boys in the tub The term twin most notably refers to two individuals (or one of two individuals) who have shared the same uterus (womb) and usually, but not necessarily, born on the same day. ... The uterus or womb is the major female reproductive organ of most mammals, including humans. ... Schematic frontal view of female anatomy The cervix (from Latin neck) is the lower, narrow portion of the uterus where it joins with the top end of the vagina. ... Arterial hypertension, or high blood pressure is a medical condition where the blood pressure is chronically elevated. ... See the article on the kidney for the anatomy and function of healthy kidneys and a list of diseases involving the kidney. ... This article is about the disease that features high blood sugar. ... The urinary system is a system of organs, tubes, muscles, and nerves that work together to create, store, and carry, urine. ... STD is an abbreviation used in several different contexts that stand for different terms. ... Some microbiological techniques use the appearance of bacterial colonies on culture media to help identify the species of organisms that have been isolated. ... Species Nicotiana acuminata Nicotiana alata Nicotiana attenuata Nicotiana benthamiana Nicotiana clevelandii Nicotiana excelsior Nicotiana forgetiana Nicotiana glauca Nicotiana glutinosa Nicotiana langsdorffii Nicotiana longiflora Nicotiana obtusifolia Nicotiana paniculata Nicotiana plumbagifolia Nicotiana quadrivalvis Nicotiana repanda Nicotiana rustica Nicotianasuaveolens Nicotiana sylvestris Nicotiana tabacum Nicotiana tomentosa Ref: ITIS 30562 as of August 26, 2005... Functional group of an alcohol molecule. ... Drug abuse has a wide range of definitions, all of them relating either to the misuse or overuse of a psychoactive drug or performance enhancing drug for a non-therapeutic or non-medical effect. ... Aarhus ( ) also commonly known by its contemporary Danish spelling Ã…rhus, is the second largest city and the principal port of Denmark situated on the peninsula of Jutland on the northern shore of Germany. ... The updated USDA food pyramid, published in 2005, is a general nutrition guide for recommended food consumption. ... Pre-eclampsia is said to be present when hypertension arises in pregnancy (pregnancy-induced hypertension) in association with significant protein in the urine. ...

Prevention of preterm birth

Some newer research has identified possible methods to prevent preterm birth, pre-eclampsia/eclampsia, premature rupture of membranes, and preterm labor.


This research includes self-care methods to reduce infections, nutritional and psychological interventions, and the control of preterm birth risk factors (eg. working long hours standing on feet, carbon monoxide exposure, domestic abuse, and other factors).


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:

  • Four or more uterine contractions in one hour, before 37 weeks' gestation.
  • A watery discharge from the vagina which may indicate premature rupture of the membranes surrounding the baby.
  • Pressure in the pelvis or the sensation that the baby has "dropped".
  • Menstrual cramps or abdominal pain.
  • Pain or rhythmic tightening in lower abdomen or back.
  • Vaginal spotting or bleeding.

Contraction can mean: Contraction (childbirth), a contraction during childbirth; Contraction (linguistics), a new word formed from two or more individual words; Contraction (science), one that can occur to solid matter as it cools; Contraction mapping, in mathematics, a type of function on a metric space; Muscle contraction, one that occurs... The pelvis (pl. ... The menstrual cycle is the periodic change in a womans body that occurs every month between puberty and menopause and that relates to reproduction. ...

Treatments for premature birth

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 cervix, which may allow it to stay lengthened longer, and avoiding unnecessary movement may reduce uterine irritation, which can lead to contractions. Likewise, proper nutrition and especially hydration are important: dehydration can lead to premature uterine contractions. In a hospital setting, a drug-free IV drip may be used to try to stop premature labor simply by improving the mother's hydration. Lastly, there are anti-contraction medications (tocolytics), such as ritodrine, fenoterol, nifedipine and atosiban. Schematic frontal view of female anatomy The cervix (from Latin neck) is the lower, narrow portion of the uterus where it joins with the top end of the vagina. ... Tocolytics are medications used to suppress premature labor (toco refers to contractions, and lytic to removal). ... Ritodrine hydrochloride (Yutopar®) is a tocolytic drug, used to stop premature labor. ... Nifedipine (brand name Adalat and Procardia) is a dihydropyridine calcium channel blocker. ... Atosiban (Tractocile®) is an inhibitor of the hormone oxytocin, and is used in premature labor. ...


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 are routinely administered at least one course of glucocorticoids, a steroid that easily passes 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 24 weeks. In cases where premature birth is imminent, a second "rescue" dose 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 dose of steroids, but the consequences of RDS are so severe that a second dose is often viewed as worth the risk. Surfactants are wetting agents that lower the surface tension of a liquid, allowing easier spreading, and lower the interfacial tension between two liquids. ... Infant respiratory distress syndrome (RDS, also called Respiratory distress syndrome of newborn, previously called hyaline membrane disease), is a syndrome caused by developmental lack of surfactant and structural immaturity in the lungs of premature infants. ... The name glucocorticoid derives from early observations that these hormones were involved in glucose metabolism. ... Betamethasone dipropionate is a corticosteroid with anti-inflammatory and immunosuppressive abilities, used especially where water retention is undesirable. ... Dexamethasone is a potent synthetic member of the glucocorticoid class of steroid hormones. ...


Aspects of prematurity

Infants born more than 3 weeks prior to 40 weeks show physical signs of their prematurity and may develop other problems as well. Common problems in infants with severe to moderate prematurity (26 to 34 weeks) include jaundice, hypoglycemia, hypocalcemia, infant respiratory distress syndrome (IRDS), bronchopulmonary dysplasia (BPD) which is also called Chronic Lung Disease, intracranial hemorrhage, retinopathy of prematurity (ROP), necrotizing enterocolitis (NEC), patent ductus arteriosus (PDA), urinary tract infection [1], inguinal hernia, anemia, and rickets. The human infant An infant or baby is an extremely young person. ... Jaundice, also known as icterus (attributive adjective: icteric), is a yellowing of the skin, conjuctiva (clear covering over the sclera, or whites of the eyes) and mucous membranes caused by increased levels of bilirubin in the human body (or the body of another red blooded animal). ... Hypoglycemia (hypoglycæmia in the UK) is a medical term referring to a pathologic state produced by a lower than normal amount of sugar (glucose) in the blood. ... In medicine, hypocalcaemia is the presence of less than a total calcium of 2. ... Infant respiratory distress syndrome (RDS, also called Respiratory distress syndrome of newborn, previously called hyaline membrane disease), is a syndrome caused by developmental lack of surfactant and structural immaturity in the lungs of premature infants. ... This page meets Wikipedias criteria for speedy deletion. ... This article needs cleanup. ... Retinopathy of prematurity (ROP), previously known as retrolental fibroplasia (RLF), is a disease of the eye that affects prematurely born babies. ... Necrotizing enterocolitis (NEC) is a medical condition primarily seen in premature infants, where portions of the bowel undergo necrosis (tissue death). ... Patent ductus arteriosus (PDA) is a congenital heart defect wherein a childs ductus arteriosus fails to close after birth. ... A urinary tract infection (UTI) is an infection of the urinary tract. ... Anemia (AmE) or anaemia (BrE), from the Greek () meaning without blood, refers to a deficiency of red blood cells (RBCs) and/or hemoglobin. ... Osteomalacia, also known as rickets , is among the most frequent childhood diseases in developing countries. ...


The earliest gestational age at which the infant has at least a 50% chance of survival is referred to as the limit of viability[2]. As NICU care has improved over the last 40 years, the limit of viability has declined to about 24 weeks. As risk of brain damage and developmental delay is significant at that threshold even if the infant survives, there are ethical controversies over the aggressiveness of the care rendered to such infants. The limit of viability has also become a factor in the abortion debate. Gestational age is age of a fetus (or newborn infant) from presumed conception. ... The limit of viability is the gestational age at which a fetus/infant has a good chance of surviving outside its mothers womb without major impairment. ... Mental retardation (abbreviated as MR), is a term for a pattern of persistently slow learning of basic motor and language skills (milestones) during childhood, and a significantly below-normal intellectual capacity as an adult. ... Medical ethics is the discipline of evaluating the merits, risks, and social concerns of activities in the field of medicine. ...


Some of the complications related to prematurity are not apparent until years after the birth. For example, children who were premature babies (especially if born less than 1500 grams) have a higher likelihood of having attention deficit problems, behavioral problems, delays in motor development, and difficulties in school than their peers who were healthy full term babies. More than their peers who were full term, former preemies need 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:

  • Placing the infant in a warmer or isolette. Premature infants are easily susceptible to infection, and preventing this is a key priority.
  • Infants under 32 weeks typically do not produce enough surfactant in their lungs to enable them to breathe on their own. In these cases, surfactant will be administered to assist them.
  • In extremely premature infants, a breathing tube may be inserted in the infant's trachea, and a respirator and supplemental oxygen may be used.
  • Adequate nutrition, via a feeding tube or, in extremely premature infants, intravenously. If a feeding tube is used, expressed breast milk from the mother or a breastmilk bank can be used, which lowers the risk of necrotizing enterocolitis.

The alveoli (singular:alveolus), tiny hollow sacs which are continuous with the airways, are the sites of gas exchange with the blood. ... A feeding tube is a medical device used to provide nutrition to patients who cannot do so via the normal oral route. ... Breast milk usually refers to the milk produced by a human female which is usually fed to infants by breastfeeding. ... According to a joint statement of WHO and UNICEF The best food for a baby who cannot be breastfed is milk expressed from the mother’s breast or from another healthy mother….The best food for any baby whose own mother’s milk is not available is the breastmilk of... Necrotizing enterocolitis (NEC) is a medical condition primarily seen in premature infants, where portions of the bowel undergo necrosis (tissue death). ...

Prematurity and the parent

Adjustment after preterm birth for parents can be very difficult. The NICU setting is foreign and often intimidating and scary. Additionally, parents often have difficulty becoming involved in their child's care because of the NICU setting. This affects the parents transition into parenthood because they are unable to fulfill their expected roles. Furthermore, often premature birth is accompanied by a difficult NICU course and therefore parents are forced to confront difficult decisions about their child's care. Studies have shown that the transition to parenthood for parents of preterm infants follows a different and longer course than that of parents with term infants.


In a study by Jackson et al (2003)[3] researchers found that both mothers and fathers travel a course from alienation to responsibility to confidence to familiarity in approximately the first 18 months of the child's life.


In a separate study by McHaffie[4], researchers found that parents of very low birth weight infants (<1500g/3.3lbs) follow a similar but slightly different course, likely because their infants tend to be more in peril. Mothers travel from anticipatory grief to anxious waiting to positive anticipation while the infant is in the NICU. After discharge the mother travels from anxious adjustment to exhausted accommodation to confident caring, usually within the first three months following discharge.


In Popular Culture

  • On the show Freak Show, one member of the Freak Squad is Primi the Premature Baby.
  • On medical drama, House in episode Forever, in a dialogue between protagonist Dr. Gregory House and Dr. Robert Chase who kissed an underaged girl because she had terminal cancer, House mocks his subordinate for working in the NICU, supposing that he's only trying to expand his "work-out pool" to include preemies as well.

Freak Show is an animated television series on Comedy Central featuring actors David Cross and H. Jon Benjamin. ... House M.D., often referred to simply as House, is an American medical drama television series created by David Shore and executive produced by film director Bryan Singer. ... House, M.D. (commonly promoted as just House) is an American television series produced by the Fox Broadcasting Company. ... Dr. Robert Chase Dr. Robert Chase is a fictional character, portrayed by Jesse Spencer, on the medical drama House. ... A neonatal intensive care unit, also called a newborn intensive care unit or NICU, is a unit of a hospital specializing in the care of ill or premature newborn infants. ...

References

  1. ^ Martin JA, Hamilton BE, Sutton PD, Ventura SJ, Menacker F, Kirmeyer S. “Births: Final Data for 2004.” National Vital Statistics Reports, vol. 55, no 1. Hyattsville, Maryland: National Center for Health Statistics, 2006.
  2. ^ Mathew TJ and MacDorman MF. "Infant Mortality Statistics from the 2003 Period Linked Birth/Infant Death Data Set." National Vital Statistics Reports, vol. 54, no 16. Hyattsville, Maryland: National Center for Health Statistics, 2006.
  3. ^ March of Dimes. The Growing Problem of Prematurity. October 2006.
  4. ^ Mayo Clinic. Premature Birth. 6 Nov 2006.

Links for Parents of Preemies


 
 

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